Sociology Essay 221

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CHAPTER 5. PATHS TO HEALING: STRATEGIES FOR OVERCOMING LIFE’S STRESSORS

It’s impossible to turn on the television or pick up a magazine without seeing some new tips to battle stress. The past two decades have seen an explosion of popular books, magazine articles, and websites focused on reducing stress, but which tips work? And do particular strategies work better for some people than others? In this chapter, I briefly highlight those interventions, practices, or programs that have been identified as being effective for battling stress and its related health woes. Yet I also show that individual efforts to reduce stress (or to stay healthy in the face of stress) are only one part of the solution. Certainly, steps such as improving one’s diet, talking to a therapist, doing deep-breathing exercises, changing potentially self-destructive thought processes, reaching out to friends and family, and, in some cases, relying on medications to reduce depression or anxiety are effective ways to survive a stressful time. Yet many of the stressors we face are not just personal problems; they’re sweeping social concerns. Unemployment, lack of access to affordable childcare, difficulties in making an appointment to see a health care provider, the high costs of college, workplace discrimination, and widespread social pressures to “have it all” contribute to the stress levels of millions of Americans. Public policies to remedy problems such as poverty and limited access to health care may also be effective in helping us to battle stress and its consequences.

As we search for ways to minimize stress and its accompanying health effects, it’s important to remember that stress affects people in different ways. As discussed earlier in the book, we know that our responses to stress vary based on our personalities, our ways of coping, how optimistic or pessimistic we are, the social support we receive, how much money and power we have to enact changes in our lives, and even our genetic makeup. We also know that different people experience different symptoms in the face of stress; some become depressed, some anxious, some angry. Some toss and turn all night and suffer from health-depleting sleep problems. Others take on unhealthy behaviors such as smoking, drinking, drug use, or “stress eating,” each of which may give rise to health problems such as obesity, metabolic syndrome, diabetes, and high blood pressure. Our reactions are not due solely to personal traits or personal choices but are also linked to the nature of the stress we’re experiencing, including its intensity, duration, and the accumulation of other related stressors. Understanding why, how, and for whom stress affects health is a critical first step in figuring out appropriate solutions. I’ll briefly summarize a few of the most common strategies used to combat stress, and will show whether, how, and for whom they’re effective.

Changing Our Behaviors

Our health behaviors are a critical pathway linking stress to health. Smoking, drinking, consuming copious amounts of caffeine, eating unhealthy comfort foods, and using illegal drugs might make us feel better in the short term, but each of these quick-fix mood enhancers may give rise to even more stress, health troubles, and anxiety. Yet kicking bad habits is easier said than done. Nicotine, drugs, alcohol, and even caffeine have addictive properties, which makes it hard for us to give them up. Most Americans who try to lose weight fail; scientific studies show that crash diets and weight loss drugs are ineffective. Weight Watchers is one of the few programs that has demonstrated long-term effects on weight loss. A study published in the international health journal attributed theThe Lancet success of Weight Watchers to its social support component; the frequent “check-ins” and team-based approach boosted participants’ motivation. This lesson applies to other health behaviors as well; those hoping to kick an unhealthy habit may find it’s easier to do if they have friends also striving toward the same goal, or if they have regular “check-ins” with the friends and family members who care about them.

Kicking bad habits is just one half of the equation, however. The other is adding positive health behaviors, including giving oneself an extra hour of sleep each night, fitting in exercise at least three

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times each week, and cutting unhealthy foods from our diet and replacing them with healthy foods. Given that time pressures are a leading source of stress, experts advise that busy stressed-out people incorporate healthy behaviors into their regular daily routines. Taking stairs rather than the elevator at work, and walking rather than driving to nearby appointments is a quick way to add fitness to one’s day. Ensuring that one’s refrigerator is empty of sweets and fatty foods helps some to avoid these treats altogether. Adding fruits and vegetables to one’s diet, even preprepared frozen produce, is a healthy alternative to fast food. Drinking water rather than coffee, tea, or cola not only calms down our nerves but helps us to sleep better at night and also fights the health-depleting symptoms of dehydration. Experts acknowledge, however, that it is impossible to make major behavioral changes overnight, and attempts to do so may increase our stress levels further by making us feel like failures. Slow and steady is the key. And few people can “get healthy” on their own; a supportive social network is essential.

Another important step toward reducing stress is cutting out of our lives those minor stressors we have some control over. As with healthy behaviors, this is easier said than done. At the very least, experts suggest that we try to find some balance between positive and negative experiences each day. Cancel a coffee date with a “toxic” or mean-spirited coworker, and instead schedule a friendly walk with a person whose company you enjoy. To the extent that it is possible, don’t procrastinate. The distressing feeling of chasing an overdue deadline will then be replaced by a positive feeling of having completed one’s task in a timely manner. Give yourself an extra ten minutes to commute from Point A to Point B; the stress of time pressure will be replaced with a few moments of replenishing downtime. Although many of us cannot alter the major stressors in our lives, we can make minor behavioral changes on a daily basis that may bring down our heart rates and enhance our moods a bit.

Changing Our Thoughts

Can we “think” ourselves out of a stressful situation? The short answer is sometimes. As described in , many effective coping strategies involve rethinking the stress in our lives. Strategies suchChapter 4

as seeing the humor in a bad situation, finding meaning or benefit in a major challenge, or positively reframing a situation are associated with better mental health. By contrast, ruminating and catastrophizing are thought processes that increase our distress levels, and may actually lead to more stress. Ruminating, as discussed earlier, is the process whereby we dwell on negative aspects of our lives, including our mistakes. Catastrophizing is a thought process whereby we irrationally believe that a minor problem is far bigger than it actually is, often imagining a spiraling-out of negative consequences. For instance, a catastrophizer might get a speeding ticket, and then worry that taking a day out of work to contest the ticket will lead to lost pay and potentially being fired. But not taking the day out of work to challenge the ticket might lead to going to jail! Certainly, these imaginary thoughts could be highly distressing. Neurotic personality types are particularly susceptible to these harmful thoughts. By noticing when we engage in these harmful thoughts and then shifting our thoughts to more realistic or positive possibilities, we can minimize our emotional distress. For those who cannot shift their thinking on their own, receiving professional cognitive behavioral therapy (CBT) could be useful.

Some experts also call for greater spirituality in our lives; the belief that there is some “higher power” may help people to gain perspective, whereas others find solace in the belief that their current difficulties are quite minor and fleeting, in the grand scheme of things. Devotees of meditation swear that it helps to calm their minds and bring down their stress levels. Even those who are scared off by words like “meditation” could benefit by finding a few minutes each day to sit in silence, breathe deeply, and focus on a single image. This helps our minds to become less scattered, and adds focus and a sense of calm to our hectic lives. One particular blend of cognitive and spiritual approaches, mindfulness-based therapy, has been found to be particularly effective in fighting depressive symptoms, anxiety, and even psychosocial adjustment among cancer patients.

Although mental exercises like these might make us feel better in the short term, they are

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emotion-focused coping strategies that don’t cut to the core of the stressor. Often, our situations must change if we want our stress to disappear. One of the most effective ways to cut down on worries and distressing thoughts is to streamline or cut back on one’s obligations. As a recent Gallup Poll found, one of the most common sources of stress in the United States is the persistent feeling of time pressure. Experts suggest that we “just say no” when we’re asked to take on another task that might put us over the edge stress-wise. Politely turning down invitations gives us more time to work on the tasks at hand, and helps our schedules to remain (relatively) uncluttered. Moreover, saying “no” to an opportunity—whether work or social—may lead to that opportunity being passed along to another person who may want or benefit from it more. For instance, turning down the invitation to serve on an important committee may give a junior colleague the opportunity to shine in the role. By “paying forward” a potentially rewarding opportunity, we might also bring ourselves a short-term mood boost.

Reach Out to a Friend

Social support is one of the most important resources we have for coping with stress. Our friends and family can provide a listening ear or a shoulder to cry on. Equally important, though, they may provide the practical support we need—whether a ride to a job interview, a cash loan to help pay bills, or a place to crash if our own home and spouse are the source of our stress. Many stressed-out people fear reaching out, however, because they think this signals that they’re not capable of managing on their own. Yet this view is wrong-headed. One of the foundations upon which social relationships are based is reciprocity, or the assumption that in the future we will help out those who helped us in the past. Asking for help isn’t a sign of dependence but rather the first step in what may be a long journey of “give and take” with loved ones.

Of course, not all people have a network they can reach out to. As noted in , the peopleChapter 4 who face the greatest stress may also be embedded in social networks in which friends and family also are overwhelmed by life’s challenges. In such cases, reaching beyond one’s family and friends—perhaps to a local social worker or to a support group—may provide the assistance one needs. Although some people may be reluctant to reach out to strangers, thinking that “they’ll never understand,” one of the most effective sources of help is peer support, or peer counseling. Widow to Widow, for instance, is a long-running program that helps recently bereaved spouses to take care of themselves, manage their grief, and get their lives back on track. Recently bereaved persons are matched with a long-bereaved person who can serve as their mentor and guide them as they navigate their new role of widow. Psychotherapist Phyllis Silverman developed this program in the 1960s, and it has been a model for other peer-to-peer support systems. Peers understand what we’re going through, and may provide not only thoughtful advice but also the assurance that it is possible to live through something as traumatic as widowhood and still find happiness and fulfillment in the future.

When Is Professional Support Necessary?

When stress levels get too high, it may be desirable to see a professional, whether a clinical psychologist, psychotherapist, clinical social worker, psychiatrist, or general practice physician with whom one feels comfortable. These professionals are trained to help individuals, couples, and families to work through their stress, with many specializing in particular types of problems, ranging from marital troubles to eating disorders to major depression. Of course, not all people are comfortable seeking professional help. Studies have documented generational differences, in which older adults are reluctant to seek therapy for fear of the stigma that comes from needing help. Likewise, some ethnic and racial groups are reluctant to “air their dirty laundry” outside the confines of their homes and families. Still others find the cost of professional help to be prohibitive. Only very

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recently have most major medical insurances provided mental health benefits that are on par with physical health benefits. The Mental Health Parity and Addiction Equity Act of 2008 now requires that mental and physical health care coverage be roughly comparable.

Professional psychological help isn’t the only kind of help we need in times of stress. Given the toll that stress takes on our bodies, it is essential that we seek timely and regular medical care to help detect early signs of trouble—such as high blood pressure, early onset of diabetes, or a high body weight that puts us at risk for other diseases. As with mental health care, high-quality medical care may be beyond the financial grasp of poor and uninsured Americans. Ironically, these are precisely the people who are most susceptible to stress and its unhealthy consequences. However, disparities in access to coverage changed in January 2014. Under the Affordable Care Act (ACA), all Americans now have access to many free services, including depression screening, substance use disorder screening, blood pressure screening, obesity counseling and screening, assistance with quitting smoking, vaccines against several infectious diseases, and counseling for domestic abuse victims. These services may help some to extricate themselves from stressful situations, such as abusive marriages, while they may alert others to the fact that their bodies and minds are succumbing to stress as evidenced by the results of depression and blood pressure screens. Although this health information alone cannot help all Americans, especially not those with limited access to health care, it is a first step toward detection and treatment for stress-related health conditions and symptoms.

Medications

The number of Americans relying on medications to help them through times of stress has skyrocketed in recent years. An estimated one in ten Americans today is on antidepressants, and as many as one in four women in their forties and fifties rely on these medications. Most antidepressants fall into a class of drugs called SSRIs (selective serotonin reuptake inhibitors). These medications work by altering the naturally occurring chemical messengers (neurotransmitters) that communicate between brain cells. SSRIs block the reabsorption or “reuptake” of the neurotransmitter serotonin in the brain. Changing the balance of serotonin helps our brain cells to send and receive chemical messages, which in turn elevates our mood.

Although antidepressants are widely prescribed, they are not effective for everyone. Most mental health researchers have found that these medications are best suited for treating people with major depressive disorder (MDD), described in . For people suffering from persistent and seriousChapter 2 symptoms of major depression, medications can make a tremendous and positive difference. However, for people with mild depressive symptoms or sadness, these medications are far less effective. According to sociologist and mental health scholar Allan Horwitz, sadness is a “normal” response to many of life’s stressors, such as divorce, death, or personal disappointment. Talking through the problem with a trained therapist or counselor, figuring out ways to move beyond (or change) the problem, and even the simple passage of time may be more effective than SSRIs for those experiencing such sadness. Talk therapy may not be equally effective for all, however. Its effectiveness may hinge on finding a good “match” and on persisting with therapy. One recent study by found that therapy was most effective if patients stuck with it for thirteen visits.Consumer Reports Although studies vary in what they deem the “magic number” of sessions one should attend, most agree that one visit is not adequate.

Changing Our Society

Social critics reading this chapter might be thinking that therapy, medication, and maintaining a healthy lifestyle are effective ways to cure the consequences of stress, but not the roots of stress itself. This would be an accurate appraisal. Many, if not most, of the stressors discussed in this book have their roots in major social inequalities based on one’s social class, race, gender, age, or even body

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size. As such, we might hope for the enactment of public policies that could erode the main sources of stress in our lives. Let’s revisit several of the people introduced earlier in this book, to show how social policies and interventions could have improved their lives. Recall Rob, the unemployed repairman, who committed suicide by gunshot after two unsuccessful years of searching for a job. Economic programs to enhance job training or increase job creation could have reduced Rob’s stress regarding unemployment. Stricter gun laws might have stopped Rob from purchasing the very gun he used to kill himself. A culture that encouraged men to share their feelings of distress and disappointment rather than keeping their feelings of shame and anger bottled up might have given Rob the outlet he needed.

Now let’s consider Marisol, the college student who exhausted herself while trying to carry a demanding course load and work full time. Expanded grant and loan programs for college students could have given her some reprieve from her daunting schedule. With a bit more sleep and less stress, her immune system might not have faltered and led to a bad case of the flu.

Naomi, our overburdened caregiver who had a stroke just months after her ailing husband and mother died, could have benefited from public programs to provide caregiving assistance. Public health insurance programs, such as those included in the ACA, might have enabled Naomi to get a timely doctor’s checkup. Recall that Naomi had lost her insurance when her ailing husband took a disability leave from his job.

No one would argue that public policies are a cure-all. Nor are they sufficient to eradicate all sources of stress and stress-related health woes. By the same token, individual-level initiatives to live healthy lives and “think ourselves” happy also are not sufficient to eradicate stress and its consequences for our minds and bodies. Stress is a persistent part of life, and that fact will never change. In fact, some minor stress is good for us. It toughens us up, helps us to develop coping skills, and keeps us “on edge” just enough that we force ourselves to prepare for the stressful tasks we foresee in our future. Yet persistent and accumulated stress can have long-term and devastating effects on our life spans and daily well-being. Public policies, individual behaviors, and community efforts to support one another in times of need, together, may be the most effective way to ensure that all Americans can lead lives marked by health, happiness, and peace of mind.

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