Mastering Hypertension: The Power Of Mindset

Catherine Van Tassell

Thanks for having me. I’m excited to be here.

Laurie Marbas, MD, MBA

Yes. Any question you might have on how to improve your life in any space, Catherine will be your go-to person. To get started, I want to highlight to you the importance of habits. And so the first question is, why is it important to prioritize gradual changes over drastic lifestyle overhauls when trying to either manage hypertension or other chronic diseases?

Catherine Van Tassell

Yes, well, I think this comes down to how we set ourselves up for success. It’s just if you think of anything we’ve ever done in our lives: graduate high school, maybe have a baby, get married, go to college, start a new job. You never do all of those things overnight. It takes nine months to have a baby. It takes 12 or more years to get an education. Whenever we do this, which we have good evidence of, January 1st is the perfect example of how this has never worked in the history of ever, because two weeks later, about 50% of us have given up, and then four weeks later, forget about it, we’re back to where we’ve been. That’s not because we’re not strong enough. We don’t have enough willpower. It’s because that’s the way life is. Our brains are set up, just as things play out. Instead of thinking, okay, I’ve been given maybe a diagnosis of hypertension, and that scares me. I’m worried about this. I’m worried about my future. I want to be here for my kids or my family, whatever that looks like to you. I need to get on top of this. Well, what is one thing you could do today? Then that thing will be tomorrow and the next day, and those things add up, and then you add something else to that. It’s very tangible and easy, and it doesn’t feel overwhelming because we get a lot of guilt and shame when we feel we haven’t done something wrong. What’s going to happen if we set ourselves up for failure? Now we’re going to have more guilt and shame. Then, just on January 28, we gave up, and we’re back to the beginning.

Laurie Marbas, MD, MBA

Yes, absolutely. Those small, fragile changes—can you give an example of what that might be? Maybe there are some of those things that someone can start small and build over time that will have an impact on something like high blood pressure.

Catherine Van Tassell

Yes. How does somebody take inventory? Okay, maybe. How did I get here? Always the good news. Let’s always look at the good news. Well, I have lots of ways to address this. We know that food, sleep, exercise, and stress management are important. Well, just look at those four things. Of course, what have we been given by our provider? Maybe we’re starting a medication or increasing it while we’re doing other lifestyle changes, and we have all of these things that can make a great change and be positive. Let’s pick one where we feel that one. I feel strongly about that. I could do something. Am I  sleeping for only five or six and a half hours a night? We know that sleeping less than 7 to 8 hours a night can increase your chances of worsening your hypertension by 200%. We see that in the age group of 45 and older. Is there something I could do? I just watch one less Netflix show a night. Does that mean I start pushing back the things that I do at night so I can get into bed earlier? That might be motivating because if I sleep longer, I’m going to feel better. If I feel better, I’m going to make another change that might make it easier for me to get up and exercise because I’m not so tired. Okay. I just made one small change by not watching that extra. I got to bed earlier and got more sleep. Then that can roll over into another exercise. What if I sleep? Okay, sleep seems a little overwhelming. I want to focus on nutrition. 

Well, let’s look at what is holding me back: that family and this family love to have high-fat, sugary-tasting foods for all the reasons why they’re very addictive to us. Who can I talk to my family about it? Hey, I have this diagnosis. I want to make some changes. Involve your family with you, and it’s more fun to do things together, especially if you’re living together. That can be challenging if you’re doing one thing and they’re not. Not all families want to make change, and that’s okay too. That’s where you have to set boundaries for yourself. This is important to me, and I would love it if you supported me. Let’s build an environment here where I can be successful and everybody in the family is happy too. Stress management and meditation. We know meditation is so effective for so many diseases, and hypertension is not exempt from that, because if you are in a constantly stressed state, you’re in this fight or flight, and you’re pumping a lot of cortisol through your body all the time.

When you’re in this fight or flight state, your body’s trying to save you. Your heart rate increases or your blood pressure goes up. That’s the last thing that we want. We know that just simple breathwork and square breathing. Breathing in for four or holding four for breathing out for holding for just doing that for 5 minutes. That will bring down your heart rate. Your body goes from fight or flight to rest and digest. That’s free. You can do it anywhere, and it’s very accessible. Look at all the areas where you can make some behavioral changes. Again, just pick one. We’re not going to do all of them. What seems most interesting, or you can maybe get a partner on board, pick one thing you can do and start doing that, and then pick another and another.

Laurie Marbas, MD, MBA

That’s a great segue into the next question. Let’s say that we’ve picked one: nutrition, sleep, stress management, whatever that might be. How do we know when and how to add in a secondary habit to see that compounded effect?

Catherine Van Tassell

Yes. I think once we feel we’re not overwhelmed by that first habit, that first habit starts to become more of a habit. We think about brushing our teeth. I’m pretty sure that 99.9% of us never think about having to get up and brush our teeth or brush our teeth at night. Now we’re just a repetitive behaviors, and our brains are plastic. This is what’s so cool about neuroplasticity. Essentially, we build these tracks in our brains the more we make a habit. That’s why if we start small and aren’t overwhelmed, we’re more likely to continue to do that behavior. We’ll just use exercise for this example. Let’s say you want to start exercising honestly. All I would say is for the first week, and if exercise is brand new to you the first day, all you do is put out a pair of shoes and walk around the block. That’s it. 

You get a sense of accomplishment from doing that. You showed up for yourself, and you committed and followed through with your plan. Then the next day, could you do another block, and you can see how this goes? Now I’ve been doing this for a week—two weeks. I’m walking for 20 minutes three times a week. I don’t feel overwhelmed. It’s now on my schedule. People know what I’m doing. They’re not bothering me or trying to take away from the time that I’ve set aside for myself. What else can I do? I start now focusing on my sleep. What about nutrition? Could I start going through my house and taking out some of the foods that aren’t maybe contributing to my health? Once you feel you’ve got one down and you’re not going to be overwhelmed to add another, that’s when I would say to add that second behavior change.

Laurie Marbas, MD, MBA

Well, let’s dive into the nutrition piece. How we would start eating those foods, or how would you suggest moving in that direction? Because I think nutrition is something we do three times a day. Most of us do it multiple times a week; it’s required for us to survive. How can we start making different choices and what foods should we maybe focus on first? Or how would you suggest that someone get started?

Catherine Van Tassell

Yes. I love the question about food. This food is almost a religion to people. We see a lot of people have very strong feelings about what diet they should be following, with other people telling us what diet we should be following or not following. I always say, Let’s just be very sensible about this. What do we know that I don’t think is too controversial? We know that unprocessed foods are better than processed foods, and we know that fruits, vegetables, grains, nuts, and seeds are all healthy foods. What do we know in terms of help that I think very few people, no matter where you fall, would agree on?

Well, it’s mostly fruits, vegetables, and whole grains. Let’s start there because those are the foods that are highest in fiber. They make us feel full because nobody wants to be hungry when they’re changing the way they’re eating. Also, being hungry when you change the way you’re eating is probably the first thing that’s going to send you back to doing what you were doing before. We don’t want to have hungry bellies. I don’t. Hungry is a word for a reason. We’re going to start. We know we just want to have more unprocessed foods. If this is very overwhelming, my suggestion is to just start with one meal a day. Let’s say this is week one of new and improved. We use me as an example of an improved character, and she’s going to make a change that’s going to set herself up for success. 

Let me just pick breakfast. Let’s just start with breakfast. What can I change in my breakfast? Let’s say I want to include more whole, unprocessed foods. They’re plant-based in the morning. I usually have cereal. Could you replace cereal with oatmeal? What if you wanted to have bacon, eggs, and pancakes? Okay. What about a whole-grain toasted tofu scramble that has your favorite veggie? Would that be mushrooms, bell peppers, or broccoli? You choose, you get to do whatever you want, and you just pick. What are you eating now? And how could you replace that with a new breakfast on Sunday? Set yourself up. Getting those prepared. You could get oatmeal baggies and put the oatmeal in them, and maybe put in some flaxseed. That’s great for our health. How about your vegetables? Do that for a week. Neuroplasticity—we’re going to build a behavior after you have that. Now next week, we will just focus on lunch. I could make a week full of grain bowls. All I’m going to do is cook a whole bunch of rice, open some cans of beans, sauté some sweet bell peppers, and maybe add some carrots. I can do that in less than an hour, make all my lunches for the week, and already have breakfast down to about two-thirds of the way there. 

Okay. Week three is not overwhelming for me. I have breakfast and lunch, and now I’m going to go to dinner. What can I have for dinner? What are the things that I normally eat? Okay, let’s say spaghetti a lot. Well, let’s do whole wheat or chickpea pasta. Can we sauté some spinach into that? Where can we add more greens and unprocessed foods but not change all of the things that we try and stay in that same wheelhouse? But look for replacements that are healthier for you. Tacos, two corn tortillas, and lots of veggies. You could put some tofu in there, some lentils, and some mushrooms. There are so many different options; get creative with them. Instagram has tons of different ideas. The Internet, get a new cookbook and bring your family into it. Bring your support system in.

Laurie Marbas, MD, MBA

Okay, small, consistent changes within a day, week, or month, and then just keep adding to it as you feel better and just keep making progress. Great. That’s awesome. We’ve made these changes, and we’re humming along, but of course, things happen. What strategies can someone employ to remain consistent with these small changes, especially when media results may not be truly apparent? Pressure can improve quickly, but sometimes it takes a little bit longer. What do you suggest for someone to remain consistent for the long haul? Six to 12 months might be required to see significant change.

Catherine Van Tassell

Yes. I think there’s so much here. A couple of things that I think are small, realistic goals. The benefit of doing this is not only having better blood pressure outcomes but also all the side effects: you’ll feel better, you may lose some weight, you may have more energy, and your skin might be better. These are just the things that happen when you start using stress management techniques: you start eating better and you start sleeping better. Start noticing the things that you’re seeing that are changing. One good thing would be to have a journal on your nightstand, on your bed, and every night write down a couple of things you’re grateful for that day: how you showed up for yourself, maybe a change that you made when it was hard. Maybe everybody in your family went out for ice cream, and you got sorbet instead of dairy ice cream. Write those down. Those are big wins where you showed up for yourself. Also, give yourself grace. We see this. We may have made a choice that didn’t align with our values. 

Then we just throw everything out the window. This is my stop sign or stoplight analogy. How many times if we had a meal that we thought was bad? There’s not bad or good; there’s just what fits with our goals and how we feel. We have this meal that we perceive as bad, and then we have guilt and shame. Then what happens? Well, I already screwed up. I’m just going to screw up everything after that because now I almost have the flight path that I’ve given myself. But we would never do that if we accidentally ran a stoplight or a stop sign, which we all have probably done. Now, what do you do immediately? Well, that was close. I’m glad we’re okay. Next time, I’m going to be a little bit more careful. If for some reason, you don’t wake up that morning and exercise or you only get 5 hours of sleep, okay, sure, that happened. Now for our next meal, I’m going to be on point, or tonight, I’m going to make sure that I get to bed on time. It’s just that that was just evidence of one thing: what maybe happened that threw you off track of what you’ve set up for your goals, and how can I have that not happen again? This is just sports. What do these teams that make millions of dollars do? They analyze all of the games. I don’t know how that happened. We’re going to do it better next time. There’s no reason why we can’t just do better next time.

Laurie Marbas, MD, MBA

Perfect. And I guess we could maybe go back a little bit, retrace your steps, and just give an example of exactly why it is a habit loop because I think once people understand, they can design their behavior to be the behavior designers of their own lives. It’s quite empowering. Could you explain what the power movements are? How to power? 

Catherine Van Tassell

Yes. I love this because I think once you understand it, it helps you understand why maybe we haven’t been successful in the past or maybe had a successful behavior change. Let’s pick a behavior that we want to change. Let’s say it’s nutrition. We want to change. Let’s say we’re always overeating or eating too many sweets at the end of the night. Okay. Well, let’s look at that. What is happening around that time? Is there stress that’s happening around that time? Boredom. Did we not eat enough during the day? We go to dinner hungry. We always want to be aware of our triggers and what’s going on. When we look at a behavior we want to change, what we typically do is just try and white-knuckle it.

Today’s Monday because everything starts on Monday, whether it’s the new year, a birthday, or I don’t know. It’s just, which is good. It’s good to pick a good time for that. But it’s Monday, and I’m not going to do this. Even though I’ve done this for the past five years, today I’m not going to do this. Then it’s just sheer willpower, and that usually never works out well. That’s because when we weren’t aware of why we did that until we didn’t replace that behavior with something else. That’s where you get into behavior change, where you’re successful. I don’t want to eat, and I eat a lot of high-sugar, fatty foods at the end of the night, even when I’m not full. Well, I know I do that when I get bored. Tonight, I’m going to make a change. I have my regular dinner. Great. I know I get bored, and I have this behavior. I’m going to replace it instead of just not doing it. I’m going to replace it because I ask my friends to go on a walk after we eat dinner, or my family or I’m going to a place to go, or I’m going to watch that favorite movie I wanted to watch, or I’m going to play some music to play an instrument.

You can go pick anything that you like and just replace that behavior, and then if you continue to do that over and over again instead of white-knuckling it, you just have this replacement. I always tell people to write down a list of ten items that you have to do. Whether that’s playing music, playing with your dog, being with your family, painting your nails, or knitting crochet, I play solitaire, play games, whatever goes for a walk, whatever looks, that brings you joy. Make a list so that when you’re going to change a behavior, you have this list ready. I want to do that. Insert that. There we go. I’m moving on, and I’m going to be successful.

Laurie Marbas, MD, MBA

Perfect. That is one strategy: behavior substitution. There’s so much more. But before we continue, I do want to just mention everyone. Thank you for joining us today. I hope you found this part of our conversation insightful and engaging. If you’re a summit purchaser, stay here because we’re about to dive right in even a little bit deeper into this discussion. I want to speak about mindset and some other things with Catherine. If you’re not a summit purchaser, please feel free to click the button below or to the side to access the rest of the conversation. Now, if you’re watching this, thank you for being a valuable member of the community, and let’s continue. We spoke to the habit loop and substituted behaviors. Can we maybe even speak to one mindset, or how do we stop bad behavior? Maybe there’s a detrimental behavior that we’re having or our habits. Those two things go together. How would you approach someone who is struggling with something that keeps undermining their goals or moving in a healthy direction?

Catherine Van Tassell

Yes, absolutely. It’s fun to dig into these because there’s usually some reason why this is happening. I would start, okay. What do you see? That is difficult for you to follow through with this change that you’ve wanted to do. Then give me some examples. Let’s look back at what you’ve tried. What has happened during that time? There are so many different reasons. I think this is the other thing about having grace with ourselves. This then also translates into a mindset instead of negativity, guilt, and shame, bringing positivity, grace, and compassion to ourselves, because if you look at this, I always want to say this isn’t because somebody didn’t want to make the change or they didn’t know they should. Many factors play into this. This could be socioeconomic; this could be stress; this could be time management; this could be family dynamics; or friend dynamics. Those are all the things that, not necessarily, I want to say, get in our way that can build some resistance in difficulty for us to make these behavior changes. 

Let’s be concrete and look back at when you weren’t successful and what happened there, so we can pull that apart and see. Okay, well, we noticed that this was a family system issue within our home. Great. Let’s dive into that. What did you try, and how didn’t that work? Instead of repeating the same behavior and expecting a different result, let’s change that. Or did you pick something that wasn’t sustainable and didn’t have a realistic goal? Let’s change your goal then. Let’s say, exercise. You chose to start running five miles a day, and you’ve never run before. Was it not that sustainable? Can we make a change there? I would say going back and looking at what potentially could have stood in our way and looking at all of the different ways that we can hit some resistance. Then there was one other thing I was going to say about that. But now I can see it, and now it has gone out of my brain. Education about it. Do you feel that maybe you didn’t go in with enough knowledge? You felt, Yes, I got this and then you got there, and you were, I don’t have this. I don’t know. 

Is there some more education that could be given, and who could give that to you? Maybe there needs to be another team member that we pull into your care team. Would it be beneficial for you to meet with a trainer? Do you have a lot of back pain from going out and doing an exercise program on your own is not realistic. Or what about a nutritionist? Would that be helpful? Then the other part of this that I think would be helpful is that we know a lot of behaviors can come out of trauma. We have these maladaptive behaviors that have happened, coping with trauma that we’ve had in the past, especially childhood trauma, or anything during our developmental years. It is not necessarily that you don’t have this realistic goal and that you have the support around you, that maybe something is underlying and it would be helpful to meet with a therapist with that, maybe to come back and look at what’s happening with that trauma that is standing in the way of your goals? That would be another way that I would suggest getting some help.

Laurie Marbas, MD, MBA

Perfect. I like the trauma aspect because I think a lot of people develop these habits unbeknownst to them, just trying to learn how to cope with something. How can someone start investigating the trauma that they’ve had? Is there a special type of therapist, or is there some journaling? How does someone even begin to understand? They’re saying, Yes, I do do this. How do they know if I can go back and say, Yes, that was the time that it started?

Catherine Van Tassell

Yes. If anybody has had trauma in the past, have they ever addressed it? Again, do they feel it’s impacting their lives now? I would say that most people would say yes because they’re seeing these habits that are impacting their lives as a result of that trauma. We see a lot of that. With food habits, we tend to have negative relationships with food when we’ve had trauma in the past. Let’s say we’ve identified that. What would be the best way to approach getting help? There are a few different options. If this individual is working at their workplace, do they have an EIP? Again, we want things that have the least amount of resistance and are easily accessible, especially when it comes to mental health. We know that people get better with mental health conditions, but they also need care that’s easily accessible and quick to access. 

And that would be one of the easiest ways. If it’s free, you can usually just call a phone number. Let’s try that. If not, we can look through insurance. There’s a website, PsychologyToday.com, where you can filter through your area’s insurance type of therapist. You can see their picture and read their bio so you can feel, this person I feel I can mesh with or not. Therapists are swimsuits or your favorite pair of jeans. Sometimes you have to try on a few to get the fit. Then there are types of therapy to be aware of. Maybe research EMDR can be effective if somebody has had a traumatic event in their past, and so those would be some. We’re just going to get started. Has this happened to me? Do I feel I have maladaptive behaviors from that? Here are some ways that I can start to look for some help.

Laurie Marbas, MD, MBA

That’s perfect. Any conclusions to looking at habits as helping someone? Maybe they’re feeling a little overwhelmed. There’s so much here I can maybe start with. Maybe address the initial overwhelm just for you to get started with people or talk themselves out of even taking the first step?

Catherine Van Tassell

Yes. I would start with a visualization exercise. I would sit down and then close my eyes. I would envision you on this finish line. Right now you are on the start line, I would envision what you are hoping to get at the finish line, whatever it looks like to you. Moving your body with your friend three days a week and sitting down and having nutritious meals that you had fun making together with your community. You name it. Whatever that is. Maybe you are now playing pickleball with your friends or your family. Going to the doctor standing on the scale, what are your goals and your blood pressure is within normal range. Visualize all of these things. Before anyone would say, that is crazy. NBA players that do visualization, and this is Olympic athletes, any major athlete. They have studies done when they visualize themselves making the basket or whatever that goal is. When they do that before, they’re more successful in doing that. We know that this works.

Again, in these organizations that have the most, that have all of the resources given to them and all the best science to make these athletes amazing, let’s pull that into our everyday lives and think of us as our athletes in our lives. What is this you look at at the end? Okay, the reason I also want you to do that is because it’s positive. No shame, no guilt. How am I going to get there now and then pick this is again a marathon and pick what are you going to do from now at mile one, and then we’ll worry about mile two? We’re only worried about mile one because we’re not going to be overwhelmed. We’re going to pick one small goal, and it’s fun. You can plot out miles, two, three, and four because we love to check things off lists. Whether you do that on an app or pen and paper, plot that out after you do this visualization exercise. You will get there. We’re just going to start with day one and how does that look for you?

Laurie Marbas, MD, MBA

Perfect. Well, thank you, Catherine, for sharing your wisdom and your experience with this. I hope everyone found this very helpful. See below where you can learn more about Catherine and potentially work with her in the service this year. Thank you.

Catherine Van Tassell

Thanks.