This is a collection of the latest evidence in neuropsychology, functional/lifestyle medicine, and clinical data to help you deal more effectively with the unprecedented burdens of stress in our modern culture.
There has been a revolution in medicine concerning how we think about the diseases that now afflict us. It involves recognizing the interactions between the body and the mind, the ways in which emotions and personality can have a tremendous impact on the functioning and health of virtually every cell in the body.
Sapolsky, Robert M.. Why Zebras Don't Get Ulcers: The Acclaimed Guide to Stress, Stress-Related Diseases, and Coping (Third Edition)
Please bookmark this page and refer to it when you need inspiration to deal with the ebbs and flows of stress in your life.
In this report, I will cover:
Step 1: Inner Work: What is your stressor? How do you deal with it?
How can we know the difference between an external stressor and an internal psychological trap?
The fascinating research behind personality, and the major traits associated with higher stress response.
How to map anxiety loops and eight examples to inspire you to build greater agency.
Step 2: Habits: Proven coping methods, their limitations, and when to use them.
7 Evidence-Based exercises proven to calm the brain in moments of stress
What limitations do exercise and meditation have on stress? When do they work, how long do their benefits last, and how much do we need?
How depression and anxiety are linked through stress.
Step 3: Clinical Data: How do we measure stress in our bodies? How do we know if what we are doing is working?
Why is blood cortisol not the best way to measure stress? What tests are better?
What validated surveys can we use to track psychological and occupational stress though?
Bonus Appendix: Outlines the science of how stress impacts Nutrition, Sleep, Exercise, Relationships, and Addiction.
In this report are 42 citations from studies published in notable scientific journals or a snippet from one of the following books. Click on the footnotes to dive deeper into any piece of information you find interesting.
The following books are the ones I used for my research. Dig into any of them for further reading.
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The Gumption Stress Report
First, here is what you need to know about the biology, neurology, and physiology of stress…
Stress happens when an external or internal trigger stimulates the Brain (hippocampus) which then releases hormones and generates a nervous Stress response.
This is very healthy in the short term, but a prolonged and chronic stress response is detrimental to almost all of our bodily functions. The modern world gears us towards a chronic stress response.
The stress hormones tell the adrenal glands to release Adrenaline and Glucocorticoids (Cortisol) among other stress hormones [Important because this can be measured, see Step 3: Clinical Data section]
The Brain also generates stress from the nerves engaging the:
Central Nervous System (to activate muscles and run or fight)
Autonomic Nervous System. This system has two parts
Sympathetic Nervous System (This is activated with the Stress Response to make us breathe faster, increase heart rate, sharpen memory, and widen pupils)
Parasympathetic NS: This is a system mainly controlled by the vagus nerve, that opposes the stress response and tells the brain to relax. [Important because this is how we can use the body and Somatic therapy to relax a stress response see Evidence-Based Habits]
In addition to the famous Fight or Flight action mode, studies have shown that under prolonged stress, humans and animals go into a “Freeze” mode where we ‘play dead’. (This is explained by the Learned Helplessness hangup below.)
Massive, prolonged stress response causes anxiety in the short term and depression-like symptoms in the long term. When we go into a stress response, dopamine rises in the beginning, but after sustained exposure, we can start experiencing the loss of pleasure associated with Depression. The medical term for that hallmark system is ‘anhedonia’.
The body sends nerve signals back to the brain and therefore we can use exercises such as breathing, proprioception, touch and eye movement effectively decrease our stress response. This is helpful if the stressor is internal. Using such methods to cope with external setbacks can backfire.
The evidence-based coping mechanisms mentioned below are effective only if they do not cause more stress to adopt them. For example, exercise is only stress-relieving if you enjoy it.
Stress has a vicious cycle vis-a-vie addictive behaviors, broken relationships, and sleep deprivation. It also impacts nutrition and exercise. (See Appendix for more)
“This is a crucial moment, so please read this slowly: With the same brain mechanisms as that unnamed cave person, we modern geniuses have gone from learning to survive to literally killing ourselves with these habits. And it’s gotten exponentially worse in the last twenty years. Obesity and smoking are among the leading preventable causes of morbidity and mortality in the world. Undeterred by modern medicine,anxiety disorders top the charts as the most predominant psychiatric conditions.” Brewer, Judson. Unwinding Anxiety: New Science Shows How to Break the Cycles of Worry and Fear to Heal Your Mind
Step 1 Inner Work: Understanding the Triggers
What is the nature of that lion your body is running from?
👉 Is it an external setback such as financial difficulties, a terrible work environment, or diseases?
👉 Or is it an internal Hangup, such as social comparison, overachieving, and compulsive worrying?
If the trigger is an external setback, then you have to fight it with discussions, advocacy, social/political activism or escape!
“...the more disastrous a stressor is, the worse it is to believe you had some control over the outcome because you are inevitably led to think about how much better things would have turned out if only you had done something more.” (Sapolsky, Why Zebras Don't Get Ulcers p404)
Example 1: Low Socioeconomic status
Poverty, political displacement, and racism constitute uncontrollable factors that cause disease and can’t be addressed by “working harder”.1
Example Anxiety Loop Trigger: Poor living conditions
Behavior: Alcoholism and smoking
Reward: Numbing the stressor
Result: Addiction and further worsening of stress
Example 2: Job loss and Unhealthy work environments
High-pressure, fast-paced jobs with low autonomy are associated with increased stress and ill health2
Job insecurity or fear of job loss can instigate disease, even after accounting for stress-related behaviors such as smoking, drinking, and eating. [17]3
According to Christina Maslach’s research, fulfillment at work depends on Control, Reward, Workload, Fairness, Community, and Values. (More on this in the data section). 4
Here is an example of how that gets us anxious: Trigger: Fear of lay-offs
Behavior: Working over the weekend
Reward: More control
Result: Exhaustion
“Neoliberalism[…]has made the world of work far less secure and consequently more stressful and health damaging,” write two British health academics, “. . . resulting in a myriad of chronic diseases including musculoskeletal pain and cardiovascular disease.”
Maté, Gabor. The Myth of Normal: Trauma, Illness, and Healing in a Toxic Culture
Example 3: Early Trauma, Epigenetic Changes and Chronic Diseases
Children cared for by mothers early on have less cortisol and active stress machinery. This is even true for rats held by students for an extended period. Early childhood abuse or neglect has a proven impact on stress system activation.5
Examples of Anxiety Loops: Trigger: Get a Diagnosis
Behavior: Feel guilty for getting the disease
Reward: Understanding brings some calm
Result: Guilt and shame keep us locked in the same behaviors
“In a five-decades-long British study that followed nearly ten thousand people from birth until the age of fifty, it was found that early-life adversity—abuse, socioeconomic disadvantage, family strife, for example—greatly increased the risk of cancer before the mid-century mark. Women who experienced two or more such adversities had a doubled risk by midlife.[3]” (Maté, Gabor. The Myth of Normal).
Trying to control environmental or systemic factors by using well-advertised stress-coping strategies backfires.
If the stressor is out of your control, blaming yourself for it will only render you more helpless in the situation.
Talk to others, observe your environment, or plan an escape from the lion hunting down your neck.
However, if it is an internal hangup -such as your personality or a psychological trap- your body may suffer from unnecessary high-stress levels due to your brain’s thought patterns.
Like a seed needing fertile soil, the old survival brain creates the conditions for anxiety to sprout in your thinking brain (chronic). This is where anxiety is born. Fear + uncertainty = anxiety.
Brewer, Judson. Unwinding Anxiety
The next time you get anxious or stressed, notice…
What is triggering you? [Trigger]
What are you doing to cope with it? [Response]
How is the coping helping you [Reward]
What also happens as a consequence of that coping? [Result]
Take some time to observe the hangups and map them out.
Here are some examples of internal hangups that can be addressed via the coping mechanisms in the habits section.
Hang up Example 1: Compulsive Worrying (to get more certainty)
Anxiety itself can trigger worry as a way to avoid negative feelings. Conversely, worry leads to more anxiety and it becomes a cyclical behavior of worrying.6 (Brewer, Unwinding Anxiety)
Example:
Trigger: Someone is late
Behavior: Text them 30 times and call four times
Reward: Increased sense of control
Result: Sustained release of stress hormones damaging the body
Hang up Example 2: Learned Helplessness (to increase predictability)
After prolonged exposure to stress, animals, and humans have shown a tendency to give in, and even ordinary tasks seem too much. We adopt a mindset of “this is just how it is going to always be.” 7 (Sapolsky, Why Zebra’s Don’t Have Ulcers)
Example:
Trigger: Work keeps piling up unpredictably
Behavior: Staying home and social isolation
Reward: Increased predictability of the environment
Result: Being stuck in an unhealthy environment
Subjected to enough uncontrollable stress, we learn to be helpless—we lack the motivation to try to live because we assume the worst; we lack the cognitive clarity to perceive when things are going fine, and we feel an aching lack of pleasure in everything.*
Sapolsky, Robert M.. Why Zebras Don't Get Ulcers
Hang up Example 3: Feelings of unworthiness (due to low social support)
Trigger: Seeing a hot person online
Behavior: Eat cake
Reward: Delicious serotonin to counter the negative feelings
Result: Gain more weight
Hangup Example 4: The Overachiever, Type A, John Henryism
Type A people who tend to Overachieve are more liable to have cardiac diseases through stress or attempting to overachieve (John Henryism8).
Example: Trigger: See insurmountable task
Behavior: Offer herculean efforts to finish the project
Reward: Pouring the frustration into extreme effort
Result: Exhaust heart and nervous system
Hangup Example 5: The Stress-prone persona (Type-C)
On the other hand: People who compulsively put others’ needs before theirs, repress healthy anger, have a problem saying No, and have an over-identification with a sense of duty or responsibility, are more prone to stress-related diseases. (Gabor Mate, When the Body Says No)
Example: Trigger: Boss says hurtful comment or acts inappropriately
Behavior: Repress anger to avoid confrontation
Reward: A sense of calm and predictability
Result: Putting oneself in the same situation over again
What purpose is this hang-up serving?
Before we dive into the habits you can do to improve coping with stress, there is one last crucial step of inner work remaining, which is to understand how the hangup is serving you.
This boosts self-compassion which is proven to increase healthy behaviors and health outcomes.
When we develop parts that look angry or “protective” on the outside they are usually trying to get us one of the following proven things:
1- Control
2- Predictability (fear + uncertainty = anxiety)
3- Social support (the lower the social capital, the more the anxiety)
4- Outlets of Frustration
Which one of these rewards do you notice recurring the most when you map your anxiety loops?
These are your current unmet needs driving these anxious parts of you to act.
“Emotional competence requires: • the capacity to feel our emotions, so that we are aware when we are experiencing stress; • the ability to express our emotions effectively and thereby to assert our needs and to maintain the integrity of our emotional boundaries; • the facility to distinguish between psychological reactions that are pertinent to the present situation and those that represent residue from the past. What we want and demand from the world needs to conform to our present needs, not to unconscious, unsatisfied needs from childhood.”
In summary, we have to understand whether the stressor is a setback or a hangup and deal with it accordingly by either setting new boundaries (setbacks), or healing old emotional wounds via therapy and coaching (hang ups).
Now we can dive into lifestyle changes and proven habits that work.
STEP 2: Behaviors and Habits - Evidence-based habits proven to regulate our stress response.
The research is clear that reducing stress is possible in various forms and methods. Selecting the one that works for your life’s context is crucial.
We are not short on evidence for well-proven ways to reduce stress where it does not need to be activated.
1- Sustained, Low-intensity, aerobic exercise (one that does not make you go out of breath) for 30 minutes a time, several times a week. It has to be enjoyable for you.
Slow sustained exercise that you enjoy is best for stress reduction. Yes enjoying it is a most important qualifier!
Low-intensity, sustained (aka Zone 2 exercise) is the most effective. This is the type of exercise that you can do while still having a conversation or being on a call.
Higher-intensity exercise increases stress, but it offers other benefits for heart health and metabolism. Your HIIT workout or hot Yoga makes you feel better but does not reduce stress like lower-intensity movement.
Exercise only reduces stress hormones within 24 hours of activity. You need to do about twenty or thirty minutes at a time, a few times a week, of sustained aerobic movement to get the stress reduction benefits of exercise
Neck pain and back pain are strongly confirmed to correlate with stress. The more neck pain we have the more stressed we feel. (Ortego et al. 201610)
Stretching helps the body to feel safe and can act as a reset button11. The muscles have a sweet spot for flexibility and how it impacts anxiety. Too much or too little flexibility can trigger the stress response.
Overall guidelines are to stretch at about 50% of the intensity and for 30 seconds each stretch 12. More than that can cause more damage than good.
Sitting can activate the stress response by contracting the Psoas muscle when we run away and to take extra-deep breaths that keep us running. This theory explains how sitting may be causing a lot of our stress13.
Important muscles to stretch for stress:
Scalene (in the neck), Sternocleidomastoid (SCM) muscle, Trapezius, and the Psoas. They are all directly related to the stress response14.
Meditation decreases stress hormones while one is meditating, but it is less clear if all the health outcomes persist long afterward. (Sapolsky, 2004)15
Mindfulness-Based Stress Reduction designed by Jon Kabat-Zinn has been proven to decrease the stress response in eight weeks 16. Try a 10 min MBSR meditation here
Self Compassion six-week programs developed by Dr. Kristen Neff, have been shown to improve overall wellbeing and a decreased stress response.17Learn more here.
5- Breathing with the exhale being longer than the inhale
The same neurons that control breathing, also control the panic area of the brain. (Yackle et al. 2017).
Abdominal breathing let’s the body relax, while upper chest breathing upper chest breathing is associated with a high stress response.
When the exhale > inhale, our bodies relax. When the inhale > exhale our bodies go into arousal. Try this relaxing sequence out the next time your are stressed.
6- Vision and Eye movement Exercises can relax the stress response system
Our visual system is one of the strongest ways we can shift our stress response. Our retinas (back part of the eyes) are part of the Central Nervous System.
EMDR and moving the eye from side to side can calm the brain. (Baek et al. 2019)
In addition, eye movement releases tension in the neck, with the aforementioned benefits of that stress. (see above)
Expanding our visual field to the panoramic view, and dilating the pupils can relax the stress response system. This can be done by relaxing your eyes, blurring the object in front of you, and focusing more on expanding the environment around you. Believe it or not, this is proven to relax the stress response.
Learn more about Rapid Eye Technology (RET) and Eye movement desensitization and reprocessing (EMDR) therapy if this sounds interesting.
7- Being with Uncomfortable Feelings when triggered by others (versus avoiding them) helps improve our stress response in challenging relationships (this extends to race, gender, and other social justice issues)
Leaving an intense situation to ‘gather your senses’ and settle into your body is a great way to improve relationships long term. However avoiding the relationship discomfort altogether can worsen stress.
Diversity training does not address the idea that things like racism, gender imbalance, and white supremacy live in our bodies, not just our minds. 18
Being more aware of bodily sensations (for example feeling your toes on the warm sand), touching your belly or chest, or connecting with nature in a way that brings joy all drive resilience and improved stress response.
High-frequency friendships can help regulate our stress response, and decrease the impact of cortisol.
Are you ready to deep dive into some of these old patterns weighing you down?
STEP 3 - How to Measure Stress: Subjective and Objective Measures
I hope that by now you realize that stress is a well-studied multidimensional phenomenon that is as physical as it is psychological.
Therefore, measuring stress accurately needs to take both objective physical biomarkers and validated subjective surveys.
I - Subjective measures of work burnout and psychological distress are critical data points
1- Self-Compassion Score: A 2024 study of undergraduates taking their final exams, showed that stress measured by a survey based on Dr. Kristen Neff’s Self-compassion Scores correlated with the level of stress hormone levels in their urine. (2024).
2- Occupational Stress: The Areas of work-life balance survey by Christina Maslach is an accurate predictor of burnout and occupational health. Click on the footnote to learn more about measuring subjective stress in the workplace. 19
II -Labs, Wearables, and Objective measures of stress
We can easily measure our biological Cortisol Awakening Response (CAR) levels to assess how stressed our bodies are.20
You may want to save your money on the new shiny wearable that claims to releive stress. Wearables claiming to improve stress by Heart Variability work in theory, but their studies are done in academic setting, with limited populations, and have not show to be conclusive in improving stress alone.21
Acute Stress: There is an endless list of ways to measure a momentary stress response all over the body.
Pulse and Blood Pressure: The OG duo measure the impact of acute stress in the blood vessels. These can be measured with the hand or an regular blood pressure device.
Heart Rate Variability via wearables: High variability means better functioning of the Vagus “Rest and Digest System”, while low variability is associated with more stress and increased risk of stress-related health problems.
From the heart electric activity: Electrocardiogram (ECG)
From the muscles: Electromyographic activity
From the skin: Electrodermal activity (EDA) - one of the most accurate measures on this list.
From the saliva: Cortisol or alpha-amylase (a metabolite of Cortisol). Saliva tests are not as dependable as urine.
From the blood: Cortisol (Most popular, but most useless since it is a single point in time, and lacks the full picture)
From sleep: As discussed below, stress and sleep are intertwined through cortisol, and sleep analysis via sleep study or wearable can show signs of stress.
However, other tests do a better job of capturing Short/Medium-term stress which is more meaningful since Cortisol activation happens over time and changes throughout the day.
✅ Urinary Cortisol ✅ (DUTCH test). I recommend this test for both its convenience and its longer accuracy.
You can do it at home and measure cortisol multiple times a day so it shows a meaningful picture of what state your body’s stress response is in. For example, the blue curve here shows a normal cortisol graph, versus the orange where the body sustains a stress response until sleep time.
The Urine test also measures Cortisone and other adrenal metabolites of cortisol which are important for understanding the bigger picture of adrenal function. Learn more about this from Peter Attia’s summary here.22
Urine epinephrine and norepinephrine
These “Catecholamines” are good indicators of sympathetic system activation in the short-term. They can be measured using 24-hour urine samples.
Lastly, these tests detect the long-term chronic impact of stress on the immune system and promising results from studies measuring long-term cortisol levels!
Interleukin (IL)-6: Measures inflammation from chronic stress but is not specific to stress. Can be altered if you exercise 24 hours before the test.
C-reactive protein (CRP): Does not need to be measured several times a day, and is a good measure of chronic inflammation. Not specific for stress.
Herpes virus antibodies (including Epstein Barr virus, herpes simplex virus type 1, and cytomegalovirus): Show that the immune system has been hyperactive with white blood cells, possibly triggered by the prolonged exposure to stress.
Hair cortisol: 1 cm of hair has been shown to store cortisol for a month’s duration. So hair could be a good cumulative measure of stress23, just like HbA1c for sugar (more on that in the Gumption nutrition report).
APPENDIX: HOW IS STRESS RELATED TO OTHER FUNCTIONAL MEDICINE AREAS?
Exercise
Exercise helps us cope with stress via energy expenditure24, hormonal balance25, and acting like a stress coach26. It also reduces various metabolic and cardiac diseases that stress increases the risk of.
Exercise can also cause stress27 through injury, overdoing it, or thoughts of guilt around not doing enough exercise.
Exercise has tremendous benefits on stress relief as long as we enjoy the exercises that we do. The evidence is clear that we generally require 20-30 min of aerobic exercise (where we don’t go out of breath) to relieve stress a few hours to a day afterward. We need sustained exercise over some time to get the benefits.28
Abdominal muscles and posture have a huge role in stress.
When we understand how exercise helps us with our work, we are likely to have improved health outcomes from exercise and be more consistent.29 (Crum and Langer 2007)
Sleep
Stress impairs sleep, and sleep deprivation increases stress. Increased cortisol removes adenosine and deprives us of sleep, leading to more stress. This decreases melatonin, leading to lethargy, and low motivation. 30
Anticipating waking up unpredictably at an abnormal time (such as in shift work) increases the level of stress hormones in the body.31
Stress dysregulates melatonin, which disrupts sleep, and decreases your energy to get moving while stimulating your appetite for salty or sugary snacks. And here we are—caught in another vicious cycle.
Nutrition
If a diet creates stress, it may be more harmful to the body than eating unhealthy food. 32(Godoy 2020)
Diets have been repeatedly shown to cause weight in the long run. (Tribole and Resch 2020) This is likely due to the stress of comparing oneself to standards and going on diets that one does not enjoy. Stress can diminish the benefits of healthy foods.(Kiecolt-Glaser et al. 2014)33
The gut is often called the “second brain”. Stress and the microbiome are bidirectional: Stress can cause digestive and absorption systems, and gut inflammation can drive a stress response by the brain. 34
Stress and cortisol lead to weight gain and insulin resistance in many ways as the body attempts to store fat, and we crave more sugary foods. (Tribole and Resch 2020) 35
Addiction
Variable rewards (think social media) and immediate availability (think Amazon Prime) are key drivers of dopamine-driven compulsive behaviors. This is very new to us humans. This rate of instant variable gratification and our stress response to that have both exploded over the past twenty years (Brewer).36
People who are “High Reactors” to stress are more likely to take on addictive behaviors. When stress is coupled with drug consumption, they both boost dopamine in the short term and deplete it later, amplifying each other’s effect. (Sapolsky) 37
Vicious cycle: Stress can create the conditions for both addiction and relapse. Addictive substances relieve stress in the short term but induce more stress when the dopamine effects wear off. 38
Returning to the same settings or stressful environments where compulsive behaviors were used to cope may be sufficient for relapse into addiction.39 (Think of someone who goes on a retreat and quits smoking cold turkey, only to relapse a few weeks after they return to work.)
The tendency to fall into the loop of stress and addiction is heavily related to early trauma, early relationships, childhood conditions, and personality. This requires deep work to untangle emotions at their root, rather than dealing with the symptoms of anxiety and addiction. 40
Addictions represent, in their onset, the defenses of an organism against suffering it does not know how to endure. In other words, we are looking at a natural response to unnatural circumstances, an attempt to soothe the pain of injuries incurred in childhood and stresses sustained in adulthood.
Maté, Gabor. The Myth of Normal: Trauma, Illness, and Healing in a Toxic Culture (p. 216). Penguin Publishing Group. Kindle Edition.
Relationships
The “Rest and Digest” part of our autonomic nervous system is supplied by the Vagus nerve which is linked to the nerves of the face that help us communicate with one another. 41
High frequency friendships help us counter adversity, and help us improve our longevity even more than losing fat and quitting smoking.42
We have evolved to feel social rejection and physical pain in the same brain region. We experience heartbreak and pull muscles in the same way.
When we get triggered, protective parts of us or “reflexive constrictions” are old patterns that block our ability to connect with others in new or stressful environments.43 Research shows that identifying and being with the uncomfortable feeling helps disarm these reflexes. (Menakem) 44
“Disconnections can hurt in the same way a cut stings or a pulled muscle aches.” Donnelly, Chantal. Settled
“True belonging doesn’t require you to change who you are; it requires you to be who you are” (Brown 2021, 158)
Thanks for reading the report! I hope you have found what you need in it.
See you next Sunday and don’t forget to bookmark this page and come back to it for more later!
Let me know when you get out of it in the comments.
“…in the Whitehall studies, smoking, cholesterol levels, blood pressure, and level of exercise explain away only about a third of the [Socioeconomuc Status] gradient. For the same risk factors and same lack of protective factors, throw in poverty and you’re more likely to get sick”.
Sapolsky, Robert M.. Why Zebras Don't Get Ulcers (p. 372)
William T. Gallo et al., “Involuntary Job Loss as a Risk Factor for Subsequent Myocardial Infarction and Stroke: Findings from the Health and Retirement Survey,” American Journal of Industrial Medicine 45, no. 5 (May 2004): 408–16; and W. T. Gallo et al., “The Impact of Late Career Job Loss on Myocardial Infarction and Stroke: A 10 Year Follow Up Using the Health and Retirement Survey,” Journal of Occupational and Environmental Medicine 63, no. 10 (October 2006): 683–87.
https://pubmed.ncbi.nlm.nih.gov/10621016/ Leiter MP, Maslach C. Six areas of worklife: a model of the organizational context of burnout. J Health Hum Serv Adm. 1999 Spring;21(4):472-89. PMID: 10621016.
Moshe Szyf et al., “Maternal Programming of Steroid Receptor Expression and Phenotype Through DNA Methylation in the Rat,” Frontiers in Neuroendocrinology 26, nos. 3–4 (October–December 2005): 139–62.
There’s plenty of research showing that anxiety gets perpetuated as a negatively reinforced habit loop. Over the past several decades, T. D. Borkovec, a researcher at Pennsylvania State University, wrote a number of scientific papers showing that anxiety can trigger worry. Back in 1983, Borkovec and his colleagues described worry as “a chain of thoughts and images, negatively affect-laden, and relatively uncontrollable,” representing an attempt to engage in mental problem-solving on an issue with an uncertain outcome. When worry gets triggered by a negative emotion (e.g., fear), it can also become reinforced as a way to avoid the unpleasantness of that emotion: Trigger: Negative emotion (or thought) Behavior: Worry Result: Avoidance/distraction In the dictionary, worry is defined as both a noun (“I am free of worry”) and as a verb (e.g., “I worry about my children”). Functionally, the act of worrying is a mental behavior that results in a feeling of anxiety (nervousness or unease). On top of this, the feeling of anxiety can trigger the behavior of worrying, which becomes cyclical:
Brewer, Judson. Unwinding Anxiety: New Science Shows How to Break the Cycles of Worry and Fear to Heal Your Mind (pp. 39-40). Penguin Publishing Group. Kindle Edition.
This phenomenon, called learned helplessness, is quite generalized; the animal has trouble coping with all sorts of varied tasks after its exposure to uncontrollable stressors. Such helplessness extends to tasks having to do with its ordinary life, like competing with another animal for food, or avoiding social aggression. One might wonder whether the helplessness is induced by the physical stress of receiving the shocks or, instead, the psychological stressor of having no control over or capacity to predict the shocks. It is the latter. The clearest way to demonstrate this is to “yoke” pairs of rats—one gets shocked under conditions marked by predictability and a certain degree of control, the other rat gets the identical pattern of shocks, but without the control or predictability. Only the latter rat becomes helpless.
Sapolsky, Robert M.. Why Zebras Don't Get Ulcers: The Acclaimed Guide to Stress, Stress-Related Diseases, and Coping (Third Edition) (p. 301). Henry Holt and Co.. Kindle Edition.
“According to our model,” writes Seligman, “depression is not generalized pessimism, but pessimism specific to the effects of one’s own skilled actions.”
Sapolsky, Robert M.. Why Zebras Don't Get Ulcers: The Acclaimed Guide to Stress, Stress-Related Diseases, and Coping (Third Edition) (pp. 304-305). Henry Holt and Co.. Kindle Edition.
According to legend, John Henry's prowess as a steel driver was measured in a race against a steam-powered rock drill, a race that he won only to die in victory with a hammer in hand as his heart gave out from stress. (Wikipedia)
”John Henryism in a world of people born into poverty, of limited educational or occupational opportunities, of prejudice and racism, it can be a disaster to be a John Henry, to decide that those insurmountable odds could have been surmounted, if only, if only, you worked even harder—John Henryism is associated with a marked risk of hypertension and cardiovascular disease.”
There’s a surprising connection between the brain’s role in abdominal activation and the adrenals, which produce the stress hormone, cortisol (Drum, Levinthal, and Strick 2016)
Research confirms there is a strong correlation between psychological stress and neck pain (Ortego et al. 2016). It’s like the feedback loop that Nestor described: We chest breathe when we’re stressed, and our chest breathing causes stress.
Donnelly, Chantal. Settled: How to Find Calm in a Stress-Inducing World (p. 124). New Degree Press. Kindle Edition.
Stretching communicates safety to the immune system, waving the white flag and calling off the battle instigated by inflammation. Stretching, as Williams explains, “could act as a reset button that stops a bad day from turning into a runaway stress response” (2021, 154).
Donnelly, Chantal. Settled: How to Find Calm in a Stress-Inducing World (p. 145). New Degree Press. Kindle Edition.
the psoas is the muscle connecting the stress response to the physical act of running away and the extra-deep breaths that are needed to keep it up. And, since the psoas is shortened by too much sitting, the theory goes, it’s hardly surprising that we are all so stressed: we are constantly in a state of half-formed fight-or-flight. (Williams 2021, 141)
Donnelly, Chantal. Settled: How to Find Calm in a Stress-Inducing World (pp. 152-153). New Degree Press. Kindle Edition.
Oxygen monitoring revealed they also hyperventilated more than their non-stressed counterparts. This change in breathing was attributed to the exaggerated trapezius muscle activation (Schleifer et al. 2008).
Donnelly, Chantal. Settled: How to Find Calm in a Stress-Inducing World (p. 156). New Degree Press. Kindle Edition.
meditation seems to be pretty good for your health, decreasing glucocorticoid levels, sympathetic tone, and all the bad stuff that too much of either can cause. Now the caveats: First, the studies are clear in showing physiological benefits while someone is meditating. It’s less clear that those good effects (for example, lowering blood pressure) persist for long afterward. Next, when the good effects of meditation do persist, there may be a subject bias going. Suppose you want to study the effects of meditation on blood pressure. What do you do? You randomly assign some people to the control group, making sure they never meditate, and some to the group that now meditate an hour a day. But in most studies, there isn’t random assignment. In other words, you study blood pressure in people who have already chosen to be regular meditators, and compare them to non-meditators. It’s not random who chooses to meditate—maybe the physiological traits were there before they started meditating. Maybe those traits even had something to do with their choosing to meditate. Some good studies have avoided this confound, but most have not. Finally, there are lots of different types of meditation. Don’t trust anyone who says that their special brand has been proven scientifically to be better for your health than the other flavors. Watch your wallet.
Sapolsky, Robert M.. Why Zebras Don't Get Ulcers: The Acclaimed Guide to Stress, Stress-Related Diseases, and Coping (Third Edition) (pp. 402-403). Henry Holt and Co.. Kindle Edition.
Eriksson, T., Germundsjö, L., Åström, E., & Rönnlund, M. (2018). Mindful self-compassion training reduces stress and burnout symptoms among practicing psychologists: A randomized controlled trial of a brief web-based intervention. Frontiers in psychology, 9, 2340. PDF
Sarah S. Brom, Gabriele Buruck, Irén Horváth, Peter Richter, Michael P. Leiter, Areas of worklife as predictors of occupational health – A validation study in two German samples, Burnout Research, https://doi.org/10.1016/j.burn.2015.05.001. The Areas of work-life balance survey by Christina Maslach is an accurate predictor of burnout and occupational health.
This includes:
Community (How much do you like the people you work with?
Workload (How much work is on your plate?)
Reward (How much are you getting paid for said workload?)
Values (How aligned do you feel with company goals and culture?)
Fairness (How much do you feel like hard work gets rewarded vs nepotism
Control (The OG stressor - How much autonomy do you have on your life?)
Keep tabs on these six critical areas. Score yourself from 1-10 on each every month to see how work-related stress is impacting you.
If it is low in only one area then think of how you can advocate for yourself to improve it. If it is low in most and stays that way, consider switching your environment!
Dorsey A, Scherer E, Eckhoff R, et al. Measurement of Human Stress: A Multidimensional Approach [Internet]. Research Triangle Park (NC): RTI Press; 2022 Jun. Available here.
Pragst F, Balikova MA. State-of-the-art in hair analysis for detection of drug and alcohol abuse. Clin Chim Acta 2006;370(1-2):17–49. 10.1016/j.cca.2006.02.019
Exercise is good for you because it absorbs part of your daily energy quota so you don’t have enough juice left for stressing. As Pontzer observes, “We have evolved to require daily exercise” (2021, 148).
Donnelly, Chantal. Settled: How to Find Calm in a Stress-Inducing World (p. 135). New Degree Press. Kindle Edition.
This is because exercise affects the amygdala, the brain’s fear center. Exercise lowers the amygdala’s reactivity, modulating hormones released in the body (Kozlowska et al. 2015). Exercise also stimulates the release of feel-good hormones, including dopamine, adrenaline, endorphins, and endocannabinoids. This beautiful chemical soup helps stabilize our nervous system and improve resilience. Over time, exercise decreases cortisol and increases
Donnelly, Chantal. Settled: How to Find Calm in a Stress-Inducing World (p. 135). New Degree Press. Kindle Edition.
Exercise is a stressor. “Exercise, by definition, is the application of stress to our bodies,” explains Dr. David A. Sinclair (Sinclair and LaPlante 2019, 103). You are physically stressing your body when you exercise, and your brain can’t tell the difference between push-ups and a lion chasing you. To the brain, it’s a job for the same hormones.
Donnelly, Chantal. Settled: How to Find Calm in a Stress-Inducing World (p. 136). New Degree Press. Kindle Edition.
However when we are stressed we don’t have the sternght to go exercise
or-flight or freeze), the motivation to exercise seems out of reach. If you feel like you’re being chased by a lion, you’re too busy running away, defending yourself, or hiding to make exercise a priority. Focusing on exercise when your alarm system is in overdrive feels unrealistic. You’re in survival mode, not fit-into-your-jeans mode. Unfortunately, this is when we need exercise the most—when it seems unfeasible, unimportant, and unsafe. But in this state, adding exercise to your “shoulds” can be yet another stressor in itself and a source of what I call “self-care guilt.” You start feeling like there must be something wrong with you since you can’t commit to taking care of yourself.
Donnelly, Chantal. Settled: How to Find Calm in a Stress-Inducing World (pp. 138-139). New Degree Press. Kindle Edition.
Exercise enhances mood and blunts the stress-response only for a few hours to a day after the exercise session. Exercise is stress reducing so long as it is something you actually want to do. Let rats voluntarily run in a running wheel and their health improves in all sorts of ways. Force them to, even while playing great dance music, and their health worsens. The studies are quite clear that aerobic exercise is better than anaerobic exercise for health (aerobic exercise is the sustained type that, while you’re doing it, doesn’t leave you so out of breath that you can’t talk). Exercise needs to occur on a regular basis and for a sustained period. While whole careers are consumed figuring out exactly what schedule of aerobic exercise works best (how often, for how long), it’s pretty clear that you need to exercise a minimum of twenty or thirty minutes at a time, a few times a week, to really get the health benefits. Don’t overdo it. Remember the lessons of chapter 7—too much can be at least as bad as too little.
Sapolsky, Robert M.. Why Zebras Don't Get Ulcers: The Acclaimed Guide to Stress, Stress-Related Diseases, and Coping (Third Edition) (pp. 401-402). Henry Holt and Co.. Kindle Edition.
In one of my favorite research studies, Dr. Alia Crum, who we met in Chapter 4, and Dr. Ellen Langer looked at the effect of mindset on the physical fitness of hotel cleaning staffs. They gave the maids at seven hotels information on the benefits of exercise. At four of the hotels, they also informed them their housekeeping work satisfied government recommendations for staying active and told them how many calories they were burning during their most frequent tasks: changing bed linens, vacuuming, etc. The workers in these hotels became the “informed” group. Subjects at the other three hotels were the “control” group. They received the same written description of the benefits of exercise, but they did not get information connecting those benefits to their physically demanding jobs. After one month, the control group showed no health changes. The informed group, however, had lowered their blood pressure, lost an average of two pounds, and improved their body-fat percentages. Since there were no other changes in the subjects’ exercise or nutrition, researchers attributed these results to a shift in mindset (Crum and Langer 2007). This study points to the importance of our perception about daily exercise.
But stress not only can decrease the total amount of sleep but can compromise the quality of whatever sleep you do manage. For example, when CRH infusion decreases the total amount of sleep, it’s predominantly due to a decrease in slow wave sleep, exactly the type of sleep you need for energy restoration. Instead, your sleep is dominated by more shallow sleep stages, meaning you wake up more easily—fragmented sleep. Moreover, when you do manage to get some slow wave sleep, you don’t even get the normal benefits from it. When slow wave sleep is ideal, really restoring those energy stores, there’s a characteristic pattern in what is called the delta power range that can be detected on an EEG (electroencephalogram) recording. When people are stressed presleep, or are infused with glucocorticoids during sleep, you get less of that helpful sleep pattern during slow wave sleep.
Sapolsky, Robert M.. Why Zebras Don't Get Ulcers: The Acclaimed Guide to Stress, Stress-Related Diseases, and Coping (Third Edition) (p. 236). Henry Holt and Co.. Kindle Edition.
But the second group of volunteers went to sleep at the same time but were told that they would be woken up at six in the morning. And what happened with them? At five in the morning, their stress hormone levels began to rise. This is important. Did their stress hormone levels rise three hours earlier than the other group because they needed three hours less sleep? Obviously not. The rise wasn’t about them feeling rejuvenated. It was about the stressfulness of anticipating being woken up earlier than desirable. Their brains were feeling that anticipatory stress while sleeping, demonstrating that a sleeping brain is still a working brain.
Sapolsky, Robert M.. Why Zebras Don't Get Ulcers: The Acclaimed Guide to Stress, Stress-Related Diseases, and Coping (Third Edition) (p. 238). Henry Holt and Co.. Kindle Edition.
One of the things we as a community need to talk more about is [that] all this effort that goes into trying to change our shapes exacts a toll on our emotions that may be riskier than the health consequences of obesity. (Godoy 2020) Donnelly, Chantal. Settled: How to Find Calm in a Stress-Inducing World (p. 124). New Degree Press. Kindle Edition.
“Healthy” weight loss programs are not healthy if they put us in distress—the figurative weight of dieting can alter our ability to process nutrients properly. In one study demonstrating this, women were given either a breakfast consisting of healthy monounsaturated fats or a calorically identical breakfast consisting of unhealthy saturated fats. The results showed women with moderate-to-high stress had increased inflammation, regardless of the type of breakfast they ate. The positive effects of healthy fats were diminished by stress (Kiecolt-Glaser et al. 2014). studies show diets actually increase weight in the long run (Tribole and Resch 2020).
The walls of the intestines contain a nervous system so important and complex that the gut is often called the “second brain.” This brain in your bowels communicates with the brain in your skull through the “gut-brain axis,” a pathway connecting your immune system, hormonal system, autonomic nervous system, and about 100 trillion microorganisms. I told you it was complex! The communication between brain and gut goes both ways: Just as stress can cause digestive problems, gut inflammation can kick off a stress response. What causes this kind of inflammation varies from person to person. Depending on your microbiome and personal tolerances, your gut may react to dairy, alcohol, sugar, gluten, or processed foods, just to name the biggies.
Donnelly, Chantal. Settled: How to Find Calm in a Stress-Inducing World (p. 159). New Degree Press. Kindle Edition.
However, studies show diets actually increase weight in the long run (Tribole and Resch 2020). This is partially because diets often cause stress—and stress often causes weight gain.
Donnelly, Chantal. Settled: How to Find Calm in a Stress-Inducing World (pp. 160-161). New Degree Press. Kindle Edition.
First, the most crave-ogenic (that is to say, meant to make you crave) type of reinforcement learning is called intermittent reinforcement. When an animal is given a reward that isn’t on a regular schedule or one that seems random (intermittent), the dopamine neurons in the brain perk up more than usual. Think of a time when someone surprised you with a gift or party. I bet you can remember it, right? That’s because unexpected
The second everyday addiction maximizer in the modern world is immediate availability. Buying those shoes back in the 1800s was a lot of work, and that was a good thing. If I had a hankering for new shoes to celebrate the end of the Civil War, I couldn’t just impulsively order them, knowing that they’d show up at my barn the next day. And because the process was arduous and time-consuming and slow and, crucially, not immediate,
Brewer, Judson. Unwinding Anxiety: New Science Shows How to Break the Cycles of Worry and Fear to Heal Your Mind (p. 35). Penguin Publishing Group. Kindle Edition.
Who are the individuals who are more prone toward putting on fat around their gut, becoming apples, the less healthy version of fat deposition? We saw that they are likely to be people with more of a tendency to secrete glucocorticoids in response to stressors, and to have a slower recovery from such a stress-response. Same thing here. Which rats are most likely to self-administer when given a chance and, once self-administering, to do so to the point of escalating addiction? The ones who are “high reactors,” who are most behaviorally disrupted by being placed in a novel environment, who are more reactive to stress. They secrete glucocorticoids longer than the other rats in response to a stressor, causing them to pour out more dopamine when they are first exposed to the drug. So if you’re the kind of rat who is particularly thrown out of kilter by stress, you’re atypically likely to try something that temporarily promises to make things right.
Sapolsky, Robert M.. Why Zebras Don't Get Ulcers: The Acclaimed Guide to Stress, Stress-Related Diseases, and Coping (Third Edition) (pp. 349-350). Henry Holt and Co.. Kindle Edition.
Experience severe and prolonged glucocorticoid exposure, and we’ve returned to chapter 14—dopamine depletion, dysphoria, and depression. But with moderate and transient glucocorticoid elevation you release dopamine. And transient activation of the amygdala releases dopamine as well. Couple the glucocorticoid rise with the accompanying activation of the sympathetic nervous system, and you’re also enhancing glucose and oxygen delivery to the brain. You feel focused, alert, alive, motivated, anticipatory. You feel great. We have a name for such transient stress. We call it “stimulation.”*
“This is the phenomenon of context-dependent relapse—the itch is stronger in some places than others, specifically in places that you associate with prior drug use. You can show the identical phenomenon in a lab rat. Get them addicted to some substance, where they are willing to lever-press like mad to get infused with the stuff. Stick them in a novel cage with a lever and you may get some lever pressing out of them. But put them back in the cage that they associate with the drug exposure, and they lever-press like mad. And, as with humans, the potential for relapse doesn’t necessarily decrease over time.”
Sapolsky, Robert M.. Why Zebras Don't Get Ulcers: The Acclaimed Guide to Stress, Stress-Related Diseases, and Coping (Third Edition) (p. 346). Henry Holt and Co.. Kindle Edition.
“significantly more widespread symptoms of depression and anxiety,” as well as, ominously, lower cortisol levels.[11] The latter is a marker of long-term stress: a sign that people’s healthy, protective stress-response mechanism was burning out. It often augurs future disease.[*] “One can suspect that the social crisis in Greece is beginning to have biological effects on the residents of the country,” the study warned. Similarly, in Canada it was found that when women are under economic pressure, their children’s stress-hormone levels rise markedly by age six, elevating the risk of illness later in life.[12]
Maté, Gabor. The Myth of Normal: Trauma, Illness, and Healing in a Toxic Culture (p. 280). Penguin Publishing Group. Kindle Edition.
The vagus nerve and the communication-oriented cranial nerves (recall, if you will, “Vagus and The Quartet”) combine to form our social engagement system. Our vocal tones, facial expressions, head gestures, eye contact—these are all vehicles into the nervous system’s calming mechanism. These face-to-face connections provide portals to that feel-good, sustainable stillness.
Donnelly, Chantal. Settled: How to Find Calm in a Stress-Inducing World (pp. 186-187). New Degree Press. Kindle Edition.
with others—even strangers—and maintaining an abundance of close relationships does more to increase longevity than keeping trim, getting flu shots, or quitting smoking (Pinker 2017).
Donnelly, Chantal. Settled: How to Find Calm in a Stress-Inducing World (p. 187). New Degree Press. Kindle Edition.
When we’re unable to repair a fractured social connection, our nervous system moves into what author and clinician Deb Dana calls “patterns of protection” (Dana 2020). These are our default responses and dominant tendencies anytime we fear rejection or hurt. Strained relationships are stressful, and stress makes relationships strained—a vicious cycle, and the cause of those patterns of protection.
Donnelly, Chantal. Settled: How to Find Calm in a Stress-Inducing World (pp. 193-194). New Degree Press. Kindle Edition.
He emphasizes being aware of physical responses without trying to change them or run from them: “When you get the impulse to analyze or think about the discomfort, bring yourself back to the sensation of discomfort itself” (2017, 165–170). Menakem predicts that understanding and processing the “reflexive constrictions” in this way will help move the needle on collective healing.
Donnelly, Chantal. Settled: How to Find Calm in a Stress-Inducing World (p. 197). New Degree Press. Kindle Edition.
