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02 MAY 2017
How to handle chronic stress
At a recent symposium in Philadelphia, former U.S. Surgeon General Vivek Murthy had a question for the audience: Does society consider emotions a source of weakness – or power? "Weakness" was the consensus among those who raised their hands, but it appears that most got the answer wrong.

"Emotions are a source of power," said Murthy in an interview with Wharton marketing professor Patti Williams at the April 12 event, "Under Pressure: Using Emotion as Power Over Stress," held by the Leonard Davis Institute of Health Economics at the University of Pennsylvania. "I’m not saying that because that’s my philosophical belief. I’m saying that because that’s what science actually tells us.

"When we are predominantly experiencing positive emotions, whether that is gratitude or inspiration or a sense of awe or connection or love, we are able to do more, we are able to handle more, we are able to perform better," said Murthy, an appointee of President Barack Obama who announced on April 21 that he had resigned after being asked to step down from the post by the Trump administration. "When we are predominantly experiencing negative emotions, like fear or anger or jealousy or rage, we may find that in the short term, that may motivate us to do more, but in the long term, it saps us of our strength, of our vitality and of our energy."

Take the experience of high-performance athletes. "The key to success is not just physical fitness," Murthy said. "It’s also emotional fitness. That’s why the mental game is such an important part of how athletes train, and it’s what makes the distinction between those who win and those who come up short." For example, when a professional tennis match enters the fifth set, he said, victory hinges on the player’s mental game as the competition runs through the final stretch.

"Emotional well-being is that force that allows you to be resilient in the face of adversity, it’s what allows you to function at the top of your performance scale," Murthy said. But too often, people have a limited understanding of emotional wellness, mainly equating it with being free of depression, anxiety or other mental dysfunctions. "Emotional well-being is more than the absence of mental illness. We want people to not just be free from disease. We want them to function optimally."

Linking chronic stress to disease

To be sure, not all stress is bad. Short-term stress - facing a deadline for a paper, playing the final minutes of a basketball game - can enhance one’s ability to perform. "Chronic stress," however, "is a problem," Murthy said. "Chronic stress is when that acute response continues for a prolonged period of time." When stress stays around for a while, "the impact on us is physiological. The effect on our body is not a healthy one."

Murthy said that when there are "prolonged activations of your stress responses and prolonged elevation to your cortisol levels … [it can] increase your risk of cardiovascular disease, cancer and a host of other chronic illnesses." He further said that chronic stress is a form of pain - both physical and emotional. "It’s instructive that pathways in our brain for emotional pain and for physical pain are very similar and you can actually experience emotional pain as physical pain."

As surgeon general, Murthy said one of his responsibilities was to provide scientific information so people can make good choices about their health. "It became very clear to me that if we do not address chronic stress in our country, if we don’t look for ways to enhance emotional well-being, then we will be failing to address an important, critical driver of our wellness," he said.

The epidemic of loneliness

Murthy cited the seminal work of Martin Seligman - a University of Pennsylvania professor known as the father of positive psychology - linking gratitude and other positive emotions to happiness, which can alleviate stress. In one experiment, participants were asked to write down three good things that happened each day for a week. Six months later, they were still happier and less depressed than when they started out. "Gratitude is a really powerful emotion and one that can influence how we look at our lives more broadly," Murthy said.

Feeling socially connected is also important to emotional health. Human beings have evolved to be "socially connected creatures," Murthy said. "That’s not to say we all have to be extroverts. Whether you are an introvert or extrovert, you still need some degree of social connection. The question is how much." Back when mankind existed mainly in tribes, he said, those with social connections were more likely to have a stable food supply and more able to protect themselves from predators.

"Connection matters. When we are isolated, when we are subjectively lonely, that actually puts us in a stress state because that’s not how our body was built to operate," Murthy said. "That stress can have a lot of the adverse effects [similar to] stress [coming] from other sources." It might surprise one to know that alongside chronic illness, poverty, discrimination and violence, loneliness actually can contribute to chronic stress.

"The reason loneliness is important for us to think about is it’s right under our noses," Murthy said. And it is a growing epidemic: In the 1980s, 20% of adult Americans said they were lonely, he said. Today, the percentage has doubled to 40%, "despite the fact that we live in the most technologically connected age in the history of civilisation," he said. "It’s because technology in some ways has been looked at as the solution to connection. We have a lot of social media platforms. But the problem is that we have forgotten that not all relationships are the same."

Murthy continued: "The kind of gratification and nourishment that you get from a deep relationship with someone who understands you and whom you understand is different from somebody you friended on Facebook [after you saw them] for two minutes [at] a conference three years ago" and had very little interaction with since then. "Those are not equivalent relationships." Research shows that online tools can help strengthen offline relationships. "But if online platforms become a substitute and in fact diminish our offline relationships, that’s when things can be a little bit dangerous and we run into challenges with isolation," he said.

Building a socially connected america

To build a more socially connected country, it starts locally. "It starts with how you build connections right here on campus, in your community or [in your city]," Murthy said. By strengthening social ties, a society becomes healthier as well. It is part of the "solution for us to increase wellness rates and help address drivers of addiction and other illnesses."

Murthy confessed that when he was younger, he didn’t handle stress very well. "I put a lot of demands and expectations on myself. It wasn’t imposed upon me by my parents or teachers. I had a lot of self-imposed standards and I wasn’t always able to meet them - and that was really stressful and it was really isolating," especially since he tends to be shy, he said. In retrospect, he recognized that "connections can be therapeutic. If I had known that, I would have pushed myself more … to reconnect in times of stress with people who understand me or see me for who I am." Exercise is also therapeutic, Murthy added.

"One thing I wish that I had also done is that I more proactively reached out to others who are experiencing stress," Murthy said. "There were people who saw my stress - they didn’t reach out to me because they didn’t want to make me uncomfortable and they didn’t want to invade my privacy. Privacy is important, but we all have the ability to be that source of relief, to be that source of therapeutic potential to people around us."

Hand in hand with social connections is recognizing the "power of pausing," Murthy said. "There are times when pausing is what we need to step back from the craziness of the day-to-day. We are living a life of experiences that are coming at you from mobile devices all the time." The human heart exemplifies the benefits of pausing, he said. In the systole phase, the heart ejects blood to vital organs such as the brain, lungs and others. In the diastole phase, the heart takes a moment to refill with blood. "Pausing, in fact, is what sustains the heart," Murthy said. "There is a powerful lesson in there for us.

"If we can build those moments of pause into our lives, whether it’s a meditation practice you have or a moment to breathe before you jump into a new endeavor, or just standing still outside a patient’s door before you greet them and provide them with care," Murthy continued, "those moments of pause can also help sustain us."

In the end, two emotions drive the decisions we make: love and fear. Everything else is a manifestation of one or the other, Murthy said. Love manifests itself as generosity, kindness and compassion. Fear shows itself in jealousy, anger and rage. "When fear drives our decisions, more often than not it tends to lead us to darker places. It tends to have negative impacts on our health and it tends to drive us apart, separate us and isolate us," he said. "When love is driving our decisions, and informing our interactions with each other, it tends to be nourishing, it tends to be good not only for our health but it also builds that connection, that cohesion in society that we ultimately need."
Useful resources:

Knowledge@Wharton
Knowledge@Wharton is the online research and business analysis journal of the Wharton School of the University of Pennsylvania. Visit our InfoCentre or website.

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