A presentation to a group of health professionals explaining; How stress may lead to illness,

How psychological factors may mediate the relationship between stress and illness

Introduction

 Stress isn’t always bad. In small doses, it can help you perform under pressure and motivate

you to do your best. But when you’re constantly running in emergency mode, your mind and

body pay the price. If you frequently find yourself feeling frazzled and overwhelmed, it’s

time to take action to bring your nervous system back into balance. You can protect yourself

— and improve how you think and feel — by learning how to recognize the signs and

symptoms of chronic stress and taking steps to reduce its harmful effects.

What is stress?

 Stress is your body’s way of responding to any kind of demand or threat.

 When you sense danger whether it’s real or imagined, your body's defences automatically

process the perceived threat. This process is known as the “fight-or-flight” reaction or the

"stress response".

 Thus, stress is the body’s way of protecting you.

 When functioning properly, stress helps you stay focused, energetic, alert, and defend

yourself. For example, it can stimulate you to slam on the brakes to avoid an accident. Hence

an adequate amount of stress might actually save your life.

 Stress can also help you cope with challenges. For example it is what drives you to study for

an exam when you'd rather be watching TV.

 Regardless, beyond a certain point, stress stops being helpful and starts causing severe

damages to your health, mood, productivity, relationships, and quality of life.

Fight-or-flight response: what happens in the body

When you feel threatened, your nervous system responds by releasing a flood of stress

hormones, including adrenaline and cortisol, which rouse the body for emergency

action. Your heart pounds faster, muscles tighten, blood pressure rises, breath

quickens, and your senses become sharper. These physical changes increase your

strength and stamina, speed your reaction time, and enhance your focus—preparing

you to either fight or escape from the danger present.

Effects of Chronic Stress

 The human nervous system isn’t very good at distinguishing between emotional and

physical threats. For example, if you’re stressed over an assignment deadline, your body can

react just as strongly as if you’re facing a life-or-death situation.

 In addition, the more the emergency stress system is activated, the easier it becomes to

trigger and the harder it becomes to shut off.

 Exposure to chronic states of heightened stress, can eventually lead to serious health

problems.

 Chronic stress disrupts nearly every system in your body.

 It can suppress your immune system, upset your digestive and reproductive systems,

increase the risk of heart attack and stroke, and speed up the aging process.

 In more extreme cases, it can even rewire the brain, leaving you more vulnerable to anxiety,

depression, and other mental health problems.

Health problems caused by stress include:

1. Depression and anxiety

2. Pain of any kind

3. Sleep problems
4. Autoimmune diseases

5. Digestive problems

6. Skin conditions, such as eczema

7. Heart disease

8. Weight problems

9. Reproductive issues

10. Thinking and memory problems

Signs and symptoms of stress overload

 The most dangerous thing about stress is how easily it can creep up on you and how easily it

is to get used to high levels of stress.

 That’s why it’s important to be aware of the common warning signs and symptoms of stress

overload.

Cognitive symptoms Emotional symptoms

Memory problems Depression or general unhappiness
Inability to concentrate Anxiety and agitation
Poor judgment Moodiness, irritability, or anger
Seeing only the negative Feeling overwhelmed
Anxious or racing thoughts Loneliness and isolation
Constant worrying Other mental or emotional health

problems
Physical symptoms Behavioural symptoms
Aches and pains Eating more or less
Diarrhea or constipation Sleeping too much or too little
Nausea, dizziness Withdrawing from others
Chest pain, rapid heart rate Procrastinating or neglecting
Loss of sex drive
Frequent colds or flu responsibilities
Using alcohol, cigarettes, or drugs to

relax
Nervous habits (e.g. nail biting,
 pacing)

Causes of stress

 The situations that cause stress are known as stressors.

 We usually think of stressors as being negative, such as an exhausting work schedule.

 However, anything that puts high demands on you can be stressful. This includes positive

events such as getting married, buying a house, going to college, or going on a vacation.

 Not all stress is caused by external factors. Stress can also be internal or self-generated. For

example, when you worry excessively about something that may or may not happen, or have

irrational, pessimistic thoughts about life.

 Finally, one of the major causes stress depends, at least in part, on our perception of it. (Also

known as Personal Appraisal)

Common external causes of stress:

1. Major life changes
2. Work or school
3. Relationship difficulties
4. Financial problems
5. Being too busy
6. Children and family

Common internal causes of stress:

1. Pessimism
2. Inability to accept uncertainty
3. Rigid thinking, lack of flexibility
4. Negative self-talk
5. Unrealistic expectations / perfectionism
6. All-or-nothing attitude

Top 10 stressful life events

According to Holmes and Rahe Stress Scale, these are the top ten stressful life
events for adults that can contribute to illness:
1. Death of a spouse
2. Divorce
3. Marriage separation
4. Imprisonment
 5. Death of a close family member
6. Injury or illness
7. Marriage
8. Job loss
9. Marriage reconciliation
10. Retirement

How much stress is too much?

 This question is subjective as some people seem to be able to roll with life’s punches, while

others tend to crumble in the face of small obstacles or frustrations.

Things that influence your stress tolerance level

Your support network – Having support from friends and family is an enormous buffer against

stress. When you have people you can rely on, life’s pressures don’t seem as overwhelming. In

fact, the lonelier and more isolated you are, the greater your risk of succumbing to stress.

Your sense of control - Having confidence in yourself and your ability to face challenges makes

it easier to deal with stressful situations.

Your attitude and outlook - The way you look at life and its inevitable challenges makes a huge

difference in your ability to handle stress. If you’re generally hopeful and optimistic, you’ll be

less vulnerable. Stress-hardy people tend to embrace challenges, have a stronger sense of humour,

believe in a higher purpose, and accept change as an inevitable part of life.

Your ability to deal with your emotions - If you don’t know how to calm yourself down when

you’re feeling sad, angry, or troubled, you’re more likely to become stressed and agitated. Having

the ability to identify and deal appropriately with your emotions can increase your tolerance to

stress and help you bounce back from adversity.

Your knowledge and preparation - The more you know about a stressful situation—including

how long it will last and what to expect—the easier it is to cope.

Improving your ability to handle stress

Get moving - Regular exercise can lift your mood and serve as a distraction from worries,

allowing you to break out of the cycle of negative thoughts that feed stress. Rhythmic exercises

such as walking, running, swimming, and dancing are particularly effective, especially if you

exercise mindfully (focusing your attention on the physical sensations you experience as you

move).

Connect with others - talking face-to-face with another human can trigger hormones that relieve

stress when you're feeling agitated or insecure. Even just a brief exchange of kind words or a

friendly look from another human being can help calm and soothe your nervous system. So make

it a priority to build stronger and more satisfying connections.

Engage your senses - The key is to find the sensory input that works for you. Does listening to

an uplifting song make you feel calm? Or smelling ground coffee? Or maybe petting an animal

works quickly to make you feel centered? Everyone responds to sensory input a little differently,

so experiment to find what works best for you.

Learn how to relax - You can’t completely eliminate stress from your life, but you can control

how much it affects you. Relaxation techniques such as yoga, meditation, and deep breathing

activate the body’s relaxation response, a state of restfulness that is the polar opposite of the stress

response. When practiced regularly, these activities can reduce your everyday stress levels and
boost feelings of joy and serenity. They also increase your ability to stay calm and collected under

pressure.

Maintain a healthy diet - The food you eat can improve or worsen your mood and affect your

ability to cope with life’s stressors. Eating a diet full of processed food, refined carbohydrates,

and sugary snacks can worsen symptoms of stress while eating a diet rich in fresh fruit and

vegetables, high-quality protein, and omega-3 fatty acids, can help you better cope with life’s ups

and downs.

Get an adequate amount of sleep - Feeling tired can increase stress by causing you to think

irrationally. At the same time, chronic stress can disrupt your sleep. Whether you’re having

trouble falling asleep or staying asleep at night, there are plenty of ways to improve your sleep so

you feel less stressed and more productive and emotionally balanced.

Identify the cause of stress - Monitor your state of mind throughout the day. If you feel stressed,

write down the cause, your thoughts and your mood. Once you know what's bothering you,

develop a plan for addressing it. That might mean setting more reasonable expectations for

yourself and others or asking for help with household responsibilities, job assignments or other

tasks. List all your commitments, assess your priorities and then eliminate any tasks that are not

absolutely essential.

Get help - If you continue to feel overwhelmed, consult with a psychologist or other licensed

mental health professional that can help you learn how to manage stress effectively. Professionals

can help you identify situations or behaviours that contribute to your chronic stress and then

develop an action plan for changing them.

 Hans Selye – General Adaptation Theory

“Every stress leaves an indelible scar, and the organism pays for its survival after a stressful

situation by becoming a little older.”

Hans Selye (1907-1982)

Three Phases of Stress Response:

1. Alarm Stage

In this phase, the initial reaction of the body to stress is to label the stressor as a threat or danger

to balance, that is why it immediately activates its fight or flight response system, and releases the

“stress” hormones such as adrenaline, noradrenaline and cortisol. These hormones enable you to

perform activities that you don’t usually do.

2. Resistance Stage

After the body has responded to the stressor, it is more likely that the stress level has been

eradicated, or simply reduced. After the fight or flight response, your body’s defences become

weaker, as it needs to allocate energy to the repair of damaged muscle tissues and lower the

production of the stress hormones.

Although the body has shifted to this second phase of stress response, it remains on-guard,

particularly when the stressors persist and the body is required to fight them continuously,

although not as stronger as it could during the initial response.

3. Exhaustion Stage

During this phase, the stress has been persistent for a longer period. The body starts to lose its

ability to combat the stressors and reduce their harmful impact because the adaptive energy is all
drained out. The exhaustion stage can be referred to as the gate towards burnout or stress

overload, which can lead to health problems if not resolved immediately.

The Maltese Context

There are few studies about stress and illness specific to Malta. However, through other

studies we can see the effect that stress has on the population. Studies show that Maltese

people are high in obesity (Cuschieri et al., 2016). This could be due to the behavioural

symptoms that are caused by stress. In addition, in a study by Grech (as cited in Cefai &

Camilleri, 2009) “university students [in Malta] are much more susceptible to the depressive

symptoms, maybe due to the high stress environment that they are in” (2011). In the study

by Muscat (2016) more than half of the caregivers for people with dementia had moderate to
severe anxiety and a quarter of them had moderate to severe depression caused by high

levels of stress.
References:

Cuschieri, S., Vassallo, J., Calleja, N., Camilleri, R., Ayrton Borg, A., Bonnici, G., . . . Mamo, J.

(2016). Prevalence of obesity in malta John Wiley & Sons, Inc.

Grech, J. (2011). What is the effect of religiousness/spirituality and perceived peer support on

depressive symptoms in university students University of Malta;Faculty of Education.

Krantz, D.S., Thorn, B., Kiecolt-Glaser, J. (Last updated: 2013). How Stress Affects Your Health.

Published by American Psychology Association. Retrieved from;

http://www.apa.org/helpcenter/stress-facts.pdf

Muscat, M. (2016). Depression, anxiety and quality of life of caregivers of individuals with

dementia living in the community in malta University of Malta;Faculty for Social Wellbeing.

Department of Gerontology.

Ogden, J. (2012). Health Psychology A textbook. (5th Ed) Open University Press.

Segal, J., Smith, M., Segal, R., Robinson, L. (Last updated: February 2018). Stress Symptoms,

Signs, and Causes. Improving Your Ability to Handle Stress.

Sincero, S.M. (Jul 10, 2012). General Adaptation Syndrome. Retrieved Apr 20, 2018 from

Explorable.com: https://explorable.com/general-adaptation-syndrome

Taylor, S.E. (2011). Health Psychology. (8th Ed.) McGraw Hill.