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Sleep More, Stress Less, Live Longer

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

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

Physical Threats to Sleep

TIME

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

LIFESTYLE

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

ENVIRONMENT

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

CHEMICALS

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

Psychological Threats to Sleep

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

STRESSORS

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

INADEQUATE COPING

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

ALLOSTATIC LOAD

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

The Path to Better and Longer Sleep

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

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

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

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

Sympathetic Muscle Tension and Stress

One of the well-known phenomena that accompany the stress response is the spontaneous and uncontrollable action of the sympathetic nervous system on the musculoskeletal structures of the body. Stress, muscular tension and pain often go hand in hand.

The Alarm or Stress Response of the Sympathetic Nervous System

bungee-jumpingWhen the sympathetic nervous system is suddenly stimulated by a stressor, there is an almost immediate increase in the body’s ability to carry out unusually vigorous muscle activity, even in individuals who would ordinarily not be capable of it.This almost prodigious increase in strength is facilitated by a cascade of physiological changes that is precipitated by stressful situations.

These changes, which take place in a matter of mere seconds, include:

  1. Increased arterial blood pressure.
  2. Increased blood flow to the muscles along with a corresponding decrease in blood supply to the gastrointestinal tract and the kidneys, which are not needed in mounting the body’s rapid response to the threat.
  3. Increased rates of cellular metabolism, which speed up the body’s rate of functioning.
  4. Increased blood glucose concentration, which provides increased levels of energy.
  5. Increased glycolysis in the liver and in the muscle, also a factor in energy supply.
  6. Increased muscle tension and preparedness to work, which increase tone and strength.
  7. Increased mental activity, which provides acuity, alertness and greater focus on the threat.
  8. Increased rate of blood coagulation, which protects the body from significant blood loss if it should sustain minor cuts and puncture.

The combined effects of the mobilization of virtually all principal organs is what enables the body to perform significantly more strenuous physical activity than it is ordinarily possible. Stress of any kind, physical, emotional or mental, excites the sympathetic system, whose purpose is to provide above-normal activation of the body’s resources. Because of this stimulation, the stress response is often referred to as the sympathetic stress response.

Emotional vs. Physical Stress

The sympathetic system is activated during physical danger, but it is also and more frequently activated by many real or perceived emotional stressors. Guyton-Hall cite the example of anger or rage,

…which is elicited to a great extent by stimulating the hypothalamus, signals are transmitted downward through the reticular formation of the brain stem and into the spinal cord to cause massive sympathetic discharge; most aforementioned sympathetic events ensue immediately. This is called the sympathetic alarm reaction. It is also called the fight or flight reaction because an animal in this state decides almost instantly whether to stand and fight or to run. In either event, the sympathetic alarm reaction makes the animal’s subsequent activities vigorous.
–Textbook of medical physiology by Arthur C. Guyton & John E. Hall, 11th ed.

Chronic Stress

The same exact response can be elicited even daily in individuals exposed to multiple or repeating stressors, such as a negative environment, a dysfunctional relationship, poor working conditions, or difficult socio-economic challenges. In this case, the muscle tension and sympathetic stimulation can be so great and so frequent that the body cannot return to a normal state of relaxation, in which case a chronic stress condition can ensue.

Heed the Message, Don’t Shoot the Messenger

VirginIslandsNP_EN-US154535774The messages provided by the stress reaction that something is wrong, or dangerous, or simply requires our attention are often very powerful, even debilitating. Just think of the feeling we get in our gut (seat of the enteric nervous system) when something is not quite right. Even though we might not identify the threat right away, the stress signal activates our body’s defense almost instantaneously and we become fully alert. In the absence of a clearly identifiable threat, or upon identification of a threat that we cannot immediately escape, we may choose to treat stress itself as if it were the enemy. The common phrase, “I have too much stress” should in fact be restated as, “I have people, situations or circumstances that are an emotional, physical or mental threat to my well-being.”

Turning off the stress alert system is possible, especially with the use of powerful drugs or alcohol, at least for time. In fact, this amounts to unscrewing the warning lights on a dashboard so as not to be bothered by what they signal. The stress messenger conveys valuable information in the form of neural signals (mediated by the limbic system), sensations, and subjective feelings. The messenger does its job, the way it should, to ensure our survival. Nevertheless, the repeated stress signals may rise to a high and uncomfortable level of intensity, depending on the perceived dangerousness of the situation. That noxious feeling of being stressed is trying to give us a priority notification, to make sure that certain signals (which represent an important message) grab our full attention. Refusing to heed the signals of stress, or simply shutting them off or ignoring them, is not an appropriate response.

The best use we can make of stress messages is twofold:

  1. Use its intensity and the timing of its occurrence to become aware and acknowledge that a psychological or physical threat exists, and gauge its significance. For example, an immediate physical danger will elicit a more immediate and dramatic body reaction than a psychological threat that may occur in the future.
  2. Identify and address the cause of the stress reaction (which is usually accompanied by more or less severe anxiety) and focus our attention on it, with the aim of confronting, reducing or eliminating the stressor. For example, in a relationship that isn’t quite working the way it should the stress signal is the anxiety and worry over it, the stressor is that painful aspect of the relationship that needs to be confronted, reduced or eliminated.

In short, stress is the message, the stressor is its cause. It is much more productive to focus our efforts on the stressor, rather than just unscrew and throw out the red light bulb.

Emotional Safety, Stress and Health

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

Emotional Stress Often Translates Into Physical Symptoms

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

Emotional Stress Can Contribute to Mental Disorders

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

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

Emotional Stress Is Fear Under Another Name

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

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

How To Tame Fear and Fight Chronic Stress

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

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

How Good and Bad Stress Are the Same

MountRotui_EN-US1706638791Eustress (or good stress) and bad stress (acute or chronic) cause the exact same reaction in the human body. Even during voluntary “stressful” activities such as sport or exercise or when we receive unexpected good news, the brain stem, the oldest and more primordial part of the human brain, immediately mobilizes the body’s resources. The brain stem does not know, and one might say does not care, what triggers the sudden demand for additional physical activity. All the brain stem knows, prior to any higher brain intervention such as a decision to be afraid of something, or a decision to exercise, is that more blood is needed immediately to fulfill physical demands that may already be occurring (in the case of exercise or a real and impending threat) or that may be presumed to occur (in the case of perceived danger in a situation).

When the motor areas of the brain and the limbic system become activated by a positive but sudden event, most of the reticular activating system of the brain stem is also mobilized. This activation includes greatly increased stimulation of the vasoconstrictor and cardioacceleratory areas of the vasomotor center of the brain stem. Thus, the increase in arterial pressure permits to keep pace with an expected increase in muscle activity. A similar rise in pressure occurs during negatively stressful situations. The need to prepare to meet the danger posed by the stressor mobilizes the reticular activating system and the vasomotor center of the brain stem.

During dangerous situations (real or perceived), arterial pressure rises to as high as twice its normal value within a few seconds. This dramatic increase can immediately supply blood to any or all muscles of the body needed to respond. This translates into an enormously increased ability to fight against or to flee from the cause of danger. It is indeed a significant survival factor that no conscious decision is needed when this split-second mobilization is required.

3 Good Ways of Responding To a Panic Attack

OBriensTower_EN-US194301618A panic attack ambushes the mind, the body, and the soul. Its targets are self-esteem, a balanced self-assessment and the ability to analyze situations and expected outcomes. When panic strikes, the present becomes a bleak landscape of dangers and the future includes a (seemingly) real possibility of annihilation. In the presence of a real (or perceived) significant stressor, one’s abilities to respond to the challenging situation becomes severely impaired. For the span of the panic attack, chest pains, shortness of breath, shaking, sweating, and even nausea and vomiting can give the sensations of impeding death. Can something be done to prepare for a panic attack with any degree of success?

One: Know Thyself

A first important tool is the ability to anticipate one’s own reactions, by getting to know them well enough so that they do not become stressors in themselves. Knowing the likelihood (and thus anticipating the possibility) of the physical sensations that go with feelings of panic (chest constriction, shortness of breath, increased heart rate, and sweating) may help avoid the distress that these symptoms can cause. The very fact of knowing that these physiological reactions will take place, and allowing them to happen as a natural and understandable reaction to a threat to our well-being, can be beneficial.

Two: Know About Panic

Panic attacks are about as close to feeling imminent death as one can get, as anyone who has experienced them in all their severity will attest. A panic attack occurs without anyone else’s intervention (usually no one else is present). It can be extremely frightening even when no real physical danger exists (it can strike a person comfortably seated in his or her favorite recliner). A panic attack, by definition, occurs without any clinical danger of death and cannot by itself cause death or serious injury. A the most, when it reaches a certain level, a panic attack may trigger a loss of consciousness through hyperventilation (prolonged shallow breathing). This usually resolves the physical symptoms by momentarily taking the brain out of the picture, whereby the body can returns to homeostasis. When the person comes to, usually the panic attack is gone just as suddenly as it came. Exhaustion is not infrequent at this stage, as a panic attack can be a real workout for the heart and muscles.

Three: Manage Your Response

BearAttackA useful tool in preventing the recurrence of panic attack is stress management. Allowing the body to react, in concert with the mind, to a situation that may objectively warrant fear, sadness or worry is not only strategically sound, it is also physiologically healthier. Just as courage is not the absence of fear but simply good fear management, allowing a naturally-occurring biopsychic reaction to a stressor is simply good stress management.

Thus, the key to successful panic attack management is not in denying or attempting to prevent the stress reaction, but in what to do next (our chosen response). After the initial physical reaction ebbs and subsides and the heart rate naturally returns to near-normal levels, the real stress management response has a chance to begin. This response should first and foremost consist of addressing the stressor that is causing the panic attack to occur.

3 Good Ways of Addressing Serious Stressors

Three options usually exists in addressing significant stressors:

  1. Eliminating the stressor that caused the panic attack to occur.
  2. Removing oneself from the stressful situation, if option 1 is not available.
  3. Reducing the impact of the stressor through relaxation techniques or good coping mechanisms, when options 1 and 2 are not available.

The Stress of… Stress

ClareIsland_EN-US2748591595There are times in which the stress reaction and the level of anxiety caused by a stressor are so high that the body’s reactions become extreme and add to the burden. Stress becomes stressful in itself and a problem of its own. Although the stress reaction itself is normal and necessary for survival, learning and for personal growth, the body’s reaction to the increased alert level causes a predictable and rather universal set of physical changes. These include:

  • Increased central nervous system activity—a state of full awareness
  • Increased mental activity and brainwave activity—full mental alert
  • Increased secretion of adrenaline (epinephrine), noradrenaline (norepinephrine), and cortisol into the bloodstream—a state of endocrine mobilization
  • Increased heart rate, cardiac output, and blood pressure—the way in which the body prepares to meet the physical demands of the stressor
  • Increased breathing rate, breathing airways dilation—brings more oxygen into the lungs
  • Increased metabolism, oxygen consumption, oxygen to the brain—oxygen is the principal sustainer of life for brain cells and for the whole body
  • Blood is diverted away from the digestive tract and directed into the muscles and limbs—the processing of food become secondary to averting or confronting the danger
  • Increased muscle contraction, which leads to increased strength—for either fight or flight, muscle readiness is automatically brought to the highest levels
  • Increased blood coagulation (blood clotting ability)—helps the body minimize the impact of possible injuries
  • Increased circulation of free fatty acids, a source of cellular energy—contributes to the readiness of the body to greater energy expenditure
  • Increased output of blood cholesterol—makes the blood richer in nutrients to be carried to muscles and other organs
  • Increased blood sugar released by the liver, to nourish the muscles—another important source of energy for best performance and strength
  • Release of endorphins from the pituitary gland—an activating hormone that boosts alertness throughout the body
  • Pupils of the eyes dilate—increases field and acuity of vision
  • Hair stands on its end—a remnant from the time when hair covered the most vulnerable body parts
  • Blood thins—this speeds up blood circulation for faster travel from center to periphery and back
  • Sweat glands increase secretion—a well lubricated body presents a slippery surface in a fight and cools it down below dangerous heat levels
  • Increased secretion from apocrine glands resulting in foul body odor—designed to repulse enemies
  • Capillaries under the surface of the skin constrict with a consequent increases in blood pressure—blood pumping to all parts of the body is enhanced
  • Immune system is suppressed–the immune system may have energy made available for it via reduction of other activities, may change in energetically conservative ways when the protection it confers needs to be balanced with the energetic demands of other activities such as fight or flight, or may be suppressed when other activities are more important than immunity for total well-being
  • Reproductive and sexual systems stop working normally—in times of high stress, sex and reproduction take a back seat to survival and protection
  • Decreased perception of painthe analgesia system, a pain suppressing mechanism that effectively shuts off sensory transmission to the brain, so that we are permitted to go about the business of getting out of the gravest danger without the crippling sensations of pain.

Stressed_WomanNo command is needed to activate these reactions that are programmed in the genetic code. Moreover, they cannot be prevented from occurring, except to a limited extent. At best, one can learn to control what is visible to others and, in some individuals, the heart rate can be somewhat controlled.

This cascade of physical reactions is good in two ways. First, when there is a danger or threat of some sort (e.g., a bus coming straight at us) we are instantaneously aroused into action: we step out of the bus’s path without really planning to do so, automatically. In this way, we have a chance to avoid and/or survive many physical threats to our well being. This ability enabled a  physically weak human race to survive and thrive among larger and stronger animals, earthquakes, fires, and interpersonal conflict during our long history on this planet. Can we imagine surviving very long without the mobilization caused by the stress reaction alarm system?

Second, we are programmed to respond not only to physical threats but also, and more importantly in our society, to non-physical threats that are emotional, social or psychological in nature. This is of great value because most threats nowadays come from circumstances of social living, such as relationships, jobs, economics, politics, environment, and technology.

Unfortunately, the stress reaction can be so overwhelmingly strong that we become stressed by stress itself, incapable of moving beyond its mesmerizing message of danger. Changing back the focus from the stress reaction to the stressor is the key to making an appropriate use of this vitally important warning system. It is also the key to responding vs. simply reacting. Learn this, and stress becomes the alert system most useful in navigating the treacherous straits of modern life.

Widely Used, Unlikely Stress Reducer: Salt

Sunset at Sea, 1882There may be a very good reason for the impulse to reach for salt-laden foods and snacks. New research from the University of Cincinnati, reported in the April 6, 2011, issue of The Journal of Neuroscience, shows that elevated consumption of salt can reduce the body’s natural stress reaction. Sodium, the main ingredient of salt, inhibits the release of hormones along the hypothalamic-pituitary-adrenal (HPA) axis, which are released into circulation in reactions to stressors. More specifically, an elevated sodium intake limits the stress reaction by suppressing the release of the octapeptide angiotensin II (Ang II), which provides the major hormonal support of the growth and function of the zona glomerulosa of the adrenal cortex and the secretion of the excitatory hormone aldosterone. Conversely, higher sodium intake increases the activity of oxytocin, an anti-stress hormone.

Life stressors cause an immediate challenge to the body’s homeostatic balance, and cause physiological and psychological reactions that affect hormonal, cardiovascular, and behavioral responses. This new research examined the neural mechanisms underlying the stress reaction within the context of such a homeostatic challenge. The focus was on the impact of an elevated intake of sodium on the hypothalamic-pituitary-adrenal (HPA) axis, the cardiovascular system, and behavior in response to an acute psychological stressor.

Relative to controls whose sodium levels were normal, subjects with elevated salt intake showed a decrease in HPA activation in response to a psychological stressor. In addition, the increase in sodium also reduced the cardiovascular response and promoted faster recovery to pre-stress levels. Even more remarkable, subjects with increased sodium intake had significantly more oxytocin- and vasopressin-containing neurons within the supraoptic and paraventricular nuclei of the hypothalamus and greatly elevated circulating levels of oxytocin. The endocrine and cardiovascular profile of subjects with elevated sodium also produced a decrease in anxiety-like behaviors when they were put through a social interaction test.

The researchers concluded that the results single out sodium as a potent inhibitor of the HPA, cardiovascular, and behavioral aspects of the stress reaction.

Eat More Salt, Feel Less Stress?

Apparently, we are already doing so, by the millions of pounds. Americans have consistently consumed approximately 3,700 mg of sodium daily throughout the last three decades, or nearly 65% more than the recommended daily salt intake of 2,300 mg. Most restaurant food, prepackaged and processed food, deli food, table and bar snacks, and fast food are loaded with salt, sugars and fats. Sodium is added primarily as a flavor enhancer, but also to satisfy our hidden and very powerful salt appetite.

The downside of elevated salt consumption: too much sodium is a precipitating factor in heart failure, an increased risk for gastric cancer, a contributor to hypertension. In fact, the ill-effects of too much sodium consumption are so widespread throughout the body that salt-intake reduction is often one of the first approaches to the treatment of a variety of metabolic conditions. Could it be that this widely used (and tasty) stress reducer is not what it appears to be? Perhaps its “calming” and anxiety reduction effects—much like those of alcohol—come at a price that, if properly understood, we may not be willing to pay.

Appraisal: The WYSIWYG of Stress

LindauHarbor_EN-US1129072404From the cave to the modern city, survival has depended on the ability to quickly and reliably distinguish between harmless and dangerous situations. Today, distinctions are often subtle, complex, and abstract. The ability to make these distinctions has been made possible by the evolution of the prefrontal areas of our brain, which are capable of symbolic representation and can derive new knowledge about the self, world and the future through experience. This complex process of evaluation and distinction is called cognitive appraisal.

The cognitive appraisal of possible harm or loss, threat, and challenge is intimately implicated in the stress reaction. In recognizing harm or loss, we assess that some measure of physical or psychological damage has already occurred, e.g., an injury or an illness, some damage to our well-being or self-esteem, or the loss of a loved or valued person. In evaluating a threat, we assess damage or loss that has not yet occurred but that is anticipated, or perceived as likely to occur. Harm or loss that has already occurred is always suffused with threat because every serious injury or significant loss is also full of negative implications for the future. Challenges are often perceived as threats as every challenge, either psychological or physical, calls for the mobilization of our coping resources.

Stressed_WomanThus, in this process of appraisal, we come up with an assessment of the seriousness of the situation that is before us. What we see or do not see determines the level of physiopsychological arousal and how we will respond. The idea that our emotional and behavioral response to a stressor is determined by the meaning we attribute to an event or situation has a long tradition in Western thought. The Roman philosopher Epictetus famously stated, "Men are disturbed not by things, but by the views which they take of things.” A few centuries later, the same idea was expressed by William Shakespeare in Hamlet, "There is nothing either good or bad, but thinking makes it so" (Act II, Scene 2, line 259).

The immediate outcome of appraisal, whether of a threat or a challenge, is the notion that something must be done to manage the situation, because it is serious enough to warrant our attention. This first level of assessment is often referred to as primary appraisal. Subsequently, and often almost without pause, our task becomes that of evaluating what might and can be done, a second level of processing that we call secondary appraisal. While neither is more important than the other, secondary appraisal activity is crucial in the choice we make between fight or flight, i.e., between approach and avoidance. The WYSIWYG of appraisal is that, in most cases, what we see in the situation is how we choose to respond to it. Whereas some will see in a particular event nothing but a nuisance, others will see the same event as a dangerous threat.

Primary Appraisal: How Serious Is the Stressor?

What determines the quality of our primary assessment of a situation or event are its novelty, its predictability, and event uncertainty. Also important are time factors, such as the imminence, the duration, and the temporal uncertainty of the stressor. Additionally, primary appraisal is affected by the ambiguity of the stressor and by the timing of stressful events in our life cycle.

Generally, the more imminent a stressful event, the more urgent and intense our process of primary appraisal will be, as for example in deciding whether or not to step out of the path of an oncoming truck. The less imminent an event, the appraisal process becomes more deliberate and thus more complex, as in deciding whether to take a new job. Ambiguity is unfortunately a salient characteristic of many of today’s stressors. Greater ambiguity signifies that more factors can shape the meaning of the situation, and vice versa.

The timing of stressful events as they happen throughout our life cycle can also affect the quality of our appraisal. Many life events, such as the death of a child, are more significant and turn into crises because they occur "off time." Off time events are more threatening because they are often completely unexpected and therefore pose a challenge for which no preparation or anticipatory coping was possible.

Secondary Appraisal: Can I Handle It?

BearAttackOur individual assessment of a situation leads to an appraisal of our possible responses. When our vital interests appear to be at stake, secondary appraisal takes front and center and we can become literally and figuratively frozen in place, as we feel the enormous pressure of producing the right response.

Individual temperament, upbringing, personality, life experiences, and prior traumas play a leading role in determining the quality of our secondary appraisal.

A stress-prone individual is primed to make extreme, one-sided, absolute, and global judgments. Because the appraisals tend to be extreme and one-sided, the behavioral responses also tend to be extreme. A hostility-prone individual may be primed to react to a relatively minor slight by another as if it were a criminal offense and, consequently, will be inclined to attack the other verbally or physically. A person who is susceptible to fear reactions may interpret an unfamiliar noise as a gunshot or the start of an earthquake and will have an unstoppable urge to escape. A depression-prone individual may hear an otherwise humorous comment as a rejection and will want to withdraw.

In the primitive world of an instinctual stress reaction, the complexity, variability, and diversity of human experiences are lost and quickly reduced to a few crude categories. It is do or die, eat or be eaten, a survival of the quickest and strongest. In a more mature world of cognition, stimuli are analyzed along many dimensions or qualities, appraisals are quantitative rather than categorical, and are relativistic rather than absolutistic. When it comes to stressors, what you see can be just exactly what you get.

Stuck On Wide Open: Emotional Dysregulation

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

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

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

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

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

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

What Causes (And Cures) Emotional Dysregulation

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

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

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

Disorders of Emotional Dysregulation

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

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

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

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

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

Ultimate Stressors: A Complete Upheaval

minamisanrikuThe unexpected convergence of catastrophic events that generated widespread damage, loss and destruction in Japan readily meets the dictionary’s definition of disaster. The common characteristics underlying natural disasters such as earthquakes, tsunamis, hurricanes, and man-made ones such as terrorist attacks or nuclear accidents are the virtually total lack of anticipation, limited preventive planning and, subsequently, the drama of human vulnerability.

A few typical phases of disaster are readily discernible, regardless of the type of disaster or its location: an initial impact characterized by shock, fear, and anxiety; an heroic phase, characterized by survivors reaching out in concerted effort to prevent further loss of life and property; a honeymoon phase, within 2 weeks to 2 months after the disaster, when survivors are buoyed up by an outpouring of support, services and supplies. Later, a disillusionment phase may follow, when hopeful expectations give way to resentment as promises of substantial help are broken or snarled by red tape. Finally, a reconstruction phase, which may last several years, characterized by the affected communities’ efforts to rebuild and by individuals coming to grips with their personal losses.

japan-nuclear-reactor-meltdownThe goal of stress reduction and trauma management programs is to help survivors achieve their pre-disaster level of functioning. The majority of individuals exposed to a mass disaster will experience acute stress that may be short-lived and does not develop into a clinically diagnosable disorder, especially if rescue is rapid and effective (as in the recent case of the trapped Chilean miners) and reconstruction or restoration can happen in a relatively short time. However, a substantial portion of individuals exposed to traumatic events will experience clinically significant stress and subsequent mental health problems. These include Acute Stress Disorder, Posttraumatic Stress Disorder (PTSD), depression, chemical abuse and dependence, and anxiety disorders. In the Japanese situation, the rebuilding of families, homes and businesses may turn out to be painfully slow due to the obliteration of entire communities by the tsunami, which increases the likelihood of significant mental health consequences. On the other hand, the Banda Aceh, Indonesia experience shows that even after a near-total erasure of structures by the tsunami of 2004, a community will begin to come back to life—albeit after many years of continuous and painstaking reconstruction.

bandaAcehSome of the most frequently observed behaviors that occur following a disaster include intrusive reactions (efforts to process traumatic events), avoidance reactions (efforts to minimize distressing memories), and physical arousal reactions (efforts to keep the body prepared to survive additional threats). Intrusive reactions occur through recurring dreams about the event, persistent thoughts and images, and the experience of a continued sense of fear and danger. Avoidance reactions manifest as the survivor’s reluctance and resistance to discuss the event, to think about the event, or to revisit any reminders associated with the event. Physical arousal reactions include increased anxiety, hypervigilance, psychomotor agitation, difficulty sleeping, and concentration problems. All these post trauma reactions following a disaster of large magnitude should not be considered abnormal or necessarily indicative of mental health problems or of the need for continued treatment.

katrina_goes12In the best cases, first aid psychological support during major disasters takes place immediately after the event and may last up to one week. In the first critical days, rescuers engage survivors in conversations to determine whether they may be at greater risk for ongoing problems. An effort may also be made to identify survivors that are more likely to be at risk for further mental health problems, such as individuals with pre-existing personality and psychiatric disorders, those who exhibit the severest symptoms, those who lack social support, those who have a history of interpersonal difficulties, and those who have been previously exposed to trauma. Psychological first aid consists of a set of procedures that facilitate a survivor’s adaptive coping, and is based on the premise that safety, calm, self-efficacy, connectedness and hope must be promoted. In the initial, critical phase it is vital to provide survivors with human contact and engagement, physical and emotional safety and comfort, environmental stabilization, information, practical assistance, connections with social supports, information on available help, and linkage with collaborative services.

9-11In the second phase, after the first week and up to one month after the disaster, the primary goal of psychological aid is to promote anxiety management, further reduce stress, and begin the process of restoring normal functioning. This is accomplished through the development of targeted services such as psychoeducation, psychotherapy, skills enhancement, cognitive restructuring, and relaxation training. Care givers also remain alert to any signs of the development of mental health issues, such as derealization (a belief that the world has become strange or unreal), depersonalization (an unnatural feeling of detachment from one’s body), and flashbacks. In the final phase of recovery, taking place within 1 month and 3 months after the event, psychological care is provided to those in need—often for years afterwards.

The convergence of multiple disasters onto a finite geographic region at the expenses of the a limited number of individuals may appear as capable of affecting a specific locale only. In reality, as Chernobyl, Katrina, 9/11 and Banda Aceh have demonstrated, the repercussions quickly have a planetary impact. Stress is no longer a local phenomenon.

Japan-QuakeThanks to instantaneous communication and the transmission of color images via multiple media channels, the experience is quickly shared by the entire planet. This also means that stress is radiated from the epicenter of the disaster outward to all who view and hear it, thus creating intrusive, avoidance, and arousal reactions on a global scale. Moreover, the economic and political consequences of disaster are immediately felt by the financial markets, at the fuel pump, and even in the supermarket aisle.

The world of stress has never been so small.

Tsunami Deja Vu: Greece and Alexandria

800px-Kamakura_tsunamiWe’ve never seen anything like the pictures emanating out of Japan. Modern video and still photography technology give us an unprecedented view of a phenomenon of vast power and consequence. It might seem like something that has never been witnessed before. However, the impact of a tsunami (Japanese: 津波, lit. “harbor wave”), only by chance a Japanese word that has entered into worldwide parlance, was reported in chilling detail by at least two prominent Greek and Roman historians.

Over four centuries before Christ, the Greek historian Thucydides wrote in his History of the Peloponnesian War about a tsunami that had struck Greek coastal towns. We can recognize the imagery more readily now, as it parallels the footage we are seeing out of Sendai, Japan.

thucydidesThe next summer [426 BC] the Peloponnesians and their confederates came as far as the isthmus under the conduct of Agis the son of Archidamus, intending to have invaded Attica; but by reason of the many earthquakes that then happened, they turned back, and the invasion proceeded not. About the same time (Euboea being then troubled with earthquakes), the sea came in at Orobiae on the part which then was land and, being impetuous withal, overflowed most part of the city, whereof part it covered and part it washed down and made lower in the return so that it is now sea which before was land. And the people, as many as could not prevent it by running up into the higher ground, perished. Another inundation like unto this happened in the isle of Atalanta, on the coast of Locris of the Opuntians, and carried away part of the Athenians’ fort there; and of two galleys that lay on dry land, it brake one in pieces. Also there happened at Peparethus a certain rising of the water, but it brake not in; and a part of the wall, the town-house, and some few houses besides were overthrown by the earthquakes. The cause of such inundation, for my part, I take to be this: that the earthquake, where it was very great, did there send off the sea; and the sea returning on a sudden, caused the water to come on with greater violence. And it seemeth unto me that without an earthquake such an accident could never happen.—Thucydides (ca. 430 BC), History of the Peloponnesian War, (89), Thomas Hobbes, Ed., London: Bohn.

Centuries later, Roman historian Ammianus Marcellinus described the tsunami caused by a large earthquake that devastated Alexandria, Egypt in 365 AD. In this even more evocative description, the effects of the retreating sea and its catastrophic return are described in terse and dramatic language.

Ammianus_BookWhile that usurper of whose many deeds and his death we have told, still survived, on the twenty-first of July in the first consulship of Valentinian with his brother, horrible phenomena suddenly spread through the entire extent of the world, such as are related to us neither in fable nor in truthful history. For a little after daybreak, preceded by heavy and repeated thunder and lightning, the whole of the firm and solid earth was shaken and trembled, the sea with its rolling waves was driven back and withdrew from the land, so that in the abyss of the deep thus revealed men saw many kinds of sea-creatures stuck fast in the slime; and vast mountains and deep valleys, which Nature, the creator, had hidden in the unplumbed depths, then, as one might well believe, first saw the beams of the sun. Hence, many ships were stranded as if on dry land, and since many men roamed about without fear in the little that remained of the waters, to gather fish and similar things with their hands, the roaring sea, resenting, as it were, this forced retreat, rose in its turn; and over the boiling shoals it dashed mightily upon islands and broad stretches of the mainland, and leveled innumerable buildings in the cities and where else they were found; so that amid the mad discord of the elements the altered face of the earth revealed wondrous sights. For the great mass of waters, returning when it was least expected, killed many thousands of men by drowning; and by the swift recoil of the eddying tides a number of ships, after the swelling of the wet element subsided, were seen to have foundered, and lifeless bodies of shipwrecked persons lay floating on their backs or on their faces. Other great ships, driven by the mad blasts, landed on the tops of buildings (as happened at Alexandria), and some were driven almost two miles inland, like a Laconian ship which I myself in passing that way saw near the town of Mothone, yawning apart through long decay.—Marcellinus, A. (360) Res Gestae, Vol. II, (26) 15-19.

The History of Stress In Very Small Bites: 6

HansSelyeBy far the most important figure in the history of the concept of stress as applied to human behavior is Hans H. B. Selye (1907-1982), who is credited with starting modern research into the concept itself and its physiopsychological manifestations. In 1950, in addressing the American Psychological Association convention, Selye introduced his theory of stress reaction, which has since become the standard model of stress. In 1956, he published The Stress of Life, in which he elaborated his stress theory and perfected its definition of physiopsychological stress as “the nonspecific response of the body to any demand made upon it,” which could be a real or perceived threat, challenge, danger or change that requires the body and the mind to adapt.

Selye’s research made important contributions to psychology, biology and medicine. He had begun his work in 1926 when, as a second year medical student, Selye noticed many similarities among patients who, in spite of suffering from very disparate diseases, all seemed to have many symptoms in common. He would later describe this constellation of common symptoms as a syndrome, ‘‘the syndrome of just being sick.” 

His discovery of the stress response was a byproduct of his research on the effect of hormone injections in rats. Noticing that many of the rats became sick after receiving the injections and that the same sickness struck a control group of rats injected only with a neutral solution containing no hormones, he had the intuition that the rats could be having a reaction to the trauma of being injected rather than to the hormones. Selye surmised that being handled and injected caused high levels of sympathetic nervous system arousal in the rats, which eventually developed health problems such as ulcers. Selye coined the term "stressor" to label the traumatic stimulus that acted psychologically on the mind while at the same time producing a physical effect.

In refining his theory of the stress reaction, which he dubbed the General Adaptation Syndrome, Selye identified three distinct stages. The alarm reaction is the first stage, which occurs when the organism first becomes aware of the stressor. In the second stage of recovery or resistance, the organism mounts a response to the stressor, by mobilizing resources, using energy and repairing itself. The third stage of exhaustion occurs if the organism is unable to put an end to the stressor. This third stage also signals the onset of chronic stress.

With remarkable insight, Selye sliced the concept of stress into four variants. These he called eustress (the good stress caused by positive and exciting stressors), distress (the harmful stress caused by unpleasant or negative stressors), hyperstress (caused by stressors so overwhelming that they overcome all abilities of the body to adapt), and hypostress (the mildest stressors that barely cause a physical and psychological reaction, while still being noticeable).

Stress Like an Egyptian

hosni-mubarakPower stresses. Absolute power stresses absolutely. This easy paraphrase of a famous saying about the corruptive effect of political power can perhaps convey the enormous stress that tyrannical political power can cause at the micro and macro levels of a nation-state. The classic fight-flight-freeze stress reaction is magnified by the stark reality of the actual physical danger, and enormous emotional cost, that comes with ruling a country with an iron fist. An absolute ruler is nearly always unloved, feared, and only forcibly respected by his immediate entourage and of course even more so by his countrymen at large. This must be Mr. Hosni Mubarak’s plight right now, as his country of Egypt is in the throes of a more or less peaceful, and some say long overdue, revolution to overthrow his 40-year-old quasi-dictatorship. How is he coping?

The 82-year-old Mr. Mubarak is nothing if not a survivor of trauma. A seemingly perennial victim of acute traumatic stressors, he has survived three wars, an Islamic uprising and multiple assassination attempts. His beloved 12-year-old grandson, Muhammad, died suddenly of a brain aneurism. He came to power on October 7, 1981 when the president of Egypt, Mr. Anwar el-Sadat was assassinated not three feet away from then-vice president Mr. Mubarak in a hail of gunfire and grenades. It is possible that, since that day, Mr. Mubarak may suffer from posttraumatic stress disorder (PTSD).

This seminal traumatic event, and the others that followed, may have engendered in Mr. Mubarak a strong desire for safety and stability above all else. In the current circumstances, he has reacted to the calls for his resignation in true-to-character fashion with a staunch change-resistant response, which one Arab official has called, “his reflex adherence to the status quo.”

It is perhaps not coincidental that President Obama told reporters he believes that Mr. Mubarak’s decision not to seek reelection may represent an important “psychological break” that could transition the Egyptian president out of power. The decision must not have come easily for Mr. Mubarak, and must have required a significant departure from his usual modus operandi of maintaining the safety of the status quo.

Mr. Mubarak appears to have rationalized his deep-seated aversion to change and his need to ensure survival and safety for himself, his family and the country he rules, with a near-absolute belief that he is the only person who can guarantee Egypt’s political, economic and social stability. It is nothing short of a psychological drama that he is now the focus and the very symbol of Egyptian crisis, the very instigator of chaos on the streets and political and economic turmoil.

For 40 years, Mr. Mubarak has lived in splendid isolation from danger in the presidential palace in Cairo or at his private residence in the seaside community of Sharm el Sheik, both heavily guarded by a corps of bodyguards. His acquaintances describe him as a man who does not show emotion, who can be forceful and aggressive in pursuing his views, but maintains a near-absolute control over the privacy of his feelings. As if the world around him was just too dangerous to risk betraying the slightest hint of weakness.

Disaster! 9 Critical Crisis Management Skills

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

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

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

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

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