Summary:

You can heal from chronic pain and illness, but most conventional doctors won’t help you. Science has shown us a great deal about why people develop chronic pain, fibromyalgia, and chronic illness, and what makes those debilitating conditions get worse. A major part of what worsens chronic pain and illness is lifestyle issues: unbalanced stress, unhealed trauma, inadequate nutrition, sleep, and physical activity feed the disease process in a vicious cycle. Science continues to clarify the pathways by which it happens. Unfortunately, conventional medicine focuses on acute illness and trauma. Most conventional doctors don’t learn about stress and lifestyle and how they can make you sicker. They’re busy dealing with acute problems which have simpler solutions. So the patients often remain in the dark, and get progressively worse. It doesn’t have to be that way. When you understand your own stress response and what triggers it, then you open up possibilities for healing from Chronic Pain, Chronic Illness, Anxiety, and Fibromyalgia. Understanding your stress response is a key part of healing from chronic pain, chronic illness, and fibromyalgia. Your Body-Mind System has a brain within your brain. It’s called your autonomic nervous system, and it touches every organ, every cell, and influences your entire body and mind.   There are two branches to the autonomic nervous system. The stress response is responsible for “fight, flight, freeze”.  It makes you ready for action.  It’s your “get up and go”. The relaxation response is responsible for “rest and digest”.  It helps you be nourished, restores your energy, and enables you to heal from illness or injury. When there is an imbalance between the two, it can be a problem. In our society, many of us are walking around with an overactive stress response.  In a susceptible person, that can worsen pain, worsen chronic illness, and create a whole host of unpleasant symptoms. This video talks more about the stress and relaxation systems.  How they can make you miserable. And how you can take charge and start to heal. This is video part 1 in the Understanding Stress series. 

Did You Know:

Dr Shiller gives regular free mind-body training sessions on zoom. You can get the schedule and register at www.mindbodygroove.com

Related Posts:

• https://youtu.be/rCPvoRim_mw
• https://youtu.be/TpFIaIxSevc
• https://www.drshiller.com/heal-fibromyalgia-pain-inflammation-fatigue-mindbody-healing/
• https://www.drshiller.com/heal-pain-mindbody-wholeness/

Full Transcript:

(this talk was given as a scientific presentation and includes slides to illustrate the point.  If you prefer to read the transcript, you can also download the slides) Stress Reactivity Talk Slides Hey, it is Dr. Shiller.  We are going to talk today about stress reactivity, and if you have got a chronic illness or chronic pain, you should really listen carefully and pay attention.  It is vitally important information.  If you can get your head around and understand what I am talking about, you are opening up a door to improving your quality of life and maybe even healing your illness.  I am saying this based on my own experience and with hundreds and hundreds of people as well as the latest and decades of scientific research, which are really showing us that your mind-body connection is extremely powerful.  It has the power to make you sick, it has the power to help you heal, and you get to choose. Pretty much everybody knows at this point that chronic stress is not good, that it is part of what contributes to anxiety and depression and can make pain and headaches worse.  It can affect job performance and relationships, and what we are understanding now is that it actually contributes to inflammation and can drive chronic illness.  Let us talk about a particular case, because it is illustrative.  A woman who came to see me, who I call Rebecca, who was suffering with fibromyalgia, and that means she has pain all over her body.  She could not sleep.  She had digestive problems.  She had been a really successful, accomplished, go-getter business person, who was doing a lot of good things in life, and around age 43, she had a car accident.  It was not that severe.  She had a little pain in her neck and felt a little shocked afterwards, but then the pain got worse, it spread to her arm, to her other arm, to her leg.  Pretty soon, her whole body was painful, and she started having other classic symptoms of fibromyalgia, and she felt like her life was spinning out of control.  She was not able to be the person she used to be.  She talked about how she would come home after a day of work.  She worked as a marketing professional.  She would come out after a day of work and be irritable and angry with her kids for just being kids.  They were doing normal kid’s stuff, and it was breaking her heart that she was not able to be the mommy she wanted to be.  The key thing here is fibromyalgia, like a lot of chronic illnesses and chronic pain states, has a huge aspect of it that has to do with a person’s stress response, and the functioning of all of the kind of chemical and neurologic aspects of stress in the body, and she kind of had a classic case in that way, and the classic case of somebody with fibro is kind of a high achiever, go-getter, like really active, go, go, go, go, go person, doing really well in life, and then some stressor or shock, maybe it is an operation or a car accident or other trauma and boom, their system just tanks and turns upside down, and they sort of descend into this spiral that develops the symptoms.  I have described Rebecca’s case as a classic case of fibromyalgia because of its kind of chronic ongoing stressor and then a big jolt and then kind of a tipping over, that is not to say that everyone develops fibromyalgia that way, there is a lot of different patterns, a lot of different triggers, it is very individual.  One of the things we hear over and over from a lot of patients is this picture of chronic stressor, big stressor, and then kind of a dysfunctional stress response associated with a lot of the other changes. There are other aspects for sure that contribute to fibromyalgia. This is not to say that fibromyalgia is just stress or just anxiety or only caused by stress.  There are some people who develop fibromyalgia when they are kids.  There is a lot of different factors that are going into it, but there is an aspect of dysfunctional stress response, and in some patients, that seems to be what is most prominent.  What did she do and how did that help her and how does it relate to stress response?  So, part of what we did together was she learned a lot about stress reactivity.  She learned to see the patterns in her own life.  She learned the aspects of what is going on inside of her that leads to an overactive stress response, and she learned how to deal with that.  She learned techniques for bringing on relaxation.  She learned techniques for developing awareness of what were her own triggers, and by doing so, she actually turned that boat around, and she did other things that had to do with nutrients and the other aspects of healing from fibromyalgia, but a key part of it, one of the things that helped her really grab hold of the whole situation was working on that stress picture and developing her mind-body skills. Let us talk a little bit more about what that is.  So, let us talk a little bit more about what that means and why and how is it that stress has these effects on the body.  So, we are going to do the basics of that physiology.  This is a very big topic.  This is part one in a number of talks about stress reactivity and the stress relaxation system in the body. First question, what is stress? Because the definition of something, it is kind of like once you know the enemy, you can do something about it.  So, there is really two ways people think about stress, kind of like two definitions, one is, it is the stimulus or the event that brings on the stress, that there is something that happens to me and that is a stressor, and then the other is that it is the response of the organism to external demand or pressure.  What is stress, is it the stimulus or is it the response to the stimulus?  It is actually a really important question, because especially in our culture, in my eyes, we have got it kind of jumbled up.  So, you could hear people saying, “hey that was very stressful or you could hear someone saying, “I feel so stressed and anxious.” Those are two very different things.  If I say that was stressful, kind of implicitly assuming that the stress is the stimulus, it is happening outside of me, it is happening to me, and if I say I feel so stressed and anxious, I am acknowledging that stress is my response, and when I acknowledge that it is my response, then I can actually do something about it.  I can learn about my responses.  I can learn to generate different responses.  I can learn to work with my own experience of stress so that I am not a victim of it.  That is such a key piece of healing from chronic illness, especially chronic pain, especially fibromyalgia is putting you in the driver’s seat, so that you can understand what is going on and make conscious choices to help yourself heal. Okay, so what determines the impact of stress? Well, first we talked about this notion of perception and that our mind-body organism as a whole can either perceive a stimulus as stressful or not, that is the key first thing.  Second aspect is the magnitude of that response to stress.  Some people have a more intense response than others.  The third thing is whether that stress response shuts off or persists.  We all know somebody who goes through some really difficult thing and 10 minutes after it is over, he is like okay what is for dinner and on to the next thing.  He is not even thinking about it, and then there is somebody else who has a really difficult experience, and for like hours, they are shaken by it, and it is still with them, because their body is full of stress hormones and stress biochemistry, and it stays with them for a while, and finally how does a person respond to recurrent stimuli? So, do I have something over and over and over again, does my body react more and more to it, do I become more and more activated, does my stress response really start to fire off?  So, these things are obviously complex and very individualized.  There are aspects that are genetic.  There is conditioning from life experience.  There is what is going on in the environment and the culture, and there is behaviour, the kind of things the person does when they are faced with stressful experiences.  So, a lot of this has been sort of figured out by Dr. McEwan, he is a scientist, professor at Rockefeller University, and he has really done a lot to help our understanding of stress. This is actually a diagram or picture from Dr. McEwan about some of these similar things, and so, you know, big picture, that is what he is trying to present here.  We have external things that can happen, environmental factors, major life events, trauma, abuse, bad stuff, and then there is the way the organism responds to it, perceives stress, which depends on a lot of things, like is there a perception of stress or helplessness? Is the person in those conditions already hypervigilant, their body is keyed up and ready to go, and then there is sort of individual differences that depends on genetics and history and then behavioural responses of persons like diet, smoking, drinking, exercise, things like that, that modulate the stress response, and all of that determines physiologic responses, and he describes this thing called allostatic load, and allostatic load is this pressure on the organism that makes us figure out how to adapt and deal with the circumstances.  So, we are going to unpack that a little bit. Okay, so how does the body generate stress. Stress, there is this physiologic response going on, and part of it is biochemical.  There are stress hormones.  There is epinephrine and norepinephrine, which are the same things as adrenaline and noradrenaline, and those are our acute immediate stress hormones.  When someone has a really intense thing happen, and they get that jittery feeling all over their body, that is epinephrine and norepinephrine, that creates that activation intensity.  Cortisol is more like our chronic stress hormone.  When stress has been going on for a while, the cortisol levels go up to help the body and mind cope with that situation, and then we have got all these chemicals called peptides that color the stress response in various different ways depending on what is going on, depending on the meaning of their stress response.  You know, dancing at a wedding is stressful, but it is a joyous, fun and connected kind of stressful.  Running away from a wild animal is a different kind of stressful, and it has a different biochemical environment, and it means something different and has a different impact on the body and mind.  This is kind of the neurologic part of the stress system.  We have a brain within our brain that is called the autonomic nervous system.  You could rename that and call it an automatic nervous system.  It is the part of our mind that allocates our energy, and it does that both through the chemicals we just talked about and a whole series of nerves that go from our brain all the way down to the bottom part of our spine, and there is two branches, that is what we call the sympathetic branch.  You do not need to remember that word, but it is a kind of code word, the sympathetic and parasympathetic.  The sympathetic branch is the stress response, that is why it also gets called fight-flight-freeze, it is responsible for “get up and go” when I need to go into action, and then the parasympathetic branch is the relaxation response.  It is also relevant to recover and repair, it is like rest and digest when the body and mind are calm, when our body is able to absorb nutrients, remove waste products, we are able to connect with people, we are able to have a pleasurable experience, and these two are meant to be in balance. Let us talk about what happens when we have a stress response, that is the acute fight-or-flight freeze response.  It prepares us for action, and all the things that it does to all the organs in our body are based on that.  I forgot to sort of point out here, just kind of pointing out that these nerves from the sympathetic branch and the parasympathetic branch, you know, they hit the brain, the throat, the heart, the lungs, all the digestive organs, the sweat glands, the muscles, the digestive organs, the bladder, the sexual organs. So, brain, increased arousal and vigilance.  Sensation, we become more sensitive.  Why do people do extreme sports? One aspect of it when you jump out of a plane or bungee jump is it is a rush, it is intense, it feels good, everything becomes vivid and amazing and beautiful.  You feel like you are connected to life because you are aroused, because your sensitivity is on high, because you are ready for action.  The endocrine or glandular system, it mobilizes energy from our liver.  We actually mobilize and increase blood sugar, so our muscles and our body can do things with it.  We have stress hormones like we talked about.  The heart increases blood pressure and heart rate.  The lungs increase ventilation, so we get more oxygen.  The digestive system does not need to work when we are running away from the tiger or running after the bus.  We have decreased secretions and decreased motility of the intestines.  The neuromuscular system gets ready for action, our reflexes become more active, our muscle tone and strength can increase, blood flow increases to our big muscles that we use for action and running.  Stress itself is not bad.  Stress is part of living.  We got to do stuff in the world, and our stress response helps us do stuff.  When it is in balance with our relaxation response, that is good, it is normal.  You  know, you see over here that here is the stress level and here is time, and like I have a stressor, and I chill, and I have more stress, but I will relax for a while, and I have more stress, and it comes down, I have something big, but then I calm down afterwards, maybe I am sleeping and this drops, maybe I am just sitting down and relaxing, maybe I am having a glass of wine with the person I love.  I have a balance and my baseline stays even over time.  That is not true with what we call chronic stress.  It is an imbalance of stress and relaxation.  Our stress response is going up and up and up and it might be coming down sometimes, but the baseline keeps going up overtime, because it is not balanced by the right degree of relaxation response, and this is where stress causes health problems.  Let us think about what that looks like.  The effects of chronic stress.  Organ systems are interconnected.  We are going to look at categories here, but they can be kind of misleading, because what affects one thing affects everything, everything is connected to everything else.  They are actually not in yellow, I guess I got to correct that slide. The brain, when we have chronic stress, insomnia, irritability, anxiety, depression, impaired learning, the actual part of the brain that is responsible for new memories becomes smaller in people who have chronic stress.  Brain fog, when you cannot think straight. The endocrine system, we can actually have dysregulation of our hormonal systems that can cause a lot of issues with sleep, shifts in the immune system, all kinds of things, because the body’s natural cortisol patterns overtime can get out of whack.  So, they are not as consistent with help like they should be.  We lose our normal, active in the daytime, relaxed and sleeping at night time, we get upside down and turned around, and that is not good for us. The heart causes hypertension, arrhythmia.  Our blood clotting factors, our platelets can become more coagulable from chronic and acute stress. Digestive system, there is something that is called intestinal permeability.  Intestinal permeability seems to be associated with inflammation and all the chronic diseases that we are dealing with.  This is recent science in the last 10 years or so.  A lot of doctors do not even know it yet, but it is going to be in the textbooks in another 10 or 20 years, and everyone is going to know.  Constipation, irritable bowel syndrome, inflammation of the gut, all of these can be associated with chronic or intense acute stressors. Sensation, we can have increased pain transmission.  We will talk more about that later.  People can have more physical symptoms.  The number of people who have symptoms in various parts of the body, they got funny sensations, things do not feel right, they go to the doctor or they do all these tests, they do not find anything, and then they learn to like relax, meditate, deal with their stressors or their emotions, and the symptoms just go away. Neuromuscular, tight muscles, cramping, painful muscles. Bladder, irritable bladder, having to go to the bathroom all the time, hurts to pee, things like that are related to chronic stress. Let us talk a bit about pain.  Briefly, this looks complicated, but there are a few basic things.  One is we have got pain receptors in our body, and those pain receptors send signals through nerves, they go to our spinal cord, and in our spinal cord, they talk to other nerves, and that goes up to our brain, to the thalamus, and the thalamus is what integrates a lot of sensory information, our emotional information, a lot of our belief systems, it is a big integrator place in the core of our brain, connected to our limbic system, and from there the signal gets transmitted out to the cortex, and the cortex is where I go auh, I have got pain in my hand, and it is really super complicated physiology.  It is not like an electrical wire, where you flip the switch and the light goes on, this is like a wave of biochemical, electrochemical energy that flows up towards the brain and is color and can be turned up and turned down by a lot of different things.  What are the things that can turn up pain transmission? Emotional distress, disconnection, fear, anxiety, helplessness, anger, frustration, insomnia.  What are things that turn down the transmission of pain and actually block pain? Meaning, purpose, joy, things that make us feel good.  Sometimes, distraction, doing things we enjoy. Another important part that I want to just point out is that, there are all these pathways going on, but there are two main pathways.  There is the sensory discriminative pathway and the affective motivational pathway.  The sensory discriminative pathway is the part that helps my brain know that I have got a burning sensation in my hand, but it does not give it any emotional value or any emotional impact.  It is like, oh, I got burning in my hand.  The affective motivational pathway is the part that goes, “ah, I got burning in my hand, I got to do something about it” that motivates us, that activates us, that is the place where stress, anxiety, depression, and other negative mind states have a huge impact on pain’s transmission.  It is an integration of pain and affect or emotional aspects of ourselves.  Pain modulates our emotional experience, and emotional experience modulates pain.  It is a loop, it is a cycle, and that is something that comes up over and over again for people who develop chronic pain, and that was a big part of what had happened with the patient, Rebecca, that we discussed at the beginning, that when things started to get bad for her, she started to get really bent out of shape about it, she just was really stressed out about it.  She was irritable.  She was anxious.  She was not sleeping well, and that is probably part of what helped amplify and make the pain system worse, because it feeds stress response pain, stress response pain. Let us go forward.  We saw this slide before, but I want to bring out a couple of other key points, right? We learned about the individuality of whether something is stressful and how much impact it has on a person? And the key thing I want to talk about is how a person responds to recurrent stressful stimuli? Because there are three aspects.  There is adaptation, habituation, and sensitization.  Adaptation is what we saw before, it is the way we overall as an organism learn to deal with whatever pressure is on us, it is like our bodily, mental, emotional responses and choices.  There are these two other aspects called habituation and sensitization.  There is that adaptation thing.  Habituation and sensitization, habituation is kind of like I get stimulated by the same thing and I learned to ignore it.  Sensitization is more like I get more and more sensitive each time.  I get reactive more and more.  So, habituation, think about somebody who goes to train in the army, and the first time they are like next to an artillery shell, boom, like they get all startled by it, but then they hear it over and over again, it does not even bother them anymore.  Frequently, there is a deeper response in the body that can be going on below the level of their conscious awareness, but they habituate because they learn to ignore it, and they just got to live their life and go forward.  Think about, for instance, suppose you are in a car accident or you have some sort of traumatic experience and you have some pain and it was traumatic, and it was difficult, and you are a little flipped out by it, but you know what, you got to go to work the next day.  So, you get up and you put on your work face and you do what you got to do and you have an extra cup of coffee and you go through your life, and you are just like habituated, you are dealing with it, you are not worrying about it.  Meanwhile, there can be a stress response that is building underneath, and because you are not paying attention to it, but it is there.  Maybe you start to have a little aching in your neck, maybe you have an extra drink or two or you smoke a little bit more.  These are ways of adapting and habituating to kind of our chronic stressful response that is in your body and in your system.  Sensitization is a different story, that is the person where they had that stressful event.  You know, PTSD is a sensitization type of experience a lot of times, sometimes it is not, but the point is imagine someone who has that car accident, they cannot even get in a car, or you get bit by a dog when you are a kid, and you are traumatized by that.  So, you are sensitized to the overall experience of what is a dog.  When you hear a dog bark or a dog comes near you, get scared.  Sometimes you even see a picture of a dog and you get scared, you can develop a phobia to it, that is a sensitization response.  Again, this was really relevant to the case we talked about, because most people are a combination of these things.  With that patient Rebecca, listening to her story, initially she sort of just tried to deal with it and be a good person and do her work and do her job, and you know take care of business and be responsible, and she habituated and she adapted, but overtime, her system became sensitized, and she was not able to anymore.  She started getting more and more irritable. This is that curve of chronic stress where things build up and build up over time, and that is where the bad effects of stress come on a person.  So, what do we do about stress reactivity? This is going to be brief, because really I want to just give the big picture, but the point is, the main thing is learn mind-body skills, because they are simple basic techniques anyone can learn that reduce the stress response, activate the relaxation response, and it is about working on a different part of our brain, because most of us do not learn how to do that.  These days, it is a little bit different.  It is getting more and more common that people are learning mind-body techniques and meditation.  They stimulate your inner healing intelligence, they take away that chronic stressor, so you can get into rest and digest, and your body can get into that repair state from parasympathetic activity like we talked about earlier.

What about mind-body skills?

Well, there is one aspect which is relaxation, stimulating the relaxation response.  Another aspect which is working with our perception, there is something called mindfulness.  Mindfulness is where we learn to pay attention in a conscious intentional way to our thoughts, emotions, bodily and sensations, and we start to learn about how we respond to reality.  We start to notice the inner voice that is going on inside of us that we normally do not notice, that colors the way we perceive and colors the way we react, and we start to learn to be conscious and we start to respond rather than reacting, and that is mindfulness, and there is transformation, there are techniques for actually taking traumatic experiences or chronic negative emotions that maybe we have been storing for years or decades, that are living in our subconscious mind and affecting our body by generating stress all the time, and we can actually bring awareness and compassion and melt and dissolve and reframe those persistent negative emotions and trauma, and that can have a huge impact on our health.

How do I develop mind-body skills?

First of all, many people are listening to this and they are nodding their heads, and they are saying, “Yeah, I want mind-body skills, how do I do that?” And some people are sitting there with their arms pulled across their chest and they are thinking to themselves, “Look, I don’t meditate, I am not a mind- body guy, this is not me, I don’t relate to that,” and my suggestion if that is where you are holding is start checking out the science.  If you are a rational concrete person and you are not into this, like oozy-woozy stuff, you should know it is not oozy-woozy stuff, it is scientifically proven stuff, stacks and stacks of research for decades, back as far as the 1960s and 1970s when Herbert Benson started proving what the relaxation response is and how it affects various states of body and physiologic systems.  This is real stuff backed by real science, and I suggest you get over your anti-Kumbaya syndrome.  I respect where you are coming from.  You may have had experiences that make you think that, “Okay, I am not going to sit around in the circle and burn incense and meditate and listen to chimes and bells and all that silly stuff and enya,” but that is not what meditation is anymore.  Meditation is serious mind training; it is scientifically based.  If you saw the number of top athletes and top-level business executives who are using meditation practice to enhance their performance, you might think differently about it.  So, the invitation is, get with modern science and modern culture and realize that these are powerful tools that can have a huge impact on your life if you are dealing with chronic illness and chronic pain.  Anyone can do it.  You got to take action, you got to learn the techniques and do it, and start small, five to ten minutes a day is a good start, one minute counts also.  Regular consistency is the main thing.  There is a lot of different techniques.  We will talk about that in other talks. So, if you want more information from me on this, go to Facebook and find the group that is called “WhatHeals” and you can join that group, and that is a private Facebook group that I have, where I put out notices about all the different things that I, you know, content and information and educational type of things, so you can get notified stuff there through Facebook.  There is also a community, there is a kind of a dialogue going on there, and then you can go to my website at www.drshiller.com and sign up for the newsletter, because every time I put out another post, I send it out an email to all my subscribers, so you can get that information.  This is the first of a number of different talks related to this topic.  There is a lot to understand.  There is a lot of information that can really help you make better choices and do things that are going to have an impact on your health.  I look forward to supporting you in that, and very interested in your feedback on this video if you want to leave it, whether it is on YouTube or on Facebook or wherever you see it, I love to hear your feedback.  So, thanks a lot for watching and listening, and I wish you all the best.