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Many of my patients exhibit symptoms related to stress without much knowledge how their perceived stressors impact their emotional and physical wellbeing.  Thus, I believe a discussion (actually several discussions) on this issue is needed.  This first article describes how the human body is “designed” to handle stress.  Knowledge of this is paramount for understanding the symptoms and treatment for stress-related illnesses.

 

What Is Stress?

 

Stress is a part of everyday life.  It can’t be avoided and it exists on a continuum from bad stress to good stress.  Getting married, building a house, starting a new job - these are examples of situations that are usually considered favorable.  However, they can still be very stressful.  

 

In primitive times, humans faced multiple life or death situations (extreme heat and cold, periods of starvation, predators).  Our ancestors' survival was dependent upon their ability to fight or flee danger or adjust to environmental stressors.  Perhaps you have heard of the “fight, flight, freeze” response.  This is nature’s way of protecting animals and humans from worldly dangers.  

 

Body’s Response

 

The perceived need to survive stimulates two stress responses.  The acute alarm reaction, which prepares the body to fight or flee; and the chronic vigilance reaction, which prepares the body for long-term endurance. 

 

On very simple terms, it works like this.  Consider your brain the CEO and your body the corporation of workers.  When the brain (CEO) perceives stress, it tells the body (workers) to get to work.  In terms of the stress response, this means the brain signals the adrenal glands into action.  The adrenal glands are located just above the kidneys (most people have one on each side of their body).  The adrenal glands produce and release a variety of hormones, including adrenaline and cortisol.  The adrenal glands play an important role in many body processes - but we are going to limit this discussion simply to the stress response.  

 

Think of adrenal glands like golf balls or candy gum balls - they have an outer cortex shell (conveniently referred to as the cortex) and an inner middle (referred to as the medulla).  

 

The adrenal medulla is driven by the sympathetic nervous system in response to immediate stressful threats.  The adrenal medulla releases the majority of the body’s adrenaline supply (also called epinephrine) and a small amount of the body’s noradrenaline supply (also called norepinephrine).  Adrenaline and noradrenaline act throughout the body creating the fight or flight response.  The actions of adrenaline and noradrenaline help increase heart rate, blood pressure, and breathing rate to prepare the body to either fight or flee.  

 

The adrenal cortex releases the hormone cortisol, which is part of the long-term vigilance reaction to stress and helps restore homeostasis (stable equilibrium) following exposure to stress.  Cortisol is responsible for a number of things, but in response to long-term stress it helps the body during periods of starvation by playing a role in ensuring the body’s supply of blood glucose to be used by muscles and the brain.  Cortisol promotes the retention of sodium helping to regulate blood pressure during periods dehydration.  It is posited that cortisol, along with adrenalin, helps to create the snap-shot memories of stressful events; this helps mammals remember what to avoid in the future. However, longterm exposure to cortisol actually damages the hippocampus (responsible for memory formation).  Cortisol also suppresses the digestive and reproductive systems (don’t need to make babies or digest a big meal when running from a bear).  Cortisol prevents the release of inflammatory substances in the body and suppresses the immune system.

 

How This is Problematic

 

Did you catch all of that?  It isn’t hard to see how a constant triggering of the body’s stress response is not good. The ongoing release of cortisol ultimately causes a lot of problems.  Cortisol weakens the immune system, raises blood glucose, adversely effects the hippocampus (region of the brain where memory is processed), reduces bone formation, lengthens wound healing time, contributes to weight gain, and possibly precipitates depression and anxiety by lowering brain serotonin levels (Cowen, 2002; Tafet, Toister-Achitus, & Shinitzky, 2001).  Repeated release of adrenalin is not good either; it can have adverse effects on the cardiovascular system, resulting in increased heart rate and blood pressure.  

 

Constantly stimulating the stress response system has a detrimental effect on the immune system.  The suppression raises the risk of viral infection and delays wound healing.  Stress can worsen broncho-constriction in the lungs of asthmatics.  Stress alters insulin which can worsen diabetes.  Stress alters acid concentration in the stomach, possibly increasing the risk of peptic ulcers or ulcerative colitis.  Stress may increase the risk of atherosclerosis (plaque build-up in arteries).  From a mental health standpoint, stress intensifies and possibly causes depression and anxiety.  Stress worsens a person’s ability to concentrate and form memories.  

 

It you could bottle all of this in a pill, I doubt you would make much money.  Who would buy it?  Yet, people who treat everyday stressors as life-death threats, continually trigger this stress response.  This has damaging effects on the body and erodes away at one's physical and emotional wellbeing.  Stress is unavoidable.  That’s right…we can’t completely eliminate stress.  It is a natural part of our universe.  But, how a person chooses to respond to stress is a different story.  It is simply that - a choice.  

 

What Can I Do?

 

Here’s the good news.  You can change the way you perceive and respond to stressors in your life.  Overacting to stressful events can become habitual (see article on habit formation).  Many people who over-react, don’t even realize they are over-reacting; it is a blind, autopilot response.  Awareness is the first step.  You can’t change what you are not aware of.  

 

Here’s more good news.  The brain is the CEO of the body, and you can teach the brain (regardless of age) new ways of responding.  New neurons and habit patterns can be formed.  Seeking help and learning new ways of perceiving and responding to stress is the next step.  Just like learning a new hobby, sport, musical instrument, or language - humans can learn new ways of responding to stress.  

 

 

References:

Cohen, P.J. (2002). Cortisol, serotonin and depression: All stressed out?  The British Journal of Psychiatry, 180(2), 99-100.

 

Tafet, G.E., Toister-Achituv, M.,  Shinitzky, M. (2001).  Enhancement of serotonin uptake by cortisol: a possible link between stress and depression.  Cognitive, Affective & Behavior Neuroscience, 1(1), 96-104.