It's Monday, which means it's recovery Monday. Today on Recovery Monday, Episode 17, we're going to look at examining your three reactions to anxiety, the reaction before, during, and after. So let's get cooking. Let's wait for the usual suspects to roll in. I'm going to put the chat overlay up on the screen. If you guys could just let me know that you can hear me so I make sure everything is working correctly. We've had a fancy new internet upgrade since last stream. So hopefully it is going to be a little bit better than it was, although I do understand that there are some technical problems still happening upstream of me. So bear with me if you will. Today we are doing lesson number 3.5 out of this book, The Anxious Truth, every week on Recovery Monday. We teach a lesson out of this book. This is my anxiety recovery guide. If you do not have the book and you would like to read along with it, you can always find it on my website at theanxistruth.com. Excellent. Thanks, guys. Appreciate it that you let me know that you can hear me. Everybody just let everybody know where you're coming from. So we can all get to know each other a little bit. Chats up on the screen so you guys can see what each other is saying, which is always nice. I enjoy that. If you are coming from the Facebook group, by just a quick reminder, ReStream will not show me your name. It'll just say Facebook user, but we'll do the best we can. That's okay. So today, let's get into it right away. We're going to talk about reactions and really looking at and examining your current reactions to anxiety and panic and fear and all those things, right? So we know that the key in recovery is learning to change the way you react to anxiety and fear and the way you relate to anxiety and panic and fear. But before we go ahead and change those reactions, it's really helpful to understand what those reactions even are. And I primarily concerned with and I wrote about three reactions, the reaction before, which is anticipation and anticipatory anxiety. And then there's the reaction during, which is what do you do when you are actually in the middle of an exposure or a challenge or you're feeling very panicked. And then afterwards, Joyce is here. Hey, Joyce, good to see you. And then the reaction after is one of the most important parts of this that we miss all the time. We're going to talk about it today, which is what is the story that you tell yourself after it's all over? So when you face a challenge or you have a panic attack or you go through a big anxiety waiver and anxiety spike, and then it sort of dissipates and it goes away, what's the story that you tell yourself after that's the reaction after? So we really should look at those three reactions because they are important. And when we start to learn and understand what our reactions are, then we get started to work on changing them into something that's a little bit more productive, a little more recovery focused that moves us forward in those steps at a time, right? So that's what we're going to talk about today. Let's see who is here. Ashley is here. Billy is here. Joyce is here. Kathy K is here. What up? Cadence is here from Hamilton, Ontario. Cadence, I haven't seen you on Instagram, but just bundled up like you're in the Arctic Circle. It must be cold in Ontario these days. I don't know, but always funny. Beth, I thought you couldn't hear me, but it was her headphones not being connected. Thank you. I appreciate the technical help there. Anyhow, so let's get into this. Welcome, everybody. Christine is here from Long Island, fellow Long Islander. Welcome, neighbor. So let's talk about this. Three reactions that we care about, right? When we are anxious, then let's talk about that. Like we said, it's the reactions that matter and recovery is really about learning new reactions and a new relationship with the stuff. So let's look at the three reactions that we care about and let's start with the reaction before. And this is what we would commonly refer to as anticipatory anxiety, right? So I'm generally talking about a situation where maybe you have an exposure coming up or you have a challenge coming up. Like you have to go to a wedding or some sort of family function or a job interview or you have to go to a doctor or dentist appointment and you've been avoiding those things, right? So, and now you have a life challenge coming up. Life is going to make you do a scary thing. You cannot get out of it. And now you are in that like anticipatory anxiety trap where you are just thinking about it. You're obsessing about it.  You're dreading it. You can't seem to get back to the present. That is the reaction before. Now it doesn't have to be necessarily in front of an exposure or a life challenge. It could really be almost any time. So any time you find that yourself, you're in a situation where you are anticipating or worrying about what might happen to make you anxious, what might trigger you, what might make you panic today, what might make you feel badly. One really good example of this that doesn't necessarily have to do with either a forced life challenge like a wedding or a doctor visit or a planned exposure would be sleep. So your reaction before being anxious, when you can't sleep and you are thinking OMG, if I don't sleep enough tonight, then I am going to be anxious tomorrow and you get yourself into that anticipatory anxiety like lather because you think that if I don't sleep, then my anxiety is going to go through the roof. It's going to trigger me and I might panic tomorrow. I'm not going to feel. So these are really common things. When you are anticipating how you might feel down the road and you are worrying about how you might feel if you will be triggered, if you're able to handle it, this is your reaction to anxiety beforehand. Now in that moment, you're also anxious. So it's a little bit strange in that way. But it is important that we look at that. How are you reacting to things that you think might happen or are going to happen? That's your first reaction that we care about. As we go on in these lessons, we'll talk about changing those reactions. But today we just care about identifying them and giving you something to think about so that you can really sit down and say, well, what do my reactions look like? Am I sitting frozen and just thinking about the event? Am I constantly in my head ruminating over it? Am I trying to predict the future? Am I desperately on the internet trying to find a way to make myself feel better about this thing that I'm worried about? Look at what your before reactions are, your reaction before. What is it that you're doing? What are your habits that you engage in when you are in that pre-anxiety, even though you're anxious at the moment, pre-exposure, pre-challenge, worried about the future state? So in the end, it helps for you to sit down and really start to look at like, well, what am I doing in that state? Now the second reaction that we care about is the reaction during, which is the reaction when you are actually in that anxious state.  So what is your reaction while you're in it, while you are in the panic when you're feeling it starting to rise, when the anxiety wave comes up over you, when that health anxiety is kicked up or when those anxious thoughts or scary thoughts popped up, that's your reaction during. Like what happens when you are in that state?  And for most people, the reaction by default is to brace, to fight, to try to stop it, to get away from it, to run away, to escape, to soothe, to calm. So you really got to think about that, right? Yeah, okay, Ashley says the reaction, run! Like yes, the reason why we call them panic attacks is in panic, you have that like really strong desire to just run, like escape, right? Then that's common, that's the normal reaction. So that is the way that goes, right? You have to look at when I am in an anxious state, when that panic is rising or when I'm in panic, when I'm at that wedding or that birthday party or I'm stuck at the restaurant with my family or we're not going to leave for two hours or whatever it happens to be. What am I doing? How am I reacting to my fear, to my anxiety, to all the thoughts and sensations that come with it? That's the reaction during what happens during the event. How do you react and relate to your anxiety during the event? That's probably the one that we think about more than any other. So this is probably the one that's at the forefront for most people. What happens when I panic? What do I do when I panic? What do I do when I have these scary thoughts? What do I do when I want to Google symptoms because my health anxiety is kicked up? That's the one that we probably pay attention to more than any other is what happens when I feel this bad. What can I do? What can I do? So I don't know who it's freezing for, but you could try it on YouTube. I don't know if it's freezing on Facebook. I don't know, but it's on my YouTube, so you can check it out there if you want. So when you are in the thick of it, right, when you are in the thick of it, what exactly do you do to respond to anxiety and panic? And like I said, that's the one that we probably care about the most. If you are watching videos like this, you're reading my books, you're following other people like me online, and you're kind of invested in all this recovery stuff, you are primarily, you are primarily probably worried about what you fear, what you are feeling when you're in the thick of it. But that's only one of the reactions. Remember, we had the one before, that's the anticipation reaction. But and then the one while you're in the thick of it is the one that you are probably worried about the most. How do I make myself feel better? How do I make it stop? How do I make it go away? You're only focused on your reaction during the anxiety, whatever, the anxiety spike in that highly anxious state. You're worried about that more than any other. But you have to really think about the first one before, and you're going to have to think about the second one, the third one, which is the one that I'm talking about in a second, we're going to get to that. So take a second and really think about, well, what do I do when I feel the panic rise? When I feel my anxious thoughts come up, do I feel, do I automatically speak them out loud? Do I have to automatically tell somebody how I'm feeling just in case so they know that, you know, my heart is beating really quickly so that they can save me? Do I automatically run to Drew's Facebook group and post about it and search the group and looking for people to reassure me, you know, what is it? So really think about that when you are in the thick of it, which is the part again that we care about the most understandably. We totally understand that. What do you do when you get into thinking about what are your reaction habits in the middle when the shit is hit the fan and the chips are down? What do you do? Okay. The third reaction that we care about, and this is the one that I think we talk about the least, but it might be the most important one and hear me out on this. Everybody cares about when you're in the thick of it, like I was just saying, first and foremost, that's the one you care about most. The second one you care about is anticipation. Oh my God, I have a dentist appointment coming.  So we care about the anticipation before because it's super uncomfortable. We certainly care about what it feels like when we're in the heat of it in the moment. But the part that we forget almost more than any other is that third reaction, which is the reaction afterwards. The reaction afterwards is actually where the magic happens. So when I talk about the reaction afterwards, what I'm talking about is after this experience is over or you're coming out of it, you're exiting it, it's an exposure, the wedding is over, your dentist appointment is over, your partner comes home from their trip and then you're not left alone anymore. And, you know, so that the crisis has passed or whatever it is, what is the story that you tell the panic attack is over, right? What is the story that you tell not only the world, more importantly yourself afterwards? What is the lesson that you take from that experience? There are two ways you can go with that.  That was the worst thing ever. I almost passed out. I almost did this. I almost went insane. You really interpret it as it's the worst thing to ever happen to me. I cannot ever let that happen again. I do not want it to happen again. I barely made it. Like I don't know what got me through it. I just managed. I luckily got through it. If that is your reaction afterwards, then no matter what you do during, it becomes really difficult to make a meaningful change on the large scale, right?  It's all level 10. It's all the mother of all panic attacks. It's, it's the worst. I just barely made it. I felt like I was going to go insane. It felt like I was going to die. It felt like it was going to pass out. If you do that, right?  It's in the reaction after that we actually take on the lesson. So I did a podcast on this not too long ago. I think it was called refusing to, to learn the lessons of recovery, which was all about that at the, after that anxious experience, the anxiety will sit in the back of the room and scream at you. That was terrible. That was awful. That was awful. That was awful. But really and truly reality is telling you, well, you were very afraid. You were unsure. You were vulnerable.  So the best story, for instance, for a panic attack that you could possibly tell would be, I had a panic attack. That was really scary. Now it's over. Nothing happened. That's it. Now I know that for a lot of people that sounds like, well, I'm not allowed to say what I feel like I'm supposed to suppress my emotions. No, not at all. But what I would rather see everybody do and what I had to learn how to do, this was a big deal. I had to learn to really speak about the experience to myself, to myself, first and foremost, in a more objective way. So telling everybody that it was terrible and hell on earth, okay, but that didn't help me at all. The reality of it was, well, nothing happened. I was really afraid. I was panicky. I was really afraid, or I was stuck in that loop of thinking about death and dying in existence. But that is one way to definitely, if you're going to keep describing it as, I barely made it. We talk about it all the time in the Facebook group. We talk all the time. Somebody will say, oh, I had to do this thing. It was a big exposure. It was a big deal. I had to do this exposure. I had to go to a wedding or we took a trip. We drove to the next city today and we went to a museum. Didn't think I could do it. I made it. And a lot of times a bunch of us will roll in and would say, no, no, you didn't make it. You did it. You were always going to make it. You were always going to make it. You did it. So I see the difference in the language there. So the reaction after is the one that we overlooked the most, but it might be the one that matters the most. So after you get past running and escaping and fleeing the actual anxious situation, if you could get yourself to the point where now I'm going to stay in it and navigate, that's awesome.  So we really have to care about that third reaction, the reaction after really important, really important. The story you tell yourself and everybody that will listen is really important. That's the reaction after. So when you're examining the way you react and relate to your anxiety or panic, your fear, all the stuff that comes with it, ask yourself, what do I do when I'm anticipating fear and anxiety and panic and scary things? What do I do when I'm in the thick of it? And then what do I do after? It's really important to really sit down and sort of be honest with yourself, write it down or think about it, whatever, record it into your phone. What do I really do? Walk myself through that. What am I doing? What am I actually doing when I'm in those three situations? Anticipation in the thick of it and then after, what do I do? So before you can start to really make meaningful change in a more healthy and productive way, it would be really helpful to know, oh, this is the way I do it now and I see what it is and I'm going to have to change. That helps a lot. This is the thing I say all the time and I am the last person in the world that loves structure and planning. I hate it. I literally hate structure and planning, but in recovery, structure and planning could be super useful because if you're just going to make it up as you go along and just be in reactionary mode to every thought, feeling, sensation and situation, you're just going to react to it without having any idea of what you're going to do ahead of time. It gets really, really, really difficult because when we're in reactionary mode, especially because we are afraid, we don't make good choices. We don't make good choices. So think about those three reactions. Reaction before, reaction during, reaction after. Start to think about what you do in those situations and then we can start to move on to like, well, what can we do differently? What can we do differently? So let's take some questions here. That wasn't bad. I got through the whole thing in about 60 minutes. Very good. I apologize. This is starting to look like a Facebook problem more than anything else. People are saying that it's freezing on Facebook. It's working perfectly on YouTube, it appears. So I don't know why it's freezing on Facebook. If it was a problem that I could solve, then it would be freezing everywhere. So sorry about that. Welcome everybody. Welcome everybody. Welcome everybody. Let's see here. I have a agoraphobia of what needs to be unconcurrent with constant exposure. Can you, can give you PTSD? Anything that makes you live in worry? Elevated card. Okay. This is a pretty big, okay. So there's a pretty big comment here. William was talking about like, can, can you get PTSD from recovery? I mean, I'm gonna get, if you're asking for my opinion, that reaction afterwards plays a big role. So I just talked about the reaction afterwards. I think it sort of matters, right? So you have decided that, oh my God, I was in a worried state. I had cortisol in my bloodstream. Like cortisol is natural, but I saw you say cortisol, elevated cortisol levels. It's going to turn into memory loss. Like that story as opposed to, hey, look, I did some really scary things and now I'm not afraid to do them anymore, which by all accounts would be a really positive experience. And they're trying to minimize what you went through, but look at the way you are talking about it. Yeah, but yeah, but yeah, but I had cortisol and that could be damaging. Yes, but it was really scary. And like scary things can cause you to be traumatized. I'm not saying that they can't, but I can't give you a definitive answer as to whether or not you can get PTSD from recovery, but how you are going to frame that and talk about it and decide, well, I did it, but let me tell you all the reasons why what I did was actually bad. Instead of I overcame my agoraphobia, that can play a role. I can't give you a definitive answer to it. Nobody can. Like maybe you got a therapist, maybe you talked about with your therapist, but the internet certainly cannot answer that question for you. So there you go. Let's see what else we got here. This was one of the funniest thing when Ashley put this up here. Sadie says you are the stories you tell yourself. There's a certain truth to that. Ashley kind of nailed that. The reaction run is pretty common. That would be the normal reaction for most of us. And one of the things that makes recovery in this process so difficult is that is the reaction that almost all human beings would have to run to run, but recovery lies in not running. So that's what makes this like so counterintuitive and so difficult. Let's see here. I remember this from your book, changing before and after reaction. Okay, this is good. I'm putting it up on the screen. I think these are things that we miss a lot when we are solely focused on, but what do I do when I am most afraid? You are missing all the fuel that you pour on the fire ahead of time, and you are missing the fact that you may completely discount the fact that nothing happened. So it's the before and the after that really become the secret sauce. Yes, what you do in the middle of the package act certainly matters. It's probably the first thing you're going to care about. But if you do not address the before and the after, you may find yourself in a loop where it's like, well, I'm doing the things I'm doing and I'm doing it, but nothing is changing. That's one of the reasons why, possibly, because you're missing that. So let's see here. Okay, this is another very typical example. Open the window, put the AC on, anything to get your mind off it, the need to go home, the Zoomies. I know the Zoomies. I give full credit to my editor, Hillary. She put the word Zoomies in 7% slower and it seems to have caught on. Those are the standard responses that any human being would want to have. I want to decrease my discomfort right now. Nobody blames anybody for that, but those aren't the most productive responses. So let's see here. This is great. Crystal, let's pop this up in the screen. It's not great that you weren't feeling well, but it's great that you're going through this in a productive way. Home alone with the babies, anxiety, air hunger has been nonstop, ragged on, not calling anyone, just surrender. And yes, eventually it will show you that it was safe.  Like that was really scary. I'm not telling anybody to pretend that it's not difficult or scary. You don't have to deny that you were afraid. Like you literally were afraid. That's correct. That fear is 100% real just that the basis beneath it isn't necessarily real. Like the fear in this case, we're learning that fear and danger are not necessarily the same thing. So it's okay to acknowledge that it was really difficult. That was super scary. It was like scared to death. Okay, that's cool. But nothing actually happened. Nothing actually happened. It's always, and nothing actually happened. Being afraid is not an event that is worthy of like, no, no, but it really did happen. I panicked. I know, but what happened as a result of the panic? Nothing. So you have to be really careful about that, right? Let's see here. I feel relief after, okay, this is important. I feel relief afterwards and I can see things clearly. Yes, you will feel relief. Noel, thank you for saying this because it's important for us to acknowledge this. After the fact, the reaction after there will be relief. Anybody, I'll use driving anxiety. Like that was my jam, right? Anybody who's ever been in a situation where they're driving it really anxious driving, the minute you turn that car towards home and you get closer and closer to the home, that sense of relief is real. You feel that relief. So you can 100% acknowledge that. And Noel, I'm really glad that you brought it up because that's real. The relief is real.  Yeah, it feels a whole lot better when I go home. But the fact that you're acknowledging, well, I can see things more clearly when I get into a state of relief. It's important because that tells us, well, when we're in freak out mode, we don't really see things terribly clear. We just don't. But yes, I was, I had a sense of relief when the exposure was over. I had a sense of relief when we got home or whatever it happens to be. But really, even when I was really afraid, nothing bad happened. So you have to be careful that you don't take that relief, which is the thing that starts to fuel the disorder, because then you will say, we'll see when I go home, I got relief. And so therefore, I must always go home. For example, I must always go home. That isn't necessarily true.  That's, that's the lesson there. So like I didn't do anything to save myself and I was still okay. Okay. We are the story we tell ourselves is a thing. It is a thing. I'm not a big, huge fan of like a lot of that stuff at a very deep level, but in the end, we are the stories we tell ourselves. This is a, these are philosophical things about perceptions and reactions showing we could love to talk about that stuff. But yes, let's take that as having a grain of truth to it. It does matter.  And some people will say like, well, you know, then, you know, I don't have to say like it really, the bad thing really does happen because you see the panic as the bad thing or you see that the scary thoughts are being afraid as the bad thing. But being afraid, you know, being afraid is not an event. Like it's a thing, it's impactful, but we have to, if you're in that situation where you think, no, feeling panic is the event, the bad thing really does happen. Being afraid really does happen. That's a tough one. So you have to really redefine that and say, well, yeah, but what was the result of that? So let's see. So I'm doing this, I'm going to try to be more quiet about mine. Okay, this is important. Let me throw this up on the screen real quick. And I always like to truly be like super clear about this. I'm going to be more quiet about mine says Julie. Hey, Julie, how are you doing? So I want to talk about that for a second, like be quiet about it. I know that I've written about that. I talk about that. My podcast episode, how do you talk about your anxiety or what is your habit of words was another podcast episode that you did that's really popular. And some people really like, well, what do you mean I have to be quiet? And I can't say this enough that I'm not trying to teach anybody to stuff your emotions or never express yourself. We just really have to take a look at like, well, what are we defining as self expression or healthy self expression, continually speaking the same fear again and again and again, and telling the same horror stories again and again and again. Okay, you could say that's expressing yourself. Sure, technically it is. But is that a really productive and healthy way of self expression? I would argue that there are other ways that you can more healthily express yourself and honor your emotions. I was really afraid. Like I was really unsure of myself. Yes, validate those emotions, validate those experiences. But you can do that without drawing the conclusion that and it was terrible and it was it was awful because you handled it. So we're never trying to learn to like stuff our emotions. I've had people say, I'm never allowed to tell anybody how I feel anymore. No, no, no, that's not it at all. This is very specific that we're talking about. So let's see here. Oh, no, no, no, no, no, no, no. You believe that this will work? Yeah, let me throw this out here. I know it's a really common question, right? Do you believe that this will work for anyone to matter to what extreme their anxiety is at or ingrained in them? So this is one of those perceptual things or this is all about the story that you tell. So many, many people, some of you guys watching right now, people in the community, podcast listeners, people who read my books, will often say, Yeah, but my anxiety is so bad. My anxiety is so bad. If I could line 15 of you up in a room, have you sit?   I would almost bet that every one of you would would probably make the assertion. But my anxiety, yeah, but yeah, but yeah, but is a is probably the number one phrase used in the community. Yes, but or but what about anything with the word but in it, right? So the assumption is no, no, no, I feel it so intensely that I think I probably have it worse than anybody else because I feel it really intensely, right? That might be a mistake, right? I'm not trying to minimize or invalidate your experience or what you feel. I know you feel that way. I get how afraid you are and how it feels so intense. But you are basically saying, Well, I'm taking these reactions, these physiological reactions and these thoughts that we all share, we all have those same reactions like biology is biology. And you've decided, Well, because of the way I feel about it, this is what is my proof that it is really bad. So I did, I said a thing a few months ago. So there's two things that I could tell you about anxious thoughts, because in the end, that's a thought problem. Anxious thoughts are really strong, but they're also really wrong. So those two things are true at the same time, I'm not going to say that they are not strong. The feeling that your anxiety is so intense is very strong. That's a really strong feeling and thought, but it could also be really wrong, just that the stronger it is, the less likely we are to entertain the idea that is also strongly wrong. So they could be really strong, but they can be epically wrong, except that the strongness makes us discount the fact that, well, they keep, they're wrong every time. So my anxiety is the worst. I, it's so, I feel it so intensely. So therefore it must be true that it is special, is not correct, but there's a, we have a bias. We do evaluate things based on how we feel and our emotions and things like that. That's so normal. That's just built into every human being, but we have to really question that, like, is that true? All right. So let's see here. Donna, welcome back.  I'm happy to see you on your feet again and like getting there. So take, take good care of yourself, but happy to see you like on the upswing. Very good. So let's see here. Okay, this is good. I can't tell who this is. I had a panic attack for the first time in a long time today. I felt so self-involved until I paused. Ah, I wish I knew who that was. I'm sorry because it only shows me Facebook user, but yes, I am going to give a big fist bump to that comment. I felt so self-involved. That is so, so, so important in these situations. Recognizing that anxiety will essentially be, pay attention to me, me, me, me, me. Not that you're selfish, but anxiety. You're not self-involved, but the anxiety and the fear is incredibly, incredibly self-involved. It's all about me and how I feel. In that moment, all we care about is me, me, me, me, me. How am I feeling right now? What am I thinking? This is the worst. I am having the worst experience ever, but that pause that you're able to put in and kudos to you, like huge fist bump for doing that, gives us a little bit of space where we start to see that, oh, wait a minute here. Wait a minute. We could do something a little bit differently. Wait a minute. We could do something a little differently, right? So, that's so important. I love the way you brought that up. I was very self-involved until I put in a pause. That is so important. That's where that power is. It's in that little tiny pause.  Good job. Excellent, excellent job. So, let's see here. I'm going to try and scroll down to the bottom here. I don't have too much more time, but let's see here. This is a, this is kind of, I hear this all the time. Let me throw this out here. So, let me throw this out here. I'll try to put some on the screen. Okay. Why do we get more anxious when I'm reading your posts and books and podcasts? I feel more anxious like I'm feeding my health anxiety. This is a thing that I hear quite often. In fact, you know, I wrote this book and I've written other books, right? So, there is a very large segment and, you know, I'm very fortunate. The Anxious Truth has sold many, many copies, many, many copies. But I estimate that somewhere between 20% and 30% of all the people who bought it start reading it. Love chapter one and chapter two because it's the feel good. Like you're not broken. You can do this part and then they get really afraid to read the rest. So, sometimes listening to people who sound like me, and you know, like my friends and frequent collaborators, we all say very much similar same thing.  It could totally be triggering. That's actually really common. So, all I can, I can't exactly tell you why you get more anxious because I can't be in your head and they don't know you personally, whoever said that, but know that it's extremely common. I have a lot of people who say they have a problem sometimes listening to me because it's like, oh no, he's telling me the stuff that I don't want to hear. I understand. I'm not telling you stuff to make you feel bad, but I feel like I'm trying to say the things that we have to hear. All right. Let me scroll down, scroll down, scroll down. Let's see here. It's a good question. What did I tell myself during exposure? I'll throw it up on the screen. Billy asks, what did I tell myself during exposure? I didn't tell myself a lot, right?   So usually what I would tell myself is I would prepare myself and like, all right, here we go. I'm going to, this is it. I'm going to do this really scary thing. The only thing that I might be, if I think about what my inner dialogue really was, it was more instructive than anything else. Like, relax, put your shoulders down. You know, I was reminding myself of the actions that I had to take. Now, in the beginning, all of my talk during a challenging situation was soothing or calming talk, but as I got better at it than that talk, if I really think about that, it was a really good question, Billy. That dialogue changed from being soothing and calming to being more instructive, right? So, oh, that's right. I have to do this. Remember to breathe, put your shoulders down, like, go, you know, relax, no tensing. I would have, I would remind myself of those things. Chin up, chest out. Like that was what my talk looked like during exposures when they got really effective. It's a good question, really good question. Let's see here. Let's see. Let's see here. I feel like, okay, this is good too. Let's throw this out really quick. I feel like after the panic attack, I actually remember it as worse than it really was. Yeah, you probably do. You probably do. Now, that actually can change over time. So, well, here's a common theme, right? This is a thing that you can, where was that? Hide the message, take it off. So that's a common theme. And here are the red flags that I see all the time. It was the worst panic attack. It was the mother of all panic attacks. I had a level 10 panic attack. Look at the words that you use to describe it, right?  So the way you describe that, if you are continually in the habit of saying it was level 10, it was five alarm, it was, you know, it was hell, it was the worst panic attack, the mother panic attack. One of the things that's really common for people that have panic disorder to do and people in the community is to describe almost every panic attack is the worst panic attack. It's not possible that every panic attack could be the worst. It's just not possible because that would mean that there was an infinite layer of worstness that can happen in panic. And that's just simply not true. So panic is panic. Adrenaline can only do so many things. When it does what it does, what makes it feel and makes you interpret it as more severe or not severe is the level of fear in that moment. What do you do?  And you think of it as like, I don't know what I did, but I made it and I barely escaped death or incapacitation. Then you're basically interpreting the same physiology that you always experience. In that case, for whatever reason, it seems like, oh, that one was worse. Well, no, you were just more afraid of that one. It doesn't mean it was objectively worse. That's important too. People, if you were hooked up to all kinds of medical monitoring devices during panic, you would see that for the most part range of response is relatively limited.  It's not possible. So let's see here. What do I think about untangle? Okay. I'll put it up on the screen. What do I think about untangling your anxiety? I've read Untangling Your Anxiety. It's Josh and Dean's book. It's very similar. If you've read The Anxious Truth, you're not going to find anything that's very different. If you've read Untangling Your Anxiety, you might not find anything different in my book. We're all very much saying the same thing, right? One way or the other. We're all essentially giving you guys the same message again and again and again. Everybody says it a little bit differently. So you might find that Josh and Dean, the way they wrote their book, it resonates more with you more than I do. There's nothing wrong with that. For some people, the way I write and speak resonates a little more. So the message is almost always the same. I would never review those books because it's probably not fair because those are people I collaborate with and they are friends of mine. So I might be biased in that. But I would tell you that you find the people that resonate with you, but you're going to find that for the most part. We're all telling you the same thing, right? I'm going to put this on the screen real quick before we end this because this is important. I don't know if it's the same person or not. Again, I can only see Facebook user. I get anxious because reading your books and podcasts is like I'm telling myself that, yes, I'm broken and I need help. This is a good point. Nobody who does what I do, I did not write these books to make you feel like you were broken. I wrote the books and I do this podcast and I do what I do to try to tell you to offer you the alternative perspective that says you are not broken. You just can change the way things are going. So I, first time I've ever heard anybody say that and I appreciate you bringing that out there, but it depends on how you're going to consume it. If you can, if you continue, I'll throw this out here to end it up, right? Because I think it's important to say, if you're in the habit of consuming this type of information, the information that I produce, my books, my podcasts, Josh's stuff, Deans, Kimberly's, whoever you like to follow, Jenna Overbaugh, all of the people you see me work with, if you are following us and consuming our information again and again and again, but not necessarily really acting on it, then you could definitely wind up in a situation where all it does is remind you that you have a problem. Because if you take the information that I'm putting out there and I'm not blaming anybody, I'm not saying that I'm not picking on anybody, I'm not invalidating anybody or shaming you for this, but if you consume the information again and again and again and you don't actually act on it, then it would be very easy to wind up in a situation where you might feel, well, I just, all I'm doing is reminding myself that I have a problem. And that would be true, right? That would be true. So, you know, for somebody, for instance, like, you know, I was a gym, a fan of going to the gym, right? So into strength training and powerlifting. And for a while, I did spend a lot of time learning about the sport of powerlifting. I would watch videos and instructional videos, proper form and technique and different theories of muscle development and kinesiology and that sort of stuff. If I did that without ever going to the gym and actually lifting heavy things, I would not get any stronger. I would not become a better lifter. And that information might lead me to conclude, I'm just weaker than every one of these people, right? So it was great to have all that information at my fingertips, but I had to take that information and then actually use it and do that work. Yeah, I was still probably weaker than a lot of those guys in those videos because they were just monsters. But in the end, I could, you could see where, if you don't actually put the information into practice, whoever information it is, you could, you could wind up, you could wind up in that situation. Okay, there you go. So this is important. All right, Simon, that's, that's a good point. And it's a lot of insight there. So it's a really good comment that you made. I'm going to guys, I'm going to wrap it up because I'm getting that running out of time. But if all you're doing is reading and researching and thinking and posting and discussing and talking about it, and you're hoping that that will somehow get you to the point where things begin to change, you can wind up frustrated and in that situation where it's like, this just feels like an unsolvable problem because part of the solution that you're missing would be the action. Right? So really important. There you go, guys. That was, I don't know what lesson this is in the anxious truth. That was chapter three, lesson five, three dot five in this book. You don't have the book and you want to want to follow along. You can find it on my website, the anxious truth.com. And I will put this up on the screen because these are going so well. I'm really happy with the way this is going. If you are not subscribed to the anxious morning, there's an email newsletter to the podcast.  People seem to be really loving it. I'm enjoying producing it. And there you go. So if you, this will stay in the Facebook group, it'll stay in my Facebook page. It'll stay on my YouTube and I will post it on Instagram in about an hour. So if you're on YouTube by all means, subscribe to the channel and like like and subscribe and do all that stuff. I'm done. I can tell you that. I appreciate you guys coming. Next week, we get into changing your reactions. I believe that was the longest chapter in this book. Lesson 3.6 was the, I remember the day that I wrote that. It was an all day writing session and that chapter by itself is several thousand words. So next week we're going to talk about changing your reactions. We'll see you next Monday at the same time, same place. See you guys later. And yeah, keep moving forward.


If you want to pump your body and expand your mind, there's only one place to go. Mind pump. Mind pump. With your hosts, Sal DeStefano, Adam Schaefer, and Justin Andrews. I'm excited. We have the boy, our boy Justin, in the house today. Dr. Brink is here. Yeah, the other handsome Justin. The other one. That's right. Which is the other? I refer all the ones waiting to you. This is a quick little update. What do you say? What do we want to call this? This is like... Well, I think we're taught... Let's talk a little bit about what we're about to... We're going to do a seminar, right? We're going to do a webinar and talk about our... Some new stuff that we're coming out with. Not just new stuff that we're coming out with. It's not just stuff. We're doing something different than we've ever done before. So we are going to offer people... So we are going to let people see the program, Maps Prime Pro, that we had been working on with Justin for quite some time now. And we are going to show them everything on this webinar. So those that are interested or curious about this or suffering from aches and pains or imbalances or have issues with their ankles, their knees, their neck, their shoulders, their elbows, anywhere. This is... Now, Dr. Brink, when we released Maps Prime, since we met you, we've sent you our programs, got lots of feedback from you. Easily, for us, we respect you the most when it comes to just total human movement. I've been doing this for 20 years. I've never met anybody who understands the human body and its entirety in terms of movement and how the feet communicate all the way up to the neck, for example, as much as you do. And when we showed you Prime, the original Prime, Maps Prime, you were very impressed, but you also had some feedback and said, look, we need to go deeper, there's a lot more here. So we took Dr. Brink on one of our... We took you up on that. One of our infamous program creating trips, which, by the way, how was that experience for you? Yeah, well, the... Which part? Do you need to remember it? Were you nervous going into that at all? Is there a little hesitation where you let the switch rock and roll? It was like, hey, let's do this, but it was like, you know, we went to what? Gernville, and it was, you know, the... It was like Noah's Ark was outside. Oh, that's right. You know, when the tree fell down, it was like, we're not getting out of this place. That was crazy, that was crazy.  You entered into our flow. Yeah, it was amazing.   I mean, it started on the moment we got in the car. Right. I mean, this is where it started that two and a half hour drive all the way up. And, you know, once we get set and once we're in, it's like it was full-blown go. So, yeah, it was a good time. Now, the concept of priming your body, you know, we talked to you about when we did Maps Prime, but Prime Pro is a little different because it's much deeper. And it talks about other aspects of the body. Let's go into that a little bit. Yeah. What are the areas of the body that Prime Pro covers? Every major joint. So, let's start... I mean, we're starting at the neck, from the neck to the shoulder. Shoulder to elbow, elbow to wrists and fingers. You've got mid-back, low-back, hip, knee, you know, ankle and feet. Now, why... Let's start with the feet, for example.  I mean, they're... You're trying to burn body fat. How are you technically doing that? Probably on a, you know, treadmill or trying to go out and do some degree of cardio, which means you've got to put your feet to the ground.   Now, do you see a lot of hip issues because people have feet problems? Oh, yeah, all the time. Yeah. All the time. And what about the hands? Do though, if your hands aren't firing or optimally or working optimally, do you see problems in the shoulders and neck? Yeah, you definitely can. You know, I think we use our hands more than we use our feet, obviously. But we think the other way around, you know, we strap shoes and socks on our feet all the time. And we get that downgrade of information where we don't wear mittens on our hands 24-7. So, I don't know about you guys talking to you, Adam and Justin, but the movements that I was introduced to with Prime Pro that you showed us, I had not seen a lot of them. If not many of them, I'd never seen before. I think it's a lot of the motivation behind the webinar is we know if we just released this program. So, have you been a long-time listener of Mind Pump? We knew that a majority of those people would be excited about it no matter what. And we have a lot of personal trainers and professionals. And so, we knew that initially this program was really geared towards those people. Towards that mindset. Yeah, we knew those people right away would be, but we also knew, too, that if we didn't share this with everybody, that so many people would be missing out. And there's so many moves that Brink took me through that have been literally life-changing for me. I have bursitis in my hips. I've suffered from low back pain. I've dealt with all that. And I didn't realize how much dysfunction that I had, like in my feet, for example. And some of the moves that I've taken from Prime Pro have become staple moves in my life and have literally changed how I do everything, how I exercise, how I walk, how I run, how I do anything, even though I don't do a lot of running. It has changed a lot of that. And I think it's important that we share all of this program with everybody so that people fully understand how much it can help every single person. Yeah, and I think keeping in mind, too, like for me immediately, I took a lot of these concepts that we learned from Dr. Brink and started applying them with family and my dad and my close friends that I knew had certain issues that needed to be addressed in great detail before we even got to a gym setting where we're gonna be able to complete a good workout. And it's like a lot of times you tend to prescribe something that's a little less involved for somebody like that. Like, oh, well, you just start by walking and just start by doing these things with your diet and really small things that you can accomplish consistently. But I didn't really have, say, it's an ankle, it's a foot, it's a wrist. It's something that's a little bit more laser-focused as far as being the issue. Now this is just another great tool to provide in my toolkit where I can be, okay, well, this is kind of where you're feeling pain, but maybe this is a shoulder issue. And like, let's dive into that. Well, the difficulty with Prime Pro, a lot of what we spent, a lot of the time, at least we spent working on this, was in organizing and designing this kind of these self, I mean, for lack of a better term, self-assessment movements. That's what took us most of the time, because it's like, how do we put this together for all these different parts of the body in ways where people can easily do some of these movements and identify if they have problems. And in our free webinar that's open to everybody. And by the way, we're really trying to give you as much as possible for free.  You're going to tune in and get everything. We're going to go over all of this for, so you can watch it and learn all this stuff for free. But we want to show people like, how these assessments work, what to look for. You get to have Dr. Brink break it down probably on one of us. Yeah, think about that. I mean, we were able to break down our years of training knowledge to kind of try to complete with Prime, just like an assessment process of how we could sort of like present that as far as the self-assessment way to do that. Now think about that from, you know, movement specialist chiropractor, how they see, you know, all these like pending issues and things from that perspective now he's been able to help us create this program specifically to dive even deeper than that.  I would say what I like about this, I think this program has heard this great example from, you guys just had Aaron Alexander on. And the example was, you know, imagine we're all born with a thousand dominoes, right? And over time, we slowly take one domino out somewhere in the mix, right? We can still move, but because we've taken one domino out, right, it's not moving as fluid. Now let's say we injure ourselves, you take four out. What has to happen? Something else now has to kick into gear in order for that domino to keep going. So our job here, my job now, you know, with this Prime Pro is to insert those dominoes back into working order again. So now we can start from start to finish and we have one continuous chain of domino versus skipping steps somewhere throughout the pattern. Now the big fear when doing this and something we discussed quite a bit when putting this together with you was how do we do this in a way that's not going to just blow people's heads off in terms of like, everybody needs to be able to see it and understand it, you know what I mean? That's the hard part. That's what I think we'll explain. Well again, that's part of the why I think we were so adamant about having the webinar and saying like we've got to just, we can't be afraid of sharing all of it with everybody in fear of oh wow, if we share all of it then nobody will want to buy any of it, like who gives a shit, there's so much of this that people need to absorb and learn that let's just show everybody exactly what it's all about and I guarantee that there's going to be enough people that are going to need it and they're going to want to revisit it. You can always revisit it. That's the beauty of it. You can always go back and do a self-assessment. That's the whole process. If you feel like I got a little, something in my shoulder today, I wonder why. We'll go back to the very basic and let's go to the beginning and figure it out. I've already done that, I've already felt whereas before I'd feel pain in an area and I would just focus on that area and I still do that so if my hips bother me I look at my hip first but then I start to go distal and I start to look at the joints surrounding it and through using what you've taught me I've been able to identify that many times, actually more often than not, it's not coming from that target area. It's not that I'm using my shoulder wrong necessarily, it's that my shoulder's compensating for something else and had you asked me five years ago if I thought that that would have been the case I would argue the opposite. I would say no, your shoulder hurts obviously there's a problem with your shoulder or obviously there's a problem with your hip when in fact it was one of those other areas so in the webinar I would like to and hopefully we have enough time to do this I'd like to go over all of these assessments and talk about what to look for and then maybe give people examples of movements and whatnot. Here's the other thing too which is very similar to Prime Prime Pro these movements are not designed to really alleviate pain so they're designed to address the root cause of the problem and to connect you to the movement so they're not the movements aren't passive, they're active you're active, you're tensing you're contracting muscles while you're moving through these particular positions so that you're training these new pathways, you're training these new techniques and we'll definitely get into the details of why we do that like type stretches or foam rolling so for sure we'll cover that now I believe Doug has set up you could register now you should register now cause we're going to shut off registering at some point so you want to register early it's totally free it's lots of free information this is a mind pump first we've never basically given away a program before or during its release we've never given all the information out and that's what you're going to get with this webinar you're going to get a lot of what Prime Pro is about and a lot of examples and a lot of instruction from the man himself, Justin Brink what is the link that people go to it's mapsprimepro.com that's it? simple if you go to mapsprimepro.com and then it's going to be Thursday right so and it's Pacific Standard Time at 12 o'clock so 12 p.m. Pacific Standard Time and so all they have to do is what do they have to do they just have to go on here register and then they'll get information that's it? so once they register will they get like an email reminder okay so you'll actually get an email reminder too so that's awesome yeah register right away make sure you're in there the plus the benefit of it if you do decide to purchase it I know that there'll be a huge discount for the people that are actually watching it on that day but I do want to be clear everybody's going to get something from this webinar whether you enroll in the program or not you're going to get a lot from it so again our goal is to just inform you and teach you what we've put in the program so give you the tools to make yourself better again it's a first and this is I think how we'll be doing things from now on so register again you go to mapsprimepro.com register yourself it's totally for free and then we'll see you Thursday let's do this July 13th July 13th at noon pacific time see you then thank you for listening to mind pump if your goal is to build and shape your body dramatically improve your health and energy and maximize your overall performance check out our discounted rgbsuperbundle at mindpumpmedia.com the rgbsuperbundle includes maps anabolic, maps performance and maps aesthetic nine months of phased expert exercise program designed by sal adam and justin to systematically transform the way your body looks, feels and performs with detailed workout new prints and over 200 videos the rgbsuperbundle is like having sal adam and justin as your own personal trainers but at a fraction of the price the rgbsuperbundle has a 30 day money back guarantee and you can get it now plus other valuable free resources at mindpumpmedia.com if you enjoy this show please share the love by leaving us a 5 star rating and review on itens and by introducing mind pump to your friends and family we thank you for your support and until next time this is mind pump


Thanks for joining us. Like Pandora said, my name is Lillian Medis, and I'm a nurse midwifery and women's health nurse practitioner student at Georgetown University. Today, I'm going to be talking to you all about work my work with women in crisis and specifically refugee women in the US and in Greece. This will be in a storytelling format and I plan to share stories about how I got involved in the work and then how also you can prepare for humanitarian work, how students can get involved early in their careers and share some of the stories of the women I've come to care so deeply for. So I was happy to see in some of the polls that there are a few students and educators joining us. We'll have time for discussion and questions and sharing of some of your experiences at the end of the presentation. If you do have a question, please feel free to put it in the chat box and if I can all address it at the time. Otherwise, I'll address them all at the end. And also, while I want, I want to address that there are refugees from many nations and cultures. My experience is with Muslim refugees and that will be the focus for today. So before I begin, I just had two quick poll questions. I'm not sure if the polls are set up, but otherwise we can put them the answers in the chat box. So I was just hoping that if you're joining us today, you could tell us if you have ever worked internationally and if so, where and also if you have ever worked with refugee women or infants. I think it just gives us a good gauge of what's going on. What are the experiences that we have in the room and then also gives us a place where we can start a discussion at the end if you all have stories or experiences that you can share about. So I'm going to continue on. And I thank you all for answering those questions and please feel free to continue to put your answer in the chat box if you haven't had a chance yet. So peace on earth begins with birth. I wanted to begin the presentation with this quote because I think it sums up why midwives must be part of the crisis work around the world. We're champions of women's health and we can play a part in the empowerment of women to change communities. This is just a bit of background on me. Like I said, my name is Lily and I'm a student at Georgetown University. I live in Fremont, California. And I'm a registered nurse and certified as a domestic violence and sexual assault counselor. And I'm also certified in trauma counseling. And I'm the incoming student representative to the American College of Nurse Midwives Board of Directors. So I wanted to share a bit about how I got started in crisis work as I started my career pretty young and also just to talk about how educators can be part of this process as well. So this picture is from my first experience in crisis work when I went to Southeast Asia as a high school student. I worked with an organization called Rafa House that seeks to love, rescue and heal victims of child sex trafficking. While I was there, I was able to learn about trafficking, the work of Rafa House, as well as the immense emotional, social and physical needs of women and girls who have been sexually exploited and abused. I was able to spend time with a women's health care provider who worked at the safe house, learning about her work and the needs of the girls and the women. One of the young girls I met who had been trafficked was only four years old at the time. Several other older girls came into the safe house pregnant and terrified about what was going to happen to them. My idea of health care expanded and I began to see how quality women's health care empowers women and girls. I didn't know it at the time, but of course we all know that midwives do more than just deliver babies. We care for women across the lifespan and we're uniquely equipped to work with women and girls like this in crisis. I knew that I had to do something to engage in justice work through reproductive health services. So when I came home, I began speaking and fundraising on behalf of Rafa House for a few years. I first learned about midwifery care as an undergraduate nursing student at the University of Iowa. My professor for maternity and women's health was a nurse midwife and after I expressed my interest to her, she agreed to be a mentor for me throughout school. She had worked extensively in international aid work as a midwife and also started a clinic in our hometown for low income women. She taught me through mentorship stories and she would even take me to the local free clinic and help with women's appointments. I just mentioned this briefly to highlight to any of you that may teach at nursing schools or in midwifery programs that even if you're not able to do the work itself, such as my mentor was retired from clinical practice at the time. Mentorship of students is integral to increasing the number of midwives who are working in crisis or low income areas. So after undergraduate, I moved to California and my city in Greenmont, California has the largest population of immigrants from Afghanistan and refugees in the US and it's estimated to be anywhere from 60 to 80,000 Afghan refugees. For the past three and a half years, I've been working with an Afghan social services agency called the Afghan Coalition on Serving Refugee Women. The needs in the community are vast, from language to financial empowerment, chronic health conditions, post-traumatic stress disorder and domestic violence. Despite all of the challenges that Afghan women face, they're hopeful and resilient. I'm currently the facilitator of domestic violence services at the Afghan Coalition and help to create a support group specific to Muslim women who have survived domestic violence. And that's called Strong Together and I can give you the link to that if you're interested to learn more. I'll share a few stories of the women I have worked with in the past years in this presentation. Prior to beginning Midwifery School, I also worked as a nurse at a small community hospital where many Afghan women delivered their babies because it was the only hospital in the area that took on or underinsured women. So I'll share a bit about the care that these refugee women received as well. And of course, all of the names and pictures have been changed to protect the women that I work with. So while working as a newborn nurse at the hospital I just referred to, I had an experience that helped to guide and solidify my calling to Midwifery. As a newborn nurse, I attended all the deliveries and provided newborn care and resuscitation. I would sometimes be a support for the woman but was not actively involved in her care. Fatima was a young refugee from Yemen that spoke little English. She had received all of her prenatal care at the women's practice associated with the hospital. Throughout the prenatal period, she was seen by only the female provider in the practice who also happened to be a Muslim immigrant, which helped the transition to the U.S. medical system. However, it wasn't made clear, unfortunately, to Fatima or her family that this provider may not be able to deliver the baby. When she came to the hospital, delivery was imminent and the only obstetrician available was a male who she hadn't met. She was frantic and afraid, preparing to deliver her first child in a foreign country without an Arabic translator and only a male provider, which is strictly prohibited in her culture. Having worked with Muslim refugees for several years, I understood some of her concerns and her fear, but most of the staff did not. There was yelling, frantically trying to convince her to let the doctor in before the delivery, and finally, her mom convinced her to let him come inside the room right before the baby was born. There were many insensitive comments. I even remember one of the providers saying, if she doesn't want me to care for her, then she can do it herself. Her eyes were wide and afraid during the delivery, and I think possibly she may have walked away traumatized by the situation and may not want to seek health care the next time she's pregnant. Refugee women and women of other underserved populations in my area lack access to midwifery care. While the hospital and the obstetricians tried to provide care to them as best as they can, these women would benefit from care with a midwife. Our hallmarks of culturally competent care involved in a family in the health care system and advocating for the woman to be an active member of her health care team may have improved the situation and possibly helped Fatima have an empowering and a beautiful experience delivering her first child. So this painting was made by one of the participants in the domestic violence support group that I helped facilitate. Nazia was an Afghan woman and she was part of one of the groups. She's another woman who inspired me to pursue education as a nurse midwife. She was married to her husband for many years and was never able to conceive. We all know how heartbreaking this can be from women of any background, but specifically women who are Muslim and Afghan infertility is a huge shame in the community and can be the source of much violence in the family. So her husband grew more and more upset about the infertility and eventually became emotionally and physically abusive of Nazia. She went several times to the local free health clinic where many Afghan women received care to talk about fertility issues with her provider. Unfortunately, she was never provided a translator and the physician didn't realize that Nazia didn't understand what was being explained to her. She continued going back but was never able to conceive. Eventually her husband divorced her and married a younger woman. Several years later a social worker went with her to an appointment. She learned that all along Nazia could have had a simple procedure and likely achieved conception. By then it was too late for her. The lack of understanding of the Afghan culture and the struggles the Afghan refugees faced inspired me to become a midwife. Finally I want to share with you about Shukria. First story expands on the needs of immigrants and refugees in the U.S. and how I believe midwives are uniquely prepared to handle them. Shukria was a young Afghan woman, even younger than myself. She had a daughter who was a toddler and had recently delivered another daughter. Her husband, who was also emotionally and physically abusive, took the family for a visit back to Afghanistan. He left early to return home to California and prepare for the new family to permanently settle in California. When Shukria came back several weeks later, she learned that her husband had stolen everything, including her immigration paperwork, got rid of their apartment and disappeared with another woman. She was left without knowing the language or the system to care for two young children. For many nights they slept in a 24-hour laundromat because it was the only place that they could find shelter. Until a social worker at the agency where I work was able to get them into a Muslim domestic violence shelter. There were many emotional, financial and physical needs for this family, but I noticed after taking her to several health appointments that when the free clinic she attended provided a Dari translator, understood her culture and asked questions about her, not just her situation or her health, she walked away feeling more optimistic and capable. I think midwives are prepared to walk with women through the lifespan, especially at trying times like the one Shukria was going through. They can be the hub and the wheel. We can connect women to the services she needs. We're also educators. In addition to everything else Shukria was going through, she didn't have any knowledge of basic nutritional or health topics for her children or herself. Midwives can provide culturally relevant education to empower women to be their own advocate and to be part of the healthcare team. So after working in the Afghan community for several years and meeting many, many women like the ones I just shared with you about, I decided that I would go back to school to become a midwife at Georgetown. I was having wonderful clinical experiences and learning a lot from the midwives who were precepting me. However, I was still feeling distant from the reasons and especially the women who I wanted to be a midwife for. I knew when I began school that my calling was to provide midwifery care to those who have little or no access to it, specifically Afghan and Muslim refugees in the US, as well as one day hoping to work internationally in areas of conflict or crisis. As I continued clinical rotations in a wealthy area of California, I was learning a lot but didn't feel connected to my true passions. That's when I began researching how I could use my skills as a nurse and as a student midwife in the refugee crisis in Greece. So how did I choose the organization that I was going to work with? When I decided that I would go to Greece over the winter break to use my skills and experiences, I began to do a lot of reflecting and thinking about the values that I would look for in an organization. I think it's important to know your skills and your limitations, especially as a student, as well as the values that are important to you when deciding where you're going to volunteer. For me, cultural sensitivity, empowerment of individuals and working on a team were important. For instance, I was asked to work with several organizations where I would be the only women's healthcare provider and I knew that as a student I wasn't prepared to do that. So I decided not to accept those invitations. The organization that I did work with in Greece is called Nurture Project International and I'm going to share a lot about their work with you now. So before I share some more stories about the women that I met and the experiences that I had in Greece, I just want to give you a brief overview of obstetric and women's healthcare needs in Greece. So from the Nurture Project International website, it says that according to the International Rescue Committee, there are 62,000 refugees currently in Greece. Over half of them are women and children. The demographics of the population require specialty care, which we all understand, regarding infant and young child feeding and support for pregnant and lactating women. While a significant amount of resources have flooded the area since the beginning of the crisis, challenges remain inadequately addressing individual needs, more so than just donations or the large amount of resources that have come into the country. With the Balkan countries closing their borders in early March 2017, the refugee population remains stranded in Greece for the foreseeable future. And then from an article that I'll share with you at the end from the Guardian on healthcare in Greece, a preliminary report on anti-natal care birth and postnatal care refugees in Greece shows that of the 29 women questioned, 60% had received C-sections, in line with the extremely high Caesarean rate in the general Greek population. Of these women, only one was given an epidural, and all of the others were given full anesthesia, even though there was no way to take any medical history because of lack of translation. So women recovering from the trauma and stress of fleeing war in their home countries, caring for their children and refugee camps, are being re-traumatized by the lack of choices, unsafe conditions, and fear surrounding birth and breastfeeding. And that's where Inerture Project International comes in. So I provided their website and I highly encourage any of you who are interested to go and look at some of the resources and information that they have available. So the vision of NPI is a safe and supported motherhood is a human right. NPI works to create a world where that right is upheld in every crisis and emergency. They provide technical lactation support, reproductive healthcare, and nutrition support to families on the front line at the time they need it. They also work closely with other organizations such as MSF, Syrian American Medical Society, and Refugee Trauma Initiative. They work to develop innovative technology to provide access to lactation support to vulnerable families, advocate for change in the humanitarian field by informing policies specifically on lactation and women's healthcare rights, and they facilitate access to and train healthcare providers within their own organization as well as others to apply technical skills to the unique needs of vulnerable families and refugee camps. NPI began in 2016 when founder Brooke Bauer, who is a lactation consultant from the U.S., saw the need for breastfeeding support in refugee camps in Greece. They're currently working in Greece and have a new project in Iraq as well. As we go through some of the photos from the camps, I'll talk about how I saw them filling a specific need in the refugee camps in Greece. In Iraq, they are currently doing mentorship and training of Iraqi midwives and traditional birth workers on lactation support and prenatal care rather than just bringing in Western midwives to take over the role that Iraqi women can fill themselves. The next few slides are going to have a lot of pictures that I think help to tell the story of what's going on in Greece better than I can by just sharing with you my experiences. This is a picture of a man cooking a meal for his family inside one of the tents in a refugee camp in Greece. I just think it shows not only how real these families are. I think that was one of the first things that struck me was that these families came from highly educated, wealthy backgrounds and all of a sudden are living in a camp and still need to learn how to provide food for their families. How do they get education for their children in this setting? And then even a lot of them would say, what do we do with our time? Because just sitting in a refugee camp all day long with little resources or things to do. So I think that just brings light to that. This is another picture of one of the camps in Greece in some of the tents that families would live in. So one of the unique things that NPI does is they provide prenatal care to all pregnant women in the camps that they're located in. So one women's story that I wanted to share with you is just a good reminder of the importance of midwifery care for all women. I was providing prenatal care in her small room that her family called home. She was a young woman 37 weeks along with her fifth child and alone. Her husband was in another European country and the rest of her family had been scattered when they fled Syria. As we sat there, one of my colleagues helped play with her children and it was probably one of the first times that she had had a chance to sit down and just take a breath in the last couple of weeks trying to care for all of her children and find something for them to do all day every day in this setting. So I empowered her to care for herself by teaching her simple ways to reduce the discomforts of pregnancy. She was having a lot of lower back pain so we talked about how she could even use a scarf that almost all Syrian women have with them to support her lower back and taught her how to do that herself when she was alone. And we brought back a sense of normalcy just by sitting, talking and listening to the baby's heartbeat and just letting her be still in that moment. This is the beauty of midwifery to me, helping bring normalcy, health and wholeness, especially to women in crisis who might not otherwise experience it. This is a picture of one of the young NPI babies in one of the camps. And right now many of the camps in Thessaloniki, which is the city that I worked in in Greece, the camps are closing or half closed and that brings new challenges to the work that NPI is doing. During the winter the camps got so cold that it was no longer safe for the refugees to continue living there. And the UNHCR began to move refugees from the camps into what they call hotel settings. So they're small rooms. Each family has one small room. They're communal bathrooms and possibly a communal kitchen. Sometimes no kitchen is available and just food is provided to them when the food is available. So while that means that there is access to a bathroom and it's warm, it brings other challenges, specifically that NGOs such as NPI are having a harder time following up with refugees and a lot of people are getting lost in the shuffle as they try to figure out which hotel and where in Greece the refugees have been taken and how to continue to follow up with them when they aren't just going from one tent to the next but having to take the mobile unit and drive from hotel to hotel and how to first provide those services to all pregnant women that have now been scattered. And the reason for closing some of these camps is because some of the camps in other parts of the country were becoming overfull and so eventually these camps will then be refilled with people from the camps that are now full but that hasn't happened yet. So I think one of the things that's unique about NPI is that they see these needs and they continue to try to fill them even when it's not necessarily how they began their work. So when they saw that refugees were being moved to the hotels then they developed a protocol for a mobile unit and continued to provide care for these women as they were moved around. This is just another picture of one of the tents and then this mom you can see she was washing her family's clothing and was hanging it outside the tent to dry. So NPI began with breastfeeding support. Lactation consultants provide support to all women in the camps who are breastfeeding. They provide extra help to women having difficulties as well as to women who have stopped breastfeeding and want to relaxate. They also educate pregnant women and even women who aren't pregnant about the benefits of breastfeeding so that they can support each other. As I'm sure you all know it's especially important to breastfeed in this fragile environment. There's no access to clean water. Sterilization equipment is obviously not available and there's an unstable access to an ongoing supply of formula. What happened, what they saw was that many NGOs just immediately began giving pregnant and pregnant women an infant's formula without having a long-term plan in place about how that formula would continue to be supported. And as we know with bottles not being sterilized many infants were getting sick. Some were malnourished and even dying because of lack of access to clean water to make the formula. So that's when NPI stepped in and began teaching other NGOs that breastfeeding really needed to be supported and encouraged as the only safe way to feed an infant in a refugee camp. However, something that some people ask sometimes is if a woman is unable or unwilling to breastfeed. NPI does continue to support them and they support with one-time use bottles so that the lack of clean water or sterilization equipment is not important because they give pre-made one-time use bottles and then they give them to the women every several days. So they're following up with them making sure that they are feeding them correctly and then disposing of the dirty bottles afterwards. So nutritional support is another area that NPI is now currently providing help with. They give meal packs to women and children every week from six months to two years old and then any pregnant or lactating women. They do this because, as I said, they believe as we all do that breastfeeding is the best way to support an infant in this unstable environment. So the best way to feed a baby is to feed the mother to make sure that she's getting adequate nutrition so that she's able to provide breast milk to her children. And it's really just important to them that they provide culturally appropriate food. They provide halal food, so that means no pork products. And it's fresh. So whereas the UNHCR provides some staples such as rice or other dry products, NPI is providing additional support with fresh foods, fruits and vegetables, and meat that they wouldn't otherwise get from UNHCR. NPI also has support groups. So while I was there, it was over in New Year's and we got to have a New Year's party and this is a picture from a party like that where we would get treats and fruit that were just special to them in their culture and they didn't have access to very often. And so it would just be an exciting time where women could come to the women's tent that NPI has at every camp that they work in. And it's just a sacred space. No men are allowed in that tent, only women and children. And it's a protected space for women to come, to talk and to bond, not only between each other but also with the NPI volunteers who are there. They also host women's classes in these rooms. So sometimes that means a breastfeeding class or breastfeeding support group. When I was there we had a contraception class. So one of the organizations that NPI works closely with brought in obstetricians and they talked about contraception and what the options are for contraception even in the camp. These women as long as they're in a camp where these NGOs are supporting them do have access to IUDs. They have access to birth control pills and then NPI provides condoms whenever a woman needs them as well as referrals to long-term birth control. And like I said, it's a safe space without men that they can process the trauma of their life, the trauma of coming to the refugee camp. They can talk about their birth experiences. And if it comes up that one of the women needs more support with mental health issues, NPI will provide referrals to refugee trauma initiative or to MSF, Doctors Without Borders. So every camp that NPI works in has two tents. The first is the women's tent that I was just talking about and the second is the baby hamam. Hamam means bath and in the Syrian culture giving the baby a bath is very important for the mother. And there was no safe bathrooms. Many women even had their older children begin using diapers again at night because of the risk of going to the bathroom outside in the middle of the night. There was cold dirty water in the showers and lack of soap available. The baby hamam provides a private, warm and safe place for the mother and the baby to bond. Volunteers do not give the bath to the children. Instead, they give the power back to the mom to have that sacred part of her job back as a mother. Soap, towels, hot water and diapers are provided and closed on a case-by-case basis if needed. And then lastly, infant health is another aspect of the care that NPI provides. So diapers and wipes are provided to all mothers who need them. And then frequent weighing and measuring and doing health checks of all the babies who are breastfeeding or beginning on solid foods to make sure that babies are growing adequately and don't need extra support in that way. And then as I said, referrals to MSF and Syrian American Medical Society or other NGOs are often done if the midwife or the nurse thinks that it's necessary. So finally, I want to share a quick story about a woman that I worked with in Greece. Lila was a young woman. She was living in the refugee camp and went into preterm labor, which is quite common. She was transported to the hospital and delivered her first child at 36 weeks. The infant was kept in the NICU for four weeks after delivery for breathing support and for feeding. Lila, however, was discharged back to the camp. She would travel to visit the baby as much as she could, but as you can imagine, it's quite difficult having to find a bus and the money and support to get there. The baby was discharged at four weeks of age. And when we did the first check when she got back to the camp that day, we noted that the IV location was infected. There was a large wound on the foot because the IV hadn't been rotated probably the whole time that she was in the NICU. So as you can imagine, the wound was quite large and infected. So we didn't have many supplies and it was over a holiday when this was going on. So myself and the other midwife created a dressing as best as we could and tried to sterilize the wound as well as we could. The baby also continued to lose weight as they had been giving formulas only in the hospital and then mom was trying to breastfeed when she came back to the camp. We talked to the family about needing to take the baby back to the hospital for weight support as well as to get the wound treated and for needing systemic antibiotics. However, the mother and especially the father were traumatized by seeing the care that was provided to the mom and the baby and he didn't want to take them back to the hospital. He was just trying to protect his family. He even told me at one point we would have gotten better care at the hospital in Syria than what we got here. So NPI hired a Syrian translator who had also been a refugee and she helped with cultural understanding and with translation. Eventually she was able to explain to them why it was important that we took the baby back to the hospital and the midwife and the translator went with them to the hospital. So as you can see that one-on-one support of moms and babies is a key role that NPI plays. They build trust with the women so that even as volunteers come in and out they trust anyone who works with NPI because they've seen how they continue to show up and help with their needs. So how to prepare for this work. I know many of you may have experience so this is coming more for students or people who don't have experience. So I've learned a lot of lessons these are just a few of them. My first is prepare before you go. Research, learn about the situation, the culture and maybe even a bit of the language. Evaluate your ability and capacity to cope with harsh conditions but I think more importantly to be able to engage with women who have experienced trauma and loss without re-traumatizing them by becoming overwhelmed to carry the weight of their experiences that they're sharing with you. There are many roles for individuals who aren't able to go to the field as I'm sure you know. Fundraising, raising awareness, education and mentorship. It's important to have someone who you can debrief with after returning or if you're working long term on a regular basis. So I have a friend who's a therapist and I talk to her almost every week about the domestic violence work that I do. Have a sense of humor and don't take yourself too seriously. When I went to grace it was much different than I expected and like I think I noted the bathrooms need to be clean. The storage area needed to be organized and even if that's not our specialty we need to be able to step in and do those things so that we can see the long term success of the organization you're working with. And lastly something I'm continuing to learn about women, the needs and the work is so much bigger than any of us. It was before it was there before us and we'll continue to go on when we leave. So that reminds me of two things. One is that it's okay to take a break and to take care of myself when I need to and second is that I am not the savior. I simply have tools and skills I can bring to the table to help the women help themselves. So these are just a few resources some things that I've done that were helpful and I'm sure if you end up going working with an organization they'll have extra educational resources for you. The first is an excellent trauma counseling certificate that I would recommend anyone working with women in any setting look into. It's an online graduate level certificate and it helps you to learn about trauma, how to provide trauma informed care referrals and many other issues in trauma. And the second is the minimum initial services package. It teaches about reproductive health care and crisis settings and the minimum care that must be provided to all women no matter the setting. So I would highly encourage anyone who's even interested in this kind of work to take the MISP it's also an online course. These are several organizations and PI like I talked about and Midwife Pilgrim will be doing the next presentation so I highly encourage you to stay and learn about the work that they're doing and how they place midwives around the world for volunteer work. And lastly these are just a few articles that I found helpful and that you can look into and read about the work and how to prepare. So I just wanted to finish with this quote from Brooke Bauer the CEO of NPI in reference to the work with refugees the time is now to hold space for our fellow woman to take a step back and say I might not fully understand what's going on here but I will stand back and give you the platform. In our work we are not the saviors that go in with all of the answers the mothers have the answers we just hold space for their voice. So I thank you all for your attention and if you have any questions I would love to open it up for questions now. Thank you for the informative presentation giving us a snapshot into life in the refugee camp. Can you tell us a little bit more about the concept of living safe spaces within refugee camps? Yes, so as you may have heard if you've been following the refugee crisis or reading articles about it there is a high number of sexual assaults in refugee camps in Greece and a need for a safe place for women to be with their children without the risk of sexual assault or violence or exposing their children to violence that's going on between other men in the camps and so that's why for NPI the safe space for women is so important it's literally a safe space from the risk of violence as well as a safe space to share their thoughts and their feelings surrounding what they've gone through surrounding being a mom during this transition in their life, breastfeeding all of their issues around women's health care and contraception so NPI has a small it's a tent but it's a permanent tent that stays in the camp and they made it into a beautiful space for dogs and pillows and places to sit tea is available to the women and it's just a place to come and sit and take a breath to be around other women and to just know that they are able to talk about the issues that are going on in their life quite amazing and definitely required so I think for those of the Western perspective you can think of a continual standing red tent concept of women who are displaced let me briefly touch on the concept of safety again because the toilets and the latrine situation that can actually be one of the most dangerous points for women in camps going to the bathroom so that actually leads to another women's health issue of a lot of the UTIs or the latrines actually being the site where women would report sexual assault is happening so something that can be quite a scary thing and not just for the participants but for sometimes the volunteers and workers so Lillian one last question how did you deal with the fear associated with you know going to this place where there's people from everywhere what would you suggest to them considering volunteerism deal with any fear yeah so I think that being aware ahead of time so I did a lot of research like I said I knew that that was an issue when I went in that there was a risk for violence and for assault so I think NPI does a good job of preparing their volunteers we did a lot of reading and many many oh no we've lost Lillian we seem to have lost Lillian she was speaking to the issue of preparation for these experiences the reality is that you read, you prepare and go into it with the knowledge that as much as you prepare you have to remain extremely flexible because the textbooks and the newspapers are never quite able to give an accurate position at their Lillian coming back and having an open heart and not letting negative reports stop the progress thank you all are there any last questions before we close our discussion I saw someone said do men in Greece give support to women so the camps that NPI primarily works in are camps that are primarily women and children and possibly some men if they're married but more of the young men single men live in the other camps to help mitigate some of the risks that we were talking about and I would say that it all depends on the family some men are not supportive of women they're not supportive of breastfeeding and other men are some men are especially helpful with the children they're supportive of their women like the husband that I was talking about with the young infant who was sick he was extremely supportive of his wife and of his family so I think that that depends on the unique family situation thank you very much Lillian for the transformative presentation in a time where issues of disaster and conflict are hugely in the news and in our realities and with some say it's more dangerous to be a woman in times of conflict than to be an armed soldier thank you very much we'd like to remind everyone that the sessions are recorded so that you can go back and refer to