Are You Brave, or are you Reckless?

If you can sit quietly after difficult news; if in financial downturns you remain perfectly calm; if you can see your neighbors travel to fantastic places without a twinge of jealousy; if you can happily eat whatever is put on your plate; if you can fall asleep after a day of running around without a drink or a pill; if you can always find contentment just where you are: you are probably a dog. ~ Jack Kornfield

Are You Brave, or are you Reckless?

What makes a healthy individual?  Healthy is usually defined as a lack of something –an absence of overt physical /mental disease.  More recently “subclinical’’ markers or vulnerabilities for future disease have been identified in humans (i.e. pre-diabetes, metabolic syndrome, etc).  The focus on stress as a disease, has hindered progress in understanding how stress responses fit into the normal physiology of a healthy individual.  Romero et al (2015) are developing mathematical models to predict vulnerability and ask important questions:  Does the stress phenotype change across life history, across the day or over the course of the lifespan, and if so, why? Why are some individuals more likely to progress to stress-related disease than other individuals? What underlies the individual variation in the consequences of stress responses? How long must measures be at a certain level before we define them as exhibiting a stress phenotype? How does natural selection act on the stress phenotype?  

The constantly changing healthcare environment is ripe for determining factors that contribute to stress resilience.  Novelty seeking may be disproportionately represented among certain populations in healthcare (emergency room physicians, surgeons, etc) that our society views as altruistic and heroic. Mujica-Parodi et al (2014) demonstrated a fine line between individuals who are “brave” and those who are “reckless.” The brave feel fear but nonetheless overcome it. The reckless fail to recognize danger. Those who fail to recognize risk are less likely to mitigate it. From a clinical perspective, it matters not only whether an individual avoids or embraces risk, but also whether the response to risk is adaptive or maladaptive.  The most well educated student is not the one with the highest scores on standardized tests, but the one who is positioned to create successful interactions with complex, variable, and unpredictable environments (Gerdes 2015).  Adaptive clinicians both accurately recognize risk and avoid being paralyzed by fear.

If vulnerability and prediction of responses to future stressors could be incorporated into conceptual models of stress, a better concept of health and disease might arise.  The physiological and behavioral responses to stressors are critical mechanisms of resilience for healthy organisms. Sterling and Eyer (1988) defined allostasis as “stability through change,” which contrasts with the idea of homeostasis, or “stability through constancy.”  Allostasis is a paradigm for physiological regulation consistent with evolutionary theory.  In contrast to homeostasis, allostasis recognizes change, not constancy as the norm.  Success is defined as fitness in the context of complex natural context.  Geodes (2015) notes that education with this framework could lead out the full potentiality of learners, to support their successful engagement with complex, changing, and unpredictable environments.  

Psychologist Kelly McGonigal (2015) shares a simple and effective mindset intervention.  Simply knowing that stress is what arises when something one cares about is at stake, and that stress and meaning are linked leads to more positive outcomes. Both "we don’t stress out about things we don’t care about"and "we can’t create a meaningful life without experiencing stress". 

Like a self fulfilling prophesy,  when stress is viewed as inevitably harmful and something to avoid, one becomes more likely to feel doubt about their ability to handle challenges, alone in suffering, and unable to find meaning in struggles.   Stress is most likely to be harmful when one feels inadequate to it; becomes isolated from others; and feels meaningless and out of control. 

In contrast, accepting and embracing stress can transform these states into a totally different experience. Self-doubt is replaced by confidence, fear becomes courage, isolation turns into connection, and suffering becomes meaning—all without getting rid of the stress.

Viewing the stress response as a resource works because it helps one to believe “I can do this.” This belief is important for both ordinary and extraordinary stress. Seeing the upside of stress is about choosing to see how stress can help meet challenges in life which can influence long-term outcomes, such as health, happiness, and longevity.

Effective mindset interventions have three parts: 1) learning the new point of view, 2) doing an exercise that encourages to adopt and apply the new mindset, and 3) providing an opportunity to share the idea with others.  

McGonigal (2015) offers the following Stress Mindset Tools/exercises:

“One of the best ways to notice, value, and express your own growth is to reflect on a difficult time in your life as if you were a journalist writing a restorative narrative. How would a storyteller describe the challenges you have faced? What would a good observer see as a turning point in your story— a moment when you were able to reengage or find meaning? If a journalist were to follow you for a week, what evidence would the journalist see of your strength and resilience? What do you do that demonstrates your growth or expresses your values? What would friends, family, coworkers, or others who have witnessed your journey say to describe how you have changed or grown? What objects in your home or office would a photojournalist want to photograph as evidence of your growth or resilience?”

“Bring to mind a stressful experience from your past in which you persevered or learned something important. Think about what that experience taught you about your strengths and how to cope with stress; set a timer for fifteen minutes and write about the experience, addressing any or all of the following questions.  What did you do that helped you get through it? What personal resources did you draw on, and what strengths did you use? Did you seek out information, advice, or any other kind of support? What did this experience teach you about how to deal with adversity? How did this experience make you stronger? Now think about a current situation you are struggling through. Which of these strengths and resources can you draw on in this situation? Are there any coping skills or strengths you want to develop? If so, how could you begin to do so using this situation as an opportunity to grow?  Choose an ongoing difficult situation in your life or a recent stressful experience. What, if any, benefits have you experienced from this stress? In what ways is your life better because of it? Have you changed in any positive ways as a result of trying to cope with this experience?”

 

Bibliography

Gerdes et al (2015) A groundwork for allostatic neuroeducation

McGonagle, K (2015) The Upside of Stress http://kellymcgonigal.com/books/

Mujica-Parodi, LR (2014) The fine line between ‘brave’ and ‘reckless’: Amygdala reactivity and regulation predict recognition of riskhttp://www.sciencedirect.com/science/article/pii/S1053811914007125

Romero et al (2015) Understanding stress in the healthy animal –potential paths for progress

Sterling,P.,and Eyer, J.(1988).“Allostasis:a new paradigm to explain arousal pathology,