Family Stress Archives - The American Institute of Stress https://www.stress.org/category/family-stress/ Thu, 06 Jun 2024 16:09:06 +0000 en-US hourly 1 https://wordpress.org/?v=6.5.4 https://www.stress.org/wp-content/uploads/2023/07/AIS-Favicon-100x100.png Family Stress Archives - The American Institute of Stress https://www.stress.org/category/family-stress/ 32 32 New Research Sheds Light on the Impact of Stress on Tobacco Users https://www.stress.org/news/new-research-sheds-light-on-the-impact-of-stress-on-tobacco-users-2/ Sun, 02 Jun 2024 20:12:56 +0000 https://www.stress.org/?p=68690 Why My Father Never Spoke About His Heroism During WWII  https://www.stress.org/news/why-my-father-never-spoke-about-his-heroism-during-wwii-2/ Wed, 06 Mar 2024 14:41:03 +0000 https://www.stress.org/?p=84287 By Nadia Rupniak, PhD 

*This is an article from the Winter 2024 issue of Combat Stress

A letter found after my father’s death led me to discover his military decorations and the brutal retaliation inflicted on his family. 

 The transition from military service to civilian life presents many challenges for Servicemen and Servicewomen. They may have experienced combat trauma, the deaths of close friends, and political changes that seemingly negated their sacrifices. Recently, I discovered the terrible burden that my father, Captain Marcin Rupniak, took to his grave. 

At my father’s funeral, I felt as if I’d never really known him. Why had a man with his remarkable intellect settled for menial work in a factory that was far below his capabilities? Why had he not made more of his life? Whenever I asked him about it, his explanation left me none the wiser: “Because of the war, my girl.” 

I had no idea what he meant by that because he never spoke to me about the war. All I knew was that he had been a captain in the Polish army and could never return to Communist Poland because he would be arrested and shot. I didn’t know that the Polish army had made heroic contributions to the allied liberation of Europe in 1944. Fighting alongside American, British, and Canadian troops, they played pivotal roles in the victories at Monte Cassino1 and Falaise.2 

After the war, my dad corresponded regularly with his brother, Tomasz, in Poland, but the contents of their letters, written in Polish, were a mystery to me. When the Soviet Union collapsed in the 1990s, Tomasz’s daughter, Helena, came to visit my dad. I couldn’t speak a word of Polish, nor she English, and so our limited communications went through him. As a result, I learned almost nothing about her or the reason for her journey. 

It was not until both my parents had died that I discovered my dad’s family were victims of a Soviet genocide. Such was my dad’s secrecy about his family that my mother had written to Helena after her visit, requesting information. Among her personal papers, I found Helena’s reply. It said that during the war, my grandmother (aged 68) and three uncles were arrested and deported to Siberia because my dad was an officer in the Polish army. 

I found Helena’s letter truly shocking. All those years, my dad lived with the guilt that his mother and brothers had been targeted because of him. This Soviet aggression explained why he could never set foot in Poland again. And my poor grandmother. How much suffering had this elderly woman endured? No wonder he didn’t want to talk about it. 

I arranged to visit Helena to learn what had happened to our family. In case she was no longer at the same address, I also searched for other Polish relatives on the internet. When I typed “Rupniak” into the search engine, I was astonished to find a website listing my father as a recipient of the Virtuti Militari, the Polish equivalent of the Medal of Honor.3 I was in complete disbelief. Surely, this had to be an error. How was it possible that he had earned such high military distinction and never said a word about it to me? I promptly requested a copy of his military records. 

Some months later, a large manila envelope landed in my mailbox. Inside, a dossier contained dozens of pages that bore my dad’s photograph, the words “Virtuti Militari,” and a war diary written in my dad’s distinctive handwriting. There had been no mistake. My father, a humble factory worker, was indeed a Virtuti Militari.

My friends assumed that I must feel incredibly proud, but that wasn’t how I felt at all. My chance discovery had pitched me into mental turmoil. Why on earth didn’t he tell me about this? Why had he deliberately kept me at such a distance, his own daughter? I was angry with him and ashamed of the lack of respect I’d shown him. I began to question the reliability of all my relationships. If I had misjudged him so badly, how many other good people had I dismissed? 

Researching his service records, I learned that my dad was twice recommended for the Virtuti Militari during the invasion of Poland in 1939. He had shown great courage and leadership by firing on advancing German tanks from an exposed position, forcing them to retreat. During intense fighting, he had maintained command of antitank guns and took over communications when his telephone operator was killed. His cool head in the thick of battle won him the respect of his men and his superiors. 

I read that Stalin had waited until the Polish Army was exhausted from weeks of continuous fighting before joining Hitler’s invasion.4 Unable to fight on two fronts, the Army received orders to evacuate. This march must have been agonizing for my dad, as he would have passed signposts to his hometown. The evacuation left Polish civilians, including his family, defenseless against the brutal German and Russian invaders. 

My dad and thousands of other Polish Soldiers later regrouped in Britain, where they joined the Allied liberation of Europe in 1944. Hundreds of thousands more of these Soldiers, unable to escape, were captured by the Soviets and tortured, executed, or deported to hard labor camps in Siberia. Twenty-two thousand Polish officers were executed on Stalin’s orders, their bodies dumped in mass graves at Katyn.5 This massacre, rendering Poland incapable of launching a military uprising against its oppressors, was an act of genocide. 

While I was researching these events, I heard back from my cousin, Helena. Considering the obstacles in communication I’d experienced with my dad; I was taken aback by her openness. She said that her father, Tomasz, loved his brother Marcin very much and had dearly wished to see him before he died, but travel was impossible during Communist rule. When Poland regained independence, she had visited my dad to fulfill Tomasz’s last wishes. Her letter added, “Marcin was very hurt by what happened to his mother, and he worried about it very much. Please don’t be surprised that he didn’t talk about it.” 

Soon after this, I traveled to Poland and met with my cousins. They told me that it was not only Polish soldiers who were arrested by the Soviets, but also the families of Polish Army officers and others that were deemed enemies. From elderly grandparents to newborn babies, 1.7 million Poles were rounded up and deported to Siberia, my grandmother and three uncles among them. Most disappeared without a trace. 

Armed Soviet Soldiers had come in the dead of night to arrest my grandmother and her sons Ludwik, Michał, and Józef. They were taken to the nearest railway station, where the men were separated and sent to hard labor camps. Józef and Ludwik were sent to a timber logging camp near the Arctic Circle. While working in the forests felling trees, Ludwik was killed by a bear. The death toll from starvation, cold, and disease was so high, that Józef knew he would also die unless he escaped. A locksmith by trade, the guards made use of him to repair locks at the perimeter gates. Twice, he broke out but was recaptured. Subjected to brutal beatings by the guards, he almost died. On his third attempt, he succeeded.  

Most of the women and children were deported to Kazakhstan, a journey lasting several weeks in crowded cattle cars with a hole in the floor for a toilet. Upon arrival, they were taken to remote settlements to work on collective farms. Everything they produced was surrendered to the Soviet administrators in exchange for starvation rations. Constantly bitten by parasites and living in crowded, unsanitary conditions, infectious diseases took many lives.6,7 

When Hitler ordered an invasion of the Soviet Union, the Polish president, Władysław Sikorski, worked with Prime Minister Winston Churchill to secure the release of the prisoners to form an army against Hitler. Stalin agreed, but only one tenth of the Poles were released and evacuated to safety in Iran, which was under British control. The evacuees were in appalling physical condition, emaciated by starvation, infested with parasites, and dying of typhus and other epidemics.8 Miraculously, my grandmother and her sons, Michał and Józef, reached Iran, but soon after their arrival, she and Michał died. Józef, the only survivor, later served with distinction at Monte Cassino. 

The optics were not good for the West’s newly forged alliance with Stalin and an alternative explanation was manufactured to explain the arrival of 170,000 Polish refugees in Iran. Newsreels in America and Britain portrayed the Poles as having escaped from Nazi oppression.9,10 When the bodies of the murdered Polish officers were later discovered at Katyn, the crime was again reported in the West as a Nazi atrocity to preserve our alliance with Stalin.11

In Iran, the Poles were ordered by their British overseers not to divulge their treatment in the Soviet Union, blackmailed into silence to protect their families in occupied Poland and the prisoners still held in Siberia.12 The letters of Polish Servicemen were censored for content criticizing the Soviet Union and Soldiers were threatened with imprisonment if they spoke out. Polish leaders received repeated assurances from American and British politicians that in return for their army’s loyal service, their country would be liberated. 

In 1944, Polish Soldiers fought alongside their allies in Europe under great psychological duress, not knowing the fate of their loved ones in Poland. Pursuing the fleeing German Army, the Poles constructed bridges across rivers and canals, naming them after Warsaw and other Polish cities. Each country they liberated brought them a step closer to home. In France, Belgium, and Holland they were mobbed by jubilant crowds celebrating freedom. 

When the Polish Army got as far as Germany, only a few hundred miles from the Polish border, they were given orders to halt. The war was over. During secret meetings, the political leaders of America and Britain had ceded half of Poland to the Soviet Union. The effect on the Polish troops was devastating. My dad’s letters to Tomasz speak of betrayal and deceit, indicating that he felt “utterly broken and destroyed.” Some Polish officers committed suicide. 

The American and British public saw Stalin as friendly “Uncle Joe,” who helped to rid Europe of Nazi tyranny. They were unaware of the need to liberate Poland from Soviet rule. Political leaders reneged on their promises to ensure free elections and Poland remained subjugated under a Communist dictatorship for five decades. The deportation of whole families from Poland to Siberia continued and Tomasz’s association with my dad put him in great personal danger. When a local official came to his house and noticed an airmail letter, Tomasz was arrested, beaten, and interrogated as a spy. He was lucky to have been spared deportation. This was why my dad wouldn’t talk to me about the war. He couldn’t risk any criticism or opposition of the Soviet Union, even from abroad, that might compromise his surviving family’s safety. 

I can only imagine my dad’s disillusionment. Despite tremendous sacrifice and heroism, he would never see his family again. Forced to live in exile abroad, Polish Veterans had to settle for whatever jobs they were offered. My dad’s superior officer, General Stanisław Maczek, one of the most distinguished commanders of the war, earned a living as a bartender in Scotland. 

I wish I had known about this while my dad was still alive. At least I could have supported him. Discovering what he endured fills me with admiration for his incredible resilience. Even though he’s gone, I feel closer to him now than ever. 

If you would like to read more about my family’s experiences during the war, please visit my website www.nadiarupniak.com and YouTube channel https://www.youtube.com/channel/UCEGGC43hyDPYQXJKuaBW46g. 

 

References 

  1. Anders W. An Army in Exile. (2004). The Battery Press, Nashville TN. 
  2. McGilvray E. Man of Steel and Honour: General Stansław Maczek. (2015). Helion Studies in Military History, Warwick, RI. 
  3. Polish Order of the Virtuti Militari Recipients https://feefhs.org/resource/poland-virtuti-militari-recipients. 
  4. Snyder T. Bloodlands: Europe Between Hitler and Stalin. (2012). Basic Books, New York, NY. 
  5. Urban T. The Katyn Massacre 1940: History of a Crime. (2020). Pen & Sword Military, Barnsley, UK. 
  6. Sklenarz K. Two Trains from Poland. (2011). Xlibris Corp., Bloomington, IN. 
  7. Piechuta A., Chmielowski E., Czapulonis, A., Synowiec-Tobis S.H., Yon B. The Mass Deportation of Poles to Siberia. (2009). Classic Printing, Chicago, IL. 
  8. Polish refugees flee Poland and arrive in refugee camps in Iran (Persia) (1943) https://www.youtube.com/watch?v=49A2pImHJgQ. 
  9. HD Stock Footage WWII Polish Refugees in Iran Fight for Freedom 1943 Newsreel https://www.youtube.com/watch?v=OWTOVlqCO1o&list=PLE7F068B835C375E8&index=41&app=desktop. 
  10. Memos show U.S. helped cover up Soviet massacre https://www.cbsnews.com/news/memos-show-us-helped-cover-up-soviet-massacre/. 
  11. Prazmowska A. Britain and Poland 1939-1943: The Betrayed Ally. (1995). Cambridge University Press, Cambridge, UK. 
  12. Mikołajczyk S. The Rape of Poland. (2007). Kessinger Publishing LLC, Whitefish, MT. 

ABOUT THE AUTHOR

Nadia Rupniak, PhD, is presently completing a ten-year investigation into her family history, prompted by a chance discovery about her father, a Polish World War II Veteran. With exclusive access to his military service records and personal correspondence, Nadia discovered how he became a stateless immigrant after the shameful political betrayal of his country by its allies. 

Nadia is also an internationally recognized neuroscientist with a special interest in depression and anxiety disorders. She has published over 140 articles, has given podium presentations at international conferences, and an article about her research was published in the Wall Street Journal. Despite her credentials, she had no idea that her own life had been affected by her father’s combat stress until she began researching his experiences during the war. 

Nadia has BA and MA degrees from the University of Oxford, and a PhD from the University of London, UK. Her father was immensely proud of her admission to Oxford and displayed a photograph of her matriculation on his bedroom wall. She believes it represented the vicarious fulfillment of his own academic potential and aspiration to become a doctor before his life was upended by war. 

 

Combat Stress Magazine

Combat Stress magazine is written with our military Service Members, Veterans, first responders, and their families in mind. We want all of our members and guests to find contentment in their lives by learning about stress management and finding what works best for each of them. Stress is unavoidable and comes in many shapes and sizes. It can even be considered a part of who we are. Being in a state of peaceful happiness may seem like a lofty goal but harnessing your stress in a positive way makes it obtainable. Serving in the military or being a police officer, firefighter or paramedic brings unique challenges and some extraordinarily bad days. The American Institute of Stress is dedicated to helping you, our Heroes and their families, cope with and heal your mind and body from the stress associated with your careers and sacrifices.

Subscribe to our FREE magazine for military members, police, firefighters,  paramedics, and their families!

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Stress From Adolescence to Adulthood Linked to Higher Cardiometabolic Risk in Young Adulthood https://www.stress.org/news/stress-from-adolescence-to-adulthood-linked-to-higher-cardiometabolic-risk-in-young-adulthood/ Fri, 16 Feb 2024 18:33:07 +0000 https://www.stress.org/?p=83733
Increased perceived stress in adolescence to adulthood increases cardiometabolic risk in adulthood.

Individuals who have consistently increased levels of perceived stress from adolescence to adulthood have a higher cardiometabolic risk compared with those with other stress patterns, according to a study in the Journal of the American Heart Association.

Researchers assessed associations between perceived stress in childhood, adolescence, and adulthood and 7 markers of cardiometabolic risk in adulthood and whether patterns of perceived stress from adolescence to adulthood predict cardiometabolic risk in adulthood.

Data were obtained from the Southern California Children’s Health Study (CHS). Participants from cohort E of the CHS were recruited in 2003 (mean age, 6.3 years), and followed up every 1 to 2 years through the end of high school, and questionnaires were completed by parents and by the children themselves after age 12 years.

A substudy on cardiovascular health was conducted in a subset of CHS cohort E participants (n=737) from 8 southern California communities in 2008. These participants were invited to participate in a follow-up cardiovascular assessment in 2018.

Our findings suggest that promoting healthy coping strategies for stress management early in life (eg, adolescence) may facilitate the prevention of cardiometabolic diseases.

A cumulative cardiometabolic risk score was calculated based on 5 markers. Multivariable linear or logistic regression models included 3 measures of perceived stress in the same model and assessed their associations with each of the 7 cardiometabolic outcomes and the cumulative risk score.

The analysis included 276 individuals (55.8% women; 62.0% White). Their mean age was 6.3±0.6 years in childhood, 13.3±0.6 years in adolescence, and 23.6±1.6 years in adulthood. Parent-perceived stress based on participants’ childhood (mean, 3.9) was lower vs participants’ Perceived Stress Scale (PSS) score in adolescence (P <.001) and adulthood (P <.001). Adult PSS had a significant association with adolescent PSS, but not with childhood PSS perceived by parents.

Individuals who had a greater PSS score had significantly greater carotid artery intima-media thickness (β, 0.01; 95% CI, 0.0003-0.02; P =.043), diastolic blood pressure (β, 0.94; 95% CI, 0.13-1.75; P =.024), and systolic blood pressure (β, 1.27; 95% CI, 0.09-2.45; =.035) in adulthood.

PSS scores in adulthood had a significant overall association with the cumulative cardiometabolic risk score (β, 0.12; 95% CI, 0.01-0.22; P =.031), and PSS scores in childhood and adolescence were not significantly associated with this cumulative score.

Models that predicted cardiometabolic risk by perceived stress patterns indicated that individuals who had consistently high PSS from adolescence to young adulthood had significantly increased cumulative cardiometabolic risk scores (β, 0.31; 95% CI, 0.02-0.60; P =.036), android/gyroid ratio (β, 0.07; 95% CI, 0.02-0.13; P =.009), and percent body fat (β, 2.59; 95% CI, 0.01-5.17; P =.049), as well as greater odds for obesity (odds ratio [OR], 5.57; 95% CI, 1.62-19.10; P =.006), compared with individuals who had consistently low PSS scores.

Participants who had decreasing PSS scores over time also had significantly higher odds for obesity (OR, 4.87; 95% CI, 1.30-18.34; P =.019) compared with those who had consistently low PSS.

Among several limitations, the population was young adults primarily living in southern California, and parent-perceived stress in young childhood likely reflects the children’s social environment at home, which may not represent the children’s stress level. In addition, the analysis may not fully adjust for time-varying covariates, and the cardiometabolic cumulative risk score assumed that each indicator has equal weight toward the cardiometabolic risk.

“Our findings suggest that promoting healthy coping strategies for stress management early in life (eg, adolescence) may facilitate the prevention of cardiometabolic diseases,” the study authors wrote.

 

Photo by cottonbro studio

By Colby Stong

This article originally appeared on The Cardiology Advisor

References:

Guo F, Chen X, Howland S, et al. Perceived stress from childhood to adulthood and cardiometabolic end points in young adulthood: an 18-year prospective studyJ Am Heart Assoc. Published online January 17, 2024. doi: 10.1161/JAHA.123.030741

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How Stress-Dumping and Free-Floating Anxiety Hurts Relationships https://www.stress.org/news/how-stress-dumping-and-free-floating-anxiety-hurts-relationships/ Fri, 09 Feb 2024 14:26:47 +0000 https://www.stress.org/?p=83557 Left unchecked, free-floating anxiety can destroy relationships.

KEY POINTS

  • Stress-dumping and free-floating anxiety are often driven by internal fears projected outward onto others.
  • Living with free-floating anxiety is exhausting, leaving you conditioned to worry and catastrophize.
  • Manage your anxiety by cultivating new self-soothing techniques such as discharging physical tension.

There are times in life when anxiety is natural and necessary. Anytime you take a risk, try something new, or engage in potentially dangerous activities, a burst of anxiety is a wake-up call, a tap on the shoulder that says, “Hey! Pay attention! Be careful!”

In this way, anxiety can be a protective force that keeps you focused, alert, and engaged.

But what happens when anxiety becomes the dominant emotion in your life? What happens when stress becomes embedded in your sense of identity?

What is free-floating anxiety?

While walking through a neighborhood park in New York City, I spotted a poster perfectly capturing the essence of free-floating anxiety: a cartoon of a woman calmly asking herself, “What should I worry about today?”

When anxiety becomes a way of being, you’re conditioned to worry. In fact, you’re searching for new things to be upset about. Free-floating anxiety (also known as generalized anxiety disorder) is an internal state of agitation that attaches itself to new situations and concerns. Rather than sit with the anxiety and process, examine, or relieve it, you project it outward onto people, places, and things. Free-floating anxiety is, in essence, internal discomfort displaced onto the world.

Here are some of the troubling outcomes of free-floating anxiety:

  • You try to control others in an attempt to regulate your worries. (See “Do You Have a Controlling Personality?“)
  • You develop inflexible beliefs and opinions.
  • You make fear-based decisions.
  • You see potential disaster and stress everywhere.
  • You’re increasingly distrustful of others and society.

All this can make living with free-floating anxiety exhausting, leaving you feeling constantly beleaguered and on edge.

Let’s consider the significant damage it does to your relationships.

How stress-dumping and free-floating anxiety hurts your relationships

Years ago, while working in a mental health clinic, I had a supervisor who lived in a permanent state of angst. She worried about the therapists she supervised, their patients, and her patients. She worried about budget cuts, politicsthe environment, the color of the waiting room walls, the cleaning staff, the bathroom supplies—you name it, she worried about it.

She also had a bad habit of spewing anxiety and dumping stress onto anyone who came in contact with her, ranting to them about all her worries and concerns.

She was notorious for inducing tension in others. For example, even if you were having a good day, when she called you into her office, you left exhausted and discouraged, and you desperately needed a nap.

What did her free-floating anxiety get her? She was universally avoided and disliked.

It’s draining to be in the presence of permanently anxious people because they are constantly pulling us into their latest crisis. Their high stress levels are contagious, making them terrible listeners and impossible to please. As they pull you into their vortex of worry, the more you begin to avoid and resent them, or even block them on social media.

Friends, partners, lovers, co-workers—virtually any relationship can be damaged by excessive worrying and stress-dumping. (See “The Inner Voice of an Anxiety Disorder.”)

The negative impact on parent and child relationships

Parents are among the biggest worriers in the world—and with good reason. Being charged with your child’s well-being is an enormous responsibility, chock full of worries and concerns. A parent who doesn’t worry about their kids is most likely neglectful.

But, at a certain point, those anxieties can become corrosive to parent-child relationships. When a parent constantly shares their worries about their child with their child, their child experiences the parent as being critical, having no confidence in them, and just plain depressing.

Children begin to think, “You don’t believe in me. You don’t see me as a capable person.”

This dynamic eats away their sense of trust in their parents. The more parents express their worries, the more kids want to push them away.

How to stop stress-dumping anxiety

If you think you suffer from free-floating anxiety, consider the following steps:

  1. Identify the internal source of discomfort. Chances are, there’s something you’re unhappy about. Maybe it’s your job or relationship; discomfort and frustration are most likely generating that anxiety. Try to identify what it is.
  2. Cultivate self-soothing techniques. Are you sleeping well? Eating well? Are you engaged in creative activities, such as painting, hiking, writing, or community-based activities that bring you peace and comfort? Anxiety needs soothing activities—not rumination.
  3. Discharge physical tension. Not all anxiety can be put into words. When we’re unable to identify it, anxiety transforms into physical and mental tension. A cardio workout of 30 minutes or more three times a week can lower anxiety by up to 75 percent. Move your body and discharge that tension rather than look for someone to dump your worries and concerns on.
  4. Bring more joy into your life. What brings you joy? What makes you smile and laugh? What gives you a boost of adrenaline, endorphins, and old-fashioned happiness? People who experience free-floating anxiety and engage in stress dumping are notorious for being unhappy. Target that unhappiness and find a way to address it.
  5. Consider medicationIf you’ve tried therapy, counseling, coaching, exercise, and everything mentioned above, and your anxiety isn’t improving, it’s time to consider medication. Why white knuckle your way through life with such high tension and stress levels? Make an appointment with the psychiatrist and schedule a consultation.

Originally posted in Psychology Today

Photo by fauxels

By Sean Grover, L.C.S.W.,  author and psychotherapist who leads one of the largest group therapy practices in the United States.

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Sick of work already? Micro-stresses (or your childhood) could be invisible causes https://www.stress.org/news/sick-of-work-already-micro-stresses-or-your-childhood-could-be-invisible-causes/ Mon, 05 Feb 2024 15:04:34 +0000 https://www.stress.org/?p=83441 As holidays fade and the working year springs into focus, some of us might feel dread. How can work stress creep up? And what are the signs of burnout?

Paula Davis remembers all too well the feeling that would overcome her after just a few weeks back at work following a blissful break. Like many of us, she would take annual leave and try to forget about the workload, the petty office politics, the anxiety-inducing emails – and for a few days it would work. But then, as a new working year loomed, it was as if the leave had never happened. The now-former lawyer sums it up in a single word: dread.

Eventually, Davis diagnosed the cause: chronic burnout that no amount of leave could cure, and went on to write a book, Beating Burnout at Work, in the hope of helping others manage workplace stress.

Many of us have experienced similar feelings – or will over the next few weeks as the working year begins in earnest and we encounter, once again, those gossipy co-workers, pointless mandatory meetings and, now that school’s back, too, the unavoidable and impossible “work-life” juggle. These daily hurdles don’t even need to be particularly noteworthy to impact our quality of life and physical wellbeing; indeed, as a pair of US academics have explained, seemingly trivial “micro-stresses” can ripple outwards like a stone thrown into a pond.

So how can we create a more congenial life this year? How is it that people seem to do it so much better in some other countries (such as France, home of the multi-course lunch and month-long summer holiday)? Is there anything in quiet quitting, lazy-girl jobs and silent partners? And might you suffer from ergophobia?

What is it about workplaces …?

The frustrations and indignities of paid toil have long provided a wealth of material for social observers. US poet Theodore Roethke spoke of the “inexorable sadness” of pencils and manila folders. British poet laureate John Betjeman hated watching the one-time village of Slough being turned into an industrial park in the 1930s, bemoaning its “air-conditioned, bright canteens, tinned fruit, tinned meat, tinned milk, tinned beans, tinned minds, tinned breath”. Though pity the young clerks, he implored. “It’s not their fault that they are mad, they’ve tasted Hell.” Slough was naturally the go-to location for The Office, the BBC sitcom written by Ricky Gervais and Stephen Merchant about awful bosses and make-work paper shuffling.

Charles Dickens was perhaps the most penetrating critic of the emerging modern workplace with his withering descriptions of lawyers’ offices (Bleak House), workhouses (Oliver Twist) and the grimy streets of Hard Times, “inhabited by people equally like one another, who all went in and out at the same hours, with the same sound upon the same pavements, to do the same work, and to whom every day was the same as yesterday and tomorrow, and every year the counterpart of the last and the next”. Oof.

Much of our behaviour at work remains inexorably influenced by unconscious patterns laid down in our childhood.

We do, overall, have it better today. For many, work is not necessarily “Hell” but a setting in which we hope to find personal satisfaction, build relationships, achieve ambitions and earn enough to fund a decent lifestyle. Yet beneath its laminated surface, the modern workplace can still be a conflict zone, fraught with anxiety, paranoia and narcissism. At least, that’s the picture painted by London psychotherapist Naomi Shragai in her book, Work Therapy, or The Man Who Mistook His Job for His Life.

Based on her conversations with clients, Shragai describes a world of perfectionists, people-pleasers, gossips and bullies, suggesting that much of our behaviour at work remains inexorably influenced by unconscious patterns laid down in our childhood. “We all carry unresolved conflicts inside us that we’re not aware of much of the time,” she tells us from London. “If unchecked, these unconscious motivations can sabotage our ambitions and desires.”

One client had particular issues with female superiors. “He always imagined they were undermining him and intending to make him look bad. But, of course, that wasn’t the case. What he was actually reacting to was a historic relationship with his own mother, who was very intrusive, wanted to know everything about him, and always made him feel as if he was bad.” Another client was convinced his boss was a bully, yet that did not match co-workers’ assessments. “Why did my client misread his boss as being a bully? As it turned out, it’s because his father was.”

That’s the Freudian flavour to Shragai’s work, but she is equally interested in how organisations make an impact on us, and we on them – “a mix between psychoanalytic and systemic practices”. Ironically, she says, people from difficult backgrounds navigate this landscape most readily – “in their home life, they had to be hyper-vigilant and the same hypervigilance can be a superpower in the workplace” – while those who have enjoyed comfortable upbringings can both struggle to read toxic situations and collapse at the first sign of negative feedback. “It’s not all plain sailing for these people who come from wonderful, warm, caring backgrounds.”

What’s the difference between stress and burnout?

You know the feeling: something happens – a snide comment, a harsh email, an aggressive driver during your commute – and your shoulders tighten, the adrenaline pumps, perhaps there’s a pain in your stomach. What’s happening physiologically, says neurobiologist Seena Mathew, is “you release cortisol when you are stressed and your body returns to ‘normal’ after the stressful event has subsided”.

“If you are experiencing constant stress, then you will have cortisol released for extended periods of time. This can lead to fatigue as your body is running in a constant fight or flight state, constantly driven by the sympathetic nervous system.”

The trouble with micro-stresses, they say, is they go unrecognised and so are inadequately processed.

This chronic stress, says Mathew, from the University of Mary Hardin-Baylor in Texas, can lead to various unwanted physical ailments, including lower immune system functioning, increased inflammatory responses, and an increase in muscle tension and pain. It has also been associated with cell ageing, disrupted blood-sugar levels and poor sleep.

“A lot of people are chronically stressed, which can lead to burnout,” says Perth psychologist Marny Lishman, who defines burnout as “a more kind of severe and chronic state of not just stress but emotional, physical, mental and spiritual exhaustion”. Panic attacks and depression disorders are burnout’s bedfellows, along with what was coined in the 19th century as ergophobia – the excessive fear of the workplace – from the Greek “ergon” (work) and “phobos” (fear), which is not specifically listed as a disorder in the Diagnostic and Statistical Manual of Mental Disorders but probably should be.

We might be less aware of what authors Rob Cross and Karen Dillon call the micro-stress effect: tiny, “pernicious” triggers. “Micro-stresses may be hard to spot individually, but cumulatively they pack an enormous punch,” they write in Harvard Business Review. “For example, if your teammates fail to complete a key task, you’ll have to clean up their under-delivery and have an uncomfortable conversation about what happened. In addition, you’ll have to ask your partner to take your child to the dentist, even though it’s your turn and the child likes that you always remember to pack their favourite toy. And beyond that, you might not have time to work on a professional development project as you’d planned to.”

Cross and Dillon explain that a healthy person usually responds to typical everyday stress – being admonished by the boss, bearing down on a deadline – through something called allostasis, which helps re-regulate our system after a stressful encounter (typically described as the fight or flight response a caveman experienced after coming across a dentally over-endowed tiger). The trouble with micro-stresses, they say, is they go unrecognised and so are inadequately processed.

Even micro-stresses can lead to burnout, they warn, or at least have us on the edge of it. Which tallies with the experience of Paula Davis, who describes burnout as an insidious malaise that creeps up on you, even if you try to deny its existence. “You might think, ‘Wow, I just have to deal with this’, or ‘I’ve got bills to pay’ or ‘It’s, you know, our busy season’. We try and explain it away. And then the further down the road you go with burnout, bigger decisions have to be made. You may need to ask, is this the right team that I’m on? Am I working at the right organisation? Is this really what I want to be doing?”

So how can we minimise the effects of work stress?

Short term, there are many ways you can decompress around work, although they might be Band-Aid fixes if the real problem is your employer, not you. Any decent GP will tell you to cut down on alcohol (a glass of wine or two at knock-off might help you unwind but increases your vulnerability to anxiety and other maladies in the long run); ditto smoking. Coffee is a more personal thing, but dozens of espresso shots a day are unlikely to help you relax. Exercise is obviously good, especially if it floods your system with dopamine, the chemical that gives you a feeling of wellbeing. Even a decent walk will go some way to doing the trick.

Then there’s a host of more creative suggestions. Visit a forest, say Japanese researchers, for a spot of shinrin-yoku (“forest bathing” or “taking in the forest atmosphere”). Take three deep breaths, say plenty of psychologists. Pause and mentally name the capitals of 20 countries or the 50 states of the United States (don’t forget Hawaii and Alaska). “Check in with your toes. How do they feel? Wiggle them,” suggests TheNew York Times. Try systematic muscle relaxation, clenching and relaxing the muscles in first your hands, then arms, then shoulders … and so on for up to an hour. Or buy a skipping rope, rub a piece of velvet or write down your worries, which apparently helps.

Or try a dose of even more stress. The University of California San Francisco has examined the fundamentals of “hormetic stress”, the theory that short, sharp shocks to the system can build resilience or even reverse chronic damage. Techniques include hyperventilating, deliberately holding your breath, intermittent fasting, or – as the Scandinavians knew long before universities were invented – taking ice baths or going cold-water swimming.

Former journalist Annie Lawson draws on a far older method of self-preservation: Stoicism, the ancient philosophy that seems to be having a moment today (founded by Zeno in about 300BC, popularised back in the day by Epictetus, Seneca and Marcus Aurelius). Lawson was forced to re-think her attitude to work when she moved into corporate life and lost much of the autonomy she had previously counted on. She recalls: “There was a day where I had four meetings with the same people but in different meeting rooms, essentially talking about the same thing. I had this existential crisis: Oh my God, I’m going to die and my only legacy will be sitting in meetings with people using language like ‘deep dive’ and ‘strategic paradigm’.”

In the self-help section of a bookshop, she found Meditations by Marcus Aurelius, one-time Roman emperor and follower of Stoic philosophy. “It grabbed me. The central principle that underpins it is, do not worry about what you can’t control but focus on what you can control. And I think if you take that to the workplace, it’s amazing how many little irritants just fall away.”

Another key principle of Stoicism, she says, is having a sense of purpose and drive – or work ethic – and to expect that in pursuing goals, you will encounter obstacles, among them annoying people. “And when you do that, you will not be disappointed, you’ll be well-prepared – because the workplace is, quite frankly, filled with them.”

Many of the experts we spoke with agreed that opting out of office politics is rarely a solution. Says Shragai: “People are always moaning about work politics but, essentially, politics is relationships. So people who say, ‘I don’t do politics’, what they’re saying is, ‘I don’t relate to people and I’m not very interested in what’s going on here’.”

‘As soon as I let go of my identity being entirely wrapped up with work then I felt freer in the workplace and, in many respects, I think I performed better.’

Author Annie Lawson

Instead, sit back and try to understand what makes the people around you tick, what motivates them, and amend your behaviour accordingly, especially if you’re a manager. Personality profiling is, of course, nothing new but there are some broadbrush ideas that can help, according to Michelle Duval, the founder of F4S, a company that, among other things, uses AI to improve online communication between colleagues.

Duval has collected data, for example, suggesting that, broadly, Baby Boomers and Gen Xers thrive when they have specific goals to achieve. “But when we look at Millennials and Gen Z, they have nearly zero focus on goals.” Instead, she says, younger workers may be more process-oriented, preferring to solve problems and overcome challenges as they arise. “We help by helping people to understand themselves and to understand their team, and then to be able to motivate managers based on the people you’re working with.”

Lawson eventually adapted some of what she learnt into her own self-help book, Stoic at Work, which examines how the Stoics welcomed feedback of all kinds, why you should be wary of compliments (flattery can derail you from your purpose) and whether, just perhaps, that annoying colleague is actually you. This year, she says, “I went back [to work] without the sense of dread I know everyone has where they think, ‘Maybe I should change jobs’. Because I thought, what is my grand purpose? And I’ve just meditated on that problem. What do I really want out of life?”

Her conclusion? “My grander purpose isn’t just the job I have. And the thing that makes me happy is having a creative outlet and a social life and family. As soon as I let go of my identity being entirely wrapped up with work then I felt freer in the workplace and, in many respects, I think I performed better.”

What about the bigger picture, though?

Sometimes, of course, the problem is not you, it’s them. The workplace might be actually unprofessional and unpleasant. Or your immediate boss truly is a psychopath. No amount of toe-wiggling is going to help that. “We have to stop thinking about preventing burnout as solely something that individuals have the ability to do or that they should do,” says Davis. “Burnout is the individual manifestation of a workplace system or culture issue.”

Many seem to have come to this conclusion post-pandemic, after a period spent working from home shone a light on irritating workplace practices we had previously considered were a given. If you believe what you read on social media, by 2022-23 our younger generations were either resigning en masse (the Great Resignation, presumably for those who could afford it), “quiet quitting” (doing the bare minimum), or hoping to snag a “lazy girl job” (which seems to be a sinecure that pays the rent and perhaps funds overseas holidays). “Silent partners”, meanwhile, are apparently colleagues who turn off the Zoom camera, say nothing in meetings, make Monday their in-office day and quietly slink into obscurity, albeit while getting their work done.

Yet there was something in the new terms, says US author Sarah Jaffe. “What quiet quitting, in particular, describes is something that organised labour refers to as work to rule, which is a process of doing exactly what your job description is, often in meticulous detail, and no more, as a way of exerting power.” (Jaffe recently published Work Won’t Love You Back: How Devotion to Our Jobs Keeps Us Exploited, Exhausted and Alone.) Just be careful it doesn’t backfire, she warns. “If you’re the only one at your workplace doing the bare minimum, and all your co-workers are still doing the most, staying late, eventually your boss will notice and then you’re in trouble.”

One Swedish council even considered a scheme to give municipal employees a paid hour every week to go home and have sex.

This pushback seems a little depressing, however, when considering the alternative – trusted co-operation between employer and employees that helps everybody integrate their work and life.Evidence suggests that, at least in some industries, shorter working hours can benefit everybody. Some trials of so-called four-day weeks (typically spreading between 30 and 32 hours over a working week) have resulted in measurable reductions in burnout, lower stress overall and a 44 per cent drop in absenteeism. Several four-day trials in Iceland between 2015 and 2019 suggested workers’ wellbeing improved with no hit to productivity. Another study of Australian organisations reviewed by Swinburne University researchers reported some workplaces even had a productivity bump.

Yet the jury remains out: while a long-term trial, run over two years in the Swedish city of Gothenburg, that cut hours to six a day, showed multiple benefits for workers, it came at an unsustainable cost, thanks to having to employ extra staff to fill gaps in sectors such as aged care that required round-the-clock staffing.

Even working full-time, however, the Swedes routinely enjoy perks we can only dream of: a cash allowance to spend on wellbeing activities, “fika” – the sacrosanct workday ritual of meeting for coffee and pastry – and flexible working hours . In 2017, one Swedish council even considered a scheme to give municipal employees a paid hour every week to go home and have sex. The Spanish still cherish siestas, even though surveys suggest fewer people actually take one these days. The French, too, guard their spare time as if their lives depend on it. For many, a month-long summer holiday remains de rigueur. An hour must be reserved for a proper lunch – indeed, eating at your desk is strongly discouraged. And more than 1 million people took to the streets last year to protest against plans to extend the state pension retirement age from 62 to 64 (in Australia, it’s 67).

What we do have in Australia is a culture of long weekends – mini breaks that can sometimes do more good than longer holidays, since they demand zero planning and require little more than relaxing. The “hack” is to add some days of annual leave. Many Australians can, for example, organise 16 days off in March and April this year by booking an additional eight days of annual leave around the Easter public holidays, and another nine consecutive days with an annual-leave burn of just four days around the King’s Birthday in June.

Then, when you’re back at work again, incorporate a little of what you found most relaxing on leave into your day-to-day, says Lishman. “Whether it’s going for a swim or going for a sunset walk. How can you incorporate that into your life on a weekly basis, not just on your holidays? You don’t want to get to the finish line and be completely exhausted. You want to be able to enjoy life all the time, not just on your holiday.”

Visit: STRESS.ORG

Originally posted by THE SYDNEY MORNING HERALD

By Angus Holland

Photo by Valeria Ushakova

Photo by MART PRODUCTION

Photo by Paul Efe

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Childhood stress linked to higher risk of heart disease in adulthood https://www.stress.org/news/childhood-stress-linked-to-higher-risk-of-heart-disease-in-adulthood/ Wed, 31 Jan 2024 15:04:55 +0000 https://www.stress.org/?p=83322

  • Researchers are reporting that stress early in life can contribute to cardiometabolic diseases in adulthood.
  • They say that’s because high levels of stress hormones may contribute to heart disease.
  • Experts say there are a number of ways parents can help children understand and deal with stress.

Stress in adolescence and early adulthood may contribute to the development of cardiometabolic diseases later in life, according to a studyTrusted Source published today in the Journal of the American Heart Association.

To reach their findings, researchers looked at the health information of 276 participants from the Southern California Children’s Health Study from 2003 to 2014 and a follow-up assessment from 2018 to 2021.

The stress participants felt was measured using the Perceived Stress Scale, with questions about thoughts and feelings during the previous month. Assessments were done in three life stages: childhood (average age of 6 years), adolescence (average age of 13 years), and young adulthood (average age of 24 years).

In early childhood, parents provided information on their child’s stress levels. During adolescence and adulthood, the responses were self-reported.

The researchers categorized participants into four groups:

  • Consistently high stress
  • Decreasing stress
  • Increasing stress
  • Consistently low stress

The scientists used six different markers to determine a cardiometabolic risk score in young adulthood:

Participants received one point for markers above the normal range. The scientists did not use BMI in calculating the risk score as the body fat percentage and the android/gynoid ratio provided a comprehensive assessment.

End scores ranged from 0 to 5, with higher scores indicating higher cardiometabolic risk factors.

Details from the children stress study

The researchers found that adults with high perceived stress, particularly those who indicated high stress levels beginning in adolescence, might be more likely to develop cardiometabolic risk factors as young adults. For example, higher perceived stress is associated with higher neck artery thickness, a blood vessel injury, and hypertrophy marker that could indicate atherosclerosis.

“This study underlines the idea that stress reduction should be a component of our public health strategy,” said Dr. Sameer Amin, a cardiologist and the chief medical officer at L.A. Care Health Plan who was not involved in the study.

“As we have all suspected, high perceived stress can lead to lifestyle choices that worsen cardiometabolic health. When we do not cope with our stress, a healthy diet and regular exercise often fall to the wayside,” Amin told Medical News Today.

Experts say the findings suggest that promoting stress-coping strategies early in life might reduce the risk of developing cardiometabolic diseases as adults.

“For quite some time, we have known that stress can increase the risk of cardiovascular sequalae such as high blood pressure, heart attack, and congestive heart failure,” said Dr. Hosam Hmoud, a cardiologist at Northwell Lenox Hill Hospital in New York who was not involved in the study.

“This paper sought out to quantify perceived childhood, adolescent, adulthood stress and the relation to cardiometabolic risk factors such as blood pressure, obesity and the narrowing of a crucial artery that supplies blood to the brain-the carotid artery,” Hmoud told Medical News Today. “Interestingly, increased perceived adolescent stress led to higher rates of obesity while adults had higher levels of blood pressure and carotid initima thickness. Whether these cardiometabolic risk factors lead to higher rates of stroke, heart attack, and/or congestive heart failure have yet to be elucidated.”

“There are some nuances to this paper that must be kept in mind. The subjectivity of perceived stress and lack of factoring in familial inheritance could confound the results of the paper,” Hmoud added. “It would’ve been interesting to link blood levels of HS-CRP, a known marker of inflammation, with said outcomes. More research is needed to better understand how stress impacts our body from a cardiometabolic standpoint.”

Why stress can lead to disease

“The study did not investigate the reasons why stress in childhood might affect someone’s health at age 40,” noted Dr. Andrew Freeman, a cardiologist at National Jewish Health who was not involved in the study. “If I needed to hypothesize, this is likely because if someone has a history of chronic stress – going back to childhood – they could have maladaptive ways of dealing with stress.”

“There could be a million reasons why the 40-year-old has certain health conditions, but habits persist, and someone who has trouble dealing with stress as a child probably has trouble dealing with stress as an adult,” Freeman told Medical News Today.

“The brain and body are still developing during childhood and adolescence, and stress can disrupt these processes,” said Dr. Daniel Ganjian, a pediatrician at Providence Saint John’s Health Center in California who was not involved in the study.

“Chronic stress can lead to changes in stress hormone levels, inflammation, and other biological factors that increase the risk of disease. Children and adolescents may have fewer coping skills and resources to manage stress effectively,” Ganjian told Medical News Today.

“It’s also important to note that while this research highlights the potential negative effects of chronic stress, it’s not all doom and gloom,” he noted. “Resilience is a key factor in how people cope with stress and there are many things that can be done to build resilience in children and adolescents.”

Originally Posted in Medical News Today 

By Eileen Bailey on January 17, 2024 — Fact checked by Jill Seladi-Schulman, Ph.D.

Photo by Mikhail Nilov

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Enjoy Your Holidays: Effectively Managing Holiday Stress https://www.stress.org/news/enjoy-your-holidays-effectively-managing-holiday-stress/ Wed, 06 Dec 2023 16:19:52 +0000 https://www.stress.org/?p=81867

*This is an article from the Winter  2023-24 issue of Contentment Magazine.

By Josh Briley, PhD, FAIS 

For many people, their attitude toward the holidays is aptly summed up in Billy Crystal’s quote from When Harry Met Sally, “Boy the holidays are rough. Every year I try to get from the day before Thanksgiving to the day after New Years.”1 This movie was released in 1989, and neither our daily lives nor the holidays have gotten easier during the past almost 25 years.  

According to the most recent Gallup Global Emotions report,2 the Negative Experience Index remained at record highs for the second consecutive year. This means record numbers of people reported having some type of negative experience (worry, sadness, anger, stress, or pain) on the day before answering the survey. Forty-one percent of adults worldwide reported experiencing worry, and forty percent reported experiencing stress. In other words, on a typical day, almost half of the world’s population has some type of unpleasant emotion related to stress. 

The results of this poll highlight the magnitude of the stress we feel in our daily lives. One way to think about feeling stressed is when we believe we do not have the resources to meet demands. Often, we feel we do not have enough time, energy, money, or emotional capacity to successfully accomplish all the things we need or want to do. The result is feeling stressed. Simply enduring this stress, rather than managing it effectively, saps a person’s remaining physical and emotional resources, which decreases the resources available to meet new and existing demands, and thus potentially starts a downward spiral. 

The holiday season, while intended to be a time of contentment and enjoyment, is often anything but. There are specific and unique demands placed upon us at this time of year, that if not managed appropriately, can further exacerbate the downward spiral described above. These demands come at us from almost every aspect of our lives. As a result, rather than having fun with our family and friends, we are more likely to lose our tempers, feel rushed and anxious, and even begin to dread not only each individual event, but also the holidays as a whole.  

In this article, we will examine some of these unique stressors and explore methods to effectively manage holiday stress. These are not methods of eliminating the stress from these demands, that is not a feasible goal. The techniques in this article are not intended to replace any positive stress management techniques you may already practice. You should continue engaging in these practices, and possibly even utilize them more frequently, during the holiday season. The techniques in this article are designed to supplement any healthy stress management techniques you currently utilize. If you do not regularly practice healthy stress management, these techniques can be a good starting point to building a more comprehensive and effective method of managing stress in your daily life. 

Note, the holidays are not a time to initiate stress management techniques that require significant time and effort, such as beginning a new exercise regime or a new diet plan. While such changes are necessary to maximize managing the normal, daily stress we experience, trying to initiate significantly new behaviors and habits during the holiday season only adds to the already overwhelming stress most of us experience during this time of the year. Rather, use this time to plan for such changes when the New Year begins.  

Let’s explore some of the unique, or exacerbated, stressors related to the holidays. We will discuss some of the specific stressors we all typically encounter, which may individually or collectively contribute to feeling overly stressed and interfere with our ability to enjoy the holidays. Then, we will discuss some common sense, but not necessarily simple, approaches to effectively managing holiday stress. 

Crowds 

Holiday activities mean more people are out more often. Whether you are at a restaurant, shopping, or traveling, there are significantly more people engaged in the same activity at the same time. The result is that available resources are overwhelmed, leading to longer wait times, reduced availability of items, and possibly even less room to move about in. As a result, both customers and employees often feel impatient as if they have little or no control over the situation. This combination of factors results in a “powder keg” of irritability, anger, and frustration that most often is unleashed in full in response to a relatively insignificant stressor. The resulting conflicts not only add to the tension in already stressful situations, but also increase the wait times of other customers and perpetuate the cycle of impatience and frustration. 

Traffic and Travel 

Related to the crowds that are prolific during the holidays, traffic congestion is also significantly increased, especially around large shopping centers. But traffic congestion is also increased during holiday travel, whether it is on the highways for road trips or in airports. Traffic jams contribute to the same sense of impatience discussed above, and the constant honking from frustrated and irate drivers adds to the cacophony, and therefore the environmental stress, of the holidays. As a result, “road rage” is more likely, leading to more aggressive driving that may cause further traffic difficulties. 

Additionally, inclement weather can have an adverse impact on travel. Driving can become difficult, if not dangerous, due to unexpected inclement weather or storms that were more severe than anticipated. Inclement weather can also cause flight delays or cancellations. Weather conditions can result in travel delays, unplanned overnight stops, or even damage to a vehicle or injury from an accident. Weather is something that is out of our control, and dealing with the increased difficulties caused by inclement weather can have a negative impact on our mood and attitude surrounding the holidays. 

Holiday Activities and Celebrations 

The holidays are a busy time of the year. In addition to the shopping and arrangements for travel discussed above, there are activities that are unique to this time of year that add to the already busy schedules of our lives. There are holiday parties for work, and in households with two or more incomes, there may be parties for each job. Not to mention holiday parties at our kids’ schools, the programs schools or churches may put on that require additional time for rehearsals if we are participating in them. Friends and families may gather for celebrations that require not only time to attend, but often for us to prepare food to bring to the gathering. These additional obligations, while hopefully enjoyable, contribute to a sense of being overwhelmed and too busy during the holidays. 

Finances 

The holidays are expensive. We buy gifts for our children, our spouses, parents, family members, coworkers, and friends. We may buy specialty themed clothing for parties or perhaps matching outfits for holiday photos or family traditions. We buy groceries for large family dinners, food for holiday parties, and may eat at restaurants more often due to the increased demands on time for shopping and holiday activities. There are also the additional financial aspects of travel that was mentioned earlier. The financial stress of the holidays can negatively impact not only our enjoyment of the season, but it is also a stressor that can reverberate throughout the year as we attempt to climb out of any financial situation that may have arisen because of the holidays. 

Health and Physical Stress 

The increased level of activity, celebrations, travel, and time spent in crowded situations has a toll on our physical wellbeing during the holidays. Often, when we have overscheduled ourselves, the first aspects of self-care that get set aside are sleep and nutrition. Because we have so many things to do and no additional time to do them, you may notice that you are staying up later and/or getting out of bed earlier in the mornings to try to accomplish everything. The busier than usual schedules leave little time for healthy meal preparation, and holiday parties rarely have healthy food choices. Therefore, during the holidays we are more likely to eat foods that are high in fat, sugar, and calorie content, but low in nutritional value. Due to holiday meals and other celebrations, as well as “stress eating,” we may also consume more of these unhealthy food options than normal. This pattern of overeating high calorie, low nutritional foods results in feelings of bloating, fatigue, emotional instability, and a general malaise. 

In addition, people may tend to drink more heavily than usual at holiday parties or as a coping mechanism for the stressors we have discussed above. As a result, they are likely to feel the negative impact the next day (hangover) or lead to problematic levels of alcohol consumption. Alcohol may not be the only substance abused more frequently during the holidays. As more people are turning to substances such as marijuana (either legally obtained or not), and other illicit or prescribed medications, the adverse effects of such substance abuse negatively impact their daily functioning. Frighteningly, often the person abusing the substances is unaware of the extent of the negative impact on their lives, and loved ones are reluctant to address the topic with them. 

Due partially to the decrease in quality sleep and nutrition, the use of substances to celebrate at holiday parties or as a coping mechanism, but also due to being in crowds of people more often during the holiday season, physical illnesses such as the common cold, the flu, COVID, and others seem to be more prevalent during this time of year. Often, instead of heeding the illness and getting some rest for a few days, we “push on” and work from home, continue trying to accomplish everything we need for the holiday season, and further exacerbate the physical stress on our bodies. 

Expectations 

The stressors we have discussed so far in this article are, for the most part, beyond our control. We can manage the stress and stressors, as we will discuss techniques for doing so in the next part of this article, but these stressors are, for the most part, unavoidable. The one stressor that is completely avoidable, and yet probably the most intense stressor for many during the holiday season, is the expectations we put on ourselves, our loved ones, and others to have the “perfect” holiday. More than any other time of the year, traditions are emphasized and treated with an almost sacred reverence. New trends are quickly adopted in the fear of “missing out” or not giving our children the same experiences as their classmates. 

We remember the holidays of our childhood with rose colored glasses, remembering everything as going smoothly, the food being perfect, the presents neatly wrapped and labeled, and everything looking like a Hallmark movie. In reality, it is highly unlikely any part of our childhood holidays was as idealistic as we remember. But we put unnecessary pressure on ourselves to try to recreate these unrealistically idyllic holidays. Or, quite the opposite, we remember very conflictual, stressful holidays with dysfunctional family members, and we put undue pressure on ourselves to ensure our children’s holiday memories are happier. 

Managing the Additional Stress of the Holidays 

Any of the aspects of holiday stress discussed above would significantly add to stress levels. When these stressors are combined, our ability to manage the additional stress can be significantly compromised. However, it is possible to establish a stress management plan with approaches that can be done before the additional stressors of the holidays begin, during the midst of the holiday chaos, and finally at the end of the holidays. These approaches may supplement any healthy stress management techniques you practice in your daily life. However, these commonsense approaches are good to implement even if you do not have a current healthy stress management regimen.

Plan Ahead 

Most people are familiar with the saying, “If you fail to plan, you plan to fail.” This logic can be applied to approaching the holiday season. As chaotic as the holidays can be, many of us engage in roughly the same activities every year and can plan for them. Making a plan and sticking with it regarding finances, scheduling, the effort you are able to expend for each activity, and even how much you will eat and drink at celebrations, will alleviate much of the stressors discussed above before the season even begins. Decide ahead of time how much money you can spend on the additional demands for the holidays, including gifts, contributions to celebrations, groceries for meals, and budget accordingly. Similarly schedule the time needed for each task to be completed. Give yourself extra time to deal with traffic congestion, crowds, and unexpected inclement weather. If you are planning to travel, get to the airport early to give yourself time to comfortably navigate through the crowds at the check-in, at security, and at the gate. Plan games to play, download movies and shows to watch, or take something to read to help make the time you are waiting more enjoyable. Similarly, if taking a road trip, plan additional time to accommodate unpredictable obstacles such as traffic congestion, inclement weather, and construction. Planning for this additional time helps eliminate the stress of worrying about whether you will “make it,” and thus helps you enjoy the holiday activities, instead of trying to rush through them. Also, develop a strategy regarding celebrations that allow you to enjoy yourself, while not overdoing it.  

Finally, manage expectations regarding holiday plans. What traditions are important for your family to continue? Are there any that typically cause stress and frustration that can be retired or replaced? What activities can be delegated to other family members? What tasks can be substituted with easier to accomplish goals? For example, if you do not have time to bake homemade cookies for your children’s holiday parties, check into local bakeries that can deliver the homemade taste and texture without spending hours in the kitchen that you may not have. Obviously, saving this time will mean an additional financial expenditure that should be budgeted for, and striking a balance in budgeting time and finances is especially important during the holidays.

Manage in the Midst 

Once you have a strong plan for managing your time, finances, celebrations, and other obligations, it is important to stick to it, with some degree of flexibility. The unexpected occurs, and being able to adapt and adjust to changing situations is important. In the midst of the holiday chaos, things often feel out of control, and it is easy to become overwhelmed and upset. But one thing you can control is what you choose to give your attention to. It is easy to get swept up and overwhelmed by everyone hustling for a spot in traffic, or people complaining about the wait times in line, or the people who are being rude and selfish. Focusing on such things will only serve to exacerbate your own sense of frustration and impatience and increase the stress you feel. Instead, deliberately look for the good. Find the couple that are laughing and smiling in their conversation together, the children who are being polite and helpful to their parents and other adults, the employee who greets each customer with a genuine smile. Listen closely to the holiday music and the cheerful melodies and lyrics, maybe even hum or sing along quietly. Make it a practice to pleasantly greet everyone you encounter, you never know when a sincere kind word can make someone’s day, and as a bonus, you will feel more joy yourself. 

If you feel yourself becoming upset, anxious, or impatient, take a moment to decompress. Take a few slow, deep breaths to calm your heart rate slightly. Ground yourself by looking around and focusing on enjoyable things such as those described above. Engage your senses, look at the holiday decorations around you, listen to the music, smell the candles and other holiday aromas, maybe you have a hot beverage that you can feel the warmth of and enjoy the flavor. 

Finally, check your attitude. We rarely respond to the actual events around us. Rather, we respond to our interpretation of the events around us and to our mood. For example, you can sit in congested traffic and allow yourself to get angry at the idiots on the road that cannot drive. Or you can use the time to have a conversation with those in the car with you, listen to your favorite songs, make more progress in the podcast or audiobook you may be listening to, or simply turn off what you have been listening to and take a few moments of relative quiet and allow yourself to decompress. Learning to be flexible in handling the stressors of the holidays is one of the most important factors in successfully managing holiday stress. A favorite saying of mine when working with clients, or to remind myself, is that the things that go wrong are the funny stories you tell later. Therefore, when the unexpected happens that has a negative impact on my plans, I start mentally rehearsing how I will tell the story later and trying to see the humor in the situation. This approach almost always changes my mood. 

After the Holidays 

Assessing how the holidays went and how well your plan worked is important. Be honest with yourself, in which areas have you done well and in which areas did things go awry? It is important to be gentle with yourself during this assessment. This exercise is not to criticize yourself for what did not go as planned, but to see where you succeeded in better managing your holiday stress and where you need to make improvements for next year. This is also a good time to review your overall stress management system and make plans to implement a healthy strategy for managing stress or improving your current strategy. If you find the increased stressors of the holiday are easily overwhelming you, or old difficulties have been brought to light, then reach out to a qualified professional for help in coping with these struggles. 

Navigating the holiday season is fraught with potential stressors that are either unique to this time of year or are exacerbated. However, the stressors do not have to steal the joy we want from celebrating time with friends and family. Planning ahead and budgeting finances, time, and effort, looking for good things that are happening all around us rather than focusing on the negatives, being flexible and patient with unexpected occurrences, and gently and patiently checking in with yourself to see how you are doing are keys to not just surviving the holidays, but enjoying and thriving in them. 

References 

  1. When Harry Met Sally. Directed by Rob Reiner, Columbia Pictures, 1989. 
  1. Gallup Global Emotions Report 2023. Retrieved from https://www.gallup.com/analytics/349280/gallup-global-emotions-report.aspx. October 22, 2023 

ABOUT THE AUTHOR

Josh Briley, PhD, BCMAS, FAIS is the Clinical Education Director for Electromedical Products International, Inc., the manufacturer and distributor of Alpha-Stim devices. Dr. Briley is a licensed clinical psychologist who earned his doctorate in clinical psychology in 2003 from the University of North Texas. He began his career at the Federal Bureau of Prisons, where he focused on drug treatment, crisis intervention, and anger management and was quickly appointed leader of the Crisis Support Team and Regional Assistant Team Leader. He went on to work in an outpatient clinic for the Veterans Health Administration specializing in individual and group therapy for PTSD, depression, anxiety, and chronic pain treatment. Dr. Briley has also owned a private practice, taught online undergraduate and graduate level courses, and conducted teletherapy for Betterhelp.com. He is a board member and Fellow of the American Institute of Stress. 

 

 

Contentment Magazine

The dictionary defines “content” as being in a state of peaceful happiness.  The AIS magazine is called Contentment because we want all of our guests and members to find contentment in their lives by learning about stress management and finding what works best for each them.  Stress is unavoidable, and comes in many shapes and sizes that makes being in a state of peaceful happiness seem like a very lofty goal.  But happiness is easy to find once you are able to find ways to manage your stress and keep a healthy perspective when going though difficult times in life.  You will always have stress, but stress does not always have you!

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Give yourself the perfect gift: Trim your holiday stress https://www.stress.org/news/give-yourself-the-perfect-gift-trim-your-holiday-stress/ Fri, 01 Dec 2023 14:31:39 +0000 https://www.stress.org/?p=81646 We all know the popular holiday song “It’s the Most Wonderful Time of the Year.” But for many people, a more appropriate lyric might be “It’s the Most Stressful Time of the Year.”

Buying gifts for loved ones, decorating the house, planning parties and dinners, and getting together with relatives – it’s all enough to send stress levels soaring.

Sarah Woods, Ph.D.

Sarah Woods, Ph.D., is Associate Professor and Vice Chair of Research in the Department of Family and Community Medicine.

Experts at UT Southwestern Medical Center say there are ways to manage stress and make your holidays much more enjoyable – and they start with adjusting your expectations, which will help relieve the pressure you put on yourself to achieve perfection.

Sarah Woods, Ph.D., Associate Professor and Vice Chair of Research in the Department of Family and Community Medicine, said remembering that the holidays are a season of gratitude can help ease the burdens we put on ourselves.

“Think about what you’re grateful for and put it in writing,” Dr. Woods said. “Focusing on the good can help you relax and cope with the not-so-good.”

A poll by the American Psychiatric Association in December 2022 showed that 31% of Americans expected to feel more stressed at the holidays compared with the previous year, with most of the anxiety linked to money. Rita Smith, a Licensed Clinical Social Worker in the Clinical Heart and Vascular Center at UT Southwestern, said it’s best to make a spending plan for gifts and celebrations because holiday debts can lead to additional stress in the new year. Be practical and creative with your gifting.

Dr. Woods said stress linked to strained family relationships can cause short- and long-term health problems. Feelings of stress produce cortisol, a hormone created by the adrenal glands that acts as an alarm system for the body. Elevated cortisol can cause disrupted sleep, headaches, inflammation, reduced pain tolerance, and shortness of breath.

When preparing to be with relatives, it helps to have a strategy, Dr. Woods said. Discuss with your partner how much time you wish to spend with family members and what conversations – politics, religion, parenting, education – should be off-limits. Stay attuned to each other’s signals: a hand gesture, a wink, or even a touch on the shoulder will work. If you find yourself in the middle of a difficult conversation with a relative, try saying: “I love you and respect you. Can we put this conversation on pause for now and talk about something else?”

The holidays can be especially difficult if you are caring for a loved one who is ill or spending your first holidays alone after a divorce or the loss of a spouse, Ms. Smith said.

“Excess stress wears and tears on our bodies,” she said. “The best holiday gifts you can give yourself are equal doses of self-care and grace.”

Ms. Smith recommended several ways to handle holiday stress:

  • Self-care activities. Taking time out to exercise, get a massage, nap, or read a book is time well spent if it helps you stay positive.
  • Healthy eating habits. Holiday celebrations invite overindulgence. Remember, food and mood are related.
  • Stay socially engaged. If you’re sad because of a loss or disappointment, talk to your doctor, a trusted friend, or a counselor. There are many groups that provide support for people dealing with divorce, grief, or depression. Don’t isolate yourself from social activity, even if you don’t feel joyful.
  • Volunteer. Many people have additional needs during the holidays. Take a meal to a neighbor, go to a senior center and visit the residents, or work with a food bank. You’ll feel a sense of purpose and accomplishment.

Dr. Woods holds the Stanley Gilbert, M.D. Professorship in Family Medicine.

About UT Southwestern Medical Center  

UT Southwestern, one of the nation’s premier academic medical centers, integrates pioneering biomedical research with exceptional clinical care and education. The institution’s faculty members have received six Nobel Prizes and include 26 members of the National Academy of Sciences, 20 members of the National Academy of Medicine, and 13 Howard Hughes Medical Institute Investigators. The full-time faculty of more than 3,100 is responsible for groundbreaking medical advances and is committed to translating science-driven research quickly to new clinical treatments. UT Southwestern physicians provide care in more than 80 specialties to more than 120,000 hospitalized patients, more than 360,000 emergency room cases, and oversee nearly 5 million outpatient visits a year.

Original post

Photo by Andrea Piacquadio

FOR MORE INFORMATION ABOUT STRESS GO TO THE AMERICAN INSTITUTE OF STRESS

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Surviving the Family This Holiday Season https://www.stress.org/news/surviving-the-family-this-holiday-season/ Wed, 22 Nov 2023 15:53:02 +0000 https://www.stress.org/?p=81420 Eight in ten Americans say that expectations and events around the holidays cause them to feel increased stress, with 31.1% admitting their physical and mental health definitely worsens in the last quarter of the year.

Many people dread going home for the holidays. It can be a stressful time of tiptoeing around fractious family members, trying to keep the peace, and maintaining some personal space.

The American Institute of Stress claims that a score of 150 to 300 points on their Holmes-Rahe Stress Inventory equals a 50% chance of a health breakdown in the next two years. The total score is the sum of all one’s stressors; for example, divorce tops the stress scale with a 100.

The holidays are a veritable smorgasbord of stress, with vacations (13 points), holidays (12 points), and potential in-law troubles (29 points). Those who don’t manage their space and set boundaries, could experience changes in residence (20 points), recreation (19 points), social activities (18 points), sleeping habits (16 points), family get-togethers (15 points), and eating habits (15 points). Adding all those together gives a person a score of 157 points, which puts them at an elevated stress risk, even if everything else is going great.

This Too, Shall Pass

One strategy is to recognize that stressors are temporary. People can try keeping calm and carrying on with a stiff upper lip, figuring it’s better if they can enjoy their families. Coleman Concierge interviewed five travel and relationship experts to learn what it takes to not only survive, but to thrive this holiday season.

Plan It Out

Planning is the first step of any endeavor. That’s especially true when confronting unresolved issues from childhood or unrequited affections from youth. A family visit can bring up those issues. Relationship experts have some advice and tips for preparing for the holidays physically, spiritually, and emotionally.

Stephen Barton, owner and founder of life coaching site Over The Looking Glass, and author, offers, “My advice to anyone is: ‘Be true to who you are, always in all ways.’”

Yancy Wright, leadership coach and founder of Casa Alternavita, provides these concrete steps for doing just that: “Create a clear agreement with your significant other about how long you plan to stay with their family. Whether it is just for a few hours, overnight or even for a few days, give yourself permission to create space for you to be on your own to recharge as needed.”

There are a few options for finding safe spaces when people or their partners are in times of conflict. Renée D. Burwell, LCSW and Educator, says, “Maybe your parents have an in-law suite, stay at a hotel, or your bedroom or even a closet can be your safe haven when space is needed.”

Dr. Christina Kraft, DMD, has some guidance for being intentional about holiday travel. “Spend some time before your trip thinking, meditating, or journaling on why you are visiting family this holiday,” she says. “Consider the purpose of this family time and why it’s important. Focus on positive feelings and memories and visualize an experience filled with love, laughter, and gratitude. Most importantly, grant yourself and others grace and forgiveness if things don’t go as planned.”

Couples may have some unique travel issues. Jennifer Coleman, a couples travel expert, offered practical advice for couples travel particularly appropriate for a gift-giving holiday, “Money is a major source of stress for most couples, so discussing your budget and financial expectations before embarking on your trip is essential. When your budget is decided beforehand, all you need to do on vacation is to enjoy yourselves.”

Peace and Goodwill to All People

The professionals also offer pointers for maintaining peace and goodwill during time with the family. They suggest being careful around controversial topics like conspiracy theories, religion, and politics.

Barton added caveats for controversial conversations like, “unless they bring up the subject,” and “It’s best not to have an opinion about anything even when asked.” Wright suggests people, “find a way to go in with a mindset of curiosity,” while Dr. Kraft takes that idea one step further. She advises, “Understanding that people’s reactions to others are more about themselves and their own internal dialog than it is about you.”

If things do go astray, all is not lost. Yancy suggests guests, “Try to redirect the conversation to something else, something more generative of laughter and connection.” Dr. Kraft recommends self-care by scheduling, “a short trip with lots of private time so everyone has space to decompress.”

If things get heated, Burwell recommends having safety signals and to check in with your partner often because, “Having each other’s back and maintaining a strong unit will help to preserve peace this holiday season and potentially years to come.”

Make Some Space

Some aspects of holiday travel can be more stressful if sharing a family space instead of staying in a hotel. Coleman encourages establishing travel rituals because they, “provide a sense of stability amidst the excitement and unfamiliarity. It could be something as simple as having breakfast together each morning or setting aside time daily to reflect on the day’s experiences.” She continues, “Mistakes and disagreements are bound to happen. Learn to forgive and let go of any resentments. Holding onto grudges will only dampen the joy of your travel experiences. Embrace forgiveness and keep your focus on the present.”

Appreciate the Opportunities

The winter solstice is the longest night of the year, but even the darkest nights have a dawn, and a new year will soon arrive. Yancy says, “Focus on what you can appreciate. Even the little things, like how some food might be prepared or what someone is wearing. It’s so easy to get into a critical and judgmental mindset, so it takes practice to instead focus on things that bring you into the present moment.”

Coleman calls on her adventure travel expertise, equating a family visit with a spot in one’s comfort zone. For some, it’s as comfortable as a warm hug; for others, it can be as uncomfortable as eying the water below a 40-foot cliff jump. She says, “Just beyond your comfort zone is the growth zone, where you can learn and accomplish things you’ve never thought were possible and return with more confidence and courage to face new challenges.” She describes the experiential learning cycle she used while teaching skiing as, “learning a new skill, trying it out, and reflecting on what you’ve learned.”

Remember to reflect on what went right and what went “not so right” during the holiday season and what can be done next time to manifest those goals and desires you visualized before hitting the road. Family connection could be the greatest holiday gift you’ll ever receive. Approaching  loved ones with gratitude and forgiveness makes almost anything possible.

This article was produced by Media Decision and syndicated by Wealth of Geeks.

Visit The American Institute of Stress

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Positive parenting can counteract the negative impact of childhood stress on brain development, study suggests https://www.stress.org/news/positive-parenting-can-counteract-the-negative-impact-of-childhood-stress-on-brain-development-study-suggests/ Wed, 16 Aug 2023 16:42:23 +0000 https://www.stress.org/?p=78743 Childhood stress is linked to decreased hippocampal volume — a brain region important for memory and learning, according to new research published in PNAS Nexus. The study indicates that positive parenting practices act as a protective factor, but only when perceived positively by the youths themselves. The new findings contribute to our understanding of the impact of childhood stress and the factors that can promote resilience in children’s neurodevelopment and psychological functioning.

Previous research has shown that childhood stress can affect brain regions like the amygdala and hippocampus, leading to potential mental health issues. On the other hand, positive parenting has been linked to better outcomes for children, both behaviorally and neurobiologically.

“It’s well known that stress experienced in childhood (e.g., chronic illness, death of a loved one) has negative effects on the brain and behavior of a developing child,” explained study authors Isabella Kahhale, a clinical and developmental psychology graduate student, and Jamie Hanson, an assistant professor at the University of Pittsburgh.

“Our team has seen this really consistently for two brain regions involved with learning, memory and emotion– the hippocampus and the amygdala. When kids are stressed, parents and caregivers often want to know what they can do about it (i.e., how they can support youth in times of challenge). We sought to explore what role positive parenting – that is, warm and supportive caregiving, like providing praise for doing something well – would have in attenuating links between stress and negative effects on the brain.”

“This is often seen for behavior, but few people have investigated it in the brain. We have previously found smaller volumes in the hippocampus and the amygdala after stress, but we wondered if this relation between stress and the brain would be different if there was a great deal of positive parenting in a child’s environment.”

To conduct the study, the researchers gathered data from 482 participants aged 10 to 17 years. They used structural brain imaging to examine the volumes of the amygdala and hippocampus. The amygdala and hippocampus are two important structures in the brain that play significant roles in emotion processing, memory formation, and behavioral regulation.

The amygdala is a small, almond-shaped structure located deep within the brain’s temporal lobe. It is often referred to as the “emotional center” of the brain because of its critical role in processing emotions, especially negative emotions like fear, anxiety, and aggression. The hippocampus is another brain structure located in the medial temporal lobe, adjacent to the amygdala. It plays a crucial role in memory formation, learning, and spatial navigation.

Childhood stress was measured using a checklist of negative life events, with the participants rating their distress in response to these events. Positive parenting was assessed through both youth and caregiver reports. Youth behavioral functioning was measured through a well-validated instrument assessing problem behaviors.

 

The researchers found that childhood stress was related to smaller hippocampal volumes, but not to differences in amygdala volumes. Positive parenting acted as a buffer against the negative effects of childhood stress on hippocampal volumes. In other words, youths who reported high levels of positive parenting did not show smaller hippocampal volumes even when they experienced higher levels of stress.

Interestingly, only the youth’s perspective on positive parenting mattered for this buffering effect; caregiver reports of positive parenting did not show the same relationship with neurobiology. This highlights the importance of considering youth perspectives in understanding how their experiences shape their brain development and psychological well-being.

“One of the biggest takeaways is that youth perception of support matters!” Kahhale and Hanson told PsyPost. “We found that positive parenting protected against an association between childhood stress and smaller volumes in a part of the brain called the hippocampus, but ONLY when positive parenting was measured by asking kids what they thought. When parents were asked about their caregiving style, their responses did not have the same protective effect. The big point is that it’s not enough for a parent to think they’re being warm and supportive – youth actually need to feel/perceive it, too.”

Examples of positive parenting practices include telling your your child that you like it when he/she helps out around the house, letting your child know when he/she is doing a good job with something, and rewarding your child for behaving well.

“Based on some other work demonstrating that youth perceptions are particularly important, we expected the effects of youth perceptions of positive parenting to be stronger than those of parent perceptions — but it was still surprising that there was such a limited/small effect of parent perceptions of positive parenting on the stress-brain link,” the researchers added.

The results suggest that positive parenting can have a protective effect against the harmful impacts of stress on the brain. It may do so by influencing biological processes, such as the hypothalamic–pituitary–adrenal (HPA) axis and cortisol reactivity, as well as socioemotional skills like self-regulation. However, the observed effects were relatively small, and the study had some limitations, such as its cross-sectional design and wide age range of participants.

Further investigations are needed to explore the complex relationships between stress, parenting, and the brain, with longitudinal studies and targeted age ranges to uncover potential critical periods for buffering effects.

“Our team’s work and that of others underscores that stressful experiences can have a detrimental impact on development; we’re still learning more about what aspects of stress matter, and how,” Kahhale and Hanson said. “For example, does it matter more if stressful experiences occur when someone is 5 years old, compared to 12? Also, what types of experiences might be particularly impactful? For example, experiences that are threatening, like violence, may influence the brain differently from experiences of deprivation, like not having enough food.”

“While we as researchers might think that certain types of stress have particular characteristics, the person experiencing the stress may not feel that way. That is, not having enough food might feel very threatening to the person going through it. We are aiming to really centralize perceptions of experiences in our future work focused on stress exposure and the brain.”

The study, “Positive parenting moderates associations between childhood stress and corticolimbic structure“, was authored by Isabella Kahhalé Kelly R. Barry, and Jamie L. Hanson.

 

by Eric W. Dolan

Photo by Gustavo Fring

Original postPsyPost

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