A Blueprint for Managing Toxic Stress

Are you sad, worried or stressed? If you answered yes to any of the above, please know you are not alone. In 2021, four in 10 adults worldwide said they experienced a lot of worry (42%) or stress (41%), and more than one in four experienced sadness (28%) according to a Gallup survey.

Women are having the hardest time

In 2021, they were more stressed, worried, and sad than they were in 2020 — or at any point in the past decade. Stress and worry each increased by three percentage points within the span of a year, while sadness notably rose by six percentage points according to the Hologic Global Women’s Health Index.

What’s going on?

Women, particularly mothers, are still more likely than men to manage a more complex set of responsibilities on a daily basis — an often-unpredictable combination of unpaid domestic chores and paid professional work. So much is expected of women and this invisible labor takes an emotional toll.

Women have disproportionately shouldered the emotional burden of the pandemic as many families faced job insecurity, unstable housing, and interruptions to medical and childcare services.

The pandemic is not entirely to blame for the uptick in negative emotions. The negative trajectory has been trending for over a decade.

The mental and physical consequences of toxic stress

Living in a chronic fight or flight takes a toll. Ongoing stress can lead to or aggravate insomnia, family conflict, depression and anxiety. It is also linked with physical conditions such as hypertension, heart disease, obesity, and diabetes.

What can we do?

I have written a great deal in the past about individual strategies to boost positive emotions and combat stress. Spending time in nature, prioritizing sleep, eating a healthy diet, and building more movement into everyday life are all data-driven strategies to improve mental health. However, individual interventions are not enough.

If we want to tackle toxic stress, we need to zoom out and consider the bigger picture and zoom in to get to the root of the problem. Reducing stress levels is up to us as a society as a whole, not the responsibility of a single person. As Wharton Professor Adam Grant observed, “Burnout is not a problem in your head; it’s a problem in your circumstances.”

Grant suggests utilizing the Demand-Control-Support model to help manage toxic stress.

Demand

Make structural changes that lighten the load. If you are an employer, encourage breaks, honor downtime, weekends and family time, and respect work/life boundaries. Create Zoom-free days if your company is still working from home. Zoom fatigue is worse for women and can lead to “mirror anxiety.”

Control

When you can’t eliminate demands, you can at least give people the autonomy and skills they need to handle them. If possible, allow for flexibility. Encourage personal goal setting and the pursuit of individual interests. A Harvard Business School study found that engaging in learning activities can buffer workers from detrimental effects of stress including negative emotions and burnout.

Support

Cultivate a culture that makes it easy to request and receive help. As Dr. Elizabeth Fitelson, director of the women’s program in Columbia University’s psychiatry department, observed, “Focusing on improving the social supports for basic needs would have a far greater intervention than any specific mental health intervention.”

Other tools

Screening and access to treatment are essential tools to combat the extraordinary stress levels people are facing. A panel of experts now recommends doctors screen all patients under age 65 for anxiety. The intention is to help prevent mental health disorders from going undetected and untreated for years or even decades.

Bottom Line: Individual interventions can be helpful but culture and community are essential for building resilience and managing stress.

I wish you all the best,

Dr. Samantha Boardman

Just Letting You Know … How We Underestimate People’s Desire for Constructive Feedback and What We Can Do About It 😉

If you were having a conversation with me and noticed I had a piece of spinach in my teeth, would you tell me? Be honest.

Unless you are a really good friend or one of my kids (who are always happy to point out rogue roughage) odds are you would not say a word. A study published in the Journal of Personality and Social Psychology found that only a handful of participants — fewer than 3% — informed a tester if they had food or lipstick on their face. An overwhelming majority kept their mouths shut.

Source: Journal of Personal and Social Psychology

Why do we often fail to tell someone something specific and actionable that they could do to improve their performance or learning or appearance? Fear of embarrassing the other person or upsetting them makes us reluctant to speak up. Concern about our own popularity might also factor into the decision to stay mum. Another reason that we don’t say anything, according to the study, is because we underestimate the other person’s desire for feedback. Most of the time, people are grateful for input and advice. Failing to provide it deprives them of an opportunity to make a change.

“People often have opportunities to provide others with constructive feedback that could be immediately helpful, whether that’s letting someone know of a typo in their presentation before a client presentation, or telling a job candidate about a stained shirt before an interview,” said lead author Nicole Abi-Esber, a doctoral candidate at Harvard Business School. “Overall, our research found that people consistently undermine others’ desire for feedback, which can have harmful results for would-be feedback recipients.”

There may not be many consequences for having spinach in your teeth but there are scenarios where receiving commentary and critique can make a meaningful difference. Feedback is critical for learning and growth. Without it, it’s harder to get better. As Bill Gates observed, “we all need people who give us feedback. That’s how we improve.”

I vividly recall a professor in medical school telling me I needed to work on my presentation skills. He gave me specific pointers: “Stop saying ‘like,’ slow down, ask the audience questions, look up from your notes now and then, stand up straight, and recap your argument at the end.” I am forever grateful for this thoughtful advice and input. Whenever I give a talk today, his words of wisdom are in the back of my mind.

Closing the feedback gap

Given that most people desire and benefit from feedback, what can we do to help potential feedback givers overcome their doubts about giving it? According to the study, a perspective-taking strategy increased the likelihood of someone speaking up. Simply asking, “If you were this person, would you want feedback?” helped participants recognize the value of feedback to the other person and helped close the giver-receiver gap.

Bottom Line: Even if you are hesitant to give feedback, think again. As Abi-Esber advises, “Take a second and imagine you’re in the other person’s shoes and ask yourself if you would want feedback if you were them.”

P.S. If you see spinach in my teeth, please let me know.

If you’re still nervous about giving feedback, read this.

I wish you all the best,

Dr. Samantha Boardman

The Benefits of “Non-Exercise” Exercise

If you are feeling stressed out, burned out, or worn out, making a small change in your daily routine might help you feel significantly better. According to a new study published in the Journal of Public Health, spending 30 minutes less on social media every and engaging in physical activity significantly boosts mental health. Participants who followed this advice for just two weeks felt happier, more satisfied, and less depressed than those who stick to their usual routine. Moreover, these effects lasted even six months after the study ended.
Source: Experimental longitudinal evidence for causal role of social media use and physical activity in COVID-19 burden and mental health

Making the effort to move more and scroll less is especially good advice for active couch potatoes, the scientific term for those of us who manage to squeeze in some exercise each day but spend the rest of the day sitting down. Despite the commitment to physical activity, active couch potatoes are at risk for a variety of health problems including high blood sugar, cholesterol, and body fat.

There is no doubt that taking time to workout is commendable and has well-established health benefits — the issue is what we do the rest of the day.

In 2012 I-Min Lee, an epidemiologist at Harvard University, published a landmark paper in The Lancet showing that prolonged periods of inactivity kills more than 5 million people every year, making the health risks similar to smoking and obesity. Spending the majority of our time immersed in low-energy activities like watching TV, working at a computer, and scrolling through social media has adverse psychological effects too.

The good news is that just a little more movement in our daily lives can make a big difference.

There is a clear link between moving more and feeling good. Individuals who are more physically active are happier. Moreover, individuals are happier in the moments when they are physically active. A study entitled Happy People Live More Active Lives published in PLOS ONE discovered that individuals who had been moving in the past fifteen minutes were in a better mood than when they had been reclining or sitting down. Of note, “non-exercise” physical activity i.e. non-rigorous exercise such as standing and walking contribute to both physical health and happiness. Putting one foot in front of the other can be enough to brighten your mood and even turn a bad day around.

There is no need to spend extra time at the gym or wake up earlier to jog that extra mile. The key is to try and move just a little more.
  1. Add more non-exercise movement to each day

Schedule a casual stroll around the block at lunchtime. Meander down the hall at the end of each hour. Turn phone calls into walking opportunities. Getting off the bus a stop before your regular stop, using the stairs instead of the elevator, taking the dog for an extra loop around the block, parking a little further away from your destination, and going for a walk after dinner instead of collapsing on the couch are all small but effective ways to increase the amount of physical activity in your day. No need to break a sweat or put on sneakers.

  1. If you sit a lot, try to sit in “active resting” positions

Consider getting an inflatable ball for sitting at your desk. During leisure time, sit on the floor sometimes. If you cannot resist reclining, be sure to stand up regularly and stretch your legs.

  1. If you’re reading this sitting down, stand up, and take a walk

Bottom Line: Take advantage of every opportunity to move, even when you’re not in the mood. While you’re at it, put your phone away.

 

I wish you all the best,

Dr. Samantha Boardman

The Best Way to Support a Friend Who Is Having a Hard Time

What is the best way to support a friend in need? According to research, this may be the wrong question. Simply showing up and expressing warmth and love is what matters most. The study, Too Reluctant to Reach Out: Receiving Social Support Is More Positive Than Expressers Expect published in Psychological Science found that all too often we hesitate to express support because we worry too much about saying or doing the “right thing” and question our competence to provide what the person needs.

According to the study, there is a gap between how expressers and recipients perceive the very same supportive act. Expressers tend to focus on how effectively they are supporting another person whereas recipients tend to focus on the warmth and kindness that they receive. As a result of the mismatch, we systematically miss opportunities to help others more in daily life:

“Each day offers opportunities to reach out and show some form of support, however large or small, to a person in need. Our experiments suggest that undervaluing the positive impact of expressing support could create a psychological barrier to expressing it more often. Withholding support because of misguided fears of saying or doing the wrong thing could leave both recipients and expressers less happy than they could be,” explained the researchers.

When in doubt, send that text, make that phone call and show up. It means more than you realize.

West Wing fans may remember the iconic scene when Leo McGarry tells his friend, Josh Lyman, the story about the man in the hole. Josh is having a hard time and Leo shares these words of wisdom:

“This guy’s walking down the street when he falls in a hole. The walls are so steep he cant get out.

A doctor passes by and the guy shouts up, ‘Hey you. Can you help me out?’ The doctor writes a prescription, throws it down in the hole and moves on.

Then a priest comes along and the guy shouts up, ‘Father, I’m down in this hole, can you help me out?’ The priest writes out a prayer, throws it down in the hole and moves on.

Then a friend walks by, ‘Hey, Joe, it’s me can you help me out?’ And the friend jumps into the hole. Our guy says, ‘Are you stupid? Now we’re both down here.’ The friend says, ‘Yeah, but I’ve been down here before and I know the way out.'”

Simply being there for someone is an act of grace. As Cecilia Irene reflected on her blog “Leo’s quotation is the definition of love and friendship. Prayer is infinitely valuable. Medicine is good. But sometimes what you really need is for someone to meet you where you are and try to help you climb out of the pit.”

The Man in the Hole story reminds me of a beautiful letter poet Robert Lowell wrote to his fellow poet John Berryman who was going through a rough patch:

“I have been thinking much about you all summer, and how we have gone through the same troubles, visiting the bottom of the world. I have wanted to stretch out a hand, and tell you that I have been there too, and how it all lightens and life swims back … “

Don’t let agonizing over finding the right words or doing the right thing keep you from expressing warmth and love. Reach out to others in need more often and remind them that life swims back.

I wish you all the best,

Dr. Samantha Boardman

Age and Attitude: How You Think About Aging Impacts How You Age

Surely you have seen the meme with smoking hot Jennifer Lopez next to matronly Golden Girl, Rue McClanahan, with the caption: Jennifer Lopez is 51 years old, which is the same age Rue McClanahan was when she began playing Blanche on The Golden Girls.


While looking like JLo is not a realistic option for mere mortals, the meme (plus a big birthday at the beginning of the year) got me thinking about how our beliefs about aging affect how we actually age.

Many think of getting older as synonymous with decline — a progressive worsening of physical and cognitive functioning along with reduced quality of life. Studies show that this negative view is far from the truth. Contrary to the stereotypes that tell us it’s all downhill after 50, getting older is, in fact, associated with higher well-being and better psychosocial functioning. Most people become more responsible, more agreeable, and less neurotic with age. This is known as the Maturity Principle. Despite the stereotypes portrayed in the movie Grumpy Old Men, people tend to get nicer, more productive and to become greater contributors to society in their old age. We also get better at regulating our emotions and experience fewer negative emotions and enjoy more positive ones. In other words, we are like fine wine, we get better with time.

The key is focusing on what age gives us, not what it takes away. People with more positive attitudes about growing old tend to live longer and healthier lives than those with negative thoughts about aging, according to research.

A study of 14,000 adults over age 50, co-authored by experts at Harvard T.H. Chan School of Public Health, found that the people who had the highest satisfaction with aging had a 43% lower risk of dying from any cause over a four-year period compared with those who were the least satisfied. The study also found that people more satisfied with the aging process had lower risk for conditions such as diabetes, stroke, cancer, and heart disease; better cognitive functioning; were more likely to engage in physical activity and less likely to have trouble sleeping; were less lonely and depressed; and were more optimistic with a greater sense of purpose.

Harvard psychologist Ellen Langer explored the power of the link between. mindsets and aging in her famous Counterclockwise study. She bused a group of elderly men in their 70s and 80s up to a New England hotel that was retrofitted to look like a hotel would have looked 20 years earlier. It was as though they had stepped into a time capsule — food, the magazines, the music, even the television programs were authentically 1959. The intention wasn’t to invoke nostalgia for the good old days, it was to re-create the good old days. The men were told to act as though it were 1959.

The results were astonishing. After only one week, the men were more physically fit and flexible. Hearing and memory improved. People who saw photos of them judged them to be younger. Perhaps most astonishing was finding that their fingers were longer. Because their arthritis had lessened, they were able to extend their fingers farther. Dr. Langer’s experiment literally turned back time.

A new book, Breaking the Age Code, by Becca Levy furthers the argument about the link between aging and attitude. Levy found that the single most important factor in determining the longevity of participants in her research was mindset:

“More important than gender, income, social background, loneliness, or functional health was how people thought about and approached the idea of old age. Age beliefs, it turns out, can steal or add nearly eight years to your life. In other words, these beliefs don’t just live in our heads. For better or worse, those mental images that are the product of our cultural diets, whether it’s the shows we watch, the things we read, or the jokes we laugh at, become scripts we end up acting out.”

So thank you JLo for expanding our idea about what middle age and beyond can be.

“Age is of no importance unless you are a cheese.” — Billie Burke

I wish you all the best,

Dr. Samantha Boardman

How To Help Teens Navigate Stress and Boost Resilience

Being a teenager has never been easy but these days seems harder than ever. In addition to the ordinary stresses of coming of age — a global pandemic, war in Europe, mass shootings, economic insecurity, and 24/7 exposure to social media are all contributing to what has been described as a youth mental health crisis.

“Adolescents today are more stressed than ever, exhibiting record levels of stress-related internalizing symptoms, such as anxiety and depression,” says Jeremy Jamieson, an associate professor of psychology at the University of Rochester.

A new study published in Nature and co-authored by Jamieson offers a promising strategy to help adolescents counter stress and boost resilience. The one-time 30-minute intervention involves two key components:

  1. A Learning Mindset 

This is based on the idea that ability is not set in stone but can be developed through effort, effective strategies, and support from others. As part of the process, students were presented with scientific information about the malleability of the brain. They learned that the brain is like a muscle and when you use it, it grows stronger and smarter. They also learned about the importance of flexibility and deploying new strategies and asking for help when they feel stuck. To help them internalize the message, they were asked about how they might use a learning mindset in their own lives, such as in math class or on the sports field.

To encourage your adolescent to develop a learning mindset, model a learning mindset. Welcome challenges and stick to them, try new strategies to problem solve, ask for advice when you are stuck, and use mistakes to learn and grow. Have conversations with the following questions in mind:

  • “What is a challenge you have faced?”
  • “How did you overcome that challenge?”
  • “What advice can you give to someone facing a challenge?”
  • “How can you use what you learned to overcome a current or future challenge?”
  1. A stress-can-be-enhancing mindset

This is predicated on the idea that our physiological responses to stress such as sweaty palms, racing heart, deep breathing, and feeling anxious are not harmful but instead can be viewed as positive changes because they mobilize energy and deliver oxygen to our tissues. Rather than something to be avoided, these physical experiences mean our body is ready to take on and overcome a challenge. The stress-can-be-enhancing mindset messaging encourages adolescents to see the activation of their psychophysiological stress response, which often follows engagement with challenging stressors, as a helpful resource that energizes their pursuit of valued goals, rather than as a problem.

To encourage your adolescent to develop a stress-can-be-enhancing mindset, remind them that stress is a normal and even defining feature of adolescence.

  • Talk to them about how the stress the body feels when you face challenging experiences is also preparing you to learn from them.
  • Discuss people they admire who became good at something who had to face and overcome struggles.
  • Have conversations about your own stressful experiences and what you learned from them.

Students who embraced these mindsets described feeling more liked, satisfied, and good about themselves. They also reported feeling less insecure, less anxious, and less disconnected. Their grades also improved. Changing how teens think about stress, and the ability to handle it, is at the core of the intervention.

In the play, The Cursed Child, Draco says, “People say parenting is the hardest job in the world — they’re wrong — growing up is. We all just forgot how hard it was.”

Today, growing up seems harder than ever. Thankfully there are tools we can provide to help children navigate these challenges with stamina, grace, and fortitude.

I wish you all the best,

Dr. Samantha Boardman

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