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An Ultimate Guide to Stress: The Science Behind Why You Get Stressed

October 29, 2020 20 min read

An Ultimate Guide to Stress: The Science Behind Why You Get Stressed

This guide is designed to explain everything you may want to know about stress’ effects on the body in an easy to understand manner while also providing a breadth of detail into the science of stress. We’ll also be covering some ways you can have balanced levels of stress in your life by giving some lifestyle tips on reducing excessive stress you may accumulate from day to day life. But before all that, first we must define what stress is in the first place.


Defining Stress

What we’ll be primarily focused on is psychological stress. It’s important to realize that just because this form of stress is mental, it doesn’t mean itcannotharm your physical body as well. Mental stress can very much affect you physically too, which is why it’s important to ensure it is kept in check. Another important thing to know is that not all stress is bad - stress is simply the body's response to changes that create a taxing demand.


Eustress Vs. Distress


Eustress is the term used for positive stressors, while Distress is used to define negative stressors. Eustress is motivational, typically short-term, does not feel overwhelming (actually, it usually feels exciting to experience), and can improve your performance. Most importantly, tasks which cause eustress lead to a rewarding experience rather than feeling relief. Some examples which cause positive stress include things such as cooking a satisfactory meal, completing a personal short term goal, gardening, winning at a game, starting a new job, or completing a puzzle.


Distress on the other hand are the stressors that cause negative experiences. They can’t always be avoided in life, but being aware of them can aid in coping with them. They can cause anxiety, can be shortor long-term, are perceived as outside of our coping abilities, can decrease overall performance in all kinds of tasks, and most concerning of all, have the ability to lead to both mental and physical health problems. Some wide examples of that which can cause varying levels of distress include the death of a loved one, abuse, illness or injury, financial issues, unenjoyable repetitive tasks, difficult testing, social conflict, and trouble sleeping.[1]


Three Main Types of Psychological Distress

Within distress that is caused mentally, there are three distinct forms to be aware of that indicate the severity of the distress.[2]


  • Acute Stress: This form of distress is shorter term. It can cause situational anxiety which increases your heart pulse and blood pressure, along with muscle stiffness, headaches, and intestinal pain, depending on severity and length of time - but these symptoms tend to subside rather quickly but gradually as the acute stressor eases on by. Acute Stress is always caused by a specific short term negative situation, such as a near miss of having severe injury, a heated argument, a foreboding phone call, or a deadline that is due soon. Despite this, acute stressors don’t typically severely interfere with your life or well being, and can still be handled decently well. If they happen regularly and frequently however, they are categorized as something else.

  • Episodic Acute Stress: When acute stressors happen frequently, then it becomes episodic acute stress. While the symptoms are similar at first, they occur more often and keep building up over time, slowly worsening. This causes the person to begin to live in a near constant state of tension, and, over time, can start to affect your social and work life. After a while, it can also begin to affect your health, with the negative health effects amplifying if you deal with these stressors using unhealthy coping mechanisms, such as binge drinking, overeating, or constant gambling. Fortunately, this form of stress can still be managed with small actions that help offset the negativity, such as social counselling or activity, hobbies you enjoy, light exercise, or small personal goals that you set for yourself that are easy to achieve, such as drinking a little less alcohol to save money and purchase something you pick out, cleaning or organizing your bedroom, or trying some new things. If this form of distress is poorly managed however, it can lead to serious illnesses like cardiac disease or clinical depression, so if all else is failing, it is recommended you seek out a professional therapist to aid you as well. 

  • Chronic Stress: This form of stress if the kind which wears you down with its continuous near daily - if not daily- onslaught. This is the kind of stress that mentally and physically wears people down over the years. It nearly always arises from serious life problems that are usually out of our control. Although it is typically associated with underdeveloped countries in which the population suffers in harsh environments that include poverty, war, and/or famine, this form of stress can still be prevalent in developed countries since it is not limited to overall societal environments. Factors such as abuse, trauma, and consistent overload can also lead to chronic stress. Things like childhood trauma, non stop, extremely demanding work, or years of spousal abuse can alter your brain to behave as if perpetually threatened by poverty or illness as well, causing a generalized anxiety disorder which then makes the chronic stress persist in a feedback loop. Regardless if the cause of your chronic stress is the environment you are in or your state of mind, most stop trying to change things and instead try to accommodate to the situation, which means this form of stress can also be very well hidden. Despite that, it is important you get professional help if you think you may be suffering from chronic stress, as having it long term can cause serious mental and physical health illnesses.

The Hypothalamic-Pituitary-Adrenal (HPA) Axis


This axis plays an important role in your stress response, and is a major function of the neuro-endocrine system. The communication between these three glands regulate many body processes, such as digestion, mood, the immune system, emotions, sexuality, and of course, stress response. The HPA axis is the intricate “phone line network” between your brain and your hormonal system. Namely, the HPA axis contains 3 hormone secreting glands from your nervous and endocrine system: the hypothalamus, pituitary, and adrenal glands. The hypothalamus sits just above the brainstem, and controls the release of hormones to the pituitary gland. It registers external stimuli, processes it, and then signals the pituitary gland. In turn, the pituitary gland controls the release of hormones to the bloodstream, which can reach several targets, in order to send the brainstem’s “command” to the rest of the body. In the case of the HPA, we want to focus on how hormones from the pituitary gland travel down through the bloodstream, reach the kidneys, and then affect the secretion of hormones from the adrenal glands, which sit on top of the kidneys. The adrenal glands are heavily involved in stress response, and therefore are of high importance when talking about how stress affects the body. If you’ve ever read about amazing feats of strength someone displayed when in a highly stressful situation, such as a mother lifting a car to save her child, or if you’ve ever gotten a sudden surge of energy despite being tired - that is the work of the adrenal glands.[3]




Effects of Continuous Stress on the Physical Health


I’ve mentioned here a few times that distress can cause mental and physical illness, but have yet to explain how exactly that happens. In this section, we’ll cover the effects of continued forms of stress on various bodily systems in closer detail so you can be informed of exactly how stress can affect your body if left unmanaged.


Lymphatic-Immune System

Distress (along with a variety of psychiatric illnesses that can be caused by long term chronic stress) are increasingly reported to be associated with immunosuppression. The main observed cause of this is due to stress signals that disturb homeostasis by altering the equilibrium of various hormones which have a significant impact on the immune response in general. This disruption in turn leads to a weakened immune system and a lagging response to action against disease.[4]This suppressive effect is also easily visible as a form of burnout, when after a difficult prolonged period of stressful work and sudden vacation you get sick with flu like symptoms due to your immune system having been diminished and barely keeping up with demands while at work. 


Post burnout illness is not however the greatest danger prolonged chronic stress can present. Suppression caused by excessive stress in the long term can lead to a higher chance of developing cancer, since another important role your lymphatic-immune system has is killing cancer cells that develop in your body.[5]T-cells, which are the primary immune cell in charge of detecting and eliminating cancer, have diminished production when your body undergoes the kind of distress that affects your lymphatic-immune system. Not only that, but they are less likely to detect cancer cells due to the endocrine disruption as well.


Cardiovascular System

Psychological stress causes changes in sympathetic-parasympathetic balance and of the HPA axis, which can negatively affect the cardiovascular system - both acutely, by precipitating myocardial infarction, left-ventricular pressure dysfunction, or dysrhythmia - and chronically, by accelerating the process of arteries hardening and narrowing.[6] Although there are various ways how these things can occur through stress, I’ll be quickly covering a few more common ones instead, to keep things from getting too long.


The first one to cover is how emotional stress affects your heart directly. Distress caused by constant anxiety for example elicits a hormonal response which increases your heart rate to high levels. This means that if the anxiety lasts for hours, it would be the equivalent of running non stop for hours, but without the benefit of exercise and movement. This in turn can then lead to an increased blood pressure, which then in turn can cause other cardiovascular issues including affecting the ventricles in the heart, which can eventually lead to a cycle of dysfunction.[7]The constant anxiety doesn’t even have to be caused by a single extreme source of distress either - it can be caused by poverty for example, which leads to those suffering from it to constantly wonder what or if they’ll be able to eat or have electricity (which is one big reason cardiovascular health tends to be poor in impoverished communities in developed countries - they suffer from constant anxiety while not necessarily partaking in laborious tasks as those in poverty in underdeveloped countries).


Another primary way that constant or sudden but huge sources of distress can cause issues in the cardiovascular system is through disruptions in the parasympathetic nervous system. The parasympathetic nervous system innervates tissues throughout the body, especially the heart, vasculature,

and adrenal medulla, and it is through these means by which the brain controls organs in response to acute stressors (this is also how your brain manages to perform automatic tasks, such as the speed your heart pumps at or breathing - at least until you think about your own breathing, like right now). Excessive stress causes disruptions to regulation of stasis of your parasympathetic nervous system by causing increased concentrations of circulating catecholamines, corticotropin, and cortisol, which in turn increase heart rate, blood pressure, sympathetic nerve outflow, and blood viscosity.[8]Now, your cardiovascular system can normally handle these “shocks” of disruption short term (unless you are already suffering from a chronic cardiac illness), but repeated exposure to these events can cause damage that can then build up over years.


Endocrine System

This section I will keep short, as how stress affects the endocrine system has already been partially covered in the section talking about the HPA axis.


Other than the HPA axis relaying responses to stressful stimuli to the rest of your body, the rest of the endocrine system can begin to malfunction from repeated exposure to chronic stress. The reasons vary, from a developed oversensitivity to stressful stimuli due to constant exposure, to the brain releasing more of certain hormones as a way to cope with the excessive stress. This can not only lead to many kinds of issues, since the endocrine system affects all major organs, but also to mental illnesses such as long term depression.[9]


Digestive System

You may have yourself at some point felt the effects of stress on your digestive system. During stress, the gastrointestinal system is inhibited via the vagus nerve, while also being overstimulated at the level of the large bowel via the sacral parasympathetic system, which is activated by brain stem derived norepinephrine.[10] This nearly always leads to the sensation of having to use the bathroom suddenly or consistently, depending how long the source of distress lasts and the intensity. In some cases however, rather than speeding up motor function through stimulation in the large bowel, stress can instead slow down motor function, leading to constipation.


However, although that is the most commonly experienced and known form of digestive stress, there are others as well. Functional disorders can involve all parts of digestive tract: feeling of obstruction the upper esophagus (dysphagia), irritable bowel syndrome, vomiting and pain in right abdominal upper quadrant which might correspond to a form of migraine without headache, and ulcers to name some examples. These mainly occur in the younger, anxious, and/or sometimes obsessional population.[11] These more severe symptoms that are mentioned are more commonly formed by episodic or chronic distress however, rather than acute. However, they can lead to serious health complications in the long term if not taken care of, such as anemia, malnutrition and/or severe weight loss (and not the good or pleasant kind).


Effects of Stress on the Brain

Distress can affect your brain in different ways. Here’s how:


Memory: There is evidence that cortisol levels in the blood can affect your memory, although how exactly is not completely known yet. One example is an investigation that was conducted to explore the relationship between acute changes in cortisol and memory and attention in the context of an acute stressor commonly experienced: examination stress.[12] Sixty students (36 male, 24 female) participated in an assessment of self-reported levels of stress, had their salivary cortisol measured, and had their short term memory, selective and divided attention, and auditory verbal working memory checked. Assessments were conducted during both a “relaxed” and exam period.

 

The results revealed that although the exam period was associated with an increase in perceived levels of stress, there was a significant reduction in levels of salivary cortisol, compared with the non-exam period. This reduction in cortisol was associated with enhanced short-term memory (as measured by the total number of words recalled in a free recall task), impaired attention, and an impairment in a hippocampal-specific index of short term memory (but with no significant effects on auditory verbal working memory).[13]


Emotional stress on the other hand seems to greatly affect how well a memory is stored, with the greater the emotional stress, the more accurate and detailed the memory. This however isn’t always good, as when it comes to negative memories, such as those caused by abuse or trauma, the memory can trigger an adrenal response and/or cause the anxiety felt during the event all over again.[14]The unique features of stress-induced plasticity in the amygdala, in association with changes in other brain regions, could have long-term consequences for cognitive performance and pathological anxiety exhibited in people with affective mental disorders. Sometimes, having an improved memory is not a positive thing.


Cognition: Corticosteroid hormones secreted by the adrenal cortex protect the brain against adverse events and are essential for cognitive performance. Typically, they are helpful in that they let you adapt and overcome stimuli which cause distress. However, that is not always the case - sometimes, they can lead to maladaptive behaviors that make things worse instead. They can cause the person to seek activities which cause a dopamine response feedback loop, such as the kind found in gambling or drinking excessive alcohol. These maladaptive behaviors in turn cause increased negative decision making, decreased self awareness, and other cognitive problems.[15] This is most common the longer someone is exposed to stressors without a marked decrease or significant break.


Learning: The kind of stress you experience can either improve or hinder how well you learn something.[16] Some primary observed factors of these stressors in relation to learning ability are as follows:

  • Exhaustion: exhaustion is negatively related to learning performance, with tasks being harder to memorize, complete, and having increased levels of mistakes done the higher the level of exhaustion reported. Motivation for doing new tasks that have not been experienced before also drops drastically the more exhausted the person is.
  • Hindrance: Hindrance stress (such as illness or anxiety) is negatively related to motivation to learn overall. Efforts to learn while going through a hindrance also result in less effective learning, despite attempts.
  • Challenge: challenging stress (such as a questioning curiosity or puzzles) is positively related to motivation to learn, which in turn positively related to learning performance. If something is challenging, regardless of interest level, it leads to better learning as long as other major stressors are absent (although having interest in the stimuli which causes challenging stress is what specifically increases motivation).

Sleep: Stress and sleep are closely connected, which can lead to quite an insidious cycle. The more stressed someone is, the less sleep they typically get, and likewise, the less sleep you get, the more stress can affect you.[17] The reason stress affects sleep is because the hormones that are released in response to stressful stimuli commonly affect the ones involved with sleep. This can happen by causing less of a certain hormone to be released (such as dopamine) that aids in getting sleepy / falling asleep, to taking up neuro slots that other hormones would use while asleep, to raising levels of certain hormones that cause alertness prematurely or at night when they should be lower. Sleep on the other hand is important due to its ability to aid in overall bodily homeostasis. Of all the effects stress can have on the body, its disruption towards sleep is possibly the worst, due to how involved sleep is in maintaining the health of your body overall, and its negatively reinforcing cyclical nature.


Effects of Genetics, Gender, and Age on Stress


Stress doesn’t affect everyone the same; and even in the same person how it affects you can vary over time. Let’s go over some major factors which can alter how stress can affect you differently.


Genetics

Genetics can play a huge factor on how and what kind of stress affects. Alterations in a number of neurobiological systems for example have been associated with increased suicidal behavior when experiencing chronic stress, or perhaps being prone to maladaptive behaviors when encountering episodic stress.[18] Genetic differences may also contribute to alterations in functioning of neurobiological systems, as well as resistance, or being further prone, to illness. One study for example showed that some men were more prone to having myocardial infarction when exposed to emotional stress compared to others.[19]


Epigenetics 

Epigenetics is a complex topic, but to keep it as simple as possible, it is the study of changes in the expression of genes thatdo not result from alterations in the sequence of the genetic code. To simplify it a little further in another manner, they are changes to how cells act despite there being no change in the DNA sequence itself. What causes these changes is external stimuli - of which distress is part of. Adversity in early-life has developmental consequences on these systems that persist into adulthood.[18] This means that things like trauma, hardship, or illness experienced when young can physically alter your body, despite what your DNA is, and thus change how you react and tolerate stress once you become an adult.


Sex

Although there are confirmed observed differences when it comes to how the different sexes handle stress, it is still unknown why that is. For instance, one large scale study indicated that the women scored significantly higher than men in chronic and minor daily stressors. Although there was no difference in the number of life events experienced in the previous two years, the women rated their life events as more negative and less controllable than the men. There were also differences in listed causes and intensity of stress; women listed family and health-related events more frequently as a source of major stress than men, whereas men listed relationship, finance and work-related events instead.  Women also scored significantly higher than men on using emotional and avoidance coping styles and ranked lower on rational and detachment coping. Men on the other hand were found to have more emotional inhibition than the women overall. And finally, women scored significantly higher than men in having sleeping issues and psychological distress.[20] What this study does not confirm however is if these differences are caused by biological difference or if they are caused due to societal ones, as it could be that societal expectation of the genders is the reason for the observed coping mechanisms - it only notes that there is a difference (which other studies also find) when it comes to a person’s sex, at least in the populations of the USA.


Age

As we get older, stress affects us differently. Due to life experience, stressors can either affect you further or affect you less than when you were young (or both). Tolerance for minor stressors typically goes down the more we age, but interestingly enough, coping mechanisms do not change significantly whether you are a young adult or elderly.[21] Overall, age causes how much stress affects you to change, but doesn’t really change how you deal with it.


Ways to Mitigate Stress


Now that we cover the many ways stress can affect the body, perhaps you’d like to know some steps on how to manage or reduce distress. Here we cover some everyday things that can aid with that.

Disclaimer: If you suffer from chronic stress or severe depression, consider getting professional help, as the following tips are unlikely to help in those severe cases.


Meditation

Research suggests that meditation is effective at reducing anxiety and is even officially used as a prescribed self-regulatory behavioral strategy to help those who suffer from generalized anxiety control their stress levels.[22]If you find yourself suffering from some anxiety due to being overwhelmed by stressors in your life, you should consider trying meditation as a form of relief.


Exercise

Exercise is a coping mechanism for stress. Both exercise and distress are actually similar; the cardiorespiratory responses of both include increases in heart rate, cardiac output, systolic blood pressure, skeletal muscle vasodilation and oxygen consumption. Both also increase blood cortisol levels.[23] The main difference is that exercise physically strengthens your body after recovery, which then makes it resist distress better, since as we have covered previously, distress affects the physical body as well, along with aiding you in physically working through your stress.


Diet

Your diet is very important if going through high levels of stress. Increased stress tends to trigger a craving for less healthy foods as a coping mechanism, since, fatty, salty, and sweet foods tend to trigger the brain’s reward system.[24]Eating a healthy diet when very stressed helps strengthen your body physically against the ills that that stress can cause. Not only that, but what you eat can affect your endocrine system as well, which plays a major role in stress expression. One major example of that are adaptogens.


Adaptogens

Adaptogens are a way you can reduce stress through diet a little more directly. An adaptogen’s main purpose is to reduce the intensity of various stress responses in the body, and depending how they do so, are then classified as primary, secondary, or companionary. The most common way primary adaptogens function are as analogues to signalers your body has - mainly, the hormones released by the endocrine system mentioned previously, such as corticosteroids, cytokines, and catecholamines. Adaptogens have the ability to reduce stress levels by either inducing a milder reaction that takes up the space where an otherwise more powerful agent would be (such as cortisol), or by “turning off” the signal that responds to stress by attaching to the site and causing no stress response to occur in the first place.[25] The chart below gives a basic overview of how the mechanisms of stress work in the body (including the HPA axis:

The items in bold are some of the ones that adaptogens tend to mimic (agents which mimic to a degree a function in the body and/or can take its place are known as “analogues”). In the case of corticosteroids for example, some adaptogens metabolize into analogues, which then tell the body to “switch off” excess production of other stress related elements in different organ systems, thus reducing overactive stress production in the body and reducing things like inflammation. Another way adaptogens can aid against distress is by triggering eustress responses instead. With cytokines, adaptogens can cause the body’s white blood cells to become more active via eustress response, improving the immune system momentarily. As a final example, with adaptogenic catecholamine analogues, various organ systems can be aided in regulation of bodily functions and metabolism by taking the place of catecholamines, which can then in turn aid in bodily homeostasis through such means as lowering blood pressure, aiding in clotting, or lowering blood sugar.[26]Some foods that are particularly high in adaptogens which can reduce stress include many kinds of mushrooms, certain plant roots, and some edible leaves.


Conclusion

We hope this article assisted in helping you understand how stress works better. If you’d like to read more on tips on how to deal with stress, especially in relation to how adaptogens can potentially aid in regulating excess stress, check out our wellness library, where we have very in depth articles covering the science behind adaptogens. The powders we have in our online store are also composed of high quality adaptogens that we have chosen based on the results of scientific research done behind them.




Mental Health Disclaimer:

The contents of this website, such as text, graphics, images, and other material contained within, are for informational purposes only. The content is not intended to be a substitute for professional advice, diagnosis, or treatment. Always seek the advice of your mental health professional or other qualified health provider with any questions you may have regarding your condition, especially if you believe you suffer from severe depression or other mental illness due to chronic stress. Never disregard professional advice or delay in seeking it because of something you have read on here if you think the issue is serious.


If you are in crisis, or you think you may have an emergency, call your doctor or 911 immediately. If you're having suicidal thoughts, call 1-800-273-8255 (USA) to talk to a skilled, trained counselor at a crisis center in your area at any time. If you are located outside the United States, call your local emergency line immediately or visithttps://www.iasp.info/resources/Crisis_Centres/ 


Reliance on any information provided by Peak and Valley, Peak and Valley employees, or others appearing on the website at the invitation of Peak and Valley, or other visitors to the website is solely at your own risk.




References:


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2: Chrousos, G. P. (2009). Stress and disorders of the stress system. Nature Reviews Endocrinology, 5(7), 374-381. doi:10.1038/nrendo.2009.106


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6: Brotman, D. J., Golden, S. H., & Wittstein, I. S. (2007). The cardiovascular toll of stress.The Lancet, 370(9592), 1089-1100. doi:10.1016/s0140-6736(07)61305-1


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8: Bacon SL, Ring C, Hee FL, et al. Hemodynamic, hemostatic, and endothelial reactions to psychological and physical stress in coronary artery disease patients. Biol Psychol 2006; 71: 162–170.


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10: Taché, Y. & Bonaz, B. Corticotropin-releasing factor receptors and stress-related alterations of gut motor function. J. Clin. Invest. 117, 33–40

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11: Michel H, Blanc P. [Stress and the digestive system] L'encephale. 1993 Mar;19 Spec No 1:157-161.


12: Vedhara, K., Hyde, J., Gilchrist, I., Tytherleigh, M., & Plummer, S. (2000). Acute stress, memory, attention and cortisol. Psychoneuroendocrinology, 25(6), 535-549. doi:10.1016/s0306-4530(00)00008-1


13: Bohnen, N., Houx, P., Nicolson, N., Jolles, J., 1990. Cortisol reactivity and cognitive performance in a

continuous mental task paradigm. Biol. Psychol. 31, 107–116.


14: Roozendaal, B., McEwen, B. & Chattarji, S. Stress, memory and the amygdala. Nat Rev Neurosci 10, 423–433 (2009).https://doi.org/10.1038/nrn2651


15: Lupien, S., Maheu, F., Tu, M., Fiocco, A., & Schramek, T. (2007). The effects of stress and stress hormones on human cognition: Implications for the field of brain and cognition. Brain and Cognition, 65(3), 209-237. doi:10.1016/j.bandc.2007.02.007


16: Lepine, J. A., Lepine, M. A., & Jackson, C. L. (2004). Challenge and Hindrance Stress: Relationships With Exhaustion, Motivation to Learn, and Learning Performance. Journal of Applied Psychology, 89(5), 883-891. doi:10.1037/0021-9010.89.5.883


17: Hicks, R. A., & Garcia, E. R. (1987). Level of Stress and Sleep Duration. Perceptual and Motor Skills, 64(1), 44-46. doi:10.2466/pms.1987.64.1.44


18: Mann, J., & Currier, D. (2010). Stress, genetics and epigenetic effects on the neurobiology of suicidal behavior and depression.European Psychiatry, 25(5), 268-271. doi:10.1016/j.eurpsy.2010.01.009


19: Strike PC, Magid K, Whitehead DL, Brydon L, Bhattacharyya MR,

Steptoe A. Pathophysiological processes underlying emotional

triggering of acute cardiac events. Proc Natl Acad Sci USA 2006; 103:

4322–27.


20: Matud, M. (2004). Gender differences in stress and coping styles.Personality and Individual Differences, 37(7), 1401-1415. doi:10.1016/j.paid.2004.01.010


21: Aldwin, C. M. (1991). Does Age Affect the Stress and Coping Process? Implications of Age Differences in Perceived Control. Journal of Gerontology, 46(4). doi:10.1093/geronj/46.4.p174


22: Effectiveness of a meditation-based stress reduction program in the treatment of anxiety disorders. (1992). American Journal of Psychiatry, 149(7), 936-943. doi:10.1176/ajp.149.7.936


23: Perna, F., Schneiderman, N., & Laperriere, A. (1997). Psychological Stress, Exercise and Immunity.International Journal of Sports Medicine, 18(S 1). doi:10.1055/s-2007-972703


24: Chrousos, G. P., Loriaux, D. L. & Gold, P. w. (eds) Mechanisms of Physical and Emotional Stress (Advances in Experimental Medicine and Biology, Vol. 245) (Plenum Press, New York, 1988).


25: Panossian A, Wikman G. Effects of Adaptogens on the Central Nervous System and the Molecular Mechanisms Associated with Their Stress-Protective Activity. Pharmaceuticals (Basel). 2010;3(1):188–224. Published 2010 Jan 19. doi:10.3390/ph3010188


26: Panagiotis Anagnostis, Vasilios G. Athyros, Konstantinos Tziomalos, Asterios Karagiannis, Dimitri P. Mikhailidis, The Pathogenetic Role of Cortisol in the Metabolic Syndrome: A Hypothesis, The Journal of Clinical Endocrinology & Metabolism, Volume 94, Issue 8, 1 August 2009, Pages 2692–2701, https://doi.org/10.1210/jc.2009-0370


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