Stress is turning up more and more as a contributor to health problems of all kinds, including anxiety and depression. The problem isn’t so much the worst traumas, such as the death of loved ones, divorce, or losing your job. It’s also the constant stress arising from pressures at work, the burden of debt, living in deeply troubled relationships - conditions that can stay with us for years and years.
There’s an impressive list of studies linking long-term stress to many illnesses. Neurochemicals released by stress responses can damage the production of immune system cells and contribute to autoimmune diseases, like lupus. They can contribute to heart disease, arthritis, chronic fatigue syndrome and fibromyalgia. Most important here they’re related closely to anxiety and depression.
Living with daily stress keeps the hormones circulating that are meant to protect us from immediate, temporary threats. The surge of adrenalin and cortisol, as well as dozens of neurochemical reactions, turn down some body functions and turn up those the body needs for instantaneous flight or fight responses.
Recurrent and chronic depression keeps that stress reaction going, and the continuing flow of the stress chemicals can damage many systems in the body. In particular, brain areas that help regenerate nerve cells can die off, contributing to the limitations on mental functioning that depression brings on. It’s a vicious circle in which stress and depression feed into each other. Breaking that cycle can go a long way to helping us heal.
The research on stress is creating a much more complicated picture of depression that we usually hear about. The illness isn’t caused solely by reduced levels of serotonin and a couple of other neurotransmitters. There are hundreds of neurochemical interactions related to stress, among other factors, that also influence the course of depression. That may be why today’s antidepressants often relieve only a few symptoms, leaving others that increase the risk for recurring episodes.
The medications are important and effective for many who take them, but depression seems to be related to external stresses in life as well as internal neurotransmitter deficits in the brain. So reducing those external sources of stress can also help limit the intensity of depression.
Yet changing the conditions we live with is easier said than done. Major change is not feasible for most people. You can’t just quit your job, get out of debt, take the stress out of relationships or feel secure when it’s hard to make ends meet. For a lot of people, especially in a down economy, there are no other jobs, no way to enhance income, to reduce pressures at work or to lessen the strain of caring for a chronically ill family member. You have to make the best of what you’re living with right now.
Even if you do have some flexibility in the outward conditions of your life, depression is hard at work stifling your energy, motivation and ability to cope. You may think so poorly of yourself when under the controlling influence of depressed thinking that you believe you could never get a better job. Or you may feel so overwhelmed that attempting a community college program to learn new skills for a different kind of work would be too much to handle. Depression can also put you at a disadvantage in dealing with abusive relationships. You might blame yourself rather than see what’s really going on. The connection between stress and depression also means that basic systems in your body, including your resistance to disease, are running down at the same time that you feel overwhelmed emotionally and mentally.
Despite the difficulty, however, the ongoing damage to your life makes it vital to do all you can to cut down on stress. Short of completely changing how you live, what can you do? Probably the first thing is to realize that it’s going to take a lot of time to deal with a problem that has such pervasive effects on your life.
Two of the most helpful guides I’ve found are Richard O’Connor’s Undoing Perpetual Stress and Bob Stahl and Elisha Goldstein’s The Mindfulness-Based Stress Reduction Workbook. Both identify mindfulness as the core skill, partly because of recent research demonstrating its effectiveness in reducing both stress and depression.
Mindfulness emphasizes the ability to interrupt the constant tension of living in a state of "doing," as some psychologists call it. That means being preoccupied with goals, focusing on what you now lack and evaluating yourself in relation to standards, deadlines and accomplishments. In many ways, "doing" keeps us all going and benefits everyone. But when that state of mind and feeling becomes too dominant, we lose the ability to relax, and stress becomes perpetual.
The practice of mindfulness interrupts this tension by refocusing energy and attention on the present - or the state of "being" rather than "doing." Mindfulness has been shown to induce a physical relaxation response that can shut down the release of stress hormones. It centers mind and feeling through concentration on the details of life as it is in the moment, exactly the ones that disappear when we’re preoccupied with the future and see only the limitations of the present. Through developing powers of self-observation, it helps create distance, or detachment, from stress - as well as depression. That’s an important step in relieving the sense of being overwhelmed by these powerful forces.
Meditation is the best known method for learning to refocus in this way, but, as O’Connor points out, there are several forms of therapy that help cultivate the state of being in different ways. One that has been tested in controlled studies is Mindfulness-Based Cognitive Therapy (MBCT). It combines meditation’s ability to center mind and feeling on "being" with cognitive therapy’s emphasis on changing patterns of thought. Some studies have shown that MBCT is as effective as antidepressant medication in preventing depression relapse.
Other therapies incorporating mindfulness aim for similar outcomes but use different methods. Dialectical Behavioral Therapy, for example, is a structured approach dependent on interaction with a therapist. Creative Mindfulness emphasizes the importance of the environment on well-being and relies on sharpening sensory alertness to our surroundings. Daniel Goleman’s Emotional Intelligence draws together emotion and intellect to instill awareness of the whole mind.
Mindfulness is entering the mainstream of psychotherapy, and more attention is also being paid to more traditional lifestyle changes of moderate exercise and nutritional supplements. The benefits of these changes, like those of mindfulness, are getting more and more confirmation from formal research. As a result, physicians and psychiatrists are more likely to emphasize them as part of a comprehensive approach to managing stress and depression.
All of us have our ways of relaxing, but usually they offer only temporary relief. The deep relaxation and relief from stress I’ve felt on great vacations have rarely survived a single day back at work. Long-term stress reduction takes a lot of practice to become a regular part of daily life.
What are some of the techniques you have found helpful to reduce stress? Have you found a way of adapting your life to limit the impact of stress on your health?
Sorry to say that this is my last post for now. I’m having to cut back on writing commitments in order to put more time into developing my new site, Recover Life from Depression, while also sustaining my personal blog, Storied Mind. I’m sorry to have to end the relationship here at Health Central. I couldn’t ask for more inspiring support than I’ve received from Merely Me and from all of you who have taken the time to comment. You’ve been a great help in my own recovery process.
My best to all – John