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SHOW NOTES

In this episode I share with you a chapter from a book called Burnout written by Emily and Amelia Nagoski.  The chapter is called ”The Secret to Unlocking the Stress Cycle”.  There are some things regarding stress that have changed dramatically over the decades and there are some things that have remained remarkably the same. I review the different kinds of stressors we have in the modern day as well as talk about how we can learn to process our stress.   I am especially excited that there are many different options presented and hopefully, there will be away for everybody.

TIME STAMPS

Stress vs Stressor

What is the Stress Response?

Completing the Stress Response Cycle

How is Stress Different in Modern Day?

How we ignore and suppress our stress response

Ways to complete the stress cycle

Exercise and Muscle Relaxation

Breathing and Positive Social Interaction

Laughter, Affection, Crying and Creative Expression

www.burnoutbook.net

Do you know how burned out you are?  Take the MBI quiz now and find out.  Click below

https://www.deannalarsonmd.com/mbi-assessment-lp-linked-to-website-assessment-1

Here is the calendar to set up a free consult call

 https://calendly.com/djl-2 

Podcast #8 Stress Today

I've been interested in learning about stress in our modern society. How it is different or changed or how it has changed throughout the decades. And most importantly, how we can prevent or process it.

I have found a book that I've been reading, and I want to share some of it with you. It is called Burnout. It is by Emily and Amelia Nagasaki. Honestly, I haven't been able to get past this first chapter called "The Secret to Unlocking the Stress Cycle." Every time I start to go onto the next chapter, I want to go back and reread this one. It has so much great information that I need to share with you all.

Based on the title, burn out, you can guess this entire book is about burnout; it is not, however, specific to physicians.

"Dread is anxiety on steroids!". Dread is described in this book as anxiety that comes from the accumulation, day after day, of stress that never ends. Many of our jobs today have stress that you can never get rid of. And I think we are all familiar with having A SINGLE STRESSFUL DAY, but dread happens when it's repeated over and over again, and you feel like there is no end in sight. Sometimes the stressors are not even directly related to our job choice. As a physician, this probably sounds familiar because much of our job is unrelated to being a clinician, such as paperwork, administrators, Insurance companies, etc. The book gives the example of how a teacher may be more stressed by the administrators and paperwork and enjoy teaching the children.

Next, we need to differentiate the stress from the stressor. Because dealing with the stress is a completely separate process from dealing with the things that cause our stress.

The stressor is what causes our stress. Stressors activate our stress response system in our body to a potential threat. Often we cannot get rid of the stressor. We can't go to work today and wish away a toxic boss. We can't suddenly get rid of administrators. 

Stressors can be external or internal. External stressors are more recognizable: Work, Money, Family. Internal stressors are often vaguer: self-criticism, body image, memories, the unknown future. Anything that you can see, hear, smell, touch, taste, or imagine that could harm you can trigger your body's stress response.

Our stress response is the neurological, physiological, hormonal shift that has evolved in our body when we encounter a threat to help us survive (hopefully).

The book offers a few of these, and as physicians, we know there are many, many more: increased blood pressure and heart rate to get more blood to your muscles so you can run, decreased pain sensitivity, focused attention on the short term and, other organ systems are deprioritized such as digestion and immune system functioning. The main goal is still all of the body responses you would think of if a lion was chasing you. This complex, multi-system response from our fantastic body still has the same goal from decades ago: to move oxygen and fuel into your muscles so that you can escape from a lion.

So let's continue to play this out the way it would have in the past. You run from the lion, you die, or you escape. Let's say you survive! You run it back to your village with the lion chasing you, and you shout for help. All your friends and family come out and help you kill the lion, and you are saved. You are so grateful to be alive! You start to relax, knowing that you're in a safe place again. The village cooks a lot of the lion and has a communal feast. You bury the parts of the lion that can't be used in an honoring ceremony. You may give thanks to the lion for its sacrifice. Maybe even a lion's claw is made into a necklace you can now wear around your neck. You are with the people you love; you can take a deep breath, relax, and know that you are safe.

This entire process is called "completing the stress response cycle." It is more than just escaping from the lion. The lion is this stressor. Just because you've dealt with the stressor doesn't mean you've dealt with the stress itself. Suppose you were running away from the lion and it suddenly got struck by lightning and was killed. Would you suddenly feel peaceful and relaxed? No. Your body would still be in fight or flight.  

This author proposes that your body needs to actively do something to signal that you are safe for the chemicals and hormones to shift into relaxation. I feel like physiologically, eventually, this would happen, but I think it is such an exciting and curious way to think about our stress. In the modern-day, and even in coaching, we tend to use our intellect and thoughts to convince us. We say to ourselves, "You're safe now. Calm down".  

I think there is value in the way we talk to ourselves, but possibly our body needs to also do something, in combination, to help us process our stress or maybe process it faster.

The other thing the book talks about is how different stress is today. There are no wild animals in your place of employment, but there may be some jerk. The jerk may not be able to kill you, but they continually say or do jerky things to you every day. And you are supposed to act professional and pleasant. You certainly can't jump over the table or punch them in the face. Your body may still trigger the same stress response if you feel that your job is threatened. And often this kind of stress happens day after day after day.  

Think about the possible physiological damage to our body from chronically activated stress responses, even if we think of ONLY the cardiovascular system with elevated blood pressure. We know HTN will increase the risk of stroke and cardiovascular disease. And this is just one organ system! We know how many chronic diseases this will lead to.

When we ignore or suppress our stress response, we end up walking around with decades of incomplete stress response cycles and the authors call this "getting stuck in the stress." Here are some examples

Number 1 is when a chronic stressor keeps you in chronic stress. If you have chronic stress from your job every day that you really can't get away from, if you find a way in the evening to complete the stress cycle, such as running or dancing. You feel better afterward, but unfortunately, you go back to the same stress the next day. And the cycle begins again. We are stuck in a stress-activating situation. This is not always bad, but sometimes the amount of stress outpaces our capacity to process it.

Number 2 is when our brain activates a stress response, and you can't do the reaction because of the social appropriateness required today in our society. If we are anxious during a meeting and our stress response tells us to RUN, oh well, we can't. We're in the middle of a meeting. So we politely smile and hold all of our feelings inside. Sometimes people in the world tell us we are wrong for how we are feeling. Have you heard people tell you, "it's not professional if we stand up for ourselves"

Ways to complete the cycle

Remember running from the lion? Exercise or physical activity is the single most efficient strategy for completing the stress response cycle. Anything that moves your body enough to get you breathing deeply. 20 -60 minutes a day, on most days.

Why? We have to recreate the activity that tells your body and brain that you have successfully run away and escaped the lion, and you are now safe to live happily ever after. In your body's language, you have to tell your body, which means moving your muscles, breathing deeply, working up a sweat, and all the things.

What about those of us who do not enjoy physical activity. I hate to admit it, but this is me. There are alternatives 

1. Muscle relaxation activities

A simple way to start-

Stand up from your chair, take a deep breath, tense all of your muscles for 20 seconds, exhale out, and shake out your muscles. Doesn't sound too awful?

Here is another example of a muscle tension/relaxation technique given in the book. I searched through the references to find more information about this technique because it sounds fascinating. It combines progressive muscle relaxation with visualization. I have never seen anything like this before. I googled for about half an hour and couldn't find anything. I will reach out to the author and see if I can find more information.

It was described as a "branch of research on body-based therapies.

"Lie in bed. Progressively tense and release every muscle in your body, starting with your feet and ending up with your face. Tense them hard, hard, hard for a slow count of 10. Even spend extra time tensing the places where you usually carry your stress. And while you do that, visualize, really clearly and viscerally, what it feels like to be the living daylights out of whatever stressor you've encountered. Imagine it clearly. You should notice your body responding, like your heart beating faster and your fist clenching, until you reach a satisfying sense of victory. Some of the things that can happen while doing the muscle tension activity can range from waves of frustration, anger, tears, or body shaking. It is supposed to represent the release of these stress response cycles built up inside over time. It sounds a little woo woo, but I am interested in more information.

Also, I want to mention that the same kind of theory is mentioned in many types of meditation. I was trained in the form of Vedic Meditation. They also believe that when you undergo a specific stressor, there is a part that is leftover in your body. Let's use an example if you were in a car accident. Your body, and all of your senses, remember that danger for the future. Sometimes it associates things that don't necessarily correlate. Let's say a particular song was playing on the radio when you had the accident, or you had coffee in your cup holder, and your brain associated the coffee smell. In short, your brain associates all your senses involved in the accident as potential warning signs for the future. The things that really helped you may have been seeing the car out of the corner of your eye, hearing sirens, or hearing screeching brakes, but your brain also missfiles the coffee and the song on the radio. The meditation instructors believe that since you have these stored associations, you may have micro stresses in the future when the song plays or you smell the coffee. They also think that these stored stressors are cleared out of your body during meditation. And this may be one of the reasons people who meditate regularly are more zen. I always had a little bit of trouble buying this with my Science trained mind, but there are definitely similarities in the trains of thought.

1. Breathing

Deep, slow breaths down-regulate the stress response. Breathing triggers your parasympathetic system. It is best when the exhalation is long and slow and goes all the way to the end of the breath. Breathing is a gentle way to start but may not be enough to handle a challenging stressor. Personally, I have difficulty with breathing exercises as I tend to hyperventilate. I have found that even if I can take one deep, slow breath, it can help me a little bit, but more than that tends to be a distraction. This book recommends a simple exercise of

Breathe in for a slow count of five

Hold your breath for a count of five

Exhale for a slow count of 10

Pause for a count of five

Do that for three rounds.

1. Positive social interaction

Most of us think that we will have a better plane ride if the person sitting next to us leaves us alone, but studies have shown that people experience greater well-being if they've had a polite, casual chat with their seat mate. Relaxed but friendly social interaction can reassure your brain that the world is a safe place. You will get a checkmark here for those of you who enjoy small talk with strangers. People with more acquaintances are happier. How about just offering some nice words to a stranger." Have a nice day." 

1. Laughter

Laughing together or even just reminiscing about the times you've laughed together increases relationship satisfaction. You know the ones I am talking about? I'm talking about the deep -almost make you pee your pants – belly laughs.

1. Affection

Affection from a beloved person who you like, respect, and trust. They give some examples. They are a little odd.  

The first example is the" Six-Second kiss ."You kiss your partner for six seconds. One kiss for 6 seconds. This seems potentially awkward, but the theory is that it's far too long to kiss someone that you resent, dislike, or feel unsafe with. It requires you to deliberately notice that you like this person, trust this person, and feel affection for them. By noticing these things, it tells your body the same.

The following example is the "20 Second hug". OK, so it's 20 seconds and obviously with someone that you love and trust but a little bit different than the way we usually hug. Typically when we hug someone, we both lean in and sort of support each other. If one person pulled back, the other would fall over. In this hug, they recommend both people stand on their own and support their weight. Then put your arms around each other. Studies have shown that this can lower your blood pressure, lower your heart rate, improve mood, and increase oxytocin. Again basically, the goal is to send a message to your body and brain that you are safe and have escaped the lion.  

Pets can also be used to complete the cycle with affection.

1. Crying

Where are my criers out there? I have always noticed such a feeling of relief after crying. I even have my favorite crying movie list. My kid thinks I'm a little nuts, but for some reason, it has always helped me, and now this book proves that I'm not nuts! Going through the emotions with the characters in the movie allows your body to go through it too. The story guides you through the complete emotional cycle.

1. Creative expression

So many options here. Sports, painting, music, theater. The goal is to create (or even encourage) BIG EMOTIONS.  

This one rings true to me in music. Music/Songs. As a coach, almost everyone enjoys writing and journaling. I have to tell you this doesn't do it for me. I don't like my handwriting. I don't like reading back the things I have written. This doesn't make it bad for those of you who enjoy journaling. It just doesn't work for me. That is what I like so much about this chapter. It gave soooooooo many options.

So back to songs. Think about the first few months when you are falling in love. Every love song speaks to you and seems to be written about you. Same with sad songs after you have a break-up, right? Who has a break-up playlist? A workout playlist? A somehow prepare me for work playlist????

I have a song that got me through my pregnancy. Through my dad's death. A song that feels like it was written about my coaching journey. The lyrics lead me through my feelings in a musical way and give me a chance to move through whatever big emotion I am having. The book calls it a "Nice loophole" that allows us to be emotional and still politically correct. Remember, whatever it is, it needs to help you create the required emotion. Whether art, literature, or music, take advantage of the loophole.