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Coping With Chronic Stress

Remember the poster depicting a helpless kitten hanging on to a frayed rope by one claw? It was once a classic wall decoration in elementary school classrooms and its inspirational message said something like, “Hang in there.” Who hasn’t at one time or another felt like that kitten dangling in the air, questioning if she has the strength to hang on, fearing what might happen if she lets go and struggling to shimmy back up to safety. No wonder that kitten pulls at the heart strings. People relate to its stress.

The human condition requires undergoing stressful events. Stress is a natural, programmed physiological process. It’s like an internally regulated alarm system alerting a person to danger and providing the physical means to acknowledge and address a possible cause of harm. In simplest terms, according to Dr. Beth NeSmith, Ph.D., associate professor in the Georgia Health Sciences University Department of Physiological and Technological Nursing and an acute care nurse practitioner, it is the body’s arousal response to a perceived threat.  “It’s concern over something that may or may not happen,” she explains. It strikes in situations in which a person doesn’t know what to expect next or how he will handle it.

When the normal stress response, or what some experts refer to as the fight or flight response, is triggered, the brain signals the adrenal glands near the kidneys to release a surge of hormones that includes adrenaline and cortisol.  Adrenaline energizes the body, elevates heart rate and increases blood pressure. Cortisol curbs the activity of body systems not necessary for fending off the danger. It slows digestion, alters immune system functions, shuts down reproductive drive and slows growth. At the same time, it causes an increased release of glucose, or sugar, into the bloodstream, improves the brain’s use of glucose and aids in the release of substances responsible for tissue repair. When a dog growls or a sudden, loud noise erupts, all of these physiological processes happen instantaneously without the person even thinking about them. When the perceived or actual threat resolves, the body and brain return to normal activity.

Stress isn’t only related to potentially harmful events. Many happy occasions come with their fair share of it. A wedding, for example, harbors the unknown of everything from how it will be financed to whether the caterer will come through as promised. Anticipation of life as a married couple can elicit worry. The welcomed birth of a baby is riddled with uncertainties about finances, taking care of a newborn amidst an already demanding schedule and the ability to properly parent it to adulthood.

In addition, some stress is good. It has the power to push a person to move in the right direction. “Stress may be motivating you to make a change in your life,” says Dr. NeSmith, whether that’s a big long-term modification or a small short-term adjustment. Make the change and the stress subsides. The physiological response to stress gets our legs moving away from danger and our voices calling for assistance. It saves us from physical or psychological peril. In addition, it helps us get things done. Accomplishing little things like planning and preparing a meal can depend on an appropriate amount of anxiety over whether family members will enjoy the meal or if it will be completed early enough to get the children to bed on time.

Most stress is acute, meaning that it passes as soon as the situational threat recedes. “Chronic stress comes when a person never sees a way out of the situation,” says Dr. Janis Coffin, M.D., medical director of the Georgia Health Sciences Family Medicine Clinic. In chronic stress, anxiety over the unknown—will the presentation be completed on time, will Mother recover enough to be independent again, will the business make payroll taxes, and so forth—is sustained for long periods of times. Consequently, the body’s stress response remains stimulated, sounding the alarm on and on and maintaining a perpetual state of readiness. It continues to inhibit routine functioning of important body systems and over-arouses others, putting the chronic stress sufferer at increased risk for serious health problems.   

Financial insecurity, job market uncertainty, health concerns, marital problems and caregiver demands, among other things, can cause ongoing elevated fear of the unknown or chronic stress. Issues in multiple areas can compound it. Dr. Coffin says, “The level of stress has increased for the entire population.” Over time a person may become acclimated to the steady worry and not relate common complaints back to his anxieties. Dr. Coffin notes that symptoms can be emotional, physical, cognitive, behavioral or some combination. A quick temper, insomnia, racing thoughts, overeating, unexplained fatigue, severe procrastination, poor decision-making, tearfulness, lower back pain, neck pain, joint pain, lack of focus, headaches and a slew of other ailments indicate that the mind and body are not holding up well under the endless strain. Dr. NeSmith suggests, “Try to notice [symptoms] and identify a pattern.”

flight response contributes to the development of troublesome health issues. “About 30 percent of people who are chronically stressed have signs and symptoms of depression,” notes Dr. Coffin. Obesity, digestive problems, heart disease, memory impairment and prolonged sleep problems have all been linked to chronic stress. Dr. NeSmith, who conducts research on the impact of chronic stress on patients’ recovery after a traumatic injury, explains that sustained activation of the immune system touches off an inflammatory response. Studies suggest that inflammation due to prolonged stress is related to cardiovascular disease, some types of cancer and diabetes. “Our bodies have no more reserves to fight and we end up with immune suppression and we get sick,” she says.

A person’s strategy for coping with chronic stress also influences how much and the way in which it impacts the mind and body. Naturally, when a person feels uncomfortable, physically or emotionally, he tries to do something to make the unpleasant feeling go away. For example, he may attempt to dull the anxiety or pain with alcohol, some other substance or other self-destructive behaviors that bring immediate pleasure but unwanted consequences in the long run. Undesired results, maybe in the form of financial, legal or marital problems, can actually produce more anxiety, co-morbid health concerns and, thus, more stress and eventually a vicious cycle.

Fortunately, the consensus is that progressive damage can be slowed or stopped when chronic stress is properly managed or eliminated. Dr. Coffin recommends getting plenty of exercise, eating healthier, improving sleep habits and reducing the use of alcohol or other substances. Meditative approaches, such as journaling or talking things out with a counselor, trusted confidant or friend can also help

In regard to the stressor itself, Dr. NeSmith says, “If it can be removed, do it.” For example, if a particular personality in the workplace causes the daily angst, explore ways to reduce contact with that person or try to disarm him with kindness or humor. Dr. NeSmith acknowledges, however, that just like adding 30-minutes of exercise to the schedule might be impossible, it might also be a challenge to ditch the source of anxiety. Chronic stressors, despite a person’s efforts to minimize them or to gain control over them, are so vexing because they are not easy to escape.

Still, individual perceptions play a large role in determining who feels stress and under what circumstances. “The meaning we assign to events in our lives,” says Dr. NeSmith, “makes a huge difference in the way we feel stress or don’t. Dr. Coffin agrees that stress is a purely individual experience with the same event eliciting different interpretations from people who experience it simultaneously. While one person describes it in purely negative terms, another may give an account that glows with joy. A third person might feel entirely neutral.

Attitude is everything. According to Dr. NeSmith, the person who interprets events and situations negatively and habitually expects the worst to happen has learned pessimism as a coping strategy. The poorest physical, psychological and social outcomes are predicted for this type of person. Nonetheless, she gives encouragement, saying, “We really have the ability to change our attitude and our outlook in life.”

Learning to reframe events from a positive perspective is a powerful and proven strategy for managing chronic stress. “If it’s not something you can remove from your life, you have to look at it a different way. That’s how people in horrible situations get through them,” adds Dr. NeSmith, who believes that thinking outside of the box and looking at the situation with the goal of identifying the wonderful possibilities in it is a top coping strategy. When lifestyle changes aren’t possible or they’re not enough, change the interpretation of the problem. Find the silver lining in it. Dr. NeSmith advises, “The stress will come out one way or another, whether it’s a good way or a bad way.” Often we have little control over what happens, but a great deal of control over how we respond.

There’s an updated version of the poster featuring the kitten clinging to the rope. Along the way, someone realized that desperately clinching the claw and hanging in there isn’t the answer. The quote at the bottom of the new poster, credited to Franklin D. Roosevelt, reads, “When you get to the end of your rope, tie a knot and hang on.” Make a lifestyle change. Reframe the problem. Manage the stress.

Lucy Adams is a freelance writer and the author of Tuck Your Skirt in Your Panties and Run. She lives in Thomson, Ga. Email Lucy at and visit her website,

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