Fake It ’til You Make It: Posture Lowers Stress

Is it possible, by deliberately assuming a simple two-minute high-power pose, to instantly become more powerful? In a study conducted conjointly at Harvard and Columbia universities, researchers have shown that humans and animals can increase the beneficial effects of power by deliberately assuming open, expansive postures for as little as two minutes, and suffer the effects of powerlessness by deliberately assuming closed, constrictive postures. The study results revealed that assuming certain postures almost immediately produces neuroendocrine and behavioral changes. High-power postures (widespread limbs, enlargement of occupied space, and spreading out) trigger a rise in testosterone, a decrease in cortisol, a perception of power and a willingness to take more risks. Assuming low-power postures (limbs touching the torso, minimizing occupied space, and collapsed inwardly) produces the opposite effects.

chinatown-jack-nicholson

By simply changing our physical posture, we can better prepare our body and our mind to take on stressful situations. Intentionally assuming certain postures can have the immediate effect of improving self-confidence in such situations, e.g., a public speech, a job interview, disagreeing with someone, preparing for a sports challenge or even taking a financial risk. As it turns out, “Fake it ‘til you make it” is not just a phrase:  even minimal postural changes, if sustained over time, can  improve our health and well-being, even if we may often feel quite powerless due to lack of resources, occupying a lower rank in an organization, or being part of a low-power social group.

How Does Posture Reduce Health Risks?

forrest-gump-p111Although short-term high cortisol levels are a normal reaction to stressors large and small, being in a position of lower power (at work, at home, in social groups) has been shown to cause a higher incidence of stress-related illnesses (Cohen et al., 2006). For people who hold positions of power or are able to exercise more power at work, at home or in social situations, the contrary is true. Their typical combination of high testosterone coupled with low cortisol is often associated with leadership capabilities and a higher resistance to disease. The stress-marking hormone cortisol is lower when we are in a position of power, indicating a lower level of reactivity to stress. The continuous state of alarm and elevated cortisol experienced by low-power individuals can produce negative health consequences such as inflammation, high emotional reactivity, a high allostatic load, stress-related illnesses (irritable bowel syndrome) and memory loss.

In short, arranging our body posture to indicate power (regardless of whether we feel powerful or not) causes specific advantages and adaptive psychological, physiological, and behavioral changes, with more positive subsequent behavioral choices. A simple two-minute pose can embody power and instantly make us more powerful. Who’d have thunk it?

When Stress Hurts: Curing Psychogenic Pain

villa-Era-Vigliano-Biella_Current treatments that effectively reduce or eliminate psychogenic pain is the subject of this, the sixth and last post in the series on the close association between psychological stress and psychogenic pain. Encouraging news for psychogenic pain sufferers from the pharmacist: A growing number of patients reports that by taking antidepressants they have experienced a significant reduction in the frequency and intensity of pain. More specifically, relief of psychogenic pain with antidepressants has now been thoroughly documented in the treatment of pain associated with bulimia (Faris et al., 1998), vulvodynia (Stolar & Stewart, 2002), chronic pain of undefined origin (Davis, 1990; Pilowsky & Barrow, 1990), migraine headaches (Kaniecki et al., 2006), chronic pain associated with depression (Bradley, Barkin, Jerome, DeYoung, & Dodge, 2003), functional bowel disorder (Drossman, Toner, & Whitehead, 2003), neuropathic pain (Fishbain, 2000; Saarto & Wiffen, 2005), and post-herpetic neuralgia (Max, 1994).

Non-pharmaceutical Treatments

As we have seen in a previous post, there is a strong emotional and affective component to pain of any origin, whereby pain always has a depressive effect on our mood. There is also ample evidence that pain is often the unwelcome companion of depression, anxiety, psychological trauma, anger and irritability. Even the mere expectation of pain, in the absence of any noxious stimuli, appears sufficient to produce it  and its perception, as has been documented in functional MRI (fMRI) changes to specific brain structures (Fields, 2000; Keltner et al., 2006). Conversely, diverting cognitive attention or causing distraction can mitigate pain, as shown in PET scans of cortical activation (Petrovic, Petersson, Ghatan, Stone-Elander, & Ingvar, 2000).

SH_Rcmds_sm UnlearnPain_BookHoward Schubiner, MD and Michael Betzold are the authors of Unlearn Your Pain, an excellent book that seeks to help reverse chronic pain by promoting a thorough understanding of its principal cause, learned nerve pathways (see Stresshacker’s explanation of the concept in this post). It offers a revolutionary step-by-step process that has been reported to work well by many psychogenic pain sufferers. It is Stresshacker’s recommended book resource.

Psychological Treatments That Can Eliminate Psychogenic Pain

The effectiveness of purely psychological interventions in the relief of chronic or acute pain is supported by the fact that pain and stress share many of the same biochemical processes, neural pathways and CNS structures (see this post for a full explanation).

Decreasing psychological stress through better stress management or counseling has been documented as effective in treating low back pain that is co-occurring with depression (Middleton & Pollard, 2005). There is also evidence that psychosocial interventions are efficacious for pain secondary to arthritis or cancer (Keefe, Abernethy, & Campbell, 2005). Multidisciplinary approaches, including relaxation therapy, biofeedback, behavior modification, hypnosis, desensitization and cognition therapy, have also been proven successful in treating chronic pain of unknown origin (Singh, 2005). Biofeedback therapy can be particularly successful in reducing colorectal pain (Jorge, Habr-Gama, & Wexner, 2003). Hypnotherapy, cognitive therapy, and brief psychodynamic psychotherapy appear to work well in patients suffering from irritable bowel syndrome (Blanchard & Scharff, 2002). Hypnosis has been proven effective in relieving oral pain (Golan, 1997), cognitive behavioral therapy for functional bowel disorder (Drossman et al., 2003), behavioral therapy for the treatment of headaches (Lake, 2001); and family therapy interventions have been associated with successful psychogenic pain treatment (Liebman, Honig, & Berger, 1976; Roy, 1987).

Previously in this series:

9 Ways to Beat Procrastination…Tomorrow.

Langisjor_EN-US2321196967Procrastination is three times as stressful as getting things done right away. First, because tasks that need doing aren’t getting done; second, because it is stressful to think about all that needs to be done…and remains undone. Third, procrastination in itself is a source of stress due to its impact on self-esteem and psychological well-being.

Procrastination is a delay in deciding to start a task or in completing it. Men and women in roughly equal percentage suffer from this debilitating condition. Situational procrastination happens to everyone and simply describes an occasional delay that does not indicate a habitual pattern. Dispositional procrastination applies to people who delay many tasks on a regular basis, including tasks that are important and sometimes even critical to optimal functioning. Among dispositional procrastinators, two major types can be discerned based on their presumed motivation: arousal procrastinators, who (often subconsciously) need to be motivated to act by the adrenaline rush that comes from cutting it close to the deadline, and avoidant procrastinators, who are de-motivated to act by their fear of failure or success and/or by task aversion.

Here are nine ways to beat procrastination that have been proven to work with many people. (Try one or two, if you have some time…perhaps tomorrow?)

1. Learn to Tell Time

lastminuteHabitual procrastinators, even when faced with simple tasks, don’t seem as capable to estimate the time necessary to perform the task as non-procrastinators. They overestimate how much time it will take to finish the task, and are therefore reluctant to begin it; or they underestimate how long it will take to complete it, and are afraid of not being able to finish it. Learning to better estimate time to task completion is a skill that needs to be developed by procrastinators who, for whatever reason, seem to fall short of its mastery.

GTD-cover2. Banish Disorganization

Not being able to plan a task, misplacing some of the things needed to perform a task effectively, or losing track of what has already been done are areas that cause people to delay starting a task or its completion.

Getting rid of the very idea of disorganization is the start of a better strategy for getting things done. The enormously popular book Getting Things Done: The Art of Stress-Free Productivity may help…

3. Post-It and Read It

Sometimes the simplest things carry the most value. Any procrastinator can benefit from the little yellow notes strategically posted in visible locations that act as silent reminders of tasks that need to be done. If the notes are read and acted upon, procrastination can become a less frequent problem.

4. Make It Easy to Concentrate

Not having a specific, designated place in which to concentrate and focus exclusively on a task introduces the scourge of distraction to the misery of indecision. Being in a place where there are too many other stimuli competing for attention is not a winning strategy. Getting in the zone and achieving flow is key to task completion.

LeoMarvin5. Take Baby Steps

Sometimes even a relatively simple task can appear complex, until it is broken down into smaller chunks. Behavioral psychologists recommend chaining, which is a series of responses needed to perform a particular target end-behavior or, in simpler terms, baby steps. Getting things done one small chunk at a time. Simple. It works.

6. Take Small Time Bites

Complexity of the task can be compounded by the (often incorrect) estimation of the total  time needed to complete it. To take care of this aspect of the problem, it helps to break down the task into small bites of time—say, 5-minute segments—instead of staring at the total time needed and freezing in place.

7. Put the 80-20 Rule to Work

Even the best laid out strategy of eliminating procrastination cannot be accomplished in one day. We simply can’t go from “total procrastination” to “total completion” in one fell swoop. A more realistic and achievable plan may be to apply the 80-20 rule, where success means completing at least 80% of the tasks, instead of aiming for 100%.

8. Seek Role Models

Go with a procrastinator and you’ll learn to procrastinate more. Seek non-procrastinators as role models, get past the negative comparisons, and you will learn useful techniques and approaches that may come natural to them, but can be a godsend on the way to getting things done.

9. Take Responsibility

Everyone knows that there are consequences for delays and for failing to get things done. Procrastinators know that, too. Unfortunately, the habit of making excuses that can be accepted by others simply sharpens the skills for coming up with “reasons” that just sound plausible. A procrastinator who is willing to take responsibility is only a few short steps away from kicking the habit.

How Owning a Dog Extends Your Life

Puppy_1-21-09Human interactions have a biochemical signature that is most evident in what happens between a mother and her baby. A study presented at the 12th International Conference on Human-Animal Interactions that took place this summer in Stockholm offers convincing evidence that the same biochemical process plays a role in the bond between dogs and their owners. Researchers Linda Handlin and Kerstin Uvnäs-Moberg of Sweden’s Karolinska Institute believe oxytocin is the “bonding hormone” that is released in humans and in dogs during mutual interactions. To test their theory, blood samples were taken from dogs and their owners before and during a petting session. “We had a basal blood sample, and there was nothing, and then we had the sample taken at one minute and three minutes, and you could see this beautiful peak of oxytocin,” said Uvnäs-Moberg in an interview on PBS. “The fascinating thing is, actually, that the peak level of oxytocin is similar to the one we see in breastfeeding mothers.”

The hormone oxytocin has a powerful physiological effect. It can reduce blood pressure, increase tolerance to pain, and reduce anxiety. Research indicates that owning a dog could even extend your life. “If you have a dog, you are much less likely to have a heart attack, and if you have a heart attack, you are three to four times more likely to survive it if you have a dog than if you don’t,” added Uvnäs-Moberg.

Oxytocin: The Baby-love Puppy-love Hormone

Oxytocin is a polypeptide hormone that has long been known to stimulate the contraction of the uterine muscles and the release of milk during breast-feeding. It is now recognized as an important modulator of the stress response. Stored in and released from neurons in the posterior pituitary as well as in the brain, oxytocin is synthesized in cell bodies of the magnocellular neurons located principally in the paraventricular nucleus of the hypothalamus. However, oxytocin is more ubiquitous as it is also synthesized in neurons that are widely distributed within the central nervous system. Oxytocin facilitates mother–infant interactions and tends to facilitate behaviors that oppose classic fight-or-flight behavioral responses to stress.

The Study: Dogs Have Feelings of Love, Too

Mother and childHandlin and Uvnäs-Moberg sought to establish a correlation between levels of oxytocin and those of the stress hormone cortisol during interactions between dog owners and their dogs. Ten female dog owners were asked to evaluate the quality of their relationships with their dogs via a standardized questionnaire. They were also asked to interact with them, stroke them and talk to them for one hour. The owners’ oxytocin levels correlated significantly with questionnaire items indicating positive feelings and closeness to the dog, while cortisol levels were significantly correlated to items regarding negative feeling towards their dog. The dog’s oxytocin and cortisol levels also correlated significantly with the owners’ answers to items regarding their attitude toward the dog. The scientists concluded that hormones in both human and animal were related to the owners’ perception of their relationship with the dog. “A short-term sensory interaction between a dog and its owner [can] influence hormonal levels in both species,” says Uvnäs-Moberg. “The dogs’ oxytocin levels displayed a significant rise just three minutes after the start of the interaction. There was also a significant positive correlation between the dogs’ and the owners’ oxytocin levels after 15 minutes.”

Stress Hardware Update: Limbic System 2.0

LimbicSystemGeographyThe term limbic system designates the entire neuronal circuitry and forebrain structures that control emotional behavior, motivational drives and the processing of present and past sensory experiences. The brain structures of the limbic system are located around the middle edge of the brain. Several limbic structures are involved in determining the affective nature of sensory inputs, i.e., whether the sensations are pleasant or unpleasant. The emotional qualities we attach to the input provided by our five senses are also called reward (when they are pleasing to us and therefore we crave more of them) or punishment (when they are unpleasant and therefore we seek to avoid them), or satisfaction or aversion. Neurobiological research on the functions of the limbic system dating back to its XIX century pioneer Pierre-Paul Broca (1861), later expanded by James Papez (1937), Giuseppe Moruzzi and Horace Magoun (1949), and Ross MacLean (1949, 1952) identified the “reticular” and “limbic” systems as regulating the energizing and expressive roles in the central nervous system.

The limbic system is comprised of numerous structures, the most important of which are the hypothalamus, the amygdala, the hippocampus, the cortex, the cingulate gyrus, the striatum, the pallidum, the thalamus, and Meynert’s nucleus basalis. Each of these structures performs a specific function, and often also serves to receive, transmit and amplify communication within the limbic system, with other areas of the brain, and with other parts of the central nervous system.

The Hypothalamus: The Central Autonomic Controller

A major component of the limbic system is the hypothalamus and its related substructures. The hypothalamus complex controls the internal state of the body, such as temperature, osmolality of the body fluids, appetite and thirst and the regulation of body weight. Despite its very small size of only a few cubic centimeters (which represents less than 1% of the brain mass), the hypothalamic complex has two-way communicating pathways with all levels of the limbic system and is the key structure for higher level coordination of autonomic and endocrine functions. There would not be a stress reaction, with its almost instantaneous activation of physical and psychological defense mechanisms, without the hypothalamus providing the critical signal activation.

The Amygdala: The CPU of Emotional Response

AmygdCingGyrusThe amygdala is a group of nuclei embedded in the anteromedial temporal lobe, which receives input from all five senses. It performs the analysis of form and color and facilitates the recognition of complex stimuli such as human faces. The amygdala can influence heart rate and blood pressure, gut and bowel function, respiratory function, bladder function, and many more instinctive physical reactions. It is in the amygdala and its connection to other limbic structures that the determination of the affective value of sensory stimuli (rewarding or aversive) is made and our mood (or feelings about something) is determined. Stimulation of the amygdala produces the defense reaction that prepares us for fight, flight or freeze, along with complex sensory and experiential phenomena, which may include fear, sensory hallucinations, feelings of deja vu, and memory-related flashbacks and nightmares. The amygdala receives neuronal signals from all portions of the limbic cortex and is the “central processing unit” in which the limbic system produces an emotional response to events, people and situations. The amygdala also interacts with higher brain regions that govern such processes as directed attention, declarative memory, and response inhibition (Davidson, Putnam, & Larson, 2000; LeDoux, 1995).

The Hippocampus: Memory Chips and Orientation

The hippocampus is a highly specialized region of the cerebral cortex, which along with surrounding areas of the parahippocampal gyrus is directly involved in memory processing and spatial orientation. The hippocampus provides the neural mechanism for association of different parameters that is necessary for the moment-to-moment incorporation of experience into our short- and long-term memory banks. Almost any type of input from the five senses causes activation of at least part of the hippocampus, which in turn distributes many outgoing signals to the anterior thalamus, to the hypothalamus, and to other parts of the limbic system, especially through the fornix, a major communicating pathway.

The Orbital and Medial Prefrontal Cortex: Food and Personality

PhineasGageThe cortical areas of the limbic system are divided into two interconnected networks with related but distinct functions. Many of these functions are related to food or eating (e.g., olfaction, taste, visceral afferents, somatic sensation from the hand and mouth, and vision), and neurons in the orbital cortex respond to multisensory stimuli involving the appearance, texture, or flavor of food. Therefore, the orbital and medial prefrontal cortex have the function of evaluating feeding-related sensory information and to stimulate appropriate visceral reactions. More importantly, damage to the ventromedial frontal lobe can produce dramatic behavioral changes, which suggests that the visceral reactions evoked through this cortical area are critical in evaluating alternatives and making choices. As the well-publicized 19th-century case of Mr. Phineas Gage’s accidental head impaling by a steel rod demonstrates, individuals with damage to the ventromedial prefrontal cortex have no problem with their motor or sensory function, their intelligence or cognitive function, but show devastating changes in personality and choice behavior.

The Cingulate Gyrus: The Cement of Society

Intriguing data and ideas have been proposed by several researchers seeking to identify specific functions of the cingulate gyrus. In what has been termed the affiliation/attachment drive theory, Everly (1988) has shown experimentally that the removal of the cingulate gyrus eliminates both affiliative and grooming behaviors. MacLean (1985) has argued that the affiliative drive may be hard-coded in the limbic system and may be the anatomical underpinning of the “concept of family” in humans and primates. The drive toward other-oriented behaviors, such as attachment, nurturing, affection, reliability, and collaborative play, which has been referred to as the “cement of society” (Henry and Stephens, 1977), appears to originate in this relatively small limbic system structure.

The Ventromedial Striatum, Ventral Pallidum, and Medial Thalamus

The nuclei of the ventromedial striatum are also related to reward and reward-related behavior, whereby they inhibit or suppress unwanted behaviors while allowing other behaviors to be freely expressed. The dorsolateral striatum and related areas of the globus pallidus appear to be involved in switching between different patterns of motor behavior, whereas the ventromedial striatum and pallidum may allow changing of stimulus–reward associations when the reward value of a stimulus has changed. These areas are examples of the complexity and redundancies built into limbic system structures that permit multiple iterations of signal transmission and reception, and a much more complex and refined analysis of sensory inputs from the five senses.

Nucleus Basalis (of Meynert)

The nucleus basalis of Meynert is a prominent group of large cells located in the basal forebrain, most of which are involved in the activation of acetylcholine or GABA neurotransmitters, indispensable in activation of the stress reaction and our defense mechanism when a physical or psychological threat is perceived. The magnocellular basal forebrain nuclei are well situated to modulate brain activity in relation to limbic activity.

Disorders of the Limbic System

Although lesions to limbic structures do not necessarily result in sensory or motor deficits, any loss of function in these structures is usually associated with a variety of psychological problems, including depression, bipolar disorder, obsessive–compulsive disorder, and schizophrenia.

Structural changes have been noted in the hippocampal formation, medial thalamus, and prefrontal cortex in schizophrenic subjects. Images obtained through positron emission tomography scans show that the amygdala, prefrontal cortex and medial thalamus are abnormally active in patients suffering from severe unipolar and bipolar depression.

The complete removal of the amygdala and other nearby structures in laboratory settings causes specific changes in animal behavior called the Klüver-Bucy syndrome, whose characteristic symptoms are a complete lack of fear of anything, extreme curiosity about everything, rapid loss of short-term memory, tendency to place everything in the mouth and sometimes even trying to eat solid objects, and a sex drive so strong that it leads to attempts to copulate with immature animals, animals of the wrong sex, or even animals of a different species. Although similar lesions in human beings are rare, afflicted people respond in a manner not too different from that of the affected animal.

Getting Better for Absolute Beginners

PalmIsland_EN-US349499969Getting better is the goal of every stress management program… and every other program, plan, treatment, intervention we may choose to undertake. But what does getting better mean? Are there some specific characteristics to recovery that would clearly indicate that we have succeeded? These important questions, for one reason or another, often are either not asked or not fully replied to, leaving us wondering where all that effort went and whether it was really worth our time and investment.

The Meaning of Not Doing Well

Before we attempt to define the specifics of getting better, let’s clarify the characteristics of not doing well.  In the case of chronic stress, two criteria can be used to reliably define its severity: subjective distress and level of functioning. The first, subjective distress, indicates how much we are bothered by the condition. Chronic stress can produce bothersome physical symptoms (gastrointestinal problems, fibromyalgia, skin rashes, headaches) and distressing psychological problems (irritability, anger, sleeplessness, poor concentration, memory loss). When these signs appear, it can be said that an individual’s subjective distress has risen to levels that go beyond just feeling pressured and have escalated to affecting multiple aspects of the mind and the body.

The second major indicator, level of functioning, can be gauged by examining personal productivity, balance between work and family life, quality of significant close relationships, and social connectivity. When problems appear in these areas, ranging from interpersonal difficulties to the inability to keep a consistent work schedule or to take care of tasks and chores that could be previously accomplished, one’s level of functioning is said to be impaired. Impairment of functioning can be somewhat of a subjective measure, and for this reason it is often helpful to compare our own perception of how well we are functioning under severe stress to the perception of those around us, as they may be able to give us a more balanced assessment.

Getting Better

As recently described by Dr. Marianne Farkas of the Center for Psychiatric Rehabilitation at Boston University at the Refocus on Recovery 2010 conference, getting better can generally be defined as, “the deeply personal and unique development of new meaning and purpose as one grows beyond the catastrophe… reclaiming a meaningful life… a long-term journey with many dimensions [which] include re-engaging in life, finding a niche or major role, developing secondary roles, reawakening hope, [and] developing a sense of purpose…”

In practical terms, this definition comes down to two essentials: the individual feels better (about meaning and purpose of life, hopefulness, and motivation) and functions better (by re-engaging in more meaningful and productive activities, and adding new roles and dimensions). Thus, the two hallmarks of feeling poorly, distress and impaired functioning, are both mitigated or reversed to fully express the reality that the person is indeed free of distress and capable of functioning at or near optimum levels.

Some indicators of having successfully overcome chronic stress:

  • A return to prior levels of happiness, enjoyment of life, and positive outlook
  • An increase in energy levels and the ability to apply energy toward productive activities
  • The ability to manage personal resources in a way that takes into account the need to replenish them before reaching exhaustion, e.g. better nutrition, more regular sleep patterns
  • A significant reduction or disappearance of the physical symptoms of stress, without the need for medication, alcohol, nicotine, or illegal substances
  • The restoration or improvement in the quality of interpersonal connections
  • A noticeable increase in self-esteem, feelings of well-being, a sense of empowerment

Using the two measures of well-being, distress and level of functioning, can be a quick and simple way of gauging different aspects of our life. Wherever distress is detected, or a stress reaction is taking place, there is an indication that something is not right and requires our attention. Likewise, detecting a reduced level of functioning at work, in leisure or in interpersonal relations should not be overlooked, as it indicates that our resources are dangerously depleted and must be restored.

When Stress Hurts: The Credibility Gap

StMarksSquare_EN-US761640507How the brain processes and maintains psychogenic pain is the subject of this, the fifth post in the series on the close association between psychological stress and psychogenic pain. Hope is hard to come by for swift and lasting relief of chronic back pain, muscle pain, headaches, migraines, stomach pain, and other stress-related conditions. Medication can help but carries the dangers of addiction or dependency. Non-medical remedies do exist and can work well, but may not be as well known or easy to apply. So the pain continues without relief in sight. And then there is the credibility gap.

Unbelievable Pain That Is Hard To Believe

Even though there is no diagnosable medical condition in the body, and even though
the physical injury that may have originated the pain is now healed, the pain is real. Unexplained. Mysterious. Intense. This is hard to accept by the sufferer, by family and friends, by physicians and pharmacists. There is no “proof” of its existence or intensity that anyone can see. This apparent credibility gap, in itself, creates additional stress to the pain sufferer, which (you guessed it) creates even more pain.

The best illustration, and the best indirect proof that psychogenic pain is real, is offered by “phantom limb” pain, a well-known condition not uncommon among amputees. Significant pain is felt in an arm or a leg that has been amputated. Clearly, there can not be anything wrong with a limb that is no longer there—yet this pain can be excruciatingly intense. What’s going on? What we know about phantom limb pain is that it is created by overly sensitized nerve endings that stop at the point of amputation, but continue to transmit previously learned and now outdated pain information along “stuck” pathways to the brain, as if the arm or the leg was still there. These pathways produce a continuing cycle of pain that can last for months, years, or even decades.

A similar phenomenon of “stuck” pathways takes place in psychogenic pain. Let’s see how it works.

How the Brain Processes Psychogenic Pain

Psychogenic pain is produced when overly sensitized nerve pathways are established between the brain and certain parts of the body, which may be initially provoked and later maintained by a continuing psychological stressor.  The nervous system learns to process psychological distress along these neural pathways (exactly why this happens we aren’t quite sure) and the longer the stress goes unattended, the more sensitized and overactive these peripheral nerves become, producing significant amounts of pain to the muscles, the head and other parts of the body.

The brain interprets these nerve signals and transforms them into the experience of pain. The event that started this learning process in the nerves may have been an injury or a stressful event earlier in life, or the pain may just appear without any directly verifiable reason. Only a careful and detailed look at our current situation and life history can reveal the stressors that may have originated and continue to maintain psychogenic pain.

The Case for Fibromyalgia

Musculoskeletal pain localized in the lower back, shoulders, and arms appears frequently to be unrelated to physiological disease. Fibromyalgia has reportedly become one of the most frequent reasons for patient referrals to rheumatology clinics. It is a disorder that affects many musculoskeletal structures and is characterized by persistent pain, sleep and mood disturbances.

Fibromyalgia origins have been traced to stuck pain pathways in the central nervous system, which cause decreased levels of pain-reducing serotonin and increased levels of substance P in the cerebrospinal fluid. These pathways are further reinforced over time by a stress reaction to the pain. Just about everyone who has chronic fibromyalgia pain reacts to it with fear, anger, anxiety, frustration, and other negative thoughts and emotions. Anger and sadness specifically have been recently linked to an increase in fibromyalgia pain.

Psychological stressors, negative thoughts and emotions, conscious or subconscious,  thus appear to be major causative factors in psychogenic pain and its related syndromes, such as fibromyalgia. The decreased activity, diminished income, difficult relationships that are byproducts of constant fibromyalgia pain do nothing but add to the misery of it all, making the pain-producing nerve pathways even stronger.

In our next and final post on this series we will take a look at the medical and non-medical remedies that have been devised to cure psychogenic pain.

Previously in this series:

Next:

  • Medical and Non-Medical Treatments for Psychogenic Pain

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.

Forced to Lie About Stress

aaDelacroix_1852_LaMerADieppeA full 36% say it’s stomach upset, 13% that it’s a cold; 12% claim to have a headache, 6% a medical appointment; 5% blame it on a bad back. The rest cite a variety of reasons, from housing problems to the illness of a loved one or the death of a beloved relative, for not showing up for work. None of it is true. What’s going on? In most cases, nothing more than an intense stress reaction forces 19% of workers to call in sick, yet as many as 93% feel compelled to lie to their boss and coworkers about the real reason for missing work.

Although employees are willing to go to great lengths to cover up their dangerously high stress levels, the vast majority do not like having to lie: 70% say that they long to be able to discuss stress with their employers. While some try, most can’t seem to find the courage to bring it up and remain hopeful that their boss will make the first move and approach them directly when they show signs of strain. Few employers do.

Millions of people experience unmanageable stress at work, and the fact that so many people feel forced to lie about it rather than finding a solution should be a major concern for our businesses. If employees don’t feel they can be honest about the pressures on them, problems that aren’t addressed can quickly snowball into low morale, low productivity and high sick leave. We’d urge employers to encourage a culture of openness at work so they can solve problems now, rather than storing up problems for the future.–Paul Farmer, Mind Research

These sobering statistics were published in a study released by the British mental health research group Mind, an organization which campaigns vigorously to promote and protect good mental health and advocates that people with experience of mental distress are treated fairly, positively and with respect.

Not being able to come clean clean on workplace stress claims its toll: 62% of employees feel their bosses aren’t doing enough to look after the well-being of their staff and resent this apparent neglect. One in five becomes physically ill from stress, but only 10% seek help from their doctor or from a counselor on specific issues of stress. Doctors and therapists are often told a different reason, at least initially, for the symptoms the individual may be experiencing.

Stress-related symptoms still appear to carry a stigma in the workplace, as stress may be associated, at least in Western cultures, with a negative perception of one’s ability to manage a heavy workload. In this day and age, the fear of being perceived as a stressed out (and therefore unproductive) worker may have the power to trump honesty and reasonable self-care.

The Vote: Fear, Anger and Resignation?

IVotedLest Stresshacker be labeled left, right or center, this post is about the prevailing psychological states of US voters that may have prompted the choices made yesterday at the polls in the midterm election. The brief moment in the voting booth when each voter was about to punch, press or pull on the input device was as always the point of real decision, along a continuum of choice either matured over a long and careful analysis of the options or arrived at on the spur of the moment. The vote was either reaction or response, instinct or deliberation. In any case, this vote was a blend of rationality, emotion and convenience, a culminating of feelings that translates into a choice.

Americans voted not only with their minds and hands, but also and perhaps mostly with their hearts. They voted for or against their congressman, their senator, Congress in general, and president Obama. Former speaker Tipp O’Neill said famously that all politics is local, meaning that in his view decisions are made at the polls mostly on the record of the local incumbent and challenger. The advent of 24/7 news access and the impact of social media may have changed this to the point where those who lost or won their seat may have been helped or hindered, more than used to be the case, by a broader and more macroscopic view.

Voters, interviewed extensively by news media as they exited their polling stations, reported not liking the way the President is doing his job, and they sounded even angrier at Congressional Democrats, which may explain why they gave the House back to the Republicans. Given the magnitude of the shift, it also appears that Obama policies passed through the filter of voter anxiety, as voters looked back at a decade of economic decline. And this, only two years after “the audacity of hope” propelled Mr. Obama into the White House, is remarkable in itself.

senateThat this was the most expensive midterm election campaign in the nation’s history, when a record $3.8 billion was spent in all races big and small, only confirms the perception by contributors and recipients of this sizable amount of money that this election reflected more than rational choice—it expressed a mood, a feeling, an emotional reaction pointing to prevailing psychological states that range from simple malaise, to frustration, overt anger and underlying fear. Nothing can focus the mind and the pocketbook like justified fear for one’s present and future situation.

And the situation in the United States appears indeed grim, although it may not be as bad as reported, due to the well-known axiom that good news does not sell newspapers, online clicks or TV commentaries. If there is good news about the economy, it may not be reported with the same alacrity (and a bit of schadenfreude) as the bad. It is therefore not surprising that the interviews with voters conducted for the National Election Pool, a consortium of television networks and The Associated Press, show a majority of Americans saying that the country is headed in the wrong direction. Almost 90% said they were worried about the economy and more than 40% said their family’s situation had worsened in the last two years. Enough to worry and be angry about.

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