Are you feeling tired? Exhausted? Completely burnt out? If so, this episode is for you.
Harvard physician Dr. Aditi Nerurkar reveals the groundbreaking science behind stress management and burnout prevention. Prepare to have your understanding of resilience completely transformed as we delve into practical strategies that can rewire your brain and revolutionise your approach to work and life.
Dr. Nerurkar, a renowned expert in stress medicine and bestselling author of ""The 5 Resets"", gives invaluable insights on:
š§ The five key resets for managing stress in our hyperconnected world
šŖ The surprising truth about 'toxic resilience' and why it's holding you back
š¤ How to identify your stress 'canary in the coal mine' and what it means for your health
ā±ļø The power of micro-breaks and why they're essential for peak performance
2ļøā£ The game-changing 'resilience rule of two' for sustainable habit formation
š± Why your digital habits might be sabotaging your stress levels (and how to fix them)
Whether you're a high-achiever on the brink of burnout or simply looking to optimise your stress response, this episode provides actionable advice to help you thrive in today's demanding world.
Connect with Dr. Aditi via her Instagram, LinkedIn and Website. And grab a copy of The 5 Resets.
My new book The Health Habit is out now. You can order a copy here: https://www.amantha.com/the-health-habit/
Connect with me on the socials:
If you are looking for more tips to improve the way you work and live, I write a weekly newsletter where I share practical and simple to apply tips to improve your life. You can sign up for that at howiwork.co
Visit https://www.amantha.com/podcast for full show notes from all episodes.
Get in touch at amantha@inventium.com.au
Credits:
Host: Amantha Imber
Sound Engineer: Martin Imber
Episode Producer: Rowena Murray
Are you feeling overwhelmed, burnt out, or constantly on edge? You are not alone. In today's episode, I'm joined by doctor Aditi Naruka, a Harvard trained physician and one of the world's leading experts in stress medicine. With over two decades of experience, doctor Naruka has helped countless patients overcome burnout and revolutionize their approach to stress management. But doctor Narruka isn't just a stress expert. She has lived it, from working eighty hour weeks as a medical resident to experiencing her own stress induced healthscare. She's walked to the path from burnout to breakthrough, and today she's going to share some game changing strategies for rewiring your brain, mastering resilience, and thriving in this high pressure world. So whether you're a CEO, busy parent, or anyone feeling the weight of modern life, this episode will definitely help you feel a lot less stressed. Welcome to How I Work, a show about habits, rituals, and strategies for optimizing your day. I'm your host, Doctor Amantha Imber, as a doctor who specializes in stress, I wanted to know what our doctor adities go to daily rituals or routines for managing her own stress.
Everything that I write about in the five Reset Samantha, I live and breathe it, and I truly do walk the talk. So there are some key things that I do because of course stress affects us all. Even if you know all of the science, you still are not immune to feeling stressed, right, and so keystone stress reset would be to really prioritize sleep like the vital resource it is. So aim for a ten o'clock bedtime. That's what I do now. I don't need to set a bedtime alarm because I've been habituated to this pattern, But initially I would set a bedtime alarm of nine thirty. We have alarms to wake us up, and why not bedtime. So really making sure that you are protecting your sleep like the vital resource it is, because sleep has a great effect on your mental health, your brain, your body, your stress, and how you cope with the day. So when you are particularly having bad days, you know, like lots of hot stuff happening, you need to really focus on having good nights.
What else do you do? What are the other corner starts to your retains around managing stress.
Another thing that is key for me is some form of movement every day. So perfect example, today I had pack day meetings and really very little time to exercise, and so instead of saying, oh, I'm not going to do it, I did twenty minutes of pilates. Did it really make a den in my overall fitness for the day. No, But when you twenty minutes that I did today with twenty minutes I did yesterday, it was a very busy day for me. I couldn't fit in my usual one hour or forty five minute workout, so I did another twenty minutes. So when you think about that, I did twenty minutes yesterday, twenty minutes today. And we know the science shows that these short workouts ten twenty minutes, even five minutes can have a profound impact on your brain and your body, particularly when it comes to mental health. In fact, studies have shown that ultra short bursts of activity one to two minutes can have an influence on your mental health. Get up, lace up your sneakers, head outside if you live in a safe area, and take a small walk and then come back. So sleep and exercise would be the key things that I do. And then one of my other really important things that I really tried to double down on when I'm faced with lots of stress in life is that I create some digital boundaries for myself. So what's a digital boundary? For example, during the day, I keep my phone out of arms reach, or if I'm sitting at a cubicle working, put it in a drawer. What that does is that then I'm not incessantly checking my phone. Because when you are feeling a sense of stress, you are scanning for danger, because it's that primitive brain, you're amygdalad that is on high alert when you're feeling a sense of stress. And then what's our modern day way to scan for danger. We scroll, We look at headlines, we look at social media, We're looking at lots of the news. And scrolling is a form of self preservation. It's your primal urge to scroll. So I try to do different things like that. And we are so good with making sure that our kids have the right amount of screen time, and we're very vigilant with screen limits, right, we need to parent ourselves in many of the same ways and create limits for our own screen time because while our brains are not of course children's brains, because children's brains are developing at a rapid rate. Our brains are always changing because of neuroplasticity, which is the concept that your brain is always responding to external stimuli. And so because of that premise, I really do focus on all of these various things, which seems to help, you know, because stress isn't this like mythical, magical creature that we make it out to be. It is something that can be quantified, measured, curtailed, and overcome with these very simple habits.
I've heard you talk about breathing techniques, and I feel like I could do with a good lesson in this. As I go about my day, I'm very aware of my stress levels, and I know that exercise is great and movement is great, but I'm interested in breathing techniques, something that I can do when I'm just sitting at my desk. Can you take me through something that I can do to reduce that stress in the moment?
Ooh, what a good, juicy question, especially that feeling of really breaking out right, like, how do you You're feeling a sense of overwhelm and this feeling of doom and gloom because that's what your stress response does. It's your amygdala, it's part of your brain. It's self preservation mode, and you're thinking about your immediate survival, So how do you squash that in the moment. It's like your breath is the gateway to that moment because your breath is the only biological mechanism in your body that is under voluntary control and involuntary control, so your heartbeat can't be controlled by you, your brain waves, your digestion, so it's the only bodily process where you and I are going to do. Maybe we'll do a breathing technique together and then we can just hang out and chat and you're breathing. Your breath is so so important when it comes to stress. And then the other reason is because your brain and body, your nervous system. In your body, there are two nervous systems. There is the sympathetic nervous system, which is fight or flight, and when that sympathetic system is an overdrive, like when you're feeling stressed, that's the dominant system. Your breath is quick, shallow, rapid, it's like anxious breathing. And then the other one is the parasympathetic system rest and digest, and those two systems are mutually exclusive. They can't be on at the same time. So when you modulate your breathing through a couple of things that we're going to talk about right now, we can switch. It's like a light switch moving away from sympathetic to parasympathetic. And those two reasons, the breath being under voluntary involuntary control and this light switch of sympathetic to para sympathetic is why the breath is such an important and transformative tool when you're feeling that immense sense of doom and gloom, are overwhelmed. So there's a couple of things that we can do together. The first is stop breathe. B It's a three second brain reset, So let's do it together. You stop, you breathe, and you be ground yourself in the present moment. When you do this three second reset over and over throughout your day, it's great if you practice it over and over again. Pick one thing that you can do to practice it, you know, like whether it be joined zoom, or every time you check email, every time you get up up and move to go to another meeting, if you're working in an office, anything that you do that's a habitual, mundane part of your day that you do over and over. Another technique for seven eight breathing, that's when you inhale for account of four, hold for account of seven, and exhale for account of eight. Mind body connection, move out of sympathetic stress response and back to that parasympathetic rest and digest. And when you practice these breathing techniques, when you do a lot of these resets that you and I are talking about today, you can actively shift who's in that driver's seat, so your prefrontal cortex gets back in the driver's seat, the parasympathetic rest and digest system gets back on track, and then you can start thinking more strategically, solve complex problems, do all sorts of things. So your breathing can be a really important gateway to that whole biological process and physiological process.
I want to talk about the difference between stress and burnout because I feel like gets very confused, and I'd love to start by understanding, have you ever been close to burnout or hit that moment?
Oh, I've absolutely been burnt out before. Doctors are socialized to play small. We never talk about our own personal stuff when we are trained to be with patients, and first and foremost you think about your patients. I was asked over and over again. My patients over the years have always said, how'd you become a doctor with an expertise and stress, Like what made you choose this? And I'd say, oh, well, it's just an interest of mine. But the truth is that I went through my own stress struggle. I was a stress patient. I had debilitating stress, acutely debilitating stress. I was looking for answers, went to go see my doctor, didn't really get any answers, and so then I decided to be the doctor that I needed during that difficult time, and I put on my scientist's hat. And so that's like my villain origin story. I was working eighty hours a week and I was a medical resident in training death and dying on a daily basis. Things that no mere mortals should see, right, like really awful, terrible things that you've seen when you're in your medical training, because you have to. This is part and parcel of you becoming a doctor. I was told very early on in my medical training, pressure makes diamonds. And we went through medical training thinking like, ah, I'm a diamond in the making. We'd get to scrub in for a surgical procedure that was I don't know, seven or eight hours long. You'd be like, ooh, I'm a diamond in the making, Bring it on. And then my diamond cracked and it cracked. One day when I was a senior medical resident in charge of the cardiac ICU rounding, after a thirty hour shift rounding on my patients, and I suddenly felt a stampede of wild horses across my chest out of the blue. Didn't know what was happening, sat down. I was, of course sweating. It knocked the wind out of me. I sat down immediately. My nurse that I was working with, she brought me some orange juice and gave it to me. Could tell something wasn't right. And then within seconds the feeling passed and I kept working, which just goes to show you, right, like that idea of like diamond in the making. And then every night it never happened again, that feeling of the stampede of wild horses ever ever again.
At work.
What would happen is I would go home after a thirty hour shift or you know, twelve sixteen hour day, go home and as I was going to sleep. As my head was hitting the pillow, I would feel that stampede of wild horses. So it happened. I don't know for about two weeks until I finally said, okay, I need to go see a doctor about this, like what is going on? And then the doctor did the full work up, heart, ultrasound, EKG, blood test forr anemia and thyroid and electrolytes and everything. Everything checked out fine, and the doctor said, oh, it's probably just stress, big reassuring smile, everything's normal. It's probably just stressed. Just go home and relax. I know, medical training is really stressful for all of us, We've all been there. I was like, hmm, try to relax, Like what does that mean? So I did all of the things that you think of when you think about, Okay, I'm going to have a relaxing time. I watched movies, to dinners with friends and family, went to a spa, got a massage, took a vacation, did things that I was like, Okay, this is what the doctor means. But it didn't really work. And then that's when I put on my scientist's hat and I thought, Okay, what's going on with my brain and my body for me to feel this way and how can I find my way out? And then over time it took about three months. I kept working eighty hours a week, seeing patients all of it, and over time I started bringing in a lot of the things that I learned in the research into my everyday life. And then I found my way out of my stress struggle. And that is when I vowed to become the doctor that I needed during that really difficult time, so that I wouldn't say to my patients who are stressed, but which, by the way, sixty to eighty percent of all doctors visits have a stress related component, and only three percent of doctor's counsel for stress. And I wouldn't say to those patients like augh, just try to relax, go home and try to relax. And so this is not a personal failing or something wrong with doctors or the medical profession. And more so, it's a system. It's the system that is broken and to blame. And so that was my personal stress story. I mean, I struggled as a stressed patient. I was desperate for answers, and then I became the doctor I.
Needed with the idea of a first tell how can people that are listening to this work out what their first tell is? Because I'm listening to you, and I'm like, I wonder what mine is? How do I know for sure? How did you know that yours was irritability?
So with such certainty, often other people will tell you. Even now, my husband will often say to me, they're really cranky these days, And then I was like, oh my god, I have been cranky. It's probably Streuss, you know, like you because again you're going through life thinking, oh, I can handle it all. We as humans are really bad in terms of because of this resilience myth to know like, wait a second, I think I need to take a break because we have been taught from a very young age that lots of discomfort and tolerating that discomfort is really what resilience is all about. And that's the myth, because that's toxic resilience and not true resilience. And so you can kind of figure out what your tell is because think about a pattern. You know, when things get really out of hand, we all know, right, typically that first tell is like a whisper. It's like your canary song, but it's like just a little you know, tweet here and there, and then after a point, your canary starts belting out of tune. Think about what's happening to you on a day to day basis that you are disturbed by. So you've gone to your doctor. Let's say you're having headaches and your doctor's like, oh, ivery, thing's fine, everything's normal. I'll give an example of like a patient who was a type a high achiever, and anytime she had to present, which was often at work, she's a high powered lawyer, she would have a stomach ache and then she would present and it was pretty bad, like her abdominal pain, you know, really interfered with her everyday life. And then she would present and then immediately that day after the presentation, her abdominal pain would disappear. And so she noticed a pattern, and of course first went to her doctor. And so this patient nothing else was going on with her, and then it was stress related. Because it's the mind gut connection, that thing that is the tell your canary is kind of trying to get your attention. And then once you start bringing some of these other strategies that you and I have already talked about, that will start working its way out. But it's your canary just wants you to pay attention.
I've heard you talk about a typical burnout, and I was really intrigued by that concept. Can you share a bit about what that is, because when I heard you talk about this previously, I thought, hmmm, is that what I'm experiencing.
The who identified burnout in twenty nineteen as an occupational phenomenon. It was kind of reserved for the work setting, and it was very validating for millions of people, and they called it an official clinical syndrome. But this was pre pandem and then the pandemic happened and everything shifted, and so what happened So when you think about burnout, classic typical burnout, what that looks like, what that person looks like, apathy, disengaged, or unmotivated. We all know the face of burnout. But what happened over the past several years from the pandemic and in the post pandemic era, which we are all squarely in, is that we started to see more atypical features of burnout. In one study, sixty percent of people with burnout their feature was an inability to disconnect from work, which is fascinating because you never think of someone with burnout as an inability to disconnect from work. When you think about classic symptoms, that's the opposite. So for many people, burnout is difficult to identify in yourself and others because for many people, they're thinking, like, I can't have burnout. I'm always on, I'm always engaged, I'm always checking my email, and I'm always at work and I'm always on twenty four to seven. That could be burnout and a tip go modern day burnout. And so ask yourself, are you different now than you were, say in twenty eighteen. Now, granted, because of that global catastrophe that we all live through, the pandemic, we have all changed. But when it comes to your mental health and your work, or you know, the way you relate to others or your family life, for how you are and your relationships, are you different? Do you feel different? Based on the data, anywhere from seventy to seventy four percent up to ninety percent of people would say resoundingly yes, yes I feel burned out or yes I am stressed. And you are very much the norm and the rule rather than the exception, because that is what burnout has become. It's unprecedented what we are seeing now in terms of stress and burnout, and a lot of the reason is because your brain is built like a dam, so when you are going through periods of acute stress, you keep it together at all costs. I've seen this time and time again with my cancer patients. They're given a diagnosis of cancer, or they start seeing they're oncologists, maybe they're getting chemotherapy or radiation. They don't shed a tear when they come to see me. They are given the clean bill of health. At the end, you know, they finish their treatment, their oncologist says, you're all clear, and then they're in my office the next day bursting in tears, saying, oh my god, I should be celebrating, but I am weeping. I've been weeping uncontrollably. And I explain that it's a very normal reaction. It's called the delayed stress response. And so what happens to my cancer patients is that they keep it together and then they feel psychologically safe because the acute threat has passed and the dam breaks. All of those pent up emotions come to the surface, and it's a delusion. And my sense is that that's what we're all going through right now, because we lived through the pandemic in twenty twenty, twenty twenty one, even a little bit in twenty twenty two, right and so finally we were told, like it's over, go out and enjoy yourself. We were kind of promised the Roaring twenties after the pandemic, but no one feels like that. The damn broke for all of us, and so many people now more than ever, are feeling that sense of stress and burnout and all of those pent up emotions are really coming to the surface. So this is healthy and good even if it feels really bad. If you feel like it's really affecting your work and your life and your relationships and your day to day, it's really important to see a therapist or a counselor psychiatrist, you know, someone in the mental health community to help you work through these painful and difficult emotions. The only way around us through and once you get through this, then you can get to the Roaring twenties.
We will be back with doctor Aditi soon talking about how to understand if you're just stressed or actually burnt out. If you're looking for more tips to improve the way you work, can live I write a short weekly newsletter that contains tactics I've discovered that have helped me personally, and sign up for that at Amantha dot com. That's Amantha dot Com. I'd love to know in your own life, how do you know whether you're stressed as opposed to burnt out? Because I feel like knowing where you're at would then determine a different course of action. Breathing is always going to be good, Sleeping is always going to be good. But how do you I make a self diagnosis in terms of Okay, well, what's going on and what do I need to do?
Yeah, we're seeing unprecedented rates of stress and burnout right, it's not specific to any country. We're seeing this on a global scale. Certainly age groups are more affective than others. The younger age groups so eighteen or twenty four particularly affected, and two thirds of parents have parenting burnout. Burnout was considered an occupational phenomenon, something that happened at work, but certainly not now because we're seeing the hybrid work culture and so many changes that we've all endured over the past four to five years has really had an impact on us. What is your stress response fight or flight. Fight or flight in literal terms evolutionarily meant that when we were all cave people living in you know, tribes, people living in the forest, and in caves, you saw a tiger in the forest who either fought the tiger or you flee. Fight or flight. That is what the fight or flight response, that's what it comes from. And so when you are feeling that sense of acute stress, You're amygdala is on high alert. When you are feeling short bursts of stress. Your brain is expertly designed to handle that. Your amygdalah, you know, volume goes all the way up. The acute threat is over, and then you get back to baseline. The tiger in the forest, you either fight or you flee, and then there's like a calm. The challenge over the past few years is that we haven't come back to baseline because these metaphorical tigers like financial constraints or job challenges, marital conflicts, climate disasters, the pandemic and you know auto on it. Oh, these are not one off, short term things. They are always going on in the background, and so your stress response, because we're all hyper connected, so you are constantly feeling that sense of threat and those tigers all around you, they're circling you. They're all not just like a one and done thing. And so when you're amigdala is chronically activated in the background, it's like at a low hum for all of us. What happens is that is what leads to burnout. So if you are wondering, like, huh, do I have stress? Do I have burnout? What's the difference? I would say, right now, in this moment in time, this is not what I would have said three, four or five years ago, But right now, in this moment in time, you can use many of the same strategies for your stress and your burnout. And it kind of doesn't matter whether you have stress or burnout. You know, it's a spectrum. You can reset your stress, rewire your brain. Again, we talked about row plasticity. It's your brain. It's plastic, meaning it is always evolving, it's in flux. It's not like, oh, the brain I have at birth is the brain I got forever. No, your brain is always changing and evolving, and actual structures in your brain are growing or shrinking based on external stimuli. What you do, I would say, if you are wondering, do I have stress or burnout. Chances are you do, because just look at the data, most people do.
In terms of making change. I've heard you talk about the resilience rule of two. Can you share what that is? Because ultimately, if someone is identifying somewhere on that spectrum, they're going to need to change their behavior.
The resilience rule of two is how your brain responds to change. So change, even positive change, is a stressor on your brain. Think about New Year's resolutions. You might have like ten or fifteen things that you want to do. You might say twenty ways that I'm going to change my diet and exercise. There's high pressure moments right in our life and throughout our weeks and days and years, and so when you take on this everything but the kitchen sink approach of like I'm going to do it all how it usually happens. It maybe like a week or two, maybe three at most, you really do do all of those things, and then before you know it, you're like doing one or zero because your brain needs time to adapt. And by the way, all of these things that you're trying to bring into your life are positive. Right like when we make neuro's resolutions, these are wonderful positive things. Unfortunately, your brain because it is adapting to this newness, whatever that new thing that you're bringing into its orbit, you can only do two new things at a time. And the rule of two comes from a seminal study done many decades ago by two scientists and psychiatrists, doctor Holmes and Rehee, and they found that when they studied five thousand people and forty three of the most common things that happened to people like positive things, marriage, graduation, promotion, having a child, all of these personal achievements, and compared those along with difficult experiences grief, depth, divorce, loss of a job, health issues. They found that whether the thing that was positive or whether it was negative, it's about the life events that happened to you, and that when more life events that happened, that those people had a greater propensity for stress and illness later on in life when you're taking on too much these positive changes, when done all at once, your brain gets overloaded and can't actually follow through. So if you want something to be sustainable, do something two things at a time, Focus on those two things, and then give yourself eight weeks. It takes eight weeks to build a habit. Once those eight weeks have passed new folded in these two new changes into your life, then add two more and then keep going. So the rule of two is really how your brain makes change happen, and it's about working with your biology rather than against it.
Yeah, clearly someone that loves what you do for whack. And I don't like the term work life balance, but I kind of wonder I'm definitely predisposed to heading into atypical burnout because I can get really involved in my work and really into flow and not want to switch off right now. I have to force myself too, because a few weeks ago I definitely hit burnout. What do you do in your life to not fall into a typical burnout, which I imagine is just hard when you love your work.
I have had moments of atypical burnout. It again, because you know, the science doesn't mean that you're immune to atypical burnout. It just means that you can quickly recognize it for what it is and then find your way out. Back in the day when I didn't have this scientific knowledge, when I was like that diamond in the making before my diamond cracked, rest was a four litter word. For me, it was like, oh my goodness, rest, No, I'm going to be productive all the time, constantly, because that's just what I was taught. That is what it means to be successful. And now rest is like, I have no trouble unplugging and just chilling out. It is my favorite thing to do. And that is because it's taken me years and it was really a psychological shift that took decades. But if only someone had told me early on that your productivity in fact, will increase when you take a break. So now I know all of the science, and so when I do take brain breaks, I like relish in them, and I take brain breaks very often, particularly if you have a high pressure job, forward facing job, a lot of responsibility. All the more recent tape take more frequent brain breaks, and in fact, there's been many studies. Microsoft did a study where they compare two groups of people. One group took no breaks and just worked straight through the day. The second group took incremental ten minute breaks several times a day. And they looked at brain scans of these two groups and found that the people who took frequent short breaks throughout the day, at the end of their workday, their cumulative stress was much lower, and they said that there was greater engagement, cognition, attention, all of these things. So your brain needs a break. It's a biological necessity. It is not a luxury. And that reframe is really important, particularly for people who are always on the go. Productive reframe and say, oh no, my brain actually needs this to decompress. It's called neural consolidation. Every day we're learning new things, but your brain needs time to cement free floating information that is just information in your brain into deep knowledge. And that only happens neural consolidation. That process happens during rest, not activity or practice. New learning happens at moments of rest. There was a study that showed that even ten seconds of rest is helpful. The reason you want to honor your breaks instead of like, oh, I'm just going to mindly scroll through social media, take a walk, do some deep breathing, figure out ways that you can really actively relax and manage your stress instead of passively relaxed. Because we know that there's nothing passive about scrolling. It has a very active influence on your brain and your stress. But when you honor your breaks and really cherish them and take them very seriously. That can have a profound impact, because human productivity is not linear. For true resilience to show itself, you do need rest and recovery. You need a little bit of stress, but that healthy stress, not unhealthy stress.
Love that, and I particularly love being reminded of the importance of brain breaks. I'm looking ahead at my day today and it's looking very busy, but I'm definitely going to prioritize brain breaks thanks to this chat.
Schedule it in what you can do is particularly for people who are working in corporate settings or a really high achiever. Schedule it in the way you would schedule a meeting. I try not to schedule back to back meetings, So if a meeting ends at two, I will the next one will start at two fifteen, simply because I need a brain break to do nothing more than just like get up, stretch, practice breathing. Like I said, I walk the talk, So practice some deep breathing, do some stretching, honor that break. No mindless scrolling, but just ground yourself to some stop breatheinge, do some four to seven A breathing techniques. All of the things that we really talked about honor your break and cumulatively, these things add up. So you have to schedule it in the way you would a meeting, because it's an important check in with yourself.
Doctor Adititie, I'm so glad we could make this chat happen. I've learned so much and I'm feeling very inspired to be applying a lot of your strategies throughout my working life and certainly today. Sorry, thank you so much for your time.
It was such a pleasure to join you.
I hope you enjoyed this chat with doctor Aditi and that it's given you some tactical ideas on how to reduce stress in your own life. I have definitely started breathing more thanks to this interview. Obviously I breathe every day, but you know, breathing exercises. And if you're looking to dive deeper into doctor Aditi's work, I highly recommend the Five Resets, which is out now wherever you buy books. If you like today's show, make sure you hit follow on your podcast app to be alerted when new episodes drop. How I Work was recorded on the traditional land of the Warrangery people, part of the Kulan nation. A big thank you to my editor Rowena Murray and Martin Nimmer for doing the sound mix.