What’s your definition of stress?

This guest post is by Benjamin Miller, PsyD, Director of the Office of Integrated Healthcare Research and Policy at the University of Colorado School of Medicine.

Stress. You’ve experienced it. Chances are, even as you read this blog, you are in the process of experiencing it. No, not that reading blogs is inherently stressful, but rather because we live in a society that is go, go, go. We move at breakneck speed always aware of the next deadline we must meet or the next place we must be. We are a society on the move. What happens when too much “need to” starts to wear on us? What happens when we start to feel a bit overwhelmed like we just can’t take on one more thing? How do we respond?

Well, rest assured, you are not alone. According to the American Psychological Association’s 2012 “Stress in America” survey:

  • Americans report their mean stress level as a 4.9 on a 10-point scale where 1 means “little or no stress” and 10 means “a great deal of stress,” while they define a healthy level of stress as a 3.6 on the same scale. Twenty percent of Americans report stress levels that are extreme (an 8, 9 or 10 on a 10-point scale).
  • The most commonly reported significant sources of stress include money (69 percent), work (65 percent), the economy (61 percent), family responsibilities (57 percent), relationships (56 percent), family health problems (52 percent) and personal health concerns (51 percent).
  • Only 17 percent of those with high stress say that they are doing an excellent or very good job of managing their stress, compared with 59 percent of those with low stress and 37 percent of Americans nationwide.

These data help shine a light on an often dark corner in healthcare – the role of stress. Before we dive any deeper on the topic, let’s define what we are talking about here. According to Merriam-Webster, there are no fewer than six different definitions of stress.

Rather than pick one of these definitions, I would like to propose a more simple definition for us to consider – stress is change. When you read through all the various definitions of stress in the dictionary it becomes quite clear that whether good or bad, stress is something happening to us within our environment.

With this definition in hand, let’s begin to consider how stress plays a role within health and healthcare. Like many things in healthcare, we try to separate out stress; we try to isolate it as its own entity when in reality this could not be further from the truth. You see, stress, whether you identify it or not, is having an impact on your health. For example, over thirty years of research examining the effects stress on cardiovascular health have suggested:

  • Chronic stress related to work and/or one’s personal life is associated with a 40-50% increased likelihood of coronary heart disease.
  • Those already diagnosed with coronary heart disease have poorer prognoses if they have more work-related stress and social isolation.
  • Increased risk of heart disease is now thought to be due to repeated and long-term stress on autonomic and inflammatory processes.
  • This persistent long-term stress in the workplace, in particular, has been found to impact health and has been characterized as both 1) high psychological demands such as multiple responsibilities with high productivity demands, and 2) low personal control and restricted ability to make decisions.

The costs of stress to you, the consumer, and to the healthcare system are exorbitant:

  • Over $300 billion is spent in legal and insurance costs, and reduced productivity, absenteeism and turnover due to job stress.
  • Healthcare spending was 46% higher for workers with high levels of stress.
  • An estimated $2 trillion in annual healthcare costs are due to the management of chronic diseases, which are largely contributed by chronic stress.

Now, consider that we have novel ways to treat stress.

Meditation for stress reduction programs are demonstrating long-term health improvements. In a recent five-year study examining Transcendental Meditation, participants experienced a 48% decreased risk of stroke, heart attack, and death, as well as reductions in blood pressure, stress and anger.

Laughter and learning to take yourself less seriously are approaches that are also receiving more attention for reducing stress and improving health. Humor is known to release endorphins, those feel-good neurochemicals, and reduce circulation of stress hormones. Laughter Yoga Clubs, which combine laughter and yogic breathing, are becoming more popular at companies and colleges worldwide.

More generally, positive thinking is thought to improve immune function and coping with pain, and reduce incidence of depression and overall distress.

“How stressed are you today?”

I remember once working in a primary care practice where every patient was asked the same question: “On a scale of zero to ten, how stressed are you today?”

The answers were always telling, and would in some ways predict how the rest of the visit would go. For example, if a patient said:

“Well, you know I have been feeling a lot of deadlines at work recently. I just haven’t been able to relax as much as I used to. These deadlines have kept me out of the gym, too, which is one way I always fought off my stress. Right now, I would say I am a 7 out of 10.”

With a patient like this, it was fairly obvious that they knew what the stressor was, knew possible solutions on how to manage it, and saw the entire issue pretty clearly. Other patients, on the other hand, were not as insightful.

“On a scale of zero to ten, how stressed are you today?”

The patient, calm, cool, and collective, would look at you straight in the eye and say “zero”. It was during these moments that you knew something was really going on; because, let’s be honest, who has no stress in their life? How do you manage change in your life? How do you identify “stress”?

Follow Ben Miller @miller7, and watch him moderate our Great Challenges live event about  coping with the health effects of stress on Thursday, March 14th at 1pmET.