I’m a clinical neuropsychologist and have co-written When Crisis Strikes: 5 Steps to Heal Your Brain, Body and Life from Chronic Stress, with Dr. Jennifer Love. Ask Us Anything

What is your general opinion on weed? I have a positive appreciation for it. But it isn't harmless either.

I know there are different meanings about this topic, but having worked with young people with thought disorders the past 10 years, my view is clearly negative. Many people develop serious thought disorders after prolonged use. Very often it is used as a coping mechanism - like a self-medication strategy, which functions first to avoid dealing with the underlying problem and, second, causes a dependency condition. I've seen too many young people's lives ruined by long-term cannabis use to have anything positive to say about it, sorry. Another issue is if it's used under close supervision by a doctor to treat chronic pain. But I don't have a lot of experience with that, maybe Dr. Love can say something about her experience in this regard. Kjell Tore

We could talk about this for hours. As an addiction medicine specialist I spend a lot of time looking at the data every year. While I can't give medical advice here, I can affirm it isn't harmless. Studies in Europe suggest CBDs are carcinogenic. Weed in the short term for most people seems to decrease anxiety, but current studies show longer term use tends to worsen anxiety. It can cause ADD symptoms, lower motivation and interfere with executive function. The more you use the worse it becomes. Some people become psychotic with weed--they can hear voices and develop symptoms of bipolar disorder or schizophrenia. The more you know....

What's your favorite kind of pasta?

Jennifer here. Pasta isn't a favorite of mine, but if I am ever going to splurge, its going to be my homemade bison bolognese or pasta with pepperoni (a recipe I picked up from an old man in Venice).

I saw your response about keeping your mind busy with activities like exercise, social contact to counter stress symptoms. What do you think about mindfullness/meditation?

I have had a break-up that has affected me a lot for the past 2,5 months and I seem to not get better, activities are limited due to the lockdown so I would really like to know how much trying to practice meditation can help me with getting my mind of my ex and all the negative things that go with it.

Hi, Jennifer here. Michael Sealey has a great guided meditation on YouTube called something like "Letting go of past relationships." He has dozens of free sessions online. Hope this helps. :)

Have you done any research on the effects of growing up in a hoarding house on children? There seems to be only a very limited amount of studies done on hoarding, but not really any on the children of hoarders who grow up with shame, guilt and secrets. What are your thoughts on this? Do you think there would be patterns like learned helplessness, poor emotional intelligence, anxiety, cptsd? Would this make someone more resilient or less so in the rest of their lives having grown up under the constant stress of living in a hoarded house?

Hi, Jennifer here. I haven't researched this (Kjell says he hasn't either). When I think of hoarding (which is on the OCD spectrum, by the way), I think about mold and other potential toxic exposures, as well as the genetic link to other anxiety disorders. Any disruption to healthy childhood development can be traumatic, resulting in anxiety, PTSD, depression. Some children will grow up with more resilience, some less. I often recommend EMDR therapy for "survivors" of such childhoods to help address the shame, guilt and secrets.

What can you tell me about cannabis use after a stroke? Is it helpful? Harmful? Are edibles safer than smoking or vaping?

There isn't enough data for me to recommend it. I wouldn't recommend smoking anything following a stroke.

What are your thoughts on various herbal/food remedies for chronic stress? Is there evidence basis for any of it?

There are so many articles and books on this! We could talk all day. As an M.D. I was never trained in supplements, "neutraceuticals," and herbal remedies, but over a decade in southern cal and I've had to do a TON of studying up on this! There are studies, and some are studied more than others, as they slowly inch towards mainstream attention. Melatonin, SAMe, NAC are all frequently discussed in the medical literature. Naturopathic Doctors probably know more than anyone the evidence and use. For chronic stress, there are a few that tend to help. For that initial high stress alarm state, relora, L-theanine, Holy Basil extract seem to help. For the exhaustion that comes with chronic stress, ashwaghanda and rodiola help many of my patients. Look for articles related to institutions--Stanford has studied SAMe, for example. There is actually a lot of info out there.

Do you have any good resources that are geared towards athletes?

I've worked with golfers, ski jumpers and alpine skiers. These are individual sports where it is critical to have trained in pre-shot, pre-jump and pre-piste mental routines. Unlike some sports where much of the activity is reacting to other's actions (tennis, ice-hockey, baseball, football...), the above sports are fully dependent on the athlete being primed to perform at peak as they initiate movement. This means that their attentional focus must be fully under their control at critical points in time. This work involves quite a bit of visualization training and meditative work to help them control the flow of thoughts and feelings through their mind when they need it to perform at peak. Kjell Tore

As a person who has lived with chronic pain for almost 15 years, and the added stress that gives.

I know pain influence our stress response. Personally I got stressed from taking an abundance of pain medication, as I felt I could not function properly. But the pain is also a bummer. What is your number one tip for breaking this cycle.?

Hi, Jennifer here. I actually have a story about a similar situation in the book! Its about a patient of mine with chronic pain, chronic opioids, and how both tore his life apart, and how he used the steps to move forward. I DEFINITELY recommend finding someone who specializes in this--whether an addiction specialist, therapist, psychiatrist--who can help you move through this emotionally, physiologically, psychologically, socially, etc. It is a complex medical problem. Many of my patients come to me because they are miserable on pain meds, but don't want to stop b/c they are miserable without them. Instead of focusing on "what's your level of pain," I work on "what's your level of life." In other words, what can we do to improve someone's quality of life on a daily basis? There are so many options. Best to you, and you can read about this in the "Chronic Illness" section of the book.

Thank you for the AMA.

I've been trying to research this but struggle to get a clear answer: in your opinion/experience can chronic stress directly cause hearing loss?

Not to my knowledge, but an ENT (ear, nose, throat) doc might know more.

Hi, Thank you ahead of time. 31 male ...I find myself having a very difficult keeping a conversation going. I've never dated anyone even though I've had chances, I freeze up...and my mind always goes to worst case scenarios...I was generally a hermit throughout my 20s. Now that I'm trying to go out, I'm finding that I'm so far behind when it comes to developing a personality and knowing myself...is there any advice you can give me? Thank you

Sounds like you are on the right track SteakStrict8556. Get out and practice. Don't worry about keeping a conversation going. Be yourself. Silence can be golden, and your earlier life of being on your own and independent can be good to have. Small talks starts with being observant and then concrete. Spend time training your mind and thoughts to be observant about your surroundings, instead of going to those dark scenarios. Keep your eyes and mind open and look around you. Are here colorful flowers on the next table, is there a beautiful sunset outside.... what positive sights, sounds and smells can you lift up and bring attention to. Filling your mind and conversation with conrete positive things is a start. The rest will come. What a wonderful adventure it sounds being 31 and discovering the world. Sounds like you prefer a social life to being a hermit. Best of luck in your journey of discovery. Kjell Tore

As a Clinical Neuropsychologist, what's your favorite part of your job.

I work at a mental health inpatient facility, what is the most effective way to encourage self-help / coping skills in patients who find no purpose or are stuck in a loop of crisis?

My favorite part of my job is helping clients get back into school or back into work. I work primarily with young people with early signs of psychosis. It's important to understand their strengths and weaknesses cognitively and personality wise, and help them chart a path with those variables (in collaboration with their families and employers) to a stable, daily routine that is within their scope of abilities. For people who find no purpose or are stuck in a loop of crisis, I encourage them to start with the basics that they have control over in their lives. Meals, hygiene, exercise routines, social contact, having fun (doing what they think is enjoyable and makes them forget their problems). I get them to focus on the basics in their lives, and establish good routines to make these daily routines automatic. Kjell Tore

What is your professional opinion on the use of methadone to manage opiate addiction?

Way too long to discuss here--I could talk about it for hours! Methadone and suboxone each have their pros/cons for maintenance therapy. Each person is individual, but on the whole, I think suboxone (buprenorphine/naloxone) is better (it is certainly safer). However, so many factors go into the decision....

Kind of an odd question, but are there correlations between chronic stress and vocal disorders? I developed spasmodic dysphonia a few years ago after a lifetime of unchecked anxiety and I’m curious how stress could affect it.

Jennifer here. I haven't studied vocal disorders, but the vocal chords are controlled by muscles, and muscles tighten with stress. I bet a good ENT doc (ear, nose and throat) could point you to some articles. I'm sure there are many other factors in play other than stress, as spasmodic dysphonia isn't that common, and stress is!

What’s wrong with me?

Thanks for the question. Any positive change starts with a question. But I like to start with the question, "What's right with me?" Start with the right, consider the wrong, then decide on what to cultivate and what to downplay, do something about, or get help with. But never forget the right. It's in us all, and it will keep the fire burning and the hope shining.

What can you say about depersonalization/derealization in response to stress? I remember a while back when extremely stressed about something work related I had DP/DR for like a week

Its more common when people experience their first really stressful event in childhood; its one of the brain's coping strategies (kind of checking out). Often I recommend EMDR therapy (depending on the situation). Cognitive therapy only helps when we're capable of tapping into our cognition. When we depresionalize/derealize, we detach and can't use cognitive techniques, so I find EMDR more helpful. :)

Do you study psychedelics at all in your work? What connection or benefit can they provide in relieving the effects (or perhaps the sources) of chronic stress?

Hi, Jennifer here. I'm trying to keep up with the research; Stanford had an interesting conference on this topic in 2020 (it was virtual). I think there's a lot of research coming in this area but the risks/benefits aren't yet clearly understood.

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Hi, Jennifer here. We neglect our bodies b/c we're taking care of too many other people!!! There is definitely a connection between stress and the musculoskeletal system (the basal ganglia modulate both), which is why exercise is so helpful. There are studies on exercise and the benefits for stress, anxiety disorders, depression, even early dementia! 150 min/week of cardio seems to have become the standard. In these studies muscular activities such as yoga or pilates that don't get the hart into its target zone don't seem to have the same effect, so I don't really know all the mechanisms involved.

Are stress and memory loss connected? I find when in stressful situations I either forget small details or cannot fully remember during the recollection of a such situation.

Yes! I work with youth who have serious thought disorders and seniors with early signs of dementia. The clinical picture is dramatically clear how their existing cognitive functioning (including memory function) improves when we remove sources of stress from their lives - either where they are living or admitting them into the hospital for a period of time. Imagine being at the fair late at night with lights and noises and people coming at you from all angles - do you remember the specifics, or does everything just become a mush of general impressions... We all have limited attentional resources, and stressors/attention-grabbing stimuli reduce the amount of resources we have available to remember specifics in a given situation. Kjell Tore

Yes! Jennifer here. Stress effects working memory in particular--the ability to be in the moment and pay attention. I have so many older patients coming to me complaining of dementia, and it turns out stress and/or anxiety is getting in the way of them paying attention to where they put their keys, or to the name of the person they just met.

Hi, I know you´re dealing with long term stuff, but how do you deal with short term stuff ? I mean I usually get drunk as fuck which helps no one(especially me with my fitness program)

Do you know any tactics that help you overcome this ?

Jennifer here. Alcohol is an escape mechanism--works in the moment, makes the next day worse, and doesn't solve anything. We talk a lot about escape in the book. The steps work on shorter term things too--I've been using the steps all of 2020 as things creep up in my life. If you can't stop drinking, please seek help. If you can but don't have better coping skills, there's help for that too. :) What is your motivation? What do you want to do? Is alcohol getting in the way of that? What are you willing to do about it?....

Hi Dr Love,

I have schizophrenia. I experience stress over things that don't make sense (or never stressed me out before), or over things that are not real (or haven't happened).

Is my stress treatable?

I recommend working with a good psychiatrist who can help manage your stress. Stress worsens symptoms of schizophrenia, so minimizing stress/anxiety and learning good coping strategies can really be helpful in maintaining a higher quality of life day-to-day. :)

Dr. Hovik, is there any evidence to suggest that chronic stress exposure can objectively affect performance on cognitive assessments? There are countless anecdotes detailing the negative effects of chronic stress on frontal lobe domains like EF, WM, and PS, but to my knowledge, this has never been born out in the literature.

Hello dontyouhatepants, I think the evidence is mixed because the concept of stress is still too vague and should be better conceptualized. Stress is a double-edged sword. It can be both good and bad. Doing crosswords, solving math problems or Sudoku, and playing chess can be stressful, but we know these things improve cognitive performance for many. Living in a household with parents who are continuously screaming and yelling at each other, however, is not conducive to positive cognitive outcomes. In my practice, I try to focus on increasing the good type of stressors (in moderation) in people's lives, and decreasing the bad type of stressors. I usually prefer to ask questions than talk... people usually know what is best for them. Sometimes they just need help putting concrete words on those thoughts and feelings. Kjell Tore

My family recently lost our mother to COVID-19 and my father is struggling mentally, physically, emotionally. I understand the stress as a result from his grief is probably compromising his immune system. What suggestions would you have for our family when trying to find that balance of being firm about the things he needs to prioritize but also affirm what he is going through?

I'm so sorry to hear your loss. Condolances to you and your family. Many of us will experience the challenge of a parent struggling mentally, physically and emotionally as seniors. I hear you have a dual focus these days which is smart. Daily routines are critical. Adjustments will have to be made to earlier habbits and routines, so work out with your father what he is able to mange on his own, what he needs help with, and how those needs will be met. His daily routines will be important for him gaining balance moving forward. Him feeling in control of his life and situation at his level of mastery of the situation should help reduce the stress factor some. We are always more stressed when we feel we do not have control. In addition, my experience is that seniors often need to talk to other seniors about the loss of a loved one. Helping him spend time being social or engaging in activities with other seniors is quite helpful for many. If they are seriously struggling, I recommend they talk to a therapist. What families have is the enduring love and support that only they can provide -- but the social contact with peers and persons outside the family can be a valuable scaffolding structure to get back on one's feet. I wish you and your family a safe and healthy time in the months ahead. Kjell Tore

Jennifer here; I am so sorry for your loss--I don't have words to express my empathy. Grief counseling may help with some of these tools. I only wish I could offer a simple solution in a chat.

Also, how long would one expect to start seeing the damage from living with a covert narcissist?

What would it do to a person? Asking for a friend.

The personalities of our partners will always affect us right away in that we start adapting, changing and compensating. I don't know the specific relationship you are talking about, so I won't comment on it specifically. In general, however, each of us individually have to take responsibility for our own mental health and well-being. We have control over ourselves, not over other people... not even our partners. Taking care of ourselves is priority number 1. If we are in a relationship with a person with a mental disorder and/or behavioral/personality issues, they need to get help for that disorder. We can't fix it, they need to work on it (requires insight and motivation on their part - we can help them with this). Personalities that demand a lot of attention will have a tendency to drain their partner of their independence, self-confidence and feelings of self-worth -- a certain recipe for a stressful, miserable life. Encourage your friend to get their partner the help they need to make positive changes in their relational pattern. No quick fix. Kjell Tore

Hey. I had to put my 15 year old dog down two days ago. For the past 5 days I helped her do absolutely everything from stand up to drinking water. It’s been two weeks since I’ve gotten proper sleep which I thought I would get last night. I went to restart my regular exercise but I wound up pulling my right shoulder blade muscle which is always an uncomfortable injury. So I looks like I won’t be sleeping well for another few days while I recover from all that. What advice you got? Perfect timing for you AMA hahaha.

Jennifer here. First, losing a pet is THE WORST!!!! Ever! I'm so sorry. If its safe in your area, a well-trained massage therapist can be gold (I have one, but can't go right now). Get fresh air, walk if you can without further injuring your shoulder, or even try some restorative yoga before bed (don't do any positions that hurt), or some guided meditations at bedtime.