It’s Killing Me Stress as a Life-threatening Condition Michael S. Krasner, MD October 21, 2009...
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![Page 1: It’s Killing Me Stress as a Life-threatening Condition Michael S. Krasner, MD October 21, 2009 Perinatal Network of Monroe County Managing Stress for Healthier.](https://reader031.fdocuments.us/reader031/viewer/2022032517/56649c9b5503460f94959a82/html5/thumbnails/1.jpg)
It’s Killing MeStress as a
Life-threatening Condition
Michael S. Krasner, MDOctober 21, 2009Perinatal Network of Monroe CountyManaging 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 subject’s 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
– Attentional difficulties
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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