The holidays are a time of increased stress for many and as year-end tasks pile up, it can make it challenging to get the support and perspective one needs to re-prioritize. As stress can be cumulative, and is also hard to objectify, I think that introducing a scale to assess the burden of stress in the past year may help to gain some perspective on the toll stress has taken before the demands of a new year are upon you. I will also provide you with tips on how to improve your resilience to stress which will hopefully make for a healthier year ahead!
But before I discuss this scale in depth, let me elaborate a little on the effects of chronic stress on both psychological and physical health. Over time, continued stress can lead to anticipatory anxiety, depression, learned helplessness, PTSD (post-traumatic stress disorder), low self-esteem and self-efficacy, pessimism, transient psychosis, substance abuse, insomnia and nightmares. Physically there are a myriad of deleterious effects: neurological complaints (migraine headaches, Raynaud’s), cardiovascular disorders (angina, high blood pressure, atherosclerosis, arrhythmia, atrial fibrillation & heart attack), gastrointestinal disorders (irritable bowel syndrome & leaky gut), autoimmune disorders (allergies, multiple sclerosis, Hashimoto’s thyroiditis & pernicious anemia), endocrine disorders (amenorrhea, metabolic syndrome and infertility, erectile dysfunction, preterm labor & miscarriage), connective tissue/dermatological disorders (acne, eczema, low back pain, muscle strain, osteoporosis), respiratory disorders (asthma and hyperventilation) and accelerated aging and cancer. As long as this list is, it does not encompass all of the effects of stress – which really can cause or contribute to almost any illness.
The Holmes-Rahe Stress Scale was developed to attempt to quantify the effects of life changes in a year in terms of stress on the individual’s health in the following year. The scale consists of 43 life events and the relative weight of these stressors on well-being. These findings are translated into ‘Life Change Units’ listed in the table below. It is worth noting that even so-called positive or enjoyable life transitions are not without stress in this scale. (This has long been known in homeopathy with several remedies indicated for ‘Ailments from excessive joy’.)
To determine your score, add each relevant event (from the past year) with the corresponding life change unit score to obtain a total. (See how to interpret your score in the information following the table1).
A total score of:
≥ 300 is associated with an 80% risk of illness in the following year
150-299 is associated with a 50% risk of illness in the following year
< 150 is associated with a slight risk of illness in the following year
Use your score to determine your need to make life changes and seek support to protect your health in the New Year. Implicit in this scale is the understanding that stress has a more negative effect when it is unrelenting. Whatever can be done to spread out or pace life transitions and stressful events will help lower your stress levels and allow you to better recover psychologically and physically. If you are interested in assessing how your body is coping with stress further, you can complete the Adrenal Stress Profile Questionnaire posted in another blog post.
A discussion on the impacts of stress would not be complete without looking at the positive sides of stress and also how to improve your capacity to deal with stress (known as ‘resilience’). Genetic (Down’s syndrome), cognitive (depression and defeatist beliefs) and sociocultural variables (limited financial resources, poor nourishment, limited access to health care and poor access to advancement) can decrease stress tolerance, whereas behavioral skills, cognitive strategies, a healthy sense of self-efficacy, confidence and motivation, good physical and emotional health and supportive relationships can improve stress tolerance/resiliency.
As with many things in this culture, stress gets polarized as ‘bad’ (and less often as ‘good’), wherein in reality a balance is the best way to conceptualize stress. Too little stress and people suffer from low motivation and impaired learning and performance, too much stress and illness, impaired learning and performance can result. Eustress (or a healthy amount of stress), as termed by Hans Selye (who conceptualized the General Adaptation Syndrome Model of stress) is what is needed to learn and perform well; promoting the neurological connections and coordination to analyze, respond to and learn from a challenge and thus to grow.
Preliminary research discussed by Stanford health psychologist, Dr. Kelly McGonigal, adds an intriguing and hopeful look on how to understand and overcome the impacts of stress on our health and how to improve resilience; adding a new dimension to the work of Holmes & Rahe. Dr. McGonigal’s work is summarized in this TED Video, in which she describes a study in which one’s beliefs or interpretation of stress plays a significant role in one’s response to stress:
“People who experienced a lot of stress in the previous year had a 43% increased risk of dying. But this was only true for the people who also believed that stress is harmful for your health!”
Dr. McGonigal also discusses how caring for others helps increase one’s resilience to stress.
So as the new year begins, may your score from the Holmes-Rahe scale, Dr. McGonigal’s research and a realization that challenges and stressors are integral to growth, help you to navigate it less stressfully and with more support. All the best for a healthier and happier year ahead!
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Sahler, O.J.Z. & Carr, J.E. (Eds.). (2012). The Behavioral Sciences and Health Care. (3rd ed.). Cambridge, MA: Hogrefe Publishing, 52-60.
McGonigal, K. (2013, June ). Kelly McGonigal: How to Make Stress Your Friend. [Video file]. Retrieved from http://www.ted.com/talks/kelly_mcgonigal_how_to_make_stress_your_friend.html