Stress

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Table of Contents
Stress And IBS
Physical Activity
Breathing Exercises
Mindfulness
Autogenic Training
Hypnotherapy
Aromatherapy
Take Control
Get Support
Have Some “Me Time”
Spend Time In Nature
Challenge Yourself
Helping Others
Work Smarter
Gratitude
Understand Your Sphere Of Control
Further Information And References

Stress And IBS

Stress does not cause IBS, but it can make the symptoms of IBS worse (1) (10). The World Health Organisation’s definition of stress is “a state of worry or mental tension caused by a difficult situation” (2). Symptoms of stress include emotional responses such as being irritable, tearful, angry, anxious, worried, hopeless, scared, having racing thoughts, a feeling of overwhelm and a difficulty in making decisions. There can also be physical symptoms such as headaches, muscle pain, stomach problems, skin problems such as rashes, dizziness and nausea. (3)

Stress is different to pressure. Stress involves too many demands without the time, energy or resources to deal with them. Pressure involves the need to produce a specific result, for example performance at a job interview, presentation to a client or meeting a work deadline. Normally stress is accompanied by a feeling of overwhelm whereas pressure is feeling the need to deliver. It is important to recognise the difference between the two. A response to stress may involve the need to back off and give yourself some space such as going for a walk, whereas pressure requires performing successfully. (4)

The central nervous system, that makes up the nerves in the body and the brain, control parts of the body on autopilot. It includes the parasympathetic system (rest and digest) looking after bodily functions such as urination, defecation, digestion and saliva production, and the sympathetic nervous system (“fight or flight”), which is triggered by anxiety and stress. In fight or flight mode, the body releases hormones to increase heart rate and pump more blood to the muscles, whilst de-prioritising functions such as digestion. After events causing stress have gone away, hormones return to normal levels (homeostasis). In situations of chronic (ongoing) stress and anxiety, the body finds it difficult to return to the normal balanced state of homeostasis. (5)

Stress results in the production of corticotropin-releasing factor (CRF). Chronic stress produces extra CRF that can cause oxidative damage to the colon, compromise the intestinal barrier, increase intestinal permeability and activate the body’s immune response, which could explain reactions to certain healthy foods in IBS sufferers. CRF disrupts the gastrointestinal system which can result in gut bacterial imbalances (dysbiosis), with bad bugs dominating in the gut, increasing the risk of IBS symptoms. (33) Gut microbiota also maintain the back and forth communication between the gut and the brain with abnormal microbiota interacting with the immune system and nervous system affecting the brain/gut axis. (6) This can cause changes in how quickly food moves through the digestive system resulting in diarrhoea or constipation and increased sensation in the gut leading to feelings of bloating or abdominal discomfort (5). Imprints on the nervous system can be left behind from stressful events relating to poor early life experiences (e.g. neglect, physical or emotional abuse) in addition to those in adulthood such as relationship breakdown. These past stressors can contribute to subsequent development of IBS in predisposed individuals (6), since there can be a genetic or familial component in the potential to develop IBS (7) (8) (9).

There are a number of things that can help reduce stress:

Physical Activity

As previously mentioned, during times of stress our bodies go into fight or flight mode, with increased heart rate and blood being sent to the muscles creating pent up energy that would ordinarily help us to flee from an evolutionary perspective, but when we don’t, the energy is still stored there, leaving us feeling tense. Animals have a natural response to stress and releasing that pent up energy by shaking, which also helps to reduce adrenalin and cortisol. Humans have this innate ability too, but have suppressed it to avoid social judgment leaving that pent up energy and tension in place. A technique called ‘Tension Release Exercises’ (TRE) has been developed that triggers the same shaking reflex in humans that already takes place in dogs and in other animals. (11) (12). You can find more information about this here, here, here, here and here. In fact, you can shake like a dog even without triggering this reflex. Consider shaking your arms and legs and wriggle your hips vigorously mimicking a dog when it comes out of water and you can experience a similar effect.

The same can be experienced from running. This is the equivalent of enacting the flight response helping to use up that pent up energy in the muscles designed for exactly that purpose. If you are new to running or are returning to running after injury, there is a useful interval training program that recommends a mixture of walking and running for a set number of minutes at a time, which increases over a number of weeks, though you can do this at your own pace. The program can be found here and here. For example, on the program “3x (1’R / 1’W)”, means run for one minute, then walk for one minute and repeat for this for a further two times. Building running up gradually helps to avoid injury and reduces the chances of giving up early. For example, if you try too much too soon and get injured, you might decide that running isn’t for you, when starting more slowly would improve the chances of being able to run on a longer term basis. Stretching after a run can also help avoid injury – examples of stretches are here and here.

The UK government recommends at least 150 minutes of moderate intensity activity a week or 75 minutes of vigorous intensity activity a week. Moderate activity includes activities such as brisk walking, water aerobics, riding a bike, dancing, doubles tennis, pushing a lawn mower, hiking and rollerblading. Intense activity includes running, swimming, riding a bike fast or on hills, walking up the stairs, skipping, aerobics, gymnastics, martial arts and sports, like football, rugby, netball and hockey. (13)

Research has also found that just 11 minutes of brisk walking a day has health benefits (14).

Exercise can boost the level of endorphins, the feel good chemicals in your body. These can help you forget your worries and give you a longer lasting sense of wellbeing which will also help to reduce stress. (15)

Breathing Exercises

A breathing exercise that can help reduce stress consists of either sitting or lying down in a quiet place, breathe in for 4 seconds, hold your breath for 7 seconds, then exhale for 8 seconds. This is called 4-7-8 breathing. (16) Heart rate increases slightly when you inhale and decreases when you exhale. Drawing out the exhale could slow down the heart, which might have a slowing effect on an overactive brain. (17)

Under the influence of the parasympathetic nervous system (“rest & digest”), breathing slows and deepens when you are feeling calm and safe. The sympathetic nervous system under the fight or flight response, quickens breathing. When a person smiles intentionally it can attract pleasant feelings in the brain. Similarly, slowing down breathing can exert control over emotions by increasing activity of the vagus nerve, part of the parasympathetic nervous system, slowing heart rate, decreasing blood pressure, relaxing muscles, providing a feeling of being calm and safe and a sense of peacefulness. (17)

Coherent breathing is another method of slowing down breathing. This involves breathing in for 6 seconds and out for 6 seconds. (18)

Diaphragmatic breathing (also called “abdominal breathing” or “belly breathing”) involves a method of deep breathing that can slow the heart rate. From birth we know how to breathe diaphragmatically and ideally we should be breathing this way automatically, but we are out of the habit, tending to take more shallow breathes usually do to the stresses of life. (19) Breathe out first with the belly going in and then breathe in whilst expanding the belly to allow the lungs to fully expand. A video explaining this approach can be found here. Diaphragmatic breathing can be used in conjunction with any of the counted breathing techniques as described above.

Mindfulness

Mindfulness is the act of being completely aware of what is happening in the present moment. Often this involves engaging our five senses (sight, sound, smell, taste, and touch). Our minds can only have one thought at a time (20), which means that if we engage our senses, this mentally challenges the brain (21) crowding out other thoughts.

In fact any form of distraction such as concentrating on breathing, being aware of each breath in and out, as is used in meditation, can help clear the mind. There are also audio guided meditations, guiding you through imagining being in pleasant surroundings (“visualisations”) or sensing your feet on the ground or your hands in your lap which engages the senses.

Sometimes people prefer practicing meditation in a group rather than on their own. If you are having trouble finding a local group, the Plum Village community hold meditation groups globally. You can use the link here, to find a group local to you. The community is based around the teachings of Buddhist monk, Thich Nhat Hanh, but is open to all.

Tai Chi, Qigong and yoga could be considered forms of moving meditation. Some may find the stillness of sitting meditation difficult, whereas these practices allow you to focus on specific sets of movements and, in doing so, this helps to clear the mind.

A relaxing breathing method, called 5 finger breathing, uses a combination of focusing on your breath and doing an activity which involves tracing the outline of one hand using the index finger of the other hand – details here.

There is a mindfulness technique called STOP. Whenever you are thinking stressful thoughts, you tell yourself to stop, take a breath (perhaps one of the breathing techniques already discussed), observe your emotional state and bodily and mental sensations, then decide how to proceed. (31)

Mindful based therapies have been proven to be effective in helping to relieve IBS symptoms due to their ability to reduce stress and in altering the brain; changing the way the brain processes sensations, thoughts and emotions. (22) (23) (24)

Autogenic Training

Autogenic Training involves working through a script in your mind instructing you to focus on a feeling warmth or heaviness in different parts of your body, such as “my arms feel heavy and warm”. This helps to instil a sense of calmness. (15) Information about how to practise autogenic training can be found here.

Hypnotherapy

During hypnotherapy, the hypnotherapist guides a person into a relaxed, yet awake state with a focused mind. It is in this state that the patient’s brain is more able to absorb suggestions made by the hypnotherapist. This can not only help with phobias, but can assist with many things including stress and pain management. (25)

A study of 204 IBS patients showed symptom improvement from gut directed hypnotherapy which lasted at least 5 years. ‘Gut directed’ relates to the specific suggestions, during the hypnotherapy session, made towards controlling and normalising gut function. (26)

There are also convenient gut directed hypnotherapy apps available such as the Nerva app.

IBS sufferers can have miscommunication between the brain and the gut, with either the wrong messages being sent from the gut to the brain or the right messages being sent, but the brain picking up normal messages as bad, resulting in symptoms such as pain, constipation or diarrhoea. The idea of gut directed hypnotherapy is to help the patient regain control over this two way communication, recalibrating it whilst also decreasing stress, which can improve IBS symptoms. (27)

Aromatherapy

Some essential oils can have a calming effect (15). Lavender oil is very relaxing and can be placed in a diffuser or even on a piece of tissue or cotton pad next to your pillow as a sleep aid or on your shoulder whilst sitting.

Take Control

Stress can be worsened by believing that you can’t do anything about your situation. Whereas working on your own problems and symptoms by doing research, speaking with your GP or consultant and actively take measures to help yourself can reduce stress. (28)

Get Support

Participating in a support group such as IBS Network on Healthunlocked or joining a charity such as the Guts Charity for information and support, can prevent you from feeling alone in your condition. (5)

Spending time with friends and family on activities can be a distraction and help relieve stress. They can also be a source of support and help you to talk through and resolve your problems. (28)

The body can hold tension from unresolved issues from traumatic events or difficult childhoods causing present day overreactions to ‘threats’ (triggers) that seem similar to what has happened in the past. This can place a strain on the body and contribute to IBS. In these cases, you can seek support from a psychotherapist (5), who can provide you with techniques for coping or work with you to commit these events to longer term memory stores so they have less of a present day hold over you, reducing tension and reactivity. In the UK it is possible to self-refer for this service, here.

There is also Cognitive Behavioral Therapy (CBT) which seeks to challenge unhelpful thinking rather than delving into the past. (29)

Biofeedback Therapy involves the use of devices to monitor your level of stress and provide techniques for reducing stress levels. A 2019 review found that Biofeedback Therapy can help reduce IBS symptoms. (30)

Have Some “Me Time”

Many people are very busy with work, day to day chores or helping others. This is about intentionally setting some time aside to do things that you enjoy, which could be socialising, relaxing, exercising or being involved in a hobby. For example, this might mean setting aside a couple of nights a week just for you. (28)

Spend Time In Nature

In a study 63 healthy participants were given some stressful tasks to do and then either had a one-hour walk in an urban (busy street) or a natural environment (forest). Participant brains were scanned before and after each walk. The amygdala part of the brain activity decreased after the walk in nature, whereas it remained the same after the walk in the urban environment. Since the amygdala is highly involved in the fight or flight response, this means that walking in nature can reduce stress levels. (32)

Trees and plants release chemical compounds called phytoncides, which we inhale. These compounds help the immune system, even providing an anti-cancer function in the body. Walking in a forest or participating in ‘forest bathing’ has been proven to reduce stress hormones. (34)

Challenge Yourself

Challenging yourself, by setting yourself some goals or learning new things, can improve confidence, which in return can improve resilience and subsequently reduce stress levels. (28)

Helping Others

Evidence has shown that helping others such as volunteering can make people more resilient. (28)

Work Smarter

Understand that there are only so many hours in a day, accept that you may not have time to do everything that you want to and focus on those tasks that will make a real difference, leaving less impactful tasks until last. (28)

Gratitude

At the end of each day try to think of three things that you are grateful for, however small these might appear to be. (28)

Understand Your Sphere Of Control

There is a saying as follows: “grant me the serenity to accept the things I cannot change,
the courage to change the things I can and the wisdom to know the difference.”

Understanding what is under your sphere of control and what isn’t, can help to reduce your task or worry load, allowing you to concentrate on improving those things that you can influence. (28)