Stress Management

Throughout this semester, I have written about the causes and consequences of stress. For example, constantly being connected to technology or worrying about terrorism can cause stress. This stress can manifest itself psychologically, but also physically in the form of cardiovascular disease or other serious illnesses. We might stuff our faces with junk food to combat the stress, and it might work for a minute. But then we might have to deal with the consequences of being overweight or at higher risk for diabetes, all of which can be connected back to stress again. Luckily, it’s not all bad news. There are active steps we can take to reduce the stress we experience on a daily basis and aim to slow down the deterioration of our bodies as we age.

One of my go-to remedies for a long day at the office is exercise. I think I’m extremely lucky not only because I enjoy exercise, but also because it has been a regular part of my life since I was young, so it is a core part of my life. Of course, there are days I feel too tired to go, but I always feel better afterwards. Previous research appears to support my positive views of exercise. Sapolsky (2004) notes that exercise not only improves mood, but also decreases risk of cardiovascular and metabolic disorders. In addition, Von Haaren, Haertel, Stumpp, Hey, and Ebner-Priemer (2015) found that a preventative aerobic exercise intervention led students to experience lower levels of emotional stress reactivity during a final exam. Less stress, less chance of disease, and a better mood—what’s not to like about exercise? (answer: burpees).

For those who are less athletically inclined, don’t worry—there are other ways to handle your worries. In fact, it is possible to train yourself to handle stress better. Evers et al. (2006) found that individuals trained in stress management with just three personalized training plans mailed to them were more likely to engage in stress management techniques long term and also experienced significantly less stress than those who were not given the intervention. Furthermore, engaging in mindfulness—purposeful, present-focused thinking—has shown positive outcomes both in terms of physical and psychological wellbeing (Alsubaie et al., 2017). Even though it is unclear whether the mechanisms behind Mindfulness-Based Cognitive Therapy or Mindfulness-Based Stress Reduction are the same for people with different disorders (Alsubaie et al., 2017), the important message is that we can employ various cognitive strategies to help us cope with stress more effectively.

Indeed, Sapolsky (2004) emphasizes the importance of flexibility to allow us to change coping styles when needed. For myself, this makes me think of how I adapt when certain coping strategies are no longer available. For example, last year I tore my ACL and was unable to engage in my usual sporting activities for over six months. It sucked. But during that time I sought out other activities that allowed me to cope with my stress.

As people get older, they may gradually lose access to the coping strategies they used to use. They may be physically unable to play a sport or perhaps lost a close loved one they used to vent to. Unfortunately, along with this loss of (perceived) functioning, the elderly may lose their agency and sense of purpose. Sapolsky (2004) discusses how control, predictability, social support, a sense of responsibility, and feeling needed are all important components to staying healthy as an older adult. He describes how nursing homes can often be a detriment to the elderly as they can lead to infantilizing, loss of control, and loss of social support. This certainly calls into question our society’s trend toward outsourcing the care of our parents and grandparents to paid professionals, but that is a discussion for another day. The important thing is that we all need to find ways to manage the stress of our everyday lives, and hopefully we have supportive people around us to help us get there.

References

Alsubaie, M., Abbott, R., Dunn, B., Dickens, C., Keil, T., Henley, W., & Kuyken, W. (2017). Mechanisms of action in mindfulness-based cognitive therapy (MBCT) and mindfulness-based stress reduction (MBSR) in people with physical and/or psychological conditions: A systematic review. Clinical Psychology Review.

Evers, K. E., Prochaska, J. O., Johnson, J. L., Mauriello, L. M., Padula, J. A., & Prochaska, J. M. (2006). A randomized clinical trial of a population-and transtheoretical model-based stress-management intervention. Health Psychology25(4), 521.

Sapolsky, R. M. (1994). Why zebras don’t get ulcers. New York: WH Freeman.

Von Haaren, B., Haertel, S., Stumpp, J., Hey, S., & Ebner-Priemer, U. (2015). Reduced emotional stress reactivity to a real-life academic examination stressor in students participating in a 20-week aerobic exercise training: A randomised controlled trial using Ambulatory Assessment. Psychology of Sport and Exercise20, 67-75.

Stress and Substance Abuse

Throughout this semester, we have been talking about the negative effects of stress on both our psychological and physical health. Even without understanding the details of how our body responds to stress, people know that it is uncomfortable, and thus seek out ways to cope with this negative feeling. One common solution that people turn to is drugs. Had a long day at work? Come home and smoke some weed to relax. Feeling a little anxious at a party? A few drinks can change that. Indeed, research has shown that these types of drugs blunt your stress response (Sapolsky, 2004). In addition, they change the way you appraise a situation (Sapolsky, 2004). For example, drinking alcohol at a party may make you less likely to notice when others are looking at you, reduce your inhibitions, and leave you inventing new moves on the dance floor.

Unfortunately, many of these drugs we turn to in times of stress can be addictive. When we start to take drugs, it feels good because it leads to the release of dopamine in our system, often at much higher levels than everyday pleasures such as food or sex (Sapolsky, 2004). For example, rats experience a 50 to 100-fold increase in dopamine when they are given food, but cocaine can increase their dopamine levels 1000-fold. As our neurons become desensitized to dopamine, our desire for drugs turns into a need for drugs; it’s no longer about seeking the pleasure of taking drugs, but more about avoiding the lows you experience when you don’t have the drug (Sapolsky, 2004). Thus, our tolerance increases and we become addicted.

Stress is not only involved as an initial motivator for turning to drugs, but can also influences our drug-related behavior in more nuanced ways. For example, stress increases our chance of becoming addicted to a drug as well as our chance of relapsing after finally kicking the habit (Sapolsky, 2004). Furthermore, it is not just an issue of acute stress. Rather, cumulative stressors in early adolescent drug users have been associated with substance abuse (Hoffman, 2016). These results suggest that stress in the moment and across one’s lifetime can influence how likely we are to move from getting drinks on the weekend with friends to feeling the need to binge drink every night.

Luckily, knowing that stress can be a risk factor not only for substance abuse but also for a variety of physical and psychological issues (as discussed in previous posts), there are some concrete steps we can take to avoid these negative outcomes. For example, stress management techniques have been shown to be associated with fewer health risk behaviors (Lipschitz, Paiva, Redding, Butterworth, & Prochaska, 2015). This is true not only for people who already employ stress management techniques compared to those that don’t, but also for those who improve their stress management. Another technique that we often associate with stress management is mindfulness—a technique people employ to try to stay in the present, be nonjudgmental, and intentional in their thoughts (Bowen, De Boer, & Bergman, 2017). One study investigated the association between mindfulness, posttraumatic stress disorder (PTSD), and substance abuse—two disorders that are often comorbid (Bowen et al., 2017). The authors found that mindfulness mediated the relationship between PTSD symptoms and substance abuse such that greater PTSD symptoms were associated with lower levels of mindfulness and greater substance dependence. My mom actually works at a mental health center teaching Qigong (which has some overlap with mindfulness) and definitely receives positive feedback from participants that centered, mindful thinking exercises improve their conditions. I am excited to see how these techniques can not only help improve the lives of people with PTSD, but also the lives of others who may just be experiencing everyday stressors.

References

Bowen, S., De Boer, D., & Bergman, A. L. (2017). The role of mindfulness as approach-based coping in the PTSD-substance abuse cycle. Addictive behaviors64, 212-216.

Hoffmann, J. P. (2016). Cumulative stress and substance use from early adolescence to emerging adulthood. Journal of Drug Issues46(3), 267-288.

Lipschitz, J. M., Paiva, A. L., Redding, C. A., Butterworth, S., & Prochaska, J. O. (2015). Co-occurrence and coaction of stress management with other health risk behaviors. Journal of health psychology20(7), 1002-1012.

Sapolsky, R. M. (1994). Why zebras don’t get ulcers. New York: WH Freeman.

Stress in the Geopolitical Context

Presidential elections are always stressful, but this one was different. When Trump was elected nearly a year ago, more was at stake than conservative versus liberal policies. Many politicians have hidden racist or sexist leanings in policy in the past, but Trump was unashamed to openly say that Mexicans are rapists or that his talk about sexual assault was simply passable as “locker room talk.” He vowed to ban Muslims from the country, deport immigrants, and support “religious freedom” by threatening women’s health care. His election was unique not only because of his outrageous behavior, but also because it was a surprise—most people predicted a Clinton win. It was certainly a stressor for me, and unfortunately, the stress continues to this day.

However, this event was not stressful for all people. Majumbder et al. (2017) explored what factors might put people at risk for experiencing stress and anxiety as a result of the 2016 election. They sampled participants both before the election (October 20-21, 2016) and after (January 20-21, 2017). They found that women experienced more stress and anxiety than men, both before and after the election. In addition, in the post-election survey only, democrats and low socioeconomic status individuals experienced more stress than others. Interestingly, factors such as geographic region and age were not significant predictors of stress. Looking at individuals’ specific concerns, Majumbder et al. (2017) found that people concerned about Trump’s capability, moral values, international policy, immigration policy, and temperament, as well as those who thought the outcome of the election would impact things such as their healthcare or place of residence were more stressed than others. These findings are interesting in that they clearly go beyond partisan opinions. It would be interesting to see if people had such stressful concerns about previous presidents’ characters.

Unfortunately, there were some important data points missing from this study that would have been interesting to examine. For example, they did not ask about participants’ race in their initial survey. Given how racially charged Trump’s rhetoric was as a candidate, I’m not sure how they could have missed this! In addition, the post-election dates on which they conducted the second survey were both significant in their own ways and could have contaminated the data with stressors other than those simply associated with being “post-election.” January 20th was the Women’s March, a day in which people came out in historic numbers to support women’s rights, particularly related to reproductive healthcare. This day was also taken by many to be anti-Trump. January 21st, was Trump’s inauguration. Thus, measuring people’s stress or anxiety on these days may have been tapping into other issues besides Trump being elected (although clearly these events directly resulted from his election).

Beyond demographic characteristics and party affiliation, underlying beliefs about the way society should operate also influence how much stress people feel during an election. When Barack Obama was elected in 2008, Trawalter et al. (2012) investigated participants’ physiological response by measuring both testosterone and cortisol levels. Specifically, they were interested in whether the degree to which participants expressed social dominance orientation (SDO)—the view that the existing hierarchy is legitimate and should be upheld—would be related to their physiological markers. They found that while all participants experienced cortisol “blunting” the day of the election (preparing for the possibility that they would have to mobilize resources once the results came out), participants high in SDO experienced significantly higher morning values after the election, indicating they were more stressed. However, they also experienced significantly higher morning testosterone levels the day after the election, possibly indicating that they were ready to respond to Obama’s election and fight back against this perceived threat to the status quo. These two studies demonstrate that the way in which we experience significant geopolitical events varies greatly, not just based on our demographic characteristics, but also based on our attitudes.

Another major type of event that affects people throughout the world is terrorism. Terrorism can adversely affect health in a myriad of ways, including PTSD for those that experienced the event (in person or not), targeting of health centers, and an association with increased suicide rates and schizophrenia hospitalizations (Garfin & Holman, 2016; Strand et al., 2016). Interestingly, in many cases it is difficult to know whether being at the scene of the crime is actually worse than experiencing it indirectly (Garfin & Holman, 2016). This last point is quite interesting. Although some studies in Garfin & Holman’s (2016) review have examined the effects of watching television footage of events such as the 9/11 attacks on the world trade center in NYC, I believe media effects on trauma are understudied. Both 24 hour cable news channels and sites such as YouTube make traumatic events widely accessible and allow us to be exposed to these events over and over again. I am curious whether the benefits of knowing about an event outweigh the consequences of exposing more people to the traumatic event. For example, some people would consider police brutality against Black Americans as state-sponsored terrorism against Black communities. While I think it is really important that these terrible events be documented to raise awareness, what are the potential consequences to individuals who view these events over and over again, particularly Black individuals who may identify strongly with the victims? The degree to which we should control exposure to these events in the age of iPhone cameras and social media is surely an important debate we will continue to have in the future.

References

Garfin, D. R., & Holman, E. A. (2016). Terrorism and Health.

Majumder, M. S., Nguyen, C. M., Sacco, L., Mahan, K., & Brownstein, J. S. (2017). Risk factors associated with election-related stress and anxiety before and after the 2016 US Presidential Election.

Strand, L. B., Mukamal, K. J., Halasz, J., Vatten, L. J., & Janszky, I. (2016). Short-term public health impact of the July 22, 2011, terrorist attacks in Norway: a nationwide register-based study. Psychosomatic medicine78(5), 525-531.

Trawalter, S., Chung, V. S., DeSantis, A. S., Simon, C. D., & Adam, E. K. (2012). Physiological stress responses to the 2008 US presidential election: The role of policy preferences and social dominance orientation. Group Processes & Intergroup Relations15(3), 333-345.

 

Technology and Health

One of the things I appreciate the most about the work that I do is that I can do it from anywhere. Well, not all of it, but most of it. As a PhD student researching social psychology, much of my time is spent collecting background information, coming up with a groundbreaking research question, designing an experiment that will answer it, testing out undergrads or online participants, and then writing up my results and attempting to publish them in a fancy journal (we’ll put coursework and TAing aside for now). With the blessing of my advisor, I was able to continue this work for a whole month this past summer while sitting in a cabin, looking out at a beautiful lake, and surrounded by mountains…in rural Japan! How? Technology.

Just in my own lifetime, there have been some life changing developments in technology—from the invention of the Internet and the World Wide Web (remember when you had to write “www.” before everything?) to smartphones to social media—we are able to stay connected, no matter where we are in the world. When I studied abroad in Tanzania, there were no refrigerators in the town I lived in, but people were constantly sending me friend requests on Facebook with their cellphones.

Back to my Japan story…while technology enabled me to be in the same space as my family while still fulfilling my work obligations, it meant that I didn’t have a clear separation between work and vacation time. In a sense, this was simply a macro version of what I experience during the school year at Tufts—blurry lines between work time and “having a life” time. So while it is great to have flexibility that technology affords us, constantly being connected and having access to the resources we need online may have negative consequences.

Indeed, Ayyagari, Grover, and Purvis (2011) reviewed literature related to technostress—a modern disease characterized by being unable to cope with information and communication technologies (ICTs) in a healthy manner. They examined how different aspects of ICTs such as usability features (the usefulness, complexity, and reliability of technologies), dynamic features (the pace of change of technology), and intrusive features (to what degree technology supports “presenteeism”—how reachable users are, and anonymity—the degree to which one’s privacy is encroached upon) cause strain amongst users. They found that 35% of participants’ strain was explained by the variables reflective of ICT impact. The top two contributors were role ambiguity and work overload. In other words, participants’ stress was associated with difficulty balancing conflicting demands amidst constant interruptions (role ambiguity) and feeling overwhelmed with their workload. It is likely not difficult to think of examples of this in your own work life. For me, even if I am at home outside of regular work hours, I have to balance whether to spend time focused on my family, responding to a TA student’s urgent email, or making progress on my research grant. And the constant availability of the Internet means my research hours are not limited to the library hours, and neither are the expectations from others about how many hours I should be putting into my job.

Unfortunately, technostress is not just limited to our professional lives. Rather, technology can continue to stress us out and lead to poor health outcomes even in our own free time! A review of the effects of Facebook use on mental health outcomes showed that it was associated with Facebook addiction (apparently this is nearly a clinically diagnosable disorder!), anxiety, depression, body image and disordered eating, and drinking cognitions and alcohol use (Frost & Rickwood, 2017). Interestingly, the review highlighted that the effects of Facebook may vary depending on the individual and how they use it. One point that really rang true to me was that greater Facebook use predicted fewer new social connections but better maintenance of long-term relationships. I could really relate to this because Facebook has been an awesome way for me to stay in contact with people, even as we all go our separate ways and move around the world. However, I can definitely see how continuing to invest in old relationships and interacting online may provide you with fewer opportunities to get to know new people in person.

While it may be easy for us to see examples of the direct effect of technology in our everyday lives, it is important not to forget that technology may be working all around us to improve our lives in ways that we do not even realize. For example, Kirchner and Shiffman (2016) reviewed research on geographically-explicit ecological momentary assessment (GEMA) and explored how devices such as mobile phones can help us gain more data about individuals’ movements, and subsequently provide eye-opening assessments of population level data on health-related outcomes such as diet, drug-use, and susceptibility to environmental pathogens. While I am still trying to comprehend the scope of this research, I was curious how apps that track your geographic location may also affect health on the individual level. For example, how effective are apps such as mapmyrun that promote exercise? Is tracking fitness and eating habits through fitbits or weight loss apps effective, or could the data be either misleading or discouraging in some way? Technology is evolving so quickly and opens our world to new possibilities, but it is important to we continue to think critically and attempt to understand both the good and the bad so that we can integrate it in the healthiest way possible.

References

Ayyagari, R., Grover, V., & Purvis, R. (2011). Technostress: technological antecedents and implications. MIS quarterly35(4), 831-858.

Frost, R. L., & Rickwood, D. J. (2017). A systematic review of the mental health outcomes associated with Facebook use. Computers in Human Behavior76, 576-600.

Kirchner, T. R., & Shiffman, S. (2016). Spatio-temporal determinants of mental health and well-being: advances in geographically-explicit ecological momentary assessment (GEMA). Social psychiatry and psychiatric epidemiology51(9), 1211-1223.

 

How Intergroup Relations Affect Health

In the United States, there is a strong cultural belief that if you work hard, you can accomplish anything in life. Socialism is largely rejected because people feel that they are in their position because of their own hard work or intelligence and shouldn’t have to share their bounty with those undeserving people who didn’t put the work in. Unfortunately, this cultural belief is largely an illusion. People in this country experience disparate outcomes based on numerous uncontrollable factors such as their race, gender, or family history (economic or otherwise). The reality is that demographic factors can literally be the difference between life and death, or at the very least between a shorter/more sickly life and a longer/healthier one.

While there is a huge literature detailing both socioeconomic and racial disparities in access to health care, I would like to explore more subtle factors that may fly under the radar but have enormous consequences for our health. Poverty is the single biggest risk factor for health outcomes including deadly diseases such as cardiovascular disease and cancer (Sapolsky, 2004). One of the main reasons Sapolsky (2004) cites for this outcome is that low socioeconomic status (SES) leads to chronic stress, which, as I’ve discussed in previous blogs, has severe consequences on various aspects of our health. Thinking of what it must be like to not know where your child’s next meal is coming from, fearing your heat may be shut off in the middle of winter because you couldn’t pay the bill, or hearing gunshots in your neighborhood as you fall asleep are obvious examples of how low SES individuals might struggle with both physical and psychological stressors on a daily basis.

However, beyond stressors that threaten impoverished individuals’ immediate survival, their psychological relationship to these structural inequalities can also be telling. In fact, an individual feeling poor can be more predictive of health than actually being poor (Sapolsky, 2004). Not surprisingly then, income inequality in one’s local community predicts poorer health outcomes (Sapolsky, 2004). Not only is income inequality on the rise, but also our understanding of “local” has expanded with globalization and the invention of the internet, leaving us to compare ourselves to the richest of the rich. Hence, it is not surprising that despite being a very wealthy country, America (with it’s extreme income inequality) suffers from subpar health outcomes (and likely getting worse with Trump in town…).

Seeing how mere psychological variables can be better predictors at times than actual financial ones when looking at health outcomes for the poor, it is not surprising that other stigmatized groups suffer from poor health as well. A rich social psychological literature speaks to the ways in which racial minorities in particular fall victim (see Major, Mendes, & Dovidio, 2013, for review). Low status individuals often experience both implicit and explicit prejudice from high status members, are vigilant as they try to stay prepared for these adverse events, and experience uncertainty in their interactions as a result of not knowing whether or not to attribute outcomes to their race. All of these factors lead to more stress and subsequent negative health outcomes. Interestingly, incongruence between how much injustice an individual expects and how much they experience can be an additional stressor, even if their experience was more just than they were expecting (Lucas et al., 2017). Finally, racial minorities may experience sub-par health care when they seek treatment for their health concerns as the largely White population of physicians may also show bias against them (Major et al., 2013).

Interestingly, interracial interactions are not only stressful for minority participants, but for Whites as well. Perhaps ironically, Whites who are concerned about appearing prejudiced experience the most anxiety in interracial interactions, demonstrated both by increased cortisol levels and behavioral indicators (Trawalter, Adam, Chase-Lansdale, & Richeson, 2012). In fact, over the long-term, participants concerned with appearing prejudiced showed signs of chronic stress in association with their interracial interactions.

Whether we like it or not, race and other group differences play a huge role in our society and cannot be ignored. As we work to give people equal opportunities in life, it is vital that we continue to recognize that factors totally unrelated to an individual’s abilities or effort are constantly at play and affect things as fundamental as their health. Of course, racial disparities involve both structural and interpersonal factors, and learning how to approach these difficult topics more comfortably is essential to produce positive outcomes for both high and low status groups.

Works Cited

Lucas, T., Pierce, J., Lumley, M. A., Granger, D. A., Lin, J., & Epel, E. S. (2017). Telomere length and procedural justice predict stress reactivity responses to unfair outcomes in African Americans. Psychoneuroendocrinology.

Major, B., Mendes, W. B., & Dovidio, J. F. (2013). Intergroup relations and health disparities: A social psychological perspective. Health Psychology32(5), 514.

Sapolsky, R. M. (1994). Why zebras don’t get ulcers. New York: WH Freeman.

Trawalter, S., Adam, E. K., Chase-Lansdale, P. L., & Richeson, J. A. (2012). Concerns about appearing prejudiced get under the skin: Stress responses to interracial contact in the moment and across time. Journal of experimental social psychology48(3), 682-693.

 

PTSD and Physical Health

As our knowledge of both physical and mental health has grown, it seems that we have become increasingly focused on identifying specific conditions and finding the best treatment to address them. Rather than simply labeling someone as sick, we are able to identify whether they are suffering from the flu, a sinus infection, or an autoimmune disease, and each of these conditions calls for a different treatment. While this specificity has done wonders to extend our life expectancy and decrease unnecessary loss of life, the more we learn about a specific condition, the more we realize that both its causes and consequences can be far broader than what originally meets the eye. Gaining a more complex understanding of how our bodies operate and how different health issues may interact with each other is crucial to ascertaining both effective treatments and preventative options.

One condition that is still quite early in this process of holistic understanding is post-traumatic stress disorder (PTSD). PTSD is a psychological condition in which individuals experience a traumatic event and fail to adequately recover from it. As a result, they re-experience the physiological symptoms of distress that were present during the original incident, attempt to avoid thoughts and reminders of the incident, and experience hyperarousal symptoms such as hypervigilance and insomnia (Yehuda & LeDoux, 2007). These symptoms result in impaired social, occupational, or interpersonal functioning, and are often comorbid with substance abuse disorders and depression (Yehuda & LeDoux, 2007). For example, a veteran returning from war may have been traumatized by a life-threatening situation in combat and experience severe distress when hearing fireworks go off because the sound reminds them of their traumatic experience. As a result, their heart may start racing or they may desperately try to get everyone around them to take cover, thus disrupting their social life (e.g., at a New Years party). While it is unclear what causes one individual to develop PTSD in the wake of a traumatic incident while another simply resumes a normal lifestyle, research suggests that individual differences in genetics and epigenetics play a huge role in determining whether people are resistant to stress, how well they recover from it, and who actually becomes more resilient after the traumatic stressor (Yehuda & LeDoux, 2007).

In order to address these symptoms, mental health professionals are often the primary source of treatment for individuals with PTSD. However, we are beginning to see that the effects of PTSD are not simply limited to psychological symptoms. Although evidence is not completely clear yet, a review of 15 studies conducted between 1980-2014 suggested that PTSD was negatively associated with physical activity and positively associated with binge eating behavior (Hall, Hoerster, & Yancy, 2015). It is not surprising, then, that a large-sample (n=54,224) prospective study also found that PTSD was associated with faster weight gain and increased risk of obesity among female nurses (Kubzansky et al., 2014). Furthermore, PTSD has been shown to be associated with chronic diseases such as cardiovascular, metabolic, and neurological conditions as well as cancer (Schnurr, 2015). Interestingly, these conditions are not a direct result of trauma, but rather, they originate alongside severe and persistent distress (Schnurr, 2015).

Before reading these articles, I had no idea so many physical health conditions were associated with PTSD. Some, such as cardiovascular disease, are somewhat logical because of their link to the physiological symptoms of PTSD such as increased heart rate when re-experiencing trauma. However, others, such as weight gain and unhealthy eating, are less predictable. Given the seriousness of many of these chronic diseases it seems critical that we increase awareness of their connection with psychological conditions such as PTSD. Individuals with PTSD should not only see mental health professionals but should also receive guidance from medical doctors to monitor and attempt to prevent the onset of medical conditions such as obesity or cancer. Furthermore, future studies should continue to examine PTSD as holistically as possible, including looking at health consequences that at first glance may not seem connected. Our bodies work in complex ways that we are only just beginning to understand, and sometimes we need to remind ourselves that the physical and mental cannot be compartmentalized, but rather, are intimately connected within one body.

 

References

Hall, K. S., Hoerster, K. D., & Yancy Jr, W. S. (2015). Post-traumatic stress disorder, physical activity, and eating behaviors. Epidemiologic reviews37(1), 103-115.

Kubzansky, L. D., Bordelois, P., Jun, H. J., Roberts, A. L., Cerda, M., Bluestone, N., & Koenen, K. C. (2014). The weight of traumatic stress: a prospective study of posttraumatic stress disorder symptoms and weight status in women. JAMA psychiatry71(1), 44-51.

Schnurr, P. P. (2015). Understanding pathways from traumatic exposure to physical health. In Evidence Based Treatments for Trauma-Related Psychological Disorders (pp. 87-103). Springer International Publishing.

Yehuda, R., & LeDoux, J. (2007). Response variation following trauma: a translational neuroscience approach to understanding PTSD. Neuron56(1), 19-32.

10.3 Stress and Immunity

As discussed in one of my previous posts, stress is an ambiguous, all-encompassing construct that people often use to label both physically and psychologically suboptimal states in which an individual is struggling to cope with the demands placed on him or her. You may say your body experiences stress when attempting to escape from an attacker, but you could also be stressed just worrying about an upcoming presentation. Despite these very different scenarios, the term “stress” is used to describe both states. Stress not only has a broad definition but also is broadly implicated in society as a major cause for anything from mild medical concerns such as catching a cold to more serious diseases such as cancer and even psychological conditions such as depression. But do these charges hold true? With this popular narrative it is easy to retrospectively identify stress as a cause for poor health outcomes, but does the evidence actually support this assertion?

First, let’s take a look at the simplest (i.e., short-term) health concern: infectious disease. Our body defends itself from infectious disease through a complex immune system (Sapolsky, 2004). Innate immunity is our first line of defense, and is a nonspecific response to infectious agents that causes inflammation. Acquired immunity, on the other hand, is a more complex system that allows us to target a specific pathogen, build up immunity against it, and boost our defenses if the same pathogen shows up in the future.

So how does stress impact our immune system? At first, stress appears to enhance it (Sapolsky, 2004). However, if the stressor is too intense or continues for too long, it may actually lead our immune system not only to return to baseline levels, but also subsequently to plummet further. For example, stress may enable you to push through that exam week without getting sick, but just when you’re arriving home for the holidays you may find you’ve succumbed to the flu. Alternatively, if you’re constantly overworked and sleep deprived you may find yourself catching a cold more easily. Indeed, Cohen et al. (2012) found that recently experiencing a long-term threatening stressor increased participants’ risk of getting a cold. In fact, they demonstrated the mechanism behind the effect: stress led participants to demonstrate glucocorticoid receptor resistance (GCR), those with greater GCR were at higher risk of catching a cold, and greater GCR also predicted greater inflammation in infected participants.

Interestingly, while stress can impact how our immune system operates, our immune system can also affect how we are impacted by stress. Hodes, Kana, Menard, Merad, and Russo (2015) found that our peripheral immune system alters our response to stress and can make us vulnerable to mood disorders such as depression. Dysregulated immune responses to stress may cause inflammation, which in turn may contribute to depressive symptoms. Thus, our physiology and psychology are intimately connected when it comes to stress and its impact on health.

The more immediate effects of stress on our immune system and ability to fight off infectious may be clear, but what about more long-term diseases such as cancer? Despite popular belief amongst the general population and cancer patients that stress contributes to the onset and worsening of cancer, the evidence for this is mixed and studies showing a connection are often flawed as they use retrospective methods (Sapolsky, 2004). One large-scale, prospective study, on the other hand, found that self-reported frequency of stress and adverse life events did not affect future breast cancer risk (Schoemaker et al., 2016). This disconnect between popular belief and scientific evidence could be detrimental as it has the potential to lead to ineffective preventative techniques and treatments. Thus, it seems critical that we improve health-related education as it relates to stress so that lay people do not mistakenly use stress as a catch-all explanation for poor health.

References

Cohen, S., Janicki-Deverts, D., Doyle, W. J., Miller, G. E., Frank, E., Rabin, B. S., & Turner, R. B. (2012). Chronic stress, glucocorticoid receptor resistance, inflammation, and disease risk. Proceedings of the National Academy of Sciences109(16), 5995-5999.

Hodes, G. E., Kana, V., Menard, C., Merad, M., & Russo, S. J. (2015). Neuroimmune mechanisms of depression. Nature neuroscience18(10), 1386.

Sapolsky, R. M. (1994). Why zebras don’t get ulcers. New York: WH Freeman.

Schoemaker, M. J., Jones, M. E., Wright, L. B., Griffin, J., McFadden, E., Ashworth, A., & Swerdlow, A. J. (2016). Psychological stress, adverse life events and breast cancer incidence: a cohort investigation in 106,000 women in the United Kingdom. Breast Cancer Research18(1), 72.

 

9.26 Nutrition and Health Decision Making

In the past, I have generally analyzed major health problems in the United States by comparing our outcomes to other countries. Take diabetes, for example. There are many reasons why an individual in the U.S. might be at greater risk of developing diabetes than someone in Japan. It may relate to factors such as food regulations, having routine exercise built into you day, genetics, food servings, access to affordable health care, or even public school lunches. There are many sociological and societal factors at play that influence an individual. However, what I perhaps did not realize was how many different physiological and psychological factors are at play just in our own bodies that may be producing these outcomes. It is not simply that we eat too much sugar and get sick. Rather, our bodies are highly complex, and each dietary or emotional or other event causes downstream consequences that we may not even be aware of. In addition, although we are often able to adapt or compensate for unhealthy steps along the way, these adaptations in and of themselves may reconfigure our body’s response and lead to long-term, irreversible consequences.

On the surface, if we just look at diabetes, we have a pretty good understanding of how it works, as outlined by Sapolsky (2004). In juvenile (Type I) diabetes, an individual’s ability to secrete insulin is severely compromised. As a result, they are unable to process glucose correctly, their cells begin to starve, and eventually leads their organs to malfunction. In addition, the glucose and fatty acid that has been left in the bloodstream clogs blood vessels in various parts of the body, further causing organ failure. Thus, Type I diabetes must be managed with insulin injections. In adult (Type II) diabetes, an individual’s cells actually fail to respond to insulin. When individuals are overweight and have a fat surplus, their fat cells are full and cannot take up as much glucose when prompted by insulin. As a result, the pancreas produces more insulin, their cells become less responsive to insulin, and the cycle continues. Subsequent exhaustion of insulin-secreting cells can lead an individual to then develop Type I diabetes.

On the surface, diabetes may seem easy enough to prevent (at least Type II diabetes)—don’t overburden your fat cells! Unfortunately, simply avoiding that pumpkin pie at the end of your Thanksgiving meal may not protect you. As it turns out, simply being stressed (e.g., preparing that entire Thanksgiving meal for your extended family) decreases how much energy we use after we eat and increases our insulin production, both potentially contributing to the downward spiral of diabetes (Kiecolt-Glaser et al., 2015). To counteract this stress, we may dig into some post-meal chips once everyone has left. Indeed, as many all-nighter college students might be able to attest, stress increases consumption of such comfort foods, just filling up those fat cells even more (Finch & Tomiyama, 2014). If you then begin to reflect on the political conversation from your (2016) Thanksgiving meal and enter a depressive state, you may also experience higher postmeal cortisol release, leading to triglyceride (fat) accumulation (Kiecolt-Glaser et al., 2015). All that fat accumulation and you didn’t even get to enjoy that pumpkin pie!

When we talk about weight management in the U.S., it is often in the form of concrete input and output of food and exercise. I ate three cookies for breakfast. I burned 300 calories at the gym. Then I ate a piece of pizza but maybe the negative calories from my celery stick balances it out? But in reality, the factors that determine our weight and general health are so much more complex. And understanding what each of the factors is is just the first step. Once we identify an influential factor, we must develop interventions to help change an individual’s course and prevent negative outcomes. One area of study that has been identified as particularly in need of study is affect in the context of health decision making (Magnan, Shorey, & Brady, 2017). While economic theory may give us a precise cost-benefit analysis for how we should make important decisions that impact our health, the reality is that issues related to our health (and food!) are inevitably affect-laden. Precisely measuring how affect contributes to health-related decisions we make has the potential not only help identify new and reliable predictors, but also to design more effective interventions to prevent individuals from succumbing to a multitude of deadly diseases.

 

References

Finch, L. E., & Tomiyama, A. J. (2014). Stress-induced eating dampens physiological and behavioral stress responses.

Kiecolt-Glaser, J. K., Habash, D. L., Fagundes, C. P., Andridge, R., Peng, J., Malarkey, W. B., & Belury, M. A. (2015). Daily stressors, past depression, and metabolic responses to high-fat meals: A novel path to obesity. Biological psychiatry77(7), 653-660.

Magnan RE, Shorey Fennell BR, Brady JM. Health decision making and behavior: The role of affect-laden constructs. Soc Personal Psychol Compass. 2017;11:e12333. https://doi.org/10.1111/spc3.12333

Sapolsky, R. M. (1994). Why zebras don’t get ulcers. New York: WH Freeman.

9.19 Stress and Cardiovascular Disease

Many of us know or have heard that stress, particularly chronic stress, is unhealthy. Not just that it may have psychological or emotional consequences, but that it has adverse effects on us physically as well. Despite having this vague sense that stress has negative effects on our health, I didn’t really understand the physical mechanisms through which stress could impact our bodies until recently reading an excerpt from “Why Zebras Don’t Get Ulcers” (Sapolsky 1994). In this book, Sapolsky explains how chronic stress can lead to cardiovascular disease (CVD)—the leading cause of death in the United States. He describes how typically, when we get stressed, our heart rate and blood pressure increase, arteries dilate, and we experience increased blood flow to our muscles and decreased flow to nonessentials such as digestion. While these responses would be adaptive in “fight-or-flight” circumstances, chronic activation of such a response essentially wears down our cardiovascular system, causing hypertension, an imbalanced heart, an inflammatory response in our blood vessels, and increased likelihood that atherosclerotic plaque will stick to these inflamed areas, causing heart attacks or stroke.

I think there are two main difficulties associated with tackling the issue of chronic stress leading to CVD. First, it is largely invisible to us. We may feel our heart racing when we are stressed, but we cannot actually see the effects it may be having on our cardiovascular system without medical equipment. Relatedly, it is a long-term problem and therefore the damage may not be visible until years into living a stressed-out lifestyle. When we are weighing the pros and cons of completing a grant proposal or essential work presentation on time, we probably are not considering that the stress may be contributing to future cardiovascular issues.

Perhaps identifying more specific concepts or behaviors than general “stress” would help us to monitor our behavior better to help combat CVD in the future, and scientists are attempting to make these links. For example, Newman et al. (1995) found that participants who displayed any amount of hostility in an observational interview had a greater risk of incident ischemic heart disease (IHD) than those who displayed no hostility. This may suggest that working to decrease hostile thoughts or behavior may decrease our risk of heart disease. Unfortunately, there were several limitations to this study. For example, Whooley & Wong (2011) called into question Newman et al.’s (1995) results due to the fact there were very few patients who actually demonstrated no hostility (about 10%), making it difficult to draw firm conclusions based on the data, and the mechanism linking hostility to IHD was also unexplored. Therefore, it is difficult to say whether reducing hostility may actually improve cardiovascular outcomes.

Tuck, Adams, Pressman, & Consedine (2016) explored another characteristic that may help explain differences in CVD that I refer to as the “fake-it-till-you-make-it” trait. That is, they found that a participant’s ability to express positive emotion was associated with lower CVD risk scores. Perhaps the ability to appear happy or unstressed actually lowers stress levels and leads to a lower risk of cardiac problems. While Tuck at al. (2016) did find significant results, their experiment was highly questionable. Firstly, their sample was biased—it was largely White and female, and additionally was self-selecting. Secondly, when split into gender groups, their results were only significant for men. Thirdly, while they found a significant relationship between ability to express positive emotions and CVD risk scores, they were unable to accurately assess whether this may also be true of the ability to express negative emotions because of facial coding problems and an uneven distribution of results. If, when properly examined, ability to express negative emotions was also related to CVD risk scores, we may infer very different conclusions about why there may be a connection to CVD risk scores. Finally, the researchers were unable to establish the direction of the relationship. That is, while it is possible that the ability to express positive emotion buffers men from CVD, it is also possible that men with generally poorer health are less able to signal positive emotions.

I believe that much of the difficulties associated with conducting the types of studies I discussed above arise from the long-term nature of behaviors that may lead to CVD as well as the huge multitude of behavioral, environmental, and genetic contributions that may lead to increased risk of CVD. In many cases, CVD may present itself at the center of a perfect storm between individual and environmental factors. However, working to understand what the greatest risk factors are and how to effectively communicate these risks to the public to produce real behavioral change is the challenge we are faced with as we attempt to combat this deadly disease. In addition, if the experiments described above are even somewhat on the right track, it seems that emotion regulation that involves decreasing stress and increasing positive and calming affect may be important to our cardiac health. I am excited to explore such techniques in future posts!

 

References:

Newman, J. D., Davidson, K. W., Shaffer, J. A., Schwartz, J. E., Chaplin, W., Kirkland, S., & Shimbo, D. (2011). Observed hostility and the risk of incident ischemic heart disease: a prospective population study from the 1995 Canadian Nova Scotia Health Survey. Journal of the American College of Cardiology58(12), 1222-1228.

Sapolsky, R. M. (1994). Why zebras don’t get ulcers. New York: WH Freeman.

Tuck, N. L., Adams, K. S., Pressman, S. D., & Consedine, N. S. (2017). Greater ability to express positive emotion is associated with lower projected cardiovascular disease risk. Journal of Behavioral Medicine, 1-9.

Whooley, M. A., & Wong, J. (2011). Hostility and cardiovascular disease.

 

9.12: Stress and Emotion

From my experience, stress is a term that is used frequently, under a variety of circumstances, to imply a large range of states, and seems highly relatable across individuals and situations. Perhaps surprisingly, given its versatility, many people seem to have an intuitive sense of what others mean when they talk about being stressed out and have a vague sense that it may not be so healthy. But if we dig a little deeper, we realize that stress is not only a complex interdisciplinary concept, but in fact may not be as straightforward and understandable as we may presume when we use the term in everyday life.

This week’s readings provided several perspectives on how our bodies respond to stress physiologically (Sapolsky 2004), how we might model stress in wild animals (Romero & Wingfield 2016), and how stress interacts with reason, appraisal, motivation, emotion, societal structures, individual differences, and a variety of other complexities that accompany the study of socially complex animals such as humans (Lazarus 1999).

Despite all being scientific chapters, I was surprised at the difference in evidentiary support provided in each of the articles. Although Sapolsky (2004) wrote about how our bodies respond to stress in general terms with few citations, this may have been because he was targeting a more lay audience. More interesting is the contrast between the other two papers. Whereas Romero & Wingfield (2016) weighed a great deal of laboratory evidence in support of the various animal models of stress before making their argument for which they found most compelling, Lazarus (1999) took a more theoretical approach. He stated, “Psychology has long been uncomfortable with theory, but it is important to find the most accurate and all-encompassing theoretical understanding we can construct” (p.99), and built his argument on larger conceptual ideas about what psychologically or socioculturally might explain the emotions and stress we experience. He seemed far more concerned with fitting his model into his view of society rather than providing empirical evidence.

Understanding how each of these articles examines stress not only points to how our conceptualization of it may vary between organisms and circumstances (i.e., wild animals versus humans), but also based on whether it is examined through an experimental or theoretical lens (or both). This emphasizes the point that despite this extensive analysis (and likely thousands of other similarly dense papers), we still do not have a clear definition of stress. And this is simply looking at scientific understandings of stress! This makes me wonder whether it is even valid to attempt to define stress as one construct, or if in fact, we are using stress as a blanket term to refer to a whole host of unique constructs that have yet to be fully fleshed-out. While Roskies’ (as cited in Lazarus 1999, p.30) proposal that “stress serves the same purpose in modern society as ghosts and evil spirits did in former times, making sense of various misfortunes and illnesses that otherwise might remain simply random games of chance” may have given too little credit to how far we have come in understanding the connection between the psychological and physiological health of individuals, it similarly alludes to the idea that we often use stress as an all-encompassing term when perhaps we need to challenge ourselves to be more specific.

Regardless of how we define the boundaries of stress, I have many specific questions remaining regarding how it operates practically in our everyday lives. One specific one I have been thinking about relates to acute versus chronic stress as discussed by Sapolsky (2004). That is, is it possible that low levels of chronic stress are adaptive in order to avoid high levels of acute stress? For example, perhaps the stress we feel on a daily basis to complete our readings or assignments is needed in order to a) force us to do our work, and b) prevent us from the huge amount of stress that would result from us procrastinating everything and possibly losing our jobs. I do certainly feel that I need some level of stress to really be productive. But back to my broader question above—are acute and chronic stress part of the same construct? Or might they be fundamentally different in more ways than we realize?

 

Works Cited

  • Lazarus, R. S. (1999). The cognition-emotion debate: A bit of history. Handbook of cognition and emotion, 3-19.
  • Romero, L. M., & Wingfield, J. C. (2015). Tempests, poxes, predators, and people: stress in wild animals and how they cope. Oxford University Press.
  • Sapolsky, R. M. (1994). Why zebras don’t get ulcers. New York: WH Freeman.