Ask Dr. Rick About:

Stress

Which three methods do you consider generally to be the most effective in managing stress?

In principle, there are three places we can intervene to make things better: out in the world, in the body, and in the mind. All are important. For example, a person could reduce stress by shifting out a living situation (intervening out in the world) that has stressful roommates in it. In this context, I’ll focus on three methods inside the mind.

Obviously, what is most effective in the mind will depend on the person and his or her situation. And we need to recognize that challenges need not be experienced as stressors. For one person, a promotion with new responsibilities (challenge) could feel demanding, intense, and like a lot of work, but not feel significantly stressful; for a different person, the same challenge could feel really stressful (e.g., body revved up, unpleasant sense of pressure, negative emotions like anxiety or irritability).

In this light, and in general, here are my top three stress-busters:

  • Exhaling – And relaxing the body in other ways as well.
  • Turning toward some authentic positive experience – Washing your hands, eating something good, thinking of something you feel grateful for, smelling something nice, etc.
  • Giving or receiving love – Any form of caring is good here, such as feeling included, seen, appreciated, liked, or loved.

We evolved to handle brief bursts of stress for immediate survival purposes, but chronic stress – even mild to moderate – is not good for long-term physical and mental health. Remember that negative emotions are stressful in their own right; it wears on body and mind to be chronically anxious, frustrated, irritated, hurt, or insecure.

What is one of the most effective practices for instant stress relief?

  • Activate the parasympathetic wing of your nervous system by taking several long exhalations, at least twice as long as your inhalation.
  • Notice that you are actually basically alright right now. Not perfect, but basically OK.
  • Bring to mind the felt sense of being with someone who loves you.

I'm wondering how I can change my cortisol level, as I've been under severe stress for years?

Regarding stress and cortisol, there are numerous things a person can do:

  • Physical activity metabolizes cortisol. Walking, etc. Plus it promotes neurogenesis (new neurons) in the hippocampus, which gets harmed by cortisol.
  • Oxytocin (released when we feel loved or loving) counters cortisol. Even if it’s hard to find others who love us, we can always love others (I’m using “love” broadly to include compassion, friendliness, good wishes, and warmheartedness).
  • Positive emotion – including mild but genuine experiences of pleasure, gratitude, beauty, accomplishment, fun, companionship, etc. – also helps clear cortisol, plus has many other benefits.
  • Meditation in one form or another deepens our sense of calm center, buffering us from stress.

Can you strengthen certain circuits in the brain to get more resilient?

Much research shows that we can definitely change the brain for the better. As the “hardware” of the brain improves in key regions such as the prefrontal cortex (PFC) behind your forehead, that part of the brain becomes more effective. For example, if a person is being challenged by stressors, improved regulation of the amygdala – sort of the alarm bell of the brain – by the PFC can help a person feel calmer under pressure. Just because there is a stressor does not mean we need to feel stressed, and improved brain function is like a shock absorber between us and the world.

What are the health benefits to thankfulness?

The mental and physical health benefits of gratitude are hot topics these days. Researchers have found that gratitude helps calm down the stress response – and this strengthens your immune system so you can better fight off colds this season. Gratitude also supports the neurochemistry of well-being, and protects against depression. It builds resilience, so we get less rattled by events and bounce back faster. And gratitude turns us toward others as we appreciate the people we care about, and this sense of connection and what’s called “social support” provides additional health benefits itself.

So every day this season, take your Vitamin G: gratitude!

What can be done in order to support a shrunken hippocampus?

In terms of how chronic stress and thus cortisol can damage the hippocampus, there are five kinds of good news:

  • New baby neurons are born in this part of the brain, encouraged by exercise and stimulation.
  • Existing synapses in the hippocampus can form new connections with each other.
  • Other parts of the brain can compensate, like the prefrontal regions that we can draw on if we slow down our emotional reactions by a few seconds.
  • We can grow other psychological resources, embedded in neural structure and function, such as positive emotions, mindfulness, and wholesome intentions.
  • We can treat ourselves well, with compassion and encouragement and respect – thereby treating ourselves like we matter even if others didn’t (or don’t).

What can I do to minimize holiday stress?

Take care of your body, emotions, thoughts, and actions.

In your body, keep activating the antidote to the sympathetic nervous system and its related hormones (this is our ancient fight-or-flight, stress response system): the parasympathetic nervous system PNS). Easy ways to light up the PNS include l-o-n-g exhalations, relaxing the tongue, warming the hands (or imagining that they are warm, like holding a cup of cocoa), and relaxing the body as a whole.

In your emotions, keep turning to the small positive experiences available during the holidays (and during life in general): for example, decorations are pretty, oranges smell good, it’s fun to go sledding, kids are cute, and it feels sweet to make others happy. Then take a dozen seconds or more to savor the positive experience so that it can transfer from short-term memory buffers to long-term emotional memory, and thus really sink into you.

In your thoughts, beware “shoulds” and “musts.” The things we do during the holidays are only means to ends: goals such as happiness, love, sacredness, generosity, and fun. If the means get in the way of the ends – as they so often do at this time of year – it is time to lighten up about the means. Keep coming back to simplicity inside your own mind as an end in itself: the simple truth that in this moment, each moment, you are actually basically alright; the simple fullness of being in the present, not regretting the past or worrying about or planning the future.

In your actions, slow down and do less. Keep coming back to your breathing as you look for gifts, do dishes, wrap presents, or visit friends. Don’t let others rush you. Be kind; cut others slack; this time is probably stressful for them. Don’t try to have the perfect Christmas, Hanukkah, whatever. Don’t go nuts with presents. There are other gifts that can be the biggest ones of all: like giving the gift of your full attention to others, rather than being distracted by your to do list; or the gifts of forgiveness, gratitude, and wholeheartedness.

One last thought would be the reflection that the practices of thought, word, and deed that lead to sanity during the holidays sound like a pretty good way to live year round!

Do you think people over-complicate the holidays? If so, why?

Emotionally, we usually bring to the holidays natural desires for closeness with others, giving and receiving, etc. It’s wonderful when these longings are fulfilled, but when they aren’t, that stirs up the stress response system, with associated uncomfortable feelings such as anxiety, disappointment, let down, and so on. Plus we often lay holiday tasks on top of our regular workload (e.g., job, housework, childrearing), which makes them harder to get done, and sets one up for feeling pressed and frustrated: not so good.

How do you trust your intuition and gain courage when everything around you is falling apart, even globally?

It’s natural to feel stressed and overwhelmed by it all. My suggestion at times like this is to make a clear list of what you can actually do each day, and focus on that. Take the steps you can. It’s classic advice for a reason, it’s profoundly true. Time is like money: spend it where it will help you most. For example, if you want to make a painting, set aside the time to do that and protect that time. Disengage from what you can’t change and focus on what you can. And then find confidence and refuge and self-respect in knowing that you are making honorable efforts and also making progress where you can. Action and clarity can really help when we feel stuck in a fog; they are not the only things – self-compassion and perspective and calming help, too! – but they are important pieces, and under our control.

Dr. Ramani Durvasula is a licensed clinical psychologist, author, and expert on the impact of toxic narcissism. She is a Professor of Psychology at California State University, Los Angeles, and also a Visiting Professor at the University of Johannesburg.

The focus of Dr. Ramani’s clinical, academic, and consultative work is the etiology and impact of narcissism and high-conflict, entitled, antagonistic personality styles on human relationships, mental health, and societal expectations. She has spoken on these issues to clinicians, educators, and researchers around the world.

She is the author of Should I Stay or Should I Go: Surviving a Relationship With a Narcissist, and Don't You Know Who I Am? How to Stay Sane in an Era of Narcissism, Entitlement, and Incivility. Her work has been featured at SxSW, TEDx, and on a wide range of media platforms including Red Table Talk, the Today Show, Oxygen, Investigation Discovery, and Bravo, and she is a featured expert on the digital media mental health platform MedCircle. Dr. Durvasula’s research on personality disorders has been funded by the National Institutes of Health and she is a Consulting Editor of the scientific journal Behavioral Medicine.

Dr. Stephen Porges is a Distinguished University Scientist at Indiana University, Professor of Psychiatry at the University of North Carolina, and Professor Emeritus at both the University of Illinois at Chicago and the University of Maryland. He is a former president of the Society for Psychophysiological Research and has been president of the Federation of Behavioral, Psychological, and Cognitive Sciences, which represents approximately twenty-thousand biobehavioral scientists. He’s led a number of other organizations and received a wide variety of professional awards.

In 1994 he proposed the Polyvagal Theory, a theory that links the evolution of the mammalian autonomic nervous system to social behavior and emphasizes the importance of physiological states in the expression of behavioral problems and psychiatric disorders. The theory is leading to innovative treatments based on insights into the mechanisms mediating symptoms observed in several behavioral, psychiatric, and physical disorders, and has had a major impact on the field of psychology.

Dr. Porges has published more than 300 peer-reviewed papers across a wide array of disciplines. He’s also the author of several books including The Polyvagal Theory: Neurophysiological foundations of Emotions, Attachment, Communication, and Self-regulation.

Dr. Bruce Perry is the Principal of the Neurosequential Network, Senior Fellow of The ChildTrauma Academy, and a Professor (Adjunct) in the Departments of Psychiatry and Behavioral Sciences at the Feinberg School of Medicine at Northwestern University in Chicago and the School of Allied Health at La Trobe University in Melbourne, Australia. From 1993 to 2001 he was the Thomas S. Trammell Research Professor of Psychiatry at Baylor College of Medicine and chief of psychiatry at Texas Children's Hospital.

He’s one of the world’s leading experts on the impact of trauma in childhood, and his work on the impact of abuse, neglect, and trauma on the developing brain has impacted clinical practice, programs, and policy across the world. His work has been instrumental in describing how traumatic events in childhood change the biology of the brain.

Dr. Perry's most recent book, What Happened to You? Conversations on Trauma, Resilience, and Healing, co-authored with Oprah Winfrey, was released earlier this year. Dr. Perry is also the author, with Maia Szalavitz, of The Boy Who Was Raised As A Dog, a bestselling book based on his work with maltreated children, and Born For Love: Why Empathy is Essential and Endangered. Additionally, he’s authored more than 300 journal articles and book chapters and has been the recipient of a variety of professional awards.

Dr. Allison Briscoe-Smith is a child clinical psychologist who specializes in trauma and issues of race. She earned her undergraduate degree from Harvard and then received her Ph.D. in clinical psychology from the University of California, Berkeley. She performed postdoctoral work at the University of California San Francisco/San Francisco General Hospital. She has combined her love of teaching and advocacy by serving as a professor and by directing mental health programs for children experiencing trauma, homelessness, or foster care.

Dr. Briscoe-Smith is also a senior fellow of Berkeley’s Greater Good Science Center and is both a professor and the Director of Diversity, Equity, and Inclusion at the Wright Institute. She provides consultation and training to nonprofits and schools on how to support trauma-informed practices and cultural accountability.

Sharon Salzberg is a world-renowned teacher and New York Times bestselling author. She is widely considered one of the most influential individuals in bringing mindfulness practices to the West, and co-founded the Insight Meditation Society in Barre, Massachusetts alongside Jack Kornfield and Joseph Goldstein. Sharon has been a student of Dipa Ma, Anagarika Munindra, and Sayadaw U Pandita alongside other masters.

Sharon has authored 10 books, and is the host of the fantastic Metta Hour podcast. She was a contributing editor of Oprah’s O Magazine, had her work featured in Time and on NPR, and contributed to panels alongside the Dalai Lama.

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