I Will Never Tell You To Relax

When I was in medical school some 30 years ago, I was taught never to tell a patient to relax. Nothing seems to make someone less relaxed than being told to do so. The alternative advice was to tell them to clench their toes and then slowly let go and feel the sense of relaxation sweep up your legs into the rest of your body. Showing them how to relax proves much more effective than telling them. That actually seems to work and I've tried it on myself numerous times.

I share this anecdote because it is a good prelude to today's topic. How do you tell someone about the dangers of stress without stressing them out?  That would seem to defeat the purpose of alerting them. I'll come back to this paradox later.

It's been an acceptable axiom for some time now that stress wreaks physiological damage on our bodies, even perhaps on the chromosomal level. I've seen references to a study that revealed that the telomeres which are the end of our chromosomes, shorten secondary to stress. Scientists generally believe that when a telomere shortens to a certain length, typically a cell undergoes apoptosis or cell death.

Along comes a meta-analysis study by Tom Russ, MRCPsych, of the National Health Service Scotland, and colleagues that reviewed 10 British cohort studies that showed that the risk of all-cause mortality or reasons for death in adults with the lowest level of psychological distress -- termed subclinically symptomatic -- was significantly higher than that of asymptomatic adults at an age- and sex-adjusted hazard ratio of 1.20 (95% CI 1.13 to 1.27). In other words, stress increases your likelihood to die from any number of reasons.

To quote medpagetoday.com, "The study measured the association of psychological distress with death by any cause, cardiovascular death, cancer death, and deaths from external causes using data from the Health Survey for England. The survey included data from 1994 to 2004 on 68,222 adults ages 35 or older, mean age 60 years, who were free of cardiovascular disease and cancer, and who lived in a private household in England at baseline."

As an observational study, in which results are observed as opposed to created, the study has its limitations. For example, we don't know the cause and effect relationship. Did people who became unhealthy develop more stress and therefore die at higher rates or did people who became more stressed thereby became unhealthy, which led to their death? There is no good way to do a high quality study of this kind because you can't have a group that you stress out to see if the stress will kill them. So, we are left with correlative studies such as this one as our best science. Notwithstanding, I think we can all agree that stress is not a good thing.

I know that whenever I hear about the dangers of stress to my health it raises my stress. It's like someone telling you not to think about something and you start thinking about it incessantly. The mind is a wonderful machine that still escapes our full understanding. Still, we have to work with what we know and that is it is better to be somewhat relaxed than somewhat stressed. In the book, The Longevity Project, by Doctors Friedman and Martin, we learn that a little bit of neuroticism is a good thing. I wrote about this some time ago. It's healthy to be aware of your surrounding and potential dangers. It's normal to worry about finances and relationships. It becomes unhealthy when you are consumed by such thoughts.

So how do we find a healthy balance between legitimate worries and irrational thoughts? I think the answer is focus. Ask yourself what is the focus of your life? Is it on potential and possibilities or what has gone wrong? Is it on tomorrow or yesterday? Is it on things you have to be grateful for or things that bother you? For some people making these choices is easy. If you are one of them and your focus is on the positive, I suspect that you enjoy life more than most. If you are hampered by a continuous stream of consciousness that accentuates the negative, you need to address this proactively. You can't ignore it; you need a plan. Speak to your clergyman, a doctor, or anyone you think may help.

I share these concerns about stress because despite the fact that it may raise you stress in the short-term, you will be better off in the long term by developing effective ways to lessen its toll on you.

As the studies suggest, living with stress means dying early from stress. Don't let yourself become a statistic.

We All Can Use A Little Help Sometimes...

I have always been a fan of psychologists. When I was in college, I was very distraught over a family situation. In a mere fifteen minute session, a college-based psychologist gave me advice that served me profoundly well. Sometimes, we get so lost in our heads that we need someone, trained and professional, to help us get some clarity. I did that day and it made me a believer.


Psychologists, particularly those with a PhD, spent as much as ten years, including postdoctoral internships and fellowships, getting the full range of their intensive education, and they can make a huge difference in your life.

That is why, before MDPrevent had it first patient, I hired a full time health psychologist for our team. Her name is Dr. Jessica Kordansky and patients rave about her. She offers the full range of health psychology services and also leads our Mindfulness Meditation classes each week.

What is a health psychology? It is a field of psychology concerned with understanding how biological, psychological, environmental, and cultural factors are involved in your physical health and illness. In other words, it takes all aspects of your life into consideration to help you maintain the best possible emotional and mental health. It helps you develop strong coping mechanisms to deal with the inevitable stress and anxiety that seems to accompany most people as they age.

New Study

Why do these matter? A recent population-based study showed that individuals scoring higher on a measure of general mental health had an increased risk of stroke mortality. Psychological distress predicted a significant 66% elevated risk of death from cerebrovascular disease, according to Mark Hamer, PhD, of the University College London. It's really simple. Stress kills.


"These [new] data suggest that the cardiovascular effects of psychological distress are not limited to coronary artery disease," Hamer's group wrote.

Scientists know one of the mechanisms by which stress kills is by shortening your telomeres, which are the tails of your chromosomes. Each time your cell divides, your telomere shortens and eventually when it reaches a certain length, the cell dies. Stress accelerates this process. Another mechanism by which stress induces great harm is by its affect on your blood pressure. Increased blood pressure damages both your heart and vascular systems thereby increasing your risk for stroke and heart attack.


I think that the overwhelming majority of patients would benefit from one-on-one time with a health psychologist.   It seems that as we live our lives, we accumulate a lot of mental baggage and it gets really crowded in our heads making and keeping sense of it all. A health psychologist can help you sort out the things that you should stop thinking about because they are not meaningful, the things that you need a plan to address, such as your finances, and the things that you can't stop thinking about, such as your children, that you can't change, but need a effective and useful way to cope with it.

I often quip that smart people always take advantage of psychological counseling because I learned in medical school from a family friend who worked in a local mental health center that many of my fellow medical students were taking advantage of the service available to us. I also once heard that Newton, Massachusetts, where I lived for ten years, has the highest per capita rate of counseling anywhere in the U.S. It's not surprising because it is also home to some of the smartest people in the country who are professors and doctors at local universities such as Harvard, MIT, Tufts, Boston University, Boston College, Wellesley, Brandeis, etc.


The best part of health psychology is that it is covered by Medicare and most other insurances.  So if you find yourself believing that your "thoughts are facts," which they are usually not, and would like to get some stress reduction, better sleep, less anxiety, and an overall better handle on life, maybe it's time you spoke to a health psychologist? At a minimum, it may help you avoid a stroke.

There are many excellent health psychologists. I am impartial and think I have one of the best, who by the way trained at Emory University. If you are interested in speaking with Dr. Kordansky, you may reach her at (561) 807-2561.

Either way, if stress, anxiety, difficulty sleeping, strained relationships, loneliness, depression, or anything else is affecting your health or your life, consider speaking to someone. It doesn't really matter why, but if you you think you would benefit from such support, you should do so because we can all use a little help sometimes...