Download Hormonal and neurological aspects of stress and anxiety

Hormonal and neural aspects of stress
and anxiety
The science of stress physiology
• Hans Selye
Defining “stress”
• Etymology: Latin strictia, strictus meaning "compressed”
The broadest definitions of stress include the entire complex
sequence of events:
• the event that requires some change (external or mental; real or
imaginary),
• internal mental processes (perception, interpretation of the event,
learning, adaptation, or coping mechanisms)
• emotional reactions
• behavioral-bodily reactions (nervousness, sweating, stumbling over
words, high blood pressure).
• In a more limited usage, stress is the upsetting situation. However, most of
us use the term stress loosely for both the threatening situation and the
anxious reaction.
Stress
• Stress may refer to meeting any "demand"
made on us, even good, reasonable, enjoyable
ones, which throw the body out of balance.
New baby
Promotion
Wedding
Thrills
Exercising
Sex
Bad stress
• Any change outside our control
• Daily hassles (constant nagging, flat tire, an uninvited
visitor, a headache, a long form to be filled out)
Traffic
Technology
Information overload
Frustration, threat, conflict
•Stressors may be real or imaginary, past or future
obstacles
•If something (or someone) has interfered with our
"smooth sailing" in the past, it is called a frustration or a
regret. It may upset us and depress us.
•If the obstacle is expected in the future, it is called a
threat. This may be an accurate or an unrealistic
expectation; in either case it causes anxiety and worry.
• A common human dilemma is when our own inner
wishes, needs, or urges push us in different directions. This
is the world of psychological conflict.
Internal conflict
• Ambivalence – you want something but
shouldn’t have it because it’s bad for you
Internal conflict
• Better avoid it because if I start I won’t be able
to stop
Internal conflict
• You want them both, you can only have one
Internal conflict
• Too many complex choices
Internal conflict
• Choosing between two unappealing options
Other external and internal stressors
(Schaffer, 1982)
External
• noise, polluted air, overcrowding, poor lighting (those dreadful
fluorescent lights!)
• unpleasant relationships
• uninteresting work (mindless repetitive tasks) or poor conditions of work
• too much or too little responsibility
• too many "rules." (mind the gap!)
Internal
• poor diet, little exercise
• physical strain on the body, rushing or being unable to adjust to the
pace of others
• having no time for yourself
• sexual frustration
Lack of meaning or purpose
Physiology of stress
Stress-related illness
Mechanism for stress-induced
cardiovascular disease
Mechanism for stress-induced
diabetes
Accelerated neural death in the
hippocampus
Hippocampal neurons
Healthy (left) and stress damaged
neuron (right)
PTSD hippocampus
Studying stress response in primates
Doctor Robert Sapolsky, professor of
neuroscience and human behaviour biology at
Stamford University
Why study stress in primates
• perfect models for westernized stress-related
diseases because “like us they have the luxury of
generating psycho-social stress”.
• This particular group of baboons studied by
Sapolsky live in ideal conditions in the Serengeti
ecosystem.
• They are not stressed by predators or the threat
of malnutrition, but by each-other
• “If you’re unhappy it’s because some other
baboon has worked very hard to bring that state
about. ‘’
What is stress about in a baboon’s
world?
Dominance hierarchies
• Baboons have the highest aggression rates of nonhuman
primates.
• The leading cause of death in male baboons is male
baboons.
• Rank is a powerfully organizing feature of their society, with
an overall stabilizing effect. If you’re smart enough to know
your place there will be fewer fights.
• To establish your high rank you have to win the right fights.
• Common threats of violence
Aggressive display
Rank
• Life is very different for a high-ranking versus a
low-ranking baboon
• Rank influences who grooms who, what food
and females you get access to.
Top baboon being groomed
The making of high-ranking baboons
• Big, muscular, with long canines
• Also social intelligence, impulse control
(knowing which provocations to ignore)
• Bodies that deal well with stress. The higher
rank – the lower the level of glucocorticoids in
the bloodstream.
• Knowing when to turn the stress response on.
Profile of a low ranking baboon
• A sluggish response to stress and sluggish recovery
from stress
• Elevated glucocorticoid secretion in the absence of
stress because as a low ranking baboon you’re always
stressed
• Lack of outlet for frustration, lack of sense of
predictability and control
• Subordinate baboons have the same profiles as
depressed humans (elevated basal levels of cortisol,
CRF hyper secretion, blunted pituitary sensitivity to
CRF)
• Low ranking baboons have elevated stress related
disease and reduced immunity
Differences in temperament and
personality styles
• Can they tell the difference between
threatening and neutral interaction?
• Do they take control?
• Can they tell whether you won or lost a fight?
• Do they have coping outlets?
• Social affiliation: How often they groom; how
often do they stay in contact with someone
else; how often do they play with an infant?
Baboon societies and cultures
Social rank is important but much more
important is the kind of society they live in.
•Stable societies: being high ranking is best
•Unstable societies (chaotic, lots of conflict):
being high rank is stressful
•Your personal experience in that society.
•The chance emergence of a new culture.
The human underdog
Correlation between social rank and health
• Whitehall I and II studies , examined over 28,000 civil
servants, beginning in 1967.
• Men in the lowest grade of employment (messengers,
doorkeepers, etc.) had a mortality rate three times higher
than that of men in the highest grade (administrators).
• High blood pressure at work was associated with greater
"job stress," including "lack of skill utilization," "tension,"
and "lack of clarity" in tasks assigned.
• The higher blood pressure among the lowest grade servants
was found to be related to the highest job stress score.
• Lack of control, predictability and outlets enhances the risk
of stress-related disease
Anxiety
Fear, phobia, panic, anxiety
• All these affects are on a continuum
• Fear is a here-and-now bodily felt, involuntary reaction
when you are faced with a dangerous, life threatening
situation.
• Phobia is excessive fear, an over-reaction to a situation or
object that objectively or statistically doesn’t represent a
risk: phobias of heights, flying, bugs, enclosed places, open
spaces, or of speaking in public)
• Panic attacks are sudden, overwhelming reactions, often
without an obvious external cause, usually involving rapid
breathing, heart palpitations, fear of dying, and a frantic
attempt to get to safety.
Anxiety
Anxiety is a pervasive sense of disquiet, unease, which
arises mainly in interpersonal contexts. The presence of
anxiety is deeply interlinked with our history and beliefs
about self, others and the world.
Anxiety is about anticipating something unpleasant:
punishment, being shamed, humiliated, judged, found
out, disappointing, seen as unworthy of respect and
seen as failing by others.
It is a fear of not meeting expectations and not being
able to master our surrounding environment and
relationships.
Signs of anxiety
Bodily involuntary responses
•muscles tight or aching, nervous tics, hands unsteady, restlessness, touching
yourself repeatedly, clearing your throat
•Frequent colds, pain, upset stomach, sweating, skin problem or itch, stiff
posture, holding things tightly, strong startle response, headaches, high blood
pressure, ulcers, heart disease, colitis
•hemorrhoids, rashes, diarrhea, or frequent urination.
Behavioral-emotional signs
•hyperactivity, walking or talking faster, in a hurry, irritation with delays,
panicky, blushing, getting tongue-tangled, avoiding people
•nervous habits (strumming fingers, eating, smoking, drinking), changing
habits (becoming less or more organized), poor memory, confusion, stumbling
over words, inattentiveness, excessive worrying
•preoccupation with a certain situation, obsessive thoughts, compulsive
actions, outbursts of emotions, bad dreams, apathy, etc.
Brain structures involved in coordinating fear
and stress response
The orbito-limbic system: Amygdala, Hypothalamus,
Hippocampus, the Prefrontal cortex
General Anxiety Disorder (GAD)
• A chronic, debilitating condition consisting of excessive
worry, disruptive anxiety, and distressful tension that
has lasted for at least 6 months and maybe for years.
• It is the second most common psychiatric disorder
(after depression); about 5% of the world's population
suffers with this disorder.
• GAD frequently results in sleeplessness, irritability,
poor concentration, and fearful hyper-vigilance.
Social anxiety disorder
• An intense fear of being embarrassed or humiliated
publicly.
• Elfriede Jelinek, Austrian writer, winner of the Nobel
prize for Literature in 2004, author of “The piano
teacher”
Comorbidity
• Anxiety and depression are frequently and closely
associated.
• Some aspect of anxiety accompanies neurotic
disorders, including somatization (a physical problem
with a psychological cause)
• Hypochondriasis (fear and excessive complaints of
bodily disease), dissociative reactions (amnesia,
sleepwalking, multiple personality)
• Obsessive-compulsive disorders (OCD)
• Personality disorders: avoidant, paranoid, dependent,
obsessive-compulsive
Causes of anxiety
• Any of the stressors good and bad mentioned
earlier
Early influences which cause loss of self-esteem
• Insecure attachments, abuse, early loss –
divorce, death of a parent
Social contexts
• Abusive leadership
• Feeling poor when all around you have plenty
Self-help for stress and anxiety
Body
•Progressive relaxation technique (contracting and relaxing different group
muscles, in order to teach the body to notice the difference between tense and
relaxed)
•Exercise (a minimum of 30 minutes at least three times a day)
•Massage, touch, acupuncture, aromatherapy
•Nutrition
Mind
•Meditation
•Spirituality: The serenity prayer:
God, grant me the serenity to accept the things I cannot change,
Courage to change the things I can
And wisdom to know the difference. (Reinhold Niebuhr)
•Clarifying your values, principles and ethics
•Mindsight (Daniel J. Siegel)
•Flow (Csikszentmihalyi, 1991)
•Desensitization through facing the fear
Relationships
•Keep communicating about your inner world
•Community – do something for free for others!
Counselling and Psychotherapy
Counselling:
•Short term
•Symptoms of recent onset
•Extremely focused
•Clarifying the problem
•Exploring different choices
•Non-judgemental support
Psychotherapy
•Longer term project
•Chronic symptoms that cause reduced functioning and significant distress
•Making implicit assumptions, values, beliefs explicit
•Exploring relational patterns
•Having the developmentally needed for experiences
•Interpersonal affect regulation
Interpersonal learning changes the
brain
• Through intentional use of the relationship we access
someone’s mind and the brain changes! (Schore)
• The neural synapse, the site of learning and memory, is
strengthened by repeated experience. The environment
triggers the expression of genes. (Eric Kandel, 2000)
• LTP – Long Term Potentiation – a long lasting
enhancement of signal transmission between two
neurons that fire together. (“Neurons that fire together
wire together” Hebb, 1949)
Our brains will have changed as a result of what we’ve
learned and remembered from tonight!
Long term potentiation