Cheryl Martin (Host): Life these days is getting busier and more complex, and that reality can produce stress, manifesting itself in many ways. So, how do we cope? We'll get some tips for managing stress from Dr. Amber Tebay. She's a clinical psychologist at Memorial Health System.

This is Memorial Health Radio with Memorial Health System Ohio. I'm Cheryl Martin. Dr. Tebay, I'm so glad you're on to discuss this topic, because so many people are living stressful lives these days. Glad to have you on.

Dr Amber Tebay: I am very glad to be here. Thank you for having me.

Host: So, what are some of the top stress triggers?

Dr Amber Tebay: Oh, goodness. Just living, in general.

Host: For one.

Dr Amber Tebay: Yeah, exactly. Stress management is such a broad topic. I can go on and talk about 50,000 different things. So, I kind of ask questions to people out in society about what things that they would benefit when I discuss anything regarding stress management. So, the thing that I found interesting was a lot of people have a hard time with saying no to certain things. So, that goes with like work-life balance, family responsibilities, dividing their time, I guess. So, time management would be a big one.

But there are so many factors. Work-life balance is huge. Trying to find time balancing between being a parent or being a child to an aging parent or school schedules with children, extra activity schedules that they have, so sports activities, and then also balancing time for yourself, exercise, diet, drinking water, religion, spirituality. All of these different things, I think that everybody kind of has a hard time balancing.

Host: In light of that, how would a person know? How would stress manifest itself in a person?

Dr Amber Tebay: One of the main things is feeling fatigue and irritability. Those are some of the things that kind of present initially that I have a lot of individuals come in and describe. "I just feel like I have no motivation to do anything anymore," or "I'm becoming more irritable," or "I can't sleep," or we start to lack on self-care more. And sleep is probably one of the biggest ones I hear, that, "I'm not sleeping very well." So then, we'll kind of start to explore what might be going on and then you know go a little further from there.

Host: So, can a change in lifestyle then improve your ability to handle stress?

Dr Amber Tebay: Absolutely. But that's kind of hard, behavioral change is hard. So when I go do any speaking activities regarding stress management, I can tell you six specific lifestyle management factors that can help. I know that that can seem overwhelming to some individuals. But regarding all of these six factors, there is like little things that you can tweak here and there.

Host: So, please share some of those tips.

Dr Amber Tebay: Okay. Well, the first would be hydration. Our brain cells are comprised of 85% water. So, when I start discussing how we have to restore our brain, I tell people to think of it like a battery cell, where the tippy top of our charge is going to be the frontal part of our brain. So, in the frontal part of our brain, that's where we have thinking, our emotional state, higher order processing of information. So if that starts to be diminished in any way, those capacities are going to be impacted as well.

So, something that I recommend is making sure you're drinking at least half of your body weight in ounces per day with a minimum of two liters per day. The second would be nutrition. Now, nutrition is hard. We have all of these things out there in society now, like "This diet's better, blah blah blah." I tell everybody that we don't want to focus on that because everybody's body is different. Everybody has different needs that this person might not have and so on and so forth. So, if I could give the best advice for this, It would be to focus on finding things with sustainable energy, more vegetable-heavy, not unprocessed foods would be better, whole foods is priority, and cutting out as much sugar as possible. Now, I don't want people to come at me about the carbs. I am here for carbs and that's fine, but it's more related to the processed sugars that we have. I encourage people to look at food like fuel. If you have a V8 engine, you're not going to want to put diesel into that engine because you're not going to have it perform and it's not going to function well long term. So if you can start to look at food going into your body as fuel in that way, that can sometimes help.

The third would be sleep. Our body needs a minimum of seven hours of sleep at night for optimal health. If nothing else, the periods of time between 10:00 p.m. and 2:00 a.m. is when we experience optimal physical repair. So, these are the peak periods of nighttime when our body is fully restoring itself. So to reflect back on that battery charge that I described with hydration, it's very similar with sleep. If we don't get enough restorative sleep at night, we will start to have problems in cognitive functioning, which will impact throughout our day. A lot of people struggle with getting to sleep and, if they have a lot of things on their mind, it can take them from that.

So, several different strategies I can throw out there. Writing things out before you go to bed. If there are things or thoughts or worries or stresses, just get them out of your head and putting on something tangible can be beneficial for you. Another strategy would be a progressive relaxation strategy, where you lay in bed and you tense all of your muscles from your head all the way down to your toes, so each individual muscle groups. If you could do that, that's something that does help. There is also another strategy where you lay on the floor with your bottom up against the wall and your legs up the wall. And this is actually an inversion strategy that helps to regulate our nervous system. So, you could do this at any time, not just before bed, but it also helps with getting your body regulated when you go to lay down to rest, to be more rested. Another strategy would even be guided meditation. I encourage that a lot. There's an app it's called Insight Timer. I value that app so much for so many reasons, but that's one I recommend to a lot of people.

So, the fourth is movement. There was actually a study done in 1999 with Duke University where they found that exercise was just as effective as antidepressant usage. So, there were more studies done following this to show that physical activity assists with relief of anxious distress, as well as depression.

The other interesting piece of this was six months following this study though, the individuals that found improvement with physical activity, they were the least likely to relapse in significant depressive symptoms. So, moving our body is so important. It positively influences neurochemistry, neuroplasticity, and neurogenesis, which allows us to think better and faster, be more creative, experience less brain fog, improvement in problem-solving. And it also helps with the structure and functioning of our brain in general. It helps with increasing memory, verbal memory and learning. So, I'm not going to say go out and start running a marathon or you have to do anything crazy like that. The minimum is at least 150 minutes a week of moderate exercise. That's not completely programming a whole regimen for you. That's just focusing on just getting up and walking. I encourage people to do this after dinnertime, especially. If you can go and just walk for 20 minutes after dinner, and that helps with family time and all of that. It also helps your body process and also preparing for bedtime too. So, that's not going and doing a big jog. It's just walking. That's an easy way to kind of slide that into your routine.

The fifth would be thinking. The final two that I'm going to talk about are probably the hardest areas for people to kind of get a hold on sometimes, but they're also the most empowering, I feel like. So with thinking, stress begins in the mind. We produce approximately 68,000 thoughts a day, and 90% of them are negative in orientation. So, the majority of them are things that we're focusing on from the previous day or we're ruminating about things from when we were 12 years old, or like things that are happening that could potentially happen in the future.

So, one of my favorite quotes from the Buddhist community is, "If I have control of my mind, I don't need control of anything else." It is a very empowering statement for me because realistically, in any moment, all we have control of is ourselves. We are always going to have adversity. We are always going to have hard times. Life is not easy, everybody has problems. But if we can find a way to manage this in our mind, then that is probably the most beneficial thing that we can do and realizing that we actually have more control with that, I think, is beneficial. So, how do we do that? I could sit here and tell you like a little worry tree that I have. But the main thing to really think about is focusing on the areas of control, recognizing is this something that I can fix in this moment? Is this something that I have the ability to impact change?

 In reality, there are so many things that we don't have control over. So if we could give weight to more of a matter of what's going to make me feel better about this situation or what can I do that might not impact here, but what can I do for me that would make me feel better about it? So, I work with individuals that have been in remission from cancer, for instance. So, thinking about that. They're always in a constant state of worry and preoccupation that they're going to get sick. Realistically, we don't have control of that. Our body kind of does its own thing and things pop up.

So, the thing that I encourage a lot of people to do is taking control of the things that they know that they can do to ensure they are healthy. Anybody that has a fear of death, for instance, same kind of thing. Taking responsibility and making sure you are healthy, doing the things you know you can do to make sure you maintain healthy and healthy lifestyle and risk assessment, you know, not putting yourself in dangerous situations. And also, focusing on the time you have, how you are spending that time and making sure you are enjoying time with people that you love and care about.

And the final one would be breathing. This one seems so silly to people. I mean, this is something we involuntarily do. Our body just naturally does it to take care of us. Yes, absolutely. But it is the one thing that changes when we start to experience stress in our life. When we experience stress, it takes two seconds for stress to reach our adrenal gland and release adrenaline and cortisol. And in that moment, our breathing begins to change because it is enacting the sympathetic nervous system reaction. But again, just like with our thinking, our breath is always here for us. If you can focus on regaining control of that, it will automatically begin to regulate your system.

So thinking about babies, how stressful everything is to them. I mean, everything's new, everything's stimulating, everything's overwhelming. They're trying to survive without being able to tell you what they need. That's a lot. If you can reflect on a time when you've been around a baby and you've heard them breathe in when they get upset or worked up, they actually have a natural reset breath that is helping them regulate our system. And it's actually one that I teach people in my office. They take two very rapid inhales and a strong exhale. And it is a way that our body's nervous system actually knows how to reset itself and regulate. So, that's one that anybody can do when they start to feel kind of stressed or overwhelmed.

But another one that I do recommend that is actually done very prominently in our military community is called box breathing. It's simple and I can kind of describe that here and hopefully maybe people can do it while they're listening. But you take a deep inhale for four seconds. You hold at the top for four seconds. You exhale for four seconds. And then, you hold that at the bottom for four seconds. And you complete that cycle, I say, for a minimum of four turns, and then kind of see where your body is. It helps you naturally regain regulation of what's going on in your nervous system if you are feeling stressed and overwhelmed. And there is a significant improvement in experience of anxious distress in those moments when we do utilize that strategy.

Host: I was actually practicing it when you gave it, so thank you so much and I will continue to do that.

Dr Amber Tebay: Yes.

Host: In our remaining time, let me ask you, when would a person know that it's time to seek help from a mental health professional like you in dealing with stress?

Dr Amber Tebay: I would say the moment they start to recognize they aren't caring for themselves or they're feeling like they don't want to do their basic needs. Some individuals would say, "My sleeping is declining. I don't even want to make food or make dinner. I'm irritable. I'm becoming short-tempered," just more anxiety, feeling anxious, sad, any of those feelings.

Host: It's when they realize they need help.

Dr Amber Tebay: Yeah, or even having others encourage them, recognizing, "Is everything okay? You seem overwhelmed" or "You seem like you're stressed," because a lot of times people will be open about that, especially loved ones.

Host: What services do you offer at Memorial Health?

Dr Amber Tebay: I provide therapeutic services, so psychotherapy, as well as psychological evaluations.

Host: Anything else you want to add about what's available at Memorial Health for those who want help managing their stress?

Dr Amber Tebay: We have wonderful resources for our therapy. We also have nutritional services where if you are seeking help and guidance with nutrition and getting a better handle on that, you can call and get set up with someone to review that with you. Those would be good outlets.

Host: Dr. Amber Tebay, thank you for sharing some great tips for managing stress. I know I learned a lot. Thank you so much.

Dr Amber Tebay: No, you are so welcome.

Host: And that wraps up this episode of Memorial Health Radio with Memorial Health System. Head on over to our website at mhsystem.org/services/behavioral-health for more information and to get connected with one of our providers. Please remember to subscribe, rate, and review this podcast and all other Memorial Health System podcasts. And thanks for listening to Memorial Health Radio.