Smash Stress Blog

To the outside world, Catherine Thompson England seemed to be handling the pressure of her job as a caseworker for abuse victims well. Though she had told her boss that stress was mounting, it didn't appear to be a problem, since she was getting the job done. But the Pennsylvania social worker was staying late and working at home to do it, a growing trend in a world of tight budgets and understaffing.

Things weren't going well at all. One day the pressure exploded and Thompson England had a breakdown. She was hospitalized for 10 days.

"People don't want to hear about stress, because everybody has it," says Thompson England, who has a five-year-old son. "You will deal with a lot of stress before you reach out, because it's not taken seriously."

Stress has become such a normal part of the day-to-day that it has become a kind of adrenalized wallpaper. Bringing up the subject is to point out the obvious—or that you are a wimp. Fear of being wimpy, though, leads to real weakness—physically, since stress plays a role in five out of the six leading causes of death, and financially, since stress costs the nation a boggling $1 trillion a year.

Chronic stress triggers conditions that kill more people every year than cancer and nicotine combined, but it's treated as if it's no more serious than excess gas or bloating. Take a pill and deal with it. Americans certainly do, consuming $16 billion worth of antipsychotics each year and $11 billion in anti-depressants.

There's a disconnect between stress and the conditions it sets off—hypertension, stroke, coronary artery disease, diabetes, insomnia. Many of us watch our cholesterol, get exercise, keep sugar under control, and yet don't do anything to manage the switch linked with the diseases we're otherwise trying to prevent: stress. That's because we've never been taught to take stress seriously—until a heart attack or burnout.

I come across this every day in my work as a stress management educator. There was the manager at a government security agency who had a stroke in his 40s. The real estate agent with panic attacks. The CEO leveled by a heart attack. 

Unlike more exotic bugs and conditions, there is a cure for stress: knowledge. We know how to prevent and manage it. The stress response is activated when a perceived threat overloads ability to cope with the danger. It's an early warning system that worked well in hunter-gatherer days when threats to life and limb were frequent, but it doesn't know how to compute the social stressors of the modern world. A number of proven stress management processes can turn off the false alarm of stress. Once the danger signal has been shut off, the stress stops in four minutes.

Job stress isn't weakness; it's a serious business. Brian Curin, president of Flip Flop Shops, which sells sandals and a casual lifestyle at 80 stores around the country, discovered that he took too casual of an approach to his own health. Though he exercised and ate well, years of stressful business-building had taken a hidden toll. Curin failed a treadmill stress test, and a follow-up angiogram revealed that his heart was starving for oxygen. He had four major blockages, one of them 100 percent—at the age of 38.

"It was years of running as fast as I could go at the speed of business," said Curin. "It really shows the effect that stress can have on you. They said if I had had a heart attack, they wouldn't have been able to help me."

He had to have a quadruple bypass to repair the damage. Curin was so shaken by the experience he decided to do something about it. His company started an initiative with the American Heart Association, My Heart, My Life, to advocate for stress tests at companies and educate customers on stress prevention.

Stress testing, whether by exercise test, ECG, blood pressure testing at work (one out of five people have elevated readings at work but not at home) or other modalities, has to become as routine as dental or cholesterol checks to identify people like Curin, who are unaware of the problem, or England Thompson, who fear reaching out might mark them as a wimp or burden to others.

England Thompson learned she has to speak up more, set boundaries, and share the load with others. "We need to normalize the fact that stress is a very real thing and you don't have to deal with it on your own," she said.

Stress testing, coverable mental health counseling, and social pressure to change macho attitudes can make it acceptable to get help and overcome the shame, bravado, and willful ignorance that feed the chronic disease mill of stress.

It's a habit of human minds to believe that inner agonies are experienced only by us. They're inside our heads, after all. We alone have to bear the burden of a particular torment. That's especially true when it comes to stress, something we keep to ourselves and away from serious conversation with colleagues, supervisors, and even friends (too much of a buzz kill).

In a bravado culture, no one wants to be seen as not being able to take the pressures coming our way, so we suck it up. Instead of talking about stress and flushing it into the open, we think about it. Stress thrives on rumination. The longer we obsess about the alarmist thoughts set off by the stress response (which thinks you are about to die) and don't challenge them, they become entrenched, and the stress along with it. Our mental isolation chamber, driven by the illusion of separateness, keeps us on the ledge of anxiety.

Two weeks before a stress management workshop I led at a large consulting firm, one of the team's hardest workers had a massive heart attack and died on a bathroom floor. No one knew how close to the end he was, though everyone knew how much overtime he was pulling. He was overwhelmed but didn't talk about his problems with anyone. Colleagues didn't speak up about their concerns. A man in his 40s with everything to live for was gone because of the unwritten rule that we must appear to be invincible.

Talking surfaces the false beliefs behind stress, brings forward perspective and solutions, lets people know they're not alone, and takes a load off. It's time to talk about stress, to our colleagues, bosses, friends, and loved ones. The silent treatment has made stress public health enemy number one, a $1 trillion sinkhole that is destroying lives and bankrupting all of us. Its numerous health blowbacks are responsible for the vast majority of all doctor visits.

The fallacy that stress is a private torment that you have to deal with on your own has prevented any public policy solutions. Stress-triggered chronic diseases, from coronary artery disease to irritable bowel, and personal bankruptcies keep mounting. I started the Smash Stress Campaign to provide a vehicle to get people talking, and better yet, acting to kill the behavior that feeds stress. You can help by signing our petition here for stress screening for all, an effort that would add stress screening and management to the preventive services of the Affordable Care Act. It could have saved the life of the consultant who died in the prime of life. It could save yours or that of someone close to you.

The stress epidemic has gone uncontested for too long. We can change that by becoming a nation of first responders, creating a social movement of people who reach out when someone is in need, who talk and listen, not look the other way, who can be Stress Lookouts and Disrupters.

Think about someone you know who's struggling with anxiety. Take a minute and ask them how they're doing. Share the load by becoming a Stress Disrupter. It's kind of like a Vulcan Mind Meld minus neck grip. Let the person vent. Agree to talk once a week or whenever the need is there. Inform them of their stress testing options -- whether by treadmill test, saliva, or stress questionnaire. Help them get professional help, if it's needed.

Who can you help take a stress load off today? Someone in your family, a work colleague whose health is deteriorating? Someone overwhelmed with fear of the future?

You can stop the rumination and help lower the emotional temperature that feeds fight-or- flight. Ask them: Is it an emergency or a projection trap? What's the false story fueling the stress? What's the most likely story? What's a new story that could reframe the I-can't-cope story that triggers the stress response? Yes, I have 200 emails, but I can handle it.

Let me know your stories of what happened when you got the conversation going. Who were you able to help? What stress did you disrupt? Were you able to get someone to a stress test? What impact did opening up the conversation have on them, on you?

Let's create a national army of Stress Lookouts and Disrupters. Social scientists have a truckload of evidence for the ability of social interaction to buffer stress and increase positive mood. And not just for the receiver, but for the giver as well. It's truly better to give than to receive. Helping others for no other reason than the act of service is one of the most reliable ways to increase your own satisfaction.

As free time has dwindled and work hours have climbed, stress has soared, and there are fewer and fewer people with an unbooked minute or close enough connection to the people around them to step up and listen to a friend's dilemma. The number of people who feel they have someone they can confide in has shrunk by a third in the last 20 years to two people, while a quarter of folks have no one to confide in.

We are the safety net. Let's disrupt the see-no-evil, hear-no-evil, speak-no-evil code that keeps stress out of sight but seldom out of mind.

It's a comment doctors are not surprised to hear from heart attack patients. "But... I didn't know I was stressed."

You can be the last to know about the time bomb ticking inside your body from chronic stress. This is particularly true for Type A's and workaholics, who are prone to ignore the signals -- the gastric volcanoes, insomnia, tightness in the chest, frequent headaches -- and keep doing what they've been trained to and gotten props for their whole lives, keep on going until the paramedics arrive.

That happened to Tom Row, a former scientist in Tennessee, who had a heart attack in his office and had to be carted off on a stretcher. "I didn't know I was even stressed," Row told me for my book, Work to Live. He racked his brain in the ambulance on the way to the hospital. What got him here on the brink of death? He realized that 60-hour workweeks, 10-12-hour days, and the lack of downtime to recover had done a number on his health.

In my work as a trainer in stress management, I run across people from every walk of life who have had to find out the hard way that chronic stress is a very insidious thing. It can be wreaking havoc on your body, and you can be completely oblivious to it. The problem is that stress sets off a flood of adrenaline, a hormone that masks the damage done being done by keeping the body in emergency mode too long. It plants a time bomb we pay for later -- not just the individual with a trip to the ER, but in staggering costs to the nation.

The stress response was meant to be a momentary event until you were out of harm's way. The changes it triggers in your body to enable you to fight or run -- suppressing the immune system and tissue repair system, jacking up blood pressure, interfering with gut function, decreasing the good cholesterol and increasing the bad -- aren't sustainable over the long run. The surge of adrenaline creates a sense of power, as it's supposed to in a real life-and-death emergency, a belief you are handling everything, when you are not. Over time you can wind up adapting to the adrenaline buzz, while the damage goes on inside.

This is one of many reasons we need regular stress screening and monitoring to walk us back from our ledges. Some 525,000 people have heart attacks every year in the U.S., like Tom Row. How many lives and tens of millions of dollars could we save with effective stress prevention? The lack of a plan to deal with stress fuels the last-minute myopia of our healthcare-by-ER system.

Most of us know it's important to monitor our cholesterol or blood sugar numbers. Why not our stress levels? The evidence tells us that stress levels are the most crucial item to be keeping track of, since stress is a factor in five out of the six leading causes of death and costs the nation a staggering $1 trillion a year, according to Peter Schnall's Unhealthy Work.

We can stop surprise heart attacks and save lives by making sure everyone has access to stress screening and management. Very few have access to these critical preventive services now. You can change that by joining with the Smash Stress Campaign to sign this petition here that would get stress screening and management covered for all, by making it a preventive service of the Affordable Care Act. It's a simple executive action that would add stress screening to 16 other preventive services, such as cholesterol screening and colorectal screening. This could be one of the most important actions you ever take, since stress plays a role in the vast majority of all doctor visits.

The Obama Administration released a 125-page document, the National Prevention Strategy, outlining the preventive approach that is the basis for the new health care law. It's a plan designed to keep people out of doctor's offices and ERs, yet stress prevention is left out of the equation. Stress is always the forgotten health hazard, with no social or political constituency to champion it. Policy-makers have been giving it the ostrich treatment for decades.

But ignoring it is only making it worse. Stress has grown as much as 30 percent for some in recent decades. Some 90 percent of Americans will have hypertension, a condition multiple studies link with stress, by the time they are 75, cites the Center for Social Epidemiology. We can't afford the silent treatment any longer.

Humans are creatures of adaptation, and had to be through the eons, or we wouldn't still be around. We're so good at it our bodies have the ability to adapt to conditions that are extremely harmful, such as chronic stress.

But it's all a colossal mistake, a maladaptation. The ancient stress response was built for another time and place, tens of thousands of years ago on an African savanna. It doesn't 
know how to cope with the social stresses of the modern world, which might be challenging, but aren't life-or-death. Identifying and managing modern stressors can turn off the danger signals, so they're not sowing the seeds of heart disease, cardiovascular problems, irritable bowel, cancer, stroke, and a host of other diseases that drive unnecessary suffering and unsustainable medical bills.

When we learn how to turn off the false danger signal of stress, the stress response stops in four minutes. We can get that knowledge out there through the stress screening petition and prevention movement.

Let's make stress prevention a normal, covered service and insure that everyone has the tools to avoid adaptation to self-destruction. It's nonsensical to wait until after the rush to the ER before we treat the root cause of so many chronic diseases. It's time to treat stress as what it is: America's number one health risk.

It would be great if stress were an exotic flu or an illness that needs a cure. It's our bad luck, though, that stress is far from exotic, and we know exactly how to fix it. This has allowed stress to have the perceived virulency of a hangnail. So under the radar it's off the radar, stress has exploded to an invisible, $1 trillion health epidemic, according to Peter Schnall's Unhealthy Work. That's more expensive than the cost of cancer, smoking, diabetes, and heart disease combined.

It's an astounding enough fact to be in Ripley's, yet one we've never heard of. And there is more hidden from view. Stress is a factor in five out of the six leading causes of death -- heart disease, cancer, stroke, lower respiratory disease, and accidents. An estimated 75 percent to 90 percent of all doctor visits are for stress-related issues.

There seems to be a trend here. Illness and stress. Spending wild amounts of money and stress. The culprit behind so many of our health problems is staring us in the face. Want to cut chronic diseases and health bills? Start with stress, the crisis at the heart of the health care crisis. Want to cut the deficit? Encourage policies that prevent and manage stress, and lop off a few hundred billion bucks.

Of course, stress is more than numbers. It's a daily crucible for millions of us. I meet a lot of people caught in its vice-grip as a work-life balance and stress management educator. Away from earshot of work colleagues, people pull me aside to confide the toll stress is taking. I met a 29-year-old government worker who had an assortment of illnesses you'd expect to see in someone in their 70s. A man in his 40s at an aerospace company told me about the heart attack he'd had two months earlier. He managed to get another position at the firm to get the stress down, but the new position was even more stressful. On the legal frontlines, an attorney told me, "Everyone I know is on Paxil!"

If there were an America's Most Wanted for health problems, stress would be at the top of the list. The U.N. calls stress the 21st century health epidemic. So why does it continue to remain out of sight and out of mind for policy makers and health insurance when it's ravaging so many lives and bankrupting the nation? One, stress is thought to be normal and no big deal. Two, stress is considered a personal, and what's worse, mental problem with no effect on anyone else. Three, there has been no social or political movement to challenge stress as there has been to fight smoking or cancer.

The good news is that we can do something about the latter and in the process fix the other two. I've launched a campaign to fill the grassroots void called Smash Stress. We have a very specific health care policy petition I hope you'll check out and sign here that calls for stress screening and management for all. It only requires an executive action, and it could transform health in America. I hope you will join the Center for Social Epidemiology, a group of the top stress researchers led by Peter Schnall, to get stress out of the back alleys of personal agony and into the forefront of public health policy. We have the opportunity to do something historic right now.

The problem is that we've been treating the symptoms of stress -- heart disease, high blood pressure, stroke, diabetes -- instead of the cause, stress itself, and shutting that down. Our petition calls for reversing that approach, adding stress screening to the preventive services of the Affordable Care Act. There are currently 16 preventive services covered by the law (22 preventive services for women), from colorectal screening to depression screening. We are asking President Obama and Health and Human Resources Secretary Kathleen Sebelius to add stress screening, the most important preventive measure of all, to the law, as well as accessible and affordable stress management. This is a doable executive action that fits perfectly with the Administration's National Prevention Strategy, which states that, "preventing disease and injuries is key to improving America's health."

Can signing a petition do anything? Ask Dena Patrick, of the social volunteering site wishadoo.com. She submitted a petition at change.org calling for health benefits for part-time FEMA workers, who didn't get any. They get health benefits now, because the administration changed the policy after her petition attracted 112,000 signatures. We can do it too and save millions of lives and billions of dollars.

Collective action helped change social behavior around smoking. Sarah Speck, a cardiologist at Swedish Hospital in Seattle, calls stress "the new tobacco." Like nicotine and tobacco, it constricts blood vessels. Also like smoking, stress is another default habit that requires social intervention to change the attitudes that create it, both for stress perpetrators and reactors. With knowledge and social sanctions, it becomes less acceptable, more costly, more stupid to engage in stress.

We know how to manage stress. We just need to get the information out to everyone. 
Smash Stress is lobbying the surgeon general and the CDC to sponsor vigorous, ongoing stress awareness and prevention programs.

We've been sold the idea that stress is some kind of personal flaw whose demons we alone must bear. Though it's not infectious, stress is highly contagious. It's easily spread between workmates, spouses and significant others through "pass-along strain." It drives the hair-trigger emotions and false crisis mentality that spill out into the accident and crime reports of our communities and make our world more angry, panicked, sleep-deprived, and dangerous than it needs to be.

Maybe we can say someday, beginning with action on stress screening and management today, that we made our world a less angry, healthier, safer place to live.