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Definition
• >30%ofadultsreportthatstresshasaverystrong or strong impact on their physical health and their mental health
• Averagestresslevelsofthosewhoreportfacing discrimination are higher than those who deny facing discrimination
– True for race, disability, sexual orientation
• Money,work,andfamilyresponsibilityarethetop three sources of stress
• 39%ofadultsreportovereatinginthepastmonth due to stress
• Residentsofurbanareasreportmorestressthan their rural counterparts
• Womenreporthigherstressthanmen,butgap is closing
• MillennialsandGenXersreportgreaterstressthan Boomers and Matures |
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| a state of mental or emotional strain or tension resulting from adverse or very demanding circumstances |
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• Positive form of stress
• Beneficial effect on health, motivation, performance, and emotional well-being |
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• Negative form of stress
• Pain or suffering affecting the body, a bodily part, or
the mind |
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• A relatively stable state of equilibrium or a tendency toward such a state between the different but interdependent elements or groups of elements of an organism
• Stress threatens homeostasis |
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| things chronic stress affects |
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Definition
| growth, reproduction, metabolism, immunocompetence, behavior, personality |
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• Adaptive stress response: Interrelated series of physiologic and behavioral responses aiming to maintain or reestablish homeostasis
– Mediated by neuroendocrine, cellular, and molecular infrastructure (stress system) in both the CNS and periphery
– Genetics, environment, and developmental factors->Individual response – Intensity is largely mediated by glucocorticoids (cortisol) |
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| stress regulation mechanism |
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Definition
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– CRH and AVP activate the HPA axis
– As cortisol levels increase, exert negative feedbacka -> Homeostasis
– Repeated or chronic stressors a-> Sustained HPA axis activation |
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| hormone response and stress |
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Definition
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| Full body Response to Stress |
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Definition
• Arginine-vasopressin (AVP):
– Increases reabsorption of water in kidneys and induces vasoconstriction à Increased blood pressure
• Catecholamines:
– Epinephrine, norepinephrine
– Elevated HR, BP, respiration
– Long-lasting elevationà Atherosclerosis, increase clotting, increase
muscle tension
• Cortisol:
– Restores homeostasis after stress by blocking CRH release
– Metabolic: • Careful regulation of circulating blood sugar:– Stimulates gluconeogenesis (increases blood sugar levels)– Simulates glycogen synthesis in the liver (decreases blood sugar levels)
– Ion regulation:
• Regulates pH after destabilizing event:
– Prevents sodium loss, accelerates potassium excretion
– Immune response:
• Blocks T-cell proliferation and blocks T-cell recognition of interleukin signals
• Inhibits histamine secretion->Decreases inflammation
• The detrimental effects of chronic stress on the
immune system increases susceptibility to infection
– Memory:
• Multiple cortisol receptors on hippocampus (where memories are processed and stored); excess cortisol overwhelms hippocampusa->Atrophy (usually reversible with
stress reduction) |
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| Behavioral Adaptation to stress |
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Definition
Adaptive redirection of behavior
Increased arousal and alertness
Increased cognition, vigilance, and focused attention
Suppression of feeding behavior
Suppression of reproductive behavior
Inhibition of gastric motility; stimulation of colonic motility
Containment of the stress response |
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| Physical Adaptation to stress |
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Definition
Adaptive redirection of energy
Oxygen and nutrients directed to the central nervous system and stressed body site(s)
Altered cardiovascular tone; increased blood pressure and heart rate
Increased respiratory rate
Increased gluconeogenesis and lipolysis
Detoxification from toxic products
Inhibition of reproductive and growth axes
Containment of the stress response
Containment of the inflammatory/immune response |
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Definition
• Impact on metabolism:
– Glucocorticoids exert catabolic effects to utilize available energy against stressor • Increase hepatic gluconeogenesis and glucose plasma levels, generally induce lipolysis despite increased abdominal and dorsocervical fat accumulation, promote protein degradation
– Glucocorticoids antagonize anabolic actions of growth hormone, insulin, and sex steroids on respective target organs and tissues
– Catabolic shift by activation of HPA axis typically reverses with removal of stressor
– Chronic HPA axis activation à Increased visceral adiposity, suppressed osteoblastic activity, decreased lean body mass, insulin resistance
• Hypercortisolism
->Insulin resistance in peripheral organs/tissues
-> Reactive compensatory insulin hypersecretion + further increased visceral obesity and sarcopenia
-> Type 2 diabetes, dyslipidemia, hypertension
• Impactonmetabolism:
– Acute stress:
• Neuroendocrine crosstalk between central stress system, HPA axis, and CNS centers of appetite, satiety, and energy expenditure->Anorexia and thermogenesis
– Chronic stress:
• Associated with low-grade inflammatory state due to visceral fat accumulation
• Results in
– Increased levels of circulating pro-inflammatory adipokines and cytokines (leptin, resistin, TNF-a, and IL-6)
– Decreased levels of anti-inflammatory adipokines (adiponectin, omentin)àMetabolic syndrome
– Insulin resistance, hypertension, atherosclerosis, hypercoagulability, thrombosis, cardiac dysfunction
• Glucocorticoids->Induce insulin and leptin secretion àLeptin-resistant state characteristic of obesity |
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| stress and disease throughout the life span |
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• Heightened vulnerability to intense acute and/or chronic stressors during fetal life (remember epigenetics?), childhood, and adolescence
• Early nutritional stress and low birth weight -> Increased risk of obesity/obesity-related cardio- metabolic disease later
• Early chronic stress (including anxiety, depression, PTSD)->Increased cortisol and catecholamine plasma levels at rest->Higher risk of obesity and hypertension later |
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• Insulin resistance
• Dyslipidemia
• Hypertension |
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| stress and Cardiovascular health: |
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Definition
– Acute stress:
• Increased epinephrine, norepinephrine, and
cortisol -> Elevated BP and HR
– Chronic stress:
• Long-term elevation of BP and HR -> Increased risk of hypertension, myocardial infarction, atherosclerosis, and stroke
– Estrogen levels in premenopausal women have protective effects on blood vessels during stress->Reduced risk of MI |
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• Triggering a relaxation response: – Diaphragmatic/abdominal breathing
– Relaxation response: Focus on a single soothing word – Guided imagery: Visualization of tranquility
– Repetitive prayer
– Yoga, tai chi
• Massachusetts General Hospital double-blind study of 122 patients with hypertension, >55 yo
– Half assigned to relaxation response training, half provided information regarding blood pressure control
– 8 weeks: 34 (>54%) in relaxation group had >5 mmHg systolic BP reduction
• Eligible to reduce levels of BP medication they were taking: 50% were able to remove one medication vs. 19% in control group
• Physical activity:
– Deepens breathing
– Relieves muscular tension
• Social support:
– Multiple theories that those who enjoy close relationships receive emotional support that indirectly helps coping during chronic stress |
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