Discovery: A New Brain Pathway for Stress

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In many individuals, a major stressor activates a critical and previously unknown pathway in the brain that regulates anxiety in response to traumatic events. The amygdala, which is the emotional center of the brain, reacts to the stressor by increasing production of the protein neuropsin. The release of neuropsin activates a series of chemical events  that further stimulate amygdala activity, which in turn activates a gene that determines the stress response at a cellular level. Due to this gene activation, these individuals develop long-term anxiety and a typical anxious response to real or perceived stressors.

A study just published in the journal Nature for the first time clarifies the mechanism whereby, in certain individuals and not in others, the extracellular proteolysis triggered by fear-associated responses facilitates neuronal plasticity at the neuron–matrix interface. This process centers around the activity of the serine protease neuropsin, which is critical for stress-related plasticity in the amygdala. Neuropsin determines the dynamics of the EphB2–NMDA-receptor interaction, the expression of the “anxiety gene” Fkbp5 and the triggering of anxiety-like behavior. When faced with a stressor, individuals who are neuropsin-deficient show a much less frequent expression of the Fkbp5 gene and low anxiety. On the other hand, the behavioral response to stress in individuals who are rich in neuropsin shows a more frequent expression of the Fkbp5 gene and much more significant anxiety-related behavior. The researchers, consisting of a team of neuroscientists at the University of Leicester, UK, in collaboration with researchers from Poland and Japan, conclude that their findings establish a novel neuronal pathway linking stress-induced proteolysis of EphB2 in the amygdala to the development of an anxiety-driven response to stress.

Stress-related disorders affect a large percentage of the population and generate an enormous personal, social and economic impact. It was previously known that certain individuals are more susceptible to detrimental effects of stress than others. Although the majority of us experience traumatic events, only some develop stress-associated psychiatric disorders such as depression, anxiety or posttraumatic stress disorder… We asked: What is the molecular basis of anxiety in response to noxious stimuli? How are stress-related environmental signals translated into proper behavioral responses? To investigate these problems we used a combination of genetic, molecular, electrophysiological and behavioral approaches. This resulted in the discovery of a critical, previously unknown pathway. –Dr. Robert Pawlak, University of Leicester.

The study took four years to complete and it sought to examine the behavioral consequences of a series of cellular events caused by stress in the amygdala. They discovered that when certain proteins produced by the amygdala were blocked, either via medication or by gene therapy, the study subjects did not exhibit the highly anxious traits.

This is a significant discovery for the study and treatment of maladaptive stress responses that result in anxiety. By knowing which chemicals along the neuropsin pathway are present in the human brain at the moment of traumatic events, the researchers believe that it will be possible to design intervention therapies for controlling stress-induced behaviors and for the prevention and treatment of stress-related psychiatric disorders such as depression and posttraumatic stress disorder.

Ultimate Stressors: Public Drama, Private Pain

charlie-sheenRecently televised interviews with Mr. Charlie Sheen appear to have focused attention on the symptoms and manifestations of the manic phase of bipolar disorder. A public display of inflated self-esteem or grandiosity, profuse talkativeness, increase in goal-directed activity, psychomotor agitation, and the excessive involvement in pleasurable activities that have a high potential for painful consequences (e.g., engaging in unrestrained buying sprees, sexual indiscretions, or foolish investments) are the textbook criteria for a manic episode. More privately, the individual in the grip of mania also experiences a decreased need for sleep, flight of ideas or racing thoughts, and distractibility. When this disturbance is sufficiently severe, it can cause marked or total impairment in occupational functioning, usual social activities and relationships with others and may necessitate hospitalization to prevent self-harm or harm to others. Episodes of mania, whose symptoms are the opposite of those denoting depression, are rarely seen alone. Usually, the manic state is preceded and followed by depressive periods in an alternating fashion, with each state lasting from many months to a few weeks, the latter being described as ‘‘rapid cycling.’’

This constellation of symptoms was known, until a few years ago, as manic-depressive disorder. Nowadays, it goes by the somewhat more cryptic label of bipolar disorder. The neurochemical basis of bipolar disorder is not exactly known. One of the most valid hypotheses regarding the neurochemical mechanisms of bipolar disorder is the synergy between two neurotransmitters that determine mood states, whereby a lower than normal release of norepinephrine produces a disordered mood (significantly higher or lower than the normal range), while the levels of serotonin determine the direction the symptoms will take, i.e. downward toward depression or upward toward mania.

What Bipolar Disorder Feels Like

The subjective experience of these intense mood swings ranges from abject despair and hopelessness to not entirely distressing and almost pleasurable. Depression produces a pervasive
and relentless sense of gloom, inadequacy, rumination, guilt, and worthlessness. No logic, willful effort or remembrance of wellness seems capable of dispelling these cognitive and emotional experiences, often for prolonged periods.

Mania reverses and accelerates upward from the disappearance of depression, through a state of well-being that can be considered a normal mood state. Normality soon becomes exuberance, enters into a state of unexplained euphoria, and finally culminates into a chaotic state of racing, incomprehensible, disconnected thoughts, and bizarre behaviors. Given a choice, the individuals so affected report that they much prefer the state of mania, in which they experience a release from inhibitions, a hedonistic focus, and a pursuit of pleasure and gratification that can be nearly devoid of accountability or restraint. Self-medication with alcohol and illegal drugs is often present in the manic phase, which sets up a circular relationship that exacerbates its symptoms and impedes treatment and recovery.

An individual in a state of mania can be frightening, annoying, or amusing to the casual observer. It is perhaps easy to overlook the nature of the behavior, especially when there is an assumption of intent. In most cases, however, the individual has virtually no control over thoughts, words and behaviors and little if any insight into their bizarre, provocative, and sometimes dangerous presentation. The loss of reality testing, judgment and moral restraint of bipolar disorder is sure to cause psychological pain to the people who experience it and to the people who love them. Mr. Charlie Sheen has been variously portrayed as victim and perpetrator, and variously diagnosed by experts and entertainment reporters.

Bipolar Disorder: A Brief History

The first connection between a manic state and depression as belonging to the same neurochemical disorder was established in 1686 by the French physician Theophile Bonet, who observed individuals who appeared to cycle between high and low moods, and described their presentation as ‘‘manico-melancolicus.’’ In the middle of the 19th century, two other French researchers, Falret and Baillarger, who had independently observed the same cycling of moods in their patients, arrived at the same conclusion that the symptoms must be two different presentations of the same illness. Falret described the disorder as ‘‘circular insanity’’  and hypothesized a hereditary component to the disorder. In the late 1800s to early 1900s, German psychiatrist Emil Kraepelin elaborated the description and classification for manic–depressive illness that is considered the standard presentation that we see today.

It was John F. J. Cade, a doctor in the Mental Hygiene Department of Victoria, Australia, who introduced and promoted the belief that manic–depression was a biological disorder of the brain. On the basis of his research on neurochemistry, Cade administered a lithium salt preparation to several highly agitated manic patients and observed a remarkable reduction in symptoms, with a near return to a normal mood state. Lithium is currently the standard of care for the pharmacological treatment of bipolar disorder, and still the most effective in the management of its symptoms.

Faith in God Positively Influences Treatment for Individuals with Mental Disorders

faith-healthBelief in God may significantly improve the outcome of those receiving short-term treatment for psychiatric illness, according to a recent study conducted by McLean Hospital investigators. McLean Hospital of Belmont, MA is the largest psychiatric affiliate of Harvard Medical School.

In the study, published in the current issue of Journal of Affective Disorders, David H. Rosmarin, PhD, McLean Hospital clinician and instructor in the Department of Psychiatry at Harvard Medical School, examined individuals at the Behavioral Health Partial Hospital program at McLean in an effort to investigate the relationship between patients’ level of belief in God, expectations for treatment and actual treatment outcomes.

“Our work suggests that people with a moderate to high level of belief in a higher power do significantly better in short-term psychiatric treatment than those without, regardless of their religious affiliation. Belief was associated with not only improved psychological wellbeing, but decreases in depression and intention to self-harm,” explained Rosmarin.

The study looked at 159 patients, recruited over a one-year period. Each participant was asked to gauge their belief in God as well as their expectations for treatment outcome and emotion regulation, each on a five-point scale. Levels of depression, wellbeing, and self-harm were assessed at the beginning and end of their treatment program.

Of the patients sampled, more than 30 percent claimed no specific religious affiliation yet still saw the same benefits in treatment if their belief in a higher power was rated as moderately or very high. Patients with “no” or only “slight” belief in God were twice as likely not to respond to treatment than patients with higher levels of belief.

The study concludes: “… belief in God is associated with improved treatment outcomes in psychiatric care. More centrally, our results suggest that belief in the credibility of psychiatric treatment and increased expectations to gain from treatment might be mechanisms by which belief in God can impact treatment outcomes.”

Rosmarin commented, “Given the prevalence of religious belief in the United States — over 90% of the population — these findings are important in that they highlight the clinical implications of spiritual life. I hope that this work will lead to larger studies and increased funding in order to help as many people as possible.”

Crying: Public, Political, and Private

BoehnerCryingDespite the popular (and clinical) consensus that emotional tears are beneficial, dating back to ancient history, the benefits of crying to one’s physical health and its effectiveness as stress reliever turn out to be unexpectedly controversial. Scientific evidence is inconsistent at best, owing in part to the difficulty in measuring the effects of crying on the body and on the psyche in a valid, reliable and reproducible way. Crying remains a poorly understood phenomenon whose physiology is not a mystery but whose product, human tears, appears to stir controversy when analyzed for composition and function.

It is some relief to weep; grief is satisfied and carried off by tears.- Ovid

Perhaps the best known and most controversial theory on the function of crying continues to be the 1985 research published by Dr. William Frey, who hypothesized that emotion-triggered tears may simply be an excretory process. Like other bodily waste, the primary function of emotional tears may be to remove ACTH, prolactin, endorphins, toxic substances and hormones that accumulate during emotional stress. Frey reported that emotional tears, at least those he studied in his laboratory, appeared to contain higher concentrations of some hormones. Frey also reported differences between the protein content of emotional and irritant tears. These results have proven difficult to interpret and duplicate, making it unclear whether this difference has any clinical relevance. Frey’s critics contend that the amount of tears shed by humans is generally so small that it is unreasonable to presume that this process would have any physiological benefit.

ClintonCryingA recently published book by Tom Lutz, Crying: A Natural and Cultural History of Tears offers plenty of insights into the history of public crying, but few scientific explanations for the phenomenon. Lutz, a professor of creative writing at UC Riverside offers interesting anecdotes about the political value of public tears. Says Lutz, “Men cried openly and often in the upper classes in the 18th century. Lincoln and Douglas both cried on the stump. And men cry more openly now than they did 50 years ago. Issues of ‘control’ are always in relation to these changing social norms. Bob Dole cried in public exactly twice before his 1996 campaign. But in the early 1990s, Bill Clinton had transformed the political meaning of crying; it tracked very well with women voters. All of a sudden Bob Dole couldn’t control his crying and did it often.”  As to the reasons for public crying, “We do so for a number of reasons,” he says. “For emphasis (this is so important I give myself permission to break the rules); for self-definition (I don’t care how I’m supposed to act; this is who I really am); to ward off criticism (he’s too upset for me to challenge him); to suggest intimacy (he feels so comfortable with me he will break the rules in front of me); and so on.”

The BBC lists the following as the ten most frequent reasons people cry in public:

  1. Making one’s parents proud. For men, this most often refers to Dad, as many movies having this theme can attest, e.g. Field of Dreams.
  2. The birth of a first child or grandchild.
  3. The suffering of a loved one.
  4. Letting a loved one down.
  5. Saying I’m sorry.
  6. Letting yourself down.
  7. Being dumped.
  8. Being beaten in a hard-fought game.
  9. Winning a hard-fought game. Most recently famous is Iker Casillas, the goalie of the Spanish soccer team who just couldn’t stop crying after winning the 2010 World Cup.
  10. These aren’t emotional tears. It’s just bits of dust.

ronaldo-cryingPsychologically, crying appears to perform a valuable interpersonal function. Tears can be a powerful way to get what we want.  And there is some evidence to suggest that a process of natural selection favors infants whose cries are most alarming.  This bit of psychology appears intuitively to make sense when we think about how babies get attention — they cry. And so do Bill Clinton, John Boehner, Hillary Clinton, TV preachers, and countless others on baseball, football, soccer fields and TV sets everywhere. And they get attention.

Angry? Aggressive? All You Need Is a Prayer

Pisa%20-%20Piazza%20dei%20Miracoli%20-%202Pray for Those Who Mistreat You: Effects of Prayer on Anger and Aggression is the descriptive title of a study published a few days ago in the peer-reviewed journal, Personality and Social Psychology Bulletin. According to its authors, Dr. Ryan H. Bremner of the University of Michigan, Ann Arbor, Michigan, Dr. Sander L. Koole of VU University, Amsterdam, The Netherlands, and Dr. Brad J. Bushman of Ohio State University at Columbus, prayer has a surprisingly strong and near instantaneous effect in reducing anger and aggression.

The study consisted of three experiments, which tested the hypothesis that the act of intentionally praying for others can significantly reduce anger and aggression after a provocation. In the first experiment, provoked participants who prayed for a stranger reported feeling their anger subside, whereas other participants who just focused their thoughts on a stranger did not report any lessening of their anger.

People often turn to prayer when they’re feeling negative emotions, including anger. We found that prayer really can help people cope with their anger, probably by helping them change how they view the events that angered them and helping them take it less personally.—Brad Bushman, Ohio State University.

In the second experiment, provoked participants who prayed for the individual who had angered them were less aggressive toward that person than were participants who just thought about the person who had angered them. In the third experiment, provoked participants who prayed for a friend in need reported acting less aggressively and feeling less anger than did people who simply thought about a friend in need.

These results are consistent with recent evolutionary theories, which suggest that religious practices can promote cooperation among unrelated people or in situations in which reciprocity would be highly unlikely. Also consistent with these findings are those previously published on Stresshacker about the connection between faith and stress, and that between longevity and spirituality.

Heart Attack or Stress?

Warsaw_EN-US2451207088Emergency room or a chill pill? What is that sudden stabbing pain that lasts only a few seconds? Or that pressure on the chest that won’t go away and feels like it’s getting worse? A heart attack, heartburn or something else? Dramatic questions like these bring people to emergency rooms or doctors’ offices by the thousands every year. The stress caused by chest pains and severe discomfort in the area around the heart can be acute, and fear of the worst in fact augments the symptoms and brings on additional ones, such as sweating, dizziness, racing heart beat, and more.

But how can we tell when to seek emergency treatment and when to simply lay down and relax? Pain or severe discomfort centered around the heart can be caused by literally dozens of conditions, from pancreatitis, to pneumonia, to an anxiety attack. Given the variety of causes, some of which carry a lethal risk, it is not surprising that most people choose to consult a doctor. In fact, it may be the wisest thing to do, unless pain and discomfort subside in just a few minutes.

The most accurate (but slow) way to determine whether a person has experienced a heart attack is a blood test that identifies creatine kinase and cardiac troponin, chemical markers that appear in the blood stream when the heart muscle has sustained some damage. A faster (but less accurate) method is an electrocardiogram (ECG). The third method (the most immediately available but least accurate) is the person’s own description of the chest pain and any other symptoms to an emergency room physician.

The Harvard Medical Letter describes the following symptoms as generally indicating a condition other than a heart attack, including anxiety or stress:

  • sharp or knifelike pain brought on by breathing or coughing
  • sudden stabbing pain that lasts only a few seconds
  • pain clearly on one side or another
  • pain confined to one small spot
  • pain that lasts for many hours or days without any other symptoms
  • pain produced by pressing on the chest or with body movements.

These symptoms may not require a visit to the emergency room, especially if they resolve within a few minutes. When they persist longer, a doctor’s visit would be necessary to identify their exact cause and take the appropriate remedies.

On the other hand, the following symptoms may indicate a stronger likelihood that a heart attack is in progress and should be taken much more seriously:

  • sensation of pain, or of pressure, tightness, squeezing, or burning
  • the gradual onset of pain over the course of a few minutes over a diffuse area, including the middle of the chest, and its persistence
  • pain that extends to the left arm, neck, jaw, or back
  • pain or pressure accompanied by other signs, such as difficulty breathing, a cold sweat, or sudden nausea
  • pain or pressure that appears during or after physical exertion, or emotional stress, or while at rest.

The appearance of these symptoms would more clearly warrant a 911 call.

Humor: The All-Natural Remedy Against Stress

GinettoA stress reaction to challenging people and situations may be expressed by anger, hostility, aggression or seething inward rage. These instinctive reactions have their obvious drawbacks, but are altogether too common. There are other, more adaptive and sublimated responses (see this post for a complete list) that can turn angry reactions into assertiveness, the ability to effectively stand up for one’s rights, to engage in a respectful and yet passionate discussion of opposing points of view, an energy-releasing all-out workout at the gym, or humor. There is an abundance of evidence that proves the therapeutic value of humor. When used appropriately, this 100% natural remedy against stress is an adaptive, cathartic release of tension, a safe outlet for hostility and anger, and an effective defense against depression. Moreover, humor not only indicates emotional intelligence but also causes healthy neurological, immunological and physical changes. The mere act of laughter immediately increases muscular and respiratory activity, elevates the heart rate and stimulates the production of anti-stress hormones.

What Psychologists Say About Humor

American psychologist and psychotherapist Gordon Allport, in his research The Nature of Prejudice reported that 94% of people he questioned said their sense of humor was either average or above average. Allport stated that “the neurotic who learns to laugh at himself may be on the way to self-management, perhaps to cure” (p. 280).

American existential psychologist and author Rollo May, in Existence, suggested that humor has the function of “preserving the sense of self. . . It is the healthy way of feeling a ‘distance’ between one’s self and the problem, a way of standing off and looking at one’s problem with perspective” (p. 54).

mans-search-for-meaning-viktor-franklAustrian neurologist, psychiatrist and Holocaust survivor Viktor Frankl, in his best-selling autobiographical Man’s Search for Meaning, shared as his learned experience that, “to detach oneself from even the worst conditions is a uniquely human capability.” He specified that this distancing of oneself from aversive situations derives “not only through heroism . . . but also through humor” (p. 16–17).

American physician and psychologist Raymond Moody (Glimpses of Eternity and Life After Loss: Conquering Grief and Finding Hope), noted for his well-researched studies on grief, loss and the possibility of an after-life, also pointed to the ability to detach oneself as intrinsic to humor: “A person with a ‘good sense of humor’ is one who can see himself and others in the world in a somewhat distant and detached way. He views life from an altered perspective in which he can laugh at, yet remain in contact with and emotionally involved with people and events in a positive way” (p. 4).

What Is Humor?

Humor is expressed in many ways: verbally (a funny story, joke, stand-up routine), visually (a mime’s movements, funny faces and gestures) or behaviorally (slapstick, pie-in-the-face comedy). It can be triggered by a book, hours-long stage or film productions or by just a few words, as in this very short story,

A passenger carried his own bomb onto a plane. When questioned by the TSA, he said that it was for his own safety, because the odds of there being two bombs on the same plane are virtually nil.

What makes this story humorous? The stress-relieving fun of it lies in the entirely natural and universal human need to seek safety and reassurance, which is however expressed by integrating two contradictory beliefs, no matter how absurd the result. In fact, it is the absurdity or incongruity of the synthesis that is the essence of humor.

Humor is therefore a mental capacity, the skill of discovering, expressing, or appreciating the ludicrous or absurdly incongruous. Its effectiveness, i.e. the difference between funny and inappropriate, depends on the incongruity between what we expect to happen or to be said and what we perceive with our senses. Not all incongruity is humorous: in addition to being there, the incongruous must also be meaningful or appropriate, and must be at least partially resolved.

Humor and Human Development

BabyLaughingIn developmental psychology, humor is a form of play expressed by the manipulation of images, symbols, and ideas. Humor can be detected in infants of about 18 months of age who have acquired the ability to manipulate symbols and objects. Some believe that humor may be present in infants as young as four months old if humor is defined as the ability to perceive incongruities in a playful way and accept them without distress.

From a very early age, humor serves a number of social functions. Beginning in early adolescence and into young adulthood, humor can be an effective coping strategy, can reinforce interpersonal connections, or can be used to test the status of relationships.

One of the most important signs of a healthy self-esteem and maturity is the ability to laugh at one’s own shortcomings and mistakes. Most prominently in adulthood, humor is often used to express forbidden feelings or attitudes in a socially acceptable way, a device at least as old as the Renaissance fool or court jester who was, up to a point, allowed to speak of unpleasant truths and openly mock those in positions of authority.

Humor and Mental Health

Flirt_DepressionIt is a recognized fact in mental health practice that the presence of humor in a person’s narrative is a healthy way of reducing anxiety and indicates the ability of reasserting mastery over a situation. Conversely, one of the clear signs of depression is the inability to appreciate or use humor in any situation.

A judicious use of humor ushers in the opportunity to detach from the most painful aspects of a situation, albeit briefly, and exercise some control over its impact by laughing at the seemingly inescapable predicament. This dynamic, psychological attempt at regaining control by interjecting an element of incongruity is concretized in this popular German witticism about two contrasting points of view, “In Berlin, the situation is serious but not hopeless; in Vienna, the same situation is hopeless but not serious.”

{tab=Humor and Pain}
pain-signA 2005 study by Zweyer and Velker conducted at the Department of Psychology, Section on Personality and Assessment of the University of Zurich, 56 female participants were assigned randomly to three groups, each having a different task to pursue while watching a funny film: (1) get into a cheerful mood without smiling or laughing, (2) smile and laugh extensively, and (3) produce a humorous commentary to the film. Their pain tolerance was measured using a cold presser device before, immediately after, and 20 minutes after the film. Results indicated that pain tolerance increased for participants from before to after watching the funny film and remained high for the 20 minutes. Participants low in trait seriousness had an overall higher pain tolerance. Subjects with a high score in group 1 showed an increase in pain tolerance after producing humor while watching the film whereas subjects with a low score showed a similar increase after smiling and laughter during the film.

{tab=Humor and Immunity}

ilovebacteriaThe functions of the immune system that are essential for good health are known to be strongly affected by psychological experiences. Stressful events often result in immunosuppression, which leaves the body highly vulnerable to illnesses. Dillon, Minchoff, and Baker (1985) hypothesized that if stress and negative emotions can cause immunosuppression, it may also be true that humor, a positive emotional state, may be a potential enhancer of the immune system. In testing their hypothesis, they found that laughter induced by a humorous video caused a measurable and significant increase in concentrations of salivary immunoglobulin A (S-IgA), which is often described as the first line of defense against upper respiratory infection. Later research by Dillon and Totten (1989) replicated and expanded on these findings. Working with a group of mothers who were breastfeeding their infants, they found a strong relationships between humor and S-IgA.

Further connections between humor and immune system functioning were established by Lefcourt, Davidson, and Kueneman  in 1990, who found that the presentation of humorous material resulted in increased concentrations of S-IgA. When the humorous material was universally rated by participants as being highly funny (they used the video “Bill Cosby Live” for this research), S-IgA concentrations of most participants increased. However, when the humorous material produced variation in funniness ratings (when they used Mel Brooks and Carl Reiner’s “2000-Year-Old Man” video), larger increases were found only among some of the participants.

Changes in immune system activity with laughter are not restricted solely to immunoglobulin A concentrations. Berk et al., in their 1988 study, reported that mirthful laughter while watching a humorous film was associated with increased spontaneous lymphocyte blastogenesis (production of white cells) and increased natural killer cell activity.

Because immunosuppression appears to commonly occur in stressful circumstances when negative emotions are triggered, these findings would suggest that humor reduces negative emotions and/or increases positive emotions, with a corresponding beneficial effects on the functions of the immune system.

{tab=Humor and Stress}
climate-change-bears
In addition to interacting with immune system functioning, humor has also been found to influence physiological responses associated with stress. In a landmark study, Berk et al. (1989) examined the effects of humor on neuroendocrine hormones that are involved in classical stress responses. The study participants were asked to watch a 60-minute humorous video during which blood samples were taken every 10 minutes. A control group of people who were not watching the funny video were asked to enjoy 60 minutes of “quiet time” during which they were exposed to neutral stimuli. Blood samples were tested for the presence of eight hormones which usually change during stressful experiences, such as corticotrophin (ACTH), cortisol, beta-endorphin, 3,4-dihydroxyphenylacetic acid (dopac, a metabolite of the neurotransmitter dopamine), epinephrine, norepinephrine, growth hormone, and prolactin. Five of the eight hormones were found to have measurably decreased among participants who watched the funny video, while they remained virtually unchanged in the control group.

The importance of humor in prolonged stress situations, and its effectiveness as a stress-reducer, can hardly be overemphasized. The ability to laugh, not only with others but also at oneself, is a vital skill of survival that promotes better adaptation to adversity. Former prisoners of war have claimed that single instances of a humorous circumstance made them feel better for weeks to months later. A remarkable example of how humor can serve as an emotion-focused coping response in highly stressful circumstances is the case of Brian Keenan, whose powerful book An Evil Cradling: The Five-Year Ordeal of a Hostage describes the way in which he and other hostages in Lebanon used humor to survive their incredible ordeals during five years of captivity.

{/tabs}

Coaching Insights: Stretched or Stressed

Vermeer_1662_Art_of_painting Whether work demands stress or simply stretch is a subjective assessment and is often a matter of degree or accumulation. Subjectively, what may be stressful for one individual may be stimulating or productive in another.

I’ve been an air traffic controller at Kennedy International Airport for 20 years. Most people would call this job high-stress, but I thrive on it. You either love this type of job or you quit, or you never get into it in the first place. You’d think I was the type of kid who loved excitement or always took chances. I wasn’t. I could never be a firefighter and go into a burning house. That would be stressful. It’s just not in my makeup. (…) While we’re working, we’re “in the zone.” We work for two hours and then take a break. It’s mandatory. I don’t care how good someone is, after directing busy traffic for awhile, you need to decompress. At the end of those two hours, you know you’ve done a good job if the planes assigned to you were within the limits. I like that instant feedback.
Stephen Abraham

Degrees of stress or its accumulation also matter in determining stress vs. stretch. One may be able to manage stressful situations quite well at work (where specific motivation, competencies, skills and experience may come into play) but not in other aspects of life such as relationships, parenting, nutrition, fitness (where different skills may be required).

One way to determine whether work demands constitute simple stretch or even stimulating arousal that leads to more productive results, or instead cross over into the harmful stress category is by assessing balance. See a simple how-to after the jump. Read more

Stress News: The Good, the Bad, the Ugly

Stress and the Unborn

Overexposure to stress hormones in the womb can program the potential for adverse health effects in those children and the next generation, but effects vary depending on whether the mother or father transmits them, a new animal study suggests. The results were presented this past Saturday at The Endocrine Society’s 93rd Annual Meeting in Boston.

Posttraumatic Stress Disorder

Depressed-Soldier-02A new study from the Journal of Traumatic Stress finds that for active-duty male soldiers in the U.S. Army who are happily married, communicating frequently with one’s spouse through letters and emails during deployment may protect against the development of posttraumatic stress disorder (PTSD) symptoms after returning home.

Veterans of the Iraq/Afghanistan wars showed a 50 percent reduction in their symptoms of post-traumatic stress disorder (PTSD) after just eight weeks of practicing the stress-reducing Transcendental Meditation technique, according to a pilot study published in the June 2011 issue of Military Medicine.

Individuals with post-traumatic stress disorder (PTSD) are likely to have a higher chance of developing heart disease and to die prematurely, US researchers reported in the American Journal of Cardiology. They found that those with PTSD were more likely to have coronary artery disease, an accumulation of plaque in the arteries that lead to the heart disease.

Stress and Multiple Sclerosis

Contrary to earlier reports, a new study finds that stress does not appear to increase a person’s risk of developing multiple sclerosis (MS). The research is published in the May 31, 2011, print issue of Neurology®, the medical journal of the American Academy of Neurology.

Stress and Alzheimer’s Disease

Stress promotes neuropathological changes that are also seen in Alzheimer’s disease. Scientists from the Max Planck Institute of Psychiatry in Munich have discovered that the increased release of stress hormones in rats leads to generation of abnormally phosphorylated tau protein in the brain and ultimately, memory loss and dementia.

When Stress Becomes Trauma

aaHiroshige_TakanawaThere have been considerable advances in the last few years of our understanding of stress, its origin, its antecedents and the course of its manifestations. Significant progress has also been made in understanding what can help reduce its effects on functioning and mood. In spite of the barrage of advertising that promotes such “remedies” as prescription opioids and “benzos” and the ever-present allure of alcohol or marijuana, many people now know that exercise can work just the same, if not better, in reducing stress and anxiety.

There are certain stressors, however, that produce effects that go beyond and cross into a different domain, that of traumatic stress. Recent research places posttraumatic stress disorder (PTSD) within a theory of pathological anxiety, whereby the individual becomes vulnerable in two very important ways.

The first vulnerability precedes the traumatic stressor and is an innate, and therefore genetic, biological predisposition of the individual toward experiencing intense, negative emotions that can easily escalate into panic or degenerate into depression. This biological vulnerability can have many effects, chief among which is the inability to correctly assess the difference between true and false alarms and the subsequent inability to correctly decide on the most appropriate response between fight, flight or freeze. A true state of alarm arousal is the normal and most appropriate reaction to a truly threatening event or situation, i.e. what most people would find dangerous or risky. A falsely perceived state of alarm is one that causes a sudden and involuntary mobilization of the body and the mind’s defenses, in the presence of a situation or event that is objectively non threatening but is assessed as such by the individual who is genetically predisposed to an intense alarm reaction.

The second vulnerability is psychological in nature. Individuals who develop this sensitivity report a greatly reduced sense of control over events and situations. They tend to approach the present and imagine the future with anxious apprehension. Their mood is often characterized by an anxious state of exaggerated vigilance, whereby it is inherently hard to relax and enjoy life. Cognitively, they expect and anticipate the appearance of various threats, external and internal, with an attending constellation of negative emotions (fear, obsession, panic). This complex system of cognitive and emotional arousal usually promotes avoidance and triggers a near-constant state of worry.

When applied to traumatic stress, these vulnerabilities magnify the experience of a traumatic event and trigger a significantly more severe state of alarm at the time of the trauma. It is well known fact that some individuals appear able to remain relatively calm in the face of traumatic events, while others (who are more likely to have bio-psychological vulnerabilities to intense stressors) seem to quickly “fall apart” and be seemingly “destroyed” by the circumstance.

When the intense trauma passes, these individuals remain in a state of arousal that continues to trigger alarms in response to internal and external stimuli associated with the trauma, and their
initial response to it. For example, a sudden noise may trigger the stimulus associated with a bomb blast, or a burst of anger by another may trigger a stimulus associated with physical abuse. These learned responses to real or perceived threats produce a state of anxious apprehension which, in PTSD, includes the re-experiencing of emotions. This near-continuous state of alarm may, in time, be mitigated by coping mechanisms which generally consist of an individual’s efforts at avoiding the triggers of the learned alarms and the strong emotions associated with them. Intense avoidance of any stimulation that may results in a re-experience of the traumatic events and its associated emotions can eventually developed into a state of emotional numbing, where even those stimuli that should provoke a reaction do not.

Do You Know the Answer to These 10 Critical Questions About Stress?

vanGogh_1888_YellowHouseWhat questions come to mind when we think about stress depends on our relationship with it. If we consider stress as our mortal enemy, then our questions will revolve around the fear of its effects, ways of getting rid of it or at least greatly reducing it, and how we can best distract our mind and tame our symptoms. If, on the other hand, we consider stress as our ally, a friend that warns us when something or someone requires our attention by turning on certain body signals, then our questions will be entirely different. They will revolve around ways of using it to our advantage, toward understanding its precious and vital function, and how best to accept and honor its purpose. Here are the 10 most important questions about stress.

10 Questions About Stress

  1. Is stress always bad?
    No, not always. However stress can be bad, even dangerously bad. It starts out in childhood, as we become aware of the world and its dangers. If it is misunderstood, not explained, ignored or abused, stress can grow with us into something to be feared, avoided, to run from. It can become a constant yet unwanted companion, albeit a greatly misunderstood one. A relationship with stress is thus set up that is entirely adversarial. Its power as a warning system and as a motivator is overlooked. Stress is always bad when, in this way, it becomes a disease.
  2. What is the prevalence of stress in humans?
    It is 100%. Every man, woman and child who ever lived, now lives or will ever live experiences stress. This is not because we are cursed with it, but because we are blessed by its helpful action. In the presence of any stressor, real, imagined or impending, our body instinctively mobilizes for action, helping us better protect and defend ourselves, our loved ones, our property and our values. Without it, we would be inert, uncaring, detached and defenseless individuals.
  3. What are the variations and severity of stress?
    There are two kinds of stress: the stress reaction and chronic stress. The stress reaction is the immediate arousal that occurs in the presence of danger; it rises rapidly, peaks, and subsides after a time; afterwards, the mind and body return to their normal relaxed state. The stress reaction can be more or less intense, and more or less prolonged, depending on the severity of the stressor and on its resolution. Chronic stress is simply a persistence of the stress reaction, which continues at or near its peak without return to the normal relaxed state. The severity of chronic stress depends on the stressor that first triggered it and the continuing stressors that maintain it, and on the lack of any real resolution. Chronic stress is what most people refer to when they complain of suffering from stress.

    A day without stress is like, you know, night. –Anonymous

  4. Can chronic stress be prevented?
    Yes, stress can be prevented from becoming chronic, especially in children and young adults. Adults and elderly people have a more difficult time preventing stress from becoming chronic. What is most helpful in prevention is understanding its function and learning to appreciate its value. People who do best are the ones who view a stress-free life not only as the absence of symptoms, but as one that is rich in exercise, balanced nutrition, effective time management, good decision-making skills, appropriate releases of energy and emotion, and strong relationships.
  5. What are the most common stress triggers?
    The most frequent and severe stressors, or stress triggers, are associated with our interpersonal relationships (beginnings, ongoing difficulties, losses) and our physical health. Others that can be very severe but less common are natural disasters, accidents, conflict, or crime. In general, change is a stressor, as are most transitions from one phase of life or age to the next. Work and financial demands are also frequently associated with stress reactions.
  6. Are there ways for parents to reduce the risk of their children developing chronic stress? 
    Yes, through educating themselves about the function, benefits and dangers of stress, and passing this knowledge along to their children. There is no better time to learn about how to accept and make the best use of the stress reaction than in childhood and young adolescence, although it can be learned at any age.
  7. What are the risks associated with stress? 
    The risks associated with stress are minimal if the stress reaction is allowed to occur and take its normal course, and if stressors are addressed and resolved in a timely manner. Chronic stress, however, carries biological, psychological and social consequences. It can result in severe illness, especially to the cardiovascular and immune systems. It can significantly worsen the prognosis of psychological disorders such as depression, anxiety, bipolar disorder, borderline personality disorder and many others. Lastly, chronic stress can have a significantly adverse impact on relationships, at work and at home, by augmenting the effects of anger, fatigue, or irritability. It can also diminish productivity and lead to poor decision-making.
  8. Can stress be cured? 
    No, the stress reaction cannot be cured because stress itself is not a disease. Stress is a natural and helpful reaction to a danger that mobilizes our defenses. It is impossible to “cure” stress if it means attempting to eliminate it; it would be tantamount to trying to eliminate fear, or joy, or surprise from our lives. On the other hand, chronic stress must be addressed and treated adequately to avoid its most serious consequences to our health, our mind, and our relationships.
  9. What questions should I ask my physician about stress?
    The two most important questions to ask are 1) How seriously has chronic stress affected my physical health (heart, blood pressure, cholesterol, and digestive system being the most vulnerable), and 2) What changes do I need to make to reduce my chronic stress back to a normal stress reaction.
  10. What can I do to reduce my risk of chronic stress?
    There are many different stress management programs available, perhaps even too many to consider them all. Often, lack of success with them prevents their continued application. Often lack of time or motivation are the problem. Often, acute stress itself prevents us from being able to choose an adequate treatment. In many cases, it is advisable to get some external help that facilitates the process. In those cases, a good coach is the ingredient that makes it possible to discover, develop and make the best use of our natural ability to manage stress.

Hear and Feel Your Stress Drift Away

aavanGogh_1888_ArlesDanceHallCan music reduce stress? Yes, and the evidence is strong. Music can reduce stress, lessen pain, diminish hostility and have a positive effect on emotions and cognition. Beginning with an experimental study by Hatta and Nakamura (1991), researchers have continued to investigate the effects of relaxing music on psychological stress, finding good evidence of its benefits. Rhythmic music may change brain function and treat a range of neurological conditions, including attention deficit disorder and depression, suggested scientists who in 2006 gathered with ethnomusicologists and musicians at Stanford’s Center for Computer Research in Music and Acoustics. The diverse group came together for the symposium, “Brainwave Entrainment to External Rhythmic Stimuli: Interdisciplinary Research and Clinical Perspectives.”

Music with a strong beat stimulates the brain and ultimately causes brainwaves to resonate in time with the rhythm, research has shown. Slow beats encourage the slow brainwaves that are associated with hypnotic or meditative states. Faster beats may encourage more alert and concentrated thinking… Most music combines many different frequencies that cause a complex set of reactions in the brain, but researchers say specific pieces of music could enhance concentration or promote relaxation… Studies of rhythms and the brain have shown that a combination of rhythmic light and sound stimulation has the greatest effect on brainwave frequency, although sound alone can change brain activity. This helps explain the significance of rhythmic sound in religious ceremonies. – Stanford University News Services, 2006

Music therapy is now considered a useful adjunct in the treatment of many illnesses including cancer, stroke, heart disease, headaches, and digestive problems. There are numerous reports that music played before, during or after surgery reduces anxiety, lessens pain, reduces the need for pain medication and reduces recovery time.

In 2010, Wesa, Cassileth & Victorson published evidence in Focus on Alternative and Complementary Therapies Journal that music dramatically decreases distress for women hospitalized in a high-risk obstetrics/gynecology setting.  In 2009, a group of scientists headed by Thaut & Gardiner confirmed that music therapy can improve executive brain functions and contributes to better emotional adjustment in traumatic brain injury rehabilitation. Their study examined the immediate effects of neurologic music therapy (NMT) on cognitive functioning and emotional adjustment with brain-injured persons and a control group. The patients who received the music treatment showed a statistically significant improvement in executive function and overall emotional adjustment, reduced depression, lessened sensation seeking, and lower anxiety. Control participants, who did not receive the music treatment, showed decreases in memory, less positive emotion, and higher anxiety.

An extensive study by Good, Anderson, et al. (2005) tested three non-pharmacological treatments—one of which was music therapy—for pain relief following intestinal surgery in a randomized clinical trial. The 167 patients were randomly assigned to one of three intervention groups or control. The results showed significantly less pain in the intervention groups than in the control group, resulting in 16-40% less pain.

Finally, a just published German study offers case-study evidence that music therapy has positive effects on basic vital signs, the reduction of pain and on neurological development in newborn babies with health problems. At the other end of life’s spectrum, a very recent study of patients suffering from dementia of the Alzheimer’s type who exhibited disruptive behaviors showed that weekly session of live music therapy- and occupational therapy-based structured activities over 8 weeks resulted in a significant improvement in disruptive behaviors and depressive symptoms.

Worst Stress Relievers: Pain Medication

painmeasurementscale Who is to say for sure how much pain I have right now, I had yesterday morning, or will have this afternoon?   Only I can know for sure the pain I am feeling—and I can lie, to myself and to others.  Herein lies the greatest challenge of addiction to pain medication. There is no objective measuring tool for pain. The best we can do is to ask the person to rate his or her own pain on a scale of 1 to 10, with all the accuracy that can be expected from such a subjective assessment, which isn’t very much because pain can always feel more intense than it actually is, physically or sometimes just psychologically.

The sad result of the greater availability of pain medication, its greater potency, the beneficial effects felt by the individual by taking what amounts to a legal hit of morphine is an ever increasing number of people who are dying from abusing or misusing pain medication.  Among some groups, deaths from prescription drug overdoses are more than ten times higher than they were in the late 1960s. These are the results of an age-period-cohort analysis using data from the US Vital Statistics and the US Census, available online.

In the absence of significant pain, prescription painkillers are ingested because of their very powerful relaxing effects on the central nervous system and for the sensations of well-being that characterize their action. The presence of hydrocodone, which is the equivalent of synthetic opium, in these drugs makes them highly addictive. The first signs of a painkiller overdose include loss of appetite, nausea, vomiting, stomach pain, sweating, and confusion or weakness. Later symptoms may include pain in the upper stomach, dark urine, and yellowing of the skin or the whites of the eyes. Overdose symptoms may also include extreme drowsiness, pinpoint pupils, cold and clammy skin, muscle weakness, fainting, weak pulse, slow heart rate, coma, blue lips, shallow breathing, or no breathing.

The rapid increase in mortality due to accidental poisoning that has been observed since 2000 is almost tenfold for whites and threefold for blacks over the study period. This appears to result at least in part from the coming of age of baby boomers who, as they age, are becoming addicted to prescription medications, most especially pain killers. The majority of prescription drug abuse involves painkillers, according to the Drug Enforcement Administration. In the US, Vicodin (containing acetaminophen and hydrocodone) is the most commonly abused prescription drug.

The greatest proportion of overdoses appears to occur in people in their 40s and 50s. While in 1968 about one per 100,000 white women in their early 50s died from accidental poisoning, the number has risen to 15 per 100,000 in 2007. Among black women of the same age, accidental poisoning deaths increased from about two per 100,000 to almost 17 per 100,000.

getty_rm_photo_of_woman_taking_prescription_pain_medication What’s the fix for this nationwide epidemic?  In the absence of an objective pain measure, it is hard to imagine how anyone can take exception to the screams of pain that can come from someone who is in the process of becoming addicted to pain medication, or already is.  Many doctors have taken the no-hassle course of prescribing, rather than questioning the veracity of the patient’s pain.  Many other medical practitioners, such as dentists and surgeons, have taken to dispensing large quantities of “samples” to patients who have had even the simplest procedure, “just in case you feel any pain.”  Of course, the patient takes the stuff, the pain (if any) goes away, and the powerful effects of the drug go to work by inducing a high that feels incredibly good. At this point, and in many sad cases, only a few short steps separate the patient from the addict.

More recently, the DEA has cracked down on pharmacies and doctors, with the intent of reducing the supply of these medications. More needs to be done to stop the flow, but also and most especially to educate the public on the potential addictive nature of these substances. They do work extremely well against pain, but at what cost?

Stress Task Manager: What Processes Are Running?

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Being fired… Witnessing a crime… Getting bad medical news… Finding out you’re pregnant… The computer getting a virus… Coming into (big) money… Getting engaged… The laundry coming out pink… Being offered a new job… The pet running away… Getting lost in the woods… Losing the wallet… If any of these stressors have happened to you, then you are already very familiar with the way your body reacts to stress. Knowledge is power, and being familiar with our natural body reactions is conducive to a better handling of the situation. But what happens exactly at the moment of stress? Take the jump and find out.

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The Valor of Stress

James_DixonUnlike for physical injuries, no formal recognition is currently given by the US military for the biopsychosocial injuries sustained in combat, known as posttraumatic stress disorder or PTSD.  It is as if the many behavioral, emotional, and social consequences of traumatic stress are perceived to be of lesser impact, and thus less deserving of acknowledgement.  That they can be serious enough to warrant medical and psychological attention is now fairly well established.

The evidence is certainly not lacking, as serious outcomes of PTSD continue to occur. Most recently, the blog The Soldier’s Load reported  the story of  James “Rooster” Dixon III, an ex-Marine and long-time sufferer from PTSD who was killed by a State Police SWAT team in front of his house in Baxley, Georgia.

James sought treatment from the VA for his Post-Traumatic Stress Disorder (PTSD), but was unable to shake the constant anxiety and depression that are hallmarks of the disorder. On February 19, 2012 James decided to end his struggle by walking into the bullets of law enforcement: as much a casualty of the war as any service member who died in Iraq.

The blog’s editor, as someone with direct experience of war zone and combat stress and its psychological consequences, also offer insights into his own struggles with PTSD.

I became a functional recluse—avoiding social situations and new experiences that might trigger a panic attack. Friends and acquaintances got accustomed to me declining their invitations to socialize. Eventually they stopped asking. I drank heavily and destroyed romantic relationships in a depressing cycle of thrilling novelty, fear of entrapment and cold dismissal. After three years of struggling with the symptoms of my unknown malady, I chose to leave the Marine Corps. On my way out the door, the VA finally diagnosed me with combat-induced PTSD.

A Purple Hart for PTSD?

images Events such as the tragic end of James Dixon highlight the important questions that still surround how PTSD is perceived, labeled, acknowledged and treated—including the idea of awarding a Purple Hart in recognition of this very serious constellation of injuries that are sustained by so many service men and women. According to the Military Order of the Purple Heart, the Purple Heart medal “is awarded to members of the armed forces of the US who are wounded by an instrument of war in the hands of the enemy and posthumously to the next of kin in the name of those who are killed in action or die of wounds received in action. It is specifically a combat decoration.”  Should this wording be applicable to PTSD?

The Soldier’s Load asks,

Why do we fail to classify veterans with PTSD as combat wounded? I suggest that the reason has less to do with logic and more to do with the emotions surrounding a small bronze portrait suspended from a narrow purple ribbon. (…) Until we correctly label combat-induced PTSD as a “wound” suffered from contact with the enemy, we as a society will continue to view its sufferers as a shadow legion of men with strange habits and questionable character. We will not methodically identify the trauma, apply medical treatments, and provide appropriate rehabilitation and therapy during the recovery process. In short, we will draw distinctions between segments of combat veterans based on an arbitrary and antiquated determination that only the visible wounds of war are worth recognition, honor and treatment. Such a view will not be helpful to the thousands of combat veterans waging a daily war within, nor prevent some from ending that struggle before victory is won.

Read the full blog post. Do you support a Purple Hart for PTSD?