Qigong and Stress (1)

Understanding  Stress

Martin Eisen, Ph.D.

Before reviewing Qigong and Tai Chi research in stress and its consequences, the definition of stress, its effects, and some treatments will be discussed.

1.  Introduction to Stress

Forces or stressors from the outside world affect the individual.  Stress is a psychological and physiological response to stressors.  Stress can have a positive, negative or neutral effect.

Species that adapted best to stressors have survived and evolved in the plant and animal kingdoms.   Man has adapted to all types of environments and his neo-cortex, the thinking part of the brain, has become most sophisticated among animals.  Then, why can stress have a negative effect?

Faced with a perceived threat the body automatically releases stress hormones, resulting in the “fight-or-flight” response. Heart rate and blood flow to the large muscles increase in order to run faster and fight harder. To minimize injuries, blood vessels under the skin constrict to prevent blood loss.  Pupils dilate to increase visual acuity.  Blood glucose is increased leading to an energy boost and speeding up reaction time. At the same time, body processes, not essential to immediate survival, are suppressed. The immune response is inhibited. The digestive and reproductive systems slow down.  Growth hormones are switched off.

This fight or fight response helped cavemen survive life threatening situations.  Today most of the stress is in response to psychological rather than physical threats.

Unfortunately, your body doesn’t make this distinction.  Stressful situations may be traffic jams, doing taxes, or listening to news.  The problem with the stress response is that the more it’s activated, the harder it is to shut off. Instead of leveling off once the crisis has passed, your stress hormones, heart rate, and blood pressure remain elevated.  This may lead to heart disease, obesity, infections, anxiety, depression, and many other problems.

2.  Scientific Theory of Stress

The different effects of the same stressors on different individuals can be understood from the current theory of stress.  Two main systems are involved:

(i)   The hypothalamic-pituitary-adrenal (HPA) system consists of the hypothalamus, a central part of the brain, the pituitary and adrenal glands.

(ii)  The sympathetic nervous system (SNS), which is part of the autonomic nervous system (ANS), the sensory and motor neurons that innervate the viscera.  The other part of the ANS is the parasympathetic nervous system (PNS).  These systems are usually not under consciou control.  Consider sympathetic as “fight or flight” and parasympathetic as “rest and digest”.  More generally, these two systems modulate vital functions, in usually antagonistic fashion, to keep the body in equilibrium (homeostasis).  An example is the constant, second to second modulation of heart rate by sympathetic and parasympathetic influences, as a function of the respiratory cycles.

These two systems are activated primarily by a nucleus in the brain stem (lowest part of brain) called the locus coeruleus (Latin for ‘the blue spot’), which is responsible for physiological responses to stress and panic.  The HPA axis and the locus coeruleus systems are linked through the hypothalamus and an area of the brain known as the limbic system.  The limbic system influences the endocrine system and the ANS. It is highly interconnected with the nucleus accumbens, the brain’s pleasure center, which plays a roe in sexual arousal and the “high” derived from certain recreational drugs. There responses are modulated by dopamine from dopaminergic projections of the limbic system.  The limbic system is also connected to the prefontal cortex, allowing rational behavior.

The limbic system is the control area for emotion and the processing area for memory. These linkages are critical.  For example, if you hear a strange noise downstairs the locus coeruleus immediately initiates the stress response.  However, when you see that it is not a burglar, but your brother, your memory will turn off the stress response.

The connections also include the endogenous opiate (opium-like) system and the reward (dopamine) system. Thus, during stress, pain is reduced and an extremely happy feeling (euphoria) may result.

The system linkages work as follows. The limbic system performs an emotional analysis and memory review of the information provided by the senses. Then, the multiplicity of connections allows us to determine whether the current stressor is a past, successfully adapted to event, or no threat or perceived danger.  All of this internal activity occurs in milliseconds.

If there is perceived danger, he locus coeruleus immediately secretes norepinephrine and stimulates other brain centers to do the same. It controls the tempo of the brain. Hence, it increases arousal and vigilance, and modulates the action of the ANS, including the SNS. The ANS regulates blood flow, heart rate, blood pressure, and respiration. It can also temporarily shut down the gastrointestinal and sexual systems until the crisis is over. These initial reactions, to get our blood flowing, heart pumping, and muscles energized, occur very quickly and automatically.

Next, the secondary long term effects are caused by the hypothalamus releasing corticotrophin releasing factor (CRF). The CRF stimulates the pituitary gland, to release adrenocorticotrophic hormone (ACTH). ACTH is released into the bloodstream and causes the cortex of the adrenal gland to release the stress hormones, particularly cortisol, which is a corticosteroid hormone. Cortisol increases the availability of the body’s fuel supply (carbohydrate, fat, and glucose), which is needed to respond to stress. However, if cortisol levels remain elevated for too long, muscle breaks down, there is a decreased inflammatory response, and suppression of the immune system occurs.  Corticosteroids also can cause fluid retention and high blood pressure. Therefore, it is critical that the response to corticosteroids be carefully controlled (modulated). This control usually is accomplished by a feedback mechanism in which increased cortisol levels feeding back to the hypothalamus and pituitary turn off production of ACTH. In addition, extremely high levels of cortisol can cause depression and psychosis, which disappear when the levels return to normal.

In summary, the HPS and SNS systems interact with each other and influence other brain systems and functions.  Their response is regulated by a negative feedback loop.  This means that increased amounts of a substance – for example, a hormone, inhibits the release of more of that substance, while decreased amounts of the substance stimulate the release of more of that substance.  Overwhelming or prolonged responses of these systems can be harmful.  An important point is that different people, depending on their genes or training, can respond differently to similar stressors.

3.  Signs and Symptoms of Stress=

You must learn to recognize stress since the signs and symptoms of stress vary widely from person to person. Some people experience physical symptoms, others emotional symptoms, and still others, changes in thinking or behavior.  Some possible symptoms are:

Cognitive: Anxious or racing thoughts, constant worrying, fearful anticipation, inability to concentrate, indecisiveness, loss of objectivity, memory problems, poor judgment, seeing only the negative, and trouble thinking clearly.

Emotional: Agitation, depression or general unhappiness, feeling overwhelmed, feeling tense, inability to relax, irritability, impatience, moodiness, restlessness, sense of loneliness and isolation, and short temper.

Physical: Chest pain or rapid heartbeat, diarrhea or constipation, frequent colds, gastrointestinal ulcers, headaches or backaches, hypertension, insomnia, loss of sex drive, muscle wasting, tension and stiffness, nausea, dizziness, skin breakouts (hives, eczema), suppression of the immune system, and weight gain or loss.

Behavioral: Eating more or less, isolating yourself from others, nervous habits (e.g. nail biting, pacing), overdoing activities, overreacting to unexpected problems, picking fights with others, procrastination, neglecting responsibilities, sleeping too much or too little, teeth grinding or jaw clenching, and using alcohol, cigarettes, or drugs to relax.

These signs and symptoms can be the result of other physical or psychological problems.  A medical diagnosis is required.

4.  Post Traumatic Stress Disorder (PTSD)

Severe stressor from catastrophic events or traumatic experiences such as war, a natural disaster, a sexual assault, or a life-threatening accident can lead to stress symptoms that don’t go away.  Life doesn’t return to normal and the body doesn’t regain its equilibrium.  Symptoms such as:  avoidance of places and things associated with the trauma; chronic irritability and tension; depression; flashbacks, intrusive thoughts, or nightmares about the trauma; hyper vigilance for signs of danger.  These severe and persisting reactions to trauma are known as post-traumatic stress disorder.  PTSD is a serious disorder that requires professional intervention.

5.  Broken Heart Syndrome

In the study (3) of apparent heart attack victims, eighteen of the 19 patients were women and their average age was 63.  All of the attack occurred after sudden emotional stress, such as: news of a death, shock from a surprise party, fear of public speaking, armed robbery, a court appearance, and a car accident.  Unlike typical heart attack patients, these people had no evidence of coronary artery blockages. Blood tests also didn’t reveal elevated levels of enzymes typically released after a heart attack from damaged heart muscle.  Magnetic resonance imaging revealed that none permanent damage to the heart muscle. The levels of stress hormones in these patients were two to three times higher than those who had an actual heart attack and 64 times higher than a normal person. This suggests that the surge of stress hormones may play a critical role in this stress cardiomyopathy condition, termed the broken heart syndrome.

Another important, distinctive feature of the syndrome was the heart’s unique contraction pattern as viewed by echocardiogram, or ultrasound. The bottom of left ventricle, contracted normally but, there was weakened contraction in the middle and upper portions of the muscle and it also appeared enlarged. Other characteristics included a distinctive pattern on electrocardiogram, or EKG.

The biggest surprise was that the recovery rates among people with broken heart syndrome were much faster than those seen after a heart attack. Some patients showed dramatic improvements in their heart’s pumping ability within 72 hours and all had completely recovered within two weeks. Recovery after a heart attack can take months because the heart muscle is damaged.

This is an excellent example to show that the mind can control the body.

6.  Early Separation from the Mother and Stress in the Womb

Early separation from the mother has also been seen as another potent stressor in animals. Such separation has been linked to increased levels of the stress hormones that cause the stress syndrome, which includes depression.  Maternal stress can also affect the fetus through their common blood circulation. The mother’s blood carries both good (e.g., nutrients and oxygen) and bad substances (e.g., alcohol, nicotine, illicit drugs, prescription drugs, and stress chemicals, such as cortisol and norepinephrine) to the fetus.

Animal and human studies seem to indicate that stress leads to depression. In other words, chronic stress in the mother’s womb (in utero) or early deprivation (separation from the mother) can predispose a person to developing the psychiatric syndrome of clinical depression in later life. Furthermore, other experiments show that the administration of stress hormones can actually decrease brain connections and even the number of brain cells in crucial areas, such as the limbic system. This loss of brain connections and cells then can lead to further maladaptive (inadequate adjustment) responses to stress.

7.  Drugs, Alcohol, Natural  Supplements and Stress

Some people, when stressed, use drugs and alcohol.  Many of these substances make habitual users even more responsive to stressors. As a result, small problems produce big surges of stress chemicals. Attempts to mask stress with drugs and alcohol 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.

Even prescription drugs for anxiety can be counterproductive in the same way.  There are tranquilizers, sedatives, hypnotics, antidepressants and beta-blockers for specific complaints.  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 are extremely useful.

Others find relief for their stress by using aromatherapy, or nutritional supplements like chamomile, spearmint, kava kava, adaptogens and St. John’s wort.  However, these may be also counterproductive like drugs.

8.  Mind-Body Methods for Stress

These methods are preferable to drugs for the reasons stated in Section 7 and because drugs can have undesirable side effects. No one method is suitable for everyone, and   when arbitrarily imposed on others, can be dull, boring and stressful.

Some stress relievers are: walking, jogging and other aerobic exercises, different types of meditation, deep breathing, prayer, and yoga.  Other popular practices are: various progressive muscular relaxation exercises, autogenic training, deep breathing, massage therapies, visual imagery and self hypnosis practices are popular. There are also acupuncture, acupressure, biofeedback, Alexander, Reiki, Feldenkrais and other bodywork and postural techniques.

Some people find that listening to music, hobbies, volunteer work, keeping a daily journal of events and how they feel, laughter, playing with pets, taking short breaks or shopping helps them to relax. Strong emotional support from group therapy, family or friends is also helps reduce stress.

Stress created by harmful habits or traits can be reduced using cognitive restructuring techniques such as behavioral modification, assertiveness training, time management and stress inoculation.

In addition, a variety of cranio-electromagnetic stimulation devices have been found to be effective and safe.  Sitting under a pyramid is another electromagnetic stress reducer.  These methods are effective for anxiety, insomnia and drug resistant depression.

The above methods reduce the effects of stress. Recently, the idea of preventing such problems has come into vogue.  This type of intervention is called critical incident stress debriefing (CISD).  It involves discussing the traumatic event as soon as possible after the event.  CISD can lessen extreme (pathological) reactions to stress and often prevent PTSD.  Milder forms of stress might also be helped by the CISD techniques.

9.  Future Methods of Stress Reduction

People have different responses to the same stressors because of their genetic make-up. Pharmacogenetics studies drugs that enter the cells’ DNA and turn on or off certain genes.

Thus, in the future, the genes of people, genetically determined to be over-or under-reactors to stress, could be altered to react more favorably to stressors.

References

1.  Understanding Stress:  Signs, Symptoms, Causes, and Effects,

http://www.helpguide.org/mental/stress_signs.htm.

2.  Panzarino, P.J., Stress,

http://www.medicinenet.com/script/main/art.asp?articlekey=488&pf=3&page=1.

3.  Wittstein, L. S., et al, Neurohumoral features of myocardial stunning due to sudden       emotional stress, New England  J. of Med., Vol. 352, No. 6, 539-548, 2005.

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About Martin Eisen

By profession, Dr. Eisen was a university Professor specializing in constructing mathematical models such as those in cancer chemotherapy and epilepsy. He has studied and taught Yoga, Judo, and Aikido. Dr. Eisen was the founder and chief-instructor of the Shotokan Karate Clubs at Carnegie-Mellon and Dusquene Universities and the University of Pittsburgh. He helped teach Yoga in Graterford prison. His curiousity about the relation of Qi to healing and martial arts led him to study TCM, Tai Chi and Praying Mantis Kung Fu. He was initiated as a Disciple of Master Gin Foon Mark. Dr. Eisen now teaches (at his Kwoon and by webcam), writes and researches Praying Mantis, Qigong and Yang Tai Chi - see http://home.comcast.net/~carolezak
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