When Stress Hurts: Psychogenic Pain

PendulumThis post kicks off a Stresshacker series on the close association between psychological stress and psychogenic pain. Psychogenic pain is by definition a physical pain that can only be associated with psychological stressors. Psychogenic pain is said to occur when all possible organic causes of pain are ruled out and its symptoms cannot be associated with a medically diagnosed condition. There can be a stigma associated with this type of pain as being “all in one’s head,” and the suffering it causes has often been discounted or dismissed as unexplainable and therefore not treatable with conventional medical approaches.

I’m 23, and have had chronic pain since I was in middle school. Doctors always brushed it off, saying it was "growing pains" or "all in my head." About two years ago, I was given the diagnosis of fibromyalgia. I felt like that doctor visit was a waste of time. I certainly do believe that fibromyalgia is a real condition, but that was not what was wrong with me. Doctors are quick to throw some label on patients to placate them… — Mrs. Smith of SC @ Aug 21, 2010 21:20:28 PM

Pain, of any kind, is a complex peripheral and central nervous phenomenon that acts as a signaling mechanism, usually indicating the presence of injury or disease. The International Association for the Study of Pain (IASP) defines pain as, “an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage.” Pain is more than just physical since, like all human experiences, it includes a cognitive and emotional component.

spinozaThe 17th century philosopher Spinoza recognized the emotional and physical valence of pain when he defined it as a “localized form of sorrow.” This definition is particularly appropriate when pain is present in all its debilitating intensity and does not appear to be a sign of injury or a diagnosable illness.

The persistence of unexplained pain to shoulders, upper arms, lower arms, hips, upper legs, lower legs, jaw, chest, neck, or abdomen can lead to a diagnosis of fibromyalgia especially if associated with other symptoms such as irritable bowel syndrome, fatigue, anger and sadness, problems thinking or remembering, muscle weakness, abdominal pain or cramping, numbness or tingling, dizziness, insomnia, depression, constipation, nausea, nervousness, chest pain, fever, dry mouth, itching, frequent or painful urination, or wheezing. Treatment for fibromyalgia can range from powerful prescription pain killers (which can be dangerously addictive) to gentler and often as efficacious non-medical approaches such as psychotherapy and tai chi.

That a reciprocal association exists between psychological stress and unexplained pain symptoms has long been observed in clinical settings. A significant number of patients suffering from psychogenic pain also complain of stress, often made worse by other psychological disturbances such as depression or anxiety disorders.

A review of recent medical literature on pain and stress yields strong evidence for increased sensitivity to stress in patients with psychogenic pain, and vice versa. Studies conducted in the last decade suggest that psychogenic pain and stress are psychological and sensory experiences that require a multidisciplinary, biopsychosocial approach in their treatment.

Next in this series:

  • Psychogenic Pain, Stress and the Central Nervous System
  • The Neurochemistry of Psychogenic Pain and Stress
  • Psychological Stressors and the Sudden Appearance of Psychogenic Pain
  • Fibromyalgia, Severe Headaches and Other Stress-Related Misery
  • Medical and Non-Medical Treatments for Stress and Psychogenic Pain

Army Suicides Highest Ever and Rising

aaCarignano_CrimeaThe number of suicides among active duty US soldiers is very high and it is rising at a faster rate: 125 Army soldiers have taken their own lives in the first eight months of this year. If suicides continue at this pace they will exceed the total for 2009, when there were a record 162 suicides. The trend shows little sign of abating, despite a now 20-month-old suicide prevention program and work aimed at removing the stigma of psychological counseling, the New York Times reports

Medical corps Army officers familiar with the situation have identified several factors that may be involved in the rising rate of suicides. While there is a widespread belief that repeated deployments are the principal cause of suicides, Army records show that 80% of soldiers who killed themselves were deployed in combat zones only one time or not at all. A significant number of the soldiers had experienced serious problems in their marriage. Many had sought counseling from Army psychologists for anxiety and posttraumatic stress symptoms. Interviews with family members indicate that in many cases, the soldiers believed that a diagnosis of posttraumatic stress disorder would ruin their careers. Additionally, many believed that their counselor or psychologist would not treat their condition as confidential, but would convey up the chain of command what the soldiers reported in private counseling sessions.

Expectant Mother Stress and the Unborn Child

JapaneseGarden_EN-US1668112966Stress during pregnancy is usually discussed in negative terms and fear and anxiety seem to be the rule in explaining its possible consequences. A recent and soon to be published study by Janet Di­Pietro suggests that, at least in part, the contrary may be true. DiPietro, an internationally recognized leader in the field of child development, is credited with having described for the first time the ontogeny of human fetal brain–behavior relations throughout gestation, the associations of maternal and fetal characteristics with the neurobehavioral maturation of the fetus, and the fetal neurobehavioral origins of individual differences in infant physiology and behavior. Her latest study shows that 2-week-old infants of women who experience relatively more stress during pregnancy showed faster neural conduction, “evidence of a more mature brain.” Thus, maternal stress during pregnancy may actually stimulate the unborn child’s brain development, suggesting that the dreaded nefarious effects of stress on the child may be simply a matter of degree.

In her other studies, DiPietro outlined evidence to support the notion that the effects of maternal stress on the unborn child are actually quite modest in magnitude, pointing out that the placenta breaks down the stress hormone cortisol in the woman’s blood, preventing most of it from reaching the fetus. However, she is also careful to note that maternal stress may directly influence the developing fetal nervous system; that these effects on brain development may be aggravated over time by various characteristics of postnatal development; and that existing research on the effects of maternal prenatal/perinatal stress on child development lacks conceptual and methodological consistency and scientific rigor.

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Science writer Anne Murphy, author of the recently published new book Origins: How the Nine Months Before Birth Shape the Rest of Our Lives, classifies prenatal stress as belonging to the “profoundly unsatisfying” category of “it depends.” While describing her second pregnancy, Paul traces the developing literature on fetal origins, which has been called the staging ground for well-being and disease in later life. In her chapter on stress, she cites the existence of 200 industrial chemicals that can be found in babies’ umbilical cords, the link between low birth weight and later cardiovascular disease, and raises the possibility that a dietary supplement might one day protect future children from cancer.

Her focus on how expectant mothers can minimize harm to their unborn child during pregnancy makes Paul’s book a fascinating read that will help understand and put into perspective the opportunities and dangers of this fascinating period. It is the Stresshacker Recommended book for this week.

ADHD Breakthrough: Not Just Bad Behavior

IntlSpaceStation_EN-US2825695802 Attention-deficit/hyperactivity disorder (ADHD) is a genetic, neurodevelopmental disorder and not just a behavioral problem. In a study published online in the Sept. 30 issue of The Lancet, investigators from the University of Cardiff in the United Kingdom say their findings show that ADHD has a genetic basis. In the genome-wide analysis, 366 children 5 to 17 years of age who met diagnostic criteria for ADHD but not schizophrenia or autism and 1047 matched controls without the condition were included. Researchers found that compared with the control group without ADHD, children with the disorder were twice as likely — approximately 15% vs. 7% — to have copy number variants (CNVs). CNVs are sections of the genome in which there are variations from the usual 2 copies of each chromosome, such that some individuals will carry just 1 (a deletion) and others will have 3 or more (duplications).

The breakthrough results of this study should help in the controversy as to whether ADHD is a "real disorder" or simply the result of bad parenting, in shifting public perception about ADHD and promoting further research into the biological basis of the disorder with a view to developing better, more effective therapies for affected individuals.

Anger and Sadness Increase Fibromyalgic Pain

Turner_1835_DidoBuildingCarthage Perhaps another study that falls into the “I knew it all along” category: Anger and sadness increase pain in women who suffer from fibromyalgia.

A recent study conducted at the University of Utrecht on 121 women, 62 of which were suffering from fibromyalgia, confirmed a significant increase in pain levels in response to both anger and sadness. A greater angry or sad reaction was associated with a correspondingly greater amount of pain response.

Results of the study showed that in half of the female patients, the experience of anger or sadness in response to a significant daily emotional event predicted more pain at the end of that day. The anger–pain link was more pronounced among patients with a longer duration of fibromyalgia and among those with higher average anger levels. 

Among the study participants, pain levels were highest on Fridays and lowest on Sundays, which might reflect a gradually increasing pain during the work week. However, patients who worked did not show a more pronounced weekly pain increase than unemployed patients. Relaxing activities and quality time during the weekends of both working and non-working women appeared to reduce the pain.

The Rising Cost of War: Military Sexual Trauma

RioAlseseca_EN-US608673953 The latest research on the long-term health consequences of Operation Enduring Freedom in Afghanistan (OEFA) and Operation Iraqi Freedom in Iraq (OIFI) suggests that US veterans are bringing home a significant number of psychological problems. The most recent study published in August by the American Journal of Public Health estimates that 19% to 42% of returning veterans have one or more clinically-diagnosable mental health conditions.

Returning servicemen and women are turning to the Veterans Health Administration (VHA) for health care in record numbers, with nearly 40% enrolled as of the end of July. In addition to posttraumatic stress disorder, depression, anxiety and stress disorders, and sleep impairment, another (somewhat overlooked until now) contributor
to this burden of mental illness is exposure to sexual assault or harassment during service. The newly categorized disturbance is referred to in military lingo as military sexual trauma.

This is not a new phenomenon, as military sexual trauma had been documented in veterans of previous wars. What is different this time, though, is that OEFA and OIFI veterans are the first generation of VHA users to return from a large-scale deployment and have access to comprehensive screening and treatment services.

The most recent study was conducted at the National Center for Posttraumatic Stress Disorder and the Center for Health Care Evaluation, VA of Palo Alto, California. It was the  first comprehensive assessment of the mental health profile associated with a history of military sexual trauma among Iraq and Afghanistan veterans.

The results show high rates of postdeployment mental health conditions among all OEFA and OIFI patients. Women and men who reported military sexual trauma were significantly more likely than those who did not to also be diagnosed with posttraumatic stress disorder (PTSD), other anxiety disorders, depression, and substance use
disorders.

Additionally, and not surprisingly, the study shows that the co-occurrence of military sexual trauma and PTSD is substantially more frequent among female soldiers than among males, suggesting that military sexual trauma may be a particularly relevant gender-specific clinical issue in PTSD treatment settings.

Mild to Deadly: Stress At Work

CloudToGround_EN-US2741696585 Stress at work can take many forms and range in severity from mild annoyance to burnout. It may be relatively easy to tell if co-workers appear to be under severe stress by observing the appearance and persistence of certain characteristic behaviors. It may not be so easy to diagnose dangerous levels of stress in ourselves, however, especially when other considerations of self-esteem, personal ambition to succeed, economic pressure, deadline requirements, and career goals may interfere with a sound and unbiased self-diagnosis.

Mild vs. Severe Stressors: It’s About Control

The first consideration is the severity of the stressors. Are they mild and can they be addressed by making appropriate adjustments? Stressors such as a noisy environment, not knowing one’s job objectives, and skipping meals can be (although not always) addressed by closing the door, asking for clarification, and committing to take lunch and snack breaks as needed.

The second consideration is whether or not the stressors are under our control. The presence or lack of control creates an internal vs. external locus of control situation, with important psychological consequences (see this post on the difference between internal and external locus of control).

Stressors that are beyond our control are far more difficult to address, as for example when there are too many things to do and not enough resources to get them done. Its opposite, the situation when there is hardly anything to do at all, is also stressful and may not have an easy solution.

Other relatively difficult stressors that may not have a solution within our control is not enjoying the job, and not knowing what else one could be doing or being in a situation where a change of job is just about impossible. In the current job market, this may not be an uncommon situation, as jobs that used to be good have become more stressful and jobs that were bad to begin with have not gotten any better.

Another difficult stressor where external control may be an issue is the experience of being caught between conflicting demands, often with insufficient information or resources to address them appropriately. Not feeling appreciated or under-appreciated while putting in long hours and hard work can also create a considerable level of stress.

On the other hand, many stressors can be successfully addressed because they do fall within our control. The most common are interruptions and how they are handled (the well-known inability to say “no”). Another is poor delegation skills, or not sharing work responsibilities with others. These are two examples of stressors that, although not easily eliminated, at least can be controlled and limited in their impact by making changes that are well within our possibilities.  

When Stress at Work Is too Much: Burnout

There are times when the symptoms of stress are just too severe, too persistent and too intractable to be dismissed. They interfere not only with productivity and efficiency on the job, but they also have important negative health consequence in addition to being detrimental to interpersonal relationships at work and at home. The resulting complex cluster of psychological, physical and behavioral symptoms is defined as occupational stress or, for short, burnout.

The emotional exhaustion of burnout can result in diminished interest in work, fatigue, and detachment. Hopelessness is common: we "give in," "numb out," and "march like robots through the day."

The depersonalization of burnout, or the defensive distancing from the surrounding world, can result in diminished contact with coworkers and the public, withdrawal of psychological investment, self-absorption, and an overall negative attitude toward others.

The dissatisfaction of burnout, or the perception of unsatisfactory personal accomplishment, can result in feelings of failure, fatalism, diminished competence, and incapacity to respond to further job, personal and environmental demands.

Early Warning Signs of Work Stress

One of the first noticeable signs that stress is beginning to have a behavioral impact is irritability. Fellow workers will notice this first. They may or may not be able to point it out, but if they do, it is worth paying attention to their feedback and asking ourselves a few questions.

The second sign is fatigue. Even though it is hard to miss, fatigue very often goes unchecked not because it isn’t visibly affecting us but because we may refuse to acknowledge it. Pushing harder can become a mantra, a repetitive “principle-driven” set of behaviors that pushes rest and relaxation aside, with potentially serious health consequences.

Difficulty concentrating and forgetfulness are also early signs of severe stress. Sometimes, stress affects memory in such a severe manner that, by evening time, we can’t remember what we did all day, or what we ate for breakfast.

Sleep ceases to be a safe haven for regenerating and recharging and becomes a place of torture. Lack of sleep is linked to so many health consequences, and to stress itself, in a circular causality pattern. Less sleep means more vulnerability to stress, which leads to more stress by the time we get to bed, with even less chances of getting a good night’s sleep. A potentially deadly vicious cycle!

The body complains about stress, too. Its messages take the form of bowel irritation, chronic fatigue, asthma and other respiratory ailments, headaches, rashes, tics, cramps, and many more pains and problems that appear to come out of nowhere and stubbornly refuse to go away.

Finally, withdrawal and depression may raise their ugly head. Burnout has arrived. It may take a few years to get here, or maybe just a few months of severe stress. In any case, burnout may be the end game of one very simple losing strategy: ignoring the obvious, steaming through the warning signs and hoping that stress will just go away by itself.

Chronic Fatigue Syndrome Not Caused by a Virus… or Is It?

Corot at Stresshacker.com Big news for people suffering from chronic fatigue syndrome (CFS), which affects an estimated one million Americans. Besides profound exhaustion, CFS symptoms include sleep disorders, cognitive problems, muscle and joint pain, sore throat and headaches. Patients show signs of abnormalities that affect immune and endocrine systems and neurological functioning. These symptoms are frequently diagnosed as a mind-body illness, perhaps related to stress, trauma, or other “non-medical” causes. There is often a veiled dismissal that can accompany these tentative diagnoses. Their suffering has just not been taken seriously enough, CFS patients complain, because nothing specific could be found through accepted diagnostic procedures… until now—maybe.

Two studies have just been published that report on evidence that CFS may be triggered by an acute viral illness. Both studies were conducted by impeccably reputable sources. Both targeted the connection between CFS and a viral cause. Neither is conclusive, because the studies’ results contradict each other.

The study that supports a viral cause for CFS was conducted by researchers from the National Institutes of Health, the Food and Drug Administration, and Harvard Medical School, and was published in May. The study discovered the presence of DNA from a xenotropic murine leukemia virus (XMRV) in the blood of 67% of CFS patients, as compared with 3.7% found in testing a control group of healthy individuals. Another test on  patients meeting accepted diagnostic criteria for CFS found traces of a similar virus (MRV) in 86%, compared with only 7% among healthy volunteer blood donors. The researchers concluded that there appears to be a strong association between CFS and these viruses, although they stopped short of saying whether these viruses play a causative role in the development of CFS, and whether they represent a threat to the blood supply.

But in July, researchers from another federal agency, the Centers for Disease Control and Prevention, published a study finding no XMRV or other MRV-related viruses in patients with CFS. This study tested 51 persons with CFS and 56 healthy persons for evidence of XMRV and the results were consistently negative. Thus, researchers from this study concluded that there is no trace of XMRV in the blood of CFS patients or healthy controls and  therefore there is no evidence to support an association of CFS with XMRV.

News of the conflicting findings has led some patients to express alarm that important scientific information about CFS might be suppressed. People with a diagnosis of chronic fatigue syndrome are used to hearing scientists, doctors, employers, friends and family members dismiss the condition as psychosomatic or related to stress or trauma, despite mounting anecdotal evidence that CFS often follows an acute viral illness.

The CFIDS Association of America, the advocacy group for CFS patients, expressed the hope that these studies will help “shape immediate and longer term priorities for research and will build consensus about these agents, the conditions with which they may be associated and the exact nature of those relationships, one to another,” and that “few will question whether CFS is real or not,” as this research may help “lay that controversy to rest, at long last.”

Stress at 40, Dementia at 60?

Vermeer at Stresshacker.com New research just published that falls into the “I sure hope this isn’t true” category: midlife psychological stress may have a relationship to the development of dementia later in life. As the number of people with dementia continues to increase dramatically with global aging of the human population, the exact causes of this frightening disease are poorly understood. Now comes this 35-year-long study, whose results have been published in the peer-reviewed journal Brain, that adds new fuel to the speculation that psychological (i.e. cognitive and emotional) stress may have something to do with the development of dementia…at least in women.

Swedish and American scientists at Gothenburg University and at the SUNY Downstate Medical Centre in Brooklyn analyzed the relationship between psychological stress in midlife and the development of dementia in late-life. A group of 1,462 women, whose age ranges between 38 and 60, were examined in 1968–69 and re-examined in 1974–75, 1980–81, 1992–93 and 2000–03. During the 35-year follow-up, 161 cases of dementia were diagnosed among the women in this study—105 of the Alzheimer’s type, 40 vascular dementia and 16 other dementias.

The results indicate that the incidence of dementia was higher among women who had reported frequent or constant psychological stress in 1968, in 1974 and in 1980. More specifically, women who reported frequent or constant stress in 1968 and 1974 had more cases of Alzheimer’s disease. Moreover, women who reported psychological stress at one, two or three examinations were found to have a sequentially higher risk of developing dementia in later years.

The researchers conclude that this study demonstrates a clear association between psychological stress in middle-aged women and the development of dementia, especially Alzheimer’s disease. While they caution that additional studies are needed to confirm these findings and to study potential neurobiological mechanisms of these associations, nonetheless the length of the study and the rigorous collection of data from multiple sources lend credibility to the results.

PUFAs-Inflammation-Stress: The Axis of Evil

Nighttime at Stresshacker.comIn a prior post on the benefits of fish oil in preventing stress-related illness, the subject of inflammation—the principal cause of stress-related illnesses—was touched upon briefly. It is of such importance, however, that we return to it today and discuss further the connection between inflammation, stress and low polyunsaturated fatty acids (PUFAs) intake.

The Problem: Too much ALA, Not Enough LA

In most industrialized countries, including the United States, we now consume five to 20 times as much proinflammatory omega-6 fatty acids than anti-inflammatory omega-3s. What’s the difference between the two, where do these fatty acids come from, and why is this happening?

Omega-6 and omega-3 are the two major types of PUFAs, contributing between 95 and 98% of dietary PUFA intake. Omega-3’s principal component is linoleic acid (LA) and omega-6’s is a-linoleic acid (ALA). LA is abundant in corn, sunflower, soybean oils, and their margarines. ALA is found in green vegetables, soybean and rapeseed oils, nuts, flaxseed and flaxseed oil. The availability of LA in Western countries increased greatly in the second half of the 20th century, following the introduction and marketing of long-shelf-life cooking oils and margarines. This changed pattern of consumption has resulted in a significant increase of bad-PUFA omega-6 intake vs. good-PUFA omega-3.

Why Do We Need PUFAs?

PUFAs are important in the membrane protein function of human cells, in maintaining
membrane fluidity, in regulating cell signaling and gene expression, and in overall cellular
function. It is through the interactions of fatty acids that anti-inflammatory agents in the bloodstream can pass through blood vessel walls and reach the site where their intervention is needed.

Inflammation can be caused by a physical pathogen (an insect bite, a burn, or a traumatic injury), or by a stressful event that triggers the body’s defensive mechanisms and causes the release of inflammatory agents such as norepinephrine and cortisol in the blood stream. PUFAs are active in facilitating the removal of inflammation induced by either a physical pathogen or by stress.

Which PUFAs Reduce Stress?

Omega-6 and omega-3 PUFAs play different roles in facilitating anti-inflammatory responses. Research indicates that it is the ratio between these fatty acids that is most important in preventing or reducing the severity of stress-induced diseases such as rheumatoid arthritis, asthma, and inflammatory bowel syndrome. A favorable ratio of LA (eating foods rich in omega-3) vs. ALA (eating less food that contains omega-6) appears to produce the best anti-inflammatory effects.

Foods Rich in Omega-3 Fatty Acids

  • Nuts: walnuts.
  • Vegetables: kidney beans, navy beans, tofu, winter and summer squash, broccoli, cauliflower, green beans, romaine lettuce, and collard greens.
  • Fruits: raspberries and strawberries.
  • Meats: free-range beef and poultry.
  • Fish: herring, mackerel, sturgeon, salmon, and anchovies.

Stress and Burnout Endanger Clergy Health

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Members of the clergy are more likely to suffer from stress-related illnesses such as obesity, arthritis, diabetes, high blood pressure, asthma and depression than most Americans. These are the first published results of the continuing survey of 1,726 ministers, which began in 2007 and is being conducted in North Carolina by the Clergy Health Initiative at Duke University. Researchers Proeschold-Bell and LeGrand report that the obesity rate among clergy aged 35–64 years is nearly 40%, or over 10% higher than among the local population.

A similar survey by the Evangelical Lutheran Church in America (and cited by the New York Times) reported 69% of its ministers as being overweight, 64% as having high blood pressure, and 13% as taking prescription antidepressants. Similarly, a 2005 survey of Presbyterian clergy had reported that occupational stress and burnout played a factor in 4 times as many ministers leaving the profession during the first five years of ministry, as compared with the 1970s.

What Is Occupational Burnout?

According to its most widely accepted definition, occupational burnout includes:

  1. Emotional exhaustion, which can result in diminished interest in work, fatigue, and detachment.
  2. Depersonalization, or the defensive distancing from the surrounding world, which can result in diminished contact with coworkers and the public, withdrawal of psychological investment, self-absorption, and negative attitude toward others.
  3. Dissatisfaction, or the perception of unsatisfactory personal accomplishment, which can result in feelings of failure, fatalism, diminished competence, and incapacity to respond to further environmental demands.

There are several theories that have been proposed to explain the genesis and development of occupational burnout. Read about them after the jump, with some suggested remedies and a summary of the most recent research.

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Rock-a-bye Baby

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A Lullaby As Effective Stress Management

The repetitive soothing sounds and rhythm of the lullaby have been used for millennia as a natural tranquilizer. Globally, children are gently rocked, lullabies are hummed, nursery rhymes are recited, affectionate sounds are spoken in a lilting fashion—all with the intended purpose of inducing relaxation. Without formal training or explanation, human caregivers are acting out of an intuitive awareness of the soothing effects of such rhythmic activities on the children’s psychophysical state. It works. But what makes it work? What is the basic science behind lullabies and can it be put to use in inducing relaxation in adults?

The rhythmic component of the lullaby may be the most important factor in inducing calm, as its rhythmicity is the single common factor among the vastly different types of lullabies sung or spoken in hundreds of languages and dialects around the world. It is not coincidental that rhythmicity is also the key component of mantra meditation.

What Is Mantra Meditation?

There are two basic types of meditation: concentrative or non-concentrative. Concentrative meditation is based on limiting stimulation by focusing on a single unchanging or repetitive stimulus, such as a word mantra or a candle flame. Non-concentrative meditation techniques, e.g. mindfulness or yoga meditation, seek to expand awareness to include as much mental activity as possible. Of the two approaches, mantra meditation is the easiest to learn and use, the most natural technique, and one of the most effective forms of stress relief capable of producing lasting results.

Mantra meditation, much like a lullaby and acting on the same principle, can rapidly induce a deeply restful state. During mantra meditation, body and mind are beneficially affected. During 20–30 minutes of meditation, oxygen consumption is lowered to a level equivalent to that of 6–7 hours of sleep, and both heart and respiration rates generally show a significant decrease. Psychologically, mantra meditation appears to induce a fluid state of consciousness, with shared characteristics of sleep and wakefulness, and comes closest to the sleep-inducing state than any other meditation technique.

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When the Doctor Herself Is Stressed


“I could easily blame stress for the many emotional and physical symptoms I experienced from early childhood. Free floating anxiety, feeling unworthy and undeserving of love and happiness, feeling hypersensitive and yet numb to many of my emotions and constantly judging, criticizing and berating myself were just some of the unhealthy defense mechanisms I had learned over the years to cope with stress.”

Thus begins Dr. Lori Leyden-Rubenstein’s compact (a little over 200 pages), concise (13 short chapters) yet comprehensive and insightful book, The Stress Management Handbook: Strategies for Health and Inner Peace.

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Throughout the book, Dr. Leyden-Rubenstein never loses track of her own experiences and refers to them often but judiciously, which creates the right feeling of connection without narrowing her suggestions solely to her own experience. After telling her story, she explains what stress is and how to manage it, including its effects on the body and mental health, all in precise yet easy to understand language. She then offers no fewer than 35 strategies for relieving stress, ranging from physical to psychological, and from concrete to spiritual.

Another great book worth having and definitely worth reading and practicing. It gets this week’s Stresshacker Recommended badge.

Stress and Breast Cancer

Chenonceau Castle at Stresshacker.com Learning how to better cope with stress had a significant positive impact on the lifespan and quality of life of a group of women with recurrent breast cancer. Researchers at Ohio State University’s department of psychology reported the results in the latest issue of Clinical Cancer Research Journal, published by the American Association for Cancer Research.

"Patients [who learned how to reduce stress] evidenced significant emotional improvement and more favorable immune responses in the year following recurrence diagnosis. In contrast, stress remained unabated and immunity significantly declined in the assessment-only group," said Dr. Barbara L. Andersen, principal researcher at the Ohio State University Comprehensive Cancer Center – James Cancer Hospital and Solove Research Institute.

Analysis of the data of the 11-year-long study showed that of 227 women in the study group, the women who had received stress management training had a 59 per cent lower risk of dying of breast cancer.

This excellent news, reported by Medical News Today, is further confirmation that treating the symptoms of the stress reaction through cognitive (psychoeducational) and behavioral interventions can have a powerful effect on health. It is especially beneficial to learn how to directly manage the stressor that is causing the reaction, how to reduce its impact by a combination of stress-reducing techniques of relaxation, appropriate nutrition, adequate sleep, and the affirmation of positive statements about one’s ability to cope and overcome the challenge.

Why Can’t I Just Fall Asleep!

Aaah, to sleep. Peacefully. Like a baby, a puppy, a kitty… Is that possible anymore? I haven’t slept well in so long. Every night is a struggle. I futz and futz and go to bed later and later—it doesn’t do the trick. Tell me doc, what do I gotta do?

Villefrance at Stresshacker.com Sleep deprivation is literally a form of torture, and a very effective one at that. You don’t have to be a fiendish Capulet spy to find out how true that can be. US statistics from the Department of Transportation estimate that 20% of drivers doze off regularly at the wheel, while the National Highway Traffic Safety Administration estimates conservatively that, during an average year, “drowsy driving” causes 100,000 automobile wrecks, 71,000 injuries and 1,550 fatalities. These staggering stats are supplemented by data from the US military, children studies, surveys of truck drivers, shift workers, couples, medical students—all pointing to one simple fact: we can’t sleep. Let’s see what is happening, why, and look at some possible remedies.

What’s Happening to Sleep?

Sleep is under attack from many sources. First and foremost, especially in the westerly and northerly parts of the planet, our schedules simply allow much less time for sleep. While this may seem like a no-brainer and suggest that there is a simple remedy (just allocate more time to sleep!), the problem of sleep scheduling is actually very complex and with no easy solution. The reason for this is below the surface and can be uncovered only by identifying that our fundamental belief about sleep has changed. To put it simply, many of us no longer believe in the necessity of sleep, while continuing to proclaim its virtues and benefits, at least out loud. Secretly, don’t we wish we could simply do away with sleep altogether?

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