Q&A with Dr. David Spiegel, Director, Center for Integrative Medicine

David Spiegel, MDDr. David Spiegel has spent the majority of the last 33 years teaching, researching and providing psychiatric care for patients at Stanford Hospital & Clinics. He is an Associate Chair of Psychiatry at the Stanford University School of Medicine, and runs Stanford Hospital’s Center for Integrative Medicine. In preparation for the upcoming holiday season, Dr. Spiegel shares some tips for staying stress-free and making the most of the holidays.

Question: What do we now know about stress that we didn’t know 10 years ago?
Spiegel: We have a more complicated understanding now of both the psychology and physiology of stress. We recognize that stress isn’t just when big events happen like the loss of a loved one or the loss of a job. It is rather the accumulation of little stressors that make a big difference. We have a stress response system in our body that gets turned on when we have a big stress (this was crucial in the old days when a saber toothed tiger was on the attack). It makes our heart rate and blood pressure go up and creates the secretion of cortisol which elevates glucose and makes our body ready to fight or flee. What is happening in the modern era is we have lots of little stressors that are not physical and yet our bodies react as if they were physical stressors. The accumulation of all of these little stressors keep the stress response system turned on for longer then it should be and it begins to affect our judgment and our sleep patterns, and can make us irritable or jittery. This creates a snowball effect: the more tired we feel the more easily stressed we become and then the worse we feel physically. This pattern can have adverse effects on our mood, can cause anxiety and depression and can have bad effects on our body in the sense of accelerating a disease like heart disease or cancer.

Question: Who is most vulnerable to stress during the holiday season-men or women?
Spiegel: I think that women tend to carry most of the burden of the holiday season. Women are working now too, but they tend to get a disproportionate amount of the other responsibilities on top of working. So I think the holiday season becomes a particularly stressful time for women who are trying to do their jobs, and bring the family together, and feed everyone and make it all work. There are other seasonal conditions, though. Because the day is shorter, some people have what’s called seasonal affective disorder. This occurs when the photoperiod is shorter. That is why you see a lot of depression in Scandinavia, where the winters are very long with very little daylight. There are some people who will routinely get depressed in the winter, but feel better in the summer.

Question: What are some recommendations for reducing stress during the holidays?
Spiegel: Because we’re still working but now have all these extra things to do like shopping for presents and cooking big meals, one thing that can help is to try to keep some regulation on our circadian pattern. Make sure you get enough sleep, some exercise, and even if you don’t eat normally, eat sensibly. If you indulge in a couple of big dinners, then be more careful at other times. I think a little attention to the usual health maintenance things can go a long way during times of stress. Do what your grandmother told you to do: eat well, sleep well and get plenty of exercise. It is really good for your health and you will enjoy the holidays more.

Question: What can people find at the Center for Integrative Medicine that could help them with stress reduction during this season?
Spiegel: We have terrific massage therapists for example, and a lot of people just drop in for a quick massage. Our massage therapists are very experienced and are able to help despite any medical condition you may have. We also offer a Mindfulness Meditation Based Stress Reduction course for those who want to take a little more time and learn how to live in the present in order to regulate one’s emotional responses. It can be a useful thing to learn. Additionally, we have acupuncture and hypnosis training services that can help people better deal with such problems in their lives as pain and fatigue.

Question: What advice can you give those who have to work or are patients at a hospital during the holidays?
Spiegel: I think working during the holidays is a very hard part of the job, but it is our responsibility as people who work in the healthcare industry. One of the reasons why I admire people who work in healthcare is that they are willing to make such sacrifices. Families can help by changing schedules to accommodate those who have to work. Perhaps Christmas dinner can become more of a lunch so that mom can go to her night shift at the hospital but doesn’t have to miss out on a special meal with the family. I also think it is nice to decorate around the hospital. It cheers up patients and staff and makes the hospital feel more like a family. When I was a resident, I was on duty at a psych hospital on one New Year’s Eve. I wasn’t thrilled about this, but I ended up spending the evening playing guitar and singing with the patients in the day room of the ward. We sang songs together most of the evening. It is a really nice memory for me. We’re here to help people and that’s our first priority, but we can try to soften it a little bit around the edges during the holidays.

Question: What is your favorite holiday?
Spiegel: My favorite holiday is Thanksgiving, because you are not busy running around buying stuff for people. You’re just sitting together, having a meal and thinking about what you have to be thankful for. I think this year has been particularly tough for a lot of people. People are stressed out about their finances and their retirement, but I think it’s also an occasion to take stock of what you’ve got and be grateful for all that you do have. There are a lot of people who realize now that their families are much more important to them then their 401Ks and bringing families together this time of year is a good way to remind ourselves of that.

Question: Are New Year’s resolutions effective?
Spiegel: Well, if I had a nickel for every broken New Year’s resolution I’d be a lot better off than I am now. However, there is research on behavior that suggests people go through stages: pre-contemplation, contemplation, efforts and then consolidation. I guess an argument could be made that New Year’s resolutions are a kind of pre-contemplation. You’re never going to do much if you don’t at least think about what you might do. I think that the mental act of thinking ‘well what might be better if I did something differently’ is not a bad thing to do. Many of the resolutions people have are good things to try to do - like lose weight, stop smoking or get more exercise. There are a lot of programs around here at the Center that can help people achieve those things. If you’re looking at percentages, and one out of four resolutions is successful, then that’s great.

Question: What are you thankful for this holiday season?
Spiegel: Well, I am of course thankful for my family and my loved-ones. They mean the world to me. I’d say the other thing I’m most thankful for is the change in this country. I’ve been really despairing. I have a friend who is a Provost at the University of Cape Town, and he and I have been in touch for many years and talked about his going through the apartheid era. At the height of the of the Bush lunacy, I sent him a despairing email about what was going on here and he wrote back to me: “I believe there is a fundamental decency about the American people that will prevail sooner or later.” I frankly didn’t believe him. Well, I wrote him an email about a week ago that said ‘You were right and thanks for believing it.’ I think the people have spoken and it is really good to see that this country is going to be on a different path. It is really inspiring to see that it can happen, so I feel very grateful about that.

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