The importance of keeping cool can’t be stressed enough
By Kate Silver
Stress has been a lifelong problem for Claire.* For years, the 32-year-old has struggled with health problems—irritable bowel syndrome and endometriosis, for starters—plus the memories of abuse from her youth that began coming back to haunt her when she reached adulthood. Despite extensive therapy, she’s struggled to manage those moments of stress, when her mind churned and her muscles clenched and her life felt out of control.
This year, between working full time as a research coordinator, pursuing her PhD in public health and battling all the stressors that had always been lurking just below the surface, she started feeling like she stood in quicksand. “The stress was just out of control; I couldn’t get anything done,” she says.
Claire isn’t alone. In 2012, the American Psychological Association (APA) surveyed Americans and found that 44 percent reported their stress had increased over the previous five years; 53 percent reported health problems as a source of stress; and 94 percent believed that stress can contribute to major illnesses including heart disease.
Stress is pervasive, and it’s a problem nationwide. While there are tools to manage stress, only 29 percent of people believe that they are doing a good job tackling it, according to the APA.
For Claire, the stress had become too much to bear on her own. She set out to find a way to take control back from the stress that was controlling her.
From her personal interest in stress and her work in the public health arena, Claire was familiar with something called mindfulness-based stress reduction, a form of participatory medicine by which participants experientially learn about their stress, stress reactivity and how they might be able to respond to their life challenges.
Determined, she signed up for the eight-week mindfulness-based stress reduction program at Rush University Medical Center, and began learning about different ways to cope. Under the guidance of the program’s director, Claire and her classmates learned to separate the stress reaction from the stress causation and develop a sense of control, where previously they’d felt none.
Claire says that before the program, she’d become distraught if her bus was running late, causing her to miss a meeting at work. She says she would have arrived at the office flushed, apologetic, disruptive. “I would have been so mad at myself. So mad,” she says.
Today, if the bus were late, Claire says, she wouldn’t just focus on her physical reaction but the thoughts behind it. “[Today], the bus didn’t come. [Previously, I would have been] frustrated, and I’m [feeling] guilty because I’m going to be late to my meeting,” she says. Then she considers why that’s a problem: They’re waiting for her. She’s not going to be able to share her latest work at the meeting. Then she focuses on her physical reaction: her jaw is clenched and her neck is tight. She tells her body to release the jaw. Relax the neck. Focus on her breathing. Accept her annoyance and then move on. “And then I can go, ‘OK. That was the incident. Now I’m moving forward with my day.’”
It sounds so simple. But if you’ve ever tried taking charge in a moment that feels like the world is swirling around you, pulsating beyond your control and you’ve tried to bring yourself back to reality, you know it’s far more difficult than it would seem.
There’s a reason it’s challenging: because of how we’re wired.
Patricia Normand, MD, assistant professor at Rush’s departments of Preventive Medicine, Internal Medicine and Psychiatry and director of the Mindful Life Program, led the stress reduction courses that Claire took at Rush. When asked about the history of stress, Normand brings up Walter Cannon, a Harvard physiologist who coined the phrase “fight or flight,” as a physiological response to stress.
Speaking in evolutionary terms, this kind of response was what saved our ancestors’ lives when confronted by, say, a saber-toothed tiger. It empowered them to run away or pick up a spear and fight. That response served an important purpose: saving their lives so that they were around long enough to contribute to the gene pool.
Today, we don’t see many saber- toothed tigers running down Wacker Drive or up State Street. But when stressed, our bodies still respond as though we do. “The stress response is nonspecific. Whatever is perceived as stressful will start this response going,” Normand says.
And whatever is perceived as stressful is completely relative, depending on the person confronting the stress. It could be something as simple as a traffic jam on the Stevenson Expressway or a line at Mariano’s, or it could be as complex as a family member becoming ill or a divorce in the family. Regardless, all of our cylinders fire at the same level. “Our bodies are still reacting as if the stressor were the saber-toothed tiger,” Normand says.
Normand, who for years ran a private practice in adult psychiatry and also did a consultation with medical outpatients at Massachusetts General Hospital, says she became interested in mindfulness and integrated medicine when it became clear to her that diseases of the body and diseases of the mind were interconnected. She says mindfulness appealed to her because it empowered her patients.
“I was interested in using more of a holistic approach,” she says. “It allows people to be active [in] their own healthcare.” Not only can mindfulness keep ailments from getting worse, she says, it can also help prevent diseases from happening—just by altering the response to stress.
53 percent reported health problems as a source of stress”
“Most of the time in most of our daily [lives], we are living on autopilot—you know, where you drive somewhere in the car and you haven’t [perceived] anything along the way, or you eat a meal and haven’t tasted anything,” she says.
Mindfulness is the opposite of autopilot. It’s driving while alert. Eating with enjoyment. Reading a book to your child and actually paying attention to the words. Mindfulness is purposefully observing sensations, thoughts and feelings in the present moment in a nonjudgmental way rather than zoning out and focusing on what happened five minutes ago, or what’s about to happen in 10 minutes.
“We spend very little time in the moment we’re actually in,” Normand says. “And therefore, we tend to be very reactive to what may be going on around us.” Because the brain truly can’t focus on more than one thing at a time, it’s easy to disappear, mentally, into what irked you last night, or to cerebrally plow ahead to your 3:00 p.m. presentation and worry about how you’ll do.
Normand says that if you can bring yourself back to the present moment by focusing on something simple, like the way you breathe or the feel of your feet on the floor, you will give yourself a moment of pause, which then allows for a conscious response rather than an automatic reaction. And because you can only focus on one thing at a time,
being in the moment means that you’re not stressed about the past or the future. The goal of mindfulness, Normand says, is to increase your capacity to tolerate stress, regardless of what’s causing it.
“What mindfulness does is [teach] you techniques to pause, and [to] just be present with whatever is happening,” Normand says.
If all of this mindfulness stuff sounds a bit woo-woo and touchy/feely, stick with us.
There’s no doubt that the concept of mindfulness-based stress reduction could use a rebranding campaign. But it’s a legitimate medical practice. It was developed in 1979 by Jon Kabat-Zinn, PhD, at the University of Massachusetts Medical School, and is now offered at hospitals and medical centers across the world (in Chicago, there are mindfulness classes at NorthShore University HealthSystem, Rehabilitation Institute of Chicago, Loyola University Chicago and Northwestern University).
Garry Sigman, MD, who teaches first-year medical students at Loyola University Medical Center about stress, illness and how they fit together, admits that mindfulness sounds hokey but defends it as a philosophy. It is, he says, consistent with every form of religion and psychotherapy.
“It’s got a bad rap, but all it means is being here, being now, learning to think before you react, learning to be aware of what you’re feeling before you react, and what your tendency is before you do something without thinking about it,” says Sigman, who is also the director of adolescent youth and adult medicine at Loyola University Health System. “It should be called something else, and then people would accept it.”
Sigman is a believer, and uses relaxation and mindfulness meditation techniques frequently with his adult and adolescent patients. “Mindfulness is a core phenomenon that if humans practiced more, would reduce a lot of problems, both individually and in groups,” he says. “Mindfulness helps one evaluate the stressful stimulus and be able to evaluate its true significance, so one can affect the appraisal of the stress. ‘Is it truly something that I need to get upset about?’ and ‘I realize that I have the resources to take care of this.’”
Stress is something that begins early and builds throughout our lives. When newborn babies cry, it’s a form of stress reaction. A baby reacts emotionally when it’s in pain, hot, cold, hungry or needs a diaper change. With age, people begin to modulate that stress response. Sigman says our stress response is formed by genetics as well as environment. How emotionally your parents responded to stress will shape the way you, too, respond.
Men and women respond differently to stress. It’s more acceptable for women to express themselves and share what they’re feeling, he says. Men hold it in more, which can result in pent-up emotions and can occasionally lead to anger, violence or substance abuse.
Child or adult, man or woman, the short-term physiological response to stress is quite similar to that of animals, Sigman says. It happens through the autonomic nervous system, and it looks like this: The heart beats faster. Airways open up to get more air. Excretion is inhibited. The pupils dilate. In this moment, whether you just burned the oatmeal raisin cookies or you lost your job, you’ve got some decisions to make.
This is the precise second that your body is appraising stress, asking itself—without even knowing it—“Is this something I need to worry about?” The second question creeps in just as quickly: “Do I have enough energy or support or resources to cope with the stress? Or do I fall apart?” Your reaction depends on your ability to cope, your biology, your emotions, your level of fatigue and other factors coming into play. Will you fight? Will you flee? Will you focus?
The longer-term response to stress takes place in the glandular system, Sigman says, and this is where some longer-term health-related issues can come into play. The brain gives off a hormone that makes the adrenal gland emit cortisol, which is a steroid that moderates the stress hormone. If it weren’t for cortisol, Sigman says, we’d be toast. “The organism would kind of destroy itself from stress,” he says.
But even though the cortisol is saving us, it can lead to different problems. Cortisol also works to suppress the immune system. That’s why people who are stressed are at a greater risk of getting sick.
“There are many studies that show a correlation between chronic stress and disease. Even minor illnesses, the common cold,” Sigman says. “Two people can be exposed to the same viruses, but the one who’s more stressed is going to get sick.”
And then there are the maladies that stress doesn’t cause but can certainly worsen. Sigman ticks them off: inflammatory bowel disease, rheumatoid arthritis, hypertension, heart disease, peptic ulcer disease, headaches. “Even diabetes,” he says. “Stress can make the blood sugar higher because certain hormones increase blood sugar when under stress.”
Ann Davis, MD, a cardiologist with Edward Heart Hospital and Midwest Heart – Advocate Medical Group, says that one of the challenges of stress is that there’s no physical test for it. “I don’t have an exact blood test for how freaking stressed out you are, like a number—wow, you’re 34.5; you really need to be 3.0,” she says.
Still: “You know it when you see it.”
Davis says she cautions her patients to protect themselves against stress. “It’s not just some goofy little thing. It’s a real thing that could impact somebody’s cardiovascular health in a real way,” she says.
While Davis says there are no studies that show a direct link between stress and heart disease, she adds that there is no question that continual stress can result in elevated levels of adrenalin, increased blood pressure, heart rate and inflammation, all of which are connected to blood clots, stroke, heart attack and other serious health events. “I don’t even need to know what you’re referring to or the topic, but whatever the question is, the answer is going to be yes, stress is going to make it worse,” she says.
Davis points out that people who are more stressed are less inclined to exercise and more prone to eat poorly and gain weight—all of which contribute to the unhealthy cycle and can lead to even more stress. “I’m not a psychologist or a psychiatrist, but stress, anxiety and depression can lead to physical symptoms,” she says.
She tells patients that the key is to find what you enjoy doing, and do it. Make the time to do what you love, and don’t feel guilty about it. Learn to say no when people ask you to take on more responsibilities. Focus on your own happiness. “Because if you’re not present and on your game and happy and healthy and strong, how are you going to help all the people around you that you have to be happy and healthy and strong for?” she says.
Martin Boyer, DO, a radiation oncologist with Alexian Brothers and St. Alexius Medical Centers, says that when patients come to him for cancer treatment, a stress screening is a part of the appointment.
Still Feeling Stressed?
The experts interviewed for this story recommended the following to help combat stress and feel better.