May 3 | Psychiatric News


A Pandemic Year of Chronic Stress: Robert Sapolsky Reviews Science Behind Chronic Stress and What It Is Doing to Us

By Mark Moran

Fear, uncertainty, ambiguity, unpredictability, lack of autonomous control, and deprivation of social contact—the past pandemic year has been a perfect stew activating the hormonal and neurobiological mediators of chronic stress, said Robert Sapolsky, Ph.D., in a keynote address at APA’s online 2021 Annual Meeting.

“There is a beautiful and large literature by pioneers in [the field of psychological stress] going back decades showing precisely what the building blocks for psychological stress are,” Sapolsky said. “For the same external reality, you will feel more subjectively stressed, you are more likely to activate a stress response, and you are at more risk for stress-related disease if you feel like you have no outlet for the frustrations [you are experiencing]. Moreover, you will be more at risk if this circumstance is occurring [in a situation] where you feel like you have no control, no predictability, no information about how bad it will be. Additionally, psychological stress is built on a subjective perception that the external reality represents things getting worse. Finally, the absence of social support is perhaps the most central feature of all.”

Sound familiar? It’s the nearly universal experience of the human race in the face of the global COVID-19 pandemic, Sapolsky said. He is the John A. and Cynthia Fry Gunn Professor of Neurology and Neurosurgery at Stanford University. His 2017 book, Behave: The Biology of Humans at Our Best and Our Worst, won the Phi Beta Kappa Award for Science and was listed among Best Books of the Year by The Washington Post, The New York Times, and The Wall Street Journal.

He described laboratory experiments that have highlighted the distinction between risk—to which people have a wide variety of responses—and ambiguity, underscoring the special disdain humans have for uncertainty. “People across the board hate ambiguity,” Sapolsky said. “When you perform neuroimaging [of peoples’ brains] when they are dealing with ambiguity, ambiguity is preferentially lighting up the amygdala and insulate cortex, areas having to do with negative affect, fear, anxiety, disgust. We don’t like ambiguity.

“What we have been facing this year is ambiguity, over and over,” he said. “How bad is this? How many are going to die? How long until there is a vaccine? Do you have immunity after the vaccine? Can you get infected again? We have spent the past year with the best of experts telling us, ‘It’s not clear.’”

Most consequential of all has been the prohibition on social connectedness, and Sapolsky showed images of COVID-19 youth parties and protests at state capitols against mask wearing and social distancing. These are evocative (horrendously, in this case, he said) of the human resistance to not being allowed to socialize. “We have been asked not to assemble, not to congregate, not to hang out and hook up, not to be social primates,” he said. “One of the most defining things about us being a primate is our profound sociality. This profoundly primatological trait of ours is what we have been asked to give up this year.”

Sapolsky took his audience through a tour of 40 years of research exploring the relationship between chronic stress, depression, anxiety, and other mental illnesses. Most recently, this research has shown in laboratory studies that chronic stress can blunt emotional empathy.

He closed his remarks with a reflection on this year’s Annual Meeting theme, “Finding Equity Through Advances in Mind and Brain in Unsettled Times.”

“An entire literature has shown that unequal societies make for unhealthy ones, more violent ones, and that unequal societies are ones that are less kind,” Sapolsky said. “We have seen the last year expanding our inequality in every possible way—who dies from this virus, who is shot unarmed by the police, who makes a fortune off of others during this pandemic. This has been a year of bringing out the worst of some of our behaviors.

“I think the fact that it is also brought out some of the most caring and some of the most extraordinarily self-sacrificial, altruistic behaviors is a mark of just how good we have been in the face of one of the worst types of stress you can imagine—and how tough it is going to be to lessen that inequity.” ■