Don’t Panic: How Stressful Situations Affect the Brain

Q&A with Eric J. Nestler, M.D., Ph.D.
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Author:
Kayt Sukel
Published:
March 20, 2020

Over the past few decades, neuroscientists have shed new light on how chronic stress can make the brain more susceptible to mental health disorders. Many of those studies have looked at the long-term effects of adverse childhood events (ACES) or living through traumatic events like the terrorist attacks on September 11, 2001 or Hurricane Katrina (See Childhood Trauma Leaves Lasting Marks on the Brain). The majority have shown that some people display more resilience in the face of these sorts of challenges (See The Resilient Brain) – and that resilience is an active neurobiological process that can protect the brain despite increased and prolonged environmental stressors. Now, as people worldwide struggle to adapt to school and work closures, as well as other significant lifestyle changes, in response to the COVID-19 pandemic, our favorite public figures are telling us not to “panic.”

Nestler portraitHere, Eric J. Nestler, M.D., Ph.D., Nash Family Professor of Neuroscience and Director of the Friedman Brain Institute at the Icahn School of Medicine at Mount Sinai and a member of the Dana Alliance for Brain Initiatives (DABI), discusses how stress affects the brain – and how we can train ourselves to be more resilient whether we are facing a pandemic or any other disastrous situation.

What’s the difference between stress and panic?

These are two very different things. Stress is anything that puts an extra burden or requirement on a system. It could be physical, psychological, or emotional. And it’s important to note that not all stress is bad. Years ago, I used to tell my teenage children that it was okay to stress a little – it helps us to focus, work harder, and get things done. The challenge is when there is prolonged or too much stress. If you think about stress as an inverted U-shaped curve, a little bit of stress helps improve performance. But eventually you reach a tipping point where it all becomes too much, and you end up having difficulty functioning. You don’t want to get to that point.

People use the term panic quite casually, but I think one should be careful in doing so. In psychiatry, it has a distinct meaning. A panic attack, for example, describes a particular collection of symptoms that occur sometimes spontaneously and other times when a person experiences overwhelming stress. There is a subjective feeling of panic, like perhaps that you are going to die, and that attack is associated with physiological changes like elevated heart and respiratory rate. If you have regular panic attacks, you may be diagnosed with a panic disorder, a type of anxiety disorder.

It’s important to emphasize that feeling stressed out or afraid is not the same as a panic attack. This COVID-19 crisis is not causing a panic attack or a panic disorder in people. It’s just a period of very heightened stress.

Why do people have such different responses to periods of heightened stress?

The challenge is to try to maintain your normal functioning as much as possible no matter what’s going on. It’s not easy. There’s no question that during periods of heightened stress, some individuals are going to become more vulnerable and show deleterious effects in response to that stress, whereas others will remain more resilient. We are only starting to understand why that is so.

Our work, and the work of other labs, has shown that resilient people have additional active processes happening in the brain that are protective and allow them to better adapt to whatever is going on. But I think it’s important to emphasize that this doesn’t mean that some people are weak, and others are strong. What we see is that one person may be susceptible to a certain type of stress, but resilient to many other types. Another person might be more susceptible to a different kind of stress. This isn’t something about which we should be making value judgments.

What is happening in the brain in these heightened periods of stress?

It’s very complicated. One of the best studied stress responses is a network called the hypothalamic-pituitary-adrenal axis (HPA axis). It’s the pathway in the brain that leads to the secretion of glucocorticoids, better known as stress hormones, like cortisol from the adrenal glands. When people are stressed in an acute manner, there’s a blast of these glucocorticoids that helps us adjust to the stress. In the short term, this is a good thing because it helps the brain and body adapt to whatever’s happening. There are dozens of other stress response systems in the brain, too – all of which are critically important to dealing with stress and mediating emotional responses through the limbic system, which can all help you cope.

But in periods of particularly severe stress, and when it’s prolonged or sustained, all these different stress response systems begin to produce changes in the brain, actual altered brain chemistry and circuitry, that can make some people’s brains more susceptible to stress the next time it occurs. Whereas, in other people’s brains, different changes might do the opposite, making the person more resilient in the face of stress.

That said, we also know that when stress is particularly strong and sustained, the changes in the brain will be more dramatic. And even the more resilient people will face increasing challenges. That’s why it’s important to find ways to maximize your individual capacity for resilience.

Being told to “calm down” or “don’t panic” often increases feelings of stress. So how can people maximize resilience?

No, it does not help to be told that. But there are things you can do to boost your resilience. To start, it really helps to have a social network. When you are an active member of a group, whether it’s a family or friends, or just being active in your neighborhood, it helps a lot.

People who are optimistic tend to be more resilient. You can even teach optimism. Have a pessimistic person keep a log of their predictions for a while and they’ll soon see that pessimistic predictions are only right a small part of the time – and they can then learn how to reframe to become more optimistic.

A belief system helps, too. It doesn’t have to be religion. It may be a belief in a moral code, a belief in community, or just in the common good. These psychological factors are all very important to making your brain more resilient and people can learn how to better utilize these approaches.

Beyond that, physical exercise is good for resilience. Eating a healthy, balanced diet is key. Too often, people want to reach for junk food when they are stressed. But eating well really does help. Mental exercise is also important. Especially when we are looking at many of us having to stay home for what might be a couple of months, it’s going to be more and more important for people to keep their bodies and brains busy in productive and positive ways. That’s going to boost our resilience.

How do big breaks in our regular routines affect our stress response systems?

When people are taken out of their element or put in new situations, that’s stressful. Adapting to something new is always a challenge, but it’s also a great opportunity for resilience. It’s an opportune way to force the brain and body to adjust and adapt to those novel things.

For example, you may not be going to work right now. Your gym is closed. How do you get physical exercise? You find new, creative ways to remain active, whether it’s getting outside for long walks or walking up and down the stairs. It’s therefore important to emphasize: These challenges pose difficulties, but they also pose opportunities that can allow each of us to drive our resilience.

Any other advice – whether a person is trying to manage a pandemic or some other event, like a flood or hurricane – to help people be more resilient in the face of stress?

One key lesson is to be deliberate. Listen to the advice from the experts. Follow their guidance. And be mindful if you are starting to feel overly stressed.

Using tools of mindfulness, like meditation or hypnosis, can be very effective in building resilience. There are so many great meditation apps out there now. I would urge people who are sitting at home, watching the news with a high feeling of anxiety or uncertainty, to use them. Meditation can help us get the conscious part of our brains in better control of the unconscious parts. When you are in an unknown situation like the current pandemic, many people may have vague feelings of anxiety or stress and not even realize where those feelings might be arising – or what to do about them. Mindfulness and meditation are wonderful ways to gain control of those impulses so you can do better, feel better, and be ready to respond productively to whatever challenge comes next.