#54. Self-Injury and Emotion Regulation - Dr. Kealagh Robinson

Nonsuicidal self-injury (NSSI) is a self-inflicted act that causes pain or superficial damage but is not intended to cause death. Dr. Kealagh Robinson, of Massey University, works in emotion and emotion regulation, with a specific emphasis on how these factors underpin self-injurious thoughts and behaviours. She discusses the role of emotion regulation in self-injury behaviours and some fascinating results from her latest study which demonstrate that the role of emotion in NSSI is more complex than prominent theories can account for.

If needed, please contact:
https://www.helpguide.org/find-help

Dr. Robinson's latest study:
https://www.sciencedirect.com/science/article/pii/S016503272401187X

Transcript

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Welcome everybody to the Smooth Brain Society and Happy New Year.

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It's not New Year just yet while we record this, but it will be by the time this comes out.

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So Happy New Year everybody.

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Hope you guys had a fun Christmas, New Year's, partying, arguing with family, whatever.

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All of it, none of it.

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Um...

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So this episode, our guest today is Kealagh Robinson.

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Dr.

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Kealagh Robinson is a senior lecturer in psychology at Massey University,

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is also adjunct at Victoria University of Wellington,

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so works at two universities at the same time.

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Very fancy.

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Her research uses experimental, longitudinal, and meta-science approaches.

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Even I don't know what that means, so she will explain.

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to understand emotion regulation with a specific emphasis on what factors underpin

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self-injurious behaviors,

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self-injurious thoughts and behaviors.

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So great to have you on, Kealagh.

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Thank you for being here.

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Thanks so much for having me.

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And as always, you know how the podcast goes.

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We have a co-host on who has no clue about the topic.

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But in this case,

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Kealagh does some very interesting work,

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which uses a bunch of different research and techniques and top and topics.

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And I know a little bit about it, but not a lot.

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So we decided to get someone who knows a little bit about the other aspects,

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but not a lot about the aspects,

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which I know on,

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uh,

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she's been on before,

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uh,

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now Dr.

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Ellie Rakawai,

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who is now a lecturer at Victoria University of Wellington in psychology,

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who's,

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if you guys remember the episode which she's on,

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is her expertise is in Maori mental health and wellbeing,

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and she's also a clinical psychologist.

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So welcome Ellie.

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Oh, thanks.

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Not a clinic yet, but one day.

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So yeah, thank you.

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How did you guys spend your New Year's?

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It's because it hasn't happened yet, not because you don't remember what happened.

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Yeah.

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Awesome.

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All right.

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Kealagh,

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let's start with a little bit of a background,

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because I have mentioned that you do use quite interesting techniques to look at

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things in unorthodox ways,

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I would say.

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So could you give us a background into how you got introduced?

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your field of research and looking at self-injury and emotion regulation through

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sort of neuroscience techniques.

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Yeah, sure.

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So when I first started at uni,

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I was really drawn to kind of cognitive science ways of understanding the world.

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And so when I came to start doing research, I started working on labs in second year.

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I was doing a lot of kind of memory research, attention kinds of research.

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And I ended up working with Professor Gina Grimshaw on how we attend to emotional

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stimuli in our environment.

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using kind of base or bench cognitive psychology techniques like response time and accuracy.

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And then I got to the end of the honours year.

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And as anyone who's done honours knows that that's pretty hectic year and I needed

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a bit of a break.

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And so very conveniently for me,

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another research group that I was working for at the time,

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the lab manager and the postdoc,

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well,

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the postdoc who was the lab manager,

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had a baby.

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And so I...

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took over parts of her role while she was on maternity leave and absolutely fell in

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love with doing self-injury and suicide research in a community informed and

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community based way.

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So I had done some bits and bobs of self-injury research in undergrad,

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mostly because I thought quite probably quite arrogantly that I wanted to know why

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people self-injured.

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Because when I was a young person in school,

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I had a close friend who self-injured and I was kind of part of her support network

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and kind of went along to some of her therapy sessions as well.

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scared and so worried about her and just feeling like I was like holding a lot of

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like emotional weight and so there was this kind of summer scholarship that came

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across my emails one day looking at how guidance counsellors in New Zealand respond

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to self-injury in schools using qualitative techniques which is not something I

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know anything about

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um and i thought oh you know i need a job over summer and you know i i reckon it'd

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be interesting to figure out why people suffer like that's like a really

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interesting question to me because we have all of these um really strongly embedded

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kind of evolutionary reflexes to protect our body from harm and here we have a

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behavior where people are

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you know, deliberately overriding those.

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So naively or arrogantly,

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I thought I'll spend,

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you know,

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10 weeks of a summer and I'll figure it out.

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Joke's on me, that was a decade ago and we still haven't figured it out.

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So yeah, when I was working with the Youth Wellbeing Study, which is now called the

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social justice justice and social justice justice and justice justice and social

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yeah cut this part working for the youth well-being study which is um head up by

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professor mark wilson

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I fell in love with the topic and I fell in love with doing research where you

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could go out to two people in the community,

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you could leave the university and talk to people about what's going on for them.

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I also had the amazing opportunity as somebody who's not a clinical psychologist.

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to attend a clinical training focused on emotion regulation and group therapy that

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was run by Kim Gratz and Matt Tull,

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who are amazing emotion researchers,

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particularly emotion dysregulation and self-injury researchers,

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who are in a training about their therapy for guidance counselors in New Zealand.

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And they started the training with some emotion psychoeducation around emotion in

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the body and things like that,

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which we can get into later.

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And I just had this lightning moment of like,

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oh,

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wow,

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this is how you do affective science,

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emotion science,

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and this is how it actually translates to

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helping people in the community or on the ground or things like that.

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So when it came time to do a PhD,

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I thought I have this background in experimental methods and affective science in particular.

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So using these kind of quote unquote bench cognition skills to really kind of

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tackle kind of understanding self-injury in a way that we can,

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improve knowledge to be able to help people and better support people who self-injure.

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So it's a very long-winded kind of explanation,

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but it does mean that I kind of sit in between these two worlds,

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kind of sometimes comfortably,

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sometimes awkwardly,

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where I have kind of cognitive expertise and I teach undergrad students cognitive

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psychology at Massey.

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So I'm very comfortable in that space.

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And then I also spend a lot of time

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working with social psychologists and clinical psychologists and ed psychs,

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primarily out in schools and in universities,

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but people who spend a lot of time sitting with people who are really struggling at

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the moment.

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So that's where I kind of live.

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So it's really cool to have Elion,

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who I don't think she talked about it in her episode,

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but a lot of her PhD focused on non-suicidal self-injury.

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And Zaheer as well,

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who actually taught when he was a first-year student,

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which makes me feel very old.

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Yeah.

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Yeah, no...

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That was ages ago, because when was that?

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That was 2014?

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Should I be saying it?

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When you used to teach me?

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Yeah,

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well,

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I have another old ex-student,

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I guess,

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who's now a practicing clinical psychologist,

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which is a career choice that takes a lot of years to train.

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And I went to his graduation, and he introduced me to his mum, which was very sweet.

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And now I teach the first year.

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So it's a population I care a lot about.

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So that's quite cool.

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That's true.

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That's cute.

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I think so...

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wellington for those who aren't from there there's only literally like one sort of

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area you can go to when you're going out in town at night and where is the story

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and i stopped going i stopped going out when in phd i was a tutor and i was

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teaching and i was doing what kealagh used to do which was like teach first years and

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I remember bumping into one of my students, one of my students going, oh, Sahir, what's up?

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And I was like, I'm never going out again.

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That's it.

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This is when you know you're too old.

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Except for Friday, two weeks from now.

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You can be coming out then.

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Professor Marc Wilson,

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who has also been on the show,

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he supervised,

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was one of my PhD supervisors,

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but he's taught generations of first-year students,

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including me.

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And he says that from time to time,

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he gets free drinks at restaurants because,

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you know,

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a lot of first-year psychology students work in hospital.

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It's not yet to happen to me, but I look forward to if any of my students are listening, please.

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No, no, that did happen to me.

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It didn't make it any less weird.

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It did happen to me.

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I did get a free drink out of it.

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I haven't had a free drink yet, but I've had multiple students be like, hey, Ellie.

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And I'm like, oh.

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Oh, no.

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Changing boundaries, eh?

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Yeah.

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Actually, I ran into a student at a festival.

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Yeah.

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It was really sweet.

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It was like, he was like, oh, I'm really like,

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Are you Ellie?

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I was like, yeah.

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He's like, Ellie Rookawai.

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I was like, yeah, that's me.

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Thinking it was someone from like high school.

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He was like, oh, you were my lecturer.

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And I was like, oh.

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But then he was like, no, no, no, no, no.

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I'm sorry.

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I thought about not saying anything because I didn't want to make it awkward.

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But I just wanted to let you know that I really enjoyed your lectures.

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I was like, oh, bless.

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Okay.

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That's very sweet.

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Yeah.

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Yeah.

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okay your lectures are people too okay your teachers are people too we have lives

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when we're young yeah we are young say it say it enough times it will come through

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um

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I am younger than you both.

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I am young.

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Ellie told me that you can be rangatahi up until like 70.

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So I'm willing to kind of take that approach.

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Awesome.

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You can be young in some ways and old in others, right?

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Okay, after that segue though, back.

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back to kelly's work um so so yeah you you're talking about sort of being in both

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worlds uh i will ask probably a bit more about the world i don't know about so

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could you explain nssi a little bit to me it's a non-suicidal self-injury i know

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mark wilson had touched upon it once upon a time yeah but yeah if you could talk

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about it a bit more or um i usually just say nssi

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Um, goes by a bunch of other names.

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Often people might know it as self-harm.

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Um,

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so this is a behavior where people are deliberately injuring their bodies,

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um,

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not because they want to die,

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but because,

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um,

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often they're dealing with really overwhelming or unwanted feelings.

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And this is, um, a behavior that helps them manage that.

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Um,

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so that is typically,

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that typically shows up in things like cutting or scratching or banging the body

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against hard surfaces.

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So yeah, it's a behavior that about 18% of the population engage in.

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which often when I talk to people who aren't in this area,

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they're surprised by the prevalence of the behaviour.

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Actually,

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Mark and I have done some research,

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and I think he came on the podcast to talk about it,

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with a large community sample of older New Zealand adults,

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so 18 to 71 plus,

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and we tend to find about 20%

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report having ever self-injured in their lifetime.

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And in combination with some other kind of surveys of community folks kind of

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suggest that New Zealand has a little bit higher rates of self-injury compared to

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places like Australia,

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but particularly the US.

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So that's what NSSI is.

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A lot of my work is focused on self-injury among young people.

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So adolescents from 13 to 18 out in schools.

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And when I was over in Western Australia as part of my postdoc,

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I kind of focused on slightly older adolescents or emerging adults attending universities.

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And again, there we see around 20% self-injure with about 10% in the last year.

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Rick,

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because the prevalent rate is so high,

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are there like many reasons,

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not many reasons,

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sorry,

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many behaviors which sort of are associated with it?

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Because I feel like when you talk about self-injury generally,

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you think about people cutting themselves.

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But I feel like if 20% are doing it,

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you could see,

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be able to see it more than the numbers suggest.

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So this is an interesting question because we typically measure self-injury

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focusing on about 13 different things.

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most typical behaviors.

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So those are things like cutting, scratching the skin is the most common.

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And then there's behaviors such as like breaking bones,

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which are very uncommon in the population,

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probably less than 1%.

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But there's actually an ongoing conversation in the self-injury field at the moment

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around kind of what are the bounds of

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self-injury or kind of risky behaviours.

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So there's this really interesting discussion about whether or not deliberately

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being injured by other people counts, quote unquote, in our academic definition of NSSI.

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So this is things like going out deliberately to start fights with a person you

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know will punch you,

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for example.

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I've also heard from my clinical colleagues of folks who are in martial arts who

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will change their weight class deliberately for weigh-in and then be kind of

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underweight

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when it comes time for the fight so they're more likely to be injured or folks who

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deliberately throw a rugby tackle knowing that they'll get pummeled pretty hard

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because they have the skills to know what's going to happen in that situation.

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So it's an ongoing conversation about whether those behaviours which cause injury

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but are not direct in the same way count as self-injury.

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More generally in the literature,

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a lot of the work coming out of the UK doesn't typically distinguish between

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self-injury behaviours by the intent or what the person intends the behaviour to have.

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So they kind of

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take a self-harm approach that includes behaviours where their intent for suicide

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is a little bit more ambiguous or is a direct suicide attempt.

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So what counts as self-injury is actually quite a contested question in the literature.

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Yeah,

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I just want to add to that too that in my thesis,

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one of the measures that we use when we ask people about self-injury

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has like an other box and then it gets people to write what they did.

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And a lot of people in mine talked about restrictive eating,

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like starving themselves or something along those lines,

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which is really interesting because traditionally that wouldn't have been

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considered a type of self-harm because it's not like an immediate,

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it doesn't have an immediate impact on your body.

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but yeah so I thought that was really interesting and that's something that I'm

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kind of keen on looking at a bit more but also there's some really cool stuff about

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self-injury and how Māori experience it so Talia Kingi in 2018 I think has been her

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she finished her thesis either 2018-2019

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she interviewed a whole heap of rangatahi about their self-injury and some of them

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talked about like getting non-cultural tattoos as being self-harm because their

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family didn't like give their consent and it was to harm their wairua so not their

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physical being but their like spiritual being um

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and to have a whanau connection as well yeah yeah so like things like that i think

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add to the complexity of like well what is self-harm and i think i'm very much of

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the opinion that if the person who is self-harming thinks of it as self-harm then

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we treat it as self-harm um because

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People actually know themselves really well.

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But this is it.

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I'm a methods nerd.

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So this is a really tricky coming from cognitive background.

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This kind of complexity ties my head in knots because the only way we know about

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somebody's self-injury is if we ask them and they tell us.

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Right.

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So I agree with Ellie that the language that somebody uses

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to describe their behavior as the one that we should use.

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So if you work clinically,

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for example,

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and somebody talks about their cutting,

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then that's the best way to talk about that with a young person,

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even though that's not necessarily how I would describe it in kind of my academic world.

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But I have done some research on how we assess self-injury through self-report measures,

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because it's worth kind of explicitly stating that self-injury is a really

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stigmatized behavior.

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A lot of people who self-injure are really worried that the folks that are

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important to them are going to think that they're kind of being attention-seeking

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or manipulative with their self-injury,

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and that's why they're self-injuring.

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And there is research that shows that folks who self-injure have really awful experiences,

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particularly a lot of this research is based in kind of healthcare settings of

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people

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emergency departments or nurses or kind of mental health professionals more

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generally kind of making really dismissive comments about people's self-injury so

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it kind of puts people in this double bind where if they want to reach out and get

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support they kind of have to overcome this they have to find somebody safe that

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they can disclose to so all of that kind of stigma is kind of going on in

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somebody's head or in their psychology

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when they come to answer my research questions about, do you self-injure?

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And back when we started doing this research in 2012,

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going out into high school,

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well,

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when I came on board in 2012,

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when we were going out to high schools,

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one of our requirements by ethics committee was that we had to ask a screening

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question about self-injury.

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So have you ever self-injured, for example, cutting, scratching, banging walls?

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because the Ethics Committee was concerned that if we showed young people a list of

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self-injury behaviours,

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that might make them,

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that might,

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quote-unquote,

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plant ideas in their head.

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So there's kind of iatrogenic risk.

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That's a very reasonable concern, and this has been really well-researched.

(00:21:38):
in self-injury, but also in kind of other mental health adjacent areas.

(00:21:41):
And there's absolutely no evidence that asking about self-injury or suicide kind of

(00:21:46):
increases the risk that that person will go on to experience suicidal ideation or

(00:21:51):
to self-injure or things like that.

(00:21:54):
But when you ask people about self-injury,

(00:21:56):
obviously they're coming with all of their pre-existing ideas about what

(00:22:00):
self-injury is,

(00:22:02):
who self injures.

(00:22:03):
They might have concerns about what we're going to do with that information,

(00:22:06):
if we're going to kind of give them involuntary treatment or kind of tell the

(00:22:11):
school about their self-injury.

(00:22:13):
And so there's some really interesting work that Mark and I did that looked at if

(00:22:18):
you ask people in this kind of have you ever self-injured way versus here's a list

(00:22:23):
of self-injury behaviours,

(00:22:24):
have you ever done this?

(00:22:26):
We actually get quite a lot of discrepancy.

(00:22:28):
So it's about a third of people will say they have engaged in self-injury behaviours,

(00:22:33):
but then they say,

(00:22:34):
no,

(00:22:34):
I've never self-injured.

(00:22:35):
So they don't.

(00:22:36):
And,

(00:22:36):
you know,

(00:22:37):
it's tricky to tease that apart is that because they're not kind of claiming that

(00:22:40):
self-injury label for themselves.

(00:22:42):
Is that they're concerned about the consequences of disclosing in a research setting?

(00:22:47):
Or is it something completely else?

(00:22:49):
So I think that's a really interesting and tricky research puzzle for us to tease

(00:22:54):
apart around how we ask about self-injury and how we understand self-injury.

(00:22:59):
Yeah, the self-injury behavior thing is pretty interesting because...

(00:23:05):
uh i can say from my personal experience that if i've gotten mad at someone or

(00:23:09):
something i've punched a wall and if you tell me have you have you ever done these

(00:23:14):
behaviors i'd probably tick yeah i've definitely punched a wall or two before but

(00:23:18):
most of the time it's because i'm being nice to that person who probably deserved

(00:23:23):
to be punched so so but in in that regard like

(00:23:30):
I would probably be someone, if you just purely asked, have you partaken in these behaviors?

(00:23:36):
I probably have, but is it necessarily the same?

(00:23:40):
Well, that's an open research question.

(00:23:43):
And I would say that men are more likely to tick

(00:23:47):
um yes to one of the behaviors and then say no uh to the overall arching question

(00:23:52):
which maybe is kind of tied to this kind of idea that self-injury is something that

(00:23:57):
young women who are sad do yeah and maybe they're not like planner yeah like i said

(00:24:03):
identifying with that label yeah yeah i guess that was going to be my next question

(00:24:09):
are there i i feel like men would probably are less likely to say that they're

(00:24:15):
self-injured in general but

(00:24:17):
As far as rates go,

(00:24:18):
is there any real difference in rates between men and women,

(00:24:22):
boys and girls,

(00:24:23):
depending on the ages?

(00:24:24):
Well, the biggest gender difference is actually among gender diverse people and trans people.

(00:24:30):
So we see much,

(00:24:31):
much higher rates of self-injury and kind of associated mental health challenges

(00:24:39):
among gender diverse,

(00:24:41):
intersex and trans young people.

(00:24:44):
In terms of young men and young women, young women tend to report slightly higher rates.

(00:24:54):
They tend to start self-injuring a little bit younger.

(00:24:57):
And then so they might start at,

(00:24:59):
say,

(00:24:59):
13,

(00:25:00):
whereas like a young boy might start a little bit later,

(00:25:03):
14,

(00:25:03):
15.

(00:25:03):
So by the time we get to university,

(00:25:07):
that difference between men and women is much smaller than it is during adolescence.

(00:25:12):
That with a large caveat that,

(00:25:14):
like I've already kind of alluded to,

(00:25:15):
the way that we ask about self-injury really impacts the rates that we get and also

(00:25:22):
potentially is the way that we ask the question works differently for men and women.

(00:25:29):
Yeah.

(00:25:30):
But when you were talking about your experience punching walls,

(00:25:34):
I think something that came up for me was that this behavior is really functional,

(00:25:37):
like people are doing this because it's helping them in that situation.

(00:25:43):
And right at the top of the episode, we talked about how or I talked about

(00:25:48):
how self-injury is often used to kind of deal with overwhelming or unwanted feelings.

(00:25:53):
So that's often things like anger or kind of shame.

(00:26:00):
Ellie can talk a little bit around some of the cool work she's done on whakama

(00:26:04):
among rangatahi who self-injure.

(00:26:07):
But another really kind of common form or function of self-injury is self-punishment.

(00:26:14):
So this idea that

(00:26:16):
I've done something really bad and I deserve to be punished.

(00:26:19):
And so self-injuring helps me kind of meet that goal of self-punishment.

(00:26:25):
And then that makes me feel better because I've kind of worked through it.

(00:26:29):
And I kind of see all of the functions of self-injury.

(00:26:34):
There's typically we measure about 13 as having to, as kind of linked around emotions.

(00:26:43):
So for example, another person,

(00:26:45):
more kind of social function of NSSI is to kind of demonstrate toughness or show

(00:26:51):
strength to those around you and again like the self-punishment I think there's

(00:26:56):
kind of big feelings going on around there as well so I like obviously I'm biased

(00:27:01):
because I focus on emotions but I think there's a lot of emotions around

(00:27:05):
self-injury and this kind of self-injuring is a way to kind of

(00:27:10):
reduce the kind of like intensity in your body or to work through like uh shame or

(00:27:16):
anger or to kind of prevent yourself from doing something worse like hitting

(00:27:20):
somebody or kind of acting on suicidal ideation thoughts um they're all kind of

(00:27:24):
tied up with with big feelings as well which is why i focus on on the emotion side

(00:27:29):
of things all right so should we

(00:27:36):
Go there then to speak about the emotion side of things.

(00:27:41):
Maybe I should let you take the floor and tell me like what,

(00:27:46):
tell us basically what are the key things that we should probably know or learn or

(00:27:51):
what you want to talk about with regards to emotion and self-harm.

(00:27:56):
Yeah,

(00:27:56):
so like I was talking about earlier,

(00:27:57):
I come from this kind of tradition of affective science or cognitive science,

(00:28:02):
which sees emotions as this kind of symphony of physiological changes.

(00:28:08):
So changes in your heart rate and how sweaty your skin is,

(00:28:13):
if you're blushing,

(00:28:14):
for example,

(00:28:16):
as well as the kind of subjective feeling.

(00:28:18):
So we talk about feeling happy or feeling nostalgic or feeling

(00:28:22):
feeling embarrassed um so we have these kind of generally kind of positive feelings

(00:28:27):
and generally negative feelings um there's no kind of moral lens on that that's

(00:28:32):
just kind of how they feel um and then we have emotional behavior as well so um

(00:28:38):
If you think about someone who's really angry,

(00:28:40):
they might cross their arms,

(00:28:43):
their eyes might close a little,

(00:28:45):
they might lean back in their seat.

(00:28:48):
So we have emotion across these kind of three different domains.

(00:28:52):
And we are attending to something in the environment environment.

(00:28:59):
Whether that's our external environments,

(00:29:01):
we might see our beloved cat sitting on the couch,

(00:29:07):
or it might be something in our internal environments,

(00:29:10):
we might be reminded of a person who's very dear to us.

(00:29:15):
And then that stimulus gets appraised in light of our goals and our previous experiences.

(00:29:23):
And then that gets tagged as a value.

(00:29:25):
So if it's in the,

(00:29:26):
you know,

(00:29:26):
your beloved cat,

(00:29:27):
for example,

(00:29:28):
you might feel really like warm and,

(00:29:31):
you know,

(00:29:31):
that kind of love feeling.

(00:29:34):
You might smile.

(00:29:36):
Your pupils will dilate if you're looking at something that you have a really

(00:29:41):
strong positive feeling.

(00:29:44):
label to.

(00:29:45):
So we have this kind of, often we're mostly aware of the kind of subjective feelings.

(00:29:49):
So I feel good,

(00:29:50):
I feel bad,

(00:29:50):
I feel angry,

(00:29:51):
I feel joyful,

(00:29:54):
but kind of going on under the hood,

(00:29:56):
as it were,

(00:29:57):
as all these kinds of behaviours and physiology as well.

(00:30:00):
And that's because emotions are really functional.

(00:30:02):
They're kind of evolutionally evolved phenomena that help prepare us and our bodies

(00:30:08):
to respond to our environment.

(00:30:12):
So, for example, being frightened and our heart rate accelerating and

(00:30:20):
you know,

(00:30:20):
our muscles kind of getting ready to run helps us,

(00:30:23):
you know,

(00:30:23):
run from the threats in our environment.

(00:30:28):
And over time that has become kind of largely focused on social threats because

(00:30:35):
that's a really important part of our psychology.

(00:30:38):
Yeah, so I come from this kind of tradition that sees emotion in quite a nuanced way.

(00:30:45):
And in the self-injury world, emotion, the kind of tradition is much more,

(00:30:50):
clinically based.

(00:30:52):
And so while the affect to science side sees emotion as this kind of like a broader

(00:30:59):
puzzle with lots of important pieces linking together in the clinical domain,

(00:31:05):
they take a much broader,

(00:31:06):
more holistic approach to emotion.

(00:31:08):
And typically that's called emotion dysregulation,

(00:31:11):
which I wanted to kind of call out to some amazing work that's been done here in Aotearoa.

(00:31:18):
So we actually have a new,

(00:31:19):
as of this year,

(00:31:20):
we have a te reo Māori word for emotion dysregulation,

(00:31:24):
which is kare a roto ko titititi.

(00:31:26):
And I wanted to tell you a little bit about the etymology of the word because I

(00:31:29):
think it describes the phenomena really well.

(00:31:33):
So kare a roto is used to describe emotions and feelings or kind of internal states.

(00:31:40):
And ko titititi is one of the te reo Māori words for...

(00:31:47):
the rifleman or the smallest bird in aotearoa which flies very short distances very

(00:31:51):
quickly um and i'm a massive bird nerd so i can tell you that the average kind of

(00:31:57):
weight of a kootitititi is around six grams um so they get buffeted about in the

(00:32:02):
wind a lot um because they're just so small so this idea of kind of being like yeah

(00:32:08):
buffeted about um all this kind of um

(00:32:12):
yeah,

(00:32:13):
quick,

(00:32:13):
short distance metaphor is a really apt one for describing someone's kind of

(00:32:18):
emotional experience.

(00:32:20):
So clinical psychology tends to focus on this kind of holistic pattern of kind of

(00:32:26):
emotional functioning and then affective science comes at it from a very like

(00:32:29):
zoomed in.

(00:32:31):
What's your body physically doing in this environment?

(00:32:34):
Is your heart rate elevated?

(00:32:36):
Are your palms sweaty?

(00:32:39):
Yeah,

(00:32:39):
so that's kind of my general approach to emotion is trying to marry those two

(00:32:44):
things together.

(00:32:45):
So a lot of the NSSI work has looked at emotion dysregulation.

(00:32:50):
So we know that people who self injure report much greater challenges managing their emotions.

(00:32:58):
And I'm talking like a Cohen's day of like 1.2,

(00:33:01):
so substantially higher,

(00:33:03):
really meaningful differences in kind of these emotion dysregulation self-report measures.

(00:33:11):
And so when I was reading the literature, emotions seem to come up again and again.

(00:33:16):
in self-injury worlds and when you ask people about their self-injury they often

(00:33:21):
talk about the big feelings that are kind of going on with their self going along

(00:33:24):
with their self-injury or that their self-injury is helping to manage and then

(00:33:29):
coming in with my

(00:33:31):
affective science background i was like oh well um we know a lot at this kind of uh

(00:33:36):
zoomed out level um kind of what's going on in the body what's happening um in that

(00:33:41):
kind of myutia of an emotion unfolding um so that's kind of where i got to my phd

(00:33:47):
was this kind of um yeah trying to marry these two worlds together these two

(00:33:52):
different literature bases

(00:33:55):
Sorry, I just keep rambling.

(00:33:57):
Clearly.

(00:34:00):
I told Ellie this morning that I had to reread this paper and I was like,

(00:34:04):
oh yeah,

(00:34:04):
let me re-remember what I did for my PhD.

(00:34:07):
But clearly it's all still in there.

(00:34:11):
Yeah.

(00:34:13):
No, there's a lot in there.

(00:34:16):
But the idea of marrying...

(00:34:19):
the emotion dysregulation with the cognitive side of emotion,

(00:34:25):
which we sort of think of as purely physiological and behavior and that feeling.

(00:34:32):
How hard is it actually to do considering you've been doing it for what, eight, 10 years now?

(00:34:38):
It's very fun and challenging.

(00:34:43):
So Sahir asked me to talk about a specific paper, which was published earlier this year.

(00:34:49):
And the background to that was I started piloting that experiment as part of my

(00:34:53):
master's in 2016.

(00:34:55):
So that kind of gives you an indication of some of the difficulties in this area.

(00:35:03):
I have been really lucky to kind of work across different kind of conceptualizations.

(00:35:11):
Like I said,

(00:35:11):
I'm not a clinical psychologist,

(00:35:14):
but I have a number of really fantastic clinical colleagues who are very generous

(00:35:19):
with sharing their knowledge and kind of talking about their clients' experiences

(00:35:26):
with me.

(00:35:28):
And equally, I have a number of really excellent kind of

(00:35:33):
affective science colleagues who when I say kind of some of the assumptions that

(00:35:38):
underlies my work are like oh but wait how does that how does that work so for

(00:35:42):
example when I present about self-injury and kind of more cognitive spaces one of

(00:35:47):
the questions I always used to get was well how would how could hurting yourself

(00:35:51):
possibly make you feel better

(00:35:53):
Right.

(00:35:53):
Like it seems so counterintuitive.

(00:35:56):
And so here you might know this,

(00:35:57):
but there's this kind of operant conditioning process where if you take away

(00:36:05):
something bad,

(00:36:06):
you feel better.

(00:36:07):
So in this instance, and then that gets reinforced over time.

(00:36:12):
So you're more likely to engage in that behavior in the future.

(00:36:15):
So here people are tapping into a kind of an embedded basic part of psychology

(00:36:23):
where removing something bad actually helps you feel better in the moment.

(00:36:28):
And we kind of see this in lots of animals, including non-human animals.

(00:36:33):
So there's this argument that we can study some of the kind of more genetic

(00:36:38):
contributions or the epigenetic contributions to self-injury by looking at things

(00:36:42):
like over-grooming in rats and macaques.

(00:36:47):
Yeah.

(00:36:48):
Yeah, I know about the over-grooming one with rats.

(00:36:58):
So, but then that's one thing of...

(00:37:00):
Yeah, like you said, cognitive people.

(00:37:02):
And my first question was also going to be something like,

(00:37:04):
how does this actually help you feel better?

(00:37:08):
Or how does harming yourself technically help you feel more in control?

(00:37:13):
But then how would you measure what's happening

(00:37:18):
in terms of the cognitive because when you think about cognitive research you're

(00:37:22):
getting people in a lab and sort of yeah strapping them up to heart rate brain

(00:37:29):
scans whatever and you in that situation how are you going to how are you going to

(00:37:34):
measure something or assess something which is you know someone trying to feel

(00:37:38):
better and therefore harming themselves how were you able to sort of marry that

(00:37:43):
Yeah,

(00:37:44):
so I would say that my research kind of looks at emotional functioning among people

(00:37:49):
who self-injure rather than necessarily kind of the emotions that precipitate or

(00:37:55):
are antecedents to an instance of self-injury.

(00:37:59):
Like you kind of mentioned, the kind of pragmatic constraints of...

(00:38:07):
working with people who are just about to self-injure or who are self-injuring

(00:38:11):
currently are really,

(00:38:12):
really tricky.

(00:38:14):
And there's kind of a big ethical question around what you would do as a researcher

(00:38:19):
in that kind of space.

(00:38:21):
So I've done a little bit of research using kind of ecological momentary assessment

(00:38:26):
techniques where you

(00:38:29):
send people like a text message at different times throughout the day,

(00:38:33):
kind of asking what's going on for them,

(00:38:35):
have they self injured,

(00:38:36):
things like that.

(00:38:37):
And there's some really exciting kind of developments in psychophysiology tools

(00:38:47):
that are kind of in progress at the moment.

(00:38:50):
So if you, for example, were in one of my colleagues studies, you might be wearing like a,

(00:38:58):
smart watch that has a heart rate monitor in it and then also kind of measuring or

(00:39:03):
also responding to these um self-report prompts about whether or not you have

(00:39:08):
self-injured um what's going on how are you feeling what's happening in your

(00:39:13):
environment

(00:39:15):
And I think there's some really interesting and cool statistical models that can be

(00:39:19):
built using that.

(00:39:22):
But that is a really new area of technological development, actually.

(00:39:29):
And so we're beginning to see some of the first kind of pieces of evidence out of those studies.

(00:39:35):
But I was more interested in

(00:39:38):
what is the kind of general emotional functioning of people who self-injure?

(00:39:43):
So,

(00:39:43):
um,

(00:39:44):
across all of our theories of self injury,

(00:39:46):
there's this idea that because people are relying on self injury as kind of one

(00:39:50):
tool to help them manage overwhelming emotions,

(00:39:53):
um,

(00:39:54):
Perhaps their emotions are more intense or they come on more strongly than others.

(00:40:01):
Or maybe they have less,

(00:40:04):
they have developed less effective kind of immediate ways to help them manage things.

(00:40:11):
those big emotions.

(00:40:12):
So I'm talking about things like cognitive reappraisal,

(00:40:17):
changing the way that you think about the situation to change your emotional experience.

(00:40:24):
So that's often like seeing the silver lining.

(00:40:27):
So baked into kind of all of our theories is this kind of underlying assumption

(00:40:31):
that there's something different happening in the kind of emotional process of

(00:40:38):
people who suffer into it.

(00:40:40):
And so I was really interested in kind of looking at that idea for my PhD because

(00:40:45):
Like I mentioned earlier, emotions are composed of lots of different domains.

(00:40:50):
So you have the behavior, you have the physiology, and you have the subjective feeling.

(00:40:54):
So one of the ideas I was trying to tackle was,

(00:40:57):
is there something kind of at a physiological level where people who self-injure,

(00:41:02):
their emotions are generated naturally?

(00:41:05):
in their body more intensely?

(00:41:07):
So maybe their body is more responsive to things going on in the environment,

(00:41:12):
for example,

(00:41:13):
than their peers?

(00:41:15):
Or is it kind of happening more at the subjective level?

(00:41:18):
So their kind of physiological responses kind of...

(00:41:23):
similar to people who don't self-injure,

(00:41:24):
but the way that they're interpreting them is a little bit different or they're

(00:41:29):
interpreting them as more intense or less tolerable or things like that.

(00:41:35):
So you're right, it's quite tricky.

(00:41:36):
So I spent most of the years of my PhD

(00:41:42):
bringing volunteers and participants into one of the cognitive behavioural testing

(00:41:48):
labs here at FICC and wiring them up with lots of electrodes and then creating an

(00:41:55):
emotional challenge for them.

(00:41:57):
So again, using the kind of more experimental, but it was an experiment.

(00:42:01):
using some of those affective science techniques where you create an emotional

(00:42:06):
challenge so you have more experimental control over a person's experience.

(00:42:15):
So what I did was I used a component of a very well-established stress induction,

(00:42:20):
the Trier social stress test,

(00:42:23):
um which um asks the part that i use asked participants to count backwards in

(00:42:29):
intervals of 17 from 2020 um and while you were doing that um i had a lovely i had

(00:42:38):
nine lovely confederates um so a person wearing a white lab coat with a clipboard

(00:42:45):
telling you to go faster and giving you a very stern assertive look because they're

(00:42:52):
I've told you that they're measuring your working memory and your intelligence.

(00:42:57):
So as you can imagine, a POP math test is quite stressful.

(00:43:01):
And in fact,

(00:43:03):
the part that kind of carries the most stress is this kind of social element where

(00:43:07):
you have,

(00:43:08):
where you're struggling and somebody is giving you very little,

(00:43:12):
you know,

(00:43:12):
positive feedback.

(00:43:13):
So they're not nodding.

(00:43:14):
They're not going, or anything like that, which is really hard to do.

(00:43:20):
I had participants like making jokes and just,

(00:43:23):
you know,

(00:43:23):
like really counting on their fingers and becoming quite,

(00:43:28):
you know,

(00:43:29):
stressed.

(00:43:29):
And my lovely love confederates had to sit there

(00:43:32):
with this kind of poker face on and not kind of jump in and like,

(00:43:35):
this is very like,

(00:43:36):
you know,

(00:43:37):
natural,

(00:43:38):
um,

(00:43:38):
response to be like,

(00:43:39):
it's okay.

(00:43:40):
This is designed to be hard.

(00:43:43):
Um, so yeah, so I created emotional challenge, um, and that works really well.

(00:43:47):
That's that test is used around the world.

(00:43:49):
It's like the gold standard for creating stress in the laboratory.

(00:43:53):
Um,

(00:43:54):
and so I measured how people felt,

(00:43:56):
um,

(00:43:56):
before during the stress,

(00:43:58):
and then I got them to rest for five minutes afterwards.

(00:44:01):
Um,

(00:44:02):
as well um so i asked them how they were feeling and i was measuring their heart

(00:44:06):
rate um and also um how sweaty the palms of their hands were so the electrodermal

(00:44:11):
response as well um so that was a large amount of my life um kind of running

(00:44:19):
participants individually through this session and like um

(00:44:23):
Obviously, doing that in an ethical way is really important to me.

(00:44:29):
And so the test itself,

(00:44:31):
I think,

(00:44:31):
took the experiment itself took about 40 minutes when you had all the

(00:44:34):
questionnaires and the stressor and the debriefing and things like that.

(00:44:40):
But I would actually book out an hour and a half because I had some really amazing

(00:44:44):
conversations with young people as part of the debriefing process where we talked about,

(00:44:49):
okay,

(00:44:49):
well,

(00:44:51):
first,

(00:44:51):
the math test isn't real.

(00:44:52):
It's not a measure of intelligence.

(00:44:54):
It's just a way that we create stress.

(00:44:56):
Thank you so much.

(00:44:57):
This is why we create stress in the lab.

(00:44:59):
This is why we can't do it any kind of other way.

(00:45:03):
And then talking a little bit about self-injury and other ways that young people...

(00:45:08):
manage stress, particularly in university environments.

(00:45:12):
And had some really excellent conversations with young people.

(00:45:14):
I showed them around the cognitive and the neuroscience labs up here,

(00:45:20):
showed them the EEG chamber.

(00:45:22):
And I think,

(00:45:23):
you know,

(00:45:24):
I get really excited about methods and talking to young people and students about

(00:45:30):
how these kind of cognitive science approaches can tell us things that we can then

(00:45:35):
apply down the line to help people out.

(00:45:38):
Yeah.

(00:45:38):
So it was a large amount of my work life for many, many years.

(00:45:43):
And I would say that as stressful as it was for my participants by design,

(00:45:48):
and I'm very grateful for them,

(00:45:50):
it was also very,

(00:45:51):
very stressful for me because I would be waiting outside the door for the five

(00:45:57):
minutes while my confederate was stressing my participant,

(00:46:00):
being like,

(00:46:01):
how is it going?

(00:46:02):
Are they doing okay?

(00:46:03):
Like,

(00:46:04):
Is everything fine?

(00:46:06):
Because obviously participants have the right to withdraw their consent at any time.

(00:46:13):
And that is something that I was really careful to highlight for them in the

(00:46:17):
informed consent process.

(00:46:18):
But also at each stage of the experiment, I asked them if they were willing to continue.

(00:46:22):
And I had a few participants who were like, actually, I'd like to stop now, which is amazing.

(00:46:26):
And we would talk about,

(00:46:29):
we kind of did the whole debriefing process there and have a conversation.

(00:46:32):
But I also had participants who asked to stop during the stress induction,

(00:46:37):
which I think is amazing because there's this real power differential between a

(00:46:40):
participant and

(00:46:42):
and the experimenter and to say,

(00:46:44):
hey,

(00:46:44):
I'd like to stop to an experimenter who's,

(00:46:47):
you know,

(00:46:47):
being quite stern or like poker faced to you is a real,

(00:46:54):
yeah,

(00:46:54):
it's a really impressive thing to do.

(00:46:56):
So I was always kind of lurking awkwardly in the corridor, like, how's things going?

(00:47:01):
And then, you know, it's also hard to stress someone.

(00:47:03):
Like it's a stressful thing for my confederates.

(00:47:06):
So it was a lot of kind of checking in with them and seeing how that goes.

(00:47:10):
But yeah, that's why they gave me a PhD because it was quite hard.

(00:47:13):
Yeah.

(00:47:18):
So a little bit different from the,

(00:47:20):
a lot of the community stuff that I was doing in that,

(00:47:22):
like folks were coming into the university and that was kind of,

(00:47:26):
they had to come in because the tech was based up here.

(00:47:29):
It's not super mobile.

(00:47:31):
Yeah.

(00:47:35):
Oh yeah.

(00:47:37):
First, who are your confederates?

(00:47:39):
How do you get,

(00:47:39):
was it five people,

(00:47:41):
nine people to...

(00:47:42):
I had nine people and I deliberately,

(00:47:44):
because I recruited mostly,

(00:47:46):
I recruited young women as a kind of way to,

(00:47:50):
again,

(00:47:51):
increase the experimental control of the study because we know that...

(00:47:57):
young men and young women kind of respond to emotional challenge slightly differently.

(00:48:00):
And there's kind of this evidence that maybe their self-injury shows up in slightly

(00:48:04):
different ways as well.

(00:48:06):
So to kind of highlight the kind of power differential that I think is important

(00:48:10):
for the stress,

(00:48:11):
I recruited every single man in psychology that I had any kind of relationship with.

(00:48:18):
So I had some really lovely friends and colleagues in the lab,

(00:48:23):
including Dr.

(00:48:24):
Chris Maiman,

(00:48:25):
who was recently on the podcast.

(00:48:28):
He was very good.

(00:48:30):
They were all excellent.

(00:48:32):
But what was really funny was I asked my lab at the time,

(00:48:36):
I did a little fun survey to ask, who do you think is the most effective at stressing people?

(00:48:42):
Because I have the data, right?

(00:48:45):
I can tell.

(00:48:46):
And I would say I had to massively p-hack my way,

(00:48:49):
but the lab manager at the time was considered to be the most scary,

(00:48:55):
but he actually wasn't.

(00:48:56):
So I thought that was really funny.

(00:49:00):
He's a close friend of mine to say that everyone in our lab is afraid of you.

(00:49:06):
But actually, the participants, you weren't that scary.

(00:49:12):
I guess the other thing,

(00:49:14):
because you did mention the ethics of it,

(00:49:17):
how do you get people to sort of be part of the study?

(00:49:21):
Because I assume you still need to tell them at the beginning that the study

(00:49:25):
related to self-harm in some way,

(00:49:27):
shape or form.

(00:49:28):
So then recruiting someone who, I guess, shows higher rates or higher levels.

(00:49:33):
Concepts.

(00:49:35):
Yeah,

(00:49:35):
so for the study that we're talking about,

(00:49:38):
I recruited 50% of the sample had a past year history of self-injury and 50% had

(00:49:45):
never self-injured in their lifetime.

(00:49:48):
And again, I was quite drawing from my affective science background.

(00:49:52):
I was a little bit worried about telling people that I had recruited them to the study

(00:49:59):
based on their self injury history,

(00:50:01):
because we know that people who self injure report much higher kind of emotion dysregulation.

(00:50:07):
Um,

(00:50:07):
so I thought kind of priming that or making that very obvious before I kind of very

(00:50:12):
obviously create an emotional challenge,

(00:50:15):
um,

(00:50:15):
would kind of impact the results,

(00:50:18):
um,

(00:50:19):
and impact the results differently for people who self injure versus the control group.

(00:50:24):
So, um,

(00:50:25):
What we did was we had our self-injury survey measures embedded into part of the

(00:50:33):
kind of mass testing that all first-year students are invited in psychology and are

(00:50:40):
invited to take part in.

(00:50:41):
So if they consented to,

(00:50:43):
they were asked questions about their self-injury behaviours,

(00:50:47):
why they self-injure when they started self-injuring,

(00:50:49):
things like that.

(00:50:50):
And at the end of that section,

(00:50:52):
we asked them,

(00:50:53):
would you be interested in being invited to take part in other self-injury research?

(00:50:59):
So what I did was I then took all the people who said yes,

(00:51:02):
they're willing to take part in self-injury research,

(00:51:05):
and I advertised my study to them.

(00:51:07):
So I told them on the consent form that they're going to take part in an arithmetic challenge,

(00:51:14):
that there's going to be these kind of physiology recordings.

(00:51:19):
Given that we're in Aotearoa,

(00:51:20):
New Zealand,

(00:51:21):
I told them,

(00:51:21):
you know,

(00:51:22):
your head isn't going to be touched.

(00:51:23):
I kind of explained how we put on the electrodes.

(00:51:29):
And,

(00:51:30):
yeah,

(00:51:30):
that informed consent process was very important to me because it was a stress

(00:51:35):
induction or an emotional challenge,

(00:51:36):
but also because of the self-injury angle.

(00:51:40):
So I would send people the consent form 24 hours ahead of time via email,

(00:51:46):
chat with them for about 10 minutes beforehand.

(00:51:49):
So I did have to have this kind of element of deception where I didn't tell them.

(00:51:53):
during like right before the experiment started that it was about self-injury but I

(00:51:58):
kind of told them all the bits of all the bits that I could and then during the

(00:52:03):
debriefing we'd really talk about you know we'd get rid of that just well I'd

(00:52:08):
explain that deception and I'd explain why it was important and things like that

(00:52:12):
yeah and again that kind of emphasizing that

(00:52:17):
Participants can withdraw at any time.

(00:52:19):
They still will get their credit.

(00:52:21):
It doesn't impact, like, it's not a problem for my research or things like that.

(00:52:26):
Really emphasizing that that's their right,

(00:52:28):
and I really welcome that if that's where they're at.

(00:52:31):
Yeah.

(00:52:34):
I guess it's also the thing in the screening process.

(00:52:37):
You had mentioned at the start that some people would be nervous about what you do

(00:52:41):
with the information,

(00:52:42):
what you do with the data.

(00:52:44):
Yeah, absolutely.

(00:52:46):
Do you feel as a researcher,

(00:52:49):
if you see someone,

(00:52:50):
if you get,

(00:52:51):
if you come across a screening case where you think they probably should get help

(00:52:55):
with it,

(00:52:55):
you need help,

(00:52:56):
what,

(00:52:57):
how,

(00:52:58):
how does it go then?

(00:52:59):
Well, what goes through your mind with anything else?

(00:53:03):
Yeah, yeah.

(00:53:04):
So we know that from kind of the scientific evidence that people who self-injure

(00:53:12):
are usually self-injuring because there's lots of other challenges going on in

(00:53:16):
their life.

(00:53:17):
So people who self-injure report much greater anxiety,

(00:53:20):
depression,

(00:53:22):
challenges with kind of social relationships.

(00:53:25):
And we also know that people who self-injure are at elevated risk of future

(00:53:30):
suicidal ideation and suicide behavior.

(00:53:34):
But what we don't know is at what point self-injury might be kind of clinically meaningful.

(00:53:41):
And that's a bit of a kind of, again, an ongoing conversation.

(00:53:44):
Self-injury is included in the DSM-5 as a condition requiring further study.

(00:53:50):
So this is kind of an active area of clinical research.

(00:53:55):
So I was really mindful that...

(00:54:01):
that if I was going to break confidentiality,

(00:54:04):
which is,

(00:54:05):
you know,

(00:54:06):
sometimes a thing that needs to happen because you're worried about somebody's safety,

(00:54:10):
that I would only do so in an instance where the information that I was receiving

(00:54:16):
from the participant was kind of

(00:54:20):
to a significant extent where it was meaningful clinically and I relied a lot on my

(00:54:27):
amazing clinical collaborators in that regard because that's outside of my

(00:54:31):
expertise so I didn't actually for this study have I didn't pass on anyone to any

(00:54:40):
kind of clinical

(00:54:42):
um support um and i think that's actually really important because people are

(00:54:46):
signing up for a research study they're not signing up for therapy or intervention

(00:54:52):
and i'm also not qualified to provide those things so you know we talked a lot at

(00:54:56):
the um in the debriefing about kind of managing challenges and managing stress and

(00:55:02):
kind of

(00:55:04):
ways that are kind of aligned with our values and where we're going and ways that

(00:55:08):
we kind of take us away from the person we want to be.

(00:55:12):
And all of my participants,

(00:55:14):
you know,

(00:55:15):
as first year university students,

(00:55:16):
we're navigating challenges.

(00:55:19):
So every single student received a list of resources that are available to them in

(00:55:23):
the community.

(00:55:24):
And we could talk about if a person asked more about a specific resource,

(00:55:29):
I was very happy to talk about that.

(00:55:31):
But that was also one of the things that I was mindful of working with my

(00:55:37):
Confederates because most of my Confederates were in kind of cognitive psychology spaces.

(00:55:42):
And so this was the kind of first time they were really thinking about self-injury

(00:55:47):
and how they might show up for people.

(00:55:48):
So kind of sitting with them and debriefing afterwards,

(00:55:50):
particularly if somebody had kind of like visible scarring and things like that,

(00:55:55):
just kind of managing the distress that that can create for experimenters,

(00:56:00):
male researchers.

(00:56:01):
Yeah.

(00:56:04):
So...

(00:56:06):
So shall we move on to what you found then?

(00:56:08):
You put these poor people,

(00:56:11):
you made them do a math test,

(00:56:13):
which is stressful at the best of times,

(00:56:15):
but they came to you voluntarily and you put them through that.

(00:56:20):
You plugged all sorts of things to them to measure their heart rates and all.

(00:56:24):
You bullied your friends into being Confederates.

(00:56:29):
And after all that, yeah, let's talk about what you found and what does it mean?

(00:56:35):
Yeah, well, this is a very short answer.

(00:56:37):
I found not much.

(00:56:42):
So I found that the participants who self-injured reported much higher difficulties

(00:56:50):
managing their emotions than the control group.

(00:56:54):
I found my math test was stressful.

(00:56:56):
Great.

(00:56:57):
And I found that... Didn't need much for that.

(00:56:59):
No, no.

(00:57:01):
Pretty well established.

(00:57:03):
And that five-minute resting period afterwards kind of helped people kind of reduce

(00:57:09):
their emotions as well.

(00:57:11):
So their heart rate decelerated,

(00:57:12):
their palms got less sweaty,

(00:57:14):
and they kind of reported less negative mood.

(00:57:17):
I also found that the self-injury group came into my study of reporting a little

(00:57:23):
bit higher negative mood than the control group,

(00:57:25):
which makes sense if you think about the fact that

(00:57:29):
People who self-injure are often navigating lots of other challenges, right?

(00:57:32):
So they might also be experiencing,

(00:57:34):
I found that my NSSI group were reporting,

(00:57:38):
would report more mental health diagnoses than my control group,

(00:57:41):
which is again consistent with the literature.

(00:57:44):
What I didn't find is any kind of meaningful difference between my self-injury

(00:57:49):
group and my control group and how they responded to the emotional challenge.

(00:57:53):
So they felt the kind of change in their negative mood was very similar,

(00:58:00):
how their heart rate changed was very similar and how their subjective response changed.

(00:58:05):
changed as well, very like not meaningfully different from each other.

(00:58:10):
So that's kind of showing us that there's not anything different happening in the

(00:58:15):
autonomic nervous system of how people are responding to emotional challenge or at

(00:58:19):
that kind of subjective level of how they're interpreting it.

(00:58:23):
I also ask people about two different kind of common emotion regulation strategies.

(00:58:27):
So cognitive reappraisal,

(00:58:28):
that kind of seeing the silver lining that I talked about earlier and suppression.

(00:58:33):
which is kind of trying to not show an emotion response, kind of lock it down.

(00:58:40):
I found no difference in the strategies people use.

(00:58:42):
I also followed up with a group,

(00:58:44):
a subset of the sample two weeks later about how they remembered feeling during the

(00:58:49):
During the task.

(00:58:50):
What I thought was quite funny is they they remembered feeling more negative mood

(00:58:55):
two weeks later than they reported at the time.

(00:58:57):
So it kind of got worse in memory.

(00:59:01):
And I think that's possibly because in that debriefing process,

(00:59:04):
I talked about how the study was designed to be stressful and things like that.

(00:59:08):
But again,

(00:59:09):
I found no difference between the NSSI group and the control group and how that

(00:59:12):
kind of emotional memory unfolded.

(00:59:17):
So what does that mean exactly?

(00:59:19):
It means that there's kind of this dissociation or difference between how people

(00:59:26):
feel their emotion,

(00:59:28):
how people evaluate their emotional functioning and how they actually responded to

(00:59:33):
a specific emotional challenge in a very controlled environment.

(00:59:38):
And as with all kind of cognitive experimental research,

(00:59:41):
the question is,

(00:59:42):
okay,

(00:59:42):
well,

(00:59:43):
how ecologically valid is that?

(00:59:45):
I created an emotional challenge in a very controlled situation.

(00:59:50):
I made it really clear to participants that they could choose to quit at any time.

(00:59:53):
They knew they were in a study.

(00:59:55):
That's quite different from a fight with your romantic partner, for example.

(00:59:59):
Yeah.

(01:00:01):
So what I've done since then is trying to kind of cross off lots of other different

(01:00:06):
emotional challenges to see if it's,

(01:00:08):
you know,

(01:00:09):
the stress induction that I use is the gold standard.

(01:00:12):
It's a very effective tool, but it's not specific to that person, right?

(01:00:17):
So one of my amazing PhD students,

(01:00:20):
Hannah Paisi at Curtin University in Western Australia,

(01:00:24):
has done a similar experiment just looking at negative mood.

(01:00:29):
and asking people to recall a negative event that happened to them.

(01:00:33):
So a highly personal event.

(01:00:37):
And I've had another excellent honours student who's been doing a content analysis

(01:00:42):
of those kind of open text responses.

(01:00:44):
And so folks are talking about really...

(01:00:47):
a wide range of things.

(01:00:49):
So they're talking about interpersonal conflict at work,

(01:00:51):
they're talking about death of a loved one,

(01:00:54):
they're talking about financial challenges,

(01:00:57):
interactions with police,

(01:00:58):
things like that.

(01:00:59):
And again, we find that the emotional challenge made people

(01:01:06):
increased their negative mood and that the NSSI group reported greater negative

(01:01:12):
mood in general,

(01:01:13):
but there's no difference in how they were responding to that task.

(01:01:16):
So again, kind of showing that even in a really highly personalized situation,

(01:01:23):
emotional challenge there's not a difference in kind of how the emotional process

(01:01:27):
unfolds in a specific emotional instance um which isn't to say that we should

(01:01:33):
completely ignore the emotion dysregulation um uh findings because those are really

(01:01:38):
robust and we know that um

(01:01:41):
Poorer emotion dysregulation predicts the onset of NSSI over time.

(01:01:47):
That was some of my master's research out in schools, tracking kids from year nine to year 11.

(01:01:52):
So kids who say it's hard for them to manage their emotions are at elevated risk of

(01:01:57):
self-injuring a year later.

(01:01:59):
And interestingly, it also goes back the other way.

(01:02:01):
So if you self-injure a year later,

(01:02:03):
you're more likely to say it's more difficult for you to manage your emotions.

(01:02:07):
maybe because there's this kind of narrowing of regulation tools that you're kind

(01:02:13):
of developing.

(01:02:15):
And we know that some of our best therapies for NSSI are working because they're

(01:02:21):
reducing emotion dysregulation.

(01:02:23):
So there's something really important about what people think about their emotions,

(01:02:29):
but that's quite different from how they're actually emotionally responding in a

(01:02:35):
specific emotional instance.

(01:02:37):
Wow.

(01:02:39):
I think I've missed it.

(01:02:41):
Or maybe you could clarify.

(01:02:45):
They clearly did not have sort of, they showed the same physiological responses.

(01:02:51):
Was it including like it didn't take them sort of longer to come back to normal or

(01:02:58):
whatever in that sort of way?

(01:02:59):
Yeah, so their heart rate went up the same amount from baseline.

(01:03:03):
They recovered to the same extent.

(01:03:06):
It took them as long to recover.

(01:03:09):
Because I think we associate sometimes like that heart rate variability and all

(01:03:12):
with ability to regulate emotions,

(01:03:14):
right,

(01:03:15):
as well?

(01:03:15):
Yeah, yeah.

(01:03:16):
So I looked at heart rate as like an overall measure, so in terms of beats per minute.

(01:03:23):
And I also looked at heart rate variability,

(01:03:25):
which is a really interesting physiological measure that talks about how variable

(01:03:30):
the time between your heartbeats is.

(01:03:33):
And that is a measure of kind of top-down control of your autonomic nervous system.

(01:03:39):
So this is both a state measure,

(01:03:42):
so our heart rate variability decreases under emotional challenge,

(01:03:46):
but it's also thought to be a state measure.

(01:03:50):
So if you're someone with greater variability,

(01:03:53):
you're more able to respond faster in your environment,

(01:03:57):
which is supposed to be,

(01:03:59):
which is thought to be,

(01:04:01):
a component of better emotion regulation capacity.

(01:04:05):
So interesting,

(01:04:06):
there is some research that shows that people who suffer to have lower trait level

(01:04:13):
heart rate variability.

(01:04:14):
That's a little bit...

(01:04:16):
murky sometimes there's not a lot of physiology research in self-injury i found no

(01:04:22):
difference in my nsci group and my control group and i found no difference in how

(01:04:29):
they responded over the course of the experiment as well so in across kind of three

(01:04:34):
different measures of physiology or how the body is responding across different

(01:04:38):
domains of the autonomic system

(01:04:41):
found no difference so this is kind of the the call of my phd was like is there a

(01:04:45):
difference no and that's really interesting because theory suggests that they

(01:04:53):
should be yeah it tells us something

(01:04:59):
So I find it really hard to tell my PhD students,

(01:05:01):
even if you find nothing,

(01:05:02):
they still give you a PhD.

(01:05:05):
As long as you ask and address an interesting question.

(01:05:09):
But I think that's a very interesting outcome, right?

(01:05:12):
Because then it's not those,

(01:05:15):
but there must still be something in there because people are reporting differences

(01:05:21):
and therefore maybe you need to put them...

(01:05:22):
And those reports are meaningful.

(01:05:24):
Yeah,

(01:05:24):
so you might need to put them under like a brain scan and see and other things,

(01:05:29):
see where the difference lies,

(01:05:31):
because it must be somewhere.

(01:05:33):
Well, so Ellie and I have recently received funding to kind of explore this further.

(01:05:39):
So what we're going to do is look at what people believe about their emotions,

(01:05:44):
because I think that's a really interesting kind of area to take this.

(01:05:48):
So we see that people are saying that their emotions are much more difficult to

(01:05:51):
manage in this kind of holistic sense.

(01:05:54):
But really, they're remarkably resilient and responding to instances of emotional challenge

(01:06:01):
as well as their peers, right?

(01:06:03):
So I think there's something going on with how we're evaluating our emotions.

(01:06:07):
So the extent to which we think our emotions are controllable or useful or useless

(01:06:14):
is thought to relate to how dysregulated we say we are.

(01:06:19):
And so Ellie and I are going to go out to schools

(01:06:22):
It's a bit of a returning to my research roots, which is great.

(01:06:26):
And work with young people and a member of their whānau and do a longitudinal study

(01:06:30):
of how young people and their family member experience emotions,

(01:06:37):
what beliefs they hold about their emotions,

(01:06:39):
their emotion dysregulation and their self-injury.

(01:06:42):
So we can look at how emotional beliefs might turn into emotion dysregulation for

(01:06:46):
young people and if that process unfolds differently in families where kids self-injure.

(01:06:52):
So we're going to start that next year.

(01:06:54):
I'm so excited.

(01:07:00):
Yeah,

(01:07:00):
for context,

(01:07:02):
for people,

(01:07:03):
Kayla and Ellie just won this massive grant called the Marsden Grant.

(01:07:08):
Marsden FASTA.

(01:07:09):
Sorry, Marsden what?

(01:07:11):
Marsden FASTA.

(01:07:13):
FASTA.

(01:07:14):
Yeah, which is for early career researchers.

(01:07:16):
But for context,

(01:07:18):
for people who are not in New Zealand or necessarily do academic research,

(01:07:24):
academics run,

(01:07:25):
try to like...

(01:07:27):
attack each other as much as they can over such grunts.

(01:07:33):
I think there was a 12% success rate this year.

(01:07:38):
So it's very competitive and lots of different phases of writing and trying to

(01:07:45):
convince people that your research is interesting and well conducted and gets

(01:07:50):
reviewed by international experts and it's all a little bit overwhelming and then

(01:07:54):
you kind of find out.

(01:07:55):
It's also hard because New Zealand is a really small community and

(01:08:01):
You know, everyone kind of finds out around the same time.

(01:08:03):
So while you're celebrating, you know, other friends are not.

(01:08:08):
I was actually on two grants this year.

(01:08:09):
I was very happy to get this one, but I was also really sad to not get the other one.

(01:08:14):
So it's a bit of a mixed bag.

(01:08:17):
And it takes like a year from applying to like finding out.

(01:08:23):
So I'm thrilled to not have to write another grant application next year as well.

(01:08:27):
For a few years.

(01:08:29):
For a few years.

(01:08:30):
And so,

(01:08:32):
but based on your reporting,

(01:08:34):
if you got rejected from the grant,

(01:08:38):
if you're someone who is part of your NSSI group,

(01:08:42):
you would report greater emotional dysregulation,

(01:08:46):
but the physiological effect of getting a rejection letter would be the same.

(01:08:51):
Exactly the same.

(01:08:52):
Yep, exactly.

(01:08:53):
There you go.

(01:08:55):
I learned something.

(01:08:56):
Real world applications here.

(01:08:59):
So,

(01:09:00):
I mean,

(01:09:00):
in terms of real world application,

(01:09:03):
when I go out to schools and I talk to whānau or talk to clinicians,

(01:09:07):
I think the applications of this research is that young people who self-injure are

(01:09:13):
experiencing their emotions as really challenging.

(01:09:18):
At the same time,

(01:09:20):
there's likely instances where they've done really amazing emotion regulation and

(01:09:24):
they've kind of responded in a very kind of typical way that anyone in that

(01:09:31):
situation would respond,

(01:09:32):
right?

(01:09:33):
So we know that people who self-injure are more likely to experience life challenges.

(01:09:37):
They're more likely to have kind of interpersonal conflict,

(01:09:42):
more likely to feel disconnected from their school,

(01:09:44):
things like that.

(01:09:45):
They're more likely to have...

(01:09:47):
Yeah, like objectively challenging things happen.

(01:09:52):
They're more likely to experience bullying.

(01:09:54):
And so maybe one of the things that's going on to that kind of evaluation of how

(01:10:00):
they're doing is that they're just kind of dealing with more shit than everyone else.

(01:10:03):
So I think therapeutically kind of highlighting instances where people have done

(01:10:08):
really great emotion regulation,

(01:10:10):
kind of upping that kind of self-affigacy beliefs is possibly the way to go.

(01:10:15):
And also I find it when I talk to particularly family of young people who self-injure,

(01:10:22):
this kind of idea that NSSI is functional and it's helping people manage big

(01:10:28):
feelings is actually a really great

(01:10:29):
way to kind of bust some of that stigma or that kind of and explain why people

(01:10:35):
might be engaging this behavior that often you know older generations have never

(01:10:41):
heard of before although it was definitely happening and kind of develop some of

(01:10:46):
that kind of empathy and understanding yeah yeah oh the old generations thing

(01:10:53):
It's funny because they always say things like, oh, this didn't used to be there at the time.

(01:10:58):
No, you kind of just ignored it, didn't you?

(01:11:01):
well there's descriptions of self-injury in the bible um yeah and there's um ellie

(01:11:08):
is probably the better person to kind of talk to about this but within wellington

(01:11:12):
there's an area of um the landscape called red rocks that and the rocks are red

(01:11:17):
because of um like a myth around self-injury or about um yeah self-injuring as a

(01:11:23):
way to cope with emotional distress yeah this is part of our you know this is part

(01:11:28):
of our yeah

(01:11:30):
Yeah,

(01:11:31):
so for Māori there was and probably still is a practice called kirihaihai,

(01:11:37):
which literally translates to lacerate the skin.

(01:11:42):
And that was done under extreme distress at the loss of a loved one or something.

(01:11:51):
But it wasn't necessarily encouraged,

(01:11:53):
but it also wasn't looked down upon because the scars were seen as like a reminder

(01:11:58):
of that person and who they were.

(01:12:00):
And yeah,

(01:12:02):
it was just an extreme expression of grief and emotion at the loss of that person

(01:12:10):
and their artwork that

(01:12:12):
depicts it,

(01:12:13):
you see it talked about in like Waiata or Mooteatea,

(01:12:18):
Purako,

(01:12:19):
so stories and yeah,

(01:12:21):
like it,

(01:12:23):
South Hamza,

(01:12:25):
I don't want to say normal,

(01:12:26):
but it comes up in a lot of

(01:12:28):
It's been with us for a long time.

(01:12:30):
This is not just a 10 people these days.

(01:12:35):
You guys saying this actually reminded me that there is something very similar in

(01:12:40):
Shia Islam where the certain times of year where you sort of blade yourself on the

(01:12:46):
chest and back to try to...

(01:12:49):
based on a story which if I get into it's not but yeah it's oh yeah it's the point

(01:12:54):
of self-injury being part of it similar I've seen similar sort of practices in

(01:13:00):
Hinduism as well

(01:13:02):
but not my religions.

(01:13:04):
I can't claim further, but I've seen, you know, like that, I can see this sort of practice.

(01:13:09):
Maybe I'll get Pharaoh back on and she can explain.

(01:13:11):
But yeah.

(01:13:13):
And it's interesting.

(01:13:14):
We're talking right at the top of the episode around definitions,

(01:13:17):
but again,

(01:13:18):
there's a big conversation about how these kind of culturally embedded practices,

(01:13:21):
if they counted self-injury or not,

(01:13:24):
and what we can learn from this kind of cultural practices and what we can bring

(01:13:29):
from particularly some of the biological kind of knowledge of self-injury,

(01:13:34):
how we can marry those together to better understand what's happening.

(01:13:37):
Yeah,

(01:13:38):
because I'm not at the beginning,

(01:13:40):
you all,

(01:13:42):
not just the beginning,

(01:13:43):
throughout,

(01:13:43):
you said that this self-injury is sort of used as a way to,

(01:13:47):
uh,

(01:13:49):
sort of feel like control as a sense of like a feeling of control.

(01:13:54):
And therefore,

(01:13:55):
when you're talking about treatment for,

(01:13:57):
or sort of treatment practices,

(01:14:01):
which are done to sort of reduce self-harm,

(01:14:04):
self-injury,

(01:14:08):
I feel Ellie could probably answer this better as someone who works,

(01:14:12):
who does clinical work.

(01:14:16):
Is that sort of like, how do you go about sort of

(01:14:20):
training someone out of it.

(01:14:21):
Because I think in a way, it sort of links back to how I think of rituals, right?

(01:14:27):
Like sort of ritualistic practices are done to reduce anxiety,

(01:14:29):
reduce sort of stress,

(01:14:32):
even just like sort of things which you do before a sports game to make you feel comfortable.

(01:14:37):
There's some really interesting work done by Dr.

(01:14:41):
Sophie Hayward where she interviewed people who self-injure.

(01:14:44):
And one of her participants said that they would start every day by self-injuring

(01:14:48):
kind of preemptively as a way to kind of make it through the day.

(01:14:52):
And that reminds me again of what you're saying around rituals and kind of getting

(01:14:57):
yourself prepared to go through like a big challenge.

(01:15:00):
Yeah.

(01:15:02):
Ellie works with people.

(01:15:06):
I'll leave her to answer this question.

(01:15:08):
Not yet.

(01:15:09):
I haven't yet, but next year probably.

(01:15:16):
I guess it's kind of,

(01:15:19):
I think it's a bit mixed at the moment in how,

(01:15:21):
like,

(01:15:22):
what is the gold standard for

(01:15:24):
of working with young people who self-injure and because there's the whole like oh

(01:15:29):
rubber band and around your wrist and snap it but that is just another form of

(01:15:36):
self-harm really yeah and there's work that says that people who self-injure find

(01:15:41):
that really invalidating yeah exactly exactly well like um i've heard of i don't

(01:15:49):
know if this is um

(01:15:52):
like TikTok knowledge or not.

(01:15:55):
I'm pretty sure I've seen people have been told to like,

(01:15:58):
oh,

(01:15:58):
put your hand in an ice bath or like things like that.

(01:16:03):
And again, I can imagine that that's really invalidating for people.

(01:16:09):
And also like water is really, really cold, probably still a form of self-harm of some kind.

(01:16:15):
Yeah, if you leave your hand for long enough, you will get sufficient.

(01:16:19):
So you can't just replace

(01:16:21):
one form of self-harm with another, that's not going to work.

(01:16:25):
So I think,

(01:16:26):
yeah,

(01:16:26):
a lot of what we focus on is the emotion dysregulation side and teaching strategies

(01:16:33):
around emotion regulation and

(01:16:40):
I had something that's gone.

(01:16:41):
It's left my head.

(01:16:43):
So the kind of gold standard at the moment is dialectical behavior therapy for

(01:16:48):
adolescents or for adults.

(01:16:50):
And there's some really interesting work around kind of embedding those skills more

(01:16:56):
generally in schools and stuff.

(01:16:57):
And I will provide Sahir with some resources if you're listening to this and you're like,

(01:17:02):
oh,

(01:17:02):
I'd love to know kind of

(01:17:04):
some resources for where to go for support or just to kind of have in my back

(01:17:08):
pocket if I come across this in my life.

(01:17:12):
I'll link to some excellent work that's done by an organisation called SIOS,

(01:17:17):
which is run by researchers and people with lived experiences of self-injury.

(01:17:24):
around sharing their stories of recovery and what helps them I would say possibly

(01:17:28):
controversially but we know that self-injury is functional and is helping people

(01:17:35):
and for some people self-injury is a way that they

(01:17:39):
can work through intense feelings of suicidal ideation.

(01:17:43):
And in that instance,

(01:17:45):
you know,

(01:17:45):
from a kind of pragmatic perspective,

(01:17:51):
I think taking away something that helps someone kind of manage is probably

(01:17:56):
unhelpful in the long term.

(01:17:58):
And again, it's kind of supporting people

(01:18:02):
uh while they're self-injuring because a lot of people don't want to stop

(01:18:06):
self-injuring right um and so kind of working around what's going on that's kind of

(01:18:11):
creating the context for self-injury and then if somebody would like to stop or um

(01:18:16):
would like to kind of start that recovery process kind of supporting them to do

(01:18:19):
that as well again i'm a big fan of um kind of autonomy and and using particularly

(01:18:24):
lived experience perspectives can inform how we understand self-injury and

(01:18:29):
particularly work with people who self-injure

(01:18:32):
Yeah,

(01:18:33):
I think too,

(01:18:34):
like making sure that people are looking after their loans,

(01:18:39):
like properly looking after them as part of working with people who don't

(01:18:43):
necessarily want to stop self-harming at the time.

(01:18:46):
And I think,

(01:18:47):
Taylor,

(01:18:47):
you just said something that reminded me too,

(01:18:49):
like about working with the context as well.

(01:18:51):
Sometimes we can't change, well, a lot of the time we can't change the context, right?

(01:18:56):
So the first thing that pops into my head is, well, you know,

(01:19:02):
a lot of minority groups might self-harm because of the racism,

(01:19:09):
the discrimination,

(01:19:10):
colonization,

(01:19:11):
intergenerational trauma.

(01:19:13):
You're one person.

(01:19:14):
How are you supposed to fix that?

(01:19:16):
Like you can't fix these things that are institutionalized.

(01:19:18):
Well, you change your voting pattern.

(01:19:20):
I mean, yeah.

(01:19:21):
I'm an activist, right?

(01:19:23):
I feel like a lot of people who work in digital health are also activists.

(01:19:28):
Absolutely.

(01:19:30):
You do what you can, right?

(01:19:31):
Yeah.

(01:19:32):
You're working within these constraints.

(01:19:34):
And as much as I would love to be like, fix colonization.

(01:19:38):
Rewind.

(01:19:41):
we'll just make people not discriminatory or racist anymore that's like not

(01:19:48):
something that you can just change like that it is something that takes time and so

(01:19:53):
yeah you have to work with the person with where they're at and also with where

(01:19:58):
society is at and working around developing coping strategies for when they

(01:20:04):
encounter racism discrimination those kinds of things that

(01:20:10):
provide them with a, an alternative coping strategy to, um, self-harm.

(01:20:16):
Yeah.

(01:20:17):
And I mean, Debbie too, one of the core goals is to build a life worth living, right?

(01:20:20):
So it's that really holistic, um, big picture.

(01:20:26):
Yeah.

(01:20:27):
Um, yeah, I don't have much else to add to that.

(01:20:33):
Supervision with Teresa.

(01:20:34):
Oh, awesome.

(01:20:36):
Um, just to, uh,

(01:20:40):
just to finish off then because we've been recording for a while and yeah,

(01:20:43):
I guess I could ask a lot more questions,

(01:20:45):
but I think it's good to end here and Ellie gave snippets for when we can get her

(01:20:49):
back on to talk about all of her work and maybe a little bit more about the project later.

(01:20:55):
Kayla, final question then for you.

(01:20:59):
If you had one piece of advice to give all our listeners, what would it be?

(01:21:06):
About self-injury or about life?

(01:21:08):
About life.

(01:21:09):
About life.

(01:21:12):
I'm going to answer about self-injury while I think about my advice for life.

(01:21:18):
In terms of self-injury,

(01:21:19):
I think if you're somebody who self-injures,

(01:21:21):
know that you are not alone.

(01:21:24):
There's a lot of people who self-injury, this is a perfectly understandable behavior.

(01:21:29):
This is not something...

(01:21:31):
that is unique.

(01:21:33):
There's a lot of people who are also kind of going through life using self-injury

(01:21:38):
as a way to cope.

(01:21:40):
If you're somebody who is supporting somebody,

(01:21:43):
a loved one who self injures,

(01:21:45):
again,

(01:21:46):
I would say you are in a group of people who are also trying that.

(01:21:51):
doing their best to look after people and support people who self injure.

(01:21:56):
And there's a lot of really great resources for how to sit in that quite difficult

(01:22:02):
stage of life.

(01:22:03):
And again, I'll pass those along to Sahir so you can link them at the bottom of the podcast.

(01:22:08):
In terms of life, I mean, let's say, well, I'll be very cheesy.

(01:22:16):
A lot about life is the connections that we make along the way, right?

(01:22:19):
So Ellie and I probably has come through quite clearly.

(01:22:22):
We know each other quite well.

(01:22:23):
Ellie and I.

(01:22:24):
did phds in the same lab and particularly in science but i think in life in general

(01:22:30):
um the community you have around you as well is what matters and kind of making the

(01:22:33):
time to prioritize that is important as well which is also such a psychology answer

(01:22:39):
it is it is but it's a really good answer so thank you so much kelly thank you so

(01:22:46):
much ellie for joining

(01:22:48):
Thank you everybody who listened, who's listening, who got to the end.

(01:22:56):
Yeah.

(01:22:57):
Now I need to, it's a new year, so I need to start plugging things again.

(01:23:00):
So follow me,

(01:23:02):
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(01:23:05):
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(01:23:10):
Follow, sign up to our Patreon.

(01:23:11):
We've got a Patreon now.

(01:23:13):
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(01:23:16):
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(01:23:17):
Make a resolution.

(01:23:18):
Pay $3 a month.

(01:23:20):
Whatever it is.

(01:23:22):
It could be going to a gym, but instead, give it to us.

(01:23:28):
Die happy and knowledgeable at a young age because you weren't fit.

(01:23:31):
It's fine.

(01:23:37):
Thank you so much.

(01:23:38):
Like, follow, subscribe, all those things.

(01:23:40):
And see you in the next episode.

(01:23:41):
Take care.