Podcast: Juggling Stress at Work and Home
Jenn talks to Dr. David H. Rosmarin. David provides an overview of burnout symptoms, offers ways to manage our own stress, and shares methods to counterbalance other stressors that impact our daily lives.
David H. Rosmarin, PhD, ABPP, is the director of the Spirituality and Mental Health Program at McLean Hospital and an assistant professor of psychology in the Department of Psychiatry at Harvard Medical School. He collaborates with laboratories to study the clinical relevance of spirituality to anxiety, mood, psychotic, substance use, and other disorders.
Jenn: Hey everyone, welcome to Mindful Things.
The Mindful Things podcast is brought to you by the Deconstructing Stigma team at McLean Hospital. You can help us change attitudes about mental health by visiting deconstructingstigma.org. Now on to the show.
Hi there, and thanks so much for joining our session today. I’d like to introduce myself. I’m Jenn Kearney, and I am a digital communications manager at McLean Hospital. And this session is all about how we can balance stress, self-care, and the happenings of the world around us.
So, on a good day, managing stress is kind of like using a fire extinguisher. You can put out the really big fires and take care of anything that seems alarming or like a hotspot. When times get tough though, it might feel like your home’s burning down and you’ve been given like a water balloon. It’s not great.
So, during the session, Dr. Rosmarin is going to share ways to manage our own stress. Methods to counterbalance other stressors that impact our daily lives, even when we don’t think that they are impacting our daily lives and providing advice, how we can care for ourselves, even when in dire times, that seems like it might be pretty impossible to do so.
If you are unfamiliar with David Rosmarin, you were in for a real treat. Dr. Rosmarin is the Director of The Spirituality and Mental Health Program at McLean Hospital. And is an assistant professor of psychology in the department of psychiatry at Harvard Medical School. In addition, he is a clinical innovator who’s work on integrating spirituality into cognitive behavioral therapy has wide acclaim.
He’s received media attention from ABC, NPR, Scientific American, the Boston Globe, the Wall Street Journal, and the New York Times, just to name a few publications. So, David, thank you so much for joining us. I’m so excited and I’d love to hand the mic over to you.
David: Jenn, thank you very much. Really appreciate your kind introduction and to you and to you Scott O’Brien and all of McLean’s amazing Media Affairs Department, for inviting me to give this workshop and thank you all for coming to this mini workshop, we’ll call it, on managing stress in dire times the importance of self-care.
So, prior to 2020, when I would think about stress management, this is the image that comes to mind. We are blessed in many ways to have so many modern conveniences about.
Whether it’s technology, technological advances or medical advances, travel, international travel, but commensurate with those blessings of the modern era, we have expectations, and the expectations for a performance are higher than they ever have been, our expectations on ourselves and on others. And as a result.
And again, this was prior to 2020, we were all faced with very high levels of stress to quantify that a little bit, again before 2020, just anxiety alone, according to The National Institute on Mental Health, nearly one fifth of adults in any given year had an anxiety disorder, 20%, actually 19.1, but close enough.
And over the lifespan, it’s two fifths, two fifths of American adults have an anxiety disorder at some point during their lives. And that’s just anxiety. Also, if you look at the severity, the severity of anxiety and stress was through the roof.
We’ll get some more data on this later, but one in 20 American adults prior to 2020 were incapacitated or suicidal due to anxiety and stress. And the data suggests among college students that one fifth or engaging in self-injury. Self-injury is when people are actually harming themselves to cope with distress on within the past year.
Let’s be very clear. We live stressful lives and that’s prior to this year, the challenges that we’ve had over the last 12 months have been just staggering, before doing this talk. I was going through a history of 2020, which read like a novel, just putting it together, in January, we had the death of Kobe Bryant.
I was in Los Angeles that month giving a talk. I don’t know if you recall at this point, COVID was just starting to rage in Asia, East Asia. And there was talk like, Whoa, what if it comes to America like, let’s see what happens then Kobe Bryant, helicopter crash.
Then all of a sudden it was becoming more apparent that this tidal wave of COVID was coming towards us. And the stock market crashed in early March. The pandemic reached our shores mid to late March. Lockdown, school closures, cancellation of travel, family plans, sports, right? What happened to NHL, NFL, everything, baseball?
And then in May, the murder of George Floyd, National riots and even more painful than the riots was this recognition of longstanding racial inequality, which hopefully will be a catalyst to change. And hopefully we’ll have a blessing at the end, but it was such a painful summer that perhaps was one of the worst things of 2020 to cope with.
Then in August, a massive explosion in Beirut, which almost leveled the city. We didn’t know at the time, was an act of war? Like what’s going on here. Further in August, West coast wildfires. September the death of Ruth Bader Ginsburg. Murder Hornets in October and November, the election, which we’re reasonably hopeful is done. But like, who knows, like it’s been insane.
So, when I think about stress management today, it’s not just this, it’s really more like this. Like if you look at the CDC, the CDC reports that prevalence of anxiety has risen 50%. The numbers of people having anxiety disorders today are 31% up from 19.
More than one in eight adults in America have started or increase their use of illicit substances. Started to use or increased their use in the past 12 months. More than one in eight. So, what this picture means to me is somebody who is managing stress under the most unusual of circumstances. It’s a very unusual year and beyond diagnoses, everybody is managing stress.
For those who are fortunate enough to have jobs, quarantine suddenly left us working from home. For those with children, what do we do? They’re out of school. Are they in school hybrid models? There was at one point a concern about supply chain and groceries. We had people stockpiling, consumer staples, economic concern is not over by any means.
Although certainly things have regulated to a large degree, not to mention medical concerns, issues of racial inequality like I mentioned before, the election its distress is most unusual.
So before getting into methods of actual stress management and domains, really a better way to think about it is domains in which we can have either stress or resources, distress, or resources. I wanted to discuss a couple of important preliminary points.
Point number one, what is stress? So, stress is fairly simple to define in modern psychology. It occurs when our demands exceed our resources. It’s an imbalance between demands and resources. When the former outpaces the latter.
When our demands are greater than what we have to accomplish or to meet those demands, we experienced that depletion is called stress. Any demand, what’s a resource? A resource is anything that any area of life that gives us the capacity to do things. Time, money, capabilities, education, social, there are so many domains and we’ll go through several of them soon.
And what’s a demand? Anything that we need to get done. Any responsibility, any task, anything on our to-do list. You know, a classic example is, if you’re 20 minutes away from your destination, and your meeting is supposed to start in 10 minutes, you’re going to be stressed by 10 minutes. You’re behind the clock. That’s point number one.
Stress is an imbalance between demands and resources. Point number two, not all stress is bad. Exercise physiology has taught us that muscles grow stronger when they experience mild to moderate stress.
Apparently Jenn Kearney is a long-distance runner, which I did not know. And I am too, by the way. So, we should chat about marathons and half marathons at some point. And I’m sure she can tell us from her experience.
And I certainly can tell you for mine. My limited experience is that our muscles grow when they experience mild to moderate stress, when we’re pushed just beyond really up to our capacity, but not well beyond our capacity.
The temporary depletion of resources can build greater strength. It can build greater resilience, since the more our bodies get used to it, the more we can handle over time, you can actually grow your resources by having strategically certain levels of stress.
But to take the analogy further, our muscles can become strained, our muscles can become damaged if we have sustained or excessive pressure. In fact, I’m not running now because I’m nursing and a hamstring injury, which was not due to overuse by the way, it just happened from the way I was sitting.
But in any event, having that excessive strain, excessive pressure, having too much stress can create damage. Our muscles and our minds, they need recovery time. They need to have this intentionally and mindfully toggled.
How much intensity we have, and the relationship between stress and productivity looks like what’s on your screen right now is an inverted U-shaped curve. And what that means, is that at low levels of arousal or low levels of stress.
Performance is actually low. when people don’t feel stressed at all, when they have all the resources and really know no demands. Conversely, on the other end, when we have way too many demands and way too few resources, productivity is also low.
In the middle is that sweet spot where people can balance between their demands and their resources. In other words, at a certain point, there’s diminishing returns. But more than that, this is a psychological truism and it kind of makes intuitive sense, when we’re not being challenged.
When we’re not being evaluated, people do become complacent and unproductive. But when we’re overwhelmed and overtaxed and overburdened, we can become worn down and unable to unable to perform.
So, when we face challenges because of the second point, we need to be mindful, is the resulting stress that were experienced, is it going to increase our performance or is it going to decrease our performance?
And during stressful periods such as 2020, it’s critically important to provide adequate and commensurate time to rest and recuperate and recover, because I think we’re all on the right side of the curve at this point.
Okay, another point, the third point, and these are all preliminary ideas, is that research has taught us that not all stressful situations impact us the same way. So not all stress is made equal. When challenges are simple, when they’re predictable, when we have clarity, higher stress levels can increase learning and increased productivity like we saw on the previous slide.
But when people have complex and ambiguous situations, the increased stress is more sensitive. We’re more likely to be on the left side of the curve than the right side of the curve. There’s a classic study done. It was actually done in the early 1900’s with mice. Mice were given a very simple task. They were provided with a black box and a white box.
And if they entered the black box, they got an electric shock. And if they went to the white box, then they didn’t get a shock. So not surprisingly, this is a stressful task, cause the mice are getting, right, zapped and it was easier for the mice, it was fairly easy for the mice to learn this, like, okay, I’m just going to avoid that one box and I’m going to go to the other box.
And then the mice were given a more visually complex task. They were given black boxes and then dark gray boxes. And at that point, oh, I’m sorry. One more time. One more thing about the first condition. When the mice, when the experimenters rather, gave stronger shocks, when they increased the stress, the mice learned to avoid the black boxes more quickly.
So, their performance increased, with a simple task through higher stress. But in the second condition, the mice were given black boxes and gray boxes, dark gray boxes. And it was hard for them to distinguish between the two.
And the experimenters had a couple of conditions there. They started with lower shocks and they gave them more intense shocks. When they gave them more intense shocks, in that second condition, it actually made it harder for the mice to distinguish between black and gray boxes.
They were more likely to get shocked, which is interesting because high pressure, it can help us increase our productivity when tasks are simple. But when we have challenging tasks, not just challenging, when we have ambiguous tasks, things where we’re not sure what to do.
When we have higher levels of stress that actually decreases our concentration, decreases our learning, and decreases our productivity. And that’s very important today, because in 2020, everything was ambiguous. It has not only been a stressful year.
It’s been a confusing year. How many times over the last, not even 12 months, how many times in the last eight months have you said to yourself, I don’t know what to do. I can’t count the number of times where I was sitting facing the situation.
And I’m like, I really don’t know what’s best. I think this is the thing, but maybe tomorrow, the whole thing’s going to change. And then it’ll be that. Or maybe it’ll be the opposite of what I picked. There was so much ambiguity and uncertainty this year.
So, it’s even more than stress. It was an unusual year, and humans are obviously very different than mice, but the same effects occur once we know what we need to do. A little stress can nudge us along. Cause that’s part of being alive.
But if we’re unclear about what’s required, we need to take a different more nuanced approach to manage how we feel. Given all the ambiguity of today, more than ever we need to spend time focusing on our stress and recognizing that, that curve that we saw beforehand, it’s a lot more complex than just positive and negative.
I’ll give you another preliminary point. Stress is shaped by our perceptions. So, this is a figured ground drawing. And if you focus on the black part of the image, what you’ll see is someone with a big nose playing saxophone, wearing some pretty cool shoes.
And if you focus on the right side of the image, the white part, what you’ll see is the face of a woman, looks to be a face of a woman, at least to me. So too, for some individuals, financial stressors they’re hell on earth, pardon the phrase for other people, they’re much more accepting of those financial strain, but other areas of life are extremely stressful for them.
And then for those first people, those aren’t so bad. Some people cannot stand being late. Others, they’ll saunter in 10 minutes late, 20 minutes late. Hey, oh, the meeting started early? Oh, sorry, so it really depends on your perception. And without passing value judgments on either direction.
We have to recognize that the perspective that we take to life will impact our level of stress, more than anything else. A lot of people have to be fully prepared for situations. We don’t like to be thrown off course, and others are very fine improvising. Some people relish in that, great bring on the uncertainty.
Along these lines, people can tolerate different levels of stress. Some people can handle more. Some people can handle less. Some people can handle ambiguity more. Some people don’t like the ambiguity.
So, what constitutes a high level of stress for one person is really not the same as another. And you can’t compare yourself to anybody else. We all have our unique levels of stress that we can handle and the unique situations that make us stressful.
So, any approach to stress management today, it’s not going to be like, do these three things and you’ll feel fine. It’s more like here are 20 things you can do of which four or five, maybe 10, might apply to you or might not. And given that unique profile, I think we have to have a broader set of tools that we can use to deal with stress today.
Okay, fifth point and then the sixth, and then we’ll move on. So, fifth is, that there are no laboratory tests for stress. Yes, there’s cortisol levels, but it’s really more relative to you. Like how much cortisol has spiked relative to a baseline. By the way, it’s the same by depression, anxiety and stress, and any other facet of emotional life.
Here at McLean Hospital, we have some of the most advanced neuroimaging technology on planet earth to be able to look at neuro-biological correlates of all sorts of emotional aspects of emotional functioning and behavioral health. And I’m sorry to tell you that there are no clear biomarkers for any of these.
I couldn’t put somebody in any one of our scanners and tell you whether you’re depressed or not. It’s not a reliable diagnostic tool. And also, it’s not like you’re either depressed or not depressed, or stressed or not stressed or anxious or not anxious.
We see indicators of depression and stress and anxiety in the scanner. Don’t get me wrong. It’s not like there’s no signal at all, but it’s not like, oh, you hit a cutoff of blah, blah, blah, therefore you’re depressed.
That’s not how it works. And the reason why its cause at any point in time, we all are on a continuum of high, medium, or low stress. And what’s important. Isn’t where we stand relative to other people.
It’s important is where we stand relative to ourselves. Is our baseline depression higher or lower? Sorry is our level of depression now higher? How does that, let me say that again. How does our level of depression or stress or anything compared to baseline level?
Compared to what it used to be before a certain situation. The most advanced technology for measuring stress is actually what’s on your screen right now. And I’m not kidding. It’s a zero to 10 rating scale, I’m just going to teach you how to use this. Cause there is somewhat of a strategy here.
Zero means that your stress is at a zero. There’s no stress at all. That’s not a good thing. That probably means you’re dead in fact, because nobody has zero stress. So, zero is out. If it’s a 10, then you probably wouldn’t have the wherewithal to be able to sit through this program today. In fact, cause zero means probably a hospital visit.
So, let’s rule out 10, at least hopefully for present company. That leaves us with one through nine, okay? Let’s divide that into three. We have one, two and three, which we’ll call mild. We have four or five and six, which we’ll call medium. And we have seven, eight and nine, which we’ll call high.
Take a moment right now, this moment and rate yourself on that scale of zero to 10, with zero being out and 10 being out So really one to nine. Is your stress high, medium, or low?
And within those categories, is it high on the high side, low in the high side, the medium side. Is it really kind of getting towards high, like a six or is it getting towards low like a four? Or are you at a one, two or three?
If you’re at a one or a two or three, then I’m not sure why you’re here, but you’re welcome to stay. If you’re at a four or six, that’s fairly typical today. And I think in some ways that’s a sweet spot because of 2020, normally I’d prefer people to being in those sort of like three to four range.
And if it’s a seven, eight or nine, then well this workshop is definitely for you, but there might be some more strategies that we need. Okay, and the final preamble point, and perhaps this is most important. How do we manage stress in a nutshell, in a single slide? Again, to define stress, stress is an imbalance between demands and resources.
So, for all the mathematicians in the audience, there’s only two solutions to that equation. Demands greater than resources equals stress, then how do you balance the equation? Its only two solutions, we either increase our resources or we reduce our demands.
Now given the subjective nature of stress, it’s not only an external aspect. It’s not like a solution to financial stress is not always more money or spending less. Sometimes it’s the way in which we interact with our money. So, it’s a more dynamic than just changing our circumstance.
And I’ll get into that with all the examples we’ll go through. I think with pretty much all of the examples we’ll go through, but nevertheless, there’s only two options here we’re either increasing our demands or decreasing our resources, increasing our resources, or decreasing our demands or both.
And when we do both in whatever domain we’re experiencing stress, we are most likely to balance the equation and to reduce our stress to levels that are more optimal for us.
Okay, so stress can occur in many domains of life. Here are seven, and these are more examples. I mean, there are many more, but we only have so much time. It is critical to note again, stress is an imbalance between resources and demands. So, given that these are domains of stress, they are also potential domains of resources to us in our life.
Yes, they are demands and those demands can outpace our resources, but they could also be areas of actual resilience and resources that we can use. And with a bit of good luck and careful management, each of these seven domains does not have to be a stressful aspect. It can actually increase our well-being in very important ways.
So, I don’t want to only focus on the negative here. We have to also realize that these could be wonderful domains of life in which we can have greater richness. Finances, so in Western countries, financial stress is a very considerable mental health burden. It’s associated with greater depression, anxiety, substance, and alcohol use. Even physical health decline.
There’s a study a couple of years ago in the Journal of Community Mental Health by Thomas Richardson and colleagues from the UK that financial difficulties predicted greater depression and stress over time.
That’s not surprising, but the effects were specially high for people who considered dropping out or not attending college for financial reasons. Also important is that there are bi-directional effects. I think that was the most important aspect of the study.
Financial strain predicted mental health decline and that mental health decline predicted subsequent financial strain. And the reason this is important. Well, aside from the fact that this occurs primarily in Western countries where we value material success, there are many cultures where living in dire poverty is actually not such a stressor.
Yes, there are associated stressors with it, but a lot of it has to do with the value that we place on money and our perspectives in dealing with this. Remember the figure ground drawing.
So, stress is highly subjective, and it’s related to our perceptions. And we can’t forget that cultural reality, but getting back to the cycles, stress and financial burden, there’s an inter dependent relationship between financial burden and stress.
When people are highly stressed, their earning capacity can decrease and that can impact sleep, eating habits, which can increase our mental health concerns, which can make it harder to earn money that can lead to physical health concerns.
Because often when people are low on cash and struggling with stress, firstly, making more unhealthy choices makes us more likely to have physical concerns, but also decreased utilization of the medical system.
People will push off getting an appointment for something, cause they’re feeling stressed. They’re financially having a difficult time. They’re doing whatever they can, they’ll delay getting necessary medical attention. And then when they’re stressed out from that, they’re more likely to make poor financial choices.
So, we see highly interactive patterns between financial stress, poor decision-making, in those domains, physical health decline, mental health decline, all of these can really interact with each other in a very pernicious ways.
The most pernicious and problematic though comes to debt. The debt cycle. The debt cycle is a trap and people get caught in it when they have a need to borrow. And that can be predicated by an unexpected expense and having limited or no savings, but basically having a need to borrow.
And if that happens suddenly, that can lead to people taking on high cost debt, the interest which accrues, creates a tremendous financial burden, which puts strain on people’s income and expenses.
And then if they have another need to borrow, people can get really very easily caught in this cycle. And this is something to be extremely cautious and careful about today. Fortunately, there are a lot of ways to break out of the cycle. And a lot of ways to manage financial concerns. I’m a huge fan of financial counseling and debt counseling.
The reason why is because many people don’t understand the debt cycle, they don’t understand the relationship between, Oh, when I put things on my credit card and don’t pay them, that accrues at rates of 17, 20, 25%, 30% interest, those can add up extremely quickly.
And there are often ways even with lower credit scores to be able to minimize that consolidate debt. But more important than that, people often don’t have information about their financial situations.
There are a couple of organizations that I’ve seen in the Boston community, which do such a fabulous job about this cause in addition to providing financial support, handouts of some degree in certain areas, that limited support that’s provided is I think dwarfed by another service, which is the financial counseling. When people declutter their budget and have a realistic approach to it.
And when they have somebody who will help them and meet with them on a monthly or bi-monthly basis, to make sure that they’re sticking to it in addition to finding additional resources for income and trying to increase that, but decreasing expenses.
Obviously not all financial situations can be managed, but the more that these are managed, the more that these can be in many cases, a financial burden can be at least decreased or at least we can become aware of it.
The worst part about financial burden is when people aren’t aware of it and then it catches them off guard and financial counseling can make a big difference. But equally important for financial advice is to validate people’s financial stress and strain validation involves recognizing people’s feelings and acknowledging them as important.
It involves being empathic, taking the perspective of the other person, conveying that their feelings are real. It doesn’t mean we agree with the person. You can completely disagree with someone and think that choices are poor while validating their feelings, but it does require temporarily dropping an agenda for change.
Validation’s a lot harder than one would think. And then it seems, basically what it entails is three steps. Listening, actively listening, hearing a person out in a non-judgmental way, letting them speak their mind, speak their heart.
Often when it comes to finance, the reason I am mentioning it here is cause when it comes especially to financial pressure, the gut reaction in many cases is to give a person advice. And yes, that’s important.
But there’s something more important which can help alleviate financial stress, which is hearing a person out in a non-judgmental way, letting them speak their mind, giving verbal and non-verbal indicators that you’re listening, being in touch with a person’s emotions, staying carefully aware of how they feel when they’re speaking to us about this domain, sometimes repeating back what they said to make sure that they understand that we get it.
Empathizing like I mentioned, normal and most of all, normalizing reactions. It makes sense you’re feeling down. It makes sense. You’re having a hard time. These are real stressors that you’re facing, given everything that’s going on, you’re actually doing really well.
And obviously avoiding invalidating comments like correcting teaching, blaming, giving unsolicited advice, trying to Hoover up people’s emotions.
There is a delicate balance, between financial counseling, which is crucial, I think, but at the same time, validating people’s emotions and understanding that often these stressors are very real and helping people to recognize that their emotions around these stressors are also very real.
Let’s move on to educational stress. Okay, educational stress. This comes up in spades for high school and college students. In high school, people are going through identity formation and college forming their identities, lots of social pressure.
Especially with social media and educational demands are increasing, college students especially needing to independently manage their course work and requires good study habits and eating habits, sleeping habits, all of which are very hard to do. And in college environments.
And as a result, and I mentioned this before the severity of mental health concerns that we’re seeing, but adolescents and young adults have very high levels of stress today. Mental health is actually in an all-out crisis when it comes to young people.
Suicide is the second leading cause of death for individuals ages 10 to 34 in this country. It’s only second to accidents, which by the way are often suicides. I hate to say. Not always, obviously, but more times than one would think.
More people die from suicide today, than cancer, heart disease/AIDS, birth defects, pneumonia influenza, and chronic lung disease combined, every year, combining all of those factors.
In fact, the 2018 Harvard Medical School study found that 9% of all college students at one point had tried to take their lives, 9%. In addition to the 20, I mentioned beforehand, who had engaged in self-injury to harm themselves. So young people definitely don’t have it easy today.
There are a couple of critical stress reduction approaches that students can take. And it’s not only 2020, but although all the more so today when things are more ambiguous. The first is I believe the concept of multiple intelligences. This became popular by Howard Gardner is a Harvard psychologist in the early eighties. It’s been around for a while.
The basic idea here is that human ability is manifest in multiple modalities. There isn’t just a single general ability. There’s things that are much more than that. Gardener’s concept is certainly true.
And it’s a vital importance, but especially today, cause one concept that gets lost today is that I believe all children, all people, all adults have the capacity for greatness. It’s just not necessarily in the same way that everybody else.
Some kids are better at logical thinking, others are better at athletics. Some kids have these amazing musical talents. Other kids love science. Some are math wizards; some are interpersonally amazing. There’s so many different pathways to greatness.
And ultimately, I might even go as far as to say that the primary reason why people fail, is cause they’re trying to do someone else’s job. If we’re on our right path for us, then we’re going to be successful because that’s what we’re supposed to be doing. People don’t play to their strengths enough.
It’s always a bet in education today. There’s a single standard. Like the test has 50 multiple choice questions. If you get 45 right, you get an A. As opposed to approaching the material in a certain way. Now I’m not saying all of education has to be, the entire education system has to change. But I am kind of saying that the entire education system has to change.
The main point is, it’s extremely important today to be flexible about how we define success and to find ways for people, especially children, especially young adults, to be successful and to find their talents and to exploit those areas and to move forward. A related concept, which we see in educational stress, is that it’s important to fail forward.
Failing forward, it’s one of my favorite concepts, in education, the idea here is that failure is not the end of the world. It’s a part of life. Everybody fails at some point and it gives us information. Firstly, we fail it’s for a reason, either we didn’t prepare enough, or we don’t have the aptitude for it.
And both of those are okay. If we didn’t prepare enough, we have to prepare more next time. And if we don’t have the aptitude, then we’ll be successful in another area. Just, that’s probably not our job.
Now, it’s hard to distinguish between those two and I wouldn’t give up so quickly, but at the same time, it’s not the end of the world falling apart emotionally when we fail. I have kids.
I love it when my kids come home and they have a bad grade at school, it’s much better than if they’re doing well, because then I can say, oh, what happened? Like let’s have a chat about it, perfect. Like I failed plenty of tests, believe me.
And there are a couple of options that people usually resort to when they fail. One is falling apart, our emotions getting wicked intense. And the other is pretending like, oh, I did fine. It’s not an F it’s a B. And another way of the ladder is sort of turning away from it.
People often resort to substance abuse, like, hey everything’s fine, like whatever. And that’s really where these stressors become problem. You see perfection is the enemy of progress.
The classic understanding of that is that if I’m trying to do something perfectly, I’m never going to be able to progress and move it. But there’s another meaning to that today. Perfection is the enemy of progress. Cause if I’m so bent on being perfect, we’ll never progress.
Because failure happens. When we fail and we ignore avoid thoughts about failure. It causes distress. And then if we ignore and avoid those thoughts about distress, that just perpetuates more failure and we can get caught in that quagmire pretty quickly.
So, related to this, the most critical stress reduction reproach, I think for people in the educational system is to teach this message on your screen is that it’s okay to struggle and it’s okay to not be okay. When we give people permission to struggle, it’s an immediate solve.
Our whole perspective shifts and our level of stress decreases. The worst part about suffering, the worst part about stress is feeling judged for having that stress it’s just going to compound it further. I’ll tell you something else.
The hardest patients that I’ve ever seen, the most complicated, difficult, challenging patients that I’ve seen in practice are always the brightest, most academically accomplished and best looking for college students from the best schools.
When someone’s used to keeping up an image that roadblock, it’s not just an impediment, it can bring down the whole house and the first message to tell those patients and frankly, anybody else today, is I want to see you at your worst. Like bring it on.
If you’re not struggling, like cry, panic, be angry, that’s fine, but acknowledge that it’s happening and deal with it as opposed to pretending that everything’s fine. Now, I don’t necessarily recommend that you say that to your clients and coworkers, because it’s different being in mental health.
You might not want to see people at their worst and that’s okay, but it is important to give others and to give ourselves permission to have really bad days. I’ve definitely had a couple of bad days this year. I don’t know about you and it’s okay to not be okay. And if we are struggling then, well guess what? We’re human beings, and that’s par for the package.
Another critical aspect here is self-compassion. So, Professor Marissa Silveri who runs a neurodevelopmental laboratory in the imaging center here at McLean. She and I have been collaborating for a while.
And one of Marissa’s students, who’s now a student of mine and Eleanor Schulenberg, she’s doing some pretty cool research on forgiveness of self when people are self-compassionate and anxiety and depression.
And what she’s found is that forgiveness is not only associated with less depression and anxiety, especially among people who are at higher risk, whose parents have had depression or anxiety, but actually it’s associated with greater cortical volume in certain areas of the brain, the left caudal middle frontal gyrus, the left rostral middle frontal gyrus, right?
Caudal middle frontal gyrus, all certain areas of the brain that we know are associated with depression and anxiety. In fact, in the same study, those areas were negatively correlated with anxiety and depression.
So, we’re seeing similar effects, when people are compassionate with themselves, it takes so much air out of the balloon. It’s just so much less tense and less stressed and self-compassion is critical, especially for younger adults. Okay, that’s two out of seven.
Jenn: Hey David?
Jenn: Could you provide a little bit of context into what fight or flight means for our listeners?
David: Sure, fight or flight? So, when people perceive a, I didn’t say fight or flight, did I, but I guess someone’s asking about it, the fight or flight system mediates anxiety and stress. And I think that’s a fair question, given the topic.
So, the fight or flight system, when people perceive a threat to themselves, there is a system that will cascade into place, mediated by the adrenal glands, which either puts us into a state of approach or avoid.
We’re either going to fight and muster up the energy to deal with that concern, or we’re going to retreat and move away from it. And actually, we’ll come up a little bit in these coming slides on human interactions, believe it or not.
And those two approaches, sometimes it’s more adaptive to fight or to muster up, to increase our engagement with something. And sometimes it’s better to pull away and to not. I think it’s more dynamic than that. I think that often we have a single stressor in one area and it’s not just approaching or avoiding that stressor.
It’s really modulating our emotions more dynamically around that. So, I think it’s more of a simplistic model that still has a lot of utility. That’s very true, but that’s one of the reasons why I didn’t take that approach in our talk today. Any other burning questions, Jenn?
No, okay, human stress. So, our relationships with others, these are critical, critical determinants of our wellbeing, Robert Waldinger, he is a faculty member in my department here in the med school.
He has run the Harvard study on adult development for the last, what is it, eighty years? Following a group of Harvard college students from the graduation of college, or I think even during college, throughout the rest of their lives.
And what he found after eighty years was that our relationships at age 50, the degree to which we are connected to people at age 50 is the most critical determinant of healthy aging from anything else, more than physical health, more than mental capacity, more than financial material success, more than any other aspect of wellbeing, is how satisfied we are with our relationships at age 50.
And in order to have satisfying relationships at age 50, usually those don’t just materialize in middle age, people typically have to, the reason why that’s such a key predictor is cause to have relationships at age 50, people usually have to invest more long-term in there’s twenties, thirties, and forties when they’re working wicked hard. And when it’s harder to do so.
In 2011, there was a study in the proceedings of The National Academy of science by Naomi Eisenberger and colleagues from the University of California, Los Angeles. So fascinating study and it’s worth mentioning, female participants and long-term romantic relationships and monogamous relationships.
They underwent FMRI scanning as they received painful electric shocks and they were different conditions. In condition one, they were shown pictures of their partner, and condition two, they were shown control images of strangers, people who they had no connection to or objects, not people.
The pain ratings were significantly lower when those women were shown pictures of their partners. So, they actually experienced less pain.
More importantly, there were also reductions in pain-related neural activity in certain areas of the brain, which are associated with pain. And furthermore, those reductions in neural activity, mediated relationships between their perception of partner support, the length of their relationships and the pain ratings.
So very clear indications, which is why it was in such a prestigious journal that our relationships have a massive impact on the way in which we interact with the world.
Close relationships, particularly of a romantic nature, but not only, they benefit our survival. They’re a key factor in reducing distress. And this is one of the reasons why we are faring so poorly in this current crisis.
In, in 2018, there was a study by Cigna health insurance, a huge study that three in five Americans today are lonely. Among college students it’s particularly bad. The American College Health Association reported two thirds of females. And more than half of male college students are very lonely being the top anchor on a four-point scale. Very lonely.
And it’s so odd to me about the college students, because that’s the most social time of life. People have shared living, shared dining, shared everything. And I think the reason is cause colleges teach everything today except for skills to forge meaningful human relationships.
Beyond romance and close relationships, our social lives are very restricted today. Our U.S. workplace culture relentlessly encourages the pursuit of success, whether it’s material or recognition, and it can be often be toxic relationships. Many people are very isolated and alone today.
I think because of these large-scale cultural factors, if one thing in fact came positively out of 2020, I think it’s that we’re more connected than ever. My wife said to me in the first week of quarantine. So, the world just got really small, didn’t it?
And personally, I’ve definitely connected more with people through electronic means granted, but I’m definitely using this and this a lot more, to connect with people than I ever have.
And it’s not just me, WhatsApp, Facebook, they saw a 40% increase in usage since the start of the pandemic over the first two months. 40%, they were already used quite a bit. I think it’s ironic that we’re more socially connected than ever during an age of social isolation, but I guess that’s what it took.
But beyond increasing our interpersonal connection, managing stress and relationships, it takes time and it takes effort. Someone mentioned fight or flight beforehand. And then we see this pattern occur in relationships.
Dr. Sue Johnson, who created a very dynamic and wonderful form of couples therapy, called Emotionally Focused Therapy or EFT. She says there are three primary damaging patterns of interaction with people.
The first is fight and fight, where people are pursuing and pursuing and basically double blaming. You did this. No, you did that, blah, blah, blah. So, like you’re sort of typical prototypical fight where two people are arguing with each other.
The second type, which is even more common is when one party will fight, and the other party will flee. This is called in language of the EFT the Emotionally Focused Therapy, pursue, withdraw. Cause the one is pursuing and the other is withdrawing.
The one party blames, the other party retreats. The problem with that, is that’s going to happen forever. And at a certain point, it usually hits a breaking point. So that’s not a long long-term sustainable.
The last one though, is some ways the worst, withdraw, withdraw. Where both parties retreat. I’ll give you an example of a couple of fighting over money. The first pattern people would say, they’re blaming each other. You’re spending too much. Well, you don’t make enough.
That kind of dynamic. And the second one, the one party is chasing the other and the other one’s getting the cold shoulder. You’re irresponsible with money. And the other one’s like, well, let me think about it. I’ll get back to you. Or let’s change the subject. Or, you know what? I can’t talk about this now. And sort of ghosting the conversation.
The third pattern though, the concerned party doesn’t raise the issue. And the other party permanently avoids the topic. That’s actually the worst. Because I mean, all of the patterns are problematic, but according to Sue Johnson’s research in other people, that last pattern is the most damaging because firstly, aside from it signifying a fundamental lack of trust.
It’s associated with relationship decline and mental health concerns more than the other two, because that concern remains there despite the fact that it’s not being dealt with, of course, by the way, this is not just romantic relationships. This occurs in or workplace relationships. It occurs in community settings. It occurs among friends.
The two patterns and relationships are also known as silence and violence. People are either choosing violence approach or fight or silence or withdraw or flight. One solution is to recognize when we’re getting stuck in silence or violence patterns of blame avoidance criticism. And to show vulnerability to our partners. or to other people, not necessarily romantic partners.
An alternative way of dealing with that financial concern is, you know what, instead of, hey you’re irresponsible, something like I’m really struggling with our financial situation. I know it’s not your fault. You’re doing whatever you can, but I’m having trouble sleeping at night and I’m feeling really stressed. Can you please help me?
That’s a very different plea, than it’s your fault. I need you is very different than what on earth are you doing? And we tend to respond much more favorably to the former. Who doesn’t want to be a hero?
So, when someone needs you, you’re more likely to help and actually get in there and make a difference. Not always, but it’s going to increase the chances of it happening as opposed to being blamed. I don’t know about you. I respond a lot more favorably, when someone asks me for a favor, than when someone blames me.
Sharing our needs with the partners, it’s not an argumentative approach is not top heavy, if anything, we’re making ourselves vulnerable. I need you; I’m stuck. And that provides for attachment needs, which is really what relationships are about.
The reason why those women in the scanner were doing better is because they felt securely attached to their partners. They were able to show needs and have those needs met. They felt that their partners needed them, and they were able to be there for them.
That’s ultimately what relationships are about, but it requires showing surrender, showing that we are dependent on other people.
And it’s not just that we’re the powerful ones and our significant others are meek, it’s the other way around. The more we need somebody, the better it’s off for relationships. Dr. Johnson speaks a lot about interdependence as opposed to independence. And in our society, I think we often favor independence over interdependence.
Dependence has taken it too far granted, but that interdependent where we both need each other is a great strength, cause it shows others that we care about them, that they need us. And that we’re actually in a relationship with them. There’s so much more to say about this, but I’m going to keep moving on.
Okay, let’s talk about physical stress. We know that stress impacts the physical body, and haven’t really talked about it too much, but I think it’s fairly obvious, headaches, muscle pain, dizziness, stomach upset, irritability, anger, sadness.
I figured that that was a more basic and I don’t really have to review all of those. But in addition, our physical wellbeing can impact our stress.
And that’s something that I think is overlooked because the relationship between our physical wellbeing and our stress is cyclical. The most important resource in many ways is our physical health.
And psychologically speaking, American culture is so hard on the body. We push ourselves to the max. We pride ourselves, not getting enough sleep, not getting enough of the diet, favoring productivity, over self-care. We treat ourselves like dirt, dirt.
And there are so many aspects of self-care, but firstly, it’s not selfish and there’s nothing to be embarrassed of. And if people need a mental health day or more then please take it. But more than that, I want to speak about sleep, exercise, and diet. Sleep, this is the most important aspect of self-care that we’re going to speak about.
Ever since Thomas Edison, I think he was a good guy trying to make the world a better place, but ever since Thomas Edison, our society has been on a downward trend because we’re chronically sleep deprived. We don’t get enough sleep and the effects are catastrophic.
And the recent meta analytic study, chronic partial sleep deprivation had a colossal effect on depression, anxiety, stress, lower cognitive performance, emotional reactivity. People, when we make errors and we’re low on sleep, we are much more likely to react severely to ourselves.
Research on sleep regulation. There’s some fascinating research done in the last couple of years. That’s simply regulating sleep can be as effective in helping people manage depression as serotonin re-uptake inhibitors, exercise, cognitive behavioral therapy, many tried and tested aspects of mental healthcare simply by regulating sleep.
Of course, that’s not the case for everyone, but in many cases, simply focusing on sleep can help. A practical strategy, have a bedtime. If you have a bedtime at 11 o’clock and you go to bed at one, your jet lagged. Your jet lagged the next day. You’re in a different time zone by two hours.
So, what I like to stress to people is if you want to have a 1:00 AM bedtime, that’s fine. You need to wake up later. It might not be the best strategy, but that’s fine. You want to go to bed at 3:00 AM. That’s going to be harder to do, but if you do it regularly and on the shift, I could be okay with that, but not going to bed at 11:00 AM. And then all of a sudden 3:00 AM.
I recommend to people to have a bedtime and then to go to bed within one hour on either side. So, if your bedtime’s 11, go to bed between 10 and 12, every night, consistently, even on the weekends. Maybe 90 minutes on the weekend, one day, maybe. If we’re good about the rest of the week.
Practical strategy, exercise. The Heart Association of America and the US Department of Health, specifies that people should have 150 minutes to 300 minutes a week of moderate intensity exercise. That’s between two and a half to five hours.
It’s a lot, mental health, we don’t have recommendations for this, shockingly. I think the American Psychiatric Association should definitely come up with some clear recommendations, cause exercise is so integral to managing stress.
But 30 minutes, five times a week is just an upper cardiac health. And at a minimum, at a minimum, we would say that that would be the strategy for mental health, if not more. All of my patients, almost, I should say almost. Almost all of my patients I encouraged to do an exercise and in of itself its going to be a tremendous lift for people with anxiety and depression and certainly stress.
When it comes to diet, this is what most people think of when they think about stress and food, but obviously that’s not what I had in mind. Nutrition has an enormous impact. Aside from the effects of caffeine, which are underestimated.
Caffeine is a very powerful psychoactive substance, which affects our entire nervous system. It can create jitters, headaches, stomach upset, but the most important things is that people often use caffeine as a sleep supplement, which is not what it’s intended to do when people are engaged in use of caffeine and sleeping six hours a night.
Well, in fact, I have another slide on sleep that I messed up. So, I’ll come back to it after. When people are not sleeping enough and using caffeine, that’s where we have higher blood pressure, behavioral problems, very significant levels of stress.
The sleep duration recommendations, for your average adult American is between seven and a half and nine hours a night. How many people here, you can raise your hands, can comfortably say that you get between seven and a half and nine hours a night sleep? Thank you, Debbie Lipton. Jenn, you rock.
Jenn: I’ve only started doing that post quarantining.
David: Post quarantine?
Jenn: Yep and taking better care of myself sleep wise. I look at that.
David: Has it made a big difference?
Jenn: Yes, sill stressed. But at least a well-rested and stress.
David: Can you imagine what life would be like without it?
Jenn: I don’t want to think about it, so no .
David: Right, it’s amazing what happens when we sleep. It’s just a recharge. By the way, I think it has to do with the vulnerability thing. When we sleep, we’re saying like I’m shutting off. I’m not in charge. I’m just going to; I’m going to be vulnerable for a little bit. We are more vulnerable when we sleep.
So, I wonder about the emotional relationship there, but that’s just a pet theory that I’m just waxing poetic. People don’t realize about also caffeinated beverages, just one more thing about caffeine. One iced tea has 70 milligrams of caffeine. For kids, the maximum dose, which is recommended by American Pediatric Society is 45 milligrams.
So, people don’t often realize what they’re putting in. Also, sugar consumption, sugar consumption in America is completely out of whack. This is the primary reason why obesity is such a high challenge. For kids, a max daily intake of sugar should be about 25 grams. A single can of soda. Does anyone know? 36 to 50 grams. A Dannon yogurt, has more than 25 grams.
Sugar is, I’m listening. it’s hard to avoid in American day, but we have to realize if we’re not going to curtail and curb this, then it’s important to recognize that it’s going to have an impact on us and to go from there.
Just getting back to sleep one more second, is if you look at these levels of sleep, What kind of covered this in terms of how much sleep people need? So where is it for young adults and adults? Seven to nine, older adults is even, in this range over here, okay.
Occupational stress. Occupational stress, work burnout is definitely real. And it occurs when people feel dread in the morning. They want to leave early. They’re not engaging in work. They’re thinking about work too much. Ironically, they think about work more when they’re not at work, even though they’re burned out, and work stress does seem to be on the rise.
There’s a national organizational consulting firm called Korn Ferry. And they found that work stress has in 2019 they did a large-scale study on this. Work stress has increased over 20% over the last 30 years. And 83% of workers are stressed.
But more important than work is also people who don’t have work at all. A lot of folks here on the call today, help individuals to get work. And I think, you know, better than I ever will. How looking for a full-time job is a full-time job.
A very critical strategy to managing work stress when people are employed, is to recognize our limits, a very simple point, but an important one, to advocate for ourselves, to get the resources we need.
If we can’t get the resources, I like to say it like this. If we don’t have the resources to do a job, it’s not our job. It’s that simple. If we can’t get it done with the resources that we have and the knowledge that we have, it’s someone else’s problem.
And we can validate and say like, that’s hard to superior about that, but that doesn’t make it my issue to have to deal with. And I think there’s some assertiveness that we need. And in this era of trying to be perfect all the time, people tend to forget that important point, but another work-related issue.
In fact, the primary work-related stress is not just being overtapped by, too much work and not enough play. But this is an addition to finances and physical health that we speaking about before. Interpersonal wellbeing, this moderates, our occupational wellbeing, more than anything else.
There was just a study done. Just a study, came out I should say. Last week that who we work with is a better predictor of job satisfaction than what we do.
People can have very stressful jobs, but if they work with a good team, then it decreases our stress, by orders of magnitude, having supportive bosses, and supportive coworkers, but more important than support, it’s feeling valued at work. It’s more than just support. It’s a very specific construct. Do you feel valued at work?
This is the greatest most crucial predictor of job satisfaction and explain why it relates to the slide in a minute. In that same study previously by Korn Ferry, 93% of individuals who feel valued by their employer are motivated. And 33% of people who are not. When people feel important to others, this relates to the human aspect that I was speaking about before.
When we feel needed by other people, we are more likely to come through for them. Our job satisfaction is more important, sorry, feeling needed at work. Feeling valued at work is more critical for job satisfaction, than financial compensation.
The only reason it would be opposite is if financial compensation is so low, that people don’t feel that they’re valued enough, but it’s not about the money. It’s about what the money represents, which is the value of our work.
The reason why I think, cause of concept called meaning making. Meaning making is a process by which we understand and make sense of life events. It was introduced to modern psychiatry by Viktor Frankl, who was an Austrian Jewish neurologist and psychiatrist and a Holocaust survivor. He found out something called logotherapy, which is still used to this day.
And he observed that even in the most dire conditions of the Nazi concentration camps, when people had a sense of meaning when people had a sense of purpose, when people felt that their suffering was to an end, they were able to survive.
And when people conversely, when people lost hope, when they lost not hope, when they lost the sense of meaning, when they felt that there was no meaning, no value, no purpose in the difficulty that they were going through, that actually led according to Frankl, to people to not even suicide for people to wither away and die.
Once people lose their vision, that what they’re doing is important, it has catastrophic effects. And this is again, related to the subjective quality of stress. Remember the figure ground drawing, where it really depends on the way that you see life.
When we feel that our work has meaning it’s not just drudgery. Even if it’s hard. When we feel that it has a purpose, we can carry on, even though the circumstances are difficult. These are key motivational factors.
I want to also make this relevant to people who are not working. A related concern, when it comes to occupational stress, is our pervading culture of productivity and how that’s been impacted by technology.
This applies equally to people who are and are not currently employed. The concern is as follows; we have to understand how powerful technology is on our stress levels. And we have to participate properly.
I like to give an analogy that technology is like nuclear energy. It is like nuclear power. If you harness it in the right way, nuclear energy can power entire cities. It can be used in radiation treatment.
It can cure destroy cancer cells. It’s incredible what you can do with nuclear power. But if you use it as a disruptive force or more importantly, if we just let it go, what happens to nuclear energy? When you just let it out? Untold devastation.
These devices, right? These like electronic appendages that everybody is walking around with today, they can do the most incredible things, but only if we harness it, if we don’t take precautions, it’s like having an atom bomb in your house.
The good news is, we can use them, communicate with each other, take store, keeping, sharing pictures, navigating the world, right? Google maps, Ways, you pick it. Completing daily tasks, shopping, banking, ordering Starbucks, you name it.
Turning off sound systems and lights at home. Keeping up with the weather news, fashion, sports, accessing critical information, telling the time and date in any place at any time. And it can enhance our relationships for sure. How many people today, show of hands sent a WhatsApp or a text message to somebody who they care about? That filled up pretty quickly.
And in the past six months, how many people have used a device to connect with family or friends that they otherwise probably wouldn’t have connected to. For sure, two hands. Wow look at that.
So, these are powerful devices that we can definitely use for good, but at the same time, there are some definite significant drawbacks. And unfortunately, it goes a lot beyond texting and driving, which by the way is dangerous and we should not do, but we are literally in love with our tech.
There’s a very controversial piece in the New York Times, a couple of years ago, when someone claiming to have done a FMRI experiment showing activity in the insular cortex associated with iPhone use. Insular cortex is also associated with love.
So, people literally, the idea behind the New York Times article’s, people literally love their phones. People have phantom experiences. I don’t know if you’ve ever had this. where you’re like, oh, it’s buzzing. Oh, no, it’s not buzzing actually. But you sense that it’s buzzing and like your phones on the other side of the room, right? Am I the only one who’s had that experience?
Jenn: Or when one person’s phone rings and all of a sudden 15 people in a room, well, pre COVID, 15 people in a room would jump toward it, yeah.
David: Right, don’t show your hands for this one. But how many people touch their phone or use their phone before using the bathroom in the morning? Don’t show your hands. Don’t worry, Julie, secret’s safe with us. Vicki, thanks for helping Julia .
We are over-reliant on tech so much, and I think it makes us pretty weak. People get very easily frustrated. Nope, reload, reload, reload. It’s taken three seconds. That’s completely unacceptable. It makes us more impatient, more tense.
We have unrealistic expectations of ourselves and others cause people can’t keep up with machines. They’re faster than us, right? I admit defeat right? Even on the marathon course, forget it. Like I’m going to get outpaced by operating system. The new operating system that Apple just released. They also give us no time alone. We always have to be doing something.
Back in a time when people used elevators, right? People don’t use elevators anymore. But the first thing people do when they get into an elevator is? People don’t just stand in line. I myself am guilty of this, but just sitting, just being, we’re so uncomfortable with ourselves, sleep dysregulation, that’s another massive factor here.
And this is an addition to like legitimate, dangerous, like internet use, internet addiction, chatroom infiltration, cyber bullying, inadvertent, and unintentional exposure to all sorts of content, people’s information getting tracked, financial information, getting exposed.
So, all of these are some pretty difficult stressors that we have to face today. And we have to be very mindful of what these devices really are intended to do hopefully, and what they’re not. I think most of all though, we’re so focused on productivity today with our devices that we often give up our relationships.
I mentioned before, treating ourselves like dirt, but it’s a more, it’s not interacting with other people or having those close relationships. We’re showing people that we need them. Devices are for productivity and they’re for multitasking. And they’re great.
And yes, today in the era of COVID-19, we do have to use them to connect with other people. But a lot of the strategies we’ve spoken about so far, self-care refocusing on relationships. These are critical to use in a digital age, even more so.
The more busy we are, the more self-care and the more we need time and distance from our tech. I recommend to people today to take a break from tech. If all you can do is put your phone down for five minutes, great. But I would recommend more. 25 to 30 minutes. During dinner, no tech. During the morning routine, no tech.
When you’re exercising at the gym, please put your phone down, before bedtime 30 minutes, for sure. And just putting on the blue light option. No, that’s not going to work. The data is clear,’ using technology close to bed, it can disrupt circadian rhythms. The night mode is not going to help enough.
And these are critical issues that we all have to face in the digital age. Okay, I want to speak about emotional wellness. This is important. Emotional stress, talk about emotional stress. It’s a critical aspect of stress today.
Not just because stress as a facet of emotional wellbeing, but because when people struggle mentally or the way in which we struggle mentally, can massively impact our stress.
I do some consulting for The Substance Abuse, Mental Health Services Administration, otherwise known as SAMHSA, out in Washington, DC. And whenever I go there, they refer to the no casserole disease.
They refer to mental health concerns as the no casserole disease, why? When people get cancer, people have surgery, the neighbors come and bring over a casserole. But when people have depression and anxiety, no one shows up with a lasagna.
It’s very atypical for someone to say, hey, I know that you’ve been depressed lately. Can I bring you over some dinner? Can I order pizza for your family, why? The reason why, is cause people feel weird around others who are struggling with mental distress, because it reminds us that we ourselves also struggle with aspects of anxiety and depression.
All human beings struggle with these pieces. And I think we take it often as an indicator that people are broken or who knows what’s going on. Because it reminds us, that we too are often not in control of how we feel.
And instead of accepting and embracing others when they need emotional support, we ditch them, and the repercussions are massive for them and for us. That judgmental approach without bringing a casserole, it insidiously creates this pressure to feel perfect.
Not only to be perfect, but the feel perfect, or at least the pretend to feel perfect. And that perpetuates the cycle in ways that are unbelievable.
The reality is that all human beings have something to deal with in the emotional sphere, all of us, some sort of internal patterns of thought and behavior that we need to correct. We’re not born perfect that’s life. And when we expect ourselves or others to be perfect, emotional problems only grow.
So, my point here in terms of stress and emotional functioning, is that we are not going to be even keeled. We are not going to be in check all the time and when we don’t feel normal, even healthy. And we react negatively to that, that just gets us down further. The reality is that normal human beings have a range of emotions. Sometimes we’re fearful or happy or sad.
And if COVID has taught us anything it’s this. That when we judge ourselves or others for feeling down, that’s a surefire way to make things worse. And it’s also not based in reality. Related to this, there are 10 levels of care.
Everybody doing this workshop today needs at least one of these. On the left side are non-professional forms of mental health care. And on the right side are professional forms of mental health care.
And whether you need prevention or self-care or social support, self-help being like books like self-help books or mentorship, to speaking to a non-professional about what’s going on maybe a coach that’s fine, but whatever it is, we would at least need one of those.
Some people need professional help, consultation. Consultation’s interesting, it’s not therapy. It’s just meeting once or twice with a mental health professional to get their take. Then there’s therapy like regular treatment.
People can add to that. Either certain groups like dialectical behavior therapy groups or medication, and then there’s higher levels of care, like in intensive outpatient treatment or residential, that’s what we do here at McLean, the last two and the third, the last one also.
But primarily the last two. But everybody needs something on the spectrum at any point in time. And the main thing is to get it and not to stress about that. Let’s talk about spiritual stress, resources and demands, cause, hey, that’s like what I do here at McLean.
So, I have to talk about this one. Just to make it clear, spiritual domains are any way of relating to something which is sacred, transcendent, metaphysical, or distinct from the physical world. It does not have to be religious. Religion is associated with specific cultural systems. Spirituality can be any way of relating to the sacred, not necessarily a culture bound, religious one.
Although statistically, the majority of people who have spirituality do find that within a religious framework. My research at McLean suggests that 60% of our patients affiliate with a religious group about the same number, want to discuss spiritual matters and more than 80% of our patients use spirituality or religion to cope in some way.
And just like all the other aspects that we’ve seen so far, spirituality can be a resource. It can protect people against depression and suicide and substance abuse, the largest bodies of literature.
I’m not going to get into all the details about that but suffice it to say there is a substantial amount of empirical literature tying it to those aspects of life. But just like anything in life, it can also create significant demands and stress.
We call these spiritual struggles where people have beliefs or emotions about spirituality that exacerbate, or maybe even contribute to they’re distressed in some way. These are definitely problematic and occur in many contexts.
I’m so attempted to go into this but suffice it to say that there’s some data suggesting that I’ve found that those spiritual struggles are very problematic. But this is a more important slide. Sometimes the same exact aspects of spirituality can be helpful or harmful to people depending on internal factors.
This is a study I did with my colleague, Dr. Steven Pirutinsky in a specific cultural group that the Jewish community, what we found was that when people are engaged in spiritual practice, that either protected against depression or was associated with greater depression, depending on how much they valued it.
When people are engaging, and this relates to the workplace stress that we spoke about before, when people value spirituality and they’re engaged in spirituality, it can tremendously benefit them.
If they don’t value it and they’re engaged in it, it’s like a tax on the human psyche. And it’s something that they have to do so to speak that can be associated with decline. And if they neither value it nor don’t value it and they’re engaged in it, then it’s not particularly helpful.
And along those same lines in all areas of stress that we spoke about today, these can be helpful or harmful depending on how we use them.
In terms of finances, if we’re on top of our finances, and if we get the validation that we need, commensurate with our stress level. We can do really well. But if we have financial stresses and we don’t validate who support each other, we can turn a stressor into a tremendous curse.
Educationally teens and young adults, we can buy into the culture of perfectionism, experience dangerous levels of mental health decline, or we can accept the limits of our condition and understand that failure is just a part of life. Try to figure out our specific roles to play in this world and in areas of strength and play to those and become more resilient.
When it comes to human resources and stressors, we can give our relationships short shrift. We can become entrenched in patterns of silence or violence, or we can recognize that we are social beings and we need connections with other people and enhance our relationships in ways that we’ve never done before.
Physically, we can ignore our body’s needs. We can drive them into the ground, or we can take the necessary time and energy and get adequate sleep and exercise and nutrition, and really fill our own tank in order to be able to make it through the day.
On the occupational fronts, And in terms of productivity, again we can pretend we don’t need human connection. We can just drudge through the day, or we can try to find meaning in what we do and realize the importance of valuing our tasks and the value that other people bring to our work and navigate our connection with others without letting technology get in the way.
And emotionally we can judge ourselves or blame ourselves for our struggles, or we can become more self-compassionate, we can become more understanding and give ourselves permission.
Just like we spoke about with regards to spirituality, these can be resources or domains of distress. And in some, we live in dire times, but there is so much that we can do to manage stress, even under these most unusual circumstances.
And my hope is that in covering these topics today, that we’ve identified a couple of things that we can do going forward in order to thrive in difficult times, okay.
Jenn: So a few folks we’re curious about how do you stay empathetic and validating when you’re dealing with people who have the beyond help, or I just can’t win mentality, especially if they’re complaining about stress dissatisfaction and then when are offered solutions, they don’t have time, or that’s an impossibility. Do you have any advice for dealing with these people?
David: Yeah, I do. That’s exactly when I would use a validation. Because all the advice in the world is going to bounce off of them, and why? The reason why is because they’re emotionally stressed, they’re not hearing it. You can come with the greatest solutions on planet earth. They’re too emotionally dysregulated to hear.
The purpose of from a psychotherapy standpoint, the main function of validation is to make sure that your patient, if you will, from a clinical, right? I want to make sure my patient feels heard by me. Because if they don’t feel that I care about them and that I really understand them, they’re not going to listen to what I have to say.
So that’s exactly the kind of case where we would want to validate, validate, validate. If we don’t have practice or clinical training in how to do that, then we need to get clinical training and practice on how to validate. And it’s obviously more than just the two slides that I provided today, but at least that’s a direction to go in in terms of internet searching or workshops that have been done.
Jenn: How do we set better limits with our time? This is something that, whether you’re a freelancer that’s taking on additional work, or you’re just overwhelmed with everyday tasks of work and home, and you just can’t get to self-care like you used to. Any suggestions for setting boundaries while maximizing the time that we do have.
David: Yeah my two go-to strategies for that but it’s funny that I’m answering this question with one minute to the buzzer, I just got to reflect on that irony.
But the two things that I would do, honestly, our bedtime and technology limitation, if you go to bed at 11 plus minus one hour every night, you’re not going to run yourself ragged to the extent that you would, if you’re staying up an extra hour doing work.
And in terms of technology limits, you’re only going to get done how much you can get done based on how much you interface with this device or this device over here. If you have certain limits, like during dinner, I’m not doing it, during exercise, I’m not doing it. It’s just not going to get done. And then it’s clear what you have to say no to, but I would take a behavioral approach as a first step.
Jenn: Do you have any more information about the differences between interdependence and dependence in relationships?
David: I wish I did. I never learned how to do Emotionally Focused Therapy. If I could go back now, I certainly would get trained in it, but I do know that we value independence more than EFT teaches. And I think that that is a certain big drawback of our relationships today.
The reality is we do need each other, Jenn, I wouldn’t have been able to do this without you. It’s true, so thank you for setting this up, and when we’re okay needing other people in order to do our work that’s part and parcel of the human experience. I think that’s the direction that we have to go relative to where we are today.
Jenn: The feeling is very mutual. I could not have had the session without you. You are just a terrific resource. I think we can squeeze one more question in if possible, is there any research on the number of strong relationships that are ideal to have at age 50 and does it matter who the relationships are with? It does it need to be siblings, family members, colleagues, et cetera.
David: It’s a good question. I’d have to look up the Waldinger piece, but if I remember correctly, it’s more a matter of the quality of relationship than quantity. So those, having one or two very close friends or a long-term romantic partner that we’re really securely connected to is going to be more powerful than having 10 people who relates more on the surface level.
I believe it’s more about quality than quantity, but whoever asked that question, you’re to email me I’ll look it up.
Jenn: So, David, thank you so much for giving us your time today to talk about juggling stress, self-care, and how we can better get through those dire times. And thank you to you for joining. This actually ends our session until next time. Be well, stay safe, wash your hands, and have a great day. Thank you so much, bye.
Thanks for tuning in to Mindful Things! Please subscribe to us and rate us on iTunes, Spotify, or wherever you listen to podcasts.
Don’t forget, mental health is everyone’s responsibility. If you or a loved one are in crisis, the Samaritans are available 24 hours a day at 877.870.4673. Again, that’s 877.870.4673.
- - -
The McLean Hospital podcast Mindful Things is intended to provide general information and to help listeners learn about mental health, educational opportunities, and research initiatives. This podcast is not an attempt to practice medicine or to provide specific medical advice.
© 2021 McLean Hospital. All Rights Reserved.