The mind-body connection: patients with somatic complaints with no organic cause
Julie M Schirmer MSW, Alain J Montegut MD, Stephen J Spann MD, Gabriel Ivbijaro MD, Alfred Loh MD in Behavioral Medicine in Primary Care, 2017
Over the past 50 years, researchers have linked the body’s physical state to stresses in the psychosocial spheres. Hans Selye initially proposed the concept of a stress response as the body’s natural reaction to help to mobilize resources when threatened.6 The stress response has been described as the “fight or flight response”, triggering hormones in order either to prepare to confront danger, or to escape from danger. In short bursts, the stress response can be life-saving. However, in the long term it can damage the body by exacerbating pain, chronic disease, and mental health conditions. Chronic exposure to the stress hormones can cause cumulative strain on several organs and tissues, but especially on the cardiovascular system. These physiological symptoms provide the incentive to learn how to respond to stress in healthier ways.
Cognitive-Behavioral Interventions for Chronic Pain
Andrea Kohn Maikovich-Fong in Handbook of Psychosocial Interventions for Chronic Pain, 2019
Chronic pain can lead to both physical and psychological stress. One way this stress manifests is through muscle tension and an activation of the “fight or flight” response. Relaxation training for chronic pain may consist of progressive muscle relaxation (PMR), diaphragmatic/deep breathing, and/or guided imagery. Increased muscle tension can exacerbate the physical pain experience. The goal of PMR is to help the patient become more aware of muscular tension as it begins to occur and then respond by physically relaxing the tense area (McCallie, Blum, & Hood, 2006). Although typically a clinician guides patients through a PMR activity the first time, patients can learn to do this on their own or with a guided recording in order to better self-manage their pain. PMR intervention may include a range of muscle groups, typically starting with 16 major groups including the hands, arms, areas of the face, neck, upper torso, legs, and feet. This can be modified into briefer instructions that include only eight or four muscle groups. The patient is instructed to systematically tense and then relax various areas of the body while focusing on the differences between the sensations of tension and relaxation.
Understanding Anxiety During Pregnancy and the Postpartum Period
Sheryl M. Green, Benicio N. Frey, Eleanor Donegan, Randi E. McCabe in Cognitive Behavioral Therapy for Anxiety and Depression During Pregnancy and Beyond, 2018
When we perceive danger (or even when we simply anticipate danger) our brain starts by activating the sympathetic nervous system. When this system is activated, there is a release of hormones (e.g., epinephrine (adrenaline) and norepinephrine (noradrenaline)) that brings about changes in the body very quickly to help us prepare to fight or flee. These changes may affect cardiovascular function (e.g., increased heart rate, changes in blood flow), respiration (e.g., increased rate of breathing), and temperature regulation (e.g., increased sweating). Importantly, the sympathetic nervous system operates on an ‘all-or-none’ principle. That is, once it is activated, all or most of the systems that could help you fight the danger that you are faced with or flee/run away from the danger become activated regardless of the situation. This explains why we often experience more than one physical symptom when we are anxious. For further reading about the fight-or-flight response, Barlow and Craske (2007) provide a summary. Have a look at Figure 1.1 to understand some of the other bodily changes that take place and the functions they serve when the sympathetic nervous system is activated during a fight or flight response.
Utility of the cold pressor test to predict future cardiovascular events
Published in Expert Review of Cardiovascular Therapy, 2019
Sjaak Pouwels, Michel E. Van Genderen, Herman G. Kreeftenberg, Rui Ribeiro, Chetan Parmar, Besir Topal, Alper Celik, Surendra Ugale
In general stress exposure is associated with the activation of two systems: 1) the hypothalamic-pituitary-adrenal (HPA) and 2) the sympatho-adrenomedullary (SAM) [1]. If the stress is sufficient to be a possible derangement in the organism’s homeostatic balance, the SAM triggers increased activity in the sympathetic branch of the autonomic nervous system (ANS), which is associated with a release of catecholamines from the adrenal medulla and sympathetic nerve endings. The release of catecholamines causes an increase in heart rate and blood pressure. This is generally known as the ‘fight-or-flight’ response [2]. Although the response will be inhibited eventually by a subsequent activation of the parasympathetic ANS, ascending catecholamine neurons interfacing with the brainstem structures will contribute to a slower HPA activation and will lead to cortisol release from the adrenal cortex [2,3]. The understanding of the relationship between stress modality and specific dynamics of the stress response itself has been the subject of research for many years in various clinical and non-clinical fields.
Measuring stress: a review of the current cortisol and dehydroepiandrosterone (DHEA) measurement techniques and considerations for the future of mental health monitoring
Published in Stress, 2023
Tashfia Ahmed, Meha Qassem, Panicos A. Kyriacou
The general adaptation syndrome comprises of three stages: the alarm reaction; the resistance and the exhaustion stage. Immediately upon the body’s perception of a stressor, the alarm reaction is triggered, i.e. the stress response or “fight or flight” response. The stress response is responsible for several physiological and biochemical changes in the body, to restore homeostasis (Mcewen, 2005). Once triggered, catecholamines (adrenaline and noradrenaline) are released into the bloodstream via the sympathetic-adrenal-medullary (SAM) axis for mobilization of energy required for the “fight or flight” responses (Juster et al., 2010; Romero & Butler, 2007). In parallel, corticotrophin-releasing hormone (CRH) is released from the hypothalamic-pituitary-adrenal (HPA) axis, which subsequently leads to the synthesis and release of glucocorticoids, such as cortisol, into the bloodstream (Sapolsky et al., 2000; Schmidt et al., 2011). As a result of the biochemical responses, there are several physiological changes that occurs, such as an increase in heart rate and blood glucose levels, muscular tension and perspiration (Charmandari et al., 2005; Evans, 1950). Furthermore, there are adaptive redirections of behavior such as increased arousal and alertness and, focused attention (Charmandari et al., 2005). These characteristics and responses contribute to the restoration of homeostasis interrupted by a short-term stressor.
Mirtazapine for chronic breathlessness? A review of mechanistic insights and therapeutic potential
Published in Expert Review of Respiratory Medicine, 2019
N. Lovell, A Wilcock, S Bajwah, S. N. Etkind, C. J. Jolley, M Maddocks, I. J. Higginson
The regions identified in the above studies closely relate to neurological circuits involved in threat perception and the experience of fear [42,50,53]. The ability to perceive threat is vital for survival. The response to threat is multi-faceted and regulated by numerous neuronal connections entering and leaving the amygdala (Figure 1). These pathways are responsible for the motor and endocrine features of the ‘fight or flight response’, combined with the conscious perception of fear [56,57]. The fight or flight response is mediated by neuronal transmission from the amygdala to the periaqueductal grey area. Ongoing transmission to the hypothalamus and areas of the brainstem results in a rapid release of cortisol, and an autonomic response is triggered by the locus coeruleus which can include an increase in heart rate and blood pressure [57]. The emotional response to a threat involves neural transmission between the amygdala, the orbitofrontal cortex and the anterior cingulate cortex [58]. Given the potential role of fear circuits in the perception of breathlessness, drugs acting within these regions such as mirtazapine may be beneficial. This is further discussed in section 3.2.
Related Knowledge Centers
- Adrenal Medulla
- Adrenaline
- Cortisol
- Estrogen
- Testosterone
- Sympathetic Nervous System
- Catecholamine
- Norepinephrine
- Psychological Trauma
- Injury