Relaxing with Dr. Rajita Sinha

Breathe in, breathe out.
Breathe in, breathe out. // Annelisa Leinbach

The Yale Stress Center: just sounds like a description of Bass Library during finals, right? In fact, the Stress Center is a recently established research group looking at how everyday pressures affect our bodies and minds. Located on the second floor of an ominous-looking building near the Medical School, the Center combines clinical practice with empirical analysis in an integrated approach to treating and studying stress. WEEKEND sat down with Dr. Rajita Sinha, the Center’s founding director, to find out about the work she does and maybe pick up some tips for surviving Yale with our sanity relatively intact.

 

Q. Are there aspects of life at Yale that provide new sources of stress compared to life here in the past?

A. That’s a good question. There’s also the question of, are the things we have and do today different? Not are they good or bad, but are they different? I think social media is different, very concretely. It means having access to a lot more information, information on multiple levels – intellectual information, social information. That’s definitely different, and that can be in some ways good, but there are also downsides to it. Maybe having too much information can be a lot to deal with. Having multiple demands adds load to the brain. It divides up attention. Some of the classic studies have been about, “How many things can we keep in our working memory?” or in our conscious memory. How many tasks can we perform? Whatever that capacity is, it’s limited — it’s not endless. The more demands you put on this executive, I like to call it our “brain executive,” the more it’s going to get burdened, possibly at the risk of overload, and then the ramifications of overload are feeling weakened. Not that you’re feeling physically or emotionally weakened, just that your ability to take it all in can be weakened in a physiological way.

Q. As a clinician and a researcher, can you tell us what is empirically effective to deal with stress?

A. There are some very simple things that help with that regulatory homeostasis: drink plenty of water, get sleep, eat three meals a day, have some social connections, take breaks. Those are basics, but if you think about college life, they’re not a given: Sleep? Food? Water? I’m talking about the body I don’t exclude the brain — the brain needs that very much too. So that’s number one. What are additional things you can do? Here I would expand on positive activities and social relationships, because they take you out of worrying and choices and all of these other things that can stack up.

The other thing that people in college aren’t careful with is alcohol, drugs and food: healthy and unhealthy behavioral choices. You have a drink and suddenly you’re more social, you might make some new friends, it’s also the thing that people do together when they party. But in fact the stress system is a target for alcohol — it sort of chips away at your stress system.

Q. What is that “stress system”? How does a mind-altering drug chip away at it?

A. We take most drugs to change our mood, and that’s the clue: If it’s to change your mood, it’s having other effects on your ability to manage your moods and emotions. The stress pathways in the brain have to do with all of these different levels of functioning: basic levels of survival, all the way up to thriving and enriching our lives. We have the “fight or flight” response, and then we stop thinking about stress, as if it stops there. But that’s the basic level of survival: Hormones get released, chemicals get released, and that mobilizes your body so that you can be functioning in that moment of crisis to protect yourself. What also happens is that those hormones are going back into the brain and signaling the brain to get that next level of coping going: not just protecting yourself, but learning from it. For example cortisol goes back into the brain and helps shut down this acute arousal response, but it also has influences on memory and cognition, and so does adrenaline. Alcohol directly changes the signal that releases cortisol, it desensitizes this arousal response, because it’s a depressant: it starts to make you calmer in the acute state, but over time, and with lots of it, that becomes permanent. You lose the ability to not only be aware of stressors and respond to them, but also the secondary effects that come from it, like learning, like differentiating what’s important versus what’s not. The ability to have those pieces of information starts to get chipped away.

Q. How does stress get connected to destructive behaviors like drugs or drinking or binge eating?

A. That’s what I’ve been obsessed with, I guess, in my life. We know a few things about this connection. One of them is that stress hormones, actually, are very involved in our learning pathways. So if you are overloaded with stress, these motivational and learning pathways that are linked to our stress hormones start to have an impact, and downstream effects. If you start to have lower motivation under stress, you might want to have a pick-me-upper. And rather than taking good care of your brain, it’s sometimes easier to have a couple of drinks. There’s also some evidence that the amount of reinforcement you feel from a drug that feels pleasurable is different if you’re stressed versus not stressed. And then there are these direct effects of stress hormones on dopamine, which the mainstream media will often talk about as the “reward chemical.” Those are some of the links that we’ve studied: this dopamine pathway or “reward pathway” also goes all the way up to our frontal executive and helps us think and manage cognitive tasks. So these are very intricately linked, and what’ we’ve discovered is that there isn’t much of a difference, at least in the neurochemical pathways, between what’s involved in motivation and learning and what’s involved in stress and stress regulation.

Q. You helped found the Stress Center as a director. How did you end up putting something together like this, both clinical and research-based?

A. My work has been in stress and emotions for a long time, and how stress affects behavior and choices, the link between stress and addictive behaviors. NIH [the National Institute of Health] was interested in complex biomedical and behavioral problems that don’t get solved with more traditional ways of studying, and what they asked for was to set up consortia: bringing teams of people with different expertise to solve complex problems. We put together a consortium here at Yale, with two other universities as collaborators, with leading scientists to target the links between stress and these addictive behaviors of alcohol, nicotine and comfort food, because those are three of the main behavioral causes of chronic diseases, and we felt the brain mechanisms had been ignored. It was all research from basic science, animal studies all the way to human-based studies and population studies. But what we found was that people who were calling in to participate in our studies were saying, ‘What can you do about it? Can you help us with our stress? Can you teach us what to do?’ And in fact we were developing new interventions as well as looking at things that had worked in the past. I’d found that people were not paying attention to thinking about health from an integrated perspective, integrating brain issues and body issues.

In terms of medical treatment, we’ve divided the body into different pieces, and of course there’s importance for specialists, but wouldn’t it be good to have a place somebody could come and have a team approach to what’s going on with them? Could that perspective open up a different way of thinking about health, and well being, and addressing people’s problems? A lot of times in chronic disease, there are multiple causes, and those issues are related to stress, so it made sense to start with the concept of stress and all of its multiple effects in the brain and body, to construct what we call ‘clinical and preventive services’ that would link to the research, and there would be a really nice back-and-forth between research and clinical presentations. So we established the stress center first as a research center, and three or four years later — that was only two years ago — we opened it for clinical and preventive services. It really is an experiment, we don’t know if this is going to take off, but it’s at academic centers that we should be trying new things.

Q. Was it difficult to get recognition for stress as a medical issue?

A. Actually, it’s not like a diagnosis right now. It’s still experimental to think you want to treat it with medication, in fact we studied that in our consortium: identifying those who are highly stressed, who we know are highest-risk for developing stress-related diseases, whether cancer, asthma, cardiovascular diseases, neurological diseases. Can we begin to prevent these diseases? People have been studying stress and it’s been known to be a medical phenomenon that’s very critical, but it hasn’t reached the place where it’s become a treatable, preventable issue. In fact, one of the goals of the Stress Center is to approach stress as something that we address and treat in a routine way. Our vision is that if we do that, we’ll change the relative risk ratio of stress contributing to these diseases.

Q. You mention some pretty startling physiological manifestations of stress: cancer, asthma, cardiovascular disease. How does a mental state like stress turn into a physical ailment?

A. I should say very clearly that stress is not the cause of cancer, as in, ‘A leads to B.’ It’s a really important contributing factor. The reason for clarifying is because stress, especially chronic stress, leads to changes. The stress pathways that I described to you earlier are there to learn and adapt to the challenges of the environment. So, it inherently is one that changes. So as it changes, those changes can be good or they can also be bad. If you have too much bad stress, you start having changes as a result of those adaptations, changes in secondary systems. For example, if you have too much adrenaline flowing around that doesn’t shut off, it will change your baseline state of things that are affected by adrenaline — that may be heart rate, it may be blood pressure. If you’re pumped up all the time, and can’t go back to your homeostatic state, the body’s system starts to shift. And now your basal level of blood pressure might be different than it was five years ago, and there are then secondary effects of higher blood pressure, in your blood vessels and other things. Those changes may be at the cellular level. So things can translate pretty quickly. Really, the complex diseases that I‘m talking about don’t have one cause. We have to stop thinking in those simple ways, we’re not in the domain of simplicity. In fact I’m working on a paper on this. I think we might need a different scientific approach to think about complex systems.

Q. I’d love to hear about that paper.

A. I think we need a paradigm shift in our approach to science. All of us have been trained in the reductionist model, of breaking things down to see if A leads to B, and as you’re breaking things down you’re not going to get the answer for something that’s a complex, interconnected phenomenon. The paper is just taking shape, but it’s about the question of whether we need different scientific models and frameworks for addressing complex phenomenon, as is true in other disciplines like physics.

The one last thing I would say is that it can sound bad that we have so much stress in our lives, and sometimes people ask me, ‘Do you have hope?’ It’s crazy, everybody is getting stressed, and I have a lot of hope because I think we have a lot of capacity as humans to regulate ourselves. We haven’t explored all of those options, we haven’t tested them, so there’s a lot of hope in terms of plenty of things that can be done.

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