Essentials: Manage Stress & Build Resilience | Dr. Elissa Epel
Guests: Elissa Epel
Full transcript · Read the full conversation in order, with its original context.
§01Transcript — part 1
Welcome to Huberman Lab Essentials, where we revisit past episodes for the most potent and
actionable science-based tools for mental health, physical health, and performance.
I'm Andrew Huberman, and I'm a professor of neurobiology and ophthalmology at Stanford
School of Medicine. And now for my discussion with Dr. Elissa Epel. Dr. Epel, welcome.
Thank you.
So great to have you here. I'd love to just kick off by you explaining a little bit about
the different forms of stress. We hear stress, stress is bad, stress can kill us, no one likes
to feel stressed, et cetera. But as you and I both know, that's not the entire picture. So
I'd love for you to just educate us a bit on what stress is and what it isn't,
where it can be problematic, and where perhaps it can even be beneficial.
So as a stress scientist, it is a word I use a lot, but it has to be broken down because
it has so many different kind of dimensions and meanings. So there's good and bad stress,
there's acute and chronic stress. And, you know, technically, it just means anytime we feel
overwhelmed, that we feel like the demands are too much for our resources. So that's kind of a
very technical way to put it. But really, so much of life is about meeting challenges. And
And we're never going to get rid of different stressful situations in life.
If anything, they are increasing.
And so it really comes down to not the stressors of what happens to us, but really how we respond,
the stress response.
So when something happens, we mount a stress response and we recover.
And that's beautiful.
No harm done.
We need that.
That's why we're here still alive is that survival response.
It's a problem these days of just, we keep it alive in our head.
We keep it alive with our thoughts.
Our thoughts are the most common form of stress.
What, to your knowledge, is the best way or what are the best ways for us to manage overthinking
and ruminating on stressful topics?
Should we work with them in the sense that we try and rationalize or understand the basis
of the stress?
Or should we try and divert our thinking away?
I like to bin it in three categories. So one is we, well, I'll just say, first of all, we have to have some awareness of how our mind works, or we're just like, you know, a subject to thinking our thoughts are real, thinking that it's helpful to keep ruminating and problem solving, because that's our tendency is to go toward whatever we think there's threat or risk and to problem solve that.
We could just be stuck there all day in this kind of threat mode or red mind state.
And that's just a shame.
We don't need to turn on that stress response all the time.
But that's where we are as a society.
We're so used to feeling daily stress from our urban and modern life that we don't notice it.
We're just used to it.
And so we're going through the day with kind of like clenched hands.
And just, you know, for listeners, just even just taking a check in now and noticing how you might be holding stress in your body.
That's a huge clue.
It's a huge place where we accumulate tension.
So we might not be aware that we're stressed, but we're clenching our hands.
So going back to this notion of overthinking, what are the tools that are most efficient for dealing with overthinking or ruminating when people just can't seem to let go of the stress or thinking about not the stress in their body, but the thing that caused the stress, the difficult conversation, the thing that irked them?
I wish I had one answer, but I'm going to say lots of strategies tackle that. And so in those three bins, one are top down strategies of awareness and things that we can say to ourselves since our beliefs and mindsets can really help us release stress, use stress more positively.
The second bucket is not that the mind changes the body, but the body changes the mind.
And those are the set of strategies that you tend to use the most, right?
We're working stress out of the body.
We're metabolizing it.
We're burning it up.
And we get relief.
It changes our amygdala activity and moves us to more an experiential state where we're
more in our somatosensory cortex.
And then the third bucket is change the scene.
Just getting away from all the stress triggers that we have in our office or in the city and being in an environment that we find calming.
It might even be just be a corner of the house, but implanting what I call safety signals, having things like comforting pets, pictures, smells, music.
When we talk about stress, it's clear that there's short-term, medium-term, long-term stress.
You studied all these different forms of stress.
If you would be so kind as to just give us an overview of the different forms of stress, how we can learn to recognize those, pepper our minds with knowledge about stress in all its beautiful and not so beautiful forms.
When we think about stress, we usually think feeling stress, reporting stress, and that's important.
What our body is doing is also important, and it's not always related to our minds. So measuring levels of the nervous system and how vigilant we are is another way that we can understand stress. And that's particularly important and interesting because that's how stress gets under the skin. And we might not be aware, we might not report stress, but we're still holding tension and being much more sympathetically dominated, meaning that our body is vigilant and scanning for cues and we don't feel safe.
And so we're mobilizing a lot more energy than we need to.
And stress is so expensive to the body.
The stress response uses a tremendous amount of energy, ATP, that's made by our mitochondria.
And if we have that kind of vigilant stress response on all day, we're just going to feel
exhausted.
And we don't necessarily get so threatened that we release a lot of cortisol, but our
nervous system is going up and down all day.
Then there's kind of moderate stressful events that maybe take days or months to cope with.
And what's important there is that noticing like right now, am I really coping acutely
with something or can I restore?
So that kind of daily restoration is very important.
And then there are chronically stressful situations that go on for years.
Many of us, not all of us, but many of us have those in our life.
If these are situations, I'll just use caregiving as an example, that we can't change.
We can't change other people.
We can't change certain situations or resources.
And we can be thinking about them chronically problem solving, trying to wish things were different.
Or we can use acceptance, radical acceptance strategies and other strategies to live well with them.
That's a really important strategy for people who feel like their life is going to be stressful forever because of X or Y.
You can actually be dealing with uncontrollable chronic stress in ways that it's not going to take that toll on your body.
I mean, I study chronic stress and how it accelerates cell aging, and I can tell you there's so much variance between people.
People are so different.
So among caregivers, some of them look as biologically young or younger than our controls,
people with no identifiable big tough situation in their life.
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optimal aging, typical aging, and accelerated aging. How does one measure optimal versus
accelerated aging? And why would it be that some stress is better than no stress when it comes to
aging ideally? Having no stress means we're not really living. Like we're not engaging in the
gifts of life, which are inevitably have some challenge and risk. And let me give you an
example. One study took elderly people who have retired and society kind of labels them as you're
kind of done with your meaningful work in life and you are pretty much not able to contribute
to society. I mean, there's so many negative stereotypes that people then kind of embody
and then live. And this program brought them to work in schools and tutor young at-risk students.
And what happened to them is they went from feeling maybe safe and understressed to feeling
challenged, but generative. They were feeling more purpose. They were feeling like they were growing
and they were feeling like their day had more meaning. They had these caring relationships
with the students. And in this study, they took images of the hippocampus and those who engaged
in the program, particularly the men, actually had growth of their hippocampus during this program.
So at any stage in life, we can be growing and challenging ourselves even in our much later years and growing our brain.
And you know more than anyone, like what does that hippocampal growth mean for their well-being and their cognitive function?
I almost have to wonder if it's like exercise where, you know, so many people, I think now everybody hopefully understands that exercise is going to lower blood pressure, reduce resting heart rate, improve musculoskeletal function and bone density.
all that stuff. But that if you took a snapshot of the bodily response during exercise,
blood pressure is way, way up. Heart rate is way, way up. Stress hormones are way up. Cortisol is
through the roof during a hard workout and immediately afterwards. And yet that sets in
motion a series of adaptations that brings you to a better place most of the time. Is there any
evidence that short bouts of stress provided that they're managed well, meaning that we don't spend
the next 24 or 48 hours ruminating on the stressor, but that we're able to move through the
stressor and resolve it in some way, that that's actually beneficial for us because of the
mobilization of energy stores and maybe even changing our threshold for reacting to stressors
in the future. We know, as you said, that physical stressors, when they're short and repeated,
like high-intensity interval training, they are promoting not just aerobic fitness, but stress
fitness. People feel less rumination, less depression, less anxiety. So they're kind of
tuning up the nervous system. What about psychological stressors? We know two things.
So one is I do think that there is a level of engagement with moderate stressors that when we
are used to them, we get fit and our stress resilience builds, meaning we're less threatened
by them. Two people can approach the exact same stressor and one person is having a pretty
overreactive stress response where they basically are feeling their survival is threatened. So it's
high cortisol, high vasoconstriction, and blood pressure goes up equally in both. But the person
who's feeling super threatened, either their survival or their social survival, their ego,
their blood pressure went up because of the vasoconstriction. The other person who is viewing
the same stressor as, I can do this. This is a great challenge and opportunity. I have what it
takes, those types of thoughts generate a different hemodynamic response, which is
actually more cardiac output. So blood pressure is going up, but in this healthier way,
more oxygenation to the brain, better problem solving. They're able to maintain this positive
outlook. So we've measured this threat challenge response in many lab studies, and we know lots
of things. So if you're having more of the challenge response, at the end of it, you're
less inflamed. So just in the lab within an hour or two, we see that they didn't trigger all that
pro-inflammatory response. And their telomeres tend to be longer, which is a measure we can
talk more about. But basically, it looks like they have a slower speed of aging. So we could
call this kind of, to be really simplistic, two types of psychological stress response, feeling
threatened, like you're going to fail, you're embarrassed. That social pain response, we know
well. That feels terrible. But that also that huge stress response when we, you know, we feel it in
our stomach, our heart is pounding. It's just an over-exaggerated response. That response
biologically is different and the thoughts that go with it are different and we recover a lot slower.
And then there's the challenge response, which it's more of that kind of activated, excited
response. And the beauty is that there are lots of studies out there done by emotions and social
psychologists that tilt people toward the challenge response. We can actually promote
that challenge response. And so when you asked about like, is it good to have a repeated stress
response? Yes, if it's manageable, right? Then we're kind of building the muscle of stress
resilience. What are the sorts of things that people, I, can do in order, including me, I should
say, can do in order to wage that challenge response? Is this purely based on mindset? Like
instead of saying, why me? Why this? Why now? I can't believe this is happening. Is it a mental
pivot to, okay, this is a great opportunity for growth. I don't know how I'm going to manage this,
but I'll manage this. You want to stop me, you got to kill me type of mindset. Is that the switch
that then the body follows?
The whole trick here is that people need to find
the strength statements, the stress shields, I call them,
that fit them, that feels right, and that they believe.
Be the lion instead of the gazelle.
So the lion and gazelle are both high blood pressure,
high stress, and the lion's chasing the gazelle.
But the gazelle's having this total threat,
vasoconstriction response, because she might die.
The lion might get dinner, right?
So it's needing to mount the stress response
because it's so excited to get the tasty dinner for, you know, the next few days. And so the lion
is having that challenge response. And so we can remind ourselves, be the lion. It's not that we're
always lion or gazelle. We get to shape that. There's all these strategies and you got to use
what works for you. Telling yourself, I got this, I can do it. I can get through it. I have what it
takes. Those are all good shields. And another set is, you know, we've, some of us feel really
stressed out by stress. Like once we get feel our heart racing, that leads to oh, no, you know,
this is bad for me. And so rather than getting stressed by stress, we actually want to remind
ourselves that this stress response is empowering. This is going to help me cope. My body is excited.
My body is doing just what it should right now. So that reframing in studies by Wendy Mendez and
others, my colleagues who do this reappraisal research, they have basically trained people
to view stress as positive. During the stressful situations in the lab, people do better. They
perform better. They feel more positive emotion. They problem solve better. They recover more
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§02Transcript — part 2
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I'd love to talk a little bit about some of the other health metrics that you've explored.
There's a graph in one of your papers.
It's the Picard paper, 2018.
It essentially describes the relationship between mitochondrial health and mood in the context of people who have different type of mood tendencies.
If you would be willing to just kind of describe the top contour of that study and some of the points that you find most interesting.
Yeah, we've done these in-depth studies where we are looking at people under a lot of daily demand, caregivers.
And then we look at normal people, parents of neurotypical children who still have a lot of stress.
But we then ask, do people under chronic stress have accelerated aging?
So we look at telomeres, epigenetics, mitochondrial health.
And then what explains those who look really good, who look resilient and don't look vulnerable?
And so then we can find out, like, what's the magic sauce in the day that protects them from chronic stress?
So Martin Picard, my colleague who has been obsessed with mitochondrial health as a pathway to understanding both stress and really health and disease,
he has developed a way to measure mitochondrial health in humans.
So we can measure a bunch of enzymes and then we can adjust it for how many mitochondria we have.
So we have this really nice index we can get from the blood.
And in this study of young mothers who had either typical children or children with autism,
we found that the caregiving moms had significantly lower or dampened mitochondrial activity.
What that means is they can't produce as much energy.
So if they're feeling more exhausted from the chronic stress, we know why.
It was quite dramatic.
Martin commented some of those low levels even looked like people with some genetic reasons
to have low mitochondrial activity.
But here's the beauty of that study.
We then get to look within their day at their mood and ask, well, what about the caregivers
who have really great mitochondrial enzymes and thus should be making a lot of ATP?
they had more positive emotions, both waking up and in the evening, but especially in the evening.
And what's so interesting that is all of these daily diary studies of stress and mood,
one of the things we know that matters for long-term health is how positive you feel at night.
So especially on a stressful day. So at the end of a stressful day, can you muster some feelings of
content, ease, confidence, joy? Do you have any of that? Or has it just wiped out your positivity?
And so for people who feel either lower negative or higher positive, they tend to have better
health trajectories. So like a decade later, less depression, less heart disease, less early death.
So that's why we care so much about daily moods. In our study, it looks like the daily mood was
really quite correlated with the mitochondria levels that same day. And we measured mood like,
you know, days away from that, it was much less correlated. It's just our first study on this,
but it really leads us to think that our mitochondria are sensitive to our thoughts
and our feelings probably on a daily basis. So for those of us that find ourselves in a state of
chronic stress, chronic stress of the sort that really the stressor, the fact that a very close
relative or family member is dealing with a lifelong condition, or the fact that we can't
extract ourselves from a situation, that we are not in full agency to remove the stressor.
Radical acceptance of that fact then can ratchet into an understanding of, okay, and yet there are
tools that we can use to not just offset the negative health effects, but maybe even thrive
in the context of this, essentially turning what initially was thought of as a curse into a
blessing, at least biologically speaking. What do we know about best practices for mitigating these
essentially non-negotiable stressors? I think it is partly how we view life and our purpose
in our own life. What's this game that we were born into? And even just the idea that bad things
shouldn't happen sets us up for vulnerability to feel victimized, to feel like we can't accept bad
things that have happened. So just stepping back and asking everyone listening, do you have a
situation in your life that is unwanted and you can't change? How much time do you spend thinking
about this? The more we spend time trying to problem solve or worry or just wishing things
we're different, the more we are creating a chronic stress state. And so just even taking
that first kind of step back to get perspective on what are the situations in my life that stress
me out? And which of these, can I circle those that I can't change? Just that recognition of
this isn't going to go away, is incredibly powerful because we can, as I say, put the baggage down
and give ourselves some relief and some freedom from the big space it holds in our mind and in
our body. And this is not a one-time thing. It's a practice. Radical acceptance is something we
practice over and over to help us loosen our grip on unwanted situations, on letting them control
our well-being and taking up this mental real estate that's so precious, our attention.
I'm an expert at this because I'm a caregiver.
And I often need to refocus from wishing things were different, trying to solve things,
to radical acceptance of this is how things are right now.
and by just reminding ourselves that there is freedom within that,
that there are things that you can do,
you can actually live better, live well with these situations.
So let me tell you what we found from our caregivers.
We measure where their mind is at night.
We ping them and we say, in the last five minutes,
how much have you been wishing things were different?
How much have you been engaged and focused in what you're doing right before we pinged you?
And just those two questions tell us so much about that person's well-being.
And actually, yes, the caregivers are doing more of what I'll call suffering, wishing things were different, not being present for their lives.
But regardless of that difference, whether people are a caregiver or not, this negative mind wandering state of not being present for your evening, wishing things were different instead of being engaged, predicts more unhappiness.
It predicts shorter telomeres.
So it suggests that it's a pattern that has gone on for days, months and years that has been wearing on them.
And so some of the metaphors that I think are helpful for this are think of this unwanted situation and think of how you're pulling a rope that's attached to a brick wall.
And you're doing that because you care.
You want things to be better for yourself or this person or a group.
I mean, it's something you're passionate about.
And so you're pulling and pulling and every day you're pulling and you can't move that brick wall.
So the only thing that's happening is that you're chafing your hands.
What if you just drop the rope?
I say that to myself, drop the rope.
When I start getting going on trying to solve unsolvable problems, the brick wall is still
there.
It's never going to move.
Yet my hands are free.
And so I can be freed up to live in the ways that I do have control over.
As you described this pulling on a brick wall, I find it a very compelling image and one
that makes total sense to try and drop the rope, as you describe it, because of the incredibly
high energetic demand that pulling on that rope represents. As you said, it's sort of a way of
diverting resources toward something that has no conclusion, right? And in dropping the rope,
you can divert those resources toward other things. We really, really, really love control.
and we want to control the future, not just because it makes us feel powerful and happy,
but because then we can relax. If we know what's going to happen next, if it's predictable,
we're that much happier. We're not vigilant and looking ahead and being prepared for what
might happen. Being comfortable with uncertainty is a beautiful but rare resilience factor. People
who tolerate uncertainty have much less anxiety and depression. And when stressful things happen,
they get over it more quickly. And I think there are practices we can do that help us feel ease
with the uncertain future. Some of these mindful check-ins, noticing that we are carrying around
uncertainty stress is one way. And then reframing uncertainty as the beauty of the mystery of life
and the freedom that we can feel when we realize we don't control tomorrow. We just go with it and
we do our best and what delight there is in just viewing things with curiosity and just seeing what
emerges. So even just our posture, here's an exercise for dealing with uncertainty.
instead of like kind of that alert posture when we're like trying to take it all in and
predict the next second and like just lean back and take some slow breaths. We know that's going
to help orient us and realize that we can actually face time in that way by letting it come to us
and receiving what happens. And that's a completely different body stance than our usual
go mode during the day. And that's just a way of saying, I am in a receptive mode and I'm going to
just be curious about what arises. And so I actually learned that on a meditation retreat
because I tend to be type A and I leave a retreat going from like very relaxed to
like that leaning forward tense of like, where's the to-do list? And so carrying with me that
posture of like, let time unfold as it will without trying to control things.
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It's really interesting. It gets right to the heart of something that I spent a lot of time
thinking about in the context of stress management and also just general thriving, which is that I
think that about half of the messages that we get related to stress and mind-body interventions
relate to adopting this forward center of mass. This idea of when challenge arises, you smash
into it, you go through it. On the other hand, there are these stress mitigation techniques,
both mental and physical, body-oriented, mind-oriented, et cetera, that are more of the sort that you
described that are, they're not being back on your heels, so to speak, like letting things
bulldoze you, but are more of this receptive mode. Do you think it's fair for us to adopt a sort of
general framework and model that perhaps people can adopt for themselves if they like, that,
of course, it's not an either or, but that having both of these in one's kit of tools could be
valuable. Because one is less energetically demanding, but of course offers less opportunity
for agency, or at least apparently so. That's the leaning back. And then the other certainly
gives an opportunity for agency. But we know from 100 years or more of psychology and psychiatric
literature and from the emerging literature on stress mitigation that it's work. It's not
something that is without a cost. It can get you far better results than it were you to just let
stress bulldoze you, but that it's work. And so we have to emphasize that work in very deliberate
ways. When we know it's productive, we should work. And when we know there's a brick wall,
we should let go. So I think of it, I like this forward mass idea. I think of it as
you muscle it and or you release it. And we need both. And so that letting go is a really
important, wise, you know, discerning way to mitigate stress in the right situations in the
right time. And, you know, we can't muscle through everything, right? So another way I like to think
about it is just the waves of life. Like, I mean, we are in an ocean and we have small waves, we have
big waves, we're always going to be hit by the next wave. And so it's this skillful surfing or
navigating that we can do better when we realize, when we control things, when we can't, when we
can truly feel safe and have ease versus when we need to kind of gently paddle. For people that are
listening to this and that want to start to adopt practices, do you think that spending some time
creating a written or a spoken narrative is helpful? I mean, we hear this, but are there
any data that support the use of journaling as a tool? Definitely. Creating a coherent narrative
is critical to our ability to make sense, find meaning, find resolution, have a social identity
around our lived experience, what happens to us. So narrative is kind of everything, right? In
stress research, it's not what happens to us, it's how we're interpreting it and how we're
responding to it. And I've heard you say the exact same thing when you've talked about
what is stress. It's really what narrative we're creating around it. So I think a narrative of
purpose, fill in the blank about what's meaningful to you, but that is why we're different than just
the rats that we study or the monkeys. We have the ability to do this projection to the future,
to ask what is our purpose in life, to see and know that we are going to die and we can
have some control over how we live and maybe even how we die and how we want to be remembered.
That is so beautiful. That helps us rise above this being monkeys in clothes.
I want to first of all just say thank you for doing the incredibly important work you do.
I also just want to thank you for taking the time today to share this information. I know I speak on
behalf of many, many people. And I just really want to extend my gratitude.
Thank you so much. And thank you for, for your podcast.
Well, it's a labor of love and it's days like today and discussions like this that make it
worthwhile. So thank you.
Thanks, Andrew.