An Interview with Psychologist Timothy Strauman
Dr. Strauman is a Professor of Psychology and Neuroscience at Duke University and is an expert in self-regulation.
Nicole Izquierdo: Thanks for joining us today for this installment of the Seattle Psychiatrist Interview Series. I'm Nicole Izquierdo, a research intern at Seattle Anxiety Specialists, and today I'd like to welcome with us Clinical Psychologist and Researcher, Timothy Strauman. Dr. Strauman is a professor of Psychology and Neuroscience at Duke University. He is also an affiliate for the Center for Brain Imaging and Analysis, the Duke Initiative for Science and Society, and the Center for Child and Family Policy. He is an expert in self-regulation. His research has amounted to over 13,000 citations and focuses on the psychological and neurobiological processes that enable self-regulation, conceptualized in terms of a cognitive-motivational perspective as well as the relation between self-regulation and affect. Before we get started with some questions, can you please tell us a little bit more about yourself, Dr. Strauman, and what made you interested in studying psychology and, eventually, self-regulation?
Timothy Strauman: Sure. Well, thank you for having me. It's actually hard to know. I've never quite been able to figure out why I got interested in psychology. I think very early on, I remember in high school being interested in mind-body things, and what at the time were called "psychosomatic illnesses," so I think I was sort of going back and forth between, did I want to be a physician, or did I want to be a psychologist? Psychology just appealed to me partly because it was a science and partly because the idea of intervening the way psychologists intervene and seeing impacts that it can have on people's behavior, on how they think, on how their bodies are responding to stress, it's just something that's always been interesting to me, so I'm very grateful to have the career that I have, and I'm as excited about it as ever.
Nicole Izquierdo: That's awesome. Do you want to talk a little bit about where you went to school, what your training kind of consisted of, and then, I guess, how you ended up with a position here at Duke?
Timothy Strauman: Sure. I was an undergraduate psychology major at Duquesne University in Pittsburgh, which I actually went to because their Psychology Department was very humanistic. I got there and, you know, that was fine, but I sort of realized that for me, personally, I needed to be in a mainstream, so I went to the University of Chicago into an interdisciplinary program called Human Development. Got there and decided that's not exactly what I wanted to do either, so I got a master's degree there, and then I actually went to work for a drug company doing cancer research, clinical trials, and it was a great experience. I did that for four years, learned a ton about research, a lot about statistics, and then kept applying to graduate schools, and eventually got accepted at New York University, and I was able to do both clinical psychology and social psychology there, which was absolutely phenomenal.
The research that I do takes how a social psychologist thinks about experimentation and thinks about mental processes and applies them to what makes people feel sad and what makes people feel anxious, and then what would you do about it, and how would you know that the treatments were working? I did my internship at Einstein in New York and it was absolutely fabulous. Then went to the University of Wisconsin, where I was for 15 years. I was in the Psychology Department, and then I moved over to Psychiatry because I wanted to do more clinically-focused work, and then I came to Duke and I've been here ever since. It's a great place to work and it's particularly good because the medical center's right next door and it's a wonderful place. Amazing students, by the way. Very smart students.
Nicole Izquierdo: Thank you. Yeah, we're lucky to have you here. So, I guess your research revolves around this term called "self-regulation." For our audience members that aren't too familiar with what that means, would you mind defining it to someone that could be listening to this?
Timothy Strauman: Sure. Yeah, it's kind of a fancy psychology term, but what it really boils down to is all of us when we were growing up learned that it was important to be a particular kind of person and it was important to not be a particular kind of person, right? It's kind of what it means to have family, what it means to have parents. We learned very early on to constantly sort of monitor ourselves. What are our goals? What are our standards? What are we trying to be? What are we trying to not be? That's really what self-regulation means. Part of what's interesting about it is it's always happening. We do it unintentionally, but it's always happening in the background. It's always happening, pretty much automatically. It's as automatic as if you look at the letters C-A-T, you can't not see the word "cat." It's impossible, it's so overlearned.
Self-regulation is the same way. Any situation that we're in, there's something in the background saying, "How am I doing in this situation? Am I being the person I want to be in this situation? Is it working? Is it not working?" That's really the approach that we take. We spend a lot of time in our research, basically, it's pretty straightforward. We ask people, "What kind of person would you ideally like to be? What kind of person do you think you ought to be, you're supposed to be, and how are doing in reference to those standards?" We basically will bring people into the lab and have them think about it or expose them to those ideas and just watch what happens. See, if you get people thinking about a goal that they feel like they're attaining, they'll feel positive. If you get people thinking about a goal that they feel like they're not attaining, they'll feel negative.
The other thing, though, that's an important twist to this is there are basically two kinds of goals. There are goals about making good things happen, which we call "promotion," and there are goals about keeping bad things from happening, which we call "prevention." One of the things we've learned in our research is that depression is associated with not being able to make enough good things happen, whereas anxiety is associated with not being able to keep bad things from happening, at least in your own head, so in the treatment research that we've done, part of what we do is to try to help people understand that there are both of these kinds of, two ways of thinking about goals, and depending on which way you're thinking, it could make you happy or sad, or it could make you anxious or calm. We try to integrate that into treatments. That's not in and of itself terribly revolutionary, but what we do in our work is really try to help people focus on it and actually learn it as a skill.
Nicole Izquierdo: I noticed that one of your papers was on a model for generalized anxiety disorder and depression comorbidity. Would you say that these individuals are with these deficits to their self-regulatory systems that makes them more vulnerable to both not being able to make good things happen and not being able to stop bad things from happening?
Timothy Strauman: Yeah, that's the model. You're absolutely right. A lot of the work that we've done has been developmental, where we basically, we either ask people to look back on what things were like with their kids, or sometimes we've just studied groups of children and followed them. Everybody learns how to make good things happen and everybody learns how to keep bad things from happening, right? I mean, anybody who's a parent will say, "Oh my gosh, of course I want my kids to know that," and anybody who's ever been raised by an adult says, "Oh, I know exactly. I know exactly what I was supposed to be doing and what they really wanted me to be doing." That's part of human nature and we carry it with us and it's really adaptive.
We've actually found that there are two ways that these things can get disrupted. One is for people who are used to succeeding, sometimes when they get into a patch in life when they're just not getting the positive reinforcement, it creates a sense of, "I'm not being the person I really would like to be," and that in the moment it leads to sadness, which that's not a big deal because that just motivates us to work harder. But what if you keep working harder and harder and harder and nothing's changing? Part of the work we've done is to say that's a potential pathway to depression.
The other thing that we've learned is many people when they're growing up are raised in a family environment where the focus is really on stay out of trouble, be careful, make sure the world's a dangerous place, and as a parent, of course, is exactly what I did with my kids. But if you focus on that exclusively, it ends up having the unfortunate side effect of you never learn how to make yourself feel good. You only learn how to keep yourself from feeling bad and that's actually not enough, and so our model of why generalized anxiety and depression go together is because for lot of people we've found that they're really focused on keeping bad things from happening because that's all they actually ever learned to do. We'll say, "What do you do to make yourself feel good?", and they'll look at us like, "I don't know. Nobody ever told me it was okay to do that."
A lot of us grew up in different kinds of families. That doesn't mean we had bad parents. It means we had parents who really wanted to keep us safe and just one of the byproducts of that is sometimes we're not balanced about, "Oh, actually, I need to make myself feel good so that I'm not constantly focusing on things that are dangerous and things that might go wrong." That's a long-winded answer to your question.
Nicole Izquierdo: Would you say that these people are essentially doomed or are there some strategies that you have found that they can implement to restore their self-regulation?
Timothy Strauman: Oh, first of all, people are amazingly resilient. One of the things that's a real privilege as a therapist is to work with people and watch as they think through, "Okay, I have a set of standards. Some of them are from a long time ago. Maybe I don't need them anymore," or, "No, I like the standards I have, and I'm going to stick with them, but I'm going to explore what am I doing to pursue them, and can I do that differently?" People are amazingly resilient and the work that we've done developing and testing therapies where we're really focusing on this, people understand the distinction between ideals and odds. I think they feel really comfortable with the idea of getting balance.
In fact, the whole wording of “make good things happen versus keep bad things from happening” came from people who were in our early studies because we were using all this psychology terminology. You're like “No, no, no, no, it’s just what you're talking about,” which is, “Am I trying to make something good happen? Or am I trying to keep something bad from happening?" We were like, "Yes, that's exactly what we're talking about." Both of those things are essential, they're just different. If you want to be happy, you have to do the one, and if you want to be safe, you have to do the other. In a complex world like ours, you really want to be able to do both. No, I don't believe people are doomed at all. Folks are amazingly resilient and these are skills that we know people can learn and we know they're helpful.
Nicole Izquierdo: I guess to make this more applicable to our listeners, I was thinking about it and, you know, not everyone has the access, the time, or the money to afford to go to a therapist and sit in a therapy session so what are some techniques that you would recommend that could fall under the umbrella of restoring these systems that people can do in their everyday life?
Timothy Strauman: Oh, sure. In fact, the work that we do and the work that the people at your clinic do, the whole goal is to help people acquire new perspectives and skills that they take with them out into the real world and not just in the therapist's office. There are a couple of things that I think can be really helpful. One is just the recognition that it is always going to be important to us to make sure we are being the kind of person we want to be. That's just human nature. That's really what it means to be human. That's all always true, it's always happening, and we get to decide, what are those goals and standards going to be?
Yes, as we grew up, we acquired a set of beliefs about what's a good person and what's a bad person from the people around us, of course we did, but we always have the opportunity to say, "That worked for me when I was younger. I'm not so sure it's working for me now. Do I want to tweak it? Do I want to change it?" I think one of the things that's really empowering is just to be able to say, "Yeah, you know what? That actually matters. It always matters. Even if I'm not thinking about it intentionally, it's always going to be there in the background. I care if the people I love think I'm a good person or not. I care if the people I love think I'm keeping myself safe and avoiding danger. It matters. It matters to them, and therefore, it matters to me." That would be one thing.
The other thing that I think can be really helpful is just when you're in the middle of a situation and you're starting to feel something's not right, something's not working here, maybe you're feeling frustrated, maybe it's making you sad, maybe it's making you anxious, and maybe you can't do it right at this moment, but after that moment say, "Okay, what was happening there? What was my goal? What was I trying to make happen? Was I trying to make a good impression on somebody? Was I in talking to my boss and worried about somehow my boss thought I had done something wrong? What was I trying to do? What was the goal? How did the other person respond? Did they respond the way I wanted them to? Or did they not? Then how did that make me feel?"
Those three things: what was my goal in that interaction? We always have one. How did the other person respond to whatever it was I did that I was trying to pursue this goal? Then how did their response make me feel? That's a very old psychotherapy technique, it's not new, but thinking about it in that language makes it really easy to do in any situation. Then you can sort of stop and say, "Okay, is there anything I might have done differently? Did I do a good job of what I wanted to do and just didn't get the reaction I wanted? Is that my fault? Is it nobody's fault?" Then you're in a position to be able to say, "Okay, what happened?"
You can use the emotion as a signal that something important happened, and you can really dig into it and look at it rather than having the emotion be the endpoint. The emotion is sort of like, "Okay, something significant just happened here, but I'm going to figure out what it is, and I'm going to figure out why it made me sad versus guilty versus anxious." I'm going to figure that out and that's going to put me in a position that next time I'm in that situation, I'm going to know a little bit more about what's in my mind when I'm going in there, what's going to be in this other person's mind. I think that's really helpful to people and you don't need to be in therapy to be able to do that.
Nicole Izquierdo: Thank you. Thank you for that. I guess in terms of the pandemic itself, what we've seen, especially in the beginning, a massive increase in anxiety and depression symptoms across the population. Have you done any work on this yet? Or have you found, I guess, any connections between the self-regulation model and this uptick in symptoms?
Timothy Strauman: Yeah, I think so. I mean, obviously, this doesn't explain everything because the pandemic is enormously stressful, but one of the things that it has done is, just to use the example of parents, it's made it harder to be a good parent. Let's say you're a working parent and suddenly your kids are home. You have a whole set of expectations about what does it mean to be a good worker, and you have a whole set of expectations about what does it mean to be a good parent, and because of the pandemic, you're really not able to live up to either of those sets of expectations. You just can't. It's not possible, right? That puts us in a situation of something in the back of your head saying, "I'm not being the person I want to be. I'm not being the person I'm supposed to be." It's totally out of our control, but that doesn't stop. We're so used to evaluating ourselves that way.
I think one of the things that's very important for people to do to cope with the pandemic is to say, "Okay, I'm going to have to adjust what I expect of myself because there are things happening that I have no control over." In pre-pandemic days, what did it mean to be a really good parent? Okay, it meant certain things. In the middle of the pandemic, what does it mean to be a good parent? It's a very different set of things and it's okay to let yourself say, "This is what it means right now and I'm doing everything I can."
I think it's really important for people to be able to distinguish what's under my control and what's not under my control and not let all of the pre-pandemic stuff that, of course, it's how we lived our lives, and then suddenly we're in this situation where we just don't have the ability to do it, and it's really important just to say it this way to let ourselves off the hook, and knowing we're going to do everything we can do, but knowing it is artificially limited right now, and that does not feel good, but it doesn't mean we're not being good people. We're being the best people we can be under a set of circumstances that's absolutely extraordinary.
Nicole Izquierdo: When I took my psychology stats course with you, I remember mentioning that you had some work about some public school interventions in relation to the self-regulation. Do you want to talk a little bit more about that, how that process has been? I imagine the pandemic probably caused a stint in that progress, but how has it been collaborating with public schools and implementing the work from the research to the real world?
Timothy Strauman: Boy, it is such a privilege, and it's so exciting. Yeah, it's been on hiatus because of COVID. We are actually just now getting back to where, and probably within the next two weeks or so, we'll be back in at least one of the schools. The work that we're doing is really simple. This is with my colleague, Dr. Ann Brewster, who's an Intervention Scientist. We're trying to help people, especially people who are at risk for bad academic outcomes, so folks who've had long-term suspensions, or people who are moving from middle school to high school, but already have some academic indicators that they're probably going to struggle when they get to high school. We're trying to help them learn what I guess I would call "metacognitive skills," which is this general ability to stop, take a step back and say, "Okay, what's happening here?" We have really good data that that’s an enormously helpful thing for people to be able to do, and not just adults, but teenagers.
It's funny because when we got into doing this work, there was some skepticism about, can teenagers even do that? The answer is absolutely yes, they can do it. They do it all the time. There's nothing that we've tried to teach that has been at all foreign to people and students are amazing at it and it's really empowering because it puts them in a situation to be able to make better decisions. Just as an example, a couple of the people that we were talking to recently, why are they long-term suspended? Because they got into fights. Telling them, "Hey, don't fight," is not an effective intervention. Giving them the opportunity to step back and say, "Okay, what was happening in that situation? What was I trying to accomplish? Was I trying to make something good happen? Was I trying to keep something bad from happening? What were my options at that moment? One option was fight. Maybe that was the only good option. Okay, then it was the only good option. Maybe it wasn't the only good option."
What's powerful about it is, it's not us telling them this, it's us saying, "Here's a set of skills that we think might be useful. Give it a try. Tell us if you think..." And then they do it and then they come back and say, "That's interesting, because at the moment it didn't occur to me that I had any other options, but now as I look back, I can see that I did." As adults, we're not immune to that, we know exactly what that's like, but we do know it's enormously powerful.
The work that we did first that really got us established working with the Durham Public Schools was with these kids who were really at highest risk, and a lot of people, I think, probably just thought, "It's too late. Nothing can be done." It's absolutely not true. It is never too late. These folks helped us learn how to do the intervention. They helped us shape what the skills would look like. It is enormously inspiring and it's such a privilege to be able to do that work. We're actually hoping this spring we'll be back in the schools and in the fall we're going to roll it out through a couple of the Durham public high schools, and we're hoping by about a year from now, it'll be rolled out through the entire school district.
Nicole Izquierdo: That's amazing. Would you say that they're receptive, both students and their parents and caregivers about these programs, and even the teachers and administrators themselves?
Timothy Strauman: Yeah. There's a history of, there are some really well-thought-out interventions that are not punitive. They're not stigmatizing. They're not presented as, "Okay, you are getting pulled out of the classroom because you're a troublemaker. You're getting sent down the hall to this other thing where you have to see the psychologist who's going to make you a better..." It's not like that at all. It's for everybody, everybody in the school. It's a skillset and it's very respectful of the individual. Some of the interventions that we base this on are about, "What do you want your legacy to be? 10 years from now, 20 years from now, what do you want to be known for? Oh, and by the way, in the interim, what are the kinds of things that might get in your way? What kinds of situations might make that harder for you?"
We do a lot working with the older adolescents with frustrations they have about trying to get a driver's license, trying to find a job, helping them problem-solve about it, but what's really gratifying is once they learn the skills, they do the problem-solving, so they're able to say, "Okay, I went, I filled out an application. I handed it in, the person kind of grimaced, and took it away from me, and that was that, I haven't heard back from them." Okay, let's analyze that situation. Did you meet your goal? Absolutely, you met your goal. Your goal was to apply for a job. Beyond that, it's out of your control. The person's grimace, who knows why that person was grimacing? Maybe they're having a bad day, maybe they're... But whatever it is, you met your goal, your goal is to apply for a job.
Now, what are your options? One option is, "I'm never going to apply for another job. That was it. I'm done." Maybe another option is, "That was one possibility, but there are lots of other possibilities and I'm not going to let that person's grimace stop me from applying for the next job, or reapplying to that place," right? But they don't need an authority figure telling them that. That doesn't work. What works is for them to arrive at those kinds of options for themselves in a way that's empowering and non-critical and non-stigmatizing.
Nicole Izquierdo: I guess the main takeaway among all the things for the interventions from the adolescents to with older adults is just remembering that some things are out of your control, whether it's the pandemic, or school systems, and then I guess, reframing the issue and evaluating all your options after the fact, and then, hopefully, implementing those in the future, would you say?
Timothy Strauman: Yeah, I think that's a really good summary. To take it back to the whole idea of self-regulation, in every interaction, we have a goal, and there are aspects of those situations that we have control over, and there are aspects that we don't. We don't want to evaluate ourselves based on things we had no control over. We want to evaluate ourselves in, "Is the goal reasonable and did I do a good job of pursuing it?" We definitely want to evaluate ourselves, but not about things we have no of control over, and just learning to sort that out puts people in a situation to say, "Okay, I didn't get the job, but good for me for persisting, even with this person who was grimacing at me while I was filling out the application. Good for me. Whose problem is that? That's not my problem." Or, "I tried something and it didn't go the way I wanted." Okay, that's important information.
Just being able to take that step back and say, "What was the goal? Is it a reasonable goal? Did I do a reasonable job of pursuing it? Then is there anything else that was under my control? Maybe not. Okay, then I'm not going to hold myself responsible for the things that weren't under my control. That's asking too much." Yeah, I really like your summary. I think you nailed it.
Nicole Izquierdo: Thanks. I guess we're going to shift a little bit. I saw that you have some papers on the training of clinical psychologists, mainly graduate students, and I also noticed when I was registering for courses last semester that you offer one for graduate students, kind of like a training course. Don't remember the name, but maybe it involves some ethics or something. Do you want to talk a little bit more about that and I guess what you think should be the core values in our future clinical psychologists and what it's like teaching graduate students here at Duke?
Timothy Strauman: Sure. Yeah, thank you for bringing it up. That's an important part of my job and it's something I'm really committed to. The way that I think about Clinical Psychology is first and foremost, it's psychology, it's a science. There are a lot of things we know, there are a lot of things we've learned, and it's the job of a clinical psychologist to take that knowledge into a situation and somehow find a way to address whatever its public health problem it is, or whatever sort of problem it is you're trying to deal with. The training always has to be about that. It always has to be: get the knowledge base and then learn how to apply it.
Therapy is clearly one way of doing that, but it's not the only way of doing that. For example, it's become much more sort of an ethical responsibility of psychologists to advocate for their clients, to advocate more broadly in terms of social justice, and the American Psychological Association actually is saying that now. It's like we have a set of ethical principles and those are now part of the ethical principles, as they should be, because other healthcare professions were already doing that. It is our job to advocate for our clients, and that can mean a lot of things, but it's something that we need to do.
The other thing that is really important to us is, like many other sciences, clinical psychology has fallen short because we've basically only studied privileged people. We are as guilty of systemic, structural racism and its unintended consequences, let alone its intended ones, as anybody else, and it really is our responsibility to take a step back and say, "We can actually do better." It boils down to things like in my research study, who are the people that I'm recruiting to be participants? Why am I recruiting them? Are they representative of the people in my community? Are they representative of the people more broadly that I think my research is relevant to? If they're not, then I need to stop and say, "Okay, that's a problem."
We know a lot about intervention, but we don't know a lot about what interventions work for different kinds of people from different backgrounds who have different needs and who live in different kinds of communities and we absolutely need to learn those things. When we do learn those things, we will be better at our jobs, we will help more people. I definitely believe there are universal principles of behavior. I don't think it's the case that people from different communities are not like each other, but I think we've made a big mistake in not looking closely at people's individual circumstances.
There's so much that goes on in our society that is tainted by privilege and tainted by racism and the impact that it's had on education. When we go in and work in the schools, part of one of the reasons we're working the Durham Public Schools is that there is a history of discrimination in that school district and they're very well aware of it and it continues to reverberate. I mean, if you're from minoritized background, you're five or six times more likely to have academic difficulties than if you're not. It has nothing to do with your innate abilities, it has nothing to do with the quality of your parenting, it has to do with racism. That's something that I think psychology in general and certainly our training in particular, we see that as a mission is we have not been broad enough. We have not been comprehensive enough and we absolutely need to do that or we're not doing our jobs.
Nicole Izquierdo: Yeah, I totally agree. Actually, an article will be published soon on The Seattle Psychiatrist site. It was some research that I did on the disproportionate impact the pandemic has had on the mental health of racial, ethnic, sexual, gender minorities, and it is due not to their abilities or some innate differences, but because of these systemic and institutional inequalities that we have in the US and you can argue around the world.
Timothy Strauman: Yeah. You can't overstate how powerful those forces are. I mean, they're in the air, like that trivial example I gave before, you can't not see "cat" when you see C-A-T. If you are from a privileged background, you can't not see the world through the lens of a privileged background. That doesn't mean that you're a bad person, it doesn't mean you created the world that way, but it's still a fact, and we have to tell the truth about it. It's too easy for psychologists to say, "I'm going to do my research with a bunch of undergraduates at my university," which is fine. It's probably a good place to start, but it's certainly not a good place to stop.
Some of the best work that psychologists have ever done is work that's been underpinning changes in how our country deals with social justice. The Brown vs. Board of Education decision that the Supreme Court used to legally eliminate discrimination in education was entirely driven by psychologists who were doing research saying, "This occurs and it's harmful." I would say even the Supreme Court got it and that's a proud part of the legacy of psychology. There are a lot of parts of the legacy of psychology that are not so proud, but there are some good ones, and that's the one that inspired me when I was in graduate school because I was at New York University, and a lot of that work had been done by people who happened to have been in that department, so it was in the air and it was a good thing. Those things are in the air again now and that's exciting.
Nicole Izquierdo: Thank you. Well, I guess we're going to wrap up now. I don't know if you'd like to add any last words or anything else you'd like to share, advice you'd give to our listeners?
Timothy Strauman: Boy, advice. People are amazingly resilient. People are amazingly resilient and there is always a way. It is absolutely mind-blowing and a total privilege to work as a therapist, as an interventionist, and watch people empower themselves. It is remarkable and I've been able to participate in that in my career and it's so gratifying. I am a relentless optimist and I really believe that for everybody, there is a way. Thank you. I mean, it's a privilege just to be able to talk. I really appreciate being able to share some of my experiences and I hope this is useful to people who are listening.
Nicole Izquierdo: Well, thank you so much for joining us, Dr. Strauman. We really appreciate you taking the time to speak with us and we wish you the best.
Timothy Strauman: Thank you. I wish you the best as well.
Please note: The views expressed by the interviewee are for educational and informational purposes only, are not meant to diagnose or treat any condition, and do not necessarily reflect the views of Seattle Anxiety Specialists, PLLC.
Editor: Jennifer (Ghahari) Smith, Ph.D.