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It’s Killing Me
Stress as a
Life-threatening
Condition
Michael S. Krasner, MD
October 21, 2009
Perinatal Network of Monroe County
Managing Stress for Healthier Babies, Healthier
Lives, Healthier Neighborhoods
More than any other time in history, mankind faces
a crossroads. One leads to despair and utter
hopelessness. The other, to total extinction.
Let us pray that we have the wisdom to choose
correctly.
Woody Allen
Stress Theory
• Claude Bernard “milieu internal,” studied and
conceptualized “homeostasis”
Stress Theory
• Walter Cannon: “Fight or Flight”
• Hans Selye: Acute and Chronic Stress
• Richard Lazarus: Individual appraisal of stress
• McEwen: Allostasis and allostatic load
• Schwartz and Shapiro: “Intentional Systemic
Mindfulness”
– Intention leads to attention leading to connection
leading to regulation leading to order leading to
health
Stress Definition
• Change needed, demand to be met (as
appraised by the subject)
• That change may overwhelm (or “stress”) the
subject’s resoures (the resources as appraised
by the subject)
• Stressor: Anything that causes this reaction in
the subject.
Stress Reaction Cycle
• Stressors
• Internal Events
• Perception/Appraisal*
• Stress Reaction
• Internalization
• Maladaptive Coping
• Breakdown
Physiology of Stress
• Sympathetic/Parasympathetic
Imbalance
• Sympathetic Hyperarousal
• Low (relative) Parasympathetic tone
• Activation of H-P-A axis
– When chronic results in:
• Increased monoamine neurotransmitters,
eventual depletion
• Increased pro-inflammatory cytokines (IL-1, IL-6,
TNF alpha, Interferon gamma)
• Increased cortisol
• Amygdala activation leading to a threat relevant
attentional bias and enhancement of negative
memory networks
• Suppression of specific immunity (NK cells,
humoral immunity)
• Chronic cortisol stimulation
– Impairs brain centers with high concentration of
cortisol receptors
– Suppresses specific immunity
– Activates amygdala
– Is neurotoxic
– Inhibits trophic factors that help neurons grow and
develop (Serotonin, BDNF, Estrogen)
– Can lead to adrenal fatigue
• Hyperactive systems
–
–
–
–
–
–
Sympathetic nervous system
HPA Axis
Cortisol
Amygdala
Cytokines
Right PFC (behavioral inhibition, negative
emotions)
• Underactive systems
–
–
–
–
–
–
Parasympathetic influence
Hippocampus
Left PFC (behavioral activation, positive emotions)
Cingulate (attention, decision making)
Specific Immunity
Monoamine system burnout
• Long-term physiologic and cognitive effects of
sympathetic overload:
– Thyroid/endocrine burnout
– Obesity, DM
– Immune suppression
– HTN, CV Disease
– Cancer
– Negative mood
– Negative attention and memory bias
– Decision making difficulties
– Inability to learn new associations
– Attentional difficulties
• Real or imagined threats induce the same
stress response:
– Imagined scenarios involving threat or failure
– Perceived threat
– Comparison of actual situation with ideal
– Degradation of self or present situation
– Recall of disturbing events
– Self-criticism hostility
– Rumination about a negative event
– Emotional avoidance
– Pessimism, denial
• Stress-realted physiology and their reversal by
meditation:
– HPA axis hyperactivation
– Hypercortisolemia
– Decreased Hippocampal activity
– Decreased PFC/Cingulate activity
– Low parasympathetic tone
– Serotonin depletion
– Negative memory bias
– Immune suppression
• Stress-realted physiology and their reversal by
meditation:
– Sleep disruption
– Cytokine elevation
– HTN
– Heart disease
– Endocrine dysfunction
– Hyperlipidemia
– Chronic pain
– PFC asymmetry
Responding versus Reacting
• Stressors
• Internal Events
• Mindful Perception and Appraisal*
• Stress Response
Research
Questions and
?Answers