Melanie Cole, MS (Host): UAB Medcast is an ongoing medical education podcast. The UAB division of continuing education designates that each episode of this enduring material is worth a maximum of .25 AMA PRA Category 1 credit. To collect credit, please visit uabmedicine.org/medcast and complete the episode’s post-test.

One interesting approach when you're considering wellness is to observe the satisfaction of core human needs that are related to our sense of flourishing. Assuming our basic material needs for food, water, and physical safety are adequately met, what do humans need to flourish? Welcome to UAB Medcast. I'm Melanie Cole and today we’re discussing the four C’s, a guide to mental and emotional wellbeing. Joining me is Dr. Michael Wiederman. He’s the director of leadership and professional development in family and community medicine at UAB Medicine. Dr. Wiederman, thank you so much for being with us. This is such an interesting topic. I think that it crosses all the lines of the typical podcast we do here at UAB between providers, patient care, patient satisfaction, and provider wellness. So before we jump into those four C’s, how does our mental health influence how we think and feel and behave in our daily life? How does it effect our ability to cope with stressors, overcome challenges, and be resilient to recover from life’s setbacks and hardships?

Michael Wiederman, PhD (Guest):   Well, I think you sort of implied in the answer in the sense that our mental capabilities are our own tool for dealing with the world and being effective and doing what we do professionally and personally. So if that tool or that motive of being in the world is impaired due to decreased wellness and wellbeing then that’s going to effect literally everything that we do regardless of whether we realize it or not.

Host:   Well as I said in my intro, assuming our basic material needs are met, how is wellbeing defined Dr. Wiederman? How would you define it?

Dr. Wiederman:   I would define it as humans we have more needs than just those basic needs. Once those are met to really be satisfied and to feel like we’re actually living a full life or living our best life or whatever phrase you might want to use, there are these sort of other needs that psychologists have identified that are more mental, emotional, and really form the core of whether we feel like we’re doing well in the world and that there’s purpose and meaning and a reason to live.

Host:   Is there a way to measure that Dr. Wiederman?

Dr. Wiederman:   Well measure is a tricky word, but certainly psychologists have identified pans full of these core needs. So I like to sort of lump them into or label them the four C’s as a pneumonic to remember what they are, but there's certainly four that psychologists agree upon.

Host:   Well then let’s talk about those as we’re looking at evidence based practices that can help to promote growth in each. So why don’t you start with your first one and give us a little background and some examples.

Dr. Wiederman: The first one in my mind we’ll call contribution or calling. We could call it either one. It’s the idea that we humans have   a need to feel like what we do matters. It doesn’t have to be in a worldwide scale or that we’re changing the world, but that there is some purpose in what we do and that it actually matters to someone. That we’re contributing to something larger than ourselves. Again, that sense of calling or contribution. It could be raising a family. It could be engaging a good patient care. It could be involved in some kind of hobby or avocation and feeling like we’re actually, again, contributing to something beyond just our world or selfish needs.

Host:   That one is really interesting to me. As someone who educates the public and helps to educate by bringing on experts such as yourself, I feel like I'm making a contribution. That word calling is an interesting word as well. If somebody doesn’t have that calling, if they don’t feel like there is something that they can do to make the world a better place, do you have some advice on ways that they can look for that?

Dr. Wiederman:   It doesn’t have to be anything large or overarching arc. So I like about some research showing that when people volunteer to help others that that really boosts their wellbeing and resilience. I attribute it to that very fact that when we help others, it does give us a sense of satisfaction that we are actually contributing to another person’s wellbeing or another group’s wellbeing. So I think that’s a nice easy one to start with is to find something to start with that interests you around volunteering and contributing to those that need your help.

Host:   That’s great advice. So give us another of the four C’s Dr. Wiederman.

Dr. Wiederman:   So the second one I would call competence or capability. So as humans we have the need to feel like what we do is generally effective. That we have some level of competence in what’s important to us. Maybe even more importantly that we’re getting better or that there’s improvement or that I'm learning and growing. So that’s the capability part of it.

Host:   Let’s expand on that a little bit more as well as we continue to learn. I have a 96 year old father, Dr. Wiederman, and he’s still always trying to learn. So to what degree do we know that we’re competent at something because some people feel like they are when others maybe feel like they're not. How do we know and how can we keep improving on that?

Dr. Wiederman:   Well, that’s a great example. Some folks are familiar with the Krueger-Dunning effect which shows that people who know the least about something tend to be the ones to overestimate their ability. So to me that fits here because the more we learn about something, the more we realize the nuances to it and the more we realize what we don’t know. So that’s why the true experts in a field are less likely to even label themselves as experts. Because even though they are objectively, they realize that they don’t know it all. So I would say in that regard to sort of know what you don’t know, you have to sort of plow into an area or a topic and try to learn as much as you can and start to open your eyes to that area.

Host:   That is really a great piece of advice. Know what you don’t know because then we’re forever learning. It adds a little humility to whatever it is that we’re doing that we feel competent at. So why don’t you give us another one of the four C’s?

Dr. Wiederman:   The third one I would call control or choice. This one I think most of us can resonate with on a daily basis or an experiential basis that we humans have a need to feel like we have some choice and some control over what we do and how we do it to the extent that that choice is taken away. It can be very demoralizing to do something. Even if it was something we wanted to do but we have no choice and people are telling us how to do it or that we must do it.

Host:   Another interesting one, because some of us don’t have the choice we wish we had. So when we’re talking about autonomy, what if you are someone who maybe financially doesn’t have the choices you’d like to have, educationally, family. How can we change that one just a little bit?

Dr. Wiederman:   So many ideas are running through my head. One is to really maybe just focus on our mental framing of it. So I might fall into talking about things well I have to do this, or I must do this, or I have no choice. If I back up and be a little more objective, it may feel like I don’t but in reality I always have the choice. There may be terrible consequences if I decide not to do something, but it still is a choice. So if I can sort of take that step back to realize that I'm doing it for my family or I'm doing it for my future. So yes, it’s not the ideal right now or it’s not what I would choose if I had the choice. Again, to get that little bit of objectivity which is really at the core of cognitive aspects or cognitive approaches I should say to counselling and therapy. So there are lots of good self-help books out there that help us with our language, help us with our sort of how to frame our experience so that we’re not unnecessarily causing ourselves to feel negatively about it.

Host:   I'm going to stick with this one for just a minute Dr. Wiederman. In this unprecedented time and the anxiety level is really through the roof, people are feeling that they don’t have control. They don’t have control of whether they have a job. They don’t have control of whether or not if they get this virus it’s going to be something that lands them on a respirator. All of these things feel outside of our control. Is there some advice you can give us for emotional wellbeing that will make us feel that somehow, even in the smallest way, have control of our tiny little universes?

Dr. Wiederman:   I think you hit it right on the head. Why this time is so anxiety provoking because it’s the lack of control. So you're right. I think this really highlights why this is such a core human need or how it is a core human need. I don’t know that this is going to be very satisfying, but I think to draw what I refer to as a priority table. So if you can picture taking out a sheet of paper and making a two by two grid. On the top label the first column urgent and then the next column less urgent. Then the side rows the first row important and the bottom row less important. Then just sort of walk through what you do on a day to day basis and what’s expected of you and sort of plot out where those tasks or responsibilities fall. I think sometimes we fall into doing a lot of things that are urgent that aren’t necessarily very important, but it’s the urgency that pulls us into having to do them or feeling like we have to do them. What we often neglect is that upper right corner which are important things that are less urgent. There I would include things like relationships and recreation and things that are in planning, reflection, things that are very vital to our wellbeing, but we tend to ignore those because of the tyranny of the urgent.  

Host:   That was actually very satisfying as someone who is a bit of a control freak. Well, my kids would tell me that anyways. I am a list maker. I do exactly what you just said. So hearing you reinforce that and that some are urgent, but some are just desires that we want. We make this list and it’s very satisfying when you do get to cross things off. Let’s hit the last one now, connection and community. I think this, for some people, may be the most important of your four C’s.

Dr. Wiederman:   Yeah, absolutely. So as humans even if we don’t feel like we’re a people person, we are wired to need to feel like we have some connection or sense of community. So it’s not that we expect everybody to like us, but that we do feel like there are people who respect us and like us and there is a tribe to which I belong or a group of people with which I identify.

Host:   Again, back to what people are feeling right now. As someone with teenagers and anybody, physicians as well, are feeling this in such a strong way as some of them—surgeons specifically—can't even really go home. Or we’ve seen stories about people staying in trailers outside of their house. So this connection right now is what some people are missing the most. Do you have some really good advice for us about people feeling that sense of connection when we have to be at a certain distance and some people cannot even see those that they love?

Dr. Wiederman:   Yeah. I think, again, just like with the volunteering it doesn’t have to be something that is long term. We get little boosts from connections to people that are very fleeting and that may be strangers. As a practice that psychologists refer to as engaging in daily pro-social behavior. It’s just a fancy way of saying I'm going to start the day by saying today my goal is to give three genuine compliments to people I encounter throughout the day. I'm going to keep track of whether I do that. Make a little tally or put three rubber bands on my left wrist when I start the day. The only way to get each rubber band to the right wrist is I have to give a compliment to somebody that’s genuine. So it prompts us to do little things when we interact with others to have that human connection, even if it is sort of fleeting. Research on this shows that people who engage in it for several days end up having better wellbeing and actually long-term effects for trying this for let’s say a week.

Host:   That’s really important information. Wrap it up for us with your final thoughts on a guide to our mental and emotional wellbeing for providers that are feeling more stress right now than they’ve probably felt in their careers except maybe in medical school, and what you’d like us to know about using those four C’s to center ourselves and to help guide our emotional and mental wellbeing.

Dr. Wiederman:   Yeah. I think with regard to giving yourself some permission to realize that these are unusual times and that we do need to spend more attention and time focused on our own wellbeing if we’re going to be of any use to others. That certainly other people around us are struggling with their wellbeing. So how can we use these four C’s as just sort of a tool or a guideline for taking some time to reflect on how am I personally doing in each of these four areas? What little thing can I do in each of these four areas to help get me through this tough time? Then even in regard with others who may not be familiar with the four C’s, how might I reflect on what they might need in each of these areas? How might I contribute or help them with each of these four domains?

Host:   It’s great information. What an excellent episode. Dr. Wiederman, thank you so much for joining us today and sharing your incredible expertise. It’s something that I think we all needed to hear right now. So thank you, again. A community physician can refer a patient to UAB Medicine by calling the MIST line at 1-800-UAB-MIST. That wraps up this episode of UAB Medcast. For more information on resources available at UAB Medicine, please visit our website at uabmedicine.org/physician. Please also remember to subscribe, rate, and review this podcast and all the other UAB podcasts. I'm Melanie Cole.