6 Lessons for Handling Stress

Friday, Jan. 19, 2007
By CHRISTINE GORMAN
Take a deep breath. Now exhale slowly. You're probably not aware of it, but your heart has just slowed down a bit. Not to worry; it will speed up again when you inhale.
This regular-irregular beat is a sign of a healthy interaction between heart and head.
Each time you exhale, your brain sends a signal down the vagusnerve to slow the cardiac muscle. With each inhale, the signal gets weaker andyour heart revs up. Inhale, beat faster. Exhale, beat slower. It's an ancientrhythm that helps your heart last a lifetime. And it leads to lesson No. 1 inhow to manage stress and avoid burnout.REMEMBER TO BREATHEEVOLUTION HAS BEQUEATHED TO OUR BRAINS A variety ofmechanisms for handling the ups and downs of life--from built-in chemicalcircuit breakers that shut off the stress hormones to entire networks of nerveswhose only job is to calm you down. The problem, in the context of our alwayswired, always on-call world, is that they all require that you take regularbreaks from your normal routine--and not just an occasional weekend trip. Youcan try to ignore the biological need to periodically disengage, but there'sgrowing evidence that it will eventually catch up with you. Insurance claims forstress, depression and job burnout are now the U.S.'s fastest-growing disabilitycategory.Making matters worse, Americans tend to cope with stress in all thewrong ways. A November survey by the advocacy group Mental Health America foundthat we frequently deal with chronic stress by watching television, skippingexercise and forgoing healthy foods. The problem with these coping mechanisms isthat they keep you from doing things that help buffer your stress load--likeexercising or relaxing with friends or family--or add greater stress to yourbody. Indeed, using many of our most cherished time-saving gadgets can backfire.Cell phones and mobile e-mail devices--to give just two examples--make it harderto get away from the office to decompress. Working from home may, in some cases,exacerbate the situation because it isolates employees while simultaneouslyblurring the line between work and leisure.We also have a lot of misconceptionsabout who gets stressed out and why. Twenty years ago, psychologists almostexclusively blamed job stress on high workloads or lack of control on the job.More recent studies, says Christina Maslach, a pioneer in burnout research atthe University of California, Berkeley, show that unfairness and a mismatch invalues between employees and their companies play an increasing role intriggering stress. "Probably one of the strongest predictors is when there's avacuum of information--silence about why decisions were made the way they were,"Maslach says. "Another is having to operate in conflict with your values. Do youneed to shade the truth to get authorization from the insurance company? Are youselling things that you know people don't really need?"NO. 2STRESS ALTERS YOURBLOOD CHEMISTRYFOR YEARS PSYCHOLOGISTS HAVE concentrated on the behavioralsymptoms of burnout: lost energy, lost enthusiasm and lost confidence. Now,thanks to new brain scans and more sophisticated blood tests, scientists candirectly measure some of the effects of stress on mind and body--often withsurprising results. You are probably familiar with the signs of an adrenaline surge (racing pulse,hairs on the neck standing on end), which evolved to help us fight or fleepredators and other immediate dangers. And you may have heard of cortisol,another stress hormone, which is produced more slowly than adrenaline andlingers in the bloodstream longer. But did you know that too little cortisol inyour bloodstream can be just as bad as too much? Or that tucking into comfortfoods, while soothing in the short term, can sabotage your long-term stressresponse by increasing the number of inflammatory proteins in your body?What's emerging is a complex picture of the body's response to stress thatinvolves several interrelated pathways. Scientists know the most about cortisolbecause until now that has been the easiest part to measure. "But when one thingchanges, all the others change to some degree," says Bruce McEwen, aneuroendocrinologist at Rockefeller University who has spent decades studyingthe biology of stress, primarily in animals. So just because you see animbalance in one area doesn't mean you understand why it is happening. "We'relearning that post-traumatic stress disorder (PTSD), burnout, chronic fatiguesyndrome and fibromyalgia are all related in some ways," McEwen says. The nextstep is to figure out if there are any genetic predispositions that tip theresponse to stress toward one set of symptoms or another.NO. 3YOU CAN'T AVOIDSTRESSEVEN GETTING OUT OF BED CAN BE TOUGH ON THE BODY. SEVERAL hours beforeyou wake each morning, a tiny region at the base of your cerebrum called thehypothalamus sends a signal that ultimately alerts your adrenal glands, whichsit on top of your kidneys, to start pumping out cortisol, which acts as awake-up signal. Cortisol levels continue to rise after you become conscious inwhat is sometimes referred to as the "Oh, s___! It's another day" response. Thismay help explain why so many heart attacks and strokes occur between 6 a.m. and8 a.m.Because cortisol is a long-acting hormone, you can dally under the coversa bit without losing any steam. But your brain is already taking steps toprotect you from the shock of starting a new day. Rising cortisol levels signalthe hypothalamus to stop sounding the alarm. Other parts of the brain chime in,and eventually the adrenal glands ratchet down their cortisol production. Inother words, the brain's stress response contains its own off switch.Mostpeople's cortisol, as measured by a saliva test, peaks a few hours after waking.Levels then gradually decline during the course of the day--with a few blipsscattered here and there. That pattern typically changes, however, in people whoare severely depressed. Their cortisol level still rises early in the morning,but it stays high all day long. It's almost as if their hypothalamus hasforgotten how to turn off the stress response. (Intriguingly, people who aresleep deprived also exhibit a high, flat cortisol level.)Researchers figured something similar had to be happening in burnout victims.But rather than finding a prominent cortisol peak, investigators discovered ashallow bump in the morning followed by a low, flattened level throughout theday. Intriguingly, such blunted cortisol responses are also common amongHolocaust survivors, rape victims and soldiers suffering from PTSD. Thedifference seems to be that people with PTSD are much more sensitive to cortisolat even these low levels than those with burnout. "We used to blame everythingon high cortisol," says Rachel Yehuda, a neurochemist and PTSD expert at theMount Sinai School of Medicine in New York City. "Now we can blame things on lowcortisol as well."STRESS CAN AGE YOU BEFORE YOUR TIMESCIENTISTS HAVE LONG SUSPECTED THATunremitting stress does damage to the immune system, but they weren't sure how.Then two years ago, researchers at the University of California, San Francisco,looked at white blood cells from a group of mothers whose children suffered fromchronic disorders like autism or cerebral palsy. The investigators found clearsigns of accelerated aging in those study subjects who had cared the longest forchildren with disabilities or who reported the least control over their lives.The changes took place in microscopic structures called telomeres, which areoften compared to the plastic wrappers on the ends of shoelaces and which keepchromosomes from shredding. As a general rule, the youngest cells boast thelongest telomeres. But telomeres in the more stressed-out moms weresignificantly shorter than those of their counterparts, making them, from agenetic point of view, anywhere from nine to 17 years older than theirchronological age.NO. 5STRESS IS NOT AN EQUAL-OPPORTUNITY EMPLOYERIN 1995, INA NOW CLASSIC EXPERIMENT, SCIENTISTS AT THE University of Trier in Germanysubjected 20 male volunteers to a situation guaranteed to raise their stresslevels: participating in a mock job interview and solving arithmetic problems infront of strangers who corrected them if they made mistakes. As expected, eachsubject's cortisol level rose at first. But by the second day of the trial, mostof the men's cortisol levels did not jump significantly. Experience had taughtthem that the situation wasn't that bad. Seven of the men, however, exhibitedcortisol spikes every bit as high on the fourth day as the first. Only by thefifth day did their stress reaction begin to disappear.More recently,researchers have found that subjects with low self-esteem are more vulnerable tostress. Jens Pruessner at McGill University in Montreal believes that thehippocampus, a finger-size structure located deep in the brain, is at leastpartially responsible. It turns out that the hippocampus, which helps you formnew memories and retrieve old ones, is particularly sensitive to the amount ofcortisol flooding your cerebrum. So when cortisol levels begin to rise, thehippocampus sends a set of signals that help shut down the cortisol cascade.Using several different types of brain scans, Pruessner has shown that peoplewho test below average on self-esteem also tend to have smaller-than-averagehippocampi. The differences become clear only when you compare groups of people,Pruessner notes, so you can't look at any single person's brain scan anddetermine whether he or she has low self-esteem. But when you look at overallresults, they suggest that a smaller hippocampus simply has more troublepersuading the rest of the brain to turn off the stress response.Still unclear is how the body goes from having repeated activation of the stressresponse to showing the typically blunted cortisol levels of someone sufferingfrom burnout. "We are still studying this," says Samuel Melamed of Tel AvivUniversity in Israel. "But if there is no relief and the cortisol stays up forlong periods of time, the body stops responding and readjusts the level."NO. 6THERE'S MORE THAN ONE WAY TO RELIEVE STRESSTHIS IS PROBABLY THE TOUGHEST LESSONTO INTERNALIZE BECAUSE when stress overwhelms the system, your choices oftenseem more limited than they are. Behavioral scientists have a name for thispsychological reaction. They call it learned helplessness, and they have studiedthe phenomenon closely in laboratory rodents, whose nervous system bearsstriking similarities to that of humans.Here's how the experiment works: if youprovide mice with an escape route, they typically learn very quickly how toavoid a mild electrical shock that occurs a few seconds after they hear a tone.But if the escape route is blocked whenever the tone is sounded, and new shocksoccur, the mice will eventually stop trying to run away. Later, even after theescape route is cleared, the animals simply freeze at the sound of thetone--despite the fact that they once knew how to avoid the associated shock.Obviously, humans have more intellectual resources at their disposal than micedo, but the underlying principle remains. When too many of the rules change,when what used to work doesn't anymore, your ability to reason takes a hit. Justbeing aware of your nervous system's built-in bias toward learned helplessnessin the face of unrelieved stress can help you identify and develop healthyhabits that will buffer at least some of the load. But the one thing you should not do is ignore the risks. Animal research hasshown that there is a relatively small window for reversing the physiologicaleffects of chronic stress. Studies of people are starting to produce similarresults. Once a person's cortisol level gets completely blunted, it seems tostay that way for years. You owe it to yourself and your loved ones not to letthat happen.