Sleep More, Stress Less, Live Longer

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

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

Physical Threats to Sleep

TIME

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

LIFESTYLE

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

ENVIRONMENT

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

CHEMICALS

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

Psychological Threats to Sleep

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

STRESSORS

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

INADEQUATE COPING

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

ALLOSTATIC LOAD

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

The Path to Better and Longer Sleep

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

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

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

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

“Rich” Nutrition Linked to Poor Mental Health

killer-fast-foodPsychological stress is known to increase the production of pro-inflammatory cytokines. The deriving inflammation is accompanied by an accumulation of highly reactive oxygen species, also known as oxidative stress, which is a contributing factor in the development of severe depression. A diet rich in antioxidants, vitamins, minerals and fiber is associated with reduced systemic inflammation. Conversely, diets that are low in essential nutrients, such as magnesium and sugar- and fat-rich western diets are associated with increased systemic inflammation.

A new study of 3040 Australian adolescents 11 to 18 years of age collected information on diet and mental health by self-report and anthropometric data by trained researchers. Improvements in diet quality were mirrored by improvements in mental health over the follow-up period, while deteriorating diet quality was associated with poorer psychological functioning. Researchers concluded that the quality of one’s nutrition is associated with adolescent mental health both cross-sectionally and prospectively. Moreover, improvements in diet quality were mirrored by improvements in mental health, while reductions in diet quality were associated with declining psychological functioning over the follow-up period.

There are many ways in which an insufficiency of healthy foods and/or an excessive intake of unhealthy and processed foods may increase the risk for mental health problems in adolescents. Fruits and vegetables, as well as other components of a healthy diet such as whole grains, fish, lean red meats and olive oils, are rich in important nutrients such as folate, magnesium, b-group vitamins, selenium, zinc, mono- and polyunsaturated fatty acids, polyphenols and fiber. Many of these nutrients have already been reported as of importance in depressive illnesses, however the critical importance of these food components as modulators of reactive oxygen species (inflammation) and immune system functioning, both pathophysiological substrates of depressive illness is increasingly appreciated.

stressed-dessertsA new meta-analysis, reporting on data collected at many time points and thus more reliable, has reported large generational increases in self-reported mental health problems among American high school and college students between the 1930s and 2007. Paralleling this increase in the rates of psychological illness among young people are data indicating a reduction in the quality of adolescents’ diets over recent decades. A report based on trends in adolescent food consumption in the US identified a reduction in the consumption of raw fruits, high-nutrient vegetables and dairy foods, which are important sources of fiber and essential nutrients, between 1965 and 1996, with an associated increase in the consumption of fast food, snacks and sweetened beverages.

Concurrently, population surveys demonstrate a substantial increase in overweight and obesity among children and adolescents over recent decades. Obesity does not necessarily indicate nutritional deficiency: paradoxically, high-energy foods typically have poor nutrient content.

Fast Food, Depression and Anxiety

Another study of 5731 men and women 46 to 49 and 70 to 74 years of age found that those with better quality diets were less likely to be depressed, whereas a higher intake of processed and unhealthy foods was associated with increased anxiety.

USA-Obesity-RateA third study examined the extent to which the high-prevalence mental disorders are related to habitual diet in 1,046 women 20–93 years of age. Results showed that a “traditional” dietary pattern characterized by vegetables, fruit, meat, fish, and whole grains was associated with lower odds for major depression or log-term depression (dysthymia) and anxiety disorders. A western diet of processed or fried foods, refined grains, sugary products, and beer was associated with a higher prevalence of mental disorders. These results demonstrate an association between habitual diet quality and a higher prevalence of mental disorders.

In a fourth study (1999–2010) of 12,059 Spanish university graduates discovered a detrimental relationship between a diet rich in trans unsaturated fatty acids (TFA) and depression risk, whereas weak inverse associations were found for monounsaturated fatty acids (MUFA), polyunsaturated fatty acids (PUFA) and olive oil. These findings suggest that cardiovascular disease and depression may share some common nutritional determinants related to fat intake.

Most notably, results of a 2010 randomized placebo controlled trial showed that fish oil supplements prevented conversion from a subthreshold psychotic state to full-blown schizophrenia. Another recent randomized controlled trial study suggested that omega-3 supplements may help reduce anxiety.

More Stress, Skipped Lunches & Temp Jobs

In the 2011 survey, What’s Keeping HR Leaders Up at Night?, Human Resource Executive® reports that 74% of Human Resources executives say their level of job stress has increased in the past 18 months. Almost one third (32%) blame that on the difficulty they encounter in retaining key talent. “And it absolutely should keep them up at night,” says Wayne Cascio, senior editor of the Journal of World Business and a professor at The Business School at the University of Colorado in Denver. “I would be worried, too, and I’d be especially concerned about replacing high performers.”

This latest survey on the insights and perspectives of 782 senior-level HR executives at organizations nationwide finds that the top two challenges identified in last year’s survey – ensuring employees remain engaged and productive (41%), and retaining key talent as the economy recovers – also remain top of mind for this year’s respondents.

No Lunch For Most Workers

Two thirds of employees either eat lunch at their desk or take no lunch at all, according to a survey by Right Management, a division of global temporary staffing and consulting giant Manpower Inc.  One third of employees, or 34%, said they take a break for lunch, but eat it at their desks. Fifteen percent said they take a break from time to time, while another 16% said they seldom do. Only 35% said they regularly take a break for lunch.

Temporary Jobs Often the Only Game in Town

Staffing employment increased 5.4% from the first to the second quarter of this year, according to data released by the American Staffing Association (ASA). This is the sixth straight quarter of temporary and contract employment growth since the industry began its recovery from the 2007–2009 recession.

The U.S. staffing industry had a healthy second quarter as businesses continued to turn to flexible workforce solutions to meet increases in demand for their products and services—Richard Wahlquist, ASA President and CEO.

“For job seekers the news is also encouraging, as staffing and recruiting firms added more than 200,000 new jobs in the past 12 months.” U.S. staffing firms employed an average of 2.8 million temporary and contract workers from May through June — 8.6% more workers than in the second quarter of 2010.

Emotional Safety, Stress and Health

Many individuals who suffer from chronic stress report being “on edge” or “keyed up” most of the time. This near-constant state of arousal is reported at times when the person should be at rest, i.e. during normal sleeping hours, while relaxing with family or friends, or even while eating or taking a shower. Certain features appear to be common to most people who share this emotional state. Let’s look at a few of the most important ones.

Emotional Stress Often Translates Into Physical Symptoms

In most instances, psychological stress caused by real adversities or by the anticipation of adversity causes the body to react in an attempt to fight the stressor, flee from it or shut it off and away from immediate consciousness. In the process of taking these defensive measures, muscles tense, the cardiocirculatory system kicks into high gear, and many non-indispensible systems (such as the digestive and sexual systems) shut down or significantly slow their functioning. Since the stressor is often non-physical in nature, this bodily mobilization of resources never quite finds its target. Over time this may wear down certain organs of the body, which begin to manifest signs of illness. High blood pressure, irritable bowel syndrome, erectile dysfunction, muscle spams or pain, ulcerative colitis are but a few of the more or less serious physical ailments that can be directly associated with chronic anxiety and stress.

Emotional Stress Can Contribute to Mental Disorders

Frequent stress has an augmenting and, some say, even causative effect on poor mental health. In the presence of serious stressors, such as the loss of a home or a job, or a serious physical illness, or the loss of a significant relationship, many people develop symptoms that are typical of certain mental disorders. It is debatable whether the mental disorder comes first and the stress comes next, or vice versa, but regardless of whether the chicken comes before the egg, the results can be quite the same. A serious stressor may provoke depressive symptoms or acute stress disorder. What makes a difference is the individual’s proneness to manifest a psychological disturbance either in an “externalizing” manner, e.g. with visible signs of anxiety, or in an “internalizing” manner, e.g. with the shutdown of activity that is typical of depression.

Taking the other side of the equation, people who already suffer from an anxiety disorder or a depressive disorder may feel that their symptoms are aggravated by another stressor added on top of the ones they have experienced in the past. Anxious individuals will feel less prepared to meet the new psychological challenge, and even the mere anticipation of a new threat may be sufficient to produce a panic attack. Depressed individuals, who also may feel that their personal resources are inadequate to cope with a new challenge, may not show any signs of panic or heightened anxiety and will instead further retreat into the dark recesses of depression.

Emotional Stress Is Fear Under Another Name

Psychological stressors share a common characteristic: they are caused by generally unwanted and often unexpected events or situations. Regardless of their origin, negative stressors produce a reaction of surprise and, in most cases, fear. Since negative consequences usually accompany the arrival of a stressor, and since most people are quite capable of predicting a whole range of possible negative outcomes resulting from a stressful event or situation, fear (often masking as anxiety or even anger) is the naturally occurring and logical emotion. Even in the classic case of a positive stressor such as winning the lottery, fear is not too far behind the initial moment of wild elation. Even the arrival of a large sum of money can produce fears of its loss even before the unexpected windfall lands on the lucky winner’s bank account. Stories of big winnings have often culminated in poor choices, reckless decisions, broken relationships, and ultimate unhappiness.

Regardless of its origin, a significant stressor may produce quite a significant state of perceived danger. Many people feel that they can meet the challenge, but many others may not feel up to the task because of low self-esteem, a personal history of negative outcomes, low resilience, or a pessimistic outlook on life. A feeling of emotional safety is a protective condition that helps us make better decisions, enhances our judgment, and is generally good for our physical health. Conversely, the lack of emotional safety (which may range from a mild state of anxiety to the perception that a catastrophic event is about to occur) may be conducive to poor decision making, errors in judgment, inefficient allocation of personal resources or lack of adequate self-care, and may be linked to a higher probability of physical illness.

How To Tame Fear and Fight Chronic Stress

Emotional safety is one of the ingredients of good mental and physical health that, especially nowadays, appears to be in especially short supply.  How can it be increased? A good place to start is by developing better insight into our situation. Insight is the awareness not only of the content of our worries and stressors (“what” makes us feel stressed), but also of the process (the “how”) by which we attempt to manage or cope with the situation. In many cases, our coping attempts are so automatic and out of awareness that they happen without our direct control. Insight into the process can change this. There is a significant reservoir of power and energy that can be tapped by the simple act of self-observation. It is the ability to say not only, “I can’t believe this is happening to me,” but also and at the same time to be able to say, “and just look at how I am handling this right now.”

Insight into the process of coping leads to one very important moment of choice. Being able to ask the question, “Is this way of (over)reacting the only option I have right now?” constitutes a tremendous step forward from a wholly automated and fear-driven response. While it is possible that in the moment no other reaction may be possible except anxiety or depressive thoughts, the presence of insight into the process can help come up with options and alternative ways of handling the stressor. This sets up the vital, and perhaps best, way to cope with the unexpected: an initial automatic and spontaneous reaction to a stressor (which may be physical and psychological in nature, entirely human and to be expected), followed by a more intentional and not so automatic response that comes from the ability to choose between several available options.

Sugary Drinks Linked to Higher Blood Pressure

aaMatisse_1948_PlumBlossomsSoft drinks, sweetened fruit juices, and sugar-loaded sports drinks raise blood pressure, according to a International Study of Macro/Micronutrients and Blood Pressure (INTERMAP). The researchers measured the consumption of sugar-sweetened drinks, sugars, and diet beverages (which contain high quantities of glucose and fructose) over the course of four days, administered two 24-hour urine collections and eight blood-pressure recordings, and asked questions about the patients’ lifestyle and medical history. Results show that there is a direct correlation between fructose and glucose intake and increases in blood pressure and that sugar-sweetened beverages are associated with a 1.1-mm-Hg increase in systolic and 0.4-mm-Hg increase in diastolic blood pressure after adjustment for weight and height.

Sugar-sweetened beverages have been linked to high blood pressure, obesity, type 2 diabetes, and heart-disease risk, and this is one more piece of evidence showing that if individuals want to drink these drinks, they should do so in moderation. Also, one of our interesting findings was that the association between sugar-sweetened beverage consumption and blood pressure was stronger in people who are consuming more sodium. We already know that salt is bad for blood pressure, but what we’re finding is that if you’re consuming more sodium, you appear to be, at least in this study, exacerbating the effects of these sugar-sweetened beverages.—Lead investigator Dr. Ian Brown (Imperial College London, UK)

Stress of Cell Phone Use Disturbs Sleep, Mood

WestminsterAbby_EN-US1401418381Evidence of a direct link between cell phone use and mental health problems just keeps on coming. A major prospective study over a period of one year of young adults who used their cell phones frequently reveals significant disturbances to sleep patterns, increased stress symptoms, and an increased incidence of clinical depression. Researchers at the University of Gothenburg, Sweden investigated possible negative health effects of mobile phone exposure. The study, published this month in BioMed Public Health, focused on the psychosocial variables of mobile phone use and their possible effects on the mental health symptoms in a group of over 4,000 young adults.

Cell phone exposure variables in the study included the frequency of cell phone use, the demands on availability put on the individual, the perceived stressfulness of accessibility, the effects of being awakened at night by the phone, and instances of personal overuse of the cell phone. The mental health outcomes included in the study were current stress levels, symptoms of sleep disorders, and symptoms of depression. Prevalence ratios were calculated first as a baseline at the beginning of the study, and one year later. Mental health outcomes for men and women were studied separately. Any participant who reported mental health symptoms at baseline was excluded from the study.

cellphone_brainA detailed analysis of results showed a cross-sectional association between high cell phone use and elevated stress levels, increased sleep disturbances, and more frequent symptoms of depression for both men and women. High cell phone use was associated with sleep disturbances and symptoms of depression among men and symptoms of depression among women at 1-year follow-up. All exposure variables showed a correlation with mental health outcomes. In particular, cell phone overuse appeared to increase stress and sleep disturbances among women, and high accessibility appeared to produce elevated stress, sleep disturbances, and symptoms of depression among both men and women.

The researchers concluded that a high frequency of cell phone use over a period of one year is a risk factor for stress, sleep and mood disorders among young adults. The frequency of mental health symptoms was greatest among those who had perceived their near-constant accessibility via cell phones to be stressful.

A New Stressor: FOMO

Sm-bandwagonThe power of communication has been unleashed on the Internet as never before. It is now possible to know almost instantly what is happening around the world, to broadcast one’s ever-changing “status” to real or virtual friends and acquaintances, to express oneself endlessly in 160-character increments, to blog multiple times a day one’s erudite or inane musings to an audience that can number in the tens of thousands. Everyone has the power to become a “brand” and many have done so to great lengths, baring their life and its inspiring or sordid details without regard for privacy, confidentiality or simple reserve. With this phenomenon, new stressors are born, old ones are better overcome, and still others morph into more or less ominous sources of anxiety.

Take for example the ability to know, via Facebook, Twitter, Foursquare and Instagram, the whereabouts and activities of our immediate and extended social network. It is possible to know, just by virtue of swiping the screen of a smartphone, who’s out, who’s dining with whom and where, who’s at the club or the sports arena—often with photos and videos of the event as it unfolds in some sort of electronic play by play. Truly fascinating glimpses of reality in some cases, not so interesting and even banal in many others.

One of the newest stressors originated by this type of instant access is “fear of missing out,” or FOMO. It is a bizarre reversal of social anxiety, the particularly debilitating condition which causes people to reluctantly withdraw from interpersonal contact due to stress overload. In FOMO, the stress comes from the anxiety provoked in recipients of instant messages by the awareness that others are socially involved at that very minute, while they are supposedly missing out on something fun and interesting. In other words, being at home, at work, or otherwise “not there,” not doing the things others are doing and that are being portrayed in the photo or video or described in the message, is sufficient to produce anxiety, which perhaps could be referred to as non-social in nature.

texting-while-drivingFOMO is a close cognate of that other need to be connected at all times, for which there may already be an acronym of which I am not aware, yet. Being “out of touch” means not having 24×7 access to email, IM, social media—and that’s simply too horrible to contemplate. Voice calls are becoming an endangered species, as people seem to prefer, in increasingly greater numbers, to text or post. The stress of not having access, no rhyme intended, can be fiercely acute. Its excesses bear on the ridiculous, and increasingly more often, on the tragic—as in the train operator in the San Fernando Valley who wrecked his passenger train while texting to his friends. For the growing number of car accidents caused by this technological distraction there is already an acronym, TWD or texting while driving.

Stuck On Wide Open: Emotional Dysregulation

domesticviolenceEmotional regulation is perhaps the most dramatically visible and the prototypical feature of an individual’s personality. Many people appear to be mostly in command of their emotions at critical moments, while others appear to be particularly (and sometimes explosively) reactive to environmental and interpersonal challenges. In general, affective or emotional instability, inordinate bursts of anger, intense efforts to avoid real or perceived abandonment, and unstable interpersonal relationships point to an underlying attribute of emotional dysregulation. This set of features has been popularized as belonging to “drama queens,” or persons who tend to react to every situation in an overdramatic or exaggerated manner.

Sometimes, instances of emotional dysregulation in children (“acting out” behaviors) or in adults under the most severe stressors can be viewed as the only available response in circumstances in which overwhelmingly strong emotion must be expressed, such as in the context of an emotionally abusive family environment or in times of great personal upheaval.

DramaQueen1A large body of research suggests that alcohol use can increase underlying emotional disturbance and disrupt cognitive functions that are very important in emotional self-regulation. Support for this hypothesis comes from studies that find associations between alcohol use and short- and long-term emotional change. In the short term, alcohol can disrupt emotional stability by effectively removing barriers against violence, verbal abuse, and inappropriate behaviors. In the long term, alcohol dependence and addiction can create a false persona in which it becomes difficult if not impossible to distinguish between the individual’s genuine personality traits and those modified or instigated by alcohol use.

Emotional disorders, particularly when they are characterized by pervasive emotional dysregulation, are often characterized by high negative emotionality and low positive emotionality. A significant challenge in trying to downregulate negative emotions is to become less vulnerable to negative or distressing emotions, with the objective of increasing calmness and resilience in stressful situations.

To achieve better emotional regulation, biological change and contextual change are needed. Biological change is achieved by reducing individual reactivity to emotional stimuli. Even when this reactivity may be due to genetic dispositions (temperament) and early developmental experiences (nurture), most people can learn ways to better control their emotional expression. There is a combination of skills and interventions that is particularly helpful in promoting biological homeostasis and emotional stability. These include treating any underlying physical illness that may have a negative effect on mood, balancing nutrition and eating to replenish and maintain physical resources, staying off non-prescribed mood-altering substances, getting sufficient but not excessive sleep, and getting adequate physical exercise.

Contextual change refers to learning and practicing emotional resiliency, which is the ability to minimize negative effects of stressful events and situations, and to maximize the positive effects of positive outcomes and opportunities. The skill of resiliency is learned and reinforced by intentionally accumulating positive life events, i.e., making a conscious and deliberate catalog of what’s positive in one’s life and referring to it often until it is present and readily available in time of need. It also consists of developing practical skills that build a sense of generalized mastery and promote self-esteem, e.g., completing school, obtaining additional job training, taking an assertiveness course, and the like.

What Causes (And Cures) Emotional Dysregulation

The amygdala has been implicated in emotional dysregulation, aggressive behavior, and psychiatric illnesses such as depression. Anxiety disorders and dysregulation may be the result of too much activity in the amygdala and not enough activity in the prefrontal cortex (PFC), which is the executive center of the brain that sets boundaries of behavior and responds to criteria of calm, assertiveness, and emotional regulation.

BDNFStress, coupled with a genetic vulnerability, decreases the production of brain-derived neurotrophic factor (BDNF). BDNF is a protein that acts on the nervous system by helping the survival of existing neurons and promoting the growth and differentiation of new neurons and synapses. A reduction in BDNF production causes a thinning of neuronal structures, which can results in emotional disturbance. These structural changes make the prefrontal limbic governing system vulnerable to disruption and dysregulation. Thus, emotional stress, loss, or  other significant psychological factors cause the system to lose self-regulation.

Treatments such as antidepressant medications, lithium, electroconvulsive therapy, exercise, psychotherapy and good social support can reverse this process, increase the production of BDNF, renew neuronal growth, build more resilient self-regulating circuits, and return the individual to a healthy mood.

Disorders of Emotional Dysregulation

PTSD, or posttraumatic stress disorder, is characterized by very significant emotional dysregulation. Its sufferers experience unwarranted arousal—often caused by stimuli processed Depressed-Soldier-02outside of conscious awareness—and exhibit an exaggerated startle response, vivid intrusive thoughts, and flashbacks and nightmares related to past traumatic events. PTSD victims may frantically try to avoid physical or psychological reminders of their trauma, and may experience dissociative symptoms or emotional numbing. PTSD is a disorder of emotional dysregulation characterized by excessive fear, triggered by a severe and often life-threatening traumatic event.

Borderline personality disorder (BPD) is characterized by emotional dysregulation, the temporary but frequent inability to change or regulate emotional cues, experiences, actions, verbal responses, and nonverbal expressions. Individuals with BPD experience greater emotional sensitivity, greater emotional reactivity, and slower return to normal levels of arousal after intense stimulation.

Frontal lobe disorders, which have become rather common among combat survivors, are the product of traumatic brain injury and are characterized by emotional dysregulation, attention deficit, impulsivity, lack of inhibition,  poor insight, impaired judgment, and low motivation. These frontal-subcortical disorders can result not only from war zone trauma, but also from infection, cancer, stroke, and neurodegenerative disease. Explosive violence, often directed at family members, is a common occurrence, particularly in individuals in whom impulsivity, disinhibition, and emotional dysregulation are the most dominant features.

Finally, obsessive-compulsive disorder (OCD) is characterized by emotional as well as cognitive dysregulation, brought on by a disruption of both the “thinking” prefrontal and the “feeling” paralimbic networks.

In these and other disorders that feature emotional dysregulation, it is interesting to note that the anatomic structures that are affected have emotional as well as cognitive functions. This coincidence highlights once again the close interdependence of affective and cognitive operations in the human brain. We can’t feel deeply without thinking intensely, and vice versa.

Stress and the Female Brain Advantage

drlouannbrizendineIn 1994, Louann Brizendine, a neuropsychiatrist at the University of California, established the Women’s Mood and Hormone Clinic in San Francisco—one of very few such institutions in the world—and focused her attention on the etiology and functioning of the female nervous system.

In 2007, she published The Female Brain as the culmination of her 20 years of research and a compendium of the latest findings from a range of disciplines. It is a fascinating and, in some ways, startling revelation of the most noteworthy particularities that characterize the human female brain.

Size Does Matter… and So Does Density

Women and men have very nearly the same number of brain cells, even though the female brain is about 9% smaller than men’s. This fact had been known for some time and had been, more or less jokingly, interpreted as meaning that women were not as smart. Dr. Brizendine reveals a much simpler explanation: women’s brain cells are more tightly packed into the skull.

To further dispel any notion of masculine brain superiority, she says, women have 11% more language and hearing neurons than men and a larger hippocampus, the area of the brain that is most closely associated with memory. Much more developed in female brains than male’s is also the circuitry for observing emotion on other people’s faces. Dr. Brizendine concludes that, when it comes to speech, emotional intelligence, and the ability to store richer and more detailed memories, women appear to possess a richer brain endowment and thus a natural advantage.

The amygdala in males, on the other hand, has far more processors than in females, which could explain men’s greater intensity in perceiving danger and their higher proneness to aggression. The male body is much quicker to mobilize to anger and take violent action in reaction to an immediate physical danger.

Are women not as capable of reacting to danger? Dr. Brizendine says that a woman’s brain is as capable to perceive danger or deal with life-threatening situations, but that it mobilizes the body’s resources in quite a different way. The female brain appears to be wired to perceive greater stress over the same event than a man’s. This greater arousal and more forceful stress reaction appears to be a natural way to ensure adequate protection against all possible risks to her children or family unit. Brizendine suggests that this ancestral reason may account for the way a modern woman may view unpaid bills as catastrophic and naturally perceive them more intensely threating to the family’s very survival.

[amtap book:isbn=0767920104]

MRI scans have pushed knowledge much higher by allowing the observation of the workings of the brain in real time. The brain lights up in different places depending on whether it is stimulated by love, looking at faces, solving a problem, speaking, or experiencing anxiety. What lights up, where and when, is different between men’s and women’s brains. Women use different parts of the brain and different circuits to accomplish the same tasks, including solving problems, processing language, and generally experiencing the world.

This is a fascinating book for the scientist and the novice alike, well worth reading. It is the Stresshacker Recommended selection for this month.

When Stress Hurts: Curing Psychogenic Pain

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

Non-pharmaceutical Treatments

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

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

Psychological Treatments That Can Eliminate Psychogenic Pain

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

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

Previously in this series:

Getting Better for Absolute Beginners

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

The Meaning of Not Doing Well

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

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

Getting Better

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

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

Some indicators of having successfully overcome chronic stress:

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

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

Beyond Reaction: An Intelligent Response to Stressors

aaAltdorfer_SusannaElternA stress reaction that gets “stuck” into alarm mode and never progresses toward a resolution of the stressor can develop into chronic stress or depression. The latter can be conceptualized as turning inward, shutting off the world and avoiding all but the most necessary contact with the stressor. It is a rather primitive and ultimately ineffective way of coping with stressful events and situations (for better ways of defending against stress see this post), but it is undeniable that it works at reducing the level of incoming inputs and the effort required to respond. When stress causes anxiety, what follows is a semi-permanent state of arousal (which can have dangerous health consequences). When the response is depression, what follows is a significant reduction in functioning—to the extent that the person is not anxious but apathetic, withdrawn, and unresponsive even to positive stimulation.

The Coping with Stressors Inventory

Adapted from the Coping Styles Questionnaire (CSQ) by Roger, Jarvis, & Najarian, (1993), this is a simple way to determine our instinctive and preferred ways of managing stressors as they appear in our lives. These are ways that are characteristic of our behavior and are most likely to be used under conditions of severe stress.

Instructions: Mark as many as apply, but make sure to choose only the ones that you are most likely to use or have definitely used in coping with severe stressors.

When I am confronted with a severe or continuing stressor:

1. I ignore my own needs and just work harder and faster.
2. I seek out friends for conversation and support.
3. I eat more than usual.
4. I engage in some type of physical exercise.
5. I get irritable and take it out on those around me.
6. I take a little time to relax, breathe, and unwind.
7. I smoke a cigarette or drink a caffeinated beverage.
8. I confront my source of stress and work to change it.
9. I withdraw emotionally and just go through the motions of my day.
10. I change my outlook on the problem and put it in a better perspective.
11. I sleep more than I really need to.
12. I take some time off and get away from my working life.
13. I go out shopping and buy something to make myself feel good.
14. I joke with my friends and use humor to take the edge off.
15. I drink more alcohol than usual.
16. I get involved in a hobby or interest that helps me unwind and enjoy myself.
17. I take medicine to help me relax or sleep better.
18. I maintain a healthy diet.
19. I just ignore the problem and hope it will go away.
20. I pray, meditate, or enhance my spiritual life.
21. I worry about the problem and am afraid to do something about it.
22. I try to focus on the things I can control and accept the things I can’t.

Results Evaluation: Even-numbered ways of coping are more constructive, while the odd-numbered ones are less constructive tactics for coping with severe or continuing stressors. Checking more even-numbered items indicates a better approach to stressors that takes into account the need for self-care, emphasizes the seeking of support, and confronts the stressor in effective ways. If more odd-numbered items are checked, this may indicate an attempt to cope with stressors by avoidance, smothering the stress reaction with chemical means, and generally retreating into tactics that may temporarily reduce the symptoms of stress but fail to address the causes.

Stress Relief: Taking Charge or Letting Go?

David_Marat Chronic stress can produce a feeling of being overwhelmed. It makes it difficult to shift perspective and see the stressor from a different angle. Rather than seeing stress as a useful signal and address the cause of it, the tendency is to focus on the stress reaction itself as something that can be just pushed away. The results are often the very opposite of what is intended: rather than going away, stress continues as a flashing light on the dashboard that just won’t shut off, while its cause continues to wreak havoc on the mind, the spirit and the body.

It doesn’t have to be this way. Taking responsibility for finding a solution to the stressor is the answer, of course. But how can it be done if all that we can see and feel are the emotional and physical symptoms of the stress reaction? The following are proven ways that can help in shifting perspective from the signal (stress) to its cause, the stressor itself.

Take Charge, List, and Delegate

When I ask general audiences if they can control their stress level to make it work for them, no more than half say they can. If I ask audiences of pilots or neurosurgeons the same question, they all say they can. –Esther M. Sternberg, M.D.

Airline pilots are trained to use the stress response as a useful way to monitor their own behavior. When a pilot flies an airplane through a storm, her heart races, her breath becomes shallow, and her attention is intensely focused on the job at hand. The pilot experiences to the fullest the physiological arousal that defines stress, without necessarily labeling the situation as stressful. Having done this before, the pilot knows what to expect, takes full charge of flying the aircraft and remains in control. On the other hand, the passengers aboard the aircraft may be far more uncomfortable because the plane is bouncing around and there isn’t anything they can do about it. They are stressed, and their racing heart, shallow breath, and intense focus on every bounce and every noise of the plane is coupled with the feeling of being at the mercy of the elements and in the hands of the pilot. Two similar situations, two very different stress reactions. The difference? Being able to take control.

Whenever possible, a shift of perspective can be facilitated by taking charge and exercising a greater control over our choices. When we believe we might be able to control a situation, and step up to try and resolve it, chances are that the very act of acting on it reduces our stress levels. We are finally doing something about it, and it feels good. Have you noticed how the toothache seems to go away, at least to some extent, when we arrive at the dentist’s office? Or our problems take a different, and often less dramatic tinge, when we open up and just talk to someone about them?

Another useful technique for making use of stress signals instead of being overwhelmed by them is to make a list of the stressors that need to be addressed, and front-load it with the ones that can be taken care of quickly. As we check off accomplishments, the feeling of being in control rises and stress begins to ease. It is also useful to take the list a step further and classify each stressor into one of three categories:

  1. Stressors that can be eliminated by making a choice, e.g. taking time off from work, saying no to another request, getting out of a noisy environment.
  2. Stressors that can be reduced or modified, e.g. working on a relationship problem, cutting down on caffeine, lightening the work load.
  3. Stressors that cannot be eliminated or reduced and therefore have to be managed, e.g. working through a loss and the grief caused by it, searching for a job, taking care of our own or a loved one’s illness.

A third technique is delegating, not just to coworkers but also to children, spouse, and friends. This may be difficult, as it appears to contradict the previous suggestion of taking charge of the situation. While taking control is a good stress reliever, it requires moderation and good judgment. One’s anxious need to be in direct personal control of everything at all times, or at least attempting to gain it, can create a stress of its own. Our finite resources of time, energy, and motivation can become exhausted. Anxious control ceases to be a step toward resolving our stressors, and can simply become an attempt to reduce our anxiety about getting everything done. Delegating is the answer.

Accepting That Life Is…Well…Stressful

No one can control everything. A child’s schedule may inevitably conflict with a work deadline. Bad weather may flood the picnic. There are literally thousands of situations when one task interferes with another, is interrupted, must be postponed, or ends up producing unexpected results. Is this because of poor control skills? Sometimes that is the case, but more often than not life is just full of surprising and unexpected turns.

Chronic stress can have a physical impact on the body. Interrupting the sequence of stressful moments with moments of calm and relaxation, i.e. letting go instead of taking control, can lessen that impact. This letting go may at times feel counterintuitive but it produces results. When a series of crushing deadlines looms at work, we can take some time off in between them. A weekend at the beach or the mountains can do wonders for the equilibrium. Distracting oneself with something soothing, such as cooking, knitting, or breaking out the watercolors can bring a smile to our face and a balm to the soul. And if taking off an entire afternoon is just not in the cards, just getting out for a walk can be a powerful stress reliever. Even a short stroll can make a difference.

6 Worst and 6 Better Ways to Manage Time

How much can time management cost in terms of stress and health risk? It depends on how we choose to manage it. Some choices appear more effective but have short-term benefits and high cost. Others appear lower in stress and health cost but do not seem to use time efficiently. What’s the right answer?

Let’s look at some of the most popular time management approaches, their costs and benefits in terms of allostatic load and stress-related health risk, and an estimate of their long-term effectiveness in getting things done.

  1. Manage time resources allowing for ample relaxation time and with the goal of avoiding all stress.
    couchpotatoAllostatic Load: Probably low to very low.
    Stress-related Health Risk: Probably low. There may be other health risks connected with low physical activity levels.
    Long-term Effectiveness: Probably not great at getting things done in a timely manner.
    Not all stress is bad and to be avoided. We experience the stress reaction not only in terms of frustration and anxiety, but also as excitement, thrill, energy and useful motivation. The attempt to eliminate all stress from our life would run counter to our biopsychosocial nature, which requires stimulation, interaction and activity.
    The Better Way: Achieve balance between work and relaxation, family and job demands, personal time and social time, activity and rest.
  2. Manage time resources on a moment-to-moment basis with little or no planning ahead because planning itself just takes more time. frantic-harrison-ford1
    Allostatic Load:
    Probably high.
    Stress-related Health Risk: Probably high, as stress symptoms may be ignored.
    Long-term Effectiveness: Probably very good at getting some things done in the short term, giving the illusion of long-term efficiency.
    Frantically going from crisis to crisis, handling each new task as it comes up, without assigning priorities or allocating resources is a reactive approach to time management. It can appear chaotic to the observer. Each new challenge is met head-on and is always “new” because there is little or no provision made in advance.
    The Better Way: Plan ahead for demands and challenges that can be predicted, anticipated and prepared for. Planning indicates self-care, not weakness.
  3. Manage time resources and get more done in less time by using caffeine, sugar, alcohol, nicotine, “energy” drinks or other chemical enhancers. crash
    Allostatic Load:
    Probably high, but masked by chemical “fixes.” Chronic stress.
    Stress-related Health Risk: Probably high, as useful stress signals for rest may be ignored, sleep suppressed, nutrition casual and expedient.
    Long-term Effectiveness: Probably very good at getting many things done in the short term.
    When using chemical means to increase energy and output over what the body can safely handle before needing to rest and replenish depleted resources, quality of output is likely to suffer and efficiency to diminish. The illusion of strength that can be derived from these forms of self-medicating fatigue may be merely postponing a crash,  intoxication, tolerance and, in some cases, addiction.
    The Better Way: Listen to the body’s signals. View natural sleep as vitally important, wisely use times of pause and relaxation to recharge depleted resources. Avoid becoming dependent on chemical substances to function.
  4. Take stress and inefficiencies to mean that there isn’t enough time to get done what needs to get done, and that just having more time would “easily” fix it.
    lastminuteAllostatic Load: Probably high.
    Stress-related Health Risk: Probably high, as stress symptoms may be ignored.
    Long-term Effectiveness: Probably okay to get some things done in the short term, but poor long-term efficiency.
    Actually, a time management problem is not using time to the fullest advantage, and to get done what needs to be done with just the right amount of energy expenditure, no more no less. Simply adding more time slots to the schedule, cramming a full to-do list, and shortchanging quality is a short-term strategy.
    The Better Way: Find an optimal schedule that fits available energy and mental resources levels, and stick to it. Say “no” to some demands as a key to preserving balance between rest and activity.
  5. View being always very busy, and generally busier than others, as a badge of honor and a sure pathway to success.
    workaholic Allostatic Load: Probably very high, chronic stress.
    Stress-related Health Risk: Probably high, as the need for balance may be dismissed.
    Long-term Effectiveness: Can lead to some success in the short term, but may take the highest toll on physical, mental and social health.
    Although this approach is by far the preferred one by type A individuals who take pride in being productive and getting a lot of things done, it has significant drawbacks. There is an an adjective that describes its devotees: workaholic. Being always extremely busy can result in poor allocation of resources, i.e. doing mostly what is considered urgent and too seldom what is truly important.
    The Better Way: Work is a means and not an end unto itself. Success is also measured by other yardsticks besides those of wealth and power. Balance is valued as a smart, resource-efficient strategy for long-term success in all facets of life.
  6. Pursuing time management strategies that ignore the truth: I feel pretty good, I am getting things done, so I must not be too stressed.
    IBS Allostatic Load: Probably very high.
    Stress-related Health Risk: Probably high, symptoms of stress go unnoticed.
    Long-term Effectiveness: Can lead to some success in the short term, but may take a high toll on physical, mental and social health.
    In reality, many adults don’t even know when they are at dangerously high stress levels until their bodies tell them so in a dramatic way, e.g. when sudden chest pains lead them to the nearest emergency room. It is easy to miss the early warning signs of chronic stress, as long as coping still works, more or less. Many psychosomatic illnesses are directly related to stress and overwork but are attributed to other causes or even ignored altogether.
    The Better Way: Listen to the body’s signals. View pain as a precious ally that alerts us to something in our system that requires immediate attention, and self-care as more than just a quick fix that kills the signal without addressing the cause.

Hunger, Food Insecurity or Stress?

Is hunger an “alarming” and “dramatic” problem in the United States today? Widespread famine is the impression one might get from headlines in the New York Times (“Hunger in the US at a 14-year high”), USA Today (“1 in 6 went hungry in America in 2008”), and The Washington Post (“America’s economic pain brings hunger pangs”).  In fact, a closer reading indicates not so much a decrease in food availability (which is reported to be at or near historic highs), as much as a decrease in food security. The reason for the insecurity (“Will I have enough food for me and my family?”) has been linked to the current and persistent economic downturn.

maslows-hierarchy-of-needs1Since time immemorial food insecurity has been and continues to be one of the most important stressors of the human race. The innate and genetically programmed need to eat enough food is the primary driving force of human activity. Food is at the basis of the pyramid of needs (Maslow,1943), along with water, warmth, clothing, shelter and rest. It supersedes all other needs, including safety, relationships, self-esteem, and creativity. Which means that, for food, humans will take the greatest risks, go to war with each other, stoop to begging and stealing, and revert into pure hunters and scavengers. Such is the power of the food insecurity drive.

Too Little or Too Much

Depending on type and duration, stress can either increase or decrease food intake. Mental disorders such as depression and anorexia nervosa trigger changes in food intake that are activated by the stress response. The psychological alteration in perceived body image is a factor not only in anorexia but also in obesity; both conditions are associated with a variety of psychological stressors, primarily interpersonal in nature.

When stressed, 70% of individuals experience mild to severe anorexia, whereas 30% tend to overeat. For stressed overeaters, chewing appears to be as important as the actual type, quality or quantity or food. In other words, chewing is reported to be the stress response, rather than the food itself. When the stressor is boredom, overeating appears to be the most common behavior.

Well, I think probably the main reason people overeat is stress.
–Jenny Craig

Here’s a brief technical explanation of how stress influences the brain’s perceptions and contributes to the formation of the food insecurity we often mistake for real hunger.

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