Heat Stress & Mental Health: 20 Tips to Survive

Hey there, everybody, and welcome to today's video on how heat impacts mental Health and 20 Survival Tips. I'm your host, Dr. Donnellice Snipes. In this video, we're going to examine the ways long term exposure to excessive heat can cause or worsen mental health issues. And when I'm talking about long term exposure, I'm not talking about an hour or even two hours, I'm talking about all day. And we'll identify 20 tips to try and beat the heat. A lot of times people think that heat just makes other people cranky, and that's how heat increases irritability and impacts mental health. But there is so much more than that. They found in one study in 2007 that psychiatric illnesses tripled the death risk during heat waves. So that's pretty notable there. Now, it is important to note that they also didn't rule out for confounding variables that we're going to talk about in a few minutes. That means what else did people who had psychiatric illnesses have going on that might have contributed to their death risk? So physically, when you are hot, when you can't cool your body down, you don't get good sleep. One of the things that happens when we go to sleep is our body temperature drops. And if your body temperature can't drop, then it's going to be harder to actually get good sleep. And it's going to be harder to fall asleep when you're not getting good sleep, then that negatively impacts your cognition and negatively impacts your mood. And it increases slow stress on your body, which we all know causes the HPA axis or the stress response to activate. So when you're fatigued, your body tries to help you wake up by activating that HPA axis so that in and of itself can contribute to increased levels of anxiety and irritability in people. Pain perception tends to go up when people are exposed to ongoing heat pain. Part of that can be because the HPA axis is activated, and when it stays activated for a while, we start seeing more systemic inflammation. Part of it could be because when people don't get adequate quality sleep, it affects the levels of their neurotransmitters, so their pain threshold naturally goes down. And part of it could be because when people are hot, they tend to not move around as much. They want to sit still still, they don't want to increase their body temperature. And we know that sedentariness increases a lot of pain for people. It increases stiffness and joint pain and those sorts of things. Dehydration is another Impact of heat. We cool ourselves and other animals, like horses, cool themselves by sweating. When we sweat, we lose weight. Water. So if you're not drinking enough water and electrolytes to not only stay hydrated, but keep your body's electrolyte balance, you know, in sync, then you may start experiencing symptoms of dehydration. When you are dehydrated, it contributes to problems with cognition, problems thinking clearly, problems with emotional regulation. Consuming diuretics is another thing that can contribute to the negative impact of heat on mental health. And particularly the diuretic I'm thinking about is alcohol. A lot of people, when they get hot, they're like, hey, I'll drink a cold beer. Well, yeah, the beer may be cold, but the alcohol increases the water loss in the individual. It serves as a diuretic. The less water you have in your body, the less you can sweat. The less you can sweat, the less you can regulate your temperature. I already mentioned HPA axis activation or your stress response. Well, multiple studies have shown that extended exposure to heat activates that HPA axis. Any of us who've been hot have experienced that. Where when you start to get hot, what happens? You start to sweat, your blood pressure goes up a little bit, your heart starts to beat a lot faster. That's your body's way of trying to mobilize that blood, get it to the skin so it under the skin so you can cool your body temperature. Hyperglycemia often happens under exposure to heat. Why is this? Well, there's a lot of reasons, but one of them is that chronic activation of the HPA axis, when your stress response is activated, your body dumps thyroxine, which is a thyroid hormone, cortisol, which is your stress hormone, and glutamate, which is an excitatory neurohormone, and it triggers your body to release glucose glycogen into, into the blood so you have energy for fight or flee. And they found that in some people, not everybody, but in some people, they can actually have such a significant blood sugar dump that it causes hyperglycemia, or blood sugar that's too high, and the associated cognitive difficulties, irritability and anxiety associated with that. They also found that people who were exposed to ongoing heat stress may develop something called hyperthyrosis, which is hyperthyroid, as a result of ongoing heat stress. When that HPA axis stays activated, the thyroid stays activated. It's going to keep dumping thyroid hormones, which can lead to an elevated thyroid state. That doesn't happen for everybody, but it does happen for Some people. And it's important to recognize that when thyroid hormones go up, the symptoms of anxiety and irritability tend to go up. When thyroid hormones go up and HPA axis is activated, sleep is impaired. So we're starting to see how the body starts kind of breaking down in its communication when, when it is exposed to extreme heat stress. Serotonin. Now this is our main antidepressant reference chemical. Although dopamine and norepinephrine and a bunch of other neurochemicals are involved in mood, they did find that serotonin is one of the most potent neurochemical mediators involved in increasing the permeability of the blood brain barrier. And that's not what we want. So that's bad. When serotonin goes up. And we find that people who have anxiety, anxiety like symptoms and even HPA axis hyperactivation stress often have higher levels of serotonin. Again, not everybody, but they found that when exposed to heat, heat, stress, the body does release increased amounts of serotonin. And I thought it was fascinating in this particular study that I looked at, they found that the blood plasma levels of serotonin actually corresponded to the serotonin levels in the brain. Now obviously this particular study was done on lab rats because we can't adequately and accurately measure the brain levels of serotonin in humans at this point in time. But it was interesting to note that heat led to increased serotonin. But those increases, remember, serotonin is kind of Goldilocks. Not enough person may feel depressed too much, they're going to feel anxious. But that also is a take home message to consider for people who are on antidepressants, who are on SSRIs that increase serotonin levels. Well, when they're exposed to heat, that may increase their serotonin levels even more. And we're going to talk in a minute about how particular medications actually impair your body's ability to cool itself down. Well, I guess we're going to talk about that right now. When people are exposed to ongoing heat. And again, this isn't if you're out for an hour. This is multiple hours of exposure to heat. Whether you're working outside or maybe you're out on the lake or, or you don't have air conditioning or it's a brown out. Whatever reason, if you're exposed to excessive heat for multiple hours, there's changes in blood plasma concentrations of a lot of different medications, antipsychotics. So people who have schizophrenia or who take antipsychotics or even Atypical antipsychotics like Seroquel will may have a change in the blood plasma levels of their medication, which means that's going to alter how that medication is actually working or how well it is working for them, which is important. When I worked in a crisis stabilization unit way back when, during the summer in Florida, we would see a significant increase in crisis stabilization unit admissions during the heat waves that we would have. And a lot of times it was people who were on already on particular antipsychotic or mood stabilizing medications. And one of the reasons for that, it's not just because the heat is increasing their irritability in their HPA axis, but it's altering the levels of the medication in their system. So that medications that are especially sensitive to hydration and dehydration levels include antipsychotics, mood stabilizers, anticonvulsants. Those are medications that are used both for epilepsy and bipolar disorder, and a medication called cyclosporine, which is an immunosuppressive that some people who have autoimmune diseases may be taking. If you're on any of these types of medications, it's really important and you're probably already getting your blood checked with regularity. But it's really important to recognize that dehydration or consequently over hydration, if you respond to dehydration by drinking too much fluid too fast, will affect the ability of the medication to do its job. Additionally, there are a lot of medications, including anticholinergics, antidepressants, muscle relaxants, blood pressure medications and opioids that impair your body's ability to reduce its own heat. There's a. The heat loss system becomes compromised in people taking these drugs. So if you're on these drugs, then it's important to recognize that you are going to experience heat related stress faster and maybe more intensely than people who aren't on these drugs. But recognize it's not only psychotropic medication, you also have anticholinergics and blood pressure medications and opioids, pain medications. So it's important to be aware of how medications impact you. Additionally, under heat stress, the remember I said serotonin goes up and it increases the permeability of the blood brain barrier, which is just as it sounds, is this barrier around the brain that's designed to protect it from neurotoxins, from anything that leaks out of the gut, from anything that could contribute to brain inflammation. But when that blood brain barrier becomes more permeable, we start to see more Inflammation in the brain. The brain is exposed to toxic neurochemicals in the system. You know, byproducts waste that is produced when your body functions normally, nor is supposed to be just whisked away. But when the blood brain barrier becomes more permeable, it can get up there and get into trouble. It also alters the metabolism and transport of drugs in the brain. And it's important to recognize that heat can alter the metabolism. When your HPA axis is active, think of it as your body's in overdrive. So you may be metabolizing drugs faster or slower depending on the person and depending on the medication. But it's important to recognize that dehydration as well as HPA axis activation can contribute to differences in the way your body actually handles medication, which can make it again less effective. So just to sum up, medication effectiveness can change in result to heat stress. And medication can also make your body less able to effectively cool itself in response to heat stress. So it's a double whammy there. Affectively or emotionally. At the beginning I said a lot of us when we get hot, we get cranky, we get irritable. When that HPA axis, your stress response system is kicked off that the fight or flight response, we become anxious, we become irritable. Our body is telling us, hey dude, it is too hot, you need to cool off. This is not healthy for us. So you're in that fight or flight state. That's where that irritability may be coming from. I remember when my son was little, he used to have the hardest time regulating his little body temperature. And this was when he was an infant and he would get overheated and we would like and start to just cry and fuss and be miserable, even in stores. I mean, we're not talking about being outside at the beach or something. And we would be frantically pulling off his little socks so he could cool himself down. And he lost all of his hair after he was born. So he had a cute little bald head that could emit heat. But it was important to help him reduce his temperature. As soon as his temperature would go down, his irritability would go down. People can also experience anxiety symptoms, increased heart rate and HPA axis activation that they normally associate with panic or anxiety. They may start feeling those feelings and not be sure where it comes from and attribute it to anxiety and then start looking for what to be anxious about. Either way, when people are feeling anxious, when that HPA axis is triggered, it makes them more vulnerable to stress, cognitive stress, interpersonal stress. Whatever. So as heat stress goes up, anxiety goes up, and stress tolerance goes down, people may become more depressed as serotonin levels change, but just especially as they're not able to get good sleep. A lot of times, people, and we're going to talk about that in ways to beat the heat. Stay inside when it is really, really hot out. And if you can't afford air conditioning, if you don't have good windows, a lot of people will close their blinds to prevent the sun from heating up their house. Well, that's a good way to keep it from heating up the house as much. But that also disrupts your circadian rhythms, which can contribute to depression and anxiety and poor sleep. We also see increased agitation and cognitive impairment in people with dementia and Alzheimer's. So if you're somebody who has early onset dementia, you're in the early stages, be aware that heat stress can exacerbate your symptoms, but more likely you're a caregiver of someone who has dementia or Alzheimer's. Recognize that if they suddenly start becoming more irritable, more argumentative, more confused, that could be because they're getting overheated. And it's really important for, for maintaining their comfort and their emotional stability to make sure that their body temperature is well regulated. For the average person, when we're exposed to heat stress, they find that our cognitive abilities quickly become impaired. The increased temperature of our brain and the body's reduced ability to bring oxygen to the brain. And there's a whole big explanation for that, if you want to read the article that's in the video notes. But the body actually loses ability as the blood gets hotter to transport oxygen. So when we start to get hot, when we start to get overheated, our brain temperature actually goes up because our blood temperature goes up, there's nothing cooling it. And it's less able to access oxygen because the blood's not carrying as much oxygen to it. Couple this with increased blood brain barrier permeability and you've kind of got a trifecta here. They did some interesting studies with radioactive dye, and they found out that under heat stress, there are certain areas of the brain that are more susceptible to heat stress, unfortunately, and you're going to find out in a second. They are highly involved in, guess what, thinking and emotion management. They found that under heat stress, the cingulate cortex, which is involved in emotion processing and behavior regulation, the frontal cortex, which we talk about all the time, that's involved in executive functioning and impulse control, and the hypothalamus, remember HPA axis, hypothalamic pituitary, adrenal axis, the hypothalamus, which is responsible for maintaining the system, keeping the system going, maintaining what we call homeostasis or balance. That area is also significantly impacted by changes in the brain that result due to extreme exposure to heat. And this doesn't. We're not talking like 115 degree temperatures. We're not talking a body temperature of 108 or above. We're talking extended exposure to high ambient temperatures that start impacting the body's ability to cool itself. I want to especially consider here people with poor air conditioning. A lot of people with, how shall I say this? Low socioeconomic status is a stressor. I think we can all agree on that. A lot of people who have a low socioeconomic status are at increased risk of depression and anxiety issues. So you have people who are already under stress and they may not be able to afford to crank up their AC in response to 102 degree temperatures outside. So people who are in lower socioeconomic statuses or we need to recognize that they may not be able to mitigate the heat as well as others. People who are in areas that are experiencing rolling brownouts or blackouts or whatever they call them, where you lose power for multiple hours at a time. Now the nice thing about brownouts is a lot of times you can prepare for them. So if you know that there could be brownouts in your area, you can freeze water bottles, especially the big 2 liter ones that take a while to thaw in order to help cool your temperature during the brownout. But it is important to recognize that during brownouts people are, that their temperature is going to go up, the ambient temperature is going to go up and we're often going to see increased irritability, increased aggression. Because that HPA axis, it's fight or flee. And if people can't fight, flee, then they often get defensive and may become more irritable and not necessarily physically aggressive, but verbally aggressive. You know, they're just, you know, get away from me. I can't deal with it. We also need to remember people who work outdoors or law enforcement or soldiers. Soldiers are often outdoors and they have to wear all that gear. Law enforcement has to wear all that gear. My husband was in law enforcement for about 20 years. And you know, between the uniform and the bulletproof vest and the undershirts and all that, it was hot. And it's important to recognize that even when they're in their cars driving around, the heat is beating down into their Cars. And I don't know about you, but I have yet to be in a in many vehicles that really have good air conditioning systems. So most of the time cops are getting in and out of their car. So it's not like they can sit in this nice ambient, cool car all day long. So we do need to pay attention because guess what? When roofers, for example, start having cognitive problems, they start having difficulty thinking clearly, they become more impulsive, they have difficulty concentrating, they're at much greater risk of injuries, much greater risk of making mistakes. Law enforcement, soldiers, they too are at greater risk because their reaction times are going to become somewhat impaired or altered. So we do need to recognize that heat is not something that is just totally benign. It impacts us emotionally, cognitively and physically. So what can we do? I said at the beginning we were going to talk about 20 or so tips in order to handle the heat. Not everybody's going to be able to do all of these, but there's probably a few things you can try. Cover your windows to block the sun. That does tend to make it darker in your area. Ideally you would have LED lights that you could turn on so you didn't mess up your circadian rhythms. You not everybody can afford to turn on lights and keep them on all day long. So I recognize that that might not work for you. Turn on a fan and expose your skin. You cool yourself as you sweat, and as the sweat evaporates, one thing that you can do is create sort of a makeshift swamp cooler. Place a frozen 2 liter bottle in front of a tabletop fan and turn it on. As the air goes across the frozen 2 liter bottle, it cools the air and then that cooler air gets to you. I have one of those set up on my bedside table. During these hotter months, cold compresses on your wrists. The blood circulates really close to the skin on your wrists, so if you put cold compresses there, it helps cool your body. There's also receptors in your wrists that help trigger the cooling response. Some people will put cool compresses on their neck. You typically want to be careful, especially if you've got migraines or epilepsy, against putting temperatures that are too cold on your neck. You don't want to shock yourself and trigger more problems than you already had, but a cool compress can be helpful. Take cool, but not cold showers and a lot of people are going to go, oh woo hoo. Because I hate those cold showers. If you take a shower that's too cold, your body says, oh, I need to warm this person up. I need to keep them from getting hypothermic so you don't want to trigger the warm up response. Taking a cool shower, one that feels comfortable to you, can help you increase your humidity, if you will, and help your body cool down a lot more effectively. Stay hydrated, especially with cool fluids. When you drink cold things, if you've ever, you know, gotten one of those big 64 ounce drinks or something and just chugged it, you know you can start getting really cold. I'm not recommending doing that by the way, but the point being, if you drink cooled fluids, then it can help cool you from the inside. It is important to recognize that you can quote over hydrate. Water itself is wonderful and we're made up of a huge percentage of water and we need to drink it, but we also need electrolytes. And if you drink too much water and flush out all of your sodium and potassium and other electrolytes, you can start having cramps and other problems. So it's important to not over hydrate, but stay hydrated and if you can afford it again. I know that electrolyte drinks can be expensive, but some of those electrolyte based sports drinks can be helpful during this period. Minimize cooking. When you cook, you increase the temperature in your house. Close your doors and block drafts from unused rooms. If you're all congregating in the living room, for example, close the doors to the bedrooms and put a towel in front of the gap at the bottom of the bedroom door so any air conditioning stays collected more effectively where you are at. Also close the vents in those rooms, especially rooms that you're not going to be occupying. So more air conditioning is sent to where you're congregating at if you live in an apartment. I remember when I was little, one of the ways that we stayed cool was hanging out in the breezeway of the apartment. Now if you don't live there, obviously don't go hang out there, but I remember spending afternoons and stuff because the area between the two apartment buildings, it was covered and it was a breezeway, was really breezy. There was a good strong air current that came through and it helped us stay cooler during the hot Florida summers. Dry your clothes on a clothesline or when you're not going to be home. And the dryer, even though you've got a vent that goes outside, the dryer, puts off a lot of heat. So it's important if you can, to dry your clothes on a clothesline. If you're not going to Be home. At least that gives the heat a chance to dissipate after the dryer shuts off. Or use a laundromat. Laundromats usually have pretty decent air conditioning and that avoids heating your home. Laundromats can also be expensive, so I understand, again, it may not work for you. Wear light colored, loose furniture fitting clothing. And the biggest issue here is loose fitting. They've done some studies that have found that unless you're out in direct sunlight, the color doesn't make that much of a difference. But if you wear loose fitting clothing, then the air can get underneath the clothing to evaporate the sweat and help you stay cooler. They have a lot of personal fans that you can get now that you can keep on your desk or even some that you can wear around your neck. Wet your hair. And I know some of us are not going to go to the office or, you know, go out in public with our hair like completely dripping wet, looking like a drowned rat. So it may not be an option. But if it is an option for you, if you're willing to do it, if you're hot enough, it will help you cool down. You lose a lot of your body heat through your head and your feet. Take your socks off. If you can be in an environment where you don't have to have your shoes and socks on, then that can also help you stay a little bit cooler and regulate your temperature a little bit better. Sprinklers, hoses, or slip and slides, these can be favorites. Some apartment complexes, for example, pay for the water. It's included in your rent. So you know, running a hose may not increase your utility bills. And I'm trying to be cognizant of not only people's temperature and their health, but also their financial status. But even a light sprinkler, if you have it running, will help you get wet with cooler water. And then that water has to evaporate so it can help you stay cooler. Ideally, put it somewhere where you're in the shade. And you know, I know I've talked about a lot of physical ways to handle the heat, but it's also important to recognize emotional ways to handle the impact of the heat. Stress. We know that heat causes stress. We know that heat triggers that stress response. And when we have that stress response going, our body runs hotter. It just does. So reducing stress can be helpful not only to reduce your core temperature, but also just to deal with the discomfort of being hot. Breath work is really helpful. And you can do this just by inhaling for four, holding for four, exhaling for four and holding for four and repeating that a few times or. And another great summer activity is to get bubble stuff and blow bubbles. And your kids can blow bubbles. That slows their breathing, that triggers the relaxation response and the vagus nerve. But it's also still kind of fun to do. And anytime you can add fun is also going to help increase the happy chemicals for to just keep it simple, which will buffer against the stress chemicals. So breath work plus fun is really, you know, helpful loving kindness meditation and you can look online and find different versions of it. I've got a video that narrates the loving kindness meditation. But the loving kindness meditation helps you focus your attention and try to focus on developing compassion for other people. Recognizing that everybody just wants to feel safe, happy and loved. And that can be huge. When tempers are flaring, when people are kind of on their last nerve because everybody's hot and uncomfortable and there's no end to the heat wave. Loving kindness meditation can be really helpful. Self compassion is also helpful. Not getting angry with yourself because you're having difficulty remembering things. Not getting angry. Angry with yourself because you don't have a lot of energy. Not getting angry because you didn't sleep well the night before. Well, you didn't. Getting angry about it's just going to worsen the situation. Having self compassion recognizing like right here. We're going through a heat wave here in middle Tennessee and I would love to get out and do some stuff in my garden and I really need to. However, I'm not going to right now. It is too daggom hot and I am prioritizing my health and well being over my green peppers. That's just the way it is. I'm having self compassion and I'm not going to feel guilty about letting my garden get a little bit overgrown because it's just too dagum hot for me to go out and worry about it right now. Don't forget the animals. I grew up in Florida and I remember one day when I was in college, very clearly there was this poor little squirrel who was just belly crawling across the concrete because he was so hot and he was so dehydrated and I gave him water and it helped him cool down and he ended up, you know, moving off a little while later. But all animals, even the feral animals, are susceptible to heat stress. If you've got pets or you tend a feral cat colony like I do, or you feed the birds like I do, pay attention to your domestic as well as your wild Friends use a frozen ice block in their water dish every morning and then put a new one in there in the evening. Yeah, in the evening, the temperature goes down some, but it doesn't go down completely and they're probably still dehydrated and overheated from the day. Make sure animals have shade, especially if it's a domestic animal like a dog or a cat. Make sure they have somewhere they can go and get out of the sun, preferably somewhere that has a little bit of a breeze. Have fans that are outside for equines and other animals that sweat. Dogs don't really sweat, but equines do. So having fans available for them, I know we have one for our mini donkey that she's able to go stand in front of and cool off a little bit. Minimize activity of the animals, including sniffing, particularly for dogs during hot weather. Sniffing as well as other activity increases body temperature. That's not what you want to do during hot weather. So encourage Fido to chill out for a little bit during hot weather. And if you have birds that you like to feed and watch or you just care about the birds in your area, shaded bird baths can be really helpful because they cool themselves off by getting wet. And if you've got a solar fountain in the bird bath, and I know you're going, but it's a shaded bird bath. True, but you can put a solar fountain in a shaded bird bath and have the solar battery component thingy out in the sun. You don't have to have it as an all in one thing, all in one fountain. You can have the battery somewhere else, which not only reduces the growth of algae in the bird bath, but it also keeps the water a lot cooler for the animals. There's a lot of birds, including hummingbirds, that will fly through little misty fountain and you can get them for, you know, 15, 20 bucks offline if that is something that you choose to do. And of course you have the money to do. Otherwise, just putting out a, like a big baking dish with a frozen block of ice in it gives animals somewhere where they can go as the ice melts. They can kind of cool off their little feet in the water. If you're on medications and they don't seem to be working as well as they're supposed to. Contact your doctor. This is not the time to think about it. You know, if you notice that your medications are not working as well, reach out to your doctor and find out if you are on one of those medications that's affected by heat or hydration levels. They can advise you about steps to take in order to adjust whatever you need to adjust so it manages your condition appropriately. If you need additional help. Maybe you can't afford your electric bill or you're getting ready to be homeless because you can't afford your rent payment or you're already homeless and you really want to get through into a, into some sort of a shelter. 211.org and you can go to 211.org online. Just go to pretty much any library and you can get on it. Or if you have access to a phone, you can call 21 1. And they have a huge database of nonprofits and places. A lot of them not, not even nonprofits, just organizations that care about people that are willing to help with a variety of things from providing shelter to help paying electric bills to free clinics. There are pretty much anything you can think of. There's probably a resource for it through 211. And if you are having difficulty with affording keeping your house as cool as you need it during the day. I know when my kids were young we, we had difficulty with that. And when I was very young we had difficulty being able to afford air conditioning. Going to the library. Libraries typically stay pretty temperate and you can read books and surf the Internet and do whatever. I remember taking my kids to the library and we would hang out there for a few hours and get a reprieve from the heat. Going to the mall or bigger stores like Home Depot or Walmart or something where you can walk around and look at stuff. That's not ideal if you've got kids because they tend to start going a little stir crazy. But if you're an adult and you just like to window shop or you just want to go and sit on a bench, that's fine too. Some malls have play areas for kids sort of in the middle. So if you have smaller children, that might be another place that you could spend some time at and benefit from somebody else's air conditioning. And churches. Now I have a little asterisk beside churches because you don't want to just show up at any old church. Likely anytime you contacted somebody at a church, they would welcome you with open arms. But you want to call ahead, see if they have a community room, see if they have somewhere that you can sit and read a book or spend time even in the sanctuary. Not every church keeps their sanctuary open all the time, but it is a place where some people will go again to get reprieve. But you know, sometimes also to pray. Whatever works for you. Most people who run churches really want to help others. And so if you go and you present your case, you let them know that you know you can't afford air conditioning. A lot of times they'll try to work with you or help you out. Maybe not every day, but today that might be an option, and then tomorrow you might need to look for a different one. Heat stress can make anybody irritable because it triggers your stress response system. It triggers that HPA axis and actually causes changes in the brain, including in the hypothalamus, the prefrontal cortex, and the cingulate cortex. Ongoing heat stress can alter cognitive functioning and make people more prone to slower reaction times, confusion, and just plain old poor judgment. People with mental health issues are at high risk of symptom increases due to changes in hormones and neurotransmitters and the influence of medications on their body's ability to cool. Its now, we can't reduce the temperature, we can't control Mother Nature. But we can reduce the related stress by being creative and also being compassionate and trying to help one another. The more we help each other, the more we reduce stress in our community, the better the effects are going to be. Maybe that's just me.