Stress is, as a word, one of the most commonly used in modern communication, both in the interpersonal and digital spheres. As a topic, stress is ubiquitous in the perception and considerations of most modern people these days. As a term, it is variously defined; yet, it mostly leads to a unique meaning. As a consciousness, it is publicly present, its essence partially understood and still vaguely valued, although it is approaching deeper insights. However, the latter happens slowly and with resistance.

Keywords:

stress, scientific approach, stress prevention, stress management, mental health

As an issue, stress has risen to the top of the scale of human issues in the 21st century. The fact that it is a direct or indirect cause of about ninety percent of modern (non-traumatic and congenitally predominantly unencumbered) diseases, including death, puts stress on the leading position in the ranking of issues the human race is facing today.

Stress is associated with the leading causes of death: heart disease, cancer, lung disease, diabetes, accidents, cirrhosis and suicide. At the same time, the largest health insurance costs are borne due to the consequences of unregulated stress.

All these data point to the astonishing insight that despite its ubiquity in various spheres of life, countless information, articles, recommendations, interpretations and advice, stress remains unrestrained, and in some mysterious way, the main means of disabling modern man, not only biologically but also on a psychological and social level.

Thus, the story of modern stress grows into a fascinating truth about the ignorance that kills!? All of the above points out to the burning need to spread scientific awareness about the adequate understanding of important facts about stress, as well as about providing access to the right knowledge about stress and the disorders it causes to a wider population.

History

How did the science of stress appear?

The foundations of the scientific approach to stress were laid by H. Selye in 1936, who discovered in his pioneering work the basic laws in the reactions of the human organism during such (stressful) conditions and the accompanying mechanisms of action. He defines stress as: “… a uniform, but the non-specific response of the organism during the action of stressors …”, i.e. as “General Adaptation Syndrome” (GAS).

Further, he defines a stressor as: “… any agent (physical, chemical, infectious, mental and social) that can endanger the physical and mental integrity of an individual.” In addition to this, Selye emphasizes the fact that there is only a small number of universal stressors (disease, wars, natural disasters, etc.) whilst the largest number represents the so-called individual stressors that contain specific hazards to only one individual. This means that stress is an individual experience, that is, each person has their own spectrum of psychological and social stressors, which they react to qualitatively and quantitatively as if they were biologically endangered.

On basis of the consistency of his research and the obtained results, the following can be concluded: “Stress is a state of endangering the integrity of the organism that arises under the influence of various factors originating from the external or internal (mental and somatic) environment.”

To this day, extensive and numerous scientific researches in the field of stress and stress disorders have been carried out and are currently being conducted on a daily basis. At this time, science has more than enough proven knowledge that can explain the most important variations of cause-and-effect relationships between stress and the human body. It remains rather unclear why such knowledge does not function in the wider human reality in a proper, preventive way?

Current science and knowledge

Psychosomatic medicine, neurobehavioral science and specialized science that deals with stress and its consequences in humans have come together to clear data and sufficient knowledge about the causes, mechanisms of development and outcomes of stress reactions in human organisms.

At the moment, more than enough data are available in the form of quantitatively and qualitatively determined parameters that can explain in detail all the important stressors and their impact on man, human groups and society as a whole. All in all, they can explain stress in important spheres – biological, psychological and social. In addition to this, effective stress management programs have been developed in the meantime in all these areas, on a scientific and controlled basis.

In general, all the pathways of stress reactions lead through the nervous system to the brain, i.e. its associated reactions on several levels. Subsequently, through the neural network and existing electrochemical systems, the brain sends back impulses that are converted into specific mental and organic responses, i.e. reactions of the psychic, neuromuscular, endocrine, visceral and immune types.

All this makes it clear that the human mind is the one that can recognize and adequately regulate stress responses and turn the situation from a loss to a positive outcome, with its experience, knowledge and specific skills. It is also a natural way for the brain to gain even greater power of control over the situation, preserving health and acting more efficiently towards the set goals.

Basically, the human body produces a stress response with the aim of enabling adaptation to unexpected changes, i.e. changed living conditions, with the possibility of finding new modes of behavior. Thus, the results of a stressful situation can be positive – eustress and negative – distress.

Positive results lead to proper adaptation, motivation, further development of the individual and his/her maturation whilst negative results lead to the maintenance or deepening of a stress (dysfunctional) condition on the way to illness (a defect of an organism) or death.

Stress triggers

The main cause of stress in the first phases of the civilizational development of the human race was the natural environment, in the form of climate change, relations in flora and fauna, struggle to provide food, water, reproduction, shelter and the like.

Thousands of years of experience of this type have remained permanent memories in the nervous system, genetically provided, in the form of instinctive and bodily reactions (e.g. “fight – escape – paralysis”).

However, with the development of civilization, especially through the creation of a system of organization of human groups and technological progress, the influence of man as a stress factor in his environment has been increasing over time. Nowadays, man is the biggest cause and producer of stress in his environment!

The list of factors that modern man and human groups produce with their behavior, and that further generate stress in the human environment, is endless. Extreme climate changes, wars, existential insecurity, interpersonal conflicts, media violence and aggression, uncontrolled development of digital technology and virtual reality, pollution, noise, disintegration of male-female relations and family systems, collapse of education, health and social security, emotional insecurity, the breakdown of one’s identity and stability, unrealistic ambitions, extreme competitiveness, social cloning of unhealthy human structures that are educationally, emotionally and educationally neglected, dependent or traumatized individuals and many more are factors that generate further a new and inexhaustible stress pathology on the biological, mental and social level.

Modern man is strongly influenced by this multitude of factors. He is under constant pressure to maintain adaptation to accelerated and frequent changes in the environment and his organism. At the same time, the dynamics of events in the environment and changes in the conditions to which he needs to adapt create increasing obstacles to the ability to meet internal needs, which is perceived as a state of frequent frustration.

The dangers lurking from the environment that may violate his integrity are multiplying, which often confronts him with the fear of his own endangerment and uncertain future. Everyday disturbances of the ecological environment, increasingly traumatic and catastrophic situations (violence, wars, earthquakes, fires, floods, pandemics, recessions, media intimidation, etc.) that are spreading around the world, existential insecurity, disturbances in family and social relations are becoming real and permanent sources of stress for modern man.

A psychosocial type of stressors, in addition to biological (infectious agents), physical (temperature, vibration, radiation, magnetism, noise, climate change, etc.) and chemical (changes in the composition of air, water, food, etc.) is one of the most common sources of stress today. In interpersonal relationships, modern man often feels traumatized, frustrated or threatened in an attempt to achieve and maintain his authentic or presumed identity.

During those interactions, he experiences and survives the fear of conflicts, possible losses of important categories of his emotional life, as well as facing problems in resolving the aroused self-aggression and inability to communicate with others.

All these, together with the aforementioned biological, chemical, physical, infectious and socio-political factors, are perceived by a human individual as his own threat, which is a real basis for the development of stress.

Workplace stress occupies an increasingly important place in the spectrum of psychosocial suffering of today’s (global) man. Back in 1992, the United Nations declared work stress a disease of the twentieth century, and the World Health Organization (WHO) a “world epidemic.” The past decades of the 21st century have indicated its progress towards a leading position in the spectrum of stress disorders.

The potential of its destructive power through the development of “burnout syndrome”, combined with chronic stress, becomes the main human enemy in urban areas. In July 2019, this finally led the WHO to introduce the obligation of a nosological (diagnostic) recognition of this syndrome and the necessity of conducting an organized treatment.

In recent years, the new causes of an increasing incidence of stress disorders in humans have arisen from a strikingly unhealthy attitude towards food, rest, day and night rhythm, time management, unbalanced use of new devices in the field of informatics, telecommunications, digital and virtual reality as well as a spreading addiction of various kinds.

All these factors reduce the general resistance of the human organism and thus expose it to harm even during minor stress provocations. The effects of this new wave of sources of stress will culminate very quickly, leading humanity, if it does not react with appropriate prevention, into new forms of disease and deviation.

Žena sa bolom u vratu

Physiology and pathophysiology of stress

Physiology and pathophysiology, as fundamental medical sciences, distinguish two types in the field of stress – acute and chronic stress.

Acute stress

Acute stress has the task of preparing the body for a quick and explosive fight-flight reaction. It is activated instantly on a specific occasion (by a stressor) and develops within two to three minutes, lasts for the next few hours, maximum 24-48 hours, and then begins to lessen. It disappears no later than the third day after activation if a stressor ceases.

In the brain, the reaction in the form of acute stress is activated first in the nuclei called the amygdalae (almond-shaped nuclei). These nuclei send a rapid, activation impulse to a central part of the brain called the hypothalamus. This central part of the brain then activates the pituitary gland and the sympathetic nervous system at the same time, which further stimulate the work of the adrenal gland, i.e. its cortex and marrow, in their own way.

By secreting the adrenocorticotropic hormone (ACTH), the pituitary gland activates the adrenal cortex, i.e. the hormones corticosteroids (glucocorticoids) such as corticosterone and cortisol. The role of cortisol, as the main glucocorticoid, is to provide energy for fight or flight during stress by increasing blood sugar levels through glycogenolysis (the release of blood sugar from deposits in the liver and muscles) and gluconeogenesis (the creation of new blood sugar from fats and amino acids).

At the same time, cortisol achieves accompanying physiological effects in the form of insulin suppression as well as the suppression of the inflammatory response and immune reactions, the increase in blood pressure, catecholamine secretion, attention activation, short-term memory improvement, etc. The adrenal gland, which secretes adrenaline, is activated sympathetically.

The secretion of catecholamines (the hormones noradrenaline, adrenaline, dopamine) enables the performance of rapid physical reactions in combination with strong muscular actions (in support of the fight or flight reaction).

At the same time, the secretion of catecholamines results in the body reactions such as: the acceleration of heart rate and respiratory rate, the increased muscle tone, pale or reddened skin, the obstruction of gastric and intestinal actions caused by a decelerated digestion process, the constriction of blood vessels (vasoconstriction) in many parts of the body in favor of the dilatation in muscles and brain, the release of metabolic energy for muscle work, pupil dilation, the inhibition of external glands (lacrimal, sweaty, salivary), hearing loss, tunnel vision (peripheral vision loss), body tremors, bladder relaxation (the effect on sphincters), the disinhibition of spinal reflexes, the acceleration of blood coagulation process (in case of massive blood loss), the inhibition of sexual function, etc.

In the field of emotions, acute stress produces the states of pronounced anxiety and aggression in more reactive individuals. In the cognitive field, there is a more pronounced tendency to direct attention to negative contents and outcomes. A similar reaction occurs in the field of perception, where acute stress transiently causes an altered perception of certain parts of reality in terms of their overestimation or underestimation, which further leads to the development of anxiety and aggression.

Likewise, temporary behavioral disorders are often noticed on the social level, especially in ambiguous situations, in the form of a hostile attitude, which is in line with the fight-flight reaction.

Chronic stress

Chronic stress confirms “the paradox principle“, which is also one of the basic laws of nature – the duration of “too good” in the long term produces bad outcomes!? What should basically aid the preservation of homeostasis and survival of an organism in the short term becomes its harmful factor in case of chronic stress or a dysfunctional response to stress.

The hypothalamic-pituitary axis shows the characteristics of a “maladaptive response” to stress when chronic stress or dysfunctional response (weak reaction) occur.

In case of a prolonged duration of the enhanced response, which is characteristic of acute stress, the stimulation of the adrenal cortex and medulla, the sympathetic nervous system as well as the secretion of glucocorticoids and catecholamines is prolonged, along with all other side effects characteristic of acute stress. If such an activity is not interrupted by an impact on the hypothalamus with a feedback after a certain period of time, this may lead to the depletion of reserves and control mechanisms in the organism, which further causes dysfunctions on several levels, disorders and diseases.

Thus, a chronically increased impact on the heart and blood vessels leads to the stabilization of high blood pressure – hypertension. Furthermore, along with the accompanying metabolic changes caused by the reaction to stress, atherosclerosis of blood vessels develops, which leads to the possibility of a myocardial infarction, a stroke, etc.

The consistent effect of cortisol on the chronically high blood causes chronic hyperinsulinemia. However, as a result of “insulin resistance”, which also occurs because of cortisol, the effects and reserves of insulin are depleted and type 2 diabetes develops.

Catecholamine secretion causes a maladaptive reaction in the gastrointestinal tract in the form of poor blood circulation in its upper segments, reduced nutrient transport and mucosal-bicarbonate secretion (which serves as protection against gastric (stomach) acid), which further leads to mucosal damage, micro and macro-hemorrhages, ulcers and digestive disorders. In its lower segments, it can lead to poor peristalsis, nervous colon syndrome (irritable bowel syndrome), the development of ulcerative colitis, Crohn’s disease, etc.

Hormonal changes caused by a chronically increased stress response in the body accelerate the development of the damaged thyroid gland, as well as metabolic diseases (dyslipidemia, etc.), obesity, etc.

Chronic stress also leads to the development of certain brain dysfunctions, such as insomnia, long-term anxiety, depression, motivation disorders, emotional disorders, burnout syndrome, etc. Prolonged stress can also lead to the damage of cells in the area of ​​the brain called the hippocampus – responsible for contextual, verbal and spatial memory, as well as to certain changes in other regions of the limbic cortex (amygdala, prefrontal region, etc.).

The effect of chronic stress on the immune system is reflected in the appearance of phenomena such as accelerated apoptosis (decay) of memory B cells, stimulation of suppressor CD8+ T cells, and inhibition of NK cell function. It should be definitely kept in mind the clear immunosuppressive effect of cortisol, which is constantly elevated in the blood in this type of reaction of the organism.

In case of chronic, maladaptive stress of the “weak response” type, there appear the phenomena in the form of an impaired cytokine response and weakness of normal reactions of the body to inflammation, poor healing or non-healing of wounds, chronic exhaustion, chronic pain, degenerative disorders, autoimmune diseases such as rheumatoid arthritis, psychasthenic and depressive states, etc.

Classification of stress disorders 

At the moment, in accordance with the Tenth Revision of the International Classification of Diseases, the following forms are categorized in the field of stress disorders:

F43 Reaction to severe stress and adjustment disorders
F43.0 Acute stress response
F43.1 Posttraumatic stress disorder
F43.2 Adjustment disorder
F62 Permanent change of personality of a non-organic origin
F62.0 Permanent change of personality after a disaster
F23 Acute and transient psychotic disorders – associated with acute stress
F23.0 Acute polymorphic psychotic disorder without symptoms of schizophrenia
F23.1 Acute polymorphic psychotic disorder with symptoms of schizophrenia
F23.2 Acute mental disorder similar to schizophrenia
F23.3 Other acute predominantly insane psychotic disorders
F23.8 Other acute and transient psychotic disorder
F23.9 Acute and transient psychotic disorder, nonspecific
F45 Somatoform disorders
F45.0 Somatization disorder
F45.1 Undifferentiated somatoform disorder
F45.2 Hypochondria
F45.3 Somatoform dysfunction of the autonomic nervous system
F45.4 Constant somatoform pain
F45.8 Other somatoform disorders
Z73.0 Burnout syndrome

Scientific perspectives

Taking into consideration what has been previously discussed, it can be seen that the existing international medical classification still does not have a complete and adequate-to-the-existing-reality “coverage” with its diagnostic criteria for recognizing psychosomatic, neuroendocrine and immune disorders associated with stress. Such conditions, although there is a huge spectrum of extremely destructive disorders, are categorized rather vaguely and undefined under the code F.45.3 – Somatoform dysfunction of the vegetative nervous system.

At the same time, the increase in these disorders, still “invisible” to the diagnostic criteria of classical, descriptive medicine, in contrast to the empirical one, which encounters the consequences of these conditions on a daily basis, took the form of a world epidemic.

This situation has been maintained for the last few decades, despite many years of efforts by many proven scientists and experts in these fields to introduce them into the official, international classification. It was not until 2019 that the WHO allowed the introduction of a diagnostic criterion for “burnout syndrome”, several decades after finding out that it was going to gain pandemic proportions, impairing and killing millions of people since the end of the twentieth century when it was identified by the UN as the main killer of a working man in the years to come!?

All these facts have shed light on the seriousness of the issue and the need for the right approach to stress, and have given a clearer answer to the questions that arise from modern statistics about the extremely high percentual relation between stress and the causes of illness and death.

The way out of this mortal and mutilating labyrinth, which is still naively researched by modern medicine, which in the meantime, truth be told, has become completely mechanistic and “post-industrial”, easily and recklessly entering into the rhythm of modern life, should be the institutionalization and further development of a special sector of the science of stress. This would enable the correct and complete integration, scientifically and methodologically, of knowledge and experiences that spring from classical medicine, neuroscience, stress management, psychiatry and psychotherapy.

Will it happen at all and when? This is currently a burning question that needs to be answered. Meanwhile, stress still remains at the level of “… the true story about the ignorance that kills“!

Stress prevention

The primary prevention of stress disorders is based on a healthy lifestyle. This style is based on the following parameters:

  • Consumption of healthy food – in the required quantities and rhythm
  • Healthy sleep and maintaining a proper day-night rhythm
  • Regular physical exercise
  • Optimal organization of time – work, leisure, rest time
  • Positive social activity – communication, emotional fulfillment
  • Staying close to nature
  • Relaxation
  • Creativity (hobbies)

Regulation of stress disorders

The regulation of stress and stress disorders is currently left to predominantly superficial, unscientific and incomplete programs. This does not only represent one of the consequences of an insufficiently defined place of the science of stress in medicine, but also one of the dominant causes of giving stress the role of a “silent and invisible killer“.

A serious and scientifically defined program for the regulation of existing stress requires an integrative approach. Only such a comprehensive approach can enable the correct identification and resolution of all the important components that make up a complicated state of accumulated stress, that is, the factors that are scattered and connected on several levels in the human body – neuromuscular, visceral, neuroendocrine, neuro-immunological, cognitive, emotional, voluntary, behavioral, professional, interpersonal, etc.

In such a holistic approach, it is first necessary to make a complete, physical and mental, map of all the factors related to the development and maintenance of the existing disorder.

Afterwards, a plan should be prepared and an adequate program of “stress cleansing” from the body should be carried out in all areas where there are trapped accumulations and fixations (traumatic memories, psychosomatic dysfunctions, intrapsychic conflicts, defense mechanisms, developmental and structural disorders, habits, etc.), and which, acting together, produce existing stress disorders in a specific person in which they develop.

References

You can see more about the integrative approach in stress management at: http://www.um.org.rs/stres/integrativni-stres-menadzment.