The Stress Reaction. How we perceive events

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1 The Stress Reaction The rationale for writing this piece is really two-fold. Firstly most people seem curious and interested in how the body works. Secondly it gives a context in which to make sense of the stress reaction and related issues. Knowledge of how the body works can enable people to work with something that has previously defied them, if it has been previously been beyond their understanding. The approach taken here is a holistic one. That being that the mind are body are inextricably linked. Thus the focus is to a great extent on the perception (mind) and the physiology (body), and how stress affects these. Hopefully an understanding of these will also enable other aspects and approaches to stress to be utilised better. In this piece the perception of events is first explored. That is how we see events and how they hold significance for us. We will then go on to look at how this ties in with and what happens in a normal, adaptive stress response in reaction to a physical threat. Finally we will look at what can go wrong with the stress response, and how signs and symptoms may be experienced. How we perceive events Within life one thing that is for certain is that everything changes. Life is in a constant state of flux. To quote Benjamin Franklin, But in the World nothing can be said to be certain except death and taxes. How we perceive change though very much affects how we respond and behave to events. Generally speaking change is perceived as either a challenge/opportunity, a neutral event which has no significant effect or a threat. With perception an emotional evaluation is also made. From this we can assume the following: FIG. 1 PERCEPTION CHALLENGE/OPPORTUNITY EMOTION A POSITIVE EMOTION e.g. ENJOYMENT EVERYTHING CHANGES NEUTRAL A NEUTRAL EMOTION e.g. INDIFFERENCE THREAT A NEGATIVE EMOTION e.g. FEAR 1

2 In our perception of events however individuals can vary greatly and what one person may find quite enjoyable another may find quite distressing. To illustrate this an example could be how roller coaster rides may be perceived. Some people find them exhilarating, whilst others find them threatening, avoiding a ride at all costs. Another example may be going to see a friend at home and the friend has a dog. If dogs are liked this may add to the pleasure of the trip. If, however, dogs are perceived as a threat, a visit to the friend s house might be quite an unpleasant experience. Thus, it can be seen that the same event can be perceived quite differently by different individuals with a corresponding difference in behaviour. It is not therefore events themselves that are stressful but our perception of them that makes them so. As Shakespeare writes, there is nothing either good or bad, but thinking makes it so (Hamlet). There are some events however, which the vast majority of people would find stressful. How we perceive and respond to events is based, to a great extent, upon our values, beliefs, personality and what is going off for us at the time. The stress response as an adaptive biological process The perception of a physical threat to an individual leads to an appropriate response within the body for dealing with the threat. This is an adaptive response as it prepares the body to take the necessary action. Information is taken in by the senses and assessed. If an event is judged to be a physical threat a biological response automatically follows. See Fig. 2. 2

3 Fig. 2 EVENT (Stressor) Information SENSES Event perceived as a physical threat and emotion experienced ACTIVATION OF NERVOUS SYSTEM (SYMPATHETIC BRANCH) RELEASE OF COCKTAIL OF STRESS CHEMICALS INTO BLOODSTREAM (Adrenaline, Noradrenaline, Cortisol) Broadly speaking, if fear is the emotion experienced we flight. That is, we run away. On the other hand, if anger is experienced, we fight and try to combat the stressor. This is often cited the fight / flight syndrome. (For those interested, the adrenaline and noradrenaline levels increase in both fight and flight situations. Adrenaline is predominantly released in flight and noradrenaline predominantly in fight. Cortisol levels show an increase in flight only). An example might be if a person were attacked with a knife, a perception would be made that is registered as a threat and their body would leap into action to either run away or fight the attacker. The biological changes made within their body would have facilitated this. So what does go on when these biological changes occur? This is the next area to address. 3

4 Actions of adrenaline and noradrenaline of the body Fig. 3 4

5 As can be seen in fig. 3 there are a whole range of physical responses that take place within the body automatically. That is without conscious thought. In general there is a slowing down of the routine maintenance systems such as the digestive tract, which as these are not useful in dealing with the physical threat. So then there is increased activity systems which will allow us to exert ourselves. This stress response as already mentioned is a normal adaptive response and after the source of threat has gone the system should restore itself back again to its normal state of rest. This response is a vital and useful system, but one that can unfortunately go wrong by being used inappropriately. This can happen by the system enduring prolonged periods of threat for which it is not really designed. The fight / flight reaction works excellently in the short term. However, in the long term the effects of over using the system, if not allowed to return to its resting state, become evident. It can also react to inappropriate stressors, these being perceived threats which require no active physical response (non-physical stressors). If the system is overused or used inappropriately signs and symptoms are often experienced. Non-physical stressors are in the main threats to personal integrity of a none physical nature. An example of this might be a business man who is stuck in a traffic jam and knows he is going to be half an hour late for a very important meeting. He starts to feel jumpy and irritable, muttering at others driver s incompetence. As he continues to be held up he starts to bang his fist on the steering wheel and becomes quite angry. He feels quite tense and develops a headache. Eventually as the traffic clears he drives like a maniac and arrives half an hour late for his meeting. He is still angry and tense. He therefore finds it very hard to concentrate on the rest of the meeting. In this example the perception of the threat gives rise to a stress reaction. The threat here being the business man s personal integrity, which is threatened by being late. A physical response is experienced for which the boy has no need and no appropriate physical outlet. The body however finds an outlet for this stress which is excessive to the needs of the situation. It does this in the form of discomforting symptoms. If left unchecked, these eventually lead to disease. In the above example irritability, anger and tension are caused. Symptoms, however, do vary amongst individuals and there is no set pattern of symptoms that people experience. Care must also be taken that symptoms may be wrongly attributed to excessive stress reaction when there may be other underlying medical causes. (Medical advice may need to be sought). To help understand the long term effects of an excessive response let us again return to the actions of this response on the body. 5

6 Short Term (useful) Alert mind facilitates quick decision making. Anger or fear experienced. Senses more acute especially hearing and vision. Lung; airways dilate and breathing becomes more rapid to increase oxygenation of the blood. Gut activity slowed. Reduced blood flow to gut. Increased acid production. Saliva production reduced. Muscles at opening of anus and bladder are relaxed. Heart beats faster and harder. Increased blood pressure. Reduced flow to extremities (i.e. hands and feet). Large skeletal muscles tense and get ready for action. Energy stores mobilised. Cortisol output increased. Helps reduce inflammation if injured. Increased sweating. Adrenaline and noradrenaline released into the blood. Effects of a Stress Reaction Long Term (harmful) Alert mind causes difficulty in sleeping, can t switch off thoughts therefore constantly rehearsing past or future events. This can cause an inability to concentrate, confusion and a difficulty making decisions. Emotionally overwhelmed. Irritability and/or depression. Distorted, irrational ideas, worrying. Hypervigilance (constantly on the lookout). A heightened sensitivity to loud noises and bright lights. Again relates to a difficulty in sleeping. Hyperventilation (over breathing to the needs of the body). This could lead to faintness, feelings of unreality, pins and needles in the hands and feet, chest pains, yawning and sighing in extreme, panic attacks (8-10 breaths a minute, at rest are about the norm). Diarrhoea, constipation, Irritable bowel syndrome, loss of appetite or comfort eating, indigestion, stomach ulcers and other gastrointestinal ailments, frequent urination. Palpitations. Increased blood pressure leads to arterial wall damage, strokes, heart disease. Cold hands and feet. Prolonged muscle tension leading to muscular/skeletal problems e.g. bad backs and necks, jaw clamping and teeth grinding. Headaches. Feelings of exhaustion due to the tension which is constantly using up energy. Repetitive fidgeting in an attempt to dissipate some of the muscle tension. Depresses immune system. This leads to an increased susceptibility to illness from colds to cancer. Increased sweating. This maintains the response. Artificial substances such as nicotine and caffeine also heighten the response. A change in sexual behaviour with libido decreased or increased. 6

7 Conclusion Hopefully it can now be seen that:- 1. Stress is not something that outside influences cause us alone, but is instead an interaction of events and our perception of them based on beliefs, personality etc. 2. The stress reaction is a normal response and a very useful one at times. 3. The stress reaction can become excessive and signs and symptoms are experienced. Signs and symptoms can be treated, but it is far better to treat the cause of the excessive stress rather than the symptoms as symptoms reoccur. This can be done by changing the environmental stressors (often not possible to do) or changing the way in which we perceive and react to the environment. Health Psychology Service April 2012 Compliments, comments, concerns or complaints? If you have any comments, concerns or complaints and you would like to speak to somebody about them please telephone Are we accessible to you? This publication is available on request in other formats (for example, large print, easy read, Braille or audio version) and languages. For free translation and/or other format please call extension 5587, or us communications@dchs.nhs.uk 7