Greetings,

1. Do you think burnout will ever be recognized as a medical diagnosis?

2. I have read that stress, especially when chronic, can change someone on a molecular level. Can you speak to what exactly that means and how it happens?

Thank you.

>Cognitive behavioral therapy does have strong empirical evidence supporting its effectiveness in addressing anxiety

That's a little outdated now, lots of new evidence that CBT is only useful for treating symptoms, not causes, and so only offers temporary relief.

Hi Dr. Lee, thanks for your time. I tend to have an optimistic outlook, but I feel lost when trying to help somebody who has a pessimistic outlook.

Do you have any advice on how to speak with and/or guide somebody that we care about?

How do I get my optimism back? Me trying to navigate the shit mental health system in the UK that keeps getting worse has killed it :(

Is it possible that optimistic people are optimistic because they are in generally better health?

What evidence exists (references please) that childhood adversity/stressors exist and carry over? Would querying for childhood adversity result in a confirmation bias of sorts due to calling attention to a potential issue? How do you establish a negative control for these types of questions? Also, who is your biggest funding source, and how's the tenure track work coming along? I ask because I'm a researcher at Forsyth but work with microbes! Hi neighbor

I have a teen on the spectrum who tends to fixate on things. Right now the fixation is past problems that caused stress, some big, some very small. But remembering causes stress and meltdowns, over and over again. How can we help them deal with the issue and move on, or at least recognize when the stress is coming and be able to control it?

Thanks so much!

Is there any way to become an optimist if you have pessimistic tendencies?

Drs always telling me physical issues can be caused by stress and to stress less, even though I don't feel I have anything particularly stressful going on in my life. Are there some people who are chronically stressed and don't realize it? How do you 'stress less' when you don't feel stressed?

Hi! I spend a lot of time doing research and the AMA gives me an opportunity to talk to non-researchers about findings of studies that may help us think differently about our health and well-being. In my clinical work, patients have always been curious and appreciated conversations about scientific findings, so I welcome the opportunity to engage with a wider audience through the AMA. Thank you for this question and being here!

I don't remember a link to talking about x-rays, and a review of the history didn't reveal a link from you I didn't read.

So what am I looking for?

The scientific evidence is pretty robust in suggesting anxiety has a role in the development of heart disease. In studies that follow participants over time, researchers have repeated noticed that people with higher anxiety levels at the beginning of the studies were more likely to develop heart disease over time, even after accounting for how healthy the participants were at baseline.

Thank you for being here and asking a question. It is great that you are taking steps to take care of your health. Stress and grief can feel like such huge burdens on our day-to-day life - often times people feel sad and unmotivated to do things that they normally do, like self-care. Some people just want to be alone even though they feel lonely. Stress can bring a host of negative emotions, like anxiety or even panic, sadness, anger. Negative emotions can affect how we see the world around us and interpret things that happen to us - for example, anxiety may cause us to feel vigilant and be on the lookout for something bad that may happen to us. Depression may make us interpret situations in a much more negative way than they really are or focus on the most negative aspects of things. Feeling stressed can also take a toll on your physiology - for example, it may keep your blood pressure higher for a longer time, which in turn takes a toll on your heart. You can see how that can trigger a downward spiral.

I appreciate that you are aware of the potential effects of stress and grief on your heart and your health - that is already a great first step. Self-care is important - it's one way to stop the downward spiral. Take time to take care of yourself - eating a healthy diet at regular intervals, not smoking, making time to exercise and being in green space, spending quality time with supportive people. If you catch yourself feeling negative emotions - if it is a reasonable response given the circumstances (e.g., grieving the recent loss of a loved one), you may choose to accept it and let it run its course without judging yourself for feeling negative, or do something to make yourself feel better. If your emotions feel too overwhelming and/or seem disproportional to the situation on hand, then it's worth seeking professional help. Sending good wishes your way.

Thank you for your thoughtful response, Dr. Lee!

Why is it important for you to do an IAmA?

Do you have any advice on dealing or recovering from work related burnout?

With ACEs and trauma in general being a significant risk factor for people who use alcohol or substances - what advice would you give for those with trauma and active self-medicating behaviours? I'm aware of safety and stabilisation techniques but is there anything else that you might consider?

I am sorry to hear that. Without knowing more about what caused his anxiety, it's a bit challenging to make suggestions. Cognitive behavioral therapy does have strong empirical evidence supporting its effectiveness in addressing anxiety, so that seems like a reasonable approach. Being present, empathetic, and supportive is always helpful. He may be aware of his own change from being the life of the party to being much more withdrawn, and be sensitive to how others may be perceiving him as well - it's wonderful that you care so much for him, and reassuring him of your support (regardless of whether he is the life of the party or not) may be helpful, too. Best wishes to you and your family member.

This is so helpful. Thanks for your reply!

Are there any pharmacological interventions that have been shown to reduce the effects of psychosocial stress at least in the short term?

Thank you for your question. In a nutshell, higher levels of optimism have been linked to lower risks of poor physical health outcomes, such as developing heart disease and dying from chronic diseases; higher optimism levels have also been linked to more favorable physical health outcomes, such as living longer and staying healthy in old age (defined as not having memory complaints, chronic disease, major physical limitations, and living beyond age 65).

Psychologically, more optimistic people tend to have better emotional well-being (that is, higher levels of positive emotions and lower levels of negative emotions), even when faced with stressful situations like a major medical diagnosis. When dealing with stressors, more optimistic people tend to think of the situation as challenging rather than threatening, and they are less likely to feel helpless or hopeless.

One caveat is that scientists can not yet definitively say optimism *causes* good health because most of the data have come from observational studies - that is, scientists compared more versus less optimistic people on their health outcomes. A rigorous scientific approach will involve, for example, using randomized clinical trials to test the causal effect of increasing optimism levels on health in the long run.

I’m really curious about healthy aging. I, myself, have been diagnosed with PTSD and am in a field that constantly triggers me (veterinary medicine).

Over many years of therapy I have been able to develop better coping strategies that has aided in my success. However, I do worry about the stress itself and how it affects my aging.

As an already optimist, how can leveraging my optimism more help improve aging?

Secondly, how DOES stress affect aging?

I’ve always worried my adrenal glands would give out and cause a myriad of hormonal and neurological issues in the future (I see a LOT of vet med professionals kill themselves or have to retire due to their bodies giving out).

For more AMAs on this topic, subscribe to r/IAmA_Academic, and check out our other topic-specific AMA subreddits here.

Does anxiety can create heart related issues ?

Thanks for doing this, Dr. Lee! My question, which is very relevant for me specifically today, is: what is the best way to manage stress and grief so as to minimize its short-term risks to your health, especially heart health?