Ep 138 – Pursuing Health Pearls: 10 of Our Favorite Ways to Combat Stress and Anxiety

Ep 138 – Pursuing Health Pearls: 10 of Our Favorite Ways to Combat Stress and Anxiety

Given that we are all experiencing a tremendous amount of stress with the current coronavirus pandemic, we thought this would be a good time to open up a discussion about stress. Please keep in mind that this is an enormous and complex topic. We will just begin to scratch the surface here, but we will keep coming back to this topic in future episodes.

 

Stress and the Stress Response

Stress was defined by Hans Selye as “the non-specific response of the body to any demand for change.” Stress can be perceived or actual, and in today’s modern society much of the stress we feel on a day-to-day basis is perceived stress. Perceived stress has three attributes:

  • The nature of the stimulus or event is unpredictable
  • The stressor is perceived as a threat to the body or ego
  • The individual experiences a sense of loss of control

Our bodies have developed complex systems for responding to stress. We’ll go into these systems including the sympathetic nervous system or “fight or flight response” and hypothalamic-pituitary-adrenal axis or HPA axis in more detail in future podcast episodes. It’s important to note that these systems have been developed through hundreds of thousands of years of evolution to protect us from acute stressors - such as running away from a predator, or securing food for our loved ones - and they do a great job at protecting us in those situations.

In our modern lifestyles, however, we are being threatened with perceived stress all the time, from our go-go-go lifestyles to the near-constant alerts we receive from our technology. As a result, the physiologic stress response that was meant for acute situations is often activated consistently at a low level. This prolonged low-grade activation of the stress response can contribute to serious health consequences over the long term such as anxiety, depression, asthma, heart disease, stroke, cancer, autoimmune disease and neurodegenerative disorders. It’s estimated that 60-80% of primary care doctor visits are related to stress in some way.

 

Finding the Right Balance

It’s important to note that not all stress is bad. We need stress in order to grow, adapt, and reach our full potential. But too much stress, without enough time for recovery, is what can become problematic.

 

There are 2 main factors at play when it comes to handling stress:

 

    1. How much stress are we being faced with?
      Essentially, this is the total stress load in terms of quantity and quality of the stressors we are being faced with. This is what Hans Salye’s definition above refers to as the “demand for change.” How big is that demand?
    2. How capable are we of returning to baseline after the stressor resolves?
      This is called resilience: the ability for our body and mind return to baseline, or homeostasis, after the stressor.

These are the two variables we have to play with when it comes to managing stress. We can dial each one up and down as needed depending on the day, week, or season of life we are in. In the case of the coronavirus pandemic and many other commonly encountered stressors, we don't have a lot of control over the stressor itself. What we do have control over is our ability to build resilience.

10 of Our Favorite Ways to Build Resilience:

Here we’ll share 10 of our favorite ways to build resilience against stress:

1. Breathing Techniques are great for promoting relaxation during brief moments throughout the day - waiting in line, driving in traffic, before a big presentation, or before falling asleep. You can do them anytime, anywhere, for any length of time, with no equipment needed:

  • 4-7-8 Breathing is a technique popularized by integrative medicine physician Andrew Weil, MD. Essentially, it involves breathing in for 4 seconds, holding for 7 seconds, and out for 8 seconds, and repeating that cycle 2-3 times. You can check out this handout and video demonstration for more detailed explanations of this technique. 
  • Box Breathing is a simple 4-step breathing exercise. Visualize the sides of a box as you complete each of four steps: 1) breathe in for 4 seconds, 2) hold for 4 seconds, 3) breathe out for 4 seconds and 4) hold for 4 seconds, then repeat the cycle as needed.

 

2. Mind Body Techniques are methods for practicing being in the present moment and uncoupling anxious thoughts from your body’s physiological response. There are a number of different techniques available, and we are big fans of trying out several to learn what works best for you.

  • Mindfulness and Meditation are techniques for “quieting the mind” or bringing awareness to the mind and body in the present moment. Here are some of our favorite apps for starting a mindfulness or meditation practice:
    • Headspace is a friendly, non-intimidating way to begin a meditation practice under the guidance of co-founder Andy Puddicombe’s British accent. You can try it free for 2 weeks and then the cost is $69.99 per year or $12.99 monthly. They’ve also pulled together meditations specific to the COVID-19 crisis for healthcare workers, the workplace, and educators, and they are offering a free year of Headspace Plus for healthcare workers with an NPI number.
    • Waking Up is an app designed by neuroscientist, philosopher, and New York Times bestselling author, Sam Harris. The app not only guides you through meditation practices but also incorporates education about the science and theory of meditation along the way. You can preview content for free or subscribe for $14.99/month or $99.99/year. There is also a full money-back guarantee if you don’t find it valuable.
    • Stop, Breathe & Think is an app that offers guided meditations based on a quick assessment of your current physical, mental, and emotional state. You can try a free version, or subscribe for $9.99/month or $58.99/year. There’s a kids version, too!
    • Insight Timer is a free app with over 30K guided meditations for various situations - there is something there for everyone!
    • iMindfulness is an app for practicing Mindfulness Based Stress Reduction, a program developed in the 1970s by professor Jon Kabat-Zinn at the University of Massachusetts Medical Center. You can download the app for $2.99 which gets you several free guided meditations. In-app purchases also provide additional content.
    • The Calm app offers daily meditations as well as a library of different meditations (including some with people like Lebron James!). You can try it for free first but the cost is $69.99 for a year-long subscription.
    • The Simply Being app offers meditations from 5 to 30 minutes accompanied by music or nature sounds. This is an app Julie used a lot while training for the CrossFit Games. It’s just like the name - simple, and only a $1.99 one-time purchase.
  • Guided imagery uses words and music to evoke visualization experiences that promote health and healing. Belleruth Naparstek is a psychotherapist and social worker whose audio recordings have popularized this technique. You can access these through healthjourneys.com, and a number of free audio recordings are available through Kaiser Permanente.
  • Progressive Muscle Relaxation is a technique used to learn to relax muscles which often become tense with anxiety and stress. This is a great technique to use at the end of the day when trying to fall asleep. Many of the above apps feature progressive muscle relaxation sessions in addition to meditation.
  • Biofeedback is a technique where physiological information from your body such as heart rate, brain waves, breathing, muscle contraction, temperature, and others are used to provide you with feedback so you can learn to make subtle changes to be in a more desirable state.
    • Heart Math is a biofeedback tool that uses heart rate variability, the subtle beat-to-beat change in heart rate which acts as an indicator of parasympathetic nervous system activation. As you practice meditation while viewing an app, your heart rate data provides you with feedback about whether you are in a state of high or low coherence. The app is free to download, and the sensor is a one-time cost of $129-$159.
    • Muse is another example of such a tool that uses brain wave feedback to help the user access a more relaxed state. The muse headband costs $249.99-$349.99 and the app is $46.99/year, but bundled packages are available and there is a money-back guarantee.

 

3.  Exercise and Movement help to build both physical and psychological resilience and is something that can be incorporated on a daily basis. Our Morning5 sessions are a great way to start the day with 5 minutes of movement in the morning and can be done by anyone, anywhere. Our Train for Life program offers 30 minute sessions, 5 days per week that include a warm up, workout, and cool down that can be completed by beginners or those who are already active with minimal equipment. We find that a balance of both high-intensity exercise with more restorative exercise such as gentle stretching, yoga, or walking outside is most beneficial.

 

4.  Time in Nature has been shown to increase the natural killer cells of the immune system, which are important for fighting off viruses and tumors, as well as possibly decreasing sympathetic nervous system activity. Getting some sun exposure first thing in the morning while drinking your coffee, going for a walk with loved ones after dinner, or doing a workout or picnicking in a local park on the weekend are great ways to incorporate some time in nature on a regular basis.

 

5.  Sleep quality and quantity are both important for building resilience against stressors. Employing a bedtime routine with reduced blue-light exposure, a cool sleep environment, and time to wind down (perhaps with one of the mind-body exercises above!) can help to improve sleep quality. Most adults need between 7-9 hours of sleep per night.

 

6.  Connecting with Loved Ones is important for feeling socially safe, supported, and loved which plays a key role in resilience against stress. In the times of social distancing, there are still ways to connect with loved ones through phone or video conversations, letters, or acts of kindness to show them you care.

 

7.  Eliminating Toxic Substances that themselves act as physical stressors on your system can be important for building resilience against stress. Some examples of these substances include high amounts of sugar and caffeine, alcohol, and smoking - there’s never been a better time to try eliminating them than now!

 

8.  Gratitude practices may be formal, such as writing down three things you are grateful for every morning or evening, or informal, such as noticing and appreciating small things throughout the day. Regular gratitude practices have been shown to reduce perceived stress, among other benefits.

 

9.  Consuming a Nutrient-Rich Diet can provide the nutrients your body needs to regulate key genes in your body’s stress response. As discussed above, replacing sugar and processed foods with nutrient-dense foods such as vegetables, fruits, nuts, meat and fish also help to reduce inflammation and improve resilience. The foods we eat can also impact the gut microbiome, which plays in an important role in our immune and stress response.

 

10.  Counseling - we are huge fans! We like to think about mental health in the same proactive way we think about physical health. Psychology Today is a great resource for identifying a professional counselor or therapist that meets your needs. Other services such as TalkSpace and BetterHelp provide accessible, remote counseling resources. There are also exercises that can be done on your own:

  • Journaling to process thoughts and emotions
  • The Feeling Good Handbook by Dr. David Burns, which walks readers through a technique called Cognitive Behavior Therapy (CBT) that is widely used by counselors and psychologists to help individuals challenge and change unhelpful thoughts, beliefs, attitudes, and behaviors in order to improve the ability to cope

Measuring Stress

Just as with our workouts, we like interventions to improve resilience to be measurable, observable, and repeatable. Below are a couple of tools that can be used to more objectively measure stress:

  • The Perceived Stress Scale is a 10-item questionnaire used to measure perceived stress. Scores can be compared with norms based on age, gender, and race, or the tool can be repeated periodically to assess the impact of changing any of the behaviors described above. This is a no-cost, easy way to roughly estimate perceived stress yourself - something that humans are traditionally not great at!
  • Heart Rate Variability (HRV) is a measure of beat-to-beat changes in heart rate that provides insight into the health of the autonomic nervous system. Devices such as the Whoop and Oura Ring can be worn continuously to provide HRV data. Generally speaking, higher HRV is an indicator of a more robust parasympathetic state.

The whole world is facing a tremendous amount of stress right now.  As individuals, we have little control over these stressors, but we do have a lot of control over increasing our resilience. We hope you find at least one idea from the list above to be helpful. Try obtaining an objective measure of your stress before and after implementing a new behavior to better assess its impact. Remember to take some big deep breaths (4-7-8!), and know that we will all get through this together!

If you have other favorite ideas for combatting stress that we didn’t include above, please let us know in the comments below or on social media so we can continue updating this list for others.

 

Disclaimer: This podcast is for general information only, and does not provide medical advice. We recommend that you seek assistance from your personal physician for any health conditions or concerns.

This post was originally published on April 7, 2020.

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