Stress: The Good, Bad and Downright Ugly

As a neurologist, how do you understand stress? Is all stress bad for you?

When we think about stress, we immediately think it’s something negative. We all complain that we’re ‘stressed out’. But stress has different meanings in different contexts. From a brain-body perspective, it can be either good or bad.

To overcome challenges, our systems have to exert what is known as a stress response. This is an unconscious response to either overcome something or flee from it – the ‘fight or flight’ response. Our perception of danger is partly based on our own personal mindset, memories and experience.

When the stress is too high, or prolonged, that is when it is bad for us. But when, through the stress response, we overcome a challenge and are able to move back to the state we were previously in, that’s good stress. Once overcome, our system turns off the stress response and goes into this baseline relaxed physiological state, which maintains our brain-body system. It is this state that replenishes, restores and refuels us. 

What happens in our brains (and bodies) when we experience stress?

The stress response system is led by the brain. When faced with a challenge, the brain engages the hypothalamus. This small structure on top of the brainstem receives information from the outside world via the amygdalae (known as ‘the seat of emotion’, and of fear in particular). These small, almond-shaped structures deep in our temporal lobes evaluate the challenge and determine whether it poses a danger or not. Danger alerts the hypothalamus, which directs the sympathetic nervous system and releases noradrenaline, which increases physical responsiveness. A racing heart, for example, sends blood away from our skin and stomach – which is why we look pale and feel queasy – to our muscles and brains so we are able to make good decisions, run away or stay and ‘fight’. 

The hypothalamus also stimulates a hormonal response via the pituitary gland and the adrenal glands, triggering the secretion of cortisol. In the right doses, cortisol plays a beneficial role in the functioning of the immune system and it looks after our brains on a molecular level. 

Cortisol has also been found to be very active in the hippocampus (the seat of learning and memory), which responds favorably to small and intermittent amounts of cortisol that are released during a healthy stress response. It helps us process and remember the emotional experience. Forming memories of the event can influence our future behavior and emotional responses. Cortisol therefore also functions adaptively - in the right doses.

What happens when stress lasts too long?

When stress is chronic, the constant flood of cortisol becomes detrimental to the brain-body system. It reduces neural connections, limiting our capability for memory formation and learning, and can even lead to cell death (manifesting as illness). 

Specific parts of our prefrontal cortex, which is our problem-solving center, are negatively affected, which hampers our abilities for agile thinking, flexibility and innovation. The amygdalae become hyper-reactive and we become irritable and impulsive, an emotional state aggravated by our compromised prefrontal cortex. 

So does long-term, chronic stress actually change our brains? 

Stress, really, is how we respond to challenges around us. In certain situations, for example, we are indeed able to stretch ourselves and compensate. This kind of ‘tolerable stress’ means we can endure and overcome. Being complex and adaptive – that is, learning from challenges and becoming better at overcoming them – is part of the compensatory process and it is this that builds resilience. We learn, we grow and we move back into the baseline relaxed physical state.

Unhealthy stress, on the other hand, can be ongoing, low-dose chronic stress or very severe and intolerable stress that eventually leads to decompensation. This is a psychological term that refers to a range of negative consequences such as anxiety, depression, anger, or even physical symptoms. It may manifest as difficulty sleeping, changes in appetite, social withdrawal or difficulty functioning in daily life.

Continual struggle and exposure to challenges will mean that, at some point, you simply override all your compensatory mechanisms. This leads to irreversible problems at a molecular and cellular level that can and do lead to disorders such as cancer, autoimmune and degenerative diseases, and even death. 

If chronic stress has such an effect on our bodies, it sounds like much more than just a feeling. Is it?

Prolonged stress can have a profound effect on our bodies, causing changes in everything from our gut flora to our cardiovascular system. Hypertension, for example, accelerates damage to the blood vessels, causing inflammation in their walls. Stress also raises cholesterol, which together with inflamed blood vessels poses a major risk for heart attacks and strokes. Our skin can be affected (psoriasis, acne) and the endocrine, reproductive and metabolic systems can go into disarray. The imbalance between the brain and the liver can increase the risk of obesity, which is further accelerated by lack of sleep. 

It’s a cascade of damage, really. Chronic stress leads to structural dysfunction that we think can be repaired or recovered – unless, of course, there is decompensation over time and there is irreversible damage. It is very important to understand that chronic stress is a serious illness. And it should be seen as an illness or condition, not as something that we just have to prevent because our lives are better without it. Chronic stress is a killer. 

This is why resilience – the ability to overcome challenges and to remain in a state where we can have good and tolerable stress only – is such an effective antidote. 

What can we do to protect ourselves against the negative effects of stress? 

Our mindsets – the way we interpret information – can affect our psychology, our brains and behaviors, and can play a role in moderating our own stress response, keeping it in the ‘good stress’ or ‘tolerable stress’ zone. 

How do we ensure that our brain-body system is otherwise psychologically and physiologically protected? This is when we must focus on behavior, which brings me to Neurozone. The so-called ‘Neurozone domains’ are five clusters of behaviors that are scientifically demonstrated or theorized to protect us against stress. 

At the core, we have the rhythms. The high-performance rhythms are exercise, movement, sleep, nutrition and the practice of mindfulness. These are protective tools against the negative effects of chronic stress, or preventative ones against the development of chronic stress.

The second group are the connectors. We need to have a sense that we are safe. Apart from physical and financial safety, we also need social safety – both a sense of bonding and of belonging. There’s also psychological safety, which includes being free to express our opinions within a group. These different kinds of safeties provide us with a layer of protection against the potential development of chronic stress. 

Then we have transformers. Our mindsets, and our perceptual system of mindful, present self-awareness, contribute greatly to resilience. We need to adjust our beliefs in what is possible, and ensure we have an optimized ability to unconsciously see what is actually possible, in order to expand our innovation resources for dealing with stress. 

High-performance energy is very important because you want to have enough psychological energy to assign to tasks to overcome challenges. This energy enhances our abilities to conquer difficulties. In this way, it can turn a ‘bad stress’ into a ‘good stress’.

And, finally, there are high-performance innovators. You can only be as innovative as what you know, so learning and having knowledge and skills to overcome challenges is critical. This can be enhanced significantly by working as a group, and indeed being part of a team can be very beneficial. There is a business case, too, for building neurobehavioral insights into companies’ teams and individual goal management. Given the shifts in modern workplace culture, I’d say it is more vital than ever for businesses that want to build a culture of high performance.