Stress vs. Stressors

Before you can understand how to complete the stress cycle, you need to understand the difference between stress and the stressor. The stressor is the thing that cause your stress. Stressors are kids and marriage arguments. Stressors are those demands at work. A sick or crashing patient is a stressor. The stressor is the full EMR inbasket of unanswered messages and the page of notes from today that you still need to sign. 

Simply put stressors are anything that actuated the stress response in your body. Anything that you see, smell, touch, taste, hear, or even imagine might be able to cause you harm is a potential stressor. 

Stressors can be internal or external – external stressors are some of those I just shared: work, financial pressures, schedules, family demands, the time crunch that we feel in this modern world, cultural norms and expectations, and more. 

Internal stressors are things like our identity, memories, body-image, self-doubt, imposter syndrome and criticism of ourselves. 

There are a whole lot of things in this life that can cause us to feel threatened. It can, honestly, feel incredibly overwhelming to think about the sheer number of stressors in the world that exist outside and inside ourselves. 

I’ve shared my story of burnout, so if you’re curious what happened when I didn’t use these techniques to complete my stress cycle, check it out here.
Concerned that you might be burned out? Take the Burnout Risk Assessment Quiz.

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Stress Response

Stress is the physiology and neurological reaction that the body has to the threats we encounter. Learning to have a stress response was how we evolved to live, thrive, and respond to things like being chased by a lion. 

Let’s take that being chased by lion. Pretend you are a caveman, woman or person. You’re out and about, minding your own business, taking a stroll or probably more accurately you are out hunting or gathering to survive. And BAM – there’s a lion. Oh shit. 

You have three options; fight, flight or freeze. Your brain immediately calculates which response is best and you think (quickly, in the span of a second) I’ve been working out, but I don’t think I can take this lion – fight is out. Freeze doesn’t sound like a great option because I’ll be lunch. Flight it is! 

And you take off running. Your heart is pounding. Your legs are pumping. Adrenaline is here for the party. Your epinephrine is helping your muscles get the blood flow and the energy stores are mobilizing to help you run your best mile time ever. 

Increases in blood pressure, pulse, your muscle tension, your pupils dilate, you are alert, attentive and downright vigilant. It’s not a good time to trip or take time to smell the proverbial flowers around you as you are running for your actual life. 

Your one single goal: survive. Outrun the lion. All of your body systems are reacting to the lion to help you get the heck out of there. 

What are things you don’t need to do right now? Digest your food, fight off a virus, recover your body and heal from prior injuries, or reproduce – all these systems are downregulated as a part of the stress response to be able to focus on the stress at hand. 

Stress is a complicated and multisystem response that includes neurology, vascular, metabolism and more. All those systems are working in concert to help you RUN. 

And then what? Well, either your mile time is shorter than the lion’s and you get eaten… or you get away! If you escape, outrun the lion, evade or make it back home where your village of fellow cave people can help you, well that’s excellent news.

You make it home, shouting for help, they come out and slaughter the lion. I should take a moment here to tell you that stress is my specialty, specifically helping you to complete the stress response cycle, even if you are burned out, but that I’m not a historian and cannot speak to the historical accuracy about my assumptions about cavepeople. 

But, your village comes out, you celebrate your escape, maybe you kill the lion and use fire to cook it – I have no idea – but there is joy and relief and celebrating. 

You take deep breaths. You hug your friends and family. 

Maybe you even sing and dance around said fire. 

You take another calm, cleansing breath and give thanks to the gods and the universe that you lived to see another day. 

Your stress response cycle is complete and you live happily ever after. 

The Problem with Stress

Our body doesn’t know the difference between a lion, a full inbasket of test results, and a disparaging comment from a coworker or even the criticism in our own mind. We react to the stress all the same. 

Sometimes, the behavior that addresses the stressor doesn’t help us to complete the stress cycle. Outrunning the lion did – you completed the stress cycle in our cavepeople scenario.

But what about your overdue notes or your full in basket. That’s the stressor. The behavior that addresses the stressor is sitting down and completing the notes, replying to all the tasks and finishing up for the day or week. 

What if, when you were running away from the lion – poof – he disappeared. You’re trucking it, right. He’s hot on your tail. You are running for your life and poof – gone.

You look around – no sight or sound of him – you’re confused as all get out. What just happened? Your heart is racing. You are ready to flight but you now have no reason to. You’re confused. The threat has disappeared but you haven’t completed the stress response cycle. 

Stuck in the Stress Cycle

Simply eliminating the stressor – whether it’s a disappearing lion or the inbasket scenario – doesn’t mean you’re not going to feel stressed. Your body isn’t sure what to do with that stress. 

You’re stuck inside the stress response. You don’t realize that it’s ok – the lion is gone, the inbox reads zero – simply knowing those things to be true is not enough. What your body needs is a signal from you that all is OK – that it’s safe to relax, to rest, to digest and to be calm and not on high alert. 

If you don’t complete the cycle – that high alert running from the lion state is where you live – with high levels of stress hormones and high neurologic awareness, hypervigilance – it’s exhausting! 

It’s also dangerous. When you are in that high stress state your body doesn’t have a chance to do the things that we know are physiologically necessary to thrive. You can’t digest, fight off infections, recover your cardiovascular health, repair your muscles and bones, or reproduce. Essentially you can’t rest and you can’t heal when you are stuck in the middle of a stress response. 

Simply addressing the source of the stress doesn’t necessarily mean you’ve completed the stress cycle.

What to Do

We cannot always remove the stressor from our lives. Especially when we work in medicine – medicine is inherently a part life that is stressful by nature. 

This episode is not about eliminating every single stressor in your life. It is about how to deal with your stress. We deal with stress by finding ways that work for us in order to complete the stress cycle. 

How to Complete the Stress Cycle

The best way to complete the stress cycle is whatever works best for you. Yes, I know that’s incredibly infuriating but each of us is different. 

Practice body awareness and mindfulness. We are often too busy and probably too burned out to be really tuned into our bodies needs. Your body is sharing signals about stress and tension with you. Take time and find ways to listen to what your body is sharing with you. 

1 – Exercise

What do you do when you’re being chased by a lion? You run!

What do you do when work and family life and #allthethings are stressing you out? You run! Or bike! Or dance! Or do Yoga. 

Exercise! Moving your body in a way that feels good. The science tells us that between 20 and 60 minutes a day is best for most people to complete this stress cycle – and that you should move most days.

Because you experience stress most days. 

If that 20-60 minutes of structured exercise is making you want to pause this episode and chuck your device up against the wall because “where the heck am I going to find an extra HOUR a day, Tracy?” – start small.

Standing up from your desk, taking a deep breath, squeezing all of your muscles as tight as you can and releasing them, exhaling and shaking everything out is a great start. 

Your body doesn’t know what chart prep or stressful patients are. It doesn’t understand administrative demands or a kid that you’re worried about. Your body doesn’t speak English.

Your body speaks… well, it speaks body language. That’s why movement and breathing as so incredibly effective when it comes to completing the stress cycle. 

When we exercise we are communicating to our body (in a language that it understands) that it is safe. The threat is gone and our body is a safe place to be, again. 

Physical activity is the single most efficient strategy for completing the stress response cycle. 

It doesn’t have to be structured, formal exercise. Have a dance party in the kitchen. Move around. Do lunges while you fold laundry. Do 20 jumping jacks before you flop on the couch. Find ways to move that bring you joy and complete that stress response cycle on a regular basis. 

2 – Breathing

Ok. Take a deep breath in through your nose and out through your mouth. Take one more deep breath and release the tension in your shoulders as you exhale. 

You understand how the human body works so it will come as no surprise to you that slow, deep, intentional breaths downregulate your stress response. 

Deep breaths are particularly effective when you have a long slow exhale and your core muscles tighten at the end of your exhalation. 

Breathing – being aware of and intentional with your breaths – can help in a situation where you are about to blow (read: anytime I’m interacting with my kiddos around bedtime and they are beyond exhausted and forget how the routine goes) or in a situation where the stress level isn’t too high. 

Taking nice deep breaths is an awesome way to deal with trauma.

You can try box breathing where you take a deep belly breath in for 4 seconds, hold for 4 seconds, and exhale for 4 seconds, then pause for 4 seconds. Just like you are inhaling up, holding across, exhaling down and pausing across the 4 sides of a box. 

You can do this box breathing in the elevator, while charting, or when walking to a patients’ exam room. 

3 – Positive Social Interactions

I bet you already knew this one, intuitively, right? You feel better when you go out for girls night or poker night, get together for book club, or head out for date night.

That positive, relaxed social interaction helps your body to realize that not only is your body a safe place but the world is, too. 

It doesn’t have to be long or drawn out – it can be small talk with your MA or nurse, complimenting the cafeteria worker, saying an earnest thank you, or having a positive interaction with a patient. All of these encounters serve as a reminder to your brain that all is well and no one else is running from a lion, so you’re in a safe place. 

4 – Laughter

I literally want to start laughing right now. My kiddos have been the biggest teachers to me of how laughter works to diffuse stress and help us to feel better, safer and happier. 

Actual laughter is the best, but even reminiscing out loud or in your mind about times that you’ve laughed is helpful, too. 

I’m talking, deep, improper, borderline rude belly laughs where you are snorting and thankful that you went to pelvic floor PT to rehab your pelvic floor so you don’t experience stress incontinence laughter. 

Don’t believe me? Google babies or toddlers laughing. Let your guard down and let yourself be silly, funny, and entertained. 

5 – Affection

Oh, lala! Affection as a way to complete the stress response cycle. Leaning on a deep connection with someone who loves us, respects and trusts us can do wonders to help you complete your stress cycle. 

It can be physical – a long, non-sexual hug can really help your body realize that it’s safe. John Gottman sites the “six-second kiss” as something you should be doing everyday with your romantic partner, if you have one. That’s one six second kiss, not six one second kisses. 

In preparation for recording this episode we started trying this – Dan, of course, insisted that they be seven seconds long because 6 just didn’t sound like enough for him – here’s why the 6 second rule exists, though, in case you’re curious.

Six seconds is too long to kiss someone that you don’t like/don’t feel safe and secure with. Kissing for six seconds make sure that you like, trust, and feel safe enough to let your guard down with this person. 

Let’s talk hugs – to have a really great, positive hug – hug someone that you love and trust for a complete 20 seconds while both of you are standing over your own center of gravity. 

Research shows that this nice, long, trusting hug – one that lasts 20 seconds – has the ability to decrease your blood pressure, heartrate and boost your mood. These things happen because of the oxytocin you release in response to the social bonding you experience as a part of your embrace. 

If you’re not into timing your hugs and kisses – you can hug until you’re both relaxed. Warning – this may feel awkward at first and can take some getting used to. 

No people around? Never fear – you can complete the stress response cycle with petting a cat or hugging your dog – these activities have also been associated with decrease in blood pressure and this social response that you feel loved and supported. 

Bonus points for taking a walk with your dog – exercise and social interactions with others you encounter but also with your pup! 

6 – A Nice, Good Cry

Letting your emotions out in the form of crying, sobbing, and taking those deep and cleansing breaths at the end can help to signal to your body that the threat is no longer of concern. 

7 – Creative Expression 

If you haven’t read the book Unicorn Space by Eve Rodsky, I’ll link it in the show notes – engaging in creative activities helps to complete the stress response cycle and helps you to feel more excited, energetic, and enthusiastic than before. 

Bringing it Home

You have to find a way to complete the cycle. Otherwise you will be stuck in a high stress cyclone forever where you feel like you are being chased by a lion eternally. Not only is that downright exhausting but it’s terrible for your health.

Move your body, share affection and laughter with those you love, take some deep breaths and make time to creatively express yourself. You don’t have to do them all and you certainly don’t have to do them everyday – but you do need to find a way to complete that stress cycle my friend. 

Simply telling yourself that all is well won’t’ work – you have to speak your body’s language – which isn’t, remember, English. Powering through or berating yourself to get over it and be strong and hustle harder is not the answer. 

Find the healing that you need on the other side of these strategies to complete the stress response cycle. 

First, find what works for you. What activities help you to no longer feel like there’s a lion lurking around every corner? 

Second, create a practice of taking time to check in with your body. This means turning away from the stressor, tuning in to how you are feeling, and giving your body what it means. It also means finding out what the completion of that stress response cycle looks like for you and being on the lookout for when you are stressed and when you complete the cycle to determine if your coping mechanisms are working. 

Third, you have to deal with the stressor – but that’s a topic for another day. 

You cannot keep living in this fight/flight/freeze state of the nervous system overwhelm. Eventually it will erode your mind and body until your wellbeing is nonexistent. 

Looking back now I can see that’s what happened to me when I was in the depths of my burnout. I hope that these strategies can help you to recover from or avoid what I walked through. 

Wellness is not a state of being, but a state of action. Each time you take a step towards wellness you are casting a vote for the whole, well, healed person that you want to be.