2015 Family Medicine Experience

Approach to Stress Determines How It Affects You

October 05, 2015 01:50 pm David Mitchell Denver –

Kelly McGonigal, Ph.D., hopes you have a stressful day. But before you jump to conclusions about her, let the health psychologist, researcher and author(kellymcgonigal.com) explain.

Author and researcher Kelly McGonigal, Ph.D., speaks during the AAFP Family Medicine Experience. McGonigal talked about stress during the Oct. 1 general session in Denver.

"Like all of you, I was trained to view stress as the enemy of all things good and that stress increases the risk of anything you don't want, from divorce and depression to death," she said during her Oct. 1 general session presentation during the 2015 AAFP Family Medicine Experience. "And the only way to deal with stress actively and responsibly is to reduce stress or avoid stress."

McGonigal, however, said she has changed her approach to stress and now thinks that how people think about stress plays a big role in how they experience it.

She opened her presentation by asking how many people in the audience had been stressed the previous day. Many hands rose.

"I've gotten very interested in what we think the right answer to that question is supposed to be," she said.

A Gallup World Poll(psycnet.apa.org) of people in 121 countries asked the same question. Researchers then created a stress index for those countries based on the percentage of people who said yes. They then looked to see whether a nation's stress index was correlated with other indices of well-being.

"They found it was, but in exactly the opposite direction of what they had expected," McGonigal said.

Researchers found that countries with higher stress indices were also those with high gross domestic product, longer life expectancy and higher levels of satisfaction with work, life and community.

"Overall, what they found is that the happiest people on the planet were those with high levels of stress," she said, "and the unhappiest, most depressed people on the planet were reporting a lack of stress in their lives."

How can this be? McGonigal said some of the greatest sources of stress -- work, family, relationships and goals -- also can be sources of love, laughter and happiness.

"Guess what the No. 1 life circumstance was that best predicted both experiencing a great deal of stress yesterday and smiling and laughing a lot yesterday?" she said. "Having a child under the age of 18 living at home."

Although stress can lead to poor health outcomes, it also can make a person more resilient. One study found that 82 percent of men(www.ncbi.nlm.nih.gov) said they cope with stress by drawing on strength acquired from handling previous difficulties.

Research also has shown(www.ncbi.nlm.nih.gov) that stress in a person's life can confer a heightened level of compassion for others who are suffering, and people can experience joy from helping others in need.

McGonigal said one thing that influenced the way she thought about stress was the stress inventory or checklists that some health professionals use. Such resources assign point values to things like divorce, loss of employment and moving. Patients then add their scores based on all the negative events they experienced in the past year, and the tool indicates their likelihood of having a poor health outcome based on their score.

"Think about what it means when you tell someone, 'Yeah, life is stressful. Your life is killing you,'" McGonigal said. "That's not helpful. Put that checklist away."

McGonigal said how people think about stress affects how they experience it. The body and brain both respond to stress in some ways that are helpful. Conversely, people who try to reduce or avoid stress completely are more likely to feel despair and self-doubt and to be unable to handle challenges, she said. They also are more likely to hide problems from loved ones and colleagues and are thus less likely to receive support, make positive changes or experience growth.

"The opposite is true for people who take a more balanced view of stress," said McGonigal.

Researchers at the University of Buffalo found that helping and caring for others(www.sciencedirect.com) reduced negative effects of stress. Similar results were found in a study involving people who cared for friends or family members(www.ncbi.nlm.nih.gov) outside their own homes.

"These are just two of many studies that suggest people who engage in regular caring, helping, volunteering -- people who experience compassion and choose altruism -- do not show the relationship we expect between stress and negative health outcomes," she said. The reason, she said, is the "biology of what it feels like to be helpful and have empathy for others."

"When your body is flooded with oxytocin because you are helping someone, you feel of service," McGonigal said. "You're feeling compassion and connection. When you are feeling that emotional state, part of that is biology that is actually reducing inflammation and strengthening your heart."

McGonigal said it is important to identify the sources of stress that matter, finding the meaning in them and not dwelling on those that are temporary and meaningless, such as a traffic jam. For example, she said men who have a heart attack may be motivated to change their lifestyles, have a greater appreciation for life and become more connected to their spouses.

People who find benefit in their difficulties,(www.tandfonline.com) she said, have a greater sense of purpose, hope and confidence in their ability to cope with challenges.

That's important because studies have showed that having a sense of purpose(www.sciencedirect.com) is associated with a reduction in cardiovascular events and all-cause mortality.(circ.ahajournals.org)

So what does it all mean for physicians? McGonigal pointed to a program developed at the University of Rochester(www.physiciansfoundation.org) that brought primary care physicians together once a week to talk about stress. The program reduced depression, anxiety, fatigue and made physicians less likely to regret their career choices. It also resulted in higher job satisfaction. Moreover, it increased physician empathy for complex patients and made them grateful -- rather than overwhelmed -- when spending time with a suffering patient.

"This is the outcome not of reducing stress but of changing your relationship with stress," McGonigal said.

She closed by asking audience members if they hoped the next day would be stressful. "If I've done my job," McGonigal said, "you should be really confused about what the right answer to this question is."

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