#11 More about stress.

I have always had a fear of public speaking. Well, almost always. It started in sixth grade. Before that, I was a typical Russian overachieving student, always raising my hand to answer questions and being called to the blackboard to solve the most challenging problems. 

In sixth grade, my Russian language teacher (funny that I can see her face, but don’t remember her name and still see the sunny window and green blackboard) called on me to present the homework. I had to go to the blackboard and answer questions on whatever material was assigned in front of the class. As I was talking, she interrupted me and asked me why I was so fidgety? Apparently, I was braiding the end of my long braid, the one after the hair tie that is too short to be in the braid. I was braiding, unbraiding, and braiding it again as I was reciting the lesson. It was probably an innocent question. The longer I stood there as she talked about how it is unnecessary to be nervous, the more I felt anxious and stressed out. This was it. Since that day, the anxiety about speaking in public showed its ugly head at every significant speaking event, oral quiz or presentation, and would cause me to have a migraine. 

 It took me years to gradually decondition myself. In medical school, I could no longer afford to have a migraine every time I needed to talk during the rounds or do a presentation. I learned how to cope with small exposures but still dreaded large audience talks. I practiced and learned how to relax. My last presentation was in front of 300 plus people, and I survived.  

Pain and stress are related. My migraines are almost always stress induced.  

Pain itself is stressful. 

Other stressful situations can make the pain worse. 

How you judge a stressful situation can affect your physical response to that situation, based on how you think about it. Your thoughts create feelings that cause a reaction in your body. 

The stress response is a reaction to something (an event, physical feeling like pain, or emotion) that you think you cannot cope with. It produces a response in your body and brain. Your brain creates images and thoughts about the stressor. This stress answer generates an increase in blood pressure, pulse, and muscle tension, as stress hormones are released, blood flow is diverted to large muscles so you can run away if needed, and digestion is put on hold. 

The thoughts lead to uncomfortable feelings – anxiety, anger, sadness, shame, or fear. The feelings lead to action – you may run or hide, withdraw or start an argument, go to bed, or eat something or drink. 

Anything that produces this stress response is a stressor. 

Pain is a stressor. 

How you react to pain is also a stressor. If you push to get things done and crash due to pain, you create a pushing and crashing cycle. The crash forces you to rest, stay in bed, and wait until you feel better. As you rest, your pain may improve, but you start to feel guilty. You start feeling stressed out about all the things that are on hold. The thoughts of having to rest, the need to put your life on hold produce the feeling of frustration. That frustration may push you to get out of bed and start doing the activities you paused while recovering. That push again will likely lead to a crash, and the cycle continues. 

Another part of your stress response is your brain’s way of categorizing the stressor. As I described in blog #10, the brain judges the stressful situation as a threat, loss, or challenge. 

How you judge the situation will affect your thoughts. Your thoughts will change your emotions/feelings and produce a reaction in your body or lead you to take a certain action. It will also affect your pain level. 

If you judge the situation as a loss or threat, it will produce a more stressful response than if you believe it is a challenge. Challenges we know we can overcome. The loss or a threat are more defeating, and these situations will produce more pain. 

Learning about stress and how to manage it can reduce your pain. Learning about pain and how you react to it will reduce stress.   

Learning how to judge a situation as a challenge and not automatically think of it as a loss or threat can improve your pain level. 

The antidote to stress is a relaxation response. 

The relaxation response is a specific action of the brain and body that counteracts the stress response. 

The body starts to relax, lowering blood pressure and pulse. Your breathing becomes slower and deeper, putting more oxygen in your body. Your blood flow goes back from the large muscles to the digestive organs, and you can start digesting again. It is automatic but can also be intentional, induced by your thoughts. 

You can reduce the harmful effects of stress by learning how to create an intentional relaxation response.   

Creating the thoughts that make you feel calm and relaxed will produce a body response of relaxation. 

As you feel more relaxed, the muscle tension reduces, and your brain calms down, and you will notice the change in your pain intensity. 

You have had an automatic relaxation response before – after a good meal, a funny movie, a walk on the beach, a conversation with a friend, a quiet time on a couch with a book or cuddle. 

The trick is to learn how to create an “on-demand” relaxation response that you can tap into when you start feeling the stress or increase in your pain level.   

In my next blog post, I will discuss various relaxation techniques known to reduce stress and pain. 

See last week blog post #10 Stress Appraisal -  https://www.rheumcoach.com/blog/10

DISCLAIMER: This blog provides information only, and does not provide any medical or psychological services or advice. None of the content on this blog prevents, cures or treats any mental or medical condition. You are responsible for your own physical, mental and emotional well-being, decisions, choices, actions and results.