It is hard to dispute that stress is generally believed to have a negative affect on health. But, were did this idea originate. Although many different healing philosophies throughout time hinted at this idea, modern mainstream medicine, until recently, has been hesitant to embrace the connection. It wasn’t until recently that this idea has been brought to the forefront of allopathic medicine. This is important as we each face ever-increasing demands placed on us. It is no wonder why we have become over stressed and over worked in modern society. Recent studies have brought illumination to the mechanisms involved, and to what degree stress affects our health. Although, we are perhaps at the beginning of understanding this area, we can use what is currently at the forefront to help bring relief for those who are suffering from the effects of stress.
History of mental and physical health
To understand the present perspective of stress, and how it is linked to health, we should take a look at the past to see how conditions of the mind and body were viewed.
There has been reference to emotional distress and its treatment since ancient times. Indeed, there has been recorded history of its treatment since ancient Egypt. During this time, for example, one way emotional distress was treated was by “the scribe of the house of life”(1). In which “The Pirankh or house of life was used as a kind of retreat”. Where, “the ill were prepared for their therapeutic dreams. Isolation, silence and dim light were the means to put the patient in a state of receptivity with the intention of unraveling the unknown. This was akin to hypnotherapy and was probably known to the Egyptians before the Greeks’ therapeutic temples”(1).
In ancient India, Hindu scriptures made reference to depression and anxiety(2). Ayurvedic Medicine, which is the traditional medicine to India and has its origins that predate the first millennium, believes that conditions of the mind and body are the result of imbalances of the Dosha’s. The three Dosha’s are the characteristics that use dynamics in nature to describe ones constitution. It is still believed, in Ayurveda Medicine, that balancing these Dosha’s through therapies and lifestyle changes, is paramount for mental and physical well-being.
In ancient Greece, Hippocrates, suggested that imbalances of the “humors,” or four fluid types, leads to disease of the mind and body. It is interesting that Galen, an ancient Greek physician, who is credited for his understanding of medicine and anatomy, is quoted saying with reference to the physician, “He cures most successfully in whom the people have the most confidence.” Indicating that he believed in the effect that the mind could have over health.
The Humoral Theory persisted through ancient Rome and into the Middle Ages. This physical approach to medicine during the middle ages was sometimes combined with the evil spirit approach that meshed with faith issues surrounding Christianity. It seems that the type of treatments involved dealt with flushing out the evil spirits from the body. The spiritual and physical approach to stress manifesting as anxiety, anger, aggression, sadness, depression, and obsessions, were adopted during the Persian, Arabic, and Muslim Empire(6).
In the early 1600’s, René Descartes suggested, that the mind was a nonmaterial thing, and that the body was a material thing. He proposed they both worked together for the benefit of the person. Towards the end of the 17th century, the philosophy of healing moved away from addressing the spiritual element.
Modern progression of understanding stress and longevity
During the 20th century, a shift in thinking by the medical establishment was under way. In the 1930’s the term stress, was increasingly linked to mental disorders(6). However, the dominant thought was that conditions of the brain and its behavior were somewhat isolated from the rest of the body. This isolation approach to conditions of the mind inspired treatments ranging from drug therapy, psychotherapy, shock therapy, and o lobotomies, which were performed as late as the 1970’s.
One of the first modern pioneers that suggested the possibility between stress and physiology, was Walter Cannon. In 1915 he recognized physiological changes in the body during the ‘fight or flight’ response such as increase glucose availability. He also noticed that when animals where under emotional stress their stomach movements ceased(8,9).
During the 20th century, Hans Seyle proposed the theory of ‘General Adaptation Syndrome’. He was one of the most prominentdoctors to realize the relationship between stress and the body. He suggested emotional as well as other stresses on the body he termed “stressor,” could lead to disease.
Recent revelations on stress and longevity
In 1964, psychiatrist George Solomon, noticed that people with rheumatoid arthritis got worse when they were depressed. He began to investigate the impact emotions had on inflammation and the immune system in general(9). He coined the term “Psychoimmunology”. Later to be termed “psychoneuroimmunology” by Robert Ader in 1975.
Robert Ader performed one of the first studies to show “that the nervous system could affect the immune system”(9). “To condition the rats, he used a combination of saccharine-laced water and the drug Cytoxan which induces nausea and suppresses the immune system. Ader was surprised to discover that after conditioning, just feeding the rats saccharine-laced water was sufficient to suppress the immune system of the rats. In other words, a signal via the nervous system (taste) was affecting immune function”(9). Even though this was a study on rats, the change in thinking that the workings of the brain could affect physiology, was revolutionary thinking.
The study of Psychoneuroimmunology, or PNI, has opened the door to the medical community, that a relationship exists between well-being and stress. The study of PNI in essence, legitimatizes the relationship between emotional stress and health by attempting to explain scientifically the physiological relationship between the mind and body.
The idea that cognitive manifestations effect different body systems is evolving to an area of ever increasing interest as more research is being done. PNI understands psychosocial factors, such as stress, bereavement, or divorce, and how it can change or deplete immune performance and alter neuroendocrine function. Through the study of PNI, it has been found that emotional stress has been implicated in dysfunction of the immune system. It is through this dysfunction of the immune system that changes in blood vessel walls can lead to coronary artery disease, stroke, or congestive heart failure. In addition, it is thought that the immune system gone awry can lead to osteoporosis, arthritis, type 2 diabetes, Alzheimer’s, periodontal disease, and cancers such as multiple myeloma, non-Hodgkin’s lymphoma, chronic lymphocytic leukemia. There is also evidence that chronic stress dampens the immune response that could lead to prolonged infection. For instance, it was noted in military cadets that displayed high motivation predicted a greater susceptibility to Eptstein-Barr virus infection(16). In addition, it was found that medical students who reported greater test associated anxiety did not produce adequate antibodies to the hepatitis B vaccine(16). Additionally, the effects of stress can be related to seemingly unrelated health outcomes. For example, “Psychological factors have also been implicated in the onset and exacerbation of various skin disorders, including allergic inflammatory process in atopic dermatitis”(13). In another example, “among dental students, healing of an oral punch biopsy wound took 40% longer during exams than during summer vacation”(16). Also, longer postoperative hospital stays are associated with immune system dysfunction(16). It is clear from these examples that stress has an impact on health. The question that arises is what is the nature of the harmful stress that causes these problems.
Although immune changes appear in situations of acute stress it is believed that chronic stress carries the most adverse affects. For example “In a study in which volunteers were inoculated with several different strains of cold viruses, stressors that lasted a month or more were the best predictors of developing colds” and it is noted that in the case of caregivers “Immune dysregulation can persist several years or more after caregiving ends” additionally “Marital discord, a persistent interpersonal stressor, has been associated with poorer immune function”(16). Along with the chronicity of the stress, the severity of a stressful event may have long lasting effects on the immune system as well. “Immune dysregulation can persist several years or more after caregiving ends” and “Immunological changes have been documented for weeks or months after such natural disasters as earthquakes and hurricanes”(16).
Also gaining more momentum is the idea of the effect of emotional stress on the hormonal system. This is understood through what is recognized as the chronic stress response. In this response, what is known as a stressor, induces the hypothalamus to release chemical messengers in the body through the HPA Axis. This then results in the release of the stress hormone, cortisol, from the adrenal glands. The ‘stressor’ can be emotional in nature such as anger, fear, anxiety, worry, depression, guilt, and mental strain. It is important to note that physiological stress such as loss of sleep, infection, trauma, pain, toxin exposure, indigestion, etc. can also elicit cortisol production. The release of cortisol is a healthy response to a short-lived stressor such as, a bear chasing a person in the woods. In this scenario, cortisol would increase glucose in the blood for fuel for the body and mind to help the individual escape from the bear. The problem occurs when the stress is chronic. Cortisol is a catabolic hormone. This means that it tears down the body tissues. In a state of chronic stress the increase in cortisol secretion for long periods of time can lead to muscle wasting, increase in blood sugar levels, osteoporosis, immune suppression, and fat accumulation around the waist. With prolonged exposure to stress the adrenal glands can become fatigued leading to the possibility of adrenal exhaustion. It should be noted that some of the results of impaired adrenal function are stress inducers themselves such as disease, depression, irritability, feelings of frustration, and nervousness thus feeding back into the stress response loop. It can be suggested that the negative result of the stress response could facilitate an ongoing adrenal dysregulation compounding the negative health affects.
In 2009, the Nobel Prize in Physiology or Medicine 2009, was jointly awarded to Elizabeth H. Blackburn, Carol W. Greider and Jack W. Szostak, for the discovery in the early 1980’s of “how chromosomes are protected
by telomeres and the enzyme telomerase”. As Dr. Elizabeth Blackburn indicates in a CBS 2009 interview with Scott Pelley: “If you think of a strand of DNA as a shoelace, the telomere is the plastic tip on the end. It protects the DNA from damage. Telomeres naturally get thinner as we age, and the thinner they get, the thinner the protection.” Telomeres are involved when the DNA replicates itself and this replication is the bases of how our cells reproduce to create more cells. When the ability of cells to reproduce is compromised then we get signs of aging. Indeed, in another study in 2009 co-authored by Dr. Blackburn, it was indicated the not only does the telomere “shorten with chronological age”, the length of the telomere “predicts risk factors for cardiovascular disease independent of age, and is shortened in people with age related diseases, including atherosclerosis and diabetes”(21). When referring to a study Dr. Blackburn co-authored that looked at telomere length of mothers who cared for their chronically ill child, Dr. Blackburn continues in the interview by saying, “We were astounded that they were absolutely, consistently showing that the shorter the telomeres were, the worse stress people had had. … That said, that these cells … aged much faster than they should have been aging if they had not had that stress. Dr. Blackburn goes on to say, “It was as though there had been in excess of 10 years of extra aging in these individuals’ blood cells. … And that’s actually an underestimate. That’s a very conservative estimate.”
Perception of stress
Now that we understand stress and the relationship to longevity more thoroughly through these different mechanisms, it is important to now take a look at what type of stress has harmful affects on our health. In addition, to the severity and chronicity of stress there is growing evidence to suggest that perceived stress correlates directly to the health of an individual. It also appears that the type of perception matters when it comes to how stress affects the body. A person may feel a type of stress that is a “threat” if they feel that it is harmful to them and cannot be overcome. A stress that is perceived as a “challenge” is the perception that a stress can be overcome. The perception of a threat is associated with cellular aging and is considered harmful vs. the perception of a challenge(21). It is critical to mention that the perception of stress is correlated with the feeling of control over the stressor(21). The greater the feeling of control over the stressor the greater the perception of the stress being a challenge instead of perceived as a threat(21). Therefore, a feeling of being empowered to handle stress throughout the day appears to reduce the harmful affects of stress.
What can we do?
Escaping stress is nearly impossible in today’s world. We may be able to limit our exposure to stress; however, it is unlikely that we can eliminate it altogether. It is believed that modalities, that help make a cognitive shift within an individual to feel empowered and improve self-image, can help reduce the risk of stress related aging and disease.
The goal of this report was to present some of the most up to date ways found to address the aging effects of stress. This list cannot be considered exhaustive when searching for what works for everyone. These are just some of the techniques found in the new research that appear to improve health by the alleviation of stress.
Mindfulness meditation is a focus on the moment. It helps situations that are stressful to be perceived as less threatening, while at the same time, help the person let go of the feeling that they need to be in control(21). Research has demonstrated that mindfulness mediation may reduce symptoms of anxiety, depression, and chronic pain(25).
Transcendental meditation helps the mind “settle inward beyond thought to experience the source of thought – pure awareness”(26). It is highly studied in universities and medical schools for its positive health affects. In addition, it seems to attract celebrities such as Jerry Seinfeld and Hugh Jackman.
Cognitive Behavioral Management (CBSM) is a technique that includes meditation and can be effective at shifting the perception of stress from threatening to a challenge. It also has been shown to lower cortisol reactivity in response to a stressor(21).
Hypnosis can reduce interleukin 6 (IL-6). High IL-6 in the blood stream is linked to psychological stress and is part of the physiological stress response. IL-6 is a Proinflammatory cytokine, which means it is a major communicator in the inflammation pathway. A higher than normal IL-6 has been associated with an elevated mortality rate from cardiovascular disease(16). Elevated blood IL-6 levels predict future disability in older adults(16). IL-6 was found to be decreased following a 12 week hypnosis listening program(25). In addition, positive cognitive changes where found as the participants’ appraisal of a threat was minimized(25). Further, the participants reported to have a significant decrease in the use of negative appraisal coping (such as, self-deprecating statements, perfectionism, and catastrophic and pessimistic thinking)(26).
Exercise is also an important part of the arsenal to combat the effects of stress. Exercise increases self-confidence and promotes a sense of control over stresses in life. Among the many benefits of exercise it also promotes a good nights sleep. It is also important for people to remember to follow their health professionals’ advice regarding an exercise program to minimize the effects of stress.
It is important to maintain healthy habits. Negative behavioral changes in people that are under stress for prolonged periods of time may manifest. They may present as shifts in lifestyle that may affect longevity such as loss of sleep, increased smoking, increased alcohol consumption, deterioration of health regimes such as exercise or eating well, and poor adherence to medical prescriptions.
It is the goal of this report to help people understand how stress affects individual health and also the type of stress that causes health issues. The role stress plays in our longevity can no longer be overlooked. It is important to take steps to address stress in our lives. The techniques found to be effective in this report allow the individual the ability to attack stress at the root cause rather than attempt to micromanage thousands of different stressful scenarios and circumstances that are forever changing within our lives. Instead, it appears that by addressing how stress is perceived will have the most profound impact in reducing the consequences of stress. Although, stress is nearly impossible to remove from our lives, this report illuminates some of the avenues available to help take control over stress for optimal health.
Please continue to educate yourselves in this area, because your health affects everything you do, and everyone you know.
Yours in Health,
Sean Ripp, D.C.
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- Bhugra, D. (1992). “Psychiatry in ancient Indian texts: a review”. History of Psychiatry 3 (10): 167–186. doi:10.1177/0957154X9200301002.
- http://www.medicinenet.com/stress/page2.htmPMID 11623029
12. Mind-body medicine | University of Maryland Medical Center http://umm.edu/Health/Medical/AltMed/Treatment/Mindbody-medicine#ixzz2fm63pK1E
13. Rahul Kumar and Vikram K. Yeragani Psyche and Soma: New insights into the connection. Indian Journal Psychiatry 2010 Jan; 52(Suppl1): s233-s239; doi:10.4103/0019-5545.69238.
15. Roger CM, MBBS, MMed(Psych), MRCPsych, Li Fang Neo, BA(Hons), Anna NC Chua, BSc (Hons), Alicia AC Cheak, BSc, Anselm Mak, MBBS, MMedSc, FRCP(Edin). Research on Psychoneuroimmunology: Does Stress Influence Immunity and Cause Coronary Disease?; Annals Academy of Medicine 2010;39: No.3
16. Janice K. Kiecolt, PhD, Lynanne McGuire, PhD, Theodore F. Robles, BS, Ronald Glaser, PhD. Psychoneuroimmunology and Psychosomatic Medicine: Back to the future. Psychosomatic Medicine 2002;64:15-28.
19. Epel ES, Blackburn EH, Lin J, Dhabhar FS, Adler NE, Morrow JD, Cawthon RM.Accelerated telomere shortening in response to life stress. Proc Natl Acad Sci U S A. 2004 Dec 7;101(49):17312-5. Epub 2004 Dec 1.
21. Elissa Epel, PhD, Jennifer Daubenmier, PhD, Judith T. Moskowitz, PhD, Susan Folkman, PhD, Elizabeth Blackburn, PhD. Can meditation slow rate of cellular aging? Cognitive stress, mindfulness, and telomeres. Ann N Y Acad Sci. 2009 Aug;1172:34-53; doi:10.1111/i.1749-6632.2009.04414.x.
24. Sheldon Cohen, PhD, Denise Janicki-Deverts, PhD; Gregory E. Miller, PhD. Psychological Stress and Disease. JAMA. 2007;298(14):1685- doi:10.1001/jama.298.14.1685.
27. Schoen M, Nowack K. Reconditioning the stress response with hypnosis CD reduces the inflammatory cytokine IL-6 and influences resilience: a pilot study. Complement Ther Clin Pract. 2013 May;19(2):83-8; doi:10.1016/j.ctcp.2012.12.004. Epub 2013 Jan 18.