Cortisol Doesn't Know if Stress is Real or Perceived

Does thinking about stress make it real?

It is easy to think that the effect of stress is only worrisome when there are physical stressors – like working out, or a car accident, or something that feels like an obvious action of stress. We can often forget that mental and emotional stressors can pile on to our stress reaction! Our Hypothalamic-Pituitary-Adrenal (HPA) axis must monitor many daily factors including glucose regulation (when and what we eat), capacity to shuttle glucose to our cells for energy, and the need to run or fight when necessary. This blog will focus on the importance of real and perceived stress and how these stressors show up in the body. A majority of people do not consider how mental stressors, like family gatherings or an important meeting with your boss, can also add to our stress load and affect our HPA axis resilience. Let’s take a look at a few examples:

Julie had a planned trip to see her family for the holidays. She was looking forward to this trip – her family brings her joy, and she finds her time with them to be relaxing and fulfilling. She has to be at the airport by 4:30am to catch her flight, and she usually doesn’t wake up until around 6 am. She will be able to rest once she gets to her destination, and she has time put aside to do that once she arrives.

Travis will be finishing finals for his winter term. As soon as he's done with his finals, he’s driving to see his family. He is expected to be home for the holiday season, and he generally enjoys being with his family. This term has been so stressful, though, between school, work, and then planning for this family trip. With all the stress from this term he has also not been sleeping well.

Between the two scenarios, we have two different stress responses.

Julie’s stress is considered a real stress: a physical stress due to change and/or loss of sleep pattern.

Travis’s stressors are both real and perceived: he has suffered real stress from loss of sleep and poor diurnal regulation. His perceived stressors include schoolwork, juggling multiple expectations, and he knows that his family wants him to be with them during his break from school. He is so tired and stressed and just wants to rest during his holiday break.

Is Stress All in My Head?

The body, more specifically the brain, responds to both real and perceived stressors in the same way. There is no distinction between “good stress” and “bad stress” in our brain – it is an on-off switch. The other major difference regarding the stress response is perception.

In walking through the nuances of stress perception, we can see significant psychological impacts from stress: mental and emotional.

It is well-studied that cortisol and our stress response are invaluable in our day-to-day lives. We rely on cortisol to help us stay ready to fight, flee, or freeze in the presence of stress. Cortisol is an active hormone in glucose regulation and metabolism, as well as supporting a healthy circadian (daytime/nighttime) routine. We have many studies on cortisol and how cortisol responds in acute and chronic phases.

In fact, one study shows the outcomes of thinking about stress, and the effect of how negatively someone thinks about stress. The study outlines three major categories:

• Perception of how stressed a person is (subjectively)
• Do they think their stress affects their health
• Are they implementing stress management techniques

In considering the stress response, it is important to review:

• How often does this stressor occur
• How severe is the stressor
• Does one feel in control of their stress(ors)

In our above example, Julie has a minimal stressor that does not occur often, and she feels in control of this stressor, as she was able to plan and support her routine. Travis has multiple stressors – some that are continuous (like school), and others that may occur infrequently (holiday break with the family). The stress response for Travis is also determined by how severe his stressors feel to him, and how much control he has over these stressors.

Most interestingly, in the above mentioned study, the major impact of stress was not due to the actual stress(or) itself, but the thought of how much the stress was impacting their health! It has been hypothesized that stress can increase risk for diseases, such as cardiovascular disease including high blood pressure, or lack of sleep and loss of cellular repair, etc. This study states that the statistical significance lies in the psychology of how someone interprets their stress as a contributing factor to “bad health”. The commonalities lie in that someone who rates their stress as high, with a negative outlook on stress, will likely see negative health outcomes. On the other hand, the subject who is not bothered by their stressors, and objectively rates that they feel in control and have a positive outlook on how they handle stress or plan to handle stress, have improved health outcomes.

The Additive Effect of Stress

Definitions of stress can be variable depending on who is defining them. Certain experts may categorize stress as more environmental, such as poverty, whereas other experts may define stress through psychological impact: life events (divorce, death, marriage), daily stressors, and exposure. All of these are stressors that can be compartmentalized between perceived and real stressors.

Though we have lots of research on cortisol and its function, collecting data on stress and the effect of stress is complex. There are many factors to consider when evaluating the stress effect. Each person’s baseline of stress is likely different, and these factors are influenced by genetics, environment and social structures, and physical and psychological aspects. When we look at the effects of stress, we are also evaluating the influence of stress on disease and aging. The cumulative effect of stress can influence how well we age. Stress that goes unchecked can have negative effects on memory, sleep, cardiovascular health, nerve health, and can greatly affect mood.

It is noteworthy that negative emotions can greatly impact overall health in general. A stark example of this is how mindset and emotions influence cancer patient health outcomes. Depression and anxiety are most noted to affect patients with cancer. We see in this study that quality of life and risk for recurrence or mortality are increased in cancer patients struggling with mental health and mood concerns. We can see that these factors create a sort of stacking that can also lead to feeling overwhelmed, and the burden of overwhelm can feel out of control. This continues the cycle of perceived stress being significant, as well as overwhelming or insurmountable, and this can contribute to negative thought patterns, furthering the concern of health being affected by stress, and therefore leading to significant health issues in any population. Generally speaking, the more layers to the stress, the more impact stress will have on quality of life, aging, and capacity for stress management.

Reducing the Effects of Stress

It is not as doom and gloom as it sounds! There are options to support reducing this stress effect and managing overall expectations for stress. The key is to ensure a plan for stress management and support. Because each person has a different threshold for stress, a different capacity for managing stress, as well as different layers or components to their stress mountain, the path to support may look different for each person. The stress effect is also responsive to how resilient someone may be to recovery. Resilience is an important factor and should be considered when discussing stress support.

Generally speaking, these are some helpful ways to reduce stress:

• Improve mood: reach out to your support network (friends/family) and practice gratitude
• Practice meditation or prayer
• Identify the cumulative additives to stress: are these daily stressors or occasional? If these stressors are daily, it is important to consider adjusting the daily routine
• Resiliency training: this can include increasing sympathetic vs parasympathetic nervous system balance. Our autonomic nervous system activates the sympathetic nervous system to deal with stress, keeps you awake, and allows the nervous system to be easily activated to respond to stress.
  • The sympathetic nervous system has the capacity to suppress the parasympathetic nervous system as a protective mechanism
  • The sympathetic nervous system drives action (fight/flight), where parasympathetic nervous system functions to calm and rest our system.
  • Support for our parasympathetic nervous system includes calming things like singing, yawning, gargling, and cold water on the face.
• Redefine your schedule: it is important to allow things that don’t overwhelm you. This may include fewer hours at work, implementing boundaries, asking for help, and creating time/space for adventure.
• Allow time for rest and sleep in your schedule

Some folks know that their baseline life includes a high level of stress. Some people are unaware of how much stress is piling into their lives.

Testing is a Great Place to Start

A DUTCH Complete or DUTCH Plus test can offer insights into your stress response. Knowledge is power, and it offers some semblance of control, which can also lead to feeling less overwhelmed. And though stress affects our health outcomes, our perception of how stress is affecting our health has more literal impact on our health. Therefore, the mindset we have walking into our day or into stressful situations can greatly influence how we feel on the other side.

Learn more about this topic in our webinar replay with Dr. Debbie Rice, Addressing the Connections Between
Cortisol and Weight Gain.