University Times

“Stress is not going to go away. You’re going to be exposed to stress,” said medical school faculty member Bruce Rabin, perhaps stating the obvious to an audience of more than 100 Pitt faculty and staff in a Feb. 11 lecture.

In the second of a three-part lunchtime series on stress relief sponsored by the University Senate benefits and welfare committee’s mental wellness task force, Rabin followed up on his discussion on the effect of stress hormones on physical health with an overview of how stress hormones affect mental health.

Stress not only can interfere with focusing and thinking clearly in the moment; left unchecked, it can contribute to depression, cardiovascular disease and even a shortened lifespan, said Rabin, a faculty member in pathology, psychiatry and psychology at the School of Medicine and medical director of the UPMC healthy lifestyle program.

To combat these effects, “You need to change your brain,” Rabin said. “We need to focus on positive things. We need to find happiness in the things that we do. We need to be nice to other people. We need to have social groups that we interact with. We need to be with people,” he said.

“If we start doing that, even though our brains are perceiving things as stress … we will decrease the likelihood of those stress events having an effect on our health.”

When sudden stress arises, a person may respond with inappropriate words or actions, Rabin noted. Why? When the brain perceives stress, “there’s a hormone called norepinephrine that goes up in concentration and it interferes with your ability to focus and think clearly. And that’s why you may do something inappropriate,” he said.

To combat these stress hormones, Rabin recommended deep breathing, humor, a little Pavlovian conditioning — and sticky notes.

Breathing

People breathe more shallowly or hold their breath when experiencing acute stress, Rabin said. That raises carbon dioxide levels in the blood, leading to the production of more norepinephrine. “The only way to reduce it is to get more oxygen into your blood” with several deep breaths. “It works within seconds,” reducing heart rate and blood pressure and helping with clearer thinking and focus. “You’re changing hormones just by that simple thing,” he said.

Humor

Laughter indeed is good medicine, but nothing seems funny when you’re under stress, Rabin said. Store something that makes you laugh in an imaginary box in your head now, so you can draw on it when stress strikes, he advised.

Find a positive mantra

Rabin advocated for repeating a chant such as “All will be well” or “Things will be good” when you’re happy. With practice, the brain will associate the phrase with happiness — simple Pavlovian conditioning.

“When you’re upset, all you have to do is think that little phrase, think that chant. As soon as you do it, you will drop the concentration of your hormones and you will be able to think clearly,” Rabin said.

Sticky notes

“So, someone says something to you that upsets you, somebody cuts you off while you’re driving. You’re upset. You may do something inappropriate. You can’t focus. What are you going to do?

“You’re not going to remember,” he said. “So, if you take these yellow sticky notes and put them up all over the place with reminders (of what to do), you will remember.”

More important, he advised, share the strategies with friends, colleagues and family so that people around you not only can learn how to calm themselves when they’re under stress, they can help when you need reminding.

“The more you do this and the more often you do it, you will eventually remember to do it. But it takes time to remodel your brain,” he said. “When you do a new behavior, there are changes that take place in your brain, structural changes, which make it easier for you to remember to do these things.”

Stress and depression

“Everybody knows, when you’ve been under stress for a while, you get the blues, you get depression,” he said.

“There are many different causes of depression,” he said. Stress is one.

When people experience stress for long periods of time, they get depressed, Rabin said. The reason is inflammation, but not the sort that arises from a splinter or an infection.

“There is this other cause of inflammation that we now call ‘sterile inflammation’ because it doesn’t involve an infection,” he said.

The role of cytokines

“When you experience stress there are changes in your blood,” he said, explaining that the concentration of cytokines — chemicals that are involved in fighting off infection — increase. Cytokines bind to the ends of nerves and travel to the brain.

“Think about when you have an upper respiratory viral infection. How do you feel? … Is your appetite suppressed? Are you tired? Are you down in the dumps? It’s not the virus that is doing it. What is causing you to feel that way are the cytokines, components of the immune system that are released in response to this infection,” he said.

“Just experiencing stress causes the production of exactly those chemical messengers that go to your brain and cause you to feel down in the dumps and tired,” Rabin said.

“These cytokines will cause you to be depressed,” he said, noting several predisposing factors. “If you are overweight, there is more production of these cytokines. If you have had a history of depression, the cytokines are more effective, they will do more.”

In addition, childhood abuse is a factor that predisposes many people to depression. When there is neglect or physical, mental or sexual abuse, changes occur in the structure and function of the brain, Rabin said.

Predisposing factors are important because they lead to an exaggerated inflammatory response, induced by the brain’s response to stress.

Treating depression

In treating minor and moderate depression with medication, antidepressants work, but largely through the placebo effect, Rabin said. Anti-inflammatory agents, which lower cytokine concentrations, are an alternative.

Dietary changes — losing weight and eating more fruits and vegetables — can help as well, but most important are physical activity and social interaction, Rabin said.

Physical activity doesn’t necessarily mean going to the gym. Brisk walking activates the paraventricular nucleus and locus coeruleus, two parts of the brain that also are activated by stress.

“When those brain areas are activated, they cause an elevation of the concentration of the stress hormones in your blood. The more times you activate them by physical activity … it becomes harder for a psychological stressor to activate them,” Rabin explained.

In addition, “Loneliness is a critical issue as a factor predisposing you to becoming depressed when you are under stress,” he said.

“If you are alone and not lonely, that’s okay,” he said. However, those who feel that they are lacking companionship, left out, have no one to talk to or feel they aren’t part of a group of friends are more at risk.

Volunteering for something that interests you is one strategy for buffering loneliness, Rabin said, noting that it fosters interaction with people who have similar interests.

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Constant activation of the inflammatory response is associated with more than long-lasting depression. Stress hormones can change the lining of blood vessels, increasing cholesterol accumulations and raising blood pressure. They shorten telomeres, the caps at the ends of chromosomes. “As they get shorter as you go through the aging process, your risk of physical and mental illness increases,” Rabin said.

Stress hormones also damage brain cells and neurons. “The hippocampus is the part of the brain where the cells that regulate depression are located,” said Rabin.

“People with depression have fewer cells in the hippocampus, because one of the stress hormones damages these brain cells. If you get the concentration of the hormones down, not only brain cells in the area of the brain involved with thinking increase, but the amount of brain cells in the area of the brain involved with depression increase.”

The end result

Dying is inevitable. But staying healthy as long as possible, enjoying life, then checking out quickly is preferable to suffering with disease, illness and pain until life ends, Rabin said.

What can you do to increase the likelihood of a healthy life and quick death? Don’t smoke. Be active. Eat a healthy diet.

“And you need to increase your ability to cope with stress,” Rabin said, re-emphasizing the importance of friends and social interactions.

In addition, “Be high in optimism,” Rabin advised. “If you do something wrong and make a mistake, accept that it doesn’t mean you’re a bad person. It’s okay to make mistakes.

“If you keep blaming yourself every time that you do something wrong — that you’re not a good person — it’s going to affect your health, your risk of depression, more heart disease, more diabetes,” he said.

And take care of your spiritual life, whether it’s participating in religious activities or being spiritual for those who aren’t religious. “Whatever you do to calm yourself is considered spiritual,” he said. “It has a positive effect on the quality of mind and body.”

Eliminate hostility

“If I had to pick out one thing that will predispose you to an early death, it’s hostility,” Rabin said. “If you don’t like people, if you don’t trust people, if you are angry at people.

“This is not just associated with heart disease, it’s associated with dying of a heart attack,” he warned.

“Hostility is a critical factor in quality of life and duration of life. If you fly off the handle easily, if you get angry at people, if you’re mad at people, if you don’t find the good things in people, if you’re a hostile person — you’re at risk of dying of a heart attack.”

Impact on others

“One of the things that is important is consistency of behavior in relationships,” Rabin said. How do you behave after a tough day at work? Don’t go home to your partner or children upset, he advised. Sit in the car and take a few deep breaths or go for a walk around the block first.

“Calm yourself so that when you go home you will always behave the same way. This is especially important when there are children in the home,” Rabin said.

“When parents show inconsistent behavior towards children, that is perceived by the children as abuse. Something as simple as that can have that effect on children,” he cautioned.

In the workplace

Being happy at work is a critical factor in dealing with stress. “If you don’t feel a part of the work environment, if you don’t feel respected when you are at work, the risk of heart disease, the risk of heart attack and death, is much greater than for individuals who go to work and are happy there and feel that they’re part of the workplace,” Rabin said.

His advice for managers: “If you are responsible for people, be nice to them. Care about them. Make sure that they are involved in decision-making because it’s not just at the workplace where they’re going to be affected by that. You’re talking about their health and their longevity,” he said.

“It is so important that we pay attention to the work environment,” Rabin said. “Anybody who is responsible for people can be somebody who has an influence on the quality of mental health of those they are responsible for.”

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Rabin’s stress relief resources are posted at hr.pitt.edu/mentalhealth. His final talk in the series, “Stress Buffering Techniques,” is set for noon March 4 in the William Pitt Union Kurtzman Room.

—Kimberly K. Barlow