Stress

Pain.

A new study by Prof. Ruth Defrin of the Department of Physical Therapy at TAU’s Sackler Faculty of Medicine published in the journal PAIN finds that acute psychosocial stress has a dramatically deleterious effect on the body’s ability to modulate pain. Prof. Defrin, together with TAU (Tel Aviv University) doctoral student Nirit Geva and Prof. Jens Pruessner of McGill University, applied acute stress tests on a large group of healthy young male adults to evaluate the behaviour of the body’s pain modulation mechanisms prior to and after the induction of stress.

The researchers found that although pain thresholds and pain tolerance seemed unaffected by stress, there was a significant increase in pain intensification and a decrease in pain inhibition capabilities.

For the purpose of the study, 29 healthy men underwent several commonly accepted pain tests to measure their heat-pain thresholds and pain inhibition, among other factors. In one test, for example, subjects were asked to signal the moment a gradually increasing heat stimulus became painful to identify their respective pain thresholds. They underwent a series of pain tests before and immediately after exposure to the Montreal Imaging Stress Task (MIST), a computer program of timed arithmetic exercises, designed to induce acute psychosocial stress.

In a way, the stress test is a psychological trick. MIST provides live feedback on submitted responses, registering only 20-45% of the responses as correct, whether or not a submitted response is the right answer. Because the subject has been previously informed that the average participant tends to score 80%-90%, he is reminded of his “poor performance” but has no way of improving his score, despite his best efforts. This provides the “stress” element of the experiment.

“To further test the effect of stress on pain, we divided the group according to stress levels,” said Prof. Defrin. “We found that not only does psychosocial stress reduce the ability to modulate pain, the changes were significantly more robust among subjects with stronger reaction to stress (‘high responders’). The higher the perceived stress, the more dysfunctional the pain modulation capabilities became. In other words, the type of stress and magnitude of its appraisal determine its interaction with the pain system.

“We know from our previous studies and studies of others that chronic stress is far more damaging than acute stress, associated not only with dysfunctional pain modulation capabilities but also with chronic pain and systemic illnesses,” said Prof. Defrin.

“Stress is defined as a sense of uncontrollability and unpredictability, precisely like being stuck in traffic where you are helpless and have no control over the situation,” said Prof. Defrin. “Stress can have positive repercussions in a challenging work environment, for example, but overall it has primarily negative effects.”

The results were also somewhat surprising. “We were sure we would see an increased ability to modulate pain, because you hear anecdotes about people who are injured during fighting or sports having greater pain modulation,” said Prof. Defrin. “But we were surprised to find quite the opposite. While there was no visible effect of acute stress on the subject’s pain threshold or tolerance, pain modulation decreased in a very dramatic way.

“Modern life exposes individuals to many, recurrent stressful situations,” Prof. Defrin observes. “While there is no way to predict the type of stress we will feel under different circumstances, it is advisable to do everything in our power; adopt relaxation and stress reduction techniques as well as therapy; to reduce the amount of stress in our lives.”


Coping Strategies.

A pilot study from North Carolina State University finds that people are not consistent in how they prepare mentally to deal with arguments and other stressors, with each individual displaying a variety of coping behaviors. In addition, the study found that the coping strategies people used could affect them the following day.

The findings stem from a pilot study of older adults, which is the first to track the day-to-day coping behaviours people use in advance of stressful events.

“This finding tells us, for the first time, that these behaviours are dynamic,” says Dr. Shevaun Neupert, lead author of a paper describing the study and an associate professor of psychology at NC State. “This highlights a whole new area for researching the psychology of daily health and well-being.

“And these are behaviours that can be taught,” Neupert adds. “The more we understand what’s really going on, the better we’ll be able to help people deal effectively with the stressors that come up in their lives.”

To learn more about how older adults prepare themselves mentally ahead of stressful events, the researchers developed a pilot study of 43 adults between the ages of 60 and 96.

Participants were asked to fill out a daily questionnaire on their activities and feelings, including whether anything stressful had happened, on the current day. Participants were also asked to predict whether they expected there to be a stressful event the following day, and how they were preparing for it. The participants were asked to complete the questionnaire on eight consecutive days. The researchers ultimately had data on 380 days, since some participants missed reporting days.

“The reporting was done using very specific questions with clearly defined metrics, such as ranking how stressed they felt on a scale of one to five,” Neupert explains. The questionnaires also asked participants the extent to which they were engaging in specific behaviours associated with coping with upcoming potential stressors.

The results found that people used different coping behaviours to prepare for different stressors, and that those coping behaviors changed from day to day.

“The findings tell us that one person may use multiple coping mechanisms over time, something that’s pretty exciting since we didn’t know this before,” Neupert says. “But we also learned that what you do on Monday really makes a difference for how you feel on Tuesday.”

Some anticipatory coping behaviours, particularly outcome fantasy and stagnant deliberation, were associated with people being in worse moods and reporting more physical health problems the following day. Stagnant deliberation is when someone tries, unsuccessfully, to solve a problem. Outcome fantasy is when someone wishes that problem would effectively solve itself.

However, stagnant deliberation was also associated with one positive outcome. Namely, stagnant deliberation the day before an argument was correlated with fewer memory failures after the argument.

The researchers also looked at plan rehearsal and problem analysis as anticipatory coping strategies. Plan rehearsal involves mentally envisioning the steps needed to solve the potential problem, and problem analysis is actively thinking about the source and meaning of a future problem. The researchers found that the use of these strategies changed from day to day, but the changes in these strategies were not related to well-being the next day. They were also not related to the way that people responded to arguments the next day.

“This was a pilot study, so we don’t want to get carried away,” Neupert says. “But these findings are very intriguing. They raise a lot of questions, and we’re hoping to follow up with a much larger study.”

The paper, “Solving Tomorrow’s Problems Today? Daily Anticipatory Coping and Reactivity to Daily Stressors,” was published online in the Journal of Gerontology: Psychological Sciences. The paper was co-authored by Dr. Gilda Ennis, a former Ph.D. student at NC State, who is now a postdoctoral researcher at Georgia Tech, and NC State Ph.D. students Jennifer Ramsey and Agnes Gall. The study was funded solely by NC State.


.

Anger.

University of Sydney research reveals that the risk of a heart attack is 8.5 times higher in the two hours following a burst of intense anger.

Published in European Heart Journal: Acute Cardiovascular Care, this is the first Australian study to investigate the link between acute emotional triggers and high risk of severe cardiac episodes.

“Our findings confirm what has been suggested in prior studies and anecdotal evidence, even in films, that episodes of intense anger can act as a trigger for a heart attack,” said lead author Dr Thomas Buckley, Sydney Nursing School, University of Sydney, and researcher at Royal North Shore Hospital.

“The data shows that the higher risk of a heart attack isn’t necessarily just while you’re angry, it lasts for two hours after the outburst.

In the study, ‘anger’ was qualified as 5 and above on a 1-7 scale, referring to ‘very angry, body tense, clenching fists or teeth, ready to burst’, up to ‘enraged, out of control, throwing objects’. Anger below this level was not associated with increased risk.

“The triggers for these burst of intense anger were associated with arguments with family members (29 per cent), argument with others (42 per cent), work anger (14 per cent) and driving anger (14 per cent),” said Dr Buckley.

“The data also revealed that episodes of anxiety can also make you more likely to have heart attack.

“High levels of anxiety were associated with a 9.5 fold increased risk of triggering a heart attack in the two hours after the anxiety episode.

“Increased risk following intense anger or anxiety is most likely due to increased heart rate, blood pressure, tightening of blood vessels and increased clotting, all associated with triggering heart attacks,” he said.

The study was an investigation of consecutive patients suspected of heart attack and confirmed by angiography reports at Royal North Shore hospital. Patients confirmed with acute coronary blockage were admitted, interviewed about their activities in the 48 hours before the onset of symptoms, and usual frequencies of activities were recorded for comparison.

“Although the incidence of anger-triggered heart attacks is around 2%, of the sample, those people were 8.5 times more likely to have a heart attack within two hours of the emotional episode. So while the absolute risk of any one episode triggering a heart attack is low, this data demonstrates that the danger is very present.

“Our findings highlight the need to consider strategies to protect individuals most at risk during times of acute anger.

Senior author Professor Geoffrey Tofler, Preventive Cardiology, University of Sydney said “Potential preventive approaches may be stress reduction training to reduce the frequency and intensity of episodes of anger, or avoiding activities that usually prompt such intense reactions, for instance, avoiding an angry confrontation or activity that provokes intense anxiety.

“Additionally, improving general health by minimising other risk factors, such as hypertension, high cholesterol or smoking would also lower risk.

“For those at high risk, it is possible that medication such as beta-blockers and aspirin taken at the time of a trigger may interrupt the link between the stressor and the heart attack. We are currently recruiting subjects for a study examining this option.

“Our research suggests that when managing a person with heart disease or in preventing heart disease in others, a person’s frequency of anger and anxiety should also be assessed and be part of helping individuals to take care of themselves.

“Our message to people is they need to be aware that a burst of severe anger or anxiety could lead to a coronary event, so consider preventative strategies where possible,” Dr Tofler said.


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