Stress-Awareness: Insights and perspectives from Psychoneuroimmunology

 

Stress – A challenge for mind and body

 In recognition of stress awareness month, here is a short summary of a recent podcast featuring an interview with Dr. George Slavich, a prominent figure in stress research. He is a professor and the director of the laboratory for stress assessment and research at the University of California, Los Angeles and an expert on the psychological and biological mechanisms that link stress to poor health outcomes. He recently shared his expertise on “Speaking of Psychology”, hosted by the American Psychological Association:

The Rise in Reported Stress:

There has been a substantial rise in reported stress across America in recent years. According to the American Psychological Association’s Stress in America survey, conducted in the early months of the year, factors such as inflation, economic uncertainty, global tensions, war and global conflict, and the lingering effects of the COVID-19 pandemic have significantly contributed to this surge in stress levels. Notably, rising prices were identified as a significant source of stress by over 87% of respondents, while global uncertainty was cited by 81%.

Defining Stress:

Stress is a pretty amorphous concept and so researchers emphasize a distinction between “stressors”, such as divorce, moving, death of a loved one, loss of a job, and “stress” – the term used to describe the consequences of experiencing a stressor. The concept of stress encompasses the psychological, neurological, physiological and immunological shifts that result from the stressful experience.

Types of Stressors:

An important distinction can be made between global stressors, like war and inflation, and personal stressors, such as divorce or job changes. Dr. Slavich emphasizes the importance of social relationships and support networks in navigating stress, suggesting that individual-level stressors may significantly impact our lives, sometimes more so than broader global issues.

The Psychoneuroimmunology of Stress:

Dr. Slavich explains how the recent rise in stress is extremely concerning as stress exerts a negative impact on body and mind. Recent advances in psychoneuroimmunology (which examines the interplay between psychology, neurobiology and immunological functioning) indeed underscore the way in which stress can have far reaching consequences. He explains, that our brains are geared toward keeping us biologically safe and that the brain and the immune system work together to make that happen. When we experience a stressor, our system prepares itself to enact a self-preserving chain of events (e.g., biological preparedness to flee or fight and an immunological reaction, such as an inflammatory response, ready to support healing). He refers to this mechanism as being like an early detection system whereby the brain sends a signal to the immune system to prepare for an impending wound.  This all may work very well when dealing with the immediacy of a particular stressful event but when stressors are prolonged and uncontained the chronic activation of this defensive system can wreak havoc on our minds and bodies.

Ruminative Chronic Stress:

Dr. Slavich goes on to highlight how the negative health effects of stress are augmented by how long and often we ruminate about the stressor – essentially keeping our systems in a chronic state of defensive alert.  Though non-human animals are able to disengage once an immediate stressor has subsided, we humans are able to imagine and otherwise symbolically represent a stressor and so can keep it with us continuously.  Lying awake at 2:00 am thinking about what your co-worker meant by that comment made 2 years ago at the holiday party would be an example of this. For all the great benefits of being able to form mental representations and to anticipate possible future consequences (which help us survive both physically and socially), it also comes with some negative consequences (e.g., sleepless nights and lingering stress).

Stress Management:

 One of the key stress management techniques emphasized by Dr. Slavich is mindfulness meditation. He describes how implementing this type of relaxed and gentle focus on the present moment may be one of the keys to disengaging from the ruminative tendency that allows stress to overstay its welcome. Explaining a bit about mindfulness and stress reduction, he reminds us that most of our negative stressor-related thoughts are about experiences we are anticipating in the future or that have happened in the past and are rarely about the present moment.  Attending to the present moment, even for a short period each day, translates into less time spent activating the immune system for a potential threat.

With a background in Cognitive-Behavior Therapy, Dr. Slavich also describes how the cognitive restructuring of negative automatic thoughts is an important key to reducing the negative impact of stress.  He reviews how this technique involves challenging our negative automatic thoughts with alternative explanations and evidence so as to weaken and dismantle the hold of such thoughts.  He emphasizes that the ongoing presence of these negative automatic thoughts, which may be wholly unsupported by the reality of the actual situation, maintains the stress response to adversely impact health and wellbeing.  Any treatment or method that can limit or otherwise derail the duration and intensity of the stress response will be seen to have important benefit.

Knowledge is Empowerment: the importance of measurement

 Dr. Slavich underlines the importance of the careful measurement of stress as a means of motivating people to make important life changes. When it comes to stress, what we don’t know can certainly harm us and the cumulative impact of stress can be rather insidious and go unnoticed for years. Though some people may know they are feeling stressed, they may not recognize the factors that are contributing to that stress.  Others may not even acknowledge the many stressors that are nonetheless impacting their lives and health. The Stress and Adversity Inventory is a tool developed by Dr. Slavich to assess lifetime stress exposure, providing a metric that can motivate individuals to engage in stress reduction efforts and make informed decisions about their health.  When it comes to managing stress, knowledge can be empowering.

Future Directions: Acetaminophen and Social Stress

 Provocative research suggesting that social stress may be registered by our neural circuity in a manner similar to the experience of physical pain, led Dr. Slavich and his team to explore the potential impact of acetaminophen on the stress response experienced by social rejection.  Based on a preliminary clinical trial, they indeed found that acetaminophen did help to reduce social pain.  Interestingly, this effect mainly occurred however in individuals who tended to engage in greater self-reported social forgiveness. Though based on a relatively small sample size, the results are quite intriguing.  According to Slavich, acetaminophen may act by “turning down the volume” on the physical/social pain signal. Though he did not mention the findings on the interaction between acetaminophen and forgiveness in this podcast, this added psychological mechanism seems worthy of further study as well.  You can find the citation for the study below.

Alleviating Social Pain: A Double-Blind, Randomized, Placebo-Controlled Trial of Forgiveness and Acetaminophen (2019) George M Slavich, PhD, Grant S Shields, MA, Bailey D Deal, BA, Amy Gregory, EdS, Loren L Toussaint, PhD.  Annals of Behavioral Medicine, Volume 53, Issue 12, December 2019, Pages 1045–1054,

https://doi.org/10.1093/abm/kaz015

The podcast concluded with Dr. Slavich expressing an optimistic and encouraging view regarding the stress of living in our current times. He views these stressors and challenges as a potential opportunity, or invitation perhaps, for growth towards a more resilient, connected, and well-being-oriented society.

If you want to read the original transcript of the podcase with Dr. Slavich, here is the link:

https://www.apa.org/news/podcasts/speaking-of-psychology/stress

The Importance of our work as therapists:

As therapists, I think that Dr. Slavich’s perspective underlines the important role psychotherapy plays, regardless of theoretical orientation, in reducing the negative mental and physical health consequences of stress.  Most, if not all, types of psychotherapy include techniques and interventions that aim to help individuals unlock themselves from the clutches of stress inducing and perpetuating experiences, traumas, ruminations, negative thoughts, repetitions, and behaviors.  In light of the many known health risks associated with stress, perhaps it could be argued that mental health treatment is always a medical necessity.

 

Happy Stress-Awareness Month (April)

-Patricia at Note Designer-