January 2004

Stress and Your Life

by

Harry L. Mills, Ph.D.

About Dr. Mills

Stress can be toxic or it can be the spice of life. Whether it is the one, or the other, depends on both the source and on you. It is essential that we understand stress and its impact on our bodies. Developing resiliency to stress is essential for health and happiness. The most important factors in managing stress are control and predictability.

There are many definitions of stress. The most useful definition is that stress is the anticipation of our inability to respond adequately to a perceived demand from our physical or social environment, accompanied by our anticipation of negative consequences for our expected inadequate response. According to psychologist Richard Lazarus stress occurs when an event is appraised by the person as taxing their personal resources and thus endangering their well being. Lazarus uses the word coping to refer to our efforts to manage those demands which tax or exceed our resources.

Built For Stress

In many ways we are built for stress. However, we are built for a different kind of stress than the type that we experience in our modern technological society. Our bodies are the same as they have been for thousands of years, but the world has changed a thousand times over during that same period. We have the same automatic reaction that our tribal ancestors possessed. We are "wired" to respond to threats with what physiologists call the fight-or-flight response. If we encounter a bear while hiking along a trail our bodies prepare to react by either fighting the bear (considered an unwise decision) or making a quick exit from the dangerous situation. Our nervous system orchestrates these changes to prepare for either event:

¨Digestion slows so blood may be directed to muscles and the brain in preparation for action.

¨Breathing gets faster to supply more oxygen to muscles.

¨The heart speeds up and blood pressure soars forcing blood to parts of the body that need.

¨Perspiration increases to cool the body.

¨Muscles tense in preparation for action.

¨Chemicals are released to promote blood-clotting (helpful if the bear bites you).

¨Sugars and fats are poured into the blood to provide fuel for quick energy.

Fight Flight or Freeze

Psychologists who conduct research on stress say there are three basic ways we respond to stress:

• We fight like a panther;

• We flee like a rabbit; or,

• We freeze like a pheasant.

Fighting is the power response, we try to influence the source of stress by attack or counter attack. Sometimes it is better to escape--to run away and fight another day. When the threat is overwhelming, flight may be the wiser option. When fighting or running is not appropriate we may simply freeze. In sports this is called choking. The best of all responses is to learn from the experience: to learn how to predict the negative stress and to avoid it in the future.

The fight-or-flight response is a magnificent set of mechanisms for dealing with live bears. You're more likely to encounter the kinds of situations encountered by Herman Bright. Herman Bright is the vice-president for marketing in a corporation. His boss just chewed him out for failing to increase third-quarter sales. As he leaves his boss' office the blood in his temples is pounding, he is flushed, and perspiring, his breathing is rapid and the tension in his lower back has turned to pain. The sugars and fats pouring into his blood for energy will go unused. And if this occurs often enough, these fats may start to clog his arteries. He goes back to his office, sits in a chair and stews in the juices of stress for the rest of the day. Herman Bright is wired for bears, but he must deal with bums, like his boss. Herman Bright has a stress problem. And he is not alone; four out of five working Americans report significant stress on the job.

The flight-or-fight response is an automatic alarm. How we respond when the alarm sounds is critical to health and happiness. We may fall into mindless reactions that become destructive, vicious cycles. External events of biological, social, physical or economic origin impinge on us from outside our bodies. These events may be highly predictable or they may be unpredictable. These lead to activation of changes in your nervous system, as well as your cardiovascular, musculoskeletal, immune and digestive systems. Your reaction depends on your appraisal of the events. If the events are appraised as a threat to you (e.g. a sharp pain), your body will activate your alarm system.

Biology of Stress

It was physiologist Dr. Hans Selye who first studied the nature of the natural alarm systems. He found that to a certain level stress is challenging and useful. He called it "...the spice of life." However, when stress becomes excessive or chronic, it becomes distress and takes its toll on body and mind. If events are appraised as threatening, the changes in the body come about because of the activation of a particular branch of the autonomic nervous system (ANS). This branch is called the sympathetic nervous system (SNS), and it functions to speed things up. The other branch, called the parasympathetic nervous system (PNS) acts as a break. Its function is to slow things down -- to calm the body. The hypothalamus controls the activity of both branches. It is the master control switch.

The opposing functions of the two branches is summarized in these functions:

SNS dilates the pupils while the PNS constricts the pupil

SNS inhibits salivation (e.g. dry mouth) while the PNS stimulates salivation

SNS accelerates heartbeat while the PNS slows heartbeat

SNS inhibits digestion while the PNS stimulates digestion

It is the SNS that kicks into action in situations you find threatening. It serves the goals of vigilance, arousal, activation and mobilization. The PNS provides for calm body maintenance. It promotes growth, energy storage and other activities important for longer term survival.

Learning how these switching mechanisms work has been a most challenging task for scientists. Two scientists, Roger Guillemin and Andrew Shally, won the Nobel prize in 1976 for their work in identification of the hormones that are active in this kind of body regulation. We now recognize that the hypothalamus contains a huge array of hormones that instruct the pituitary gland, which in turn regulates the secretions of peripheral glands.

Hormones, called glucocorticosteriods, provide the chemical basis for the fight or flight response. At the same time both the pituitary and the brain secrete a class of endogenous morphine like substances called endorphins and enkephalins which help blunt pain perception and make us feel very, very good!

The hypothalamus is part of a region in the brain called the limbic system. It is the limbic system that is thought of as the seat of our emotions. There are complex interconnections between the limbic system and the higher cortical centers, where we do our thinking and problem solving, the endocrine system and our musculoskeletal system. Mobilization of our response to stress involves magnificent orchestration of all of these systems. The way we have learned to think is part of the process and the way we feel is intimately involved.

Among the more naive notions about health is that means the absence of illness. In no advanced and enlightened culture has health been so defined. The word health has its origins in the old high German word "hale" or whole. In China and in ancient Greece health was thought of as being in balance with nature. The vital task was seen as maintaining equilibrium in the face of extensive demands. The World Health Organization (WHO) definition of health is a state of complete physical, mental and social well being.

Do emotions have influence over illness and disease? In their 1994 book Passion and Reason, Richard and Bernice Lazarus explore the evidence to support such a relationship.

Certain ailments have been recognized for some time as being responsive to stress. The most common example is intestinal distress such as indigestion and colitis and other disorders like migraine, tension headaches, high blood pressure, arthritis and certain skin disorders. However, as evidence has increased many researchers would agree with Richard and Bernice Lazarus that, "...today we have reason to believe that any ailment can be effected by stress emotions." In some instances stress emotions seem to make an ailment worse while in others stress may be a primary factor in bringing on illness.

The immune system has been called our liquid nervous system. With our growing knowledge of the system has come an increasing conviction that there are emotional factors in colds, flu, mononucleosis and other such infectious illnesses. It appears that some of the hormones secreted in the presence of stress emotions impair or weaken the immune process by reducing the number of disease-fighting components such as lymphocytes (white cells) thus leaving us more vulnerable to infection. This may be one of the reasons why so many people die within a year or so of their spouse's death. Recently there has been research into why some HIV positive patients develop full blown AIDS while others do not. One interesting finding is that patients with a more active style of coping with stress (i.e. confident and forceful) seem to have stronger resistance as a result of stronger immune systems.

Researcher Sheldon Cohen tested the stress hypothesis by actively planting a cold virus in the nasal passages of experimental subjects. Those subjects who had been under high levels of stress had a much greater number of actual colds than those with low stress. It is now reasonable to hypothesize that stress emotions increase secretion of certain hormones. These hormones weaken the immune system and that weakness results in an increase likelihood of infectious illness. However, much more research is needed.

There are at least three reasons for believing that emotions have something to do with cardiovascular disease. First, stress emotions increase the level of low-density blood cholesterol and this leads to clogging the arteries to the heart. Secondly, stress emotions result in maladaptive coping such as smoking, drinking and overeating, which can damage the heart and surrounding vessels. Thirdly, stress emotions result in powerful hormones which result in increases in heart rate and blood pressure.

The notion that life-style could influence heart disease led two cardiologists Meyer Friedman and Ray Rosenman to propose that a certain type of personality characterized by an obsession with perfection and a stressful lifestyle, the type A personality, involved increased risk of heart attacks. Years of research on this concept has led to a hypothesis that the emotional factor most influential is the emotion of anger. It is not so much the intensity of anger as it is the frequency of anger. People who are often made angry may be an increased risk of cardiovascular disease. But it may be more a matter of the way people cope with anger. In one study researchers examined three coping styles: (1) anger directed at oneself; (2) anger directed toward another and (3) anger handled reflectively. Directing anger toward ourselves and at other people may be damaging. The third option, recognizing anger, accepting it but managing it reflectively may be the healthiest way to cope.

Several hypotheses are being explored in the role of emotions in cancer. Again emotions may play an indirect role leading the person to smoke or drink excessively. More direct influence is attributed to a tendency to suppress or deny emotions. There is some evidence that those who suppress emotions are more susceptible to cancer. Again the mediating factor is hormonal activity. However, much more research is required.

While many more questions remain than have been answered, it seems clear that the naive notion that a germ automatically leads to illness is no longer acceptable, although much of the lay public subscribes to the theory. Richard and Bernice Lazarus point out:

Today we know that the idea of a single external cause, such as a germ, is oversimplified; the presence of the germ does not always cause the illness. Whether or not it does depends on the amount of the germ one is exposed to, the type of animal species studied, and the physical condition of each animal. Some species and individuals are immune to tuberculosis, apparently because they have antibodies against it in their immune system; others are vulnerable when their physical condition is poor - that is, when their resistance is low - but not when their physical condition is good...

So the cause of illness is not quite as simple as we once thought, it requires both a vulnerable individual and exposure to a large quantity of germs to make us ill. If we live in an urban center, we are exposed to many people who carry the germs, but most of us do not become ill. (pg 252)

Workplace Stress

Stress is much like the weather. Everybody talks about it but no one really does anything about it. Stress has been a hot topic at work for over a decade. However as a 1991 study by Northwestern National Life demonstrates, stress continues to take its toll on workers and otherwise intelligent businessmen continue to pay the escalating costs. The following were key findings based on research involving 600 employees nationwide: Seven of ten employees experience stress related illnesses often. One third of workers reported thinking seriously about quitting because of stress. Sixty-nine percent report reduced productivity because of stress. Sources cited include minimal control to their jobs, merger acquisitions or ownership changes, work force reduction and reorganization. Ninety-one percent agreed that employees should act to reduce stress in the work place. But will pointy haired bosses do anything?

Cost of Stress

Companies like Hughes Aircraft, Connecticut General Insurance, Equitable Life, Bon Ami, Tranco and Adolf Coors have conluded that the financial costs of job stress are such that they have joined the 1 in 5 large companies that have ongoing stress management programs for their employees. The direct cost of executive stress in lost work days, hospitalization, outpatient care and executive mortality has been estimated at $19.7 billion dollars per year in the United States. And that is the direct cost. When the indirect costs in the form of lowered creativity, reduced motivation and reduced efficiency are considered, experts estimate the cost at between $75 and $90 billion dollars annually. Executive Health Examiners estimates that one in four of the thousands of professional business women examined each year show significant effects from stress. As the linkage between stress and a wide variety of disorders, including hypertension, heart disease, ulcers, and colitis, become clearer, it is increasingly evident that stress contributes significantly to the soaring healthcare costs being bourn by corporate America.

Our Antique Responses

In many ways we are built for stress. The problem arises in that we are built for a different kind of stress than the type we experience in our modern technological society. Our bodies are the same as they have been for thousands of years, but the world has changed a thousand times over in that same period. We have the same automatic response that our tribal ancestors possessed. We are "wired" to respond to threats with what physiologists call the fight or flight response. If we encounter a gator or a bear while hiking along a trail our bodies prepare to react by either fighting the bear (considered an unwise approach) or making a quick exit from the dangerous situation. Our nervous system orchestrates changes to prepare for either event.

Digestion slows so blood may be directed to muscles and the brain in preparation for action.

Breathing gets faster to supply more oxygen to muscles.

The heart speeds up and blood pressure soars forcing blood to parts of the body that needs it.

Perspiration increases to cool the body.

Muscles tense in preparation for action.

Chemicals are released to promote blood clotting (helpful if the gator bites you).

Sugars and fats are poured into the blood to provide fuel for quick energy.

A magnificent set of mechanisms for dealing with live bears. But how often have you encountered gators or bears in the last several months?

You're more likely to encounter the kinds of situations encountered by Herman Bright. Herman Bright is the vice-president for marketing in a Florida corporation. His boss just chewed him out for failing to increase third-quarter sales. As he leaves his boss' office the blood in his temples is pounding, he is flushed, he notices he is breathing rapidly, perspiring and the tension in his lower back has turned to pain. The sugar and fats are pouring into his blood for energy will go unused. And if this occurs often enough, these fats may start to clog his arteries. He goes back to his office, sits in a chair and stews in the juices of stress for the rest of the day. Herman Bright is wired for bears, but he must deal with bums like his boss. Herman Bright has a stress problems. And he is not alone. Four out of five working Americans report significant stress on the job.

We are often told that the higher up the ladder one goes in a company the greater the stress. It is lonely at the top. However, frustrated middle managers countered, "Top management doesn't have ulcers, they give ulcers." Research has indicated that in most organizations it is the middle managers that experience the greatest stress. They often find themselves trapped in webs spun of conflicting demands from those above them and those in subordinate positions. Thus, it may be accurate to say it's lonely at the middle.

What is the main source of stress in the middle? In a word - PEOPLE. In an excellent study done at NASA it was found that those individuals in positions that involved working with people rather than things experienced distinctly more stress and were more susceptible to stress-related illnesses.

The tensions of deadlines and quotas make accounting a stressful occupation. For instance, research has indicated that blood cholesterol levels rise as April 15 approaches for tax accountants. Interestingly, it is the administrative issues associated with being a police officer that contribute to stress in the occupation more than the threat to life. Over and over research has shown that the greatest source of stress for most of us comes from being caught in the middle between forces we can't control.

The common sources of stress in the work place are: Lack of control sufficient to obtain expected results. The sheer volume of work. Ambiguity and uncertainty about the work role. The urgencies of demands placed on the executive.

Other problems often mentioned are: Poor management or an ineffectual boss Lack of adequate authority to carry out responsibilities Company Politics

It is noteworthy that each of these involve a limitation on the control one has over one's life in the work place or the predictability of events in that setting. We have learned that predictability and control are a necessity of life. In their absence we experience deep distress.

Psychologist Suzanne Kobasa has studied four characteristics of people who seem to possess a resilience to stress. She found that certain managers experienced high levels of stress with low levels of illness and that their resiliency seemed based on three protective factors: challenge, commitment, and control. The hardy executive were those who were involved and committed to their work, believed that they had control over their lives and saw the demands of work as a challenge and opportunity, rather than a threat. Those individuals were contrasted with the highly stressed executives who tend to fall ill, feel powerless to control their own work lives, feel overwhelmed by the demands of the work place, have an aversion to change and have low self-esteem. Again it is those at the top of the ladder, who are more likely to experience debilitating stress that contributes to illness.

On Becoming a Stress Survivor

These findings have led stress researcher Walter H. Gmelch to recommend the following mechanisms to become a stress survivor in the work place: Find humor whenever possible. The type of humor found in the hit television series M*A*S*H typified the value of humor in coping with crisis and stress. Put the stressful situation in perspective. Try to step back from the situation and view it as you would view the episode five or ten years later. How much would it really matter? Study all aspects of the stressful situation before taking action. Probe all sources of information before taking action. Try to see the crisis as a challenge. Remember that "every pearl is the result of an oyster's victory over irritation." Try to make pearls out of irritation. Try to find creative solutions rather than pat answers. Take out a blank sheet of paper and fill the entire sheet with notations about possible solutions to the problem. Don't stop until the entire sheet is filled. Above all, keep your flexibility. Stress tends to force us into rigid and unproductive response patterns. Maintaining flexibility can keep options open.

Who Seems to Cope Best With Stress?

Dr. John Rhoades a professor of psychology at Duke University School of Medicine has carried out an interesting study of a group of corporate vice presidents, physicians, lawyers, and academics, all of whom worked at least a 60 hour week, but some of whom seemed to work more effectively under stress than others.

"Long hours of work," Dr. Rhoades determined, "are not what makes one ill. If the work is enjoyed and provides reasonable amount of freedom and judgement from immediate supervision, there is no good reason for an individual to become ill."

Individuals who are most effective in coping with stress were able to postpone thinking about problems until it was necessary to deal with the problems. This seems to be a key to coping with stress. Continued rumination about work problems seems to be counterproductive. Those able to cope most effectively with stress were able to notice the signs of fatigue in themselves and to take appropriate actions. Individuals with interests outside their work were the most effective individuals in coping with stress. Individuals who rated as "seriously overworked" were notably also by the lack of a sense of humor. The executives and professionals who seemed to respond best were able to list a number of diversions including music, gardening, painting, sculpturing, and other such activities. Finally, individuals who were successful in coping with stress were able to maintain a minimum of six hours of sleep a night in spite of pressures at work. It is important to note that all the characteristics of individuals who can successfully cope with stress can be learned by most individuals given proper training. Most of us can become effective in coping with stress. For many of us it is a matter of knowing where to start. The best answer is start with sleep.

Knitting Up the Raveled Sleeve of Care or a Kingdom for a Snooze

One of the effects of stress in our lives is sleeplessness. It is estimated that as many as 40 percent of all Americans will have trouble sleeping tonight. It is quite possible that statistic will include you. Many will be replaying the stresses of the day in their minds eye. Perhaps reliving a stressful sales meeting or being dressed down by the boss. Others will be pre-playing tomorrow's stressful events. A deadline that must be met. An argument that might take place.

Studies have demonstrated that excessive daytime stress decreases the amount of rejuvenating deep sleep that one experiences, and increase the frequency of awakenings during the night. Sleep problems are all the more unfortunate since they rob people of one of the most important methods of coping with stress.

Sleeping Pills

It is estimated that thirty million doses of sleeping medication will be taken tonight. More than $100,000,000 is spent each year on sleep medication, an amount second only to dollars spent on aspirin. The three things you should know about sleeping pills are:

• They have dangerous side effects.

• They are addictive.

• They actually don't help you sleep at all.

Many experts believe that over-the-counter pills should not be sold at all and that prescription medications are often abused. They do not induce natural sleep. Dr. Edmund Jacobson has said that such drugs work by "delivering a knock-out blow to your brain cells. You sleep because your brain cells are paralyzed by what you swallow." The sleep you experience does not have the recuperative qualities of natural sleep. Used regularly, they can create many problems. If you are already using sleeping pills you should keep these points in mind:
Self-Medications can be dangerous. Over-the-counter pills should not be used without a physician's recommendation. Ask what the side effects of a particular medication are and whether there is a danger of addiction. Never take pills after drinking. The combination can cause death. If you find yourself using pills for more than a few nights in a row or if you think you are dependent, consult a specialist.

YES! Regular exercise promotes deep sleep. Research shows that vigorous physical activity in the late afternoon or early evening leads to more of the deep kind of sleep that is most refreshing and necessary for good health. FATIGUE IS THE BEST TRANQUILIZER. The options are many. Walking, running, bicycling, swimming or aerobic dancing are excellent. A brisk walk after dinner is a good place to start.

© 2004 Harry L. Mills, Ph.D.