Stress: Is It All In Your Head?

“Stress.” This one word can describe anything from the national economy to work conditions to one’s psychological state on any given day, when long commutes, work deadlines and family duties have taken their toll. Stress — much like its relative “addiction” — is a 21st century buzzword. But is stress real, as in an external phenomenon that can be measured, or is it all in our heads?

Perceived Stress Versus Actual Stress

Sheldon Cohen, PhD, a professor of psychology at Carnegie Mellon University in Pittsburgh, is best known for his creation of the Perceived Stress Scale (PSS). The PSS is the most widely used instrument in Dr. Cohen’s profession for measuring a person’s perceptions of stress. Walk into just about any therapist’s office and chances are you’ll encounter the PSS sooner or later.

The PSS test asks questions designed to evaluate the degree to which various life events are causing changes in one’s mood or mental state. For example, a sample question reads, “In the last month, how often have you been upset because of something that happened unexpectedly?” and respondents are expected to circle a number between 0 and 4 to rate the level of their distress.

It turns out that a person’s perceptions of stress are more influential than the so-called stressors themselves. In other words, you’re as “stressed out” as you think you are — a phenomenon maybe best evidenced by the fact that stress is largely a white, middle-class construct according to author Dana Becker, PhD, in her book One Nation Under Stress: The Trouble with Stress as an Idea.

Dr. Becker, a professor of social work at Bryn Mawr College in Pennsylvania, believes that stress as we understand it today is a culturally conditioned idea, one that’s evolved and changed over the years — and, that an accompanying slew of contemporary literature on stress relief contains “middle-class answers to primarily middle-class problems.”

Stress: A Cultural Construct?

The stressors in the life of a middle-class person probably aren’t any greater than those in the life of a poor person on welfare or a family whose members have gone off to fight in a war. But by Becker’s reasoning, the vocabulary of today’s middle class for interpreting those stressors is usually quite different. Her book seeks to understand and interpret this difference, with a view to asking how beyond using self-help strategies to cope with stress we might do a better job of addressing and remedying the stressors themselves, as opposed to just the feelings of stress that such stressors produce.

Becker writes: “When we say, for example, that poverty is stressful (in fact, in the academic literature, poverty is often called a stressor), we’re saying that people subjectively experience poverty as stressful; one person’s stress is another person’s challenge. But poverty is not merely — or mainly — a subjective experience.”

Poverty may be subjectively experienced as stress, in other words, but the reality of poverty (the so-called stressor itself, as opposed to merely its subjective experience) should really garner the greater societal response in the way of national reforms. Becker argues, however, that our current climate has its priorities backward, that instead of addressing the moral problem of poverty, we (or at least most middle-class Americans) are excessively focused on internalized efforts to relieve our stress via self-help techniques like meditation and healthy nutrition. In other words, if Becker is right, our perceptions of stress are more important in dictating how we live than the stressors themselves.

The Challenge of Measuring Stress Levels

There’s also a practical reason for why perceptions of stress are currently more important than the stressors themselves: Measuring perceptions of stress is more feasible and yields more useful data. Studying how an individual perceives how their financial troubles are affecting their mood and thoughts is rife with complicating variables — but studying the intensity of stress itself? Even more so.

“Intuitively we know stress is not good for you, but it’s not easy to measure,” says Gideon Koren, MD, who holds the Ivey Chair in Molecular Toxicology at Western’s Schulich School of Medicine & Dentistry, in a Science Daily article.

Dr. Koren is one of a number of scientists trying to solve the conundrum by finding a biological marker that objectively measures stress levels. So far one answer, not without its own complications, has been to find ways to monitor levels of the hormone cortisol, often described as the “stress hormone.” Stressed-out human beings produce more of it, and Koren and his associates have found a way to measure amounts of cortisol in strands of human hair.

“We know that on average, hair grows one centimetre (cm) a month, and so if we take a hair sample six cm long, we can determine stress levels for six months by measuring the cortisol level in the hair,” Koren says.

Is Stress on the Rise or Just Perceptions of It? 

In the meantime, stress and stress management are all the rage, from doctors’ and therapists’ offices to the self-help sections of bookstores and the conversational circles of distinguished academics. Becker reports that between the years 1970 and 1980, 2,326 academic articles with the word “stress” were published. Between the years 2000 and 2010, that number skyrocketed to 21,750. Does this growth signify a genuine rise in Americans’ stress levels, or is it only emblematic of growing perceptions of stress?

The answer to that question may change depending on whom you talk to. When interviewed for an article in The New York Daily News, Stanford University School of Medicine psychiatrist David Spiegel, MD, is paraphrased as saying that “it makes perfect sense stress levels would be higher than 25 years ago. Economic pressures are greater, and it’s harder to turn off information, and it’s harder to buffer ourselves from the world.”

Dr. Spiegel may be right. When Cohen and his team at Carnegie Mellon and the Laboratory for the Study of Stress, Immunity and Disease, which he directs, analyzed data from the years 1983, 2006 and 2009, they found that people’s stress levels had risen between 10 to 30 percent, at least according to their self-reporting (i.e. perception) of stress. People with less education, no job or lower-income levels, and also women and young people, were more apt to report stress.

Is What You See What You Get?

Such perceptions may also be what, in the end, are most killing us. The results of a London-based study published in the European Heart Journal in June 2013 show a strong correlation between levels of perceived stress and risks of heart attack. The study followed several thousand London-based civil servants since 1985 and found that people who believe stress is affecting their health “a lot or extremely” had double the risk of a heart attack compared to people who believed stress was affecting their health only minimally.

Findings elsewhere serve to confirm the link between perceived stress and health complications. In a study published by the American Journal of Cardiology in September 2012, researchers at Columbia University Medical Center reported that perceived stress raises risks for coronary heart disease as much as smoking five cigarettes a day does. And the National Institutes of Health link worry — another way to describe perceived stress — with a long list of other health issues.

The takeaway? Stress may only be as damaging as we think it is. The next time we feel harried, we might want to think twice before saying we’re “stressed out.”

By Kristina Robb-Dover

Follow Kristina on Twitter at @saintplussinner

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