Your Stress Pal
This week I am talking to Pennie Sempell, JD, CEO for StressPal (@Stress_Pal) that is working to build better resilience in healthcare communities to stress and burn out. Pennie started out in Psychology, graduated from law school, and worked in mediation that led to a career focused on stress reduction. Pennie has penned several recent articles on the challenges faced by the healthcare community – here on HealthItAnswers and on KevinMD both pointing to the exploding problem of burn out that is now in “uncharted territory”
We talk about the incremental training steps offered from a science-based approach that goes above and beyond the traditional meditation and mindfulness that you might be familiar with and how their solution builds on this with a privacy-based system. We discuss the existing burden of stressors on healthcare staff, many that pre-date COVID19 (System and administrative such as data entry, EMR’s and the financial challenges with payor) and the additional burden imposed by the Pandemic that includes the additional risk and fear associated with the disease.
Listen to hear why physicians are more resilient to stress but that resilience is not a given, can be increased or decreased, and needs constant nurturing, and hear what your 3 steps to flexibility and resilience to stress are
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Raw Transcript
Nick van Terheyden
And today I’m delighted to be joined by Penny Semple she is the co founder and CEO of stress pal. Penny, thanks for joining me today. Glad to be here. So as I do always, as part of my show, I like to establish people’s background you’ve got an interesting and unique background certainly in the healthcare space of somebody that’s focusing on the area that you are, obviously stress given the name of the company. Tell us a little bit about your background and how you arrived at this point in your career.
Pennie Sempell
Sure. Okay. Thank you. Well, I have actually been involved in integrative health advocacy and self care education from the earliest days of Mind Body medicine. I was a graduate from UC Berkeley in psychology and I was teaching guided imagery meditation biofeedback. At a psychotherapy clinic in San Francisco. I went on to law school and there as an attorney and a mediator, I continued to see up close the impact of stress on psychological and physical health and on relationships, both family and work. This led me to explore advanced training and conflict resolution, mediation and a variety of Mind Body approaches to health I developed courses for attorneys, I started them leading I became involved in a 20 year collaboration with physicians at a Medical Center here in San Francisco, where we pioneered Complementary and Alternative Medicine approaches to self care, particularly focusing in that extended period of time on patients with chronic stress related diseases. And of course, in that capacity, I had a chance to both see the rising case loads that doctors were faced with and the lack of evidence based materials to help other patients with the with chronic stress related conditions. I collaborated and teamed up with my co founder, Jim Unruh PhD in clinical psychology, and a broader team of physicians and nurse advisors and together we spent the next four years developing the research and development for stress PAL and patient facing tools and this clinical tool stress pal frontline, which is now available.
Nick van Terheyden
So, what led you as you sort of navigated from psychology, the stresses mediation into the healthcare space? What sort of drove you along that direction? What what came about? And what sort of, what were you seeing that launched you into this focus?
Pennie Sempell
Well, I think I’ve always really had a fascination. I’ve looked back at this about myself, I’ve had a real interest in how do we take chaotic, conflictual situations and bring about a harmonious and a resolution. And for a number of years, I actually did both. In the 90s, I was both practicing law and I was focused on mediation. And I was starting to become involved on a grant at South Pacific Medical Center to work with ICU patients getting heart transplants. And we saw how effective these complementary alternative modalities were even with ICU patients in these critical conditions, that led to physicians asking me to join a practice that led to the next couple of decades. So we really pioneered how do we support physician care on the patient side with patient engagement and self care around lifestyles and Integrative Health concepts? So it just, I just found that’s my passion. That’s my love. So when I teamed up, I see myself as having the strength on the education side, how do we bring these the evidence based concepts and traditional concepts to the fore? How do we make them fun and engaging and efficient? Because there’s such a lack of resources out there for people, particularly that are private and secure? And that’s that’s a big point for us.
Nick van Terheyden
So I would say interesting, you started with patients. But I think your primary focus now is around the healthcare providers and the teams or does it extend past that into the patient community as well?
Pennie Sempell
Oh, yes, the stress pal resilience is the name of the tool that’s continuing the development, that would be a clinical adjunct tools. So if you’re the provider that’s on your dashboard is one of the tools Joe comes in with hypertension, you say, Hey, Joe, in addition to your meds, we’d like you to continue, we’d like you to get started on our stress resilience training program. It’s an in house tool, with the monitor assessments that are provided to the clinician. So that tool is in development, we hope to have that released about this time next year. So it’s a it’s a, it’s an expansion, it expands this concise program that we’ve developed for clinical care teams, and, and healthcare leadership. So this is a condensed, kind of a little bit more tight pace, but the same concept,
Nick van Terheyden
right. So as you think about the sort of the, the setting of the healthcare world, we’ve seen this huge increase. I think, just based on some of the things that have happened over the last several months, I think many people are certainly familiar with other meditation type apps, you know, the columns, the head spaces, Nirvana and so forth. And I’ve certainly talked about those, it’s, you know, some of the things that I use and sort of advocate and help the listeners understand because I think this is slightly different. What are the what is it that they do and what is it that you do and how do you sort of separate out the sort of the functions and features as it were?
Pennie Sempell
Yeah, thanks for that question. So, you know, mindfulness and meditation have been the subjects of study, and there are in some of these popular apps that are out there. There’s an extensive body of research around a therapeutic modalities that really helps support this concept of psychological flexibility, and resilience. And these cognitive behavioral therapy. And mindfulness based therapeutic modalities like acceptance and Commitment Therapy, have been well researched as as looking at how do we really help protect and rebuild this complex phenomena we call psychological resilience. So I would say that one of the ways in which important ways in which we are moving forward is by integrating these leading mindfulness based therapeutic model of acceptance and Commitment Therapy, in an innovative way, with cognitive behavioral therapy, and mindfulness meditations. So it’s all in one package. So in our program, we’re doing this incremental training, like five, maybe 10 minutes a day, most days, over a period of about a month, it’s a, it’s a self paced course, with ongoing mindfulness meditation supports ongoing. So we’re putting that all together both in a training model, and in a stress resilience support model. We’re also importantly, making this private and secure. So there’s no sharing of personal data, there’s absolutely no sale of personal data, there’s no upsells. This becomes a tool within the organization that the organization can use with its teams. And, and we’ve used pre and post assessment. So that’s another way that we’re very different from popular apps out there. So we’ve got the privacy, that’s huge. Only 4% of behavioral health apps out there even less than that are really strong in terms of their privacy standards. And and the privacy, the training model. And the the being available as a tool that has metrics that are again anonymized to the organization and shared with the individuals so that privacy extends there, too. So we’re tracking outcomes, and providing that information to the individual and in the aggregate to organizations. So there’s it’s a bit different model and a different way of providing information, both the common areas that mindfulness meditation would be a feature in both programs and the dominant feature in the apps. Does that help? So I’m thinking about that. And, you know, the current rise that we’ve seen, I think it’s unquestionable, we’ve seen this huge increase in stress burnout. You know, we’ve been talking about burnout for physicians, for as long as I can remember, why should we didn’t use the term but you know, we’ve certainly been talking about it, what is going on? And why do we have such a problem with this, particularly in the healthcare space and with healthcare providers? Okay, well, we, you know, we were being both Dr. Monroe and I have several decades of work in multidisciplinary clinics. And his expertise is really around psychological medicine, and the stress resilience piece. And we both observed in our independent practices, the rising pressure system, drivers of burnout for physicians, and one of which was the rising case loads of stress related disease. But there’s all you know, very much so the administrative burdens, the electronic health record technology burdens, and of course, increasing in financial burdens, issues with payers that preceded this pandemic. And we were already seeing, you know, disturbing levels of symptoms of burnout in clinical care teams. Of course, the infection fears, and the new strains around finances are significant in this past year, and I think I’ve really pushed it to the point where there’s an awareness among physicians who are, by the way, very highly resilient people, you know, they’re above average, in this is, you know, studies have been done on levels of resilience. Resilience is something that can be measured and assessed. But we’ve run into the problem that the brain of the human brain is activated by these persistent stressors, these adverse conditions. So even if you have high inherently higher levels of resilience, these print highly pressured and persistent external, environmental stressors will start to erode that flexibility and the brain starts activating stress triggered thoughts, feelings, behaviors, like irritability. You know, errors and physical responses and all that’s happening in response to these rising stressors in the healthcare environment. So therein lies another area where we really feel we are helping to differentiate in terms of by making this tool available to your teams and to management, you can start improving the capacity to have collaboration around solving some of these complex drivers of stress. And every, you know, every medical center is going to have its own situation, how it wants to approach it. But as you under the high stress environment, right now, if you can start to alleviate some of that, and provide some some deeper levels of improve resilience across the board, you’re going to start having more effective creativity, problem solving and collaboration, which are known benefits of resilience, as well as all the physical, physical and behavioral benefits of resilience.
Nick van Terheyden
So for those of you just joining, I’m Dr. Nick, the incrementalist and today I’m talking to Penny samphel. She is the co founder and CEO of stress pal, we were just talking about the impact of burnout, the increase in burnout in the current environment of COVID-19. You know, importantly, as you rightly point out, there’s infection fear that’s been added to all of the other things that existed before. But you made an interesting point, I’m curious to understand why you said, you know, physicians are more resilient, what is it about them that makes them resilient? What’s going on with the clinical team, I mean, that’s good news. It’s obviously not good enough, because we’re still being burnt out. And you know, struggling with that?
Pennie Sempell
Well, resilience is a complex phenomenon in the brain. And I think one of the misconceptions in the general knowledge around this is that resilience is something there is an inherent quality, but we also can improve our psychological resilience, and we can protect it. Conversely, it can also be worn down and eroded. So people who track into medicine, you are going to likely be more inherently resilient, as psychologically resilient, that doesn’t mean that other people couldn’t develop that resilience, and then also undergo the rigorous training that is required to be a physician. But we might think of it as an analogy I’d like to share, if we can think of resilience as complex phenomenon in the brain that’s about how the brain first perceives, and then instantly responds to the stress triggers in the environment. And how do we adapt? How do we learn from and how do we recover? That’s the really the training around resilience is those first, those first perceptions and reactions and in the, in the more resilient brain, that will de escalate the stress response, and the action of the amygdala in the cortisol response in a cascade of hormones that follows. So if we can protect that capacity from erosion, if we can provide these daily, small in the moment, in the heat of the moment, under the stressor, strategies that are well studied in psychology, bring them over to medicine here and help clinicians learn these strategies. It becomes something like, you know, brushing your teeth, that’s a quick thing. It doesn’t require sitting down and stopping what you’re doing, you could actually in the moment, take take these cognitive strategies, and apply them right then and there. isolating, I mean, I’m thinking about that, you know, as I sort of ponder, you know, super stressful moments from my past medical career. And, of course, the first thing that springs to mind is codes, you know, patients, you know, in critical condition and the enormous stress and the decision making, and I’m thinking about how you would apply that what are the sort of approaches in that moment where, you know, you have a, a tsunami of inputs that are coming from people from machines now from, you know, all around you? What are the sort of approaches that you counsel and are supported by the evidence that help people sort of navigate that avalanche of inflammation and stress? That’s a great question. See, when we look at the mindfulness based therapeutic model of acceptance and Commitment Therapy, which is the core of our training program, it’s developing, it’s going beyond present moment awareness, which we often think of with mindfulness based approaches to get into a very practical application by and we’ve refined this would call the three mindfulness reflections models. It’s a core this training, very easy to remember the first Step is cultivating, which is happening over the course of you know, these weeks of our training, cultivating an awareness, the capacity to be aware in the moment of your stress triggered thoughts, feelings, behaviors, you know, how you’re acting or behaving? And your physical responses, you know, is there a headache rising? Is there a stomach ache? What are those thoughts, feelings, behaviors, then, to cultivate an awareness of whether these stress responses are helpful and useful to you is that is that response actually helping to what you value? What matters to you, and you’re learning in it does, you know, in these little practice interactive steps that we that we provide, you’re learning how to cultivate the capacity to become aware of what have awareness of the thoughts, feelings, and such, whether it’s useful or not to what you value, which we then you need to take a little moment here to really bring you to learn in the learning process, you’re learning also how to reflect on what is important to you, and what you value. And the third step, is being flexible to act on a more workable strategy. So of course, you need to know what those strategies are. And there are some very well studied cognitive strategies that you apply in a moment. So we’re really harnessing the extraordinary capacity of our creative brains to be able to, in the moment, hold these levels of awareness bring forth these more sophisticated levels of awareness that are very personal to our salient thoughts and feelings, and responses to stressor. And in doing that, we’re we’re engaging a different part of the brain in response to the stressor. And we are not responding with that that big, we’re de escalating that that stress response. So that’s how the, that’s the core of the training. Um, you’ve had lots of experience with clinicians, you’ve got this body of knowledge, you’ve been working for a number of years, can you share any stories, or specific examples of that in practice, and how that sort of played out for individual physicians or even groups of physicians or, you know, clinicians in general, what’s been some of the the sort of positive outcomes or experiences from so what what we can see here is that this situation, the external environment, is not likely to be changing anytime soon here. But what we are what we are, what we hear from what the research shows what our own clinical experiences evidencing is that when you refine these capacities, these levels of awareness, these mindfulness, levels of awareness, and some of the other cognitive behavioral strategies, we bring it around behavioral sprays, when you can call those forth in the moment, you find that you are able to, to, to feel that you have more capacity to bounce back, that you have that you’re able to start utilizing these, of course, over time, we get better, just like practicing meditation. So we’re in this condensed program, we’re teaching you these capacities, you within that month period of time or so it’s a self paced program. So some you have to take the time you need. But with that, and the ongoing support, you’re going to get better and better. And this is the report we hear is that capacity to feel that you are taking, taking better care of oneself is a little bit too, you know, vague, but But well, no, I think that’s a great, actually, you know, if you don’t take care of yourself, how can you take care of other people’s Well, yes, it’s taking care of itself in a complex way. And it’s really at the level of what’s important to you, what what matters to you is highly personalized, the way we’ve developed, this program is customized at every step. So it’s really about your own personal values, your own personal goals, and thoughts and feelings. And that’s why it’s going to be you know, very much how you then apply that in those situations that stress those very things that are important to you. And, and, and how you, you know, I think one of the things that we’ve heard back consistently, is that, this, I use this all the time I use these thoughts, these strategies popped in my mind, and what the trajectory that we want to see in this incremental learning is that over initially, this may these may seem like what really over time, you start to notice that it does pop in your mind and that’s it’s that cognitive shift that happens in your navigating these adverse situations that becomes very important and we work to cultivate In the way we structure we call it life practice in our program. So in the closing minutes, as you think about going forward, we’ve obviously had this sort of big inflection point around COVID-19. It’s, you know, layered on additional stress. I think there’s, I don’t want to say widespread acceptance, but the certainly more awareness of, you know, the challenges. Do you think we’re sort of turning the corner of just general acceptance, that this is not the stigma that’s normally associated with, you know, our inability to cope in these circumstances? All of those sort of drivers? Do you think we’ve made progress? And where do you think we’re going in the coming months?
Nick van Terheyden
Well, these stressors have been extraordinary. And I think the thing about medicine that needs to be acknowledged here is that it is one of the most inherently challenging and unpredictable work environments. So, you know, hats off to everyone in healthcare, if we can start to see what we would like to see is that organizations health or care organizations are robustly ramping up. And we feel we can be of great help to that with our really low cost tool to really ramp up cultures of resilience to support wellness in this very challenging profession, that is healthcare. And the we’re going to face ups and downs of all kinds. No one feels that more acutely than health care clinicians. And I think non clinical teams to management too. So I hope we see across the board that there’s a robust ramping up of support, and and indeed, both personal resilience and for tackling the system drivers that drive burnout. And I think they work together. I think there’s an interrelationship there, and we’d like to be a part of providing a low cost effective solution. Fantastic. So ultimately, you know, this is an ongoing problem, we’ve got to sort of continue to focus and address on it, we’ve got to accept that this exists in, you know, the healthcare settings. The good news is that there are solutions based on what you’ve shared with us, and certainly your experiences and some of the reports from, you know, your user base and people that have access this. I think the important thing now is to get the word out and to start start to address some of the stresses that we can change. So hopefully, we’re going to change some of those, but those that we can, you know, focusing on our method of dealing with them, and I think this sounds like a great way for folks to really start to think about that. So as we have most weeks unfortunately, we’ve run out of time, it just remains for me to thank you for joining me on the show today.
Pennie Sempell
It’s been a great discussion. Thank you so much for inviting me. I’ve enjoyed the conversation.
