A Blueprint for Managing Toxic Stress

Are you sad, worried or stressed? If you answered yes to any of the above, please know you are not alone. In 2021, four in 10 adults worldwide said they experienced a lot of worry (42%) or stress (41%), and more than one in four experienced sadness (28%) according to a Gallup survey.

Women are having the hardest time

In 2021, they were more stressed, worried, and sad than they were in 2020 — or at any point in the past decade. Stress and worry each increased by three percentage points within the span of a year, while sadness notably rose by six percentage points according to the Hologic Global Women’s Health Index.

What’s going on?

Women, particularly mothers, are still more likely than men to manage a more complex set of responsibilities on a daily basis — an often-unpredictable combination of unpaid domestic chores and paid professional work. So much is expected of women and this invisible labor takes an emotional toll.

Women have disproportionately shouldered the emotional burden of the pandemic as many families faced job insecurity, unstable housing, and interruptions to medical and childcare services.

The pandemic is not entirely to blame for the uptick in negative emotions. The negative trajectory has been trending for over a decade.

The mental and physical consequences of toxic stress

Living in a chronic fight or flight takes a toll. Ongoing stress can lead to or aggravate insomnia, family conflict, depression and anxiety. It is also linked with physical conditions such as hypertension, heart disease, obesity, and diabetes.

What can we do?

I have written a great deal in the past about individual strategies to boost positive emotions and combat stress. Spending time in nature, prioritizing sleep, eating a healthy diet, and building more movement into everyday life are all data-driven strategies to improve mental health. However, individual interventions are not enough.

If we want to tackle toxic stress, we need to zoom out and consider the bigger picture and zoom in to get to the root of the problem. Reducing stress levels is up to us as a society as a whole, not the responsibility of a single person. As Wharton Professor Adam Grant observed, “Burnout is not a problem in your head; it’s a problem in your circumstances.”

Grant suggests utilizing the Demand-Control-Support model to help manage toxic stress.


Make structural changes that lighten the load. If you are an employer, encourage breaks, honor downtime, weekends and family time, and respect work/life boundaries. Create Zoom-free days if your company is still working from home. Zoom fatigue is worse for women and can lead to “mirror anxiety.”


When you can’t eliminate demands, you can at least give people the autonomy and skills they need to handle them. If possible, allow for flexibility. Encourage personal goal setting and the pursuit of individual interests. A Harvard Business School study found that engaging in learning activities can buffer workers from detrimental effects of stress including negative emotions and burnout.


Cultivate a culture that makes it easy to request and receive help. As Dr. Elizabeth Fitelson, director of the women’s program in Columbia University’s psychiatry department, observed, “Focusing on improving the social supports for basic needs would have a far greater intervention than any specific mental health intervention.”

Other tools

Screening and access to treatment are essential tools to combat the extraordinary stress levels people are facing. A panel of experts now recommends doctors screen all patients under age 65 for anxiety. The intention is to help prevent mental health disorders from going undetected and untreated for years or even decades.

Bottom Line: Individual interventions can be helpful but culture and community are essential for building resilience and managing stress.

I wish you all the best,

Dr. Samantha Boardman