Chapter 7 Important of stress management

1. Chapter 7Important of stress management

2. Gene and relaxation responses • Mind-body practices that elicit the relaxation response (RR) have been used worldwide for millennia to prevent and treat disease. • Mind-body approaches that elicit the RR include: various forms of meditation, repetitive prayer, yoga, tai chi, breathing exercises, progressive muscle relaxation, biofeedback, guided imagery and Qi Gong (Benson, 1983) • The RR is characterized by  oxygen consumption,  exhaled nitric oxide, and  psychological distress. • It is the counterpart of the stress response that exhibits a distinct pattern of physiology and transcriptional profile. (Dusek, Otu, Wohlhueter, Bhasin, Zerbini, et al., 2008)

3. Gene and relaxation responses • Stress related changes in gene expression profile (GEP) include up-regulation of several cytokines/ chemokines and their receptors, inflammation, apoptosis and stress response, metabolism and RNA processing pathways. • Pathways controlled by activation of a protein called NF-κB—known to have a prominent role in inflammation, stress, trauma and cancer—are suppressed after RR elicitation. (Dusek, Otu, Wohlhueter, Bhasin, Zerbini, et al., 2008)

4. Gene and relaxation responses • RR switches off genes associated with chronic inflammatory responses which are believed stress the body, possibly contributing to a host of chronic ailments : heart disease, inflammatory bowel disease, and DM. • RR switches on genes linked with variety of functions: The use of energy in the body, the release of insulin (which helps regulate blood sugar), the maintenance of telomeres (protective end-caps on chromosomes that erode with age until a cell dies), the functions of tiny cellular power-houses called mitochondria. The later may create energy reserves that help the body counter oxidative stress that harm cells. (Harvard Health Publication, 2013)

5. Gene and relaxation responses • Evidences confirm that the RR elicits specific gene expression (tied to inflammation, metabolism and insulin) changes in short-term (8 weeks) and long-term practitioners. • The RR is clinically effective for ameliorating symptoms in a variety of stress-related disorders including cardiovascular, auto-immune and other inflammatory conditions and pain. (Dusek, Otu, Wohlhueter, Bhasin, Zerbini, et al., 2008)

6. Cardiovascular disease • Stress may affect behaviors and factors that increase heart disease risk: • High blood pressure • High cholesterol levels • Smoking • Physical inactivity • Overeating • Some people may choose to drink too much alcohol or smoke cigarettes to “manage” their chronic stress, however these habits can increase blood pressure and may damage artery walls. (AHA, 2014)

7. Cardiovascular disease • Body's response to stress may be a headache, back strain, or stomach pains. Stress can also zap a person’s energy, wreak havoc on his/her sleep and make him/her feel cranky, forgetful and out of control. • A stressful situation sets off a chain of events. The body releases adrenaline, a hormone that temporarily causes the person’s breathing and heart rate to speed up and also blood pressure to rise. These reactions prepare the person to deal with the situation — the "fight or flight" response. • When stress is constant, The body remains in high gear off and on for days or weeks at a time. Although the link between stress and heart disease isn’t clear, chronic stress may cause some people to drink too much alcohol which can increase their blood pressure and may damage the artery walls. (AHA, 2014)

8. Cardiovascular disease • Managing stress is a good idea for the overall health, and researchers are currently studying whether managing stress is effective for heart disease. • A few studies have examined how well treatment or therapies work in reducing the effects of stress on cardiovascular disease. Studies using psychosocial therapies – involving both psychological and social aspects – are promising in the prevention of second heart attacks. After a heart attack or stroke, people who feel depressed, anxious or overwhelmed by stress should benefit form stress reduction. (AHA, 2014)

9. Cardiovascular disease • CVD encompasses a range of ailments that affect the heart or impinge upon the thousands of miles of blood vessels that nurture cells throughtout the body: Atherosclerosis (accumulation of fatty deposits on artery walls), heart attacks, and high blood pressure. • Chronic stress contributes to all three and also trigger arterial fibrillation, palpitations, PVC, and other arrhythmias. • Modifiable risk factors: Smoking, inactivity, obesity, high cholesterol, type 2 DM, and stress. (Harvard Health Publication, 2013)

10. Cardiovascular disease • Psychological and social factors that play significant roles in CVD development: Depression, anxiety, anger, hostility, a lack of social support, work stress, marital stress, low socioeconomic status, and caregiver strain. Acting alone, each of these factors heightens the chances of developing heart trouble. When combined, their power increases exponentially. • People with high stress after the terrorist attack were twice as likely to develop high blood pressure and more than 3 times as likely to develop other heart problems during the following 2 years compared with those who had low stress levels. (Harvard Health Publication, 2013)

11. Cardiovascular disease • People with high stress after the terrorist attack were twice as likely to develop high blood pressure and more than 3 times as likely to develop other heart problems during the following 2 years compared with those who had low stress levels. • Individuals’ perception: People who believed stress had effected their health “a lot or extremely” were twice as likely to die from heart disease or have a non fetal heart attack, compared with those who reported stress was not harming them. (Harvard Health Publication, 2013)

12. Cardiovascular disease • How stress contribute to CVD??? • Released stress hormones (epinephrine) into blood stream cholesterol made by the body • Aroused sympathetic nervous system BP and platelets become stickier  blood clot more likely • BP  damages the heart, blood vessels, and other organs  chance of CVD development • Chronic stress exacerbates chronic inflammation   chance of heart disease development (Harvard Health Publication, 2013)

13. Cardiovascular disease • How stress contribute to CVD??? • Inflammation serves many useful function (defense mechanism, remove debris, and repair damaged tissue), but chronic low-grade inflammation contributes to atherosclerosis development. • Atherosclerosis narrows blood vessels dangerously, causing chest pain, a heart attack, or stroke. • Chronic inflammation influences the formation of artery-blocking clots cause of heart attacks and strokes (Harvard Health Publication, 2013)

14. Cardiovascular disease • How stress contribute to CVD??? • Negative emotions shape behaviors: Smoking and physical active • In vulnerable people, mental stress  sudden spasms in coronary arteries  block blood flow to part of the heart chest pain and heart attack • Those who had a first heart attack reported that they had various forms of stress in the preceding 12 months: Job & home stress, financial problems, and major life events. (Harvard Health Publication, 2013)

15. Cardiovascular disease • Treating depression, controlling anger and hostility, and improving social support could lower the odds of developing heat disease. • Stress management as part of life style modifications (including exercise and nutrition counselling) had positive effect on cardiac risk factors: weight, cholesterol, and reported greater psychological well-being  improved cardiac function  hospitalization and death rate. (Harvard Health Publication, 2013)

16. Hypertension • The pumping of the heart keeps blood circulating throughout the body, carrying nutrients and oxygen to cells and carting off carbon dioxide and other metabolic debris to the organs responsible for their disposal. • BP fluctuates throughout the day, spiking when exercise or get upset and dipping when rest quietly or sleep. • Stress hormones  HR BP • Repeated stress responses  consistently HR BP (Harvard Health Publication, 2013)

17. Hypertension • High BP  force the heart to pump harder to circulate blood, but the heart’s blood supply does not increase  the heart gradually weakens  heart failure • High BP  damages artery walls  promotes atherosclerosis  narrowing arteries + interfering with blood flow  angina, heart attack, stroke, vision problems or loss, and kidney damage • Eliciting the relaxation response helps BP  medications usage (Harvard Health Publication, 2013)

19. Gastrointestinal disease • Combination of psychological and physical factors can trigger gastrointestinal pain and other bowel symptoms. • Severe life stress often precedes the onet of functional bowel disorders. • Laboratory experiments: Digestive system responds to emotional arousal and mental stress ( abnormal contraction gastric acid secretion  heartburn and inflammation of esophagus  ulcers). (Harvard Health Publication, 2013)

20. Gastrointestinal disease • Stress  permeability of intestines and regeneration of a layer of mucosa  impaired defense of body against harmful pathogens  unhealthy gut • Stress  abnormal food movement through the small intestine  irritation bowel syndrome + constipation or diarrhea (Harvard Health Publication, 2013)

21. Immune function • Short-term sources of stress (academic exams) and long-term sources (job strain, ongoing conflict with spouse) affect immune system • Short-term stress: Boost the transfer of lymphocytes from the blood stream to the skin(block infection and enhance healing) • Long-term stress: Harmful effects on lymphocytes, suppress natural killer cells (attack virus-laden cells and certain tumor cells) • It’s possible that regular practicing the relaxation response could help in healthful regulation of immune system activity (Harvard Health Publication, 2013)

22. Carcinoma • Long-term stress tampers with immune defenses • Ineffective immune system  The body’s ability to head off the uncontrolled proliferation of cancerous cells. Cancer cells are able to multiply. • Three-month Ornish’s Program which combines a healthy low-fat diet with exercise, stress reduction techniques, and social support: Major changes in gene “expression”- helps protect against cancer and other major diseases. (Harvard Health Publication, 2013)

23. Asthma (Harvard Health Publication, 2013)