Transcription
I'm doctor Make events. Welcome to this visual lecture answering the question: What is the single most important thing we can do to manage your stress?
A few years ago, we moved our family to France for three months. It was a time of the European Cup football championships. So, we would take our kids to a local bar to watch the game on TV. Watching the moods of people from different countries swing from pure joy to total anxiety to despair and back again was as entertaining as the game itself. And I wondered if there is any scientific analysis so how this can a stress affects people.
It turns out there has been a study in the quarterfinal of the 1996 championship between the French and Dutch teams. A draw at the end of overtime resulted in a sudden death penalty shoot out, which is won by the French. When researchers look back to see if there were health changes on that day, it turned out there was a relative increase in the risk of death from a heart attack by about 50 percent among the Dutch men on the day of the match compared with the five days on either side of the match. There is no such effect on French men or women from either country, for that matter.
So, this story is striking because it it's about one event and really one negative health outcome, stress. But in reality, stress is very complex, multiple factors, multiple outcomes. Physiologists see stress increase blood pressure, heart rate, or changes in the chemicals that modulate the immune system. The social worker sees vulnerability with compromised social networks, coping, and problem-solving skills. The doctor sees increased visits, estimated that up to 70 percent of primary care visits are stress-related, worse health outcomes, bad self-treatment with alcohol and drugs, gateways to depression and anxiety, and of course, the worst quality of life.
These perspectives represent the standard negative picture of stress. But I believe we also see a positive side to stress. Athletes are able to find a stress level that is high, but but not too high, for optimum performance. Executives, mothers, or aid workers who manage stress like a bicycle tire: they regulate enough pressure to keep rolling, but not too much so that if they hit a bump, they explode.
And to me, this is really the most interesting question. When we look at stress and health, under some people undergoing intense stress, remain healthy and even thrive. And what makes them stress-resistant? Well, I think the answer includes factors like how much control people feel they have in their lives, their social network, and I mean that in the old sense of the word, openness to change, attitudes like optimism, self-care skills such as exercising, and and humor, and so on.
Research on mental health shows that we are sort of a bento box for more severe mental health issues in trying to figure out what works and what doesn't, which is great. But we've done much less research on the most common problem, stress. And when it is studied, it's usually in the context of other diseases.
So, based on the current literature, my pick for the single most effective treatment for managing stress is actually kind of a simple one: change your thinking style. Most people think stress is something that happens to us, like a piece of steel on a bridge that is constantly being stressed and then eventually stretched. This is a physical model, but it's it's actually not a human model. The difference is stressed passes through a two-pound piece of tissue on the top of your face called your brain. So, we see things like, "My job is stressful," or "My friend Sylvia is stressing me out." But in fact, we create the stress in our brains. Your work or Sylvia isn't stressful; what you're thinking about them brings the stress. Your brain is is a volume dial that can turn to stress out. But I think you can also track. People think we're born with certain attitudes and and I think that's down. But the truth is, stress management is a skill that can be learned.
Doctor Mat Gulliksson and his colleagues in hoops, Sweden, published a trial in 2011 in the Annals of Internal Medicine, following over 400 people, mostly women, that had significant heart events such as heart attack or bypass surgery. Half the group received usual care, and the other half got usual care plus cognitive behavioral therapy, or CBT. CBT has become an umbrella term where you learn practical techniques such as problem-solving, relaxation, and and challenging common thinking traps. So, for example, negative filters: so if five people say "great job" and one says nothing, and you think, "I blew it." Fortune-telling: "I'm not going to that job interview, they'll just reject me." Mind reading: "A friend walks by without noticing me, you assume he dislikes you." Polarizing or black and white thinking: "I feel I might die if I bite into that piece of cake, now I might as well eat the whole thing," and so on.
The thought record is then used to reframe your automatic thinking into a more healthy thinking. As the American psychologist William James said over 100 years ago, "The greatest weapon against stress is our ability to choose one thought over another." So, the researchers wanted to see if people could use these techniques to reduce their daily experiences of stress, time urgency, and hostility. So, could that lead to better outcomes? So, so not a drug, not a diet, not a stent, just changing the way you think.
The participants were followed for over seven years. Those that got the CBT had a forty-one percent reduction in heart attacks and a 28 percent lower death rate. The more CBT sessions a person attended, the better they did.
Now, another way to change your thinking style in order to reduce stress is through the use of mindfulness techniques. Mindfulness used to be more through it, I will call the king by crowd, but the programs have actually become much more mainstream. In fact, my patients who have heart attacks and chronic diseases now often take mindfulness courses as part of their treatment, and there's a growing evidence about its effectiveness. A recent trial following clinically depressed patients by Doctor Zindel Segel, College of University of Toronto, is a good example. When the patients experienced remission, they were randomized to an antidepressant or placebo or mindfulness-based cognitive therapy. The results show that mindfulness was as protective against relapses as medications. My sense is that the success from mindfulness is probably due to the fact that it combines many useful techniques for stress reduction, such as increased self-awareness, involving a physical component like breathing or muscle relaxation, meditation, and perhaps most important in our busy world, an emphasis on letting go of distractions and being in the moment.
Mindfulness can give us the ability to let go of worry and not get trapped in the anxious leap. Perhaps less about changing the thought and in really more about choosing where to place your attention. As a famous Austrian psychiatrist Victor Frankel pointed out, "Between stimulus and response, there's a space." And I think mindfulness teaches us awareness so that space is in. And that we have the power of choice.
So, another factor that the research tells us that impacts your thinking style is your attitude, your outlook on life. Doctors Suzanne Kobasa and her colleagues from the University of Chicago looked at this by following a natural experiment in the 1980s, the breakup of the Ma Bell Telephone Company. They followed who coped well and who didn't and identified three key traits of those who coped well. The first trait was commitment. The stress-resistant executives were committed to different aspects of their lives. So, even while facing uncertainty, they stayed committed to quality work, engaging with family and friends, their communities, their faith, hobbies. They saw, and I think, were committed to the bigger picture success. And this allowed them to weather the turbulence in in a specific area of their lives.
The second trait was control. This is interesting in that because of restructuring, these executives actually had little control. In fact, you might see their skill in fighting stress is more about being a let go of control. They could see that the sands were shifting, and if they were too rigid in their control over territory or department, they might actually lose a bigger opportunity or even their job. Other psychological research has focused on locus of control or self-efficacy, which is really the extent to which individuals believe they can control events affecting them and their competence or or ability to make change. The executives may have understood that a lot of what was happening was out of their control, but they could adapt. And I think you can choose and feel confident about what they could control.
The third trait was change. The stress-resistant execs were able to limit their self-importance and and see the change happening around them as a potential stepping-stone, not a stumbling block.
So, as we come to the end of our story about what reduces stress, it might be helpful to know that the research has shown that simply writing about your distressed story can make a big difference. The act of giving coherence and I think, writing your own personal narrative to stressful events in a letter can be an effective way of negating the stress of those events. The classic therapeutic letter writing exercise is writing a letter to somebody who stresses you out and then not posting it.
Finally, I'd like to leave you with this advice: to improve your thinking style, think basics. When I play tennis and things are going badly, which is often the case, I forget about everything else to say, "Move your feet, watch the ball." That's it. When things are stressful, sometimes you need to keep it simple. Save yourself. "I will keep a regular sleep routine. I will avoid crap. I will walk." Will mingle. And and I think there's some early evidence for altruism, where doing good. As Abe Lincoln said, "When I do good, I feel good. When I do bad, I feel bad. And that is my religion." And I'm often reminded about the power of simplicity from a a lesson one of my patients taught me. I did deliver bad news to him, and when I did, he kind of shrugged his shoulders and said, "I'll be okay. I followed the 90/10 rule. 10 percent of how we do in life is based on what happens to us, and and ninety percent is how we respond."
I think the same may be true for stress. To take a deep breath, think about your big picture commitment, your sense of control, your openness to change. Consider doing some homework on yourself: reframe, rethinking, redirect your attention, maybe read a letter. Repeatedly. The evidence shows that people who manage their stress well, they have better health outcomes for virtually any disease they may suffer from. And remember, the challenges will always be out there. That's life. But remember too that your thoughts and your attitude are the key holders for the stress you experience. Not the traffic, not your boss, not your job, not your neighbor, but you. Something you can improve your thinking. Hope this helps. Thanks for listening. Just just.