Town Hall Webcast Segments
Susan Dentzer: Good morning. I’m Susan Dentzer, and I’m delighted to be moderating today’s discussion on the all important topic of stress. We’re coming to you from the Knight Studio at the Newseum in Washington D.C., and those of you joining us at home and online are the first to learn the findings from the American Psychological Association’s newest report: Stress in America: Our Health at Risk. Since 2007, the American Psychological Association has commissioned the Stress in America survey. Each year the survey examines the serious physical and emotional implications of stress. It goes without saying that stress is a part of all of our lives, and most of us also know that stress has a big impact on our health. Today we’ll discuss some solutions that could lessen this impact, including policy changes and more community support.
Joining me today is a group of experts on stress on physical and emotional health and, most important, on how our physical and emotional health are connected. Dr. Suzanne Bennett Johnson is the president of American Psychological Association and a distinguished research psychologist at Florida State University College of Medicine. Dr. Norman Anderson is the CEO and executive vice president of APA. He’s well known for his research and writing on the effects of stress on development of hypertension. Dr. Katherine Nordal is the executive director for professional practice at APA. Before APA Dr. Nordal managed a clinical and consulting group practice in Mississippi. Jonathan Lever is the vice president for health strategy and innovation at YMCA of the USA. Mr. Lever has been a chief architect in the wise response to the nation’s lifestyle-related health crisis. APA invited all of you to attend this event because of your interests in primary care and mental health and disease prevention and management. We’ll be taking questions from all of you this morning and hope that this is just the start of a larger dialogue about health policy solutions to stress that include behavioral and physical health. For those of you watching at home you can submit questions via the American Psychological Association’s Facebook page and on Twitter using #stressAPA. So let’s begin today’s conversation with some key findings from Stress in America: Our Health at Risk. For that we’re going to turn to Norman Anderson again the CEO and executive vice president the APA. Dr. Anderson, before we get to the findings though let’s establish: What do we mean when we use the word “stress”?
Dr. Norman Anderson: Well, stress occurs when we’re faced with situations and circumstances in our lives that exceed — that go beyond — our ability to successfully cope with them. Now, we all need some challenges in our lives just to prevent boredom, to stay engaged and actually to perform. And research has shown that a certain level of challenge — when it goes up — we actually do better in our lives, particularly in our work. It’s just when stress reaches a level that exceeds our ability to cope with it and it goes on for a long period of time — when it’s chronic — that we can say that people are in stressful situations.
Susan Dentzer: And we know more and more that stress actually translates into changes in our bodies, not all of which are good.
Dr. Norman Anderson: That’s one of the reasons we are very interested in studying stress and communicating how important it is. Stress has been found not just to affect us emotionally in terms of increasing depression and anxiety. It affects our behavior and interesting new research is showing it has profound effects on every system of our body. It affects our cardiovascular system, our immune system, our endocrine system. A recent report came out just this week that shows that stress actually causes a reduction, a shrinkage, in certain parts of the brain. So, stress has profound effects on all aspects of functioning.
Susan Dentzer: And as I understand that these happen to be parts of the brain that actually influence what we are going to be experiencing in terms of hypertension or other symptoms.
Dr. Norman Anderson: Yes and it’s a logical extension of stress affects — negatively affects — all these systems of the body, and stress increases our risk for a whole host of chronic illnesses that you will hear about later today.
Susan Dentzer: Okay, so we know this is really worth taking seriously. Let’s go to the findings then of this year’s survey. What are the top line results?
Dr. Norman Anderson: Well it’s really, what we found this year is really a good news, bad news story. The good news is…you know, we started doing the survey in 2007, and what we found over the years is that there is a very slow gradual decline in the level of stress Americans are reporting. It was uh when you look at that top level of stress, that extreme stress category, and in our survey we have a one to 10 scale, with eight, nine, and 10 being extremely high stress. The percentage of people in that extreme stress category has gone down gradually every year, so that’s the good news. The bad news is that nearly 50 percent of our survey participants are reporting that their own individual stress has gone up in the last 5 years and expressly in the last year.
Susan Dentzer: It’s kind of counter intuitive that stress levels would be going down. The economy has been miserable, there is a lot of joblessness, do we have any idea what’s going on?
Dr. Norman Anderson: Well, we are not positive, but what you have to remember is that when we started doing the survey in 2007, that was really the beginning of the massive recession we had, so people were already feeling and experiencing the effects of that recession. So, the decline that you see is really from that extreme high back in 2007. But, still nearly 25 percent of the American public is saying that they experience extreme stress, and because of the large effects of stress on people this is not good.
Susan Dentzer: Now, this year’s survey also asks some particular questions about the effect of stress on caregivers and on people with obesity. What do those results show?
Dr. Norman Anderson: Well, what we found this year, we really wanted to look carefully at a couple of subgroups. One of those subgroups are people we call caregivers. These are people who care for family members who are suffering from a variety of chronic illnesses such as a heart disease, a cancer or Alzheimer's’ disease. Our research this year corroborates; other research has been done that shows that this group is one of the highest stressed demographic groups in this country. It’s really quite remarkable that to see the level of stress that they are under. The other group that’s under a high level of stress are people with chronic diseases including heart disease, but also people with things such as obesity and depression are reporting an extremely high stress levels as well.
Susan Dentzer: And we know we have plenty of reasons now to be concerned about obesity with two-thirds of American adults either overweight or obese. It really is a crisis for our country. And Dr. Johnson, what does this mean then for individuals who are obese, as we’ve discussed, or have chronic illnesses?
Dr. Suzanne Bennett Johnson: Well, I think what the survey shows is that being obese or having a chronic illness at all actually increases your stress level. It turns out that over half of the people that responded to the survey said that either their own health problem or health problem in their family was a major source of stress for them. So, if you think about that, and then you add on top of it just all the stressful things that happen in someone’s life, then you realize that having a chronic illness is going to be very difficult to manage. Added stress of the illness and then added stress in your life is going to make it very difficult for you to successfully manage your disease.
Susan Dentzer: So a kind of vicious cycle essentially takes off?
Dr. Suzanne Bennett Johnson: Yes, it is a vicious cycle, and it’s actually the cycle is even bigger than that because it turns out that behaviors that are linked to stress have a lot to do with whether you get these diseases to begin with. It turns out that about 80 percent of heart disease, 80 percent of stroke, 80 percent of diabetes is actually caused by poor lifestyle behaviors. If Americans would quit smoking, eat better, exercise more, we could actually reduce the number of people with chronic illness in this country.
Susan Dentzer: Well, it sounds like all of that is obviously going to be desirable but it’s not going to happen without some policy changes or some, certainly some different ways of delivering health care to these individuals. Correct?
Dr. Suzanne Bennett Johnson: Yes. We are very concerned about the way health care has been delivered in this country. I like to sort of think about it as the disease model of health care. If you have a disease we are going to treat with either drugs or surgeries, but we haven’t successfully addressed the behavioral aspects of either having the disease or either getting the disease, so I think our health care system needs to focus more on people and less on disease.
Susan Dentzer: So Dr. Nordal sounds like there’s role here increasingly to marry psychological interventions with what we would think of as strictly health care of related physical interventions.
Dr. Katherine Nordal: Absolutely. As Dr. Johnson said, chronic illness is a huge problem in this country. We spend about 75 percent of all our health care dollars on chronic illness, and then we have four major behaviors — alcohol and drug use, tobacco use, lack of exercise or sedentary lifestyle and poor nutritional habits — that lead to and exacerbate these chronic illnesses. We have a huge public health concern. It would be easy if we could all, just as the old saying goes, “Just do it” and change our behavior, but it just not that simple. It’s hard for people to change engrained habits of behavior. So when we get stressed out we need to take stock of what it is that’s causing the stress — are we managing it appropriately or not? If we are not able to make the changes we need to by ourselves, we need to consult our physician or a psychologist or another health care provider that can help people make the changes that they need to make because if you just can’t do it on your own and you know you’re running the risk of some really bad health outcomes, it’s important that people take some action to get the help they need.
Susan Dentzer: And the survey this year actually speaks to that topic — the importance of support networks and strategies, really — for supporting people particularly among caregivers.
Dr. Katherine Nordal: Absolutely. The caregiver group seems to do much better when they are plugged in to some sort of a support system. They demonstrated less isolation, less loneliness, better coping strategies, less depression, less irritability and just less risk of chronic disease when they are plugged into the those family and friends and other sorts of community based support systems.
Susan Dentzer: So Jonathan Lever the Y has been wading into this problem, exploring a number of strategies in response to everything we’ve been talking about — obesity, chronic illness and so forth. What are the community level interventions now that you all are engaged in?
Jonathan Lever: Yeah, well, and everybody knows of the Y, but what folks may not know about the Y is that over the last several years we’ve really moved from a focus on the sort of “already fit” population. The people who, if you gave them the keys to YMCA, would be happy to go in and run on the treadmill to folks that we call “health seekers” – people who really struggle to adopt and sustain healthy lifestyles. And as local Ys have begun to think about health seekers, the folks who need support and struggle they’ve become more and more involved in chronic disease prevention programs. And so, the Y and many communities across the country now have chronic disease prevention programs — primary, secondary, tertiary kinds of programs focussed on individuals. Like we have a diabetes prevention program now. Excuse me, it’s now running in many places across the country. It’s a group-based program. We have a program with the LIVESTRONG foundation that’s focused on cancer survivors. We work with families on childhood obesity, and we also work at the community level to address sort of those policy systems change issues — more sidewalks helping kids adopt policies that enable kids to walk to school.
So, working at the community level as well and one of the things I thought would be interesting to share is some of the learnings that have really come from this work as it relates to stress. And it has really been touched on by Dr. Nordal already, which is why many programs are group-based. There is magic in group-based programs because people feel encouragement and support by others who are in the program with them. In our diabetes prevention program when people are scared to step on the scale it’s the group that encourages them; you know: “Come on get on that scale and let’s see how we did this week.” Another magic of community-based organizations like the Y is for people who are coping with the disease — not going to a hospital or a clinical setting — to get an intervention really has important psychological benefits. So going to a YMCA where there are kids and families, as you’re wrestling with a disease, is really uplifting and is different than going back to the hospital where it feels like “Wow, I’m back in treatment again.”
Susan Dentzer: The Y has a very important new partnership with APA in engendering a lot of this. Let’s talk about that a bit.
Jonathan Lever: Yeah, we’ve been really blessed to be able to work with the APA and their network of psychologists to run workshops, free workshops at local YMCAs, to help families that are struggling with childhood obesity in their family. And we’re working on a new program with APA and psychologists across the country to help people live well with a particular chronic condition. So we are thrilled to be able to be working with APA and others.