Category: Mental Health

Stress stimulates appetite, it increases abdominal fat, it increases risks for disease and it can even play a role in our intimate relationships.

The list could keep going, but what exactly is stress and how is it connected to all these consequences? This guide will provide you with a thorough understanding of many aspects of stress.

• A definition of stress
• The harms and benefits of stress
• How mental perceptions affect stressors
• Stress in males vs females
• Metabolism
• Cortisol – its benefits and detriments
• Stress management techniques

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What is Stress?

Stress can be is defined as a nonspecific response to any stimulus that overcomes, or threatens to overcome, the body’s ability to maintain homeostasis (state of equilibrium of the body’s internal biological mechanisms) (1). In other words, when the body is exposed to, or anticipates a stressor, it initiates a response mechanism to help restore a state of equilibrium.

However, it is important to remember that this biological response is essentially the same regardless of the type of stress we impose upon ourselves, and only differs by magnitude of the response needed.

A breakdown of the stress-response mechanism

Our stress-response mechanism is designed to respond to acute physiological stresses – ones that place stress upon our body for only short periods of time (e.g., escaping a sabre-tooth tiger) where we respond with physical work.

We often refer to this mechanism as our ‘fight-or-flight’ response. We either confront the stressor or remove ourselves from it (1). The stress is short-lived and allows ample time for the body to recover from the stress response.

After we remove the stressor, the body theoretically seeks to return to a state of calm to re-establish baseline or homeostasis, or perhaps undergo adaptation to tolerate future exposure to that same stressor better. This recovery phase ensures adequate time for each system (e.g., immune system) to complete any needed recovery, replenishment, repair, or adaptation and is illustrated below.

Mental perception and stress

Is stress harmful to the body? Is it something that should be avoided, managed, and reduced – or should it be embraced and utilized to benefit the body?

While no definitive answer exists, there is emerging evidence to suggest that while the manifestation of stress is mainly physiological, it may be the mental perception or interpretation of stress that ultimately dictates whether it is beneficial or harmful.

In a study conducted by Keller and colleagues, 30,000 individuals were tracked to determine their perceptions of stress and its impact upon mortality (Keller, et al., 2012).

As expected, individuals reporting low levels of stress experienced the lowest levels of mortality. In contrast, those experiencing high levels of stress demonstrated the highest risk of mortality, but the interesting discovery lay with the perception of how stress affected the body.

Those who did identify high levels of stress, but also believed that stress was not harmful to the body demonstrated similar mortality rates to those experiencing low levels of stress. Although this study faced some scrutiny, it paved the way for other studies that examined the same notion of mental perception as a key indicator of the effects of stress.

The two Stress-Response Mechanisms

To better understand this difference, it may be helpful to first review key stress-response mechanisms. Our biological stress response was designed for survival and is regulated by both the neural and endocrine (hormonal) systems.

The nervous system is a rapid-acting, but short-livedcommunication system that functions by transmitting nerve impulses – it reacts very quickly to stimuli, but its effects do not last very long (e.g., the sudden, short-lasting elevation of heart rate when startled).

The endocrine system is a slower-acting, but longer-lasting communication system that functions by hormonal action – it is activated more slowly (sometimes by nerve activity) and its effects may last longer (e.g., the sustained elevation of heart rate during a 60-minute run).

STress Reponses and their physiological influence

Our ancestors’ primary stressors involved a fight for survival or to the death against a predator or aggressor and the nature of the stress was an intense, acute physiological response (Figure 1).

However, after this brief, but stressful encounter, what followed was ample recovery to return to baseline (state of calm – parasympathetic or PNS dominance).

This allowed each physiological system (e.g., immune system) time to restore and regenerate itself after fighting to maintain homeostasis.

By contrast, today’s stress generally involves lower-intensity, sustained psychological stressors that sometimes never go away (chronic stress, or in extreme cases, PTSD) but accumulate (Figure 2).

For example, you might sleep through your alarm and wake up in a panic late for your meeting, skip breakfast, get delayed by a slow commute, arrive late for a presentation, get reprimanded by your boss, then finally make it to your office whereupon you receive a call that your child is sick and needs to be picked up from school – sound familiar?

These sustained stressors, although smaller individually, accumulate and deny the body that needed time to repair, recover and replenish.

Nonetheless, in either situation (ancestors v. present-day) the body activates its stress response in similar ways, albeit it at different intensities. And while we are familiar with many responses (e.g., increased heart rate and blood pressure, mobilization of stored fats, increased sweat rates), we may be unaware of others that merit concern (Table 1).

For example, elevated levels of epinephrine enhance blood clotting ability by increasing platelet adhesiveness (5). By design, this might be needed to stop one from bleeding to death during a survival fight, but think about this sustained effect upon cardiovascular health.

Ever wonder why you get dry mouth when nervous, why a dog urinates when scared or why you need to run to the bathroom before a big race?

Consider our need for survival – during a stress response, specific systems require additional resources, essentially borrowing from other systems deemed unnecessary during the ‘fight-or-flight’ response (e.g., reproduction, growth, maintenance).

In other words, some systems automatically shut down to provide the needed resources and energy to the critical systems and locations to facilitate survival (e.g., muscles, skin for thermoregulation). An example of this is saliva and digestive enzyme release in the mouth, stomach, and upper GI to facilitate chewing, digestion, and absorption shut down.

In contrast, the lower GI and bladder’s smooth muscle contractility become activated to void unnecessary urine and fecal matter that may slow you down in the event you need to run to survive. We list many of these allocations or resources in the table below.

Table One: Stress Response Influence on Physiological Systems

Events Activated	Events Inhibited
Increased cardiopulmonary responses Increased vessel dilation in the needed location Increased mobilization of fuels Increased blood clotting ability Increased large intestinal contractility Increased bladder contractility Increased immune function – short-term Increased sweat rates	Decreased salivary and digestive enzyme secretion, and digestion Decreased stomach/small intestinal contractility Reduced pain perception (analgesia) Reduced growth, repair, and maintenance Decreased reproduction capacity Immune function – sustained long-term

While these events are undoubtedly tolerable for a brief period (e.g., workout), think about these events’ consequences during a sustained bout of stress.

For example, blood clots more rapidly during an acute episode of stress to prevent excessive bleeding, but think to the health risk of a stroke or embolism if this effect lasted indefinitely?

What is cortisol and what are its benefits?

Cortisol is an essential hormone released from the adrenal gland in response to stress and provides many benefits:

• Sparing liver glycogen to ensure blood glucose preservation necessary for important physiological events like oxygen transportation to the brain by our red blood cells can only fuel themselves using glucose.
• Promoting the breakdown of stored fat within our adipose tissue to be used as fuel by muscle cells.
• Promoting fat uptake into muscle cells during activity.
• Suppressing continued cytokine synthesis and release following the acute phase of inflammation – a normal and healthy process. In other words, cortisol helps protect the body from potential detrimental consequences of an overactive immune response by acting in immunosuppressant capacity.

These events are modulated by and during the presence of cortisol under acute bouts of stress. Now, consider how exposure to stress has changed in humans living today. We have shifted from experiencing infrequent, acute, and short bursts of stress followed by periods of recovery to a lifestyle of sustained episodes of stress that do not include periods of recovery, as illustrated below.

The effects of elevated cortisol levels

Consider the effects of sustained, elevated cortisol levels on the body’s physiological systems. Many of our planned interventions with clients and athletes focus on controlling appetite, increasing metabolism and fat utilization, building muscle mass, and reducing abdominal fat and overall body fat.

However, under sustained stress and elevated cortisol levels, the actions of many of the hormones responsible for these desirable events are impeded or even inhibited, including:

Stress + Cortisol can lead to an increased desire to eat

Furthermore, stress coupled with elevated cortisol can trigger an increased desire to eat given cortisol’s impact upon neuropeptide Y, a neurotransmitter in the brain that regulates appetites.

What follows eating is an elevation of insulin, which acts to inhibit fat metabolism within the body, another undesirable event. 

STress Management Techniques

What stress-coping mechanism can you employ to help reduce your client’s stress levels? In addition to exercise as a stress management technique, there are many different techniques exist that demonstrate varying levels of success and while they should all be considered, select the one(s) most appropriate for your client(s) (7). Examples include:

1. Deep Breathing (also known as paced breathing; belly, abdominal or diaphragmatic breathing):

• Find a place (physically or by clearing your mind) free of distractions.
• Close your eyes; and after a few normal breaths, draw in one long-slow breath through your nose engaging your diaphragm (include your chest – apical, if so desired).
• Pause momentarily, then slowly exhale through your mouth.
• Repeat for 30 – 60 seconds.

2. Mindful Techniques:

• Start by repeating the breathing sequence, but now visualize relaxing scenes or visualize / repeat (slowly) any focus word or phrase that helps you relax.
• Practice in a place free of distractions 1 – 2 x per day for a minimum of 10 minutes each time.
• Variations of this technique include:
• Progressive mind relaxation – gradual intensification of the image, word or phrase.
• Mindful meditation.
• Yoga, Tai Chi or Qi Gong – including mind-body movements.
• Feldenkrais or guided imagery – super-slow (eyes closed) visualization inducing a deeper sense of mindfulness and mental imagery – often used to rehearse before movement.

3. Body Sensation Awareness:

• Noticing subtle sensations (e.g., itching, tingling) without judgment – let them pass (progressive relaxation techniques).
• Progressive muscle relaxation – technique of visualizing tension release from muscles using sequential muscle contractions.
• Noticing emotions and feelings (e.g., anger, sadness) with judgment – accept them and progressively let them pass (diminish).

4. Stored Energy Release:

• Stress can sometimes create muscle tension.
• For example, a gazelle under intense SNS activation that has eluded the interest of a predator proceeds to jump around after stress removal to release muscle tension. Similarly, humans also need physical sources for stress removal (e.g., exercise, punching).

5. Reprioritization:

• Create opportunities to reprioritize matters – following a stressful event, spend time on an enjoyable activity or with person(s) who holds high priority in your life (e.g., hugging/playing with your kids).
• This helps prioritize and build perspective.

6. Social Support:

• Studies examining primates and our ancestors demonstrated how females, following bouts of stress, resorted to affiliative behaviors such as grooming and hugging that offers a social calming effect (i.e., lowered blood pressure, cortisol levels).
• Research on oxytocin levels in female primates and human ancestors demonstrated more of a friend-and-befriend response rather than a fight-or-flight response, where they tend to their offspring and bond with one another when stressed (8, 9).
• For females especially, help plan and develop social support system that offers this same calming effect.

7. Predictive Information:

• Awareness or anticipation of type, magnitude and duration of stress enables development of effective coping mechanisms.
• For example, planning ahead for a restaurant meal by reviewing the menu when trying to control caloric intake helps cope with the stress of making a rushed decision.
• Information however, must be relevant (i.e., tied to stressful event) and must be time-appropriate (e.g., information provided 3 weeks prior to, or one minute prior to ordering offers little help).

8. Sense of Control:

• Creating impressions of or actually having control of a stressful situation can reduce stress.
• Low levels of control plus stress demands = poor stress response, whereas higher levels of control plus stress demands = better stress responses.
• With mild-to-moderate stress levels, increased control promotes self-efficacy.
• With high stress levels, one may benefit from less control to avoid extreme pressure, desperation or blame should they not succeed.

9. Cognitive Flexibility:

• This involves developing the ability to remove stressors that you do control, but adapting to those stressors you cannot control. In essence, it helps one interpret things as always improving (i.e., positive outlook with glass half full).
• The Serenity Prayer by Reinhold Niebuhr, a 20^th century Theologian helps summarize this strategy:
• “Grant me the serenity to accept the things I cannot change, the courage to change the things I can, and wisdom to know the difference.”
• Being able to overcome impostor syndrome.

In conclusion

In closing, we may hear that stress kills. Still, perhaps a more appropriate interpretation is that it is our inability to accommodate or allow appropriate recovery from stress, considering our naturally-designed stress response, and how we perceive the impact of stress upon our lives that is becoming the problem.

As fitness experts, perhaps it is time to retrain how we approach the subject of stress in our programming and exercise selection for clients.

References:

1. Cannon, W. B., (1926). Physiological regulation of normal states: some tentative postulates concerning biological homeostatics. IN: Pettit, A., & Richet, A.C., Ses amis, ses collègues, ses élèves, Paris, France, Éditions Médicales.
2. Sapolsky, R. (2010). Stress and Your Body. Chantilly, VA., The Teaching Company. http://www.thegreatcourses.com/tgc/courses/course_detail.aspx?cid=1585. Retrieved 2013-01-21.
3. Crum AJ, and Langer EJ (2007). Mindset matters: Exercise and the placebo effect. Psychological Science, 18(2):165-171.
4. Hoehn, K, Marieb. EN. (2010). Human Anatomy and Physiology. San Francisco, CA: Benjamin Cummings
5. Sapolsky, RM. (2004). Why Zebras don’t get ulcers. New York, NY: Henry Holt and Company, LLC.
6. Keller A, Litzelman K, Wisk LE, Maddox T, Cheng ER, Creswell PD, and Witt WP, (2012). Does the perception that stress affects health matter? The association with health and mortality. Health Psychology, 31(5), 677.
7. Selye, H. (1978). The stress of life. New York, NY: McGraw-Hill

The Author

Fabio Comana

Fabio Comana, M.A., M.S., is a faculty instructor at San Diego State University, and University of California, San Diego and the National Academy of Sports Medicine (NASM), and president of Genesis Wellness Group. Previously as an American Council on Exercise (ACE) exercise physiologist, he was the original creator of ACE’s IFT™ model and ACE’s live Personal Trainer educational workshops. Prior experiences include collegiate head coaching, university strength and conditioning coaching; and opening/managing clubs for Club One. An international presenter at multiple health and fitness events, he is also a spokesperson featured in multiple media outlets and an accomplished chapter and book author.

Imposter syndrome is a common internal experience that can occur to anyone even in the fitness world. The good news is that individuals who might experience Imposter Syndrome can work on these tendencies and slowly chip away and overcome these thoughts and feelings.

What is Impostor Syndrome?

Imposter Syndrome is when an individual believes that the good fortune or positive opportunities, they have experienced is a result of luck, and not their hard work or skill.

Often, individuals who experience this do so despite past moments of success or accomplishment. Due to this fact, feelings of Imposter Syndrome commonly conflict with what others around the person might think or believe to be true. Imposter Syndrome can impact thoughts and feelings that emerge in work and even personal situations. A common non-fitness-related example is a situation where someone just got promoted to a new role and feels insecure.

This individual might think thoughts like, “Am I the right person for the job?”, “Did I get here only by luck?”, and “What if I am not cut out for this?” As this example shows, these thoughts are fueled by feelings of insecurity and doubt.

A more fitness example, for wellness coaches out there,  might include a situation where a person used to be extremely overweight and sedentary but is now more active and has lost that weight.

Despite that this person regularly exercises and accomplishes their personal fitness goals, he or she might still feel that they are out of place or believe that they do not quite belong in the fitness community. This individual might think or feel this despite others around them seeing clear evidence that they do belong to this community.

8 Steps To OVercome Impostor Syndrome

There are eight recommended steps to get over Imposter Syndrome:

#1 Increase Self-awareness & Reflect 

Become self-aware of your thoughts and feelings, and perhaps which type you identify from the list above. Being aware of tendencies or a type can take some time, so it might be helpful to keep track in a journal or make a list of what you notice and spend some time reflecting.

#2 Identify When it Occurs 

As you utilize the self-awareness and reflection identified in step one, notice which situations and events the Imposter Syndrome comes up in more frequently. Continue to build on that journal or list to help keep track of trends and situations that evoke more of a response.

#3 Utilize Cognitive Reframing

As you become more and more familiar with what thoughts you might be having related to Imposter Syndrome; it will be helpful to challenge your self-talk with cognitive reframing. When you notice, you might say to yourself something that is not true, reframe the thought into a more adaptive and true statement, and repeat this to yourself. Continue to repeat this true statement and affirmation as many times as is helpful to continue to strengthen this new mindset.

#4 Make a list of your “evidence”

It is important to realize that Imposter Syndrome often appears despite evidence of success and accomplishment. Due to this, it can be helpful to make a list of all successes and accomplishments that relate to what you feel insecure about. Pull up and reference this list when you start to feel that the Imposter Syndrome feelings and thoughts are taking over. This will help remind you of what is true in moments you need it most.

#5 Practice, Practice, Practice

Practice makes progress, so the next tip is to continue to utilize steps one through four in an ongoing fashion. These four tools can continue to be revisited and restarted anytime you need them. The more you do any of these items, the better you will get at noticing them, identifying trends, utilizing cognitive reframing, and reminding yourself of your successes.

#6 Trust the Process

It is important to trust the process. Change takes time, especially while modifying core beliefs. Changing the cognitions and feelings that relate to these core beliefs takes ongoing motivation and consistency. It is important to know that there will be days that feel easy, and days that might feel harder. Trust that over time practicing these skills will continue to help this resolve.

#7 Demystify the Myth of Perfectionism

An important myth to demystify when it comes to Imposter Syndrome is the idea of perfectionism. It is essential to remember that perfectionism does not exist. Working towards accepting and believing this can make significant progress on reducing Imposter Syndrome.

#8 Don’t be afraid to utilize additional support 

If you find that Imposter Syndrome is having a significant impact on your life, it is always best to talk to your Primary Care Physician and/ or work with a therapist who can help provide a standard of care that might be needed. Don’t be afraid to utilize additional support you may need in this process.

As these tips show, getting over Imposter Syndrome takes time and diligence. The good news is that these tools when used regularly can help make a positive difference.

Types of Impostor Syndrome

There are various types of Imposter Syndrome: the soloist, the superhero, the natural genius, the perfectionist, and the expert.

Soloist

The soloist type will often be reluctant to ask their social support for assistance out of the belief that they should know the detail or fact already. They might believe that only imposters, or frauds, would ask for help and it can be perceived as a flaw.

In the fitness environment, it might be a fitness center member who does not ask the personal trainer available onsite even if they have a question. It could also be a newly hired personal trainer who does not feel comfortable asking a veteran personal trainer a question since they “should know this already.”

The Superhero

The superhero type will often be associated with individuals who are high achievers and expect that he or they should work harder than everyone else.

This is often fueled by the desire to not appear weak or incompetent before others, and the fear of failure in the event they do not push themselves hard enough. In the fitness environment, this could be a person that believes they need to work harder than everyone else, and if they don’t, they will appear pathetic.

The Natural Genius Type

The natural genius type will often expect that they should achieve what they set out to achieve the first time they try something. This leads to more frustration if they do not get something as easily on the first try. It can also lead to fear of trying something new due to not wanting to “get it” right away.

In the fitness environment, this could be a fitness center member who just joined the gym and believes that each new exercise they try should come easily. When it does not, they could get easily frustrated. They could then minimize trying new exercises due to not wanting to appear a novice or because the exercise continues to be challenging.

The Perfectionist

The perfectionist type is just like it sounds. Those who identify as this type do not like making mistakes, feel bad if they make mistakes, and believe that they should be correct one hundred percent of the time. They are also hyper-focused on flaws and inconsistencies in their efforts rather than their successes since they fear any imperfection will be viewed negatively by others.

In the fitness environment, this could be a personal training client who gets upset or frustrated at themselves if they do not perform an exercise correctly. If their trainer tells them they did a great job, they might respond with what was not perfect in their attempt, or that they could do better the next time.

The Expert Type

The expert type will often constantly seek out more and more information since they never believe they have enough to be successful, despite conflicting evidence that they do. If they end up not knowing a detail or fact, they might be reluctant to take on a project or task at hand. In the fitness environment, this could be a fitness professional who constantly believes they do not know enough to be great at their job.