Stress -- Actually Dealing With It (March 30, 2021)
Stress is a funny thing. It's one of those normal/abnormal conditions, like pregnancy. In other words, it's not exactly normal operating procedure for a body, but it's called for under special, limited, TEMPORARY circumstances. Problems arise only when it stops being temporary and becomes a more-or-less permanent state of affairs. (I'm not going to flog the analogy with pregnancy any further. Feel free to indulge your own creativity.)
Here is an example. You are sleeping peacefully when you are awakened by someone whaling on your front door with an axe at 3 AM. Your body instantly pumps out a flood of cortisol that causes your pupils to dilate to take in more light so you can see what's going on better (the guy with the axe has a neck beard? Uh OH!), your muscles tense for action (grab the house pistol or the phone?), your heart speeds up and your blood sugar and blood pressure rise, etc., etc. Very simply, when you perceive a threat, your body goes into overdrive to deal with it, and it stays that way UNTIL THE THREAT IS DEALT WITH.
You can see that when the threat is as obviously physical as that, "fight or flight" makes sense. And evolutionarily, that's what most threats ARE -- physical. The mastodons stampede through camp, you grab your kids and run. The river floods, you drag your stuff up out of the way. The yams are all eaten, you dig up some more. Then when the crisis is past, your body goes back to normal.
These days, most threats are of a different nature; an eviction notice, unexplained charges overdrawing your checking account, a teenager who disappears at odd hours for long periods of time and who won't tell you what's going on. (Ok, I'm sure that there's nothing new about the latter. But, you get my drift.) They are longer term threats and don't demand the physical responses that a rampaging sabre-tooth tiger did. But that's all your body's got, and that's what it gives you.
It's the ongoing nature of the threats now that causes the ill effects of stress. In days of yore and well before that, after the required herculean physical effort your body could go back to what is meant to be its normal state -- a sort of placid grazing mode that can be succinctly described as "rest and digest". But that doesn't happen anymore. Modernity is like the life of a bunny who's nesting in the yard of a crazy cat lady; constant vigilance interrupted only by moments of extreme panic.
When you are always on edge dealing with the last threat or anticipating the next, your body never relaxes enough to digest its food properly or sleep deeply, your blood pressure and blood sugar never quite go back to normal, etc. We already know that that state of constant alertness takes a toll on the mind; you can see now how it takes a toll on the body, too, and how ongoing stress is not in any way a desirable thing. So -- how to deal with it?
Exercise is good. Especially if you're having headache or other pain from stress (usually with muscle tension as its source), some weight-lifting in particular (and two sessions a week are part of the federal guidelines for exercise, as it so happens) is fabulous for removing that tension and decreasing any associated pain you're having. Your body has mobilized for action; putting it through any kind of physical activity will allow it to more easily return to normal.
You can get rid of the stressor or threat. This IS an underused technique. But one reason for its rare deployment is that few modern threats will fully yield to it. You can't chain your teenager up until she tells you where she's going (well, you CAN, but going to jail is pretty stressful too, so that's out) and you can't double your income overnight if money is the stressor. Most modern stressors are persistent by their very nature. You can and should mitigate any stressors you can, but that very often doesn't solve the problem.
Medications can help with the symptoms in the short term (anxiety, depression, high blood sugar, pain, hypertension, etc.) but if your stress is bad enough to be prompting you to use medication to lessen the symptoms, you should probably deal with the stress itself. (There is, of course, no medication that directly addresses stress.)
Right now the gold standard medical treatment is CBT, or cognitive behavior therapy. CBT teaches you to control the thinking that produces the stress response (since, after all, it's your perception of a threat that causes the downstream effects). You basically train yourself to stop perceiving threats as -- well, quite so threatening. That aforementioned flood of cortisol doesn't happen as often or as violently, so the emotional and physical responses follow the same pattern.
CBT is great as far as it goes. Once you've paid for the therapy and done it, anyway, it's very helpful. (Insurance often covers it, if you're lucky enough to have insurance.)
There's acupuncture too. Regular acupuncture (or a course of it) will decrease the amount of cortisol that your body pumps out any time it does perceive a threat by about 50% or so. That is a BIGGIE. Your kid still smells of marijuana but you don't freak out about it quite so much. That means that you not only don't get a headache or throw up or break anything (whether a bone or furniture), but you can actually THINK BETTER about how to solve the problem that has presented itself.
The CBT, of course, will produce that same effect of less cortisol, fewer symptoms, and enhanced thinking from a different angle. So -- my very carefully thought-out opinion right now is that if someone's experience of stress is bad enough to be disrupting their life, CBT plus acupuncture is the way to go. Either one is great; together, I think they're unbeatable. That is, of course, assuming you can't just chuck it all and go live at the beach. Ok, THAT's what's unbeatable. But CBT+acupuncture is a close second.
--dr. diane holmes
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