– Mayo Clinic Q&A –
Welcome, everyone. I'm Dr. Halena M. Gazelka. I don't know about you, but covid has been tough for sticking to good habits and not developing bad habits. This last year and a half have created stress and anxiety and changes in many of our lives. I've had to fight my way back from a few bad habits. And I bet you have to.
I have a family practice physician from Mayo Clinic, Dr. Ben Lai, here to discuss this with us today. Ben and I are friends and work together on multiple committees here at Mayo, and I knew he would be just the person to talk with us today. Thanks for being here, Ben.
Doctor Benjamin Lai: Thanks for having me, Halena. It's great to be here.
Doctor Halena M. Gazelka: Why, in the world of business, is it so hard to kick bad habits when you form them?
WHY AM I FEELING SO STRESSED LATELY?
Doctor Benjamin Lai: Yeah. So, you know, I think covid-19 has presented with just a slew of changes. And I think this all boils down to stress. When we're all under stress, we all revert back to what's comfortable, what’s familiar. So let's look at what stress is. Well, stress’s novelty.
Doctor Halena M. Gazelka: I know it when I feel ready.
Doctor Benjamin Lai: Yes. Unpredictability, a threat to yourself or your ego, and a sense of loss of control. Well, with covid-19, that's the perfect setup. This is new. None of us have ever experienced something like this before. We don't know when it's going to end. You know, many of us are faced with furloughs, changes in our routine. We're working from home now, and gyms are closed. It's a threat to ourselves.
Are we going to get sick? Are we going to be safe at work? And we have no control over the situation. And we're faced with this chronically, especially with covid because some of our traditional coping mechanisms are no longer there. We can't go to the gym anymore to exercise. We can't go visit a friend anymore because of social distancing. We go back to what's familiar, like comfort eating. Some of us seek alcohol. Some of us might spend too much time on social media. And so it really is kind of a culmination that all boils down to chronic stress.
Doctor Halena M. Gazelka: And Ben, I think for some individuals, probably the very change in how they work, so you and I still go to an office, to the clinic and see patients in the clinic. But many of our colleagues are actually working from home now. And I think just that change in pattern as well lends itself to some bad habits.
Doctor Benjamin Lai: Yeah, I agree with you completely. I think it's that blurring between what's personal and what's work. I think it's the lack of routine or the change in routine. You know, many of us just get up and then we go to our desk and we start working, and then we go back to our families all in the same living space. And I think oftentimes that blurring really can create psychological and even mental confusion or havoc. So I think that really is creating more disruptions if anything else.
COVID-19 BAD HABITS
Doctor Halena M. Gazelka: Ben, before you and I were going to do this podcast today, I was trying to think up a list of bad habits that were potential during covid either that I've had, others have had, or that I could think of being a possibility. One is being at home and stress eating or eating comfort foods and then maybe not staying in your exercise routine like you mentioned because the gyms weren't always open. Now, some of them are opening in some areas.
Alcohol, drinking more because it's an anxiolytic, I guess, and because we're home more so a lot. But there are many, many things. And what else do patients talk to you about?
Doctor Benjamin Lai: Well, I think a lot of people spend too much time, or more time than before, watching TV or tuning into the news. Social media is a big one. Many just lose the motivation to do their normal tasks. So they just end up sitting and not doing very much. They worry. They watch the news. It's very concerning. And there are multiple issues going on in the news that can consume their energy. And so they feel very lethargic.
One of the biggest things that I hear from patients is, “I just don't have the motivation to do anything anymore.” And, you know, alternatively, there is a small group of patients actually who actually are taking charge and doing more things. I have some patients who have lost a lot of weight because they're no longer eating out. They're not working as many hours, so they're taking the opportunity to go out for more walks and exercise.
But I think, by and large, the majority of patients seem to have lost that motivation to want to do things. They no longer go on vacation. They can't. And so there is nothing really to look forward to. I remember one patient telling me, “Well, we used to go out for movies every weekend. We can't do that anymore. So what do I do with my family?” So I think that is the biggest issue.
AM I SUFFERING FROM DEPRESSION/ANXIETY BECAUSE OF COVID?
Doctor Halena M. Gazelka: Ben, how do you know when someone is facing a lack of motivation or difficulty engaging, maybe even socially, because of stress? Or how do you know if they're really suffering from significant depression that they should talk to their clinician about? Because that sounds like this could be depression, I imagine.
Doctor Benjamin Lai: Yeah, so, you know, initially it's an adjustment. We all kind of adjust to this new way of living. However, if it's prolonged, if it starts to get in the way of them doing their daily routines and their tasks, some patients are very open with me and say I really just don't see a point. I think those are definitely red flags for me to seek help. And it's OK to seek help. This is stressful for everybody. And that's what I tell a lot of my patients.
We say that this is perhaps a bit of a hidden pandemic, really, with everyone adjusting to all of this. It's OK to ask for help. It's OK to feel, even if it’s not as well as you'd like to feel. I encourage my patients that every time they feel something that's different to come and talk to me. It doesn't hurt to talk about it. And if we deem that this is an adjustment issue, we have plenty of tools to help our patients through. And if we feel that the patient needs a higher level of care, we certainly would offer that.
Doctor Halena M. Gazelka: Well, that's great to know. So, Ben, just thinking back to taking an example of a habit, maybe we can each identify one habit that we'd like to tweak or change that has resulted from covid. What are the steps that someone takes when they want to kind of reverse things?
IMPORTANT STEPS TO BREAK YOUR BAD COVID HABITS
- BABY STEPS
Doctor Benjamin Lai: Well, I think let's use weight loss as an example. You know, this is very common, perhaps even more so with the covid pandemic. Typically, I might have a patient that comes in and says, “I'm 50 pounds overweight, I need to lose this, right?”
Well, 50 pounds is a huge challenge. It's a big mountain to climb. I think one thing is for us to break the bite-size chunks. Going for a walk, even if it's a five-minute walk, that's five minutes you didn't do the week before. And if you're able to meet these small goals, it gives you more motivation to kind of do more of the following week. Sometimes it's helpful.
- COMMITMENT & ACCOUNTABILITY
Sometimes it's also helpful to write your goals down or to tell somebody about your goals. Tell your husband, tell your wife, tell your children – that's now a commitment, a goal that you've committed yourself to, and other people are there to keep you accountable, or they might want to join you. So, your husband or wife might say, “You know what, I think I need to go out for a walk, too.” And that sometimes is helpful...
Doctor Halena M. Gazelka: ...and it is easier to form a new habit if someone else is willing to do it with you.
- ENVIRONMENT MATTERS
Doctor Benjamin Lai: Absolutely, and to keep each other accountable. I think setting your environment up so that it's easier to do these things is helpful. For example, you want to set your shoes up in front of your door, and that way it's easy to do it. Or, if you want to eat better, stock your fridge up in your pantry with healthier options rather than some of the unhealthy options. That way, if you're tempted to snack, well, you have to snack on the healthy stuff.
Doctor Halena M. Gazelka: Tortilla chips are in the cattle.
- BE PATIENT WITH YOURSELF
Doctor Benjamin Lai: Tortilla chips, but plenty of vegetables and fruits and things like that. And I think one thing is, you know, none of us are machines. We're all humans. And I think learning to forgive yourself is important. We all could revert back to our old habits.
The thing is, recognizing it, picking it back up, and doing it again. If we give up, there is zero chance for success. Right? But if we do it again, there is at least a chance, even if it's minuscule, it's still a chance that we can succeed and at least improve. So those are kind of the main things.
- ROUTINE HELPS
Doctor Halena M. Gazelka: I like what you said, Ben, it made me think of my own life routine, which is helpful to me. I'm kind of a person of structure. I tend to follow the same schedule every day so that I know that I'm going to get up, and I'm going to work out, and I'm going to fit that in my day somehow. Sometimes I'll even jot notes to remember to go walk up the 20 flights of stairs in this building during the break, during the day, or something like that.
I like goals to set and I like routine. So I think that your techniques for fitting it into your day and making sure that it gets done are really helpful.
- CREATING A SCHEDULE HELPS
Doctor Benjamin Lai: Yeah. Routine is very important, and I encourage my patients to write things down. Timetable your days – set yourself a lunchtime, set a time when you go out and exercise, etc.
Going back to the example of my patient who says, “Well, I don't know what to do with my family anymore because every Sunday we would go out for movies.” I made the suggestion, why don't we pencil in a family night? We may get something special. We put on a really nice movie, but then we maybe make a meal together as a family with the kids. And that way, even if you can't go out and do what you previously did, you can still make it a special occasion that way, creating a routine and then having something to look forward to is important.
Doctor Halena M. Gazelka: It is. I can see that being very valuable to those who work at home, too, and making sure that they have a schedule for the day. It's easy to miss lunch when you just keep going to meeting after meeting, or think, “I'm just going to finish this document because I'm at home, and I can run and grab something any time.” So I think that those are really good points.
- WRITE IT DOWN
Doctor Benjamin Lai: You know, Halena, one thing that I have identified is that many of us during this time ruminate. You know, we all think about, boy, you know, what am I going to do? Am I going to lose my job? What are my kids going to do? And so there is a lot of pent-up anxiety and stress and irritability and anger even, and that's part of the stress response.
Going back to stress, you know, we all have developed a stress response as mammals to run away from our danger. So when we're stressed, all our stress hormones are elevated, raising our heart rate and increasing our blood sugars.
Well, sometimes it's helpful to channel that energy and do something more meaningful and active. I encourage my patients: instead of ruminating, let's write that down. Let's try to plan ahead, use that energy. That way, we make it into something that's constructive. And I think that is helpful for many of my patients. Just writing it down, developing that routine has been helpful for some.
Doctor Halena M. Gazelka: That's really interesting. Someone had once told me that anxiety is trying to control things that you don't have control over. And sometimes you have to find a way to control what you can, but give up those things that you can't by probably making lists and writing them down in a good way.
Doctor Benjamin Lai: Yeah, yeah. That's a great point. That's great.
Doctor Halena M. Gazelka: You know, we're talking now past the Fourth of July when we had such big, lofty goals for getting the United States immunized. And many people have been vaccinated against covid and feel that maybe they should be re-engaging their families, be engaging. People are starting to have weddings again. They're starting to have events.
But there may be those who have sort of a reluctance to re-engage just because it's become a habit almost not to. It's easier sometimes to stay home on Friday night than to decide that you're going to go out, even if it might be safe to go. In what ways can we encourage individuals who need to re-engage but are having trouble doing so?
- RE-ENGAGE
Doctor Benjamin Lai: That's a great point. You know, re-engagement is another big change, right? For many of us, we've gotten so used to this. We've developed these routines now working from home and homeschooling and learning not to leave our house and working out at home. And all of a sudden, we're bombarded with these changes.
And there is also so much uncertainty, especially with the Delta variant. You know, there are pockets in the country where Covid is really surging again. So that creates a lot of anxiety, stress, and unpredictability in patients. So one thing that I encourage people to do again is to take things small bits at a time.
One of my patients, for example, who I saw recently, said, “I am just not fully comfortable going back to my gym.” And I said, “Well, this is summer. This is the perfect time to walk outside, enjoy the outdoors. Let's try just doing a ten-minute walk outdoors every day.” And I think part of that is creating a routine so that you feel comfortable and safe, at least exercising and going outdoors again.
And, you know, one thing that I always ask people to remember is that this has to be a continual daily process. Give yourself no more than one day's break, because if you break two days in a row, you're more likely to break it again that third day and that fourth day, and so forth.
And once you feel comfortable doing that exercise for ten minutes, maybe you can expand that to fifteen minutes or twenty minutes. And then maybe you can call up one of your friends who you used to go to the gym with and see if you could go together. And again, just little by little, you make this small reintegration.
Similarly, for the people who are concerned about gatherings, I would often say, “Why don't we send them an email, your friends or your family, or maybe give them a call, do a zoom meeting? If you feel comfortable, maybe just start gathering in small groups, just one or two outdoors.” And oftentimes if we start slow, we're able to go back up again.
Certainly, you know, letting them know that there is still the possibility of getting sick. And, you know, if anyone develops any symptoms, they need to seek the appropriate health care and contact their health care providers.
- SOCIALIZE TO YOUR COMFORT LEVEL
Doctor Halena M. Gazelka: And I do think that one of the silver linings – I'm always looking for silver linings of covid – is that it's OK for people to say, ‘I'm going to wear a mask or maybe we could wear masks, even if that's not the recommendations of the states or the area that you're in.” If there's concern about, you know, children who aren't vaccinated or others who, you know, maybe aren't vaccinated, that's socially acceptable.
Doctor Benjamin Lai: It is. And I say go for it. You know, if you feel comfortable wearing a mask, you should. And so, when people are stressed out, we often think about trying to just tell ourselves that it's OK. If we're around people who are stressed, we become stressed. So sometimes it's helpful to be the one that breaks that cycle.
It's that phenomenon called stress resonance. If I'm in a very stressful meeting, even if I go into the meeting in a good mood, I'd come out feeling like there are butterflies in my stomach, and I think it's important to start developing these positive habits and positive ways of thinking so that we can spread this positive energy and this positive outlook to others or in our family.
Doctor Halena M. Gazelka: We can usually find something to be grateful for, can't we?
- EMBRACE YOUR BLESSINGS AND BE GRATEFUL
Doctor Benjamin Lai: Absolutely. That's a great point, Halena, positive reframing. We want to make sure, even though this has been a tremendous change for all of us, really, there are things that we can still be grateful for.
And so oftentimes we think, at the end of the day, what am I grateful for today? Maybe it's going to work. Maybe it's with your family. Maybe it's just beautiful weather. And I think sometimes, in the midst of all the bad news and all the catastrophic news that we hear on TV, it's important to remind ourselves that there are still things that we can be grateful for.
Watch the interview here.
