October 8, 2012

Stress: An Insidious Danger to Body and Mind
By Carolyn Gutierrez
For The Record
Vol. 24 No. 18 P. 22

Whether attributable to coding backlogs, a wayward HIT project, or marital strife, stress takes many forms—all of which can have serious health ramifications.

Living in a culture that thrives on 24-hour accessibility, stress is a given in our daily lives. But because it can be so subjective, stress is challenging to precisely measure or define.

In addition to threatening our mental well-being, researchers have long found that stress can be harmful to the human body. Workplace stress, ranging from the day-to-day annoyances of Dilbert-esque corporate mores to the harrowing demands of law enforcement and emergency responders, takes its toll, wreaking havoc on the immune system, circadian rhythms, and cardiovascular health.

Widespread Effects
Although human beings and animals have always experienced mental and physical tension and strain, Hungarian researcher Hans Selye was the first scientist to attempt to give a name to this elusive state of discomfort. In 1936, Selye coined the term “stress” to describe “the non-specific response of the body to any demand to change.”

Experiments in which Selye exposed animals to various stimuli, such as deafening noise, bright lights, and extreme temperatures, demonstrated pathologic changes such as shrinkage of the lymphoid tissue and enlargement of the adrenal glands in the creatures’ physiology. Repeated exposure to the stress-inducing stimuli eventually brought about diseases that resembled those seen in humans, such as kidney disease, rheumatoid arthritis, heart attacks, and strokes. Selye later defined stress as “the rate of wear and tear on the body.”

Scientists believe that when we experience stress, our body prepares to defend itself through a “fight-or-flight” response in which the sympathetic nervous system signals the adrenal glands to release the “stress hormones” epinephrine and cortisol. Glucose levels rise, producing the rush of energy needed to aid the body during a crisis.

Heart rate increases during stress, and stronger heart muscle contractions occur. Blood vessels dilate and an increased amount of blood is pumped. Repeated episodes of severe stress are thought to predispose a person to inflammation of the coronary arteries, possibly leading to a heart attack. Stress can cause hyperventilation in some people, bringing on panic attacks. Once the perceived danger has passed—after about 90 minutes—the body’s metabolism recovers from the fight-or-flight response and returns to normal.

But the effects of stress can be far-reaching. In addition to cardiovascular strain, the musculoskeletal system also is under siege, and muscles tensing for extended periods of time can bring on severe headaches. Migraines are associated with and exacerbated by stress. Gastrointestinal complications such as irritable bowel syndrome are highly linked to stress, as are skin conditions such as eczema and psoriasis.

According to Amy Przeworski, PhD, an assistant professor in Case Western Reserve University’s department of psychological sciences, “[Stress] also weakens the immune system. There are some studies that have looked at people with superficial wounds and those who were under high amounts of stress. It took longer to actually heal the wound [for those under stress] than it did others who were not under the same level of stress. And the same thing for colds and viruses—they were more common in people who were under large amounts of stress than folks who weren’t. The thinking is that chronic stress and all of the hormone fluctuations that go along with it [are] impacting the immune system’s ability to really do its job.”

One important distinction when looking at the effects of stress on the body is whether the stress experienced is acute or chronic. Although the fight-or-flight response is powerful in the moment, acute stress is short-lived, with the body returning to a normal state relatively quickly. With chronic stress, the body is besieged relentlessly, and health problems are compounded, as the body is not meant to endure such a continuous loop of heightened pressure. Not surprisingly, studies suggest that people experiencing chronic stress are more at risk than people experiencing acute but infrequent stress.

Police Officer Study
A new study by researchers from the University at Buffalo’s School of Public Health and Health Professions took an in-depth look at the health risks posed by chronic stress on police officers over a five-year period. As the very nature of police work is unpredictable and intense and law enforcement personnel clearly experience more job-related stress than the general public, the Buffalo study effectively homed in on just how vulnerable the human body can be to the barrage of physiological symptoms brought on by unchecked stress.

Participants in the study, 464 Buffalo Police Department officers, underwent thorough testing for cholesterol, blood pressure, glucose levels, and body mass index as well as ultrasound scanning and other clinical measures. The officers also responded to a battery of psychological and self-reported questionnaires chronicling sleep habits and smoking status. The mean age of the study participants was 41, and approximately 76% were men. Twenty percent of the study participants were African American and 1.8% were Hispanic. Data for the general population comparisons were culled from several large-scale epidemiological studies, including the National Health and Nutrition Examination Survey, the National Health Interview Survey, and the Framingham Heart Study.

Funded by the National Institute for Occupational Safety and Health, The Buffalo Cardio-Metabolic Occupational Police Stress (BCOPS) study was one of the first to examine associations between stress and lifestyle (including smoking, diet, exercise, and sleep) and adverse psychological, metabolic, and cardiovascular outcomes in a population of police officers.

 “We found that about a quarter of [the police officers] had metabolic syndrome, which is a constellation of five distinct risk factors involved with heart disease,” says John Violanti, PhD, principal investigator and a professor of social and preventive medicine at the University at Buffalo School of Public Health and Health Professions. “It seemed that the higher the chronic stress levels were, the more likely they were to have metabolic syndrome.”

In the general public, 18.7% of the employed population has metabolic syndrome, the classic components of which are hypertension, abdominal obesity, reduced HDL cholesterol, elevated triglycerides, and glucose intolerance.

Previous studies looking at associations between stress and cardiovascular disease in law enforcement work noted that the greater the perceived stress, the higher the risk of cardiovascular problems; approximately 25% to 30% of police officers had classic stress-related health conditions, such as hypertension or coronary heart disease, as well as higher cardiovascular disease mortality rates compared with the general population.

Researchers believe that chronic stress results in hyperactivity of the hypothalamic pituitary adrenal axis (the system modulating the body’s stress response and release of hormones) that may elevate cortisol levels to cause abdominal obesity, hypertension, and high blood cholesterol levels. For female officers in the BCOPS study, both abdominal obesity and reduced HDL cholesterol were consistently found to be associated with police stress, especially stress related to organizational pressure and lack of support. (The researchers noted that more studies are needed to fully examine the stresses inherent for female police officers working in a male-dominated profession.)

Not surprisingly, the BCOPS researchers found that shift work seemed to be a catalyst for many stress-induced symptoms. “We wanted to know if working the night shift was related to health outcomes as well,” Violanti says, “and it turns out that it was. Police officers really don’t get very much sleep. The majority of them are actually sleeping less than six hours a night, and that’s affecting their health.”

Of the police officers who reported the highest levels of perceived stress, males were found to be almost six times more likely to have poor sleep quality and females were almost four times more likely to have poor sleep quality compared with other study populations. Violanti and his team found that officers who worked a non-day shift (almost one-half of the police officers in the study) had a higher risk of metabolic syndrome than those working the day shift.

Insomnia is perhaps the most obvious by-product of stress, leaving the body vulnerable to fatigue, anxiety, and depression. Studies have shown that depression resulting from a lack of sleep leads to a lower quality of life and compromised work performance, resulting in yet more stress. As police work unquestionably requires alertness and instantaneous decision making, proper rest is essential.

Obesity, particularly abdominal obesity, and its association with depression and stress also were examined in the BCOPS study. Violanti and his team found that 40% of the Buffalo police officers were obese compared with 32% of the general public. On-the-job stress can escalate into unhealthful behaviors, such as smoking, inactivity, alcohol abuse, and poor eating habits, that increase the likelihood of abdominal obesity and insulin resistance.

Reining in the Cycle of Stress
Whether it is the constant demands of the workplace or the home, stress undoubtedly takes its toll on the body and mind, perpetuating an ongoing cycle that is challenging to break.

“It’s something that we all struggle with,” Przeworski says, “I think one of the most important things to do is to recognize how essential it is to take time out for yourself and have some downtime. There are so many demands on people at this point—folks are trying to work multiple jobs because of the economy and handle things at home. In a lot of ways, there are increased demands even relative to 10 or 15 years ago.”

Although it may seem counterintuitive, Przeworski recommends scheduling time to relax. Working out for a half-hour every day, reading, or doing absolutely nothing—and not feeling guilty about it—can help you to decompress.

Good-quality sleep is a challenge for those suffering from stress. Przeworski notes that downtime to help your body relax at least a half-hour before bedtime brings about better quality rest. Consistency in sleep and wake-up times are helpful when battling insomnia.

Exercise has long been known to reduce stress as the “feel-good” endorphins and serotonin released during physical activity help promote feelings of high energy and clear thinking. Exercising earlier in the day also helps stave off sleeplessness at bedtime.

While short breaks during the workday can help reduce stress, taking a vacation to decompress is essential and may actually increase workplace productivity in the long run, according to stress experts.

Addressing the stress inherent in our 24-hour work culture, Przeworski says, “Unplugging at some point is really important. You [should] stop checking your e-mail, turn off your computer, turn off your phone, and don’t respond to texts because those are all more demands on you and that’s obviously not going to help you to relax. Separating yourself from all of those demands on occasion is important.”

The Mind/Body Connection
Meditation has been found to reduce feelings of stress in a fast-paced work environment. A new study conducted by David Levy, PhD, a computer scientist and professor with the Information School at the University of Washington, examined the effects of meditation training on multitasking office workers. As a baseline for the experiment, three groups of human resource managers were given stressful multitasking tests involving answering telephone calls, e-mails, and instant messages; composing memos; and scheduling meetings. Upon completing the test, one group underwent eight weeks of mindfulness meditation training, a second group underwent eight weeks of body relaxation training, and a third group (a waitlist control group) received no initial training.

After the training sessions, the groups were again given the multitasking tests. Levy and his team measured the accuracy and speed of all three groups and noted the frequency and extent to which the participants switched tasks. Self-reported perceived stress and memory performance also were recorded.

Interestingly, only the group that received the meditation training spent more time on each task and switched tasks less frequently yet were still able to complete all the tasks in a timely manner. Although all three groups reported feeling stress after the multitasking test, the meditation group reported lower levels of stress and higher levels of concentration than the other groups.

Both the meditation group and the body relaxation group showed improved memory performance during their tasks. When the waitlist control group received meditation training later in the study, their stress levels also were reduced and their memory performance improved.

“I don’t want to suggest that there’s anything definitive about these results,” Levy says, “but as we hoped, we saw some interesting results that suggest that this is a promising direction for further research.”

There are countless meditation techniques, but in methods such as mindfulness meditation, the emphasis is on paying attention to and keeping your mind focused on the sensation of breathing. “It is training the mind to be more attentive. It’s training you to stay present,” Levy says.

Mindfulness meditation can help strike a balance between alertness and relaxation and, according to Levy, studies have shown that meditation also can help with emotion regulation when dealing with strong feelings such as anger. “Meditation can help you to become more aware of strong emotions and work through them instead of just reacting negatively through them,” he notes.

Stress-reduction clinics that teach mindfulness meditation practices are becoming more mainstream, integrating with hospitals, medical centers, and universities across the country.

Researchers such as Violanti, a former New York state trooper, believe education and awareness of the risks of stress should start early. For example, young police officers need to be “inoculated” against the stress they will no doubt encounter in their careers. Training programs specifically geared toward handling stressful and upsetting events may better prepare those in law enforcement. Experts note that a holistic approach, including a healthful diet and physical activity, may be the best defense against all forms of stress.

“One of the recommendations that have come out lately is something called a mental health check,” Violanti says. “In other words, just as you go to the dentist and the doctor every year for a physical checkup, maybe you ought to stop in and see a counselor every year just to talk a little bit. If nothing’s bothering you, that’s great. If there is something bothering you, maybe it’s time to talk about it. And if you do this every year, it prevents the small problems from becoming big ones. There are a lot of things we can do [to treat stress]. It’s just a matter of getting them implemented into organizations and, unfortunately, with the economic times we’re in, it’s getting more difficult to do that.”

— Carolyn Gutierrez is a freelance writer based in New York City.