Stressed out

Factors of resiliency, chronic illness and economic stressors can improve negative health outcomes caused by stress.

Brian Distelberg, PhD, says stress can impact physical and mental health more than most people might realize.

Distelberg, who serves as director of research for Loma Linda University Health’s Behavioral Medicine Center, works to uncover the impact of stress and find supportive solutions for patients.

Distelberg directs the MEND program, an initiative that supports patients and their families in maintaining or regaining emotional health and balance during significant medical illness or treatment. Enrollment in the program has grown 300% in the last 18 months.

For May’s Mental Health Month, Distelberg sat down for an interview to discuss the unexpected connections between stress and physical and mental health — and what could be the solution. Edited excerpts:

Let's start with off with a seemingly basic question: what is stress?

That's a tough question because, in terms of an academic definition, there is no definition of stress. Stress is the term that we use in our everyday world, and it can mean different things to different people.

Someone might feel stressed because somebody makes a loud noise right behind them, prompting a stress response because they have been startled. It's a natural reaction and probably not what most people are concerned about when we're talking about stress.

There's also stress at the psychological level, which is called cognitive stress. This stress can come from financial difficulty, problematic relationships, work or even from just being human. 

What people are generally more interested in is the idea of “distress,” or when our bodies and minds are under a constant state of stress. This stress happens at the biological level and creates a biochemical reaction in the body that involves not only our brain but several different body processes.’

Does long-term stress have a different impact than a more acute short-term stress?

Unquestionably. The length and severity of the stress make a huge difference in how your body may react. Prolonged or heightened stress can absolutely have a more long-term effect on the body than a serious, but short-term stress. If stress is sustained for a long period of time, it’s also going to increase the chances of a physical health condition or mental health condition developing or worsening.

What body systems can be impacted by stress?

A popular area of science right now is focused on identifying how stress impacts the body as a whole. Prolonged distress is shown to have an effect on the body — whether it’s your heart rate increasing, your breathing rate quickening, or another "in the moment" reaction to a situation. If that distress continues long-term, it can exact a cost.

At a biological level, we're beginning to see that certain diseases are "stress-based" or "stress-linked" diseases. These are things like asthma, diabetes and certain pain disorders.

Are any groups more susceptible to the impact of stress?

There's an entire field of science called health disparities research that looks into health outcomes based on race, ethnicity or socioeconomic status. We wouldn't say that they're more susceptible to stress, but we are seeing that they tend to be disproportionately under more stress.

These groups show more negative health outcomes because they live in communities where environmental impactors are higher for them. There are many reasons why individuals who are lower income are having more negative health outcome consequences — stress being one.

Age can also be a factor. Recent studies show that stress is having an impact on cognitive functioning. When stress is high, it can deplete a person’s cognitive ability. This research surrounds adolescents and suggests that their age group can be more susceptible to the effects of that negative distress.

On the older spectrum, we look at the relationship between stress and dementia, and it does seem like there are some links between heightened levels of stress and a more rapid progression of dementia over time.

How can people who can't avoid stress, such as nurses, students, etc., learn to manage it?

We can't ever completely avoid stress. However, a person can combat stress by building their resiliency. Each person can tolerate a different level of stress, but without knowing where the level is, a better option is to focus on building resiliency.

Eating a healthy diet, getting enough sleep and exercising — making sure that were active at least thirty minutes out of every day — are all critical in building resilience to stress.

We also see that being in relationships with others and having social support and social interaction is critical for moderating the effects of stress on the body.

Why has the MEND program focused so much on children with chronic illnesses?

We actually developed the program with chronic health issues in mind. There are often social stressors in relation to the physical health issue.

Not all kids with chronic illness would need a program like this because the family’s resiliency in partnership with the health system is often enough to support the family through that process. However, some families have additional external stressors, such as finances, complicated treatment protocols, housing or other high-stress issues.

The program is mainly to help a family through that chronic illness in a couple of different ways. First, it helps teach the kids how to build that resiliency by helping them understand what the internal state of the body is, and how to know when the stress responses are coming, and how to cope with those internally. There are a few programs in the country that do that, but what's unique about the MEND program is that it doesn't just work with the kids, it walks through the process with their families, siblings, guardians — everyone. 

We're seeing that stress is the differentiator between kids with chronic illness who do well and those kids and families who struggle. The ones who struggle tend to be those families are under higher levels of stress. This program can help reduce that stress, and in turn, increase cognitive functioning and actually work to reverse the damage due to the stress.

To continue the conversation, watch Brian Distelberg’s Facebook Live segment, "The Unexpected Connection Between Physical Health, Mental Health and Stress."

If you, or someone you know is struggling with a mental health issue related to a chronic illness, make sure they know about the MEND program. Visit llubmc.org/mend to learn more.