SPEAKER_00: 0:01

Welcome to the Healthy Matters Podcast with Dr. David Hilden, primary care physician and acute care hospitalist at Hennepin Healthcare in downtown Minneapolis, where we cover the latest in health, health care, and what matters to you. And now here's our host, Dr. David Hilden.

SPEAKER_03: 0:18

Hey everybody, it's Dr. David Hilden, and welcome to the Healthy Matters Podcast. Today, we're going to talk about something that likely every one of us deals with on an everyday basis, and that's stress. Now, stress gets blamed for a lot of things. We say, I'm stressed when we're busy. We say it when we're overwhelmed. But stress isn't just a feeling. It can have real effects on your heart, immune system, your sleep, even your digestion. So today we're going to discuss what stress actually does to your body and your brain, and more importantly, what you can do about it. I'm lucky to be joined today by clinical psychologist and a repeat guest on the show, Dr. Mitch Raiden. Mitch, welcome back to the podcast. Thank you for having me back. Happy to be here. Okay, so let's just start with the basics. When people say I'm stressed, what does that actually mean from a psychologic standpoint, a physiologic standpoint? Right. How do you want to tackle that? A couple ways to tackle it.

SPEAKER_02: 1:07

I think the first one, there's like stress, stress, where people just don't want to do something and are kind of dreading it. People use stress in that form just as a descriptor. When we're talking about real stress, what we're talking about is an impact on our system where we're exposed to something or about to do something, where our body has a response to it that indicates that we're under specific threat. So our nervous system and our brain activate to respond to something that feels imminent, and our body and our brain aren't making a distinction between, say, me giving a speech or being on this podcast or being confronted with a bear. It just knows that I'm confronted with something that feels threatening. And so my body lights up to respond to that threat. So is all stress bad? Absolutely not. There's a big distinction between you stress, which is a good kind of stress. It's when our body activates or mobilizes in a way to manage something that's difficult. So it fills us with a little bit of adrenaline and cortisol to allow our bodies to activate, to respond in a way that's fast and prepares us to deal with whatever's in front of us. What gets problematic is when that acute stress, which is common and our body is adapted to be able to kind of spike and then come back down, when that doesn't stop, when we're chronically spiked or when we're under chronic threat where our body never really comes down, we're at a spike that stays stable or doesn't come fully back down, when our body is flooded with stress hormone, our body isn't making a distinction between real threat and perceived threat anymore. And we're always activated in that way we're confronted with a potential threat. So that bear is always in front of me.

SPEAKER_03: 2:50

So is that bad then? Is it you if you're in this always activated stress response stage to a bear that isn't about to attack you? Could you say more about that?

SPEAKER_02: 2:59

Aaron Powell Yeah. I don't know that I think about it as good or bad. I think it has impacts and consequences. So if I'm legitimately in an environment where I am always under threat when I have to confront something that has to keep me in a position where I'm mobilized chronically to confront something, I need to be in that state. What becomes problematic about it is if I'm unable to down-regulate from that state, and my body and my brain are no longer making a distinction between when I'm in that environment or confronted with that thing and when I'm home and safe and wanting to relax. My body wants to stay in a state of regulation, but if I'm always in that intensely activated state, what my body thinks is my baseline is a lot higher than it should be. And so it never really fully comes back down to that state of calm.

SPEAKER_03: 3:49

So what's going on in your body then in this fight, this fight or flight response? And I actually think there's a couple more F's involved in that, maybe, aren't there? Yeah, there's some expletives typically that come out when people are really stressed.

SPEAKER_02: 4:01

But yes. So there's the fight, flight, freeze, and fawn response. And so there are a couple ways to think about this, but really the way that it makes the most sense to me is that our nervous systems are adapted to scan the environment for threat and safety all the time. Our system, our bodies want to be regulated and they want to be in a state where we're able to respond immediately to what's in front of us. So throughout the day, we go a little bit up and a little bit down in that state of regulation to hold more tension in some circumstances, but then down-regulate and then go a little bit kind of lower in our system to relax when we need to into that parasympathetic state. But under conditions of stress, this is a common uh framework for trauma therapy and in therapy in general. It's one of the dominant frameworks, is polyvagal theory. So we used to think about the autonomic nervous system as this binary system where we're either in sympathetic state of activation or we're in a parasympathetic state of rest and digest, relax. But after this guy named Stephen Porgius, 40 years or so ago, now was doing some research on premature babies, and what he ended up discovering really is that our nervous system has three separate parts that all work in tandem. It's not a binary system. We have this kind of vagus nerve that goes from our brainstem all the way down to our pelvic floor, branches out to all of our major internal organs, and kind of indicates what they're supposed to do. So when we are fully regulated in a state of calm, that upper part of our vagus nerve, or what they call the ventral vagus part of our system, goes from your diaphragm up to your brainstem, branches out to your heart and your lungs. That's the part that is kind of dictating how much energy is coming from the other parts of my nervous system. That's the regulating mechanism, or what Stephen Porges calls the social engagement part of our system that impacts how I'm able to respond to the environment and socially engage with other people. The lower part of that nervous system goes from your diaphragm down to your pelvic floor, branches out to all of your other major internal organs. And that's the part that, yes, under the right conditions, when that ventral vagal part is operating the way it's supposed to, puts us in that state of rest and digest where everything can kind of slow down and relax. But when we're overwhelmed and we're super stressed, that part is designed to preserve our metabolic resources in the context of an overwhelming threat, slow us down and anesthetize us against threat so that we don't feel or remember that experience of being eaten by a bear, because that's not particularly fun or adaptive for us. So that's that overwhelming part that shuts us down and puts us in a dissociated state or a state of deep fatigue and overwhelm where the world starts to look really hopeless. Then there's that sympathetic part of our nervous system that goes from our brainstem all the way down our spine. That's the part that mobilizes to activate us into that stress state or that fight or flight state that prepares us to deal with something imminent in front of us. Again, like our ventral vagal system is always working to keep us regulated, but when we are in that chronic state of overwhelm, we spike into that sympathetically activated state. So now our social engagement system is off. We are hyper-attuned to threat in the environment at the expense of everything else. We're no longer able to interpret the environment in the way that we typically would, and we end up a lot more distressed by the things around us because we're interpreting threat in place of things that might feel safe.

SPEAKER_03: 7:30

That's fascinating. Yeah. That was like a neurologic study in how your brain and your neurologic system functions. And it and it does seem to then affect other parts of your body. Is that why then people get some physical symptoms? You know, people would say, you know, this is not just in my head. I'm my heart's racing and my chest feels tight, and everybody, everybody gets like intestinal gurgling and nausea and diarrhea and everything. Is that because of what you just described?

SPEAKER_02: 7:58

Precisely because of what I've described. Because when that sympathetic nervous system is activated, what it's doing is mobilizing all of those internal organs to respond to the threat in front of it. So our blood sugars increase to give us more energy. Our adrenal glands are pumping out adrenaline. We've got cortisol flooding into our system, all this stuff to activate us, and our internal organs are responding to either evacuate what we don't need or to slow down our metabolic resources so that, you know, we we can kind of preserve them over time. I have not met a person with severe anxiety or somebody with significant trauma who doesn't have some GI issues, either they have a lot of constipation or irritable bowel-like symptoms, because that body isn't ever coming down into that state of full regulation. It's either in that sympathetically activated state, which is telling that body to just go kind of haywire because you're in a fight, or to completely shut down because you need to preserve your metabolic resources because you're about to potentially die and you don't want to bleed out.

SPEAKER_03: 9:04

Right. So if you have if you're under chronic stress or you have an anxiety type of disorder or a situation, you're not alone if your intestines are some of the first things that are affected. Is that problematic in the long term? What does the science tell us about the effects of having chronic stressors that isn't adequately addressed or regulated?

SPEAKER_02: 9:25

Yes. It is very problematic long term, and it is the source of a lot of medical problems for people because again, that body becomes confused. If you think about it, if my nervous system is on a yo-yo where I am confronted with something threatening and I spike into a state of sympathetic activation where everything mobilizes, and then I come back down and I'm in a regulated state, but very shortly after I'm spiked back into a state of sympathetic activation, but then I'm overwhelmed and drop into my lower parasympathetic state where everything is shutting down. My body can't sustain that level of activation, deactivation. It no longer is able to regulate itself. So now my baseline is either in that state of hyperactivation or hypoactivation, where everything is either hypermobilized or immobilized in my system. My inflammatory system becomes overwhelmed because cortisol is an anti-inflammatory kind of hormone. But what happens when we're chronically flooded with it is that our body stops responding anymore to that anti-inflammatory component of it, and everything starts to become overwhelmed. And so everything becomes inflamed in our system, and inflammation becomes this big problem in terms of how everything works, and then our immune system is impacted. And I will tell you, since I I've never had uh significant like rashes, skin conditions, anything like that. After the enunciation shooting, about a month after, I started getting these really intensely itchy little bumps all over my body, and I ended up with like in plainness, which is uh an autoimmune. Yeah. And it's an autoimmune.

SPEAKER_03: 10:58

So your immune system is affected, something you didn't previously had. Yep. So I'm gonna pivot a little bit on that thought. You started and are the director of a program to support hospital employees who are experiencing stressors. And so your job, and some of your passions, I know, and some of your most biggest impacts have been in supporting our teams through stressors. What are you seeing there with people and their own health in this system?

SPEAKER_02: 11:27

That's a great question. It comes out in lots and lots of ways. What I'm seeing in real time on the units is people are losing connection with the things that feel important about their work. Again, so if you think about that social engagement system, so here's one way to look at it. Um, and this is this is relevant to what's happening in the body and how this impacts us. When you think about the social engagement system, think about you're walking with a friend, you're going up a hill, you're having robust conversation. But as you start getting further up that hill and you're getting out of breath because the hill is pretty steep, what happens to conversation? It naturally drops off. Nobody's trying to slow down conversation. Our nervous system is indicating it's not appropriate to be using our metabolic resources to be having a conversation right now. Let's deal with the threat, get to the top of the hill. Once you get to the top of the hill, breathing regulates again. You end up picking up conversation and kind of carry on. Conversely, think about that moment. And so, you know, we can talk about this stuff because we work in a hospital system. Think about that moment, maybe you're out for a cup of coffee or having dinner with a friend and you're having a robust conversation, and all of a sudden you get that first gurgle of diarrhea. Are you able to meaningfully look at your friend across the table and continue with a robust conversation as that bead of sweat is dripping down your forehead? Nope. Is all you want to do is get away and you don't want to talk and you don't want anybody to touch you, your social engagement system is deactivated in a way in that lower parasympathetic part of your body that tells you it's not appropriate to be having a conversation. You need to preserve your metabolic resource and go evacuate this toxin in your system. So we're unable to make a distinction between real threat and perceived threat socially anymore. And so what I'm seeing on the units when people are chronically activated in that hyperactivated or hypoactivated state is they're losing the ability to meaningfully attune to each other and meaningfully attune to their patients. So I'm seeing more and more fractures and infighting in teams. I'm seeing more and more distress around situations with patients, deeper senses of helplessness, that kind of thing, which is amplifying that already activated stress response. So I'm seeing people as a result of all that not sleeping well, not eating or hydrating during their day, ending up with skin conditions, lots of people kind of going to the doctor for new conditions that have popped up.

SPEAKER_03: 13:51

I'm seeing that all the time.

SPEAKER_02: 13:53

Yeah.

SPEAKER_03: 13:53

I know a guy who lost his vision for about 20 minutes the other day. And uh that guy um happened to be me. And it was uh uh uh I have a job here that involves a certain amount of stressors, as do you. And uh literally something that's a new symptom I've not had, and I kind of lost vision. And it went away. It's fine. I'm fine, gonna l live to see another day. But there are physical manifestations of stressors.

SPEAKER_02: 14:20

You're saying that's fine is precisely what we need to do with it. Just recognize and acknowledge that these stress responses are normal and they are adaptive and appropriate to conditions of chronic threat. Our job is to slow down and recognize, okay, wait, I'm responding appropriately to the stressors and the threat in front of me. I just need to figure out how to downregulate from time to time. And if I'm aware that I am under this level of stress and aware that these new symptoms are starting to come up, I can start to potentially anticipate them or do things proactively to mitigate the impact of these stressors, to regulate that nervous system so that I'm in that more ventral vagal or regulating part of my body.

SPEAKER_03: 15:01

We're gonna take a short break. I'm talking with Dr. Mitch Raiden. He is a clinical psychologist at Hennepin Healthcare. And the biggest expert I happen to know about stress and responding to trauma. He is sort of the psychologist for 7,000 people here, although I don't want to put too much pressure on you there, Mitch. No stress. When we yeah, no stress at all in your job. We are gonna continue the conversation in just a bit. So stay with us, we'll be right back.

SPEAKER_01: 15:27

When Hennepin Healthcare says, we're here for life, they mean here for you, your life, and all that it brings. Hennepin Healthcare has a hospital, HCMC, a network of clinics in the metro area, and an integrative health clinic in downtown Minneapolis. They provide all of the primary and specialty care you'd expect to find, as well as services like acupuncture and chiropractic care. Learn more at Hennepinhealthcare.org. Hennepin Healthcare is here for you and here for life.

SPEAKER_03: 16:03

And we're back with Dr. Mitch Raden talking about stress. Okay, Mitch, could you tell us when does everyday stress that we all see cross over into something more concerning, like a mood disorder or depression or anxiety? When is it something more concerning than our stuff that many of us see every day?

SPEAKER_02: 16:21

Well, my my primary answer to that is whenever it feels concerning to the individual who's experiencing it. If it feels overwhelming and you're concerned about it, it's worth talking with somebody about it, which is a big part of my job. I'll bet it's a huge part of your job. Yeah. A lot of it's just normalizing that some of the experiences are appropriate to the way people's bodies and brains are activated and giving them some basic framework and understanding of some of that neurobiological mechanism at play can really normalize it and help people recognize, oh, this is a thing that I can actually deal with. There's an actual kind of neurobiological system at work here that I can interact with in real time. When people don't feel that relief with getting some of that information, aren't able to practice really basic things to understand that, you know, the body is just doing something in response to threat and a little bit confused, and there are ways to manage it. That's when I'm more prone to refer people to therapy or do a little bit more intensive work with people, just to help them kind of figure out ways to manage the thinking that goes along with this and manage some of those physical manifestations of stress or understanding the way that the body is activated to be able to deactivate it. And a lot of therapies uh work specifically to help both the mind and the body.

SPEAKER_03: 17:38

What about those who might be at a higher risk for some of those complications of stress, people with previous trauma uh in their life, people with previous anxiety conditions or mood conditions?

SPEAKER_02: 17:50

Aaron Powell Yeah. So the the way that I I talk about this a lot with people, my framework is we want to contextualize before we pathologize anything. There's typically some source for what people are anxious about, if not present, something that happened a while ago. And our body does not know the difference between past and present, real and perceived threat. Our body just knows that it does not. Our brain does, but our body doesn't. And if you think about it, all of our sensory nerves are coming from outside our brain, feeding our brain. We're getting all of this information from the outside world before it ever gets to our brain at a speed way faster than our brain can process. And so we get into these reflexive modes of responding to the world based on how activated or deactivated our body thinks it needs to be. So if I experience something really distressful at work and I have a deeply felt sense of this is just an example, this did not happen to me, but you know, somebody looking like they're about to hit me, and I have a flood of stress hormone in my body, my heart rate speeds up, I suddenly hold a bunch of tension in my body. That's now stuck because that was a threat. My brain is optimized to remember that. But more so, my body has now held that as a reference point in my nervous system. So now I go home and I'm doing something that is a little bit more kind of physical. I'm doing a little bit more exertion, my heart rate suddenly speeds up, or I experience something, my body is now confused. Is this the same thing that I experienced before? Flood me in that moment, and now I'm overactivated and feeling a deep sense of anxiety. My brain is scanning to make sense out of whatever it is that's coming from my body. And sometimes it can't really figure it out. So now I'm just generally confused and anxious, and I don't know why, and I feel like I'm crazy because there's something wrong with me, I haven't contextualized it. Yeah.

SPEAKER_03: 19:45

That makes sense to me at an individual level. I want to explore with you what about when the whole world seems to be experiencing stressors at the same time? Does that make sense to you? Absolutely. You know, you know, when when external things in our world, in our hospital, in our city, in our nation, globally, when the whole world seems a little bit more on edge, how does that work for an individual when you see that everybody around you is also that way? Maybe as a normal response. Yes.

SPEAKER_02: 20:14

So a couple things. First, like, how do you feel when you're reading really distressful news? What do you notice in your body? What starts to happen? It's not good. Right. Typically, I mean, I know for me, I start holding more tension in my body, my breathing typically shifts. I start feeling distress, and I'm having all these arguments in my head with whatever I'm reading. That's me kind of attuning to the world as a less safe place, and there are more and more distressing things that I need to be in a fight against. So I'm a little bit more sympathetically activated. I'm flooding myself with a little bit more cortisol. That's the individual part of that. But now I'm out in the world and everybody that I'm coming into contact with is holding more tension in their body and a little bit more activated. We as human beings are literally designed to co-regulate with each other. We're designed to feed off of each other and understand the world and community. And if our whole community is under stress and under threat, and everybody feels like there's no safety out there, or there's very minimal safety, or only safety in certain contexts, now we're feeding off of each other's stress and distress and amplifying it for each other rather than slowing each other down, pointing out these particular stressors, helping each other down regulate in meaningful ways, because we don't think about it. We're just kind of doing it in an unconscious way.

SPEAKER_03: 21:36

So let's talk about coping mechanisms or responses to stressors, both of the very acute thing and then in more in a chronic setting. So when someone's feeling an acute rising in a stressful situation, what do you advise?

SPEAKER_02: 21:48

Normalize that it's okay to be stressed and overwhelmed, and that anything you experienced in that moment of overwhelm is normal and adaptive. Everybody's nervous system is different. Five people dealing with the same. Stressor will probably have a different response to it. And one person's response is not better or worse. It's just based on their own individual context and the way their nervous system is operating. So trying not to judge whatever the response is, but also doing something immediately following that stressor, or if you can, during the stressor, to deactivate what's happening in the body. Like what? What could people do? So this is one of the more important pieces of all of this. If nobody takes anything else from this podcast, pay very close attention to this piece of it because what's important is that we like to think that our brain is the control mechanism of our stress response. It's really not. It's our heart. Our heart is that regulating mechanism in that nervous system. And we can't typically control our heart by way of just thinking about it, but we can control our heart by way of our lungs because our lungs are connected to them. So when we breathe in, our heart rate goes up a little bit. When we breathe out, our heart rate goes down a little bit. It's the downbeat on that heart rate that literally changes the signal from body to brain that slows down that limbic system, that puts that prefrontal cortex or thinking part of your brain online. It does not solve any problems. What it does is position you to problem solve. You just moved yourself from a place of reactivity to a place of responsiveness and intention so that you're now aware that you had a stress response and you can continue to downregulate. So that stress activates our body where we're holding tension. Our breathing gets tight and shallow or we're holding our breath. If that's happening, if you stop right after a stress response and check your body and you notice that breathing is tight and shallow or I'm holding my breath, I've got a ton of tension in my shoulders and I'm clenching my fists. I'm having a stress response. My job is to do the opposite of what my body's trying to do if I'm in fact safe in this moment and remind my body that this threat is over. I am now remembering and not reliving this. And I'm going to shake it out to release that tension, control my breath. One slow, deep breath will move you from that place of reactivity to intention where you can now move forward to first normalize, okay, just having a stress response, and then continue that down-regulating process. And if we are doing that throughout the day, we are mitigating the impact of chronic stressors and helping our bodies get in a better position to stay on a typical rhythm. So the way our bodies are supposed to work is in the mornings we get more cortisol, wake us up, keep us going, and that cortisol is supposed to drop off throughout the day. But if we're not doing anything to mitigate or disrupt that chronic kind of onslaught of cortisol that we're experiencing throughout the day, now our cortisol levels flatten and we have the same amount in the morning as we do at night. If that's happening at night and we're flooded with cortisol, we're not sleeping. And so our sleep is disrupted, which amplifies our stress response to all that stuff in our body. Yeah. It's all part of that same system. And our then our appetite might change where we're either craving foods that may be more inflammatory or we don't want to eat at all, all kinds of other things. But again, so if we slow down and we just check that body, do the opposite of what our bodies are trying to do in those moments, to re-regulate just a little bit intermittently through the throughout the day, we're not just going up in that kind of escalating kind of mountain of stress throughout the day. We're going up, leveling off, going up, leveling off, and we're significantly lower in our stress level at the end of the day than we would be otherwise.

SPEAKER_03: 25:30

Just breathing is the first thing. Breathing is the first thing.

SPEAKER_02: 25:32

Are there things that are harmful to do? Again, it's context-driven. Like some people would say, yes, it would be really harmful for you to go have a drink or whatever. Some people would say it's the healthiest thing to exercise. Sometimes a drink is very relaxing and will bring your system down if you're doing it in moderation and it's realistic that people are going to have a drink. It's how you think about that. If you're stressed when you're having a drink, that's going to be really problematic and you're going to be stressed out and amplify the impact of whatever that alcohol is doing. But if you're doing it in moderation in a socially engaged manner, you're slowing things down and co-regulating with somebody in a meaningful way. Exercise, similarly, moderate exercise is great. When we exercise, we're flooded with cortisol in a really healthy way and then it comes back down. So we're controlling it. But if we're always exercising at really hard intensity, we're continuing to amplify that stress on the body and amplifying our cortisol levels, confusing our system and becoming sort of fatigued in our system and overwhelmed. So finding balance in everything we do is kind of the solution to a lot of it. What is cognitive reframing? I've heard that term. Cognitive reframing is really just noticing a thought and looking for a different understanding or definition of what that thought is. So I can't do public speaking because I'm going to mess up and everything is going to fall apart and I'm not going to survive it. The cognitive reframe for that is simply, oh, I really don't like public speaking. It scares me, but people make mistakes. It's not the end of the world. I'm just looking at a thought and I'm looking at an alternative way to understand that. Is that a helpful strategy for people? It's actually a very helpful strategy because it's it's, you know, we talk about mindfulness as this thing often where, and I'm not making fun of this, but it's that idea that we need to sit on the mountaintop for an hour in lotus position and go into this sort of deep meditative state. That's great for some people. For some people, that stresses them out. What we're talking about with mindfulness is just a moment-by-moment recognition of our states of being, understanding where we're at, and being thoughtful about what's happening in that moment. If I'm not mindful, I'm just going to go with that thought. If I give this public speech, my whole career is going to end and I'm, you know, I'm going to die from it. Now I'm stressed and I'm moving through the world. But once I slow down and I take that mindful moment, that's the cognitive reframe. Okay, I'm recognizing that I'm having this stress response and that of course this is a distortion. Let me look at it in a more measured way. That's helpful.

SPEAKER_03: 28:06

Yeah, that's helpful. Okay, when does somebody need to seek professional help?

SPEAKER_02: 28:11

Again, I think when somebody is overwhelmed and doesn't know how to manage the stressors or symptoms that are coming up for them, even if you feel like you know how to manage it, but are confused and aren't quite sure whether it's normal or whether you can make it through this, why not get some help to talk to somebody who can validate your experience and give you some extra strategies to manage it? This is the crazy thing, and I use crazy intentionally here, about the way that people think about mental health stuff. Mental health stuff is just your nervous system in distress. It's a dysregulated nervous system. There's a neurobiological, physiological event happening or structural issue happening. We will go see a physical therapist if we have a problem with our shoulder and we will tell everybody about it. And I'm doing all these exercises in public to mobilize that shoulder. But if something happens where somehow or other, you know, we're stressed or not feeling like we're managing our mental well-being very well, that becomes this point of shame and distress, and we feel like we have to manage it on our own. And we don't. Remember, we are hardwired, neurobiologically designed to be in communion with other people and engage with other people to help us regulate and understand the world. A therapist just has a deeper understanding of some of these mechanisms and some ways to manage it that can help you move through it. Could help if you need it. It's a sign of strength, not a sign of weakness.

SPEAKER_03: 29:37

Okay, Dr. Raiden, if you could leave our listeners with one or two thoughts, what would it be?

SPEAKER_02: 29:41

First, remember that your body is responding appropriately most of the time when it is confronted with a real stressor. Remember that our body does not know the difference between past or present, real threat or perceived threat. It is our job to help remind that body and slow it down because it's going to respond to familiar sensations in similar fashion as it did in the moment of a stressor. So we want to make sure that when we're thinking about stressful things, we're remembering and thinking about them and not reliving them. And that comes with attuning to your body to release the tension and control that breathing. If somebody tells you to take a deep breath, it is not the equivalent of telling you to calm down, which angers most people. It is actually telling you to engage meaningfully with your neurobiology in a way that regulates your whole system and puts your brain online to problem solve. Again, it does not solve any problems. It positions you to problem solve. And if we are doing that regularly throughout the day, we are mitigating the impact of chronic stress and positioning ourselves to survive stressful jobs, stressful experiences out in the world, and be able to again engage with that social engagement system in that meaningful way where we can stay connected to the people in our world that we want to stay connected with rather than be irritated with them or uh feel like we want to isolate.

SPEAKER_03: 31:07

Golden tips, Mitch. Golden tips. You and your team are sort of the psychologists of 7,000 employees at this healthcare system. We couldn't do it without you. And so thank you for that. And thanks for being on the show today. Thank you for having me. Always fun. Okay, folks. So feeling stress is not a failure, it's part of being human. But if you feel yourself needing some additional help, it is available to you, and I encourage you to seek that out. Thanks for listening to our show today. I hope you'll join us in two weeks' time for another episode. And in the meantime, be healthy and be well.

SPEAKER_00: 31:38

Thanks for listening to the Healthy Matters Podcast with Dr. David Hilden. To find out more about the Healthy Matters Podcast or browse the archive, visit healthy matters.org. Got a question or a comment for the show? Email us at healthymatters at hcmed.org. Or call 612-873-TALK. There's also a link in the show notes. The Healthy Matters Podcast is made possible by Hennepin Healthcare in Minneapolis, Minnesota, and engineered and produced by John Lucas at Highball. Executive producers are Jonathan Comito and Christine Hill. Please remember we can only give general medical advice during this program, and every case is unique. We urge you to consult with your physician if you have a more serious or pressing health concern. Until next time, be healthy and be well.