Road to Resilience

The Recharge Room

• David Putrino, PhD • Episode 38

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When COVID-19 hit New York City, David Putrino, PhD, Director of Rehabilitation Innovation at the Mount Sinai Health System, converted his lab into recharge rooms for front-line healthcare workers. Informed by the latest research on the connection between natural environments and stress-reduction, Dr. Putrino and his team created multi-sensory experiences that can reduce stress in just 15 minutes. In this interview, Dr. Putrino talks about the science behind the recharge room and shares tips for creating relaxing spaces at home. Drawing on his work in high-performance sports, he also explains why resilience is best viewed as a social resource. “You may not be the most resilient person on the planet, but if you’re part of a highly resilient team, it elevates you,” Dr. Putrino says.

The recharge rooms were conceived by Studio Elsewhere and the Abilities Research Center, part of the Department of Rehabilitation and Human Performance at the Icahn School of Medicine at Mount Sinai, with support from The Office of Well-Being and Resilience.

The immersive audio content in the recharge rooms was created by EMBC studio composer Jacob Marshall and violinist Tim Fain. Their music appears at the beginning of this episode. Follow @the_embc on Instagram and Facebook to hear more of their work.

Links:

Visit https://www.mountsinai.org/clinical-trials to see if you're eligible to enroll in a clinical trial with the Mount Sinai Health System.

Check out more episodes of Road to Resilience —as well as guest pictures, transcripts, and more— on the Mount Sinai website.

Road to Resilience brings you stories and insights to help you thrive in a challenging world. From fighting burnout and trauma to building resilient families, we explore what’s possible when science meets the human spirit.

HOST:

From the Mount Sinai Health System in New York City. This is Road to Resilience, a podcast about overcoming adversity. I'm Jon Earle. Say you had to design the most relaxing space possible. What would you put in it? Maybe a few candles, some incense? Well, it turns out there's a science to this, and recently Mount Sinai's Dr. David Putrino applied that science to help front-line workers de-stress. Dr. Putrino specializes in using technology to boost human performance, and when COVID-19 hit, he converted his lab into what looks like a spa. He and his team applied the science of relaxation to craft an experience that could take, say, an ICU nurse from stressed-out to chilled-out in just 15 minutes. In our conversation, Dr. Putrino shared with me the science behind the recharge rooms, including tips that you can use to create relaxing spaces in your own home. We also talked about resilience as a social resource rather than an individual trait, and about the connection between resilience and storytelling. Dr. Putrino, welcome to Road to Resilience.

DR. PUTRINO:

Thanks for having me.

HOST:

So you have somewhat of an unusual title. I can't say I've met another director of innovation. When people ask you what you do for a living, what do you tell them?

DR. PUTRINO:

I tell them that, really, my job is to use technology to make people's lives better. And so really what we do at the Abilities Research Center is we create rapid clinical trials for technologies that we believe in. We advocate for technologies that we believe in to get them into the hands of clinicians faster and to get them into the hands of people who need it the most. And we work with a bunch of different technologies that range from really niche technologies for high performance athletes to assistive technologies helping people with ALS who have very, very little function left.

HOST:

So when COVID-19 hit New York City, I know you closed down your lab very quickly and you immediately set about looking for ways to help in the fight against COVID-19, including by boosting the performance of healthcare workers. What was the problem that you identified and how did you set about trying to solve it?

DR. PUTRINO:

When we first saw the writing on the wall that this was going to be a big issue, we made the decision to shut down the lab. And then we were stuck with this funny situation of,"Well, we have 3,000 square feet of lab space. What can we do with it?" Because it's sort of sitting dormant. And to us, seeing what was coming in and hitting the hospital, it was really clear what was next. And that was—we needed to take care of our front-line healthcare workers. So in the course of an afternoon, I teamed up with a long-time collaborator of mine, a group called Studio Elsewhere—they create these immersive, multisensory experiences that are actually designed to change your physiology—to create rooms that can create all sorts of physiological effects within people. And I said to them,"Listen, what we need is a space or a series of spaces where our healthcare workers can sit down and for just a moment have a lot of their stress just relieved and taken away from them." And they were absolutely up to the challenge. They took my space and in one day transformed it into recharge rooms for the staff.

HOST:

Wow. You've said that space is never neutral, it helps or it harms. Can you tell us about some of the key design elements that are at work in the recharge spaces?

DR. PUTRINO:

Yeah, absolutely. And all of the work that we've been doing is based on really solid foundations of science around the impact of nature and green spaces on human physiology. So how natural environments can relieve stress and how even short exposures to natural environments can create stress relieving effects. So the first thing that we did was we brought in these artificial plants that sort of cocoon the person. So you will sit in an experience and you're surrounded by these plants that make you feel like you're in a forest. We then project beautiful HD images of different natural scenes. We bring in all sorts of experiences that have been shown over years of research to reduce blood pressure, decrease heart rate, reduce stress hormones in the observer. So things like having campfires tends to be really important. Things like having waterfalls and scenes of still water and things of that nature. And then in addition to what you're taking in from a visual perspective—the plants, the projections—we have brought in a phenomenal group of composers to create music experiences, again, that are founded on clinical research. These are auditory experiences that are known to reduce stress, that use specific tempos, timbre of music and intervals of music that reduce stress as opposed to increase arousal. Because we know that music can do both. It can pump you up or it can slow you down. And then, finally, we're also tapping into smell and sense of smell. So we're using aromatherapy, combinations of different scents that replicate nature, forest-floor scents and things of that nature in order to really bring you in and have you feel like you're actually having the nature experience that's being projected to you.

HOST:

Wasn't there something about outdoor bathing as well?

DR. PUTRINO:

Some of our experiences— because we give people a menu of different experiences that they can have. One of them was heavily inspired by forest bathing, which is widely practiced in South Korea and in Japan. It's being studied as a very powerful way of creating stress relief on a daily basis in a way that is entirely natural, very simple to achieve, but does something to the body that just brings stress hormones down. So we tried to create, in one of our environments, we tried to create this immersive forest-bathing experience.

HOST:

So front-line healthcare workers finish their shift, they come into this space, which is kind of like a spa, they spend 15 minutes or so in one of these recharge rooms. What's the response been like?

DR. PUTRINO:

The response has been really overwhelming. All we've heard from all of the healthcare workers is how much this means to them. Not just from a point of view of stress relief, although in a dataset that we collected with an anonymous survey, what we saw was that 15 minutes in a recharge space across 146 experiences resulted in on average 65 percent reduction in stress. So what we're seeing is that this experience creates enormous short-term stress relief. And that's wonderful to see, and that's been really gratifying to see that we're actually having an impact on short-term stress. But on a broader perspective in terms of organizational wellbeing, taking the pulse of an organization, just hearing the responses to the room of,"It is so nice that the hospital system is doing this for us. It's so nice to know that the system has our back." That really means a lot to a lot of people.

HOST:

So the recharge rooms are for healthcare workers at Mount Sinai. I'm wondering if there are lessons in their design that somebody at home could take to design relaxing spaces.

DR. PUTRINO:

Absolutely. I think everyone needs to hear that just dealing with what is happening right now in the world, out there in the world, takes mental effort. So you're going to notice that you're not as productive. You're going to notice that some days are really, really hard for you and you don't know why. That's grief. That's what's happening there. And it does take a toll. It needs to be addressed with self-compassion and understand that it's okay. But also ways that we can mitigate that is by creating little spaces within the home that we treat as sanctuaries. Where we maybe say,"Okay, you know what? In this area, my phone doesn't come with me. Or in this area, this is going to be my little meditation corner for right now." And, again, we can follow these design principles really, really simply. I mean, Amazon's still kicking. You can definitely order some artificial plants off of Amazon. There are incense diffusers and things of that nature that you can create. Noise-canceling headphones can work wonders for people who are living in close quarters with other roommates and spouses and housemates and kids. We've seen some really creative stuff with people just pulling their shower curtain shut and turning their bathtub up into a little sanctuary. But really I think the main point is finding something that works for you in your environment, getting a little bit creative, setting some rules similar to the way that we think about sleep hygiene, where we think about the bed being a space where you go to sleep and nothing else. I think creating a space where you can just take five or 10 minutes even to reduce stress and deal with the emotions that are happening as a result of this is really, really important to everyone.

HOST:

There's a line that you said before that sticks with me."The institution has my back." I really like that. And it makes me think of—often when we're talking about resilience, we talk about it as an individual trait. You have it, or you don't. You're developing it, or you're not. And that I think puts a lot of pressure on the individual. And they could feel like,"I'm not being resilient. There's something wrong with me," or"I'm doing something wrong." When in fact resilience is a communal trait, and there are ways in which institutions can support resilience. Can you just expand on that thought?

DR. PUTRINO:

Yeah, absolutely. Especially working in high-performance sports, we are really focused on this idea that resilience is a social resource. It's not an individual trait. Or put another way, there are certainly individual elements to resilience—you can be a resilient person—but resilience is so much more meaningful when you view it as a social resource and when you view it as a shared resource. Because you can be the most resilient person in the world, but if the rest of your team isn't resilient, it doesn't mean anything, and vice versa. You may not be the most resilient human on the planet, but if you're part of a highly resilient team, it elevates you. And so one of the things that I've seen with a lot of dismay over the years is, I would call it weaponization of the term"resilience." We sort of throw it at the feet of medical students and say,"You need to be more resilient. You need to meditate. You need to do this, you need to do that. You need to eat right, exercise." And that is not aligned with the literature. What the literature is telling us is—no, the organization needs to signal that we have your back no matter what. The organization needs to say,"We hear and we feel what you are going through, and we're going to make things better for you." And every little way that they can focus on signaling that one thing—we see you, we hear you, we appreciate you and we're working to make it better even though the situation may suck—that is what creates a resilient organization, that is what we need to strive for, not telling individuals that they need to become more resilient.

HOST:

And there's also a mission aspect, right? You know, a mission-driven organization is primed to be more resilient, when you're all striving and rowing towards the same goal.

DR. PUTRINO:

Absolutely. I think that being mission-oriented versus being compliance-oriented or profit-oriented or whatever else you may be oriented toward, I think is really, really important.

HOST:

What does that term mean,"mission-oriented"?

DR. PUTRINO:

Yeah, mission-oriented. In the simplest terms it means understanding exactly why you're getting up and going to work every day. And that being part of a larger mission that is shared by everybody. What happens with large organizations sometimes is they become siloed because they've grown so large. So what you'll have is you'll have someone in finance saying,"I'm waking up this morning to make sure that our bottom line is in the green." And you'll have someone in HR saying,"I'm waking up this morning to make sure that we don't get sued today." And you have all of these people waking up with different missions in mind, and that creates a low resilience because no one cares about the overall mission. They just care about their mission, which they tie to their job performance, which they tie to their job security, which they then tie to overall doing well in life. However, when you have an organization that is mission-oriented—so you think about Mount Sinai during this crisis. Our job is to look after New York in the face of overwhelming odds. Every single person dropped everything and went to fight this thing. We, you know, good New Yorkers we ran toward the danger. We did not run away from it. And every single person in the building, when I show up to Mount Sinai Hospital, they know what they're there for. And that is the definition of being mission-oriented, and it's been a great time for organizational resilience despite being the worst of times in many regards. To see everyone pulling together with one mission and nothing else matters.

HOST:

Last time we spoke you were talking about high-performance teams, and you said that when teams are really well-bonded, their heartbeats actually sync up. I was wondering if you could just bring us that thought because I thought it was so inspiring.

DR. PUTRINO:

Yeah, absolutely. In a lot of the high-performance athletes that we work with, we see this concept called bio synchrony, where in well-bonded teams, not just heart rate, but other sort of physiological responses will sync together. It's not just that if everyone's experiencing stress, everyone's physiology changes together, but it's actually if you're watching a team member in stress, your physiology will show markers of stress if you're well-bonded to that person just by watching what's going on. And I think that it can be something that is used to calm a team together. So if everyone is stressed to hell, but they see one of their team members having a calming experience, it will soothe them as well. So having the experience together, I think, is much more powerful than having it as an individual. And one of the things that we have noticed is that one of our recharge rooms, well, actually now three of our recharge rooms that we've developed are a little bit larger than personal experiences. We initially designed the rooms to be personal. So you go in, you shut out, and you just have a moment to yourself. But what we started to notice was that in some of the larger rooms, there was a preference for people to go in in groups of two, three, sometimes even four. Still maintain good social distancing, but have the experience together. And that was something that was quite a surprise. We didn't intend on that. We didn't plan for that. It was something that happened totally organically. People just, rather than asking to have the individual experience, asked if they could have it as a group. And we sort of said, you know," Why not?" And then it was a clear preference.

HOST:

I mean it's almost as if well-bonded teams become a single organism, almost on a biological level.

DR. PUTRINO:

I think that is exactly where a lot of the literature is going. It's like this—you become the system as opposed to becoming, you know, rather than being individualistic, you're becoming collective. And this is an area of great interest to high-performance athletes as well as to military operators. I mean, what we seein SEAL training, in fact, there's just incredible importance placed on a group's ability to team. So you can be the best operator who's nailing all the tests and making it through what we all know from the mythology as being one of the toughest quote-unquote"entrance exams" of all time to get into the Navy SEALs. If by the end of SEAL training you have not teamed with colleagues, you won't make it through as a SEAL. They don't just require you to make it through, but they require you to bond with a group of others who allow you to get through the training. And so we've also seen in military circles this idea of hive mind, thinking as one, not having to think about what you're doing, everyone's just inherently knowing their roles and adjusting to it. And I think that one of the things that we see as teams become very, very good at that is this biosyncing, which is truly very interesting.

HOST:

You also mentioned that New Yorkers run towards the danger. They run towards the challenge. And something that's interesting about resilience is storytelling and mythmaking, that New Yorkers' self-conception as being resilient and a tough city actually contributes to their resilience, does it not?

DR. PUTRINO:

Absolutely. I think that we play around with these ideas in high-performance sports as well. This idea of belief state. So the level of belief that you have in your ability and the task ahead of you significantly influences your task success. And then, belief state is strongly linked to storytelling, mythology, things like that. So one of the groups that is an absolute master of this is the New Zealand All Blacks. They're a rugby team. They're probably one of the most successful sporting teams of all time. And when you dig into their culture, it's phenomenal. Everything about it is based on storytelling. It's based on mythology. It's based on you deeply understand the people who have gone before you and you're really standing on the shoulders of giants. And it means something to be a part of that team. And they are widely renowned as one of the most resilient teams of any sport. They're widely renowned as one of the best examples of performance under pressure as a group. And a lot of it, I think, comes down to the storytelling, the mythology that creates a sense of belonging and cohesion that leads them to being highly resilient. And I think that New York is the same. New York has taken some big hits over the years, and every time it comes back and every time it comes back stronger. And every time we have that storytelling and that mythology to say,"Hey, remember Sandy? Remember 9/11? Remember, remember?" And we do remember! And we say,"Yeah, you know what? We thought that that was the worst of times and we came back from that." And so I think that knowledge gives people comfort and it gives them the ability to see the light at the end of the tunnel. Knowing what's possible, knowing that you have been there before and gotten through it—it increases your belief state that you'll get through it again and it makes you far more resilient.

HOST:

And I think you really feel the city coming together every day at 7:00 PM when the claps and the cheers start and this entire city resounds with unity and support.

DR. PUTRINO:

Yeah, absolutely. And I think that in terms of when we were just discussing signals, this is such a huge signal. I'm gonna confess that when I first read that New York was going to be doing this, I kind of internally eye-rolled. I was like,"Ugh." You know?

HOST:

Why?

DR. PUTRINO:

It's just too cheesy for me! And then what you realize is that there are days where you really need it. You just need to—you've had a bad day, you've taken a few hits, and you step out and there is this ambient reminder, very powerful, very loud, very in-your-face, of all of the people who are appreciating you. And that is a signal to every healthcare worker,"We see you. We hear you. Keep up the fight." And with a lot of the stuff that we have been putting out out of the lab as well—our Kids vs. COVID campaign. We've got gratitude walls in all of the recharge spaces where messages from kids, messages from people in the community about how much they're appreciated—those are real things and those are really important messages to hear because you never know when you're going to need to see a message like that.

HOST:

Thank you so much, Dr. Putrino, for being with us on the podcast. Really appreciate your time.

DR. PUTRINO:

Thank you for having me.

HOST:

Dr. David Putrino is Director of Rehabilitation Innovation for the Mount Sinai Health System. He and his team have built recharge rooms in five of our eight hospitals. Road to Resilience is a production of the Mount Sinai Health System here in New York City. It's made by Katie Ullman, Nicci Hudson and me, Jon Earle. Lucia Lee is our executive producer. Help fight COVID-19 here in New York by donating to Mount Sinai's response fund. Your donations help support front-line clinicians and pioneering researchers. Follow the link in the show notes to find out how. And thank you. I'll also put a link in the show notes to our podcast e-newsletter. Sign up and we'll keep you in the loop about new episodes. And lastly, if you've enjoyed this episode, please leave us a rating and a review on Apple Podcasts. It helps other listeners find us. Thanks. We'll be back soon with more episodes of Road to Resilience and until then, stay safe and be well.

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