Part 1: Understanding Stress
In this first of two article we will discuss what is stress and why it affects us the way it does. I am a big believer that when we understand why things happen and how normal these reactions are it can help us to be less critical of ourselves. The trick after understanding though, is working out if it is helpful to us. Whilst it may not be our fault, that our ancestral aunt-pilot has taken hold, it is important to work out ways we can be mindful of this and what strategies we can use to move us forward and take care of ourselves.
What is stress?
Stress is a feeling we all experience when we feel overwhelmed by situations or circumstances. We often will feel that we do not have the capacity or skills to cope with what is occurring, and this experience activates our bodies “fight, flight and freeze” response. In the short-term stress provides us with focus and energy to manage the “stress” balls we are trying to juggle, but long-term it can leave us feeling depleted, exhausted and wreak havoc on our wellbeing and life.
Why do we feel stressed?
If we look in an over-simplified way at stress, for millions upon millions of years, stress has helped us learn and adapt, ensuring our ancestors evolved with the knowledge and skills they needed to survive.
- Stress draws our attention to potential danger. A snake on the ground, a fire that could burn us, a person who could harm us.
- Stress draws our attention to potential famine. The need to hunt and gather, the need to store and protect.
- Stress draws our attention to the need for community. The people who will keep watch at night, the people who will protect us in battle, the people who will allow us to create family.
When we feel stressed, in the short term, it can motivate change, adaption, productivity and the minimising of risks to us.
What are stressors?
In short, they are anything that makes us feel “stressed”. These are quite unique to each of us, like our fingerprints. They are also constantly changing, based on our emotional, mental and physical capacity to cope at any one time. They are influenced by how many “stressors” we are managing at any one time. A flat tire may not matter to us after a relaxing weekend away. But give us a flat tire on our way to a busy day at work, in the middle of the harbour tunnel and our stress response is likely to kick in. Our stress response is the set of physical, emotional and mental sensations/experiences that occur when we feel stressed. These are known as the “fight, flight and freeze” response. That same system that kicks in when we a fearful, in pain and many other emotions that are focused on keeping us safe and protected.
Fight and Flight made easy.
Our heart starts pounding, our can feel your breathing get shallow and quick, a surge of adrenaline hits our body, with this a burst of energy, then our attention pinpoints on the danger at hand and the need to act quick to either fight/act or move/flight. Blood flow moves to our brain, heart and any muscle that will help us get out of this situation. No need to think about breakfast, digestion, procreation or any other non-vital functions, survival is our one and only focus when “fight or flight” hits us.
Fight or Flight and Stress.
So how does this situation look when it comes to Stress? Your mind is moving a million miles per hour, trying to work out all the potential “threats” or “dangers” that may occur. Our feelings of being able to cope and sort this situation are at a low. The possible risk of “danger” is high, because we feel ill-equipped to manage what is either happening, about to happen or we perceive might happen. Now this has got our attention, our heart is pounding, we unable to think clearly, our breathing is shallow and quick, our muscles tighten, we feel overwhelmed, uncomfortable and out of control … our mind is fixated on the disaster that could occur any minute …
We then look to “numb-ers” to avoid the unpleasantness of this experience – these could be food, alcohol, distraction, avoidance – anything to not feel “stressed” and overwhelmed. But this is where the challenge lies, the longer we be “that emu with its head in the sand”, the more life falls out of balance and the greater our stress becomes. Unfortunately, we can’t selectively numb to only the “bad stuff” so these numbers tend to numb the “feel good” brain chemicals too.
What happens in our brain when we feel stressed?
So, what does our brain look like on stress?
Our prefrontal cortex is responsible for thinking and problem-solving. It is like the CEO of your brain, being able to integrate memories (hippocampus) that have been filed away, with situations that are occurring right here and now. It is the home or a majority of our conscious activities … where we can focus, be present and be aware. Your prefrontal cortex has a slight lag-time to kick in, allowing our “fight or flight” system to kick in first and move us from harm before dissecting what occurs. This can be a challenge when we are stressed, is our “thinking rational brain” often gets muffled by the voice of our other brains.
Here lies a majority of our unconscious behaviours that ensure our survival, including our “security system” the Amygdala and “coordinator” the hypothalamus. The amygdala is a fast-acting super-highway for detecting real or perceived threats and danger, and ensuring the “fight or flight” system is activated, with the help of the hypothalamus which releases our “stress hormones” – adrenaline, cortisol and few others.
When we are stressed, our amygdala is working on overdrive – pinging left, right and centre – at all the potential issues that could occur. Given the chance, we can use our prefrontal cortex to calm our amygdala down, but this takes practice and awareness of what is going on inside us. Sometimes like that “frog who sits in water and the heat is turned up gradually”, stress can be brewing away inside us without us even noticing.
Here lies all of our unconscious bodily functions, including the blood that pumps around our body and our pain response. These functions are vital for life and the communication channels are open and reactive to the information from the rest of the brain. Interestingly, despite breathing being found here, and it being automatic, involuntary and continuous, it can be regulated through the “conscious part” of our brain. This can be incredibly useful when it comes to stress, because our breathing can act like the “mumma-duck” of our fight or flight response, aiding us to calm that system down.
What happens in our body when we feel stressed?
When it comes to short-term stress a few things occur:
- Adrenaline: Released in times of stress and magnifies messages of threat and danger through the “fight or flight” response
- Cortisol: Released in response to stress and attempts to slow body processes that are not vital, can calm us
But if stress continues for a prolonged period:
- Persistent high levels of cortisol cause memory issues, poor healing, libido issues, depression, decreased physical performance, hormone imbalances, changes to metabolism and sleep, changes to fat-storage
- Persistent high levels of adrenaline can cause wear and tear on our physical health such as high blood pressure
What happens to our emotions when we feel stressed?
When we are stressed, we are more likely to experience feelings of anger and fear, partly due to the feeling of being out of control and overwhelmed, and partly due to the “threat/danger” we are perceiving.
“Threat/danger” causes a cascade of bodily processes which feed into our emotions such as:
- Glucose is sent to the brain to be used as a source of energy for thinking
- Heart rate is increased to get blood flow to vital organs including large muscles in arms and legs
In the short term, our emotions are fuelled by “survival” – what can we do to make this stop and feel better. In the long-term, our emotions can be depleted by the relentless effort to overcome, and we can experience the “freeze” response to stress, which can be seen as depression.
What happens to our diet when we feel stressed?
As we discussed, food can become a “numb-er” when it comes with dealing with chronic stress, but there is actually more at play here. For majority of human existence, stress has marked danger which may result in a lack of food and therefore risk to our safety and survival. This is why stress will often mark the need to:
- Store quickly accessible energy (fat) in our easily accessible “body pantry” (waistline)
- Increase our attention to food, particularly high energy food to keep us going in case of a period of famine
- Increase our desire for food, just in case we can’t get our next meal
In modern times, if we then add chronic stress with restricted eating and vigorous exercise, we will find ourselves only feeding our “prehistoric” survival mechanism and not having the desired effect of weight loss. In times of chronic stress, the best path forward is small, regular meals and relaxing movement like tai chi, yoga, walking and swimming.
What happens to our sleep when we feel stressed?
All those “stress hormones” we release when we are stressed are aimed at keeping us alert and awake, not sleeping. Why? Because for millions of years, our “threats” were a lion or sabretooth tiger sitting outside our cave, and there was no time for sleep, when our survival was at stake. This is why, no matter how exhausted you are, stress will always flow into sleep quality or quantity.
- Stress may kick in at 2am, with a surge of adrenaline and a feeling of panic with the impending doom of the day that lies ahead.
- Or it stops you from getting to sleep with a flood of thoughts and worries, that your rational brain can’t sort out.
- Or it may wake you at 4am, tired and wired, and unable to get back to sleep.
- Or it may do all of the above … leaving you perpetually exhausted, with your capacity to cope diminishing with every bad night.
So, what can you do?
- Schedule “worry” time well away from bed, where you do a mental dump of all the “stressors” you are experiencing
- Practice deep breathing and things you find relaxing every time you feel stress take hold
- Practice sleep hygiene, sleep restriction and stimulus control (link)
- Limit caffeine, as this feeds into the stress cycle
- Limit sugar, as this feeds into the stress cycle
Chronic Pain & Stress
They have been labelled the two side of the same coin. When one is bad, it will feed into the other, only making it worse. Stress shifts blood flow away from our “conscious thinking” brain and towards our “emotional brain” which is also responsible for the “alarm bell” which triggers the fight or flight response (Amygdala and Autonomic Nervous System). Stress is stored in the “pain parts of our brains” activating our “alarm bell”; causing changes to our body (spasms, tension etc.); pinging our “emotions” and triggering fear, anxiety, worry about pain; and dampening our ability to decrease pain which can cause a “wind up” of our nervous system. “Wind up” or sensitisation is when our nervous system learns to react to pain more efficiently and effectively, at lower and lower levels of activity or experience (touch, pressure, temperature etc.), to pain. In essence “turning up the volume” on pain.
Our mind and body are affected by stress and pain. We can feel overwhelmed, having a cascade of thoughts about how to cope in the future with pain if it continues. We can feel like we are developing other problems like headaches, pain almost everywhere, palpitations, bladder and bowel issues, tension in muscles, issues with circulation. Although pain can be hard to directly target, we can work on reducing our stress levels. This may involve working with your health care team to deal with grief, anxiety, unresolved hurtful memories, childhood trauma, isolation and loneliness and many others.
Signs you might be stressed.
Stress affects our autonomic nervous system, it controls our heart rate, blood pressure, vision, hearing, concentration, breathing, digestion, muscle tension, immune function, sexual function, sleep and energy levels, metabolism and weight, and pain. Signs you might be stressed may include tension, aches and pains; sleep problems; feeling “tried but wired”; difficulties having sex; an upset stomach or problems with bowel or bladder; getting recurrent infections, colds or virus’; changes to mood; surges of worry or anxiety; and many more. Often, we also notice change to behaviour, as a means to cope with the stress, these may include drinking too much, too often; addictive or compulsive behaviours like social media, shopping or gambling; developing eating disorders or overeating; smoking or recreational drug use.
Measuring your Stress Levels
Stress is subjective (not measured with tests) and on a spectrum, from alert/excited/anxious, to mild, to moderate, to severe “fight, flight, freeze”, and finally severe “fight/aggression”. Only the person experiencing it can determine if they feel it is present and how severe it is.
Stress can be labelled in 3 ways:
- Positive Stress – normal and brief; mild activation of “fight, flight”, but quick recovery
- Tolerable Stress – short duration; activates “fight, flight” but buffered by ability to cope
- Toxic Stress – strong, frequent and prolonged; disrupts ability to “bounce back” from “fight, flight” causing physiological changes that impact on health and wellbeing
If you are wanting to learn more about stress reduction, relaxation and chronic pain, this section includes:
- Stress Management Resources
- Mindfulness Resources
- Relaxation Resources
- Free Worksheets
Stress Management Resources
- Article: NPC: 12 Quick Tips for Managing Stress (link)
- NPC YouTube Channel: Manage Stress (link)
- Article: IPC: Stress and Chronic Pain (link)
- Factsheet: CCI: Stress and Anxiety (link)
- Factsheet: CCI: Coping with Stress (link)
- Factsheet: TA: Self-Care Tips (link)
- Factsheet: TA: Stress Management Tips (link)
- Factsheet: TA: Fight or Flight Response (link)
- Factsheet: TA: Time Management Tips (link)
- Factsheet: TA: Positive Steps to Wellbeing (link)
- Factsheet: TA: Symptoms of Stress (link)
- NPC Youtube Channel: Practising Mindfulness and Meditation (link here)
- Free Online: Mindfulness Based Stress Reduction Course (link)
- Website: Jon Kabat-Zinn: Mindfulness Based Stress Reduction (link)
- Journal Article: Mindfulness-based stress reduction: a non-pharmacological approach for chronic illnesses (link)
- Article: APA: Mindfulness-based Stress Reduction (link)
- Article: NPC: Relaxation, Mindfulness and Meditation (link)
- Article: TA: The Benefits of Mindfulness (link)
- Factsheet: ACI: Mindfulness (link)
- Factsheet: TA: Mindfulness Skills (link)
- Book or Movie: My Year of Living Mindfully. Shannon Harvey (link)
- Movie: The Connection. Shannon Harvey (link)
- Article: NPC: Relaxation, Mindfulness and Meditation (link)
- Factsheet: ACI: Progressive Muscle Relaxation (link)
- Factsheet: CCI: Progressive Muscle Relaxation (link)
- Factsheet: ACI: Focused/Slow Breathing (link)
- Factsheet: CCI: Breathing retraining (link)
- Factsheet: ACI: Imagery (link)
- Factsheet: ACI: Relaxation (link)
- Article: NIH: Relaxation Techniques for Health (link)
- Article: Inner Health Studio: Relaxation Techniques (link)
- Article: Chronic Pain Australia: Relax (link)
- Factsheet: TA: Relaxation Techniques (link)
- Worksheet: TA: Mindfulness Exercises (link)
- Worksheet: TA: Stress Exploration (link)
- Worksheet: TA: Self-Care Tips (link)
- Worksheet: TA: Family Mindfulness Schedule (link)
- Worksheet: TA: Mindful Meditation (link)
- Worksheet: TA: Progressive Muscle Relaxation Script (link)
- Worksheet: TA: Stress Management (link)
- Worksheet: TA: Problem Solving (link)
- Worksheet: TA: Emotion Thermometers (link)
- Worksheet: CCI: Fun Activities Catalogue (link)
- Worksheet: CCI: Behavioural Activation Worksheet (Fun and Achievements) (link)
- Worksheet: CCI: Healthy Me (link)
- Worksheet: TA: Worry Exploration (link)
- Worksheet: TA: Gratitude Exercises (link)
- Worksheet: CCI: Daily Record of Your Breathing Rate (link)
- Worksheet: CCI: Monitoring Your Relaxation Level (link)
- Worksheet: TA: Recognising Stress (link)
- Book: The Stress-Proof Brain. Master your emotional response to stress using mindfulness and neuroplasticity. By Melanie Greenberg, PHD
- Book: Rushing Woman’s Syndrome. The impact of a never ending to-do list on your health. By Dr Libby Weaver
- Book: Neuroscience of Pain, Stress, and Emotion. By Magne Flaten Mustafa al’Absi (link here)
- Website: Institue for Chronic Pain: Chronic Pain and Stress (link here)
- Website: Help Guide: Stress Management (link here)
- Website: Positive Psychology: 62 Stress Management Techniques, Strategies and Activities (link here)
- Website: Zety: Burnout: Prevention, Treatment, and Advice for Employees & Employers (link here)
- Website: Psychology Today: The Connections Between Emotional Stress, Trauma and Physical Pain (link here)
- Journal Article: Chronic Pain and Chronic Stress: Two Sides of the Same Coin? (link here)
- Journal Article: Pain in Times of Stress (link here)
- Journal Article: Anxiety and stress can predict pain perception following a cognitive stress (link here)
- Journal Article: The stress model of chronic pain: evidence from basal cortisol and hippocampal structure and function in humans (link here)
- Website: Harvard Health: The Pain-Anxiety-Depression connection (link here)
- Website: The Stress & Chronic Pain Cycle (and how to break it!) (link here)
- Website: The American Institute of Stress (link here)
- Website: Cureable: Chronic Pain a cycle of stress and pain (link here)