By: Gary Maguire, M.Sc., P.T.   http://www.linkedin.com/pub/gary-maguire-m-sc-p-t/7/455/449

PhysioSympath: The Path to Resilience ©

Welcome to Military Network’s new PTSD section.  Articles that appear in this section are aimed at reducing the stigma of posttraumatic stress disorder (PTSD), strengthening resilience and providing new strategic solutions for PTSD treatment.

Emerging neurophysiology and physiotherapy medical devices are being developed to support mental healthcare professionals.  Your comments and feedback are welcome to improve the newsletter.

MANAGING FIGHT OR FLIGHT SYMPTOMS

High blood pressure (hypertension) and cardiovascular disease

While the neuroendocrine system’s activation (a nerve cell that releases a chemical messenger, especially a neurohormone, directly into the bloodstream) during stress results in many cardiovascular effects that enhance performance in the act of fleeing or fighting the danger before us, such a response on a chronic basis leads to very pervasive and negative consequences (e.g., PTSD). 

One result of this activation is sympathetic innervations of the blood vessel walls, which while leading to greater blood flow to major muscles during a crisis, can lead to hypertension if sustained for a long-term. http://dx.doi.org/10.1001/jama.2009.1084

In addition other cardiac damage can occur when stress is not properly addressed and insufficient repair (i.e., down time) does not occur.  While research in the 70’s focused on Type A personalities and the impact of always feeling hurried, research in the 90’s focused on the contribution of a specific element of Type A behavior – hostility – played in cardiovascular disease. 

The most recent research sheds light on the different role that each primary emotion associated with stress – anxiety, anger, and depression – uniquely contributes to the onset of recovery from hypertension, angina, myocardial infarction or other cardiovascular conditions.

The emotional correlates of stress have been implicated as a primary cause of coronary artery disease.  Two different mechanisms for such effects are the direct and indirect pathways through which anger/hostility, anxiety and depression lead to cardiovascular disease (CVD).

Direct effects of stress on blood pressure and CVD outcomes

• Elevated blood pressure and family history of hypertension predict cardiovascular response to stress.
• Increased testosterone, cortisol (stress hormone), and cholesterol that result from elevated stress play a role in blood pressure regulation.

Indirect effects of stress on behaviors that lead to CVD

• Increases in unhealthy behaviors (eating, drinking, and smoking) that often result from increased stress have significant impacts on a variety of CVD outcomes.
• Chronic moodiness is not only the most important factor in the stress-CVD link, but can be self-perpetuating in that moods influence expectations that in turn influence behavior and relationships (i.e., poor listening).
• Extremes of emotional expression (e.g., anger) cause a cascade of negative outcomes, primarily social connectedness. “Anger out” promotes continued interpersonal conflict, social isolation and stress with increased blood pressure, whereas non-lonely people have increased blood pressure due to increased cardiac output (the more normal response to stress).
• A predominantly “anger-in” response promotes brooding, inactivity and negative self-soothing.  Such a response is associated with increased rates of alcoholism, nihilism (total rejection of established laws and institutions) and social disconnection.  These responses are highly present in PTSD veterans and military personnel.  Given the wealth of research data showing the importance of social connections to our health as we age this response would be associated with poor health outcomes.

Interventions for minimizing the impact of stress on cardiovascular health

• Reduce hostility.  Research suggests multiple skills provide cool relief from the heat of anger.  Understanding how to “use” anger and shorten its “life cycle” is critical to minimizing the impact of stress-related anger on heart health.
• Practice the [AAA] model.  Starting with [A] for AWARENESS.  One must decide to [A] ACT if there are options to exert primary control, or [A] ACCEPT if secondary control is all that’s available.  Studies consistently show positive health outcomes for those who not only enjoy high levels of perceived control, but who can quickly engage in cognitive strategies to maintain perceived control.

 [AAA]= AWARENESS+ACT+ACCEPT

•  Create and maintain an optimistic attitude.  Studies show that beyond lowering anger, anxiety and depression, people who maintain a positive outlook have fewer cardiac events than those with more pessimistic attitudes.
• “Listen” to your health behaviors and enjoy healthy pleasures.  Small changes over time predict better health than any single factor or attempts to make significant changes in one’s life.  Moments of separation between stressful events, utilizing smart goal-setting and cognitive flexibility all play critical roles in maintaining heart health.  Assessing one’s health status is sometimes found to lead to greater change than being informed on what to change.
• “Connect” inside and out.  Social support has been identified as a primary factor in healthy aging, just being self-aware and self-assured predicts health throughout our lifespan.

Posttraumatic Stress Disorder (PTSD) has real physiological consequences that cannot be ignored over time.  The role of stress-related symptoms is vital for survival, yet sustained nature of such symptoms causes significant distress.  Cortisol in the short term improves learning, memory, suppresses digestion, increases cardiovascular tone and increases glucose utilization.  However, chronic activation leads to cardiomyopathy, digestive disorders and damage to parts of our brain (hippocampus) resulting in cognitive/emotional impairment.  http://www.ptsd.va.gov/professional/pages/ptsd-physical-health.asp

A good book to help better understand these relationships is: Why Zebras Don’t Get Ulcers, written by Robert M. Sapolsky a professor of biological sciences, neurology and neurological sciences at Stanford University. http://www.getabstract.com/summary/5656/why-zebras-dont-get-ulcers.html

Posttraumatic stress disorder (PTSD) is a silent killer.  Overcome the stigma and seek help from trained medical professionals.  Your long term health depends on it.  Act now!

REAL WARRIORS GET REAL HELP: http://www.realwarriors.net/

Copyright © 2010 Gary Maguire, M.Sc., P.T., PhysioSympath©.  All rights reserved.

Related posts:

1. PTSD and Neurophysiology [Vol 1/Num 6]
2. PTSD and Neurophysiology [Vol 1/Num 4]
3. PTSD and Neurophysiology [Vol 1/Num 2]
4. PTSD and Neurophysiology [Vol 1/Num 5]
5. PTSD and Neurophysiology