Stress: What You Need to Know

UCF Grad Works at Johns Hopkins Hospital to Prevent and Control COVID-19 Spread | University of Central Florida News

Stress: What You Need to Know | Johns Hopkins Medicine

Frankie Catalfumo ’13 has worked through outbreak responses to cholera in Haiti and Ebola virus disease in the United States, but he says the current coronavirus (COVID-19) pandemic is more stressful than any of his other work with controlling infectious diseases.

“You see the waves in China and then we started to see it spread across the globe,” says Catalfumo, an infection control epidemiologist in the Department of Hospital Epidemiology and Infection Control at the Johns Hopkins Hospital in Baltimore.

“You have a warning of what’s to come and you’re just waiting to see what the next day will bring as you see more and more cases pop up in your own state.

” As of April 21, Maryland has had 13,684 cases positive for and 582 deaths due to COVID-19, according to data compiled by the Center for Systems Science and Engineering at Johns Hopkins University.

“You have a warning of what’s to come and you’re just waiting to see what the next day will bring.”

For the general public, controlling the spread of the virus mainly consists of practicing excellent hand hygiene, social distancing and staying home.

But in hospitals across the nation, healthcare professionals must consider many other factors to keep patients, themselves and everyone else safe.

It’s Catalfumo’s job to help develop the necessary infection prevention and control practices to ensure safety is maintained.

“A hospital’s kind of a sick hotel, so patients being admitted may have some type of infection and risk of spreading it,” says the health sciences graduate. “Now is an especially important time for healthcare providers and other frontline staff to collaborate on identifying how this particular infection may be communicable to everyone in the hospital, and outside of it.”

His recent workdays consist as much of being responsive to the many matters that evolve daily as of thinking ahead on potential obstacles. One of the biggest issues hospitals across the nation are dealing with is providing essential personal protective equipment (PPE) for healthcare workers.  Catalfumo has helped establish guidance at his hospital.

“In a pandemic, it is crucial to know how to clean specific PPEs, such as face shields, so we can reuse them,” he says. “Knowing which type of equipment can be reused and how it can be cleaned will help the hospital mindful use our supplies.”

Catalfumo also has to consider routes that minimize contact between patients and others, proper laboratory specimen collection and transport, and problem-solving with staff on personal concerns, such as what to tell family members now that they’re working with COVID-19 patients.

“Epidemiologists frequently work behind the scenes and if an outbreak doesn’t become very notable that’s because they were able to intervene.”

Before working at Johns Hopkins, Catalfumo worked as a consultant for the Department of Defense and the Centers for Disease Control and Prevention.

While studying at UCF, he volunteered with International Medical Outreach (IMO), a student-led nonprofit organization that specializes in medical service and shadowing trips in impoverished areas around the world.

It was with IMO that he gained his first experience working hands-on with epidemiology in Haiti and subsequently motivated him to pursue a master’s degree in public health.

“All disasters and all public health emergencies are incredibly interdisciplinary. Even if you’re working with an issue that appears simple or more readily understood, such as cholera, or one that’s new and evolving, such as COVID-19, you have to be able to adapt and be flexible when responding to the event,” Catalfumo says.

For epidemiologists, a job well done is often one that the majority of people can’t tell has even happened.

“Epidemiologists frequently work behind the scenes and if an outbreak doesn’t become very notable that’s because they were able to intervene,” he says. “It requires providing a lot of hands-on, in-the-moment education, to make sure everybody has the information they need to feel very safe caring for patients.”

“It’s a marathon, not a sprint. We need to make sure we’re going to be at our best and be prepared in our response.”

When it comes to making sure the general public has the knowledge they need, he suggests referencing the CDC website on a frequent basis to get the most accurate and up-to-date information available.

many other healthcare professionals, Catalfumo can feel the strain of the everchanging conditions in hospitals. To remain on top of their responsibilities, he knows it’s essential to maintain another good practice off the clock.

“Right now, it’s important for healthcare workers to practice self-care because we’re just beginning,” he says. “It’s a marathon, not a sprint. We need to make sure we’re going to be at our best and be prepared in our response.”


From our collaborators at Johns Hopkins Medicine International | How exercise helps you de-stress

Stress: What You Need to Know | Johns Hopkins Medicine
Posted August 4, 2017By Kerry Stewart, Ed.D., Professor of Medicine and Director of Clinical and Research Exercise Physiology, Johns Hopkins University School of Medicine

The physical and emotional demands of life often lead to high levels of stress.

A stressful situation at work, a divorce or separation, a death in the family or a diagnosis of a serious health problem may lead us to fall into poor eating habits or give up on exercise, making it even more difficult to cope with the challenges of life.

During challenging times, some of us might even start or resume destructive habits smoking, drinking too much alcohol or taking drugs. Yet, such physical or emotional problems are the very situations where maintaining healthy habits, especially exercise, can be the perfect prescription for what ails you, particularly for high levels of stress.

Conclusive research shows that 150 minutes of exercise per week — about a half hour five days per week — reduces stress by lowering blood pressure, relieving muscle tension and improving mood and concentration. Someone who is physically active has more vigor and is better able to tolerate fatigue, another factor that contributes to stress.

Consider fitness a first line of medication

Despite these proven rewards, many health care providers fail to recommend exercise as a first-line treatment for stress. Too often, stressed patients are offered medications instead. Yet, in many cases, increasing one’s level of physical activity can be one of the best treatment strategies for busting stress and improving stress-related high blood pressure or a racing heart rate.

For most otherwise healthy adults with mild high blood pressure, the guidelines from leading health organizations recommend a trial of several months of exercise and diet before starting to take blood pressure medications.

When a patient with cancer is suffering from the fatigue that most people experience when undergoing radiation or chemotherapy, many doctors still offer the misguided advice of resting as much as possible, even though maintaining an active lifestyle has been shown to be the best medicine for fighting physical fatigue and emotional stress in cancer survivors.

Many studies have shown that exercise, both in healthy people and in those with health problems, improves mild depression, anxiety and other psychological challenges.

Besides helping the body remain as physically fit as possible, exercise relieves nervous and muscle tension, and helps you to feel better about yourself.

This could be due to an increase in endorphins, a chemical produced in the brain with higher levels of activity that reduce pain and induce euphoria, or it could be due to taking your mind off your worries.

Fatigue from fitness can be beneficial for sense of self

Although exercising during difficult times might itself cause some fatigue, the fatigue from exercise, un the tiredness that results from feeling stressed, worried or being ill, also instills a sense of accomplishment and personal satisfaction from completing a workout.

In some of our work at Johns Hopkins, we have measured this sense of accomplishment in patients with serious heart problems.

After becoming more physically active, these individuals reported feeling greater confidence in their ability to be active, which in turn led to further increases in their activity levels and reaping the health benefits that naturally flow from exercising more. Increased confidence in your ability to perform at higher levels of physical activity is also a great stress buster.

Not only does exercise help people better manage and treat their health problems, it also helps them feel more in charge of their health because they are now being proactive rather than just living from one doctor visit to another, or going to the drugstore every month to stock up on pills. Taking an active role in your own health care is an excellent way to reduce anxiety, a major contributor to stress.

People who exercise regularly also tend to stop or decrease their smoking and eat better, both actions that further improve their ability to cope with life’s inevitable challenges, including stress.

Exercising in groups is motivating, offers new sources of support

The benefits of exercise for stress reduction can be further enhanced when exercising with someone else or in a group.

Working out with a buddy or in a group helps to maintain a consistent schedule, exposes you to a social and fun environment, and eliminates the boredom that sometimes occurs when exercising alone.

Being part of a social network that provides friendship and support is a great way to improve mood and reduce stress.

So regardless of the physical and emotional challenges that life may throw your way, staying as physically active as possible will get you through tough periods of stress, leading to a healthier and happier life.

Content courtesy of Kerry Stewart, Ed.D., professor of medicine and director of clinical and research exercise physiology at the Johns Hopkins University School of Medicine.

The content was reproduced with permission of the Office of Marketing and Communications for Johns Hopkins Medicine International. Additional reuse and reprinting is not allowed.

The information aims to educate readers and is not a substitute for consultation with a physician.


Your holiday stress relief primer

Stress: What You Need to Know | Johns Hopkins Medicine

For many, this can be a stressful time of year. The good news is there are things you can do to minimize the stress – and help you savor time spent with the ones you love during the holidays.

What is stress — and what causes holiday stress?

Stress is the feeling you get when you’re overloaded – you’re wondering how you can possibly get everything done. According to Medical News Today, we go into “fight or flight” mode and start breathing faster and our muscles tense.1

The holidays have been known to cause stress. You may feel spread too thin, overworked and underappreciated. From travel to school to baking and entertaining, the calendar entries and obligations abound.

Too much of a good thing?

Anxiety and stress – and in some cases, depression – can especially arise during the holidays. That’s because there’s usually more on your plate, from tasks to social events.

Your routine is often affected because you’re trying to fit more in your day. This can wreak havoc on your sleep schedule. You may not be eating healthy or exercising you usually do. And buying gifts can take a toll on your budget.2

The holidays aren’t necessarily a happy time for everyone, either. They can be a sad and emotional period if you’re unable to visit friends and family who live far away – or if you’re grieving the loss of a loved one.2

But take heart — there are things you can do to minimize the stress and enjoy the holidays, however you choose to celebrate them.

How can I prevent holiday stress?

If you know you perennially get stressed during the holidays, it’s key to take action to prevent yourself from getting stressed out in the first place.2

Manage your expectations — let go of what you think the holidays “should be” — things don’t have to be perfect!

Here are some useful tips you can work on before the holidays descend to help prevent stress from overtaking you:1

Tips for preventing mental and physical stress

  • Practice deep breathing
  • Learn how to relax through meditation or yoga
  • Recognize your physical signs of stress – so you know when to keep yourself calm
  • Identity what helps you de-stress – so you can take action at the first sign of stress ( take a walk or listen to music)

Tips for preventing financial stress

  • Stick to a holiday budget. Live within your means. And try cutting back on the number of gifts you give or do a gift exchange. Remember, it’s the thought that counts, not the amount of money you spend.
  • Don’t rely too heavily on credit cards. What may bring you joy now, will not be so joyful when the monthly bill rolls around in January.
  • Forgo gift giving altogether and donate those funds to a family in need or favorite non-profit.
  • Instead of serving family or friends a three-course meal, save on your food and beverage budget and host a potluck.

How can I manage holiday stress once it hits?

Particularly during the holiday season, you can manage stress by learning to say no.3 You don’t have to take on everything yourself. Maybe you tell your child’s school you can’t make the costumes this year. Or ask another friend or family member to host Christmas Eve dinner instead.

It’s also important to take time for yourself to unwind. Don’t short-change yourself and cut out things in your life that make you happy or help you de-stress. Keep up your workouts. Take that bubble bath. Watch that football game. Get a babysitter and go shopping on a weeknight.

Changing your perspective about the holidays can also help. If something doesn’t get done, what would happen? Would a crisis ensue? Probably not. So be realistic.

The Mayo Clinic also says it can be helpful to set aside differences during this time and get professional help if you need to.3

Tips for enjoying the holidays

Johns Hopkins Medicine offers some simple things you can do to make your holiday less stressful. If you apply these to your life, this can be a season of enjoyment. And you can take pleasure in creating new holiday memories with friends and family:4

  1. Think about what makes the season meaningful for you — That way you can be intentional about who you spend your time with – and how you spend your time during the holidays. 
  2. Make a plan early on — Do at least one thing you enjoy during the holidays, attending a holiday concert or checking out local lights displays.
  3. Don’t do everything yourself — Accept help when people offer it and proactively ask for help. Also practice saying no.
  4. Stay healthy — Don’t skip your workouts and eat healthy when you can. This can be easier said than done, but can help you stay energized.  It’s easy to overindulge during the holidays, so eat and drink in moderation.
  5. Manage your expectations for family gatherings — When multiple generations and multiple families celebrate together, it can be challenging to feel heard and understood. Be clear about what you need the most and flexible about the rest.
  6. Recognize what worked for you during this holiday season — Pat yourself on the back for being less stressed this year! What could you improve on? Plan to make adjustments for next year, so your holiday is even more enjoyable.

Happy holidays to you and your family! May your days be merry and bright – and a little less stressful.


Mental Health – Johns Hopkins Cystic Fibrosis Center

Stress: What You Need to Know | Johns Hopkins Medicine

Emotional support

One of the keys to emotional health is a good support system. Most of us are born with a support system—our families. As we get older, the system expands to include friends and colleagues. Amazingly this process happens with little attention from us. But we would certainly take notice if the people who make up our support systems suddenly disappeared.

What is a support system?

A support system is a network of people who provide an individual with practical or emotional support. In real life, your support system is the people you connect with. Your CF care team is part of your support system, too. Some connections may be stronger than others, but they are all important.

One of the challenges for people with CF is the necessity of infection control, which makes CF a very isolating disease. Connecting with other people and families with CF through social media and virtual events are ways to connect with others experiencing CF.

Why is a strong support system important?

Most human beings interacting with other human beings. Going through life alone is difficult. Support systems are also important in managing stress, which is important to physical, as well as emotional, health. Individuals and families living with CF experience many stressful situations.

A strong support system is helpful in maintaining a sense of normalcy, which helps lower stress levels. Also, a strong support system can help people with CF feel connected, even when they’re isolated because of infection control issues.

The professionals at your CF center are also a good source of support.

The Facts on Depression

It is normal to feel sad sometimes. According to the American Psychiatric Association, one in 10 Americans suffer from depression each year. Unfortunately, many people go undiagnosed and untreated because they didn’t know that they were depressed or they were afraid of being labeled mentally ill.

Having a chronic illness CF puts one at higher risk for becoming depressed. Depression can interfere with your ability to keep up with your CF treatment regimen, so it’s important to get help.

It is possible to experience symptoms of depression without being diagnosed as clinically depressed, but you should let a professional make that


You should talk with your doctor or social worker at your CF center if you experience one or more of the following symptoms for 2 weeks or more:

  • Feelings of sadness or hopelessness, or anger and irritability.
  • Difficulty sleeping or sleeping more than usual.
  • Loss of interest in activities.
  • Changes in appetite with either significant weight loss or weight gain.
  • Loss of energy for no reason.
  • Difficulty concentrating.
  • Frequent thoughts of death or suicide.

These symptoms are some of the general symptoms used to diagnose depression. They are NOT meant to be a way for you to diagnose yourself or someone else with depression.

These symptoms should help you to determine whether you or someone you know need further evaluation by a professional to determine whether treatment for depression is necessary.

Additionally, the CF Foundation recommends annual screening for depression and anxiety.

For more information, check out the American Psychiatric Association’s website.

According to the American Academy of Child and Adolescent Psychiatry, approximately 1 in 20, or 5 percent, of children and adolescents suffer from depression.

Just adults, children and adolescents with CF are at higher risk of depression. Adolescents may be the most under-diagnosed population because many of the symptoms of depression are similar to typical adolescent behavior.

Also, children and adolescents are unly to be familiar with possible symptoms of depression.

Diagnosis of depression in children and adolescents relies on the observation of others, usually a parent or guardian. While it is often difficult for a child or adolescent to communicate feelings of sadness and hopelessness, a parent may notice a change in normal behavior.

A child who normally is very active and social with neighborhood friends, for example, begins to stay inside more often. Such a change in behavior does not necessarily mean that your child is depressed, but it is a sign that something could be wrong and worth further evaluation.

For more detailed information about depression in children and adolescents, please visit the American Academy of Child and Adolescent Psychiatry, Depression

For more information to share with your child or adolescent about depression, please visit Kids Health, Teens Site, Depression and Kids Health, Kids Site, Why Am I So Sad? for children.

Treatment for Depression

Your primary care physician is a good place to start. However, for further evaluation and treatment, a mental health provider is recommended.

Licensed clinical social workers, psychiatrists, psychologists, and counselors are trained in treatment of depression and other mental health issues.

Psychiatrists are the only providers among this group able to prescribe medication, so often a social worker, psychologist or counselor will work with a psychiatrist to provide care.

Depending on severity, depression can be treated with medication, psychotherapy or a combination of both.

Severe cases of depression are most effectively treated by a combination of medication and psychotherapy, while milder cases may be treated with medication or psychotherapy alone.

Once evaluated, your mental health provider will talk with you about which mode of treatment is right for you.

Accessing Mental Health Care

If you think you need a mental health care provider, contact your CF center’s social worker, who can help you access the appropriate type of care. If you do not have access to a social worker, let your primary care physician, CF doctor or nurse know about your concerns.


Most insurance plans cover mental health services. To find out if your plan has a mental health benefit, check the back of your insurance card for a number for mental health benefits. Some important questions include:

  • What is my co-pay?
  • How many visits are allowed?
  • Do I need a referral?
  • Can you give me a list of providers in my area?

With most insurance plans there is a network of mental health providers. When you call the mental health number on your insurance card, ask for a list of providers in your area.  The social worker at your CF center may be able to help you navigate this system. More information about insurance coverage can be found at the American Psychological Association website.