The impact of mindfulness and stress management on health and longevity

Highlights:

• Stress is linked with depression, anxiety, and neuroticism and negatively impacts the brain
• Stress can be categorized into acute stress, chronic stress, posttraumatic stress disorder, and distress
• Meditation and mindfulness was proven to improve the health of individuals experiencing stress

Introduction

One of the lifestyle factors that have harmful effects on the longevity and health of your patients is stress. Mitigating it using mindfulness techniques and meditation seems to have a significant impact on the health of older patients. Even though the effects of meditation on older persons has to be studied, the results are so far promising: reducing cardiovascular risk factors, stress, anxiety, insomnia, or feelings of social exclusion. It seems that mediation and other mindfulness techniques can protect the brain from aging and positively affect attention and memory. This approach is just a reiteration of general wisdom, the best expressed in American president Thomas Jefferson quote: “When angry count to ten before you speak. If very angry, count to one hundred.”

Stress affects health and psychological well-being

In physics, stress describes the forces on objects undergoing deformation, or an interaction between a force and the resistance to counter it. This force may elongate the object (tensile stress), or compress it (compressive stress), squeeze it from all sides (bulk stress). In psychology and medicine, stress, most simply put, is a reaction to a situation by activating the nervous system. Stress was introduced to medicine by Hungarian-Canadian endocrinologist Hans Selye, the founder of the stress theory (1). He defined it as "the non-specific responses of the body to any demand for change." According to Selye , when exposed to stress, the human body goes through General Adaptation Syndrome (GAS) with three stages: alarm, resistance, and exhaustion (2). The fight-or-flight response usually characterizes the alarm stage.

Stress is a complex interaction of genetic, physiological, behavioral, and environmental components and impacts how the body reacts to diseases (3). In general, stress is linked with depression, anxiety, and neuroticism and negatively impacts the brain, its structure, and function, increasing the risk for dementia (4). It increases the risk of diseases and illnesses, such as cancer, HIV and cardiovascular disease (3).

There are three types of stress: acute stress, chronic stress, and posttraumatic stress disorder (long-term psychological symptoms following a traumatic event). Stressful events can be divided into two categories. Life events can be a relocation to a nursing home, death of a spouse or an illness, or extreme, a traumatic stressor such as a war or surviving holocaust. 

• Posttraumatic stress disorder is the answer to traumatic stressors. 
• Acute and chronic stress is a reaction to habitual life events. 
• When talking about stress, another term is also used: distress, or more specifically psychological distress, which describes more specifically a patient's discomfort related to illness or treatment (5).

Not all stress is detrimental: short-term stress can promote longevity by improving cellular response to this stress in a hormesis/hormetic response (hormetic stress) (6). Examples of hormetic stress may be exercises or dietary energy restriction (7).

Acute stress, as seen in hormetic stress, may not be so harmful to older persons. Working memory is negatively affected by stress in young adults. But stress does not have an impact on this cognitive function in older adults, suggesting that older people could be less sensitive to stress (8) . On the other hand, recall after interference was impaired in older, not young people (9) . Stress can harm the health, both psychological and physical, of older adults. 

Chronic stress has an impact on the immune functioning of older adults. When caring for a family member with dementia, older adults have a poorer immune response to vaccines, impaired control of latent viruses, produce more inflammatory mediators, and accelerate their cellular aging (10). Concretely, chronic stress down-regulates the immune response to influenza virus vaccination in adults caring for a spouse with progressive dementia (11) . 

Not only does physical health deteriorate: 30% of dementia caregivers also experienced a depressive disorder, compared to only 1% of the matched control group  (12) . 

Posttraumatic stress disorder has general psychological effects, physical effects in the form of excessive physiological reactivity, including the higher possibility of somatic manifestation of trauma-related symptoms (13).  

Can we know in advance how stress events impact older people? The best predictor of how one reacts to a traumatic event is their pre-trauma psychological functioning; when studying flood survivors, levels of depression, anxiety, and general distress before the flood accounted for 30% to 40% of the variance in symptom levels after the flood (14).

Distress increases the risk of several diseases: arthritis, cardiovascular disease, chronic obstructive pulmonary disease, and diabetes. This association was demonstrated in more than 16 thousand adults from the UK Household Longitudinal Study; the relationship between distress and incidence of those diseases was measured over the period of three years (15).

Every type of stress (acute, chronic, post-traumatic stress disorder, and distress) has a detrimental effect on health. There are ways to cope with the stress and prevent its impacts, such as mindfulness-based techniques, such as deep breathing or Jeffersons' “count to ten”, and other coping strategies.

Coping with stress with meditation and mindfulness

Meditation is a procedure using specific techniques, including muscle relaxation and “logic relaxation”, self-induced and using self-focus skill (16). This procedure  has a positive impact on longevity from a biological, clinical, and societal perspective - and we will also analyze the results of studies of this effect.

Meditation is, for the purpose of this article, simply a practice of emotional and attentional regulation. Mindfulness-based therapy, or mindfulness, in short, is a secular version of meditation and cultivates attentive presence in the process of being aware of thoughts and emotions. Kabat-Zinn defines mindfulness as "the awareness that arises from paying attention, on purpose, in the present moment and non-judgmentally" (17).

How can this practice help in counteracting the unfavorable effects of stress? Let's take a look at a study that compared six adult Buddhist meditators with more than 10,000 hours of practice to 79 older adults in the control group. Using magnetic resonance imaging and PET data, the study showed that gray matter volume and glucose metabolism was higher in meditators in several parts of the brain (cortex, insula, and temporoparietal junction). It is those parts of the brain that experienced the steepest age-related decline in the control group. It may mean that long-term meditation protects the brain from aging. 

In another study, 141 older adults completed training in Mindfulness-based stress reduction. Before undergoing the training, researchers evaluated the mood of participants, and compared this baseline with the results after the training. Anxiety and clinical depression decreased by more than 50% (18).

Another benefit of mindfulness training consists of improving attentional performance. After six months of training, participants displayed, when visually processing, neural changes (enhanced neural activation) and experienced behavioral improvement in their attentional performance. It suggests that mindfulness may improve neural processes that are subject to age-related deterioration (19).

There are other types of stress prevention and treatment. Social support can buffer specific stressors, such as bereavement, crime, or social network issues (20). Park-based leisure experience (spending time in nature) can positively influence stress, mood, and health (21).

In a nutshell, mindfulness practice brings many benefits:

• Protection of the brain from age-related decline
• Improvement of mood and battling anxiety and depression
• Improvement of cognitive functions, such as attention
  Conclusion
  

Conclusion

Stress in moderate and fast doses may be supporting longevity by providing beneficial, adaptive responses to stress. Long-term stress, on the contrary, has only a negative impact on both health and psychological condition. In older patients, stress is associated with increased depression, anxiety, deterioration of mood, and cognitive functions. Stress is also linked to numerous health issues. Mindfulness training, i. e. the attentive presence or a process of being aware of thoughts and emotions improves brain structure and its functions, mood, and cognitive functions.

References

1. Tan SY, Yip A. Hans Selye (1907-1982): Founder of the stress theory. Singapore Med J. 2018;59(4):170-171. doi:10.11622/smedj.2018043
2. Cunanan, A.J., DeWeese, B.H., Wagle, J.P. et al. The General Adaptation Syndrome: A Foundation for the Concept of Periodization. Sports Med 48, 787–797 (2018). https://doi.org/10.1007/s40279-017-0855-3
3. Baum A, Posluszny DM. Health psychology: mapping biobehavioral contributions to health and illness. Annu Rev Psychol. 1999;50:137-63. doi: 10.1146/annurev.psych.50.1.137. PMID: 10074676.
4. Chételat, Gaël & Lutz, Antoine & Arenaza-Urquijo, Eider & Collette, Fabienne & Klimecki, Olga & Marchant, Natalie. (2018). Why could meditation practice help promote mental health and well-being in aging?. Alzheimer's Research & Therapy. 10. 10.1186/s13195-018-0388-5.
5. Psychological distress: concept analysis, Sheila H. Ridner MSHSA MSN PhD ACNP-C, First published: 18 February 2004, https://doi.org/10.1046/j.1365-2648.2003.02938.x
6. Elissa S. Epel, Gordon J. Lithgow, Stress Biology and Aging Mechanisms: Toward Understanding the Deep Connection Between Adaptation to Stress and Longevity, The Journals of Gerontology: Series A, Volume 69, Issue Suppl_1, June 2014, Pages S10–S16, https://doi.org/10.1093/gerona/glu055
7. Mattson MP. Hormesis defined. Ageing Res Rev. 2008;7(1):1-7. doi:10.1016/j.arr.2007.08.007
8. Matias M. Pulopulos, Vanesa Hidalgo, Mercedes Almela, Sara Puig-Perez, Carolina Villada & Alicia Salvador (2015) Acute stress and working memory in older people, Stress, 18:2, 178-187, DOI: 10.3109/10253890.2015.1004538
9. Acute Stress Impairs Recall After Interference In Older People, But Not In Young People, Vanesa Hidalgo, Mercedes Almela, Carolina Villada, Alicia Salvador, DOI: 10.1016/j.yhbeh.2013.12.017
10. Gouin JP, Hantsoo L, Kiecolt-Glaser JK. Immune dysregulation and chronic stress among older adults: a review. Neuroimmunomodulation. 2008;15(4-6):251-9. doi: 10.1159/000156468. Epub 2008 Nov 26. PMID: 19047802; PMCID: PMC2676338.
11. Kiecolt-Glaser JK, Glaser R, Gravenstein S, Malarkey WB, Sheridan J. Chronic stress alters the immune response to influenza virus vaccine in older adults. Proc Natl Acad Sci U S A. 1996 Apr 2;93(7):3043-7. doi: 10.1073/pnas.93.7.3043. PMID: 8610165; PMCID: PMC39758.
    12-Dura JR, Stukenberg KW, Kiecolt-Glaser JK. Chronic stress and depressive disorders in older adults. J Abnorm Psychol. 1990 Aug;99(3):284-90. doi: 10.1037//0021-843x.99.3.284. PMID: 2212279.

13. Averill PM, Beck JG. Posttraumatic stress disorder in older adults: a conceptual review. J Anxiety Disord. 2000 Mar-Apr;14(2):133-56. doi: 10.1016/s0887-6185(99)00045-6. PMID: 10864382.

14. Phifer JF. Psychological distress and somatic symptoms after natural disaster: differential vulnerability among older adults. Psychol Aging. 1990 Sep;5(3):412-20. doi: 10.1037//0882-7974.5.3.412. PMID: 2242245.

15. The effects of psychological distress and its interaction with socioeconomic position on risk of developing four chronic diseases, Kyle J.J. McLachlana,b and Catharine R. Galec,d,⁎

16. Roberto Cardoso, Eduardo de Souza, Luiz Camano, José Roberto Leite, Meditation in health: an operational definition,Brain Research Protocols, Volume 14, Issue 1, 2004, Pages 58-60, ISSN 1385-299X, https://doi.org/10.1016/j.brainresprot.2004.09.002.

17. Jon Kabat-Zinn: Defining Mindfulness: https://www.mindful.org/jon-kabat-zinn-defining-mindfulness/

18. Mindfulness-Based Stress Reduction: Effect on Emotional Distress in Older Adults, Laura A. Young, MD, PhD1 and Michael J. Baime, MD

19. Isbel B, Weber J, Lagopoulos J, Stefanidis K, Anderson H, Summers MJ. Neural changes in early visual processing after 6 months of mindfulness training in older adults. Sci Rep. 2020 Dec 3;10(1):21163. doi: 10.1038/s41598-020-78343-w. PMID: 33273707; PMCID: PMC7713117.

20. Neal Krause, Social Support, Stress, and Well-Being Among Older Adults, Journal of Gerontology, Volume 41, Issue 4, July 1986, Pages 512–519, https://doi.org/10.1093/geronj/41.4.512

21. Elizabeth Orsega-Smith, Andrew J. Mowen, Laura L. Payne & Geoffrey Godbey (2004) The Interaction of Stress and Park Use on Psycho-physiological Health in Older Adults, Journal of Leisure Research, 36:2, 232-256, DOI: 10.1080/00222216.2004.11950021