Can Psychological Stress Increase Cancer Risk?

FaggioBurcinaThe continuous circulation of white immune cells throughout the body is our defense against disease caused by bacteria, viruses, harmful chemicals, as well as our built-in, 24×7 surveillance system against the development of cancer. A healthy body sees between 4,000 and 11,000 white cells per microliter of circulating blood, but this concentration increases in response to a threat. Psychological stress has an immuno-suppressive effect by reducing the white cell count and thus the body’s ability to fight diseases ranging from the common cold to cancer.

How Stress Affects the Immune System

The direct communication between the sympathetic nervous system (SNS) and the immune system consists of adrenergic projections and sympathetic nerve terminals that are found in many organs of the body, such as the spleen. An acute SNS activation by a stressor causes the immediate release of catecholamines from nerve endings, initiating the automatic arousal that takes place during the stress reaction. This neuroendocrine response to stressors also increases the levels of glucocorticoids (primarily cortisol) in circulation, which are steroid hormones that in addition to rapidly mobilizing the body against the threat also have an effect on the immune system.

Acute vs. Chronic Stress

Stressors, depending on their nature and duration, modulate the functions of the immune system by influencing the number of white cells circulating in the bloodstream. The effects of a brief, acute stressor (e.g., a sudden noise) on white cell circulation are short-lived and subside when the stressor passes. There are longer lasting effects on white cell circulation when the stressor is prolonged and severe (e.g., a relationship problem), as in chronic stress.

Regardless of its origin, psychological stress always leads to a change in white cell count at varying degrees depending on the type and duration of the stressor. Current research shows that longer-lasting stressors cause a reduction of immune function and increase our vulnerability to disease. Numerous studies document the immune system suppression caused by severe stressors such as marital strife, bereavement, long-term caregiving, living in unfavorable conditions, and by the psychological reaction to environmental disasters such as floods, earthquakes, fires, and hurricanes.

Stress, Immune System and Cancer

According to the National Cancer Institute’s current information on the possible association between stress and cancer, at least three areas of investigation are being explored: stress effects on virus-related cancer, stress effects on cell processes, and stress effects on tumor growth and spread.

Virus-related Tumors. An indirect relationship between certain types of virus-related tumors (Kaposi sarcoma, Burkitt lymphoma, cancer of the liver) and stress has been established. The indirectness results from the fact that some cancers are triggered by a process that involves certain precursor infections (such as herpes and hepatitis) that are known to be exacerbated by stress and a weakened immune system.

Cell Processes. The body’s natural neuroendocrine response has been shown to alter important cell processes that protect against the formation of cancer, such as DNA repair and the regulation of cell growth. Age-related deficits in protein synthesis and the responsiveness of cells to stress, decreased cell-cell communication, and inefficient signal transduction may render old cells less able to withstand stress (genotoxic stress).

Tumor Growth and Spread. The precise biological mechanisms underlying the influence of stress on the growth and spread of cancer are not yet well understood, but a link between the effects of stress on the immune system and the growth of some tumors has been documented. A recent study at the University of Texas Anderson Cancer Center in Houston indicates that stress hormones, especially norepinephrine and epinephrine, can contribute to tumor progression in patients with ovarian cancer.

Other Factors in the Effects of Stress on the Immune System

There are many factors that can exacerbate the negative influence of stress on the immune system. Age, nutrition, gender, ethnicity, and psychosocial characteristics of the individual can affect white cell circulation in response to stressors. Depression, lack of social support, or a hostile personality can cause altered immune cell responses to acute stress. Among the protective factors, physical fitness appears to be a very important positive mediator of white cell activity in the presence of psychological stressors.

eClass 2: Coping and Risk Factors in Stress Responses

Lion-Frieze-from-the-Palace-of-Darius-I-mid Coping is positive response outcome expectancies. This means that the individual expects that he or she will be able to handle the situation with a positive result. In these situations, there is a low level of subjective health complaints and low levels of psychophysiological, psycho endocrine, and psycho immune arousal[i].

Coping can be divided into two general categories:

  • Problem-focused coping: those strategies aimed at doing something to solve the problem.
  • Emotion-focused coping: its goal is emotion-regulation.
Helplessness and Hopelessness

When it is impossible for the individual to establish coping, other expectancies may develop. When the individual learns that there are no relationships between anything the individual can do and the outcome, we refer to this as helplessness. Overmier & Seligman found that dogs with previous experience with inescapable shocks did not learn avoidance tasks[ii]. They found that this state of “helplessness” generalized to situations where control is possible. Helplessness occurs when the perceived probability of avoiding the aversive stimulus with a response is the same as for no response. In other words, the response is without any perceived consequence for the occurrence of the aversive event. The organism has no control. This expectancy has been accepted as a model for anxiety and depression[iii].

Hopelessness is even worse. This term is used for an acquired expectancy that most or all responses lead to negative results. Hopelessness is more directly opposite of coping than helplessness, since it is negative response outcome expectancy. There is control, responses have effects, but they are all negative. The negative outcome is his or her fault since the individual has control. This introduces the element of guilt, which may make hopelessness an even better model for depression than helplessness.

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Is Stress Entertainment?

Avatar at Stresshacker.com The rep is that stress is to be avoided. The reality is otherwise. Stress is avidly watched, read, and heard because, contrary to what we think we believe about it, stress is entertaining. Why?

The truth is, stress sells—in movies, books, quiz shows, talent shows, and crime scene dramas. Not always and not for everyone, to be sure, but in vast numbers of book plots, screenplays, TV storylines, in radio plays, and theater plays, stress reigns supreme.

The surface reason is that stressful situations, when they are happening to someone else as in most forms of entertainment, hold our attention. Peaceful, restful, and relaxing situations, when we watch them happening to someone else, generally do not. There is not much fun in reading about someone having a really quiet day when nothing much is happening, but isn’t it great to watch a-thrill-every-second action on the big screen? Indeed, there is a deeper, genetically programmed reason why stress can be fun.

What’s the Fun in Stress?

To understand what’s happening, we must step back and consider the mechanics of stress. When we perceive a threat (a risk, a danger, a challenge), our mind is instantly alerted by the stress reaction that we experience in the body. Most often, this consists of increased heart beat, elevated blood pressure, muscle tension, and a release of excitatory hormones into the blood stream (cortisol, epinephrine, adrenaline), plus a host of other biological changes that very quickly get us ready for action. Now, what is interesting here is that, in addition to mobilizing the body, the excitatory hormones also generate a certain amount of pleasurable sensations. Is this nature’s little joke, or what?

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The Stress-free Marriage – Part 2

Both spouses must be able to “see” the cycle that has taken over communication between them, before they can begin to make any changes.

In identifying the cycle, each spouse must accept (even without agreeing with it entirely) that regardless of whether each spouse is guilty or innocent of wrongdoing against each other, the cycle itself is the most pressing problem. What matters most is not what cannot be talked about (the content), but why it cannot be talked about (the process). Noticing the process that takes place in most discussions helps the couple identify their cycle.

Noticing the cycle helps the couple identify who between them is most likely to play the role of pursuer or that of the withdrawer. The pursuer notices that she or he acts this way out of feeling disconnected from the other, e.g., feeling alone, isolated or ignored. The withdrawer notices that he or she acts this way as a defense against the pursuer’s strong emotions and repeated attempts to connect.

In the cycle, both the pursuer and the withdrawer have run out of options on how to reestablish a positive, intimate connection with each other. Noticing that the cycle has taken over and that either spouse is powerless to break it on his or her own is crucial for positive change to occur.

The cycle of destruction cannot be stopped or changed until both spouses agree to lay down their verbal and emotional (and sometimes physical) weapons. Thus, the first step is a mutual truce, by which both partners intentionally agree to stop causing emotional pain to each other.

To break the cycle, both spouses must also become aware of how what one is saying is received by the other and how he or she is reacting to it. Instead of being concerned simply with what he or she wants or means to say, both spouses must become familiar with how the other receives it and responds to it.

Safe Haven MarriageMany problems in couple communication are created or made worse by one spouse meaning to send one message and the other spouse receiving another. The cycle of destruction can be broken by doing less of what does not work, e.g., tit-for-tat escalation, and more of what works, e.g., active listening.

The next step in breaking the cycle of destruction is by joining each other’s side. When two spouses feel passionately about an issue or have different viewpoints, they often take a confrontational stance toward each other. They will figuratively stand facing each other. Often they will talk at each other rather than to one another.

A much more effective and safer way of communicating differing points of view is for one spouse to join the other and stand together on the same side while examining the issue. This does not require the spouse who initiates the joining to automatically agree with the other’s point of view, but it allows both spouses to alternatively see things from the same perspective.

In joining, the issue being addressed becomes “our” common problem that both spouses try to resolve together, rather than working against each other. In this way, neither spouse “owns” the problem alone. The problem is viewed as external to both spouses and something that challenges both as a couple, as opposed to coming between them.
The cycle of destruction is broken by making it “our” problem and by refusing to engage in its pattern any longer. Accepting that the spouse is not the enemy (even though he or she might feel or have felt as such) helps the couple externalize the problem of faulty communication and use more positive ways of connecting with each other.

In creating a safe haven for each other, both spouses become intentional in viewing the other more frequently as a potential ally and friend, and less frequently as a potential enemy. Each spouse is willing to have unconditional positive regard for the other, refusing to take the role of parent, judge or critic of the other.

In a safe haven marriage, each spouse gives the other more than just the benefit of the doubt on most issues. They both intentionally believe and are willing to accept their spouse to be innocent and guileless and to regard him or her as truthful, innocent of wrongdoing, and worthy of respect.

If and when an issue arises that causes a spouse to doubt the other’s sincerity or innocence, the doubt is handled with all the respect and loving care that a close, intimate partner deserves. Doubts are expressed in an inquiring rather than accusatory way, with the intention of learning the truth and respecting that the other’s perception of it may be different.

In those instances when a breach of trust occurs, or something is said or done, or not said or done that causes emotional injury to the other, each spouse is willing to give the other a pass. A pass must be openly declared as such to be effective, so as to not go unnoticed and build resentment. A pass does not deny the need for apologies or amends, but recognizes and accommodates the humanness and fallibility of each spouse.

Empathy in marriage is striving to see the other spouse’s point of view, trying to imagine his or her feelings, and accepting that both points of view and feelings are legitimate and that they deserve to be expressed and heard with respect. In the safe haven of marriage, opinions and beliefs are admitted without prejudgment or penalty.

Each spouse hears and makes room for the other’s point of view and the feelings that go with it, without seeing it as either right or wrong, but simply as his or hers. Empathy is present when a spouse expands his or her point of view to make room for that of the other spouse. Both points of view can, for a time, exist alongside each other as the spouses engage in a dialog to come up with the best possible solution to their issue.

Empathy extends beyond successful problem solving. Empathy is present when one spouse accepts and makes room for the shortcomings of the other, without being critical or judgmental. In helping each other overcome their personal challenges, both spouses show their interest in learning how the other sees the problem, how it makes him or her feel, and what obstacles stand in the way of growth.

Emotional safety is facilitated when each spouse has the inner assurance that the other is genuine and truthful in what he or she says. Genuineness is the active ingredient that must be present for feelings, words, and behaviors to convey the truth to each other. Genuineness provides the opportunity to know each other more intimately and completely and to rely on the truth of this knowledge to take whatever action may be necessary to strengthen, maintain or repair a safe haven relationship.

Genuineness, when embraced and maintained by both partners, strengthens the relationship and the feeling of being able to share with and receive from the other the good, the bad, the ugly and the indifferent of life together. There is power in knowing that, no matter the issue may be, each spouse can know it at the same time as, and with the same level of detail, as the other does.

Genuineness maintains a safe haven marriage healthy and strong. It helps repair any temporary breaches that may occur, and do occur, in every relationship. Although seeing eye to eye in all things and always maintain a balanced approach in every issues may seem goals worth pursuing, they are unrealistic, given our imperfect control over our emotions, words and actions. Accepting of naturally-occurring relationship breaches, and the ability to repair them successfully, are enhanced by the inner assurance of genuineness toward each other.

Truth in feelings, words, and behaviors sets the spouses free. They become aware of each other’s challenges, shortcomings, successes, and uncertainties, as soon as they happen. Each spouse is given a fair opportunity to respond to the other in the most appropriate way. Truth builds and maintains trust between the spouses. Sometimes truth may hurt, but lies always destroy. Without genuineness, there cannot be trust. Without trust, there cannot be a safe haven marriage.

Alasting marriage is built on the bedrock of emotional safety. A safe marriage is one where both spouses have each other’s back. No longer living as individuals, husband and wife genuinely share their lives with each other in every conceivable way. A loving marriage, where each spouse can be trusted and counted on to understand, empathize with, and unconditionally accept the other is a treasure of incalculable value.

Love is patient and kind. Love is not jealous or boastful or proud or rude. Love does not demand its own way. Love is not irritable, and it keeps no record of when it has been wronged. It is never glad about injustice but rejoices whenever the truth wins out. Love never gives up, never loses faith, is always hopeful, and endures through every circumstance. I Corinthians 13:4-7

Women’s Heavy Burden of Stress-Gets Heavier

Lake Wanaka at Stresshacker.comThe most recent survey of stress in America indicates that women continue to bear the heavier burden of stress, particularly due to financial concerns and worries over their family’s health and family responsibilities. Women consistently report more physical and emotional stress than men, and are more likely to lack the willpower to make changes recommended by health care providers, the survey results also show. What is causing this unhealthy gender bias? Allostasis, or more precisely allostatic load, is the key to understanding gender differences in stress. Let’s first understand allostasis, its benefits, and potential dangers.

Allostasis: Too Much of a Good Thing

Allostasis defines the processes that attempt to maintain the body’s internal stability in the face of physical or psychological challenges. Physiological and behavioral changes are initiated automatically during the stress reaction to external environmental and developmental threats, such as danger, conflict, financial worries, interpersonal difficulties, family and job demands, and other life stressors. Allostasis as a process is a very good thing and aids in survival and coping. It can work well at restoring the body’s equilibrium and ensure an adequate response to the threat. However, allostatic processes can cause physical and psychological damage when they extend beyond their intended short-term activation. This prolonged state of activation creates a burden on the system, known as the allostatic load.

Four factors can contribute to the formation of a heavy allostatic load:

  1. Repeated physical or psychological challenges (e.g., prolonged financial stress, a stressful job, multiple and conflicting demands of time and resources, a serious illness, childhood trauma, adult abuse or violence)
  2. Inability to adapt to these repeated challenges (the feeling of being at the end of one’s rope)
  3. Inability to produce an adequate response to the stressor (such as the phenomenon of learned helplessness, depression or anxiety)
  4. Inability to end the stress reaction even after the stressor has been removed (chronic stress)

Allostatic load accumulates over time. The continuation of multiple small changes in physiological and psychological functioning (which are meant to be only short-term), due to a persisting state of alert against perceived threats (the classic stress syndrome), creates the potential for illness.

What Happens to the Body During Allostasis

During the normal stress response and the body’s process of allostasis, the stress hormones serum dehydroepiandrosterone (DHEA), cortisol, norepinephrine and epinephrine are secreted into the blood stream. The immune system and neurological responses are activated, along with muscular, cardiovascular and pulmonary system. Alongside these physical reactions, psychological changes take place in response to anxious, fearful, hostile or aggressive states produced by the stressor. Behavioral changes also occur in trying to cope with the stressor, sometimes consisting of alcohol abuse and other substances,  working too many hours, or exercising compulsively. Sleep disturbances, depression and other psychological symptoms are usually the first evidence of an increasing allostatic load.

At the physiological level, allostatic load can cause atrophy of the hippocampus and structural changes in the amygdala and the prefrontal cortex, resulting in a more or less severe impairment in spatial learning and memory. Certain tell-tale physical responses are also indicative of a heavier allostatic load: higher blood pressure, changes in waist-hip ratio, higher serum high-density lipoproteins (HDL) and cholesterol, and glycosylated hemoglobin levels.

These psychophysical changes, though helpful in the short run, can cause damage. This damage is the cost of maintaining an allostatic state longer than is optimal for health. Numerous studies of allostasis show the risk of stress-induced illnesses such as cardiovascular disease, atherosclerosis, metabolic syndrome, Type 2 diabetes, depression, anxiety, and immune/auto-immune disorders.

What about the effects of allostatic load on women?  Details after the jump.

Read more

Just 14 of the Many Facets of Stress

aaTintoretto_SanGiorgioDragoMRI scans have revealed that children of depressed mothers have a larger amygdala, a part of the brain associated with emotional responses, researchers from the University of Montreal explained in the Proceedings of the National Academy of Sciences (PNAS).

A new study published in the American Journal of Industrial Medicine reveals that the World Trade Center attacks affected the health of the New York City Fire Department (FDNY) resulting in more post-9/11 retirements than expected.

Researchers in the Hotchkiss Brain Institute (HBI) at the University of Calgary’s Faculty of Medicine have uncovered a mechanism by which stress increases food drive in rats.

Do you run when you should stay? Are you afraid of all the wrong things? An enzyme deficiency might be to blame, reveals new research in mice by scientists at the University of Southern California.

Constant bitterness can make a person ill, according to Concordia University researchers who have examined the relationship between failure, bitterness and quality of life.

Listening to music or sessions with trained music therapists may benefit cancer patients. Music can reduce anxiety, and may also have positive effects on mood, pain and quality of life, a new Cochrane Systematic Review shows.

Researchers at Harvard-affiliated McLean Hospital have found that those who believe in a benevolent God tend to worry less and be more tolerant of life’s uncertainties than those who believe in an indifferent or punishing God.

Knowing the right way to handle stress in the classroom and on the sports field can make the difference between success and failure for the millions of students going back to school this fall, new University of Chicago research shows.

An 8-week course of stress-reducing Transcendental Meditation resulted in a 50% reduction in PTSD (post-traumatic stress disorder) symptoms among Iraq/Afghanistan veterans, researchers reported in Military Medicine. The pilot study involved five veterans aged 25 to 40 years with PTSD symptoms – they had all served between 10 and 24 months and had been involved in moderate or heavy moderate combat.

When parents fight, infants are likely to lose sleep, researchers report. "We know that marital problems have an impact on child functioning, and we know that sleep is a big problem for parents," said Jenae M. Neiderhiser, professor of psychology, Penn State. New parents often report sleep as being the most problematic of their child’s behavior.

By helping people express their emotions, music therapy, when combined with standard care, appears to be an effective treatment for depression, at least in the short term, said researchers from the University of Jyväskylä in Finland who write about their findings in the August issue of the British Journal of Psychiatry.

Young adults whose mothers experienced psychological trauma during their pregnancies show signs of accelerated aging, a UC Irvine-led study found. The researchers discovered that this prenatal exposure to stress affected the development of chromosome regions that control cell aging processes.

A child who has a psychological adversity or a mental disorder that starts during childhood has a higher chance of developing a long-term (chronic) physical condition later on, researchers from the University of Otago, Dunedin, New Zealand reported in Archives of General Psychiatry. The authors explain that child abuse has been linked to a higher chance of adverse physical health outcomes.

Individuals with anxiety-related symptoms who self-medicate with drugs or alcohol have a higher risk of having a substance abuse problem and social phobia, researchers from the University of Manitoba, Winnipeg, Canada, revealed in Archives of General Psychiatry.

Seeing Stress Anew Between Two Covers

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A fresh perspective on stress doesn’t come easy, given the explosion of self-help books and manuals on the subject that have been published in the last few years. Reading something truly illuminating and new about stress and how to manage it is a rare find. One of the few books that manages to be informative, practical and refreshingly new at the same time is Stress Management: A Comprehensive Guide to Wellness by Dr. Edward Charlesworth and Dr. Ronald Nathan, first published in 1982 and now in its fourth edition.

A pocket-sized 400+ pages little manual of treasures, the book includes chapters that explain stress in everyday language, teach relaxation in an engaging style, address the issue of special stressors, and puts it all together in a captivating and surprisingly simple stress management formula that is sure to be feasible by just about anyone. It earns the nod as Stresshacker Recommended book for this week.

[amtap book:isbn=0345468910]

The Stress-free Marriage – Part 1

Safe Haven MarriageA good marriage is a stress-free, safe haven for both spouses. In its fold, both partners come to feel emotionally secure and emotionally stable.  They become physically, emotionally and cognitively connected to each other.  There is no challenge or difficulty that cannot be confronted and successfully managed together, as a couple.

In the safe haven of marriage, each spouse feels freer to be truly herself or himself.  Both partners learn to make adjustments to better fit their personality to the other, and over time these changes become almost effortless, are positively motivated, and are long-lasting.  Neither feels compelled to be significantly different from his or her true self.

When a marriage is emotionally secure for both partners, discrepancies in points of view do not cease to exist.  A safe marriage is not a marriage without disagreement.  It is a marriage where disagreement, when it occurs, is handled with fairness, mutual respect, and with an eye toward a mutually beneficial resolution.

Spouses that are in the habit of providing an emotionally safe environment for each other know how to externalize their problems in a way that does not make either spouse to be the problem.  They know that the problem is the problem, not each other.

Both partners learn to work on their significant issues together.  There is no problem of one spouse that does not automatically involve the other.  The partners come to embrace each other’s challenges as their own and are empowered to confront them together.  They know that two working together are stronger, safer and more effective than either working alone.

Two people can accomplish more than twice as much as one; they get a better return for their labor.  If one person falls, the other can reach out and help.  But people who are alone when they fall are in real trouble.  And on a cold night, two under the same blanket can gain warmth from each other.  But how can one be warm alone?  –Ecclesiastes 4:9-11.

For a variety of reasons, marriages can start out to be or become emotionally unsafe.  An unsafe marriage is one where both spouses co-create an emotional barrier that keeps them from being close to each other.  This barrier can be made of negative experiences, negative expectations, or negative assumptions about each other and about the relationship. Read more

When Stress Hurts: The Psychology of Pain

SerraDosOegaos_EN-US952673641Psychological factors that play a role in the onset of physical pain are the subject of this, the fourth post in the series on the close association between psychological stress and psychogenic pain.

Likely Causes of Psychogenic Pain

Negative interaction with one’s spouse has been correlated with the sudden appearance of pain symptoms in otherwise healthy individuals (Campbell, 2002; Hughes, Medley, Turner, & Bond, 1987). Numerous studies show that the appearance of pain is often closely associated with the onset of psychological stress, financial problems, job dissatisfaction (Melin et al., 1997), unemployment, and with other less severe but long-lasting life stressors (Bennett et al., 1998). Covington (2000) speaks of a continuum of suffering of pain and stress and suggests the terms “psychologically augmented pain” (p. 292) to describe physical suffering that appears to be at least partially caused by psychological factors.

Chronic stress in adults, especially over many years and of particular severity, often results in alterations in the allostatic control system, which in the case of gastrointestinal disorders can lead to an exacerbation of symptoms (Bennett et al., 1998). Earlier in life, significant stressors in an infant’s life have been shown to produce a permanent upward modification in the levels of Corticotrophin Release Factor secretion and in the overactivation of the locus ceruleus (Ladd, Huot, Thrivikraman, & al., 2000). Moreover, prolonged abuse or neglect at any stage of life has been linked to a permanent alteration of the HPA axis response to stressors (Heim, Newport, & Heit, 1999).

Certain life stressors have been positively linked with the onset and persistence of gastrointestinal disorders, including inflammatory bowel disease (IBD), irritable bowel syndrome (IBS), functional gastrointestinal disorder (FGD), and gastro-esophageal reflux disease (GERD). Research has also established a correlation between acute stress in adults (such as rape or combat situations) or early life stressors (such as child abuse) and the later onset of these gastrointestinal disorders (Mayer, 2000).

Stress-related Muscle and Bone Pain

Pain in the muscles and joints is often associated with stress. Musculoskeletal pain localized in the lower back, shoulders, and arms appears frequently to be unrelated to any disease and thus bear all indications of having psychological causes (Harkness, Macfarlane, Silman, & McBeth, 2005). Researchers postulate that an increase in this type of pain observed in data collected by the Arthritis Research Campaign over a 40-year span may be due to “an increase in the proportion of the population who are psychologically distressed”  (Harkness et al., 2005, p. 893).

Other research suggests that musculoskeletal pain may be caused by multiple factors such as psychosocial environment, individual personality, specific behaviors, and mental stress. A study by Melin and colleagues (1997) on several hundred factory workers, assembly line workers, and supermarket cashiers suffering from musculoskeletal pain showed that the telltale signs of strong HPA axis activation, i.e. urinary catecholamines and cortisol, salivary cortisol, blood pressure and heart rate, and norepinephrine output all increased due to psychological stress.

Stress, Mental Health and Pain

Physiological pain and psychological disorders such as depression often coexist. Blackburn-Munro & Blackburn-Munro (2001) reported that while approximately 30 percent of individuals who report pain are diagnosed with clinical depression, 75 percent of patients diagnosed with depression also suffer from physical symptoms, including pain. Drossman (1982) provided evidence that individuals who seek medical help for irritable bowel syndrome are significantly more likely to present with psychiatric disorders, abnormal personality patterns and greater life stress.

Katon et al. (2001) in their extensive review of large epidemiological studies found that headache and other variously localized pain are associated with approximately 50% of visits to primary care physicians, and that most of the time, no clear medical explanation of the pain symptom is found. Stressful life events, anxiety and depressive disorders, childhood and adult trauma, and specific personality traits have all been found to be associated with multiple physical symptoms. Kroenke & Mangelsdorff (1989) reviewed over 1,000 patient records and noted 567 new complaints of chest pain, fatigue, dizziness, headache, edema, back pain, dyspnea, insomnia, abdominal pain, numbness, impotence, weight loss, cough, and constipation, and that an organic etiology was demonstrated in only 16% of these cases.

Finally, data from the World Health Organization’s study of psychological problems in general health care was used by Gureje and colleagues (2001) to examine the course of persistent pain syndromes among 3197 randomly selected primary care patients in 14 countries, which evidenced a strong and symmetrical relationship between persistent pain and psychological disorders.

Previously in this series:

Next:

  • Fibromyalgia, Severe Headaches and Other Stress-Related Misery
  • Medical and Non-Medical Treatments for Stress and Psychogenic Pain

Expert Advice: How To Tell Good vs. Bad Anxiety

Dr. Daniel Pine, a psychiatrist, directs the research program on mood and anxiety disorders of children and adolescents at the National Institute of Mental Health in Bethesda, MD

Q. What is the difference between an anxiety disorder and anxiety that is an appropriate response to an uncomfortable or threatening situation?

A. The easiest way to differentiate between these two responses is to talk about the concept of impairment. The idea behind impairment is that the person’s anxiety interferes with his or her ability to do something. The feelings of anxiousness prevent that person from doing something that other people in the same situation could do, leading to avoidance. In other words, the anxiety prevents the individuals from going places or doing things that they would like to do.

For example, everybody has some degree of anxiety in social situations. But we think of it as a disorder when the anxiety is so extreme that the person would refuse to do presentations at work or would refuse to go to parties or would not talk in public places where one is obligated to talk — for example, ordering a meal in a restaurant or requesting a book from a librarian. This is the easiest way to distinguish between normal and abnormal anxiety.

Generalized Anxiety Disorder – Expert Q & A – Evaluating Anxiety From an Early Age – NY Times Health

Sleep More, Stress Less, Live Longer

iStock_000007980637XSmall People who are sleeping less than six hours a night are at risk for more cardiovascular events, more likely to develop diabetes, and more likely to die sooner, according to a recent study. People who sleep at least seven hours per night have better immune systems, less stress and lower body weight.

Sleep deprivation can be dangerous not only to one’s health but also to that of others around us. US statistics from the Department of Transportation estimate that 20% of drivers doze off regularly at the wheel, while the National Highway Traffic Safety Administration estimates conservatively that, during an average year, “drowsy driving” causes 100,000 automobile wrecks, 71,000 injuries and 1,550 fatalities. These staggering stats are supplemented by data from the US military, surveys of truck drivers, shift workers, couples, medical students. All pointing to one simple fact: if we can’t sleep, sooner or later the body will react negatively, sometimes with tragic consequences.

Physical Threats to Sleep

TIME

Sleep time is under attack from many sources. First and foremost, our work and leisure schedules allow too little time for sleep. While this may seem like a no-brainer and suggest that there is a simple remedy (just allocate more time to sleep!), the problem of sleep scheduling appears to be more complex and somewhat intractable. The reason for this may be below the surface and may be due to a change in how we perceive sleep. While we continue to proclaim its virtues and benefits, at least out loud, aren’t many of us secretly wishing that we could simply do away with sleep altogether?

LIFESTYLE

Many people have a more complex lifestyle that demand an ever finer slicing of time slots. Time is a finite resource that can be neither reduced nor expanded, which forces a setting of priorities. And here is the heart of another problem: for many people sleep is no longer a priority. In fact, it is often considered a time waster that can keep us from other, more important activities.

ENVIRONMENT

Another potential problem is that sleep is not as undisturbed as it once was, in environmental terms. There is the interference of noise, either unwanted or induced (as in keeping music, TV or noise-makers on to “help us fall asleep”). There is the interference of artificial light, or rather too much of it, which we have grown so fond of and subconsciously seek. There is the interference of artificially controlled air, which may be either too dry or too humid or too hot and all variables in between. The A/C or fan or heater is on, adding to noise. One just can’t win the environmental battle in the bedroom!

CHEMICALS

What we eat, drink, smoke, snort, inject, wear, rub or apply can interfere with sleep. Medications, self-care products and nutritional practices that are designed to address specific issues may be very effective, but can cause side effects that have a negative impact on our ability to sleep. These modern chemical helpers may be (or perceived to be) necessary to fix a specific issue, and thus take priority over side effects that may include a negative impact on sleep.

Psychological Threats to Sleep

Individual situations vary greatly, but the following are probably perceived by most sleep-deprived individuals.

STRESSORS

Our own individual and habitual way of reacting to stressors large and small may have a significant impact on sleep. By suppressing a necessary release of emotion in the face of a stressor, we may temporarily “bury” feelings, thoughts, and impressions that find a way of resurfacing later, just when we are trying to relax and fall asleep.

INADEQUATE COPING

Our inability to cope with significant stressors in a timely and effective way may impact our ability to sleep. Not all stressors can be taken care of, i.e. eliminated, in a swift and painless way. Many do linger on, while we are looking for the right solution. Many stressors can be reduced in intensity or frequency. Others can be tolerated or ignored, after a suitable period of adjustment. Some stressors are of such magnitude and impact that we can only resolve them by removing ourselves from their influence, i.e. by moving away. Whatever the case may be, our coping response to stressors is multidimensional along time, frequency, and severity scales, and sleep deprivation is often a byproduct of the coping process.

ALLOSTATIC LOAD

Our stress level may rise and remain at high levels throughout the day, including the time when we’d need it to be lower so that we can fall asleep. This phenomenon is called our individual allostatic load. Allostatic load is the piling up of stress reaction upon stress reaction, without resolution, and without a return to normal arousal levels. Over time, this situation has the effect of permanently raising the set point of our stress level, whereby it is very difficult if not impossible to turn it down at will when we are trying to relax and fall asleep.

The Path to Better and Longer Sleep

There are so many sleep aids available nowadays, it’s a wonder we can even stay awake!  Fact is, most of them don’t work. The ones that do work do so by simply knocking us unconscious via powerful chemical agents. Is that real sleep? Many people report that it does not seem to refresh and restore, and chemically-induced relaxation simply bypasses the issues and turns the switch off. When we reawaken, these issues return and require another dose to be shut off again. This cycle repeats and repeats. Is that the way to fix this and get some rest?

The fix must start with identifying the stressors that keeps us from falling or staying asleep. Each night when you are trying to go to sleep, make a list of the thought-items that are swirling around in your mind. Do so for 7 nights. On the 8th day, look at the 7 lists, group thought-items together into issues. Now, you know within a good approximation what issues are keeping you awake.

Next, address the stressors so that they will no longer keep you from sleeping. Look at your issues and group them into three categories: the ones you can resolve, the ones you need to adapt to, and the ones you can ignore. Call upon your problem-solving skills and address the issues that can be resolved during the day. When you get to bed, intentionally stop trying to solve problems. Give yourself a break until the next day.

What about the issues I can’t resolve?  Here’s a radically different piece of advice: don’t even try to resolve them now. Accept that they cannot be resolved at 10pm or 2am. And, even more importantly, accept the idea that working on these issues will make your sleep more difficult and that it’s an exercise in futility. Instead of becoming more and more frustrated and agitated because you can’t relax, choose not to acknowledge your situation and don’t fight its impact. This may be the time to read a good book, go get a cup of herbal tea, listen to the crickets, make your list, jot down a few ideas about the screenplay, instead of tossing and turning and trying in vain to go to sleep.

Can Comfort Food Reduce Stress?

MammothHotSprings_EN-US66686672 When eating is a way to tame anxiety instead of hunger, it is an emotion-driven behavior that adds calories, fat, cholesterol and inches to the waistline, while providing at best a temporary relief to feelings of stress and anxiety. So what is emotional eating, does it relieve stress or can it do more harm than good? In this post, we’ll take a look at its symptoms, learn how to distinguish it from real hunger, and how to prevent it from ruining our diet, our mood and our health by stopping it or simply bringing it under control.

How to Recognize Emotional Eating

The normal physiological response to emotional distress caused by a stressor is a noticeable loss of appetite. The stress reaction is a complex physiopsychological mobilization of resources that also causes the blood flow to be temporarily diverted from the digestive system to other parts of the body where it is most urgently needed to activate the fight or flight response, i.e. the musculature and the cardiovascular system. Thus, under normal functioning, the stomach contracts and hunger is reduced during times of stress and anxiety.

When there is an increase in appetite under stress, it may look like a real need for food, but in reality there are several differences between emotional hunger and physical hunger. The most significant difference is the speed at which the urge to eat is felt: emotional hunger appears suddenly or in a matter of minutes, while physically appropriate hunger occurs more gradually.

The next most significant difference is in the type of food that is usually craved during bouts of emotional eating. Specific high-calorie, high-fat and sugar foods, such as pizza, cookies or ice cream, are often the only foods that will satisfy the emotional need. When the appetite is caused by real physiological hunger, there is more willingness to eat a variety of different foods, even ones that we do not ordinarily like as much but that happen to be available (broccoli, Brussels sprouts, day-old soup). 

A third difference is in the way emotional hunger triggers the anxiety to eat right away, whereas normal physical hunger very seldom has an anxiety component attached to it. Another difference is in the way emotional hunger appears to shut off our natural ability to regulate the amount of food we eat at any one sitting, i.e. the ability to stop when the stomach is full. When eating to satisfy an emotional need, there is higher likelihood that the eating will continue until all the food is consumed. Last but not least, guilt often accompanies emotional eating. Physical hunger is very seldom associated with negative emotions such as guilt or regret.

Is Emotional Eating Just a Problem for the Waistline?

In theory, a simple food fix in times of high stress and anxiety does not appear to be a problem. Indeed, occasional use of food to self-soothe and comfort negative feelings is a proven remedy that has been known since the beginning of time. However, the prolonged recourse to food to assuage emotional needs carries significant health risks, chief among them an increase in levels of cortisol, insulin, and lipids, which over time can lead to obesity and the development of metabolic syndrome.

The repeated use of food to alter negative emotions, unfortunately, tends to become less effective over time. This is due to physiological changes that take place, but principally due to the ineffectiveness of food as a coping mechanism. At best, comfort food can act as a distraction from worry. Often, comfort food becomes a metaphor of the “hunger” for the emotional closeness with significant others that could provide the comfort and help that would truly benefit the individual under stress.

How to Stop or Control Emotional Eating

When emotional eating becomes a habit while losing its ability to reduce stress and anxiety, there are ways to manage it and eventually stop it entirely. This is often possible without counseling or medication, but the latter may become necessary when emotional eating has become compulsive and the person simply does not have the psychological resources to bring it under control. The following suggestions may be helpful and worth a try, before seeking professional help.

  • Recognize emotional eating, distinguish it from real hunger, and learn what triggers it.
  • Improve the quantity and quality of sleep by napping or getting to bed earlier. Tiredness may increase the need for an energy boost. Take a nap or go to bed earlier instead.
  • Use an effective stress management program, such as as yoga, exercise, meditation or relaxation techniques. Reducing stress is often the key to eating only when hungry.
  • Give yourself a hunger reality check by asking, “Is my hunger physical or emotional?” Check when you ate the last time, and calculate whether you should be hungry now. Give time to the sudden craving to pass, while trying to make sense of it.
  • A food diary where you note what and how much you eat may be very helpful in establishing the connection between stress, mood changes, sudden cravings, and emotional eating. Awareness is often the first step toward developing options and making better choices.
  • Connect to a support network. When food is a substitute for companionship, friendship, and interpersonal connections, it is more likely to be the one comfort that is readily available. It is a better approach to reach out to family, friends, colleagues or a support group.
  • Boredom can be a powerful trigger of emotional eating. You may snack healthy (low-fat, low-calorie, fresh fruit, vegetables with fat-free dip, unbuttered popcorn) or not at all by choosing to take a walk, watch a movie, play with your pet, listen to music, read, surf the Internet or call a friend.
  • If nothing but comfort food is available and you recognize it clearly as triggered by stress or anxiety, try to practice moderation by dividing the bag of chips into smaller portions and eating only one or two servings. Eating only four bites, according to studies at the Food and Brand Laboratory of Cornell University, may be sufficient to create a positive memory of food that is recalled as just as good an experience than eating the whole thing.

Stress, Women and Sound Sensitivity

SH Stress Women and SoundCourtesy of Stockholm University’s Stress Research Institute, a new study indicates that stress may make exhausted women over-sensitive to sounds.  The research offers evidence that women suffering from stress-related exhaustion exhibit hypersensitivity to sounds when exposed to stress.  In some cases, a sound level corresponding to a normal conversation can be perceived as painful.  This according to a study from Karolinska Institutet and Stockholm University’s Stress Research Institute which tested sensitivity to sounds immediately after a few minutes’ artificially induced stress.

The study, which is published in the online scientific journal PLoS ONE, involved exposing 348 people (208 women and 140 men) between the ages of 23 and 71 with low, medium or high levels of “emotional exhaustion” to five minutes of experimentally induced physical (hand in ice), mental (performance on a stress test) and social (being observed) stress.

The results show that women with a high level of emotional exhaustion exhibit higher sound sensitivity after an experimentally induced stress exposure than those who were not exhausted.  Some even experienced sound levels as low as 60 decibels, the level of normal conversation, as uncomfortably loud.  People with a low level of exhaustion, on the other hand, became less sensitive to sound immediately after being exposed to five minutes’ stress, a phenomenon that the researchers describe as “shutting their ears” – a normal stress reaction.  The same trends could be observed in men, but the differences were not statistically significant.  The researchers also point out that, interestingly, there was no difference in sensitivity to sounds between the groups prior to the stress exposure.

“When you are hypersensitive to sound, some normal sounds, such as the rattle of cutlery or the sound of a car engine, can feel ear-piercing,” says Dan Hasson, Associate Professor at Karolinska Institutet’s Department of Physiology and Pharmacology and affiliated to Stockholm University’s Stress Research Institute. “Given how common it is for people to work in environments with different kinds of disturbing sounds, this hypersensitivity can be really disabling for certain individuals.”

An earlier study by the same research group shows that some 32 percent of working Swedes report some form of auditory problem (impaired hearing, tinnitus or both). It has already been established that stress is linked to hearing problems, although the mechanisms are not fully understood; the present study, however, is the first to demonstrate empirically a direct association between experimentally induced stress in humans and hypersensitivity to sounds.

Of Washington, Stress, and the Mind

b_800_600_16777215_0_stories_immagini_Inverno_Alba_sul_primo_piazzaleThe way we perceive a situation, and decide whether it is positive or negative, is an active, continuing process of appraisal of the risks, costs, and likely gains of our
possible responses. Three individuals may be stuck in traffic at the same time and each may perceive and appraise the situation quite differently. “OMG,” one may say, “late again, my boss will be furious!” The second may think, “I’m going to be late, but my boss will understand how unpredictable this traffic really is.” The third may settle in, turn on the radio and say, “It’s a good thing I left a little early, I can’t speed this up so I’ll just catch up on the news.”

Depending on this cognitive appraisal of a situation, the stress reaction will mobilize the body to action. The greater the anxiety generated by the situation, the higher the level of physical and psychological arousal. Sometimes, overt behavior will be produced directly by the mobilization of impulses, drives, or wishes. One specific and frequent set of behaviors is likely to occur most frequently, as a behavioral inclination to act in a certain way due to our background, beliefs and available resources. Depending on the content of our thoughts about the situation, the behavioral inclination may be a desire to withdraw (flight), attack (fight), approach, or avoid (freeze). The emotions corresponding to these inclinations are anxiety, anger, affection, and sadness, respectively. The ultimate response to a stressor can be conceptualized as a structure of the mind, where a set of beliefs about one’s self, the world, and the outcome activates and controls the behavioral inclination and the emotional response.

Life’s stressors, especially if significant to our physical, psychological and social well-being can disrupt the normal activity of the mind. In addition to almost immediate loss of the ability to concentrate, recall, reason and control impulses, a severe and unexpected stressor produces a relative increase in instinctive, more primitive, and less rational processes. Instinctive reactions are usually paired to specific stimuli. These almost mandatory reactions are characteristic to the specific sensitivity of each individual. They can give way to inappropriate or excessive behavioral reactions. For example, the need for a stiff drink, reaching for a cigarette, crying, or being unable to breathe or move can be automatic, with little insight and thus virtually unstoppable.

The wide differences between people in their specific sensitivities explains why an event that is an almost unbearable stressor for one person may be an annoying or even benign situation for another. The seasoned public speaker may still get butterflies in the stomach, but is able to carry on and deliver an excellent presentation, whereas another may be terrified at the very idea of speaking before an audience.

Core differences in one’s personality also account for the wide variations in individual
sensitivities to stressors. The independent and somewhat misanthropic personality will not be sensitive to the same stressor as the individual who craves human connection and feels dependent on it for validation. Excessive or ineffective reactions to stressors, such as hostility, anxiety, and depression, also result from specific behavioral inclinations, personality structure, and specific sensitivities.

Finally, reactions to stressors may be dictated primarily by one’s internal motivations, with no apparent connection to the events or circumstances of the outside world. For example, the belief that the only road to happiness is through total success is characteristic of achievement-oriented individuals who are therefore extremely vulnerable to excessive and ineffective reactions at the slightest doubt of failure—regardless of evidence to the contrary.

Obama & Boehner at Stresshacker.comStressful interactions with other people who may be equally as stressed, albeit for different reasons, produce a mutually reinforcing cycle of excessive and ineffective reactions. Specific psychological mechanisms, such as an egocentric approach, negative framing, and polarization, increase the level of arousal experienced by each individual and, consequently, to higher and higher levels of collectively shared stress. This cycle seems to be in evidence at this time in Washington, as the executive and legislative powers appear to be locked in a mutually reinforcing cycle of excessive and ineffective reactions to each other.

I hate myself and it stresses me out!

Self-loveOne of the most important loves of our lives is the love of self, in the right measure, and in the proper perspective. Love of self is an important component in child development that helps produce healthy, fully functioning adults. The acquisition of a healthy love of self in the child can be disrupted or even completely blocked by a variety of factors: traumatic events; lack of love, attention and validation by primary caregivers; mental health issues such as depression, anxiety, and attention disorders. Often, children perceive a disconnect between what their mind tells them they should think of themselves and what is generally true (smart, capable, likable) and how they feel inside about themselves (not good enough or even downright unlikable). This dissonance between self-perception and reality can be quite jarring to a child or adolescent’s mind. It often leads to experimenting with artificial means of enhancing self-esteem, or of at least shutting down temporarily the negative feelings about the self: alcohol, marijuana and other “feel good” drugs.

In the right measure, love of the self is not boastful, arrogant or self-centered — this would indicate a narcissistic personality, or in extreme cases even antisocial (chiefly manifested in a near total lack of empathy towards others). In the right measure, love of the self is strong and yet balanced by an understanding and acceptance of certain shortcomings or vulnerabilities that help the individual be fully human. There is a lot of good, some bad and even some ugly in all of us: the realization of this very human mix of characteristics does not preclude love of the self, it simply makes us more emphatic, compassionate and understanding of our and other’s shortcomings.

The proper perspective on self-love comes from positive experiences, but also from the successful survival of negative experiences that occur throughout our lives. For children and adolescents, this can be hard going especially in the absence of supportive parents, mentors and positive adult role models. It is not unusual for fully grown adults to be wrestling almost daily with an incomplete or insufficient love of the self. This usually takes the form of negative self-talk, a merciless beating one’s self up for even minor mistakes, a virtual barrage of negativity toward the self that is self-produced, self-contained and, for this reason, all the more harmful and tragic. Often, one’s self image does not match that which others have of this person; friends and co-workers may think that the individual is actually pretty good or even excellent in many areas; family members may observe, to their dismay, the contradiction between what they think of their loved ones versus what they think of themselves.

What can be done, when love of the self – out of no fault of the individual – was thwarted by an unfortunate set of circumstances in childhood or adolescence? Can it be regained? The answer to this question is an unequivocal YES! Will it be easy? No, it won’t be easy. What will it require?

It will require at least these three steps:

1. Becoming aware and accepting that the problem of self-love is real, it is a problem in the individual’s life, and that it should be the target of corrective action. This is the contemplative stage of change, when the individual at least knows there is a problem, albeit not knowing what to do about it.

2. Begin noticing all the dozen, hundred and thousand ways in which the individual reinforces negative self-esteem through automatic thought processes. When making a mistake, by action or omission, what do I tell myself? What insults do I hurl at myself, in my own mind? How many times a day do I think something negative about myself? A steady diet of negative selkf-talk fed to the brain every day, over weeks and years, can do some real damage to self-esteem.

3. Begin changing the pattern of negative thoughts by switching off the automatic thinking and becoming more intentional about what we tell ourselves, replacing negative thoughts with more positive ones, at least some of the time.

This initial three-step process of change must be consolidated and maintained over time to create lasting change. Often, the old habit of self-beating comes roaring back, like some bad programming routine that runs in the background, automatically. The important thing is not to give up on the idea that change is possible, that the effort is worth doing in exchange for a happier, healthier and better-adjusted life.