What about Stress?

By James N. Dillard, M.D.

Shelli sat across from me, gripping her purse, fists with white knuckles. Her burning leg pain was better, but it was still keeping her from sleeping. “I don’t know what to do,” she told me. “I feel like I’ve seen so many doctors, and I’ve tried everything, but it just won’t go away. It’s ruining my life.”

Shelli and her husband ran a family business together, and they had three kids. The eldest boy was applying to college. Times were tough for the business, and her husband had been ill. She looked like a woman who had been running a marathon.

“I just can’t stop worrying about everything,” she said. “I lie down and try to sleep, but there’s just so many thoughts there, so much to worry about.”

“Can you ever get away from all the things that keep you wound up?” I asked her. She thought for a second. “No, I really don’t — not ever,” she replied. Shelli looked down at her hands.

It is such a common experience for so many of us, to feel as if the thoughts and worries never stop. It comes to seem so normal, so expected. But it doesn’t have to be that way.

As a conventionally trained pain specialist, I could have given Shelli a sleeping pill or an anti-anxiety drug like Xanax or Valium. That’s what many doctors would do. But she seemed ready to hear something else.

“Have you ever tried to step away from all the chattering thoughts that you have, just to let it all go, to let it all stop for a minute?” I asked her.

“You mean like meditation or something?” she answered. “Yeah, I tried that in college for a while. It kind of helped. Do you think that would make any difference?”

When someone says the word meditation, it can conjure up images of the Beatles meditating with the Maharishi, or a blissed-out yoga model. But it doesn’t have to. Meditation can be close to relaxation or to prayer. It can just mean slowing things down, which can be tough these days.

Many folks have trouble with the pushy pace of life. It keeps them running and thinking all the time. The one thing they don’t ever really do is stop — just completely stop.

Even when they think they are stopping, they’re still doing something. When they are trying to relax they still have to be doing something, like watching the game. They’re fiddling with an iPhone, BlackBerry, or a datebook on the beach. Some people can’t stop talking. And if they try to be still, their minds are racing, babbling on like a room full of monkeys.

It can be tough to stop, because it feels as if there’s a premium to doing things and being “on top of it all.” But experts argue that being constantly “on” is the very thing that will make you sick and hobble your capabilities.

I asked Shelli if she thought that worrying all the time made her more able to make clear decisions in her life, be present for her family, and get things done. She said that it was just the opposite — that it felt self-destructive, confusing, and painful.

I adjusted the dosage of her nerve medicine, and we made a plan for Shelli to stop completely twice a day. She didn’t have to wear saffron robes, chant, or drink wheat grass juice (not that there’s anything wrong with that). I showed her a simple relaxation technique with breathing, and gave her resources to learn mindfulness-based stress reduction, the dominant form of relaxation training done in hospitals.

With it, you sit quietly with phones off and focus on your breathing. Your thoughts and worries will come up. You don’t judge them, you just acknowledge them to yourself and let them pass, returning your focus to your breath. You don’t judge what comes up, and you don’t judge yourself. After a while, your mind will get quieter.

For many, such a practice seems flaky and way out there. But solid research studies published by Jon Kabat-Zinn, Steven Rosenzweig, John Astin, and others have shown mindfulness-based stress reduction to reduce chronic pain, ease anxiety and depression, sharpen attention span, lower blood pressure, and even help normalize blood sugar in diabetics.

Dr. Kathy Sanders of Massachusetts General Hospital summarized the usefulness of this meditation practice in psychotherapy in the winter 2010 issue of the American Psychiatric Association’s journal Focus. These ideas are not far out and freakish; they have sound science behind them.

No one can really get away from his or her own thoughts. It’s not possible; they are always with us. But it’s a bit like looking at paintings. If you always stand too close to them you will never be able to fully see what the paintings are about. You have to stand back a bit to understand them.

In the same way, if you can be still with your mind each day and get a little distance from your thoughts, then dealing with life can become easier. People usually like this idea, but they almost always forget to do it. Here’s a way to remember:

Mom taught us to brush our teeth twice a day so we can keep them, and not gross people out. I tell patients to brush their minds twice a day as well, so they won’t lose them, either. Stuff sticks to our teeth and to our minds, so just think dental-mental hygiene.

Shelli started to practice sitting and breathing twice a day after she brushed her teeth. It was hard to stop completely at first, but then she started to get the hang of it. In the office three weeks later, she told me she was sleeping better, and she didn’t notice the pain so much. Her hands were resting in her lap.

I don’t think most people like the feeling of thoughts going, going, and going in their heads all the time, particularly if the thoughts are worry thoughts. Negative thought fantasies that are not real and never will be real dominate the minds of many people. It is not helpful and can be a great waste of mental energy.

The father of stress science research, the man who coined the term “stress,” Dr. Hans Selye, once said, “It’s not stress that kills us, it is our reaction to it.” Being able to clear your head can make you healthier, quiet your pain, and help you to manage your life. There is a gentle way to let go and find some healing stillness.