Definition of stress
Stress is without a doubt one of the most overused and perhaps misused words in contemporary western culture.

It is generally used to define both the factors that cause stress (stressors) and the condition of people affected by these factors.

Apart from the semantic confusion, it is worth observing that the definition of stress covers a wide range of other situations, including a number of para-physiological (borderline normal) conditions, and others that are unquestionably physical and mentally pathological.

A little more clarity would certainly not go astray in this jungle of sometimes widely differing definitions and conditions, in order to understand the role that the discipline we are proposing and other possible treatment strategies might conceivably play.

Stress is generally understood to be the interaction between an external condition (stressful event) and the reaction it arouses in the individual at the physical, mental or combined physical and mental level.

A distinction has to be made between:
- external stressors
- the individual’s reaction to stress

(link: American Institute of Stress)

The role of stress
Stress appears to be able to influence health.

It is believed that several diseases are aggravated if not actually caused by stress, especially cardiovascular diseases, cancer, mental disorders, immune disorders (animal trials have proven that viral infections like herpes simplex are related to stress).

Within certain limits, the individual’s response to stressful internal or external factors may raise performance levels (in this case we refer to eustress).

(link: Rossi’s Hypotesis, modified by Ciancaglini)*

*A number of factors, including external (environmental stressor) and internal stimuli (psychobiological factors), can contribute to an overall concept of stress by far exceeding the tradidional behavioural and psychosocial aetiological conception.

Stress could enhance the neuropeptide cascade, beginning witrh corticotropine releasing factor (CRF), proopiomelanocortine (POMC) leading to the release of corticotropine hormone (ACTH) and the beta endorphyn which coordinate the chronobiological processes of mind body communication and healing.

Stress models
Hans Selye, who defines stress as a physical reaction to external and internal influences, classifies stress depending on the causes. 

Based on animal experiments Selye claims that stress, which some theories call general adaptation syndrome, causes the body to pass through three coping stages:

1) alarm reaction: which generates a decrease in the individual’s efficiency and performance levels;
2) resistance: the body summons up greater efficiency to tolerate the stressful condition;
3) exhaustion: physical efficiency wanes (immune defenses weaken) and disease develops (sometimes even death). This stage appears if the stress is repeated frequently and becomes increasingly intense.

The body will respond to stress either positively or negatively depends on the intensity and duration of the effort required of the body to cope with the stress, and its ability to adapt.

Consequently, stress may be positive (eustress), if it generates drive, efficiency and enhanced performance, or negative (distress), if it slows, alters or impairs body functions (neurological, mental, physical, cognitive and behavioral disorders)

Therefore, if stress is repeated so frequently that the parasympathetic system is never able to take action, then the state of excitement will last until the individual reaches a state of exhaustion, due to the body’s inability to sustain the situation (continuous pressure) and the onset of psychosomatic symptoms.

However, the model described here does not explain the “specificity” of  the effects on individual organs. 

Two types of “specificity” have been proposed: individual and situational.

According to the individual-specific response theory (or model), for every individual there is a specific psychosomatic response model that is genetically determined or acquired (i.e. everyone has their own personal target organ system).

According to the situation-specific response theory, specific environmental stimuli arouse the same reactions in everyone (e.g. fear and anger generate specific physiological response patterns).

The cognitive model (situation-specific) is based on the assumption of a specific reaction related to personal experience.

Lazarus suggested that stressful events cause situation-specific and individual-specific responses in relation to knowledge acquired by experience (socio-cognitive learning theory). The individual makes appraisals of his biological, psychological and social resources.

According to Holmes and Rahe, the incessant flow of adversities and joys (“daily hassles” and “daily uplifts”) induces similar reactions to major “life events”. The authors therefore suggest a “life change unit” or “health effects rating” for major life-changing events.

The sympathetic nervous system, endocrine system and immune system interact in response to stressors with a series of adaptive processes aimed at restoring homeostasis (pre-existing balance/reward). This response is seemingly mediated by two systems, the HPA (hypothalamus pituitary adrenal) system and the locus ceruleus-noradrenalin (LC – NA) system.

The stress response of the body is rather like a Formula One race car, with its engine revved up and ready to start a race. All the on-board systems, mechanisms and instruments have been fine-tuned to provide the utmost efficiency in terms of performance, safety and control (e.g. engine, electrical and electronic systems, position monitoring, track viewing cameras, driver protection devices, etc.), but won’t kick in until the flag is waved and the race actually starts. If the start is delayed for whatever reason, all these “functions” are switched off and the vehicle returns to the “rest” position.

This is what happens to our body under conditions of stress. All systems (i.e. the heart, blood vessels, immune system, lungs, sensory organs, digestive system, and brain) are modified to meet the perceived threat.

Stressors
Stress factors, which “threaten” the body, may be internal or external.

1) External stressors:
- adverse physical conditions (including pain, or hot or cold temperatures)
- stressful psychological conditions (psycho-social factors), such as poor working conditions or relationships that cause pain and suffering.

Human beings, like animals, can experience any number of external stressors.

2) Internal stressors:
- physical (inflammations, infections, metabolic endocrine disorders, etc.)
- psychological (intense justified or unjustified worry).

As far as is known, psychological stressors are rare or absent in animals. Stressors can also be defined as acute (short-term duration) or chronic (long-term duration).

Acute stress
Acute stress is the reaction to an immediate threat, commonly known as the fight or flight response. The threat can be any situation that is experienced, even subconsciously or falsely, as a danger.

Common acute stressors include:

• noise

• crowding

• isolation

• hunger

• danger

• infection

• imagining a threat or remembering a dangerous event.

Under most circumstances, once the acute threat has passed, the response becomes inactivated and levels of stress hormones return to normal, a condition called the relaxation response.

Chronic stress:
Frequently, however, modern life poses on-going stressful situations that are not short-lived and the urge to act (to fight or to flee) must be suppressed. Stress, then, becomes chronic.

Common chronic stressors include:

• on-going highly pressured work

• long-term relationship problems

• loneliness

• persistent financial worries.

The negative effects of acute stress
In prehistoric times, the physical changes in response to stress were an essential adaptation for meeting natural threats. Even in the modern world, the stress response can be an asset for raising levels of performance during critical events such as a sports activity, an important meeting, or in situations of actual danger or crisis.

If stress becomes persistent and low-level, however, all parts of the body's stress mechanism (the brain, heart, lungs, blood vessels, and muscles) become chronically over- or under-activated. This may produce physical or psychological damage over time. Acute stress can also be harmful in certain situations.

For example, an accumulation of persistent stressful situations, particularly those that a person cannot easily control (for example, high-pressured work plus an unhappy relationship).

Persistent stress following a severe acute response to a traumatic event (such as a car accident). But also an inefficient or inadequate relaxation response. And, lastly acute stress in people with serious illness, such as heart disease, cancer or a neurodegenerative disease.

Psychological Effects of Stress
Several studies have suggested that the inability to adapt to stress is associated with the onset of depression or anxiety. Statistically, two-thirds of people who experience stressful situations have an almost six times higher risk of developing depression within the same month.

There is evidence that repeated release of stress hormone produces hyperactivity in the hypothalamus-pituitary-adrenal axis and modifies normal serotonin levels, the nerve chemical that is essential for well-being. Certainly, and obviously, stress affects the quality of life by reducing feelings of pleasure and satisfaction, and relationships are often threatened.

Pain
Researchers are attempting to find the relationship between pain and emotion, but the area is complicated by many factors, including effects of personality types, fear of pain, and stress itself.

Muscular and Joint Pain. Chronic pain caused by arthritis and other conditions may be intensified by long-term stress.

Back ache (arthritic dorso-lumbar and sacro-lumbar pain) is aggravated  by prolonged stress and the trauma of job dissatisfaction.

Headaches. Tension-type headache episodes are highly associated with stress and stressful events. It is generally agreed that tension-type headache sufferers may actually have some biological predisposition for translating stress into muscle contraction.

Among the wide range of possible migraine triggers is emotional stress (although the headaches often erupt after the stress has eased). One study suggested that women with migraines tend to have personalities that over-respond to stressful situations.
(link: headache)
(link: craniomandibular disorders)

Sleep Disturbances
The tensions of unresolved stress frequently cause insomnia, generally keeping the stressed person awake or causing awakening in the middle of the night or early morning.
(link : sleep disorders)

Teeth and Gums
Stress has now been implicated in increasing the risk for periodontal disease, which is disease in the gums that can cause tooth loss.
(link : gengival bleeding)

Bruxism
Rugh and Solberg proved that everyday stressful events (driving along a motorway, having meetings with bosses, fighting with one’s spouse or children) lead to an increase in para-functional activities (clenching and grinding of teeth), having noticed a rise in EMG potentials using surface electrodes and portable electromyographs.

This activity is significantly greater in individuals with temporomandibular joint dysfunction but non existent in individuals with back ache. Jones also showed that in women with temporomandibular joint dysfunction the response of steroid hormones to stress induced experimentally was greater. It therefore appears to be confirmed that there is a correlation between stress and temporomandibular joint dysfunction. It also seems that treatments to control stress (relaxation techniques) lead to significant benefits in relieving the symptoms of temporomandibular joint dysfunction.
(link: craniomandibular disorders)

Personality studies on individuals with temporomandibular joint dysfunction and pain related to bruxism indicate that these people tend to be unable to relieve their aggressiveness.

However, no specific personality profile could be correlated to temporomandibular joint dysfunction

Psychological treatment, except in cases featuring neuropsychological disorders, must provide support and care in cases in which pain or dysfunctional dysmorphism has induced reactive secondary neurosis.
(link :psychotherapy)
(link: Milton Erickson.org)

Strategies for controlling stress
Since it is virtually impossible in modern life to significantly reduce or eliminate the causes of stress, it would seem more reasonable to learn to control it.

For some general rules and harmless procedures that could be recommended to everyone, please refer to:
- the smiline checklist (see introduction)
- the strategies below:

RELAXATION TECHNIQUES :
 

• BREATHING TECHNIQUES (i. g.: Sudarshan Kriya®)

• YOGA

• THAI CHI

• SHIATSU

• REFLEXOLOGY

• MEDITATION

• AUTOGENOUS TRAINING

• BIOFEEDBACK

• REIKI

• MUSCULAR RELAXATION TECHNIQUES

• MASSAGE THERAPY(SWEDISH MASSAGE)

Can be very useful:

• PSYCHOTHERAPY / HYPNOTHERAPY
  (link :psychotherapy)
  (link: Milton Erickson.org)

We suggest also:

• THE SMILINE GAME (link : THE SMILINE GAME)

And as  general rules:

• LOWER AIMS AND INCREASED EFFORTS

• THE SMILINE CHECKLIST (see Foreword)

However, before making any decisions concerning your lifestyle and habits, and about your therapy or treatments, I recommend that you:
- consult your doctor to check compatibility between the method you wish to use and your physical condition, your constitution, talents and inclinations.
- talk about it with your “relationship anchors”, who are the people who have earned and deserve our trust and confidence.

In addition to these strategies, which will be illustrated in more detail later on (i.e. open air exercise, cold-water all-season swimming, kite flying etc.), there are many traditional stress-fighting activities that can be practiced like yoga, disciplines that teach correct breathing).
Yoga will be discussed in a separate chapter.

Here is a brief comment about correct breathing.

BREATHING
The importance of breathing in the vital balance of the body is evident, since it is the source of our most important fuel: oxygen. The physiology of breathing belongs outside the scope of this manual, therefore we recommend obtaining information from accredited sources…

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