Its Killing Me

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Its Killing Me

• Stress as a
• Life-threatening Condition
• Michael S. Krasner, MD
• October 21, 2009
• Perinatal Network of Monroe County
• Managing Stress for Healthier Babies, Healthier
  Lives, Healthier Neighborhoods

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More than any other time in history, mankind
faces a crossroads. One leads to despair and
utter hopelessness. The other, to total
extinction.Let us pray that we have the wisdom
to choose correctly.

• Woody Allen

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Stress Theory
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Stress Theory

• Claude Bernard milieu internal, studied and
  conceptualized homeostasis
• Walter Cannon Fight or Flight
• Hans Selye Acute and Chronic Stress
• Richard Lazarus Individual appraisal of stress
• McEwen Allostasis and allostatic load
• Schwartz and Shapiro Intentional Systemic
  Mindfulness
• Intention leads to attention leading to
  connection leading to regulation leading to order
  leading to health

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Stress Definition
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• Change needed, demand to be met (as appraised by
  the subject)
• That change may overwhelm (or stress) the
  subjects resoures (the resources as appraised by
  the subject)
• Stressor Anything that causes this reaction in
  the subject.

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Stress Reaction Cycle
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• Stressors
• Internal Events
• Perception/Appraisal
• Stress Reaction
• Internalization
• Maladaptive Coping
• Breakdown

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Physiology of Stress
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• Sympathetic/Parasympathetic Imbalance
• Sympathetic Hyperarousal
• Low (relative) Parasympathetic tone

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• Activation of H-P-A axis
• When chronic results in
• Increased monoamine neurotransmitters, eventual
  depletion
• Increased pro-inflammatory cytokines (IL-1, IL-6,
  TNF alpha, Interferon gamma)
• Increased cortisol
• Amygdala activation leading to a threat relevant
  attentional bias and enhancement of negative
  memory networks
• Suppression of specific immunity (NK cells,
  humoral immunity)

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• Chronic cortisol stimulation
• Impairs brain centers with high concentration of
  cortisol receptors
• Suppresses specific immunity
• Activates amygdala
• Is neurotoxic
• Inhibits trophic factors that help neurons grow
  and develop (Serotonin, BDNF, Estrogen)
• Can lead to adrenal fatigue

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• Hyperactive systems
• Sympathetic nervous system
• HPA Axis
• Cortisol
• Amygdala
• Cytokines
• Right PFC (behavioral inhibition, negative
  emotions)
• Underactive systems
• Parasympathetic influence
• Hippocampus
• Left PFC (behavioral activation, positive
  emotions)
• Cingulate (attention, decision making)
• Specific Immunity
• Monoamine system burnout

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• Long-term physiologic and cognitive effects of
  sympathetic overload
• Thyroid/endocrine burnout
• Obesity, DM
• Immune suppression
• HTN, CV Disease
• Cancer
• Negative mood
• Negative attention and memory bias
• Decision making difficulties
• Inability to learn new associations

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• Real or imagined threats induce the same stress
  response
• Imagined scenarios involving threat or failure
• Perceived threat
• Comparison of actual situation with ideal
• Degradation of self or present situation
• Recall of disturbing events
• Self-criticism hostility
• Rumination about a negative event
• Emotional avoidance
• Pessimism, denial

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• Stress-realted physiology and their reversal by
  meditation
• HPA axis hyperactivation
• Hypercortisolemia
• Decreased Hippocampal activity
• Decreased PFC/Cingulate activity
• Low parasympathetic tone
• Serotonin depletion
• Negative memory bias
• Immune suppression

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• Stress-realted physiology and their reversal by
  meditation
• Sleep disruption
• Cytokine elevation
• HTN
• Heart disease
• Endocrine dysfunction
• Hyperlipidemia
• Chronic pain
• PFC asymmetry

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Responding versus Reacting

• Stressors
• Internal Events
• Mindful Perception and Appraisal
• Stress Response

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Research
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Questions and ?Answers