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Many people wonder if or how they should talk to someone who is experiencing despair or another emotional crisis. I would strongly encourage you to reach out. Even before you say a word, you can be present for that person. Listen without judgment. Be kind.

There is a simple and down-to-earth way to start a conversation about emotional distress. This approach was developed by a national support organization called Active Minds and is called the “3 V-A-R Steps: Validate, Appreciate, Refer.”

Validate their feelings. Let them know that what they are feeling is okay and that you believe in them. Validate sounds like this:

  • “I believe you.”
  • “That makes sense.”
  • “That sounds difficult.”
  • “I’m sorry you are struggling right now.”

Appreciate their courage. Speaking up about personal challenges and pain can be a challenging step. Let them know it’s a good step. Also show them that you are there for support. Appreciate sounds like this:

  • “Thank you for sharing.”
  • “Thank you so much for talking to me. That took a lot of courage.”
  • “You are not alone.”
  • “I’m here for you.”

Refer them to other sources of support. Let them know help is available and refer them to appropriate resources. Refer sounds like this:

  • “I’ve been using this meditation app. It’s really helped me slow down my thoughts.”
  • “I think it might be helpful to talk to someone. I can stay with you while we call/text a hotline or a counseling center.”

"I encourage all of us to speak openly about emotional suffering as a way to abolish stigma with honesty, vulnerability, and compassionate connection with each other."


If you are a healthcare professional who needs help or if you know of a colleague who needs help, the Ohio Professionals Health Program (Ohio PHP) provides a compassionate, supportive, and safe environment for you to receive confidential services to improve your health and well-being. For more information, contact us today:


I recently watched a speech entitled “Removing the Mask” by Carrie Cunningham, MD, the incoming President of the Association for Academic Surgery (AAS). She is an accomplished Harvard surgeon and former teen tennis champion. It was incredible to witness her raw and intimate story of recovery from addiction and depression on such a wide-open stage as she delivered her Presidential Address in March 2023. I was shocked and inspired by her courage and vulnerability. She has decided to use her story and her platform to change the culture of silence around deaths of despair, especially in the medical profession.

Dr. Cunningham’s presentation and personal story was posted on YouTube in March 2023. In a little over one week, her story has been viewed over 10,000 times. I encourage you to watch and listen to her message. Each of us, in our own way, can dismantle the culture of silence, one story at a time.

Watch on YouTube


  • 3 V-A-R Steps: Validate, Appreciate, Refer by Active Minds
  • Beseran, E., Pericàs, J. M., Cash-Gibson, L., Ventura-Cots, M., Porter, K. M. P., & Benach, J. (2022). Deaths of despair: a scoping review on the social determinants of drug overdose, alcohol-related liver disease and suicide. International Journal of Environmental Research and Public Health, 19(19), 12395.
  • Center for Disease Control and Prevention (2022). “Drug Overdose: Death Rate Maps and Graphs.” June 2, 2022. Atlanta, GA: Centers for Disease Control and Prevention, National Center for Injury Prevention and Control (website accessed 3-9-2023).
  • Gold, M. S. (2020). The role of alcohol, drugs, and deaths of despair in the US’s falling life expectancy. Missouri Medicine, 117(2), 99.
  • Sterling, P., & Platt, M. L. (2022). Why deaths of despair are increasing in the US and not other industrial nations—insights from neuroscience and anthropology. JAMA Psychiatry, 79(4), 368-374.
  • Center for Disease Control and Prevention (2022). “Suicide Increases in 2021 After Two Years of Decline.” September 30, 2022. Atlanta, GA: Centers for Disease Control and Prevention, National Center for Health Statistics (website accessed 3-9-2023).


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