How to Identify and Manage Stress Triggers
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About the Show
On this episode, Chuck Gaidica is joined by Senior Health Care Analyst for Blue Cross Blue Shield of Michigan, Josh McCullough. Together, they explore ways to build resilience through stress, develop better strategies to cope and not let the cycle repeat itself.
In this episode of A Healthier Michigan Podcast, we explore:
- Practical steps individuals can take to improve their stress resilience
- Early warning signs that stress is impacting both mental and physical health
- How someone can effectively manage chronic stress
- The impact social support has on managing stress
Transcript
Chuck Gaidica:
Struggling to manage stress?. This is episode 171 of A Healthier Michigan Podcast, the podcast dedicated to navigating how we can improve our health and well-being through small, healthy habits that we can start implementing right now. I'm your host, Chuck Gaidica. On this episode, we're diving into ways to build resilience through stress, develop better strategies to cope, and not let the cycle repeat itself. With me today is Senior Healthcare Analyst for Blue Cross Blue Shield of Michigan, Josh McCullough. Good to see you, Josh.
Josh McCullough:
Likewise. Good to see you again.
Chuck Gaidica:
Hey, thanks. Whether we're juggling work responsibilities, navigating personal challenges, or responding to the unexpected, it seems like stress impacts everyone in different ways and the questions are many, but what happens when stress goes unchecked, seeps into your physical and your mental health and well-being, and then we're going to try to understand today what causes our stress and learn how to spot patterns and help manage that as well to help us gain a better self-awareness and hopefully a healthier life physically and mentally as we wind down this year and move into the next. So let's start with this question. Why do some people seem to be more resilient? We hear that word resilient or resiliency in our personal lives being good for us and also in our workplace, but why are more resilient to stress than others?
Josh McCullough:
There's a lot of different reasons, and I think maybe the first reason I could think of is that some people just kind of biologically are a bit more resilient or less resilient than other folks. I mean, there's folks that are more outgoing and less outgoing, for instance. We know that they process things differently. Similarly, folks that handle stress better, we may know these people, these folks that no matter how tough the going gets, they always have the plan. They always can handle things.
Emergency room physicians, for instance. Maybe they start out with a little bit of that extra resilience. Then another part of it is kind of learned. How do we learn growing up as kids, as teenagers, young adults into adulthood? How are we taught to manage stress? It's one of those skills that we just kind of assume people are going to get, but really maybe some folks have a better history of having people teach them how to handle stress than others. Again, emergency room physicians, they are taught different techniques, styles, quick ways of thinking and encompassing problems that you or I just don't have, for instance. And that's a pretty extreme example, but some people may just get those different lessons over time then others don't. The old kind of pull yourself up by the bootstraps. It helps if you've got bootstraps to pull up to begin with.
And some folks may live in just chronically stressful situations. I mean, I think the pandemic laid that pretty bare for all of us to see that some folks are under a lot more stress just as a normal course of daily living than some other folks. So I think there's a lot of different things that go into it. What we see is the outward sign, well, someone's having a tough time or an easy time handling stress, we tend to ascribe that to some sort of personality issue. Josh just can't handle things. But really there are so many factors that go into it that a lot of times we just don't think about.
Chuck Gaidica:
So you've said a lot there that has, I look at myself and I think, well, I am, and I've been told by extended family, the resilient word hasn't come up, but I don't internalize things. I'm kind of like a duck. Stuff hits me that's maybe not great for the day or for the minute and it kind of rolls off my back. I don't internalize it, I act on it, I navigate it, and I move on. And I guess that's resiliency in a way. But to me that talks about me being wired a certain way. You're also saying that whether you're a physician in an ER or maybe in daily life, there are some things we can learn that will help us navigate that, right?
Josh McCullough:
Yeah, absolutely. And you and I have talked about these similar things on another podcast, but I think the first thing to look at is I think to look at it. I think so many times we're taught that we just have to accept things and the popular concept of acceptance is kind of to suffer. I just have to sit here and accept it, just is what it is and I just have to sit here and kind of take whatever life throws at me. And so often, even in the mental health profession, well-meaning people will say that, you have to accept it. Unfortunately, people end up suffering. They don't truly understand what accepting means. Part of it is to rather than run away from or sit down and suffer with what's going on, is to kind turn around and look at it. What's going on? Why am I responding like this, however. This is because our emotions, our actions, are trying to do something for us.
And it's almost like there's a lot of different parts to ourselves, and I kind of think of it as kind of a party. Like Chuck is the host of the party, Josh is the host of the party. There's a lot of different people in attendance, a lot of different emotions and feelings and thoughts going on. And to be a good party host, we want to make sure that all of those things are kind of in harmony. Maybe some people are being a little bit louder at the party than others, maybe some people need a little bit of coaxing out, but we want to kind of pay attention to all of them rather than ignore them. And I think emotions are a lot like that.
Chuck Gaidica:
Do you have practical steps then that we can start to think about that can help us deal with that party and noise? Because by default, we probably go through this a lot. That party could be kids running around as they're growing up. It could be at work. There's not a literal fire, but something's going wrong and the papers are all thrown in the air and you've got to deal with it. But what are the practical steps that we can start to think about to get us down to this path of wellness when it comes to resiliency?
Josh McCullough:
Well, I think the first step is to identify are there any patterns? Are there any situations that keep coming up, that keep recurring? It's impossible to plan for every single thing that could happen to stress us out, but are there reliable stressors? Maybe it's family events, holidays, situations at work, things like that. Identify are there those patterns? Take a look at how I, we have responded to them in the past. And then are there small ways that we can shift things even just a little bit? Can we get the train on a slightly different set of tracks? Rather than shutting down or not talking is there someone reliable I could talk to before or after the event? Is there a way I could sit down and maybe write out how I would like to handle this better in a journal or type it out to ourselves? Am I paying attention to my breathing?
The more stress we tend to get, the tighter our muscles tend to get, the less we tend to breathe and it induces its own kind of anxiety response, its own stress response. It's kind of like the thermostat's getting too hot. I may need to pay attention to am I breathing correctly? Am I dropping my shoulders? Kind of loosen up a little bit. We talked a little bit about some folks may be under chronic stress. I don't want to minimize folks who have experienced something that's very traumatic. It may lead to post-traumatic stress disorder. Folks may need to seek professional help one way, shape or form.
If even it seems that there's always these things we cannot control, they're always happening to me or I'm quite frequently reminded of a stressful event, a very traumatic event, maybe time to talk to our primary care physician, maybe seek a counselor or psychiatrist because that's a very special sort of stress to have. And I don't want to gloss that over or say that we can just handle that like any old problem. It reminds me of an old saying, if you've got a Jaguar, don't take it to the Jiffy Lube. Nothing against either one of those, but if you've got a very special, very unique thing that needs a lot of special attention, don't take it to just any old place to get it fixed. Post-traumatic stress, generalized anxiety, these kind of special things may need a special intervention.
Chuck Gaidica:
And you said this in a little different way, I guess, than I'll probably reflect it, but you talked about patterns, things that are being thrown at you, but also your reactions could turn into a pattern. I mean, if you're one of those people where every little thing gets you to blow a gasket, well, some self-awareness there may be in order to try to figure out, "Well, why do I get so upset every time the dog does something or the kids do something?" Those patterns can also come up.
Josh McCullough:
Oh, absolutely, absolutely. And again, that's a good place to sit back and reflect like, "Why am I having this? What is my reaction trying to do for me?" Because it's trying to do something to be helpful. It's just coming out crooked. Maybe there's a different way to get the outcome I'm hoping for, or at least express myself without blowing a gasket, yelling at people, isolating, falling to pieces every single time something comes up to shake our world up.
Chuck Gaidica:
When we think of those practical ideas, and I know you've worked with children and adolescents and young kids and adults alike, the practical step of something as simple as breathing, is that a good place to start to think about this, that if that's not something that you bring out of your toolbox to deal with these stressors and triggers, is that a good place to start just to see if maybe that simple practical step is helpful?
Josh McCullough:
I would say so because you can't grab an emotion. You can maybe write your thoughts down and tackle that, but a behavior is a much easier place to get started. And there's one technique called box breathing where we kind of breathe in for four seconds, breathe out for four seconds, breathe in for four, out for four, kind of the box, so to speak, that can help kind of grab onto our body because the more stressed we get, breathing may get more quick but more shallow, heart rate may increase, muscle tension may increase. If we can grab a hold of some of those things, then we may be able to slow the train down.
And I really, really advocate for people to practice and start using any of these techniques well ahead of time because so often people say, "Okay, I'll try that." But they try it when life is at its worst and they say, "Oh geez, it didn't work." Well, I don't know if there's anything any of us do that we didn't have to practice to get really good at. So if we try and use something we've heard of once or twice when the going is absolutely at its roughest, we haven't really stacked the deck in our favor.
If we can try that even just a few minutes a day, one of my old professors recommended putting a little sticker or some sort of tag on your keys, something you would see every day that when you see it, you say, "Oh, I'm going to try my breathing, my box breathing, for 10 seconds or 10 repetitions." So we think to practice it and then also think about practicing it when the moment happens, but just almost like acting, like a practice. We look at people like Olympic athletes, you may see them, they're in their head and they're practicing their routine, things like that, to get ready for the big event. If we can do that, "Geez, the next time I encounter this person, I'm going to do my box breathing." When we think about that person and we practice our box breathing, we may be more likely to use it and have it work rather than just going in cold.
Chuck Gaidica:
That's great advice, that idea of practice. And if you know that your trigger is that you have to walk down the hall once a week and do a presentation in front of people, and you're the last person in the world that wants to grab a mic and do a presentation, ducking into that coat closet or some other vacant office and doing box breathing, to your point, and turning around and walking into the meeting, if that's a recurring thing, you may discover a way to deal with this because you're actually literally practicing it while you're in the game, right? I mean, that would be very interesting.
Josh McCullough:
And I think that also what happens is so often people visualize or imagine either complete success or complete failure. You talk about giving a presentation, "Either I will completely bomb this presentation and be laughed out of the room, or I will give a presentation that would make Winston Churchill weep." And I think that it also helps to think of the in-betweens, because life is so often in-between. Life is so rarely complete success, complete failure. Maybe I'll stumble, maybe I'll have a little thing. Maybe I could grab a drink of water if I'm stumbling over my words, maybe I could pause and ask, "Does anyone have any questions," to help regain my pattern of thinking. I could have my notes available to me. So yes, there are going to be times that maybe I stumble, but I can also imagine some different ways that I can recover from that because it's inevitable.
Chuck Gaidica:
So if you are headed down a path where this is starting to impact both your mental and physical health, you're literally noticing that stressors and triggers are doing that, what are the warning signs that we should be looking for? So how we can address them, these warning signs, and also the stress that's coming before it escalates into a recurring problem?
Josh McCullough:
Well, as we talked about these sort of getting ahold of outward behaviors like breathing, I think maybe some of those outward signs like, how am I eating? Am I eating more, less? Am I not taking care of my basic biological building blocks? How is my sleep? Is my sleep impacted? We'll all have that tight deadline that comes up a few times a year that we may stress out over. But if I'm stressing out over every deadline or if I'm imagining the next one coming down the pipe and they haven't even given me the assignment yet, or I'm really losing sleep over it, I find myself waking up and just ruminating, thinking over and over about bad stuff, and I can't get good sleep, if I'm letting my routines go, not just work, but am I not hanging out with friends and family like I used to? Am I not going to the gym like I used to, engaging in hobbies?
All of these early warning signs are points where we could start to say, "Hey, is this happening a lot? Is this a once a year type of thing?" And then also getting good input from the people that care about us, the people that can truly see outside and say, "Josh, I noticed you haven't picked up your guitar in months and you're pretty quiet and you're not eating like you used to. How are you doing?" It helps to have those outside sources of truth, so to speak, to be able to talk to and listen to, to give us feedback for, "Geez, maybe I haven't been paying attention to this like I should. Maybe I need to do something about it."
Chuck Gaidica:
So if the self-help idea or what we could call, I guess, traditional ways of dealing with this through breathing and mindfulness or whatever practices you're trying to employ, they don't seem to work, how do we determine that? I guess we can determine that maybe more quickly than what to do next and then is what we should do next?
Josh McCullough:
Yeah, so if I've given it the old college try so to speak, given some of these basic self-help building blocks a try and they're just not working, there's a good many ways. I'm a psychologist by training, so I always advocate for people to look into counseling, mental health therapy. There's a good many ways to do it. If folks go to the bcbsm.com, find a doctor, they can filter and look for social workers, psychologists, counselors that they can meet with. Telehealth is increasingly popular. Folks don't even have to leave the comfort of their own home. They can schedule it. Very flexible times. And we've got this ever-increasing network of providers that are able to do that, to meet with someone, to get a good professional eye on things. It may require medication for some folks. And there's nothing wrong with that either, either through the primary care physician or maybe seeing a psychiatrist. And there's ever-increasing psychiatrists that are seeing members via telehealth, kind of like you and I are doing. It's like a video call or a phone call. Very convenient.
And again, we talked about some of these very special things like post-traumatic stress, some different anxiety disorders or other mental health disorders that may require a specialist touch. Primary care physician may be able to get folks started, but they may consult with a psychiatrist or recommend that you see a psychiatrist to get more specialized medication. Because all we want is for our members to be as healthy and happy as possible. It may take a team to do that. And so if folks are trying by themselves, it's not working, the last thing we want to see people do is say, "Geez, I can't fix this myself. Holy cow." And that adds to the stress. Call in experts, call in supports, call in people that can take some of that burden off you.
Chuck Gaidica:
And it seems as we've come out of a pandemic and it's in the rear-view mirror, the idea of socialization seems so important in this process because you're saying, "Well, let's turn to our spouse or our little kitchen cabinet, third parties, to kind of say, 'Hey, how you doing, Josh? What's going on?'" Well, you may not have that because we're living at a time where what the Surgeon General said, loneliness is an epidemic in every single age demographic. It boggles the mind when you think about how many friends people think they have on this thing, but they're not maybe really true friends. So what is this idea of managing stress and how can we, maybe if we have a limited support team, this idea of socialization around us, how can we build healthy relationships that can reduce stress? Could it be as simple as going to play pickleball with a group or what else could we do?
Josh McCullough:
Absolutely. And there's a good many ways to do it. There are some popular apps, and I'm mentioning one just because it comes to my head, but it's not endorsed by Blue Cross, I'm not endorsing it, I'm simply saying that I know this exists, called Meetup. And through it, people can find so many groups of people that may have similar interests, physical activity, gyms, I like to do trivia, I like to play music. In fact, myself, I have met a good many musicians I've known for a long time through that application who just get together once a month and play songs together. Gardening, I know that you're a gardener. There may be other folks that like to garden. And so that is one way to do it. Again, I'm not endorsing. I'm simply saying I know that it's out there.
Depending on where you're at, there may be flyers. If you're a gardener, there may be flyers at the local gardening store of people who are looking to start a community garden. You may see flyers around town. But it's joining a local gym. YMCA, perhaps, again, not endorsing, just knowing it's out there, or these various 24-hour fitness clubs to try and give a shot and just see how it goes. Dipping our toe in the water a little bit. Anything we can do to keep our eyes open to seeing what may be out there and giving it a shot is very worthwhile. Because you mentioned that, maybe not everyone has this great support network, or we may have one or two really close supports, but they're not always available.
And I always envision it like building a safety net. If we've ever been to the circus and we see the high wire acts, they've always got a safety net underneath them. And that's there to catch us if we fall. And in our own personal safety nets, maybe we have some ropes that are really, really super strong that we know very, very well, know us well. Maybe we have some smaller ones that are equally valid and helpful, but they don't know us as well. But it's still helpful to have them there to catch us when we fall or if we're taking a tumble. And there's nothing wrong with having various very, very close relationships, some more casual relationships to kind of mix it up so that if for some reason our very, very closest supports are not available, we still have other folks that we can connect with.
Chuck Gaidica:
And I think the ancillary benefits to that, I'll just use one more example here before we start to wrap it up, my wife and I started playing pickleball Wednesday nights. This past week, we had an eight-year-old and an eighty-year-old as part of this group. And that's like the outliers of the demographic, right? I'm not great, but I'm smashing a ball, I'm using my paddle to high-five my teammates, even if we win or lose, and I'm building relationships with people that I've not had relationships with before.
I'll tell you what, I'm not great at it, but time just kind of disappears. And I look at my watch and I'm thinking, I've been doing this in a rotation for two and a half hours. It's not because of the simple nature of physical activity. I know there are studies that show that's a good thing, but it's just this idea that I'm with people and I'm interacting. And I guess my point of all this is you can't build these relationships that may be important for your support system unless you start them. I mean, you've got to go find a place to dip your toe in the water and just see if it works.
Josh McCullough:
And oftentimes the more stressed we are, the more emotionally distraught we are. We may think, "I am the only person like me. I'm the only person experiencing this. I'm the only person that understands what I'm going through." And you may find that there are more people like you or who just need to take a break. There's nothing wrong with taking our minds off things for a few hours. And indeed, we may find that if we play pickleball, our mind is occupied. It's tough to be depressed or anxious and occupied at the same time. It's very difficult. And if we take our minds off it a little bit, that may raise our mood a little bit. "Oh geez, after I got done playing pickleball, I feel a little bit better. Things don't seem as bad. I still have some things I have to tackle, but it's not as crushing. I was able to enjoy life along with these stressful moments in life." There's nothing wrong with that at all.
Chuck Gaidica:
Well, lots of great stuff again on this episode. Do you want to leave us with any takeaways here as we wrap it up?
Josh McCullough:
Yeah. Like we talked about, take a look at some ways we can kind of manage our physical stress through breathing, through relaxation. There's guides online and all sorts of tips, but that box breathing, that four seconds in, out, in, out. Taking a look at our support network, if they're noticing things that maybe we're not noticing, that could be a clue that maybe we have to start paying attention to what's stressing us out. Seeking some professional help if necessary. And it's available to our members, and we want to make sure that special problems get special attention. And like you said, just doing what you can to engage in some sort of physical activity or activity outside of ourselves along with other people. That connection one way, shape or form, can be very powerful to help relieve our stress, take our mind off some of the things that are troubling us and help us enjoy life even though there are some stressful things going on.
Chuck Gaidica:
That's really great. I don't know if you've noticed, just during our episode recording this, when my shoulders are relaxed, I'm feeling better about pickleball. You may have noticed that. So we'll see Wednesday night if it works.
Josh McCullough:
I did, I thought I saw that. It's the play and practice.
Chuck Gaidica:
Good to see you, Josh. Thanks so much.
Josh McCullough:
Likewise. Thank you so much.
Chuck Gaidica:
Oh, sure thing. Josh McCullough is a Senior Healthcare Analyst for Blue Cross Blue Shield of Michigan. We're so glad he was with us and we're glad that you were here listening to A Healthier Michigan Podcast. It's brought to you by Blue Cross Blue Shield of Michigan. If you liked the show, you want to know more, check us out online at ahealthiermichigan.org/podcast. You can leave us reviews or ratings on Apple Podcast or Spotify. You can also follow us on Facebook, Instagram, or X. And you can get new episodes, old episodes for your smartphone or tablet. And you can subscribe to us too on Apple Podcast, Spotify, even a YouTube channel, or just your favorite podcast app. I'm Chuck Gaidica. Be well.
Struggling to manage stress?. This is episode 171 of A Healthier Michigan Podcast, the podcast dedicated to navigating how we can improve our health and well-being through small, healthy habits that we can start implementing right now. I'm your host, Chuck Gaidica. On this episode, we're diving into ways to build resilience through stress, develop better strategies to cope, and not let the cycle repeat itself. With me today is Senior Healthcare Analyst for Blue Cross Blue Shield of Michigan, Josh McCullough. Good to see you, Josh.
Josh McCullough:
Likewise. Good to see you again.
Chuck Gaidica:
Hey, thanks. Whether we're juggling work responsibilities, navigating personal challenges, or responding to the unexpected, it seems like stress impacts everyone in different ways and the questions are many, but what happens when stress goes unchecked, seeps into your physical and your mental health and well-being, and then we're going to try to understand today what causes our stress and learn how to spot patterns and help manage that as well to help us gain a better self-awareness and hopefully a healthier life physically and mentally as we wind down this year and move into the next. So let's start with this question. Why do some people seem to be more resilient? We hear that word resilient or resiliency in our personal lives being good for us and also in our workplace, but why are more resilient to stress than others?
Josh McCullough:
There's a lot of different reasons, and I think maybe the first reason I could think of is that some people just kind of biologically are a bit more resilient or less resilient than other folks. I mean, there's folks that are more outgoing and less outgoing, for instance. We know that they process things differently. Similarly, folks that handle stress better, we may know these people, these folks that no matter how tough the going gets, they always have the plan. They always can handle things.
Emergency room physicians, for instance. Maybe they start out with a little bit of that extra resilience. Then another part of it is kind of learned. How do we learn growing up as kids, as teenagers, young adults into adulthood? How are we taught to manage stress? It's one of those skills that we just kind of assume people are going to get, but really maybe some folks have a better history of having people teach them how to handle stress than others. Again, emergency room physicians, they are taught different techniques, styles, quick ways of thinking and encompassing problems that you or I just don't have, for instance. And that's a pretty extreme example, but some people may just get those different lessons over time then others don't. The old kind of pull yourself up by the bootstraps. It helps if you've got bootstraps to pull up to begin with.
And some folks may live in just chronically stressful situations. I mean, I think the pandemic laid that pretty bare for all of us to see that some folks are under a lot more stress just as a normal course of daily living than some other folks. So I think there's a lot of different things that go into it. What we see is the outward sign, well, someone's having a tough time or an easy time handling stress, we tend to ascribe that to some sort of personality issue. Josh just can't handle things. But really there are so many factors that go into it that a lot of times we just don't think about.
Chuck Gaidica:
So you've said a lot there that has, I look at myself and I think, well, I am, and I've been told by extended family, the resilient word hasn't come up, but I don't internalize things. I'm kind of like a duck. Stuff hits me that's maybe not great for the day or for the minute and it kind of rolls off my back. I don't internalize it, I act on it, I navigate it, and I move on. And I guess that's resiliency in a way. But to me that talks about me being wired a certain way. You're also saying that whether you're a physician in an ER or maybe in daily life, there are some things we can learn that will help us navigate that, right?
Josh McCullough:
Yeah, absolutely. And you and I have talked about these similar things on another podcast, but I think the first thing to look at is I think to look at it. I think so many times we're taught that we just have to accept things and the popular concept of acceptance is kind of to suffer. I just have to sit here and accept it, just is what it is and I just have to sit here and kind of take whatever life throws at me. And so often, even in the mental health profession, well-meaning people will say that, you have to accept it. Unfortunately, people end up suffering. They don't truly understand what accepting means. Part of it is to rather than run away from or sit down and suffer with what's going on, is to kind turn around and look at it. What's going on? Why am I responding like this, however. This is because our emotions, our actions, are trying to do something for us.
And it's almost like there's a lot of different parts to ourselves, and I kind of think of it as kind of a party. Like Chuck is the host of the party, Josh is the host of the party. There's a lot of different people in attendance, a lot of different emotions and feelings and thoughts going on. And to be a good party host, we want to make sure that all of those things are kind of in harmony. Maybe some people are being a little bit louder at the party than others, maybe some people need a little bit of coaxing out, but we want to kind of pay attention to all of them rather than ignore them. And I think emotions are a lot like that.
Chuck Gaidica:
Do you have practical steps then that we can start to think about that can help us deal with that party and noise? Because by default, we probably go through this a lot. That party could be kids running around as they're growing up. It could be at work. There's not a literal fire, but something's going wrong and the papers are all thrown in the air and you've got to deal with it. But what are the practical steps that we can start to think about to get us down to this path of wellness when it comes to resiliency?
Josh McCullough:
Well, I think the first step is to identify are there any patterns? Are there any situations that keep coming up, that keep recurring? It's impossible to plan for every single thing that could happen to stress us out, but are there reliable stressors? Maybe it's family events, holidays, situations at work, things like that. Identify are there those patterns? Take a look at how I, we have responded to them in the past. And then are there small ways that we can shift things even just a little bit? Can we get the train on a slightly different set of tracks? Rather than shutting down or not talking is there someone reliable I could talk to before or after the event? Is there a way I could sit down and maybe write out how I would like to handle this better in a journal or type it out to ourselves? Am I paying attention to my breathing?
The more stress we tend to get, the tighter our muscles tend to get, the less we tend to breathe and it induces its own kind of anxiety response, its own stress response. It's kind of like the thermostat's getting too hot. I may need to pay attention to am I breathing correctly? Am I dropping my shoulders? Kind of loosen up a little bit. We talked a little bit about some folks may be under chronic stress. I don't want to minimize folks who have experienced something that's very traumatic. It may lead to post-traumatic stress disorder. Folks may need to seek professional help one way, shape or form.
If even it seems that there's always these things we cannot control, they're always happening to me or I'm quite frequently reminded of a stressful event, a very traumatic event, maybe time to talk to our primary care physician, maybe seek a counselor or psychiatrist because that's a very special sort of stress to have. And I don't want to gloss that over or say that we can just handle that like any old problem. It reminds me of an old saying, if you've got a Jaguar, don't take it to the Jiffy Lube. Nothing against either one of those, but if you've got a very special, very unique thing that needs a lot of special attention, don't take it to just any old place to get it fixed. Post-traumatic stress, generalized anxiety, these kind of special things may need a special intervention.
Chuck Gaidica:
And you said this in a little different way, I guess, than I'll probably reflect it, but you talked about patterns, things that are being thrown at you, but also your reactions could turn into a pattern. I mean, if you're one of those people where every little thing gets you to blow a gasket, well, some self-awareness there may be in order to try to figure out, "Well, why do I get so upset every time the dog does something or the kids do something?" Those patterns can also come up.
Josh McCullough:
Oh, absolutely, absolutely. And again, that's a good place to sit back and reflect like, "Why am I having this? What is my reaction trying to do for me?" Because it's trying to do something to be helpful. It's just coming out crooked. Maybe there's a different way to get the outcome I'm hoping for, or at least express myself without blowing a gasket, yelling at people, isolating, falling to pieces every single time something comes up to shake our world up.
Chuck Gaidica:
When we think of those practical ideas, and I know you've worked with children and adolescents and young kids and adults alike, the practical step of something as simple as breathing, is that a good place to start to think about this, that if that's not something that you bring out of your toolbox to deal with these stressors and triggers, is that a good place to start just to see if maybe that simple practical step is helpful?
Josh McCullough:
I would say so because you can't grab an emotion. You can maybe write your thoughts down and tackle that, but a behavior is a much easier place to get started. And there's one technique called box breathing where we kind of breathe in for four seconds, breathe out for four seconds, breathe in for four, out for four, kind of the box, so to speak, that can help kind of grab onto our body because the more stressed we get, breathing may get more quick but more shallow, heart rate may increase, muscle tension may increase. If we can grab a hold of some of those things, then we may be able to slow the train down.
And I really, really advocate for people to practice and start using any of these techniques well ahead of time because so often people say, "Okay, I'll try that." But they try it when life is at its worst and they say, "Oh geez, it didn't work." Well, I don't know if there's anything any of us do that we didn't have to practice to get really good at. So if we try and use something we've heard of once or twice when the going is absolutely at its roughest, we haven't really stacked the deck in our favor.
If we can try that even just a few minutes a day, one of my old professors recommended putting a little sticker or some sort of tag on your keys, something you would see every day that when you see it, you say, "Oh, I'm going to try my breathing, my box breathing, for 10 seconds or 10 repetitions." So we think to practice it and then also think about practicing it when the moment happens, but just almost like acting, like a practice. We look at people like Olympic athletes, you may see them, they're in their head and they're practicing their routine, things like that, to get ready for the big event. If we can do that, "Geez, the next time I encounter this person, I'm going to do my box breathing." When we think about that person and we practice our box breathing, we may be more likely to use it and have it work rather than just going in cold.
Chuck Gaidica:
That's great advice, that idea of practice. And if you know that your trigger is that you have to walk down the hall once a week and do a presentation in front of people, and you're the last person in the world that wants to grab a mic and do a presentation, ducking into that coat closet or some other vacant office and doing box breathing, to your point, and turning around and walking into the meeting, if that's a recurring thing, you may discover a way to deal with this because you're actually literally practicing it while you're in the game, right? I mean, that would be very interesting.
Josh McCullough:
And I think that also what happens is so often people visualize or imagine either complete success or complete failure. You talk about giving a presentation, "Either I will completely bomb this presentation and be laughed out of the room, or I will give a presentation that would make Winston Churchill weep." And I think that it also helps to think of the in-betweens, because life is so often in-between. Life is so rarely complete success, complete failure. Maybe I'll stumble, maybe I'll have a little thing. Maybe I could grab a drink of water if I'm stumbling over my words, maybe I could pause and ask, "Does anyone have any questions," to help regain my pattern of thinking. I could have my notes available to me. So yes, there are going to be times that maybe I stumble, but I can also imagine some different ways that I can recover from that because it's inevitable.
Chuck Gaidica:
So if you are headed down a path where this is starting to impact both your mental and physical health, you're literally noticing that stressors and triggers are doing that, what are the warning signs that we should be looking for? So how we can address them, these warning signs, and also the stress that's coming before it escalates into a recurring problem?
Josh McCullough:
Well, as we talked about these sort of getting ahold of outward behaviors like breathing, I think maybe some of those outward signs like, how am I eating? Am I eating more, less? Am I not taking care of my basic biological building blocks? How is my sleep? Is my sleep impacted? We'll all have that tight deadline that comes up a few times a year that we may stress out over. But if I'm stressing out over every deadline or if I'm imagining the next one coming down the pipe and they haven't even given me the assignment yet, or I'm really losing sleep over it, I find myself waking up and just ruminating, thinking over and over about bad stuff, and I can't get good sleep, if I'm letting my routines go, not just work, but am I not hanging out with friends and family like I used to? Am I not going to the gym like I used to, engaging in hobbies?
All of these early warning signs are points where we could start to say, "Hey, is this happening a lot? Is this a once a year type of thing?" And then also getting good input from the people that care about us, the people that can truly see outside and say, "Josh, I noticed you haven't picked up your guitar in months and you're pretty quiet and you're not eating like you used to. How are you doing?" It helps to have those outside sources of truth, so to speak, to be able to talk to and listen to, to give us feedback for, "Geez, maybe I haven't been paying attention to this like I should. Maybe I need to do something about it."
Chuck Gaidica:
So if the self-help idea or what we could call, I guess, traditional ways of dealing with this through breathing and mindfulness or whatever practices you're trying to employ, they don't seem to work, how do we determine that? I guess we can determine that maybe more quickly than what to do next and then is what we should do next?
Josh McCullough:
Yeah, so if I've given it the old college try so to speak, given some of these basic self-help building blocks a try and they're just not working, there's a good many ways. I'm a psychologist by training, so I always advocate for people to look into counseling, mental health therapy. There's a good many ways to do it. If folks go to the bcbsm.com, find a doctor, they can filter and look for social workers, psychologists, counselors that they can meet with. Telehealth is increasingly popular. Folks don't even have to leave the comfort of their own home. They can schedule it. Very flexible times. And we've got this ever-increasing network of providers that are able to do that, to meet with someone, to get a good professional eye on things. It may require medication for some folks. And there's nothing wrong with that either, either through the primary care physician or maybe seeing a psychiatrist. And there's ever-increasing psychiatrists that are seeing members via telehealth, kind of like you and I are doing. It's like a video call or a phone call. Very convenient.
And again, we talked about some of these very special things like post-traumatic stress, some different anxiety disorders or other mental health disorders that may require a specialist touch. Primary care physician may be able to get folks started, but they may consult with a psychiatrist or recommend that you see a psychiatrist to get more specialized medication. Because all we want is for our members to be as healthy and happy as possible. It may take a team to do that. And so if folks are trying by themselves, it's not working, the last thing we want to see people do is say, "Geez, I can't fix this myself. Holy cow." And that adds to the stress. Call in experts, call in supports, call in people that can take some of that burden off you.
Chuck Gaidica:
And it seems as we've come out of a pandemic and it's in the rear-view mirror, the idea of socialization seems so important in this process because you're saying, "Well, let's turn to our spouse or our little kitchen cabinet, third parties, to kind of say, 'Hey, how you doing, Josh? What's going on?'" Well, you may not have that because we're living at a time where what the Surgeon General said, loneliness is an epidemic in every single age demographic. It boggles the mind when you think about how many friends people think they have on this thing, but they're not maybe really true friends. So what is this idea of managing stress and how can we, maybe if we have a limited support team, this idea of socialization around us, how can we build healthy relationships that can reduce stress? Could it be as simple as going to play pickleball with a group or what else could we do?
Josh McCullough:
Absolutely. And there's a good many ways to do it. There are some popular apps, and I'm mentioning one just because it comes to my head, but it's not endorsed by Blue Cross, I'm not endorsing it, I'm simply saying that I know this exists, called Meetup. And through it, people can find so many groups of people that may have similar interests, physical activity, gyms, I like to do trivia, I like to play music. In fact, myself, I have met a good many musicians I've known for a long time through that application who just get together once a month and play songs together. Gardening, I know that you're a gardener. There may be other folks that like to garden. And so that is one way to do it. Again, I'm not endorsing. I'm simply saying I know that it's out there.
Depending on where you're at, there may be flyers. If you're a gardener, there may be flyers at the local gardening store of people who are looking to start a community garden. You may see flyers around town. But it's joining a local gym. YMCA, perhaps, again, not endorsing, just knowing it's out there, or these various 24-hour fitness clubs to try and give a shot and just see how it goes. Dipping our toe in the water a little bit. Anything we can do to keep our eyes open to seeing what may be out there and giving it a shot is very worthwhile. Because you mentioned that, maybe not everyone has this great support network, or we may have one or two really close supports, but they're not always available.
And I always envision it like building a safety net. If we've ever been to the circus and we see the high wire acts, they've always got a safety net underneath them. And that's there to catch us if we fall. And in our own personal safety nets, maybe we have some ropes that are really, really super strong that we know very, very well, know us well. Maybe we have some smaller ones that are equally valid and helpful, but they don't know us as well. But it's still helpful to have them there to catch us when we fall or if we're taking a tumble. And there's nothing wrong with having various very, very close relationships, some more casual relationships to kind of mix it up so that if for some reason our very, very closest supports are not available, we still have other folks that we can connect with.
Chuck Gaidica:
And I think the ancillary benefits to that, I'll just use one more example here before we start to wrap it up, my wife and I started playing pickleball Wednesday nights. This past week, we had an eight-year-old and an eighty-year-old as part of this group. And that's like the outliers of the demographic, right? I'm not great, but I'm smashing a ball, I'm using my paddle to high-five my teammates, even if we win or lose, and I'm building relationships with people that I've not had relationships with before.
I'll tell you what, I'm not great at it, but time just kind of disappears. And I look at my watch and I'm thinking, I've been doing this in a rotation for two and a half hours. It's not because of the simple nature of physical activity. I know there are studies that show that's a good thing, but it's just this idea that I'm with people and I'm interacting. And I guess my point of all this is you can't build these relationships that may be important for your support system unless you start them. I mean, you've got to go find a place to dip your toe in the water and just see if it works.
Josh McCullough:
And oftentimes the more stressed we are, the more emotionally distraught we are. We may think, "I am the only person like me. I'm the only person experiencing this. I'm the only person that understands what I'm going through." And you may find that there are more people like you or who just need to take a break. There's nothing wrong with taking our minds off things for a few hours. And indeed, we may find that if we play pickleball, our mind is occupied. It's tough to be depressed or anxious and occupied at the same time. It's very difficult. And if we take our minds off it a little bit, that may raise our mood a little bit. "Oh geez, after I got done playing pickleball, I feel a little bit better. Things don't seem as bad. I still have some things I have to tackle, but it's not as crushing. I was able to enjoy life along with these stressful moments in life." There's nothing wrong with that at all.
Chuck Gaidica:
Well, lots of great stuff again on this episode. Do you want to leave us with any takeaways here as we wrap it up?
Josh McCullough:
Yeah. Like we talked about, take a look at some ways we can kind of manage our physical stress through breathing, through relaxation. There's guides online and all sorts of tips, but that box breathing, that four seconds in, out, in, out. Taking a look at our support network, if they're noticing things that maybe we're not noticing, that could be a clue that maybe we have to start paying attention to what's stressing us out. Seeking some professional help if necessary. And it's available to our members, and we want to make sure that special problems get special attention. And like you said, just doing what you can to engage in some sort of physical activity or activity outside of ourselves along with other people. That connection one way, shape or form, can be very powerful to help relieve our stress, take our mind off some of the things that are troubling us and help us enjoy life even though there are some stressful things going on.
Chuck Gaidica:
That's really great. I don't know if you've noticed, just during our episode recording this, when my shoulders are relaxed, I'm feeling better about pickleball. You may have noticed that. So we'll see Wednesday night if it works.
Josh McCullough:
I did, I thought I saw that. It's the play and practice.
Chuck Gaidica:
Good to see you, Josh. Thanks so much.
Josh McCullough:
Likewise. Thank you so much.
Chuck Gaidica:
Oh, sure thing. Josh McCullough is a Senior Healthcare Analyst for Blue Cross Blue Shield of Michigan. We're so glad he was with us and we're glad that you were here listening to A Healthier Michigan Podcast. It's brought to you by Blue Cross Blue Shield of Michigan. If you liked the show, you want to know more, check us out online at ahealthiermichigan.org/podcast. You can leave us reviews or ratings on Apple Podcast or Spotify. You can also follow us on Facebook, Instagram, or X. And you can get new episodes, old episodes for your smartphone or tablet. And you can subscribe to us too on Apple Podcast, Spotify, even a YouTube channel, or just your favorite podcast app. I'm Chuck Gaidica. Be well.
