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We have all felt stressed at one point or another in our lives. In fact, according to Statistics Canada, in 2013, 23% of Canadian citizens 15 yrs and older reported feeling “quite a bit or extremely stressed” most days (1).
This is 6.6 million people, so chances are high that even if you are not stressed right now, you will be interacting with someone who is soon!
So what is stress anyway and why does it matter?
Stress is experienced whenever a person perceives the demands from their environment as being more than what they have the resources to handle (2). It is when we say things like “I just can’t take this anymore”, “I can’t cope”, “This is too much!”.
What we experience as stressful varies depending on what internal and external resources we believe we have available to us at that time (2, 3). Stress results in a series of psychological and biological changes that appear to increase our risk of disease (2).
So stress is bad – right?
There is significant evidence that exposure to stress is associated with poor health outcomes, including heart disease, diabetes, high blood pressure, depression and premature death (3). Stress has also been found to impact overall quality of life scores, immune function (1), and pain scores (4). These findings have not been universal however (3) and scientists have been trying to understand why.
In recent years, research is showing that our beliefs about stress matter, and may be a mitigating factor that explains why some of us have negative health outcomes, and others do not, in the face of stress.
A study published in Health Psychology in 2012 (5), revealed that having the belief that stress is harmful to our health AND having moderate to high reported levels of stress increased risk of death by 43%. The study was based on data previously gathered from a national survey (NHIS) in 1998 with a sample of 28, 753 respondents over an 8 year study period. Based on their findings, it was estimated that negative beliefs about stress accounted for 20, 231 excessive deaths during that time in the US, earning its ranking between the 13th and 14th leading cause of death in the United States according to the CDC statistics from 2006. They noted that neither the amount of stress reported, nor our beliefs about whether or not stress had a negative impact on our health predicted early death when looked at independently. The effect was only seen when both of these factors were present. This means that we only experience poor health in the face of stress when we have moderate to high degrees of stress AND we believe the stress is bad for our health. Both pieces of the puzzle are needed in order to increase our risk of premature death.
Another study published in the European Heart Journal in 2013, found that people who believed stress impacted their health “a lot or extremely” were 2.12 times more likely to die due to heart issues or have non-fatal heart attacks. The impact was less, but still statistically significant, even when researchers adjusted for other biological, behavioral and psychological factors, including social support and perceived stress levels. The study was based on 7268 men and women over an 18 year follow up period.
One possible mechanism to explain poor health outcomes associated with the belief that stress negatively impacts our health, is that our beliefs shape our behaviors. A study on beliefs and aging from the Journal of Clinical Nursing in 2014 (6), found that negatively held beliefs about aging significantly predicted people’s sense of self efficacy. It also predicted their engagement with health promoting behaviors. The author called for people to begin changing their attitudes towards aging as a means of improving the health status of the aging population (6).
TAKE HOME MESSAGE
What we believe matters and changes both our behavior and health outcomes.
When dealing with people who are stressed…
1. Help them identify and access internal resources
- Talking about their strengths and how they can use these to tackle the issue at hand
- Talking about past obstacles they have overcome, helping them anchor to past successes
- These help people adjust their thinking filter from “I can’t”, to “I can”, using their own life experience. This fosters an internal locus of control which is associated with better health outcomes
- Help them identify and access external resources
- This may include problem solving how to engage social support from friends, family or researching community activities to find new supports
- This may also involve advocating for their access to additional insurance coverage, social services or collaborating with other relevant agencies like food banks, health care providers or single parent support groups
- Help people shift their beliefs about stress
- Reinforce that the energy we get when stressed, is our bodies rallying to help us take action so we can be physically and emotionally well again
- Emphasize that in order for us to be well, we need to take action towards wellness, otherwise we are left in inaction, which is associated with anxiety
- Kelly McGonigal: How to make stress your friend TED talk, 2013 – summarizes the stress related finding from the 2012 study cited above.
- New brain/ old brain, mindfulness & compassion – 3 part blog about how our emotional state impacts our thinking and attention filters, and what to do when we get stuck in a negative loop.
- Wellness Series – 7 partially animated 5 min videos that can be used as a resource to assist people in distress, reinforcing some of the items discussed above.
- Nabi, H. et al. Increased risk of coronary heart disease among individuals reporting adverse impact of stress on their health: the Whitehall II prospective cohort study. European Heart Journal 2013; 34: 2697-2705.
- Lazarus RS, Folkman S. Stress, Appraisal, and Coping. New York: Springer Publishing Company; 1984.
- Cao, J. et al. Short-term pre- and post-operative stress prolongs incision-induced pain hypersensitivity without changing basal pain perception. Mol Pain 2015; Dec 2; 11(1):73. doi: 10.1186/s12990-015-0077-3.
- Keller, A. et al. Does the perception that stress affects health matter? The association with health and mortality. Health Psychol. 2012 September ; 31(5): 677–684. doi:10.1037/a0026743
- Hyun-E Yeom. Association among ageing-related stereotypic beliefs, self-efficacy and health-promoting behaviors in elderly Korean adults. Journal of Clinical Nursing May 2014; 23:1365–1373. doi: 10.1111/jocn.12419
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