THE STRESS

November 1, 2011 by Dr Rajiv Desai

THE STRESS:

Prologue:

In my previous article “Creativity”, I have stated that I had lived a very stressful life in India. The word “stress” caught my imagination as everybody experiences some stress everyday in modern world. Stress is a term that has become part of daily language in the 21st century. While stress is not new, it is a term that is used so often that perhaps it might be time to take a closer look at its meaning. If you were to take a poll in downtown and ask people to define stress, or explain what causes stress for them, or how stress affects them, you would probably receive many different answers as people that you asked. The reason is that there is no definition of stress that everyone agrees on because what is stressful for one person may have little effect on others and we all respond differently to stress. Just about everybody—men, women, children and even fetuses—suffer from stress. Relationship demands, physical as well as mental health problems, pressure at workplaces, traffic snarls, meeting deadlines, growing-up tensions—all of these conditions and situations are valid causes of stress. In my previous articles “The sleep”, “The anger” and “Nicotine addiction”; the word “stress” has been used not infrequently. Plenty of books are written on stress and one of them is “why zebras don’t get ulcers” written by stress expert Stanford Professor Robert Sapolsky. Zebras respond to stress in life-threatening situations and for short periods of time. When chased by a lion, zebras have evolved to temporarily shut off “non-essential” bodily functions (e.g. reproduction, brain/neuron growth, immune system, digestion) in order to escape the lion. Zebras turn off the stress response when the threat disappears — so they don’t get ulcers. On the other hand, we humans aren’t good at shutting down the stress response. We get stressed out by all sorts of things that are less threatening than a lion (e.g. getting cut off when driving, someone speaks badly about us at the office, political news, etc.), but our bodies still respond as if we’re trying to escape a lion. Our bodies aren’t built for chronic stress, so over time stress results in cardiovascular decay, brain degradation, ulcers, and the like. Learning to understand and manage stress can prevent the counter effects of stress.

Stress statistics:

Before discussing stress, let me show stress statistics. Then you will understand gravity of problem.

1)75% of the general population experiences at least “some stress” every two weeks.

2) Forty-three percent of all adults suffer adverse health effects from stress.

3) Medical research suggests that up to 90 percent of all illness and disease is stress-related, according to the Centers for Disease Control and Prevention. Stress can cause headaches, irritable bowel syndrome, eating disorder, allergies, insomnia, backaches, frequent cold, anxiety, depression, arthritis, skin disorders, hair loss and fatigue; to diseases such as hypertension, asthma, diabetes, heart ailments and even cancer.

4) Seventy-five to ninety percent of all doctors’ visits are due to stress-related ailments and stress-related disorders.

5) The lifetime prevalence of an emotional disorder is more than 50%, often due to chronic, untreated stress reactions.

6) The Occupational Safety and Health Administration (OSHA) declared stress a hazard of the workplace. Stress costs American industry more than $300 billion annually.

7) Stress also contributes to the development of alcoholism, obesity, suicide, drug addiction, nicotine addiction, and other harmful behaviors.

8) Tranquilizers, antidepressants, and anti-anxiety medications account for one fourth of all prescriptions written in the U.S. each year.

Stress is a word derived from the Latin word stringere, meaning to draw tight, and was used in the seventeenth century to describe hardship and affliction. During the late eighteenth century, stress denoted ‘force, pressure, strain, or strong effort’, referring primarily to an individual, or to the individual’s organs or mental powers. Stress is a term in psychology and biology, borrowed from physics & engineering, first employed in a biological context by the endocrinologist Hans Selye in the 1930s. It refers to the consequence of the failure of an organism — human or other animal — to respond adequately to mental, emotional, or physical demands, whether actual or imagined.

The term “stress”, as it is currently used was coined by Hans Selye in 1936, who defined it as “the non-specific response of the body to any demand for change”. Selye had noted in numerous experiments that laboratory animals subjected to acute but different noxious physical and emotional stimuli (blaring light, deafening noise, extremes of heat or cold, perpetual frustration) all exhibited the same pathologic changes of stomach ulcerations, shrinkage of lymphoid tissue and enlargement of the adrenals. He later demonstrated that persistent stress could cause these animals to develop various diseases similar to those seen in humans, such as heart attacks, stroke, kidney disease and rheumatoid arthritis. At that time, it was believed that most diseases were caused by specific but different pathogens. Tuberculosis was due to the tubercle bacillus, anthrax by the anthrax bacillus, syphilis by a spirochete, etc. What Selye proposed was just the opposite, namely that many different insults could cause the same disease, not only in animals, but in humans as well.

The word “stress” is defined by the Oxford Dictionary as “a state of affair involving demand on physical or mental energy”. A condition or circumstance (not always adverse), which can disturb the normal physiological and psychological functioning of an individual. In medical parlance “stress” is defined as a perturbation of the body`s homeostasis. This demand on mind-body occurs when it tries to cope with incessant changes in life. Some researchers define stress as “the degree to which one feels, perceives or believes one is not in control of one’s circumstances”. Control – or people’s perception of being in control – seems to be the key to susceptibility to experiencing stress. Short-term stress can come from normal, everyday activities, such as a job interview, a first date, your wedding, buying a house, or taking a test. Chronic stress can be triggered by problems at work, difficult relationships, worrying about money, or dealing with an ongoing illness. Traumas such as war, rape, inappropriate sexual experience, accident, illness, bereavement, or natural disaster may lead to severe stress disorders, such as PTSD (vide infra). In a challenging situation, the brain prepares the body for defensive action—the fight or flight response by releasing stress hormones, namely, cortisol and adrenaline (epinephrine). These hormones raise the blood pressure and the body prepares to react to the situation. We all encounter various stressors (causes of stress) in everyday life, which can accumulate, if not released. Subsequently, it compels the mind and body to be in an almost constant alarm-state in preparation to fight or flee. This state of accumulated stress can increase the risk of both acute and chronic psychosomatic illnesses and weaken the immune system of the human body.

General adaptation syndrome:

Dr. Hans Selye, an endocrinologist, developed a three-stage model of the body’s response to stress as general adaptation syndrome (GAS). The first phase is an alarm reaction, the second stage is one of resistance or adaptation, and the final stage is one of exhaustion.
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1) Alarm is the first stage. When the threat or stressor is identified or realized, the body’s stress response is a state of alarm. During this stage, adrenaline will be produced in order to bring about the fight-or-flight response. There is also some activation of the HPA axis, producing cortisol.

2) Resistance is the second stage. If the stressor persists, it becomes necessary to attempt some means of coping with the stress. Although the body begins to try to adapt to the strains or demands of the environment, the body cannot keep this up indefinitely, so its resources are gradually depleted. However, if the body adapts to the stressor with enough resources, next stage is not reached.

3) Exhaustion is the third and final stage in this model. At this point, all of the body’s resources are eventually depleted and the body is unable to maintain normal function. The initial autonomic nervous system symptoms may reappear (sweating, raised heart rate, etc.). If stage three is extended, long-term damage may result, as the body’s immune system becomes exhausted, and bodily functions become impaired, resulting in decompensation. The result can manifest itself in obvious illnesses such as ulcers, depression, diabetes, trouble with the digestive system, or even cardiovascular problems, along with other mental illnesses. Critics of Selye’s work say it ignores both the psychological impact of stress on an individual, and the individual’s ability to recognize stress and act in various ways to change his or her situation.

By looking at stress as resulting from a misfit between an individual and his/her particular environment, we can begin to understand why one person seems to flourish in a certain setting, while another suffers. Tom Cummings and Cary Cooper in 1979 explored the stress process in a cybernetic framework as follows:
(i) Individuals, for the most part, try to keep their thoughts, emotions, and relationships with the world in a ‘steady state’.
(ii) Each factor of a person’s emotional and physical state has a ‘range of stability’, in which that person feels comfortable. On the other hand, when forces disrupt one of these factors beyond the range of stability, the individual must act or cope to restore a feeling of comfort.
(iii) An individual’s behavior aimed at maintaining a steady state makes up his or her ‘adjustment process’, or coping strategies.

Psychologist Connie Lillas uses a driving analogy to describe the three most common ways people respond when they’re overwhelmed by stress:

Foot on the gas (accelerator): An angry or agitated stress response. You’re heated, keyed up, overly emotional, and unable to sit still.

Foot on the brake: A withdrawn or depressed stress response. You shut down, space out, and show very little energy or emotion.

Foot on both: A tense and frozen stress response. You “freeze” under pressure and can’t do anything. You look paralyzed, but under the surface you’re extremely agitated.

Change:

Let’s begin with the concept of change, because life is a process of change. Therefore, anything that involves change contains within it the “demand” that we adapt to it, in one way or another. Graduating from school can be as demanding as starting school, and starting a new job can be as demanding as losing a job. How we perceive the change really determines how we manage to adapt to it. If the perception is positive, we generally embrace the change with open arms and relief. And the story essentially ends there. If the perception is negative—that is, if the change challenges our stamina or resources—the body will automatically—and dramatically—respond to this perceived threat with a variety of physiological responses.

To your body, stress is synonymous with response to change. Anything that causes a change in your life causes stress. It doesn’t matter if it is a “good” change, or a “bad” change, they are both stress. When you find your dream apartment and get ready to move, that is stress. If you break your leg, that is stress. Good or bad, if it is a change in your life, it is stress as far as your body is concerned. Even imagined change is stress. (Imagining changes is what we call “worrying”.) If you fear that you will not have enough money to pay your rent, that is stress. If you worry that you may get fired, that is stress. If you think that you may receive a promotion at work, that is also stress (even though this would be a good change). Whether the event is good or bad, imagining changes in your life is stressful. Anything that causes change in your daily routine is stressful. Anything that causes change in your body health is stressful. Imagined changes are just as stressful as real changes.

Going one step further, stress is an internal process that occurs when a person is faced with a demand (produced by change) that is perceived to exceed the resources available to effectively respond to it, and where failure to effectively deal with the demand has important undesirable consequences. In other words, stress is experienced when there is an awareness of a substantial imbalance between demand and capability, under conditions where failure to meet the demand is perceived to have unwanted consequences. Perception and awareness of the imbalance between demand and capability, and the negative consequences of not meeting the demand is needed in order for the person to experience stress. The perception does not have to be accurate, however. A false belief can cause significant stress.

Going another step further, stress is any force that puts a psychological or physical factor beyond its range of stability, producing a strain within the individual. Knowledge that a stress is likely to occur constitutes a threat to the individual. A threat can cause a strain because of what it signifies to the person. Stress certainly involves a range of bodily reactions. Man is the product of many thousands of years of evolution, and to survive required a quick physical response to dangers. Stress is the body’s physical response to a perceived threat. In other words: stress is a response to danger. For stress to occur there must be a perception of some level of danger or threat. If there is no danger…there is no stress. The perception of danger is usually a result of evaluating the demands of a situation, identifying the resources you have to address it and realizing that you do not have enough resources to adequately meet the demands. This is the main feature of stress. The “fight or flight” response helps us escape from danger. For most of human history, danger came in the form of surprise encounters with predators. When faced with this danger a person had two options for survival: attack the predator (fight) or run away as fast as possible (flight). Although these are two different ways of addressing the situation, they both require the same physical response, which is to prepare the body for some intense physical activity. Once the stress response is activated, the body’s energy is diverted to where it is needed, thus heart rate, blood pressure and breathing rate increase. All non-essential body functions are temporarily shut down or operate at reduced level; these include digestion, growth, sexual systems (menstrual cycle, libido, and testosterone production), immune system, storage of energy as fat, etc. In response to threat, glucose, proteins and fats are rapidly released from storage (in muscles, fat cells and liver) and energy becomes abundantly available to those muscles which will help you fight the danger or run away from it. In extreme cases bowels and bladder will spontaneously evacuate to lighten the load; the smell may also help to deter the attacker. There is no point in digestion, reproduction and immune system etc continuing to operate if you’re likely to be the tiger’s dinner in the next ten minutes – better divert your energy into avoiding being on that menu. This response is hardwired into us for millions of years. Fortunately for our ancestors, once the predator was dead or safely out of range, they were able to sit down on a rock somewhere and relax. With the threat gone, the body would stop secreting adrenaline and cortisol and the person’s body would return to its normal state of equilibrium. The days of being chased by a predator are long gone, but the “fight or flight” response is still wired into us. Today’s threats and demands last much longer than what our ancestors were accustomed to. Going to school, getting a job, dealing with conflicts, managing finances, daily hassles and raising a family are only a few examples of long-lasting, stress-provoking situations. The body responds to these demands the same way it did when our ancestors were faced with a predator. Modern man has retained his hormonal and chemical defense mechanisms through the millennia. But for the most part, the lifestyle in the modern world today does not allow physical reaction to the stress agents we face. As researchers pointed out, attacking the boss, hitting an insolent customer, or smashing an empty automatic cash dispenser are not solutions allowed by contemporary society. Even the non-aggressive ‘flight’ reaction would hardly be judged appropriate in most situations. The executive who flees from a tense meeting, and the assembly worker who dashes out in the middle of a shift, will likely suffer the consequences of their actions. Our long-evolved defense mechanisms prepare us for dramatic and rapid action, but find little outlet. The body’s strong chemical and hormonal responses are then like frustrated politicians: all dressed up with nowhere to go. One example is sufficient. A pilot in charge of flying an aircraft is called the pilot in command. All pilot training involves coping with equipment failures and other emergencies. Emergencies can happen no matter how well-prepared and competent the pilot may be. When an emergency occurs, physiological changes resulting from the threat to life favor strong surges of energy in the large muscles, and they foster a narrow focus of attention on the “blood rage” necessary for survival. In a crisis, however, a pilot needs precise hand and foot movements—not gross physical strength—and he or she needs clear thinking—not the tunnel vision of rage. Consequently, the “natural” survival skills triggered by an emergency (fight/flight reaction) can actually contribute to a pilot losing control of the aircraft. Therefore, in order to manage an emergency, a pilot—or any person—needs a third option, a sort of “unnatural” option: not fleeing the problem, and not fighting the problem either, but taking command of it. In fact, it is this wasteful natural fight/flight response to stress may actually harm us. Keeping the body in a stimulated state of “fight or flight” for long periods of time contribute to health problems, but even a short period of stress can be detrimental to health.

All of the body’s ‘rev-up’ activity is designed to improve performance. But if the stress which launches this activity continues unabated, researchers believe, the human body begins to weaken as it is bombarded by stimulation and stress-related chemicals. As stress begins to take its toll on the body and mind, a variety of symptoms can result. Researchers have identified physical and behavioral symptoms of stress occurring before the onset of serious stress-related illnesses; these include: insomnia, eating difficulties, breathlessness without exertion, a tendency to sweat with no good reason, frequent intestinal difficulties, loss of sense of humor, constant irritability with people, difficulty with making decisions, suppressed anger, difficulty in concentrating, the inability to finish one task before rushing on to the next, and so on. Many of these symptoms are the prelude to more serious illnesses, in which stress is one of the risk factors. Recent research has shown that the psycho-social or stress risk factors can be found in hypertension, chronic fatigue syndrome, coronary artery disease, mental disorders, and a range of other illnesses; also suppression of immune responses by the stress-related hormones may provide chemical explanations of links between environmental & emotional pressures, and susceptibility to diseases.

For some people, stress is the feeling of being stretched to the breaking point, like a rubber band about to snap. For others, it is the events that lead to muscle tension, tightened fists, and clenched jaws. Researchers have defined it as the state in which individuals are faced with the need to make difficult or undesirable changes in order to adapt to events and situations in their lives. Under this definition, stress includes not only the body’s response to physical and psychological demands, but the mental, emotional, and behavioral responses as well. The demands may be highly significant–a death in the family, or the loss of a job, or taking part in armed combat. But more often they are the ordinary hassles we all experience in the course of our daily routine—a traffic jam, a disagreement with a colleague, a deadline at work, a day that just does not go as planned. It is the way we handle these demands that has a profound impact on our health and well-being. Not all stress is detrimental. Indeed, a certain amount of stress in life is desirable. It relieves monotony, spurs people toward worthwhile goals, and is an integral part of many pleasurable activities: the joy experienced with successful accomplishments. Stress is a common feature in all our lives. Even though, it’s often seen as a negative emotion, stress plays an important role in our survival. It helps us face threats and dangerous situations, gets us motivated and can even make us perform better. A little bit of stress is exciting—it keeps us active and alert. But chronic stress can have detrimental effects on health. You may not be able to control the stressors in your world, but you can alter your reaction to them. We all react to and cope with stress in different ways, and it’s these differences that determine whether or not stress becomes a negative force in your life. Stress is essentially an imbalance between the demands put on you and your ability to cope with these demands. Pressure can come from all sorts of places – from moving house to money worries to relationship problems. But most often, the biggest culprit is work. According to the Samaritans, one in five people get stressed on a daily basis, and the Health and Safety Executive reports that a third of all work-related illness is due to stress.

Stress is the physiological, psychological, emotional and behavioral response of a person seeking to adapt and adjust to internal and external pressures or demands. It is basically a physical survival response leading to a ‘flight-or-fight’ reaction. All living organisms – from plants, to animals, to humans – have a stress response. That’s why certain species have survived to this day. Stress is not a condition made up in the 21’st century. Stress is powerful because it’s been around so long. It is our stress reaction that allowed us as a species to survive. The humans who responded best to the stress of survival, are the ones still around today. The acute adaptation of the ‘flight-or-fight’ reaction was great for prehistoric man who fought mammoths, meteors and man-eating sabre-toothed tigers. Cavemen lived on the physiological edge. Today, we get the same unconscious reaction to stress. The response is engraved deep inside the old reptilian part of the brain we share with amphibians and reptiles. Confronted with a real physical threat to survival, the response is great. But faced with psychological threats often created in our own minds, is not so great. We take all these frequent little (and often not so little), daily stresses and we internalize them. There they accumulate, stew and erupt in destructive volcanoes of ‘disease’ after months or years of unrelieved stress buildup. We need to learn how to use our ‘new’ brain or neo cortex (actually millions of years old) more effectively to help us manage our stress and use it appropriately. While many people associate the term ‘stress’ with psychological stress, scientists and medical doctors use the term to describe anything that impairs the stability and balance (homeostasis) of the body.

For many people, stress is so commonplace that it has become a way of life. Stress isn’t always bad. In small doses, it can help you perform under pressure and motivate you to do your best. But when you’re constantly running in emergency mode, your mind and body pay the price. If you frequently find yourself feeling frazzled and overwhelmed, it’s time to take action to bring your nervous system back into balance. You can protect yourself by learning how to recognize the signs and symptoms of stress and taking steps to reduce its harmful effects. Your ability to tolerate stress depends on many factors, including the quality of your relationships, your general outlook on life, your emotional intelligence, and genetics.

The stress response process shown in the figure above consists of five stages.

Stage 1 is the environmental demand;

Stage 2 is the human’s perception of the environmental demand;

Stage 3 is the stress response to the environmental demand;

Stage 4 is the behavioral consequences of the stress response to the behavioral demand;

Stage 5 is the return to a homeostatic position.

Different people respond with different degrees of stress to different stressors, a fact which has dogged research. However, there are at least four factors which determine the degree to which one will feel stressed:

1) Control: a person feels stressed to the extent to which they perceive they are not in control of the stressor.

2) Predictability: a person feels stressed to the extent to which they are unable to predict the behavior or occurrence of the stressor.

3) Expectation: a person feels stressed to the extent to which they perceive their circumstances are not improving and will not improve.

4) Support: a person feels stressed to the extent to which they lack support systems, including work colleagues, management, personnel, union, partner, family, friends, colleagues, persons in authority, official bodies, professionals, and the law.

Not only different people respond differently to same stress but different species respond differently to same stress. For instance, whereas a polar bear would experience 25 °C as life threatening because it cannot dispose of its body heat and cooks itself to death when hunting, a Drosophila at the same temperature thrives near optimal. At temperatures below zero the roles naturally would be reversed. Therefore, environmental stress and the level of stress imposed can only be defined in relation to the organism or population experiencing this particular stress. In general, we expect organisms and populations to be the least stressed in the environment they experience most of the time, and to become increasingly stressed when they encounter environments, which are more alien to them.

Types of stress:

Stress is classified as acute stress or chronic stress, and positive stress (eustress) or negative stress (distress).

Stress can affect you both instantly (acute stress) and over time (chronic stress):

Acute (short-term) stress is the body’s instant response to any situation that seems demanding or dangerous. Your stress level depends on how intense the stress is, how long it lasts, and how you cope with the situation. Most of the time, your body recovers quickly from acute stress. But stress can cause problems if it happens too often or if your body doesn’t have a chance to recover. In people with heart problems, acute stress can trigger an abnormal heartbeat (arrhythmia) or even a heart attack. In acute stress, the mind and body respond with a fight or flight response that involves activation of the sympathetic nervous system and release of stress hormones such as cortisol. Psychologically, this increases the organism’s alertness and response time. Physiologically, these changes provide the organism with the energy needed to meet the emergency. Such intense activation helps the organism in the short term, but prolonged activation of this system creates problems in that it may increase the risk of certain disease states, and once set into motion, chronic stress responses may be difficult to extinguish. Alternatively, a severe acute stressor may result in a stress-response syndrome such as an acute stress disorder or a post-traumatic stress disorder (PTSD).

An acute stressor or psychological trauma, such as a life-threatening circumstance, presents a person with new information that may be difficult to assimilate. In an attempt to adapt, the person will typically alternate between contemplation of the stressor and avoidance of reminders of the event. Such a cycle allows for dose-by-dose psychological processing of the event. Difficulties in adaptation may present as an acute stress disorder that manifests itself as an extreme version of this cycle. People with such a disorder may have intrusive remembrances, nightmares, or even flashbacks of the stress event. These can alternate with emotional numbing, interpersonal alienation, and extreme avoidance of traumatic reminders. A diagnosis of post-traumatic stress disorder (PTSD) is made if these symptoms persist longer than one month (vide infra).

Chronic (long-term) stress is caused by stressful situations or events that last over a long period of time. This could include having a difficult job or dealing with a chronic disease. If you already have a health problem, stress can make it worse. Chronic stress kills through suicide, violence, heart attack, stroke and perhaps, even cancer. People wear down to a final, fatal breakdown. Because physical and mental resources are depleted through long-term attrition, the symptoms of chronic stress are difficult to treat and may require extended medical as well as behavioral treatment and stress management.

Chronic stress is the response to emotional pressure suffered for a prolonged period over which an individual perceives he or she has no control. It involves an endocrine system response in which occurs a release of corticosteroids. If this continues for a long time, it can cause damage to an individual’s physical and mental health. Animals exposed to distressing events over which they have no control, respond by releasing of corticosteroids. These, if prolonged, lead to structural changes in their brains. Changes happen to neurons and their synapses in the hippocampus and medial prefrontal cortex. These produce impairments in working memory, spatial memory, and increased aggression. Linked to impairment of the medial prefrontal cortex are deficits in the part of the striatum with which it is linked. This can bias decision-making strategies, as affected individuals shift from flexible behavior to one dominated by habit. Changes also occur to dopaminergic activity in the prefrontal cortex.

Positive stress (eustress) and negative stress (distress):

Eustress is a stress that helps a person perform at a higher level and achieve their goals.

Distress is a stress that is overwhelming and hinders performance and overall well-being.

Where stress enhances function (physical or mental, such as through strength training or challenging work), it may be considered eustress. Persistent stress that is not resolved through coping or adaptation, deemed distress, may lead to anxiety or withdrawal (depression) behavior. Positive stress is the result of good management and excellent leadership where everyone works hard, is kept informed and involved, and importantly, is valued and supported. People feel in control. Negative stress is the result of a bullying climate where threat and coercion substitute for non-existent management skills. When people use the word “stress” on its own, they usually mean “negative stress”.

Stress is a word used to describe experiences that are challenging emotionally and physiologically. “Good stress,” in the popular jargon, generally refers to those experiences that are of limited duration and that a person can master and which leave a sense of exhilaration and accomplishment, whereas “bad stress” or “being stressed out,” in the vernacular, refers to experiences where a sense of control and mastery is lacking and which are often prolonged or recurrent, irritating, emotionally draining, and physically exhausting or dangerous.

The words ‘positive’ and ‘stress’ may not often go together. But, there are innumerable instances of athletes rising to the challenge of stress and achieving the unachievable, scientists stressing themselves out over a point to bring into light the most unthinkable secrets of the phenomenal world, and likewise a painter, a composer or a writer producing the best paintings, the most lilting of tunes or the most appealing piece of writing by pushing themselves to the limit. Psychologists second the opinion that some ‘stress’ situations can actually boost our inner potential and can be creatively helpful. My life is classical example of stress stimulating creativity as I took stresses of my life as challenge and not adversary. Most people do not think in a way I think and therefore consider stress as adversary which stifles their creativity.

Experts tell us that stress, in moderate doses, are necessary in our life. Stress responses are one of our body’s best defense systems against outer and inner dangers. In a risky situation (in case of accident or sudden attack on life etc), body releases stress hormones that instantly make us more alert and our senses become more focused. The body is also prepared to act with increased strength and speed in a pressure situation. It is supposed to keep us sharp and ready for action. Research suggests that stress can actually increase our performance. Instead of wilting under stress, one can use it as an impetus to achieve success. Stress can stimulate one’s faculties to delve deep into and discover one’s true potential. Under stress the brain is emotionally and biochemically stimulated to sharpen its performance. Stress is, perhaps, necessary to occasionally clear cobwebs from our thinking. If approached positively, stress can help us evolve as a person by letting go of unwanted thoughts and principle in our life. Very often, at various crossroads of life, stress may remind you of the transitory nature of your experiences, and may prod you to look for the true happiness of life.

Stress is part of life in a fast-paced society. However, contrary to popular belief, stress is not always bad. We need some stress to stimulate us. A certain level of stress is beneficial. This type of stress is called eustress. It helps us to set and achieve goals as well as perform at a higher level. For example, the demands of an upcoming competition, work project or exam can create stress, which stimulates a person to work harder to win the competition, finish the project on time or do well on the exam. However, there are times when stress is overwhelming. This type of stress—called distress—paralyses rather than stimulates. It contributes to decreased health and well-being. In fact, stress is a factor in 11 of the top 15 causes of death in Canada and is a significant reason for physician visits. Therefore, an important part of healthy living is to learn to bring stress to beneficial levels.

Is all stress bad for you? Not at all.

We need stress to thrive, excel and enjoy life. This is called positive stress. But even positive stress can become negative if not balanced and managed correctly. Our goal is to aim for a positive-stress phase.

Signs of positive stress

1)Increased creativity – not only in making or creating things, but also in developing new ways to solve problems or finding better ways of doing things.

2) Increased productivity at work and on a personal level.

3) A general feeling of wellbeing, happiness and joy – which is how we should feel. It is our birthright to lead happy, fulfilled lives during our physical sojourn on earth.

4) An immune system that functions optimally, with an increased resistance to infections and cancer. Even if you’re surrounded by people with all kinds of germs, you simply don’t become ill.

A mild degree of stress and tension is good for us. Feeling stressed and pressurized when completing an assignment, often motivates us to do a good job. Moderate exercising can produce temporary stress on some body systems, but its health benefits are indisputable. It is only when stress is overwhelming, or poorly managed, that its negative effects will manifest. The goal of dealing with stress is not at all to eliminate it or even reduce it. Stress management and relaxation techniques help you to manage and control your daily stress, to ensure mental, physical and emotional well being.

One of the problems in talking about stress is the subtle difference between stress and stretch. It is widely accepted that a degree of pressure is essential for good performance at work but there is a danger that the pressure may get too intense and the quality of work thereby suffer. Eustress is the enthusing and challenging pressure which leads to enhanced performance while distress is the overburdening pressure that leads to depression, fatigue and, ultimately, illness and collapse. The problem is knowing when the former becomes the latter for each individual person. As illustrated in the diagram below, increased stress results in increased productivity – up to a point, after which things go rapidly downhill. However, that point or peak differs for each of us, so you need to be sensitive to the early warning symptoms and signs that suggest a stress overload is starting to push you over the hump. Such signals also differ for each of us and can be so subtle that they are often ignored until it is too late. Not infrequently, others are aware that you may be headed for trouble before you are.

The above diagram illustrates some important points:

1) Increased stress produces increased performance, initially.

2) Once you pass a certain point (the hump), any more stress results in decreased performance. Trying harder at this point is unproductive or even counterproductive. The only sensible move is to take a break.

3) We need a certain amount of stress to function well (healthy tension) – this is called eustress (good stress). However, stress becomes harmful (distress) when there is too much, when it lasts too long or when it occurs too often.

4) One of the first symptoms of distress is fatigue, which we tend to ignore. We should have a healthy respect for fatigue and doing something about it before it becomes exhaustion.

Let me put it differently.

The graph below shows how health, happiness and productivity depend on your level of stress:

We all know that too much stress is bad for us, that it wrecks our health and our relationships and makes us miserable. But too little stress is just as harmful. Life becomes dull and meaningless, and that causes its own health and performance problems. Just the right amount of stress, the optimal amount for you, and you feel challenged, fully alive and at your personal best. So instead of trying to eliminate stress, make it work for you and think in terms of optimizing it.

When does stress become distress in animal experiments?

Distress is an aversive state in which an animal is unable to adapt completely to stressors & the resulting stress and shows maladaptive behaviors. It can be evident in the presence of various experimental or environmental phenomena, such as abnormal feeding, absence or diminution of postprandial grooming, inappropriate social interaction with conspecifics or handlers (e.g., aggression, passivity, or withdrawal), and inefficient reproduction. Distress can also result in pathologic conditions that are not directly evident in behavior, such as gastric and intestinal lesions, hypertension, and immunosuppression. Maladaptive responses that briefly reduce an animal’s distress can be reinforced and thus become permanent parts of the animal’s repertoire and seriously threaten its well-being. Generally, any behavior that relieves the intensity of distress is likely to become habitual, regardless of its long-term effects on an animal’s well-being. Examples of such behaviors are coprophagy, hair-pulling, self-biting, and repetitive stereotyped movements.

An attempt to graphically depict the relationship between distress and welfare is shown in the figure below. Whereas minor perturbations (e.g., short-term restraint of a rodent) affect an animal’s welfare in terms of its moment-to-moment emotional state, they do not impair its adaptive capacity and thus do not cause distress. In contrast, a major homeostatic disruption (e.g., postsurgical infection), which causes measurable behavioral (withdrawal) and physiological (fever) changes that impair the adaptive capacity of the animal, is considered “distressful” and is indicative of “poor welfare”.

The above picture depicts relationship of stress, distress, adaptive capacity, and animal welfare. An animal’s quality of life may be progressively deteriorating while it is still successfully coping with a stressor. The precise moment of transition to the maladaptive state or what precipitates it is unknown, but once the tipping point is attained, the deterioration into a severely sick or debilitated animal occurs fairly quickly. At this point, welfare conditions are very poor and immediate ameliorative action is necessary.

The use of reserve resources to cope with prolonged or severe stress has a negative impact on other bodily functions (including behavior) and leads to distress. In the hypothetical scheme depicted in the figure below, the “biological cost of distress” requires a prolonged recovery period to revert to homeostasis.

Prolonged or severe stress depletes bodily reserves and affects normal functions thus requiring extended time to revert to homeostasis. During the recovery period, the animal’s well-being and welfare are compromised and the period of distress will last until the biological resources are sufficiently replenished. The shift in biological resources, such as stunted growth in distressed young animals, or evidence of maladaptive behaviors that occur in this general scheme of transition to and establishment of distress could be useful in recognizing distress.

Stress and distress are dissociable concepts, distinguished by an animal’s ability or inability to cope or adapt to changes in its immediate environment and experience. Stress responses are normal reactions to environmental or internal perturbations and can be considered adaptive in nature. Distress occurs when stress is severe, prolonged, or both. The concepts of stress and distress can be distinguished from that of welfare, in that an adaptive and beneficial stress response may occur against a backdrop of a transient negative emotional state. Both stress and distress represent potential complications in a wide range of experiments, and should be proactively addressed by good experimental design.

Stressors:

Stress is the effect produced by external (i.e., physical or environmental) events or internal (i.e., physiological or psychological) factors, referred to as stressors, which induce an alteration in an animal’s biologic equilibrium. When a covert or overt response of an animal to a stressor is adaptive, the animal returns toward a state of comfort. Responses to stressors often involve changes in physiologic function (biochemical, endocrinologic, or autonomic), psychologic state, and behavior. An animal’s response can vary according to its age, sex, experience, genetic profile, and present physiologic and psychologic state. Stress might not be harmful to an animal; it might evoke responses that neither improve nor threaten an animal’s well-being. In some cases, environmental alterations that induce stress also initiate responses that have potential beneficial effects. Some stress probably is necessary for well-being, if adaptation occurs with a reasonable expenditure of energy. Whether stress and the responses or behaviors it induces should be considered adaptive should be based on professional evaluation and judgment.

Stress is a term we use to explain the experience felt in mind and body when we encounter, respond or react to challenging life stressors. The scale of the reaction known as the ‘stress response’ is determined primarily by how we perceive the stressful event, our ability to cope with the stressor, and by the scale of the event. How an individual perceives and handles stress therefore plays a major role in determining their well being. Life stressors can be physical, mental or emotional stimuli, and include both imaginary and real events. The ‘stress response’ has a very physical component that is mediated via complex interactions between the nervous, hormonal and immune systems.

Historically, the definition of stress has emphasized physiologic characteristics, especially those related to neuroendocrine systems. However, it is now known that physiologic measures of stress might not be highly intercorrelated. Differences among physiologic measures in their relation to eliciting stimuli, time course, and adaptive implications have led most scientists to conclude that stress is not a discrete, well-defined physiologic state. Stress remains a useful descriptor nonetheless: it provides a convenient means of identifying, describing, and summarizing important phenomena. For example, it is generally agreed that some environmental conditions or events can act as stressors, cause pronounced or persistent stress in an organism, and lead to alterations in neuroendocrine activities. The neuroendocrine changes can in some instances be severe enough to place the organism in a state of vulnerability to dysfunction or disease, although its behavior might not differ markedly from that typical of its species and might not yet have become maladaptive. Although there is no single measure or manifestation of such a state, some of the pathways and mechanisms through which it is brought about are reasonably well understood. Departures from a normal level of neuroendocrine activity can be considered as one kind of evidence of stress, and anything internal or external that can cause such departure is a stressor.

One view is to define a stressor as an environmental event causing a negative outcome, such as a disease. Another approach is to view stressors as virtually any challenge to homeostasis and to regard disease processes as a failure of the normal operation of adaptive mechanisms, which are part of the stress response. With either view, it is necessary to include psychological stressors, such as fear, that contain implied threats to homeostasis and that evoke psychosomatic reactions. These are reactions that involve changes in neural and hormonal output caused by psychological stress. Psychosomatic reactions may lead to adaptive responses, or they may exacerbate disease processes. Whether the emphasis is on adaptation or disease, it is essential to understand the processes in the brain that are activated by stressors and that influence functions in the body.

The causes of stress can include any event or occurrence that a person considers a threat to his or her coping strategies or resources. Researchers generally agree that a certain degree of stress is a normal part of a living organism’s response to the inevitable changes in its physical or social environment, and that positive as well as negative events can generate stress. Stress-related disease, however, results from excessive and prolonged demands on an organism’s coping resources. It is now believed that 80-90% of all diseases are stress-related.

One cause of stress that has affected large sectors of the general population around the world since 2001 is terrorism. The events of September 11, 2001, the Bali nightclub bombing in 2002, the suicide bombings in the Middle East in 2003 as well as numerous terrorist attacks on London, Madrid and Mumbai have all been shown to cause short-term symptoms of stress in people who read about them or watch television news reports as well as those who witnessed the actual events. Stress related to terrorist attacks also appears to affect people in countries far from the location of the attack as well as those in the immediate vicinity. It is too soon to tell how stress related to episodes of terrorism will affect human health over long periods of time, but researchers are already beginning to investigate this question. In 2004 the Centers for Disease Control and Prevention (CDC) released a report on the aftereffects of the World Trade Center attacks on rescue & recovery workers and volunteers. The researchers found that over half the 11,700 people who were interviewed met threshold criteria for a mental health evaluation. A longer-term evaluation of these workers is underway.

Examples of potential stressors:

That Cause Physiologic Stress		That Cause Psychological Stress	That Cause Environmental Stress
Injury	} pain	Fear	Restraint
Surgery		Anxiety	Noise
Disease		Boredom	Odors
Starvation		Loneliness	Habitat
Dehydration		Separation	Ecology
			People
			Other species
			Chemicals
			Pheromones
Note that pain is shown as resulting from physiologic stressors. It could also result from environmental stressors (e.g., chemical) and be potentiated by psychological stressors (e.g., fear).

The situations and pressures that cause stress are known as stressors. We usually think of stressors as being negative, such as an exhausting work schedule or a rocky relationship. However, anything that puts high demands on you or forces you to adjust can be stressful. This includes positive events such as getting married, buying a house, going to college, or receiving a promotion. What causes stress depends, at least in part, on your perception of it. Something that’s stressful to you may not faze someone else; they may even enjoy it. For example, your morning commute may make you anxious and tense because you worry that traffic will make you late. Others, however, may find the trip relaxing because they allow more than enough time and enjoy listening to music while they drive. In general, stress is related to both external and internal factors. External factors include the physical environment, including job, relationships with others, and all the situations, challenges, difficulties, and expectations a person is confronted with on a daily basis. Internal factors determine the body’s ability of a person to respond to, and deal with, the external stress-inducing factors. Some of these internal factors which can influence a person’s ability to handle stress include his nutritional status, overall health and fitness levels, emotional well-being, and the amount of sleep and rest you get.

Here are some of the stressors in your life. External stressors are events and situations that happen to you. Some examples of external stressors include:

1) Physical environment: Bright lights, noise, heat, cold, weather, traffic…

2)Social/relational: Rudeness or aggressiveness in others, conflicts with others, not spending enough time with important people, lack of social support, relationship issues, family changes, sexuality, loneliness and social phobia, loneliness…

3) Financial: Taxes, bills, unplanned expenses, “making ends meet”…

4) Organizational: Rules, regulations, school or work deadlines, getting a passing grade, bureaucracy, school or work culture…

5) Life events: Death of a family member, loss of a job, illness, starting university, work promotion, birth of a child, marriage, divorce, winning the lottery…

6) Lifestyle choices: Not enough sleep; poor time management; physical inactivity,.

7) Physiological: Poor health, physical illness, pregnancy, injury…

8) Trauma such as sexual abuse, earthquakes and military combat.

9) Nutritional factors such as poor eating habits, poor nutritional intake and dieting.

10) Substance abuse such as caffeine, alcohol, medications, smoking and drugs.

11) Socio-economic stressors such as malnutrition, poverty, racism, casteism etc.

Not all stress is caused by external factors. One of the biggest causes of stress in our lives is our beliefs, our attitudes, and our thoughts! Stress can also be self-generated as depicted in table below:

Inability to accept uncertainty

Pessimism

Negative self-talk

Unrealistic expectation

Perfectionism

Lack of assertiveness

Internal stressors:

Not all stress stems from things that happen to you. Much of our stress response is self-induced. Those feelings and thoughts that pop into your head and cause you unrest are known as internal stressors. Examples of internal stressors include:

1) Fears: Common ones include fear of flying, fear of heights and fear of public speaking.

2) Uncertainty: Few people enjoy not knowing what might happen. Think about how you might react when waiting for the results of a medical test.

3) Beliefs: These might be attitudes, opinions or expectations. You may not even think about how your beliefs shape your experience, but these preset thoughts often set us up for stress. Consider the expectations you put on yourself to create a perfect holiday celebration or advance up the career ladder.

The good news is that we have the ability to control our thoughts. The bad news is that our fears, attitudes and expectations have been our companions for a long time and it often takes some effort to change them.

What’s stressful for you?

What’s stressful for you may be quite different from what’s stressful to someone else. Although often cited as the main causes of stress, it is believed that stressors, as listed above, are really not the leading causes of stress. Because what’s seems stressful for one person may not be so for another. Consider these for example:

1) Some people enjoy speaking in public; others are terrified.

2) Some people are more productive under deadline pressure; others are miserably tense.

3) Some people are eager to help family and friends through difficult times; others find it very stressful.

4) Some people feel comfortable complaining about bad service in a restaurant; others find it so difficult to complain that they prefer to suffer in silence.

5) Some people may feel that changes at work represent a welcome opportunity; others worry about whether they’ll be able to cope.

If stressors are really the main or biggest causes of stress, their effects on people would be the same but that was not the case. As such, something else that is within the person must have caused the stress observed instead. And the main culprit is in fact believed to be……..”The negative reaction within people”. It all boils down to the way that people choose to react to external stressors that is the main causes of stress. Choose to look at them in a positive way and you would feel happier and better but if you choose to see the negative side of it, then they will end up as stress. It’s really that simple!

The Family Stress Model:

The Family Stress Model says that family poverty consists of low income, economic pressure and difficulties created by lack of money (i.e., being unable to pay monthly bills). As welfare states became less generous over the time, poor families were increasingly expected to seek employment income and/or to upgrade their educational qualifications, leading to a complex juggling of work and domestic responsibilities for those with children. According to family stress model, this contributes to emotional distress (e.g., depression) and family dysfunction. Family distress causes problems in the relationship between adults that are, in turn, linked to less effective parenting—a complex notion that involves insufficient surveillance, lack of control over the child’s behavior, lack of warmth and support, inconsistency, and displays of aggression or hostility by parents or older siblings.

Child outcomes of high levels of family stress and ineffective forms of parenting include poor emotional adjustment, which may be externalized as various forms of aggression, or internalized as depression or low self-esteem. Healthy child adjustment, on the other hand, should emerge as achievement and on-task behavior in school, persistence in difficult tasks, and enjoyment of daily life. The Family Stress Model is supported by good evidence from respected psychologists and sociologists. Research findings from as long ago as the depression years of the 1930s, suggests that children were protected from the possible adverse consequences of poverty so long as the relationship between adult caregivers was supportive and stable.

Stress signs:

Stress signs & symptoms could be emotional, physical, mental, behavioral and even anti-social. The table below depicts few of the signs of stress and if you have any one of them, you could be stressed.

Physical signs	Increased heart rate; Dry mouth; Muscle aches, stiffness or pain (especially in the neck, shoulders and lower back); High blood pressure; Frequent colds or flu Worsening of an existing illness (asthma, skin rashes etc.); Chest pains; Headaches; Indigestion; Constipation; Heartburn, gas; Sweating; Nausea; Trembling; Fatigue; Weight gain or loss; Sleep disturbances; Irritable bowel syndrome; Hair loss; Periodontal disease, jaw pain; Reproductive problems; Growth inhibition.
Behavioral signs	Increased smoking; Drinking alcohol; Drug use; Yelling; Swearing; Aggression; Social withdrawal; Changes in eating habits (increase or decrease); Changes in sleeping habits (increase or decrease); Nervousness (nail biting, fidgeting, pacing etc.);
Mental signs	Difficulty concentrating; Decreased memory; Poor judgment; Seeing only the negative; Difficulty making decisions; Mind going blank or mind racing; Confusion; Loss of sense of humor; Decreased libido; Inattentiveness; Bad dreams; Depression.
Emotional signs	Anxiety; Anger; Irritability; Impatience; Frustration; Worry; Fear; Phobias.
Anti-social signs	Increased arguments; Road rage; Isolation from social activities; Domestic or workplace violence; Conflict with co-workers or employers; Overreactions; Frequent job changes.

Indeed, stress symptoms can affect your body, your thoughts and feelings, and your behavior. Being able to recognize common stress symptoms can give you a jump on managing them. Stress that’s left unchecked can contribute to health problems such as high blood pressure, heart disease, obesity and diabetes. Of course, if you’re not sure if stress is the cause or if you’ve taken steps to control your stress but your symptoms continue, see your doctor. Your doctor may want to check for other potential causes. Keep in mind that the signs and symptoms of stress can also be caused by other psychological and medical problems. If you’re experiencing any of the warning signs of stress, it’s important to see a doctor for a full evaluation. Your doctor can help you determine whether or not your symptoms are stress-related. Effects of stress on personality include shattered self-confidence & self-esteem, low self-image, loss of self-worth & self-love.

Who’s most at risk?

People with the following conditions or characteristics are at a higher-than-average risk for developing a stress disorder:

1) Men are at greater risk than women

2) Older people and children

3) People with the following personality traits: neurotic, extroverted, poor self-confidence, past history of psychiatric problems

4) Genetic predisposition

5) Guilt or shame

6) Lack of social support or financial security

7) Early separation from parents, childhood neglect/abuse

8) Alcoholic parents

9) Poverty

10) People who are target of racial/casteist/religious discrimination etc.

Physical Effects of Stress on the Internal Systems:

The American Psychological Association has summarized the most common physical effects of stress on the internal systems of human’s body.

Nervous System:

When stressed physically or psychologically, the body suddenly shifts its energy resources to fighting off the perceived threat. In what is known as fight or flight response, the sympathetic nervous system signals the adrenal glands to release adrenaline and cortisol. These hormones make the heart beat faster, raise blood pressure, change the digestive process and boost glucose levels in the bloodstream. Once the crisis passes the systems usually return to normal.

Musculoskeletal System:

Under stress muscles tense up. The contraction of muscles for extended periods can trigger tension headaches, migraines and various musculoskeletal conditions.

Respiratory System:

Stress can make you breathe harder and cause rapid breathing, which can bring on panic attacks in some people.

Cardiovascular System:

Acute stress – stress that is momentary, such as being stuck in the traffic – cause an increase in heart rate and stronger contractions of the heart muscle. Blood vessels that direct blood to the large muscles and to the heart dilate, increasing the amount of blood pumped to these parts of the body. Repeated episodes of stress can cause inflammation in the coronary arteries, thought to lead to heart attack.

Endocrine System:

When the body is stressed the brain sends signals from the hypothalamus, causing the adrenal cortex to produce cortisol and the adrenal medulla to produce epinephrine – sometimes called “stress hormones”. When cortisol and epinephrine are released, the liver produces more glucose, a blood sugar that would give you the necessary energy to fight or flight in an emergency.

Gastrointestinal System:

Esophagus-
Stress may prompt you to eat more or much less than you usually do. If you eat more or different foods or increase your use of tobacco or alcohol you may experience heartburn or acid reflux.

Stomach-
Your stomach may react with “butterflies” or even nausea or pain. You can vomit if the stress is severe enough. Stress can result in hyperacidity and peptic ulcer.

Bowels-
Stress can affect digestion and which nutrients your intestines absorb. It can also affect how quickly the food moves through your body. You may find that you have diarrhea or constipation.

Reproductive System:

In men excess levels of cortisol, produced under stress, can affect the normal functioning of the reproductive system. Chronic stress can impair testosterone and sperm production and cause impotence. In women stress cause absent or irregular menstrual cycles or more painful periods. It can also reduce sexual desire.

Immune system:

The immune system is the internal system which is designed to protect us from any external bodies (viruses or bacteria). It costs a lot to the body meaning that it has very high energy usage. Under stress your body needs energy to run or fight! This is why it changes its chemistry to suppress the immune system. This is why we usually get ill before or after exams or big challenges at work.

Psychological Effects of Stress:

Aggression:
This is an emotional state of anger towards you, another person or sometimes towards the whole world. Usually you can assess this state as wrong but you cannot stop it. It is stronger than you and keeps manifesting day after day.
Apathy:
This is a feeling that you don’t care about anything and you don’t want to do anything. The apathetic person is not interested in the events around or in the future and cannot do anything to protect themselves in case of a danger.
Guilt:
This is a feeling which comes when we have already done or want to do something which we classify as wrong. Often the thought which results in guilt might be unconscious.
Depression:
Depression is a state in which you are sad and feel that you cannot enjoy anything because your situation is so difficult and unpleasant. Present and future look so dark and obscure resulting in suspicions and fears suppressing the pleasure from the usual simple things.
Nightmares:
Those are the bad dreams you often have. Some people dream exactly the same dream many times, which might result in states of chronic fears and depression.
Bad mood:
Bad mood and lack of mood at all are the slighter forms of apathy and depression. They are not so unpleasant and usually manifest as unwillingness to talk and share or indifference towards any undertakings of the team.
Tension:
This is the feeling coming with the strong will to do something even if it is not so clear what exactly. It comes because you are ready to do something but at this very moment you either cannot or do not have the resources needed.
Inability to focus:
This feeling is similar to forgetting facts for short period of time. You know that something has just gone through your mind but cannot recollect it. It is there but you cannot use it immediately… Or you listen to somebody and until he finishes his sentence you have already forgotten the beginning.
Low self esteem:
This is the feeling that you are good for nothing and cannot do anything of true value. All others look better to you and more skillful to do their job.
Irritability:
You are easily annoyed and feel irritated by everything and by everybody. You think that everything you are told is wrong and think how come the person in front of you is so blind to not see it?!
Disappointment:
It is the state of feeling rather sad because something has not happened or something is not as good as you hoped. Disappointment comes also when you have been denied something you want or need. It may come when you just feel helpless to do anything.
Loneliness:
This is the unhappiness because you do not have any friends or do not have anyone to talk to. It is the feeling that you are isolated by your relatives, friends and colleagues. Often you feel that nobody cares about or understands your problems and worries.
Being worried:
You keep thinking about problems of yours or about problems that might happen; you feel scared with no specific or direct threat. When you are worried you are also anxious, tensed, and irascible; you cannot focus, feel unhappy, cannot sleep or have nightmares.
Tiredness:
If you feel tired, you want to rest or sleep. Tiredness is natural consequence of long working hours or conflicts and is one of the most common physical effects of stress. If tiredness becomes chronic it is a sure signal that our body cannot restore effectively from stress.

Neurobiology of stress:

The limbic system is made up of the amygdala, the hippocampus, the cingulate gyrus, fornicate gyrus, hypothalamus, mammillary body, epithalamus, nucleus accumbens, orbitofrontal cortex, parahippocampal gyrus, and thalamus. These structures work together to process emotions, motivation, the regulation of memories, the interface between emotional states and memory of events, the regulation of breathing and heart rate, the production of hormones, the “ fight or flight ” response, sexual arousal, circadian rhythms, and some decision — making systems. The limbic system is part of the old brain and developed first evolutionarily, followed by the new brain: the cortex, which is sometimes referred to as the neocortex. Put very simply, the limbic system feels and remembers; the cortex acts and reacts. And they communicate with each other. The limbic system figures prominently in what is called the stress response. These days, both our old and new brains are activated when we are under stress. The primitive part, the limbic system (notably the hippocampus), sniffs out danger well before the new brain (the neocortex) actually processes it. The old brain responds first, acting as a sort of fire alarm system. It is the neocortex, and in particular, the frontal lobe (the pre-frontal cortex), that helps us make sense of the alarms. The prefrontal cortex is responsible for planning complex cognitive behaviors, the expression of personality, decision making, and social behavior, as well as the orchestration of thoughts and actions necessary for a person to carry out goals. In humans and other primates, an area located at the forward part of the prefrontal cortex is called the orbitofrontal cortex. It gets its name from its position immediately above the orbits, the sockets in which the eyes are located. The orbitofrontal cortex is very involved in interpreting rewards, decision making, and processing social and emotional information. For this reason, some consider it to be a part of the limbic system even though it is part of prefrontal cortex. The amygdala, a part of the limbic system, is a brain structure that is responsible for decoding emotions, especially those the brain perceives as threats. As we evolved as a species, many of our alarm circuits have been grouped together in the amygdala. Not surprisingly, many regions of the brain send neurons into the amygdala. As a result, lots of sensory messages travel instantaneously to the amygdala to inform it of potential dangers lurking in our neighborhood. The amygdala is our guard dog. The amygdala is directly wired to the hippocampus, also a part of the limbic system. Since the hippocampus is involved in storing and retrieving explicit memories, it feeds the amygdala with strong emotions triggered by these recollections. The amygdala is also wired to the medial prefrontal cortex. This two – way communication between the prefrontal cortex and the limbic system (particularly the amygdala) enables us to exercise conscious control over our anxiety. The emotion — cognition connection allows us to feel that we can do something about the danger that lies ahead. The brain not only allows us to imagine a negative outcome, which can help us avoid danger, it makes it possible for us to imagine dangers that do not actually exist. The thalamus, another part of the limbic system, sits on top of the hypothalamus which, in turn, sits on top of the brain stem, which is in the center of the base of the brain. This is a great location for the thalamus because it acts as a relay system that sends nerve fibers upstairs to all parts of the cerebral cortex as well as many sub-cortical (underneath the cortex) parts of the brain. The thalamus receives information from every sensory organ and its associated neurons except the olfactory (smell) system. The hypothalamus gets information from the eyes, the ears, the skin, and the tongue, and it forwards these messages to the corresponding areas of the cortex where they are processed. In terms of stress, this relay system is how the brain knows that it’s in a dangerous environment.

The brain is the key organ of the response to stress because it determines what is threatening and, therefore, potentially stressful, as well as the physiological and behavioral responses which can be either adaptive or damaging. Stress involves two-way communication between the brain and the cardiovascular, immune, and other systems via neural and endocrine mechanisms. Beyond the “flight-or-fight” response to acute stress, there are events in daily life that produce a type of chronic stress and lead over time to wear and tear on the body (“allostatic load”). Yet, hormones associated with stress protect the body in the short-run and promote adaptation (“allostasis”). The brain is itself a target of stress, and the hippocampus was the first brain region, besides the hypothalamus, to be recognized as a target of cortisol. Researchers have also discovered that chronic stress induces impairment of spatial working memory because of prefrontal dopaminergic dysfunction. Stress and stress hormones produce both adaptive and maladaptive effects on these brain regions throughout the life course. Early life events influence life-long patterns of emotionality and stress responsiveness and alter the rate of brain & body aging. The hippocampus, amygdala, and prefrontal cortex undergo stress-induced structural remodeling, which alters behavioral and physiological responses. As an adjunct to pharmaceutical therapy, social and behavioral interventions such as regular physical activity and social support reduce the chronic stress burden and benefit brain & body health & resilience.

A hallmark of the stress response is the activation of the autonomic nervous system and hypothalamo-pituitary-adrenal (HPA) axis, and the “fight-or-flight” response is the classical way of envisioning the behavioral and physiological response to a threat from a dangerous situation, be it a predator, a mugger, an accident, or natural disaster. The organism needs the normal stress hormone response to survive such situations, and inadequate or excessive adrenocortical and autonomic function is deleterious for health and survival. Yet, unlike zebras, who don’t get ulcers because they do not worry, human beings are prone to prolonged periods of elevated activity of the same systems which help us survive more acute challenges. This prolonged elevation may be due to anxiety; to constant exposure to adverse environments involving such irritants as noise, pollution, and interpersonal conflict; and to changes in life-style and health-related behaviors that result from being under chronic stress.

In response to a stressor, neurons with cell bodies in the paraventricular nuclei (PVN) of the hypothalamus secrete corticotropin-releasing hormone (CRH) and arginine-vasopressin (AVP) into the hypophyseal portal system. The locus ceruleus and other noradrenergic cell groups of the adrenal medulla and pons, collectively known as the LC/NE system, also become active and use brain epinephrine to execute autonomic and neuroendocrine responses, serving as a global alarm system. The autonomic nervous system provides the rapid response to stress commonly known as the fight-or-flight response, engaging the sympathetic nervous system (SNS) and withdrawing the parasympathetic nervous system (PNS), thereby enacting cardiovascular, respiratory, gastrointestinal, renal, and endocrine changes. The HPA axis, a major part of the neuroendocrine system involving the interactions of the hypothalamus, the pituitary gland, and the adrenal glands, is also activated releasing CRH and AVP. This results in release of adrenocorticotropic hormone (ACTH) from the pituitary into the general bloodstream, which results in secretion of cortisol from the adrenal cortex. This cortisol involves the whole body in the organism’s response to stress and ultimately contribute to the termination of the response via inhibitory feedback.

The two main systems involved are the hypothalamic-pituitary-adrenal (HPA) axis and the sympathetic nervous system (SNS). Triggered (activated) primarily by an area in the brain stem (lowest part of brain) called the locus coeruleus, the SNS secretes epinephrine and norepinephrine. The HPA axis is a grouping of responses to stress by the brain and the pituitary and adrenal glands to release the stress hormones, particularly cortisol, which is a corticosteroid hormone. Cortisol increases the availability of the body’s fuel supply (carbohydrate, fat, and glucose), which is needed to respond to stress. The following are the five most important concepts to remember about these two systems SNS & HPA:

1) They are governed by a feedback loop to regulate their response. (In a feedback loop, increased amounts of a substance — for example, a hormone — inhibit the release of more of that substance, while decreased amounts of the substance stimulate the release of more of that substance.)

2) They interact with each other.
3) They influence other brain systems and functions.

4) Genetic (inherited) variability affects the responses of both systems. (That is, depending on their genes, different people can respond differently to similar stresses.)

5) Prolonged or overwhelming responses of these systems can be harmful to an individual.

Healthy human responses to stress involve three components:

1) The brain handles (mediates) the immediate response. This response signals the adrenal medulla to release epinephrine and norepinephrine (SNS response).

2) The hypothalamus (a central area in the brain) and the pituitary gland initiate (trigger) the slower maintenance response by signaling the adrenal cortex to release cortisol and other hormones (HPA response).

3) Many neural (nerve) circuits are involved in the behavioral response. This response increases arousal (alertness, heightened awareness), focuses attention, inhibits feeding & reproductive behavior, reduces pain perception, and redirects behavior.

The combined results of these three components of the stress response maintain the internal balance (homeostasis) and optimize energy production and utilization.

Among the many neurotransmitter systems activated by stress is noradrenaline (norepinephrine), produced by neurons with cell bodies in the brainstem that have vast projections up to the forebrain and down the spinal cord. Stressful experiences activate the noradrenergic system and promote release of noradrenaline; severe stress leads to depletion of noradrenaline in brain areas such as the hypothalamus. This release and depletion of noradrenaline stores results in changes at two levels of neuronal function: phosphorylation is triggered by the second-messenger cyclic AMP and occurs in the presynaptic and postsynaptic sites where noradrenaline is released and where it also acts; and synthesis of new protein is induced via actions on the genome. Both processes enhance the ability of the brain to form noradrenaline when the organism is once again confronted with a stressful situation. Stress also activates the neurally mediated discharge of adrenaline (epinephrine) from the adrenal medulla and of hypothalamic hormones that initiate the neuroendocrine cascade, culminating in glucocorticoid release from the adrenal cortex. Thus, the activity of neurons triggered by stressful experiences, physical trauma, fear, or anger leads to hormone secretion that has effects throughout the body. Virtually every organ of the body is affected by stress hormones.

Of all the hormones in the endocrine cascade initiated by stress, the glucocorticoids (cortisol) are the most important because of their widespread effects throughout the body and in the brain. The brain contains target cells for adrenal glucocorticoids secreted in stress, and receptors in these cells are proteins that interact with the genome to affect expression of genetic information. Thus, the impact of stress-induced activation of the endocrine cascade that culminates in glucocorticoid release is the feedback of glucocorticoids on target brain cells. The effect is to alter the structure and function of the brain cells over a period of time ranging from hours to days. In the case of noradrenaline, glucocorticoids have several types of feedback effects that modify how the noradrenergic system responds to stress. Glucocorticoids inhibit noradrenaline release, and they reduce the second-messenger response of brain structures such as the cerebral cortex to noradrenaline. Glucocorticoid feedback also affects the serotonin system, facilitating serotonin formation during stress but at the same time altering the levels of several types of serotonin receptors in different brain regions, which has the net effect of shifting the balance within the serotonergic system. Taken together, evidence points to a role of glucocorticoid secretion in leading to restoration of homeostatic balance by counteracting the acute neural events such as increased activity of noradrenaline which is turned on by stressful experiences and modifying serotonin system. Other neurotransmitter systems may also respond to glucocorticoid action. Moreover, the other hormones activated by stress have effects on the brain and body that must be considered.

Understand natural stress response:

When you encounter perceived threats — a large dog barks at you during your morning walk, for instance — limbic system in your brain sets off an alarm system in your body. Through a combination of nerve and hormonal signals, this system prompts your adrenal glands, located atop your kidneys, to release a surge of hormones, including adrenaline and cortisol. Adrenaline increases your heart rate, elevates your blood pressure and boosts energy supplies. Cortisol, the primary stress hormone, increases sugars (glucose) in the bloodstream, enhances your brain’s use of glucose and increases the availability of substances that repair tissues. Cortisol also curbs functions that would be nonessential or detrimental in a fight-or-flight situation. It alters immune system responses and suppresses the digestive system, the reproductive system and growth processes. This complex natural alarm system also communicates with regions of your brain that control mood, motivation and fear.

Implicit in Cannon’s “fight or flight” theory, is the teleological premise that our automatic and involuntary responses to stress have been progressively developed over the lengthy course of man’s evolution. It is postulated that they represent adaptive changes which were essential for the survival of our ancestors when faced with a life threatening physical threat. The outpouring of adrenalin and stimulation of the sympathetic nervous system caused the pupils to dilate and promote better vision, blood clotting was quickened to reduce loss from lacerations or internal hemorrhage, blood pressure and heart rate rose increasing flow of blood to the brain to facilitate decision making, and carbohydrate and fat stores in the body were broken down raising blood sugar and lipid levels to provide fuel for more energy. The circulation of blood was shunted away from the gut where it was not immediately needed for purposes of digestion, to the large muscles of the extremities, brain and heart. This produced greater tension and strength in the arms and legs to assist in physical combat, or speed of locomotion away from a scene of potential peril.

In general, stress hormones are protective and adaptive in the immediate aftermath of stress, and the organism is more vulnerable to many conditions without them. However, the same hormones can promote damage and accelerate pathophysiological changes, such as bone mineral loss, obesity, and cognitive impairment, when they are overproduced or not turned off. This wear-and-tear on the body has been called allostatic load. It is based upon the notion that allostasis is the active process of maintaining stability, or homeostasis, through change, and allostatic load is the almost inevitable cost to the body of doing so.

The sympathetic nervous system (SNS) turns on the fight or flight response. In contrast, the parasympathetic nervous system (PNS) promotes the relaxation response. Like two tug-of-war teams skillfully supporting their rope with a minimum of tension, the SNS and PNS carefully maintain metabolic equilibrium by making adjustments whenever something disturbs this balance. The strongmen on these teams are hormones, the chemical messengers produced by endocrine glands. Named after a Greek word meaning “to set in motion,” hormones travel through the bloodstream to accelerate or suppress metabolic functions. The trouble is that some stress hormones don’t know when to quit pulling. They remain active in the brain for too long – injuring and even killing cells in the hippocampus, the area of your brain needed for memory and learning. Because of this hierarchical dominance of the SNS over the PNS, it often requires conscious effort to initiate your relaxation response and reestablish metabolic equilibrium. The stress response is regulated by the sympathetic nervous system, whereas the relaxation response is regulated by the parasympathetic nervous system, and can be conditioned by the individual. It is a response that is designed for repair and maintenance of the body and so is vital to well being. The involuntary stress response can be changed to a relaxation response by the use of voluntary deep breathing, meditation, progressive relaxation, self-hypnosis, biofeedback and prayer, all of them stimulate PNS. This conditioned ability for us to actively relax can bring a measure of control over the way stress affects us.

The figure above shows that once stressor is removed, PNS is stimulated releasing acetylcholine and stress hormone level fall back to normal.

Stress hormone actions have important effects outside the brain on such systems as the immune response. Glucocorticoids and catecholamines from sympathetic nerves and the adrenal medulla participate in the mobilization and enhancement of immune function in the aftermath of acute stress. These effects improve the body’s defense against pathogens but can exacerbate autoimmune reactions. When they are secreted chronically, the stress-related hormones are generally immunosuppressive; such effects can be beneficial in the case of an autoimmune disease but may compromise defense against a virus or bacterial infections. At the same time, glucocorticoids are important agents for containing the acute-phase response to an infection or autoimmune disturbance. In the absence of such containment, the organism may die because of the excessive inflammatory response.

Besides affecting the immune response, stressors are believed to exacerbate endogenous depressive illness in susceptible individuals. Major depressive illness frequently results in elevated levels of cortisol in the blood. It is not clear whether the elevated cortisol is a cause or strictly a result of the brain changes involved in depressive illness.

The importance of acknowledging the protective, as well as the potentially damaging effects of the mediators of stress and adaptation, has led to the introduction of two terms: “allostasis,” meaning the process of maintaining stability (homeostasis) by active means, namely, by putting out stress hormones and other mediators; and “allostatic load or overload,” meaning the wear and tear on the body and brain caused by use of allostasis, particularly when the mediators are dysregulated, i.e., not turned off when stress is over or not turned on adequately when they are needed. It is stated that two factors largely determine individual responses to potentially stressful situations: the way one perceives a situation and a person’s general state of physical health, which is determined not only by genetic factors but also by behavioral and lifestyle choices.

The picture above shows central role of the brain in allostasis and the behavioral and physiological response to stressors.

The brain is the organ of the body that interprets experiences as threatening or nonthreatening and which determines the behavioral and physiological responses to each situation. Besides the hypothalamus and brain stem, which are essential for neuroendocrine and autonomous responses to stressors, higher cognitive areas of the brain play a key role in memory, anxiety, and decision making. These brain areas are targets of stress and stress hormones, and the acute and chronic effects of stressful experiences influence how they respond. This is particularly evident over the life course, where early life experiences, combined with genetic factors, exert an important influence on adult stress responsiveness and the aging process.

In neuroscience and neuroendocrinology various studies have shown how aging and adrenal stress hormones impact the hippocampus. The hippocampus also plays a role in shutting off the HPA stress response, and damage or atrophy of the hippocampus impairs the shut off and leads to a more prolonged HPA response to psychological stressors. This led to the “glucocorticoid cascade hypothesis” of stress and aging. Longitudinal studies on aging human subjects support this model. For example, researchers revealed that progressive increases in salivary cortisol during a yearly exam over a 5-yr period predicted reduced hippocampal volume and reduced performance on hippocampal-dependent memory tasks. Besides stress hormones, four peptide/protein hormones (insulin-like growth factor I, insulin, ghrelin, and leptin) are able to enter the brain and affect structural remodeling or other functions in the hippocampus.

There are two key aspects of the stress response. On the one hand, the body responds to many experiences by releasing chemical mediators, for example, catecholamines that increase heart rate and blood pressure. These mediators promote adaptation to an acute stressor, as well as to simple acts like getting out of bed in the morning or climbing a flight of stairs. On the other hand, chronic elevation of these same mediators, e.g., chronically increased heart rate and blood pressure, can cause pathophysiological changes, for example, in the cardiovascular system that result, over time, in pathophysiological conditions like atherosclerosis, which can result in strokes and myocardial infarctions. So there are paradoxical actions of these mediators in both protection and damage (duality of existence).

Thus protection and damage are the two contrasting sides of the physiology involved in defending the body against the challenges of daily life, whether or not we call them “stressors.” Besides epinephrine and norepinephrine, there are many mediators that participate in allostasis, and they are linked together in a network of regulation that is nonlinear, meaning that each mediator has the ability to regulate the activity of the other mediators, sometimes in a biphasic manner. For example, glucocorticoids produced by the adrenal cortex in response to ACTH from the pituitary gland are the other major “stress hormone.” Yet, pro- and anti-inflammatory cytokines are produced by many cells in the body, and they regulate each other and are, in turn, regulated by glucocorticoids and catecholamines; that is, whereas catecholamines can increase proinflammatory cytokine production , glucocorticoids are known to inhibit this production . And yet, there are exceptions, e.g., proinflammatory effects of glucocorticoids that depend on dose and cell or tissue type. The parasympathetic nervous system also plays an important regulatory role in this nonlinear network of allostasis, since it generally opposes the sympathetic nervous system and, for example, slows the heart, and it also has anti-inflammatory effects. What this nonlinearity means is that when any one mediator is increased or decreased, there are compensatory changes in the other mediators that depend on time course and level of change of each of the mediators. Unfortunately, biomedical technology cannot yet measure all components of this system simultaneously and must rely on measurements of only a few of them in any one study. Yet the nonlinearity must be kept in mind in interpreting the results. Looking at a larger picture, this nonlinearity and presence of paradoxical effects are the basis of the theory of Duality of Existence in living organisms.

Allostatic overload resulting from chronic stress in animal models causes atrophy of neurons in the hippocampus and prefrontal cortex, brain regions involved in memory, selective attention, and executive function, and causes hypertrophy of neurons in the amygdala, a brain region involved in fear and anxiety as well as aggression. Thus the ability to learn and remember and make decisions may be compromised by chronic stress and may be accompanied by increased levels of anxiety and aggression.

The common experience of being “stressed out” has as its core the elevation of some of the key systems that lead to allostatic overload: cortisol, sympathetic activity, and proinflammatory cytokines, with a decline in parasympathetic activity. Nowhere is this better illustrated than for poor or inadequate sleep, which is a frequent result of being “stressed out.” Sleep deprivation produces an allostatic overload that can have deleterious consequences. Because the brain is the master regulator of the neuroendocrine, autonomic, and immune systems, as well as behavior; alterations in brain function by chronic stress can, therefore, have direct and indirect effects on the cumulative allostatic overload. Reduced sleep duration has been reported to be associated with increased body mass and obesity. Sleep restriction to 4 hour of sleep per night increases blood pressure, decreases parasympathetic tone, increases evening cortisol and insulin levels, and promotes increased appetite, possibly through the elevation of ghrelin, a proappetitive hormone, along with decreased levels of leptin. Moreover, proinflammatory cytokine levels are increased with sleep deprivation, along with decreased performance in tests of psychomotor vigilance, and this has been reported to result from a modest sleep restriction to 6 hour per night.

Opposing effects of stress on learning depend on the timing of the events.

The picture above shows how the timing of stress in relation to learning affects learning process.

A: Stress within the context of a learning situation leads to the release of norepinephrine (NA), corticotropin releasing hormone (CRH), and corticosterone (CORT), all of which are active in the brain at the time that the initial phases of learning take place. At this stage, the neurotransmitters and hormones facilitate the ongoing process. Corticosterone (cortisol), however, also initiates a gene-mediated pathway, which will elevate the threshold for input unrelated to the initial event and restore neuronal activity (normalization), with a delay of more than an hour.

B: If an organism has been exposed to a stressor some time before the learning process takes place, the gene-mediated suppression of activity will have developed by the time that acquisition occurs. Under these conditions cortisol will impair learning processes.

Stress remodeling of brain:

Several monoamine neurotransmitters are important in regulating the HPA axis, especially dopamine, serotonin and norepinephrine (noradrenaline). There is evidence that an increase in oxytocin, resulting for instance from positive social interactions, acts to suppress the HPA axis and thereby counteracts stress, promoting positive health effects such as wound healing.

Sensitization to Stress:

Dysfunction of the HPA occurs by a process called sensitization. Sensitization is caused by the factors that amplify the normal stress reaction. You may have noticed some people become very stressed and agitated for seemingly little reason. This is because their HPA has become sensitized due to sensitizing factors. There is a period directly after a stress response where the HPA system remains sensitized. If another stress response occurs within this time of sensitization, there will be an amplified release of stress hormones. If you are exposed to various sensitizing factors too frequently, you will begin to feel stressed very often, and may feel anxious for little or no reason. Many of these sensitizing factors are actually generated by exposure to stress, thereby setting up a vicious cycle of chronic stress and the development of HPA dysfunction.

The major sensitizing factors include the following:

1) Low estrogen – this female hormone is one of the body’s key anti-stress hormones responsible for calming down the nervous system. This hormone often reduces times of mental and emotional strain. Estrogen enhances calming effect of oxytocin.

2) High Testosterone- this male hormone acts as a promoter of the stress response and reduces calming effect of oxytocin.

3) Thyroid – thyroid hormones are increased during acute stress to aid the fight or flight response. However, during long-term stress, raised levels of cortisol eventually leads to depleted thyroid hormones resulting in low thyroid activity and the onset of low thyroid symptoms.

4) Nutrient deficiencies – Deficiencies of magnesium, zinc, vitamin B and C and essential fatty acids sensitize the body’s response to stress and may worsen conditions like depression and anxiety. These deficiencies upset the balance of chemicals (neurotransmitters) on the brain, leading to an increase in the stress response. Further, the adrenal gland requires these nutrients to cope with the excessive stress.

5)Environmental Toxins – alcohol, pesticides, and heavy metals such as mercury and lead can activate the stress response and induce nervous system hypersensitivity.

6) Internal Toxins – Like external toxins, internal toxins can cause HPA sensitization. Poor gut health and toxin overload can aggravate our responses to stress and may place added strain on our nervous system and liver. Cortisol and adrenalin can also decrease the body’s defenses against infections and worsen pre existing gut problems. A monitored gut and liver detoxification program, together with a good healthy diet, will prevent the negative effects stress may have on the gut along with increasing your resistance to infections.

7) Infections/Allergies – Chemicals that are released during inflammation can increase the sensitivity of your HPA system and typically amplify the stress response. Chronic infections require the release of cortisol from the adrenal gland to dampen down these inflammatory cytokines to prevent more tissue damage.

The figure above shows that dysfunction of the HPA axis occurs in progressive stages depending on the severity of the stress exposure and the level of sensitizing factors present. Stages 1 and 2 relate to acute hyper-reactivity and stages 3 and 4 relate to chronic stress and nervous system failure. Each stage of the stress response needs to be treated differently to support the repair of affected organs.

Stage 1- Reactivity:

This is the first stage of HPA dysfunction and is associated with:

-An increased release of hormones from the adrenal gland

-Increase immune responses and allergic reactions

-An increase in hormone sensitivity i.e. worsening of PMT(premenstrual tension)

-Thyroid gland overactivity

Symptoms include: anxiety, nervousness, insomnia, panic attacks, PMT, trembling, rapid shifts in body temperature, blood pressure, decreased appetite, diarrhea, palpitations and shortness of breath.

Treatment also needs to be targeted at decreasing your levels stress and sensitizing factors.

Stage 2- Hyper-Reactivity:

This stage is an exacerbation of stage one and starts to deplete some of the crucial hormones involved in managing stress. The main features involved include:

-Increased risk of depression, anxiety, insomnia and fatigue.

-Decreasing resistance to infections and aggravating allergic reactions

-Depletion of sex hormones and libido

-Decreasing thyroid function, insulin resistance, and obesity.

Symptoms and conditions associated with stage 2 hyper-reactivity responses include: Intense anxiety, Melancholic Depression, Insomnia, Poor appetite, Anorexia, Allergies and Addictive disorders such as alcoholism.

Stage 3- Hypo-activity:

The third stage of stress dysfunction exhibits a near depletion of adrenal and hormonal reserves to combat the effects of stress and can place the body into “exhaustion”. Muscles, nerves, immune responses and sleeping patterns are effected, thus promoting the body’s likelihood of developing Chronic Fatigue Syndrome.

The main changes occurring in the body at this stage relate to:

-Adrenal gland exhaustion

-Decreased sex hormone reserves and libido

-Autoimmune disorders such as Rheumatoid arthritis

-Decreased thyroid gland activity

-Allergies and poor resistance to infections

-Nervous system reserves are exhausted and depression may become a major problem

Symptoms and conditions include atypical depression, increased sleep, and tiredness, weight gain, lethargy, fibromyalgia, rheumatoid arthritis, multiple allergies and chemical sensitivities.

Fibromyalgia is a common disorder in this stage. Energy levels are extremely low at this stage and manifest as muscle weakness and pain.

Treatment in stage 3 is primarily focused on repairing the activity of the adrenal glands and maintaining energy levels and muscle function.

Stage 4- Nervous System Damage and Exhaustion:

This is the most severe stage of stress dysfunction and demonstrates an inability of the nervous system to cope with stress. The adrenal glands are exhausted, and energy levels are low. Chronic Fatigue Syndrome is common in stage 4.

The main bodily changes occurring at this stage include:

-Sleep disturbances and depression

-Muscle and joint aches

-Increased risk to infections

-Multiple allergies and chemical sensitivities

-Poor libido and hormonal disturbances

-Hypothyroidism

Symptoms reflective of this stage in the stress response include those of Chronic Fatigue syndrome. These symptoms are mild fevers, sore throat and increased infections, painful lymph nodes, muscle weakness, headaches, painful joints, depression and sleeping disturbances.

The treatment in this stage is similar to stage 3, but with more emphasis on repairing damaged nervous tissue and adrenal glands.

____

Stress and blood brain barrier (BBB):

Stress can dramatically increase the ability of chemicals to pass through the blood-brain barrier. During the Gulf War, Israeli soldiers took a drug to protect themselves from chemical and biological weapons. Normally, it should not have crossed the BBB, but scientists learned that the stress of war had somehow increased the permeability of the BBB. Nearly one-quarter of the soldiers complained of headaches, nausea, and dizziness – symptoms which occur only if the drug reaches the brain. Corollary from this study would suggest that many drugs, toxins and chemicals that were impermeable to BBB can cross BBB during stress.

Stress measurements and stress tests:

Levels of stress can be measured. One way is through the use of psychological testing: the Holmes and Rahe Stress Scale is used to rate stressful life events, while the DASS contains a scale for stress based on self-report items. Changes in blood pressure and galvanic skin response can also be measured to test stress levels, and changes in stress levels. A digital thermometer can be used to evaluate changes in skin temperature, which can indicate activation of the fight-or-flight response drawing blood away from the extremities.

STRESS SCALE FOR ADULTS:

In the following table you can look up representative changes in your life and see how much stress value each of these changes is adding to your life. Note any item that you may have experienced in the last 12 months. Then, total up your score.

STRESS	EVENT VALUE
DEATH OF SPOUSE	100
DIVORCE	60
MENOPAUSE	60
SEPARATION FROM LIVING PARTNER	60
JAIL TERM OR PROBATION	60
DEATH OF CLOSE FAMILY MEMBER OTHER THAN SPOUSE	60
SERIOUS PERSONAL INJURY OR ILLNESS	45
MARRIAGE OR ESTABLISHING LIFE PARTNERSHIP	45
FIRED AT WORK	45
MARITAL OR RELATIONSHIP RECONCILIATION	40
RETIREMENT	40
CHANGE IN HEALTH OF IMMEDIATE FAMILY MEMBER	40
WORK MORE THAN 40 HOURS PER WEEK	35
PREGNANCY OR CAUSING PREGNANCY	35
SEX DIFFICULTIES	35
GAIN OF NEW FAMILY MEMBER	35
BUSINESS OR WORK ROLE CHANGE	35
CHANGE IN FINANCIAL STATE	35
DEATH OF A CLOSE FRIEND (not a family member)	30
CHANGE IN NUMBER OF ARGUMENTS WITH SPOUSE OR LIFE PARTNER	30
MORTGAGE OR LOAN FOR A MAJOR PURPOSE	25
FORECLOSURE OF MORTGAGE OR LOAN	25
SLEEP LESS THAN 8 HOURS PER NIGHT	25
CHANGE IN RESPONSIBILITIES AT WORK	25
TROUBLE WITH IN-LAWS, OR WITH CHILDREN	25
OUTSTANDING PERSONAL ACHIEVEMENT	25
SPOUSE BEGINS OR STOPS WORK	20
BEGIN OR END SCHOOL	20
CHANGE IN LIVING CONDITIONS (visitors in the home, change in roommates, remodeling house)	20
CHANGE IN PERSONAL HABITS (diet, exercise, smoking, etc.)	20
CHRONIC ALLERGIES	20
TROUBLE WITH BOSS	20
CHANGE IN WORK HOURS OR CONDITIONS	15
MOVING TO NEW RESIDENCE	15
PRESENTLY IN PRE-MENSTRUAL PERIOD	15
CHANGE IN SCHOOLS	15
CHANGE IN RELIGIOUS ACTIVITIES	15
CHANGE IN SOCIAL ACTIVITIES (more or less than before)	15
MINOR FINANCIAL LOAN	10
CHANGE IN FREQUENCY OF FAMILY GET-TOGETHERS	10
VACATION	10
PRESENTLY IN WINTER HOLIDAY SEASON	10
MINOR VIOLATION OF THE LAW	5

So, if you have experienced total stress within the last twelve months of 250 or greater, even with normal stress tolerance, you may be OVERSTRESSED. Persons with low stress tolerance may be OVERSTRESSED at levels as low as 150. OVERSTRESS will make you sick.

Note: I have asked you to look at the last twelve months of changes in your life. This may surprise you. It is crucial to understand, however, that a major change in your life has effects that carry over for long periods of time.

Tests as the Trier Social Stress Test attempted to isolate the effects of personalities on ability to handle stress in a laboratory environment. Other psychologists, however, proposed measuring stress indirectly, through self-tests. Because the amount of stressors in a person’s life often (although not always) correlates with the amount of stress that person experiences, researchers combine the results of stress and burnout self-tests. Stress tests help determine the number of stressors in a person’s life, while burnout tests determine the degree to which the person is close to the state of burnout. Combining both helps researchers gauge how likely additional stressors will make him or her experience mental exhaustion. Assessment of sympathoadrenal medullary system (SAM) activity is only possible to date via measurement of catecholamines in blood plasma or via electrophysiological methods. Both ways of measurement are restricted to endocrinological or psychophysiological laboratories, as both require either immediate freezing of blood samples or complex recording devices. Efforts have therefore been undertaken to find a method comparable to salivary cortisol measurements, in which noninvasive samples can be taken at any place and stored at room temperature for sufficient time before later analysis in the laboratory. Salivary alpha-amylase (sAA) is a candidate that may prove useful in this context. Various studies found that salivary amylase level was more significantly increased and reacted more rapidly than cortisol by psychological stressor, suggesting that it is a better index of stress. Saliva sampling has the advantage that it is non-invasive, making multiple sampling easy and stress free. Various studies show that sAA activity is increased by acute psychosocial stress (Trier Social Stress Test) and that increases in sAA correlate with increases in norepinephrine. More recent work has described a reliable diurnal pattern of salivary alpha-amylase activity, and associations of daily amylase secretion with relevant psychological states have been reported. Daily amylase secretion, for example, changes in response to the chronic stress of caring for a family member with brain cancer; daily secretion is furthermore altered in individuals with posttraumatic stress disorder (PTSD), in people with higher self-rated depression (BDI), and is associated with chronic stress in children with asthma and low socio-economic status. Taken together, these recent findings show that assessment of salivary alpha-amylase provides important additional information for the understanding of psychological states and psychiatric / psychosomatic diseases. Yamaguchi M and Yoshida H (2005) have analyzed a newly introduced hand-held device called the Cocorometer developed in Japan. They state that this can be reliably used to analyze the amylase levels and is definitely a cheaper alternative as compared to the more expensive ELISA kits. The working consists of a meter and a saliva collecting chip, which can be inserted into the meter to give the readings. The levels of amylase obtained have been calibrated according to standard population, and can be categorized into four levels of severity.

Oxidative stress as surrogate marker of stress:

Oxidative stress is the process by which free radicals, or reactive oxygen species, damage cellular components including DNA, proteins and lipids. Healthy bodies maintain a balance between so-called free radicals, which can damage cells, and antioxidants, which are necessary for the body to repair itself from various insults and injuries. But various factors, including behaviors such as smoking or eating fried food, will tip the seesaw in the wrong direction, resulting in more free radicals and, therefore, more oxidative stress, which wreaks havoc on the cellular functions that keep us alive. Some studies have shown that psychological stress increases oxidative stress which is a precursor to many illnesses like diabetes, cancer, heart disease and aging itself. Researchers have shown that the simple cut of whiskers causes psychological or emotional distress in mice leading to oxidative stress in tissues. Whiskers play a critical role as a locomotive sensor in mice, and thus, sensory input is directly connected to motor neurons controlling their locomotive activity. Therefore, the removal of whiskers may affect their locomotive behavior causing anxiety on hyperlocomotion, and thus, psychological or emotionally stressed condition. This model shows that measurement of oxidative stress in tissues can give some idea regarding stress experienced by animal or human.

Stress and health:

A fish predator’s mere presence can trigger enough stress to kill a dragonfly. Scientists suggest that the finding could be used as a model for studies on the lethal effects of stress on all organisms. As we learn more about how animals respond to stressful conditions… we increasingly find that stress brings a greater risk of death, presumably from things such as infections that normally wouldn’t kill them. Stress is linked to six of the leading causes of death in humans: heart disease, cancer, lung ailments, accidents, cirrhosis of the liver and even suicide. Stress also becomes harmful when people engage in the compulsive use of substances or behaviors to try to relieve their stress. These substances or behaviors may include food, alcohol, tobacco, drugs, gambling, sex, shopping, and the Internet. Rather than relieving the stress and returning the body to a relaxed state, these substances and compulsive behaviors tend to keep the body in a stressed state causing more problems. The distressed person becomes trapped in a vicious circle. Stress kills, even in moderate amounts, a new study suggests. Men chronically stressed over a number of years have a 50% higher early mortality rate, researchers from Oregon State University and Boston University said.

Stress can have wide ranging effects on emotions, mood and behavior. Equally important but often less appreciated are effects on various systems, organs and tissues all over the body, as illustrated by the following diagram.

There are numerous emotional and physical disorders that have been linked to stress including depression, anxiety, heart attacks, stroke, hypertension, immune system disturbances that increase susceptibility to infections, a host of viral linked disorders ranging from the common cold and herpes to AIDS and certain cancers, as well as autoimmune diseases like rheumatoid arthritis, and multiple sclerosis. In addition stress can have direct effects on the skin (rashes, hives, atopic dermatitis, the gastrointestinal system (GERD, peptic ulcer, irritable bowel syndrome, and ulcerative colitis) and can contribute to insomnia and degenerative neurological disorders like Parkinson’s disease. In fact, it’s hard to think of any disease in which stress cannot play an aggravating role or any part of the body that is not affected.

Stress and health

Stress has been linked to many diseases, conditions and even societal problems. They include:

Heart disease;

High blood pressure;

Stomach problems;

Respiratory problems;

Type II diabetes;

Back problems;

Headaches and migraines;

Obesity;

Rheumatoid arthritis;

Cancer;

Skin problems;

Mental health problems;

Immune system problems

Child and partner abuse;

Suicide;

Homicide;

Alcohol and drug use and abuse;

Tobacco use;

Violence and aggressive behavior;

Accidents;

Sleep problems;

Sexual problems.

Stress is also signaled by changes in behavior. Typically, these include finding it difficult to focus, losing your sense of humor or losing your temper more quickly than normal. In later stages, stress can manifest itself in over-eating or under-eating as well as smoking or drinking to excess. Short periods of it are manageable, but it can lead to serious health problems, such as heart disease or stomach and bowel problems.

Stress and heart:

A physiologic holdover from ancient times, the fight-or-flight response to a stressful situation helps the body mobilize for physical defense. When it occurs in response to mental stress, however, the hormones and fatty fuels it unleashes can be excessive and thereby set the stage for coronary heart disease or exacerbate existing myocardial ischemia. Among other things, these changes can raise the heart rate and increase the blood pressure by constricting the blood vessels, both of which can result in angina pectoris or other manifestations of myocardial ischemia. Whether responses to stress are inherited traits or learned behavior is not yet clear; however, research has clearly shown that there are certain types of behavior that raise the risk of heart disease especially type A behavior.

The relationship between stress, heart disease and sudden death has been recognized since antiquity. The incidence of heart attacks and sudden death have been shown to increase significantly following the acute stress of natural disasters like hurricanes, earthquakes and tsunamis, and as a consequence of any severe stressor that evokes “fight or flight’ responses. Coronary heart disease is also much more common in individuals subjected to chronic stress and recent research has focused on how to identify and prevent this growing problem, particularly with respect to job stress. In many instances, we create our own stress that contributes to coronary disease by smoking and other faulty lifestyles or because of dangerous traits like excess anger, hostility, aggressiveness, time urgency, inappropriate competitiveness and preoccupation with work. These are characteristic of Type A coronary prone behavior, now recognized to be as significant a risk factor for heart attacks and coronary events as cigarette consumption, elevated cholesterol and blood pressure.

Does stress increase your risk of having a heart attack?

Research has found that people who become stressed are more likely to suffer from hardened arteries. A study measured volunteers’ levels of cortisol, a stress hormone, while they carried out tests aimed at raising their stress levels. It found that people who had increased cortisol levels were more likely to have high calcium deposits in the arteries, a marker of coronary heart disease measured by computerized tomography. Researchers say that coronary artery calcium (CAC) is an indicator of subclinical coronary atherosclerosis, and is a predictor of future coronary heart disease (CHD) events.

Stress Cardiomyopathy:

Stress cardiomyopathy is a type of cardiomyopathy in which there is a sudden temporary weakening of the myocardium (the muscle of the heart). Because this weakening can be triggered by emotional stress, such as the death of a loved one, a break-up, or constant anxiety, the condition is also known as broken heart syndrome. Stress cardiomyopathy is a well-recognized cause of acute heart failure, lethal ventricular arrhythmias, and ventricular rupture. It typically occurs in middle-aged or older women. They present with classic symptoms of chest pain, shortness of breath and ECG changes that look like a typical myocardial infarction (heart attack), but on angiogram, their coronary arteries are normal.

The above picture shows schematic representation of stress cardiomyopathy (A) compared to the situation in a normal person (B).

The treatment of stress cardiomyopathy is generally supportive in nature. Although patients with stress heart disease may be hypotensive, treatment with inotropes will usually exacerbate the disease. Since the disease is due to a high catecholamine state, patients should not be given inotropes. Treatment recommendations include intra-aortic balloon pump, fluids, and negative inotropes such as beta blockers or calcium channel blockers. In many individuals, left ventricular function normalizes within 2 months. Despite the grave initial presentation in some of the patients, most of the patients survive the initial acute event, with a very low rate of in-hospital mortality or complications. The patients are expected to have favorable outcome once recovering from the acute stage of the syndrome, and the long-term prognosis is excellent.

Most physicians now believe that emotional stress can contribute to the development of heart disease. Stress appears to lead to heart disease in at least two ways. First, if you experience chronic emotional stress, you may be more likely to develop atherosclerosis, the disease process that produces coronary artery disease (CAD), stroke and peripheral artery disease. Second, periods of intense stress apparently can precipitate acute heart problems, such as heart attacks. This acute increase in cardiac risk is thought to be due to the significant elevations in blood pressure, heart rate, vascular tone (or vein constriction), inflammation, and accelerated blood clotting that can be seen, even in typically serene individuals, with severe emotional stress. These changes in physiology can increase the likelihood of plaque rupture — the event that produces heart attack. Furthermore, chronic emotional stress is often accompanied by a worsening in several other cardiovascular risk factors. Smokers under stress commonly increase their consumption of tobacco, for instance. And overeating (and thus weight gain) is quite common in people under emotional stress. There are however other studies that show that stress has no effect on heart. One such study investigated the impact of major life events (MLE) in childhood, adulthood and at work, singly and accumulated, on incident IHD (ischemic heart disease) and found that no associations between accumulated MLE and IHD. MLE is, however, strongly associated with VE (vital exhaustion) and use of tranquillizers.

Stress and hypertension:

You may have been told that you’re “hyper-tense” or have an A-type personality, and that you have hypertension because you’re too wound-up or stressed. So does stress cause hypertension? The answer is yes and no! Stress can most certainly increase your blood pressure by accelerating your heart rate, increasing force of contraction of myocardium and increasing peripheral vascular resistance by vasoconstriction. But that’s a temporary state. It enables you to respond to threats, triggering the so-called fight-or-flight response. However, it’s incorrect to say that stress causes permanently raised blood pressure, or hypertension. Stress can cause your blood pressure to soar, but it will revert to its normal levels once the source of stress is removed. A bewildering number of events have been found to increase blood pressure – everything from hearing a baby cry to talking on the telephone. But none of these events will cause hypertension. So working in a stressful environment or playing strenuous, demanding sports each day won’t cause hypertension. Stress management techniques do not seem to prevent high blood pressure. However, such techniques may have other benefits, such as making you feel better or helping you to control over-eating. It’s only when your body is subjected to continuously elevated levels of blood pressure that there’s any danger. However, some studies found that even temporary bouts with high blood pressure can cause damage to your heart, blood vessels, and kidneys, if they occur on a regular basis. Studies have also found that some blue-collar workers who had limited education and were in stressful positions over which they had no control may eventually developed hypertension. Men who continually lived beyond their means and were preoccupied with improving their financial status also risked developing hypertension over time.

Stress and cerebral stroke:

The relationship between stress and cerebral stroke is not entirely clear. A 1997 study published in the medical journal Circulation suggested a possible connection between high levels of mental stress and stroke, but more research is needed to prove such a link. While there is clearly cause for concern about this issue, researchers face a difficult task because the word “stress” has no concrete definition upon which most people agree. A situation that makes me very tense might not bother you much at all, and vice versa. However, several studies found strong links between stress and ischemic strokes. Many patients urgently admitted to hospital with cerebral infarction state that they were under great stress over a prolonged period prior to suffering their stroke. Stress can cause atherosclerosis of blood vessels which may result in strokes. Frequent or persistent activation of the sympathetic nervous system, the hypothalamus as well as pituitary and adrenal glands may also lead to hypertension and/or metabolic disturbances that could lead to strokes. Also, stressed people are having other risk factors, such as being smokers, doing less exercise, being heavy drinkers and having high blood pressure; all of that can increase probability of cerebral stroke.

Stress and cancer:

In the Holmes-Rahe Scale, the four most stressful life change events all involve loss of important emotional relationships, with death of a spouse and divorce heading the list. If stress can cause cancer, one would therefore expect that affected individuals would demonstrate significantly higher rates of malignancy. It has long been recognized that widowed and divorced individuals die at much higher rates for all the leading causes of death including cancer. It is also quite clear that depression of immune system function predisposes to cancer, as is vividly illustrated by a host of AIDS related malignancies, including the rare Kaposi’s sarcoma. Over the past two decades, a variety of studies have demonstrated that following loss of a spouse, there is a prompt and impressive decline in immune system defenses, and possibly, this aberrant adaptive response is a mechanism that may explain some stress related malignancies.

Why are the study results inconsistent regarding relationship between cancer and stress?

It is difficult to separate stress from other physical or emotional factors when examining cancer risk. For example, certain behaviors, such as smoking and using alcohol, and biological factors, such as growing older, becoming overweight, and having a family history of cancer, are common risk factors for cancer. Researchers may have difficulty controlling the presence of these factors in the study group or separating the effects of stress from the effects of these other factors. In some cases, the number of people in the study, length of follow-up, or analysis used is insufficient to rule out the role of chance. Also, studies may not always take into account that cancer is not a homogeneous (uniform in nature) disease. Also, stress can lead to unhealthy behaviors, such as overeating, smoking, or abusing drugs or alcohol, that may affect cancer risk.

Stress and cancer link confirmed by scientists:

A direct link between stress and cancer has been confirmed by scientists for the first time. Researchers found stressed cells can emit tumour-inducing signals. Until now it was widely held that cancer-causing genetic mutations only affected individual cells. But studies on fruit flies in the US and China found that stress caused cytokine proteins to pass between cells. Researchers say that physical & emotional stress and infections were triggers.

Stress and immunity:

Evidence for nervous system–immune system interactions exists at several biological levels. The immune system and the brain talk to each other through signaling pathways. The brain and the immune system are the two major adaptive systems of the body. Two major pathways are involved in this cross-talk: the Hypothalamic-pituitary-adrenal axis (HPA axis) and the sympathetic nervous system (SNS). The activation of SNS during an immune response might be aimed to localize the inflammatory response. The HPA axis responds to physical and mental challenge to maintain homeostasis in part by controlling the body’s cortisol level. Dysregulation of the HPA axis is implicated in numerous stress-related diseases. HPA axis activity and cytokines are intrinsically intertwined: inflammatory cytokines stimulate adrenocorticotropic hormone (ACTH) and cortisol secretion, while, in turn, glucocorticoids suppress the synthesis of proinflammatory cytokines. Molecules called pro-inflammatory cytokines, which include interleukin-1 (IL-1), Interleukin-2 (IL-2), interleukin-6 (IL-6), Interleukin-12 (IL-12), Interferon-gamma (IFN-Gamma) and tumor necrosis factor alpha (TNF-alpha) can affect brain growth as well as neuronal function. Circulating immune cells such as macrophages, as well as glial cells (microglia and astrocytes) secrete these molecules. Cytokine regulation of hypothalamic function is an active area of research for the treatment of anxiety-related disorders. Cytokines mediate and control immune and inflammatory responses. Complex interactions exist between cytokines, inflammation and the adaptive responses in maintaining homeostasis. Like the stress response, the inflammatory reaction is crucial for survival. Systemic inflammatory reaction is mediated by the HPA axis and the SNS. Common human diseases such as allergy, autoimmunity, chronic infections and sepsis are characterized by a dysregulation of the pro-inflammatory versus anti-inflammatory and T helper-1 (Th1) versus T helper-2 (Th 2) cytokine balance. The T helper 1 (Th1) type responses result in cell destructive effects and inflammation while T helper 2 (Th2) type responses which are both neuroprotective and anti-inflammatory. Recent studies show pro-inflammatory cytokine processes take place during depression, mania and bipolar disease, in addition to autoimmune hypersensitivity and chronic infections.

Chronic stress can significantly affect many of the body’s immune systems, as can an individual’s perceptions of, and reactions to, stress. The term psychoneuroimmunology is used to describe the interactions between the mental state, nervous and immune systems, and research on the interconnections of these systems. Immune system changes can create more vulnerability to infection, and have been observed to increase the potential for an outbreak of psoriasis for people with that skin disorder.

Short term stress enhances immune function. Sustained stress suppresses immune function. The more stress, the fewer antibodies you will produce. Both kinds of immunity (cell mediated and humoral immunity) are affected by unrelenting stress, which means that you’ll be more likely to be infected by viruses, (also those linked to cancer), bacteria, fungi and parasites. You’ll also be more sensitive to environmental toxins, electromagnetic emanations from high tension electrical cables, and pollution. The link between stress and immune function is far reaching, explaining the effect stress has on disorders ranging from the common cold, autoimmune diseases (such as multiple sclerosis, systemic lupus erythematosis, rumatoid arthritis, ulcerative colitis, Crohn’s disease) to HIV/AIDS, through to cancer. Evidence shows chronic stress can lower immunity and make people more susceptible to infections. Colds and viruses are more common in stressed people. Viruses can cause some cancers, thus keeping a strong healthy immune system is a must. Conversely, stress-reduction strategies, such as meditation, relaxation, and exercise, have been shown to help reverse this effect (by increasing the number of infection-fighting T cells and feel-good chemicals called endorphins in the body, for example) and prevent disease.

Stress priming innate immune response through gut bacteria:

The human digestive tract is a universe filled with microbes. There are probably 100 trillion bacteria in the average human, 90% of which live mainly in the intestine. They easily outnumber human cells 10-to-1 in each person. Stress not only sends the human immune system into overdrive – it can also wreak havoc on the trillions of bacteria that work and thrive inside our digestive system. New research suggests that this may be important because those bacteria play a significant role in triggering the innate immune system to stay slightly active, and thereby prepared to quickly spring into action in the face of an infection. But exactly how stress makes these changes in these bacteria still isn’t quite clear, researchers say. “We know now that if we knock the population of bacteria down with antibiotics, we don’t have the same innate immune response,” researchers said. That showed that the bacteria are involved in the ability of stress to prime the innate immune system. The research shows that some of the changes in systemic immunity in the body can be influenced by changes in these bacterial colonies, a result that reinforces the idea that they have a broader effect on the immune response.

Stress and diabetes:

In people with diabetes, stress can alter blood glucose levels in two ways:

1) People under stress may not take good care of themselves. They may drink more alcohol or exercise less. They may forget, or not have time, to check their glucose levels or plan good meals.

2) Stress hormones may also alter blood glucose levels directly. Epinephrine and cortisol elevate blood sugar directly by neoglucogenesis and indirectly by suppressing insulin action.

Stress hyperglycemia (also called stress diabetes) is a medical term referring to transient elevation of the blood glucose due to the stress of illness. It usually resolves spontaneously, but must be distinguished from various forms of diabetes mellitus. It is often discovered when routine blood chemistry measurements in an ill patient reveal elevated blood glucose. Stress hyperglycemia is especially common in patients with hypertonic dehydration and those with elevated catecholamine levels. It has been found that even fear of needle prick during blood collection raises blood sugar level due to release of catecholamine.

According to the American Diabetes Association (ADA), a diabetic’s “fight-or-flight” response to stress doesn’t work properly. In people with type 2 diabetes, this can trigger a dangerous increase in blood glucose. Stressed people with type 1 diabetes, however, may experience either a rise or fall in blood glucose. In addition, people under stress often forget to take care of themselves. They may forget to exercise, eat the wrong foods, or drink too much alcohol. All of these habits can significantly affect blood sugar. The ADA advises that you can learn to help control your reaction to stress. Performing relaxation techniques can help keep you calmer during stressful times, and making lifestyle changes can help avoid sources of stress altogether, the ADA says.

Stress and visceral fat:

In a study of 42 female monkeys, the Researchers at Wake Forest University found that those with the most social stress — in the monkeys’ case, that meant being at the bottom of the social hierarchy — packed away the most fat around the abdomen (visceral fat). Recent evidence suggests that visceral fat cells are active, unlike the fat cells found elsewhere in the body just under the skin, known as subcutaneous fat. Those fat cells are essentially just storage sinks for calories. But visceral fat cells actively secrete hormones and other agents that affect the metabolism of sugar and the way the body burns calories. Visceral fat has been linked to metabolic changes, such as higher blood pressure and blood-sugar levels, that increase risk for diabetes and heart disease. This study shows that psychological stress, which we know can affect stress-hormone levels, can have a fairly rapid influence on where extra calories go. Extrapolating the finding in humans suggest a possible cause-and-effect link: stress may promote accumulation of visceral fat, which in turn causes metabolic changes in the body that contribute to heart disease and other health problems.

Stress and weight:

When humans were hunters and gatherers, they had stress when they were being stalked by a predator. The body understood this stress and releases sugars for instant energy so we could flee or fight. Now, when the stress causes the sugars to release, we don’t use them for energy. They go unused and the body stores them as fat instead. Stress also appears to stimulate appetite and contribute to weight gain. Stress releases chemicals in brain which make us eat high calorie foods – this is why we crave items that are not in the best interest of our bodies – increasing calorie intake was historically necessary for survival – now the opposite is often true, but our biology has not changed. Occasionally, stress may also suppress appetite, so stress can also cause weight loss albeit infrequently if stressed person is not eating at all.

Miscellaneous health effects:

Chronic stress has also been shown to impair developmental growth in children by lowering the pituitary gland’s production of growth hormone, as in children associated with a home environment involving serious marital discord, alcoholism, or child abuse. Skin doctors have found that many skin conditions, such as hives and eczema, are related to stress. Stress has also been linked to Parkinson’s disease.

Stress and noise:

Human infants are all ears. They are very conscious of sound and focus on every word they hear, so they can learn to speak. Loud noises trigger a “startle response” – large movements of the baby’s limbs and torso – even while in the womb. Until 18 months old, infants react strongly to distress sounds from other infants. Crucial to survival, this instinctual reaction to noise enables us to go from a deep sleep to a quick sprint in a matter of seconds. . . or to do battle with surprising strength. Sudden sound is an urgent wake-up call that alerts and activates the stress response – a biological alarm that affects the brain in powerful ways. Because loud noise often heralds bad news, animals and humans have evolved a rapid response to audio stressors: the roar of a carnivore, the crack of a falling tree, the scream of a child. More recently: the explosion of a weapon, the wail of a siren, the crash of the stock market. Not just loud or sudden noises provoke a stress response. Chronic low-level noise also negatively influences the brain and behavior. Whether from the road or in the office, low-intensity noise has a subtle yet insidious effect on our health and well-being. Noise at home or school can affect children’s ability to learn. Compared to kids from quieter neighborhoods, children living near airports or busy highways tend to have lower reading scores and develop language skills more slowly. Psychiatric hospitalizations are higher in noisy communities. Bad moods, lack of concentration, fatigue, and poor work performance can result from continual exposure to unpleasant noise. Included in noise-related problems are high blood pressure, peptic ulcers, cardiovascular deaths, strokes, suicides, degradation of the immune system, and impairment of learning. Noise is also associated with an increase in aggression and a decrease in cooperation. Even everyday traffic noise can harm the health and well-being of children. In a study to look at the non-auditory health effects of typical ambient community noise, it was shown that chronic low-level noise from local traffic raised levels of stress hormones in children, as well as their blood pressure and heart rates.

A loud noise can trigger cardiac arrest in a disorder of the heart’s electrical system, known as the Long QT Syndrome. Acoustic stress – such as awakening because of a loud noise – can trigger an episode. Common examples of startle events include sudden noise, like sirens, the telephone, and the alarm clock. LQTS is estimated to cause as many as 3,000 deaths in the U.S. each year – mostly in children and young adults. Stress can exacerbate a number of psychiatric disorders, many of which are associated with the prefrontal cortex (PFC), the area of the brain unique to humans. A Yale University study looked at the effects of noise stress on brain function in monkeys. Results indicate that stress impairs PFC cognitive function through its influence on dopamine, a key neurotransmitter that’s involved in many brain disorders, including ADHD and Parkinson’s disease. The researchers think that stress may take the PFC ‘off-line’ to allow more habitual responses . . . to regulate behavior. This mechanism may have survival value, but may often be maladaptive in human society, contributing to the vulnerability of the PFC in many neuropsychiatric disorders.

Because of the immediate need to respond to noise threats, the conscious mind is bypassed. It may not be fast enough to deal with a situation that could be a matter of life and death. University College London researchers observed the process using functional MRI brain scans of human test subjects who had been stressed by an unpleasantly loud noise that was combined with visual images. Even when a fearful stimulus was present only at the unconscious level, the threat signal triggered activity in the attention center of the cerebral cortex, where the fear response is then channeled to other parts of the brain that prepare the body in the classic flight or fight reaction. It makes perfect sense – you can’t stop and think about certain things, you have to react immediately.

Stress and memory:

Chronic over-secretion of stress hormones adversely affects brain function, especially memory. Too much cortisol can prevent the brain from laying down a new memory, or from accessing already existing memories. Researchers have shown that sustained stress can damage the hippocampus, the part of the limbic brain which is central to learning and memory. The culprits are “glucocorticoids,” a class of steroid hormones secreted from the adrenal glands during stress. They are more commonly known as corticosteroids or cortisol. During a perceived threat, the adrenal glands immediately release adrenalin. If the threat is severe or still persists after a couple of minutes, the adrenals then release cortisol. Once in the brain, cortisol remains much longer than adrenalin, where it continues to affect brain cells. Excessive cortisol can make it difficult to think or retrieve long-term memories. That’s why people get befuddled and confused in a severe crisis. Their mind goes blank because “the lines are down.” They can’t remember where the fire exit is, for example.

Stress, cortisol, elderly, brain degeneration and dementia:

Normally, in response to stress, the brain’s hypothalamus secretes a hormone that causes the pituitary gland to secrete another hormone that causes the adrenals to secrete cortisol. When levels of cortisol rise to a certain level, several areas of the brain – especially the hippocampus – tell the hypothalamus to turn off the cortisol producing mechanism. This is the proper feedback response. The hippocampus, however, is the area most damaged by cortisol. Since older people often have lost 20-25% of the cells in their hippocampus, so it cannot provide proper feedback to the hypothalamus, so cortisol continues to be secreted. This, in turn, causes more damage to the hippocampus, and even more cortisol production. Thus, a Catch-22 “degenerative cascade” begins, which can be very difficult to stop. Studies done at Stanford University showed that lots of stress or exposure to cortisol accelerates the degeneration of the aging hippocampus. And, because the hippocampus is part of the feedback mechanism that signals when to stop cortisol production, a damaged hippocampus causes cortisol levels to get out of control – further compromising memory and cognitive function. The cycle of degeneration then continues. In a study titled “Cortisol levels during human aging predict hippocampal atrophy and memory deficits”, a third of the 60 volunteers, who were between ages 60 and 85, had chronically high cortisol levels, a problem that seems to be fairly common in older people. The size of the hippocampus averaged 14% smaller in one group and showed high and rising cortisol levels, compared to a group with moderate and decreasing levels. The small hippocampus group also did worse at remembering a path through a human maze and pictures they’d seen 24 hours earlier and – two tasks that use the hippocampus. Suffering from stress for long periods of time can shrink the brain – and it can even cause dementia, researchers claim. Types of stress linked to the condition include that suffered by those who were in loveless marriages, dead-end jobs and post-traumatic situations. The discovery first came about after doctors treated Wall Street bosses for post-traumatic stress after the September 11 attacks. Brain scans showed that the executives’ hippocampuses had shrunk to the size of those of elderly people suffering from dementia.

Fatigue:

The fight or flight mechanism is designed to operate briefly and intermittently, but when activated for abnormally long periods, causes the body’s physical, mental and emotional batteries to drain dry. Energy stored in the body as protein, glycogen and triglycerides is rapidly converted back to amino acids, glucose and fatty acids etc to help the body deal with the perceived threat. The process of conversion, achieved via the release of stress hormones such as glucocorticoids, glucagon, epinephrine (adrenaline) and norepinephrine (noradrenaline), itself consumes energy. The stress hormones also trigger the conversion of protein in those muscles not required for flight or fright into amino acids. Whilst the human body is capable of withstanding considerable levels and periods of stress, when the stress response is turned on for long periods, the body inevitably sustains damage through prolonged raised levels of glucocorticoids (which are toxic to brain cells), excessive depletion of energy reserves, resulting in fatigue, loss of strength and stamina, muscle wastage (as in steroid myopathy when patients receive large doses of glucocorticoids to treat various illnesses), and adult-onset diabetes. The weakened immune system cannot fight off viruses (e.g. colds, flu, glandular fever etc) and the person suffers constant illnesses during which the batteries do not recharge. Even without viral infection, the obsessiveness and disturbed sleeping patterns prevent the body from replenishing stored energy.

Irritable Bowel Syndrome (IBS):

Irritable Bowel Syndrome, or IBS, is a classic symptom of stress. It’s not a disease but a functional disorder (i.e. a malfunction) of the digestive system; hence it’s other name of spastic colon. Certain foods, especially whole wheat and fat, cause a violent spasm of the intestine resulting in abdominal pain (often excruciating), stomach cramps, bloating, endless tummy rumbling, gas, belching, nausea and sometimes vomiting, constipation or diarrhoea (or both alternating) and a general debilitating feeling of great unwellness. Attacks are triggered by certain foods and can last a day. The cause is unknown and IBS can start at any age with no apparent reason, although long-term stress is often, if not scientifically, implicated. Up to 20% of the population may experience IBS to some degree, but sufferers may find diagnosis can be difficult to obtain. There’s no “cure” but strict attention to diet can reduce or even eliminate the symptoms. Many people suffer for years before obtaining diagnosis, after which their life is transformed with a new diet.

Some drugs may cause or worsen symptoms of stress:

Some inhaler medicines used to treat asthma

Thyroid drugs

Some diet pills

Some cold remedies

Caffeine, cocaine, alcohol, and tobacco products may also cause or make symptoms of stress worse.

Prognosis:

The prognosis for recovery from a stress-related illness is related to a wide variety of factors in a person’s life, many of which are genetically determined (race, sex, illnesses that run in families) or beyond the individual’s control (economic trends, cultural stereotypes and prejudices). It is possible, however, for humans to learn new responses to stress and thus change their experiences of it. A person’s ability to remain healthy in stressful situations is sometimes referred to as stress hardiness. Stress-hardy people have a cluster of personality traits that strengthen their ability to cope. These traits include believing in the importance of what they are doing; believing that they have some power to influence their situation; and viewing life’s changes as positive opportunities rather than as threats.

Post traumatic stress disorder (PTSD):

PTSD is a natural emotional reaction to a deeply shocking and disturbing experience. It is a normal reaction to an abnormal situation. Many people who go through traumatic events have difficulty adjusting and coping for a while. But with time and taking care of yourself, such traumatic reactions usually get better. In some cases, though, the symptoms can get worse or last for months or even years. Sometimes they may completely shake up your life. In a case such as this, you may have post-traumatic stress disorder. Symptoms may include flashbacks, nightmares and severe anxiety, as well as uncontrollable thoughts about the event. Post Traumatic Stress Disorder (PTSD) is defined in DSM-IV, the fourth edition of the American Psychiatric Association’s Diagnostic and Statistical Manual. For a doctor or mental health professional to be able to make a diagnosis, the condition must be defined in DSM-IV or its international equivalent, the World Health Organization’s ICD-10.

The diagnostic criteria for Post Traumatic Stress Disorder (PTSD) are defined in DSM-IV as follows:

A. The person experiences a traumatic event in which both of the following were present:

1. the person experienced or witnessed or was confronted with an event or events that involved actual or threatened death or serious injury, or a threat to the physical integrity of self or others;
2. The person’s response involved intense fear, helplessness, or horror.

B. The traumatic event is persistently re-experienced in any of the following ways:

1. Recurrent and intrusive distressing recollections of the event, including images, thoughts or perceptions;
2. Recurrent distressing dreams of the event;
3. Acting or feeling as if the traumatic event were recurring (e.g. reliving the experience, illusions, hallucinations, and dissociative flashback episodes, including those on wakening or when intoxicated);
4. Intense psychological distress at exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event;
5. Physiological reactivity on exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event.

C. Persistent avoidance of stimuli associated with the trauma and numbing of general responsiveness (not present before the trauma) as indicated by at least three of:

1. Efforts to avoid thoughts, feelings or conversations associated with the trauma;
2. Efforts to avoid activities, places or people that arouse recollections of this trauma;
3. Inability to recall an important aspect of the trauma;
4. Markedly diminished interest or participation in significant activities;
5. Feeling of detachment or estrangement from others;
6. Restricted range of affect (eg unable to have loving feelings);
7. Sense of a foreshortened future (eg does not expect to have a career, marriage, children or a normal life span).

D. Persistent symptoms of increased arousal (not present before the trauma) as indicated by at least two of the following:

1. Difficulty falling or staying asleep;
2. Irritability or outbursts of anger;
3. Difficulty concentrating;
4. Hypervigilance;
5. Exaggerated startle response.

E. The symptoms on Criteria B, C and D last for more than one month.

F. The disturbance causes clinically significant distress or impairment in social, occupational or other important areas of functioning.

The focus of the DSM-IV definition of PTSD is a single life-threatening event or threat to integrity. However, the symptoms of traumatic stress also arise from an accumulation of small incidents rather than one major incident. Where the symptoms are the result of a series of events, the term Complex PTSD may be more appropriate. PTSD resulting from accident, disaster, war, terrorism, torture, kidnap, etc has been extensively studied and literature is available elsewhere. Studies suggest that approximately 0.5 percent of men and 1.3 percent of women meet criteria for PTSD over their lifetime and accounts for considerable disability and morbidity. A larger percentage (approximately 15%) of subjects was found to have some symptoms but did not meet criteria for the full disorder.

Physiologic factors:

The amygdala is a key brain structure implicated in PTSD. Research has shown that exposure to traumatic stimuli can lead to fear conditioning, with resultant activation of the amygdala and associated structures, such as the hypothalamus, locus ceruleus, periaqueductal gray, and parabrachial nucleus. This activation and the accompanying autonomic neurotransmitter and endocrine activity produce many of the symptoms of PTSD. The orbitofrontal cortex exerts an inhibiting effect on this activation. The hippocampus also may have a modulating effect on the amygdala. However, in people who develop PTSD, the orbitofrontal cortex appears to be less capable of inhibiting this activation, possibly due to stress-induced atrophy of specific nuclei in this region.

As with most mental health problems, PTSD is probably caused by a complex mix of:

Your inherited mental health risks, such as an increased risk of anxiety and depression.

Your life experiences, including the amount and severity of trauma you’ve gone through since early childhood.

The inherited aspects of your personality — often called your temperament.

The way your brain regulates the chemicals and hormones your body releases in response to stress.

The most common events leading to the development of PTSD include:

Combat exposure

Rape

Childhood neglect and physical abuse

Sexual molestation

Physical attack

Being threatened with a weapon.

Risk factors for PTSD after a traumatic event, including:

Being female

Experiencing intense or long-lasting trauma

Having experienced other trauma earlier in life

Having other mental health problems, such as anxiety or depression

Lacking a good support system of family and friends

Having first-degree relatives with mental health problems, including PTSD

Having first-degree relatives with depression

Having been abused or neglected as a child.

PTSD which by definition lasts longer than one month is characterized by three sets of symptoms: “Hyperarousal,” an agitated state in which the heart may race, concentration and sleep are disturbed, startle responses are exaggerated and anger easily triggered; “Re-experiencing” the original trauma – in nightmares, intense and disturbing memories, and flashbacks; and “Avoidance” of trauma-related thoughts and feelings, coupled often with a sense of detachment and estrangement, emotional numbness and an apprehension about a bleak future.

Common symptoms of PTSD and Complex PTSD that sufferers report experiencing:

Hypervigilance (feels like but is not paranoia)

Exaggerated startle response

Irritability

Sudden angry or violent outbursts

Flashbacks, nightmares, intrusive recollections, replays, violent visualisations

Triggers

Sleep disturbance

Exhaustion and chronic fatigue

Reactive depression

Guilt

Feelings of detachment

Avoidance behaviors

Nervousness, anxiety

Phobias about specific daily routines, events or objects

Irrational or impulsive behavior

Loss of interest

Loss of ambition

Anhedonia (inability to feel joy and pleasure)

Poor concentration

Impaired memory

Joint pains, muscle pains

Emotional numbness

Physical numbness

Low self-esteem

An overwhelming sense of injustice and a strong desire to do something about it.

Having PTSD also may place you at a higher risk of other mental health problems, including:

Depression

Drug abuse

Alcohol abuse

Eating disorders

Suicidal thoughts and actions

In addition, PTSD may increase your risk of certain medical illnesses, including:

Cardiovascular disease

Chronic pain

Autoimmune diseases, such as rheumatoid arthritis and thyroid disease

Musculoskeletal conditions

Lab Studies:

Cortisol levels may be decreased, norepinephrine and epinephrine levels may be elevated and hypothalamic-pituitary-adrenal axis activity may be abnormal in patients with PTSD; however, these findings are still only used for research. Natural opiates, which are produced by the body to mask pain in the face of danger, may be found in higher levels in people with PTSD, even after the danger has passed. This may lead to the blunted emotions seen in persons with this condition.

Imaging Studies:

Magnetic resonance imaging (MRI) studies of the brain suggest that the amount of hippocampal atrophy correlates with the intensity of PTSD symptoms, but MRI is still not a recommended diagnostic test.Some studies in monozygotic twins show that a small hippocampus may be a predisposing factor to the later development of PTSD in the face of a stressor.

Post-traumatic stress disorder treatment often includes both medication and psychotherapy. Combining these treatments can help improve your symptoms and teach you skills to cope better with the traumatic event — and life beyond it.

Medications:

Several types of medications can help symptoms of post-traumatic stress disorder improve.

Antipsychotics: In some cases, you may be prescribed a short course of antipsychotics to relieve severe anxiety and related problems, such as difficulty sleeping or emotional outbursts.

Antidepressants: These medications can help symptoms of both depression and anxiety. They can also help improve sleep problems and improve your concentration. The selective serotonin reuptake inhibitor (SSRI) medications sertraline and paroxetine are FDA-approved for the treatment of PTSD.

Anti-anxiety medications: These drugs also can improve feelings of anxiety and stress.

Prazosin: If your symptoms include recurrent nightmares, prazosin may reduce or suppress nightmares in many people with PTSD.

Psychotherapy

Several types of therapy may be used to treat both children and adults with post-traumatic stress disorder. You may try more than one, or combine types, before finding the right fit for you. You may also try individual therapy, group therapy or both. Group therapy can offer a way to connect to others going through similar experiences. Some types of therapy used in PTSD treatment include: Cognitive therapy, Exposure therapy and Eye movement desensitization and reprocessing (EMDR).

Untreated, PTSD symptoms can last a lifetime, impairing health, damaging relationships and preventing people achieving their potential. Sufferers often find that knowledge and treatment of PTSD (and especially Complex PTSD) is difficult to obtain. However, prospects for recovery are good when you have the right counsel and are in the company of fellow survivors and those with genuine insight, empathy and experience. Taking support from family, friends and religious preacher after surviving traumatic event may help prevent PTSD. New research suggests certain long-term psychotherapies may do a better job than an antidepressant in preventing post-traumatic stress disorder (PTSD) following a traumatic event. A steroid injection given shortly after a traumatic event could reduce the risk that the victim will later develop PTSD, a new study suggests. It is possible people who are predisposed to PTSD have abnormalities in the way their brains release cortisol, researchers said. By injecting hydrocortisone, the researches may be augmenting the stress response and thus helping to prevent PTSD. Cortisol also may act to prevent the formation of memories of traumatic event.

The legal system and PTSD:

One major reason for litigation in the event of trauma and criminal offenses is to punish persons involved in violence and criminal activity. As a witness to an act of violence/rape, the victim has an obligation to report the crime and to cooperate with law enforcement officials. The victim acts as a witness to the case and, therefore, is not a party to the criminal proceedings and is not represented. This can be difficult after experiencing the event itself, which characterizes loss of power, control, and dignity. Victims often require the support and advocacy of legal representation, but the system does not provide it. The prosecuting attorney is the supposed advocate for the victim, but the attorney’s job of defending the interests of justice may conflict with the interests of the victim. The process of a trial can be very traumatic for the victim, particularly in cases of sexual assault. Defense tactics sometimes involve blaming the victim for the crime by tainting her character; this may add more pain to an already painful process.

Stress and pregnancy:

Developmental biologists once thought fetuses were conceived with a “blueprint” from their parents’ genes. As long as you gave the growing fetus the right nutrients and avoided harmful substances, this blueprint would develop into a healthy baby. That’s not what experts believe anymore. This view has more or less been completely turned upside down. At each stage of development, the organism uses cues from its environment to decide how best to construct itself within the parameters of its genes. Stress is an example of how a fetus responds to stimuli in the womb and adapts physiologically. When the mother is stressed, several biological changes occur, including elevation of stress hormones and increased likelihood of intrauterine infection. The fetus builds itself permanently to deal with this kind of high-stress environment, and once it’s born may be at greater risk for a whole bunch of stress-related pathologies. Pre-term births and low birth weight are among the most recognized effects of maternal stress during pregnancy, established over nearly two decades of animal and human research. Recent studies suggest that women who experience high levels of psychological stress are significantly more likely to deliver pre-term. Typically, one in 10 women delivers pre-term (before 37 weeks).

Prenatal stress:

Researchers at Columbia Presbyterian Medical Center in New York recently measured fetal stress triggered by frustration in the mother. Expectant mothers were given challenging computer exercises while heart rate, blood pressure and breathing were measured. Sensors simultaneously measured fetal heart rate and movements. As the women struggled with computer-generated challenges, their responses reflected biological changes consistent with stress, such as increased heart rate and elevations in blood pressure. The breakthrough was that biological changes were also detected in each fetus.

Prenatal stress reduces fertility and fecundity in female offspring:

Female rats subjected to prenatal stress later experienced fewer conceptions, more spontaneous abortions and vaginal hemorrhaging, longer pregnancies, and fewer viable young than non-stressed rats. The offspring of the prenatally stressed rats were lighter in weight and less likely to survive the neonatal period. Prenatal stress may influence the balance of adrenal and gonadal hormones during a critical stage of fetal hypothalamic differentiation, thereby producing a variety of reproductive dysfunctions in adulthood.

Stress exposure in intrauterine life is associated with shorter telomere length in young adulthood:

Leukocyte telomere length (LTL) is a predictor of age-related disease onset and mortality. The association in adults of psychosocial stress or stress biomarkers with LTL suggests telomere biology may represent a possible underlying mechanism linking stress and health outcomes. A research study provides the first evidence in humans of an association between prenatal stress exposure and subsequent shorter telomere length. The study suggests that stress exposure in intrauterine life can produce variations in LTL, thereby potentially setting up a long-term trajectory for disease susceptibility.

Children born to mothers who are highly stressed during pregnancy exhibit genetic changes that may make them more vulnerable to stress themselves, new research finds. A study found that children and teens whose mothers had been victims of domestic violence during pregnancy had altered expression of a gene that has been linked to stress response and behavioral problems. Researchers say the finding suggests that alterations in gene expression in the womb that result from exposure to maternal stress can persist through childhood and into adulthood. Researchers link stress during pregnancy to sustained changes in DNA methylation, a process involved in turning genes on and off. This is a potential mechanism to explain how exposure to prenatal stressors could influence psychological function throughout life.

Stress during pregnancy may lower baby’s IQ:

Severe stress during pregnancy can damage a baby’s brain and put the child at greater risk of anxiety, depression and Attention Deficit Hyperactivity Disorder later on in adolescence, according to British research. The higher the levels of cortisol – a stress hormone – in the womb, the lower the toddler’s “baby IQ” at 18 months, the researchers found. They found that if the mother was more stressed while she was pregnant, the baby scored significantly lower on the mental developmental index. Cortisol is naturally elevated during pregnancy, and rises again before a mother gives birth. Normally, the placenta protects the unborn baby from cortisol by producing an enzyme that breaks it down but the enzyme works less efficiently when the mother is stressed out. The more anxious a mother was, the more cortisol appeared in her amniotic fluid, the researchers found. Experiments on pregnant primates have shown that stress can shrink a foetus’s hippocampus by 30 per cent. The hippocampus plays an important role in memory, learning and emotional development. Maternal anxiety also affects other areas of the foetal brain, including the corpus callosum, which connects the right and left hemispheres, and the amygdala, which regulates our response to fear.

Stress linked to miscarriages:

Stress could be linked to miscarriages, researchers have suggested. However, the study published in New Scientist magazine suggests giving at-risk women extra doses of the hormone progesterone could protect pregnancies. The researchers found stress hormones such as cortisol are raised in the bloodstream, suppressing the production of progesterone – a hormone which is crucial to the maintenance of a healthy pregnancy. Falling levels of progesterone lead to a fall in the levels of progesterone-induced blocking factor (PABF) which trigger the production of molecules such as interleukin-4 and interleukin-10 within the immune system. In healthy pregnancies, these molecules tell the immune system to tolerate the foreign cells of the placenta and foetus.

Major stress during pregnancy linked to autism:

Women who have had a major stressful event – death of a spouse, job loss, or a long-distance move – midway through their pregnancy may have a greater chance of having an autistic child than do their unstressed counterparts say researchers at The Ohio State University Medical Center. Stress levels for the mothers of autistic children were nearly twice those of other mothers in the study. Researchers have been examining the genetic component of the disease for years, but there is now evidence through this study that autism is also linked to external factors, such as prenatal stress.

Maternal separation stresses the Baby:

New research published in Biological Psychiatry provides new evidence that separating infants from their mothers is stressful to the baby. It is standard practice in a hospital setting, particularly among Western cultures, to separate mothers and their newborns. Separation is also common for babies under medical distress or premature babies, who may be placed in an incubator. In addition, the American Academy of Pediatrics specifically recommends against co-sleeping with an infant, due to its association with Sudden Infant Death Syndrome, or SIDS. Humans are the only mammals who practice such maternal-neonate separation, but its physiological impact on the baby has been unknown until now. Researchers measured heart rate variability in 2-day-old sleeping babies for one hour each during skin-to-skin contact with mother and alone in a cot next to mother’s bed. Neonatal autonomic activity was 176% higher and quiet sleep 86% lower during maternal separation compared to skin-to-skin contact. More research is necessary to further understand the newborn response to separation, including whether it is sustained response and whether it has any long-term neurodevelopmental effects. However, skin-to-skin contact has known benefits, and certainly, most would agree that unnecessarily stressing a newborn is unacceptable.

Stress and gender:

Animal studies involving stress and gender:

Animal studies have shown significant sex differences in the effects of stress. There are sex differences in the effects of stress on the hippocampus and amygdala, whereas nothing is yet known about the prefrontal cortex in this regard. Chronic foot shock stress for 3 weeks caused a decrease in proliferation in dentate gyrus in singly housed male rats but caused an increase in proliferation in female rats, and both effects were prevented by group housing. CRS induced retraction of dendrites in the CA3 region of hippocampus is found in males but not in females unless the females are ovariectomized. Chronic restraint stress for 21 days has been reported to either enhance or have no effect on performance of female rats in a spatial learning task, while having an inhibitory effect in males. Interestingly, as noted above, females did not show the chronic stress-induced enhancement of ibotenic acid-induced damage in the CA3 region, in contrast to chronically stressed male rats. In basolateral amygdala, chronic restraint stress increased dendritic length in males and in estradiol-treated females, but not in ovariectomized females. Furthermore, as another example of a sex difference, acute tail shock restraint stress produces opposite effects on classical eye blink conditioning, enhancing performance in males and reducing it in females, and both developmental and adult activation effects of gonadal hormones are involved.

Stress difference between men and women:

Gender in humans is an important biological determinant of vulnerability to psychosocial stress. A study used perfusion based functional magnetic resonance imaging (fMRI) to measure cerebral blood flow (CBF) responses to mild to moderate stress in 32 healthy people (16 males and 16 females). Psychological stress was elicited using mental arithmetic tasks under varying pressure. Stress in men was associated with CBF increase in the right prefrontal cortex (PFC) and CBF reduction in the left orbitofrontal cortex, a robust response that persisted beyond the stress task period. In contrast, stress in women primarily activated the limbic system, including the ventral striatum, putamen, insula and cingulate cortex. The asymmetric prefrontal activity in males was associated with a physiological index of stress responses—salivary cortisol, whereas the female limbic activation showed a lower degree of correlations with cortisol. This study may represent an initial step in uncovering the neurobiological basis underlying the contrasting health consequences of psychosocial stress in men and women.

Biological differences in the stress responses exists between men & women and researchers make a convincing argument that high sympathetic nervous system activation (targeted primarily at the cardiovascular system, thereby optimizing physical performance), effective activation of pain inhibition systems (to prevent distraction of fight and flight performance from injury related pain), and high cortisol responses (that mitigate the immune response and repress inflammation) are characteristic biological components of the male stress response. These responses are related to higher male sex hormone levels. In contrast, in females, greater activation of vagal mechanisms (associated with parasympathetic nervous system “relax and restore” responses and increased gastrointestinal activation), and greater release of oxytocin (a calming hormone amplified by estrogen) and endorphins within the brain will inhibit the underlying fight and flight response, and promote attachment behavior both to the offspring as well as to other females. Do these differences also apply to the non-life threatening stressors of daily life; and could the differences in biological mechanisms play a role in the well known fact that men are more likely to die of chronic diseases of the cardiovascular system (hypertension, coronary artery disease), while women appear more likely to suffer from a wide range of functional disorders, such as IBS, fibromyalgia, and interstitial cystitis are the questions researchers trying to answer. UCLA researchers found that men often react to stress with a “fight-or-flight” response, but women are more likely to manage their stress with a “tend-and-befriend” response and in fact this stress response is seen in many species. Females respond to stressful conditions by protecting and nurturing their young (the “tend” response), and by seeking social contact and support from others – especially other females (the “befriend” response). Females, under stress, are more likely to turn to other females for support and defend each other from perceived threats. Social support helps females manage their response to stress. This pattern is in sharp contrast to the fight-or-flight behavior, long considered the principal method both sexes used to cope with stress. Fight-or-flight means that, when confronted by stress, individuals either react with aggressive behavior – such as verbal conflict and more drastic actions – or withdraw or flee from the stressful situation. “Befriending” methods include talking on the phone with relatives or friends, to such simple social contacts as asking for directions when lost. The “tending” pattern is especially apparent in the differences between fathers’ and mothers’ behaviors with their children after a stressful workday. When the typical father came home after a stressful day at work, he responded to stress by wanting to be left alone, enjoying peace and quiet away from the stress of the office; when office-related stress was particularly acute, a typical response would be to react harshly or create conflict with his wife or children. When the typical mother came home from work bearing stress, she was more likely to cope with her bad day by focusing her attention on nurturing her children. Men are more vulnerable to the adverse health effects of stress. Men are more likely than women to develop “certain stress-related disorders, including hypertension, aggressive behavior, or abuse of alcohol or hard drugs.” Because the tend-and-befriend regulatory system may, in some ways, protect women against stress, this biobehavioral pattern may provide insights into why women live an average of seven and a half years longer than men. The tend-and-befriend pattern exhibited by women probably evolved through natural selection. Thousands of generations ago, fleeing or fighting in stressful situations was not a good option for a female who was pregnant or taking care of offspring, and women who developed and maintained social alliances were better able to care for multiple offspring in stressful times. Oxytocin, a hormone secreted in both men and women as a response to stress, has been shown to calm rats and humans, making them less anxious and more social. In several animal species, it leads to maternal behavior and to affiliation. Male hormones seem to reduce the effect of oxytocin, but the female hormone estrogen amplifies it.

Defensiveness is a trait characterized by avoidance, denial or repression of information perceived as threatening. A strong defensive reaction is useful to maintain one’s self-esteem faced with this potential threat. A study found that those women who show strong defensive reaction to judgment from others or a threat to self-esteem would have high blood pressure and heart rate resulting in higher cardiovascular morbidity & mortality rates despite protective effects of estrogen & oxytocin.

Women in the Canadian Forces are significantly more likely to suffer post-traumatic stress and depression than male troops, suggests a new study that points to key psychological differences between the uniform-wearing sexes — even as the military lines between them are blurred. The findings do not explain why the differences exist, but the study cites one theory that military women could face additional pressures because, as still a relatively small minority, they are treated as outsiders and routinely face stereotyping. Also, women in the forces often fill dual roles at home and work that can make the unpredictable life more stressful. Also, sexual harassment in the military is also a fact of life women have to deal with. So even though, men are more vulnerable to stress than women due to biological differences, working women who have to fill dual roles at home & work, women who are gender discriminated and women who suffer sexual harassment & exploitation at work place suffer more due to stress as compared to their male counterpart.

Stress aging:

If stress does not kill you, it will at least age you. A finding that was presented at the 114th Annual Convention of the American Psychological Association (APA) shows that “age may be more related to reactions to stress and the absence of disease rather than to a person’s chronological age…” Chronic stress, the kind that drags on rather than being just a momentary crisis, can drastically affect hormonal levels and shift the body’s hormonal balance. Researcher says that it is likely that the imbalance in the hormones is responsible for many of the psychiatric and medical diseases associated with aging. Chronically elevated cortisol reduces lean mass, bone density and shifts fat distributions that can precede the onset of many age-related diseases like osteoporosis, Alzheimer’s disease and major depression. The article “Chronic Stress May Make You Age Faster” states that older adults often face chronic stress in the form of social isolation, bereavement, financial stress and care giving. However, not all adults handle chronic stress the same way. Those able to take such stressors in stride often look younger than more stressed adults their age.

So stress can age you faster but one study says that stress declines with age!

Americans report a significantly lower incidence of worry and stress as they get older, particularly as they move into and beyond their mid-60s. This finding runs counter to the hypothesis that those who are older would be more apt to worry about deteriorating health, fixed incomes, or impending death. On the other hand, many seniors are beyond the point where they have to worry about varying income, and previous research has shown that seniors are the only age group satisfied with the amount of time they have to enjoy life. These cross-sectional data do not allow for a determination of whether the worry-age phenomenon reflects a cohort effect (reflecting the particular history and life experiences of those who are older today) or a generational effect (such that past and future generations of Americans would be found to exhibit the same patterns of worry and stress). The analysis does suggest, however, that several logical reasons for older Americans’ worrying less — including that they are much less likely to have children in the home or to be employed, or that they are more religious and more likely to be female — do not appear to be explanations.

Genes and stress:

How genes can affect stress response and how stress can affect genes is discussed here. I have already discussed earlier in the segment “stress and pregnancy” that maternal stress does cause genetic changes in the fetus.

Recent research indicates that some vulnerability to stress is genetic. Scientists at the University of Wisconsin and King’s College London discovered that people who inherited a short, or stress-sensitive, version of the serotonin transporter gene were almost three times as likely to experience depression following a stressful event as people with the long version of the gene. Further research is likely to identify other genes that affect susceptibility to stress. Biology is not entirely destiny and knowing that there is a gene that produces the symptoms we associate with mental stress means we can bypass the expression of that gene by avoiding stress-provoking situations. These are the patients who respond well to exercise, relaxation techniques and lifestyle changes.

Why don’t all traumatized people develop PTSD?

Only a minority of people exposed to severe trauma develop post-traumatic stress disorder (PTSD), which suggests that certain factors (some of them possibly genetic) may be involved in vulnerability to PTSD. Two studies look at this question. Mehta and colleagues studied 209 people recruited from an inner-city hospital (90% black; mostly low-income) who had experienced at least one adult trauma; 70% had developed PTSD. The researchers focused on links among PTSD, sensitivity of the glucocorticoid receptor (GR), and a single nucleotide polymorphism (SNP) of FKBP5, a GR co-chaperone involved in negative feedback regulation of the hypothalamic–pituitary–adrenal (HPA) axis. Among PTSD patients, after adjustment for childhood and adult traumas and depression, greater GR receptor sensitivity (measured by dexamethasone suppression) was associated with being an allele carrier than with GG homozygosity, which was associated with lower baseline serum cortisol levels. Neither PTSD nor genotype alone predicted dexamethasone suppression. However, researchers identified another 41 genes (32 previously unreported) that participate in GR regulation; 19 appeared to form a network related to FKBP5 regulation of HPA axis activation in PTSD. In Mercer and colleagues’ study, 204 undergraduate women (mean age, 20), who had participated in a study of traumatic experiences, social supports, and sexual victimization, were reassessed twice after a lone shooter killed or wounded 26 people on campus (mean follow-ups, 3.2 weeks and 8.4 months). Genotyping of three loci in the serotonin transporter genetic region was performed. Severity of post shooting PTSD symptoms was predicted by the number of exposure events (e.g., hearing gunfire or being hurt), but not by previous traumas or social support. After statistical corrections and adjustment for the shooting exposure, higher PTSD symptom scores (especially avoidance) and acute stress disorder after the shooting were associated with a multimarker genotype that decreases expression of the serotonin transporter. These studies show that vulnerability to an abnormal stress response is genetically heterogeneous. People with a specific allele in a gene network that regulates the HPA axis may be vulnerable to suppression of cortisol production resulting from burnout of the stress response. Genetic interactions that reduce resilience of serotonergic systems that moderate arousal may increase susceptibility to excessive stress responses. As genotyping becomes cheaper and more reliably tied to clinical phenotypes, clinicians may be able to identify trauma-exposed people who would respond to interventions aimed at a specific dimension of stress response systems.

Gene that ties stress to obesity and diabetes discovered:

All of the body’s systems are involved in the stress response, which evolved to deal with threats and danger. Behavioral changes tied to stress include heightened anxiety and concentration, while other changes in the body include heat-generation, changes the metabolism of various substances and even changes in food preferences. What ties all of these things together? Researchers suspected that a protein known as Urocortin-3 (Ucn3) was involved. This protein is produced in certain brain cells — especially in times of stress — and it’s known to play a role in regulating the body’s stress response. These nerve cells have extensions that act as ‘highways’ that speed Ucn3 on to two other sites in the brain: One, in the hypothalamus — the brain’s center for hormonal regulation of basic bodily functions — oversees, among other things, substance exchange and feelings of hunger and satiety; the other is involved in regulating behavior, including levels of anxiety. Nerve cells in both these areas have special receptors for Ucn3 on their surfaces, and the protein binds to these receptors to initiate the stress response. The researchers developed a new, finely-tuned method for influencing the activity of a single gene in one area in the brain, using it to increase the amounts of Ucn3 produced in just that location. They found that heightened levels of the protein produced two different effects: The mice’s anxiety-related behavior increased, and their bodies underwent metabolic changes, as well. With excess Ucn3, their bodies burned more sugar and fewer fatty acids, and their metabolic rate sped up. These mice began to show signs of the first stages of type 2 diabetes: a drop in muscle sensitivity to insulin delayed sugar uptake by the cells, resulting in raised sugar levels in the blood. Their pancreas then produced extra insulin to make up for the perceived deficit. This study showed that the actions of single gene in just one part of the brain can have profound effects on the metabolism of the whole body. This mechanism, which appears to be a ‘smoking gun’ tying stress levels to metabolic disease, might, in the future, point the way toward the treatment or prevention of a number of stress-related diseases.

Stress targeting genes through cortisol:

In response to stress, the brain activates several neuropeptide-secreting systems. This eventually leads to the release of adrenal corticosteroid hormones, which subsequently feedback on the brain and bind to two types of nuclear receptor that act as transcriptional regulators. By targeting many genes, corticosteroids function in a binary fashion, and serve as a master switch in the control of neuronal and network responses that underlie behavioral adaptation. In genetically predisposed individuals, an imbalance in this binary control mechanism can introduce a bias towards stress-related brain disease after adverse experiences. New candidate susceptibility genes that serve as markers for the prediction of vulnerable phenotypes are now being identified.

Effects of stress can be inherited:

Our genes encode proteins, but whether and how those genetic instructions are ultimately read and expressed depends on how those genes are chemically modified and “packaged” into a more complex structure known as chromatin. Some portions of the genome are more tightly wound into what’s known as heterochromatin. Heterochromatin is maintained from one generation to the next and typically doesn’t contain active genes. Over 20 years ago, researchers discovered a gene in yeast (called activation transcription factor-2 or ATF-2 for short) that is required for those tightly packed, heterochromatin structures to form. ATF-2 is altered by stress-activated protein kinases in response to environmental stress, inflammatory cytokines, and reactive oxygen species (ROS). But it wasn’t entirely clear what this might mean for other organisms. It is now confirmed that ATF-2 is required for heterochromatin assembly in multicellular organisms. When fruit flies are exposed to stressful conditions, the ATF-2 is modified and disrupts heterochromatin, releasing genes from their usual silenced state. Importantly, these changes in genomic structure are passed on from one generation to the next. The researchers expect that this finding in flies has relevance for humans, noting that we also carry the ATF-2 gene. Those epigenetic changes may influence basic cellular functions as well as metabolism, behavior and disease. In particular, researchers suggest that epigenetic causes may play a role in “lifestyle diseases”, including heart disease and diabetes, and in psychological diseases, such as schizophrenia.

Child abuse impacts stress gene:

Abuse in early childhood permanently alters how the brain reacts to stress, a Canadian study suggests. Analysis of brain tissue from adults who had committed suicide found key genetic changes in those who had suffered abuse as a child. It affects the production of a receptor known to be involved in stress responses, the researchers said. A research team led by McGill University, in Montreal, examined the gene for the glucocorticoid receptor – which helps control the response to stress – in a specific brain region of 12 suicide victims with a history of child abuse and 12 suicide victims who did not suffer abuse when younger. They found chemical changes which reduced the activity of the gene in those who suffered child abuse. And they showed this reduced activity leads to fewer glucocorticoid receptors. Those affected would have had an abnormally heightened response to stress, the researchers said.

Can stress control our genes?

Researchers from University of Copenhagen have shown that external factors can stress our cells through the control of our genes. They found that stress-activating factors can control our genes by turning on certain genes that were supposed to be silenced. It is very important that some genes are on and others are off in order to ensure normal foetal development and correct function of our cells later in life. We know that different protein complexes can associate with specific proteins (histones) to which DNA is wound around and thereby determine whether the genes are active or inactive. Small chemical groups can cause protein complexes to bind to histones and these can control gene activity. The researchers have studied in detail a complex called PRC2. PRC2 can attach small chemical groups – methyl groups – to the histones. Protective complexes can bind to the histones when this marker is present and the genes are turned off. Their new results show that the protective complexes are lost and selected genes turned on when cells are exposed to external stress factors. The reason why the complexes are lost is that the stress factors instruct an enzyme named MSK to attach another chemical group – a phosphate group – to the histones neighboring the methyl group. The phosphate group neutralizes the effect of the methyl group and turns specific genes on. The consequence is that genes that should be turned off are now active and this may disturb cellular development, identity and growth. This means that without damaging our genetic code external stress factors can control the activity of our genes.

So in a nutshell, genes do affect stress response and stress do affect genes and stress induced genetic changes can be passed on to new generation.

Stress, Adaptation and Evolution of life:

Stress has existed throughout the evolution. About 4 billion years ago, violent collision of rock and ice along with dust and gas, led to the formation of a new planet. The planet survived more than 100 million years of meltdown to give birth to microscopic life. These first organisms endured the harshest of conditions—lack of oxygen, exposure to sun’s UV rays and other inhospitable elements, to hang on to their dear life. Roughly 300,000 years ago, the Neanderthals learnt to use fire in a controlled way, to survive the Glacial Age. And around 30,000 years, Homo sapiens with their dominant gene constitutions and better coping skills, won the game of survival. Each step of evolution a test of survival; and survival, a matter of coping with the stress of changing conditions. Millions of trials and errors in the life process have brought men to this stage. Coping with events to survive has led men to invent extraordinary technologies, beginning with a piece of sharpened stone. Although the term stress is most often used to indicate either the environmental or the biological component, it is clear that from an evolutionary perspective that environmental pressure and biological response should be considered integrative. This implies at the same time that changes in level of stress experienced by organisms or populations can be a consequence of changes of either the stressor or the stressed.

Stress has driven evolutionary change (the development and natural selection of species over time). Environmental stress can be characterized as a force shaping adaptation and evolution in changing environments, and it is a property of both the stressor and the stressed. Like stress, adaptation is also a concept that often causes confusion as it is used in many different ways and contexts, and many definitions are simply physiologically oriented and less suitable in an evolutionary context. In a general sense, adaptation can be defined as the process of change in an organism to conform better with (new) environmental conditions, whereby the organism (or group of organisms) acquires characteristics, involving changes in morphology, physiology or behavior, that improve their survival and reproductive success in the particular environment. Such changes can occur phenotypically, within a set genotype, and this phenotypic adaptation is the result of what is called ‘phenotypic plasticity’, the capability of a genotype to change its phenotype according to prevailing environmental conditions. Adaptation can also occur through changes in allele frequencies as a result of the selection pressure exerted by the environment. This process is known as genotypic adaptation or evolutionary adaptation. As the occurrence of plasticity and possibly also the degree of plasticity are genetically based, both these phenomena are important from an evolutionary perspective. Thus, the species that adapted best to the causes of stress (stressors) have survived and evolved into the plant and animal kingdoms we now observe. From the molecular to the biogeographic levels of organization, stressful environmental conditions underlie much evolutionary change. An understanding of evolutionary rates therefore depends upon a fusion of ecology and genetics especially under stressful conditions. From the viewpoint of microevolution, stress induction of transpositions is a powerful factor, generating new genetic variations in populations under stressful environmental conditions. Passing through a ‘bottleneck’, a population can rapidly and significantly alters its population norm and become the founder of new, evolved forms. Gene transposition through Transposable Elements (TE)—’jumping genes’, is a major source of genetic change, including the creation of novel genes, the alteration of gene expression in development, and the genesis of major genomic rearrangements. In a research on ‘the significance of responses of the genome to challenges,’ the Nobel Prize winning scientist Barbara McClintock, characterized these genetic phenomena as genomic shock. This occurs due to recombinational events between TE insertions (high and low insertion polymorphism) and host genome. But, as a rule TEs remain immobilized until some stress factor (temperature, irradiation, DNA damage, the introduction of foreign chromatin, viruses, etc.) activates their elements.

The moral remains that we can work a stress condition to our advantage or protect ourselves from its untoward follow-throughs subject to how we handle a stress situation. The choice is between becoming a slave to the stressful situations of life or using them to our advantage. Our current knowledge of the stress proteome, i.e. all the proteins that are involved in realizing the cellular stress response through induction, post-translational modification, or protein–protein/DNA interaction, is still fragmentary. Nevertheless, we know that common sets of homologous stress proteins, including molecular chaperones, cell cycle regulators, proteasome regulators and DNA repair proteins are induced by stress in

archaea, eubacteria and eukaryotes. Many of these proteins are among the most highly conserved proteins in all organisms. In fact, stress response genes of humans account for 67 (18%) of the 368 phylogenetically most highly conserved proteins. They are associated with the most basic constitutive functions of all cells, in addition to their roles for stress adaptation. Because such functions are evolutionarily ancient, it is likely that a core stress proteome appeared early in cellular evolution, helping cells to survive stressful fluctuations in the earth’s archaic environment. Thus, the very first organisms and cells may have been eury-tolerant, i.e. they probably had high tolerance limits towards environmental change. Other stress proteins could have originated by gain-of-function mutations or adaptive radiation of genes involved in these basic cell functions at various times during the course of evolution.

An interesting question from an evolutionary perspective pertains to the above-mentioned hypothesis that primordial cells and organisms were originally eury-tolerant. This hypothesis can be tested by comparing the degree of sequence conservation of key stress response genes in eury- tolerant versus steno-tolerant species. Tolerance is an ability of an organism to survive environmental conditions. The prefixes eury- and steno- refer to wide and narrow ranges of tolerance respectively. An organism can be widely tolerant of one factor, such as temperature (eurythermal), but narrowly tolerant of another, such as salinity (stenohaline). However, for many species, high tolerance limits towards fluctuations in a particular environmental factor are indicative of high tolerance limits towards changes in other environmental factors as well. Thus, if ancestral cells were eury-tolerant (stress tolerant) we would expect key stress response genes to be more highly conserved in contemporary eury-tolerant species than in steno-tolerant species, in which these genes have been evolutionarily optimized for other functions. More comparative data are needed to address this hypothesis. A complicating factor in such a conceptual framework is the possibility that some species have secondarily acquired or `reinvented’ eury-tolerance, perhaps by recruiting a few novel genes to reconstitute the cellular stress response network. This might principally be the case for organisms that consist mainly of cells with low tolerance limits towards stress, but also contain particular highly specialized tissues capable of withstanding extreme stress. Renal inner medullary cells of mammals that are able to tolerate many forms of extreme environmental stress provide a good example, which also illustrates that in highly organized metazoans, critical parts of the stress proteome have to be constitutively expressed for cells to be able to display a high stress tolerance. The low osmotic stress tolerance of most non-renal mammalian cell types clearly indicates that it is not sufficient to hold a stress proteome blue-print encoded by the genome. Further questions arise when analyzing the cellular stress response in the context of organismal plasticity towards environmental change. Does the expression of a highly functional stress proteome confer increased stress tolerance at the cost of decreased fitness in stable environments? The history of life on earth is that of periodic extinctions, e.g. in the Silurian, Permian, and late Jurassic periods, followed by explosive adaptive radiation of surviving species. Mass extinctions are commonly attributed to sudden and severe environmental change. One of the many factors that would favor survival during such stressful periods is a high capacity of eury-tolerant species to tolerate such environmental change. The extraordinary conservation of critical elements of the stress proteome, in combination with other adaptive features in such species, may contribute towards enhancing their potential for surviving catastrophic events such as asteroid impacts. Following mass extinctions, lack of competition probably resulted in promoting rapid adaptive radiation of surviving species into suddenly open ecological niches. Steno-tolerant species, although more complex and highly organized, are more susceptible to sudden changes in the earth’s climate, possibly because critical stress response genes were subject to more extensive modification during evolution to accommodate the higher complexity and organization resulting in increased fitness in stable environments. On a vast time scale one could view the evolutionary process of life on earth as a succession of periods of stability favoring adaptive radiation of steno- tolerant species, interspersed with periods of sudden, severe and global environmental change favoring natural selection of eury-tolerant species. Although many factors are important for surviving mass extinctions, the phenomenon of maintenance and natural selection of eury-tolerance may be one of the critical elements. This phenomenon could be described as Mega-Evolution, and may explain the abundance of eury-tolerant species despite the enormous selection pressure towards ever greater specialization over successive cycles of mass extinctions and adaptive radiations. The underlying evolutionary driving force for such Mega-Evolution merits further study, but it seems plausible that a high capacity for a cellular stress response is one of the crucial pre-requisites for such a process.

In a nutshell, it can be said that the more tolerant you are to sudden stressful environment (eury-tolerant), the less specialized and organized you will be as stress proteome genes are exclusively working on adapting to stress. On the other hand, the less tolerant you are to stressful environment (steno-tolerant), the more specialized and organized you will be as stress proteome genes are doing work other than adapting to stress. In other words, greater the adaptability to stressful environment, lesser is the specialization and organization of a species. Lesser the adaptability to stressful environment, greater is the specialization and organization of a species (provide all other factors remain same). During stable environment, steno-tolerant species will flourish and evolutionarily result in development of highly intelligent (specialized) species. During unstable environment, eury-tolerant species will flourish and evolutionarily result in less intelligent (specialized) species. The key word is survival for all species on earth no matter the quantum of stress and no matter whether you are eury-tolerant or steno-tolerant. We, the humans, are at the top of evolutionary ladder, highly specialized intelligent species, cannot survive if environmental temperature rises as in heat waves but lower species e.g. cold blooded animals survive extreme temperature variation, proving point that greater the adaptability to environmental stress, lesser the specialization and vice versa. However, we, the humans, have invented fans, air-conditioners etc to combat heat proving the point that specialization helps in combating stress without having adaptability.

The bottom line is:

Ability to survive = Ability to adapt to stress + Ability to specialize/organize

Evolution is propagated by stress and over the time, different species emerged with different adaptability and different specialization. Nonetheless, the sum total of adaptability and specialization remains same i.e. the ability to survive.

Stress, race and socioeconomic status:

Socioeconomic status and stress:

A research team discovered that high-ranking baboon males generally had lower stress hormone levels than other males barring few exceptions. Research uncovered that dominant baboon males had the lowest stress levels, while submissive baboons were in worse health with increased heart rates and higher blood pressure. Baboons are not only genetically closely related to humans, but like humans they live in highly complex societies. An important insight from this study is that the top position in some animal—and possibly human—societies has unique costs and benefits associated with it. British professor Sir Michael Marmot, who studied the health of civil servants, said the similarities between the baboons and humans are startling. His study on civil servants found that the lower you were in the hierarchy, the higher your risk of heart disease and other disease. Humans with higher socioeconomic status have lower stress as compared to lower socioeconomic status. A study, published in the journal Psychological Science, found that the longer kids spent in poverty, the worse their bodies were at handling the stressors of their environment, increasing their risk for long-term health problems. The income-achievement gap is a formidable societal problem, but little is known about either neurocognitive or biological mechanisms that might account for income-related deficits in academic achievement. Another study showed that childhood poverty is inversely related to working memory in young adults. Furthermore, this prospective relationship is mediated by elevated chronic stress during childhood. An additional study found that children in lower-income homes received less positive parenting and had higher levels of cortisol in their first two years than children in slightly better- off homes. Cortisol was higher in African American children than in White children. Higher levels of cortisol were associated with lower levels of executive function abilities. So early stresses in the lives of children living in poverty affect how these children develop executive functions that are important for school readiness. Stress in the lives of poor children is one cause of the early achievement gap in which children from low-income homes start school behind their more advantaged classmates.

Racial discrimination and stress:

Researchers looked, for the first time, at whether there was a link between reports of racial discrimination and red blood cell oxidative stress among 629 participants enrolled. Overall, African Americans reported more racial discrimination than Whites and more oxidative stress originating from their red blood cells as measured by a novel marker. In addition, African Americans who reported suffering from racial discrimination had higher levels of oxidative stress than those who had not experienced prejudice. Discrimination was not linked to levels of oxidative stress in Whites. The consequences of psychological stress, resulting from racial discrimination, may contribute to racial health disparities in conditions such as cardiovascular disease, diabetes and other age-associated diseases. This is according to analyses of data from the epidemiologic study Healthy Aging in Neighborhoods of Diversity across the Life Span (HANDLS), conducted by the National Institute on Aging (NIA), National Institutes of Health. The psychological stress of racial discrimination is thought to be one of the factors that explain racial health disparities, for conditions such as high blood pressure, obesity, cardiovascular problems, poor self-reported health and premature disease-related disability. I have already discussed earlier that oxidative stress is a surrogate marker for stress and there is some evidence to show that psychological stress increases oxidative stress which is a precursor to many illnesses like diabetes, cancer, heart disease and aging itself.

Statistically, black males in America are at increased risk for just about every health problem known. African Americans have a shorter life expectancy than any other racial group in America except Native Americans, and black men fare even worse than black women. Some of it can be chalked up to poverty, the most powerful determinant of health, or to lifestyle factors. But even when all those factors are accounted for in studies, the gap stubbornly persists. Now researchers are beginning to examine discrimination itself. Racism, more than race, may be cutting black men down before their time. It is possible, they believe, that the ill health and premature deaths can be laid — at least in part — at the feet of continuous assaults of discrimination, real or perceived. We have always thought of race-based discrimination as producing a kind of attitude. Now we have sufficient information to say that it’s more than just affecting your attitude. A person experiences it, has a response, and the response brings about a physiological reaction. The reaction contributes to a chain of biological events known as the stress response, which can put people at higher risk of cardiovascular disease, diabetes and infectious disease.

From above discussion, it is evident that in India; upper caste Hindus should have lower stress than lower caste Hindus, just like whites in America have lower stress than blacks. India is a divided society between upper caste Hindus and lower caste Hindus, and the discrimination against lower caste is a reason to perpetuate reservation policy all over India. Discrimination would result in higher stress and therefore a study should be done to measure cortisol level in blood among upper caste and lower caste Hindus. I have already stated in my article on “Caste based reservation in India” that the best way to end casteism is inter-caste marriage. Apparently, Hindu lower caste people are willing for inter-caste marriages but Hindu upper caste people are unwilling for inter-caste marriages. So even in 21^st century, upper caste Hindus believe that they are superior to lower caste Hindus. Under such circumstances, I expect lower caste Hindus to have higher stress despite reservation. The same logic applies between rich and poor people. I expect stress level to be high among poor people as compared to rich people. The same logic applies between majority community and minority community based on religion or ethnicity, if there is discrimination against minority community.

Stress, race and crime:

Statistically speaking, blacks are more involved in criminal behavior than whites in America. There is a well perceived notion that exposure to stressors is positively associated with criminal behavior. A study found that racial differences in criminal involvement are largely reducible to exposure differences, with blacks typically exposed to significantly more stressful events over their lifetimes than members of other racial/ethnic groups.

Stress management:

Just as we all have cycles of deep sleep and dream sleep throughout the night (at roughly 90- to 120-minute intervals), we also have cycles through the day (peaks of energy and concentration interspersed with troughs of low energy and inefficiency) as seen in the figure above. These cycles are called “ultradian rhythms” because they happen many times per day (as opposed to the 25-hour circadian rhythm with which we are all familiar). The important point is that we need to watch for these troughs and take 20 minute “ultradian healing breaks” when they occur, as opposed to working through them and building up stress.

No one would expect a hockey player to play an entire game without taking breaks. Surprisingly though, many otherwise rational people think nothing of working from dawn to dusk without taking intermissions, and then wonder why they become distressed. It is not always convenient for people to take time-outs when nature tells us to but we can all become better at this. A mid morning break, lunch, a mid afternoon break and supper divide the day into roughly two hour segments. These time-outs can include power naps, meditation, daydreaming, social interlude, short walk, refreshment break, change to low-concentration tasks or listening to music.

If you listen to music when you’re stressed out, you’re not alone. The American Psychological Association found that a majority of people polled for the last two years running claim music as their number one stress reliever. This year, 49% of respondents reported turning to tunes when worried; 44% said they exercise. Reading helps calm 41% of respondents, while watching television or a movie and social interaction help ease the stress of 36% of those surveyed. Things like heading to your favorite spa, grabbing a quick session of yoga or even grabbing a drink at the bar are all drastically lower than one might expect.

The graph above shows various stress management techniques used by people.

Stress Management is the ability to maintain control when situations, people, and events make excessive demands. What you can do to manage your stress? What are some strategies?

Stress is a normal psychological and physical reaction to the ever increasing demands of life. Surveys show that most people experience challenges with stress at some point during the year. In looking at the causes of stress, remember that your brain comes hard-wired with an alarm system for your protection. When your brain perceives a threat, it signals your body to release a burst of hormones to fuel your capacity for a response. This has been labeled the “fight-or-flight” response. Once the threat is gone, your body is meant to return to a normal relaxed state. Unfortunately, the nonstop stress of modern life means that your alarm system rarely shuts off. That’s why stress management is so important. Stress management gives you a range of tools to reset your alarm system. Without stress management, all too often your body is always on high alert. Over time, high levels of stress lead to serious health problems. Don’t wait until stress has a negative impact on your health, relationships or quality of life. Start practicing a range of stress management techniques today.

Stress management is the amelioration of stress and especially chronic stress often for the purpose of improving everyday functioning. Stress produces numerous symptoms which vary according to persons, situations, and severity. These can include physical health decline as well as depression. According to psychologists, the process of stress management is one of the keys to a happy and successful life in modern society. The table below gives some guidelines in management of stress.

Look around. See if there really is something you can change or control in the situation.	Set realistic goals for yourself. Reduce the number of events going on in your life and you may reduce the circuit overload.
Exercise in stress reduction through project management/prioritizing.
Remove yourself from the stressful situation. Give yourself a break if only for a few moments daily.	Don’t overwhelm yourself by fretting about your entire workload. Handle each task as it comes, or selectively deal with matters in some priority.
Don’t sweat the small stuff. Try to prioritize a few truly important things and let the rest slide,	Learn how to best relax yourself. Meditation and breathing exercises have been proven to be very effective in controlling stress. Practice clearing your mind of disturbing thoughts.
Selectively change the way you react but not too much at one time. Focus on one troublesome thing and manage your reactions to it/him/her.	Change the way you see your situation; seek alternative viewpoints. Stress is a reaction to events and problems, and you can lock yourself in to one way of viewing your situation. Seek an outside perspective of the situation, compare it with yours. And perhaps lessen your reaction to these conditions.
Avoid extreme reactions. Why hate when a little dislike will do? Why generate anxiety when you can be nervous? Why rage when anger will do the job? Why be depressed when you can just be sad?	Do something for others to help get your mind off your self.
Get enough sleep. Lack of rest just aggravates stress.	Work off stress with physical activity, whether it’s jogging, tennis, and gardening.
Avoid self-medication or escape. Alcohol and drugs can mask stress. They don’t help deal with the problems.	Begin to manage the effects of stress. This is a long range strategy of adapting to your situation, and the effects of stress in your life. Try to isolate and work with one “effect” at a time. Don’t overwhelm yourself.
Try to “use” stress. If you can’t remedy, nor escape from, what is bothering you, flow with it and try to use it in a productive way.
Try to be positive. Give yourself messages as to how well you can cope rather than how horrible everything is going to be. Stress can actually help memory, provided it is short-term and not too severe. Stress causes more glucose to be delivered to the brain, which makes more energy available to neurons. This, in turn, enhances memory formation and retrieval. On the other hand, if stress is prolonged, cortisol can damage hippocampus and disrupt memory.
Most importantly: if stress is putting you in an unmanageable state or interfering with your relationship and/or work life, seek professional help at counseling center.

Healthy versus unhealthy ways of coping with stress:

Unhealthy coping strategies may temporarily reduce stress, but they cause more damage in the long run:

Unhealthy ways of coping stress-

Smoking;

Drinking alcohol too much;

Overeating or under-eating;

Zoning out for hours in front of the TV or computer;

Withdrawing from friends, family, and activities.

Using pills or drugs to relax;

Sleeping too much;

Procrastinating;

Filling up every minute of the day to avoid facing problems;

Taking out your stress on others (lashing out, angry outbursts, physical violence);

Victim behavior, manic behavior

Overspending.

Healthy ways of coping stress:

A positive mindset;

Rest and relaxation;

Regular exercise;

Spend time in nature;

Call a good friend;

Sweat out tension with a good workout;

Write in your journal;

Take a long bath;

Light scented candles;

Time planning;

Financial planning.

Play with a pet;

Work in your garden;

Get a massage;

Curl up with a good book;

Listen to music;

Watch a comedy;

Adequate and balanced nutrition;

Good communication;

Emotional support;

Humor

Guide to Managing Stress

Stress management is an extremely important skill to develop, both for better health and for a better life experience. The following step-by-step guide can help you structure your approach to stress management.

Step 1: Identify if you are stressed-

The first things you should look for are your particular signs of stress. Although there are hundreds of signs of stress, each person does not experience all of them. In reality, people tend to have their own specific reactions to stress—something like a stress fingerprint (or “stressprint”). For one person, the signs might be difficulty sleeping, back pain and aggressive behavior. For another, they might be sleeping too much, forgetting things and sexual problems. Generally speaking, a person’s reaction to stress remains relatively stable over situations and over time. In order to identify if you are stressed it is important to get to know your own “stressprint”. Take some time to think about how you respond to stress and identify the signs you experience.

Step 2: Identify the stressor-

Now that you know you are stressed, the next step is to look for the cause. An event or situation that causes stress is called a “stressor”. Some people can easily pinpoint the cause of their stress, while for others it can be difficult. Stress is usually related to change, so a good place to start is to look for changes in your life. You can narrow down the stress-related changes by looking back at when the symptoms started. If you started having sleeping problem two weeks ago, then look at the changes in your life that took place two weeks ago.

Step 3: Identify the reason for the stressor-

Remember, the stress response is only triggered when you perceive a danger. In this step you need to determine why you see the situation you identified in Step 2 as a danger. In general, a person evaluates a situation to be dangerous if they perceive that they lack resources to effectively handle the demands of the situation. Therefore, a person needs to look at two aspects of the situation: their perceived demands and their perceived resources. If the perceived demands are greater than the perceived resources, then the person sees that they won’t be able to handle the situation. They see it as a threat or a danger. However, if the person perceives their resources to be greater than the demands, they know that they will be able to handle the situation and they will not experience stress. It is important to emphasize that the person needs to examine the perceptions they hold of the demands and of the resources. Sometimes our perceptions are consistent with reality (i.e. the facts) and sometimes they aren’t. Often, stress happens because the perception we have of the demands is greater than they really are, or because the perception we have of our resources is less than they actually are, or a combination of both.

Step 4: Select an appropriate stress management strategy and apply it-

Now that you know you are stressed, what is causing the stress and the reason why it causes stress; your next step is to select a stress management strategy and to apply it. There are literally hundreds of ways to manage stress. The strategy you use will depend on your particular situation. However, all stress management strategies can be placed into 2 general categories:

A: Strategies that address the symptoms of stress

B: Strategies that address the stressor

A: Stress management strategies that address the symptoms of stress are typically relaxation strategies. Remember that the “fight or flight” response stimulates the body by increasing heart rate, blood pressure, respiration and more. It is this continued state of stimulation that contributes to health problems. Relaxation strategies help to reverse the stimulation caused by the stress response. Therefore, they can reduce the risk of stress-related health problems. It is important to note that relaxation strategies can be useful for managing stress in the short term, but because they don’t get to the heart of what is causing stress (i.e. they don’t remove the danger), they are not useful at managing stress in the long term. Ultimately, your goal is to manage stress in the long term. Long-term strategies are discussed the next section. Various relaxation techniques are breathing exercises, progressive muscle relaxation, massage, exercise, visualization, meditation, hot bath, music appreciation, sex, hobby, spending time with loved ones-friends-pets, yoga, tai chi, laugh, look for positive etc. Just as stress is different for each of us there is no stress reduction strategy that is a panacea. Jogging and other aerobic exercises, different types of meditation, prayer, yoga and tai chi are great for many people but when arbitrarily imposed on others, prove dull, boring and stressful. There is certainly no shortage of stress relievers and in addition to the above, various progressive muscular relaxation exercises, autogenic training, deep breathing, massage therapies, visual imagery and self hypnosis practices are popular. There are also acupuncture, acupressure, biofeedback, Alexander, Reiki, Feldenkrais and other bodywork and postural techniques. Some people find that listening to music, hobbies, volunteer work, keeping a daily journal of events and how they feel, laughter, playing with pets, taking short breaks or shopping help them to relax. Others find relief for their stress related symptoms from aromatherapy, nutritional supplements like chamomile, spearmint, kava kava, adaptogens and St. John’s wort or even sitting under a pyramid. There are also prescription tranquilizers, sedatives, hypnotics, antidepressants and beta-blockers for specific complaints. In addition, a variety of cranioelectromagnetic stimulation devices have been found to be effective and safe for anxiety, insomnia and drug resistant depression. Strong emotional support from group therapy, family or friends is a powerful stress buster.

B: Stress Management strategies that address the stressor:

There are two categories of stress management strategies that correspond to two categories of danger:

1. The problem solving approach (for real dangers)

2. The cognitive approach (for imagined/perceived dangers)

The problem solving approach includes problem solving, decision making, critical thinking, time management, communication, conflict resolution, budgeting etc. The cognitive approach includes changing stress producing thinking, cognitive restructuring, behavioral therapy etc.

Step 5: Evaluate-

Now that you have done your best to manage stress, it is time to evaluate and see if your stress has been eliminated. To do this go back to step one and identify if you are still stressed: Are you still experiencing the symptoms of stress? If the answer is “no” then you can pat yourself on the back for doing such a good job. But be prepared because this certainly won’t be the last time that you will experience stress. If the answer is “yes”, you should review the stress management steps. Perhaps you didn’t accurately identify the stressor or why it was a stressor. Perhaps you selected an ineffective stress management strategy. Perhaps your stress is not a result of the situation; rather it is a result of your perceptions of the situation and so on.

How do you react to stress?

How you react to stress may influence the relaxation technique that works best for you:

Stress Response	Symptoms	Relaxation Technique
Overexcited	You tend to become angry, agitated, or keyed up under stress	You may respond best to relaxation techniques that quiet you down, such as meditation, deep breathing, or guided imagery
Under excited	You tend to become depressed, withdrawn, or spaced out under stress	You may respond best to relaxation techniques that are stimulating and that energize your nervous system, such as rhythmic exercise
Frozen (both overexcited and under excited at the same time – like pressing on the brakes and gas simultaneously)	You tend to freeze: speeding up in some ways while slowing down in others	Your challenge is to identify relaxation techniques that provide both safety and stimulation to help you “reboot” your system. Techniques such as mindfulness walking or power yoga might work well for you

Various relaxation techniques are as follows:

Breathing meditation

Progressive muscle relaxation

Body scan meditation

Mindfulness meditation

Visualization meditation

Yoga and tai chi

Meditation, yoga, prayer and various other relaxation techniques might switch off stress genes:

Correlating with my earlier discussion about how genes affect stress response and how stress can also induce genetic changes; a study found that relaxation techniques used to reduce stress does help us by influencing our stress genes. Researchers say they’ve taken a significant stride forward in understanding how relaxation techniques such as meditation, prayer and yoga improve health by changing patterns of gene activity that affect how the body responds to stress. The changes were seen both in long-term practitioners and in newer recruits. What they have found is that when you evoke the relaxation response, the very genes that are turned on or off by stress are turned the other way. Researchers compared gene-expression patterns in 19 long-term practitioners, 19 healthy controls and 20 newcomers who underwent eight weeks of relaxation-response training. More than 2,200 genes were activated differently in the long-time practitioners relative to the controls and 1,561 genes in the short-timers compared to the long-time practitioners. Some 433 of the differently activated genes were shared among short-term and long-term practitioners. Further genetic analysis revealed changes in cellular metabolism, response to oxidative stress and other processes in both short- and long-term practitioners. All of these processes may contribute to cellular damage stemming from chronic stress. The study demonstrates that all these techniques of relaxation response have a biofeedback mechanism that alters gene expression. The skeptics pointed out that the researchers looked at blood cells, which consist largely of immune cells. You’re getting the response most probably in the immune cell population and therefore it cannot be extrapolated to all cells. Nonetheless, how various relaxation techniques change patterns of stress genes is a matter of research and whether relaxation induced stimulation of parasympathetic nervous system (PNS) alter response of stress genes is also a matter of research. Remember, it is relaxation that is important no matter whether it is meditation, yoga, prayer or listening to music. Everybody can have his/her own way of relaxing as long as it reduces stress. I never prayed nor did yoga in my life and yet, I am the most relaxed doctor when there is a medical emergency. On the other hand, I know many doctors who regularly practice yoga and yet while facing a medical emergency, they are trembling or sweating or anxious.

Pharmaceutical Agents:

It is important to note that there are many useful pharmaceutical agents, such as sleep medications, anxiolytics, beta blockers, and antidepressants that counteract some of the problems associated with being stressed out. Likewise, drugs that reduce oxidative stress or inflammation, block cholesterol synthesis or absorption, and treat insulin resistance or chronic pain can help deal with the metabolic and neurological consequences of being “stressed out.” All of these medications are valuable to some degree, yet each one has its side effects and limitations, as illustrated by recent problems with the cyclooxygenase- 2 inhibitors for chronic inflammatory pain. Because of the nonlinearity of the systems of allostasis, the consequences of any drug treatment may be either to inhibit the beneficial effects of the systems in question or to perturb other systems that interact with it in a direction that promotes an unwanted side effect. An example is the use of anti-inflammatory agents to treat fever associated with an infection. Because the fever is a sign of the body’s attempt to fight the infection, it is unwise to suppress the fever completely. On the other hand, septic shock represents the excessive, unregulated response of the defense system to an infection that can be lethal. Thus some means of containing such responses are needed, and both glucocorticoids and activation of parasympathetic responses are helpful.

Prescription drug treatment for stress:

The tranquilizers belonging to a class of compounds called benzodiazepines work in part by relaxing muscles; they also inhibit the excitatory projection from the locus coeruleus into the amygdala, thereby decreasing the likelihood that the amygdala will mobilize the sympathetic nervous system. Benzodiazepines produce their calming effects by activating (or ‘agonizing’) a naturally occurring neurotransmitter substance commonly found in the brain called GABA. GABA is an inhibitory neurotransmitter whose function is to slow down brain activity. By activating GABA, benzodiazepines function to inhibit brain activity and thus slow and calm down the body. The net result is a calm body–and a less anxious body means a less anxious brain. They may also play a role in symptomatic relief of irritability, sleep disturbances, and other hyperarousal symptoms. While effective, however, benzodiazepines are also sedating and addictive, and considerable research now focuses on finding less troublesome versions. Drugs called beta blockers fit into some kinds of epinephrine receptors, preventing real epinephrine from transmitting any information. Beta blockers have long been used to reduce high blood pressure driven by an overactive sympathetic nervous system, as well as to reduce stage fright. But recently researchers have shown that the drugs also blunt the formation of memories of emotionally disturbing events or stories. Based on their findings and others, clinicians have started studies in which beta blockers are given to people who have experienced severe trauma in the hope of heading off the development of post-traumatic stress disorder. The selective serotonin reuptake inhibitors (SSRIs) work by blocking the reuptake of serotonin. SSRIs such sertraline and paroxetine have been FDA approved to treat PTSD as well as other disorders. The monoamine oxidase inhibitors work by inhibiting monoamine oxidase, which causes an increase in endogenous amines such as norepinephrine, epinephrine, serotonin, and dopamine in the brain. Tricyclic Antidepressants are a class of antidepressants that work by inhibiting the reuptake of norepinephrine or serotonin at presynaptic neurons. Chronic secretion of stress hormones glucocorticoids and catecholamines as a result of disease, may reduce the effect of neurotransmitters, including serotonin, norepinephrine and dopamine, or other receptors in the brain, thereby leading to the dysregulation of neurohormones. SSRI’s, SNRI’s and tricyclic antidepressants acting on serotonin, norepinephrine and dopamine receptors have been shown to be immunomodulatory and anti-inflammatory against pro-inflammatory cytokine processes, specifically on the regulation of IFN-gamma and IL-10, as well as TNF-alpha and IL-6 through psychoneuroimmunological process. Drugs like carbamazepine, clonidine, prazosin, risperidone, olanzapine etc are not approved by FDA for use in PTSD but may be used in occasional patients.

Complementary and alternative medicine (CAM):

Treatment of stress is one area in which the boundaries between allopathic and alternative therapies have changed in recent years, in part because some forms of physical exercise (yoga, tai chi, aikido) that were once associated with the CAM have become widely accepted as useful parts of mainstream stress reduction programs. Other alternative therapies for stress that are occasionally recommended by mainstream medicine include aromatherapy, dance therapy, biofeedback, nutrition-based treatments (including dietary guidelines and nutritional supplements), acupuncture, homeopathy, hypnotherapy and herbal medicine. There are several herbs that can help you manage stress including Licorice Root, Passion flower, Kava Kava, St. John’s Wort, Lavender, Valerian, Ginseng and Siberian Ginseng , Schizandra, Skullcap and Lemon Balm.

Physical Activity (exercise):

A sedentary life-style is a major risk factor for many of the diseases of modern life including obesity, diabetes, cardiovascular disease, depression, and dementia, and recent studies have shown that moderate physical activity can be beneficial for the brain and cardiovascular and metabolic systems. Voluntary physical activity has been shown to increase neurotrophin expression in cortex and hippocampal regions of the brain, as well as to increase neurogenesis in the dentate gyrus of young as well as aging experimental animals. One mechanism for these effects involves the actions of circulating IGF-I, which is taken up by the brain and acts via receptors found in the hippocampus. Moreover, increased neurogenesis in dentate gyrus has been linked to the actions of antidepressant drugs, providing a potential parallel with the antidepressant actions of physical activity. Increased neurogenesis improves memory, and new neurons are believed to participate in learning of hippocampal-dependent tasks. Although the role of neurogenesis in dentate gyrus is still controversial, new neurons appear to be more excitable and may contribute to greater cognitive flexibility. So exercise promotes neurogenesis and thereby reduces stress. It’s true that exercise is an excellent stress reduction tool. Exercise helps release built-up tension in the body. Exercise can give you a venue for releasing emotional tension as well. Exercise releases endorphins and other “happy hormones” in your body, promoting a feeling of wellbeing. Exercise helps promote overall health and wellbeing, which can also lessen your experience of stress. Some forms of exercise allow you to be social, which can also be great for stress reduction. Other forms of exercise can allow you to get into a meditative state. Exercise can also raise feelings of self-esteem and bring other benefits that improve life quality.

Social Support:

Another behavioral intervention that has begun to be investigated in terms of brain and body health is “social support.” Social support is composed of emotional and instrumental support. It is an advocative interpersonal process characterized by reciprocal exchange of information; it is context specific and it results in improved mental health. Social support in the form of having regular social contacts with supportive friends or family or health professionals, who provide emotional support and provided useful information, has been shown to reduce the allostatic load score, which measures key physiological markers related to chronic stress and a potentially health-damaging life-style. A study found that social support also ameliorates the type of chronic stress in caregivers that has been associated with reduced length of telomeres in white blood cells. So far nothing is known about how social support may benefit brain circuits that are affected by chronic stress and allostatic load, although it is clear that social support has beneficial effects on mood and overall mental health. Support in your life from family, friends, and your community has a big impact on how you experience stress. Having support in your life can help you stay healthy. Support means having the love, trust, and advice of others. But support can also be something more concrete, like time or money. It can be hard to ask for help. But doing so doesn’t mean you’re weak. If you’re feeling stressed, you can look for support from.

Social time crucial to stress reduction:

People are happiest on days when they spend 6 to 7 hours socializing.

Findings from the Gallup-Healthways Happiness-Stress Index underscore the crucial role of spending time with friends and family in determining the daily emotional wellbeing of the American public. As you can see from the graph above, as the number of hours spent with family-friends increases, happiness increases and stress decreases.

Stress and Sleep:

Lack of sleep can contribute to stress. On the other hand, if you are stressed, you may not be able to get good sleep. Either way, if sleep is a problem, read my article on “The Sleep”.

Stressed? Write About It!

But there’s another way to beat stress, and it may be as easy as obtaining a pencil, a pad of paper, and 30 minutes of free time. A 1988 study found that disclosing information about traumatic things that have happened to people was actually good for them. When 50 college students were asked to write for four days in a row either about superficial things or traumatic experiences they’d had, the students who wrote about their trauma had fewer illnesses and more positive moods six weeks down the line. Another study in 1994 with people who had just lost their jobs found that those who wrote about losing their jobs for five days in a row found new jobs more quickly than those who wrote about what they were going to do that day. In an attempt to reproduce these findings in medical patients in 1999, a study was done on asthma patients and rheumatoid arthritis patients. These patients either wrote about the most stressful event in their lives, or wrote about a more neutral topic. Four months after the writing took place, 47% of the patients who wrote about their stress showed clinical improvement, as opposed to only 24% for the patients who wrote about something neutral. So if you are stressed, just write it down and it will de-stress you.

Cognitive restructuring:

Cognitive restructuring teaches people to rethink the basic assumptions that cause them to experience more stress than is absolutely necessary. While an excellent and effective technique for stress reduction, it is also a long-term strategy. Several weeks of practice and training must occur before substantial stress reduction can be expected. Even though it is a good idea to invest the time and effort necessary to learn cognitive restructuring, it is an equally good idea to know about effective alternative strategies that can bring about more rapid, if only temporary forms of stress relief, for example, distraction and humor.

Distraction:

One of the simplest psychological techniques for rapid stress relief involves finding ways to distract yourself from whatever it is that is bothering you. You’ll recall that as we become more stressed out, our attention tends to narrow and focus on what we perceive as threatening. Distraction techniques work by interrupting this process of attentional narrowing so that we stop thinking about what is bothering us for a while and instead think about something else. As the saying goes, “Out of sight, Out of mind.” Different people cope with stress in different ways, and distraction as a stress coping and management technique works better for some of these people than for others. There are many ways people may distract themselves away from stressful thoughts. Popular distractions include doing chores and work, engaging in hobbies and projects, socializing and seeking out sources of entertainment such as movies, games (including video games) and books. It helps if the activities are interesting, absorbing and immersive; as such things are easier for people to focus on for sustained periods of time. Things that are merely time occupiers may not hold attention, and therefore fail to distract people from their stress and worry for very long.

Humor:

For many people, humor is a very effective, simple and inexpensive way to decrease stress. Humor is effective as a stress-relieving method for numerous reasons. First, humor functions as a distraction, interrupting the chain of thought that results in stress. Effective humor also results in laughter, which is a physical release of tension. Humor shifts the focus of attention away from oneself and focuses it instead on others. This shift of attention enlarges people’s anxiety-narrowed perspective to include the misfortune of others, thereby reducing the perceived need to stress about their own problems. Humorous stories often help people to recognize that however bad their situation might be, there is always someone who is worse off. It’s relatively easy to add humor to your everyday life and to use it as a means of coping with stressful events. Funny movies, comedy shows and videos are easily available through various forms of media outlets. Entire television channels devoted to humor, including Comedy Central and Cartoon Network, are widely available on cable and satellite television services. The Comedy Central website features streaming video of their television shows, as well as a large collection of jokes and stand-up comedy routines.

Humor is an individual thing – what is funny to one individual may be hurtful to another. It is wonderful when patients can poke fun at themselves. We can also do this with patients, but we have to be careful and respectful in what we say. If you think of something funny that may help the patient, say it if you feel it will ease their tension and not be offensive. I often throw in a quip or joke when I think it is appropriate. When it is done sensitively, laughter is a great gift to people you cares about.

Realistic Expectations:

A common source of stress is unrealistic expectations. People often become upset about something, not because it is innately stressful, but because it does not concur with what they expected. Take, for example, the experience of driving in slow-moving traffic. If it happens at rush hour, you may not like it but it will not surprise or upset you. However, if it occurs on a Sunday afternoon, especially if it makes you late for something, you are more likely to be stressed by it. When expectations are realistic, life feels more predictable and therefore more manageable. There is an increased feeling of control because you can plan and prepare yourself (physically and psychologically). For example, if you know in advance when you have to work overtime or stay late, you will take it more in stride than when it is dropped on you at the last minute.

Reframing:

This is one of the most powerful and creative stress reducers. Reframing is a technique used to change the way you look at things in order to feel better about them. We all do this inadvertently at times. One example is sufficient. A patient suffering from cancer died and a close relative is in shock. Reframing this situation and explaining that he had metastasis in all organs, he was intractably suffering, death brought relief to all miseries and peace to his soul, would help calm down the close relative. The key to reframing is to recognize that there are many ways to interpret the same situation. It is like the age-old question: Is the glass half empty or half full? The answer of course is that it is both or either, depending on your point of view. There is more than one meaning to the same reality. However, if you see the glass as half full, it will feel different than seeing it as half empty because the way we feel almost always results from the way we think. The message of reframing, then, is that there are many ways of seeing the same thing – so you might as well pick the one you like. One of the things psychologists can do with patients is help them reframe stressful situations. This most often involves helping them see positives in a negative situation and assisting them in understanding the behavior of other people.

Belief Systems:

A lot of stress results from our beliefs. We have literally thousands of premises and assumptions about all kinds of things that we hold to be the truth – everything from, “You can’t fight City Hall” and “The customer is always right,” to “Men shouldn’t show their emotions” and “Children should make their beds.” We have beliefs about how things are, how people should behave and about ourselves (“I can never remember people’s names”). Most of our beliefs are held unconsciously so we are unaware of them. This gives them more power over us and allows them to run our lives. Beliefs cause stress in two ways. The first is the behavior that results from them. The second way is when they are in conflict with those of other people. Mind well, it is very difficult to change or challenge beliefs.

Ventilation/Support System:

Doctors/psychologists have all had patients who come into the office upset, talking incessantly about a problem, and feeling better when they are finished. They have told their story, cried or made some admission, and the act of doing so in the presence of a trusted and empathic listener has been therapeutic. Doctors/psychologists often do not have to say much. They just have to be there, listen attentively and show our concern and caring. On other occasions they might offer validation, encouragement or advice. But the combination of the patient being able to ventilate and seek their support can be profoundly beneficial. There is an old saying that “a problem shared is a problem halved.” People who keep things to themselves carry a considerable and unnecessary burden. Health care providers can do much for patients by allowing them to ventilate or encouraging them to do so. We can also help by urging them to develop a support system (a few trusted relatives, co-workers or friends to talk to when they are upset or worried). Another form of ventilation that many people find helpful is writing about stressful event which I already discussed earlier.

Religion and spirituality:

Religion & Spirituality can decrease stress, by allowing a person to:

1) Create a sense of quiet, stillness, and peace:

Time spent meditating, praying, or just appreciating what is around and within us in that given moment can allow space to detach from and find perspective on stressors, enhance our sense of awe at the amazing world that is around us, as well as give us time to gain some or all of the other positive benefits described next.

2) Give up control:

Believing in something greater than ourselves allows us to realize that we aren’t responsible for everything that happens in our lives. Bad things and good things will happen no matter what, through no fault (or through no specific effort) of our own. Spirituality can allow us to release (or at least decrease) the need to always blame ourselves for bad times and/or continuously scramble to achieve good outcomes.

3) Increase meaning:

When those inevitable positive and negative events happen, spiritual practice can help us look for a way to think about those events in a meaningful way. Asking “What can I learn?” or “How can I grow stronger?” instead of asking “Why me?” When something bad happens, spirituality can serve to decrease negative stress feelings by fueling constructive behavior. Similarly, feeling grateful, when good things happen can encourage us to “spread the wealth” and practice altruistic acts toward others.

4) Enhance a sense of connectedness:

Feeling a part of something greater than ourselves can make us feel less isolated and alone. In addition, many people who belong to religious and/or spiritual groups receive social support benefits (interpersonal interactions; group activities; mentoring; help with money, food, transportation, respite, etc. in times of need). Most stressors seem smaller and easier to deal with if we know that we belong to and can connect with a group who can offer acceptance, solace, strength and possibly even solutions.

5) Maintain a sense of purpose:

Most of us have spent some time wondering what life is “all about.” People who start to think that meetings, unpleasant chores, and the “rat race” is all that there is to life frequently start to feel depressed and stressed. The enhanced sense of connectedness and increased sense of meaning derived from spiritual practices allow us to look beyond ourselves, which increases our sense of responsibility for our wider community and universe.

6) Gain perspective:

Spiritual practice can help us to shrink obstacles that seem insurmountable into something approaching a manageable size. In addition, spirituality helps us to clarify our values, and focus on related goals that are important, rather than becoming consumed by material things or circumstances that are truly unimportant.

Stress Reliever Games:

When tension mounts and frustration builds, it’s a sure sign of stress. Playing a stress relieving game relaxes you and is a good way to win over stress! The trick to stress reliever games is to play ones you can win easily. What you want to do is show yourself that you can be successful. After you get a few “wins” under your belt, frequently you’ll see your original problem in a new perspective.

Internet Flash Games:
From pounding a ground hog to batting a tennis ball, there are (virtually) tons of flash games on the Internet and best of all, most are free to play! The best way to load up your anti-stress arsenal is to do a simple search for “Free Flash Games” or “Flash Games” and bookmark a few of them in your favorites.

Computer Games:
If you’re running Windows, you already have a few easy stress reliever games on your PC. FreeCell, Minesweeper, and Solitaire are great ways to relieve your stress. If you’re tired of those, many Internet sites offer a free, timed-trial version of their computer games.

Deck of cards:

Play a quick game of solitaire the old-fashioned way! Along with your deck, you might consider purchasing a book of Solitaire Games. Many books are specially published for Solitaire players and offer hundreds of games and game variations.

Rubik’s Cube:

Although trying to solve the whole puzzle can be stressful in itself, the few minutes it takes to match up the blocks on one side can help you quickly reduce your stress.

Punch balls:

Okay, they’re not a game, but they can be a great stress reliever and they’re sure a better choice than hitting a wall or kicking the side of your desk when stress sets in! You can find cheap punch balls in toy departments, novelty stores, and most dollar stores.

Darts:

Whether you’re hitting a target or targeting a photo, the physical motion of throwing the darts in itself will help reduce your stress. Dart balls stick to a Velcro board. They won’t hurt you or your neighbor – if you miss!

Crossword Puzzle Books:

Many crossword puzzle books also include word-find games, mazes, and other pencil puzzles. Buy some that have puzzles that range from easy to hard and tackle them according to your mood and your stress level!

A counselor or health professional is useful for:

1) Cognitive-behavioral therapy (CBT): CBT teaches you to be aware of how you perceive stress. It helps you understand that the way you think about stress affects your response to it. CBT helps you create and use skills to deal with stress.

2) Biofeedback: This technique teaches you how to use your mind to control skin temperature, muscle tension, heart rate, or blood pressure. All of these things can be affected by stress. Learning biofeedback requires training in a special lab.

3) Hypnosis: With hypnosis, you take suggestions that may help you change the way you act. It’s important to find a health professional with a lot of training and experience. Some psychologists, counselors, doctors, and dentists know how to use hypnosis.

Psychotherapy:

At present, psychotherapy is the mainstay of treatment for stress response syndromes. A variety of approaches exist, but they share a common goal of assisting the patient with conscious contemplation of the event in such a way that it may be assimilated and anxiety responses extinguished. Care must be taken to create an environment of safety and to avoid retraumatization, which may occur with overly rapid exposure to traumatic memories. Patients experience decreased feelings of guilt and shame as they learn that they responded to the trauma as adequately as possible. Contemplation of the event in therapy may lead to further benefits, including an enhanced understanding of the meaning of the event in the larger context of the individual’s life.

Other stress relieving techniques are Emotional Freedom Technique and NLP.

When to contact a Medical Professional:

You are having thoughts to commit suicide.

You have feelings of panic, such as dizziness, rapid breathing, or a racing heartbeat.

You are unable to work or function at home or at your job.

You have fears that you cannot control.

You are having memories of a traumatic event.

Our body is the vehicle that keeps us going and moving forward throughout our day. However, when it comes to stress it is our body that suffers the most from the consequences of our constant destructive emotions. As a result our body responds in negative and lethargic ways that could potentially lead to health concerns in the future. It is our responsibility to read our bodily signs and balance both rest, activity, work and play appropriately. Here are some suggestions for a stress-less body:

There are certain actions that we can take on a daily basis that promote harmony and provide balance when things get out of hand. Here are a few suggestions for some stress-less actions you can take throughout your day that will ease the feelings of stress and improve your sense of wellbeing:

Policy of the state vis-à-vis stress:

With respect to policy, to help individuals cope with adversity, tried and true coping and support interventions should be more widely disseminated and employed. To address health inequalities, the structural conditions that put people at risk of stressors should be a focus of programs and policies at macro and meso levels of intervention. Programs and policies also should target children who are at lifetime risk of ill health and distress due to exposure to poverty and stressful family circumstances.

Healthy Living and Stress:

Adopting health-enhancing behaviors can help you be less vulnerable to stress or make you better able to manage it when it arises. After all, health is arguably your greatest resource, and the more resources you have the better able you are to manage stress. Beyond having a positive impact on stress, these behaviors are also associated with many other benefits such as reduced risk of physical and mental illness and an enhanced sense of well-being.

A) Eat a Healthy Diet:

Related to effects of exercise on neurogenesis is the effect of dietary restriction, which also increases neurogenesis and elevates the level of BDNF in hippocampus. BDNF is an important factor in current thinking about the actions of antidepressant treatments, including the consequences for hippocampal volume, memory, and mood disorders of having the Val66Met allele of the BDNF gene. Combine healthy eating habits with a regular exercise program. Reach a healthy weight and maintain it. A healthy diet focuses on plant-based foods such as fruit, vegetables, grains, beans, nuts and seeds. Some general guidelines for healthy eating include:

1) Eat a diet that is rich in plant foods (e.g. fruit, vegetables, grains, cereals, nuts, and seeds);

2)Eat a diet that is low in overall fat, low in saturated fat, low in sodium and low in sugar;

3)Avoid trans fats, which are found mostly in commercially prepared baked goods (e.g. cookies, crackers, pies) and hydrogenated fats (e.g. shortening, some margarines);

4) Eat regularly throughout the day by including a breakfast, a mid-morning snack, lunch, a mid-afternoon snack, dinner and an evening snack;

5) Eat a variety of foods;

6) Eat real food, not junk such as fast food, junk food and highly processed foods.

7) Make small changes in your diet over time.

Most patients do not realize that caffeine (coffee, tea, chocolate and cola) is a drug, a strong stimulant that actually generates a stress reaction in the body and therefore caffeine intake should be limited. I recommend avoiding alcohol rather than limiting it.

New evidence shows that a diet rich in probiotics can help to relieve stress according to a new study featured in the October issue of Food Nutrition & Science. According to the published report, the study looked at how probiotics affected the brain function of mice. Researchers found that the presence of bacteria in the gut altered behaviors that relate to anxiety and depression. It also reduced the stress-induced elevation in corticosterone – a hormone that regulates stress. By modifying the gut microflora in mice, researchers were able to see reductions in responses to stress and anxiety – extremely important considering the existing, known relationships between gastrointestinal disorders and stress-related psychiatric disorders. The most profound observation reported in the study is that mice that were fed a probiotic-rich diet for a few weeks were more relaxed all around than mice that were fed placebos. Scientists observed that some of the reactions recorded were similar to receiving an acute injection of the anti-anxiety drug diazepam. The next time you are feeling stressed out, try reaching for a fermented food that is rich in probiotics. However, researchers caution that there will be differences between the actions of probiotic yogurts from strain to strain – even within the Lactobacillus family. The strain they used is not commercially or clinically available. What they have done is demonstrated that there is potential for bacteria-based food products to have marked effects on brain and behavior.

B) Engage in Regular Physical Activity:

Regular physical activity is associated with many health benefits including a significant reduction in the risk of heart disease, high blood pressure, diabetes, cancer, stroke, depression and other illnesses as well as better sleep, better sex, and a healthy weight. The recommendation to achieve these benefits is to engage in 150 minutes of moderate to vigorous physical activity each week. This translates to 30 minutes, 5 days a week. Moderate activities are those that increase your breathing so that you can still talk but can’t sing during the activity. They include leisure bicycling, low-impact aerobics, dancing, shoveling snow, and recreational badminton. Vigorous activities are those where your breathing is such that it is challenging to talk during the activity. These include jogging, high-impact aerobics, most competitive sports and swimming steady-paced laps. Other forms of physical activity include flexibility activities (e.g. stretching, yoga) and strength training activities such as weight lifting.

C) Don’t use tobacco:

There is not one good thing about using tobacco. If you use tobacco, the best thing you can do for your health—by far—is to quit. The only reason the vast majority of people continue to use tobacco is that they are addicted to nicotine. Nicotine stimulates the pleasure center of the brain. When the brain of a smoker is deprived of nicotine, he or she experiences negative emotions, which feels like stress. Tobacco does not relieve stress—in fact it causes it. Although it can be difficult to quit, millions upon millions of people have done so.

D) Get sufficient, quality sleep:

Lack of quality sleep negatively affects some of your resources. It reduces your level of energy; decreases your ability to think clearly and problem solving; negatively affects your mood (e.g. increased irritability); weakens your immune system (so you get sick more often) and more. The best way to promote sufficient, quality sleep is to establish a routine by going to bed at the same time every night and getting up at the same time every morning.

E) Establish and maintain healthy relationships:

The people in your life are extremely important resources for stress management. They can provide help (e.g. feed your cat when you are away) as well as emotional support. Although Facebook and other social networking sites are a convenient way to communicate with people, they are not the basis of a mutually-beneficial, health-enhancing relationship. Qualities of good relationships include a balance of taking and giving, being able to share, expressing vulnerability, trusting the other, showing respect and more. The flip side of nurturing healthy relationships is eliminating those relationships that are “toxic”, abusive or otherwise unhealthy. It can be difficult to end a relationship with a friend or a partner; however, it can also be quite detrimental to hold on to these relationships.

F) Build Skills:

The problem solving approach to stress management requires building and using skills to remove the danger. Don’t wait until you are stressed to learn these skills. In fact, the best time to build these essential stress management skills is when you are not experiencing stress. Take any opportunity you can to learn more about the skills to solve problems and to practice and refine them.

Stress Management Tips:

People can learn to manage stress and lead happier, healthier lives. Here are some tips to help you keep stress at bay.

1) Keep a positive attitude.

2) Accept that there are events that you cannot control.

3) Be assertive instead of aggressive. Assert your feelings, opinions, or beliefs instead of becoming angry, defensive, or passive.

4) Learn to manage your time more effectively.

5) Set limits appropriately and learn to say no to requests that would create excessive stress in your life.

6) Make time for hobbies, interests, and relaxation.

Is stress elimination desirable?

Without stress we wouldn’t have survived as a species up to now. Positive stress helps us to thrive, perform well, be creative and productive and adds anticipation and excitement to our lives. The quick stress response also helps us to survive threats to our lives, such as avoiding an accident by reacting fast, or running away from an attacker, or protecting our children. We all thrive under a certain amount of stress. Deadlines, competitions, confrontations, and even our frustrations and sorrows add experience, depth and enrichment to our lives and help us to grow and evolve as human beings. Our goal is not to eliminate stress, but to learn how to manage it and how to use it to help us. Too little stress acts as a depressant and may leave us feeling bored, dejected or useless. Excessive stress on the other hand, may leave us feeling exhausted and anxious. We need to find the balance of an optimal level of stress that will individually motivate but not overwhelm us. Bear in mind that an appropriate stress response is a healthy and necessary part of life. One of the things it does is to release norepinephrine, one of the principal excitatory neurotransmitters. Norepinephrine is needed to create new memories. It improves mood. Problems feel more like challenges, which encourages creative thinking that stimulates your brain to grow new connections within itself. Stress management is the key, not stress elimination. The challenge in this day and age is to not let the sympathetic nervous system stay chronically aroused. This may require knowledge of techniques that work to activate your relaxation response. Some kinds of acute stress are beneficial. For example, Ohio State University researchers found that stress from engaging in a memory task activated the immune system, whereas the stress from passively watching a violent video weakened immunity (as measured by salivary concentration of IgA, a major immune factor). Their results suggest that deadlines and challenges at work, even if annoying for a short time, could be a good thing that helps strengthen the body’s defenses.

Work related stress:

The flow chart below shows causes and consequences of work-related stress.

Stress reactions may result when people are exposed to risk factors at work. These reactions may be emotional, cognitive, behavioral and/or physiological in nature. When stress reactions persist over a longer period of time, they may develop into more permanent, less reversible health outcomes, such as chronic fatigue, burnout, musculoskeletal problems or cardiovascular disease. Individual characteristics, such as personality, values, goals, age, gender, level of education, and family situation, influence one’s ability to cope. These characteristics may interact with risk factors at work and either exacerbate or alleviate their effects. Physical and psychological characteristics, such as physical fitness or a high level of optimism, may not only act as precursors or buffers in the development of stress reactions and mental health problems, but may also change as a result of the effects. For example, if workers are able to deal with risk factors at work, they will be more experienced and self-confident in overcoming similar situations the next time they have to face them. On the other hand, stress reactions, like fatigue and long-term health problems, will often reduce a person’s ability to perform well, and thus aggravate the experience of stress, which will ultimately result in exhaustion and breakdown. The most common causes of stress for workers are an excessive workload, the management style of a boss, restructuring in the workplace, and problems at home.

Numerous surveys and studies confirm that occupational pressures and fears are far and away the leading source of stress for adult people and that these have steadily increased over the past few decades. While there are tons of statistics to support these allegations, how significant they are depends on such things as how the information was obtained (self-report vs. answers to carefully worded questions), the size and demographics of the targeted group, how participants were selected and who sponsored the study.

1) Stress has become the most common reason for a worker being signed off on long-term sick leave. Stress has even eclipsed stroke, heart attack, cancer and back problems.

2)40% of job turnover is due to stress.

3)60 to 80% of accidents on the job are stress related.

4)80% of workers feel stress on the job, nearly half say they need help in learning how to manage stress and 42% say their coworkers need such help.

Workplace stress is the harmful physical and emotional response that occurs when there is a poor match between job demands and the capabilities, resources, or needs of the worker. Stress-related disorders encompass a broad array of conditions, including psychological disorders (e.g., depression, anxiety, post-traumatic stress disorder) and other types of emotional strain (e.g., dissatisfaction, fatigue, tension, etc.), maladaptive behaviors (e.g., aggression, substance abuse), and cognitive impairment (e.g., concentration and memory problems). In turn, these conditions may lead to poor work performance or even injury. Job stress is also associated with various biological reactions that may lead ultimately to compromised health, such as cardiovascular disease or in extreme cases death. Stress in the workplace is a major factor in the development of heart disease and diabetes, a study says.

When dealing with stress it is essential to identify the cause of stress and work to reduce or eliminate the cause. Sending employees on stress management courses may sound good on paper but coercing people to endure more stress without addressing the cause is going to result in further psychiatric injury. Stress is not the employee’s inability to cope with excessive workload and excessive demands but a consequence of the employer’s failure to provide a safe system of work.

Stress conditioning:
The nature and type of stress has changed over the last few hundred years. Life stressors are more long term and imaginary today. Most of the things that stress people out in modern life, never happen; it is more related to ‘what if that happens’. The subconscious mind cannot distinguish the difference between a real stressful event or a mental preoccupation of a stressful event, and so the physical body reacts in a manner as if it is real. An imaginary stressor repeated long enough can filter through and alter perception of the event, thereby creating a form of conditioned response. Stress conditioning will eventually lead to a negative hyper-response in the face of minimal stressors. This is often what triggers anxiety, insomnia, and other symptoms of chronic stress. This is also the reason that many people have to relearn the ‘relaxation response’.

Stress resilience and stress competency:
Stress resilience is our ‘fitness’ to cope with stress. It is largely dictated by our physical, mental and emotional state of well being, by our perception/paradigm of the stressful event, the environment and support structure, and by the healthiness of our stress-coping habits. Effective stress competency can be developed, and will increase stress resilience. Resilience is most commonly understood as a process, and not a trait of an individual. Resilience is a dynamic process whereby individuals exhibit positive behavioral adaptation when they encounter significant adversity, trauma, tragedy, threats, or even significant sources of stress. It is different from strengths or developmental assets which are a characteristic of an entire population, regardless of the level of adversity they face. Under adversity, assets function differently (a good school, or parental monitoring, for example, have a great deal more influence in the life of a child from a poorly resourced background than one from a wealthy home with other options for support, recreation, and self-esteem). The American Psychological Association suggests “10 Ways to Build Resilience”, which are: (1) maintaining good relationships with close family members, friends and others; (2) to avoid seeing crises or stressful events as unbearable problems; (3) to accept circumstances that cannot be changed; (4) to develop realistic goals and move towards them; (5) to take decisive actions in adverse situations; (6) to look for opportunities of self-discovery after a struggle with loss; (7) developing self-confidence; (8) to keep a long-term perspective and consider the stressful event in a broader context; (9) to maintain a hopeful outlook, expecting good things and visualizing what is wished; (10) to take care of one’s mind and body, exercising regularly, paying attention to one’s own needs and feelings and engaging in relaxing activities that one enjoy. Learning from the past and maintaining flexibility and balance in life are also cited. Family, school, community and religion play role in fostering resilience among people. There is also controversy about the indicators of good psychological and social development when resilience is studied across different cultures and contexts. The American Psychological Association’s Task Force on Resilience and Strength in Black Children and Adolescents, for example, notes that there may be special skills that these young people and families have that help them cope, including the ability to resist racial prejudice. People who cope may also show “hidden resilience” when they don’t conform to society’s expectations for how someone is supposed to behave (in some contexts, aggression may be required to cope, or less emotional engagement may be protective in situations of abuse).

Are stress and hair loss related?

Yes, stress and hair loss can be related.

Three types of hair loss that can be associated with high stress levels are:

1) Alopecia areata: A variety of factors are thought to cause alopecia areata, possibly including severe stress. With alopecia areata, white blood cells attack the hair follicle, stopping hair growth and making hair fall out.

2) Telogen effluvium: In this condition, emotional or physical stress pushes large numbers of growing hairs into a resting phase. Within a few months, the affected hairs may fall out suddenly when simply combing or washing your hair.

3) Trichotillomania: It is an irresistible urge to pull out hair from your scalp, eyebrows or other areas of your body. Hair pulling can be a way of dealing with negative or uncomfortable feelings, such as stress, anxiety, tension, loneliness, fatigue or frustration.

Stress and hair loss don’t have to be permanent. If you get your stress under control, your hair may grow back. Be sure to talk to your doctor if you notice sudden or patchy hair loss or more than usual hair loss when combing or washing your hair. Sudden hair loss can also signal an underlying medical condition that requires treatment.

Stress and adjustment disorder:

Work problems, going away to school, an illness — any number of life changes can cause stress. Most of the time, people adjust to such changes within a few months. But if you continue to feel down or self-destructive, you may have an adjustment disorder. When you have so much trouble adjusting to the stressful change that you find it difficult to go about your daily routine, you may have developed an adjustment disorder. An adjustment disorder is a type of stress-related mental illness that can affect your feelings, thoughts and behaviors. An adjustment disorder can occur in both adults and children. Signs and symptoms of an adjustment disorder can include: Sadness, Crying spells, Thoughts of suicide, Worry, Trouble sleeping, Difficulty concentrating, Fighting, Poor school or work performance and Vandalism. Your normal daily routines may feel overwhelming. Or you may make reckless decisions. In essence, you have a hard time adjusting to change in your life, and it has serious consequences. Researchers are still trying to figure out what causes adjustment disorders. As with other mental disorders, the cause is likely complex and may involve genetics, your life experiences, your temperament and even changes in the natural chemicals in the brain. Most adults with adjustment disorder get better within six months and don’t have long-term complications. However, people who also have another mental health disorder, a substance abuse problem or a chronic adjustment disorder are more likely to have long-term mental health problems, which may include: Depression, Alcohol and drug addiction and Suicidal thoughts and behavior. In addition to depression, substance abuse and suicidal behavior, teenagers with adjustment disorder are at risk of developing psychiatric illnesses such as: Schizophrenia, Bipolar disorder and Antisocial personality disorder. The main treatment for adjustment disorders is psychotherapy, also called counseling or talk therapy. You may attend individual therapy, group therapy or family therapy. Therapy can provide emotional support and help you get back to your normal routine. It can also help you learn why the stressful event affected you so much. As you understand more about this connection, you can also learn healthy coping skills. These skills can help you deal with other stressful events that may arise in your life. In some cases, medications may help, too. Medications can help with such symptoms as depression, anxiety and suicidal thoughts. Antidepressants and anti-anxiety medications are the medications most often used to treat adjustment disorders. As with therapy, you may need medications only for a few months.

Stress and mental illness:

The above figure shows that we all do need optimum stress. Less than optimum stress may lead to depression and high stress may lead to anxiety.

Researchers in the field of psychoneuroimmunology (PNI) study the ways in which the immune system and the nervous system communicate with each other and impact people’s mental and emotional health. Even though the field is relatively new, many studies have been designed to examine the influence of immune and nervous systems on the psychological consequences of stress. PNI research suggests that chronic stress can lead to or exacerbate mood disorders such as depression and anxiety, bipolar disorder, cognitive (thinking) problems, personality changes, and problem behaviors.

Psychiatric injury due to stress:

Over time, chronic stress result in psychiatric injury, this is not synonymous with mental illness. Despite superficial similarity, and comments (both direct and implied) from those around you, there are many distinct differences between psychiatric injury and mental illness including-

a) mental illness is assumed to be inherent (internal) whereas psychiatric injury is caused by something or someone else (external) – who is liable;
b) an injury is likely to get better;
c) the person suffering mental illness exhibits a range of symptoms associated with mental illness (paranoia, schizophrenia, delusions, etc) but not with psychiatric injury, whereas the person suffering psychiatric injury will typically exhibit a range of symptoms (eg hypervigilance, hypersensitivity, obsessiveness, irritability, fatigue, sleeplessness) associated with psychiatric injury but not with mental illness.

A table showing the differences between psychiatric injury and mental illness

Mental illness	Psychiatric injury
the cause often cannot be identified	the cause is easily identifiable and verifiable, but denied by those who are accountable
the person may be incoherent or what they say doesn’t make sense	the person is often articulate but prevented from articulation by being traumatized
the person may appear to be obsessed	the person is obsessive, especially in relation to identifying the cause of their injury and both dealing with the cause and effecting their recovery
the person is oblivious to their behavior and the effect it has on others	the person is in a state of acute self-awareness and aware of their state, but often unable to explain it
the depression is a clinical or endogenous depression	the depression is reactive; the chemistry is different to endogenous depression
there may be a history of depression in the family	there is very often no history of depression in the individual or their family
the person has usually exhibited mental health problems before	often there is no history of mental health problems
may respond inappropriately to the needs and concerns of others	responds empathically to the needs and concerns of others, despite their own injury
displays a certitude about themselves, their circumstances and their actions	is often highly skeptical about their condition and circumstances and is in a state of disbelief and bewilderment which they will easily and often articulate (“I can’t believe this is happening to me” and “Why me?”)
may suffer a persecution complex	may experience an unusually heightened sense of vulnerability to possible victimization (i.e. hypervigilance)
suicidal thoughts are the result of despair, dejection and hopelessness	suicidal thoughts are often a logical and carefully thought-out solution or conclusion
exhibits despair	is driven by the anger of injustice
often doesn’t look forward to each new day	looks forward to each new day as an opportunity to fight for justice
is often ready to give in or admit defeat	refuses to be beaten, refuses to give up

One of the symptoms of psychiatric injury is reactive depression – it is a reaction to an external event. My understanding is that the chemistry of reactive depression is different to clinical or endogenous depression (which is associated with mental illness).

Stress and depression:

It seems to be common sense that hard times are associated with developing depressive symptoms. When a personal crisis occurs, many people who had been coping pretty well become clinically depressed. The two classic examples are losing a relationship or losing a job. However, if a company terminates 100 employees, most of them don’t develop a depressive illness. An important question is why one employee manages to cope while another develops a mood disorder. Seven years ago, an important paper published in one of our most respected scientific journals reported that people with a genetic variant of the serotonin transporter gene were more likely to become depressed when they had experienced stressful situations. If a person had this genetic variant and wasn’t exposed to very stressful situations, they weren’t any more vulnerable to depression than if they had the more protective form of the gene. It was only when they had experienced severe personal distress that their depressive symptoms occurred. People without this genetic variant were often able to tolerate quite severe stress and not develop symptoms. A new analysis of 56 studies demonstrated that people with the less active form of the serotonin transporter gene were more vulnerable to developing depression when they experienced severe stress. There is strong evidence that stress can trigger depression and that the onset of depression is far more likely in people who are genetically vulnerable to developing a mood disorder. The most important point that this analysis makes is that there is a biological vulnerability to depression just like there is a biological vulnerability to diabetes, asthma, or cancer.

There is much psychological research that confirms that there is a relationship between stress and depression. The relationship is not a simple one, however. Keep in mind that experiencing depression symptoms is not necessarily the same as experiencing clinical depression. The depression symptoms are only considered clinical depression when they last and are severe enough that they interfere with your ability to function in some important area of your life. Not only does stress contribute to depression symptoms, but depression contributes to stress. Stress and depression research has confirmed this as well.

One way in which stress brings about depression is by acting on the brain’s mood and pleasure pathways. To begin, prolonged exposure to glucocorticoid hormones depletes norepinephrine levels in the locus coeruleus neurons. Most plausibly, this means that the animal–or a person–becomes less attentive, less vigilant, less active: psychomotor retardation sets in. Continued stress also decreases levels of serotonin–which may be important in the regulation of mood and sleep cycles, among other things–as well as the number of serotonin receptors in the frontal cortex. Serotonin normally arrives in the frontal cortex by way of the raphe nucleus, a structure that also communicates with the locus coeruleus. You can probably see where this is going. Normally, serotonin stimulates the release of norepinephrine from the locus coeruleus. When serotonin becomes scarce, less norepinephrine is released–exacerbating the shortage caused by earlier unremitting glucocorticoid bombardment. Stress affects dopamine, the main currency of the pleasure pathway, in a way that seems counterintuitive at first. Moderate and transient amounts of stress–and the ensuing presence of glucocorticoids–increase dopamine release in the pleasure pathway, which runs between a region called the ventral tegmentum/nucleus accumbens and the frontal cortex. More dopamine can lead to a feeling of well-being in situations of moderate or transient stress during which a subject is challenged briefly and not too severely. For a human, or a rat, this situation would entail a task that is not trivial, but one in which there is, nonetheless, a reasonably high likelihood of success–in other words, what we generally call “stimulation.” But with chronic glucocorticoid exposure, dopamine production is curbed and the feelings of pleasure fade. Not surprisingly, the amygdala also appears relevant to depression. Researchers have reported that the images of the amygdala of a depressed person light up more in response to sad faces than angry ones.

Stress also acts on the hippocampus, and this activity may bring about some of the hallmarks of depression: difficulty learning and remembering. As I discussed before, stress and glucocorticoids can disrupt memory formation in the hippocampus and can cause hippocampal neurons to atrophy and lose some of their many branches. In the 1980s several laboratories showed that glucocorticoids can kill hippocampal neurons or impair their ability to survive neurological insults such as a seizure or cardiac arrest. Stress can even prevent the growth of new nerve cells. Contrary to long-held belief, adult brains do make some new nerve cells. This revolution in our understanding has come in the past decade. And although some findings remain controversial, it is clear that new neurons form in the olfactory bulb and the hippocampus of many adult animals, including humans. Many things, including learning, exercise and environmental enrichment, stimulate neurogenesis in the hippocampus. But stress and glucocorticoids inhibit it.

Anxiety is considered to be a normal reaction to a stressor. However, anxiety can often occur without an identifiable triggering stress.

Psychosomatic disorders:

“Psychosomatic illnesses” are now called somatoform disorders. Such illness is classified as neurotic, stress-related and somatoform disorders by the World Health Organization in the International Statistical Classification of Diseases and Related Health Problems. The field of psychosomatic medicine fell into disrepute clinically due to this incorrect use of this term. Some physical diseases are believed to have a mental component derived from the stresses and strains of everyday living. Few examples will suffice. Lower back pain and high blood pressure, which appear to be partly related to stresses in everyday life. While peptic ulcer was once thought of as being purely caused by stress, later research revealed that Helicobacter pylori caused 80% of ulcers. However 4 out of 5 people colonized with Helicobacter pylori do not develop ulcers, and an expert panel convened by the Academy of Behavioral Medicine Research concluded that ulcers are not merely an infectious disease and that mental factors do play a significant role. One likelihood is that stress diverts energy away from the immune system; thereby stress promotes Helicobacter pylori infection in the body. Research shows that stress and emotions are still significant factors in causing IBS.

Stress and alcohol:

Acute stress is thought to precipitate alcohol drinking. Yet the ways that acute stress can increase alcohol consumption are unclear. A new study investigated whether different phases of response to an acute stressor can alter the subjective effects of alcohol. After stressful and non-stresssful task, participants received intravenously administered infusions containing alcohol (the equivalent of two standard drinks) and a placebo. One group of participants (n=11) received alcohol within one minute of completing the tasks, followed by the placebo 30 minutes later. The other group (n=14) received the placebo infusion first, followed by the alcohol. Researchers measured subjective effects such as anxiety, stimulation, and desire for more alcohol, as well as physiological measures such as heart rate, blood pressure, and salivary cortisol before and at repeated intervals after the tasks and infusions. Findings indicate bi-directional relationships between alcohol and stress. Alcohol can change the way that the body deals with stress: it can decrease the hormone cortisol which the body releases to respond to stress, and it can prolong the feelings of tension produced by the stress. Stress can also change how alcohol makes a person feel: it can reduce the pleasant effects of alcohol or increase craving for more alcohol. Researchers added that it is often hard to separate alcohol’s effects upon stress reactions from its effects on the perception of how stressful an experience is. However, in their study, they administered alcohol after the stressful experience, and then examined the effects of alcohol on stress responses, so ruling out any effect of alcohol upon perception of the stress. They showed that alcohol decreases the hormonal response to the stress, but also extends the negative subjective experience of the event. They also showed that stress decreased the pleasant effects of the alcohol. These findings illustrate complex bi-directional interactions between stress and alcohol. In summary, using alcohol to cope with stress may actually make a person’s response to stress worse, and prolong recovery from a stressor. Stress may also alter the way that alcohol makes us feel in a way that increases the likelihood of drinking more alcohol. Stress responses are beneficial in that they help us to react to adverse events. By altering the way that our bodies deal with stress, we may be increasing the risks of developing stress-related diseases, not the least of which is alcohol addiction.

Nicotine addiction and stress has been discussed in my article “Nicotine addiction”.

The stress from deepening debt causes plenty of health problems for millions of people all over world. The picture below shows finding of AP-AOL survey in the U.S.

In India, thousands of farmers have committed suicide due to stress of debt.

Stress in sports:

Stress is a factor of life that affects everyone, but athletes tend to suffer from it more than non-athletes, due to the amount they are required to balance, between their studies, practices and games, as well as family pressures and everyday life. Stress and anxiety affect everyone daily, but research has found that many athletes struggle with these conditions more than the rest of the population. Despite the well-documented benefits from exercise and sports participation on mental health, some athletes will at times experience psychological, emotional, and behavioral problems. Many factors which can influence the performer’s psychological state and so alter it from the optimum required for their performance. Many athletes struggle to handle the stress and anxiety that comes along with a full class load, the demands of their sport, as well as the pressures of their family and friends. Athletic trainers need to be sure they help their athletes utilize the counseling center, and other techniques to help limit their stress and anxiety.

Stress and police officer:

Research indicated that an extremely high percentage of police officers ended up divorcing their spouse. Police officers are stressed by many things including their supervisors, shift-work resulting in the loss of time spent with their families, fellow officers, the citizens at large, low pay and irregular sleep schedules. From all of this we can conclude that police officers need training and education to help deal with the many challenges they face daily. With proper support, education, and counseling, the officers will be able to perform their job much more efficiently and safely. A research indicated that when officers were properly trained and had the ability to recognize the effects of stress, they were able to manage their stress more effectively. This stress management resulted in officers taking less stress home with them to their families and they were able to maintain higher morale. The police departments need to take more responsibility in educating, training, and combating officer stress. The department also needs to provide confidential counseling to officers that are being affected negatively by job stress. Since the primary function of the police (and the military) is to prevent crime & terrorism and to protect the civilian population, I urge the police and the armed forces of all countries to consider this approach. Today’s police and military personnel train their minds and bodies, but mostly separately. They fill their minds with information about how to respond to every imaginable situation, and train their bodies for strength and endurance. Strong protective armor is provided to protect their bodies from physical harm, but nothing for their minds to protect them from stress. Research on the relaxation techniques used by police officers indicates that the practice produces beneficial effects for the mind and body, opposite to those of chronic stress. It cannot be overemphasized that security services under stress will perform sub-optimally and thereby increases occurrence of crime & terrorism.

Stress of War hits army kids hard:

Army wives whose husbands are deployed to Iraq and Afghanistan have committed markedly higher rates of child neglect and abuse than when their spouses are home, according to a study in the Journal of the American Medical Association. The Army-funded study found child neglect was almost four times greater during periods when the husbands were at war. Physical child abuse was nearly twice as high during combat deployments. Deployment … has been associated with increased stress among non-deployed parents, which may hamper their ability to appropriately care for their children, the study said.

Not having spare time is stressful but having too much spare time is also stressful:

According to researchers, there is one thing that matches the stress of not having enough free time: having too much time. Experts from the University of Cincinnati in Ohio and Baylor University in Texas asked 1,329 teenagers how much spare time they had, and how happy they were. Those who thought they had little free time were often miserable – but teens with plenty of time to themselves soon run out of things to do. What is more desirable: too little or too much spare time on your hands? To be happy, somewhere in the middle, the researchers said. They claimed that too much free time can exacerbate the negative side-effects associated with living in our consumer-orientated society. Materialistic young people need just the right amount of spare time to feel happier. We now live in a society where time is of the essence. The perception of a shortage of time, or time pressure, is linked to lower levels of happiness. At the same time, our consumer culture, characterized by materialism and compulsive buying, also has an effect on people’s happiness. The report concluded: “Living with a sensible, balanced amount of free time promotes well-being not only directly, but also by helping to alleviate some of the negative side effects associated with living in our consumer-orientated society.”

Sex and stress:

Sex has a positive impact on stress and increasing sexuality in a committed relationship has been researched to be linked with decreased stress (an incidentally, an increased immune system) and yet, stress has a negative impact on sexual frequency and desire. If you look at what chemicals (I will be calling hormones and neurotransmitters as chemicals for simplicity) are released in the brain when you take anti-anxiety/ depression medications, you will find that your body naturally releases many of the same chemicals during sex (and exercise). Sex does not have all the side effects of medication such as a reduced libido. Sex in a committed relationship (yes the improvements are more significant in a trusting relationship… some of the positive chemicals are not released simply due to orgasm) has a wide range of positive impacts. Healthy sex has a dramatic effect on promoting a positive mood. A healthy sex life greatly reduces feelings of stress and anxiety. Sex in committed relationship can also be a place to access individual spirituality, deep spiritual connection to another, and an egoless state. A healthy sexual relationship promotes a continued healthy sexual relationship… healthy sex = less stress = more healthy sex = more stress reduction etc… this is a positive feedback loop.

Stress can certainly interfere with a man’s (and a woman’s) ability to perform sexually. The mind and body make priorities. Stress activates the defense against danger. This causes priority to fight or run. If you are obsessed by thoughts about the stresses of the day, this prevents you from thinking of love and tenderness. Paradoxically, certain kinds of stress can also intensify sexual behavior. It is well-known that the birth rate goes up during war. The baby boom during the Second World War is still visible in the age distribution of the population in affected countries. And there are people who seek out so-called adventurous sex in unusual surroundings. The difference is if you are in control of the situation. Studies show that stress increases sexual activity for the dominant male, but reduces it for the non-dominant males.

Stress code in brain:

Every day stress “reshapes” the brain – nerve cells change their morphology, the number of connections with other cells and the way they communicate with other neurons. In most cases these responses are adaptive and beneficial – they help the brain to cope with stress and shape adequate behavioral reaction. However, upon severe stress things can get out of control, the brain “buffering” capacity is exhausted and the nerve cells in the hippocampus – an area of the brain responsible for learning and memory – start to withdraw their processes, don’t effectively communicate with other cells and show signs of disease. One strategy that brain cells particularly like to use to cope with stress is changing the shape of tiny processes they normally employ to exchange information with other neurons, called dendritic spines. Spines can be as small as 1/1000 of a millimeter and have various shapes. Long spines (called “thin” spines) are like children – very mobile and inquisitive, constantly change shape and “conversation” partners – they help us learn new things. Once spines learn, they change into mature “couch potatoes” – they are mushroom-shaped, have stable connections, do not change partners and do not like to move. Mushroom spines help us remember things we once learned – but it is not always good. Some very stressful events would better be forgotten quickly or they may result in anxiety disorders. There is a constant battle of forces in our brain to help maintain the right balance of thin and mushroom spines – or how much to remember and what better to forget. Researchers have identified a protein that the brain produces in response to stress in order to reduce the number of mushroom spines and therefore reduce future anxiety associated with stressful events. This protein, lipocalin-2, is normally not produced, but its fabrication dramatically increases in response to stress in the hippocampus. When they added lipocalin-2 to neurons in culture the way it occurs on stress, neurons started losing their “memory spines” – the mature, mushroom-shaped ones. They therefore asked – what if we remove lipocalin-2 from the brain and subject mice to stress? Would that affect the way they react? To this end they used mice in which the lipocalin-2 gene was disrupted and found that, on stress, they were more anxious than normal mice. For example, they were less “outgoing” and preferred hiding in dark, enclosed spaces instead of exploring the neighborhood normally. They found that in these mice, mushroom spines were more readily formed in the brain after stress and therefore they had stronger memories of the stressful event. Thus, the brain produces lipocalin-2 in order to protect us from “too much anxiety” and help us cope with various adverse life events. Identification of lipocalin-2 as a new player the brain uses to help us cope with stress is an important step forward. Researchers are getting closer to deciphering molecular mechanisms of stress that, which if not functioning properly, may lead to stress-related psychiatric diseases.

Stress and GDP growth:

There appears to be a link between stress levels and GDP growth. Business owners in mainland China, Vietnam, Mexico, India and Turkey all feature high on the stress league table and are working in environments where growth is high. But it’s not just in countries with high growth that stress levels are high – at the opposite end of the growth scale Ireland, Spain and Greece all feature high on the stress league table. So we have businesses at both ends of the GDP growth scale experiencing high stress for very different reasons. In mainland China the pressure is on to keep up with the pace of expansion while in Ireland, for example, the economy is shrinking and business owners are worried about doing business in tough times.

____________

The moral of the story:

1) Stress in biology is defined as a response to change; change could be physical, physiological, psychological or social; change could be environmental and/or within self; change could be real and/or virtual (perceptual); change could be short term and/or long term; and change could be antenatal (before birth) and/or postnatal (after birth).

2) When a covert or overt response of a living organism to a stressor is adaptive, the organism returns toward a state of comfort (homeostasis). When response of a living organism to a stressor is maladaptive, it harms organism.

3) Stress is the basis of evolution of life. If there was no stress, there would not have been evolution.

4) Ability to survive = Ability to adapt to stress + Ability to specialize/organize

5) Genes do affect stress response and stress also affects genetic code. Stress induced changes in genetic code including the creation of novel genes, the alteration of gene expression in development, and the genesis of major genomic rearrangements are carried forward in next generation to help next generation to adapt to stress. This explains why there is a generation gap in thinking, cognition and attitudes; and also why younger generation is smarter than previous generation. This also explains why youth support me rather than their parents.

6) When stressors are measured comprehensively, their damaging impacts on physical and mental health are substantial. Seventy-five to ninety percent of all doctors’ visits are due to stress-related ailments and stress-related disorders.

7)Differential exposure and/or differential response, to stressful experiences is a primary way that gender, racial, ethnic, marital status, and social class inequalities in physical and mental health are produced.

8)Stress in humans can be managed by regular exercise, healthy diet, relaxation techniques, structured timeouts, and learning new coping strategies to create predictability in our lives. Many behaviors that increase in times of stress and maladaptive ways of coping with stress e.g. drugs, alcohol, smoking, and eating– actually worsen the stress.

9) Discrimination based on race, caste, religion, ethnicity or economic status may cause stress in discriminated persons and it can be scientifically proved by measuring oxidative stress in tissues, stress hormones in blood/saliva and immune markers. Stresses due to discrimination proliferate over the life course and across generations, widening health gaps between advantaged and disadvantaged group members. Poverty itself is a stressor and poor people have higher level of stress even if there is no discrimination against them.

10) The impacts of stressors on health and well-being are reduced when persons have high levels of mastery, self-esteem, and/or social support.

11) Too little stress acts as depressant and stifles creativity, and too much stress exhaust you and destroys creativity. We need to find the balance of an optimal level of stress that will individually motivate but not overwhelm us. Stress management is the key, not stress elimination.

Dr. Rajiv Desai. MD.

November 1, 2011

Postscript:

In my article on “creativity”, I have proposed theory of creative neurons and I have also stated that what genetic mutation caused creative neuron system to develop in the first place is a matter of research. After going in depth about “stress’, I am convinced that environmental stress caused genetic mutations to develop creative neuron system because creative ideas would help human species survive the changing environment. So changes in environment motivate genetic changes which in turn will help you & your offspring to cope up with new environment and this is how stress propagated evolution.

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THE STRESS

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