Minimising and Avoiding Stress
The comments in this section are my general observations derived from my experience and notions and hypotheses developed from a wider reading and knowledge of science outside of medicine and psychiatry. Some are supported, directly or indirectly, by peer-reviewed science.
All sorts of evidence from various areas of study suggests that modern life and the consumer society have an insufficiently recognized effect on our mental functioning/outlook, our ability to cope, and on our biorhythms and physiology.
These digressions and examples are simply an explication of the informal evidence which leads me to suggest that many will benefit by paying some attention to basics, like blue sky and fresh air and sunlight, exercise, adequate peace and quiet and isolation, among other things.
As far as our general environmental surroundings are concerned, I suggest the default assumption should be that we are adapted to be healthy (stress-wise) in a non-industrialized society. That has implications for our biorhythms and our habits of daily life, in terms of activities and sleep, as well as our need for solitude and quiet. What I mean by the default position is this, it is a reasonable baseline assumption to make in the absence of evidence to the contrary.
‘Sleep hygiene’ is a ghastly term that refers to promoting good habits for sleeping well. It has no universally agreed or defined meaning. Here are a couple of ‘fact sheets’ on the web
Calling these ‘fact sheets’ is something of a misnomer since the supposed facts (they vary from source to source) are not generally supported by good evidence, e.g. see [1-3].
Nevertheless, it is obvious that some of these interventions are so simple, cheap, and straightforward that not to take notice of them and consider them is not smart. In my view the basic physiological variables of arousal level and light exposure are so fundamental to biorhythms that one might suppose attending to them is a good starting point.
The advice, in some fact sheets, not to take a siesta, seems to be contrary to some research, as well as observations of the animal kingdom and man, and data on biorhythms; even fruit flies have a siesta . Biorhythms show in distinct middle of the day dip in arousal levels. Many people benefit from a siesta , I most certainly do, so don’t try and Skype me between 2 o’clock and 4 o’clock.
It is clear that shift work impairs people’s health and increases the frequency of accidents and has various other negative consequences . That suggests that good regular sleep of a certain minimum duration is necessary for general health and well-being. Light is of course particularly important as far as the illness is concerned because we know that melatonin is suppressed by the light of certain frequency and brightness [7-12]. Such observations have major implications in relation to the type of lighting used in workplaces and homes, especially at night.
I find it impossible not to indulge myself in another little diversion here. It has long been observed some blind people have circadian rhythm disturbances, but others do not. This has even led some doctors to suppose that such patients are feigning blindness. In a seminal piece of research in this last decade Brainard, from Thomas Jefferson University, in the USA, has investigated the exact wavelengths of light which suppresses melatonin in humans [12, 13]. This revealed that the wavelengths known to be the optimal wavelengths of responsiveness for the three different colour photo-receptors in the human eye do not correspond with the maximum sensitivity for the wavelength of light which most suppresses melatonin secretion.
They therefore predicted that there would be another photo-sensitive pigment in the eye that was linked to the melatonin pathway. Not only that, but also, because of the specific absorption spectra, they predicted the molecular properties of pigment. They were correct. The seminal paper that describes this is interesting reading. The new photo-pigment, named melanopsin was found in human retinal cells called ‘intrinsically photosensitive ganglion cells’ (ipRGCs) that project to the SCN and are the primary photoreceptors involved in circadian responses .
It turns out that blue monochromatic light is more potent than other wavelengths for evoking circadian phase shifts, including body temperature . Needless to say, watching a screen late in the evening is going to be a powerful way of suppressing melatonin secretion. Not only does that make it more difficult to go to sleep, but also research shows that entering the restorative phases of deep sleep is substantially inhibited: ‘deep sleep was reduced under a high colour temperature (i.e. blue) compared to a low colour temperature (red) during the first half of sleep’ .
I recall one or two decades ago deciding to look for research to support the idea that noise was a significant and under-recognized stressor. Many people may think that is obvious. I would agree. But when I looked into it, I found a remarkable dearth of interest, research, or hypotheses in that area. I recall more recently seeing something which indicated that there had been an international working party that had produced recommendations for the World Health Organization which made recommendations about background noise levels in cities [17-19]. Small progress is better than none. For an update see:
Default assumption: periods of peace and quiet are good.
I would put more emphasis on absence of stimulation for an hour or two before retiring. This would seem to me to involve lowering the lighting level, not using lighting sources with high blue wavelength light content, and using relaxing music to settle the system down, rather than stirring it up with television. It is easy to find a range of styles of such music for relaxation. References re Music and stress [20-24].
Although the ability to respond to positive feedback may be substantially diminished in the illness, nevertheless, a focused attempt to increase pleasant stimuli through humour can be helpful. One way of helping to relax and reduce anxiety prior to retiring for the night (see section on sleep) is to select a few books that are easy to read and light-hearted. Because concentration for reading is usually diminished in the illness, the kinds of books that maybe the particularly useful are books of quotations. The Oxford book of humorous quotations is large and excellent value for money, and there are many others. Some people might prefer books of cartoons, of homilies, whatever suites your taste, there is something out there.
The value of pets should not be forgotten, and for those so inclined who are in a position to own a dog [cats are the cause of serious environmental damage and are the companions of witches and the harbingers of evil spirits , they should be eschewed]. There is little doubt that animal companionship contributes to feelings of happiness and well-being for a variety of reasons, including promoting exercise and social interaction. There is reasonable evidence from general principles and research of a beneficial effect on mental health, improved sleep and improved energy [26-29]. The nature of the scientific research substantiating such assertions is reviewed by Herzog .
I always had my dogs in my private office whilst I was in practice and most patients found that relaxing and comforting. I may even have claimed their care expenses against tax under ‘security measures’.
Having written about the free-market economy and its destructive effect on science, it seems particularly appropriate to highlight here the beneficial effect that altruistic giving and sharing appear to have on happiness of the individual doing the giving (Mr Warren Buffet may yet die happy). Note that British PM Cameron announced plans in Nov 2010 to measure happiness as an indicator of national progress, instead of relying on gross domestic product (GDP). Progress at last, or perhaps he just knew what was going to happen to the economy! The first happiness index of the British people is expected to be published in 2012. ‘Happiness economics’ is slipping into the mainstream. France is pursuing the same path, as is Canada. But in Bhutan the idea is decades old. Gross national happiness has been part of the lexicon since the 1970s .
I shall not discuss giving at length, but a few references are included below for those interested. What this information suggests is that participating in social activities where you contribute and give something to other people is an effective way of increasing your chance of feeling better yourself. Such activities are likely to be focused on interests or hobbies that people have. Someone who likes gardening might choose to involve themselves in helping at the local botanic Gardens, someone who plays a musical instrument might volunteer to visit old folk’s homes etc. The resultant increase in positive social interaction and the sense of contributing can be valuable.
One major pillar of capitalism is the holy grail of the continuing growth of an unrestricted free-market economy and increased standards of living.
Bugger the environment, bugger the planet — the phrase ‘shitting in your own nest’, comes to mind. However, moving on…
This requires advertising and the media (fatally addicted to advertising) to inculcate us all with the idea that we need more of just about everything in order to be successful, happy etc. (See aphorisms).
To get this message across all forms of media have to compete in an ever more aggressive way for your attention. That leads to an exaggeration of reliance on material related to ‘the lowest common denominator’, instant cheap thrills, over-simplification, and mental laziness (e.g. trivialize, sensationalize), as represented by Mister Rupert Murdoch’s anti-intellectual and anti-science media empire. It seems ironic that as I write this [the first version] his ‘News of the world’ paper in the UK has just self-destructed, or should we call it infanticide? If only the population would come to its senses and stop buying the rest of his wretched output, then the rest of his empire would self-destruct too. Oh! happy dreams!
One powerful way of inducing despair and hopelessness is to continually confront people with negative stimuli over which they have little or no influence, power, or control.
Now go and watch or listen to today’s news!
And just in case you miss any of the objective, accurate and perceptive reporting, and information, that is of course so essential to daily needs (yes, that is sarcasm), watch/listen on the hour for every waking hour of the day. How much time do people spend every day listening to the news? How much do they benefit from it? It is, as the saying goes, a no-brainer. It may well be a powerful negative factor reducing wellbeing for many people. I see there are now sites with only good news, good idea:
To give but a few examples of aggressive competition for your attention: consider the beat of the music that is predominant now, compared to past decades. There is no argument about the fact that most modern music is to a beat around 120-180 per minute, frenetic, whereas when I was a young man 80 beats was probably the limit of the ‘hippie hippie shake’.
Take a look at any kind of television program produced in the 1960s and 1970s compared to the last decade. It does not matter whether it is a documentary, news program or drama. The number of times the picture switches from one scene to another (ASL- average shot length) is similar to the increased beat frequency in music. We have not had a television for many years now, one of the best decisions we ever made, but when I see videos I usually start counting the moment the picture changes. I rarely get to 5 seconds before it changes again, and I would guess that in many programs there is a picture change every three seconds or so. It is almost like viewing a kaleidoscope. I suspect this may play a role in attention deficit disorder . It is difficult to keep people’s attention nowadays with subject matter of substance and duration.
The mean and average shot length of American movies decreased from around 12 seconds down to 4 seconds between 1960 and 2005 [33-35]; I am sure advertisements and commercial news is even worse. I am sure that this adrenaline driven frenetic attention-seeking media conduct has significant and enduring effects on our ability to maintain concentration and a calm and relaxed equilibrium.
Also, there is no doubt at all that if you play interactive computer games in the hour or so before you try to go to bed your sleep will be impaired. Likewise, the average television program does not try to lull you into a sense of relaxation. Nobody is going to pay for advertising if people are asleep in front of their televisions. Watching television in the evening is a stimulating and arousing activity, not a relaxing one. It is most definitely not calculated to induce peace of mind and a relaxed state.
Suggestions: stop watching/listening to the news, no TV after 8 pm, better still get rid of it altogether.
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2. Hellstrom, A. and A. Willman, Promoting sleep by nursing interventions in health care settings: a systematic review. Worldviews Evid Based Nurs, 2011. 8(3): p. 128-42.
3. Montgomery, P. and J. Dennis, Cognitive behavioural interventions for sleep problems in adults aged 60+. Cochrane Database Syst Rev, 2003(1): p. CD003161.
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5. Naska, A., et al., Siesta in healthy adults and coronary mortality in the general population. Arch Intern Med, 2007. 167(3): p. 296-301.
6. Schernhammer, E.S. and C.A. Thompson, Light at night and health: the perils of rotating shift work. Occup Environ Med, 2011. 68(5): p. 310-1.
7. Holzman, D.C., Blue alert: The dark side of night light New Scientist, 2011(2811): p. http://www.newscientist.com/article/mg21028111.400-blue-alert-the-dark-side-of-night-light.html.
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9. Glickman, G., et al., Light therapy for seasonal affective disorder with blue narrow-band light-emitting diodes (LEDs). Biol Psychiatry, 2006. 59(6): p. 502-7.
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16. Kozaki, T., et al., Effect of color temperature of light sources on slow-wave sleep. J Physiol Anthropol Appl Human Sci, 2005. 24(2): p. 183-6.
17. Gan, W.Q., H.W. Davies, and P.A. Demers, Exposure to occupational noise and cardiovascular disease in the United States: the National Health and Nutrition Examination Survey 1999-2004. Occup Environ Med, 2011. 68(3): p. 183-90.
18. Moszynski, P., WHO warns noise pollution is a growing hazard to health in Europe. BMJ, 2011. 342: p. d2114.
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21. Pelletier, C.L., The effect of music on decreasing arousal due to stress: a meta-analysis. J Music Ther, 2004. 41(3): p. 192-214.
22. Bradt, J. and C. Dileo, Music for stress and anxiety reduction in coronary heart disease patients. Cochrane Database Syst Rev, 2009(2): p. CD006577.
23. Cabrera, I.N. and M.H. Lee, Reducing noise pollution in the hospital setting by establishing a department of sound: a survey of recent research on the effects of noise and music in health care. Prev Med, 2000. 30(4): p. 339-45.
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29. Knight, S. and V. Edwards, In the company of wolves: the physical, social, and psychological benefits of dog ownership. J Aging Health, 2008. 20(4): p. 437-55.
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34. Cutting, J.E., J.E. DeLong, and K.L. Brunick, Visual activity in Hollywood Film: 1935 to 2005 and beyond. Psychology of Aesthetics, Creativity and the Arts. 2011.
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36. Epictetus, Encheiridion of Epictetus. Handbook 6, (trans. Oldfather), 55-135 AD: p. http://www.iep.utm.edu/e/epictetu.htm#SH2b http://www.btinternet.com/~k.h.s/epictetustranslations.htm.
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