I’m Dr. Lewina Lee, Assistant Professor of Psychiatry & Clinical Research Psychologist. Ask me anything about the role of psychosocial stressors on health, the lifelong legacy of childhood adversity, how optimism boosts longevity, & health...

Hi Dr. Lee! Hope all is well!

I'm curious to learn more about how optimism affects an individual’s physical and mental health. Can you go into more detail on this? Looking forward to reading your insights. :)

Thank you for your question. In a nutshell, higher levels of optimism have been linked to lower risks of poor physical health outcomes, such as developing heart disease and dying from chronic diseases; higher optimism levels have also been linked to more favorable physical health outcomes, such as living longer and staying healthy in old age (defined as not having memory complaints, chronic disease, major physical limitations, and living beyond age 65).

Psychologically, more optimistic people tend to have better emotional well-being (that is, higher levels of positive emotions and lower levels of negative emotions), even when faced with stressful situations like a major medical diagnosis. When dealing with stressors, more optimistic people tend to think of the situation as challenging rather than threatening, and they are less likely to feel helpless or hopeless.

One caveat is that scientists can not yet definitively say optimism *causes* good health because most of the data have come from observational studies - that is, scientists compared more versus less optimistic people on their health outcomes. A rigorous scientific approach will involve, for example, using randomized clinical trials to test the causal effect of increasing optimism levels on health in the long run.

Have a family member who developed bad anxiety during Covid divorced 65 year old man. He used to be life of the party and now he is a shell. What the heck can we do? Is CBT the way to go?

I am sorry to hear that. Without knowing more about what caused his anxiety, it's a bit challenging to make suggestions. Cognitive behavioral therapy does have strong empirical evidence supporting its effectiveness in addressing anxiety, so that seems like a reasonable approach. Being present, empathetic, and supportive is always helpful. He may be aware of his own change from being the life of the party to being much more withdrawn, and be sensitive to how others may be perceiving him as well - it's wonderful that you care so much for him, and reassuring him of your support (regardless of whether he is the life of the party or not) may be helpful, too. Best wishes to you and your family member.

Hi Dr.Lee -- Have you observed people who changed their stress response drastically over time? In you opinion, how could one go about it?

Thanks.

Yes, most certainly, but this also depends on the type of stress response. For example, our behaviors to stressful situations (e.g., over-eating when feeling stressed) is something that can be modified over time. Other responses (e.g., a startle response when hearing an unexpected, loud sound) are more ingrained and automatic. Does that help?

Hi Dr. Lee - thank you for doing this AMA! I was wondering, what are healthy versus unhealthy responses to stress?

Thank you for your question! One way we can evaluate a stress response is to consider whether it is helpful in dealing with the stressor on hand and what other costs or consequences it may bring about. For example, if I deal with an upcoming deadline by working overtime several days straight, that may help me meet the deadline (i.e., resolving the stressor); however, I may get sick from not eating and sleeping well, or miss out on family or social obligations (i.e., other costs and consequences).

Another consideration is what's helpful in the short-term may not be so in the long-term. For example, some stressful situations (e.g., death of a loved one) can be emotionally overwhelming. Ignoring or setting aside these emotions at the moment may help us focus mentally to deal with the challenges on hand; however, denying or suppressing strong negative feelings is not good for us mentally nor physically in the long run.

It is generally helpful to weigh the situation from different perspectives and determine what's effective for you.

I have a teen on the spectrum who tends to fixate on things. Right now the fixation is past problems that caused stress, some big, some very small. But remembering causes stress and meltdowns, over and over again. How can we help them deal with the issue and move on, or at least recognize when the stress is coming and be able to control it?

Thanks so much!

I love that you have this wonderful insight into an unhelpful pattern and are talking about it (sometimes it can take years for people to spot this or to even acknowledge unhelpful patterns)! What you are describing sounds like rumination to me - playing the same scenario over & over in your head, perhaps sometimes thinking about the many ways that they're "wrong", and the many more ways things can still go wrong going forward - quite maddening, isn't it?

Sometimes when we are ruminating (one of my patients called it "spinning" when she caught herself doing it) - we may generate thoughts that we later realize don't make a lot of sense. Can you write down some of those thoughts and "check" them later? Over time, you may catch yourself falling into rumination again, but you may become more skillful about reminding yourself that the thoughts you have during these moments tend to be inaccurate and unproductive, and you may feel more capable of / motivated to end the rumination. Is there something that can help "yank" you out of a ruminative state? For some people, it may mean doing something very different at the moment - dunking your face in icy water, going outside for a run (or running up & down a staircase), writing a post-it note that you can look at when you fall into rumination, listening to upbeat music, or talking to a supportive person. Sending good thoughts your way!

With ACEs and trauma in general being a significant risk factor for people who use alcohol or substances - what advice would you give for those with trauma and active self-medicating behaviours? I'm aware of safety and stabilisation techniques but is there anything else that you might consider?

Thank you for bringing attention to this important issue! I think it is important for people, especially those dealing with the aftermath of traumatic events, to understand the concept of self-medicating behaviors. Self-medicating behaviors often arise because people are dealing with distress so intense that they need an "out" - getting drunk, abusing drugs, over-eating, over-exercising, self-harm, and other behaviors done in an excessive manner (e.g., excessive spending) . These behaviors are often drastic means to bring relief from the severe distress we are experiencing at the moment - because being drunk, having blacked out, or being pre-occupied with something else that is intense (physical pain, the 'high' from spending money or eating food) - helps to numb or distract us from distress. The costs of self-medicating behaviors are high, as one can imagine.

Because self-medicating behaviors are often used as a means to cope with a difficult event and/or PTSD, my suggestion is to seek treatment for dealing with the difficult event and/or PTSD. There are a number of treatments with strong scientific backing (such as cognitive processing therapy, prolonged exposure, and written exposure therapy, as well as pharmacological treatment) so I strongly encourage people dealing with this (or thinking they may be self-medicating) to consult with health professionals. Thank you for bringing to light this important phenomenon.

I’m really curious about healthy aging. I, myself, have been diagnosed with PTSD and am in a field that constantly triggers me (veterinary medicine).

Over many years of therapy I have been able to develop better coping strategies that has aided in my success. However, I do worry about the stress itself and how it affects my aging.

As an already optimist, how can leveraging my optimism more help improve aging?

Secondly, how DOES stress affect aging?

I’ve always worried my adrenal glands would give out and cause a myriad of hormonal and neurological issues in the future (I see a LOT of vet med professionals kill themselves or have to retire due to their bodies giving out).

Thank you for this question. It must be challenging but also meaningful to be in veterinary medicine with PTSD. I'm impressed that you are keenly aware of the role of stress in your health and to do something about it. There are many ways in which stress -- experiencing stressors as well as our responses to them -- can affect our aging process, and it is probably not an understatement to say that stress response engages all of our bodily systems. PTSD is a precursor to age-related health conditions (e.g., cardiovascular disease, diabetes) , is associated with accelerated biological aging, and highly comorbid with other psychiatric conditions. You mentioned being triggered often in your day-to-day work and acknowledged your career as high-risk -- do these triggering situations involve experiencing flashbacks or intrusive thoughts about your trauma? what is the impact of your job on your mood, thinking, ability to have meaningful relationships, and ability to accomplish goals that are important to you? I wonder what the cost-benefit calculus is for pursuing this line of work, and whether there are ways to have the same or similar benefits without such costs?

Researchers are just beginning to understand the behavioral pathways linking PTSD to age-related diseases. Are you taking time to allow your body to rest and recuperate from stressors - good quality sleep, physical activity, and doing activities that allow your physiological systems to take a break from being triggered (e.g., progressive muscle relaxation, diaphragmatic breathing, yoga)? Are you nourishing yourself with a healthy diet, avoiding toxic exposures (e.g., cigarette smoking), and spending time in nature? Are your needs for connection and intimacy met?

Does the idea of different stress response depending on expression of the COMT gene hold up? Does this mean that we need to approach stress in very different ways depending on the type of person we are?

There are studies showing differences in our immediate physiological response (e.g., having higher levels of the stress hormone cortisol) to stressful situations in the laboratory context. It is important to remember that genetic effects on many characteristics, including stress response, tend to be quite small; the effect is much smaller when we are just looking at 1 gene. Many other factors - genetic or otherwise - may alter our stress response and/or the effect of COMT on our stress response.

It's a great point to think about how we approach stress based on who and how we are. It is effective to understand our strengths and weaknesses, what has worked well for us and what hasn't. Dealing with stress is certainly a lifelong learning process.

Hi Dr. Lee, thanks for your time. I tend to have an optimistic outlook, but I feel lost when trying to help somebody who has a pessimistic outlook.

Do you have any advice on how to speak with and/or guide somebody that we care about?

Thank you for this question. It is wonderful that you are trying to help others. Often times, especially when people are in distress, they may not be ready to change their way of thinking. When we offer a different way to think, the implicit message is that their way of thinking is not good (even if you don't mean it and are well-intentioned) - that may come off as judgmental and create additional distress for the recipient. Know that it is already a gift by being present, available, and expressing that you understand their difficulties.

Does anxiety can create heart related issues ?

The scientific evidence is pretty robust in suggesting anxiety has a role in the development of heart disease. In studies that follow participants over time, researchers have repeated noticed that people with higher anxiety levels at the beginning of the studies were more likely to develop heart disease over time, even after accounting for how healthy the participants were at baseline.

Why is it important for you to do an IAmA?

Hi! I spend a lot of time doing research and the AMA gives me an opportunity to talk to non-researchers about findings of studies that may help us think differently about our health and well-being. In my clinical work, patients have always been curious and appreciated conversations about scientific findings, so I welcome the opportunity to engage with a wider audience through the AMA. Thank you for this question and being here!

Thanks for doing this, Dr. Lee! My question, which is very relevant for me specifically today, is: what is the best way to manage stress and grief so as to minimize its short-term risks to your health, especially heart health?

Thank you for being here and asking a question. It is great that you are taking steps to take care of your health. Stress and grief can feel like such huge burdens on our day-to-day life - often times people feel sad and unmotivated to do things that they normally do, like self-care. Some people just want to be alone even though they feel lonely. Stress can bring a host of negative emotions, like anxiety or even panic, sadness, anger. Negative emotions can affect how we see the world around us and interpret things that happen to us - for example, anxiety may cause us to feel vigilant and be on the lookout for something bad that may happen to us. Depression may make us interpret situations in a much more negative way than they really are or focus on the most negative aspects of things. Feeling stressed can also take a toll on your physiology - for example, it may keep your blood pressure higher for a longer time, which in turn takes a toll on your heart. You can see how that can trigger a downward spiral.

I appreciate that you are aware of the potential effects of stress and grief on your heart and your health - that is already a great first step. Self-care is important - it's one way to stop the downward spiral. Take time to take care of yourself - eating a healthy diet at regular intervals, not smoking, making time to exercise and being in green space, spending quality time with supportive people. If you catch yourself feeling negative emotions - if it is a reasonable response given the circumstances (e.g., grieving the recent loss of a loved one), you may choose to accept it and let it run its course without judging yourself for feeling negative, or do something to make yourself feel better. If your emotions feel too overwhelming and/or seem disproportional to the situation on hand, then it's worth seeking professional help. Sending good wishes your way.