#146 - Guy Winch, Ph.D.: Emotional first aid and how to treat psychological injuries

KEYPOINTS

• 01

  We treat physical injuries reflexively but ignore emotional ones

  Guy Winch, a New York psychologist in practice for nearly 30 years and co-host of 'Dear Therapists' with Lori Gottlieb, wrote 'Emotional First Aid'. He was annoyed that every home has a medicine cabinet but none has a psychological one. He argues that failure, rejection, guilt, loneliness and low self-esteem are injuries that worsen when untreated, just as a wound gets infected.

• 02

  Our instincts for emotional injury are evolutionarily young

  Every animal worries about physical injury, but caring for emotional injury depends on language, which may be only about 50,000 years old. Winch's conclusion is that we don't have another 5,000–50,000 years to work it out, so the skills need to be taught deliberately.

• 03

  Rumination is replaying, not thinking

  Rumination feels productive ('something's troubling me and I'm thinking about it'), but it is an emotional hamster wheel. Research suggests two to three minutes of a task that needs concentration, such as a memory task or a puzzle, is enough to make the urge pass. Then reframe the worry as a problem to solve. 'I have so much work' becomes a scheduling problem, and putting it in your calendar eases both the stress and the urge to ruminate.

• 04

  Guard rails between work and home matter most

  Winch calls this the most important step. Choose a time, say 7, 8 or 9 p.m., after which you're off, tell everyone, and build rituals of transition: change out of work clothes, put on music, change the lighting, and get into 'ten-year-old mode' with your kids or romantic mode with your spouse. You have an obligation to show up mentally for the people at home.

• 05

  Change the habit rather than medicating rumination

  Winch says referring a ruminating patient to a psychiatrist straight away often skips the real fix. The habit sets you up to ruminate, so changing it is more effective than suppressing the symptoms.

• 06

  Most complaining is venting, and venting makes you feel powerless

  Research from customer service shows that about 95% of people with a complaint about a product never raise it, because it seems too hard. Instead they tell 12–16 people about it. Retelling a story of being wronged without acting on it reinforces a sense of victimhood. Complaining used to be transactional: if the blacksmith fitted the horseshoe wrong, you went back.

• 07

  Social comparison can make success invisible

  Winch says that on any metric he could name, he could find 10 people better than him in 30 seconds. He sees patients who went from nothing to $20 million but don't feel successful because a peer made $50 million. Attia admits he struggles to acknowledge any achievement, such as shaving a lap from 1:16 to 1:14 after months, before moving the goalposts.

• 08

  Positive affirmations can backfire

  Positive affirmations are a multi-million-dollar industry. Research shows that generic ones ('I am going to be a great success') help one specific group but harm those with low self-esteem, the very people they target. The statement doesn't feel believable, so it reminds them how much they feel like failures. Useful affirmations are believable, hopeful and goal-setting, and too long for a fridge magnet.

• 09

  A good therapist retells your story so that you're no longer stuck

  In a first session, Winch listens and then tells the story back with a different account of why you feel stuck and what to do. Attia compares it to being shown an onion and seeing it has 12 layers.

• 10

  The pandemic changed how organisations see emotional injury

  Winch says it moved the dial more than anything else because few people escaped stress, grief, loneliness or relationship strain. Organisations that would never have contacted him now ask for talks; one was to 7,000 front-line health workers. Therapists are already full, so online interventions for loneliness and anxiety are being studied as a way to scale.