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The Prospering Soul – Christians and Anxiety

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When you say the word “anxiety”, it can mean different things to different people. To a lot of people, anxiety is the same as being a little frightened. To others, it’s being really scared, but with good reason (like if you have to give a speech and you’re afraid of public speaking).

Medically speaking, anxiety isn’t just being frightened or stressed. After all, it’s normal to be frightened or stressed. God made us so that we could experience fear, because a little bit of fear is actually protective. There are dangers all around us, and if we had no fear at all, we’d end up becoming lunch for a wild animal, or road-kill. So there’s nothing wrong with a little bit of anxiety – in the right amount, for the right reason.

But anxiety in the wrong amount or for the wrong reason, can disrupt our day-to-day tasks and make it hard to live a rich and fulfilling life. That’s the anxiety that we’ll be talking about today.

The official description of anxiety reflects this idea of the wrong amount of anxiety about the wrong things: “… marked symptoms of anxiety accompanied by either general apprehension (i.e. ‘free-floating anxiety’) or worry focused on multiple everyday events, most often concerning family, health, finances, and school or work, together with additional symptoms such as muscular tension or motor restlessness, sympathetic autonomic over-activity, subjective experience of nervousness, difficulty maintaining concentration, irritability, or sleep disturbance. The symptoms are present more days than not for at least several months and result in significant distress or significant impairment in personal, family, social, educational, occupational, or other important areas of functioning.” (This is taken from the beta-version of the latest WHO diagnostic guidelines, the ICD-11, but has yet to be formally ratified).

There are six main disorders that come under the “anxiety disorders” umbrella, reflecting either an abnormal focus of anxiety or an abnormal intensity:
1. Panic Disorder (abnormally intense anxiety episodes)
2. Social Anxiety Disorder (abnormal anxiety of social interactions)
3. Post-traumatic Stress Disorder (abnormally intense episodes of anxiety following trauma)
4. Obsessive-Compulsive Disorder (abnormally intense and abnormally focussed anxiety resulting in compulsive behaviours)
5. Specific phobias (abnormally focussed anxiety on one particular trigger), and
6. Generalised Anxiety Disorder (abnormal anxiety of everything)

The common underlying theme of anxiety is uncertainty. Grupe and Nitschke wrote, “Anxiety is a future-orientated emotion, and anticipating or ‘pre-viewing’ the future induces anxiety largely because the future is intrinsically uncertain.” [1]

The dysfunctional approach to uncertainty that underlies anxiety is in turn related to genetic changes which affect the structure and function of the brain, primarily in the regions of the amygdala and the pre-frontal cortex, which then alters the processing of our brain in five different areas:
> Inflated estimates of threat cost and probability
> Hypervigilance
> Deficient safety learning
> Behavioural and cognitive avoidance
> Heightened reactivity to threat uncertainty

In simpler language:
> the brain thinks that threats are more likely and will be worse than they are
> the brain spends more time looking for possible threats
> the brain fails to learn what conditions are safe, which is aggravated by
> the brain over-using avoidance as a coping mechanism, and
> the brain assumes that unavoidable uncertainty is more likely to be bad.

It’s important to understand at this point that anxiety disorders aren’t the result of poor personal choices. They are the result of a genetic predisposition to increased vulnerability to early life stress, and to chronic stress [2].

The other way of looking at it is that some people are blessed with amazing tools for resilience [3, 4].

It’s not to say that our choices have no impact at all, but we need to be realistic about this. Everyone will experience stressful situations at some point in their lives, and everyone will also make dumb choices in their lives. Some people are naturally better equipped to handle this, whereas some people have genes that make them more vulnerable. It’s wrong to blame yourself, or allow other people to blame you, for experiencing anxiety, just as it’s wrong for other people to assume that if one person can cope with the same level of stress, then everyone else should too.

It’s not to say that you shouldn’t fight back though. Just because your facing a mountain doesn’t mean to say you can’t climb it. It will be hard work, and you’ll need good training and support, but you can still climb that mountain.

Managing anxiety is very similar to managing depression like we discussed in a previous post. Following the tap model, there’s overflow when there is too much going into the system, the system is too small to handle it, and the processing of the input is too slow. So managing anxiety involves reducing the amount of stress going into the system, increasing the systems capacity through learning resilience and coping skills, and sometimes by improving the systems processing power with medications.

Reducing the input – stress management

Sometimes the best way of coping with anxiety is to reduce the stress that’s fanning the flames. It mightn’t seem to come naturally, but as we discussed in the last chapter, there are a few basic skills that are common to all stress management techniques that can form the platform of ongoing better skills in this area.

Engaging the “vagal brake” as proposed by the “Polyvagal Theory” [5] is as important in anxiety as it is in depression. By performing these techniques, the activity of the vagus nerve on the heart via the parasympathetic “rest-and-digest” nervous system is increased, which not only slows down the heart, but enhances the activity of other automatic parts of our metabolism. Some of the techniques allow a relaxed body to have a relaxed brain which can cope better with whatever is confronting it. The full list will be a blog for another time, but the simplest technique is to breathe!

It’s really simple. 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.

Increasing capacity – coping and resilience

Like with depression, anxiety responds well to psychological therapies which help to increase coping skills and enhance our innate capacity for resilience. And like depression, anxiety improves with CBT and ACT [6, 7], which enhance the activity of the pre-frontal regions of the brain [8]. For anxiety, CBT teaches new skills to handle uncertain situations, and to re-evaluate the chances of bad things happening and what would happen if they do. ACT puts the train of anxious thoughts and feelings in their place, and teaches engagement with the present moment, and a future focusing on values, and accepting the discomfort of uncertainty by removing the distress associated with it.

Practicing each of these skill sets is like practicing any other skill. Eventually, with enough practice, they start to become more like a reflex, and we start to cope with stress and anxiety better automatically.

Increased processing – Medications

Sometimes, to achieve long-term successful management of anxiety, a little extras help is needed in the form of medication. Like depression, the main group of medications used are the Selective Serotonin Reuptake Inhibitors (or SSRI’s for short). Medications appear to reduce the over-activity of a number of brain regions collectively called the limbic system [8], which are involved with many innate and automatic functions, but in its simplest form, the limbic system controls many of our emotions and motivations, including fear, anger and certain aspects of pleasure-seeking [9]. So essentially, SSRI’s help the anxious brain to make better sense of the incoming signals.

There are other medications commonly used for anxiety treatment, collectively called benzodiazepines. Most people wouldn’t have heard that term before, but would have heard of the most famous member of the benzo family, Valium. Benzos are like having a bit too much alcohol – they slow down the activity of the brain, and induce a feeling of relaxation. When used appropriately (i.e.: in low doses and in the short term), they can be helpful in taking the edge off quite distressing feelings of anxiety or panic. But benzos are not a cure, and after a while, the body builds a tolerance to them, where a higher dose is required to achieve the same effect. Continued long term use eventually creates dependence where a person finds it difficult to cope without them.

The final way to help manage anxiety is prayer. Like for depression, there is limited scientific information on the effects of prayer on, although a small randomised controlled trial did show that prayer with a prayer counsellor over a period of a number of weeks was more effective than no treatment [10].

Though given that anxiety is a future orientated emotion, excessively anticipating possible unwelcome scenarios and consequences, it’s easy to see why prayer should work well for anxiety. Trusting that God has the future in hand and knowing “that in all things God works for the good of those who love him, who have been called according to his purpose” (Romans 8:28) means that the future is less uncertain. The Bible also encourages us, “Do not be anxious about anything, but in every situation, by prayer and petition, with thanksgiving, present your requests to God. And the peace of God, which transcends all understanding, will guard your hearts and your minds in Christ Jesus.” (Philippians 4:6-7) When we give the future to God, he will give us peace in return.

Again, like in the case of depression, it’s sometimes hard for Christians to understand how strong Christians can suffer from anxiety in the first place. After all, we’ve just read how God gives us peace. And the Bible says that the fruit of the Spirit is peace (Galatians 5:22).

So when you’re filled with the opposite, when all you feel is overwhelming fear, it makes you feel like a faithless failure. Christians without anxiety assume that Christians with anxiety aren’t living in the Spirit. And it’s the logical conclusion to draw after all – if the fruit of the Spirit is peace, and you’re not filled with peace, then you mustn’t be full of the Spirit.

But like depression, when you look through the greatest heroes in the Bible, you see a pattern where at one point or another in their lives, they went through physical and emotional destitution, including mind-numbing fear … Moses argued with God about how weak and timid he was (Exodus 3 and 4), Elijah ran for his life in panic and asked God to kill him, twice, over the period of a couple of months after Queen Jezebel threatened him (1 Kings 18 and 19). Peter had spent three years with Jesus, the Messiah himself, hearing him speak and watching him perform miracle after miracle after miracle. But Peter denied his Messiah three times when he was confronted with possible arrest (John 18).

For the same pattern is also seen in King David, Gideon, and a number of other great leaders through the Bible. The take home message is this: it’s human nature to suffer from disease and dysfunction. Sometimes it’s physical dysfunction. Sometimes it’s emotional dysfunction. It’s not a personal or spiritual failure to have a physical illness. Why should mental illness be treated any different?

As the stories of Moses, Elijah and Peter testify, being a strong Christian doesn’t make you impervious to fear and anxiety. Hey, we’re all broken in some way, otherwise why would we need God’s strength and salvation? Having anxiety simply changes your capacity to experience God’s peace. As I said in the last chapter, closing your eyes doesn’t stop the light, it just stops you experiencing the light. Being anxious doesn’t stop God’s peace, it just makes it harder to experience God’s peace.

In summary some anxiety, at the right time and at the right intensity, is normal. It’s not unhealthy or sinful to experience some anxiety. Anxiety at the wrong time or at the wrong intensity, can disrupt our day-to-day tasks and make it hard to live a rich and fulfilling life. Anxiety related to a dysfunctional approach to uncertainty, and is a future-orientated emotion because anticipating or ‘pre-viewing’ the future induces anxiety largely because the future is intrinsically uncertain. Anxiety disorders can be debilitating.

Like depression, anxiety disorders can be managed in four main ways, by reducing the amount of stress coming in with stress management techniques, by increasing capacity to cope with psychological therapies like CBT and ACT, and sometimes by using medications, which help the brain to process the uncertainty of each situation more effectively. Prayer is can also useful to helping to manage anxiety.

Christians are not immune from anxiety disorders, and it’s important for the church to understand that Christians who suffer from anxiety are not weak, backsliding or faith-deficient. Having anxiety is not because of making poor choices. Though if you have anxiety, trust in the promises of the Bible, that God has the future under control.

References

[1]        Grupe DW, Nitschke JB. Uncertainty and anticipation in anxiety: an integrated neurobiological and psychological perspective. Nature reviews Neuroscience 2013 Jul;14(7):488-501.
[2]        Duman EA, Canli T. Influence of life stress, 5-HTTLPR genotype, and SLC6A4 methylation on gene expression and stress response in healthy Caucasian males. Biol Mood Anxiety Disord 2015;5:2.
[3]        Wu G, Feder A, Cohen H, et al. Understanding resilience. Frontiers in behavioral neuroscience 2013;7:10.
[4]        Russo SJ, Murrough JW, Han M-H, Charney DS, Nestler EJ. Neurobiology of resilience. Nature neuroscience 2012 November;15(11):1475-84.
[5]        Porges SW. The polyvagal perspective. Biological psychology 2007 Feb;74(2):116-43.
[6]        James AC, James G, Cowdrey FA, Soler A, Choke A. Cognitive behavioural therapy for anxiety disorders in children and adolescents. The Cochrane database of systematic reviews 2013;6:CD004690.
[7]        Swain J, Hancock K, Hainsworth C, Bowman J. Acceptance and commitment therapy in the treatment of anxiety: a systematic review. Clinical psychology review 2013 Dec;33(8):965-78.
[8]        Quide Y, Witteveen AB, El-Hage W, Veltman DJ, Olff M. Differences between effects of psychological versus pharmacological treatments on functional and morphological brain alterations in anxiety disorders and major depressive disorder: a systematic review. Neuroscience and biobehavioral reviews 2012 Jan;36(1):626-44.
[9]        Sokolowski K, Corbin JG. Wired for behaviors: from development to function of innate limbic system circuitry. Frontiers in molecular neuroscience 2012;5:55.
[10]      Boelens PA, Reeves RR, Replogle WH, Koenig HG. A randomized trial of the effect of prayer on depression and anxiety. Int J Psychiatry Med 2009;39(4):377-92.

If you’re suffering from anxiety or any other mental health difficulties and if you want help, see your GP or a psychologist, or if you’re in Australia, 24 hour telephone counselling is available through:

 Lifeline = 13 11 14 – or – Beyond Blue = 1300 22 4636

The Prospering Soul – Christians and Depression Part 2

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For most church-goers, putting the terms “Christian” and “depression” in the same sentence just doesn’t seem natural. In part 1, we looked at what depression is and why depression affects a lot more of the church than the church is aware of.

In this instalment, we’ll look at some general ways to handle depression, and what the Bible says about being depressed.

In the first blog, I explained how I understood depression as the end result of the brains capacity to deal with the demands of life. Too many demands or not enough resources overwhelms the brain and low mood is the end result.

So how do you manage depression? Well, if the system is failing because of increased demand or decreased capacity to cope, then it’s logical to manage depression by decreasing demand and increasing capacity to cope.

We can increase our capacity to cope by increasing our brains capacity to grow new nerve branches, and to make the cells more efficient at doing their job.

Increasing the growth of new nerve cell branches (in science speak – ‘synaptogenesis’) involves increasing the growth factors. BDNF has been proven to be increased by anti-depressant medications [1, 2] and by exercise [3, 4]. There may be some evidence that diet might improve depression in a similar way although the evidence is weak [5], so we should take that with a grain of salt.

The next way of managing depression is to increase the capacity to cope. The way we do that is through psychological therapies. There are several styles of psychological therapies, too many for me to discuss them all here. In the real world, most psychologists use a mix of a number of techniques that they tailor to the needs of their patient. I’m going to quickly outline the two most commonly used therapies.

Cognitive Behavioural Therapy, or CBT for short, is “based on the theory that emotional problems result from distorted attitudes and ways of thinking that can be corrected. The aim is to treat difficulties by problem solving, finding better strategies for coping, and overcoming irrational fears.” [6] Essentially it’s the combination of two different therapies, Cognitive therapy, and Behavioural therapy. Cognitive therapy, as the name suggests, assumes that people have mental health problems because of patterns of irrational thinking. Behavioural therapy is quite broad, but looks to challenge the thinking patterns with action (for example: gradual exposure to something a person is afraid of).

CBT is the most well researched form of psychotherapy, and has a lot of evidence for it’s effectiveness [7]. Though there is good evidence that it’s the behavioural arm that gives it any clout [8, 9]. Trying to change your mental health just by trying to change your thoughts is generally ineffective.

In the last couple of decades, a new wave of psychological therapies has emerged from this idea that Cognitive Behavioural Therapy is just Behavioural Therapy with bling. The most notable is Acceptance and Commitment Therapy, or ACT for short. ACT is different to CBT in that ACT doesn’t rely on the idea of changing thoughts, but on simply accepting them. ACT “is a psychological therapy that teaches mindfulness (‘paying attention in a particular way: on purpose, in the present moment, non-judgementally’) and acceptance (openness, willingness to sustain contact) skills for responding to uncontrollable experiences and thereby increased enactment of personal values.” [10]

According to ACT, you don’t have to change your thoughts, because thoughts aren’t that powerful to begin with – they’re just words. Sometimes they’re true, and sometimes they’re helpful, but if we spent all of our time trying to fight them, we miss out on experiencing the joy in the present moment, and we can lose sight of the values that guide us into our future fulfilment.

The common link between good psychotherapy is that their therapeutic effect comes from improving skills in different areas that the patient lacks. That is, psychological therapies increase the capacity of the patient to cope with things that would have otherwise wouldn’t have handled well and would have caused distress.

The last way to manage depression is to limit the excessive demands that have been placed on the system in the first place, or in other words, reduce the unnecessary stressors. People who are depressed tend to be bad at this, but there are a few basic skills that are common to all stress management techniques that can form the platform of ongoing better skills in this area. The full list will be a blog for another time, but the simplest technique is to breathe!

It’s really simple. 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.

To recap, there are three main ways to manage depression – increase the brains ability to process the incoming information, increase the capacity to cope, and decrease the amount of stress that our brains have to process.

The fourth way to help manage depression is prayer. There is limited scientific information on the effects of prayer on depression, although a small randomised controlled trial did show that prayer with a prayer counsellor over a period of a number of weeks was more effective than no treatment [11]. But the Bible encourages us, “Do not be anxious about anything, but in every situation, by prayer and petition, with thanksgiving, present your requests to God. And the peace of God, which transcends all understanding, will guard your hearts and your minds in Christ Jesus.” (Philippians 4:6-7)

And Jesus himself called to those heavy in heart, “Come to me, all you who are weary and burdened, and I will give you rest. Take my yoke upon you and learn from me, for I am gentle and humble in heart, and you will find rest for your souls. For my yoke is easy and my burden is light.” (Matthew 11:28-30)

One final thought. It’s sometimes hard to understand how strong Christians can become depressed in the first place. After all, the Bible says that the fruit of the Spirit is joy (Galatians 5:22). 1 Peter 1:8 seems to suggest that every Christian should be “filled with an inexpressible and glorious joy.”

So when you’re filled with the opposite, it makes you feel like a faithless failure, and Christians without depression assume a similar thing for Christians they know who are suffering from depression. It’s the logical conclusion to draw after all – if the fruit of the Spirit is joy, and you are not filled with joy, then you mustn’t be full of the Spirit.

But when you look through the greatest heroes in the Bible, you see a pattern where at one point or another in their lives, they went through physical and emotional destitution. Sure, their lives had some pretty amazing highs, but they often experienced some amazing lows as well. Moses spent forty years in the wilderness, and when God appeared to him in the burning bush, he argued with God about how weak and timid he was (Exodus 3 and 4).

In 1 Kings 18, Elijah had just seen God rain down fire to supernaturally consume his sacrifice, capture and kill four hundred and fifty prophets of Baal, and watched God break the drought over Israel. At the height of this run of amazing connection to God, Jezebel the evil queen threatened him, and he ran for his life in a panic and asked God to kill him, twice, over the period of a couple of months (1 Kings 19).

Peter had spent three years with Jesus, the Messiah himself, hearing him speak and watching him perform miracle after miracle after miracle. Peter even saw the empty tomb first hand on the very first Easter Sunday, but still, he gave up on life with God and went back to his former occupation, which turned out to be lots of hard work for very little reward (John 21:1-3).

The same pattern is also seen in King David, Gideon, and a number of other great leaders through the Bible. The take home message is this: it’s human nature to suffer from disease and dysfunction. Sometimes it’s physical dysfunction. Sometimes it’s emotional dysfunction. It’s not a personal or spiritual failure to have a physical illness. Why should mental illness be treated any different?

As the stories of Moses, Elijah and Peter testify, being a strong Christian doesn’t make you impervious to low mood or emotional fatigue. Hey, we’re all broken in some way, otherwise why would we need God’s strength and salvation! Having depression simply changes your capacity to experience the joy and love of God. Closing your eyes doesn’t stop the light, it just stops you experiencing the light. Being depressed makes it hard to experience God’s love, but it doesn’t stop God’s love.

In the 80’s and 90’s, a popular Christian musician was a man named Carmen. One of his best known songs had these words,

“When problems try to bury you and make it hard to pray, it may seem like Friday night, but Sunday’s on the way!”

It’s really hard when you’re afflicted by the dank darkness of depression. But nothing will separate us from the love of God (Romans 8:35-39), including depression. You may not feel it, but God’s love is there, and Sunday’s on the way.

Remember:

  1. Depression is a common mental health condition that can have prolonged and devastating consequences. Depression is characterised by either a sadness or a lack of joy which are abnormal in their intensity and their duration, but also affects sleep, appetite and motivation. It’s caused by abnormalities in genes which affect the brains ability to grow new nerve cell branches, and which also affect in-built coping mechanisms, so stress is both more likely to occur in people who are more prone to depression, and the stress is then handled poorly, overloading their emotional capacity.
  1. The management of depression is three-pronged: to improve the brains ability to grow new nerve cells through exercise and/or medication, to learn new ways to cope with distress, and to decrease the amount of stress in the first place.
  1. Christians are not immune from depression, and it’s important for Christians to understand that Christians suffering from depression are not weak, or failing in their spiritual walk, or are unloved by God. The love of God is always present, even if they are unable to process it properly. As dark and dismal as depression can become, there is hope. It may seem like Friday night, but Sunday’s on the way.

References

[1]        Duman RS, Li N. A neurotrophic hypothesis of depression: role of synaptogenesis in the actions of NMDA receptor antagonists. Philosophical transactions of the Royal Society of London Series B, Biological sciences 2012 Sep 5;367(1601):2475-84.
[2]        Anderson I. Depression. The Treatment and Management of Depression in Adults (Update). NICE clinical guideline 90.2009. London: The British Psychological Society and The Royal College of Psychiatrists, 2010.
[3]        Karatsoreos IN, McEwen BS. Resilience and vulnerability: a neurobiological perspective. F1000prime reports 2013;5:13.
[4]        Rimer J, Dwan K, Lawlor DA, et al. Exercise for depression. The Cochrane database of systematic reviews 2012;7:CD004366.
[5]        Lai JS, Hiles S, Bisquera A, Hure AJ, McEvoy M, Attia J. A systematic review and meta-analysis of dietary patterns and depression in community-dwelling adults. The American journal of clinical nutrition 2014 Jan;99(1):181-97.
[6]        NowOK. Cognitive Behavioural Therapy. Dictionary of Psychotherapy 2015 [cited; Available from: http://www.dictionary.nowok.co.uk/cognitive-behavioural-therapy-cbt.php
[7]        Ruiz FJ. Acceptance and Commitment Therapy versus Traditional Cognitive Behavioral Therapy: A Systematic Review and Meta-analysis of Current Empirical Evidence. International journal of psychology and psychological therapy 2012;12(3):333-58.
[8]        Longmore RJ, Worrell M. Do we need to challenge thoughts in cognitive behavior therapy? Clinical psychology review 2007 Mar;27(2):173-87.
[9]        Dobson KS, Hollon SD, Dimidjian S, et al. Randomized trial of behavioral activation, cognitive therapy, and antidepressant medication in the prevention of relapse and recurrence in major depression. Journal of consulting and clinical psychology 2008 Jun;76(3):468-77.
[10]      Smout M. Acceptance and commitment therapy – pathways for general practitioners. Aust Fam Physician 2012 Sep;41(9):672-6.
[11]      Boelens PA, Reeves RR, Replogle WH, Koenig HG. A randomized trial of the effect of prayer on depression and anxiety. Int J Psychiatry Med 2009;39(4):377-92.

If you’re suffering from depression or any other mental health difficulties and need help, see your GP or a psychologist, or if you’re in Australia, 24 hour telephone counselling is available through:

Lifeline = 13 11 14 – or – Beyond Blue = 1300 22 4636

Don’t stress about stress – Part 4: Stress breaking bad

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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

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  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