There has been a lot of buzz about the American Psychological Association’s recent Stress in America survey. Some question whether it really represents the state of the nation’s stress, others question whether or not we can really do anything about our stress, and some wonder if it even matters.

After all, everyone always has to deal with some stress, right?

Deborah Kotz of the Boston Globe’s Daily Dose questioned whether the APA’s survey results were accurate. She did her own (though admittedly unscientific) poll online.

Interestingly at the time I wrote this post, her results  mirrored those of the APA survey, and in fact, made the situation even more alarming. Her results indicated that 34.28 percent of Americans described themselves as extremely stressed, have gained weight and are having other health problems. And another 29.32 percent of Americans feel frazzled a lot and don’t believe they are dealing well with stress.

Her article has generated lots of comments by people frustrated at the lack of available services. The stigma they feel is attached to a diagnosis of mental illness and the cost of getting help. Others have pointed out the need for increased education about  stress and mental illness and the benefits to individuals and their families.

Here are some very important facts:

• People with serious mental illness have a 25-year shorter life span than those who do not. Three out of five of these people die of mostly preventable conditions, such as obesity and heart disease.
• Estimates are that 11 percent to 36 percent of primary care patients have a psychiatric disorder.
• One recent survey of mental health conditions in urban family medicine practices revealed that more than 40 percent of survey respondents met criteria for a mental health disorder. But, many come to the physicians’ offices with complaints of headaches and stomach issues such as irritable bowel. Too often patients are told to lose weight, take it easy or handed a prescription with no follow-up.

The American Academy of Family Physicians noted the following:

Psychiatric problems are a major health issue. In the United States, neuropsychiatric disorders have now surpassed other disorders such as cardiovascular diseases and malignant neoplasms as the number one cause of disability as expressed as disability-adjusted life years.

According to the most recent data available, mental health expenditures in the United States, expressed as a percentage of total health care expenditures, were more than 6 percent.

Most family practice physicians are not well trained to manage psychiatric issues. As a result, lots of unnecessary and very expensive medical tests are performed when psychotherapy might be what is needed.

So the answer is yes, stress matters! And yes, we need to learn to better manage our stress.

We need to learn about mental illness and make sure we provide and receive appropriate treatment. Financially, we can’t afford not to. The loss of life is so often unnecessary. There is no price to put on the life and unnecessary death of a loved one.

While I recognize that simply taking a bubble bath, as one person commented, will not solve the tremendous financial and family pressures that  people currently are facing, reducing our stress levels in areas where we have control–such as exercise, breathing techniques, massage, meditation and even bubble baths–can clear our minds so we are capable of making better choices and decisions and can be more resilient.

And remember: This is today. It does not mean things will be like this forever.

Photo by isabisa via Flickr

When we are stressed we have higher levels of a chemical (cortisol) that damages our system. It’s like a little hammer chiseling away at our healthy insides. (Watch the effects of stress on the body with this cool graphic.)

The problem is that not everyone understands just how unhealthy this is on our physical health. Because of this, many people may be less likely to use stress management strategies that improve their health.

Have you looked at the recent findings of APA’s Stress in America survey? This survey highlights the negative impact of stress on physical health, and it shows that not all survey respondents were aware of the connection.

According to the survey,

“Although the majority of adults understand that stress has a strong impact on a person’s health,  a sizeable minority still think that stress has only a slight or no impact on their own physical health (31 percent) and mental health (36 percent).”

Notice that reference to mental health. Depression also comes into play. Research shows they are related, but it’s thought to be bidirectional. That means that the more depressed you are, the more you engage in unhealthy eating and physical activity habits; and the more you engage in these behaviors, the more depressed you become. It creates a vicious cycle from which it’s tough to break.

More from APA’s stress survey

Obesity and depression are often exacerbated by stress. Those who suffer from these conditions report that they are unable to take the necessary steps to relieve their stress or improve their health and, therefore, engage in maladaptive coping behaviors.

• People with depression (27 percent) or obesity (24 percent) are more likely than the general population (20 percent) to report feeling dissatisfied with their lives and less likely (76 percent for the general population vs. 69 percent for those depressed or obese) to report feeling satisfied with family relationships.
• Those with depression (33 percent) or who are obese (28 percent) are significantly more likely than the general public (21 percent) to say they do not think they are doing enough to manage their stress.
• As compared to the general public (11 percent), more people who are obese (34 percent) or depressed (22 percent) report that their disabilities or health issues prevent them from making positive changes in their lives (i.e., reducing stress and improving health).

The good news is that research shows that depression, obesity, and stress share common effective treatments. Each can be improved (i.e., increased positive mood, weight loss, and lower stress) by a variety of methods, including cognitive (the way we think) and behavioral (what we do) components.

Here are two techniques to help you started on the road to a happier, healthier, more relaxed life.

Rate your mood before and after an activity. Then, rate your feelings of accomplishment before and after this activity. Begin to recognize those that improve your mood (not just in the moment, but later on) and make you feel better about yourself.

You may find that some of your favorite activities (Friday morning trips to the donut shop or Tuesday night carryout pizza) may cause momentary happiness, but lower your self-confidence in making positive choices or decreased physical health that creates more stress and depressed feelings.

Move more and sit less. Research has linked higher BMIs (indication of overweight) with higher rates of screen time (time spent with TV, video games, cell phones, computer, etc). Make your goal simple. Say something like “I will get a few tasks accomplished before I plop down on the sofa and catch up on TV.” For kids, this could be as simple as having them pick up their belongings and engage in a productive, physical activity prior to watching TV or playing video games.

By starting with these two things, you may find that you are identifying activities that make you less stressed, help you get healthier, and improve your interactions with others. You’re putting down that stress chisel, and improving your mental and physical health.

Photo by practicalowl (via Flickr)

APA released its annual Stress in America survey yesterday, and we have again found that our nation is under pressure. Yes, average stress levels have declined somewhat from their max in 2007 and 2008, but that was at a time of extreme economic uncertainty when the housing crisis began to bubble, and the nation’s economy was on the cliff, about to take a deep fall.

But even as the nation’s economy begins to improve, we found that yet again, the majority of people surveyed said they are experiencing very high degrees of stress at levels that are higher than they consider healthy.

Our snapshot of stress is even bleaker for those who said they are caregivers or living with a chronic condition. Caregivers reported higher levels of stress, poorer health and a greater tendency to engage in unhealthy behaviors to alleviate their stress than the general public. They report feeling overwhelmed by the amount of care their aging or chronically ill family member require of them.

And those with chronic conditions, such as depression, obesity and Type 2 diabetes, are also caught in a vicious cycle. They said they were unable to take necessary steps to reduce their stress and engaged in unhealthy behaviors to manage their stress, thereby reducing their ability to appropriately manage their illness.

We have said for years that people need to be more aware of their stress levels; need to recognize what triggers stress for them; need to recognize how stress can damage their health; and need to manage their stress more effectively.

But while the majority of Americans know this is true, let’s face it, change isn’t easy.

There are a lot of reasons that Americans aren’t taking better care of their stress and their bodies. I believe, along with many others, that while we’re all responsible for our own health, change cannot happen in a vacuum. Aside from individual efforts, supportive social and community networks, as well as a responsive health-care system are needed to help individuals make the changes needed for better health.

We all need to think differently about health and illness.

Most chronic conditions can be prevented by better managing our stress and making better choices about our nutrition, activity level, alcohol and tobacco use, and our strategies for managing stress. By understanding the relationship between stress and chronic illness, we can all take steps to make better choices.

Psychologists working side by side with physicians—as part of someone’s personal health-care team—enhance the possibility that health care focuses on the whole person, not just an illness. Access to the right kind of care from the right kind of health-care provider must be assured in our evolving health care system. More focus on prevention will save lives and health-care dollars in the long run.

We need big changes in our evolving health-care system.

I believe they can happen. They need to happen.

Until then, do your best to make small changes and practice better stress management strategies.

• Engage understanding people who support the changes you want to make for yourself.
• Increase your activity level, and make better food choices.
• Set realistic expectations.

And if your efforts aren’t paying off for you, consider talking to a psychologist who can help you identify and remove those barriers that are standing in the way of the changes you want.

Photos by hradcanska and yourdon (via Flickr)

Imagine if you’d spent as much time learning to understand your emotions as you did learning to read, write and count. Unfortunately, like most of us, you likely received very little education or guidance in this area, surrendering your emotions to chance.

That often doesn’t work out too well.

Life is complicated and people are even more so. The chances are that at some point, we are faced with some difficult and emotionally challenging situations involving loss, conflict or rejection. These stresses (all too common in this ongoing economy) can often cause us to feel anxious or a bit down. If you don’t have the emotional skills to understand and manage these feelings, and this cycle goes on long enough, it can lead to feeling depressed or out of control, causing major problems in everyday life.

But here’s the really good news. Even if you weren’t blessed back in the days of the 3 Rs in school with learning how to understand and manage your emotions, it’s not too late!

Psychotherapy is a remarkably effective technique that helps you take back emotional control of your life and live better. Through the context of the therapeutic relationship, the therapist teaches you important skills for understanding and managing difficult emotions in your present life, but also helps you to retain these skills so you can apply them in future situations. Psychotherapy has the power to not only make you feel better, but to positively change the course of your life. As a practicing psychologist, I see evidence of this every day in my office.

Recently a group of psychologists produced a video for the public, which beautifully and evocatively illustrates the powers of psychotherapy. Take a look for yourself.

If you are unsure of how to find a good psychotherapist, you can start with talking to your primary care physician. (Psychotherapy is covered by most major insurance providers, as well as Medicare and Medicaid.) You can also check out the APA’s Psychologist Locator Service for a list of psychologists–doctors trained to listen and help–in your area.

Don’t leave your emotions to chance. Consider psychotherapy–take control of your emotional life now, and learn to hold on to it forever.

Photo by room_onfire (via Flickr)

My mother-in-law is 97 years old. She was born in Italy and moved to the United States when she was 6. She has always been a homebody. She cooked, cleaned and took care of her family. And boy did she cook. Pasta was truly home made. Her fresh baked rolls, bracciolini, ravioli, squash blossoms and risotto were to die for! She rarely sat down. After her husband died, she moved in with her sister and ultimately became her older sister’s caretaker. This continued until she was in her late 80’s and her sister was in her early 90’s.

After she, herself, turned 90 she began to need  help for herself. She moved away from her home and friends and moved in with my sister-in-law who lives in another state. This took some adjustment (for both of them), of course. I think it is always a bit difficult to take two people who are used to running their homes in a certain way and ask them to change how they do things.  I recall my sister-in-law’s frustration when Mom would become upset she was using paper plates for a quick lunch. After all, she had lived through the Great Depression…paper plates were a waste of money.

As my mother-in-law has become more frail, she would tell us she was simply waiting for the grim reaper to come and take her. She became too tired to even read. Her hearing has failed and conversation was difficult, especially with multiple people in a room talking. We have talked about what she wants to happen when she dies. This was really important for all of us. We hoped that when her time came, she would simply die peacefully at home. But, unfortunately she had a mild stroke, fell and had to be hospitalized. She developed pneumonia, and although she survived all of that, she could no longer be cared for at home.

Within a week, she had left her home, spent hours in an emergency room, a few days in a hospital and then changed rooms three times in the nursing home before she was finally settled. There were days she didn’t know who we were or where she was.

The other day I brought her chicken soup and matzo balls. (Yes we have that whole Jewish/Italian thing in our family). When she was awake, her mind was clear. Maybe that is the hardest part. She knows what is happening. She knows where she is. She really wants to go home…not just back to my sister-in-law’s, but to her final home.  She is more than ready to go. She doesn’t like being helpless and just waiting for her life to end. I could see the sadness in her eyes. We held hands, watched some football and a cooking show together for a short while and I promised her jelly donuts the next time I come to see her. She smiled and told me I could go home as she was ready to go to sleep for the night. I know she wants to sleep forever. As humans, when we get to this point in life, we have to wait and wait. We don’t make our pets do this. We help them leave this world peacefully and with dignity.

Death is a hard topic to discuss. There is so much we don’t understand. But talking helps us prepare. What are your thoughts?

photo by LZ Creations