Okay, I’m stressed. Now what?

We can change the way we cope, both
physiologically and psychologically.

Acute stress and the body’s response to it is typically a one-two-three quick and it’s over situation, with the body soon returning to its healthy wellness balance. Chronic stress, on the other hand, is ongoing, providing precious little opportunity for the body to return to its healthy wellness balance. It is the chronic stress that causes the damage, and the damage can be physical, emotional or psychological, or any combination of these. From Robert Sapolsky, page 245 of Why Zebras Don’t Get Ulcers:

…the hormones of the stress-response should be nice and quiet when nothing bad is happening, secreted in tiny amounts. When a stressful emergency hits, your body needs a huge and fast stress-response. At the end of the stressor, everything should shut off immediately.”

To understand what happens when the stress-response doesn’t shut off immediately I suggest you read Sapolsky’s book, as he goes in-depth into how undue stress impacts us, with focus on multiple stress-related diseases. Thankfully, he also provides some insight into how to ameliorate the impact of ongoing stress, citing four factors the management of which can make a positive difference.

  • Having an outlet, “especially a healthy outlet, especially physical activity” is primary because the stress response primes the body for physical action so what better approach than to provide an outlet for that physical need! In any case, the frustration generated by the stress needs to have a positive outlet.
  • Being part of a social network or having a close friend to provide support to you but also, equally important, for you to provide support to them. Social support is a two-way process of receiving and of giving.
  • The importance of predictability, the ability to have a sense of what will happen by having “accurate information and in manageable quantities,” though Sapolsky noted that too much predicability can lead to boredom and too little can lead to stimulation, some of which might be exciting and too much of which can be stressful.
  • The importance of control, the ability to have an impact on the direction of events. “Hope for the best, prepare for the worst” and “control what can be controlled.”

Sapolsky says that the loss of predictability and control are closely related. The sense of being able to predict and control something provides the perception of things improving, which can have a positive impact on managing the response to the stress.

He further suggests that meditation can be a balm when done regularly and sustained over a period of time. Finally, it is important to pick the right strategy at the right time.

Repetition of certain activities can change the connection
between your behavior and activation of your stress-response.

The Physiology of Stress

Robert Sapolsky’s Why Zebras Don’t Get Ulcers hooked me from the title. At first read the title may sound irreverent but it actually is a true statement. I took copious notes based on his explanation of the science of stress and his suggestions, at the end, for managing stress. I’ve written about the nervous system in prior blog posts, but this is the first time the physiology has made its way front and center in my blogging and understanding.

As Sapolsky notes, our sympathetic and parasympathetic nervous systems work in opposition to one another. The sympathetic system turns on with excitement or alarm, causing the release of epinephrine (adrenaline) from the adrenal glands and norepinephrine (noradrenaline) from all other glands. This, in turn, speeds up the heart and sends blood to the muscles, allowing for a fast and efficient response to whatever caused the initial response. When the mellow parasympathetic system is activated via the vagus nerve, it slows down the heart and diverts blood from the muscles, making it possible to calm, slow down, or sleep. Each of these nervous system responses causes different, opposing reactions within the body. What intrigued me, and to the best of my recollection I have not written about, is the actual science of what happens in the body when it undergoes a stress response.

The Physiologic Details, in other words, the chemical flow
Within 15 seconds of being triggered by a stressor, the Hypothalamus releases CRH (corticotropin releasing hormone) which turns on the sympathetic nervous system and also suppresses appetite. CRH signals the Pituitary to release ACTH (adrenocorticotropic hormone or, simply, corticotropin). The pituitary regulates peripheral glands, and within a few minutes ACTH reaches the adrenal gland. The adrenal gland, in turn, releases glucocorticoid, which also stimulates appetite for starch, sugar and fat, those being energy sources which would be necessary if you needed to move your muscles and get out of a situation quickly! The adrenal glands also release the epinephrine and norepinephrine noted in the paragraph above.

The adrenals hand off to the pancreas, which releases glucagon, causing increases in the levels of glucose (glucose being sugar). The pituitary and brain release endorphins and enkephalins to blunt pain perception. The pituitary also releases vasopressin, which impacts cardiovascular response.

You might begin to see a cascading chemical soup that, depending upon the magnitude of the stressor, can begin to saturate the body. You might also wonder why the body might both suppress or stimulate appetite from the same series of signals. Turns out that the type of stressor, its duration and the time it takes to recover from the stressor all determine if appetite is suppressed or stimulated.  According to Sapolsky, two-thirds of people eat more when under stress (hyperphagic) and one-third eat less (hypophagic). (I am of the first type and my husband is of the second. The good news is, once you know your tendencies you can work to adjust accordingly.)

Stress and the Heart
The heart’s sole job is to pump blood thru the “hoses” – the veins and arteries snaking thru the body. Blood pressure is the force with which the blood flows thru these “hoses.” If you’ve had your blood pressure measured in a doctor’s office, you likely know there are two numbers generated. Systolic pressure is the upper number and is the force with which blood leaves the heart thru the arteries. Diastolic pressure is the lower number and is the force with which blood returns to the heart thru the veins.

Ideally, to keep a healthy heart, the hoses need to be free of obstructions and the blood pressure needs to be able to return to a healthy level after engaging in a stress response. What makes the difference is whether the body is undergoing an acute response to stress (quick and over soon) or a chronic response (ongoing, which provides insufficient opportunity to recalibrate at healthy levels).

Our breathing has an effect on our heart. Generally, inhaling turns on the sympathetic nervous system, allowing it to energize, and exhaling turns on the parasympathetic, sending the signal to calm. The interplay of the inhales and exhales is what can stimulate the relaxation response (more about the response here and here).

The length of time between heartbeats is HRV (heart rate variability). A higher HRV signifies short interbeat intervals during inhale and long interbeat intervals during exhale. A minimal HRV means it is difficult to turn on the parasympathetic and turn off the sympathetic. To quote what I wrote about HRV in a prior post:

Typically, during an INhale the message is to speed up the heart rate, which in turn activates the sympathetic nervous system. This automatically kicks in when we feel stress. During an EXhale the heart rate slows and that, in turn, activates the parasympathetic nervous system. The other piece of this process is HRV (heart rate variability). Whereas heart rate refers to the number of beats per minute, and can be measured by taking a pulse, heart rate variability is the time between each heart beat and requires an EKG machine for measurement. The higher HRV, the more parasympathetic activity there is, which bodes well for long-term health. Curiously, this is a measurement that is rarely provided during an annual physical!

A Visual Summary
I have taken numerous yoga trainings with Jillian Pransky and in just about every training she has shared imagery that distills what happens in the body when the stress response is activated. From Jillian’s imagery I created the graphic below, which also includes the Relaxation Response. 

Imagine a house with six rooms: reproduction, immunity, growth and repair, elimination, digestion, and a safe room. As a result of the FIGHT or FLIGHT response being activated, resources are channeled via a hormonal response to the safe room and shut off to the other rooms. In the safe room the brain is primed to isolate, build a wall, and separate and protect.

With activation of the REST and DIGEST response, resources are channeled via a hormonal response to the five main rooms and shut off to the safe room. When these other rooms are functioning the brain is primed to “tend and befriend.” The LARLAR at the upper left is Jillian’s acronym for how to manage the body’s response to stress and return to homeostasis: Land (the body internally and on the ground), Arrive (with your breath, guiding it deeper), Relax (arriving with a deeper breath will stimulate relaxation), Listen to yourself, Allow space for what you hear, Repeat because “the LARLAR is never done.”

imagery

Book Review – Why Zebras Don’t Get Ulcers

from my Goodreads Review:

In the recent yoga therapy training I took with Jillian Pransky she referenced this book multiple times. Before sitting down to read Robert Sapolsky’s book I watched this 90 minute talk he gave at The Beckman Institute for Advanced Science at the University of Illinois in June 2017. Sapolsky is an entertaining speaker and makes his points with a wonderful blend of humor, anecdotes and science.

zebrasHis book is written in that same voice, making it immensely easy to read, absorb and digest. Sapolsky starts off by explaining what stress is and how the body responds to stress. With the physiology as a foundation, he then tackles a multitude of diseases, each receiving their own chapter. Some of these I skimmed, some I skipped and others I devoured. He concludes by culling from previous chapters some of the strategies that can be useful for managing stress, along the way reminding us that even the strategies require a balance between too much and not enough.

Science has found many connections between stress and illness, both biological and psychological, and perhaps the most daunting are the causes related to what Sapolsky calls in the apt named chapter 17: “The View from the Bottom.” The place a person has in society, the education of a person’s parents, the level of wealth or poverty, socioeconomic status…these all impact the role that stress can have on a child as the child grows and develops, and on the ensuing adult that child becomes.

There is much in this book that could be construed as daunting, yet Sapolsky presents a balance in almost all of his teaching (for that’s what this book is, a teaching.) I was intrigued by the biology of stress and now understand what is happening in my body when it produces a cold sore. It was interesting to learn why some people eat when stressed and others have a loss of appetite.

Ultimately, everything boils down to understanding our autonomic nervous system, which is composed of the sympathetic nervous system – those parts of our system over which we have little to no control – and our parasympathetic nervous system – those parts over which we do have some control. The biggie here is that the sympathetic nervous system is what activates our stress response, what is commonly referred to as fight, flight or feint, while our parasympathetic nervous system, when activated via the vagus nerve, is known for rest and digest.

For more on any of this, however, read Sapolsky’s book! Take in the early chapters to create a base line of understanding about stress and the body, then read those chapters that have a connection to you, and finish up with the final chapter.

Book Review – The Vital Psoas Muscle

from my Goodreads Review:

psoas coverI quite enjoyed reading this book but have to giggle because upon falling asleep last night I mentally began composing this review and thought the title was “The Little Psoas Book” – not because the muscle is little, but because the book is smaller-sized, short and sweet.

Staugaard-Jones has compiled a concise book that highlights the psoas muscle. I especially liked the diagrams, which made it quite easy to understand the location not only of this important muscle but of other muscles and systems, and their interrelationships and interdependencies. The book’s physical size and paper, as well as colors and font helped make it a handy, legible guide that is comfortable to consult as well as mark-up with my additional notes.

As a fairly new yoga teacher of a little over two years, I appreciated the way Staugaard-Jones organized poses and stretches (some yogic and some pilates) complete with explanations of how the movement impacts the psoas and related muscles. I am considering purchasing The Concise Book of Yoga Anatomy, by this same author, as her style of writing and book design appeals to my sense of organization. While I have multiple books on yoga anatomy, many of them either have diagrams that are overly complex or explanations that are more technical than my needs or interest warrants.

You can learn more about Jo Ann Staugaard-Jones at Move To Live.

A Reflection

A few weeks ago I cut a quote out from the December 2, 2018 Letters to the Editor section of the Sunday NY Times magazine. I did not recall, and perhaps never even read the article to which it referred, but the quote resonated:

Aging is not the issue. The issue is decline, and it is different for everyone.

This evening I finished Frank Ostaseski’s book The Five Invitations: Discovering What Death Can Teach Us About Living Fully. In reading the book, which took me close to three weeks, I was touched by how profound the ideas were and by the anecdotes Frank lovingly shared of individuals he accompanied on their path to dying. You can learn more about The Five Invitations here and read my book review here.

During this afternoon’s walk I was telling Fred, my husband, about my response to the book, and he asked me what it was I found profound. In replying I described the many touching anecdotes and the explanations of Buddhism (which I sometimes had to reread to follow the full meaning). But mostly my mind lingered on the five invitations and the understanding that what can serve us in approaching our mortality can serve us as well in approaching our living.

Fred took in my words and then mentioned the science writer Robert Wright, who has written books about God, Buddhism, religion, as well as numerous articles for various magazines. It turns out Wright also teaches the coursera course Buddhism and Modern Psychology for which I signed up and started as of this evening.

These paragraphs may seem a bit disparate but that is not the case. Frank Ostaseski co-founded the Zen Hospice Project. While not everyone who turns to hospice is old in the sense of years, as the opening quote notes: it is not aging that is the issue, it is the decline, and decline can happen at any time along the aging continuum. Zen Buddhism is but one way to approach dying as well as living. It is this blend of looking at the aging continuum  thru a Zen lens that appeals to me.

Perhaps my interest stems from having witnessed my parents end-of-life, particularly my Mom’s and her decision to follow VSED. Or perhaps it is my own aging, having last month celebrated my 64th birthday, launching me full of wonder into my 65th year. Or maybe it is because I have become immersed in my yoga practice and yoga teaching, and wanting to try meditating – maybe for a spiritual reason but definitely because of the positive health benefits for the brain. Between the teachings of the book and what I may wind up learning from the course, I feel as if there are multiple strands of light waiting for me to braid them together into understanding.

Therapeutic Yoga Teacher Training, Module Two

Overview of Jillian Pransky’s Therapeutic Yoga Teacher Training, Module Two

Knowing full well what to expect in terms of format and my energy levels, this second second weekweek of training was in many ways less intense than the first week. DK, another yoga teacher participating in the training, coined our floor space as “apartments” and this is my apartment, which looked the same day-to-day and week-to-week.

There were close to 40 participants the first week, so imagine my “apartment” with others just like it nestled some 10 inches near by on each side. For this second week our numbers were pared down to 26, permitting a more spacious configuration.

On the first day of Module Two we revisited an overview of our relationship to wellness, stress, pain, and what it is we are trying to accomplish with therapeutic yoga. There was much in this discussion that resonated with me on a personal level. Ultimately, we are teaching out students how to create a safe space inside and to do that we create conditions outside so they can create conditions inside.

To paraphrase Jillian multiple times:

We aim to seek and find the barriers that inhibit energy and love, and when we find them, to love them. We change our perception of and relationship to our conditions (both the physical diagnosis and the emotions around it) which then sets up conditions for self-healing.

Dis-ease happens when the breakdown process happens faster than the healing process. Chronic pain IS chronic stress.

Wellness is an ongoing changing state of balance – the constant ability to adapt to the ever new now. This is the Ayurveda approach.

We also discussed the difference between tightness (muscle fibers contracting based on a load or force, i.e. an activity, that one voluntarily does) and tension (the sympathetic nervous system’s response as part of a self-protective mechanism.) Tension holds pain and limits the chemistry of healing. Both tightness and tension happen together.

This was followed by an in-depth look at fascia, which you can think of as similar to the white portion – the pith – of an orange. Fascia is the “stocking” or the “pith” around our muscles, as well as a communication system and “force transmission system” between muscles.

The remainder of the day included talk about hyper mobility versus flexibility, acute and chronic pain, and kinesthetic awareness.

Our second morning began with an almost two hour self-care session that was also a yoga tune-up ball experiential workshop. Small world – I walked into the room and immediately recognized the teacher as Darcy Bowman, a teacher whose restorative classes I have taken several times at my local yoga studio!

The rest of the morning included lecture on the history of yoga in the United States, and detailed information on how to design a therapeutic yoga session including the interview session that normally precedes any partnership. Before heading to lunch we partnered up for a structural alignment master class, switching partners at the end of the day so each of us had the opportunity to observe and be observed.

In the afternoon Heather Seagraves was our guest lecturer, speaking specifically about spine curvesspinal anatomy, pathology and injury management. I was reminded of the anatomy I already knew, and finally nailed anatomy about the spine that I was somewhat foggy on.

Day three began with extensive discussion about the psoas muscle, which is such a big deal in the body that it has a book dedicated to just it. This was followed by getting information about who each group of twos’ client would be the next day, with time to research and prepare for our session. The day concluded with another guest speaker, Dinneen Viggiano, whose focus for this talk was on shoulder injury and knee injury management.

Our final day of training began with a moving talk by Jenny, a friend of Jillian’s who lived with MS from her early twenties thru her thirties before having it go into full remission for the past 20 years. Jillian concluded the morning with lectures about high blood pressure, heart disease, stroke, diabetes, MS, fibromyalgia, and chronic fatigue, followed by a lovely and nourishing experiential session on applying touch. If we feel emotionally and physically present and available when providing a therapeutic yoga session, or indeed when leading a yoga class, we can warm up our hands and

  • move the body into alignment by moving structure (bone) with the entire palm and thumb pad,
  • massage to provide a “feel good” sensation using as much surface of the hand as possible,
  • place a solid yet light hands-on touch to promote stillness via cupping any of the joints,
  • simply leave our hands off and just sit with silence.

Our afternoon began as it had the prior week, meeting our clients and working with them, followed by small-group debriefing and then a full group debrief. As our clients headed home, we positioned ourselves in an oval and began an emotionally positive sharing about our eight day journey together with Jillian.

The bulk of additional resources were provided during the first week, in addition to manuals from each week. This week’s additional resources, besides links noted above, were:

Therapeutic Yoga Teacher Training, Module One

Overview of Jillian Pransky’s Therapeutic Yoga Teacher Training, Module One

For four days I was immersed in a powerful, tiring, emotional, informative thought-provoking, stimulating and interesting training. My distillation and assimilation of the train stationexperience and information will likely span several weeks, especially as there are only two days off before diving into the four days of Module Two, the second and final portion of the training. (That’s me on the first morning of my 90-minute commute door-to-door.)

The first day covered a deep dive into what happens in the body when it is experiencing normal stress vs chronic stress. This included discussion of “healing” as opposed to “curing”, multiple principles around the sense of wellness, sharing of research about yoga’s impact on health, and a review of the nervous and endocrine systems. Additionally, there was much information about how yoga can be used therapeutically to couple with medicine, counseling and other mind-body approaches.

remem wellnessI’ve written extensively about “remembered wellness” on my Neurons Firing blog. This is a photo of the words we each came up with after doing a guided meditation designed to return our thoughts to a time of remembered wellness.

On the second day we continued the exploration of stress by taking a look at depression and anxiety. We discussed how medical treatment and yoga therapy each have a role and noted what issues are (and could be) treated by each. There was specific discussion of insomnia and circadian rhythms, the phenomenal power of breath, and how using the Koshas (description here) and Ayurveda (The Ayurvedic Institute’s description here) as a lens for working with imbalances in the nervous system.

Day Three focused on dealing with trauma. Deborah Lubetkin was our guest speaker and she spent four hours with us sharing an abundance of information that included leading us through exercises and a practice. She said that when thinking about trauma and clients, we should consider a person as someone with a wound and not as a traumatized person. We need to remove the label “traumatized person” because there is more to someone than their trauma. She also shared a beautiful quote by Rumi: The wound is the place where the light enters. A portion of her talk revolved around the ACEs Study – Adverse Childhood Experiences, as well as Trauma, PTSD, layering PTSD on the Gunas (article about Gunas here), and polyvagal theory (explanation here) and the vagus nerve.

Prior to one of the practices Deborah asked if any of us preferred to not be touched. She mat cardsthen shared the “mat cards” that she uses during her group practices. Mat cards are placed by a person’s mat so that the yoga teacher can unobtrusively see who does and does not want to be touched. An equivalent object in some studios is the use of a coin.

In the afternoon, as we learned about how to craft a one-on-one therapeutic yoga session, we gathered into groups of threes. Each group was given a client intake form that had been previously filled out by an individual willing to volunteer for a private session, and our task was to think about how we might craft a session for that person  knowing full well that our plans could easily change the next day when we actually met our client.

Our final day consisted of three more guest speakers. The first two were Alice and Lou a married couple who both participated in the training; Lou had also volunteered to be a client. Alice spoke first, sharing a bit of her 30 plus years in nursing and then winding up as a hospice volunteer in retirement so she could continue to be of service to people. She talked about end-of-life options and working with people and families of people in hospice. Lou, a practicing psychotherapist, talked about his background experiences that led to his working with people dealing with anxiety, depression and addiction.

Their talks were followed by an intensely moving hour with Scott Chesney, a paraplegic  who wound up in a wheelchair as a teenager. He is a motivational speaker and spoke not just about himself but about the work we all do as people in healing professions, and the power of believing in yourself. He, too, was a client in our afternoon practice.

The afternoon was spent meeting our clients, working with them, debriefing with them in our small groups and then as a whole group. After they left we continued to converse as a full group to talk about the experience, wrap up our four days, and reground ourselves. A large number (about 3/5) are returning next week for the second and final module during which we will focus on specific diseases and, once again, have private clients.

Below are some of the many resources mentioned during lectures and talks.

Books & Publications:

  • Why Zebras Don’t Get Ulcers by Robert Zapolsky
  • The Five Invitations: Discovering What Death Can Teach Us About Living Fully by Frank Ostaseski
  • How to Change Your Mind by Michael Pollan
  • Mudras for Healing and transformation by Joseph & Lilian Le Page
  • Cutting for Stone by Abraham Verghese
  • The Chemistry of Joy by Henry Emmons and Rachel Kranz
  • The Happiness Trap by Russ Harris and Steven C Hayes
  • The Vital Psoas Muscle by Jo Ann Staugaard-Jones
  • Counseling Today – website of the American Counseling Association

Documentaries:

  • HEAL – a documentary about healing and belief
  • Ride the Wave – a documentary about Scott Chesney and surfing

Apps recommended by participants in the training: