Why We Are Stressed Out And What To Do About It
A Conversation with Dr. Janice Kiecolt-Glaser, Ph.D.
Posted Apr 23, 2018
Dr. Janice Kiecolt-Glaser, Ph.D., is a professor of psychiatry and psychology at The Ohio State University and is the Director of the Institute for Behavioral Medicine Research at OSU's Wexner Medical Center where she conducts research around the health consequences of stress.
Social Brain Blog: What is the current brain health-based thinking about how best to recover from stress?
JKG: There’s evidence showing that mindfulness meditation, yoga, or similar practices can decrease responses to stress. In addition, health behaviors matter so much in terms of managing stress. When people are stressed they tend not to sleep, and being short on sleep is itself very stressful. They tend to eat more poorly, and that can exacerbate mood and make people feel worse. You know, cupcakes are really appealing when you’re stressed but you generally don’t feel better after you eat them—even though the process is fun...
Another thing we really know is that social relationships and close personal relationships are so important and so connected to our health. One meta-analysis suggested that being socially isolated was the equivalent of smoking in terms of health risk. And when we’re stressed we tend to isolate ourselves, and that’s the very time when social relationships matter most. Part of the recovery process involves talking with people, being with people you care about and who care about you, and being able to talk about what you’re feeling and what you’re going through.
SBB: Stress is now supposedly an epidemic, but it’s always been around. So what’s changed? Is there actually more stress, or are we just more aware of stress?
JKG: The basic definition of stress that I use is when you’re feeling overloaded, unable to cope, or out of control. We face an electronic barrage now: You may have 20 new emails when you’ve been away from your computer or phone for an hour or two, you wake up in the morning and messages are waiting for you, you have texts, you have so much going on that you’re supposed to respond to. And then some of the research suggests that with Facebook there’s the perception that everybody else is doing so much better than you are.
SBB: And when we’re stressed we take out our phones. So your phone becomes like a cupcake.
JKG: Exactly. And rather than talking to someone about your day you’re pulling out your phone and trying to weed through all your email.
SBB: So what we think will make us feel better, alleviate the stress, is actually digging a deeper hole.
JKG: Exactly right... One of the most important things is simply recognizing that you're stressed. We tend to be on the go all the time and we’re not mindful about how we’re feeling. Just sitting down and doing some self-reflection about what my body and mind are doing makes a big difference.
SBB: You’ve done some groundbreaking research involving couples, exploring how couples can stress and de-stress each other out. What did that research show?
JKG: The good news about good marriages is they are so de-stressing. In a good marriage, coming home to your spouse and talking to your partner about how you’re feeling can make such a difference. The flip side, of course, is that if the marriage is contentious, then what should be your major source of support has instead become your major source of stress, and you really are doubly damned because you don’t have anybody there and you can’t typically go out and find the replacement right away...
I’m a clinical psychologist by trade, and I’ve always been fascinated by how close personal relationships affect our health. So my earliest studies were with medical students where we were showing that not only did they have poorer immune function during exams compared to lower stress times, but lonelier students were faring more poorly immunologically than their less-lonely counterparts. We also showed among men and women who were caregiving for a spouse with Alzheimer’s or another dementia, those who had fewer close relationships had greater declines in immune function over time.
SBB: You’ve done a lot of research on the caregiver role. What have you learned from some of your work around caregivers and stress?
JKG: What we know from our research is that spousal caregivers become increasingly isolated over time. And it’s because of a combination of problems—not wanting to take the spouse out in public because they’re unpredictable or they’re difficult to control, not inviting people to the home because of the spouse’s behavior—and not being able to leave the impaired spouse alone because they can’t be safe when they’re by themselves. As a result, there’s a cycle of increasing isolation. The caregivers we studied talked how they didn’t want to keep telling the same stories over and over, or to keep talking about how difficult caregiving was for them. They felt like people got tired of it. So they wouldn’t talk about it…and they were often reluctant to have someone come in and help take care of the spouse, often because of financial concerns.
There’s also the stress of having someone so close to you who has become a very different person—they’ve lost so much of them. It has been called a living bereavement: there’s a body with little of the personality and intellect remaining as dementia progresses. Coping with that major stressor without support really becomes very difficult. One of the biggest issues for caregivers is making sure they don’t lose their network and maintain contact with people, but that’s something that’s often very difficult to do.
We know from our research and others that rates of clinical depression are relatively high in caregivers. While for most people who are older the best predictor of clinical depression is having been depressed before, we actually see new episodes in people that had not appeared vulnerable previously.
SBB: You noted that one issue with stress is that people don’t recognize they’re stressed. Is there an acute issue specific to caregivers where they might not realize what they’re going through and how they might be able to be helped?
JKG: As a caregiver, you’re so busy providing care that you’re often not taking care of yourself. You can’t leave the impaired spouse alone for very long once they reach a certain point because they’re a danger to themselves. You’re constantly vigilant and also have increasing levels of care you need to provide. You have to help them shower, shave, brush their teeth, and get dressed. It’s physically draining to do all that, and it’s emotionally draining because you’re losing the person at the same time. There’s not a lot of time for self-reflection in there.
SBB: What do you think is the next frontier in stress research?
JKG: The microbiome. There are really interesting data in mice where they injected feces from depressed patients into germ-free mice and could actually show an increase in depressive-like behavior. There are also some studies with mice and humans suggesting that certain probiotics or prebiotics may be helpful for anxiety. When animals are stressed they get a leaky gut, producing a more pro-inflammatory state in the body, and that inflammation can feed back to the brain and increase both stress and depression. Interrupting that cycle becomes really important.
Some of the newest work that I’ve been doing is related to metabolism, and it shows that when you’re stressed and you’re eating high-fat food you burn fewer calories. You oxidize less fat, you increase your insulin so that you're not burning fat….it shows us how stress could actually worsen obesity epidemic that we have in this country.