Lessen your stress

Do you recognize when you are stressed out, but can’t find a way to overcome the negative feelings that often accompany stressful situations? BeWell talked with Kim Bullock, MD, clinical associate professor of psychiatry and behavioral science at Stanford School of Medicine, about what stress is really all about and how we can better manage it.

How do you define stress?

While stress can be defined in many different ways, I (as a neuropsychiatrist) view stress in relation to negative emotions: when we are stressed, we just plain “feel bad.” An emotional response in the neural circuitry of the brain tells us stress is present, and this negative emotion urges the caveman inside of us to make an informed change in our behavior. Fortunately, emotions usually are adaptive and help motivate us to take actions to make our life better.

For example, imagine you are on a beautiful hike and a dangerous predator suddenly appears and is heading your way. Evolution steps in and uploads one of three different options — fight, flee or freeze — and prepares your physiology to implement one of them. Such a confrontation with danger, dread or fear — together with the demanding need to decide among difficult options — defines a highly stressful incident. If your emotion on the hike is anger, you may attack the predator, which may be a good idea if the predator can be intimidated and you are physically able to overtake the animal. A more modern day example could be the emotion of fear experienced in a hostile work environment that may motivate a person to find a new job in a friendlier workplace.

However, in certain instances emotions can interfere with problem solving and functioning. For example, in the hiking scenario, anger could be quite deadly if the predator is not intimidated or we are physically weaker than the animal. In this case, we probably should be fleeing or hiding from the animal instead of fighting. If the maladaptive emotion of anger gets us to fight in this scenario, we’ve probably just been eaten. Similarly, in the modern world, if we are experiencing maladaptive stress or fear in a perfectly safe workplace, we may need to change the way we feel instead of looking for a new job. Unhelpful emotions and behaviors can cause poor decision-making and make stress worse.

What are the most common causes of stress?

The causes of stress are the same as the causes of negative emotions and are multifactorial. Thoughts, emotions, behaviors and physiology are all intimately intertwined and influenced by events and our surroundings.  


Negative emotions from thoughts and cognitions:
One of the largest contributors to stress can be our beliefs. Humans are “meaning-making machines.” When we think about the world, we may sometimes create negative interpretations or narratives, which in turn create negative emotions leading to physiological changes, mood changes, and behavioral changes — all of which may influence our environments.

Negative emotions from behaviors:
Overworking and avoiding pleasant activities can also cause negative emotions. Saying yes to every request can cause exhaustion. Avoiding things can cause anxiety. The more anxious we become, the more we avoid the task and the more stressful the task becomes. A good example that everyone can relate to is procrastination: when we procrastinate, a very benign task becomes overwhelming due to the positive feedback loop of anxiety and avoidance behaviors.

Negative emotions from physical status:
Illness or surgery can create increased physiological demands and stress. Or, our roles may require decreased sleep or overworking with not enough rest time or exercise. A new baby, while adorable to admirers, can cause stress to the exhausted new parents, through hormonal physiological changes or sleep deprivation. Poor nutrition or malnutrition can be another cause of stress.

Negative emotions from the environment:
Just as being on the beautiful Stanford campus can make us feel excited and happy, working in a dimly lit and unfriendly office can make us feel depressed and fatigued. Our work environment, the economy, our socio-economic status, level of exposure to sunlight, or our social influence and power are intimately connected to our stress levels. Those that are most disenfranchised or lack power experience much more stress.

Is stress seasonal?

Depending on your responsibilities and culture, rituals surrounding seasons can increase stress reactions. In the Stanford academic culture setting, the early fall is time for an uptick in work, new classes, moving, and deadlines. September can be associated with an increase in stress levels for students, staff, and faculty alike.

Additionally, holidays can increase stress exponentially. Demands go up in the winter: there are parties to go to, presents to buy and family to see (and we all know seeing your family can be stressful). There is often an increase in one’s workload in order to offset holiday vacations or sick co-workers. Compounding the stress is the common need to cut back some stress-relieving activities and behaviors — such as exercise, good sleep, hygiene and good eating habits — to make time for the holiday activities.

Are there everyday skills to help deal with stress?

Yes! (That’s why I love my job.) Relieving the suffering associated with stress and negative emotions is not only possible, but actually fairly straightforward. Although we can’t directly change negative emotions — we feel what we feel — we can change our thoughts, behaviors, physiology, and environment.

Involve yourself in at least 3-4 pleasant activities per day that give you joy or a sense of mastery. Even the simple things we do every day, such as stopping to talk to a friend for a few minutes, can prove powerful therapy for treating depression. The brain needs pleasure, mastery, novelty and stimulation in order to feel good. When we have increased demands placed on us, or are ill, we often miss out on these vital “feel-good” activities. It is easy to get into a vicious cycle of feeling worse and doing less and feeling worse, which is why it is important to schedule fun and pleasure into your day, every day — a technique called “behavioral activation.”

Spend time with people with whom you have a good relationship. We release relaxing, pleasant hormones like oxytocin and vasopressin in response to time spent with people we care about. Romantic relationships have even more bang for their buck due to activation of dopamine reward circuits. Interestingly, women release cortisol, a stress-buffering hormone, when they are “madly in love.” So I recommend that when women are stressed they fall madly in love immediately! [just kidding] 

Change your emotions by acting the opposite. In recent clinical research, participants were asked to smile during a stressful task while submerging their hand in ice water for one minute. Those who smiled had lower physiological and subjective measures of distress than a group that did not smile. Smiling, therefore, is not just a result of happiness: smiling actually makes you happy. Similarly, if you are fearful and anxious, acting as if you are not scared can actually help relieve those emotions over time. In psychiatry, we call this exposure therapy. For example, if someone is afraid of public places, exposure therapy would involve sending that individual to public places, often, until the public places are no longer upsetting. When a feeling of fear has changed, we call it desensitization. Disclaimer: This does not work if an emotion is justified. If you continued to visit a lion’s den daily, it’s unlikely your fear would go down over time since it is justifiably a dangerous place. Thus, acting the opposite only works for unjustified or maladaptive emotions.

Develop mindfulness to combat negative thinking, reduce stress, and even alter physiology. Mindfulness involves the practice of keeping one’s attention on the present moment and without judgment, simply observing. There is no ruminating on the past or tripping about the future. Everything is simply accepted in the present moment, and one is open to all experience without pushing anything away. Mindfulness skills can be developed through meditation, prayer, yoga, or mindfulness courses. Many religious and healing traditions have components of mindfulness. Research studies support the benefits of practicing mindfulness to overall mental health.

Redirect your thinking. A hallmark of depressive emotion is the feeling that the future is hopeless or that one’s self has no relative value. Redirecting your thoughts toward concepts such as gratitude, compassion, and altruism have been shown to improve emotional states.

... any final thoughts?

Attending to both physical and mental health are necessary to buffer against stress. Visiting your doctor regularly, obtaining preventative care, and receiving mental health treatment when necessary are important ways to affect the physiological aspects of stress.

Exercise, relaxation, massage, changes in temperature (ice bath, hot tubs) can also change the way we feel. Some of us, including myself, have difficulty overcoming the anti-hedonistic judgments that often stop us from creating physiological well-being through self-care. Although work and productivity are important, prioritizing taking care of yourself is vital. Pleasure and self-care reduce stress and, paradoxically, increase productivity and performance. So work hard at having fun!

Interview conducted by Julie Croteau and edited by Lane McKenna Ryan.