When did saying "I'm so stressed" become the norm? Stress seems to be a given for anyone out there adulting so it's hard to know when it becomes a problem and what to do about it. In this episode, we talk about stress with Dr. Matt Scult, VP of Clinical Science at Scenario, licensed psychologist, and Duke alum! We discuss what stress is, when is it helpful vs. harmful, and evidence-based tips to managing stress in healthy ways. He introduces Scenario, an app that helps people prepare for the stresses of everyday life.
Resources:
When did saying "I'm so stressed" become the norm? Stress seems to be a given for anyone out there adulting so it's hard to know when it becomes a problem and what to do about it. In this episode, we talk about stress with Dr. Matt Scult, VP of Clinical Science at Scenario, licensed psychologist, and Duke alum! We discuss what stress is, when is it helpful vs. harmful, and evidence-based tips to managing stress in healthy ways. He introduces Scenario, an app that helps people prepare for the stresses of everyday life.
Resources:
Welcome back, Little Helpers. Today we are going to talk about something that affects all of us, but in varying degrees. It affects us at work, in relationships, and especially may affect us if we have loved ones who are suffering from mental health disorders. The topic is stress, and today we have helping us Dr Matt Skalt, who is a licensed clinical psychologist in private practice in New York, a digital mental health consultant and the VP of clinical science at Scenario. So, Matt, thank you for coming to talk to us about all things stress.
Speaker 2:Thanks so much for having me. I'm happy to be here.
Speaker 3:Before we get into like the important stuff, just want to also say that Matt is probably responsible for most of my career, because we went to grad school together at Duke and then he pulled me into the internship program at Cornell and then I I basically credit you also for like pulling me into digital mental health as well. So you were mad and that is why I, like you, know what is it like mentor behind the scenes.
Speaker 2:Well, I just love working with Kimmy. So I, you know, I'm just trying to figure out every way to to keep figuring out ways that we can. We can work together and chat about mutual interests.
Speaker 1:I have no idea Matt was so influential in your life. I also spoke with Matt before. Was I already? I don't even know if I was already in Duke or if you were just some.
Speaker 2:I think you were applying. I was applying.
Speaker 1:You don't even know if I was already in Duke or if you were just some. I think you were applying, I was applying, you were thinking of it. Remember how we got connected. But yeah, we had a conversation on the phone about like application best practices or something, or maybe it was interview tips. So I guess what I'm saying is Matt has been marionetting us behind the scenes for a long time. Marionetting us behind the scenes for a long time. Thanks, Matt. I hope it's been helpful.
Speaker 2:Yeah, just excited to help, however I can.
Speaker 1:So, matt, can you tell us a little bit about yourself and how this topic became so prominent for you?
Speaker 2:Yeah, absolutely so.
Speaker 2:Let's see, I, you know, in college I was studying neuroscience and um was just fascinated by how the brain works and how the interaction between what's going on in our brains and our bodies and how that's connected to everything that makes us human, how we're feeling, how we're thinking, how we're acting.
Speaker 2:And so after college I started working at a mind-body medicine institute at Mass General Hospital, the Benson Henry Institute, and there was studying the physiological effects of stress and interventions to target stress and, in particular, was looking at meditation-based interventions that were trying to kind of have the opposite effect of some of the physiological effects of stress. And it was fascinating. I mean, I saw, you know, we were doing studies showing that that things that you're doing, like meditating over the course of eight weeks, can have effects on your physiology in the way of like affecting your um which genes are turned on and off and having like that profound and impact, yeah, over that short a timeframe. Um, and you know it wasn't. That's what we were studying, but it's not unique to meditation. It's really that, by learning, by experience, what we're doing really has an impact on um, our bodies, and vice versa, like what we're doing, you know, with our bodies is affecting how we're feeling and thinking and behaving.
Speaker 1:And so.
Speaker 2:I think that kind of really kicked it off for me. I, you know stress was always like a factor, even if it wasn't the primary thing. I studied in grad school at Duke, as you mentioned, and was studying the neuroscience of kind of risk and resilience for developing different disorders and of course, we were always looking at how stress was coming into play and a factor there. And then after grad school and then was studying kind of digital interventions for targeting anxiety for young adults and really was fascinated by the different ways that we might be able to use these digital tools to expand access to care. And so, um, I after that started working at um, some industry, some companies that were looking at this and saying, okay, how can we really get these tools out to people in a way that's going to help as many people as possible? Um, and so I started working at modern health and was overseeing our clinical strategy for in-app content and our groups there Did that for a couple of years and then started consulting In the background. I was doing the private practice piece as well.
Speaker 2:And then started working about a year ago at the company called Scenario At that time it was called Loop at the company called Scenario at that time was called Loop and looking at how we can use digital tools there to help improve kind of a variety of different everyday challenges that we're having. The original focus was on social anxiety and then loneliness, but we soon realized that kind of the approaches we were using were much broader than that and could help with a variety of different challenges and really things that are bringing up stress in our lives and thinking about, like, how do we flexibly, uh, adapt and approach these situations so that we can, you know, decrease some of the negative effects of of the stressors, um, that are having on our day-to-day life?
Speaker 3:that's cool, that's really cool. What, what, what is stress? I mean, I, I, that's such a stupid question. No, it's a great question, because when I just hear stress now, I think, well, that's just like a catch-all word for bad, bad feelings. You know who isn't stressed, right? Who would say that they're not stressed. You know who isn't stressed, right, like, who would say that they're not stressed? But I almost think, like that, we that it's so vague that I'm not even sure what it is aside for like a more vague term for anxiety or depression, or just general ickiness, yeah yeah, no, and you're definitely not alone there.
Speaker 2:I think the term is just used in so many different contexts that it kind of does start to lose meaning. I think the definition that I think is the best is stress is when something happens in our lives that feels beyond our ability to cope with it, and it's especially true when there's situations that are unexpected or can't be controlled, and so that is really broad. Then the other part of stress is there's the stressor, there's the thing that causes stress, and then there's the stress response. That's your body marshalling resources to deal with the situation. You're probably familiar with your heart beating faster to get more blood to your muscles and your brain. You're breathing more quickly to get more oxygen. Your muscles are tensing up to prepare you to run away or fight.
Speaker 2:That's all stress. Like you said, stress gets this negative connotation, but stress isn't necessarily a bad thing. It's this natural response. There are many situations where stress is good and can actually be helpful and adaptive, and so I think that's a really important thing that you know happy to talk more about of like how we kind of think about when stress is helpful, when it's not, how the ways we think about stress might actually impact how, whether it's going to be helpful or unhelpful, and so I think those are all like really important things to kind of tease apart there.
Speaker 1:I'm like very invested in this topic because I have a partner who is chronically stressed and, um, I'm I would love to know how to help him or how he can help himself. And so I guess the first thing is, yeah, this idea that there's good stress or bad stress, or maybe that stress could just be conceptualized differently. How is there like a tipping point for stress when it becomes bad? Or is it more about attitude, like how do we know if stress is good or bad?
Speaker 2:Yeah. So I think kind of it's this complex's this complex interplay, and part of it is so how you're viewing it. So part of it is the intensity and the chronicity, so like, are you under really extreme stress? Are you experiencing some really kind of traumatic on the high end of your you know some traumatic event that is happening and so you know that might be. You know the level of stress is gonna have not necessarily completely determine the impact, but it's gonna have a big, big effect there.
Speaker 2:Then there's the how kind of chronic it is. Is it something that's happening one time? Is it happening kind of all the time? Like low levels of kind of chronic, ongoing stress can be really difficult as well. And then it's like is the stress something that, yeah, that we're able to kind of like recover from? So I think an analogy that I find helpful is like, let's say, you are going to go for a run, right? So if you're like, all right, I'm going to start right now and I'm just going to run and not stop, Like if you just did that for like days on end, that's not going to be stressful, yeah.
Speaker 2:Be stressful, you know your body wouldn't last that long.
Speaker 2:Like it's not something that's really sustainable, right, and would would kind of probably all agree that running forever isn't something that's really going to work out that well.
Speaker 2:On the other hand, like exercise is one of the best research things that's actually, like you know, improves our physical and mental health, right, like so, when you go and you're, you know, get physically active, you know, on a regular schedule, multiple times a week, but then you have time to recover from the stress of the exercise, then and um, and you know, exercise actually has some parallels to, like, the physiological effects of stress, um, interestingly, but when you're kind of pushing your body in that way and then you can recover, it actually is really good for your body, it's used to that challenge. And then, um, let's say, then you do have to go for a long run, um, you're being chased by a bear or something. Then, like, you're ready to do it, right, your body's ready to go. You're, like I've been running every day. Um, I hope you didn't, you know, none of our listeners, you know, run into a bear that's trying to chase them down.
Speaker 2:But it's like I think like that, that's preparing your body then and or that type of situation and so like the actual like active of the exercise more regularly isn't necessarily a bad thing. And I think for stress we can think about it the same way, Like if you're constantly stressed, then it's going to take a toll on your body. But if you have, like you know that there are a bunch of things that really push you and are beyond your comfort zone and ability to cope, but then you do cope with them and then you have time to recover, like that's actually something that's going to be helpful in the long run and can be really useful.
Speaker 3:So it's really it's more of the up and down, it's like the stress and then being able to recover, versus like stress all the time. That's really the key that makes it helpful and not harmful.
Speaker 2:That's one of the keys. Yeah, we wouldn't say necessarily it's the only one, but I think that's definitely one of. One of those factors is like do you have the ability to, to recover from that um?
Speaker 1:recover to what degree? Like recover to the point where you are no longer stressed at all, um, or like, if you have chronic stress at work, is like every weekend getting some downtime. Is that enough, or does it depend on how you conceive of the stress? I'm trying to calculate when exactly jason will die, so I'm just trying to.
Speaker 3:There's a handy calculator there for the right or, if you like, switch between stresses right, like if you, you know, on the weekend there's a different kind of stress than the work. Work day. Is that? Does that count?
Speaker 2:yeah, I think like different. I mean the, the short-term stress response is actually like a very short time scale. So we're talking on the order of like something that's happening over you know a couple of minutes, and so like when we think so, that's like. But when those then add up, right. So if you have like that a hundred times a day, then that's going to be different and so like it's.
Speaker 2:I think the different types of stressors matter for our kind of flexibility and ability to cope with them. But yeah, I think some of it is also like how often is this you're having this stress response? And I think, like the way you're viewing it does come into play, right. So do you see it? There's actually some great research by Aaliyah Crum, who's at Stanford, on like stress mindset is the research and she found that people who like see stress and there's some interesting interventions where they kind of like help people train this way of thinking is that like if you see stress is all bad and all negative, it ends up kind of being a self-fulfilling prophecy that it actually is worse for you than if you're able to see it as like.
Speaker 2:Well, stress actually sometimes can be helpful and adaptive and help me to grow and, and so if you're, then see that you are able to benefit more from these, these moments of like when you're being pushed and challenged versus and you don't have some of the negative effects, um, of the long-term stress, like I don't know if she's looked at dying sooner necessarily as the outcome, but uh I think they've been shorter term, uh, scales of the studies.
Speaker 2:But yeah, like some of the other negative effects in terms of like, yeah, just how you're like the, you know the oxygenation of the and the oxidation I mean of you know the, how much nitrous oxide you have in your blood, and things like that which are kind of like the short term, some of those short term negative effects kind of like the short term um, some of those short-term negative effects, things like that.
Speaker 3:Okay, well then. So if the stress mindset is that you should see stress as good sometimes but you know me, I'm like always stressed. But how do you know when it's like too much? Right, like there's some people like me who just seem to chronically get themselves into a stressful situation or constantly overloading themselves. If you're like, oh, all stress is good, but then you're overloading yourself, how do you know when to cap that or to limit that?
Speaker 2:Yeah, so I think there's a couple different answers to that cap that or to like limit that, yeah, yeah, so I think there's a couple different answers to that. One is like you know, as, as you probably talked about and oh yeah, I remember in some of the previous episodes you're talking about like noticing, like getting in tune with um, you know the, the. You're like something you're doing cbt right, like looking at what are different triggers, what are the different thoughts that happen, behaviors that happen, physiological responses, so kind of noticing how your body is responding in different situations and saying like, okay, after a day of doing this, am I completely exhausted and have nothing kind of left and am I completely depleted? Am I more irritable? Am I like?
Speaker 2:Looking at how you're responding can be some of those clues of like, ok, maybe these are really, you know, things that are pushing me beyond kind of the limits of what's, what's making me to to function really well. You can also see, like, when you're in that like medium, like stress zone, which is really kind of the ideal, you often like feel energized, you often like are really able to focus better and perform really well, and then, when it starts getting to be too much, it's actually harder to focus and harder to perform well, and you notice that maybe things are getting pushed a little too far. So I think being able to tune into this, either on your own or having someone, either a friend or professional, helping you to notice some of these of your own like warning signs and like when things are kind of getting to be too much, can be helpful to say like all right, it seems like the the impacts of stress are clearly clearly affecting me. Um, and so how can I do some things to help myself recover a little bit more? What are some things that are going to be rejuvenating, more relaxing, uh, to bring down some of the stress level and counteract some of that?
Speaker 1:It seems to me there's a okay, there's a difference between two kinds of stresses I'll bring up, but I wonder if there's an actual physiological difference between the two. So one is somebody who is stressed because of objective life circumstances that are stressful, so like somebody who can't feed their family and they're just like constantly having to, you know, figure out how to make money. It's just go, go, go. And then there's a kind of stress where it's more about perspective. So, like I've noticed in getting a phd, I'm a fairly like lower stress person and I think one of the reasons is because I'm able to say basically, like it's going to work out and this isn't the be all, end all for me.
Speaker 1:So, like, approaching I there are, there were some milestones that I would approach really differently than my colleagues who I I mean one of them, I think like developed like a diagnosis around the MAP or so around the thesis paper, and so that's more like that's less about objective circumstances and more about the way you think about the stressful circumstance. Like this passing this MAP is so important. What if I fail? And then who will I be? Where will I go? Everything is catastrophic, is there like does that get processed? The same exact way in the brain and body, or is there a difference?
Speaker 2:Yeah, it's a great question and I think it's like. I think that is a really important distinction to make. I think, like there, in terms of how it's processed, it depends a little bit what exactly you're getting out there. Like, if you're worried about putting food on the table right, then that the the worry is going to have a lot of the same physiological effects as if you're worrying about failing your MAP or dissertation, and so, like that worry if you don't have enough food, that's a different type, that's going to like impact your body in a different way and that, you know, also is a way of kind of like taxing the body having a stressful impact.
Speaker 2:So like if you, you know, yeah, if your body's not, if you're malnourished, like that's definitely going to have like a impact in a different way.
Speaker 1:Um, I guess maybe even a better example might be like a resident who has to work 80 hours a week and they don't really have a choice about it. So it's just like this very objective stress versus versus like is there a?
Speaker 3:objective stress though I mean to Matt's point. It's like one is the examples you're bringing is like pure survival right, like you're blocked from, like certain like basic needs of like food or something like that, whereas, like you know, yeah, I'm just wondering how much is objective versus subjective?
Speaker 2:Because right.
Speaker 2:I mean, there might be residents who are like this is amazing, this is like my life's calling and that yeah and someone else might be like, and that's where I think these interact and like why, um, you know, I'm excited to talk about some of the like ways we can target the, the mindsets, but also the environments and both kind of pieces of that, because I think, like, like you said, we can't in many situations it's really hard to disentangle the two right, like if we, like you, were rarely completely, you know, isolated, meditating in you know the mountains by ourselves, and like, not interacting with the world, like if the world, if we're not interpreting anything that's happened, like we, it's hard to kind of even conceptualize what that would be like if we didn't have any interpretation of, like, what was going on. And so you know again, there are those like basic like, if those basic needs aren't being met, that's going to have these physiological impacts as well. But I think outside of that it is a lot of it is, I mean, you're bringing up like some of these are maybe more controllable than others. And that's one of the key things of like often how stressful people find things. And so if things are perceived as uncontrollable, that's often more stressful or unpredictable.
Speaker 2:But it is that perception like, even like one of the best measures that is used in the stress literature is this perceived stress scale, or at least one of the most commonly used measures. I don't know if I'd say the best, but it's the perceived stress scale. It's like how do you perceive the stress? And that is just so baked into all of our models of stress is you have to kind of interpret things and that there is a level of subjectivity to that. But it's also not devoid from what's going on in our lives, and so we need to kind of think about both. How are we thinking about things and how are we targeting the sources of our stress and trying to decrease, minimize them, get them in a state that we're able to better handle them?
Speaker 3:What are different sources of stress? Just because, like, we're talking about controllable and uncontrollable and we're talking about work and relationship, I'm curious if there's like I mean I think when people think about stress at least when I do it's like the obvious stuff, right, deadlines, or like a fight with someone. Are there like secret sources of stresses that? Or like where are there? Are there some that are like worse than others?
Speaker 2:or interesting well what?
Speaker 3:what stresses us out?
Speaker 1:let's talk about all of our individual stressors.
Speaker 2:Um, I know that there's, like you know they're, the american psychological association does a survey every year of like the top kind of sources of stress and for them, like in the last one they put out I was just looking this over like actually adult education, like college, you know that grad school, that MAP, jacqueline, that you mentioned you know is definitely up there A lot of people who are in education as adults are reporting that as a big source of stress. Health, both physical health problems, mental health, is what people are reporting as sources of stress. Work for people who are employed, and money, as we were talking about. And then relationships are big as well. So whether it's intimate relationships, family relationships, friend relationships, so those are some of like the top things that people often are reporting and you know. And then there's like the societal level things as well, like social division and things like that are highly rated. And so there's like the kind of getting back to Jacqueline's point.
Speaker 2:For a lot of these there are the, the objective and the subjective. So like there's like the Kind of getting back to Jacqueline's point. For a lot of these there are the, the objective and the subjective. So like there's one of the questions delve deeper into like money right as the cause of stress. But One of the things was like money is the cause of a lot of fights or tension in my family. Is what some of the one of the things people are reporting? So it's both the fact that, like if people don't have enough money to feed their family, that is stressful and that like you need food, and there's the like added layer of stress there of like how that leads to family tension and fights and arguments and like how you know the the interpersonal kind of relationship piece that's that's layered on top of that is also an added source of stress. That's interesting.
Speaker 3:How do you deal with stress? Because, as you mentioned, grad school and the thesis, the MAP paper that we had, I just had a memory of you being in the midst of writing that paper and we were in this really tough class and stuff like that. I remember you said at some point that that was probably the more stressful times in grad school, but I remember you as always like even keeled, like it's so funny that we're talking about stress with you because you seem to you do like really hard stuff and don't seem stressed at all. You're always smiling, you're always, like you know, engaged and like curious I've never seen you go fuck this Like I'm, I'm, I'm, I'm, tapped out. I've never seen you do that. So how do you deal with it?
Speaker 2:so yeah, so I do. I mean I I do get stressed, uh, I think like for, but I think like what? Some of the things you mentioned are things that I find helpful. Like you mentioned like kind of being curious and I think like that for the mindset, like that's kind of overarching. One of the things I see is like that the our mindsets have a big role and that's like kind of that alia crumb literature and itets have a big role and that's that Aaliyah Crum literature and it's backed up with other literature.
Speaker 2:There's single-session interventions and those target all different things. But in particular, a lot of the approaches are like how do we help people have like a more open mindset about things and be like curious? So like bringing some openness and curiosity, kind of being able to like, from the cognitive restructuring literature, see things in different ways and try and like say like all right, what's a different way to view this situation? Um can be really helpful and just something that, like I, often is like a go-to for me, just like does happen. Um, you know, somewhat naturally, and then I've tried to develop it more, um, so I try and be like how can I like have fun with this, learn something new, like um, you know, see, see, kind of like the flip sides of like, okay, these are the parts that are hard about it and these are the parts that, like, are really cool about what I'm doing and like you know where I'm thinking about learning and growing, um, so I think those all have been helpful.
Speaker 2:And then I have found meditation. Like I started meditating in college and I'm not always the best about doing it regularly, but kind of having a, a meditation practice and mindfulness is helpful. When I exercise, it's helpful, but I'm pretty bad about getting into a regular exercise routine, so, but when I do it, it's helpful, but I'm pretty bad about getting into a regular exercise routine, but when I do it, I find that also helpful.
Speaker 1:Well, that part's interesting too. I mean, first of all, I just find meditation so stressful, so I was kind of talking about the mechanism there, but again with the objective and subjective like. One of the reasons I think Jason is so stressed is because there's a lack of sleep and his job is very physical, so he's exerting his body so much, um, and yet exercise is often prescribed as like a you know, something helpful for stress, um, is it? Does that depend on where the stress is coming from? Like his exercise only helpful if you're, if most of the stress is kind of coming from your head? Um, when, when does, yeah, when? Is mindfulness maybe more appropriate? How is mindfulness good for stress when a lot of people's experiences of deep frustration?
Speaker 2:Yeah, I mean, I think the, I mean like, what is terms of, like, what's kind of Is exercise different? How, for different types of stress? I Don't think I have like necessarily an immediate, like good answer for that. I think, like it does, you know, different people are drawn to it and like the different, like with everything, like there are a lot of nuances and so it depends, like, what type of exercise, how much.
Speaker 2:If he's already doing A lot of things that are really physical, um, yeah, maybe there is bodies already taxed in that way, and so that's you know, um, there are other things that would, would help, be more helpful, or like be there's little added value at that point, potentially, um of additional exercise. Um, with sleep, you know, yeah, like sleep impacts how we're feeling. So if he's having trouble with sleep, like, um, I think, like you know, I've worked with people in doing cognitive behavioral therapy for insomnia and like those treatments can be, um, you know, challenging to go through but can make a real difference for people. Um, but like how that comes into play for me. Again, this doesn't work for everyone, but, like with mindfulness, if I wake up in the middle of the night and I'm thinking about stuff.
Speaker 2:Um, my practice of doing meditation or mindfulness helps me to like to let that go, to let the threads like my mind's racing about something, or I'm worried about something.
Speaker 2:I'm like, oh, all right, this is the middle of the night, worried thought, that's one thing that like helps me to like get a little distance from it. And then I'm like all right, here's, I'm like, if this is a real concern, I can kind of think about it more in the morning when I'm in a you know better headspace to kind of think about this. And then, with the mindfulness also, like, I've practiced like bringing my attention back over and over and over again. And so I like you know I do that in the middle of the night if I'm up and I'm like all right, I'm going to like bring my attention Like I'm going to let go. I'm latched, my mind's latching on to the thought again, and it maybe does it like 50 times, but I keep like letting it go and coming back and I'm like all right, maybe, like when I'm tired I'll fall asleep, but right now I'm not falling asleep. So I guess like, and the practice has helped me to.
Speaker 2:Then put less pressure on that for myself, like I need to fall asleep right now and so those are all things, that kind of like ways those come into play for me in those situations. Again, like everyone's different, everyone has different needs and like, so you know, this might not work at all or different variations might be more helpful for him, but those are kind of like in my situation what those look like or how they come into play.
Speaker 3:Do you really meditate regularly? Do you have a regular practice?
Speaker 2:Yeah, I mean like I'll go through periods where I won't do it at all for like a month or two and then I'll be doing it like four or five days a week for like 10 or 15 minutes a day. That's kind of like my practice. And then, um, but yeah, I, I find it helpful. But you know, one of the things that I kind of like I think it's a great technique, like I find it really helpful. But as like you both were saying, or at least talking with saying like you were, you were saying that, like you know, you don't like it as a technique, right.
Speaker 1:Well, I honestly I like mindfulness a lot. Meditation I find really frustrating. So everything you were talking about, like noticing your thoughts and being able to kind of label them and say like this is not something I need to focus on right now, I can let that go, um. Or releasing judgments about myself, um, so basically, getting a little bit more meta and being able to look at the content in my brain and sort of decide what to focus on and notice what's pulling me in or not, I find that very helpful. But when I have to go through like a 10-minute meditation, just the mind wandering and then bringing it back over and over again tends to frustrate me and I guess it just doesn't. I guess it just doesn't feel relaxing.
Speaker 1:So I've always thought of it as, like you know, mindfulness doesn't need to be relaxing, but over time it's really helpful in kind of getting the geography of your brain under control and being able to. I can see how it would reduce stress in the long term because it allows you to not focus on the thoughts that might be increasing your perception of stress, for instance, like it could. It could help cut through some rumination, um, I just, for whatever reason, find that like when I have to do that as a practice I can almost do it more like as I'm walking through my day and I notice thoughts coming in, just be like, yeah, I don't need to focus on that. But when I have to sit down and like think about what's happening in my body and, like you know, get in a comfortable position with my eyes closed, I just it immediately kind of makes me more stressed out.
Speaker 2:Yeah, because I think like and I mean I think that is a common experience for me. Yeah, because I think like and I mean I think that is a common experience for me like the practice, like it's a way of just practicing so that I can better do have the mindfulness in the day to day for me, and so like. But yeah, I think people are, for some people that when you're, when you aren't doing the other things at the same time, it's just like there's too much right and it's not, and like it's easier to do a walking meditation or you know, or doing a mindfulness exercise of like, yeah, noticing, tuning into the sensations of, um, you know, while you're you're typing or eating or whatever it is, and like doing other mindfulness exercises that aren't the like meditation, like kind of a seated meditation time for me yeah, for me it's just like is a practice that helps, like a literally practicing, like the way I would practice tennis to then be better at playing when I'm playing a game, and so like that's. I see the meditation is just like the practice time, but like the the.
Speaker 2:The other thing I think is like that it's not like in, and this is kind of like coming back to the digital mental health piece. It's like I saw that, like in, what's available to people mostly right now is meditation, right, they're like very popular meditation apps and so, if you want like some mental health tools, like most things people are going to do is they're going to go headspace or calm and start like doing one of those meditations. But there's so many you know different tools that we have Right, but there's so many you know different tools that we have right, like as clinicians, that people are just like you.
Speaker 2:It's hard to have access to if you're not in therapy, and so I think, like that's one of the things that drew me to kind of digital mental health and like the work at Scenario was like doing, thinking, like how do we get some of these tools, other tools, to people? Like, if people don't like meditation, right, or if they've been doing it, doing it and it is does work for them, but like then you just have like only one tool, right, and so how do we like get these other tools to people? Um, and so that's where, like, yeah, working on something like scenario, which is like you're able to then use these ways to personalize techniques and and teach them to people you know, and people to practice and learn other techniques that could be really helpful for them. Um, that's what gets me kind of excited about like where we're at right now, about like how we can, um, yeah, help people with other tools yeah, tell us more about the taking a bath, which I don't like to do.
Speaker 3:You know, like I I think of just I just get annoyed at the um, almost like the, the overused um strategies of just relaxing, which you know. If you're in a really stressful time you got deadlines you get in a fight with someone. Like you know, doing something like taking a bath doesn't really fix it right. So like what, what do we know what? What tools are, think, ways to help are you talking about?
Speaker 2:or yeah, and I think that's like really the key though, like that it's really been popularized.
Speaker 2:The people that like if you're stressed, you need to do things like take a bubble bath, right, but but as you said, that's not getting at like any of the sources of stress and so, like, what actually does is like figuring out, like often there are things that, right, we're avoiding is like and that and so like a lot of the sources of stress are things that are difficult in some way or uncomfortable, and so it could be like difficult conversations. It could be like, you know, starting on that to-do list when you really don't want to right, and it's like this isn't a fun task and it's like something that like isn't enjoyable. It's like being how do you navigate? Like conflict at work, or like how do you like support a loved one who's really struggling with things, and like those are like a lot of things that are causing stress and right now, like, most of the tools out there like have nothing to do with actually addressing these things right, and so, like that's where, um, you know the these types of tools that I'm working on, like at scenario, we're trying to target, like how do you actually, um, you know, approach some of the things that are the sources of stress and in an effective way? Um, so what we do is you come into the app and it says, like what's the situation you're dealing with? Um, and so you just like write it out, like let's say, um, yeah, I'm getting um in arguments with a partner, okay, like, and that's like a big source of stress. Or um, yeah, or my partners have is really stressed. Like let's use the you know jacqueline example. You were saying, like my partner is really stressed, has a difficult like time, like, has a stressful work life isn, isn't sleeping well and I just feel kind of helpless, like I don't know what to do to support them.
Speaker 2:And then we ask what is your goal in this situation? And thinking through drawing from evidence-based practices like DBT, does this various CBTs? Thinking through what is my real goal here? Like sometimes, like even that in and of itself can be a real intervention. It's like, am I trying to like get a certain result, you know, am I trying to like make sure that I get like something that I want? Am I trying to like show up for the other person and like is the relationship like really the most important thing that I'm focused on? Is it my own, like self-respect, or like kind of like having my own like emotional needs or what I need to put at the forefront? And like what if those are in conflict? Like what if I can't have it all. Like I, of course. Like, whenever I think about this or go through this, I'm like, yeah well, I want all those things right All the time, but like what if you can't have all of them all the time? Like, even going through the exercise of like, articulating them and prioritizing, like well, right now I'm actually showing up for my partner is the most important thing. Like, even though I know I'm right about this argument, you know that like, like, I don't need to make that point because that's not the most important thing. The most important thing is that I want to show that, like I'm there for for you, you know, and so, like, I think that can be like and uh, like, subtle but important.
Speaker 2:Like step of an, like micro intervention or like a piece of an intervention, right, um, so like, what's your goal? And then, like, having insight into what, like, what are what's getting in the way? Like, what are the kind of the blockers that are showing up? Like, why is this something that's challenging it? It's like, oh, we kind of fall into the same patterns or arguments or we're just stuck. I don't know what the next step is. So even figuring that out and having some guided questions to get there can be really helpful. And if you don't know what the problem is, it's really hard to know where to start.
Speaker 2:And then thinking about, like what's an effective approach. And that's where, like we, like I've you know here, like in scenarios, example, like curated a list of, like all these different evidence based approaches, starting with like interpersonal things, like things to you know, navigate conflict with other people, be like supporting other others, but then also like what even like if it's just something that you're, you know, ruminating about or struggling with like what are some evidence based approaches you can draw from, because that, like often, people yeah, like I said, there's just only a few of those that are often in the literature so, like, being able to like have those as like examples and what they mean and explain them just in the moment when you really need it, can be a really helpful way to go. And then what we do is we put those into what we're calling a visualization. Visualization means different things to different people, but it's really drawing from some of the, even the skills training literature, the psychoeducation, but also the exposure literature, and so here it walks you through a situation.
Speaker 2:Let's say, I'm going to have that conversation now with my partner about all right, I've noticed that you come back from work and you're really stressed and then we get an argument and then you don't sleep well and things like that. But I don't know where to start. I've been avoiding this conversation, um. So then walking through, like almost like a narrative scene that you can read or listen to, helps, like, bring up some of the like, um, the emotions that are going to likely come up in that situation, so that if it's something I've been avoiding because I'm like I don't want to, like, get in this, I don't want to feel uncomfortable, I don't want to feel upset by going through it ahead of time, it helps to bring down some of the emotions so that when you do it in real life, you feel better prepared, it's less overwhelming.
Speaker 2:So it's both illustrating how, some ideas. It's not telling you how to do it, but it's some ideas for how you could do this in a potentially effective way, trying to get some of that flexibility that I mentioned before of like, all right, oh, I hadn't quite thought about. Like, maybe if I try this approach or like think about it this way, it could, things could go a little differently than they did, you know, when we get in the same argument. And then, like now, I feel kind of better prepared because instead of just like going in hot, like I'm ready to like have this, like kind of I've already worked through it myself and so I'm ready to kind of like focus on my goal, which is showing up for my partner, you know, um, and so that's like one example of like how we're using these tools in um in a way to kind of like personalize these types like of examples and situations.
Speaker 1:I'm having some, some murky thoughts that I'm going to try to pull apart, um, so I I love the idea that it's like we're actually going to get to the bottom of your stressor and try to solve it, so that the root of your stress is not there anymore. Um, I'm, I guess I'm. That feels a little bit like an approach to well, it feels a lot like an approach to anxiety, and so I guess my thoughts are murky, because so Kibbe brought up the bath situation I feel like a lot of people opt for relaxation techniques because of the physical component that stress can take on, and I mean, maybe there's a conflation between physical stress and emotional stress. I know when I think of chronic stress, when there's not necessarily anything to solve. So, for instance, my patients who are going through fertility treatments, where it's just like we are infertile, there's nothing I can do except for go to these appointments.
Speaker 1:I can see why relaxation tends to be the advice, because it's like, what can you confront right now? Um other than to just relax your body, which might be like a little bit like might be strained from the effects of your stress? So I guess, what, what is the place of relaxation? Um, and maybe what tools might you use if the stress isn't something solvable or something you can necessarily confront, but just something you're living through?
Speaker 2:Yeah, really good question. I think there are a couple different components, so I do think there's a place for relaxation. I think I think more of the issue is that it's overused than it like shouldn't be used, and I think, like relaxation is helpful. It helps, like bring down, you know, it can help bring down the stress, um, but it like, like you said, it doesn't solve the problem and often people are using relaxation in situations that like problem solving or like identifying, like targeting the problem, would be more helpful when you can't I mean I also have patients who are very resistant to it.
Speaker 2:Like people say they don't have time for it for some people makes them feel like, you know, notice their bodies, which they don't usually, and they're like trying to bring it down, expect, have these expectations that's going to happen immediately and then, when you don't, it feels more stressful. So they're all different reasons where relaxation might not be the go-to, um, I think, but it is a tool that I think, yeah, is useful in some situations. I think acceptance is another one that's really hard, but it is like an important piece that like is you know, the mindfulness can help with some acceptance sometimes, but like, I think, more explicitly, kind of working through, like how do I come to terms with this and accept, like whether it's a particular outcome or the the unknown of what the outcome, and like how?
Speaker 2:do I come to kind of like make sense of this for myself and in a way that, like I am able to accept the reality of like what is happening right now, rather than kind of like fighting against the reality of it.
Speaker 2:You know, like I think acceptance is a hard concept because a lot of people think it means that you're okay with what's happening where, when it's not right, um, so I think, like these can help get at that by kind of like illustrating examples of like, how you might like we can also do like self-talk in the app and so like, if you're talking to kind of like your inner thoughts in a way of like, how can you do that in a kind of like your inner thoughts in a way of like, how can you do that in a kind of accepting way?
Speaker 2:And then there, you know, I think a lot of times there is then this like there are that interpersonal, there are those interpersonal pieces later on top. So like, if you're going through the infertility treatment, like, does it add to like kind of difficulties in your relationship? Does it help go through, like you know, with the partner, with like friends and family and different ways, and so like if those are also then contributing to the stressors, like thinking through, like all right, how do I have those conversations is another kind of like what you can target some of the sources. It's not the original source, but it's like the secondary sources of stress.
Speaker 3:Can you give an example of how most people use scenario?
Speaker 2:Yeah, so people use it. I mean there's, it's cool. There's a variety of different use cases. Like the people are using it for job stress there are a lot of relationship stresses, so people are in relationships or like people who are in new relationships Like.
Speaker 2:So there are a lot of people who are saying like all right, how do I you know, I'm going on a first date and nervous about it, like like I want to prepare for this. How do I kind of go through and you can practice. Like some people are like I'm terrible at making small talk, right, which you know it's judgmental kind of self-raising, but like it's, you know that's how people are viewing it. And so it's like how do I? It makes them really uncomfortable. And so how do they kind of practice being with that discomfort of like making small talk, both like generating some ideas of like, oh yeah, here's like different things I could talk about I wasn't even thinking about. Or and like what if there is like a moment of silence like in the conversation? Like how do I cope with that, right?
Speaker 1:so um like so stressful yeah exactly did you feel the stress?
Speaker 2:so, like, how do I, and so like going through that and being able to like tolerate that um, which I know I don't know if you two have had this experience? Like a lot of you know, therapists I know whether or not they were really comfortable with silence beforehand become more comfortable, like throughout their training and working as clinicians and like, whereas a lot of you know non-clinicians might not be. And so I think, like you know, you can, you can practice. That's something that, like you can kind of train and get more, um, comfortable with the discomfort.
Speaker 2:And so, yeah, those are all different types of situations, but sometimes people are also like, how do I? Yeah, like there's something about my own mental health or the mental health of a friend who, like I don't know how to have this conversation with them about it, like there's something that I've noticed that they're not taking care of themselves. How do I have this conversation? I've had, um, you know, I'm concerned about my teenager who's like is, like seems really anxious after um, you know it's. I think there's like some connection between kind of what's going on like maybe even the parent doesn't know like what's going on with, like there's, you know their interactions with social media and like what they're feeling their kids stressed about.
Speaker 2:They have a friend or partner who's, like depressed and they don't know how to like talk to them about it, and so these can be all things that, like people can practice and can practice like doing, and so, like I think the I didn't mention before but scenario uses AI to help personalize things, but I think a lot of uses that I've seen that are not ideal is AI is like here we'll tell you what to say, and I think that's not going to be helpful for people in the long run.
Speaker 2:And so here it's more about it might help give you some ideas, but it's more about the practice of going through a realistic not you know, it's not going to be what actually happens, you know verbatim, of course but like a realistic type of uh situation, so that then you can be when you're actually in it. It feels less of this like unknown thing that just like you're trying to do for the first time and when it's happening, and instead you can be like all right now I like um, feel better prepared for it, because it's just like you know, so many things like we prepare for that are not our social lives and our emotions, and it's like we prepare for all these, like professional, academic, like all these things, but like it, it just you know. It makes sense that it would also be helpful to prepare for our social, emotional lives as well well.
Speaker 1:Well, I was just wanting to know about the. I know I'm stuck on the physical, but like, are there physical effects of stress and is this reversible? Like, if we, you know, using scenario like how, how much wear and tear is there on the body and if you get treatment for something like this, can it be reversed or are you just halting a process? Do you know anything about that side of things?
Speaker 2:yeah. So I mean, like before when you said I don't know if you're joking, but there is, you know there are animal studies and there are. I think some, um, specific study isn't coming to mind, but I think some like in the human literature about like stress and like life span, right and and mortality rates, and so I think, like they're, um, you know, certainly in like telomere length and things like that. So there are, like you know, physical impacts of stress that can have things on our health and like our longevity, um, and but the, the good news is like, coming back to actually the, some of the work I was talking about when I was a mass general, is like there are things we can do that, even over the short term, have an impact. And like when we go like, yeah, if you start meditating, exercising, trying like different, you know techniques that they can actually have an impact over the course of like several months, techniques that they can actually have an impact over the course of like several months, and you know some of the, even the effects, um, you know kind of very different literature.
Speaker 2:But like smoking, like if you, you know, stop smoking after a few years, like you, you drastically increase your chances of living longer again. Um, and so like they're. The good news is, like you know, everything we do impacts us and we can't remove experiences Once we've had them. Experiences have an impact on us, but, going forward the experiences that we're having, there's a lot we can do to have really positive impacts, and so that certainly is true of the stress literature that when we do things that are going to have like be adaptive and healthy and for our physical and mental health, that that's going to be able to have those downstream effects on in terms of our physical health as well.
Speaker 3:My last question is how can loved ones help? Right, if we see I mean this is to applying to your situation, jacqueline but like if you're, if you have a loved one who's stressed all the time and I know it's a common thing to be like, don't stress, you should relax, you should chill out but that doesn't seem to help. What can loved ones actually do to help a loved one? Yeah, they're stressed.
Speaker 2:Yeah, and I think so. You know, I think the example you just gave is like a situation that might come off as invalidating, right, and so like how can you, how can someone instead be kind of validating in their response? And so like that's something that can be really helpful and something that you know could be practiced in a situation like through something like scenario. But I think, like like everything else, it's not always one size fits all.
Speaker 2:I mean, I've seen kind of the opposite end of the spectrum where sometimes people are trying to be really validating and empathic but it ends up kind of like, you know, kind of enabling in an unhelpful way, right, and so, like, I think like that's where these personalized interventions whether it's talking with a therapist or coach who can help you, or getting some ideas from some of these app-based interventions can help you to think through, all right, what's something that might be most helpful for this person in this situation?
Speaker 2:Is it actually figuring out a way to step back a little bit and not put as much pressure on them, or is it helpful to kind of help push them a little bit and say, like this person's not getting out of bed, like saying like that's OK, why don't you just stay in bed all day if they're really depressed isn't going to be helpful, and so, like, how do you kind of think through? You know different ways that you can can really be helped to be that effective support person, and I think they're different. You know, yeah, that being able to have these different tools and different ways of doing so is really important.
Speaker 1:I remember seeing Caitlin Fang's dissertation about burnout where it was like it was like half the group, one of the groups did like deep breathing or something like some relaxation thing and the other half just did their project and the group that did their project is the one who had less burnout. So it just reminds you that, like a lot of the time it might feel like the work is what's burning you out, when it actually might be maybe like avoidance or anxiety around the work or perceptions around the work. Is scenario like? Is it available to everyone right now? How would somebody sign up?
Speaker 2:yeah, it's in the app store. Um, I think, if you search scenario and maybe I can give you a link um to put in or um get scenario, the website is get scenarioai. Um, and right now, just like all of us, a work in progress, and so, like I think, like how we think about, yeah, we'd love kind of things that you love about it, things that you don't, things that aren't working, so you can think about how to improve it as we continue working on it.
Speaker 1:Cool, I'm going to yeah, I'm going to get it and test it out and see if Jason would actually use it and maybe benefit from it.
Speaker 2:I'm excited to hear my crusade to lengthen his telomeres.
Speaker 1:Yeah, I know.
Speaker 2:We've measured some outcomes in terms of confidence. Our initial ones is that it helps boost people. People report increases in confidence in approaching these situations from using it and then so like, yeah, like a third of people, so that they um, or there was a 33 sorry, increase in confidence levels from before to after, um, yeah, this makes me want to go down a new road, because I will say, like I, I think confidence might be the major difference between when I'm stressed and when I'm not stressed.
Speaker 1:If I have confidence that I can do it, that the outcome will be good, then I just have the normal stress of like having to use my brain for several hours in a row. But I feel like so much of the time when I'm stressed, it's because I'm doubting myself. I'm getting really, really frustrated because I'm like I can't do this, I can't do this, and that just skyrockets stress. So I would think that raising confidence would be a huge um win.
Speaker 2:Yeah, yeah, absolutely. And I think, like, like I couldn't agree more. Like I think that comes back to like. At the beginning we were saying, like the you know, thinking about stress is like when it's beyond my ability of like something that I can handle and like so, if we're increasing, like if you were like, oh, actually, like it's the same situation, but now I'm like more confident that I can handle it, Then that that completely shifts it, like that makes a total difference. So, um, yeah, we still need to look at kind of like specific stress outcomes for you know, for this app, but I think, like confidence for situations is is hugely important in terms of like how people are going to you know the stress impacts of it.
Speaker 1:All right. Well, matt, thank you so much for coming to talk to us about stress. I know I'm going to try out Scenario and I don't know if you would do. You want us to provide a link to our listeners?
Speaker 2:Yeah, that'd be great. I'll send them along.
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