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The Brain in Crisis & Chronic Stress
by Michelle Castle Stress is a normal reaction to an abnormal event.
Our Brains and Bodies During a Traumatic or Crisis Event Stress can happen as the result of a single, short-term event that is experienced by the person as traumatic or incredibly stressful. In these situations, we utilize the survival parts of our brain – the basal ganglia (reptilian brain) and the limbic system (emotional brain). The neocortex (thinking brain) which is responsible for higher order functions and with emotional regulation, is turned off during a crisis by the limbic system. It is the limbic system that controls our response to a stressful event and activates our “fight-or-flight” response. Within the limbic system, an are called the amygdala will send a distress signal to the hypothalamus. |
The hypothalamus of the limbic system functions like a command center, communicating with the rest of the body through the nervous system so that the rest of the body has the energy to fight or flee. Adrenaline and cortisol are released in preparation for fighting for fleeing and this is accompanied by changes in multiple physiologic systems. These physiologic changes can include increased respiratory rate, heightened senses, elevated heart rate, possible temporary hearing loss and tunnel vision.
Levels of adrenaline and cortisol will fall back to normal as the body returns to homeostasis.
Our brain changes the way it works in these crisis situations and accessing the neocortex can become exceedingly difficult. Stress can make decision-making more irrational, hurried, and unsystematic. Crisis situations can result in a rapid decrease in our ability to have logical-thinking, inductive, deductive, and abstract-thinking. Crisis and stress situations impair our working memory, increases distraction, lowers reaction time, and reduces our ability to process information. Brains exposed to repeated crisis situations can also be more susceptible to peer pressure, prejudice, and group constraints.
During and in the immediate aftermath of a traumatic or crisis event, there are things we can do, that can help alleviate the consequences of a crisis situation. It is important to remember that each person perceives and reacts differently to each situation. This means that some individuals may not perceive a situation as a traumatic experience, due to their life experiences and personal resiliency. Others might define the same experience it as a life-defining traumatic event. There is no right or wrong reaction to stressful events, and many will need help to process what they saw, experienced and felt during the event.
As healers, we deal with tragedies and extremely difficult situations all the time. We usually see people during their worst moments of life and most of us have been taught how to put our emotions and experience on the back burner. This is how we can do our jobs, maintain clinical objectivity, and provide the needed care in the moment. We also form different connections with our colleagues as well as our patients. These connections may result in more heart dis-stress than others.
It is important to have procedures and avenues for professional support built into the workplace environment. These can include diffusing immediately after an acute or crisis event, a debriefing that is held 24-48 hours after the event, and resilience training to help with learning ways of coping.
Higher levels of care and treatment include access to support through trained individuals in crisis interventions, stress management, trauma-informed care, therapeutic modalities, counselors, and other healthcare professionals.
Levels of adrenaline and cortisol will fall back to normal as the body returns to homeostasis.
Our brain changes the way it works in these crisis situations and accessing the neocortex can become exceedingly difficult. Stress can make decision-making more irrational, hurried, and unsystematic. Crisis situations can result in a rapid decrease in our ability to have logical-thinking, inductive, deductive, and abstract-thinking. Crisis and stress situations impair our working memory, increases distraction, lowers reaction time, and reduces our ability to process information. Brains exposed to repeated crisis situations can also be more susceptible to peer pressure, prejudice, and group constraints.
During and in the immediate aftermath of a traumatic or crisis event, there are things we can do, that can help alleviate the consequences of a crisis situation. It is important to remember that each person perceives and reacts differently to each situation. This means that some individuals may not perceive a situation as a traumatic experience, due to their life experiences and personal resiliency. Others might define the same experience it as a life-defining traumatic event. There is no right or wrong reaction to stressful events, and many will need help to process what they saw, experienced and felt during the event.
As healers, we deal with tragedies and extremely difficult situations all the time. We usually see people during their worst moments of life and most of us have been taught how to put our emotions and experience on the back burner. This is how we can do our jobs, maintain clinical objectivity, and provide the needed care in the moment. We also form different connections with our colleagues as well as our patients. These connections may result in more heart dis-stress than others.
It is important to have procedures and avenues for professional support built into the workplace environment. These can include diffusing immediately after an acute or crisis event, a debriefing that is held 24-48 hours after the event, and resilience training to help with learning ways of coping.
Higher levels of care and treatment include access to support through trained individuals in crisis interventions, stress management, trauma-informed care, therapeutic modalities, counselors, and other healthcare professionals.
What Happens Under Chronic Stress
Stress occurs for multiple reasons. The 2015 Stress in America survey reported “that money and work were the top two sources of stress for adults in the United States for the eighth year in a row”.
Other contributors included family responsibilities, personal health concerns, health problems affecting the family and the economy. When recurring conditions cause stress that is both intense and sustained over a long period of time, it can be referred to as chronic stress. While all stress triggers physiological reactions, chronic stress is specifically problematic because of the significant harm it can do to the functioning of the body and the brain. When chronic stress is experienced, the body makes more cortisol than it has a chance to release. High levels of cortisol can wear down the brain’s ability to function properly and increase the risk of heart disease, high blood pressure, and diabetes. Other systems of the body, such as the digestive, excretory and reproductive systems may also not function correctly. Chronic toxic stress can impair the body’s immune system and exacerbate existing illnesses.
Stress can cause physical, spiritual, cognitive, and emotional stress that leads to compassion fatigue and vicarious trauma. The individual experiencing chronic stress may also experience fatigue, insomnia or sleep changes, changes in appetite, digestive problems and headaches. Cognitive changes such as a lack of focus and concentration, flashbacks, decision-making difficulties and poor problem solving may also be experienced. Our emotions are impacted and individuals are more likely to experience anxiety, depression, anger, emotional numbing, and irritability. These short-term emotional changes can result in longer term behavioral changes including decreased empathy, decreased sense of purpose or accomplishment and depersonalization.
Chronic stress that is not resolved, and especially when it involves moral stress or injury, eventually will lead to burnout. Burnout is a state of profound exhaustion in all areas and is a major component to anxiety, depression, and suicidal thoughts or actions. Moral injury is a major contributor to burnout and suicides in the healthcare fields when a healthcare professional must go against their personal and/or professional values and ethics. Stress reaction components can include feelings of a loss of autonomy or agency, helplessness, ethical violations, confidence, anger, grief, and guilt.
Workplaces should have policies and procedures to recognize and support members of the care team. This includes all levels, from peers, managers, supervisors, upper management and owners. Peer support is invaluable since our co-workers spend the most time with us and may be able to know or see changes in behavior or other signs of distress. Managers should have an active role with checking in with each person, asking how they are personally doing and offering true open-door policies that is safe for one to ask for support. When discussing policies, having input from the whole team is helpful and can be invaluable in terms of retention and workplace satisfaction. Ask all levels of the team, how this will impact how the essentials of the job and the daily functions of the practice. A key piece is to have continuing education opportunities that provide training on stress, coping skills, and resiliency training and offer time during the workday for self-care and resiliency practices. This can be as simple as implementing a 5-minute mindfulness practice at the beginning of the shift. Also, offer and utilize employee assistance programs for individual and team support services. More opportunities and education on these will be offered.
Remember: Social support is needed to combat stress and is “Being truly heard and seen by the people around us, feeling that we are held in someone else’s mind and heart” – Bessel A. van der Kolk, MD “The Body Keeps the Score: Brain, Mind and Body in the Healing of Trauma” (2015).
Stress occurs for multiple reasons. The 2015 Stress in America survey reported “that money and work were the top two sources of stress for adults in the United States for the eighth year in a row”.
Other contributors included family responsibilities, personal health concerns, health problems affecting the family and the economy. When recurring conditions cause stress that is both intense and sustained over a long period of time, it can be referred to as chronic stress. While all stress triggers physiological reactions, chronic stress is specifically problematic because of the significant harm it can do to the functioning of the body and the brain. When chronic stress is experienced, the body makes more cortisol than it has a chance to release. High levels of cortisol can wear down the brain’s ability to function properly and increase the risk of heart disease, high blood pressure, and diabetes. Other systems of the body, such as the digestive, excretory and reproductive systems may also not function correctly. Chronic toxic stress can impair the body’s immune system and exacerbate existing illnesses.
Stress can cause physical, spiritual, cognitive, and emotional stress that leads to compassion fatigue and vicarious trauma. The individual experiencing chronic stress may also experience fatigue, insomnia or sleep changes, changes in appetite, digestive problems and headaches. Cognitive changes such as a lack of focus and concentration, flashbacks, decision-making difficulties and poor problem solving may also be experienced. Our emotions are impacted and individuals are more likely to experience anxiety, depression, anger, emotional numbing, and irritability. These short-term emotional changes can result in longer term behavioral changes including decreased empathy, decreased sense of purpose or accomplishment and depersonalization.
Chronic stress that is not resolved, and especially when it involves moral stress or injury, eventually will lead to burnout. Burnout is a state of profound exhaustion in all areas and is a major component to anxiety, depression, and suicidal thoughts or actions. Moral injury is a major contributor to burnout and suicides in the healthcare fields when a healthcare professional must go against their personal and/or professional values and ethics. Stress reaction components can include feelings of a loss of autonomy or agency, helplessness, ethical violations, confidence, anger, grief, and guilt.
Workplaces should have policies and procedures to recognize and support members of the care team. This includes all levels, from peers, managers, supervisors, upper management and owners. Peer support is invaluable since our co-workers spend the most time with us and may be able to know or see changes in behavior or other signs of distress. Managers should have an active role with checking in with each person, asking how they are personally doing and offering true open-door policies that is safe for one to ask for support. When discussing policies, having input from the whole team is helpful and can be invaluable in terms of retention and workplace satisfaction. Ask all levels of the team, how this will impact how the essentials of the job and the daily functions of the practice. A key piece is to have continuing education opportunities that provide training on stress, coping skills, and resiliency training and offer time during the workday for self-care and resiliency practices. This can be as simple as implementing a 5-minute mindfulness practice at the beginning of the shift. Also, offer and utilize employee assistance programs for individual and team support services. More opportunities and education on these will be offered.
Remember: Social support is needed to combat stress and is “Being truly heard and seen by the people around us, feeling that we are held in someone else’s mind and heart” – Bessel A. van der Kolk, MD “The Body Keeps the Score: Brain, Mind and Body in the Healing of Trauma” (2015).
References:
1. Bernstein, R. 2016. The Mind and Mental Health: How Stress Affects the Brain. Health and Human Services. Retrieved on July 5, 2020, from https://www.tuw.edu/health/how-stress-affects-the-brain/#:~:text=Chronic%20stress%20has%20a%20shrinking,brain%20more%20receptive%20to%20stress.
2. 2018. Your Brain Under Stress: It’s a scary thing. The Noggin Blog. Retrieved on July 5, 2020, from https://www.noggin.io/blog/your-brain-under-stress-its-a-scary-thing.
1. Bernstein, R. 2016. The Mind and Mental Health: How Stress Affects the Brain. Health and Human Services. Retrieved on July 5, 2020, from https://www.tuw.edu/health/how-stress-affects-the-brain/#:~:text=Chronic%20stress%20has%20a%20shrinking,brain%20more%20receptive%20to%20stress.
2. 2018. Your Brain Under Stress: It’s a scary thing. The Noggin Blog. Retrieved on July 5, 2020, from https://www.noggin.io/blog/your-brain-under-stress-its-a-scary-thing.
