Chronic Stress: The Body Connection

WebMD Live Events Transcript

Stress isn't just a state of mind -- it can affect your entire body. Learn which systems of your body are most affected by stress, and the toll stress takes on us in our day-to-day lives. Our guest was Herbert Benson, MD, founding president of the Mind/Body Medical Institute, on Nov. 4, 2004.

The opinions expressed herein are the guests' alone and have not been reviewed by a WebMD physician. If you have questions about your health, you should consult your personal physician. This event is meant for informational purposes only.

MODERATOR:
Dr. Benson, what is it about stress that alters our physical selves?

BENSON:
Stress evokes the fight-or-flight response. The fight-or-flight response is characterized by increased metabolism, increased heart rate, increased breathing, increased blood pressure, a 300 to 400 hundred percent increase in the amount of blood flowing to our muscles, which prepare us to run or to fight.

Obviously, in today's world, when under stress we don't run, we don't fight. Yet we have adrenaline coursing through our blood system, and this is what leads to a number of stress-related symptoms, including:

• Anxiety
• Depression
• Excessive anger and hostility
• Hypertension (high blood pressure)
• Insomnia
• Heart irregularities
• Recently it has been demonstrated that stress is a risk factor for heart attacks

And there are a number of gender issues directly related to stress.

• In men: decreased sperm count, decreased sexual performance
• In women: PMS, infertility, and menopausal hot flashes made worse by stress

So what do we mean by stress? Stress results from any condition that requires you to change, to adjust behaviorally. The changes can be positive or the changes can be negative.

For example, getting married, a wedding, is a joyous event. It's also stressful for many. Having an illness and having to adjust to that is a negative stress. And in our world today, we are constantly having to adjust to change. The changes of financial problems, the changes of terror, the changes of having family issues. These are not going away. And that is why we are seeing many illnesses caused or made worse by stress.

MODERATOR:
What level of stress causes these kinds of problems? Is there a "measurable" amount to be aware of?

BENSON:
There is a relationship called the Yerkes-Dodson law, and that is the relationship with stress and performance and efficiency. As stress increases, there is no doubt that performance and efficiency and good health increase. In other words, when we have a deadline, we are more proficient, we perform better. But only to a point. Then performance and efficiency start to decrease. It's like an inverted U. So the more stress, the worse the performance, the worse your efficiency. Because most of us are on the down side of that curve, that's why we are burning out.

So what are stress symptoms? What are the symptoms that one can recognize when the stress begins to exceed our capacity to handle it? I'll talk about four symptom categories: physical, behavioral, emotional, and cognitive.

Physical symptoms:

• Headaches
• Indigestion
• Stomach aches
• Sweaty palms
• Sleep difficulties
• Dizziness
• Back pain
• Tight neck and shoulders
• Racing heart
• Restlessness
• Tiredness

Behavioral symptoms:

• Excessive smoking
• Bossiness
• Compulsive gum chewing
• Attitude critical of others
• Grinding one's teeth at night
• Overuse of alcohol
• Compulsive eating
• Inability to get things done

Emotional symptoms:

• Crying
• Nervousness
• Anxiety
• Boredom (there's no meaning to anything)
• Edginess (a readiness to explode)
• Feeling powerless to change things
• An overwhelming sense of pressure
• Loneliness
• Easily upset

Cognitive symptoms:

• Trouble thinking clearly
• Forgetfulness
• Lack of creativity
• Memory loss
• Inability to make decisions
• Constant worry
• Loss of sense of humor

It's clear that stress can either cause or make these symptoms worse. Obviously a person might be anxious or depressed, and medications obviously are in order. But stress can certainly make the condition worse, and in some cases actually cause it. So either way, the harmful effects of stress are present.

MODERATOR:
So what does one do to lessen these effects?

Fortunately, just as we have the fight-or-flight response, so we have another response: the relaxation response, which needs two steps to bring it forth:

• Repetition. The repetition can be a word, a sound, a prayer, a phrase, or a repetitive motion.
• Disregarding everyday thoughts, and a return to repetition.

When one carries out these two steps, there are physical changes opposite to those of fight-or-flight. They are: decreased heart rate, decreased blood pressure, decreased rate of breathing, slower brain waves, physical changes within the brain and the brain is quieter.

There are scores of different techniques that will bring forth the relaxation response. They may be secular or religious. One such technique is:

• Sit quietly in a comfortable position.
• Close your eyes.
• Relax your muscles starting with your feet, your calves, your thighs.
• Shrug your shoulders around.
• Roll your head and neck around.
• Sit at ease and breathe slowly.
• And each time your breath is coming out, repeat a word, a sound, a prayer, or a phrase that conforms to your own belief system:
  
  If you are of secular inclination you could use the word love, you could use the number one, you could use the word peace.
  
  If you are of a religious and of Protestant faith, you could use, the Lord is my shepherd; Our Father who art in Heaven; Make a joyful noise unto the Lord.
  
  If you are Catholic, you could use Hail Mary, full of grace. Not the whole Mary prayer, just Hail Mary, full of grace.
  
  If you are Jewish, the Lord is my shepherd, or the shamah prayer.
  
  If you're of Hindu faith, Om.
  
  If you are of Islamic faith, a prayer from the Koran.

Other thoughts will come in to your mind while doing the technique. They are natural and should be expected. But when they occur, don't be upset, simply say "Oh, well," and come back to your repetition.

This approach should be practiced once or twice daily for 10 to 20 minutes each time. Good times to do this are upon awakening in the morning or in the late afternoon. How do you know when the time is up? Do not set an alarm, but do have a clock or watch near, and when you think "It's time," peek. If it's not time, go back to it. When the time is up, sit for a full minute with your eyes closed and allow other thoughts to come in to your head. Then open your eyes, continue to think regularly, and stand up.

There are many other techniques that also evoke the relaxation response. They include yoga, tai chi, other forms of meditation. It is your individual choice. If it is a word or sound or prayer you are using, do so silently in your original language.

When the relaxation response is evoked regularly, it will counteract the harmful effects of stress. But you should try first to change the stress.

For example, if the stress is from a scheduling problem, work to change that. If it is a relationship issue, work at it. But we all know that often these are difficult to change. Yet we have within us this inborn capacity for the relaxation response, which will physiologically counteract the damaging effects of stress, so we should use it. We have allowed the stressors of the world to take over and given up what people for thousands of years have been doing.

MEMBER QUESTION:
What reading do you recommend about the relationship between infertility and the mind/body connection?

BENSON:
I would recommend the works of Dr. Alice Domar. For years, Dr. Domar was part of the Mind/Body Medical Institute and is the pioneer in using mind/body techniques to effectively counteract the harmful effects of stress that contribute to infertility.

MEMBER QUESTION:
Can stress hinder weight loss?

BENSON:
Many people overeat because of stress, so-called compulsive eating. So yes, often it's more difficult to diet when you're under stress.

MEMBER QUESTION:
I can't eat at all when I'm stressed -- is that a common reaction? What can I do about it?

BENSON:
Some people do lose their appetite when under stress. First you should try changing the circumstance causing you stress. Then choose an approach of your choosing to evoke the relaxation response and elicit it daily, once or twice a day.

MEMBER QUESTION:
As long as I find comfort in foods like mixed green salads, rice cakes and wheat crackers (I know, I'm weird) is turning to food to soothe my soul after a stressful day such a bad thing?

BENSON:
Not at all. In fact, it's quite healthy to be able to eat in a healthy fashion and it is an appropriate behavior. I do not think you are weird.

MEMBER QUESTION:
What if you have stress that is affecting your health from outside sources you cannot change (chronic illness of a family member, unemployment, etc.)?

BENSON:
The daily elicitation of the relaxation response on a regular basis will help you counteract the harmful effects of your symptoms.

The stress often cannot be changed, but you can learn to protect yourself by choosing a technique that conforms to your own belief system. It could be secular or religious, it's your own choice. But to have its effects, the techniques should be performed once or twice daily for 10 to 20 minutes.

MEMBER QUESTION:
I am a single mom with little time for anything but out-of-control stress. How do I increase the quality of my sleep?

BENSON:
Is it possible for you to wake 10 minutes early every day to carry out a relaxation response technique? If so, it will help you stabilize your stress, and in many cases, it can lead to better sleep.

MODERATOR:
It seems it would cause more stress to think about getting up earlier, to enable one to eventually get more sleep. How do we deal with the stress of making time to de-stress?

BENSON:
Remember the Yerkes-Dodson curve. If you invest a little time, 10 or so minutes, to decrease the effects of stress, you will become more efficient and your performance will be enhanced.

Although it paradoxically sounds as though you need that extra 10 minutes for rest or sleep, by using it to evoke the relaxation response, it will actually buy more time, because you will be more efficient.

MEMBER QUESTION:
My husband has severe asthma and has had one mild heart attack. He carries his weight in his belly. He is tired a lot of the time. He has a very stressful job, and we have a child with chronic mental health problems that make home pretty stressful too. He doesn't make the connection between his stress and his body. How can I discuss what I see as the physical effects of this stress on him without causing him more stress?

BENSON:
My answer is for you as a prototype, not for you as an individual, because I am not allowed to give individual advice in this forum. Which of your husband's behavior would give you a chance to give him appropriate advice? Is he a religious man, does he pray regularly, does he exercise regularly?

MEMBER QUESTION:
He doesn't exercise. I've tried getting him to walk the dogs with me to no avail. He grew up being told if he exercised it would cause an asthma attack. I understand you can't treat on the internet; I'm just wondering if there is some way to help someone to an awareness of the mind/body connection without beating them over the head with a book and causing more stress!

BENSON:
He might read a recent issue of Newsweek , in which the cover reads, "The New Science of Mind and Body." The date is September 27th, 2004. Have him read my article which is the opening of the entire section. It could help convince people who don't believe in the mind/body connection, how important that connection is.

MODERATOR:
Do you think yoga is a good choice for everyone looking for stress relief?

BENSON:
Yoga is a wonderful way to elicit the relaxation response through movement. The focus on the breathing, the focus on the postures, also brings forth the same physiologic changes that occur when you are sitting silently.

Obviously your metabolism is higher because of the activity of yoga, but still, it elicits the basic physiologic changes of the relaxation response.

MEMBER QUESTION:
I live in a crowded area and drive to work, and have felt road rage many times. When is the right time to deal with this anger?

BENSON:
You should elicit the relaxation response very first thing in the morning. Get up, go to the bathroom, shower, sit quietly and repeat something appropriate for you: a word, sound or phrase. When other thoughts come to mind, they're natural and expected. Just say, "Oh well," and return to the repetition.

Let's say you're using the word peace in repetition. First of all, you will be less angry throughout the day. Secondarily, if you find yourself in a traffic condition which is making you angry, take a deep breath with eyes open, when you're stopped in your car, and slowly let it out, and as you're doing that, say the word peace.

That will bring forth a mini-relaxation response, which can counteract the harmful effects of stress and interrupt what could be an escalating set of angry thoughts. Once again, that should not be done in your car if you are moving. But only when the automobile is stopped.

MODERATOR:
Do you have any final words for us, Dr. Benson?

BENSON:
I thank you for this opportunity. I wish you good health and well-being.

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