Dr. Natasha Bijlani Khubchandani on Stress Busting Strategies
So nice to see such a lovely crowd here. I’m standing in front of a group of tremendously accomplished, successful individuals. All of you have undoubtedly imbued a lot of drive, determination, and dedication into achieving success in all the different fields and spheres that you are experts in. But with such success comes a heavy load, right? In today’s high-paced world, stress can seem like a constant companion. We all develop high expectations, relentless schedules, and the ever-present push to excel. That can so easily take a toll, and you get caught up in a cycle of always being “on.” And that’s when we start to feel the weight of stress.
Today, I’d like to help you flip that script a bit. I think everybody in this room is used to strategies for achieving more. Let’s talk about strategies for stressing less.
Now, with many things in life, there usually isn’t a very complicated solution to the problem. Quite often, all one needs to do is to dial back, go back to basics, and recalibrate oneself and the way one functions. So, the ideal strategy, in my opinion, is to live your life in a way that optimises balance and harmony to minimise experiencing excessive and prolonged stress, which can lead to burnout. I have no doubt that all of you are going to be quite familiar with many of the suggestions and ideas that I might throw your way today, but the crucial question that I want each and every one of you to reflect on and think about is how many of you are actually trying to practise those strategies on a daily basis. We all have the knowledge, and I’ll put my hand up as a consultant psychiatrist. I sit in my clinic proselytising and giving people advice on things, but quite often I forget to apply these strategies, and I think this is a reminder to all of us to keep that balance and do the things that I’m going to mention.
So, what is stress? What I’d like to do, in the half an hour that I’ve been allocated, is to divide this presentation into three big topics. I’m going to say a little bit about what stress actually is in a physiological and psychological way. Then, I’m going to talk about what stress does to you, your body, and your mind, and the final bit is going to be about what each and every one of us can do about stress.
So, what is stress? Stress can be defined in many different ways. But ultimately, it’s more than just feeling overwhelmed. When we get stressed, we enter into a complex reaction that our bodies exhibit in response to various demands. Actually, the word “stress” — are there any engineers in this room? No? The word “stress” originates from the field of engineering. It refers to the load that a structure can bear. Human beings, of course, are a lot more complex than structures. When we are faced with demands that can be quite diverse — whether financial, relationship, work, health conditions — there are many different stresses we can encounter. All these demands, whether single or multiple, can make it feel like you’re a performer in a circus, juggling balls in the air while trying to balance on life’s precarious tightrope.
Stress is also quite cultural. By that, I don’t mean the culture of a nation. I’m talking about the culture in which we all grow up. It’s a conditioned response. Quite often, we don’t stress about what’s actually happening around us; we stress about what we think might happen. We fear things. And sometimes we overburden ourselves with that. We learn what to fear. With the busy lives we all lead, we tend to forget that we are actually part of nature. One analogy I often give to my patients in my consulting rooms is to think of your mind as a garden. A garden is a living entity. We have plants and trees; there are lawns. It needs to be tended, cultivated, and managed with care. If you don’t look after your garden, you’re not going to have a healthy garden. If you have a storm that devastates the garden, you may need a professional landscape gardener to help you restore it to a state of equilibrium. The analogy with health is quite clear, right? We have to manage our bodies and minds. Then, when things go wrong — if you haven’t been looking after yourself, or if something happens that’s out of your control — you need to seek professional help.
I’d like to talk a little bit about understanding different sorts of stress. We can roughly divide stresses into four big domains. The first is acute stress, which is usually the kind of stress all of us are probably used to, like what I had just before presenting today. It’s good stress, the stress that arises in response to an imminent deadline. The other type of stress, which is actually a very healthy form, is called eustress. Eustress is like the stress you feel when you’re about to attend an interesting event, like a wedding or a party. It’s a mixture of chaos and excitement, and you feel a sense of anticipation. It’s healthy stress. Chronic stress, however, is the one we all need to be aware of, because it’s like a nagging presence that eats away at you. It’s like that unwelcome party guest who never wants to leave. Chronic stress grinds you down, and it’s often something we’re not aware of until it escalates to distress, which is a dangerous point. Chronic stress not only impacts your mental health, but also contributes to anxiety. I’m not talking about the kind of anxiety we all fear or experience occasionally; this is anxiety that can escalate into a full-blown anxiety disorder. It can lead to depressive disorders, and at that point, you’ll need someone like me — a psychiatrist — an expert to help you manage and unravel the problem, possibly with medication and maybe even hospitalisation. The aim is to avoid reaching that stage.
Has anyone seen this graph before? This is the Yerkes-Dodson graph, devised in 1908. Researchers, experimenting with mice, found that moderately stressed mice performed much better than those either unstressed or overburdened. In human terms, this graph shows that as arousal, pressure, and demand increase, our performance improves. You know, how you get better and better when practising something, or approaching a deadline — you just get into that flow, and you perform. But if you keep up that pressure and don’t allow yourself to step back and take a breather, you reach the peak of the graph, after which everything begins to decline. It’s like falling off a cliff edge, putting you in a dangerous state of mind and body.
Let me illustrate that with another example. Sandip, if I were to give you $1,000 to throw a basketball through a hoop, you might feel a little bit of excitement or you might just think, “Ah, I can’t be bothered.” If I said I would give you $10,000, that might make you feel a bit more stressed about getting it right. But if I were to offer you a million dollars, I think you’d probably feel quite a bit of stress and think, “I’ve got to get this right.” That’s the Yerkes-Dodson curve in action.
Stress is individual. Stress itself is not what makes you ill; your response to stress does. It’s how you handle things that affects your well-being. It depends on your personal view of the stressor, your reaction to whatever is causing the issue, and your capacity to cope with the stress. There are two big categories of stress causes, and there’s a slide on present and past causes. In a nutshell, what I want to convey is that different people experience stress for different reasons. Current stress can include a fear of change, or difficulty adapting to change. We all fear change, but it’s the only constant in our lives. If you don’t tolerate change, you’re not going to adapt to circumstances, and that leads to feeling stressed. Holding the belief that nothing should ever go wrong is also unhelpful. Conflicting needs arise when two mutually incompatible needs collide. For instance, if someone thinks, “I need more rest, but I also need to earn more money,” or “My parents need me — they’re alone and lonely — but I also need more time for myself,” these are conflicting needs. Constantly battling these issues will inevitably lead to stress. Some of us too readily take responsibility for others’ happiness, or struggle to communicate well.
The next area involves three major thinking errors that some of us fall into, either frequently or occasionally. When we overgeneralise, we tend to believe that if something goes wrong, everything will be bad. Selective abstraction is when you focus only on the negatives of a situation. Black-and-white thinking involves viewing things in a binary way — everything is either all bad or all good. Yet, as we all know, life is full of shades of grey. When we are unkind to ourselves, refusing to accept or adapt to who we are, we are bound to feel stressed. The takeaway from this part of the talk is to be kind to yourself.
Past causes of stress can be genetic or environmental, or both, and it’s often challenging to separate the two. A child brought up by their parents shares both their genes and their environment, as well as the behaviours those parents exhibit. Twin studies can help differentiate these factors. Some conditions have a stronger genetic component, while others are more influenced by environmental factors. However, conditions that lead to stress are more likely to be caused by environmental factors. So, what does that teach us? We can change how we respond to stressors. Additionally, personality traits — both ours and those of people around us — can impact stress. I’m sure we all know people who display some of these characteristics: boundary invaders who drain your energy, individuals who are self-obsessed or narcissistic, people who are aggressive or subtly sadistic. Sometimes, these behaviours are so covert that you don’t even realise you’re in a co-dependent relationship. Insecure, reassurance-seeking people may also affect you if you feel compelled to help them constantly, leading to a kind of stress that slowly eats away at you.
The stress response is inherent in all living creatures. Any living organism, including plants and animals — and certainly humans — when faced with danger or the threat of danger, experiences anxiety. Anxiety is normal; it keeps us safe. For instance, crossing the road makes you anxious, but you need to temper that anxiety according to the situation, leading to a fight-or-flight response. The body prepares to either confront or avoid the threat.
Remember, anxiety and stress can lead to physical changes in the body, and if these go unmanaged and become chronic, they put you at risk for endocrine disorders like diabetes. You are more likely to develop mental health issues, and your immune system weakens, leaving you more susceptible to various illnesses. Once you reach that stage, there are often no cures, only management options. Stress also causes psychological and behavioural changes.
The emotional effects of stress are familiar to many of us, but extreme stress can lead to more serious conditions. For example, post-traumatic stress disorder (PTSD) can develop in individuals who have experienced significant adversity — such as being brought up in a war zone, suffering abuse, or surviving a traumatic accident. In some cases, severe stress in a vulnerable person can even lead to psychosis, a mental state in which they lose touch with reality. Symptoms of psychosis may include hearing voices, having delusions, or experiencing paranoia, and often require hospitalisation and medication. Cognitive effects of stress — such as difficulty concentrating, forgetfulness, irritability, and rigidity in thoughts — are things we’ve all likely experienced. Behavioural effects are numerous as well, including difficulty sleeping, developing unhealthy habits like comfort eating or smoking, or a loss of appetite. High stress makes it hard to relax and more prone to accidents. Some of the biggest accidents, like the Chernobyl nuclear disaster, the Exxon Valdez oil spill, and the Space Shuttle Challenger explosion, were caused by people who were likely sleep-deprived and under stress.
So, what is stress-busting? Stress-busting refers to the range of techniques and strategies aimed at reducing and managing stress effectively, which then leads to fostering a sense of well-being and calmness. It’s not merely about putting a band-aid or a sticking plaster on a problem; it’s a robust system of tactics specifically tailored to combat stress head-on. The primary objectives of stress-busting are to reduce anxiety, enhance your emotional health, and improve your productivity through targeted interventions that tackle the sources of stress. Before you can start thinking about anything else, you need to understand and recognise your major sources of stress at present. Everybody has different levels of capacity and endurance for stress. We get used to dealing with the life we choose. So, you need to personalise it and understand how the stresses that affect you impact you. As much as possible, try to anticipate and plan for stresses.
Now, I know we can’t plan for everything that happens to us because many things are unforeseen. Disasters can happen. But in our everyday lives, we encounter different kinds of stresses, and I think a wise person will sit down, plan ahead, and find a way to manage them. You need to find your optimal level. You don’t want to be overly controlled, but you also don’t want to be too lackadaisical and allow the stress to engulf you, because then you will end up drowning. Two main errors that I have noticed in people who repeatedly come to me with stress are that they fail to live in the present, right?
And the second big error is that they just refuse to let life be. When you’re caught up in a tornado of stress — something happening to you, something catastrophic, or just something slowly eating away at you — you’re constantly swimming. Again, this is an analogy. I always break off into analogies; I think that’s just the way my brain works, and I feel people can relate. So, if you’re swimming in an ocean and the tide is pushing you towards the shore, but you want to go across to an island in the middle of the ocean, if you keep swimming hard and fighting the current, what’s going to happen? You’re going to be exhausted, burnt out, and you might drown. So, sometimes, when there’s a storm, it’s important to just lie back and float on the ocean of life. You can’t always fight things. It’s about being adaptable and understanding what you can and can’t deal with. Be aware of it. Don’t keep thinking about the same thing again and again. Think about the changes that happen in life, embrace those changes, and adapt to them.
I am now going to give you 10 quick tips, some not so quick. The first one is to recognise and identify your stresses. For most of us, the obvious response is to change how we emotionally respond to stress, right? But there’s also another approach: think about changing the environment. If you’re constantly around people who drain your energy, maybe distance yourself from them. If you’re in a career that has become overly stressful despite your best efforts, perhaps it’s time to change the environment. Put your needs and abilities first. Take control and take action. The second tip is to adopt a problem-solving approach. Have you all heard of the salami principle? You know what a salami sausage is, right? It’s a big sausage that no one can eat in one bite. So, what you need to do is slice it into bite-sized chunks. That’s the best way to manage a big, overwhelming problem: approach it one stage at a time. Develop, evaluate, and execute a course of action. And when you encounter stumbling blocks — because who hasn’t been in a project that led to a problem — you need to pivot, recalibrate, and move forward.
I’m telling you all this, and I’m sure some of you think, “Oh, I’ve heard all this before,” but we often forget these things, do we not? Sometimes we do. I tell my patients that depression and anxiety disorders are the bread and butter of my work. But I still attend talks, presentations, and conferences about these same topics and always leave having learned something new. I’m hoping that will be the response here.
Tip two continued, as there are many aspects: develop new, effective behavioural skills. If people are stressing you out, ask yourself, “Am I being clear in my communication? Am I expressing what I want simply and openly?” Negotiation and assertiveness skills are essential. You might think that leaders, or I as a consultant psychiatrist, would be experts at negotiating and being assertive. And in certain areas of our lives, we are. I feel very much in command in my clinic, where I know what I’m doing. But in everyday life, it doesn’t always work that way, right? Aren’t we all different with different people and in different environments? So, if you’re in a relationship or situation where you’re constantly subverting your own needs and desires, consider professional coaching or training. There are many well-qualified, talented individuals whom people like me often refer patients or clients to, and they can help improve these skills. It’s not something you have to be born with, although some people are naturally gifted. It’s a skill that can be learned and practised.
Many of us also procrastinate: “Oh, I’ll do it tomorrow.” My mother-in-law often used to say, and I’ll switch to Hindi here: “Jo kal karna hai woh aaj karo, jo aaj karna hai abhi karo.” I sometimes quote her in my clinic as well. In our professions, we have to maintain high standards — you wouldn’t want a doctor or an engineer who cuts corners — but you can’t be perfect in every single thing. You also have to allow yourself to be “good enough.” Striving for perfection in everything is a disaster waiting to happen, leading to burnout. Don’t take responsibility for other people’s workload. As we climb the career ladder, whether in medicine, industry, or business, I see many patients who find it hard to let go. They micromanage and overdo things, and then they come to me burnt out. We need to reflect on what we’re doing and step back. Prioritise, prioritise, prioritise.
Tip three: everybody, every single person, we get the same 24 hours every day. It’s like a big pie. It’s up to us to cut that pie into the chunks we want for the activities that we feel are important. And that can change from day to day, from weekday to weekend. When people tell me, “I don’t have the time,” that’s the response I give them. You have to rank your priorities. Is anyone familiar with the Pareto Principle? I can see some people nodding here. The Pareto Principle refers to the idea that 20% of your efforts are going to reap 80% of your reward, whereas the remaining 80% of your effort will only give you 20% of the reward. You need to work smart, not necessarily always work hard. Planning sometimes and writing it down: when patients come to me for the first time, I spend an hour with them, and I say to them, “I’m going to be like a drone, and you are a garden. I’m going to hover over your whole life, finding out what your current issues are.” I’m going to look at things that might have happened to you in the past, and my job in the hour I have with you is to whiz through your whole history, have a panoramic view of what’s been going on in your past so I can make sense of what’s happening now. Then, towards the end, I’ll be able to give you a diagnosis, and we can think of a treatment plan. You can’t go into too much detail at that point. So time management is important. You need to think about what the agenda is and how you’re going to approach it, and then you go deep into things.
I’ve talked about delegation.
Avoid distraction. How many of you – I’m looking at all of you – how many of you are holding your mobile phones in your hand and, every now and then, surreptitiously looking? Probably many of you. What did we do before we had these amazing devices and gadgets? I think mobile phones have transformed us and our lives – communication, information, everything – but they’re also disruptive. The distractibility, click, click, click. We can’t focus anymore. And I’m not really into much social media, but I recently got onto Instagram, and I’m more of a voyeur. I’m a ghost; you won’t see a picture of me. I don’t post anything, but sometimes when I get into bed after a stressful day and I’m finally relaxing, I’ll look at Instagram, see what the girls are up to, see what friends are doing. It’s like a bottomless downward rabbit hole. Time goes by, and I think, “Oh my goodness, look at the time.” So, mobile phones can be a distraction. My advice is to be boundaried. Don’t just get drawn in; use them to your advantage.
Okay, tip number four. You’re going to say, “Yes, she’s teaching her grandmother to suck eggs here.” You are Rotarians. You are the masters and mistresses of communication skills. You know how important it is to connect with people, socialising and doing things together. Research is now showing us that it’s so good for our brains to have connections with others. So, I’m not going to say much here, other than to remember when you’re stressed, talk to people. It’s not just about sharing your problems. Maintain good mental and physical health by doing things with others.
Now we are going to talk about a healthy lifestyle. Common sense again, you’re going to say, but how many of us are consistently practising these? I spend most of my time sitting down and talking to people. And then, when I’m not in front of a patient, I’m dictating letters, checking emails, or making calls. So I’m standing here as a guilty party myself. I’m not pretending to be more than I am. I have recently started going to my gym, and I now do something called Body Balance, which is fabulous. It works for me. It’s one hour to some beautiful music tracks. We start off with Tai Chi, follow it with yoga, do some strength work, then balance – which can be tricky depending on how much sleep I’ve had the night before and if I’ve missed a few classes – and end with relaxation on the floor. It is fantastic. You all need to find what works for you. The general plan, if you’re going to do the bare minimum, is 20 or 30 minutes, at least two or three times a week. You can choose to do it individually – you can put on YouTube and follow any classes there, go to groups, get personal trainers, or go and play a sport. The whole point of exercise is that, firstly, it helps your mood. Moving our bodies improves our circulation, releases endorphins – and that’s a feel-good. I think the trick is to overcome that initial inertia that all of us have about, “Oh, I can’t be bothered. I’m tired.” Go do something.
Diet: you are what you eat, right? Modern developments, modern living, have given rise to so many foods packed with ultra-processed substances. Basically, anything you buy that is packaged in shiny packaging and advertised by companies is definitely food you should not be eating too much of. They might be tasty, but that’s deliberate – foods constructed by manufacturers to make them palatable and tasty, but they’re not healthy at all. Our parents and generations before them lived much healthier, purer lives. They would have butter and ghee, not margarine and crisps, chips, and all these things. Sometimes, when we get stressed, some of us go into comfort eating, right? We all do that. Sometimes I just feel I need a dark chocolate biscuit, and I’ll sit there trying to eat slowly. Or sometimes I have patients who binge eat. Sometimes, when you’re stressed, you don’t eat. You have to be aware of how your behavioural response to stress is and adapt.
Alcohol: you know, I’m an honest doctor. I tell my patients I drink, but I have rules for myself. When I’m in my normal working week back home in London, I have boundaries. I don’t drink during the week because alcohol is a toxic carcinogen. It’s a number one carcinogen. But with everything in life, you balance the risk and the benefit. Alcohol can be tasty. You like drinking in social company. It’s fun, but you have to balance it. So you need to know what your limits are. And usually, the received wisdom – this doesn’t come from any scientific background but just came up when doctors got together many years ago – is that people should have no more than 14 units in a week. And that’s not actually a lot. One unit is a very small glass of wine, half a pint of beer – people drink a lot of beer in the UK – or one peg, one measure of a spirit. So just think about when you’re drinking, how much you’re drinking, plan ahead, and don’t use it as a stress response, because that’s a slippery slope.
Tip number seven is just a general healthy lifestyle: sleep. How many of us marginalise our sleep? From time to time, you can get by with less sleep than your needs are. Sleep needs change through the ageing cycle. Babies sleep a lot; children need less and less sleep. As adults, we need less sleep, and as we get older, the quality of sleep changes, the architecture of sleep changes. So be aware of that. That could be a whole hour’s lecture on sleep.
And then these habits that some people pick up when they get stressed – smoking, recreational substances – think about avoiding these.
Make time for pleasure. Make time to do things that you enjoy, hobbies. Don’t just marginalise that. Do you really want to be a hamster on a wheel all the time? You’ve got to step back. You will actually perform better if you give yourself time to flourish in whatever suits you. Stop rushing around. And again, this is really self-confessional for me. I’m always rushing around. When I first started in private psychiatry, my first secretary called me “Road Runner.” Are any of you old enough to know that cartoon? Yeah, we are, right? My goodness, because I’m always rushing from one appointment to another and telling her something and then rushing out. And I’d come home in the evening feeling exhausted. Now I’m trying to slowly change that, but some of our careers are such that we have patients booked back to back, or you might have appointments and meetings, but every now and then, you have to change. I decided I was going to do something about that. So I’m speaking with confidence here to say, I now work three full days a week. That’s when I see my patients, and those are my heavy clinic loads. The other two days, I go and get my hair done, or I might get my nails done. I do admin work and am available for emergencies. So I’ve tried to find my balance. So I’m just saying to everybody, we know all these things; try to make time to do them.
Okay, learn something new, pick up a new hobby. My new year’s resolution last year was to take up singing lessons. I’m sorry to say, I haven’t done that yet, but I’m really hoping – there are still a few more weeks left before the end of this year – I am going to make sure I do it.
Okay, stop worrying. We are all worriers, aren’t we, in different ways? We worry about all kinds of things. We try to do the right thing. This is the strength pose that I often do in one of the body balance classes. And all the millions of thoughts our minds are going through: checking, “Am I doing this? Am I happy? Do I look okay? What do people think about me?” Try and lose that self-consciousness. Just be. This is quite an important tip. Setting aside time for reflection, for meditation, mindfulness, journalling, gratitude, and positive self-talk. This is all about being kind to yourself. A lot of patients, I would say to them, when they’re stressing, sometimes journalling your thoughts, getting into the habit of thinking at the end of the day – maybe that’s usually when people have more time than in the morning when they’re rushing around – can be really beneficial.
Mindfulness. It is about paying attention to what’s going on inside yourself, inside your mind, in your body, and outside. It’s easy to stop noticing the world around us, to lose touch with the way you are. By practising mindfulness, you start becoming more aware of everything around you. So when I came here, I was looking at the beautiful chandeliers, the beautiful walls, soaking in the ambience. If you’re more mindful, you’re going to get more out of life, and you can train your mind and your brain to be more robust.
Give to others. And it’s not just about charity. It’s about things, little things like saying thank you to someone, being kind to people, spending time with people who are lonely. When you give to people, you get so much back in return, and you’re not doing that to get something back. You’re just doing it because you enjoy it. It makes you feel good. And it also gives you a sense of self-worth and confidence.
If all this fails, seek professional help, because if you carry on pushing yourself, the end stage that I mentioned right at the beginning — the stage of burnout — is potentially very dangerous. It’s a medical and it can be a psychiatric emergency. If you come to see someone like me, as I said, you’d get a thorough assessment. You will almost invariably be referred to talking treatments, and there are many different kinds — no time to discuss them all. Sometimes patients need medication. Medication and therapy work in a two-pronged way. And for severe cases, inpatient admission is warranted.
If anyone wants to ask about cognitive behaviour therapy, it’s about changing the way you think about something, which can then change how you behave with the stress response.
So, finally, I’ve borrowed this beautiful serenity prayer, which I’m sure everybody here is familiar with, and I think it really does give you a lot of peace. Words of wisdom: “Grant me the serenity to accept the things that I cannot change, courage to change the things that I can, and the wisdom to know the difference.”