The Compound Interest of Stress

Wood_1930_AmericanGothic What makes chronic stress potentially lethal is its duration and the constant accumulation of its effects. Stress upon stress grows like compound interest on a loan. When only the minimum payment is made, the balance continues to grow and can never be fully repaid.

Humans respond to stressors such as physical or perceived danger, an infection, or a crowded and noisy environment, by initiating a complex biopsychosocial adaptation and coping response. This response is initiated by the sympathetic nervous system and leads to release of excitatory stress hormones (the catecholamines) and glucocorticoids from the adrenal cortex (the well-known adrenaline rush).

The objective is to engage with the situation, resolve it and return to the status quo. This process of regaining stability through change and adaptation is called allostasis. The arousal and mobilization of biopsychic resources is intended to be temporary and is shut off when the challenge has passed.

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Research News: Can Stress Kill?

Waterhouse_1888_LadyShalott_Tate Copenhagen – Researchers assessed the effect of psychological stress on total and cause-specific mortality among men and women. Danish participants in the Copenhagen City Heart Study were asked two questions on stress intensity and frequency in 1981 and were followed in a nationwide for twenty-three years. The results show that men with high stress had higher mortality. This finding was most pronounced for deaths due to respiratory diseases, accidents, and suicide. High stress was related to a significantly higher risk of heart disease mortality for younger men. In general, the effects of stress were most pronounced among younger and healthier men. No associations were found between stress and mortality among women.

American Journal of Epidemiology. 2008;168(5):481-491.

The Cardiopsychology of Stress

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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


The Changing Face of Stress: Who Me? Worry?

14938596 Worried_Bernanke

There is a new way of managing stress and it’s called “don’t worry, be happy!” Yes, I know the Bobby McFerrin song that hit #1 on the charts before the French Revolution, that is, way back in 1988. This is 2010, however, and it’s way more than just a popular song.

It is the new creed of the Why Worry Generation, as it has been aptly named, which is also known as Generation Y or simply Generation Me. It is composed of the young people who grew up in the boom-and-bust years, that have known Columbine, September 11, and the biggest recession since the Great Depression. They have seen their parents lose their jobs, their bank go bust, their family savings evaporate; many have had their homes foreclosed. They have also experienced the skyrocketing cost of school, saw gas seesaw up to almost $5 per gallon and back. They have seen Katrina, the big spill in the Gulf. They have lived through Desert Storm, Iraq, Afghanistan. Many have died or been wounded there or know someone who did.

And yet, they are optimistic. They are positive about the future. Despite the fact that there are no jobs available. That the graduating classes of ‘08, ‘09, and ‘10 have had an increasingly hard and frustrating time in finding any decent job, let alone a good paying one or one with career advancement opportunities. That their parents and anyone older than 40 is walking around with good reasons to be gloomy and depressed.

These young adults seem to exude positive self-regard, ooze self-esteem, and a resilience that older generations may dismiss as foolish and reckless. Their self-confidence seems unfazed by having to live at home instead of getting their own place, or even having to move back into their parents’ home after a brief stint on their own.

There is another explanation for this resilience in the face of a steady barrage of bad news. It may be the result of adjusting to high stress levels and, over time, building up tolerance for change and uncertainty. This is what is predicted for individuals who are able to accept and rationalize adversity and turn it into a learning experience, instead of being destroyed by it. It is the ability to use the stress reaction to produce an adequate response to challenging circumstances.

So unlike the Greatest Generation, the Millennials, and of course the Baby Boomers, this generation is making good use of stress, making the changes that are called for, and refusing to worry or to feel sorry for themselves. Way to go, guys!

How Owning a Dog Extends Your Life

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

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

Oxytocin: The Baby-love Puppy-love Hormone

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

The Study: Dogs Have Feelings of Love, Too

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

The 5-point, 45-second Stress Management Training Program

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Reduced to its most essential and most consequential points, here’s the absolute beginners stress management training course:

1. When we perceive a physical or emotional stressor, our body reacts immediately by producing the natural stress response, which is a vital survival mechanism. After the threat passes, the body returns to its normal state.
2. In contrast, the chronic stress response continues beyond the immediate threat, therefore exposing us to emotional and physical health risks.
3. Most frequently, it is psychological (rather than physical) stressors that activate the stress response long enough to produce health consequences.
4. The power of emotion-based psychological states to disrupt normal stress arousal and then return to normal means that our thoughts and emotions have the power to make us sick. Effective cognitive, emotional and behavioral management of stress is therefore critical to our health.
5. Intentional management of stressful thoughts and emotions decreases the risk of prolonged activation of the stress response and increases the effectiveness of behavioral responses to stressors.

My even shorter summary: practice safe stress.

Business of Stress: Self-efficacy Predicts Success

StradaCampoImperatore In the demands-control model of occupational stress a situation is created whereby high demands are placed on the individual with little opportunity to exercise control over the work environment or the task design. This is the most common type of workplace stressor and it has been shown to have an impact on cardiovascular health. But is the problem simply a matter of demands/control stress diathesis? Why isn’t everyone succumbing to heart disease? Indeed, many individuals seem to thrive even in work environments where personal control is minimal and job demands are chronically high. How?

At least a partial explanation can be found in self-efficacy. Self-efficacy is the perception that personal resources are adequate to meet life’s demands. Even in situations of low control/high demands, adequate self-efficacy can act as an important protective factor.

When personal resources are perceived as lower than perceived job demands, low self-efficacy results. Task demands are felt to exceed coping abilities, which often creates emotional and physiological overload. Prolonged exposure to occupational stress with low self-efficacy increases vulnerability to burnout, which is characterized by physical and emotional exhaustion, interpersonal difficulties, apathy toward personal accomplishment, and occupational disengagement through cynicism about the importance or worth of one’s work contribution.

Individuals with adequate self-efficacy believe that their available personal resources are sufficient and may even exceed what is required by their workloads. In day-to-day work activities, this belief in one’s adequate resources accompanies the process of assessing tasks and personal capabilities: in most instances, the perceived balance is in favor of having more than what it takes and the task is undertaken with vigor and confidence. Read more

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:

The History of Stress In Very Small Bites: 4

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

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

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

Are you a human being or a human doing?

When I make a mistake, forget something, mess up something or miss an appointment… is it just what I do sometimes, or does it say something about who I am? This is a crucial question whose answer can make a difference between a healthy or a not so healthy opinion of one’s self. Answering the question requires an understanding of the difference between “being” and “doing.” It is the being that determines a person character, true personality and, ultimately, his or her true self. It is the doing that often is out of character and does not accurately reflect the personality or the true self. The problem is, the doing is often confused with the being. Said another way, what a person does is often confused with who that person really is. Think of it this way: mistaking the doing for the being can lead to a misunderstanding of the person in almost every case. Take for example the immoral, cheating, antisocial individual who writes a large check to a charity and then receives a public recognition of generosity. Or, the church-going, honest, and caring individual who drives by a person in need and does not stop to render aid. Both individuals simply do or don’t do something in a specific situation. Their doing, however, can be interpreted by an observer as representative of the individual’s character, personality or true being, without it being the case. When the doing is not sincere or reflective of the true being of a person, it does not stand the test of time, the test of consistency, or both. In the first example, the evil nature of the individual may never become known to the charity that received the donation, but it is certainly going to be known to anyone who interacts with this person on a regular basis because the true being can never stay hidden for very long. In the second example, the good nature of the individual may not be reflected in the failure to stop and help but it would be known to others who see this person being good in many other situations. So, as far as a person’s social image is concerned, the difference between what people occasionally may do and who they truly are is straightforward: time and consistency will always tell the tale.

There is, however, another more significant problem that affects all individuals who do not understand the difference between what they do and who they are. They tend to misinterpret their own occasional or inconsistent actions as being reflective of their true being. In one scenario, they may form an opinion of themselves which is narcissistically positive by focusing on their occasional good deeds and conveniently ignoring their more frequent missteps. In another scenario, they may have an overwhelmingly negative view of themselves by focusing on their occasional (but perceived as too frequent) missteps and ignoring their good nature, sound character or engaging personality. Either positive or negative misinterpretation of a person’s true being is produced by focusing attention on infrequent, occasional, or inconsistent behaviors. Evaluating a person, or one’s self, based on too few observations (or data points) can lead to the wrong conclusion. A good example of this type of evaluation is that of a new couple who has just fallen in love with each other. Both parties, temporarily blinded by love, need, want, passion, lust or a combination thereof, may gather very little “hard data” on the other person and pay an inordinate amount of attention to what the other person does, misunderstanding his or her actions as being consistent, stable over time, and reflecting of the person’s true nature, character and personality. In many cases, thank goodness, this turns out to be true: he or she IS truly wonderful, and not just temporarily doing wonderful things. In some other cases, however, after the honeymoon is over and things settle down, the behaviors that are inconsistent with the person’s true being become rarer, while the behaviors that are reflective of the person’s true being become more frequent and consistent. At this stage, either the couple accept each other’s finally discovered true being, or they break up.

The hard truth in all of this: the opinion that I have of myself and others must be based, to be valid and usable, on time and consistency of behavior. The good news: this opinion can be changed (and indeed should be changed) on the basis of acquiring additional information on the true nature of the self or on that of others. In individuals who suffer from low self-esteem the opinion they have of themselves is often distorted by a negative observational bias: what they “do wrong” matters far more than who they truly are. The perverse reality in this is that, often, what they “do wrong” is based on their own poor observational skills, on a misinterpretation of motive, or a harshness toward the self that is frequently unjustified. They will say negative things to themselves such as, “I am such a failure, I always mess things up, I can’t get anything done, I am so stupid,” at every turn, many times, every day, no matter the circumstances. What they do becomes a definition of who they are which is far from being objective, measured or consistent with their true being. How many otherwise fairly successful, decent, good human being are walking around believing themselves to be otherwise and are therefore fighting depression, anxiety, and pessimism?

To break this cycle of despair, to change one’s opinion to a more balanced view, to truly find out that what we sometimes do is not the same as who we consistently are requires introspection. It is only by taking a look at our actions in context that we can see the many variables that have caused us to behave a certain way: the lady did not stop her car to help the person by the side of the road because she was traveling through a neighborhood that she deemed unsafe, or because she was running late to pick up her son, or a variety of other legitimate reasons. The man who gave to the charity did so to gain the advantage that an image of generosity could provide to him in certain business deals, or to impress a would-be girlfriend, or to soothe guilty feelings caused by a previous misdeed. Ascertaining our true self also requires honesty of intent, whereby we seek objectivity in knowing who we really are so that we can change what we can, accept what we cannot, and have the wisdom to know the difference.

Faith And Stress: The Connection

My view is that "bad" stress is handled through scripture, prayer, and faith. That is not naïve but a way to perceive the circumstances of life which would invade our peace and joy. –Doyle Kee

Hurricane at The belief in the existence of a supernatural being who has
a plan for each human being, and the opportunity to connect with others who share the same belief, can be powerful relievers of the stress of life. The psychological appeal of faith is beyond dispute: there are over 100,000 registered religions in the United States alone, and membership is constantly on the rise. An even greater number of people accept a form of personal spirituality which includes the belief in a higher being, without subscribing to any one specific movement.

Religious belief and affiliation appear to rise significantly in times of severe stress. Some of history’s most prominent, and some of the most unusual and charismatic, religious movements have arisen in times of great political, economic and societal turmoil. In times of war, widespread famine, poverty and natural disasters, and impending death and illness nearly all religious groups have seen and continue to see their appeal grow.

Sigmund Freud, in his book on The Future of an Illusion admitted, without accepting it, that faith in God could reduce psychological stress. Carl Marx famously stated, “religion is the opiate of the masses” in the introduction of his book Contribution to Critique of Hegel’s Philosophy of Right. And we can certainly consider the meaning attached to faith by the 9/11 suicide bombers who went to their death (and took many with them) as a testament to the power of their religious fervor.

The Connection Between Faith and Stress

Research has shown that faith in a supernatural being, with all its corollaries and attributes, appears to be particularly effective in relieving certain specific psychological stressors. Here are the most important ones:

  • Psychological and physical escape from stress: religious organizations offer physical as well as spiritual shelters where food, clothing, and healthcare are available, along with social support, structure, and spiritual guidance.
  • Consolation, devaluation of and disassociation from the illusory trappings of the material world, and the ephemeral appeal of beauty, money, success.
  • Appealing models of resilience and positive outcomes in the face of life-threatening stressors.
  • Cognitive and dialectical techniques that are useful in coping with stressors, such as individual prayers, group rituals and collective petitions. Nearly all religious movements provide ways of giving voice to individual and collective distress, including the fast-growing Internet-based churches.
  • Explaining the inexplicable: in a world that seems ruled by chaos and administered by randomness, faith in a superiorly organized universe is an appealing provider of stability. By prayer, penance, code, dietary laws, rituals, or positive thinking, faith-based movements promote a sense of personal control.
  • A meaning to life and to life’s end. Faith can promote a hopeful and optimistic outlook with its emphasis on a more peaceful (and stress-free) existence and its promise of life after death.
  • A refuge from aloneness and abandonment. The profoundly comforting sense of belonging to a community of mutual love and support, and the incomparable feeling of being loved unconditionally by someone who epitomizes love and trust are perhaps the most appealing attributes of faith.

As an intensely personal experience, faith remains beyond the investigation by scientific means. In psychological terms, faith can positively influence us in cognitive and emotional terms, in the way we come to perceive ourselves, our world, and our future. When embraced sincerely and whole-heartedly, it can become an important protective factor against the effects of stress in our lives.

Generalized Anxiety: The Logic of Unending Gloom

I am sure there is a reason why things keep going the wrong way. Once my grandmother told me that I looked like someone who would never be happy. I still remember her saying that, her tone of voice was so… matter of fact. All I have to do to believe her is to look at my relationships: it’s like looking at a trailer park after a tornado. (…) Oh my so-called career… let’s not even go there. (…) I had so many dreams when I was a kid. Where have they gone? I can’t even dream anymore. Heck, I can’t even sleep. (…) And my health! Every bone in my body screams bloody murder… I panic just thinking about going somewhere. (…) Why can’t I just be happy?

These statements (taken from a variety of similar cases) are representative of the way of thinking that is characteristic of individuals suffering from a stress disorder. They are so categorical–and, in the patient’s view, so logical–that anything anyone could say or do would appear to be just another futile attempt at fixing the irretrievably broken. The gloom can be so palpable and real that it falls over the therapy room like a cloak.

vanGogh_1889_StarryNight_MOMANY The apparent logic of these statements requires the experienced therapist to apply a judicious dosage of empathy and attunement while gently challenging their validity, in order to establish a positive therapeutic relationship.

Unfortunately, this type of personal narrative is not uncommon. In fact, most individuals who come in for help on issues of depression, anxiety, and stress disorders have a similar presentation. In some cases, the symptoms are focused on a specific stressor, but in many cases

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Of Mel Gibson, Narcissus and Stress

mel-gibson-oksanaA sad pattern seems to be emerging: as Mel Gibson becomes distressed, some self-medication ensues, allegedly alcohol. The medication, instead of solving the problem, appears to merely loosen Mel’s inhibitions and he unleashes a now painfully public tirade laced with profanity, discrimination, and sexism. In many quarters, his behavior has been described as the epitome of narcissism. But is this really his problem? Let’s consider the story of Echo and Narcissus.

In the vicinity of Mt. Olympus, about 2,500 years ago, the sylvan nymph Echo fell in love with Narcissus. Narcissus was an uncommonly handsome and incredibly vain man who would live on beyond Greek mythology and become the eponym of self-centeredness. He rejected Echo’s love with such callousness and contempt that she died of a broken heart. Apollo, angered by Narcissus’ vanity and cruelty, cursed him to die without ever knowing human love. Not too long afterwards, as a thirsty Narcissus went to a pool of clear water and knelt beside it to drink, he saw his face reflected on the surface of the water and fell in love with it. Unable to reach the image in the water, Narcissus continued to stare at it forgetting everything else, and eventually died beside the pool.

From ancient tale to modern problem, the term narcissism today describes a mental disorder that is characterized by an excessive positive self-evaluation and near-total lack of consideration for others. As a personality type, a narcissist is prone to a grandiose evaluations of self, a constant preoccupation with success and power, an exaggerated sense of entitlement, and an exploitative approach to others. A narcissistic personality shows an enduring pattern of personal adjustment characterized by grandiosity, need for attention and admiration, and a lack of empathy. Individuals with this disorder believe that they are special and are excessively envious of others while being preoccupied with their own achievement and power.

Freud believed narcissism originated in childhood, making it particularly difficult to treat in adults. There is much controversy as to the core problem in narcissism. Some believe it may be primarily an emotional problem; others view it as a cognitive deficit, i.e. the narcissist’s inability to construct an accurate view of self. A third school of thought theorizes that a narcissist is cursed with an ‘‘empty’’ sense of self; yet another group argues that the narcissist may have a ‘‘disorganized’’ self.

The problem that originates all these theories as to the origin of narcissism is produced by the lack of accurate measurements of its impact and severity. Narcissistic people do not admit their problems when asked. When diagnosed, they are very reluctant to cooperate with the treating therapist. In fact, they are widely considered by clinicians as among the most intractable of mental health patients.

In the most recent large-scale research, Russ, Bradley, Shedler, and Westen (2006) have produced evidence that a clinical distinction may be made between grandiose narcissism, characterized by genuinely inflated views of self and a need-gratifying approach toward other people and relationships, and fragile narcissism, characterized by explicit grandiosity paired with feelings of inadequacy or self-loathing.

So where can we place Mr. Gibson along the continuum from normal self-evaluation to narcissism?  If there is narcissism in his personality, would it be the grandiose, or rather the fragile type? Without falling into the trap of long-distance diagnosis, a few comments can be made on his reported behavior. First, if there is self-medication with alcohol as has been reported, the something that is being medicated hurts, perhaps deeply, at the emotional level. Relationship problems, as they have been reported to exist, invariably cause emotional reactivity and chronic sympathetic arousal, i.e. chronic stress. The combination of stress and the disinhibiting effects of self-medication can produce a state of mind that exacerbates any feelings of entitlement, lack of empathy for others and an exploitative approach to problem-solving (a condition popularly known as an amygdala hijack).

It would seem that there is a match with Mr. Gibson’s recently broadcast telephone rants.

eClass 4: Best and Worst Food For Stress

Italy_Tuscany2 How, when, and what we eat tells a lot about who we are. It also says a lot about how well we handle our stress reaction. Food can help or hurt our coping abilities and thus make a difference in how well we respond to stressors.

Food intake is one of the critical factors ensuring adequate growth and development in all species. Just ask my puppy dog where food ranks on his daily list of priorities! In particular, brain development is sensitive to specific nutrient intake such as proteins and fats, which are important for cell membrane formation and myelinization.

A surprising amount of the stress we may experience on a daily basis can be caused by the chemicals we consume in our food. By eating, drinking or inhaling certain substances we can put our bodies under elevated chemical stress. Similarly, if we are eating an unbalanced diet we may be stressing our bodies by depriving them of essential nutrients.

Eating too much of certain high-calorie foods for a long period is a leading cause of obesity. How much food is consumed as a stress reliever? Gaining too much weight puts our heart and lungs under stress, overloads our organs and reduces stamina. It may also significantly shorten our lives.

Stress reactions are a pervasive factor in everyday life that can critically affect our development and functioning. Severe and prolonged exposure to stressors can have a negative effect on our balance mechanisms.

Let’s look at some of the most important effects of food on our psychological state right after the jump.

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Stress Hardware Reviews: The Hippocampus

clip_image001What brain structures rouse us from inactivity and set in motion our defense mechanisms when a stressor is perceived? Predictably, the brain’s older and more primordial area, the so-called animal brain, where the hypothalamus, the amygdala, the hippocampus, the septum area, the basal ganglia and the thalamus are located. These structures, collectively called the limbic system, are interconnected and work together to initiate motor and other functional activities of the brain that mobilize the body. In this post about stress hardware, we discuss the hippocampus.

Virtually any experience perceived by the five senses appears to cause the activation of at least some part of the hippocampus. The hippocampus in turn redistributes these sensory signals to the thalamus, the hypothalamus, and other parts of the limbic system. Thus, the hippocampus acts as an important switching center through which incoming sensory signals are retransmitted and initiate behavioral reactions for different purposes. Its importance has been demonstrated empirically: experimental artificial stimulation of the hippocampus can induce a wide variety of behavioral patterns such as pleasure, rage, passivity, or excessive sexual drive.

The cells of the hippocampus appear to be especially sensitive to the effects of various stressors. Although not directly involved in the stress response, its ventral regions appear to exercise a regulatory influence on the hypothalamic-pituitary-adrenal (HPA) axis activity and are also a primary target for elevated glucocorticoid levels. The glucocorticoid hormones owe their name to their important effects on blood glucose concentration, which is the principal source of energy of the human cell. They also regulate protein and fat consumption, and the utilization of carbohydrates to produce additional quantities of energy. Cortisol is the principal glucocorticoid. Read more