Stress: How inability to handle life's 'minor hassles' affects your health
November 19, 2012 5:00 AM
By David Templeton Pittsburgh Post-Gazette
When it comes to stress, it's better to be Teflon than Velcro.
Don't let stress stick to you like fuzzy stuff to Velcro. Let it slide away, like a cooked pancake off a Teflon skillet.
Such advice is warranted, given stress's dramatic effect on American health, even if it isn't as dire as the health problems caused by smoking, obesity and poor diet.
Local psychologists -- with Pittsburgh serving as a national epicenter of stress research -- long have known that chronic stress causes psychological ailments such as depression, anxiety and anger. But "reactivity" to stress -- or the overreaction to stress -- gets physical and can lead to cardiovascular and infectious diseases and the worsening of autoimmune diseases and HIV/AIDS cases.
It even makes people more susceptible to the common cold.
But it gets even worse.
PG graphic: Stress and disease (Click image for larger version)
Until recently, studies focused on chronic stress from sexual abuse, irascible personal or family relationships, long-term care of a sick child or family member, post-traumatic stress disorder or long-standing unemployment, underemployment or employment in a hostile workplace.
Now a Penn State University study says a person's inability to handle the "minor hassles of life" on a daily basis -- a pending deadline, unpaid bills, road rage, a burdensome chore or a spat with a loved one or colleague -- also affects health.
In 1995, the Penn State research team interviewed 435 participants each day for eight days to gauge the stress levels they experienced and their reactions to the stress. The team also did saliva tests to measure their levels of the stress hormone, cortisol. A decade later, in 2005, the team repeated the testing regimen.
Published recently in the Annals of Behavioral Medicine, the study found emotional reactivity to daily stress was "associated with an increased risk" that a participant would report a chronic physical health condition 10 years later.
"Results indicate that people's reactions to daily stressors are predictive of future chronic health conditions," the study states.
In a key finding, "minor hassles" of daily life can take a toll on health, independent of what chronic stress can cause.
"Daily stressors are less severe than chronic stressors, but they are nonetheless associated with adverse same-day physical health outcomes," the study says, noting the occurrence of fatigue, sore throat, headache and backache. It also worsens illness-related symptoms for those with chronic health conditions, including increased pain sensitivity for those who get tension headaches, elevated joint pain for those with rheumatoid arthritis and worsening of psoriasis, among other impacts.
Reactivity to daily hassles also can lead to hypertension, stressful social interactions that increase the risk for metabolic syndrome that's a precursor to type 2 diabetes and even cardiovascular disease. The study says the problem isn't stress but a person's reaction to it.
Velcro and Teflon types face daily stress. But Velcro types respond more emotionally and have problems letting the moment pass. For them, every unit increase in stressor reactivity results in a rise of 10 percent in the risk that participants in the study would report a chronic health condition 10 years later.
"I think our activities of daily life have evolved faster than body physiology," said David M. Almeida, a doctor of psychology at Penn State's Center for Healthy Aging, and the study leader. "We are trying to determine who the Teflon people are and who the Velcro people are. Not surprisingly, people who have more financial and socioeconomic resources are more likely to be Teflon people. They also are less neurotic and have higher levels of cognitive skills."
Easygoing types also have less stress, the Penn State psychologist said. People raised with warm parental relationships and higher levels of education, and those who are clever and quick to solve problems, encounter fewer problems with stress.
The study is the first to link everyday stressor reactivity to certain physical health conditions previously associated only with chronic stress, including digestive problems, pain-related problems and urinary-bladder conditions. The study calls for further investigation of how chronic and daily stressors interact on health effects.
Thomas Kamarck, a University of Pittsburgh professor of psychology and psychiatry whose studies include the health impacts of stress, said the Penn State study examines "emotional reactivity to daily stress as a predictor of chronic disease 10 years later."
The problem isn't the daily hassles, but the distress they engender.
"The unique twist in this study is that the authors measured daily stressors shortly after they occur, at the end of each day, rather than measuring chronic adversity, such as long-term unemployment, marital strain and so forth," he said. "The findings suggest that there may be some value in measuring stress and [response to stress] with a finer resolution than we've been accustomed to seeing in this research."
His own research at Pitt found that chronic adversity may be related to daily stressors. In other words, the big stuff affects the small stuff, which points to the need for "a head-to-head comparison of these two sources of strain as a predictor of chronic distress."
Stress, the Pitt psychologist said, can generate changes in behavior and biology, but he said there's a need for greater understanding of the mechanism.
There's already been some explanation of the pathway from stressors to disease.
Sheldon Cohen, the Carnegie Mellon University director of the Laboratory for the Study of Stress, Immunity and Disease, and his research team were the first to show how chronic stressors lead directly to disease, in this case the common cold. That model is now the standard to explain how stress can cause excess inflammation in the body that leads to other diseases as well.
Stress occurs when demands of the moment exceed one's ability to cope, he said, or when demands are high but one has little control over the outcome.
The series of Carnegie Mellon studies reveal the following processes:
When a stressful situation occurs, the body's fight-or-flight mechanism kicks in, shutting down systems not necessary to withstand the stressful situation while releasing adrenalin and other hormones to face or flee the problem.
The body's reaction includes a release of the hormone cortisol whose many functions include reducing the immune system's inflammatory response.
But when stress lasts for a prolonged period, the person continues pumping out cortisol and eventually the body becomes resistant to it, with the cortisol receptors on the surface of the cells turning inward or becoming less sticky. This prevents the hormone from attaching to the cell's cortisol receptors and reducing the release of inflammatory chemicals.
The result is the body's inability to control ongoing inflammation contributing to disease processes, including the progression of infectious diseases like colds and flu, autoimmune disease such as rheumatoid arthritis and coronary artery disease that can result in a heart attack.
Studies at CMU found that immune cells of people suffering from chronic stress, including conflicts with their bosses, spouses or close relatives or prolonged unemployment or underemployment, became insensitive to cortisol's ability to reduce inflammation. In turn, when exposed to a cold virus, their bodies were unable effectively to prevent disease symptoms caused by the inflammatory response.
Those with ongoing conflict with others had 2 1/2 times more risk of getting a cold than people without chronic stress issues. People who were unemployed or underemployed had five times the risk of getting a cold when exposed to the virus compared with people who had no chronic problems with stress.
Studies also reveal that people suffering from chronic stress exercise less and are more likely to smoke, drink alcohol, eat poorly and have problems sleeping, all of which also may put them at risk for a range of other diseases.
Doctors recommend exercise and lifestyle improvements to help the impact of stress, with health interventions necessary for those unable to handle stress.