Chronic stress - more prevalent than believed

Part I

Dr Jaan Suurküla

Stress has traditionally been considered an emergency state, elicited by especially demanding or threatening situations. We will present reasons to reevaluate this belief. Chronic stress appears to be the common state in modern man while persons with a low average stress level are rare.

It is a common belief that stress is caused by external conditions. This was the initial theory of Dr. Hans Selye, who created the stress concept. He defined Stress as a reflex-like physiological response to "stressors", defined as influences that threaten or harm the organism and demonstrated that pain and frightful situations, elicited the secretion of the stress hormones adrenalin and cortisone and the activation of the sympathetic nervous system. Later it was found that the stress response was more complex, involving other hormones, including the thyroid. It is designed to mobilize the physiology so that its ability for "fight or flight" is optimized. Energy is mobilized, blood rushes to the muscles, the brain stem survival centers are activated leading to egoistic survival-oriented behavior etc.

Scientifically, stress is a physiological response, and nothing else. There is some confusion about this, because laymen tend to use it also to designate stressful situations.

Stress is mostly not caused by external circumstances

Research in the last decades has established that the causation of stress is much more complex than Selye believed. In humans, stress is not just a simple reflex that is automatically brought about by specific "stressors" as Selye believed.

In stead, it is now evident that a decisive factor is how the person perceives or interprets the situation. The key factor here is whether it is consciously or subconsciously perceived as threatening.

No doubt, in the extreme cases of obvious threat, everybody react with stress as an adequate response to mobilize the "fight or flight" capability.

But in modern life such obvious dangers are infrequent and don't explain the high prevalance of stress. So there must exist other factors eliciting a feeling of being threatened. Research has long been confused because of insenstive test methods:

Trait anxiety testing has underestimated the prevalence of stress

Psychological research has discovered that a completely subconscious feeling of threat (anxiety) is far more common than formerly believed.

The so called "trait anxiety" tests have been used as indicators of the persistent presence of a feeling of being threatened but it has turned out that they a very insensitive.

This was discovered through the use of a test, designed to reveal the presence of psychological reactions always with trait anxiety. These reactions, so called defence mechanisms, are active in people who have tendency to react with anxitey. They distort or suppress the perception of the anxiety-provoking situation so as to reduce the level of anxiety or even eliminate it.

When subconscious anxiety is present, people tend to react with strong anxiety in threatening situations, and that is way reality-distorting defence mecanisms are activated. This is obviously dangerous in a situation where you must respond adequately and realistically in a split-second.

When defence mechanisms are active, people may sense no anxiety at all in a threatening situation and they therefore respond like anxiety-free persons in trait anxiety testing.

Therefore, common trait anxiety tests were found to be useless for selection of Air-Force pilots, who need to be very stable and anxiety-free in order to be able to rapidly and calmly handle acute threats.

Swedish Airforce research found subconscious trait anxiety to be very common

The Swedish Airforce found that the major cause of accidents and crashes is that defence mechanisms are activated in stressful situations, distorting the judgment of the pilot. They concluded that common trait anxiety tests were very insensitive, yes useless in practice, for selecting pilots who can act adequately under severe stress. Therefore they called for the development of a new selection method.

The task was given to Dr Thomas Neumann, Ph.D., at the Military Resarch Institute. He developed a test, DMT-Neumann, which was found to be very effective and reliable in revealing the defense mechanisms indicating subconscious trait anxiety, not revealed by common trait-anxiety tests and psychologist interviews (Sandahl, F.P. 1980).

The Airforce research also discovered that very few people in the population seemed to befree from such disturbances. Out of 700-800 candidates for Air Force Pilot training, barely 20-30 were enough healthy psychologically to be safe pilots according to DMT.

While, before DMT about 70-80 % of the pilots dropped out of flight training because of inability to remain calm in stressful flight situations, very few if any dropped out for this reason after the introduction of DMT (Sandahl FP, personal communication). Also, after the introduction of DMT for pilot selection, there has been a great decrease (to almost zero) of accidents and incidents caused by pilot losing their head in stressful situations.

For more about DMT, see "DMT ad modum Neuman".

The prevalence of trait anxiety has been greatly underestimated

The experience of the Swedish Air force research indicates that subconscious trait anxiety, a chronic state of feeling insecure is very common, see footnote of said DMT article. This concurs well with the fact that a large proportion of the population in modern society has stress-related somatic disorders, including cardiovascular disorders, hypertension, gastrointestinal disorders, immune system disturbances etc.

Recent research indicates that the prevalence of high blood pressure is very high in the US. Among people over 70, it was found in about 70% of them. Also it has been found that 30-50% of people with high blood pressure are not diagnosed in the US. So the real figure may be above 90% among people above 70 (for more, see the more academic version of this article at "Chronic stress - a highly prevalent condition").

In addtion, stress-related psychological disturbances, including overt anxiety, worries, depression and sleep disturbances are very prevalent, reflected in the extensive consumption of sleeping pills, anxiety-reducing and antidepressant drugs, as well as different means, legal or illegal to improve the sense of wellbeing, which is weak or absent in chronic stress.

It is evident that chronic stress is highly prevalent in the modern society. Stress researchers have blamed it on various aspects of our modern intense life style, but causal factors have not been pin-pointed. On the contrary there are some studies indicating that with the same work and living condition, great differences occur.

For example a study found that people living in one suburb "Roseto" in USA had a much lower rate of myocardial infarction than in other suburbs of the same city. The analysis revealed that predominantly italians lived in this suburb, and it was found that their family traditions provided a considerably greater sense of social security than commonly in the american society. So in spite of being exposed to the same "stressors" of modern life, people with a high sense of security succumbed considerably less to stressrelated diseases. It seems that an inner feeling of insecurity is a much more important factor than external conditions in the elication of chronic stress.

Confusion due to insensitive tests

Because of the insensitivity of common tests for measuring the presence of trait anxiety, there has been quite some confusion regarding the relationship between stress and anxiety. Although trait anxiety testing of people with chronic stress-related disorders like hypertension have found an increased incidence of anxiety, a considerable proportion have been reported anxiety-free.

In reality, as demonstrated by DMT-research, a majority of subjectively anxiety-free persons can have pronounced defence mechanisms, indicating a considerable level of trait anxiety.

This is also supported by studies measuring the level of stress hormones in the blood that have found that many people with high levels of stress can be completely unaware of being in a state of stress.

"Reference values" misleading

The reference values for stress hormones are based on the average situation in the population. However, if stress is highly prevalent, the reference values does not indicate what is a healthy level.

To find out what is a healthy level of stress hormones, one would have to eliminate all people with trait anxiety, stress-related symptoms and disorders. Especially as trait anxiety testing is too insensitive, it has not been possible to establish what is a healthy level.

An italian longitudinal study that followed indicators of stress in nuns over 30 years is worth mentioning in this context. It found that healthy nuns who were satisfied with their life had a permanently low concentration of serum adrenaline throughout life. A control group of house wives had a higher level, and interestingly, this level increased throughout life (Timio 1997). This result indicates that a reference value based on the latter category would yield a "normal value" that gives a misleading idea of what is a healthy level of adrenaline.

Brain research on stress contributed to clarity

Brain research using PET-scanning and magnetoencephalograpy on animals and humans show that in stress situations certain midbrain regions are activated at the exposition to threatening or painful stimuli. It has been established that these midbrain "survival centers" are an imporant element in the stress response. Their activation is strongly associated with the subjective experience of insecurity, fear and anxiety, that is, emotions associated with the feeling of being threatened for conscious (fear) or subconscious reasons (insecurity, anxiety).

Thus brain research confirms that the physiological stress response is activated whenever threat is experienced either the reason is internal or external.

The research on DMT and other research indicates that people with a high level of inner security (emotional basic trust) are rare in modern society. Brain-physiologically they are "prefrontal brain dominated" and psychologically they exhibit the caractheristics of selfactualization as first formulated by Abraham Maslow. There has not been any systematic studies on the prevalence of this condition, but the estimate of Maslow and others is that it is present in at best 1-2 percent (perhaps even less than 1%) of the population and the DMT studies indicate a prevalence of the similar order of magnitude.

If so, the remaining over 95% of the population, is more or less midbrain-dominated and consequently in a more or less pronounced state of chronic stress. But this has not so far been recognized, as said, because of faulty reference values and insensitive test methods.

Conclusion

It is well established that the key stimulus eliciting the physiological stress response is an experience of threat or danger. In humans, chronic anxiety or insecurity cause a persistent expierence of being threatened. Because of defence mechanims this experience is often subconscious. Due to the great insensivity of common anxiety tests and due to faulty reference values for stress hormones, the presence of trait anxiety and consequent chronic stress has been highly underestimated. On the basis of recent research, including brain research, hypertension prevalence research and DMT research, there are reasons to believe that it may be present in over 95% of the population.

Part II Why is chronic stress the common state in modern man?

It is explained why subconscious or conscious anxiety or insecurity is common in modern man. It is probably the most important factor in the generation of chronic stress disorders.

References