How to reduce stress with precision medicine

“There’s a concrete way that we define stress,” said Professor Walker, of the University of Newcastle and Hunter Medical Research Institute.

“It tends to be events that are threatening, uncontrollable and unpredictable.”

He advocates for constructive strategies to help people reduce the severity of threats.

“Humans are exceptionally good at predicting threats and opportunities in their environment,” he said.

“We understand a gun in our face, or a shark in the water, or a lion on the savannah as a threat. But there can be perceived threats as well.

“In fact, it’s almost as if our success at being human has come from how good we are at predicting where opportunities and threats come from.”

Professor Walker said small spikes in stress can be beneficial if a person’s life is generally balanced.

Stress can improve thinking and flexibility, giving people the drive, hunger and motivation to achieve.

It can also improve the way our immune system is working.

But problems can arise when stress becomes chronic, when a person’s autonomic nervous system stays on alert for prolonged periods, without naturally returning to normal.

“Chronic stress is consistently associated with low motivation, fatigue and burnout and compromised immune functioning,” he said.

Modern society is ripe for chronic stress because it is filled with the expectations of striving people.

“For example, insert yourself in city traffic,” he said.

“That person in front of you is driving in a really obnoxious way. They’re cutting in, speeding. That’s starting to stress you out.

“The reason for this is that you have an unrealistic expectation that people will be courteous and considerate when driving in traffic.”

There can be a big gulf between expectation and reality.

“You’re feeling frustration. Essentially, you find their behaviour threatening. Your sense of appropriate social behaviour is being challenged.”

Chronic stress results in a tendency to engage in more habit-related behaviour and less effortful decisions.

“It literally changes the structure of your brain. Effortful decisions become harder. It affects your motivation,” he said.

And while some people accurately perceive real threats, others spend a lot of time boxing at shadows.

“Often, we have this fantastic ability to see perceived threats that are far over the horizon,” he said.

They can, in fact, be imagined threats. 

“For instance, if I don’t do something today or if I don’t get something accomplished this month or this year, if I don’t lose this weight or don’t get that promotion or don’t get that report done on time, or don’t get this mark in my assignment – then a sequence of events can play out as stress.”

Stress tends to creep in when there’s “a gulf between expectations and reality”.  

Many people in modern life have unrealistic expectations, as they struggle and strive for a “quality” life.

Common sources of stress include finances, relationships, social situations and the workplace.

“Chronic stress predisposes individuals to the development of mood disorders, such as depression,” he said.

Some people, stroke patients for example, can be at particular risk.

“In stroke patients, the incidence of depression is about four times higher than the regular population.”

He said stroke patients can become “incredibly stressed”, which can impair their motivation.

This then affects their willingness and level of engagement with the intensive rehabilitation needed on the path to recovery.

“It can influence the quality of their decision-making, so they’re not necessarily making the best possible decisions with the information they have.

“It’s impacting on their brain repair, which is essential for that time in their life.

“It’s also predisposing them to have compromised immune function, so they can get sick.”

This can negatively interact with repair processes.

“It’s essentially a double whammy,” he said. 

It’s for these reasons, in part, that Professor Walker is conducting stress research on stroke patients.

“We’ve got a study set up, which is the first study in Australia to longitudinally measure stress in stroke patients,” he said.

The study is using a novel procedure – it is measuring stress in hair.

“If you can’t measure it, it’s nearly impossible to know whether you're changing it,” he said.

This work is being done through the university, using biometrics [measurement and analysis of physical or behavioural characteristics].

The centre is also examining the use of portable devices to measure stress through things like heart and respiration rates.

“We’re interested in the full range of tools that can be used to look at chronic health,” he said.

He said there were a number of “robust programs” for people with mood disorders, including traditional psychological interventions.

However, he wants to reach people before they need to see a GP or psychologist.

His work falls into the field of precision medicine, which aims to target prevention measures and treatment to people based on their individual needs.

As such, the university’s Centre for Innovative Technologies in Rehabilitation Settings is examining programs that can help stroke patients and other people to reduce stress.

The centre is considering everything from singing in choirs, pottery and men’s sheds to targeted exercise strategies and antidepressants.

The aim is to help people pinpoint real or perceived threats and ask, “how can I bring more certainty, control and predictability to them?”.

“We’re talking about meaningful interventions to combat stress,” Professor Walker said.