STRESS, IMMUNE SYSTEM & EXECUTIVE FUNCTIONING: Creating a Solid Health & Self-Care Practice

The first wealth is health.

-Ralph Waldo Emerson

PSYCHONEUROIMMUNOLOGY (PNI)

The immune system's chief function is to prevent or limit infection, and as long as it's running smoothly, we will not know it's there. It quietly and efficiently does its job recognizing and neutralizing harmful substances from the environment and fighting disease-causing pathogens. Without our immune system, we would have no way of fighting off these harmful invaders. 

Decades ago, it was believed the immune system operated within itself rather than as the well-integrated system in constant communication with the brain and nervous system that we now know it to be. Not only do these systems communicate, but each affects the other in profound ways. Their synergy is both staggering and powerful and collectively coined psychoneuroimmunology, or PNI, for short. The PNI model comprises 3 major components: 

• Psychological
• Neurological
• Immunological 

My interest in PNI began approximately two decades ago while enrolled in my Ph.D. in Clinical Psychology program, with heavy emphasis in neuropsychology. Whereas terms such as frontal and prefrontal lobes, hemispheric dominance, and amygdala were commonplace, PNI was a relatively new area of study emphasizing the role stress plays in the manifestation and proliferation of disease. 

The effects of prolonged, unchecked stress include many health problems such as high blood pressure, heart disease, diabetes, and susceptibility to infections. Add cognitive concerns such as foggy thinking and memory problems to the list and the result is suboptimal executive functioning (a collective term defining the regions of the frontal and prefrontal lobes responsible for core competencies such as planning, focusing, organizing, problem solving, and decision making). Stress and immune functioning engage in an inverse relationship: 

STRESS, EMERGENCY ROOM VISITS & MEDICATION 

Well known even to first-year psychology students is the preponderance of emergency room visits due to anxiety and stress-related symptoms. Individuals living with unmanaged levels of stress tend to be high users of health care, often involving expensive hospital and doctor visits that burden the healthcare system. Many confuse difficulty breathing, tightness or shortness of breath, and overwhelming feelings of fatigue and lethargy as serious medical and/or life-threatening conditions rather than extreme reactions to anxiety and stress. This often necessitates an emergency room visit that results in the prescription of benzodiazepines and a brief mention of a lifestyle change to mitigate stress by the attending physician. 

Of those cases in which a potentially life-threatening condition does exist, such as asthma, stress and anxiety can certainly fan the bronchial flames. There are numerous studies, replicated across decades, communicating the correlation between psychological stress and rates of respiratory infections and the common cold. 

While occasional stress and anxiety are normal parts of life, persistent and uncontrollable levels eventually become disabling. We all experience periods of stress and anxiety, from time to time, as we journey through life. Stress is meant to be temporary, but to many, it has unfortunately morphed into a lifestyle. Initially, it was subtle. Over time, it mindlessly led to counterproductive habits, compromising our energy and health. 

The building blocks of stress as a "lifestyle" are habits. 

Neurons that fire together, 

wire together

This statement eloquently expresses the power of our behaviors and how quickly they can become habits. Similar to "practice makes perfect," we  need to be mindful and cognizant of exactly what we're practicing. If we connect poor coping strategies to stress, such as over-eating, over-thinking (ruminating), or avoidance, then these neuronal patterns will strengthen. Without realizing it, we can easily fall into a pattern of perpetual stress and a lifestyle that is basically not supporting our energy levels, goals, higher plans, and purpose. 

The same is true when utilizing effective coping strategies. When taking a calm, yet assertive action toward a crisis or problem, we strengthen our sense of self-efficacy, confidence, and resilience. Resilience helps us recover quickly from difficulties. It helps us bounce back. 

THE VAGUS NERVE AND THE SYMPATHETIC & PARASYMPATHETIC NERVOUS SYSTEMS

Let's unlock the mystery of our brain and nervous system in an effort to deepen our understanding of stress and immune functioning. Connecting our brain to different parts of our head, neck, and trunk are the 12 pairs of cranial nerves, each named for their structure and function. 

For the purpose of understanding PNI, we are most interested in the 10th cranial nerves, the vagus nerve. Possessing both sensory and motor functions, it is the longest cranial nerve in the body (extending from head to abdomen). It communicates information from the ear canal, which contains the vestibulocochlear nerve, and parts of the throat. The throat plays an important role in calming the nervous system. By just simply humming, whether a tune or the equivalent of the Om mantra (familiar to yoga practitioners), the vagus nerve will be stimulated. Since it is the fundamental regulator of the parasympathetic nervous system (PNS), its stimulation is directly associated with relaxation. 

The PNS is responsible for rest and digest, and its counterpart, 

the sympathetic nervous system (SNS) is responsible for 

fight-or-flight, or freeze. 

Both the PNS and the SNS are part of the Autonomic Nervous System (ANS). An easy way to remember the ANS is to associate autonomic with automatic. The ANS automatically regulates certain body processes, such as breathing, blood pressure, and digestion, to name a few, without any conscious effort on our part. The PNS and SNS were created to work in tandem, ensuring the restoration and protection of our bodies. 

A key take-away is the sophisticated communication system functioning inside of us; without our knowing. It is similar to being a passenger on a commercial flight, traveling smoothly, unaware of the communication taking place between the cockpit and ground control. If we thought about it, we would know it's happening. However, most of us give little to no thought or attention regarding this detailed, intricate, and coordinated communication system. 

The PNS is responsible for bringing a state of restorative calmness, and through the innervation of the vagus nerve, it releases an assortment of hormones and enzymes that directly link to the enhancement of immune functioning.  For example, listening to music we enjoy releases dopamine, the feel-good hormone. Additional benefits include a reduction in inflammation, improvement in memory, feelings of relaxation and reduction in aches and pains, especially headaches. However, when stress is a lifestyle (as is unfortunately the case for so many), the partnership between the SNS and PNS changes and shifts from a synchronistic, mutually beneficial system to one in which the SNS hijacks the relationship, working long-hours, and depleting our bodies of health, energy and focus. In short, we become dysregulated; out of balance. 

We have created lifestyles and engaged in habits that are making it harder for the PNS to resume control, as chronic states of stress warn the brain to maintain vigilance and alertness. We are over-worked, over-scheduled, and over-stimulated. We have become mass consumers of distressing and upsetting news, and are chronically living with a sense of burdensome deadlines and urgency. The SNS is chiefly responsible for keeping us alert in case of danger and was only meant to be engaged or activated for a brief period of time, as a protective mechanism. Following a brief period of stress, the body will naturally attempt to return to homeostasis. The heart rate slows, the muscles relax, and breathing returns to normal. It is the heaviness of chronic stress that increases the likelihood of poor health. 

Without a plan, or use of one's executive functioning, the management of life becomes random, scattered, and reactive. Executive functioning, through the use of the frontal and prefrontal cortex, promotes higher cognitive functions. Higher order thinking moves us from lower level, reactive functioning to higher level, proactive functioning. Stress and anxiety severely challenge executive processes. Try focusing and concentrating when "stressed to the max." 

Telltale signs often signaling an over-active SNS include memory and concentration problems, racing or anxious thoughts, moodiness, irritability, agitation, feeling "wired" and/or overwhelmed, depression, increased and rapid weight gain, body aches and pain, rapid heartbeat, chest pain, gastrointestinal distress (diarrhea and/or constipation), nausea, dizziness, low energy, increased tendency to catch a cold/flu (lower immune system), fatigue, foggy thinking, procrastination, addictions, and non-restorative sleep. 

ANXIETY DISORDERS & THE CULMINATION OF CHRONIC STRESS

According to the World Health Organization (WHO), globally 1 in 13 individuals suffers from anxiety, and anxiety disorders are, in fact, the most common mental disorders worldwide. 

Anxiety disorders have a deep biological underpinning and can be described as chronic intermittent disorders. Interference in day-to-day functioning is an important criterion in the diagnosis of an anxiety disorder. Although highly treatable, only about 1/3 of those diagnosed receive treatment. 

Cognitive behavioral therapy (CBT) is the most widely used treatment and while it has made significant advances, most afflicted with an anxiety disorder cannot be fully or successfully treated with CBT's typically simple applications of changing the thought in order to change the feeling. This has been mostly evidenced in the emerging field of trauma work. 

Successful management of anxiety and its associated feelings of stress involve, in part, developing a higher tolerance for ambiguity and uncertainty, and appropriately evaluating what one thinks and feels. It often involves creating a lifestyle that supports physical and mental health such as purposeful work, healthy relationships, exercise, good nutrition, restorative sleep, and a mindfulness practice. When we have a regular and trusted functional routine, life's interruptions may create the need for a detour but they won't take us completely off path. 

               We circumvent. We adjust. We re-route. 

But what happens when the interruption is global and unfamiliar, with potentially dire consequences, such as the coronavirus? Adding to the pandemic is political and societal unrest, which  results in a confluence of stressors that have reached exponential heights. When a system becomes overwhelmed, it shuts down or collapses under the weight of its heaviness and pressure. Many are reporting feeling overwhelmed to the point of crisis, fatigue, depression, and anxiety. Again, as stress levels rise, executive and immune functioning drop. 

The culmination of chronic stress results in burnout, adrenal gland depletion, and a compromised immune system. When our blood pressure is high, production of hormones regulating metabolism is off, and fighter-cells cannot fend off infection and disease, we will experience low energy and executive function fatigue. 

Possibility Does Not Equal Probability

For those finding themselves experiencing difficulty coping, a starting point would be to assess one's current situation and apply rational thinking. A thorough and honest assessment of present circumstances, vulnerability and threat is recommended. To learn more, listen to the COGNITIVE DISTORTIONS PODCAST.

By rationally approaching a crisis, one can find that the situation is not as dire (or hopeless) as it initially seemed. An important concept taken from statistic's probability theory is that possibility does not equal probability. Just because it's possible, it doesn't mean it's probable. Under the effects of an amygdala hijack, the frontal cortex weakens and problem-solving takes a back seat to emotional exaggeration and excitement. Anxiety has an insidious way of distorting reality and invoking worst-case scenarios, by occupying the mind in endless ruminations. The final destination? Living in fear. 

The anxious mind either erroneously believes this behavior is functional or understands that it is not but, either way, cannot shut itself off. It results in the depletion of cognitive resources. 

One simple solution is to manage incoming information such as turning off (or significantly limiting) the round-the-clock news coverage. Periodically, check in for updates but don't allow yourself to absorb an endless stream of doom and gloom. In lieu of endless background chatter about the coronavirus and "all that is wrong with the world;" perhaps listening to an educational podcast or soothing music may help calm an over-active nervous system. This is not to minimize the impact of the seriousness of all that is happening around us, but more about maximizing our strength and resiliency to best handle emerging and troubling conflicts and situations. 

Calm is a super-power, and if we can maintain a state of equanimity, we will simply be more resourceful. 

For those who have consistently used effective coping strategies and have a solid self-care practice in place, then the challenge becomes to maintain such excellent practices when faced with uncertainty or stress. Unfortunately, it is not unusual for humans to dismiss good habits and practices when under stress. Stress management and the regulation of anxiety lead to the stabilization of other affective states and executive functioning. 

ACEs & ADDICTIONS

Two important discussions that will be mentioned here but exceed the purpose of this article include Adverse Childhood Experiences (ACEs) and the role addictions play in our lives, especially during times of uncertainly and stress. 

Aces

The science behind ACEs includes research on the prevalence and consequences of potentially traumatic events experienced in childhood (0-17 years). These include, but are not limited to, violence, abuse, and neglect. Research is well documenting their effects on lifelong health. If interested, google Take the ACE Quiz to learn your score. Also, the Center for Disease Control (CDC) has taken a special interest in ACEs and continues to provide updated research on their website. This score is meant to be a guide and not a fait accompli. Neuroplasticity is your ally. Building on the knowledge that the brain and body seek healing and homeostasis, there is a lot one can do from the perspective of prevention and /or curtailing disease.  

Addictions

An addiction is generally defined as the repeated involvement in an activity or with a substance that is harmful and/or maladaptive. The following proverb is applicable to the discussion of addictions:

A chain is only as strong as its weakest link 

The best-laid plans can easily be derailed by defaulting to patterns rooted in self-dysregulation and disconnection. We each have areas of vulnerability. These vulnerabilities become most pronounced when we are unable to emotionally regulate (via modification of emotional reactions and tolerance to negative emotions).

While addictive behaviors allow us to temporarily disengage and help push the pause button on what feels like insurmountable stress, it unfortunately comes with a large cost that grows exponentially if left unchecked. Renowned addictions expert and physician, Gabor Mate, M.D. has this to say about addictions and stress: 

"For those habituated to high levels of internal stress since early childhood, it is the absence of stress that creates unease, evoking boredom and a sense of meaningless. People may become addicted to their own stress hormones, adrenal and cortisol. To such persons, stress feels desirable, while the absence of it feels like something to be avoided."

There are healthy ways to push the pause or re-set button, as presented in research from the field of positive psychology known as entering the flow state or being in the zone. This occurs when an individual is fully immersed in an activity in which focus, creativity, and engagement are heightened. When exiting the zone, one feels a sense of fulfillment, accomplishment, and/or calm. In contrast, addictive behaviors, whether to a substance, food, exercise, work, or negative thought patterns produce different outcomes; typically, feelings of exhaustion, self-deprecation and fatigue. 

To successfully manage addictions, an organized and mindful treatment approach is required, as addictions typically gain speed in their destructive path. Often, professional intervention is warranted. 

BOUNDARIES

We cannot have an intelligent conversation about health without addressing the important topic of boundary-setting. Whereas location is paramount in real estate, communication and boundaries hold the same importance in relationships; both with ourselves and with others. Good, well-defined boundaries create a healthy connected and integrated sense of self, and they help create and maintain healthy relationships with others.

When you feel yourself becoming resentful, or exhausted, pay attention to where you haven't set a healthy boundary. 

-Crystal Andrus

Setting and maintaining boundaries require self-knowledge and assertive communication skills. These are learned skills and our relationships will feel more enjoyable and satisfying as we grow and cultivate these necessary competencies. 

THE RESILIENCE TOOLBOX

Offered below are helpful tools to place in your Resiliency Toolbox to manage both short-term and long-term stress. And yes, easier said than done!  This should never be an excuse for not doing what you know will be helpful. If random adults were polled and asked how best to reduce the effects of stress and anxiety, most would generate a good and realistic plan involving and incorporating many of the suggestions listed here. 

We are typically not lacking in information, but in initiation or in organization, meaning we have difficulty integrating and applying what we already know!

RESTORATIVE SLEEP

Sleep and the circadian system have a profound regulatory influence on immune functioning. Aim for 7-9 hours nightly. Chronic sleep loss compromises the body's ability to ward off infections. 

Bedrooms should be cool and dark, and free from distracting noise. Some find white noise or background sounds of nature soothing. 

Establish a relaxing bedtime routine. Dim the lights and gradually remove yourself from screens and the lights emanating from devices and electronics, and make sure your phone does not interrupt you with notifications while you're sleeping. 

NUTRITION

Numerous studies have documented the effects of a healthful diet on mental health and immune functioning. 

If you are already in the habit of eating real food, mostly plant based, and within reasonable caloric portions, then continue. If not, then this may be a good time to re-assess your diet and make changes that are best for you.

Dietary supplementation may be helpful, and is individual to each person's specific needs. 

Avoid overly processed foods and sugar. Both can spike levels of fatigue, and increase susceptibility to disease. 

Limit caffeine intake (if anxious), especially coffee and/or caffeinated soft drinks. Instead, enjoy tea (caffeinated and herbal). Caffeinated teas, such as black and green, offer a balance of energy, while also delivering a calming effect. If you have high blood pressure or tend to feel jittery and yet desire caffeine, black or green tea may be a better alternative.

Hydrate. Keep your immune system humming by drinking plenty of water. It staves off infection and naturally eliminates toxins from your body. If flavoring your water will help you drink more, then add lemon, mint, or cucumber. 

EXERCISE 

There is no scarcity of studies showing a clear, inverse correlation between engaging in moderate exercise and the risk of a wide variety of illnesses, including infectious diseases. Moving one's body enhances immune functioning. The minimum requirement is 150 minutes per week.

The exercise regimen should include cardio, weight lifting and stretching for optimal benefits.  

Exercise releases endorphins, which trigger a positive feeling in the body that typically lasts for most of the day. 

The physical practice of yoga has been well established in yielding the following benefits:  reduction of stress and anxiety, improvement in sleep, decrease in inflammation, and the improvement of many medical conditions such as asthma, high blood pressure, pain management, and cardiac disease. A particular practice of yoga I strongly encourage is Yin. Yin can complement a more active yoga practice or any other workout, for that matter. 

Yin Yoga: many of the yoga practices across North America are considered more "yang" in that they tend to be more vigorous or fast paced, such as power yoga. For the purpose of exercise, you will certainly get a good, sold work-out. Yin, in contrast, is more of a work-in (as opposed to a work-out). However, for the sake of clarity in accurately representing the practice of yoga, all traditional yoga practices comprise a 'work-in.' Yin yoga targets the deep connective tissues, such as fascia, ligaments and joints, and poses are held for a longer period of time. By stretching and deepening into poses, the body experiences a restoration of healthy energy flow.  

NATURE

Research has shown that spending time outside is good for our bodies and our minds, which translates into healthy boosts of immune functioning. Few of us would disagree that after experiencing stress, the simple act of stepping outside almost immediately lifts our spirits. 

Connecting with nature is a wisdom stored deep within our souls. While technology and screens lure us further into their worlds, we need to conscientiously and intentionally remove ourselves from our concrete walls and connect with nature. Whether we take a stroll at a nearby park, swim in a lake or ocean, or drop a line at our favorite fishing hole, going outside and experiencing the fresh air renews our minds and bodies. 

If you are unable to step outside and just need a minute to re-connect and rejuvenate as you're feeling your stress and tension levels rise, then click on the following 1-minute YouTube video link for a soothing sound and visual experience of the ocean. While viewing, you can manage your stress by taking deep breaths; inhalations and exhalations to a count of 4. 

BREATH & MEDITATION

 

Breath

As already mentioned, the practice of yoga has many benefits and at its root is proper breathing. Pranayama is the formal practice of controlling the breath, which is the source of prana (or life force). The importance of maintaining a steady, rhythmic breath is emphasized in yoga. The physical practice of yoga can be viewed as a moving meditation, incorporating the steadiness, sound and depth of the Ujjayi (or ocean) breath to help connect the mind and body, and achieve calmness.

To access this breath: 

• get into a comfortable seated position.
• breathe in through your nose and exhale through your mouth. Imagine you are fogging a mirror with your breath.
• when breathing, inhale to contract the diaphragm to create space for your lungs to expand, and when you exhale, relax the diaphragm and gently push the air from your lungs. 
• try to inhale and to exhale to a slow count of 4.    

Meditation

The relaxation element of meditation, in its many forms, provides long    lasting health benefits to the mind and body, including increasing volume in brain regions, reducing anxiety and depression, and improving immune function. 

Although there are many different types of meditation, mostly falling under the categories of guided and unguided (or silent) meditations, there is not a universally accepted or "best" method. The best method, as with principles of health, is the one that is best for you. Also, you may enjoy a combination of different types of meditation. If desired, add a calming essential oil, such as lavender,  to your meditation practice to enhance its effects. 

Starting a meditation practice does not need to be complicated. A quiet place and a comfortable seat are all you need to begin: 

• sit or lie comfortably.
• focus your attention on your breath and on how your body moves with each inhalation and exhalation.
• breathe naturally. 
• notice when your mind and thoughts wander and bring your attention back to your breath.

 

DAILY GRATITUDE PRACTICE

A daily practice in which you connect with at least three things you're grateful for has shown time and time again to be both a good-luck and abundance attractor. GRATITUDE amplifies happiness! The simple practice of appreciating what you have,  who you're with, and what you've been through is psychologically powerful. When we can see the good, the lesson, the learning experience, etc., we shift our perspective. Through this shift, greater clarity occurs. The following are just a few benefits of a daily gratitude practice. 

Gratitude improves: 

physical health

mental health

mood

confidence

immune function

sleep

relationships

resilience

PERSONAL DEVELOPMENT

1. Manage your consumption of news and information.
2. Listen to uplifting music. 
3. Listen to an uplifting or educational podcast.
4. Meal plan; prepare and cook nutrient dense food. 
5. De-clutter and organize your living space.
6. Connect with others.
7. Connect with nature.
8. Go for a walk.
9. Reach out to family, friends, or acquaintances you have either lost touch or have not had time to connect with and use this opportunity to re-connect and catch up. The benefits of modern technology is that you can socially connect even when geographically distant. 
10. Volunteer,
11. Enjoy a hobby.
12. Read for fun.
13. Write, draw, create. 
14. Journal
15. Cultivate an excellent time management system by using a planner and systematizing and routinizing many aspects of your life. 
16. Find your stillness, embrace the present moment, and try to find your gratitude in the midst of chaos and uncertainty. 
17. Do not hesitate to reach out for help. This could be a friend, family member, co-worker, clergy and/or a mental health professional.

5 Positive Outcomes of Stress Management 

1. Better executive functioning, which means improved clarity, planning, problem solving, decision making, and focus. 

2. Greater tolerance for uncertainty, which translates into less anxiety (especially anticipatory anxiety).

3. Tendency toward proactivity versus reactivity. 

4. A more peaceful life journey.

5. An enhanced immune system.

The information presented in this blog is intended for general knowledge 

and is not a substitute for medical advice or treatment. 

PROCEED AS IF SUCCESS IS INEVITABLE!

If you enjoyed this article and would like to read more, then let's connect:

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