Resources including the PERMA Model, helpful information, and recommended apps for wellbeing.
The PERMA Model
Martin Seligman’s PERMA Model of Wellbeing – The 5 Pillars of Wellbeing: Strengthening these will increase your resilience.
P - Positive Emotion
How do you make room for things that feel good? This isn’t some frivolous, feel-good meme. Positive emotions (including gratitude and awe, in addition to happiness) lead to increased life satisfaction by building resilience. In other words, happiness seems to lead to the development of skills and resources for positive life outcomes. We humans have to overcome the ‘Negativity Bias’. The cost if we don’t? Pessimism. And pessimism is a liability to your health.
- Cultivate gratitude (see tab this section)
- Practice forgiveness (see tab this section)
- Savor (be in the moment) pleasurable, wonderful things that are happening now
- Develop optimism (see video in this section)
- Remember a time when you experienced a positive emotion
- Act like you do when you feel positive emotions
- Put yourself in situations where you are more likely to feel positive emotions
- Be more mindful of your feelings in general
The benefits of gratitude:
- Lower risk of certain psychiatric illnesses (depression, anxiety, substance misuse and bulimia)
- Among people with PTSD, gratitude predicts better daily functioning
- Higher life satisfaction
- Higher ‘authentic living’ (behaving consistent with values and beliefs)
- Stronger relationships (may be related to more willing to forgive)
- Increased hours of sleep and feeling of well-restedness
- Less envy
- Less materialistic
- More positive emotions
- More empathic, forgiving and helpful
- More time spent exercising
- Fewer reported physical symptoms
- Higher optimism
Emmons & McCullough (2003); McCullough, Tsang & Emmons (2002); Wood, Froh & Geraghty (2010)
How to do it:
- Within 2 hours of going to sleep, write down 3 things that happened today that you are grateful for.
- Include your role in bringing these things about.
- Must do for at least 14 days.
See 3 Good Things app under the Apps section.
Our forgiveness is not predicated on the deservedness of our offender.
It is not necessarily meant to release the other from culpability.
It may be based on our acceptance of the other’s circumstances.
We forgive to release ourselves from the burden of resentment.
E - Engagement
Identify your strengths and engage them.
- Take the Values in Action (VIA) Test. Take your top three character strengths and apply them in one new way this week. For example, if Forgiveness is one of your top strengths, think about how you might apply it to someone whom you never considered needing forgiveness.
- To cultivate interests and discover strengths, ask yourself:
- Where does my mind wander?
- What do I avoid?
- What would I do if I weren’t afraid?
- Then engage these – spend time on them, congregate with others who share them, practice, set goals that reach a bit.
- Know that getting stuck and feeling frustrated are part of the learning process.
- Believe in the blessing of failure.
- Set goals that cause you to reach a bit – don’t be afraid of mistakes.
- Celebrate your progress, even if it is slow.
- Think about how your goals serve others.
- Be comfortable being in the minority of thinkers.
- Take the Grit Scale Survey
R - Relationships
Put effort into your relationships. Isolation is an ailment. Loneliness and conversely, connectedness are contagious.
John Cacioppo, PhD
- Unplug – put away screens and devices
- Do small favors – do something helpful or nice for others. Their gratitude will make you feel more connected.
- Work together – take a task that you usually divide up and do it with someone else.
- Engage people around your differences – we usually join around our commonalities. Share ideas or opinions that may help you and the other person grow in knowledge.
- Just say hello – Oprah Winfrey (John Cacioppo, PhD)
- Active Constructive Responding
- Will you be there for someone when things go right?
- Active Constructive (Joy Multiplier): Authentic, enthusiastic support. Ask questions that flesh out the achievement or success. Highlight or get your partner to talk about his/her role in bringing about this outcome.
- Passive Constructive (Conversation Killer): “That’s nice.”
- Passive Destructive (Conversation Hijacker): “That reminds me of the time…” or “Well, did I tell you what happened to me today?”
- Active Destructive (Joy Thief): “Well too bad there’s no raise to go along with it.” or “You’re in for a big headache.” or “Be careful what you wish for.”
- Will you be there for someone when things go right?
Obviously, the Active Constructive response builds and deepens relationships. Give it a try. Practice it. Developed by Dr. Shelly Gable at UC Santa Barbara.
M - Meaning
What do you value? What gives your life purpose? A pleasant life consists of a string of positive experiences and acquisitions. The happiness associated with this tends to be short-lived. A meaningful life has to do with self-expression, serving others and staying connected to your community. This type of life tends to result in longer lasting happiness and greater resilience. Spirituality sometimes fits under this heading and in very general terms this can be thought of as serving something greater than yourself.
Caution, a meaningful life can be more stressful. But, think of the profession you chose to go into. You knew it was going to be hard, but you have a sense that it is worth it. There is a time and place for learning how to relax/cope/slow down. But, sometimes it is good to explore passion and purpose and intensity.
- Who is your community? How do you stay connected to it?
Faith | Family | Science | Politics | Justice
Leisure | Social Causes | Professional Organizations
- What (values) brought you to the field of healthcare in the first place? How can you apply this in your learning environment every day?
Values - Your Core
Acceptance | Commitment | Loyalty | Reason
Credibility | Equity | Gratitude | Tolerance | Honesty | Respect | Peace
Responsibility | Humility | Industriousness | Charity | Trust | Mercy
Optimism | Patience | Flexibility | Integrity | Compassion
Generosity | Sincerity | Wisdom | Autonomy
Competence | Moderation | Justice | Generosity
Hope | Dependability | Fortitude | Self-Control | Perseverance
- If one of your values is Compassion, what is one way you can foster compassion in your co-workers?
- If one of your values is Justice, how can you make sure that an underprivileged patient gets everything she needs today?
- If you value developing relationships with your patients, add, “What do you like to do for fun?” to your History and Physical/Intake interview.
- If you value Equity, how can you be an ally and speak up when you hear microaggressions in your vicinity?
- If you value Listening, practice one reflective statement per patient (e.g., “Sounds like you are feeling scared right now.”)
- Work with your mentor/faculty/attending to see how you can carve out a niche to pursue one of your passions (e.g., create a new clinic, service, form, didactic).
A - Achievement
Identify your goals and cultivate the skills needed to reach them. Then celebrate your successes and feel your effectiveness. Learners in advanced studies in medicine or other healthcare fields are already high achievers. In fact, the danger among this crowd is developing the sense that you ARE your accomplishments – that your worth equates with your achievements. That’s not what this pillar is about. This is about becoming your best and feeling effective. One of the key signs of burnout is a sense of ineffectiveness.
Work on goal setting:
- Distinguish between extrinsic goals (tied to other’s expectations) and intrinsic goals.
- Extrinsic goals are instrumental (e.g., a new title, credential, pay raise). There is nothing wrong with these, just be sure to ask yourself, “What will I use this for?”
- Intrinsic goals can be observed by others, but are tied to your expectations for yourself. There is no immediate, external reward connected to these. Intrinsic goals are born out of your wish for yourself (e.g., to become more authentic, to develop better self-discipline). Intrinsic goals are more likely to be related to wellbeing.
- Choose goals that involve effort (activity) rather than an end-goal or a material thing.
- I will study in 45 min. periods and then take a 15 min. break to re-charge my batteries vs. I will get High Pass on this next exam.
- I will eat 4 servings of fruits and vegetables per day vs. I will lose 10 pounds.
- Choose promotion goals rather than prevention goals.
- Promotion goals are about opportunity, striving, reaching (e.g., “I will seek out leadership opportunities.” Which will add another skill set to your CV).
- Prevention goals are about treating, correcting, ameliorating (e.g., “Beef up my CV in order to increase my chances of a successful match.”)
Additional Information on Wellbeing
Other Topics on Wellbeing: Optimism
Other Topics on Wellbeing: Mindfulness
“The purpose of meditation is not to create a blank mind. It is to change your relationship to your thoughts and feelings…from a sense of urgency …to a sense of calm, observing nonjudgment.” Todd Davison, MD
“Paying attention in a particular way: on purpose, in the present moment, and nonjudgmentally.” Kabat-Zinn (1994) Wherever you go there you are: mindfulness meditation in everyday life. New York: Hyperion.
Mindfulness practice has been shown to increase left prefrontal activation. And, people with more left prefrontal activation report more positive affect and have reduced levels of cortisol (Hall, 2008).
Improved self-regulation comes from increased acceptance and self-awareness. In other words, approaching and accepting stressors or negative emotions leads to less avoidance behavior, rumination and impulsive reactions to these inner experiences. Perry-Parrish, et al. (2016). Mindfulness-based approaches for children and youth. Current Problems in Pediatric and Adolescent Health Care.
Outcome Data for Mindfulness
- 2015 meta-analysis found moderate evidence of improved anxiety, depression and pain. Effect sizes ranged from 0.30 – 0.38. Goyal, et al. (2014). JAMA Internal Medicine, 174(3):357-368.
- 2010 meta-analysis found mindfulness-based psychotherapy to be moderately effective for improving anxiety and mood symptoms. Effect sizes ranged from 0.59 – 0.97. Hofmann, et al. (2010). Journal of Consulting and Clinical Psychology, 78(2):169-183.
- 2004 meta-analysis found that mindfulness training among medical patients (mixed cancer diagnoses, coronary artery diseases, chronic pain, obesity, etc.) produced medium strength effect sizes on measures of mental health (mood, anxiety, sleep) and on physical health (pain, physical impairment, report of physical symptoms). Effect size of approximately 0.5. Grossman et al. (2004). Journal of Psychosomatic Research, 57: 35-43.
Resources to Begin your Practice
- UW Health Mindfulness Program Guided Practices
- Free Mindfulness-Based Stress Reduction Class
- Academy for Mindfulness Guided Practices
- Guided Imagery
- Stanford WellMD
- 10% Happier by Dan Harris
- Radical Acceptance by Tara Brach
- Wherever You Go There You Are by Jon Kabat-Zinn
- Mindfulness for Beginners by Jon Kabat-Zinn
Self reflection helps to set right the relentless technical and impersonal aspects of healthcare. By reflecting on our experiences, we reconnect to what gives meaning to work and life. Pausing to reflect gives us the chance to consider the ethical aspects of healthcare, to tolerate uncertainty, maintain curiosity and to promote empathy. There is good evidence for the health and emotional benefits of reflective writing (Pennebaker, 2000), and these are potentiated when you choose to share with a trusted friend or colleague. For some pointers on how to get started, try the University of Texas at Austin's Dr. Pennebaker’s suggestions.
Visit the Medical Humanities website and, inquire about joining Moving Pens – a writing group for students, residents and faculty which meets on campus two times per month.
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