Tag Archives: health

#AtoZChallenge: Of Trials and Tribes

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Since my last post, I’m thinking more about this Tend and Befriend response to stress–to Trials. When I first mentioned it in this post, I did not really understand it, though I thought I did.  I thought it was about empathy, responding to others’ stress.  Later I started calling it the ‘mama bear’ response, but this is not exactly right, either.   It is attributed to a maternal aspect of human nature, but the bear metaphor conveys too much of the ‘fight’ reflex.

As I reread this summary article, I modified my frame to the ‘mama anything’ response.  The author describes work by Michael Meaney at McGill university, that shows the ‘tend’ aspect:

“He and his colleagues remove rat pups from their nest for brief periods–a stressful situation for pups and mothers–and then return them to the nest and watch what happens. The mothers immediately move to nurture and soothe their pups by licking, grooming and nursing them. This kind of tending response stimulates the growth of the pups’ stress-regulatory system.”

Further in the article, the ‘befriend’ aspect is explained:

“Taylor and her colleagues detail evidence from rodent studies and studies in humans that when they are stressed, females prefer being with others, especially other females, while males don’t. Indeed, in humans, women are much more likely than men to seek out and use social support in all types of stressful situations, including over health-related concerns, relationship problems and work-related conflicts.”

YES! It reminds me of a post I wrote last November about Teams.  Now I’m thinking about prides of lionesses, herds of elephants, and Tribes of people.  Throughout my life, I have had Throngs (okay maybe not, but it’s a great T word!) of people to reach out to in times of need.  Off the top of my head, here are some tribes I belong to:

Mamas

Docs

Mama Docs

Mama Docs of Children With Anaphylactic Food Allergies

My Cheng Cousins

My Hwang Cousins

American Born Chinese (ABCs, the so-called second generation)

AHS Warriors

Patient care Teams (including medical assistants, nurses, receptionists, ultrasound technicians, nutritionists, exercise physiologists, and other physicians)

Northwestern University

The University of Chicago

Conscious Life Journeyers

The Counsel of Wisdom and Caring, convened on my 41st birthday

 

More from the article, research by Nancy Collins, PhD:

“…tend-and-befriend may be just as adaptive for men as for women in certain contexts, says Collins, whose research finds no gender differences when examining how often husbands and wives seek support from their most intimate companions–for example, each other.”

So really, as the article concludes, Fight or Flight(, Challenge,) and Tend & Befriend are just a spectrum of human stress responses.  Not mama bear, not just mamas, not even just parents, but all of us.  Tend and befriend simply describes and exemplifies the basic human need to belong—we all need our Tribes.

#AtoZChallenge: Stress Assessments in a 15 Minute Clinic Visit

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In my practice, I focus a lot on stress management. Over the years I have developed a series of questions that facilitate an efficient and productive assessment of stress and its impact on health.  I share this approach here.

 

Meaning to Stress Ratio

  1. On a scale of 0 to 10, 10 being very high, how high do you rate the overall stress of your work?
  2. What are the sources of stress?
  3. On the same scale, 0 to 10, how high do you rate the overall meaning of your work to you? I mean personally, subjectively, regardless of how you think the world perceives your work, how much fulfillment to you yourself get from your work?
  4. What are the sources of meaning?

Examples of stress sources would be volume, hours, intensity, risk, pressure to perform, and toxic relationships. Examples of meaning sources might include contribution to society, providing for the family, mentoring, supportive relationships, creativity, and intellectual stimulation.

I started asking these questions to patients about seven years ago. I remember the first time I thought to use the trusty 0 to 10 scale to assess stress.  It made the conversation instantly faster and more focused.  Most people answer the first two questions easily, especially if stress is high.  A fair few, however, find the second two much harder.  They often get pensive for a moment.  This is when I know I might be cracking open an important door in a person’s consciousness—a door that, I believe, leads to important discoveries of self and overall health.

Everybody wants high meaning, low stress. But before we idealize ‘low stress,’ let us remember that all stress is not bad, and some stress is required for motivation, challenge, and productivity.

I soon realized, both for my patients and myself, that both the absolute values of stress and meaning, as well as their ratio, play significant roles in health. Let’s take a look:

Low stress/low meaning : Boredom; disengagement.

High stress/low meaning: A different form of disengagement:  Burnout.

Low stress/high meaning: Restlessness: Lack of challenge, looking for something useful to do in service of a cause.

High stress/high meaning: This one is significant.  In my interviews, the people who are happiest in their jobs report this combination.  The key is that meaning must outrank stress—the meaning:stress ratio must be one or greater—and meaning itself must meet or exceed 6/10.  We can tolerate high levels of stress, even for prolonged periods, if we perceive intrinsic value in what we’re doing.  It moves the peak of the stress/performance curve to the right.  In other words, the stress has to be worth it.

 

The Three Awareness Questions

  1. When you are stressed or overwhelmed, where do you feel it in your body? For example, some people get headaches; others feel fatigued. Others get constipated or short of breath/palpitative. Still others notice mood swings and angry outbursts. While we all likely manifest each of these some of the time, most of us have a telltale sign or two that are specific to us.
  2. What are your existing resilience practices? What do you already do that keeps you from falling off the edge? What keeps you sane on a daily basis? We all have these practices, though it may take some contemplation to identify them. This awareness is important, though, so we may actively monitor. For so many people, exercise is a key stress reliever, and also the first thing cut out of the schedule when life gets busy.
  3. What are your de-escalation practices? When you feel yourself slipping off the cliff (the headache returns, your bowels grind to a halt), what do you do that brings you back from the edge? Examples here might be physical (running, boxing, or otherwise tantruming), verbal (journaling), or other.

When people make the connection between physical symptoms and subconscious stress, they can let go the fear and dread that often accompanies these chronic and often bothersome sensations. They can use them as smoke alarms—signals to take a step back, look around, and see what is out of balance, smoldering, or actually on fire.

Threat-Challenge-T&B Pie Graph

I previously referenced three major responses to stress here.  In summary:

  1. Threat stress: This is what we generally mean when we say ‘stress.’ It’s the fight, flight, or freeze response, when we sense a treat to survival, or we appraise that we lack the resources to cope with our circumstances. It’s mediated by cortisol.
  2. Challenge stress: We face a challenge that we feel at least somewhat qualified to tackle but it will be hard, test our limits. If we’re lucky, it’s something we care deeply about and we rise to the occasion—I’m thinking this could lead to a state of flow. This stress results in increases in DHEA and testosterone.
  3. Tend and befriend stress: This is the Mama Bear response. Under stress, we reach out and protect those around us.  We circle the wagons, bring in the kids, make sure everybody’s okay.  Oxytocin rises here.

If you were to draw a pie graph representing the proportions of these three stress responses in your work, home, or life in general, what would it look like? All three responses are natural, functional, and serve a purpose.  But when threat stress, in particular, becomes chronic and unrelenting, health suffers—we suffer.  Fortunately, there are strategies to convert threat stress to challenge stress.  Here are some resources for that, if you’re interested:

http://www.google.com/url?sa=t&rct=j&q=&esrc=s&source=web&cd=1&cad=rja&uact=8&ved=0ahUKEwjklePAq6jMAhUBZiYKHYjRAaMQFggcMAA&url=http%3A%2F%2Fwww.ascd.org%2Fpublications%2Feducational-leadership%2Ffeb14%2Fvol71%2Fnum05%2FConvert-Stress-to-Challenge.aspx&usg=AFQjCNEoBg56lNydHzXTJcXs-9WwoNxmRg&bvm=bv.119745492,d.cWw

https://www.google.com/url?sa=t&rct=j&q=&esrc=s&source=web&cd=4&cad=rja&uact=8&ved=0ahUKEwjklePAq6jMAhUBZiYKHYjRAaMQFggvMAM&url=https%3A%2F%2Fhbr.org%2F2011%2F06%2Fturning-stress-into-an-asset%3Fcm_sp%3DTopics-_-Links-_-Read%2520These%2520First&usg=AFQjCNGCm6kfdy2ElyCRFilRd__NQ3TX8w&bvm=bv.119745492,d.cWw

http://believeperform.com/performance/stress-appraisal-challenge-vs-threat/

This is now the framework with which I interview all patients about ‘stress’ and its impact on their health. It’s my favorite part of the patient encounter.  This is when I really get to know a person, and learn, from every encounter, how people experience life.  I’ve said it before and I’ll say it again: It’s a tremendous privilege to be allowed into people’s lives so intimately.  My job is to help people live their best lives.  In the hectic culture of the twenty-first century, we cannot underestimate the importance of stress management in that endeavor.

#AtoZChallenge: Never and Now

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Fire swamp

Photo found at http://www.cinemablend.com/images/reviews/6079/main.jpg

Scampering into the Fire Swamp to escape Prince Humperdink and his cronies…

Buttercup: “We’ll Never survive.”

Westley: “Nonsense. You’re only saying Never because no one ever has.”

 

“I will Never pay more than $___ for a house.”

“I will Never be able to swing a 14kg kettlebell without hurting myself.”

“I will Never get through all 12 weeks of this TRX Force program.”

“I Never thought it would turn out this way.”

As we all know (“’to blave’ means to bluff…” and holy cow, if you don’t know, please stop reading this instant and watch The Princess Bride!), Westley and Buttercup make it through the Fire Swamp, albeit with a few bumps and bruises.  Despite Buttercup’s grim forecast, Westley leads her one step at a time: past the Flame Spurts, out of the lightning Sands, and in spite of the ROUSs, or Rodents Of Unusual Size.  Having believed him dead, then being rescued by him from a trio of bandits, tumbling down a mountainside after him, and following him through the Swamp, Buttercup learns a critical lesson in overcoming passivity and nihilism.  Okay maybe that’s a stretch, but whatever, this is my post.

We all have our Nevers. The ones above are just a few of mine.  I spent more than I ever planned on my house and regret nothing.  I can wing a 14kg kettlebell with confidence—I rather kick ass, if I do say so myself.  I Never could have predicted my life looking this way—the good, the bad, the gorgeous, the ugly—and yet here I am.  And it is, really, mostly good (as opposed to “mostly dead”).  I’m starting to see possibility around the TRX thing, but I still think, I’ll believe it when I see it.  No, actually, I look forward to it.  On any given day of the program so far, I have thought, No.Way. It wants me to do what?  I try anyway, just to see how far I will get, and lo, turns out I actually get through.  So who knows what I can really do?

What helps us overcome our Nevers? In Buttercup’s case it was clearly Westley’s courage and love.  For me, the kettlebells, and the TRX, it’s Melissa, my trainer.  She has completed the program herself, she knows what’s required, and she knows what I can do—better than I know myself.  As for the rest of my life, well, it’s everybody else—my family, friends, colleagues, mentors, patients, et al.  I’ve said and written it ad nauseam—it’s my relationships that hold me up and save me.  I have very few Nevers anymore, because I’m surrounded by people who give me the courage to try.

And, there is another important practice to overcoming the Nevers: Mindfulness, the practice of the Now.  Never is about the future or the past.  Often it’s a shadowy, catastrophizing perspective of things.  But we cannot predict the future, despite our arrogant human certainty.  And we cannot live every day to come based solely on what has already happened or not happened.  Circumstances and attitudes change.  Landscapes change—at times literally, and in an instant.  We evolve, we learn, we grow.  How can we be so sure that Never is real?

Mindfulness teaches us to redirect our attention to what actually is.  It invites us to let go of what and how we think things should be, or will be, or were.  We don’t have to like it, and we also need to be comfortable with, or at least accepting of, our dislikes.  When we practice mindfulness, we slow down.  We see and think more clearly.  Anxiety and depression loosen their vice grips on us.  Mindfulness liberates us from the constraints of Never.

We are better off thinking, speaking, and acting in the Now. It is the mindset of agency.  This is what I know Now.  This is what I can promise you Now.  My sincerity is real Now, and I ask you to trust me.  I will keep my eyes and ears open to the new Nows; I will roll with the punches.  Westley makes no guarantees.  He simply forges ahead with conviction, bringing with him all (and only) the knowledge, skills, and wit he has acquired until this moment, when he realizes the only way out of the Fire Swamp is through.  He is present to the swamp’s dangers, and also to the potential tools available to him in this harsh environment.  He has no idea what will happen, whether they will actually survive.  He only refuses to accept the Never, and focuses like a laser on the Now.

There may be some things to which we can truly apply the word Never. I think we need to reserve it for the truly deserving statements, and leave the rest of our minds open to possibilities and growth.

Still, most of me thinks I will Never try bungee jumping…