5

The Stress Response

I have been through some terrible things in my life, some of which actually happened.

—Mark Twain

I’ve missed more than 9,000 shots in my career. I’ve lost almost 300 games. Twenty-six times, I’ve been trusted to take the game-winning shot and missed. I’ve failed over and over and over again in my life. And that is why I succeed.

—Michael Jordan

How Your Body Reacts to a Wolf Attack

Imagine you’re a caveman. It is the dawn of human history and you have been out all day hunting. On the way home, you and your friends accidentally startle a pack of wolves. They growl as you pick up a stone to throw at them. You haven’t moved far, but inside your body a lot is happening. Anticipating a brawl, your body’s fight-or-flight alarm system goes off. Adrenaline and cortisol are pumped into your veins to boost energy levels. Your blood pressure and heart rate jump to send more oxygen to your muscles. Your pupils dilate so you can see better in the dark. The vessels in your lungs dilate so you can take in more oxygen. Pancreatic levels are adjusted to give you more quick-fix sugar energy in your blood. The pain-message system in the brain gets suppressed so that pain will not stop you from defending yourself.

This astonishing response is great for helping you survive dangerous encounters. In your state of heightened alertness, you hurl a stone at the wolves. This time you are lucky. They growl, then retreat. You let out a sigh as your whole body relaxes. You walk back to camp, where you enjoy an evening by the fire. Life as a Neanderthal is physically difficult, but predictable. Accidental encounters with wolves are rare.

Jump forward to today—to this morning. You awake startled as the alarm on your smartphone drags you away from a pleasant dream. While prodding the screen to make the incessant beeping stop, you notice a calendar reminder about the meeting you have later with your boss. That means either good or bad news about your bonus—which you need to take the vacation by the sea that you have been looking forward to. Despite leaving early, a traffic jam delays your journey.

Your boss is angry when you turn up late. He warns you that you can forget about your bonus if you are late again. He hands you a stack of files and tells you to go through them before lunch. You grip your coffee mug a little tighter as you momentarily indulge the fantasy of hurling it at your boss. In reality, you swallow, look down, and get back to work. Back at your desk, you feel a stabbing pain in your back caused by an old sporting injury. Regular exercise usually helps, but there is no time for that now, so you reach into your drawer for a few painkillers. You feel tired, so you make yourself another cup of strong coffee.

After work you go home on time hoping to enjoy the evening with your spouse. Your spouse hasn’t returned from work yet and you should probably pay the three overdue bills and insurance renewal waiting on your home desk, but it has been a hard day, so instead you pour yourself a glass of wine and flop down on the sofa to watch television. The news bulletin presents a world of economic crises, war, and natural disasters, and the commercial break reminds you of the expensive holiday you can’t afford. You awake to your spouse’s amusement at your having dozed off in front of the television again.

Unless you work in a zoo, wild animals probably no longer pose a threat, but many modern-day activities cause the same fight-or-flight reaction that wolves caused our ancestors. But while our ancestors could release the stress by throwing a rock at the wolves or running, we are forced by societal pressures to behave. So all that adrenaline hangs around in our veins. This makes us edgy and we overreact to things. Then to escape the daily stress we look forward to weekends, where we seek to distract ourselves with drinking, extreme sports, sex, or drugs.

In moderation, these things are good. However, many people take it too far and their efforts to relax have the opposite effect. If you have worked a stressful sixty-hour week, you probably need sleep more than you need a pub crawl or bungee jumping. In excess, these things can increase stress by making us tired, depressed, and emotionally chaotic.

At other times we look forward to vacations, where we spend our free evenings researching the “best” place; go on tours; eat, drink, and party too much; then fly home and get back to work before we have even had time to unpack. All this can be bad for our health.

How a Harvard Researcher Used a Goose to Discover the Fight-or-Flight Response

Powdered rice was used as a primitive lie detector test for thieves in India some 2,000 years ago. Suspects would be sat in a row and given a tablespoon of powdered rice each to chew. At the end of five minutes, they were ordered to spit the rice onto a fig leaf. The suspect whose rice was dry when he spat it out was deemed to be the thief. The rationale was that being nervous makes the mouth dry. The test was not perfect, because some thieves are good at lying, and some innocent people might get a nervous dry mouth when they are falsely accused. In spite of its imperfection, the idea behind this primitive test—that our nerve messages change when we are stressed out by lying—underpins the lie detector tests we use today. The notion is that our bodies react automatically when we perceive a threat. A Harvard researcher named Walter Cannon discovered the details of this automatic reaction more than a hundred years ago.

X-rays had just been discovered when Cannon graduated from medical school. At the time scientists argued about how food passed from the mouth to the stomach. Some scientists thought the act of swallowing pushed the food down the stomach with a single forced effort. Others thought it was massaged down slowly by wave-like contractions called peristalsis. In an effort to discover the truth, Cannon used X-rays to watch geese swallow buttons. He chose geese because their long necks provided more time to observe the process. (I don’t know how he persuaded geese to swallow buttons.)

People didn’t realize how bad X-rays could be at that time, and there weren’t many animal-rights activists around to stop him. Cannon defended the use of animals for his research and claimed to treat them very well. Using X-rays, he saw clearly the wave-like peristalsis in action, and the scientific debate was resolved. Next he showed that dogs and cats swallow in the same way as geese. He also observed signs of peristalsis in cats’ and dogs’ stomachs and digestive tracts. This led him to make a surprising discovery.

One day he was watching a cat digest food when dogs in a nearby room started barking loudly. This made the cats agitated and in many cases halted the peristalsis in their stomachs and intestines. This seemed strange to him, so he contacted his friend, the famous Russian psychologist Ivan Pavlov, who was doing related experiments with dogs. Pavlov, famous for the “Pavlov’s Dog” experiments—which I’ll talk about more in Chapter 9—was happy to hear about Cannon’s experiments because he had made a similar discovery. When Pavlov’s dogs heard another dog barking aggressively, they would become excited and growl and stop producing the gastric fluids required for digestion. Together, Pavlov and Cannon proved that when dogs and cats felt threatened, they stopped digesting.

During the First World War, Cannon was sent to the front line to treat soldiers suffering from traumatic shock, where he made two more discoveries about the fight-or-flight response. First, humans react similarly to cats and dogs when they get scared. Not only does our digestion stop, but a host of other changes occur: our mouths get dry, our pupils dilate, our heart rates rise, and our adrenaline and cortisone levels go up. Basically, he discovered what happened to our caveman when he saw the wolf.

Second, Cannon discovered that the physiological changes that make up the fight-or-flight response come as a package, happening more or less simultaneously. He supposed that there must be a single “switch” that activated all of these things. Eventually he called this group of nerves that gets activated during the fight-or-flight response the sympathetic nervous system. A nerve is like an electrical cable that sends information from one part of the body to another, for example from the brain to the stomach. The sympathetic nervous system is an interconnected set of nerves linking the brain and spinal cord to the parts of your body that you need to fight or run, such as the eyes, the adrenal glands, and the leg and arm muscles.

A few years after Cannon’s discoveries, a man named Hans Selye found that even small things can cause mini fight-or-flight responses.

Selye’s Bad News: We Can’t Escape Stress

Born in Vienna and raised in Hungary, Hans Selye began researching stress following his move to Montreal, Canada, in 1936. He found that almost everything we do in life causes a mini fight-or-flight response that he called the stress response. Most things in life cause stress, including illness, the excitement of our favorite sports team winning a game, or the upset of our team losing a game. Whether we are worrying about our job or our finances, or feeling happy because we are getting a pay raise, we get a stress response. We get the same reaction when falling in love or breaking up with a partner. Almost any new experience causes a mini stress response. Since every day brings new things, every day brings stress. Even if your days are all the same, worrying about your boredom can cause you stress.

Some scientists estimate that we have fifty stress responses per day, and a recent survey conducted by the American Psychological Association found that 25 percent of Americans rated their stress levels at eight or more on a ten-point scale. The stress problem is getting worse, with US stress levels rising 10 percent between 2012 and 2013. In fact, according to a US Surgeon General report in 1999, anxiety and stress-related disorders are the major contributors to mental illness in the United States. Nobody knows for sure why stress is rising. It might be because jobs are less secure and most people in developed nations are having more and more trouble paying their bills. It could be that the media bombards us constantly with bad news, or that traditional relationship roles are breaking apart, making family life more difficult. It is probably a combination of all of these.

On top of all this, it is getting more difficult to switch off. Our awesome mobile-phone technology means that our e-mails, messages, and reminders follow most of us into bed. Perhaps counterintuitively, affluence is another cause of increased stress. Ready-made food at the supermarket means we don’t have to chop food, let alone hunt. The easy availability of drugs from local pharmacies means we don’t have to deal with headaches or colds. And health and safety laws mean children don’t have to deal with adversity while they grow up. All this is great in many ways; however, since we are so protected, we have lost the ability to deal with challenges and stress.

Suspecting all this stress was bad, Selye looked for a cure. He worked tirelessly and ended up publishing 40 books and 1,700 articles on the problem. Sadly for those seeking to banish stress from their lives, his main discovery was that stress can’t be avoided. The best we can do, according to Selye, is to manage it. Once a reporter challenged Selye, saying that he must be under a great deal of stress because he worked so hard. He admitted that he did work very hard, but he said he only engaged in activities he could “win,” that he could manage. Unfortunately, Selye didn’t explain how we can choose wisely to focus on activities that we, too, can win or manage.

I’ll explain some techniques to do just that in Chapter 6. A better understanding of the strength of the links between stress and ill health might also motivate you to use them.

Stress and Health: The Damaging Facts

Heart disease is caused when the heart’s blood supply is blocked by a buildup of fatty substances in the blood vessels around the heart. This can lead to heart attacks and strokes. While it used to affect mostly older people, heart disease now affects a large number of younger working people. Today it’s the leading cause of death in the world, killing more than seven million people each year. We have known for a long time that obesity and lack of exercise can increase the risk of heart disease. Other psychological factors like depression, anxiety, and financial stress can also increase the risks.

We have recently learned that stress is also an important contributor to heart disease. A group of researchers in Germany identified four high-quality studies measuring the effects of stress on people with heart disease that together involved more than 2,500 patients. The people in these trials had already been diagnosed with heart disease. For example, they had already had a heart attack, but they were now well enough to return to work. Soon after they went back to work, the patients were asked about their stress. They were asked things like:

They were also asked to confirm whether they worked in a quiet and pleasant atmosphere, whether people at their workplace got along, whether they felt supported at work, and whether they got along with their supervisors. Participants were then monitored for three years. Taken together, the studies concluded that people who reported having lots of stress at work were 65 percent more likely to have suffered a cardiovascular disease event such as a heart attack or stroke than those who did not feel stressed at work.

In one of the studies, a Swedish one, about 10 percent of people with high levels of stress died from cardiac disease compared with only 5 percent of the people with low job stress.

Other evidence also suggests that too much stress increases the risk of sleeping disorders, depression, anxiety, autoimmune diseases, asthma, constipation, diabetes, cold sores, infertility, pain, post-traumatic stress disorder, tooth problems, slower wound healing, and sexual dysfunction.

A problem is that the evidence linking stress with ill health suffers from the “chicken-and-egg problem.” What came first: the bad health or the stress? If bad health causes higher stress, then it is obvious that people with more stress die younger, since the highly stressed people are also less healthy.

The only way to solve the chicken-and-egg problem would be to do a randomized trial. In theory, we could take lots of people and expose only half of them to stressful situations. This would tell us whether stressful situations were bad for health, but it would also be unethical to randomize people to do unhealthy things then watch them die. The good thing is that there are other good reasons to believe that stress actually does cause bad health, so we may not need randomized trials in this case.

For example, the authors of the studies on the links between stress and heart disease were pretty smart and used statistical techniques to help solve the chicken-and-egg problem. They asked people not only about their stress levels, but also about their general health at the beginning of the study. They did the best they could to make sure the people with high stress in their studies were not less healthy to start with. Another reason I believe the evidence about stress and health does not suffer from the chicken-and-egg problem is the link between stress and the immune system.

Stress and the Immune System

A group of researchers in the United States and Canada identified 293 studies that looked at what happens to our immune system when we are under stress. All but a handful showed that chronic stress suppressed the immune system. This happened in numerous ways, most often by either reducing natural killer cell activity or increasing inflammation. The immune system is complex, and these studies are not perfect; however, they all point in the same direction: chronic stress suppresses and confuses the immune system.

It is actually a bit more complex than that, because your immune system gets a short boost during a fight-or-flight response so you can survive a wolf bite. But too many stress responses each day messes with the immune system’s on/off switch, which can increase the risk of an autoimmune disease. An autoimmune disease is one caused by your immune system turning itself on when it shouldn’t.

The best example is an allergic reaction. If you inhale harmful bacteria, it is good to sneeze and have a runny nose to get them out. But if you swallow or eat something that is not intrinsically bad, like pollen, there is no need to sneeze. Sneezing because of an allergic reaction is basically an immune-system reaction gone wrong. Other autoimmune diseases include asthma and rheumatoid arthritis, as well as much more serious illnesses such as multiple sclerosis, Crohn’s disease, and lupus. There are no randomized trials I am aware of that show stress causes these diseases. However, as we will see in Chapter 6, lowering stress can reduce the symptoms of some of these diseases.

So what do we do about stress? There are basically three ways to react to it: run, fight, or manage it.

  1. 1. One way to run is to become a monk and live in the Himalayas chanting Om all day. If you do this you will not have car payments, mortgages, bosses, or relationships to stress you out. I have a lot of respect for monks, and we could all probably benefit by learning some life simplifying techniques from them. But a monk’s life is not for most of us.
  2. 2. The other way to deal with stress is to fight it. Fighting stress does not have to involve wolves and stones. When you wake up and see an e-mail that needs to be dealt with, reply before breakfast. When a bad driver makes you swerve, shout at them and report them to the police. Complain to the manager when a waiter doesn’t bring your food quickly enough. Argue and confront everyone and everything that causes stress. The problem with fighting stress is that you are probably not releasing it fully, the way the caveman was when he threw a stone. You are letting stressors control you. And you might end up dead or in jail. You certainly won’t make many friends.
  3. 3. Between these two extremes lies managing stress. It is what Selye hinted at when he suggested only engaging in activities we can “win,” or have some control over. Another way to put that is to avoid getting overwhelmed by stress. Besides the techniques we will learn in Chapter 6, the very knowledge that you have some control over whether you get a stress response helps.

The Cause of Stress Is Not Always “Out There”—It Can Also Come from Within

Before I had dogs of my own, I could not tell the difference between friendly barking and barking that meant a dog wished to bite me. Dogs scared me, so if I saw one when I went running I would get a fight-or-flight response right away. I would feel my body tense up and if I couldn’t easily avoid the dog, I got ready to fight and I tried to scare it off by shouting. That all changed when I got dogs of my own. I learned about dog body language and the differences between happy and aggressive barks. Now I am happy when I see a dog. Most dogs are friendly. It was not the barking that caused my previous fear, but my ignorance. More generally, neither dogs nor rain are stressful in themselves. Our inner reactions to them generate our stress responses.

We have some choice over the way we perceive things, including those that seem to be bad at first. Michael Jordan was probably the best basketball player of all time, but he was not selected for the varsity team in his sophomore year in high school and played for the junior varsity team instead. Instead of interpreting that as a negative, he saw it as an opportunity. It made him work twice as hard as anyone else, which is what made him so successful as a professional. So not making the team was actually a good thing.

Joe Greenstein, also known as the Mighty Atom, was one of the world’s first strong men. He was born with so many diseases that doctors predicted he would not live past five years old. His illnesses made him realize how precious every day was and he used that passion to succeed. Mahatma Gandhi failed to start a revolution in South Africa before his epic success in India. The “failures” of Jordan, the Mighty Atom, and Gandhi were an opportunity to learn and improve. When things that seem bad happen to me, I like to think of the story of the poor Chinese farmer:

Once upon a time there was a poor Chinese farmer who had only a son and a horse and a small piece of land. One day, the horse escaped into the hills. The farmer’s neighbors came to visit because they felt sorry for him: he had lost his only horse! “What bad luck!” they said.

The farmer replied, “Bad luck? Good luck? Who knows?” A week later, the horse returned with a herd of wild horses from the hills. This time the neighbors congratulated the farmer on his good luck. Now he had a whole herd of horses: he was rich! But he replied, “Bad luck? Good luck? Who knows?”

Then, when the farmer’s son was attempting to tame one of the wild horses, he fell off its back and broke his leg. Everyone thought this was bad luck. His only son was injured! Not the farmer, who said, “Bad luck? Good luck? Who knows?”

A few weeks later the army marched in to recruit all the young men to fight a war. Since the farmer’s son had a broken leg, the army let him go.

“Bad luck? Good luck? Who knows?”

The fact that a more positive attitude toward life can help does not take away the fact that some things suck. When I told my colleague Sir Iain Chalmers about stress being (partly) under our control, he said, “Tell my friends in Gaza whose houses are being bombed that stress is just in their minds.” Iain is right. It is ridiculous to suggest to starving people or those living in a war zone that their worries are just in their heads. I have never been in a war zone, and the closest I have come to starving is a voluntary fast.

Yet I can empathize a little bit with how these people might feel from the time when my mother suffered from metastatic breast cancer and was going through radical treatment. She was the most loving mother any child could have wanted. She was the closest thing to an angel I’ll ever know. She didn’t deserve to suffer. She tried everything from chemotherapy to diets to trying to gain weight (or lose weight) and nothing worked, because the cancer was too aggressive. I really tried to help her relax, but the cancer and the radiotherapy had messed with her brain, so she even had trouble doing that. On top of that, she was worried about what would happen to her children once she was gone, even though we were all grown up. So I know that when things really suck, changing your mind doesn’t change much.

That is why I want to make it clear, for anyone who is reading this book and something really terrible is happening, I am not telling you to snap out of it because it is only in your mind.

Fortunately, most of our problems are not that serious. It is much easier to adopt a positive attitude and reaction to things that suck less than fatal metastatic breast cancer, or living in a war zone. Ironically, one of the people who inspired this book is one of Iain’s friends, Khamis Elessi, who does live in Gaza. I met Khamis when he came to Oxford to attend one of my courses. The day I met him he had completed a three-day ordeal just to arrive in England. His journey had involved multiple passport checks, full-body searches, delayed planes, and numerous other indignities. He was worrying about his family back at home. On top of all that, he knew it would be difficult for him to pass the course at Oxford because there was no good internet access where he was staying. This made it almost impossible to complete the online activities that were required for the course.

Yet on the first morning of the course he arrived before all the other students with a big smile on his face. He turned out to be one of the happiest, friendliest, and most bubbly people I have met. He participated actively and respectfully in class discussions with other students from all walks of life and all religions and with a wide variety of political beliefs. After I drafted this story, I e-mailed him to ask if he was okay with me using his name and story in my book. His response was as inspiring as his story:

Dear Beloved Teacher,

I thank you so much for your kind message . . . smile is the most natural and spontaneous expression of happiness. The Secret of my Positivity and persistent smile most of the time is that I strongly believe in destiny, meaning “what will be will be,” but at the same time we are gifted with a free and amazing power of healing wounds, building bridges of trust, and beautifying our lives and that of others, which is the “SMILE.” It takes less effort to show, fewer muscles to exhibit, and shorter time to show its effect. It is an effective and instantaneous remedy for worries, distrust, and disputes . . . It can bring back hope and light as the way forward for us. I always say “whatever your brain can imagine, your hand will achieve one day.” There is no excuse for me and many others not to smile when we are being gifted and cared for by Great brothers, teachers, and friends . . . Despite everything . . . Keep smiling.

With my highest respect,

Khamis

Khamis’s positive attitude and smile do help him deal with his difficult circumstances in a more constructive way. If you watch the news, you might think that stories like Khamis’s are rare, but they’re not. You only have to look for them (and avoid most mainstream news). I recently found another inspiring story about a woman named Alice Herz-Sommer.

Alice was a renowned concert pianist who recently died at the age of 110. If you looked at the facts of her life, you would not be crazy for assuming that she might have been bitter. As a young woman during the Second World War she was taken to a concentration camp, where her husband and most of her family died. She and her son survived, but her son later died prematurely of an aneurysm. In her old age, she lived alone for years in London in a single-room apartment and suffered a great deal of pain. Yet she never stopped playing the piano and never stopped moving, and she never stopped being friendly to anyone who visited her.

How did she remain positive? In her words: “I look at the good. When you are relaxed, your body is always relaxed. When you are pessimistic, your body behaves in an unnatural way. It is up to us whether we look at the good or the bad. When you are nice to others, they are nice to you. When you give, you receive.”

If circumstances in the world were the sole cause of stress, then Khamis Elessi and Alice Herz-Sommer should have been stressed and unhappy, but they weren’t. And if things in the world made us relaxed and happy, then people who had beauty, wealth, and fame like Marilyn Monroe and Michael Jackson should have been blissful, but they were not. At least up to a point, the source of our stress is inside us.

Takeaway: Five Easy Ways to Move Away from Stress and Anxiety

The most evidence-based ways to deal with stress are to relax and meditate, and we will talk about those in Chapter 6. In the meantime, here are five strategies I use to move away from stress that you, too, might find helpful:

  1. 1. Breathe to relax. The easiest way to move from the fight-or-flight to the feed-and-breed response is to slow down your breathing. Randomized trials show that regulating the breath can reduce anxiety and stress. To do this simple exercise, breathe in for six seconds, and then breathe out for six seconds. If you can’t look at a clock, then make your best guess at the timing. If six seconds is too long, then try five, or four seconds. Just breathe in as slowly as is comfortable, then breathe out as slowly as is comfortable. Try it now and see how you feel. Most people find that slowing the breath calms the mind and the body. I demonstrate this in my seven-minute YouTube video called “Slow Breath for Reducing Stress.”
  2. 2. Take action. Instead of worrying about stress, ask yourself, “What concrete action can I take to address the thing that is causing me stress?” If your car breaks down, switch your attention from worrying to fixing it or calling a tow truck. If you can’t think of a concrete action that will address the problem, any action will do. Do something altruistic (see Chapter 12). Go for a run. Jump up and down. Scream. Almost any action will help you feel better. If you are calm enough to sit down, you can read inspirational stories or do the “what if” exercise (see #3 below).
  3. 3. The “what if” exercise. Think of the thing that is making you feel stressed. It might be that you are having trouble following a diet, or you want a better job or a great relationship. If nothing specific comes to mind, it could be stress itself. Then ask yourself the “what if” question. Here are some I have asked in the past:
    • What if I followed the diet properly?
    • What if I had my dream job?
    • What if I had that amazing relationship?
    • What if I could revolutionize and improve the way people view their bodies and their health?

    Close your eyes and imagine what it would feel like if all those “what ifs” came true. Try to imagine through all your senses and in as much detail as possible.

    For example: How would you feel if you followed that diet? What would you say? How would you look? How would the world look? How would you and the world be if you had that dream job or had that peaceful, loving relationship . . . ? How will you use the “new and improved” you to help the world?

    Write this down. Leave it for an hour while you have lunch, dinner, a bath, or a break. Then read it quietly. Read it aloud if you like. Read it as often as you like. The best time is when you first wake up or just before you go to bed. This will help you have a new attitude toward any potential worries.

  4. 4. Don’t add stress to your stress. It’s one thing to worry about something (maybe your car broke down). Then you might realize you are stressed, and after reading this chapter you might say to yourself, “Oh no, I’m stressed and that is bad for my health!” If you do that you are worrying about two things: you are stressed that your car broke down, and you are stressed about being stressed. Focus on a solution to the first problem (your car breaking down), and stop being stressed about being stressed. It doesn’t help and it doesn’t make sense.