The Stress Paradox
We are often told that stress is bad for us. Indeed, when I ask those attending my workshops about the impact that experiencing a lot of stress over a 12-month period would have on their health, 99% of the several thousand people I have worked with say it would be bad for their health. They seem reassured, albeit anxiously so, to learn that there is research to back up their widely held belief. A longitudinal study conducted in the US, found that out of the 29,000 Americans they tracked for eight years, those who had experienced a lot of stress in the previous 12 months were 43% more likely to die the following year. Proof, if ever you needed it, that experiencing lots of stress for a prolonged period isn’t so good for your health.
The problem with the ‘stress is bad’ narrative, is that it doesn’t tell the whole story. We should be wary of stories that paint things in black and white, as they ignore the rich shades of grey that lie in-between. In that same study, the researchers found that, whilst stress did indeed have a negative impact on those who experienced a lot of it, there was a caveat. It only had a negative effect, if an individual believed that stress was bad for their health. The research found that those who experienced a lot of stress but thought that stress was empowering, fared better than those people who only experienced a small amount of stress but thought that stress was bad. A UK longitudinal study, called the Whitehall II study, found a similar correlation; namely, people who believed that stress was negatively affecting their health ‘a lot’ or ‘extremely’ had double the risk of a heart attack compared to people who didn't believe stress would have a negative effect.
What does that research tell us? In its simplest form, the research suggests that stressing about being stressed is potentially worse for our health than the stress itself. To understand that paradox, we first need to understand our stress response, better known as our fight or flight (or freeze) response. It is a mechanism born out of evolutionary biology, which we share with every other mammal on the planet. It evolved to aid our survival in times when we believed that we lacked the necessary resources to deal with a threat, such as coming face-to-face with a sabre-toothed tiger or a waring tribe. Cue fight or flight, which sees a flurry of electrochemical and biochemical activity take place throughout the brain and body.
I often liken the transformation that happens to us in fight or flight to the transformation that Dr Bruce Banner experiences when he turns into the Hulk (less us ripping through our shirt or turning a darker shade of green). For those not familiar with the Marvel comic book character, the transformation is remarkable. A geeky, logical Dr Banner with a highly impressive IQ, is replaced with an ill-tempered, irrational and dumb green giant of a man with superhuman strength. You may (or may not) be surprised to learn that triggering our fight or flight response has a similar effect on us, as humans.
Fight or flight takes place in several waves. The first wave, via the sympathetic nervous system, triggers the release of epinephrine (more commonly known as adrenaline) from the adrenal glands which increases heart rate, blood pressure and the amount of blood being pumped to the muscles. This enables us to react quickly and instinctively to threats, such as being able to jump out of the way of an oncoming vehicle without conscious awareness.
The second wave kicks in as the initial surge of epinephrine subsides. The second wave is mediated by the hypothalamic-pituitary-adrenal axis (HPA axis) resulting in the release of cortisol from the adrenal glands. Cortisol continues to be produced, until such time as the threat has passed. That last piece of information is critical to explaining the paradox of the US study and the Whitehall II study. However, let’s first take a look at the effect of cortisol on the brain and body.
The darker side of stress
Cortisol, together with adrenaline and noradrenaline, play a significant role in re-distributing the mind and body’s resources to tackle a perceived threat. Faced with a sabre-toothed tiger, for example, it’s likely you’ll be less worried about digestion and reproduction and more concerned with finding safety. Faced with a waring tribe, you’ll probably prefer to have your blood flow diverted to the muscles in your legs and arms ready for battle, rather than your intestine or… elsewhere. You have no doubt read about the link between chronic stress and erectile dysfunctional in men. There is also some evidence that it may affect fertility in women.
Cortisol also plays a significant role in suppressing the immune function and influencing levels of inflammation. Cortisol is generally thought of as an anti-inflammatory, but more recent evidence has demonstrated that it has both an anti and a pro-inflammatory effect across the brain and body. Evidence over the last decade has been mounting, demonstrating a causal link between the effects of psychological stress on the body's ability to regulate inflammation, which can promote the development and progression of disease. For example, we know that we are more likely to catch a cold, our wounds will heal more slowly, and cancer can spread more rapidly, when we experience chronic negative stress. More recent evidence is pointing to a causal link between increased inflammation and mental ill-health. The evidence substantiates the widely held view that our body was not designed to deal with long-term stressors.
Turning to the brain, both the prefrontal cortex and hippocampus are negatively impacted by the long-term release of stress hormones such as adrenaline and cortisol. The prefrontal cortex is responsible for executive functioning (logical, rational thinking), whilst the hippocampus is involved in memory consolidation and retrieval, amongst other things. Chronic stress has been shown to adversely impact the size and connectivity of both of these brain regions, significantly increasing the risk of mental ill-health. However, acute stress can be equally as debilitating, negatively impacting the effective functioning of the prefrontal cortex and also impairing the ability of the hippocampus to retrieve long-term memories. If you have ever found yourself struggling to remember salient facts while standing on stage in front of a microphone, you will now have a better idea as to why.
The impairment of the prefrontal cortex also results in us becoming far more impulsive and less able to think logically and rationally, much like the Hulk. There is evidence to suggest that our IQ takes a substantial hit when we’re under the influence of fight or flight, with several studies finding IQ can drop as much as 10-15 points, the equivalent of going a night without any sleep or being drunk. We’re also far less able to regulate our emotions and we experience far greater tunnel vision, which prevents us from seeing things clearly and rationally. The bottom line is that we are far from the best version of our self when under the influence of fight or flight, even more so when stress becomes chronic. We often make poorer decisions, adopt poorer behaviours and undermine our relationships with others, as a result.
Thinking back to the stress paradox in the first blog, it is now easier to understand why stressing about stress is harmful to health. Our stress response was only ever designed to be used in short bursts of up to 30-minutes, to escape an imminent threat to survival. When a zebra is chased by a lion, it either has its intestines ripped out from under it, as it tries in vain to escape, or it successfully outruns the lion and returns to graze peacefully with not a care in the world. Where humans appear to go wrong, compared to other mammals on the planet, is two-fold. Firstly, the vast majority of the threats that humans perceive today, do not actually pose a threat to our long-term survival. However, our brain interprets a perceived threat by triggering fight or flight, irrespective of whether our fear stems from a life-threatening sabre-toothed tiger or co-worker who rubs us up the wrong way.
Secondly, unlike a zebra who will merrily go back to grazing once a threat has passed, as humans, we have a tendency to replay the stressful event in our minds over and over again or take aversive action, such as drinking alcohol or taking drugs, to avoid those stressful thoughts. We know from research that rumination (replaying negative thoughts over and over in the mind) is strongly correlated with a significantly increased risk of mental ill-health, including anxiety and depression. Your brain, left to its own devices, has no way to differentiate between a bunch of neurons firing as a result of external stimuli in the present moment or because you happen to be replaying a past event in your head. Both scenarios result in the same pattern of neurons firing, which your brain will then interpret as if it is actually happening.
A key way to stop the negative cycle, is to break the train of thought and focus your attention elsewhere. Let’s look at that next.
Changing our relationship with stress
Those people who thrive under pressure, are those that see challenges not as insurmountable obstacles but as opportunities to grow – they look for solutions rather than staying stuck ruminating on the problem. There is plenty of evidence to demonstrate how our perception of a situation influences the outcome. Most of us just assume that the thoughts that pop into our head when faced with a situation, are just part of who we are. I wish someone had explained to me, much earlier, that we have the capacity to significantly change our inner narrative. If we experience extreme self-criticism, we can learn to become far more compassionate towards ourselves. There is compelling evidence, albeit counterintuitive perhaps, that practising self-compassion actually helps us to perform better and hold ourselves to a far higher standard, compared to those who are highly critical of themselves.
Learnable skills based in Cognitive Behaviour Therapy and positive psychology can permanently rewire how the brain processes information. Situations we perceive as threatening now, do not have to remain so. It is possible to teach an old dog new tricks. Of course, there are fundamental things which can adversely affect how stressed we feel – we have an evolutionary propensity for safety and belonging. Studies, such as the Whitehall studies I and II, have identified that a lack of perceived control and feeling isolated were major contributing factors to poor health and wellbeing amongst participants. More recent studies have been able to quantify such effects. Looking at social isolation, for example, researchers have found that it appears to be as bad for someone’s health as smoking 15 cigarettes a day.
Re-evaluating our relationship with stress isn’t simply about thinking differently though. The behaviours we adopt have a significant impact on our ability to cope with stressful events. Failing to sleep sufficiently or exercise regularly predisposes us to be more readily susceptible to experiencing negative stress. Sleep deprivation (regularly sleeping less than seven hours per night) triggers our fight or flight response. Many people mistakenly believe that sleep, exercise and good nutrition are optional, yet, we become far less effective, are far more emotionally reactive and increase our risk of mental and physical ill-health when we ignore the basics. One of the quirks of being in a near constant state of fight or flight is that we become far less able to differentiate between what is urgent and what is important. Our impulsivity instinct kicks in and we end up wasting much of our time on things that are of little consequence. It is worth noting that you will perceive a far greater number of sabre-toothed tigers in your environment when you haven’t prioritised self-care.
Of course, irrespective of how much sleep and exercise we get, there will be times when we find ourselves face-to-face with a metaphorical sabre-toothed tiger. I remember well the anxiety I used to experience when asked to speak in front of a room full of partners as a trainee solicitor or, thinking further back, when I was required to present my chemistry thesis at university in front of a room full of my peers. No one had ever explained to me that those feelings of crippling anxiety were in fact optional. That I didn’t have to feel that way forever and that my brain had the capacity to significantly alter its negative response to those situations I found stressful. Of course, I was never in any real danger, but my brain reacted as if I was. It was scared, which made me scared and, in turn, adversely affected my performance.
The best advice I give to people who find themselves in such a situation is two-fold. First and foremost, take a slow, deep, breath (or several in fact). Many of us don’t realise that much of the time we are breathing from a very shallow place in our chest (on the cusp of hyperventilating), whereas we operate at our best when we are taking long deep breathes from our abdominal area. Research conducted by Stanford University, found that army veterans who had been suffering with post-traumatic stress disorder for several years were able to reduce their symptoms by as much as 40%, after attending a one-week intensive breathing exercise programme. Conversely, another study found that shallow breathing, without any other adverse stimuli, was able to trigger symptoms of fight or flight. Deep breathing works thanks to the calming effect it has on the brain, by stimulation of the Vagus nerve. The breath is the cornerstone of most meditation and mindfulness practices.
Secondly, I recommend that people practise switching their attention to something which empowers them rather than undermines them. Our present moment experience is heavily influenced by where we focus our attention. If you are focused on terrible things, you will feel terrible. Learn to switch your attention to more positive things and you will feel more positive. In the case of public speaking, simply shifting your focus so that you are thinking about how excited you are to be sharing your knowledge or about how grateful people will be hear your insights, will materially alter the electrochemical and biochemical processes happening inside of you. Change won’t happen overnight; it can take weeks and sometimes even months to rewire neural connections within the brain. As with most things, the first step is to become aware that you are having debilitating thoughts. Practising mindfulness cultivates greater moment by moment awareness and enables people to have far greater control over the thoughts they engage with and, consequently, the feelings they experience.
Finally, thinking back to the Stress Paradox, it is important to remember that emotions are only ever your brain’s best guess of how you should be feeling right now, based on your previous experiences. They are there to alert you to what may pose a threat. However, they aren’t a fool proof survival guide and should be taken with a pinch (if not a whole bucket) of salt. They are not something to fear, but merely exist as a guide. Much of the time we create our own fears. Fear of failure, fear of not being good enough, fear of not being accepted, fear of simply not being enough. Whether those fears are warranted or not would probably require an entire book. The short answer, however, is most likely to be that those thoughts are not warranted. In Cognitive Behavioural Therapy you would be asked to look for the evidence to dispute your current debilitating way of thinking, so perhaps that is a good place to start.
This blog was originally penned for the charity LawCare and was published in three parts over three months, from April 2019 to June 2019. LawCare is striving for a legal community where anyone who may be facing a personal or professional difficulty that is affecting their mental health and wellbeing, understands how and when to seek help, without fear or stigma. It wants the legal community to know what help is available to them and how to access it.