S1E24 Stress

Stress is something that everyone experiences, especially in 2020. Although it's common, stress can have a negative effect on our overall well-being and physical health without proper awareness and coping skills. Dr. Rubin and Dr. Pete discuss the impact of stress, and offer ways to manage it using behavioral tools and mindfulness practices.




Pete: Well, there was always this campaign that said, ‘stress kills,’ and today we're going to discuss the impact of stress. Hey Nikki;

Nikki: Hey Pete. Wait, was that from the 80s?

Pete: I think so. [inaudible 0:03] or are those drugs kill? Those are durgs.

Nikki: Right. That was like the one where like that you crack this is your brain on drugs, like you crack the eggs.

Pete: Stress leads to drug use.

Nikki:  It can. Maybe I don't want to freak people out, like stress kills. I always hear that from patients where they'll go like, I'm not allowed to be stressed. Like it's going to make [inaudible 0:53].

Pete: But it does. It has a negative impact on physical health so on some level, it kills you.

Nikki: It does.

Pete: And I have the same intervention we use where we say no one's died from anxiety and so it's a similar sort of dynamic here. And so stress itself won't kill you but the effects of taxing your body can, over time. So the chronic impact of stress. So yeah, I think this is a very relevant point of conversation today. Nicky, do you ever feel stress?

Nikki:  Oh, yeah. Do you?

Pete: Yeah. I think there's a bear poop in the woods.

Nikki:  Yeah. So Pete and I are frequently texting about our levels of stress.

Pete: But I also think socially, people will say things like, “Hey, how you doing today?” “Good.” it's not something we're commonly saying, like, I'm really stressed; I make a point to model. So I was just talking to my research coordinator and she was like, so how are you Dr. Pete? I'm like, well, it's a busy time of year, it’s week three in the semester and I recorded my lecture three times today. Well, the first time the computer crashed, the second time, I forgot to click record.

Nikki: Delightful.

Pete: Delightful. And then the third time it worked, but then the file was too big so then the extra level of stress was how do I make the file smaller? So stress is inevitable.

Nikki: It's inevitable. And I think what I like about that example is, if we think about stressors, so things that obviously cause stress on a spectrum though there are these, like small stressors that we all are encountering all the time that add up, right. Like, you have to re record something, I'm thinking like, the printer breaks, there's traffic and then there are these, like, what's called macro stressors, I guess. Obviously, we're recording this during the time of the pandemic, there's an election coming up obviously, currently on the West Coast here, where there's like the devastation of the fires down in Alabama. There's a hurricane there, I mean, there's obviously, what's been going on, in terms of the racial justice movement, there’s a lot.

Pete: Hey 2020, thanks a lot girl!

Nikki: It's like, yeah, you want to throw in macro stressors. So I think what I'm really curious to hear is, first of all how do you talk to patients about stress? Because, at least in my experience, I think sometimes people can have a hard time, actually really understanding and recognizing the stressors that exist in their environment. And then the impact that that places like, I see a lot of self invalidation, like the pandemic, I keep bringing up with people like, okay, let's not forget, we're in the middle of a global pandemic, like, that's having an impact on your brain.

Pete: Yeah, so you're validating.

Nikki: I’m validating, yeah.

Pete: Yeah, normalizing and validating is certainly in third wave, cognitive behavioral therapy, we spend a lot of time doing that and I think for me, that's a skill. Because when we talk to students about it, especially for any clients that are listening, not of our own, but just people in general in treatment, you understand that this is a skill that we teach, but also it's the reality of the human suffering. This brings in the eastern experience, is that we all have, there’s not a person in the world that doesn’t have stress.

Nikki: And it's interesting, because I think that there's also a story that exists that everyone sees someone again, I was bringing the social media, people are like, well, this person doesn't have stress, they have a perfect life.

Pete: I wish they had a perfect life.

Nikki: Yeah, the poster perfect life, we have to say more about, you know, how does Buddhism conceptualize stress? Like, what would be like the language that's used?

Pete: Yeah, I guess just this radical acceptance around it, there's no real teaching on stress, well, I'm not aware of.

Nikki: Is it suffering?

Pete: Yeah, suffering. Exactly and I guess the idea is just to make sure you take time to slow down. So one of my sitting community partners, she just retired and she was the chair of the academic department, and so she's still sitting in so we'll email back and forth once a while. Because she's having some strong sympathy for me of like, what it's like to chair department during a pandemic, and just that academia and life in general has changed. And so one of her comments was like, ‘I'm just so glad that I still see you sitting because just to make sure you make the time for it.’ And so I think that's, that's the Ultimate Teaching is like; we always have time for the cushion, right. And so what that means is you always have time to sit down to meditate and I find that that's true, say, for example, this morning. I worked out once this week, It's we're recording this on a Thursday. And so I did workout ones but I usually like to workout at least like, every two days.

Nikki: Yes. But sometimes you like to do more than one workout back to back.

Pete: Once in a while. You wouldn't tell by looking at our YouTube channel but I'm just saying.

Nikki: That it's not true.

Pete: I’m not posting my abs on Instagram.

Nikki: That's my friend you're talking about?

Pete: Yeah. Don’t you dare, I got your back.

Nikki: All right. So that makes sense. So Buddhism, it sounds like conceptualized like, under the umbrella of suffering and that you want to make time to basically take care of yourself.

Pete: And for stillness. That was my point with the working out. This morning, I was up in time, I definitely could have gone, and then I just made the decision of sitting or working out and I sat. Because I always take my barometer and so I sit every morning, but sometimes longer than others, and I sit with my community when I know I need a longer sit, and maybe even a teaching accompanied with it. And that's okay. So my stress this morning was acknowledging that creating space for it. And then I did feel better after. Yeah, I'm feeling a little fat and bloated today, so I'll commit to now I know, I definitely will work out tomorrow morning. You know, and so that's balanced. That's, that middle path that we talked about, also?

Nikki: Absolutely, absolutely. And what was going through my mind as you were talking about, making the space to sit and for stillness. What I was thinking about is like, a common kind of, like, refrain all here, when it comes to stress and my recommendation to patients, you know, for the patients that are so my friends, is that when people are really stressed, all here, but I don't have time for that…. Yeah, I'm so stressed. I can't fit in anything else even if I, like intellectually know that that's not healthy for me.

Pete: There’s always time.

Nikki: Well say more about that because I think people often have a hard time believing that and I mean even myself, I know I've been, again, I'm a human with the human brain.

Pete: You’re such a cute human brain.

Nikki: Oh thank you. Thank you.

Pete:  I mean, there's time for everything, I think maybe that's more of an Eastern thing. I was talking to a colleague recently who she said; I'm going to share the compliment she gave me. She goes, ‘you do a lot and you do it with humility.’ And sometimes I said to her, well, that's one of the best compliments I've ever received. And I think my sitting for that, because it's really about, you know, detaching from anything. So yes, we're busy, and there's always time.

Nikki: How do you help someone buy into that, though, because I think that's the sticky piece. It's like, people, you know, they're like, I can't I've got too many things on my plate, there's no way.

Pete: So there's always a 5 or 10 minute window somewhere, you can wake up 5 minutes earlier, you can take a 5 minute lunch break. You can shut your device off 10 minutes earlier at night, you know, there's always ways that you can try it. If you're creative you have to. And so I think creativity is a big piece of that but I sort of think about it with there's that movie in that book like he's just not that into you in terms of dating. It's like, there's even time for that where someone's like, oh, they're so busy and they met well, there's time. When something fits, and I find that the universe is perfect. It's also an Eastern belief.

Nikki:  Yes. In its imperfections, right?

Pete: Yeah, that 2020 is perfect.

Nikki: Well, maybe you could like take a moment just because I'm thinking of like the broken cup metaphor, that one about, I think like that like a cup that's broken like from like a Buddhist lens. They would say like, that broken cup is perfect, right, because it's just being itself.

Pete: Exactly. So there's colons in the eastern world and so the colons are, I guess it's sort of like the Torah or the Bible or the Quran in a way. There are stories that don't make any sense and so the Zen Buddhist way is to try and make sense of them because perception is different. So it'll say something like, does a dog have to put a hood?

Nikki: Oh.

Pete: My teacher loves that colon. And so just to kind of think about it, whatever that means and there's all different types of it. So the broken cup is perfect and 2020 is perfect because everything's imperfect and so when I can truly accept that, and I sound like a hippie and my clients and I joke about myself in that way, because it does feel very granola, crunchy.

Nikki: I think that's another sort of story and I've shared on this podcast before, that was like a judgment, I believed like many, many years ago, and in reality it's just actually about being with reality and what is. And so to pull stress back into it, it's like stress as a part of that, like stress is, and I think, this is kind of coming to my mind right now. Formulating as I'm speaking here.

Pete: That’s what we do.

Nikki: That's right, that's what we do. Thank you.

Pete: You’re welcome.

Nikki: As people sort of, have trouble buying into this notion that they don't have space, or they don't have a moment, or they don't have time, I think that behavior, so here I am bringing in the western behavioral science here. That behavior of like, no, no, no, I have to keep doing, doing, doing instead of being, interestingly enough functions as a way to avoid the discomfort of the stress that we're experiencing, right? Like we want to get away from it, we don’t want to fix it. And one thing Pete and I talk about on this podcast a lot is this paradox that exists that obviously comes from the eastern traditions here that we've borrowed in cognitive behavioral therapies, which is when we actually pause and make space for the discomfort, right? So including stress like allowing space to acknowledge it, to normalize it, to feel it to be still and actually like softens the edges around the experience of it.

Pete: Yeah, like holding on to this porcupine.

Nikki: Oh, I love that.

Pete: If I squeeze it hurts, if I just rest the porcupine in my hand it’s okay.

Nikki: Oh, I'm stealing that metaphor, I love that one.

Pete: Well, sometimes I grab the actual ball like a tennis ball in your office or something. Think about it, if you picture what it would look like, a porcupine hurts when you squeeze, but if you don't squeeze, she's going to rest there.

Nikki: Yeah, I’m really going to be using that later today in my sessions.

Pete: You're welcome. So in 2017, the American psych Association, and there are many organizations that study stress and interestingly, the number one cause of stress was the future of our nation in 2017. So I think that's an interesting thing to bring up today because I think we feel 2020 is this, like apocalypse with all the things going on Including race relations in the future of our nation for some folks. This means that deleted data were collected in like, 2016 and so, money was number two, work. So actually, future of our nation money and work were like, 63%, 62%, 61%, so they were right, up there 1, 2, 3. So I think that those are things that most people and if I think about today, as we record this future of our nation, money and work, it’s totally relevant.

Nikki: Absolutely. And I'm imagining that there are people listening thinking, okay, yeah Nikki and Pete, I know that already, like, I know, these are stressors, how am I supposed to deal with it? And I think maybe something that we want to weave in here, in addition to maybe talking about in a moment, some concrete steps that you can do to help create space, right, in a way as a way to ground ourselves and regulate a little bit. I think we also want to bring in this idea of radically accepting uncertainty, which of course, we have a whole podcast episode called uncertainty where we talk about that. So if you want to learn more, that's a more in depth discussion of that.

Pete: That's Episode 17.

Nikki: Thank you. But the reason why it's so important to accept that we can't control what's going to happen, like, we can't figure out what's going to happen, right? We have to just come back to dealing in the now right? That that's actually a really important component of regulating and tolerating stress, which again, seems counterintuitive right. To say, like, I got to let go of knowing what's happening tomorrow, or how the election is going to turn out or when the pandemic is going to end.

Pete: That’s where the porcupine comes in,

Nikki: Correct, yes. We’re on the same page.

Pete: Otherwise I'm holding that porcupine so tight because I'm trying to create or hold on to, control what the future is and a lot of us we do, do, do to create that. And frankly, the paradox as we're saying, let's don't, don't, don't.

Nikki: Yes.

Pete: Let's stop, stop, stop. Let’s create calm because you know it’s stress, we started by saying stress kills, and there are multiple symptoms related with stress, like fatigue, headaches, issues with the GI tract, muscle tension, changes in appetite, teeth grinding. You don’t see things like people with restless leg syndrome, or things like that.

Nikki:  Difficulty concentrating in like, not driving joy or pleasure out of things. I mean, some of these, by the way start to also sound similar to anxiety and depression.

Pete: And there's likely research to support correlations between increased stress lead to increased depression, anxiety.

Nikki: Absolutely, absolutely. And so again, I just want to keep reinforcing that by making space for these things by acknowledging it without actually trying to totally rid ourselves of the stress, right? Like, by trying to figure out what's going to happen or saying, I can't pause by actually just holding the porcupine and coming back to this moment and making room to contact What is it softens the edges, right? It's so hard for our minds to, to intellectually understand that-

Pete: That human brain?

Nikki: Oh, you know, brains are cool. But they also [inaudible 16:26]

Pete: So Nikki, what are some other strategies that you use with yourself, loved ones and or clients?

Nikki: Well, I think in addition to what you've already been sharing in terms of, you know, mindful practice and being strong in that it does. I've said before, like, all roads lead to mindfulness, I guess that is sort of like my first—

Pete: Sort of like mindful brick road.

Nikki: You should do. That's cute.

Pete: That's the thing.

Nikki: Yeah, that's the thing; it's also actually just like, finding small moments to do something, I think that feels soothing, or a small moment of connection. I think sometimes when we're really stressed, or we're really burned out, of course, what we do is we fantasize about, being able to, like, take that amazing vacation, or like have a wonderful, I don't know date night with our partners, or like hanging out with our best friends. And maybe those things aren't possible, especially, you know, given what's going on right now. So what I'll tell people is like, look, do the small things that there can be like a cumulative effect, just like there's a cumulative effect of stress, like all the little annoying stressors add up, all the little lovely things add up. So I actually the other day, I was telling one of my best friends, who is, like us all dealing with lot of stress because small child at home. And I said, you know, this might sound silly, but I was like, can you like take five minutes and like, take your coffee out on your deck and just like have your coffee by yourself? You know, five minutes, like when your husband's got the got your kid? And, she was like, “You know what, yeah, I can do that. I've not been doing anything like that.” So it's like, things like that, again, sometimes like, I'll I don't know, like, I'll take my lunch outside. You know what I'm saying?

Pete: Yeah. And that's why it goes back to the point of we all have time for this. And I think to normalize even more 74% of people have felt stressed, and so much so that they report feeling overwhelmed or unable to cope.

Nikki: Yeah.

Pete: I think everyone listening can relate to that, where we've all had moments. And I'll just share, like this summer, it was a busy summer. And as an academic, I'm usually much quieter, and I took on the book. And so like, in addition to everything else, I was writing a lot. And so there were moments of like, wait, I'm unable to get through this.

Nikki: Of course.

Pete: Right, thoughts like that. And it's just so part of the human experience. And that also brings in the Zen that the eastern piece, I wanted to also make sure we talked about U-stress, because we're saying it's very negatively. And there is this term, you stress U-S-T-R-E-S-S, and there's some positive stressors. So stress is not just about negative events.

Nikki: That's a very good point. Yes.

Pete: Things like weddings, for example, which is always the best example.

Nikki: Yeah.

Pete: They cause the same amount of stress and the same impact that negative global events can also have on so I just wanted to make sure we talked about that too.

Nikki:  Well, I'll throw in there. Because, again, that's pretty usual, on the same wavelength and something like shocker that I share with patients a lot. The reason those that is a stressor is because change is a stressor, even changes that we want, even changes that we'd like that for the brain when we go from something comfortable and familiar, and you know, practiced, and then we're in a new context, even a context that we enjoy or want. That shift is a stressor on the brain. And so maybe Pete, you remember this is what the example is with patients. This is some psychological measure that I can never remember the name of that measure stress that basically like, as the ones that you would think like divorce, like losing a job, you're like, oh, yeah, those would be stressors. But then they have things like getting married, buying a home. And what I always tell the patients is that if you're coding that when you're scoring it, the positive stressors and the negative stressors or events are rated at the same, meaning that they're equally stressful on the brain. And so yeah, important to keep that in mind too. So do you remember that?

Pete: No. Producers, where are you? So again, as we just thinking about the idea that stress is normal. Trying to build this connection between your mind and body slow down, take some small moments and all things lead to mindfulness. So remember, everybody follow the mindful brick road.

Pete: This has been When East Meets West. I'm Dr. Peter Economou.

Nikki: And I'm Dr. Nikki Rubin. Be present. Be brave.

Pete: This has been When East Meets West; all material is based on opinion and educational training of doctors Pete Economou and Nicky Rubin.

Nikki: Content is for informational and educational purposes only.