The History of Stress In Very Small Bites: 5

WalterCannonA key figure in our understanding of the mind-body interaction and the concept of stress is American physiologist, professor and chairman of the Department of Physiology at Harvard Medical School, Walter B. Cannon (1871-1945). He is credited with the discovery of the process of homeostasis and the fight or flight stress reaction. In investigating the process of homeostasis, Cannon hypothesized that if a living organism is threatened by change, the change is automatically interpreted as threatening and corrective mechanisms are initiated to avert the threat or restore the status quo.

The research that made possible the discovery of the mechanism of homeostasis began with the study of the emergency function of the adrenal medulla. Cannon and his colleagues at Harvard University linked emotional excitement to the physiological changes that occurred in response to the secretions by the adrenal glands. Cannon hypothesized that the sympathetic nervous system is responsible for mobilizing the body’s defenses  during intense fear or rage. He correctly identified these emotions as the prime movers of the body’s mobilization toward meeting a physical or psychological danger. The pathway of mobilization (the hypothalamic-pituitary-adrenal axis, HPA) initiates in the hypothalamus, which stimulates the anterior pituitary gland to secrete the activating hormone ACTH, which in turn stimulates the adrenal glands to produce excitatory hormones that activate the body’s defenses.

Got idea that adrenals in excitement serve to affect muscular power and mobilize sugar for muscular use—thus in wild state readiness for fight or run! — Entry in Cannon’s journal dated January 20, 1911

In 1929, Cannon first used the term fight or flight response to describe this emergency mobilization. He attributed the system-wide arousal of the body to a neurochemical produced by sympathetic nerve endings which he called sympathin, now known as norepinephrine. Cannon began using the term homeostasis in 1932 to describe the body’s physiological processes, controlled by the sympathetic nervous system, aimed at maintaining or restoring a stable internal environment.

In time, Cannon came to conceptualize physical and psychological stress as disturbances of homeostasis under conditions of cold, lack of oxygen, low blood sugar, and powerful emotions such as fear and rage. It was the first connection ever made, and verified by laboratory research, between the disruption of equilibrium caused by stressors and the body’s attempts to meet the threat and restore balance.

Freshmen Stress, Debt Worries Grow Higher

JeffersonMemorial_EN-US2610056053Results of the 2009 survey of over 200,000 first-year students at 4-year American colleges, administered by the Cooperative Institute Research Program of the Higher Education Research Institute at UCLA, show that at least 67% of freshmen are concerned about financing their college cost, the highest percentage since 1971. Moreover, 53% of first-year students have taken out loans to finance college, 4% more than in 2008 and the highest percentage in the last ten years. 

The global economic downturn is having an impact on the characteristics, attitudes, and beliefs of incoming first-time students at four-year institutions. They are more concerned about finances, more likely to take out loans and need grants in higher amounts. They will likely be graduating with higher debts and have shifted majors and career aspirations away from business fields. Although the values of these students coming into college show a slight retrenching towards financial security and less towards social agency, there is hope that their increased desire for volunteering and community service will foster an increase in such attitudes during their college careers. — Pryor, J.H., Hurtado, S., DeAngelo, L., Palucki Blake, L., & Tran, S. (2009). The American Freshman: National Norms Fall 2009. Los Angeles: Higher Education Research Institute, UCLA.

The students are describing themselves as being “below average” in their emotional health in higher numbers than ever before. The percentage of students who described their emotional health as above average fell from 64% in 1985 to 52%. Female students have a less positive view of their emotional health than male students, by a wider than ever margin: 18% of the men compared with 39% of the women. Female students also accounted for 60% of the number of students who reported having sought mental health services during their first year of college.

Among the principal causes of the increase in stress, the economy appears to play the major role, due to much greater financial pressures on parents and the students’ own worries about college debt and job prospects after graduation. 29% of the students surveyed reported that they had been frequently overwhelmed by stress during their senior year of high school, up from 27% last year.

The History of Stress In Very Small Bites: 4

robert-hooke-1It was towards the end of the 17th century that the word stress came to assume a technical meaning through the writing of English natural philosopher, architect and universal genius Robert Hooke. Hooke’s work was, among his many areas of interest, focused on how bridges and other man-made structures could be made larger and capable of bearing heavy loads without collapsing.

It is thanks to Hooke’s law of elasticity (1675) that the words load (the demand placed on the structure), stress (the area affected by the demand), and strain (the change in form that results from the interaction between load and stress) came into usage.

The study of stresses and tension (another word generated within this context) eventually produced the idea that the workings and architecture of the human body were much like the machines and structures that were being invented and constructed during this time. This idea spawned another idea that profoundly influenced the way we think about stress. The idea followed the concept of the body as a machine to its logical conclusion: If mechanical structures are subject to wear and tear, and the body is built and behaves in a similar fashion, then so would the body suffer the impact of the wear and tear of life.

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.”

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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.

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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.

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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.

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I’m Bored: Does This Mean I’m Stressed?

aaEscher_RelativityBoredom, like pain, is an entirely subjective experience mediated by personality, needs, wants, past history and contingent upon one’s perceptions of the experience, and thus very difficult to describe with precision and quantify. The state of boredom has been variously described as a dullness of the mind, mental inertia, sloth, or ennui. Its characteristic features are a lack of interest in the ordinary and a lack of delight in the extraordinary. The forcibly approximate label of boredom often changes into something more precise when it can be examined without prejudice. Often, there’s an unpleasant or stressful feeling lurking in the shadows just behind boredom. Individual perception and the subjective assessment of a situation play a significant role, as the following little parable illustrates.

Sometime ago, in the Middle Ages, a traveler approached a group of stonecutters and asked, ‘‘What are you doing?’’ The first responded, ‘‘I’m cutting stone. It’s dull work but it pays the bills.’’ The second stonecutter said, ‘‘I’m the best stonecutter in the land. Look at the smoothness of this stone, how perfect the edges are.’’ The third man pointed to a foundation several yards away and said, ‘‘I’m building a cathedral.’’

Boredom is perhaps most vividly experienced at work, although its impact is rather more ubiquitous. When a work task (be it that of the chief executive or the firefighter) does not provide the opportunity to sufficiently use or develop one’s skills and abilities, most individuals can feel undervalued and underutilized, and therefore bored.

Boredom, Stress and Aggression

In time, boredom may result in apathy and lead to poor morale, irritation, depression, job dissatisfaction, and absenteeism. In more sustained cases, the stress of frustrated ambition, unfulfilled goals, and unmet expectations can cause reactions that degenerate into destructive behaviors. Examples of destructive coping strategies against boredom include workplace vandalism, sabotage, alcohol and drug abuse, and binge-eating habits.

Perhaps the most important source of aggression and destructiveness today is to be found in the “bored” character. Boredom, in this sense, is not due to external circumstances such as the absence of any stimulation, as in the experiments in sensory deprivation or in an isolation cell in prison. It is a subjective factor within the person, the inability to respond to things and people around him with real interest. In some respects, the bored character resembles those in chronic, neurotic depressed states. There is a lack of appetite for life, a lack of any deep interest in anything or anybody, a feeling of powerlessness and resignation; personal relations–including erotic and sexual ones–are thin and flat, and there is little joy or contentment. Yet, in contrast to the depressed, chronically bored persons do not tend to torture themselves by feelings of guilt or sin, they are not centered around their own unhappiness and suffering, and their facial expressions are very different from those of depressed persons. They have little incentive to do anything, to plan, and at most can experience thrill but no joy. To use another concept, they are extremely alienated. For these reasons it seems preferable to establish the concept of the chronically bored character as distinct from the depressed character. Milder forms of characterological boredom are usually not conscious, as long as the boredom can be compensated for by ever-changing stimuli. This seems to be the case with a large number of people in industrial society for whom the compulsive consumption of cars, sex, travel, liquor or drugs has this compensatory function, provided that the stimuli either have a strong physiological effect, like liquor and drugs, or are constantly changing: new cars, new sexual partners, new places to travel to, etc. This consumption pattern keeps people from nervous–and industry from economic–breakdowns, and precisely for this reason they are addicted to consumption. — The Theory of Aggression, written by Eric Fromm to introduce his book The Anatomy of Human Destructiveness, first published in The New York Times Magazine, February 1972.

The Time Dimension of Boredom

lastminuteResearch studies on boredom have uncovered that easily bored individuals generally perceive time as passing very slowly, paradoxically, even when they are busy performing a task. It is not surprising to learn that institutionalized individuals, whose days are highly regulated and monotonous, say they experience time as painfully slow. Individuals suffering from depression often say in clinical interviews that they perceive a slowing of time. Cancer patients, who experience high levels of anxiety, have been found to routinely overestimate the duration of treatments and report that hours and days never seem to go by fast enough. In general terms, these studies highlight the distress felt in situations when individuals are not emotionally or cognitively engaged, which draws attention away from meaningful thoughts and actions and focuses it on the passage of time.

Is Ours the Age of Boredom?

It has been said that today’s pervasive boredom is a manifestation of cultural disenchantment. The great danger of boredom, as Fromm surmised, is that it can lead to pursuing irrational thrills in an attempt to relieve it. German philosopher Martin Heidegger, best known for his existential and phenomenological explorations of the concepts of being and time, sought to explain boredom not as a subjective intrapsychic experience whose possible causes might be a matter of interest to psychology, but as a mood in which time becomes the focus of attention. Heidegger distinguished between three forms of boredom: The first, being bored by something, is the most common and easiest to understand. In the second, becoming bored with something, it is not always easy to determine what it is that is boring. The third, when nothing in particular is boring per se, is a profound, unexplainable boredom with existence itself.

In profound boredom, utter anonymity of self, wholesale meaninglessness of world, and total unrelatedness are fused together to create an existential extreme.—Martin Heidegger

Boredom, Stress and Health

Chronic boredom, and the chronic stress it provokes, are associated with undesirable health outcomes. Boredom often complicates and sometimes compromises the course and treatment of physical and mental illnesses that require extended care in treatment facilities. A recent study by McWelling identified sustained boredom as a contributor to the onset of postpsychotic mood disturbances, increased risk-taking and substance seeking behaviors, the exacerbation of positive symptoms such as paranoia and hallucinations, changes in distractibility and overall cognitive efficiency, and a hypohedonic state of highly generalized lack of interest. Who said that boredom is not stressful?

Gene Found to Mediate Stress and Depression

PearlHarbor_EN-US3308869662The serotonin transporter promoter polymorphism 5-HTTLPR region of gene SLC6A4, one of the over 1,000 genes located on human chromosome 17, has been positively identified as the moderator of the relationship between stress and depression. A new, extensive analysis of 54 studies of more than 40,000 individuals was recently completed at the University of Wurzburg, Germany, finding “strong evidence that 5-HTTLPR moderates the relationship between stress and depression, with the s [short] allele associated with an increased risk of developing depression under stress.”

The meta-analysis of the 54 studies looked at 40,749 individuals stratified into subgroups according to specific types of stressors. They found a statistically significant relationship between the presence of the short allele of 5-HTTLPR in the individual’s gene and increased stress sensitivity in two of the subgroups: the subgroup of individuals who had suffered childhood maltreatment and the subgroup of individuals who developed a specific stress-related medical condition.

Despite some analytical limitations due to the variety of sources and methods within the 54 original studies, the authors of the meta-analysis conclude that, “the present study suggests that there is cumulative and replicable evidence that 5-HTTLPR moderates the relationship between stress and depression. Our evidence, particularly the identification of important study characteristics that influence study outcome (stressor type and stress assessment method), can provide guidance for the design of future gene x environment interaction studies.”

This new study, already published online and scheduled to appear in the January 2011 edition of the Archives of General Psychiatry, disconfirms the findings of 2 earlier and much less extensive studies, which had found no evidence of the interaction. The authors of the new study speculate that the earlier negative findings may have been due to the small number of cases analyzed, the authors’ inability to obtain primary data for many of the studies, and the inclusion only of studies that looked at stressful life events (SLEs), and not other stressors such as childhood maltreatment.

More On 5-HTTLPR and Serotonin

5HTTLPR-Chromosome_17_svgSince its discovery in the 1990s, polymorphic region 5-HTTLPR located on SLC6A4, the gene that codes for the serotonin transporter, has received intense investigation for its possible role in stress and other mental health issues, especially mood disorders. A 2000 study uncovered evidence that 5-HTTLPR may be involved in the appearance of certain anxiety-related personality traits, and a 2003 study presented evidence that 5-HTTLPR may also be involved in the development of childhood anxiety and shyness.

Serotonin is a small-molecule indoleamine neurotransmitter that plays an important role in mood, depression and anxiety, and is also implicated in the sleep/wake cycle. Serotonin, after being released in the raphe nuclei of the brain stem and other parts of the body and having its effect on mood, is routinely removed from the synaptic cleft by the reuptake of the transmitter with the serotonin transporter. It is the blocking of this reuptake that results in the therapeutic effect of SSRI (selective serotonin reuptake inhibitor) antidepressant medications, such as Lexapro, Paxil, Zoloft, and Prozac.

The History of Stress In Very Small Bites: 3

WilliamJamesAmerican psychologist William James (1842–1910) is credited with an important contribution to the understanding of stress and the interplay of physical manifestations and emotions. In his most important book, The Principles of Psychology, Vol.1 and Vol. 2 , James sets out the theory that bodily expression of stress, such as trembling or faster heart beat, precede rather than follow emotion. This view matters in that it seeks to tie emotions directly and perhaps causally with bodily expressions. Whether one comes before the other is less important than the fact that the physical and the emotional appear inextricably connected, in the wholeness of the human experience. What, James asks, would grief be “without its tears, its sobs, its suffocation of the heart, its pang in the breast-bone?” Not an emotion, James answers, for a “purely disembodied human emotion is a nonentity” (p. 1068).

Common-sense says, we lose our fortune, we are sorry and weep; we meet a bear, we are frightened and run; we are insulted by a rival, we are angry and strike. The hypothesis here to be defended says that this order of sequence is incorrect… that we feel sorry because we cry, angry because we strike, afraid because we tremble… (Principles of Psychology, pp. 1065–6).

IndustrialRevolutionContemporary to James is the novel view of physical fatigue as both a mental and physiological phenomenon. By the late 19th century, the word fatigue was being used in connection with mental hygiene as pertaining to work performance and industrial efficiency. The industrial revolution, realizing that efficiency and high productivity could create significant psychological problems, required a re-organization of the workplace that reduced symptoms of emotional and mental instability and enhanced the workers’ adjustment to what at the time were far less than ideal working conditions. The profit motive fostered this seemingly unlikely marriage between productivity and mental health. Industry became concerned with the loss in industrial efficiency and sought to prevent it by improving the workers’ physical and mental health. This development led to the new disciplines of organizational psychology and ergonomics, the design of equipment that minimizes negative health consequences.

Why Hardiness Is Faster Than Competitiveness

aaBruegel_HuntersSnowDo you know someone who deals with stress by working harder and faster to produce more in a shorter time? These so-called type A personalities appear to have a stronger than average sense of urgency, can be more highly competitive, and may be frequently and more easily angered when things don’t go their way. Stress reduction and stress management is perhaps one of their most urgent needs, yet these individuals are perhaps the least likely to take the time to learn effective self-management techniques.

Unfortunately, as discussed in our recent post on the impact of stress on the heart, type A personalities suffer from a significantly higher rate of cardiovascular disease than type B personalities. The former may be more successful at getting things done faster. Type B’s may be slower and somewhat less effective, but they can play and relax without guilt, are much less hostile and unlikely to exhibit excessive competitiveness.

Hardiness Matters More Than Speed

The evidence for the difference in health outcomes between type A and type B originally came from groundbreaking research by S. C. Kobasa of the University of Chicago. Dr. Kobasa looked at personality as a conditioner of the effects of stressful life events on illness by studying two groups of middle- and upper-level 40- to 49-year-old executives. One group of 86 individuals suffered high stress without falling ill, whereas the other group of 75 individuals became sick after experiencing stressful life events.

The results of the study showed that, unlike the high stress/high illness executives, the type B group was characterized by more hardiness, a stronger commitment to self-care, an attitude of vigorousness toward the environment, a sense of meaningfulness, and an internal locus of control. These “slower-paced” individuals appear to view stressors as challenges and chances for new opportunities and personal growth rather than as threats. They report feeling in control of their life circumstances and perceive that they have the resources to make choices and influence events around them. They also have a sense of commitment to their homes, families, and work that makes it easier for them to be involved with other people and in other activities.

SH_Rcmds_smAccording to Herbert Benson and Eileen Steward, authors of Wellness Book: The Comprehensive Guide to Maintaining Health and Treating Stress-Related Illness, the incidence of illness is much lower in individuals who have these stress-hardy characteristics and who also have a good social support system, exercise regularly, and maintain a healthy diet.

[amtap book:isbn=0671797506]

This is a stress management book well worth reading, because it specifically targets hardiness and better stress management with type A personalities in mind. It is the Stresshacker Recommended selection for this month.

The History of Stress in Very Small Bites: 2

descartesIn the 17th century, French philosopher Rene Descartes, without addressing the concept of stress reaction in his writings, nonetheless had a profound impact on psychology, the new scientific pursuit of many of his contemporaries who were beginning to understand the impact of psychological stress on human functioning.

Descartes’ thoughts also touched on the relationship between mind and body. In his view, mind and body were clearly separated, although he recognized that the body could somehow influence the mind, or vice versa. In particular, as Descartes put it, 

…as regards the soul and the body together, we have only the notion of their union, on which depends our notion of the soul’s power to move the body, and the body’s power to act on the soul and cause its sensations and passions (Descartes, R., Oeuvres de Descartes, 11 vols., eds. Charles Adam and Paul Tannery, Paris: Vrin, 1974-1989.)

georgebeardAn important contributor to the understanding of psychological stress was the noted American physician George Beard (1839–1883), a specialist in diseases of the nervous system. Beard hypothesized that the newly imposed demands of the Industrial Revolution on 19th century life may cause an overload of the nervous system.

He variously labeled this overload as neurasthenia, a weakness of the nervous system, or nervous exhaustion. This condition, very much equivalent to our modern understanding of chronic stress, was characterized by Beard has exhibiting symptoms of severe anxiety, unexplained fatigue, and irrational fears—a state of affairs that caused an inability of the individual’s nervous system to meet the demands of daily life.

Growing Interest in Pastor Stress and Burnout

The issue of the biopsychosocial consequences of acute and chronic stress on church ministers has attracted nationwide attention over the last few years, and the level of attention appears to be on the increase. Our post Stress and Burnout Endanger Clergy Health published on August 4, 2010 rapidly rose to second all-time most-read among Stresshacker readers. Clearly, the issue stirs interest among all of us, and especially pastors, church leaders and judicatories, not only for its health implications, but also for the consequences of chronic stress on interpersonal relationships, productivity, job satisfaction, the danger of burnout and of increasingly rapid turnover among church leaders of all denominations.

{tab=Research}
Obesity 18, 1867-1870 (September 2010) published the research High Rates of Obesity and Chronic Disease Among United Methodist Clergy by Rae Jean Proeschold-Bell and Sara H. LeGrand.

Researchers used self-reported data from United Methodist clergy to assess the prevalence of obesity and having ever been told certain chronic disease diagnoses.

Of all actively serving United Methodist clergy in North Carolina (NC), over 95% (n = 1726) completed self-report height and weight items and diagnosis questions from the Behavioral Risk Factor Surveillance Survey (BRFSS).

The questionnaires were used to calculate BMI categories and diagnosis prevalence rates for the clergy and to compare them to the NC population using BRFSS data. The obesity rate among clergy aged 35–64 years was 39.7%, or 10.3% higher than their NC counterparts in the general population.

Clergy also reported significantly higher rates of having ever been given diagnoses of diabetes, arthritis, high blood pressure, angina, and asthma compared to their NC peers.

This research is the most recent, most completed and empirically validated. Clearly it does not address but a few of consequences of stress and burnout. Its results cannot be extrapolated to other organizations, other locales and other manifestations of stress. Nonetheless, it is valuable as a snapshot that identifies an area of investigation that is worth exploring.

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Clergy Members Suffer From Burnout, Poor Health was broadcast by National Public Radio on Talk of the Nation (August 3, 2010) with guests: Paul Vitello, religion reporter, New York Times; Robin Swift, director of health programs at the Clergy Health Initiative, Duke University Divinity School.

The broadcast discusses how priests, ministers, rabbis and imams are generally driven by a sense of duty to answer calls for help. The guests touch on research, which shows that in many cases, pastors rarely find time for themselves. The hypothesis of the broadcast is that members of the clergy suffer from higher rates of depression, obesity and high blood pressure, and many are burning out. Listen to Talk of the Nation: Clergy Burnout [30 min 18 sec]

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Taking a Break From the Lord’s Work, written by Paul Vitello and published in The New York Times (August 1, 2010)

“Members of the clergy now suffer from obesity, hypertension and depression at rates higher than most Americans. In the last decade, their use of antidepressants has risen, while their life expectancy has fallen. Many would change jobs if they could.”

Also published in the New York Times, Congregations Gone Wild, written by G. Jeffrey MacDonald (August 7, 2010)

“But churchgoers increasingly want pastors to soothe and entertain them. It’s apparent in the theater-style seating and giant projection screens in churches and in mission trips that involve more sightseeing than listening to the local people. As a result, pastors are constantly forced to choose, as they work through congregants’ daily wish lists in their e-mail and voice mail, between paths of personal integrity and those that portend greater job security. As religion becomes a consumer experience, the clergy become more unhappy and unhealthy.”


Peter Drucker, the late leadership guru, has been widely quoted to have said:

The four hardest jobs in America (and not necessarily in this order) are the president of the United States, a university president, a CEO of a hospital and a pastor.

The setting in which this quote was uttered is unknown, but it continues to be reported as factual. A recent retelling of this quote can be found here.


Episcopal clergy ‘very stressed,’ but ‘very happy’, written by Herb Gunn and published in the official web site of the Episcopal Church USA (August 12, 2010)

“Through analysis articulated in the Clergy Wellness Report (2006) and the initial findings of the Emotional Health of Clergy Report (2010), we have observed that there is more to the challenge of clergy stress than fickleness of congregations and the cultural pressures of increased consumerism among churchgoers.

This research points to interesting conclusions that differ slightly from the research Vitello noted, as well. CREDO’ s research found that the only major health factor for which Episcopal clergy are at greater risk than the larger population is stress. Yet, remarkably, work-related stress, which frequently leads the general population to employment dissatisfaction, job loss or job change, exists alongside notably lower “turnover intent” for Episcopal clergy. Compared to the general population, Episcopal clergy report significant levels of well-being, self-efficacy and meaning in their work.”


What Pastors Want, written by Rich Frazer of Focus On the Family (2009).

“We in the United States lose a pastor a day because he seeks an immoral path instead of God’s, seeking intimacy where it must not be found.

Focus On the Family statistics state that 70% of pastors do not have close personal friends, and no one in whom to confide. They also said about 35% of pastors personally deal with sexual sin. In addition, that 25% of pastors are divorced.”


On the cost and grace of parish ministry – Part III, written by Jason Goroncy and published on the Christian-themed blog Cruciality (August, 2010)

Mistaken attitudes to the issue surrounding clergy burnout are not helped by the frequent interchangeability of the terms ‘burnout’ and ‘stress’. While related phenomena, burnout and stress describe different realities. In his wee booklet Ministry Burnout (Grove Books, 2009), Geoff Read makes the point that ‘stress is essentially the physiological or psychological response to many different sorts of situations and demands … Burnout is one response to sustained exposure to certain sorts of stressors. A person reaches a state of burnout when the three factors of emotional exhaustion, detachment and sense of lack of achievement have reached a level of such severity that the person’s ability to function is significantly impaired’ (p. 6).”

{tab=Statistics}

This is a list of sources that have published statistics, from various sources, on the state of physical, relational, managerial and financial health of church ministers across a wide spectrum of US denominations. Some of the statistics are second- or third-hand reports of data published elsewhere, and the original source is not always identifiable. Thus, readers are cautioned about drawing specific conclusions from these data.

Pastor Burnout Statistics by Daniel Sherman. Many of Mr. Sherman’s numbers below come from H. B. London’s book, Pastors at Greater Risk:

  • 13% of active pastors are divorced
  • Those in ministry are equally likely to have their marriage end in divorce as general church members
  • The clergy has the second highest divorce rate among all professions
  • 23% have been fired or pressured to resign at least once in their careers
  • 25% don’t know where to turn when they have a family or personal conflict or issue
  • 25% of pastors’ wives see their husband’s work schedule as a source of conflict
  • 33% felt burned out within their first five years of ministry
  • 33% say that being in ministry is an outright hazard to their family
  • 40% of pastors and 47% of spouses are suffering from burnout, frantic schedules, and/or unrealistic expectations
  • 45% of pastors’ wives say the greatest danger to them and their family is physical, emotional, mental, and spiritual burnout
  • 45% of pastors say that they’ve experienced depression or burnout to the extent that they needed to take a leave of absence from ministry
  • 50% feel unable to meet the needs of the job
  • 52% of pastors say they and their spouses believe that being in pastoral ministry is hazardous to their family’s well-being and health
  • 56% of pastors’ wives say that they have no close friends
  • 57% would leave the pastorate if they had somewhere else to go or some other vocation they could do
  • 70% don’t have any close friends
  • 75% report severe stress causing anguish, worry, bewilderment, anger, depression, fear, and alienation
  • 80% of pastors say they have insufficient time with their spouse
  • 80% believe that pastoral ministry affects their families negatively
  • 90% feel unqualified or poorly prepared for ministry
  • 90% work more than 50 hours a week
  • 94% feel under pressure to have a perfect family
  • 1,500 pastors leave their ministries each month due to burnout, conflict, or moral failure
  • Doctors, lawyers and clergy have the most problems with drug abuse, alcoholism and suicide.

The following pastor demographic and church statistics compiled by Mr. Sherman come from George Barna’s book, Today’s Pastors: A Revealing Look at What Pastors Are Saying About Themselves, Their Peers and the Pressures They Face:

  • 97% of pastors are male
  • The median age is 44
  • 96% are married
  • 80% have a bachelors degree and half have a master’s degree placing the pastorate among the most educated professions – but among the lowest paid as well
  • The average length of a pastorate is about four years
  • The median pastor salary is about $32,000 a year including housing allowance and other benefits, while the national average among married couples (1991) was nearly $40,000
  • 24% of the American population is 50 or older but 51% of church attenders are at least 50 years old
  • 40% of church attenders read the bible during the week
  • 30% of congregation members would seek help from their pastor during a difficult time in their lives
  • 53% of pastors believe that the church is showing little positive impact on the world around them
  • 60% of pastors believe that church ministry has negatively impacted their passion for church work
  • 51% of pastors expect that the average attendance at their church will increase by at least 10% in the coming year
  • 4% of senior pastors (say they) have a clear vision for their church

The following list of pastor statistics (and the comments that accompany them) was compiled by Jim Rose of Year of Jubilee. In some instances, the primary or secondary source of the data is provided.

  • More than 70% of pastors do not have a close friend with whom they can openly share their struggles. The dominant cause for pastors to leave the pastoral ministry is burnout. Number two is moral failure. These are alarming statistics.
  • 80% of pastors believe the pastoral ministry has negatively affected their families (Life Enrichment Ministries – 1998)
  • Only 50% of pastors felt that the education they received adequately prepared them for ministry. Most pastors rely on books and conferences as their primary source of continuing education. (George Barna – 2002)
  • 25% of all pastors don’t know where to go for help if they have a personal or family conflict or concern. 33 percent have no established means for resolving conflict. (George Barna – 2002)
  • 40% have no opportunity for outside renewal like a family vacation or continuing education. There is a very clear relationship between the amount of time a pastor takes for personal renewal and his satisfaction in his job. (George Barna – 2002)
  • At any given time, 75% of pastors in America want to quit. (Church Resource Ministries – 1998)
  • More than 2000 pastors are leaving the ministry each month (Marble Retreat Center 2001)

Several web sites cite research done in the 1991 Survey of Pastors by The Fuller Institute of Church Growth. This institute, connected with Fuller Theological Seminary in Pasadena, California, does not have a web site and may no longer be in activity.  The original research could not be located for this post. The numbers refer to the situation as it may have existed among pastors over twenty years ago. It may indicate that what pastors are experiencing now is not new.

  • 90% of US pastors work more than 46 hours a week
  • 80% believed pastoral ministry affected their families negatively
  • 33% believed ministry was a hazard to their family
  • 75% reported a significant stress related crisis at least once in their ministry
  • 50% felt themselves unable to meet the needs of the job
  • 90% felt inadequately trained to cope with ministry demands
  • 70% say they have a lower self esteem now compared to when they started in ministry
  • 40% reported serious conflict with a parishioner at least once a month
  • 37% confessed to having been involved in inappropriate sexual behavior with someone in the church
  • 70% do not have someone they consider a close friend

Alan Fadling  published the following ministry burnout statistics in 2009, unfortunately without referencing the source of his data.

  • Churchgoers expect their pastor to juggle an average of 16 major tasks
  • Pastors who work fewer than 50 hours a week are 35 percent more likely to be terminated.
  • 87 percent of Protestant churches have full-time paid pastors.
  • 50 percent of all congregations in the United States are either plateauing or declining
  • Two-thirds of pastors reported that their congregation experienced a conflict during the past two years; more than 20 percent of those were significant enough that members left the congregation
  • The typical pastor has his/her greatest ministry impact at a church in years 5 through 14 of his pastorate; unfortunately, the average pastor lasts only five years at a church.
  • 90 percent of pastors work more than 46 hours a week.
  • 80 percent believe that pastoral ministry affects their families negatively.
  • 75 percent report they’ve had a significant stress-related crisis at least once in their ministry.
  • 50 percent feel unable to meet the needs of the job.
  • 40 percent report a serious conflict with a parishioner at least once a month.
  • 40 percent of pastors say they have considered leaving their pastorates in the last three months.
  • 19 percent of pastors indicate that they’d been forced out of ministry at least once during their ministry; another 6 percent said they’d been fired from a ministry position

The Francis Schaeffer Institute Statistics on Pastors was compiled by Dr. Richard J. Krejcir. The numbers and his comments are published here verbatim.

“Here are some startling statistics on pastors; FASICLD (Francis A. Schaeffer Institute of Church Leadership Development). This quest started in 1989 as a Fuller Institute project that was picked up by FASICLD in 1998.

From our recent research we did to retest our data, 1050 pastors were surveyed from two pastor’s conferences held in Orange County and Pasadena, CA—416 in 2005, and 634 in 2006 (I conducted a similar study for the Fuller Institute in the late 80s with a much greater sampling).

Of the one thousand fifty (1,050 or 100%) pastors we surveyed, every one of them had a close associate or seminary buddy who had left the ministry because of burnout, conflict in their church, or from a moral failure.
Nine hundred forty-eight (948 or 90%) of pastors stated they are frequently fatigued, and worn out on a weekly and even daily basis (did not say burned out).

Nine hundred thirty-five, (935 or 89%) of the pastors we surveyed also considered leaving the ministry at one time. Five hundred ninety, (590 or 57%) said they would leave if they had a better place to go—including secular work.
Eighty- one percent (81%) of the pastors said there was no regular discipleship program or effective effort of mentoring their people or teaching them to deepen their Christian formation at their church (remember these are the Reformed and Evangelical—not the mainline pastors!). (This is Key)

Eight hundred eight (808 or 77%) of the pastors we surveyed felt they did not have a good marriage!
Seven hundred ninety (790 or 75%) of the pastors we surveyed felt they were unqualified and/or poorly trained by their seminaries to lead and manage the church or to counsel others. This left them disheartened in their ability to pastor.

Seven hundred fifty-six (756 or 72%) of the pastors we surveyed stated that they only studied the Bible when they were preparing for sermons or lessons. This left only 38% who read the Bible for devotions and personal study.
Eight hundred two (802 or 71%) of pastors stated they were burned out, and they battle depression beyond fatigue on a weekly and even a daily basis.

Three hundred ninety-nine (399 or 38%) of pastors said they were divorced or currently in a divorce process.
Three hundred fifteen (315 or 30%) said they had either been in an ongoing affair or a one-time sexual encounter with a parishioner.

Two hundred seventy (270 or 26%) of pastors said they regularly had personal devotions and felt they were adequately fed spirituality. (This is Key).

Two hundred forty-one (241 or 23%) of the pastors we surveyed said they felt happy and content on a regular basis with who they are in Christ, in their church, and in their home!

Of the pastors surveyed, they stated that a mean (average) of only 25% of their church’s membership attended a Bible Study or small group at least twice a month. The range was 11% to a max of 40%, a median (the center figure of the table) of 18% and a mode (most frequent number) of 20%. This means over 75% of the people who are at a “good” evangelical church do not go to a Bible Study or small group (that is not just a book or curriculum study, but where the Bible is opened and read, as well as studied), (This is Key). (I suspect these numbers are actually lower in most evangelical and Reformed churches because the pastors that come to conferences tend to be more interested in the teaching and care of their flock than those who usually do not attend.)”

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Disaster! 9 Critical Crisis Management Skills

aaCezanne_BendOfRiverDisaster strikes…an event with sufficient impact to produce significant emotional reactions, and one that can carry significant consequences. In the range of our ordinary experience, such an event may be extremely unusual. Perhaps it is the first time that we have been in a car wreck, an earthquake, a flood, lost our job, missed the mortgage payment, or discovered a very unpleasant and unexpected truth about a person or a situation. The first time, any of these events constitute a serious crisis, with wide-ranging impact. The second or third time, these events continue to be real crises but may be approached with enhanced skills and capability to cope with their aftermath.

Whenever and however often these critical and extremely stressful events may occur, a few outcomes can be predicted as very likely to be experienced by most people. First, there will be potential and actual traumatic reactions to the event or incident, either immediate or somewhat delayed. Expecting no reaction or minimal reaction is unlikely, and a severely restricted reaction or no reaction at all may be a sign of poor cooping skills, an attempt to deny the impact of the stressor, or to minimize its seriousness. Second, there will be acute manifestations of stress (some purely psychological, other physical, or a combination of both) that must be managed and mitigated. Third, the stressful event may have an impact on the individual’s ability to function in his/her usual occupation, school, or even in carrying out daily routines. Fourth, the stressor may be of such magnitude and effect that short-term psychological or medical treatment may be necessary. Fifth, the best mitigating effects are produced by family support, peer group support and continued interaction in the workplace; isolating is an instinctive reaction when in emotional pain, but it is proven to be counterproductive when dealing with a severe stressor.

In critical incidents or severe stress situations, the first 24-72 hours after the event are the most crucial. It is important to provide to others or seek out for oneself a reduction in the intense reactions to the traumatic event. While it is normal and expected to have a stress reaction, even severe, people should be facilitated in their return to their routine as quickly as feasible. In this respect, re-establishing access to one’s social network prevents isolation and reduces anxiety. In recognizing similarities to others, being understood and supported while in pain, and not being judged or criticized for their reaction, people often are better able to cope with the challenges of troubled times.

Here are 9 ways of managing acute stressors that have been proven to work:

  1. Reaction. Allowing ourselves to have an appropriate reaction that is physical (e.g., crying), psychological (feeling upset), and social (reaching out for help), without much concern for how our grief or sorrow may “damage” our image with others. An attempt to look strong and to show no emotion in the face of a significant stressor may work in the short term, but if the reaction to its impact is not allowed to take place, this may create a situation of chronic stress over time.
  2. First Aid. Psychological “first aid,” education and follow-up are important. Talking to trained peers, chaplains, and/or mental health professionals may be just what is needed in the critical first few days following the incident. Longer term counseling or medical help may be needed to manage any anxiety or mood disorders (such as depression) that could be triggered by the stressor.
  3. Comfort. The basic human needs to be comforted and consoled when in distress and being protected from further threat or distress, as far as is possible, are important. This may mean moving away from the scene of the incident at least for a time. It is not unusual to need and benefit from a few days out of town visiting welcoming family members or very close friends, following a disastrous event or a major personal crisis.
  4. Basic Needs. Immediate care is needed to address any physical necessities caused by the severe incident. In the case of a natural disaster, shelter, food and warmth become critically important and take precedence over psychological interventions.
  5. Reality Testing. Seeking goal orientation and support for specific reality-based tasks (“reinforcing the concrete world”) is important in mitigating the effects of a severe stressor that may make the individual feel like “the world is coming to an end” or “this is too much to even comprehend” and any severe symptoms of derealization or detachment.
  6. Relationships. It is important to facilitate the reunion with loved ones from whom the individual has been separated. If this disruption of relationship occurs, reuniting parent and child, or spouses, or siblings, is critically important. If an immediate reunion is not possible, providing good information as to the loved ones’ whereabouts and health is the next best thing.
  7. Talking. At the earliest opportunity, the telling of the “trauma story” and the expression of feelings as appropriate for the particular individual should be facilitated. Even though not everyone may be willing to go into details as to what happened, at least not right away, providing the earliest opportunity to say what happened and what it means to the person affected is critically important.
  8. Ongoing Support. If the individual seems to be “lost” in the magnitude of the event, linking the person to systems of support and sources of help that will be ongoing is never a bad idea. The key is the continuity of support. For some incidents or severe stressors such as the loss of a loved one, this support may need to continue for weeks and months to come.
  9. Regaining Mastery. Eventually, after all the critical “first aid” interventions have been taken care of, the goal becomes the restoration of some sense of mastery, a regaining of control over one’s life, a new beginning and the ability to deal effectively with the new situation created by the incident. The memory of what happened will most certainly never go away, but its traumatic impact on distress and functioning is meant to fade over time, when new ways of coping have been successfully put in place.

The History of Stress in Very Small Bites: 1

I did consent,
And often did beguile her of her tears
When I did speak of some distressful stroke
That my youth suffer’d.
William Shakespeare (1605) THE TRAGEDY OF OTHELLO, MOOR OF VENICE

Here can I sit alone, unseen of any,
And to the nightingale’s complaining notes
Tune my distresses and record my woes.
William Shakespeare (1595) THE TWO GENTLEMEN OF VERONA

william-shakespeare-portraitFrom the vulgar Latin districtia (being torn asunder), through Middle French destrece,  Middle English distresses, modern English distress and, by aphesis, stress. Used in the 15th century to mean applied pressure or physical strain, in the 17th century the word stress began to be used to mean hardship or adversity.

In the 20th century, stress took on its current meaning of psychological disturbance, ill health and mental disease. Using the physiological concepts of stimulus and reflex arc, freudSigmund Freud enlarged the concept of stressors to include internal “stimuli of the mind” which he called instincts. As opposed to an external stressor, an instinct “never acts as a momentary impact but always as a constant force. As it makes its attack not from without but from within the organism, it follows that no flight can avail against it.” "Instincts and Their Vicissitudes," in Collected Papers of Sigmund Freud, ed. Joan Rivière, Vol. IV (New York: Basic Books, 1959), p. 69.

The Cardiopsychology of Stress

Happy2011What effect does psychological stress have on cardiovascular physiology? Does psychological stress contribute to cardiovascular disease? These important questions are the domain of cardiopsychology, the discipline that studies how psychosocial stressors impact the onset, course, rehabilitation and the illness processing (coping) of cardiac diseases. In this post, we look at the effects of stress on the normal heart in healthy condition, and the effects of acute or chronic stress on individuals with cardiovascular disease.

{tab=Overview}
Tuvalu_EN-US163122471The body responds to stress primarily through the mobilization of resources initiated by the autonomic nervous system and endocrine activity. Endocrine activity consists of sympathetic adrenomedullary, pituitary-adrenocortical, and thyroid responses. The most important stress hormones released by sympathetic adrenomedullary response are epinephrine and norepinephrine. The stress hormones released in the pituitary-adrenocortical response are adrenocorticotrophic hormone (ACTH) and cortisol.

Psychological conditions shown to have an effect on cardiovascular disease include anxiety disorders, panic disorders, and depressive disorders. There is compelling evidence that acute psychological stress triggers major autonomic cardiovascular responses and cardiac events. Nonetheless, the evidence that chronic stress causes cardiovascular disease is highly controversial. Although the most prevalent opinion among cardiologists, psychiatrists, physiologists, and psychologists is that psychological stress has an effect on cardiovascular disease, these effects are not easily quantifiable or attributable with any degree of precision. What we do know is that acute stress is often accompanied by cardiovascular changes, some of which can be dangerous to certain individuals.

Data on whether chronic stress may, over time, cause cardiovascular disease are less convincing. For example, there is little validated evidence that people with anxiety-related disorders have a higher prevalence of cardiovascular disease than their less anxious counterparts. Moreover, except for postmyocardial infarction depression, there is insufficient evidence that individuals with cardiovascular disease have a higher prevalence of psychological disorders than those who have no cardiovascular disease.

{tab=Normal Heart}
MaldiveAtolls_EN-US1893647453Acute mental stress alters baseline parameters on the normal heart and vascular system in good health condition. Under acute stress, it is quite normal for blood pressure to rise, due to the action of neural mechanisms that regulate stress-induced blood pressure changes as a stress reaction to a dangerous situation that requires an increase in cardiac activity.

Structures of the central nervous system involved in this rapid arousal include the medulla oblongata, the medial geniculate body, the limbic system (amygdala and hypothalamus), and the brainstem. Psychological stress-induced changes in blood pressure are usually predictable and can vary depending on many variables, including duration of stress, time of measurement, expectations, psychological preparedness, and individual background.

Specific effects of psychological stress on the cardiovascular system are increased cardiac output, higher stroke volume, stronger forearm blood flow, increased left ventricular ejection fraction, higher peripheral vascular resistance, and increased cardiac microcirculation. These effects are not dangerous on the normal heart and vessels in good health condition, and they generally subside and return to normal levels after the stressor has passed.

{tab=Acute Stress}
SnowyChristmas_EN-US2022031457As in the healthy heart, acute stress increases blood pressure (generally by 10–20% and sometimes to hypertensive levels) in individuals with cardiovascular disease. Acute stress also increases the heart rate of individuals with cardiovascular disease, and angina pectoris and ischemia may result from this increase in heart rate. In some cases, the stress-induced increase in heart rate also alters cardiac electrical stability and may cause life-threatening arrhythmias.

Acute stress may also cause coronary artery vasoconstriction, reduce left ventricular ejection fraction, and induce or exacerbate left ventricular wall motion abnormalities in individuals with cardiovascular disease. In this respect, studies have shown that frequent anger among individuals with cardiovascular disease may increase their vulnerability to cardiac complications.

Psychological stress produces strong limbic-hypothalamic activity, which may contribute to the yet unclear etiology of essential hypertension, i.e. high blood pressure that does not appear to have specific organic causes. Conversely, the presence of hypertension, borderline hypertension, and genetic risk for hypertension may have an impact on blood pressure reactivity to psychological stress, thus setting up an apparent circular causality between stress-hypertension-higher reactivity to stress.

Individuals with high blood pressure are characterized by a greater arterial wall-to-lumen ratios compared with healthy individuals. Thus, the same quantity of norepinephrine causes a greater increase in peripheral vascular resistance compared to healthy individuals who have a smaller arterial wall-to-lumen ratio. Also, individuals who are already suffering from angina pectoris react to stress with a greater elevation of blood pressure.

{tab=Chronic Stress}
KugaCanyon_EN-US1699950676Chronic stress and prolonged bereavement have been shown to increase the risk of cardiac death. A large-scale study showed that stress due to the death of the wife caused a 40% increase in the death rate of the surviving husbands during the first 6 months of loss, with two-thirds of those deaths attributable to cardiovascular disease. A similar increases did not occur among widows following the death of their husbands.

Studies conducted on individuals who exhibit type A and type B personality patterns have tested the hypothesis that personality may affect the inset, course, and outcome of cardiovascular disease. Type A personalities are those characterized by time-urgency, high competitiveness, ambitiousness, and frequent hostility. Type B personalities are unhurried, more relaxed, and less competitive. The results of these studies show that if there is a correlation between personality patterns and cardiovascular disease, this correlation is very weak. Thus, type A or type B personalities appear to have similar outcomes in the convergence of stress and cardiovascular disease.

Anxiety is a significant factor in producing chest pain even when coronary arteriography is normal, and anxiety disorders have been confirmed as a debilitating factor. Major depressive disorder is the second significant factor, and this disorder appears to predict future cardiac events among patients with coronary artery disease. Chronic anxiety, helplessness, and depression have been specifically linked to angina pectoris and sudden death by cardiac arrest. More than 300,000 Americans experience sudden (within minutes) death each year. Excluding acute myocardial infarction-induced ventricular arrhythmias, about one in ten sudden deaths are due to cardiac arrhythmias (particularly ventricular arrhythmias).

Research by Rahe and others on the health impact of significant life changes discovered that individuals who suffer a myocardial infarction are more likely to have had a major life change during the 6 months preceding the heart attack. In another study, Rahe and Lind provided evidence that life change occurs more frequently among victims of sudden cardiac death compared with survivors of myocardial infarction.

The relationship between chronic psychological stress and hypertension remains controversial. Psychological stress-induced increases in heart rate and blood pressure reactivity do have an immediate effect on blood pressure readings. Nonetheless, this clearly demonstrable increase in blood pressure following a sudden and significant stressor does not appear to carry on to produce long-term effects on blood pressure.

In summary, the extent of coronary artery disease, the degree of left ventricular dysfunction, and the presence of arrhythmias appear to determine individual vulnerability to stress-induced sudden cardiac death. When individuals are already suffering from advanced cardiovascular disease, stress-related precipitants of sudden cardiac death are ubiquitous and may be impossible to avoid. Acute stressors often contributing to sudden cardiac death include bereavement, unemployment, financial distress, dislocation, lower education levels, individual responses to psychological stress, and social isolation. Research results are somewhat contradictory in establishing a clear association between cardiovascular disease and such factors as gender, personality patterns, anxiety, panic disorder, PTSD, bereavement, depression, and occupation.

{tab=References}
REFERENCES
1. Dimsdale JE. Psychological stress and cardiovascular disease. J Am Coll Cardiol 2008;51:1237– 46.
2. Culic V, Eterovic D, Miric D. Meta-analysis of possible external triggers of acute myocardial infarction. Int J Cardiol 2005;99:1– 8.
3. Kloner RA. Natural and unnatural triggers of myocardial infarction. Prog Cardiovasc Dis 2006;48:285–300.
4. Mosca L, Banka CL, Benjamin EJ, et al. Evidence-based guidelines for cardiovascular disease prevention in women: 2007 update. J Am Coll Cardiol 2007;49:1230 –50.
5. Smith SC Jr., Allen J, Blair SN, et al. AHA/ACC guidelines for secondary prevention for patients with coronary and other atherosclerotic vascular disease: 2006 update: endorsed by the National Heart, Lung, and Blood Institute. J Am Coll Cardiol 2006;47:2130 –9.
6. Bhattacharyya MR, Steptoe A. Emotional triggers of acute coronary syndromes: strength of evidence, biological processes, and clinical implications. Prog Cardiovasc Dis 2007;49:353– 65.
7. Davidson KW. Emotional predictors and behavioral triggers of acute coronary syndrome. Cleve Clin J Med 2008;75 Suppl 2:S15–9.
8. Rozanski A, Blumenthal JA, Davidson KW, Saab PG, Kubzansky L. The epidemiology, pathophysiology, and management of psychosocial risk factors in cardiac practice: the emerging field of behavioral cardiology. J Am Coll Cardiol 2005;45:637–51.
9. Strike PC, Steptoe A. Behavioral and emotional triggers of acute coronary syndromes: a systematic review and critique. Psychosom Med 2005;67:179–86.
10. Strike PC, Magid K, Whitehead DL, Brydon L, Bhattachatyya MR, Steptoe A. Pathophysiological processes underlying emotional triggering of acute cardiac events. Proc Natl Acad Sci U S A 2006;103:4322–7.
11. Thrall G, Lane D, Carroll D, Lip GY. A systematic review of the effects of acute psychological stress and physical activity on haemorheology, coagulation, fibrinolysis and platelet reactivity: implications for the pathogenesis of acute coronary syndromes. Thromb Res 2007;120:819–47.
12. Tofler GH, Muller JE. Triggering of acute cardiovascular disease and potential preventive strategies. Circulation 2006;114:1863–72.
13. Rahe, R., & Lind, E. (1971). Psychosocial factors and sudden cardiac death: a pilot study. Journal of Psychosomatic Research, 15(1), 19.

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