Interview with Dr Natasha Lazareski, Managing Director, PsyFlex Pty Ltd
Becoming more ‘resilient’ seems to be the solution for all our health and social issues at present. There are more and more providers promoting their ‘innovative’ resilience building solutions for an ‘efficient’ return to work. So I decided to explore this topic further and understand its role in our health, wellbeing and professional life
To find answers, I spoke to a colleague of mine, Dr Natasha Lazareski (ex Kiso), Managing Director of PsyFlex. I worked with Natasha in AXA before she moved to CGU insurance to National Injury Management Department. She worked as a Wellbeing manager for Ambulance Victoria when she decided to better understand what helps people effectively deal with life challenges and how they can build these skills. Natasha spent two years researching the best practice approach and joined forces with Dr Russ Harris, medical doctor and international expert in behavioral therapy (Acceptance and Commitment Therapy -ACT) to develop resilience training that really works.
I have to say that I learned a lot. A key point to note: Natasha stresses that our traditional view of resilience as the ability to ‘bounce back’ and ‘efficiently’ deal with challenging situations is outdated. Instead we should view resilience as the ability to be psychologically flexible and to act in line with our values, to engage fully in life, through times of both ease and difficulty and through periods of both stress and calm. It is not about being ‘tough’ or feeling positive; resilience is our ability to live our life to the full and allow our feelings, thoughts and pain to be there, not ‘hooking’ on to them or struggling with them.
Developing psychological flexibility is especially important for people who have been diagnosed with a chronic illness or have been declared totally and permanently disabled by a medical specialist.
As Natasha outlined, in fact any time we are facing a challenge in our life, we experience difficult thoughts, feelings, emotions and urges, this is normal. It is normal to feel scared, worried, sad and anxious when you are in pain and/or you are not sure whether you will ever recover. Resilience does not mean that we feel only positive emotions, or have only positive thoughts, or we don’t feel pain.
What science tells us?
Studies have found that people that have gone through a training program that builds psychological flexibility (mindfulness and values based program) are able to function within society and work and engage with family, despite the physical or emotional pain they may experience. These studies have further been confirmed with strongly positive results from the programs produced by PsyFlex.
Natasha says that questions they ask are “What matters to you most?” and “How would you like to treat yourself and others in this situation”. They acknowledge “Yes, there is pain, or emotional distress, or depression or terminal illness. But also you are still here with us, and with your family and people you love and care about, so what would you like to stand for in this situation? When can you still live your life and connect with people?”
Most people are getting ‘hooked’ or what Natasha and Russ call ‘fused’, with their thoughts and feelings; it is like looking at the world through stained glasses, and everything looks dark. But resilient people are able to notice that they have stained glasses on (that they are ‘hooked’) and they are able to take them off and take another look at the world an people around them.
It was also very interesting to understand the connection between the brain, more specifically the pre-frontal cortex and our ability to have flexible perspective taking. Evidence shows that resilience training that helps people develop mindfulness skills, task focused attention and flexible perspective taking, activates the prefrontal cortex (our ‘thinking brain’) and prevents us from reacting or thinking with our ‘emotional brain’ (mammalian brain). Our emotional brain, or more specifically the amygdala, is responsible for production of the cortisol or so called ‘stress hormone’ as well as making us feel, anxious, worried, sad or angry. Activating our prefrontal cortex helps us observe our feelings, emotions, urges and thoughts without reacting to them.
As you can imagine this approach has great results in managing many conditions from chronic pain and addictions to stress, anxiety and depression.
So how would the Life Insurance Industry benefit from this type of resilience training?
Natasha says research shows that people can benefit from ACT (Acceptance and Commitment Training), in any stage of their life. There are many controlled studies showing that this type of training contributes to significant improvement in the RTW rate of people with significant disabilities. Also, there are significant studies showing increased psychological wellbeing and resilience and decreased burnout and stress in case managers who have developed psychological flexibility.
So I was wondering, should insurers invest in online resilience training for their case managers and clients?
The short answer according to Natasha is ‘yes’. If insurers invest in easily-accessible resilience training for all case managers, incorporated into an overall health and wellbeing approach, this will certainly give a great return on investment. Furthermore, research shows that increased levels of self-kindness and acceptance in managers significantly improvers their ability to help others.
Awareness building is not enough
So far many insurers have been promoting mental health education and development of case manager’s motivational interviewing skills. These are good tools to build participants’ awareness and knowledge about mental health topics and how to talk to claimants. However, it does not support staff in dealing with their internal thoughts, feelings and emotions. As Natasha, who is very familiar with the challenges of the Life Insurance Industry says, you need to be able to deal with your inner world before you are about to call a claimant with major depression and suicidal thoughts or after, when you are going home after a day of dealing with claimants, agents and doctors, as well as trying to meet business targets set for you.
As far as clients and claimants are concerned, Natasha believes that the insurance industry should start investing in resilience training. It’s been found that providing resilience training to claimants will significantly reduce the claim duration and cost. The evidence is quite clear and loud there, and online training is easy to apply with great results. However, the Life Insurance Industry should also seriously consider building psychological flexibility as a value add program for their clients as a preventative measure. Needless to say, it will also significantly contribute to building a psychologically flexible and productive society.
With such a wide range of training options these days, how do we know we have chosen the best one?
Natasha is also very clear on what kind of training should be provided. She says that resilience training should enable participants to rapidly improve their level of psychological flexibility, not just tell them what resilience is and isn’t, but also teach long lasting, life changing self-help techniques.
She warns us to distinguish between training that is just raising awareness and one that actually builds skills and changes lives.
Raising awareness means that you increase participants’ intellectual knowledge about resilience: what the characteristics of resilient people are, how to recognise if someone is not coping and some ‘tips’ on building resilience. The result is that participants feel that they have gained some knowledge, but they may feel anxious, as they recognise that they are not coping well and don’t have the skills to do anything about it.
Resilience skills-building goes much further; it actually teaches participants about how their own mind works, and helps them develop practical skills to use in challenging situations and change self-defeating behaviours. It rewires the brain.
It seems that awareness training is like watching an episode of Master Chef, whereas skill building is like actually trying those recipes at home. You can watch Master Chef all you want, and you will know a lot more intellectually about cooking, but your cooking skills won’t improve. It’s only when you actually try out the recipes in your own kitchen, that you develop your cooking skills. That is why Natasha and Russ tested their program in a randomised controlled study, to ensure that their participants do develop skills and change behaviours.
Resilience growth can be measured
The question on my mind was: “How do we know if people have actually developed resilience?” and it seems that that is also quite easy to do. The best way is to measure participants’ levels of functioning immediately before, immediately after, and a few months after the training. The most common tools are resilience assessment (AAQII) and General Health Questionnaire (GHQ). They are simple to administer, easy to complete and score, and are widely used in many studies. Results of these studies along with data on claim duration, cost, absenteeism and engagement would provide us with enough information to assess the success of implemented resilience training programs.
So it seems to me that this is quite simple. We should consider investing in building resilient case managers and support our clients by providing evidence based psychological flexibility training. For anyone interested to read more about psychological flexibility or PsyFlex training please see below research information and PsyFlex web page (psyflex.com.au)
There are over 200 randomised controlled studies showing that psychological flexibility training has a significant impact on mental health, disability, performance and life satisfaction as well as:
- Increased psychological flexibility, decreased burnout and improved general and mental health (Walker, 2017)
- Reduced absenteeism and treatment seeking behavior in chronic pain patients (Dahl, Wilson & Nelsson, 2004)
- Increased ability to innovate (Bond & Flaxman, 2006)
- Decreased distress (Flaxman & Bond, 2010)
- Improved work performance (Bond & Bunce, 2003)
- Increased job satisfaction (Bond & Bunce, 2003)
- Increased health provider’s compassion and communication (Bond & Flaxman, 2006)
Dr Natasha Lazareski (Kiso), Managing Director, PsyFlex Pty Ltd
Natasha is a co-director of PsyFlex, is an occupational health specialist, and an expert in organisational health and psychosocial risk management. Natasha has more than 20 years’ experience in occupational health, life insurance, workers compensation, strategic risk management and injury prevention. She worked with organisations and governments in Australia and overseas including AXA Australia, NAB, Ambulance Victoria, CGU Workers Compensation, International Rescue Committee and Toyota. From 2014 to 2016 Natasha researched existing training approaches and collaborated with world-renowned experts in area of organisational health, behavioural and neuro-science and occupational health to develop cutting-edge evidence-based, sustainable health and wellbeing solutions. She partnered with Dr Russ Harris, internationally renowned psychotherapist and author of best-selling self-help book ‘The Happiness Trap’ and developed numerous training programs that are designed to drive behavioural change trough mindfulness and values-based action taking. So far Natasha and her partner Dr Russ Harris trained over 5,000 people globally and completed two randomised controlled studies of our mental health and resilience training.
Dr Lazareski was interviewed by …..
Goran Lazic is a Medical Consultant at AIA and Chairperson of ALUCA Medical Subgroup with 19 years of industry experience. He has worked across a range of life insurance disciplines including underwriting, claims and product development in Australia and New Zealand. Goran joined AXA New Zealand in 1999, where he was Head of Claims. In November 2009 he moved to Melbourne where he was appointed as AXA Chief Medical Officer. Goran is also a medical doctor, specialising in blood transfusion medicine and haematology.