#49: Stress and Stress Management – Psychotherapist Giorgio Grossi

(upbeat music) Health, psychology and human nature with. I'm there, still a song. (upbeat music) Hey friends, hope you're having a great day. Are you following me on Instagram and Facebook? Please go to Health, Psychology and Human Nature on Instagram or Facebook or both, for that matter, to get the latest episodes, inspiration and more. Please take a pause and go there. Also, if you like the episode, please share it with a friend, family member, or somebody else who you think might like it. (upbeat music) You're here, welcome to the show. Thank you, it's a pleasure to be here. It's a pleasure to have you on. How was the morning for you? Well, the morning was kind of hectic because I really enjoy sleeping in. So I had to get up extra early this morning, but you know, it was worth it. It's nice to be here with you and with the listeners. Sounds great, yeah. It's the same with my girlfriend, always help her, you know, get her up off the bed when in the morning. You serve her coffee and breakfast? I sometimes have her coffee, but it's mostly, you know, being with her in the bed, you know, for perhaps 20 minutes, you know, gently waking her up so she gets a good start. 'Cause it's, I think it's very different. Like some people really have a hard time getting up in the morning. Some people are perhaps a little bit easier. Yeah, yeah, yeah, I know, that's so unfair, but here we are. Yeah, perfect. Okay, so we're going to talk about stress today. Yes. I think that is something that is on a lot of people's minds, perhaps especially now with the corona and everything. Yeah, definitely. It's a very stressful period for most of us, yeah. So I think it's a good topic to talk about. Yeah. I think maybe we should just start off talking about, a little bit about, you know, the basics. So perhaps just talking a little bit about what stress is. So what do you answer to that typically? Like if somebody asks you what stress is? Well, the typical answer is that stress is a set of survival mechanisms that we have and all animals have since eons of time. And we are programmed to react with stress in front of situations in which we feel threatened or challenged in some way. And originally, if you think of the Stone Age, we lived as hunters, gatherers. So our lives were at risk every day. And we had to fight, literally, for our existence. Predators wanted to eat us up. And we had to hunt mammoths and other huge dangerous animals in order to stay alive. So stress is really the set of physiological and psychological responses that make you able to mobilize a lot of energy so you can become angry or fearful and then have the energy required to fight or run for your life. So when we enter a state of stress, then, you know, we have an increased energy, the heart beats faster, the blood pressure goes up, we breathe more heavily, the pupils of the eyes get dilated, the muscles become tensed. So we are ready to literally fight or run. And one of the synonyms of the stress response is the fight or flight reaction. And fighting or fleeing are actually the behaviors that are motivated by stress. And that's the origin of the whole thing, you know? And then we spent the most time on Earth as hunters, gatherers, as said, and just some 12,000 years ago, we had what we call the agricultural revolution. That was not a revolution in the sense that people, you know, ran out in the industry to it. (laughing) - Big science, you know? - We won't hunt anymore, we won't hunt food. - Green. - Preserve the forest. Now, it was a slow process during which most people moved from living in no-matic bands, hunting and gathering to living, you know, permanently in settlements and, you know, devoting themselves to agriculture. And that was not very long ago from in an evolutionary perspective, just 12,000 years ago. And then we had the industrial revolution, and now we live in the modern society. And I'm saying all this in order to explain that the environment around us has changed dramatically and very fast while our bodies are still the same as for, say, 100, to 100,000 years ago. So underneath this skin, we are still the primitive creatures that are used to fight for the survival of the savannah, okay? So we still react in the same way as our ancestors did, but not as a response to, I don't know, wild animals. What's sometimes we do encounter wild animals, but that's really a rare situation. What we usually react to is, for instance, the corona pandemic or, you know, too much work or too little control over our economy or difficulties in our relationships, et cetera, et cetera. So we are still programmed to increase, you know, heart rate and breathing rate and blood pressure, et cetera, but we don't have an outlet for all that excess adrenaline through a physical, some kind of discharge. And for us, the stress becomes a chronic state. It's not like you fight with a lion and then if the lion is dead, you go to rest, you recuperate and, you know, are able to recharge your batteries in modern life. The stress goes on and on and on and on, which is something we are not built for. So in the long run, the system, our bodies will be exposed to wear and tear and some part of the system will eventually break down depending on your weak spots, so to say, which in turn are due to genetics, earlier wounds or, you know, your lifestyles at large and so that's how stress will result in some kind of disease in the long run, through wear and tear and lack of recovery. - Right, that's super interesting. So it's kind of all these evolutionary mechanisms that we had to be able to fight a mammoth or run for a life if perhaps a neighbor group or attacking us or whatever. - The Neanderthals. - Exactly, yeah, exactly. But did we win that fight with Neanderthals? Or may perhaps we don't know? - We don't really know exactly, but we know that we, Homo sapiens, did survive whereas the Neanderthals became extinct. - They're gone. - Yeah. - Perhaps the rest system, perhaps weren't as good as ours then. - We don't know, and the theory is saying that we ate them, so I don't know. - Yeah, okay. - Right, so basically it's this ancient mechanisms that we have to be able to handle these kind of more threatening situations. And then that somehow, then that system kind of is kind of over activated or perhaps activated a lot now which seems to lead to disease and it seems to. - It becomes overly activated. It becomes activated too often, perhaps too strongly. And the most important thing is that it practically never shuts off. So we continue to be stressed. Although we leave the workplace, for instance, let's say that you're stressed out because of your work situation, then it's not like you're stressed out only when you are at work. Since you and I and all humans have a human brain, we're also capable of taking work home, not in the literal sense, but in our thoughts and many of us do spend an inordinate amount of time thinking, ruminating about work or other issues that we find problematic. And oftentimes we do that in bed, okay? So one of the links between everyday stress and disease is the lack of sleep that we get when we are unable to shut off. Think thoughts about what's bothering us and we ruminate in bed and that leads to a very shallow, superficial, interrupted sleep, which in turn in the long run leads the chronic state of energy depletion, which per se becomes a disease. And as we were talking earlier in Sweden, we have this diagnosis called the stress-related exhaustion disorder, which we see has become like a pandemic, no, at least an epidemic in Sweden and a pandemic, yeah, because you know, chronic stress is a problem worldwide. And although we have this diagnosis here in Sweden only, in the rest of the world there are, you know, other diagnoses that are comparable with it, like many depressions, which are characterized by lack of energy are due to chronic stress, or many states of anxiety, for instance, or even somatic diseases, bodily diseases, like chronic pain conditions in the muscular skeletal system, or also heart disease, unfortunately, and many cases of stroke, diabetes, et cetera, are related to chronic stress. Right. Yeah. And that's this one, one of the, I think, one of the important things that stress really seems to affect kind of everything almost. It's not just one thing that only affects the heart, for example. It seems to have like this global effect on the system. It does. Well, you know, again, if you imagine yourself during the stone age and you're chased by a mammoth, your entire system has to react. Exactly. Yeah. So it's not very functional from a survival point of view, it's only defeat or activated, but the brain is somewhere else, you know. And that has repercussions on our health today, because the entire system is affected. And depending on, as I said, your weak spot, that's probably in the weakest link in the chain, that's where the illness will ensue. Right. Right. I think you said something really important also before, that it's also something that stresses also something that comes from our mind. Definitely. So basically, that you can be away from kind of the perhaps work which stresses you, but you can still be at home and still be stressed out because your brain is working on the problems or still being state of being afraid or worried about something that might happen. That's the classical, you know, function of the human brain. And then the next day, when you are at work, you may have feelings of guilt because yesterday when you were supposed to have quality time with the family, your mind was kidnapped by thoughts of work. And that's how it functions, you know, a dog or any other animal. When it's exposed to a danger, it will react with, you know, a certain degree of stress. It will fight, it will run, it will do whatever it takes to survive. And then when the danger is over, it will, you know, sleep or eat or whatever animals do. Whereas we will ruminate. And that's one of the great things of the human mind that we have such an imagination. And we have the capability of also imagining a distant future. We can imagine things that will happen, that could happen, that might happen, oftentimes we're focused on problems. Most thoughts are, you know, kind of problematic and focusing on something we have to deal with and solve. And that's also why we are such great problem solvers. I mean, could you imagine a mammoth or any other animal capable of coming up with the idea of what we are doing right now, for instance? Yeah, exactly. That's only human, right? On the other hand, humans are the only species that can imagine a future that is so hopeless, so depressing that we choose to take our lives in the here and now, although we in the here and now are, you know, pretty safe, you know, nothing bad is happening right now. But you know, if I imagine a future that is really, really terrible, then I may also choose to kill myself. And animals don't do that. The rest of the animals besides us. Exactly. I read the book from Robert Sapolsky, Y.C., but don't get the ulcers. So that's what it's all about? Exactly. It really seems to be one of his main points, that what you just mentioned, that animals, they're just the stress-sponsors comes and goes. But with us, we have this mental capability which can just keep the stress on for long periods of time. Yeah. In our thoughts. Exactly. Yeah. For my understanding also, what really seems to affect stress is the worry part or, you know, the problems that you have that you're trying to solve, but it's also like an overactivation. Would you agree with that or what's your thoughts on that that perhaps like one person perhaps is just activated a lot like from morning till bed every day of their life and they perhaps also sleep a little bit less. And then you also have this other aspect of like ruminating and worrying. I find those two a little bit separate. What do you think about that or? Well, if we generalize, we could say that there are two sides of the same coin somehow. And then, you know, we also have to make the picture a bit more nuanced in the sense that not all stress is bad. Stress is not bad per se. And it's how we stress that may be or not be problematic. And I guess that many of those individuals that you describe that have a lot of energy and do a lot of things, etc. They may, they must not necessarily feel unhappy or stressed out in an anxious way. They may be very engaged in their work, they may have a lot to do. But also a great amount of control over what they're doing. So the feelings that they're having are not anxiety or sadness or anger or guilt, but they may feel kind of happy and in a flow. And usually those people are kind of very productive as long as they get time for restitution, for recovery, rest, etc. But otherwise, yeah, the intensive thinking aspect of stress is frequently coupled with the high intensity, the high physical arousal side of the phenomenon. Right. Right. I was thinking maybe it would be interesting to kind of see a scenario from a person that is healthy, whatever that means. And then until you reach burnout or whatever word we, or whatever word we use for the diagnosis. And perhaps also it would be interesting to know a little bit about perhaps the stress symptoms. Because I think one thing that I think a lot of people wonder is, like, do I, is this bad for me in what situation am I? Yeah. It would be very interesting to know a little bit about perhaps the scenario and a little perhaps a little bit about the stress symptoms along the way that I typical are. Sure. And just to clarify one point, you use the term burnout, and burnout is one possible outcome among many of chronic stress, and there are various definitions of burnout. But for clarity, let's say that the way we use the term here is more clinical burnout. One could be burnt out without necessarily having to go to a doctor, et cetera. You're not happy. You don't function that well, but you still function. You go to work. You do your stuff. You're not happy about it, but you still go around during your business. Once you reach the level of clinical burnout, that would be the equivalent of what I was talking about earlier, you know, the stress-related exhaustion disorder in which you are totally exhausted, physically, mentally, emotionally, and that's really a state of disease, one could say. So what does the road look like from healthy to clinically burnt out? Well, to start with, in my experience and in many others' experiences, those who reach this data, clinical burnout are usually very ambitious people to start with. They're not lazy, in any way. They have a very high work, moral, they're very engaged in duties, their chores. Yeah, they are, how could you say, they have a self-esteem that is based on achievements. Right. Okay, I am what I do. And there's often very often a perfectionistic streak in their personality. And in these cases, perfectionism is not a characteristic that fills the function of you becoming happy with the perfect results in a limited area of your life. Let's say that you're a passionate, I don't know, tennis player. And you really want to achieve perfection within that field because that's something that you really enjoy doing. So then you would probably practice a lot, et cetera, et cetera, in order to achieve that. But in other areas of life, you may be more laid back. And you know that you can't be perfect at everything because that's impossible. The kind of perfectionism I'm talking about here is what we call the mal-adaptive perfectionism, which is geared at avoiding criticism. So there's an idea that if I can play the role of a person that is perfect in every area of life at work during leisure time, in my marriage, in my family life, the way I live, et cetera, then nobody will have anything to say about it. And this is a characteristic, a personality trait, you could say, that increases one's vulnerability to stress in the sense that if you end up in very demanding work situations, for instance, high demands, high workload, goals that are not very clear, you may be you have a leadership that is not enough supportive, and you lack control over your situation, then this perfectionistic and very ambitious and very loyal coworker will overwork. You know, do a lot more than is expected, and not necessarily the right things, and he, she will also overexert him herself during leisure time. So there's a lot of exertion and overambition in the process. So we have this in order to reach a state of clinical burnout, then you have to have this mismatch between the overambitious individual and the work situation that is too demanding, too unclear, and with poor leadership. And now we're only talking about work. All right. Let's remember does an entire world outside of work, too. But let's stay with work for now. So what happens is that these kind of persons usually tend to work very hard in all areas, and they sometimes reach this point where it all becomes too much. Let's say that you have a very stressful situation at work, but at home everything is okay. You have your moments in which you can relax, et cetera, although you're a bit pedantic about how things should be at home, and it might be a little bit angry on your partner. Yeah, because you think the partner is sloppy, doesn't have the same standards as you, but it's okay, you know, it works. But then suddenly, we have some kind of extra situations that arise. There may be a crisis in the marriage, or it turns out that one of your kids has some kind of diagnosis that you didn't really, you noticed that there was something different with him, but then, you know, it starts to become a problem at school, for instance, or you have financial difficulties, or some of your older. I don't know, your parents may be get old sick and need your assistance. So there's a set of new sources of stress arising. So the total sum of all the sources of stress becomes, you know, increased in a way that becomes problematic. And you being this ambitious individual that takes a lot of responsibility, of course, what you do is that you start taking even more responsibility and working harder than you did before, because you want to maintain your perfection at work, you want to be the perfect partner, you want to be the perfect parent, and son, and whatever. So you work harder and harder and harder, and downpour your retires, everything that has to do with recovery. So all free time, all your hobbies, all your friends, et cetera, sports, whatever that you enjoy, you set aside in order to be there for everybody else. And this is fine. That's a very fine thing to do as long as it's during a limited period of time. But if this continues for months, years, what happens is that besides not having any policies during your day, no time to recuperate during the day, you will probably do what we were talking about a moment ago that is bring all the problems into the bedroom, try and solve problems at night. And this leads to one of the classical warning signs that is poor sleep. And sleeping poorly now and then is not a problem. But when it's set into system that you sleep poorly for months, years, in the sense that it takes a long time for you to fall asleep, or you fall asleep immediately, but then you wake up pretty fast. And you have a series of longer and shorter awakenings during the night. You sleep very superficially. Maybe you wake up too early too, so you get, you know, around six or less than six hours per night systematically over a longer period of time. What will happen is that other warning signs will set in and those are usually those that have to do with your mental abilities. That is, it becomes more difficult to concentrate. It becomes more difficult to solve problems. You will become forgetful. You know, initially it's what many people a bit jokingly refer to as Alzheimer's light. Where did I put my keys? Where's my phone? Where did I park my car? A person's name again. And then that becomes, you know, a regular state. And the cognitive failures start increasing in magnitudes so they become more and more bothersome. And, you know, we live in a society and we have works in which the mind is the main tool, right? Sure. So when we start becoming handicapped mentally, in that sense, it becomes very bothersome. It's difficult to function properly in everyday life. So all the mental capabilities are worsened and that's something that does not improve with lack of restitution becomes worse. And actually, there are studies showing that chronic stress leads to micro-damage in the brain, not least in the prefrontal area of the brain cortex, which deals with memory, concentration, rational thinking, logistics, problem solving, planning, etc. And all those functions are, you know, the worst in our patients with the clinical burnout. Together with that, warning signs are those that have to do with, you know, emotional reactions. During stress, we are seldom angels. We become irritable, right? Yeah. Anxious. A lot of us have feelings of guilt or shame. You know, if we become more and more forgetful, we make mistakes, we lose things, etc. We create situations that are problematic for others, for instance, at work because we don't remember meetings or etc. It's easily to become ashamed and have guilt feelings that we are saying that we are not adequate for the job or, you know, that we are not as we used to be. And then we start ruminating about that. So it becomes a vicious circle. And then add to the total amount of stress that you have yourself. That becomes a stress factor in itself. Then you have all the bodily symptoms. You know, stress is a very physical set of reactions. So of course, we experience heart palpitations, for instance, difficulties, breathing, muscular tension that eventually turns into chronic pain in the neck, in the shoulders, in the back, for instance, headaches. We may experience sounds sensations like tinnitus. You know, it's the perception of sounds, although there are no sounds from any external source. Stomach problems or various kinds we may feel since of irreality, or we may feel cold in the hands and feet that has to do with changes in circulation due to stress. When we are under stress, blood is directed to the great skeletal muscles and away from fingers and toes, for instance, so we become cold there in shaky. The immune system is affected by stress, so in the long run we may become more susceptible to various infections, colds, etc. And all of this, and much more, is actually not necessarily a sign that you are moving towards a burnout state. We do have stress symptoms in our everyday lives. And if they are light, if they are temporary, then there's no real reason to be worried about it. But we have to take a look at the pattern. How do these symptoms develop over time? Are they light and pass as soon as a certain stressful situation or period is over? Or do they tend to persist? Aggregate one adds to the other and they start becoming more and more intense, so it becomes increasingly difficult to function in everyday life. And if that's the case, if they start increasing, they become more and more excruciating. Let's use that term, painful to deal with, and your function is hampered, then they are definitely telling you that you are moving towards a state of disease. And you have to do something about it, you know? Right. Okay, so it's basically the total amount of stress that you're having. So the sources can be work, it can be a personal life, and of course a combination. And it's when you have the amount of like accumulative stress, then perhaps that you start to decline in angel levels and your stress starts to increase and then your body stops to work like a little bit and then that increases as well over time. Yeah. Many of us do not notice this clearly because this process, because you know, one's focus is directed towards solving whatever is perceived as the problematic situation. And since stress also means that the energy available is increased momentarily, there are systems that we have not mentioned in the body that also relieve pain. So you don't feel how worn out you actually are. Right. And then you have hormones like adrenaline and or adrenaline, cortisol and more that make you like hyped up. Right. So you're, you know, a bit like on drugs. You don't feel the pain and you have an excess energy. Right. So it's kind of like your subjective state is not like linked to your biological state. So you feel good, but your biology is screaming kind of. That's right. And you're hyper focused on solving whatever you have to solve. That's also why unfortunately many people don't become motivated to change this course until it's too late. Because it's mainly the subjective state that perhaps makes us want to change. Yeah, when suffering becomes so pervasive that you that you find no alternative then seek help. Yeah. Then you will seek help. But as long as you feel you still have energy left to fight on trying to solve whatever is bothering you, then you will probably do so. And that's why many people who are on the verge of burnout become so irritated with their wives or children or, you know, husbands or bosses or co-workers who are trying to tell them to slow down, take it easy. Yeah. Don't talk to me. I want to hear that. Exactly. So unfortunately some people have to, as we say, it's within hit the wall in order to realize that they are not well. They need help. Another very important aspect that you mentioned is that. So let's say that you're having all these different things that add to your stress. And then because of the stress, you begin to function less well. Yeah. Because you function less well, you perhaps put in even more effort trying to function, trying to do the things that you want to do. Yeah. And then that just adds to it instead of perhaps, you know, taking a break, lying on the sofa so that your body and your mind can take a break and then perhaps regain energy to be able to solve stuff. It kind of comes a vicious cycle almost. Definitely. Definitely a vicious cycle. Yeah. Interesting. Okay. So you mentioned a couple of things there when it started to go downwards. You mentioned that sleep is one of the things that gets affected quite early on or. Yeah, usually it's pretty early on, you know, together with other things. You know, ruminations, tension, emotional upheaval inside it. And all that comes like a package. Yeah. And within that package, in that package, there is this disturbed sleep. Right. Yeah. And then it's also true that after time goes like later on that this more cognitive, I mean, this brain functions, is that later on in the process? Well, it may come early in the sense that during acute stress, the prefrontal area of the brain receives less blood. Yeah. While the emotional brain receives more blood. Right. So it becomes more. Good combo. Well, actually, if you're in front of a mammoth. Yes. Yeah, it makes sense. Yeah. So what happens then is that really already during a acute stress, you have a decreased capability of thinking logically. And then in the long run, it has to do with exhaustion. You become exhausted due to lack of sleep, due to lack of rest. And maybe these micro injuries in the brain ensue so that. Then it becomes more of a permanent state, so to speak. Right. Like you have difficulty focusing during acute stress, but once it's over, you're yourself again. Yeah. In the long run, it's a really a new state. And among the symptoms of chronic burnout, those that have to do with the cognitive functions are those that will heal the slowest if they ever do. And unfortunately, here, where we find ourselves right now, this stress clinic in Stockholm, we have the most severe cases of exhaustion. And we see that many, many, many years after they are. The treatment is completed. Many patients still have difficulties focusing, remembering, making choices, you know, decision making is quite hampered. Yeah. So I think that is also, of course, one of the. Why it's really important to really take action in, like. Oh, yeah, exactly. But still, I mean, and that is, as you mentioned, that is also perhaps also the hardest thing to do to just, you know, just hit the break and just, you know, change direction. Definitely. Yeah. I think we've also been interested in to know a little bit about. You mentioned that perhaps a lot of people have to hit the wall, so to speak, so to be able to wake up and realize that I have to do something about this. But still, if somebody's listening, if you have the earlier signs, like, do you have any tips on how you can change this vicious cycle of how you can. Yeah, how you can change the vicious cycle? Yeah. Well, again, I don't want to be too alarmistic because feeling stress symptoms, yeah, that's a. A normal aspect of everyday life, but again, okay? If they are light and if they pass, no problem. If they, you know, tend to hang on for weeks, months. And you also do know that there are situations in your life that are not, you know, reasonable that you have to be. That you have to solve, problems that you have to solve. Then you have to first step is to actually acknowledge the fact that you are under stress. Right. And that there are problems creating your stress, problems that you have to deal with. So, one suggestion could be besides acknowledging this, also try and have. Have an overview, sit down with paper and pencil and just write down whatever is going on in your life, what are you worried about? And really, sit down, focus on it, make yourself unreachable for a set of time or maybe a few days, not in a row, but not entire days in a row. But an hour here, half hour there and really write down everything and then try and sort whatever is problematic in your life into two categories. The stuff you can do something about and The stuff that is beyond your control. Yeah, you know, there's this famous Serenity prayer that is you know quoted at the A A meetings Saying something like grant me the Serenity to accept the things I cannot change to change what I can and The courage to change what I can and the wisdom to know the difference. Yeah, so sit down with paper and pencil right down everything and sort whatever is bothering you into the categories what you can change what you cannot change and then try and Yeah, systematically try and solve what you can change what you can do something about and That may have to do with your work situation. It could be your financial situation could be your relationships your lifestyles your daily routines whatever and The good news here is that our behaviors what we do what we choose to do in Our everyday lives is actually in most cases in 99% of cases the question of choice. Yeah, okay? I may feel very intimidated by my manager And I can choose to have a talk with him or her about my work situation. Yeah And you know here in Sweden and in many other parts of the world we are privileged in the sense that if you you're even expected to have that kind of talks with your manager and There are laws saying that the employer has the responsibility to see to it that nobody gets harmed From work from their work situation neither physically nor Psychologically in any way that's you know something that the Employer will be prosecuted for otherwise You know I'm punished. So as an employee You're supposed to have that kind of talks with your employer if you find that your work situation is Unmanageable you have to have a one-on-one with the manager and say look I can't cope with all this amount of work Look at my calendar. What am I help me prioritize? Yes, let's make a plan for the future. So every company has to have by law an action plan and If the managers have to be trained in spotting signs of stress in the employees have one-on-one of them Making this action plan that has to be followed up. So what I'm trying to say in this very You know complicated way is in certain parts of the the world we can do this we can take care of Some work related issues Because it's possible. It's backed up by law Okay, in other parts of the world Maybe you don't even have you don't even dream of that having that conversation with your boss because you will be fired Immediately or left that or I don't know perhaps shot. Yeah, right? So depending on where you find yourself you can do various things You can have a talk with your boss or not and as I said I studied out by saying that our behaviors are always a question of choice I may be very afraid of my boss and still have the talk Because it's worthwhile then something which is the basis for a healthy Stress management or man life management in general is to do something that is Totally unglomeruous, but you know vital in a sense and that's have regular routines Okay, so prioritize your sleep and it's difficult to sleep if you have a lot of worries, but there are things you can do worry somewhere else and doing another period of time So since the brain is a worrying machine you can decide to Again sit down with paper and pencil half our day and do worry In a concentrated way right down everything and then practice the art of letting go of thoughts during the rest of the time So when you have your worrying time, you do worry 100% Go all-in with all-in with the worst case scenario and then the rest of the time you just tell your thoughts to Not bother you there and then come back tomorrow Yeah, and believe it or not. This is something that you can practice. Yeah, it's you know practice makes perfect sure So prioritize the sleep not Ruminating bed have a couple of hours before you go to bed during which you wind down Don't work too late in the evenings. Don't start quarrels late in the evenings Do not exercise intensely Late exercise is very good for us that should be a part of a daily routine But try and finish it you know in time so that you can unwind Now that we just mentioned exercise. Yeah, if you're having a stress Let's say that you're having stress symptoms Like at what level should you be exercising? Well At a moderate Intensity and what that is that's kind of different from Person to person. Yeah, some people who have had a very sedentary life for a very long time You know, we'll find walks to be more than moderate. Yeah exertion And that's where you have to start Probably you know the important thing with exercise it that it has to be On a rate it has to be performed on a regular basis not off and on and At a level that you can handle without being Understimulated or over overstimulated Moderate intensity whatever that is and at least two three times a week Okay, if one has reached the point in which one is exhausted Then we do not recommend two vigorous exercise, right then one should actually start out with Walks yeah walking half-hour day or something like that, you know and then with time When you start coming back increasing your energy levels you may also start exercising more vigorously But it has to be a very slow and long-term Process of coming back right so no drastic changes for one day to the other It's not like running a marathon or doing high-intensity interval training. No these Walks or perhaps slow jogs slow jogs or moderate intensity spinning. You know, it's yeah How do you call it in English indoor cycling? Yeah, exactly. Yeah, yeah, right there are some studies There's one at least that I know in which they added Indoor cycling at a moderate level two to three times a week for patients who Underwent the Rehabilitation for exhaustion similar to ours here. Yeah as an add-on to that and The researchers could see that these patients had an extra benefit from it Not the least in their cognitive functions. So memory and concentration got better due to that add-on Right interesting. Okay, so if we head back to what you what you were talking about earlier. It's it's Really like taking a paper and pen setting a side time and then Writing up the things you can change the things you can affect and then the things that which you cannot change What did you say about that like how do you manage the things that you cannot change for example if somebody has a disease or Something else like how how do you what do you do with that? Well, you you can't do much about it. So We have to work on practicing what we call acceptance, right? So we don't have to like it definitely don't have to love the fact that somebody has this Disease but you know still at the end of the day it is what it is yeah, and if we you know start resisting emotionally and Ruminating about it then it just becomes worse right we create a lot of aggravation for ourselves, which is not helpful So acceptance, you know looking at it the way it is objectively and then to put your energies Direct your energy towards what you can change right like the acceptance part How do you do that practically like how do you practically start not having a resistant towards the things that happen or accepting the things that happen like is there or just like I mean. Yeah, it's a question of exercising, you know, that's why many buddhistic practices have been integrated in modern psychotherapy and acceptance is one of them and acceptance you could say is something that you can practice through a set of exercises in which you direct your attention to the here and now and that's is a practice in itself because the human mind wanders all the time towards the future towards the past we are seldom focused on the present and being focused on the present is something you achieve by focusing on one of your senses at the time without valuing what you see, what you hear, what you experience, you know, what becomes automatic for us what's very instinctive in us is to have an opinion on everything. So if I look at this microphone I could immediately say that it's a beautiful microphone, it's really perfect in its shape, it's a color that I like and it's much better than another microphone that I remember from the past for another interview which was much uglier itself and then right there and then I have put myself in the emotional brain and I'm in the past another microphone whereas this microphone is actually black it's 30 centimeters high, it's circular in its form, it has it rests on a tripod, it's in a round shape right here and that's what it is so to speak. And now what I did right now was that I narrowed my perspective to my site, I focused entirely on what I see and I described what I saw in a matter of fact way. And that's something we have to practice in order to become better, better at accepting things because not accepting things is very much a question of valuing something is very bad, okay. So let's say now let's move from the microphone to something that I may have trouble accepting, let's say that I'm having distressing symptoms of stress right now that I have, I noticed I have heart popitations, I'm very anxious so one way of not accepting that would be like valuing the whole experience in the following terms, oh my god I noticed that I'm having a heart attack right now, my heart is jumping out of my chest, I'm going crazy, this is terrible, no no no I have to run away, okay. Whereas if I stop, breathe, focus on my sensations in a more matter of fact way, then I could work on accepting them in the following way. Right now I noticed that my heart beats fast, I can count, if I count my heart beats, I notice that I have let's say a hundred beats per minute, I also noticed that I have difficulties breathing, I noticed that I'm very tensed, I noticed that I'm dry mouthed, I noticed that I'm having a thought saying oh my god I'm so stressed out and I also noticed that my the pounds of my hands are sweaty and I noticed I'm having a strong impulse to leave the room and now I noticed that I'm starting to breathe normally again and now I noticed that my heart beat is going down and so sometimes when we actually stop, don't make resistance, don't fight against our sensations, then they may even pass, but if I struggle, if I enter the struggle to control my feelings and to take them away, so to speak, then they just increase. So that's a way of practicing acceptance, just describing your experiences in the now in a very factual way, and of course this is a matter of practice, practice, practice, practice. Yeah exactly, some practice makes perfect. And choose the situations in which you actually do stop and accept and don't do anything about about what your experiences and those situations in which you actually have to act, you know, if your heart populations and difficulties breathing and tension and anxiety are caused by the fact that you're actually trapped in a burning house, then for God's sake be thinking about how to do it. But if it's a irregular panic attack or something that you can do anything about just breathe through it, right? I think that the time is running out. If somebody would like to, let's say we're I know that stress motogny and that you have a lot of information in Swedish, if somebody would like to find like your work or the work of stress motogny and where can people find you and organizations work? Well it's www.stressmotognyn.com and of course one could google me, Georgia Große and they'll find valuable links. And of course I know you also written a lot of books in Swedish as well and you also have a book coming out about stress and corona, right? Yeah, that's right. The title is not said yet but it has to do with coping with stress and anxiety during this crisis situation because the corona is definitely a potent source of stress in many ways and for different groups. Although not everything is dark. For many people it has actually implied a more relaxed way of living, you know. But yeah, that book is coming out and we hope that it will be translated from Swedish to English and other languages because since it's a pandemic we're talking about it involves the entire world, but to start with it will come out in Swedish in Sweden during the fall and then hopefully it will be translated into other languages. Great, perfect. So last question. Yeah, what do you think is that take home message from today's conversation? Well, I would say that remember this serenity prayer, grant me this serenity to accept the things I cannot change, the courage to change what I can and the wisdom to know the difference. So if you can have this like, you know, a slogan or a motto in your life, then it'll be very helpful. Perfect. Big big thank you for coming on and sharing everything you know you. Thank you. My pleasure. Hope you enjoyed the episode. Friends, I really need your help. I'm trying to get the podcast out there. So I was wondering if you could help me by leaving a positive rating and a review on your Apple device or the podcast player that you're using as well as subscribing to the podcast. That really helps getting the show more visible on iTunes and other players. And if you don't know how it's done, the YouTube has a lot of great videos so you can search there. Alright, that's it. Take care. This podcast is for general informational purposes only and does not constitute the practice of medicine including the giving of medical advice. The content of this podcast is not intended to be a substitute for professional medical advice diagnosis or treatment.