Stress Busters 101
by Roberta Lee, MD (topic expert: health)

It is now September and with the advance of fall comes school and then the holidays one by one. You know this inevitably means a lot more activity - shopping, physicals for school, appointment piled upon appointment and lots of schedules to shuffle. The pace winds up pretty quickly and with it the insidious feeling of stress. As a physician, I know full well that by the end of this month into the beginning of October, I will once again see patients with a parade of stress-related symptoms.

Stress is a word used commonly to describe uncomfortable situations. Truth is, it is hard to know exactly what it means. The Oxford Dictionary defines stress as "a disease resulting from continuous mental stress." Another dictionary definition is "a condition or feeling experienced when a person perceives that demands exceed the personal and social resources the individual is able to mobilize." Most people think of stress as an unpleasant situation or distress.

When we feel stressed, our body reacts by sending signals to flee via the limbic system, a special area of the brain designed to trigger a rapid physiological response. Stress experts believe that this response is an evolutionary adaptation whose purpose enabled victims of dangerous predators to run, escape or flee. Thus, the theory holds that those living in the cavemen and Mastodon Era with the best "fight or flight" responses survived. Eventually this physiological response was named the "fight or flight response" by Walter B Cannon, a scientist studying how animals adapted to threatening situations.

So, when danger is perceived the "fight or flight" response triggers neurohormones from the limbic system of the brain to be released into our blood stream. This effect in turn signals the adrenal glands to secrete another host of hormones known as catecholamine: epinephrine; norepinephrine and cortisol. All of these molecules mobilize energy in the body with the intent of fleeing.

Catecholamines facilitate immediate physical reactions associated with a preparation for rapid muscular action. (Gleitman, et al, 2004 ) These include the following:

• Acceleration of heart and lung action
• Inhibition of stomach and intestinal action
• Constriction of blood vessels in many parts of the body
• Dilation of blood vessels for muscles
• Inhibition of tear production and salivation
• Dilation of the pupil of the eye
• Relaxation of bladder
• Inhibition of erection
• Auditory Exclusion (loss of hearing)
• Tunnel Vision (loss of peripheral vision)

1. Frequent headaches, jaw clenching or pain dreams
2. Gritting, grinding teeth
3. Stuttering or stammering
4. Tremors, trembling of lips, hands
5. Neck ache, back pain, muscle spasms
6. Light headedness, faintness, dizziness
7. Ringing, buzzing or "popping sounds
8. Frequent blushing, sweating
9. Cold or sweaty hands, feet
10. Dry mouth, problems swallowing
11. Frequent colds, infections, herpes sores
12. Rashes, itching, hives, "goose bumps"
13. Unexplained or frequent "allergy" attacks
14. Heartburn, stomach pain, nausea
15. Excess belching, flatulence
16. Constipation, diarrhea
17. Difficulty breathing, sighing
18. Sudden attacks of panic
19. Chest pain, palpitations
20. Frequent urination
21. Poor sexual desire or performance
22. Excess anxiety, worry, guilt, nervousness
23. Increased anger, frustration, hostility
24. Depression, frequent or wild mood swings
25. Increased or decreased appetite
26. Insomnia, nightmares, disturbing
27. Difficulty concentrating, racing thoughts
28. Trouble learning new information
29. Forgetfulness, disorganization, confusion
30. Difficulty in making decisions.
31. Feeling overloaded or overwhelmed.
32. Frequent crying spells or suicidal thoughts
33. Feelings of loneliness or worthlessness
34. Little interest in appearance, punctuality
35. Nervous habits, fidgeting, feet tapping
36. Increased frustration, irritability, edginess
37. Overreaction to petty annoyances
38. Increased number of minor accidents
39. Obsessive or compulsive behavior
40. Reduced work efficiency or productivity
41. Lies or excuses to cover up poor work
42. Rapid or mumbled speech
43. Excessive defensiveness or suspiciousness
44. Problems in communication, sharing
45. Social withdrawal and isolation
46. Constant tiredness, weakness, fatigue
47. Frequent use of over-the-counter drugs
48. Weight gain or loss without diet
49. Increased smoking, alcohol or drug use
50. Excessive gambling or impulse buying

Many of my patients describe these symptoms. I wish I could say that the frequency of stress-related symptoms is dwindling. But unfortunately, a recent survey by the American Psychological Association in 2007 known as the "Stress in America Report" verifies that one third of Americans are suffering from extreme stress and the prevalence of stress is now up to 79% ( up from 59% in 2006). I could write page upon page about why and how the body responds in a stressful situation, but I am a medical pragmatist and I ultimately like to see people gain control over stress. Here are my top 10 suggestions to reduce stress that I share with patients:

1. Realize that whatever is stressing you will eventually resolve itself-nothing lasts forever
2. If you have symptoms that impact your effectiveness to work, think and behave with civility to your loved ones or work colleagues - get psychological support to figure out how you can cope in a more constructive way
3. Preserve your health sleep at least 6- 7 hours so your body can rejuvenate itself from the daily wear and tear of stress
4. Eat breakfast-- it will give you more energy to get through all the stress
5. Take a 10 minute break in the middle of the day- this gives you a mental energy boost
6. Take a multi-vitamin because we use up more vitamins within our bodies when under stress
7. Eat wholesome whole foods like whole grains, fish, lean meats, veggies and fruits. Your body needs nourishment under strain, not the empty calories of junk food
8. Mobilize and take a 20 minute daily walk-physical activity mobilizes endorphins the "feel good" hormones
9. Answer the question "What 5 things am I grateful for today?" and find something inspiring to read every day
10. Make a commitment to yourself to go visit a friend in person this week-we all need each other

There is one more stress buster. It is not intuitive under circumstances of strain but it works -do something kind for someone, compliment somebody, help someone out or wish someone well - for no good reason. Reaching out to help someone reminds us of the interconnected nature of the human experience-and our capacity to aspire to our highest nature something we often forget under stress. As the author of One Door Closes, Another Door Opens, Arthur Pine, put it "Caring can start a domino effect. "

"An enterprise, when fairly once begun, Should not be left till all that ought is won"  -- William Shakespere (1564-1616)

References:

Walter Cannon in 1915, http://www.harvardsquarelibrary.org/unitarians/cannon_walter.html

Gleitman, Henry; Alan J. Fridlund, Daniel Reisberg (2004). Psychology, 6, NY: Norton.

Pine, Arthur When One Door Closes, Another Door Opens, Delacorte Press, New York 1993.