E68: The Social Domain of Stress

Katie: Well, welcome back to the "7 Domains of Women's Health." I'm Katie Ward. I'm a nurse practitioner and professor at the College of Nursing at the University of Utah. I'm here today with my friend and my mentor, emphasis on the mentor, and longtime host of this podcast, Dr. Kirtly Parker Jones, who's a reproductive endocrinologist.

We're in the middle of a series on the 7 Domains of Stress, and this particular episode, we're going to focus on the social domain.

We have the seven domains, and in the social domain, we're always looking at culture, community, friends, and family. And so we're looking at how those things influence stress.

But of course, the social domain does not exist in a vacuum, and our social domain is also influenced by the environment, finances, our spirituality, our physical condition, our emotional state, and our knowledge. So we do hope you'll listen to all seven episodes of this deep dive into stress for a deeper understanding, and hopefully throughout this, some tools you can use to reduce your own stress.

Kirtly, the social domain is a big topic, and honestly, just preparing for it had me thinking about and going down some dark rabbit holes in places. It's some difficult things. So in order to pare it down to something manageable, I thought we'd kind of focus on just a couple of aspects.

So, in particular, to talk about the social domain in terms of social stressors you're born into and then some of the social stressors that you choose to bring into your own life.

Kirtly: Yeah, I think that's exactly right. It is a huge topic, and you're so right to bring in all the seven domains because things build on each other in a good way or in a bad way. You may have some spiritual resilience, which really is a big help for you and your social stressors, or you may live in a gorgeous environmental place that feels like it nurtures you, and it may help you with your emotional stress. So these are interwoven in good and bad ways.

But I want to start with the stressors that you are born into and experience as a child, because we now know that things that happen in utero, in young childhood, reprogram the kid's brain for how they're going to respond to a stress.

We mentioned in the physical domain that women who experience significant stress, think watching the Twin Towers come down in your neighborhood on 9/11, and they experience significant stress throughout a pregnancy, not just a single acute stress like a near disaster in your car, but long-term stress, they pass these stress hormones on to their fetus.

And the children of moms with chronic stress during pregnancy are more likely to have an overactive stress response. They have big responses to smaller events, and they don't come back to baseline easily. They don't calm themselves as easily. They hyper-respond, and then they stay at an elevated stress level.

Children who are exposed to adverse events in childhood, and they call them ACEs, Adverse Childhood Events, they have a greater response as adolescents and adults.

Some examples include experiencing parental divorce or separation, or having a family member who's in prison, or living with a family member who's addicted to alcohol or other substances, or experiencing physical and emotional neglect, or experiencing physical and emotional or sexual abuse, or witnessing violence in the family. All those things are chronic. They set up a child for long-acting responses, and they're more common than you might think.

The good news is the very kinds of things that cause these social stressors that affect children for the rest of their lives potentially can be modified, and the child can be made resilient by the same kinds of social supports that these kids need. So caregivers understanding that these kids are in a situation where they have chronic stress. Positive parenting skills, so taking the parents and bringing them some skills to deal with what might be happening at home. Understanding the kids' social and emotional health at schools, and close relationships with competent caregivers or other caring adults, like nanas. Nanas can be powerful positive social guides to help kids be more resilient and having a sense of purpose.

So some kids have had some terrible adverse child events. They find some kind of purpose, and maybe it's helping others.

There are lots of things that you can do to help correct the terrible things that can happen to children that can set them up for being overly stressed as adults, social situations, but we have tools in our environment and in our communities to help combat that and build resilience. 

Katie: I've been thinking a lot about the ACEs. They factor into some research I'm working on. So I was looking at that original study. One of the things I was thinking about, the study was done 30 years ago. It's been repeated in lots of different circumstances, and it holds up.

What it told us is that there is this strong correlation between having more. . . It's kind of a linear relationship. So half of people have one of those ACEs. But the more you have, the stronger that correlation is for having what you were talking about, that biologically embedded risk of disease, but also a greater likelihood of engaging in behaviors that further influence your health outcomes, perhaps in a negative way.

So I do think it's a valuable thing for people to know and look up their ACE score. You can go to any number of online places and plop an ACE score and kind of sit down and think about how many of those you have.

Again, that knowledge is power. It's action that you can use to sort of inform your health and say, "I know I happen to have a higher ACE score than some other people, and therefore I'm going to make sure that I see my healthcare provider regularly and get my blood pressure checked, and my cholesterol checked, and my blood sugar checked, understanding that maybe there are times when I'm going to need a little bit more support as I'm going through difficult emotional situations." So knowing that can be really powerful.

But there are also some things that the ACE score didn't take into account. So they were studying very specific kinds of events and then looking at effects on health and behaviors later. It didn't really take into account some of the kinds of trauma that really more developed in the last years.

Kirtly: Oh, gosh. Yeah.

Katie: So I think that your ACE score might be one, but that one thing was . . . If it was a school shooting, that is going to have a profound effect on you. And then in that case, the score doesn't matter.

Between the time when we started looking at this as a way to kind of think about events that cause health risk, things have gotten a lot worse. And so today we're really confronted with . . .

In fact, I think it was just earlier this year, the Surgeon General sent out a report and a warning about the amount of stress that parents are under right now. And hopefully Chloé can put a link in the show notes to this. It's just saying that a great percentage of parents are so stressed out that they really feel like they just can't even function.

The report was pretty specific about what these stressors were, and they included financial strain and economic instability and poverty, time demands, children's health, children's safety, parents feeling isolated and lonely. They called out specifically technology and social media, as well as other cultural pressures and children's futures. So there is a lot going on for all of us to try and manage these days.

The other thing I liked about this report . . . And again, anybody can go to it. But it gives a variety of long lists of ways to help. So whether you're the parent or the caregiver of a parent, specific things you can do, specific things if you're family or a friend or a policymaker or a researcher or an employer.

So this is a multifaceted, difficult time that we live in, and I think we really need to rally all of our resources. As an individual, this is hard to fix just by yourself. Again, that's what I kind of liked about this report, is it really laid out as a society, how do we tackle this?

Kirtly: I think there was something in the media just this weekend about very stressed-out parents and things that they could do. And they actually suggested making a don't-do list. People often compare themselves to some other kid who's brighter or faster or is doing soccer on Monday and is playing the piano like a genius on Tuesday and is doing computer extra things on Wednesday. And some people can't afford all that. Their kids can't do that, and they feel bad. So there are some don't-dos.

I mean, there are some dos, but you don't have to be perfect. You just have to be good enough. And good enough is just being there, trying to be consistent with your child, and loving them.

So a kid isn't made better necessarily because they speak three languages and go to soccer and play an instrument. They want the security that you're there for them.

So there are a lot of don'ts. I won't spend my time in the car driving my kid all over to activities. I won't do that.

Katie: Right. And I think that is in that list of things that are stresses and pressures, particularly on parents right now, is just that. They're sort of feeling like they have to keep their kids busy, that it's not safe to let them go out and play. And who can blame them?

Although there's a lot of good data that we actually live in the safest time ever in human history, it doesn't feel that way. And I think part of the reason it doesn't feel that way is our access to news is so much greater.

I mean, you mentioned the Twin Towers, and I think that was sort of the first time in my lifetime that I had the TV on a news station from dawn to dusk.

Kirtly: And you watched it over and over and over.

Katie: Over and over. Yep. And I was married to a firefighter, and he was gearing up to go work on the pile, and so that was a really stressful day in my household, for sure.

I think everything that goes bad, and there have been some terrible ones, now it's not even the TV in the living room that you can walk away from. It's in the palm of your hand, in that device that you use to look at just to see what time it is, or you're going to see it when somebody sends you a message, or you want to know the temperature outside. And then there it is. It pops up on your phone, whatever the latest bad news of the day is.

So I think the things that people are stressing about, how much of it is really a real risk to you, and how much is something that's . . . Not to diminish how bad it is, but it doesn't necessarily mean you can't let your kids just go outside and play. 

Kirtly: Right. We did a 7 Domains of Curiosity, if any of the listeners want to go back and check out the 7 Domains of Curiosity. We talked about doomscrolling and why it is that we focus on bad stuff and remember bad stuff. It's part of our wiring. It's really important to know that you remember that that stove is hot or that cliff leads off into 100 feet down or wherever. You need to remember the bad stuff.

But we actually seek it out psychologically, and then it keeps coming. So you seek it out once, and then your newsfeed, Google knows that that's what you want, and it keeps giving it to you all day long.

Katie: Reinforcing, yeah. And I think that that's one of the reasons we're talking so much about the impact of social media. So as we kind of transition from the stress that you're born into and that may shape how you consume your social media, but social media here is this new thing.

I was thinking about it. It really is only 15 years old, right? It hasn't always been with us, but it sure feels like it. And it really has transformed our lives in ways that I think we're just beginning to sort of wake up and say, "Oh."

All of those things that we're talking about that are stresses for parents, economic, time, social pressures, real, live risks out in the world, that is kind of being fed to us by whatever social media we have at our disposal.

And don't get me wrong, I am not a Luddite. I'm kind of an early adopter. I like technology. I'll try new things, and I've had some great experiences through social media that would have never happened to me were it not there. I've met relatives that I otherwise had no connection with. I found this fantastic tour guide and went on this amazing tour in Australia, a thing I wouldn't have found on my own. There's content on there that makes me laugh, and that's definitely one of the ways I cope with my stress.

I mean, I like to think that you and I are producing some good content out in the world.

Kirtly: I'll tell you my secret advice is watching short clips about 2- and 3-year-old girls who talk back. It's just adorable. Some little 2- to 3-year-old who's verbally very quite able, but is just telling the world how she sees it, and it is a hoot. So that's my addiction, is watching 2- to 3-year-old girls work on their verbal skills.

Katie: I've got a thing for a golden retriever on the internet that does these funny pranks. I mean, social media, it's like the rest of the world. There is all the best stuff there, and there is also all of the worst. And I guess maybe because we're primed to like the worst, we're there.

But there's also this thing there that I've been thinking about a bit as well, because if I post anything, it's my vacations. And for me, it's like sending a little postcard home. It's kind of fun to do to make sure that my family knows I'm doing okay wherever I've traveled. But if you were to just look at what's on my post, it looks like I'm on vacation all the time and . . .

Kirtly: I look at your posts, Katie, and it makes me . . . it's stressing me out because I'm not having enough fun. But I know that you are working three jobs, in the sense of three big things, both as a teacher, a researcher, and as a clinician. I know that you are not always on vacation.

Katie: And I'm single, and I spend most of my time alone. The work that I do, I get a lot of patient contact, and I enjoy that. And I have a good group of friends, and I have family in town. But I spend a lot of time at my computer, and I don't post that. Maybe I should more, but I just . . .

Kirtly: No, please don't.

Katie: But I think that's what's out there, and I think this is the case for everybody's social media post, is a paradox of where you're posting things that I'm doing to relieve stress. I want to get outside and notice the world and experience my own awe. I think that's a really important way to manage stress, is to have that experience of awe and wonder, even the things just in your own backyard.

But in doing that, I'm kind of curating this thing, and I think that that's one of the real . . . Even if you're not doomscrolling, if you're thinking you're looking at lots of little happy things, they're not. They're not people's real lives. They're carefully curated.

And that comparison, I think, really gets to another thing that's happening there that leads to stress, which is feeling like you're not keeping up with whoever your idols are.

Kirtly: The Joneses.

Katie: Yeah, the Joneses. You. How do you do social media?

Kirtly: Well, I do have Facebook because I like to see postings from my friends and kids, but now it gives me all this other stuff I didn't ask for. But most kids now use other platforms, and like many boomers, I'm not on any of them. So I'm really a face-to-face person. I like to listen to podcasts, and I play them for my husband because he's on no social media at all and never has been, and he doesn't get it. But he does like the fact that he can listen to podcasts about science and environmental issues instead of listening to the news, which seems to be all about politics these days.

So, for me, social media is a way of seeing maybe what some of kids and friends are doing, if they are even using Facebook anymore. But I don't believe what I see on social media because I grew up without it, and I grew up without a TV.

So I grew up without a TV and we didn't have a TV in my adult life until 2022, so two years ago. I think what I see on TV is all fiction, so I don't necessarily have to believe it. It doesn't really get to my heart. Whereas someone in my clinic or someone in my family who's hurt or having a problem, that will get to my heart, but not social media.

Katie: Yeah. I think about my kids. In fact, I was just watching my grandkids last night, and they want to watch these little YouTube videos. They're all short, 60 seconds or something, and they go from one to the next one to the next one. And I think that's been one of the things I've been thinking about in terms of sources of stress, is just being able to pay attention for an extended period of time. These little things come at us and they're so brief. And so, as a result, that that starts to feel normal.

I was hearing somebody talk about recently that in even long-form movies, they're changing scenes faster and faster because if they linger on something, people think, "This is taking too long."

So our minds are really . . . it's having an impact on our ability to pay attention for a period of time. We're impatient, and then the people that produce our content sort of respond to that by shrinking it further.

So I think, for me, that becomes a source of stress, and I think for lots of other people as well, of just feeling like I need to change what I'm thinking about so frequently.

Taking the time to sort of just have less things going through my mind is a really important way to de-stress. As I mentioned before, to be able to go for a walk and pay attention to the little bitty things, the sounds and the smells and the sun on my face and things like that.

Kirtly: Well, I'm a sucker for two YouTube videos. And one is the jellyfish platform where you can just watch. It's ongoing. It's sent from, I think, the Monterey Aquarium. And you can watch it for hours. It's just jellyfish doing their jellyfish thing, and it's very calming.

And I am a big fan of what I call farm equipment porn. I will watch a combine going through a field in Kansas for half an hour, just watching the combine making its turns around corners. I just love to watch farm equipment porn. I know, secrets I'm willing to tell on our podcast.

Well, anyway, back to social stressors. I understand that people may be too stressed out by their social environment to get engaged in outside things, but I remember the life's work of a really famous psychologist named Martin Seligman who studied happiness. He invented happiness science, and he wrote a book called "Flourish," which is how people develop resilience in the face of stresses. And he used the acronym, or phrase, PERMA for a model about how people rise above the stresses in their lives.

P is for positive emotions. You need to identify your emotional state and work on a positive one and get help. If you are able to identify your emotional state as being chronically anxious or depressed, you can get help, and you can feel better.

The E is engagement. Stress can make you withdraw from your work or your family, but being engaged with others, mostly people that you trust, can lift your mood and make you more resilient.

R is positive relationships. And as Snoopy says, stay close to people you know who smell like sunshine. Have positive relationships. Keep with your friends who smell like sunshine, and those really help people move and develop resilience in their stress.

Find meaning. M is for meaning. Find meaning in your life through your actions for others or yourself or your spiritual life. Engage in something bigger than yourself, because social media, you and your little phone, or your kids' little phones, they bring you into yourself. So you are the only center of your world. Engaging in something bigger than yourself can be helpful.

And then accomplishment is A. Get good at something. It can be your work something, or it can be your exercise something. You can be a better dancer, or you can be excellent as a cook, or you can be excellent at doing origami, or you can be the best cleaner, but when you're stressed, you may feel like you're not good at anything. But when you practice what you're good at, you get into a state called flow, which really puts you in a higher plane. And doing what you're good at helps build resilience.

To quote Winnie the Pooh, "Tiggers do what Tiggers do best." When you do something really well, do that. If you can teach someone else to do it, even better.

So all these PERMA activities help build resilience. These were studies of people who were resilient after really bad things happened to them in old age. They did these things.

Katie: Awesome. I like that. And there are resources, is the other thing. Hopefully we can list a few things in the show notes. I know NPR is just running a masterclass on managing stress.

Kirtly: I practiced that. Dolphin breathing. That was the first part of their masterclass.

Katie: Yeah. And we've talked about that here as well. Breathing, exercising. It just is taking the time to think about it and making the effort to step back and say, "Okay, I'm stressed. What do I do?"

Kirtly: The NPR masterclass online is free, by the way. You don't have to sign up for it. And they'll take you through several strategies for managing stress.

Katie: Yeah. And then at the University of Utah here, where our podcast originates, I know they have some classes people can take on dealing with particularly difficult situations, like a divorce or difficult people. And also, reach out and get help or give help. Those are important things to do as well. So, yeah, be a Tigger. Do what you do best.

Kirtly: As long as it's a good thing. If it ends up being bad things, don't do those. But in general, when we develop a skill and we're really good at something, it's something we have pride in doing, and we really like to share it with others.

Whether it's gardening, cooking, cleaning, or whatever it might be, when we get good at something, we feel a sense of accomplishment, which rises us, helps us lift beyond our stress levels.

Katie: Thank you, Kirtly. And thank you for listening. So, as always, if this has been interesting or if it's been helpful, please share it with a friend or use it to start a conversation with someone you love.

We will be working on the rest of the 7 Domains of Stress. You can listen to the "7 Domains of Women's Health" wherever you get your podcasts, or at womens7.com. And another deep breath.

Kirtly: And another deep breath, like a dolphin.