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General Treatment Principles

Antidepressant, antimanic and mood stabilizer drugs affect the core brain systems involved in modulating stress. Not surprisingly, the conditions in which antidepres-sant drugs are indicated are exacerbated by stress, suggesting that antidepressants may simply restore function by reversing the adverse effects of stress or buffering the brain from stressful life events. Antidepressants do not cure depression or any other condition (Hyman & Nestler, 1996 Duman et al., 1997, 1999 Stahl, 1998). This is most evident through the high rates of recurrence on discontinuation of successful treatment, even after long periods of medication-induced remission (Keller, 2001).

Selfefficacy Theory And Psychological Control

O'Leary, Shoor, Lorig, and Holman (1988) used a cognitive-behavioral intervention to increase self-efficacy among persons with rheumatoid arthritis. In this study, participants were assigned to either a control group or an intervention group. In the control group, participants received a self-help booklet in the intervention group, participants were taught skills in managing stress, pain, and disease symptoms. Participants in the intervention group experienced reduced pain and improved psychological functioning. Moreover, the degree to which people improved was correlated with the degree of self-efficacy enhancement, suggesting increases in perceived self-efficacy were responsible for the effectiveness of the intervention. In a review of the literature on self-efficacy and myocardial infraction (MCI), Ewart (1996) argues that self-efficacy theory provides a useful framework for understanding recovery from MCI. According to this author, self-efficacious beliefs influence behavioral...

Regulatory Effects Of Heat Shock Protein 60 On Innate Immune Cells

As mentioned before, it is now evident that HSP are released into the extracellular compartment in response of cells to stressful situations, e.g. during inflammation. Hsp60 has been found to be present in the circulation of normal individuals (Pockley et al., 1999 Xu et al., 2000), and increased serum levels have been observed in a number of pathological conditions like hypertension (Pockley et al., 2000 Pockley et al., 2002), arteriosclerosis (Wick et al., 2004 Xu et al., 2000) and renal vascular diseases (Wright et al., 2000). Emerging evidence coming from several studies suggest that extracellular HSP function as intercellular signalling proteins, which serve as danger signals to the innate immune system, thereby mediating and modulating a number of inflammatory reactions (Chen et al., 1999 Wallin et al., 2002). We and others have shown that human Hsp60 stimulates pro-inflammatory reactivity in innate immune cells, such as macrophages, dendritic cells (DC) and endothelial cells...

Clinical features

The night-eating syndrome, characterized by morning anorexia, evening hyperphagia, and insomnia, appears to be a manifestation of an altered circadian rhythm, precipitated by stressful life experiences.(9) People with the night-eating syndrome show frequent night-time awakenings during which they consume high carbohydrate snacks, evidently in an effort to increase the production of serotonin with its sleep-inducing capabilities. Neuroendocrine disturbances occur in the night-eating syndrome hypomelatoninaemia may impair sleep, and a failure of the night-time rise in plasma leptin may contribute to hunger and night eating.

Stress as a mechanism

Cutaneous and visceral sensation appears to differ in relation to the effect of stress on the magnitude of responses to stimulation. Although stress-induced analgesia (or hypoalgesia) has been a long-recognized phenomenon associated with cutaneous sensation, it would appear that stress-induced hyperalgesia is the correlate phenomenon associated with visceral sensation. Clinically, stressful life events have been viewed as classic triggers for the evocation of diffuse abdominal complaints of presumed visceral origin.9 It is the rule, rather than the exception, that stressful life events, unless coupled with other major physiological events such as pregnancy, lead to an exacerbation of underlying pain disorders. A prominent role for stress in the pathophysiology and presentation of multiple clinical pain states, including irritable bowel syndrome, Crohn's disease, interstitial cystitis, rheumatoid arthritis, and psoriasis, has been well documented.67'68'69'70'71 Using IC as a specific...

Development of Chronic Stress Glucocorticoid Resistance

The combined effects of inflammation and stressful life events on the immune system may result in a downregulation of glucocorticoid receptor number and function, thereby reducing the impact of HPA regulation of inflammation. Under conditions of downregulated glucocorticoid receptors, if there is a small increase in autoreactive inflammation, immune cells would be less responsive to the regulatory effects of cortisol. The autoreactive immune cascade would be able to continue uncontrolled until a full-blown exacerbation had occurred. In addition, a small drop in cortisol secondary to the resolution of stressful life events might also reduce glucocorticoid regulation of inflammatory processes, leaving the patient more vulnerable to inflammation and at greater risk of exacerbation. Thus, chronic stress, while not causing exacerbation, may leave patients less able to maintain self-tolerance when autoreactive MS immune processes are initiated.

Psychopathology Theories Of

Dency of the autonomic nervous system to react to a stressful situation in a particular way). In the organ specificity hypothesis, it is held that the individual suffering from psychosomatic disorders unconsciously chooses a particular organ, or part of the body (such as the skin for hives, or the stomach for ulcers), to be the physical locus or manifestation of her his tension or stress that has not been discharged in other more customary or healthy ways. The associated specificity theory states that through learned mediation or accidental conditioning, an association may be formed between a physiological response and an idea, emotion, or thought. Research gives only partial support to all the specificity hypotheses, and does not support completely any single approach. The nonspecificity theories maintain the etiological primacy of psychological factors in at least some cases of certain physical diseases, but do not attempt to explain symptom choice rather, the term organ...

Importance Of Psychosocial Factors In Health Maintenance

Psychosocial factors may also contribute to an individual's susceptibility to stress-related symptoms and health changes. Stressful life events ranging from daily hassles and marital discord to more traumatic events such as sexual and physical abuse, a devastating diagnosis, war, and natural disasters have all been related to the onset or exacerbation of physical symptoms in a variety of populations. In addition, underlying physiologic changes that might act to mediate these associations have been demonstrated in both healthy people (Cohen, Tyrrell, & Smith, 1991 Ironson, Antoni, & Lutgendorf, 1995 Ironson et al., 1997) and those with a preexisting medical condition (Grady et al., 1991 Lutgendorf et al., 1995 Pereira et al., 2003). Research into individual difference factors that may act as buffers of stressful events has identified several psychosocial factors that moderate the influence of stressors on physical health changes and physiologic regulatory processes such as endocrine...

Historical perspective

Brain Regions

Thus, explanations for the cause of emotional disorders produced by stroke have followed two lines of reasoning. One line suggested that brain injury may provoke specific emotional disorders, mediated through pathophysiological responses of the brain to injury. The other line of reasoning emphasized that emotional disorders were an understandable psychological response to the loss of ego integrity produced by brain injury. McHugh and Slavney (1998) have termed these differences as perspectives of psychiatry. Each perspective is based on different, underlying assumptions and methods of reasoning. Poststroke emotional disorders are usually viewed from either the disease perspective in which the brain injury provokes a pathophysiological response which leads to clinical symptoms or from the life story perspective in which a person becomes vulnerable based on their life experience and in the midst of a stressful life event they develop an empathically understandable psychological...

Partners of Chronic Pain Patients

The impact of spousal support on the health of chronic pain sufferers has come under considerable scrutiny (Thomas and Roy, 1999). A few reports are summarized below. The value of spousal support for a group of Dutch and German outpatients with rheumatoid arthritis was reported by Waltz and colleagues (1998). Negative spousal behavior in the form of criticism and baseline depression predicted a worse pain outcome. Daily emotional support and having a social life were associated with positive affect and had an indirect effect on outcome. The absence of strong social ties was the component of the loneliness construct linked to pain. This study is an affirmation of the value of a supportive spousal relationship. However, if the spousal health is compromised through altered and stressful circumstances, then it is likely to have a negative impact on the patient's health and well-being.

Medical Benefits of Tai Chi Articles

General Benefits T'ai Chi teaches inner strength while toning muscles, increasing flexibility, and boosting immune power. It is also said to reduce stress, store up energy, increase body awareness, and improve balance and coordination. T'ai Chi was the closely held secret of a few Chinese families for nearly 1,000 years. (Men's Health magazine. 8 Mar Apr 1993, 66-69.)

Interaction of the Nervous System and the Immune System

Because there appear to be important interactions between the nervous system and the immune system, modifying brain activity may alter the immune system and immune diseases such as MS. For example, psychological stress and depression may influence the functioning of the immune system. One way to manage stress is to write about stressful life events. The act of writing about such events has been associated with improved immune function and improvement in two immune diseases, rheumatoid arthritis and asthma. Many studies have examined the possible influence of psychological stress on MS. In this area, two large questions exist. The first question is Does stress cause MS attacks For the first question, several individual studies (4) and a combined analysis of these studies (5), known as a meta-analysis, indicate that the risk of attacks increases after stressful life events. At this time, however, this is still a chicken-or-the-egg question. That is, it is possible that stress actually...

Seeking Social Support

Individuals may also resist seeking social support when the support available has the potential to add stress to an already stressful situation. Social support would be feared when the support provider delivers social support in an excessive or inappropriate manner. To illustrate, an individual suffering from a chronic, debilitating illness such as rheumatoid arthritis (RA) may avoid seeking social support if doing so threatens their independence (e.g., a support provider insists on doing everything for the individual with RA rather than simply facilitating the sufferer's own coping efforts).

Stress and the Immune System

Natural killer cell function are altered by stressful events (Okimura et al., 1986). In contrast, chronic stressful life events are thought to suppress the ability of the immune system to respond to challenge and thus increase susceptibility to infectious diseases and cancers. Although there is convincing evidence linking stress with the onset and progression of certain infectious diseases (e.g., influenza, herpes), relatively little is known about the role of stress in autoimmune diseases (e.g., multiple sclerosis, rheumatoid arthritis, lupus, insulin-dependent diabetes). However, a few studies indicate that stressful life events and poor social support play a role in the onset and exacerbation of autoimmune diseases such as rheumatoid arthritis (Rimon et al., 1977 Homo-Delarche et al., 1991). Furthermore, intervention studies indicate that cognitive-behavioral stress management decreases the symptomatology of autoimmune disease (Bradley et al., 1987 O'Leary et al., 1988 Radojevic et...

Living In The Moment

Rubin sees hcryoga practice as a means to keep her well and healthy whether it's her mind or her body or both that need attention. My practice of meditation and yoga is a place where I get clear and heal, she says. Just stopping in the midst of a practice to breathe and focus gets to the real part of what is happening for me. Yoga has given me a single-pointed awareness that I can come back to in any stressful situation, and that, for mc, is the secret to stayingbalanced. *


In chronic medical conditions such as arthritis, asthma, diabetes, hypertension, and other diseases, the goal is not to cure that which cannot be cured. This does not mean that reduction in pain and morbidity are not in themselves therapeutic the emphasis, however, is in disease management. It is with these intractable conditions, medical and psychological, that management is important. Patients with physical diseases are taught how to comply with medical regimens monitor their own condition reduce stress through relaxation, imagery, and other stress management techniques and provide a support system for each other. Most so-called Axis II patients can learn impulse control so that they become more manageable and less vulnerable to the consequences of their own emotional lability. Schizophrenics are also incurable, but they can learn independent living as well as techniques to prevent the

Stress and Illness

Coinciding with the scientific community's growing acknowledgment that stressful events have direct physiological effects, much interest has developed in understanding the relations between these events and the development or maintenance of specific diseases. Probably the greatest amount of research has focused on the link between stress and heart disease, the primary cause of death in the United States. Much empirical work also has fo During the last two or three decades of teh twentieth century, applied researchers attempted to develop intervention strategies aimed at controlling the body's physiological responses to stress. This work has suggested that a number of stress management strategies can actually attenuate physiological responsivity. Most strategies teach the individual some form of relaxation (such as deep muscle relaxation, biofeedback, hypnosis, or meditation), and most of this work has focused on populations already diagnosed with a stress-related disease, such as...


Effects According to traditional Indian medicine, it is said to reduce stress and anxiety and to improve vitality, learning, and memory. It has been used to treat arthritis and help heal broken bones, and may inhibit cancer, as well. There have been few studies, but those conducted have yielded encouraging results it enhanced mood and improved hemoglobin and blood plasma protein levels in a 1993 study, was shown to alleviate withdrawal symptoms in morphine addiction in a 1995 study, and showed positive results for patients with anxiety neurosis in a 1997 study.

Figure 775

Even though we know that cortisol secretion often increases greatly in stressful situations, we are not sure why this is of significant benefit to the animal. One possibility is that the glucocorticoids cause rapid mobilization of amino acids and fats from their cellular stores, making them immediately available both for energy and for synthesis of other compounds, including glucose, needed by the different tissues of the body. Indeed, it has been shown in a few instances that damaged tissues that are momentarily depleted of proteins can use the newly available amino acids to form new proteins that are essential to the lives of the cells. Also, the amino acids are perhaps used to synthesize other essential intracellular substances such as purines,

Stress Management

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