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The Dose Transcript for March 14, 2024

Host: Brian Goldman

BRIAN GOLDMAN: Hi, I'm Dr. Brian Goldman. Welcome to The Dose. Ask most people if they're stressed out and they'll say yes. Me and most of my health care colleagues say their jobs and their lives are stressful. I tell patients that stress is bad for their health. But what exactly does stress do to our bodies? Bad and good. So this week, we're asking, what's the connection between stress and my health and well-being? Hi, Zendo. Welcome to The Dose.

ZINDEL SEGAL: Hi, Brian. Nice to be with you.

BRIAN GOLDMAN: Nice to be with you too. I'm going to ask you, do you ever find yourself saying, I've got to deal with my own stress?

ZINDEL SEGAL: Absolutely. That sometimes is the main reason why people get into this sort of work, so that they could understand their own stress and find effective ways of dealing with it.

BRIAN GOLDMAN: And what's your go to method?

ZINDEL SEGAL: It may sound like a cliche, but I've been practicing mindfulness meditation for about 25 years.

BRIAN GOLDMAN: Wow. Okay. I'll tell you, my go to, two of mine are vigorous exercise, you know, when I'm feeling an extreme level of stress, then I burn it off. The other one that I do is breathing, and I know that I'm going to want you to talk about a breathing exercise that you recommend. I might even do one that I recommend.

ZINDEL SEGAL: The other stress release mechanism that I failed to mention was Oreo cookies.

BRIAN GOLDMAN: Oh!

ZINDEL SEGAL: In case the meditation doesn't work, that's always a good fallback.

BRIAN GOLDMAN: Chocolate and vanilla interior or one of the other funky colours?

ZINDEL SEGAL: I think the classic for me, really.

BRIAN GOLDMAN: Classic. Okay. So why don't you give us a classic hi, my name is? And tell us what you do and where you do it.

ZINDEL SEGAL: Hi, my name is Zindel Segal. I'm the distinguished professor of psychology and mood disorders at the University of Toronto Scarborough. My area of expertise is mood disorders and the use of mindfulness meditation to prevent relapse and chronic depression.

BRIAN GOLDMAN: Okay, Zindel, here we go. This is a bit of a basic question, but let's start at the beginning. What do health care providers mean by stress?

ZINDEL SEGAL: I think that the word stress is very, very generic, and what it can refer to is a psychological state of feeling overwhelmed. I think it can refer to a degradation of physical organ systems in the body that aren't working to an optimal level, and I think it can also be a cumulative chronic condition that people have a hard time stepping out of. All of those things I think would fall under the umbrella term of stress.

BRIAN GOLDMAN: Okay. The distinction between acute and chronic, you know, immediate versus long lasting stress, we're going to get into in a few moments because it's really, really important. But I'm going to ask you another basic question. Just as I tell my patients in the emergency department, I have a lot of patients… we see a lot of patients who come in with their blood pressure that's up a little bit, and they tell me that they feel… they felt dizzy and they knew that their blood pressure was up, which is not true. You can't feel your blood pressure. So can you feel stress?

ZINDEL SEGAL: I think that you can feel stressed, s-t-r-e-s-s-e-d, and I think that those can have different signs. Some of those signs could be physical. For example, a pressure in the chest, constriction in the throat, shortness of breath. But stress can also be experienced psychologically in terms of emotions of fear, threat, keeping a state of constant vigilance, looking out for things that are going to harm and hurt you in a way, operating as if you're always on a kind of red alert. And what that does is it makes it very hard for the body to rest and to restore, because there always seems to be a threat lurking around the corner.

BRIAN GOLDMAN: So you’ve talked about what it can feel like. Do you have to feel stress, like be aware of the bodily feelings of stress to be affected by stress?

ZINDEL SEGAL: I don't think you have to. And I think it's a more pernicious form of stress if it's wearing away organ systems in the body without your knowing about it. I think the reason that stress is a very important topic is that people can be trained to recognize it and then take some kind of corrective action. I think that wearables and other health metrics is intended to guide people to see when they enter a zone of stress and that they can take action not to stay there indefinitely, but to step out of that. If you feel it, then there's something you can do about it. If not, it could have a bit more of a pernicious course in outcome.

BRIAN GOLDMAN: And if it is pernicious, it means you have to find another way of being aware of it. Now, I know this is something that researchers do, but just for the people listening to us who want to take this to a slightly deeper level for a moment, what can stress hormone measurement tell us about how much our bodies are under stress?

ZINDEL SEGAL: I'm not sure the exact level of correlation, but I think that there are ways in which stress hormones can help people deal with acute situations that they're facing. So you might find someone who is studying for final exams or writing entrance exams for graduate school, or having to deal with deadlines or even accountants at tax time. They may be people who show elevated levels of these hormones. But then when the tax season is over, their ability to rest and to recover would potentially be correlated with lower levels of these hormones. I think a chronic readout that these hormones are elevated can lead to other bodily changes downstream that are not going to be optimal for health.

BRIAN GOLDMAN: That's a perfect segue to my next question. What is the difference between acute stress and chronic stress?

ZINDEL SEGAL: I think we have to remember that evolutionarily, we are engineered to be able to handle stress. Our bodies very automatically shunt resources towards the area of our ability to act in ways to deal with stress, conflict, threat, combat, evasion. And after a certain period of time, there is a natural period of exhaustion, a period of rest and recovery which allows the body to recoup this sudden surge of resources. That is actually a good thing to be able to do, and people seek it out. Athletes, for example, during games, people who seek out ways of pushing themselves beyond their limits in exercise and competition. The definition of chronic stress is a system that's sort of stuck in the fifth gear without the ability to downshift. And what this does over time is that it degrades the body's organ systems to the point where you're kind of running yourself ragged both literally and psychologically. And so chronic stress is an inability to step out and to take advantage of the natural restoration capacities that we have.

BRIAN GOLDMAN: So what does chronic stress do to our bodies?

ZINDEL SEGAL: There is a sense in which the body thrives during homeostasis. Homeostasis is essentially a place of stability where energy and the body's functioning fluctuates a little bit but comes back to a baseline. And the overall load on our bodies is something called allostatic load, which is the degree to which our bodies are worn away by repeated wear and tear. Stress increases the allostatic load. It's like walking around with a 10 or £15 weight continually on your back and not being able to shed that weight. It makes your muscles work harder. It makes your heart pump harder. It maybe tunes up your immune system so that it's always ready to deal with potential inflammation. And in this way, you're marshalling resources for a conflict that you're actually not engaged in, but the mind says is continually present for you.

BRIAN GOLDMAN: So, you know, it's certainly well known that chronic stress increases the risk of type two diabetes, hypertension, high blood pressure, heart disease, among other diseases. How does stress do that?

ZINDEL SEGAL: I'm not really sure other than leading to physical changes. So for example, from what I understand in hypertension, there is a constriction of the arteries that leads to reduced blood flow, reduced efficiency that comes from stress hormones signaling to the body the need for the constriction of those blood vessels because there is an imminent threat or challenge that's going on that the body needs to adapt to. Stress helps us adapt to challenges that may not be there. The mind and the body communicating can't tell the difference. I really like this Mark Twain quote, which is, I've had a large number of worries in my life, most of them which never came true. As far as the body is concerned, if the mind worries about something, the body prepares to deal with it.

BRIAN GOLDMAN: I'm going to remember that one. What impact does stress have on our emotional well-being?

ZINDEL SEGAL: Stress plays a very big role in our emotional well-being because there are ways in which our states of mind can become very narrow. In a book that we've just published, my colleague Norman Farb and I, the book is called Better in Every Sense, have shown that when people are under stress, one of the things that we lose the ability to connect with is the sensory world. We become locked into thinking, and we become locked into certain patterns that perpetuate thinking as a way of solving our problems, to the exclusion of sensations. And sensations are a way of actually helping us step out of thinking, to ground ourselves, to come back to something which isn't thought saturated, but is much more concrete and much more tangible. Stress takes this away from us and produces the same sets of solutions so that people continue to feel despair, hopeless, ineffective, inadequate. And if those are the ideas or the perspectives that you're walking around with, they can very quickly, easily feed emotional states like depression, anxiety, avoidance, caution, and even some behaviours like addictive eating or other kinds of actions.

BRIAN GOLDMAN: Those latter actions, you know, eating or use of alcohol or drugs to try to cope with the stress itself?

ZINDEL SEGAL: To either anesthetize the sense of overwhelm or to get a brief reprieve from a dopamine hit related to food or a different kind of substance. These are, in a sense, coping skills, but they're very short lived, and they're also very short sighted.

BRIAN GOLDMAN: You know, Zindel, we've been talking about stress as a bad thing. And I'm reminded that, you know, our bodies are equipped to have an acute stress response for a reason. So I'm going to ask you, can stress be a positive thing?

ZINDEL SEGAL: Stress is actually quite necessary. You know, when you take a very simple action like weightlifting, trying to increase the strength of your muscle tone, there is a way in which lifting larger weights actually breaks down the muscles and the muscle fibres in such a way that they can regrow and be stronger. So the stress of the lifting, the stress of the muscle fibres tearing allows for a regeneration, which makes for stronger muscles and increases your capacity for strength. This is a system that is dynamic. We want to try to find the sweet spot for ourselves between having enough stress so that we can continually grow and stimulate ourselves in important ways. But we don't want to tip over into a point where the stress that we're facing is overwhelming, it's entirely out of our control.

BRIAN GOLDMAN: So we've just been talking mostly about physical challenges for which having a stress response is not only positive, as you've said, but necessary. What about acute emotional stresses, like having an argument with a boss or a co-worker or a spouse where it's not physical, the origin of the stressor is emotional? Can a stress response be positive in those instances as well?

ZINDEL SEGAL: Watch any rom com, and the arc of those movies is that people find each other, they become smitten, there is a large argument in the middle of the movie, and they are reunited at the end of the movie. The reason that they're reunited at the end of the movie, I guess the message is that in all relationships, there is conflict. In all relationships, there are arguments, and the capacity to learn from these moments allows us to be a better partner, allows us to be a better parent, allows us to be a better companion. When it comes to emotions, the ability to develop an awareness and to regulate one's self is paramount, I think, to dealing with the effects of stress and disruption in interpersonal relationships. It's eminently possible, but it depends in part on the choices that people make to allow themselves to feel difficult emotions like shame, uncertainty, fear, or whether to block out those emotions by blaming someone else, by, you know, hiding and covering up. Dealing with stress involves people being able to see that they are stressed or that stress is going on, or all of a sudden, they find themselves in the middle of an argument, and the choices that they make are to try to help them work with the stress to get to a resolution that doesn't make things worse.

BRIAN GOLDMAN: Are you saying, Zindel, that there's something positive in the stress response that can be a teacher, that can help you be aware of emotional conflicts, how you feel, for instance, and then take positive steps to deal with them?

ZINDEL SEGAL: I really do believe that. And I think part of it is where your attention goes right in the middle of the argument. Is your attention focussed on understanding what you're feeling emotionally? Or are you tuning into your body? Or are you noticing that maybe your heart is racing, or that your palms are sweating, or that your temple and forehead are pounding? Or do you focus mainly on what the other person is saying, fighting back, trying to hurt them because you feel hurt? There are all kinds of moments in these interactions that can be profitably used to address an escalation and de-escalate, or continue to feed and fanned the flames.

BRIAN GOLDMAN: Let's get back to chronic stress. What can research tell us about how to deal with stress?

ZINDEL SEGAL: A lot of what I'm noticing in the research is that there are different ways of dealing with stress. And one of the things they all have in common is the importance of grounding, grounding exercises, and even the idea that we can find a place to step back from stress into can sometimes be an important first step for us to take. The illusion of figuring it all out, the illusion of having one simple solution that like a thread, can help unravel a person's stress, is seductive, but it's not often found. The first place we need to come back to is a way of grounding ourselves, so that we can take a bit of a broader view of the situation and see what choices we have, instead of responding by habit or past reflex.

BRIAN GOLDMAN: Can you give us some examples of grounding exercises or perhaps one good grounding exercise?

ZINDEL SEGAL: All grounding exercises start with accessing sensation. And I think one of the reasons this is effective is because sensing is not thinking. And yet, thinking is the mechanism that keeps perpetuating our stress, continues to present scenarios in which we're threatened or conflicted or helpless. And so even if only for a few moments, we can tap into sensation. We step away from the model of what's going on that our thoughts are telling us, and we can see that there's a different way of being with all of this, which may reveal some options for us. One of the ways of dealing with stress through grounding that's very accessible, and I think these things have to be widely accessible so that the largest number of people can access them, is something called box breathing, a simple way of letting the mind race, but taking a little bit of control over sensations by breathing in a particular way, counting and feeling the breath more intentionally than might be the case if someone's mind was just racing.

BRIAN GOLDMAN: Can you talk me through box breathing?

ZINDEL SEGAL: Yeah, sure. With pleasure. So the first thing that I would ask people to do if they were going to learn box breathing is to find themselves sitting in a chair and noticing just a few sensations of sitting, maybe the feet pressing down into the floor, maybe their hands folded in their lap or on their thighs. And then with box breathing, the idea is we're going to breathe in for four seconds. We're going to hold that breath for another four seconds. Then we're going to breathe out for four seconds. And then on the outbreath, we're going to hold that for four seconds before breathing in again. So we're kind of creating a box here. And each side of this box is four seconds of noticing the breath, feeling the breath or holding the breath. And there's no expectation of how it needs to go. It's more of an attitude of curiosity and then finding out what people actually go through when they do this. So Brian, if you're willing, let's just start first of all, by, and I’ll count, the two of us. I'll do this with you at the same time.

BRIAN GOLDMAN: Sounds good.

ZINDEL SEGAL: So now, breathing in for one, two, three, four, and holding, two, three, four. Now breathing out. Two, three, four, holding here, two, three, four. And now. Breathing in and feeling the breath coming in. Three, four, holding, two, three, four. And then breathing out, two, three, four, holding here, two, three, four. And the last time. Breathing in, feeling the air coming into the body. Three, four, holding, two, three, four. And now breathing out, feeling the air leaving the body. Three, four, and holding here, two, three, four. And then just going back to regular breathing.

BRIAN GOLDMAN: And while you're doing that, it's very hard to think about all the stuff that's stressing you.

ZINDEL SEGAL: Yeah. At one level, it's hard to think because there is something else going on, but I would argue that it's more than just a simple distraction. I think that what you're doing is tuning into neural networks, and our research has actually shown that there's some good evidence for this. You're tuning into neural networks that are prioritizing sensation and naturally quieting down neural networks that prioritize thought and problem solving. And the breath is such a tangible, concrete thing that we can follow that is very sensory based, and then becoming curious about, well, what does it feel like to breathe in and then hold for four seconds? We usually breathe out right after we breathe in. And then when we come back to regular breathing, sometimes, there may be a bit of a different perspective we might have. I don't know if you noticed anything when this practice was over in terms of how you felt.

BRIAN GOLDMAN: I certainly felt more calm and more centred.

ZINDEL SEGAL: Yeah.

BRIAN GOLDMAN: And I felt that my kind of vista, my horizon had opened up a bit.

ZINDEL SEGAL: Yeah. Yeah. That's interesting.

BRIAN GOLDMAN: Zindel, we've had lots of great episodes of The Dose. This is the first time I have actually felt like I've received a treatment on The Dose. And for sure, a lot of our listeners feel the same way. So I want to thank you for being on The Dose and for helping us find, you know, a greater awareness of stress and what it does to us and maybe what we can do about it.

ZINDEL SEGAL: It's a real pleasure, Brian. Thank you for having me.

BRIAN GOLDMAN: Dr. Zindel Segal is a distinguished professor of psychology and mood disorders at the University of Toronto Scarborough. Here's a dose of smart advice. To feel stressed is to experience emotional or physical tension. Psychologically, stress feels like being overwhelmed. Stress can either be acute and short term or chronic and longer lasting. Acute stress can be physical, as in breaking your hip or having major surgery, or it can be emotional. For example, having a serious argument with your partner, child or co-worker. The symptoms include rapid heartbeat, face feeling flushed, tingling in your fingers, shortness of breath and pressure on your chest. The psychological symptoms include racing thoughts or thinking something terrible is about to happen. To deal with the stress, your body secretes hormones like cortisol. That response is both normal and necessary to help you cope with it. Your body can't tell the difference between a physical threat and an emotional one. It just produces stress hormones to try and cope with the stress. Chronic stress is the long term sense of feeling pressured and overwhelmed. Chronic stressors include poverty, job dissatisfaction, family conflict and financial pressures. The symptoms of chronic stress include aches and pains, poor sleep, fatigue, trouble staying focussed, change in appetite, as well as increased alcohol and drug use. Chronic stress can lead to high blood pressure, heart disease, obesity, type two diabetes, arthritis and lowered immunity. Addressing chronic stress can improve your health, and there are two ways to do that. One is to remove the source of the stress, which is not always easy to do. The other way is to reduce the impact of chronic stress on your body. You can do that by getting exercise, eating healthy foods, getting more sleep and making time for leisure activities. Another thing you can do is something called grounding techniques. These allow you to stop thinking stressful thoughts by focusing on things you can see, hear, feel and even smell in your environment. Box breathing is a simple yet effective technique that can help return your breathing to a relaxed rhythm following a stressful experience. Yoga and meditation can also help alleviate stress. If you have topics you'd like discussed or questions answered, our email address is thedose@cbc.ca. If you liked this episode, please give us a rating and review wherever you listen. This edition of The Dose was produced by Isabelle Gallant. Our senior producer this week is Jennifer Warren. The Dose wants you to be better informed about your health. If you're looking for medical advice, see your health care provider. I'm Dr. Brian Goldman. Until your next dose.

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What's the connection between stress and my health and well-being? - Transcript

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