Understanding the stress response and stress-related conditions
The fight or flight response was first described in 1914 by Walter Bradford Cannon. This is the body’s response to perceived danger and is the basis for many of the symptoms associated with panic attacks, phobias, PTSD and other anxiety-driven processes. However, there is another response known as the “freeze” or “play-dead” response which is responsible for other symptoms. The has been popularized by Dr. Stephen Porges in his books on poly-vagal theory. Whether neuroscience research will eventualy provide proof of his theories, it is evident that there are these three responses to perceived danger that we have: freeze, fight or flee. Our bodies respond to external stresses in the home, workplace, or school, or to self-imposed internal stresses in the same way as we would to physical danger – the area in the brain(the amygdala) that is responsible for keeping us safe sends signals to the adrenal glands which respond by producing the stress hormones – such as adrenaline and cortisol. These hormones give us the physical symptoms of being anxious (pounding heart, sweating, dry mouth, shortness of breath etc).
Modern stresses – such as commuter traffic, a difficult boss – cannot often be resolved by fighting or fleeing so we tense up instead and develop muscular pain, or we get exhausted and depressed. The stress reponse is necessary in the short-term if faced with danger, but long-term leads to a “burn-out” – exhaustion, depression, and pain.
Harvard Health has a useful additional article on understanding the stress response.
My first interest in stress-illness recovery was sparked by a patient reporting that her chronic neck pain had resolved while reading a book, this despite the fact that she had demonstrable degenerative changes on her neck x-ray. The book was Pain-free For Life, by Dr. Scott Brady and was based on previous work by the late Dr. John Sarno, a rehabilitation specialist, who, from the 1970s onwards, pioneered the concept of what he then called Tension Myositis Syndrome (a misnomer as -itis means inflammation), later called by various people: Tension Myoneuronal Syndrome, The Mind-body Syndrome, Psychophysiological Disorders (rather a mouthful) or now, much more preferable to my way of thinking, Stress-Induced Illness or simply Stress Illness.
After hearing about Dr. Brady’s book I had to read it and subsequently read all of Dr. Sarno’s books and many others by similar authors. Since then I have had a number of patients find their pain resolving or reducing on reading one of the books or website descriptions, or journaling, or in some cases with combinations of counselling, psychological techniques, and reading, or after resolving prior traumatic memories or conflict situations. For some the resolution of their longstanding pain was rapid; for others more gradual over weeks or months, and for others it is more a matter of using self-awareness to reduce their pain when it occurs.
It must be pointed out that nothing in this discussion suggests that symptoms are not real – they are. Pain in theses conditions is very real.
Conscious and Unconscious (or Subconscious)
By ‘unconscious’ we don’t mean comatose or asleep! So, what do we mean by these terms? Well, in this context the conscious mind is that part of your mind’s function that is actively learning new things, making decisions, calculating, using logic, planning etc. We can only concentrate consciously on a few things at a time. The unconscious mind (or subconscious) controls those functions that operate below the surface (at least partially) without your conscious awareness, such as habits, instinctive responses, walking, running activities on automatic pilot. Now, this division is just a model – a way of thinking about our mind. We don’t actually have two compartments in our mind, one conscious and the other unconscious. There is constant communication between the two. For example, when you first learned to walk, ride a bike, tie your shoelaces, drive a standard transmission, there were many different actions that had to be learned and were required to be done in the correct sequence and that took a lot of conscious attention. Once mastered, those actions can run as automatic programs from the unconscious mind while your conscious mind is busy with more pressing matters. Your unconscious mind also stores all your memories (in different bits of information in different parts of the brain including the visual, auditory, fragrances, emotional aspects of the event etc) which have to be retrieved and reassembled when you bring them to conscious remembrance. Every time we recall a memory it changes to some degree as its components may be reassembled in a fashion that’s been influenced by later experiences, what you’ve heard from others and by subsequent reflection.
When you have a new experience your brain pattern-matches that new experience to all prior experiences in order to make sense of it, and to evaluate its significance. Anything that resembles in any way a part of a previous experience can recreate it – that is why the aroma of fresh baking can transport you back to Grandma’s kitchen, a jingle on the radio can reproduce the feelings and emotions you had when you heard it before. We can make use of these positive ‘triggers’ to anchor positive feelings that you can then voluntarily access when you need them. By the same token, anything that resembles something that your mind registered unconsciously during a negative experience can trigger, amplify, or consolidate previous emotional trauma. This is the basis of phobias and post-traumatic stress disorder.
Normally, even unpleasant memories can be processed by the brain, stored as factual memories that once were unpleasant but have now had the emotional charge removed so one can recall them as past events that are now over-with. This memory reconsolidation occurs chiefly during one of the stages of sleep called Rapid Eye Movement (REM) sleep. “That was then, this is now, move on”, is how it is supposed to work, retaining what was learned, being wiser and more mature, but no longer feeling as affected. When it comes to past traumas that continue to affect one it is as though they have never been put to rest. Instead, they run as though they were present experiences, a movie in which you are a present actor. There are a number of very respectful techniques with or without hypnosis that can help to put old traumas to rest fairly rapidly, without having to relive them or even disclose them to the therapist, unlike many “talk therapies”. An excellent resource is the Human Givens Institute in the UK that publishes books, articles, and courses.
TMS wiki has a large number of links, articles, and a free course that can be undertaken online to help one understand the nature of stress-related illnesses.
Useful Concepts in considering stress illnesses:
1.The Reservoir of Rage (Accumulated stresses + final straw-> symptoms.)
2. The Symptom Imperative: the need to have physical pain as a distraction from worse emotional distress. A person may series of sequential syndromes – when one pain condition resolves another takes its place.
3. Burn-out: The Subconscious putting brakes on and saying “enough!”, leading to fatigue.
4. Metaphorical symptoms.
The Four P’s contributing to Stess Illness:
- Past experience
- Present circumstances
- Personality (perfectionist/people-pleaser)
- Psychological disorders – eg. depression, anxiety.
The Adverse Childhood Events (ACE) scale (Fellitti,et. al., 1998) is predictive of a wide variety of disorders in adulthood, such as anxiety, depression, somatic symptoms, and suicide attempts, as well as cardiac disorders, chronic obstructive pulmonary disease, and diabetes mellitus (Anda, et. al., 2006).
Anda RF, Felitti VJ, Bremner JD, Walker JD, Whitfield C, Perry BD, Dube SR, Giles WH. The enduring effects of abuse and related adverse experiences in childhood: A convergence of evidence from neurobiology and epidemiology. Europe Archives of Psychiatry and Clinical Neuroscience. 2006, 256:174-86
You may also be interested in Gabor Mate MD’s book “When the Body says no – the Cost of Hidden Stress” and Bessel van der Kolk’s book “The Body Keeps the Score: Brain, Mind, and Body in the Healing”.
It is now known that the mind and the body cannot be separated. Our emotions are mediated by chemicals (as Dr. Candace Pert, the endorphan researcher demonstrated) and via nerve pathways, our thoughts affect our nervous, endocrine (hormonal), and immune systems as well as our posture, tone and blood-flow, and hence even musculoskeletal pain.
When we sleep at night we go through a series of different stages, typically spending about 90 minutes in each cycle of sleep. For this discussion the two most important stages of sleep are REM (Rapid Eye Movement) sleep and deep sleep.
REM sleep is relatively light sleep in which the mind is very active and most of the body is motionless but the eyes are moving rapidly. It is when the mind deals with anxieties, stresses and fears, and consolidates memories. People who are very stressed or have past trauma or depression spend a larger portion of the night in REM sleep and less in the deep restorative sleep that is needed to feel refreshed and rejuvenated in the morning. This contributes to the severe fatigue experienced in people with fibromyalgia and depression, and to the exhaustion often described by people with chronic pain.
The Psychophysiological Disorders Association has an informative website, has a new book pending, and has a number of resources both for patients and health care professionals. One of the co-founders of the association, Dr. Howard Shubiner, an internal medicine specialist, has an excellent work-book/journal (Unlearn Your Pain) and a very informative website with numerous stories recorded.
Georgie Oldfield, a physiotherapist in the UK founded the Stress Recovery Practitioners Association to provide training to health-care providers in understanding stress-related illness or pain, and also an online course that members of the public can take for a fee.
Georgie’s book, Chronic Pain – Your Key to Recovery is excellent, eminently readable, and is available in print, Kindle (from Amazon) and downloadable audio formats.
Common Stress-related conditions: (any can be structural)
Chronic Pain Syndromes, Tension headaches, Migraine, Back pain, Neck pain, Whiplash, Fibromyalgia, Temporomandibular joint (TMJ) syndrome, Chronic abdominal and pelvic pain syndromes, Chronic tendonitis, Vulvodynia, Piriformis syndrome, Sciatic pain syndrome, Repetitive strain injury, Foot pain syndromes, Myofascial pain syndrome.
Autonomic disorders influenced by stress:
Irritable bowel syndrome, Interstitial cystitis (Irritable bladder syndrome), Postural orthostatic tachycardia syndrome (POTS), Inappropriate sinus tachycardia, Reflex sympathetic dystrophy, (Complex regional pain syndrome)
The Human Givens Institute has described the following basic “givens” required for humans to thrive:
We are all born with essential physical and emotional needs and the innate resources to help us fulfil them – known as human ‘givens’ – which need to be met in order to facilitate good mental health.
The human givens approach is a set of organising ideas that provides a holistic, scientific framework for understanding the way that individuals and society work. This framework encompasses the latest scientific understandings from neurobiology and psychology, as well as ancient wisdom and original new insights.
At its core is a highly empowering idea – that human beings, like all organic beings, come into this world with a set of needs. If those needs are met appropriately, it is not possible to be mentally ill. Perhaps no more powerful a statement could ever be made about the human condition: If human beings’ needs are met, they won’t get depressed; they cannot have psychosis; they cannot have manic depression; they cannot be in the grip of addictions. It is just not possible.
Our fundamental emotional needs are:
- Security — safe territory and an environment which allows us to develop fully
- Attention (to give and receive it) — a form of nutrition
- Sense of autonomy and control — having volition to make responsible choices
- Feeling part of a wider community
- Friendship, intimacy — to know that at least one other person accepts us totally for who we are, “warts ‘n’ all”
- Privacy — opportunity to reflect and consolidate experience
- Sense of status within social groupings
- Sense of competence and achievement (from which comes self-esteem)
- Meaning and purpose — which come from being stretched in what we do and think.
The resources nature gave us to help us meet our needs include:
- The ability to develop complex, long-term memory, which enables us to add to our innate knowledge and learn
- The ability to build rapport, empathise and connect with others
- Imagination, which enables us to focus our attention away from our emotions, use language and problem solve more creatively and objectively
- A conscious, rational mind that can check out emotions, question, analyse and plan
- The ability to ‘know‘ — that is, understand the world unconsciously through metaphorical pattern matching
- An observing self — that part of us that can step back, be more objective and be aware of itself as a unique centre of awareness, apart from intellect, emotion and conditioning
- A dreaming brain that preserves the integrity of our genetic inheritance every night by metaphorically defusing expectations held in the autonomic arousal system because they were not acted out the previous day.
Human Givens Institute books by Griffen and Tyrrell include:
Human Givens: A New Approach to Emotional Health and Clear Thinking
How to Lift Depression…. Fast
How to Master Anxiety: All You Need to Know To Overcome Stress, Panic Attacks, Trauma, Phobias, Obsessions and More.