Stress Response and Stress Management

Stress management can be defined in many ways. For the sake of this presentation, Stress can be defined as “any situation which tends to disturb the equilibrium between a living organism and its environment.” (1) Stress can be felt as physical stress, emotional stress, or mental stress. (1)

Physical stress consists of anything that places strain on the physical body. (1) Cause can be but are not limited to, hot/cold temperatures, physical injury, chronic illness, or pain. (1)

Emotional and mental stress can consist of anything that causes an individual emotional tension or mental strain of any kind. Causes can be but are not limited to, apprehension, fear, frustration, sadness, anger, and grief/bereavement. (1) Stimulus can occur due to anything from psychological disturbances, for example, personality disorders or post-traumatic stress disorder to something as simple as not being able to find the right pair of shoes. (1)

Historically stress has been studied about diabetes for centuries. Dr. Thomas Willis was one of the first to document stress as considered a contributing factor to the etiology of diabetes and elevated blood glucose values; Also, to the possibility that a stressful event could be one of the catalysts to the onset of diabetes. (2) As time has gone on and more research has been completed. Stress has been shown to elevate blood glucose levels. (2)

During a stressful event whether the impact is physical mental or emotional the fight or flight response occurs. (2) The amygdala receives a signal of stress and reacts by sending out another signal to the hypothalamus. (2) The hypothalamus then stimulates a sympathetic nervous system response. (2) The physiological response to the activation of the sympathetic nervous system are increased heart rate, increased breath rate, elevated blood pressure due to vasoconstriction, tense muscles, heightened awareness via visual and auditory stimulus. (2) This Signal travels down the vagus nerve and stimulates the adrenal medulla to secrete epinephrine. (2) The presence of epinephrine causes the body to pull lactate, glycerol, amino acids, and glucagon from the liver and skeletal muscles to produce glucose via gluconeogenesis. (2) Glucose is secreted from the liver back into the bloodstream thus elevating blood glucose levels. (2)

The second part of the fight or flight reaction to stressors occurs due to the initial surge of epinephrine. (2) This epinephrine stimulates the hypothalamus to release corticotrophin-releasing hormone (CRH). (2) Corticotrophin-releasing hormone triggers the release of adrenocorticotropic hormone (ACTH). (2) The adrenocorticotropic hormone stimulates the release of cortisol from the adrenal medulla which further stimulates the liver to produce glucose and secrete it into the bloodstream; ultimately elevating blood glucose levels. (2)

Chronic stress causes the persistent release of epinephrine and activation of the adrenal medulla producing cortisol via the action of the hypothalamic-pituitary axis. (3) This can cause dyslipidemia, immunosuppression, osteoporosis, damage to blood vessels and arteries, elevated risk of hypertension stroke, or myocardial infarction. (3)

Increased need for energy causes an increase in appetite thus potentially causing weight gain and increasing insulin resistance. (3) Therefore it is important to try to reduce stress to a level that is deemed acceptable by the client as everyone has different levels of functional stress. (3)

Coping with stress can occur by, but are not limited to, social support (4), physical activity (5), or meditation (6).

Social support is support access to an individual through social ties to other individuals, groups, and/or their larger community. (4) This can involve but is not limited to, family, friends, neighbors, and community members. (4) There are considered 2 dimensions of social support; structural and functional dimensions. (4) Structural dimensions consist of network size and frequency of social interactions. (4) Whereas, functional dimension consists of two categories. Emotional: Consisting of receiving love and empathy. (4) Instrumental: consisting of receiving practical help such as gifts of money or assistance with child care. (4)

It is important to emphasize the quality of the relationship over the number of relationships – As quality relationships provide deeper meaning and connectedness to the individual experiencing stress. (4)

Physical activity is another coping mechanism to reduce stress. (5)Physical activity reduces the levels of epinephrine and cortisol; Thus reducing the overstimulation of glucose into the bloodstream during a stressful time. (5) Physical activity also releases endorphins (5) Endorphins help to enhance positive mood and reduce pain (6). Blood glucose reduction can be a result of physical activity due to the demand of energy required; that is the muscles uptake more glucose to use for energy. (5) Physical exercise also provides opportunities for relaxation and or to engage in social activities which have shown to reduce stress levels as discussed above. (5) All types of physical activity will help to reduce stress. (5) Most effectively, rhythmic repetitive movements, involving large muscle groups; for example, walking, jogging, resistance training to name a few. (5) Stretching is also considered physical activity and should not be overlooked. Stretching can relax the body and can send signals of calm and control to the brain thus minimizing mental tension. (5)

Meditation is an umbrella term that encompasses multimodal pathways to intentional self-regulation of attention. (7) Concentration is a transcendental meditation with the use of a mantra or chanting using repetitive sounds or phrases. (7) Mindfulness is the cultivation of a non-judgmental present moment of awareness of the inner and outer world. (7)