Understanding and managing the stress response

by Richard Glickman-Simon, MD

Imagine for a moment that you are living in the Stone Age, some 10,000 years ago. Your day largely consists of gathering food for you and your family to eat. Life is stressful, but you have no complaints. Your priorities are clear, you know how to survive, and you take pride in your ability to handle whatever comes your way.

Now imagine that it is dusk and you and some companions are returning from a long, exhausting day of hunting. You suddenly encounter a small pack of startled wolves, obviously threatened by your presence. A violent confrontation is imminent. As if turned on by an unseen switch, you instinctively set in motion a torrent of physiologic, emotional, and behavioral reactions designed to maximize your chances of survival. This is the stress response.

To survive in the face of this stressor, you will need to see clearly (even at dusk), think coherently, move rapidly, and cooperate with your allies. This requires a sharp increase in blood flow and oxygen supply to your brain, special senses, and skeletal muscles. Your heart rate increases, your blood pressure rises, your breathing quickens, your airways

widen. Blood is diverted away from non-essential organs such as your skin, which becomes cool and clammy. Your pupils dilate and, in case youre injured in an ensuing battle, your immune system is suppressed to dampen the painful consequences of inflammation. Two stress hormones, produced in large part by the adrenal glands, primarily orchestrate these physiologic changes: epinephrine (or adrenalin) and cortisol.

You and your companions know exactly what to do. You coordinate your positions, raise your weapons, and prepare for a fight. Fortunately, the wolves retreat. As the danger subsides, so does the stress response, which is highly adaptable to a rapidly changing environment. As quickly as it turns on, it turns off once the threat has passed. You proceed home, a little shaken, but otherwise feeling fine as your epinephrine and cortisol levels return to normal.

Now imagine it is present day. Your day largely consists of making money so you and your family have food to eat. It is dusk and youre getting ready to return home from a long, exhausting day at work. On your way out, your hostile boss inappropriately accuses you of a mistake you did not commit, and insists that you immediately correct the problem. While not imminently life threatening, this blow to your integrity is enough to ignite a typical stress response, the physiology of which has not changed since the Stone Age. Wild animals no longer pose the threat. Supervisors, deadlines, responsibilities, and social injustices have replaced them.

So, what do you do?

Argue with your boss or quit your job to escape his threatening behavior? On the contrary. Feeling trapped by societies expectations, you respond, through clenched teeth, "Im sorry. Ill take care of it." While your Stone Age counterpart was free to fight or flee, you are forced to endure the standoff. Yours is a stress response with no place to go. And, unlike the retreating wolves, you are faced with similar stressors all day, every day.

A maladaptive stress response

Rather than trying to hide from the inevitable, it makes more sense to moderate the harmful effects of the stress response. There are three basic ways to accomplish this:

Use the stress response. Dont take it lying down! While your stress hormones are up, channel them into productive activities. Exercise is an ideal outlet for excess epinephrine and cortisol. Not only does regular exercise clearly benefit the cardiovascular and immune systems, it also offsets the destructive emotions often associated with the stress response, like anxiety and depression.

Alleviate the stress response. Originally, scientists assumed the stress response was involuntary