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Stress and the COVID-19 Pandemic: Paying Attention to Your Cortisol Level in Challenging Times

The COVID-19 pandemic not only worries us about our health but our very survival as a society. We all can identify with the emotional, physical and cognitive impact of stress on our bodies and minds. In stressful situations we struggle to concentrate, remember and learn. We are more prone to headaches, nausea and contracting illnesses. We are also more likely to experience thoughts and behaviors consistent with mental health conditions such as anxiety and depression. In this article I present valuable information about cortisol and your body, and then offer some practical suggestions to help you stay in control of your body’s stress reaction.

Sam Goldstein, PhD

Sam Goldstein, PhD

What exactly is the underlying biological, neurological and physiological response in our bodies that is not only a consequence of stress but in and of itself fuels further stress related challenges. The culprit is a steroid hormone known as cortisol. When used as a medication it is known as hydrocortisone. Hydrocortisone as a topical agent can reduce swelling, itching and redness. However, within our body cortisol has far more reaching effects. Cortisol is produced in many animals, primarily in the adrenal glands. It functions to increase blood sugar, to suppress the immune system and aid in the metabolism of fat, protein and carbohydrates in our bodies. It also decreases bone formation. Think of cortisol as nature’s built in alarm system. It is your body’s main stress hormone. Once released into your bloodstream, it interacts with multiple systems in the brain and body, impacting mood, motivation, fear and learning. Cortisol can be found in your saliva and hair. Cortisol is perhaps best known as fueling your body’s “fight-or-flight” system, such that in a crisis you are more likely to survive. It regulates your blood pressure. Cortisol also controls your sleep wake cycle and under times of stress boosts your energy.

We know that moderately elevated cortisol is a good thing in times of stress. However, we also know that prolonged and significant elevations of cortisol in the body, as the result of ongoing stressful experiences, turns an important protective system into a powerful, adverse force capable of causing a broad range of emotional, cognitive, behavioral and physical problems.

Over the past forty years research studies across the life span from infancy to geriatrics have demonstrated the adverse impact of extended and highly elevated cortisol levels. Elevated cortisol is found in infants living in chaotic environments. Not only that, extended levels of elevated cortisol in young children has been associated with delays in the development of abilities such as executive functioning. This has also been found true in adult’s ability to effectively problem solve. Studies completed well before the current COVID-19 pandemic have demonstrated that average levels of cortisol across the life span are higher today than ever before. In light of the current pandemic it would not be unexpected that all of our cortisol levels at this time are significantly elevated. Let’s briefly discuss more of the science.

Infants exposed to postnatal maternal depression have been found to experience higher levels of cortisol as adolescents. This suggests that early adverse experiences might even alter later cortisol and related steroid levels. Maternal depression can be added risk for depression in children. Alterations in cortisol level long term might be the link between early life events and later mental health challenges. A number of researchers have demonstrated increased cortisol levels during the day among toddlers in childcare, in particular for children with long hours in childcare but not children at home.

It has also been demonstrated that memory tends to be better for emotionally charged than for neutral information. Evidence from human and animal studies finds that when low doses of cortisol are administered in research study and participants are exposed to pictures designed to produce varying levels of emotional arousal, incidental memory for these pictures, particularly those representing significant emotional challenges, are enhanced.

In an extensive review of cortisol, stress exposure and mental health in humans in the Journal of Psychoendocrinology in 2012, researchers Sabine, Staufenbiel and colleagues in the Netherlands concluded that exposure to chronic stress was significantly demonstrated in hair cortisol levels. The authors concluded after this extensive review that the dysregulation of the hypothalamic-pituitary adrenal axis as it relates to cortisol in the development and/or maintenance of psychopathology may be subtle but clearly present in chronically stressed populations. The combination of endocrine, genetic and psychological paradigms is a pre-requisite to an integrated approach that aims to understand the specific role cortisol plays in shaping physical functioning.

Researchers have demonstrated that in an analysis of young children that preschoolers exposed to high levels of concurrent maternal stress had elevated levels of cortisol. These children also had a history of high maternal stress exposure in infancy. Finally, preschoolers with high levels of cortisol exhibited greater mental health symptoms in first grade. Elevated levels of cortisol have also been found to contribute to the diagnosis and severity of late life Generalized Anxiety Disorder.

The current levels of social distancing, staying at home and even quarantine also serves to increase stress levels. Being deprived of interactions with others is a significant risk factor to develop mental health problems at all ages. For example, newborns of all species deprived of a consistent caretaker with whom they bond develop marasmus or failure to thrive. Further, a recent research trend is the investigation of the comparative effects of social isolation and loneliness in older adults. Depression and cardiovascular health are the most often researched outcomes, followed by well-being. Emilie Courtin and Martin Knapp in the Journal Health and Social Care in 2017 found a consistent trend in research demonstrating the detrimental effect of isolation or loneliness on health. It is likely that these mental health problems are in part mediated by elevated cortisol.

Moderating Your Cortisol Levels

There are no specific medication treatments to lower cortisol level nor are there any medications one can take in a preventive way to reduce the likelihood of seriously elevated cortisol levels in stressful situations. However, the following eleven suggestions may help moderate your cortisol levels:

  1. Manage your stress. Be sensitive to your body. Get enough sleep. Eat well. Stick to a routine each day.
  2. Manage your diet. Some foods may be effective in helping control cortisol levels. These include dark chocolates, bananas and pears, black or green tea, yogurt and other probiotics. Drinking plenty of water avoids dehydration which may also help lower cortisol levels.
  3. Stay calm. Spend some time each day in a relaxation activity such as meditation, mindful thinking or even a simple breathing exercise. Take a hot bath or sit in a hot tub if you are fortunate to own one.
  4. Engage in a hobby. One study found that gardening led to decreased levels of cortisol.
  5. Unwind. Spend time each evening unwinding before bed. Read or play solitaire. Don’t watch the news before bed!
  6. Stay connected. Seek humor. Have fun and enjoy the company of others even if it is remotely through social media. Laughter releases a cascade of protective hormones. Share a favorite recipe or a post a picture from a past trip.
  7. Exercise. Aerobic exercises that increase your heart rate for at least twenty minutes to a half hour per day are beneficial. My colleague, Dr. John Ratey, has well demonstrated the benefits of aerobic exercise in his book Spark.
  8. Watch what you drink. Avoid caffeine late in the day. Limit your alcohol consumption.
  9. Maintain a bedtime routine. Studies have demonstrated that cortisol levels rise after a disagreement with your spouse before bedtime. As noted, children living in homes where there is regular conflict at any time of the day demonstrate high cortisol levels.
  10. Spend time with your pets or get a pet. One study measuring cortisol level in children undergoing medical procedures found that the presence of a canine lowered children’s cortisol levels. Another study found that contact with a canine was actually more beneficial for reducing cortisol levels in a stressful situation than a supportive parent or friend.
  11. Consider supplements. Supplements such as fish oil and the Asian herb known as ashwheandha for example, have been demonstrated to reduce cortisol level in your bloodstream.

In these unprecedented and broadly stressful times we should all pay attention to our stress and cortisol levels. I expect that that psychological studies over the next five years examining the effects of the COVID-19 pandemic will demonstrate the significant impact our experiences have on our minds and bodies for many years to come. I urge you regardless of your age to be proactive. Pay attention to your mind and body. Pay attention to your cortisol level.

This article is reprinted with permission. The original article, published on April 7th, 2020, can be viewed here.

Sam Goldstein, PhD, is a developmental neuropsychologist. He is Director of the Neurology, Learning and Behavior Center in Salt Lake City, Utah and an Adjunct Assistant Professor in the University of Utah Medical School. He is Editor in Chief of the Journal of Attention Disorders and sits on six Editorial Boards. He has authored over fifty texts, dozens of book chapters, two dozen peer reviewed articles and seven tests. He also sits on the Board of Directors for the EPIC Players Inclusion Company, a New York City based, neuro-inclusive theatre company dedicated to providing professional performance opportunities to individuals living with developmental disabilities.

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