Chronic Stress: The Mental Connection

WebMD Live Events Transcript

Significant stress or changes in your life can also trigger depression. Social stressors (such as the death of a loved one) and chronic stressors (such as poverty, family difficulties, or long-term illnesses) can significantly contribute to depression. On Nov. 2, 2004, we chatted about the health concerns that can result from stress with WebMD's in-house expert Patricia Farrell, PhD, author of How to Be Your Own Therapist.

The opinions expressed herein are the guests' alone and have not been reviewed by a WebMD physician. If you have questions about your health, you should consult your personal physician. This event is meant for informational purposes only.

MODERATOR:
Dr. Farrell, we all get stressed about things, but for those who live with it daily, what kinds of problems can they expect down the road?

FARRELL:
People, unfortunately, associate stress with just mental processes, but these mental processes also have a very real effect on our physical health, in several ways:

• Stress can cause problems in sleep. Generally people can have problems getting to sleep at night because they're constantly thinking or worrying about something; or perhaps they wake up frequently during the night and may even experience panic attacks; maybe they have early morning rising, so that they will not get sufficient restful sleep.
• Stress can also change your perceptions about yourself and the world you live in. You may begin to feel lower self-esteem; you may believe people do not regard you as highly as they did before; you may feel incompetent, and you may even have distressing thoughts of hurting yourself.

This last part can come from the fact that stress depletes certain body and brain chemicals that are necessary to maintain good mental health. So stress has an overriding effect on every aspect of our lives.

Unfortunately, stress does this in a very gradual, insidious manner. And you may not realize that it is building up to dangerous levels until you experience one of these symptoms.

MEMBER QUESTION:
How do I stop my brain from running like a top at night? Help!

FARRELL:
I can certainly understand your problem, because I've heard it from many people. We know, from the area of medicine called sleep medicine, that there are several things we should do before we get ready to go to sleep at night. Primarily, this has to do with something called "sleep hygiene."

You can look this up on the Internet and in fact, there is a national commission on sleep set up by the U.S. government. One thing that might be helpful for you is to understand is that you have the right to give yourself permission to rest and go to sleep. You need to do some self-talk and tell yourself that your job right now is to sleep.

And the only way you can take care of problems in your life is by first getting restful sleep. If you find this doesn't work, perhaps you might want to talk to your family physician and see if either a consult with someone or some mild sleep medications for a brief time might be appropriate.

"You have the right to give yourself permission to rest and go to sleep. You need to do some self-talk and tell yourself that your job right now is to sleep."

MODERATOR:
Are people who follow a regular sleep routine better at dealing with the stress of daytime activities?

FARRELL:
Absolutely. Sleep really is something that requires a routine. We find that people who have jobs that are very disruptive of their sleep routine actually suffer from higher rates of stress-induced illnesses than people who have a job that permits a regular sleep schedule.

In other words, jobs where the schedules often change -- like police officers, firefighters, hospital personnel, EMS, etc. -- are very disruptive in terms of stress levels and the ability to handle stress.

MEMBER QUESTION:
I don't sleep through the whole night -- any suggestions?

FARRELL:
Generally someone who is awakening many times during the night or who wakes up around 3:00 or 4:00 in the morning, may have a problem with either anxiety or depression and depending on how long this has been happening, you might want to have this checked out by your doctor.

MEMBER QUESTION:
I have a good, happy life, but my body reacts to every little thing as a major stress. How do I stop myself from overreacting to stressors?

FARRELL:
It sounds like what you're saying is that you are a person who may be a little more anxious than some other people and stressors or changes in your life are difficult for you to handle. You can do several things:

• First: learn relaxation breathing. You can find that on the Internet, on my web site, in my book, or a number of places.
• Use positive self-talk to help yourself calm down and realize this is not as stressful as it seems at first.
• Take a brief walk when something like this happens. Exercise, even mild walking, is very helpful in maintaining a more healthy perspective on things and also in evening out your mood.

MEMBER QUESTION:
My wife is what some people call "high strung." Does this mean she's more likely to become depressed or to end up with an anxiety disorder?

FARRELL:
High-strung people generally have high levels of stress, probably by virtue of their genetics and possibly their early family environment.

There's no need to believe that this can work itself into a very serious problem, because it is something that can be handled, particularly, by a cognitive psychologist who can help your wife look at things in a slightly different way, and to learn new coping skills.

Please understand, I'm not suggesting your wife has any type of mental disorder. I am saying that she could use some skill-building techniques, and that's what the psychologist would do for her.

MEMBER QUESTION:
Are there reputable stress-reduction experts that aren't necessarily psychologists?

FARRELL:
Unfortunately, there are many people working in the field who use a variety of titles for themselves, and this can lead to problems in finding someone who is adequately trained and truly has the abilities you seek.

No, and expert doesn't have to be a psychologist, but they do have to be someone with specialized training, and that could be:

• A nurse practitioner
• A social worker
• A specialized and certified or licensed counselor

I am always telling people that the expression, "Let the Buyer Beware," is just as valid here as it is when you're buying a used car.

"Relaxation breathing is something that helps many, many people. You can learn it within five minutes and you can begin to use it immediately. It does not take any great skill."

MEMBER QUESTION:
How does a person physically "calm down?"

FARRELL:
There are many techniques and there are some devices people can buy. The thing to remember is that techniques and devices are only good if you use them regularly and you give them a chance to work.

For instance, relaxation breathing is something that helps many, many people. You can learn it within five minutes and you can begin to use it immediately. It does not take any great skill. It can be used anywhere you wish.

If you're stopped at a red light in your car you can do it; if you're waiting in line at a movie you can do it; if you're sitting in a meeting listening to someone's presentation you can do it, and nobody will even know. It my just sound like you're sighing a little bit. That's one very effective method.

There are some other biofeedback methods that are very helpful. Generally, they use some type of small device that measures pulse rate or skin moisture; they generally have an audiotape. These devices, however, can cost several hundred dollars. So they are expensive and if they don't help you, that's money that you may feel you've wasted.

However, you can go to a psychologist who specializes in biofeedback and you can learn techniques that may not require any kind of equipment in your home. There are small cards that will give you an indication of the temperature of your thumb, and believe it or not, thumb temperature is an indicator of stress level because when you are stressed, your body draws blood away from the hands and feet and they become cooler.

So yes, there are methods available that will help you learn to help yourself without any kind of over-the-counter or prescription medication.

MODERATOR:
Some other "devices" out there are aromatherapy candles, noise generators (waves, birds, etc). Do these things work for a lot of people?

FARRELL:
Yes. And there is also a device that will help you wake up in the morning in a much more natural, calmer way because it is a globe that gradually begins to glow and increase in intensity, much like the sun coming up.

It is much more comfortable to wake up that way than to hear an alarm clock. Remember, the word is alarm clock. So you are immediately shocked awake by this sound. That doesn't begin your day in a very calm manner.

MEMBER QUESTION:
What are some good ways for an ADHD person to relieve stressors in their life?

FARRELL:
If you have been diagnosed with ADHD, I would imagine that you are currently working with a mental health professional. I recommend that that person be the one to know what would work best for you. But even if you do not have the money or the insurance coverage to get mental health services, that does not mean they are not available to you.

Each community, generally, has a mental health center or a clinic in the community hospital or some other type of community-based mental health services that are for little cost or no cost, and I would suggest you explore what is in your community. I do know that there are extensive self-help databases on the Internet.

As a matter of fact, I have a document posted on my self-help web site -- www.drfarrell.net -- that you can download and call whatever number is there for your state and they will refer you to some facility near you.

Pharmaceutical companies also make medications available free of charge to certain individuals, and I also have that posted on the self-help page of www.drfarrell.net. Click on self-help on the left-hand margin. There's also a stress page with lots of links and there's information on medication.

MEMBER QUESTION:
Is it true that stress and stress-related conditions are the leading cause of doctor visits? And, if so, why doesn't managed care help out more with stress issues?

FARRELL:
Unfortunately, mental health is still not seen in the right way, and that is that it's much cheaper and better for patients to receive preventive care than care after a problem occurs. I don't know why companies have not seen that there is a greater savings in prevention than in treatment. That's for them to decide. But you can still receive care.

"If your lifestyle no longer allows you outlets for recreation, for laughing, for what I call healthy nonsense, then you may be at risk for stress-related illnesses."

MEMBER QUESTION:
Please give some advice on first steps for women trying to break stress eating. I bake and eat chocolate chip cookies at home when I'm tense -- a whole batch!

FARRELL:
You have a problem, which is not unusual. I have surveyed nurses and people working in research facilities, and found that stress-related eating or binge eating is extremely common.

One thing you can do for yourself is understand that you don't have to deny yourself a cookie, but you do have to limit yourself. If you made two dozen cookies, you can have one or two. The rest must, and I underline this, must be given away immediately. This should provide you with some relief from the temptation, and may also help bring about a little bit of healthy guilt, because you are giving all of those cookies away and they are costing you money. So you make the decision. Two cookies, no cookies, or...what?

The "what" might be to wear a thick rubber band around your wrist and every time you go to eat a cookie or anything in response to stress, you snap the rubber band. It's a very common way that therapists help their patients deal with this very difficult issue.

The other thing you should understand is that chocolate is a wonderful mood elevator, and it does help with stress. So you are, in effect, self-medicating, but you're also encouraging your body to gain weight, and I'm sure that's not something you want to do. So think of the downside, and come up with interventions you could use to help yourself. I know you can do it.

MEMBER QUESTION:
Is there a change in behavior when someone goes from just being stressed to having a mental health problem such as depression?

FARRELL:
When you go from stress to depression, generally one of the first things you will notice after the irritability, the moodiness, and possibly the self-isolation, is that you will begin paying less attention to personal hygiene. You may notice you:

• You don't comb your hair as you did before
• You wear the same clothing
• You're not bathing
• Maybe you're also not eating and so you're losing weight

Those are some of the classic signs that depression is present and is probably reaching a point where you need to consider getting some help.

MEMBER QUESTION:
I have a stressful job and three kids and my mother thinks I'm at a higher risk for a "breakdown." Am I? Should I get yearly depression screenings?

FARRELL:
I can understand your mother's concern. I think, however, that you are probably a good judge of how well you're able to handle things in your own life and I don't know that an annual depression screening would be called for.

I think you need to make sure you have time for yourself, some time to have fun, some time to unwind. And then you should be OK.

MODERATOR:
Dr. Farrell, do you have any final words for us?

FARRELL:
Stress is a part of life. It's normal. It only becomes a concern when it begins to take over your life.

In other words, if your lifestyle no longer allows you outlets for recreation, for laughing, for what I call healthy nonsense, then you may be at risk for stress-related illnesses. And you can make changes that will help you get back on a more even keel. So don't assume that because you're leading a very active life right now that you will necessarily come down with a stress-related problem.

Take care of your diet, your exercise, talk to your doctor about multivitamins, make sure you get enough sleep, and put some fun in your life, because fun is as important as food.

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