I'm doctor make events welcome to this
visual lecture answering the question
what is the single most important thing
we can do to manage your stress
a few years ago we moved her family to
France for three months was a time the
European Cup football championships and
So we would take our kids to a local bar to watch
the game on TV
watching the moods of people from
different countries
swing from pure joy to total anxiety 
to despair and back again
was as entertaining as the game itself
and I wondered if there is any scientific
analysis so how this can a stress
affects people
it turns out there has been a study in
the quarterfinal the 1996 championship
between the French and Dutch teams
a draw at the end of overtime resulted
in a sudden death penalty shoot out
which is won by the French when researchers
look back to see if there were health changes
on that day
it turned out there was a relative
increase in the risk of death from a
heart attack by about
50 percent among the Dutch men on the
day and the match compared with the five
days on either side in the match
there is no such effect on French men or
woman from
either country for that matter so this
story striking because it it's about one
event end and really one negative health
outcomes
stress but in reality stress is very
complex
multiple factors multiple outcomes
physiologists sees stress increase blood
Heart rate or changes in the chemicals
that modulate the immune system
pressure
the social worker sees vulnerability 
with the compromised social networks coping
and problem solving skills
the doctor sees increase visits
estimated that up to 70 percent a
primary care visits are stress-related
worse health outcomes bad self treatment
with alcohol and drugs
gateways to depression and anxiety and
of course the worst quality of life
these perspectives represent the
standard negative picture stress but
I believe we also see a positive side
distress athletes were able to find a
stress level that is high but
but not too high for optimum performance
executives are mothers or aid
workers who manage stress like a bicycle
tire
they regulate enough pressure to keep
rolling but not too much so that if
they hit a bump they explode
And to me this is really the most
interesting question when we look at
stress and health under some people
undergoing intense stress remain healthy
and even thrive in and what makes them
stress resistant well I think the
answer it big include factors like how
much control people feel they have in
their lives
their social network and I mean that the
old sense of the word
openness to change attitudes like
optimism self-care skills such as
exercising and
and humor and so on research on mental
health
shows that we are sort of a bento box more
severe mental health issues
in trying to figure out what works and
what doesn't which is great but we've
done much less research and most common
problem
stress and when it is steady its usually in
the context of other diseases
so based on a current literature my pick
for the single most effective treatment
for managing stress
is actually kind of a simple one change your
thinking style
most people think stress is something
that happens to us like a piece a steel
on a bridge that is constantly being
stressed and then eventually stretched
this is a physical model but it's it's
actually not a human model
that differences is stressed passes
through a two-pound piece a tissue on
the top your face called your brain
so we see things like my job is
stressful or my friend Sylvia is stressing
me out
but in fact we create the stress in our
brains
your work or Sylvia isn’t stressful
what you're thinking that brings a
stress your brain is
is a volume dial that can turn to stress
out but
I think you can also track people think
we're born a certain attitudes and and i
think is down but the truth is stress
management is a skill that can be
Learned
doctor Mat Gulliksson and his
colleagues and hoops
Sweden published a trial in 2011 in the
Annals of Internal Medicine
falling over 400 people loosely woman
that had significant her heart events such as
her attacker or bypass surgery
half the group received usual care and
the other half got usual care plus
cognitive behavioral therapy or CBT
CBT has become an umbrella term
where you learn practical techniques
such as problem solving relaxation and
and challenging common thinking trapped
so for example
a negative filters so if five people say
great job and one says nothing
and you think you blew it
fortune-telling
I'm not going to that job interview that
just reject me mind reading
a friend walks by without noticing any
you assume he dislikes you now
polarizing are black and white thinking
I feel might die if I bite into that piece a
cake
now I might as well eat the whole thing
and so on
the thought record is then used to
reframe your automatic thinking and a more
healthy thinking
as the American psychologist William
James said over 100 years ago
the greatest weapon against stress is
our ability to choose one thought
over another so the researchers want to
see people could use these techniques to
reduce the daily experiences stress
time urgency and hostility in this so
could that lead to better outcomes
so so not a drug not a diet not a stent
just changing the way you think the
participants were followed for over seven
years
those that got the CBT had a forty-one
percent reduction heart attacks
and at 28 percent lower death rate
the more CBT session a person attended the
better they did
now another way to change your thinking
style in order to reduce stress is
through the use of mindfulness
techniques
mindful used to be more through it I
will call the king by crowd but
the programs have actually become much
more mainstream in fact my patient have
Heart attacks and chronic diseases now
often taken mine from this course part
their treatment
and there's a growing evidence about its
effectiveness a recent trial following
clinically depressed patients by doctor
Zindel Segel College University of
Toronto is a good example
when the patient experience remission
they were randomized to an
antidepressant
or placebo or mindfulness-based
cognitive therapy
the results show that mindfulness was
as protective against relapses medications
my sense is that the success from mindfulness
is probably due to the fact that
combines many useful techniques for
stress reduction
such as increased self-awareness
involving a physical component like
breathing or muscle relaxation meditation
and perhaps most important in our busy
world an emphasis on letting go of
distractions in being in the moment
mindfulness can give us ability to let go
of worry and not get trapped in the anxious
leaped
perhaps less about changing the thought
and in really more about choosing where
to place your attention
as a famous Austrian psychiatrist Victor Frankel 
pointed out between stimulus and
response
there's a space and I think mindfulness
teaches us awareness so that space in
and that we have the power choice so
another factor that the
research tells us that impacts your thinking
style is your attitude
your outlook on life doctors Suzanne Kobasa
and her colleagues from the University
Chicago look at this by following a
natural experiment in the nineteen
eighties break up of the Ma Bell
Telephone Company
the followed who coped well and who didn't
and identified three key trait of those
who coped well
the first motion was commitment the
stress resistant executives were
committed a different aspects of their
lives
so even while facing uncertainty they
stay committed to quality work in
engaging with family and friends their
communities there
faith hobbies they saw
and I think we're committed to the
bigger picture success
and this allowed them to weather the
turbulence in in a specific area of
their lives
the second motion was control this is
interesting
in that because its restructuring these
executives actually had little control
in fact you might see their skill
fighting stress is more about being a
let go of control
they could see that the sands were shifting 
and if they were too rigid in their
control over territory or department the
main actually lose a bigger opportunity
or even their job other psychological
research is focused on locus of
control or self efficacy
which is really the extent to which
individuals believe they can control
events effected
and their competence or or ability to
make change
the executives may have understood that
a lot what was happening was out of their
control but they could adapt in
and I think you can choose and feel
confident about what they could control
the third notion was change the stress
resistant execs were able to limit their
self-importance and and see the change
happening around them as a potential
stepping-stone
not a stumbling block
so as we come to the end of our story about
what reduces stress
might be helpful to know that the
research has shown that simply rating 0
distressed story
to make a big difference the act of
giving coherence in
and I think reading your own personal
narrative too stressful event in a
letter
can be an effective way of negating the
stresses those events the classic
therapeutic letter writing exercise is writing
a letter to somebody who
stresses you out
and then not posting it
finally like to leave you with this
advice to improve your thinking style
think basics when I play tennis and
things are going badly
which is often the case I forget about
everything else to say
move your feet watch the ball that it
when things are stressful sometimes you
need to keep it simple save yourself
I will keep a regular sleep routine I
will avoiding crap
I will walk will mingle and and I think
there's some early evidence for altruism
we're doing good as Abe Lincoln said
when I do good I feel good when I do bad
I feel bad
and that is my religion and I’m often
reminded about the power simplicity from
a
a lesson one of my patients taught me I 
did deliver bad news to him
and when I did he kind of shrugged his shoulders
and said I’ll be ok
I followed the 90/10 rule 10 percent of how
we do in life is based on what happens
to us and and ninety percent is how we
respond
I think the same may be true stress to
take a deep breath
think about your big picture commitment
your sense of control
Your openness to change consider doing some
homework on yourself refrain rethinking
redirect your attention maybe read a
letter repeatedly the evidence shows
that people manage their stress well
they're better health outcomes for
virtually any disease a may suffer from
and remember the challenges will always
be out there that's life but
remember too that your thoughts and your
added to our the key holders for the
stress you experience
not the traffic not your boss not your
job not you neighbour
but you something you can improve your
thinking
hope this helps thanks for listening
just
just
