The Unburdened Brain: Stress Relief for a Healthy Mind

Amy Brann  00:00

Stress, it’s everywhere, from overflowing inboxes to sleepless nights. We can all be feeling it, but are we managing it in the right way? Maybe you try to power through, maybe you try to unwind with a glass of wine, or maybe you just keep telling yourself that next week it will be slower and easier. But what does neuroscience actually say about stress relief, is mindfulness really better than exercise? Can music or deep breathing actually change your brain and more importantly, can we prevent stress before it takes over? So today, we’re going to be diving into the science of stress with what’s happening in your brain and the real cost of not unwinding, and how to build daily habits that actually work with our usual real world examples. So if you’ve ever felt overwhelmed and thought, I just need a break, then this episode is for you. Let’s get started.

 

Dr. Jessie Gulsin  00:52

So Amy, come on, tell us, what questions do people normally ask you when it comes to stress? Because it’s such a it’s something that we can all relate to, isn’t it? And you know, why is it so important for us to pay attention to this?

 

Amy Brann  01:05

Well, when we’ve been preparing for these, Jeff, we’ve there are so much we’ve tried to break it down and focus on different things at different times. So Often I’m asked, What does the neuroscience say the best way to de stress is, is it possible to relax without resorting to unhealthy behaviors. Can we, can we manage can we prevent stress, or do we just have to manage it? And how can I incorporate stress relief approaches into more of a daily routine with my team? And the reason that I think people are naturally feeling like this is something that we want to address is because there’s lots of evidence that says it’s a big deal. So a survey by the UK Mental Health Foundation found 74% of adults felt so stressed that at some point they felt overwhelmed or unable to cope. 74% that’s, you know, three quarters. That’s a lot of people. According to Gallup’s state of the global workforce report, 44% of workers experience significant daily stress, and that’s the highest rate since the survey began. 30% of adults globally have experienced clinical level anxiety or depression linked to prolonged stress and the stress related health costs in the US are estimated to be 190 billion annually. So this is why we’re driven to try and help organizations and humans do things differently. But my guess, and I don’t know if you’re sure, Jess, but my guess is that you are seeing a lot of people in your clinics who are coming to you either explicitly aware that stress is the cause of their problems and wanting help or coming because of some physical ailment, but you might be able to deduce that stress could be influencing at least, if not causing that. So what are you seeing and what are you recommending?

 

Dr. Jessie Gulsin  03:04

Well, I mean, you’ve just, you’ve kind of summed it up nicely already. Amy, those stats speak for themselves, don’t they? Stress affects so many people. And actually, I’m quite, I’m actually quite surprised by the stats of 74% because I would have put it higher to be honest. You know, people present with stress in my clinic on a daily basis, number of patients a day. But not only that, outside of my outside of my clinic room, you know, in the staff room, staff members and colleagues, we all experience stress. And I think when it comes to kind of my professional role, yes, stress is such a key component to so many aspects of our health. You know, it could be that there’s this acute fight or flight response that’s kicking in because somebody’s, you know, directly affected by a specific stressor. There’s chronic conditions. So chronic pain, for example, stress can have such a significant impact on that and dealing with things like arthritis. And you know, not only that, not only when you have a specific diagnosis, but when there’s uncertainty around a diagnosis, you know, it doesn’t automatically come to light what somebody’s you know, diagnosis is, there’s a differential list, and there’s investigations and then potential referrals. So all of that uncertainty leads to kind of hidden stress. And then, of course, you’ve got the mood disorders, depression, etc, that you know, stress is a huge factor in those conditions, so it’s massive.

 

Amy Brann  04:30

Can we wind back then? Because I was just on a call with a client who was narrating a range of different workplace intensity, challenges, things that added to people’s load at work and made it more difficult and triggered their self reported stress levels going up and up and up. And a lot of certainly the organizations we work with take this really seriously. Want things to be different for people. They’re good people out there, and they really want things to be different. And the theme that I was noticing through all these different examples this, this very experienced professional was given, was uncertainty. So you’ve used that word uncertainty, and you know you’re mentioning about arthritic conditions and chronic pain, and you and I both know my journey with being diagnosed with an arthritic based condition. And the lowest point I experienced was that the loss of hope, so the uncertainty, yes, and I know the process, and I know you know the average time it can take for different conditions to be diagnosed, and even when you know that it doesn’t always help with the experience. So certainly, the most stressed I was was when I didn’t think anymore that it was possible to move forward with a particular treatment trajectory that I thought would help, and since I’ve gone on, it had helped. So that’s wonderful, but when you’re then dealing with either with patients or, I guess, personally, do you think we recognize that this uncertainty can be so challenging? Look, do your patients recognize that it’s the uncertainty that’s causing major problems?

 

Dr. Jessie Gulsin  06:17

No, not always, not always. I mean, I think when you’ve, you know, we use the example of pain, and you’ve been there when you’re in pain, it just is so overwhelming, you know. And if it’s chronic pain as well, and it’s affecting your every day, it’s, it’s difficult to really see the wood from the trees, isn’t it? You know, rational thinking goes out the window. And the uncertainty around a situation, whether it’s a diagnosis or whether it’s, you know, a workplace based situation, may not be obvious to you until you then talk about it and have those kind of open and transparent discussions with people. I think my role as a GP is obviously to be investigating these various conditions, but validating somebody and saying, look, it’s okay for you to feel this way. Uncertainty is all part of this unfortunate process. But we will get to a point where either we’ll say, yes, you have a particular diagnosis and these are the treatment options, or actually excluding things and saying, Look, you don’t have this condition. You don’t have this condition, and we can draw a line under that, and then having closure on a few of those things is beneficial for people. I mean, I, I think it all comes down to, there’s there’s one aspect, which I try to highlight to my trainees a lot, and I do use this with patients as well, but it’s about kind of reframing the situation, isn’t it? I think if we can look at things in a in a different in a more kind of positive light, which isn’t always easy when you’re feeling down in the dumps about something, and it’s a really difficult shift to try and adopt, but we can benefit from that, and we will learn from that. And my trainees definitely need to learn from experiences that are not going in the way that they’d like them to. But I guess what I don’t want might for my trainees is for it to be a wasted opportunity. You know, if they’ve had an interaction which didn’t go their way, or a patient was upset for some reason, rather than seeing as a negative on how they’ve performed, I like, I like them to see that as an opportunity for their learning with patients, I think it’s it is challenging, because there’s so many factors which are impacting them on a social level as well as a physical level, that I don’t obviously want to be going in all guns blazing and saying, Look, this is really uncertain, and you just need to accept that it’s uncertain. I think it’s a gentle approach and actually just saying, Look, I’m here with you on this journey, and we’ll take things one step at a time, and yes, I try my best to then vocalize my thought process so that they know that a, I’m listening and I’m present and B, they can then have clarity on where they stand in that that journey. But it’s difficult. It’s really difficult it’s really difficult when you’re when you’re in the thick of it. It is

 

Amy Brann  09:04

difficult. But I love what you said there is that you try and make transparent your thought process. And I think a lot of times in organizations, we keep a lot hidden from people, and that often isn’t helpful for stress levels. It might be that bad news is coming, but if we know the journey, as you’ve said, and the trajectory points the if then plans, that can really reduce stress, because we know, we know, and that then means that our brain doesn’t have to infer or create realities which sometimes are far, far worse. Have I had a personal experience last week where I was unsure about what might happen, and I voiced like my extreme concern was really bad, and when I voiced it, the person was. Surprised that I would even think that was a possibility that reassured me, no end, and now, when those situations happen again, which they will do, I don’t have to worry about that scenario, because I heard the shock and surprise in their voice that I was thinking about that. So that’s reassured me. So sometimes that yeah, that that clarity is really important. Okay,

 

Dr. Jessie Gulsin  10:22

and I’m the same, I’m guilty of catastrophizing, but I think sometimes when I when I think about or say out loud, like the worst possible case scenario, it’s always quite nice when that doesn’t happen. So so of course, I don’t want people, you know, my patients, or my trainees, to catastrophize, but I think when you think about the worst case scenarios, and then you don’t actually ever get to that point, it’s it’s reassuring. So yeah, just like you say, worth having these open conversations about things, isn’t it? So that

 

Amy Brann  10:58

leads me on. Then, how can we reduce our propensity for this catastrophizing which many of us can be predisposed to? And certainly, I know an activity your mum does has got a really great evidence base behind it, and she doesn’t do it because of the evidence base, but it’s, I think it certainly has served her very well over the years. So what does she

 

Dr. Jessie Gulsin  11:24

do? Oh, gosh, my mum is so dedicated. So she meditates. She wakes up at 4am to meditate. Amy, as you know, and I cannot even begin to imagine wanting to wake up at that time, you know, volunteering? Yes, I do get woken up at that time by my my son, but to voluntarily wake up at 4am as bonkers to me, but she does it. She does it every morning, without fail. And yes, at times she might fall asleep during her meditation process. But actually, the the act of getting up, having that routine and that structure to her day, it’s it starts her off on a on a good footing, and then she sits and she meditates. And what I what I’ve noticed, is, like, that’s an extreme for me anyway. That’s extreme, like, I can’t wake up at that time to do that, and she does it for a couple of hours. Again, I don’t, I value my sleep and so, and that’s another thing we’ll come on to later in this podcast. But, yeah, I wouldn’t be able to do that. But you know, what I have tried to do is take a snippet of that in in and incorporate that into my day to day. So I, I don’t think I’d ever be able to manage that length of time, but 10 minutes in my day. For me, again, I try to encourage people to do this where it fits in with their routine and their pattern. But for me, the best time is lasting at night, when my mind is racing, my thoughts are racing, and I will take 10 minutes just to attempt some form of meditation. It takes practice. You know, I’m not gonna lie to you. I’m definitely no expert on it, but it does. I have found it’s helpful whether I can do two hours like my mum in the future, I don’t think so. But, uh, 10 minutes is good for me for now. Yeah,

 

Amy Brann  13:08

and that’s brilliant. I love the the flexibility in meeting people where they’re at. The evidence based for meditation, lots of different forms of meditation is strong. Even the mindfulness based stress reduction approach has got really good evidence behind it helped lots of people. It can feel uncomfortable, but and different types of different studies have shown different increases in connectivity between different regions of the brain, but at the very least, you’re looking to see the prefrontal cortex engage and connect more deeply, more connections to regions like the amygdala, some in some instances, the insular but when it, when it when we increase the brain’s ability to regulate our emotions that can help us be aware of when we’re ruminating we’re catastrophizing and when it’s not Real. So we need to be able to interrupt that process. And when we’re in a mindfulness based state, we’re reducing the activity in the default mode network, which that’s not a bad network. A lot of people, I would say, need to increase their ability to access that network, but when it’s left almost to run away to its own devices, that’s when we could then start conceptualizing things that might be negative, especially if things are challenging. And they have found that even really short sessions, like five or 10 minutes, have helped people reduce stress, not only the perception of stress, but also reduce cortisol levels. And I think that’s really interesting. Both are beneficial, but really amazing if we can actually influence cortisol levels. So yes, there’s sometimes we can learn a lot from our parents,

 

Dr. Jessie Gulsin  14:49

right? Yeah, absolutely. And you know you say the soul we always talk about, we always talk about cortisol when it comes to things like exercise. But yes, you’re right, the evidence behind meditation. And you know, that’s that to me when I when I first learned of that, I was actually quite blown away by that, because we know that exercise is important. It lowers the stress hormone cortisol, increases our endorphins, but I’d never thought about it before when it came to meditation. So yeah, even more reason to try and incorporate it into your into your routine, the

 

Amy Brann  15:19

more and more I learn about the human body, I’ve sort of been diving into some nutrition stuff recently, the more modern nutrition stuff, not the stuff. Do you remember our year, year one nutrition teacher who wrote the book on the nutrition stuff that we had to study? But it’s moved on a lot since then, like so much. And one of the things that was really coming across in some of the latest research is just how finely tuned a machine we are, and how everything is so interwoven and sensitive, really. So it’s brilliant that we’ve got all these different ways that we can dial up and dial down our cortisol levels, and so there will be something that is the right fit for different people. My daughter the idea of doing mindfulness, I’ve tried a variety of different things, and she’s really rather unclean. That said she can go and sit at the top of a climbing frame looking out over a park for an hour, and that is her version of mindfulness. And she is in the moment. A lot of the time. You ask her, What was she thinking about? I’m not so I don’t think she’s activating the default mode network at those times. I think she’s being present. And she talks about the sensations of the the wind, the weather, on her, on her skin, on her body. So yeah, different things for different people, but I want to make sure we talk about sleep, because you mentioned sleep as being really important. And again, the evidence, if we’re not getting enough sleep, can really affect our cortisol levels, but our ability to handle stress. And again, sort of my personal experience, my daughter didn’t sleep, really for three years after she was born for more than two hours at a time, and the cognitive impact was absolutely massive. And the friction between me and my husband, we had a lovely relationship up until that point. Then suddenly we were both in survival mode and sort of fighting just yet it really felt like to survive with Yeah, behaviors changed a lot so, and that obviously, then fuels stress and challenge. So what’s your experience of sleep? And do people come to you saying, fix my sleep?

 

Dr. Jessie Gulsin  17:35

Oh, all the time. Amy, all the time. And you know, I feel for them, you know, similarly to you, my son hasn’t been the best sleeper. And, yeah, it’s, you can see why people use it as a form of torture, can’t you sleep deprivation? But yeah, people come to me all the time, and I think that. I think we’re a society now where we want quick fixes for things, and that’s, you know, there’s nothing wrong with that, and there are quick fixes, but it’s not sustainable to always want the quick fix. So yes, there are sleeping tablets and medications that we can take to aid with our sleep, but really what we should be focusing on, and what I encourage patients to do is practicing good sleep hygiene. And people who suffer with insomnia sometimes do roll their eyes at me because, you know they’re doing they think they’re doing everything that they possibly can, and they just want a tablet to help them. And yes, obviously, if it’s necessary and clinically appropriate, I will prescribe a short course of these medications. But really, we need to be building into our routine practices which are going to benefit us when it comes to sleep. So for me, personally, I know that the end of the day, when I’ve had a busy day at work and I’ve been talking to patients all day, interacting with colleagues all day, then I come home and my son’s rabbiting on at me because he’s excited to see me after school, after I come home from work, and he’s been from school, but really that evening time I I just end up scrolling on my phone before bed. So I have, I’ve stopped doing that, and I’ve replaced that with my meditation, and I’ve noticed a considerable improvement in my sleep. But going back to the exercise, actually, getting exercise is so important for sleep. I have such a full on packed day that I thought it was impossible to incorporate any exercise into my day. And my one luxury in life, as you know, is my PT, weekly PT session and my lovely PT. He holds me accountable, and he says to me, Jesse, there’s no excuse. You can find exercise moments in your day. And so he expects me to send him videos of exercising in my day. So it forces me to leave the surgery, go for a walk, and I have to video myself and send it to him. I mean, he must have a phone full of some very boring videos on my feet, but, um, but then, you know, it does. It gets me out, it gets me some fresh air. I tried to do this with a train. Me recently, not that we get much time to leave the practice, but there was an opportunity on this particular day to do so. So I took inspiration from my own trainer who I had a decade ago, and we had a tutorial, and we went to a park and we walked and we discussed cases and we debriefed and we brainstormed, and just being in that different environment. We were still working, but it was just really, it just really changed our tutorial. And I’d love to do more of those, but it, yeah, I think sleep hygiene, screen times, exercise, minimizing caffeine and fizzy drinks and all of the stuff that we we know about and read about. You know, this is out there for a reason. We just need to implement those changes really. And there’s also really useful apps now available as well for cognitive behavioral therapy. And, yeah, it’s from my personal experiences that I just make excuses for these things. I just actually need to do the simple things.

 

Amy Brann  21:03

Yeah, it’s really interesting. You say that, because often in organizations, people ask for, well, what’s the new science? What’s What’s the latest? And I love New and latest as well. But often people aren’t doing the basics. And as you say, the basics for a reason, and until we’ve got those down, layering on other things, there’s no point. And I like what you say about almost the honest conversation that we need to have with ourselves. We like to think that we’re doing all the things that we need to do, but quite often, we’re not. And we tell ourselves reasons, narratives, why we’re not and think that it must be something else, but until we’ve covered those things, it might not be wise to layer on something else. Yeah, really interesting. Okay, so social support is another area that can be really useful for reducing stress, and I’m glad that there seems to be more awareness over the impact of loneliness or exclusion. I mean, we’ve had a lot of research around this for many years now, but it’s certainly, you know, organizationally, it’s not always where people would like it to be. Psychological safety, you know, people feeling connected and included in things. We know that when we have healthy, positive social interactions, it can activate the reward network in the brain and the if we’re feeling excluded. Years ago, Eisenberg showed that the the pain networks within the brain can be activated so it can it can feel. We used to say, you know, sticks and stones won’t, sticks and stones won’t, no do break my bones, but words will never hurt me. But the reality is that the words really do hurt, and feeling excluded, it can feel awful for children as well as adults, and it’s such a main, major driver of children’s behavior, young children, but also, you know, very much, teenagers behavior. And if we, if we evaluate people’s react, reactions and decisions, not taking those things into consideration, then we’re missing a big part of what’s actually driving them. There’s social prescribing has been in the news again recently. Is that something that you’re a fan of? Do you think that’s a way that we can help

 

Dr. Jessie Gulsin  23:34

people? Absolutely. Yeah, social prescribing is such a an important aspect now of my work, I personally, obviously don’t, you know, I don’t have that role, but we do have social prescribers in the practice, and I refer to them all the time, because we know that, you know, if we have vulnerable patients who are lonely, you know, having that befriending, befriending service, or, you know, having that social and human interaction is just so important to then helping with their engagement with the management plans that I’m trying to encourage them to follow through with. And you know, just generally, their overall health and well being is, you know, exponentially improved when they are having those very important social interactions. And I mean speaking from personal experience, I mean, we will, we will remember COVID, gosh, it was, it was an awful time for everyone, and when we were going to work. I mean, obviously I don’t have the opportunity to work remotely the whole time, so I was having to go to practice, and we had a 11am coffee meet up in our waiting room. So we were all socially distanced, sitting in our waiting room, which ordinarily would have been full with patients, but we used that time where patients weren’t coming in. We had a hot shed, what we call the hot shed, to see patients in outside the building, but we would sit at 11am as colleagues, and we would use. Opportunity to have a coffee together or a glass of water, because it’s important to stay hydrated, and we would discuss cases, or we would just have a chat, and we would just connect with one another because we weren’t seeing anyone, and it was very isolating for people. So that was a tough time, you know? I hope we we don’t have that again, and if we do, then we must remember all of these lessons that we’ve learned and and that and that social connection so valuable.

 

Amy Brann  25:29

So I was just, I just finished that chapter in in the make your brain work book that looked at some of the impact of how organizations value or don’t value that social connectedness time, and it reminded me, years ago, I worked with a police force, and they were telling me stories, this is way before COVID, about how their social center, which was frequented on many nights of the week, but almost Always on a Friday night, people would come together, and they would debrief the week. They would talk about what they’ve learned. None of it was formal. All of it was informal and evoked by the individuals, but the peer to peer learning, the informal counseling, coaching, connecting that went on. The decompressing from the traumas of the week was so important. And when they took that away, took the physical space away, so that there wasn’t a central place for people to meet. The negative impact was huge on engagement, but also on everything else, and the physical environment, I think, is so influential on how we do things, and then the impact it has on us. And so thinking about that, when we’re looking to reduce stress in teams, think about, how are you using your spaces, and how are you bringing people together? And how does it trigger them to bring themselves together, because a lot of times we think we need to do stuff to people. But actually, you know your example of taking a trainee out for a walk to do a meeting, you’ve changed your physical environment, and it so changes the internal, internal environment. We know the power of nature. We won’t even, won’t even go there today, but, yeah, another environmental piece that’s just so influential.

 

Dr. Jessie Gulsin  27:27

And I think actually, as you know, as working styles have changed, and you’ve got hybrid working, and, you know, a combination of remote and face to face working, you know, we’ve got to kind of change with with the times, haven’t we? And yes, being face to face and being in the same meeting room as someone is very beneficial to have these debriefs. But we as organizations, I guess you need to just consider, if you are doing remote work and that hybrid kind of work, therefore building into the week times when people are in the building using that as an opportunity to then have these social meet meet ups. And doesn’t have to be very long, five minutes, 10 minutes and, yeah, just worth bearing in mind, isn’t

 

Amy Brann  28:14

it? It is. And a lot of organizations, I’d say, really are moving forward on that and doing some great things, and there’s, there’s always so much complexity and challenge around doing different things. Maybe one final area of research that I think’s really important to bear in mind is our cognitive load. And I saw something the other day, a paper on how even this effect was actually more pronounced in women than it was in men, which is interesting, but clutter around the home, and you could extrapolate that to wonder what effect it has in the working environment as well. But this study focused on the home has been shown to raise women’s cortisol levels, raise our stress experience of stress, just by having stuff laying around in our physical environment, and experientially, I really resonated with that. And thought, yeah, when I see stuff around my home, I think that’s a job for me to do, and it may not actually be a job for me to do, but it has an impact on us. So, I mean, I guess that’s outside the scope of a GP of, you know, say, what is the state of your house like? But in terms of

 

Dr. Jessie Gulsin  29:31

actually, it really isn’t. It really isn’t, you know, I think that this is why home visits are so invaluable for in our line of work, you know, it’s a window into somebody’s life and actually seeing somebody come to the surgery, for example, you know, an elderly patient who’s always very well presented, very smart, comes across as having all together, I could go and visit their home and see a completely different environment, which paints a completely different picture. So, yeah, I do as I do. GP, maybe not tell the patient to tidy up and clear up, but, you know, enlist the help of other services to help declutter and make the environment a safe environment. You know, that’s a fire hazard in itself, but yeah, I’m all for that. I first thing I do when I come in to work is is make sure that my working environment is tidy. Now I wipe down all my surfaces and I tidy up where, if somebody’s borrowed my room, I make sure that there’s no mess anywhere, because, yeah, a clear environment for me is definitely a really big factor in having clarity for my working day.

 

Amy Brann  30:36

Amazing. Okay, I feel like this is one of those topics that we could spend another day talking about, because there are so many different things, but we will put as much as we possibly can into the the notes, into the neuro nuggets and into the synaptic spark sheets, so that you can unpack and think about how what techniques you might want to add to your repertoire for stress reduction and what things you could experiment with in a team setting to really reduce the stress, because so much of our stress is influenced by our perceptions and how the information is being filtered into our brain, so then we can adapt. But if you did enjoy today’s podcast, and please share it with a friend or colleague who you think might also find it helpful. It’s one of the best ways to help us grow and reach more people like you.

 

Dr. Jessie Gulsin  31:29

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