Are You Stressed?

Stress, it seems, is such a popular topic of conversation these days that you would think it’s a pervasively natural human condition. It’s not, or at least it shouldn’t be. Yet, depending on which statistics you believe, somewhere between 50 to 75 percent of all physician office visits are initiated for stress-related complaints and illnesses.

We talk about feeling “stressed out” or “burned out” or “losing it.” In a 2007 American Psychological Association (APA) stress poll, one-third of the U.S. population reported experiencing “extreme levels of stress.” Nearly one-in-five reported that they experience high levels of stress for 15 or more days per month. That’s a lot of stress.

But what does being “stressed” really mean? And how can you tell when “normal” stress is about to cross the line into “dangerous” stress?

Stress, simply put is our mind-body response to changes that create taxing demands on us. Stress comes in two flavors: Eustress, which is positive stress (yes, there really is such a thing) and distress, which is negative stress.

So when we complain about “feeling stressed,” we’re actually distressed.

Acute or short-term stress can be a good thing. That’s eustress. Eustress motivates us to achieve, helps us focus our energy and improve performance. It spurs us across the finish line.

Eustress is stress that’s triggered by stressors that we perceive to fall within our realm of coping abilities.

Anything that we view as physically or emotionally threatening to us in some way. Distress only occurs when we have doubts about our ability to deal with a particular stressor. In other words, stress only becomes a problem — distress — when we have too much of it and inadequate inner resources to cope with it, or at least that’s our perception. Stress reactions are always filtered through the lens of perception. Starting a new job, for example, may cause distress because we aren’t yet certain that we can do the job well, or are still unsure of our footing with our new bosses and co-workers. (For an analysis of modern workplace stress and a case study of Sahaja meditation’s impact on workplace stress, see: Sahaja meditation Relieves Occupational Stress, Depression and Anxiety.)

Whether that change is loss of a job or being served with divorce papers, adapting to new realities can require a lot of energy and good coping skills. To see how your own life changes stack up on the Holmes and Rahe Stress Scale, see: Holmes-Rahe Stress Scale.

Internal events, such as feelings, thoughts — especially unhealthy, habitual thought patterns — have just as much power to provoke distress; for example, repetitive negative self-talk about our past mistakes, perceived guilt, or lack of worthiness. As do fears (e.g., fear of flying or public speaking) or anxiously anticipating a future event. And sometimes we develop bad habits that set us up for negative stress; for example, overbooking our schedules, procrastinating until the last minute, or failing to plan ahead. Unfortunately, the human brain has become so “evolved” that it has learned to respond to psychological or internal stressors with the same damaging hormonal cascade with which it would greet a physical stressor (more on this in a minute).

Stressors generally fall into one of the following categories:

• Acute, brief, time-limited stress. A public speaking engagement or a job interview
• Distant stress. Traumatic experiences that occurred in the distant past but still have emotional and cognitive consequences for you; e.g., childhood abuse
• Background stress. Traffic jams; the neighbor who plays loud music in the wee hours of the morning; your kids screaming in the background while you’re trying to conduct a phone conversation
• Anticipatory stress Worrying about something that hasn’t happened yet; becoming stressed when anticipating a potential change
• Stressful event sequences. Major events that create a series of new challenges, but will eventually end; for example, the death of a loved one or a major disaster such as hurricanes, tsunamis or the U.S. 9/11 terrorist attack
• Chronic stress. Pervasive, recurring demands that force us to change our roles or behavior and don’t have a clear endpoint; e.g., caring for a parent or child with a permanent disability or chronic major health problem, a high-pressure job

While stress and anxiety do share some common neural real estate, the brain experiences stress and anxiety in slightly different ways.

Stress is an acute response to daily pressures, whereas anxiety is more closely aligned with fear and fear reactions, such as avoidance behaviors designed to ward off the anxiety.

In addition to tension and nervousness, anxiety always includes fearful feelings such as apprehension and dread; whereas, feelings of stress (distress) may are more closely aligned with tension and discomfort.

In people with anxiety disorders, the fear is excessive, irrational, chronic and significant enough to interfere with daily functioning. Many people suffering from anxiety disorders also have trait anxiety underlying their state anxiety they experience; for them, neuroticism is a dominant personality trait. Some anxiety disorders include specific fears, such as phobias (e.g., fear of snakes or enclosed spaces, as in Agoraphobia) or obsessions and ritualistic compulsions (as in Obsessive-Compulsive Disorder).

Feeling “stressed out” does not mean you have a diagnosable anxiety disorder. It is true, however, that untreated acute stress can evolve into chronic stress, and chronic stress usually does underpin anxiety disorders. (For more information on assessing and treating anxiety disorders, see Anxiety Disorders section of this website.)

Both eustress and distress trigger built-in physiological response mechanisms that are designed to help our bodies cope with threat and uncertainty. For example, let’s say that you were about to miss a critical deadline… you may find yourself literally sweating, your heart may beat faster.

For the effective stress manager, that natural physiological reaction kicks mind and body into gear and provides that extra boost of energy that he or she needs to focus, prioritize, perform and make the deadline. The ineffective stress manager, on the other hand, becomes anxious and fearful and may respond by freezing.

Here’s how the brain responds to acute stress…

Let’s say that you spot the proverbial grisly bear a few yards away. Under stress, a brain mechanism known as the limbic-hypothalamic-pituitary-adrenal axis (LHPA) is instantly activated. This key component of your emotional and neuroendocrine (nerves and glands) systems is a complex set of interactions between: the limbic (emotional system), the hypothalamus, the pituitary gland (the master gland that controls all the other glands), and the adrenal glands.

The LHPA triggers a cascade of physiological events to support its fight-or-flight response:

• Steroid hormones (glucocorticoids) flood your body, including the stress hormone cortisol, which plays a key role in mobilizing bodily systems (e.g., circulatory, respiratory, metabolic, digestive, immune) to deal with the bear.
• Catecholamine neurotransmitters and neurohormones (chemical messengers) are released, including dopamine, epinephrine (adrenaline) and norepinephrine (noradrenaline), the neurotransmitter of fear.
• To help us react quickly to the immediate threat, these catecholamines suppress activity in the frontal lobes and areas involved in rational thought, short-term memory, concentration, inhibition, and complex social and intellectual tasks. Increased norepinephrine triggers the release of stored glucose (simple sugar) to give us extra energy.
• Your catecholamines activate your amygdala, which generates your emotional response to the bear (most likely fear!), and signal its neighbor, the hippocampus, to store this emotionally-charged experience in long-term memory to help you avoid the bear in the future.
• Your brain releases Neuropeptide S, a small protein that modulates stress by decreasing sleepiness and increasing alertness and anxiety, creating a sense of urgency.
• Your heart and lungs ramp up… your heart rate and blood pressure increase, your breathing becomes more rapid so that your lungs can take in more oxygen. The spleen discharges more red and white blood cells into the bloodstream to increase blood flow (as much as 300 to 400 percent), which increases the flow of oxygen to your brain, lungs and muscle tissue.
• Blood flow is diverted away from your skin to support increased blood flow to muscle tissue and reduce blood loss in case you sustain an injury. You might grow suddenly pale, “as if you’ve seen a ghost.” Your skin feels cool, clammy, or sweaty. Your scalp tightens, your hair feels as if it’s standing on end.
• Nonessential functions such as digestion shut down. Fluids are diverted from nonessential locations, such as the mouth and throat. Your mouth is suddenly dry, your throat feels constricted, and it becomes difficult to speak.
• Steroid hormones prepare for injury or infection by selectively shutting down nonessential, energy-consuming components of the immune system (e.g., production of new white blood cells) and sending the emergency troops (e.g., infection-killer T cells) to the front line to prepare for battle with the bear.

And this all happened in a fraction of a second.

Without the body’s innate stress response, we wouldn’t be able to kick into gear when real danger is imminent. Acute stress is adaptive. If we accidentally bump into a hungry grisly bear in a forest, that old familiar stress response we call the fight-or-flight instinct can be the difference between staying alive and being eaten! And if the acute threat passes (let’s say the bear lumbers away), hormone levels and bodily systems return to normal, which results in what we would call “the relaxation response” (commonly known as relaxing).

But imagine that there is no bear. There are only the usual “daily grind” stressors. A work deadline is looming, you don’t have enough money to cover all the bills, you’re apprehensive about some future event. The problem is, your brain still registers these stressors the same way it always has, the same way it would register the bear, even if it’s not necessary to respond to these daily grind stressors with vigorous physical exertion — that is, by fighting or fleeing.

When the emergency stress response is triggered, the mind-body quickly mobilizes its resources for action, but the stress response mechanism isn’t always so adept at assessing true “emergency.” Your body stores that stress response and continues to churn out excess stress hormones. Next thing you know, acute stress has graduated to chronic stress.

Perhaps humans were not hardwired to manage, in a healthy way, artificial stressors like traffic jams and sitting on hold with the cable company for twenty minutes — in other words, maybe we’re not meant to sweat the small stuff. We’re wired to only react physiologically when it really matters, when our survival is at stake. After all, the modern world rarely requires the evolutionary fight-or-flight response to stress. Chances are, you’re not confronting grisly bears in your daily life.

Stress becomes dangerous when it interferes with your ability, for an extended period of time, to live a normal life.

If everyday stress experiences accumulate, they can snowball, leading to chronic stress. When we can’t eliminate or escape acute stressors, acute stressors progress to chronic stressors.

(Simple stress management strategies such as exercise, for example, fool the body into believing it’s escaping the source of its stress by increasing blood circulation and speeding up cortisol transport to your kidneys, which flush it out of your system.)

Chronic stress exerts a prolonged influence on our neuroendocrine stress pathways, tinkering with the nervous system and causing chronically elevated stress hormone levels.

Over time, chronic stress wears down your immune system and consumes more energy resources than your body can produce, making you more vulnerable to illnesses of all kinds.

(For more about how stress impacts the immune system, see: Stress and the Immune System.) Our hormones “burn out,” which can trigger emotional burnout, often coupled with feelings of despair that can easily trigger (or worsen) chronic depression and anxiety. We may feel helpless, “out of control,” constantly fatigued, unable to concentrate and struggle to fix even minor problems.

When does acute stress cross the line into the danger zone?

There is no universal line. It varies widely from person to person, influenced by “remissions” and individual resiliency. But the bottom line is that you can manage acute stress effectively if you get it under control before it progresses to chronic stress.

While chronic stress doesn’t guarantee that you’ll get sick, it definitely increases the risk. Research has overwhelmingly shown us that, in one way or another, stress contributes to most, if not all, mental and physical health problems. The longer you feel distressed, the longer your physiological reaction systems remain activated. Your body gets stuck in crisis mode, which eventually leads to mental and physical health problems. For example, stress plays a major role in accelerating aging and triggering and worsening depression, anxiety, cardiovascular disease, osteoporosis, some cancers, inflammatory disorders (e.g., arthritis), HIV and other infectious diseases. And prolonged stress even diminishes our ability to recover from illness. People who have suffered heart attacks, for example, tend to have a much harder time bouncing back if they’re also experiencing major stressors, such as financial worries or alcohol abuse. On the other hand, the ability to manage stress effectively can significantly speed recovery from a heart attack.

Our mental and physical states are inextricably linked. There’s no such thing as a “mind-body split.” Physical illnesses often emerge as a physiological response. to an emotional state.

Do any of these symptoms seem familiar?

• You frequently feel overwhelmed, like you’re literally being pulled in ten directions all at once
• You often find it difficult to focus, solve problems or make decisions
• You make mistakes that are “not like you,” such as missing meetings or appointments, forgetting to pay a bill
• You don’t sleep well at night, or you sleep too long
• You catch yourself sighing frequently
• You experience frequent headaches, an “upset stomach” or develop ulcers
• You experience appetite changes — marked decrease or increase
• You’re prone to sudden emotional outbursts: you often feel edgy, impatient, frustrated, irritable, easily annoyed
• You don’t receive as much pleasure from things you used to enjoy
• Your alcohol intake increases (you drink more “to relax”) or you take sleeping pills because you can’t “wind down” at night
• You develop nervous habits or tics

If these symptoms sound familiar, you’re distressed. But if you have good coping skills, you’ll maximize your resilience to stress and its impact on your health.