Download Stress and the Body`s Response

Stress and
Adaptation
Body Systems
Denver Integrative Massage School
Spring 2013
What is Stress?
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Physical, chemical, or emotional factor
resulting in tension of body or mind
Actual physical and mental state that
tension produces
Real or perceived threat to homeostasis
Direct consciously or indirect
unconsciously sensed threat to the
stability of the organism
General Adaptation Syndrome
General Adaptation Syndrome
•Homeostasis- the body attempts to
maintain a stable and consistent
physiological state
•Homeo = same, stasis = stable
•One optimal level
•Local regulatory mechanisms
•Allostasis- multiple optimal levels,
methods of regulation
•Allo = variable
•Anticipation
•3 stages of GAS
• Alarm- immediate response
• Resistance- mobilizing body’s
resources to withstand stress
•Attempting to restore allostasis
• Exhaustion- impaired functioning,
body can no longer reach allostasis
•Recovery also possible here
Stressors
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Agents or conditions that can produce
stress; endanger allostasis
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May be external or internal
Physical, chemical, biological, social, cultural
or psychological
Vary in scope, intensity, and duration
Reactions to stress vary depending upon
genetic constitution, gender, past
experiences, cultural influences,
developmental stage, and age
Can include both negatively and positively
perceived events
Autonomic Nervous System
Response
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NS- somatic and
autonomic
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ANS two branches- ANS, PNS
Sympathetic NSfight, flee, freeze, faint
Parasympathetic NSrest and digest,
feed and breed
General Adaptation Syndrome
- Alarm stage
-SNS activated
-adrenal medullaepinephrine,
norepinephrine
-Resistance stage
-cortisol
-immune suppression
SNS/Adrenal Activation
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Increases in
-heart rate
-blood pressure
-respiration
-blood glucose
-metabolism
-mental processing
-muscular tension
-pupil size
-night and far vision
-blood coagulation
-immune function (at first)
Digestion, growth,
reproduction, renal
function suppressed
Alarm Stage
Sympathetic NS activation
Adrenal medullaCatecholamines (epi, NE)
Resistance Stage
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Adaptation to
stressor
HPA axis
Cortisol released
Immune
suppression- LAS
and B & T cells
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Exhaustion stage
Inadequate adaptation
mechanisms or excessive
allostatic load; results in
inability to maintain
homeostasis
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Cost to body’s organs and
tissues of an excessive or
poorly regulated allostatic
response – effect of “wear
and tear” on the body
Leads to various illnesses
and disorders, both
physical and emotional
Chemical mediators from
the stress response
contribute to various
illnesses: cortisol,
catecholamines, cytokines
Allostatic
Overload
Stress Hormones
Norepinephrine
 Constricts blood vessels and raises blood pressure
 Reduces gastric secretions
 Increases night and far vision
Epinephrine
 Enhances myocardial contractility, increases heart
rate, and increases cardiac output
 Causes bronchodilation
 Increases the release of glucose from the liver
(glycogenolysis) and elevates blood glucose levels
Stress Hormones
Adrenocortical Steroids
 Critical to maintenance of homeostasis
 May synergize or antagonize effects of catecholamines
 Examples
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Cortisol and aldosterone
Cortisol
 Primary glucocorticoid
 Affects protein metabolism
 Promotes appetite and food-seeking behaviors
 Has anti-inflammatory effects
Aldosterone
 Primary mineralocorticoid
 Promotes reabsorption of sodium and water
 Increases blood pressure
Stress Hormones
Endorphins and Enkephalins
 Endogenous opioids (body’s natural pain relievers)
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Raise pain threshold
Produce sedation and euphoria
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Enhance immune system response
Prolonged stress can suppress immune functioning
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Interleukin-1
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Estrogen, testosterone, and dehydroepiandrosterone
Immune Cytokines
 Secreted by macrophages during stress response
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Example
Sex Hormones
 Affect stress responses, thus influencing allostasis
 May help explain gender responses during stress
 Examples
Stress Hormones
Other Hormones
 Growth hormone
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Prolactin
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Can increase during stress to enhance immune
function
Similar to structure of growth hormone
Role in immune response
Oxytocin
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Produced during childbirth and lactation
Associated with bonding and social attachment
Thought to moderate stress response and
produce a calming effect
Tend and Befriend
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Gender differences in
stress response
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Women more likely to
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Have protective behavior
toward young
Seek allies
Both men and women
have access to aggression
and nurturing responses
Oxytocin main hormone
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Potentiated by estrogen
Stress and the Heart
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Acute stress
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HR up
BP up
Arteries to mm and vital organs dilate
Nonessential arteries constrict
Blood flow decreased in kidneys, GI tract,
reproductive system and skin
Stress and the Heart
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Chronic stress
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Hypertension- BP up chronically
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Left ventricular hypertrophy- blood returns to the
heart with more force, heart muscle thickens
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And small vessels have to work harder to regulate local
blood flow, so they get more muscular, more rigid,
raising BP…
Irregular heartbeat more likely
Greater demand for blood
LV hypertrophy- after age, the best predictor of cardiac
risk
Blood vessels- damage at bifurcation (branch)
points
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No cell in the body is more than 5 cells away from a
blood vessel, yet the circulatory system is 3% of body
mass
Inflammatory response, foam cells full of fat
Epinephrine increases platelet activity
Also mobilizing fat, glucose, LDL cholesterol into
bloodstream
Vessel damage a better predictor of HD than
cholesterol
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C-reactive protein (CRP)
Stress and the Heart
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Plaques
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Ischemia- impaired blood flow
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Thrombus- blood moving with more force more likely to
tear the plaque loose
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Vast majority of MI’s and strokes
Myocardial ischemia- coronary arteries normally dilate
in response to stress
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Angina pectoris- heart, myocardial infarction
Claudication- lower body
But in chronic ischemia, they vasoconstrict
The damaged CV system is hypersensitive to acute
physical or psychological stressors
Sudden cardiac death- extreme acute stress causing
ventricular arrhythmia or fibrillation
Psychoneuroimmunology
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“The study of the intricate interaction of
consciousness (psycho), brain and central
nervous system (neuro), and the body’s defense
against external invasion and internal aberrant cell
division (immunology)”
Immune function can be classically conditioned
Just about every illness is influenced by how we
think and feel- at least, if not caused by it
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Psychological factors can modulate the stress
response and trigger it
Anatomy
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CNS linked to bone marrow, thymus, spleen,
lymph nodes- immune tissues laced with
nerve fibers
Changes in the brain and spinal cord affect
immune response, and vice versa
WBC’s respond to neurochemicals and produce
them
Emotions trigger hormone release
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Epi, norepi, endorphins, GC’s, prolactin, growth
hormone
Active immune cells send signals to CNS
Social Support
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The fewer social relationships, the shorter the life expectancy,
the worse the impact of disease
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Social isolation- 2-5x greater risk of CVD
 More active SNS (higher BP, more clotting)
 And more likely to die younger once dz present
For ethnic minorities, the fewer members of your group in the
neighborhood, the higher the risk of mental illness, psych hospitalization,
and suicide
Effect at least as large as smoking, HTN, obesity, and exercise
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Partnership, friends and family, church and other group relationships
protective
For the same illness (and age, gender, health status, etc), 2 ½ times the
risk of death in the most isolated people versus the most connected
Confound- isolated people less likely to take meds, more likely to
smoke, drink, etc.
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But effect still there when these are controlled for
Help thy brother’s boat across, and lo!
Thine own has reached the shore.
-Hindu proverb
Type A Personality
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“Every affection of the mind that is attended with
either pain or pleasure, hope or fear, is the cause
of an agitation whose influence extends to the
heart.”
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William Harvey, 1628
Neutral or ambiguous situation seen as
stressful
5 characteristics
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Free-floating hostility
Insecurity of status- accomplishment to hide it
Hyperaggressiveness- domination at all costs
Time urgency
Drive to self-destruction- need for release
Type A Personality
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Toxic core
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Hostility- deep-seated anger waiting to flare
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Anger- particularly if unexpressed
Cynicism- mistrust of others, negative view of life
Suspiciousness- constant need to be on guard
Excessive self-involvement- “I, me, mine”
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Anger, irritability, and resentment with little reason
Antagonism and disagreeableness
BP increases with references to self
Twice as often in type A speech
Inflexible addiction to work
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Workaholism- people who love to work, usually not hostile
Type A- work to get recognition and approval
Type A Personality
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Hostility/anger the most important- increase in mortality
across all diseases, not just CVD
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Age, weight, BP, chol, smoking controlled for
Correlation in 10 US cities btw hostility and CVD mortality
Without hostility, competition, aggression, and impatience don’t
create the CVD risk
At least as much CVD risk as smoking or cholesterol
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More predictive of early first MI
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Diet and smoking more important when older
Hostility tends to drive away social support, but SR also
activated more often
Reducing hostility reduces CVD risk
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Stress physiology
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Increased catecholaminesmicrovascular drainage in vessel
walls, allowing cholesterol to seep in
Increase in arterial spasm
Increased BP
Stickier platelets
All leading to oxygen imbalance in
the heart
Psychology
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Links to neurochemistry of
depression
Lower marriage quality in type A
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Half the angina in high-CVD-risk Israeli
men with loving support from wives
Weaker social support networks
Type A
Personality
Type A Personality
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At least as strong a CVD risk factor as smoking, cholesterol,
high BP, and synergistic
 Type A with another risk factor = 4x increased risk
 Two other risk factors = 8x risk
Type A men age 39-49 have 6.5x increased MI risk
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Also a risk factor for ulcer, asthma, rheumatoid arthritis,
thyroid dz
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Type A women 3-7x the risk
And headache, cancer, genital herpes, vision problems
A general disease-prone condition
To heal, transform the hostility and cynicism while
retaining the assertive, active characteristics
Stress and Relaxation
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Qualities of the Fight or Flight Response
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Increased heart rate
Increased blood pressure
Increased respiratory rate
Higher pulse rate
Increased oxygen consumption
Increased blood lactate
Increased muscle tension
Rapid production of cortisol
Production of noradrenaline
Unconsciously elicited
Stress inducing
Outer focus of attention
Eyes wide open
Involuntary
External stimulus
Surprise, unpredicted, stimulus
Unplanned
Active internal dialog
Narrowing or focusing of attention
Sensory
Physical activity
Physical movement
From non-movement towards movement
Unlearned
Elicited by loud noise
Builds unhappiness
Increases rate of aging
Helps the individual survive and evolve
Most excitation of consciousness
Ready for most effort
May lead to use of drugs
Experience of being at odds with environment
Attitude of resistance
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Qualities of the Relaxation Response
 Decreased heart rate
Decreased blood pressure
Diminished respiratory rate
Lower pulse rate
Decreased oxygen consumption
Decreased blood lactate
Decreased muscle tension
Reduction of cortisol
Reduction of noradrenaline
 Consciously elicited
Stress releasing
Inner focus of attention
Eyes shut
Voluntary
Internal stimulus
Daily routine or habit as stimulus
Planned
Quiet, silent internal dialog
Expansion of attention
Senses transcended
Mental activity
Physiology at rest
From movement towards non-movement
Learned
Elicited by subtle sound then silence
Builds happiness
Decreases rate of aging
Helps the individual progress and evolve
Least excitation of consciousness
Least effort
Diminishes need to use drugs
Experience of being at one with environment
Attitude of acceptance
Type B Personality
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Lack of time urgency
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Attention to present task
Not bored or eager to move on
On schedule most often, but not frenzied about it
Patient
Contemplative, sees whole more than parts
Values present and past as much as future
Ability to relinquish control
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Delegation, working as part of a team
Celebrates differences
Inspiring leaders- encourage creativity in others
Type B Personality
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High self-value, internal locus of control
 Love of self based on being, not accomplishments
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Self-acceptance
Value regardless of achievement
Failure doesn’t collapse or damage personality
Work for success not as competition-based
No free-floating hostility
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No finding fault necessary to bolster ego
Accepts trivial errors of others
Enjoys empowering others
Rarely feels tense or makes others tense
Objectivity, ability to empathize
Feeling and expressing affection in intimate relationships
Stress Resilience
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Stress buffers
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Social support
Control
Physical fitness
Sense of humor
Self-esteem
Optimism
Effective coping style
Hardiness
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Personality traits
associated with the
lowest frequency of
illness
Stress response
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Baseline as energized
calm, state of choice
Activation including
equilibrium and
equanimity- maintaining
awareness even when
crazed and stressed
In the face of strong winds, let me be a blade of grass.
In the face of strong walls, let me be a gale of wind.
-Quaker saying
Stress Resilience
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Hardiness- Suzanne Kobasa- three C’s (plus two more)
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Commitment- curiosity and involvement in life events
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Control- power of response to influence events
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Control of self and reactions to situations
Challenge- seeing change as exciting chance for growth
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Deep, abiding interest in life
Ideal greater than oneself
Confidence, self-determination, eagerness
Active coping style, expecting positive outcome
Coherence- pervasive, enduring, dynamic feeling that
inner and outer environs are predictable and that things
will usually work out as well as can be expected
Community- “plays well with others”
Tension is who you think
you should be.
Relaxation is who you are.