Forced to Lie About Stress

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

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

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

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

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

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

Optogenetics Discovers Brain Anxiety Circuit

AmygdCingGyrusThe state of heightened apprehension and high arousal in the absence of immediate threat—commonly labeled as acute stress or anxiety—can be a severely debilitating condition. Over 28% of the population suffers from anxiety disorders that contribute to the development of major depressive disorder and substance abuse. Of all the structures of the limbic system, the seat of emotion processing, the amygdala plays a key role in anxiety, although by what exact mechanism still remains unclear. Newly published research carried out by a group of neuroscientists at Stanford University using the novel technique of optogenetics with two-photon microscopy has permitted a much closer exploration of the neural circuits underlying anxiety than ever before. The optogenetics approach facilitates the identification not only of cell types but also the specific connections between cells. The researchers noticed that timed optogenetic stimulation of the basolateral amygdala (BLA) terminals in the central nucleus of the amygdala (CeA) produced a significant, acute, and reversible anxiety-reducing effect. Conversely, selective optogenetic inhibition of the same projection resulted in increased anxiety-related behaviors. These results indicate that specific BLA–CeA projections are the critical circuit elements for acute anxiety control in the brain. The results were published in the March 17 issue of the scientific journal Nature.

A Closer Look at the Amygdala’s BLA and CeA Regions

BasolateralAmygdalaThe amygdalae (amygdaloid nucleus) are two identical almond-shaped brain structures located in each temporal lobe. Each amygdala receives input from the olfactory system, as well as from visceral structures. The amygdala in humans has been confirmed by functional MRI imaging to be the area of the brain that is best correlated with emotional reactions and plays a key role in the brain’s integration of emotional meaning with perception and experience. The emotional aspect of the response of the individual is passed on to the frontal cortex, where “decisions” are made regarding possible responses. In this way, the response of the individual can take into account the emotional aspect of the situation.

Additionally, the amygdala coordinates the actions of the autonomic and endocrine systems and prompts release of adrenaline and other excitatory hormones into the bloodstream. The amygdala is involved in producing and responding to nonverbal signs of anger, avoidance, defensiveness, and fear. The amygdala has been implicated in emotional dysregulation, aggressive behavior, and psychiatric illnesses such as depression. It has also been shown to play an important role in the formation of emotional memory and in temporal lobe epilepsy.

The basolateral amygdala, one of the two structures studied in the recent Stanford research, receives extensive projections from areas of the brain cortex that are specialized for recognizing objects such as faces in central vision. Extensive intrinsic connections within the amygdala
promote further coordination of sensory information.

Biological effects initiated by amygdala include increases or decreases in arterial pressure and heart rate, gastrointestinal motility and secretion, evacuation, pupillary dilation, piloerection, and secretion of various anterior pituitary hormones, especially the gonadotropins and
adrenocorticotropic hormone, which are key agents in the stress reaction. Interestingly, amygdala stimulation can also cause several types of involuntary movement, such as raising the head or bending the body, circling movements, occasionally rhythmical movements, and movements
associated with taste and eating, such as licking, chewing, and swallowing.

LimbicSystemGeographyThe findings also show the involvement of the amygdala’s CeA region in mediating threat-related anxiety and acute fear-related behavioral and hormonal responses. Earlier studies had shown that stimulation of this same area reduces snake fear and pituitary-adrenal activity and that CeA lesions resulted in decreased expression of threat-induced freezing. Additionally, the CeA region of the amygdala was reported as being significantly involved in the consolidation of contextual fear memory, i.e., what permits us to remember so vividly and persistently objects or situations that have caused fear in us in the past.

The Overwhelming Stress of Paranoia

My spouse and I have been married for several years and we have beautiful children. Beginning some time ago, and following some life events and difficult circumstances that have occurred to us and between us, my spouse has begun suspecting me (and accusing me) of having an affair, trying to hide financial assets, threatening physical harm, wanting to hurt the children, tapping the phone, bugging the house with cameras and listening devices, not loving, planning on leaving for someone else.  I haven’t done any of these things.  I love my spouse with all of my heart, but this is definitely taking a toll on me.  I am now locked out of the house and there is a restraining order preventing me from contacting my spouse or my kids.  I remember that when we first met I noticed a slightly paranoia, which now has gone off the deep end (at least with respect to me, while still being fairly rational and normal with everything else.)  My spouse will not talk to me at all, throws away my letters, deletes my emails and accuses the counselor we were seeing of lying and now won’t go to a counselor either.  What should I do?

paranoiaIt is likely that your spouse may be suffering from a paranoid disorder. This is a condition that tends to get worse over time, since in many cases its underlying cause affects the brain much like a degenerative neurological disorder.

Some people exhibit signs of paranoid thinking at an early age, which may indicate an early psychological trauma. In one typical case, a patient seen for the first time at the age of 16 had a serious head injury when she was 6. She is now 38 and on certain occasion manifests some paranoid symptoms, but is married with three children and has steadily improved throughout her lifetime. It’s a relatively rare but encouraging example of how paranoia can remit almost completely in a supportive and caring environment.

Many patients with serious paranoid disorders eventually divorce their spouses, despite efforts by everyone who cares for them, including their loving spouses, in trying to stop them. The patient’s therapist, minister, friends, relatives and spouse may go to truly extraordinary lengths to try to prove that the paranoid fears are unfounded, but “proof” very rarely has any lasting effect.

Certain medications can help control paranoid thinking, particularly when the person is experiencing schizophrenic or manic symptoms along with being paranoid. In a pure state of paranoid thinking, without any psychotic or manic symptoms, however, medication has been shown to propduce only minimal improvement. Talk therapy is also somewhat unsuccessful, although there may be instances of nearly full recovery.

People who suffer from paranoid thinking don’t give their spouses too many chances to regain trust. It is possible that paranoid patients may let tjheir spouse back into their world again. If they do, it is important to spend as much time together as possible and be completely transparent about one’s activities and whereabouts. The more time spent with paranoid spouses, the less chances they have to imagine what one could be doing behind their back. Also, stress clearly increases paranoid thinking, and when the couple is together there is generally less wondering and therefore less anxiety.

For a while, the healthy spouse may experience singificant stress from all the accusations, and these may even cause significant anger and resentment. But it is useless to argue. Often, what works best is to reassure the spouse of love, and promise to never leave. This may calm the situation, at least temporarily. Also, it is important to call regularly throughout the day. The more of your time given, especially when it is in the form of undivided attention, the fewer symptoms you are likely to occur.

People with a paranoid disorder imagine all sorts of plots designed to do psychological, financial, social or even physical harm to them. Some are dangerous to live with because they are convinced their spouses are planning to kill them. There are documented cases of paranoid patients who have tried to kill their spouses in what they think is “self defense.” Whenever a patient who threatens to kill their spouse, a separation is a must, until there is clear evidence of remission.

If there does not seem to be any danger, the healthy spouse should make every effort to reunite with the spouse. In many case there is a positive response within a few weeks, or at the most, a few months.

It is advisable to make repeated efforts to talk, and when possible, reaffirm love. It is important to always stick to the truth, refusing to go along with any paranoiod fantasies just to try to get along. If the paranoid spouse demands a confession of having done some imaginary transgression, gently state that you would never do anything to inflict intentional hurt. Give regular reassurance that you care and don’t let yourself become so frustrated that you end up saying something that would would contribute to hurt feelings.

Humor: The All-Natural Remedy Against Stress

GinettoA stress reaction to challenging people and situations may be expressed by anger, hostility, aggression or seething inward rage. These instinctive reactions have their obvious drawbacks, but are altogether too common. There are other, more adaptive and sublimated responses (see this post for a complete list) that can turn angry reactions into assertiveness, the ability to effectively stand up for one’s rights, to engage in a respectful and yet passionate discussion of opposing points of view, an energy-releasing all-out workout at the gym, or humor. There is an abundance of evidence that proves the therapeutic value of humor. When used appropriately, this 100% natural remedy against stress is an adaptive, cathartic release of tension, a safe outlet for hostility and anger, and an effective defense against depression. Moreover, humor not only indicates emotional intelligence but also causes healthy neurological, immunological and physical changes. The mere act of laughter immediately increases muscular and respiratory activity, elevates the heart rate and stimulates the production of anti-stress hormones.

What Psychologists Say About Humor

American psychologist and psychotherapist Gordon Allport, in his research The Nature of Prejudice reported that 94% of people he questioned said their sense of humor was either average or above average. Allport stated that “the neurotic who learns to laugh at himself may be on the way to self-management, perhaps to cure” (p. 280).

American existential psychologist and author Rollo May, in Existence, suggested that humor has the function of “preserving the sense of self. . . It is the healthy way of feeling a ‘distance’ between one’s self and the problem, a way of standing off and looking at one’s problem with perspective” (p. 54).

mans-search-for-meaning-viktor-franklAustrian neurologist, psychiatrist and Holocaust survivor Viktor Frankl, in his best-selling autobiographical Man’s Search for Meaning, shared as his learned experience that, “to detach oneself from even the worst conditions is a uniquely human capability.” He specified that this distancing of oneself from aversive situations derives “not only through heroism . . . but also through humor” (p. 16–17).

American physician and psychologist Raymond Moody (Glimpses of Eternity and Life After Loss: Conquering Grief and Finding Hope), noted for his well-researched studies on grief, loss and the possibility of an after-life, also pointed to the ability to detach oneself as intrinsic to humor: “A person with a ‘good sense of humor’ is one who can see himself and others in the world in a somewhat distant and detached way. He views life from an altered perspective in which he can laugh at, yet remain in contact with and emotionally involved with people and events in a positive way” (p. 4).

What Is Humor?

Humor is expressed in many ways: verbally (a funny story, joke, stand-up routine), visually (a mime’s movements, funny faces and gestures) or behaviorally (slapstick, pie-in-the-face comedy). It can be triggered by a book, hours-long stage or film productions or by just a few words, as in this very short story,

A passenger carried his own bomb onto a plane. When questioned by the TSA, he said that it was for his own safety, because the odds of there being two bombs on the same plane are virtually nil.

What makes this story humorous? The stress-relieving fun of it lies in the entirely natural and universal human need to seek safety and reassurance, which is however expressed by integrating two contradictory beliefs, no matter how absurd the result. In fact, it is the absurdity or incongruity of the synthesis that is the essence of humor.

Humor is therefore a mental capacity, the skill of discovering, expressing, or appreciating the ludicrous or absurdly incongruous. Its effectiveness, i.e. the difference between funny and inappropriate, depends on the incongruity between what we expect to happen or to be said and what we perceive with our senses. Not all incongruity is humorous: in addition to being there, the incongruous must also be meaningful or appropriate, and must be at least partially resolved.

Humor and Human Development

BabyLaughingIn developmental psychology, humor is a form of play expressed by the manipulation of images, symbols, and ideas. Humor can be detected in infants of about 18 months of age who have acquired the ability to manipulate symbols and objects. Some believe that humor may be present in infants as young as four months old if humor is defined as the ability to perceive incongruities in a playful way and accept them without distress.

From a very early age, humor serves a number of social functions. Beginning in early adolescence and into young adulthood, humor can be an effective coping strategy, can reinforce interpersonal connections, or can be used to test the status of relationships.

One of the most important signs of a healthy self-esteem and maturity is the ability to laugh at one’s own shortcomings and mistakes. Most prominently in adulthood, humor is often used to express forbidden feelings or attitudes in a socially acceptable way, a device at least as old as the Renaissance fool or court jester who was, up to a point, allowed to speak of unpleasant truths and openly mock those in positions of authority.

Humor and Mental Health

Flirt_DepressionIt is a recognized fact in mental health practice that the presence of humor in a person’s narrative is a healthy way of reducing anxiety and indicates the ability of reasserting mastery over a situation. Conversely, one of the clear signs of depression is the inability to appreciate or use humor in any situation.

A judicious use of humor ushers in the opportunity to detach from the most painful aspects of a situation, albeit briefly, and exercise some control over its impact by laughing at the seemingly inescapable predicament. This dynamic, psychological attempt at regaining control by interjecting an element of incongruity is concretized in this popular German witticism about two contrasting points of view, “In Berlin, the situation is serious but not hopeless; in Vienna, the same situation is hopeless but not serious.”

{tab=Humor and Pain}
pain-signA 2005 study by Zweyer and Velker conducted at the Department of Psychology, Section on Personality and Assessment of the University of Zurich, 56 female participants were assigned randomly to three groups, each having a different task to pursue while watching a funny film: (1) get into a cheerful mood without smiling or laughing, (2) smile and laugh extensively, and (3) produce a humorous commentary to the film. Their pain tolerance was measured using a cold presser device before, immediately after, and 20 minutes after the film. Results indicated that pain tolerance increased for participants from before to after watching the funny film and remained high for the 20 minutes. Participants low in trait seriousness had an overall higher pain tolerance. Subjects with a high score in group 1 showed an increase in pain tolerance after producing humor while watching the film whereas subjects with a low score showed a similar increase after smiling and laughter during the film.

{tab=Humor and Immunity}

ilovebacteriaThe functions of the immune system that are essential for good health are known to be strongly affected by psychological experiences. Stressful events often result in immunosuppression, which leaves the body highly vulnerable to illnesses. Dillon, Minchoff, and Baker (1985) hypothesized that if stress and negative emotions can cause immunosuppression, it may also be true that humor, a positive emotional state, may be a potential enhancer of the immune system. In testing their hypothesis, they found that laughter induced by a humorous video caused a measurable and significant increase in concentrations of salivary immunoglobulin A (S-IgA), which is often described as the first line of defense against upper respiratory infection. Later research by Dillon and Totten (1989) replicated and expanded on these findings. Working with a group of mothers who were breastfeeding their infants, they found a strong relationships between humor and S-IgA.

Further connections between humor and immune system functioning were established by Lefcourt, Davidson, and Kueneman  in 1990, who found that the presentation of humorous material resulted in increased concentrations of S-IgA. When the humorous material was universally rated by participants as being highly funny (they used the video “Bill Cosby Live” for this research), S-IgA concentrations of most participants increased. However, when the humorous material produced variation in funniness ratings (when they used Mel Brooks and Carl Reiner’s “2000-Year-Old Man” video), larger increases were found only among some of the participants.

Changes in immune system activity with laughter are not restricted solely to immunoglobulin A concentrations. Berk et al., in their 1988 study, reported that mirthful laughter while watching a humorous film was associated with increased spontaneous lymphocyte blastogenesis (production of white cells) and increased natural killer cell activity.

Because immunosuppression appears to commonly occur in stressful circumstances when negative emotions are triggered, these findings would suggest that humor reduces negative emotions and/or increases positive emotions, with a corresponding beneficial effects on the functions of the immune system.

{tab=Humor and Stress}
In addition to interacting with immune system functioning, humor has also been found to influence physiological responses associated with stress. In a landmark study, Berk et al. (1989) examined the effects of humor on neuroendocrine hormones that are involved in classical stress responses. The study participants were asked to watch a 60-minute humorous video during which blood samples were taken every 10 minutes. A control group of people who were not watching the funny video were asked to enjoy 60 minutes of “quiet time” during which they were exposed to neutral stimuli. Blood samples were tested for the presence of eight hormones which usually change during stressful experiences, such as corticotrophin (ACTH), cortisol, beta-endorphin, 3,4-dihydroxyphenylacetic acid (dopac, a metabolite of the neurotransmitter dopamine), epinephrine, norepinephrine, growth hormone, and prolactin. Five of the eight hormones were found to have measurably decreased among participants who watched the funny video, while they remained virtually unchanged in the control group.

The importance of humor in prolonged stress situations, and its effectiveness as a stress-reducer, can hardly be overemphasized. The ability to laugh, not only with others but also at oneself, is a vital skill of survival that promotes better adaptation to adversity. Former prisoners of war have claimed that single instances of a humorous circumstance made them feel better for weeks to months later. A remarkable example of how humor can serve as an emotion-focused coping response in highly stressful circumstances is the case of Brian Keenan, whose powerful book An Evil Cradling: The Five-Year Ordeal of a Hostage describes the way in which he and other hostages in Lebanon used humor to survive their incredible ordeals during five years of captivity.


Mindfulness for Absolute Beginners

aaCarignano_SolferinoMindfulness meditation is the wonderfully effective relaxation technique that along with yoga, tantric meditation, mantra or transcendental meditation, has become an increasingly popular forms of stress management. The therapeutic value of meditation in producing positive effects on psychological well-being and ameliorating symptoms of a number of disorders has become widely studied and accepted. But, what is it and how does it work? Here is a primer for the absolute beginner, to start mindfulness relaxation today!

What Is It? The Way of Breath Awareness

Vipassanā (Pāli) or vipaśyanā (विपश्यना in the original Sanskrit) in the Buddhist tradition means insight into the true nature of reality. Vipassana practice, or insight meditation, makes use of breath to focus attention and to let go of quasi-obsessive analytical thinking, which can be very stressful. Breath is simply used to increase concentration. The focus on breath is a powerful way to redirect attention, because it is always readily available, is directly connected to the stress reaction, and is naturally rhythmic and repetitive. Mindfully redirecting attention to the breath when we feel particularly stressed reduces reactivity and provides a positive physiological feedback system that balances the responses of the nervous system.

How Does It Work? The Benefits of Open Awareness

Open awareness is the core objective of mindfulness meditation. The follo0wing are simple instructions to focus awareness on the breath and is the essence of the mindfulness technique (from Stress Management: A Comprehensive Guide to Wellness by E. A. Charlesworth—read the book review).

  1. Find a quiet place and time. If you prefer, set a timer for 20 to 40 minutes. Become comfortable in your chair, sitting with a relaxed but straight, erect posture that is balanced but not straining. Allow your hands to rest comfortably in your lap. Loosen any tight clothing that will restrict your stomach. Gently close your eyes.
  2. Simply allow your body to become still. Allow your shoulders, chest, and stomach to relax. Focus your attention on the feeling of your breathing. Begin by taking two or three deeper breaths from your diaphragm, letting the air flow all the way into your stomach, without any push or strain, and then flow gently back out again. Repeat these two or three deep breaths, noticing an increased sense of calm and relaxation as you breath in the clean, fresh air and breath out any sense of tension or stress.
  3. Now let your breathing find its own natural, comfortable rhythm and depth. Focus your attention on the feeling of your breath as it comes in at the tip of your nose, moves through the back of your throat, into your lower diaphragm, and back out again, letting your stomach rise and fall naturally with each breath.
  4. Allow your attention to stay focused on your breath and away from the noise, the thoughts, the feelings, the concerns that may usually fill your mind.
  5. As you continue, you will notice that the mind will become caught up in thoughts and feelings. It may become attached to noises or bodily sensations. You may find yourself remembering something from your past or thinking about the future. This is to be expected. This is the nature of the mind. If the thought or experience is particularly powerful, without self-judgment, simply observe the process of the mind. You might note to yourself the nature of the thought or experience: “worry,” “planning,” “pain,” “sound.” Then gently return your attention to the breath.
  6. And again, as you notice your mind wandering off, do not be critical of yourself. Understand that this is the nature of the mind—to become attached to daily concerns, to become attached to feelings, memories. If you find your mind becoming preoccupied with a thought, simply notice it, rather than pursuing it at this moment. Understand, without judging, that it is the habit of your mind to pursue the thought. When you notice this happening, simply return your attention to your breathing. See the thought as simply a thought, an activity that your mind is engaging in.
  7. When you are ready, gently bring your attention back just to the breath. Now bring your attention back into the space of your body and into the space of the room. Move around gently in the space of the chair. When you are ready, open your eyes and gently stretch out.

How Long and How Often? Practice Makes Perfect

Mindfulness meditation, like all things worth doing, requires a certain amount of effort and the setting aside of a certain amount of time. Ideally, 20 to 40 minutes once or twice per day, for at least two months. Daily practice produces the best results in training the mind to shift into a mindful state. Shorter periods of time of 5–10 minutes are very helpful in specific situations, when a quick relaxation is needed. Only practicing mindfulness meditation situationally, however, will work when you have learned the technique well. It may not be as effective in the beginning, when it may take more than 5-10 minutes to relax, particularly in moments of high anxiety or stress.

Female Soldiers At Greater Risk for PTSD

US_Flag_Flying_1Results of a 3-year longitudinal study of 2665 female National Guard soldiers began in 2008 of their mental health status before and after their deployment to Iraq provides new evidence that women have more than twice the risk of developing combat-related posttraumatic stress disorder (PTSD) than their male counterparts, 18.7% vs. 8.7%. Women soldiers, with the same level of combat exposure, are also much less likely than men to feel prepared for combat (14.3% vs. 32.2%) or to take advantage of unit cohesion, which are the two most important protective factors against PTSD.

When we investigated the reasons for this we found men felt much more prepared for combat than women, and they were also much more likely to feel they had the support of their unit than women.—Anna Kline, Ph.D. Principal Investigator, Department of Veterans Affairs–New Jersey Health Care System, East Orange

The results of this study, presented May 17 at the American Psychiatric Association 2011 Annual Meeting, confirm previous studies among the general population, which have shown a higher prevalence of PTSD from all causes among women compared with men. What made this study among servicewomen possible was the higher percentage of female soldiers in combat zones, which in Operation Iraqi Freedom and Operation Enduring Freedom reached a high of 14% of total deployed forces.

According to the researchers, these findings may be more accurate because the study was conducted in anonymity. This factor alone may have improved the reliability of findings, as asking sensitive questions about mental health and substance use among identifiable servicemen and women has been shown to produce less that candid responses.

"The military now has integrated gender-based basic training so men and women do prepare together. However, it is possible that even if they get exactly the same training, their perceptions [of training] could be very different. It is also possible that training is geared more towards the strengths of men, so they feel more prepared to handle the rigors of combat. These are areas that need further investigation," said Dr. Kline.

Stress at 40, Dementia at 60?

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

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

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

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

Can Food Be Stressful? The Evidence

aaRenoir_NiniAuJardinScientific investigators in the 1970s began to ask if a correlation existed between food and behavior. They have discovered quite a few coincidences. New and increasingly more sophisticated studies have revealed the effective existence of a food-behavior correlation in children and older adults. In a review of 10 years of studies conducted between 1985 and 1995, Breakey found evidence of a relationship between what children eat and the way in which they behave. “The most important discovery,” he concluded, “has been the presence—in nearly all studies—of one statistically meaningful variation of behavior as a result of a dietary change” (p. 193). Moreover, these studies have revealed a consistency of response to dietary variations which is also statistically significant. Although other studies have established a correlation between changes in the diet and improvements in hyperactivity and insomnia, Breakey’s unexpected discovery was that the parameter primarily influenced by the intake of certain foods is mood, most of all stress and irritability. According to a recently published study by noted psychoneuroimmunologist Janice Kiecolt-Glaser, diets that promote inflammation (i.e., stress) are high in refined starches, sugar, saturated and transfats, and are low in omega-3 fatty acids, natural antioxidants, and fiber from fruits, vegetables, and whole grains.

A study by Christensen & Christensen investigated the correlation between the course of schizophrenia and national statistics relative to fat consumption. They have found that countries with better prognosis for schizophrenia were those in which the national diet included a higher proportion of fat from fish and from vegetables. In essence, the patients who consumed greater amounts of omega-3 fatty acids showed less severe symptoms, a finding supported by a variety of other studies. If anti-oxidant agents can help in blocking the damage caused by free radicals, the treatment with these food supplements could restore cellular structure. Such a therapy, along with counseling on dietetic factors and lifestyle, could beneficially influence the prognosis of schizophrenia.

New research is also focusing attention on the role that anti-oxidants in the diet may play in the treatment of mood disorders. It is hypothesized that fatty acids may have stabilizing effects on mood with a mechanism similar to that of lithium and of valproic acid, by modifying the pathways of transmission of neuronal signals. In their action on bipolar disorder, they appear to mimic lamotrigine’s mood stabilizing and antidepressant properties. The mechanisms of action must be further clarified, as it is still unclear whether fatty acids show a specific pharmacological effect or a mere compensation of nutritional deficits. The concomitant intake of anti-oxidants vitamins (vitamins C and E) may optimize the effect of fatty acids, further preventing oxidation. A double-blind 4-month clinical study of 30 patients with bipolar disorder has shown the effectiveness of fatty acid supplements in comparison to a placebo (olive oil), added to the usual therapies. The experiment group of patients had a significantly longer period of remission as compared to the control group. Kiecolt-Glaser also cites epidemiological studies that demonstrate significant inverse relationships between annual fish consumption and major depression—the more fish eaten, the lower the prevalence of serious clinical depression.

Adjuvant nutritional therapies have also been studied in patients who showed a relapse despite continuing antidepressant treatment. A double-blind study that added omega-3 or a placebo to the conventional treatment has shown statistically significant improvements in the experiment group in as little as three weeks. Also, melatonin seems to perform as a scavenger of free radicals, beyond its well-known properties of regulation of gonadal function and of biological rhythms (e.g., as a sleep aid). Research data suggest that melatonin may positively influence neurodegenerative processes that are involved in the formation of free radicals and the release of excitatory aminoacids.

Just 14 of the Many Facets of Stress

aaTintoretto_SanGiorgioDragoMRI scans have revealed that children of depressed mothers have a larger amygdala, a part of the brain associated with emotional responses, researchers from the University of Montreal explained in the Proceedings of the National Academy of Sciences (PNAS).

A new study published in the American Journal of Industrial Medicine reveals that the World Trade Center attacks affected the health of the New York City Fire Department (FDNY) resulting in more post-9/11 retirements than expected.

Researchers in the Hotchkiss Brain Institute (HBI) at the University of Calgary’s Faculty of Medicine have uncovered a mechanism by which stress increases food drive in rats.

Do you run when you should stay? Are you afraid of all the wrong things? An enzyme deficiency might be to blame, reveals new research in mice by scientists at the University of Southern California.

Constant bitterness can make a person ill, according to Concordia University researchers who have examined the relationship between failure, bitterness and quality of life.

Listening to music or sessions with trained music therapists may benefit cancer patients. Music can reduce anxiety, and may also have positive effects on mood, pain and quality of life, a new Cochrane Systematic Review shows.

Researchers at Harvard-affiliated McLean Hospital have found that those who believe in a benevolent God tend to worry less and be more tolerant of life’s uncertainties than those who believe in an indifferent or punishing God.

Knowing the right way to handle stress in the classroom and on the sports field can make the difference between success and failure for the millions of students going back to school this fall, new University of Chicago research shows.

An 8-week course of stress-reducing Transcendental Meditation resulted in a 50% reduction in PTSD (post-traumatic stress disorder) symptoms among Iraq/Afghanistan veterans, researchers reported in Military Medicine. The pilot study involved five veterans aged 25 to 40 years with PTSD symptoms – they had all served between 10 and 24 months and had been involved in moderate or heavy moderate combat.

When parents fight, infants are likely to lose sleep, researchers report. "We know that marital problems have an impact on child functioning, and we know that sleep is a big problem for parents," said Jenae M. Neiderhiser, professor of psychology, Penn State. New parents often report sleep as being the most problematic of their child’s behavior.

By helping people express their emotions, music therapy, when combined with standard care, appears to be an effective treatment for depression, at least in the short term, said researchers from the University of Jyväskylä in Finland who write about their findings in the August issue of the British Journal of Psychiatry.

Young adults whose mothers experienced psychological trauma during their pregnancies show signs of accelerated aging, a UC Irvine-led study found. The researchers discovered that this prenatal exposure to stress affected the development of chromosome regions that control cell aging processes.

A child who has a psychological adversity or a mental disorder that starts during childhood has a higher chance of developing a long-term (chronic) physical condition later on, researchers from the University of Otago, Dunedin, New Zealand reported in Archives of General Psychiatry. The authors explain that child abuse has been linked to a higher chance of adverse physical health outcomes.

Individuals with anxiety-related symptoms who self-medicate with drugs or alcohol have a higher risk of having a substance abuse problem and social phobia, researchers from the University of Manitoba, Winnipeg, Canada, revealed in Archives of General Psychiatry.

Best Omega-3 Against Depression

aaInness_1878_AutumnOaksThe polyunsaturated fatty acid omega-3 is an important weapon in combating inflammation, the principal cause of stress-related illness. However, when it comes to helping lift depression, not all types of omega-3 fatty acids are equal. According to a study presented at the 49th Annual Meeting of the American College of Neuropsychopharmacology which took place Dec. 5-9 in Florida, only eicosapentaenoic acid (EPA) has been shown to produce significant mood improvement in patients with depression. The other type of omega-3 fatty acid, docosahexaenoic acid (DHA), has no effect on depression.

The two omega-3 fatty acids EPA and DHA are found together in food (primarily fish and nuts) in a 1:1 ratio, but man-made supplements contain either EPA or DHA or a combination of both, in a ratio that may favor one vs. the other and may vary by manufacturer. In order to take advantage of omega-3’s antidepressant effects, it is therefore important to choose supplements that have an EPA-predominant formulation.

Among the many Omega-3 supplements that are rich in EPA for antidepressant effects, some of the highest rated are NutraSea Herring Oil (with a 3:1 EPA to DHA ratio), AST Bioactive Omega-3 EPA Amino Hybrid (with a 5:1 EPA to DHA ratio), and Pharmax High EPA Fish Oil.

Stress Hardware Update: Limbic System 2.0

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

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

The Hypothalamus: The Central Autonomic Controller

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

The Amygdala: The CPU of Emotional Response

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

The Hippocampus: Memory Chips and Orientation

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

The Orbital and Medial Prefrontal Cortex: Food and Personality

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

The Cingulate Gyrus: The Cement of Society

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

The Ventromedial Striatum, Ventral Pallidum, and Medial Thalamus

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

Nucleus Basalis (of Meynert)

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

Disorders of the Limbic System

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

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

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

The #1 Reason Stress Is My Friend

TheStresshacker_142x160 Stress has been my friend for years. Not always a pleasant friend, and often an uncomfortable one—even downright painful, occasionally. Many times stress has come around with bad news, many times with good news, and always when something new, unexpected, or different was happening or about to happen.

Nowadays, stress and I know each other well but I must confess that when we first met I wasn’t very impressed. For a long time I considered the chances of having a good relationship with stress quite remote. In fact, I thought of it more as an enemy, and a dangerous one to boot. I know now that my bad attitude toward stress and my refusal to accept its friendship was simply because I did not know any better. Once I got to know stress, its function, its benefits, and the advantages that it had in store for me, our friendship became rock solid.

You may ask who would even think of calling stress a friend. I bet I know where this question is coming from: stress has a bad reputation. The reputation of something that needs to be reduced, eliminated, cured—in other words, a disease. And one can’t be friends with a disease, right? I agree, one can’t. For as much as I try to be kind and understanding to an illness, I can’t really say that it would be possible to be friends with it. So, what gives?

Well, you see, that’s really the point. Stress is not a disease. It is an alarm system. A sophisticated warning mechanism that alerts me to the fact that something or someone requires my attention. The ability that stress gives me to identify and become alarmed by threats and challenges in my environment is an essential element of survival and adaptation. This is true for me, for you and for all humans and animals. That is the #1 reason I am proud and grateful to call stress my friend. I don’t know what I would do without it.

Imagine what would happen if stress wasn’t around. If threats and challenges provoked no reaction whatsoever in me. A bus could be coming down the pike headed straight for me and I wouldn’t have an immediate instinctive reaction to it. I may be about to be attacked by road bandits, and I would placidly saunter along, oblivious to the danger. My body would continue to be calm, my muscles relaxed, my heart beating normally, my priorities elsewhere.

But, since stress is there for me, I become immediately mobilized against my attacker and I can make a quick, almost instantaneous decision to step aside, run away, attack or defend myself, with all my senses fully alerted, and my body primed and ready for activity. It takes stress only a fraction of a second to start waking all my systems up and to mobilize my resources.

Every time there is potential danger, be it financial, interpersonal, physical, psychological, or anything I think might be harmful to me, stress is there. And even when there is something wonderful and new that I might miss if I weren’t paying attention, stress is there. Stress is my friend, the one that helps me pay attention in all situations when something unexpected happens, or when something I expected does not happen. It is also there for me to give me the ability to deal with something new, when something is missing, when there is an imbalance, or when there is a physical threat to me or to the people and animals I care about.

Oh, and one more thing that stress does for me: the stress reaction acts as a safety system that automatically assigns the highest priority to a serious and sudden threat, that helps me sort quickly through what is important and urgent to me, and what is not.

Thank you, friend!

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:

Learning From Stress: The Locus of Control

Dali_1954_PiramidesWhen it comes to handling stressors and managing the stress reaction, are you an internal or an external?

Our response to a stressor can be classified in many ways, but when it comes to our interpretation of its impact on our capabilities and resources we fall along a continuum from internal (“I feel I can handle this”) to external (“I can’t handle this by myself”) locus of control.

On one side of the continuum are individuals who feel capable of taking personal responsibility and are therefore inclined to believe that success or failure in handling the stressor can be found primarily within their own resources, i.e. their locus of control is internal. At the other end of the continuum are individuals who do not feel capable of assuming responsibility over the stressful situation and are therefore more inclined to believe that success or failure in handling the stressor hinges on luck, chance, or help from others; their locus of control is external. What are the implications of locus of control? Read more after the jump.

Read more

Deflation: Chronic Stress on a National Scale

Palmyra_EN-US856764098"The economy isn’t recovering fast enough." One of the principal reasons is that sales of anything, from houses to double no-foam lattes, are down or flat across the board. American consumers are worried about their personal financial health, their jobs (or lack thereof), their families’ future, the sorry state of the economy, gridlock in Washington, and the fear of another bank/mortgage/stock market crash.

The piling up of this real heap of trouble over the last couple of years has caused most Americans to go into stress reaction mode: fight, flight or freeze. The evidence is mounting that most are choosing to freeze. Businesses that sell goods and services report flat or lower sales to fewer buyers. In a so far vain attempt to get the consumer economy moving again, prices have been and continue to be reduced through special offers, discounts, two-fers and other creative ways meant to entice more buyers.

As consumers refuse to take any risk, either because of their worries or simply waiting for prices to fall further, deflation may now be setting in. Deflation is the opposite of inflation and defines a situation when prices are mostly falling, sales stagnate or fall, with "lower business profits, which lead to layoffs and lower consumer spending and further price declines. [Deflation] makes it more difficult to pay off debt because the value of debt rises relative to income. It provokes hoarding, as consumers, businesses and banks hold on to cash, expecting that prices will keep falling," as characterized by the New York Times. In short, the paralysis of freeze

So it is that unending economic turmoil since 2008, record-high job losses, stagnating or falling employment, and the double-whammy mortgage/foreclosure crisis appear to be provoking one of the most severe stress reactions in generations, in individuals, families, and businesses across the nation. While a few are now fighting to get the economy moving again, a significant number may have left the fight and given up trying, and many more still could be just frozen in place, unable to move forward with their decisions, investments, and major purchases.

As understandable as it may be, this nationwide stress reaction is just what it is, a reaction. It is not a formulated response against a severe and persistent set of stressors, which would require the exercise of sound judgment, decision-making and risk-taking. Instead, the risk to the US economy is that this reaction may become chronic and take years before progressing toward an effective response.

The red lights are flashing and the alarm bells are ringing, urging meaningful action that will address the emergency. Not much appears to be happening. Until the paralysis of freeze is overcome and a real response begins, the alarm bells will continue to ring, while deflation takes hold. Chronic stress, on a national scale.