Fostering healthy relationships

Stressful interpersonal connections may lead to health problems, such as heart disease.

If the pandemic has taught us anything, it’s the importance of social ties and human connections. Not only do they improve your emotional well-being, but they can bring physical benefits.

"Having nurturing relationships is protective of mental health and overall brain health," says Dr. Jennifer Gatchel, an assistant professor of psychiatry at Harvard Medical School.

However, while positive relationships can boost health, the opposite is often true when it comes to problematic relationships. Chronic emotional stress may put you at higher risk for a number of health problems.

A study published March 2, 2021, in the Journal of the American Heart Association, for example, found that women who reported having high levels of social strain were more likely to have a heart attack or die of cardiovascular disease during nearly 15 years of follow-up than women who did not. To determine this, researchers asked women how many people in their life irritated them, were too demanding of them, excluded them, or tried to "coerce" them in their daily life. Based on their answers, the women were categorized as having low, medium, or high social strain. Those who scored in the high category were 9% more likely to develop cardiovascular disease than women who scored in the low category. Another 2019 study, published by the Journal of Epidemiology & Community Health, found that women who reported high levels of social stress had lower bone density six years later. The authors speculated that stress may harm bone health because stress raises blood cortisol levels, which may be linked to bone thinning. Troubled ties with others may also lead to other physical or mental health problems.

Defining a difficult relationship

A stress-inducing relationship can be one with a partner, a family member, a friend, or a professional colleague. People may find themselves at odds with others for many reasons. The pandemic and political polarization that has occurred in recent years may be exacerbating factors for some, says Dr. Gatchel. Relationship stress is often particularly challenging for people who are in a role as caretaker for a child, ailing adult relative, or partner.

"Caring for a spouse or a loved one can lead to increased stress, which puts you at risk for depression or physical health problems if the you don’t feel supported," says Dr. Gatchel.

Identifying a toxic trend

While your relationships with others may seem like they are outside of your control, there are things you can do to take them in a more positive direction, Dr. Gatchel says. The first step is identifying a problematic dynamic. A trying relationship typically comes with some warning signs, she says. These include

• feeling burned out or depleted after interactions
• having negative thoughts about the relationship
• feeling like the relationship is imbalanced — that one person gives or takes more than the other
• feeling that you are not valued or respected by the other person.

Look at the patterns of the relationship over time. Has it been more take than give? Is it stressful? "If you recognize those signs in yourself, it’s a red flag to take a closer look," she says.

Making a change for the better

If you do determine that a relationship is detrimental, that doesn’t mean you necessarily have to cut ties with the person, but you will need to make some changes.

Establish boundaries. If there is a person in your life who is difficult, setting boundaries can help put the relationship back on track. You can be there for someone and still establish limits, so that the relationship isn’t so taxing. While burnout is common in caregiver relationships, it’s a feature of other relationships as well. For example, it may stem from a friendship with someone who is in constant need of emotional support, which may feel draining. Solve the issue by setting clear limits. If the friend calls with a problem, establish a time to discuss it, rather than always jumping the second she calls.

"You can express concern; say, ‘I’m sorry to hear that, and about what you are going through. I can’t talk right now, but can I give you a call tonight or this weekend to talk about it,’" says Dr. Gatchel.

If you have differences with someone, setting boundaries can also make certain that you aren’t forced outside of your comfort zone. This might occur if a friend calls and asks you for a favor you don’t feel comfortable performing.

"You would have to evaluate if you feel safe and comfortable with that. If not, be clear that you want to help them, but you’ll need to do that in another way," says Dr. Gatchel.

Prioritize your own well-being. Establishing boundaries with a child, grandchild, spouse, or other family member can be more challenging than it is with a friend. In these instances, it may be more about designating space for yourself to recharge and reset. This is something that many people have been unable to do during the pandemic.

"People were being asked to do more than they ever would and had to maintain a marathon pace for a really long time," says Dr. Gatchel.

To get needed breaks, hire child care or enlist help from a professional, a friend, or a family member. Don’t underestimate your need to recharge.

"There is only so much nonstop care that you can provide," says Dr. Gatchel.

It’s okay to ask for support. It’s like what flight attendants say before takeoff: put the oxygen mask on yourself before you then help someone else, says Dr. Gatchel.

Protect your health. You should also take steps to mitigate the stress you are experiencing as a result of unhealthy interactions with others. Practice self-care. Make time for physical activity, mindfulness relaxation practices, and activities that you enjoy. Sometimes activities that tap into the senses, such as gardening, coloring, painting, or even something as simple as sorting beads can help you relax, says Dr. Gatchel. Also, be certain to make time for good friends who are a source of support for you. And pay attention to your physical needs. Try to get the right amount of sleep. "Sleep is central to mood, as well as your anxiety and energy level," says Dr. Gatchel. The same is true of a healthy diet and getting enough physical activity.

Achieve some distance. Sometimes when a relationship is no longer positive, taking a step back can help. For example, if you have a friend who doesn’t make you feel valued or who is critical or negative, you might want to continue the friendship, but take a closer look to see if it should occupy less of your time.

"Friendships change, relationships change, circumstances change," says Dr. Gatchel. "Investing less in some relationships is normal even if you’re not clear why you’re having negative feelings toward that person."

Open the lines of communication. Depending on the relationship, you can sometimes address problems directly. "Just be open with them about it," says Dr. Gatchel. For example, if a relative doesn’t believe in getting vaccines and you do, it may be worth a conversation. The relationship at its core might not be problematic, but that topic puts you at odds. If you continue to disagree, setting boundaries about what you can and cannot discuss is one way to address these conflicts.

When you are talking to someone about a tense subject, be certain to use positive communication strategies. "Use ‘I’ statements," says Dr. Gatchel. "For instance, ‘I’ve noticed that when we have this discussion, things seem to get heated.’ And avoid using ‘you’ statements that might sound more accusatory, such as ‘You always want to argue about this.’"

Ultimately, these strategies can help put many relationships in a better place and protect you from health-harming strain.