Health Bulletin - November 2015

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Stress and health
We all suffer from the stress induced by modern life. Most of us tend to ignore stress-related symptoms whilst unaware of their long-term impact on health. The purpose of this article is to bring awareness of stress symptoms, related diseases and alternative treatment options.

What is stress?
"Stress" has a different meaning for different people. The American Institute of Stress describes it as "physical, mental, or emotional strain or tension" [1,2]. Initially, stress benefits people's performance of a certain task (good stress). However, when it exceeds a certain limit, stress can do significant damage to our bodies and immune systems (Figure 1). The most common reasons cited for the cause of stress in the US are shown in the table below. Some symptoms of stress include recurring headaches, stuttering, grinding teeth, tremors/shaking, frequent sweating, insomnia, nightmares, muscle pains, depression, digestive difficulties, panic attacks, excess anxiety, decreased appetite, chest pain, and reduced work efficiency. Research suggests that high levels of stress can negatively affect both physical and mental health and are found to be associated with autoimmune diseases, migraines, obesity, muscle tension and backache, high cholesterol, coronary heart disease, diabetes, hypertension, and stroke [3].

Link between stress and disease
Dr. Cohen and co-workers (Department of Psychology, Carnegie Mellon University) highlight two endocrine response systems that are particularly reactive to psychological stress [4]: the hypothalamic-pituitary-adrenocortical axis (HPA) and the sympathetic-adrenal-medullary (SAM) system. Cortisol, the primary effector of HPA activation in humans, regulates a broad range of physiological processes, including anti-inflammatory responses; metabolism of carbohydrates, fats, and proteins; and gluconeogenesis. Similarly, catecholamines, which are released in response to SAM activation, work in concert with the autonomic nervous system to exert regulatory effects on the cardiovascular, pulmonary, hepatic, skeletal muscle, and immune systems. Prolonged or repeated activation of the HPA and SAM systems can interfere with their control of other physiological systems, resulting in increased risk for physical and psychiatric disorders [4, 5]. Complex physiology of the stress response is shown in Figure 1 [1].

Stress management and prevention
There is no magic pill for stress management. Fortunately, there are simpler and proven alternative methods for stress reduction and prevention. In the past few decades, Mindfulness Based Interventions have been clinically evaluated and successfully employed for the treatment of various diseases [3, 6]. Professor Jon Kabat-Zinn (Univ. of Massachusetts Medical School), who introduced Mindfulness Based Stress Reduction (MBSR) methods in clinical setting, defines mindfulness as a "moment to moment awareness that is cultivated by purposefully paying attention to the present experience, with a non-judgmental attitude," [6]. According to Hans Selye, who coined the term "stress" 50 years ago, during both eustress (good stress) and distress (bad stress), the body undergoes virtually the same non-specific responses to various positive or negative stimuli acting upon it. However, eustress causes much less damage than distress. This demonstrates conclusively that it is how an individual accepts stress that ultimately determines whether the person can adapt successfully to change[1]. This particular explanation provides a basis for how and why mindfulness-based techniques work for stress reduction and related disease management [7].

"When we speak of meditation, it is important for you to know that this is not some weird cryptic activity, as our popular culture might have it. It does not involve becoming some kind of zombie, vegetable, self-absorbed narcissist, navel gazer, "space cadet," cultist, devotee, mystic, or Eastern philosopher. Meditation is simply about being yourself and knowing something about who that is. It is about coming to realize that you are on a path whether you like it or not, namely, the path that is your life. Meditation may help us see that this path we call our life has direction; that it is always unfolding, moment by moment; and that what happens now, in this moment, influences what happens next."

Prof. Jon Kabat-Zinn
Univ. of Massachusetts Medical School

The cases listed below are examples of MBSR treatments and their effects on stress patients:
Rosenzweig (Jefferson Medical College, Thomas Jefferson University, PA) and co-workers evaluated the effect of MBSR on glycemic control in Type 2 Diabetes patients. The study included adults ages 30-75 years (14 subjects: 5 men and 9 women) with blood glucose 275 mg/dL and HbA1c between 6.5-8.5%. MBSR program consisted of 8 weekly 150-minute sessions plus a 7-hour weekend session. In addition, each participant received 2 practice compact discs to support a home practice requirement of at least 20 to 30 minutes of formal meditation per day, 6 days per week. After 8 weeks, significant reduction in HbA1c levels (0.5%) was observed. Also, symptoms of depression, anxiety, and general psychological distress were decreased by 43%, 37%, and 35%, respectively [8].

Kabat-Zinn and his group (Univ. of Massachusetts Medical School) studied 225 chronic pain patients following training in mindfulness meditation. Large and significant overall improvements in physical and psychological symptoms were recorded post-intervention. The gains were maintained at 2.5-48 months follow-up periods in a majority of subjects. They concluded that such training can have long-term benefits for chronic pain patients [9].

Yook and co-workers (College of Medicine, Seongnam, Korea) examined the usefulness of a mindfulness-based cognitive therapy (MBCT) for treating insomnia symptoms in patients with anxiety disorders in an 8-week clinical trial. Participants (18 subjects) showed significant improvements as indicated by multiple evaluation methods such as Pittsburgh Sleep Quality Index, Penn State Worry Questionnaire, Ruminative Response Scale, Hamilton Anxiety Rating Scale etc. These findings suggest that MBCT can be effective at relieving insomnia symptoms by reducing worry-associated sleep disturbances in patients with anxiety disorder [10].

Final comments: Literature suggests that mindfulness-based interventions are convenient alternative options for prevention and management of most of the common illnesses. Meditation techniques are easy to learn and can be practiced at home and in the office. As little as 10 minutes of meditation every day can provide significant health benefits for all individuals who experience stress in today's busy world.

References:

www.stress.org
http://human-factors.arc.nasa.gov/flightcognition/Publications/IH_054_Staal.pdf
Khoury et al. (2015) Mindfulness-based stress reduction for healthy individuals: A meta-analysis. Journal of Psychosomatic Research: 78, 519-528
Cohen et al. (2012) Psychological stress and disease. JAMA: 298 (14) 1685-1687
McEwen (1998) Protective and damaging effects of stress mediators. The New England Journal of Medicine: 338, 171-179
http://experiencelife.com/wp-content/uploads/2011/11/Wherever-You-Go-There-You-Are.pdf
Chrousos and Gold (1998) Editorial: A Healthy Body in a Healthy Mind-and Vice Versa-The Damaging Power of "Uncontrollable" Stress. Journal of Clinical Endocrinology and Metabolism: 83 (6), 1842-1845
Rosenzweig et al. (2007) Mindfulness-based stress reduction is associated with improved glycemic control in type 2 diabetes mellitus: a pilot study. Alternative Therapies: 13 (5), 36-38
Kabat-Zinn et al. (1987) Four-year follow-up of a meditation based program for the self-regulation of chronic pain: treatment outcomes and compliance. Clin. J. Pain: 2, 159-173.
Yook et al. (2008) Usefulness of mindfulness-based cognitive therapy for treating insomnia in patients with anxiety disorders: A pilot study. Journal of Nervous & Mental Disease: 196 (6) 501-503