This is the last blog post in my brief series on stress. Today, we’re going to look at what happens when we do hit stress overload, and a few simple methods that may be able to help you through a tough situation.

One of my favourite shows of all time was Breaking Bad. Breaking Bad told the story of Walter White, a high school chemistry teacher and average family man, who is diagnosed with terminal lung cancer. To support his wife and disabled son after he’s gone, he uses his knowledge of chemistry to launch himself into an underworld career manufacturing crystal meth.

Allostatic overload is the term modern scientists use for stress breaking bad. Stress moves from an agent of growth and change to an agent of disease and death.

In the last few blogs, we discussed that stress is actually more of a positive than a negative. It’s not that stress can’t be bad, because we know from the stress-productivity curve and from the Yerkes-Dodson Law that too much stress overwhelms our capacity to cope with it. The model used to describe the balance of stress on our body is the theory of Allostasis.

Allostasis

All living things maintain a complex dynamic equilibrium – a balancing act of the many different physiological systems that all rely on the other systems working at an optimal range. Imagine trying to stack ten spinning tops on top of each other while trying to keep them spinning. The body does the chemical equivalent of this very difficult combination of balance and dexterity every day. It’s called homeostasis. This balancing act is constantly challenged by internal or external events, termed stressors. Both the amount of stress and amount of time that the stressor is applied is important. When any stressor exceeds a certain threshold (“too strong, or too long”), the adaptive homeostatic systems of the living thing activate responses that compensate.

The theory of allostasis is related to these homeostatic mechanisms, although not just in terms of stress, but broadly to the concept of any change of the optimal range of these homeostatic balancing processes, in response to a change in the environment or life cycle of an organism [1].

McEwen and Wingfield give an example of some bird species, which change their stress response to facilitate their breeding capacity during mating season. They note that the benefit of the increased chance of breeding is important to the bird, but also comes at a cost of increased susceptibility to some diseases because of the weakening of the stress response at the time [1].

When it comes to stress, we adapt in a similar way. A lack of stress, or an excess of a stressor in some way (either too long or too strong) results in adaptation, which is beneficial, but can come at a cost. This is demonstrated by that broadly applicable U-curve, the stress productivity curve.

Chrousos wrote, “The interaction between homeostasis disturbing stressors and stressor activated adaptive responses of the organism can have three potential outcomes. First, the match may be perfect and the organism returns to its basal homeostasis or eustasis; second, the adaptive response may be inappropriate (for example, inadequate, excessive and/or prolonged) and the organism falls into cacostasis; and, third, the match may be perfect and the organism gains from the experience and a new, improved homeostatic capacity is attained, for which I propose the term ‘hyperstasis’.” [2] And as noted by McEwen, “Every system of the body responds to acute challenge with allostasis leading to adaptation.” [3]

More often than not, we adapt to the stressor, either the same as before, or possibly better. It’s only if the response to the stressor is inadequate, excessive and/or prolonged that stress ends up causing us trouble. This is what people normally think of when they think of stress – called allostatic overload – simply stress breaking bad.

Keeping stress in check

To ensure that we keep our stress levels at the optimum to ensure maximum productivity and growth, here are a few simple techniques. Remember, everyone handles stress differently, and so which of these techniques works best for you will be something you’ll have to learn by trying them.

Breathing

The simplest tool is breathing. Sounds a little silly really, since you obviously breathe all of the time! But we usually take shallow breaths, so our lungs are not being used to their full capacity. When we focus on our breathing and deliberately take slow, deep breaths we increase the amount of air going in, and therefore allow more oxygen to enter the blood stream. This better fuels our cells and helps them do their job more efficiently. However, it also sets in motion a physiological mechanism that slows our heart rate.

Our heart pumps blood from our body, through the lungs to get oxygenated. As we take a deep breath, more blood is sucked up into our chest cavity from our veins, because breathing in causes a temporary vacuum in our chest cavity. The extra blood then fills our heart more efficiently. A more efficient heart beat reduces the need for the body to stimulate the heart to pump harder. This promotes more of the parasympathetic “rest-and-digest” nervous system activity, and less of the sympathetic “fight-or-flight” nervous system, via the vagal brake mechanism.

So, to slow your breathing down simply sit in a comfortable position. Take slow, deep breaths, right to the bottom of your lungs and expanding your chest forward through the central “heart” area. Count to five as you breathe in (five seconds, not one to five as quickly as possible) and then count to five as you breathe out. Keep doing this, slowly, deeply and rhythmically, in and out. Pretty simple! This will help to improve the efficiency of your heart and lungs, and reduce your stress levels.

Remember, B.R.E.A.T.H.E. = Breathe Rhythmically Evenly And Through the Heart Everyday.

Meditation

Meditation takes the techniques of breathing one step further, in that meditation involves deliberately switching your brain’s focus to something simple, and in the present. Focussing on nothing – just breathing and turning off your thinking for while – does take some practice. Concentrating on something in the present (not thinking about the past or the future), tends to be easier and requires less practice, although ignoring all the other thoughts that routinely clamour for your attention might be hard when you first try it.

Focusing on the present moment is part of the practice of Mindfulness. Mindfulness meditation has been studied quite extensively over the last few decades, and has been shown to have benefits over a large number of psychological symptoms and disease states [4].

Sometimes it is easier to focus on something visual, that you can see easily in your field of view, or listen to something constant, like the ocean, or a metronome. The easiest thing to do is to again, focus on your breathing. Concentrate on the sound, rhythm and feeling of your breathing, but don’t engage your thoughts, or allow others to creep in. Meditation quietens the mind, which is excellent for reducing stress, and can help to revitalise and refresh your mind.

Guided Imagery

Guided imagery is a step along from meditation. Instead of focussing on something tangible, guided imagery lets you imagine that you are somewhere pleasant, relaxing, or rejuvenating. Some people describe it as a vivid daydream.

Get comfortable, close your eyes and start to breathe slowly and deeply. Once you begin to relax, imagine your favourite scene. It could be at the beach, or in a log cabin in the snow-capped mountains, or swimming in the cool waters in a tropical rain-forest. Whatever you choose, try to imagine the scene in as much detail as possible, and involve all five of your senses if you can, like, for example, the cool water of the waterfall on your bare skin, the sounds of the birds in the trees, the smell of the moss-covered rocks, the canopy of tall trees and vines split by the waterfall and stream allowing the sunlight to spill in to the forest floor. Enjoy the details and the relaxation that this brings. To “come back”, some recommend counting back from ten or twenty, and to tell yourself that when you reach one, you will feel calm and refreshed.

Guided imagery allows you to actively replace the harassing thoughts of your daily routine with pleasant soothing thoughts. There is some early scientific literature suggesting effectiveness, although more research is required [5, 6]. Again, with practice, this can be done anywhere, and can be done quickly if you need a short break to unwind.

Visualisations

Visualisations build on the techniques of guided imagery, but instead of the rain-forest or tropical paradise, you imagine yourself achieving goals, which again could be anything from improving your health, closing that deal, or hitting that perfect drive from the first tee. Again, try and imagine the scene in as much detail as you can, and involve all of your senses.

PMR

Progressive Muscle Relaxation, or PMR for short, is similar to meditation, except that you contract, hold, and then relax your muscle groups in turn. You concentrate on the feel of the tightening and relaxing of the muscles instead of, or as well as, your breathing. Like meditation, it can be done anywhere and involves very little training.

The contraction of the muscle groups, beginning in your feet – working your way up the calves and thighs, tummy, chest, arms and neck, sequentially pumps all of the blood back towards your heart, giving you a boost of blood flow to your lungs. The deep breathing oxygenates this extra blood and hence, gives your brain a burst of oxygen.

Using PMR to meditate helps engage the vagal brake, and there is some evidence that it helps to reduce persistent pain [7, 8].

Exercise

Exercise releases stress and enhances your physical health [9, 10]. It is flexible and easily adaptable – it is usually free and can often be done without any equipment. The downside is that it is not possible everywhere (you can’t go jogging in a plane), but as a daily discipline, it will enhance your physical and emotional wellbeing.

The benefits of exercise are firstly physical. It gets your heart pumping, the blood flowing and your lungs working to their full capacity. It builds physical fitness, which is important to enable the heart and lungs to work efficiently at all times. Exercise has effects on mood, improving depression [11] and anxiety [12].

It can also act as a form of meditation – the solitude of a run or swimming a few laps, concentrating only on the splash of your strokes or the pounding of your feet on the ground – is similar to meditation except that you’re moving (whereas meditation proper involves being still and relaxed). But the outcome is the same, and stress is often reduced by a session of physical exercise.

Music

Music is almost as fundamental to human existance as breathing, and it’s almost as diverse as mankind itself. Listening to ones favourite music can enhance feelings of control and can increase pain tolerance and improve short term anxiety (stress) [13]. The common characteristics of ‘therapeutic’ music was music which had less tonal (pitch) variation, less prominent chord changes, bass lines, or strong melodies [14].

But the key element was personal preference overall, as some of the participants in the study chose music like Metallica. So enjoy music. Make it part of your day. Even Country and Western may be considered therapeutic!

Yoga

Yoga is an ancient practice that has several components including physical postures (asanas), controlled breathing (pranayama), deep relaxation, and meditation.

It’s not for everyone, but it has clearly defined and scientifically validated benefits to your physical and psychological well-being. “It is hypothesized that yoga combines the effects of physical postures, which have been independently associated with mood changes and meditation which increases the levels of Brain-derived neurotrophic factor (BDNF). Other effects that have been noted include increased vagal tone, increased gamma-amino butyric acid (GABA) levels, increase in serum prolactin, downregulation of the hypothalamic-pituitary-adrenal axis and decrease in serum cortisol, and promotion of frontal electroencephalogram (EEG) alpha wave activity which improves relaxation.” [15] So, translated: Yoga is good for stress relief!

Most gyms and community centres will have yoga instructors, so go ahead and make some enquiries.

Massage

I love massage! The first time I had a proper massage was in the small city of Launceston in the tiny Australian state of Tasmania. After just 30 minutes of the therapist kneading my muscles with her fingers of iron, I felt pretty good, but when I sat up, I was actually light-headed for a little while. My heart rate and blood pressure had reduced so much that it took me a while before I could stand up properly!

Deep pressure massage has also been shown to help release the vagal brake enhancing the activity of the parasympathetic (rest-and-digest) part of the autonomic nervous system. There is good evidence of this effect in pre-term infants [16]. The evidence for adults isn’t so strong, although that’s probably because of a lack of quality research [17]. The good studies that have been done show a reduction of cortisol, blood pressure and heart rate after massage, with some studies showing small persistent effects [17].

The data might be thin, but there is enough evidence to make it worth trying at least once.

Probiotics

I add probiotics to this list as a reference for the future. There is good evidence of the anxiolytic effect of having a friendly bacteria garden in your intestines that interacts with your gut and your immune system in positive ways. But there is, at this point, very little in the way of good quality human clinical trials. And we still don’t know exactly which strains of probiotics are the most helpful for different conditions [18, 19]. But given that they are unlikely to be harmful, it may be worth trailing a course of probiotics, and see how you feel in 30 days.

The bottom line – stress is not the enemy. Sure, if it isn’t handled right, stress can overwhelm us and make us sick, but most of the time, stress makes us productive and strong, and helps us to grow. So, don’t stress about stress.

References

1. McEwen, B.S. and Wingfield, J.C., What is in a name? Integrating homeostasis, allostasis and stress. Horm Behav, 2010. 57(2): 105-11 doi: 10.1016/j.yhbeh.2009.09.011
2. Chrousos, G.P., Stress and disorders of the stress system. Nat Rev Endocrinol, 2009. 5(7): 374-81 doi: 10.1038/nrendo.2009.106
3. McEwen, B.S., Stressed or stressed out: what is the difference? J Psychiatry Neurosci, 2005. 30(5): 315-8 http://www.ncbi.nlm.nih.gov/pubmed/16151535
4. Keng, S.L., et al., Effects of mindfulness on psychological health: a review of empirical studies. Clin Psychol Rev, 2011. 31(6): 1041-56 doi: 10.1016/j.cpr.2011.04.006
5. Jallo, N., et al., The biobehavioral effects of relaxation guided imagery on maternal stress. Adv Mind Body Med, 2009. 24(4): 12-22 http://www.ncbi.nlm.nih.gov/pubmed/20671330
6. Trakhtenberg, E.C., The effects of guided imagery on the immune system: a critical review. Int J Neurosci, 2008. 118(6): 839-55 doi: 10.1080/00207450701792705
7. Baird, C.L. and Sands, L., A pilot study of the effectiveness of guided imagery with progressive muscle relaxation to reduce chronic pain and mobility difficulties of osteoarthritis. Pain Manag Nurs, 2004. 5(3): 97-104 doi: 10.1016/j.pmn.2004.01.003
8. Morone, N.E. and Greco, C.M., Mind-body interventions for chronic pain in older adults: a structured review. Pain Med, 2007. 8(4): 359-75 doi: 10.1111/j.1526-4637.2007.00312.x
9. Fletcher, G.F., et al., Statement on exercise: benefits and recommendations for physical activity programs for all Americans. A statement for health professionals by the Committee on Exercise and Cardiac Rehabilitation of the Council on Clinical Cardiology, American Heart Association. Circulation, 1996. 94(4): 857-62 http://www.ncbi.nlm.nih.gov/pubmed/8772712
10. Warburton, D.E., et al., Health benefits of physical activity: the evidence. CMAJ, 2006. 174(6): 801-9 doi: 10.1503/cmaj.051351
11. Rimer, J., et al., Exercise for depression. Cochrane Database Syst Rev, 2012. 7: CD004366 doi: 10.1002/14651858.CD004366.pub5
12. DeBoer, L.B., et al., Exploring exercise as an avenue for the treatment of anxiety disorders. Expert Rev Neurother, 2012. 12(8): 1011-22 doi: 10.1586/ern.12.73
13. MacDonald, R.A., Music, health, and well-being: a review. Int J Qual Stud Health Well-being, 2013. 8: 20635 doi: 10.3402/qhw.v8i0.20635
14. Knox, D., et al., Acoustic analysis and mood classification of pain-relieving music. J Acoust Soc Am, 2011. 130(3): 1673-82 doi: 10.1121/1.3621029
15. Balasubramaniam, M., et al., Yoga on our minds: a systematic review of yoga for neuropsychiatric disorders. Front Psychiatry, 2012. 3: 117 doi: 10.3389/fpsyt.2012.00117
16. Field, T., et al., Preterm infant massage therapy research: a review. Infant Behav Dev, 2010. 33(2): 115-24 doi: 10.1016/j.infbeh.2009.12.004
17. Moraska, A., et al., Physiological adjustments to stress measures following massage therapy: a review of the literature. Evid Based Complement Alternat Med, 2010. 7(4): 409-18 doi: 10.1093/ecam/nen029
18. Bested, A.C., et al., Intestinal microbiota, probiotics and mental health: from Metchnikoff to modern advances: Part II – contemporary contextual research. Gut Pathog, 2013. 5(1): 3 doi: 10.1186/1757-4749-5-3
19. Bested, A.C., et al., Intestinal microbiota, probiotics and mental health: from Metchnikoff to modern advances: part III – convergence toward clinical trials. Gut Pathog, 2013. 5(1): 4 doi: 10.1186/1757-4749-5-4