Stressed Out: Manage modern-life stress before health problems set in
First in an occasional series on managing stress
January 21, 2013 10:00 AM
Like other moms who work outside of the home, Stefanie Small of Squirrel Hill says the most stressful part of her day is when she returns home from work as a geriatric social worker to care for her three children. She uses a carrier to hold 11-month-old Aria as she makes dinner.
By David Templeton Pittsburgh Post-Gazette
Life is full of it.
Alarms sound and firefighters jump into fire trucks in a flash. Soldiers struggle to survive war. A mother grows exhausted caring for her children.
Corporate employees huff. Musicians get nervous. Lawyers argue. And clerks pretend that the customer always is right.
People live wholly different lives, but there's one thing they share: Life is full of stress.
Expected and unexpected daily challenges on the job, at home or out and about expose people to a constant barrage of forces that threaten their normal equilibrium.
What people don't fully realize is the toll that stress takes on our physical health. Stress kills.
Uncontrolled stress causes cardiovascular disease, obesity, type 2 diabetes, autoimmune disorders, cognitive and memory problems, and mental disorders including depression -- a biological rather than mental disorder caused by such a continuous cascade of stress hormones that the person can be disabled by it. In addition, an inability to cope with life's pressures can lead to behaviors -- such as smoking, overeating and alcohol abuse -- that compound the negative health effects.
Children who experience "prolonged adversity" from stressful experiences face higher risk for cognitive and mental health problems, with the worse consequences occurring in children who are genetically more vulnerable to stress, according to the National Scientific Council on the Developing Child. Its report says about 16 percent of children 2 to 5 years old already have mental health problems, with the number rising to 26 percent for children 8 to 17 years old. Disorders include emotional, anxiety and disruptive disorders, depression, and attention deficit and hyperactivity disorder.
Harvard University's Center on the Developing Child also reports that risk factors for adult heart disease are embedded in adverse childhood experiences, with the disease rate rising by 50 percent for people who had three adverse experiences in childhood and tripling for those whose childhood was marred by seven or more experiences.
Much as the antelope sprinting from a charging lion, people experience a fight-or-flight response when confronted with a threat or confrontation, even if it poses no threat to their lives. Early ancestors responded efficiently to stress by running faster or fighting harder to survive the dangers of the day. Those who didn't got eaten.
"We are the progeny of those who could escape danger," said Bruce S. Rabin, the noted University of Pittsburgh stress expert who successfully developed a stress management program more than 10 years ago.
Now we find ourselves unable to turn off the stress response.
However, Dr. Rabin points out that people actually can do this. His program promotes tested, efficient and free methods to control stress, based on the word and acronym RELAX -- Reflection, Expectations, Laughter, Acquaintances and eXercise. Managing stress requires mindfulness, optimism, humor, friends and family, and exercise. Add a good lifestyle and stress can be kept at bay.
The Post-Gazette's Magazine & Health section begins a series of reports today that will provide insight about how stress affects health and how best to manage it. The occasional series, in Monday editions, is based on the stress management program created by Dr. Rabin, a physician with a doctoral degree in immunology, and his colleague, Irene Kane, who holds a doctorate in nursing.
Dr. Rabin also provides free programs on stress management to groups throughout Pittsburgh based on the growing body of stress research with a focus on proven techniques to maintain good health in today's fast-paced, high-pressure world.
Starts in the brain
Stress is a normal part of life that occurs when the brain perceives a troubling situation that it cannot cope with. It becomes a problem when a person cannot turn off the brain's reaction to stress.
Stress signals from the cerebral cortex convince the body and rest of the brain that controls routine body functions to react as though a life-or-death situation were occurring.
In response, the brain pours out hormones -- adrenalin, epinephrine, seratonin and glucocorticoids -- in just seconds and halts body functions not essential to survival, causing the intestines to quit digesting food and the immune system to not fight infections. The immune system activates an inflammatory response that would protect against injury from the flight or fight. The heart beats faster to pump blood and added glucose to maximize the body's performance in a crisis.
The modern human has the same response even if there are no plans to physically react to a threat. Yet stress still kicks in when someone is cut off by another driver, bullied by a boss or spouse, or grows concerned about unpaid bills, deadlines and obligations.
Fifteen to 20 minutes after the stressful experience, the stress hormone, cortisol, begins to take effect to return the body to normal. After the chase, the antelope resumes grazing. With chronic stress, levels of cortisol decline in some people, making it difficult for the body to recover.
Problems can happen before birth, if a pregnant woman floods her fetus with stress hormones. The child who suffers mental, physical or sexual abuse, or other childhood trauma can have difficulties controlling stress for the rest of his or her life. The average person faces stressful episodes throughout life, including the death of loved ones, fires, floods, hurricanes, divorce, legal battles, problems with the family or trouble in the workplace.
If stress becomes constant, Dr. Rabin said, the effect on the human mind and body is frightening.
Controlling stress isn't a matter of medicating the body but managing the mind, he says.
While everyone experiences stress, not everyone manages it well. The reasons vary, including genetics and the degree of exposure to stressful situations beginning in the womb.
Adding to the problem is Americans' stress-filled lifestyle made all the worse by general admiration for those who invoke stress to succeed or make others work harder. Our society often chides those who can't tolerate stress: "The only difference between a diamond and a lump of coal is that the diamond had a little more pressure put on it," and, "If you can't stand the heat, get out of the kitchen."
Basic methods to manage stress include deep breathing, meditation, guided imagery, expressive writing, relaxation techniques, humor, exercise, friendships and human interaction, religion and spirituality and a healthy lifestyle.
People throughout history have realized that the brain produces problems for mind and body, but without full knowledge of the health impact.
Power of the mind
Roman rhetorician and writer Marcus Annaeus Seneca in the 1st century A.D. said, "We often are more frightened than hurt, and we suffer more from imagination than from reality." Mark Twain quipped, "I'm an old man, and I've had many troubles, most of which never happened." And poet John Milton said that the mind can make "heaven of hell and a hell of heaven."
But now research is showing that people can turn hellish situations into more heavenly ones by taking control of the mind's wayward worries and reducing the body's intractable tensions.
"For humans and animals as clever as humans, the stressors of life are predominantly socially generated ones that are both subtle and ambiguous," states Robert Sapolsky, a Stanford University neuroscientist in his famous report, "Stress in the Wild," in which he studied how baboons induce stress in each other, with resulting health effects. "To the extent that so many of our stressors are the inventions of the mind, so too must be the means of coping with them."
Dr. Rabin said a person can use tested methods in his program to train the mind to reduce stress automatically when stressful situations arise. His big message is that stress management and living a healthy lifestyle are keys to living a long, healthy life. And when the time comes, death will occur more quickly with less pain than people who die from chronic disease.
"I can say it works," Dr. Rabin said. "It's healthy. You find joy in life. When there is stress in my environment, I have no problem staying calm and focused. I don't think about it. I use a conditioned response and think of my happy place."