WHAT IS STRESS?

The stress response of the body is somewhat like an airplane readying for take-off. Virtually all systems (e.g., the heart and blood vessels, the immune system, the lungs, the digestive system, the sensory organs, and brain) are modified to meet the perceived danger (if a plane doesn’t get enough speed it doesn’t take off).

External and Internal Stressors

People can experience either external or internal stressors.

• External stressors include adverse physical conditions (such as pain, extreme weather, hot or cold temperatures) or stressful psychological environments (such as poor working conditions or abusive relationships, loss of a loved one, moving home, redundancy etc.). Humans, like animals, can experience external stressors.
• Internal stressors can also be physical (infections, inflammation) or psychological. An example of an internal psychological stressor is intense worry about a harmful event that may or may not occur. As far as anyone can tell, internal psychological stressors are rare or absent in most animals except humans.

Acute or Chronic Stress

Stressors can also be defined as short-term (acute) or long-term (chronic).

Acute Stress

Acute stress is the reaction to an immediate threat, commonly known as the fight or flight response. The threat can be any situation that is experienced, real or unreal, even subconsciously, as a danger.

Common acute stressors include:

• noise,
• crowding,
• isolation,
• hunger,
• fear
• extreme heat or cold
• danger,
• infection, and
• Imagining (real or unreal) a threat or remembering a dangerous event.

Under most circumstances, once the acute threat has passed, the response becomes inactivated and levels of stress hormones return to normal, a condition called the relaxation response.

Chronic Stress

Frequently, however, modern life poses on-going stressful situations that are not short-lived and the urge to act (to fight or to flee) must be suppressed. Stress, then, becomes chronic. Common chronic stressors include:

• on-going highly pressured work,
• long-term relationship problems,
• loneliness,
• psychological trauma, whether diagnosed or not
• unidentified illness, self or others
• depression and/or anxiety disorders
• lack of security
• persistent financial worries.

What Is The Effect Of Acute Stress?

The best way to envision the effect of acute stress is to imagine oneself in a primitive situation, such as being chased by a bear.

The Brain's Response to Acute Stress:  In response to seeing the bear, a part of the brain called the hypothalamic-pituitary-adrenal (HPA axis) system is activated.

Release of Hormones: The HPA systems trigger the production and release of corticotropin releasing hormones (CRH), including the primary stress hormone cortisol. Cortisol is very important in marshalling systems throughout the body (including the heart, lungs, circulation, metabolism, immune systems, and skin) to deal quickly with the bear.

Release of Catecholamine: The HPA system also releases certain neurotransmitters (chemical messengers) called catecholamine, particularly those known as known as dopamine, norepinephrine, and epinephrine (also called adrenaline).

Catecholamines: Activate an area inside the brain called the amygdala, which apparently triggers an emotional response to a stressful event. (In the case of the bear, this emotion is most likely fear.)

     Neurotransmitters: Signal the hippocampus (a nearby area in the brain) to store the emotionally loaded experience in long-term memory. In primitive times, this combination of responses would have been essential for survival, when long-lasting memories of dangerous stimuli (i.e., the large bear) would be critical for avoiding such threats in the future.

During a stressful event: Catecholamine also suppress activity in areas at the front of the brain concerned with short-term memory, concentration, inhibition, and rational thought. This sequence of mental events allows a person to react quickly to the bear, either to fight or to flee from it. (It also hinders the ability to handle complex social or intellectual tasks and behaviours.)

Response by the Heart, Lungs, and Circulation to Acute Stress: As the bear comes closer, the heart rate and blood pressure increase instantaneously. Breathing becomes rapid and the lungs take in more oxygen. Blood flow may actually increase 300% to 400%, priming the muscles, lungs, and brain for added demands. The spleen discharges red and white blood cells, allowing the blood to transport more oxygen.

The Immune System's Response to Acute Stress: The effect on the immune system from confrontation with the bear is similar to marshalling a defensive line of soldiers to potentially critical areas. The steroid hormones dampen parts of the immune system, so that infection fighters (including important white blood cells) or other immune molecules can be redistributed. These immune-boosting troops are sent to the body's front lines where injury or infection is most likely, such as the skin, the bone marrow, and the lymph nodes.

The Acute Response in the Mouth and Throat: As the bear gets closer, fluids are diverted from nonessential locations, including the mouth. This causes dryness and difficulty in talking. In addition, stress can cause spasms of the throat muscles, making it difficult to swallow.

The Skin's Response to Acute Stress: The stress effect diverts blood flow away from the skin to support the heart and muscle tissues. (This also reduces blood loss in the event that the bear catches up.) The physical effect is a cool, clammy, sweaty skin. The scalp also tightens so that the hair seems to stand up.

Metabolic Response to Acute Stress Stress: Shuts down digestive activity, a nonessential body function during short-term periods of physical exertion or crisis.

The Relaxation Response: the Resolution of Acute Stress

Once the threat has passed and the effect has not been harmful (i.e., the bear has not eaten or seriously wounded the human), the stress hormones return to normal. This is known as the relaxation response. In turn, the body's systems also normalize.

What Are The Negative Effects Of Stress?  In prehistoric times, the physical changes in response to stress were an essential adaptation for meeting natural threats. Even in the modern world, the stress response can be an asset for raising levels of performance during critical events such as a sports activity, an important meeting, or in situations of actual danger or crisis. If stress becomes persistent and low-level, however, all parts of the body's stress apparatus (the brain, heart, lungs, vessels, and muscles) become chronically over- or under-activated. This may produce physical or psychological damage over time. Acute stress can also be harmful in certain situations.

Stress-related conditions that are most likely to produce negative physical effects include:

An accumulation of persistent stressful situations, particularly those that a person cannot easily control (for example, high-pressured work plus an unhappy relationship).

Persistent stress following a severe acute response to a traumatic event (such as an automobile accident).

An inefficient or insufficient relaxation response.

Acute stress in people with serious illness, such as heart disease.

Psychological Effects of Stress: Studies suggest that the inability to adapt to stress is associated with the onset of depression or anxiety. Some evidence suggests that repeated release of the stress hormone produces hyperactivity in the hypothalamus-pituitary-adrenal axis and disrupts normal levels of serotonin, the nerve chemical that is critical for feelings of well-being.

Heart Disease: Mental stress is as major a trigger for angina as is physical stress. Incidents of acute stress have been associated with a higher risk for serious cardiac events, such as heart rhythm abnormalities and heart attacks, and even death from such events in people with heart disease.

Sudden stress increases the pumping action and rate of the heart and causes the arteries to constrict, thereby posing a risk for blocking blood flow to the heart.

Stressful events: May cause men and women who have relatively low levels of the neurotransmitter serotonin (and therefore a higher risk for depression or anger) to produce more of certain immune system proteins (called cytokines), which in high amounts cause inflammation and damage to cells, including possibly heart cells.       Recent evidence confirms the association between stress and hypertension (high blood pressure). People who regularly experience sudden increases in blood pressure caused by mental stress may, over time, develop injuries in the inner lining of their blood vessels.

Strokes: One survey revealed that men who had a more intense response to stressful situations, such as waiting in line or problems at work, were more likely to have strokes than those who did not report such distress.

Susceptibility to Infections Chronic stress appears to blunt the immune response and increase the risk for infections and may even impair a person's response to immunizations.

Cancer Current evidence does not support the idea that stress causes cancer. Nevertheless, some animal studies suggest that lack of control over stress (not simply stress itself) had negative effects on immune function and contributed to tumour growth.

          Gastrointestinal Problems: The brain and the intestine are strongly related and mediated by many of the same hormones and nervous system. (Indeed, some research suggests that the gut itself has features of a primitive brain.) It is not surprising then that prolonged stress can disrupt the digestive system, irritating the large intestine and causing diarrhoea, constipation, cramping, and bloating. Excessive production of digestive acids in the stomach may cause a painful burning. 

Irritable Bowel Syndrome:. Irritable bowel syndrome (or spastic colon) is strongly related to stress.

Peptic Ulcers:  It is now well established that most peptic ulcers are either caused by the H. pylori bacteria or by the use of nonsteroidal anti-inflammatory (NSAID) medications (such as aspirin and ibuprofen). Nevertheless, studies still suggest that stress may predispose someone to ulcers or sustain existing ulcers.

Eating Problems: Stress can have varying effects on eating problems and weight.

Weight Gain: Often stress is related to weight gain and obesity. Many people develop cravings for salt, fat, and sugar to counteract tension and, thus, gain weight. Weight gain can occur even with a healthy diet, however, in some people exposed to stress. And the weight gained is often abdominal fat, a predictor of diabetes and heart problems.

Weight Loss:  Some people suffer a loss of appetite and lose weight. In rare cases, stress may trigger hyperactivity of the thyroid gland, stimulating appetite but causing the body to burn up calories at a faster than normal rate.

Eating Disorders:  Anorexia nervosa and bulimia nervosa are eating disorders that are highly associated with adjustment problems in response to stress and emotional issues.

           Diabetes: Chronic stress has been associated with the development of insulin-resistance, a condition in which the body is unable to use insulin effectively to regulate glucose (blood sugar). Insulin-resistance is a primary factor in diabetes. Stress can also exacerbate existing diabetes by impairing the patient's ability to manage the disease effectively.

Sleep Disturbances The tensions of unresolved stress frequently cause insomnia, generally keeping the stressed person awake or causing awakening in the middle of the night or early morning.

Sexual and Reproductive Dysfunction Sexual Function: Stress can lead to diminished sexual desire and an inability to achieve orgasm in women. Stress response can also cause temporary impotence in men.

Premenstrual Syndrome: Some studies indicate that the stress response in women with premenstrual syndrome may be more intense than in those without  the syndrome.
 

Memory, Concentration: and Learning Stress has significant effects on the brain, particularly on memory and concentration. People suffering from negative stress may become inefficient and accident-prone.

Some memory loss may occur with age; However, stress may play an even more important role than simple aging in this process.

Who is at risk for chronic stress or stress-related diseases?

General Factors that Increase Susceptibility: At some point in their lives virtually everyone will experience stressful events or situations that overwhelm their natural coping mechanisms. In one poll, 89% of respondents indicated that they had experienced serious stress in their lives. Many factors influence susceptibility to stress.

Conditions that Influence the Effects of Stress:  People respond to stress differently depending on different factors:

Early nurturing:  Abusive behaviour towards children may cause long-term abnormalities in the hypothalamus-pituitary system, which regulates stress.

Personality traits: Certain people have personality traits that cause them to over-respond to stressful events.

Genetic factors:  Some people have genetic factors that affect stress, such as having more or less efficient relaxation response. One 2001 study found a genetic abnormality in serotonin regulation that was associated with a heightened reactivity of the heart rates and blood pressure in response to stress. (Serotonin is a brain chemical involved with feelings of well being.)

                Immune Regulated Diseases:  Certain diseases that are associated with immune abnormalities (such as rheumatoid arthritis or eczema) may actual impair a response to stress. The Length and Quality of Stressors. Naturally the longer the duration and more intense the stressors, the more harmful the effects.

           Individuals at Higher Risk:  Studies indicate that the following people are more vulnerable to the effects of stress than others: Younger adults. No one is immune to stress, however, and it may simply go unnoticed in the very young and old.

           Women in general:  Women, in fact, may be at higher risk than men are from stress-related chest pain, although men's hearts may be more vulnerable to adverse effects from long-term stress, such as from their jobs.

         Working mothers:  Working mothers, regardless of whether they are married or single, face higher stress levels and possibly adverse health effects, most likely because they bear a greater and more diffuse work load than men or other women. This has been observed in women in the Europe and the US. Such stress may also have a domino and harmful effect on their children.

Less educated individuals:  Divorced or widowed individuals. (A number of studies indicate that unmarried people generally do not live as long as their married contemporaries). The unemployed, Isolated individuals   People who are targets of racial or sexual discrimination. People who are abused, physically or mentally. Those without health insurance. Or where the prospect of timely healthcare is a problem. People who live in cities.

Effects in Childhood:  Animal studies report that rats that have been exposed to maternal grooming (i.e., positive physical affection by the mother) have lower stress hormone levels in adulthood. Depressed or aggressive mothers are particularly powerful sources of stress in children, even more important than poverty or overcrowding. Children are frequent victims of stress because they are often unable to communicate their feelings accurately or their responses to events over which they have no control. Adolescent boys and girls experience equal amounts of stress, but the source and effects may differ.          Girls tend to become stressed from interpersonal situations, and stress is more likely to lead to depression in girls than in boys.

           For boys, one study suggested events such as changing schools or poor grades are the most important sources of stress. Another indicated, however, that the probability of childhood behavioural difficulties in a boy is increased with the number and type of stressors encountered in the home.

Stress in the Elderly:  As people age, the ability to achieve a relaxation response after a stressful event becomes more difficult. Aging may simply wear out the systems in the brain that respond to stress, so that they become inefficient. The elderly, too, are very often exposed to major stressors such as medical problems, the loss of a spouse and friends, a change in a living situation, and financial worries.

Caregivers:  Caregivers of Family Members. Studies show that caregivers of physically or mentally disabled family members are at risk for chronic stress. Spouses caring for a disabled partner are particularly vulnerable to a range of stress-related health threats including influenza, depression, heart disease, and even poorer survival rates. Caring for a spouse with even minor disabilities can induce severe stress. (Intervention programs that are aimed at helping the caregiver approach the situation positively can be very helpful at reducing stress and helping the caregiver maintain a positive attitude.) Wives experience significantly greater stress from care giving than husbands, and, according to a 2000 study, tend to feel more negative about their husbands than care giving husbands feel about their wives.

Specific risk factors that put caregivers at higher risk for severe stress or stress-related illnesses include the following:

· Having a low income.

· Living alone with the patient.

· Helping a highly dependent patient.

· Having a difficult relationship with the patient.

Health Professional Caregivers:  Care giving among the health professionals is also a high risk factor for stress. One 2000 study, for example, found that nurses with low job control, high job demands, and low work-related social support experienced very dramatic health declines, both physically and emotionally.

Angry Personalities

People who are less emotionally stable or have high anxiety levels tend to experience specific events as more stressful than others. Some experts describe an exaggerated negative response to stress as "catastrophizing" the event (turning it into a catastrophe). An overly angry or hostile response to stressful situations may be dangerous to the heart, but studies are mixed. Studies in 1998 and 2000 have reported an association among women between anger, irritability, and hostility and narrowing of the arteries, a major risk factor for heart disease. The 1998 study reported that being self conscious in public and suppressing anger were also associated with this risk.  A 1999 study further reported a link in older women between long term anger and the development of abnormal obesity (the so-called apple shape), an important risk factor for heart diseases.

         Lack of Social Network: The lack of an established network of family and friends predisposes one to stress disorders and stress-related health problems, including heart disease and infections. And, a 2000 study reported that older people who maintain active relationships with their adult children are buffered against the adverse health effects of chronic stress-inducing situations, such as low income or lower social class. One study suggested this may be because people who live alone are unable to discuss negative feelings and so relieve their stress.

Work Risk Factors:  According to one survey, up to 40% of European and American workers describe their jobs as very stressful. Job-related stress is particularly likely to become chronic because it is such a large part of daily life. And, stress in turn reduces a worker's effectiveness by impairing concentration, causing sleeplessness, and increasing the risk for illness, back problems, accidents, and lost time. Work stress can lead to harassment or even violence while on the job. At its most extreme, stress that places such a burden on the heart and circulation may be fatal. The Japanese even have a word for sudden death due to overwork, karoushi. In fact, a number of studies are now suggesting that job-related stress is as great a threat to health as smoking or not exercising.

Among the intense stressors at work are the following:

Having no participation in decisions that affect one's responsibilities.

Unrelenting and unreasonable demands for performance.

Lack of effective communication and conflict-resolution methods among workers and employers.

Lack of job security.

Long hours.

Lack of proper break times

Excessive time spent away from home and family.

Office politics and conflicts between workers.

Wages not commensurate with levels of responsibility.

An Absent or Inadequate Relaxation Response:  In some people, stress hormones remain elevated instead of returning to normal levels. This may occur in highly competitive athletes or people with a history of depression.

What Other Conditions Have The Same Symptoms As Stress?

Anxiety Disorders:  The physical symptoms of anxiety disorders mirror many of those of stress, including a fast heart rate; rapid, shallow breathing; and increased muscle tension. Anxiety is an emotional disorder, however, and is characterized by feelings of apprehension, uncertainty, fear, or panic. Unlike stress, the triggers for anxiety are not necessarily or even usually associated with specific stressful or threatening conditions. Some individuals with anxiety disorders have numerous physical complaints, such as headaches, gastrointestinal disturbances, dizziness, and chest pain. Severe cases of anxiety disorders are debilitating, and interfere with career, family, and social spheres.

Depression: Depression can be a disabling condition, and, like anxiety disorders, may result from untreated chronic stress. Depression also mimics some of the symptoms of stress, including changes in appetite, sleep patterns, and concentration. Serious depression, however, is distinguished from stress by feelings of sadness, hopelessness, loss of interest in life, and, sometimes, thoughts of suicide. Acute depression is also accompanied by significant changes in the patient's functioning. Professional therapy may be needed in order to determine if depression is caused by stress or if it is the primary problem.

Post-Traumatic Stress Disorder Symptoms: Post-traumatic stress disorder (PTSD) is a reaction to a very traumatic event: it is actually classified as an anxiety disorder. The event that precipitates PTSD is usually outside the norm of human experience, such as intense combat or sexual assault. The patient struggles to forget the traumatic event and frequently develops emotional numbness and event-related amnesia. Often, however, there is a mental flashback, and the patient re-experiences the painful circumstance in the form of intrusive dreams and disturbing thoughts and memories, which resemble or recall the trauma. Other symptoms may include lack of pleasure in formerly enjoyed activities, hopelessness, irritability, mood swings, sleep problems, inability to concentrate, and an excessive startle-response to noise.

Grant me the courage to change the things I can change, the serenity to accept the things I can't change, and the wisdom to know the difference."

What Are The General Guidelines For Reducing Stress? Perhaps the best general approach for treating stress can be found in the elegant passage by Reinhold Niebuhr, "Grant me the courage to change the things I can change, the serenity to accept the things I can't change, and the wisdom to know the difference." The process of learning to control stress is life-long, and will not only contribute to better health, but a greater ability to succeed in one's own agenda.

When to Seek Professional Help for Stress: Stress can be a factor in a variety of physical and emotional illnesses, which should be professionally treated. Many stress symptoms are mild and can be managed by over the counter medications (e.g., aspirin, acetaminophen, or ibuprofen for tension headache and antacids and anti-diarrhoea medications or laxatives for mild stomach distress). A physician should be consulted, however, for physical symptoms that are out of the ordinary, particularly those which progress in severity or awaken one at night. A mental health professional should be consulted for unmanageable acute stress or for severe anxiety or depression. Often short-term therapy, including Hypnotherapy, can resolve stress-related emotional problems.

Considerations for Choosing a Strategy for Reducing Stress

           In choosing specific strategies for treating stress, several factors should be considered.

                   First, there is no single method that is uniformly successful: sometimes, a combination of approaches can be effective.

Second, what works for one person does not necessarily work for someone else.

Third, stress can be positive as well as negative. Appropriate and controllable stress provides interest and excitement and motivates the individual to greater achievement, while a lack of stress may lead to boredom and depression.

Finally, stress may play a part in making people vulnerable to illness. A physician or psychologist should be consulted if there are any indications of accompanying medical or psychological conditions, such as cardiac symptoms, significant pain, anxiety, or depression.

Overcoming Obstacles to Treatment:  Often people succeed in relieving stress for the short-term but resort to previous ways of stressful thinking and behaving because of outside pressure or entrenched beliefs or habits.

One major obstacle to reducing stress is the strong biologic urge for fight or flight itself. The very idea of relaxation can feel threatening, because it is perceived as letting down one's guard. For example, an over-demanding boss may put a subordinate into a psychological state of fighting-readiness, even though there is no safe opportunity for the subordinate to fight back, or even express anger. Stress builds up, but the worker has the illusion, even subconsciously, that the stress itself is providing safety or preparedness, so does nothing to correct the condition.

Many people are afraid of being perceived as selfish if they engage in stress-reducing activities that benefit only themselves. The truth is that self-sacrifice may be inappropriate and even damaging if the person making the sacrifice is unhappy, angry, or physically unwell.

Many people believe that certain emotional responses to stress, such as anger, are innate and unchangeable features of personality. Research has shown, however, that with cognitive behavioural therapy, individuals can be taught to change their emotional reactions to stressful events.

It is essential to remember that reducing stress and staying relaxed clears the mind so it can initiate appropriate actions to get rid of the stress-ridden conditions.

Stress Reduction and Effects on Health:  It should be strongly noted that treating stress cannot cure medical problems. Any stress management program is not a substitute for standard medical treatments, but it can be a very important component in a medical regimen. Some studies have reported the following:

A 2001 study reported that treatments that reduce psychological distress after a heart attack appeared to improve long-term outlook. Some evidence exists that stress management programs may reduce the risk of heart events (e.g., heart attack) by up to 75% in people with heart disease. One study found that stress management programs are more effective than exercise in reducing heart risks (although exercise is also protective).

A 2001 study reported that stress management techniques along with methods for coping with anger were associated with lower blood pressure.

In one 2001 study, patients with chronic daily tension headache who were given tricyclics reported greater improvement after a month than those who were taught stress management techniques. The combination of the two approaches worked even better. And at six months, stress management was as effective as the antidepressants in improving headaches.

What Are Some Specific Stress Reduction Methods?

Healthy Lifestyle:  A healthy diet and a healthy lifestyle is an essential companion to any stress-reduction program. General health and stress resistance can be enhanced by a regular exercise, a diet rich in a variety of whole grains, vegetables, and fruits, and by avoiding excessive alcohol, caffeine, and tobacco. The old adage, we are what we eat is certainly true. The brain transmutes nutrients into vital neurotransmitters/hormones; when we eat the right nutrients the brain works well, when the brain works well, so do we!

Exercise: Exercise in combination with stress management techniques is extremely important for many reasons:

Exercise is an effective distraction from stressful events. 

Employees who follow an active lifestyle need fewer sick days than sedentary workers. And most importantly, stress itself poses significantly less danger to overall health in the physically active individual. The heart and circulation are able to work harder for longer stretches of time, and the muscles, ligaments, bones, and joints become stronger and more flexible.

Usually, a varied exercise regime is more interesting, and thus easier to stick to. Start slowly. Strenuous exercise in people who are not used to it can be very dangerous and any exercise program should be discussed with a physician. In addition, half of all people who begin a vigorous training regime drop out within a year. The key is to find activities that are exciting, challenging, and satisfying. The following are some suggestions:

However, always, seek the advice of your GP or other medical professional first!

Signing up for aerobics and cardiovascular classes at a gym can be an excellent starting point.

Brisk walking is an excellent aerobic exercise that is free and available to nearly anyone. Even short brisk walks can relieve bouts of stress.

Swimming is an ideal exercise for many people including pregnant women, individuals with musculoskeletal problems, and those who suffer exercise-induced asthma.

Yoga, Pilates or Tai Chi can be very effective, combining many of the benefits of breathing, muscle relaxation, and meditation while toning and stretching the muscles. The benefits of these three disciplines may be considerable. Numerous studies have found it beneficial for many conditions in which stress is an important factor, such as anxiety, headaches, high blood pressure, and asthma. It also elevates mood and improves concentration and ability to focus.

As in other areas of stress management, making a plan and executing it successfully, develops feelings of mastery and control, which are very beneficial in and of themselves. Start small. Just 10 minutes of exercise three times a week can build a good base for novices. Gradually build up the length of these every-other-day sessions to 30 minutes or more. 

Hypno-therapeutic Techniques:  are amongst the most effective ways to reduce stress. They include identifying sources of stress, restructuring priorities, changing one's response to stress, and finding methods for managing and reducing stress. This approach may be particularly helpful when the source of stress is chronic pain or other chronic diseases.

Identifying Sources of Stress. It is useful to start the process of stress reduction with a diary that keeps an informal inventory of daily events and activities. While this exercise might itself seem stress producing (and yet one more chore), it need not be done in painstaking detail. A few words accompanying a time and date will usually be enough to serve as reminders of significant events or activities.

The first step is to note activities that put a strain on energy and time, trigger anger or anxiety, or precipitate a negative physical response (e.g., a sour stomach or headache).