Why Our Emotions Matter

In clinical settings, we often suppress our emotions, ignoring what is now considered a valuable professional dataset – yet harnessing the power of our emotional life helps improve so many aspects of our work from job satisfaction to patient outcomes. It’s only a matter of time until the industry pivots away from this seemingly learned habit. Dr. Marc Brackett, Director of the Yale Center for Emotional Intelligence and author of 'Permission to Feel,' explains how to tap into the crucial ability to use our emotions wisely. And the very real price we pay when we don’t.

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Dr. Marc Brackett:
There's no such thing as a good or bad emotion. Emotions are data. Emotions are information.

Dr. Daniel Kraft:
Hi, I'm Dr. Daniel Kraft and welcome to Healthy Conversations. Today we're in Healthy Conversations with Dr. Marc Brackett, a professor in the Child Study Center and the director of the Yale Center for Emotional Intelligence, and the co-creator of RULER. Before we dive in, maybe just the obvious question, I'm sure you get a lot. What is emotional intelligence? How do you define that? And then we'll maybe riff into how that applies to clinicians and health care systems and kids around the world.

Dr. Marc Brackett:
So the brief definition, which is by my mentor, Peter Salovey, who's the president of Yale, and Jack Mayer, who is a professor of psychology, is the ability to use your emotions wisely. How do you do that? And so there are skills, I call them the RULER skills, the skills of recognizing our own and others emotions. So paying attention to facial expression, body language, vocal tone, what's going on in your body, what's going on in your head? Understanding emotions. Why am I feeling this way? Why are you feeling this way? What are the consequences of these feelings, and my thinking, my judgment, my decisions?
Then there's the labeling of emotions. So if it's anger, is it a little bit of anger like peeved, or is it a lot of anger like enraged? Or is it content, or is it ecstatic? That's R, U, L. And then there's all right, so now what do I do with these feelings now that I have them? And so E is expressing emotions, knowing how and when to express emotions with different people across different contexts. And then the R is the big one, which everybody's asking for these days, which is regulation. What do I do with these feelings? How do I manage them? What's the strategy that's going to help me deal with the anxiety, the stress, the overwhelm?

Dr. Daniel Kraft:
So many of us in health care and even outside of health care have been stressed by the pandemic. Have you been able to measure emotional elements and how those have shifted just in terms of our being in quarantine and locked up, and now we are all interacting much more virtually? And the way you express are pick up on someone's body tone or eyes is much different if you're on a Zoom than if you're face-to-face.

Dr. Marc Brackett:
There's abundant research which shows that the anxiety levels in our nation have escalated to levels that I don't think we're even aware of in many ways because I think we don't really measure this so well in general. What am I really feeling? Most people are not very granular about how they're feeling. They say they're stressed, but maybe they're feeling overwhelmed, or maybe they're feeling nervous, or maybe they're feeling fear. And so a lot of the work we do in schools and even with doctors and others, is helping them to define these concept really clearly. Because when you can label your feelings accurately, it's easier to find the strategies that are going to help you to manage those feelings.

Dr. Daniel Kraft:
If we can recognize something and measure it, we can address it. And you've got a team of 60 working at Yale where you're training the entire oncology team on emotional intelligence. Can you tell us a bit about the study you did around emotional intelligence and job satisfaction there? And what empirical evidence came out of your work At the Yale Cancer Center?

Dr. Marc Brackett:
I had the opportunity to work with Roy Herbst, who is one of the leaders at the cancer hospital, and did a study with a number of oncologists. And what we found was that like you might predict, doctors who experienced more pleasant emotions in general, higher job satisfaction, less burnout, less likely to want to leave the profession. But doctors who experienced a lot more unpleasant emotions had higher burnout rates, greater intentions to leave the profession. And so it just goes to show you that how we feel matters.

Dr. Daniel Kraft:
And how do you measure how someone feels? I mean, in a clinical setting for a clinician or beyond?

Dr. Marc Brackett:
There's the kind of social aspects of your emotional life. Do you feel connected? Do you feel respected? Do you feel valued, appreciated? And then there's the other interesting aspects of your emotional life, which I think we don't study enough, which are the emotions like awe and inspiration around the purpose and meaning of your work. We've spent years developing surveys to tap these different areas and administer them.

Dr. Daniel Kraft:
I'm a pediatric oncologist by background, and you've seen those settings where when the kid finishes their chemotherapy is in remission, you ring the bell and everyone celebrates. Or someone's discharged from a long COVID hospitalization. Have you seen ways to design in some of those elements of mission appreciation, awe, that can help often job satisfaction, where you mostly want to kill your electronic medical record, as opposed to celebrating?

Dr. Marc Brackett:
I think it's about helping doctors in particular understand why emotions matter. And what I've learned over the years is that there's some kind of weird training that you're not supposed to feel. That you're supposed to deny, and suppress, and control your feelings, or they'll control you. And it's really the opposite. I have so many stories and examples of my interviews with doctors where they say things like, "I pretend I'm a rock. I'm not penetrable." And I'm like, "Really? Tell me why that's helpful." "Well, in oncology, I deal with patients who are having very intense experiences, and if I show my feelings, maybe it's going to be misleading." And I say, "Well, let's think about it this way. Do you believe that the patient is in dire need for connection?"
I don't know if you ever saw this in your training, Daniel, where it's a still face phenomenon. And what happens is that the mom will be with their baby and they'll be like comfy-dumfy and playful, and the baby's laughing, and the baby's reaching, and trying to learn and it's growing. And then it switches and the mom goes into a flat face. And at first the baby tries to connect, and then the baby starts getting discomfort, and then the baby starts literally crying and screaming because they can no longer connect. The same thing applies for adults, whether it be parent, child, doctor, patient. We're desperate for connection. I'm saying this because I think one of the things that I've noticed is that it's almost a fear that if I show my feelings and if I connect, I'm going to get lost in my feelings. And my response is, no. What matters is that you learn strategies to manage those feelings so that you can be a human being with your patient. I don't know if that makes any sense to you?

Dr. Daniel Kraft:
Totally does. I mean, we're hardwired for love and connection. And even if it's a patient-doctor relationship, or a very challenging one, like being an oncologist with a patient who might have a terminal illness, and even could be therapeutic. Reflecting back on my medical training in the intensive care unit, the outlet would of course be some humor, but there was a doctor room at the ICU, there were these journals that went back years of the residents writing out their feelings and their experiences that were quite eye-opening to read.

Dr. Marc Brackett:
So every year I do an institute for residents, and I always go around, I say, "A typical day, you wake up in the morning, how do you feel? It's middle day, end of day. Give me one word that you would use to describe your emotional life." It's usually things like, "Meh", "Down". Some say "Bored", "Stressed". Out of a group of 30, maybe three or four will say things like "Inspired", and "Connected", and "Awe". And it's heartbreaking, because we want to acknowledge that we have strong unpleasant feelings, but we need greater balance in life. It makes you think about what can we do differently?

Dr. Daniel Kraft:
Sometimes it's affected by physiology. If you're hunched over and looking depressed, you'll feel more depressed if you sometimes get up and go and get some exercise in. Are there simple tools?

Dr. Marc Brackett:
Sure. I think the first step is being aware of it and saying, "Is this how I want to feel? Or is this not how I want to feel? Is this emotion helping me build connections, make good decisions, be creative in life? Or is this emotion putting a hindrance on that?" I think again, in the medical field, you're taught to not even think about feelings.
And what's really interesting to me about this, by the way, Daniel, now that I think about it, my undergrads say, "Professor Brackett, this is important, but I don't got time for this emotional intelligence stuff. I got to get the A in your class so I can get into medical school." Then I meet with the medical school students and they say, "I think this is interesting, but I got to get through medical school." And then I meet with the residents, they're like, "This is really ... I got 80 hours a day, and 80 hours a week and blah, blah, blah, and I'll do this when I get my position." And so by the time anybody's ready to start learning the skills, they're in their 40s or 50s, and now they have this emotional life that's been, I don't know, stunted or something. And so I think we have to rethink education to help people see the value and importance of emotions early on.

Dr. Daniel Kraft:
Education and the culture of medicine doesn't usually support it. So I guess the question would be how could emotional intelligence make or break the culture of a company or a hospital? And how do we sometimes change that expectation of it's okay to say, "I'm not doing well today," or, "My patient died and I'm devastated," or, "I just had an amazing experience and I want to share that with the team"?

Dr. Marc Brackett:
Or check in with my team to find out how they're doing. I'll give you the best example of this. I was giving a presentation for a bunch of surgeons. And I say at the end of my presentations, "Any questions?" One of the leading physicians stands up. "What happened to this university?" He's like, "We produce Nobel laureates, not nice people." And then I said, "Well, is anybody else from another perspective on my talk?" And another physician stands up and says, "Here's what I learned, Marc. Sometimes you have to be a blank because then the people who report to you just shut up and do what you tell them to do." And so I look over at the Dean and I say, "Are we making a movie here or something? Is this my 10th of emotional intelligence?" And I thought the dean was going to start crying. And he said, "Why do you think I asked you to come in?"
I share that with you because what I happen to know are the colleagues, and the nurses, and the other staff that work for these doctors who have that mindset, and I can tell you they don't want to go to work.

Dr. Daniel Kraft:
I would argue that the surgeon with that classic sort of malignant personality, isn't going to get the best from his team, or the best outcomes from his patients.

Dr. Marc Brackett:
So we've done some really big studies across the United States in multiple professions and have shown that the emotional intelligence of a manager, leader, supervisor correlates very highly with inspiration, frustration, burnout, ethical behavior, and the list goes on. And so I always tell people if they say, "Well, I don't think this matters." What I tell them is, "You haven't read the research. We got to get these skills embedded into our medical education systems."

Dr. Daniel Kraft:
So have you had any success with that? You mean are you seeing any medical schools or examples of places where you've been able to come in, or others, and start to instigate some of this thinking and shifts?

Dr. Marc Brackett:
A little bit. The curriculum is already jammed, and then people will say things like, "Well, we can't force people to go to these courses." And so I think that we need to take a step back and really rethink what it means to educate people in the medical field, and especially pediatricians. I have a lot of empathy for adults, but kids are vulnerable creatures. And are we asking kids the questions? I'll just give you my own example. I had a pretty traumatizing childhood. I was abused as a child, which was really unfortunate and painful, and no one ever asked me how I was feeling. I was actually hospitalized five or six times from age of five to 10 during the time of my abuse, that I did not disclose for a variety of reasons. And I was labeled gastroenteritis was what it was called, I guess, back then.
And it's amazing to me that no one tried to find out what was happening in my life. There was no inquiry. I was also kind of a recalcitrant, difficult kid because I was struggling. I would yell and scream, "I hate you." And, "I don't want to go to school." And even my own parents would say things like, "Who do you think you are talking to me that way? Get to your room." So I was triggering them, and they didn't say, "Well, this is a message. Emotions are signals." This might not be what it looks like on the surface. I need to get underneath and find out what's happening. There is so much opportunity to promote healthy child development through the teaching of emotional intelligence to doctors, and obviously parents, and teachers, and everybody.

Dr. Daniel Kraft:
Just even having it on what we call the review systems.

Dr. Marc Brackett:
Yeah. And so here's the challenge though. My career started because when I was going through my traumatic experience as a kid, I didn't disclose the abuse because I was afraid to do that. And I had two parents who love me, but my mom was very anxious and overwhelmed all the time, and she was always saying, "I'm having a breakdown." I'm like, "Oh, no. If I tell my mother about what's happened to me, she's going to have a real breakdown." My father was this self-proclaimed tough guy from New York, and he'd say things like, "Son, you got to toughen up." I'm like, "Well, can't tell my dad what's going on."
But I was blessed to have an uncle who was getting his graduate degree in psychology and counseling who asked me that profound question when I was about 10 years old, which was, "Hey, Marc, how you feeling? Really? How you feeling?" It was his facial expression, body language, vocal tone. Can't tell you 100%, but whatever it was, I decided to reveal everything I was feeling and that was happening to me. And he didn't say, "Toughen up," or, "Don't tell me I can't handle it." He said, "We're going to get through this together."
And I tell you that because I spent most of my career in the beginning writing curriculum with my uncle to get teachers to do this work with kids. But we fell into a huge problem. The adults weren't comfortable doing it. "I don't want to talk about this. This is going to open up Pandora's box." And we'd say things like, "You're only going to talk about the positive feelings? That's not what it means to be human." And anyhow, over the course of my last 20 years, I've learned that we need to do quite a lot of work in developing the adults who are raising and teaching kids, or their physicians. If they're not comfortable sharing how they're feeling, how the heck are we going to get kids to be comfortable sharing how they're feeling?

Dr. Daniel Kraft:
I'm sort of reminded of that classic patient-doctor interaction where they're just about to leave that sort of doorknob moment. "Oh, by the way, Doc, what about this?" That was really why they came, but they never really disclosed until the last minute or not at all. So thank you for sharing your background on this. And your new book is called Permission to Feel: Unlocking the Power of Emotions to Help our Kids, Ourselves, and our Society Thrive. How would you maybe counsel physicians to think about maybe their own feelings and helping unlock those in their patients to maybe have very major therapeutic interventions?

Dr. Marc Brackett:
The title of my book, Permission to Feel, is a provocative one for some people. As a matter of fact, even my agent said things like, "Well, it might be uncomfortable for someone in an airport to pick up a book called Permission to Feel. It's so vulnerable." And I said, "That's the point." I'm not going to run away from this. I think honestly, the first step in this process for you, for me, for our kids, is permission to feel. Meaning, are we giving ourselves the permission to be our true feeling selves? I've had anxiety challenges my whole life, and I could blame my mother. I could blame my genetics. I know I was trying to figure out how to get rid of my anxiety for most of my life. And then I realized that maybe it's just part of who I am, and I have to learn how to manage it more effectively.
And that shift in mindset from getting rid of my anxiety to using my anxiety wisely completely changed my life. Step one is permission to feel. There's no good, there's no bad emotions. Because I write a lot about my uncle and my book as my hero. I've asked about a million people over the last about five years, did you have an Uncle Marvin? What were the characteristics of this person? And the top characteristics that I found in my research are empathy, compassion, nonjudgmental and supportive. Right now in the world we're living in, could you imagine if we had more empathy, compassion, non-judgment and supportiveness? Our country would be in a lot better place.

Dr. Daniel Kraft:
I think that's what most folks who, let's say, go into medical school want to see themselves as being, as an empathetic, compassionate, listening type of clinician. And often as we talked about already, that can get drowned out or suppressed through our clinical training or other stressors.

Dr. Marc Brackett:
I think that most of us are clumpers. We clump anxiety, stress, pressure, fear, overwhelmed into one place. And I want to unpack that for a minute because the emotion scientist says, "Tell me more." The question is, "Well, can you do a one-strategy fix all?" And the answer is "No." Right? Because I can do breathing exercises until the cows come home, but if I got too much stuff on my plate, and not enough support, guess what? I'm going to be continuously stressed out. And so one of the things that I feel is really important is to really get and build an advanced emotion vocabulary, because understanding those feelings helps you to think about what you might do for yourself, and what you might do to help others to manage those emotions effectively.

Dr. Daniel Kraft:
It sounds like you're trying to institute this. You have this RULER program, you went through the acronym that's over 2000 public and charter schools today?

Dr. Marc Brackett:
Actually, no. I'm proud to say we're in 4,000 schools as of this year. I just found out a couple days ago that this year we trained 770 new schools. We've reached 4 million kids, we've trained about 150,000 educators, and we're in schools in 27 countries. I always say I'm on the mission to create an emotion revolution.

Dr. Daniel Kraft:
First of all, thank you for that great work. It came out of your own challenges as a kid, and now I think the impact will be pretty exponential. I mean all those kids, and who they touch over the next generations.

Dr. Marc Brackett:
Yeah.

Dr. Daniel Kraft:
I understand that you also developed an emotional intelligence app with Ben Silbermann, the founder of Pinterest.

Dr. Marc Brackett:
Ben is the former CEO now of Pinterest, created a nonprofit that's separate from Pinterest called the How We Feel Project. He and a bunch of volunteers from Pinterest, and others, and I, and many of my colleagues at Yale, all worked together and built the app. You can journal about your feelings, or you can tag your feelings based on who you're with, and where you're at, and what you're doing. And then based on that information, it gives you access to over 36 evidence-based strategies to regulate your emotions. From mindfulness exercises, to cognitive strategies, to social strategies, to movement strategies. What's really cool is that it kind of keeps track of all this. By the way, we don't see your data. It's personal. We're very careful about that. And it's free, by the way. It's called How we Feel. It's available right now on iOS. It'll be available on other platforms soon. I think we have about a hundred thousand users so far.

Dr. Daniel Kraft:
I'm just downloading it right now. How we feel on the iOS store and I guess on Android also.

Dr. Marc Brackett:
Yeah.

Dr. Daniel Kraft:
Or I'll try out with my kids. I've got a six and an eight-year-old, and they definitely are changing and growing and I need to regulate my own emotional intelligence with them at times as well, as we go through our sort of life journey at different age states. Are they kind of where they were when they were a kid, and informed? Like IQ may not change that much, can their emotional intelligence be upleveled?

Dr. Marc Brackett:
I think people confuse personality and temperament with emotional intelligence. I am a self-proclaimed neurotic individual. I worry about everything. I even worry about why I worry. And then I say, "Marc, you don't have that much to worry about." And I'm like, "Yeah, but something might go wrong." It's been my wave. I'm 52. I'm also introverted. I don't want to be around loud music, and lots of people, even though I do so much public speaking. I'm always like, "Thank you very much." And I go back in the back room. Now the question is, is that my emotional intelligence? I don't think it is. That's personality, which can inform your emotional intelligence.
For example, the strategies that I choose to manage my feelings might be completely different than yours if you're an extrovert. You may say, "I want to go to a sports bar, and hang out with my friends, and watch the game, and drink a beer." If you asked me to do that, I'd be like, "Are you kidding me? I'll have a nervous breakdown." I want to go sit in a wine bar with one or two people, and quiet music, and just chat. Neither is good or bad. It's learning through life what skills are helpful to you, and what strategies within those skills work best for you.
I'm not very even-keeled emotionally. I'm irritable in the morning, then I'm fine, then I'm annoyed, and then I'm fine, and not easy to live with. But in many ways I just might have more opportunity to practice because of my fluctuation and mood. Whereas someone who's more even-keeled, someone might trigger them, and they just get flooded and they can't deal with it. And my research from many years ago showed that the correlation between our temperament and personality, and our knowledge and skill of healthy regulation strategies is actually quite low.

Dr. Daniel Kraft:
So just like we want to do precision medicine or personalized medicine, that you might want to understand if someone's an introvert or extrovert, and that will help you guide them to being more open and feeling?

Dr. Marc Brackett:
Definitely. In certain aspects of our lives, like math, statistics, precision in terms of correct or incorrect is important. But with emotional intelligence, it's kind of a game. The strategy that might help me feel better today may not be the one that I need tomorrow. The one that worked for me when I was five may not work for me when I'm 15, or 25, or 40. And so the way I think about it is that we have to be compassionate emotion scientists who are co-explorers, and helping people find the different strategies that are out there, and then the ones that work best for them based on their identity, cultural background, personality.

Dr. Daniel Kraft:
So just as we finish up, is there anything we haven't covered or that you want to make sure we uncover about emotional intelligence that might be particularly relevant to our broad-based clinical audience?

Dr. Marc Brackett:
There's the old thinking that we have to leave our emotions at the door because emotions interfere. And what I'm saying is that actually that suppression of emotion is going to interfere. Why not embrace our emotions? Be comfortable having those feelings. There's no such thing as a good or a bad emotion. Emotions are data. Emotions are information. Our patients, by the way, most people don't go to see their doctor because they're in a good mood. When we learn how to embrace all emotions, and use them wisely, we can be healthier, happier, more productive, and achieve our goals and dreams in life.

Dr. Daniel Kraft:
I'm going to try out your How we Feel app, and recommend the Permission to Feel book to my friends, family, and patients, and fellow compatriots. Professor Marc Brackett from Yale, director of Yale Center for Emotional Intelligence, co-creator of RULER. Check that out for your kids in their classrooms. And again, thanks so much for your great work and for joining us today on Healthy Conversations.