Should we treat stress?
The answer to this question, as for most complex questions, is “it depends.”
For the good and tolerable stresses of daily life, the answer is clearly “no.” By definition, we handle good and tolerable stress well enough without needing to treat it. Forget about the mythical “stress-free life”: If that were even possible, it would be bad for your health.
We need the good and tolerable stresses of daily life—demanding jobs, raising a family, taking care of where you live—to stay fit. Our stress response systems need these challenges to automatically self-regulate our temperature, heart rates, blood oxygen levels, immune responses, and all the other functions that keep us alive each day.
But for toxic stress, if we can recognize it, the answer is a clear “yes, we should treat it.” By definition, toxic stress is a persistent pattern of severe demands that we perceive to exceed our coping resources.
Imagine having to care for three family members with severe chronic illnesses. Imagine being a young mother who loses her job and then her apartment, and is now sleeping with her three kids in the back seat of a car with a hole in its muffler. Toxic stress leads to symptoms, and persistent toxic stress (over six months) often leads to illnesses. In some people, years of toxic stress can lead to diabetes, heart disease, depression, obesity, or chronic pain conditions, to name just a few. The list of stress-related conditions is long.
Toxic Stress Measurement
The decision about whether to treat toxic stress begins, ideally, with measurement. Screening can start the process of recognizing toxic stress through, for example, repeated scores above 4 on the Distress Thermometer, scoring 4 or above on the Adverse Childhood Events Scale, or high scores on the Perceived Stress Scale. These and other measures can provide common thresholds for concern that lead to more thorough evaluations by clinical psychologists or other mental health clinicians of the factors that are contributing to a person’s toxic stress or to their resilience in the face of stress.
How do we treat toxic stress? Dysregulations of the stress response system that contribute to stress-related disorders can be difficult to treat, especially if they have persisted for many years. This is partly because dysregulations in one part, such as the cardiovascular system, can cause dysregulations in another, such as the immune system.
For example, what may start out as high blood pressure in the coronary arteries eventually leads to a wound or tear in the endothelial lining of the coronary artery, or multiple tears. Under prolonged stress, the immune system may overreact and set up a chronic inflammatory response that accelerates the plaque formation that is the basis for coronary heart disease. A plumbing problem has now turned into an inflammation problem. Antihypertensive drugs or coronary artery stents will only partly improve this dysregulation of blood pressure and inflammation in the arteries of the heart muscle.
Complexities of Stress Treatments
Retraining a dysregulated stress response system takes practice and time. Achieving stress fitness relies on developing physical, mental, and social fitness all at once. Treatment programs that reverse the course of coronary heart disease require a combination of four essential approaches over six to nine months of daily practice: a) stress management skills, b) a heart-healthy diet, c) a regular exercise regimen, and d) a close support group of six to 10 others working on developing similar healthy habits. The best evidence for the effectiveness of this approach has been gathered by the Ornish Undo It! Program.
The same principles guide the National Diabetes Prevention Program. Small groups of six to 10 people at high risk for developing diabetes spend most of a year meeting every week to work on ways to change how they eat, practice physical activity, manage stress, and communicate about health and illness. They train their members to practice physical, mental, and social fitness at a level that changes the course of their illness. Over half of them will avoid developing diabetes.
Lifestyle Medicine
Similar programs have proven successful in reducing or reversing depression, PTSD, chronic pain syndromes, addictions, prostate cancer, and somatic symptom disorders. Though these conditions differ in their pathologies and their target organ systems, they all require retraining the stress response system to change the course of the illness. A pill or a surgical procedure is not enough. Toxic stress responds best to a lifestyle medicine approach.
Most people with toxic stress end up with more than one chronic condition. It’s common in primary care clinics for patients over 50 to have three or more chronic conditions. The third pillar of treatment for chronic illness, in addition to medications and surgery, is the often-forgotten daily self-management regimen. This is the practice of health habits required to manage chronic conditions: self-monitoring, self-talk, diet, affirming social contacts, exercise, sleep, meditation, planned pleasurable activities, etc.
Think about this third pillar of treatment for chronic illnesses as the daily practice of retraining of our stress response systems to regain more effective self-regulation in multiple organ systems over many months. Eventually, it feels good. Changing toxic habits becomes a way of living that is its own reward. That’s why most people stick with it.
Pearl
The treatment of toxic stress relies on the science of lifestyle medicine because medications and surgery are often not enough to reverse the course of multiple stress-related conditions.
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