MENTAL HEALTH
THE RHYTHM OF STRESS Martin Huecker , MD
“ The more you try to avoid suffering , the more you suffer , because smaller and more insignificant things begin to torture you , in proportion to your fear of being hurt . The one who does most to avoid suffering is , in the end , the one who suffers most .” - Thomas Merton
“ All of history can be summarized in two words : challenge and response .” - Arnold Toynbee
After a year like 2020 , no one can
claim freedom from stress . Many of us feel the vague , underlying baseline of responsibilities outnumbering hours . Deep investigation into stress uncovers paradox . The more you try to avoid it , the more it accumulates . Yet the more you think about it , the worse you feel . While chronic stress leads to health problems and even death , acute stress can make you stronger . Stress leads to heart disease , accidents , cancer , liver disease , suicide , absenteeism , poor productivity , cognitive impairment , depression , anxiety and relationship conflict . But on the upside , stress enhances alertness , focus , energy , immunity , neurogenesis , motivation , growth and resilience . Higher levels of stress correlate with more health care visits and higher mortality , but more happiness . Stress means something you care about is at stake . 1
We all know the biochemical marker and mediator of stress in the body , the hormone cortisol . During a stress response , cortisol rises , but so do other hormones like epinephrine and , if you are lucky , Dehydroepiandrosterone ( DHEA ). Because the degree of DHEA surge correlates with positive outcomes , the ratio of DHEA to cortisol is called the growth index . If you and I experience stress , have the same cortisol spike , but you secrete more DHEA , then you have a higher growth index . You experience more favorable physiology ( better contractility , vasodilation , wound healing , improved immunity , etc .) and better outcomes ( academic persistence , resilience , GPA , focus , less PTSD , less depression and anxiety ). 1 You are excited and energized . I am stressed .
Demands that exceed our perceived resources : threats . Demands we feel equipped to handle : challenges . This distinction is crucial because the balance can shift based solely on mindset . A mindset that fears stress and underestimates resources can harm our health and kill us . In medical education , Vicky Leblanc recommends reappraisal of resources during acute stress , thus transforming a threat into a challenge . 2 The mindset we bring to stress predicts our acute physiology and long-term outcomes . Post-myocardial infarction ( MI ) patients who reappraise are less likely to have a second MI . 3 , 4 In a study of 30,000 US adults , higher stress correlated with higher mortality only in people who believed stress to be damaging . 5
12 LOUISVILLE MEDICINE