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It can be difficult to stick to a routine – especially when it involves taking time for yourself. However, self-care is an important part of a balanced life. Psychologist Matthew Sacco, PhD, talks about how to start a self-care routine that works for you and what to do if you need to re-start a routine after a lapse.

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How To Start (Or Re-Start) a Self-Care Routine with Dr. Matthew Sacco

Podcast Transcript

Intro:
There's so much health advice out there, lots of different voices and opinions, but who can you trust? Trust the experts, the world's brightest medical minds, our very own Cleveland Clinic experts. We ask them tough intimate health questions so you get the answers you need. This is the Health Essentials Podcast brought to you by Cleveland Clinic and Cleveland Clinic Children's. This podcast is for informational purposes only and is not intended to replace the advice of your own physician.

Molly Shrodes:
Hi, and thank you for joining us for this episode of the Health Essentials Podcast. My name is Molly Shroades, and I'll be your host today. Taking time out to take care of ourselves can be a real challenge. We have endless to do lists and tasks that don't leave a lot of extra time for self-care. Today, we're talking to psychologist Matthew Sacco about the importance of self-care, and how to restart a routine after it's lapsed. Thank you so much for joining us today.

Matthew Sacco:
Oh, absolutely. Thanks for having me.

Molly Shrodes:
Now, starting off, can you tell us a little bit about the types of patients that you see and what brings them through your door?

Matthew Sacco:
Yeah, absolutely. So I work in several different places here at the clinic. I work part of my time in sports health and medicine, where I see a lot of young people, mostly athletes or folks who are being seen by orthopedics, who are referred because they were seeing their physician or maybe their athletic trainer, and something seemed a bit off, and the provider thought it might be helpful to talk to the sports psychologist. And at that point, we can focus on anything from recovering from injury to coping with depressive or anxious symptoms, to working through relationship issues and major transitions in life.

I also work in cerebral vascular center with folks who have had a stroke, and trying to adjust to some of those life changes, and I would say in that setting, this topic kind of comes up even a little more frequently, because they're typically trying to make some lifestyle changes that may reduce the likelihood of another stroke. Diet, exercise, things like that. So that's kind of where I spend most of my split and my time here at the clinic.

Molly Shrodes:
Great. Now, let's just dive in by talking a little bit generally about self-care. How would you define that?

Matthew Sacco:
Really simply. I'd say self-care is anything that kind of we deliberately kind of do or maybe in some instances refrain from doing, with our own wellbeing in mind. Anything that promotes our own physical, emotional, or psychological or spiritual wellbeing. It doesn't really have to be any more complicated than that. If somebody defines it as self-care, that's good enough for me, and who am I to argue that with another person.

Molly Shrodes:
Now, what are some of the general types of self-care that kind of fall under this? What kind of categories are we talking about here?

Matthew Sacco:
I think there's a lot of what we might consider common sense things that we could kind of pick apart in this. I mean, making sure that people focus on physical health. So that's usually how I break it up. Physical health, things like exercise, maybe diets, sleep, categories like that. And then maybe more of a psychological end of things. How are you doing things to manage your own emotional wellbeing? Maybe relaxation techniques. Socialization fits in there a little bit. There are a lot of different avenues there. And then spiritual wellbeing. Everybody has a different definition of that. It could be something like an organized religion. It could be somebody's connection with nature. There's a lot of leeway in that. But that's usually how I would kind of even break it up in their practices, the physical, psychological, and then spiritual health.

Molly Shrodes:
Awesome. And I know I've seen before some people even grouping hygiene in there now with that. Would you include pampering like spa days?

Matthew Sacco:
Yeah. I wouldn't, like I said before, I wouldn't get too picky over it. if that's something that is meaningful to somebody and that makes them feel better and they're dedicating that time to themselves. I really do like to point out to folks, especially early on, that focusing on some of those behaviors, those things that you're already doing. You had mentioned hygiene. Most of us have some sort of hygiene routine, but little things that we can be deliberate about. Maybe it's just that extra few minutes in the shower. Maybe it's just little things that provide a little boost and a little kind of sense of self. And just time to yourself can really fit into that category.

I even sometimes will say something is, when we talked about what not to do, taking a break from social media and that can fit into some of those pampering and spa days. Unplugging, going someplace where you're not going to be bothered. But you have to know yourself because I can think of people who going and getting a massage would be the furthest thing from a self-care activity that they would want to do. So really high levels of self-awareness can really improve this process and understanding what is meaningful to you.

Molly Shrodes:
Yeah. It sounds like this is extremely personal and it's extremely, as you said, you need to know yourself and know what would make you happy. Now I'm wondering if friends come into the scene, you mentioned socialization a little bit ago. Would you include friends and friend time as a part of self?

Matthew Sacco:
Absolutely. Yeah. And the word that keeps coming to my mind and I had said this earlier is that we're deliberate. When you are being kind of very deliberate with what you're doing, and this is an activity that you value and you put that on your calendar, on your map, so to speak, to go out with friends and maybe, I don't know, maybe it's to go take a walk or whatever. When it is time that you set aside from that typical routine with very specific intentions of socializing and having a good time, it doesn't have to be overly complicated. It's just that planned intentional aspect that you look at it for promoting your wellbeing. That's kind of how I would focus. If it is meaningful to you and you put it on there, absolutely.

Molly Shrodes:
That's awesome. Now, I'm just curious, for many people, a part of that could also be regular happy hours. How does that kind of, as you said, being intentional is an important part of it, but like having that scheduled time for maybe pouring a glass of wine, gathering around with a few friends. That all fits into this too, right?

Matthew Sacco:
Yeah. On the surface, absolutely. I would be mindful that there could be for some folks a bit of a slippery slope there, especially when ... The first thing that comes to my mind is when that a glass of wine potentially leads people to sabotage other areas of their life. Like maybe they start eating more unhealthy when they've had that glass of wine and then they get really frustrated and they kind of beat themselves up over that.

But when you, again, when you put this kind of in a nice little pocket where you say you're going out for happy hour, that's kind of be where you're going to allow yourself that opportunity to focus on that socialization. Then if you deserve, you tell yourself you kind of deserve that reward, then yeah, it's self-care.

Now, being kind of thoughtful about if you are doing it because you are frustrated at the end of the day, you need to unwind and you need it to settle down and that's kind of the way that you focused on it. It might be moving a little further away from that idea of it being a self-care activity. And then of course, if it becomes the only way that you decide that even relax after a nice day, but your routine is want to cook dinner and pour a glass of wine and that's for you, then absolutely.

If you find yourself reacting to these statements, like, well, who's going to tell me and I can do what I want. I might say kind of check a little bit about what you're doing and maybe develop some other coping mechanisms to go along with it. It's all about being mindful of not overdoing it.

Molly Shrodes:
And as we start kind of diving into the how often part of this, I want to talk a little bit about with these routines, these self-care routines, how often should you be integrating these into your life? Is this a daily, weekly, monthly thing, or is that kind of up to you?

Matthew Sacco:
I think there's layers. There are absolute layers. Practicing self-care activities every day is important. The things that you do daily might differ from the things that you might do weekly or monthly or even yearly. In fact, these things should be different. You may, I don't know. Maybe you do deliberately put in a time and place in your day where you do some very structured relaxation exercises every day. And maybe you do that four to five times a week.

Maybe you sit and watch your favorite television show or movie once or twice a week. Maybe you go out with friends once a month. Maybe you take a nice relaxing weekend, a couple of times a year or a major vacation one time a year. All of those things are really, really important and all our very deliberate ways that you promote some aspect of your health and wellbeing.

So the more layers and the more ways that you kind of look at this in terms of time-wise, I think the better off you're going to be, because it really does give you an opportunity to kind of recharge your batteries a little bit.

Molly Shrodes:
Now, I'm curious, how would you recommend people kind of go about finding these activities that are good fit for them? Are you thinking like list-making or is it good to just throw a lot of things at the wall and see what works for them?

Matthew Sacco:
Yeah, that's very individualized. You're absolutely right. One of the things, if you're a list person, not everybody is. If you're a list person and you like to see this stuff written down, then absolutely do that. Some people may be a little bit more haphazard and they just kind of figured out as they go. But I really encourage people to identify areas that you'd like to prioritize. So maybe say something like find something exciting or something you've always wanted to do. Maybe it's starting a game night with friends or something like that.

Then look at the areas that you feel like maybe you've been a little short on, maybe things that you feel like you need to do. Maybe one of them, probably the most common example there would be for people to start like a regular exercise routine. Something like that.

And then start really small with very clear goals in mind. We often use the acronym smart, S-M-A-R-T, for setting goals and looking at things that are very specific, measurable, attainable, realistic, and time limited. That gives you an idea of some structure. Some people like that and they can look at this stuff.

It may also be helpful to look at what you do. Maybe we're looking at replacing something like replacing one habit or routine that may be you're not quite too keen on. Maybe you like to eat potato chips. I don't know. But replace that and maybe eat popcorn once a week instead. Something that might be a little bit more health promoting. See how that goes. And then you might, depending on how often you do it, maybe you add a day or two or whatever it is, but really assessing your own life. And look at those things to start with that seem like they're doable and build a little bit of momentum and having some success with that.

Molly Shrodes:
That's great. Now, stepping back for a second, let's talk a little bit about routines themselves. How long does it take to establish a routine and really have it stick?

Matthew Sacco:
Oh, that is a really good question. And one that probably has been batted around in popular culture quite a bit. I often hear people quote the idea that it takes 21 days to form a new habit, as if that's some sort of fact. In real reality, in research, that's patently false. It was never something that the original author ever intended to be considered fact. It was kind of anecdotal observational stuff. But it kind of caught on and people really liked that idea. And unfortunately, and when we actually look at the research that this, it can take anywhere from, some studies have shown 18 to 250 days. The average is about 66 days. But there's too many variables that come into play. It's not a one size fits all. Some habits might be easier. Some routines might be easier to start than others.

So I think we do ourselves a disservice when we have this measuring stick that is 21 days. And perhaps we don't measure up to that. And then people feel like they failed and it didn't quite work out.

So I think it's really important to look outside ourselves maybe. And you look at examples that solidify our understanding of this importance of establishing routines. I think of, oftentimes I think of school teachers who, it's a good reference because and probably now more than ever with the pandemic, but if you ask teachers about the times of the year kids have the tendency to have the most behavioral problems or things that are just off. And they'll tell you it's certainly the beginnings of the school year, like right now, but that's just starting a routine.

They'll also say like around the holidays, when schedules are off. All of a sudden that predictable thing, people are watching movies, having parties, and that established routine has changed. And kids start to act a little squirrely and have a little bit difficult time because that predictability is gone and it breaks down and we're no different as adults. Many of us thrive on that routine and that predictability. We just may act out a little bit differently. It may feel a little bit different.

So I do challenge people to just think of ourselves from that standpoint. When we get into this routine and we're doing really well, be mindful of what happens when it changes, because I think that's where we can start to understand a little bit about maybe where some of our vulnerabilities lie.

Molly Shrodes:
And I imagine it's important to try to be kind to yourself as you're setting up a self-care routine and not beat yourself up when it lapses. But let's dive into that a little even more. What kind of is happening when a routine lapses? What's going on in that person's head a little bit?

Matthew Sacco:
Yeah. I'm a big proponent of recognizing that lapses or in fact relapses are going to happen. And the term relapse in and of itself is obviously to lapse again. So the expectation that you might kind of slip up, you might slip up again, it might be off schedule, giving yourself that kind of permission is really important. Circumstances change. That's usually where things break down. People were in this good routine and things are moving along and then something unexpected comes up, priorities change, and people need to adjust to these changes. We have to adapt to the new circumstances, reprioritize and then figure out a new routine. So often people try to go back to what they were doing before the change occurred and do it the same way and it doesn't account for those changes that have occurred.

And sometimes our lives require, I think, us to put other people first and it gets into this back and forth a little bit that we may struggle with, especially when we've established this routine. But if you're, for instance, I don't know, if you're a parent, you're raising kids. This isn't news, but sometimes other people's needs have a higher priority or move up. Maybe you've scheduled your favorite exercise class or yoga class or whatever it is as a part of your self-care routine. Maybe that's something that's really important. And then all of a sudden you get a call from the school and your kid's sick or is injured and you have to go. And then, before you know it, you know, now, especially that school has started and you find out that your kid's choir schedule requires them to be at practice the same time you have your class scheduled.

And that's not going to go over well, if you tell somebody, well, Hey, listen, prioritize yourself. Because until you figure out how to make this work for both, most parents aren't going to sacrifice their class and maybe you don't have somebody else, or maybe another parent is working and it just isn't going to work out that way. And people don't want to feel like they're selfishly taking advantage of that.

So, it's coming up kind of full circle and try to figure out how can you figure out what this new routine is going to look like, because most aren't going to feel good about, I'm sorry, you're not going to do choir this year because I have art class. Or I have whatever it is. So it's adjusting along the way.

Molly Shrodes:
Absolutely. There's so much balance that happens throughout all of your life, especially you see it a lot with young parents.

Matthew Sacco:
Yes.

Molly Shrodes:
So I'm thinking about, when we've been talking about self-care, I've been thinking a lot about the phrase, a body in motion stays in motion and a body at rest stays at rest. And I'm wondering, how do we fight this need to just once we've stopped to stay stopped? How do we get going again?

Matthew Sacco:
Yeah. And this is something that echoes similar to what I just said a few minutes ago. Really, it's often about needing to make adjustments to a previous routine or setting some new or different goals that are more reflective of where a person is in that moment, not necessarily where they left off, and you had said before about this idea of being a little bit more compassionate with ourselves, and you're absolutely right. Allowing some grace and compassion can be very helpful, keeping in mind that things are going to change or may simply be no longer possible based on the circumstances.

And while most of us may function really best with a consistent routine, I also know that that doesn't always work for everybody. And it also doesn't mean that tweaking and changing things or making complete outright changes at times isn't necessary to meet the current demands because it's a constant fluid process. And yes, like I said, there are some people who prefer less structure, less routine, less predictability. It doesn't mean that they don't engage in really good self-care activities or that they're somehow doing something wrong or less effective. We're all different. We all have our own preferences, strengths, growth edges, all of that. And these are valuable, just as valuable as anything else that we're talking about. And when you recognize in yourself that you're an individual and that things are going to happen. And like I said, exercise a little bit of grace and compassion for ourselves. I think it can go a long way.

Molly Shrodes:
That's great. Now, earlier you mentioned about how sometimes people can feel selfish for wanting to do this and some people will criticize self-care and I'm wondering, what are some of the criticisms you've heard in the past?

Matthew Sacco:
Oh, yeah. Selfish is first and foremost because somehow we've put self-care at one end of a continuum. Like you either do that or you take care of the other people in your life. And if you're doing one, you can't be doing the other, if you're doing the other, then it's coming at ... It's so black and white. And it can often feel like, and to be quite honest and really fair about this, I think that it's something that the way that our society is set up and the way that we're socialized. It's something that I think really weighs more heavily on women in our society in many instances than men, because of the expectations. Right. Wrong. Good. Bad. Whatever. The expectations that we place on women to do all these different things that that's where they will often feel like they're being, they might be considered selfish if they're putting their needs at a time ahead of their families. And that's historical. I mean, that's something that has been baked into the culture for a very long time.

We also run into the idea that we should be able to suck it up, plow through, tough it out and move on. And that can be very effective in a moment to moment way. But when that becomes the MO for the long-term strategy or how you deal with most things, and it becomes a long-term way of coping. It honestly makes us more ineffective and absolutely more vulnerable to poor health, physical health, psychological health.

So doing this kind of work thoughtfully, in a very planned way, it is absolutely a vital part of us as an individual level being more effective in the world around us. And I will often say, especially, especially to women, you got to be ... It's the oxygen mask on the airplane analogy. They tell you that when you get on. You got to put it on yourself first, before you help others. It doesn't take seeing a mother's reaction to a kid that they're going to grab it and try to put it on their own kid first, because that's the reaction. And that same thing applies to life. They're going to put their needs first and their needs first, their needs first, when occasionally putting the oxygen mask on yourself so that you are better able to provide those care to the people around you, that you care about, it makes you more effective. But that is a tough hurdle to get over for many folks.

Molly Shrodes:
Now, if you have a loved one, family member or friend, who is skeptical of self-care routines, what are some suggestions you might have as far as having a conversation with them?

Matthew Sacco:
Yeah. First of all, I would focus on identifying the things that people may already be doing on a regular basis that fit into that category. So yeah, maybe an easy one. If a person attends a religious service, like church, every week, because that's what they do. They deem that to be a vital part of the spiritual care. That's a self-care activity. And so if you've got people that are skeptical, that's the kind of place you would start, things that they're already doing and saying, well, you know how you feel when you walk out of there, that's the kind of thing that we're talking about here. That, for me, taking that class or going for a walk, being with nature, that is what I'm talking about. That's what I need.

And I think if you can connect it with something that they can identify with as being meaningful, you have a better chance. It's really typically more about identifying some areas of wellness that people are already doing. And maybe they're not quite as confident in some of those other areas, but being deliberate about the efforts to build and enhance that. Once you can do that and help them see that there are those commonalities and that they're already doing it, I think you get a little bit of wiggle room and a window in, and maybe an opportunity for that conversation to continue.

Molly Shrodes:
Great. Great. Now, as we start transitioning into being indoors in the fall and in the winter, for a lot of people that shifts the activities they're doing. A lot of people love being outside and they take joy in the great outdoors. How can we bring our self-care routines indoors and adapt also to the shorter days and longer dark periods of time?

Matthew Sacco:
Yeah. I think that part of the answer to that is absolutely right in the question, which is you're already anticipating these things. By being able to anticipate these changes and planning for some of this can be really, really helpful. Many activities that we enjoy, being outdoors, can't be done in the same way in this part of the country. So, and not just the winter time, but bad weather in general, anywhere you are, but having contingency plans. If you walk outside, having a backup for when the weather gets bad.

You said, it's not just, when you were talking about this, it's not just the change in the seasons as it relates to the cold and things like that. It's this change in amount of light that we get. If you're, like many people, if you're a person that's kind of susceptible to that, and you know that as the days get shorter, you might be more vulnerable to some of those changes in mood or your motivation goes down. Maybe there are some things that you can do to prevent this from being such an issue. Maybe you build your social network in such a way where you have people that can help make you accountable, that maybe they pick up the phone a little more often during the fall or the winter, maybe make one of your long-term kind of routine or goals. Maybe make a special trip in the winter months to a nicer climate. Maybe you shift some of those things. Everybody likes to go in the summer, but maybe for you that self-care, maybe it's just a weekend somewhere. It doesn't really matter.

And interestingly enough, it's kind of ironic when you said that the schedules are packed now, right? The implying that for many people's schedules become more packed in the fall and that activities pick up and that the things that weren't there in the summer. This is a perfect example of how many of us are already very skilled at creating a new routine and putting things on the schedule. But it's also reflective of just how difficult it can be to make ourselves a priority. We can see all these other things on the map. We can do all these other things because we feel that those are a higher priority targets. We just have to do that.

And it's tough. It is tough to put our own needs, especially as it relates to self-care, on that same plane as it being that important. And I think that's a real part of the convincing that we might need to make for ourselves, that we're worth doing that for. Because many of us don't feel that way or feel like, well, I'm doing everything that I need to do and this is just an added thing in my schedule that isn't going to make that much of a difference.

Molly Shrodes:
I think it's been really fascinating hearing you talk about how personal self-care is and just how much you need to know yourself and look inside to kind of form this routine for yourself. So as we finish up here, I'm just hoping you can leave our listeners with a few tips on how to kind of get started on a self-care routine, especially if they've started one in the past and seen it lapse and they want to get back at it again.

Matthew Sacco:
Yeah. Yeah. And I think that's the, in many ways for this conversation, that's probably the easier audience to target a little bit because they have experiences with these kinds of activities. I'm reminded, as you say that over the, that's a saying that I often will use in my practices. It's how do you eat an elephant? And many people are the answer is it's the same way that you eat anything else. It's one bite at a time. We can get very overwhelmed if we focus on the big picture and looking at all of the things that are on our plate that we have to do. No matter how large that task is, no matter how large and complicated things are, you really can only start with a one bite at a time. So starting by recognizing that this is going to be a process that takes some thoughtfulness and planning and maybe a real step wise approach, so starting there and not thinking that maybe, oh, I've done this before. I should be able to just without missing a beat jump right back into it.

I will also tell people that perhaps, and this is often sounds like overkill to many people and it is, and I will admit that it is, but something like if you have a difficulty figuring out how am I going to do this, where's it going to fit in, create a schedule for your entire 24 hours. Use a reward system. Figure out, okay, I'm sleeping between these hours. Have like a table or something with the hours. Write it down. I go to work, I get up at this time, I brush my teeth. I eat, I drive to work, I eat lunch. I drive home. All of that. And again, it's going to be overly detailed, but it might give you an opportunity, first of all, to identify some spots or areas that you might be able to kind of weave back into some or your previous activity or new activity. It'll also give you an opportunity to see things on a map, if you will, that you can look forward to.

That's a big part of some of this. When you have something that you can build day by day and things to look forward to, when you start to get a little bit of satisfaction out of accomplishing things. As adults, we don't necessarily think this way, but we are as adults really motivated just as kids are by stickers. Put stickers on a calendar when you've accomplished something. See it build.

And then once it becomes a more regular part of your routine, where it becomes more automatic, because that's what this is really about. It's about getting a routine that becomes more automated so that you're not ... Our brains like that. They really do. They like that automaticity because it spends less energy there and we can spend more of our energy on other things.

And we have these things that our life, all the time. Most people like, for example, you get into the car. How often do you really consciously think about buckling your seatbelt? Most of us, it just happens. For many of us, typing is that way. We don't have to think where our hands are on a keyboard. It's just automatic. Our brains love that. But it takes time to get there. And so that's kind of what this is about. And sometimes we think we should just be able to jump to that automaticity.

It may also be really helpful to think about this in terms of using the GPS or the navigation app on your phone. If you don't have an address to type into that, a destination that you're going to, you'll just see an ever-changing map of where you are in the moment. And that's okay. Once you have an address, a destination that you're trying to get to, something you're trying to work towards, like get some goals, then the GPS might give you 1, 2, 3, 4, 5 different possible routes to get there.

And so then, you certainly could choose one and say, this is how I'm going to do it. But you also may consider sitting down with somebody who kind of does this work for a living. Sitting down with a therapist can be a great place to start, especially if you feel like you've been down that road before. But even if you don't feel that way, working with somebody to help facilitate this or give you some feedback, it might help make you feel a little bit more effective.

And also, when you go to see somebody professionally, sometimes that can add to the piece where it feels like it's more important. So if your self-care is really that important enough that you're willing to go talk to somebody about getting that going, it might help to prioritize it a little more. And of course, I know there are a lot of really good people in our system and psychologists therapists who would absolutely love to help with this process and this journey. But again, it's a matter of putting kind of one foot in front of the other and getting started. And that starts with kind of knowing yourself and what you're really wanting to kind of work on.

Molly Shrodes:
That's fantastic advice. Thank you so much for joining us today and sharing your insights, Dr. Sacco.

Matthew Sacco:
Thanks for having me. I really appreciate it.

Molly Shrodes:
If you'd like to schedule an appointment with Cleveland Clinic Center for behavioral health, please visit clevelandclinic.org/behavioralhealth, or call 216-636-5860.

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