This post is by associate Triage Practitioner, and guest blogger, Matthew Savage
Awareness of stress and its effects on the human body has grown dramatically over the last few decades, with a multitude of disciplines contributing to a better understanding. However, previously stress research was mainly focused on adults and their experience of stress, with a debate surrounding stress as a negative influence compared to stress as a positive driver for action. In recent decades and as our understanding has increased, stress studies have started to examine stress across the lifespan, from pre-natal, to phases of childhood, middle age and older adults.
Pre-natal stress
There have always been issues with measuring pre-natal stress, with a focus on situations where stress occurs as a natural event. Stress during pregnancy can lead to high blood pressure and other negative effects, leading to premature birth or low birth weight. As an example, pre-natal stress has been shown to have a huge effect on the offspring of mice, and some human studies have also yielded very interesting results. After stressing mice daily during pregnancy, it was found that the offspring from gestational stressed mothers exhibited depression-like and anxiety behaviours, as well as biochemical changes to their brains. Biochemically, stress-offspring showed decreased expression of certain fluids in the hippocampus, along with certain enzyme expression which play a huge role in gene expression and inflammation (de Ruijter et al., 2003). These changes have been linked to low birth weight and have also been found to be a measure of pre-natal stress as the stress. Interestingly, recent studies have shown that low birth weight has been linked with higher elevated glucocorticoid secretion in adulthood, suggesting that our weight at birth can be an indicator of later stress reactions (Wust et al, 2005). Prenatal stress has been linked to metabolic disorders, increased basal activity and responsivity in the HPA axis, impairments in cognitive functions and memory deficits due to lower levels of neurogenesis. Multiple studies have shown that if a mother is stressed, anxious or depressed during pregnancy, this increases the chances of her child having emotional problems, ADHD, conduct disorder and impaired cognitive development (Glover, 2019). This makes it vitally important to account for stress during pregnancy, such as we would account for nutritional intake.
Post-natal stress
Once a child is born, it is important for a baby to receive a lot of love and attention for a variety of reasons, particularly to ensure stress levels are kept at a minimum in the early years. As early as the 1950s, studies were taking place to examine the difference that comfort and touch had on monkeys by feeding a group with a wooden mechanical arm and comparing their growth levels to a group fed by an arm covered in soft, comfortable fabric. This was a highly controversial experiment, but it demonstrated that monkeys comforted whilst feeding had much better outcomes in terms of growth. Later, a similar study took place with premature babies, where babies were stroked and touched for 15 minutes, three times a day. These babies grew 50% more in weight and were more alert in comparison to those that were not touched (Field et al, 1998). These studies led to concepts of stress as a young child and the importance of reducing this through close attachment. Attachment theories comparing the behaviour of young children based on their attachment style have developed from such stress studies. It was found that children who exhibit insecure anxious behaviours (children that showed a fear of rejection, separation, and high desire for company) also had higher cortisol reactivity when cortisol saliva concentrations were examined, as well as longer lasting stress responses (Smyth et al, 2015). This is important to understand as providing children with a stress-free environment can be done by providing comfort, and this leads to better growth outcomes due to higher absorption of necessary vitamins and minerals, higher resistance to disease and better resilience in adulthood. Being aware of what children find stressful is important; anything new and unfamiliar, changes in family situations, conflict, and stress in the family are all examples of these stressors and are important to reduce particularly as children move into adolescence.
Stress and Adolescence
There are a number of developmental and biological factors which can become issues during adolescence. As a period of many psychosocial and physiological changes, stress can become both a driver and also a huge issue during this important period of life, depending on coping mechanisms developed in earlier years. School pressures, career decisions, family and peer conflicts, peer pressure and bullying can all be common pressures adolescents face and it is important to ensure positive support and coping mechanisms are learnt prior to this period of life. The Adverse Childhood Event (ACE) studies examined the prevalence of adverse childhood events in under 18s and the impact these can have on health and behaviours both short and long term (Centres for Disease Control and Kaiser, 1995). The original study contained over 17,000 participants and examined three areas of adverse experience: abuse (emotional, physical, sexual), household challenges (domestic violence, substance abuse, mental illness, separation/divorce, incarcerated household member) and neglect (emotional and physical). Higher scores have been linked to higher negative outcomes with the term “toxic stress” being used to relate to an accumulation of early years stressors and excessive activation of the stress response. This can have a negative impact on a child’s developing brain, as well as the immune system, metabolic regulatory systems, and cardiovascular system. The more ACEs a child has is also heavily associated with heart disease, diabetes, substance abuse, poor academic achievement, increased risk behaviours and the development of psychiatric disorders such as schizophrenia in adolescence. This makes it extremely important to ensure children and adolescences are supported to live in an environment with reduced sources of stress, to foster strong, responsive relationships between parents and children, and to encourage stress reducing behaviours such as spending time in nature, encouraging meditation, physical exercise and aiding children to develop core life skills. Understanding and accounting for ACE’s gives caregivers and healthcare providers an opportunity to develop prevention strategies and support networks to assist individuals who have suffered ACE’s, as well as help young adults transition into adulthood.
Middle Age onto retirement
Hormonal changes in men and women, as well as psychosocial aspects of life in middle-age are often causes of the well documented “mid-life crisis”. Explanations exists that middle-age leads to a “sandwich of responsibilities”, whereby individuals and couples are expected to take care of their children, and also their parents. This is becoming a greater issue today as parents are living longer, with more chronic illness, and children are also staying at home longer. Longitudinal studies have also examined generational differences, with those born in 1970 experiencing higher middle-age stress because they left school at a time during major recession, impacting their psychological outlook on life. In addition to this, factors such as changing roles in life, a lack of perceived control and environmental factors such as financial management can all lead to a stress response and “burnout”, another term for emotional exhaustion can develop, leading to feelings of fatigue, a negative and cynical attitude and a reduced sense of personal accomplishment (Maslach et al, 1996). Burnout is extremely common amongst high-flyers, those in vocational careers, long-term family carers and those who suffer chronic conditions such as diabetes. Although not included in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), burnout is now included in the International Classification of Diseases (2019), giving it more recognition as a condition which requires attention. Over time, elevated stress response can lead to an increased level of glucocorticoids, and burnout is increasingly linked with the risk of depression. Depressives have an over-active stress response and typically elevated levels of glucocorticoids. As we age, the stress response is often overactivated, hormone levels take longer to return to normal and these can contribute to diseases such as Coronary Heart Disease.
Conclusions - the good news about aging
As has been suggested, stress is a factor that must be considered throughout the lifespan and our ability to respond and deal with stress is often reliant on previous events. As we age, we can develop or refine our coping mechanisms, improve our resilience and examine adverse childhood events in a hope to understand and correct their negative impacts. As we age, reduced social networks occur but often provide better quality relationships, meaning many of us have more support than we consider. We develop greater social intelligence as we age and may develop increased levels of happiness with the right tools. Such tools can include the support of a psychological therapist and through psychological therapies such as Cognitive Behavioural Therapy (CBT). CBT is defined as “cognitive appraisal based on lack of information, misperceptions or irrational beliefs (Beck, 1976) and helps individuals identify, recognise, change cognitive errors and appraise their situation through skill-based learning. These are all important factors to understand as a greater understanding of these conditions and mechanisms can help us to self-reflect, to examine recent changes in life circumstances as we age and to examine aspects of our lives which may be leading to an increased stress response. This, in turn, will help parents to support their children to develop more positive coping strategies which they can use throughout their lives and to develop positive learning and growth environments. Coaching and resilience training are also great options for helping individuals to make positive decisions throughout the life cycle.
About Matt Savage
Matthew Savage is an associate Triage Practitioner, has an MSc in Psychology, is a qualified personal trainer, and has worked within the field of cognitive rehabilitation for 5 years. He is an FA qualified football coach, with a keen interest in moral behaviour and wellbeing within team sports.
References
- Beck, A. T. (1976). Cognitive therapy and the emotional disorders. International Universities Press.
- Center on the Developing Child, Harvard University, (2018). ACEs and Toxic Stress: Frequently Asked Questions. Harvard University
- de Ruijter AJ, van Gennip AH, Caron HN, Kemp S, van Kuilenburg AB. (2003). Histone deacetylases (HDACs): characterization of the classical HDAC family. Biochem J. 2003;370(Pt 3):737-749. doi:10.1042/BJ20021321
- Field, T. M. (1998). Touch Therapy Effects on Development. University of Miami School of Medicine, USA.
- Glover, V. (2019). The Effects of Prenatal Stress on Child Behavioural and Cognitive Outcomes Start at the Beginning. Institute of Reproductive and Developmental Biology, Imperial College London
- Maslach C, Leiter MP. (1996). Understanding the burnout experience: recent research and its implications for psychiatry. World Psychiatry. 2016;15(2):103-111. doi:10.1002/wps.20311
- Wüst S, Entringer S, Federenko IS, Schlotz W, Hellhammer DH. Birth weight is associated with salivary cortisol responses to psychosocial stress in adult life. Psychoneuroendocrinology. 2005;30(6):591-598. doi:10.1016/j.psyneuen.2005.01.008