Introduction: It's time for Conversations with MIT Health, Care for the Community. Here's your host, Melanie Cole.

Melanie Cole: Welcome to Conversations with MIT Health. I'm Melanie Cole. and today we're discussing stress management during the COVID-19 pandemic. Joining me for this very important topic is Dr. Chowlu She. She's a Clinical Psychologist at MIT Student Mental Health and Counseling Services. And she serves on the clinical faculty of Harvard Medical School. Dr. Hsi, in these unprecedented times and more important than probably it ever has been people are feeling all sorts of things at this time. Some are strange, some they've never felt before. There's kind of a worldwide feeling of things we've never felt before. Is this normal? 

Dr. Hsi: Absolutely. Unfortunately it's quite normal. Think this way, this is the first pandemic this side of 1918 nobody around is frankly, is old enough to remember that let alone to have gone through it and surviving it. So if we have never been in this situation before, we're going to have all sorts of reactions and this is not just anything either. My analogy of this is this is almost like a World War, for those of us, fortunately enough to have never gone through a war on a World scale. So of course the reactions are quite normal and would have all sorts of reactions. Some way actions of physical, some reactions of behavior, social and some reactions are what we call cognitive or emotional. So what are these things? Physically, sometimes people will feel indigestion and stomach aches where they feel light headed, the muscle, tension, muscle ache, even though they never had this before. And sometimes people have elevated blood pressure or they have trouble breathing, the increased heart rate and often, you know, particularly breathing is a frightening thing during this particular pandemic.

People say, Oh, am I infected? And behaviorally people can have all sorts of reaction as well. Sometimes they sleep less, sometimes they sleep more or they eat more, or people who love food now hate eating. I sometimes even in fact thier basic hygiene. This is a tricky issue because, you know, now all of us are working and going to school, taking classes at home. Nobody really have to get out pajamas. Although please make sure you wear your pants. And sometimes people could have bad hygiene and that's different. And cognitively, the most common complaints here, and frankly we experience ourselves as well, are things like getting started with work or having trouble focusing, having trouble concentrating. Sometimes people have memory difficulties. You know, it's not uncommon. In this week alone I've handled three different missed meetings, a patient, a student, and myself as well.

It really can happen because this kind of traumatic catastrophic event really disrupts our lives. Emotionally, people sometimes feel like, you know, why am I feeling so anxious? Now that part probably is less because it is pandemic. But sometimes people can also feel excessive, kind of unreasonable sense of guilt or sense of shame because they're having been trouble or people would say, why are you so irritable? You know, you're so easily set off. People have mood swings and a loss of motivation and sometimes they feel downright, depressed. All of these are quite normal reactions. On the MIT Health website, there's information sheet actually I contributed to this many years ago. It's called normally action to abnormal event, so like always say, God only made us human.

Host: What an excellent explanation. You really covered the gamut, Doctor his, of everything that we're all feeling and certainly for the students in a high-pressure environment like MIT have these things amplified. So how closely as we're looking at all of the things going on and we are inundated with media and news and you know all of this stuff at once. How closely do you advise people to follow the news about COVID-19 and the latest numbers? Because too much can really stress us out too little and we're not informed. What do you want us to know?

Dr. Hsi: Well that's a great question. My answer may surprise some people I would say as little as possible. How come? This is a pandemic? People are dying, things are affected. We have no idea by the time of when this ends, what kind of life and world are we returning to. On the other hand, this is not a pre-hurricane, pre-tornado, a pre-tsunami preparatory situation. We don't need to keep track of things on the hou-to-hour basis. There really isn't very much we can do in terms of affecting the course of events. If anything, stay home initially. Now when you go out really, you know, wear your protective gears, wear your mask. As we do understand how important it is, how to be overly exposed to really keep very close tabs on this unless you're really working on a project. Some of our students are—research projects that really needs to keep track of such information as little as possible.

When the lockdown first started, I was telling everybody, I was giving this particular funny advice to people and I say, “Kill the bird”. What I meant is stop following Twitter or at least cut down how much time you spend on Twitter because Twitter is even more intense and that goes far more intense than the traditional, you know breaking news. So those things really intensify the feelings and the emotions and the reactions. Now we're not machines. God only made us human, as I just said. We will have reactions when we receive this kind of intonation. So this is not helpful and it is not being heartless or uncaring if we don't follow them closely. Again, there's a lot of things we can't do unless we're really frontline soldiers and we're not most of the time. So the less you are following, what following things closely, perhaps, the better position you will be in to make an adjustment, to cope what you have to do every day more effectively.

Don't forget, what you have to do everyday is difficulty enough. You are cut off from your loved ones. Sometimes people are not going home. Your friends, your professors, your coworkers, your neighbors. A lot of people already cut off from a lot of those things. It's very difficult, imagining you're stuck in a cave all by yourself and listening to all this news about what in the world is happening out there. So my advice is as little as possible. Maybe follow the news first thing in the morning and at the end of the day. If anything, you really need to know, think about it—all the state governments and all the universities and most of institutes we work for have emergency alerts. They basically push alerts to our phone. So you will know.

Host: Wow, that's a great piece of advice, Dr. Hsi. It really is something we could all use that piece of advice right now. So as you're telling us all of this, tell us some of the things students can do to help manage our stress while they're stuck in isolation. And also while you're answering that, why is reaching out to others so important during this time of isolation? As you just said, you know, we are isolated from our loved ones and coworkers and all of this. How do you want us to reach out? Because some people have really pulled back from all of that.

Dr. Hsi: Reaching out is a slightly complicated issue because obviously we reach out for support, but a lot of times we don't think about reaching out as also something that we can help ourselves as well. On two counts, you know, reaching out to others could listen to us to help us. But also when we reach out that we provide the support to the people we care. Obviously, you know, even if we're reaching out to you know, a hotline, we're still reaching out to another human being. When we reach out to them for the help, a lot of times it helps them to feel that they have performed a valuable service to you as well. And a lot of times, you know, we would, let's say call credit card company or have to cancel something, talk to the pharmacist, so on and so forth. They are human beings on the other end as well, just to being able to exchange a few pleasantries. How are doing? Hope your safe. Please take care of yourself. Thank you very much. All of those things could mean a lot. You could brighten somebody's day as well. So even if you're reaching out, the purpose of the reaching out is get help from other people and get support. Making that connection can still be helpful. I'm sure you don't need me to ask you, would you rather talk to a machine just like cliques or would you rather talk to a real person?

Host: That certainly is true. And now what about things we can do Dr. Hsi to really manage that stress?

Dr. Hsi: Now in terms of what we can do, it's really interesting. I'm going to introduce something here and I know I have always talked about this. Whenever I talk about anything, concerns our emotional health, which is the so-called the bio-psycho-social model. What this model means is whatever we feel, whatever we have to do, it always concerns this three aspects, the physical, the psychological, and the social aspect. So what we can do to help them manage stress could also come from three aspects as well. And you may choose one of these. You may choose all of them. Now biologically, what can we do? I'm going to ask you a questions rather than giving advice. For instance, do you take a walk every day? Now, have you done anything with do a hand, like do crafts, origami, woodwork, you know, cleaning things, repairing things, cooking, baking, play board games, actual games, you know, play with Legos, sketching.

When was the last time you sent hand written note card outside Christmas or ever? Now do you know you can actually pay for and print out postage online these days? Anything you can do with your hand, anything would get you get up from your desk and actually walk your body. Walk around. I don't just mean exercise. Exercise is great. Now psychologically, have you ever done any Zoom work sessions? “Hey Joe, I need to do this pset. Do mind doing together?” And Joe maybe needs you. writing a paper, needs to write a paper. And also, to help people to focus, how about doing some work with music? Now, music without words, otherwise maybe your brain would necessarily go with the song. And they can be soothing. They can help you to focus because your brain has something, you know, benign to mildly distracting but also engaging. I also encourage people when they'd have to do work, any kind of work frankly or to do them on paper.

I know how archaic this sounds, how old fashioned this sounds. Actually doing things on paper and with hand engages more parts of your brain. Not only it helps to pass this information and the problems solved more effectively and efficiently. It can also distract you because you can't do things with your hands, you know on paper and at the same time also ruminate very anxious thoughts. Socially, I've asked the people to ask yourself this question each time you're texting people, write an email, ask and say, “Hey, do you mind FaceTime?” or “Do you mind Zoom?” Because not only you can answer the question, talk about things quite quickly by talking to each other. You also get to see the person, have you ever organized any Zoom drop-in social hours? You know, happy hours or game playing Zoom and so forth. And these are the things you can actually do. And I also engage other people as well, play games online.

Host: Those are all great ideas of things that we can do Dr. Hsi and some of those ideas are not ones that we're used to hearing. So that's really great advice. And now one of the other things before we wrap up, sleep problems are so prevalent right now. Are they contributing to our stress or is the stress contributing to our sleep issues? And what can we do so that we can really manage our expectations and our emotions? Because there does seem to be this worldwide stress that we're feeling and so many people are not sleeping and so many people are going through this. How can we manage all of this, get a decent night's sleep? And since so much is unknown, how do we deal with what we don't know, Dr. Hsi?

Dr. Hsi: I'm so glad you asked me those questions. People don't realize, in addition to physical exercise, good, healthy sleep is one of the best protective factors. Protective, not just for steady function, but actually protective in terms of immune system. Now you couldn't ask for better protection, for better and healthy immune system during this particular pandemic right? Now in terms of sleep, a lot of people don't realize how important it is to have a regular sleep. When you don't have irregular sleep, imagine your brain is a, like a pre-verbal toddler is being dragged. It's being dragged by you around and very cranky, very tired. Couldn't really tell you what was wrong and just screaming and crying and so on and so forth, and that is your brain. That's sleep deprived. Now, if your brain is a toddler, in other words, not a machine, you cannot just turn it on off.

There's no switch. You need to, you need to be mindful of your time. This suggestion is a little bit of counterintuitive because we use alarm to wake up. We never think about using alarm to actually go to bed. On the other hand, whose brain has an alarm built in? Even old ladies don't watch 11 o'clock news anymore. We have loss the of sense of time, particularly at the lockdown. I suggest people put an alarm on the phone. It's 10 o'clock, 11 o'clock, it's 12 o'clock, it's 12:30. You know what? You need to turn off the light. Now sleep is primarily regulated by light, so turning off the lights is very important. Have your phone on night vision is very important. Secondly, sleep is also regulated by temperature, so try to dress very cool. Sleep in a dark room. I also recommend people listen to things or audio, but at a whispering volume. Why? Whispering is very soothing. This is genetically programmed into our brain. You can listen to a podcast, you can listen to an audiobook. You can even listen to a very familiar episode of TV. Let's say Friends or something, just at a whispering sound.

Most people tell me they never finish listening to anything. Why? Before long they're put to sleep and this is very important. If you don't do it on the regular schedule, however, you're like flying between time zone. So go to bed more or less at the same time. Waking up more or less at the same time is very important. How can you sleep at night while trying to really keep away all those anxious ruminations? This is listening to something [inaudible 16:08]. Why? When you're listening to something. Your brain doesn't have the extra thinking space or thinking power or thinking memory to ruminate because your brain is digesting, it's processing to the information you're listening, and that's usually very helpful. If that doesn't quite do the trick, I also suggest you read maybe on Kindle or iBook at a minimum brightness, has to be night vision. However something kind of boring, you know, if anybody needs to read a scientific paper, if that doesn't put you to sleep, I don't know what will. You know, our physicians often say read the operating manual of your refrigerator. So it's a scientific paper or refrigerator manual.

Host: This has been so informative, Dr. Hsi, wrap it up for us, how we can compartmentalize our fears, separate reality of what's happening and what's actually occurring and how we can deal with our mental and emotional stressors at this time so we can use good self-care and take care of ourselves and the ones we love.

Dr. Hsi: This is a really, really good point is in terms of compartmentalizing things. There are things that's out there. The government, you know, the government is together. The physicians, the researchers and so on and so forth they need to do. But that is, in actuality, outside a window. Inside a house, on a desk, there are things we can do. If we make a schedule, for instance, in the morning, this is something we have to do. We have a handwritten to do list in front of us, we're more likely to be engaged and each time we finished something we check it off. It gives us some sense of not only satisfaction or task completion, but also give us, make us feel less helpless. We actually can do something. So pay attention to the task inside your house and not so much out there.

This is why it's important to limit the exposure to news unless you are really a virus researcher at the moment. And also when we think about the time you can spend with other people, a quick phone call, maybe even, you know, a texting exchange and sometimes a Zoom chat or anything that you can do. The more you're engaged with what you do on your desk, the more you engage with people, the more protected you are against really the war that's raging outside the window. For a lot of us, it's actually possible. We're lucky to be protected by a house at the moment. So pay attention to what's at hand. If you know there's nothing you can do, well maybe you can do a yoga session, just following YouTube. Anything you can focus on things at hand in front of you.

Host: Great advice, Dr. Hsi, thank you so much for coming on and giving us real usable information and sharing your incredible expertise to all of us and the MIT Medical students and the MIT students at this time. Thank you again and 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.