“There cannot be a stressful crisis next week. My schedule is already full.” – Henry Kissinger

    Let’s talk a little science this week since I’m a nerd at heart.  There have been times throughout my years in private practice, that I’ve thought that stress and anxiety were at an all- time high.  I originally wrote a variation of this post in 2011  when people were reporting high levels of stress for a variety of reasons—the economy, the lack of sunlight, unemployment, etc..  In November of 2016,  there was a sharp increase in just about every negative feeling that a person could feel after Voldemort II cheated and “won” the election. And just when I thought stress levels couldn’t go up much higher, covid hits and knocks the world on its butt.   So I wanted to discuss the physiology of stress specifically what it is, how it affects us, and recap how we can control it. (My daughter is rolling her eyes right now as I’m writing this, making a huffy noise and then proclaiming “Mama you’re such a geek.)

    In simple terms, stress has been defined by two well-know researchers (Lazarus and Folkman, in case anyone is interested), as “when the demands of the environment outweigh one’s personal resources.”  Personal resources = coping mechanisms.  Emotions and stress have been thought to affect physical health for hundreds of years, but only recently have we developed the capability to show that stress creates discrete physical changes in the body.  For example, in reaction to stress, our body releases stress hormones (specifically cortisol and adrenalin) that, over time can affect health and well-being.  Granted, some stress is good, in fact we need our stress response to push us through the day.  However, too much stress can impair us.   Here are some ways in which our health can be affected:

    Heart in a vise showing the effects of stress on the cardiovascular system.

    1) Cardiovascular system:  Hormones released in response to stress raise our blood pressure.  Even a minor stressor such as yelling at someone in traffic can raise your blood pressure by as much as 10%!  That’s going from say 125 to 140 in a matter of seconds. Over time these substances cause changes in blood vessels, making them thicker and stiffer, and consequently making blood flow more difficult, eventually raising blood pressure and increasing the risk of not only heart disease, but also stroke.

    I’ll stop for a moment, because you may be asking the burning question of how exactly is stress studied and measured?  There are several different ways.  One way is to simply ask people to rate their stress levels on a scale of  1-100.  However, sometimes we need more than just self-report, because that can be very subjective…

    So another way to measure stress is to have volunteer participants come to a lab, mildly stress them out (with their permission and consent of course) and measure different parameters.  In my laboratory, many years ago, we would ask participants to complete a story-telling task and tell some of them that their answers would be judged (stress condition), while others were just asked to describe a picture (no stress aka control group).  Those who thought they were being evaluated showed an increase in blood pressure, heart rate, and cortisol.  In case you were dying to know, you can measure cortisol in saliva, so basically you stress people out and then ask them to spit into a vial and then the sample gets analyzed. Not very glamorous, but such is the life of a scientist (see graph below-I apologize for the labels.  They look like they were drawn by a 2 yr old but it was me trying to edit on my phone and make the graph more reader-friendly):

    Graphical representation of research done in my lab showing the effects of a stressful vs. non-stressful talk on salivary cortisol levels over time in college student.

    Rise in cortisol over time in stress vs. no stress groups. People who felt stressed had higher cortisol levels than those who did not experience a stressful task

    2) Immune system:  Ever notice when you’re really stressed you’re more likely to get sick?  That’s because those nasty stress hormones attack our immune system therefore making us more vulnerable to illness.

    3) Memory:  Everyone has had the experience of being under stress and having their mind go blank.  Countless studies have shown that stress directly affects memory by almost paralyzing brain cells that control memory.  Fortunately the paralyzing effects are reversible or we would all be brain dead.

    4)  Weight gain:  Yup, that nasty hormone cortisol signals fat cells to accumulate fat and hang on to it.  This is especially true for women over the age of 40.  Just great, right?

    These are just a few of the many ways in which chronic stress affects our body.  More important, here are some of the ways we can lower our stress levels with very simple interventions:

    Mr. Brain riding a bike to improve blood flow, mood and anxietyExercise.  No surprise to anyone reading this blog.  Studies show that exercise actually has the same mood lifting and anti-anxiety effects as medication.  Physical activity raises endorphins and serotonin levels and helps rid the body of cortisol quicker and more efficiently.  Exercise is the first thing I recommend to individuals who are depressed or anxious.

    Writing:  There is a profound positive effect of writing on stress and illness.  There have been numerous studies done where individuals experiencing some type of stressful event or trauma were asked to write about it, and the act of writing about stress lowers cortisol levels and their subjective experience of stress.  Several years ago, we asked college students to either write about stressful events in a stress diary or copy words out of a book.  In the end, we found that those who wrote about stressful events, not surprisingly reported feeling less anxious and stressed than those who just copied words.  Moreover, the students writing about stress reported less physical ailments and illnesses than the copying words only group.

    Imagery and meditation:  The effects of mediation and visualization on stress levels has been well-documented. Related to writing about stress, the literature also shows that writing a “script” and then rehearsing that script helps athletes (and other performers) who are anxious, perform better.  Similarly when people find themselves in a stressful situation, it’s been shown that visualizing a safe or peaceful place in detail, can lower self report of stress.  Give this a try when you feel your anxiety rising about a specific event, for example a competition (or lack thereof), or a difficult encounter with your boss ,or the election, and note the positive effects on anxiety levels, confidence and performance.

    Lean on friends: There is also a ton of evidence showing that social support buffers the effects of stress, while social isolation can actually increase your risk of heart disease.  Don’t be shy about reaching out to friends during difficult times.

    Eat healthy and get enough sleep: Remember back in the day when you were in college, during finals week your diet may have consisted of Doritos and Coke because there was nothing else to eat in your dorm room or apartment?   And you stayed up all night cramming for exams?  Inevitably, you may have felt even more overwhelmed, got into arguments with your friends, bombed the exam and then got sick.  Sleep deprivation causes decreased blood flow to areas of our brain that control our ability to reason and problem solve.   Lack of sleep = cranky and irrational.

    I know I’ve said this before but there is so much in life that we can’t control.  Why spin your wheels and waste precious energy worrying about the randomness of life? All the worry in the world couldn’t have predicted the events of the past 6 months  Instead, although sometimes difficult, direct your focus and energy on aspects of your life that you can control and change—that would be this day, this moment, and even sometimes this breath.


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