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Psychosocial Stress Reduction (Prong-6)

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Clinical Autonomic and Mitochondrial Disorders

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Abstract

Stress is an insidious factor in the lives of many, if not all, people. A little stress is actually healthy and helps people stay strong and healthy and even well. However, the stress levels in today’s society are too high for almost all people. There is little that can be done to escape it: young people are made to grow up too fast; girls are not pretty enough; boys are not strong enough or sensitive enough; the old standards are gone, including sexual identity; and no one is good enough, smart enough, rich enough, young enough, etc. This is now the norm. This before the violence of life (bullying, rape, murder), and diseases and injury, is added; even food and exercise have become stressors in many situations. As discussed earlier in this book, of this excess stress is damaging at the cellular level as oxidative stress. However, oxidative stress is exacerbated and further induced by any and all of these systemic, or psychosocial, stresses.

Systemically, these stresses are perceived by the brain and transmitted to the body and down to the cellular level through two main pathways: the hypothalamus-pituitary-adrenal axis (hormonally) and the parasympathetic and sympathetic nervous systems (neurally). Physiologic and psychologic stress and emotions (both happy and sad emotions) modulate hormonal and neural activity. Negative stresses may cause inflammation at the cellular level, suppress immune activity at the system level, and cause major adverse cardiovascular events (MACE, including stroke and sudden death). Causal factors and stress reduction factors are presented and discussed, including stress reduction as a powerful antioxidant. A tested, tried, non-pharmaceutical method to help reduce stress and mitigate its effects is presented.

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Notes

  1. 1.

    The Vagus Nerve is approximately 70% of the parasympathetic nervous system.

  2. 2.

    The standard belief is that an increase in one branch of the autonomic nervous system is accompanied by a decrease in the other branch. In this way balance and homeostasis is maintained. Unfortunately, this assumption only holds in truly healthy individuals. Unprovoked parasympathetic excess (PE) during sympathetic stimulation is abnormal. This dynamic PE is “hidden” behind a sympathetic excess that is secondary to the PE. As a result, the symptoms masquerade as if they were generated by a primary sympathetic excess (SE). However, when treated as a primary SE, the patients do not respond as expected. When they are treated for a primary PE, they do improve. An example of such a patient is a patient with both depression (from PE) and hypertension (from SE). These patients tend to not be stable, because by treating the patient with direct or indirect sympathetic blockade (i.e., antihypertensives), more of the extant sympathetic control over the PE is blocked, the body is still demanding its blood, and not all sympathetic channels are being blocked; therefore, the body finds a way to defeat the antihypertensive, and the blood pressure increases after all [17]. (See “Dynamic Parasympathetic Excess” below.)

  3. 3.

    At this stage “neuropathy” is a misnomer and has led to the misperception that P&S imbalance cannot be treated. As a result many people have suffered unnecessarily. “Neuropathy” implies “dead nerves.” The nerves are not dead, just damaged, and they can be healed and their function normalized for their age. This is why “dysfunction” is the preferred term.

  4. 4.

    A good analogy is your car. When stopped at a red light, you have your foot on the brakes. When the light turns green, the first thing you do is take your foot off the breaks. Even before you step on the accelerator, the car is moving, accelerating. Then you step on the accelerator and move faster. Acceleration is facilitated by releasing the brakes. The same happens in the body. However, if you do not take your foot off the brakes and step on the accelerator, you still go, but it takes you longer to get to speed, or you have to step on the accelerator harder, over-revving the engine. The condition of keeping your foot on the brakes is like PE with SE.

  5. 5.

    Epinephrine and adrenaline are the same chemical, discovered at the same time (1904) by two different researchers, one in the US and one in England. The US named the chemical “epinephrine” and the British named the chemical “adrenaline.”

  6. 6.

    Yes, “corollary.” The P&S nervous systems do not always work in opposition. In fact, they tend to be more synergistic, rather than oppositional.

  7. 7.

    Sympathovagal balance is the ratio of resting sympathetic activity to resting parasympathetic activity (SB = S/P). High SB indicates a resting sympathetic excess (SE, relative to resting parasympathetic activity). Low SB indicates a resting parasympathetic excess (PE, relative to resting sympathetic activity).

  8. 8.

    Chronic stress is a chronic sympathetic stimulus and results in high SB, indicating resting sympathetic dominance, potentiating a pro-arrhythmic state. Acute stress is an acute sympathetic stimulus that does not result in long-term high SB, indicating chronic SE. However, the acute sympathetic stimulus can be “the straw that broke the camel’s back” and may trigger an arrhythmia if SB is high to begin with, due to other reasons (i.e., diabetes, sleep apnea, hypertension, anxiety, etc.).

  9. 9.

    Even with the assumptions and approximations required by HRV (alone) analyses, in the cases of angry patients, the changes in the HF-HRV term is likely to be an indicator of relative changes in parasympathetic activity. The reason is that anger tends to cause an increased respiratory rate, which may be assumed to be high enough to cause the parasympathetic activity to be fully represented by the HF-HRV term, leaving no parasympathetic activity to be represented by the LF-HRV term. It is an indication of relative changes because the HF-HRV term still includes “noise.”

  10. 10.

    P&S monitoring is a spectral analysis, signal processing technique that enables independent, simultaneous measurements of both P&S nervous systems’ activities, without the assumptions and approximations required by HRV (alone) analyses [18].

  11. 11.

    The Valsalva challenge is a series of short Valsalva maneuvers that are each kept to less than or equal to 15 seconds to prevent the parasympathetic cascade that is the hallmark of long Valsalva maneuvers. As taught in medical school, long Valsalva maneuvers are strong parasympathetic stimuli, which they absolutely are, but if terminated prior to 15 seconds or so, they remain only (net) sympathetic stimuli.

    The stand challenge is a net sympathetic stimulus, where the parasympathetics normally decrease and then the sympathetics normally increase.

  12. 12.

    Like oxygen and water, inflammation is beneficial to the body in appropriate amounts. Acute inflammation helps with the immune and healing (repair) processes. Chronic inflammation, however, is never good. Chronic inflammation is acute inflammation that lasts too long or is not deactivated by the parasympathetics.

  13. 13.

    The same six breathes per minute in a stressed or hyperstate is known as hyperventilation and is neither relaxing nor an optimal stimulus for the parasympathetic or vagus nerves.

  14. 14.

    Meditation or prayer has been demonstrated to reduce stress by increasing parasympathetic activity (reducing or normalizing sympathovagal balance).

  15. 15.

    A method of deep muscle relaxation based on the premise that muscle tension is the body’s physiological response to anxiety-provoking thoughts and that muscle relaxation blocks anxiety. Therapy focuses on tightening and relaxing specific muscle groups in sequence. It’s also known as progressive muscle relaxation which teaches you how to relax your muscles through a two-step process. First, particular muscle groups in your body are systematically put under tension, such as your neck and shoulders. Next, the tension is released and should be more relaxed. Whether reducing muscle tension is a result of relaxation or a cause of relaxation is unknown. Little, if any, rigorous research has been performed in this area. However, the time spent relaxing, which is well known to increase parasympathetic activity, has been demonstrated to reduce stress by increasing parasympathetic activity (reducing or normalizing sympathovagal balance). See “Meditation or Prayer” above.

  16. 16.

    Biofeedback uses HR, for example, as a means of training the nervous system to relax. Neurofeedback uses EEG waves (from your brain) as a means of training the nervous system to relax. Neurofeedback requires trained healthcare professionals to train the patient and interpret and assess the outcomes. Biofeedback does not.

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  1. Franklin Cardiovascular Associates, PA and Autonomic Dysfunction and POTS Center, Sewell, NJ, USA

    Nicholas L. DePace MD, FACC

  2. TMCAMS, Inc., Franklin Cardiovascular Associates, PA and Autonomic Dysfunction and POTS Center, Richboro, PA, USA

    Joseph Colombo

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DePace, N.L., Colombo, J. (2019). Psychosocial Stress Reduction (Prong-6). In: Clinical Autonomic and Mitochondrial Disorders. Springer, Cham. https://doi.org/10.1007/978-3-030-17016-5_8

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