The Problem of Stress

Photo credit: Anthony Tran (Unsplash)

By Imei Hsu

Many years ago, I came into the doctor’s office complaining of heart pain (angina), fatigue, loss of appetite, and a lot of frustration. After weeks of symptoms appearing and disappearing and poor sleep, I dragged myself back to the doctor’s office for another visit.

He ran more tests. Even ran an EKG. Ruled out GERD. And then with concern filling his eyes, he asked me if I was under a lot of stress.

Well, of course I was under a lot of stress! Raised in a culture that places the burden of being a caregiver on its females, working as a healthcare professional, and having adopted a default belief that included quite a lot of “shoulds” – I should be pleasant, gracious, available to the needs of others, courteous, and beautiful – it would be more than fair to say that I was subjected to stressors all the time, and that my life choices favored stressful environments and beliefs.

It turned out that I actually did have a real medical diagnosis, which would take another decade to reveal. And at the same time, the doctor’s concern about my stress level was not wrong. It was so right.

The problem was this: I was under 30 years old, with a healthy heart, a normal weight, normal blood labs. Every test was coming back normal, no concern. But my hair was falling out, I was horribly tired, and I presented as a mystery to more than a few doctors. This doctor prescribed nitroglycerin, but I could tell that he felt uncomfortable with this “just in case” emergency medicine. His words matched my read of the situation: I was too young and healthy to need it. The very act of being prescribed Nitro at that age scared the bejesus out of me.

As people in the U.S. and around the world try to find our “new normal” in the COVID-19 pandemic, each of us needs to take a look at the impact of stress on our bodies and minds. Even as we treat overt medical fallout from COVID-19, the impact and effect of stress lurks in a body that keeps an account of what happens to it. There is truth in the title of the book, “The Body Keeps the Score” (Bessel van der Kolk). Let’s take a look at stress and how it manifests in the mind and body.

Three Kinds of Stress

The American Psychological Association identifies three categories of stress: acute stress, episodic acute stress, and chronic stress. What’s the difference between these three types of stress?

Acute stress is very familiar. You are experiencing acute stress when you are driving down the road and a wild animal bounds across the road. In your response to applying the brakes or swerving out of the way to avoid a collision, your heart rate elevates with a quick shot of adrenaline coursing through your body. That heightened sense of awareness, feelings of fear or danger, and increased respirations are all part of the acute stress response.

This stress response is meant to save your life! But if you stay in it and don’t exit this response, your body (including your mind) can get into trouble.

Episodic Acute Stress

Episodic Acute Stress is the above scenario, only on repeat. A job with project deadlines that happen multiple times a year is an example of episodic acute stress.

If your job typically pays less than the living expenses of the town you live in, monthly bill paying time could be another example of episodic stress if you anticipate more month than money.

Chronic Stress

Chronic stress is the kind of stress that happens over time. Sources of chronic stress in our society include the effects of the patriarchy, racism, poverty, war (look what is happening in Ukraine), and debilitating illness. Chronic stress can be a part of our relationships with a family member, a difficult neighbor’s behavior, or trying to help your child deal with bullying at school.

Chronic stress responses don’t get a lot of airplay in modern medicine. If you are showing effects of chronic stress, it doesn’t feel helpful to have your doctor tell you that you need to reduce stress. Why? Because many of the sources of chronic stress are external and systemic (translation: difficult to change, and often outside of your control). Change comes slowly, and yet the chronic stressors all around you bear down strongly, wearing you down.

Why the Goal Is Not a ‘No Zero’ Stress Life

Since high stress is linked to a plethora of serious medical and mental health conditions, is the goal to remove all stress from your life? Nope.

Besides the fact that it isn’t possible to live a stress free life, the bigger question is, would you want to? Growing up from a child to an adult requires stressful events to the body and mind, experiences that introduce stress as you fall in and out of love and relationships, starting a family and raising children, and even making the decision to not start a family can be stressful. It is stressful to care for ageing family members, interviewing and starting a new job, traveling to new places, and saying good-bye to loved ones as they succumb to the effects of time and disease.

Yet to truly live, you must be open to stresses that your body and mind respond to with everything from high amounts of adrenaline and cortisol to exhaustion as you rock a baby to sleep for the umpteenth time while you wish someone would hold and rock you to sleep for a change!

The most beautiful, terrifying, necessary, horrific, intimate, awe-inspiring, crushing moments in life require you to be willing to endure stressors – even embrace them – that include what would be considered good stress as well as stress that takes you into the “overwhelmed” zone. To truly live into the best that life can offer cannot be done with a “no stress” avoidance path.

Exiting the Stress Cycle

As the United States begins to return to a “new normal” while the pandemic outbreaks continue to be battled, it’s a good time to assess how you are handling the stressors of the pandemic and your plan on how to exit the stress cycle that those stressors have caused.

If you look at the SARS-CoV-2 virus as the stressor, and your area of the country is seeing cases going down, one might think that the source of stress — that is, the stressor called The Virus — is over, and therefore you are no longer experiencing stress as you might have at the start of the pandemic.

What nobody told me when I was a mystery to doctors is that even if they didn’t know what medical condition I had, I still needed to understand how to exit the Stress Cycle itself.

Let’s go back to the example of being in your car when you suddenly need to apply the brakes and swerve to avoid an accident. Let’s say you do all these actions and you avoid hitting anything or anyone. Phew! You make sure everyone is OK, and then you drive away.

Ten minutes later, you notice that your legs feel like Jell-O and you want to puke; you wipe your brow and are surprised that you are sweating! What is that? That is your body’s acute stress response. So you pull over, take care of yourself, breathe in and out a bit, and drive away. Later on that evening, you get ready for bed, yet when you close your eyes, your brain is replaying what happened. Your heart rate is still high. Maybe you manage to fall asleep but wake up in the middle of the night and have trouble falling asleep. The next day, you are groggy, irritable, and you stumble your way to the coffee maker or to a coffee shop and get yourself a double shot latte. More than one person raises their eyebrow at you as you mumble something about feeling like a battle axe, but the truth is that if one more thing gets put on your shoulders, you feel like you might just crack.

You are still in the Stress Cycle! And stress accumulates as you add more stress from different areas of your life. No amount of coffee makes the feelings go away. You try not to think about it, but every so often, the thoughts and feelings come back.

So, how do you exit this Stress Cycle you’re in? There are a number of things you can do to help your body/mind, and no one thing is the magic bullet or the automatic fix. Here are some examples:

-use meditation to still the mind

-learn how to nourish your body with food, not eat your emotions

-consistently move your body around, preferably with time outside in Nature (fresh air, sunlight, open spaces you can see sky, trees, and water particularly if you live in an urban setting)

-reframe thoughts and responses to stressful experiences

-reduce stressful inputs, including mindless scrolling of Social Media, news, and entertainment that isn’t “working” for you

– have time that is not scheduled for anything else but, “The Art of Doing Nothing”. Relaxing in a hammock, gazing out a window, and time where you aren’t demanding yourself to be productive is important for the body to de-stress and relax

-prioritize regular sleep, which is your mind-body’s way of repairing and recovering

In sessions, I cover these and other methods of exiting the stress cycle as a part of therapy. If you’d like to learn more about this, schedule a complimentary consultation and mention this post.

Addiction Change Counseling Psychology

Beyond Trend

Two glass tumbers with ice and dark brown whiskey next to bottle of Ballantine's scotch whiskey laying on its side atop a wood table.

Assessing Your Readiness to Change (Even When It’s Not Fashionable)

The following post is the expressed opinion of the author and is not be used as a substitute for medical advice. If you are struggling with a substance use disorder, eating disorder, or self-harm behavior, please seek medical advice from a licensed and/or certified provider.

The other day, I found myself chatting about a subject that rubbed me all sorts of wrong: Food Ennui.

Just a few days ago, the U.S. entered its third year in the global pandemic, and all the cracks in the system are apparent. With supply chains affected, workers shifting jobs or resigning outright, and a surge of the Omicron variant triggering localized calls for the National Guard to assist in everything from teaching in classrooms to helping in the hospitals, being bored with food seems disconnected from a reality that looks more like a war zone.

And yet I am not surprised how many people casually responded in a text chat that food ennui is real, as real as the fatigue many of us are experiencing in other parts of our lives. Some of us are really feeling tired of eating the same things, yet we’re aware that there bigger fish to fry and larger fires to put out.

Like many decisions we can make about how we function, order our days, care for our family members, and meet our own needs, not all of our decisions are going to be the latest trend. Not all of our choices are filled with fun or ease. Yet avoiding change just because it goes against the current trend has its personal consequences.

You do not need New Year’s resolutions to learn to make sound decisions and create a plan for change. So what DO you need?

Readiness for Change

The first thing you need to know before you make a change, big or small, is your answer to this question, “Are you ready?”

It’s OK if you answer that you’re not sure if you are ready, or that you want to be ready but you have some hesitation. Yet I think it’s important to give yourself a chance to hear your thoughts and feelings about how ready you are to make a change in your life, and go from there.

There is no one magic pathway to determining your readiness, yet here are a few questions to ponder that will help you think about readiness and what it would take to see some real change:

  1. WHAT do I think needs to change? What will I gain or lose by this change?
  2. WHY is that change important to me?
  3. HOW have I tried to change this before, and what stopped me the last time?
  4. WHO is in my corner, even if the only support I have is myself? Is it enough, or can I find a way to get more support?

Make a Plan with Small Steps

Whenever people find out I like to run long distances, they can’t get over how far I run. “How do you even get to a place where you can run those kinds of miles?” they ask.

“Well, you start by running from your house and around the block and back.” In essence, you start with where you are: start with small steps, and then add on more over time. Small and incremental changes that can be sustained have an accumulative effect.

My answer remains fundamentally the same whether you want to start a meditation practice, learn a language, play an instrument, or get rid of processed sugar from your diet. Once you have assessed your readiness for whatever change you have chosen (and accepting it as your choice, even if you don’t like the thing you chose in the moment), you can start with small changes.

As a therapist, I get asked for help with many of the same kinds of behavioral trends that come in and out of vogue. Here are just a few:

  • stop smoking
  • lose weight >20 pounds
  • begin and progress into a fitness program
  • learn how to cook at home to eat less processed food
  • decrease or eliminate drinking alcohol* (see comment below)
  • minimize negativity and maximize action
  • increase mental resilience
  • improve sleep
  • communicate with empathy
  • stick to a hobby
  • watch less television
  • learn to meditate and relax
  • decrease mindless activities on computer or devices

If you want to try a short exercise in how to look at a change with small steps, pick something on this list of which you experience success, and imagine sharing with a close friend how you came about experiencing that success. Take each factor, and make the steps even smaller, so that each step does not have much distance between them.

Beyond Trend

On a personal note, I noticed that Social Media is flooded with memes surrounding the pandemic, fatigue, and humorous reasons to indulge in drinking alcohol, overeating, and spending money regardless of budget or means.

This is not to say that these memes didn’t exist before the pandemic, or that people should be shamed for their personal choices. I simply noticed that the amount of content around these themes appears to have risen significantly. I’ll leave that to data scientists to tell us if my observations are statistically significant!

So let me choose one of the three to talk about here as a “beyond trend” choice. What if those who decided to try a “Dry January” — that is, a month abstaining from drinking alcohol in order to increase their awareness around their relationship to alcohol and its use — wanted to extend that practice beyond the month of January and beyond the supportive trend that has become an annual event, even a badge of honor to boast about?

Well, if you went 31 days without alcohol, you already walked yourself through an analysis of your own readiness to change, taken the initiative to implement small steps of change (i.e. removing alcohol from home, or going out with friends but telling them you are not drinking alcohol for a month, having an alternative beverage choice, choosing activities that are not centered around food and beverage, etc).

Lasting changes that go beyond the trend and support of short-term changes take more planning. It may involve talking to people in your support system and your household about what you need from them to be successful, as well as what you will provide on your own (such as boundaries, limits, and choices).

If you find yourself struggling, you may want to get more support, such as joining a group of likeminded people, hiring professional help, or broadcasting your choice and your needs to a larger group beyond your immediate support system in order to hear about more similar stories. You may discover that you aren’t among the majority making that decision, but you don’t need a majority to stick to it.

You may wish to keep track of your thoughts and feelings about your choice to abstain from alcohol in a journal, reminding yourself why you are doing what you do. In the world of sobriety, the phrase, “One day at a time” helps those who have chosen a sober life to focus on getting through each day without drugs or alcohol.

You might need to turn down the volume of the Social Media memes and messages that promote lifestyle choices* that are not in line with what you are trying to accomplish. Again, it may not be on trend with what “everyone” else is doing. Turning down that volume so you can hear your own thoughts and choices can help you maintain clarity.
Ensuring your lifestyle choice does not encourage dangerous or damaging thoughts and actions is also a part of the process of change

Living a sober life has much more complexity to it than eliminating drugs and alcohol. The underlying causes of drug and alcohol addiction or use, and even its identification in the user, have been the study of philosophers, healers, and addiction specialists for centuries.

If you have chosen to reduce and/or eliminate drugs and alcohol for any reason, there is help available for ALL of the complexity.


* Lifestyle choices – let me clarify, a lifestyle choice can have an intersection with appropriate medical advice. I am not advocating for dropping sound medical advice in lieu of a lifestyle choice. An example of this would be using one’s insulin pump for diabetes as a means to drop weight fast, or taking on a restrictive diet at the expense of syncope, hormonal damage, and severe anxiety or depression.

Change FMLA How to Psychology Rest Sabbatical

The Value of a Sabbatical

White Toyota 4Runner in open space near red rock canyon walls. iKamper roof top tent open and ladder from tent to the ground.
My rig, affectionately named Hot/Haute Sake, became my home for Part I of my sabbatical. Learn more about what sabbaticals are all about and how to plan for one. Photo: Red Rocks Canyon campgrounds, Las Vegas Nevada, Oct. 2021.

When I first thought about taking a sabbatical in order to reflect on my 30+ years in the healthcare field, it made professional sense. It made logical sense. Everything lined up on paper. It just didn’t line up with life.

The purpose of a sabbatical is to take time away from the world of work to reflect on your accomplishments, engage in personal development and enrichment, and consider professional development in your career.

For those in the corporate world, a sabbatical has sometimes overlapped with the need to take FMLA, a form of paid leave after a tenure specified by the company. Employees use FMLA for a variety of reasons, yet often the circumstances are more urgent: physical illness, disability due to injury, recovery from a surgical procedure, or care for an ageing family member.

I have lost count of the number of applications I have helped clients submit over the years. And with each one, I wondered if and when I would someday undertake my own version of unpaid leave from all work.

When I hit that 30th year in 2020, our world plunged into a global pandemic. All thoughts of taking that well-deserved and thought-provoking sabbatical disappeared behind a mask, face shield, blue plastic gown, and nitrile gloves. I worked until I was exhausted and asked by my own doctor to take a brief break. I did, and then jumped right back into the work, working in 2021 and hoping that things would improve.

Twenty months later, I started reconsidering whether a one-month sabbatical would work. And I am not alone. Perhaps you are considering something similar.

What is a Sabbatical?
As mentioned above, a sabbatical is an extended break from school, religious duties, work, and everyday routines. Its roots are found in religious literature of the ancient Hebrew people, such as Leviticus 25, which describes a break of one year after six years of regular harvest for the land to rest, with an implication that the people were not to press themselves or the land to produce more food for the purpose of selling for profit. The harvest of the seventh year was meant to be given to those in service to it. Loose translation: land and people should take a rest every seventh year, and the laborers were to enjoy the efforts of their labor without the pressure of production.

Today, sabbaticals are more typically between two to six months in duration. Extended sabbaticals tend to be paid for the first portion and unpaid for the remainder of time; however, there are some types of extended sabbaticals that are paid because of professional development that is involved. An example of this is a company that provides paid sabbatical to allow employees to volunteer for an environmental non-profit, or for a professional to pursue an academic credential.

For the most part, sabbaticals are not simply vacations, although there may be vacation time built into it. The main idea is a change from everyday work routine that frees one up to pursue other elements of life and work that would otherwise not be possible.

Who takes sabbaticals?

There are many people who take sabbaticals from their work, and many reasons to do so:

  1. A death or imminent death in the family with a need to manage an estate of the deceased or care of a remaining family member
  2. Injury, illness, or adjustment to disability of self or a family member
  3. Work burnout, after all other means to address the burnout has failed
  4. Academic pursuit
  5. Refreshing one’s career
  6. Volunteer work

How to Take Time Off for a Sabbatical

First of all, sabbaticals take planning. As a friend once advised me, take a look at Simon Sinek’s TedX video, “Start with Why” The video can help you tap into the inspiration for you to dedicate some perspiration to planning and preparing for a sabbatical, including saving some extra money if your sabbatical involves some unpaid time off, an entire overhaul of your work life, or further education.

Part of the planning may involve contacting your HR department to go over the policies and application process for time off. Some companies have sabbatical leave baked into their hiring contracts; others have a requirement of seven years of work before you qualify for sabbatical or FMLA under certain circumstances. You’ll want to find out if your job is protected while you are away, and how your role will be covered so you don’t get pulled back in if there is a challenge or crisis during your leave of absence.

If your sabbatical requires international travel, you will want to contact the countries you’ll be traveling to, and these days, that also includes understanding the requirements of the host country regarding COVID-19 protocols when arriving and leaving the country, as well as the risks to yourself and any household members traveling with you. I suggest you conduct a risk assessment regarding travel, and how much risk you can bear.

For example, if you travelled to a country that later went into a restrictive lockdown to deal with COVID-19 outbreaks, or if you have co-morbidities that put you at risk for severe illness and the country you wish to travel faces a challenge in their hospitals to provide care and beds, you may need time to plan a more extensive care strategy.

If you are working with a tighter budget and longer period of time off, you may need to look at your expenses and cancel or pause subscription-based expenses, monthly charges such as cable and Internet if you go abroad, and consider holding off on luxury purchases. Instead, you might want to schedule those doctor and dentist visits, make sure you are up-to-date with medical prescriptions and immunizations, and think ahead through the needs of your children and pets to anticipate expenses.

See You in January 2022

As my planned sabbatical Part 2 is about to start (Part 1 was in October to early November), I’m looking forward to the remaining month of a two-month sabbatical. I’m expecting to have good news to share with the counseling community when I return.