Preface: The intent of this blog is to help people understand the health ramifications of stress. The science provides strong rationale to be kind to ourselves and why we should use some great, no cost ways to manage stress and fortify our resilience. So please don’t get stressed about stress–do something about it. We have the tools to tap into what nature has given us:the ability to heal ourselves.

COVID-19 stress: COVID-19 is a powerful, multifaceted stressor. For many, it is literally life and death; for others, financial ruin or the threat of it or a combination of the two. Even if we are not afflicted with coronavirus or still have work, we must acknowledge that we are collectively witnessing death, disease, and loss while our lives are on hold.

For any single person, of course, this can be huge.  It would be entirely expected if you feel it, too. I do, as do many that I know. This stress is exacerbated by isolation, the necessary remedy to control the spread of the virus. Layered on top of these other stressors, loneliness itself affects people about the same as smoking 15 cigarettes per day.

Shouldering all of this for months on a scale of many millions portends a second epidemic due to stress’ effects on mental and physical health. Although the coronavirus pandemic will eventually end, we need to act now to fortify our resilience and prevent the stress-related consequences of COVID.

What stress does to us: On a behavioral level, stress can lead to depression and anxiety as well as anhedonia and sleep disturbances. It can cause cognitive errors and interfere with decision-making.  Like when one person shoots at another because they didn’t cover their cough.

On a biologic level, stress accelerates aging, affects immune regulation, and increases inflammation.  Clinically, stress can hamper the defense against viral infections. In patients with HIV, greater life stress was associated with a more rapid progression to AIDS.  Stress is also associated with higher risk of severe life-threatening infections.

We must anticipate, therefore, that stress can also worsen COVID-19, perhaps enhancing susceptibility to infection or worsening the disease in those infected.

Another consequence of stress is eliciting or exacerbating heart disease, diabetes, and asthma and other disorders.  And as people are stressed, drug use to quench psychologic pain will increase (alcohol, opiates, etc.).

So while the responsible professionals focus on the virus and the economy, everyone needs to better manage their stress and fortify their resilience. This will help us be more calm, improve decision-making, and be healthier. And it may directly help with COVID-19.

Four techniques to manage stress and build resilence: Fortunately, there are four very effective ways to help. Using these techniques is not a sign that someone is not “tough enough.”  Toughness alone is insufficient—it must be combined with the intelligence to use the tools that nature gave us to survive and be resilient. 

For the reader’s convenience, we have assembled a resilience resource guide with links to mostly free online instruction by many wonderful teachers. It also has a webinar that explores this subject in-depth.

The first method is meditation, a technique practiced in different ways that helps quiet the incessant chatter in our minds. These thoughts often surround fear and ego that, in turn, generate stress when we focus on them (e.g., “what will happen if I can’t work?” or “will we get infected?” or “I’m not good enough”).

The goal of meditation is to be more present and be aware of the thoughts, not judge or attach to them, making it easier to let them pass. Meditation is not intended to suppress negative thoughts or be distracted from real concerns like solvency or health. By being more present, the mind is more calm to better manage these problems. And by changing how your thoughts affect you, you will have a great skill to buffer against overreacting to future stressors and challenges.

Getting started is not hard and can be done in a variety of ways. It just takes a little practice–10-20 minutes every day can make a huge difference. There is good evidence of how it changes our psychology and physiology. And you will likely find that you are more productive with the remaining 1420 minutes.

The second practice is exercise. Exercise in many forms is well known to reduce stress. Aerobic exercise has been particularly effective as a stress reduction tactic that releases endorphins and affect inflammation.   

As gyms are closed, outdoor exercise in its many forms can be beneficial.  Walking, gardening, running, dancing, and other forms can be managed even with social distancing. In addition to the exercise, being outside allows for appreciation of nature, a great tonic for a distressed soul. 

Many exercises also have a meditative aspect to them as they require focus and presence. Yoga, which combines meditation with stretching and fitness, can easily be done in the confines of your home. 

For whichever you choose, only do them if you are able; for any questions, please speak to your doctor. 

The third modality is kindness and compassion.  There is extensive evidence that giving to someone else makes people feel good. That feeling, colloquially labeled the “helper’s high,” feels good because it activates reward systems in the brain. Caring about others is a potent stress reliever likely through creating positive connection.

There are many ways to be kind. Reach out to others. Call your neighbors, particularly those living alone. By letting someone know you are thinking of them, they know that they matter and are not alone. Or make a donation. By helping others you will also help yourself. 

Look for kindness, too.  Seeing kindness triggers much of the same internal responses as doing kindness.  Our non-profit specializes in gathering and sharing images of kindness.  People who see these are happier, more optimistic, inspired, and grateful. See how you feel after looking a the image below from Lindsay Baca.

Inspiring kindness content can also be found at: Karmatube, Uplift TV, Humankind, and Good News Network. And related to kindness is gratitude practice—a proven way to relieve stress.

Finally, laughter is great for stress. Although Norman Cousins popularized the idea of laughter as therapy, the potential of laughter to decrease pain and stress and promote health was well known for centuries .  Short laughter sessions decrease cortisol and like exercise, meditation, and kindness, increase endorphins. More time spent laughing yielded improvement in a marker of immune function associated with lower stress levels.

To amplify this further, laugh with others. Although coronavirus is highly contagious, so is laughter (and kindness); you can help each other experience its benefits.

Conclusion: We have been given the biology to help heal ourselves and be resilient.  We just need to be kind to ourselves and reach for the tools to tap into it. This is very achievable with regular practice at little or no cost. And when the Corona virus epidemic ends (which it will), these same tools will be very useful in our every day lives.

In kindness,

David (Prof K)

 

In my professional work as a scientist, I have spent a lot of time in meetings.  There were meetings that were very well organized and productive and others that regrettably were not.  It was during these disorganized meetings that my mind would begin to wander.  I found myself estimating the average salary in the room and the resulting cost of this meeting depending on its length.  And then I sighed about the waste of money.

While focusing on money was an “amusing” diversion, it was not satisfying and didn’t last long.  My mind continued to wander during these unproductive assemblies and I began to think about heartbeats.  I had remembered that for most mammals, heart rate was inversely proportional to longevity. That is, across species, the faster the heart rate, the shorter the life span[1].  For example, the heart rate of a mouse versus an elephant as compared to their respective lifespans.

That led to a more personal consideration: if my average heart rate was around 70 beats per minute, sitting in that room for an hour cost me 4,200 heartbeats.  That’s when this epiphany sank in.  I was spending a very precious resource doing something without substantive meaning.  Heartbeats are a personal metronome that Nature gave all of us to mark time.  I realized that I had to spend my heartbeats more wisely.

That’s when this epiphany sank in.

I realized that I had to spend my

heartbeats more wisely. 

The heart is an amazing organ. If you think about it, we are walking around with a pump that circulates our entire blood volume approximately once every minute at rest (for an adult, roughly 5 liters).  It works on demand; that is, it adjusts itself to our body’s needs.  If we are exercising, bleeding, sweating, etc., our heart rate changes to keep providing blood flow to the rest of the body, especially the brain. It also adjusts how much force it will exert to meet those needs.  An amazing variable demand-responsive pump.

In addition to exercise, stressors like anxiety or fear affect heart rate.  These increase heart rate, a consequence of a shift in balance of the two major aspects of the autonomic nervous system: sympathetic and parasympathetic, which respectively increase or decrease heart rate[2].  This balance also affects something called heart rate variability (HRV)[3].  That variation is the time between beats. It turns out that lower variation in the time between beats is associated with worse health.  People who have less variability have greater risk of death[4].  Diabetes, heart failure, and stress are all major causes of decreased heart rate variability, which make sense as they all have increased risk of death.

A way of thinking about HRV is the beat of a drum.  A drummer can strike the drum exactly once per second for a total of 60 beats in that minute so that there is little or no variation between beats.  Or the drummer can vary that—making it slightly quicker and slightly slower so that although there were 60 beats in that minute, the time between each beat varied more.

HRV is higher in younger people and progressively declines with age. Some consider it a test of aging.  And while psychological stress and different diseases decrease HRV, breathing, particularly slow breathing, increases it. Many forms of meditation increase HRV, including compassion meditation[5].  That is extending kindness and compassion to others through thoughts has a beneficial physiologic effect.

Extending kindness and compassion

to others through thoughts has a beneficial

physiologic effect. 

From ancient times, the heart was recognized as the center of emotion.  Poetic expressions like “he wears his heart on his sleeve,” “follow your heart,” or ”a broken heart” points to how symptoms (what a person feels) around the physical heart probably reflected manifestation of different emotions like love and anxiety.  In this model, the brain is the dominant feature telling the heart what it is perceiving.  Yet the physiology is much more complex; it turns out that the heart has its own nervous system and provides feedback to the brain that can affect feelings as well as strategic thinking[6].

The heart also is affected by oxytocin (“the love hormone”).  Released in response to different (particularly prosocial) stimuli like hugs or massage, oxytocin also directly affects the heart and cardiovascular system.  In response to oxytocin, the heart in turn releases another hormone called atrial natriuretic peptide that can lower blood pressure[7].  Oxytocin appears to lower blood pressure and heart rate through other mechanisms, too.  A physiologic way of saying that love is good for the heart.

Each heartbeat, therefore, is a reflection of a lot of complex interactions between our mental and physical states.  And how our heart beats, in turn, affects how we feel.  Beyond being a pump, each heartbeat is an important part of appreciating and living life.  We feel love, suffering, sadness, joy, and amazement through it.  We place our hand over it when expressing emotion or making a pledge.  All because the heart allows us to feel the wonders of being alive.

Love is good for the heart.

The heart allows us to feel the

wonders of being alive.

Yet it is easy to forget about how precious each heartbeat is and take its continuous operation for granted.  What if we changed that? How could we honor the gift of each heartbeat to attain greater meaning?  It might show itself as gratitude for being alive and drive the focused pursuit of doing good with the limited number of heartbeats that we each have.  And with my new-found respect for heartbeats, it is not just mine that matter—I also needed to respect everyone else’s.

After I realized the significance of heartbeats, I changed how I ran meetings.  I would prepare extensively so that everyone would find the meeting productive, emphasizing a culture of listening to each other and openly seeking the truth. The result was really positive, likely because they found meaning through doing good work that honored their own heartbeats.  Kindness here was motivated by the significance of heartbeats.

Of course, there are many other ways to honor heartbeats, not just through meetings. We honor heartbeats when we take care of ourselves (rest, exercise, eat well) and we take care of others (family, friends, coworkers, and strangers).  And this does not mean that we should not watch a silly movie or do something that might be viewed as goofing off (that’s actually relaxing).  It simply means that we should be more conscious of our heartbeats so that, overall, we spend them wisely.

Go ahead—feel your own heart[8].  Marvel at what you have been given.  And then decide what you want to do to make the most of them.  Their yours to make a meaningful life with.

In kindness,

David (Prof K)

[1] https://www.researchgate.net/publication/23486438_Heart_rate_lifespan_and_mortality_risk

[2] https://en.wikipedia.org/wiki/Autonomic_nervous_system

[3] https://en.wikipedia.org/wiki/Heart_rate_variability

[4] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5900369/

[5] Kirby, J.N., and colleagues: The current and future role of assessing heart rate variability and compassion training.  Frontiers in Public Health volume 5: pgs 1-6, 2017.  https://doi.org/10.3389/fpubh.2017.00040

[6] McCraty, R.  https://www.heartmath.org/research/research-library/basic/heart-brain-neurodynamics/

[7] Grewn, K., and Light, K.C.  Plasma oxytocin is related to lower cardiovascular and sympathetic reactivity to stress.  Biol Psychol.  Volume 87: 340-349 2011 doi:10.1016/j.biopsycho.2011.04.003

[8] You may do so by putting your hand over your heart or feeling your pulse at the wrist at the base of the thumb (don’t do so in the neck).

 

At the times in my life that I had been upset or angry, a good hug was usually a very quick remedy for what was ailing me.  After receiving a warm and genuine embrace from a loved one or friend, the tension in my body would melt almost immediately.  And while my problem did not change in that brief moment, my reaction to it had.

I have witnessed the same in others—and guess that you have also.  Imagine that someone close to you is giving you a nice hug.  Can you feel the relaxation wash over you?  Probably why anyone with a sign “free hugs” often gets a lot of business.  Most people know that hugs are a great antidote to stress.

How does a hug deliver such a remarkable effect so quickly?  Touch is a powerful means of communication.  Through touch, another’s intention is readily discernible—comforting or helpful versus antagonistic and potentially harmful.  In the positive, prosocial mode, hugs are one type of touch that relays the message: “I care about you.  You matter.”  Even perhaps for opposing tennis players at the US Open[1].

We require touch to flourish.

Without touch, especially in children,

healthy human development suffers. 

We require touch with other living beings to flourish.  The importance of physical contact was painfully observed in the orphanages of Romania: children who were provided food but not held or hugged had significant developmental and socio-emotional delay accompanied by smaller brains[2].  This means that physical contact is not only critical for how these children behaved, but for the development of the brain itself, something also observed in animals subjected to social isolation[3].

In people subjected to less extreme circumstances, touch affects the response to everyday conflict.  Murphy and colleagues interviewed 404 adults daily for 14 days regarding their health, conflicts, how they felt emotionally (positive or negative), and whether or not they received a hug[4].

People who had received a hug and had an interpersonal conflict reported feeling more positive with less severe negative reactions on that day.  They also showed evidence that hugging may favorably influence the rate of infection from a cold as well as symptoms[5].

As hugs are a great way to relieve the response to stress, it is not surprising that the number of hugs that a woman receives from her partner is highly related to lower blood pressure as well as higher levels of hormone known as oxytocin, colloquially labeled the “love hormone”[6].

Hugs, of course, are a form of touch that share elements with other types, like massage as well as gentle, light touch.  Like hugging, massage is a great way to release tension. 

Hugs and massage both help to release tension. 

They can decrease pain, improve immune responses, 

and change brain patterns. 

Massage has been shown to decrease pain in a variety of conditions, especially pain associated with cancer, back pain, migraines, etc. It affects the biochemistry that mediates pain or sadness[7] and can also lower blood pressure, reduce cortisol[8], improve immune responses, stimulate the vagus nerve, and change EEG (brain wave) patterns.

In pre-term (premature) babies, light massage for 15 minutes over the course of one week caused significant increase in weight gain.  Complementary to the studies of Romanian orphans, it is remarkable that massage helps babies grow, perhaps by changing their metabolism.

Taken together, it is clear that being touched in a loving and caring way can not only decrease stress but can also help nourish the recipient and help them heal, recover, and grow. Physiologically, we observe activation of specific neuronal and hormonal mechanisms that decrease pain, lower blood pressure (and other markers of stress), and better physical and mental health.  Nature gave us this remarkable ability to help and heal one another.

Hugs can help to decrease stress and

can nourish recipients.

The challenge is that social custom and fear of inappropriate contact (and litigation) have decreased our interaction through touching.  In a 1999 study of preschool children from Miami and Paris, Field noted that French parents affectionately touched their children much more than American parents[9].  Associated with this tactile difference, American children showed more aggressive behavior than the French[10].

The discouragement of interpersonal touch is understandably heightened by the inappropriate actions (or reactions) of either the giver or receiver, especially in a highly sensitive and litigious society that rightly has concerns about consent and intent[11]. Despite clear benefits of comforting touch, however, teachers, doctors, and many others have been admonished to be very careful about whom and how they touch someone else[12]^,[13].

There are creative efforts to satisfy the need to be touched.  Entrepreneurial “professional cuddlers” have opened up shop in different cities, offering a variety of non-sexual ways to be held and with pop up events in different locations[14].  And, as expected, there are tech based solutions, such as a hugging vest, a chair that hugs its occupant, as well as pillows that hug and also communicate with your smartphone[15].  Japanese efforts are particularly notable in the tech approach, perhaps related to the degree of stress reported in Japan.

Even seeing people hugging or touching can 

have a positive impact on brain function. 

A complementary approach may be to allow people see hugging or touching in a gentle way.  Peled and colleagues found that when people simply see images of other people hugging, they exhibited significant EEG changes.  The larger brain wave changes correlated with people who had greater empathic responses to the images[16].

This work is consistent with Envision Kindness’ own research: that images of kindness and compassion, many of which capture caring touch or hugging, are a proven and potent way to induce joy, love, optimism, and connection.  Thus, by simply looking at these images, people can experience lower stress and greater joy. 

Viewing these images should be rounded out by the real thing whenever possible.  So here’s a challenge for you, the reader: begin a regular practice of hugging others.  Start with people you are comfortable with—friends and family.  Try to give at least one each day—you don’t have to wait for National Hug Day (January 21) to do this.  And as you feel comfortable and the situation warrants it, consider extending yourself.  A hug is a gift to someone else.  And remember, giving to someone else is also a gift to you.

With hugs and kindness,

David (Prof K)

[1] https://www.nytimes.com/2019/09/06/sports/tennis/us-open-hugs.html?action=click&module=Editors%20Picks&pgtype=Homepage

[2] https://www.apa.org/monitor/2014/06/neglect

[3] Cacioppo, S. et al.  Toward a neurology of loneliness.  Psychol Bull. 140(6): 1464–1504 2014

[4] Murphy, M. et al.  Receiving a hug is associated with the attenuation of negative mood that occurs on days with interpersonal conflict. PLoS ONE 13(10):1  2018 

[5] Cohen, S. et al.  Does hugging provide stress-buffering social support? A study of susceptibility to upper respiratory infection and illness.  Psychol Sci  26(2): 135–147 2015 

[6] Light et al More frequent partner hugs and higher oxytocin levels are linked to lower blood pressure and heart rate in premenopausal women.  Biological Psychology 69 (2005) 5–21 doi:10.1016/j.biopsycho.2004.11.002

[7] Such as Substance P and serotonin.  See Field Massage Therapy Research Review Complement Ther Clin Pract. 2014 November ; 20(4): 224–229. doi:10.1016/j.ctcp.2014.07.002

[8] A hormonal mediator of the stress response

[9] Field  Social touch, CT touch and massage therapy: A narrative review.  Developmental Review (2010) 30:367-383.  https://www.sciencedirect.com/science/article/pii/S0273229711000025?via%3Dihub

[10] Also observed in adolescents

[11] https://www.theguardian.com/society/2018/mar/07/crisis-touch-hugging-mental-health-strokes-cuddles

[12] https://www.theatlantic.com/education/archive/2015/01/the-benefits-of-touch/384706/  http://theconversation.com/touch-creates-a-healing-bond-in-health-care-59637  https://www.nytimes.com/2018/10/08/well/live/the-importance-of-medical-touch.html

[13] https://www.themdu.com/press-centre/press-releases/hugging-a-patient-could-land-doctors-in-hot-water-mdu-advises

[14] http://www.cuddleparty.com/about/ and https://cuddleuptome.com/

[15] There is a research study that this last device is associated with a decrease in cortisol. See Sumioka and colleagues: Huggable communication medium decreases cortisol levels.  Sci Reports 2013. https://www.nature.com/articles/srep03034

[16] Peled et al The role of empathy in the neural responses to observed human social touch.  Cogn Affect Behav Neurosci (2016) 16:802–813 DOI 10.3758/s13415-016-0432-5  

Once a month I volunteer at a meal center to help serve food to people who are in need.  Prepping and serving the dinner is a busy yet fun team activity of 5 to 6 people, organized by two generous souls.  Despite the many other things that I need to do, I really look forward to meeting and serving the patrons, even if only briefly.

Although my motivation begins with wanting to help others and being grateful for what I have been given, it is joy that helps bring me back when I am very busy.  I first noticed this sometime ago: at the end of our shift, after the kitchen and dining room have been cleaned up, I would experience a lightness of being, a sense of satisfaction and reconnection to purpose.  It just feels good.

When we volunteer, we experience a helper’s high,

a sense of euphoria that has direct benefits 

to our health.  

Allen Luks coined this feeling “the helper’s high”, the sense of euphoria that can be experienced soon after helping someone else.  Luks defined two phases—the first characterized by that uplifted, euphoric mood; the second by a longer lasting sense of calm.  The greatest effect (the high) was observed in helping strangers.[1]

A few years ago, as I was researching how kindness affected health, I came to learn that volunteerism was associated with a markedly lower risk of dying.  Depending on the study, the decrease in death rates ranged between 20-60% or so.  For perspective, this is huge.  A good example is the introduction of clean drinking water.  After water filtration and chlorination were introduced early in the 20^th century, death rates from contaminated water dropped about 15-20%[2].

The observations on volunteering come from epidemiologic studies in which populations are followed over time[3].  They are complex in that people are living their lives and there are a lot of what are called “confounding variables”—different things happening at the same time.  For example, people are getting married or divorced, getting or losing jobs, maybe quit smoking, maybe eating and exercising better.  Science like this can be hard to sort out cause and effect.  That is, maybe people who volunteer live longer simply because they are healthier and able to volunteer.  And perhaps they also have financial resource (don’t have to work two jobs) which frees them to volunteer.

People who volunteer live longer. 

Studies suggest that volunteering

causes decreases in death rates

ranging between 20-60%! 

Scientists can try to adjust for these different life events—with reasonable consistency, studies generally report that the effects of volunteering remain after these adjustments.  Following them over time also supports this idea—that volunteerism reduces death.  One recent and large European study found that self-reported health scores were significantly better than in volunteers than non-volunteers—the difference in scores equivalent to about 5 years of aging[4].

How could volunteering cause a decrease in death?  There are several factors at play.  The first, and likely most significant, is uplifted mood, that is, lower stress.  Multiple studies have provided evidence that volunteering is good for depression, well-being, and social network, among other effects[5].  It is entirely consistent with Luks’ observations and my own microcosmic experience.  Second, people who volunteer regularly also make more effort to take care of themselves, as demonstrated in visits to their doctor for preventive health care[6].  Perhaps their networks are chiding them to do so.

Finally, people who volunteer may be more physically active, as seen in the Baltimore Experience Corps Trial, a study of the effect of volunteering in older adults.  In that study, women (but not men) had a significant increase in walking each day compared to those who did not volunteer[7].

Volunteering is good for depression,

well-being, and social network. 

To try to tie this together, volunteering likely exerts its positive effects on health by connecting people to others as well as to an activity that they find meaningful.  Achieving connection, purpose, and meaning is critical to attenuating stressors of life—particularly loneliness.  Since stress is a major cause of disease, especially heart disease, the ability to quench the need for connection, purpose, and meaning can bring about beneficial and salutary changes for people[8].  And when there is purpose and we are connected to others, we take of ourselves.

Most have heard the ancient wisdom that giving benefits the giver more than the receiver.  “A generous man will prosper, he who refreshes others will himself be refreshed” from Proverbs speaks to this point.   If we look at that solely from a materialistic perspective, the concept is hard to fathom.  But if we look at it from a spiritual and now biologic perspective, it totally makes sense.  Even many years ago, our predecessors understood this point without modern scientific techniques.

About 25% of the US population volunteers[9].  What do you think would happen if we could increase that?

And if you can’t volunteer right now but want to get that good feeling, try looking at the images of kindness, compassion, and love on Envision’s site.  Or go out and photograph it[10].  We know that even seeing kindness will give you that feeling.

In kindness,

David (Prof K)

[1] A. Luks “The Healing Power of Doing Good”.  Fawcett Columbine 1991

[2] https://www.prb.org/cleanwatershistoriceffectonusmortalityratesprovideshopefordevelopingcountries/

[3] These are studies in which a population is observed for specific characteristics.  There is no intervention—just watching what happens.

[4] Detolleneare and colleagues: Volunteering, income, and health PLoS ONE · March 2017

DOI: 10.1371/journal.pone.0173139

[5] Anderson and colleagues: The Benefits Associated With Volunteering Among Seniors: A Critical

Review and Recommendations for Future Research Psych Bull 2014  DOI: 10.1037/a0037610

[6] Kim and Konrath: Volunteering is associated with health care use among older adults.  Soc Sci Med. 2016 doi:10.1016/j.socscimed.2015.11.043

[7] Varma and colleagues: Effect of community volunteering on physical activity.  Am J Prev Med. 2016  doi:10.1016/j.amepre.2015.06.015.

[8] This concept is discussed in SoK #3. 

[9] https://www.cnn.com/2018/07/19/us/volunteering-statistics-cfc/index.html

[10] Our new kindness photo contest “Our World Is Kind” is just starting up—