November Town Hall: Brain on Overdrive

Thank you everyone for coming to our November edition of NVFP’s town hall. We are excited to have you and excited to introduce our latest addition to NVFP, Dr. Sara Tar. Dr. Tar has been a fabulous addition. She’s in our DC office, and we are thrilled to have her as part of the NVFP team. She has so much to offer us and brings a wealth of experience in medicine. We couldn’t be more delighted to have her. Dr. Tar has over 20 years of experience. She comes from the University of Arkansas, where she was the assistant dean of student affairs for the medical students. She did a lot of teaching with the students and residents and has many skills both in medicine and outside, including speaking multiple languages such as Spanish, Hindi, and Urdu, and her English is very good as well. From what I understand, she is also an extremely accomplished Zumba dancer, showcasing a wide array of talents. We can’t wait to hear what she has to say today. This is an extremely timely talk about stress and how to reduce it. During the holidays, who couldn’t use that? It’s the brain on overdrive: understanding and managing everyday stress. Just one quick comment before we get started: if you haven’t gotten your flu or COVID shots, please do so. We are happy to oblige with that if we have them, though we did run out in the Arlington office of the high-dose flu, but you can always get those at your pharmacy as well. Dr. Sara, thank you so much, and take it away.

Thank you so much, Dr. ZG. Welcome to our town hall NVFP family. It is so good to have you all here. Thank you for joining us on a rainy Tuesday evening. I hope you all are well. I’m really excited to have the opportunity to share with you some of my thoughts and ideas around managing stress. If you will bear with me, I’m going to share my PowerPoint real quick, and we will go from there. Just one other thing as she’s setting this up: if anybody has any questions, please feel free to put them in the chat, and as usual, we will get to them after she finishes her talk, and we’ll try to get to all the questions that we can. Wonderful. Can you all see this? Okay, wonderful. Thank you. As I said, I’m really excited to talk about this topic, and it’s a topic that’s touched me this year in a very surprising way. As Dr. Zag very accurately mentioned, I absolutely love Zumba. This is me and my Zumba group at OneLife Tyson’s on Halloween this year. No one can tell, but because you can’t see my gold belt, I was dressed as the genie from Aladdin. Every Thursday and Sunday, we get together and dance, get our heart rates up, have a really good time, and reduce some stress. I include this picture because I really can’t, you know, I got to walk the walk when I also talk the talk. I think that’s really important. I’m going to take a minute and be a little bit vulnerable here and share something about myself that affected me pretty profoundly. It was something that happened this year, and I think it is something that all of us in the DMV will never forget. Everyone remembers this really tragic event. I had just come home from Zumba, took a shower, sat down, had my dinner. It was about 9:00 p.m., and I remember sitting on the sofa, and we got this little notice at the bottom of the TV that said potential accident near DCA. Fortunately, thank God, I didn’t have any family or friends flying that day, so there wasn’t that level of concern, but it was really scary. We’re always concerned whenever something like this happens, whenever our fellow Americans get into a plane crash or lose their lives. As you remember, 67 people lost their lives that day. I remember sitting there on the sofa, and I was kind of sweaty. I was breathing a little fast, and I realized I was like, I think I’m really anxious right now. I remember texting my sister and saying, “I might be having some anxious feelings here.” My sister texted back and said, “Yeah, me too.” She lives in Arlington. What I realized as I took the next couple of days to process how I had felt, and it lasted about 20 minutes or so, was that my stress bucket, if you will, was full. It was overflowing, and this event kind of put it over the edge. The questions that I’m going to posit today for discussion are three: What’s unusual about stress this year in 2025? What does stress do to us in the short term? What are the consequences of chronic stress? I’m going to share some quick and easy ways in which we can counter this stress to empty our bucket. I’m going to invite you to join me in a stress-reducing exercise if you wish.

We’re not going to talk about orthopedics today, but this is what an ankle sprain looks like. This is not my daughter’s foot, but it could have been last year. She called me in the morning after getting home late in her apartment in DC. She had rushed off the metro, twisted her ankle, went home. She couldn’t sleep most of the night due to the discomfort. She couldn’t walk that morning without wincing. It looked kind of like this. It was probably more swollen. It was purple. What do I do when my daughter calls me? I immediately stop what I’m doing. I pivot. I change my plans for the day. I call orthopedics urgently, and we go now. They get her in a boot. She’s better in a couple of weeks. This is what stress looks like. This is a little meme: “I’m smiling because crying won’t change anything.” This is what stress can look like. This is what anxiety can look like. I’m not going to be talking today about generalized anxiety disorder, which requires the care of a physician and is beyond the scope of this talk, but everyday stress, what do we do? We often just hide it. We go along our day and smile and do our work and do what we’re supposed to do. This gentleman could also have been in pain like my daughter. This gentleman might not have slept most of the night either, but his pain doesn’t get addressed because we can’t see it. I juxtapose these two stories to illustrate how often we underestimate and undervalue the weight of mental pain and stress. I’m going to just ask you to keep that in your brain.

Stress in America 2025, it’s actually a thing. It hits differently in 2025. What is that about? We know from the literature, and there are a lot of articles being written about stress this year. There’s technological anxiety. We’ve kind of always had that for the past, you know, maybe 5-10 years, but there has been a rapid spread of information and misinformation, and that is likely reaching a certain level or threshold. We have an always-on culture. Many of us work in environments where we must be constantly connected to work emails and social media. Boundaries are getting blurred. Post-pandemic, a lot of people started working from home, which was lovely for a lot of people, and the boundaries got blurred. We have job instability. It’s a source of major stress for many of us, particularly in the DMV area, with a growing number of workers worried about their futures. We have economic instability. We have something called digital comparison, which probably affects my kids more than me, where social media platforms create this comparison trap where you can put all these filters, and as you’re growing and as the brain is developing, you really don’t have that understanding, and you start to feel, you know, get inferiority complexes and get concerned, and we see all sorts of psychological stress related to that. Global events and political turmoil, there is no shortage of that. Then we have something people are calling the loneliness epidemic. These new and amplified stressors are on top of the relationship stressors. We may have financial stressors, discrimination that some people might face. Those things have always existed and continue to exist. I’m interested in this loneliness epidemic, and I think I first heard it several years ago by our former surgeon general, Vivek Murthy, who in 2023, as US surgeon general, released an advisory booklet on the healing effects of social connection and community. In this book, he talks about the loneliness epidemic, which has been probably compounded by a combination of social media. We use that for lots of communication, plus the pandemic, and we’ve sort of generally become more isolated and not reaching out for human connection. What he talks about in his book is that loneliness itself is linked to serious negative health outcomes, higher risk of heart disease, significant risk of stroke, dementia, premature death. I want to underscore this concept, and I also recognize that all of you coming together here is also community. It’s also a place of connection and hopefully the start of healing and conversations.

Let’s talk a little bit about acute versus chronic stress. We all know, we’ve seen this picture. This is what acute stress looks like. You encounter a bear in the forest, and hopefully this has not happened to any of us. But the way our body responds when we see this bear, if we come across it, is that fight or flight response that we all talk about. There’s actually fight, flight, or freeze now. Basically, it’s mother nature’s way of protecting us when we feel under threat or when we’re challenged or even when there’s some crazy opportunity, we might feel this inside our body. It has always been meant to be a survival mechanism. This process, this mechanism, did not select to kill us. This mechanism was selected in us to really help us. What does that mechanism look like? This you might be able to relate to more, right? When you’re driving and all of a sudden you come across somebody on the crosswalk and you slam your brakes on because you don’t want to hit them, right? That same thing. It’s that fight-or-flight hormones that are released. What happens in the body? It causes these fight-or-flight hormones to cause an increase in our heart rate. Our heart muscle contracts stronger in order to deliver more blood to the body in order to prepare us for flight or fight or to slam on those brakes. It happens in a millisecond almost. What else happens? Our pupils dilate so that we can see better and we get a wider frame. Other changes that happen in our body, and you all can probably attest to this, we get our muscles tense up. We might sweat, and our blood flow is redirected away from the non-essential parts that are needed in that moment, like digestion, and go to the major muscle groups in preparation for us to move fast or strongly. All of these mechanisms are adaptive, and they’re not meant to last more than a few hours.

So now let’s talk about chronic stress. What happens there? That’s the acute stress response. It’s helpful. It’s an evolutionary benefit. It helps us. It’s meant to protect us. What about chronic stress? Chronic stress is that consistent sense of feeling pressured and overwhelmed over a long period of time. Unlike the acute stress of the bear or almost hitting a pedestrian, chronic stress has no adaptive benefit. It doesn’t really help us at all. On the contrary, it can cause an increase in heart rate. It can elevate our blood pressure. The consistent and ongoing increase in our heart rate and blood pressure can take a toll on the body long term, resulting in increased risk of hypertension, increased risk of stroke, increased risk of heart disease, blood clots. The chronic effects of stress really have a detrimental effect on the heart. Other consequences include headaches. If you remember, we talked about blood flow and muscle tension in preparation. Well, chronic muscle tension, we all know what that feels like. It’s not good. We get chronic muscle tension, particularly in the upper torso and the shoulders and the neck and the head. We get migraines. Stress can cause hair loss. It can make our hair follicles enter into the resting phase in which they don’t produce any new hair, and the old strands just shed easily, and we don’t have new hair. So we can get stress alopecia or hair loss. Chronically, the hormones that are released in stress can get people more sick often because they can suppress the immune system’s ability to fight infection. That’s kind of what’s happening in the body with chronic stress.

I’m going to switch and take a turn in my talk and share with you how I think about stress. It’s the stress bucket model. It’s pretty straightforward. Stressors fill the bucket. Each of our buckets is different. Some might be made of steel. Some might be a little more, you know, rubber or plastic. We have all of our vulnerabilities. Our own mental health affects the bucket’s capacity. Our physical health affects the bucket’s capacity. Our financial health affects the bucket’s capacity. Then what happens is the stress builds up, and then we got to release it. We’ve got to open the faucet and release some of that stress. We do that in two ways. One is with maladaptive coping skills. What am I talking about here? When we bury our stress and don’t talk about it. When we engage in substance abuse, overeating, aggression. It’s interesting to me how we’re seeing so much aggression out there, like people fighting on planes. It is one of the things that comes to mind, and it makes me wonder about this stress bucket model. Are we seeing all this aggression because everyone is so chronically stressed that it’s just overflowing in bad ways? Adaptive coping skills will help release that stress from the bucket, if you will. I’m going to talk about three areas. I’m going to share with you three concepts that might serve as a framework as we think about managing stress. I’ll talk about each of these three for just a little bit, and then I’m going to share four things that you can try to help reduce your stress. I bet some of you are already doing some of those things. So we’ll see.
Let’s talk about self-control. When I’m thinking about self-control, I’m really thinking about what’s out of my control and what’s in my control. When you see these little two palm trees connecting this hammock, that’s an invitation for you and me to pause and allow you to reflect a little bit. This schematic has helped me when I’m acutely in the moment of stress, when I identify that my heart rate’s a little up, my head’s a little hot. I have trained myself to think, okay, Sara, what’s in my control and what’s out of my control? What’s out of my control? The past, the future, social media algorithms, the media, other people’s behavior and beliefs about me or anything else. What’s in my control? My self-talk, my words, who I follow on social media, my own self-care and my boundaries, what I consume, what I put in my body, my attitude, and how much I’m going to work on myself. I’m going to pause for a few seconds here and just invite you to think about this scheme and see how you are thinking about what’s in your control. I’m just going to give you all a second. I’m not going to invite you to share, but do think about that for yourself. I’m going to talk about self-talk in a second because I think that’s really important, and it’s on top for a reason. When I say self-control, I’m just thinking about what’s in my control and what’s out of my control. When I do that, it kind of helps ground me and reminds me because we tend to think that we have more control over many things than we do. Really focusing on where we can direct our energy I think can be really helpful.

Self-regulation. Dr. Nawal Mustapa, this is her work here. She’s a neuropsychologist out of the UK, and I really like her approach because she focuses on practical compassionate care that’s very much rooted in scientific knowledge. Self-regulation is the ability to manage your emotions, your thoughts, and your behaviors in order to achieve a particular outcome. That includes things like resisting the impulse to yell at somebody or use bad language at somebody, calming myself down when I’m upset, adjusting to change, and that’s a big one because it feels like the world is changing almost every week, and then handling frustration so that I can maintain my inner balance. Techniques like mindfulness, which is really being aware of our emotions in real time and reframing situations once we’re calmer, can really help with self-regulation. Ms. Mustapa talks about when I’m feeling angry, I pause so I can think clearly and respond instead of reacting. When I’m overwhelmed, I write and prioritize, make lists. When I’m insecure, I’m going to work on appreciating and accepting myself. When I’m feeling rejected, I’m going to acknowledge that this feeling is no fun, but I’m not going to let it consume me because rejection is redirection. The one that I wanted to highlight today in relation to this talk is when I’m feeling discouraged, I will be kind to myself and remind myself of the reason why I’m trying, and I will use that as my strength. I’ve actually printed that the discouraged one out on my fridge and given it to both of my children because I think it’s an important reminder.

Would you mind explaining it a little bit more? I apologize if this is obvious, but it’s not to me. When you say rejection is redirection. Oh, yeah, sure. Sometimes we work really hard on a project, and we put the work in, and we think it’s fantastic, and we present it. I might present it to my boss, to my dean, and I thought it was a fantastic idea. So this obviously is rooted in a real-life story that I’m sharing here. I thought it was a fantastic idea, and I spent a couple of weeks putting it together, and I’m very proud of it. It’s very well put together. It’s a beautiful PowerPoint, and I get it to my dean, and she looks at it and says, “I don’t think this is very helpful.” What is anybody’s original reaction to that? It’s I’m totally dejected. I feel very rejected because I invested myself in this project or this class or this grade or whatever. Rejection at that point feels really deflating. But in the long run or even in the short run, it can actually just mean you just need to redirect your energy into someplace else. That’s what I did. I adjusted my project, redirected it. It was not where my boss wanted it to be, and it got accepted later on. It took a long time, and it took a lot of input. When I say rejection is redirection, initially something might feel really horribly deflating, but in actuality, it might be creating another path for you in a different way. Thank you for that.

Let’s talk about self-talk because this is something that I kind of, I will be honest, I kind of was like, okay, I don’t think that’s real, like what is self-talk until I actually started learning about it and doing the research, and then I started practicing it. What is self-talk? Self-talk is a constant running monologue in our minds, all of us, where we process daily experiences. It is a natural cognitive process. It’s a thinking process used to think through our ideas, our thoughts, process our thoughts, making decisions, and solve problems. I’ve got my palm trees up here. I’m going to ask you to reflect for a minute as I share with you what does your self-talk sound like? Is it positive? Is it neutral mostly? Or is it mostly negative? The positive self-talk is encouraging, kind, supportive, kind of like you’re talking to a friend. Positive self-talk can help build your confidence, help manage stress, which is why I’m mentioning it today, improve your persistence. Negative self-talk is critical, pessimistic, self-defeating, where oftentimes you find yourself talking to yourself more about your failures than your wins. Negative self-talk can be really harmful, leading one to inaction. What we call paralysis by analysis, where you kind of analyze and your analysis even is negative, and it leads you to inaction. It can also lead to low self-esteem. If you study Olympic athletes in sports, athletes are trained to use positive self-talk to cue the body to act in certain ways, particular ways. It’s fascinating. They use self-talk to cue the body, to cue their attentional focus, to motivate them in that highly stressful moment. They’re training four years for four minutes. It helps reinforce their self-confidence or self-efficacy. It helps facilitate the creation of what coaches train Olympic athletes to create, which is called an ideal performance state. The ideal performance state is not just the physical, but it’s also the mental and psychological and emotional. Positive self-talk is something that every Olympic athlete really engages in and trains in, i.e., Simone Biles. That’s self-talk. I’m going to invite you to think about that and think about what your self-talk is like and where you might do it differently or experiment with your self-talk or redirect your self-talk.

The third is self-compassion. Kristen Neff is a PhD researcher, a therapist, and one of the leaders globally in the area of self-compassion. She teaches at UT Austin, and she and Chris Germer at Harvard worked together to start the first center for self-compassion, and she’s brilliant. She’s written many books, and I’ve taken her course. What she talks about is that there are three doorways into self-compassion. When you notice you’re in emotional pain or stress, and if you want to approach your mental health from a space not of self-criticism, not of negative self-talk, but of self-compassion, there are three doorways in. One, you hold your thoughts and emotion in mindful awareness. What does that mean? It means I’ll give you an example. I just realized that there was a plane crash at DCA. I’m really stressed right now. I can feel like I’m a little jittery. I’m a little sweaty. I’m kind of stressed. I’m just holding that for a minute and recognizing it. That’s one thing. Usually, if you do that, the emotion releases because you’re taking a moment to be compassionate to yourself by identifying what you’re feeling and giving yourself the space to process that, and it passes. Number two, you can remind yourself that encountering emotional pain is part of a shared human experience. We feel connected to 67 strangers on a plane because of our shared humanity. That’s a good thing. If we didn’t feel pain, that would be a source of concern maybe. Remind yourself that the pain that you’re feeling is part of that shared human experience. The third door step into compassion is to give yourself kindness and care. I’m going to talk about that in the next couple of slides. What can you do to actually give yourself kindness and care?

We’ll talk about that as well. The first activity I’m going to engage you in or invite you to is a breathing exercise. I learned this originally from the Kristen Neff course, but I’ll be very honest, I didn’t practice it until January 29th, 2025, when I thought, okay, my bucket is full. I need to do something. I’m going to now invite you to engage with me if you choose in a mindful awareness breathing exercise as per the American Institute of Stress. Dedicating 20 minutes daily to this exercise can be a potent stress and anxiety management technique, or you can just do it for two minutes or three minutes when you feel it. I’m going to ask you to begin, and I’ll explain to you afterwards once we’re done with it. I’m going to ask you to begin by finding just a comfortable place. I’m assuming most of you are comfortably seated in front of a laptop or your phone or on your sofa. You can be cross-legged on the floor or lying down or sitting in a chair. I’m going to ask you to position one hand on your upper chest and the other on your abdomen just below the rib cage. So, right hand on your chest, left hand on your belly. What I’m going to invite you to do now is allow your abdominal muscles to naturally relax. We’re not showing anybody our abs right now without any undue tension. You’re just going to inhale gently through your nostrils. Your belly is going to rise, and your hand will move along with it. You’re going to take a deep breath in, and you’re going to exhale slowly through slightly pursed lips, slightly opened lips while keeping an eye on the hand that’s resting on your chest, but should remain relatively motionless. Just join me if you will, if you want to, in a few of those breaths. Whenever you’re ready, you can open your eyes. This exercise is called the diaphragmatic breathing exercise. What it hopefully offers is a simple, quick yet effective way to cultivate calm and reduce stress in your daily life. Physiologically, what’s happening is when you breathe like this, it’s activating the vagus nerve, which is a big nerve in our body, which lowers our heart rate, lowers our blood pressure, decreases muscle tension, and can even, when you do it regularly, improve sleep quality. Mentally, it sort of calms the nervous system, quiets the mind, and really can help manage feelings of that stress and frustration that arises in our daily lives. It’s very simple. The key though is using the abdominal breathing. You’re really using your diaphragm to do the breathing. It also makes us slow down because when we’re stressed or busy, we’re actually breathing a little faster. This really invites us and reminds us to slow down our breathing.

I’m going to move on to the second activity that you can do that I invite everybody to do. A lot of my patients say that’s not fun. I don’t like to exercise. I get it. I get it. Even if it’s getting up and going for a walk just to your kitchen or the restroom and back, what is that doing? Is it increasing your heart rate and making your heart strong? Probably not. But what it’s doing is it’s helping break the tension that you may be feeling and gives you a chance to think things through, rather than just sitting in that same place in front of your computer for 3 hours. I do invite everybody to work out or do something active. That means something different for everyone. My husband climbed Mount Kilimanjaro last year. That is something I will never do. I’m more of the yoga dancing person. Exercise really honestly is one of the best antidotes for stress. In the pandemic, when I couldn’t go join my friends in Zumba, I found a YouTube video called Yoga with Adriene. That’s this lovely lady here. She’s from Austin, and she has every possible yoga video for awakening in the morning, for hip pain, for neck pain, for chronic headaches, for relaxation, for toning, for stress relief, you name it. The videos might be 7 minutes to 40 minutes depending on what you’re looking for. You can modify this to do it in a chair. That’s really important, I think. You don’t have to, if you’re physically fit, you can get on the ground and you can do some of these yoga things. I cannot do some yoga things. My joints don’t allow me to do that, and I just modify. Whatever physical activity it is, I’m going to invite you to do that because it really can release these feel-good hormones that you may have read about or heard about, and it releases those feel-good hormones and over time can really help reduce that stress. If you’re a social person, then doing social exercises with other people, whether that’s yoga with the group or like my Zumba class. If you’re more of a solitary kind of a person, then I just invite you to go out for a walk. Very helpful in stress relief. That’s the second thing. We talked about diaphragmatic breathing to acutely help with stress, physical activity. The third one is something interesting that I discovered about a year ago, and it’s called binaural beats. I know it sounds weird. Just stick with me. Binaural beats is a technique involving listening to specific sound frequencies using headphones. One of your ears hears a different sound frequency, and the other ear hears a different sound frequency. There are studies on this, and the studies are small. The jury’s not fully out yet, and so there’s a growing body of evidence. A lot of my therapist friends use this regularly. The NIH, for example, has published an article on this. There was a recent article out looking at 60 or 70 college students using binaural beats, and basically what listening to it does is it primes the brain to connect with the frequency differences, and it calms the brain down. It reduces anxiety. It lowers stress. It increases relaxation. They say that it can induce a mental state associated with some simple meditation like breathing, but faster. They’re all over YouTube. You can look up binaural beats. Give it a try. It might prove to be helpful. Like I said, there’s a growing body of evidence. You do have to listen to it with headphones though. One ear has to be receiving the sound at one frequency, and the other ear has to be hearing it at a different frequency. That’s another way if you’re like, “Okay, this breathing thing is not for me. I can’t do it.” But I could listen to some music, some sounds before I go to bed or something like that. It might be something for you to try. Real simple. 5 minutes. That’s the third thing to try to manage your stress.

The last thing is I really want you to reflect on what gives you joy. I feel like we don’t ask that of ourselves, and no one’s really asking it for us. Whether that’s making music or listening to music or listening to an inspirational podcast, dancing, reading, engaging in visual art, something creative, hiking, Virginia is gorgeous. West Virginia is gorgeous. I’m going to invite you to be really intentional and seek out those small or large projects or activities weekly, monthly. Put them on your calendar that give you joy. There’s scientific evidence that tells us that engaging in these activities that take us away from the organizations and the deadlines and the left-brain stuff and put us in a right-brain kind of frame of mind that’s creative and flows can be really helpful in creating balance in our lives. I know everybody says that, and some of us do it and some of us don’t, but I’m going to keep saying it in hopes that we all do it. I’m going to end my talk by just reminding us about what Dr. VC Murthy talked about, right? We don’t heal in isolation oftentimes, but healing really helps in community. In that vein, I’m just really grateful that you all are here. I’m very grateful that you all joined today. I would love to hear your ideas and thoughts and critiques and questions. I really thank you for spending part of your evening with me. Thank you. Thank you. That was fabulous. That’s great. If you don’t mind, if I can first of all ask you, nobody has put in any questions that I see yet, but if you don’t mind me asking, which of these do you engage in the most? Do you think it’s your Zumba or what happens when you are acutely stressed? What have you found that really works for you?

Good question. I’ve been doing Zumba for about 15 years. That’s sort of my chronic daily kind of thing or weekly kind of thing. When I am acutely stressed, the one thing that works the best for me is the breathing. It immediately gets me, gets that vagus, gets my heart rate down, gets my blood pressure down, my muscle. A lot of us accumulate our tension in our shoulders and neck, especially those of us who are on laptops and computers most of the day. That’s all of us, right? Just sitting back and taking those literally two minutes, not even more than two minutes of breathing, has made a huge difference for me because I’m at the point where I identify pretty quickly, “Okay, my stress level is going from a four to a seven. I don’t want it to get to a nine when it was on January 29th. It was not a fun place. It was not a good place to be. I wasn’t helpful for anybody.” I am so aware of that night and how I felt that now I’m like, “Okay, I’m a seven now. I think I’m going to do some breathing for just a second.” That can be really helpful. Music as well, right? Oftentimes I read in the newspaper or somewhere that the DMV is now the most congested, most stressful place to drive. We beat Los Angeles. We duke it out every year. It goes back and forth, I hear. But yeah, you’re right. It is definitely up there. I had no idea. I drive in from Northern Virginia to DC four days a week to get to my clinic. I am very intentional now, very intentional about either listening to a podcast that I really enjoy or that I’m learning from that really absorbs me or really enjoyable peaceful music. Very helpful. That’s fabulous. If you don’t mind, this is something that as physicians, obviously, we deal with all day every day, both for ourselves because our jobs can be stressful and for our patients because they’re dealing with all the stress too. Not just the commute, but just being inside the beltway, the rat race, and all the things that go on around here. It can be a wonderful place to live, but also can be very stressful for everybody. I love the bucket analogy. I haven’t heard that one before. What I’ve heard, another way to look at it is called the brain gym, where the bucket is you’re getting your bucket filled with stress, and you need to release that stress somewhat. The other way I’ve learned about it is that each stressor is like an extra weight that you’re putting on a barbell. For each more and more stress that you get, the more weights you have to put up. If you want to put up lots of weights, you have to exercise. You got to exercise your body, you got to exercise your brain. Doing destressors like meditation, sleep is always my favorite, doing exercise, music, whatever that is. Getting yourself in a better frame of mind, preparing your brain to be healthy and take some time off from the stresses of the day sort of gets your brain in better shape so that you can lift those weights when the time comes. If it’s a 50 lb weight, that’s not so hard. But when it’s a 400 lb weight, you’ve got to be prepared and in shape or else things are going to fall apart. The more you do to get ready for that will help you. Not just empty the bucket when it comes, but also be able to lift the bucket if it’s full. I like both ways of looking at that. I love that analogy. Absolutely. I’m going to echo what you said, Dr. Swag. I feel like in our culture, we often brag about how little sleep we can function on. There’s this cultural thing where, oh, I don’t need that much sleep. We know that when we don’t sleep, our stress hormones are high. We eat more. Our brains need that rest, and sleep is a form of self-care. Absolutely. Sleep and also at this time of year, being careful about your alcohol, also a fabulous way to stress yourself. Maybe not at the time when you’re drinking, but the next day your stress level would be significantly higher than it would have been if you did not have anything to drink. Certainly keep that in mind. Absolutely. That’s another conversation that I have on a regular basis. Our esteemed Dr. Sullivan wanted to say, I don’t know if you see this, he put a question in here. “Many of us can be vulnerable and experience health-related anxiety. What would you say to new patients who are looking for a doctor and want to seek help with this anxiety, and what can we do now to improve before seeing the doctor?” I think that’s a great question, Dr. Sullivan. I think, and we’re seeing this a lot, even I just joined NVFP, the practice, in March, and a significant percent of my patients come in, and they’re not only stressed, I’m worried that they’re getting burned out. It’s that 2025 phenomenon or probably the accumulation since the pandemic, honestly, but this accumulation where I’m seeing a lot of burnout. I think that really seeking out, like engaging in these simple exercises, and these are now a lot of times if you seek these out on even your social media, if you’re like, “Okay, I don’t have time for books,” but the social media outlets really are offering very similar things. Part of the national conversation, and I’m really happy to see this part of the national conversation now, is about self-care, and it’s engaging in different forms of self-care, and it’s not feeling guilty when you take time out to say, “You know, I’m going to go take that art class,” or, “I’m going to go for a 20-minute walk.” What I love about the DMV or a lot of the areas around here in Northern Virginia and DC that I didn’t have in Arkansas is that this is a very walkable place. There are beautiful trails, simple places to walk around. I’m really going to invite everyone to start reading about self-care. Kristen Neff’s work is phenomenal on self-compassion. It’s a quick, easy read. She’s on a lot of podcasts if you’re a podcast kind of person. I love Kristen Neff. There’s a lot of opportunity for learning and engaging and practicing in this different form of self-care. I would also invite everybody, if you don’t have a doctor yet and you’re looking for a doctor and you’re worried, if you feel like, “You know what, I am chronically stressed. I feel it.” Make sure that you’re getting in with a primary care doctor. Make sure you’re getting your blood pressure checked. It is still the silent killer. It is still one of those things that people don’t notice until it’s really, really high, and then it’s dangerous. I’m going to invite everyone to really explore some of those things. Fabulous. I’m sorry if I pronounced this wrong. Lilia Ramirez says, “As important as sleep is, what do you recommend to quiet racing thoughts at night?” This could be its own town hall by itself. It absolutely could. The first thing I’m going to do is say what every doctor will say, which is I would be worried, and I want you to make sure that you speak with your doctor about it because sometimes racing thoughts can be more than just daily stress. Sometimes racing thoughts can be something more like generalized anxiety disorder. That would need an expert, would need a physician really taking care of that and maybe helping you with some medications. That’s number one. Definitely speak to your doctor about it. For me, the racing thoughts, I go back to again, I feel like I’m a record here. I absolutely always go back to my breathing. I have a couple of audio, like 10-minute inspirational audio musical things that just calm me down immediately. I think breaking that cycle is really important. A lot of people wake up at like 5:30 in the morning or 4:30 in the morning. They may have to go to the bathroom, and then they come back to bed, and now their mind is racing, and they’re thinking about all the things that’s on their list. It’s another opportunity to say, tell yourself, it’s that positive self-talk. “Okay, I’m getting stressed right now. 4:30 in the morning is not the time to do it. I’m going to use my breathing exercises.” You don’t have to turn on your phone. You don’t have to do anything but just get into your abdominal breathing. I think it’s central. Abdominal breathing has been part of the Indian tradition for thousands of years. There is, like I said, there’s science behind it. It’s easy to do. I would invite you to certainly do that. But also talk to somebody. Don’t suffer in isolation. Talk to somebody about it. One of the things I always like to say, well, first of all, is that at 2 or 3 in the morning, you and your brain are a terrible combination because we just think horrible thoughts at that time. One of the things, as you said at the beginning, our stress comes from the past or the future. It’s virtually never is it the present. If you can focus on the present, that’s what helps you relax. One of the things about breathing, if you just focus on your breathing, you’re not thinking of the past. You’re not thinking of the future. You’re focusing on what’s going on right now. One other thing that I like to recommend is something that I like to call micromeditation, where it’s not like an actual meditation, but just doing something as simple as rubbing your fingers together and focusing on feeling the ridges. Or if you’re in bed at night, how do the sheets feel on your body? Can you feel it? Can you feel the temperature? Do you hear anything? If you hear, try to hear the farthest sound that you can and focus on that. Just focus on one sense, one sensation, and let your mind focus on that. It takes your brain away from all the things that you’re worried and stressed about. It’s not always easy. Like I said, all this does take practice, but the more you practice it, the easier it comes and the better you’ll do with it. I’m going to remind you again, I always tell myself, what’s in my control? What’s not in my control? It has a very centering effect on me. It kind of says, “Okay, Sara, you’re not in control. You think you’re in control, but you’re not.” Of these things. Step back. Take a step back. I will sometimes physically find myself taking a step back. That can be very helpful, too. I think that’s fabulous. That’s a wonderful way to think about it. That’s great. It looks like we’ve gotten through all the questions. I think this was really terrific and a really timely and fabulous talk. One that I think everybody could use. Make sure you all practice it, especially when your families come for the holidays or if you’re going there. This is a great time to practice all these. I appreciate the thoughts. I appreciate everybody for taking their time out tonight to come and listen. I think this was terrific. If you are looking for a doctor or know somebody who is, Dr. Tar is taking new patients in DC, and like I said, we are thrilled to have her. Thank you so much. Thank you all so much. It’s a pleasure being here. That’s great. Have a great night, everybody. Take care. Bye.