The Mind/Body Connection
Stress is an ignorant state. It believes that everything is an emergency.
Real People, Real Stories
Sam Hamilton received a diagnosis of prostate cancer on a routine physical exam. His way of coping included obtaining as much information on the disease as possible. He researched the most up-to-date treatment options and sought the advice from physician friends as to which surgeons had the most experience with this type of surgery. As he shared his diagnosis with friends and colleagues, he found several men who had successfully survived without a cancer recurrence. Sam used the time between diagnosis and surgery to finish projects and delegate work responsibilities. He attended a support group with his wife and was able to obtain valuable advice on handling his emotional responses to what would happen. When the time came for his surgery, Sam was still apprehensive, but he felt as though he had done everything humanly possible to prepare for it. The actions he took before surgery reduced his stress.
“A sound mind in a sound body is a short but full description of a happy state in this world” - John Locke, philosopher, 1693
Over 300 years later, Locke’s insight into health and happiness still has relevance for us. We may have widely differing experience with stress, yet one thing is for sure; what is going on with your mind and emotions is at least as important, if not more so, than what is happening in your body. In fact, what is going on in your mind determines what is happening in your body.
Psychological health, which encompasses both our emotional and mental health, is instrumental in determining physical health. Emotional health relates to the ability to understand your feelings and achieve emotional balance. Mental health is a state in which your mind is engaged in lively, healthy interaction both internally and with the world around you. Psychologically healthy people develop awareness and control of their thoughts and feelings. The outcome is a healthy, fulfilling, satisfying life.
When you look in the mirror, what do you see? You see your body, your hair, your skin, your muscles, your face. You can see and you can understand how your body works. We can measure blood pressure and hormones and heart rate, but what about your mind? Can you measure an emotion? Can you see a thought? Can you prove that your outlook changes your level of stress? For decades scientists have studied how stress affects the body. As you learned in previous chapters, the body of knowledge explaining the physiology of stress is substantial. More recently researchers have been studying the mind-body connection to understand how thoughts and emotions relate to our experience with stress.
We know today beyond question that the mind and emotions have a powerful and very real impact on the body. “The mind clearly can have a profound effect on every aspect of physiologic functioning,” says James Gordon, M.D., Director of the Center for Mind-Body Studies in Washington, DC. “Individuals who are chronically pessimistic, angry, anxious or depressed are clearly more susceptible to stress and illness, including heart disease and cancer.” Similarly, almost every medical illness affects people psychologically as well as physically (Hales, 2003).
It is clear that stress affects your body, your physiology. In chapter three you learned about how the stress response activates a specific physiological process in your body. But what part does your mind play in your experience with stress? How amazing it is that the complex physiological process, the stress response, starts with a single thought. Your thoughts, your feelings, and your emotions have a profound impact on the quality of your life.
FYI – The Evolving Science of Stress
Read this excerpt from the online NIH video, Celebrating American Women Physicians, about Dr. Esther Sternberg’s experience as a physician and scientist.
Dr. Esther M. Sternberg – Physician and Scientist
It's really hard to say "Okay, I've made a discovery, and I know I've helped thousands of people, or millions of people." It's when you see the one patient that really has benefited from that discovery that you really know that you've helped. When the family member can come up to you and say, "Thank you, you helped save my mother." That really makes a difference. And I think that's what motivated me from the beginning when I started seeing patients on a one-on-one basis, when you know that you've saved a life. And then if you make a discovery in the lab, in a rat, that you know can be applied to saving many lives – that really is tremendously rewarding. For so many thousands of years, the popular culture believed that stress could make you sick, that believing could make you well. And people believe what they feel. But scientists need evidence. And there really wasn't any good, solid scientific evidence to prove these connections. Nor was there a good way to measure them. And scientists only believe what they can actually measure. Once scientists and physicians believed that there was a connection between the brain and the immune system, you could then take it to the next step: that maybe there is a connection between emotions and disease. Between negative emotions and disease, and positive emotions and health. And we can then say, okay, maybe these alternative approaches that have been used for thousands of years – approaches like meditation, prayer, music, sleep, dreams – all of these approaches that we really know in our heart of hearts really work to maintain health... Maybe there is a scientific basis for it.
In this chapter, we will explore the fascinating relationship between the mind and the body to better understand the role of stress in both disease and health. You will read about landmark scientific studies that provide a solid foundation of undeniable scientific evidence explaining the connection between the body and the mind. You will see how you can use this information not only to prevent disease, but also to promote optimal health.
The Role of Stress in Disease
Have you ever heard someone say, “She’s not really sick. It is all in her head?” For years the common perception of psychosomatic illness was that it was not real. That somehow the person just imagined that they were sick or didn’t feel well. Illness was caused by things like germs, radiation, tobacco, or diet. There was simply no way that our mind or our thinking could actually be the cause of our ill-health.
Thankfully, we have come a long way in our understanding of psychosomatic conditions. Psychosomatic originates from the core words psyche, meaning the mind, and soma, meaning the body. So, conditions that have a mind and body component are often called psychosomatic. Today psychosomatic conditions may also be called psychophysiological to avoid some of the negative connotation that it is somehow imagined.
Hundreds of studies over the last 20 years have shown that stress contributes to a significant percent of all major illness, including the number one cause of death in America, cardiovascular disease. Cancer, endocrine disease, emotional disorders, and a vast array of other stress related diseases and disorders account for many visits each year to health care providers. See the FYI -The Impact of Stress for some powerful statistics.
FYI – The Impact of Stress
According to Healthy People 2000, a report from the U.S. Department of Health and Human Services, stress has a great impact on our health. Did you know that:
Chronic Stress and Disease
What feedback might your mind and body send indicating continued activation of the stress response? In chapter three, you learned that chronic stress can result in exhaustion, the final stage of the general adaptation syndrome. If the fight or flight response remains activated for an extended period of time, we start to experience certain physical and emotional effects.
Chronic stress can be the result of many repeated rounds of acute stress (episodic acute stress) or a life condition, such as a difficult job situation or chronic disease. In either case, the stress response remains activated as if we are thinking we should be running from the big bear. The thought of threat, on a continual basis, sends the message to our systems that our survival mechanisms of fight-or-flight need to be continually activated. As a result, the normally functioning systems of the body cease to function so perfectly.
Awareness of both the medium-term and long-term effects of chronic stress can help you understand why preventing and managing stress is essential for your good health.
Medium-term Effects of Chronic Stress
Medium-term effects of chronic stress can include unpleasant signs and symptoms such as:
If we consider what is happening during the stress response, we can understand why these maladies happen. When the big bear shows up, we want and need to run or fight. Many functions in the body turn off because they are not needed to get away from the big bear. Other functions in the body are activated to higher than normal levels. However, when we are not in danger, continued activation of the stress response is not necessary. Remember, you only need to think you are in danger for the stress response to activate.
Following are examples of how continued activation of the stress response results in decreased wellbeing.
Muscle Tension and Pain: Do you ever feel like your muscles are so tight that your shoulders are pulled up around your ears? Do you ever experience pain and stiffness from tight neck muscles? A muscle is not normally in the contracted state for prolonged periods of time. A muscle is supposed to contract only when it receives a message to contract. When a muscle is told to fight or run for prolonged periods of time, it will remain in the contracted state longer than necessary. When this happens, we notice two obvious results. One of these is pain and the other is fatigue. When a muscle stays contracted, it activates nervous system pain receptors that deliver the message of pain.
Headaches: A headache may result from muscles that tighten in response to a threat. If those continually contracting muscles are on our head, the result is a headache. This explains why people take muscle relaxants to help them ease the pain of the headache. A headache can provide important feedback that the way we are thinking about what is happening in our environment is causing tension.
Fatigue: The other effect of continued contraction of muscles is fatigue. Have you ever come home from a rough day at work or school and you find yourself totally exhausted, yet, you have exerted little physical effort? When a muscle is continually receiving the message to be ready for action, fatigue will result. It requires considerable energy for muscles to stay active.
Upset Stomach: We do not need the digestive system when we are running from the big bear. The digestive system ceases to effectively coordinate all of the processes necessary to break food down. It won’t transport the food from the digestive system to the bloodstream as effectively when the stress response is continually activated.
Difficult time going to sleep: It should not take more than a few minutes to fall asleep. We should also sleep comfortably through the entire night without waking up several times. Sleeping is a natural experience. If we are having a hard time falling asleep, it may be because our minds are thinking too much of other things. One physiological response of fight-or-flight is increased or altered brainwave activity. When we go to sleep, we want to decrease brainwave activity. That can only happen as we are able to turn off the stress response.
Research Highlight – Sweet Dreams
Researchers report some interesting findings associated with sleep and our natural need to dream. A study was set up with college students as the subjects. Each of the volunteers was asked to participate in normal activities during the day. Rather than going to their homes to sleep at night, they agreed to come to the “sleep lab” to participate in the experiment. As the students slept, the researchers monitored brainwave activity and visually watched for Rapid Eye Movement (REM) which would indicate that the subjects had begun dreaming.
As soon as the subjects started into a dreaming pattern, the researchers would immediately awaken them in order to interrupt their sleep patterns. The researchers continued these interruptions throughout the night for several weeks. During this period, the students were monitored to see what affect this dreamless sleeping would have on them. The students became sick more frequently, they struggled in their ability to concentrate, and they were more fatigued and more easily agitated. What is most interesting is that some students reported seeing hallucinations while wide awake. They saw things that weren’t there. Apparently, the body and mind have a natural need to sleep a specified amount of time each night and they react adversely if this sleeping and dreaming are disrupted on a regular basis.
It is like a two-edged sword: Stress can affect the ability to sleep and lack of sleep can affect the ability to cope with stress and anxiety.
Cold or sore throat: Another system that is turned down during the stress response is the immune system. The immune system is our internal defense mechanism that keeps us from contracting the cold or latest flu that is going around. Without a strong immune system, the virus can get the upper hand and we are in bed for a week recovering. We do not need the immune system to run from the big bear so it turns down its high functioning protection. Have you ever noticed that you tend to get sick more frequently after you go through a stressful experience? Since the immune system is unable to work as effectively when you are stressed, you are more susceptible to every disease and illness that crosses your path.
Research Highlight – The Cold, Hard Facts
The common cold is not an equal-opportunity attacker, according to recent research from psychologist Sheldon Cohen. Why is it that some people seem to rarely catch a cold in spite of being exposed to hoards of sneezing, sniffling cold-sufferers, while others seem to catch every bug that comes along? There is a growing body of evidence that suggests that factors such as personality, stress, and social life can all affect our vulnerability to the common cold. Cohen’s research at Carnegie-Mellon University involves exposing volunteers to colds by dropping rhinoviruses into their noses. Following five days of quarantine, medical exams and questionnaires reveal the following:
*Happy, relaxed people are more resistant to illness than those who tend to be unhappy or tense. Adults with the worst scores for calmness and positive mood are about three times more likely to get colds than the more relaxed and contented adults. When happy people do get sick, their symptoms are milder.
*Serious work-related or personal stress for at least a month increases the chances of catching a cold. The longer people live with bad stress, the more likely they were to catch cold in the lab.
Looks like you can add “ less colds” to your list of stress management benefits (Elias, 2003).
This list of annoying maladies is the result of the stress response causing imbalances throughout normally functioning systems in the body. Again, these provide feedback to us that we should make some changes. It is important to keep in mind that whatever system turns on or off is in direct response to what we would need in order to run from or fight the big bear. When this happens for an extended period, our health suffers.
Long Term Chronic Stress
While the medium-term effects of chronic stress are unpleasant and annoying, the long-term effects are dangerous and contribute to disease, suffering and even death.
Stress and the Heart
Cardiovascular disease is the number one cause of death in the United States. One of the most devastating results of long-term chronic stress may very well turn out to be its impact on cardiovascular disease. What is the relationship between cardiovascular disease and stress?
Increasingly evidence suggests a relationship between the risk of cardiovascular disease and environmental and psychosocial factors. These factors include job strain, social isolation and personality traits. More research is needed to fully understand how stress contributes to heart disease risk and whether or not stress acts as an "independent" risk factor for cardiovascular disease. Acute and chronic stress may affect other risk factors and behaviors, such as high blood pressure and cholesterol levels, smoking, physical inactivity and overeating (American Heart Association).
While the research continues, researchers have made some important advances in understanding how stress affects cardiovascular disease. Here are some of the findings:
Stress and the Immune System
Stress also has a profound impact on the immune system, the network of organs, tissues, and white blood cells that is responsible for defending the body against disease. The powerful stress hormones suppress the immune system making the body less capable of fighting disease and infection. Simply stated, stress suppresses the immune system’s ability to produce and maintain lymphocytes (the white blood cells necessary for killing infection) and natural killer cells (the specialized cells that seek out and destroy foreign invaders), both crucial in the fight against disease and infection (Hoeger, 2002). Impaired immunity makes the body more susceptible to many diseases, including infections and disorders of the immune system itself such as the autoimmune disease rheumatoid arthritis.
We now have entire areas of science that study the relationship between the body and mind. One interesting field of scientific inquiry studies the chemical basis of communication between the body and mind as it relates to the nervous system and the immune system. This area of study is called psychoneuroimmunology (PNI). Psychoneuroimmunology seeks to understand the complex communications between the nervous system, the psyche, and the immune system, and their implications for health.
Research Highlight – Psychoneuroimmunology Finds Acceptance As Science Adds Evidence
According to Margaret Kemeny, an associate professor of psychiatry and biobehavioral science at the University of California, LA, psychoneuroimmunology (PNI) research has exploded in the last decade. Recent work has demonstrated that hormones and neurotransmitters released under stress can change immune cell behavior. These various cells actually have receptors to “hear” the signals, allowing the nervous, endocrine, and immune systems to “talk”.
For example, studies with a group of medical students focused on the effects of academic stress and a response to a hepatitis B vaccine, which would mimic response to an infectious agent. These studies showed antibody and immune cell responses were diminished in those with more anxiety, higher stress and less social support.
(The Scientist 10 (16):14, Aug. 19, 1996)
The affects of a compromised immune system are far-reaching including everything from susceptibility to the common cold, to the rate of wound healing, and even a link with breast cancer development. Following is a brief summary of several studies linking stress to its effect on the immune system.
Research Highlight - Chronic Stress and Immunity
Researchers at Ohio State University in Columbus, have discovered a link between chronic stress and a body chemical that is associated with the development of serious and even deadly conditions.
Dr. Janice Kiecolt-Glaser, a professor of psychology and psychiatry, and colleagues studied a group of 119 men and women who were dealing with the stress of caring for a spouse with dementia. These caregivers were compared with a control group of 106 individuals of similar age and health status who did not serve as caregivers. Over the six-year study, blood tests showed that a chemical known as interleukin-6 (IL-6) dramatically increased in the caregivers as compared to the non-caregivers. IL-6 is a chemical known as a cytokine that is involved in the body’s immune system. Overproduction of IL-6 has been associated with the development or progression of a number of medical conditions, including heart disease, type 2 diabetes, certain types of cancer, osteoporosis, arthritis, and functional decline. Even is the spouse of the caregivers died, the increased levels of IL-6 persisted for several years in the group of caregiving spouses.
This research may offer one possible explanation for the link between stress and illness by suggesting that stress may increase the risk of many typical age-associated diseases by altering the immune response. This data underscores the need for stress management and control of chronic stressors.
Other Symptoms of Stress
Long term, chronic stress not only increases the risk of cardiovascular disease and compromises the immune system, the American Institute of Stress issued this statement about the long-term effects of stress:
Many of these effects are due to increased sympathetic nervous system activity and an outpouring of adrenaline, cortisol, and other stress-related hormones. Certain types of chronic and more insidious stress due to loneliness, poverty, bereavement, depression and frustration due to discrimination are associated with impaired immune system resistance to viral linked disorders ranging from the common cold and herpes to AIDS and cancer. Stress can have effects on other hormones, brain neurotransmitters, additional small chemical messengers elsewhere, prostaglandins, as well as crucial enzyme systems, and metabolic activities that are still unknown. Research in these areas may help to explain how stress can contribute to depression, anxiety, and its diverse effects on the gastrointestinal tract, skin and other organs. (www.stress.org)
All of the following disease conditions have been shown to have a stress component:
As you can plainly see, we pay a heavy price when we have too much stress in our lives.
Culture Connection – In a Climate of Overwork, Japan Tries to Chill Out.
Karoshi in Japanese means death-by-overwork. Karoshi is a rising social concern that has resulted directly from the well-known Japanese hard-working society that produced the highest productivity for its economy in the late 20th century. In 2001, the government reported a significant increase in fatal heart attacks and strokes due to overwork, with the hardest-hit professions being information technology experts, doctors, teachers, and taxi drivers. They also reported a record high number of suicides, many related to the economic downturn. In its evaluation of working practices in the 6 months before death, the Japanese Health, Welfare and Labor Ministry found that the karoshi victims were working an average of more than 80 hours each week.
The good news is that many Japanese workers and businesses are starting to look for options to help relieve sutoresu – the Japanese word for stress. English gardening, aromatherapy, reflexology, pets, and herbs have joined the traditional leisure pursuit of hot-spring bathing in a boom in iyashi, a word that conveys a mixture of healing, calming, and getting close to nature. Until 10 years ago, the word iyashi was largely unknown outside the psychiatric profession where it was used to denote a form of healing and relaxation for those who were overworked and overstressed. Now, however, many Japanese, especially young women, want to relax and enjoy the fruits of their labor.
The bad news is that the ingrained belief that personal wellbeing should be sacrificed for one’s company means that compromises have to be made even for the most iyashi-conscious consumer. Despite the iyashi boom, Japan seems to be working harder than ever. Labor statistics show that the average worker takes only 49.5% of their 18-day vacation allowance. Interestingly, this hard work is creating economic as well as psychological problems because many of the workforce do not have enough free time to spend their money, which slows economic activity. (Watts, 2002)
In his interesting book, Mind as Healer, Mind as Slayer, Kenneth Pelletier summed it up when he wrote, “Generalized, and unabated stress places a person in a state of disequilibrium, which increases his susceptibility to a wide range of diseases and disorders.” There is no way to predict which maladies you will experience from too much stress in your life. There are too many factors involved. One thing you can know with certainty, keeping the stress response activated increases your risk for many diseases and decreases the quality of your life.
The Role of Stress In Health
What about stress and health? You now have a good understanding of how stress can result in disease and poor health, but is this an inevitable process? One thing the stress research shows beyond any doubt is that stress alone will not cause illness. How a person reacts to stress is the critical factor on whether the outcome is positive or negative. Personality and an individual’s way of viewing the events in life will determine the impact of stress. While it is interesting and important to explore the role of stress in disease, our focus in Stress Management for Life is on promoting optimal health.
Why is it that in a world full of stressors, some people seem to be immune to the ravages of stress? Why is it that when two people are exposed to identical stressors one will experience stress-induced symptoms while the other will come through in a positive and healthy manner? Too often we ask why someone became ill, when the more profound and important question might be, “How did this person manage to stay healthy?” We know that some individuals come through periods of great chronic stress, not only without disease, but actually with more physical and mental vigor than they had before. What is it about these people that makes then different?
We know that our behaviors influence health. Every day lifestyle choices like what you eat for breakfast, whether you get adequate sleep, how you choose to exercise your body, and whether you smoke and drink have a profound impact on health. But could there be other factors, in addition to our behaviors, that play a role in our ability to withstand stress and stay healthy? Research indicates that personality may be a key determinant in how well we are able to resist the negative influences of stress.
Personality and Stress
Do you think there is such a thing as a stress-resistant personality or a stress-prone personality? And is this personality a result of heredity or environment? In other words, were you born with a personality that makes you more or less prone to stress? If so, is it really possible to change your personality? You all know that behaviors influence health. Eating a balanced diet, including daily exercise in your schedule, and sharing quality time with your friends are examples of some of the behaviors that clearly relate to better health. But is it possible that something other than behavior could play a role in your ability to manage stress and maintain health? An impressive body of research indicates that personality is a major determinant in how well you deal with stressors in your life.
Understanding the personality traits that contribute to good health will help you determine what works for you in stress management. Our intention is not to open a discussion on the validity of the many personality theories, but rather to get you thinking about your personality traits and how they contribute to your ability to successfully manage stress. The cumulative results of studies conducted over the past few decades show beyond a doubt that certain personality traits keep us well, boost our immunity, and improve our immune system.
Dr. Suzanne Kobasa’s research helps us understand why individuals who despite stressful circumstances appeared resistant to the psychophysiological effects of stress. In other words, what prevents stress from leading to illness for some people but not for others? Kobasa, who teaches psychology in the City University of New York’s graduate school, was very familiar with the latest research that drew definite connections between stress and illness. The more she pondered the stress-illness connection, the more engrossed she became with the people who didn’t get sick under stress. She mobilized a group of her colleagues and went to work on a study of what she calls “the walking wounded of the stress war” – a group of high-powered business executives faced with personal and career upheaval (Karren et al., 2002).
Kobasa and her colleagues studied over 700 AT&T executives during the period of federal deregulation when many executives lost their jobs. Study subjects were given a version of the Holmes and Rahe stress inventory along with a checklist of physical symptoms and illnesses. Hundreds of executives showed physical symptoms of stress. But, under the same circumstances, a smaller group of individuals emerged who did not experience symptoms of stress. When this smaller group was studied further, it became clear that what distinguished them from those who succumbed to the stress were specific personality traits enabling them to cope with their perceptions of stress.
Three specific personality traits that collectively acted as a buffer to stress emerged from Kobasa’s study. These three traits, commitment, control, and challenge, describe what has come to be called the hardy personality.
Hardiness is “a set of beliefs about oneself, the world, and how they interact. It takes shape as a sense of personal commitment to what you are doing, a sense of control over your life, and a feeling of challenge.” The personality traits of hardiness are commonly known as the three Cs:
Other studies similar to Kobasa et al. have yielded remarkably consistent findings. Healthy controversy surrounds some of these studies, but you will learn in future chapters that there are many “stress buffers” or elements that alleviate the negative effects of stress and promote health. Factors such as social support, self-esteem, optimism, a sense of humor, and physical fitness all help to buffer stress.
Lawrence Hinkle and his colleagues at New York Hospital’s Cornell Medical Center conducted a series of studies over a twenty-year period. They found that personality traits had a definite bearing on health. Their conclusion sums it up well. Those people with a good attitude and an ability to get along with other people enjoyed the lowest frequency of illness.
Can hardiness be developed? Researchers believe so. Are we stuck with the personality we were born with? This question is a little trickier. Many experts support the premise that yes, we are born with a personality type, but we can absolutely develop a more disease-resistant, health- promoting personality. You will learn specific skills and techniques in the coming chapters that will guide you in this process.
In this chapter, we explored the fascinating relationship between the mind and the body to better understand the role of stress in both disease and health. Scientific studies provide a solid foundation of undeniable scientific evidence explaining the connection between the body and the mind. You can use this information not only to prevent disease, but also to promote optimal health.
* Psychophysiological conditions have a mind and body component and are supported by science.
*Chronic stress is a contributing factor for a large number of illnesses and diseases.
* Medium-term stress results in an array of unhealthy signs and symptoms including muscle pain, headaches, fatigue, and sleep disturbances.
* Long-term stress results in serious health problems including cardiovascular disease, compromised immune function, and digestive disorders.
* Psychoneuroimmunology seeks to understand the complex communications between the nervous system, the psyche, and the immune system, and their implications for health.
* Certain personality traits can play a role in how we deal with stress to promote health.
* Hardiness is a set of beliefs about oneself, the world, and how they interact. It takes shape as a sense of personal commitment to what you are doing, a sense of control over your life, and a feeling of challenge.
American Heart Association fact sheet, Can Managing Stress Reduce or Prevent Heart Disease, found at www.americanheart.org.
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