Stress management is an underrated form of preventive care

During my junior year of high school and sophomore year of college, I endured two severe concussions that affected my mental health. Concussions are known to produce abrupt changes in a person’s cognitive, physical, and emotional state. My case was no exception. I have struggled over the years to find relief from my lingering symptoms as side effects from common medical treatments and chronic pain sacrificed my emotional wellbeing. With the help of my healthcare team, I was motivated to remain persistent and find a routine to best manage my condition as well as promote the importance of stress management at the University of South Carolina.

For the past four years, I have worked with the University of South Carolina's (UofSC) Student Health Services as a Changing Carolina Peer Leader (CCPL). CCPL is a nationally recognized peer education organization that collaborates with faculty advisors from the student health center to facilitate health programming highlighting holistic student wellbeing in areas of general, sexual, and mental health. From my personal bouts with mental health, I joined my freshman year to specialize in CCPL's Mental Health Special Interest Group to address mental health concerns on campus and implement events geared toward the student body.

During my sophomore year, I was elected Co-Chairman of the Mental Health Special Interest Group where I led our efforts in organizing creative events and initiatives focused on interacting with students to improve student mental health behaviors and bring awareness to mental health topics and their associated on-campus resources. These efforts began in our weekly meetings where I prioritized educating our members on various coping mechanisms to manage our mental wellbeing. Some of these techniques included practicing breathing exercises or mindful hand massages to ease anxious feelings before an exam, progressive muscle relaxation to calm the body before sleep, and five minute journaling prompts to keep track of emotions. After utilizing different coping mechanisms ourselves, we successfully added realistic tips and hands-on activities relevant to our target student populations during campus events and presentations. Some of the stress related topics we touched upon that year included mindfulness, body positivity, resilience, and a Tackle Stress Tuesday series.

While Co-Chairman, I also jumpstarted the project “I Feel UofSC”. I Feel UofSC is a mental health campaign that acts as a prevention platform by educating students about identifying and classifying feelings and emotions. By integrating these skills, students not only learn to recognize and process their feelings in a healthy way but also normalize conversations around mental health. Overcoming these barriers promotes help-seeking as becoming aware of these personal cues can serve as a guideline for knowing when to reach out for help from peers, family, or mental health professionals.

As I move through different positions as an involved peer in the Mental Health Special Interest Group and an undergraduate student myself, it is well known that stress is one of the most common burdens that college students face. This realization is also present in our campus’s National College Health Assessment of Spring 2019 where stress was listed as the number one problem that hinders a student’s academic success at our university. With this in mind, other peers and I were trained by our group's advisor, the campus' Stress Management Program Coordinator, to facilitate a “How to Quiet a Racing Mind” presentation to freshmen enrolled in our University 101 program during the 2019 and 2020 fall semesters. By being trained in this presentation, I have had the opportunity to help combat this issue by educating students about the researched benefits of practicing mindfulness, understanding self-care, and utilizing on-campus resources to manage this prevalent obstacle.

Students learning to manage stress not only benefits their academic success but can serve as a way to contribute to their overall health and wellbeing well after graduation. For instance, in BIOL 460: Advanced Human Physiology, we discussed the importance hormone regulation has on maintaining a person’s immune system. In regard to stress, the adrenal glands rapidly release the hormones norepinephrine and epinephrine to positively provide us the heightened functions necessary to remove ourselves from unwanted situations or even motivate us to achieve a goal. However, stress becomes harmful to our health when it is present for long periods of time. Although in our minds we are aware of the difference in risks associated between a life or death situation, such as escaping a building on fire, and an experience of prolonged distress, such as financial instability, our body utilizes the same mechanisms in addressing each situation. This inability to distinguish true threats from others that stem from overexertion, uncertainty, or anxiety, enables the body to experience the effects of chronic stress which affects the wellbeing of people all ages.

Specifically, during exposure to chronic stress, hyper-secretion of adrenocorticotropic hormone from the anterior pituitary gland releases glucocorticoids from the region of the adrenal gland known as the adrenal cortex. Glucocorticoids release corticoid steroids that primarily conserve glucose for needed energy expenditures, but they also are useful for suppressing the immune system to combat an inflammatory responses from arthritis to interactions with poison ivy. While corticoid steroids are beneficial short term, chronic stress constantly activates the hormone responsible for its secretion and its effect on the immune system will eventually lead to atrophy of lymph glands and tissues necessary for a strong immune system. From the constant suppression of the immune system, a person will not only get sick more often which will contribute to more stress later on, but they also increase their risk of cancer. In addition, cells eventually become desensitized to corticoid steroids causing inflammation in addition to a compromised immune system. This long-term inflammation can either damage blood vessels necessary for circulation or suppress insulin signaling pathways that promote insulin resistance and in turn encourage the development of diabetes.

Understanding stress on both a personal and physiological level will help me provide well rounded patient care as a physician assistant. There is no doubt that injuries and illnesses present challenges that provoke high levels of stress in an individual. However, my personal experiences from my concussions and involvement with CCPL have shown me that there are several factors that affect a patient’s health beyond the initial diagnosis that may go unrecognized but are worth noting during appointments to develop effective treatment plans. For instance, if a patient comes into a postoperative appointment for their repaired ACL in the knee, it is just as important to address concerns with the surgery itself as it is to recognize stressors associated with the condition that are not uncovered through a physical examination or medical test. These struggles may include a patient's frustration with not being able to complete small tasks to take care of themselves on their own at home, having to rely on others to transport them to and from work, or emotional lulls from feeling restricted from their normal activities.

Circumstances such as these go beyond the injury itself, putting a patient at risk of prolonged stress that can negatively impact their recovery. By acknowledging the damaging effects chronic stress has on the body’s hormone regulation and immune system, I can work with patients early in treatment to navigate applicable stress management techniques. Incorporating stress management into a patient’s treatment plan will not only allow them to better learn how to manage their symptoms but also avoid unnecessary exposure to chronic stress that may contribute to a prolonged recovery and development of additional health concerns down the road.

Changing Carolina Peer Leader: Mental Health Special Interest Group

The collection of photos are from my involvement as a Changing Carolina Peer Leader in the Mental Health Special Interest Group. As a peer leader since January 2018, I have participated in multiple on-campus events and campaigns covering campus resources, awareness, and education on a range of mental health topics to encourage healthy help seeking and coping behaviors among UofSC students.

Events Listed Above: Stress Management Tabling (Spring 2019), National Suicide Prevention Day (Fall 2019), National Eating Disorder Association (NEDA) Walk (Spring 2019), World Mental Health Day (Fall 2018), I Feel UofSC Spotify account, & Suicide Prevention Week Instagram post (Fall 2020).

BIOL 460: Advanced Human Physiology

The figure above is an excerpt of a PowerPoint slide given during one of my BIOL 460 lectures on the endocrine system during the Fall 2020 semester. Though my understanding of glucocorticoid secretion in the adrenal cortex of the human body, I acknowledge how long term stress impacts a person’s health.