SURGEON GENERAL’S RX FOR STRESS IN AMERICA

The National Institutes of Health (NIH) has put itself firmly on record as being deeply concerned about our national epidemic of stress at the individual, organizational and societal levels. NIH’s National Center for Complementary and Integrative Health (NCCIH) broadcast on September 7th its annual Stephen E. Straus Distinguished Lecture in the Science of Complementary Therapies. The lecture was titled A Nation Under Pressure: The Public Health Consequences of Stress in America.

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PROMOTING RESILIENCE WITH OPTIMISM AND MINDFULNESS

The American Psychological Association (APA) recently documented a worrisome increase in stress in the U.S. population (Stress in America https://www.apa.org/news/press/releases/stress). Uncontrolled stress can cause or worsen anxiety, depression, PTSD and a wide range of clinical conditions affecting every organ system. Medical students, residents and practicing physicians experience higher levels of stress than their age-matched counterparts at all levels of medical training....

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ALLOWING AWE IN MEDICINE

Of all the sciences, medicine uniquely combines all domains of the human condition-biological, cognitive, emotional, environmental, interpersonal and transpersonal. The more we learn about the benefits of the interpersonal and transpersonal dimensions of health, disease and medical practice, the more we seek to populate medical schools with well-rounded students and humanize medical training and the healthcare workplace.

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patients…A change in culture is needed. Health professional training must emphasize the importance of self-care, stress management and resiliency training. We have enough research to justify this shift already and more is needed to weave emotional well-being into the curriculum and patient care in hospitals and clinics.” Recognizing this, the AMA now provides members a 2 year subscription to the Headspace meditation and sleep app. The Department of Homeland Security promotes mindfulness and meditation to its employees.


Importance of physical exercise

Murthy explained that regular physical exercise has been shown to relieve stress and have an anti-depressant effect for many people. Exercise-related increases in endorphins play a role in this positive emotional side-benefit of exercise. Happily, the choice of physical activity can be highly personal. Choosing an activity one enjoys increases the likelihood of regular practice and long-term commitment. Yoga, gardening, aerobics and walking illustrate the widely accessible  range from which one can choose to reduce stress and promote resilience. Having a buddy with whom to exercise can help keep us motivated and combat loneliness.


Emotional well being

Murthy began his tenure as Surgeon General with a  ‘listening tour,’ traveling extensively to U.S. cities and small towns and was struck by a common theme. He saw people in pain everywhere—pain from medical conditions, financial uncertainty, violence, stress of daily life and work—and the pain and grief of losing family to the opioid crisis. Regardless of geography, urban or rural residence, race, age, beliefs, background or political party, there was universal recognition that stress was overwhelming Americans’ ability to cope. Among lawmakers and citizens alike, the desire for emotional well-being was the one issue people everywhere agreed upon. He ended his tour convinced that addressing stress and emotional well-being is critical to maintaining our individual health and the health of our society.


Murthy passionately argues for a societal, public health perspective on stress and emotional well-being. “When we have stress and emotional discord that prevent us from coming together and talking about solutions to big problems as a country, that affects us all…We know from data that people who say they have a best friend at work are much more likely to stay in that job, be productive and not burn out… I believe we can build a country that is more compassionate and that is more kind—recognizes that our emotions, when properly cultivated, are our greatest source of strength.”


Meditation

Brown University School of Public Health recently created a Mindfulness Center to apply evidence-based behavioral approaches on an individual and population scale. Murthy encourages his staff to practice meditation together and is impressed with the support and rapport this creates. Just as the reasons for this epidemic are complex and multifactorial, our prevention and treatment approaches must also be varied and tailored to the educational, cultural, social, religious, financial and medical demographics of affected individuals and groups. Murthy touts the benefits of mindfulness and meditation, including practices that increase compassion, empathy and kindness, for ourselves and for others.


Psychotropic medications are an essential, and sometimes life-saving, treatment option. But we will not medicate our way out of this epidemic. Health professionals and patients are also concerned about the unintended dangers of polypharmacy and an over-medicated society. These dangers are more common in the elderly, who are more likely to have multiple chronic illnesses- but people of all ages are vulnerable to the medication burdens of cost, side effects, drug interactions and the sense of dependency on pills.


Meditation can be practiced alone, with a meditation buddy or a group. Dr Patterson offers a free weekly group class as well as an 8 week intensive mindfulness based stress reduction course (MBSR). Let’s help ourselves and each other manage this epidemic of stress and loneliness. In the process, we can gain confidence prescribing lifestyle recommendations for our family, friends, colleagues, patients, communities, society and planet.


Resources


US public health officials are alarmed by a growing mental health epidemic  of  stress,  anxiety,  depression,  loneliness,  substance  abuse and  suicide.  Britain  has  created  a  Minister  of  Loneliness  to  tackle this  ‘sad  reality  of  modern  life’  and  its  $3.5  billion  annual  drain  on  UK  employers. Vivek  Murthy  MD  is  the  21st  US  Surgeon  General.  He  was  also  the  19th  Surgeon General  under  president  Obama.  He  is  focused  on  loneliness  and  stress  as  public health priorities, saying ‘loneliness is associated with a reduction in lifespan similar to that caused by smoking 15 cigarettes a day.’ In early 2020, before the COVID pandemic, he presciently published  a  book  titled  Together-  The  Healing  Power  of  Human Connection in a Sometimes Lonely World.


Authentic social connections

Despite widespread electronic social media, many people feel isolated. This was happening before the COVID pandemic and has gotten worse. Murthy says “a quarter say they do not have anyone in whom to confide about a personal problem.” Clearly, online social networks can be helpful but are not the kind of support required to combat emotional isolation and its adverse health effects. However, though in-person classes and meetings are curtailed or cancelled, technology also provides access to meaningful interpersonal support from peers and groups with which we are affiliated in ways that are meaningful and rich in purpose and values. Technology connects patients and providers, teachers and students, friends and families- as well as continuing education, culture, art, information, music, humor and endless opportunities to learn,

BY JOHN A. PATTERSON MD, MSPH, FAAFP

grow, connect and serve those in need.


Managing stress

Serious psychological distress and loneliness can be caused by social isolation, fear of contracting COVID-19, financial strain, job insecurity, home schooling, uncertainty about the future, political polarization and our increasing violence and ‘bad news.’ This can lead to serious mental illness, suggesting acute distress during COVID-19 may cause longer-term psychiatric disorders. Stress and resilience are major research topics at NIH, the Veterans Administration and the Department of Defense. They are creating a research network seeking non-pharmacologic approaches to chronic pain and PTSD among active duty military and veterans. They focus on traditional military camaraderie as well as individual mind-body practices such as art, movement, faith, prayer, mindfulness and meditation.


Murthy says: “Stress is not evidence of weakness or a personal failure but a reality of life and we have to collectively figure out how to address it… Supportive relationships, exercise, sleep and meditation can benefit children, adults, workplaces, homes, schools, public health and medical providers and their

JOHN A. PATTERSON MD, MSPH, FAAFP

Dr Patterson chairs the Lexington Medical

Senator Alvarado earned his bachelor's degree in biology from Loma Linda University (California) in 1990, and then went on to receive his Doctorate in Medicine in 1994. He completed his medical residency in Internal Medicine and Pediatrics at the University of Kentucky in 1998. Society's Physician Wellness Commission and is certified in Physician Coaching. He is on the family practice faculty UK College of Medicine and teaches nationally for Saybrook School of Integrative Medicine and Health Sciences (San Francisco) and the Center for Mind Body Medicine (Washington, DC). After 30 years in private family practice in Irvine KY, he now operates the Mind Body Studio in Lexington, where he offers integrative mind-body medicine consultations specializing in mindfulness-based approaches to stress-related chronic conditions and burnout prevention for helping professionals. He can be reached through his website at www.mindbodystudio.org