Stress Management, Rest And Recovery

I’ve seen the stress response in action many times over the years and I typically illustrate it for my patients as the college student who crams for tests and then, when they are over, develops a bad cold. So let’s talk about stress management, rest and recovery.

I saw some pretty shocking stress-related heart symptoms in female patients when I interned one summer on Block Island (and saw what I came to call “Block Island Syndrome,” which I first wrote about in my book) where young multitasking women were coming in to the office on their vacations with chest pain and palpitations. When they jumped off the proverbial hamster wheel that was their lives, their bodies reacted with heart symptoms.

I see this syndrome often in my practice, in both women and men who come into the office manifesting stress in their physical bodies in all kinds of ways—poor lifestyle choices like eating too much, smoking, drinking excessive alcohol, or getting caught in the cycle of a lack of any self-care.

These poor health habits can lead to issues like anxiety or depression.

In fact, in 2015, 16.1 million Americans reported experiencing major depression during the previous year. Studies have shown that the mainstay of treatment strategies, such as talk therapy and antidepressant medications, may not work for everybody. When depression comes from stress, how is it possible to singularly treat the depression without treating the stress? The short answer is that it’s impossible.

Stress within the mind-body connection

We have known for decades that there is a critical connection between the mind and the body—and especially between the mind and the heart. We also know how important the role of our emotions play in heart health and heart disease.

We have focused on the role of the stress hormones, such as epinephrine, norepinephrine, and cortisol, because we can measure their influence on blood pressure, cholesterol levels, inflammation, and the immune function.

What we have not sufficiently explored is how to combat the stress syndrome that has become a seemingly normal part of the lives of (dare I say) most people in this country today.

It’s easy for doctors to say, “Manage your stress,” and that is part of the solution, but I believe there is more to it than that. We can try to reduce stress by reducing obligations or plowing through, but what we also need to do is focus on how well we are able to recover, both emotionally and physically, from the surges of stress hormones that happen so frequently. For example, most people know that the body recovers from the stresses of the day during sleep. Sleep is about more than just an idea that the body needs rest. It is about recovery and restoration. Cellular rejuvenation doesn’t happen during peak exercise or during times of stress. It happens during the phases of deepest recovery. So the question is: Are you allowing yourself to cycle through that deep recovery phase? And if not, how are you supposed to do that being that stress is relentless, ongoing, fills our thoughts, and penetrates our dreams?

Managing chronic stress

If you have chronic stress, it is essential that you prioritize time for intervening in this destructive cycle. There are some modalities that have been proven to make a difference on both stress levels and recovery. Studies done on mindfulness meditation have shown to change the appearance of functional MRI studies of the brain. These studies, which analyzed brain function in association with meditation, show that meditation does result in a reduction of brain activation in the amygdala, which is the center of the brain that deals with fear, anxiety, and stress. These studies showed an effect not only during meditation, but afterwards, as people went about their lives doing their everyday tasks–the benefits persisted beyond the actual meditating.

Other forms of meditation have shown similar benefits. In Transcendental Meditation (TM), there is a confluence of the brain waves that we can see on an EEG (a machine measuring the brainwaves in all different parts of the brain). This confluence is evidence that the brain is working synchronistically, enhancing focus, boosting creativity, and triggering what Herbert Benson, MD, calls “The Relaxation Response” (and what he wrote about in his book of the same name).

Other modalities I have seen be helpful to some patients include acupuncture, which has been shown to increase endorphins, the feel-good hormones, and activate natural pain killers. These mechanisms not only improve over-all well-being and decrease depression, but over time can help to stabilize and support a greater sense of mental and physical balance. Some people also find great success in relieving stress through yoga, or a “gratitude practice.”

The restoration of health

But what about the question of restoration? You may feel less stress with these practices, but how do you know if you are getting truly restored by them? Technology has allowed us to answer this question more easily. One way is that we can now evaluate the amygdala on an MRI, which is more informative than just visualizing the whole brain. But my favorite way to monitor restoration is through heart rate variability.

Heart rate variability (HRV) is a biomarker that allows us to understand which part of the nervous system is in charge—the fight-or-flight part (the sympathetic nervous system) or the relaxation response part (the parasympathetic nervous system). HRV looks at the beat-to-beat intervals. Variations in these intervals determine which part of the nervous system is in charge. When there is a lot of variability between beats, that is considered a healthful state and indicates the parasympathetic nervous system is in charge. When there is not much variability between beats, that is considered a less healthful state, and indicates the sympathetic (fight-or-flight) nervous system is in charge. Ultimately, HRV objectively assesses if the stress is winning or if it is being managed.

HRV indicates other things besides the stress state. It can also be influenced by the food we eat and how we exercise. It can be influenced by how well and how much we sleep, how much water we drink, even how we view the world—if we are optimistic or pessimistic, if we have gratitude, if we are mindful. Whatever you do to take care of yourself, our HRV can let you know if it is working. As your HRV rises (the variation between beats is greater), you will know that your efforts (whatever they may be) are effectively restoring your equilibrium.

Finally, how do you know your HRV? There are different technologies out there to do this. The Oura ring can track it during sleep, and it can be done in a doctor’s office through cardiac autonomic testing.

Now that you know how to monitor the effectiveness of your stress management efforts, the rest is up to you. Go find what works best and make it a part of your life. It will change everything.