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The United States of Stress 2019

You’ll Never Think About Stress the Same Way AgainFacebook TwitterPinterestCopy LinkBy Maureen Connolly and Margot SladeMedically Reviewed by Allison Young, MDReviewed: May 7, 2019Originally Published: October 23, 2018 Foreword by Nan-Kirsten Forte, MS, Chief of The Well at Everyday Health Our research shows that chronic stress is a national epidemic for all genders and ages, particularly those who are 25 to 35 years old. To unpack this problem is a matter partly of mental health and partly of physical health. Here’s the hard truth: The causes and solutions to chronic stress are a complex mixture of socioeconomic, environmental, genetic, physical, and spiritual factors. Although there are different types of stress (some are even positive), the type we need to pay attention to, say experts, is chronic stress. This is the stress that makes it hard to sleep well, makes it nearly impossible to lose weight, and finds us fighting one cold after another. It’s the stress that can both cause medical conditions and trigger and exacerbate flare-ups from existing conditions. This kind of stress depresses the immune system, alters our moods, and damages our professional and personal relationships. Just as, on the positive side, yoga has been shown to lengthen the protective caps at the ends of our DNA strands called telomeres and keep us more youthful, ongoing stress can actually change our DNA for the worse. As a country, we are struggling to address many mental health issues that, it turns out, are closely tied to chronic stress; there are not enough specialists or practicing healthcare professionals to address them. Is it any wonder people turn to social media to feel less isolated — only to find that social media itself can turn into a source of amped up, toxic stress? Everyday Health is taking a stand on stress for everyone who wrestles with it daily, and especially for those who are most vulnerable to the negative effects of unmanaged stress: those already coping with health issues.
Our goal is to empower people with the knowledge and tools to manage their own stress; to help them recognize and identify the things that trigger their stress response; and to take action before it does them harm. Because we're not taking care of ourselves right now. Everyday Health's United States of Stress special report reveals that most of us care for others before we take care of ourselves, and we internalize stress rather than find healthy ways to relieve it. Women especially have this tendency, and among them, younger women in particular — the population segment revealed to be most burdened by stress and most likely to seek help for it. Key takeaways:Almost one-third of those surveyed say they visited a doctor about something stress-related.57 percent of the survey respondents say they are paralyzed by stress; 43 percent say they are invigorated by stress.51 percent of the women surveyed say they don’t see friends at all in an average week.59 percent of baby boomers have never been diagnosed with a mental health issue; 52 percent of Gen Zers already have been.Just over a third of all respondents say their job or career is a regular source of stress. Among millennials and Gen Zers, the chronically work-stressed rises to 44 percent.More than half of women (51 percent) say they feel bad about their appearance weekly, and 28 percent say their appearance regularly causes them stress. Only 34 percent of men say they feel bad about their appearance weekly.52 percent of respondents say financial issues regularly stress them out, well above the 35 percent who cited jobs and careers as the next most common stressor.47 percent of all respondents — with women and men almost evenly matched — say that their response to stress is to take it out on themselves. S tress on steroids. That’s how life feels for many Americans today. Consider senseless shootings, a nasty political climate, catastrophic weather, increasing suicide rates. Factor in close-to-home stressors such as caring for a loved one; parenting a learning-disabled, autistic, depressed, or anxious child; managing your own chronic condition or addiction; looking for a job. Now layer in everyday annoyances — traffic, train delays, a nasty coworker, a long supermarket line after an even longer day. No wonder we feel overloaded, overwhelmed, out of control, and unsafe. Stress in the modern world is a constant. When stress doesn’t let up and is paired with the feeling that we have little to no control over the circumstances that are creating it, that’s called chronic stress. Over and over again, the research points to one key fact: Prolonged or unremitting stress exacts a stunningly toxic toll on the body, brain, mind, and soul. Its ongoing assault wears us down, measurably aging — or “weathering” — our insides, for some of us much more than others. Chronic stress zaps brainpower by damaging neural pathways and skewing judgment. It compromises the immune system. It taxes the heart, kidneys, liver, and brain. But does living in the world today mean that no matter what we do, we’re doomed to swim in a sea of stress and its ill effects, including anxiety, meltdowns, and panic attacks? Or could it be that everything we thought we knew about stress and how to manage or alleviate it is outdated or outright wrong? Maybe it’s time for everyone to get on the same page when it comes to stress. Everyday Health’s United States of Stress special report surveyed 6,700 Americans nationwide [download survey data], ages 18 to 64, cutting a wide swath across demographic groups, gender, and health conditions to find out what stresses us and how we cope. Our survey panels were chosen to closely mimic the geographic distribution of the U.S. population. (Our respondent distributions won’t match up directly with Census percentages because we phrased our questions about demographics, such as race/ethnicity, differently, with survey participants selecting as many identifiers as applied — including "other" — from a list.) Then, we invited some of the nation’s top “stress response” thinkers to weigh in on the survey data and offer insights.
Even our expert panelists — among them some of the nation’s top researchers — say they’ve been genuinely surprised about the extent of harm wrought by chronic stress and the lack of attention paid to it.

Everyday Health s Expert Wellness Advisory Board

Those thinkers, now members of Everyday Health’s Wellness Advisory Board, are:Christine Carter, PhD, a sociologist and a senior fellow at the University of California in Berkeley’s Greater Good Science CenterR.D. Chin, a feng shui architect, interior designer, author, and owner of an architectural design consultant practice in New York CityFrank H. Farley, PhD, the L.H. Carnell Professor at Temple University in Philadelphia and president of the Society for Experimental Psychology and Cognitive ScienceArline T. Geronimus, doctor of science, a professor in the school of public health and a research professor at the Institute for Social Research at the University of Michigan in Ann ArborNikita Gupta, MPH, a registered yoga instructor, certified life coach, and program director of the GRIT Peer Coaching Program Director at UCLAHeidi Hanna, PhD, the founder and CEO of Synergy, a consulting company providing brain-based health and performance programs for organizations, and the executive director of the American Institute of Stress in Weatherford, TexasKelley Holland, an award-winning business journalist and speaker and the founder of the money coaching firm Own Your Destiny in Montclair, New JerseyJanice Kiecolt-Glaser, PhD, the director of the Institute for Behavioral Medicine Research at the Ohio State University College of Medicine in ColumbusDavid Livingstone Smith, PhD, a philosophy professor at the University of New England in Biddeford, Maine, and the author of Less Than Human: Why We Demean, Enslave, and Exterminate OthersBruce S. McEwen, PhD, the former Alfred E. Mirsky Professor and head of the neuroendocrinology laboratory at the Rockefeller University in New York City, and coauthor of The End of Stress as We Know ItBernadette Mazurek Melnyk, PhD, author and dean of nursing at Ohio State University, Columbus, where she also serves as the Chief Wellness OfficerDarlene Mininni, PhD, MPH, a learning and development health psychologist at the University of California in Los Angeles and the author of The Emotional Toolkit: Seven Power-Skills to Nail Your Bad FeelingsStephen W. Porges, PhD, a Distinguished University Scientist at the Kinsey Institute at Indiana University in Bloomington, a professor of psychiatry at the University of North Carolina in Chapel Hill, and author of the polyvagal theoryRachel Simmons, the director of the Phoebe Lewis Leadership Program at Smith College in Northampton, Massachusetts, and the author of Enough as She Is: How to Help Girls Move Beyond Impossible Standards of Success to Live Healthy, Happy, and Fulfilling LivesAmit Sood, MD, the executive director of the Global Center for Resiliency and Well-Being, a former professor of medicine at the Mayo Clinic in Rochester, Minnesota, and the creator of Mayo Clinic Resilient Mind

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Financial Instability Is Making Us Stressed and Sick

W orries about finances came in as the number-one stressor across all age groups, according to the Everyday Health United States of Stress survey. Just over half of all people surveyed (52 percent) said financial issues regularly stress them out, well above the roughly one-third (35 percent) of respondents who cited jobs and careers, the next most common stressor. Women were more likely than men to report financial stress. They were also less satisfied with the state of their finances: 49 percent of women reported being very dissatisfied with their salary, while 40 percent of men were. Comparing respondents by generation, Gen Xers ages 38 to 53 reported being the most stressed out financially. Why are so many of us haunted by our finances? Kelley Holland, an award-winning business journalist and speaker and the founder of the money coaching firm Own Your Destiny in Montclair, New Jersey, says, “In speaking to researchers, it's clear that a lot of it comes down to how we relate emotionally to money. The more we see ourselves as relying on feelings in our decision-making, the more likely we are to feel that the 'unemotional, disciplined' world of finance is not for us." RELATED: The Work-Life Balance Conversation We Need to Be Having At the same time, she says, “Our financial lives have become more complicated — with debt, responsibility for our own retirement saving, and the like — but school-based financial education is often lacking, if it even exists.” The result: Many teens and young adults leave school with little or no financial knowledge, and stress soon follows. Holland urges us to remember: “You don’t have to be wealthy to achieve financial well-being.” Financial Stress and Wellness: Understanding the ProblemWhat Is Financial Wellness?How Do You Achieve Financial Well-Being?

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Putting Others First It s Burning Us Out Big-Time

W e asked survey respondents, “If stressed, are you more likely to put your needs first or last?” Sixty-five percent of women and 49 percent of men said they put their needs last. Looking across age groups, millennials (ages 22 to 37) — women in particular — are on the menu as the new stressed-out sandwich generation, caring for parents and grandparents, starting families, launching into jobs and careers. For 68 percent of millennial women and 69 percent of Gen X women (ages 38 to 53) who put themselves last when stressed (along with 48 percent and 50 percent of the men, respectively), taking care of their own needs before those of others isn’t part of their life skills recipe. But it should be, says Heidi Hanna, PhD, the founder and CEO of Synergy, a consulting company providing brain-based health and performance programs for organizations, and the executive director of the American Institute of Stress in Weatherford, Texas. We don’t always recognize, or even want to recognize, that caring — as in caregiving — for someone we love is wearing on us physically and emotionally, says Dr. Hanna. Indeed, the percentage of our survey respondents who listed “caring for loved ones” as a stressor seems stuck across all demographic groups at 16 percent — a low result due, some of our experts surmised, to both ambiguous wording (“caring” could include childcare, for example) and our respondents’ sense that caregiving for a loved one is an obligation they naturally assume. How could that possibly count as a stressor? RELATED: For Women, Getting Older May Mean Less Stress But the reality is that many studies have shown caregivers to be at heightened risk of chronic stress-induced conditions. “One study showed that caregivers had a 23 percent higher level of stress hormones and a 15 percent lower level of antibody responses than noncaregivers,” Hanna says. “Over time, elevated stress hormones can lead to high blood pressure and glucose levels, increasing the risk of hypertension and diabetes. Poorer immune response can make people more vulnerable to infections such as the flu, even after a flu shot.” Similarly, our survey showed that 63 percent of caregivers were likely to be stressed, compared with 40 percent of noncaregivers."Humor can be a very effective stress-reducing strategy for caregivers amid circumstances that are anything but funny." — Heidi Hanna, PhDFacebook TwitterHigh stress levels, says Lynda G. Shrager, the author of Age in Place: A Guide to Modifying, Organizing, and Decluttering Mom and Dad’s Home, can also increase the risk for heart disease, cancer, arthritis, acid reflux, headaches, and body pain because of lifting and handling loved ones. Many family caregivers have had to alter their work schedules because of caregiving obligations. Some have lost their jobs trying to juggle both. Caregiver stress, Shrager says, “is a public health issue requiring serious intervention.” Shrager says that central to protecting the caregivers among us from the damage of chronic stress is to gain a modicum of control, perhaps by organizing a team and putting together a care plan and a means of team communications. RELATED: Careworn by Caregiving: A Population at Risk From Chronic Stress “Humor can be a very effective stress-reducing strategy for caregivers amid circumstances that are anything but funny,” says Hanna. “It’s like massage for the brain. It initiates the relaxation response, shifting brain chemistry toward positivity, creativity, and collaboration.” The goal, she says, isn’t to laugh at what’s tough in our lives, but rather “to appreciate and strengthen our ability to notice other aspects where we can find comic relief, playfulness, and even gratitude.”

Social Isolation Is Killing Us

W e are not alone. But we are lonely. We have lots of social encounters on social media, thanks to Facebook, Twitter, Instagram, and the like. But face-to-face “real” encounters — which research suggests are how we truly gain a sense of social support — are few and far between. Some 60 to 67 percent of young adults surveyed say they check social media at least daily. Among older adults, the figure hovers around 53 percent. What’s the big deal? Studies have indicated that social isolation, beyond just being a terrible feeling, also makes us stressed out and sick. All indications are that loneliness is associated with an increase in the hormone cortisol, which leads to disrupted sleep, poor immune function, higher blood pressure, systemic inflammation, and mental health issues such as depression, cognitive decline, and dementia. “Any study that tries to quantify it comes up with pretty massive amounts of morbidity and mortality — not just suicide and depression, but also worsening of disease,” says Brian Primack, MD, PhD, the director of the Center for Research on Media, Technology, and Health at the University of Pittsburgh School of Medicine and the author of a number of studies that look at the relationship between virtual life and real-life wellness. Social support, on the other hand, is a buffer to all that, and it can make the difference between experiencing stress as toxic and experiencing it as tolerable, according to the world-renowned stress researcher Bruce S. McEwen, PhD. “Toxic stress means that you don’t have enough control over your life,” Dr. McEwen explains. “The triggers could be similar to tolerable stress, but if you don’t have good social or emotional support, or your brain architecture has been compromised because of early life struggles, you may not be as resilient bouncing back.” And social media is a mixed bag, as solutions go — often offering the illusion of connection without the perks, and even causing a loneliness backlash. Social media may increase stress if individuals receive undesirable feedback, such as negative comments or not enough “likes” on a post, says Christine McCauley Ohannessian, PhD, a professor of pediatrics and psychiatry at the University of Connecticut School of Medicine in Farmington. “Or, people who are active on social media may feel pressure to maintain their social network updates,” Dr. Ohannessian says. The sheer volume of information coming from social media sites may stress out some people, she says. RELATED: Are the Virtual Interactions of Social Media Busting or Boosting Your Stress? Social media can be used to your advantage if you use it conscientiously and wisely, with an eye to what — from a social point of view — you really need from it. When it comes to your overall well-being and lowering your stress levels, however, the experts say you owe it to yourself to commit to spending real time with others. With lives filled with work and personal obligations, our survey found that, among women in particular, time with friends is one of the first things that gets dropped from the to-do list. Among respondents, 51 percent of the women say that they don’t see friends at all in an average week. By contrast, 35 percent of men say they don’t see friends. Since women get a bigger hit of oxytocin — a kind of stress reducer — than men do when around friends, they’re effectively depriving themselves of a potent coping tool."Women are stressing out on the job because of structural inequities in the workplace, and at home because of relationships and family responsibilities." — Darlene Mininni, PhD, MPHFacebook Twitter“Putting it together, it’s a kind of chronic stress spiral,” says Darlene Mininni, PhD, MPH, the author of The Emotional Toolkit: Seven Power-Skills to Nail Your Bad Feelings. “Women are stressing out on the job because of structural inequities in the workplace. They’re stressing out at home over relationships and family responsibilities.” Dr. Mininni adds: “It’s reasonable to think women are not seeing friends because they have more family responsibilities than men and they tend to put the needs of others first. They don’t have, or don’t think they have, the time or energy. But friends are the elixir that would make women feel less stressed out.”

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Learn moreThat’s because cutting yourself off or minimizing social interactions outside of obligatory ones reduces opportunities for your nervous system to take a break from freaking out all the time, she says. Being fully present and “in person” with friends, your tribe, or a group whose members you trust allows for a whole experience that fires up the senses and communicates to your central nervous system — I’m alive, I feel good, I feel seen, I feel heard. “We don’t need proximity and face-to-face interactions all the time, but we do need a daily dose,” says Stephen W. Porges, PhD, a Distinguished University Scientist at the Kinsey Institute at Indiana University in Bloomington, and a professor of psychiatry at the University of North Carolina at Chapel Hill, whose research on the vagus nerve points to our reflexive response to cues of safety or danger in others and in the environment. “Without it, our body shifts to a physiological state where we support defensive strategies, not pro-social ones.” These defensive strategies are the kind experienced with prolonged chronic stress. The result, Dr. Porges says, is that we sacrifice not only our mental health, but also our physical health. “That doesn’t have to happen,” he says, “if we listen to our body and respect its needs.” RELATED: Stephen W. Porges, PhD: Q&A About Freezing, Fainting, and the ‘Safe’ Sounds of Music Therapy

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Resilient to Stressors but at What Cost

J udging from the responses to our survey questions, one thing was clear: Black Americans were notably more resilient to stress than “white only” and “Hispanic” respondents. In fact, compared with “white only” and “Hispanic” survey participants, black Americans were much more likely to report not being stressed. They also appeared to be more successful at managing their stress than the other two groups, and more likely to say that stress motivated them to make life changes. We wondered about these results, especially knowing that white Americans live an average of 3.6 years longer than black Americans, and that black Americans are at higher risk for chronic health conditions such as hypertension, stroke, obesity, heart disease, and cancer than other racial and ethnic groups. Health conditions, as we know, are themselves stressful. How could this population face all that and yet seem to be the least stressed out of all? Then we learned about the work of researchers such as Shervin Assari, MD, MPH, a research assistant professor of psychiatry and public health at the University of Michigan in Ann Arbor. Dr. Assari has published more than two dozen papers on black resilience, and he says our survey results are in line with his. Could Toxic Childhood Stress Be a Root Cause of the Opioid Epidemic?Dr. Arline Geronimus: Q&A About Weathering, or How Chronic Stress Prematurely Ages Your Body Assari’s research suggests that while white Americans, on average, are physically the “healthiest" group, they are also, on average, less “resilient” — that is, less able to “successfully adapt to life tasks in the face of highly adverse conditions” than black Americans. One reason, Assari says, is that white Americans are less prepared to cope with adversity because they have less experience with it. By contrast, minority groups in the United States have consistently lived under adverse economic and social conditions — exposed to a disproportionate share of adverse childhood experiences and the weathering effects of hardship, with chronic stressors such as racism leading to sustained, high-effort coping and, subsequently, internal wear and tear. RELATED: David Livingstone Smith, PhD: Q&A on Gaslighting These firsthand experiences may have taken a toll on the health of African-Americans, but they also may have engendered a belief in the ability to handle new stressors, Assari says. Of course, the interplay between chronic stress and race-ethnicity is complicated. There has been research, for example, on the transmission of stress between generations and on depression as it may manifest differently in African-American men. Some research — and many personal testimonials — also suggest that black Americans are less likely to report symptoms of mental illness.

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Learn moreThis tyranny of silence led the actress Taraji P. Henson to found the Boris Lawrence Henson Foundation. Named for her late father, a Vietnam veteran who suffered mental health challenges as a result of his wartime experience, the foundation has multiple related missions, including encouraging the training of African-American therapists, supporting mental health in urban schools, reducing prison recidivism, and encouraging black Americans with mental health issues to speak up and seek help. At the same time, studies such as “The Geography of Desperation in America,” a 2017 report by the Brookings Institution, have found that while poor racial minorities often face worse poverty-related challenges than do poor non-Hispanic whites, they are significantly more optimistic about the future and commit suicide less. What are some of the sources of this kind of resiliency among black Americans? Non-economic resources — such as connection to family, social support, and religion — are all key to maintaining a healthy physical and mental response to stress, according to McEwen. “Tolerable stress, what I call allostatic load, can be an acute life event — the death of a loved one, the loss of a job, an accident, things that make a person feel a loss of a sense of control,” McEwen says. “The events may be severe, but if you have a good sense of internal support, good self-esteem, and external social and emotional support, you can weather the storm.”"If you have a good sense of internal support, good self-esteem, and external social and emotional support, you can weather the storm." — Bruce S. McEwen, PhDFacebook TwitterAspirations — or expectations — may also matter. As the Brookings report notes, “Poor blacks and Hispanics tend to report they are better off than their parents were, while many blue-collar whites are facing a reality of downward mobility” as jobs go extinct and family structures weaken. Not all minority or marginalized groups possess supportive resources. In our survey, for instance, the lesbian, gay, bisexual, transgender, queer (LGBTQ) community appears to be highly stressed. Arline T. Geronimus, doctor of science, a professor in the school of public health and a research professor at the Institute for Social Research at the University of Michigan in Ann Arbor, says this isn’t surprising. Dr. Geronimus’s “weathering” theory addresses both the corrosive and the strength-building aspects of adversity in marginalized groups. LGBTQ people, unlike the black American population, are not generally raised from birth with a strong sense of LGBTQ identity or community, Geronimus says. Nor do they have generations of pooled adaptive responses passed on to them by their families to build resilience to homophobia, per se. “LGBTQ individuals have to find or build community on their own,” she says. “They also have to engage in the labor of constructing a positive identity and an alternative cultural framework to the dominant one in which they are marginalized.” Unfortunately, Assari has found, marginalized communities — even those who have a culture of coping — are at risk of losing some of their resilience when some of their circumstances change for the better. In his study, as black Americans experience economic gains, they don’t retain as much resilience, says Assari. That may be because upwardly mobile blacks tend to move to white neighborhoods where resilience is often tempered by distance from family and social support, such as their church, as well as, often, a new stressor: more frequent exposure to racism. To resolve these issues, Assari says, society must change how it treats minorities. Says Geronimus: “When facing chronic, toxic stressors, resilience alone is not a panacea. Resilience requires physiological coping and comes at a disproportionate cost to health for individuals in marginalized communities. We should strengthen the institutions and societal elements that help us mentally and emotionally weather adversity, while eliminating those that weather, or eat away at, our health.”

LGBTQ Buckling Under the Weight of Chronic Stress

N on-heterosexuals in our survey reported being significantly more likely to be stressed than heterosexuals. (We compared the simple binary of heterosexual and non-heterosexual populations because of sample sizes.) Non-heterosexuals are more likely to have visited a doctor or health professional about their stress in the past year and to feel paralyzed by stress. They are more likely to report crying on a daily, weekly, or monthly basis; to be worried about the state of the nation; be concerned about their mental health; feel that people treat them differently because of their gender; experience low self-esteem; feel bad about their appearance; have difficulty controlling their emotions; and withdraw socially. RELATED: Hannah Gadsby’s Comedy Coup Puts Stressors Center Stage A litany of despair, our results would come as no surprise to Ryan J. Watson, PhD, an assistant professor of human development and family studies at the University of Connecticut in Storrs and the principal investigator for the 2018 LGBTQ Youth Report, the largest ever survey of LGBTQ teens in the United States. Conducted by researchers at the university and Human Rights Campaign, a Washington, DC–based civil rights nonprofit working to achieve equality for LGBTQ Americans, the survey was conducted online among more than 12,000 teens ages 13 to 17 from all 50 states and Washington, DC.

Largest-Ever Survey of LGBTQ Teens Finds High Levels of Stress Anxiety and Feelings of Rejection

Learn moreThe key results of the survey, Dr. Watson says, are that teenagers who are lesbian, gay, bisexual, transgender, or queer overwhelmingly feel unsafe in their own school classrooms and experience high levels of stress, anxiety, and rejection. Watson says we can better understand what LGBTQ teens are experiencing if we see them as a minority group whose members think of themselves as socially marginalized, or who are treated in socially marginalized ways. LGBTQ teens will have to use stress reducers more often and more concertedly than most other people, says Watson. Queer kids may have such high levels of stress, he says, that they may override coping mechanisms such as yoga or deep breathing or other known strategies for dealing with chronic stress, especially when it’s a challenge to simply get out of bed. “We don’t just need an individual approach to reduce that stress,” Watson says. “We need a societal approach, and we hope our research findings will help inform policy and practice changes to improve the lives of these young people.”

Winner of the Most Stressed-Out Group Gen Zers

G en Zers, the generation born between 1995 and 2010, top our generational charts on virtually every distressing characteristic when asked: “In the past 12 months, how often have you … felt bad about your appearance; experienced low self-esteem; withdrawn socially; had a difficult time controlling your emotions; been concerned about your mental health; changed your eating patterns; cried." Two of our expert panelists who work on college campuses insist that Gen Z is among the most stressed-out groups of all. “They’re stressed because they were taught, 'If I'm not busy all the time and pushed to the max, then I’m not successful because there’s more that I should be doing,'” says Rachel J. Simmons, the director of the Phoebe Lewis Leadership Program at Smith College in Northampton, Massachusetts, and author of Enough as She Is: How to Help Girls Move Beyond Impossible Standards of Success to Live Healthy, Happy, and Fulfilling Lives. “They’re stressed because they’re a large class carrying lots of debt and competing for jobs in a tight gig economy,” adds Mininni. But according to our survey, Gen Z is also the most social generation — and not just via social media, which its members embrace. This group goes out! With others! Our experts agree that should make for a more mellow generational profile. There's an explanation for this contradiction, says Simmons, explaining that Gen Z socializes around studying and other activities. “They’re not taking downtime to focus on building relationships,” she says. “And that makes for people who aren’t alone but are lonely.” Are the Virtual Interactions of Social Media Busting or Boosting Your Stress?‘Snapchat Dysmorphia’: Is the Stress of Social Media Driving Teens to Plastic Surgery?“We need to tease apart whether these interactions and social connections are stress-generating,” says Robert Epstein, PhD, a senior research psychologist at the American Institute for Behavioral Research and Technology and the author of Teen 2.0: Saving Our Children and Families From the Torment of Adolescence. “The evidence suggests that they often are.” Referring to his own research, Dr. Epstein says that the turmoil we see among America’s young people is caused by two factors: We artificially extend childhood well past puberty, treating all young people as if they are incompetent children no matter how competent or mature they might be; and we isolate young people from responsible adults, trapping them and their peers in the world of “teen culture.” That world is heavily influenced — Epstein says “controlled” — by specialized divisions of the media, entertainment, and fashion industries. RELATED: How to Avoid an Emotional Meltdown, and What to Do When It Happens Anyway As a result, he says, adolescence is characterized by a high degree of self-consciousness and by tendencies to judge and be judged, to conform, to wear certain clothes and shoes, and to see peers as competitors, even if you call them friends. Says Epstein: “The result of our creating a teen culture — which doesn’t exist in more than a hundred contemporary cultures around the world — is that young people are socializing and communicating, but in trivial ways. They aren’t alone, but that doesn’t stop them from feeling stressed, inferior, lonely, or unprepared to face an uncertain future.”

Your Body On Stress The Physical Effects

T he human body’s stress response involves a chain reaction of hormonal and physiological changes. These mechanisms are meant to prepare the body’s systems and organs for a real or perceived threat. But stress — particularly in a heightened, prolonged state — can have serious, adverse health effects. Here are some of the ways that acute or chronic stress can affect different parts of the body. RELATED: Bruce McEwen, PhD: Q&A on Your Body on Stress

Chronic Conditions Stress Creates a New Norm

T he profile of survey respondents with chronic conditions — that is, the factors that regularly cause them stress — looks like the profile of people without chronic conditions. But the stress levels for each factor are more pronounced, and worse. Some of us at Everyday Health thought that “medical challenges” or even “inequality (disability)” might surpass “finances” and “job/career” or “the future” in the ranking of life’s stressors for people with chronic health issues. But according to Amit Sood, MD, the executive director of the Global Center for Resiliency and Well-Being, a former professor of medicine at the Mayo Clinic in Rochester, Minnesota, and the creator of the Mayo Clinic Resilient Mind program, “Years of experience working with thousands of patients shows that for most, over time, the condition doesn’t come to define the individual.” What’s at work? “It’s as if a psychological immune system kicks in,” Dr. Sood says. As people settle into treatment routines and living routines, they figure out how to navigate the environment. “Their struggles with the condition fade into what we think of as a normal wrestling with life: finances, job/career, and yes, ‘the future.’”

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The difference, Sood says, is that people with physical or mental health conditions may experience all these stressors more intensely, and for a variety of reasons. We all learn to value life’s basics, such as financial or job stability, in their absence. But even low-level chronic stress — meaning prolonged and unremitting stress, the kind you might experience with a chronic physical or mental health condition — damages the body and the brain in ways that leave us particularly sensitive to factors that can stress us out. “It becomes an insidious feedback loop,” Sood says. “People with physical or mental health issues have a lower set point for reacting to the stressors in their lives. Because they’re already being challenged by their conditions, it’s easier for another stressor to push them into overload where they’re stressing out. Stressing out makes a chronic condition worse, which increases our experience of stress, which can worsen a chronic condition.” Then, too, stressing out long enough or often enough can lead to chronic physical and mental health conditions, which may further aggravate the body’s stress response while adding stressors of their own to an already lethal brew. That may be why, in the survey, this group was more likely to report panic attacks, and why for this group of respondents, stress is much more likely to be paralyzing than invigorating. Whenever you develop a chronic condition and for whatever reason, including chronic stress, “I think of this as living in prey mode — your body and mind are being preyed upon, challenged, in all kinds of ways,” Sood says. “Now along comes some other stressor, and it’s like salt spread on sandpapered skin: The skin is already irritated. The salt sets it aflame and the feedback loop starts again.”

Can Stress Cause Other Issues

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Americans Lack Stress Management Skills

S tress management skills? Americans as a whole seem to be sorely lacking in them, perhaps because we don’t typically teach these skills at school or make them widely available through employers. Our survey respondents do more coping with stress by distraction than by deliberately managing stress with the intention of preventing or reducing it. Our experts say that’s a shame, because it’s not difficult to learn powerful stress management skills. Several of our experts pointed out that our survey lists lots of distractions to choose from rather than stress relief or prevention practices. We also list some potentially harmful practices, including drinking alcohol, smoking cigarettes, eating, taking prescription or recreational drugs, and shopping. But we did include the choices “meditate” or “exercise/sports,” both of which are familiar, proven stress relievers. In our survey, relatively few people in any generation saw them that way. RELATED: Smart About Stress: Top 10 Myths You Need to Know Meditation rated particularly low, with only 6 percent of women and 9 percent of men saying they turn to it as a top coping skill. Sliced by generation, it doesn’t look much better. Our Gen Zers use it as a top de-stressor even less, with only 2 percent turning to it. Some 7 percent of baby boomers (weren’t they supposed to have been the hippies?) list it as a top de-stressor, and millennials and Gen Xers in our survey are tied at 8 percent. A chronic condition doesn’t seem to make much difference: All responders with chronic conditions divided the same way, with 7 percent listing it as a top de-stressor and those with no chronic condition at 8 percent.

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Exercise/sports fares considerably better, with 24 percent of all respondents saying they engage in some kind of concerted physical activity as one of their top three techniques to relieve or manage stress. (The breakdown is 27 percent of men, 21 percent of women, 25 percent of millennials, with Gen Zers and boomers tied at 24 percent, and Gen Xers at 22 percent.) That makes it the fourth most popular stress relief practice in our survey — after music, TV/videos, and sleep, but ahead of venting/talking to others, and eating. About 22 percent overall say talking/venting is what they do when stressed (making it the fifth most popular choice), with 53 percent saying they feel better after talking to others who are experiencing stressful situations similar to theirs. Thirty-nine percent of men were significantly more likely to be irritated by those who talk to them about being stressed, while only 31 percent of women felt such irritation. RELATED: Stressed by the News? Consider Your Options Most medical experts will recommend exercise — or at least moving your body, as in walking around — as an effective way to relieve stress. “And frankly, most everyone you talk to knows that exercise is a good thing,” says Epstein. “So why don’t more people exercise or play sports when they are stressing out or to prevent themselves from stressing out?” Epstein says it’s because exercise is hard, especially when you haven’t really done it before. Even the steps involved to get to the exercise, like changing into sweats or traveling to the gym, can make exercise and sports “labor intensive,” he says. Frank H. Farley, PhD, the L.H. Carnell Professor at Temple University in Philadelphia and the president of the Society for Experimental Psychology and Cognitive Science, says that to respond successfully to the stressors in our lives, he believes we need at least three things: “Self-knowledge — you need to know who you are, what energizes you and what enervates you. For example, are you risk-seeking or risk-averse? You need motivation — that is, you have to want to do something to change the situation. And you need the resources to take effective action.”

Expert Q& As

Jillian Pransky: Q&A About Deep Listening for Toxic StressHeidi Hanna, PhD: Q&A on Reducing Overwhelm to Whelm With a SmileDarlene Mininni, PhD, MPH: Q&A About Gratitude, Mindfulness, Reframing As most of our experts point out, the resources are what many individuals and communities don’t have — a green park, a community pool, a safe neighborhood for a late-night walk. Here’s what concerns us: When asked, “What do you do in response to stress?” 47 percent of all our respondents (with women and men almost evenly matched) say they take it out on themselves. Mininni, the health psychologist in learning and development at UCLA, asks: “What does that mean? Drinking? Overeating? Indulging in self-recrimination? I wonder about this because answering, ‘When I’m stressed I …,’ some 27 percent of respondents say they engage in none of the named actions. So, what do they do when they’re stressed?” RELATED: You Say Chocolate Relieves Your Stress? Now Science Provides Some Backup Most men still don’t cry — certainly not as much as women do (0.4 percent versus 4 percent). For Mininni, “What that says is that as a society, we’re still not allowing men to show their emotions; it’s still not okay, even if this is a way to relieve stress. These kinds of gender limitations hurt everyone.”

Stress Hacks

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What Might Ultimately Save Us

There is no easy, quick fix; chronic stress is a bit too complicated for that. In the course of researching and writing this special report, our experts made this clear — none more vividly than Janice Kiecolt-Glaser, PhD, the director of the Institute for Behavioral Medicine Research at the Ohio State University College of Medicine in Columbus. “Stress is a little like an avalanche," Dr. Kiecolt-Glaser says. "It starts at the top of the mountain when something breaks off. Barreling down the mountain, it not only gains momentum, it also gains mass as it keeps destroying things in its path that become part of it, a monster feeding on itself.” Take time out to be with those you like and love or want to know. Spend time with people who make you feel seen and heard and safe.“So the broad solution,” she says, “is better recognition of the early signals,” what she considers red flag feelings — of being overloaded, out of control, unable to cope, and maybe even anxiety and the occasional panic. “That should prompt us to take stock and think about how to take care of ourselves,” she says. So take time out to be with those you like and love or want to know. Spend time with people who make you feel seen and heard and safe. We’re talking about taking a moment to exchange pleasantries with the person who makes your morning coffee. Or, instead of listening to your personal playlist, greet the person next to you on the elevator and wish them a great day. Take a break from Netflix to sit outside and actually chat with your neighbors. Grab some chalk and make a hopscotch board or a tic-tac-toe with your child or grandchild. Plant an herb garden with your partner — even if the garden is a small plastic tub. Invite a friend over for tea on a Saturday instead of running another errand. Stay for the socializing after religious services. Waiting outside a room for a meeting to start? Stop texting or tweeting or sending that last-minute email and make a human connection: Ask your colleague how his mom is doing after surgery, or what kind of dog she adopted and what she named it. Put the phone down, step away from social media, and step into your life. Your mind, body, and soul — and everyone else you encounter — will be so very glad you did. Additional Contributors: Dakila D. Divina, Maura Corrigan, Elizabeth DeVita Raeburn, Denise Maher, George Vernadakis, Ingrid Strauch, Melinda Carstensen, Sarah DiGiulio, Katie Robinson, Jamie Putman, Amy Kraft, Pharyl Knight, Beth Silvestri, Tiffany Szalay, Bethany Rouslin, Kristen Hom, Brianna Wesley-Majsiak, Larissa Green, Amanda Long, and Nicole Vegliando. Stress-Related Symptoms? Why You Might Want to See an Integrative Medicine Doctor6 Natural Fixes for Stress-Related Symptoms and Conditions