What to do when you are continually stressed
When I was at school, examinations and teachers were a constant source of stress. I looked forward eagerly to finishing and going to college where I felt I would be treated like an adult. Unfortunately, this did not happen.
College had its own share of stresses. Then came the search for jobs, the hard grind of non-stop duties day and night, more exams to become a specialist and consultant. I quit my job as a gynecologist when I realized that my clinical decisions were influenced more by the fear of litigation than evidence-based practice. Marriage, family pressures, job transfers and finally retirement — none of these have been, and are, without stress.
Stress is a normal biological reaction to a potentially dangerous situation. When you encounter sudden stress, your brain floods your body with chemicals and hormones such as adrenaline and cortisol. Stress triggers your fight-or-flight response in order to fight the stressor or run away from it. Typically, after the response occurs, your body should relax. Too much constant stress can have negative effects on your long-term health.
Is being stressed bad for health?
Stress isn’t necessarily bad for health. It’s what helped our hunter-gatherer ancestors survive, and it’s just as important in today’s world. It can be healthy when it helps you avoid an accident, meet a tight deadline, or keep your wits about you amid chaos.
We all feel stressed at times, but what one person finds stressful may be very different from what another finds stressful. An example of this would be public speaking. Some love the thrill of it and others become paralyzed at the very thought.
Temporary stress occurs before examinations, a driving test, a tournament, or even your wedding day. Once you’ve passed the fight-or-flight moment, your heart rate and breathing should slow down and your muscles should relax. In a short time, your body should return to its natural state without any lasting negative effects.
A bit of stress is a normal part of our daily lives, which can even be good for us. Overcoming stressful events can make us stronger and more capable of facing the real world. But when the stress is severe or chronic — for example caused by the breakdown of a marriage or partnership, unemployment, illness and/ or death in the family, or bullying — it needs to be dealt with immediately.
That’s because repeated stress can have a huge impact on our brain, putting us at risk of a number of physical and psychological problems.
Repeated stress is a major trigger for persistent inflammation in the body. Chronic inflammation can lead to a range of health problems affecting the whole body. When there is constant stress,the brain, which is normally protected by a blood-brain barrier, is exposed to inflammatory proteins that can cause temporary or permanent damage to the brain cells.
The brain’s hippocampus is a critical brain region for learning and memory, and is particularly vulnerable to such insults. Studies in humans have shown that inflammation can adversely affect brain systems linked to motivation and mental agility.
Chronic stress stimulates release of cortisol, corticotropin releasing factor (CRF)and adrenocorticotropic hormone (ACTH). Cortisol is a steroid produced by the adrenal glands in the body. These glands are located on the top of each kidney.
CRF is produced by the hypothalamus located just above the pituitary gland.
The pituitary gland, also known as the master gland, produces hormones that regulate the secretions of most of the endocrine glands in the body. CRF stimulates the pituitary to produce ACTH which in turn stimulates the adrenal gland to produce cortisol.
High, prolonged levels of cortisol have been associated with mood disorders as well as shrinkage of the hippocampus. It can also cause many physical problems such as hypertension, diabetes and irregular menstrual cycles.
Brain changes — Mood, cognition and behavior
Chronic stress can result in:
- headaches and/ or migraine
- alcohol or drug abuse
- anorexia (total loss of appetite)
- social withdrawal
It is well known that chronic stress can lead to depression, which is a leading cause of disability worldwide. Depression is also a recurrent condition — people who have experienced depression are at risk for future bouts of depression, particularly under stress.
There are many reasons for this, and they can be linked to changes in the brain. The reduced hippocampus that a persistent exposure to stress hormones and ongoing inflammation can cause is more commonly seen in depressed patients.
Chronic stress ultimately also changes the chemicals in the brain which modulate cognition and mood. The most important among these is serotonin. Serotonin is important for mood regulation and well-being. In fact, inhibitors of serotonin uptake (SSRIs) are used to restore the functional activity of serotonin in the brain in people with depression.
Sleep and circadian rhythm disruption is a common feature in many psychiatric disorders, including depression and anxiety. Stress hormones, such as cortisol, play a key modulatory role in sleep. Elevated cortisol levels can therefore interfere with our sleep.
Depression can have huge consequences. It impairs cognition in both non-emotional domains, such as planning and problem-solving, and emotional and social areas, such as paying more attention and acting on fake news provided by social media and What’s App groups.
In addition to depression and anxiety, chronic stress and its impact at work can cause burn out. As individuals are required to take on increased workload at work or school, it may lead to reduced feelings of achievement and increased susceptibility to anxiety, creating a vicious cycle.
Stress can also interfere in the balance between rational thinking and emotions. For example, whenever a lock-down is announced due to the local community spread of COVID-19, people rush to hoard food supplies, toilet paper, and hand sanitizers. Shops are becoming empty of these supplies, despite reassurance by the government that there is plenty of stock available.
This is because stress may force the brain to switch to a “habit system”. Under stress, brain areas such as the putamen, a round structure at the base of the fore-brain, show greater activation. Such activation has been associated with hoarding behavior. In addition, in stressful situations, a part of the prefrontal cortex, which plays a role in emotional cognition — such as evaluation of social affiliations and learning about fear — may enhance irrational fears. Eventually, these fears essentially override the brain’s usual ability for cold, rational decision-making.
Stress will never go away completely till you die. In my opinion, there is no life without stress and no stress without life. However, there are a few things that we can do to minimize it:
- Identify the factors and triggers that are causing stress and see if you can avoid them
- Maintain a good, nutritious diet
- Aim for 7 — 8 hours sleep each night
- Exercise regularly
- Take up a hobby or something that really interests you
- Minimize intake of coffee, tea and alcohol
- Stay socially connected, both physically and on social media, to get and give support
- Take time out for rest and relaxation
- Use destressing measures such as deep breathing, meditation and relaxing yogic exercises
Exercise has established benefits against chronic stress. Exercising leads to an anti-inflammatory response. It releases endorphins in the brain. The release of endorphins makes you happy. It gives you a feeling of euphoria, boosts your mood and is a very effective antidepressant. Even alcohol cannot match the effects of endorphins. In addition, exercise increases the production of new brain cells — in important areas, such as the hippocampus. It also improves mood, cognition and physical health.
Another key way to beat stress involves connecting with people around you, such as family, friends and neighbors. When you are under stress, relaxing and interacting with friends and family will distract you and help reduce the feelings of stress.
Take up a hobby — do something that you have always wanted to do but have put it off for years. You can really dive deep into your passion and lose yourself in your work, thus relieving you of the tension, albeit temporarily. Paint, draw, learn a language, learn a computer program, dance, set up a coaching class for school students, hiking or trekking, join an NGO or a volunteer group— there are millions of these to choose from. The Internet is full of ideas.
Importantly, when you experience chronic stress, do not wait and let things get the better of you. Early detection and early effective treatment is the key to a good outcome and good well-being. Remember to act in a holistic manner to improve your mood, your thinking and your physical health.
And you don’t have to wait until you are overwhelmed with stress. Ultimately, it is important that we learn from an early age to keep our brain fit throughout our whole life.