COVID-19, IMMUNE FUNCTIONING & STRESS

????????????????????????????????????????????????????????????????By Marie T. Rogers, Ph.D.

????????????????????????????????????????????????????????????????www.drmarierogers.com

?????????????????????????????????????????????????????????????????March 23, 2020

The brain, the nervous system, and the immune system are linked. They communicate with and affect one another. Their synergy is staggering, and they are collectively coined psychoneuroimmunology, or PNI for short.??My interest in PNI began approximately two decades ago, while enrolled in my Ph.D. in clinical psychology program (with heavy emphasis in neuropsychology). Whereas terms such as frontal and prefrontal lobes, hemispheric dominance, and amygdala were commonplace, PNI was a relatively new area of study emphasizing the role stress plays in the manifestation and proliferation of disease.

The effects of prolonged, unchecked stress include many health problems such as high blood pressure, heart disease, diabetes, and susceptibility to infections. Add cognitive concerns such as foggy thinking and memory problems to the list and the result is suboptimal functioning.??

Well known even to first-year psychology students is the preponderance of emergency room visits due to anxiety and stress-related symptoms. Individuals living with unmanaged levels of stress tend to be high users of health care, often involving expensive hospital and doctor visits that burden the healthcare system. Many confuse difficulty breathing, tightness or shortness of breath, and overwhelming feelings of fatigue and lethargy as serious medical and/or life-threatening conditions rather than extreme reactions to anxiety and stress. This often necessitates an emergency room visit that results in the prescription for benzodiazepines and a brief mention of a lifestyle change to mitigate stress by the attending physician. Of those cases in which potentially life-threatening conditions, such as asthma, are present, stress and anxiety can certainly fan the bronchial flames. There are numerous studies, replicated across decades, communicating the correlation between psychological stress and rates of respiratory infections and the common cold.?

While occasional stress and anxiety are normal parts of life, persistent and uncontrollable levels eventually become disabling. Stress is meant to be temporary. The body returns to a natural state following a stressful event or period. The heart rate slows, the muscles relax, and breathing returns to normal. It is the heaviness of chronic stress that increases the likelihood of poor health. Without a plan, or use of one’s executive functioning, the management of life becomes random, scattered, and reactive. Executive functioning, through the use of the prefrontal cortex, promotes higher cognitive functions such as planning, strategizing, initiating, decision-making, judgement, and execution. Higher order thinking moves us from lower level, reactive functioning to higher level, proactive functioning. Stress and anxiety severely challenge executive functioning.?

According to the World Health Organization (WHO), globally 1 in 13 individuals suffers from anxiety, and anxiety disorders are, in fact, the most common mental disorders worldwide. Anxiety disorders have a deep biological underpinning and can best be described as chronic intermittent disorders. Interference in day-to-day functioning is an important criterion in the diagnosis of an anxiety disorder. Although highly treatable, only about 1/3 of those diagnosed receive treatment. Cognitive behavioral therapy (CBT) is the most widely used treatment and while it has made significant advances, most suffering with an anxiety disorder cannot be fully or successfully treated with CBT’s typically simple applications of changing the thought in order to change the feeling. (This has been mostly evidenced in the emerging field of trauma work.) Successful management of anxiety and its associated feelings of stress involve developing higher tolerance for ambiguity and uncertainty, and appropriately evaluating what one thinks and feels. It often involves creating a lifestyle that supports physical and mental health such as purposeful work, healthy relationships, exercise, good nutrition, restorative sleep, and a mindfulness practice. When we have a regular and trusted functional routine, life’s interruptions may create the need for a detour but not take us completely off path. We circumvent. We adjust. We reroute. But what happens when the interruption is global and unfamiliar, with potentially dire consequences??

Entering the scene is Earth’s pandemic- COVID-19, which has all the essential elements of a well-written, directed and produced drama; including, but certainly not limited to, mystery, suspense, conflict, tension, fate, and devastation (in both health and finances). The uncertainty, magnitude and force are overwhelming and even the card carrying, self-proclaimed control freaks are at a total loss as to how to navigate these murky waters. In general, when a system is overwhelmed, it shuts down. It collapses under the weight of the pressure. As stress levels rise, immunity drops. This inverse relationship is paramount to our discussion of how best to proceed in these uncertain times. Whereas social distancing and raising the frequency in which we wash our hands and sanitize our environment make sense to slow the progression, managing our stress level to maximize the full utility of our immune system is another. The obvious benefit of avoiding illness translates into fewer new cases of COVID-19 and the need for medical intervention. By avoiding illness, we help to assure services are available for those truly in need.?

For those finding themselves ill-prepared to cope, a starting point would be to assess one’s current situation and apply rational thinking. A thorough assessment of present circumstances, vulnerability and threat is recommended. By rationally approaching a crisis, one can find that the situation is not as dire as it initially seemed. An important concept taken from statistic’s probability theory is that possibility does not equal probability. Under the effects of an amygdala hijack, the frontal cortex weakens and problem-solving takes a back seat to emotional exaggeration and excitement.?Anxiety has an insidious way of distorting reality and invoking worst-case scenarios, by occupying the mind in endless ruminations without an end point. The anxious mind either erroneously believes this behavior is functional or understands that it is not but, either way, cannot shut it off. It results in the depletion of cognitive resources best reserved for problem-solving. A simple solution is to manage incoming information, such as turning off the round-the-clock news coverage.??Periodically, check in for updates. In lieu of endless background chatter about the coronavirus, perhaps listening to an educational podcast or soothing music may help calm an overactive nervous system.?

For those who have consistently used effective coping strategies and have a solid, self-care practice in place, this is the time to leverage those skills and habits. Unfortunately, it is not unusual for humans to dismiss good habits and practices when under stress. Whereas the famous saying by Louis Pasteur-?Chance prefers the prepared mind- is applicable in a crisis, in fairness, there are those for whom no amount of preparedness could have mitigated current circumstances.?

Stress management and the regulation of anxiety lead to the stabilization of other affective states, which include the experience of intense and conflicted emotions that can heighten when one feels incapable of escaping pressure. An unusual and new development resulting from COVID-19 is that family members are now sharing space in a manner never before observed. Each member of the family is currently and simultaneously working and/or attending school from home. Almost overnight, our family members replaced our co-workers, with no system in place for this intensity and frequency of co-habitation. Many do not have the words to describe the feelings behind this situation, other than to express its weirdness. With no time to anticipate or prepare, families are having to figure out the logistics using trial-and-error, and adjusting their sails as they go. Unlike Captain Sullenberger successfully gliding his airplane into the Hudson River as a testament to his experience and skill as a pilot following countless hours of real flight experience and flight simulations, we have not practiced or anticipated this scenario or emergency situation.??

An important discussion that exceeds the purpose of this article includes the role addictions play in our lives, especially during times of uncertainty. The proverb-?A chain is only as strong as its weakest link- is relevant to the discussion of addictions. The best-laid plans can easily be derailed by defaulting to patterns rooted in self-dysregulation and disconnection. We each have areas of vulnerability. These vulnerabilities become most pronounced when we are unable to emotionally regulate (via modification of emotional reactions and tolerance to negative emotions). While addictive behaviors allow us to temporarily disengage and help push the pause button on what feels like insurmountable stress, it unfortunately comes with a large cost, that grows exponentially if left unchecked.

There are healthy ways to push the pause or re-set button, as presented in research from the field of positive psychology, known as entering the flow state or as it is more commonly known -?entering?or being in the zone.?This occurs when an individual is fully immersed in an activity in which focus, creativity, and engagement are heightened. When exiting the zone, one feels a sense of fulfillment, accomplishment, and/or calm. Addictive behaviors, whether to a substance, food, exercise, work, or negative thought patterns produce different outcomes; typically, feelings of exhaustion, self-deprecation and fatigue. Mindfully targeting areas of vulnerability and addictions will yield extraordinary results in the attainment of balance and equanimity. Each one of us has the power, at any given moment, to access a higher, more productive and calming thought, keeping in the forefront of our minds that calm is in fact a super power.??

Offered below are helpful tools to place in our?Resiliency Tool Box to manage both short- and long-term stress. And yes, I know, everything is easier said (or written) than done. This should never be an excuse for not doing what we know will be helpful. If random adults were polled and asked how best to reduce the effects of stress and anxiety, most would be able to come up with a decent and realistic plan involving and incorporating many of the suggestions listed here. We are typically not lacking in information, but in initiation.?

NUTRITION

1.?????Numerous studies have documented the effects of a healthful diet on mental health and immune functioning. If you are already in the habit of eating real food, mostly plant based, and in reasonable caloric portions, then continue. If not, then this may be a good time to re-assess your diet and make changes that are best for you. Dietary supplementation may be helpful, and is individual to each person’s needs.??Avoid overly processed foods and sugar. Both can spike stress levels and fatigue, and increase susceptibility to disease.?

2.?????Limit caffeine intake (if anxious), especially coffee and/or caffeinated soft drinks. Instead, enjoy tea (caffeinated and herbal). Caffeinated teas, such as black and green, offer a balance of energy level, while also delivering a calming effect. If you have high blood pressure or tend to feel jittery and yet desire caffeine, black and/or green tea may be a better alternative.?

3.?????Hydrate. Keep your immune system humming by drinking plenty of water. It staves off infection and naturally eliminates toxins from your body. If flavoring your water will help you drink more, then add lemon, mint, or cucumber.??

RESTORATIVE SLEEP

1.?????Sleep and the circadian system have a profound regulatory influence on immune functioning. Aim for 7-9 hours nightly. Chronic sleep loss compromises the body’s ability to ward off infections. Bedrooms should be cool and dark, and free from distracting noise. Some find white noise or background sounds of nature soothing.??

2.?????Establish a relaxing bedtime routine. Dim the lights, gradually remove yourself from screens and the lights emanating from devices and electronics, and make sure your phone does not interrupt you while sleeping.?

EXERCISE

1.?????There is no scarcity of studies showing a clear, inverse correlation between engaging in moderate exercise and the risk of developing a wide variety of illnesses, including infectious diseases. Moving one’s body enhances immune functioning. The minimum requirement is 150 minutes per week.?

2.?????Exercise releases endorphins, which trigger a positive feeling in the body (that typically lasts for most of the day).?

3.?????The physical practice of yoga has been well established in yielding the following benefits: reduction of stress and anxiety, improvement in sleep, decrease in inflammation, and the improvement of many medical conditions such as asthma, high blood pressure, pain management, and cardiac disease.?

BREATH & MEDITATION

1.????As already mentioned, the practice of yoga has many benefits and at its root is proper breathing. Pranayama is the formal practice of controlling the breath, which is the source of prana (or life force). The importance of maintaining a steady, rhythmic breath is emphasized in yoga. The physical practice of yoga can be viewed as a moving meditation, incorporating the steadiness, sound and depth of the Ujjayi (or ocean) breath to help connect the mind and body, and achieve calmness. Here is a beginner’s guide to accessing this breath:??

§? get into a comfortable seated position.

§??breathe in through your nose and exhale through your mouth. Imagine you are fogging a mirror with your breath.

§??when breathing, inhale to contract the diaphragm to create space for your lungs to expand, and when you exhale, relax the diaphragm and gently push the air from your lungs. Try to inhale and to exhale to a slow count of 4.?

2.????The relaxation element of meditation, in its many forms, provides long lasting health benefits to the mind and body, including increasing volume in brain regions, reducing anxiety and depression, and improving immunity. Although there are many different types of meditation, mostly falling under the categories of guided and unguided (or silent) meditations, there is not a universally accepted or “best” method. The best method, as with principles of health, is the one that is best for you. Also, you may enjoy a combination of different types of mediation. Add calming essential oils to your meditation practice to enhance its effects.?

PERSONAL DEVELOPMENT

1.????Manage your consumption of information.?

2.????Listen to uplifting music.?

3.????De-clutter and organize your living space.

4.????Listen to an uplifting or educational podcast.

5.????Go for a walk in or connect with nature.

6.????Reach out to individuals you have either lost touch or have not had time to connect with and use this opportunity to re-connect and catch up. The benefit of technology is that you can socially connect while maintaining a physical distance.?

7.????Volunteer.?

8.????Enjoy a hobby.

9.????Read for fun.?

10.??Write, draw, create.?

11.??Find your stillness, embrace the present moment, and try to find your gratitude in the midst of chaos and uncertainty.?

If struggling, reach out and ask for help. This could be a friend, family member, co-worker, clergy and/or a mental health professional. While many psychologists and psychotherapists are currently reducing face-to-face, in-office visits, most are offering telehealth and video services.?

5 Positive Outcomes of Stress and Anxiety Management:?

1.????Better executive functioning, allowing for a more accurate assessment and discernment of one’s life and understanding that possibility does not equal probability.?

2.????Greater tolerance for uncertainty.?

3.????Tendency toward proactivity versus reactivity.

4.????A more peaceful life journey.

5.????An enhanced and efficient immune system.?

Photos courtesy of Paul Rogers Photography & Video