Narrator: Coming up on Mayo Clinic Q&A,
Dr. Ben Lai: It's okay to seek help. This is stressful for
everybody. Everyone is adjusting to all of this. And it's okay to
ask for help. It's okay to feel not as well as you'd like to
feel.
Narrator: The COVID-19 pandemic has had a major effect on our
lives. Many of us are feeling challenges that can cause
stress, returning to work, the Delta variant, vaccine
hesitancy, all can be overwhelming and cause strong
emotions. Learning to cope with stress and manage anxiety can
start at the smallest level.
Dr. Ben Lai: Little by little, you kind of make these small
Dr. Halena Gazelka: Welcome, everyone to Mayo Clinic Q&A. I'm
reintegrations. And oftentimes, if we start slow, we're able to
kind of go back up again. If we give up there's zero chance for
success, right? But if we do it again, there's at least a
chance, even if it's miniscule, it's still a chance that we can
succeed and at least improve.
Dr. Halena, Gazelka. Thanks for being here today. 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 has created stress and anxiety and changes in many of
our lives. And I've had to fight my way back from a few bad
habits, and I bet you have too. 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.
Dr. Ben Lai: Thanks for having me Halena. It's great to be
here.
Dr. Halena Gazelka: Why in the world, Ben, is it's so hard to
kick bad habits when you form them?
Dr. Ben 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. You know, when we're all under stress, we all revert back
to what's comfortable, what we know that's familiar. So, let's
look what is stress? Well, stress is novelty.
Dr. Halena Gazelka: I know it when I feel it.
Dr. Ben 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, the gyms are closed, and it's a threat to ourselves,
you know. Are we going to get sick? Are we going to be safe
at work? And we have no control over the situation. And when
we're faced with this chronically, and 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 we're supposed
to social distance. We go back to what's familiar, comfort
eating, Well, some of us seek alcohol, some of us maybe spend
too much time on social media. And so, it really is kind of a
culmination, and it all boils down to, I think stress, chronic
stress.
Dr. Halena Gazelka: And Ben, I think for some individuals,
probably the varied 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 that just that probably change in
pattern as well lends itself to some bad habits.
Dr. Ben 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 a 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 and, you know, to our
families, all in the same living space. And I think oftentimes
that blurring really it can create psychological and even
mental confusion or havoc. And so, I think that really is
creating more disruptions, if anything else.
Dr. Halena 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 I could think of that were a 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 so stress eating and
eating comfort foods and then maybe not staying 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?
Dr. Ben Lai: Well, I think a lot of people spend too much time or
more than before watching TV, 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 until they feel very lethargic. So, one of the
biggest things that I hear from patients is that 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 actually
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 for more walks and
exercise. But I think by and large, the majority of patients
who 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 know 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 that many
patients struggle with, many families.
Dr. Halena 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 does someone know if they're
really suffering from significant depression that they
should talk to their clinician about? Because that sounds like
it could be depression, I imagine.
Dr. Ben Lai: Yeah. So, I mean, it all, you know, initially,
it's an adjustment. We all kind of adjusted 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,
or some patients are very open with me, they say, I really just
don't see a point. I think those are definitely red flags for me
to seek help. And it's okay to seek help. This is stressful for
everybody. And, you know, that's what I tell a lot of my
patients. We say that this is perhaps a bit of a hidden
pandemic, really, is that everyone is adjusting to all of
this. And it's okay to ask for help. It's okay to feel not as
well as you'd like to feel. So, I encourage my patients,
actually 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, you know,
we have some tools to help our patients through. And if we feel
that the patient needs a higher level of care, we certainly
would offer that.
Dr. Halena Gazelka: Oh, 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 that we'd like to tweak or
change that that has resulted from COVID? What are the steps
that someone takes when they want to kind of reverse things?
Dr. Ben Lai: Well, I think let's use weight loss as an example.
Dr. Ben Lai: You know, this is very common, perhaps even more
Dr. Halena Gazelka: Okay.
so with a COVID pandemic. Typically, you know, I might
have a patient that comes in and says, you know doc, 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 things into bite sized chunks. Go out
for a walk, even if it's a five-minute walk, that's five
minutes you didn't do the week before. So, and if you're able
to meet these small goals, it gives you more motivation to
kind of do more the following week. Sometimes it's helpful.
Oh, go ahead.
Dr. Halena Gazelka: No, go ahead, Ben. Sorry.
Dr. Ben Lai: That sometimes it's helpful to write your goals down
or to tell somebody about your goals, tell your husband, tell
your wife, tell your children. That's a commitment goal, now
you've committed yourself, and other people are there to keep
you accountable, or they might want to join you. So, you know,
your wife or your husband might say, you know what, I think I
need to go out for a walk too. And that sometimes is helpful.
Dr. Halena Gazelka: And it is easier to form a new habit if
someone else is willing to do it with you.
Dr. Ben Lai: Absolutely, and then 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 then that way it's
easy to do it. Or if you want to eat better, perhaps stocking
your fridge up in your pantry up 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.
Dr. Halena Gazelka: Right, no tortilla chips are in the
cabinet.
Dr. Ben Lai: No 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. You know, we're all humans. And I
think learning to forgive yourself, you know, we all could
revert back to our old habits. The thing is recognizing it,
picking it up and do it again. If we give up, there's zero
chance for success, right? But if we do it again, there's 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.
Dr. Halena Gazelka: I like what you said, Ben, it made me think
of in my own life routine is helpful to me, I'm kind of a
person of structure, I kind of tend to follow about 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. That's really
helpful.
Dr. Ben Lai: Yeah, routine is very important right, and I
encourage my patients to write things down. Timetable your
days, you know, set yourself a lunchtime, set yourself a time
when you go out and exercise. Going back to the example of my
patient that says, well, I don't know what to do with my family
anymore because every Sunday, we would go out for movies. Well, I
told that patient, I made the suggestion, why don't we pencil
in a family night, we make it 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 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.
Dr. Halena Gazelka: It is, and I could see that being very
valuable to those who work at home, too. You mentioned making
sure that they have a schedule for the day. Well, it's easy to
miss lunch when you're just keeping going on zoom meeting
after zoom meeting after zoom meeting, or I'm just going to
finish this document because I'm at home, and I can run grab
something anytime. So, I think that those are really good
points.
Dr. Ben 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's a
lot of kind of pent up anxiety and stress, and irritability,
and anger, even, you know, 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, you
know, so when we're stressed, you know, all our stress
hormones are elevated, and it raises our heart rate, it
increases our blood sugars. Well, sometimes it's helpful to
rechannel that energy and actually doing something more
meaningful and more active. So, I encourage my patients, well,
you know, instead of ruminating, let's write that down, let's try
to plan ahead, you know, use that energy. And that way we
make it into something that's constructive. And I think that
is helpful for many of my patients. And again, just
writing it down, developing that routine has been helpful for
some.
Dr. Halena Gazelka: That's really interesting. Ben, it
triggered in me that 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. And probably making lists and
writing them down is a good way.
Dr. Ben Lai: Yeah. Yeah. That's a great point.
Dr. Halena Gazelka: That's great. You know, we were talking
now, Ben, we're 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, re-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, even if it
might be safe to go. What ways can we encourage individuals who
need to re-engage, but are having trouble doing so to do
that?
Dr. Ben Lai: Yeah, that's a great point. You know, the
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, home schooling, 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's 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 and 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 just am
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 10-minute walk
outdoors every day. And I think part of that is to create a
routine, so that you feel comfortable, and you feel safe,
at least exercising and going outdoors again. And you know,
one thing that I always ask people to do, 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, then
you're more likely to kind of break it again, that third day,
and that fourth day, and so forth. And once you feel
comfortable doing that exercise for 10 minutes, maybe you can
expand that to 15 minutes, or 20 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 kind of make these small re-integrations.
Similarly, people who are concerned about gatherings, you
know, I would often encourage, why don't we send them an email,
send your friends or your family email, maybe give them a call,
do a zoom meeting, you know, 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 kind of go back up
again. Certainly, you know, letting them know that there's
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.
Dr. Halena Gazelka: And I do think that one of the silver
linings, I'm always looking for silver linings of COVID, is that
it's okay 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 of the state 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, it's socially
acceptable now to wear a mask.
Dr. Ben Lai: It is, it is, and I say, excuse me, and I say go for
it, you know, if you feel comfortable wearing a mask, and
you should. And so, we often think about, you know, when
people are stressed out, we often think about trying to just
tell yourself that it's okay. You know, if we're around people
who are stressed, we become stressed. So, sometimes it's
helpful to be the one that breaks that cycle, right? 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 come out feeling like there's butterflies in my stomach, you
know, and I think it's important to start, you know, developing
these positive habits and a positive way of thinking so that
we can, people we can surround, we can spread this positive
energy and this positive outlook to others in our family.
Dr. Halena Gazelka: We can usually find something to be
grateful for, can't we Ben?
Dr. Ben Lai: Absolutely. So, that's a great point too Halena,
you know, positive reframing. You know, we want to make sure,
you know, even though this has been a tremendous change for all
of us, really, there are things that we perhaps can still be
grateful for. And so, oftentimes we think, you know, 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.
Dr. Halena Gazelka: I love that, Ben. I think gratitude is a
great habit to develop.
Dr. Ben Lai: I agree. And I do it every day, so.
Dr. Halena Gazelka: That's wonderful. Thanks for being here
today, Ben.
Dr. Ben Lai: Thanks for having me.
Dr. Halena Gazelka: Our thanks to family practice physician,
Dr. Ben Lai, for being here today to talk to us about
habits, some of them bad during COVID, but how we can develop
some new better ones. I learned a couple of things today. I hope
that you did too. I think thinking about making lists,
being accountable, and fitting things into your routine is
really important. We wish you the best with that. We wish
everyone a wonderful day.
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