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Naomi Nakamura: Today I'm joined by Dr. David Lin. Dr. Lin is a clinical psychologist specializing in health psychology. He's worked in behavioral health for 20 years with the last 13 being at the San Mateo Medical Center where he founded the Medical Psychiatry Service. MPS, as it's known, is an integrated physical and behavioral health model of care that's embedded into the primary care clinic. Isn't that cool?

Through his leadership, Dr. Lin pioneered this integrative model of care and was awarded the Quality Leaders Award in 2014 by the California Association of Hospitals and Safety Net Institute. In addition to being Chief of MPS, he's also served in the hospital board as well as the medical executive, physicians' wellness and ethics committees. He recently graduated from the prestigious California Health Care Foundation Leaders Fellowship and is currently nominated for a director at large position for the California Psychological Association.

Currently, Dr. Lin serves as a Director of Behavioral Health for Ellipsis Health and that's a technology company aiming to enhance behavioral health services. He also manages a private practice on the San Francisco Peninsula and he enjoys working with adults and teens for a range of behavioral health issues from depression and anxiety to ADHD to PTSD and to other behavioral health issues related to physical health ailments.

This is how I came to know Dr. Lin, through his private practice because he's my own personal therapist. I started seeing him back in 2009 because my sleep problems were so bad that I could really barely function. A lack of sleep truly felt debilitating and no matter what I tried whether it was Ambien or Lunesta or supplements or even counting sheep, nothing helped me. I was so desperate to get a good night's sleep that I finally decided to seek professional health.

Dr. Lin was this person for me. It was through my work with him that I discovered the art of journaling and how it can be used therapeutically. Using journaling therapeutically, helped me to discover so many things that were contributing to my inability to sleep. Primarily, stressors that I just wasn't aware of that were affecting me this way. Through my work with Dr. Lin not only am I now able to sleep soundly I also learned how to recognize and then cope with all of those different things that were stressful in my life. I am really excited to share this episode with you so let's get to the show.

Hi, Dr. Lin. Welcome to the show.

Dr. David Lin: Hi. Thank you for having me.

Naomi Nakamura: We have been working together for a while. You're my personal doctor and I first came to see you I guess it was back in 2009 because I was having so much problems with sleep.

Dr. David Lin: That's right.

Naomi Nakamura: You have really been a tremendous resource for me in helping me work through those issues along with some others that we've uncovered through that. One of the first things you had me do I remember well first of all you had me do a whole bunch of lab tests to make sure there weren't underlying physical issues. Now when those came back I guess you would call clean, you had me go through a journaling exercise. That's actually something that I really stress in a lot of the people that I work with in many different capacities but maybe can you share with us just what were your goals with that and how you use that and I can share how it helped me.

Dr. David Lin: Of course so first off I really want to say you've done a great job of taking a lot of these tools and incorporating it and it has really as I've watched changed your life to allow you to have greater insights and more fulfilling life right now.

Naomi Nakamura: I would have to agree and it's interesting you say that because my integrative medicine doctor who I have been seeing since February, in my very first visit with him he actually stopped and looked at me and said, "Are you in therapy or something? 'Coz you're one of the most self-aware, you're the strongest self-awareness that I've ever seen in a patient," and I said, "I do. Thank you." I thought that was the biggest compliment anyone could ever pay me.

Dr. David Lin: It's true. It's a great compliment because I think being able to do work that brings self-awareness it's hard work. It's not something to be trivial about so kudos to you.

Naomi Nakamura: Well, thank you but I really feel that, that first journaling exercise that you had me do back in 2009 was really the start of it for me. Maybe kind of share how you use it in your practice and the things that you find come out of it.

Dr. David Lin: Yeah, definitely. Journaling is one of those activities that allows not just your brain to work but your hand to work, too. It's a little bit more of a complex process and so when we write something, it seems a whole a lot more power than necessarily just speaking it. It also gives folks the chance to go back to it and reflect on it word for word what they had written versus when you say something. At times, you may not say it back the same way. The journaling piece is terrific because you're given the option to just simply dump the feelings that are going on at that moment and capture it encapsulate it on paper at that time.

What that allows say me as a clinician in our patient-clinician work together is we get to look at that moment in time and analyze it, and look at it and then to really understand well what is going on for you. I think that's what was really useful is even though you came in with sleep issues, through your journaling we actually identified a couple other areas of your life that were actually the root causes for the sleep issues.

Naomi Nakamura: Absolutely, it helped me really see things that were my blind spot that I think were obvious to everyone else except for me. For me, those things turned out to be work related stress, which we all know we have but I don't think we necessarily maybe not fully understand just what kind of effect they really have on our health. Is that something common that you see in your practice a lot?

Dr. David Lin: Yeah, I'm-

Naomi Nakamura: Or am I an anomaly?

Dr. David Lin: No, but only I see it more and more especially as work becomes more technologically advanced and we're asked to work not just in our regular working hours but outside of our working hours. Work now, bleeds into every aspect of our life. We could be doing work, which you shouldn't be as we're driving as we're responding to text, which is terrible. We used to have that cut-off of nine to five but that's not the case anymore. Work is becoming all encompassing and so then where do we find the rest and recovery time from work in order to do our jobs well the next day?

Naomi Nakamura: Right, that white space that we need because we're not robots. We can't just react to things in the moment. I don't know for me is even though I'm not in a creative role at work I feel like I still need a lot of creativity to do the work that I do. I feel like I need a lot of that white space and also that downtime just to keep refreshed. I feel at least for me, I work in the tech world, Silicon Valley, that's not really possible.

Dr. David Lin: It's a lot harder these days and the demands of the work schedule I mean of productivity that's being asked of us, too. I think all of this is leading to this increased levels of depression and depression I think has readings some estimates like by 2025, it's going to be the third costliest disease that's out there, which is amazing. I mean that's not due just to medical costs that's due to reduced work productivity.

Naomi Nakamura: Yeah so for me we found that through journaling and again these are things that I actually, I either I typed them. I think I may have written some of them. I think I actually wrote them down and then I typed them up for you so that I could send it to you in a Google Doc, but I found it very useful because and this is what I tell a lot of my clients who I have them do food journaling but I think it translates the same way a lot of times what we think we're eating is not actually what we're eating. I think the same goes with this situation. A lot of things of what we're doing or what we're feeling are showing up in ways that we may not realize. I think that journaling piece really helps us to connect the dots.

I know a lot of people feel a little apprehensive about journaling because they think it's like a dear diary type of thing but it's really not. For me, and I don't know how it is with some of the other clients that you have but for me it was really just recording things that happened during the day with symptoms that I was having and even some thoughts that I had around it.

Dr. David Lin: You know journaling is not necessarily a natural, it's something naturally that we can just do. I think it actually takes some practice because we're not necessarily ready to sit down and think about and write down about what happened in our day or our feelings. I think one thing that I would say is if you're going to start journaling just expect to be a little bit difficult at first. Maybe for the five or six days of journaling, don't expect to write a lot. You write a sentence or two. That's not bad. You write a couple of feelings. You write a couple of summaries about what happened in your day. That's not bad but as you continue to journal feel free then to add to it, to write more about your feelings or your reactions or your interactions with other people. As you write more you'll begin to see, you know when you reflect back on your journals, "Oh, look there's a couple of things I was thinking about back then".

Naomi Nakamura: Right and I found that for me, I remember when I first started I would stare at this blank piece of paper and think, "Well, what am I supposed to do here?" At first, I just really started it as a log. Then from that point on then I would add a little bit more commentary. For me personally, I can't speak enough about what an invaluable tool it has become for me because it's also something free that I now have in what I like to call my arsenal of tools that I can go back to, to help me in a variety of situation.

Dr. David Lin: One thing I'll add about journaling too is when you talk about arsenals, sometimes it's actually good to mark one of the so a good day that took place so that when you do have a bad day you can go back to that and reminisce on that. In the same respect, if you're going through a tough time and you've journaled long enough, you'll be able to see how you recovered from those down moments and it'll give you a sense of reassurance like, "I can get through this".

Naomi Nakamura: Yes absolutely so my journaling uncovered work related stress. What are some of the primary issues that you're seeing come up with work related stress? For me, it was sleep. Are there other common ways that you see that this manifests as complaints that people have?

Dr. David Lin: Yeah, definitely. Besides sleep, one of them is depression. Pure on depression where they really have sadness most of the day. They really feel like they're not doing things that they used to enjoy doing. Those are the two real critical signs that often I've seen. Then reduced appetite, just a sense of hopelessness and when all these depressive symptoms really begin to snowball because of work that's where it gets a little bit dicey.

Naomi Nakamura: When should someone start to become concerned about these things? I think we all experience one or a few of those things at any point. When is it something that we should become a little bit more concerned about?

Dr. David Lin: I would say be concerned about it when you begin to notice a really significant change in just how you are normally. It might be that you find yourself just not eating as much as you used to or eating too much, one or the other. It might be the fact that you just don't care to go out like you used to or sometimes your family or friends might say, "Are you okay? We used to hang out but I feel like you just don't want to do anything anymore."

Naomi Nakamura: For me, I remember and I literally remember instant messaging there's still a colleague in my office where I just said, "I don't feel like myself," because I felt I was being so short with other people. One, I didn't have enough sleep so I was cranky all the time. I just felt so irritable and annoyed with people where no one could have a conversation with me.

Dr. David Lin: I think the biggest hints are when you see it affecting either social environment, your work environment, or your relationships. When you look at those three areas if somethings becomes really abnormal then it's something that I would begin to think about. Do we have any symptoms that we should be addressing?

Naomi Nakamura: Right and abnormal to the person.

Dr. David Lin: Abnormal to the person, right.

Naomi Nakamura: So we're coming up on the holiday season, which is very joyful but it can also be very stressful in the business world. It's the end of the year for a lot of people and then just having to be around relatives. We all love them but we all know what it's like to be in a house full of so many people. Do you have any three to five tips that you recommend just to help people be ale to just manage their stress or even just to cope with it a little bit better?

Dr. David Lin: Yeah, you're right this is a great time and people get very excited but there are certain things that you can do just to really help yourself get through this holiday season.

One of them I would say is to just simply be aware of your reaction to the change of the season. We have shorter days and we don't have as much sun as we used to and so for those people who-

Naomi Nakamura: It's that low vitamin D season.

Dr. David Lin: Low vitamin D season. Otherwise, we'll call it seasonal affective disorder but if that's something that anyone particularly has struggled with, with the shorter days that is something to definitely speak with your physician about because it's addressable and easy to deal with. That's one thing.

The second thing is around the holidays, we put a lot of expectations on ourselves to do our work and participate with family and do the shopping and everything's got to be just right.

Naomi Nakamura: All the holiday parties and work socials and-

Dr. David Lin: Exactly but in the end it's also about being true to yourself about how much you and or your family can really do. Having limits that you've set for yourself is really important and that can help save a lot of stress in the end.

The other things is yeah you mentioned about family interactions, this is where it's important to know and understand what's your limit of family interactions? I remember working my first shift in the ED when I was new to this career was on Christmas-

Naomi Nakamura: What's ED?

Dr. David Lin: Oh, sorry. The emergency room so I was really new in this profession and it was Christmas day. I was a person who was there on call in the ED in the emergency room to service any patients who came in depressed.

Naomi Nakamura: Does that happen a lot during the holidays?

Dr. David Lin: I was surprised how many family members came in because their stress level had just gone through the roof because they had been together just a little bit too long. Word of advice, really know for yourself how much time do you want to spend with family if you don't get along with family because the last thing that you want is to walk away from a family gathering and just have things blow up and out of control.

Naomi Nakamura: To know it's okay to do that because it's serving not only yourself but the rest of your family members as well.

Dr. David Lin: Exactly it's respecting your boundary and the boundaries of everyone else.

Naomi Nakamura: Right, boundaries. Those are a great, great thing. That's something that I'm really big on right now so maybe can you talk a little bit more about boundaries?

Dr. David Lin: Yeah, you know we tend to want to please people and will bend our boundaries but what ends up happening is ends up biting us in the butt. That doesn't really serve you any good and if you're prone to depression or anxiety the lack of boundaries can actually just exacerbate your symptoms. When you hold a boundary, you do it so that you can protect yourself, so you can protect your interest and so that you can be your best for everyone else around you. That's key.

Naomi Nakamura: I will say when I first started working with you in 2009 that was probably the most stressful time period of my career and correct me if you don't agree with me but I would say I didn't have a whole lot of boundaries back then especially in the workplace. That is something that we worked on really hard and I can say that now I feel very comfortable establishing those boundaries especially with my leadership above me. I feel that it makes a better working relationship with me and with them and I know for a fact that they appreciate that because what I found with executives and with leaders is that if you don't establish the boundaries they don't know where they are. They don't know if they're crossing a boundary and every person's boundary will look different for them.

Being able to establish that I've come to learn and to appreciate the fact that it is a respect in if you're able to establish that I would say for most good managers and good leaders they will appreciate that and they will respect that. It's just a human thing.

Dr. David Lin: It is and you're absolutely right. If you don't put up a boundary, people don't know and they may walk past a boundary that they don't realize they're crossing. As hard as it is to establish the boundary, I think after the boundary's set up you'll actually be much happier even.

Naomi Nakamura: Oh, it's the total feeling of relief and it is not easy like you said. It's very ... You know if you've never done it before it's like doing something new that you don't know what to expect but I think in the long run you feel good about it. Even if it doesn't turn out the way you want it to, you at least know that you put the effort forward. I think a lot of what the tips that you've given us have been great but what it really comes down to is self-awareness.

Dr. David Lin: Self-awareness is really difficult because we are busy and it's really hard to take time for self-awareness so I would also suggest that in the holiday season, with the hustle and bustle that everyone take time. Either if you can do an hour or even a week, just allow it to be your time. Just think, reflect, have yourself a cup of coffee and really meditate on what's going on before the whole season goes by and then you've just been spinning around with all the hustle and bustle.

Naomi Nakamura: Right and that's a great way to wrap up I think. Just want to recap a couple of the things that you've shared with us. The journaling piece I think is a great way to establish your self-awareness. Taking time for yourself to maybe meditate or even just to have a cup of coffee, just reflect on your own thoughts, and just making that downtime and that's a way to also create the white space for yourself. Even if you don't have an hour, just take 20 minutes. If you don't have 20 minutes, then yeah I think you have other issues you need to deal with. Then just allowing yourself grace.

Dr. David Lin: Yes, grace is actually very ... It's a guide in your part to love because it's a key point. Often times I think, we're just so hard on ourselves that sometimes just cutting yourself a little bit of slack goes a long way.

Naomi Nakamura: Then being willing to ask for help if you need it and I think when you have this self-awareness, you'll know if you need that.

Dr. David Lin: Right.

Naomi Nakamura: Yeah. Well thanks so much for joining us.

Dr. David Lin: You're welcome. Thank you for having me.