Scientists are putting more effort into studying complementary therapies, including hypnosis, meditation and yoga, that may ease pain with fewer side effects and help people manage their own symptoms. Read more
Recent research suggests chronic stress damage starts before we’re even conceived and cuts into our very cells. A number of studies have linked stress with shorter telomeres, a chromosome component that’s been associated with cellular aging and risk for heart disease, diabetes and cancer.
How do personality and environment play into this phenomenon? Read more (Monitor on Psychology, Oct. 2014)
Debbi Heffern was too busy caregiving to go for that colonoscopy.
A dietitian and lactation consultant in St. Louis, Missouri, Heffern had been a caregiver for decades; first, for her mother, who died of cancer; and then for her mother-in-law.
“My mother-in-law was determined to live on her own. I made sure we jumped through all the long-term care insurance hoops in the right order, and had to line up paid caregivers. When she took a turn for the worse or needed new equipment I had to be on top of all that. Then her identity got stolen. Untangling that was a nightmare,” Heffern says.
Sure, Heffern had recently turned 50, but she had a healthy life style, except for the stress, and who had time for a colon cancer screening? Unfortunately, she had an ugly surprise when she was tested three years later.
“I ended up with stage four colon cancer, which required multiple surgeries and 32 rounds of chemo. While my employer was very accommodating, recovering from surgeries and all that chemo meant a lot of time away from my own job. If I had gotten my screenings when they had been recommended, I’m told I might have had only stage two or three, and perhaps wouldn’t have needed two of the surgeries or so much additional follow-up chemo,” she says.
“Four in 10 adults in the U.S. are caring for an adult or child with significant health issues, up from 30 percent in 2010,” according to a recent national survey by Pew Research Center. Given our aging population, that number is almost certain to increase, with employers taking a chunk of the burden, at least financially: A 2011 Gallup study says full-time employee absenteeism due to caregiving duties costs employers some $25 billion annually.
What is less obvious is the hidden impact caregiving has on employee health. Byproducts of unrelenting stress, such as depression and poor sleep, and a lack of attention to personal health, including nutrition and exercise or — as in Heffern’s case — neglecting preventive care, take a toll. Eliza Corporation of Danvers, Mass., a leader in health engagement management, in partnership with Altarum Institute, developed the Vulnerability Index (VI) to help insurers and employers measure how life issues like caregiving, financial troubles or marital problems impact employee health. The Company says the index has three times the predictive power of self-reported health problems than traditional measures.
According to their research, these vulnerability factors make people much more susceptible to chronic conditions such as mental illness, lower back pain and diabetes. Caregiving shows a particularly strong link; caregiving employees are nearly three times more likely to be highly vulnerable to health issues than non-caregivers. The Pew study also showed that caregivers were more likely to have faced a recent health crisis than non-caregivers.
Caregiving measurably impacts employer health costs, too; according to a 2010 study of the MetLife Market Institute and the National Alliance for Caregiving, health care costs for caregivers are roughly eight percent more than non-caregiving employees, costing employers an estimated $13.4 billion per year extra.
Tracking a clear relationship can be tough, however, as employees are not likely to bring topics like caregiving — Eliza Corporation calls them “The Unmentionables” — to the fore.
Jon Seaman, Director of Caregiver Solutions at Care Innovations, an Intel-GE joint venture that develops technology for remote care, survived kidney disease and a transplant, then helped his wife care for his elderly mother-in-law through a series of health crises. In talking with him, one gets the feeling that the latter was the more stressful experience.
“I think because it was so obvious that I was ill at work, I was very up front. ‘I’ve got these things going on. Can you support me? But with caregiving, some of the details that would help explain where my time went were very private to my mother-in-law. I didn’t know what I could share. I didn’t think I could really talk about her incontinence, for example. The whole situation was so harrowing and depressing,” Seaman says.
Further, many caregivers don’t self-identify as such.
“People don’t even know they’re doing it. It’s just what they’re supposed to do as a family member. They often have no choice but to be a caregiver. We’re trying to get people to say, “It’s an important point in life to be a caregiver, but you need support,” he says.
The VI research says people are eager for help; about 80 percent of respondents are willing to accept help from their doctor or health plan on an “Unmentionable” issue like financial stress; that rate jumps to 96 percent of people wanting help from either their doctor, their health plan – or just as importantly, their employer – with their caregiving stress. Just being surveyed brings overwhelmingly positive feedback, says Alexandra Drane, Eliza Corporation’s Founder and Chief Visionary Officer.
“The reason people like it is because they know these life stresses are why they’re not feeling well, but nobody asked them these questions before,” she says.
“There is a lot of counseling for cancer patients available both through our insurance company and where I was treated. But I don’t think anybody ever asked me about the caregiving stress,” Heffern says.
Drew Holzapfel, who convened ReACT, a coalition that aims to assist both employees and caregivers, says employers rarely have processes in place to deal with the issue.
“Our data show high awareness of the caregiving responsibilities of employees by their front line manager. What is missing is the action. How do you start the conversation? The tools are not readily available to empower the front line manager,” he says.
Even those organizations that already have invested in tools like this to address caregiving and other life-context issues often have trouble gaining traction – simply because people don’t know about them.
“For the past few years, Cigna has been refocusing its business on the individual,” said Joan Kennedy, vice president for consumer health engagement for the health service company. “We have invested in resources and experts to help people with coaching services, care management programs, and employee assistance programs. The challenge is that many people just don’t realize these resources are available to them.”
Cigna has a pilot program in collaboration with Eliza, using the Vulnerability Index to reach out to individuals that might help, and then connecting them to the resources best matched to their needs, Kennedy says.
As caregiving becomes more common, managers may at least better understand its impact. For one, more executives like Seaman may themselves be caregivers.
“It really does matter if your leadership or direct management has gone through it. When I was a young manager in my early thirties, I had 29 people working for me. I was a stickler at the time for being present in the office during work hours.
“Would I have given them more schedule leniency? Would I have had a team member provide additional support to help them cover issues? I wonder if I would have reacted differently knowing what I know now,” he says.
Published on The Huffington Post
The following is an interview with Elissa Epel, a UCSF psychologist who has studied the health impacts of stress, from its effects on our DNA to its relationship to overeating, for two decades. Published on The Huffington Post, 4/3/2013
Some of your research has centered on the way that stress hormones contribute to increasing our drive to eat, particularly high-carbohydrate and high-fat “comfort foods.” To what degree is stress contributing to our national obesity crisis, in your opinion?
EE We can’t quantify exactly how big of a role stress plays. It could be huge. It’s invisible and it’s easy to ignore; it’s pervasive. Most of us have gotten so used to living in a matrix of stress – time pressure, demands, rushed social interactions, rushed eating – that we don’t even notice it. So we might not realize how stressed our body really is. But the effects of stress can still stimulate our appetite, and shift us to choosing more ‘white food’ – what we call “comfort food,” – high-calorie, high-fat food. This promotes metabolic disease because it causes us to store calories in the visceral area and liver. And that stored fat is at the core of many chronic diseases, not just diabetes.
I was surprised to see your study showing educational attainment is also related to telomere length. Why might that be?
EE That relationship is multi-layered and needs to be unpacked. One common theme in trying to understand health disparities is testing whether part of it stems from greater stress exposure or reactivity over a lifetime. For example, the effects of more years of education early in life can be seen decades later, in longer telomere length. Higher education, or maybe it’s the quality of education, can create an infrastructure in the brain for more adaptive coping – it can help with strengthening what we call ‘executive function’ -which helps us think clearly under stress.
Conversely, there are many active ingredients in the milieu of low socioeconomic status that cause wear and tear. Interestingly, though, perception can play a large role here. We have measured this by giving people a picture of a ladder and asking them to place themselves on a rung (the bottom rung being the lowest status). Rating oneself as low, regardless of actual income or education, relates to poor adaptation to stress. Specifically, when given the same task to do in the lab, people low on the ladder reacted hotly each time, as if it were new, instead of habituating to it. There is also the built environment of low socioeconomic status, which doesn’t leave opportunities for buying healthy food and places for exercise or safe walking. And the built environment can feed back and affect how people feel. For example, fewer parks or more liquor stores predict a decreased feeling of neighborhood trust and cooperation.
There seems to be a big disconnect between what people know is good for their health, and their actual behaviors. Is mindfulness – focusing on what we’re doing right now, in the present moment – the missing link, do you think?
EE I think that’s right on. We can’t possibly regulate our behavior and feelings, and suppress those pesky but strong impulses and other distractors, if we are not paying attention. In a high-stress environment, our brain activity shifts toward the limbic system and the emotional stress response, and away from the parts of the pre-frontal cortex that house executive control systems, the rational and analytical drivers of our behavior. So we react automatically and impulsively when we are under stress and not paying full attention.
And even if we are focusing a lot of effort on eating better or exercising, but in a really self-critical way, this can sabotage our efforts as well. Very few people meet their exercise, sleep, and nutrition goals each day. So mindful attention includes both an intention and a kind attitude, and these help clear our mind of unhelpful or intrusive thoughts, and improve our ability to carry out our intentions.
Eating is an interesting example of a behavior that is not under our full conscious control, although we have not admitted that yet. Eating is something that we can do without paying attention. Otherwise, if it took focus and effort, that wouldn’t be part of adaptive evolution. Overeating is related to stress but also altered neurobiology of the reward system, the source of our strongest motivational drives. This reward area responds to palatable food. This can drive compulsive behavior that feels out of control, an experience similar to being a drug addict for some people. We have to better understand how powerful certain types of foods can be, and that certain conditions, including stress, make people especially susceptible.
In some of our studies, we are trying to help low-income people who feel very little control over their life, with their weight. We are teaching mindfulness to pregnant women, and it looks like the training might be helping not only them but also their babies. We have to think of ‘stress reduction’ where it matters most – which includes the womb. Prenatal stress exposure can affect a child’s health for a long time, possibly a lifetime. For example, mothers who have experienced major stresses while pregnant have offspring with shorter telomeres.
One of many intriguing facts you mentioned in your TEDMED 2011 talk was that technology can actually increase stress in various ways. At the same time, we’re seeing a slew of new apps aimed at helping us to calm down.
EE I think mobile apps for stress reduction are a fabulous potential use of technology, if they really work. For example, we could be using our mobile phones to remind us to rejoin with the moment, and to breathe fully, to notice our physical body and become embodied again. We live mired in our thoughts, above the neck, and this is made worse by multitasking.
But technology devices can become part of multitasking, thus adding to the strain on our limited attention, splitting it yet one more way. There are a lot of wellness apps out there, but I also think that we need data. Almost none of them are evaluated so although they seem promising, do people really benefit from them in a way that would lead to meaningful change? This is a powerful way to reach people, and I admit that even I am involved in an effort to test a stress reduction app!
There are so many answerable questions: Can we take people deeper into a meaningful life, or do these technology interventions contribute to fractured attention and more shallow social interactions? Do people stick with them? Do the apps make a dent in chronic stress arousal over time? As a society we desperately need stress reduction. Let’s hope we can use technology to get there.
If you had the power to enforce one public health measure based on your research, what would it be?
EE Public policy makers try to use their resources well to help people, but don’t always think about how to make policy motivating to an individual, nor take into account fundamental causes of societal and individual stress. Stress is caused by a perception of lack of control and unpredictability. Policymakers can promote empowerment, helping disadvantaged people gain a sense of control over their daily life. Social scientists understand which social and structural factors need to change to help individuals change.
A main message of research today, from epigenetics in basic models to epidemiology, is that adult health is shaped early in life, in important ways we can no longer ignore. So resources are best spent early in life, with the goal of promoting good health and habits, and preventing disease. Good quality education is critical, particularly for girls. It directly translates to better health behaviors and eventually health for the next generation. Resources are just much less effective when applied to diseases that are incurable and costly to manage. Our money is spent in an unbalanced and illogical way. We skimp on education — particularly in California — and spend a tremendous amount of money and time trying to cure incurable diseases such as obesity. Instead, we spend big money on bariatric surgery and costly band-aid procedures.
Has your research changed any of your own personal or work habits?
EE It has, but only in an incremental way over many years. I have been studying the field of stress for almost 20 years, so I know all too well what we should be doing, and how my behaviors such as curtailing sleep and having too many demands placed on me affects my daily physiology, and cellular stress. Does that mean I get enough sleep, exercise, meditate every day, keep work manageable, and prioritize the things that are most meaningful, versus the most urgent? No. I am closer to that than I used to be, and maybe in another stage of life… I still experience plenty of challenging situations, and have my reactions, but now in a more mindful way, and that is a qualitatively different experience. Like most people, I am a work in progress.