Kindness and connection: the natural antidote to stress and a public health intervention

By David Fryburg, MD

It’s well-known that stress causes and/or exacerbates many diseases, particularly common problems like cardiovascular disease, asthma, and depression. In the context of a growing and aging population and high health care costs, prevention of these diseases is a necessity. The central thesis of this blog is that we can enhance public health and happiness and simultaneously reduce health care expenditures by attenuating stress on a population scale through kindness and social connection.  

The term “stress” as used here refers to the psychological and biological responses to stressors like financial, health, family, and work-related difficulties (whether actual or simply perceived). These responses include: 1. activation of inflammation; 2. increase in sympathetic nervous system tone; and 3. Impaired cognitive function, i.e., affecting how people think and make decisions.  

These interact to create disease depending on the person’s genetics and physiology (e.g., predisposed to hypertension), environment (e.g., allergens or toxins that increase risk of asthma), and resources (e.g., access to care, health literacy).

The original “fight or flight” description of the stress response centers on sympathetic nervous system activation that accompanies the acute response to a threat such as a predator. When these responses are elicited chronically, over time they can lead to disease, including high blood pressure, impaired immunocompetence, diminished wound healing, and accelerated aging.

Figure 1: People experience a differential mixture of stressors at any given time. Depending on their intensity and duration, their own environment, genetics, and resources (including how they absorb or “buffer” stressors), different medical (and non-medical) problems can manifest. One particularly important effect of stress is on cognitive function—how people think. It influences the choices that they make. Together, these effects can lower the quality of life and add more stress in a vicious cycle. Kindness and connection dampen this cycle.
© David Fryburg 2022

Stress does something else: it affects cognitive function, including paying attention to and learning new information (“working memory”), making decisions, being creative, and solving problems. It increases risk taking. And as stress becomes unbearable, people reach for alcohol and other drugs to quench the pain of existence. Decreased cognitive function has significant implications for success at school, work, and for the choices that people make in daily life that can contribute to disease. The effects of stress are summarized in the accompanying figure [1].

In medicine, particularly in specialty care, we tend to think about one problem at a time. However, most problems are interrelated. For example, suppose someone is subjected to bullying or discrimination. Those stressors can elicit anxiety and depression. The victim may develop a sleep disorder, which in turn, can cause additional problems like weight gain and high blood pressure. Complications from the initial stressor can lead to more stress and isolation, bad choices, and create a vicious cycle (figure).

There is no doubt that while providers recognize that stress from social problems is a major culprit promulgating disease, it may seem daunting to solve these (like financial issues or work-related stress) in a 15-20 minute visit. Medicine is not equipped to do so. The provider toolbox largely contains pharmacological agents or procedures. Society at large is not ready to do so either, as gaining agreement in a polarized environment is daunting.

The next best solution is to help people buffer their stressors, i.e., decrease the degree to which the stress response is elicited. Meditation and exercise are very good practices to do so and are discussed elsewhere.

A third approach, and this blog’s focus, is social connection. It has been long-­known that positive interpersonal connection is critical to overall health, particularly mental health. Support for this comes from a variety of perspectives, including how loneliness markedly increases mortality or that the longevity of people in Blue Zones (areas of the world in which people live significantly longer) can be traced in part to good relationships.

On the surface, promoting social connection is also challenging. One simple and easily executable approach to kickstart connection is the use of kindness media. This media type depicts people helping or showing compassion for another living being. In multiple academic and field studies, within two minutes of exposure kindness media (also known as prosocial media) uplifts viewers, and fosters happiness, calm, and gratitude, while decreasing irritation, stress, anxiety, and sadness. It increases generosity, the willingness to make a donation or help someone else.

Another aspect of kindness media is that, after watching it, people feel connected to others, a transcendent state in which the self-other gap decreases. This decrease extends to members of other races or cultures and has been observed by multiple investigators, which is very relevant to the need for greater equity and inclusion.

One of the benefits of kindness media is that it is passive—no training is needed and requires only a small amount of viewing time. We have studied the effects of kindness media in healthcare. In this and other studies, when streamed into waiting rooms and hallways, it increases positive emotions and decreases negative emotions (as above), as well as positively affects the way people treat each other.

It needs to be pointed out that negative media, such as cable news, does exactly the opposite—it increases anxiety and stress and fear causing anxiety to spillover onto their own lives (i.e., mood congruence).

It is possible therefore to imagine how kindness media can be a catalyst for a wider effort. Consider placing kindness media in a variety of settings such that many people are reminded on a regular basis about their humanity. Couple that with foundation and government sponsored events to promote community. Everything from incorporating seniors into events, promoting volunteerism (such as tutoring in schools), community celebrations, etc. Regularly provide and promote exercise and mediation programs.

It is quite possible to induce a shift in the stress burden of the population. And as we do so, quality of life, along with health, will rise. More details can be found here.

Article Details
Kindness as a Stress Reduction–Health Promotion Intervention: A Review of the Psychobiology of Caring
David A. Fryburg, MD
First published online January 29, 2021
DOI: 10.1177/1559827620988268
American Journal of Lifestyle Medicine

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