medical information

Stress | General adaptation syndrome | Stress and illness | Treatments for stress reduction

Stress is mental, emotional, or physical tension brought about by internal or external pressures such as anxiety or overwork. Thus, it is a negative way that a person frequently responds to environmental demands or pressures. Researchers have found significant biochemical changes that take place in the body during stress. Exaggerated, prolonged, or genetic tendencies to stress cause destructive changes which lower the body’s immune system response and can lead to a variety of diseases and disorders. These include elevated blood pressure, depression, cardiovascular disease, stroke, and cancer. When stress was first studied in the 1950s, the term was used to explain both the causes and the effects of these pressures. More recently, however, the word stressor has been used to mean the trigger (the reason) that provokes a stress response.

People experience stress from many different sources. It can come from having to take a test or dealing with a difficult person; from traumatic experiences such as the death of a loved one, or a serious illness. Stress can be acute—as in the face of immediate danger when the fight-or-flight response is triggered; or chronic—such as when a person is involved in a long-term stressful situation.

Stress often occurs in the workplace. As of 2005, according to the U.S. Centers for Disease Control and Prevention (CDC) and the National Institute for Occupational Safety and Health (NIOSH), over $300 billion was spent annually in the United States on stress-related problems. That amount equates to around $7,500 per employee. Such claims often involve stress-related compensation claims, absenteeism, health insurance expenses, reduced productivity, employee turnover, and other such adverse conditions.

People who experience severe traumas, as do soldiers during combat, may develop a condition called post-traumatic stress disorder (PTSD). During World War I (1914–1918) this was called shell shock; during World War II (1939–1945) it was called battle fatigue. Since 1980, the American Psychiatric Association has listed PTSD as a diagnostic category. Sufferers of PTSD experience depression, feelings of guilt for having survived, nightmares, and flashbacks to the traumatic events. They may be excessively sensitive to noise, become violent, and have difficulty holding a job.

General adaptation syndrome

Austrian-Hungarian-born Canadian endocrinologist Hans Hugo Bruno Selye (1907–1982) developed a three-stage model of the body’s response to stress. He called his theory the general adaptation syndrome (GAS). The first phase is an alarm reaction, the second stage is one of resistance or adaptation, and the final stage is one of exhaustion.

In the alarm stage, the body responds to a stressor, which could be physical or psychological. Perhaps a person is crossing the street and a car suddenly speeds toward the person. The person’s heart begins to beat fast and the release of adrenaline makes one move quickly from the path of the oncoming car. Or, another response might include butterflies in the stomach, a rise in the bloodpressure, heavy breathing, dilation of eyes, dry mouth, and the hair on the arms might even stand on end. To help meet the sudden danger, blood flows away from the organs not needed to confront the danger, to organs and tissues which are; for example, the heart races, the eyes dilate, the muscles tense up, and the person will not be able to concentrate on any kind of problem solving outside the danger confronting the individual.

During the resistance stage of a stress reaction, the body remains on alert for danger. When this part of the GAS is prolonged, the immune system may become compromised and the person may become susceptible to illness. Even within days of becoming stressed and maintaining a stressalertness, changes take place that weaken the body’s ability to fight off disease.

The final stage of Selye’s GAS is the exhaustion stage. As the body readjusts during this period, hormones are released to help bring the body back to normal, to the state of balance called homeostasis. Until balance is reached, the body continues to release hormones, ultimately suppressing the immune system.

Stress and illness

Continuously, studies are being aimed at trying to determine the relationship of illness and state of mind. During the 1980s, physicians at the University of California Medical Center in Los Angeles determined that emotional stress affected the immune system and that, conversely, the reduction ofstress boosted the immune system.

Significant breakthroughs in the late 1990s found stress causes an immediate and significant increase in the release of the hormone corticotrophin (ACTH) by the anterior pituitary gland, causing many stress-related behaviors in the nervous system, including the fight-or-flight response. This is followed soon thereafter by drastically increased secretion of the hormone cortisol, which is intended to relieve the damaging effects of stress. However, the prolonged secretion of cortisol has the potential to cause or worsen biological and psychological diseases and disorders.

Clinical studies reported in medical journals between 1997 and 2005 have found exaggerated response to mental stress can produce the same degree of atherosclerosis risk as does smoking and high cholesterol, thereby drastically increasing the risk of heart disease and stroke. Other studies during this same time period showed that the stress of being diagnosed with cancer also reduces the activity and therefore effectiveness of natural killer (NK) cells—cells whose role it is to seek and kill malignant (cancer) cells. It also decreases their ability to respond to recombinant interferon gamma, a form of cancer therapy aimed to help them do their job.

Other diseases associated with stress are the onset of adult diabetes (type 2 non-insulin-dependent), ulcers, respiratory infections, and depression. The stress can be psychological or it can come from stressful situations such as accidents or illness.

Recognition of stress

Identifying physical and psychological responses to stress and understanding the cause of the stress itself are important factors in reducing its negative effects. Denying the existence of stress, on the other hand, is a contributing factor to intensifying those effects. Some physical signs are a dry mouth and throat; tight muscles in the neck, shoulders, and back; chronic neck and back problems; headaches; indigestion; tremors; muscle tics; insomnia; and fatigue. Emotional signs of stress include difficulty in concentrating, feeling tense, negative thinking, brooding, worrying, depression, anxiety, or feelings of worthless.

Irritability, restlessness, impulsive behavior, difficulty in making a decision, poor judgment, difficulty relating to—and mistrusting—people, as well as tobacco, alcohol, and drug use, may all be indications of stress.

Treatments for stress reduction

A form of psychotherapy called medical psychotherapy is one of the methods used to deal with stress. It is based on the principle that when people talk about troubles they can lessen the stress they feel. It is important for the therapist to understand the nature of the illness around which the stress is involved. In this kind of supportive therapy, the goal is to help patients deal with the feelings stimulated by traumatic events, illness, or conflicts that produce stress. Medications may also be used, such as anti-anxiety or antidepressant drugs, which are best administered by a psychiatrist knowledgeable about stress-induced disorders. The American Academy of Family Physicians reports that in any given year about two-thirds of their patients come for treatment of a stress-related condition.

Selye believed that the stress of life contributed a great deal to aging. A method of treatment for stress developed after his theories became popular was called progressive relaxation. Relaxation techniques such as yoga and creative visualization are often used successfully to reduce stress and boost the immune system. Often, life-style changes are necessary also, such as a healthier diet, smoking cessation, aerobic exercise, and group discussions.

Stress-related emotional illness may be influenced by stress resulting from major life changes, such as marriage, graduation, becoming a parent, getting fired, or retirement. In the workplace, stress-related illness often takes the form of burnout (a loss of interest in or ability to perform a job because of stress). Job burnout caused by stress is estimated by the CDC and the NIOSH to occur in between 25% and 40% of U.S. workers.

A certain degree of stress is a normal part of every day life; it is when stress becomes constant that it can lead to physical and mental problems. Stress-related disease is caused by excessive and prolonged demands on a person’s coping resources. One type of reaction to stress is depression. Health experts at the Centers for Disease Control and Prevention (CDC) and the National Institute for Occupational Safety and Health (NIOSH) predict that depression will be the leading occupational disease of the twenty-first century.

Advances in biochemical research hold a promising future for the treatment of stress and its related diseases. A 1995 study published in the Journal of Neuroscience in 1997 indicated that researchers have identified a peptide in the brain and the body— prepro-TRH178-199—which significantly reduces hormonal and behavioral manifestations of stress by as much as 50%. This peptide acts by reducing levels of ACTH and prolactin—another pituitary hormone stimulated by stress—which subsequently lowers cortisol levels. By reducing levels of these hormones, anxiety-related behaviors and fear were significantly decreased. Because the overproduction of cortisol is also found in serious depression, and anxiety disorders such as anorexia nervosa, the prepro-TRH peptide may also become a valuable new approach in treating these disorders. Ongoing medical research, into 2006, was geared to such advances in biochemical research

KEY TERMS

Atherosclerosis —Abnormal narrowing of the arteries of the body that generally originates from the buildup of fatty plaque on the artery wall.

Corticotropin (ACTH) —A hormone released by the anterior pituitary gland in the brain in response to stress or strong emotions.

Cortisol —A hormone involved with reducing the damaging nature of stress.

general adaptation syndrome (GAS) —The three-phase model of stress reaction.

Homeostasis —The state of being in balance.

Peptide —A combination of two or more amino acids.

Post-traumatic stress disorder (PTSD) —A response to traumatic events such as those experienced in combat.

Prostaglandin —A fatty acid in the stomach that protects it from ulcerating.

and the general understanding of the mechanisms within the body that underlies stress.

In summary, a person’s ability to remain healthy in stressful situations is sometimes referred to asstress hardiness. Stress-hardy people have a cluster of personality traits that strengthen their ability to cope. These traits include believing in the importance of what they are doing; believing that they have some power to influence their situation; and viewing life’s changes as positive opportunities rather than as threats. It is not possible or desirable to completely prevent stress, which is an inevitable part of life. In addition, specific strategies for preventing stress vary widely from person to person, depending on the nature and number of the stressors in a person’s life, and the amount of control he or she has over these factors. In general, a combination of attitude and behavior changes works well for most patients. The best way to prevent stress is for parents to teach healthy attitudes and behaviors within their family.