S2E13 Adjusting

Whether to a global pandemic, marriage, the loss of a loved one, or a new job, humans are always adjusting. Dr. Rubin and Dr. Pete highlight the behavioral aspects of adjustment, the diagnosis of adjustment disorder, and how the world is collectively going through an adjustment. Tune in to learn about how best to adjust to new situations.




Nikki: Pete, we are recording this, as the pandemic is I'm going to say waning you know, thankfully, it's still happening but it's waning. And so we want to talk about adjusting today, which obviously goes beyond the pandemic. But hey, Pete, yeah, we’re talking about adjusting.

Pete: Adjusting is good. It's critical. It's essential. I know, we'll talk a little bit about the diagnosis too, because I never liked that diagnosis.

Nikki: You never liked adjustment disorder?

Pete: No.

Nikki: Oh, I like it quite a bit.

Pete: Well for me it's not a disorder.

Nikki: Right. So I guess, listeners will get into it a little bit more, maybe we were actually on the same page about it. I like it as a way to identify we're just, yeah. Okay, so adjusting,  we wanted to talk about adjusting because obviously, this this current contexts that we're in because Pete and I were discussing how we've been talking to a lot of folks who, even though they're grateful that things are moving in an optimistic direction with the pandemic, right. I think it's like, as of today, now, everywhere in the United States, everyone over 16, I think can get a vaccination appointment, if they want it, you know, things are starting to slowly open back up. And yet, we're also hearing people still feeling off or also feeling some anxiety about things opening up, right?

Pete: Yes, yes.

Nikki: Right. So what do you make of that, how do you conceptualize that?

Pete: It's a lot of uncertainty. So we're still in the world of uncertainty. So that's interesting for us to reflect on so as I got into this, we were uncertain and now that we're waning, or coming out of this, it's uncertain.

Nikki: Right, and then I guess this is what you and I always come back to right, which is, and things are always uncertain like that's a constant and in the universe, right, that the next moment is uncertain.

Pete: Right. So the next moment of coming out of this weather, because there's uncertainty around the vaccine, again, we're not going to get into the science of vaccinations. We're not going to get into the politics of vaccinations, which it's never we've never lived in such a highly politicized vaccination discussion, right? I mean, yeah. Yeah. I mean, yes. Jenny McCarthy had one maybe 10 years ago, but that was like, all unfolded.

Nikki: Well, yes. And that's where that's all that started. But yes, let's believe that kind of mindfully come back to, to adjusting which, yeah, well. And I also think that there's a big piece of this around, actually, like thinking of it from a behaviorist lens, right, and actually, in an exposure based lens. that we have to re acclimate to some things that we are now pretty rusty at doing, including like, being around other people, you know, it's like, I mean, I'm like, Do I know how to hold a conversation? I'm like, I don't know. I was pretty skilled interpersonally but I don't know.

Pete: May have lost a little bit of.

Nikki: May have lost, I don’t know.

Pete: I doubt it.

Nikki: Yeah. Well, I'm sure you've seen…

Pete: Everyone has felt that way though.

Nikki: Right. So there's that the smooth brain meme? Have you seen that?

Pete: Yeah.

Nikki: I mean, if you guys haven't seen it. I mean, I'm not on social media, somebody I read about in some article, like, what is this? And it's saying, like, our brains are like smooth now no full? we're just like, nothing going on in there.

Pete: Yeah, there's going to be a learning curve of readjusting to the world post COVID. And I think, again, for me it's about really embracing that this is just the world that we're in and that means it's uncertain. And this is not like a negative comment but like, I believe this is going to be, we're going to have other pandemics and a lot sooner than 100 years. And so I think that, that scares people and so I think that's what we're talking about today. Is that so? A Yes. interpersonally people are returning do I shake your hand? Do I fist bump? Do I hug? Do I not have? You know, I think that's something that people are really uncomfortable around. And then like you said just trying to hold a conversation leading probably to like substance use increase.

Nikki: Yeah, we're just not used to like, you have no scheduler than like being in your house, even energy wise, you know, like we're not used to.

Pete: Of course. Oh, I know. So I will say that I have been around a lot of people during the pandemic, because athletes were in session sports once they uptick, I didn't have to have values. I chose to be there for them because they had to be there for the people who were there for entertainment and I felt that I was working with it was important that I was there for them. So I think I've had a little bit of like, sprinkling in of like that energy. But you know, for our listeners, what I'm hearing you say is like, when I'm around a lot of people, I tend to feel emotionally drained by the end of it. So if I have a long day of seeing people right after the other by the end of the day, I want a little bit of quiet time.

Nikki: Yeah, and maybe before the pandemic you might have been somebody that you wouldn't have required as much of that, right. Because I think that I keep hearing in therapy from people is, and I teach patients about this. They'll say, like…

Pete: You teach patient in therapy?

Nikki: Yeah, I love me some jokes. Because people will go like, I don't get it. Like, why am I feeling so burned out? Or like, why is it hard? I'm like, seriously, you don't know why? And they're like, “No, tell me.” I'm like, well, I don't know, we just like went through this bananas pandemic we weren't expecting, you know, that impacts our brains, you know what I mean?

Pete: Yeah. And it's an interesting thing to remind people that that's where we're going, and I think that that's because of us coming out of it you know. I think it's like; we're all just trying to, like rip off our clothes and run out into the cold water, or in my case, rip off our sweats. [inaudible 06:35] always have their sweater on, because we've just tired of it, you know. we're tired of feeling locked down and we're just ready to get some normalcy, some inter personal connection. I will say, just to share, even pre COVID after I had a long day or based on the nature of our job I liked and needed that downtime and so one of the things for me, that was a big adjustment initially was not having the drive or the walk as my de-escalation afterwards.

Nikki: Sure, sure.

Pete: And then now, it's like, I've gotten better at that, but still looking for like, what am I doing for self-care? How am I taking care of myself as I'm adjusting back?

Nikki: Yes, and I think I appreciate that example, too, because I think really, what Pete and I are wanting to highlight is that this, you know, goes along with our change episode two is that when something shifts it requires adjusting, adapting, right like that. And this pandemic, hopefully has given people their own real world experiential data that humans are very adaptable. like, I think we don't give ourselves enough credit for that, we've got some not so helpful things about our species and how we're wired. though, that's, that's a really helpful and important one is this adaptability and this ability to adjust. And Pete just made a really great point that, you know, because everybody wants to just like, we're tired of it, like, we want things to go back to the way they were, we want to jump into the cold water. You know, that's the mind, right, creating these expectations of how it should be and it's like, we want to orient back to one step at a time. Like, there's no just snapping our fingers and turning the light switch on and going yeah, I feel great again. that's actually going to help that's going to make us feel worse when we're having a hard time so we want to really compassionately, allow ourselves to just do things one step at a time. I mean, I am practicing that myself and I am saying that in every session with people, I'm like, one moment at a time here, guys. like, you're going to get there, you're adjusting as we speak though we can't adjust, it's adjusting.

Pete: It’s not a sprint it’s a marathon, it's adjusting.

Nikki: It's adjusting, that IMG, right. Pete and I are also adjusting. Do you want to talk a little bit about then this concept of adjustment disorder?

Pete: Yeah, that we started with?

Nikki: Yeah.

Pete: Because adjustment disorder, the reason I don't like it is one, I don't think it's a disorder. So just for listeners, the DSM, the Diagnostic Statistical Manual, which we use in the US, has a diagnosis adjustment disorder which allows for a development of an emotional or behavioral symptom in response to an identifiable stressor occurring within three months of the onset. I mean, hello, like, what? So it could be anything.

Nikki: It could be anything, it could be a breakup, it could be a move, it could be a pandemic, you know, having a new baby, whatever, anything that could happen to you…

Pete: Anything you can think of could be an adjustment disorder, so that's what the diagnosis is. I mean, look, there's other stuff There's symptoms that are clinically significant or might be affecting sleep or appetite or libido. You know, you don't meet criteria for anything else and often, adjustment disorder is related to bereavement, which also gets me annoyed. Because another diagnosis where it's like don't tell me how to breathe, which we talked about Robin too.

Nikki: Yeah.

Pete: On that episode so that's the disorder. The other thing I'll say about it is that then the insurance companies give patients a hard time about it.

Nikki: Yeah, they can sometimes and like I said, a moment ago, Pete and I actually are in agreement about this, we're just looking at slightly different sides of it. I agree with everything Pete saying and the reason that I quote unquote, like it, what I mean by that is, I appreciate that there's a way for me to make the case that people need support sometimes for their response to a stressor. And so, the unfortunate thing in the way we do things from a Western psychological perspective is that we can end up over pathologizing things that's the downside. the upside is that we can sometimes really give space to say, like, no, this is a real thing that you're struggling with.

Pete: You like the validation of it, so what we'll say for listeners, which you and I are probably also on the same page with is that, any diagnosis validates a person we're working with based on whatever their experiences. So, for example, like, I've had clients who, when I can talk to them about autism spectrum disorder, they're like, “Oh that's what it is, like, thank you.”

Nikki: It’s clarifying, it's valid like, you're not alone and it's like, my, my response is real like I'm not making it up. So that that's what I appreciate about that. What I don't appreciate and I think the language piece, what Pete's really getting what's really important is like, calling it a disorder. And then even though term adjusting; like we were just kind of redefining, it's like adjustment. It's like this ending thing, and as if well…

Pete: As if you just arrived.

Nikki: Right.

Pete: So maybe that’s the Zen stuff that [inaudible 12:22] because once you feel like you've arrived, then you're going on to your next place. And so adjustment, you have to like know the definition, which of course you know I love to give.

Nikki: Yes, I know you do.

Pete: The process of adapting or becoming used to a new situation. So I should say is, the process of living.

Nikki: Yeah. They’re like, and then the next moment? It's like, I would love to have a Buddhist monk just sit there and be like, yeah, so like…

Pete: What are y'all trying to do?

Nikki: Yeah, what? Come on.

Pete: This is the natural order of suffering.

Nikki: Yeah.

Pete: And I think that that's a lot of what I'm seeing. And that's why I don't like it. But anyway, I mean, do you feel the same way about it or where are you at with it?

Nikki: No, no, I think we're absolutely on the same page and so it's another dialectic, it's another middle path, right, that it's saying like, it's important to acknowledge that adjusting, it can be really difficult. I mean so much so that in western psychology that we've even said it raises the level of like; we can give it a diagnosis sometimes, right?

Pete:  Well, I'm going to correct myself because it's not just the DSM It is also the ICD.

Nikki: Oh, yeah this is for international classifications yeah.

Pete: Yeah. Because I think that that's poor, because I kind of felt like this is more of a DSM thing. So I mean that makes me feel a little bit better about it. And actually, in the ICD, they're saying it's billable, but you and I both know, and I've had a lot of clients who have had sessions bounce back because of that code.

Nikki:  Because of that yeah, which I think that speaks to, again the bigger systemic problem.

Pete: We do an episode on that?

Nikki: Yeah, we'll probably, I'll just be complaining about… I don't know if anybody wants to hear me talked about that. But, you know, I think it's speaking that we can feel invalidated for the fact that adjusting is hard. And I think that that also links to what you're saying about this expectation. That's like, I should snap my fingers and be adjusted and go back to normal. And I think, really, what we want to leave listeners with today is this concept that we're always adjusting, right? And there are going to be times where adjusting is more difficult than others. And it's just really important to show up to that moment in a mindful way and bring some compassion to yourself because it's the natural order of being alive. This has been When East Meets West. I'm Dr. Nikki Rubin.

Pete:  And I'm Dr. Peter Economou. Be present be brave. This has been When East Meets West all material is based on opinion and educational training of doctors Pete Economou and Nikki Rubin.

Nikki: Content is for informational and educational purposes only.