Microexpressions to Make Microconnections Part 1

Welcome to the Psychiatry and Psychotherapy Podcast. The podcast to help you in your journey towards becoming a wise, empathic, genuine and connected mental health professional. I'm your host, Dr. David Puder, a psychiatrist who splits his time practicing psychopharmacology, individual and group psychotherapy, medical director of a day treatment program, medical education research, and teaching, residents, and medical students. Welcome to the podcast. I am joined here by Dr. Soon-to-be-Dr. Ayanna Cunningham. Like legally, not quite yet. Give it a few months. And today we are going to be talking about micro expression. And we have been working on a paper on this, and we will be putting up some pretty amazing resources on the website. What is micro expression? Well, it's brief emotion, very brief, like one fifth of a second. And in our topic today, we're going to be covering how it can be used, the training of it can be used to increase empathy, which can be used to create something that we would like to think that we've coined, called micro connection. I think we coined it. I didn't find it anywhere in any of the lit review stuff that we did. And we come through 75 plus articles. Yeah. And so we're going to be talking about how to create micro connections to overcome loneliness, to facilitate relationships, long term, and especially in the psychotherapy context. How do we use micro expression to build a better therapeutic alliance, to create more psychological safety, to connect with the person in front of you? So we're going to be talking both to the person who is the therapist or psychiatrist or mental health provider. But also, I think this is one of the topics that is broadly just misunderstood by the general public. Like what is emotion? Like everyone has a negative conception of emotion. That it's like a bad thing or that it's. Too much, there's certain emotions that we say are all bad and others that are all good and. Yeah, I disagree. Or like I've found that most people don't even know what emotions they're experiencing when they're experiencing them. So how can we increase the ability to label your emotions effectively? Which research has shown decreases amygdala or like the sort of the fear center of our brain? Those are some of the coolest studies that I went through on this. Yeah. So just. The therapeutic benefit of naming what you're feeling. Naming what you're feeling is therapeutic in and of itself. So a little bit of disclosure, you know, like I don't have any drug companies that pay me any money. I have no sort of secondary gains, but I do have an app that I created on micro expression. So I have to disclose that. So when I learned, when I went through training on this, I spent several hundred dollars. And so basically I wanted to create an app that was a couple dollars where you could learn the basics of how to read emotion. And so you can get it for. it's for iPhone, iPad. No, I haven't made it for any other system nor will I probably. So get a friend's iPad or iPhone if you really want to do it. And we'll have a link in the show notes to that. But that's full disclosure of financial benefit that I'll get if you go after that. And we'll have other like great free resources that people can look at as we talk about it if you're a visual learner like I am. So. Yeah, so we're going to have some pictures of the different emotions on the website and we'll have a link to that in the show notes. So, okay, let's get into it. Ariana, what is defined micro expression? So micro expressions, you kind of touched on it already in the intro, but this concept that there are facial expressions that are brief involuntary, that are communications of the true emotion that the person is feeling. And when I say true emotion, it's kind of because sometimes you aren't even aware of what you're feeling, but your body is going to show what it's feeling even if you're consciously not able to say, "I am angry, I am sad." In that moment, the observer watching your face can see certain facial movements that cue to exact, like in the moment how you're feeling consciously or unconsciously. Like a secret language almost that exists that we react to ourselves without knowing that we do. It's just, it's so cool. It's kind of like the matrix, like the second level. It really is the matrix. Once you figure out how to do this, I've had people who have trained how to do it and they're like, "Oh my gosh, I'm seeing it all the time. I can't watch the news the same way." I mean, just intentionally being engaged, like we'll get into it, but research has shown like, even without training just you intentionally trying to watch people and read their emotions improves your ability to do so. Right. And so I got into this, gosh, many years ago, I was watching a TV show "Light of Me," and it's with a kind of a character version of Paul Ekman. Very character, yes. He pisses people off and reads their expressions and tells them if they're lying immediately. He's a jerk about it. And he's an incredibly jerk. And so we want to redeem micro expressions. And I actually think he's probably not like that. It's just a movie character of him. It's Hollywood. It made for a good show. And I'll say if you watch that show, look up. Google his notes on each episode and what his critiques were. Because he wrote a blog at the same time, which you can get somewhere online, where he kind of critiques each episode and what the true science is versus what they present. There is a difference. And today, I think we're going to be talking the closest to the science that we understand. I've read tons of these papers over the years and Ariana has. And we have all the citations put up on the website so you can check it out. Okay, so brief moments of emotion. We're talking about happiness, sadness, anger, disgust, fear, surprise, contempt, which I also would consider like pride or smug, like the one-sided smile. And that's actually a good point is even though we're giving these archetypal names, like anger, a lot of people will describe, as we'll talk about later too, but people may not say I'm angry, they may say frustrated, distraught, stressed. We use a lot of words for what boiled down to these seven archetypal umbrellas of emotion. And I used to see anger and said, oh, you're feeling angry as you talk about that. And then they would just get even more angry. They would be angry at me because nobody really likes to be pointed out that they're angry. So at this point, it makes them angry. And I didn't do that that much. If you learn this, you could actually be worse personally before you're better. Okay, so is micro expressions the same across all cultures? So that's actually, that was a huge part of this debate that's gone into what are emotions, just historically speaking. And when we were looking through the literature, they brought up the fathers of this inquiry as being in the Stoic philosophers, Plato, Spinoza. And then Darwin was the first one who introduced the concept that facial, that emotions may be universal. And then that was followed up with by these really cool guys named Wallace Freason, Sullivan Tom'skins, and then Paul Ekman and Carol Isard, who created this theory called like the Pan-cultural Facial Affect Program. Like basically they went in, they studied all these indigenous civilizations tribes that had no Western influence and saw that the expressions that they conveyed were the same as we saw in Western cultures. And they did a lot of cool studies with videos, pictures, having them describe stories, describe how they felt, and they found. Instead of it being like, if you are this ethnicity, this culture, you are taught to express these things, it's that we all express these things. And the different cultures that you come from give you different, what was it called, filtering rules. Right. And so across all cultures, we experience the same emotions. And different cultures will have different triggers to the emotions. Like there may be some cultures that feel disgust towards things that other cultures don't feel disgust towards. Over, sure. And so there's different triggers, but the expression on the face is the same. So tell me, are therapists any better than the average person at reading these? Yeah, this was actually kind of something that really surprised me in going through the literature, is that they found that essentially like therapists are no better than the average Joe at reading micro expressions across the board, but there's a huge difference within that group of those who are better able to or less able to. They did studies of like, yeah, finding that the therapist effect had a bigger impact than in some cases like the placebo versus medication effect. Were there any groups of people who were less good at reading them? It was like a discouraging result for some people, because some people who had undergone previous training modalities or like law enforcement modalities that kind of have these like detect a liar programs that they do not to diminish like the awesome training that they get, but they were actually found to be worse than the average Joe. Which blows my mind like I've been to a number of forensic psychiatrists like some of the best in the field and they haven't learned how to do this. this and I'm like, I can't believe you haven't learned how to do this. Like, wouldn't you? want to know what someone is truly feeling when they're telling their story. Anyways, I could go on. But this is the first, there is nothing in the literature where they talk about the use of micro expressions to better psychotherapy training. Yeah. So that's where we felt there was such a lack in all the literature views that we were doing that this didn't exist anywhere. And so at my institution, I teach a lot of the residents how to do psychotherapy. I'm one of the main teachers that does that. And I teach them how to do micro expressions. And then when we're watching video therapy sessions, I show them the micro expressions. And I show them if they gave accurate or unaccurate empathy based on the emotion that they truly felt. And one of the things that I found is that I can take someone who is not very empathic at all. And I can help them at least have a very strong cognitive empathy. Yeah. The first step is just understanding the other person. Right. So what are the three types of empathy? So I love, love, love this topic. There's the cognitive empathy, which is just like, I understand what you're going through. There's the emotional empathy, the effective, which is like, I feel what you're going through. And then the third and final one, the first two are kind of like understanding and being with the person. And then the final third form is what they call a compassionate empathy, which is my response to what I'm seeing. Yeah. So I think of like cognitive empathy. And I think of someone who's learned how to listen. Someone who has gone through maybe psychotherapy training, they've really learned a lot of cognitive empathy. They're able to sit with the person and not just hear someone's story and then immediately launch into one of their stories or immediately negate their story in some way, which is very common actually. We just take turns. Yeah. We don't listen. Yeah. And then the kind of type, the affect of empathy, I think of like mirror neurons. And so, you know, your brain will light up the same way to some degree as my brain. And whether we like it or not, like some people are wired with more mirror neurons than other people. So some people like actually can feel other people's experience more like accurately. Like I think your innate empathy is just me feeling off of what you're feeling. Which is that mirror neuron system you're talking about. Right. We can influence it. We can like increase it. And then we can help them with their like intentional empathy, which is that cognitive skills that you're talking about. Effective empathy. Like it's something that I think we can have psychological defenses against, which is where I think that we can help people improve their affective empathy. So for example, if you're feeling someone's sadness or anger, but you do not want to feel that in your body. It feels very, very uncomfortable. You may immediately intellectualize or rationalize or deny it or suppress it. And so you can push it further into your unconscious or react against it, right? Or you can get angry and then lash out at them or get defensive. And that happens all the time. So it can be trained on how to listen to it in a certain way. Like, like you would like get better at playing the violin or playing a sport. Like you can get better at listening to your emotion and feeling it in your body and non-judgmentally and being curious about it. And then the compassionate empathy is something really beautiful. I think it's like it's when you feel moved into action to help someone else. Yeah. And I would say that this can get refined because you can learn what is the best way to help someone else. And they even say like when they differentiate between layman sometimes sounds diminutive, but it's just like layman empathy, like your average everyday versus professional applications of empathy that that compassionate that third form really is like a whole new skill set to a degree. Yeah. In the sense that we can work on it, we can improve that. Right. Because I mean, like let's say common mistake for men is they hear that they're significant other and there's some other feel sad or angry and they immediately want to go into action. Well, I'm going to help do this or what can we do or blah, blah, blah. Fix it. And, you know, the spouse is like, or the, you know, the significant other is like, I just really wanted the person to listen to me. And maybe they don't even know that, but that's really what they want. And so compassionate empathy for that person might be to just be able to drop everything, really listen and really let the other person know that they heard them and that they're feeling upset by what they heard as well. So the compassionate empathy, therefore, would be seeking the most helpful outcome for the person, which could be just listening. Yeah. Any thoughts? Oh, I just, I love this. I think that even just studying this has made me a better listener. And we talked a lot about like, I think micro expression reading and your understanding of what empathy is versus sympathy and like those three components of empathy just really enhance your ability to like engage with the other person in a way that's helpful and beneficial to them. And not just like you said, a lot of times we just speak and we're waiting turns for turns to share stories. So tell me, um, around how has it changed the way that you listen? Oh, man. I think for me, like, um, the definition of words really means a lot. I think that the concept that wants something is written or spoken that it can change my mindset. So for sure, being aware that there was those different components, one is like intellectually understand the events that happened that led to this effective empathy. Like I feel what you're feeling in this situation by engaging with you, reflecting off you and like clarifying that I'm understanding it correctly. Okay. And that there is a, that those two are like step one is understanding step two is feeling step three is responding. Okay. That I need to do step one and step two, not just step three. Kind of what you're saying, like fix it situation. Yeah, yeah. So I think breaking it down into those steps has made a huge difference in just how I'm able to engage empathically right now because I'm not in practice yet. It's more so like with my roommates, with my siblings, you know, in those day to day events that I think it can really be so beneficial. Let me just throw out one more thing about this, which I think is so important is that when someone is bringing in a distressing memory to a person to listen to, what they're doing is they're bringing out that memory from their, their brain from that sort of database of memories. And let's say they experienced that memory alone and isolated and they felt sad and they felt overwhelmed. And now they're able to in the room or with you experience someone listening to them who can understand them, who cares about them. Yeah. And that part of you gets inserted into their memory and it works the other way around too. Like I've had patients to go through incredibly stressful things and then they tell their parents and their parents freak out and get even more stressed and even like blame the victim type of thing. And that can actually make like the trauma actually extends into the family then. So I really think learning to do this right is like vital. Learning to do this right allows for recovery from stressful events in our life. And if more people I think could do this right, the world would be such a better place. Oh, just more connection everywhere. What the world needs now. Micro moments of connection. Okay. Tell me about this amazing study where in in Italy, it is in Italy, where physicians that had more empathy had better diabetes outcomes. Coolest study out there. I mean, there's a lot of studies that kind of emphasize how important empathy is for patient outcomes. But this one was this one was the best one. I mean, for one thing, it's suddenly, which is just exciting. Diabetes is high because of all the pasta. They did like 21,000 patients study and found that physicians with higher empathy scores reduce the odds of serious life threatening complications in diabetic patients by like guessing percentage. 40 percent. Right on. It's like you're saying the same notes than I am. It was just, I know it was such a like a profound one. And like I said, there's lots of other studies that support this, but this one was tied to some very like objective numerical scores. I think if I'm remembering correctly, we can look at the original study later, but it was like A1C values. Specifically diabetic complications. Yeah. We found that there were lower rates of hospitalizations from acute complications like diabetic ketoacidosis. And you know, they're not explaining like why this was the case. We don't really know why, but physicians with higher empathy had better outcomes. Better outcomes. And it was really significant. And any other studies kind of like delve into exploring different correlations of why and some of them is like, you have better follow up if your patient thinks that you're more empathetic. You have better, like they'll take the medications that you suggest. There's just like that sort of therapeutic alliance, I think, can influence so many factors. Higher compliance. Yeah. And they've also looked at outcome studies where they found that there were actually differences between psychiatrists. Oh, in like the therapy setting. Oh, and then in an outpatient management setting, like some psychiatrists were better than other psychiatrists, which actually it's really hard to find studies on this. I wish there were more. Yeah. They had the cool one by Andy. like the 2009 one, which sort of showed like interpersonal skills in relation to improvements in symptoms in the therapy setting. And then there was the other one that showed that those with like less empathy actually had higher rates of symptoms. So it wasn't just like neutral effects and then you had higher symptom like management with better therapists, but the worst therapists could actually worsen some of the patient's cases. Right, right. So those are more like therapy cases. But this one psychiatrist, one I was talking about was the 2013 study by Virm Holst. Virm Holst? Oh yeah. Who said that, you know, they looked at between difference of the psychiatrist, like so the difference is between the psychiatrist and they found that the difference is between the psychiatrist was actually bigger than the difference between the placebo and the medication. That's like, let's say that again. That's pretty mind blowing. It's a little bit, it may be sad if you're a pure biological psychiatrist, but placebo has actually worked a lot better than doing nothing. So, but the medication was better than placebo. But the difference between the medication and the placebo was actually less big than the difference between psychiatrist effects. So they found that there were some psychiatrists that placebo was better than some psychiatrist like active medication. Yeah. And then he kind of teases outright the difference between placebo effect and alliance effect. In this one, he, I think he like, I'm not sure, well, tell me what the difference is in your mind. So the way that the article kind of was like outlining things was that placebo effect as a result of deliberate or incidental suggestion of clinical benefit, whereas alliance effect is the result of increased confidence or hope and alliance effect. At least to my understanding is what you can kind of boil down to the effect of the therapist, the effect of the provider, the effect of the physician, whatever the caregiver is in that position. So one is like, take this pill, it'll help, but it's really not going to do anything biologically. And the other is like, here is me as a present person in this situation as a care provider for you. Okay. Good, good clarification because I was actually talking about earlier at McKay 2006. It was talking about the difference between placebo and medication versus psychiatrist effect. So all the stuff we said was true, but just this, the actual study I mentioned. Yeah. So really interesting when they talk about placebo, sometimes placebo effect is from just someone spontaneously getting better. So like if a placebo response in a trial is 50%, I think maybe 20% of those would have gotten better spontaneously. And the same is true for the people who take the medication. Therefore, a certain percentage of this would get spun better spontaneously. Yeah. But then you have the alliance effect, which is, you know, you have a psychiatrist or a person who's prescribing it, you know, and how much confidence, how much hope do they give you from their plan, which is huge, which is huge. And I think that's why there's such a difference between psychiatrists, but I think more studies have to be done. And a solid argument to keep us from being overtaken by robots, right? Right. Yeah. And a solid argument also for building real relationships with your patients that are meaningful and you're going to have the best outcomes and you're going to have the most, you know, like the therapist themselves, not just the medications, they hand out a part of the treatment. Yeah. So beautiful. Yeah. And encouraging for people that feel maybe like, what's the purpose? Am I like really being helpful as a provider? Do I have any function other than being a medication distribution? So yes. You know, yes, you absolutely are bringing, I mean, a lot of people who are really depressed, like they don't have a lot of meaningful exchanges. And so if you are one meaningful person in their life, like a huge difference, a huge difference. Okay. So all that to say, all these studies pointing towards higher interpersonal skills, higher empathy, improving outcomes, both in psychotherapy and in psychiatry. And so that leads us into how like one piece of that, so how do we increase the interpersonal skills? And one piece of that that's been studied is actually the micro expression thing. Yeah. So are micro expressions trainable? Absolutely. Solid definitive answer supported in literature. Multiple studies is a resounding yes, which is so good because it can be really discouraging like the first time I did your app or the first time I did different training modalities. It was like, man, you know, I'm not the best of this. So it's nice to see improvement over time. Yeah. So for the people who do my app, I tell them, okay, once you start hitting 90%, I'll give you like a private training, like a secondary training, where I'll take you through some more advanced videos. We'll talk about it. And it's hard. It's hard. How many hours do you think it took you to get to a place where you're hitting 90%? Oh, godly. You know, the tough thing is that I got to your app after I had done other training modalities. I don't know what the total number of hours would be, but I think it definitely takes time, especially because in real life interpersonal exchanges, like we said, micro expressions can be like one fifth of a second. That's so brief. Yeah. So it's more of like training was like reflex to pay attention. Yeah. And that space out. Ariana is also training in FACS and EM FACS, which are two different ways of coding this. So explain that a little bit. Just being really curious. So as we were kind of talking about, remember like the historical breakdown of how we figured out that emotions were universal. And then how do we like organize them? And we came up with the big seven of being like fear, anger, disgust, sadness, contempt, surprise, happiness. It's those big emotional umbrellas. They've had different ways of organizing and identifying those. And FACS stands for facial action coding system. And EM FACS is the same thing, but it's emotion, facial action coding system. So facts, FACS is like the individual muscles that are involved in each emotion identification. So like happiness, the true smile has like the zygomatic major muscle. And then I'm forgetting the name of the. Yeah. So there's like specific muscular movements, individual facial action unit. And they all add up to have these emotions, which is the EM FACS. One thing about the history that I think is really important to talk about is throughout history a lot of people like Plato, you know, and they put like reason above emotion and kind of desire at the very bottom. And you have the, you know, stoic philosophers who put, you know, reason above emotion. And then you had Spinoza who said that the mind and the body were inseparable. And that self-preservation is fundamental. And he sort of thought that there was this really important place of emotion. Like emotion has a biological survival purpose. Which is. We take I think for granted now, but if you like, if you rewind in history, there's certain times where people like thought that emotion was insignificant. Well, I still think people like hear anger. Like, oh, there's no purpose of anger. Anger is always bad. I should never feel anger. And that was actually something that I think was helpful for me because I think I got pulled into society's definition that of the seven like fear, anger, disgust, sadness, contempt are always bad. There was no positive meaning. But like Darwin, when he came into the picture was like, no, no, no, all emotions are here because they're adaptive and function. So if you feel anger, it's not something you should just immediately repress, but you should like examine it and look and see what caused it because you're getting an emotion because there's something significant happened in your environment. You need to like dive into further, not just push away. Yeah. And I think a lot of people, when they have emotion that seems like a lot more than they would expect for a given situation. Yeah. Then there's also the question of like, okay, are there other reasons you have that emotion in there, but they're not attached to this specific episode? Like, eventually I'll have like, why am I so angry at this inconsequential thing that showed up? Right. Stepping on gum. Couples will fight about the silliest things, right? And they become these big, big fights about things that like to them are not even that big of deals and they're like, why are we fighting about this? And maybe the things that are really going on are too big to put words to. Maybe they feel like if I were to tell this person why I'm really upset at them, there would be no relationship or the relationship would crumble. And so maybe there's a reason why they're not feeling it to the same degree. Okay. So micro expressions are trainable. Yes, which is a good news for us all. Really good news. And we'll put up some citations here, but you know, it helps you more accurately diagnose depression and anxiety. Oh yeah. Better accurate gauging of like the actual interaction that's going. So if you're in therapy and you say something and it's taken the wrong way or maybe it's taken in a wonderful way, you need to be able interpret. Are you being helpful with your words right now or not? Right. Like one of the biggest things I think that can make a resonance life or a resident improve their psychotherapy. The fastest is to be able to read how people are reacting to them. And if a person, if you share something and they immediately flash anger, you don't know if they're feeling angry because of something in their story or because of something you said, but I would err at thinking that it was something you said. You know, there's a lot of people, I think that don't wanna think that any treatment that they gave could be the harmful component. - Yeah. - But I think as a psychiatrist, I first think, am I doing something medication-wise that's causing this issue? - Yeah. - Am I doing something psychotherapeutically that's causing this issue? - Yeah. - And so yeah, to be able to read if your patients are reacting negatively to you and then being able to backtrack and figure out what did you not understand or what was going on in the patient's mind there that you may not have any idea is going on. - Real time feedback on the session to see if it's benefiting or harming. - So important. - Yeah. And then like some of the studies that we talked about earlier, like the diabetes ones in Italy, it can actually have like better outcomes if you're better at micro expression detection, which is tied to empathy, which is tied to all these therapeutic alliance things. - There's a couple of leaps there. I mean, they were not doing micro expression training in that study. But we know that we can improve empathy through training programs like this. - Yeah. - So fewer malpractice claims. And that, you know, when you look at like bare money sort of in out, like there's some real financial motivation behind micro expression training for. - Forget the financial stress of malpractice. Just think about the psychological stress. - Yeah. - If a patient sees you, like that's what you're thinking about for the next couple of weeks. All your other patient encounters are like clouded by a potential lawsuit. - Yeah. - I think the adherence to schedule appointments and to medication taking like the lifestyle, suggested adherence, all those factors are pretty big too. - So cool. So are there any people who are better at reading micro expression? - Yes. For all the people who are listening who are younger in age, would identify as being open to experience, conscientious and have a lack of law enforcement experience, you statistically are going to be better at micro expression detection. - And open to experience and conscientious. And so those are like personality, there's a part of the big five. - Oh, yeah. - If I'm correct. - It's part of it. - And younger age, maybe you're just, you don't have as much psychological defenses against it, against reading people accurately. I don't know why that would be the case. (laughs) - That's a good question. - Okay. - But are we accurate at judging our own communication skills as physicians? - You know, that was another one that was disheartening to read is that both physicians and like Dr. Tramies aren't great at judging how empathic we are ourselves. Like when we think back on an interaction or a patient we had, we aren't able to accurately gauge how well the patient felt that they were heard. Like yes, you probably have a gauge for like man, that was horrible, that went badly or that was okay. But as far as the finesse between like better or worse, not very well. - I've also seen these studies in attendings that train residents and the discrepancy between what the residents reported and the attendings said happened was huge. And specifically one study of like, not to pick on them, it was a study that I remembered on surgeons is that the surgeons thought, you know, like, oh, this was a great encounter. We had a great time. I taught this person lots of things. The resident was like, this was incredibly stressful. This was not helpful. - Yeah. - And that discrepancy. - It's concerning, especially when you put it into what should be a therapeutic encounter. That you can be like, that was great. They felt heard and then in reality not so well. And they can find like there's two studies that were done where they found that discrepancy by doing what we talked about, that facial action coding system program. Like they did that and were able to objectively measure how well the two people were connecting. And then found like that versus the survey results that the people filled out. Yeah, the discrepancy was there. - That is so interesting. So the FACS, the sort of the gold standard for this was a better judge. Okay, wow. That's really cool. - Yeah. - So how do you learn micro expression was the most effective way to learn it? - Yeah, so they did actually, it was cool. There was a lot of studies about like what is the best way to retain the most of this skill that we're trying to pass on. And they found that of all the different modalities, immediate, accurate feedback. So in the sense that like a picture is flashed in front of you or a video is flashed in front of you, you click which emotion you think is being expressed and immediately it says, you were correct or you were incorrect and here's why. - Yeah. - Which seems like intuitive, but there was other ways, you know where you do like a full set of 10 and then it gives you feedback, you do do do do do do do do do. So immediate feedback was the best. - Yeah. And what about schizophrenic population? So part of-- - Okay, this is like, this is maybe the-- - Tell me about that. - That was like the coolest part of this research is that we're talking right now in general about like healthy people who are in professions where this would be helpful. And so it's like improving skill sets you already have. - Taking people that are probably already, you know-- - Average or above average. - Probably above average EQ wise, right? Emotional, I mean just to get through school and to get interviews and you know, you have to have your EQ at a certain point. But then, okay, so schizophrenic patients teaching that micro expression skills, what happened? - So this was so beautiful. This was found in two studies, Russell 2006, Clark 2008, where they took an outpatient-- yes, this is a deficit population, but they weren't like full schizophrenia with some people maybe think about that they've seen in movies. But a more stable outpatient schizophrenic population who pre-training scores identified them is really deficient in the skill of emotion recognition. They improved by 9% with the same training modalities that they did with the professionals. And this raises an otherwise deficit population to a level of a normal control group without training. So it takes someone who was maybe more dysfunctional in society because they weren't able to read those emotional cues, weren't able to engage in what we talked about as cognitive empathy and get them to a more functional stage where they could be interactive and social and like fit in more, you know? - That is so cool. - It's therapeutic to raising people to be more functional in society. And they correlated it with other populations, like some autistics. People that you may just know in your life who maybe have a difficult time reading emotion or connecting that this could improve and help them to be more functional. Like so beautiful. - So beautiful. How about when you pay attention to someone's emotions rather than just kind of like watching them? - Yeah. - Does that change anything? - Also super encouraging without formal training just being told like when they did studies with videos and how to being people identify emotions and they just said, please pay attention to the emotion on the person's face that that also yielded improvements. Like it is. - Yeah. - It's cool how easy this is. - So they were more accurate to judge the person's emotional states and more mimicry was the cool part. So they actually mimic the other person's emotions more. So like mimicry is like if I flash sadness and then you immediately like a microc, maybe like a fifth of a second later would also flash a little bit of sadness. And that's what mimicry is. And mimicry I think is the foundation. It's showing you that the mirror neurons are working. Right? - Yeah. - So we tend to trust people that mimic us more and we tend to be a little bit cautious towards people that are just like flat emotionally. - Like those, so like pop psychology books that are out there about like body language and how you, if the other person is like folding their hands you should fold their hands so that they think you're more connected. But this is on that like innate level. - Yeah, on an innate level. - Fee shell expression. - Yeah, interestingly some women are hesitant to date someone who mimics them too much. 'Cause that's kind of like what's going on there? Are they trying to do something here? - It's kind of like the like two people, the mutual smiling episodes usually indicates like oh that interaction is going well. But if it's too high, it's like oh the interaction is crap. It's they're being fake. - Right, are they being fake? And it's like these things you cannot fake them. You can't fake concern or real concern towards someone. - Yeah, and I think that you know what we're talking about with like micro expression detection are like conscious and intentional ways to gauge things that we respond to unconsciously like all the time. You know when you have that radar where you can sort of sense this person is being genuine or not. I think a lot of that could be tied to micro expression detection if we put intentional focus. - Right, right. So what comes across to us as like a gut instinct as is person cares or what not could be just good mimicry and good, you know, but good mimicry is coming from someone who actually is empathic and who wants to care. And we don't always mimic negative emotions with the same negative emotion. - Yeah, like anger usually requires an explanation. This has been one of the studies that I came across. like all of the emotions if they're flashed, the other person will usually mimic without any effort, like we were saying, except for anger, the person usually had more of a confusion or they needed an explanation before they could like immerse themselves in the other person's emotion. It's like a protective instinct against mob mentality a little bit. And sadness sometimes too, like if it's over with the other person's sadness is sometimes we want to push it away and we may actually have some like disgust towards their sadness. Yeah, because it's putting this like emotional burden on us that we don't want to pick up. Right. Sometimes. Yeah, sometimes not. But I think we can consciously choose to kind of like, okay, at first I don't want to be there with this person, but I'm choosing to because my higher values are in alignment with connecting. Ah, so cool. This is just great stuff. So cognitive empathy can be improved. Tell me about Reese's study and why that was unique and what uniquely they've shown. Yeah. So this was, did I know what the one that correlated like micro expression reading ability to patients ratings of physician empathy, right? Yes. So this showed, you know, we're talking about like physicians aren't the best at gauging, how empathic was I with my patient, but they did this awesome study that correlated the physicians micro expression detection level to how the patient felt the encounter went, how empathically they felt they were responded to. And there's a strong positive correlation there. And they did it with like that training that they're talking about was a three hour training intervention. And yeah, like it was just, it was so cool to see that such a brief amount of time spent training three hours out of a day or a week could yield that dramatic of a result for your patients. Right. And if your patients are happy and they feel connected to you and they feel grateful, you are going to be picking up that gratitude and that happiness all day long. Like you are going to be mimicking in your brain that gratitude, which is why I feel like this learning this kind of skills, like it's so imperative for physicians because otherwise we just get burned out. But if our patients are like, even if just like 10% of our patients are grateful, like sincerely grateful, it really can just make your day. And if you have it more around like 50%, like they just come in and they're feeling grateful and it's crazy. Like when you're really connecting with someone, you feel this like heart pole towards them. Mm hmm. I'm feeling it right now. And then you feel like this, you can have joy even in the midst of talking about some crazy things like all of patients talking about like really traumatic experiences. And then after maybe 10 or 15 minutes of talking about it, if they feel really connected with me in the midst of it, they can actually have pleasure and joy. And that goes back into their memory bank of that sort of bad memory. And I think that's what makes psychotherapy work. Yeah. And that isn't kind of one of the theories even behind people who have traumatic experiences that each time they go through it in a safe environment with someone who's trained to do this, that each time that memory will hopefully be a little less traumatic. Yeah. Kind of like feel over time. Yeah. That's so beautiful. Yeah. And I would say that if you're opening up a traumatic memory with someone that you don't trust or you do not feel as empathic, then I would say it's probably better not to even open it up. Yeah. There was something like on different services as a med student that some people would say, like, I know that this is in our history or in our chart, but we aren't going to talk about it because I don't have the time or the relationship with this person to do its do justice. Right. And being a little, what's the word, like conservative as far as what you open up because you're aware of what relationship you have or how much time you can give to being connected with them through that. Yeah. Yeah. And there's some people who like the first time to meet you, they just want to like launch and do it. Yeah. And sometimes it's good to like slow them down and sometimes they appreciate that almost. Okay. Getting back into it. So our goal and what we're really talking about here is to make micro connections out of each micro expression. Yes. That sounds amazing. So we love the word micro connections. It's like a new, it's a new hot word around here. Yeah. It's pretty cool. So each emotion, if understood and responded to correctly, has this capacity of offering like this brief moment of empathic understanding. And that is what we call a micro connection. And if you build up a series of these, I think that's what is the foundational building block of things like therapeutic alliance, educational alliance, things like psychological safety, which is, you know, do you feel comfortable sharing negative feedback with someone that you're working with? Wow. That's beautiful. And I think something that you've passed on to me with, you know, just in how you approach these encounters with your patients is that for you to create moments of micro connection you have to operate on the premise that anything the patient is feeling, that they are entitled to every emotion within their experience. Because if you mentally are saying like, that's invalid, you're being too much, quote unquote, it's kind of like a trigger word, that it's impossible to empathize with emotions. We judge as being invalid. Well, if we judge the emotion period, right? Yeah. That creates, that creates the opposite. That creates some disconnection. So I was just talking to my, my wife about this because she was talking about how like I won't often get angry when someone is angry at me. And I said to her, well, I think I approach it differently. Yeah. And I think this is what Dr. Tar and really some of my mentors have kind of given to me over the years is like, when someone's angry at you, can you step back and can you see it for why they're angry, for the goals behind their anger? Yeah. And you not take it personal, not let it hurt your ego in some way. Not to effectively seek to injure back. Not seek to injure back or to get angry back, but to be curious about it. And then to maybe help the person even understand why they're angry or why they're angry at you. So it's not that I don't get angry, but when I do get angry, it's like, I feel it in my body. I feel the tightness in my chest. And I wonder, you know, like, what is the purpose of this? What goal was I trying to seek before the anger came along? What obstacle am I trying to overcome in the midst of this anger? And what would be the best way to overcome that obstacle? And very rarely is it like getting angry back at someone else in a way that would be like putting them down or blaming them or shaming them or yelling at them. Like that usually never accomplishes goals, period. No, and it certainly doesn't enhance communication or exploration of it. If you just, yeah, like that one person yells and express a yell is louder and just that kind of like barriers are just built higher. Right. Sometimes I yell at people like that I train, you know, if they're squatting incorrectly, I might yell one word, but it's not like it's not like a punitive yell. It's like a, okay, you need a gym yell. You need like, you need a louder tone of your, my voice to communicate the change. I just want to go, I was training every time I would yell deeper, he would squat deeper. Yeah. And every time I wouldn't yell at it, and it was not. If you just, it's firm, it's firmly saying it. He wouldn't squat that deep. So I'm like, obviously, I just need to sit here and just say deeper after every time you squat. Repetition for emphasis. Yeah, I don't know. So the premise is though that we are entitled to our emotions and our experience. Yeah. And the emotions are coming up for a significant reason. They're like flags that are being put up like saying like something significant happened. You need to explore this further. Otherwise it's just going to keep popping up unwelcomed or unannounced. Yeah. And if you, so if you can approach it with that sort of premise, I think that you'll be more likely to be curious and to really listen. And then that person will feel heard and understood and not judged. And I think shame always shuts people down and shuts emotions down. Oh, sure. And shame leads people who have emotions to have psychological defenses against the emotion. So if people fear the emotion or have shame around the emotion, then they'll have psychological defenses. And what I mean by that is though, either deny that it's taking place or they'll suppress it or they'll have a reaction formation. And when they're angry, they'll go clean the house. Or they, I'm an angsty jogger. I'll go for a run if I'm just feeling like a lot of pent up emotions I need like sort out in my head. Yeah. Cleaning is a really good outlet too though. So that's one of the premises. Are there any other premises? I think the second one is the meaning and the goals. So each emotion has an adaptive function. It has inherent meanings and goals that are there, whether you know it or not. So you may know or not know that you have an emotion. You may know or not know the meaning or the goal or the purpose of the emotion. And so you could not know that you're having an emotion and you could not know what the emotion is doing. And then you're just like, I'm crazy. I'm doing these things. I don't know why. I just start yelling. Mm-hmm. I feel like you're being taken over by the emotion and it's hard for you to discern any directionality at that point. Right. And maybe that's what Plato was talking about with. like these emotions need to be restrained by reason. - Anti-passion. - I would say what we need is we need an integration of the brain. And a lot of people are talking about that nowadays of like we need to integrate all of the functions of the brain. So when we have an emotion, if we can become cognitively aware of what's going on, it'll just enrichen the experience. - Yeah. And for your first reflex, kind of what you were saying was to be curious instead of just to tamp it down. - Okay, now we are going to go into the emotions themselves. So starting with happiness, where is happiness seen on the face? - So happiness, when we think about what happiness looks like, everyone can kind of figure, or remember in their minds a time that you, we're looking at someone and their smile makes you smile. When they're smile, you see not just like the raising up or the cheeks, but also kind of let like the lines at the edge of your eyes. - Crows feet. - Crows feet, yeah. - So the eyes contract, right? So they'll, you know, in pictures, smile with your eyes. - Yeah. - Oh, type of thing. - Tyra Banks says, "Smise." - It's 'smising." - And the opposite is of course, like when you get the smile with just the lower face, that creepy like psychopath smile. - There's something in you that can identify just intuitively that it's fake. So you have like the zygomatic major muscle, which is the one of the mouth, which is pushing your cheeks up, widening the mouth itself, and then the obriculars, ocular muscles, which give you those crows feet. Fun note, just because I enjoy like the history behind it, a true smile that involves both the mouth and the eyes is called a douchein smile, and it's named for the French neurologist who discovered what the actual muscles were that were involved in that. So douchein smile, true smile. - So the fake smile, you know, had a, I remember in one Gottman study, had a higher predictor of dissatisfaction, like in couples that showed the fake smile more often. - Yeah, it's the polite smile, right? - It's the polite smile, not with the eyes. So happiness, what is the purpose of happiness? - You know, it's, that's actually, it feels like a big, like a theoretical question. - Sounds big. - But when we talk about it, like of all the emotions, this is the one that everyone agrees is positive, and it's kind of like a positive reinforcement thing, right? Like we use it to help us do these, almost like outcome measures of like which of these options as I'm going for it in life will make me the happiest. So it's something that, yeah, they talk about as purposeful in making decisions, forming habits, predicting which will be the best outcome. And there's a guy named Panksepp who talks a lot about that. It's just the purpose of happiness on like a, I guess you're almost say like evolutionary scale. - Genius. - Mm-hmm. - Genius. - Oh, and quickly, I think you talked about this earlier, but what does happiness feel like? - Okay. - And it's the nicest one to describe. It feels like like a hug, like putting warm laundry on you, like warmth in your chest and a sensation of being like grounded, connected to the earth, kind of like you're aware of where you are in and of the moment, like savoring something. - Yeah, and I, so when I, when I made the app, I showed people YouTube videos. So I got real emotions based off of how they reacted to these YouTube videos. And the videos that stirred up the happiness were like cute dogs and babies that were doing really cute things. A mother reconnecting with their infant. So just that kind of stuff really does bring some happiness to us. - Yeah. - The other thing I've heard in psychotherapy meeting I was at was in positive psychology. It's important to embody the true feeling of happiness. So to ground your patience actually to ground yourself in your own happy sort of experiences. And they talked about how like if you were happier in the beginning of the encounter, it would actually change. - I could influence like the trajectory of it. - I could influence like how your patient would react to you right on. So that was interesting as well. - How do you kind of bounce that out between like giving a neutral space for your patient to bring whatever emotion they're feeling in without being influenced by yours versus, I guess starting them off a little bit on the, and not that I want to call emotions positive and negative, but. - I don't think I would give a blanket sort of thing is like oh, smile, big smile when they come in. - Yeah. - But when you greet them you can smile and be happy. You could try to embody something that you appreciate about them when you meet them. - Yeah. - But yeah, no, when a patient is reflecting on something sad or some other emotion like discussed, if you respond with a true happy smile, there's gonna be a disconnect there. And actually Beatrice Beebe, who studied four month old infants interacting with their mothers found that sort of the incongruent emotions led to worse attachment styles at like one year of age. So there's something really important about mirroring of emotions. And they have like the adult version of that that they did some studies on it with Darwin and Banninger Hubert, and some studies where they looked at like were the emotions matching between their piston patient in episodes and found. - What did you find? - Kind of like what you were saying with those infant studies that the more congruent, like if I smile, you smile some of that like mirroring, can be helpful in them being more connected. - Yeah. So kind of coming to a practical point. - Yeah. - What I see happening a lot is when people share something that they're happy about a success, I think it's sometimes harder to empathize with people's successes than it is to empathize with something that they're sad or frustrated about. - 'Cause it's almost a humbling thing. Like if someone else is sad or angry, you can almost have a superior rank if you're like, I'm not a feeling those emotions right now. But if they're feeling true happiness and you're not, then sometimes it can be difficult to like rejoice with them, you mean? I think there is something about that, it can be threatening to the ego of like, is this thing that they're sharing? Yeah, like is there success something that is like I would want personally and so it's hard for me to be just purely joyful for them. Or can we be truly joyful for someone's successes even when it doesn't lead to our success? And I think that's really important to kind of, think through and meditate on and. - Kind of gauge your reactions too when someone comes with you with certain news or a patient shares something. It feels a little more applicable to me mentally when I think of like a peer comes up to me, he's like, I ace this last test and I didn't do as well. And like how do you react to that? Like what you're instinctive versus how you can train yourself to connect with them in that moment. - Yeah, maybe at first you feel frustrated because you have sort of this competitive thing, right? Which is totally normal and you're entitled to that frustration. I would say though that that's why it's hard to connect with someone in the midst of that, right? If some, you know, staff member all of a sudden got a bonus and it was like huge and they share that with me, you know, would I first be just rejoicing with them or not? And that's something that like, I think it's, makes the just the absolute mirroring in the mimicry of someone else's joy actually really hard. And you can think about it like, like because friendship is kind of a bi-directional empathic experience, right? And in friendship, you know, if one person is coming in with like a bunch of sad things going on and the other person has like a bunch of really big successes, if the sad person goes first or if the successful person goes first, the sad person might interject with like, well, this is what's happening in my life. And then the happy person might empathize with them but the happy person might go away from that feeling to plead it because they didn't feel heard and understood. - They weren't connected with in their moment, yeah. - So, yeah, so. - You seem to think of that side of it, right? - Right. - Yeah, right? - It's not something you would at least not that I would like immediately guess at. But I've definitely, especially with like grades or at fight, like worked my tail off for a certain test or something, that example really hits home. - Or another example of that happening commonly in relationships is like, I'll share something that's successful. And then immediately the other person launches into a very similar thing. - Oh, it feels a little bit competitive. - I think it is competitive to some degree. I mean, it's their unconscious competitiveness coming out. Whereas they're not just like purely rejoicing in, you know, or not able to be completely present with your experience, but instead kind of in their own world. And that is not the empathic immersion of someone else's experience. - Yeah. - So not that you can't share a similar experience, but that you should first celebrate the other person's experience before kind of like sharing your own. - Looking to make a moment of micro connection. What are you saying? - I feel like there's like a really corny side of that. - Yeah. But I mean, it's most corny things and most cheesy things at heart are like solid. - Yeah, right. - We just use them to much. - There's the same behind every cliche is a little truth. - Yeah. Other side of the coin, should we delve into sadness? - Sadness, yeah. So where is sadness felt? - And so sadness is immediately felt as like this heaviness in the chest. I think it's kind of an easy way to think of it. Also, you might feel like really heavy in your limbs or like your mother. muscles have just gone slack. I think those poignant things that people can identify with. Think of the last sad movie you watched. You probably felt it. I'll say that for most people, it's a little bit different. If that doesn't completely register with you, next time you feel sad, check in. What do you feel in your chest? What do you feel in your stomach? I think I remember reading that sensation when you're about to cry, where your throat closes up a little bit, that that might be part of it too. I think people feel it in slightly different parts of their body. How do you see sadness on the face? The most poignant way to see that is you're going to be looking at the eyebrows. If you want, you can check along the picture that I think it's on the PDF that's attached or the website. You're going to see those eyebrows on the inner angle, like angling upwards. That's because of this muscle called the frontalis, paris medialis. The eyelids on the outer edges are going to be kind of going down and the mouth going down. So the eyelids are going to droop down on the outer. The eyebrows go in the middle of the eyebrows, that middle part goes straight up. There isn't a crease between that's created above your eyebrows. It's not a furring of the brow. It's not a furring. It's just an upward angling. It goes straight up. Yeah. David and I are making this face that he's trying right now. What happens in the mouth? So the mouth, like we said, the mouth itself is going to lower, but then there's a pouting of the lips. You know when people think of that like a predatory example of a kid pouting that lip, that bottom lip is going to be pouting outwards. And the chin, the lower chin, is going to be raised up a little bit. Yeah. Good. And so sadness is contagious. And so I would say emotion is more contagious than tuberculosis. Because you don't even need to be in the same room. You just want, you don't even need to be in the same time space. Right. I was showing people YouTube videos and they were getting sad. And that was that, was it Gally's even talked about how that can be helpful? It gets not just bad to look at a picture of someone experiencing sadness and feel that can help us learn what that is in a sense. It can help us learn what loss is and what to avoid and how to better structure our lives to not have loss. You know another one of those sort of founding principles, I don't know if we mentioned it yet, is that common experience is not a prerequisite for empathy. And just as we talked about that cognitive empathy, like identifying sadness, knowing what it feels like, this is a way that you can engage and connect with someone through an experience they've had that you have no idea what that's about. But you can understand the emotion that's attached to it. Yeah, that's a really, really good point. And I actually think like if your mirror neurons are able to tune into someone's else experience, like you can experience that experience. Yeah. To some degree. Probably the wildest example of this and someone is going to take this out of context and just. We apologize that I've had time. Just hate me for it. But when my wife was giving birth, I can feel my abdomen contract. And it was painful. Like I had to look away sometimes. She had to keep feeling it, but you had to look away, right? And actually after she got the, what do they call it, in the back, the anesthetic look when you. Yeah, she got her anesthetic. She got her anesthetic. I love our blood pressure. It was less painful for me. So that being said, like, you know, my mirror neurons probably pick up 10 to 15% what someone else is feeling. And saying that I felt the full extent of a contraction. I need to ask your wife about this. But, you know, I think you can feel a little bit higher even with someone that's like a loved one or someone you care about. Because you're more connected with them at baseline. So you might feel in an inherent sense to pain a little bit more poignantly. Yeah. Because the connection is already there. Right. Your identification and the other is always strongly there. So to some degree, I know what it feels like. Now, I think, of course, I don't know the full degrees. So please. All women listening. But I think all mothers in the crowd. I think that being said, like, like, you can feel to some degree what someone else is feeling, even if you've never gone through similar experience, as long as you're willing to open up and be listening on a deep level. And that's such, I think that's like a beautiful theory even when we talk about like humanity at large and how are we supposed to empathize with strangers that we have no connection to or with patients that we don't have any similar experiences or common backgrounds with. And like, this is grounds to connect in that way. So let's say you see someone's feeling sadness. Yeah. Here's a statement that comes from one of my mentors, Dr. Tar, as like something he would say. So he would say something like, as we are here together, I can understand in part, you feel a sense of sadness over your loss. And gosh, I can't imitate his sincerity. Of course, he would feel the sadness really intensely. And you know, it was a weeness, right? As we are here together, I can understand in part. I can only understand in part because I can never understand you fully, right? And some people will correct you if you say I can understand you fully. Because that can feel like you're diminishing the experience. For someone to hear that language. Yeah, like the comment, like when someone shares something like, oh, I completely understand you. And that innate reflex, like, thing is like, no, no, no, no, no, no, no, you don't. So he's like cushioning or he's allowing in part. Yeah. You can understand in part, you feel a sense of sadness over your loss. And then over the loss, it's like you're pointing to why they feel the sadness. This makes me think of a really pivotal paper that Freud wrote on morning and Melancholia, in which he distinguishes that morning is when we know the object of our sadness. We know what we lost, but Melancholia or depression, we don't know what we've lost. It can be the loss of an ideal or it can be the loss of something that is unconsciously not completely understood. Yeah. I think the first time someone introduced that understanding of depression, it was really poignant to me that it is this like you have yet to find what it is. That's something that's missing. Yeah. It's sort of tantalizing. But there's some depth there. So there's some sadness. There's sadness. Okay. Anything else on sadness? I wanted to cover. I think that one, Ekman 2007 thing that we talked about, I see someone experiencing sadness. And then if I respond, I will feel a sadness within my body. But even just like intentionally making the facial expression of sadness will result in some physiological changes as well. It was just a really cool finding that they did. Kind of to say to reinforce that we can truly feel and understand. The moving of your muscles in your face can lead you to have the physiological changes. Yeah. Interesting. I've seen some articles for Botox on the middle of the furrow of the brown. And they think that it can decrease depression by decreasing the amount of anger that's felt and then internalized. Now, that being said, I'm very skeptical of it at first look because Botox is a treatment modality. Yeah. Anyways. I'm curious to read that. It's an interesting study. But it kind of goes with that idea of like if you have the feeling of the emotion on your face and your flashing it throughout the day all the time, then you can have a similar experience in your brain. Okay. Let's go on with anger. So cool. Yeah. So anger, when we talk about the face of anger, it's where sadness was an upward angling of the eyebrows. Anger is more of what you think of like a furrowing of the eyebrows. You're going to see some lines in the middle. Down and together. Yeah. And then the eyelids as opposed to drooping down and sadness are actually tightening. Like you'll see some sort of like increased, almost when you're perceiving, yeah, the gaze that you'll see it tighten up there. And it's as if the person is squinting or concentrating really hard. Like those are those transient things, but anger is going to be there for a different period of time. And then what do you see in the lips? This one's interesting. You're going to see a thinning and narrowing of the lips. And what's cool about this is whereas we can all furrow our eyebrows like even right now I'm doing it just with intentionality. But the narrowing and thinning of the lips is actually the earliest and most difficult muscle movement to consciously control. So that's, we know when you look for those tails, we said like a real smile is the mouth and the eyes of fake smiles only the mouth. The thinning and narrowing of the lips is a really good unconscious tell for anger on the face. Yeah. The most common I see is the kind of the down and together of the eye, eyebrows, which is that furrow and that slight tightening. And it's very short. We're talking about, you know, sometimes one eighth of a second, sometimes one second, but we're not talking about like 20 seconds. No, that's usually the face of concentration. That's the face of someone concentrating. Yeah. And that's where it gets confusing as someone will look at that and then they'll say, but it just looks like the person's concentrating and you'd be like, yeah, but it's like one second or less. And that's anger. Yeah. The other thing that's confusing about this one is often people when they think of anger in our common vernacular of anger. they're not thinking of all of the reasons why we get angry physiologically. So often, like people get angry when they're passionate about something, when they're trying to move through an obstacle. -Okay, it's like this can be motivation. -It can be motivation, yeah. -Think of like an angry run. You'll run faster and harder and further. -Right. And so I think that's kind of another point. Where do you feel anger in the body? -Yeah, so I think like in going through the literature and even just when I think about moments for myself, there's chest tightness, this sort of like tension in the neck and the back. You might have some knots or burning sensation in the stomach at your core. You'll also have like increase blood flow to the upper extremities. And those are super cool like Greenwood 2003 study kind of looked at like blood flow with the different emotions and found that anger is increasing blood flow to the upper extremities. It was just an interesting factor, it's there. -So your blood is moving away from your stomach and away from your GI track? -We've got that like fight or flight or stress. -You don't need to digest your food, right? When you're angry and it moves to your muscles. -Yeah, it's preparing you for action to respond to overcome the obstacle that has caused you to be angry. -Right. -Which can be positive as we were talking about. So you get the glucaquodacoid release, you get the catecholamine release, all that fight and flight stuff. Now someone can flash anger and not have that, I think. But if they're angry and they're multiple flashes of anger, they'll start to release those things. -Yeah. And for the like positive side of it, we talk about short-term anger or if it's directed, can be positive if it's long-term, it's chronic, that can be really caustic on your body. But some cool short-term effects of anger is actually like analgesic. So you'll be less sensitive to pain. Think of like a mom, I don't know, you know that mama bear example where she's protecting her cubs. Think of that in like the human setting. There's sometimes you can be angry in a protective manner. And your body is put into this mode to like, to run, to engage, to do what needs to be done, to protect your loved ones. It's just, it's cool. Like they went into this hole in this Carson 2005 study that gait control Neurometric's theories of pain and found that short-term anger, analgesic, chronic or long-term anger can actually increase pain sensitivity. -Yeah, a lot of the chronic pain patients that I treat have a lot of sort of unresolved anger and unresolved stress for that matter. Like think about going through like a child custody battle that just never ends. -Yeah. -So for years on end, you're constantly fearing your kids being taken away or you know, for some reason your spouse is abusive and you're fearful of your spouse hurting the kids when he's taking care of them and then you know, all the lawyer stuff and the legal things. So that's an example in my mind of like, like a chronic ongoing stress that is just like, unrelenting and chronic and long-term. It can really cause a lot of. -Health issues. -Health issues. Yeah, health issues, chronic mood issues. -A union functioning. -Yeah, and it may be, it may be, you know, really difficult to go through that and not feel that way because it's pulling at you. Some of these biological things like taking care of your kids, that you're wired to take care of them and to try to do everything for them. -We had a phrase in our household, "Atilla the mum." Like "Atilla the hun." It's like when my mom would be like, in protective mom of bare mode, called her "Atilla the mum." -That's cute. -Yeah. So we've talked about this, but just to kind of reiterate the positive sides of anger. So I think when we're headed towards a goal, like let's say, your goal is to graduate from medical school. And then all of a sudden some obstacle gets in your way, the natural thing is to have anger towards that. And I think when anger is in a positive light, anger gives you courage to have a voice. -Yeah, desires, needs, misgivings, boundaries. It gives you that push to speak for what needs to be done. -Yeah, it gives you the courage maybe to overcome your fears. It gives you the courage to have boundaries, right? To say no, to say no, I need to do this or I need to do that or I can't do this or that. Or no, I won't do that. You know, like boundaries are so important. And I think correctly knowing how we have anger and being able to read it can help someone have the correct expression of it that protects them and protects other people. -Yeah, Greenwood in a 2003 study kind of outlined or gave this cool modality to understand that anger management style determines whether it's healthy or not. So if you give it directionality, he talks about these accesses of internalizing versus externalizing or expressing that it's really just how you channel it that can be healthier. Unhealthy. And I think we could all agree just immediately repressing anger and saying, I'm not allowed to feel this feeling is internalizing and unhealthy. You know versus what you were saying, like, love having it channel you to help like speak out boundaries, set goals, overcome obstacles. It's such a like useful way of all this energy to channel. -A lot of times when people say that they feel guilt, they flash the micro expression of anger right then. And I've been looking at that and I've never, I've seen people say, like, depression is anger towards yourself. Depression is anger directed inwards. But specifically with guilt, it's as if the obstacle is there, but instead of the anger providing courage to overcome or to have boundaries, the anger is directed at themself and they feel guilt. Like, I should have done something different or I am bad or I made a mistake. -Yeah. It's such a, I just love how this changes the understanding so much so and can kind of give us a greater empathy, overuse term right now, but a better empathy for people who are experiencing this emotion to understand like what's behind it. -Yeah. Yeah. So we're going to finish up with anger here and then we're probably going to have a part too for the other emotions and then further sort of how to use this knowledge. So anything else from anger? -Man. -I'll say it's really hard for people to overcome the idea that they have anger in the first place. -Yeah. Oh, absolutely. -So sometimes I'll label it when I'm first talking with someone and they're flashing anger. The way that I'll empathize with them is to not say anger, I'll say frustration or stress or I'll use their own words. I think that was a good tip that you've passed on to me is to always try and start with the language that the person is using. So they're saying I was really frustrated with my day. This person really frustrated me like. -Yeah, it sounds like you're really frustrating. -In very language. -It sounds like you're very frustrated. -Because we're angry. So harsh to some people. -It's harsh and it comes with cultural sort of pejorativeness or pejorative, bad connotations. The second thing is that most people I think because of that don't experience anger consciously. -Because we're pushing it down saying this isn't good. -Yeah. And so I think a lot of people, especially people who have been trained from a young age, you know, don't be angry. I catch myself saying that to my own kids sometimes. I'm like, don't be angry or don't be sad. It's like, oh my, where did I get that from? Did I get that from my parents? -Sir, where did I get that from? -And I mean, and you're someone in the field and it's studied it, but it's still like this instinctual, like societal message that comes through. I think sometimes at that. You know, something else that I think is probably like the last thing to touch on is, this really cool study by Lieberman in 2007, where he did brain imaging studies of like the amygdala and the limbic region systems. And as a quick side note, when we think of like being upset, being of high emotionality, fight or flight, that kind of modality, we think of those areas of the brain. And they found that someone verbalizing or writing an emotion, like being able to say out loud, I am angry in this moment actually helps decrease the activity in those areas of the brain, which allows your frontal lobe and your areas that give you conscious like planning centers. Next step sort of thoughts, better functionality. Yeah, and I'll say also with that, a lot of people think that they have no power over their anger. Like I've had some different patients that like are, you know, abusive and can have domestic violence. And they'll say like, yeah, I just go black and I don't see and I just do it. And I'll say, well, when you described it though, like, why didn't you kill the person? And they'll be like, oh, well, I don't want to go to jail or, oh, I wouldn't want to kill someone. I'll be like, well, like, huh, that's interesting. So it sounds like you have some control. There's still some higher level functioning. Yeah, some parts of your brain are still there. You still have control and yeah, and helping them realize that they have more control is actually really powerful and empowering. And they can actually not be abusive, you know? Yeah. And so, yeah, helping them put labels to it, especially early on when they're starting to get angry. Being aware of those body sensations that when they're at low levels and starting to rise, you can be aware of what's happening as opposed to just being swept away by it. Right. So catch it early and then find out like, well, what is the obstacle and what am I really trying to overcome? Because a lot of the times, people's solution that they create in their mind in the moment, like reactively, is not the solution. solution to the problem and actually makes the problem in their goal, it makes it worse. So a lot of the times, for example, the goal is to connect with their significant other. And the obstacle that comes up inevitably causes them to react in such a way that causes them to be even more disconnected. And once they realize that their goal is really connection and that they came home with the expectation of connection and when the obstacle came in its way, it was like then that what they can do is they can like step back and say, okay, that was the obstacle. How do I overcome the obstacle to get back to my goal, which is connection? So all right, there you go. If you like this, if this was helpful, we'll put in the show notes the link to kind of the long version of this and also to the app and some of the visual aids. And so you guys can get started learning this skill. If you do learn it, I would love to hear. Throw up a comment on one of my social medias. Reach out to me. I got it the other day like this really awesome review and I just really appreciated it. It was very encouraging. So if you have time, throw up a review on iTunes or whatnot. So there we go. Okay, Ariana, Cunningham, thank you for coming on. Absolutely. [MUSIC]