Chapter 1: What is the stress paradox and why is it important?
Tiesitkö, että joka neljäs yli 40-vuotias mies kokee virtsan karkailua? Se on todella yleistä, mutta siitä ei silti juuri puhuta. Tenamen suojat on suunniteltu erityisesti miehille. Huomaamattomat, varmat ja luotettavat. Ota tilanne haltuun Tenamenin avulla.
You're listening to TED Talks Daily, where we bring you new ideas and conversations to spark your curiosity every day. I'm your host, Elise Hu.
Ihmiset ovat syvällä kapasiteettia resilienssiin. Jokaisen päivän määrittelen ihmisiä, joita arvostan, ja kaikkea, mitä he voivat tehtyä, vaikka he käyvät vaikeuksia. Mutta lääkärin ja kirjailijan Aditi Narukarille on tärkeää muistaa, että vain siksi, että ihmiset ovat resilienssejä, se ei tarkoita, että he eivät pysty pysymään. Maailmanlaajuisen dataan näyttää, että ihmiset kokevat stressiä ja pysymystä todella paljon.
Her recent conversation with TED-curator Whitney Pennington-Rogers, Aditi shares why it's so important that we work to dismantle the, quote, toxic resilience myth and offers concrete strategies to spot the signs of unhealthy stress and instead use pressure to your advantage. We've called today's event the Stress Paradox. And if you're joining us, I'm going to go out on a limb and guess that you are no stranger to the idea of stress.
the experience of it, the torture of being stressed. Honestly, even just the word makes my heart beat a little bit faster, my shoulders tense up. Stress is a seemingly inevitable part of so many of our lives, especially if you are living a busy, fast-paced life, as I imagine many of you are. But we might be approaching it all wrong if we are just looking to sweepingly eliminate it. Maybe there are some good things stress can offer us. Maybe there is a way to use it to propel us forward,
not drag us down. And that's what our guest today is here to talk to us about. April is Stress Awareness Month, so in anticipation, we are thrilled to be joined by a woman who understands stress perhaps better than anyone. She is a Harvard physician and bestselling author of The Five Resets, Rewire Your Brain and Body for Less Stress and More Resilience. Please give a warm welcome to Dr. Aditi Noorakar. It's such a pleasure to join you and the entire TED community.
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Chapter 2: How can we identify unhealthy stress signals?
Hi Aditi, thank you so much for being with us. And we have tons of questions for you. But before we really launch into that, you are a physician. I would love to understand more about your background here. There's a world of areas you could specialize in. Why did you specifically choose to focus on stress? So that's like the million dollar question. Before I became a doctor with an expertise on stress, I was a stress patient looking for answers.
I was a medical resident working 80 hours a week in the hospital, seeing death and dying on a daily basis. As part of my training, it was a really rigorous and robust program. And one particular month I was in the cardiac ICU taking care of all of my patients' hearts, not really thinking about my own.
After a particularly brutal call, I did 30 hours in the hospital, as is typically done when you are a medical resident, and I developed a stampede of wild horses across my chest, that's how it felt. It knocked the wind out of me. Immediately I sat down, the nurse I was working with gave me some orange juice, and it went away. The sensation evaporated within seconds. We both laughed it off, and then I kept working.
That sensation never again happened in the hospital. But night after night for weeks, Whitney, I experienced that stampede of wild horses. And then I was very nervous. And so I went to go see my doctor like a good patient should. And my doctor did the million dollar workup, tested my blood, heart, doing an EKG, a heart ultrasound, echocardiogram. Everything checked out fine. And my doctor with a big reassuring smile said, hey, everything's great.
It's just stress. Try to relax. We've all been there. Medical training is tough. So I went home and I did what you're supposed to do when you hear your doctor say, just relax. I watched movies. I had a spa day, retail therapy, spent time with friends, went out to dinners. Nothing really seemed to help. And only when I put my scientist hat on, because as a medical trainee, I had access to lots of studies and data.
I put on my scientist hat and figured out what is stress? How does it affect my brain and my body? Because honestly, Whitney, my first reaction when my doctor said it's stress, I thought stress doesn't happen to people like me. I'm resilient. I was living the resilience myth. We can talk a little bit about that because in my medical training I was taught that pressure makes diamonds and I was a diamond in the making. And then my diamond cracked. And so I read everything under the sun at that time and have continued to stay up to date on all the literature.
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Chapter 3: What are the differences between adaptive and maladaptive stress?
To figure out how stress affects the brain and the body. I found my way out of stress, my own stress struggle. And when I found my way out is when I vowed to become the doctor I needed during that difficult time. So that when a patient would come to me and say I'm stressed and I would do the medical workup, my response wouldn't be, ah, it's just stress. Go home and try to relax. So my work really focuses on bridging that gap and closing that gap.
So I don't have to say to patients, just relax, I can offer them something tangible. And so that's the genesis of my work, my origin, my villain origin story, so to speak, of how I became a doctor with an expertise in stress with my background as a stress patient. Well, I'm sure there are echoes of a lot of things that definitely for me, for a lot of us, of things we might have personally experienced. And I feel like stress is this word that has almost become like a throwaway phrase culturally.
Where people are saying all the time, I'm stressed. And maybe not really understanding what the meaning is behind that. So if we could just start with the basics of setting the scene. How do you define stress? What is stress? I think stress has really been vilified. And when you look at it scientifically, not all stress is created equal.
When you use the word, I'm so stressed, or it's been a stressful week, or a stressful year, or in many cases, the stressful five years, right, for most of us. That type of stress that you're describing scientifically is known as maladaptive stress. That's the kind of stress that is dysfunctional, unproductive, and it really gets in the way of your everyday functioning. It's what causes all of the mental and physical health manifestations that you and I and all of us are aware of, you know.
Things like insomnia, anxiety, depression, the list goes on and on. We can talk about that in this conversation, the manifestations of stress. But there is another kind of stress, healthy stress. In scientific terms, this is known as adaptive stress. This kind of stress is productive and motivating and it moves your life forward. In fact,
Kaikki hyvää elämääsi on luotu siksi, että on vähän terveellistä stressiä. Tarkoituksena ei ole elää elämäänsä täysin terveellisellä stressillä. Se ei ole biologisesti mahdollista tehdä sitä, koska esimerkkejä terveellisellä stressillä ovat esimerkkejä kuten tuomio, rakkaus, uusi työsuunnitelma tai uusi kotipalvelu. Ehkä se on yrittäminen suositella suosituksesi suosituksesi suosituksesi suosituksesi suosituksesi suosituksesi suosituksesi suosituksesi suosituksesi suosituksesi
The goal is not a life with zero stress. It is quite literally, biologically impossible to do that. It's to live a life with healthy, manageable stress that can serve you rather than harm you. You talked about some of the signs for you, the wild horses across your chest. What are some of the physical and mental signs that we should be on the lookout for when we are beginning to experience stress? Stress is truly the multi-hyphenate performer.
There are people who have no mental health manifestations of stress and only physical health manifestations of stress. And stress can really impact everything all the way from your head down to your toes. It can, you know, some common manifestations, physical manifestations of stress can include worsening headaches, neck pain, shoulder pain, back pain, abdominal pain or discomfort, dizziness, nausea, weakness, fatigue. And then mental health manifestations, insomnia, anxiety, depression or irritability.
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Chapter 4: What are the five resets for managing stress?
When you have emotional reactivity and you're quick to anger. All of these symptoms could be signs of unhealthy maladaptive stress. But like me, the first thing you want to do is see your doctor, make sure that there isn't a underlying medical condition that is causing these symptoms. And then once you are given the diagnosis of stress, then you can start using some of the strategies that we're going to talk about today.
It's important to note that stress is actually, in medical terms, a diagnosis of exclusion. So just like I shared my own personal story of my doctor doing the full workup, in that way your doctor will also do that full workup. And Whitney, I want to share a really interesting, quite startling statistic with you. In the US, 60 to 80 percent
All visits, all primary care doctor's visits have a stress-related component. And yet only 3% of doctors counsel for stress. So stress is truly the elephant in the exam room. And so a lot of our conversation today will be unpacking a lot of that. Because 60-80% of patients have an underlying stressor that is causing them to come to the doctor and they get the clean bill of health like I did.
And yet there's like a gap between, okay, now what? What can we do from here? And I love the point that you made about maladaptive and adaptive stress, good stress and bad stress. So when you're feeling these things that you've just outlined, how do you know whether it is the good or the bad stress? If not looking at your life experiences, how do you know from what you're feeling that it's good or bad stress? So the first step, you know, you have to really understand, there's this fantastic concept
called Canary in the Coal Mine. And it is a historical concept. I am not a historian, but it really is appropriate for what happens to your brain and body when you're experiencing that maladaptive stress. So what is the canary in the coal mine? Historically, coal miners would go down into the mines and they would bring a caged bird with them, a canary. And the air would get bad and they'd be toiling, you know, 12, 16 hour days. When the air got bad, the canary would stop singing. And that was sort of the first tell or the first sign of like, wait a second,
We need to come out of the mines. We're not doing well. Why? Because human beings, we are notorious for pushing past our limits and our boundaries. And so my canary, the one, we all have a canary within us. And my canary was singing a song when I experienced the palpitations, that stampede of wild horses. We all have that canary within us. And that was certainly not the first time that I experienced something that was likely initially a hum or a whisper. And then when I wasn't really paying attention to my canary because I was like, I'm a diamond in the making.
Se oli silloin, kun tunti alkoi kehittyä samalla tavalla. Me kaikki olemme kanarien kappaleita, ja se on käsittää kiinnostusta. Joten ajattele, että ensimmäinen asia on rakentaa tietoa. Mikä on tämän kanarien laulaminen sinulle? Onko se yksi näkökulmasta?
mental health manifestations of maladaptive stress? Is it a physical health manifestation of maladaptive stress? There is some sort of metric that you could use, a symptom of like, wait a second, I think this could be stress-related. And so your lived experience is really the best metric of knowing. And then the second step, of course, is to quantify that. So you go to a physician, you get the workup, and if the doctor says, oh, it's likely to be just stress, what we call stress-related condition,
you can do is quantify it and so to manage it you have to measure it and what i like to do is really think about stress i would love for one day the medical system to really embrace stress the way we do with blood pressure where it's a quantified number that we continue to track and monitor and then adjust treatment accordingly i have a free tool on my website where i ask five questions and then you get a personalized stress score and you can use that every four weeks every eight weeks to really track
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Chapter 5: How does resilience relate to stress management?
Olin kirjoittanut sen, koska se oli se kirja, jota haluaisin, että olisin ollut, kun olin stressipatienti, jotta en pitänyt kuulla, että se on vain stressi, yritä rauhoittua. Ja se oli se, että rauhoittua. Ja se on minulle ainakin tämä erityinen kirja. Se on 25 vuotta tekemisessä. Ja se on hetkinen perustuskautta, joka saa sinut ulos ympäristöstä ja takaisin kasvavuuteen.
The three key tenets of the book, first, everything is science-backed, because that is a non-negotiable for me as a physician. The second is that all of the strategies I offer, and ever, whether it be in my talks, you and I talking together today, in my interviews and in the book, are all cost-free, because as a physician who has taken care of countless patients with varying resources, making sure that everything was cost-free and science-backed is really important to me. And then the third is that
I really try to aim for every strategy and technique offered in the book to be time efficient, because we do not have a lot of time.
managing your stress and trying to rewire your brain for less stress should not cause more stress. And so the five resets, it's my prescriptive model and it's a proxy for my clinical decision making and the way I have approached patients all of these years. I no longer see patients, but in the past when I had a busy clinical practice, this is the approach that I used. And so it's five key mindset shifts and 15 strategies. And the first reset is get clear on what matters most.
The second is to sync your brain to your body. The third is to find your quiet in a noisy world. The fourth is come up for air. And the fifth is bring your best self forward. And each reset has about two to three science-backed strategies that you can try today. That's the other thing, you know.
When you are dealing with stress, it is so difficult to get out of your own way. We can talk about why that happens. It's a biological thing. It's your amygdala, which is your stress center, that is focused on your survival, your immediate needs and self-preservation. And so thinking about the future, making a plan,
Creating some sort of strategy to get out of stress. It's by design almost impossible. And so this particular book helps you kind of take that process. Because stress and trying to overcome stress, it's not about knowledge or information or a gap in this. We all know what we need to do to feel better. It's about a gap in action. And this particular book helps to close that gap.
Thank you for outlining what the five resets are. Is the thinking that taken together in that order, one, two, three, four, five, just straight through, is a tool for managing stress? Or do you think that there are certain situations where you might use reset number three and certain where you might use reset number two? How do you approach that?
I leave it up to the reader. You know, this book is now available in 35 countries and 15 languages. And so I get messages every day on how people are using the five resets. And it's like my greatest joy to see how people are bringing this information and knowledge into their everyday lives. There are two kind of key metrics and assessments. So the first is to do a personalized stress score. And the second is your lifestyle inventory. Then you get some data of where you are. And then you can say, you know, I want to focus. I want to go from, you know, step one all the way through.
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Chapter 6: What role does community play in managing stress?
Ja minun työni, muun muassa, minulla on paljon kirjoituksia, jotka sanoo, että sinä vaihtit elämäni. Ja minä aina sanon, että en, sinä vaihtit elämäsi. Minä olin yksinkertaisesti ympäristö ja ympäristö, jota sinun pitäisi olla sinun perheessäsi. Minä haluan mennä näihin strategioihin ja mennä niihin hieman enemmän, mutta ennen kuin me teemme sitä, olisi yksi muu asia, jonka haluaisin, että auttaisimme ymmärtämään hieman paremmin.
which is connected to the subtitle for the book, Rewire Your Brain and Body for Less Stress and More Resilience. And resilience is a word I think we hear a lot in this sort of culture of hustle culture, grinding. And when you think about resilience as it relates to stress,
How do you look at that specifically? This is a juicy question. Let me define what resilience is. True resilience, the scientific definition of resilience, is your innate biological ability to adapt, recover and grow in the face of life's challenges. What's interesting about resilience is that there can be no true resilience without a little bit of healthy stress, because you need a little bit of healthy, adapted stress for resilience to show itself.
You can think of that relationship between healthy stress and resilience by thinking about when you were a child and you learned how to swim. So your instructor, your swim instructor who encouraged you was healthy stress and your resilience, your innate ability kept your head above water while your arms were flailing. And with time and practice, you were able to glide to the water with ease. Similarly, with some of these techniques that we're going to talk about, it's a way to build your true resilience.
I really struggled initially when I was thinking about what can the subtitle be. Using that word resilience was a weighty decision for me because I'm sure all of you listening probably feel the same way. But when I hear the word resilience now in this year, like in this moment in time, I cringe. I have a visceral response because I'm like, don't tell me to be more resilient. And so I really struggled with that. And the reason is because, you know, that's
The true definition of resilience is it honors your boundaries. It really understands your human limitations for rest and recovery and celebrates your ability to say no. However, over the past several years, Whitney, we've really seen a change in what that word resilience means. It's now everywhere. Toxic resilience.
It's like that definition of resilience has become dark and sinister. It's pushing past your boundaries or productivity at all costs. It's a mind over matter mindset. It's when your demanding boss says, you can take on another project. Look at you, you're resilient.
Or when a parent, you're a parent, I'm a parent, when people are like, oh, just work like you don't have kids and parent like you don't have a job. I mean, we hear these sorts of messages all day long. And so I hope that our conversation today and a lot of my work focuses on reframing what resilience is, moving away from toxic resilience back to true resilience. And that's really when I finally agreed, I said, you know what, I'm going to put that word in there.
And I'll write all about toxic resilience and hopefully we can then come back to what that word truly means in the here and now. So it sounds like resilience is a precursor to burnout. It is resilience. What's interesting about resilience and the relationship between resilience is and burnout.
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Chapter 7: How can technology impact our stress levels?
And over the past few years, about 74% of people across industry, these are industry-wide statistics, say the last few years have been the most difficult of their professional careers. And when you look at a room of 30 people, that's like saying 21 people are struggling with stress and burnout. And so I shared some of that data to say that resilience, the true scientific definition, it's your innate biological ability. So we all have it. And yet
It's that we are seeing these high rates of burnout, because resilience, while it's protective, it's not enough to prevent burnout. And that resilience myth is also something that I am hoping that we can dismantle here today.
and really remove that onus of responsibility of building resilience and creating resilience away from individuals. Yes, we are going to talk about many ways that we can build individual resilience, but we also have to remove that onus of responsibility away from individuals and back to the systems that are meant to support us, because people are resilient. It's the systems that burn us out. Well, I want us to dive into this more as the conversation goes on, but I know people are so eager to hear some of these strategies which you've
begun to give us a little taste of with your five resets. So when you think about stress, what are some of the go-to techniques or practices for managing stress that you use on a daily basis or that you recommend for others to use? So I had that acutely debilitating experience of stress when I was a medical trainee, that stampede of wild horses. And I have never had an acutely debilitating experience of stress like that
intensity again. However, I have had lots of experiences of stress over the years, acute and chronic and everything in between, because, you know, life happens. And so I have very much walked the talk. So all of these techniques that I share in my work, in my book, in my talks, I use them every single day, like truly every single day. One that we can start with is the one that I learned and is stop, breathe and be. I learned this from
a class that I took called Mindfulness for Healthcare Providers. I was a stressed out medical resident and a lovely colleague of mine, Dr. Michael Boehm at the University of Pennsylvania taught us this technique. I have used it to this day. And I did it in fact right before we joined our call. Stop, breathe, be. It's a three second brain reset and we can all do it together. What you want to do is whatever you're doing right now, just stop, breathe,
and B. Ground yourself in the present moment. Stop breathe B when you practice it over and over again throughout the day and ideally use it at transition points of the day. So when you're clicking join Zoom, when you're moving in and out of rooms, say a boardroom or a meeting room, when you're running to go pick up your kids or rushing off to an activity, it's a great strategy to use. I personally learned it when I was a medical resident and I would knock on the exam room door right before entering the room. It was my doorknob moment.
and as I would turn the doorknob to enter the exam room, I would say to myself, stop, breathe, be. And what that did over time is that it connected
me to my mind body connection so it made me aware of my mind body connection and the you know we can talk a little bit about what the mind body connection is but the reason stop breathing works so well is like the gateway to learning about how to manage your stress and rewire your brain is because it taps into your mind body connection it helps to influence it for better and what it does is it gets you out of that what if thinking which is you know anxiety is a future focused emotion it's really very much about what if so what if
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Chapter 8: What actionable strategies can help reduce stress in daily life?
Ja se vaihtoehto on todella tärkeä. Joten yrittä stop, breathe, be. Teet sen muutaman päivän aikana. Ja yrittä sen muutaman kuukauden jälkeen. Silloin näet merkittävän erityisen stressiä aikanaan. Ja tavoite on muuttaa sitä huolimatta stressiä läpi adaptiivisesta tasosta. Jotta se voidaan hyödyntää sinua, eikä haittaa sinua. Haluan stop, breathe, bea ja olen käytännössä harjoitellut sitä nyt, kun sanoit sen. Ja yksi kysymys minulla on siitä, mitä ajattelet.
You say stop and at that moment, where should your mind be? Where should you be focused? Well, you can be focused on anything because, you know, we were thinking about a million things all the time, right? So stop, you just stop. And you tell yourself, you know, when I first started Stop, Breathe, Be, I would say that to myself under my breath in a very busy clinic. And people might have thought I was nuts, but I did it anyway under my breath. And I would just say stop, breathe and be.
That breathe part is really important. The reason that breath is so important to recalibrate your stress response, and we can go as deep and scientific as you want, is that your breath is the only physiological process that is under voluntary control and involuntary control. Your heartbeat doesn't do that. Your digestion, your brain waves, those are involuntary. Things are just kind of happening.
Mutta vesi on ainoa asia, joka on yksilöllinen ja yksilöllinen kontrolli, mikä tarkoittaa sitä, että me olemme katsomassa ja huomaamme. Mutta sitten, kun sanot, että ottaen syvästi vesiin ja ulos, olet itse asiassa vaikuttanut vesiin, joten se on todella vahva asia. Siksi vesi on niin tärkeä, kun käsittelee stressiä. Ja syy, miksi vesi on niin tärkeä, on se, että se on todella yksilöllinen vaihtoehto
When you're feeling anxious, you have shallow breathing, so you have thoracic breathing. You're breathing from your chest. It's rapid and it's shallow thoracic breathing. It kind of triggers the sympathetic nervous system, which is your fight or flight response. We can go all down that route if you want. That is what triggers the cortisol and the amygdala. It's the cave person mode. It's like survival, self-preservation. When you feel that sense of acute stress, that's what's happening.
Mutta jos harjoittelee stop breathe B ja erilaisia huomioiden tekniikoita, minulla on noin neljä tai viisi huomioiden tekniikoita ja viisi resettiä, ja voimme tehdä niitä paljon tänään. Se, mitä tapahtuu, on, että sen sijaan kuin sympaattinen, rauhallinen, teräskyvyn huomio, muutat diafraaniin, mitä kutsumme dominoiviin huomioon. Se kutsutaan diafraaniin huomioon. Ja nopeasti se tekee sitä, kun otat niitä syvästi.
Se vaikuttaa ympäristöön, ja se vaikuttaa ympäristön ympäristöön, ja se vaikuttaa ympäristöön, ja se vaikuttaa ympäristöön, ja se vaikuttaa ympäristöön, ja se vaikuttaa ympäristöön, ja se vaikuttaa ympäristöön, ja se vaikuttaa ympäristöön, ja se vaikuttaa ympäristöön, ja se vaikuttaa ympäristöön, ja se vaikuttaa ympäristöön, ja se vaikuttaa ympäristöön, ja se vaikuttaa ympäristöön, ja se vaikuttaa ympäristöön, ja se vaikuttaa ympäristöön, ja se vaikuttaa ympäristöön, ja se vaikuttaa ympäristöön
I love that. And I feel like there's so many moments where when I'm stressed, I actually can catch myself holding my breath, right? And I imagine that that is a big part of what influences this breath exercise and helping you to relieve stress. Absolutely. I mean, there's kind of like three key elements when you're thinking about how to tap into your mind-body connection. There is your breath.
There is your posture and there is your feet. And so you can kind of bring all of those in. So I practice stop breathing at many points during the day. Ideally, it's a great thing to do at a transition point when you're entering something that's going to be potentially stressful moment. So I do it all the time in the morning when you're rushing to drop off kids at the bus stop or you're running to a meeting. It's like that.
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