Take the Stress Out of Your Life

Jay Winner: Well, as a family doctor, I deal with stressed out patients on a day-by-day basis. In fact, the American Academy of Family Physicians once estimated that two thirds of the visits to family doctors are prompted by stress-related problems. Stress influences problems such as heart disease, hypertension, irritable bowel syndrome, obesity, control of diabetes, asthma, psoriasis. The list really goes on and on. In fact, almost anything, any problem that comes – that is seen in a family doctor's office can be made worse or exacerbated by stress. So I think, in a way, the question is not, why am I so interested in stress management, but why aren't all family doctors talking about stress management on a regular basis?

Part of the problem, really, has to do with how little time family doctors have. In 15 minutes, we're supposed to take care of a list of ten problems, so stress gets – it gets thrown to the bottom of the list. It gets ignored, and in 1992, I thought that really wasn't good enough. Just giving somebody a Valium wasn't a good plan for stress management. Really, I thought that I needed more time, so I started doing stress management classes. First my patients went, other doctors heard about it, sent their patients there, and it was a way to treat the whole person, not only the physical problem, but really the emotional component, the psychological issues, the social issues, that had to do with contributing to the physical problem. And over the years, I've continued to refine the techniques, so I think I've gotten some very effective, practical, simple techniques that people can learn to reduce their stress, improve their health, improve their work performance, improve their relationships, and really live more joyfully every day.

Rachel Salaman: Well, we'll be getting on to some of those tips later, but first of all, who gets stressed? By the sound of things, is it everybody?

Jay Winner: It sure is everybody. Stress is part of our wiring. When you think about it, it came from being a caveman, and a saber-toothed tiger would attack you. The people that didn't have this fight-or-flight, this adrenalin response were eaten by the saber toothed tiger. We didn't get their genes. Their genes weren't passed on. We got the genes of the person who started getting – started having their adrenalin release, and they just ran from the saber-toothed tiger. The problem is that on our day-to-day basis, we don't run into the saber-toothed tiger like we may – as a caveman did, we run into the saber-toothed tiger of the traffic jam, or our boss getting irritated, or a co-worker not doing what we want, or our children not behaving. Those are our saber-toothed tigers. However, it's rarely appropriate to run away or punch the person we're dealing with. We need to learn other ways to deal with this fight-or-flight response that has some purpose, but the usual ways that a caveman would deal with it is not appropriate for our lives.

Rachel Salaman: So is it possible to generalize about what makes people stressed out?

Jay Winner: Yes, I think people get stressed out often when things aren't going the way that they like things to be going, and that could be in a traffic jam, that could be when people don't act as they prefer they act. That could be when things are getting busier than they'd really like to be, so that is some of the components, some of the issues that drive this fight-or-flight response, this adrenalin response.

Rachel Salaman: Is stress always a bad thing?

Jay Winner: No not at all. In fact, I remember, there was one day when my – I have twin boys. Now they're seven, but I remember when one was probably only a few years old, and I'm in a bedroom upstairs with my wife, and I hear this cry out for help, and I'm sound asleep. All of a sudden, I find myself vaulting over my wife and getting downstairs, not going around the bed, just vaulting over. Boom, I'm downstairs in five seconds, and I think even if somebody had a stopwatch and tried to time me, and I was awake, I don't think I could do that again, but the adrenalin response hit in and I was down there. And, by the way, he was fine. It wasn't, you know, it was, you know, his blanket fell off, or something like that. It wasn't a big issue, but the point is, there are times when this fight-or-flight response is really useful, especially in these physical type circumstances, and this good stress is often felt as a feeling of excitement, and a feeling of enthusiasm. We've all been in circumstances where we're playing a game or watching a movie, or a rollercoaster, and we're really having fun, we're really enjoying it, yet that fight-or-flight response is still happening, but it's about excitement. There's times of bad stress is, more often than not, felt like a feeling of worry, a feeling of anxiety, a feeling of tightness in our abdomen, this feeling like we hate what's going on. So that's some of the difference between the good stress and the bad stress.

Rachel Salaman: The bad stress can have other physical manifestations as well, can't it?

Jay Winner: Sure, and as I was saying, it can – people can feel tightness in their jaw, they can feel their heart racing. They can feel cramps, insomnia, feeling like they're not getting enough air to breathe. There's a whole lot of physical sensations and, of course, then, if the stress goes on and on for a prolonged period of time, you're not only getting just this brief blast of epinephrine, but a lot of other hormones come into play. You get, for instance, high cortisol levels, and that's going to decrease your immunity and cause weight gain right around the middle, just where people probably don't want it, and the type of weight gain that actually increases the risk for cardiovascular disease. So this bad stress, yeah, yes, it does indeed have a lot of other physical correlates that go along with it.

Rachel Salaman: Now lots of people just muddle along, putting up with those vaguely uncomfortable feelings, the knots in the stomach, etc. At what point should they start thinking, well maybe I should do something about this?

Jay Winner: Yeah, you know, well, I think basically, everybody should do something about their stress. I think it's something that is a ubiquitous issue in our environment, and it's not something that, typically, people are trained to deal with in school, although I think probably they should be. So everybody has these issues. Some people are disabled by it. They're going to a doctor, they're going to a psychiatrist, and they're plagued by panic attacks, plagued by anxiety all day long, but even if you have a milder degree of discomfort, I think everybody would like to improve their relationships, would like to enjoy everyday more, would like to feel better; would like to be healthier. So I think everybody can use some simple tips on dealing with stress.

Rachel Salaman: A lot of your book argues that stress is largely about our own responses to situations, rather than the situations themselves. Do you think there's ever a time when we should try to change the external factors, rather than our internal responses?

Jay Winner: There sure is, and I think, a lot of times, a combination should happen, 'cause even when you make a change and you say, "I want to change this or that about my job," it's going to take some time. So, even as we're making external changes, we need to learn to enjoy the process, so to speak, without getting too stressed out. If people decide to give two weeks' notice at work, still that's two weeks that they need to learn to deal with that stress. But certainly, there are times when I've had people in my class, and they were being abused by a spouse, and they needed to get out of that relationship. Or a nurse, for instance, that had gone into an administrative position, it was more pay, it was more responsibility, and she thought that was a great thing until she really got into the job, and realized she missed the clinical part of nursing. So there are certainly times to make those changes. However, you don't want that to be the only tool you have, 'cause then people just run to make change to change. If you think you're going to find a job that's going to just fulfill all your desires and be everything you want, you really have to go to a new planet, right? If you want to find a relationship, a spouse, a boyfriend or girlfriend, that's going to act always the way you think they should act, treat you always the way you think you should be treated, then I think you really have to find a new universe, and it's not going to happen here. So we, in addition to working on these external changes, we need some other tools in our armamentarium.

Rachel Salaman: And one of the most effective ones, according to your book, is relaxation. What are the benefits of relaxing?

Jay Winner: Well, a problem can occur, not so much just a little blip of stress, but when stress builds and builds and builds, and stays up at a high level, so to learn to relax whenever you want to is crucial. I think a lot of people have had, at the end of their day, or when they're going to go to sleep at night, their mind is just racing, and they just can't relax. They just can't turn it off. So the first thing I like to teach people with relaxing is, first, to relax for a specified period of time. Can you just relax for five minutes, because that's a very, very, very useful tool? Whenever you have five minutes free, boom, you know, fairly confidently, you can just relax and you can just let the heart rate simmer down, just let the worries of the day go. Of course, that's not the only tool, because if you – if your boss yells at you, "Get in here right now," and you say, "I'm going to take a five – I need to take my five minute relaxation break first," you know, you might get a really extended relaxation break. So, in essence, first we want to learn to relax for a specified period of time, then we'll – once we've learned that, we can take those skills, and apply similar skills when, in essence, relaxing on the go.

Rachel Salaman: So what are some of those skills? What tips do you have for people, particularly those who find it hard to relax?

Jay Winner: Well one thing that's really helpful is learning diaphragmatic breathing to start with, so – and just to get a little sense of that, you can put your hand on your abdomen, and with each breath in, let the abdomen gently expand or go out, and as you breathe out, let the abdomen come back in. And you just then, focus on really enjoying and tasting one breath at a time, seeing if you can pay attention to the full in-breath and the full out-breath. Before long, you'll probably notice that your thoughts start deviating to this or that, to the exercise, to work, to home, but what you want to do is, not try to push away the thoughts, but every time you notice a thought, you just notice it come up and let it drift by, and just then, focus right back on your breath. If you have 100 thoughts in five minutes, fine, you just let them go 500 times, and then focus on a full in-breath and a full out-breath. The next thing you might do is relax one body part at a time. You can start with your feet, relax them; relax your lower legs; relax your upper legs, just a few breaths each. And then, as you go up the time, by the time you get through your whole body, you'll notice that both your body and your mind are feeling much more relaxed. And again, both through the website stressremedy.com, sometimes it's hard to get just by having it described, there is a free relaxation exercise on stressremedy.com, and then a whole series of them and the CDs that come with the book.

Rachel Salaman: Is there a best time of day to do a relaxation exercise like the one you describe?

Jay Winner: Well, I'd say people can do it in two ways. One is find a time of day when it's just part of the routine. So, maybe first thing in the morning, they roll out of bed, and before they get going on the day, they just sit up and notice their breath for a few minutes, and do a quick little meditation or relaxation exercise, or maybe before lunch, some time where it just fits into the day, once or twice a day. And the other option, too, is you can do it on a – you can do it on an as needed basis, when you feel like you're starting to get – you could really use a relaxation break. That would be a good time. Matter of fact, it's a great thing if people have trouble with insomnia you can use a relaxation exercise at the end of the day to wind down and help you get to sleep. One of the exercises is in the book, one of the exercises on the CD, is particularly geared toward people who are having trouble with insomnia and trouble getting to sleep.

Rachel Salaman: You mention in your book that repetitive chores, like photocopying, can be transformed into moments of relaxation. How does that work?

Jay Winner: Well, to get a sense of that, I think we first need to talk about mindfulness. When you think about mindfulness, you think about somebody fully enjoying life. You think about somebody having a peak experience, and watching the sunset on the beach, and just really enjoying it. And you think about a basketball player in the zone, and just – there's nothing else but playing basketball, just fully involved in the moment. Then the interesting thing about life is that you think how many ways can the present moment be? And really, right now can only be one way. Just right now. Boom, this present moment can only be as it is, yet a lot of us wake up first thing in the morning, and the first thought is, oh, I wish the alarm weren't going off now. I wish I could sleep more. I wish my back felt better. And then it goes on throughout the whole day. I wish the kids would act differently. I wish, you know, the boss would be differently. If only I wasn't in a traffic jam, and there's this torrent of thoughts throughout the day, and every time we keep wishing that the present moment were different, this, in fact, increases the stress level.

So, talking about doing a repetitive activity, and making it more relaxing, the way to do that is bringing mindfulness to it. So, if you start – and you can bring mindfulness to anything just by – if you start thinking, oh, I wish I wasn't in this traffic jam, just like with the meditation I talked about earlier, you notice the thought, you don't try to push it away. Just notice it and you let it go, and then you focus back on whatever you're doing there. You can focus back on enjoying that diaphragmatic breath we talked about. If you're eating, you can focus back on the food you're tasting and really, fully tasting it. If you're listening to music, you can really tune into the music and fully listen to it and fully enjoy it. Again, if the thought comes up 100 times no big deal, it's fine. The more the thoughts come up, great, the more practice you have in letting go of the thoughts. So when it comes to doing something like ironing or photocopying, or whatever it is, answering the phone, whatever this repetitive activity is, and you start thinking, oh, I hate to do photocopying. I wish I wasn't doing it, blah, yada yada yada, you let those thoughts go, and you focus back on feeling – on what you're doing right now. That photocopying, the physical – the sensation of your arm lifting the flap to put the papers in and the feeling of your arm putting it down, so you're keying into the present moment sensations. You know, there's these jobs that we think of as extra work. We shouldn't be doing that work. For physicians, for instance, one of the big ones is paperwork and dictations. I shouldn't have to do, you know, dictations. I should just be able to see patients all day. When you let go of those thoughts and then you do the dictations with all your presence, with all your force, like the presence of a stage actor, with all the enthusiasm. And then you can see – you can actually get into those activities and have those activities be, in a way, a relaxation break from that busy day, as opposed to a time to increase the stress.

Rachel Salaman: So you're really changing something stressful into something relaxing?

Jay Winner: Exactly. Exactly.

Rachel Salaman: Some people, especially busy people, will need reminding to be mindful, or even to do a little relaxation break, like you took us through earlier. You have some tips about how to scatter reminders through our everyday routines, don't you?

Jay Winner: Yes. What you want to do is find activities that you do on a regular basis, and one, for instance, photocopying, you could – you can make a list of these activities. Driving, every time you see a red light, when maybe a beeper rings, maybe your phone rings, and sometimes these activities would be things that would stress you out, but you can make a list and assign these, that these will be times that you take a mindful, relaxed breath, fully tuning into your breath. And then, you can imagine, if you're doing these – if these activities come up multiple, multiple times a day, each time will be a time for you to become more relaxed, as opposed to become more stressed. A lot of people, the phone rings and they have to run and just get the phone. Well, if they just took at breath first, they'd get to the phone almost as quickly, and the person at the other end would enjoy a more relaxed person to talk to. Some people have even, on their computer, put a little – in their programs, put up some little reminder that comes up every once in a while that it said, "Breathe," or something like that. I had one guy that even had a little timer, a little beeper-type timer that would buzz every once in a while and remind him to do those kind of things. So those are one set of reminders.

Another set of reminders is basically, any time you find yourself wishing that the present moment were different, that's another reminder to tune into letting those thoughts go, and enjoying the breath. And again, I want to make it clear, that doesn't mean that you shouldn't try to change in the future. Certainly, you should try to make the future better, but the present moment, that can only be as it is.

Rachel Salaman: You talk a lot about letting the stressful thoughts go. Now, this isn't the same as trying to stop the stressful thoughts, is it? Perhaps you can talk us through that difference, and why it matters?

Jay Winner: Yeah, and I think that is an important distinction. Years back, in psychology, there was a technique that some psychologists liked, called Thought Stopping. And some people would have a distressful thought, and they might snap a rubber band on their wrist or yell out the word, "Stop," trying to, in essence, stop the thought. The problem with that is it set up an antagonistic mindset. Even the thought, even the word, "Thought Stopping," that sounds, kind of, antagonistic. Snapping a rubber band, yelling "Stop." So the issue then becomes, as opposed to the person being stressed because of external circumstances, now they're stressed because they have too much – too many thoughts, and they need to stop the thoughts, and that can be a whole other area of frustration. So the idea is not stopping the thoughts, but just noting the thoughts, just noticing them. Matter of fact, if you want to, you know, if you've been bothered by a lot of thoughts about the traffic jam, whatever, you could even just note to yourself, oh, traffic thoughts. Thing is, you do it in a friendly way. As opposed to trying to push the thought away, you welcome any thoughts, because you know thoughts are very transient, flimsy things. They come, and they drift by. Trying to push them away just increases frustration. So as the thought comes, it goes by, and then you enjoy your breath, you enjoy the food. It's no big deal; it's not something that you aggressively want to try to stop.

Rachel Salaman: Reframing is a useful device for turning around a stressful situation. Can you give us an example of how that might work, particularly in a business environment?

Jay Winner: Sure, well, one of the more common things we have in business, for instance, is dealing with rude people, and I do an exercise in all my class, so it's been done with thousands of people. And I ask people, "Raise your hand if you've ever been rude in your life." And of course, everybody raises their hand. The next question is, "Raise your hand if, when you're rude, it's usually when you're happiest, and feeling your best?" And at that point, nobody raises their hand. And what we can extrapolate from that is, when people are rude, usually, they're suffering in one way or another, and that's a good reframe for us. That's a good way of thinking about it. When somebody starts getting rude instead of, "How dare they treat me like that," we can say, "You know, I wonder what's wrong with that person?" It can bring forth a little empathy, and then, thereby decreasing our stress and anxiety and anger. So that's one way. When we're really busy at work, I suppose, "This is busy. This is horrible. It's so busy," or, "This is a difficult problem. How awful," it can be, "A difficult problem or busy. What a challenge." We're – in a way we're waiting in an airport. You know, a lot of people travel with business, or in a taxi, wherever. In a way it can be very stressful. I have so many things to do. There's a traffic jam. There's a delay at the airport, yet we really know, at our core, that we have to do the waiting. We have to do it in order to get to where we want to get, or even get the groceries from the grocery store. So, one way to reframe that is, in fact, most of us are very busy, and we can think of the time's wait, as opposed to a time to stress out, as a time to take a break from our busy day. One of the more novel ways of reframing, that I thought was very interesting, is there were a group of receptionists that were being harassed on a repeated basis about people complaining, and complaining in quite a rude manner. So their boss has a great idea. He goes, and he says, "I'll tell you what, the person who gets the rudest call of the week wins a prize." And it changed the whole tone. So the receptionists now were saying, "Oh, you know, you think I'm a what? Oh, how do you spell that?" You know, they weren't taking it so defensively, and in fact, a lot of us are – a lot of people are in customer service in a way, and when somebody makes a complaint, it can be thought as opposed to a personal attack, as an opportunity to make a positive difference in their lives.

Rachel Salaman: Well it won't come as a surprise to many people that lifestyle is a big factor in stress, the amount of exercise we do, what we eat and so forth. Can you run through a few of the changes we might be making in order to be less stressed?

Jay Winner: Sure. Well one way is certainly finding balance in our lives. There's also getting regular exercise. Remember that the stress response was initially physical – to promote a physical response of physical stress, so regular physical activity can be important. And for people over 35, or with particular medical problems, you want to make sure that you get your physician's okay before going along with the medical – going along with the regular exercise. Basic time management techniques; I won't go into depth here for – because of our time management that we have to have with the interview, but I cover that much more in-depth in the book. Having social support, not just a list of who has the most MySpace acquaintances, really people that you can share your problems with in developing and nurturing those type of relationships. Avoiding excess alcohol, caffeine and drugs, and, of course, you don't want to be taking cocaine. That'll increase your stress and maybe give you a heart attack, but even drugs as simple as Sudafedren, decongestants, not that they should never be used, but you need to recognize if you're being stressed out. Maybe it could be the medication, and don't stop any medication though, without chatting with your physician first.

Nutrition is important. People, in general, don't want to skip breakfast, 'cause that will raise your catecholamines, your glucagon, those type of hormones, because they're trying to keep your blood sugar up. So you have a breakfast. You try to avoid refined carbohydrates, which is the refined sugars, the white flour, white bread, 'cause that will increase your glucose, and then increase the insulin response, and in the same way, subsequently increase the catecholamines and glucagons to raise the blood sugar, but also make you edgy. Things like having ethical guidelines are important, because if you – you don't want to spend your time being stressed out 'cause you didn't behave in a way that you think is in line with your values. So you don't want to waste your time feeling guilty and stressed there, so you want to be careful in how you make your decisions and do them in an ethical way.

Rachel Salaman: All really good advice, and most of us do aspire to have a good balance in our lives, but it's very hard to actually achieve it. Do you have any tips to how we can actually get there?

Jay Winner: Well the first thing is realize how important it is. One thing that I notice, and I think if you ask yourself, most people notice this as well, as we get older, time seems to go faster. You know, you're a youngster in school, and all of a sudden it feels like it takes forever for that second period bell to ring, but as we get older, it seems like, oh, what happened to that last year? Time just seems to fly by, and I think all of us – it's not going to be, in way, that, that long in the future before we'll be on our deathbeds, and doubt that we'll go ahead and start thinking, oh, if only I'd spent a little bit more time at work. If anything, we're going to be thinking, oh, if I only spent a little bit more time with my family and my friends. Don't wait till then. Go ahead and really enjoy the different parts of your life. Be firm, and set those limits, set those priorities. Don't have all your eggs in one basket, just, for instance, just at work. You need to really nurture your friendships, enjoy your hobbies, enjoy your family, even in different aspects of your family. If you have young children, you need time with a babysitter, or have them watched by a family member so you can have just quality time with your spouse. So I think one of the ways that we can make it really happen, is to realize how important it is. And once we realize how important it is, then you don't say, when somebody says, "Oh, let's have a business meeting at 7 pm at night," and you know that your child has a performance then, you don't say, "Okay." You know how very, very vital it is in this short life to enjoy all the aspects in life, and not just try to get as much as we can. Lily Tomlin said something once. She said, "In the rat race, even if you win, you're still a rat." You know, in essence, we really don't just want to be in the rat race. We really want to enjoy and treasure this very short life.

Rachel Salaman: Finally, do you have three top tips that will help us reduce our stress levels, without committing too much time?

Jay Winner: Yes, I'd say the first one would be mindfulness, learning to let go of thoughts about how life should be, and fully enjoying life as it is, what's right in front of you, letting go the thought, I'm overwhelmed, and just doing what's right in front of you with your full focus, and concentration and joy. Second one is reframing, particularly we talked about reframing waiting around, and reframing the rude person, and reframing the rude person as somebody that may be suffering, and reframe waiting around as a time where you can a break from your busy day. Finally, I'd say, something we didn't cover much is learning to keep things in perspective, and one of the main ways to do that is gratitude. It may sound corny, but truly, we get out of focus, and we can say things to our self like, "I am so grateful to have my health. I am so grateful to have my son in my life," and really picture your son's face. When you say things like that, and repeat it on a regular basis, that takes away this urgency, like, you're thinking your life and death situation, and really brings in the wider scope, the wider perspective, and that can help as well.

Rachel Salaman: Dr Jay Winner, thank you very much for joining me today.

Jay Winner: It was my absolute pleasure. Thank you very much.

Rachel Salaman: There's more information about Jay Winner and his work at his website, www.stressremedy.com, and the name of his book again, Take the Stress Out of Your Life. I'll be back next month with another Expert Interview. Until then, goodbye.