Stress – A global crisis

By: Richard Sutton

The World Health Organisation cites stress as the health epidemic of the 21^st century. Despite our remote geographic location, South Africa is at the forefront of this global crisis. According to a recent report by Bloomberg^[1] that assessed 74 countries by evaluating seven equally weighted variables,^[2] South Africa is the second most stressed nation on the planet!

But is South Africa really as stressed as the report implies? The answer is a resounding: Yes! The reason lies with the actual root cause of stress in our lives. Understanding what drives stress has been a research journey that has taken the better part of 70 years. Much of the evidence has been extrapolated from the workplace, which is considered to be our primary stress environment.^[3]

Interestingly, the major breakthrough came from two landmark studies, which later became known as the Whitehall studies^[4] that involved more than 28 000 people over a 40-year period. These studies rigorously evaluated the effect of stress in the workplace on health and productivity. What these studies showed was that while there are several major drivers in our experience of stress, such as low social support, a lack of fairness, and an imbalance between efforts and reward, none is more impactful than a sense of having no control in our lives.

If you reflect on the many personal or professional challenges over the years that caused you distress, has the overwhelming feeling not been that you have little to no authority over the situation and feel completely out of control?

Recently, Joel Goh from Harvard Business School and Jeffrey Pfeffer from Stanford Business School published a report^[5] on the relationship between workplace stressors, mortality, and healthcare costs. The report analysed 228 high-quality studies on stress and health outcomes. What they found was that low control in the workplace (and in life, for that matter) was associated with a 40% or greater risk of premature mortality, a more than 20% higher risk of being diagnosed with a chronic illness, and a more than 40% risk of self-reported mental and physical health issues.

Although South Africa holds immense potential and has countless positive attributes, the current socio-economic environment is subject to considerable uncertainties across multiple domains (inflationary, environmental, political) where our perception of being in control may be brought into question. (The extreme volatility of my water and lights bill every month alone can easily trigger my stress response.)

Based on the current body of research literature, it is not surprising that according to Dr Renata Schoeman, a senior lecturer at the University of Stellenbosch’s Business School, work-related stress, burn-out, depression, and anxiety disorders are costing the South African economy an estimated R40 billion annually.^[6] What is even more concerning is the burden of presenteeism on the South African economy. Presenteeism is defined as the practice of coming to work when ill, injured, anxious, depressed, or simply burned out. According to Schoeman, it is estimated that presenteeism costs the South African economy over R200 billion annually.

The change we need starts with us

Whether we like it or not, we have all been called to action – our very health and success depend on it. And while stress avoidance is completely impossible in this day and age, resilience^[7] is very much attainable.

In my book The Stress Code, I explain that stress resilience can be learned in four fundamental steps:

1. Make an intentional change to the way you perceive stress and challenges
2. Change your behaviour during periods of stress
3. Develop the skill and know-how to shut down stress at will
4. Incorporate selective lifestyle activities that rebuild your physical, emotional, and cognitive abilities

The power of positive thinking

Albert Einstein said, “Reality is merely an illusion, albeit a very persistent one.” When it comes to stress resilience and buffering the negative effects of chronic stress, perception is everything.

A recent study^[8] that followed 28 753 adults over eight years found that when we perceive stress as a negative experience that corrodes our health and vitality, it becomes significantly more damaging to our well-being when compared to an indifferent or even positive view.

By contrast, several recent Harvard studies^[9] clearly showed that reframing stress as a positive biological experience − one that is necessary in order to excel in challenging situations − is enormously protective. So much so that simply seeing stress as a positive opportunity rather than a negative experience causes our hearts to pump blood more efficiently and dilates our blood vessels (lowering blood pressure).

Moreover, seeing stress as a positive biological response also enhances your recovery from stressful episodes, improves coping skills during crisis, reduces sensitivity to day-to-day stresses, and can even enhance performance during regular life challenges.

The primary lesson here is the power of the mind. We can’t always control the stressors that confront us every day, but we can certainly control the way in which we perceive and respond to them. This gives us considerable authority over our health and performance.

Practical advice:

In stressful situations, the increase in arousal you may feel during the event is not harmful. Instead, these responses evolved to help you survive and overcome crises. During the challenge, reinterpret your body’s signals as beneficial.

Behaviour: relationships, connection, community

By and large, modern society reveres success, achievement, and external strength. When confronted with significant stress, many of us become introverted, cutting ourselves off from the world until we feel strong enough to re-emerge. Could this be a consequence of society’s intolerance of failure, weakness, and vulnerability? Possibly, but whatever the root cause, this pattern is very entrenched and is leaving a trail of destruction in its wake.

The reason lies with the fact that within our complex biological makeup, we produce a hormone (and neurochemical) that has the capacity to protect us against the destructive effects of chronically raised levels of stress hormones. The molecule is oxytocin, which offers valuable physical benefits such as lowered cortisol, lowered heart rate, and lowered blood pressure to counteract the common adverse effects of a chronically elevated stress response.

Oxytocin also has anti-inflammatory actions and anti-oxidant effects and increases the production of serotonin as well as molecules that build both the brain and body.

Moreover, this incredible hormone promotes self-worth, confidence, fearlessness, optimism, a sense of calm, generosity, connectedness, and empathy towards others – an ideal profile for success in any endeavour, let alone stress buffering.

Oxytocin is unlike any other hormone or neurochemical in the body in that it is a pro-social hormone. This means that our bonds with others determine the magnitude and frequency of release. The physical triggers in oxytocin release include physical contact with others such as hugging, light touch, massage, and eye contact. Another mechanism by which we increase oxytocin levels is through pro-social behaviour. Caring for others, giving to others, showing support for others, and feeling empathy towards others all trigger oxytocin release.

Essentially, this means that the worst thing you could do during periods of stress is disconnect from those around you. Throughout human history, we have always handled challenges more successfully as a collective − oxytocin can be likened to the glue that binds us together.

Practical advice:

During personal challenges and crises, reach out to those close to you. Resist the tendency to withdraw from the world, show more care, support, and charity to those close to you. You are the ultimate beneficiary.

Shut it down

One of the biggest issues with chronic stress is that the stress axis (an interplay between the nervous, immune, and hormonal systems) gets stuck in overdrive – even when it’s not needed. So many factors contribute to this, ranging from a trend towards higher expectations from others and of ourselves; greater competition in all areas of life; higher levels of intolerance and impatience within society; constant stimuli; weakened relationships; and disconnection from others.

Fortunately, science has discovered the “off button” – the vagus nerve. The vagus nerve is one of the longest and most influential nerves in the body. It exits the skull just behind the ears and descends vertically along the front of the throat through the chest cavity and continues down into the abdomen. It is the direct interface between the brain and key organs and systems of the body, most notably the heart, lungs, and digestive tract. This so-called ‘wandering nerve’ operates far below the level of our conscious minds. Although its primary role is synchronicity between the body and the brain, its best-recognised attribute is that of calming the body following the fight-or-flight state induced by adrenaline. Medical researchers have long known that the stronger one’s vagal tone, the quicker the body can normalise itself after a perceived threat or stressful event.

This is one of the reasons that some people are seemingly immune to chronic stress, while others become overwhelmed and ill from even the slightest upset.

Fortunately, there are many activities, therapies, and practices that can increase the activity of the vagus nerve and even improve its tone. Visceral manipulation, swimming, chiropractic treatments, physiotherapy, massage, yoga, controlled breathing exercises, EFT tapping, body talk, meditation, and music therapy are all effective vagal stimulators. To manage stress effectively, several of these modalities should be incorporated into your lifestyle.

Practical tip:

During stressful periods, practice controlled breathing exercises for 3-12 minutes before going to bed in the evenings. Slow, deliberate breathing activates the vagus nerve through more than one pathway, making it highly effective in the management of both short and more sustained stress reactions.

Find a quiet place where you won’t be interrupted. You can either sit upright or be lying down before sleep. Slow your breathing rate down to 5 or 6 breaths per minute. Spend equal time on inhalation and exhalation. The goal is to build up to breathing this way for 10 to 12 minutes. Focussing on breathing this way for such a long time may be a bit challenging in the beginning, so start with 3 to 4 minutes before bed for a few days, then add a minute to the process each day until you reach 12 minutes. It is an incredible way to end the day.

Rebuilding the mind and the body

Prolonged periods of chronic stress are typically accompanied by a decline in physical vitality, emotional stability, and cognitive integrity. Even when the stressor is removed, these states often persist and require active and focussed intervention. Fortunately, restoration of vitality, health, and cognitive potency can be achieved through numerous sustained lifestyle behaviours and practices.

The key to neutralising the long-term effects of stress lies in the creation of a molecular bias. This state needs to focus on the very hormones and molecules that become down-regulated by the stress response. Many activities, nutritional supplements, dietary practices, and even certain environmental conditions can increase the production and circulating levels of several of these molecules and hormones.

For example, regular aerobic and resistance exercise, getting outdoors for 10-20 minutes a day, as well as foods and beverages such as cacao and green tea can be advantageous in this process. Nutritional supplements including curcumin, multivitamins, and omega-3 fatty acids provide additional benefit.

Practical tip: When regularly consumed (eg. cold-water fish) or supplemented, omega-3 fatty acids can:

• blunt stress hormone output during periods of chronic stress
• protect brain cells from the damaging effects of stress hormones
• lower inflammation
• promote longevity and lower rates of chronic disease
• offer greater biological benefits to those who suffer from higher degrees of stress
• improve cognition and increase brain mass

While stress is fast becoming a leading health and economic burden throughout the world, we do have the ability to buffer the adverse effects. This can be achieved by:

• changing the way we perceive stress
• building positive relationships with others, and
• acquiring the knowledge to manage its effects more successfully.

In this way, not only do we become more resilient, we also give ourselves the opportunity to thrive and excel in adversity.

For more on this and other health topics go to: www.suttonhealth.co.za

BIO:

Richard Sutton is a health and performance educator and consultant. Considered to be one of the foremost experts in his field, Richard has advised top athletes, Olympic teams, and international sporting federations. He has been a post-graduate lecturer in the areas of pain management, health, and athletic development for almost two decades, and consults to leading companies on stress resilience, employee engagement, and productivity. Richard has recently authored a book called The Stress Code, available now on Amazon and in stores locally in October. Supported by extensive scientific research, the book offers comprehensive and structured insights as well as a repertoire of interventions that will empower the reader to thrive in adversity. Kevin Anderson, this year’s US Open and Wimbledon finalist, feels that the book is a must read!

1. https://www.bloomberg.com/graphics/best-and-worst/#most-stressed-out-countries ↑
2. Homicide rates, GDP per capita, income inequality, corruption perception, unemployment, urban air pollution and life expectancy ↑
3. Anderson, Norman B., et al. “Stress in America: Paying with our health.” American Psychological Association (2015). ↑
4. Marmot, Michael G., et al. “Health inequalities among British civil servants: the Whitehall II study.” The Lancet 337.8754 (1991): 1387-1393. ↑
5. Goh, Joel, Jeffrey Pfeffer, and Stefanos A. Zenios. “The relationship between workplace stressors and mortality and health costs in the United States.” Management Science 62.2 (2015): 608-628. ↑
6. https://www.businesslive.co.za/fm/features/2017-08-31-mental-health-problems-cost-sas-economy-billions-per-year/ ↑
7. The ability to adapt successfully in the face of adversity ↑
8. Keller, A., et al. “Does the perception that stress affects health matter? The association with health and mortality.” Health Psychology 31.5 (2012):677-84. ↑
9. Jamieson, J.P., Nock, M.K., Mendes, W.B. “Mind over matter: reappraising arousal improves cardiovascular and cognitive responses to stress.” Journal of Experimental Psychology: General 141.3 (2012):417-22. ↑