Tené Lewis: Basically, the more network stressors women reported, the higher their blood pressures, both during the day and at night, the more likely they were to have sustained hypertension, which is being above the clinical cut point as they're kind of in the clinic, sitting down and in daily life. And we found that there were stronger associations between reports of network stressors and ambulatory blood pressure than between the reports of personal stressors and ambulatory blood
pressure. So basically, the idea is that it wasn't so much the things that were happening to the women themselves, but it was the things that were happening to people in their network. You know, it's not necessarily the neighbor across the street. These are people that you're close to, so your partner, your children, your other relatives, your close friends. So, those are the things that seem to be having the biggest impact on women's blood pressure in our cohort.
Welcome to the Stress Puzzle, where we explore the latest in stress science and consider how the science may translate to our daily lives, or where we might have missing 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. This is the second episode highlighting the best stress science papers of 2023 in today's episode, you'll hear from Dr. Tené Lewis, who is the lead author of the best human empirical clinical paper. Dr. Lewis and her team focused on looking at stress beyond just your individual experience and considering how stressors that affect your broader social network ma be affecting
cardiovascular health. We also discussed how her team's findings fit into broader conversations around Superwoman Schema, caregiving, burden on women, social safety nets, and how care related labor is so extremely undervalued. This is such an important episode, so I hope you enjoy and will share it widely. Dr. Tené Lewis is a professor in the Rollins School of Public Health at Emory University, where she studies health psychology and psychosocial epidemiology, with an emphasis
on cardiovascular health in women. She is particularly interested in investigating these psychological and social factors underlying cardiovascular health disparities for African American women compared to women of other racial or ethnic groups. Dr Lewis's scientific work has been honored by the Health Psychology division of the American Psychological Association, as well as the recently renamed
society for biopsychosocial science and medicine. Her work has been featured by NPR Essence magazine and the Washington Post, welcome to the stress puzzle. Dr Lewis, I'm so happy you could join us, and congratulations on leadingthe paper that we'll discuss today, titled network stressors, personal stressors and ambulatory blood pressure in African American women. Does Superwoman Schema Play a Role?
This paper was named the best stress science paper in the human empirical slash clinical category for 2023 by the stress measurement network. So, thank you for joining us to discuss this important contribution to the literature. Tené Lewis: Thank you so much for having me, and thank you for the award. It's truly an honor. I'm looking forward to digging into the specifics of these findings, and especially as it relates to the cost of caring and implications for stress science. First, I was
hoping you could describe the research question. How you arrived at this question? And I'm also curious how this study builds on prior theories or empirical work, your own or others that you were considering while preparing this project? Tené Lewis: Absolutely, so I think, honestly, I arrived at the question as I arrive at many questions through observation
and a combination of observation and literature. So, just to back up a little bit, I'm actually trained as a clinical health psychologist, but I have always been interested in context and understanding how lived experiences contribute to adverse outcomes in African American women and so from that perspective, my work uses psychological theories, but also brings in a lot of sociology, because I have found that sociologists tend to, At least historically, have often thought
more broadly about social context and historical factors and how those shape people's experiences and exposures to stress. So, given that there were two, I would say converging sort of phenomena. The first, honestly is, I am from a large
family. I have three sisters and three brothers, and there was a period of time when one of the women in my family said to me, you know, I'm fine, but I am always being pulled in three different directions because of this person's problems over here and that person's problems over there, and that person's problems over there, and I was already doing work on stress,
you know, a range of different types of stressors. And I had a cohort, and I brought this negative Life Event Scale into that cohort, and I was aware of work that Cheryl Giscombe had been doing looking at, I think the paper was entitled, Whose Stress is Making Me Sick, and that quote from my sister lined up perfectly with this idea around the cost of caring, so Cheryl Giscombe had, you know, this really catchy title, but it built on this sociological work that I was also aware of
because, again, I study stress, and I study how these lived experiences contribute to a cardiovascular risk. So, there had been a body of research, mostly theoretical or the empirical work was really dealing with mental health outcomes that made this argument that for women, it was not only the things that impacted them, but also the things that
impacted the people that they were close to. So, it sort of built on this idea that a lot of you know, almost from early on, girls and you know people socialized as girls and women in this society are socialized to be very communal and to take care of other people, and if someone's hurt, go over and make
sure they're okay, and all of these different things. And so, the thought, you know, from the mental health literature, was that, and there had been some data showing this, that if they looked at both men and women and asked about the kinds of stressors that they were experiencing, the women, both groups reported, you know, things that happened to them, but the women also reported all of these things that were happening to other people that they were close to, so their
family members, their friends, their children, their spouses, their siblings, etc, etc, etc. And those same associations or reports weren't necessarily seen in the men, and when they were they weren't as associated with depressive symptoms as they were in the women. So, I think initially this was established as cost of caring idea as a theory to understand why there
might be gender differences in depressive symptoms. And there were other studies that looked at this, including show Cheryl Giscombe's work, but again, really focused on the mental health domain. And so, my question was really around, okay, we know this matters. We know this matters in sort of women's lives on a day to day basis. Is it associated with some of the physiological outcomes that we care about?
Because, I study cardiovascular disease, and we know that for you know, African Americans, African American women in particular, elevated blood pressure is pretty much the road to later lifeheart disease, later life stroke, later life kidney disease, even you know, there's emerging literature suggesting that Alzheimer's disease has a strong vascular
component in African American women. So, that was the outcome that I thought would really sort of was worth investigating in relation to this sort of very real stressor, this very real phenomena of being more impacted by the things that happen to others than the things that happen to you.
Man, thank you for emphasizing the importance of distinguishing between these personal and network stressors in this context, and especially for the population that you're focused on among African American women, and for cardiovascular health. You know, as you're saying, that it really is striking how little we've considered the broader social network with respect to these kinds of questions, so it's such an addition to our understanding. Tené Lewis: Thank you. I appreciate that.
And then I'm wondering if you could describe a little bit about the methodology that you use to go about answering this question, and also why you focused on ambulatory blood pressure specifically? Tené Lewis: So, just to start, we took this scale that had been previously established. It's been widely used in a cohort, the study of women's health across the nation, and it really sort of included things that happen to a that could happen to
a person themselves. So, that would be being fired or laid off from a job, or quitting a job, having major money problems, having an unwanted pregnancy, a stillbirth, miscarriage, being separated, divorced, or having a long term relationship ended. So, those would be the kinds of things that we labeled personal stressors. There were other things on the scale that were
clearly about another person. And so, for example, if we had a personal stressor, well, we did have a personal stressor that asked whether the person had a major accident, assault, disaster, robbery, or some other violent thing happened tothem. Then, we asked that exact same question about a major accident, assault, disaster, robbery, or other violent event happening to
a family member. And so, we didn't necessarily have a one to one where every question was like that, but we had a series of questions that asked about things that happened to you, and a series of questions that asked about things that happened to another person. So, for example, you know a family member having a serious. Physical illness, aserious injury, a drug alcohol
problem, a family member becoming unemployed. And so, we have those things, and then we had a few things that really involved women's relationships with their close others, and these were specifically thing about around about their children and friends. So, for example, having a child move out of the house, or leaving the area having a serious problem with a child or family member taking on responsibility for the care of another child, grandchild, parent, other family
member or friend. So, those are the kinds of things that we were asking about and making those distinctions between the things that would happen to you versus the things that would happen to other people. And we separated them, you know, pretty neatly, and then we ran a series of sensitivity analyzes where we made the argument well, for example, if you're caring for
another child, that's also about you. So, what happens if we take that out and just focus on things that are assault happening to another person, or legal problems happening to another person, no matter how we divided the items, the things that happen to other people seem to be the most powerful, and so now I'm moving into the findings, but that's essentially
what we found. And to answer your question about ambulatory blood pressure, one of the things we know about blood pressure is that over the course of a day, there's a lot of variability, and so when you're in a doctor's office, you get a clinical blood pressure. And there are some people who, for whatever reason, you know, they are a little bit higher in the office than they would be in daily in that life. So, it's not really a true read for them. Other people are a bit lower in
the office than they are in daily life. And so again, it's not a true read for them. And then, you have people who are high in both places. So, those are the people that we know. We call that sustained hypertension. So, if they're above a certain threshold, both, you know, when they're just sitting and resting and in everyday life, we're pretty
certain those people have hypertension. So the thought is that ambulatory blood pressure really gets at kind of the true blood pressure throughout the day, and then also ambulatory blood pressure allows us to assess blood pressure at night, and so blood pressure is supposed to go down at night. It has a circadian rhythm. For some individuals, it doesn't go down as much. We believe sometimes, in responseto stress, it doesn't
go down as much. And there's a literature that suggests that even independent of whatever your blood pressure is during the day, your blood pressure at night is really strongly predictive of later heart attacks and laterstrokes, and so it's considered the gold standard in blood pressure assessment. So, we were really fortunate that we were able to obtain funding to assess it and actually get over 400 women to wear this cuff for 48 hours. Those are the methods in a nutshell.
Yeah, so impressive. I mean, on the methodological side, like you're saying, removing the confounding of doctors offices and actually bringing it out into folks, day to day lives, and being able to separate it out, and all of the ways that you can I just want to emphasize for folks what you were saying earlier around how a lot of these questions in this domain around network stressors had really been focused on the
mental health side. And so, by bringing in this gold standard measure of blood pressure, I just want to emphasize how important moving to the physiology and moving to it with such a strong, high quality measurement. Now, I would love to hear more about the results that you found
Tené Lewis: Sure. So, basically, the more network stressors women reported, the higher their blood pressures, both during the day and at night, the more likely they were to have sustained hypertension, which is being above the clinical cut point as they're kind of in the clinic sitting down and in daily life, and we found that there were stronger associations between reports of network stressors and ambulatory blood pressure than between the reports of personal stressors and ambulatory blood
pressure. So, basically, the idea is that it wasn't so much the things that were happening to the women themselves, but it was the things that were happening to people in their networks, so they're again. And these aren't just, you know, it's not necessarily the neighbor across the street. These are people that you're close to, so your partner, your
children, your other relatives, your close friends. So, those are the things that seem to be having the biggest impact on women's blood pressure in our cohort, in our study. You know, I think another piece that I really appreciate about this paper is how robust the associations were that you found. And so, I'm wondering if you can give us any effect sizes that might help us conceptualize the magnitude of these results? Tené Lewis: Sure, so we actually found, I believe it was an eight
millimeter of mercury. Difference in those women reporting, for example, three or more network stressors over the prior year compared to those who reported not having any. And just to give you a sense of the magnitude of that, when people do meta analysis of clinical trials that assess blood pressure medicine, right? So, anytime there's a new medication released, you want to make sure it actually lowers blood pressure.Those, on average, show about a five millimeter mercury
difference. So, this is an even stronger effect than that, right? So, basically, having multiple network stressors in a year is actually increasing women's blood pressure above what you know, kind of the average blood pressure medication would lower, right? So, it's a really powerful effect that we're seeingwith network stressors. Correct me, if I'm misremembering, but I think your sample also had around 10% or maybe higher reports of those
threeor more network stressors in that year. So, just thinking about the number of people who, you know, when we extrapolate out to larger sample sizes, etc, how many people are being affected by these network stressors, and many of these network stressors in a year? Tené Lewis: Absolutely, absolutely. And you know, one of the things that we were intentional about doing in our cohort is recruiting across the range of educational and income
levels. So, half of our cohort is above and half of our cohort is below the median income in Georgia at the time of
recruitment. And so, we have a range of socio economic, these aren't women who I say that to say like these are women who are living in urban environments, but they're not women who are necessarily living in high poverty environment or environment where there's a lot of economic distress, but this is just this idea that you know, from all walks of life, women are embedded in networks where there are lots of stressors, and there's a cost to that for their health.
Absolutely. And you know, since we care a lot about stress measurement here, I was wondering if you could say anything about on either the personal or network stress side, just how the stress levels that you found in this study mightcompare to similar cohorts, or any implications that you think when looking at this distribution of network or personal stress scores? Tené Lewis: What we found is comparable to what we've seen in
other cohorts. So, I think there were, you know, when you write these papers, you go through review, and one of the things that people are often concerned about is, well, you do have some women in your cohort who are a bit more educated, not all of them, but some. And I think what we're seeing is these levels are comparable to other cohorts that we've looked at where the level of education was a bit lower, both for personal stressors and for network stressors. So, there's nothing unusual about
the exposure to network stress that we'reseeing. So, I actually think this is, we can probably assume that this is happening in lots of different contexts and lots of different environments. Yeah, thank you for emphasizing the SES socioeconomic status split there. That is another big
strength of this paper. So, I'm just glad you're emphasizing it, and you know, we've been dancing around it, but I would love to hear what the main takeaway from this study has been for you, from your perspective, whether that's again, taking it back to your lived experiences, or moving forward with new research?
Tené Lewis: Yeah, so we do dissemination here. So, we we we have, our study is longitudinal, and so the women come back for year two, year three follow up. We're now moving into wave four follow up. And they ask, what did you find? What did you find?
And so had one of our master students create an infographic for her summer project, and it talks about basically this idea that other people's problems are raising your blood pressure, and so the main takeaway is because I think there, there are lots of there are lots of messages around self care and reducing stress levels and all the various things that that you can do as an individual to ensure that your life is, you know, to
use a colloquial term, drama free. But that doesn't necessarily mean that you won't be exposed to stress, because if you are, if you care for the people around you, which we're socialized to believe that we should, and I actually do believe that we should, right? So, the other thing that's interesting, you know, from a psychological literature perspective, is we're always taught social support is being embedded in a social network is a great thing. It's a good
thing. Not what isn't often examined is the extent to which, if these people themselves are going through stressors. What does that do to the individual? So, for me, that's the takeaway, right? That perhaps when we think about, you know, the impact of stress, and how we measure stress, and how we talk about stress, when we are focused on groups that have a
more collectivist orientation, one of the things we may. To also think about is, what are the stress levels of the individuals in their network, and how do those stress levels
impact them? So, I think that's, for me, the takeaway, right, that it's not even so much about the individual, but about the context, and that that's critically important, and we need to think more about that 100%, I mean, I appreciate everything you said, but just when you brought up the self care side of it, I think that's a place where it feels like we are just being preyed upon by companies or influencers trying to sell us things to
address ourindividual stress, and that's just something that tends to irk me a lot. So, I appreciate that you brought it up, but especially in the context of it's you're not just one individual, right? Like you're saying you're embedded in a network of individuals who also have their own stressors, and if you're a person who cares deeply and has responsibility for those humans, anyway, I just keep coming back to how ineffective so many stress solutions are for like, the real
world. Yeah. So, next, I'm wondering if there's anything that surprised you in doing this study? Tené Lewis: Yes, I think it surprised me that the personal stressors were not more impactful. So, I hypothesized right that network stressors would have a bigger impact. I didn't realize that that would be the sole impact. And so that surprised me. The other thing that surprised me is we looked at the role of Superwoman schema, and that actually comes
out of, so Cheryl Giscombe sort of coined that term. But there are other really brilliant scholars working on comparable constructs,thinking of Jasmine Abrams, and there's Melissa Harris-Perry and Chanequa Walker-Barns from different literature. So, Melissa Harris-Perry is from the political science literature, and Chanequa Walker-Barnes, I believe, is out of religious studies. But I thought that this would all be around about Superwoman Schema and this
obligation to take care of others. And what we found was that didn't play as much of a role as we thought it would. And I think part of thatis because, you know, if you have three network stress events a year, you have three network stress events a year, and that's a powerful force in an individual's life that impacts their blood pressure, and it may
whether you feel like you're obligated to help or not. If this is someone close to you, I think what we're finding is it has an impact, and so that, I think was surprising for me. And I'm curious how you see these findings pushing the field forward, as well? Tené Lewis: Yeah, so I would love to really think through
what the mechanisms right might be, right? So, part of this is this was something that, you know, as I mentioned earlier, I was seeing both in the literature and in conversations in my, you know, with family members and other women that I'm close to, and what I would love to see is more work, right, like we this wasn't a scale that was necessarily designed to capture network stressors, but it captured network stressors.
We've been able to look at this. You know, when you think about we started data collection in 2016 since then, there's been a global pandemic, and network stressors abounded throughout that pandemic, right? And so, thinking through, what does it mean to live through that. What does it mean, right now we're in a time of, you know, political change and upheaval. What do
network stressors look like in this context? So, I think for me, it really is, you know, my goal always asthis, you know, as an interdisciplinary scientist, is to really bring a lot of different disciplines to bear and think about stress and context, right? So, when we talk about stress in the body, I think so many of us in health psychology slash behavioral medicine, there are even people in public health, to a certain extent, who are really focused on being very narrow and
focusing on, you know, can we see it in a laboratory. And I think that's great, right? And that gives us a lot ofinternal validity. But when you think about the way that people really live, that, for me is what I'd love to see more of, right? Like more of lives and context and stress and context, and really thinking about the fact that none of this, none of us exist in a vacuum, and I think we saw that with the global pandemic. I think we're seeing that now as we go through a range of
societal changes. But what then, does that mean, not just for network stressors, but all the various types of stressors that we study, really sort of thinking about the ecological context and the ecological I don't necessarily want to use the word validity, but that's, that's the closest thing that's coming to what I'm thinking about at this time. So,that's what I would like to see. And then also, you know, again,
mechanisms. And when I say mechanisms, you know, of course, things like, you know, inflammatory mechanisms and the biological mechanisms. But also, to what extent do you ruminate more when it's a network stressor versus something that's happened to you, to what extent are there a cascade of other things that you are dealing with when it's something that's happened to a child or a loved one? And soon, all of those
things, I think would be interesting. Does it impact sleep because you're ruminating or because there's you're less in control, or you feel less in control? So, these are, again, all the things that I would love to see happen in future studies.
Course, you know, longitudinal associations and those kinds of things, but that's sort of, I think we've become more of a me society and I, and I'm so certain that, I mean, there, obviously there are people who experience themselves that way, but I think we've always been a we society and really thinking about what that means and how that impacts health, I think will be important. Yeah, the what you just said about stress and context in particular, I'm 100% with you. That's the direction
that we need. That's the missing piece for translation in a lot of cases. I know this is cross-sectional and earlier days of this line ofresearch for you, probably, but I'm curious, you know you're already doing the dissemination within the cohort of folks who contributed to this research. So, I'm wondering if you're thinking about how these findings might inform translation to policies that would support cardiovascular health for African American women?
Tené Lewis: Sure, you know? And I cannot, I didn't come up with this. This is someone else's quote. But, the quote is basically that in this country, we don't have a social safety net. We have women Snapped. Yes, my favorite line of the last couple of months, I'm right there with you. Tené Lewis: Yes. And so I actually think, you know, and my
work is on African American women, but I don't know that. I think that this doesn't apply to any group of women who are under resourced, or who are a part of a community that's under resourced. And I think that we need policies that support care for other people, we don't have great elder care support in this country. We don't have great child care support in this country. And this isn't about necessarily child care or
eldercare. It is about, you know, I would argue this cost of caring and the cost of caring shouldn't be born by women in this society. So, I mean, I think if we're thinking about policies, one easy thing would or not easy thing, but one if we're going to go the policy route, I think to strengthen the social safety net, particularly for overstressed communities. I think we would need that, and my guess is we would see a lot more support. I mean, the question was, what would support
cardiovascular health? We would see better cardiovascular outcomes and less cardiovascular risk if we had that in place, if we had those things in place, Yeah, I you know, again, I come back to that framing of the cost of caring, and I'm glad that you kind of brought it out to all of the other contexts. I think about it in the context of spousal caregiving or family caregiving for folks with Alzheimer's and dementia or generally difficult
chronic diseases in older adulthood. And I'm in a new environment now where there's a lot more rural caregiving to be thinking about and thinking about how little support folks have for caregiving generally, right? It's and I guess it comes down to me to how much not invisible, but unpaid labor
there is in care work, right? And that just infuriates me, like you're saying, where women are the backbone to safety net, because we do not have these structures in place exactly like you're saying Tené Lewis: Exactly. Tené Lewis: And also these, these positions are underpaid, so they're gendered. They're highly gendered. So, caregiving is very much something that women are doing for the most part. You know, disproportionately born by women. Caregiving jobs, you know, jobs that provide care.
All of those things are disproportionately born by women and underpaid in the society. So, if I were to make some policy recommendations, it would be around not having women be the social safety net for their communities. Absolutely. I have thought so much in the last couple of months, especially about just what it would look like if our society actually valued the labor that is care
work that is the most essential labor of our society. I don't know what else to say there, besides how incredible it would be to actually see all of these women, all of these folks who are really holding our society together, actually be compensated for that labor and recognized for it. absolutely Tené Lewis: I 1,000% agree. And I'm curious what motivates you or keeps you curious when it comes to this line of research, and, you know, thinking about stress?
Tené Lewis: Wow, that's a good question. Um, I guess I am a full professor now, you know, I'm past mid career. I thought, I guess I thought I would be bored by now. I don't know. I think part of what motivates me and I one, I have a great I have a great team. I really do. I'm fortunate to be in an environment where have so many great collaborators, and we have really great students and postdocs, and so I'm surrounded by these brilliant minds who challenge me and ask questions
every single day. I also love the process of discovery, so I learned new things from my research. So, it's been amazing to build a cohort. It's something that I wanted to do. I knew I wanted to do this as a postdoc. And it was this, you know, sort of labor of love. It's not easy to build a cohort, especially of healthy people who, you know, there's no motivation for them to be in a study and because they're not
ill and trying to understand their condition. And Atlanta is where this is a wide geographic area people have to travel really far to come and let us poke and prod them and so on. But, I learned so much from our data, essentially right like this. What we found in this paper, you know when, when you were asking, what surprised me? I had hypotheses, and the network stressor hypothesis was born out. But, some of the others were not. And I was I was surprised, and I'm constantly
surprised. So, I think for me, I'm motivated by the population, my team. And when I go back, when I say the population, I study African American women. When I entered the field, there wasn't very much research on African American women. There's more now, but there aren't as many perspectives from the social sciences, from really from health psychology, thinking about things from a mind, body perspective. So, I'm motivated by wanting to ask and answer these questions that I think
matter for groups that are understudied. I am motivated by working with really smart early career people and really smart collaborators from cardiology and epidemiology and psychology and sociology and so that's also a gift having all of these different disciplinary perspectives. So, I think that motivates me, all of these things keep me curious. And you know, there are new, new thingsthat happen on a daily
basis that keep me curious, right? Because this is about life, and there's always something happening that stresses people out, unfortunately, right? So, a few years ago, it was the pandemic. There are other things today. There will be other things tomorrow. So, for me, that's what motivates me and keeps me curious. Beautiful and thank you for reflecting on that. It's
wonderful to hear also how motivating your team is. I you know, and I was going to say the exact same thing you said, of just what a gift to be able to be in a position to do such impactful, important science. But, I'm curious if there are any questions that stand out to you really remaining after the study, or how you feel about where we go from here as a field?
Tené Lewis: The questions that remain for me some I mentioned earlier, which are the ways that we can sort of move this work forward and understand longitudinal associations and think through important mechanisms that might help us understand what is driving this association between network
stressors and elevated blood pressure in our cohort. The other thing I'm thinking about, and again, this is because I was trained as a clinical health psychologist, I'm always thinking about interventions, even though I myself am not doing intervention research, I'm always thinking about, what are the interventions, both at the policy level, as we talked about previously, but because we know policy moves slowly, those
changes don't happen overnight. What are some things that people can do now, today, tomorrow, if you are that woman who is somewhere overwhelmed with other people's problems. What are the what are some things that you cando? And so for me, it's understanding my you know, kind of not just what we what we were able to demonstrate or document in the paper, was this main effect, and looking at Superwoman Schema as a potential
moderator. But, I'd love to go forward and look at some other factors that might buffer this association, so either at the individual level or at thecommunity level, but really thinking about, are there things that women are naturally doing that we can capitalize on and design interventions around? So that's, for me, the question, right? Right, like we know there are, and we know there are lots of people in this position, and as society changes, and if we lose, we don't have much of a
social safety net to begin with. If we lose more of that, we will begin to see more and more network stressors. So, the thought is, what, for me, the questions that remain are, how do we help people who are in this situation manage network stressors? And I don't have the answers, honestly, but those are the next questions for me.
Well, I can't wait to follow this line of work, and especially thinking about the positive factors, like you're saying that so many folks are already going through these experiences. We know there are adaptive things that folks are doing to manage these network stressors. So, I look forward to seeing all the work that I know you'll continue to do beautifully in this direction. And thank you so much for joining us for this episode of the stress puzzle Dr. Lewis.
Tené Lewis: Thank you. Thank you. Thank you for having me. It's been wonderful. Thanks for tuning in to this episode of the Stress Puzzle we'd love to hear your thoughts and feedback on any issues we've covered today. You can email us at [email protected] and you can also send requests for
topics or guests for future episodes. The best way you can support the show is by leaving five star reviews wherever you listen to our podcast and sharing with your friends or your collaborators, and until next time, we're wishing you good stress and opportunities for rest.