Stressed Out? Let Your Freak-Out Flag Fly!

Seven months ago, we fell off a cliff into a collective freak-out, and here we are today, still falling. The stress triggered by the COVID-19 pandemic has been surreal, overwhelming, impossible. As we're falling, many of us are looking at our screens, which is good for pollers, since it means they can still survey us online about our daily emotional experiences. In the wake of the March shutdowns, Gallup reported "unprecedented increases" in worry and stress, which in the Before Times were always "highly stable metrics," but of course stability is not a hallmark of 2020.

The American Psychological Association, having taken up a monthly analysis of our mental demise, has so far produced volumes one, two, and three of its "Stress in America 2020" report. The most recent volume finds that stress has actually decreased slightly since the earlier months of the pandemic but that feelings of frustration, fear, and anger are on the rise. Stress-induced tooth fractures, too, are on the rise, according to some dentists in Virginia, so that nightmare where the thing you're chewing turns out to be your tooth, and now all your teeth are falling out – that's not just a dream.

It does feel somehow comforting that in our hyperpolarized political climate, neither party is immune to the emotional toll of the pandemic. Both Democrats and Republicans are super stressed out, say the APA data. We've entered a total stress eclipse.

Stress has profound physiological impacts, says obstetrician-gynecologist Michelle Chouteau, who works at St. David's Medical Center. Stress can manifest in the body as what commonly is known as the fight-or-flight reaction, in which a variety of hormones mobilize in anticipation of fighting, or fleeing from, a threat. "If that [reaction] is always turned on – which it tends to be, when we're in chronic stress – then we get into a state where our body is always trying to fight off that saber-toothed tiger," says Chouteau. "That means our adrenaline is turned on, our heart rate is up, our blood pressure is up, our mental acuity is higher. But the bad thing about that is it stresses our heart. It causes damage to the blood vessels, leading to heart disease." This process also can lead to weight gain and diabetes, says Chouteau, because it prompts the adrenal gland to release the stress hormone cortisol, which triggers food cravings and elevates blood sugar. "It has terrible effects on the body," she says.

Although the pandemic is affecting everyone, our experiences are not the same. People of color are experiencing illness and loss of loved ones in disproportionate numbers, a disparity rooted in factors such as racism, state violence and overpolicing, segregation, poverty, and unequal access to health care – what public health professionals call social determinants of health. These factors paired with the body's stress response can, for example, contribute to high rates of chronic stress, hypertension, and diabetes in Black communities. In turn, these conditions can increase vulnerability to the effects of COVID-19. People of color are more likely to work in high-risk frontline environments as well, increasing opportunities for infection, and they're more likely to experience other stressors triggered by the health crisis, such as unemployment and economic uncertainty.

Racial disparities in vulnerability to health and economic crises are more conspicuous perhaps now than before, but they aren't new, certainly not in Austin, where segregation has created geographical divisions that continue to shape people's lives today. "Austin has the unfortunately not-unique condition of your ZIP code being able to determine your health outcomes," says City Council Mem­ber Natasha Harper-Madison. "We happen to be one of the Republic's most segregated cities. ... Stress, financial disparities, education disparities, lack of access to healthy foods – all of those things sort of combine into one."

Other disparities are surfacing as well. Women have been hit particularly hard by job losses, a reversal of the trend in previous recessions, in which men bore the brunt of employment declines. Caregivers, too – who are more likely to be women – are struggling due to the collapse of both the formal and informal support networks that previously allowed them to maintain the casual illusion that full-time working and full-time caregiving are compatible.

For working parents of young children, keeping up with the demands of quarantine life has been brutal. Austin-based life coach Sarah Sherwood, whose practice is devoted to helping people deal with stress, says that these demands typically squeeze self-care off the to-do list. "I predominantly work with women, and they predominantly offload themselves," says Sherwood. "So they end up not having a moment of quiet or a moment where another small human is not touching them – just ongoing, unrelenting stress."

But even people with opportunities for self-care, who have job security and access to health care, and who are able to work safely from home aren't necessarily finding it easy right now to cope with stress and worry. Ample news coverage of the mental health tolls of social isolation, doomscrolling, Zoom fatigue, and endless meetings (along with reports of bosses overworking remote employees "because really where else can they go in a lockdown," as one Business Insider story put it) suggests that the seismic shifts wrought by the pandemic are not only creating new problems but exposing and aggravating problems that have been here all along, as well as our flawed approaches toward dealing with them.

This notion tracks with Sher­wood's observations. For a lot of her clients, the pandemic is proving to be an uncomfortable and sometimes unwelcome opportunity for facing long-neglected problems. "What I have found very consistently is that what people have been able [previously] to numb and ignore through busyness, all their activities – going out, meeting up with friends, celebrating big birthdays, etcetera – they've had to sit with it at home ... by themselves or inside of imperfect family relationships that they can't escape for 10 hours at the office."

Sherwood says she has found two key patterns in her clients' behaviors as they grapple with this situation. "If I were to generalize, I think people respond in two primary ways. They go into hyperdrive and can't stop, so they're spinning their wheels – kind of like cleaning out the garage and [saying] 'I can't sit down and focus on something because I need to get up and do that and do this and do that and do this.' But they're not really feeling productive on anything in particular. Or people go into shutdown, and they're finding themselves six months into this like, 'Huh, I was going to write a book and reorganize my pantry, and I have literally just sat on the couch and watched Netflix.'"

A central theme of pandemic life is that the situation causing our stress is also limiting our conventional repertoire of strategies for dealing with it. Traditionally, says Chouteau, when her patients seek advice on coping with stress, she recommends that they first try to "solve the thing that's causing the stress." But that's not always possible, especially right now. So the backup option, she says, is to take actions – such as meditation, exercise, or yoga – that mitigate the adverse effects. "Quiet your mind from all the outside noise," she recommends.

But a cruel irony of our predicament is that the mental risk-benefit analysis required for many of the simplest stress-mitigating actions we might take – socializing, going to the gym or coffee shop, getting a massage – can re-engineer these release valves into yet new sources of stress. So, too, can the interpersonal disagreements that inevitably arise as we negotiate disparate levels of risk tolerance among friends and family. For people whose go-to coping methods aren't working, the situation can be overwhelming. The pandemic, says Sher­wood, is like the vision quest that nobody asked for: We've been blindfolded in the dead of night, dropped off in the wilderness, and left there alone to contend with all the stuff we've been ignoring. "Here's your knapsack, bye!" jokes Sherwood.

So here we are. It's October, there's no vaccine, and we're still deep in the wilderness, alone with our knapsack that is presumably not packed with lavender essential oils and definitely not coins (because we're in a shortage) or Lysol wipes. Bereft of our grocery staples and creature comforts, the one thing we have in abundance is stress. Lots of it. If it were pennies, we'd be rich, though unable to carry it all out of the woods with us. If it were palm fronds, there would be enough of it to build an impressive lean-to or even a whole village of wilderness huts.

This idea – that stress itself can be a resource – is physiologically accurate, in that the purpose of the stress response is to help the body cope. But a conventional understanding of this concept does not conjure a mental image of safety. The notion that stress could and even should be understood as a friend rather than foe has emerged from research in recent years demonstrating that a person's beliefs about stress can influence how stress affects their health and behaviors.

For example, findings from mindset research – which examines how beliefs and attitudes shape behavior – show that even a brief introduction to a new way of thinking can lead to measurable changes in how people perform in stressful situations. Studies by David Yeager, an associate professor at UT-Austin, have found that such interventions can improve student outcomes. For example, he found improved academic performance and reductions in reported stress and physical illness among students introduced to testimonials and research supporting the idea that "people have the potential to change." In other studies, student GPAs improved after doing exercises in which they reflected on "the kind of person" they wanted to be and how school would help them be that person.

These interventions encourage people to reframe stressful situations as positive forces in their lives and to remember, even in the midst of distress, that they are doing something meaningful. This outlook is consistent with the work that Sherwood does with her clients. "I think people are trying to dig in their nails and hang on ... the equivalent of just kind of holding your breath," says Sherwood. "Most adults are in a chronic pattern of ignoring, overriding, and shutting down their natural nervous system reaction to stress, and that's why they drink wine every night or feel simultaneously very revved up, like stressed and agitated and unable to sleep, while also feeling kind of shut down, blasé, that life is not lived in full color." To help her clients move out of this state, she helps them focus on their values. "I think that the most resilient thing to do is to start to reconnect to your absolute, deepest core values and then slowly build in activities or outputs or expressions in alignment with those. The smaller the better."

Importantly, such interventions can potentially have physiologically beneficial effects, but not necessarily because they are less physiologically stressful. In her book The Upside of Stress, Stanford lecturer Kelly McGonigal chronicles the scientific research in this area. (Her TED Talk, "How to Make Stress Your Friend," covers similar ground.) She reports that studies priming people with positive information about stress and resilience before subjecting them to stressful situations can change the stress response by, for example, boosting the release of stress hormones like DHEA, which helps the brain learn from stressful experiences. Higher levels of DHEA in relation to cortisol can act as a buffer to post-traumatic stress and help create meaning out of stressful experiences. Other stress hormones, like oxytocin, can strengthen the heart.

McGonigal proposes that the traditional understanding of stress that laypeople are often familiar with – accompanied by its intuitively resonant narrative about the physical perils of too much tilting at saber-toothed tigers – represents only half of the story. The rest of the story says that although stress can be bad for the body, it can also be good for it. Her most compelling assertion, drawing from research in behavioral psychology and neuroscience, is that this story itself, by shaping a person's beliefs about stress, can influence these physical outcomes. The stories we tell ourselves about the stressors we face appear to be altering the chemical cocktail of stress hormones so that the body can draw strength from stress. A key reason is that these stories help us more viscerally understand whether we're facing a true threat that requires fighting or running away, or whether we're facing a "challenge" that requires a different course of action.

A Rethinking Stress toolkit is available on Stanford's website to allow anyone to try out a stress mindset intervention on themselves, just to see if it works. I tried it, in hopes it would help me manage the stress of writing this story while my 4-year-old son bounced around on the bed behind me, eating cookies and watching cartoons, because that is pandemic parenting. I can't say how it has affected my DHEA levels, but I can say that I did a lot of things I don't normally do while in crisis writing mode, such as reaching out to friends for help (leaning into the tend-and-befriend stress response, wherein the release of oxytocin encourages bonding, which in turn helps you marshal support from your com­munity). Those friends helped feed my delusion that finishing this article would be possible. And here we are – the delusion has become reality, which is on brand for 2020.

I hope it's possible that the stories we tell ourselves as a community can prompt similarly meaningful change, at a systemic level. "Often­times, I imagine what would Austin look like if everybody had access to the [same] kind of medical health care – not just physical but mental," says Harper-Mad­ison. "That's such an important component, to be able to have a therapist to help you work on coping mechanisms and develop healthy habits."

Rethinking stress won't necessarily make the source of stress go away. It won't end the health crisis or erase the injustices that can chip away, day by day, at our health and our ability to make meaning of the world. But maybe it can be a source of strength in our search for solutions and policy changes that can address the big stuff. Our current crisis, says Harper-Madison, does present an opportunity to address broader health inequities. "COVID has really shone a light on our disparities with access to clinics and medical treatment," she says. "I definitely am optimistic about changes in access to medical care. ... I think everyone's recog­nizing now how all the dots are directly connected."