Neha Pathak, MD, FACP, DipABLM: Welcome to the WebMD Health Discovered Podcast. I'm Dr Neha Pathak, WebMD's Chief Physician Editor for Health and Lifestyle Medicine. Today, we're exploring the many layers of resilience, what it means, how we can build it, and why it's crucial for navigating life's challenges.

There's a great deal of commentary, but also confusion about resilience in our culture. Some view resilience as simply bouncing back after hardship, and others think about resilience as adapting, thriving, and even developing an emotional toolkit. 

We'll explore the science of neuroplasticity. Literally what it means to change our brains, the power of small, meaningful habits, and how we can all cultivate resilience, not just for ourselves, but our families and communities.

Whether you're navigating a major life transition, moving through a difficult period. Supporting loved ones are simply looking to optimize your own wellbeing. This conversation offers valuable takeaways for everyone. But first, let me introduce my guest, Dr Tracey Marks. Dr Marks is a general and forensic psychiatrist of over 20 years, whose mission is to increase mental health awareness and understanding by educating people on psychiatric disorders, mental wellbeing, and self-improvement.

She believes that insight creates change both on a micro level and a macro level, whether that's for personal growth or reduction in fear and social judgment. Dr Marks produces educational videos on her YouTube channel, Dr Tracey Marks. Welcome to the WebMD Health Discovered Podcast, Dr Marks.

Tracey Marks, MD: Thank you for having me. I love WebMD. So, I'm very proud to be here.

Pathak: Well, I am very excited for our conversation today, but before we jump in, I'd love to ask about your own health discovery when it comes to your patients and the folks that you're working with. What questions, issues are they bringing up in private discussions with you that you want more people to feel comfortable talking about?

Marks: Two things that have been most popular for people to talk about of recent that may or may not apply to the general public is election results and how that makes people feel and etc.

But then now it's more transition to holidays and how do I deal with, how do I get through this? You know, for a lot of people, the holidays are very tough and it's not just people who have depression and struggle with depression. It can be just the average person who finds the holidays very intimidating or there's lots of loss that they're reminded of because of the holidays, all of the expectations or dealing with loneliness that becomes harder to manage or, becomes deeper during the holidays. Whereas any other time of year, they're fine with it.

So, that's kind of the predominant talk for me that I see with patients as far as a kind of a commonality of what people talk about this time of year.

Pathak: Yeah, that's really interesting because I feel like it ties into our conversation because there's something about this time of year, the end of one and the beginning of the new, the transitional feeling that makes you feel like you have all sorts of expectations for yourself, for the people around you, what that means.

And I think resilience is really something key that we need when we have these high expectations that may or may not be met. So that word gets thrown around so much, resilience. Can you define for us how you think about it?

Marks: So I think of resilience, it used to be my kind of knee jerk was “bounce back ability,” but it's really more than that. It's the ability to adapt, recover, and even thrive in the face of stress and adversities and difficult challenges. And even beyond that, so that's kind of a high-level view of how I see resilience, but there are a few components to it.

There's your ability to adapt to changes in circumstances. And some people are better able to do that than others. There's emotional regulation. So being able to manage your emotions effectively, there's problem solving, like being able to face a challenge and look for solutions and take action to change your circumstances.

And then two others that I want to mention. One is optimism, being able to remain hopeful, and see things that even are difficult at the moment right in front of you, and still see possibilities beyond your current circumstances. And then, a last thing that I would mention is, self-efficacy, I think, is an important part of resilience, and that's the ability to be able to believe that your own efforts can affect or influence your circumstances, that you have some measure of control over what you're going through and what you will go through.

Pathak: So, can you talk a little bit about factors that might predispose you to being resilient versus those that might be like, hey, this is going to be a little bit of a harder journey for you might have to work a little bit harder to build that resilience.

Marks: The bottom line is, or the final answer is that resilience is a skill set that anyone can build or develop, but there still are things that influence it. So there's biology, there's your hard wiring, what you come into this world with, which, you know, involves your temperament and your temperament affects how you respond to stress, how you view the world, your mindset, all of that.

Some people are naturally more calmer at baseline and other people are, at baseline, just naturally more triggered by things that are upsetting or distressing. But then also there's your early experiences also shape how resilient you are, the kind of nurture versus nature argument that some of it is what you're born with and some of it is what you see around you.

So if you're in a household where every time something happens, there's lots of catastrophizing and, oh, what are we going to do? And I don't know if we're going to make it. Even if you are hardwired to be more optimistic, it's going to be hard to remain optimistic as a child in that kind of environment where everyone else around you is crumbling or seeing this as a catastrophe.

So that's one factor with resilience is your biology. Another factor is the power of neuroplasticity, which is one of my favorite topics these days, of how neuroplasticity is your brain's ability to adapt and change based on your experiences and behaviors. So, certain behaviors can then generate certain responses, but you can change how you respond to things and feel about things by behaving and thinking differently.

So we have the ability to rewire parts of our brain that affect how we think. Which is different from when I finished my training in 2000. And at that time, we largely felt like the brain was fixed and you got what you got. And if you're lucky, then good for you. If not, oh well, sorry.

So this has really been a progression over time of understanding how the brain really works. So I think those are kind of like the main two, that affect, someone's ability to build resilience, kind of your biology and then your behaviors beyond your biology of how efforts you make to change and engage in behaviors that are health promoting.

Pathak: So what are some of the behaviors, some of the strategies that you try to incorporate with your patients or people that you're talking with so that they can now take whatever is innate, whatever is that learned behavior, and start shifting it towards becoming more resilient? 

Marks: So I think there's a few key pillars. And I know as you being a lifestyle medicine expert that you are also completely on the same page with these things. So those are namely diet or nutrition, exercise, sleep are three huge ones. And then there's also, you know, in the idea of lifestyle medicine, how you manage stress, and eliminating addictive substances and all that.

But kind of the three that I tend to focus the most on are sleep, diet, and exercise. I know sometimes I bring these things up and people will roll their eyes. Well, I do all that stuff. Well, do you really? Because if you really did, it's a lot of work, but it's work that you can learn or things that you can learn to do that just become routine or automatic, like brushing your teeth.

I mean, if we really made a list of all the things that we do on autopilot during the day. And just gave that list to someone say, do all of this. That person could similarly be overwhelmed. Like, well, that's just too much stuff for me to do. Well, similarly, these things that I'm going to talk about are things that you can become routine and regular parts of your day, it's just about.

Building it in and being intentional about it. I think all three are very impactful. If I had to rank the impact, and this is just all just my opinion I would put sleep at the top, diet, a very close second, and then exercise third, but granted, all three are very important.

And then with sleep kind of a very easy first step is setting a sleep schedule or setting a bedtime. I ask everyone, how's your sleep? Or no, what time do you go to bed? Well, it depends. And that is usually the answer. It depends. It should not depend. You need a time.

When you let it depend, then that means you intentionally or unintentionally deprioritize sleep. And it just becomes something you get when everything else is done. We should be building our lives around when we go to bed versus going to bed being just this end point when everything else is finished.

So that means that I schedule my exercise. I think about my wind down period, all the things that I do during the day are going to affect how well I'm able to fall asleep at night. So I always coach or talk to people about planning for sleep. So you start with a bedtime and then you work backwards from there as far as when you start preparing for bed, when you have your last caffeinated drink, when you have your last meal, like it all just falls into place. From the starting point of bedtime. 

Pathak: I love that we both really recognize the power of these lifestyle interventions. And what I think is so interesting is that these are very tangible things. They're not easy. They're simple strategies. They're not easy always to incorporate, but it is something that's tangible that you can do. 

Is going to basically optimize you and your environment so that some of the things that are harder, like, be resilient today. Yes or no, that's a hard thing to make tangible versus did you optimize your sleep, and we know when you've had a good night's rest, you are just better able to cope with whatever comes your way.

Marks: One thing about these types of lifestyle interventions is they are within your control. Now, someone might say, well, it's not within my control. I have a newborn so I can't, okay. There are circumstances that interfere with, this type of planning, but newborns don't stay newborns forever.

So we're talking about things to do for life, even if there's a period of your life where things get off kilter. So I love the fact that these are things that we can do for ourselves. We have agency over these things, as opposed to a feeling of hopelessness, or just, I just have no control and life is just I got to deal with whatever life gives me.

And there's some element of that, we can't control everything, but if you focus on the things you can control, then you can lessen the damage and you can manage how you do things. another thing that, I think is important because I've already mentioned the exercise, which kind of general recommendations for that are 150 minutes of aerobic level exercise, a moderate level per week. Or 75 minutes of high intensity, aerobic level. And interestingly enough, I was just talking to someone today about, the difference between the effect of aerobic exercise versus weightlifting. So you know, in studies and references to exercise improving health in general, but also mental health and exercise also promotes neuroplasticity.

The exercise that they're talking about is aerobic level exercise. However, with strength training, and that could be just having some, small weights or even doing calisthenics, you're building muscle for , strong bones and, and strength and flexibility in general.

So that those are still important, but it's aerobic level that's important. Another thing that I wanted to bring up about what you can do to improve your resilience beyond what may seem obvious to others, like, oh, yeah, of course, diet, exercise, sleep. I've heard all that before. I mentioned that an aspect of resilience is emotional regulation.

Well, what does that mean? And how can you do that? This is where something like practicing mindfulness becomes a very good intervention and kind of like the number one thing to help, you, reduce stress, It helps a lot of things. So we tend to function so much mindlessly with all of the things that we're doing.

We're multitasking, all of that. And so you're never, you're not present in the moment because you are doing all these other things and have got a constant to do list that is taxing on the mind. You might feel like, well, you're, you're getting a lot done because you're, you've got multiple windows open and you're doing all of this stuff, but your mind doesn't forget that that's hard.

And there's a cost that comes to that and also with anxiety, an aspect of anxiety is worrying about the future or ruminating about past. If you are making yourself stay in the present moment, there's no space to be worried about the future or ruminating about the past. And that's one of the ways, I mean, mindfulness helps in a lot of different ways, but that's one of the ways mindfulness helps reduce distress and slows your mind down and helps you think better. It engages the prefrontal cortex, which is a part of the brain that's involved in, reasoning and in thought and analysis, versus the more primitive parts of our brain, like the amygdala, which is more, emotion focused and danger and, more distressing, responses and emotions.

So mindfulness activities of just simply focusing on the present moment helps reengage your prefrontal cortex. Slow things down and better help you engage with what's going on around you and it improves how you engage with others. I have to admit, I've had conversations with people where, you know, I'm facing them, I'm looking at them, but I'm still remembering, oh yeah, that's right.

I need to go pick up gas because I'm going to run out of gas before I get home, you know, and I'm supposed to be talking to this person. even though, yeah, I can, think about different things. I shouldn't be thinking about different things and I can have better connection with that person if I'm fully engaged in their presence only and not thinking about other stuff.

Pathak: How do you talk to your patients or what are some of the things, the considerations we should be taking into account for when we recognize our life is stressed?

So a new, concern in our lives, whether that's a job loss, a new health, condition that we didn't have previously, or we're just kind of sandwiched between so many different responsibilities. So recognizing. That the world may be, to your point earlier, you have this newborn. The world for you right now is off kilter.

How can you, and how do you counsel your patients about still trying to find some of that center, that mindfulness, in those really difficult circumstances?

Marks: That's a great question. So I tend to focus then on when someone has got a lot going on, things that they can't change, things that are draining them, how do they still manage? And kind of two things. One is still trying to carve out some time for self-care, because it's very easy to just let yourself go for the purpose of helping the world or, you know, helping people around you or getting all these things done, whatever, whatever the challenge is at the moment, just to only focus on that and let yourself go. But then you let yourself go and then you're inefficient and doing all these things that you still need to do.

So you could start small with just one or two things. Like I'm going to have 15 minutes to myself to eat lunch with no one speaking to me and I'm not checking my phone or I'm going to have 20 minutes of watching television, something mindless, something on television where I can just totally zone out because that is refreshing for me. That's one thing is self-care, whatever that looks like for you. 

And there's lots of ways that that can look. And then the other part is focusing on the concept of meaning and value creating something that feels valuable to you or feels like it's meaningful, like you get something out of it, either because you're contributing or you're getting something back.

So let's say I really like watercolor painting and I create all of this stuff and then I give it to people and they love it and that makes them feel good. So that makes me feel good. it could be volunteer work, whatever it is, but find something that gives you meaning because contrasted with say the person who hates their job and they feel like they spend 10 hours a day doing stuff that's meaning less.

You have got to have that be offset by something that feels meaningful to you.

Pathak: Dr Marks, I'd also just sort of like to ask you about how do we create a structure for resilience or a resilience mindset in our home for our children or for the folks that we love in our lives, particularly if we come with some of the conditions that you had talked about earlier, either a childhood where that wasn't necessarily, something we learned, or our temperament is not predisposed toward resilience more naturally? How, how do we help our children and the ones we love around us?

Marks: So the first thing is modeling the behavior yourself. and then second is giving your children or family members, permission, to be able to grow in this So what do I mean by all that? I think I would look at focusing on kind of two pathways here. One is establishing a growth mindset, which is the idea that when faced with something difficult, even if you are unable to do it I guess, conquer it now.

You adopt this idea of yet, I am bad at this right now, or I can't do this yet. So that's one thing. Establishing a growth mindset and it starts with you demonstrating that. So that means talking about stuff out loud. You might not be used to talking about things out loud, but you might have to then start getting in the habit of saying, I lost this contract at work, but I think I can learn from that and try something different the next time.

Like I know I'm one who, I just think in my head, whereas my husband is like talking about stuff all the time. So, that's a behavior that you might have to adapt or adopt for the sake of your Children being able to learn from you. So that's one thing growth mindset.

The other part of part two is addressing and embracing emotional expression because, as I mentioned before, with resilience. Part of it is emotional regulation. Well, childhood is a, you know, a classic period of time where there's lots of uncontrolled emotional expression. There's learning how to cope with internal emotions and how to express yourself, et cetera.

And giving children, space to be able to express themselves. And see it is okay to feel this way. maybe even, you know, you can have like a corner of the room that a child can spend in whatever kind of, behavior or emotions that you might find objectionable, like screaming or something like that.

Like, let's go over here to this corner. And this is where we express that. I mean, these are just kind of quick ideas off the top of my head. but the overall concept is giving them permission to experience their emotions and then helping them see them as just emotions. You're accepting this as an emotion. It doesn't define who you are and this emotion will pass. , I'm talking about difficulty emotions versus the emotion of feeling happy. that is a great gift to give to your child, to be able to help them fully experience and accept their emotions rather than it being seen as something that's bad if they act this way or act that way.

Because then they learn to suppress certain emotions and those emotions don't go away. They just suppress them and turn up in some other behavior.

Pathak: I love what you're saying. And I kind of makes me reflect back on what you said earlier about neuroplasticity and that there's also life plasticity. So we really do have the ability to start fresh and start over and do this talk out loud so that they recognize that we're not perfect and we're, trying to improve as well. And this is how, like you said, just modeling how we're trying.

Marks: Absolutely. 

Pathak: I just so appreciate your time. I am just so thankful for this conversation. I'd love to end our time together with your closing thoughts on advice that you have, some simple actionable tips that our audience can incorporate into their lives right after listening to, this conversation. 

Marks: I would say take an inventory of how you feel you are managing your life right now. Do you feel like you've got things under control? Do you feel like things are out of control? Do you feel content?

Take a temperature read because for some people, there's more of a need to build resilience and develop some of these skills. And for others, maybe you're doing well in a lot of areas, but there's some other parts of your life that could be tweaked so that there's not this overwhelm of I've got to do all of this stuff.

Instead, you want to focus on. One area that you can improve for now, and we could kind of go back to what I said before, you could take a look when you're doing this inventory. How is your sleep? How is your diet? Are you mostly eating whole foods and reducing processed foods to reduce inflammation and all that?

We didn't get into all of that, but you know, that's where the diet comes into play. how much exercise are you getting? If all of those three areas are terrible for you, pick one. That you want to optimize in the next 30 days and be consistent with it.

Neha Pathak, MD: Thank you so much for being with us today. We've talked with Dr Tracey Marks about resilience. It's not just bouncing back, but adapting, thriving, maintaining balance in the face of life's challenges. From practical strategies like mindfulness and sleep optimization to understanding the role of biology and neuroplasticity, this discussion provided actionable insights to help us strengthen our mental and emotional wellbeing.

As we wrap up, remember that building resilience is a journey of small, intentional steps. Whether it's setting up a consistent sleep schedule, practicing mindfulness, or simply allowing ourselves moments of self-care, each effort moves us closer to a more balanced and fulfilling life. And if you're a parent or caregiver, modeling these behaviors and fostering emotional awareness in our loved ones can make an incredible impact.

Resilience is a skill we can all cultivate, no matter where we're starting from. To find out more information about Dr Tracey Marks, make sure to check out our show notes for links to her YouTube channel. Thank you so much for listening. Please take a moment to subscribe. To follow rate and review this podcast on your favorite listening platform.

If you'd like to send me an email about topics you're interested in or questions for future guests, please send me a note at [email protected]. This is Dr Neha Pathak for the WebMD Health Discovered Podcast.