What are the signs and symptoms of poorly managed stress?
Excess stress can manifest itself in a variety of emotional, behavioral, and even physical symptoms, and the symptoms of stress vary enormously among different individuals. Common somatic (physical) symptoms often reported by those experiencing excess stress include sleep disturbances, muscle tension, headache, gastrointestinal disturbances, and fatigue. Emotional and behavioral symptoms that can accompany excess stress include nervousness, anxiety, changes in eating habits including overeating, loss of enthusiasm or energy, and mood changes. Of course, none of these signs or symptoms means for certain that there is an elevated stress level since all of these symptoms can be caused by other medical and/or psychological conditions.
It is also known that people under stress have a greater tendency to engage in unhealthy behaviors, such as excessive use or abuse of alcohol and drugs, cigarette smoking, and making poor nutritional choices, than their less-stressed counterparts. These unhealthy behaviors can further increase the severity of symptoms related to stress, often leading to a "vicious cycle" of symptoms and unhealthy behaviors.
The experience of stress is highly individualized. What constitutes overwhelming stress for one person may not be perceived as stress by another. Likewise, the symptoms and signs of poorly managed stress will be different for each person.
Who is most vulnerable to stress?
Stress comes in many forms and affects people of all ages and all walks of life. No external standards can be applied to predict stress levels in individuals -- one need not have a traditionally stressful job to experience workplace stress, just as a parent of one child may experience more parental stress than a parent of several children. The degree of stress in our lives is highly dependent upon individual factors such as our physical health, the quality of our interpersonal relationships, the number of commitments and responsibilities we carry, the degree of others' dependence upon us, expectations of us, the amount of support we receive from others, and the number of changes or traumatic events that have recently occurred in our lives.
Some generalizations, however, can be made. People with adequate social support networks report less stress and overall improved mental health in comparison to those without adequate social contacts. People who are poorly nourished, who get inadequate sleep, or who are physically unwell also have a reduced capacity to handle pressures and stresses of everyday life and may report higher stress levels. Some stressors are particularly associated with certain age groups or life stages. Children, teens, working parents, and seniors are examples of the groups who often face common stressors related to life transitions.
As one example of stress related to a life transition, the teen years often bring about an increase in perceived stress as young adults learn to cope with increasing demands and pressures. Studies have shown that excessive stress during the teen years can have a negative impact upon both physical and mental health later in life. For example, teen stress is a risk factor for the development of depression, a serious condition that carries an increased risk of suicide.
Fortunately, effective stress-management strategies can diminish the ill effects of stress. The presence of intact and strong social support networks among friends, family, and religious or other group affiliations can help reduce the subjective experience of stress during the teen years. Recognition of the problem and helping teens to develop stress-management skills can also be valuable preventive measures. In severe cases, a physician or other health-care provider can recommend treatments or counseling that can reduce the long-term risks of teen stress.
What is the healthy response to stress?A key aspect of a healthy adaptation response to stress is the time course. Responses must be initiated rapidly, maintained for a proper amount of time, and then turned off to ensure an optimal result. An over-response to stress or the failure to shut off a stress response can have negative biological consequences for an individual. Healthy human responses to stress involve three components:
• The brain handles (mediates) the immediate response. This response signals the adrenal medulla to release epinephrine and norepinephrine.
• The hypothalamus (a central area in the brain) and the pituitary gland initiate (trigger) the slower maintenance response by signaling the adrenal cortex to release cortisol and other hormones.
• Many neural (nerve) circuits are involved in the behavioral response. This response increases arousal (alertness, heightened awareness), focuses attention, inhibits feeding and reproductive behavior, reduces pain perception, and redirects behavior.
The combined results of these three components of the stress response maintain the internal balance (homeostasis) and optimize energy production and utilization. They also gear up the organism for a quick reaction through the sympathetic nervous system (SNS). The SNS operates by increasing the heart rate, increasing blood pressure, redirecting blood flow to the heart, muscles, and brain and away from the gastrointestinal tract, and releasing fuel (glucose and fatty acids) to help fight or flee the danger.
How does the response to stress work?While the complete story is not fully known, scientists understand much about how the response to stress works. The two main systems involved are the hypothalamic-pituitary-adrenal (HPA) axis and the SNS. (These systems are described later.) Triggered (activated) primarily by an area in the brain stem (lowest part of brain) called the locus coeruleus, the SNS secretes epinephrine and norepinephrine. The five most important concepts to remember about these two systems are that
1. they are governed by a feedback loop to regulate their response (In a feedback loop, increased amounts of a substance -- for example, a hormone -- inhibit the release of more of that substance, while decreased amounts of the substance stimulate the release of more of that substance.);
2. they interact with each other;
3. they influence other brain systems and functions;
4. genetic (inherited) variability affects the responses of both systems. (That is, depending on their genes, different people can respond differently to similar stresses.);
5. prolonged or overwhelming responses of these systems can be harmful to an individual.
What are the effects of stress on medical and psychological conditions?There is now evidence that points to abnormal stress responses as causing various diseases or conditions. These include anxiety disorders, depression, high blood pressure, and cardiovascular disease, certain gastrointestinal diseases, some cancers, and even the process of aging itself. Stress also seems to increase the frequency and severity of migraine headaches, episodes of asthma, and fluctuations of blood sugar in diabetics. There also is scientific evidence showing that people experiencing psychological stress are more prone to developing colds and other infections than their less-stressed peers. Overwhelming psychological stress (such as the events of 9-11) can cause both temporary (transient) and long-lasting (chronic) symptoms of a serious psychiatric illness called posttraumatic stress disorder (PTSD).
Conclusions about the effects of stress
Uncontrollable, unpredictable, and constant stress has far-reaching consequences on our physical and mental health. Stress can begin in the womb and recur throughout life. One of the pathological (abnormal) consequences of stress is a learned helplessness that leads to the hopelessness and helplessness of clinical depression, but in addition, many illnesses, such as chronic anxiety states, high blood pressure, heart disease, and addictive disorders, to name a few, also seem to be influenced by chronic or overwhelming stress.
Nature, however, has provided us with wonderful processes (mechanisms) to cope with stressors through the HPA axis and the locus coeruleus/sympathetic nervous system. Furthermore, research has shown us the biological processes (mechanisms) that explain what we all intuitively know is true -- which is, that too much stress, particularly when we cannot predict it or control its recurrence, is harmful to our health.
How can we manage stress?If we think about the causes of stress, the nature of the stress response, and the negative effects of some types of stress (prolonged, unexpected, or unmanageable stress), several healthy management strategies become clear. A first step in stress management is exercise. Since the stress response prepares us to fight or flee, our bodies are primed for action. Unfortunately, however, we usually handle our stresses while sitting at our desk, standing at the watercooler, or behind the wheel stuck in traffic. Exercise on a regular basis helps to turn down the production of stress hormones and associated neurochemicals. Thus, exercise can help avoid the damage to our health that prolonged stress can cause. In fact, studies have found that exercise is a potent antidepressant, anxiolytic (combats anxiety), and sleeping aid for many people.
For centuries in Eastern religious traditions, the benefits of meditation and other relaxation techniques have been well known. Now, Western medicine and psychology have rediscovered that particular wisdom, translated it into simple nonspiritual methods and scientifically verified its effectiveness. Thus, one or two 20-30 minute meditation sessions a day can have lasting beneficial effects on health. Indeed, advanced meditators can even significantly control their blood pressure and heart rate as well.
Elimination of drug use and no more than moderate alcohol use are important for the successful management of stress. We know that people, when stressed, seek these outlets, but we also know that many of these substances sensitize (make even more responsive) the stress response. As a result, small problems produce big surges of stress chemicals. What's more, these attempts with drugs and alcohol to mask stress often prevent the person from facing the problem directly. Consequently, they are not able to develop effective ways to cope with or eliminate the stress.
In fact, even prescription drugs for anxiety, such as diazepam (Valium), lorazepam (Ativan), or alprazolam (Xanax), can be counterproductive in the same way. Therefore, these medications should only be used cautiously under the strict guidance of a physician. If, however, stress produces a full-blown psychiatric problem, like posttraumatic stress disorder (PTSD), clinical depression, or anxiety disorders, then psychotropic medications, particularly the selective serotonin reuptake inhibitors (SSRIs), are extremely useful. Examples of SSRIs include sertraline (Zoloft), paroxetine (Paxil), or fluoxetine (Prozac).
We know that chronic or uninterrupted stress is very harmful. It is important, therefore, to take breaks and decompress. Take a lunch break and don't talk about work. Take a walk instead of a coffee break. Use weekends to relax, and don't schedule so many events that Monday morning will seem like a relief. Learn your stress signals. Take regular vacations or even long weekends or mental-health days at intervals that you have learned are right for you.
Create predictability in your work and home life as much as possible. Structure and routine in your life can't prevent the unexpected from happening. However, they can provide a comfortable framework from which to respond to the unexpected. Think ahead and try to anticipate the varieties of possibilities, good and bad, that may become realities at work or home. Generate scenarios and response plans. You may find that the "unexpected" really doesn't always come out of the blue. With this kind of preparation, you can turn stress into a positive force to work for your growth and change.
For those who may need help dealing with stress, stress-management counseling in the form of individual or group therapy is offered by various mental-health-care providers. Stress counseling and group discussion therapy have proven to reduce stress symptoms and improve overall health and attitude.