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David Geffen School of Medicine

Stress Fractures

  Stress Fractures  

By Lyndon Stambler • Illustration by Otto Steininger

Americans are overwhelmed. Living in chronic-stress mode, our days running 24/7, our senses assaulted by the pinging of smart phones and our attention diverted by relentless tweets, texts and emails, we are in constant quest of all that is new and different and exciting. All this more, better, bigger, faster, sooner, now, now, NOOOWWW is driving us to the edge. Our bodies surge with adrenalin, hearts pumping, muscles twitching. That served us well when we were hunters and gatherers, but no longer. The constant strain of our modern lives leads to anxiety, depression, insomnia, obesity and a host of other illnesses.

Peter C. Whybrow, MD, executive chair of the Department of Psychiatry and Biobehavioral Sciences and director of the Jane and Terry Semel Institute for Neuroscience and Human Behavior at UCLA, has a high-stress job, and yet he keeps his smart phone switched off in his briefcase. “Every time your phone rings, somebody else is providing you with a priority that wasn’t your own before the phone rang,” he explains. We all want to control our environment. When we lose our capacity to control our future as we see it, stress begins to mount.”

Most of us live in a mindless haze of non-stop activity. But UCLA researchers have studied the impact of stress and are designing ways to cope. “Universities are supposed to be the places where you learn not only physics, but also how to live,” Dr. Whybrow says.

Philanthropists Jane and Terry Semel, whose gift in 2004 endowed the Jane and Terry Semel Institute of Neuroscience and Human Behavior at UCLA, also provided the support in 2011 to create the healthiest campus in the nation. The Healthy Campus Initiative (HCI) seeks to support the 85,000 students, faculty and staff at UCLA to eat healthy (Eat Well), exercise (Move Well), improve mental health (Mind Well), live in a healthier environment (Be Well) and thrive in a smoke-free campus (Breathe Well). Integrating the five facets can reduce stress and foster healthy lifestyles, says Assistant Vice Provost Wendy Slusser, MD, who directs HCI. “It’s caught on like wildfire. People want to eat healthfully. They want to have a balanced, high-quality life, especially the youth on campus. It’s leading to a whole culture of wellness.”

  Dr. Peter C. Whybrow  
  Dr. Robert Bilder  

Top: Dr. Peter C. Whybrow: “We want to put everything into metrics. We’ve lost the sense of humanism. Life is not about metrics. Life is about other people. If we lose that connection, we lose what life is really all about.”
Photo: Mark Berndt

Bottom: Dr. Robert Bilder: “UCLA is well-poised ... to provide people with the measurement tools that they need to be able to understand our own stressors and the life tools they need to manage our stressors.”
Photo: Courtesy of Dr. Robert Bilder

The British-born Dr. Whybrow, who has lived in the U.S. for 40 years, is a Tocqueville-esque observer of American society. In his book American Mania: When More Is Not Enough (W.W. Norton & Co., 2005), he observes Americans’ stress-inducing drive for material wealth. Now he posits a remedy for that mania in The Well-Tuned Brain: Neuroscience and the Life Well-Lived (W.W. Norton & Co., 2015). The remedy involves re-engineering society to address the problems confronting Americans. HCI created a living lab at UCLA for his ideas. The hope is that people will take the lessons beyond the campus and promote healthy living in their families and the workplace. The Semels and UCLA Chancellor Gene D. Block, whose office now oversees HCI, see the program as a beacon for others. “Whether it’s about diet, exercise, transportation or sustainability, our goal is to leverage our unique strengths in the health sciences and as a leading research university to encourage healthier outcomes for individuals and for society as a whole,” Chancellor Block says.

HCI has already spread beyond UCLA. In July 2014, University of California President Janet Napolitano, inspired by the Eat Well program, created the UC Global Food Initiative, creating programs and projects throughout the UCs.

THE ABILITY TO MANAGE STRESS and develop greater powers of resilience will be “the most important cornerstone of advancing human health in general over the next 50-to-100 years,” says Robert Bilder, PhD, Tennenbaum Professor of Psychiatry and director of Mind Well.

Technology and social media have “led to a net decrease in well-being,” Dr. Bilder says, disrupting the balance between our willed intentions and responsiveness to external stimuli. “As we see people walking around the streets with their cell phones, they’re constantly responding to signals that they’re getting from others: e-mails, text messages, phone messages, tweets. That’s hijacking people’s behavior and making them responsive to these devices in a way that prevents them from implementing their own willed intentions. It’s a cause of a lot of stress because people are now acting based on external signals that they consider valuable in part because of their social meaningfulness.”

Dr. Bilder would prefer that people use technology to reduce stress or bolster creativity. “UCLA is well-poised to do exactly this and to provide people with the measurement tools that they need to be able to understand our own stressors and the life tools they need to manage our stressors,” he says.

UCLA cognitive researchers, who have studied how people learn, might provide a key for managing those stressors. Their research may help students learn more efficiently. The Mind Well program also is developing a co-curriculum at UCLA to emphasize life skills, recognizing students for studying subjects like mindfulness in addition to physics and chemistry. And the Semels made another gift in Fall 2014 to help create a food-studies minor for undergraduates and a food-studies certificate program for graduate students, recognizing the importance of nutrition to well-being.

UCLA’S MINDFULNESS AWARENESS RESEARCH CENTER (MARC) was created a decade ago, in part by a gift from the Petit Foundation, to conduct studies of and teach the powerful tool for reducing stress: mindfulness. Over the years, there has been a surge in interest for the practice, which can be defined as paying attention to present-moment experiences “with openness, curiosity and a willingness to be with what is.”

MARC Director Michael Irwin, MD (RES ’85), Cousins/MARC Professor of Psychiatry and Biobehavioral Sciences, says that more than half of the population has incorporated some form of mindfulness into their lives at some point. Dr. Irwin began practicing yoga in 1980, while finishing medical school. But it wasn’t something he crowed about. “Quite frankly, with most of us in medicine, we kept it a secret. We didn’t talk to our colleagues about what we were doing with mindfulness or yoga.”

  Dr. Michael Irwin  
  Dr. Michael Irwin: “If you’re on the treadmill ... certainly the physical activity is producing some benefit. But if you’re also stressing ... then all of those stressors just continue to have an impact on you throughout the day.”
Photo: Courtesy of Dr. Michael Irwin

Now he is the co-author of a study published in February in JAMA Internal Medicine on the efficacy of mindfulness meditation in the treatment of sleep problems in older adults. “If you had asked me, ‘Do you think that a paper on the mindfulness topic would be published in JAMA?’ I would have said no. We actually tried to do it, without success, but that was in 2007,” Dr. Irwin says.

Ten years ago, most of the therapies targeting stress involved cognitive behavioral therapy, Dr. Irwin notes. “The use of mind-body interventions was dismissed as irrelevant to the practice of medicine when we began exploring its role in treating stress-related conditions like insomnia, depression and anxiety.”

But through randomly controlled studies of more than 600 subjects over the last decade, funded mainly by the National Institutes of Health, Dr. Irwin and his colleagues have shown not only that mind-body interventions, such as mindful meditation, yoga and Tai Chi, improve mental and physical outcomes, but also how these interventions work to reduce stress, improve sleep and possibly prevent chronic illnesses like hypertension, cancer, cardiovascular disease, dementia and rheumatoid arthritis. Mind-body interventions target behavioral and biological pathways and, within weeks, can “alter the molecular expression of genes that are involved in the regulation of inflammation, and inflammation is a principal pathway linked to many chronic diseases,” he says. “Ten years ago, we knew very little about how it was producing those effects.”

Moreover, Dr. Irwin has shown that the benefits of mindfulness, Tai Chi and yoga exceed the benefits of exercise. “Part of it has to do with the ability of the brain to control how we perceive stress, with effects on our body’s physiology,” he says. “If you’re on the treadmill and you’re working out, certainly the physical activity is producing some benefit. But if you’re also stressing about all of the things you have to get done that day and continue to be upset by these things when you step off the treadmill, then all of those stressors just continue to have an impact on you throughout the day.”

One of Dr. Irwin’s studies controlled for the physical activity of Tai Chi and found that the main benefit came from mindfulness. “You may feel overwhelmed, but there are tremendous opportunities to empower yourself by these simple practices to promote health in the midst of the stresses that we all experience. We can’t change what’s happening in the world, but we can change our own internal experiences,” he says.

Diana Winston, UCLA’s director of Mindfulness Education, began meditating 25 years ago. She has seen an explosion of interest in mindfulness in the past five-to-10 years. Time magazine ran a cover story on the topic, 60 Minutes aired a story and Winston regularly is interviewed by mainstream women’s magazines. “When I first started, it was a very hidden thing. You did not tell people that you meditated,” she says.

MARC reaches several thousands of people a year through its training sessions, and an average of 120,000-to-130,000 people a month access guided meditations from the MARC website. Winston co-authored the book Fully Present: The Science, Art and Practice of Mindfulness (De Capo Lifelong Books, 2010) with Emeritus Professor Susan Smalley, PhD, who founded MARC. Winston says that people who take the classes are dealing with stress-related illnesses: depression, anxiety, attention-deficit issues, back pain, migraines or high blood pressure. She often hears from people who face crises and find comfort from the online mindfulness recordings, such as a woman recently diagnosed with stage-four colon cancer.

  Diana Winston  

Diana Winston: “Mindfulness is about paying attention in the present moment, not being lost in the past, not being lost in the future, but coming into this moment and finding a place of ease and well-being with things as they are.”
Photo: Courtesy of Diana Winston

“Mindfulness is about paying attention in the present moment, not being lost in the past, not being lost in the future, but coming into this moment and finding a place of ease and well-being with things as they are,” Winston says. “Mindfulness is both a meditation practice and a quality of attention that you can bring to any moment in your day or life.”

Using mindfulness to cope with information overload is particularly difficult. Winston encourages people to “unplug” but finds that most have a love-hate relationship with technology. “I hear it again and again. ‘I’m overwhelmed by e-mail, I’m overwhelmed by my phone. But I love it.’ People also have a love-hate relationship with quiet. They want it, but it’s scary, or it’s hard or they can’t imagine how to get it into their lives.”

ONE REASON TECHNOLOGY IS SO STRESSFUL is it’s addictive, tapping into the most primitive part of the brain. “It ties into the nature of the central nervous system, which is to be terribly attuned to novelty,” Dr. Whybrow says. If it pings, hums or blurts, we are compelled to respond. And now, Dr. Whybrow says, “we give [smart phones] to children. When I was a kid, I used to get on my bike in the summer, ride off with a friend and come back at suppertime. Now children are tethered to their parents and their friends 24/7.”

Dr. Bilder embarrasses his own children when he happens to see two kids texting each other while sitting together on a bench. Rather than walk by, he’ll confront them: “Hey dudes, do you realize that right next to you is a three-dimensional representation of a human being, and you could actually talk to him? You can’t believe the bandwidth available to you if you just put down the phone and actually look at, listen to and maybe even touch that person.”

Although mindfulness is a simple concept, it’s not as if you can just do it once and experience the benefits. It’s a practice. And Drs. Bilder and Irwin would like to see it encouraged throughout the UCLA Health network. Dr. Irwin, for one, would like to see his primary-care physician encourage the use of mindfulness meditation and other mind-body practices, along with other lifestyle factors such as diet and exercise. “I would hope that research and the support of the institution over time will continue to foster the national leadership of our physicians as we implement these practices throughout the UCLA healthcare system,” he says.

In fact, Dr. Irwin says, mind-body approaches will be essential in this evolving age of healthcare reform for promoting wellness and reducing costs. “I’m very optimistic,” he says. “No country can sustain the huge costs of healthcare treatment that we see now. Prevention is key. Lifestyle interventions like yoga, Tai Chi and mindfulness, exercise and diet, along with not smoking or not drinking to excess, are all lifestyle factors that have robust effects upon health.”

In the future, UCLA doctors perhaps may prescribe mindfulness before they prescribe drugs for certain conditions. Dr. Bilder says that the Semel Institute, Department of Psychiatry and Biobehavioral Sciences and the David Geffen School of Medicine at UCLA are organizing a primary-care division with the goal of spreading behavioral-health programs throughout UCLA’s growing primary-care network. Prevention is the watchword. Indeed, in April 2013, UCLA became the first University of California campus to ban smoking throughout its grounds, eliminating a major environmental stressor. (UCLA Health had earlier banned smoking in and around all its facilities.)

In addition to banning smoking on campus and promoting stress reduction through MARC and HCI, UCLA is embarking this spring on a Depression Grand Challenge Project to identify risk factors and prevent a substantial number of people from becoming depressed. Nelson B. Freimer, MD, director of the Center for Neurobehavioral Genetics and professor of psychiatry and biobehavioral sciences, will coordinate the project, which will involve more than 100 faculty from across the campus. Depression has a complex causation, involving genetic, social and environmental predispositions. “Extreme stress is one of the main things that can tip someone from health to depression,” Dr. Freimer says. “If you can help people be more resilient to stress, certainly you are removing one of the factors that tips susceptible people into depression.”

  Jane and Terry Semel  

Jane and Terry Semel
Photo: Getty Images

Jane Bovingdon Semel is the founder of Ijane Inc., the nonprofit production company that produced the “Face the Issue You Are Not Alone” animated PSA campaign. Her husband Terry Semel, chairman and CEO of Windsor Media, previously served as chairman and CEO of Yahoo! Inc. and chairman and co-CEO of Warner Bros. The Semels endowed the Jane and Terry Semel Institute for Neuroscience and Human Behavior at UCLA. UCLA’s Healthy Campus Initiative, an integrated, campus-wide effort to prioritize the health and wellness of students, faculty and staff, promote healthy lifestyle choices and develop best practices that may help other communities seeking to do the same, is largely the result of the Semels’ vision and support.

"Reducing preventable diseases has been a vision of mine for a very long time. UCLA's Healthy Campus Initiative is an important step forward."

- Jane Semel

DR. WHYBROW SITS AT THE HELM of the diverse Semel Institute, thinking of the big picture, such as the HCI, and how to glue an emotionally fractured society back together. “As my daughter says, people have forgotten how to grow a tomato out of their own backyard,” he says. “We can make progress, but we have to think about it. It’s not going to happen by itself.”

For Dr. Whybrow, switching off the cell phone is a metaphor for a better life. “We had a routine for a long, long time. It’s called courtesy and social manners. If you want to get someone’s attention, then there are all sorts of ways you can do it. You can make an appointment. You can call them up on the phone and leave a message. So in other words, we all need to be more mindful of each other so that we can create a society in which manners actually are important,” he says. “That’s what glues society together, individuals being thoughtful of each other.”

Dr. Whybrow invokes Adam Smith, the patron saint of capitalism, as the person who suggested that the marketplace, fueled by self-interest, was meant to be kept in check by conscience and social concern. But that’s no longer the case in 21st-century America. “What we’ve done is we’ve primed the engine and forgotten the brakes,” Dr. Whybrow says. “We’ve built a society with no brakes. The brakes are manners, social concern, acceptance of each other as individuals — silly old things like opening the door for someone or allowing another driver to change into your lane on the freeway.”

Everything from stress in interpersonal relationships to climate change, he says, is a byproduct of our “hell-for-leather” drive to produce without any concern for the consequences. He laments that his daughter’s generation has more anxiety and depression than did his generation, and the trend continues. Dr. Whybrow cringes at a request for statistics on the issue. “That’s another problem America has. We want to put everything into metrics. We’ve lost the sense of humanism. Life is not about metrics,” he says. “Life is about other people. If we lose that connection, we lose what life is really all about. It’s a life that is no longer well-lived.”

Americans, in order to de-stress, need to re-tune their habitat, educational systems and food consumption and rediscover social conventions — in short, the things that make us human, like attachment, love and face-to-face communication. Dr. Whybrow hopes that the Healthy Campus Initiative will be a start, with roots and branches that extend beyond the confines of the UCLA campus.

“Change doesn’t occur in one fell swoop,” he says. “It occurs with individuals beginning to see opportunities for themselves and intellectual excitement around the changes that can occur. Those islands of opportunity begin to grow and then eventually coalesce, and you’ve got a cultural movement.”

To learn more about the UCLA Mindful Awareness Research Center and to access guided meditations, go to: marc.ucla.edu.

Freelance writer Lyndon Stambler teaches journalism at Santa Monica College.


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