Pillar Updates: Stress Management and Social Connection 

ACLM leadership, on a regular basis, reviews ACLM’s recommendations, including pillar definitions and titles, as an important and necessary step that allows for the consideration of new perspectives and treatments that become part of established medical practice. 

While today’s medicine is largely focused on pills and procedures, lifestyle medicine, by contrast, is an evidence-based specialty that empowers patients to exercise their internal locus of control through adoption of or engagement in lifestyle medicine’s six pillars: a whole food, plant-predominant eating pattern, regular physical activity, restorative sleep, stress management, positive social connection, and the avoidance of risky substances. These lifestyle behaviors are what evidence shows as most vital to achieving optimal health and well-being.  The six pillars of lifestyle medicine serve as the evidence-base for a whole-person approach to treating the root causes of chronic diseases, including, but not limited to, cardiovascular disease, type 2 diabetes and obesity. 

Three years ago, a group of ACLM leaders formed a task force to develop descriptions for each of these six pillars. Given the ever-evolving nature of the scientific database, ACLM leadership, on a regular basis, reviews ACLM’s recommendations, including these expanded pillar definitions and titles, as an important and necessary step that supports its stature as a medical specialty rooted in science. This process allows for the consideration of new perspectives and treatments that become part of established medical practice.  

This year, a new task force, co-chaired by ACLM Board Members Neha Pathak, MD, DipABLM, and I convened to update the descriptions of two pillars: stress management and positive social connection.  

In recent years, acknowledgement of the interconnected nature of physical and mental health, coupled with growing appreciation of the impact of psychological factors on lifestyle behavior change and the recent emergence of lifestyle psychiatry as a field, has spurred interest in revisiting the interplay between mental health and lifestyle medicine.  

The updating of the “stress management” pillar, in particular, was undertaken to add depth and complexity to the original description. By elaborating on the components of stress, for example, the task force elected to highlight the role of the subjective, both as a modifiable element subject to therapeutic interventions ranging from positive psychology to psychotherapy, as well as a potential impediment to change when factors such as trauma, personality or temperament are in effect.  

The “positive social connection” pillar was updated because of a desire to incorporate growing evidence demonstrating the physical and mental benefits associated with a broader understanding of meaningful connections—those that extend beyond social networks to include nature and the transcendent. In addition to expanding the description of this pillar, the task force has recommended that the name of the “social connection” pillar be modified to “connectedness” to represent its expanded scope and reflect the essential role relationships—both horizontal (people oriented) and vertical (spiritual or transcendent oriented)—play in underpinning meaning and purpose, a prime driver of lifestyle behavior change.  

The update to both the “stress management” and “positive social connection” pillars, as follows, shines a spotlight on the inner life of the individual as it relates to lifestyle and overall health.  

Stress Management 

Stress, a natural human response, involves the body’s reaction to demands or challenges.  Demand stems from the interplay between the subjective and objective. Unlike the latter which may not always be controllable, the former is potentially modifiable. Additionally, variables such as temperament, personality traits, and past experiences may be relevant.  

Stress can reduce overall quality of life, job and school performance, and exacerbate health issues such as sleep deprivation, depression, anxiety, elevated BMI, insulin resistance, and cardiovascular disease.  

Additionally, burdens that accrue from chronic external stresses such as those arising from bias, discrimination and the other financial and social influencers of health can result in allostatic load or weathering.   

Resilience and stress management are interconnected and work together to help individuals navigate challenges and maintain well-being. There are many interventions that can help manage stress and improve overall whole-person health. The ACLM suggests partnering with an interdisciplinary health care team to determine a plan of action for helping patients reduce stress levels. 

Ultimately, stress management interventions that calibrate subjective perceptions and expectations while addressing individual dynamics, when relevant, foster the capacity to meet the ever-changing demands of life, bolstering resilience, the ability to adapt and bounce back from stress and adversity. 

Positive Social Connection now Connectedness  

Research highlights the positive role of connection for both physical and mental health, extending beyond social networks to encompass meaningful relationships with pets, the natural world, and spirituality.  

Social connection plays a key role in happiness and health span, reducing the risk of chronic diseases such as depression, anxiety, heart disease, stroke, and dementia. 

Social networks can significantly influence health choices. Individuals are more likely to adopt the health behaviors, such as alcohol consumption, exercise, and diet, of those within their close social networks.  

Moreover, relationships, whether horizontal or vertical, are essential to an individual’s sense of meaning and purpose–the “why” that drives behavior change, the centerpiece of lifestyle medicine.  

There is always more to learn and improve, especially within the field of healthcare. ACLM, as always, is committed to providing and refining resources that bring clarity and alignment with evolving science. 

In closing, please note that these changes, especially the move to using the pillar title of “Connectedness,” will take time to implement across courses, handouts, the ACLM website and social platforms. We encourage you, though, to begin using these broader concepts in your daily practice.  

My sincere thanks to my task force co-chair, Dr. Neha Pathak, and to all ACLM leaders and staff who assisted in this important work.