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.


Lying and Hiding

Press the button. But is it that easy?

Recently, I read an article in Psychology Today, “Why You Lie to Your Therapist” (June 2019). The article is similar to an earlier article by Ryan Howes, PhD, “Why People Lie to Their Therapists” (Oct. 2018), but in interview form with Matt Blanchard, one of the researchers behind, “The Lying Lab” where studies have been conducted. With his colleague Melanie Love, Blanchard has authored a book called Lies and Secrets in Psychotherapy. 

Apparently, lying (and hiding, for that matter), is a thing.

Even during therapy sessions, and even when there is a trusting, warm connection between client and therapist, lying happens often enough to warrant an entire arena of dedicated study. And according to the Lying Lab studies involving 547 patients, 93 percent of them recalled specific instances where they identified lying to to their therapists.

You can read about the reasons why clients lie to their therapists in the first article. My bet is that just about anyone who has ever been in therapy can relate to the primary reasons why people lie to their therapists:

  1. To avoid shame
  2. To control the focus of what is talked about (i.e. an external problem rather than an internal or threatening flaw)
  3. To avoid repercussions (particularly negative and painful ones)
  4. Lack of trust with the therapist

In this blog post, rather than covering the topic of lying again (the articles are well summarized, so why reinvent the wheel), I thought I’d write about what comes after either the client or therapist recognizes that a lie has been told.

“Um, I Wasn’t Exactly Honest”

As I client, you’re in an uncomfortable situation. You’re paying someone to listen to you talk about what is or has been going on in your thoughts and actions. You’re investing your time and money, and you’re engaging another person to enter into your reasons for doing so. They were important enough to call a therapist, make an appointment, and build a relationship.

So the moment you catch yourself suppressing, withholding, or embellishing the truth, or your therapist notices something about the way you just did one of the above, the last thing that any good therapist is going to do is to try to nail you with shame.

Instead, the research seems to indicate just the opposite. The research supports clients wanting their therapists to not only catch them, but to acknowledge not only the difficulty in being honest, but actually ask about what they just saw and heard in the client’s story.

When a client says, “Um, I wasn’t exactly honest when I told you about…”, just acknowledging how difficult that must have been to admit, and to have a discussion around what that was like holding onto that lie, can help address the underlying fear about what it would mean to tell the truth.

Just Ask

Because I understand that people have their reasons for lying, I’m not offended. Instead, I can ask directly, “I’m wondering what would make it easier for you to tell me what’s truly on your mind.” This is a more gentle way for me to say, “I think you just lied to me.” My thoughts are to fostering the next step into a client owning a dishonest moment and then choosing to change the direction into an honest one.

When I acknowledge the fear that I am seeing in my client’s expression and body language, I have a lot of empathy. It can be pretty scary to see your own crap for what it is. Worse, it can feel overwhelming to take the next step into doing something about your crap.

My approach involves asking you directly. “What do you think may happen if you told me what was really going on?” Often times, that’s just enough of a prompt to get the truth, “on the table” where we can look at it together. Underlying fears can be addressed. Concerns about what happens next can be talked about, and the client can name the actions, thoughts, and feelings to be sorted through.

More than identifying with a client’s culture, class, or by applying more skills to the moment, the Lying Lab findings all point to the therapist asking directly about the subject. Here are a few examples:

“Did you struggle with drinking last night? Did you drink one glass, or was it the whole bottle?”

“If you are feeling out of control and you aren’t sure if you can control those thoughts about hurting yourself, can we talk about what you think might happen if you tell me you’re feeling suicidal?”

“Did you think that thought, or did you actually say that aloud to your husband?”  

Are these scary conversations? Hell yes! Are they helpful ones? Yes, they are if your reason to be in therapy was to get into the “what” and the “why” of YOU, and to allow you the opportunity to be the author of your “how” into something better.

Help Me Help You

The Lying Lab studies also revealed that a little over 72% of the respondents of the study reported lying about the psychotherapy itself, such as liking the feedback more than they did, or saying that the sessions are more helpful than they are.

Most therapists want to do a good job at the thing they love: helping others. When you are afraid to tell your therapist what you really feel about a session, it doesn’t honor your story, even if you are concerned you might hurt the therapist’s feelings.

I like to ask my clients a question at the end of a session, such as, “Was this what you thought this session would feel like? Was this helpful? What would you like more or less of next time?” And I ask them to write that feedback down — and watch them do it — as well as add the feedback in my client note.

Your Turn

If you’ve been thinking about trying therapy or returning to therapy to get deeper into resolving your personal issues, I hope you can hear that we understand that it’s not always easy to face those issues with honesty and transparency, even if when a strong connection is formed with a therapist. We get it, and we’re prepared.

I would not blame you if your first reaction to hearing that people lie to their therapists is, “Well, I would never do that.” Again, we understand that you are investing time, money, and effort in your own personal development and insight. We also just acknowledge that we’re all human. Lying and hiding happens in therapy. A good therapist knows how to ask and to seek when sensing that a subject is difficult to talk about.

Together, we’ll find you.

Change Client-centered Therapy How to Psychology Therapy

Why Is It So Damn Hard To Change

Change, Behavior, CBT, Lifestyle Change

by B. Imei Hsu, RN, LMHC

Why is it so darn hard to change? If you can understand it, you can take steps to make change happen for you.
Why is it so darn hard to change? If you can understand it, you can take steps to make change happen for you.

If you are looking for a scholarly explanation about why it is difficult for so many people to change something in their lives, keep looking. You won’t find that theoretical discussion here.

However, if you are searching for a more pragmatic discourse about why it is so damn hard to change, you’ve come to the right place! Right here, right now, I will serve my observations to you with no holds barred, completely unrestrained, straight up, and the plain and simple truth (with a small letter ‘t’).