Modern Day Stress: A New Paradigm of Meaning For Clinical Practice

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I always have thought that empathy is an essential quality of a superior and effective practitioner, noted here in an excerpt I wrote for an upcoming textbook. “We are the healing container that our patients seek out to get help and feel safe to partner with. In order to intuit compassion, ease, gentleness, and understanding, providing the necessary space for the immeasurable bandwidth of emotions, feelings, sentiments, and experiences our patients present, it is imperative that we have a process of understanding ourselves. Whether it be with our bodies (e.g., healing from a physical crisis, being increasingly conscious of how we nourish ourselves, reaching and maintaining an ideal weight); with our minds (e.g., calming the judgmental tendencies we suffer due to our own fear and ignorance of the incongruence we have within the chasm of “knowing” and “doing”); with our hearts (e.g., calming the fires of pain around unresolved or misunderstood emotional issues); or with our souls (e.g., screaming from a deeper place, crying out for attention and begging us to change), we must continue to become aware and grow our own container in order to be able to authentically and fully facilitate this growth in another person.”  I was poignantly reminded of this quality recently. Here is what happened.

It was 7:30 pm on a Friday evening, I had landed from a business trip where I had lost my phone, made my way through the maze at LAX to stand on an hour long cab line, spent and hour and fifteen minutes on the 10 freeway to go approximately 8.2 miles to my home, only to be greeted by a stack of mail, (mostly bills), 67 emails, (mostly spam), 5 voice mails (2 were my mother in law) and a nice pile of cat puke on my entryway landing. Exhausted, I poured myself a glass of wine and slumped down in a chair, chin in hand, fought back the tears and thought to myself, “this is what I hear my patients share with me every day!”

Life in our modern day society seems to have brought, not only a flight of prevailing technology, a sea of information and anti-biotic resistant bacteria, but as well, a new form of “stress”.  Stress that is chronic, insidious and worthy of a new paradigm of meaning and a different conversation when it comes to the way it is affecting our health. A national survey, released by the American Psychological Association found that one-third of Americans are living with extreme stress and nearly half (48%) report their stress levels have increased within the past five years.  This is an area of my life that I can fully admit to needing to continue to learn and grow my own container, in order to most effectively help my patients because as Bob Dylan sings, “the times they are a-changin”.

The traditional definitions of stress summarize the entity as a physical event, for example an injury, or a mental state like anxiety that disturbs the body’s normal state of functioning and / or requires the body to respond. In its most refined and simple definition, stress is a disruption that causes a reaction. The traditional stress reaction consists of a surge of chemicals released in the body after an individual perceives danger to prepare the body for survival. It is part of the very primitive ‘fight or flight’ reaction to danger, one that has not evolved with these modern times. Whether the stress is acute or chronic, perceived or real, good or bad, passive or active, the response by our bodies is intended to preserve life; it is our survival mechanism. A healthy human stress response involves many components. As a general review, the brain initiates the most immediate response signaling the adrenal glands to release epinephrine and norepinephrine. The hypothalamus and pituitary glands then activate another part of the adrenals releasing cortisol. This is followed by the nervous system initiating behavioral responses like alertness, focus, reduction of pain receptors, increase in heart rate, blood pressure, release of glucose and the inhibition of reproductive behaviors and desires. To accommodate these demands there is a massive increase in energy production and utilization of nutrients and fluids in the body. Traditionally of course, once the stressful situation has passed, the brain signals the responses to be “turned off” and finally recovery and relaxation allows the body to re-establish balance in all systems, replacing lost nutrients and eliminating waste products accumulated during the process.

Besides the damage done to our tissue by the chronic release of cortisol and catecholamine’s another of the key element in this stress response that is missing in our modern day stress paradigm and therefore contributing to what is showing up clinically is RECOVERY. While there were built in recovery times for life threatening events like getting chased by a polar bear, there are few for the recurring events like backed up traffic, relationship troubles, financial pressures, job stresses, negative self-talk and image, poor physical conditioning, artificial lighting, malnourished diet, inadequate sleep, genetically modified foods, environmental toxin accumulation and so on. In fact, these types of stressors each day can string themselves together rendering the stress response to be “turned on” all of the time and is contributing to many of the health issues I see in my practice each and every day.  Patients, with their own stories of persistent stress, are complaining of anything from a compromised sleep/wake cycle free of medication, a decrease in libido, poor digestion, constipation, hormone imbalances, thinning hair, adult acne, chronic and persistent fatigue, weight gain around the belly, mood swings, hormonal imbalances, and depression. In addition, my patients who are under this type of chronic stress utilize medications, drug, food, alcohol and tobacco products in order to help them cope, making the entire situation worse! (I will remind you of the glass of wine I poured J)

No matter what the diagnosis rendered clinically, there has not been one patient that I have seen in the past several months who hasn’t had a story of stress and a need for modulation and support. In these times, it is absolutely crucial that the underlying aspects of stress and adrenal dysregulation are addressed or most of our treatments will be implemented as if they were sand against the tide. Note, I use the word “dysregulation” instead of “fatigue or failure”, which are commonly used by alternative practitioner, because I believe this is what is happening. There is a complex collection of symptoms a patient presents that is due to a dyregulation of the hypothalamic-pituitary axis of which there are several phases and different aspects to depending on the individual.

As adjunctive interventions to the clinical treatment plan for the rendered diagnosis I use a three-pronged approach in helping to control this pervasive contributing factor influencing our modern day disease landscape.  First, repleting nutrients lost due to the lack of recovery and also increased need is essential. Pantothenic acid, vitamin B6 and vitamin C, are often depleted when the demands on adrenal gland cortisol production are continuous. Second, helping the patient to break the sympathetic constant fodder of fight or flight responses by offering instruction on simple and effective activities to induce the parasympathetic portion of the autonomic nervous system can be very helpful.  I have one of my patients, diagnosed with anxiety and hypertension,  who starts off his day with coffee and about 360 emails, take a “power pause” and do alternate nostril breathing, before he gets downloaded with a barrage of information.  You would be surprised and how effective that 3-minute intervention has been in his healing process. Lastly, utilizing the class of herbs called adaptogens to aid in resisting and managing the myriad of stressors in a patient’s life can improve treatment outcomes.  An adaptogen is an agent that produces a nonspecific response to counter physical, chemical or biological stressors, thus allowing the body to “adapt” to the stressful circumstance.  This normalizing influence on physiology is irrespective of hyperfunction or hypofunction of an organ or organ system. Adaptogens commonly used for their anti-stress qualities and stabilizing effect on the HPA axis include American ginseng, astragalus, ashwagandha, rhodiola, Asian ginseng, cordyceps,  eleutherococcus, holy basil, schisandra, and licorice.

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  • Kim Castle

    Incredible post! So dead on. Especially for us Type A professinal women, I don’t think we can even recognize stress. It’s such a part of who we are, it’s our fuel to get stuff done. And it’s slowly killing us and making us sick, tired, and old.

    • drhollylucille

      Word up sister! :)