Practical Techniques For Dealing with Holiday Stress
December 6, 2012 4:44 p.m.
Dr. Mimi Guarneri, cardiologist, founder of Scripps Center for Integrative Medicine
Related Story: Practical Techniques For Dealing With Holiday Stress
CAVANAUGH: Many people make a promise to themselves every year that they will enjoy this holiday season. Only to become overwhelmed with tasks and shopping and relatives and money worries. All of that adds up to stress, and stress can do more than just ruin your holiday. It can make you depressed and physically ill. A workshop aimed at helping people deal with stress is being held tonight at Scripps Memorial Hospital. Leading that will be Mimi Guarneri, founder of Scripps center for integrative medicine. And thank you so much for coming in.
GUARNERI: It's terrific to be here, thank you, Maureen.
CAVANAUGH: What is it about the holidays that triggers stress in people?
GUARNERI: I think you have to remember that stress is about your perception. Many people associate the holidays with all the things you said, rushing around, buying things, maybe I don't have enough money, overextending our commitments, not being able to cope. So when we have that cascade of things coming together, people begin to identify themselves as stressed.
CAVANAUGH: Right. Exactly. We commonly refer to people who seem maybe just a little bit tense as being stressed out. What's the difference between having a bad sort of touchy mood and chronic stress?
GUARNERI: I think the important thing to remember is we have things in our life that are challenging. So a challenge can be a good thing. Gee, I have to come and do this interview accident but I'm going to get there on time, and wee Donna have a good work. Stress is when we add another thing on our plate, when we exceed our ability to cope. And it could be acute. Happen instantly, and that could affect us. Or it could be chronic over a long term.
CAVANAUGH: So this sounds as if people is that you need to learn how to control in the choices that you make.
GUARNERI: Every day. That's what the workshop at Scripps is about tonight. How do I see life and what is my perception? My response to the things I see. Putting some tools in my toolbox that I can use right now, like deep breathing exercises, prayer and mantra repetition, learning some simple forms of meditation, even going out walking in nature. There are many tips and things that we can do to really transform the stress response.
CAVANAUGH: You see people every day who come to you because they have some health problem related to their lifestyle and so forth. What is your perception of how general or pervasive a problem, just stress, not bad diet, not anything else, just stress is for people who are trying to keep up a good, healthy lifestyle.
GUARNERI: It actually has been studied, 75-90% of all the visits we see in healthcare providers come from stress-related disorders. And if you think about it, Maureen, headaches are related to stress, high blood pressure, related to stress. Not being able to sleep at night, related to stress. Diabetes, high cholesterol, and the list goes on and on. So all of these things, be all of these medical conditions we see every day in our practice at Scripps for example, for many people what's driving the train is stress.
CAVANAUGH: How is this usual handled by the medical profession? Is it treated symptom by symptom?
GUARNERI: Well, unfortunately the way we were trained in western medicine is to think about it this way. We have an ill,y woo name it, then we have a pill. So the ill to the pill mentality. What makes integrative medicine different is to say let's get to the underlying cause of the depression, the underlying cause of the stress, underlying cause of the anxiety. And let's put things into place in someone's life. Let's give someone the tools to transform the way they respond to these situations. And that can be through yoga, meditation, mantra, prayer, singing, and so on. Many different paths to healing.
CAVANAUGH: Now, if someone came into your office and said I have bad headaches, and also they presented to you with high blood pressure and so forth, you would start to think to think stress has something to do with this.
GUARNERI: Absolutely. If I'm looking at hypertension, high blood pressure and headache, I'm thinking okay, let's change the food someone eats. Let's get you off the sodium, give you physically active. I may give you a medication. But I'm certainly going to factor in stress. And unfortunately, the classic way of treating this is to give people antidepressants. We have a $10 billion antidepressant industry and give people drugs which quite frankly are addicting. I'm not against medication. I'm just looking for other options.
CAVANAUGH: And the other options you were talking about, some of them sound a little strange. Someone goes to the doctor and the doctor basically saying sing.
[ LAUGHTER ]
CAVANAUGH: Tell us how these new techniques actually work to help people deal with things that before this time they couldn't deal with and they were stressed out about.
GUARNERI: Well, let's take a look at some of the research. Let's go to the evidence. If we take meditation, there's beautiful research in the literature that shows meditation lowers blood pressure as much as 10 millimeters of mercury. It improves insulin resistance, prediabetes symptoms, medication can lower cortisol levels. High cortisol is associated with inability to fight infections, for example. So we know from our post traumatic stress disorder research that we just performed at Scripps that healing touch and guided imagery decreases all the symptoms of post traumatic stress disorder. We know from the research that biofeedback, learning to breathe in and out, controlling your body's autonomic nervous system changes your heart rate variability, helps you to improve your thinking, decreases your blood pressure, improves asthma. The list is endless. So it's not just pie in the sky, oh, we're guessing at things. The research is there. It's my job as a physician to bring the evidence-based research into mainstream medicine, not just being the limited to drugs but to have both when we need it.
CAVANAUGH: Now, are these techniques tested against the efficacy of pills?
GUARNERI: Absolutely. Take our post traumatic stress disorder study. Will we were working with active marines in Camp Pendleton. 50% of whom were already on medication. And they were randomized to guided imagery and healing touch, for example. And they still remained on their drugs. And we had statistically significant improvement using what we would call complimentary or global healing techniques. And same thing with the meditation studies. People are on their medication. But we added something to the medication which was meditation.
CAVANAUGH: Do you ever get people off their medication?
GUARNERI: Certainly you can. You can get people to lower their medication. Most people want to have less side effects from medication, and it requires four things in life: You have to put food first. You have to really look at what you're eating, you have to be physically active. You have to look at how you respond to stress and tension. Two people can see the same exact thing and have a totally different response to it, and we'll talk about that tonight.
CAVANAUGH: I want to talk about that a little bit more right now! I was thinking about, okay, if you're dealing with chronic stress, I can see how these ways could help you lower your levels of blood pressure, and basically get you into a much more relaxed and healthy state. But when you are confronting, when you are actually in a stressful situation or one that you're perceiving as stressful, you're on a line long during the holidays, you're in a traffic jam, looking for a parking space at a shopping mall, really starting to get wound up about something that's happening in the present moment. How can something like this help me in that moment to feel better?
GUARNERI: We will do an exercise at the workshop tonight to address exactly this, but the first thing I would say is the minute that you identify that you're in that state, take a timeout. Recognize it. And the next thing I want you to do is breathe. 5 seconds in, and 5 seconds out. And as you breathe, you're going to shift the stress response. Your autonomic nervous system will respond. And then the next thing I want you to do while you're breathing is to think about something you love or appreciate, maybe you have a grand baby or a new puppy or something that really brings you the sensation of joy and love and automatically, you're going to see how your whole perception changes. Even if you're in a room, in a business meeting, you can do your breathing. No one has to know you're wreathing slowly, in and out. So these are the kinds of technique we'll teach tonight.
CAVANAUGH: If you know that you are prone to acting badly in a particular situation, and we were talking before about managing stress often comes down to the idea of making the right choices, is it wise to sometimes avoid those situations if you can?
GUARNERI: I think it's important to know what your triggers are. I know for me personally, if I get a voice loop on a telephone and you just keep hearing that over and over again, I start to feel stressed! So if you put into place, yes, you can avoid but we can't avoid life, Maureen. It's really not what people do to us. Stress is how we respond to the outside world. It's our ability to cope. And we have to improve our resiliency. And there may be a point where we have to learn to say no. I have enough on my plate. Can't do anymore. Maybe I can do this at another time. We also have to look at how we're handling all of those things that life throws us.
CAVANAUGH: Right. When it comes to actually making plans, and I'm going to talk about the holiday season, because that's what we are in right now, a lot of people think if they do more, if they extend more, if they buy more presents, if they go more places, they are actually going to have a better time. Do you think people should expect maybe a little less from the holidays and decrease their stress that way?
GUARNERI: Absolutely. I don't want to turn religious on you, but I think we have to remember why are we celebrating the holidays? We're grateful for the Chanukah candles which never burnt down. We're grateful for the birth of a spiritual leader. We have to really look at what is important to us. And one of the things that we'll talk about tonight is practicing appreciation, practicing gratefulness. Instead of buying holiday gifts, we go and serve food at the food bank. Maybe we go and buy food and bring it to the food bank. Service is something that makes us feel good. I know I don't need one more gift or trinkets the my house. But if someone says I brought food to the food bank in honor of your name, or I served food and that's my gift to you, I'm touched. My heart is open. I think we need to think more in that way instead of getting caught up in all of the alcohol and the spending of money that many people don't have.
CAVANAUGH: Now, when you are punishing yourself getting stressed, when you start to feel it, and you start to feel it often you start to feel you're having symptoms from this particular tenseness in your life, when do you know that you should see somebody about it? Is it enough for someone to just tell themselves to calm down on their own? When do you really start to know that this has become a potentially bad problem for your health?
GUARNERI: Right. Many people will recognize that they're on overload this way. They'll say I'm losing my memory. Very common side effect. I'm not sleeping well at not. My fuse is short. I'm angry. The kid comes in, our kid comes in and says something simple, and I jump and yell at them. I'm saying things I regret the second I say them. You're on overload, and you need to put the brakes on. And if you don't have the tools in your tool box, you come into a place like Scripps center for integrative medicine, and we teach you, we train you, we guide you. In western culture, we're not trained to do many of these things which transform the stress response.
CAVANAUGH: If you were to tell me about someone who was losing their memory or who was snapping at people and saying things that they didn't want to say, I would say that sounds like an emotional problem. Maybe some sort of psychological problem. But when you're saying is this is a physical problem due to stress.
GUARNERI: It absolutely can be due to stress. That doesn't mean when somebody comes in and say I can't remember that we don't do the proper medical evaluation. But this is classic signs and symptoms of stress. Of
CAVANAUGH: Are patients becoming more open to the concept of integrated medicine?
GUARNERI: Our patients are very open to the concept of integrated medicine. And to remind people, integrated medicine is about getting to the underlying cause of the problem. If someone is diabetic, it's about eating the right foods, and decreasing stress. And the nice thing about integrative medicine is we use western allopathic medicine. We use medications. If somebody needs surgery they go to surgery. But at the same time we really rely on lifestyle change, herbal medicine, are yoga, meditation. The path for healing is different for everyone, and we need to help people find their path.
CAVANAUGH: Are you measuring outcomes using integrated medicine against those that just use as you said the usual pill to the ill format?
GUARNERI: Many studies have done that. One of the largest diabetes studies looked at medication alone and compare today to exercise and lifestyle change, nutrition, versus placebo. Those who did the integrative approach of proper nutrition and exercise did the best. So there are many, many studies. And I'm not saying we have to get rid of what we do well in western medicine, but where we're really failing in healthcare is in prevention and in how we manage chronic disease. You cannot manage chronic disease with 16 pills a day. It doesn't make sense.
CAVANAUGH: What would you recommend for someone who finds stress is causing them to be overwhelmed this time of year? Is there a point where you need to reach out for help either from integrative medicine or some sort of medical practitioner because this is just no longer a problem you can handle on your own?
GUARNERI: Yeah, I would say to those people feel like they can't cope, just put the brakes on. Stop. Take a look at your schedule. Look at what you can realistically accomplish. I have the serenity prayer in my office because people are always trying to change things they have no control over. And it's a reminder. What do I really have control over, which is ultimately only me. How do I start to restructure my life and put in those things that are important, spending time with children, with family, and so on. And we're here to guide people if they need help.
CAVANAUGH: When you start to present this approach to a patient who comes to you, what is the biggest hurdle that you have to overcome? Is it changing diet? Is it changing attitude about meditation or weaning them off their medication? What do you confront most often?
GUARNERI: It depends on the individual. Most people know what's going on with them. You know your own best physician. When I start talking to them about stress, and I tell them stress is causing you to overeat, stress is causing you to overdrink, it's causing you to use your credit cards too much. It's a cause of all the addictions we see, people get it! So it's a matter of what's going to be a path that they can resonate with. Not everybody wants to hear about meditation. Someone else might be very comfortable praying the rosary. Someone else might want to go back to singing. You laughed at singing, but there's huge research, if you're dancing you're probably not depressed or stressed, right? So there are some things that can be quite principal.
CAVANAUGH: Well, much more on this topic is coming up tonight at a free workshop on transforming holiday stress into strength. It'll be held tonight at 7:00 at Scripps Memorial Hospital. Registration information is on our website at KPBS.org. Thank you very, very much.
GUARNERI: Thank you.