When does stress help you and when does it hurt you? There is no doubt that stresses of the wrong sort can lead to anxiety, emotional turmoil — and eventually depression and diseases like atherosclerosis and cancer. Yet a central theme of this blog is that certain stresses are “hormetic”: at the right dose and frequency, stress can actually make you stronger and more resilient. The many posts on this blog illustrate how stress can be channelled to build muscle, retrain appetite, improve eyesight, strengthen immunity, defeat allergies, and tame addictions and anger. Judicious exposure to stress can even promote joy and excellent health.
But one can come away from the study of hormesis with the misleading impression that it’s all about adjusting the level and timing of stressors to induce an appropriate adaptive or defensive response. In this article, I would like to focus on a frequently overlooked ingredient in hormesis: the role of intention, attitude and voluntary choice. If you omit this ingredient, you are leaving out an important element of the way that stress helps you become stronger.
Voluntary, deliberate exposure to stress can be particularly effective in providing psychological benefits, including overcoming anxieties, obsessions and phobias, and vanquishing appetite cravings, addictions. Beyond overcoming such self-defeating tendencies, deliberate exposure works to unleash confidence and generate a sense of joy and accomplishment.
General Adaptation Syndrome. Our modern understanding of stress can be traced in large part to Hans Selye, the Hungarian-born endocrinologist whose detailed studies of animals and humans under stress led to a model of stress as a generalizable force capable of causing disease. Selye distinguished between good stress, which he called “eustress”, and bad stress, which he called “distress”. While acknowledging that some stress is good because it is energizing and activates our defenses, Selye spent most of his career studying the negative effects of exposure to stress, which he fit into a pattern called GAS or General Adaptation Syndrome. Selye claimed that GAS proceeds through three stages:
- Stage 1: Alarm reaction is what is often called “flight or fight” syndrome — a quickening of the heartbeat, tensing of the muscles, release of adrenaline and a cascade of other neurochemicals. This is typically a short term galvanizing response, reversible once the source of stress is removed.
- Stage 2: Resistance or adaptation occurs when the stressor is sustained. Glucocorticoid hormones and catecholamines are ramped up to maintain alertness and provide a continued supply of blood glucose, and blood pressure increases to sustain tonicity of the muscles and other organs. Positive coping and adaptation during this stage can increase resistance and immunity, although not indefinitely. With time, and if continued unimpeded without periods or rest and relaxation, this stage leads to mental fatigue, overtaxing of the adrenal glands and immune system, and vulnerability to disease
- Stage 3: Exhaustion, in which the organism becomes depleted of energy energy reserves and immunity. Mentally, it leads to emotional withdrawal and depression. If sustained, this third stage leads to grave illness and eventual death.
While Selye did acknowledge some positive aspects of stress during Stage 1 and the Stage 2, he did not leave much room in his model to account for the beneficial biological aspects of stress. Looked at this way, only relatively mild and short-term stresses can be considered useful and positive, insofar as they activate readiness and resistance. But even here, Selye held that repetition of Stage 1 and Stage 2 stresses can weaken and degrade resilience. He saw chronic, repetitive, and sustained stress as uniformly damaging to both the psyche and the body. The possibility that routine or frequent stress could significantly and sustainably build resilience was something he did not address.
Learned helplessness. Angela Patmore, in her illuminating book, The Truth About Stress, points out that Selye’s model has led to an emphasis on “stress management”, which is largely about stress prevention and strategies for coping and relaxation. While acknowledging Selye’s contributions, Patmore believes that he overlooked a key factor which can make a very big difference in whether stress is beneficial or detrimental:
In animal experiments using inescapable threat (prolonged and repeated tail shock, forced swim, water restraint, hot plate contact and other ordeals dreamed up by researchers), long-term inability to respond to perceived danger results in a syndrome that is the biological opposite of the galvanizing stress response. In this quite different response, which has nothing at all to do with survival, the subject gives up the struggle for its life and resigns itself to its fate. This is the so-called ‘third phase’ of Selye’s GAS, but it is important to realize, as Selye evidently did not, that the animal may do this in return for a degree of neural tranquilization, and that its brain may now release pentapeptides and other opiate-like substances to dull the pain and horror of its situation. The resigned animal then succumbs to morbid physiological changes…Giving up may buffer you from reality, but at considerable cost. Resignation causes the suppression or shutting down of the immune system. If you’ve given up, why would you need an immune system anyway? (TTAS, pp. 110-111)
The act of “giving up” or resignation literally turns a switch and redirects the entire physiology of the animal’s response into a downward spiral of depression and failing health. This is seen not only with animals, but also in human studies. Patmore describes experiments by Martin Seligman that demonstrate much the same phenomenon:
…Seligman and his colleagues turned their attention to students, shutting them in a room with loud unpleasant noise, and various knobs that might or might not control the volume. Some continued to alter the sound levels. Others gave up. By now Seligman had developed a model of depression based on his experimental work. His concept of learned helplessness — resigned failure to act in the face of threat — has become of fulcrum of psychological research. (TTAS, p. 113)
The concept of learned helpless highlights the importance of looking beyond the type and extent of stress alone, to consider the internal mental state of the subject. The essential factor is the perception of control and self-determination:
A number of key studies in the stress literature have highlighted the importance of control in the vulnerability to illness from distressing experiences. Here we plainly see why this is so. Those who act to help themselves assume control. Those who fail to act requlinquish it…Viktor Frankl studied [first hand] the behavior and susceptibilities of the victims of Auschwitz and Dachau, and formulated a theory of survival that he called the ‘will to meaning’. Of immense significance was self-determination. As Frankl observes: ‘Everything can be take from a man but one thing: the last of the human freedoms – to choose one’s own way.’ Taking action based on personal choice..may also send vital messages from the brain to the body to keep fighting and not fall sick. (TTAS p. 116)
Countering Selye’s GAS theory, Patmore puts forward an alternative theory of stress:
The distress-disease link that he formulated was not the direct, simple bond that he envisaged, but a complex sequence of events dependent on each individual’s psychological make-up, courage and coping skills. According to this alternative theory, disease strikes not a direct result of the response to threat, but as a result of resignation, helplessness and failure to act. (TTAS, p. 118)
Learned control and mastery. We can take these learnings about the negative effects of learned helplessness and turn them around: Perhaps we can enhance the effectiveness of adaptation and resistance to stress by enhancing our sense of intentionality or deliberate control when we are exposed to stress. One way to do this is to train ourselves to become more resilient to stress by deliberately exposing ourselves. This is well recognized in the case weight lifting or athletic training to become physically stronger and more skilled. But I’m talking here about something more fundamental: our attitude towards facing life’s challenges and hardships.
In contrast to the modern ideology of stress management, which teaches us to avoid stress in order to stay healthy and sane, Patmore recalls that
…there was a far different school of thought, dating back to the Romans, based not on avoiding negative emotions such as fear and tension, but on rehearsing them. Children were taught resourcefulness and mental strength by ‘character-forming pursuits’ that developed fortitude and self-mastery. By using the opposite of stress management – emotional rehearsal…our ancestors made themselves psychologically more robust….Childhood dares, games and contests, sport and adventure activities — all provide emotionally challenging experiences that help people to understand and season their own sensations and feelings, and take them through unpleasant emotions in order to achieve a resolution…
This attitude goes back at least to the Stoic philosophers such as Epictetus, Seneca and Marcus Aurelius. William Irvine, in his excellent modern reinterpretation of Stoicism, A Guide to the Good Life, notes:
Indeed, by practicing Stoic self-denial techniques over a long period, Stoics can transform themselves into individuals remarkable for their courage and self-control. They will be able to do things that others dread doing, and they will be able to refrain from things that others cannot resist doing. They will, as a result, be thoroughly in control of themselves.
By rehearsing or training techniques such as these, you can substantially improve your resilience in handling everyday stressors, whether they be physical or social and emotional. But what about situations in which we actually have no real control, or where the outcome is highly uncertain? Perhaps ironically, I think that fostering a sense of control can be helpful even when we may not or do not actually have much control over the situation. By “making the involuntary voluntary”, we can transform the way the way we respond to stress at the deepest levels of both our biology and our psyche.
I think this attitude of voluntarily embracing unavoidable stress is most articulately expressed by Epictetus, the Greek Stoic and slave whose teachings have inspired two millennia of philosophical and religious thought. Epictetus distinguished between externals — the events and actions of others which we cannot control — and internals — our values and attitudes. A slave for much of his life, Epictetus realized how much freedom he nevertheless retained in choosing how to react to his fate. A Stoic “sage”, he said, never finds life intolerable, but sees in every challenge as an opportunity to test and improve oneself:
You should look to the faculties that you have, and say as you behold them, ‘Bring on me now, O Zeus, whatever difficulties you will, for I have the means and the resources granted to me by yourself to bring honour to myself through whatever may come to pass.’ (TD, Book One, Ch. 6, p. 18).
Furthermore, it is by how we handle the challenges in life that our character is revealed and built:
Difficulties are the things that show what men are. Henceforth, when some difficulty befalls you, remember that god, like a wrestling-master, has matched you with a rough young man. (TD, Book One, Ch. 24, p. 53).
By deciding to accept the hardships that come your way, as if you had deliberately chosen them, your reactions are transformed. What may otherwise have been a stress that leads to resignation, giving up, and Selye’s third phase of exhaustion, now becomes a challenge deliberately embraced. This does not mean deceiving oneself and pretending that you can control the uncontrollable. Rather, it means embracing the challenge as an opportunity to demonstrate your ability to handle a physically or emotionally difficult situation with courage and grace, to grow from it, and to actually become stronger, not weaker. Whether or not the stressor eventually diminishes or resolves, with or without your intervention, you are left more resilient as a result.
For a more detailed discussion of Stoicism and its similarity to Hormetism, the philosophy advocated in this blog, I would encourage you to read my page on Stoicism.
Real world applications. Many of you who have read this far may be wondering: “Interesting philosophy, but how do I actually apply this to my life?”. I’d like to answer that by illustrating with three very different examples. Cold showers, intermittent fasting, and exposure therapy for anxiety and phobias.
Cold showers. The single most popular page on this blog is the March 2010 article on Cold Showers. Initially, it surprised me that so many people would show an interest in something that is without any question uncomfortable. And for some people: terrifying. The article recites a number of health benefits that have been shown or claimed to result from taking cold showers or baths.
But the article goes beyond the objective physical health benefits to describe my subjective experience of taking cold showers. In particular, I noted that cold showers are initially quite uncomfortable, provoking an involuntary reactions like rapid breathing, a pumping heart and even laughing. While the shock and discomfort becomes less the more cold showers you take, my experience is that–unless the weather outside is hot–there is almost always hesitation and discomfort when first stepping into the cold shower. It takes an act of will to force myself to do this. But I do it willingly because I’ve come to understand the benefits that result. Beyond that initial hesitation upon jumping into the cold shower each morning, I embrace it and enjoy it.
The intentional, voluntary attitude makes a big difference to the experience. Consider the case of those who must take cold showers unwillingly, perhaps because they have no hot water for a period of their lives, or perhaps were forced to take cold showers at camp or school dormitories. I get comments from such people, and their attitude towards cold showers is typically very negative. It is likely that they did not receive much physical or psychological benefit from taking cold showers. Perhaps the experience even had an adverse effect on them, at least psychologically.
Intermittent fasting. Going without food some days, or eating only one meal per day is the involuntary fate of millions of people living in poverty or near-poverty. It can also happen to you if you become lost, stranded or trapped in a place without ready access to food. This experience of hunger can be quite uncomfortable, even painful.
It’s entirely different matter, however, to abstain from eating periodically for 12-24 hours as a deliberate, voluntary practice. I’m not talking about eating disorders hear, but rather the practice of intermittent fasting (IF), undertaken to achieve not merely for healthful weight management, but for the well-documented health and longevity benefits, which I’ve discussed in my video article, Intermittent fasting for health and longevity. When you engage in IF voluntarily, you’ll surely experience moments and periods of hunger cravings. But in just knowing that hunger cravings are expected and are possible to
“ride out” without adverse effects, you gain a sense of control over your urges. You soon come to recognize the difference between a conditioned craving that can be extinguished by training, and true biological hunger that deserves attention. The sense of achievement in mastering your appetite, rather than being its slave, can be empowering.
I’ve found that intermittent fasting works best for me when I am the one who controls the eating schedule. Rather than follow someone else’s rigidly prescribed diet or eating schedule, I like the flexibility that IF affords. I can choose which days to fast and which meals to skip, adapting the schedule to the demands of my week. But once I make a decision, for example to skip breakfast and lunch tomorrow, I am very disciplined about sticking to my plan. Here again, I believe that feeling “in control” plays an important role in the outcome. A prisoner forced to follow a fasting regimen against his would be much less likely to reap the benefits — unless perhaps he decided to “own” the imposed diet in the manner of Epictetus.
Exposure therapy for anxiety, obsessions, and phobias. One of the most common and successful approaches to treating anxiety, fear and obsessive-compulsive disorder (OCD) is the use of exposure therapy. Often this involves both a cognitive and a behavioral component, in which a therapist works with the patient to identify beliefs, emotions and responses relating to stimuli that provoke anxiety, fear, obsessive thoughts and compulsive behaviors. Cognitive Behavioral Therapy (CBT) emphasizes the cognitive component and proceeds by demonstrating that the underlying beliefs are false or irrational.
My personal view is that the changing the behavioral component by controlled exposure to the problematic stimulus is the most important aspect of exposure therapy, and may be sufficient even without examining your beliefs. The essential element of treatment is progressive exposure to stronger stimuli until habituation or extinction occurs. The theory of Pavlovian extinction and deconditioning is discussed in more detail on the Psychology page of this blog.
So if you have a fear of height, snakes, or social situations, you should progressively–and very gradually–expose yourself to tougher situations. To counteract acrophobia, you could start by ascending very small elevations. Walk to a height that just begins to make you anxious and hold there for a while, but retreat before it becomes too uncomfortable. If you fear snakes, start by looking at photographs of snakes, then handle fake rubber snakes, or observe real snakes cages at zoos. Eventually, work on handling real, but harmless snakes for increasing amounts of time For social situations, start with small groups of friends, and build from there. A related version of this exposure therapy, called exposure and response prevention, has been found useful in treating OCD. The key is to recognize the obsessive thoughts or compulsive behaviors as “escape responses” or “safety behaviors” in response to stressful stimuli, while learning to prevent the escape response to progressively stronger stimuli.
It is especially important with exposure therapies that you stay in control of the situation at all times. There must always be an “exit hatch” that allows you to back down and escape or stop the stressful stimulus before real panic sets in. Being forced by a therapist or third party to go beyond the edge of your comfort zone can be extremely counterproductive and anxiety-inducing. The therapist, if any, should be at best a “guide” or coach. If you are strongly motivated to succeed, exposure therapy may be quite effective if you do it yourself, without a therapist.
Psychology and hormesis. What all the above practices and treatments have in common is an important psychological dimension. In each situation, the extent to which the exposure process is voluntary is the key to successful hormesis. When stress exposure is voluntary, the gains in resilience can be substantial, even when the stress faced is sustained or repeated over the long term. Contrary to Selye, chronic and repeated exposure to stress does not invariably lead to impaired health and depression. What is perceived as stress can be turned into an energizing stimulus, when it is approached with a willing and inviting attitude. Just as you can decide to “give up” in the face of stress, you can make the opposite choice: to persevere and embrace mastering what challenges you.
Voluntariness is not an essential component of all types of hormesis. For example, it is likely that low level exposures to radiation, chemical toxins and allergens build biological resilience by activating DNA and mitochondrial repair mechanisms, endogenous antioxidant enzymes, and immune responses that involve no psychological or neurological mediation. But a surprisingly large realm of human biology, including digestive, metabolic, immune processes — has a significant psychological or neurological dimension. An entire field — psychoneuroimmunology — has been laboring to elucidate the mechanisms of such neurologically-mediated processes. Human intentionality — or what is sometimes called “will”– must be considered a key factor in the successful application of hormesis to improve your health.
At points, paradoxically in spite of his focus on the detrimental aspects of stress, Selye himself came close to appreciating the importance of this. I was particularly struck by one statement attributed to Han Selye, that succinctly crystallizes the essential insight of this entire article:
“Adopting the right attitude can convert a negative stress into a positive one.”