Slavich on Stress: Complexities, history, and future

pieces for actually making that connection. I'm your host, Ryan Brown, and I'm a social health psychologist working with the stress measurement network, which is a team funded by the National Institute on Aging and includes internationally recognized stress experts from UCSF, UCLA and Yale in today's episode, I'm joined by Dr. George Slavich, an Associate Director of the Stress Measurement Network, George does an excellent job of highlighting specific scientists theories and

papers that might be of interest to listeners, but we don't want you to feel like you need to be taking notes or anything like that, so we've linked all of those references in the show notes for you. Specifically, we talked about the history of how stress exposures have been conceptualized with a focus on key theories and perspectives around stressful life events, before we turn to the kind of research that will shape the next decade in stress science.

We're joined today by Dr George Slavich, who's a professor in the Department of Psychiatry and Biobehavioral Sciences at UCLA, where he's also the Founding Director of the Laboratory for Stress Assessment and Research. He has outstanding expertise and enthusiasm for bettering the conceptualization assessment and management of life stress, and for identifying the psychological and biological mechanisms that link stress to

mental and physical health. George has received numerous awards for his research mentorship and teaching, and we're so happy that he brings this experience and passion for precision stress science to the stress measurement network. All right, welcome George. We're so happy to have you here today.

have already been brought up. So I really hope that this and future episodes will support anyone who's interested in stress science to feel more knowledgeable about our history. And I can't think of anyone better to walk us through this history than George, who has both so much knowledge on the topic and is really engaging to hear from you can really feel his passion for advancing stress science and knowing where we

came from in our history. So George, I would really love to hear your perspective on how stress science started and where you see it going.

title stress puzzle, the stress puzzle. And obviously, I think the history of the conceptualization of stress is perfectly captured by this metaphor of a puzzle insofar as there seems like there are 1000 different pieces, each piece has a different approach, a different framework view on the conceptualization of stress and and we do, in fact, see that if we we look back 200 years with all the key players that have been woven themselves into this fabric

response. When somebody else use says the word stress, they may refer to some kind of life event like a divorce or hearing bad news or being physically attacked, and so we honestly see that colloquial use of the word stress play out in all the conflict and confusion that's present in the scientific literature.

that kind of stress. So it's interesting to see the development of this concept and how far we've come to now, this point where we have such a large focus on stress in the process of diseases.

universe. I think, I think what you're picking up on is that not, not at all times during the course of human history have we been totally comfortable looking at ourselves in the mirror, I should say, looking at our psychological selves in the mirror. And so I do feel that you're right on point that in sometimes we've sort of swung to this, well, if it's not a physical stressor, then it's not relevant for human health and

well being. And at those time points, we have sort of focused on physical stressors as being the only things that you know could impact the brain and the body. But there's no shortages of early, you know, early roots of thinking about how the challenges, you know, of the social environment impact,

impact mental health and well being as well. It's really just that there are so many different traditions that are woven together, and of course, that the term is used so permissively as to essentially render itself totally useless.

visibility of the effects of psychological stress. It really is striking that those early studies of things like Shell Shock initially were a little bit dismissed because there wasn't something you could physically point to and so soldiers would be sent back into war. And I wonder if you see places, or if there are any pivotal moments in history that stand out to you as affecting how comfortable we are with acknowledging the psychological element.

responsibility. You know, there's a certain part of our psyche I think that wants to relinquish control to more macro factors or to the gods of the world, so that, you know, we feel like we don't have to be the one in charge of doing something about it, and I love the examples that you gave. So as soon as you recognize that shell shock and PTSD are a thing, then all of a sudden it's the onus is on the military leaders and the mostly men in power to not send, you know, our

young men and women overseas to fight senseless battles. Once we recognize that the stress of a of a interpersonal relationship has been grinding on us for months or years now, we have to ask ourselves why we didn't get out of it sooner, if we're stuck in a high interest mortgage in a house that we love, but that's dragging ourselves down and our relationship down. Now the onus is on us to get out of the mortgage and make difficult decision of moving somewhere else. So I just think that life

is rife with examples of how stress is complicated. And as soon as we say yes, in fact, stress is terrible, by the way, not that it is always terrible. We will get into that soon, I imagine, but once we realize that, you know, the negative life events or chronic stressors are problematic now, all of a sudden, we have the responsibility to do something about it, and that responsibility is something that we don't always like to have.

are as many perspectives and definitions. So I think just to get that off the bat, there is very little consistency, which I talk a lot about in my writing, around different conceptualizations of stress, I would say that the rule of thumb is that there's general disagreement and non overlapping definitions. So we can, you know, go back to sort of modern,

modern thoughts. You know about stress, and that's, let's say, around the mid to late 1800s you know, we have the early origins thinking about Charles Darwin and Claude Bernard, they, you know, they were really the first to describe in any scientific sense, how it is that humans and other mammals, other organisms, you know, really the part of the ongoing challenge that life course is this adaptation to ever changing environmental circumstances. So, of course, that's, you know, when we think

about stressors, right? You have a psychological or physical

stressor, and now the organism has to adapt. And then later on, we think about, you know, in the late 1890s there's Sir Clifford Allbutt, who, you know, talked about how the modernization, industrial revolution were really impacting people's psyches, causing nervousness, disability, hysteria, frightfulness, and then the turn of the century, 20th Century, Walter Cannon is really talking, I think, for the first time, about how emotions really have specific physiological

consequences. So in some ways, we don't maybe think of cannon is like a prototypic stress researcher. But you know, he really brings into this narrative the connection between thoughts and emotions and physiology. And of course, as stress researchers, we care a lot about how our thoughts and

emotions affect our physiology and in turn, impact health. And that really sets the stage for, you know, one of the key players, I would say, in kind of the classic models and frameworks around stress, which, of course, is, is Hans Selye. And there's a there's a lot of reasons why Selye is so impactful, even on our current thinking of stress. First of all, he, he was extremely prolific. You know, he wrote 39 books on stress and related topics. He published almost 2000

articles. So by any standards, you know, he would have had an incredible impact. But you know, his work was also very experimental, very careful, and in some ways, you know, he did the most to advance stress research, and I would say in some ways, he also did the most to hamper our current

understanding. And the reason that I say that is because he's really famous, in part, for saying, you know, that that stresses the non specific response of the body to any demand, and that stressors are, quote, unquote, that which produces stress. And sort of this circular reasoning, really, I think, has pervaded our thinking today, we don't have

clear boundaries between stressors and stress. And defining stressors as anything that produces stress, you know, is something challenging to grapple with, and the biggest problem is really just, you know, his non specific conceptualization of the stressor construct, and that has

really lingered. You know, we generally still talk about stressors as all having an equivalent impact on physiology, and we do not do a good job of identifying different types or dimensions of stressors that might have different physiological consequences.

apt description. And you know one thing that came up for me when I was thinking about this episode and reading back on these figures, given how much we link stress to, you know, something like IBS or general stomach issues, I found it really interesting that Walter Cannon's son, in writing the biography for Walter Cannon was writing about how cannon was really interested in peristalsis, and was studying that wave like motion and how that became disturbed when a cat

was distressed or alarmed. And so that idea of emotional effects on internal functions, and how many of these early studies of stress were. Not necessarily focusing on stress, but another process, and the way that you go about handling or animals really highlighted the way stress is affecting their physiology. That has just been standing out to me since we talk so much about, you know, IBS girlies and the stress there.

mathematical. You know, we have so many of these conceptualizations, you know, sort of after the days of Selye, Holmes and Ray, Seligman approach, Lazarus and Folkman, we can talk about all these, you know, they're, they're sort of striking to me in the sense that they mostly, okay, well, these are all very smart people, so no disrespect intended, but, you know, we've all done, myself included, you know, a lot of

armchair theorizing. You know, it's sort of, you know, taking a step back and trying to imagine what the contours of psychological stressors are without, let's say much, you know, mathematical reasoning behind it. I mean, actually, part of that is sort, sort of was my impetus of, you know, introducing Social Safety Theory. I'm not a mathematician and, and, not to be misleading, there is no math in Social Safety Theory. But what I tried to do there was sort of think about.

do have its mathematical principles. Thinking of that is is beyond my capacity, but I do think, like what we would do, well to do is to move sort of closer to saying, you know, what are the, what are the systems that are relevant for understanding psychosocial stressors, and you know, what are the dynamics, the regulatory logic, or the Mathematics of

those systems. And if I think if we could characterize that, then we would probably have a much more concrete understanding of the physiology, and I think then we would be able to arrive at much, much more well grounded theories of stress at the psychological level?

external contours of the human skull. So, so essentially, I think that's what we've been doing in stress research for a long time. We've had very poor measurement of stress as a construct, and as a result of that, we've only been measuring the external contours of the stress construct. And as a result, we have theories and definitions of stress that are only as sophisticated as our measurement tools allowed. So in phrenology, of course, you're measuring the contours of the

skull. So how on earth could you do any degree of accurate brain mapping? Right? You fast forward 150 years now you have structural and functional fMRI, and you see how far human brain mapping has come in a period of 20 years. You know, we now, we don't have these totally ungrounded, silly notions of the way in which the brain is organized, either structurally or functionally. So, you know, I argue in that tongue in cheek stress, the stressnology paper that you know, essentially

stress research needs its fMRI moment, right? If, if you can't, if you can't image the stress construct in high resolution. Then the theories that we will inevitably have about, you know, about the dimensions, the contours, the nature, sort of the, you know, human brain mapping, version of the stress construct, then they will be really poor. And, you know, we see this in, you know, sort of the last, I don't know, seven.

70 to 80 years of all of the different ways in which we have defined the important aspects of stress just based on associations between life events and a variety of outcomes, while totally ignoring the biological dynamics that un that underpin those associations. I think that has something that's really hampered our progress.

right? You know, we've done the other way around for a while, but seeing folks be thinking about how inflammation may be affecting social experiences or behaviors or affiliative behaviors, you know, work coming out of Keely Muscatell's lab, I think that gets us a lot closer to a, you know, more responsive and responsible consideration of these factors that are playing together, even if we're usually looking at them only in one direction.

painted all over our personal lives. You know, when we're when we're sick, we, you know, we might feel anxious, we might feel hyper vigilant, we're probably pain sensitive, usually, we, you know, we don't like engaging in social, affiliative behaviors. You know, we seclude ourselves. We're not motivated. We don't, we don't, you know, we don't, don't want to seek out fun things. We're mostly anhedonic. We don't, you know, we're not, don't feel sexual. All these quote,

unquote, sickness behaviors are totally adaptive. If you have, if you have a communicable disease, then it's best for the herd, for you to not be socializing, you know, to not to not, not be motivated to socialize, because, you know, shouldn't pass that, that communicable pathogen on to other people. And also, there's, of course, the benefits of general malaise for, you know, recuperation and recovery. So all you know, all of these sensations and motivations you

know, that change dramatically when you're ill. But I totally agree that, you know, we've, we've mostly studied kind of top down regulation of immunity, much more so than we've studied, you know, sort of immune regulation of psychology and behavior. And, you know, at the end of the day, it's both, right these it's not one direction or the other. I think we I think we really need to understand both directions.

change got rated the highest score. So, you know, you go down this checklist, you check the number of life events on the screener that you've experienced. Each one of those life events has a quote, unquote, change score associated with it. And after that, you know, so you have five life events. You you do a summation of the change scores associated with all of them, and that's your quote, unquote, stress

score. You know? Sure enough, that's so the more change upheaval you have in your life, the more stress you've experienced. Okay? What about Marty Seligman? Controllability, escapability, right? Marty Seligman, especially in the 70s

and 80s. You know, he was doing this work that was leading to these helplessness theories of depression that turned into helplessness slash hopelessness theories of depression, along with Meyer and Weiss, you know, he really tried to say that those stressors that are less controllable, less escapable, were, you know, at the heart of what makes particular stressors more versus less stressful. We come back to California and the

Bay Area, you know, we have Lazarus and Folkman. They're really talking about such situational demands of stressors interacting with an individual's ability to adequately cope, right? So you have, you have more situational demands, but somebody who can cope really well with them, they may be more resilient, but then you have more situational demands and inability to cope. Okay, that's going to be probably, you know,

lead to less resilience and more illness. And then, you know, there are a few people who are not necessarily stress researchers, but I think their concepts have been really impactful for the conceptualization of stress, like Aaron Beck, the father of CBT and Cognitive Theory. He had these ideas around life events, stressors. And, you know, he

binned them into interpersonal versus achievement. So interpersonal stressors, you know, involving like intimate relationships, achievement stressors, sort of work related stressors or education related stressors. And he brought in the really interesting idea, which is kind of a diathesis stress idea, that you know, a person's likelihood of breaking down is going to be increased when the nature of the stressor maps on

to a person's specific cognitive vulnerability. So, for example, getting fired is going to be the most worse for somebody who has negative core beliefs that lead them to be rejection sensitive.

So getting fired, in general, is bad. But if we're talking about like the magnitude of the association between getting fired and the onset of depression, then the person who has the negative cognitive schema that they're not good enough is going to be more likely to become depressed when they're fired compared to the person who doesn't have that negative cognitive schema. And okay, I'll just mention two

more. Paul Gilbert, who I also don't necessarily think of as a card carrying stress researcher, you know, but who's done, you know, some of the most elegant work, I think the thinking, you know, he focuses a lot on social conflict, conflict competition and the importance of social psychological characteristics of interpersonal stressors. You know, stressors are stressful if they reduce or have implications for social status, social rank,

value or regard. Talks a lot about, you know, defeat. That is also a construct. I think that has come up a lot in animal model work over the years. And then we have George Brown and Tirril Harris, who developed one of the most high quality systems for assessing stressors, called the Bedford college life events and difficulty schedule, or leads, for short. And you know, they really had brown and Harris had this concept of cognitive upheaval or disruption in relation to an individual's

goals, plans or aspirations for the future. So if you have a life event that really, you know, throws the throws the top off of its access and requires the person to sort of reconceptualize and reorient their goals, plans and aspirations for the future, then those are the types of stressors that are most stressful.

have really informed your work the most. And I guess another sort of piece of this question that maybe is maybe a more critical view of of some of these theories that you know, because I think about so I'm going to come back to the question of how it's affected your work, because this was just kind of bubbling in my head as you were speaking, which is that, you know, in our intro psych classes or early in grad school classes, you learn about these theories, but you don't

always hear exactly how people are thinking about them more in the more like updated, modern sense. And so I wonder if there are any theories that you would point to as still really relevant to be considering, or any that you would say we've updated them, and you can look in this direction now.

often never. Is that can we say that we often never? And test the boundaries of effects. Yeah. Another way of saying it, if you prefer, is that we never do sensitivity analyzes. So how does that impact? Kind of the conceptualization of stress, right? Let's say that you have this idea that that work

stressors are very impactful. So you use a Life Events scale that assesses work stressors, and sure enough, you find that the more work stressors somebody has experienced, or the greater severity of those work stressors, the more likely somebody is to become depressed. So sure enough, you've confirmed your a prior hypothesis that work stressors are, in fact, associated with your outcome of choice, and the more work stressors you have, the more you know, the worse people are. Now,

what's the problem? Of course, I mean, you know all the listeners already know all the problems, right? What you you've confirmed your hypothesis, but you haven't said anything useful about whether work stressors are more or less relevant for that outcome as compared to literally the inverse of work stressors, which is anything else that somebody could have experienced.

well. So for example, let's say you you take the Holmes and Rahe approach, and you really think that it's about the change or upheaval. So now you take all the life events that you've assessed and you give them a change or upheaval score. So then you see that, you know, the more change somebody's experienced, the more likely they are to get ill. I guarantee you that the correlation is moderate, you know, to strong. Why? Because a lot of stressors that we think are important

actually do involve a lot of change. So take a divorce, for example, right? You get divorced, a lot of things change. Your relationship changes your finances change, where you live might change your housing situation might change. A lot of things change, but you haven't assessed other social psychological characteristics of divorce. So now again, you reify

the idea that change is at the heart of the matter. And I would say, you know, if I look at, if I look at divorce from the perspective of the immune system or the brain, I and I've made this argument, so I don't think that the brain, or I don't think that the immune system, particular is is coding or listening to degree of change the brain probably is much more

so than the immune system. But my point is that there are other characteristics of a divorce that may, in fact, and I'm not trying to say that it is in fact, but may in fact, be more important or a stronger predictor of whether or not people get ill, then change. But if you don't measure other social psychological dimensions again, then you will come you will reify this idea that change is in fact what's most

important, or change is in fact important. But again, you haven't compared it to other dimensions that, as I said, may lie at the heart of what makes people ill.

that we use. Because, you know, it's hard to assess all aspects of stressors, etc, etc. So there's some measurement issues, some measurement challenges embedded in that problem as well. Well and this might be a naive or too idealistic kind of question, but essentially, what do we do about that is, is the world of unmeasured social psychological experiences so vast that this is sort of a problem we're always going to have, or how can we better our science in this way you

mentioned sensitivity analyzes. And I'm wondering if you have any other thoughts on this.

have a 24 page interview. You sit down with a patient or a participant, you go through this 24 page interview takes a minimum of about an hour and a half, but you know more likely somewhere between an hour and a half and two hours. You then spend another hour to two hours summarizing all of that

information in detailed vignettes. And then you spend another hour to two hours presenting each of those acute life events and chronic difficulties that the person has experienced to independent panel of rater who consult a 524, page manual, during which time they are comparing the context and the severity of the life events that your participant experienced to pre rated case vignettes that enable the raters to come to essentially grounded judgments of severity for the

stressors that your participant experienced in a way that enables standardization across interviews and cases. Now, if you started sweating just thinking about how many hours.

afford that system. I mean, I mean that literally, like, you need an r1 just to implement the system. So actually, the LEDS does get you a high resolution photograph of of recent life stressors, but it comes at an enormous expense, and that was really the impetus for me developing the stress and adversity inventory or strain I ran into this problem where, you know, I couldn't even afford to use the LEDS in my own research, because, as I said, you need an R01 just to implement the stress

measurement. The other thing that was, I would, I would say, shocking to me, is that I was putting in all of that effort and only getting an assay of stress or exposure over the past year to two years, and that didn't comport with my idea that the impact of stress on the brain and the body is cumulative over a much, much, much longer period of time. So if you're looking to predict onset of depression or onset of anxiety disorders, you might be able to make the argument that recent

life stressors are what matter most. But actually, I would immediately play devil's advocate and say, What are you trying to say that early life stressors don't matter, or that you know that thing, that that nasty divorce that happened so you know you're 50 years old, that terrible divorce that happened to you when you were 35 years old. Do you mean that that really terrible experience when you're 35 isn't relevant for your likelihood of becoming depressed at 50. I find that

hard to believe. So, you know, what was really shocking to me is that we were spending so much time and effort to use this high resolution system, and we were ignoring the vast majority of

people's lives. And you know, that was really the strongest push for me to say, okay, you know, what we need is a conceptualization of lifetime stressor exposure and a system for assessing of large variety of different types of stress over the over the person's entire life course, and moreover, that assay of lifetime stress exposure needs to be able to provide a high resolution panoramic photograph of all the major life events and chronic difficulties that a person has

experienced in a relatively short period of time. PS, it's hard to do, you know what?

only realize the benefit of it until several years later. But you know, I think what we've done now, which was, you know, the goal is, you know, what I like to say is democratize the expert assessment of lifetime stressor exposure. We have a system. It takes about, you know, 18 minutes you can get, as I said, a lifetime assay of stressor exposure based on the

strain. You have about 445, raw variables that you can then crunch the numbers using, you know, standard scripts, we have to get about 115 different lifetime stressor exposure

summary scores. So if you don't care about the nuances of stress and don't want to look into the nooks and crannies of people's lives, which you may not and and that's fine, so then you can focus on the strains main variables, which is total count of lifetime stressors or total severity of lifetime stressors, but to the extent to which you think like I do, that it really does matter whether those stressors involved interpersonal loss versus physical danger versus entrapment versus role

change or disruption or versus deprivation versus threat. You know, whatever your conceptualization is, you can pull out variables that will focus just on those dimensions.

And what I think is really important for the field as a whole is that then you can compare and contrast what I call stress signals, whatever you want to refer to them as with one another, and you can both do your confirmatory analyzes just like you always hoped, but you can also try to understand the boundaries of those effects and do disconfirmatory analyzes as

well. So that enables you to say, you know, for example, that interpersonal stressors are really important, but you can compare the magnitude of your favorite stressor to, you know, other stressors that that you don't like as much, and then you can, I think, you know, provide, provide information that really moves the ball forward much more.

activity is low. In other conditions it's high. But if you could only image the amygdala, the whole story, you know, the whole story of human nature, would all be amygdala driven, right? So again, you confirm that the amygdala is implicated, but you know, but you don't, you, but you're not testing the boundaries of that, right? And you're certainly not looking at the relevance of the amygdala to all of the other 1000s of brain systems that are also engaged during a particular task.

transcriptomics. You know, now it almost sounds Theranos like so, forgive me, but you know, with a relatively small sample of blood, in many cases, even dried blood spots, you can now subject those samples to these multi omics approaches. And you know, what that gives you is a, you know, 300,000 variables plus or minus 100,000 that enable you to look at, you know, metabolomic functioning, lipidomic function. Functioning,

genomic functioning, transcriptomic functioning. You know, all these different systems that have units of analysis, if you like, that are relevant now. How many of us have, have, you know, applied a multi omics approach? Well, probably very few. And the reason for that right now is, well, a, you might not know about it, totally fair. B, even

if you do know about it's extremely costly. So although the prices have come down quite a bit, you know, doing a full proteome analysis still costs, let's say, eight to $900 per sample. So for most of us, that's extremely pricey. You know, we're thinking about, like the 30 to $50 range would be great or cheaper. So, you know, $800 is not scalable. You know, even $100 is not very scalable. So, you know, to your question

about, like, what aren't we doing that we could be doing? I think the next 10 years looks like much more highly sophisticated biological profiling as the cost of these technologies come comes down, therefore making them available, not just to kind of card carrying biomedical Researchers or geneticists, who you know, on average, are more well funded

than you know social scientists are. You know, when the costs come down, and what I'm trying to say, when the costs come down, then you know, they'll, they'll, those approaches will be more usable, more feasible for for us folks in the social sciences, psychology, psychiatry, who, you know, also have a lot of other things that are expensive, like, you know, setting up a longitudinal cohort, and, you know, doing, you know, interviewing people at multiple time points, which also

in itself, in of itself, is pretty costly. So, so I think that's, I think that's what we're missing, you know, we we still focus on a few number of analytes, and that's a great start. But I think that, you know, we'll have a, we'll have a much more sophisticated view of biology going forward.

methods for assessing stressor exposure. And what I mean by that is that if you're using a very short scale for assessing stress experience or stress exposure, then you will, in fact, have very limited things that you can say about the nature of how different stressors are related to one another, as well as whether or not some stressors are more impactful for your mechanisms or mediators or outcomes as

compared to different stressors. And I think that that is, you know, of I don't think that we need any more research on the fact that stress is impactful. I think we know that that's clear.

I think now we need to further refine and advance our theories around stress and I and so I'm really making the argument for using systems for assessing stressors, whether it's the strain or other systems that are much more high quality the you know, the second thing I'll mention, which again, we all already touched on, is not just to look, you know, where you've shined the light, you know, but to move the flashlight around and to look at other constructs, other risk factors that we all

know are also implicated. So you know, when we talk about life events, don't just look at the life events you think are most important, but compare and contrast those life events to others, and again, sort of just to the point of improving theory. I think when you compare and contrast different predictors slash stress signals, that, again, will do much more for advancing our conceptualization and theories of stress than the approach of just looking where you've always

been looking this whole time. Okay, there's probably other comments, but I would say those are the two. You know, good places, places to start. And you know, of course, if you want to know more about that, or if you're looking, you. You know, for a motivated partner in that work, then, you know, feel free to ping me. You know, what can I say about personal stress experiences? I think that especially in the United States, we to differing degrees all where stress is a badge of

honor. And, you know, in some ways, I think that's an indication of just how resilient we are as a culture. We you know, tend to be individualistic. We tend to feel very empowered and efficacious. We tend to believe, you know, on average, that, you know, if we just pull ourselves up by our bootstraps and tackle something head on, that, you know, we can get through it. And I think, you know, again, that doesn't describe all of us, but, you know, if we look at other

cultures, we we're pretty high on those dimensions. I think there's a pro and con to that. I think the pro is that we can get a lot done. We sort of, you know, can be highly productive. The con is that just because we're productive doesn't mean that it that that productivity doesn't come at a cost. You

know? It may mean that we persist despite experiencing a lot of chronic stress that can cause wear and tear or allostatic load on our system, and we may not see the downsides of that allostatic load relatively early in our life, because we don't have a lot of preclinical disease processes going on. We're not in our 40s yet, and sort of, you know, you can still manage to sleep, you know, five or six hours a night

and get up and and go at it again. But you know, there's collateral damage that is occurring under the hood that you know once you turn 50, 60, and 70 will begin to rear its ugly head and and so I get, I apologize for the monologue here, but so I think, as a culture, what my hope is is that we start to have kind of a more fair and balanced or informative view of stress, which acknowledges both the upsides of having a, you know, moderately filled, challenging or stressful

life, but we also are fair and honest with ourselves about the cost of that, you know, not just to our interpersonal lives, like you know, how do our relationships potentially suffer when we work all the time or when we're stressed? But you know how our biology might be suffering as well, even if we're not experiencing the somatic symptoms now we put ourselves at increased risk for developing, developing those symptoms later

on. So I guess the point being, let's, let's get past wearing stress as a badge of honor, and let's start to prioritize other things, like, you know purpose, meaning and joy. You know time outside, you know time spent with friends, certainly family, and other things that are, that are enjoyable and and and make us feel purposeful and love life, you know, beyond just work and things that give us that energetic experience of stress.