According to the American Psychological Association, 43% of adults suffer adverse health effects from stress, 75-90% of all physician visits are for stress-related ailments, and stress is linked to the top six leading causes of premature death. The Occupational Safety and Health Administration (OSHA) has declared stress a hazard of the workplace and estimates that stress costs American industry more than $300 billion annually. Stress also weakens the immune system, reducing your body’s natural ability to fight off infections, leading to innumerable other serious and fatal diseases.
Stress not only disrupts our physical health, but also our mental health. Many experts believe anxiety is the root cause of most, if not all, psychological disorders. We’ve all witnessed firsthand how high stress often leads to destructive coping mechanisms such as drug and alcohol abuse, eating disorders, and tobacco addiction. When taken altogether, directly or indirectly, stress is implicated in many physical and mental disorders, wreaking a terrible toll on our collective health and welfare.
What is Stress?
Stress is a broad term that has many different definitions, depending upon which dictionary one consults. In a medical or biological context, stress can perhaps best be summed up as:
‘Any external event creating mental tension leading to temporary or chronic biochemical imbalance.’
Let’s take a close look at each part of this definition. Some stress experts like to suggest stress can have both external or internal (as from a disease) sources, but generally external events precede the internal events (studies show most diseases have an environmental cause)—and this article focuses on how our mental responses to external events contributes to internal disorders.
These external events take many forms and come from many sources, including the workplace, your home environment, social interactions, external problems, accidents, weather, etc., but in all cases they are some kind of change that we are not used to.
These unexpected changes elicit a mental response, where we process the event and decide how to manage it. Oftentimes, the initial mental and physiological response is considered a ‘good’ stress, insofar as it increases our awareness and alertness as part of the innate ‘fight or flight’ response mechanism. This has a positive evolutionary function by helping us avoid or survive various environmental threats. It is only when the mental response becomes dysfunctional or chronic, leading to physical pain or disability, that we consider the stress negative, or a type of ‘distress’.
The mental response, depending on how we react to the external event(s), in turn evokes an internal physiological response. This can be temporary and beneficial, as in the case of extra endorphins which block pain while fighting off an assailant, or harmful, as in the case of elevated corticosteroids which interfere with the proper functioning of the immune system.
The Biochemical Effects of Stress
The physiological response to stress is very specific and very immediate. Catecholamine hormones including adrenaline or noradrenaline are quickly released into the bloodstream, preparing and enabling the muscles for violent action. This triggers many autonomic responses, including acceleration of heart and lung action, dilation of blood vessels feeding the muscles and constriction of blood vessels in other parts of the body, liberation of essential nutrients (particularly glucose and glycogen), dilation of the pupils, horripilation (making hair stand on end), and inhibition of the reproductive organs.
The adrenal glands also secrete glucocorticoids, hormones that produce an array of supportive effects in response to stress. These include mobilizing energy into the bloodstream from storage sites in the body (fat), and delaying long-term processes in the body that are not essential during a crisis such as feeding, digestion, growth, and reproduction. Some of these actions of glucocorticoids help mediate the stress response, while other slower actions counteract the primary response to stress and help re-establish homeostasis. In the short term, adrenaline mobilizes immediate energy and delivers it to muscles for the body’s response, whereas glucocorticoid cortisol promotes energy replenishment and sustained cardiovascular function.
All of these immediate physiological responses are designed to maximize the chance of short-term survival in the face of an external threat. But if the external stressor or its mental and physiological response persists over time this can lead to the development of chronic diseases. (In some cases, stress can continue when the external stressor is removed, as in the case of Post-traumatic Stress Disorder, or PTSD, where the fight or flight response basically stays on rather than shutting off once the threat has passed.)
How Chronic Stress Weakens the Immune System
When long term stress becomes chronic, many systems in the body are affected. Chronic stress results in high levels of cortisol and other corticosteroids circulating in the blood for a long period of time. While there are fight-or-flight advantages from short term exposure to these hormones, over the long term mental and physical damage may occur. Cortisol suppresses inflammation during a response to stress. If it is present in the blood for long periods, the body develops a resistance to cortisol and does not respond to it properly. Instead, it ramps up production of substances that actually promote inflammation, leading to a state of chronic inflammation. These pro-inflammation substances, called cytokines, are associated with a host of chronic inflammatory and autoimmune conditions.
Chronic stress also results in lower amounts of a protein that is critical to signalling immune cells. Without these reinforcements, the body is susceptible to contracting acute illnesses and prolonged healing times. Specialized white blood cells called lymphocytes are a major component of the immune system. They kill invading organisms that can cause disease and they recognize harmful substances and help defend against them. Cortisol and corticosteroids suppress these infection-fighting lymphocytes.
These harmful effects have been clinically proven. In one study, researchers questioned 176 men and women about difficult experiences they experienced in the recent past. Drops of the common cold virus were then inserted into their nose and the researchers monitored if they caught the germ. Those who had been under stress were twice as likely to develop a cold. Tests showed their immune systems had become less sensitive to cortisol, the stress hormone which dampens the immune system. This allowed the part of the immune reaction called the inflammatory response to escalate, leading to the symptoms of the cold.
A second experiment confirmed that the inflammatory response feeds off stress. Inflammation, which can express itself as redness, itchiness, swelling and pain, occurs when the immune system spots an infection and is a vital first step in fending off disease. However, when it persists, it not only raises the risk of colds but many other illnesses. Researcher Professor Sheldon Cohen, of Carnegie Mellon University in Pennsylvania, concluded: “The immune system’s ability to regulate inflammation predicts who will develop a cold, but more importantly it provides an explanation of how stress can promote disease. When under stress, cells of the immune system are unable to respond to hormonal control, and consequently, produce levels of inflammation that promote disease.”
Diseases Associated with Stress
There is a long list of diseases associated with stress and its secondary effects on the immune system.
One of the key functions of insulin is to regulate excess amounts of glucose in the blood and direct it into fat tissue as long-term energy stores. Glucocorticoids inhibit this function during stress in order to provide more fuel for fighting, but if they persist for too long in the bloodstream these chemicals facilitate the development of diabetes.
Stress also exerts an immediate and dramatic effect upon the cardiovascular system. Increased heart rate, blood volume, and blood pressure are all a consequence of the adrenaline and vasopressin hormones released while experiencing stress. While these reactions speed the delivery of oxygen and energy to the muscles that need it during the initial fight-or-flight response, in the long run they create chronic hypertension, atherosclerosis, and heart disease.
In the stomach, glucocorticoids inhibit enzymes and mucosa required for digestion, promoting gastric ulcers. Ulcer repair is normally facilitated by prostaglandin, which is also inhibited by stress.
Stress suppresses virtually all reproductive functions, since these are long-term activities not required to manage immediate threats. Specifically, the reproductive hormones LH and FSH are inhibited, inducing a loss of parasympathetic tone and erectile function. In women, adrenal secretion of androgens impairs reproduction at the level of the ovaries.
Stress inhibits the release of GnRh and growth hormones, which if prolonged can cause dwarfism during the development years and loss of bone density in adulthood.
Stress also promotes the development of cancer, in two ways. First, by weakening the body’s natural immune defence against foreign pathogens, and secondly through the continued presence of adrenaline, which facilitates the growth and spread of tumor cells.
Indirectly, chronic stress often leads to the adoption of destructive coping mechanisms including drug and alcohol abuse, smoking, and overeating disorders. Over time, these can lead to other physical diseases including cirrhosis of the liver, lung cancer, and diabetes.
In terms of general pain management, in the short term, stress releases beta-endorphins and other endogenous opiates, which modulates pain during a violent conflict or escape. In the long term, your system becomes habituated to the continued presentation of these substances, so chronic pain occurs without the benefit of these analgesic agents.
Sources of Stress
External stressors can come from a number of sources.
At work, overbearing bosses, uncooperative coworkers, and general competitiveness for career advancement is a constant struggle. Heart attacks occur with significantly higher frequency on Monday mornings than any other time of the year. Sometimes there are specific fears for job security. The constant demand to learn new procedures and tools leads to frustration, associated with inevitable errors and movement out of our ‘comfort zones.’
At home, spousal arguments and the challenges of raising unpredictable children is a frequent source of stress. Technical problems associated with solving malfunctions of the myriad electronic, mechanical, and organic elements of the home environment raise our blood pressure. And of course, the constant pressure of meeting the obligations of our mortgage and household budget exert both a conscious and subconscious toll.
Outside the home and office, other social interactions can create friction and conflict. From thoughtless drivers, to rude retail employees, even friends who occasionally offend our sense of dignity or trust, there is no end for opportunities to raise our ire.
Sometimes our personal safety can be threatened, either by ill-intentioned people or angry wildlife. Accidents lurk around every corner. Even unexpected severe outbursts of weather or natural disasters can compromise our safety or composure. Stress is a natural and largely unavoidable facet of everyday life. The key in terms of maintaining our mental and physical health relates to how we respond to it.
Coping Mechanisms of Stress
We all respond to stress in different ways. The classic initial reaction to a present threat or stressor is either ‘fight’ or ‘flight’. We either choose to engage the perceived threat and fight to neutralize it, or we withdraw/flee to remove ourselves from the threat. For some people, the ‘fight’ response can be verbal, and for some it can be physical. For others, the fight can be carried out surreptitiously, where someone works behind another’s back to undermine them. Similarly, the ‘flight’ response can be literal, where we might run from a charging animal, or passive, where we simply acquiesce or remain silent in the face of a belligerent superior.
When exposed to unrelenting stress, psychologist George Boeree outlines five ways we typically respond:
- Self-medication (drugs and alcohol);
- Somatization (bodily aches and pains);
- Anxiety disorders (distraction behaviors);
- Depression (mental withdrawal);
- Dissociation (‘trance’ states, including psychosis)
Self-medication can take various forms, from alcohol abuse, over-the-counter pain medication, reliance on prescriptions such as opioid drugs, or recreational drugs such as marijuana, methamphetamine, or heroin.
In the absence of pain relief, many people ‘absorb’ or ‘transfer’ their pain to one or more parts of their body. This can manifest in chronic headaches or migraines, stomach upset and ulcers, racing heart and arrhythmias, muscle tension and pain, excessive sweating, or sometimes simply repetitive and unconscious body movements or tics.
Some people ‘internalize’ the stress and manifest it in the form of one or more anxiety disorders, or neuroses. This can take many forms such as obsessive-compulsive disorder, where chronic stress leads to obsessive and unpleasant thoughts, which are in turn partially relieved by refocusing attention on compulsive behavior such as hand washing, checking, or hoarding. Other types of anxiety disorders include agoraphobia (fear of public places), PTSD, Aspergers, and other phobias.
People who are constantly exposed to external stressors and who aren’t able to relieve it in another way, often fall into a state of depression. This is a form of mental withdrawal, were the individual essentially ‘gives up’ and dwells excessively on their unhappy predicament. Some people vacillate between extremes of mania and depression, by overreacting to positive and negative stimuli, often referred to as bipolar disorder.
In extreme cases, some people lose grasp of reality altogether and slide into psychotic states. These can take the form of delusions, where the individual believes he’s talking to the devil or controlling someone’s behavior telepathically, or schizophrenia, where he ‘inhabits’ and swings between multiple roles he’s fashioned in his subconscious.
How to Gain Control over Stress
Most of these coping mechanisms are dysfunctional in one form or another, either because they only treat the symptom of the problem and thus require constant expression, or because they provide some mental or physical harm to the individual or others. The challenge, or opportunity, is to find more constructive ways of managing stress. ‘Stress management’ has become a sizeable industry, taking various forms including psychotherapy, industrial counselling, physical massage, aromatherapy, tapping/EFT, reflexology, etc. But there are also some quick and simpler forms of stress management that anyone can practice at any time.
Simple focused breathing often is enough to calm yourself and restore homeostasis after a stressful experience. This works in multiple ways. First, it consciously counteracts the unconscious racing of the heart and lungs as part of the initial fight-or-flight response. Second, it brings clean fresh oxygen into your system and expels carbon dioxide from your tissues. Third, it refocuses your mind away from negative associations in the stressful moment toward simple somatic relaxation exercises focused on calming your body.
Meditation, which often includes a form of focused breathing, also helps to divert our attention from negative thoughts to more peaceful and relaxing images. This usually takes the form of ‘freeing’ your mind and simply thinking of nothing or something simple and pleasant like lying in a meadow or walking on a deserted beach. Meditation can be also be practiced while participating in certain gentle exercises such as yoga, Tai Chi, or slow stretching.
More strenuous exercise such as lifting weights, running, or participating in sports can be another constructive outlet for stress. Besides finding an immediate and useful outlet for your charged up cardiovascular and musculoskeletal system, this action has the secondary benefit of releasing endorphins to mask your pain and elevate your mood. It also helps to improve long term organ and tissue health through its regenerative effects on bone, muscle, heart, and other body systems.
Research shows that one of the easiest and most reliable ways to reduce stress is by interacting with people you know and trust. Many studies have demonstrated a clear association between healthy social relationships and overall health. This can take the form of close pair-bonds in marriage, comfortable social interaction with friends, and even casual play or cuddling with pets.
Oftentimes, all that is needed to reduce stress is removing yourself from the stressful situation. Going for a walk, taking well-needed vacation time, ‘counting to ten’ before reacting, or just ‘walking away’ instead of choosing to engage in a fight can quickly relieve the mental and physiological tension of the moment.
Of course, the best way to manage stress is to avoid placing yourself in stressful situations in the first place. Choosing compatible mates, enjoyable work, supportive friends, and avoiding known ‘danger zones’ in terms of geography and social contexts lays the foundation for creating healthy, peaceful, and stimulating life experiences.
Stress is a largely unavoidable factor in our daily lives. In spite of our best attempts to avoid it, and sometimes because of the cultural or personal styles that define us, it seems to find us around unexpected corners. Sometimes stress can be constructive in focusing our concentration and physical energies on an important challenge or task in front of us. Other times, it can be dangerous or harmful, both to our emotional or physical wellbeing.
Whether we choose to remain exposed to stressful situations, and how we choose to respond to and manage them is our choice. If we take constructive action to channel the stress in more productive directions or attempt to relieve the stress through focused relaxation techniques and other methods, we can keep control of stress and not let it control us. The alternative is internalizing the stress and allowing it to slowly erode our mental and physical capacities. Ultimately you are in charge and have control. You can either worry or lash out inappropriately, or you can take a deep breath and focus your energy on building positive life experiences that enrich both yourself and those around you.
By Reid Jenner