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Stress and Adaptation Body Systems Denver Integrative Massage School Spring 2013 What is Stress? 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 Agents or conditions that can produce stress; endanger allostasis 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 NS- somatic and autonomic 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 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 Adaptation to stressor HPA axis Cortisol released Immune suppression- LAS and B & T cells Exhaustion stage Inadequate adaptation mechanisms or excessive allostatic load; results in inability to maintain homeostasis 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 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) Raise pain threshold Produce sedation and euphoria Enhance immune system response Prolonged stress can suppress immune functioning Interleukin-1 Estrogen, testosterone, and dehydroepiandrosterone Immune Cytokines Secreted by macrophages during stress response Example Sex Hormones Affect stress responses, thus influencing allostasis May help explain gender responses during stress Examples Stress Hormones Other Hormones Growth hormone Prolactin Can increase during stress to enhance immune function Similar to structure of growth hormone Role in immune response Oxytocin Produced during childbirth and lactation Associated with bonding and social attachment Thought to moderate stress response and produce a calming effect Tend and Befriend Gender differences in stress response Women more likely to Have protective behavior toward young Seek allies Both men and women have access to aggression and nurturing responses Oxytocin main hormone Potentiated by estrogen Stress and the Heart Acute stress 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 Chronic stress Hypertension- BP up chronically Left ventricular hypertrophy- blood returns to the heart with more force, heart muscle thickens 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 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 C-reactive protein (CRP) Stress and the Heart Plaques Ischemia- impaired blood flow Thrombus- blood moving with more force more likely to tear the plaque loose Vast majority of MI’s and strokes Myocardial ischemia- coronary arteries normally dilate in response to stress 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 “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 Psychological factors can modulate the stress response and trigger it Anatomy 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 Epi, norepi, endorphins, GC’s, prolactin, growth hormone Active immune cells send signals to CNS Social Support The fewer social relationships, the shorter the life expectancy, the worse the impact of disease 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 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. 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 “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.” William Harvey, 1628 Neutral or ambiguous situation seen as stressful 5 characteristics 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 Toxic core Hostility- deep-seated anger waiting to flare 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” 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 Workaholism- people who love to work, usually not hostile Type A- work to get recognition and approval Type A Personality Hostility/anger the most important- increase in mortality across all diseases, not just CVD 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 More predictive of early first MI 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 Stress physiology 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 Links to neurochemistry of depression Lower marriage quality in type A Half the angina in high-CVD-risk Israeli men with loving support from wives Weaker social support networks Type A Personality Type A Personality 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 Also a risk factor for ulcer, asthma, rheumatoid arthritis, thyroid dz 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 Qualities of the Fight or Flight Response 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 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 Lack of time urgency 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 Delegation, working as part of a team Celebrates differences Inspiring leaders- encourage creativity in others Type B Personality High self-value, internal locus of control Love of self based on being, not accomplishments Self-acceptance Value regardless of achievement Failure doesn’t collapse or damage personality Work for success not as competition-based No free-floating hostility 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 Stress buffers Social support Control Physical fitness Sense of humor Self-esteem Optimism Effective coping style Hardiness Personality traits associated with the lowest frequency of illness Stress response 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 Hardiness- Suzanne Kobasa- three C’s (plus two more) Commitment- curiosity and involvement in life events Control- power of response to influence events Control of self and reactions to situations Challenge- seeing change as exciting chance for growth 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.