What is Stress?
We can all recognize the onset of stress: the quickend pulse, the surge in blood pressure or shortness of breath are physical symptoms of stress.
A close brush with danger can trigger it, and so can a looming presentation at work, a job interview or a money-related problem.
The world "stress" was first used by Selye in 1956 to express the consequences of an alteration of the inner balance of our bodies (known as homeostasis). The factors that upset this balance are known as "stressors", and can be anything from an external stimulus, a biological agent, an environmental condition (heat, cold, noise, strong lights, overcrowding, aggression, etc.)
When we are subjected to stressors our bodies react with a "stress response" to regain our balance.
Selye also noticed that exposure to prolonged stress led to disease.
Schneiderman, Ironson and Siegel (2008) ( 4 ) point out several stressors and stressful life events that can affect us severely and harm our health by causing anxiety and then depression, which in turn can provoke illness:
- People admitted for psychiatric treatment due to depression had a higher proportion of recent divorcees, unemployed and suicide of relatives than in a control group.
- Being diagnosed a major medical illness (strong stressor) is accompanied by high rates of depression
Trauma also leads to stresss; roughly 40 to 70% of Americans have been exposed to traumatic events and around 13% of adult women in the US have been exposed to sexual assault (4).
This type of trauma in 25% of the cases leads to Post Traumatic Stress Disorder or PTSD. Although most people recover from traumatic events without developing PTSD.
Stress also leads to harmful behaviors such as heavy smoking, eating disorders, substance abuse, alcoholism, sleep problems and higher rates of accidents. (4)
Communities with high divorce rates or that have experienced natural disasters or job loss due to business closures have higher rates of smoking (and lung cancer).
The biochemistry of Stress
Human beings evolved in a world structured on predators and prey. Our ancestors were at one time in the distant dawn of mankind, defenseless four-foot tall biped apes with a tiny brain, no tools, claws or fangs. Survival depended on our ability to act quickly and physically: to flee or stay put and fight.
Evolution has fine tuned the body to react when it feels threatened. This reaction is called Stress.
A percevied threat causes stress, which in turn sets in motion a chain of phsyiological and psychological responses that prepare it to react to danger.
In the past the presence of a lion or a hyena on the African savannah elicited the fight-or-flight response, so stress was a very useful survival tool.
But nowadays, the threats or harmful events that we perceive as dangerous are more mundane, but no less lethal: deadlines, pressure at work, a looming presentation or a midterm exam.
These banal modern threats are lethal because chronic stress they provoke can cause serious health conditions in those that experience it.
The stress response prepares the body to deal with a threat (in the past these were physical), so the nervous system which senses the threat sends signals along the nerves that cause the adrenal glands to release adrenaline and noradrenaline.
These increase heart rate, blood pressure, glucose release and breating rate (which is quite logical, you need to move oxygen and nutrients very quickly within your body if you intend to outrun a predator or fight it).
Blood flow is shifted from the skin to the brain, legs, arms and muscles. Causing you to turn pale (your face may flush due to the blood surging towards your brain).
Blood clotting factors increase (in case you suffer injuries), to reduce blood loss.
Pupils dilate to improve vision of your surroundings.
Muscles tense as they gear up for action, this may result in trembling.
Once the threat has passed, the body unwinds, a process which takes from 20 to 60 minutes.
The whole process is involuntary, you cannot control it. Even psychological fears (fobias) such as the fear of flying or of heights can trigger a stress response.
Stress is not necessarily harmful. Some stimuli can provoke a strong stress response and not provoke side effects, other situations can exceed the individual's ability to adapt to them and change. This causes continued stress and this can have consequences on the individual's health.
Stresss and health
If the brain continues sensing stress, a second mechanism kicks in inside the brain causing it to release hormones which in turn release glucocorticoids (GCs).
GCs interact with receptors located in the body's organs and tissues (such as nerves, immune cells and the brain itself) and unleashes a series of continued stress response events.
During chronic stress the GCs damping mechanism (which inhibits it, once the threat has been dealt with) does not work. The receptors of GCs become saturated and their response continues unabated.
The effects are devastating and cause long-term damage to organs, tissues and the immune system.
Effects of chronic stress on brain structure
According to Mariotti, (2015) ( 3 ) "chronic stress is linked to macroscopic changes in certain brain areas, consisting of volume variations and physical modifications of neuronal networks", this impairs our cognitive abilities.
Stress also stimulates the immune system to prepare itself to prevent damage, protect and repair it. This in turn releases cytokines which provoke inflammation. White blood cell count also surges.
Chronic stress leads to chronic inflammation and the following diseases have been linked to both: "cardiovascular dysfunctions, diabetes, cancer, autoimmune syndromes and mental illnesses such as depression and anxiety disorders". (3)
Stress related neurochemicals and high levels of cytokines in the brain cause damage to its strucuture and neuronal death (3).
The increased blood pressure triggered by stress becomes chronic and this forces the heart to pump harder and provokes an enlargment of its left ventricle, in the long run this causes plaque formation and damages the arteries.
Depression and Fatigue
The excess of cytokines is linked to a condition known as chronic stress-associated depression. Cytokines induce the body to save energy so that it can be used to react quickly during the threat and later hasten recovery from any wounds.
In the modern world, the cytokine induced energy-saving mode causes the individual to feel tired, fatigued, to suffer alterations in mood and mental abilities. Stressed out people become socially isolated.
Furhtermore stress causes the "the oxidation of tryptophan (a precursor of serotonin) to Kynurenin (Kyn) ... [which] affects the brain levels of serotonin and thus serotonergic transmission and its mood and behavioral effects, but it is also responsible for the production of tryptophan metabolites that have neuroinflammatory properties..." (3).
Serotonin is a neurochemical which helps reduce anxiety, depression and controls sleep, blood and bone health an libido.
So stress reduces serotonin increasing anxiety and depression furthermore the tryptophan by products inflame the neurons. A very unhealthy cocktail indeed.
Exercise against stress & Depression
However "physical exercise can sustain brain health by regulating the production of neurotrophic factors, neurotransmitters, as well as inflammatory molecules..." (3) this is because muscle contractions during exercise favor some biochemical reactions that reduce the amount of Kyn circulating in the body allowing for serotonin recovery.
Marioti (3) concludes that: "This suggests that programs of physical exercise should be formally proposed as a preventive measure to people known to be exposed to intense stress (eg., work-related stress), and could be prescribed as a form of therapy in combination with other treatments to ease mood and cognitive deficits caused by chronic stress.".
Take home point
Stress can also be managed with physical activity.
Stress in the elderly group
Vulnerable groups such as the elederly population suffer severe health consequences due to stress.
Chételat et al (2018), ( 2 ) point out that stress, depression and anxiety can "affect sleep, cognition and mental health and well-being in aging populations and [are] associated with increased risk for Alzheimer's disease".
Half older adults have sleep disturbances and 10 to 15% suffer from depression, furthermore, according to Chételat "each depressive symptom increases dementia risk by approximately 20%".
Stress, worry, anxiety all contribute to sleep disturbances, affect mental wellbeing, promote cognitive decline and alter the brain structure and function.
Aging leads to a gradual loss of immune function and stress makes this effect even worse because it reduces the ability of older adults to produce antibodies after being vaccinated or while fighting off a viral infection. They fall prey to the flu (even after getting their influenza shots) or infection in higher rates, which are a major cause of mortality in the elder population. (4)
It is crucial to target these pshyco-affective traits by non-pharmacological means to improve the overall wellbeing of elderly adults.
Managing Stress through Meditation and Relaxation
Many people use meditation to counteract stress and its nasty side effects, others use it to promote overall health and wellbeing. And some people use relaxation and meditation as sinonyms, but they are not the same thing. They are different:
Although Meditation is a form of relaxing, the opposite isn't true: relaxation is not mediation. Let's see what are these differences.
Relaxation is handling stress, letting it go, unwinding, uncoiling the springs that stress builds up inside of us. It is about reducing anxieties and releasing tension.
Relaxation is the absence of arousal provoked by anger, anxiety or fear, it is a state of low tension.
In fact relaxation is the opposite mechanism to the stress-response; it is the quieting of the body, it is the relaxation-response.
Under normal conditions, the stress-response mechanism halts after some 20 to 60 minutes and the body gradually returns to its normal state, and this is because the parasympathetic autonomous nervous system unwinds the body's fight-flight response (slowing heart beat, reducing blood pressure and breathing rate).
However under chronic stress situations relaxation can be quite difficult to achieve.
This relaxation response can be evoked using relaxation techniques such as these:
Autogenic (or "self generated" technique is a kind of "auto hypnosis" and involves concentrating passively on the physical sensations (warmth, relaxation, heaviness) of different parts of the body while the subject repeats certain phrases such as "My legs are warm. My right leg is warm. My left leg is warm. Both of my legs are warm" and "My heartbeat is calm and regular", "My breathing is calm and regular".
The setting should be a calm one and the subject can either sit or lie down and breathe deeply and slowly.
Progressive muscle relaxation (PMR)
Devised by Jacobson (1938) and Wolpe & Lazarus (1966), it is based on the theory that two opposing nervous system circuits (the sympathetic and the parasympathetic autonomous systems) are associated with anxiety and relaxation. While the sympathetic system kicks in during stress (anxiety), the other one is responsible for relaxation.
So by deliberately applying relaxation on the body, one could overcome the tension caused by stress and be able to relax.
The technique involves tensing and releasing different muscle groups in sequence and this relaxes the body. The subjects observe the sensations of the tension felt in each muscle and also the effect caused by releasing this tension, and this monitoring of tension-relaxation cycles provokes a quick drop of muscular tension, promoting the parasympathetic system to kick in and reduce stress.
As described by Hayes-Skelton and Roemer (2013) ( 6 ), this is a self-monitoring technique. The subjects must pay attention to situations which provoke anxiety and record them and their reaction to these stressors. The outcome is that they learn how to distinguish the different components (emotional, intellectual, physiological) and their behavior when faced with them. AR, this is primarily accomplished through self-monitoring activities. Clients are asked to pay attention to and record situations in which they experience anxiety as well as their reactions to these situations throughout the week. They learn to distinguish between cognitive, affective, physiological, and behavioral cues during this process of monitoring.
To this monitoring, PMR is added to achieve a state of relaxation.
So it involves an active interaction to learn how to cope with the stressors and identify them as well as releasing stress via PMR.
Relaxation is effective for treating anxiety
Manzioni et al., (2008) ( 8 ) analyzed a series of studies that spanned a ten-year period to see if relaxation was an effective treatment for anxiety problems. They found that it was: "relaxation training showed a medium-large effect size in the treatment of anxiety".
Meditation on the other hand focuses the individual's attention and awareness in order to achieve mental clarity and place mental processes under control. This in turn results in a state of peace and calm. Clarity and concentration.
Although meditation is often considered to be a form of relaxation, it not only provokes a relaxation response; it also produces an altered state of consciousness. And it is this enhanced awareness is what distinguishes meditation from relaxation.
The Enlgish word comes from the Latin "meditatio" the act of contemplation, pondering or thinking.
It has been practiced for thousands of years and has formed part of religious beliefs and cultural traditions (such as dhyana among Yogis).
There are different meditation techniques and some are also coupled with dietary or physical exercise therapies such as ayurveda or yoga schools in India
Meditation focuses on "mindfulness", "concentration" and "automatic self-trascendence", and achieve this through different techniques such as the use of a mantra in trascendental meditation or the present-focused awareness of "mindfulness".
According to Hari Sharma (2015) ( 7 ), the goal of meditation is to "connect oneself to one's deep inner Self", and there are a variety of techniques to do so which work at different levels: mind, emotions, senses, intellect.
Some techniques, some involve nature sounds (ocean, wave, birds) others involve exercise, as is the case with tai chi, Yoga and Mantra. They also include contemplation, concentration, and guided meditation. (7)
Is Meditation effective in managing stress?
Yes and No and Maybe... read why below:
Madhav Goyal, et al., (2014) ( 1 ) performed a meta-analysis (a statistical study that combines information from different studies and tests) involving 47 trials with 3,320 participants trying to find evidence about the health benefits of mediation. They reached the following conclusions:
- Moderate evidence that Mindfulness meditation programs improved anxiety, pain and depression.
- The effects although small were "comparable with what would be expected from the use of an antidepressant... without the associated toxicities"
- Low evidence that it "improve[s] stress ⁄ distress and mental health-related quality of life".
- Low or insufficient evidence or no effect of any effect of "meditation programs on positive mood, attention, substance use, eating, sleep, and weight".
- No evidence that "meditation programs were better than any active treatment (drugs, exercise, other behavioral therapies)".
Manzioni et al., (2008) (8) support this: thet reported that meditation had a higher "efficacy" in treating anxiety when compared to mere relaxation techniques. Meditation by itself or combined with cognitive therapy as is the case of Mindfulness Based Cognitive Therapy (MBCT) during an "8-week course for patients with recurrent depression or recurrent depression and anxiety, [resulted in] a great average reduction of anxiety, as well as depression.
Take home point
Meditation can handle pain, anxiety band depression as well as medication without the toxic side-effects.
Meditation programs are not more effective than exercise, cognitive-behavioral group therapy, progressive muscle relaxation in changing mood, substance abuse, weight, insomnia, etc.
Meditation could prevent brain function decline with age
A study by Chételat et al (2018), ( 2 ) involving older subjects (it compared brain structure and blood sugar in six senior expert meditators and 67 normal persons taken as control subjects) found that:
- "gray matter volume and ⁄ or glucose metabolism was higher" in the meditator group.
- "suggest[ing] that long-term meditation practice might help preserve brain structure and function from progressive age-related decline".
Trascendental Meditation benefits
Walton, Schneider and Nidich (2004) ( 5 ) describe the benefits of Trascendental Meditation or TM, which is based on the ancient Vedic traditions of India: it had a significantly greater impact on stress reduction and anxiety than the other types of meditation, PMR or other relaxation techniques.
TM also has positive effects on psychologic health indicators which are also greater than that of other forms of meditation and relaxation techniques.
This is a technique which is in currently in vogue, though it has ancient roots in Buddhism and has been applied in psychological therapy since the 1970s.
A good definition is the one given by Zabbat-Zinn: mindfullness the awareness that arises through "paying attention in a particular way: on purpose, in the present moment, and nonjudgmentally".
This requires an attitude of curiosity and acceptance, but not passive acceptance or resignation; in mindfulness acceptance means the abilty to experience things fully.
Keng, Smoski and Robinsa (2011) ( 9 ) look into mindfulness and its effects and concluded that "mindfulness brings about various positive psychological effects, including increased subjective well-being, reduced psychological symptoms and emotional reactivity, and improved behavioral regulation."
When stress becomes a daily issue and we can't adapt to the threats we sense in our surroundings, it can cause serious health issues, from impairing our brain functions to reducing our immune system's abilities to fight off infections. Chronic inflammation unleashed by chronic stress can provoke heart disease, diabetes and even cancer.
Quality of life decreases with the fatigue, lack of sleep, depression and anxiety caused by the biochemical sequels of chronic stress.
In older persons it can lead to dementia.
Meditation techniques and relaxing (plus the help of physical exercise) can, together with other therapies help control stress, anxiety and even depression without the need for medication.
Cite this article:
A. Whittall. ©2018. Relaxation and Meditation. Patagonia Wellness, Oct. 24 2018. http://www.patagoniawellness.com/wellness/relaxation.html
Subject: Meditation and Relaxation: tools to help us manage stress, keep it from becoming chronic and preventing its negative health effects.
References and Further Reading
(1) Goyal M., et al., (2014). Meditation Programs for Psychological Stress and Well-being: A Systematic Review and Meta-analysis. JAMA Intern Med. 2014 Mar; 174(3): 357-368. doi: 10.1001/jamainternmed.2013.13018
(2) Gaël Chételat et al (2018). Why could meditation practice help promote mental health and well-being in aging?. Alzheimers Res Ther. 2018; 10: 57. 2018 Jun 22. doi: 10.1186/s13195-018-0388-5
(3) Mariotti (2015). The effects of chronic stress on health: new insights into the molecular mechanisms of brain-body communication. Future Sci OA. 2015 Nov; 1(3): FSO23. 2015 Nov 1. doi: 10.4155/fso.15.21
(4) N. Schneiderman, G. Ironson, and S. Siegel, (2005). Stress and Health: Psychological, Behavioral, and Biological Determinants. Annu Rev Clin Psychol. 2005; 1: 607-628. doi: [10.1146/annurev.clinpsy.1.102803.144141]
(5) K. Walton, R. Schneider and S. Nidich, (2004). Review of Controlled Research on the Transcendental Meditation Program and Cardiovascular Disease Risk Factors, Morbidity, and Mortality. Cardiol Rev. 2004; 12(5): 262-266. doi: [10.1097/01.crd.0000113021.96119.78]
(6) S. Hayes-Skelton and L. Roemer, (2013). A Contemporary View of Applied Relaxation for Generalized Anxiety Disorder. Cogn Behav Ther. 2013 Dec; 42(4): 10.1080/16506073.2013.777106
(7) Hari Sharma (2015). Meditation: Process and effects. Ayu. 2015 Jul-Sep; 36(3): 233-237. doi: [10.4103/0974-8520.182756]
(8) G. Manzoni, F. Pagnini, G. Castelnuovo and E. Molinari, (2008). Relaxation training for anxiety: a ten-years systematic review with meta-analysis. BMC Psychiatry. 2008; 8: 41. 2008 Jun 2. doi: [10.1186/1471-244X-8-41]
(9) S. Keng, M. Smoski and C. Robinsa, (2011) . Effects of Mindfulness on Psychological Health: A Review of Empirical Studies. Clin Psychol Rev. 2011 Aug; 31(6): 1041-1056. 2011 May 13. doi: [10.1016/j.cpr.2011.04.006]