Stress: Its Science & Management

“Research has linked even moderate levels of stress to lower life expectancy“

Economist magazine, 25 April 2015

Stress: What it’s good for

The human body is beautifully adapted to dealing with acute stress – getting blood, nutrients and energy to those muscles most needed to get us out of imminent danger – quickly!

Picture yourself at a beautiful Polynesian resort lolling about on a surfboard a couple hundred feet offshore – the sun is shining brightly, your family is frolicking happily on the beach, you’ve not a care in the world – life couldn’t be better.

And then, without warning, a siren blares out, shocking you out of your peaceful bliss – there’s a SHARK in the water!!!!

In a split second your body kicks into action:

Your sympathetic nervous system, the one responsible for quickly mobilizing the body, kicks into action. At the same time, your parasympathetic nervous system, responsible for calming the body, shuts down.
Epinephrine (aka adrenaline) is pumped into your blood stream, triggering a rapid cascade of escape-assisting activity. It’s quick release gives you that “kicked-in-the-stomach” feeling.
Your heart starts racing, pushing more blood and nutrients to your shoulder, arm, and leg muscles so that you can start motoring like a paddlewheel on a Mississippi steam boat.
Your blood pressure rises as a result of your pounding heart.
Under the influence of the extra epinephrine, your platelets (blood cells that promote clotting) start clumping together more readily, thus thickening your blood, helpful should you suffer bodily injury.
Your breathing quickens to suck in more oxygen for those hard-working muscles.
Insulin secretion is suppressed and fat cells’ sensitivity to insulin is reduced – no point removing glucose from the blood when it’s urgently needed.
Glucose, proteins, fats, and “bad” cholesterol are sucked out of your fat cells, liver, and non-essential muscles and dumped into your blood stream to provide your shoulder, arm, and leg muscles with immediate fuel – no time to wait for that bacon-and-egg breakfast to digest! In fact, digestion comes to a halt to re-direct energy to where it’s needed right now.
Your colon contracts making you involuntarily soil your bathing suit – and it’s the runny diarrhea kind. No point wasting energy removing water from faeces or carrying around excess weight.
To conserve energy, non-essential activities like appetite, digestion, bone growth, pain sensation, and sex drive are all suppressed.
With digestion and stomach acid levels temporarily decreased, renewal of the stomach’s acid-resistant protective lining is minimized .
The immune system is temporarily boosted in readiness for a short-term danger.
Your senses become more acute.
More blood and nutrients are directed to your brain, enhancing your ability to remember facts (such as how to escape from a shark)!

And then, after you make it to shore safely, the whole process reverses: the parasympathetic nervous system kicks in to calm you down, your heart rate and breathing slow, your blood pressure drops, nutrients begin to be re-deposited to your fat cells, epinephrine levels go back to normal, and routine bodily activities like digestion and cell growth re-start; beautiful!

Stress: What it’s bad for

Unfortunately, this wondrous system for keeping us safe in the face of imminent, life-threatening danger cannot distinguish between real danger and things that are merely upsetting.

It also kicks in over situations like discovering a big scratch on your car door, or being overwhelmed at work, or having to rush home to feed your daughter and then get her to her 6pm soccer practice on time – across town and through rush-hour traffic.

When chronically triggered over life’s little stuff, our stress reaction turns from saviour to annihilator, leading to:

A five-fold increase in the risk of developing cardiovascular disease.
A suppressed immune system.
Increased risk of anxiety disorders and depression in later life among children born to chronically-stressed mothers.
Increased risk of diabetes and greater difficulty keeping it under control.
Increased junk food craving and fat storage.
Increased sensitivity to stressors and an impaired calming system.
Increased risk of gastrointestinal disease such as an ulcer.
Increased risk of osteoporosis.
Increased risk of reproductive problems.
Increased risk of memory impairment.
Increased impulsivity and emotional swings coupled with impaired decision-making ability.
Sleep impairment (and the many harms this brings on).
Increased risk of depression and of anxiety disorders.
Among the elderly, an increased risk of memory impairment and compromised ability to generate new neurons.
More easily fatigued.
Greater risk of substance abuse.

Our Ugly Side

Aside from the physical and mental damage caused by chronic stress, it also turns us into the person no one wants to be around. When stressed, we tend to exhibit the following traits:

We feel there is an urgent need to fix whatever appears to be the problem, but this at precisely the moment stress has taken our wisdom “off-line” (this by compromising our ability to access our prefrontal cortex, the locus of our executive functioning).
We raise our voice.
We lose our sense of humor.
We act in an abrasive manner and lose our kindness and compassion for others.
We lose the ability to concentrate. We are quick to judgment and blame.
We say and do things that damage relationships.
We are unpleasant to be around which further strains our relationships.

As covered at the outset, our stress system evolved to protect us from acute, short-term, imminent danger and it still serves this purpose – put your hand on a hot stove and you will automatically react, no need to consciously think about what to do.

However, our stress system has yet to evolve to the point where it is able to discern the difference between true danger (which is rare and short-lived) and those things we merely find upsetting (which are numerous, frequent, and often drawn out).

This latter type of stress is referred to as “psychological stress”, the kind we totally make up in our heads.

So, subject the stress system to numerous, frequent, drawn-out, troubling thoughts and we put ourselves at risk for all of the ills outined above.

In short, being chronically stressed is awful for us – physically, mentally, and socially – with implications that have the potential to extend into the future, affecting our children and grandchildren.

The Future Nature of Stress

By its very nature, psychological stress is rarely about things that have already happened (unless what happened in the past has potential future consequences, in which case, stress and anxiety are still about the future).

So, when our body is here, in this present moment, but our mind is in the future, we will inevitably experience anxiety and stress.

For example, picture yourself starting a beautiful day with a nice warm shower, joyfully breathing in the scent of your favorite shampoo, smiling inside and feeling terrific when, suddenly, into your head pops your day’s very long, very arduous to-do list: goodbye good feelings, hello stress. Your body is in the shower, but your mind is already at the office.

Whenever we do this we can immediately feel the stress reaction in our body – our muscles tighten, our stomach begins to churn, a sense of grim despair settles over us – and all because our body and mind have just entered different time zones.

A second factor that contributes to stress is the sense that we are not up to dealing with the future. After all, if our to-do list were completely manageable, we wouldn’t be stressing about it.

Such self-doubt appears to be a common human frailty, as evidenced by this snippet of wisdom from almost two-thousand years ago:

“Never let the future disturb you. You will meet it, if you have to, with the same weapons of reason that today arm you against the present.”
Marcus Aurelius, Roman emperor, 161-185 AD

Factors That Accentuate the Harm of Stress

Four factors often cited for making it more likely that a stressor will inflict harm include:

Lacking a sense of control over the stressor. Work in a job where you have little or no control of your work load, the way you work, or your working conditions and you are at greater risk of the job’s stressors making you sick. Even having the perception of control is better than feeling you have zero control.
Facing a stressor that is unpredictable. Even if you lack control over a stressor, knowing things like its timing, duration, or extent are still going to help lessen its impact.
Lacking healthy mental coping techniques or physical outlets to deal with the stressor. Mindfulness practice is one example of a healthy outlet for dealing with stress. Another is exercise because it mimics what the stress response was created for – physical exertion to escape danger.
Lacking perspective about the stressor. One person’s stressor is another’s interesting stimulation, only the thought about the stressor differs; change the thought, change the perspective, and the stressor ceases to be stressful. This is empowering.

Stress Management

Here, then, are some techniques and perspectives on managing stress:

Techniques for Managing Stress

Change the situation or remove yourself from it, if you are able. If this is not possible, then full and total acceptance is your only other sane option. Once accepted as your reality, some of the other coping techniques can then be brought into play.
Practice P.B.S.: 1) Pause and close your eyes to block out sensory distractions and facilitate a calming inward focus. 2) Breathe slowly and deeply two to three times, in for four, hold for seven, out for eight. This activates your calming parasympathetic nervous system. 3) Smile, inwardly or outwardly, even if forced. As discussed here, this releases feel-good neurotransmitters like dopamine, serotonin, and endorphins.
Practice S.T.O.P.: 1) Stop whatever it is you are doing. 2) Take a few slow, deep breaths. 3) Observe your thoughts, feelings, and emotions, becoming consciously aware of them and naming them (“I’m feeling anger”, “I’m feeling frustration”, etc.) which has been found to diminish their ill effect. 4) Proceed to do yourself a kindness; take a stroll, have a friendly chat, go grab a healthy snack, etc.
Take a moment to sense which muscles are tight due to stress. Next, breathe deeply and slowly while consciously relaxing those muscles. Because body and mind are intimately connected, it is not possible to be stressed and completely relaxed at the same time.
If feasible, increase your exercise regimen. It is important to burn off all the extra energy released by your stress hormones.
Practice insight (vipassana) meditation (see this post). Notice the feelings underlying your stress – anger, frustration, fear, guilt, envy, embarrassment – whatever they may be. As per the S.T.O.P. technique, mentally call them out.
Practice Tonglen meditation (see this post), a technique that changes your focus away from “woe is me” to one of concern for all others in similar straits, mentally taking in all of their suffering and, in its place, sending out good wishes for them to be at peace.
Re-double commitment to your mindfulness practice (see this post) to keep your focus on the present moment and so stop your anxious mind’s troubled wandering.
Slow down everything you do, otherwise your rushing will send a signal to your stress system that danger is afoot. And don’t be concerned that slowing down implies that your productivity will suffer. If anything, by calming a scattered, rushed mind, your enhanced clarity of thought will make you more productive. It is no coincidence that our best ideas typically come to us when we’re relaxing in the shower or are snuggled in our bed half awake in the pre-dawn of morning; in other words, times when our minds are still – the only time our subconscious intelligence is able to reveal itself.
Related to the previous point is to also slow down your life – say ‘no’ to those things you really don’t wish to do so you are able to say ‘yes’ to those things in life that bring you joy (including the joy of doing of absolutely nothing)!
Seek out quiet. Noise is a stressor and so best avoided. For example, near the end of my career my employer changed to an open-concept office layout. For the sake of my sanity I invested in a good set of noise-canceling headphones. From a stress-management perspective this returned control to me. It also replaced the unpredictability of office noise with the predictability of my favorite classical music.
Seek out soothing music and sounds. Related to the previous point, meditative music or just gentle sounds aid in accessing your calming parasympathetic nervous system and turn off its high-alert sympathetic counterpart. A walk in the woods to simply listen to the forest sounds also works in the same manner (with the added benefit of exercise).
Seek out social support. There is a link between social isolation and having an overly-active sympathetic nervous system. As a result, staying close to family and friends not only makes you happier but also helps manage stress.

Perspectives on Managing Stress

Keep things in perspective. As outlined in this post, we often place great importance on issues that, in the big scheme of things, are little more than trivia.
Change your thinking. Remember that it is not external circumstances that cause your stress but, rather, your perspective about such situations that does. Change your thinking, change your perspective, and your take on the situation changes as well; a stressful situation is suddenly seen as tolerable. Remember that you are always the master of your thoughts, they are not the master of you. If you do not feed negative thoughts, if you do not give them your continued attention, they will dissipate of their own accord and healthier thoughts will take their place. Psychological stress is nothing more than troubled thoughts. Remember that thoughts cannot hurt you, they are merely ephemeral biochemical reactions going on in your brain, they have no physical existence of their own.
Remember than pain and impermanence are an inescapable part of life and that resisting this reality leads directly to needless suffering, making an already unpleasant situation even worse.
Have confidence in yourself and know with certainty that you already possess the innate wisdom to deal with whatever life throws at you – because you do. Remember that to access that wisdom (i.e. your prefrontal cortex) you must be in a calm state of mind as otherwise you will be thinking with your decidedly-unwise amygdala. Think of it this way; even if the future turns out to be painful, you will assuredly handle it better if you approach it mindfully, using the calm, wise, responsive, and creative part of your brain rather than the unthinking, reactive part. With mindfulness practice, you get to choose.
Think of stressful situations not as problems to be gotten rid of but as opportunities to strengthen your mindfulness practice. After all, it’s easy to be mindful when things are going your way. It’s only when life throws up challenges that you truly get to put your mindfulness skills through their paces.

“The most precious opportunity presents itself when we come to the place where we think we can’t handle whatever is happening.”
Pema Chodron, from her book, “When Things Fall Apart“

“… the things we all find stressful – traffic jams, money worries, overwork, the anxieties of relationships. Few of them are “real” in the sense that a zebra or a lion would understand. In our privileged lives, we are uniquely smart enough to have invented these stressors and uniquely foolish enough to have let them, too often, dominate our lives. Surely we have the potential to be uniquely wise enough to banish their stressful hold.”

Dr. Robert Sapolsky, from his book, “Why Zebras Don’t Get Ulcers“

Warmest wishes,

Rob @ Living a Mindful Life

Appendix A: The Health Risks of Stress

Cardiovascular Disease

The stress system was designed for acute, short-term stressors which lead to a temporary increase in your blood pressure. However, when chronically stressed, your blood pressure becomes chronically high.

Higher blood pressure and blood flow cause your artery muscles to thicken in order to handle the higher pressure and to control the higher flow rate. In doing so, they become less elastic which serves to further increase blood pressure – a vicious cycle has begun.

The left ventricle of your heart, the one being buffeted by the high-pressure returning blood flow, also experiences a thickening of its muscles, creating an imbalanced heart which increases the risk of an irregular heartbeat.

Chronic high blood pressure also damages the interior of your arteries at branching points, creating rough spots. As a result, inflammation-suppressing cells start congregating there. In addition, these rough spots trap things like fatty cells, “bad” cholesterol, clumped platelets, and miscellaneous fibrous crud. In this manner, an artery-blocking plaque is formed which can lead to heart attack and stroke.

Finally, there is a reason that high blood pressure is known as the ‘silent killer’ because much of the damage it wreaks occurs without symptoms. It is often under an episode of higher-than-normal stress that all the damage suddenly makes itself known and results in death.

It has been found that ‘Type A’ personalities (i.e. those individuals characterized by impatience, hostility, and hyper-competitiveness) are at greater risk of cardiovascular disease due to the fact that stressors have an amplified impact on such people.

Disease Susceptibility

While the immune system is boosted in the short-term, prolonged stress begins to suppress it. White blood cell and antibody production decline and white blood cells already in circulation are subjected to removal and destruction by stress hormones. As a result, when stressed, you become prone to catching whatever illness is making the rounds such as the flu or common cold.

In addition, frequent stress also increases the risk of developing an autoimmune disease (e.g. lupus, celiac disease, multiple sclerosis, rheumatoid arthritis, and psoriasis).

Generational Harm

The offspring of chronically-stressed mothers have been found to have greater “bad cholesterol” release when under stress, so your poor reaction to stress today may also harm your children.

For example, a fetus exposed to high levels of maternal stress hormones is at heightened risk of obesity, high blood pressure, cardiovascular disease, and Type II diabetes. Further, its own children may also be at greater risk of these illnesses.

There is also some evidence that such children are at increased risk of both chronic anxiety and impaired brain development.

Juvenile Diabetes

By suppressing insulin production and the sensitivity of fat cells to insulin, chronic stress promotes insulin resistance, potentially increasing the risk of getting juvenile diabetes and making its control more difficult.

Junk Food Craving

In between chronic episodes of stress your body attempts to reverse the stress reaction process. The resulting stress hormones (known as glucocorticoids) stimulate appetite to begin replacing the energy stores that it expected you to use while fleeing from danger – danger that never happened.

And the foods these hormones lead you to prefer? That’s right, the starchy, sugary, and fatty stuff. And because these food types make you feel good (by temporarily reducing the stress response) they make you crave even more of them, leading to yet more gunk in your blood stream to amplify the arterial damage caused by chronic stress.

Further, in the presence of high insulin (remember the insulin-resistance angle), these hormones also increase the storage of this junk food.

And just to make matters worse, they preferentially pack it away in fat cells around the abdomen. This is a dangerous location because fat released from abdominal fat cells more readily finds its way into your liver which then turns it into glucose. This leads to even higher blood sugar levels and greater insulin resistance.

Impaired Calming Ability

By chronically shutting down your calming parasympathetic nervous system you become less able to calm down after upsets.

Digestive Tract Diseases

Chronic stress-related colon contractions can lead to Irritable Bowel Syndrome, a thoroughly unpleasant illness whose symptoms include cramping, abdominal pain, bloating, gas, and diarrhea, constipation, or both.

During the recovery periods between episodes of chronic stress, stomach acid levels return to normal and are greeted by temporarily-reduced stomach wall defences, resulting in ulcers.

Osteoporosis

With the growth of new bone and the uptake of calcium restricted, stressed adults are at increased risk of osteoporosis.

Impaired Child Development

A child subjected to stressors may experience stunted growth, impaired intellect, and personality issues making it difficult for them to fit into society.

Reproductive Issues

By reducing testosterone levels in men and estrogen levels in women, stress reduces sex drive.

Further, the achievement of a male erection requires activation of the calming parasympathetic nervous system. Given that stress triggers the exact opposite – the sympathetic nervous system – impotence often results.

In females, stress reduces the secretion of key reproductive hormones leading to reduced ovulation and insufficient uterine lining changes to support the implantation of a fertilized egg. The result is an inability to achieve pregnancy.

Memory Impairment

While short-lived acute stress enhances explicit memory (i.e. the ability to recall facts), chronic stress impairs it.

So, if you’re stressing about that big exam tomorrow afternoon, it’s likely that you won’t be able to remember all the things you studied. Well, at least until you’ve calmed back down which, unfortunately, likely won’t be until after the exam is already over.

Executive Functioning Impairment

Stress negatively impacts the functioning of the prefrontal cortex, the locus of our executive functioning – emotional control, impulse control, and creativity. Wise decision making is compromised.

Sleep Impairment

Stress impairs both the ability to get to sleep as well as the quality of whatever sleep you do get. This results in diminished attention, slowed working memory, an impaired ability to create new memories, reduced cognitive ability, a depressed mood, and an inflammatory response from the body (which, in turn, increases the risk of cardiovascular disease and cancer).

In what becomes a vicious cycle, sleep deprivation itself is a stressor, resulting in elevated levels of stress hormones making you prone to all of the troubles outlined previously.

So, back to that big exam: pull an all-nighter studying and the resulting lack of sleep will impair your ability to recall all those facts you worked so hard to cram into your head.

Depression

Exposure to repeated and frequent stressful episodes increases the level of stress hormones which, in turn, increases the chance of developing depression (i.e. an inability to experience pleasure).

In part this is due to the fact that stress hormones can mess up the neurotransmitters that work on triggering the brain’s pleasure pathways (i.e. dopamine, serotonin, and norepinephrine) .

Women are more prone to depression than men, this thought to be due in part to their greater tendency than men to ruminate about their problems (unlike men who have a greater tendency to ignore their problems).

Stressors over which we believe we have no control can induce a feeling of helplessness, one of the symptoms of depression where sufferers give up on life. They assume it will only get worse even in the face of contrary evidence.

Diseases of the Elderly

As humans age their ability to return to a calm state becomes impaired due to the fact that dissipation of stress hormones takes longer.

In addition, the elderly often have higher base levels of stress hormones even in the absence of stressors. These elevated stress hormones lead to all of the problems listed previously, including impaired memory and reduced production of new brain neurons.

Fatigue

Under acute stress your body taps into its existing stores of energy and postpones new deposition. If the stress is repeated and chronic, your energy level becomes depleted and you fatigue more easily.

Anxiety Disorders

Severe stress can both damage the hippocampus (thus impairing the ability to lock away memories for future recall) and make the amygdala permanently more reactive (thus making an individual yet more sensitive to stressors). The result is anxiety over a stressor without any conscious understanding of why you are feeling anxious.

Substance Abuse

Drugs like cocaine directly trigger the release of dopamine, a neurotransmitter that activates the part of the brain that creates the feeling of pleasure. As a result, if stressed, such drugs take away the pain of stress.

However, three problems occur. First, dopamine levels afterward drop below where they were prior to taking the drug. You feel even worse than before and so crave another hit to feel better again.

Second, the brain has a mechanism to limit the impact of excessive dopamine by becoming less sensitive to it. The result is the need for even more of the drug to get the same ‘high’.

And third, in the absence of getting more of the drug, stress hormone levels in the brain increase greatly, leading to activation of the amygdala which triggers feelings of fear and anxiety.

Addiction is the unsurprising result – an ongoing need to make the pleasure come back and make the fear and anxiety go away.

Income Inequality

While living in abject poverty is stressful and leads to many awful health outcomes, in most Western societies it is relative poverty that predicts ill-health.

In other words, it’s not about how much money you have but, rather, how much money you have relative to others that generates stress.

As a result, the greater a society’s income inequality, the worse the health of those on the bottom looking up.

Best wishes,