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November 23, 2009

Stress & Survival
Alan Rosenstein, MD

Interestingly when most people hear the word stress it usually brings to mind a negative connotation of somethings gone wrong. What is stress? Why is it there? And what type of impact does it have on the body? The following section will try to answer these questions and more by defining stress, describing the impact on body function, and suggesting ways to minimize the unwanted consequences of the protracted stress response.

In a medical sense the term stress may mean different things to different people. On one hand we have the concept of physical stress which is usually related to a physical ailment such as stress fracture, or the stress related to heavy exertion if you have an underlying condition such as a bad back or weak heart. Here the stress is easy to identify and its impact is well defined. There a specific cause or stressor, in this case the physical exertion and there is a specific, predictable outcome, the physical impact on the body. On the other hand we have the concept of emotional or psychological stress. Unlike the physical stress described above the stressor is usually less identifiable and the subsequent impact on the body is less well defined. Most of the common feelings of stress fall into this latter category.

Stress Response:
Is stress necessarily a negative condition? In order to answer this question, let us consider the nature of the stress response and impact on body function. The stress response was designed to prepare the body for action. The body goes through a series physiological and psychological reactions in an effort to prepare the body for an immediate response to an environmental challenge. Physically the body is stimulated by the release of adrenaline and steroids and other hormones into the blood stream, which causes a surge of energy by releasing sugar and other nutrients. At the same time muscle tone tightens, blood pressure rises the heart rate increases. Psychologically the body is stimulated to prepare for reaction by intensifying attention and concentration to the issue at hand.

Physiological &
Stressor ---> Psychological ---> Action

This stress response was designed for a specific purpose. Man, in his natural habitat, had to face certain challenges in the environment as a struggle for survival. These challenges translated into what we call the flight or fight phenomenon. Depending on the nature of the stressor, Man would either face the stressor or retreat.

Under this arrangement the stress reaction was appropriate. The stressor was well identified, the appropriate body response would be initiated, and there would be a cause and effect response with an immediate reaction. In today's world however, things are not quite as simple. First of all the nature of the stressor is less clear (aggravation and frustration rather than a specific environmental stressor), and while the body is stimulated, there is no direct cause and effect relationship and action is impeded. Instead of the programmed flight or flight response, we wind up with a stimulated body without an appropriate release. If this situation persists for a prolonged period of time, we may begin to run into trouble.

Stress and Disease:
The chronic stress reaction as described above can have significant effects on both physical and psychological body function. Psychologically we may note subtle changes such as an increased level of tension, agitation or anxiety, difficulty sleeping, undue fatigue, changes in appetite or loss of concentration, which in later stages may develop into more significant personality and behavioral disorders. Physical symptoms can vary from nonspecific complaints such as headaches, back pains or gastrointestinal disturbances, to more significant symptoms such as dizziness, chest pain or shortness of breath. While these symptoms themselves are cause for concern, is there a true relationship between stress and disease?

If we think back to the physiological effects of stress on the body, we know that one of the predominant consequences of the stress response is to increase blood pressure and accelerate the heart rate. So one of the first things we worry about is the relationship between stress and heart disease and strokes. Early investigative research into this concern identified a link between a Type A personality and heart disease. This Type A personality was used to describe an individual who was constantly geared up for action, under constant pressure, unable to relax, who eventually developed personality traits characterized by overly obsessive, time dependent, aggressive, hostile behavior. There appeared to be a direct relationship between this type of individual and the incidence of heart attacks. More recent studies have confirmed this relationship by showing a direct relationship between stress and known risk factors for strokes and heart disease such as hypertension (high blood pressure), elevated cholesterol level, obesity and arteriosclerosis (hardening of the arteries). With heart disease and strokes ranking as the number one and number three causes of death in the United States, we can definitely say that there is a link between stress and longevity. Other commonly described stress aggravated medical disorders include migraines, ulcers, asthma, eating disorders, hormonal and metabolic disorders, and possibly even a relationship between stress and cancer, the second leading cause of death in the country.

There is also a link between stress, accidents and suicides, with its obvious effect on longevity. Many of the effects of stress on the body are accentuated by other body insults related to smoking, alcohol, drug abuse or other bad habits. Stress ten s to affect each individual differently, attacking the weakest link in the body.

Treatment of the stress response can be approached from several different vantage points. First we must go back to the original question about the nature and intent of the stress response and answer the question: is it positive or is it negative? When the stress is appropriately tied to a known stressor and is going to be relatively short lived, it may not be necessary to do anything about it. Examples in this category might include intense study the night before an exam, or performing better when the pressure begins to build. But if the stressor is more chronic and there's no end in sight, then we may have to take certain steps to reduce the stress response.

I usually divide treatment of the stress condition into several different steps.
(1) The first step is recognition. Recognizing that you're acting and feeling the way you do because of some external force is the first step to a successful treatment program. Depending upon the nature and severity of the symptoms, this may require a visit to a physician who will verify the fact that the source of the problem is external rather than internal by performing the appropriate evaluation and diagnostic tests. The symptoms of a stress related disorder may be just as severe as the symptoms related to an organic medical disorder and only a trained physician can make this determination.

(2) The second step is stress avoidance. If you can avoid the stressor, that's the ultimate goal of therapy. While it might be easy to avoid rush hour traffic, stop volunteering for additional projects when you're already swamped, or avoiding possible confrontational situations, simple avoidance will usually not work for most of life's major chronic stresses.

(3) The third step is relaxation. As mentioned previously, most of the problems with stress arise when there is constant bombardment of the body without a break in the action. It's this vicious cycle of constant turmoil that does the damage. Taking time out to rest and relax will do wonders for the body. Strategies range from simply occupying your mind with more pleasant, positive thoughts gained from reading, movies or enjoyable hobbies, getting. involved in Yoga or other meditation techniques, or adhering to more comprehensive relaxation programs supported by lectures, books or video tapes. Select the alternative which works best for you.

(4) The fourth step is stress reduction. Exercise is a wonderful form of stress reduction because it not only gets your mind off all the unpleasant stresses of the day, but it also gives you an opportunity to burn off some of the stress induced energies. Being physically and emotionally drained can give you a wonderful sense of peace and accomplishment. If needed, professional stress counseling is always an option.

Stress is a common byproduct of today's society. Although it frequently goes unrecognized and may be difficult to describe, it has profound effects on the body and the way we feel. To some individuals stress can present positive energy and enhance their productivity and efficiency. To others, stress can too often be a negative force impairing their physical and mental performance. While disease or disorder may vary from one individual to another, we know that the effects of chronic turmoil can produce wear and tear which will eventually have an impact on longevity of the body.

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