Understanding and Managing Stress and Burnout

Dr. Aditi Nerurkar, a Harvard physician, specializes in stress, burnout, and resilience, emphasizing the importance of managing stress for a healthier life.

### Understanding and Managing Stress: A Physician's Perspective
* 🩺  Dr. Aditi Nerurkar, a Harvard physician and author, emphasizes the importance of distinguishing between **healthy, adaptive stress** and **unhealthy, maladaptive stress**.
* 🧠  In times of stress, the brain shifts from the prefrontal cortex to the amygdala, triggering the **fight-or-flight response** and **amplifying the inner critic**.
* 🧬  Childhood experiences and trauma can shape our stress response, but the brain's neuroplasticity means we can **create new pathways for managing stress over time**.
* 🛑  Two key resets for managing stress in the moment are a simple breathing exercise (**Stop, Breathe, Be**) and a gratitude practice (**writing down five things you're grateful for and why**).
* 📈  Gratitude is effective due to cognitive reframing - "**What you focus on grows**".
* 🧘‍♂️  Dr. Nerurkar stresses that stress management is a skill that can be learned and practiced, emphasizing that "**you can rewire your brain and body for less stress and more resilience**."
* 🌱 " The goal of life is not to live a life with **zero stress**; it's in fact biologically impossible to do this. It's to live a life with **healthy, manageable stress**, so stress can serve you rather than harm you.
* 💬 " If you are feeling a sense of stress and burnout, if that inner critic is relentless in your ear, understand that **first you are not alone** and it is **not your fault**.

- Stress is a force that is all around us, like gravity. It's a part of our lives, and it's inescapable. There are so many societal perceptions of what stress is and burnout is, and how we are supposed to behave, that we often don't feel a sense of openness in sharing our own struggles, vulnerabilities, or weaknesses. But understand that underneath it all, you are not alone. It is not your fault, and likely, many other people are feeling just like you. I noticed it when I was a clinician in Boston seeing patients in a packed waiting room. No one speaks to each other, but those same patients would come into my exam room, the door would close, and they would burst into tears because of the stigma and taboo about stress and burnout. The goal of life is not to live a life with zero stress; it's in fact biologically impossible to do this.

It's to live a life with
healthy, manageable stress, so stress can serve you
rather than harm you. I'm Dr. Aditi Nerurkar,
a Harvard physician with an expertise in stress, burnout, mental health, and resilience, and the author of The Five Resets: Rewire Your Brain and Body for Less Stress and More Resilience. I became an expert on stress and burnout because I wanted to
become the doctor I needed during a difficult time. I was a medical resident in my second year of medical residency. I was taking care of
everyone else's hearts but not my own in that cardiac ICU. My head would hit the pillow, I'd be exhausted from a long day's work, and I would suddenly have the stampede of wild horses across my chest, and it continued to happen. My doctor did the full medical workup, and everything checked out normal. And so my doctor very
reassuringly with a big smile,

said, Everything's great. It's probably just stress. We've all been there. Just try to relax. My first reaction was, Stress? Stress doesn't happen to people like me. I'm resilient, because I was living the resilience myth as many people are. I was taught at a very young stage of my medical training that pressure makes diamonds, and so as I was moving through medical training working 80 hours a week, I would say to myself whenever there was a difficult moment, Hey, I'm a diamond in the making. And then my diamond cracked, and the resilience myth is that resilient people don't get burned out and don't feel a sense of stress. But in fact, true resilience also honors your boundaries and human limitations. It honors your ability to say no, and it uses a lens of self-compassion. And so I was living the resilience myth because I didn't know any better. And then when I found my way out of stress,

that is when I said, I wanna be the doctor I wish I had back during that difficult time. Not all stress is created equal. In fact, there are two kinds of stress. There is healthy, productive stress. In scientific terms, we say that that is 'adaptive stress.' Getting a new job or a promotion, falling in love. Healthy stress moves your life forward. But when stress goes unchecked and is untamed, dysfunctional, and unproductive, that's when stress goes from being adaptive to maladaptive. And those two are very different when it comes to how they impact your brain and your body. Under normal circumstances, our brain is led by the prefrontal cortex. That's this area right behind your forehead, and that area, the prefrontal cortex, governs things like memory, planning, organization, forward strategic thinking. But under periods of stress, your brain is governed by the amygdala, and your amygdala is focused on survival.

and self-preservation or your fight-or-flight response. Think back to when we were all cave people: You would be in the forest and you would see a tiger. You could either fight the tiger or you could flee. The challenge now is that all of the tigers that we have in the modern day are ongoing and chronic. Bills, relationship constraints, job constraints, or parenting. All of these metaphorical tigers in the modern day make your stress response and the amygdala on in the background at a low hum, chronically. During stress, your inner critic gets a megaphone. Those negative experiences are sticky in the brain like Velcro. Your brain grabs onto those because it's a sense of hypervigilance and your body and brain are trying to keep you safe. And so often there's this tension between that inner critic and that sense of self-agency and self-efficacy.

You want to be able to do new, important, exciting things in your life, and when you reset your stress, you can take that megaphone out
of your inner critic's hand. There are so many false
perceptions about ways that stress can influence you. Unhealthy maladaptive
stress can feel like a sense of constraint on the mind because you are living
in a scarcity mindset. So think about that as you're
moving through your day and moving in the world, that likely the same amount of good and bad is happening at all times. The goal with resetting your stress is to make negative experiences less sticky, moving away from Velcro to Teflon. If you are feeling a sense
of stress and burnout, if that inner critic is
relentless in your ear, understand that first you are not alone and it is not your fault. There is robust data to show that early childhood experiences, particularly adverse events in childhood, can influence your stress response.

throughout your life into adulthood. But it's also important to understand the science of the brain. We used to think that your brain, what you had at birth is
what you have for life- it was like a real grab bag- but now we are learning that
your brain in fact changes, grows, and adapts based
on life's circumstances, situations, and stimulation. And through the process
of 'neuroplasticity,' your brain is constantly regenerating brain cells and circuits. So if you have had a difficult
childhood experience, if you've experienced trauma and you do have an influence
on your stress response, you can over time with
patience and practice, create a new neural pathway for managing your stress and burnout. It is a misconception to think that to decrease your stress and burnout, you need to revamp your whole life. So how can you reset
your stress and burnout in the here and now in the middle of your
messy, over-scheduled

and stressful life? Let's start with these two resets: The first is a breathing exercise, and the second is gratitude. The reason your breath is such a great first step is because your breath is the only physiological process in the body that is under both voluntary and involuntary control. So you can use your breath as a way to tap into your mind-body connection to understand it, and then later influence it to serve you. This is a three-second exercise. Stop, breathe, and be. The instructions are in the name. The first thing you're gonna do is no matter what you're doing, you're just gonna stop. Take a beat and take a pause. Next, you're going to breathe. Take a deep breath in and out, and then you're going to be. Just ground yourself in the here and now in the present moment. When you are feeling a sense of stress and burnout, you're often feeling anxious, and anxiety is a future-focused emotion.

You are on that runaway train of what if thinking. What if this doesn't go well? What if I fail? What if it's a disaster? It's all of this doom and gloom thinking. And stop, breathe, be gets you out of that what if thinking back to what is - in the here and now in the present moment. Gratitude is also a very effective practice. What you wanna do is you wanna write down five things you're grateful for and why. The reason gratitude is so important in reframing your stress and burnout is because it focuses on a scientific principle called 'cognitive reframing.' What you focus on grows. A written gratitude practice at 30, 60, and 90 days has shown to have demonstrated effects in managing your stress, burnout, mood, and resilience. So often when we are feeling a sense of stress, overwhelm, and burnout, there are things in our external world that are happening that are out of our control.

and so we often end up feeling powerless. Learning how to manage
your stress is a skill, just like riding a bike; it's not an innate thing
that we are born with. It is something that you
can teach your brain to do, and it is something that you
can teach yourself to do. You can rewire your brain
and body for less stress and more resilience.

Harvard’s stress expert on how to be more resilient | Dr. Aditi Nerurkar

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Understanding and Managing Stress: A Personal and Professional Journey

Stress is unavoidable and often stigmatized, leading to a lack of openness in sharing struggles and vulnerabilities.

Aditi Nerurkar, a Harvard physician, emphasizes the importance of healthy, manageable stress and aims to rewire the brain for resilience.

Her expertise in stress and burnout stems from her own challenging experiences during medical residency, driving her to become the doctor she needed during difficult times.

The Resilience Myth and the Reality of Stress

The speaker initially believed in the "resilience myth," thinking that stress couldn't affect them, but later realized the importance of honoring boundaries and self-compassion in true resilience.

There are two types of stress: adaptive stress, which is healthy and productive, and maladaptive stress, which is unchecked and unproductive, impacting the brain and body differently.

During stress, the brain shifts from being led by the prefrontal cortex to being governed by the amygdala, prioritizing survival.

Managing Modern Stress: The Battle with Your Inner Critic

Stress in the modern world is chronic, activating the brain's amygdala and inner critic.

The constant stress leads to a sense of constraint and hypervigilance, making negative experiences stick in the brain.

Resetting stress is crucial for promoting self-agency and reducing the impact of unhealthy stress on the mind.

Childhood experiences can also influence the way we respond to stress in adulthood, emphasizing the importance of self-compassion.

The Science of Neuroplasticity and Stress Management

The brain is now known to change and adapt throughout life, with the ability to create new neural pathways for managing stress and burnout.

Two resets for dealing with stress are a simple breathing exercise and practicing gratitude, both of which can help tap into the mind-body connection.

Stress and burnout are often linked to anxiety, a future-focused emotion, but grounding oneself in the present moment can help alleviate these feelings.

Reframing Stress and Burnout with Gratitude

Reframing "what if" thinking into "what is" can help alleviate stress and anxiety.

Practicing gratitude has a scientifically proven impact on managing stress, burnout, mood, and resilience.

Learning to manage stress is a skill that can be developed, allowing for less stress and more resilience in the long run.