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Under pressure

Stress is one of the most significant health issues facing Canadians today, contributing to numerous problems including heart disease, high blood pressure, diabetes and depression. Are you at risk?

Planning and perspective Stress-busting tips The stress response Coping with stress

BY JOEL SCHLESINGER
Winnipeg Health Region
Wave, May / June 2009

Even when times were good, Valerie Chatain-White understood
that her job as a financial advisor carried with it a certain amount of stress. But with the sudden economic downturn of the last six months, the Winnipeg woman's coping skills have really been put to the test.

At this time last year, she urged her clients to curb their euphoria about the bull market conditions as stock values hit record levels. But in the span of just a few weeks last autumn, stock prices crashed. A bear market was at hand, and a different set of sensations sunk in for investors - fear and disillusionment.

"There's certainly been more stress," says Chatain-White. "Anytime you have the extremes of greed and fear in the consumer's mind, it usually means more work for the advisor."

Fortunately for Chatain-White, she has been able to handle the additional stress without missing a beat. That's partly because she recognizes the source of her stress and has the experience and skills to deal with it. But it's also because she takes care of herself: she exercises regularly, eats well and has a number of interests outside her work.

For others, however, coping with stress can be more challenging. Over the years, stress has emerged as one of the most significant health issues facing Canadians. And while the temporary stressors of daily life are not necessarily life-threatening, prolonged feelings of stress - no matter what the source - can contribute to serious health problems, including heart disease, high blood pressure, diabetes and depression. It's also believed that stress can undermine health because it can lead to increased drinking, smoking and drug use.

"It (stress) is a normal part of the wear and tear of life," says Marion Cooper, a program specialist with the Winnipeg Health Region's Mental Health program. "But it can also take a toll on your life."

Of course, not all stress is bad. For example, the stress one feels when taking on a challenge and succeeding can be good and is actually part of a person's natural development and growth as a human being. Complicating things is the fact that we all react to stress differently. As Cooper explains, two people may work in the same environment and have the same frustrating boss. But one may be able to handle it and continue working, while the other may well need to find a new job in order to preserve their mental and physical health.

In order to deal with stress, it is important to understand what it is and how it affects mind and body. Dr. Murray Enns, Medical Director of Mental Health for the Winnipeg Health Region, says stress is a person's response to demands or pressures that are perceived to be threatening or exceed the person's ability to cope.

"The whole concept of stress is predicated on the idea that in order for a situation to be stressful, it must be interpreted as being stressful. While some situations are inevitably stressful for almost anyone, some situations that are quite benign for one person may be quite challenging and difficult for another," Enns says.

The stress response is controlled by the hypothalamus, the part of the brain responsible for regulating the body's metabolic functions with bio chemicals called hormones. Think of the hypothalamus as your internal thermostat, regulating the interior at a constant temperature and blood flow at a steady, manageable rate.

Once someone perceives themselves to be in a stressful situation, the body undergoes a series of chemical changes. For example, Noradrenaline, a chemical known as a neurotransmitter because it helps cells communicate with each other, rises in the brainstem and projects to the brain and spinal cord. Another chemical - Adrenaline - is also released into the bloodstream and carried to organs throughout the body. Stress also activates the HPA (hypothalamic, pituitary, adrenal) axis, which ultimately results in increased levels of cortisol, which has widespread effects on organ systems. Other hormones involved in the stress response, include vasopressin, thyroid hormone and endorphins.

All of these chemicals work differently in the body, but all ultimately contribute to what is called the "fight or flight" response, which is characterized by increased heart and respiratory rate, increased sweating (to dissipate heat), increased blood flow to muscles, and decreased blood flow to digestive organs.

Enns says this reaction typically occurs in a highly threatening situation and has been with us since cave-man days. (If mental images of prehistoric tribes-people fleeing a sabre tooth tiger or hunting a woolly mammoth come to mind, you're not far off base.)

"In other words, the fight or flight response prepares the individual to take prompt and decisive action. All of these physical preparations make the individual better able to either run or to respond physically to the threat. This would represent an advantage to the individual and would have been favoured in an evolutionary context," says Enns.

Modern man does not typically confront such highly threatening situations in daily life. However, the "fight or flight" response can be activated by more common stressors, such as relationship discord, frustrating moments or when one feels a loss of control. Other stressors are episodic, and can more acutely tax a person's coping abilities. "Some typical examples include bereavement, divorce or separation, job loss, personal illness, retirement or financial losses," says Enns.

The chemical changes in the body caused by perceived stress can affect a person's immune system and resistance to variety of diseases. In the short term, stress can result in feelings of tension and anxiety. In the long term, chronic lower-grade activation of stress responses can contribute to physical conditions such as high blood pressure, and heart disease. It can also affect the blood sugar levels of people with diabetes. "The course of many different emotional disorders (e.g. clinical depression, generalized anxiety, panic disorder) are also strongly influenced by stressful life events," Enns says.

Fortunately, there are many techniques available to help control and relieve stress.

Valerie Chatain-White, for example, does a number of things to maximize her wellness. A couple of mornings each week, she rides the stationary bike at home while catching up on reading. Other mornings, she swims, then takes a few laps around the track at the gym. On weekends, she unwinds with golf and cycling in the summer and cross-country skiing in the winter. But her fitness regime is more than just about having a healthy body. It's about having a healthy mind. "It makes me feel better and really enables me to survive the days," she says.

Cooper says Chatain-White has the right idea. Most people can handle regular stressors that arise from daily life - challenges at work, car repair bills, personal issues - simply by taking care of themselves: eating well, exercising regularly (which helps reduce the production of stress hormones). "These strategies reinforce the importance of that body-mind connection to be physically active to manage stress," she says.

Social networks of friends and family can also be helpful in relieving stress. One of the leading experts in the field of stress research is Dr. Robert Sapolsky, a neuroscientist at Stanford University in California. He has spent more than three decades researching the effects of stress on our health, much of it studying wild baboons in Africa.

In a 2007 article by the Stanford News Service, Sapolsky explained that primates share many similarities with human beings when it comes to how they respond to stress. Baboons, like humans, are very intelligent and have complex social hierarchies compared with other animals. At the top of the food chain, they feel no threat from predators, and they spend very little time searching for food. This leaves them with a lot of time for socializing and climbing the social ladder.

"So the baboon is a wonderful model for living well enough and long enough to pay the price for all the social-stressor nonsense that they create for each other," Sapolsky told the Stanford News Service. "They're just like us: They're not getting done in by predators and famines, they're getting done in by each other."

Not surprisingly, Sapolsky found the baboons that experience the most psycho-social-related stress were often at the bottom of the baboon community. Research also revealed that Type A individuals - those who are controlling and in charge - were also among the most stressed-out baboons. These baboons not only experienced greater levels of stress; they also had poorer overall health. But research also revealed another factor that helped some baboons of low rank live healthier lives than others of similar status: social connectedness.

Unlike apes, people have a much greater ability to overcome social rank, and it's also much easier for us to break free of our social isolation - or so it would seem. The lesson here is clear: people who experience some stress or a lot are often better equipped to deal with it if they have a good social network of family and friends.

Of course, the stress we experience can become so overwhelming that even the support of friends and family isn't enough. Extremely unpleasant experiences - such as serious accidents, sexual and physical abuse, and witnessing acts of violence - can cause such extreme stress responses in the body that they may lead to a longerlasting mental disorder known as posttraumatic stress disorder (PTSD). In people with PTSD, the mind's ability to switch off the stress response is impaired. People diagnosed with PTSD often complain of trouble sleeping, flashbacks to the stressful events, nightmares and mood swings.

"Among the anxiety disorders, PTSD is often associated with the greatest impairment," says Dr. Jitender Sareen, an associate professor of psychiatry at the University of Manitoba.

In the past few years, Sareen and other researchers at the university have published studies on both PTSD and panic disorders and their effects on physical and mental health. A 2006 study on panic disorders revealed that people who experience higher levels of stress and anxiety also are more likely to be afflicted with physical health problems like migraines and diabetes, Sareen says. "This study showed that even if you took out the effects of depression, alcohol and drug problems, anxiety still was associated with a lot of physical health problems," Sareen says, adding that anxiety is a mental state of high stress.

When we are no longer able to manage, we can reach a breaking point, and that is when mental health care providers often need to intervene.

Cooper says crisis intervention mental health services are available throughout the Winnipeg health region when people are no longer able to cope with mental health issues, including stress. "The services will provide telephone support, but they are different in that they also do mental health assessments and will send out a team."

Many mental health programs, however, aim to educate the public to deal with stress and its related problems before it reaches crisis levels. Education includes promoting healthy eating, regular exercise and fostering positive social relationships.

Programs also focus on helping people understand how stress can affect their lives. Central to our ability to cope with life's challenges - big and small - is being able to identify them and understand how we respond to them. "Usually, people know over time that things are getting worse," Cooper says. "As things build up, people's ability to cope with what's going on for them is reduced, and it can be some little thing that sets them off, like road rage."

What many do not realize, however, is that there are contributing factors, which we can easily control, that lead to a mental meltdown. "What makes people vulnerable to that experience of losing control is that they are probably not taking care of their physical needs," Cooper says. "They are hungry, tired and feeling isolated and alone on top of all the stress."

It may be cliché, but taking a deep breath and pausing to think about how we feel will help. "Once you know what the problem is that is eating away at you, then you can begin to do something about it," Cooper says.

Joel Schlesinger is a Winnipeg writer.

	About Wave Wave is published six times a year by the Winnipeg Health Region in cooperation with the Winnipeg Free Press. It is available at newsstands, hospitals and clinics throughout Winnipeg, as well as McNally Robinson Books. Read the May / June 2009 issue of Wave