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Of Washington, Stress, and the Mind

b_800_600_16777215_0_stories_immagini_Inverno_Alba_sul_primo_piazzaleThe way we perceive a situation, and decide whether it is positive or negative, is an active, continuing process of appraisal of the risks, costs, and likely gains of our
possible responses. Three individuals may be stuck in traffic at the same time and each may perceive and appraise the situation quite differently. “OMG,” one may say, “late again, my boss will be furious!” The second may think, “I’m going to be late, but my boss will understand how unpredictable this traffic really is.” The third may settle in, turn on the radio and say, “It’s a good thing I left a little early, I can’t speed this up so I’ll just catch up on the news.”

Depending on this cognitive appraisal of a situation, the stress reaction will mobilize the body to action. The greater the anxiety generated by the situation, the higher the level of physical and psychological arousal. Sometimes, overt behavior will be produced directly by the mobilization of impulses, drives, or wishes. One specific and frequent set of behaviors is likely to occur most frequently, as a behavioral inclination to act in a certain way due to our background, beliefs and available resources. Depending on the content of our thoughts about the situation, the behavioral inclination may be a desire to withdraw (flight), attack (fight), approach, or avoid (freeze). The emotions corresponding to these inclinations are anxiety, anger, affection, and sadness, respectively. The ultimate response to a stressor can be conceptualized as a structure of the mind, where a set of beliefs about one’s self, the world, and the outcome activates and controls the behavioral inclination and the emotional response.

Life’s stressors, especially if significant to our physical, psychological and social well-being can disrupt the normal activity of the mind. In addition to almost immediate loss of the ability to concentrate, recall, reason and control impulses, a severe and unexpected stressor produces a relative increase in instinctive, more primitive, and less rational processes. Instinctive reactions are usually paired to specific stimuli. These almost mandatory reactions are characteristic to the specific sensitivity of each individual. They can give way to inappropriate or excessive behavioral reactions. For example, the need for a stiff drink, reaching for a cigarette, crying, or being unable to breathe or move can be automatic, with little insight and thus virtually unstoppable.

The wide differences between people in their specific sensitivities explains why an event that is an almost unbearable stressor for one person may be an annoying or even benign situation for another. The seasoned public speaker may still get butterflies in the stomach, but is able to carry on and deliver an excellent presentation, whereas another may be terrified at the very idea of speaking before an audience.

Core differences in one’s personality also account for the wide variations in individual
sensitivities to stressors. The independent and somewhat misanthropic personality will not be sensitive to the same stressor as the individual who craves human connection and feels dependent on it for validation. Excessive or ineffective reactions to stressors, such as hostility, anxiety, and depression, also result from specific behavioral inclinations, personality structure, and specific sensitivities.

Finally, reactions to stressors may be dictated primarily by one’s internal motivations, with no apparent connection to the events or circumstances of the outside world. For example, the belief that the only road to happiness is through total success is characteristic of achievement-oriented individuals who are therefore extremely vulnerable to excessive and ineffective reactions at the slightest doubt of failure—regardless of evidence to the contrary.

Obama & Boehner at Stresshacker.comStressful interactions with other people who may be equally as stressed, albeit for different reasons, produce a mutually reinforcing cycle of excessive and ineffective reactions. Specific psychological mechanisms, such as an egocentric approach, negative framing, and polarization, increase the level of arousal experienced by each individual and, consequently, to higher and higher levels of collectively shared stress. This cycle seems to be in evidence at this time in Washington, as the executive and legislative powers appear to be locked in a mutually reinforcing cycle of excessive and ineffective reactions to each other.

Stress Hardware Review: Anterior Cingulate

Dolomites_EN-US3033597177The anterior cingulate cortex is a region of the brain that is activated by sensation, cognition, and emotion. It appears to play an important role in autonomic, affective, and cognitive behavior. Because of its position, the anterior cingulate is anatomically and functionally well positioned to integrate information across the physical, intellectual and emotional domains. Important in the stress reaction, the anterior cingulate region is activated during self-regulation of arousal through its connections with the cholinergic basal forebrain. The whole structure, but especially area 32, produces inhibitory inputs that decrease amygdala responsiveness and are helpful in mitigating the effects of fear and in preventing or at least delaying “amygdala hijacks.”

The normal functioning of the anterior cingulate area leads to a normal response to stressful events, which is a psychophysiological arousal or increased emotionality. The normality of the brain response to traumatic stimuli also serves to inhibit feelings of fear when there is no true threat.  Any chemical or structural failure of activation in this area and/or decreased blood flow in the adjacent subcallosal gyrus can lead to an exaggerated response to stress, resulting in significantly higher emotionality and the inability to properly regulate fear. The latter condition provides the inducing cues in anxiety disorders, i.e. increased and persistent fearfulness that is not appropriate for the context.

What the Anterior Cingulate Does

BrodmanBrainAreasPhysically, stimulation of the anterior cingulate (especially in area 24) induces changes in blood pressure, heart rate, respiratory rate, pupillary dilation, skin conductance, thermoregulation, gastrointestinal motility, and changes in adrenal cortical hormone secretion (ACTH). Cognitively, the anterior cingulate cortex plays a leading role in learning new behaviors, whether as a conditioned response to predictors of painful stimuli, as an instrumental response to avoid such stimuli, or in response to reduced reward. Emotionally, the anterior cingulate (along with other structures in the limbic system) mediates emotional responses including fear, agitation, and euphoria, and verbal expression with affective content, such as sighs, cries, and screams.

Neuroimaging studies with powerful fMRI instruments show electrical activation in the rostral–ventral anterior cingulate cortex when individuals under study are asked to recall sad memories or view faces with sad expressions, when they are told to anticipate an upcoming painful electric shock, and when exposed to scenes or words with emotional content. It should come as no surprise that stress-induced activations in the amygdala and orbitofrontal cortex occur simultaneously with those in the anterior cingulate cortex.

Genes, Stress and the Anterior Cingulate

Genetic studies have conclusively demonstrated that the anterior cingulate cortex is highly sensitive to environmental stressors, either physical, psychological, or behavioral. Anoxia (lack of oxygen), maternal separation, amyloid protein expression, and drug abuse all induce hypometabolism, gliosis, and programmed cell death in the anterior cingulate cortex. After prolonged and continued exposure to stress, nerve cells in the anterior cingulate cortex are damaged and killed by excessive stimulation, a process called excitotoxicity.

When the Anterior Cingulate Malfunctions

Several psychiatric disorders are linked with abnormalities in the function of the anterior cingulate cortex. Significantly elevated neurochemical activity in this region of the brain has been observed in obsessive–compulsive disorder, tic disorder, and depression. A normal range of activity is restored with behavioral and pharmacological treatment of these disorders. Other psychiatric disorders that have been associated with abnormal functioning of the anterior cingulate cortex include attention deficit hyperactivity disorder (ADHD) and schizophrenia.

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.

Heart Attack or Stress?

Warsaw_EN-US2451207088Emergency room or a chill pill? What is that sudden stabbing pain that lasts only a few seconds? Or that pressure on the chest that won’t go away and feels like it’s getting worse? A heart attack, heartburn or something else? Dramatic questions like these bring people to emergency rooms or doctors’ offices by the thousands every year. The stress caused by chest pains and severe discomfort in the area around the heart can be acute, and fear of the worst in fact augments the symptoms and brings on additional ones, such as sweating, dizziness, racing heart beat, and more.

But how can we tell when to seek emergency treatment and when to simply lay down and relax? Pain or severe discomfort centered around the heart can be caused by literally dozens of conditions, from pancreatitis, to pneumonia, to an anxiety attack. Given the variety of causes, some of which carry a lethal risk, it is not surprising that most people choose to consult a doctor. In fact, it may be the wisest thing to do, unless pain and discomfort subside in just a few minutes.

The most accurate (but slow) way to determine whether a person has experienced a heart attack is a blood test that identifies creatine kinase and cardiac troponin, chemical markers that appear in the blood stream when the heart muscle has sustained some damage. A faster (but less accurate) method is an electrocardiogram (ECG). The third method (the most immediately available but least accurate) is the person’s own description of the chest pain and any other symptoms to an emergency room physician.

The Harvard Medical Letter describes the following symptoms as generally indicating a condition other than a heart attack, including anxiety or stress:

  • sharp or knifelike pain brought on by breathing or coughing
  • sudden stabbing pain that lasts only a few seconds
  • pain clearly on one side or another
  • pain confined to one small spot
  • pain that lasts for many hours or days without any other symptoms
  • pain produced by pressing on the chest or with body movements.

These symptoms may not require a visit to the emergency room, especially if they resolve within a few minutes. When they persist longer, a doctor’s visit would be necessary to identify their exact cause and take the appropriate remedies.

On the other hand, the following symptoms may indicate a stronger likelihood that a heart attack is in progress and should be taken much more seriously:

  • sensation of pain, or of pressure, tightness, squeezing, or burning
  • the gradual onset of pain over the course of a few minutes over a diffuse area, including the middle of the chest, and its persistence
  • pain that extends to the left arm, neck, jaw, or back
  • pain or pressure accompanied by other signs, such as difficulty breathing, a cold sweat, or sudden nausea
  • pain or pressure that appears during or after physical exertion, or emotional stress, or while at rest.

The appearance of these symptoms would more clearly warrant a 911 call.

When Stress Hurts: Neurochemistry Cognates

In this third post in the series on the close association between psychological stress and psychogenic pain, we take a look at neurochemical substances that are involved in the process of psychogenic pain generation and reaction to psychological stress.

The Neurochemistry of Pain: Substance P

aaGiotto_DeposizioneSubstance P, discovered in the 1950s, is the quintessential pain neurochemical, which is activated in response to physiological pain as well as to psychological stress (DeVane, 2001). It is a prototypic neuropeptide of the tachykinin family that has been linked to the production of over 50 neuroactive chemical substances (Brain & Cox, 2006). Its best documented role is as the modulator of signals to nociceptive neurons that communicate the intensity of noxious or adverse stimuli, not only those caused by pain but also those produced by psychological stress (DeVane, 2001; Shaikh, Steinberg, & Siegel, 1993). Substance P receptors are found throughout the CNS but especially in the substantia gelatinosa of the dorsal horn, which is the first point of arrival of afferent pain signals to primary nociceptive fibers.

It is not coincidental that Substance P is also present in the limbic system of the CNS, in the hypothalamus and in the amygdala, all structures that are closely associated with the perception and processing of emotions (Bannon et al., 1983; Culman & Unger, 1995; DeVane, 2001; Stahl, 1999).

Some purely psychological and psychogenic reactions of the organism also see the involvement of substance P, such as the vomiting reflex, anger and defensive behaviors (Krase, Koch, & Schnitzler, 1994), changes in cardiovascular tone (Black & Garbutt, 2002), stimulation of salivary secretions, and other physiological responses that are associated with the general adaptation of the body (Selye & Fortier, 1950) to stressful stimulation.

Kohlmann and colleagues (1997) reported the discovery of substance P in blood pressure regulation in individuals with essential hypertension, a condition that has been related to maladaptive responses to stress (Palomo et al., 2003) and has been shown to respond to psychotherapeutic interventions (Amigo, Buceta, Becona, & Bueno, 1991). Other evidence of the concurrent role of substance P in signaling pain and in the stress reaction comes from animal studies that show an array of defensive behavioral and cardiovascular changes in animals subjected to stressful stimulation (Krase et al., 1994), as well as the detection of substance P in the amygdala of laboratory animals upon neonatal separation (Kramer et al., 1998).

The Neurochemistry of Stress

The neuroendocrine response to a real or perceived stressor consists of the near simultaneous release by the sympathetic nervous system (SNS) of the catecholamines norepinephrine (NE) and epinephrine, the release by the hypothalamus of corticotrophin releasing hormone (CRH), the inhibition by the hypothalamus of gonadotropin releasing hormone (GnRH) and pituitary gonadotropins, the release by the pituitary gland of prolactin (PRL), and the release by the pancreas of glucagon (Sapolsky et al., 2000).

Upon release of NE into the synaptic cleft, approximately 10% of it enters the plasma, thus making plasma NE levels one of the most reliable measures of SNS activity and the magnitude of the body’s response to stressors. Peroutka (2004) has proposed that a migraine attack may be triggered by a significant decrease of NE due to the excessive or prolonged release of adenosine, dopamine and prostaglandin by the over-stimulated SNS. Since sympathetic activation is the primary component of the stress response, stress is thus unequivocally linked to the onset and maintenance of migraine headaches.

The Closest Association: Stress-Induced Analgesia

Livingstone_LionRThe body’s reactivity to real or perceived stressors provokes measurable changes in the autonomic nervous system (ANS) and in the structures controlled by the hypothalamic-pituitary-adrenal (HPA) axis. These changes include blood pressure elevation, pupil dilation, and secretion of cortisol. In the presence of a significant stressor, the stress response also includes a “stress induced analgesia,” or a decreased sensitivity to further pain (as writer-explorer David Livingstone so eloquently reported). This antinociceptive action of the ANS translates into an inverse relationship between blood pressure and pain sensitivity in animals and humans, and is designed to maintain the integrity of the body’s defense systems. Additionally, the release of CRF by the hypothalamus has known analgesic effects (Okifuji & Turk, 2002).

The ANS was recognized by Cannon (1914; Cannon, 1933) as the originator and enabler of the “fight or flight” response to stress. Stress-related releases of adrenaline stimulate the feedback provided by the afferent and efferent vagal fibers. Once again, these same fibers are involved in the activation of endogenous pain modulation centers (Bielefeldt, Christianson, & Davis, 2005). Pain and stress just seem to go together.

Previously in this series:

Next:

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

Beyond Reaction: An Intelligent Response to Stressors

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

The Coping with Stressors Inventory

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

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

When I am confronted with a severe or continuing stressor:

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

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

When Stress Hurts: Central Nervous System

In establishing the connection between the onset of psychogenic pain and stress, it is important to notice that pain and stress share the same central nervous system (CNS) pathways and structures. In this second post in the series on the close association between psychological stress and psychogenic pain, we’ll take a look at these shared structures.

CNS Structures Mobilized by Pain and Stress

PendulumThe body’s response to pain engages a large number of CNS structures that are often the same as the ones activated by the stress reaction. The afferent pathways that carry pain signals connect to the thalamic nuclei and from there to the somatosensory, insular and anterior cingulate (ACC) portions of the brain cortex. A recent functional MRI (fMRI) study (Keltner et al., 2006) on the effects of pain expectation on pain transmission provides the best evidence for the activation of the rostral ACC (rACC), periaqueductal gray (PAG), and medial prefrontal cortex. This and other imaging studies provide evidence of a bidirectional pain pathway receiving input from the limbic system and the amygdala, converging on the PAG, traveling through the pontomedullar nuclei, and controlling spinal pain transmission neurons (Fields, 2000; Fields & Martin, 2001). As the authors of this study point out, “expectation for a higher intensity noxious stimulus increases subjectively experienced pain intensity in part through the action of a descending pathway that facilitates nociceptive transmission at and/or caudal to the region of the contralateral nucleus cuneiformis (nCF)” (p. 4442). The nCF, in humans and other primates, has a composition similar to the PAG and its neurons project directly into the rostroventral medulla, the hypothalamus and the amygdala, all structures directly involved in modulation of the stress reaction.

PMR_muscle-crampsLikewise, the body’s stress response engages a large number of the same CNS structures, specifically certain subregions of the hypothalamus such as the paraventricular nucleus (PVN), the amygdala, and the periaqueductal grey; and certain cortical brain structures, such as the medial prefrontal cortex and subregions of the anterior cingulate and insular cortices (Maier, 2003). These structures provide output to the pituitary and pontomedullar nuclei, which in their turn stimulate the body’s neuroendocrine secretions, as well as to the hypothalamic-pituitary-adrenal (HPA) axis, the endogenous pain modulation system, and the ascending aminergic pathways. The feedback controlling the stress response is provided by the serotonergic (raphe) and noradrenergic (locus ceruleus) structures and by the levels of glucocorticoids in the blood stream, which provide inhibitory impulses to the medial prefrontal cortex and to the hippocampus. Corticotrophin releasing hormone (CRH) is the fundamental chemical substances mediating the stress response, which is secreted by PVN, amygdala, and locus ceruleus neurons. Acute or chronic stress can temporarily or permanently modify the level of responsiveness and output of the CNS to stress (Bennett et al., 1998).

Sharing Pathways, Sharing Outcomes

With this significant convergence of pathways, neurochemical activity and CNS structure activation, it should come as no surprise that acute stress can provoke physical pain, often in the head, the muscles, and the abdominal region. Equally unsurprising is that pain, especially when sharp and unexpected, is in itself a cause of stress that mobilizes the body into immediate action (think of the hand that immediately goes to cover the cut or the burn). Continuous pain, of any origin, is inherently stressful. Continuous stress can be, and often is, manifested by otherwise unexplained (thus psychogenic) physical pain.

Previously in this series: When Stress Hurts: Psychogenic Pain

Next:

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

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.

A Woman’s Stress Relief: Tend-and-befriend

ElGreco on Stresshacker.com Reaching out vs. retreating appears to be what distinguishes the instinctual reaction to stress between men and women. For women, the choice between fight or flight in the presence of a stressor applies less frequently than tend-and-befriend.

Whereas the typical male is more likely to narrow his response to stress down to a decision whether to fight the stressor directly and aggressively or retreat from it by way of an emotional withdrawal, most women choose to turn to family and friends by tending to or cultivating connections. Forming a network of support appears to be an innate characteristic of females also among primates, intended as a form of protection for themselves and their offspring. Clearly, the assumption is that there is more safety in numbers than in trying to make it alone in potentially dangerous situations.

Most women naturally construct a more intimate and complex social network than men do, and when they are stressed, in danger, or in times of change, they can turn to this network for support. Thus, they are more likely to seek out the company of other women and less likely to flee the stressor by withdrawing or isolating or to fight it directly and single-handedly, as most men appear to do.

This natural response to the stress reaction, moderated by a support system such as tend-and-befriend, might help explain why women live an average of five years longer than men. Men are also capable of creating complex social networks (now enormously facilitated by technological connectivity), but male-created social networks may lack the necessary level of intimacy or remain underutilized as a coping mechanism.

The Science Behind Tend-and-befriend

Research being conducted at UCLA under a grant by the National Science Foundation on Biopsychosocial Bases of Social Responses to Threat indicates that, in times of danger, most people seek positive social relationships that may provide safety for themselves and their offspring.  This and prior research by Dr. Shelley Taylor at UCLA’s Social Neurosciences Lab suggests that the hormone oxytocin and other opioid peptides produced in the body stimulate these responses, most especially in women. Oxytocin in particular appears to function as a social thermostat that monitors the availability of social resources and prompts the seeking of additional connections when needed.

Stress Relief: Taking Charge or Letting Go?

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

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

Take Charge, List, and Delegate

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

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

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

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

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

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

Accepting That Life Is…Well…Stressful

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

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

Can Comfort Food Reduce Stress?

MammothHotSprings_EN-US66686672 When eating is a way to tame anxiety instead of hunger, it is an emotion-driven behavior that adds calories, fat, cholesterol and inches to the waistline, while providing at best a temporary relief to feelings of stress and anxiety. So what is emotional eating, does it relieve stress or can it do more harm than good? In this post, we’ll take a look at its symptoms, learn how to distinguish it from real hunger, and how to prevent it from ruining our diet, our mood and our health by stopping it or simply bringing it under control.

How to Recognize Emotional Eating

The normal physiological response to emotional distress caused by a stressor is a noticeable loss of appetite. The stress reaction is a complex physiopsychological mobilization of resources that also causes the blood flow to be temporarily diverted from the digestive system to other parts of the body where it is most urgently needed to activate the fight or flight response, i.e. the musculature and the cardiovascular system. Thus, under normal functioning, the stomach contracts and hunger is reduced during times of stress and anxiety.

When there is an increase in appetite under stress, it may look like a real need for food, but in reality there are several differences between emotional hunger and physical hunger. The most significant difference is the speed at which the urge to eat is felt: emotional hunger appears suddenly or in a matter of minutes, while physically appropriate hunger occurs more gradually.

The next most significant difference is in the type of food that is usually craved during bouts of emotional eating. Specific high-calorie, high-fat and sugar foods, such as pizza, cookies or ice cream, are often the only foods that will satisfy the emotional need. When the appetite is caused by real physiological hunger, there is more willingness to eat a variety of different foods, even ones that we do not ordinarily like as much but that happen to be available (broccoli, Brussels sprouts, day-old soup). 

A third difference is in the way emotional hunger triggers the anxiety to eat right away, whereas normal physical hunger very seldom has an anxiety component attached to it. Another difference is in the way emotional hunger appears to shut off our natural ability to regulate the amount of food we eat at any one sitting, i.e. the ability to stop when the stomach is full. When eating to satisfy an emotional need, there is higher likelihood that the eating will continue until all the food is consumed. Last but not least, guilt often accompanies emotional eating. Physical hunger is very seldom associated with negative emotions such as guilt or regret.

Is Emotional Eating Just a Problem for the Waistline?

In theory, a simple food fix in times of high stress and anxiety does not appear to be a problem. Indeed, occasional use of food to self-soothe and comfort negative feelings is a proven remedy that has been known since the beginning of time. However, the prolonged recourse to food to assuage emotional needs carries significant health risks, chief among them an increase in levels of cortisol, insulin, and lipids, which over time can lead to obesity and the development of metabolic syndrome.

The repeated use of food to alter negative emotions, unfortunately, tends to become less effective over time. This is due to physiological changes that take place, but principally due to the ineffectiveness of food as a coping mechanism. At best, comfort food can act as a distraction from worry. Often, comfort food becomes a metaphor of the “hunger” for the emotional closeness with significant others that could provide the comfort and help that would truly benefit the individual under stress.

How to Stop or Control Emotional Eating

When emotional eating becomes a habit while losing its ability to reduce stress and anxiety, there are ways to manage it and eventually stop it entirely. This is often possible without counseling or medication, but the latter may become necessary when emotional eating has become compulsive and the person simply does not have the psychological resources to bring it under control. The following suggestions may be helpful and worth a try, before seeking professional help.

  • Recognize emotional eating, distinguish it from real hunger, and learn what triggers it.
  • Improve the quantity and quality of sleep by napping or getting to bed earlier. Tiredness may increase the need for an energy boost. Take a nap or go to bed earlier instead.
  • Use an effective stress management program, such as as yoga, exercise, meditation or relaxation techniques. Reducing stress is often the key to eating only when hungry.
  • Give yourself a hunger reality check by asking, “Is my hunger physical or emotional?” Check when you ate the last time, and calculate whether you should be hungry now. Give time to the sudden craving to pass, while trying to make sense of it.
  • A food diary where you note what and how much you eat may be very helpful in establishing the connection between stress, mood changes, sudden cravings, and emotional eating. Awareness is often the first step toward developing options and making better choices.
  • Connect to a support network. When food is a substitute for companionship, friendship, and interpersonal connections, it is more likely to be the one comfort that is readily available. It is a better approach to reach out to family, friends, colleagues or a support group.
  • Boredom can be a powerful trigger of emotional eating. You may snack healthy (low-fat, low-calorie, fresh fruit, vegetables with fat-free dip, unbuttered popcorn) or not at all by choosing to take a walk, watch a movie, play with your pet, listen to music, read, surf the Internet or call a friend.
  • If nothing but comfort food is available and you recognize it clearly as triggered by stress or anxiety, try to practice moderation by dividing the bag of chips into smaller portions and eating only one or two servings. Eating only four bites, according to studies at the Food and Brand Laboratory of Cornell University, may be sufficient to create a positive memory of food that is recalled as just as good an experience than eating the whole thing.

Get Away From the Maddening City—Now!

Blackwell at Stresshacker.com Incidence of schizophrenia and other psychoses is greater in urban than rural areas, but the reason remains unclear. Various studies have found the link between living in the city and severe mental illness, and none have determined a specific cause. A new study claims to have the explanation. The study examined a group of over 200,000 people born between 1972 and 1977 whose medical history was cross-referenced with demographic, school, municipality, and county information.

The study, published this month in the Archives of General Psychiatry examined whether individual, school, or area characteristics could be associated with psychosis and whether the effects of individual characteristics on risk of psychosis varied according to location.

The incidence of psychosis was significantly higher among people living in urban settings as compared to those living in the country.  Further data analysis showed that psychosis appears to be a reflection of the increased social fragmentation that has become a feature of city living.

The principal researcher, Dr. Stanley Zammit of the Center for Neuropsychiatric Genetics and Genomics of Cardiff University, said that previous studies had found that the severity of schizophrenia risk depends on the context of the living situation, with increased risk found for those living in an area with few people of their own ethnicity.

Of this study, Dr Zammit says that "it was somewhat surprising that we found this sort of context-dependent effect across a range of characteristics: ethnicity, social fragmentation, and deprivation. Although it makes sense that such an effect would not be restricted to ethnicity but to potentially any characteristic that might define someone as being different from their peers as they grow up."

With the caution that is characteristic of studies that avoid the presumption of absolute revelation, the researchers point out that much more investigation is needed before it could be said (if ever) that living in the city causes schizophrenia. What can be said from this and other similar studies, however, is that there is a greater risk of developing a severe mental illness such as psychotic disorder for people who live in a predominantly urban setting. Is this enough to make you want to live in the boonies? Maybe not. But this may be another consideration for a move to the more distant ‘burbs.

Something Needs to Be Done About Hostility!

Ginetto at Stresshacker.com Hostility is stressful, both ways. To giver and receiver alike, hostility metes out its toxic charge of badness. Far from being a true relief for frustration, pent-up anger, or unexpressed emotion, a sudden explosion of hostility merely releases a burst of energy and briefly discharges some muscle tension. Beyond these ephemeral effects, it is hard to find a good justification for hostility in everyday situations. So why is it so prevalent?

Two reasons account for hostility’s “popularity.” The first is the genetically programmed aggression instinct, which, in its proper setting and situation, can be useful (in a competitive physical sport like football), or downright vital (in combat situations, to fight off an aggressor, or in other situations of danger when a calm and relaxed demeanor would be clearly out of place). We can be aggressive and hostile by design, but we are also given a brain that helps mitigate the limbic system’s rage of emotions, and the amygdala’s watchfulness against aggressors, real or perceived as they may be.

The second reason for the pervasive presence of hostility is a misfiring of the very structures of the brain that are supposed to help us regulate it. Poor regulation of negative emotions can unleash hostility. Notoriously so, antisocial personalities have little to no self-regulation of hostility and most of the times this lands them in jail. Many more individuals, though, fall short of law-breaking hostility but still exhibit plenty of it in everyday situations (behind the wheel of their car, while waiting in line, with customer service people, with their spouses, children, friends) to make life more stressful for themselves and for anyone they come in contact with.

Steve Slater on Stresshacker.com At the other end of the spectrum, hostility, while present as a natural emotion, can be sublimated into a more productive and less threatening display of displeasure with someone or a situation.  Well-regulated hostility and aggressive instinct become assertiveness, standing up for one’s right, engaging in an passionate discussion. It can also sublimate into artistic pursuit, an all-out workout at the gym, or humor. A recent example of the latter was portrayed by JetBlue flight attendant Jeff Slater. Justifiably enraged by an unjustifiably aggressive passenger, Mr. Slater regulated down his hostility, expressed himself aloud on the plane’s PA system, grabbed a couple of beers, activated the emergency slide, slid down to the tarmac, ran for his car and drove home.

Hostility and (Bad) Health

Negative emotional states, such as anger and hostility, when they persist over time and become chronic, can negatively impact health. The risk to health comes through a number of mechanisms, including engaging in high-risk behavior (verbally provoking, physically attacking others), loss of social support (no one wants to be with a chronically hostile individual), and social isolation.

Chronic negative emotions also induce a semi-permanent activation of the stress reaction and cause sustained systemic inflammation, both of which increase the risk of disease. Research on hostility and aggressive personality has clearly established a link between these emotional states and heart disease, heart attacks, and cardiac-related mortality. Hostility not only contributes to a higher incidence and increased severity of heart disease, but is also related to symptoms of metabolic syndrome, including insulin resistance.

What Can Be Done?

Taking a page from Mr. Slater’s playbook, humor is one of the highest levels of sublimation that can be achieved in down-regulating aggression and hostility. Other forms of self-regulation of hostility (which incidentally are also ways of dealing with stressful situations in general) can be listed as follows:

  • Anticipation (the ability to anticipate the consequences of hostility and evaluate alternative responses)
  • Affiliation (turning to others for help and support, initiating a dialogue instead of a confrontation)
  • Altruism (taking into account the needs of others, and being able to contain rather than meet their aggression head on)
  • Humor (finding the amusing and the ironic in the situation)
  • Self-assertion (expressing feelings and thoughts directly and openly, but without resorting to verbal or physical violence)
  • Self-observation (reflecting on one’s own reactions and regulating them appropriately, before the explosion occurs)
  • Sublimation (channeling negative feelings into positive behaviors, i.e. taking it out on gym equipment, a good run, a distracting activity)
  • Suppression (intentionally avoiding catastrophic, negative and pessimistic thoughts that can lead to aggression).

Marriage Reduces Level of Stress Hormones

Venice at Stresshacker.com It is a well-established fact that being married can improve health outcomes. Now, new research findings get more specific and suggest that a long–term bond between two people can also reduce the production of hormones associated with stress. This is according to Dr. Dario Maestripieri, Professor in Comparative Human Development at the University of Chicago and lead researcher, who published the results of the study in the August 2010 issue of the peer-reviewed journal Stress.

To measure the effects of a committed relationship on stress levels, Dr. Maestripieri and his team monitored changes in salivary concentrations of testosterone and cortisol in response to a mild psychosocial stressor (a set of computerized decision-making tests) on a sample of over 500 participants. The aim of the study was to investigate any gender differences in hormonal responses to psychosocial stress; the relationship between pre-test hormone levels and stress-induced hormonal changes; and any possible sources of same-gender variation in pre-test hormone levels as compared to hormonal responses in a larger human subject population. 

The results show that males had higher concentrations of the stress hormone cortisol than females both before and after the test. After the stress-test was administered, cortisol level increased in both sexes but the increase was larger in females than in males. Single males without a stable romantic partner had higher testosterone level than males with stable partners, and both males and females without a partner showed a greater cortisol response to the test than married individuals with or without children.

It would appear from the test results of this study that married individuals, when faced with a new stressor, respond with a lower production of stress hormones. This can have two major benefits: it can permit a more deliberate response to the stressor (as the system is not overloaded with a debilitating and hormone-filled stress reaction), and it can, over time, reduce the accumulation of allostatic load on the organism—two good things that help married people confront challenges in more supportive, less stressful, and more effective ways.

Women’s Heavy Burden of Stress-Gets Heavier

Lake Wanaka at Stresshacker.comThe most recent survey of stress in America indicates that women continue to bear the heavier burden of stress, particularly due to financial concerns and worries over their family’s health and family responsibilities. Women consistently report more physical and emotional stress than men, and are more likely to lack the willpower to make changes recommended by health care providers, the survey results also show. What is causing this unhealthy gender bias? Allostasis, or more precisely allostatic load, is the key to understanding gender differences in stress. Let’s first understand allostasis, its benefits, and potential dangers.

Allostasis: Too Much of a Good Thing

Allostasis defines the processes that attempt to maintain the body’s internal stability in the face of physical or psychological challenges. Physiological and behavioral changes are initiated automatically during the stress reaction to external environmental and developmental threats, such as danger, conflict, financial worries, interpersonal difficulties, family and job demands, and other life stressors. Allostasis as a process is a very good thing and aids in survival and coping. It can work well at restoring the body’s equilibrium and ensure an adequate response to the threat. However, allostatic processes can cause physical and psychological damage when they extend beyond their intended short-term activation. This prolonged state of activation creates a burden on the system, known as the allostatic load.

Four factors can contribute to the formation of a heavy allostatic load:

  1. Repeated physical or psychological challenges (e.g., prolonged financial stress, a stressful job, multiple and conflicting demands of time and resources, a serious illness, childhood trauma, adult abuse or violence)
  2. Inability to adapt to these repeated challenges (the feeling of being at the end of one’s rope)
  3. Inability to produce an adequate response to the stressor (such as the phenomenon of learned helplessness, depression or anxiety)
  4. Inability to end the stress reaction even after the stressor has been removed (chronic stress)

Allostatic load accumulates over time. The continuation of multiple small changes in physiological and psychological functioning (which are meant to be only short-term), due to a persisting state of alert against perceived threats (the classic stress syndrome), creates the potential for illness.

What Happens to the Body During Allostasis

During the normal stress response and the body’s process of allostasis, the stress hormones serum dehydroepiandrosterone (DHEA), cortisol, norepinephrine and epinephrine are secreted into the blood stream. The immune system and neurological responses are activated, along with muscular, cardiovascular and pulmonary system. Alongside these physical reactions, psychological changes take place in response to anxious, fearful, hostile or aggressive states produced by the stressor. Behavioral changes also occur in trying to cope with the stressor, sometimes consisting of alcohol abuse and other substances,  working too many hours, or exercising compulsively. Sleep disturbances, depression and other psychological symptoms are usually the first evidence of an increasing allostatic load.

At the physiological level, allostatic load can cause atrophy of the hippocampus and structural changes in the amygdala and the prefrontal cortex, resulting in a more or less severe impairment in spatial learning and memory. Certain tell-tale physical responses are also indicative of a heavier allostatic load: higher blood pressure, changes in waist-hip ratio, higher serum high-density lipoproteins (HDL) and cholesterol, and glycosylated hemoglobin levels.

These psychophysical changes, though helpful in the short run, can cause damage. This damage is the cost of maintaining an allostatic state longer than is optimal for health. Numerous studies of allostasis show the risk of stress-induced illnesses such as cardiovascular disease, atherosclerosis, metabolic syndrome, Type 2 diabetes, depression, anxiety, and immune/auto-immune disorders.

What about the effects of allostatic load on women?  Details after the jump.

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