We often forget that stress can be a powerful and positive thing. It helps keep us alert, motivated, and ready to get out of harm’s way. Do you remember how the stress of an upcoming exam allowed you to work harder and stay awake longer?

If a wild animal chases me, my acute stress response will hopefully temporarily turn me into the sprinter Usain Bolt. But stress over long periods is detrimental to our health and well-being.

Today, we explore how stress affects our biology, before turning to my unusual ritual to help me cope with it.

Stress — Acute versus chronic

Your body’s autonomic nervous system regulates your breathing, pulse, vision changes, etc. This system revs up your stress or “fight-or-flight” response, helping us cope with stressful situations in the short term.

On the other hand, if you experience chronic (long-term) stress, this continuous activation of your autonomic system causes damage to your body. The result? Adverse emotional, behavioral, and physical symptoms.

Chronic activation of the stress response impairs health in several ways. With long-term overexposure to cortisol and other stress hormones, you may suffer from numerous disorders, including:

• Anxiety
• Depression
• Digestive problems
• Headaches
• Muscle tension and pain
• Heart disease, heart attack, high blood pressure, and stroke
• Sleep problems
• Weight gain
• Memory and concentration impairment

The physical manifestations of chronic stress may include achiness, chest pain, or the feeling that your heart is racing. You may have headaches, higher blood pressure, changes in sleeping, and exhaustion.

Some chronic stress sufferers have digestive problems, muscle tension (I used to experience jaw clenching), a weaker immune system, or trouble having sex.

Associated behavioral issues can include too much alcohol consumption, overeating, gambling or other compulsive behaviors (such as shopping or internet browsing), smoking, and illicit drug use.

Stress — The power of a smile

Those of us in the United States smile a lot, perhaps too much (according to non-American friends). So here is my secret weapon to reduce stress — I smile.

As I smile, my brain releases feel-good hormones known as endorphins. Endorphins are our natural pain relievers and can give your mood a boost, too. Those positive vibes during sex? Endorphins. Feeling good while laughing with friends? Yep, you just got a rush of endorphins.

Endorphins are endogenous opioids, a group of protein chains known as peptides. These substances are primarily controlled and released by our brain’s hypothalamus and pituitary gland.

Let’s break down “endogenous opioids.” Endogenous means from the body, and morphine is an opiate pain reliever.

I use a broad smile to trigger a flood of endorphins. I almost always feel refreshed and less anxious after smiling. My stress level is dropping at the moment.

Smiling and stress reduction

By smiling, I may be tricking my brain into thinking that I am happy. University of Kansas (USA) researchers examined how different types of smiling, and the awareness of smiling, affects the ability to recover from stress episodes.

Did you know that there are two general types of smiles? A standard smile utilizes the muscles surrounding our mouths. On the other hand, a Duchenne smile engages the muscles surrounding the mouth and the eyes.

The Duchenne smile is the one that causes the corners of our eyes to wrinkle up with crow’s feet. Some argue that this smile form represents the most authentic expression of joy.

Publishing in 2012 in Psychological Science, researchers Drs. Tara Kraft and Sarah Pressman showed some positive benefits of smiling in a randomized clinical trial. The investigators studied 170 subjects who held chopsticks in their mouths (to create a Duchenne smile, a standard smile, or a neutral expression).

They asked half of the participants in the smiling groups to smile (the other half got no instructions linked to smiling). Here are the results:

All smiling participants (whether they were aware of smiling) had lower heart rates during stress recovery than the neutral group. The Duchenne smilers had the most positive response, by a small margin.

Those in the smiling group who did not get clear instructions to smile had less of a positive effect during their performance of a stressful task (compared with the neutral group).

The study authors concluded that there are psychological and physiological benefits to maintaining positive facial expressions during stress.

So if you are stressed or a bit down, try smiling. Fake it until you make it; you may reduce your level of psychological fatigue.

Before we go, let me share with you some of my other tricks for dealing with stress (I am an oncologist, after all):

• Relaxation response. I meditate each day and do deep breathing exercises as well. I also like to visualize tranquil scenes.
• Physical activity. Movement is my go-to for stress reduction. My daily walk at noon is something to which I always look forward.
• Social support. I need to do better in this domain, but friends can provide a life-enhancing social net and improve longevity.
• Practice gratitude.

Please seek medical attention if you feel overwhelmed, have thoughts about harming yourself, or if you are using drugs or alcohol to cope. Thank you for joining me. Did you notice my broad smile in my profile photo?

The post My Ritual to Drop Stress appeared first on Medika Life.

In my last article (Debunking 1 in 5 COVID-19 Patients Develop Mental Illness), I debunked a claim circulating around the world — that a Lancet Psychiatry study found 1 in 5 COVID-19 patients would become mentally ill in the first 3 months after diagnosis.

Researchers drew on the electronic health records (EHRs) from a US managed health care system to match 62,354 patients COVID-19 with patients with 6 other medical diagnoses.

Claims about mental illness were based on recording in the electronic health records of mental health diagnoses 14–90 days after diagnosis of COVID-19 or the comparison health conditions. These diagnoses of mental illness were originally made for administrative purposes — billing and documentation — and would be considered poor quality for scientific purposes.

I pointed out that the excess of mental health diagnoses associated with COVID-19 was almost entirely due to more adjustment disorders.

Patients diagnosed with COVID-19 were likely to be experiencing some anxiety (worried) or depressive symptoms (sad, pessimistic) that were not serious enough to justify a diagnosis of major depression or a serious anxiety disorder. So, a diagnosis of adjustment disorder was entered into their EHRs.

These do not seem like abnormal reactions to me. In fact, adjustment disorders were formerly called adjustment reactions and clinicians could not be reimbursed for treating them.

Dissenting from the portrayal of the study in the media

Why was my interpretation of the Lancet Psychiatry article at odds with almost all of the media coverage I could find, which proved to be remarkably similar?

I arrived at my conclusions by looking at the study design and closely examining the tables of numbers.

I applied knowledge that any journalist should have in writing about a topic that has great importance to readers facing a profound public health crisis like COVID-19.

America is facing a profound crisis of faith in democracy and in science. It desperately needs media filled with articles by journalists who think for themselves and consult experts when they need to.

In an ideal world, journalists should have called up their own independent experts and asked them about their impression of the study. Were these experts expecting a tsunami of mental health problems or did they think these authors might have overstated the importance of their findings a bit?

Journalists should have had the curiosity to ask how serious a mental illness an adjustment disorder and why there was not more depression associated with COVID-19.

In a bygone era, journalists were better able to play an important function in society. At their best, journalists buffered laypersons and policymakers from the self-promotion, conflicts of interest, and sheer overenthusiasm of researchers for their own work. Journalists provided independent assessments of science to satisfy readers’ curiosity, but also to guide their personal and collective decision making.

But journalists face different challenges than only a few years ago.

Most newspapers and magazines have laid off their full-time staff and depend on freelance journalists. Journalists can no longer assume researching articles will be reimbursed.

Often, journalists will not have the time to look at a scientific paper carefully or to consult their trusted sources. Few will have the courage or the recklessness to say that the authors of the Lancet Psychiatry study (from Oxford University, after all) are exaggerating the significance of their findings.

Editors will also not be pleased with a story on which they cannot slap a clickbait, screaming headline like “1 in 9 mentally ill!!”

Media have gone online, some abandoning print editions altogether. They need clickbait to attract and retain readers’ interest. Traffic to a media website and readers’ time spent there are tracked as altmetrics, which determine the advertisements the media get and what they can charge for ads.

This consideration matters for which articles from which journalists are published.

Science Media Centre of London (SMC_L)

Media coverage of the Lancet Psychiatry article was almost identical worldwide. If articles quoted an expert, it would likely be identical quotes from the same experts. A lot of the articles credited Reuters News Service. The articles that did not credit Reuters but named a journalist in the byline were generally quite similar, even having the same quotes.

Noting that some authors of the Lancet Psychiatry article were at Oxford University, I immediately suspected the Science Media Centre of London (SMC_L) was involved.

The SMC_L website welcomes journalists.

When science hits the news agenda, it’s our job to pass on to journalists as much accurate information as we can, as quickly as possible. In order to do this, we send out quotes from experts and statistical analyses of scientific studies, in addition to running regular press briefings on the latest hot topics. Find our most recent Roundups and Rapid Reactions, briefings and ‘Before the Headlines’ analyses below…

Who are the experts that SMC_L consults? Can anyone submit their credentials and expect to be called?

We are always on the lookout for top experts, but it’s important that each scientist knows us before we call them. So, we generally don’t add scientists before we’ve worked with them at least once.

It sounds like British English for “Don’t call us, we will call you.”

SMC_L warns of storms around science stories in the media.

When science hits the headlines, it’s not only journalists and scientists who find themselves in the eye of the storm, but also press, media and communications officers, working to support their scientists and engineers whilst also providing journalists with what they need.

I expect that bad science will get into the media and even good science will get misrepresented. Such occurrences are inevitable. When it happens, controversy and criticism are healthy and necessary parts of fixing things.

You might get a sense that SMC_L disagrees. They seem to be offering shelter from such “storms.”

Expert reaction to study looking at psychiatric diagnoses after COVID-19

I don’t like authorities telling me how to think or what to write, even if, like Ringo Starr, they can call themselves Sir or Dame or wear medals at breakfast.

Searching for the Lancet Psychiatry study, I found a past Briefing and an Expert Reaction with seven of SMC_L’s usual suspects as experts.

Six of the seven mostly sounded like experts, but really did not get into the nitty-gritty of the study, content enough to demonstrate expertise.

One expert had “Sir” between “Prof” and his name. Another had “Dame” between “Prof” and her name.

I cannot understand why Brits bring up knighthood and damehood in these contexts. When Ringo Starr got to call himself Sir, it did not improve my appreciation of the Beatles.

There was not very much reference in this Expert Reaction to crucial methodological details of the study and the limitations of EHRs as scientific data.

It would seem that a grasp of these details should temper any recommendations for clinic or public health policy based on the study.

No expert conveyed any sense of the messiness of big data from an American health care system, especially if one is intent on making policy recommendations for organizing a response to mental illness associated with COVID.

Six of the Expert Reactions sounded like a string sextet accustomed to playing together, mostly without creating a fuss. The seventh, however, arrived like a tuba player, oblivious to not contributing to the harmony.

Prof David Curtis politely alluded to a lot of problems with the Lancet Psychiatry study. He seemed to wonder aloud why such a fuss is being made about it. He injects some uncommon common sense into the discussion

“It may be unsurprising that this happens a bit more often in people with COVID-19, who may understandably have been worried that they might become seriously unwell and who will also have had to endure a period of isolation.”

If there is any doubt about where he stands, he clarifies at the end:

“Overall, the results reported seem broadly plausible but I’m not sure that they have specific implications for patients or health services.”

My kind of expert. I hope Prof Curtis gets invited back by SMC_L.

Getting personal

I think my humility is still intact after decades of writing hundreds of scientific papers, some that deserve more criticism than they received. I welcome criticism from experts. I welcome peer-review by academics, but also feedback from patients who are experts on their experience and who have had to live with the modest clinical and public health implications of what I have written.

Yet, I think there is a vital distinction to be drawn between expertise and authorities. The good experts have the credibility to gain our attention by showing things we might not know, but that we would agree we should. The not-always-good authorities believe they have the power to enforce rules and tell us how to think and what to write.

I think that is what SMC-London is doing here. I am biased by my experience with them, but that bias is valuable because it is grounded in experience. I have seen their ways too often for my liking.

• One of the experts being cited in this Expert Reaction — the Dame — also endorsed an awful study that she claimed showed cognitive therapy for psychosis was effective for psychosis in the absence of medication. The study did not show that, but such claims encouraged some patients to refuse medication. The Cochrane Collaboration showed twice in systematic reviews that cognitive behavior therapy was ineffective.

• One of the experts who was cited — the Sir — advocated cognitive behavior therapy and graded exercise for chronic fatigue syndrome, which patients insisted was ineffective and harmful. Fiona Fox, Director of SMC_L organized a campaign that media that condemned the patients as militant terrorists. The press releases were picked up in British media. The patients were subject to considerable abuse and harassment as a result.

Whiskey, tango, foxtrot! The patients were often bedbound or confined to wheelchairs. I do not think anyone would recruit them as suicide bombers or even assassins.

• I decided to look into the matter. I requested data from the PACE clinical trial for reanalysis. I believed the PACE investigators were legally bound to make these data available. Fiona Fox, Director of SMC_L organized a letter-writing campaign to Parliament calling for researchers to be exempt from such requests.

As promised, SMC_L tried to provide shelter from the storm.

• More recently, patients with chronic fatigue syndrome and professionals from around the world convinced the UK National Institute for Clinical Excellence to issue draft recommendations that no longer endorsed GET as a safe and effective treatment. SMC_L has organized resistance from academics strongly invested in this treatment, including the Sir.

I am exceptionally lucky. I came out of public housing on a shitty mudflat in Chelsea, MA, and spent my high school years on welfare. By many accidents of circumstances, I somehow ended up an emeritus Ivy League med school professor.

I am painfully aware of my deficiencies in preparation and seek my corrective expertise where I can find it. But I don’t like authorities telling me how to think, even if, like Ringo Starr, they can call themselves Sir or Dame or wear medals at breakfast.

America is facing a profound crisis in its faith in democracy and in science. It desperately needs media filled with articles by journalists who think for themselves and consult whatever independent expertise they feel they need.

I don’t care that SMC_L gives lots of stuff away free and does not mind if journalists plagiarize them.

Journos, please find your own experts and write your own articles on which you can proudly stick your byline.

The post No Tsunami of Mental Illness Accompanies Covid-19 appeared first on Medika Life.

No need to hurry. No need to sparkle. No need to be anybody but oneself — Virginia Woolf

Stress and anxiety are intimately related, but distinctly different in two diverse ways, one is emotional, and the other is biological. Working together with one tripping the other, however, is a concerted attack against your physical health and your mental health. Of most concern is that it can kill brain cells and shrink the size of the brain. It’s power, therefore, is formidable.

Stresses can be external (from the environment, psychological, or social situations) or internal (illness, or from a medical procedure). Stress can initiate the “fight or flight” response, a complex reaction of neurologic and endocrinologic systems.

Stress and anxiety work in concert. First, the person may perceive a psychological threat, and then the biological stress reaction is put in action. As Hans Selye indicated, there is a General Adaptation Syndrome that follows a designated path. Selye’s syndrome is comprised of three stages; alarm, resistance, and exhaustion. Tragically, the final stage of exhaustion can be death.

Stress is, thus, defined as a state of threatened homeostasis, which is reestablished by a complex repertoire of physiologic and behavioral adaptive responses of the organism.

I had my first experience with contagious anxiety in third grade. I was seated quietly waiting for a test paper to be passed around. I wasn’t concerned because I knew I had studied when, suddenly, the first seated in front of me whirled around and, in a very frightened voice asked, “Are you afraid? Do you think you’ll be able to pass the test?”

The thought had never entered my mind, but suddenly my heart began to race wildly and I felt myself shiver at the thought of taking a test. No, I never had test-taking anxiety before. I always remained calm until that day. She shook me to the core.

Anxiety is an emotion characterized by feelings of tension, worried thoughts and physical changes like increased blood pressure.

People with anxiety disorders usually have recurring intrusive thoughts or concerns. They may avoid certain situations out of worry. They may also have physical symptoms such as sweating, trembling, dizziness or a rapid heartbeat.

Much is written about managing stress without addressing the environmental, physical, and biological substrates in any detail. Stated more directly, The National Institute of Mental Health defines stress as merely “the brain’s response to any demand.”

Failure to Manage Stress

The dynamic pairing of stress and anxiety does require management. If prolonged stress is not managed, physical health may be the deadly target and psychological and physical illness results. Physical illnesses include hypertension, sleep disorders, and immune system dysfunction. But how does each work?

Studies have shown that there is a clear relationship between anxiety, stress, and early childhood experiences. Therefore, a predisposition to heightened levels of stress and anxiety can be assumed, and, theoretically, a primed network in the brain to respond is developed. The brain changes are especially true in the “fear center,” the amygdala, which increases in size with heightened stress and anxiety.

One of the most apparent biological markers of increased stress is easily demonstrated; salivary cortisol (the stress hormone). A bright note is that the brain change process appears to be lifelong and mitigates for remediation of stress and anxiety.

Brain development is a continuous process throughout life that goes through sensitive periods during which stressors and nurturing experiences can have lasting effects. Many adult diseases such as cardiovascular disease and depression have their origins in adverse early-life experiences, such as neglect and physical and sexual abuse, as was shown in the Centers for Disease Control Adverse Childhood Experiences Study.

Changing the Brain in the Face of Anxiety

Deleterious brain changes in adulthood appear to be amenable to repair according to research. But one question remains to be answered, and that is whether or not anxiety is contagious.

One researcher found that the brain retains the possibility of increasing and strengthening its network of neurons, the cells that comprise the brain and the body’s nervous system.

This work is contributing to a new understanding that the brain stays this plastic organ throughout your life, capable of change.

Therefore, the hope remains that childhood deficits in brain development tied to early emotional responses and anxiety may be overturned.

Anxiety Contagion, Real or Not?

What about anxiety having a component of contagion? Can you become more anxious if you’re in the company of anxious people or a person? It appears to be true. Behavioral or herd contagion was being studied during the 1950s.

In fact, according to one paper, “…herding may encompass a much wider range of our social behaviors than had been previously thought.”

While fear helps us survive, when mixed with uncertainty, it can lead to something quite bad for our mental health: anxiety. And when anxiety is spread by social contagion — defined as the spread of affect from one person to another — it can lead to something even more problematic: panic. Just like walking into a party and suddenly feeling like you’re in a “social mood” when you hadn’t been moments before, fear and anxiety are two emotions that spread easily from one person to another.

A contagion of this type has also been shown to be an unlearned response, as is demonstrated by babies that cry when they hear other babies crying. The fear response kicks in quickly at birth.

Emotional contagion does not arise only in dyadic or group face-to-face interactions. Several cultural artifacts are capable of transmitting emotions, such as movies, videotapes, cartoons, and songs.

Researchers have demonstrated that movies are very effective instruments for communicating emotions. Several studies have obtained evidence that Duchenne smiles (genuine smiles) appear in participants who are watching pleasant movies . The Duchenne smile is perceived as a more affective smile.

What Appears to Be Most Effective in Managing Stress/Anxiety?

Numerous exercises have been suggested as being useful in managing stress and anxiety, but the one which appears to work best is mindfulness.

The therapeutic efficacy of mindfulness has been demonstrated in outpatient pain patients and has realized its potential in multiple settings for varied difficulties. Today, the practice is available online through several hospitals and clinics.

As noted by The Lancet, mindfulness is a worthwhile program and, while useful for anxiety and stress, is not often used due to finance, time constraints, or other personal considerations.

The editors of the journal indicated its value not merely for current use, but as something that has lifelong value.

This process of paying attention to novelty and to the context of the current situation leads one to having a multiplicity of possible perspectives, reframing events in more than one way. Processing information within this framework has been shown to result in positive health-related outcomes, including increased longevity.

A study that evaluated the Mind-Op program online did find it helpful and that it addressed some of the concerns expressed in The Lancet editorial.

Online, brief, non-proprietary self-guided interventions hold great promise, given their scalability and their ability to address several of the barriers to access, most notably costs, experienced by those who need these treatments most.

Note: Although I have named an online mindfulness program concerning a specific study, this is not an endorsement, and readers should not see it that way.

Are anxiety and stress contagious? They certainly are. Can we learn to help ourselves by using techniques such as mindfulness? We sure can and we should. Health, both of the physical and mental type, is too valuable to waste.

The post Is It Stress or Anxiety That’s Contagious? appeared first on Medika Life.