Beating Stress
Stress is basically a disconnection from the earth, a forgetting of the breath. Stress is an ignorant state. It believes that everything is an emergency. Nothing is that important. Just lie down.
—Natalie Goldberg
There are many factors that affect our health: genetics, environment, diet, chance. Some of these variables we can control; some we can’t. One of the most important health factors that we can control is stress. Stress, specifically chronic stress, is poison to our system—literally. The more we learn about how stress affects our bodies, the more we realize just how much impact it has on our health.
Nearly every week new studies are published regarding the ever widening circle of negative effects that result from chronic exposure to stress. The link between stress and cardiopulmonary disease is well established, with heart disease, arteriosclerosis (hardening of the arteries), and hypertension at epidemic level in the United States and other “modern” countries. But as we peel back the successive layers of this condition, we are finding that it affects adults and children in ways that we did not anticipate.
We are finding that it affects our brain’s ability to learn and remember; it causes us to age prematurely; it impedes the healing process; and it can lead to a variety of psychological and emotional disorders such as panic and anxiety attacks, insomnia, anger and irritability.
Some might note that stress was not recently invented and wonder why these effects have not been identified before. For all of history, people have faced hardship, fear, and anxiety, but it is important to remember that in previous generations infectious diseases were the biggest threat to livelihood and well-being. In general, people did not live as long and the effects of stress may have been masked or not fully understood. With the constant advances in medicine, stress-related maladies are more exposed, better understood, and on the rise along with lifestyles that increasingly expose us to chronic unresolved stress, whether from our job, traffic, globalization, twenty-four-hour news cycles, or other contemporary threats to our health and well-being.
What Is Stress?
Stress is the body’s response to environmental events that challenge us, frighten us, inhibit us, derail our intentions, or generally require us to change our behavior. Those events are called stressors, and the body’s response is called stress. In general, the body’s stress response consists of the release of chemicals such as adrenaline, cortisol, and homocysteine. These chemicals help to provide us with strength, energy, and stamina for short periods of time so that we can overcome the threats and obstacles in our environment.
Stress is oftentimes thought of in a negative light, but not all stress is bad. In fact, stress is and has been very important to our survival and to our advancement as humans. The stressful situations that we are faced with challenge us, and by responding to those challenges, we are pushed to find new ways of doing things. We imagine, we invent, we create, we find new ways to protect and provide for our families and ourselves. We become stronger and better able to withstand the threats to our existence.
If you are swimming at the beach and someone yells “shark!” a rush of stress hormones and chemicals will quickly course through your system. Your heart beats faster and your breath becomes fast and shallow. Your mind and senses become more alert to everything around you and often you will find that you can swim much faster than you ever thought possible.
Problems arise when we become continually stressed with no immediate outlet for that stress, and that the problems we face have no solution or are beyond our abilities. When there is no shark, no tiger, no bear, or no marauding band of outlaws, the same stress response that helped to ensure our survival in the past now becomes a threat to our health. When we are caught in a river of red taillights on the freeway; when the wait line for that critical morning latte is almost out the door; when your computer asks you to “Please stand by while important data is destroyed,” our body reacts the same as it would if we believed we were about to become the featured item on the seafood buffet. In fact, just imagining stressful situations such as giving an important presentation or reliving past events that elicit angry, frustrating, or sorrowful memories can create the same response.
When the perceived threats are constant, when there is no threat that can be dealt with and dispatched, the body’s stress response can become toxic rather than lifesaving. The same chemicals that sharpened our senses and reflexes, activated our immune system, and boosted our strength, now dull our mind, mood, and memory. They suppress our immune system, constrict blood flow, and sap our power and stamina.
Stress affects us all and some more than others. Each person is affected differently. According to an American Psychological Association survey, the top five sources of stress are money, work, family or personal health problems, the state of the world, and raising kids.
You may find the following pages, well, stressful. Our understanding of the many ways in which stress is eroding the health of our minds and bodies is a bit frightening, but remember: Knowledge is power. Understanding what you are up against empowers you to take action. There are many ways to counteract the effects of stress, but the simplest and most effective weapon is literally right under your nose!
The Bottom Line
The effects of chronic stress are wreaking havoc with our health and the impact on the workforce is downright shocking. Between 1997 and 2001, sick days due to stress tripled. If you missed work today due to stress, you would have been in good company. The National Safety Council estimates that one million of your coworkers also missed work for stress-related reasons. Talk about your million-man march!
As mentioned before, approximately 60 percent of work absenteeism is directly caused by stress. Similar results have been returned from studies in England, South Africa, India, and Australia. Personnel Today, the United Kingdom’s preeminent human resources magazine, reported that a staggering 97 percent of senior human resources professionals believe that stress is the biggest threat to the future health of the UK’s workforce.
There is much emphasis nowadays on employee retention and many of the top companies offer a variety of perks—everything from health benefits to on-site massages, daycare, dry cleaning, and auto services. But how many of them realize that 40 percent of employee turnover is due to stress?
In a study performed by the Families and Work Institute (a nonprofit research center) of more than a thousand employees, 54 percent reported being overwhelmed by their workload in the past thirty days, while a full third were found to be chronically overworked. As health-care costs continue to mount and the impact on productivity increases, more and more businesses realize this is a problem they can no longer ignore.
Besides the deleterious effects on our mind and body, stress can also contribute to an unsafe workplace. Alan C. McMillan, president and CEO of the National Safety Council, says that “with all its many advantages, the global, multicultural work environment has also contributed to a new workplace health hazard—stress.” He adds, “Employers are beginning to recognize that the better they can prevent and address occupational stresses, the more productive and healthy their workers and businesses will be.”
Donna Siegfried, executive director of workplace wellness programs for the National Safety Council, agrees: “In the U.S. alone, stress is creating a workplace hazard every bit as damaging as chemical and biological hazards,” she said. “With the proper tools, training and education, it will be possible to address this new menace as efficiently as we have addressed the more traditional causes of lost productivity.”
They have their work cut out for them. The American Institute of Stress reports that stress is a major factor in up to 80 percent all work-related injuries.
Kids Are Not Immune
We tend to think of stress as an adult affliction. It’s a product of our jobs, relationships, child rearing, and a heavy, complicated world that often feels like it’s resting squarely on our shoulders. But the kids feel it, too.
Although we tend to think of childhood as a carefree time, children are often exposed to plenty of stress. According to Dr. Sabine Hack, an assistant professor of clinical psychiatry at the New York University School of Medicine, “Children feel stress long before they grow up. Many children have to cope with family conflict, divorce, constant changes in schools, neighborhoods and child care arrangements, peer pressure, and sometimes, even violence in their homes or communities.”
The impact of stressful events is different from child to child. Dr. Hack maintains that “it depends on a child’s personality, maturity, and style of coping. It is not always obvious, however, when children are feeling overtaxed. Children often have difficulty describing exactly how they feel. Instead of saying ‘I feel overwhelmed’ they might say ‘my stomach hurts.’ When some children are stressed they cry, become aggressive, talk back, or become irritable. Others may behave well but become nervous, fearful, or panicky.”
Just as in an adult, stress can directly affect both the mind and body of a child. “Asthma, hay fever, migraine headache and gastrointestinal illnesses like colitis, irritable bowel syndrome and peptic ulcer can be exacerbated by stressful situations,” adds Dr. Hack.
But it can also be a factor in academic performance. In a recent issue of Psychoneuroendocrinology (in case your subscription lapsed) researchers at Douglas Hospital Research Center reported that chronic stress can be harmful to your health as well as your brain. Specifically, they found that stress hormones such as cortisol can inhibit the learning abilities of young adults. Dr. Sonia Lupien, director of the center’s Laboratory of Stress Research, found that even acute stress (and the accompanying increase in cortisol) could lead to reversible memory impairment in children ranging from six to fourteen. They also found that higher cortisol levels corresponded with lower socioeconomic status presumably due to the associated family, and nutritional and environmental stresses.
At McGill University in Montreal, Canada, researchers also found a link between childhood stress and health in children with asthma. The children were four times as likely to have a sudden increase in symptoms within two days of a traumatic event and even six weeks later, they were found to still have twice the occurrence of symptoms. The most powerful triggers were found to be births and deaths in the family, moving to a new home, family changes, and conflicts such as divorce and separations.
And in one of the world’s longest running health studies, researchers at New Zealand’s University of Otago have recently tied childhood stress directly to adult health issues. The study shows that children who experienced maltreatment, ranging from sexual and physical abuse to instabilities such as frequent changes in residence and/or caregivers, were nearly twice as likely to develop heart problems later in life when compared to children who rated their childhood as “happy.”
Associate Professor Dr. Richie Poulton, the study’s author, stated, “It’s the first study in the world to show a strong biological, plausible link between stress at a young age and physical health outcomes in later life,” and that our health is “the cumulative experience of a lifetime.”
Aging Gracefully—Or Not!
Modern science continues to make inroads in the area of extending our lives, but many people are now focusing on extending the quality of our lives. Living longer isn’t an attractive proposition if you are no longer happy or healthy. Once again, stress has been found to play an important role in how we age and the quality of our life.
According to a recent report in the Proceedings of the National Academy of Sciences, chronic stress can accelerate the aging process and the onset of age-related disease. Dr. Elissa Epel (University of California, San Francisco) led the study, which is believed to be the first solid link between aging and stress.
Dr. Epel and her colleagues examined the physiological effects of stress at the molecular level. Most cells in the body are constantly dividing. This enables them to repair themselves, keep the body healthy and counteract the effects of disease. Cells cannot divide indefinitely, and their ability to divide is governed by telomeres, which are the caps on the ends of chromosomes. Each time a cell divides, the telomere shortens. When the telomere reaches a certain point, the cell stops dividing and dies. If you ever wondered why you are losing your hearing and eyesight (among other things), blame your telomeres. They directly control the aging process and are associated with premature death from cardiovascular disease and infections.
Dr. Epel’s study found that there was a direct link between high levels of stress and the length of telomeres. They also found a link between stress and a substance in the blood that controls and slows the rate of aging. The study was conducted with women who were caregivers for children who had serious or chronic illnesses. The caregivers ranged in age from twenty to fifty and were compared with women who had healthy children. They found that the caregivers with the highest stress levels had telomeres that had aged an additional ten years. This is why, according to Dr. Epel, “People who are stressed over long periods tend to look haggard and it is commonly thought that psychological stress leads to premature aging and the earlier onset of diseases of aging.”
The study’s co-author, Dr. Elizabeth H. Blackburn, added that “not all caregivers fell into the high-stress group. This points to the importance of trying to use stress-reduction interventions as much as possible.”
The previously mentioned study by Dr. Lupien also had implications for older adults experiencing chronic stress. Not only has stress been found to impact their health, but brain function as well.
The Douglas study looked at adults over a three-to-six-year period and measured their stress levels by the cortisol level in their blood. What they found was that individuals with consistently high levels of cortisol had a noticeably smaller hippocampus, which is the section of the brain that controls learning and memory. They also found that those individuals did not perform as well on memory tests.
Offers Lupien, “This study clearly shows the negative effects of long-term stress” and “explains why some older adults show poor brain function while others perform very well. Perhaps, through early interventions, we can modify the cortisol levels and enhance brain function of the at-risk individuals.”
Lupien concludes, “All these studies show that people of all ages are sensitive to stress, and we need to acknowledge the importance of this factor on our mental health.”
The Physiology of Stress
In chapter 4 we laid out the list of afflictions where stress is strongly implicated. What is truly disturbing is that they have all become so commonplace that we don’t give them a second thought (unless of course we are the ones being diagnosed). High blood pressure? Anxiety attacks? Insomnia? Par for the course. But what is it that gives rise to these problems? What is actually happening to our body when we become stressed our exposed to it for a period of time?
When we are exposed to a stressor (things that cause stress), whether is it getting up in front of an audience to speak (many people say they fear it more than death), dreaming that you are falling, or replaying an argument in your mind, your body responds the same way. It is an amazing fact that our minds don’t really distinguish between real and imagined events. Anyone who has awakened from a frightening dream with a pounding heart and racing adrenaline can attest to that. This is why it is so important to practice positive thinking—our thoughts directly affect our entire body.
In his book Ageless Body, Timeless Mind, Deepak Chopra writes, “Our cells are constantly eavesdropping on our thoughts and being changed by them. A bout of depression can wreak havoc with the immune system; falling in love can boost it. Despair and hopelessness raise the risk of heart attacks and cancer, thereby shortening life. Joy and fulfillment keep us healthy and extend life. This means that the line between biology and psychology can’t really be drawn with any certainty. A remembered stress, which is only a wisp of thought, releases the same flood of destructive hormones as the stress itself.”
When we are faced with stressors, whether real or imagined, our body responds by releasing excess amounts of adrenaline and cortisol into the bloodstream. Our heart rate and pulse go up, and often times we hold our breath, which is a holdover from our distant past when it helped us to hear better and stay completely still. The body goes into survival mode, which means that all unnecessary functions are shut down. The body doesn’t put any energy into repair and restoration, as there won’t be any need, if it doesn’t survive the current threat.
Larry Woodruff, senior lecturer in the exercise and wellness department at Arizona State University Polytechnic, says that when chronic stress keeps the levels of cortisone elevated in our system, it “switches from being a protector to being a very toxic substance.” In addition to the myriad effects mentioned previously, it can make us more susceptible to the development of abdominal fat (a key indicator for heart disease and insulin issues) even in people who eat sensibly and exercise.
It adversely affects our hearts by causing our veins, arteries, and capillaries to constrict, which impedes the blood flow to the cells and systems that help to keep us healthy. It also elevates the levels of cholesterol and homocysteine which can damage arterial walls and is implicated in the onset of cardiovascular diseases.
Stress is also associated with short shallow breathing which has recently been shown to be associated with high acid levels in the blood. Among other things, this makes our body less able to eliminate salt from our systems, which in turn causes our blood pressure to rise, which in turn puts more pressure on our heart.
You Are What You Think
The medical community has long resisted the idea that our thoughts could actually cause damage to our bodies, but there is mounting evidence that that is precisely what is happening. Study after study is showing that our thoughts, perceptions, and overall outlook on life directly affect our health and longevity. Dr. Greg Markway, psychologist with St. Mary Health Psychology Services, says that strong negative emotions, such as anger, frustration, depression, and hostility, are strong risk factors for heart disease. “People who are depressed have less heart rate variability,” explains Markway. “This means the heart rate remains high, and doesn’t ever relax or recover.” In addition to increasing the heart rate and blood pressure, “It also creates tiny little tears in the arteries,” Markway says. These microscopic tears can provide a foothold for blockages and exacerbate the tissue inflammation that also is a common byproduct of stress and also promotes heart disease in a number of ways, from plaque formation to heart attack.
A heart attack patient who is clinically depressed has three times the chance of dying in the next twelve months, regardless of the severity of the attack, and 50 percent of people who have heart attacks do not have high cholesterol. What is being discovered is that an individual’s emotional and psychological makeup may be better indicators of heart attacks and heart disease than physical monitors such as EEGs. Edward Suarez, associate professor of psychiatry and human behavior at Duke University, says, “Hostile and depressed people respond to the world in a chemically different way. They oftentimes perceive the world in a negative way and interpret more situations as threatening or hostile. This triggers the ‘fight or flight’ response which results in a persistent stressful state.”
Researchers like Bruce McEwen, a Rockefeller University neuroendocrinologist, are beginning to develop a model of stress that portrays it as somewhat of a vicious circle, where stress hormones create an inflammatory response in the body that affects the brain, which affects the body until something finally gives (usually the patient). They have found that stress hormones can also affect higher cognitive functions such as memory, fear, and anxiety. Says McEwen, “It turns out that circuits in these parts of the brain are very sensitive to stress, and we’re just beginning to realize the myriad consequences that this will have on a person.”
The Antidote
So what can we do about stress and all of its destructive effects? Even if it were possible to rid ourselves of stress, we wouldn’t want to eliminate the positive effects of stress, as they play an important role in our lives and development. The world wouldn’t be a very interesting place if we were never challenged or bumped out of our comfort zone, although a month of it in Hawaii doesn’t sound too bad about now. We can’t control the causes of stress, but we can control how stress affects us. We do have control over that.
Dr. Herbert Benson, president of the Mind Body Medical Institute in Boston and an associate professor of medicine at Harvard University, wrote the pioneering work The Relaxation Response back in 1975 when stress wasn’t even on the radar. He counsels that when we become stressed, we often turn our backs on what we need most and that the goal of stress-reduction techniques is to counteract the effects of stress on the body.
During the times when other stress-reduction activities are falling by the wayside, our breath is an indispensable ally in the battle to counteract the harmful effects of stress. Most every meditation, relaxation, or emotional remedy includes an emphasis on the breath, and it is our breath that is usually the first and best indicator when stress begins to tighten its grip on us. Whenever we are confronted with a stressful situation, it is reflected in our breath. When we are tuned in to our breathing we can intercept the signals and take steps to deal with the stress in the moment, rather than letting it accumulate in our system and silently eat away at our health and well-being. It allows us to step back and examine the source of our stress, understand why it is causing our discomfort, and give us an opportunity to deal with the situation in a way that reduces our stress level.
Becoming familiar with the way your body responds to stress is the key. Once you have trained yourself to notice the tightening of your chest muscles and the held or shallow breath that almost always accompanies stress, you can immediately alter the equation by slowing your breath, pulse, and heart rate and dealing with the situation from a stance of calm, focused awareness. This approach minimizes the stress on our minds and bodies and maximizes our mental and physical resources so that we can be more effective in dealing with life’s tough problems.
In an article published in JAMA, the Journal of the American Medical Association, Dr. James Blumenthal describes the results of a study to test the effects of exercise and stress-reduction programs on heart patients. Researchers found that stress-reduction exercises were just as effective as traditional exercise for improving the health of heart patients. He says that “those patients who underwent the stress management or the exercise training experienced significant improvements in levels of depression and overall psychological distress, and not only did they experience those psychological benefits, but they experienced physical benefits as well.”
They found that “when patients experienced mental stress, exercise and stress management training were equally effective at reducing ischemia, which is when narrowed blood vessels prevent blood from flowing to the heart. But people who got stress management training saw added benefits in improved blood vessel health and the way the body handles surges in blood pressure.”
Remember, we can control how stress affects us. Intentional breathing is our most effective antidote to stress, and in this chapter we’ve seen just how effective it is at neutralizing its many effects on our minds and bodies. At the same time it’s counteracting the consequences of stress it is also bolstering our body’s natural defenses, and as we will see in the next chapter, increasing our natural ability to heal.
(For more information on stress, see chapter 4.)