Dismantling the Barriers to Recovery – Part II

Stressors and Their Effect on Health

In the previous newsletter, I wrote about how toxic disease narratives or stories and unhelpful thinking patterns are major barriers to recovery, not only in chronic pain but in nearly all chronic diseases. The third major recovery barrier is a?protracted or severe stress load. The stress concept has been widely and thoroughly discussed for decades, but I do need to highlight a few points.

Stress is how our minds and bodies react when we feel under pressure or threat, our brains having set off an alarm reaction. The triggers are usually anything from challenging situations to existential threats. These may be physical, mental, or even emotional dangers. The unfortunate part is that stress has become so normalized that we are no longer overly perturbed on even concerned by it, no matter what the stress variant. The prevailing notion is that most successful people with responsible jobs simply?must?live with it. This is precisely why I prefer the term?allostatic load, though some may deem it long-winded and unnecessary. What?is?unnecessary is when we carry a heavy stress burden for years without making much of an attempt to remove what burdens we can, or at least reduce the load. The?load concept?is a great reminder that if hiking were a metaphor for living, we would be way more diligent in ensuring that we didn’t carry unnecessarily heavy, non-essential items.?

Presently, such commonplace demands like deadlines, loss of social standing and constant overwork can also be stress triggers as well as our perceptions, and even our misinterpretations when no conceivable danger exists.

As life becomes more complicated, technologically advanced, increasingly filled with ‘stuff, ‘and requiring more skills to survive, our ancient but very effective physical and physiological stress coping mechanisms now still react in the same way to stressors in the way that they would to large carnivores or club–wielding invaders. Presently, such commonplace demands like deadlines, loss of social standing and constant overwork can also be stress triggers as well as our perceptions, and even our misinterpretations when no conceivable danger exists.

The?autonomic nervous system?that directs our stress and relaxation-restoration response is part of our?peripheral nervous?system,?the brain and spinal cord constituting the central nervous system. The sympathetic or?flight and fight?component of the autonomic system prepares us for battle or escape, raising our pulse and respiratory rates among other features, while the parasympathetic system is more associated with restoring our equilibrium, relaxation, digestion, procreation and so forth. While much of the autonomic nervous system is?involuntary,?it is by no means?automatic, which means that with practice and skill we can partly to significantly control how we?perceive and react?to stressors. As we know, all stressors are not equal, and what would almost floor one person may not even faze another.?

The sympathetic division of the autonomic nervous system is key to our survival and proper bodily function, but it is vital that this alarm response is not activated too often or that it continues for too long, ideally just long enough to escape or overcome a challenging situation. If not, it will certainly wreak bodily havoc with the surge of hormones like adrenaline and cortisol attacking our brain, lowering our mood, weakening our cardiovascular system and immunity, and unfavorably changing our gastro-intestinal system as well as our gut biome, the enormous mass of essential bacteria resident in our bowels. Apart from the ability of prolonged stress to cause disease, it plays a major factor in the aggravation of established chronic mental and physical disease, and is also hardly the type of internal environment that can support recovery

While much has been said about our stressors; our fast-paced living, the demands of technology, information overload, and the often-corrosive effect of social media, not nearly enough is said about the part that?we?may play in this dynamic, and most often we do have a sizeable role. In the end, an essential aspect of anyone’s recovery is recognizing the unhelpful part that we may have played in our own distress and disease process, but in the case of stress, it takes skill and experience to know exactly when, and how thoroughly this can best be addressed.

For example, the common wisdom that one should try to lead an authentic life is timeless, and this does not imply some onerous or astonishing achievement, but rather shedding what is?not you, as Paolo Coelho, the Brazilian author suggests.

For example, the common wisdom that one should try to lead an authentic life is timeless, and this does not imply some onerous or astonishing achievement, but rather shedding what is?not you, as Paolo Coelho, the Brazilian author suggests. It also by extension involves no longer struggling to fulfil several ill-fitting roles and having to portray several different personae. Nevertheless, depending on one’s nature of work, one is often required to wear several hats and adopt certain roles or duties, some of which could clearly be less comfortable than others.

Then again, perhaps one is stressed because of wildly unrealistic expectations of life, or one’s constant need to ingratiate oneself to others for societal approval, work ratings and the like. Society is, after all to a significant extent, the coagulum of the opinions, beliefs, aspirations, and fears of the various social clusters of mediocrity. This is not at all an unfair comment, but a numbers game issue. It is also in no way a call to ditch society or it’s structures, or to become overly guarded or combative towards it, but ultimately the question remains just how much society should be permitted to?dictate?how one leads every aspect of one’s life?

Another is the myth of multi-tasking, the result of which is more often than sometimes little more than a blueprint for the simultaneous and unsatisfactory ‘completion’ of tasks. Shoe-horning a sizeable number of tasks or even a single complicated task into an obviously inadequate time slot only invites more stress, even in the hands of the adept. While a skilled cartoonist can complete a facial caricature in less than a minute, a portrait of course takes way longer, skill and mastery notwithstanding. How about completing fewer things more competently?each day, also perhaps socializing more with people who accept one as one is and discontinuing to indulge in behaviors and interactions that cause ongoing discomfort when there are clearly reasons for the unease. Endless prosperity anecdotes, after all, don't exactly have ‘legs ‘when it comes to one’s personal health or even happiness, for that matter.

The above constitutes some of the stress reducing changes that can be made to control the load. Obviously, the selection of these changes and modifications is going to vary from person to person, and from time to time, and some are going to be situation specific.?

Now when it comes to considering choice of daily stress interventions to combat stress from less avoidable sources, the principle is that you choose things that you can relate to, possibly even get to enjoy, and that you are likely able to perform almost daily. Some practices require more effort and motivation, as they vary in complexity.?

The Solution

My first recommendation for controlling stress is meditation and the consequent mindfulness that it confers. Meditation has the further advantage of not requiring complicated training or equipment, and can be practised almost anywhere, even in public without anyone else even being aware, as when on an airline flight. Some are intimidated by the thought because they feel that they somehow must qualify in order just to learn to meditate. I reassure them that meditation is not some exalted state but more like a return to when you were a child. The effects of meditation have been thoroughly investigated, and found to be most helpful in reducing stress, and increasing awareness. It can furthermore reduce chronic pain, by slowing us down and bringing us closer to the?here and now?and prevents us from immediate, almost reflex reactions to challenges which would most likely only have led to other poor choices and further stress. It can improve concentration and quality of life and actually make one happier, even changing the brain in ways that can support this.

My other immediate go-to solution is simply to spend more time in nature and preferably combining this with physical activity. Many of us have NDD,?nature deficit disorder,?as mentioned by one of my guests on my podcast, and patients are often impressed by its early benefits. Not overly surprising when one considers that nature is literally tailor-made for our well- being, and when a return to nature is essentially a journey back 'home' and a natural solution to many of the man-made and self-made problems that we face. Ideally, any wilderness, under- populated area, or a walk along a river, lake or the ocean is ideal, but even sitting and reading in a park can do wonders. My personal happy place is the baseball diamonds a few blocks from where I live. While not exactly an oasis or even a suburban park, but simply consisting of expanses of grass, bordered by rows of trees, and punctuated by baseball diamonds. Just being there for five minutes even before exercise can lighten my mental state and lift my mood. Having the convenience of proximity removes any excuse for not having time. I have also come to learn that on the days that I least feel like going are exactly the times that I simply?must?go.

For more immediate reduction in stress, there are several breathing and relaxation exercises. The advantage here is it that our breathing is much easier to control than our heart rate and the way that it functions. Breathing techniques could involve simple controlled belly breathing at a slower rate or the so-called body scan technique, also known as progressive muscle relaxation, and this again is not only easy to perform but also possible to practise almost anywhere and at any time.?

On a more everyday note, making time for socialization even with a single family member or friend, enjoying a catch- up, especially when paired with humor and laughter can markedly change the way you view things. Keeping a pet can also reduce stress. Significantly, pets are generally ever-present, receptive, and forgiving, dogs perhaps a little more than cats. Studies have shown that caring for pets not only reduces stress but may further reduce pain levels in chronic pain and symptom severity in early dementia.?

More structured interventions for stress reduction include yoga, Yoga Nidra, Tai Chi, and Qi Gong. Tai Chi is a type of shadow boxing, a Chinese martial arts practice for defence training, meditation and health benefits, Qi Gong - a coordinated breathing, body movement and positioning meditation used to promote health and spirituality. Yoga Nidra is basically a guided audio meditation which I've personally effectively used during a period of insomnia I experienced. It provides a possible alternative for patients who don’t feel that meditation is a good fit for them.?

... with regard to biofeedback, many with chronic pain constantly describe their poor or even lack of control over their situation, so what better way to counter this belief than by showing them that they actually can increase and improve their control?

Biofeedback is a therapy that employs sensors attached to your body to measure certain bodily functions, the intension being to allow you to learn and get used to how your body works, enabling you to have better control over your body functions like heart rate, breathing, temperature and muscle tension. Biofeedback has great potential, and we see that that chronic pain patients in multi-disciplinary treatment programs either take to it quite readily or, in my view, give up too early and easily. Also with regard to biofeedback, many with chronic pain constantly describe their poor or even lack of control over their situation, so what better way to counter this belief than by showing them that they actually can increase and improve their control?

Other accessible, everyday activities that can reduce stress levels are simply listening to the music one loves while perhaps cooking supper or reading a book. The pursuit of hobbies, especially if these are of a creative nature such as writing, drawing, playing a musical instrument, are a pleasant distraction but can also reduce stress and energize one.??

Be aware that there will be days where you feel too wired to do anything about your stress but unsurprisingly these are also the exact times that you cannot afford not to do anything about it.?

In life, there is no escape from change, taxes, and stress.

For more on biofeedback, listen to my podcast "The Science and Practice of Heart-Brain Coherence" with Dr. Rollin McCraty

For more on biofeedback and a special 8 week breathing routine, review "Breathing, Biofeedback and Heart Rate Variability" with Dr. Raouf Gharbo.

For more on meditation and and the iRest method, check out "Knowing Yourself the iRest Way" with Dr. Richard Miller.

Podcasts can be accessed through the episode listing on the Media section of my website.

www.trevorcampbellmd.com

Disclaimer: The material in this post is for educational and informational purposes only and is not intended as specific medical advice. For individual treatment and guidance, seek? counsel from appropriately qualified health professionals knowledgeable about your health status.