Melanie Cole, MS (Host): Welcome to Conversations with MIT Health. I'm Melanie Cole. When you're on campus, the stress level can run so high. Here to tell us about cultural differences in stress management is my guest, Dr. Showlu She. . She’s a psychologist at MIT Student Mental Health and Counselling services. Dr. Hsi, you’ve been known to say that stress is normal and natural and not necessarily bad. Can you explain that for us? 

Xiaolu Hsi Ph.D. (Guest): Oh, absolutely. This is actually one of the things that many of us either don’t remember or don’t know because we’re raised to know stress as something really bad. People don’t remember stress which is becoming alert and alarmed about changes or something difficult or challenging. It’s actually very adaptive and evolutionally necessary. I often compare this to the sensation of pain because if we can't feel pain, frankly our species would not have existed because we would have died of minor injury. So if we cannot be scared, we probably would be eaten up a long time ago. So stress’s alarm signal is actually very, very important. So that’s why I want people to remember before they want to learn how to manage their stress, that stress is actually very adaptive. It’s a very useful tool. We just have to learn how to use it.

Host: We certainly do. What a great explanation Dr. Hsi. So women deal with stress differently than men. Children deal with stress differently than adults. Tell us a little bit about the cultural differences in managing stress.

Dr. Hsi: Yes. Many cultures, like how they handle many different things, they have different values and attitudes towards the certain kind of life experiences. Although, I have to say, if you take the names off, a lot of people will claim to say, “Yeah, we do that too.” One of the things I wanted to point out is, I need. In a lot of cultures, particularly mine—I'm Chinese—that we place such a value on being stoic. Meaning that you need to be very strong. So the signs of maturity sometimes—not sometimes actually in Chinese culture anyways—is understood to be very stoic. That you do not experience emotional reactions to difficult things. You just handle them. If you can't actually suppress the reaction, you're supposed to kind of hide it at least.

Of course, God only made us human. Whichever culture your from, we are made human by God knows what. So you inevitably would have reactions that we can hide, and then sometimes we experience them as an emotional expression. Sometimes you experience them as a physical sensation. So in this sense, the emphasis placed on being stoic, of not either experience the emotion or not showing them, can be counterproductive.

Host: That is so interesting. As someone who’s Jewish, we were taught to let our stress out and yell and scream and get it out, which I don’t know that that’s necessarily any better. Certainly we all have our different ways of dealing with it, as you said. Are there some unique ways that you’ve seen that stress manifests itself in MIT students specifically?

Dr. Hsi: Oh, absolutely. For instance, sleep is one of the difficulties. The students may not say I can't sleep. They just say, “Oh, I go to bed very late.” Sometimes we look at the schedule and say wait. You thesis are done. Why are you still up? But a lot of times the anxiety keeps them up. And there’s certainly people that stress eat. People sometimes stress exercise, although exercise can be quite helpful. Then sometimes people take on so many things. So they're so exhausted they cannot feel the psychological, the emotional distress of feeling anxious, feeling inadequate, of being scared or feeling sad, or being homesick. So these are often the things they do. They find ways to either push the stress quite far out of the side or they're simply too exhausted to feel anything.

It’s not uncommon the student will come to counselling and after a few sessions will say, “I figured this out. I just have to keep busy. Now I'm taking seven classes. I'm okay.” Unfortunately they come back in very different ways. They don’t come to us, which is on the third floor. They go to the urgent care, which is on the first floor. So all stress has to go somewhere, has to be expressed somewhere. So if it’s not in the heart or in the head, it’s going to be in the body.

So there's a model we call in psychiatry and in clinical psychology. We call them biopsychosocial model, meaning our being is made of biology, of psychology, and environmental factors. So this is how our stress will be expressed one way or the other.

Host: What a great description. So tell us some of your best advice for self-help techniques for managing that stress. What do you recommend for students?

Dr. Hsi: You know, it’s funny because probably most people would expect me to say, “Oh, if you're stressed out, go talk to mental health people.” I love the MIT students. I always think they're the best of this university. Of course we’d love to work with them. But believe it or not, before people actually think about going to a counsellor or before people end up frankly in the urgent care for really being run down with a third cold in a month, there are things that they actually can do. My advice may be a little bit idiosyncratic if downright weird, but this is something I actually have known ever since I came to MIT. MIT has made me an expert in this aspect for better or for worse. What I'm referring to here is adequate sleep.

You won't believe how little people know about what sleep can do for you and what sleep deprivation can take away from you. The basic sense is—People used to say—I've seen the changes in attitude. I'm very pleased. People used to I’ll sleep when I'm dead. I would mumble under my breath and say you will be dead if you don’t sleep, which is actually true. But if you think about what MIT students have to do, this is a place with very intense intellectual academic cognitive demand. You simply have to use your brain. If you're sleep deprived, it’s a little bit like half of your cells are locked behind a vault you don’t have access to.

Now if you cannot do your academical work and you are here as MIT student, I don’t think anybody needs me to tell you what happens. How are you gonna feel about this? So often people would say, “Oh my god. Maybe I'm not smart enough for MIT.” I say no. You just haven’t slept enough at MIT. Now what is enough? Students would say, “Oh, I sleep a lot.” I've learned to ask how much is a lot. They say six hours a day. That’s moderate sleep deprivation.

Now when you're sleep deprived, regardless if you have academic demand or not, it is a sure road to anxiety and depression. This is what we do. You look at new mothers. One of the reasons is because they're so sleep deprived. Their sleep is so fragmented. See, it’s almost like when people get stressed out. The first thing they need to look at is are they sleeping adequately? Adequately is at least seven and a half to nine hours. Now, I know that makes me sound absolutely deranged. Who’s getting this kind of sleep? Well guess what? A lot of people are stressed out. I actually place sleep before exercise and eating. I'm not saying exercise is not good. I'm not saying eating is not essential. But if you are moderately to severely sleep deprived, exercise is not going to give you the kind of cognitive efficiency your sleep deprivation has taken away from you. Not to mention when you're sleep deprived, your immune system’s going to be compromised. You're going to constantly get sick as well. Guess what? That’s going to make you miss classes.

Also in terms of stress level. People often when they are exhausted, they say I can't think straight. They're also that much more irritable and things feel that much more impossible. Sometimes people just burst into tears because they're so exhausted things feel overwhelming. I cannot tell you—I'm sure a lot of people have this experience. They feel so overwhelmed, they feel so depressed, they feel so helpless, they feel like they want to drop out. Okay, never mind. I'm going to bed. They wake up the following morning and say, “Well, guess what? This doesn’t feel that bad. What happened?” Well, you got some sleep. So that’s one of the most important things people should check in. Of course if you're stressed out, your sleep will also be really disrupted. So learn some ways of how to have good sleep. Plenty of things you can google. Our wellness center provides plenty of tips as well. Suffice to say, that’s the first thing I want to look out for.

Host: What a great description of how important sleep is because it is so important. As you say, it increases our likelihood of getting sick and crying, tears. We’ve all been there. Thank you for that. What else besides sleep when you talk about exercise? Things like yoga, meditation. Are there any foods we can be eating that can help reduce our stress levels?

Dr. Hsi: There are plenty of things people can do. You mentioned yoga and meditation. Those are all wonderful ways. A lot of times, really in terms of the stress management. What I want to encourage people to think about is how to incorporate this into your everyday function because the reality is when at MIT, you're very busy. So eating right definitely would be helpful. People often ask me say, “What happened to me? I always have this—Between my 1:00 class, I can never stay awake. I just can't function, can't think straight.” Well guess what? That’s actually the natural first dip in your circadian rhythm. Taking a break, taking a walk, or shut eye for 10 minutes can be very, very helpful. Spending time with people will be very helpful. Taking yoga classes with your friends will be very helpful. Taking Zumba classes or just exercise together.

Whenever I encourage people to exercise, I always ask them, say, “Do you think you can find friends to run with you?” Because the benefit you get from that is even more than just running on your own. I made an acronym of stress management; I call that SIPS. Like sips of water. S-I-P-S. First S, I'm sure you know, means sleep. I means interaction, which is socialization. P means what? Means physical. Physical here doesn’t actually mean exercise per se. It would be great if you can work out, but a lot of times we don’t have time to. Have you never noticed in office, in order for you to get that thing that comes out of the printer, you don’t get up, you wheel your chair over. What if you just get off your chair, actually physically move over there? The kind of thing we do these days have reduced so much of our mobility. Take a long way to your class. I would ask people instead of you kind of leisurely walk over with your friends, how about you walk over really fast, as if you're late for important appointment? Because this actually, when you pant a little, sweat a little, your heartrate goes up enough you actually can get a little bit of vascular benefit from this brisk walk. Imagine if you do this every day, you have something in there as well.

The last S stands for separation, meaning putting some distance between you and everything else around you. MIT should not be the end all, be all for you. I know that’s very difficult to do, but how about making friends from other schools? Getting off campus and doing other things as well, making connections with other things and other people, volunteer, and do things that’s not just about your thesis and your grades. I think this is the kind of things that’s entirely possible to do. Most of all, I think it would be really helpful for people to remember that being stressed is not a sign of weakness. Help seeking is something that should have built in with us, that we should not dismiss as a sign of weakness. Really help seeking can improve the chance of success and of survival.

Host: So true Dr. Hsi. What a great educator you are. What services are available to MIT students in general, and to Asian students specifically to help combat stress?

Dr. Hsi: Plenty. A lot of really just learning the basic stress management and wellness helps. We have a wonderful, wonderful community wellness center. You can schedule individual appointment with them, and you can have discussion with them. You can take group classes with them. You can also actually get acupuncture there now and plenty people find it very, very helpful. When you do have a pretty significant stress and you feel like by self-helping it has not improved adequately, it would be most helpful for you to make an appointment to come see us. And just have a chat and see what’s going on, what’s some of the things you can do, what’s some of the things we can do to help you to sort this out. You can call and ask to be seen urgently if it feels very urgent. You don’t wait and usually can be seen the same day. You can call to make appointment as well.

Our service is very diverse. Truly we have many people from many different backgrounds and a few of us are from Asian backgrounds as well. I know two other providers who are Asian women currently running the Asian women’s group and specifically trying to help people with this particular understanding about Asian cultures and how we understand each other. You know our goals and the ways to pursue them and so on, so forth. It can be very, very helpful.

Host: If you have to give your best advice, one last piece of advice—and what a great, informative segment Dr. Hsi—give your best advice to MIT students about dealing with that stress, the cultural differences in the way that we all deal with stress. What you want them to know about MIT Health health and wellness counselling.

Dr. Hsi: I’d say feeling stress is normal. You should really pay attention to that and not to dismiss it as a sign of weakness, but as sign of needing some care. If you do, there’s plenty of things you can do. You can come to us. If you can want to look up doing things on your own first or talk to your peers for support, that would be great as well. We are here to really take care of the student and work with them from both the biological, the psychological, and the social aspect of the experiences. I promise. We don’t just treat people and say, “Five minutes and here’s your antidepressant.” No, that will never happen. We’re really here to help a student as a whole person, as a human being. Not just one aspect of experience.

Host: What great information. Doctor, thank you so much for joining us today and telling us these great ways of dealing with the stress that we all face. Listeners can visit Health.mit.edu for more information and to get connected to one of our providers. That concludes this episode of Conversations with MIT Health. Please remember to subscribe, rate and review this podcast and all the other MIT Health podcasts. . I'm Melanie Cole. Thanks so much for joining us today.