We initially spoke with Dr. Drew Ramsey last fall for our October trend report, “Health & Happiness: Hand in Hand” (see Q&A here). We checked in again with the Columbia University assistant clinical professor of psychiatry while researching one of our 10 Trends for 2013, The Super Stress Era. As stressors big and small mount and multiply, stress is getting more widely recognized as both a serious medical concern and a rising cost issue. Ramsey’s clinical work focuses on the treatment of depression and anxiety with a combination of psychotherapy, lifestyle modification and psychopharmacology. Co-author of The Happiness Diet, he is one of psychiatry’s leading proponents of modulating diet to help balance mood, sharpen brain function and improve mental health. We discussed why stress is on the rise today, the implications for our health, and how brands, governments and employers can intervene.

Do you think people are more stressed now than they were five years ago?

Yes, for sure. Everyone is more stressed as the world is struggling economically. There are a lot of changes afoot in the world politically. And on top of that, I think the modern world is much more stressful than it’s ever been. Never before have we had to keep track of so many things. Stress is perceived and responded to by the brain, and if you think about what your brain is asked to do in the modern world, it’s really quite phenomenal. Just think about the advent of the smartphone—it’s incredibly convenient, but at the same time, if you don’t respond to an email within a few minutes, that produces anxiety and stress. There’s very little downtime in the modern world.

What is the impact of this type of stress on health?

Stress is funny when it comes to health. Some stress is good for your health. Exercising is stressful for the body—it causes you to release a burst of free radicals, but as with anything, too much or excess is detrimental over time. So it’s important to differentiate between acute time-limited stressors and chronic stressors. I think there has been an increase in chronic stress. When you have chronic stress, you have increased inflammation throughout the body, and this is now linked to heart disease, diabetes, depression. All of those big diseases that cause pain, what we call disease burden.

Do you see stress as a global health concern?

For sure, because as we develop into more urban living, there tends to be both more opportunity and more stress. Just think about the subtle stressors: background noise of traffic, the rushing and competing with other people for limited resources. This is the urban existence, and it is stressful. That’s why there’s such a thriving wellness industry within urban environments. You go to a rural environment, you don’t find a lot of yoga studios, because the level of stress is just different.

From my standpoint as a psychiatrist, the other thing is that your brain responds to stress by releasing a variety of hormones that actually change the structure of your brain. For example, the hippocampus, which is very important for cognitive function, is actually changed by stress. And this is why I think addressing stress is so important, that a chronically stressed brain doesn’t perform as well. You end up in this downward spiral. Increased stressors or chronic stress decreases your brain’s ability to deal with stress. This then feeds upon itself.

I see this all the time in clinical practice, where you have somebody that’s stressed out and they’re saying, “My memory’s not as good, I can’t think as clearly, I feel more irritable, I know I’m not performing at my best.” And that makes the stress worse. You can’t complete your work, and you’re not as present in your relationships.

So much of chronic stress seems to be tied to work. Do you think companies should be doing more to help reduce stress for employees?

Since companies rely on people working optimally, there is a role for occupational health programs, and there’s a payoff. If you look at companies that incorporate wellness programs and do it well, you find employees that function better, have better work performance and are also happier. So there is an important role. A great example is Google. Google has a huge wellness program. They have massage therapists on site, they take care of their employees. And as a consequence, they get good performance.

Should governments be doing more to help reduce stress?

That’s a great question. I think about that one a lot because I’m not sure about my political stance on that. If the role of government is to produce healthy, happy citizens, public health messages around the idea of stress are very important. Simple things like, for example, the notion that good sleep, that exercise, that eating well, that spending quality time relaxing are important not only to your health but to a nation’s health. I think these are very relevant, and one could argue an important part of a country’s public health spending or public health messaging.

We often see public health messages that are downstream. For example, we hear a lot of public health messaging about drinking. But we don’t hear as much about why people drink. In general, one of the ways people tend to deal with stress is increased alcohol consumption.

Do you think brands or marketers have a role to play in reducing stress?

People are desperate to reduce their stress and always looking for tools that will help them do that in time-efficient ways. So if you have a product that can help people reduce their stress and increase the quality of their life, people will become very loyal to that and are certainly willing to spend money for it.

Do you see stress increasing or decreasing in the next five years?

Stress is increasing for sure, there’s no doubt about it. Stress is increasing because the demands continue to increase from increased media exposure. That’s something we haven’t talked much about, but now we get minute-by-minute updates of every bad thing that happens around the world. That’s never happened before, so it’s not just enough to know what’s going on in your local community, we now have an expectation that people have a global awareness. That’s only going to increase. I think social media increases stress because there is a time demand. Twitter is a great example.

Human beings feed on information. We love information, we love to learn, but when you consider the bandwidth that’s now required to take in the amount of information out there. I would argue that social media actually can increase stress. It’s like a blessing and a curse. You can get more done than ever before, but that also means suddenly you’re required to do more than ever before. If I just think about my day-to-day … today I’ve seen my clinical patients. I’ve negotiated contracts. I have had conference calls with people around the country. I’ve probably sent and received over 100 emails. I’ve sent five or six tweets. I’ve posted to Facebook. I’ve edited some blogs. I mean, it’s a rich and full and exciting life, but at the same time, it’s a lot of stress.

What do you think is absolutely necessary to prevent stress from becoming an even bigger global epidemic?

This is where the individual really has to take ahold of his or her own life. You can have a very rich and full and exhilarating life, and have great stress management. Most people know the pillars of good stress management, but a lot of people struggle to employ them. Exercise is certainly the No. 1 tool to battle stress. We know that exercise is an excellent intervention for feeling worried and anxious, in part because it takes you out of your head. If you’re on the court playing basketball or pushing yourself in the gym, you get your mind off things, you allow yourself to kind of rest.

I know that diet is very important and that poorly nourished brains tend to have increased stress responses. Diets that consist of more highly processed foods and more sugars tend to increase stress responses. Good sleep is absolutely fundamental to battling stress. In fact, there’s nothing worse than poor sleep because you start the day off with a strike against you because you are fatigued. It’s one of the reasons that exercise also helps—people get a little bit more energy and enthusiasm and confidence, and they also sleep better.

I would argue other things that are vital for stress are addressing any underlying mental health issues. Being depressed is absolutely horrible for your brain. We have lots and lots of good evidence-based treatments, but we know 60–80 percent of people that have mental health problems don’t seek treatment. I would say another is learning to prioritize and to say no. It’s something that’s very hard in the modern world, and again, there’s this tension—there’s never been more opportunity in terms of connecting with people around the globe, and that’s exciting. But it’s also a potential hazard that easily could get overwhelming.

Do you think there’s a big difference in the type of stress that people in established markets experience versus those in developing markets, or are they starting to converge?

I would argue that the challenge in an established market like New York is for the individual. The challenge there is how to offer a unique product for the individual on how to incorporate strategies that reduce stress. I think in developing markets there are still great opportunities to help people focus on wellness and to establish brands that people associate with stress reduction. So I see them as a little different. I think over time they will come together.

There are also probably significant cultural differences in how people deal with stress. For example, more traditional cultures tend to focus more on family and extended family as a source of stress reduction, as opposed to more fragmented families like we see in the developed world. So I think it’s something where there’s tremendous opportunity, but there are real differences in how people think about stress. In America, an elliptical trainer is a good way to spend an hour a day. I would say in Pakistan, visiting your family and having a meal is probably seen as a calming and stress-reducing strategy.

Is there anything else you’d like to add before we close?

It’s clear that stress changes the brain; it challenges the brain. We know that chronic stressors structurally change the brain for the worse, that brain cells actually aren’t as healthy. And it does perpetuate itself. The quality of work decreases. The quality of sleep decreases. Your ability to engage in stress-reducing activities like going out to dinner and having a nice time gets completely derailed, because you’re worried. We’ve all been out on that date where you can’t stop looking at your email because you’ve got something you’re worried about at work. So instead of having a nice time and relaxing, that opportunity is lost, and you end the evening just as stressed as you were in the beginning, even though this was supposed to be fun and relaxing.