How a Simple Mindset Shift Can Reduce the Risk of Heart Disease and Improve Overall Health | Dr. Tara Narula

This is the 10% happier podcast. I'm Dan Harris. Hey, hey everybody. How we doing? Speaking as a lifelong hypochondriac, I found this conversation to be extremely helpful. I don't know if this is true for you, but I spent a lot of time dreaming up horrible health scenarios and then marinating in anxiety. But I learned a ton in this interview about how one of the most effective things you can do to protect yourself from heart disease and other health conditions is to shift your mindset, specifically to shift your mindset toward resilience. I'll let my guest today provide a detailed definition of that term resilience. She's also going to provide a detailed cookbook for training in resilience. Said guest is Dr. Tara Nerula. She's a board certified cardiologist at Lenox Hill Hospital in Manhattan. She's also the chief medical correspondent for my alma mater ABC News. She's got a new book called The Healing Power of Resilience. In this conversation, we talk about what resilience really is, why most of us already have it, and how it can be strengthened, the overlooked link between mental health, physical health, and recovery from illness, why mindset matters as much as medical treatment when you're facing health challenges, how resilience applies to major life changes, trauma and chronic disease, practical psychological tools for working with anxiety, fear, and repetitive thought patterns, why flexible thinking matters, how to adapt when life does not go according to plan, how beliefs and the mind, body, connection, shape, stress, healing and resilience, why movement, sleep and facing fear are essential ingredients in building resilience and much more. One great way to practice resilience and reduce rumination is meditation. And I've got a new meditation app that you might want to check out. It's called 10% with Dan Harris. You can sign up at danharis.com. There's a free 14 day trial if you want to try before you go by. We're just getting started, but we've already got a large and growing library of guided meditations from the world's greatest teachers. We also do weekly live meditation and Q&A sessions where you can get your questions answered and meditate in the carpool lane with a bunch of other meditators. Also, the app has a bunch of community features so you can meet your fellow meditators. Danharis.com, join the party. Okay, we'll get started with Dr. Tara Nerula right after this. I feel like my skin is looking better these days and I believe that a big part of that is that my evening ritual, my wind down routine before I go to bed now includes putting a product called Osea on my face. It's a moisturizer. Specifically, I use Osea's dream night serum, which is a clinically tested formula powered by bio retinol and designed to help reduce the visible effects of stress on your skin while you sleep. 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Thousands of five-star reviews help you shop with confidence. Fine furniture, decor and essentials that fit your unique style and budget head to Wayfair.com right now to shop all things home. That's W-A-Y-F-A-I-R.com. Wayfair. Every style, every home. Dr. Tara Narola, welcome to the show. Thank you for having me. It's a pleasure to have you here. Let me start with some obvious questions. The first is how and why did you get so interested in this subject of resilience? That's a great question. It's something that I think I've been fascinated by my whole life, but definitely being in these two worlds of journalism and medicine made me more interested in it because I feel like I'm seeing it every single day. Clearly, in the news, we report all the time on stories of people overcoming some sort of difficult life event or tragedy, whether it is a natural disaster like a hurricane or a school shooting or a personal issue. It just fascinated me about what is it that makes someone able to come through that and continue on with their life? Then in the same token, I was seeing that in my patients. I have patients who survive heart attacks and are living with heart failure and strokes and still have an attitude of being able to proceed with their life and move forward and advance and have a wonderful quality of life despite having faced a very difficult situation. When I was actually approached by Simon and Schuster in 2020 about writing a book, they asked me, what do you want to write about? I said, I want to write about resilience. It was something that I had actually brought to CBS when I was there as well as a topic that I was interested in and had done a few pieces there in terms of reporting on the science of resilience. It's something that's really just fascinated me as a human being, myself and my own life and my family members, my friends, and then, as I said, in my patients and the stories I was seeing on the news. A lot of us think that we're going to crumble and fall apart when something bad happens. One of the biggest things I learned in my initial reporting on resilience was when I interviewed the psychologists who study resilience and they said, the majority of us, 70, 80 percent of us are innately resilient, meaning we are not going to develop PTSD if something bad happens to us. That was really eye-opening for me. I felt that's something that I wish everybody knew, that we're actually so much stronger than we even know. I think that's a huge win to just have that knowledge inside you that, okay, if something bad happens, I am hardwired, essentially, evolutionarily, genetically, biologically, to be able to get through this event and not fall apart. That was really the first thing I really wanted to get out there. The second is that this is a skill that you can build. I think that also was eye-opening to me that it's not just set in stone. There are tools and tips and science there from the world of psychology that can allow all of us to be able to become more resilient. What a great thing that is to know, I just have to build this skill just like I would build a muscle. The next time something happens, I can actually face whatever that is even better and even stronger than I was when I initially faced something difficult. We're going to get into how to build that skill. That's going to take up the bulk of our time, but just staying at a high level for a second. It seems like one of your insights and maybe critiques is that in the medical community, doctors are really focused on the diagnosis, what medicines, what interventions are going to be required, and not so much on the mental health of the patient. That's especially stupid given that our mental health and our physical health are not divisible. That's exactly right. That is the crux of why I really framed a lot of this book around the medical world. I wanted this book to be applicable to anyone who's facing any sort of challenge in their life, but Dan, I think where I really see it coming into play is also in the medical field. As you mentioned, I'm a cardiologist. I see patients four and a half days a week and we talk a lot about, okay, we're going to send you for this test and I'm going to give you aspirin and this cholesterol medicine and we're going to do this procedure to open up your arteries. We focus so much on these prescriptions around interventions and medications, and we so often forget about the mind-body connection. I ask my patients, every single one of them, every time I see them, how is your mental health? What is your stress level? Because we know, even in the world of cardiology, that that is a risk factor. If your mental health is not a great place, if you are under stress, that is a risk factor for cardiovascular disease. Cardiology, I would say, has been a little bit at the forefront of at least guiding the way towards other fields, recognizing that mind-body connection. But even in my field of cardiology, we don't do a great job asking about it and we certainly don't do a great job in terms of scaffolding patients with that kind of care. My patients are often surprised when I, number one, ask about it, but number two, say, I think you should see a therapist. I wish that we had psychology built more into the framework of how we treat patients, because it is so important for them to not only heal from what's happened, but to prevent and so much of disease prevention as well. I have, and I'm sure you share this, I have a lot of empathy for physicians. They're working within a system that's largely broken that doesn't provide them with a lot of time to create meaningful connections with their patients. And yet, this approach of just focusing on the sort of technical medical aspect without taking into account the psychological aspects, which are, as we keep saying, are indivisible from our physical health, it's like going to a knife fight with a spoon and one arm tied behind your back. It's just like you're just missing a huge part of the flywheel of human flourishing. Huge, huge part. And, you know, like I said, it's not even about prevention of disease, which of course is really the future of medicine. How do we prevent? But it is so much about the healing process. And I think that was the other big thing that became apparent to me is that I would send a patient, for example, for valve surgery or a stent, and they would come back to see me afterwards. And when I would walk in the room and say, how are you? The first thing they would say to me is, you know, when am I going to feel like myself again? I'm so afraid. I'm so fearful. I am so overwhelmed by what has happened. I don't know how to move forward. And it just became so glaringly obvious that the stress and the impact of a medical diagnosis or a treatment is on par with any other stressful event that we have in life. And again, like this is an opportunity for us to intervene. And that's where I hope this book will come into play is to say, you know, yes, this has happened to you, but you can still thrive. And here's how, because when my patients would look at me with that sense of fear and almost paralyzed, it's hard as a doctor, you want to be able to help someone through that. And there's like no guidebook right now to how to do that. And how am I going to get someone to take their medicines and start exercising and eating healthy when they're just overwhelmed by the mental impact of what has just happened to them? And we just don't recognize that being told you have breast cancer or you had a stroke or you have liver failure is a traumatic event. One last high level question here before we get into your very practical tips. How are we defining, and I think you make the case for redefining resilience? I think everybody has their own definition. And that's definitely part of what I came across as I was doing research for this book and talking to different psychologists. And I don't think you're going to find a universal answer. And for me, it was really this concept of, when something happens to you, you are never ever going to be yourself again. That is what I started to tell my patients, you are not going to be the person that you were before this event happened to you. But you can still be a version of you that can enjoy life. And at the end of the day, that was what this was about for me. It's about quality of life and enjoyment of life. And how do I take who I was, who I am now and be able to move forward? So it is this idea of sort of bouncing forward from what has happened to you, not reclaiming who you were, but taking what's happened and literally still being able to suck all the joy out of life that you can, despite whatever challenge you faced. Because that's what people care about, Dan. That's what they care about. They want to be able to still be happy even if something has changed. Yeah. So it's not snapping back to exactly what you were. It is, as you say in the book, it's about being able to work skillfully with the non-negotiable truth of change. Correct. And still find meaning in life and purpose and joy and hope and love and all of those things that make life worth living. Yeah. I mean, this is where things, in my view, and I'm going to get a little weird and Buddhisty on you, this is the poignancy of being alive that most of us overlook because we're programmed for denial. Life seems like a solid movie. I look the same as I did in the mirror yesterday. If I don't, that's an emergency and I got to change it. But we are not these solid nuggets moving unchangingly through time. We're more like a river, a process that unfolds over time. And happiness, flourishing, calm, all depends on our ability to live with this flux in some sort of a quantumist way. That's exactly right. That's exactly right. And that's why in the book, I use the example of Michelangelo sort of freeing the angel from the marble. We are a work in progress. There is something always being chiseled out and created that's new, but something really amazing and beautiful if you can look at it that way. Yes. Okay. So in the book, you've got these eight ingredients for resilience. And we'll see how many of them we can get through given the time we have allotted here, but I'll aim to get through all of them. The first is acceptance. What do you mean by acceptance and how are you drawing the line between that and resignation? Yeah. Again, when we were sort of figuring out the framework for the book, there are different psychologists that have different sort of tools or recipes. And I think for me, number one in the list had to be acceptance, meaning you can't accomplish any of the other things on your path towards resilience if you first don't accept what has happened to you. For me, Dan, I, like everyone else, faced my own challenges in life. And my memory of learning acceptance goes back to medical school, which I talk about in the book when I lost vision and part of my eye. And no one knew why I was very scared. I was in the middle of my training. I was like thinking I'm never going to be able to be a doctor. My whole life is over. And literally, like I said, my patients are, I was paralyzed, almost paralyzed with fear. My mother, who's amazing, sent me a little card in the mail and on the card, it had the serenity prayer, which, you know, basically very quickly says, you know, God grant me the serenity to accept the things I cannot change, the courage to change the things I can and the wisdom to know the difference. And she said, why are you wasting all your time worrying about something that might never happen? Why don't you just enjoy every day? And if it happens, you'll deal with it. And if it doesn't, then you haven't wasted any time. And literally, it was that one card, that one conversation that allowed me to say, okay, I can't take back that I've lost vision in my eye. I can't change that. I can't change the fact that I might lose my whole eyesight next month or next year and my whole life might change. But for now, I'm going to accept that this has happened so that I can continue to finish medical school and graduate and go on to the next step. So this whole thing became very clear to me when I was faced with my own health challenge. That's why I made it really step one in this process, because you literally cannot face your fears and exercise and find love if you can't just say, this has happened to me, bad stuff happens, life is going to throw stuff at you, and I have to accept it in order to be able to move forward. I bump up against this a lot in my work, which is that I personally hate cliches, and yet they are so fucking true all the time. And the Serenity Prayer is a great example of that. It's knit onto throw pillows and therefore, to me, a little bit annoying. And yet, it is incredibly wise. And I will say on top of that, as wise and honestly, as obvious as it is when stated skillfully as the Serenity Prayer does, it's hard to do. I have hosted this podcast for 10 years. I live in this world of imbibing, drinking out of the fire hose of this wisdom. And yet I still worry about shit I can't control all the time. So did that one conversation with your mother really do it for you, or do you have to remind yourself over and over? Yeah, I mean, it's work. Like everything else in life, something doesn't change overnight. And it's a process. It's a process of rewiring your brain. I mean, that's where therapy for a lot of people comes in, right? You don't suddenly make a change by one session in therapy. It's a pattern and a, you know, that pathway that you're continuing to kind of hammer down over and over again. So no, it was not as simple as it was, okay, she sent me the card, all of a sudden I was on the right path. But that was so eyeopening for me. So that every time I started to kind of go in that direction of worry and fear, I would think about it. Then the more time that would go on and nothing happened, I said, okay, I'm a little farther away from this event, and nothing's happened. I feel a little more comfortable. And that's something that I tell my patients to, which is, you know, time, it's very helpful. Because if you can just put one foot in front of the other, the farther away you get from the event, it never is going to go away. But that kind of intensity of the worry and the fear will diminish a little bit. So, yeah, I mean, it's hard work to change your mindset. It's just like it's hard work to eat healthy and to wake up every morning and exercise when you don't want to and to pursue your dreams and your career. I mean, nothing comes easy. But just knowing that that's like the first key step is really valuable because you can keep going back to it. And I think having role models for people who have done that, and that was another thing that was important to me when that happened to me was, I don't know how I stumbled upon it, but I came across Richard Cohen's book Blind Sided. Richard was Meredith Vera's husband, prolific journalist himself. And he talked about his life and what he had faced with multiple sclerosis diagnosis and colon cancer and hit after hit and how he was able to still have this beautiful life with his wife and children and work in a career that he loved. And so for me, again, it was reading my mom's letter and reading Richard's words and having time pass and realizing I can accept that this has happened even if I don't know if it's going to happen again. You recommend some modalities for helping us work with anxious or self-pitying thoughts. And those include both mindfulness, which we talk about a lot on this show, and ACT, acceptance and commitment therapy. I'm not going to ask you unless you really want to give an entire explanation of what mindfulness and ACT are, but are there specific tools from either or both modalities that you think would be useful for the listener? I think everybody's different, Dan. I mean, I think for everyone, different types of therapies work differently. And depends on who you are and what resonates with you. I will say I was first introduced to mindfulness and meditation through Jeff Warren and using his meditations on the calm app and then introduced it to my husband, who was a Type A surgeon and said, I could never meditate. And I said, yes, you can listen to Jeff. He's relatable and it's quick and you can do it, and we would do it together. And so for me, I discovered that through him and I loved it. That was helpful. I've been in therapy. I have family members that have been in therapy. Cognitive behavioral therapy is extremely powerful because like ACT, it really provides you with tangible ways to take your thoughts and kind of work with them. I'm just a huge advocate for any technique that works for you as a person. And for some people, it may be DBT or ACT or CBT. There may be different modalities, maybe all those modalities, but it is a personal thing. But I encourage people to be open to trying them because what might work for you might not work for someone else. And I know what worked for me, which was definitely CBT over, for example, talk therapy. And so CBT cognitive behavioral therapy helps you kind of notice when you're stuck in recurring, repetitive thought patterns and to break out of them. Correct. Yeah. I had never done therapy until my 30s. And now, you know, I'm a huge advocate. So I said I'm a huge advocate for, I think everybody should be in therapy because they think we all can work on our mental health and we all need help based on our own life experiences and our upbringing and everything that's happened to us along the way. Just for those who've never heard of Jeff Warren, very close friend of mine and amazing meditation teacher who's done incredible work over on the Com app. He's also on my app and in my life in a deep way. And so I hear from people all the time who found Jeff either through my app or through Com and just what a positive impact he's had. So go Jeff. Coming up, Dr. Tara Nerula talks about why flexible thinking matters, how to adapt when life doesn't go according to plan, and why movement, sleep, and facing your fears are essential ingredients when it comes to building real resilience. A thoughtfully built wardrobe comes down to pieces that mix well and last. And that is where quints shines. Premium fabrics, considered design, and everyday essentials that feel effortless to wear and dependable even as the seasons change. Quint has the everyday essentials I love with quality that lasts. They've got lightweight cashmere sweaters. I've got three of those I think. Short sleeve Mongolian cashmere polos and linen bottoms and shorts. Tees in 100% Pima cotton and European Jersey linen. These are versatile pieces that make a wardrobe actually work from season to season. 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For everyone who solves crime from their couch knows more about forensics than their own job and has trust issues with small town sheriffs. Amazon music's millions of podcast episodes are calling. Just download the Amazon music app and start listening to your favorite true crime podcasts ad free included with prime. Okay, so we've talked about the first of your eight ingredients for developing the skill of resilience. The first is acceptance. The second picked right up on this notion of thinking and it is flexible thinking or embracing flexible thinking. What do you mean by that? Yeah, so in the book another incredible woman that I interviewed both for CBS and her work ended up in the book is Lucy Hone who is a resilience researcher herself. She lost her own daughter tragically in a car accident and so the woman who studied resilience had to implement it in her own life and in one of my interviews with her she talked about this idea of basically having a goal in your mind, having a goalpost and then thinking when something happens, okay, I'm going to pick up the goalpost and move it somewhere else and I just thought that analogy was so simple to understand that we can be going down a path of where we think we're headed and something happens and that doesn't mean that you're derailed. It means that whatever your vision was you have to have that flexible thinking to say I'm going to move my goals and put it somewhere else and so for her life's path changed when her daughter Abby died but she realized she still had her husband and her sons and she had to be there for them and create a new life without her daughter Abby so the goalpost moved. That's like the easiest way for me to explain that concept of flexible thinking. It's the ability to rework your vision of what you thought your life was going to be and create a new vision for where your life is going to be. I believe in the chapter on flexible thinking you also talk about harnessing the placebo effect. So we talk a lot about that in medicine. How is it that if I tell somebody here's a pill that's made of sugar and here's a real medicine and I give them the sugar pill they actually might do better and there really is a science there that just our beliefs that we're getting something that is actually helping us can actually help us and that is again speaks to what you spoke about earlier which is that mind-body connection which is extremely powerful and that Dan goes back to what we talk about in the very first chapter which is the stress response and so you know when something happens to you you have this whole pathway from your amygdala to your hypothalamus to your adrenal glands and adrenaline and norepinephrine and cortisol and all these stress hormones and so the converse is that if we are able to change that and rewire we can change a stress response to a resilient response and so you have to imagine if you can release all those stress hormones and responses stress in that pathway if you have a placebo effect might you be able to have the beliefs and release for example anti-inflammatory lower your stress hormones or reduce them or decrease inflammation so the mind-body works both ways and I think you can't just say it's bad you have to understand that if you're the mind-body is working in a negative way you can also harness it to work for you in a positive way simply by believing that something you are doing is going to make you better. For example if people in the wake of a difficult diagnosis or the loss of a loved one or the worried well who are there's no catastrophe in their immediate past but they're spending a lot of time wearing down their resiliency by being mired and useless rumination they can go do a form of therapy or go do meditation and just having the belief evidence-based belief because there's evidence for all of these that this is going to help me it kind of kicks in it brings on line parts of our nervous system that are helpful in healing. That's right I mean there is an incredible healing effect just by the belief that you can get better that you will get better. It's just so helpful to be reminded of that. Yes it's very easy to forget we just don't do a great job teaching people about the power of the mind-body connection to me that was really so important with this book was linking the roles of psychology with clinical medicine because no one's really doing that there's no bridge they need to be connected in order for us to really heal our patients and to help people why are they so separate it's kind of ridiculous so yes the mind-body connection works both ways. Another aspect of flexible thinking is denying future certainty so like not having this fixed view that whatever diagnosis you've just gotten or whatever's just happened to you is a guaranteed shitshow. Exactly it's denial used in a positive way for example and we talk about actually Richard Cohen in that section and again as a physician I see this all the time you know people who have 10 stents in their heart and they look at me and they say oh this means I'm going to die tomorrow I'm only going to be able to live till 60 and I tell them that's not true I have patients who live till their 90s you know this is not something that is a death sentence for you there's not a necessary outcome from this I have patients who you never think would live more than one or two years because they have end-stage heart failure and they live five six seven years nobody but god if you believe has insight into what the future holds for you and I think anyone who says otherwise in medicine or elsewhere is not correct frankly. I'm close friends with this great legendary meditation teacher Sharon Salzburg who has this riff that I've heard her go on many times about certainty and that most of us subconsciously or consciously embrace certainty because it's a bulwark against a chaotic world but it's a fool's errand because actually certainty makes you feel worse it's curiosity it's openness it's optimism as long as it's not like harmful optimism like I for example believing that I'm going to join the NBA probably not good optimism but like it's curiosity and openness that feels much more soothing than fixed views about how things are going to go. That's absolutely right and I think for so many people who struggle with anxiety for example it is this fear that things should be a certain way and if they're not that way the whole world's going to fall apart and it's really recognizing that no there is no certainty that things can fall apart and I'm going to survive it's a totally different mindset it's an acceptance that something may or may not happen we don't know and I can live in that state of uncertainty I think that is really the hallmark of how so many people learn to deal with anxiety is learning to accept the uncertainty. Third ingredient in Dr. Nouroul's resilience toolkit is get fit. Now we've all heard this but the way you put it is really interesting you say exercise is medicine. It is just like food is medicine there is just so much power in the movement of our bodies getting our heart rate up our muscles working how we approach fitness whether that's cardio or muscle or yoga or Pilates or whatever it is that is medicine that helps us we've seen it in a million ways and research you know that exercise helps with cardiovascular disease and cancer and our bone health and dementia risk the list goes on and on but it is hard for people to again I think recognize how powerful exercise is just like it's hard for many people to understand how powerful nutrition is they think how could food really be that powerful in terms of changing the course of what might happen to us physically but it is and it's the same with exercise. What are hope molecules? Hope molecules hope molecules molecules that are released that basically endorphins sort of when we exercise that allow us to feel better like endorphins essentially. It's really cool to know that just getting your body moving can have all these kind of magical physiological and psychological effects as well as eating well and in this part of the book you also talk about prioritizing quality sleep. Yes and yet we all know this and most of us don't do it. Yeah. What do you tell your patients about actually doing this stuff that is super obvious but under subscribed? The first is obviously educating people about how important it is for example sleep I think we all take it for granted and I was just having this conversation with someone the other day I mean I ask all my patients about sleep and exercise and diet and stress and mental health and for many of them all those other things are in line and it's 90% of people tell me like the sleep is where they fall short and it's the easiest thing to sacrifice. I'll just stand up later and do this and we don't recognize that that time where we're out so to speak there's so much happening inside our body that is beneficial so for a lot of people it's just understanding the biology and we don't again do a great job teaching this in terms of how antioxidants in the foods we eat or the endorphins we release with exercise or how we're able to process blood sugar better exercise or with sleep the fact that you're clearing toxins out of your brain we don't explain the biology and I think people if they understood the biology more it would make sense and they might be more willing to do it number one but number two I think it has to be a priority and it's hard work just like we said you have to say I am going to make it a priority to try to get my seven to nine hours of sleep every night if that means I'm going to not get something done that I would have get done you have to make it a priority I get up every morning at five try to go to the gym I hate it but that's the only time I can do it you have to make it a priority to read the nutrition labels like no one wants to sit there and read the labels but how are you going to know how much fats in your food so all of this is effort effort effort once you get in the habit once you get in the routine it becomes easier like everything else the more ingrained in the more you do it the more it becomes part of your routine okay I'm gonna this is my daily time to exercise this is how I'm gonna eat I know I should go to sleep so I'm gonna go to sleep but it has to become routine and habit and you have to make it a pattern to answer your question I think it's understanding the real biology behind why it works but number two really making a concentrated effort to do these things in your life even when it's difficult it's much easier to take a pill it takes two seconds to pick up your water bottle and swallow a pill or have surgery you I mean it's not easy to have surgery but you go in an hour you come out something's missing it's much harder to do these lifestyle choices that require mental effort and sacrifice your sacrificing maybe time with your family or time doing something else to go to sleep you're sacrificing eating a pizza for eating something it's you're giving up something for the goal of something that you maybe can't see that's happening internally and that's also very hard I think too one thing that's been really helpful for me and I've thought a lot about habit formation and it's it is as I often say diabolically difficult and we've done plenty of episodes about how to adopt healthy habits in fact I'll drop a link in the show notes to a solo episode I did where I kind of laid out all the best tips from the researchers who look into how we can adopt these healthy habits despite all of the internal and external obstacles but the one thing that for me has been very helpful and this is an evidenced based assertion I'm making here but is self-compassion which sounds a little dopey a little soft but it is one way to think of it is just the ability to talk to yourself the way you would talk to a good friend to have to establish and develop an inner coaching relationship so the kind of supportive voice that says yeah it's 10 o'clock at night I would like to stay up and watch three more episodes of Parks and Rec but I will feel so much better if I go to sleep the Parks and Rec will be there tomorrow you're better off going to bed and then when you inevitably screw up because I screw up all the time I often think that there needs to be some word in English for the special shame that we feel for making the mistake that we thought we had figured out and that we always make and that we know better than to make and yet continue to do a million times over we need a special word for that like compound fuck up that is like so common for most of us but what I have found what I don't have the word for the thing but what I have found as a remedy for the thing is just talking to myself like you know this is millions of people are having this same shame spiral right now it's all good you know you get it this is like a golf game with a million Mulligans you can start over as much as you want. That's exactly right and I think that's what I was going to say when you said self-compassion is I think so many people beat themselves up when they thought they were going to exercise three days a week and they only did it two days a week or they went out and had a dinner that they didn't and then it sort of throws them off completely and they're like oh my god I just ruined everything and then you start to kind of spiral and we're human we're allowed to fall here and there and then we just pick up the pieces and move on you know one misstep here and there is not going to change the trajectory right so it's the overall overarching road that you're on you're off a little bit you're back on you're off you're back on but you're going in the same direction and I think yeah if we have a little bit more compassion for the fact that we're human beings and we're not always going to get it right and do it the way we should but that's okay as long as we have the vision of where we want to be and we're trying to stay on that path. Ingredient number four is face your fear say more about that. Yeah this kind of speaks to what I said when you know people are really paralyzed in that moment of something happening like I was when I lost my vision and it's this idea of how can I even begin to approach life when I'm so afraid that something might happen again and you know this is what I've heard from my patients who've had for example a mini stroke or a stroke and then it's like well what if tomorrow I have another stroke or what if I am out somewhere and I can't suddenly move or the fear is like overwhelming that whatever it was that happened to you is going to happen again that health anxiety and I see it with people who've had cancer whatever the medical issue is you name it people are afraid and in order to be able to kind of heal and move forward we have to face those fears and I think one of the best ways to face it is through therapy I think that's a very helpful way to actually tackle that number four of facing your fears because I think working with someone who can help you identify why you feel that way how you can approach when you start to feel afraid what you can do in those moments reworking your vision of what has happened to you and how processing it I think therapy is immensely important for that number four kind of tool but in order to kind of progress we can't run away from what's happened to us we can't let it overwhelm us and consume us we have to deal with it to be able to then move forward. So therapy can be great for validating the trauma which as you write about is really important you have to acknowledge what's happened in order to you want to be seen and that's a huge part of the healing and then we have to start facing it and therapy can be helpful for this as well you use this term in terms of when it comes to the facing of the fear stepwise exposure. Yeah obviously in therapy that's used a lot for example exposure therapy so you're afraid of heights and so maybe you go and you walk up one flight one day and you kind of get used to that and then over time you're able to walk up two flights and walk up three flights like this is a proven technique in therapy for people with anxieties in particular and phobias and it's the same concept with health anxieties or something that's happened to you and I use the example in the book of my brother-in-law actually who had a heart issue and ended up with a stent and a heart attack and he was a outdoorsman he loved being in the wilderness in the woods in the middle of nowhere without anyone around except the animals and after this happened to him he was afraid to go hunting again to go out into the wild and it was sad for all of us who knew him to see that medical issue take away something from him that was so incredibly important to him and his lifestyle and who he was and so we had a lot of conversations on the phone he lives in upstate new york where you know we talked about okay time is going to be helpful in terms of your healing and you take baby steps so don't go out into Alaska you know to go on a hunting trip tomorrow maybe go for a drive into the state park a little bit with your dog and walk around and then maybe in a few months go on a trip somewhere else more locally so if you need to be near the hospital in syracuse you're close enough that you can get there and little by little this is this is what he did and little by little he realized that even though he had a stent and he had survived the widowmaker heart attack he could still have a life that he loved and enjoyed he could still go hunting and he could still be out in the middle of nowhere you know that was like a great example of kind of that stepwise approach to little by little building back into your life things that you like to do and not allowing the fear to kind of overtake you coming up Tara talks about how reframing your identity can help you move forward after illness trauma or loss why connection love and little acts of kindness are powerful and underused medicine and how hope faith and purpose shape resilience healing and long-term health I feel like my skin is looking better these days and I believe that a big part of that is that my evening ritual my wind down routine before I go to bed now includes putting a product called Osea on my face it's a moisturizer specifically I use Osea's dream night serum which is a clinically tested formula powered by bio retinol and designed to help reduce the visible effects of stress on your skin while you sleep plus it smells great which doesn't hurt as a part of a wind down routine give your skin a rest and say good night to dryness dullness wrinkles and lack of firmness Osea has lots of products and not only the dream night serum that I've been using but also the dream night cream they've also got their newest product which is the dream 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on the Wayfair website many times ordering stuff huge selection of stuff for inside the home and also for the backyard in fact if you're looking for a spring refresh they've got outdoor furniture patio decor lighter bedding if you are like my wife an inveterate organizer Wayfair has closet systems storage solutions garage organization if you work from home they've got desks ergonomic chairs shelving as I've already mentioned Wayfair makes it simple to narrow down to exactly what works for your style and budget and they've got installation and assembly services for a truly seamless experience thousands of five star reviews help you shop with confidence fine furniture decor and essentials that fit your unique style and budget head to Wayfair.com right now to shop all things home that's wa y f a i r dot com Wayfair every style every home another aspect you write about when it comes to facing fears is cognitive reframing and you talk about an exercise called the identity pie yes so in the process of researching the book I spoke to a lot of psychologists and one in particular who works at Mount Sinai's wonderful Dr. D. Piero I thought this was an amazing example of really recognizing we are not just what has happened to us we are so much bigger and he used the example of drawing almost like a pie and cutting it into pieces you know and so in one piece you are the wife or the husband and another piece you are the journalist and another piece you are the sister and maybe you're an athlete and there's a part of that pie that is the survivor of whatever has happened to you but that is not the whole identity of who you are and I thought that was such a great way to help people understand that that is not what defines you that is like a part of who you are and actually this just came up I don't know if you just read Tatiana Schlossberg's article on her cancer she in the article said exactly that in one line that I am not my cancer this is not who I am this is not to find me and I think it's very easy for us to allow something that's happened to us to overtake us and that becomes who you are but I am not just a cancer patient I am a wife and a mother and this and that and all of these other amazing things so again it's taking a step out and looking at yourself from almost like floating out of your body and from a bigger perspective and it's very easy for us to kind of be stuck in the weeds of what has happened and that's why I love that identity pie example. I like it too. Ingredient number five, connections. Not a thing most doctors prescribe although they should. Yeah so one of my close friends and my former resident at the Brigham was Vivek Murthy who has been extremely helpful in terms of reframing how we think about loneliness and connection in this country through his writing and his speaking about it you know we are finally beginning to recognize that how involved we are with other human beings actually has an impact on our physical and our mental health and that it is important for us to cultivate that and so I do talk to my patients a lot of them are older and maybe have lost a spouse or are living alone about you know what is it that you love to do you have a hobby maybe you could join a group where you could do that hobby or a walking club or if you have a religion that you are part of something with your church obviously now with Facebook there's all kinds of groups people can join on social media people who are survivors so for example in my world of cardiology the Go Red for Women campaign has been incredibly helpful for women who are survivors of heart disease to see other survivors to talk to them to share their stories so there's so much power in whatever those connections are whether it's a big group whether it's people who have the same interest of you or whether it's one connection you know one person just one friendship but that is healing and that's really important and we are not meant to be singular alone creatures in our own little world and so yes I think it should be prescribed to everyone to cultivate that to foster that in again in whatever way feels right for you depending on who you are and what you love but it is important to be Harvard centric for a second you've mentioned the Brigham and women's hospital which is a Harvard hospital and Boston where my dad happened to work for 30 years he was the head of radiation oncology there for a long time oh my gosh well that's where I did my residency you might have seen him shuffling through the hallway he's not there anymore anyway also at Harvard there's the very famous Harvard study for adult development which has found that the number one variable for longevity is not how much you're sleeping how good your exercise game is it's how healthy your relationships are and so isn't that amazing yeah and it's increasingly amazing when you consider that it's not a thing most doctors recommend to people or even inquire about yeah well we talk a lot about things in my exam room that probably a lot of people don't talk about but good for you that's great literally good for you so along those lines on connections in terms of the how to because this is a thing people often hear oh we're social animals we need to have healthy relationships but how do I do that you actually do talk about the how there's a phrase you use I'd be curious to hear you unpack it find remind and bind yeah finding things that you love reminding yourself of that and then finding others who you can connect with in that way that is it's sort of like relooking at yourself who am I what do I love what is my identity reminding yourself of those things and then finding others that you can cultivate those connections with that may have similarities with you that's why I said whether you're an artist you know maybe an art club or you're a writer or you like to read you know go to libraries so in order to build those connections sometimes it just starts with sort of understanding what it is that you enjoy what it is that makes you tick and then seeking that out and others who will share that with you another thing you recommend which is much less ambitious much less takes less you know get up and go but is incredibly impactful is just to engage in small acts of kindness just say a little bit more about that if you don't mind yeah well this just came up actually this weekend my yeah my mother was in town for Thanksgiving and she said to my daughters you know do you ever do little acts of kindness around the holidays and my daughters said you know well what do you mean grandma and my mom explained you know sometimes when I go to the grocery store if someone's in front of me in line I will pay for their groceries or you know if I see someone that needs help I will help them through the door or little things that are totally unexpected and she said to my daughters and we said to her well that's so great that you do that she said it's great for everyone else but it's great for me too she said it makes me feel good on the inside to do these things for other people and I think that is so much a part of the small acts of kindness obviously you're extending yourself to someone else and helping them but it does release those same sort of feel-good hormones in you to be compassionate and caring in that way and make those small little connections it speaks to I think many of us have this view conscious or subconscious that there is a bright line between self-interest and altruism it's just like trying to divide physical health and mental health you can't do it and so altruism is good for you it is exactly that's exactly the point so it is good for someone else but it's actually also good for you okay chapter six or recommendation number six it picks right up on connections it's about love seeking out love I'm curious how are you delineating between love and connection yeah it's different that was important for me to put as a separate chapter in the book because connections are as we said it's a little more distant it's a friend that you go for a walk with someone that's at your church someone that you play mahjong with or talk to on the phone it elicits a different reaction than love which is that much more intimate connection and I think for me the chapter on love wasn't just also about love with someone else it was about love for yourself and that was very important too again in order to do anything we have to be able to love ourselves we're not going to be able to accomplish or be resilient if we are hard on ourselves so it's giving ourselves that grace and that self-compassion that you just talked about so it is both self-love and it is also seeking out that very close love that I have seen again help patients heal that's why for me these chapters were born out of what I see every single day in the patients that I treat and I see the husbands and wives that come in together to support each other and how they've helped each other through whatever the diagnosis is or the mother and the daughter who come to every appointment together or the sisters I mean there is no question that having that connection that is deeper allows people to heal but also to prevent you know there's a reason why they say married couples live longer there is no doubt that being so intertwined in that way helps you take those steps to prevent like we're going to exercise together we're going to eat healthy together we're going to take our medicine together I'm going to go to your doctor's appointment with you that I know you don't want to go to but then when something does happen that's difficult having that person by your side to be there with you no doubt helps people recover and heal I don't have the data to hand here and I may be remembering this incorrectly aren't the health benefits of marriage disproportionately conferred upon men I don't know I don't think so but maybe it just feels right whether it's right or not it feels right I will say that it is more often the wives sort of bringing their husbands to the appointments than the other way around so it may very well be a side note what is going on with mahjong you mentioned mahjong like I remember my Jewish grandmother playing mahjong at Polynesian gardens her like condo in plantation Florida 50 years ago and now mahjong has taken my wife's social circle by storm yeah it's having a renaissance rebirth okay so so um moving away from mahjong though there's one little thing I want to ask you about in the realm of love it's oxytocin which many many of the listeners may have heard of but just give us a primer or primer I never know how to pronounce that word on oxytocin so this is sort of what we call the bonding or the love hormone so for example it's released when we classically think about it when mothers breastfeed and you release oxytocin when you're breastfeeding your baby and clearly it's that moment of bonding but it's also released when we are intimate with someone you know when we are physically close to someone and so again showing that there are chemical reactions in our body and hormones and things that happen simply by touching people and being close to them physically and affectionately and and that can be a very powerful thing so you know it's again important to explain that the biological underpinnings of a lot of what we just don't recognize is even there but oxytocin is the love hormone we call it if my wife's mad at me which is not an infrequent occurrence can I get the oxytocin from the cats you might okay ingredient number seven hope and faith this is something else a lot of positions sort of steer away from but I actually feel very strongly about that we need to talk about in terms of helping our patients heal and be resilient I give the example in the book of when I again was in medical school I had an attending who was an oncologist and she told all of us medical students a story that stuck with me about seeing a patient who had end stage cancer but could have probably lived for at least another year or two but a different doctor came in the room and in front of the patient and in front of all the residents who were rounding made a comment saying you know well he failed this round of chemo he's probably only gonna live you know another few months and she said you know it wasn't shortly after that conversation in front of the patient that the patient died and she said to us as medical students you know it's very important that you never take hope away from a patient and how powerful hope can be and I never forgot her words and so I used them to this day we talked about this with certainty and uncertainty so when people say you know what does this mean I've just had a defibrillator placed I had a cardiac arrest you know what does this mean my life is over the answer is always we don't know we're gonna approach this day by day we're gonna do everything we can to help you through this to help you quality of life but no one can really predict and I think that's the truth because nobody can and when we think we can there is that again biological reaction that is so powerful that literally by telling someone this is it something turns off inside and so taking away hope is not a thing I think we should be doing in medicine or ever and faith sort of the counterpoint to that I think we steer away from talking to our patients about their spirituality and their practices but for so many people that is what keeps them going and so there is a whole body of science and medicine around a spiritual history so for example making sure we ask our patients what is your faith and what do you practice and patients surprisingly want to talk about this they want you to understand this very huge chunk of their identity as we talked about who they are and how that plays into their life and it does it plays into how they are going to approach whether they want to have surgery or if they take their medicines or if they want to be resuscitated with chest compressions when they go into cardiac arrest or they want a defibrillator so how do you take that out of how you're caring someone when it's so intertwined for so many people in the choices that they make and so again if you really want to understand the patient as a whole the person as a whole you have to understand what is important for them in terms of faith and for some people they don't have a strong spiritual faith and that's fine but that's important to know and understand and in the same way for others it is really what carries them through a lot of these challenges and I've had so many patients tell me you know when they've been hit with hit after hit pancreatic cancer and then they have this and they have that and I look at them and they say it's my faith and I see it you know they have their cross around their neck or whatever it is we talk about that very openly in my exam rooms because I know how much it matters. I'm not even sick but I feel like I would benefit from spending some time in your exam room. You're welcome to come. Everyone should get a cardiac screening so you should come in for your cardiac screening, Dan. Yeah, I may take you up on that. Okay, we've made it to the final of the eight ingredients and that is purpose. Yes, so again this kind of goes back to that goalpost movement but when something's happened to you and you need to keep going and you want to keep going having a purpose or having something that you are aiming for that you're fighting for that you're living for can become really valuable and helping you thrive and that is going to be different for every single person what that purpose is for a lot of people when something has happened to them their purpose becomes engaging in that particular thing that's happened to them. So for example in my reporting on gun violence as a public health issue I interviewed parents who'd lost children to guns either died by suicide or in Newtown Sandy Hook and another woman who I interviewed whose son was playing with a gun with another boy and the gun went off accidentally and all three of these parents became involved in working to find solutions to ending gun violence and understanding that it is part of how we need to approach public health right so that was their purpose. For other people I interviewed another woman who had bipolar and was in and out of the mental health care system for years and misunderstood and she wrote a book and now she's traveling across the country donating her book to raise awareness about bipolar and mental health and suicide. For my patients who have heart disease many of them want to join the campaign for the American Heart Association to help others so for everyone that's going to look different but I think for so many people that force that's like it's inside of you saying I still have so much I need to do I have a purpose here on this planet so I know this has happened to me it's changed my trajectory it's scarred me in some way but I am still going to keep going because this has now become meaning for me and that's why it was really important for me to have that be the last part of the ingredients because I think it is like the vision of your future where you are investing and where you're going and what's driving you. And there's some physiology here that people who have a clear sense of purpose they experience less intense bodily responses to stress. Exactly as we talked about kind of like there's the stress response that can cause negative reactions and then by having purpose and you know practicing some of these other techniques we talked about you are turning your dialing down the inflammation you're turning down the adrenaline response and the cortisol and all of that so again it works both ways and that's what we have to start to understand the same way that the stress can be negative we have the power in us to actually harness our body to do the opposite whether it's releasing oxytocin you know or the hope molecules or any of these things inside of us dialing down inflammation that's in our power and that's I think what's so we talk a lot about this in cardiology that 80% of cardiovascular disease is preventable by what you do in your life we have so much power in our hands to help ourselves to heal ourselves we just have to know how to harness it and how to do it. Another aspect of purpose links back to one of the previous ingredients in the resilience toolkit of getting fit having purpose as I understand it can help you do these behaviors that are healthy but annoying for example you know every time I can't believe I do this because I have long made fun of people who do prayer hands but every time I like get on the spin bike or sit in the sauna which is really uncomfortable I'll just make a little prayer hands be like but yeah I'm doing this so that I can be stronger and happier that's right so that I can make other people stronger and happier that's right that top spin helps me you know get on the bike or get in that ridiculously hot room you're right and I will say like for a lot of my patients a lot of their purpose revolves around family and so for many of them they will say to me I want to do this because I want to walk my daughter down the aisle or I want to see my grandkids graduate from college and so they find that drive to exercise and to eat well and to lose weight and to manage their stress and to sleep because they have a purpose they want to see that happen in the future and they know that that's how they're going to get there so you're absolutely right use a phrase in this closing section of the book give your gift away what does that mean so actually I have that sitting here so this you can't see it probably but this is the quote sent to me by my patient one of my patients it's a quote that says the purpose of life is to discover your gift the work of life is to develop it the meaning of life is to give your gift away and so he is an artist my patient and he created a beautiful he makes cards and he created one for me and inside he gave me this and wrote a beautiful note and I keep it on my desk always because I think again it speaks to that purpose right all of us in my opinion are here because we have something to do in my opinion it's to learn to love ourselves and others I think at the end of the day that's what our purpose is but hopefully it's to also leave our mark in terms of bettering the world and I think for each of us that's in a different way and so when we can recognize that we each have that gift that we need to give back that becomes a driving force that allows us to be resilient despite whatever happens to us so again it is that kind of altruistic thing that we talked about where you're giving your gift away but it's also benefiting you Dr. Nerola before I let you go can you just remind everybody of the name of your book and any other stuff that you're making that we should know about on social media or elsewhere the book is the healing power of resilience and it's going to be published January 20th 2026 and I am very excited to finally have this child be born I've had two real ones but this is the third one so I'm excited for it to be out there and I truly hope that you know this helps people through any challenge Dan that they have in their life whether that's medical or other and I also hope that it opens the eyes of those in the medical establishment to understanding that we should be creating resilience training programs for our patients and building them into how we practice medicine in every single medical school and hospital in this country that the mind body psychology physical has to be woven into how we help care for patients and how we help people heal amen and you can also catch Dr. Nerola on this random obscure news network called ABC news oh yeah that yes you can find me on ABC news mostly on Good Morning America and on social media at Dr. Tara Nerola on Instagram and Facebook and LinkedIn and X and you know all of the above Tara thank you great job really appreciate it thank you so much Dan for the opportunity thanks again to Dr. Tara Nerola in the show notes I'm going to drop a link to a solo episode I did where I laid out all the best tips from the researchers who look into how we can adopt healthy habits it's kind of my masterclass on human behavior change everything I've learned whittled down there's a link right there in the show notes if you want to check it out I also am dropping a link to danharis.com where you can get my new app 10 with Dan Harris free 14 day trial lots of guided meditations weekly live video meditation and q&a sessions you should join the party finally thank you very much to everybody who works so hard to make this show our producers are Tara Anderson and Eleanor Vassili a recording and engineering is handled by the great folks over at Pod People Lauren Smith is our managing producer Marissa Schneiderman is our senior producer DJ Kashmir is our executive producer and Nick Thorburn of the band Islands wrote our theme hey it's Howie Mandel and I am inviting you to witness history as me and my Howie Duet gaming team take on Gilly the King and Wallo to six sevens million dollars gaming in an epic global gaming league video game showdown four rounds multiple games one winner plus a halftime performance by multi platinum artist Travi McCoy watch all the action and see who wins and advances to the championship match against neo right now at global gaming league dot com that's global gaming league dot com everybody games tax refund season is here save up to eight hundred fifty dollars at mattress warehouse plus get a free adjustable base with select purchases and every mattress at mattress warehouse is backed by our lifetime price guarantee make your refund go farther only at mattress warehouse