A Woman’s Journey | Why Managing Stress is So Important

A Woman’s Journey | Why Managing Stress is So Important


>>Well, good morning! I have the tiny topic of coping with life so that we’ll get right through that. I have to say the first
thing I have to cope with as a lifelong Steelers
fan is being at a podium (audience laughs) that has a Buccaneers pirate, but I’m gonna manage. I’m gonna talk about stress. I’m gonna talk about
what it does to the body, which is nothing good,
and then I’m going to talk in really practical terms
about some of the things that we can do that
actually are not that hard, they’re not as hard as
exercising, if I may say. Which I was somewhat
inspired by my colleague to think write park farther away. Yeah. Not if you’re running late. That’s not so easy. But, I’m gonna talk about some of the really practical things we can do that can help you build resilience. Okay? So, let’s just talk about stress. Stress is universal. Anyone in this room lucky enough to not be under any stress at the moment. (audience laughs) Exactly. That’s just a silly question. There were two sociologists,
Holmes and Rahe, that fascinatingly
decided to make everything that happened in life a
number on a stress scale. What they captured, which I
think is really important, is that good things and
bad things are stressfuL. So, on their hundred point scale, the death of a family member was 100. Divorce was 73. But, marriage was 50. (audience laughs) Change, new things, having
to take on new roles, that is tricky. So, how does our body respond to stress? Well, the brain, the center of everything, the brain sends signals that
allows hormones to be released that then sends signals
down to the adrenal glands. And they sit like little ski
caps on top of your kidneys and then they pump out adrenaline. So, epinephrine,
norepinephrine and cortisol is going into your system to say, we need to be on high alert. So, when your system’s
responding that way, you essentially can go
into fight or flight mode, which is the sympathetic nervous system, or your parasympathetic
nervous system can put you with different signals
in duress and digest. So, when you think about fight or flight, imagine developmentally
that we needed to be able to run away from the
saber tooth tiger, right? So, your blood’s going
to your arms and legs, your heart’s pumping really fast, your breathing quickly
enough that you can take off or if you had to battle
the saber tooth tiger, you’d be ready. Okay? But, what is going along with that? It is a tense, ready to take on a major battle kind of feeling and I’m
sure we’ve all had that. It works sometimes or
dealing with teenagers or whatever it is in your
life, but you have this other kind of feeling where you’re geared up and not in a good way. I will contrast that with rest and digest. Now for that, the concept is one hour after Thanksgiving dinner. Right? Now, at that point, the only
blood circulating your body really is in your GI system. There’s no blood in your
legs, your brain, your arms. I mean, there is to keep it going, but essentially, your body is set. We have taken a giant
carbohydrate load into our body and we need to now process it. So, a nap will help us do that, right? You’re not ready to take it on. Your body needs to spend some time in that kind of mode, right? The other thing that’s really helpful about exercise that we
heard about so thoughtfully this morning is that that can help dissipate some of that cortisol. So, when you’re feeling
really tense and wired and you’re about to go
into a tense meeting, going for a brisk walk
just for a few minutes can help you feel a little bit better. So, there’s a new concept where
we’re trying to understand, all right, well, what does all this do to the body and the system? It’s called allostasis. And that’s the idea that
your body can adapt. The problem is is that
you never let it adapt because it’s staying on
high alert all the time. That is problematic. And I think that we have a lot of people that feel like they’re at
that high level all the time and they don’t have the
periods where they get a break. So, you can change and it
allows survival, which is great, but it also means that you might be living with a super high cortisol
level all the time, using inflammatory cytokines all the time and those being at high
levels have been associated in studies with things we don’t want. Diabetes, Alzheimer’s
Disease, depression, anxiety. These kinds of hypertension. The idea that our bodies
interconnected in a way that being in a stress mode
all the time is very unhealthy. So, what happens with the immune system? You know, I grew up thinking
that if you went outside with wet hair, you would catch a cold. That is not true, okay? (audience laughs) My mother’s a very truthful person, but she was not truthful about that. However, if you live
in stress all the time, your immune system gets affected. And what happens is that
your T cells and B cells, some of the white cells
that fight infection don’t work as well. We also know from a
really interesting study that sometimes, you don’t
have the brisk immune response to protect you that you’d like. So, Dr. Kabat-Zinn, who’s been
one of the most thoughtful researchers about meditation
and relaxation techniques, he did a study where he said,
this group’s gonna learn meditation mindfulness. And this group’s gonna just
keep doing their thing. They’ll get to learn it later. So, you have a comparison. And then, they were at a workspace. So, they did eight weeks
of meditation mindfulness, really learned it, made an
investment of time and energy, and then they gave both
groups their flu shot. And at three to five weeks,
the group that had done meditation mindfulness had a
significantly brisker response when they checked three to five
weeks after their flu shot. Because their body, I guess, was in a better position to respond. Now, we don’t know, and
I’m hoping the other group got to catch up, but what
we know is that these, this state isn’t doing
anything healthy for your body and it has implications. So, what else do we do? The American Psychological
Association did a survey of over 3,000 adults and they said, what are you actually doing? So, let me share some
responses to what they said. The majority said that they were either very stressed or extremely stressed as adults in this country. And they said, all right,
how are you responding? 40% were overeating, a
third were skipping meals, 40% were having sleep
problems, 45% felt irritable, 41% felt fatigued, and about
40% say that they lacked motivation or energy to do things. Which means one or two of you in the room might having this too. But, sort of that sense of oh, okay. Now, they also said, you know, are you doing things about this? We’ve had a couple of
references to sleep already. I’m gonna say something about
sleep ’cause it’s so critical for your mental health. Sleep hygiene is really, really important. What does sleep hygiene mean? It means you do some really basic things to improve your sleep. You go to bed about
the same time everyday, you get up about the same time every day. You do not have screens in your face a minute before you go to bed. Where you have bright
light waking up your brain by putting light into your retina. That you try to have a
room that is comfortable that you have with pillows, you
have a comfortable mattress. My colleague from rehab medicine was saying everyone comes
to see her with back pain ’cause her mattress is too old. But, you actually create
a cool environment. That you’re doing all these basic things. That you do some relaxation beforehand, that you try to get your mind here. You’re not watching the horrible news right before you’re trying to go to bed. And, although I know people
will take me on about this, the recommendation is that you not have pets in your bedroom. Now, I know you pet people do not care about that recommendation, but I’ve heard too many
stories of little snouts going in someone’s eye to
think that it’s really good for someone to sleep
with a dog on their bed, but that’s fine. So, people don’t actually do that. That same survey where
they said, all right, how important do you think it
is to eat in a healthy way? 60% said it was extremely
or very important. And yet, it was only
31% that were doing it. And then they said,
okay, physical activity. I think after hearing
the speech this morning, it’s like, yes, we all need to do this. It’s really important and
it’s important for your brain. We have to do it. So, 54% of those surveys
said it is extremely or very important and 27% were satisfied
they were doing enough. So, my theme today is not
that there’s nothing to do. There’s plenty to do, but
you actually have to do it. I do believe that buying a book
and putting it on my bedside table is sort of the
equivalent of reading it. (audience laughing) I think somehow that knowledge is coming into my brain when I’m asleep. And yet, I do know I’m being silly and it’s not actually gonna work, so. So, let’s talk about resilience. Because when you talk about coping, resilience is really critical. So, what is it? Do you have it or not have it? Is it something you can build up? If you don’t have it, can you get it? You can absolutely get it. It’s not magic. I think sometimes, you say, oh, that’s a really resilient person. That’s someone that’s less so. Resilience is something that any one of us can work on developing in
a more significant way. It’s just whether you
actually do the work. So, what is it? It’s our ability to maintain our calm. To manage stress. To manage our mental health, which is part of physical health, even when you’re experiencing adversity. ‘Cause we’re gonna experience it. So essentially, it’s your
ability to bend and not break. To adapt to circumstances
as they happen around you. And to bounce back. And it’s very much
associated with wellbeing. Because if you’re less resilient, and when they’ve done
studies and they look to say, right, you really don’t have
those traits, you don’t really have those skills, they found
that people were describing that they were dwelling on problems, that they were more easily overwhelmed, that they didn’t have coping
strategies to deal with stress. And so, they deal would avoid
it and they had much higher rates of depression and anxiety. And so, I see a lot of
people where another person in the same circumstances
who had more tools might have handled it very differently. As opposed to having
it become overwhelming. Now, there are all kinds of
things that happen in life and who we are makes us
naturally a little more or less able to handle stress, but
sometimes circumstances are so overwhelming that you
can’t imagine how anyone could. Now, about who we are,
Hans Eysenck once described that essentially, we have
introverts and extroverts in the world. And I have a twin brother
I’ve talked about here before. He is the most extroverted extrovert. And I am a very friendly introvert. And so, I’ve always been fascinated by things just being different. So, what are extroverts like? They’re very present focused. They’re not worrying about things. They’re in the moment. They are enjoying things. They are able to focus on
their immediate gratification. They are very reward driven. You want them to do something? Tell them what you’re gonna do. Guilt doesn’t work so well
in this group of people. And they also, and this is
important for resilience, they have really quick emotions, but they don’t stay with them. So, they don’t hold grudges. Now, the downside is they get bored. And so, maybe not follow through so much. Maybe switch jobs a lot. Maybe do different things. My brother kept moving to other countries at one point in our life. It’s like, why are you
going to other countries? I was at Johns Hopkins that whole time. (audience laughs) Now 31 years. But, you know, we introverts do not need novelty the same way. Clearly, 31 years at the same place. We worry about the past,
we worry about the future. We are not reward driven. We’re very much not wanting
to not be in trouble. But, the problem is the
emotions take longer to develop, but once you have them,
you’re stuck with them. And, we introverts are the champion grudge holders of the world. Like, we really, you’re in trouble, you’re in trouble for a long time. Now, the good side is we don’t get bored. We follow through on things. We take care of the details. Now, you can imagine, most of us are a blend of those two things. And in some ways or one,
some ways or the other. If you’re an extreme, you’re
gonna get yourself in trouble. And if you’re someone that
really gets either stuck in your emotions or shifting
your emotions really quickly, you could get into trouble and neither one of those
would lead to resilience. But, having some balance
where it takes a little while to get upset, but you don’t
have to stay upset forever is probably the best if we’re dealing with coping with stress. Now, I will say that many,
many successful long-term relationships, particularly
romantic relationships, involve opposites attracting. But, it also involves an enormous
amount of misunderstanding because people don’t get that other people think differently. And they really just
think, I do not understand where someone is saying I
don’t know why I’m still in trouble, I don’t understand why you’re still upset about that. I’d like to support you,
but that was weeks ago. (audience laughs) And you’re saying, I cannot
believe you’ve moved past this. That was only weeks ago, right? So, that’s the problem is
you end up with this tension and as I said, as it
relates to resilience, it’s whether you’re stuck
in these negative emotions. So, what do you do to do it? The other thing I’ll say is
there are some circumstance like being in an abusive
relationships or really on safe or untenable work situations
where the circumstance itself is so difficult, you have
to think about changing it. Not just managing. Just because you can manage something doesn’t mean you should, right? And so, sometimes the
most resilient among us stay in the worst situations
for the longest time. Okay. So, what do you do to train? Well, it’s all a form of
cognitive behavioral therapy. And the idea between
cognitive behavioral therapy is that you have thoughts,
you have behaviors, and you have feelings. And the idea is that if you
work on changing your thoughts and changing your behavior, eventually, your feelings will improve too. But, it’s starting with
something practical. I mean, the way I conceive it is that you’re changing the channel, right? You have these negative
things spinning in your head and you challenge it and say, I’m gonna stop thinking about that. I’m gonna think about
something else instead. You cannot actually think about two things at exactly the same time. You might think you can, but you cannot. So, if you’re thinking about this. Now, it doesn’t mean you want
switch back to the negatives. You have to put a lot of
energy into saying, stop it. I’m not gonna do this. People have a mantra of sorts. You know, enough of that! I’m gonna think about something else. But, you have to have worked on your substituted positive thoughts. You can’t just sit down and
say, I think I’ll do that today. That sounds like a good idea. So, the idea is that
you’re gonna challenge the distorted thoughts
and substitute them. The other thing that
helps is if you also work on positive behaviors at the same time. Paying attention to taking
better care of yourself. What message does it send to your body if you’re eating in an unhealthy way, you’re never exercising, you
never make time for yourself? Well, you’re saying
you’re not very important. Which is not going to help any of this. Cognitive behavioral therapy
has been really well studied in anxiety and depression and shown to be extremely helpful in both. And so, it’s one of the techniques we use where essentially, you’re
training your brain not to dwell on the negative and shifting to more positive things. Now, it doesn’t mean you get to ignore it and that you don’t need
to come up with plans. But, if you were essentially
paralyzed by how terrible you feel, you’re not gonna be able to do anything moving forward. Now, the other kind of technique
that has been shown to work and when I first look at this literature, I could not believe this really worked. They are positive psychology exercises that were developed by Dr. Seligman. Now, he’s done tons of this. His most recent series of studies, they got several hundred
people they recruited through the internet and they got
them to do certain exercises. So, they had one group doing
these positive psychology exercises and another
group just journaling. So, they have the group
in the positive psychology doing one of three things. One was three good things in life. Each day for just one week,
people were asked to write down three good things that were happening in their life that day. To focus on the positive. And that’s his whole idea. You’re gonna improve your
thinking, your emotions, your communication by
focusing on the positive. To me, that sounded like
a little bit of hooey, but that’s what it’s like. Write down these three good things. The other was, and this is
where the people on the internet took a little survey to see
what their positive strengths were and they were asked
each day for one week to try to use a strength in a new way. So, if you were kind to do
something you hadn’t done before. If you were smart, to
use your intelligence for something that was good
for the world, so to speak. And then the third, which I
actually find the most helpful, you were asked to do a gratitude exercise. So at some time in the day, but
often at the end of the day, you would write about things you were grateful for in your life. So, these are really basic
things anyone could do. Here’s the amazing part. They had developed a happiness
scale and what they found with one week of doing this,
there was improved happiness for people doing the positive exercises compared to just journaling randomly. Journaling often is I’m very
frustrated with my spouse or no, I hate my boss. So, that was the journaling control. The happiness improvement
was there at one month, at three months, and at six months from doing this for a week. Now, you think, well,
what if I were doing it for longer than a week? That completely surprised me. So, I said, oh, okay. And I have to say occasionally, I listen to my own good
advice and I have a mom who has dementia and as it has progressed, it has become increasing
sad, as you can imagine. So, now that she can often not
really be in a conversation, for a while, I had a
very unhealthy response of sitting there and being sad. Now, I sit with my mom
when she’s having that kind of quiet day and I tell
her what I’m grateful for. About how she raised me. And that changes the whole dynamic. Because I’m reflecting
on our life together and saying something positive and putting something
positive in my brain. So, thank you, Women’s Journey,
for getting me to actually, you know, be less ridiculous. (audience laughs) Because it was giving
a talk about happiness, I said, you know, I could do this too. (audience laughs) So, what you’re trying to
do with resilience training is to become more intentional. You’re gonna decide and
you’re gonna make choices about where you put your focus. And if you are purposeful
and put your thoughts away from the negative
and onto the positive, sometimes, people can think
about what’s meaningful. I’m sure everyone in this
room knows that their family and friends in that aspect of
their life is more important than how much money they make or where they get a promotion at work. But at any one day, you
might not remember that. Right? The other thing is you’re
trying to regulate your emotions so you feel more in control. I think one thing that people
that are resilient have is that they feel like,
okay, well, I’ll handle it. Whatever it is, I can handle it. So, if you’re not having
such strong emotions or emotions that feel out of control, then I think people can
have much more confidence that they can handle whatever shows up. Now, the other thing that is very helpful are all kinds of relaxation techniques. And everything’s been shown to be helpful whether that’s yoga or doing
progressive muscle relaxation or regular exercise,
really regular exercise, or mindfulness meditation. Now, I’m just gonna mention two apps because everyone has a
phone and some of these apps take you through relaxation. I was working with someone
and she said, I can’t. It’s a 78 year-old person. Said I downloaded that Calm app and that’s part of my bedtime routine now. I don’t watch the news. I am listening, it’s often about nature. She said I’m learning a lot about trees. You know. And so, I said that’s fantastic
that you’ve been able to do that quickly shift. So sometimes, it’s just helpful to have us know what we can do next. And so, there are two. One is called Calm. Isn’t that an appropriate
name for relaxation? C-A-L-M. And the other one is
amusingly called Headspace. So, Calm and Headspace are two ways that you can take this on. When they have looked at
mindfulness meditation training, they have found that it has
all kinds of positive benefits. They did one study of
nurses and nursing students and after they had gone
through a training, the follow-up showed that they
were reporting less stress, less anxiety, less
depression, less burnout, a greater sense of wellbeing, and probably most
importantly, greater empathy. Now, empathy is being able to imagine what someone else feels. Can’t really imagine anything for more important for a nurse. And so, with their sense of
feeling better themselves are able to take better care
of others in their own mind. They also have shown that with teenagers by teaching these kind of
problem-solving relaxation skills that they had a reduction
in depression and anxiety. And in a study of high school students, they’re able to show that
these high school students actually were using drugs less often. ‘Cause that’s often a
way people turn to deal with negative emotions. And so, they had more
positive options to do that. Now, what does resilience training not do? It does not treat serious medical problems like anxiety and depression. And I would be remiss not
to say something about those because I think we so
often are trying to avoid being identified as having those illnesses that everyone is really trying to say, no, I don’t have those illnesses. I just need, I’m burnt out. Someone that I work with, a wonderful smart person
who’s a doctor, said why is it the doctors are supposed to have burn out instead of depression? Our patients are allowed
to have depression, but we’re supposed to have burn out. I said, I do not think that. I think you have depression. I have a plan to help you feel better. So, what’s it like when
people have serious anxiety? I’m just gonna mention something about generalized anxiety and panic. So, generalized anxiety
is when you have ongoing, intense, geared up,
uncomfortable, heart racing, feeling nervous, tense all the time way out of proportion to life. We always feel a little bit of that, but this is out of proportion to life all the time for months. Panic attacks. I believe that if you live in this area, that your bridges and roads
have probably generated a panic attack in many of you. It’s no joke these bridges. I’m from Pittsburgh. I know what it is to have to put everyone through a tunnel or a bridge. It’s not pretty. Bridges, tunnels, etc. So, what happens is people
get this intense response and often, it’s to nothing. That’s the scary part. With panic disorder, you’re
having a panic response for no reason so you’re scared. You think maybe you’re
having a heart attack. Your heart is pounding out of your chest. You’re breathing really quickly. Now, you’re hyperventilating
and you’re having neurologic tingling and things like this, symptoms, because you’re hyperventilating. And so, that gets people to avoid. I better just stay home. Because if I just stay home, I’ll be safe. And so, the disability
from anxiety disorders comes from avoidance. I make my life smaller and
smaller hoping to contain it and that doesn’t work at all. Now, with depression, obviously
there’s a much greater risk. There’s a greater risk of
someone dying from depression because of suicide. So, in depression, you have
this terrible combination of your mood changing,
physical changes in your body, and changing the way
you feel about yourself. So, what happens with mood? Some people are sad. That’s sort of the Lifetime
Movie version of depression. Sad, crying, middle age woman, right? Most people with
depression don’t feel sad. They’re either irritable
or they feel nothing. They showed disconnected from feelings. And then the other part of the mood change is that you can’t feel joy or be excited about anything which is terrible. And so, okay, you have these mood changes. That’s awful. You have physical changes
where your sleep’s messed up, your energy’s gone, your
concentration is terrible, so you can’t do your job or
your work, and you do not have an ability to be motivated or go forward. Well, that’s terrible too. But, none of it is as terrible
as losing your confidence in what you care about most. So, teenage girls come and
tell me they’re fat and ugly. Teenage boys come and
tell me they’re wimps and they’re not cool and no
one wants to be their friend. Middle age women with
children tell me that they are terrible mothers,
middle age men tell me they’re terrible providers,
people like my parents in their 80s tell me they’re
a burden to their family. So, it attacks your confidence
and what you care about most. And you could see if it
progresses and gets even worse how someone might start thinking, I don’t think I really contribute. Or maybe my family would
be better off without me. Which is, of course, not true. Depression isn’t one of the
most dangerous illnesses that gets missed or
gets written off to life when it’s incredibly treatable. So, that’s why I worry so
much about it being missed. So, those are two of the things that we can really do something about. Now, while it’s good for all
of us to have coping skills, there’s really nothing more
unkind than telling someone in the middle of a panic
attack or a terrible depression that they need better coping skills. What they need is real treatment to treat their underlying condition. Okay? And so, that, many people have expressed, have described that to me. All of my friends have
a lot of advice for me. It’s like, oh, I bet they do. But, does any of it work? Nope. Okay. How about we try some actual treatment? So, what are we talking about? We’re talking about the fact
that stress is universal. Everyone can conjure up an image of why they’re stressed right now, right? Share mine. A giant dumpster in your parent’s driveway that you’re trying to clean
out their attic of nonsense. Even with a psychiatrist on the scene, this was not a pretty weekend, okay? We can all improve our resilience. We can all improve how we manage stress, but it actually take a
little bit of effort. There is not a way that you can, again, downloading an app on your phone is like the book sitting
on my bedside table. You actually have to open
the app and listen to it. First step is downloading, but still. And if you actually practice
mindfulness and gratitude and this cognitive restructuring, it will change how negative
or positive your thinking is. And so, you do have some
more control over that. But, I also think it’s helpful if we’re just kind to each other. If we actually take a
little time to think about how in the people we interact
with every day we can be kind and how we can just
distract ourselves sometimes in really positive ways. So, my dear brother, he
works in advertising. I have no idea what he does. He seems to email me things
from the internet all day. So, I think his job is
to read the internet all day and be creative. I don’t know. But, I just think you’re at work! So, he sends me disturbing
things about politics in the news and then he sends me more animal videos than any human being should ever watch. I do see the balance there. And so, if you’re really
stuck and you are trying to make today just a little lighter, I have a recommendation for you. Go to YouTube and put in
baby goats in pajamas.

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