What if stress isn’t something to eliminate, but a signal your body can learn to navigate?

Stress scientist and leadership advisor Dr. Alexandra Crosswell joins Holly Osborne and Dr. Megan Steele to explore the connection between chronic stress and chronic pain. They discuss why a healthy nervous system is flexible rather than calm all the time, how reframing manageable challenges can change our response, and why positive thinking has limits during illness, loss, and uncertainty.

Learn how sleep, movement, nutrition, progressive muscle relaxation, and recovery time can support the body during prolonged stress. You’ll also hear practical ways to work with uncertainty, focus on what you need today, and build resilience without dismissing difficult emotions. A helpful conversation for anyone living with pain, stress, or uncertainty who wants realistic ways to care for their well-being.

Guest: Dr. Alexandra Crosswell, Stress Scientist

Dr. Alexandra Crosswell is a psychologist and stress scientist, as well as a sought-after keynote speaker and corporate advisor. She has spent her career studying how stress shapes human behavior. Her training began at Duke University, and she went on to earn her Ph.D. from UCLA. After spending 15 years in a rigorous academic career studying stress and resilience funded by the National Institutes of Health, Dr. Crosswell began working with corporations and organizations to change the narrative around stress. Translating cutting-edge research into actionable insights, she enables leaders to operate more consistently and effectively while facing the demanding economic, societal, and technological pressures of today.

Alexandra Crosswell, website

Alexandra Crosswell, Substack

Links to interesting things from this episode:

• Wendy Berry Mendes’ Emotion Health Psychophysiology Lab
• “Rethinking Butterflies: The Affective, Physiological, and Performance Effects of Reappraising Arousal During Social Evaluation”
• “Bright-sided: How the Relentless Promotion of Positive Thinking Has Undermined America” by Barbara Ehrenreich
• “Explain Pain” by Dr. David Butler and G. Lorimer Moseley
• Elissa Epel, Ph.D., an international expert on stress
• Dr. Martin Picard
• “The body does not keep the score: trauma, predictive coding, and the restoration of metastability”

Stress has been plaguing me and probably everybody that I love in my orbit my entire life. And it's like one of those things you're supposed to be able to get rid of. But how the heck do you do that?

Welcome to Unpacking Pain, a podcast dedicated to understanding the complexities of chronic pain, what causes it, how it affects our lives, and what we can do about it.

Join doctor of Physical therapy and pain science researcher, Dr. Megan Steele, and me, Holly Osborne, chronic pain sufferer, as together we explore the biological, psychological and social aspects of chronic pain and create community and understanding in the process.

Today we have an incredible guest, Dr. Alexandra Crosswell, who's a stress scientist and a leadership advisor who's helping leaders thrive in high pressure environments. And high pressure, let's face it, that could just mean traffic and getting our kids to school these days.

So I think we're all living certainly in a high pressure environment.

And what's amazing about Dr. Crosswell is that after a 15 year academic career where she was studying the biology of stress as an NH funded researcher, and she was also a professor at ucsf, she actually left academia so that she could focus on bringing the science out of journals and into the real world.

And today she's working with executives and organizations really to help people use stress as a catalyst to be more clear in life, to have more resilience, to live a more sustainable life. And I love this idea of being able to take stress and not make it the enemy, but actually use it for you.

Dr. Megan and I are absolutely thrilled that we're with you today. Dr. Crosswell, thank you so much for joining us.

Awesome. Thanks so much for having me. I love to love to talk about stress.

Well, it just seemed like an obvious fit to Dr. Megan and myself when we saw what you were all about, Dr. Croswell, and the work that you do was compelling to us also as women who are working and juggling a lot.

But as co hosts of the Unpacking Pain podcast, we were like, my gosh, has there ever been a stronger correlation, you know, between two things than chronic stress and chronic pain, particularly in how they manifest in women? So just really thrilled to be able to dive into this today.

And you know, Dr. Megan, I think one of the things that you and I were just kind of asking ourselves, we would ask Dr. Croswell is, how did she get started? Because I love your origin story, like, right, Dr. Megan, how you came into all this.

But Dr. Crosswell, just start us off a little bit with you know, before we get into all the magic and the. The brilliance that you're creating, what led you to focus on chronic stress?

Yeah. Great. Well, first, thanks for having me.

And I also see a lot of overlap between the kind of science and psychology of pain and understanding stress from a more nuanced and scientific and psychological lens. So I'm excited for this conversation to begin. How did I get into this field? This has been a very, very longstanding interest for me.

There's kind of different origin stories I have, but the one that I'll highlight today is really around when I worked. My first ever job, official job, was when I was a junior in college.

I went to Duke University, and I got a job working at the Duke Cancer center with a research team.

And with that lab, one of my jobs that I had to do was I had to go into the patient waiting room for newly diagnosed people who had just gotten their cancer diagnosis, and they were about to start their very first cancer treatment, whether that was radiation or chemotherapy.

And they were in the waiting room about to go in, and you can imagine there's a lot of anxiety and angst, and they're usually there with a family member, and it's their first time getting treatment. And my job was to go and to bring them a big packet of surveys that.

Where we were going to track their symptoms, their mental health, their physical health. And I was in charge of bringing that to them and having them fill it out. And many of them really wanted to talk about their story.

They really were still processing the diagnosis and what had happened to them.

And I remember there's this one woman, and she had been diagnosed with breast cancer, and she was about to have her first round of treatment, and she said, you know, what happened to me is my divorce. That's what happened to me. I could really feel the impact of the divorce on my body. And I remember thinking, like, wow. Like, could that really be?

Like, is that. Is she right? Like, did she feel it?

You know, could it be this really hard divorce had such an impact on her that it influenced her all the way down to the level of the cell?

And that question really has stuck with me for many decades of asking, could difficult experiences be so powerful that they influence us down to the level of our cellular functioning? And so I ended up going to UCLA and working with a researcher in a field called psychoneuroimmunology, specifically on how stress affects cancer.

That was kind of where I began my research career, because I was really curious about that question.

Wow. So interesting. Thank you for Sharing that. And it's so great to hear these origin stories of one patient or a group of patients.

And then it just leaves you with this burning question of how is this just a one off? Is just this a few people, or can this be true for larger populations? That's so interesting.

And can you tell us about what your research at UCLA led to or what the findings were?

Yeah, so.

So it turns out there's actually been a significant amount of research on the impact of life events like getting divorced or having kind of major life challenges, major stressors in your life and illness, any kind of disease diagnosis, and cancer in particular was an area of very large focus in the 80s and 90s because the national Institutes of Health were really focused on funding research studies to understand why rates of cancer kept going up.

And so there's a really beautiful and elegant body of work looking at the relationship between stressful life events and cancer rates and progression and outcomes related to cancer. And overall, what the field has shown is that stress doesn't cause cancer, but it can accelerate cancerous growth in the body.

And so now in human studies and in really, really well designed animal models, you can see, for example, that mice that have a tumor implanted in them, if they're in a really stressful living environment, you can actually image the tumor growth and you can see how fast it grows.

And it grows significantly faster than a mouse who has the same exact tumor type, but is living in a really warm, cozy, well fed, well resourced environment. You can see that that cancerous growth in that mouse grows a lot slower.

And so the impact of the stress of living in a chaotic or dysfunctional environment can impact cancerous growth. And we've seen that not just in animal models, but in human models as well. So that's kind of the conclusion of the field in a way.

And of course, there's tons more work going on there, but it really kind of leads to a more important question in my mind, which is like, what do we do about it? Right, like, so there's one thing to know.

And now we have decades of research showing that stress, yes, impacts cancer's growth, but many, many other diseases, mental and physical, as, as well. What. What do we do about this?

Because the world is just stressful and divorces happen and deaths of a loved one happen, and illnesses happen and workplace stress happens. So what do we really do about that? And that, to me is a more interesting question than does stress matter? I think we all know stress really matters.

Yeah, absolutely.

And we find the same thing in the pain science research that stress doesn't cause pain, but it can contribute to pain being a prolonged experience, pain being perceived as more intense, being more complex and harder to overcome. So it's is kind of parallel the findings there, it sounds like.

And I'm curious about how we think about stress versus stressful events because we all know that person who goes through really serious adverse experiences and it's like, I'm good, you guys, like I got this. And we're going, how are you doing that?

Whether they're, you know, have putting up a facade for themselves or other people or not, there are people who manage better and others who are kind of undone by, you know, like my dentist's bill was not paid and those guys sent me to collections and I am absolutely sideways, you know, and someone who's very activated.

Are we looking at how, how someone handles stress or is it more about the adverse experience like bankruptcy, divorce, you know, a child's illness, that kind of thing? Or is it more about how someone handles stress?

Yeah, such a good question. Really. Both.

I think in the sciences we think of there's the, an objective event that can happen like bankruptcy or divorce, and then that would be a life stress stressor and then there's the stress response. How do we respond to it? And in the sciences we're really interested in both because we want an objective metric.

And life stressors or stressful life events actually aren't equally distributed against a population. Some people have more bad things happen to them than other people. That's just objectively true. We see that in the data.

And then there's the point of how do you actually handle that, which is what you're talking about. How do you respond? And do you respond well? Are you adaptive, are you resilient or is that harder for you?

And interestingly, a lot of very compelling work comes out of child development research. And what it shows is that resilience really develops in childhood. And we see a U shaped curve. And what I mean by that is that you want your system.

When you're growing up, when we're raising children, you want some challenge. Because the system, your body, your nervous system, your immune system, your psychological processes are learning how to deal with the world.

And so you have to have some struggles in childhood to learn to develop ways biologically and psychologically to handle and move through challenges.

And so we want this U shaped curve, meaning not too little stress, not too much stress like adverse childhood events that are really toxic for health. And there's a lot of very compelling Research on, on too much stress in childhood being bad for the lifespan.

But we want that middle zone of enough challenge so that you start learning how do you really handle and overcome things that are hard or disappointing or upsetting and that, that then can build resilience in the long run. And I think parents now are really kind of grappling with that as a question like how much struggle is the right amount of struggle? Right?

Yeah, I can attest to that. Absolutely. As a parent of an almost four year old, we call her our three nager. And you know, it's, I want to help all the time. Right.

I don't want her to suffer. I don't want her to be sad or upset. And at the same time, I recognize it's not my job to solve these problems for her.

It's not my job to take away any and all pain that she may experience. I'm so interested in your research on children and resilience and we see that also in the pain research.

Can you, can you give us parents any advice or tips or tricks or books or anything that we can look toward to, to help us kind of find that sweet spot and that U shaped curve?

Yeah, I think like, you know, it's so important right now, especially in our world in which needs can be satisfied just so fast.

Like I think often of like my kids when they have like we have these mini ice creams in our freezer, like these little Trader Trader Joe's, like mini ice cream cones. Have one. Yeah. Like the mini cones are so good. And the reason I wakes up and.

Says mini cone first thing in the morning.

Breakfast.

Amazing. So it must be, yeah, it must be a hot, a hot thing right now. And they always ask for a second, like they always want one more.

And I always think of the challenge of parenting here because for me I'm like, what's the big deal? It's like it's one more. Like I could easily satisfy that need by just being like, sure. And I know it's not going to make them sick. They're small.

I know it's probably not too much sugar, but I have to hold the line and be like, no, like I said, just one. We're going to enjoy just one today. We're going to save the next for tomorrow.

But in our current world, it's just so easy to get everything satisfied so quickly. Like with Amazon ordering or picking up your phone and reading the news quickly, you don't even have to go out and get the newspaper anymore.

Like, needs are so easily satisfied. And really, as parents, we have to be able to develop the skill in children of waiting, of patience, of anticipation, of disappointment.

And so it's beginning with those small ways and really being intentional about it. Like, I'm going to have the boundary of, no, you can't have that second one. And I'm just using that as like a minor example.

But really having the mentality that it is my job to, for you as a child to learn that uncomfortable emotions are okay. Being disappointed in this moment is okay, because five minutes from now you're gonna have moved on. And that. That's what we wanna develop in kids.

And you wanna start really small with no second mini ice cream cone.

And because as we know psychologically later on in life, that one of the biggest indicators of being a resilient person is can you be with uncomfortable emotions? And those emotions get much bigger as we get older.

You know, you don't get the job or you get broken up with, or, you know, you have devastating financial loss or death of a loved one. These things are heavy and big.

And the question is, can we sit with those emotions and experience them and process them and know confidently that we will get through them, we will be okay on the other side.

Kind of reminds me of what Dr. Megan and I were talking about a couple episodes ago regarding the nervous system. And I was asking if there's such a thing as repairing a nervous system or can we ever get our nervous system just to stasis and stay there?

And what it turned out that I learned from her and in that conversation is that we're not. There's really no such thing as stuff stasis. You can't stay in that neutral space, be unafraid of spikes. But the point, the.

The goal is a resilient nervous system, a flexible nervous system, one that comes back after spiking.

Kind of similar to what you're saying, Dr. Croswell, that this, this negative experience or this difficult emotion is not the bat, it's not the enemy, it's the focus, is the ability to bring it back. Can I sit with this and then regulate again after that? Is that. Does that cross over into adult territory?

Is that what we're ideally looking for in a stress response?

Yeah, you really want a flexible nervous system. And now I'm going to bring up some science, and I'm super interested, Dr. Megan, if this is similar or different in your pain world.

But one of the things that makes me think of, I'm talking about flexibility of the nervous system. Like, we want to see we, we really want to be like a rubber band, right, where you're like, you're able to stretch and then come back down.

And of course, if you never stretch a rubber band, you're going to get really brittle, right? It's going to be like a crinkly old rubber thing. So you want to kind of be working that, you know, just like exercise.

Like, you want to be moving your heart rate up and down, similar in life with your nervous system.

And the one thing that I want to highlight from stress science that's super interesting is that in research labs, when we are measuring the sympathetic and parasympathetic nervous system and we're looking at how people are responding to a variety of challenging tasks.

So in our, the stress lab, like when I was at ucsf, we'd bring people in, we're going to hook you up to all this physiological equipment, we're going to challenge you in some way, and we're going to monitor how your system responds.

And what stress science shows is that if we want you to perform at your best, so give a speech, respond to like super hard math questions, or even if you look at really interesting research studies on Olympic athletes, what we see is that when you have a nervous system that has a really huge sympathetic increase, which we tend to think of as something that we want to avoid because it's indicative of the fight or flight response. But what research shows is that when you have to perform at your best, you actually want a really, really huge sympathetic spike.

And that the higher you can get that sympathetic spike, the greater you perform on the challenging task. And what that says to me is that you never want a system that is really state like static or still in a certain place.

You want to be able to have this big spike and these big increases just at the right times, and then you want to be able to come back down. So I don't know, Dr. Megan, is that similar in sympathetic, or are you always trying to avoid sympathetic arousal in chronic pain patients?

Or how does that relate to your work?

Yeah, and that's really similar and I like the way that you talk about it. And really, we're not trying to avoid sympathetic at all costs. I mean, it's important, it's necessary. We all need to be able to go there.

It's great if you can start, know, transitioning into exercise, where of course you're going to have a sympathetic response.

I don't know that the research around the amount of sympathetic response has been done, but there is a fair amount of research about the fact that those with chronic pain, especially those that tend towards a higher anxiety, catastrophizing type of chronic pain, tend to have a harder time coming back down. But the way that we talk about pain has changed quite a bit.

And I think that is a parallel between our lines of research where I've heard you or I've read some of your, your work about, you know, you used to think about stress and pain as sign of a problem or damage, and now we think about pain as a signal. And it's a way that your body alerts you of something to make you aware of something. It doesn't always mean damage or harm.

And it sounds like you're explaining stress in a similar way. Can, can you tell us a little bit more about that?

Yeah, such a good point.

Yeah.

I really think of stress as a signal of, of something and not necessarily something bad.

There's some very cool research that's done in experimental designs where we can change and alter the way that you view a stressor and it actually changes your physiological response. And so this is done by a number of people. But one researcher I'm thinking of is an old mentor of mine, Wendy Barry Mendez, who's at Yale now.

And she's done these really neat studies where you have people come into your lab and there's going to be some stressful thing that they have to do, whether that's take a test or give a job interview off the cuff.

And you can manipulate the person into thinking of it either as a challenge, as something that they can overcome, as something that they're feeling definitely equipped for, but it's a good chance for them to show their skills or as a threat. And you can tell them, you know what this is, this is really going to be challenge. This is really going to be hard for you.

And if you don't do well, you probably won't be successful on the job market after you graduate. And you turn it into something very threatening for the person before they go out there.

And what we see is that the way in which you view and you interpret, interpret the task, the hard task you're about to do directly influences your physiological response to it and your performance on that task. When you can view a stressful thing that's upcoming as a challenge that you think you can overcome, but that will be hard.

Your body actually pumps more blood and oxygen into the brain than it does into the muscles. And what that allows you to do is get more nutrients into your brain and so you perform better.

And that's an Objective research shows that objectively, you perform better if you think of something as a challenge. And so what I've now taken that to mean is, well, what if we can view stress in general as, like, life challenges?

Everybody is going to have something stressful happen to them, whether you're, you know, you get in a car accident, so it's completely not in your control, or you. You are in a relationship that maybe you knew you shouldn't have been in, but you decided to pursue it anyway.

Whether it's inside your control or not, life will be stressful at some point. And by accepting and acknowledging that we can, we can then say, well, what do we do about that?

Well, what we can do about it is say, how can I learn and grow from this? How can I treat this as a challenge that I can overcome and I can learn and evolve? And in fact, it's kind of like a very basic idea.

It's just like, maturing and getting older and wiser. Right. But in society, we've forgotten that. And so I think there's so much narrative around, like, getting rid of stress. And like.

Dr. Megan, you said it's like a sign that something's wrong, especially to our kids and our teenagers, Right. Versus telling them, no, life is hard, right?

And.

But you can overcome it. Like, it. It's okay. You'll learn. You'll do better next time. That's how you learn and grow.

I think it's so interesting to hearken back to when you're talking about public speaking, which I've had to do a lot of in my career, and at one point, my job required public speaking every single Thursday with a different script. And so that was. Let's just say that was my propranolol year. Beta blockers, anyone?

Yeah, but Dr. Croswell, they would tell us, you know, the coaches and people who would kind of prep us for this kind of thing would say, when you're feeling nervous about going on stage, convert it into excitement and go, oh, my gosh, I'm so excited about what's happening, and never worked for me. But is that kind of. The idea is that we want to use techniques or find a technique that can actually trick our brain?

Do.

Is that what we want to do? And, you know, is it a matter of tricking or is it a refrain? Maybe a better word is reframing.

But essentially, is that what we're trying to do is kind of distract the brain and go, no, look over here. Look at the bright side.

Such a fine line. I think in what you just said you're pointing out kind of the pluses and the negatives of this approach.

So what you're talking about psychologically is called reappraisal, where you're reappraising or you're reconsidering a new way of thinking about something. And that's really the foundation of neuroplasticity, of how we change our thoughts and our mind. Yes. Reappraisal is incredibly powerful.

So thinking, tricking your mind in some way.

It's like, oh, I didn't like that guy anyway. You know, he dumped me.

I'm like, this doesn't matter anyway. Like, it's all good, you know, no one's gonna remember. You know, you know, it's. There's different ways you can kind of coach yourself into.

Into a mindset or this is a good challenge. And I'm still learning and I'm practicing, and I'm gonna get better each time. And this is kind of fun, right?

And there is definitely a similar physiological feeling of anxiety and excitement. So we can. You know, there's a. There's another study. I think it's called turning. Turning Butterflies into Bows or something.

Some catchy name of the study title. But it's basically reappraising that feeling of butterflies in your stomach as energy.

Really, physiologically, what that is, is it's blood leaving your stomach to go out into your arms and your muscles and your. In your legs and your arms and up to your brain. And you're feeling and sensing that blood literally leaving your stomach.

That's why you feel that way. But actually, that's a great thing because you need. You don't need to be digesting in that moment when you're giving a talk.

You need your blood flowing to your brain and to your muscles so you can perform, so you can re. That's one example of a reappraisal, right, where you can think of that. That feeling of butterflies in your stomach as like, okay, this is my body.

This is my body. Getting excited to really perform at my best with all that.

There is a really important caveat here, which is we're talking about kind of manageable challenges, acute stressors in our life that are, in this case, chosen by us. Like, I'm going to go up on stage and I'm going to give this talk.

There are a lot of other major life stressors, like, let's use a cancer diagnosis, where we really have to be careful around the reappraisal. And as a society, this is actually something we struggled with as A group of people.

Because often we'll say things like, you know, well, at least, at least it wasn't worse, at least it hadn't spread further. At least you live right near a hospital. At least you cut it early. Right?

All these at leasts to try and get somebody to see, like, well, it's not that bad. And that can feel really invalidating to the person who's just received this very life changing diagnosis.

There was a beautiful book written about this exact thing in the cancer world called the the Bright side. And it was talking about cancer in particular, how we as a society really treat it.

Like, if you could just think positively, you know, if you could just think of it as like a battle that you're going to win if you're strong enough. And that can really harm patients. Because while a positive mindset can be helpful, controlling cancer is not about the mind. Right.

There's a lot of bigger factors than, than just that.

And so we would never want to tell somebody and kind of take away the intensity of the experience by telling them to just reappraise it in a bright light. So there's nuance here, right? It's not so simple.

Yeah. That reminds me a lot of, you know, in. In pain research.

Twenty years ago a book came out called Explain Pain and we thought, oh, if we can just explain pain to people, then they'll have this cognitive reframe and their nervous system will come back to regulation. And yeah, here's Holly's copy.

Interesting. Yeah, right.

And the rates of chronic pain were 20%, you know, 20 years ago when this book came out. And the rates of chronic pain are 20% now. And you know, it's. We've gotten better at explaining pain.

We've gotten less kind of Pollyanna look at the bright side. But then there are. I also see things with, you know, pain reprocessing therapy, which to me feels very dogmatic.

It feels very like, just think differently, unlearn your pain. And you know, if you're not doing that, then you're not trying hard enough.

And that, like you say, can be very dismissive, very disheartening for someone who's been in a chronic long term situation.

Yeah, yeah, absolutely.

When stress is something that is unavoidable and it's.

Do we categorize, for example, work stress, like the kind of stress that is present in the infrastructure of life, it's baked in versus having a, a jerky boyfriend or a, you know, a difficult next door neighbor. Those things may or may not happen to. But if you drive a car, you're going to end up in traffic.

If you have a job and someone pays you to do a job, I don't care what it is, there will be stress. If you have a husband, there will be stress. I say that one.

Or a spouse of any kind. Yeah.

Be slightly teasing. Are you thinking, etcetera, Differently about those things? And do you coach people differently on how to manage stress in these sort of inevitable.

Like waiting at the dmv? Is that a different kind of stress than a life event like a cancer diagnosis or a financial trouble?

I tend to not think about it in the type of stress, and that's because human beings and our lives are just so complicated. So let's say it's work stress. So you think, oh, shouldn't you know, everybody has work stress?

But for that person, maybe it's work stress coupled with financial pressure, coupled with a really long physical commute that's now adding to some pain, coupled by if they quit this job, they're out of health insurance, and then their kids don't have any health insurance. So it's so layered. Right.

And so instead of looking at the type of stress, I tend to look at the person and how are they able to cope with it, and what do they really need? Whether it's mindset shifts, like the reappraisal we talked about, whether it's true lifestyle change.

So one of the biggest things you can do when you're in a toxic or really, truly chronically stressful experience is change your environment, whether that's quitting the job or making a move or ending a relationship, or is it kind of more daily habits?

So are there other health behaviors that we need to put in place, whether it's sleep or getting rid of alcohol or getting more movement on the body or dealing with true anxiety and dealing with it in a. In a medication way, you know, are.

What are the ways in which we can support the person so that they can get through this stressful time and overcome it and grow from it and become stronger because of it.

You make a really good point about kind of the compounding of these different factors.

And that's what in part makes it so difficult to study people in stress, because we all have these different confounding variables or contributing factors that make it a very individual response. And I like that you talked about sleep there. Can you talk a little bit about.

We've talked in the past on this podcast about sleep and its crucial role in managing chronic pain. I understand some of your work also Focuses on deep rest. Can you talk about that and the connection between stress and sleep?

Yeah, for sure. So one of the ways that we kind of differentiate different experiences of stress is really between chronic and acute stress.

And a lot of the work has been done in the field around people living in chronically stressful circumstances. Because what we see is it's the constant wear and tear of living in a very stressful life that has the deep effects on physical and mental health.

So all of us can go through stressful things or stressful experiences, and that doesn't necessarily put us at a greater risk for cancer, diabetes or heart disease or depression. But there's a significant number of people that live in environments in which the stress never goes away. And we call that chronic stress.

And some of the foundational work from this has been done in caregiving groups.

So whether you're caregiving for a family member with Alzheimer's disease or a disabled child, there's some very compelling work by a mentor of mine, Alyssa Epel at ucsf.

She had one of the very foundational pieces of science showing that chronic stress leads to accelerated cellular aging as evidenced by telomere shortening.

And in that study, she had a group of women who were in the Bay Area all caregiving for a child that was about middle school age who had an autism spectrum disorder diagnosis. And she compared those mothers to mothers who were caring for the same age child living in the same area of the same dmi.

And, you know, we equated all the other things in their lives who were caring for a child of neurotypical development.

And you could see that they, at the level of their cells, they had aged seven years faster, the women that were under the caregiving stress than the other mothers, seven years. And so that's seven years. And they were, you know, I think, average age, 42 young women.

And what that shows is it's that never ending and unrelenting chronic stress of caregiving that has a wear and tear on the body.

And so me and my group when I was at UCSF were really interested in really understanding how do we help people that are living in these chronically stressful circumstances where you can't get out of it, right? Like this is your duty and responsibility.

And this is very relevant in particular now with our aging population and people that are caregiving for their elderly parents and especially dementia and Alzheimer's, as people are living longer, but their brains aren't able to kind of sustain the acuity that they used to.

And so what we have found is that one of the most important things that you can do if you're living in a chronically stressful life circumstance is allow your body enough rest and recovery. And that's because what actually is happening when you're in a chronically stressful life circumstance is that your system is on high alert.

What I mean by that is that your whole body is activated nearly the whole day.

In this state of always on guard, always having to know and predict and plan for what's about to happen, respond to something that you didn't expect to happen. So you're on high alert.

We call it exhausting.

And it's exhausting. It's cellularly exhausting. And we know that now from this great researcher we collaborated with named Martin Picard, who's at Columbia.

And he founded this field called Stress Energetics. And it's really about what happens. He's a cellular microbiologist.

What happens at the cellular level when our body is under that much activation and it really depletes our mitochondria down to the level of an empty battery.

And so then the problem with that is that there's no energy left for basic repair and reconstruction that the body needs to do to maintain our physical integrity.

And so the only way to actually counteract that chronic stress is to give your body enough rest and recovery time so that it's able to do all the really important cleaning and repair mechanisms that just have to happen in order for you to be a healthy, functioning person.

And those repairs happen during sleep for all of us, right?

Yeah. So the number one time that that's gonna happen is during sleep. It's not the only time, but it is the best time.

And of course we're also in an epidemic of sleep right now where nobody's getting enough sleep and definitely not enough high quality sleep. So there's a lot of factors at play here that are really stopping us from allowing ourselves to activate their natural healing capacities.

I was gonna share anecdotally, cause this is really so profound and compelling. And for our listeners who are living with chronic pain to just take note, especially to what's being said here.

I think that the chronic stress, I won't compare it to even on the same stratosphere as having a child who's challenged or ill or a parent who's dying. But the day to day stress of my career prevented, I think, my shoulder from ever getting past chronic pain.

I was in pain throughout my entire career and I left my corporate job about three years ago. And this is the best my shoulder after eight surgeries and 27 years of chronic pain, this is the best it has ever, ever felt.

And funnily enough, I ran into my old boss, my very difficult boss at an event not long ago, and he said, you look. Well, you look, I mean, just even your face, I can tell you're not, you're not in pain. How are you doing? I said, I feel fantastic.

And he said, what have you done? What, what vitamins are you taking or what have you? I said, I, I, I teasing that away from you. Said I stopped working for you.

And he's like, oh, gosh, I'm so sorry. So this isn't about making it about me or about saying, you know, leave your job, because a lot of us don't even have that, that luxury.

But when we find ourselves in a chronic state where things aren't getting better, sometimes it goes back to what you're saying, Alexandra, about a big life change. And it doesn't often feel like it's going to be possible. But if nothing changes, nothing changes.

Right?

I mean, you know, that's the deep thought for the day. But I'm curious if you have. Has your research crossed over into the, the physical expression of that chronic stress?

And from the I'm not getting, well, my body's not healing as you've just described, even to the, just, hey, my neck and jaw always hurt when I'm stressed out, where it's just maybe because of a posture, a stress posture holding. How does the chronic stress research world think about pain and interventions thereof?

Yeah, it's such a good question. I mean, it's a very meaty, meaty topic.

And it's crossing over into kind of some of the work of Gabor Mate, who I know is very popular right now, and the books like the Body Keeps the Score, for example, and this concept of like our body kind of holding on and Dr. Megan, I'd love to hear kind of what the pain world says about that. The stress science world tends to believe two kind of maybe contradictory things at once.

Like, one is that stress is not stored in a particular place in the body. There's no evidence scientifically that like the hip holds the emotion.

And then I'm in a yoga class and you know, the hip release is supposed to release all this, these emotions, which my personal experience, I'm like, oh, that makes a lot of sense.

But, but scientifically, you know, there's, there's not really evidence for that concept that the body would hold, that would hold the stressor in a certain place in the body contradictory, contradictorily.

There is for many decades one of the best, most evidence based stress relieving protocol is progressive muscle relaxation where you squeeze and tense your muscles and then gently release them. And you do that throughout your body.

And the idea there would be that you're creating your, you're allowing the tension to exist in the body that we feel when we're under stress and then intentionally releasing it. And that is if you just look at the number of publications on the interventions for stress relief, that is the number one most evidence based one.

So that's suggesting that our muscles really do hold the tension at least maybe not in a particular place, but we do respond with tension and then we need to learn to release, release that in modern life in order to feel that, that stress relief.

Yeah, I would say the pain science world has similar lines of research. There was a recent article that got a lot of attention that came out that said, I believe the title was the body does not keep the score.

And it was like we told, you know, the research world said we told you so.

And you know, the, the more holistic sort of practitioners that use manual therapy to quote unquote, heal your trauma and release your demons said nuh, you know, you know, Descartes has entered the chat and we knew all along that you guys didn't believe in the mind body connection.

From where I sit as a pain researcher, yes, there is not, you know, your childhood abuse in your hamstring, but something about the way that that happened and the way that you moved maybe became associatively, subconsciously connected.

And if I go in and I have a certain type of touch that activates a C tactile fiber, you know, you get a subconscious reminder of that and maybe you have an emotional response response. I haven't released your trauma, I haven't solved your problem.

But I've most likely brought something that was in your subconscious up to your conscious awareness and so that you either remember it or you are able to do the work of processing it. And that's where I love to have, you know, a mental health practitioner on board.

And if things come up in sessions and treatment sessions with me, then we dialogue about it and we, I'll dialogue with somebody's mental health practitioner as well just to kind of make sure we're all bases are covered.

Yeah, I think that makes a lot of sense. I think it is in my world there's sort of the science and then there's the practice.

And what I have tended to see is that the Practitioners are out there like getting data and they're testing things and they're not as tied to the rigorous standards. And so they're able to explore and experiment and see what works and for whom.

You know, a big issue in the sciences is like, we're looking on the average, we're not looking at what works for you, we're looking at what works on the average. And I view that as a huge barrier because we're not averages, we're just us individuals. And so what I always put it back is, is back into the person.

Like what? Well, what works for you?

Like try and see what feels good, what feels healing, and follow that thread instead of just relying on what should work based on the averages.

Yeah, and I agree. I think that that is really important. And we're doing data collection every day, you know, informally.

And we have to remember as practitioners that we are so incredibly biased.

And I talk about how, you know, if you had five people in a row that day and they all had an emotional response to your manual therapy, you start to look at your hands and think like, am I magic? Right. Am I a healer? I think it can easily, you know, sort of go that way.

Yeah, hence the influencer brigade.

Right.

That's taken over and you know, self proclaimed healers and so forth, which, you know, if there's a psychological component that I think is being supported there, that's great. But we really worry about vulnerable people who are just, you know, putting their hands, their lives in these people's hands.

But, you know, and that, that actually brings me to a question for Dr. Crosswell about all of these modalities and these, these things that we can do.

I think it's so common for those of us who do research and who share tips and tricks with friends to try lots of things to rid ourselves of stress and, or chronic pain. And those things could range from acupuncture to talk therapy to practicing Tai Chi or. Right, that it's just a huge, huge, huge world.

Are we sometimes pursuing those things at the expense of the basics, the building blocks, the food, the sleep, the sunlight, the exercise?

I'll be totally honest, I'm more likely to go to an acupuncture clinic and buy a five pack of acupuncture than get to bed at a decent hour and friggin put my phone away in another room.

And sometimes when a friend, you know, or a peer has chronic pain or chronic stress or, you know, likely the two writing together, they're like, I've tried this and I've Tried that. I've tried that. And you know, they go to bed every night at 12:30pm and their alarm goes off at 5:45.

And you want to say you're never going to get there with a, you know, a sound movement class. Hate to break it to you.

So how do you, when you, when.

You're working with individuals, whether they are high performers or, or not, how do you think about getting people kind of to the fundamentals versus trying all these things that are available to us?

Oh, it's such a good question. I mean this is like the ultimate question of, of health, behavior science, behavioral science, you know, for, for many decades.

Like, how do you get people to do what they intellectually know is good for them? And we're just like human beings responding to all of our urges and desires. Especially like on your phone at night.

And there's so much interesting stuff on there that you got to read. So yeah, it's such a good question.

I definitely agree that especially, especially regarding chronic stress, the fundamentals, I'll often say that's where you have to begin.

You have to begin with the, with the movement doesn't have to be intense, but have to be moving your body, sleeping, eating regularly nutritious foods and low or no alcohol because alcohol is a depressant. Alcohol can spike your blood sugar. There's many reasons for that.

And so if you can just, if you're in a chronic stress state, starting with that can be huge. The thing that I really have found to be helpful in this narrative is that is really focusing on each day.

So instead of saying, okay, from now on, I'm going to bed every day at 10, at 10pm and then you blow it one night. So then you're like, yeah, forget that plan. Instead it's just focusing on each day. Like, how can I make today a good day?

Like, life is hard, work is hard, or relationships are hard. Whatever's going on for you. So what can I do today to set myself up for a good day?

Okay, I'm going to make sure I get outside and I'm going to do, you know, a 10 minute walk. And even if you're, even if the day feels too big, you can go to the hour. Like, okay, what can I do this hour? I'm going to get this one thing done.

I think it's one hard phone call and I think kind of shortening the time frame can help us just do the right thing for ourselves that day. And the other thing I really try to focus on is really listening to yourself.

And knowing that it's your body, the ultimate barometer, and that's a skill to develop on its own. Just how do I feel? Like, do I feel good? Do I feel like waking up tomorrow morning and going to a 6am workout class is going to serve me?

Or do I feel like I really need sleep? Like, what is my true answer for me? Not because, you know, the LinkedIn CEO said, oh, I wake up at 5am and meditate for three hours or whatever.

Like, and I think I should be doing that. It's like, no. What works for me today is the question we should be asking ourselves.

That really breaks it out and makes it achievable on every day. And if we kind of. I at one point had turned it into some sort of an acronym like a mnemonic that was like, these are the things that I need each day.

And I think that that could help people is if they make some sort of a list of like, you know, F E s, like, you know, Fess Parker, he was. Well, now, okay, well, my brain's going in blitz. It's methad. Okay, never mind.

Come up with your own mnemonic.

But you know, where it's like food, exercise, sleep, right? Fes Fes Fes. And to your point, you don't throw out the baby with the bath water.

So if you didn't get your walk in, if you didn't, you know, if you ended up ordering a pepperoni pizza for dinner, you are not throwing out the whole playbook. That's just how you showed up on that day. And tomorrow is another opportunity to start fresh.

But yeah, I mean, I'm really fascinated by the crossover that the both of you are doing.

And I think this is something that we have to continue to talk about and stress being inevitable and showing up for sure in the lives of people living with chronic pain has never helped.

I think one thing probably I want to hit on is just validating that just the world in which we live in is just so overwhelming. If you are somebody who is really overwhelmed right now by your life and the world, I think that's the majority of people.

The level of uncertainty that we are experiencing across the globe right now through because of politics, economics, technological change, like, it is unprecedented how much uncertainty there is. And so if you are feeling that, then know that it makes sense. It's not just because you're not resilient enough. Like, the world is uncertain.

And the question for all of us is, given that, how do we take care of ourselves? Like, what really do we need to do to care for ourselves. Because uncertainty is just biologically hard for our bodies.

And so we have to be aware of that and do things that make us feel safe and create ease and create recovery times for us.

That's a really powerful reminder about it's not just stress, like in this sort of giant capital S word, but the flavor of stress that a lot of us are experiencing now is the uncertainty. That flavor of stress feels particularly daunting and our brains can't fill in the blank.

Right.

It's like going back to what you were saying, Dr. Croswell, of if I can reframe something or re approach something, I may have a path closer, excuse me, a shorter path to sort of recovering from that stress. But how are we supposed to reframe uncertainty when we don't know what's on the other side of something? That's really difficult.

That's hard to tell yourself, hey, I'm just excited or, hey, I'm just learning a lesson or at least I'm out of that toxic relationship. We're kind of like, I don't know where the other shoe is going to drop, where it's going to drop and what size it's going to be.

And so I, you know, I think that's a really powerful and important reminder that you're giving us. And you know, something, I think that Dr. Megan and I are going to be, you know, we maybe need to have a whole episode on uncertainty.

And similarly, you know, finding ways that you can feel safe can be incredibly helpful for pain as well. We talk a lot about threat detection versus safety.

And so a lot of the things that are going to work for stress, progressive muscle relaxation, visualization, are that similar things at work for pain. So I think it's kind of nice in that you can get two birds sometimes. And yeah, the, the uncertainty is, is really challenging.

And I think reminding yourself of times when you, when it was uncertain and, and you overcame, I think that can be one strategy. Is that, Is that true, Dr. Crosslow?

Yeah, definitely. Like remembering your own resilience.

And then another one is from acceptance and commitment therapy, a very well established and highly utilized modality in clinical psychology, which is really about accepting reality for what it is.

And like, the reality is we don't know what's going to happen with climate change, with the political environment, with AI and the future of machines and human interaction.

And so the skill to cultivate is really being in acceptance of that and being able kind of back to the beginning of the conversation to be able to sit with that discomfort and say, like, I have to accept that. I don't know. I don't know what's going to happen. And that is uncomfortable.

And what can I do today to care for myself, to connect meaningfully with loved ones, to find compassion for myself and for others, like, for all the goodness that exists right here in this moment.

That is a really awesome reminder. I'm so glad. Like, we should kind of close. Ish on that note, because it's a really powerful reminder.

And if you'll allow me, a quick little anecdote again, is that as the war began in March in Iraq, and of course, it's just piling on, right? That's just a hundred thousand things going on before that. I started to feel as though experiencing joy was actually inappropriate.

I went through a little phase, and maybe some people listening can identify with this, where people were suffering. You're watching people on the television, bent over, bodies covered in ash, screaming.

And who am I to say, let's go get ice cream because I want to remember joy or because I want, you know, and that was something I really felt was inappropriate. I was in a state for a couple weeks of just, you need to stay down in this place. You're, you know, it's like the Taylor Swift song down bad.

Like, I'm just gonna stay down bad. Like, this is just where I am. And, you know, I think we have to allow interventions to come along.

Let someone, whether it's your pastor, a friend, a neighbor, a book, the sunshine itself remind you that just as the difficulty will always be part of life, so is the beauty. And so if you're going to taste the difficult, taste the joy also, you know, let that in. That's some of the most powerful medicine that's out there.

We're so grateful to you, Dr. Croswell.

We're going to make sure that our listeners know how to find you and your website on our show notes page and, you know, be able to ask questions as we continue because this topic is just so major and you've contributed so much to us today. Thank you very much.

Yeah, thanks so much for having me. And I hope that they'll check out my substack where I'm writing more about just how to be human in this uncertain world.

But thanks so much for this great conversation, Holly and Dr. Megan.

Oh, great. Yeah, we'll make sure people have a link to that. And yeah, Dr. Megan, thanks so much as always.

And, you know, we like to wrap up again with the positive to say if you are still breathing.

You can change your brain and you can change your pain.

Thank you so much for listening to this episode. We appreciate your tuning in and being part of the Unpacking Pain experience.

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You can get in touch at [email protected] and we'd love to hear your thoughts or questions, your stories, even topics that you'd like us to cover in a future episode. Together, we're all fostering community as we shed light on the realities of living with chronic pain and discover new ways forward.