While many of us actively investigate stress management every day for ourselves as well as our patients, have we ever understood the deeper state of why we all have so much stress? Why have we created a belief system that whatever it is we are stressed about is by far the most important thing going on in the world? In the Buddhist Tradition, the four noble truths as taught by the Buddha says, the life is full of stress (dukkha), there is a cause of this stress, it is possible to stop stress, and there is a way to stop stress by following the noble eightfold path. Stress is a part of us, stress can get things done but too much stress hurts our bodies, minds, and hearts.
Definition of Stress
Stress – the biochemical reaction from the body when it does not have internal resources to meet the external demands Stress is complex and difficult to define as it is both ambiguous and context-dependent. Stress is a significant individual and public health problem that is associated with numerous physical and mental health concerns. It is estimated that between 75% and 90% of primary care physician visits are caused by stress-related illnesses. Cardiovascular disease, obesity, diabetes, depression, anxiety, immune system suppression, headaches, back and neck pain, and sleep problems are some of the health problems associated with stress.
Many explanations contain the truth as we have yet to develop a working definition that encompasses all aspects of the word. In the world of healthcare, we talk about the word “stress” on a daily basis. The science of stress is easy to research and write about. We understand the CNS (central nervous system) as well as the biochemical reactions that take place in the body. We can measure the changes in heart rate, neural synapses, etc. But stress sets us up for lack of creativity and relaxation. It takes away from much of the meaning in life. How does this get measured in the body? Let us look at both the science and art of stress.
The Science of Stress
Stress arises when we have:
• Demands which are unreasonable in nature or too numerous for current resources.
• Reasonable demands which prove challenging as we lack one or more resources (e.g., capability, skills, equipment, staff, energy, money)
• Demands which are reasonable and sufficiently well-resourced but the allocated time determines that the proposition is challenging.
• Time and resources are available, but we have too few or insufficiently taxing demands.
Surveys conducted within the last ten years measuring burnout levels in the profession suggest that between 8% and 16% are facing levels of stress which are potentially harmful to their health, and a further 18% have signs that suggest the onset of burnout. Burnout is a particular form of stress found among the healthcare professions. It has three characteristics:
1. Emotional exhaustion – the feeling that the person can no longer find it within themselves to do the emotional work of caring for their patients.
2. High levels of depersonalization – the practitioner feels psychologically ‘removed’ from their job, often feeling as if they are going ‘through the motions’
3. Low sense of personal achievement – the individual affected feels that they derive no sense of achievement or satisfaction from their work.
The Acute Stress Response
Following the perception of an acutely stressful event, there is a cascade of changes in the nervous, cardiovascular, endocrine, and immune systems. These changes constitute the stress response and are generally adaptive, at least in the short term. Two features, in particular, make the stress response adaptive. First, stress hormones are released to make energy stores available for the body’s immediate use. Second, a new pattern of energy distribution emerges. Energy is diverted to the tissues that become more active during stress, primarily the skeletal muscles and the brain. Cells of the immune system are also activated and migrate to “battle stations”. Less critical activities are suspended, such as digestion and the production of growth and gonadal hormones. Simply put, during times of acute crisis, eating, growth, and sexual activity may be a detriment to physical integrity and even survival.
So, if we have chronic stress, our bodies then are in constant battle mode. This leaves no room for any system in our bodies to work outside of that environment. It is debilitating to many. Chronic SNS stimulation of the cardiovascular system due to stress leads to sustained increases in blood pressure and vascular hypertrophy.
Pre-modern medicine recognized this link between disease and emotion for millennia. Ancient Greek, Roman, and Indian Ayurvedic physicians all enlisted the theory of the four humours — blood, yellow bile, black bile, and phlegm — in their healing practices, believing that imbalances in these four visible secretions of the body caused disease and were themselves often caused by the emotions. These beliefs are fossilized in our present language — melancholy comes from the Latin words for “black” (melan) and “bitter bile” (choler), and we think of a melancholic person as gloomy or embittered; a phlegmatic person is languid and impassive, for phlegm makes one lethargic.
Modern science evolved from the notion that truth can only be ascertained by the visible and proven beyond a doubt. That notion leaves little room for the complicated explanation of stress and emotions. It is no wonder modern medicine is disconnected from the emotional experience of pain and suffering.
The Art of Stress Relief
Creativity, Movement, and Breath – The Antithesis to Stress
Creativity induces positive health effects, including on the heart. In a recent study, researchers provided almost forty people with art supplies such as markers and paper and told them to create anything they wanted over a period of 45 minutes. The scientists discovered that no matter the artistic experience of the participants, about 75 percent experienced a decrease in their levels of cortisol, a hormone that the body secretes to respond to stress. “Everyone is creative and can be expressive in the visual arts when working in a supportive setting,” explained one of the researchers.
In other words, when you “lose yourself” in the composition of a song or the drafting of an investor deck, you are essentially entering a healthy flow state. You do not notice time or events happening around you. According to acclaimed author Steven Kotler, during periods of flow, your brain secrets a healthy dose of pleasure-feeling chemicals such as dopamine, serotonin, and norepinephrine. By creating, we may enter flow, which can give us a rush of good feelings.
Movement can be a form of physical stress. Can physical stress relieve mental stress? Alexander Pope thought so: “Strength of mind is exercise, not rest.” Plato agreed: “Exercise would cure a guilty conscience.” Regular aerobic exercise will bring remarkable changes to your body, your metabolism, your heart, and your spirits. It has a unique capacity to exhilarate and relax, to provide stimulation and calm, to counter depression, and dissipate stress. It is a common experience among endurance athletes and has been verified in clinical trials that have successfully used exercise to treat anxiety disorders and clinical depression. It is interesting to note the exact physiological mechanisms to explain how exercise improves stress have not been delineated. Human and animal research indicates that being physically active improves the way the body handles stress because of changes in the hormone responses, and that exercise affects neurotransmitters in the brain such as dopamine and serotonin that affect mood and behaviors
The breath, the vital force, the power of our breath. These statements clearly evoke feelings of awe and inspiration. From Ancient Medicine to Modern Medicine, we can all agree that the power in our breath is real. We can control many functions of our body just with our breath. Breathing is intimately linked with mental functions. In eastern traditions, the act of breathing is an essential aspect of most meditative practices, and it is considered a crucial factor for reaching the meditative state of consciousness, or “Samadhi” (Patanjali, Yoga Sutras). The breath is called “Prana,” which means both “breath” and “energy” (i.e., the conscious field that permeates the whole universe). “Prana-Yama” (literally, “the stop/control,” but also “the rising/expansion of breath”) is a set of breathing techniques that aims at directly and consciously regulating one or more parameters of respiration (e.g., frequency, deepness, inspiration/expiration ratio)
In western culture, breathing techniques were developed independently from any religious or spiritual belief or purpose, and nowadays are mainly used for therapeutic aims (e.g., biofeedback, progressive relaxation, autogenic training). These breathing techniques are often referred to as paced breathing Both concepts show the opportunistic effects on the CNS and in turn, our fundamental wellbeing. A growing number of studies show that breathing techniques are effective against anxiety and insomnia. These techniques influence both physiological factors (by stimulating the parasympathetic nervous system) and psychological factors (by diverting attention from thoughts). Because these techniques are safe and easy to use, scientific validation might result in their being more frequently recommended and practiced.
It turns out we really do have the tools to combat stress, so what is lacking in this culture? I believe it comes from the belief system that we do not value relaxation in the same manner as we do work. Our culture has been designed to carve out every piece of time for productivity, efficiency, and profit but no time to discover ourselves, our passions, our inner peace. As we are not balancing these facets in our lives, we are directly seeing the correlation in the health of our patients, ourselves, our society. What is a deadline really? An interesting pun to say the least. Why are we so driven to get things done? Is money really the driving force? We shame the few who have pursued a simpler path, who choose not to engage so much in the rat race of a world we live in. Is all this stress we live with really good for our overall health and happiness? What would be different in us if we did not need monetary exchange for goods and services? What would we do with ourselves? Interesting questions to ponder, that is where I’d start.