Why Stress Management Is a Key Domain of Health: A Doctor’s View for HSPs

Alan: [00:00:00] So, Okay,

Todd: as part five of a special interview series with Dr. Alan Rosansky on the six domains of health.

Alan: is

Todd: parts one, two, three, and four in episodes 192, 195, 198, and 201.

Alan: a,

Todd: to the other episodes yet, Dr. Rozanski has been a cardiologist and researcher in mind body medicine for over 40 years.

He has co authored over 300 peer reviewed medical articles and book chapters, many of which are regarded as seminal contributions to the medical field. During his long tenure at Mount Sinai Morningside and Mount Sinai West Hospitals in New York City, he has served as professor of medicine director of nuclear cardiology and the leader of the cardiology fellowship training program.

He also previously served as chief of [00:01:00] cardiology. Dr. Rosansky brings a unique and holistic view of health and in the first episodes we gave an overview of Dr. Rosansky’s six domains of health and then we dove a little deeper into these domains one by one. We looked at physical health, mental vitality, emotional mastery, social connectivity, and purposeful living.

And today we’re going to look more closely at the final domain of health, stress management. So it’s great to have you back with us today, Dr. Rosansky. Thank you so much for being here.

Alan: It’s a pleasure to be here. Thank you so much.

Todd: So let’s talk about stress a little bit. Um, where, where does this fit in? Um, is stress a factor when it comes to health, when it comes to illness? Um, is there any research in all of this around stress and health?

Alan: Well, my initial [00:02:00] introduction to the mind body work, if you will, was when I was using our nuclear cardiology imaging techniques to study people’s heart function while they were undergoing mental stress. We’re doing this not to study stress. We were doing this to study how the heart functions under just different stimuli. And to our surprise, when we asked patients to just speak about the stress in their lives, these were people with significant heart disease, not people without heart disease. We were finding that some of these patients were showing very substantial abnormalities in their cardiac function. Their wall motion was slowing down, uh, during the mental stress, during the talking about the stress, which indicated they had this effect from the blockage in the coronary arteries, just as when you exercise who have significant heart disease, and that’s the way we noninvasively detect heart disease, by seeing if there’s wall motion abnormalities which occur. finding this during mental stress. that was my initial introduction to this whole area. And for a number of years, I was just studying the effects of acute stress on, on the heart. [00:03:00] over time, I gravitated in general to look at the chronic factors, which, you know, make people susceptible to health problems.

And we were looking, of course, at things like depression and social isolation. But stress has always been a big one. If you look at the data, just epidemiologically. You see that people, and they’ve studied these under many objective situations, people with a lot of work stress, long hours, people under marital stress, people with caregiver strain, a big one is child abuse and trauma, all of these conditions are associated with a greater risk risk of developing heart disease and medical problems. So that’s, that’s been known for many years. Interestingly, this is the one area where you can see analogies with using animal model studies, which have been very useful because when you put, you know, let’s say the mice model or monkey model under stress. They will develop heart disease, too, but we’ve been able to look at very sophisticated [00:04:00] methods by which that occur. And then slowly, as we’ve developed more imaging techniques in people, we’ve been able to find, Hey, wait, these are similar pathways to stress and how it causes heart disease and other, other, uh, other problems. So we have a lot of data to show that stress is Um, you know, problem. It could be a big problem.

Todd: Yeah, yeah. I mean, we all kind of sense it intuitively, but it’s interesting to see the, that it’s been studied so extensively. Um, and that it’s a, it’s a real factor in terms of, um, your, your health. So, I guess the question I have is how does this fit into your, your vitality model like you’re talking about health and the six domains of health.

Um, how do you fit this in? And why is this a part of your one of your domains of health? [00:05:00] Yeah.

Alan: talk about the effects of stress, in terms of its potential ability to cause medical problems, it’s hard for me to do that in the sense that there is this double sided aspect of stress. When you really look at this in a deeper sense, You see, there’s an essentially a U shaped relationship between stress and our sense of well being and psychological function and so forth. So that when you look at this, there seems to be a sweet spot where people who have essentially a moderate amount of stress do better than people who have very little stress or have a lot of stress. And that immediately raises, or raised for me when I became aware of this association, three questions. Why is the fact that you have little stress not so good for you? What good stress? And then what constitutes bad or toxic stress? I have, um, meditated on this, if you will, and studied it and thought [00:06:00] about it for many years. and I think that, um, uh, let me just take those three aspects of it.

So why would little stress not be so good? So here we have to go back to our discussion, uh, that we had recently in terms of sense of life purpose. And we discussed that as a basic psychological need that people have. We discussed as a basic, your body and soul. And that’s a either psychological need or soul need to pursue meaning and to have a sense of purpose and to wake up each day feeling, Hey, I got important things that I want to do and pursue. So when you don’t have that, when you have no pursuit, when you’re just feeling no challenge, we don’t thrive. We don’t thrive as well because we have this basic need to pursue challenge, to pursue meaning, to pursue goals. And that comes with stress. So boredom something people don’t tolerate well. And so that’s explaining that part of the curve.[00:07:00]

Todd: Makes sense. Yeah, right. Mm.

Alan: stress. So here, good stress, let’s call it that, is the pursuit of goals and the stress associated with that. And when we’re pursuing a goal and we have challenge, it’s very interesting, I’ll give you an analogy, just picture it, a man who’s like lifting weights. Just imagine he’s at the gym and he’s trying to lift weights and imagine it’s he’s under a lot of strain. And if you just had a picture on his face, what would you see? You would see a man with a lot of pain, right? So what you’d say is this man feeling pain inside? In a sense, he’s feeling pain. But at the same time he’s having, and I’d put this in quotes, pleasure. He’s having pleasure in the sense that he’s pursuing this goal of weightlifting and taking this on for purpose, whether it may [00:08:00] be building better muscles, enjoying it for his health, for his self esteem or whatever. may be the reasons for that. If you would take away the goal, it would be pure pain. when you have the goal that is experienced in terms of a spiritual sense as a pleasure. Now, it’s not a pleasure in the same sense as a physical pleasure. It’s a sense of vitality. When we pursue any of the basic psychological needs that we fulfill. Interestingly, in fact, when you achieve your goals, we think about, you know, whether you’re writing a term paper or getting a diploma, we know how ecstatic people are. But that, that achievement only lasts a certain amount of time.

Todd: Right.

Alan: I remember when I got into college, I was so happy, you know, well, two months later, it was just factored in. That wasn’t giving me pleasure anymore,

Todd: Right.

Alan: pursuit of my degree when I was in college, that gave me pleasure. It

Todd: Yep. [00:09:00] Um,

Alan: handle things, a sense of confidence, a sense of filling our purpose, a sense of growth. so there’s many side benefits that come from good stress. And then, then what is toxic stress? if you think in terms of stress, in terms of its quinicity, its manageability, its sense of meaning to you,

Todd: [00:10:00] Yeah.

Alan: and then you put that all together, and it’s, it’s chronic, that is the kind of stress that we’re talking about that these epidemiological studies have shown is unhealthy. What has happened over time is we have, I guess, sent a message out that stress is not good. And it’s, we, we have to emphasize duality of stress, you know? And I think part of it also is because when we feel particularly stressed, we may feel physical pain, headaches, neck pain, uh, fatigue, worry, all these emotional parts that come to it. And then we have all of the press about it. know, uh, and we’ve sent this message that stress is bad

Todd: Um,

Alan: colloquial, you know, people say, Oh, the stress is going to kill me. Or I, I, this job is not healthy for me and all these different. [00:11:00] that we associate with stress, but kind of lumping in good stress and not appreciating weight.

This, this is not bad for me. And there’s data that show that how people about their stress actually can affect their health. So that if you have a sense that your health is not going to be affected by stress, you actually have better health outcomes over time. According to some studies, I would hasten to say, I think some of that has to be reproduced in more studies, but I mean, there is a suggestion that that is true.

Todd: Okay, well, that’s very interesting, and it also, uh, kind of resonates with something we understand as highly sensitive people. We, we talk a lot about Um, optimal level of arousal where it’s like you can be over aroused or you can be under aroused, or you can be optimally aroused and over arousal is stressful.

It cause leads to overwhelm, leads to breakdown, and, and, you know, lack of good function and stress. [00:12:00] under arousal, which is boredom and just not being challenged enough is equally stressful in a way. And there’s that sweet spot. So I, I really like hearing from you how, uh, how this same idea is reflected, uh, when you talk about stress.

Alan: Well, that’s a really great point. So everybody has to figure out what their own sweet spot is. But what I’m thinking in terms of your particular community, um, hypersensitive people, um, you know, all of us, there are times where stress, we handle it better and we don’t, even in the course of a given day. there is, uh, I think very important work that was done back in the 1970s by Robert Thayer, a psychologist who had people wearing beepers and he was monitoring their, their, um, you know, energy level and their activities that they were doing and the sense of tension and the moods. [00:13:00] And he broke that up into calm energy, calm tiredness, tense energy, tense tiredness, and he found that people did not like it when they felt tense and tired. of the quick fix behaviors that people were engaging in, whether it be alcohol drinking, all the, you know, candy bars. more cigarettes, it could when people were tense and tired. Interestingly, when they were tense and energetic, they didn’t feel so bad. The moods were actually pretty good and they weren’t resorting to all these quick, quick behaviors. So I learned from that, that generally energy trumps tension. And as long as you still feel energetic. handle your tension better. So for a given person, I say, be careful about the decisions making you’re making when you’re particularly tired, intense or late at night, things like that. We just don’t think as clearly. so, um, uh, you could just think of this as a bell shaped curve. You’re moving it over when you’re more [00:14:00] or you’re more hyper aroused, be. the things you can to bring down your sense of arousal, or maybe don’t handle some of the more difficult things that you have to handle at that time. I think this is true for everybody, uh, not for any one group of people.

I think that’s a truism for all of us.

Todd: Yeah, I think so too. Um, and it is relative to each person. We all have different, uh, uh, ability to handle stress or needs, um, that are, that we have to look at, but it’s the same basic bell shaped curve, right? There’s a place where I’m too understressed and there’s a place where I’m to where I’m overstressed and there’s a sweet spot in the middle.

And I kind of think of like you’re, you know, we talk about getting out of your comfort zone. That’s a good thing, right? That means getting out of the pushing the envelope a little bit challenging yourself and getting into something that may not, you may not be already good at. But we also talk about not burning out or not, um, you know, [00:15:00] overdoing it.

So it’s a very delicate balance.

Alan: it is. That’s the art of life, right? That’s the, what we’re always negotiating with ourselves and having to run. and, and that’s why it’s good to reflect, take time out, and think about, see yourself and how you’re doing. You know, today we’re in the scrolling generation, right? My, you know, if you have the picture of someone waiting at the Port Authority in New York for a bus. You’d say they’re probably looking at their cell phones or scrolling and you’re saying today, where do we find those meditative moments where we can reflect on, you know, our pace and, and how we’re negotiating on time and energy and, uh, and, uh, we need, we need more reflective time in general.

Todd: I love that. I love that you mentioned pace, because I think that’s an overlooked, uh, aspect of life. We’re so goal oriented in many ways, and we try to fit as much as we can in. Um, but, but, um, you know, even just doing these interviews views [00:16:00] with you over the last, uh, weeks. I’ve loved how we’ve just said, you know, let’s see what we can do and then we’ll just pause and then do another one.

And,

Alan: Yeah, yeah, yeah,

Todd: is, uh, it lets you enjoy it. It lets you slow down.

Alan: absolutely.

Todd: I have a good experience. Yeah.

Alan: Yes, yeah,

Todd: So you, uh, wrote a paper on the paradigm of flexibility and use that to explain how we could think about coping skills. So can you talk a little bit about this and explain this model for us?

Alan: yeah, it’s something I developed over time, and the reason I did that was I liked always to come with a conceptual approach, you know, like the principles of how you do this, how you do that, it bothered me that You know, well, might throw out different, you know, ideas about how to manage stress, could we look at a basic roadmap or the principles that would allow people to deal with that? So, uh, I’ve always been interested in terms of [00:17:00] the physical versus the psychological in one informing the other. I guess I just had a hypothesis that, um, you know, can we look at how the body handles its physical stress use that to learn how we could handle our stress psychologically?

Todd: Hmm.

Alan: So.

Todd: Silence.

Alan: Well, the body’s got a heart rate, blood pressure. It’s got an endocrine system. It’s got, you know, your temperature.

It’s got these different things that are going on. And what does the body want to do? It wants to be in homeostasis. to always be in a steady state. There is an optimal heart rate, blood pressure, pH for the, you know, the body, you know, in terms of oxygen levels, all of that.

Todd: [00:18:00] Hello, everyone. You

Alan: that it has. When you look at this system, interestingly, in terms of the body, it’s built for us to be very flexible, and it’s based on nonlinear dynamics, which is, linear dynamics is the more strength I have, the more

Todd: [00:19:00] Okay.

Alan: all our measurements. if you look at the heart rate. If you’re looking at it and you’re grossly in seconds minute, you might have the idea that your heart rate is quite regular. But when you look at it in terms of milliseconds, there is a lot of variability from one beat to the next.

Todd: Okay.

Alan: never the same. And we actually have a term we call this heart rate variability. And actually, in medicine, that is healthy. When you have more irregularity in your heart rate, when you have disease states, you find that people with heart disease, with heart failure, people who are actually even very sedentary, people under depression, the heart rate becomes more fixed, becomes more, you know, you have less heart rate variability.

Todd: Yeah.

Alan: If you look at people in terms of their gait, your gait actually varies. As you walk, people develop [00:20:00] Parkinson’s disease, um, the gait becomes more regular.

Todd: Interesting. Yeah.

Alan: count will vary. People with leukemia develop very high white counts, but it’s also quite regular. know, people in heart failure also develop more regular breathing, becomes a more steady state. So regularity is, irregularity is like a sign of health. Flexibility is a sign of health.

Todd: Yeah.

Alan: thought about it and said, well, is this, can we apply this in the psychological domain? I said, well, we certainly can apply in terms of emotions, right? Because if you get thrown by your emotions and they’re particularly negative, that tends to transfix us and it’s painful and we want to get out of that. If you can handle that better and, you know, be able to move with your emotions. and be able to transform them, have more emotional flexibility, that’s good. A person with depression is a person who’s sad, but is also [00:21:00] stuck. They’re sad all the time. They can’t get out of it. And if you actually look at the facial expressions, they tend to be more fixed.

We actually have a term called fixed faces

Todd: Hmm.

Alan: mention in terms of when you see a depressed person. but this is also true in a cognitive sense. And we’re aware of this, that people often, they’re stuck in worry and rumination, and that often is the inability to you know, get out of a cognitive way of thinking. And one of the treatments for these people is cognitive behavioral therapy, which is teaching people how to reframe and be able to be more nimble with their cognitive thoughts.

Todd: Yeah.

Alan: when you take this paradigm and you say, now, how do I apply this to management? The name of the game is coping flexibility. The idea there is I do better if I can have a variety of coping reflexes, uh, uh, uh, strategies. So variety is good because then I can, you know, there’s times [00:22:00] when we need to problem solve. There’s other times when we just have to accept the situation and just deal with the emotions of it. we might need a different strategy at that time or something’s not working.

So you want to try something that may be not be as common to you, but maybe something that’s worth doing. Um, and so one of the things is the amount of coping. mechanisms you have, more is better. But two is that they should be high quality. And three is the ability to flexibly change from one coping mechanism to another. You know, a young kid often just very characteristic in the few coping mechanisms they have, and they can’t have a higher perspective. As we get older, one of the benefits of aging is we pick up more, become wiser, we become more flexible to try a different approach if something’s not working, you know, and that is actually a joy that you have when you are able to [00:23:00] develop that.

So those are the three aspects of coping that I think are important as a principle. Do I have a good breadth of coping, know, strategies? Are they? Good quality, and am I able to switch from one to another when I have to?

Todd: Okay, and it all kind of circles around this idea of flexibility. Uh, that

Alan: exactly. Just like, just like on the physical sense, my body can bring my heart rate back to a steady state, we generally want to be in a sense of well being, calm, know, uh, sense of vitality. Well, we got a lot of stress going on all the time. As we deal with it, we feel better about ourselves that we’re dealing with it, and then we’re less thrown by it. But you got to work on it. That’s a, that’s a lifelong endeavor. It’s a lifelong, you can always get better than you are. So

Todd: I think about, um, the evolution. If I look [00:24:00] at my evolution over the years, um, I used to think I used to really wish because sometimes it would happen that I wake up in the morning just feeling like a million bucks. You know, I just feel great, ready to hit the day and all great.

But so many times didn’t wake up feeling that way. And I felt like, oh, it’s, it’s, uh, you know, it’s not gonna be a great day. Kind of felt, uh, kind of powerless in that way. But yeah. As I’ve gathered more and more stress management, um, you know, strategies and, and, and skills and things that, that bring me back to balance, I can find doesn’t almost doesn’t matter how I wake up, I’m going to be transformed into something that feels really balanced in a pretty short amount of time.

So it’s really nice to think about how, uh, how flexible we are and that we’re not just locked into the way we. Happened to be at any particular moment.

Alan: just described is your personal growth. and how pleasurable that is. [00:25:00] And that kind of growth is something that’s with you every day, right? You know, it’s a part that you’ve changed yourself and it’s the pleasure of having grown. And so when you think about good stress, That’s what good stress does for you.

It forces you to grow. And then what you acquire with that is got a very long half life. When you go to a restaurant, meal and but that’s not going to last long. Okay.

Todd: Right, right, exactly. Yeah,

Alan: not negating the other. We need both. We definitely need both,

Todd: we’ll take what we can get. But yes, exactly.

Alan: sure.

Todd: Okay. So let’s talk a little bit about, um, coping strategies that you have, um, found to be effective and kind of, since you talk, it’s good to have a large variety of them. I’d love to just cover anything that you think, um, would be helpful, uh, or you found helpful.

Uh, we’re dealing with stress.[00:26:00]

Alan: I’ll tell you, we could do three podcasts. We could, because is the art of life, you know, this is, and you know, I do think it’s important to not just talk about good coping mechanisms, but also those which aren’t so good. Maybe mention some of those first, because I think it’s helpful for people to make an inventory, take time out and think about, Hmm, what are the stresses in my life?

And how have I coped with them over the years? Because it gives you a snapshot into yourself that may be on the more automatic side of your brain without you thinking about it. But we have, you know, um, when

Todd: Okay.

Alan: It’s the excess of these negative [00:27:00] behaviors, which is a problem. Um,

Todd: Um, This meeting is adjourned.

Alan: you know, people want to know what are more positive coping mechanisms you can have. So one of the ones that is quite overlooked is just all the things we can do in terms of releasing physical tension. And we’re talking here about, you know, uh, deep breathing. relaxation. We’re talking here about, you know, yoga, tai chi, and you know, maybe all these mind body movement exercises that people do. Some people like [00:28:00] aromatherapy. Some people like having their squeeze ball and squeezing it and so forth. I think that this is an area of stress management that is overlooked, because what happens is that as you’re like deep breathing, you’re accessing the parasympathetic system, you’re breaking the cycle of these negative thoughts you’re having, and just deep breathing alone can, you know, quickly

Todd: Silence.

Alan: rehab program, which I used to run years ago, when I was at Cedar Sun and Medical Center in Los Angeles, I was ready into this mind body holistic path. I very much wanted to have a psychologist as part of our program. And we were able to hire someone. this woman was very into These techniques and biofeedback and she was having a person come into the program and they had an opportunity to go through this short biofeedback [00:29:00] program with this man who ran it. I said, if the patients are, you know, um, doing this, I want to try it too. So I tried the biofeedback and I thought it was great. But he also gave me a tape on progressive relaxation, uh, which was meditating, you know, feeling your hands heavy. And then you were going up your arms and your shoulders and then down your back. And it was with music and it was incredible. And I learned how to. put myself into a very relaxed state. this was very helpful later, you know, times in my job when, you know, there were times I was not getting much sleep at night and wanted a way to compensate in the next afternoon. I a bed. There was, you know, there’s a lot of beds in hospitals, but no, no beds for doctors to lie down. So, uh, but I was able to take a chair in my office, close the door, and for 20 minutes, put myself in a deep, relaxed state. And this would give me energy, it’s also a great way to deal [00:30:00] with tension, all of these techniques. So that is one whole category of stress management that I think everyone should have at least one of those sort of things that they can do, deep breathing or whether it’s progressive relaxation or some of these mind body movement things.

Well, yoga today is very popular, for example. So I think that’s, that’s one whole category.

Todd: Yeah, okay. So physical tension, dealing with physical tension, I think it’s a,

Alan: So

Todd: it’s really good.

Alan: category is, um, I guess what you call all the behavioral strategies

Todd: Okay.

Alan: huge there is exercise. I, I, I, um, I was talking to my fellows just the other day. I was giving them a lecture and I said, listen, you, you guys have the most potent technique we have to help patients. I don’t think I said the most potent, one of the most potent, and I should say that, which is, you know, exercise because exercise isn’t just physical. It’s also body. It’s also spiritual. Uh, we [00:31:00] see how often people turn to exercise when down and out in life, where they’ve had, you know, some sort of trauma or some thing they’ve gone through and, and they take a marathon running, for example, and then they find all of a sudden that life. around

Todd: Right.

Alan: better.

And we have that data in terms of exercise being potent as an antidepressant There’s been clinical trials showing that it has the effects of an antidepressant and

Todd: Right.

Alan: so it has that effects on stress too and by Implication also when you’re on a good diet and you’re getting enough sleep You’re increasing your overall energy. And as I said, you know when you manage your energy actually are tolerating your stress better So that’s a whole huge behavioral mechanism for dealing with stress.

Todd: Yeah. Yeah. Okay. [00:32:00] Right. Yeah. Right. Right.

Alan: also creative or also some of the work I have to do. It’s just, I’m using a different part of my mind.

I don’t have to go and lie down. I just find that I get mentally restored from having these multiple areas of interest. So I think that having hobbies and having creative outlets is a very important. You know, I wish I knew how to play the piano. My daughter does. And, you know, in our house, she’ll, uh, start playing the piano and I love it.

And I, I don’t have that outlook, but I think for example, that’s good, but turning on music, for example, and maybe even dancing, that could be something. But then we get into this whole area and, uh, I tell you. I don’t think we can cover [00:33:00] it yet, the time management, the whole area of time. We feel so much time stress today uh, and, uh, we can put out, point out to some general principles because there’s a, there is a mindset of feeling I got so much to do and that mindset presses on you and people aren’t aware of that being in the background. And so how do you respond? You respond by learning very good time management techniques. For example, I’ll just throw out one of the big home runs, the 80 20 rule, the rules that says that 80 percent of what’s important is 20 percent of what the things I do. if you stick with your 80%, you stick with your top 20%, did I say that right? 80 percent of the benefit is from 20 percent of things you do. So if you stick with your top 20%, There’s this book, I love this book, called The One Thing, which says stick with your top 1%. You know, it’s a great book. I think, you know, we can [00:34:00] argue about the number, but if you stick in your top 5 percent maybe. Well, you know what happens is that maybe you’ll never get to the bottom 80 percent because it won’t be important. You know, so that’s one technique, but obviously trying to live with life balance and meaning. have to. Part of the stress we have is we’re constantly going out of balance achieve things.

So there’s so many principles of time management, but as a general category, that’s one of the important stress, uh, very important, uh, source of stress for people. So

Todd: Yeah, absolutely. No, it’s, I mean, you think about the things that are most scarce in life, you know, and time is, can be, especially in this modern age, uh, one of those. And so learning how to, to manage that so that you’re not caught in this. I’ve got too much to do and not enough time. It’s like time poor. I call it poverty, time poverty.

Alan: Yeah. Yeah.

Todd: Um,

Alan: a lot of this is just because of [00:35:00] the fact that this is a skill we have to develop and we have to be, you know, determined about it. I would say,

Todd: and some of it has to do with letting go of some of the things we want, you know, we want to do a hundred percent and we have, but to really get the satisfaction or to, um, yeah, make the progress focusing on 20 percent or 5%, it may actually be a more balanced approach.

Alan: yeah, yeah, yeah, yeah, yeah. So, um, There are other categories here. I think we’d be remiss if we don’t

Todd: Okay.

Alan: some of the things there. And one of this is the, I put these like under cognitive strategies. And one of them is what we say to ourselves about stress. As we talked about in the beginning of this podcast, if we that the stress is bad for us, then it is, is going to be worse for you.

You’re amplifying it. And just. [00:36:00] many ways in which we charge up stress. remember when I first, um, got into academic work and I was having to present abstracts of our research at clinical meetings, I’d never been in front of a large audience before. And I was very self conscious. And very non confident and to the point that I was memorizing the presentations, even though I had a slide set, uh, until, you know, I ran into a wise person and he said, you know, help me understand you’re charging up the stress, give yourself permission to feel, you know, nervous and the audience will say that it’s a nervous guy and, you know, they won’t think twice about it.

They’re still just, you know, They want to hear your information. So I said, Oh, you know, let me just focus on, I want to give over the information and I’m not going to worry about it. it went away. And I was just charging up the stress. And we do that, you know, so learning how to just [00:37:00] give yourself permission to feel stressed will help you feel less stressed,

Todd: Mm hmm.

Alan: it’s kind of a paradox there

Todd: I love it.

Alan: just seeing the upside of stress that when you’re going through something that’s difficult and you might not see immediate meaning in it and you might not feel and you know it’s not pleasant and you’re not feeling, you know, it’s hard just saying, I don’t know how. But there’s very likely I’m going to grow from this one way or another, know, if I can just get through this so that meaning becomes just learning to be more resilient, putting injecting that as your source of meaning already is helping you to deal with that. So when you can inject meaning into the experience, and even if it’s just a matter of this is a practice of being more resilient, that helps you get through the stress.

Todd: You can’t lose, right? Either things work out the way you wanted or you grow from it, so really there’s not a downside.

Alan: Yeah. [00:38:00] And there’s other techniques, for example, journaling. Some people find writing out what’s bothering them helps. Why? Because if you’re having a lot of negative, emotions from what’s going on, minute you’re writing on it, you’re bringing in the intellect to that. The intellect is a cool current. It begins immediately to cool down the intensity of the feeling. That’s why many people do that. They’ll keep a diary and so forth. and people have to see, is that something that works for me or doesn’t work for me? In other words, we can name 34 coping mechanisms and there’s no truism about this. What I would say is that everybody has to write their own stress management book, for them. So that’s why I think the principles are important. You get the principles down as we’ve talked about, you know, having, developing more coping mechanisms. Because you want a variety, high quality ones, and then learning how to, to do that. But then which ones work, have to just, you know, trial and [00:39:00] error, and, uh,

Todd: Of course.

Alan: and you grow over time. you know, Mindfulness is a big one for people, right? A lot of people find getting into meditative states, them, you know, deal with the stress because you’ve broken up the cycle of the rumination or the worry So that’s a that’s a big one

Todd: Yes.

Alan: And then another category Is I guess we’d call it emotional regulation. In other words when you look at the toxic stress One of the things that makes it toxic is the negative emotions that it’s generating within us so what helps there in part is having a great social life, you know, in terms of, we, and we talked about this in one of the prior podcasts, totally dedicated as we did to social connectivity. And we talked about the importance of having confidence and having a mentor and having a variety of friends, and people. It’s natural when people, let’s say going through an [00:40:00] illness and so forth, at least what I’ve seen in my career is there’s a natural reaching out to other people. People often find during that time, they’re calling up friends that they hadn’t been in touch with for 10 years or 20 years, because want social support. use that and use mentoring. And of course, if you do need it, to neglect this, you know, getting, you know, therapy or counseling

Todd: Sure. Okay. Okay. So let me just move you guys up a little bit. Okay. You

Alan: I was thinking about my research on stress, and then I see this book called The Healing Heart, it’s this red cover, and this had just come out, this was in the mid 1980s. And, so I saw it in the Barnes and Nobles or whatever the bookstore was in, and, um, was, uh, I started flipping through.

It was written by Norman [00:41:00] Cousins who had had a heart attack and had been hospitalized at UCLA. Sinai was a part of UCLA. I said, Oh my goodness, he’s an

Todd: Okay. Okay.

Alan: have my doctor come to my hotel room. And he was looking at all these Marx Brother movies and all this stuff and was using these. movies and humor to cure himself from his illness. And he did that after his heart attack too. So he used humor and laughter and these techniques and for him that worked.

Todd: Yeah,

Alan: another, another, uh,

Todd: I love that.

Alan: And then one other [00:42:00] thing in the emotional realm I really have to emphasize is the need for us to be compassionate to ourselves. You know, we, You know, we, we have to, the more we give ourselves, okay, I didn’t handle that well, or this is hard for me and it’s okay. And think about how you would, what you would say to another person and apply it to yourself. Uh, that’s very important, you know, because I think there’s a tendency often to be more critical of ourselves than with other people. So that’s all of that. So the last category though, the one that often doesn’t make, um, uh, the list of. Categories that people have is what I call meaning based and spiritual approaches to dealing

Todd: Okay, yeah.

Alan: here, I’m not necessarily implying religion. I’m playing that, you know, we have this basic psychological, spiritual need or whatever you want to call it, to have a sense of meaning and a sense of purpose. And. So, you should have a variety [00:43:00] of that, because what happens if you get unemployed? What happens if you, you know, had an accident, broke your leg on a skiing trip, and now all of a sudden you’re up in bed for, and hobbling around and can’t get to your job? Well, you know what? You’re going to handle that a lot better if you have different other interests to turn to. I mean, you know, I’m talking about not just hobbies per se, but pursuits, something that’s meaningful to you, something that’s purposeful for you. We handle an area in our life in terms of a sense of purpose, which what we’re not doing as well when we have other areas we can turn to. developing this, can’t do it overnight. In other words, you all of a sudden you broke your leg. Well, at that point you have to say. What’s on my bookshelf? What’s on my bookshelf is what I put on it in terms of coping mechanisms. Okay. So developing, I tell all our fellows, you know, they’re so busy, you know, learning medicine would have said, tell them always have one [00:44:00] other interest, be reading a book, you know, maybe it’s a half an hour a week, but make sure it’s in your Life schedule, you know, because I want people to have that sense of I’m a constant learner in life.

I’m constantly growing. Okay.

Todd: Yes.

Alan: And then, as I think we talked about being able to inject meaning into any adversity, people handle adversity better when they can find a sense of purpose of meaning through what they’re going through. Okay, that’s a truism. being able to turn to prayer for many people is extremely important.

Todd: Yeah.

Alan: a say, there’s no, you know, atheists in a foxhole, uh, but I think it’s a very powerful, know, um, you know, I mean, I’m, I’m a believer and obviously I, I think it’s very important. And then I think practicing gratitude, one of the things that we often overlook, because gratitude is a muscle. And you have to just, you know, you can say thank you and whatever, but your level of gratitude is really [00:45:00] a function of the work you put into it. boy, is it helpful that when things go bad and you can see a larger context of, so much else in my life that’s good. helps you handle stress.

Todd: Yeah, absolutely. Absolutely. So this is, you talked about variety, and we’ve got variety here,

Alan: Yeah.

Todd: like a whole range of, of ideas to draw from. Um.

Alan: yes. Yeah. And the, I guess the one other thing to say about that, you know, like when we went through COVID, there was an article in, I think it was the wall street journal. Um, and they were quoting people about how they were coping with, um, with the stress. And I remember one of the articles was about a woman who was, I think an ER doctor and they asked her, her You know, how are you coping with the stress?

So she said she was running. was saying hello to more people on the street. [00:46:00] She was baking more because she liked it. She was calling, you know, old friends. And, you know, so she had a series of techniques and they’re all good quality ones, you know? And so that’s, what we want. We want to, we hopefully no more COVIDs. But, you know, things do happen in life and we want to have that variety of things that we turn to. Interestingly, what happens is when we have a lot of stress and severe stress. Often we get into this kind of fight and flight, you know, reaction of flight and fight reaction.

Todd: Right. it.

Alan: so we, the, the amygdala gets charged up. We are focused more on the stress and our thinking becomes more narrowed and we tend to. You know, default, I’ll get thrown more into our more basic, more primitive coping mechanisms and forget maybe the more effective ones we have. And that’s just something that, that’s why I said part of coping

Todd: [00:47:00] Um,

Alan: And now

Todd: Silence.

Alan: you know? And if you get into that kind of mode of thinking and practice, it becomes actually makes your life more rich. Because you say, hey, I’m growing more and I’m learning more and I’m, I’m taking on, you know, better coping mechanisms. And it’s a process. And, and as I said, you know, oh, lifelong, you know, there’s different life stages, but we’re [00:48:00] going to deal with different things as we get older. Than we did when we were younger and it’ll, it’ll challenge us in different ways, but it all doesn’t, you know, as long as you live, you’re going to deal with stress.

Todd: Yeah, yeah, it’s part of, it’s part of what challenges us. I mean, I really like reframing that in terms of stress being something that challenges us and we do our best to rise to that and to learn from that. But know the limits of, okay, if I go too far with it, then it is going to be too much for me. And then how do I come back to balance?

Alan: yes.

Todd: Well, I really like your holistic approach to this. I mean, it fits in with your overall holistic approach to the six domains of health, which is way more than just, you know, diet and exercise. But this this little section on stress management is Really helpful because there’s so many things you can choose from you can just work on the body a little bit, you know, just some deep breathing or some [00:49:00] some muscle relaxation or or you can go focus on time management for a while or you can focus on Um, just having a creative outlet, um, and, or work on, uh, emotional regulation some more or work on, um, journaling or doing something that, uh, just reframes things or digests the, the stress or, bring in meaning or bring in spiritual practice or prayer.

Like, there’s so many different things to draw on, and if you get bored with one, you can try another. And it kind of gives a lot of flexibility, which ties back to what you were just, uh, uh, explaining to us about. The importance of flexibility. So,

Alan: yes, well put.

Todd: well, thank you. This gives, um, just a really nice overview. Um, I, I’ve appreciated all of these conversations with you and for many reasons, one that [00:50:00] you’re a scientist and a doctor and that you are, uh, sticking to facts as much as possible and looking at evidence. And I think that gives us a lot of confidence.

Um, but I also really appreciate your humanity and your, um, creativity and your interest in, in putting this together into practical terms that could, you know, actually serve us in day to day life. So, You’ve, you’ve built a bridge and I’ve been, uh, very grateful to kind of walk across this bridge with you.

And, um, so I just want to thank you for everything you’ve shared over these past, uh, five episodes and, and just thanks for being here with us.

Alan: you so much. I mean, I appreciate that. And, uh, it’s just been, uh, it’s fun. It’s been a lot of fun to do this with you.

Todd: It has been fun. Yeah, I’ve learned a lot. I’ve enjoyed, um, just sharing the stories and ideas and, uh, it’s been great. So [00:51:00] thanks again.

Alan: Thank you. Thank you so much.