Family doctor

What is stress?

Stress is defined as "the non-specific response of the body to any demand made upon it" (Hans Selye). All humans, both adults and children, experience stress.

Although the body reacts physically in a similar way to situations of excitement and pleasure, it is only when reacting to an unpleasant situation that you seek to reduce stress. This article deals with stress at the unpleasant end of the spectrum.

While there are limited studies of the incidence of stress (as opposed to anxiety or depression) in the general population it has been estimated that two-thirds of all the illnesses seen by General Practitioners are stress related and that 25% of the US work force miss 16 days per year due to stress and 55% are stressed at work.

The stress reaction can be conceptualised as a four stage cycle:

The stress cycle or fight-flight reaction:

Stage 1 - Thoughts

Stress begins with your thoughts. It is not the events of your life that cause stress, But the way you think about them. "Man (sic) is not disturbed by things but by the views he takes of them." (Epictetus, 120 AD).

Animal research shows this to be true also in rats. Problematic stress occurs only when you think negatively about whatever is stressing you.

Stage 2 - Emotions

Negative thoughts produce negative emotions*. The thought which is generated in the cortex of the brain triggers in the mid brain an emotion consistent with the thought, be it fear, anger, guilt, hatred, anxiety, regret, remorse, grief, sadness, jealousy, embarrassment or any other negative emotion.

*It is still a matter of some debate among researchers whether emotions are the second or the fourth stage in the stress cycle.

Stage 3 - Chemical Reactions

Stage 3 involves the sympathetic nervous system and the endocrine or hormonal system. Your negative thought sends nerve impulses to the adrenal glands which release into the blood stream a number of different chemicals. These circulate in the blood stream throughout the body, affecting the pituitary gland, causing it to release yet more chemicals. These are generally known as the stress chemicals, they include corticosteroids such as adrenaline and noradrenaline, other hormones and neurotransmitters.

Stage 4 - Physical Symptoms of Stress

The stress chemicals activate every organ in the body. Their physical effects are most noticeable when the emotion is intense. These physical symptoms of stress include:

Heart:

Increased heart rate, irregular breathing, palpitations.

Stomach:

Increased secretion of hydrochloric acid into the stomach, butterflies, burning, churning, nausea, vomiting.

Gut:

Increased peristalsis, lower stomach pains, diarrhoea, increased frequency of urination.

Muscles:

Muscle constriction, headaches, stiff necks, sore backs, chest tightness, shaking.

Lungs:

Constriction of lungs and bronchial tubes, breathing irregularities, sighing, yawning, hyperventilation.

Tear Glands:

Tearfulness.

Sweat Glands:

Increased sweating.

Salivary Glands:

Decreased saliva, dry mouth or throat.

Skin:

Initially, increased blood flow to the skin, resulting in flushing, red rash and temperature increase. With prolonged stress, blood flow increase to central body core resulting in feelings of coldness, pins and needles. (decreased sexual arousal may also occur because of increased muscle tension and decreased blood flow to the extremities.

Brain:

Dilation of cranial arteries resulting in migraine, sleep problems and interference with the brain's neurotransmitters which results in "stage fright", memory and concentration problems, difficulty making decisions, dizziness and fainting.

Immune System:

Destruction of leukocytes or white blood cells, increasing vulnerability to disease.

The parasympathetic branch of the nervous system acts to reverse this increased organ activity. However, because many of the stress chemicals are biochemically and psychologically depressant, it is commonly ineffective in doing so. As these chemicals pass through your brain they set off further negative thoughts and so perpetuate the cycle. Once you start to become stressed you are likely to continue to be so.

Prognosis if untreated

Long term stress can cause or exacerbate many physical ailments. These include heart attacks, asthma, ulcers, irritable bowel, colitis, spots, eczema, dermatitis, alopecia (hairloss), dandruff, herpes, shingles, high blood pressure, strokes, and such immune related illnesses as colds, pneumonia, bronchitis and influenza. According to some researchers, diabetes, multiple sclerosis, auto-immune disorders, AIDS and cancer are all more likely with prolonged stress.

Non-physical ailments due to stress include personality problems such as increased pessimism, increased irritability/anger, and loss of confidence.

Phobias, depression, burn-out, panic attacks, schizophrenic and manic depressive episodes can also be triggered by stress.

Causes of increased vulnerability to stress

Although the stress response is a normal human reaction, some conditions predispose you to becoming stressed more easily and therefore having more difficulty in managing stress. These include previous traumatic experiences, particularly during the period the brain is developing (two weeks post conception to around the age of sixteen), imbalances in the sex hormones: oestrogen, progesterone and testosterone (recent research suggests both men and women are at risk here), thyroid problems, diseases of the adrenal glands and diseases such as mononucleosis (glandular fever and hepatitis).

Treatment

First identify your sources of stress by keeping a daily stress journal or diary for a week. Write down, as they happen, thoughts or situations which cause you stress.

There are many strategies for managing stress you can teach yourself and some you can only learn through a therapist. When deciding which strategies to use ask yourself where in the four stages of the stress cycle they have their actions. The only effective long term strategies are those which shut off the cycle at stage one, i.e. which prevent the flow on effect of negative thinking. Massage or relaxation techniques for example may relax tense muscles but will not alter your negative thinking. Meditation will alter your thinking while you are meditating, but will not necessarily affect the way you think after you stop. Tranquillisers, beta blockers and anti-depressants may affect your thinking but don't necessarily address any of the issues that cause you stress; you also run the risk of dependency on them. You will probably need to use more than one technique in order to manage stress.

Once you have identified your sources of stress ask yourself can I do anything about this? Where you can take action to solve what stresses you, do so. Several studies have shown that the most effective self help strategies are: take responsibility for planning a way to cope, take rational action and avoid rash actions, seek advice and support, express feelings privately and not publicly, stay confident, use humour, confide in someone. You may at this point decide to consult a therapist.

Some stresses cannot be solved: fears of the future, regrets about the past, losses, self doubt and deliberate decisions to endure a stressful situation fall into this category. But, if you cannot change your situation, you can change your attitude. Cognitive techniques such as thought stopping and reframing are useful here. You can read about these in books such as Take Control of Your Life (see reference list at the end of this article).

Aerobic exercise is essential to managing stress, for exercise uses up in the muscles as energy the stress chemicals released into your bloodstream which both produce the physical symptoms of stress and which perpetuate the stress cycle. Exercise also releases endorphins which act as mood elevators.

Also important in managing stress is to keep a balance to life, to make sure that your life has in it vacations, recreational activities, events and activities that give you joy, satisfaction and a sense of achievement. Perception is unitary, you can only think one thought at a time. If you are thinking about something you enjoy, you cannot simultaneously be thinking of something stressful.

Among the strategies you may need to learn from a therapist are techniques such as stress inoculation, flooding, desensitisation and a variety of skills training, e.g. problem solving, decision making, assertiveness, time management and leadership.