Speaking of Psychology: Discrimination and stress, with Lynn Bufka, PhD

Experiencing discrimination in any form can be profoundly stressful for many people, according to the latest Stress in America™ survey, published by the American Psychological Association. In this episode, psychologist Lynn Bufka, PhD, talks about how stress and discrimination are linked and what that can mean for people’s health and well-being over time.

Lynn Bufka, PhD, is the associate executive director for practice research and policy at the American Psychological Association. Bufka received her PhD in psychology from Boston University. Her areas of professional interest include health care policy, practice patterns and trends, professional development, adult anxiety disorders and cross-cultural issues in psychology. She frequently serves as a media spokesperson for APA on these topics and other policy matters relevant to professional practice. She was on a panel of experts who developed APA’s 2016 Stress in America™ survey.

Before coming to APA in 2002, she served as associate director of the doctoral clinical training program and director of practica training at Boston University’s Center for Anxiety and Related Disorders. Bufka has particular experience in delivering and evaluating cognitive behavioral therapy for anxiety disorders.

Audrey Hamilton: What causes stress? Money, work, illness? What about discrimination? Nearly half of Americans report they have experienced a major form of discrimination. These as are associated with higher reported stress levels and poorer health. That’s according to the latest Stress in America survey. In this episode, we speak with a psychologist about how different groups respond to stress and how best to cope. I’m Audrey Hamilton and this is Speaking of Psychology. 

Lynn Bufka is associate executive director for practice research and policy at The American Psychological Association. She was on a panel of experts who developed APA’s 2016 Stress in America survey. A licensed psychologist, she is an expert in stress and mind, body, health matters. Thank you for joining us Dr. Bufka. 

Lynn Bufka: Thank you for having me. 

Audrey Hamilton: Let’s get right into the focus of this year’s Stress in America survey, which looks at the link between discrimination and stress. And according to the report, 69 percent of adults in the U.S. report having experienced discrimination. Sixty-one percent saying they experience day-to-day discrimination. When people are treated differently because of their race or sexual orientation or gender, for example, what effect does it have on their physical and mental health over time? 

Lynn Bufka: Well, when people are treated differently, ideally we recognize experiences of discrimination as being not about us, and recognize it as actually being discrimination or understand that’s the other person’s problematic behavior. But when it happens repeatedly, that’s really hard to do. We start to internalize. Maybe there’s something about us. Maybe it’s me that’s causing this to happen or maybe there’s something that’s not quite right or it can pick away at your self-esteem to repeatedly feel that you’re the experience, the target of these things. You may start believing negative things about yourself that are consistent with the discrimination or perhaps you’ll even behave differently or avoid situations, even if those are loved activities or possible job opportunities – or interesting classes you might want to take just because you don’t want to be potentially in a situation where you could be experiencing discrimination. 

Sometimes you might even do things like in a situation, but you’re less reserved because you want to draw attention to yourself. So you may feel like you may have to change your personality in order to not be the target of anything. And when you’re changing your thinking or behavior like this and it doesn’t feel consistent with who you are, that can lead to experiences of depression or anxiety. Certainly, it can be stressful and one would experience it as being stress. And stress over time can have a very serious impact on the body. 

Audrey Hamilton: Why is it so important to look at how different groups experience this type of stress? 

Lynn Bufka: We know that different groups report different experiences of stress. They can be stressed about different kinds of topics, they report different levels of stress. But we know less about what different experiences of stress mean for each of these groups. Does it place certain groups at greater risk for disease? Does it lead to certain kinds of behavior patterns that are problematic? There’s certainly some evidence that racial and ethnic discrimination places people at greater risk for certain health problems. But we know very little about how different groups might actually cope with stress too. While there’s a lot of different individual responses to stress, if there are group differences, we may be able to target interventions and education more effectively. We might be able to identify key sources of stress and modify those. When the source of stress is something like discrimination, sure, we want to help people who are being discriminated against figure out how to manage their response. But we also want to think about how do we change the discrimination so that they’re not experiencing it. So we do want to understand both what the individual is experiencing, but how groups are experiencing it so we know where to target our efforts. 

Audrey Hamilton: It seems many people are uncomfortable discussing racial differences, especially with children. How can parents and other adults address topics of diversity and discrimination with children of all ages? 

Lynn Bufka: Kids notice differences. They notice when people are treated differently. In discussing these differences openly in a non-judgmental way allows kids to have the space to ask the questions that they are coming up with – and ideally, parents and other adults can help children to value the differences that people have as well as recognizing what they have in common. 

When adults are going to have these conversations with kids, they need to keep in mind both the age of the child and the developmental stage so they know how best to respond. Younger children probably need simpler, more basic conversations, but with opportunities to ask questions and talk about things. 

Middle school kids – a lot of times information and facts are of a lot of interest to them. With teenagers, you want to have as much opportunity for exploration discussion with them because they’re going to have their own ideas and opinions about what’s happening and what they’ve observed. But at any point, adults should be prepared for surprising or challenging comments or questions. And with any conversation with kids it’s okay to admit our mistakes when perhaps maybe we did treat someone differently or maybe we failed to stand up to an experience of discrimination and we wished we could have done it differently. That can really go a long way in opening a conversation with a child. 

But I think another question that’s important to consider is what if your child is aware of differences and feels like he or she is being discriminated against or simply being treated differently. It’s really important for the adults in their life to acknowledge that that could be their reality. It’s appropriate to share your own experiences if you’ve had such experiences. You talk about what it means. How your child can respond if that happens again? You don’t want to dwell on it, but you certainly don’t want to dismiss it either. 

Audrey Hamilton: In past years APA’s Stress in America survey has consistently concluded that Americans are more stressed about finances than anything else. Money continues to be a significant source of stress. Was this consistent in other groups, across different groups? What can people do about money related stress? 

Lynn Bufka: Money has been a significant source of stress in almost every survey we’ve done over the years and it doesn’t really matter who’s responding – whether we divide it by different racial ethnic groups, men and women, if we look at different ages – about the only time we see money not being a top source of stress – the top source of stress -- is with the matures, the oldest demographic in our sample and they’re more often reporting stress about health concerns. 

But everyone is talking about money related stress. And sometimes the reality is there just isn’t enough money. And when that’s the case, figuring out how to get assistance so you can cover the basics, whether you need public assistance or talking with family or getting loans, that’s really important. But then the next kind of money stress is sometimes related to what we think we need or what we think we should have. We might have the money for basics, but we want other things as well. So then we need to start evaluating how we use and manage money and the choices we make with money because our perceptions of what we need and want and desire may not match with what we actually have. So shifting our perceptions and trying to understand where we’re actually spending our money – how does that fit with what we value? And trying to make those be more consistent. Budgeting is very important when you’re talking about do I have enough money or not and what is it that I think is needed? Do I need the luxury car or an economy car? There’s choices that we make. When people talk about money stress, sometimes it’s about covering the basics, but sometimes it’s about what’s my status with money and what do I have with it. People have complicated relationships with money. For some individuals, how much they earn has a lot to do with how they feel about themselves and their own personal worth. And if that’s some of the money stress that a person is feeling, they really need to evaluate that and sort of make sure that money is not defining who they are. 

Other things that are important to do are talk to family members about the money that you have and the stress you might have about that money. Maybe your partner doesn’t know the full financial situation. Or maybe your kids have unrealistic expectations and make a lot of demands. Talk with them about what’s reasonable. So it’s trying to be more aware of what your financial situation actually is. How that maps onto what your needs and values are and manage your own personal expectations about what money means, what money should buy for you to make it more consistent with the money you have. But it is tough. When you don’t have the money for the basics. No doubt about that. That is stress. 

Audrey Hamilton: As a licensed psychologist, you treat people who are dealing with stress of all kinds. You talked a little bit about this, but is all stress bad and which is considered bad stress and which is considered good stress and what sort of advice do you give to people who are experiencing this high levels of the bad stress?

Lynn Bufka: You know, stress happens all of the time. We talk in this country about being stressed for everything. Stress can happen. We can be excited about planning a wedding but feel stressed because of all the pieces we’re trying to pull together. We might feel stressed about an upcoming exam, but that stress might actually motivate us to study for the exam. So those are not necessarily bad stress. I think of bad stress as problematic stress as when the demands that you are feeling outmatch your ability to deal with them. When you just don’t have the resources to cope with whatever the situation is. That’s when stress is really becoming problematic and when you have that amount of stress where you’re feeling that your personal resources, psychological, emotional, social resources outstrip the demands on your life, a lot of things can happen – physiologically, your body gets more ramped up and you might have more experiences of a racing heart – you might have trouble digesting food – it can play havoc with your blood sugar. There’s all kinds of physiological changes that can happen. Muscle tension. All kinds of mental and emotional strain that a person can experience. And when a person gets to that point, reaching out for support – sometimes it can be support from family or friends, but sometimes you realize I need some support from a professional. And if I’m seeing somebody who’s really struggling with a lot of stress, we talk about how are they thinking about the things in their lives – are they filling themselves up with a lot of “musts” and “shoulds” and “absolutes” and “things would only be better if” but that if is awfully hard to attain. And we talk about how can we think about the situations in a way that’s a little more realistic and less demanding on the person themselves? 

But we also talk about things like how do you balance your life? Do you know how to say no? Do you turn down things that seem to be excessive? Do you do things that give you pleasure and help you relax and enjoy? You know, I tell new parents a lot of times if you don’t take care of yourself, you can’t take care of your child very well. It’s important to give yourself some down time when you can find that in your day. People find that very difficult but part of what I do is strategize with them about how to do that. I worked with somebody who was very stressed with her work situation. And we considered three questions. We thought about could she do something differently in how she responded to the demands at her work. Could she change the demands at her work? And ultimately, she decided to go with the third option, which was to leave her work and find a new job because she felt she had done many things to change her responses to the stress. She didn’t think she could change the work environment. So she determined she needed a new position. And those are all things we need to think through. Am I responding to stress in a way that is amplifying it or am I managing it in a way that I can let it go and walk away from it at times? Can I change the situation in some way or do I need to leave the situation in order to be less stressed? And those are all important things to think about. And they’re not easy. And talking with a professional can help you think through your options and challenge how you’re thinking about situations and also learn things about how to manage the physical changes that can happen with stress, whether you learn meditation or relaxation or think about other ways to help your body reduce its responsivity to stress. 

Audrey Hamilton: What can happen if you don’t address these issues and we’re talking about the high levels of bad stress? What health implications could be a result of that? 

Lynn Bufka: It’s interesting. On the APA help center we have a really neat graphic of a human body and it shows all of the different domains in the body that can be impacted by stress. So a person can – if their body physiologically is being really reactive to stress the heart rate may go up. They may be breathing more erratically. They may feel lightheaded because of that. They may have muscle tension a lot. So they may feel very stiff and have body aches. Their heart may be racing more. They may have an increase in the stress hormones. You know, the cortisol, which can have an impact on the body over time. There does seem to be some relationship between chronic physical health conditions and stress, as well as between anxiety and depression and stress. So, all of that unchecked over time can have a pretty profound impact on a person’s life. 

Audrey Hamilton: Okay, Dr. Bufka, thank you so much for joining us. 

Lynn Bufka: You’re welcome. Thank you for having me. 

Audrey Hamilton: To see the latest Stress in America report and to hear more podcast episodes, please go to our website. With the American Psychological Association’s Speaking of Psychology, I’m Audrey Hamilton.