Speaking of Psychology: How to keep stress from harming your health, with George Slavich, PhD

The American Psychological Association’s most recent Stress in America survey found record high levels of stress among Americans of all ages. George Slavich, PhD, director of the UCLA laboratory for stress assessment and research, discusses how stress affects our brain, body, and immune system; why it’s important to measure a person’s lifetime exposure to stress; and strategies to manage stress and minimize its negative effects on your health.

George Slavich, PhD, is a professor in the department of psychiatry and biobehavioral sciences and founding director of the laboratory for stress assessment and research at the University of California, Los Angeles. He is a leading authority in the conceptualization, assessment, and management of life stress, and in psychological and biological mechanisms linking stress with mental and physical health. He developed the first online system for assessing lifetime stressor exposure; and is helping pioneer a new field of research called human social genomics, which is revealing how social experiences reach deep inside the body to affect the human genome. His recent research focuses on Social Safety Theory, which describes how experiences of social safety and threat influence the brain and immune system to affect human health, aging, and behavior across the lifespan. His work has been published in leading journals including Nature Medicine, Nature Communications, and JAMA Psychiatry, among others.

In addition to these research roles, he serves as director of the California Stress, Trauma, and Resilience (CalSTAR) Network, director of the UCLA Bruin Stress Resilience Network, director of the Branco Weiss Fellowship International Collaborative Grants Program, co-chair of the APS National Task Force on Stress Measurement in Primary Care, director of the Global Belonging Collaborative, and senior program director for the UCLA/UCSF ACEs Aware Family Resilience Network, which is supported by a $41.5 million award from the Office of the California Surgeon General and California Department of Health Care Services. His work has been covered by many media outlets including The New York Times, The Washington Post, The Guardian, The Atlantic, Scientific American, TIME magazine, HBO, and NPR, among others.

Kim Mills: April is Stress Awareness Month, which this year seems more relevant than ever. The American Psychological Association's most recent Stress in America survey, fielded in February and March, found record high levels of stress among Americans of all ages. That stress was tied to inflation and economic uncertainty, global tensions amid Russia's invasion of Ukraine, all compounded by two years of the COVID-19 pandemic. More than 87% of respondents to the poll said that rising prices were a source of significant stress for them, while 81% cited global uncertainty as a significant stressor.

In recent decades, research has found that stress can harm our physical as well as our mental health, through its complex effects on our brain, body, and immune system. So how does stress get under our skin to affect our health? What are the biological pathways through which this happens? Do different types of stress affect us differently? Is it possible to measure stress objectively and to figure out whether the level of stress we're under is high enough to harm our health? And when we do feel stress, what are some strategies we can use to manage it and minimize its negative effects?

Welcome to Speaking of Psychology, the flagship podcast of the American Psychological Association that examines the links between psychological science and everyday life. I'm Kim Mills.

Our guest today is Dr. George Slavich, professor and director of the laboratory for stress assessment and research at the University of California, Los Angeles, where he studies the psychological and biological mechanisms that links stress with poor health. Dr. Slavich is an expert on the basic science, assessment and management of life stress. He developed the first online system for assessing lifetime stress exposure and is a pioneer in a new field of research called human social genomics, that looks at how social stress affects the human genome. His work on the psychoneuroimmunology of stress and health has been published in many leading scientific journals and covered by media outlets, including the New York Times, the Washington Post and Scientific American among others. 

Thank you for joining me today, Dr. Slavich.

George Slavich, PhD: Kim, thank you so much. And thank you so much for giving some air time to this topic that is on all of our minds: stress, what we can do about it and how we can all build back stronger.

Mills: Yes, we will be talking about that. And as I mentioned a minute ago, you're an expert in psychoneuroimmunology, which is a pretty big mouthful. So can you break that down into its parts and explain what it is and how stress affects our physical health?

Slavich: Yes. Psychoneuroimmunology is a very fancy term for a very simple concept. We all know that when we're stressed we have different thoughts that pop into our mind. Like, “This is never going to end. Am I doing well? I'm failing. Everybody's left me. I may never get over this.” And those thoughts that pop into our mind are obviously getting represented by our brain in some way. And then our brain is really the captain that is guiding the rest of our body. I mean, our brain can tell our immune system to ramp up or ramp down and lead to a lot of other biological changes that ultimately affect not just our mental health, but our physical health as well.

And so if you just think about the term “psychoneuroimmunology,” it's essentially just gluing together the three things that I mentioned, our psychology and how we experience the world. Neuroscience, which is the neurobiology of how we appraise and think of those things that are happening to us in the world. And then our immunology, which is, as we know now, relevant for a lot of different mental and physical health problems. So maybe an easier way to think of it is mind-body medicine, where we think about how the brain is regulating the body and how the body in turn influences the brain. But as I said, it's just a complicated term for a very simple idea, which is how our psychology influences our neurobiology, our immune system, and vice versa.

Mills: So some of the stressors I talked about in the introduction like war and inflation are big global stressors. Did those kinds of stressors affect us differently from more personal social stress stressors, like say a divorce or a breakup?

Slavich: I think we all—first of all, in some way we're all experts on stress now if we weren't two years ago. And in some way I feel like there's a lot of atmospheric pressure. We've all in some ways felt like we've been in this stress pressure cooker with uncertainty in the world, with changes in the economic situation. But the other things you mentioned are really individual level stressors. And it's interesting to me that the survey maybe didn't bring some of those individual level stressors to the top of people's minds, quite as much as I think they actually are in our lived experience. So in my job and maybe in your job as well, and a lot of our listeners, our entire personal lives, or certainly our professional lives, have been recalibrated, thrown up in the air, juggled about, in terms of needing to work from home, figuring out childcare responsibilities, whether or not to retire or not to retire.

These are all, this is a lot of cognitive upheaval and reshuffling of our social relationships. I mean, we're all used to going into work and meeting with colleagues and going to lunch with colleagues, and essentially using the social support and the social network around us. So in addition to these global things like the financial markets and Ukraine, I think we also need to think about and speak about how our own personal lives have been thrown up in the air. And for many of us, are still in flux and that in and of itself has degraded the grounding and the predictability I think that we all would normally rely on to get through these big macro stressors, like uncertainty in the financial markets or uncertainty with war and peace.

So just to answer your question, we know from a lot of research that we've done, that social relationships are incredibly important for getting us through difficult times. And there's a whole neurobiological reason for that, that we may get into. But in the absence of these close social bonds and predictable social networks, the more macro stressors that we face can have a much greater toll than they otherwise would.

Mills: So what does stress do to our bodies that is so unhealthy and even dangerous in many cases?

Slavich: Well, the first thing we need to do is to give some kind of definition to that persnickety term stress, because everybody uses it in a very different way. And so, it's useful to kind of say, what is it that we actually mean when we use the word stress? And I prefer to just make a quick distinction between stressors, which are thing that actually happened to us—like losing a job or getting divorced, or learning of some bad financial information, or having to move houses—versus stress, which is sort of an abstract, not abstract, but a general term for all of the consequences of experiencing those stressors. So the stressor might be getting divorced. The term stress may refer to the psychological and physiological, and immunologic changes that are really the sequelae from that experience.

And to sort of understand why stressors would impact the brain and the body, we have to think about what's really the primary purpose or the primary function of the human brain in the immune system. And in my writing, I make the argument that the primary purpose of the brain in the immune system is to keep the body biologically safe. And one way that the brain does that is by guiding us toward friendly other people, socially supportive relationships, people who can keep us physically and socially safe. And at the same time, try to keep us generally away from situations that might pose physical harm to us. And the immune system is actually in cahoots with this goal of keeping us biologically safe. The immune system can turn on in the presence of different pathogens. So for example, when you get a cut on your arm, you may see some redness and swelling, some heat in that location.

And that's essentially a localized inflammatory response that is intended to keep the body biologically safe and to limit the spread of infection. Now, in order to serve that purpose well, we think one thing that happened was that the immune system gained the ability to talk with the brain and to increase inflammation, not just after some kind of physical damage had already occurred to the body, but in anticipation or in advance of that physical wounding occurring. 

So I'll just give you an example, if you were, let's say now, several thousand years ago, when you're amongst a group of individuals who you didn't know well, and all of a sudden that interaction turned from very friendly to hostile. What your brain would, we hypothesize would do is to call up, pick up the red phone, call up the immune system and say, “Hey, immune system. I hope you're doing well today. I just noticed that—I thought this conversation was going really well, but it turns out that these other villagers don't look quite so nice and I don't know what's going to happen, but the situation may go sour and I'm seeing some angry faces out there. And I just want you to be prepared in case this interaction goes south and turns conflictual and at some point we might get into a fight.”

So the reason that the brain would have that sort of red phone connection with the immune system is that at the first indication of the presence of some kind of social conflict or social danger, the immune system could turn on, release these immune cells into all compartments of the body. And if physical wounding actually occurred, those immune cells would be ready and primed to accelerate wound healing and recovery just in case that physical wound healing would have occurred.

And just to put a bow on this little monologue here, my point is that we all would have been selected for having that early detection system, early threat detection system, whereby the brain would have told the immune system to ramp up in anticipation of potential physical wounding occurred. And those among us who didn't have that anticipatory response are likely no longer around us, because, well, their immune system wouldn't have had as an efficient of a response to actual physical wounding when it occurred as compared to those of us who mounted that anticipatory response.

Mills: So living as we are right now with a lot of stress, does that mean that our bodies are on alert all the time? Is that what's happening to a lot of us? And therefore your immune system is on overdrive. It's doing things that you don't need it to do, but your brain is telling it to do.

Slavich: Yeah. And I love that you ended that sentence on the brain because I think that's really the crux of the point. For some of us when we're in this stress pressure cooker and thinking about Ukraine, and thinking about our financial situation, and feeling lonely and upset about the state of the world, we may be stuck in that mental state of ruminating about the negative things that have happened. Feeling socially, disconnected, feeling alone, feeling as though we're not sure what the future is going to bring and whether or not we're essentially going to be able to continue as we all were pre pandemic. Whereas for others of us, we are not perseverating on those particular topics. We may think about a negative news item that pops up on our phone, but then once the negative news item goes away, we're no longer thinking about it anymore.

And so the question really in terms of the negative health effects is not just whether we think about it when these negative situations arise, but long and how often do we ruminate about them and perseverate about them when they're no longer in front of us. And I think Robert Sapolsky's Why Zebras Don't Get Ulcers book, which really captures this idea quite succinctly, which is that in most of the animal kingdom, animals are thinking about these threats in the environment, but only as long as they're present. And when the threats are gone, the thoughts then subside and animals go along their merry way. Whereas humans have this incredible capacity, both for better and for worse, to symbolically represent and to imagine negative situations even when those situations are not directly in front of us.

So I like to use the example of, maybe you have a nasty boss. And some conflict between the two of you or you don't necessarily get along and you have a meeting with them on Friday at 3 p.m. Well, for some of us, we wake up Monday morning and we start thinking about that meeting now, Monday 9 a.m., Monday during lunch, Tuesday, Wednesday, Thursday. By Friday, our stomach is turned upside down and all we can think about is how that conversation is going to go. But not just that, we're thinking that it's not going to go well, that he or she is going to criticize me, et cetera. So what we've essentially done is that our brain has symbolically represented that stressor now, Monday morning, Monday afternoon, Tuesday, Wednesday, Thursday, Friday, even though that stupid meeting is only from 3-3:30 p.m.

We laugh, but we all know that we do this from time to time, or we know other people who have done it. Whereas for others of us, we've saved ourselves four and a half days of the stress response, because we're honestly not even thinking of how that meeting is going to go until 2:55 p.m. on Friday afternoon, in which case the presence of that stressor is actually only 35 minutes. And there's another overlay to that, which is that we may not even go into that situation thinking that the worst is going to occur. We may understand that our boss is not the easiest person, but we actually look at that situation as an opportunity to tell our boss about all the amazing work that we've done recently, and to sort of celebrate our own work and the work of our team.

So that's the funny way in which the human brain has gained the capacity to think about other people's thoughts and intentions, and actually to take those thoughts and intentions and the likelihood of certain situations occurring. Which is really useful for getting us to get along and cooperate. Because of course, if we weren't able to imagine what was in the mind of our boss, we may not be able to anticipate it very well or to meet our coworkers where they are, or meet the demands. So it has an upside in terms of being able to foster cooperation, but it also has a downside which enables us to symbolically represent and imagine things that are negative even when they're not actually happening.

Mills: So what are some of the effective ways then, that people can alleviate those kinds of stress or at least mitigate the harm that it might be doing to their health?

Slavich: Well, I love that nasty boss example because it brings mindfulness techniques to the forefront. So the simple way that I think about mindfulness meditation is that you have these negative thoughts that pop into our mind and we all have these negative thoughts. “Am I good enough? I'm not doing well. I have a difficult meeting tomorrow. I'm not prepared. It's not going to go well.” And what you notice is that all of those thoughts, some of them are kind of about the present, but a lot of them are about negative possible things happening in the future.

For others of us, maybe we tend to ruminate about negative things that have happened in the past. “Why the hell did I say that? I can't believe I said that his shirt didn't fit or that comment was stupid. What are people thinking about me now because I said that? I really wasn't prepared. I should have done better. I should have been a better partner.” Those are ruminative thoughts about negative things that might have happened in the past. So just in terms of the state of mind, our mind can often drift to negative thoughts that are focused on the future and negative thoughts that are focused on the past. What I like about mindful meditation is that, the idea is to nonjudgmental identify that your thoughts are floating into the future, floating into the past, and gently bring your awareness back to the present where, guess what, things are actually pretty good. You're not sitting in front of your boss, you're sitting for a cup of coffee with somebody who you love.

You're reading a delightful book that you really enjoy. You're laying on the sand listening to the waves go in and out. You're laying in the grass feeling the grass and the fresh air, and the sun beaming down on your face. Of course, now while you're doing that, now the boss is creeping into your head again. So that mindfulness practice is gently and graciously bringing that awareness back to the present. So that actually what you're doing is you're limiting, you're reducing the amount of time that your mind is floating to the future and floating to the past, bringing it back to the present where actually everything is okay.

And just if we turn that practice into the minutes of the day, what you can see is that the number of minutes that you practice that mindfulness technique, the fewer minutes your brain is telling your immune system potentially to ramp up in preparation of some kind of threat. Which as I've just kind of illustrated is that, is actually not there because where you are is on a lovely beach or your fluffy couch, where those threats are not in front of you. So that's my favorite one go to and it's something that we can all practice for free with, with no tools. We don't have to purchase anything to do that.

Mills: So there's another area you've looked at though, which is cognitive behavioral therapy and its effect on inflammation. Can you tell us a little bit about that research?

Slavich: Yes. So I'm a clinical psychologist by training and cognitive behavioral therapy is, which I'm sure many listeners would be familiar with, is a different, let's say a different strategy or a different way in for reducing the negative impact that these thoughts would have on our brain in our body. So one of the key ideas behind cognitive behavior therapy or CBT is cognitive restructuring. And in a nutshell, what that involves is, first of all, being mindful about the thoughts that we're having in the moment. And in the CBT lingo, those are called negative automatic thoughts. So if I'm going along my merry way, and I'm walking down the street, and I think to myself, "Wow, I really messed up. My boss is going to hate me for this. He's never, or she's never going to trust me on an important project again."

So clearly that's a negative automatic thought, it popped up into our mind. And when those thoughts are very emotionally charged, oftentimes the thoughts are exaggerated in a negative direction, more so than what the evidence actually would suggest is true. And so the process of cognitive restructuring in the CBT framework is to, first of all, identify that negative thought when it pops into our mind, which by the way, some of us are really good at doing. And others of us feel negative for a long period of time without necessarily recognizing the thought that is causing that negative emotion. So I don't want to gloss over the mindfulness part because actually identifying why you're upset sounds simple, but can sometimes be quite complicated. So first of all, identifying the negative thought, maybe putting it down on paper or putting it on a whiteboard, or writing it down.

And then what you do in cognitive restructuring is, act as a scientist. First of all, you look, you say that thought, okay, my boss is never going to trust me again. Now what your task is, is first of all, to identify all of the evidence that you have that supports that thought. Now you're laughing, because you recognize that the more ridiculous the thought is, let's say ridiculous, the less evidence based the thought is, obviously the fewer things you're going to be able to put down to support that thought. Then what you do, so once you're done with that column, now what you have to do is identify all of the evidence that does not support the thought. This has happened before. My boss has continued to trust me. I've done a great job. I've had other successful projects.

My boss likes me, if he or she didn't like me, he or she wouldn't trust me on such important projects, et cetera, et cetera, et cetera. So inevitably what happens is you have this very short list of evidence that supports the negative thought, and you have a very long list of evidence that does not support the negative thought. And then there's the final step, as a scientist would do, which is that, to evaluate, to look at that negative thought you had, to look at the evidence that supports it, to look at the evidence that does not support it, and then to rewrite that thought now based on the balance of the evidence.

So if the original thought was, my boss is never going to trust me again because I messed up. The rewritten thought would be much more balanced and much more evidence based and sounds something like, mistakes sometimes happen. I'm doing my best. I'm a valued member of the team. And my boss understands that I'm doing my best and that failing is part of success and blah, blah, blah. Maybe I didn't say that so eloquently, but I want to highlight, the blah, blah, blah part wasn't very eloquent. What I want to highlight is that, that rewritten thought should be the result of you processing really what the reality of the situation is. And then finally, you just need to work on owning those thoughts that are much more evidence based. And it's like riding a bike. When you first do this cognitive restructuring, it involves a lot of time and effort. You need to write your thoughts down and sort of separate yourself from them. You can actually write the evidence that's for, and the evidence that's against the thought on paper so that you can own it.

But once you get good at it, just like riding a bike, you sort of learn to do this automatically where you'll just be walking along and that thought will pop up and you'll catch yourself. And you'll say, whoa, whoa, whoa, that's really out there. I know I'm feeling that in the moment, but let's take a step back and examine whether that thought is actually, to what extent that thought is actually true. And so you'll gain the ability to basically do that cognitive restructuring in the moment while you're walking down the street. And then instead of that thought bothering you for five, 10 minutes, one day, two days, all of a sudden you get to the point where you quote unquote, rewrite that thought so quickly, that you only are in that negative emotional state for two minutes, rather than two hours or two days.

Mills: You really retrained yourself how face to it and get past it. That's good advice. So let me move to another area of research where you've done a lot of work, which is around the measurement of stress. You've developed something called the Stress and Adversity Inventory, which aims to quantify people's lifetime exposure to stress. Can you talk about why it's important to be able to quantify and measure stress and how the inventory works?

Slavich: Absolutely. So in any other area of medicine, for example, in surgery, you would never cut somebody open, or you may never convince somebody to be cut open if you didn't give them some reason for why the surgery was necessary. You also have to make decisions about how much you should really care about the treatment or how high on the priority list a particular treatment should be. Or for interventions that are invasive, what the cost benefit is to intervening quickly and now versus waiting a while. I use this analogy because I think that, in other areas of medicine, you would never get people to engage in a particular treatment, or even to understand how important the treatment is if you didn't give them a hard metric about how well or how poorly they were doing.

So in the case of a cancerous tumor, for example, if you image that tumor and you sit down with a patient and you put an x-ray or some other imaging of that tumor up on the board, and you say, “You know you've been feeling really crappy for the past six months. The reason for that, unfortunately, is that you have this cancerous tumor inside of you. Now, I want to let you know that we have this therapeutic technique that is going to be able to take care of that, but it's going to require a lot of motivation on your part. It's going to require adhering to a treatment that is going to require a lot of effort, but it has a high success rate. So if you stick with me and stick with this treatment for six months, we're going to get through this together and you're going to feel much better.” Now all of a sudden when you have that metric, you fully understand what the hell is going on and why you should garner up the motivation to get on the treatment plan and to really see this through. And actually reducing your stress and moving toward wellness in life.

Not trying to make the analogy that being really stressed out is better or worse than have having cancer, but you can also die from stress. And for some of us, stress can really be quite impactful and stress can also come from a lot of sources, being in a terrible relationship, having the nasty boss, having a job that is not bringing us joy, taking on too many responsibilities at work, having difficult financial situations. And what I want to say is that in order to be motivated to really realign our life with our purpose, if you like the idea of Dharma to identify whether or not we're really pursuing our Dharma, whether or not we are living the life to the fullest in the way that is meaningful and that brings us joy and purpose, requires a lot of motivation and time, and effort.

And so, it's my monologue again, I apologize. But what I want to say is that the reason you need to assess stress clearly and with a clear metric is that, first of all, you need to build motivation for making difficult changes in life. That's the point. And if you don't assess it, then you can't address it. It's very difficult to get somebody on board with making difficult changes in their life or adhering to a challenging treatment regimen if you don't know what the magnitude of the problem is. And so, for example, if I say that I'm stressed out, I'm really stressed out. Well, what does that mean? On a scale from one to 10, does that mean I'm a three out of 10 or does that mean I'm a nine out of 10? And if a nine out of 10 means that my risk for having a cardiac event or heart attack in the next five years is now 85%.

Well, all of a sudden that's going to motivate me quite strongly to look at my stress levels in an objective way as compared to somebody else. Understand whether or not my stress is higher than normal, lower than normal. And also, in which areas of my life I can make positive changes. And that's really what the Stress and Adversity Inventory is all about, the strain, which is about creating concrete metrics, population level tricks, to understand how much stress have you actually experienced as compared to other people of similar gender and age, et cetera. So that when you're feeling really stressed out you can estimate in a concrete way your actual health risks that are associated with stress.

Mills: And so the in inventory involves looking at the stressors that you have experienced across your whole lifespan, I mean, is that what you're trying to do? And then give people a number to say that, you're an eight and you're going to have a heart attack in five years, like you said, unless you'd make a change in your life.

Slavich: Yeah, that's right. The lifetime part is really important, because if you go online and you take these stress measures, by the way, there are a bazillion of them online, the amount of time period that's covered by those questions is really important. So for example, some of them only focus on things that happened to you before age 18. And we know that early life stress is really important. It's when the brain and the body are developing. And so if you've experienced a lot of early life stress, your brain and body developed to be, for example, more threat sensitive, maybe than somebody who hasn't experienced those stressors. But I'm here to tell you that stress doesn't end when you turn 18. So if you're only assessing stress early in life, you may be missing out on 10, 20, 30, 50 years of stress exposure.

Other instruments online ask you about things that you might have experienced over the past week. And those things that are experienced over the past week may be really relevant for how anxious or sad, or disconnected you feel right now. But a lot of the biology that underpins chronic disease is much more prolonged and persistent, and slowly developing. So only assessing stressors that occur over the past week may not be sufficient for really coming to an estimate of chronic disease risk. Simply because it's the chronic stressors that are around in our lives for much longer than a week that really engage the immune system, upregulate inflammation, cause oxidative stress, lead to the development of cancer tumors and biological aging and et cetera. So you really need a panoramic snapshot, I think of all of the things you've experienced over your entire life course, and that's what an instrument like the Stress and Adversity Inventory affords us.

Mills: So I want to talk for a minute about some other research that you've done that it still shows a connection between stress and health. And that's a study that you did on how acetaminophen, which most of us know as Tylenol, might affect people who have experienced social rejection. Can you talk about those findings, because I think they're fascinating?

Slavich: Thanks for bringing that up. So we ran a clinical trial a few years ago where we essentially followed individuals over time and we randomly assigned the participants in this study to take acetaminophen for several weeks in one group or to basically take a placebo pill in the other group. So if you're a participant in this study, you're either assigned to take acetaminophen for several weeks or you take a pill that you don't know. Well, nobody in the group obviously knows what they're taking. So you're either taking the placebo pill or the see the acetaminophen. And then what we did was we followed folks over time and we assessed their levels of social pain each of these weeks. And we just asked the question, can acetaminophen reduce your experiences of social pain over time as compared to taking this placebo pill that doesn't have that active ingredient? And the neurobiology behind this is quite interesting.

If you put individuals in an fMRI brain scanner and you expose them to some kind of physical pain. So you're lying in the fMRI scanner on your back, you're in this huge magnet. And now on your leg, I put a heat pad, that's going to cause some acute physical pain. That physical pain isn't going to engage of course centers in your brain that are involved in representing physical pain. Stick with me here. But now if I put you in that same fMRI scanner, and I introduce you to two other individuals who, seemingly nice individuals. But now while you're in the fMRI scanner, I have you play a game where all of a sudden those two individuals start excluding you or rejecting you. So that's not a physical stressor. It's a purely social stressor. What we found is that some of the same neural circuitry that gets activated or engaged when you're exposed to physical pain, the heat pad, is some of the same neuro circuitry that gets activated or engaged when you're exposed to social exclusion or rejection, which is quite fascinating.

So you think of, when you're rejected, you have all these physical terms, my heart is broken. And we think one explanation for that may be that there's some, to some extent, some neuro biological overlap of the way in which the brain and the body processes physical pain and social pain. So this comes back to the study that you mentioned. Why would we even think in our wildest dreams that if somebody was experiencing physical pain, that you would give them acetaminophen? Because that just sounds totally crazy. You take acetaminophen when you're experiencing physical pain, not when you're socially rejected.

So that's the whole logic behind, that's the neurobiological explanation for why we thought that acetaminophen might help individuals get through a socially painful experience and come out more resilient than individuals who went about their lives and experienced social pain on a day to day basis, but were not takings acetaminophen. Long story short, what we think acetaminophen might be doing in this study is turning down the volume on the physical/social pain signal. So if you're a type of individual who goes about their lives and you feel really sensitive to disagreements or to social conflict. Or let's say you have that sort of nasty boss conversation coming up and you know that you're going to experience some social pain, experience in a socially rejected or socially evaluated. What the study suggests is that you may be able to tune down the volume on that negative social pain frequency by taking some acetaminophen prior, and leading up to that meeting.

Now the big caveat is that this was not a big study. And like any great scientist, what I think we need to do is replicate that work using, obviously more participants, more diverse samples. And also to really understand what it is that acetaminophen is doing in the brain in the body so that we understand the mechanisms of action and can approach this in the most scientifically sound way possible. But the reason I like this study is that we know that common treatments for depression and anxiety disorders can be effective, but they're not as effective for as many people as we need them to be. So in the context of depression, for example, SSRIs are only effective for about 40 to 60% of individual who take them.

And of course, 40 to 50% is better than five to 10%, but we need to get to a point where we have therapeutics that are successful for 80 to 90%. Or another way of saying it is that I think we need more therapeutics in our toolbox to help folks who are experiencing stress, anxiety, and depression during these difficult times. So our goal in this study is just to say, we're not sure now whether acetaminophen or similar therapeutics might be something that we could recommend for dropping into the toolbox. But we know that we need to keep our eyes wide open for any kind of tools beyond the ones that we currently have and say, anything that works we're willing to consider, let's test it out and see how good it does.

Mills: Well, Dr. Slavich, this has been really interesting. I think you've given us some things to think about. There are some treatments out there that are simple, mindfulness meditation, cognitive behavioral therapy, ways that you've already shown, we can alleviate some of the stress in our lives. So I want to thank you for being with us today.

Slavich: Thank you. And I would just like to end by saying, I think we are all in this snow globe that's being shook up for two years and it's very easy to focus on the negative side of that. But what I want to leave us all with is the question of where we will land in that landscape. If we're floating around in that snow globe right now, let's look at that as an opportunity maybe for landing on the ground in a place that feels better, more comfortable, more socially connected and more resilient than wherever it was we were on that landscape before this situation all started. So that's my hope for myself and for you, and for all of our listeners out there. Let's use this snow globe situation to land in a better, more resilient, more peaceful, more compassionate world.

Mills: Thank you. You're absolutely right. I couldn't agree more. 

You can find more information on APA Stress in America survey and more resources on managing stress on APA's website at apa.org. And you can find previous episodes of Speaking of Psychology on our website at speakingofpsychology.org or on Apple, Stitcher, or wherever you get your podcasts. And if you listen on Apple, please leave us a review. If you have comments or ideas for future podcasts, you can email us at speakingofpsychology@apa.org. Speaking of Psychology is produced by Lea Winerman. Our sound editor is Chris Condayan. Thank you for listening. 

For the American Psychological Association. I'm Kim Mills.