Lever #4: Mental & Emotional Health
How stress impacts lifespan, practical strategies for managing stress & cherishing life.
"Named must be your fear before banish it you can." - Master Yoda
A Loaded Gun
Mental and emotional health are loaded words nowadays. Increased efforts over the last couple of years to bring attention to them and remove misconceptions have contributed to great progress, however, to a large degree they’re still extremely misunderstood.
As a disclaimer before diving in, nothing here should be interpreted in relation to or as pertaining to mental illness or mental health disorders.
It’s important to understand that we do, to a certain extent, have the ability to control and improve our mental and emotional health through the choices we make and the actions we take on a daily basis. This means we must accept responsibility and accountability for this part of our lives too.
Although we may all have our own definition of what strong mental and emotional health looks like, to me it means fostering a positive relationship with myself, feeling like the number of good days I have outweigh the bad, being emotionally resilient and mindful, building distress tolerance, feeling a sense of happiness, joy, and fulfillment on a day-to-day basis, and engaging in supportive and meaningful relationships with those I love and truly care about.
Armed with a definition (feel free to use mine or create your own) and the knowledge that we have the ability to control this area of our lives, we can move on to why it matters and the tools at our disposal to improve our mental and emotional state.
Clear as Mud
Everyone acknowledges that mental and emotional health is important, but I rarely hear an explanation as to why. The first and most obvious reason is that the quality of our day-to-day lives will be rather unpleasant if we’re consistently struggling with how we feel inside.
We’ve all had days where we felt weird, out of it or a little down and although it can oftentimes be difficult to put a finger on why we feel that way or how to fix it, we know that we don’t like it. Thankfully, there are tools we can use to reduce the number of bad days we have and combat them when they do come around (we’ll get to that shortly).
So, if reason one is that having positive mental and emotional health will improve our day-to-day life (improved healthspan), why else is it important? The second, less obvious reason, is that it will also extend the length of our life (improved lifespan).
Take as an example the stories we hear of a very ill grandparent that manages to stay alive just long enough to see the birth of their grandchild. A purpose for living combined with meaningful relationships and a strong community has a direct impact on how long we live. Unsurprisingly, this is a common trend observed in blue zones, regions where a higher than usual number of people live longer than average, around the world.
Health Impacts of Stress
The biological effects of having poor distress tolerance, which is our ability to manage actual or perceived emotional distress, and thus high levels of stress over long periods of time are devastating.
Cortisol, commonly associated with stress, is a steroid hormone in the glucocorticoid class of corticosteroids produced by our adrenal glands. Thousands of years ago glucocorticoids, including cortisol, played a key role in keeping our hunter-gatherer ancestors alive through fight or flight situations.
If we were under threat of being attacked by a lion, adrenaline would come rushing into our bloodstream almost instantly kicking our primitive fight or flight response into gear. Around 30 seconds after the initial threat our glucocorticoids, predominantly cortisol, would kick in and by shutting down non-essential systems such as our digestive, reproductive, and immune systems, give us an increased ability to think vigilantly in order to formulate a plan to intelligently evade the lion.
Although the modern world has just about eliminated the chance we’re going to be taken out by a predator, it has left in its wake millions of other stressors that, if we allow them to, can keep our cortisol levels high all day.
Having elevated levels of cortisol for extended periods of time, a condition called hypercortisolemia, will send you to an early grave and make you miserable along the way. This is why distress tolerance is crucial to develop to not only live an enjoyable life but also to increase the probability you’ll live longer.
Developing Distress Tolerance
If hypercortisolemia (excess cortisol) will both make us miserable and shorten our lifespan, the question prevails: How do we cope with distress to minimize hypercortisolemia?
Here are a few of the strategies and tools we can deploy to improve our distress tolerance and minimize stress as we navigate through our days.
The Five Levers
Living a life in which we prioritize sleep, nutrition, and exercise will have profound positive impacts on just about every area of our lives, including mental and emotional health. Our mind and body are intricately connected so taking care of our mind means taking care of our body too.
Carve out 10 minutes each day to practice deliberate mindful meditation. Keep it simple. All you need to do is sit down, close your eyes, and notice what you’re sensing or feeling in each moment. If you realize that your mind has drifted off into thought, as it will, simply bring your attention back to the present moment. If it helps, count your breaths up until 10 and then start again at one while continuing to notice thoughts or sensations as they arise. This might help you realize when your mind begins to stray.
Just letting your pen flow in the morning with no guide or aim, a practice called Morning Pages, can have profound positive impacts on your life. When I’m feeling stressed, scattered, or cloudy-minded, I find that by opening a journal and writing, I clear my worries and crystalize my focus, regardless of what comes out on the pages.
Another powerful writing practice is gratitude journaling, one I partake in using The Five Minute Journal. It’s impossible to be in a negative state when you’re expressing true gratitude for the things in your life. In case you don't want to buy one, here are the morning and nightly prompts to help structure your writing:
I am grateful for… (three things)
What would make today great? (three things)
Daily affirmation. I am…
Amazing things that happened today… (three things)
How could I have made today even better? OR What did I learn today?
It’s important to know yourself and understand your values. Being clear on who you are and what you care about will guide your decisions and dictate your job, hobbies, how much free time you have and how you spend it, and so on. These pieces bind together to create your lifestyle which has a massive impact on stress levels and whether you feel good about your life as a whole. As the adage goes…
“Happiness is when what you think, what you say, and what you do are in harmony.” - Mahatma Gandhi
Start paying attention (your meditation practice will help you get better at this) and it won’t take long to determine what your stress triggers are. Whether it’s email, social media, work duties, uncertainty, or other life responsibilities, we’re all uniquely prone to be stressed by something.
Once we understand our unique stressors, we can take action to minimize the amount of stress that they cause us. For example, if each email that comes into your inbox creates a feeling of stress or unease, you can implement the practice of batching. Batching is when we group similar activities together and then set aside a predetermined time to complete them.
In the case of email, shut off notifications and then pick two times each day, say 9am and 4pm, in which you’ll check and respond to emails. You can even set up an autoresponder so that anyone who emails you will get an automatic response detailing when they can expect a reply.
By batching in this manner, you’re not like a hamster on a wheel continuously and reactively responding to email. You take power back by scheduling set times in which you’ll deal with the thing that’s causing you stress.
If batching is not an appropriate solution to your stress triggers, I find three other broad strategies, that are best thought of in a three-step process, useful: eliminate, schedule, or act.
If it’s causing you stress and it’s possible to eliminate it, cut it out of your life. Simple and easy. Life’s far too short to worry about things we don’t have to. Don’t batch things that you can eliminate.
If you can’t eliminate it, then schedule a time you’re going to deal with it. That way it’s out of your mind since you’ve taken the first step towards devising a solution. Batching falls into this category.
Oftentimes we’re worried about things that are outside of our control but we struggle with letting them go (eliminating). Instead of letting this worry cause you stress, open up your calendar, choose a date and time, add a title, and hit save. Even if it’s something silly like “Worry about my flight being delayed”. Scheduling a time to deal with your stressor, whether they’re real issues to be dealt with in the future or a silly concern, really does work.
If you can’t eliminate it and scheduling it doesn’t put you at ease, then act on it. There’s a good chance that the stress is signaling to you that it’s important to deal with its root cause right now. Be reasonable and use your judgment as you can’t act on everything right away. However, there’s a time and a place when the best response is to just act.
In short: Eliminate → Batch → Schedule → Act.
Start by prioritizing your sleep, nutrition, and exercise, and then integrate a meditation and writing practice as you see fit. By developing consistent habits in these areas, you yield great power in taking control over how you feel. Speaking from personal experience, there’s a stark difference in how I feel mentally and emotionally on days where I exercise, eat and sleep well, journal, and meditate compared to the days I don’t.
In addition, focus on prioritizing relationships and spending quality time with those you love and who bring you joy. Spend a little less time on a screen and a little more sharing stories and experiences and making memories with those important in your life.
Someone once told me that the most memorable moments of our lives will come from experiences we shared with others… looking back on my life so far, I think they just might be right.
And, as always, please give me feedback on Twitter or by hitting reply to this email.
Lucid as always. Many cogent observations about the stress reaction and it's adverse impact on cortisol secretion, and how we can convert the stress REACTION into a more conscious stress RESPONSE.
I like that you concisely summarized a selection of antidotes. I'm also hoping that you'll expand on each one. One in particular is the role not only of journaling as a form of self dialog, but that of GRATITUDE and KINDNESS journaling. Reflecting on these regularly alters our mindset in a good way, bringing it into a state of loving kindness. And as we know from Herb Bensons's work on the Relaxation Response and his research with Buddhist monks, there's nothing quite like loving kindness to quell the raging fires of anger and fear.
p.s. I wish you had taught this to me in my first year of med school.
I really like your description of hypercortisolemia! I've talked to students a lot of over the years about heightened stress response and how our bodies aren't meant to stay in fight/flight/freeze for long periods of time-- what you present here is just a really clear description of that.
Related to this series about "levers" that you're doing I found myself thinking about the idea of on my run today. I've not been running and doing yoga as much the last couple weeks and instead prioritizing sleep a bit more. It's interesting to think about the concept of levers that are all important-- but can be adjusted to higher or lower levels as we stay in touch with what we need. Not sure if that's exactly what you intended with the phrasing- but it was helpful to me!