Expert: ‘I View Stress as a Medical Issue’ That Pharmacists, Psychiatrists Can Play a Role in Addressing

As my east coast Wi-Fi signal battles her west coast signal, and our call gets disconnected not once, not twice, but 3 times, I progressively become more frazzled with each dropped connection, but Elissa Epel, PhD, professor and vice chair of psychiatry at the University of California at San Francisco (USCF) and author of The Stress Prescription, remains calm through it all. Each time we reconnect she barely misses a beat, continuing almost exactly where her thoughts had previously been cut off.

“I view stress as a medical issue,” Epel said immediately after getting back on the line after the last call had dropped. “People are experiencing very high levels of stress that should be red alerts to health professionals and societies at large. It’s important to prioritize mental health and adopt daily practices.”

Epel has spent the past 22 years at UCSF. She studies biological aging, psychology, sociology, and behavioral processes as they relate to chronic stress. Fascinated by the mind-body connection, Epel decided to study how stress affects health and aging. She is also interested in how meditation and well-being can reverse stress-related damage.

Chronic Stress vs Acute Stress

The type of stress much of modern society experiences causes a state that appears “turned on” tto stress nearly all the time, according to Epel--this is considered chronic stress. Chronic stress differs from acute stress in that the latter only lasts for minutes to days, while the former can affect people for months to years at a time.

“Chronic stress goes on and on,” Epel elaborates. “We perceive a threat, and we don’t think that we can cope well. So, when we can’t solve problems, but we still worry about them and ruminate over them, that is one way that we carry out chronic stress in our mind and body.”

It may be harder than we think to pinpoint the impact of chronic stress in the body. While physical changes like high blood pressure and a rapid heartbeat can indicate someone is stressed, Epel argues that they are not accurate biomarkers of chronic stress.

“People can adapt,” Epel said. “Their baseline levels are not always reflecting the stress that they are under.”

What this means is that people could be under the influence of chronic stress, despite not having any abnormal physical manifestation of it. In her work at UCSF, Epel has also published multiple papers that link chronic stress with aging (and cellular aging) mechanisms. Chronic stress accelerates the processes of aging by shortening telomeres—the caps at the ends of our chromosomes.

In short—shorter telomeres prevent cell division. This can decrease lifespan.

However, as Epel would tell you, not all stress is toxic--a point she emphasized. She went on to suggest that managing stress, learning resiliency, and using stress correctly, can lengthen telomeres and have a myriad of other health benefits for the mind and body.

Healthy stress is distinguished as hormetic stress, which does not last long in the body—instead, it involves short, intermittent bursts of moderate stress that can profoundly increase cell resiliency and combat the ill-effects of chronic stress. It is foundational in the science of aging, Epel notes.

Hormetic stressors include, “heat, cold, shock, ultraviolet (UV) radiation, and chemical stressors… [which] appear to make [us] more resilient,” she said. A 1-hour practice of high intensity interval training could do the trick for this purpose, Epel noted.

Mindfulness, Personal, and Clinical Management

Destressing practices should work with strategically stressful practices to maintain health. Vagal breathing is a practice that has long been used to relax the mind. It involves breathing 6 times a minute to increase heart rate variability, reduce blood pressure, and, most importantly, reduce stress.

“Breathing is so well-established [to help reduce stress],” Epel said. She offered that a potential practice for pharmacists could be that, while patients peruse through shelves or pick up their prescriptions, “it might be a good idea to hand out a card that describes a few steps of slow breathing.”

Health care professionals can learn about lifestyle and bio-behavioral stress reduction practices to refer to patients as well. These can include introducing more mind-body practices into the patient’s life and assisting them with social and pharmacological support.

Psychiatrists are also able to support mind-body work to help patients manage chronic stress. Currently, psychiatrists’ work tends to align more towards pharmacological management, such as prescribing drugs and checking in to offer suggestions. But “it really is an ideal relationship for them to suggest different stress reduction techniques,” Epel said. Mindfulness and breath-checks with patients could facilitate a more holistic, calming approach to stress reduction support.

Toward the end of our conversation, Epel asks for my thoughts on how pharmacies could engage and support beneficial mental health practices. I think about the places and things that make me calm- nature, big windows that reflect natural light, and calm blues and greens- maybe pharmacies can implement more of these elements, I say, smiling through the phone when she agrees.

“I think that is a fabulous idea,” she said. With or without the help of nature, she explained that the ideal trip to the pharmacy could be one that is a “healing or nurturing experience.”