So, from a stress management situation what are the more simplistic ideas that we can implement to reduce our natural flight/fight mechanism? For one it is important to understand that mental imagery plus physical responses creates fear.  In other words, what we visualize mentally has an effect upon our physical response systems.  Additionally, being aware of how we manage our physical stature can have an effect upon our mental systems.  So, when confronted with a stressful situation or a fear invoking situation consider the following:

• If possible prior to the event imagine what it is like to be in a fearful situation and make a mental note of how your body looks.  Are you standing up straight or hunched over? Are your muscles tight or relaxed? Are you breathing deeply (not rapidly) compared to shallow breaths? 
• You never know what the result of a situation that invokes fear or stress will be, so focus upon the best scenario in your mind.  See success clearly in your mind. (Or you killing the bug without fear and not being bitten! Silly example but true!)
• The following statement may seem obvious but it is often overlooked as a way to eliminate fear due to stressful events: Make sure you sleep, drink lots of water, eat well, exercise and avoid stimulants.
• Drive YOUR bus…Take responsibility for when things happen.  You are in charge of your behavior, both physically and mentally, and no one else has that control.
• Have total responsibility for how you feel.  You must remember to present yourself with a posture and body language that communicates confidence even if you are afraid of speaking in front of a group or getting on an airplane.  Choose your perspective and keep control of your thoughts.

If you can remember that you are in charge of your environment you will realize that the things that you may consider to be out of your control are actually IN your control.  This is a psychologically found fact (Sanders & Suls, 2008). Practice imagining best case scenarios and wonderful outcomes and the things that stress you out, due to fear, will fade away.

Sanders, G.S., & Suls, J. (2008). Social Psychology of Health and Illness. Hillsdale, NJ.

Labeling events as either good or bad, and then trying to resolve the negative situation in to a positive situation, may lead to more stress.  Perhaps reframing the way in which you view experiences can be lead to less stress.  Read:

Some of your daily stress can be relieved by simple pressure points that you can do to yourself, such as putting pressure on the small muscle between your thumb and forfinger, massaging your earlobes, raising your shoulders towards your ears for five seconds and the dropping them down, and foot massage.  Me, I think I could use a full body massage once a day! More…

Reflexology is an interested, and ancient, massage art that many claim leads to not only a reduction of stress but also contributes to healing of severe discomforts.  I am open to anything that can help reduce stress, but I also believe that you need to have a qualified reflexologist in order to get results and manage severe illnesses and stress.  That being said, a gentle foot massage can works wonders.

Additionally, exposure to high levels of stress early in life can cause health problems in adulthood.  Studies have noted a correlation between cardiac disease and early childhood stress and future studies are looking to understand the long term affect of early exposure to stress. Children whom have survived pediatric cancers also seem to be at greater risk for high cholesterol, diabetes and high blood pressure, all of which predispose them to heart disease in adulthood.

Many of these examples of stress in children may be beyond our control, but it leads me to think that we need to introduce stress management techniques and cognitive behavioral therapies to our young people sooner rather than later. 

Rheumatoid Arthritis is an example of the inflammatory response that results in negative effects such as joint swelling, stiffness, pain, and a decrease in mobility (Heijnen & Kavelaars, 2005). There is a cyclical pattern with regard to the relationship between the bone destruction and inflammation process in the arthritic joints with the patient’s symptoms of pain and immune response.

The pathogenesis of Rheumatoid Arthritis has been related to stressful events that cause inflammation in the joints resulting in pain; however, there is debate as to whether or not severe stressors or mild daily stressors are associated with the pathogenesis of this disease (Potter & Zautra, 1997).

Heijnen, C. J. & Kavelaars, A. (2005). Psychoneuroimmununology and chronic autoimmune diseases: Rheumatoid arthritis. In K. Vedhara & M. Irwin (Eds.). Human psychoneuroimmunology. NY: Oxford University Press.

Potter, P. T. & Zautra, A. J. (1997). Stressful life events’ effects on rheumatoid arthritis disease activity. Journal of Consulting and Clinical Psychology, 65(2), 319-323.

Barlow and Minns (2000) found that head injuries in children younger than one year old (in a Scotland based study) was 24.6 per 100,000 children and that acute encephalopathy, subdural hemorrhages, skull fractures, retinal hemorrhages, and cerebral edema were present in most of the cases. Sadly, the median age of injury was 2.2 months and 78% of those who did not die due to brain injury suffered long term neurological and developmental abnormalities.

Shaken baby syndrome in the United States is equally prevalent and sadly most cases are not reported so data is not well established (Hymel, Ritzen, Reinert, & Hay, 1999). However, medical professionals or parents that suspect shaken baby syndrome can look for bruises on the head or face of children, be alert for soft spots on the head, or look for previous signs of bleeding which may be found, after the fact, in spinal fluid (Hymel, Ritzen, Reinert, & Hay, 1999). The outcome for children who survive this, and other non-accidental head injury, was explained by Barlow, Thompson, Johnson, and Minns (2004) in which 64% of the children had speech and language disorders or autism, 25% had visual deficits, and 20% had cranial nerve abnormalities and over 50% were considered to be severely mentally retarded.

Most of these injuries result from parental frustration with infants who do not stop crying and the new parents have not been educated with how to handle the child without shaking them (Barr, 2007). Simply putting down a child in a safe play pen and walking away could stop the abuse. With this basic understanding of the tragedy associated with child brain injury from shaken baby syndrome I would hope the committee will approve funding for preventative measures so that these statistics can be reduced if not eliminated in the near future.

Barlow, K., Thompson, E., Johnson, D., & Minns, R. (2004). The neurological outcome of non-accidental head injury. Pediatric Rehabilitation, 7(3), 195-203.

Barlow, K. M. & Minns, R. A. (2000). Annual incidence of shaken impact syndrome in young children. Lancet, 356(9241), 1571-2.

Barr, M. (2007). What do you say to the parent of a crying baby? NENA Outlook, 30(2), 13.

Hymel, J. C., Ritzen, A., Reinert, SE, & Hay, TC. (1999). Abusive head trauma: An analysis of missed cases. Journal of the American Medical Association, 281, 621-626.

Monfore, D. (2005). Resource guide on traumatic brain injury. Preventing School Failure, 49(4), 58-62.

Walden University . (2008, April 29). Overview of brain injury in adults. Neuropsychology PSYC-8710-01. Retrieved from Walden University Classroom: http://sylvan.live.ecollege.com.

Psychological stressors, such as significant life changes or an inability to manage or cope with stress, can result in a feeling of perceived “helplessness or hopelessness” as first defined by Dr. Engel. He was a medical physician that noted the lack of incorporation of the mental and social models of behavior with the biological model of behavior.

Infections and clinical illnesses as well as health practice measures are also associated with the relationships between stressful experiences and acute infections. For example, infections often are a result in the decreased ability for the body’s immune system to fend off further attacks on the immune system. Individuals that are not experiencing stress or clinical illnesses may have a reduced inflammatory response. When there is exposure to a potentially acute infection acute inflammation occurs which is a positive defense (Miller & Cohen, 2005, p. 13-14). Additionally, health practice measures such as preventative health care, proper dietary support, and proper intervention from physicians assist in the reduction of acute infection as a physician can reduce the stress levels on the HPA axis (Sperner-Unterweger2005).

Engel, G. (1968). A life setting conducive to illness: The giving-up—given-up complex. Annals of Internal Medicine, 69(2).

Miller, G. E. & Cohen, S. (2005). Infectious disease and psychoneuroimmununology. In K. Vedhara & M. Irwin (Eds.). Human psychoneuroimmunology. NY: Oxford University Press.

The adrenal axis plays a role with depression and immunity in the sense that there is a relationship between secretions of increased levels of cortisol in conjunction with poor performing immune system responses which may result in the removal of necessary immune cells from the normal circulatory process.

The autonomic nervous system has a role with depression and immunity in that the system is altered in a variety of ways.  One example is the increase in white blood cell counts as well as an increase in lymphocytes and neutrophils (Vedhara & Irwin, 2005).  There is a variety of research currently being conducted to assess the relationships between depressed patients, the immune system, and the relationship between the production of B and T cells that will be of great interest to health psychologists forthcoming.

Reiche, V., Maria, E., Kaminami, M., Morimoto, V., & Nunes, S. (2005). Stress and depression-induced immune dysfunction: Implications for the development and progression of cancer. International Review of Psychiatry, 17(6), 515-527.

Vedhara, K., & Irwin, M.R. (2005). Human Psychoneuroimmunology.  New York, NY: Oxford University Press.

Patients and physicians are becoming more interested in understanding psychosocial factors that may impact immune mechanisms and result in biological malfunctions. For example, if severe stress occurs there is an impact on the immunological functions which may result in a decreased ability for the body to recognize and eliminate potential cancer cells in the body (Rieger, 2001).

There has long been evidence that cancers, such as breast cancer in women, may progress faster or slower based upon psychosocial factors. Stress (both perceived and real) as well as family support have an impact upon endocrine and immunological processes (Van der Pompe, Antoni, Mulder, Heijnen, Goodkin, de Graeff, Garssen, & de Vries, 1994). This is supported by research that demonstrates a relationship between specific endocrine receptors that are located on lymphoid cells that provide neuronal communications with lymphoid tissues. These endocrine receptors can influence changes in the mammary epithelium (membranous tissue) which can change the progression of breast cancer (Van der Pompe et al., 1994 ).

The body defends against cancer by assessing changes in previously cells that have mutated into cancerous cells. The immune system has natural killer cells, dendritic cells, antibodies, and T lymphocytes that all work to manage the response the body has from an immunological response (Walker et al., 2005). Further, the functionality of immune cells and their ability to fight the proliferation of cancer cells is affected by stress and depression, emotional and social demands that are a side-effect of many cancer treatments, as well as those who receive psychological support throughout their cancer treatment regime.

Rieger, P. T. (2001). Did stress cause my cancer? ONS News, 16(9), 14.

Van der Pompe, G., Antoni, M. H., Mulder, C. L., Heijnen, C., Goodkin, K, de Graeff, A., Garssen, B., & de Vries, M. J. (1994). Psychoneuroimmunology and the course of breast cancer: An overview. Psycho-Onchology, 3(4), 271-288.

Walker, L. G., Green, V. L., Greenman, J., Walker, A. A., & Sharp, D. M. (2005). Psychoneuroimmununology and chronic malignant disease:Cancer. In K. Vedhara & M. Irwin (Eds.). Human psychoneuroimmunology. NY: Oxford University Press.

Research in these areas has been forwarded by the work and research often represented in the American Psychological Association by those interested in psychology and aging.  Current topics of research include neuropsychological mediators of the links among age, chronic illness, and everyday problem solving skills as well as the understanding of how age and health are affected by psychosocial stressors (Thornton, Deria, Gelb, Shapiro, & Hill, 2007).  Age related changes, such as moving to a new location, can affect an elder’s mood and quality of life (Vedhara & Irwin, 2005).  Depression has been related to a suppression of the proliferation of lymphocytes and elders with intrusive thoughts also show higher levels of the stress hormone cortisol.  Very often these behaviors are associated with the level of social support a person receives in terms of how they manage immune responses to a variety of situations. 

Now, there is further understanding of the relationship between psychological stressors and the immune system.  Specifically, older adults experience stress differently than younger adults in areas such as mood and quality of life, bereavement, cognitions, coping, or personality (Vedhara & Irwin, 2005). 

Cohen, S., Kessler, R. C., & Gordon, L. U. (1997). Measuring Stress: A Guide for Health and Social Scientists. NY: Oxford University Press.

Lovallo, W. (2004). Stress & Health: Biological and Psychological Interactions. Thousand Oaks, CA: Sage Publications.

Thornton, W. L., Deria, S., Gelb, S., Shapiro, J., & Hill, A. (2007). Neurophychological mediators of the links of age, chronic illness, and everyday problem solving. Psychology and Aging, 22(3), 470-481.

Vedhara, K., & Irwin, M.R. (2005). Human Psychoneuroimmunology.  New York, NY: Oxford University Press.

Organ systems decline and immune functionalities may decrease so it is becoming common practice to try and prevent the onset of illness such as the “flu” in the elderly before the flu season which may be late fall throughout the winter depending on where you live. If a 70 year old patient would inquire whether or not he or she should get a “flu shot” that that age, I would tell them that I would recommend that they do receive the shot.  However, I would want to ensure that they are in good health and have not had reactions in the past to influenza inoculations. 

As patients age they experience what is call immunosenescence which is the aging of the immune system (Vedhara & Irwin, 2005).  During this process lymphocyte activities change resulting in decreased or impaired activity in the overall immune system.  Therefore, Vedhara & Irwin (2005) note that over 40% of elderly patients who receive the flu shot do not develop proficient antibodies to fight the illness so preventative steps, such as handwashing and proper nutrition, should be incorporated into a person’s lifestyle as well.

Thorton, W. L., Deria, S., Gelb, S., Shapiro, R. J., & Hill, A. (2007).    Neuropsychological mediators of the links among age, chronic illness and everyday problem solving. Psychology and Aging, 22(3), 470-481.

Vedhara, K., & Irwin, M.R. (2005). Human Psychoneuroimmunology.  New York, NY: Oxford University Press.