Irritable Bowel Syndrome Message Boards | I think most of it is stress because....

FYI

Its not the breathing that causes IBS. In order to understand this better, its important to learn about the sympathetic and parasympathetic nervous systems and the connection to the ANS and enteric nervous system.

This is something I have been trying to explain on here for years, to help with symptoms and especially pain.

This also has to do with the filght or flight system and the sympathetic and parasympathetic nervous systems.

Its also a major contributer to the "vicious cycle" of IBS.

This is also one reason why relaxation techniques can help the symptoms, regardless of stress as well, as this has to do with the physiology of the body in general and more importantly in IBS, with digestion and how it works.

The Autonomic Nervous System controls digestion.

"The ANS is most important in two situations:

1. In emergencies that cause stress and require us to
"fight" or take "flight" (run away)
and

2. In nonemergencies that allow us to "rest" and "digest"

"The ANS is divided into three parts:

The sympathetic nervous system
The parasympathetic nervous system
The enteric nervous system."

http://faculty.washington.edu/chudler/auto.html

The fight or flight responce

This fundamental physiologic response forms the foundation of modern day stress medicine. The Fight or Flight Response is our body's primitive, automatic, inborn response that prepares the body to "fight" or "flee" from perceived attack, harm or threat to our survival.

What happens to us when we are under excessive stress?

When we experience excessive stress�whether from internal worry or external circumstance�a bodily reaction is triggered, called the "fight or flight" response. Originally discovered by the great Harvard physiologist Walter Cannon, this response is hard-wired into our brains and represents a genetic wisdom designed to protect us from bodily harm. This response actually corresponds to an area of our brain called the hypothalamus, which�when stimulated�initiates a sequence of nerve cell firing and chemical release that prepares our body for running or fighting.

What are the signs that our fight or flight response has been stimulated (activated)?

When our fight or flight response is activated, sequences of nerve cell firing occur and chemicals like adrenaline, noradrenaline and cortisol are released into our bloodstream. These patterns of nerve cell firing and chemical release cause our body to undergo a series of very dramatic changes. Our respiratory rate increases. Blood is shunted away from our digestive tract and directed into our muscles and limbs, which require extra energy and fuel for running and fighting. Our pupils dilate. Our awareness intensifies. Our sight sharpens. Our impulses quicken. Our perception of pain diminishes. Our immune system mobilizes with increased activation. We become prepared�physically and psychologically�for fight or flight. We scan and search our environment, "looking for the enemy."

When our fight or flight system is activated, we tend to perceive everything in our environment as a possible threat to our survival. By its very nature, the fight or flight system bypasses our rational mind�where our more well thought out beliefs exist�and moves us into "attack" mode. This state of alert causes us to perceive almost everything in our world as a possible threat to our survival. As such, we tend to see everyone and everything as a possible enemy. Like airport security during a terrorist threat, we are on the look out for every possible danger. We may overreact to the slightest comment. Our fear is exaggerated. Our thinking is distorted. We see everything through the filter of possible danger. We narrow our focus to those things that can harm us. Fear becomes the lens through which we see the world.

We can begin to see how it is almost impossible to cultivate positive attitudes and beliefs when we are stuck in survival mode. Our heart is not open. Our rational mind is disengaged. Our consciousness is focused on fear, not love. Making clear choices and recognizing the consequences of those choices is unfeasible. We are focused on short-term survival, not the long-term consequences of our beliefs and choices. When we are overwhelmed with excessive stress, our life becomes a series of short-term emergencies. We lose the ability to relax and enjoy the moment. We live from crisis to crisis, with no relief in sight. Burnout is inevitable. This burnout is what usually provides the motivation to change our lives for the better. We are propelled to step back and look at the big picture of our lives�forcing us to examine our beliefs, our values and our goals.

What is our fight or flight system designed to protect us from?

Our fight or flight response is designed to protect us from the proverbial saber tooth tigers that once lurked in the woods and fields around us, threatening our physical survival. At times when our actual physical survival is threatened, there is no greater response to have on our side. When activated, the fight or flight response causes a surge of adrenaline and other stress hormones to pump through our body. This surge is the force responsible for mothers lifting cars off their trapped children and for firemen heroically running into blazing houses to save endangered victims. The surge of adrenaline imbues us with heroism and courage at times when we are called upon to protect and defend the lives and values we cherish.

What are the saber tooth tigers of today and why are they so dangerous?

When we face very real dangers to our physical survival, the fight or flight response is invaluable. Today, however, most of the saber tooth tigers we encounter are not a threat to our physical survival. Today's saber tooth tigers consist of rush hour traffic, missing a deadline, bouncing a check or having an argument with our boss or spouse. Nonetheless, these modern day, saber tooth tigers trigger the activation of our fight or flight system as if our physical survival was threatened. On a daily basis, toxic stress hormones flow into our bodies for events that pose no real threat to our physical survival.

Once it has been triggered, what is the natural conclusion of our fight or flight response?

By its very design, the fight or flight response leads us to fight or to flee�both creating immense amounts of muscle movement and physical exertion. This physical activity effectively metabolizes the stress hormones released as a result of the activation of our fight or flight response. Once the fighting is over, and the threat�which triggered the response�has been eliminated, our body and mind return to a state of calm.

Has the fight or flight response become counterproductive?

In most cases today, once our fight or flight response is activated, we cannot flee. We cannot fight. We cannot physically run from our perceived threats. When we are faced with modern day, saber tooth tigers, we have to sit in our office and "control ourselves." We have to sit in traffic and "deal with it." We have to wait until the bank opens to "handle" the bounced check. In short, many of the major stresses today trigger the full activation of our fight or flight response, causing us to become aggressive, hypervigilant and over-reactive. This aggressiveness, over-reactivity and hypervigilance cause us to act or respond in ways that are actually counter-productive to our survival. Consider road rage in Los Angeles and other major cities.

It is counterproductive to punch out the boss (the fight response) when s/he activates our fight or flight response. (Even though it might bring temporary relief to our tension!) It is counterproductive to run away from the boss (the flight response) when s/he activates our fight or flight response. This all leads to a difficult situation in which our automatic, predictable and unconscious fight or flight response causes behavior that can actually be self-defeating and work against our emotional, psychological and spiritual survival.

Is there a cumulative danger from over-activation of our fight or flight response?

Yes. The evidence is overwhelming that there is a cumulative buildup of stress hormones. If not properly metabolized over time, excessive stress can lead to disorders of our autonomic nervous system (causing headache, irritable bowel syndrome, high blood pressure and the like) and disorders of our hormonal and immune systems (creating susceptibility to infection, chronic fatigue, depression, and autoimmune diseases like rheumatoid arthritis, lupus, and allergies.)

To protect ourselves today, we must consciously pay attention to the signals of fight or flight

To protect ourselves in a world of psychological�rather than physical�danger, we must consciously pay attention to unique signals telling us whether we are actually in fight or flight. Some of us may experience these signals as physical symptoms like tension in our muscles, headache, upset stomach, racing heartbeat, deep sighing or shallow breathing. Others may experience them as emotional or psychological symptoms such as anxiety, poor concentration, depression, hopelessness, frustration, anger, sadness or fear.

Excess stress does not always show up as the "feeling" of being stressed. Many stresses go directly into our physical body and may only be recognized by the physical symptoms we manifest. Two excellent examples of stress induced conditions are "eye twitching" and "teeth-grinding." Conversely, we may "feel" lots of emotional stress in our emotional body and have very few physical symptoms or signs in our body.

By recognizing the symptoms and signs of being in fight or flight, we can begin to take steps to handle the stress overload. There are benefits to being in fight or flight�even when the threat is only psychological rather than physical. For example, in times of emotional jeopardy, the fight or flight response can sharpen our mental acuity, thereby helping us deal decisively with issues, moving us to action. But it can also make us hypervigilant and over-reactive during times when a state of calm awareness is more productive. By learning to recognize the signals of fight or flight activation, we can avoid reacting excessively to events and fears that are not life threatening. In so doing, we can play "emotional judo" with our fight or flight response, "using" its energy to help us rather than harm us. We can borrow the beneficial effects (heightened awareness, mental acuity and the ability to tolerate excess pain) in order to change our emotional environment and deal productively with our fears, thoughts and potential dangers.

What can we do to reduce our stress and turn down the activity of our fight or flight response?

The fight or flight response represents a genetically hard-wired early warning system�designed to alert us to external environmental threats that pose a danger to our physical survival. Because survival is the supreme goal, the system is highly sensitive, set to register extremely minute levels of potential danger. As such, the fight or flight response not only warns us of real external danger but also of the mere perception of danger. This understanding gives us two powerful tools for reducing our stress. They are:

1) Changing our external environment (our "reality"). This includes any action we take that helps make the environment we live in safer. Physical safety means getting out of toxic, noisy or hostile environments. Emotional safety means surrounding ourselves with friends and people who genuinely care for us, learning better communication skills, time management skills, getting out of toxic jobs and hurtful relationships. Spiritual safety means creating a life surrounded with a sense of purpose, a relationship with a higher power and a resolve to release deeply held feelings of shame, worthlessness and excessive guilt.

2) Changing our perceptions of reality. This includes any technique whereby we seek to change our mental perspectives, our attitudes, our beliefs and our emotional reactions to the events that happen to us. Many of these techniques are discussed in depth in Section 3 and they include: cognitive restructuring, voice dialogue therapy, inner child work, learning not to take things personally, affirmations and self-parenting. Changing our perceptions of reality is best illustrated by the proverbial saying, "when life gives you lemons, make lemonade." Without actually changing our reality, we can altered our perception of reality�viewing the difficulties of life as events that make us stronger and more loving. In the Buddhist tradition, this is referred to as developing a "supple mind."

Physical exercise can also turn down the activity of an overactive fight or flight response

Perhaps the simplest, best way to turn down the activity of our fight or flight response is by physical exercise. Remember that the natural conclusion of fight or flight is vigorous physical activity. When we exercise, we metabolize excessive stress hormones�restoring our body and mind to a calmer, more relaxed state.

For the purpose of stress reduction and counteracting the fight or flight response, we do not need to exercise for 30 to 40 minutes. Any form of activity where we "work up a sweat" for five minutes will effectively metabolize off�and prevent the excessive buildup of�stress hormones. Get down and do 50 pushups, 50 sit-ups, jumping jacks, jump rope, run in place, run up and down the stairs, whatever. By exercising to the point of sweating, we effectively counteract the ill effects of the fight of flight response, drawing it to its natural conclusion.

Sometimes when I'm upset, I close the door to my office, do 25 quick pushups, work up a light sweat, and return to work, clearer and calmer. Frequent repetitions of short exercise are easy to fit into our busy schedules. For full cardiovascular fitness, longer periods of exercise do have additional benefits, but for the purpose of stress reduction, mini-exercise sessions are practical, effective and beneficial.

Exercise increases our natural endorphins, which help us to feel better. When we feel good, our thoughts are clearer, our positive beliefs are more accessible and our perceptions are more open. When we feel tired and physically run down, we tend to focus on what's not working in our lives�similar to a cranky child needing a nap. It is difficult to be, feel or think positive when we are exhausted, sleep deprived or physically out of condition.

What is mind chatter?

If we could read the owners manual for the mind, we would find a full chapter on what is called "mind chatter." Mind chatter is the endless, restless stream of incomplete thoughts, anxieties and self-talk which constantly pulses through our minds. In order to survive, our mind is always "on"�searching for possible threats, dangers, solutions and explanations. This is called our "strategic mind." The strategic mind is always "on"�scanning both our inner and outer world for possible threats to our well-being�either real or imagined. This constant vigilance of the mind not only distracts us with excessive worry but can also trigger the activation of our fight or flight response.

Sometimes, because of the mind's incessant chatter and worry, we even begin to anticipate dangers or threats that don't really exist. This is what the soulful and gentle author Joan Borysenko, Ph.D. (Minding The Body, Mending The Mind) refers to as becoming an "advanced worrier." This condition is described brilliantly by Mark Twain who said "I've experienced many terrible things in my life, a few of which actually happened." Zig Ziglar, the great motivational speaker, says "Worry is a misuse of the imagination."

Underneath all the mind chatter and fight or flight anxiety lies a quiet place called our "inner voice", the "observer" or the "witness." The "inner voice" is what Walter Cannon, M.D., calls "the wisdom of the body." This quiet place allows us to move beyond our fears, beyond our anxieties and beyond our strategic mind�into a clearer understanding and knowing of what is true and loving. As we will soon discuss, a quiet mind calms our overactive physiology, creating a sequence of physiologic and biochemical changes that improve our physical health.

The simplest, most exquisite way I know of to quiet the mind is by eliciting what is called "The Relaxation Response. "

What is the relaxation response?

The relaxation response, discovered by the inspirational author and Harvard cardiologist, Herbert Benson, M.D., represents a hard-wired antidote to the fight or flight response. The relaxation response corresponds to a physical portion of the brain (located in the hypothalamus) which�when triggered�sends out neurochemicals that almost precisely counteract the hypervigilant response of the fight or flight response.

When we follow the simple steps necessary to elicit the relaxation response, we can predictably measure its benefits on the body. These include: a decrease in blood pressure, diminished respiratory rate, lower pulse rate, diminished oxygen consumption, increase in alpha brain waves (associated with relaxation), and in many cases, an improved sense of mental and spiritual well-being.

Because the relaxation response is hard-wired, we do not need to believe it will work, any more than we need to believe our leg will jump when the doctor taps our patellar tendon with a little red hammer. The relaxation response is a physiologic response, and as such, there are many ways to elicit it, just as there are many ways to increase our pulse rate (another physiologic response).

We must take the time to exercise our relaxation response "muscle"

The solution to overactivation of our fight or flight response is simple: when we take the time to exercise our relaxation response "muscle" we will enjoy the beneficial physiological, biochemical and mental effects. These beneficial effects are measurable whether we believe in the relaxation response or not. Some people do experience immediate emotional calm and tranquility when they learn to elicit the relaxation response, but others do not. We cannot measure the effectiveness of the relaxation response based on how it feels. Dr. Benson likens this to brushing our teeth. We know brushing is "good" for us, whether we feel it works or not. Feeling good is an added benefit. The most important thing is to actually take the time and discipline necessary to elicit the relaxation response. Once elicited, the benefits to our overstressed physiology and biochemistry will be experienced. Additionally, we bypass the fear and anxiety that so quickly narrows our perceptions and infects our beliefs with suspicion and doubt.

How do we elicit the relaxation response?

There are many ways to elicit the physiologic benefits of the relaxation response. The easiest is with a simple two-step method as follows:

1. Focus on a word or phrase that has a positive meaning to you. Such words as "one," "love" and "peace" work well. Effective phrases might also include "The Lord is my shepherd, I shall not want," "God grant me serenity," or "Lord, make me an instrument of your peace."

2. When you find your mind has wandered or you notice any intrusive thoughts entering your mind, simply disregard them and return your focus to the word or phrase you chose.

Be aware that your mind will tend to wander and intrusive thoughts will enter your mind. This is normal. Just allow those thoughts to pass through your mind like a summer breeze passes through an open window. The second step above is related to our ability to "let go" of intrusive thoughts or excessive worries. Dr. Benson says "to summon the healing effects of the relaxation response, you need to surrender everyday worries and tensions." This gets our harried minds out of the way of our body's natural ability to heal. It's funny to watch the tricks our mind plays on us. It will try to tell us things like: "This is stupid, why am I sitting here doing this?" "I hope no one sees me here meditating." "This will never work." "That's it, I'm going to quit now." When you realize your mind has wandered, just let go of the thought and return back to your word or phrase!

Remember, whether your mind wanders or your thoughts drift, simply practicing the two steps above will elicit the relaxation response and deliver beneficial physiologic and emotional benefits as predictably as flipping a light switch causes the light bulb to shine.

The key to deriving the benefits of the relaxation response is to practice it daily. Dr. Benson recommends at least 10 to 15 minutes, once to twice a day. This will produce the maximum benefit. When I first learned this technique from Dr. Benson's, I remember him telling us his dental analogy. He told us to treat the relaxation response the same way you treat brushing your teeth. Do it because you know it is good for you. Don't worry whether you think you had a "good relaxation response" or not. You wouldn't say to yourself: "That was a good tooth brushing!" would you? Whether you "felt" it was a calming, relaxing experience or not, the physiologic benefits of doing the relaxation response are measurable, predictable and repeatable. The quieting of the mind that results from eliciting the relaxation response is critical in order to open up our perceptual world, away from negativity and fear. This freedom allows us to be more awake, more aware and more conscious of the attitudes and beliefs we choose when living our daily lives.

Are there other ways to quiet the mind?

Because the relaxation response is a physiologic response (like our heart rate or respiratory rate), there are many ways to elicit it, just as there are many ways to increase our heart rate. They include:

1. During any repetitive exercise such as walking, swimming or running, repeat your "focus word" or phrase with each step or stroke. For example, when I run, with each step I might say "peace" or "love."

2. Practicing yoga, with its mental focus on postures and breathing, can elicit the relaxation response.

3. Deep diaphragmatic breathing exercises, with a focus on the breath, can trigger the relaxation response.

4. Progressive muscle relaxation techniques, where you alternately contract and then relax each muscle group moving progressively from head to toe, will elicit the beneficial effects of the relaxation response.

5. Repetitive forms of prayer elicit the relaxation response.

6. Singing or chanting your focus word or phrase, either silently or out loud, will elicit the relaxation response.

7. Mindfulness meditation, a method that comes from Buddhist philosophy and involves merely "observing" or "noticing" things, will elicit the relaxation response. For example, we may walk down the street and say, "My feet are touching the pavement, right foot, left foot, right foot, left foot. I notice the tree ahead. The top branches are swaying in the breeze. I'm feeling thirsty. My body is sweating. My feet are on the grass now. The grass is soft." By simply noticing our experience and naming it, without judging or evaluating whether it is good or bad, we tap into a source of active meditation that elicits the relaxation response. Instead of having one single focus word or phrase, the world around us and the world of feelings within us become our focus phrase.

The key is to simply notice our world and our feelings. No judgements of good, bad, right, wrong, lazy, weak, strong, kind, mean, etc. are given any attention. This is similar to simply disregarding any intrusive thoughts. Emotional mindfulness might sound like: "I am feeling sad. Tears are welling up in my eyes. I am remembering the hurt I felt when I left home that day. My stomach is growling. I feel my body shaking. I am feeling sad again." Notice there is only the simple acknowledgement, recognition and naming of the feeling or event. Any judgements about our feelings are to be passively disregarded with a return of one's mental focus to the observation or naming of emotions or bodily sensations. (For more information on mindfulness, read the remarkable work of Jon Kabat-Zinn in his books Full Catastrophe Living and Wherever You Go, There You Are.)

Other simple ways to quiet the mind

In addition to the above "formal" methods for quieting our mind, my dear friend Del Morris�in reviewing this book for me�pointed out that we don't have to make it complicated. We can take a walk on the sandy beaches and listen to the crashing waves. We can go into the forest at night, where we hear nothing but the sound of crickets. Take a warm bath. Walk by a creek and listen to the running water. I recently visited my sister and her husband in San Francisco, where an afternoon walk among the ancient redwoods of Muir Woods did just the trick. Walking across wooden bridges over running streams with loving family was as peaceful as any meditative moment I have ever experienced.

We can't learn how to swim in a stormy ocean

We need to "practice" quiet moments whenever we have the chance. Quieting our mind follows awareness and attention. When we become aware that we are rushing in our heads, we stop, breathe and take a quiet moment of reflection. With practice, quieting our restless thoughts becomes automatic. When first learning a formal technique for quieting the mind, be patient with yourself. We need to learn these techniques when things are calm. Their effectiveness comes from repetition and practice. We don't learn how to swim in a stormy ocean. Similarly, we cannot learn to elicit the relaxation response in the midst of emotional, psychological or social storms. We need to learn the techniques in calm waters. Then, when the rains come, we can utilize them to help us stay afloat in stormy seas.

What have we learned?

In order to consciously choose the attitudes and beliefs which are most empowering, we must learn to quiet our mind and quiet our body. By eliciting the relaxation response, we can stop the mind chatter, allowing us to move out of our strategic mind into the quiet mind, capable of conscious awareness and attention. The quiet mind opens up our perceptions and frees us to make the most positive choices regarding our lives.

In this sense, the mind is likened to a pond of water. Restless thoughts are like pebbles thrown into the water. They send out a ripple of activity, disturbing the tranquil surface. When the water is constantly agitated with restless thoughts, we cannot see clearly to the bottom of the pond, which represents our inner wisdom. When we stop the restless thoughts, we calm the waters, enabling us to see clearly to the bottom�where our wisest, most enlightened self resides.

http://www.mindbodymed.com/EducationCenter/fight.html

"What does this have to do with IBS
Converging evidence from different laboratories and research groups are consistent with the concept of an "enhanced stress responsiveness" as a major vulnerability factor in many IBS patients. As outlined above, such an enhanced stress responsiveness may not be obvious to the affected individual, until he or she is exposed to a period of sustained threatening stressors (financial or employment problems, divorce, aftermath of a major disaster with consequences on daily life), repeated mild to moderate stressors, or a one time severe (life threatening) type stressor (robbery or physical assault). Under these circumstances the mechanisms that normally turn off the stress response are overwhelmed, and attempts of the nervous system at adaptation or habituation fail. Many of the vulnerability factors for such enhanced stress responsiveness have been identified and many of them occur in a particular vulnerable period of the developing brain (before age 10). Some of the best-studied factors include loss of the primary care giver, distant mother-child relationship, emotional neglect, and physical and verbal or sexual abuse.

In order to understand how a chronically enhanced stress response can produce the cardinal symptoms of IBS (abdominal pain and discomfort associated with altered bowel habits) we have to go back to the earlier section on the emotional motor system: activation of the stress system will stimulate contractions and secretion in the sigmoid colon and rectum. Depending on the specific emotional context (fear vs. anger), the upper GI tract will be either inhibited (fear) or stimulated (anger). In addition, recent research in animals has demonstrated a phenomenon referred to as stress-induced visceral hyperalgesia. What this means is that in vulnerable animals, exposure to an acute moderate stressor will make the colon more sensitive to distension and the perception of discomfort or pain."

http://www.aboutibs.org/Publications/stress.html

--------------------
My website on IBS is www.ibshealth.com

Print Remind Me Notify Moderator

more information

fyi

In order to understand this better, its important to learn about the sympathetic and parasympathetic nervous systems and the connection to the ANS and enteric nervous system.

This is something I have been trying to explain on here for years, to help with symptoms and especially pain.

This also has to do with the filght or flight system and the sympathetic and parasympathetic nervous systems.

Its also a major contributer to the "vicious cycle" of IBS.

This is also one reason why relaxation techniques can help the symptoms, regardless of stress as well, as this has to do with the physiology of the body in general and more importantly in IBS, with digestion and how it works.

The Autonomic Nervous System controls digestion.

"The ANS is most important in two situations:

1. In emergencies that cause stress and require us to
"fight" or take "flight" (run away)
and

2. In nonemergencies that allow us to "rest" and "digest"

"The ANS is divided into three parts:

The sympathetic nervous system
The parasympathetic nervous system
The enteric nervous system."

http://faculty.washington.edu/chudler/auto.html

The fight or flight responce

This fundamental physiologic response forms the foundation of modern day stress medicine. The Fight or Flight Response is our body's primitive, automatic, inborn response that prepares the body to "fight" or "flee" from perceived attack, harm or threat to our survival.

What happens to us when we are under excessive stress?

When we experience excessive stress�whether from internal worry or external circumstance�a bodily reaction is triggered, called the "fight or flight" response. Originally discovered by the great Harvard physiologist Walter Cannon, this response is hard-wired into our brains and represents a genetic wisdom designed to protect us from bodily harm. This response actually corresponds to an area of our brain called the hypothalamus, which�when stimulated�initiates a sequence of nerve cell firing and chemical release that prepares our body for running or fighting.

What are the signs that our fight or flight response has been stimulated (activated)?

When our fight or flight response is activated, sequences of nerve cell firing occur and chemicals like adrenaline, noradrenaline and cortisol are released into our bloodstream. These patterns of nerve cell firing and chemical release cause our body to undergo a series of very dramatic changes. Our respiratory rate increases. Blood is shunted away from our digestive tract and directed into our muscles and limbs, which require extra energy and fuel for running and fighting. Our pupils dilate. Our awareness intensifies. Our sight sharpens. Our impulses quicken. Our perception of pain diminishes. Our immune system mobilizes with increased activation. We become prepared�physically and psychologically�for fight or flight. We scan and search our environment, "looking for the enemy."

When our fight or flight system is activated, we tend to perceive everything in our environment as a possible threat to our survival. By its very nature, the fight or flight system bypasses our rational mind�where our more well thought out beliefs exist�and moves us into "attack" mode. This state of alert causes us to perceive almost everything in our world as a possible threat to our survival. As such, we tend to see everyone and everything as a possible enemy. Like airport security during a terrorist threat, we are on the look out for every possible danger. We may overreact to the slightest comment. Our fear is exaggerated. Our thinking is distorted. We see everything through the filter of possible danger. We narrow our focus to those things that can harm us. Fear becomes the lens through which we see the world.

We can begin to see how it is almost impossible to cultivate positive attitudes and beliefs when we are stuck in survival mode. Our heart is not open. Our rational mind is disengaged. Our consciousness is focused on fear, not love. Making clear choices and recognizing the consequences of those choices is unfeasible. We are focused on short-term survival, not the long-term consequences of our beliefs and choices. When we are overwhelmed with excessive stress, our life becomes a series of short-term emergencies. We lose the ability to relax and enjoy the moment. We live from crisis to crisis, with no relief in sight. Burnout is inevitable. This burnout is what usually provides the motivation to change our lives for the better. We are propelled to step back and look at the big picture of our lives�forcing us to examine our beliefs, our values and our goals.

What is our fight or flight system designed to protect us from?

Our fight or flight response is designed to protect us from the proverbial saber tooth tigers that once lurked in the woods and fields around us, threatening our physical survival. At times when our actual physical survival is threatened, there is no greater response to have on our side. When activated, the fight or flight response causes a surge of adrenaline and other stress hormones to pump through our body. This surge is the force responsible for mothers lifting cars off their trapped children and for firemen heroically running into blazing houses to save endangered victims. The surge of adrenaline imbues us with heroism and courage at times when we are called upon to protect and defend the lives and values we cherish.

What are the saber tooth tigers of today and why are they so dangerous?

When we face very real dangers to our physical survival, the fight or flight response is invaluable. Today, however, most of the saber tooth tigers we encounter are not a threat to our physical survival. Today's saber tooth tigers consist of rush hour traffic, missing a deadline, bouncing a check or having an argument with our boss or spouse. Nonetheless, these modern day, saber tooth tigers trigger the activation of our fight or flight system as if our physical survival was threatened. On a daily basis, toxic stress hormones flow into our bodies for events that pose no real threat to our physical survival.

Once it has been triggered, what is the natural conclusion of our fight or flight response?

By its very design, the fight or flight response leads us to fight or to flee�both creating immense amounts of muscle movement and physical exertion. This physical activity effectively metabolizes the stress hormones released as a result of the activation of our fight or flight response. Once the fighting is over, and the threat�which triggered the response�has been eliminated, our body and mind return to a state of calm.

Has the fight or flight response become counterproductive?

In most cases today, once our fight or flight response is activated, we cannot flee. We cannot fight. We cannot physically run from our perceived threats. When we are faced with modern day, saber tooth tigers, we have to sit in our office and "control ourselves." We have to sit in traffic and "deal with it." We have to wait until the bank opens to "handle" the bounced check. In short, many of the major stresses today trigger the full activation of our fight or flight response, causing us to become aggressive, hypervigilant and over-reactive. This aggressiveness, over-reactivity and hypervigilance cause us to act or respond in ways that are actually counter-productive to our survival. Consider road rage in Los Angeles and other major cities.

It is counterproductive to punch out the boss (the fight response) when s/he activates our fight or flight response. (Even though it might bring temporary relief to our tension!) It is counterproductive to run away from the boss (the flight response) when s/he activates our fight or flight response. This all leads to a difficult situation in which our automatic, predictable and unconscious fight or flight response causes behavior that can actually be self-defeating and work against our emotional, psychological and spiritual survival.

Is there a cumulative danger from over-activation of our fight or flight response?

Yes. The evidence is overwhelming that there is a cumulative buildup of stress hormones. If not properly metabolized over time, excessive stress can lead to disorders of our autonomic nervous system (causing headache, irritable bowel syndrome, high blood pressure and the like) and disorders of our hormonal and immune systems (creating susceptibility to infection, chronic fatigue, depression, and autoimmune diseases like rheumatoid arthritis, lupus, and allergies.)

To protect ourselves today, we must consciously pay attention to the signals of fight or flight

To protect ourselves in a world of psychological�rather than physical�danger, we must consciously pay attention to unique signals telling us whether we are actually in fight or flight. Some of us may experience these signals as physical symptoms like tension in our muscles, headache, upset stomach, racing heartbeat, deep sighing or shallow breathing. Others may experience them as emotional or psychological symptoms such as anxiety, poor concentration, depression, hopelessness, frustration, anger, sadness or fear.

Excess stress does not always show up as the "feeling" of being stressed. Many stresses go directly into our physical body and may only be recognized by the physical symptoms we manifest. Two excellent examples of stress induced conditions are "eye twitching" and "teeth-grinding." Conversely, we may "feel" lots of emotional stress in our emotional body and have very few physical symptoms or signs in our body.

By recognizing the symptoms and signs of being in fight or flight, we can begin to take steps to handle the stress overload. There are benefits to being in fight or flight�even when the threat is only psychological rather than physical. For example, in times of emotional jeopardy, the fight or flight response can sharpen our mental acuity, thereby helping us deal decisively with issues, moving us to action. But it can also make us hypervigilant and over-reactive during times when a state of calm awareness is more productive. By learning to recognize the signals of fight or flight activation, we can avoid reacting excessively to events and fears that are not life threatening. In so doing, we can play "emotional judo" with our fight or flight response, "using" its energy to help us rather than harm us. We can borrow the beneficial effects (heightened awareness, mental acuity and the ability to tolerate excess pain) in order to change our emotional environment and deal productively with our fears, thoughts and potential dangers.

What can we do to reduce our stress and turn down the activity of our fight or flight response?

The fight or flight response represents a genetically hard-wired early warning system�designed to alert us to external environmental threats that pose a danger to our physical survival. Because survival is the supreme goal, the system is highly sensitive, set to register extremely minute levels of potential danger. As such, the fight or flight response not only warns us of real external danger but also of the mere perception of danger. This understanding gives us two powerful tools for reducing our stress. They are:

1) Changing our external environment (our "reality"). This includes any action we take that helps make the environment we live in safer. Physical safety means getting out of toxic, noisy or hostile environments. Emotional safety means surrounding ourselves with friends and people who genuinely care for us, learning better communication skills, time management skills, getting out of toxic jobs and hurtful relationships. Spiritual safety means creating a life surrounded with a sense of purpose, a relationship with a higher power and a resolve to release deeply held feelings of shame, worthlessness and excessive guilt.

2) Changing our perceptions of reality. This includes any technique whereby we seek to change our mental perspectives, our attitudes, our beliefs and our emotional reactions to the events that happen to us. Many of these techniques are discussed in depth in Section 3 and they include: cognitive restructuring, voice dialogue therapy, inner child work, learning not to take things personally, affirmations and self-parenting. Changing our perceptions of reality is best illustrated by the proverbial saying, "when life gives you lemons, make lemonade." Without actually changing our reality, we can altered our perception of reality�viewing the difficulties of life as events that make us stronger and more loving. In the Buddhist tradition, this is referred to as developing a "supple mind."

Physical exercise can also turn down the activity of an overactive fight or flight response

Perhaps the simplest, best way to turn down the activity of our fight or flight response is by physical exercise. Remember that the natural conclusion of fight or flight is vigorous physical activity. When we exercise, we metabolize excessive stress hormones�restoring our body and mind to a calmer, more relaxed state.

For the purpose of stress reduction and counteracting the fight or flight response, we do not need to exercise for 30 to 40 minutes. Any form of activity where we "work up a sweat" for five minutes will effectively metabolize off�and prevent the excessive buildup of�stress hormones. Get down and do 50 pushups, 50 sit-ups, jumping jacks, jump rope, run in place, run up and down the stairs, whatever. By exercising to the point of sweating, we effectively counteract the ill effects of the fight of flight response, drawing it to its natural conclusion.

Sometimes when I'm upset, I close the door to my office, do 25 quick pushups, work up a light sweat, and return to work, clearer and calmer. Frequent repetitions of short exercise are easy to fit into our busy schedules. For full cardiovascular fitness, longer periods of exercise do have additional benefits, but for the purpose of stress reduction, mini-exercise sessions are practical, effective and beneficial.

Exercise increases our natural endorphins, which help us to feel better. When we feel good, our thoughts are clearer, our positive beliefs are more accessible and our perceptions are more open. When we feel tired and physically run down, we tend to focus on what's not working in our lives�similar to a cranky child needing a nap. It is difficult to be, feel or think positive when we are exhausted, sleep deprived or physically out of condition.

What is mind chatter?

If we could read the owners manual for the mind, we would find a full chapter on what is called "mind chatter." Mind chatter is the endless, restless stream of incomplete thoughts, anxieties and self-talk which constantly pulses through our minds. In order to survive, our mind is always "on"�searching for possible threats, dangers, solutions and explanations. This is called our "strategic mind." The strategic mind is always "on"�scanning both our inner and outer world for possible threats to our well-being�either real or imagined. This constant vigilance of the mind not only distracts us with excessive worry but can also trigger the activation of our fight or flight response.

Sometimes, because of the mind's incessant chatter and worry, we even begin to anticipate dangers or threats that don't really exist. This is what the soulful and gentle author Joan Borysenko, Ph.D. (Minding The Body, Mending The Mind) refers to as becoming an "advanced worrier." This condition is described brilliantly by Mark Twain who said "I've experienced many terrible things in my life, a few of which actually happened." Zig Ziglar, the great motivational speaker, says "Worry is a misuse of the imagination."

Underneath all the mind chatter and fight or flight anxiety lies a quiet place called our "inner voice", the "observer" or the "witness." The "inner voice" is what Walter Cannon, M.D., calls "the wisdom of the body." This quiet place allows us to move beyond our fears, beyond our anxieties and beyond our strategic mind�into a clearer understanding and knowing of what is true and loving. As we will soon discuss, a quiet mind calms our overactive physiology, creating a sequence of physiologic and biochemical changes that improve our physical health.

The simplest, most exquisite way I know of to quiet the mind is by eliciting what is called "The Relaxation Response. "

What is the relaxation response?

The relaxation response, discovered by the inspirational author and Harvard cardiologist, Herbert Benson, M.D., represents a hard-wired antidote to the fight or flight response. The relaxation response corresponds to a physical portion of the brain (located in the hypothalamus) which�when triggered�sends out neurochemicals that almost precisely counteract the hypervigilant response of the fight or flight response.

When we follow the simple steps necessary to elicit the relaxation response, we can predictably measure its benefits on the body. These include: a decrease in blood pressure, diminished respiratory rate, lower pulse rate, diminished oxygen consumption, increase in alpha brain waves (associated with relaxation), and in many cases, an improved sense of mental and spiritual well-being.

Because the relaxation response is hard-wired, we do not need to believe it will work, any more than we need to believe our leg will jump when the doctor taps our patellar tendon with a little red hammer. The relaxation response is a physiologic response, and as such, there are many ways to elicit it, just as there are many ways to increase our pulse rate (another physiologic response).

We must take the time to exercise our relaxation response "muscle"

The solution to overactivation of our fight or flight response is simple: when we take the time to exercise our relaxation response "muscle" we will enjoy the beneficial physiological, biochemical and mental effects. These beneficial effects are measurable whether we believe in the relaxation response or not. Some people do experience immediate emotional calm and tranquility when they learn to elicit the relaxation response, but others do not. We cannot measure the effectiveness of the relaxation response based on how it feels. Dr. Benson likens this to brushing our teeth. We know brushing is "good" for us, whether we feel it works or not. Feeling good is an added benefit. The most important thing is to actually take the time and discipline necessary to elicit the relaxation response. Once elicited, the benefits to our overstressed physiology and biochemistry will be experienced. Additionally, we bypass the fear and anxiety that so quickly narrows our perceptions and infects our beliefs with suspicion and doubt.

How do we elicit the relaxation response?

There are many ways to elicit the physiologic benefits of the relaxation response. The easiest is with a simple two-step method as follows:

1. Focus on a word or phrase that has a positive meaning to you. Such words as "one," "love" and "peace" work well. Effective phrases might also include "The Lord is my shepherd, I shall not want," "God grant me serenity," or "Lord, make me an instrument of your peace."

2. When you find your mind has wandered or you notice any intrusive thoughts entering your mind, simply disregard them and return your focus to the word or phrase you chose.

Be aware that your mind will tend to wander and intrusive thoughts will enter your mind. This is normal. Just allow those thoughts to pass through your mind like a summer breeze passes through an open window. The second step above is related to our ability to "let go" of intrusive thoughts or excessive worries. Dr. Benson says "to summon the healing effects of the relaxation response, you need to surrender everyday worries and tensions." This gets our harried minds out of the way of our body's natural ability to heal. It's funny to watch the tricks our mind plays on us. It will try to tell us things like: "This is stupid, why am I sitting here doing this?" "I hope no one sees me here meditating." "This will never work." "That's it, I'm going to quit now." When you realize your mind has wandered, just let go of the thought and return back to your word or phrase!

Remember, whether your mind wanders or your thoughts drift, simply practicing the two steps above will elicit the relaxation response and deliver beneficial physiologic and emotional benefits as predictably as flipping a light switch causes the light bulb to shine.

The key to deriving the benefits of the relaxation response is to practice it daily. Dr. Benson recommends at least 10 to 15 minutes, once to twice a day. This will produce the maximum benefit. When I first learned this technique from Dr. Benson's, I remember him telling us his dental analogy. He told us to treat the relaxation response the same way you treat brushing your teeth. Do it because you know it is good for you. Don't worry whether you think you had a "good relaxation response" or not. You wouldn't say to yourself: "That was a good tooth brushing!" would you? Whether you "felt" it was a calming, relaxing experience or not, the physiologic benefits of doing the relaxation response are measurable, predictable and repeatable. The quieting of the mind that results from eliciting the relaxation response is critical in order to open up our perceptual world, away from negativity and fear. This freedom allows us to be more awake, more aware and more conscious of the attitudes and beliefs we choose when living our daily lives.

Are there other ways to quiet the mind?

Because the relaxation response is a physiologic response (like our heart rate or respiratory rate), there are many ways to elicit it, just as there are many ways to increase our heart rate. They include:

1. During any repetitive exercise such as walking, swimming or running, repeat your "focus word" or phrase with each step or stroke. For example, when I run, with each step I might say "peace" or "love."

2. Practicing yoga, with its mental focus on postures and breathing, can elicit the relaxation response.

3. Deep diaphragmatic breathing exercises, with a focus on the breath, can trigger the relaxation response.

4. Progressive muscle relaxation techniques, where you alternately contract and then relax each muscle group moving progressively from head to toe, will elicit the beneficial effects of the relaxation response.

5. Repetitive forms of prayer elicit the relaxation response.

6. Singing or chanting your focus word or phrase, either silently or out loud, will elicit the relaxation response.

7. Mindfulness meditation, a method that comes from Buddhist philosophy and involves merely "observing" or "noticing" things, will elicit the relaxation response. For example, we may walk down the street and say, "My feet are touching the pavement, right foot, left foot, right foot, left foot. I notice the tree ahead. The top branches are swaying in the breeze. I'm feeling thirsty. My body is sweating. My feet are on the grass now. The grass is soft." By simply noticing our experience and naming it, without judging or evaluating whether it is good or bad, we tap into a source of active meditation that elicits the relaxation response. Instead of having one single focus word or phrase, the world around us and the world of feelings within us become our focus phrase.

The key is to simply notice our world and our feelings. No judgements of good, bad, right, wrong, lazy, weak, strong, kind, mean, etc. are given any attention. This is similar to simply disregarding any intrusive thoughts. Emotional mindfulness might sound like: "I am feeling sad. Tears are welling up in my eyes. I am remembering the hurt I felt when I left home that day. My stomach is growling. I feel my body shaking. I am feeling sad again." Notice there is only the simple acknowledgement, recognition and naming of the feeling or event. Any judgements about our feelings are to be passively disregarded with a return of one's mental focus to the observation or naming of emotions or bodily sensations. (For more information on mindfulness, read the remarkable work of Jon Kabat-Zinn in his books Full Catastrophe Living and Wherever You Go, There You Are.)

Other simple ways to quiet the mind

In addition to the above "formal" methods for quieting our mind, my dear friend Del Morris�in reviewing this book for me�pointed out that we don't have to make it complicated. We can take a walk on the sandy beaches and listen to the crashing waves. We can go into the forest at night, where we hear nothing but the sound of crickets. Take a warm bath. Walk by a creek and listen to the running water. I recently visited my sister and her husband in San Francisco, where an afternoon walk among the ancient redwoods of Muir Woods did just the trick. Walking across wooden bridges over running streams with loving family was as peaceful as any meditative moment I have ever experienced.

We can't learn how to swim in a stormy ocean

We need to "practice" quiet moments whenever we have the chance. Quieting our mind follows awareness and attention. When we become aware that we are rushing in our heads, we stop, breathe and take a quiet moment of reflection. With practice, quieting our restless thoughts becomes automatic. When first learning a formal technique for quieting the mind, be patient with yourself. We need to learn these techniques when things are calm. Their effectiveness comes from repetition and practice. We don't learn how to swim in a stormy ocean. Similarly, we cannot learn to elicit the relaxation response in the midst of emotional, psychological or social storms. We need to learn the techniques in calm waters. Then, when the rains come, we can utilize them to help us stay afloat in stormy seas.

What have we learned?

In order to consciously choose the attitudes and beliefs which are most empowering, we must learn to quiet our mind and quiet our body. By eliciting the relaxation response, we can stop the mind chatter, allowing us to move out of our strategic mind into the quiet mind, capable of conscious awareness and attention. The quiet mind opens up our perceptions and frees us to make the most positive choices regarding our lives.

In this sense, the mind is likened to a pond of water. Restless thoughts are like pebbles thrown into the water. They send out a ripple of activity, disturbing the tranquil surface. When the water is constantly agitated with restless thoughts, we cannot see clearly to the bottom of the pond, which represents our inner wisdom. When we stop the restless thoughts, we calm the waters, enabling us to see clearly to the bottom�where our wisest, most enlightened self resides.

http://www.mindbodymed.com/EducationCenter/fight.html

"What does this have to do with IBS
Converging evidence from different laboratories and research groups are consistent with the concept of an "enhanced stress responsiveness" as a major vulnerability factor in many IBS patients. As outlined above, such an enhanced stress responsiveness may not be obvious to the affected individual, until he or she is exposed to a period of sustained threatening stressors (financial or employment problems, divorce, aftermath of a major disaster with consequences on daily life), repeated mild to moderate stressors, or a one time severe (life threatening) type stressor (robbery or physical assault). Under these circumstances the mechanisms that normally turn off the stress response are overwhelmed, and attempts of the nervous system at adaptation or habituation fail. Many of the vulnerability factors for such enhanced stress responsiveness have been identified and many of them occur in a particular vulnerable period of the developing brain (before age 10). Some of the best-studied factors include loss of the primary care giver, distant mother-child relationship, emotional neglect, and physical and verbal or sexual abuse.

In order to understand how a chronically enhanced stress response can produce the cardinal symptoms of IBS (abdominal pain and discomfort associated with altered bowel habits) we have to go back to the earlier section on the emotional motor system: activation of the stress system will stimulate contractions and secretion in the sigmoid colon and rectum. Depending on the specific emotional context (fear vs. anger), the upper GI tract will be either inhibited (fear) or stimulated (anger). In addition, recent research in animals has demonstrated a phenomenon referred to as stress-induced visceral hyperalgesia. What this means is that in vulnerable animals, exposure to an acute moderate stressor will make the colon more sensitive to distension and the perception of discomfort or pain."

http://www.aboutibs.org/Publications/stress.html

This is another part of all this.

"PET Brain Research Demonstrates Gender Differences in Pain Response
Posted November 6, 2003
Source: UCLA

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November 6, 2003: A new UCLA study shows that different parts of the brain are stimulated in reaction to pain depending on gender. The research, which represents the largest gender-comparison study of its kind, focused on people with irritable bowel syndrome (IBS), one of the nation's most common chronic medical conditions. The findings may help develop and target better treatments for IBS and other illnesses.

"We are finding more scientific differences between men and women as we improve research methods and broaden study populations," said study co-author Dr. Emeran Mayer, UCLA professor of bio-behavioral sciences, and medicine, physiology and psychiatry. "This growing base of research will help us develop more effective treatments based on a new criteria: gender."

Dr. Mayer is the director of the new Center for Neurovisceral Sciences & Women's Health (CNS) at UCLA, which conducted the study.

Published in the June 2003 issue of the journal Gastroenterology, the study examined 26 women and 24 men with IBS. UCLA researchers took positron emission tomography (PET) brain scans of patients during mild pain stimuli.

Although researchers found some overlapping areas of brain activation in men and women, several areas of male and female brains reacted differently when given the same pain stimulus. The female brain showed greater activity in limbic regions, which are emotion-based centers. In men, the cognitive regions, or analytical centers, showed greater activity.

"The reason for the two different brain responses may date back to primitive days, when the roles of men and women were more distinct," said study co-author Dr. Bruce Naliboff, UCLA clinical professor of psychiatry and biobehavioral sciences, and co-director of CNS.

According to Naliboff, these gender differences in brain responses to pain may have evolved as part of a more general difference in stress responses between men and women. Men's cognitive areas may be more highly triggered because of the early male role in defending the homestead, where in response to stress and pain, the brain launched a calculated fight-or-flight reaction.

The female limbic regions may be more responsive under threat because of their importance in triggering a nurturing and protecting response for the young, leading to a more emotion-based response in facing pain and stress.

Naliboff noted that both responses have advantages and neither is better. In fact, under conditions of external threat, the different responses may lead to complementary behaviors between men and women.

In addition, researchers found that the anticipation of pain generated the same brain responses from study volunteers as the actual pain stimulus. "The brain is a powerful force in dictating how the body responds to pain and stress," said study co-author Dr. Lin Chang, UCLA associate professor of medicine and co-director of CNS.

The next step, according to Mayer, is to look at how the results of the study may impact treatment for IBS and other disorders. Mayer adds that one current drug for IBS, Lotronex, affects the limbic system and has worked more successfully in women than men.

UCLA's Center for Neurovisceral Sciences and Women's Health studies how the brain, stress and emotions impact the development of disorders that affect mainly women.

Irritable bowel syndrome affects 15 to 20 percent of Americans and causes discomfort in the abdomen, along with diarrhea and/or constipation."

And from above which is very important.

"In addition, researchers found that the anticipation of pain generated the same brain responses from study volunteers as the actual pain stimulus. "The brain is a powerful force in dictating how the body responds to pain and stress,"

http://interactive.snm.org/index.cfm?PageID=1589&RPID=922

Also "In one interesting experiment, balloon distension of the small intestine in IBS patients caused pain. However, if the patients were mentally distracted during the balloon distension, they did not feel pain. This illustrates a typical brain-gut relationship. "

More on this and why its very important. Stressors and IBS and the immune system are part of the picture in IBS symptoms and triggers.

"Readers' Exchange
Defining Stress in IBS
Fall 2003

From Arizona -- Thank you so much for your efforts and support for those of us with GI disorders. Your first issue (Spring 2003) of Digestive Health Matters is both professional and informative. I would like to comment on one of the articles - "The CNS: Center for Neurovisceral Sciences and Women's Health at UCLA." I am encouraged to know that steps are being taken for funding research of IBS and interstitial cystitis. However, it is discouraging that researchers are still expending time and money to research "neurobiological mechanisms by which stress modulates brain-visceral interaction." I realize that stress is a popular theory in the discussion of IBS triggers, however, I believe this is completely backward and it is the chronic pain and totally unreliable bowel function of an IBS sufferer which causes the greatest stress. If research would focus on "fixing" the bowel, no doubt the panic and fear of IBS would be greatly alleviated.

Comment from Emeran Mayer, M.D. -- In contrast to the common interpretation of the term "stress" as a psychological phenomenon, it should be understood as any real or perceived perturbation of an organism's homeostasis, or state of harmony or balance. For example, in this viewpoint a severe hemorrhage, starvation, extreme temperature, or worry about the unpredictable onset of abdominal pain all qualify as stressors -- some as "physical" stressors, others as "psychological" stressors. The fear to leave the house in the morning without knowing if one can make it to work without having to stop on the freeway because of an uncontrollable bowel movement, or the fear of experiencing uncontrollable abdominal discomfort during an important business meeting are sufficient stressors to activate the central stress system.

The central stress system involves the release of chemical stress mediators in the brain (such as corticotropin releasing factor), which in turn orchestrate an integrated autonomic, behavioral, neuroendocrine, and pain modulatory response. This biological response in turn will alter the way the brain and the viscera interact, and this altered brain-gut interaction can result in worsening of IBS symptoms. Thus, pain and discomfort, fear of these symptoms, activation of the stress response, and modulation of the brain-gut interactions by stress mediators are part of a vicious cycle which need to be interrupted to produce symptom relief.

The neurobiology of stress is not a theory, but a topic that can be studied in animal models, and one of the hottest topics in drug development for treatment of IBS (e.g., substance P antagonists, corticotropin releasing factor antagonists). "

http://www.aboutibs.org/Publications/StressDefined.html

"The Response to Stress

Bruce McEwen, Ph.D., and Dean Krahn, M.D

What do we mean when we say we are "stressed out"? We may just be having a bad day, or feeling pressured by too many things to do and too little time to do them. Or we may have had a fight with a friend or family member. Or our job may be getting to us - feeling that it is just a rat race without a purpose, or feeling too much pressure and a lack of support and camaraderie. In any case, we are "bummed out" and "frazzled" and tend to think about how we feel at the moment and how to make it better right away. Rarely do we give much thought to the longer time frame and how our body is handling or not handling the pressure. Yet, it is the longer time frame of months and even years that is important for understanding the bad side of stress.

Stress activates adaptive responses. The body marshals its forces to confront a threat and, generally, does a good job of protecting us in the short run. So why can stress also be so bad for our bodies and brains?

Stress can prematurely age us and leave us chronically fatigued or depressed. When exposure to stress -- whether from a traumatic event to just the daily hassle of rush hour traffic or too much email -- disrupts the body's internal balance ("homeostasis"), it can go one of three general ways: the body can regain its normal equilibrium once the stress has passed or it can become stuck in an over- or under-aroused state. How a person copes with stress -- by reaching for a beer or cigarette as opposed to heading to the gym -- also plays a big role in the impact stress will have on our bodies.

How the Body Handles Acute Stress
When the body is challenged by almost anything that happens to us, from getting out of bed in the morning or running up a flight of stairs or having to stand up and give a talk, the brain activates the autonomic nervous system (ANS), the involuntary system of nerves which controls and stimulates the output of two hormones, cortisol from the adrenal cortex and adrenalin from the adrenal medulla. These two hormones and the activity of the ANS help us cope: the ANS and the adrenalin keep us alert by increasing our heart rate and blood pressure and quickly mobilizing energy reserves. In contrast, cortisol works more slowly, helps replenish energy supplies and, at the same time, helps us to remember important things. For example, cortisol readies our immune system to handle any threat -- bacterial/viral or injury.

Another aspect of cortisol action is called "containment." Many physiological systems are pitted against one another so that neither system can get out of control. The initial, first line response to many noxious or pathogenic agents is normally "contained" by circulating levels of cortisol. This is why we take corticoids for an inflammation or skin irritation. Cortisol also contains acquired immune responses, and this is particularly useful when those responses are harmful, such as in an allergy or an autoimmune disorder.

All of these adaptive responses are described by the term "allostasis" which means "maintaining stability, or homeostasis, through change."1 The body actively copes with a challenge by expending energy and attempting to put things right. Most of the time it succeeds but the real problems arise when the systems involved in allostasis don't shut off when not needed or don't become active when they are needed.

Chronic Stress Response - Too Much of a Good Thing!
The way our bodies work presents us with a paradox: what can protect can also damage. This is called "allostatic load." It's the price the body has to pay for either doing its job less efficiently or simply being overwhelmed by too many challenges.1

For our metabolism, the overactivity of the ANS and increased cortisol secretion produce elevated levels of sugar in the blood ("hyperglycemia"). As little as a week of inadequate sleep, say 75% of normal, can raise evening levels of blood sugar. If prolonged, what can result is a rise of insulin, the hormone manufactured by the pancreas to control sugar metabolism. If this situation goes on for a long time, continued hyperactivity of the ANS and elevated cortisol will lead the body down the path to type 2 diabetes. Elevated levels of cortisol, as in depressive illness, are also linked to gradual demineralization of bone.

For the cardiovascular system, the elevation of ANS activity, combined with hyperglycemia and too much insulin ("hyperinsulinemia") promote both hypertension and harmful metabolic conditions, as blood cholesterol rises and HDL, the so-called good cholesterol drops. This one-two punch accelerates hardening of the arteries ("arteriosclerosis"). Blood pressure surges seem particularly important. Among monkeys living in social hierarchies, the dominant males show accelerated atherosclerosis when the hierarchy is unstable and they have to continuously fight for their position. Treating these animals with beta blockers, pharmaceuticals used to control blood pressure, prevented the increased atherosclerosis.

While acute stress actually improves our brain's attention and increases our capacity to store important and life-protecting information, for example, a source of danger, chronic stress dampens our ability to keep track of information and places. Chronic stress does this by impairing excitability of nerve cells and by promoting atrophy of nerve cells in the hippocampus, a region of the brain that is important for spatial and verbal memory.

For the immune system, which is controlled by the nervous system and by circulating hormones, chronic stress suppresses the ability of the immune system to do its job. This, once again, is in contrast to acute stress. Acute stress actually helps the immune system handle a pathogen by causing immune cells to move out of the bloodstream and into tissues where they are needed. Chronic stress, however, impairs not only the ability of the immune system to relocate immune cells but also the ability of those cells to do their job of recognizing and responding to the pathogenic agent.

Too Little of a Good Thing
But what happens when the body cannot mount an adequate response to an acute stress? Clearly, many of the good things that stress hormones do will not occur, like enhancing memory, replenishing energy reserves or moving immune cells to where they are needed. One other consequence, seen most clearly in the immune system, is that systems that are normally "contained" by cortisol become hyperactive. In the immune system, we find inflammatory agents (cytokines) and self-generated responses ("autoimmune") are no longer contained by circulating cortisol. As a result, disorders like arthritis and autoimmune diseases, for example, lupus, become worse. One treatment for such disorders, as we will discuss later on, is to treat the patient with cortisone or another glucocorticoid steroid.

How Our Behavior Can Help or Hurt Us
Besides regulating the endocrine system and the ANS and exerting a powerful influence on the immune system, the brain is the master organ for our behavior. And our behavior can help us or hurt us in various ways. The most obvious way is to get us out of danger by flight or conciliation or to increase danger by confrontation or by risk-taking behaviors like driving recklessly. Another role of behavior is via health-damaging activities, e.g., smoking, drinking or eating too much of the wrong things, or health promoting behaviors such as exercise and eating a healthful diet. In other words, when we are under stress, it's important whether we reach for the bag of potato chips or go for a swim or a jog. Eating a rich diet and drinking alcohol feed into the allostatic load -- they increase the levels of these stress mediators and, thus, make hypertension and insulin resistance, among other consequences, more likely.

What We Can Do to Better Handle Stress
Individuals may differ in their health and well being because they differ in behavioral and neuroendocrine adaptive mechanisms, that is, the ways in which their hormone and nervous systems react. You might, compared to a friend, have higher or lower allostatic load, not only because you are subjected to different degrees of life stressors but because you are "wired" differently and have had different life experiences that make you react in different ways.

Whatever the cause may be, protecting your body against over-exposure to stress hormones is as important to the body as the ability to mount an adequate allostatic response in the first place. Either type of imbalance in allostasis qualifies under the definition of "allostatic load." People with long-term histories of persistent and relatively small elevations or deficiencies in stress hormone levels may show accelerated progress toward pathophysiology and disease. In the case of excess hormone production, these disorders include atherosclerosis, obesity, type 2 diabetes and cognitive impairment. For relative hormone insufficiency, the pathophysiology includes autoimmune and inflammatory disorders, chronic pain and chronic fatigue.

In dealing with the type of allostatic load involving hormone over-production, it is important to use behavioral coping skills to control over-production of stress hormones in challenging situations. This includes seeking social support, counting to ten and resisting an intemperate reaction or simply withdrawing from a situation rather than risking a destructive confrontation. Behavioral coping also includes engaging in health promoting behaviors, such as regular moderate exercise and a healthy diet with moderate food intake and controlled alcohol intake. It is also important to learn to see situations as a challenge and an opportunity, rather than as disasters about to happen. If this sounds like an admonition to "positive thinking" it is exactly that. These types of behaviors represent a first line of defense against the development of allostatic load.

In the case of relative hormone deficiency, there are experimental programs to treat with low dose glucocorticoids in the case of chronic fatigue syndrome and chronic pain but these have had mixed results.2 Admittedly, the medical community is still not certain how to treat these conditions.

How Your Doctor Can Help
Although allostatic load is a subtle phenomenon, your doctor needs to take it into account in diagnosis and treatment. A doctor can help you reduce allostatic load by encouraging you to learn behavioral coping skills that will enable you to recognize your limitations and teach you to relax. These are simple steps every doctor can provide even without the results of further research. Your doctor can also assess other areas of your health and remind you about the interactions of high fat diet and stress in atherosclerosis, the role of risky behaviors such as smoking in cardiovascular disease and cancer, and the beneficial effects of exercise. However, there are limits to what such advice can accomplish. While your doctor may point these and other matters out to you, your decision to follow the advice and your ability to change behavior patterns3,4 are, of course, critical.

Clearly, doctors of all types are involved in providing advice, counseling and/or psychotherapy aimed at helping patients deal in a more healthy way with the many stressors of life. Interestingly, different psychotherapeutic approaches might address more efficient and less costly allostasis in different ways. For example, cognitive therapy focuses on better labeling of the stimuli in the environment so that the same stimuli are subsequently interpreted in a less threatening, arousing way. On the other hand, behavioral or exposure therapy focuses on keeping the individual in a threatening environment long enough to allow the neuroendocrine and autonomic systems to handle the situation. For example, a person with a fear of flying might be treated with air travel simulations until their body learns to "cope" with the fear. Whatever you do, it is important that the right psychotherapeutic" strategy appropriate for you and your "nervous system" be selected.

Does Everybody Suffer from Stress?
The biggest problem with the frequent patient complaint of the 90s, "I'm stressed out," is that it is so general. The father of stress research, Hans Selye, writes in his autobiography5 that he was first struck by how people with many different types of illness all had some common symptoms best described as "feeling sick." Selye believed that stress caused "flight or fright." Now, we even know that stress can sometimes cause us problems by making us react too little. As noted above, underarousal (insufficient allostatic response) to a stressor is potentially as damaging to the body as prolonged arousal. So, today, we now understand that being "stressed out" or being "sick and tired" are actually the symptoms of a mismatch -- your body has not reacted correctly to the challenge or threat it faced. Unfortunately, researchers haven't figured out how much of an allostatic response is necessary or harmful.

A classic example is fever. It's not clear whether a doctor should treat it with medicine or let it run its course.6 Fever is often a good and natural response ("adaptive") to an acute infectious agent but the person with a fever must pay a significant price in "feeling sick." It now appears that the treatment of a fever might actually delay recovery from an infectious process. Similar questions are raised about the use of antiinflammatories and whether they might sometimes interrupt a healing process.

So, treating an allostatic response might be hazardous. Interestingly, some people with infectious episodes go on to develop the Chronic Fatigue Syndrome (CFS) which is often characterized by intermittent feverishness and malaise like that occurring with an infection, even though the person has no infection. It appears that this is a disorder where an inappropriate "allostatic" response is being made and this includes an insufficiency of the production of stress mediators like cortisol. Treatment will likely center on how to make the allostatic responses mounted by the CFS patient more appropriate. As we have already noted, this may include giving low dose cortisol treatment to supplement what the body produces.

Another situation often confronting doctors is whether or not to treat a patient for the symptoms arising in the wake of the loss of a loved one. Bereavement is characterized by many, but clearly not all, of the symptoms of depression, such as depressed mood, tearfulness and changes in sleep and appetite.7 Yet, many regard bereavement to be a restorative, healing and even necessary part of the process of losing a loved one. However, some bereaved people experience symptoms of such severity and length that treatment for depression is pursued.

Developing clear and useful standards for differentiating healing from unhealthy bereavement is an ongoing but difficult job and a clear example of the types of judgments facing the doctor who is going to treat the mismatches of challenge and allostatic response.

In the future, we will need to develop better detectors for environmental stressors (infectious, interpersonal, etc.), better detectors for allostatic response and better ways of determining whether a response is turned on too much or too little or is of too long or too short a duration. This allostatic framework, however, will help guide you and your doctor as you together decide whether you're sick or stressed out.

November 1999 "

http://www.thedoctorwillseeyounow.com/articles/behavior/stress_3/

These are important complex issues in IBS and its good to see people talking about them and interested in them for sure and there is no doubt understanding some of these issues can majorally help IBS. One thing though is it takes a bit of time to learn and understand, I know it did for me.

Steve, as mentioned, this does take some time, chronic stressors don't go away overnight as you are probably aware of.

"What if your deep breathing is hampered by pain, though? When I really try to fill the belly up, it seems to hit a wall and if I push on that wall, I end-up with a dull pain under my sternum that feels like a lump in there."

Yes for sure the pain can effect breathing, as a matter of fact severe pain can cause a person to hyperventilate. When you do this it causes the muscles to contract and can cause more pain. Its takes a while to learn the relaxation responce and for it to start kicking in. When the gut cramps also, it can put pressure on the diaphram and then that can effect breathing or people with dyspepsia might have along with their gut cramping contractions in their Esophagus.

Also the bowel has pressure sensitive cells that signal to the brain when the cells are activated by pressure or distension.

Serotonin is one of the messengers in regards to the communication from the gut to the brain in regards to pain.

But the opposite of muscle tension is muscle relaxation. So continued practice of these methods can start to become second nature and more effective with time.

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My website on IBS is www.ibshealth.com

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