This is the fifth article in an ongoing series. Make sure to check out the other articles when you’re finished with this one:
- What Causes Adrenal Fatigue? (Part I): An Introduction
- What Causes Adrenal Fatigue? (Part II): Blood Sugar
- What Causes Adrenal Fatigue? (Part III): Sleep
- What Causes Adrenal Fatigue? (Part IV): Inflammation
- What Causes Adrenal Fatigue? (Part V): Perceived Stress
- What Causes Adrenal Fatigue? (Part IV): Treatment
Regardless of whether a stress occurs in our mind or our physical reality, our body’s response is the same.
The effects our body undergoes in response to stress is identical whether we are skydiving or dreading a public speaking engagement. In both situations, our body is responding to a stressful event. Though only one of those events actually poses a risk.
The above is an important distinction: regardless of whether the stress occurs in our minds or in our physical reality, our reaction is the same. Stress that occurs in our mind is referred to as perceived stress.
Perceived stress is greatly influenced by: (1)
- Past history of stressful experiences
- Learned behaviours
- Personality traits
The above are predictors of whether we are at an elevated risk for developing adrenal fatigue from high levels of stress. In additon, there are four other factors that determine how large of a stress response our body creates in face of an event.
These include: (2)
- Novelty of the event
- Unpredictable nature of the event
- Perceived threat to the body or ego
- Sense of loss of control
Some refer to the above as N.U.T.S. Should an event have all four aspects, it will have a much greater risk of causing adrenal fatigue, especially if the event occurs for an extended period of time.
In order to better quantify stress, two questionnaires are commonly used.
- The Percieved Stress Scale
- Holmes and Rahe Stress Scale
The Perceived Stress Scale (PSS), created by the psychologist Dr. Sheldon Cohen, is the most widely used tool in scientific research for assessing how stressed we feel. (3) Your score on this test will help determine how likely it is that mental and emotional stress are contributing to your condition.
You can take the perceived stress scale here. The results are completely confidential.
Individual scores on the perceived stress scale can range from 0 to 40 with higher scores indicating higher perceived stress.
- Scores ranging from 0-13 would be considered low stress.
- Scores ranging from 14-26 would be considered moderate stress.
- Scores ranging from 27-40 would be considered high perceived stress.
The Perceived Stress Scale is interesting and important because your perception of what is happening in your life is most important. Two individuals could have the exact same events and experiences in their lives for the past month. Depending on their perception, their total score could put one of those individuals in the low-stress category and the total score could put the second person in the high-stress category. (4)
In 1967, psychiatrists Thomas Holmes and Richard Rahe decided to study whether or not stress contributes to illness. They surveyed more than 5,000 medical patients and asked them to say whether they had experienced any of a series of 43 life events in the previous two years. (5)
Each event called a Life Change Unit (LCU), had a different “weight” for stress. The more events the patient added up, the higher the score. The higher the score and the larger the weight of each event, the more likely the patient was to become ill. (6)
You can find a copy of the Holmes and Rahe Stress Scale here. The results are completely confidential.
Burnout and Adrenal Fatigue
Chronically high levels of psychosocial stress can lead to a condition known as burnout. Do you recall the concepts of allostatic load and metabolic reserve? If not, please revisit the first article in this series.
In burnout, our body has down-regulated the HPA axis. This is when the term adrenal fatigue describes the symptoms well. In some circles, this is also known as adrenal exhaustion. Only, it is not our adrenals that fatigue, it is our central nervous system (our brain) that has decreased the amount of cortisol circulating in our body. To use the bank account example once again, in times of burnout, we have significantly overdrawn our account.
Treatment for adrenal fatigue caused by perceived stress
Explaining the intricacies of meditation is well beyond the scope of this blog post. Instead, know that meditation is an invaluable technique in treating adrenal fatigue. In working with a practitioner, it should be an integral part of a treatment plan. However, for the purpose of this post, we’ll instead explore tips found in western psychology that can be used to alleviate perceived stress.
Research has shown that the most effective measure in lowering our response to perceived stress is regaining an element of control. (11) Often, in the experience of adrenal fatigue, patients comment on having little to no control over the events that are transpiring. Charles Duhigg describes this perfectly in what is known as a locus of control. (12)
A locus of control is a belief that you can influence an outcome based on the choices you make. One with a strong internal locus of control, for example, will assume that the raise she received at work was due to her hard work. Not her natural intelligence or negotiating skills.
High internal locus of control has been linked to:
- academic success,
- high self-motivation,
- social maturity,
- lower incidences of stress and depression, and a
- longer life span.
To contrast, an external locus of control, a belief that your life is influenced by events that occur outside of your control is correlated with high stress levels.
A study done in 1998 studied 5th graders challenged with a series of hard puzzles. All students were told that they had scored well on the test. But, half of the students were told that there score was because they were very intelligent. The other half were told they scored high because they must have studied very hard. (13)
Telling the children that they must have worked hard created an internal locus of control because hard work is something we choose to do. Complimenting the other students on their intelligence activates an external locus of control as most children don’t believe they can choose to be intelligent. (14)
Both groups of student were then asked to take another series of increasingly difficult puzzles.
The group that had been told they were intelligent, focused on the easy puzzles. They were less motivated to push themselves into solving the challenging puzzles. The other group of children (the ones praised for their hard work) began with the hard puzzles. They worked longer and scored better than the first group. (15)
Internal locus of control is a learned skill. It is not something you are born with. To better activate your internal locus of control, turn something that you view as a chore into a choice. Doing so gives us a sense of control. (16)
When attempting to turn a chore into a choice, you need a bias towards action. Your first step needs to be something small that makes you feel in charge. This will motivate you towards completing the larger task.
For myself, getting out of bed at 5:30 in the morning to go to the gym can be daunting. Some months, the result is going back to sleep more often than going to the gym.
In order to increase my odds of getting out of bed and going to the gym, I needed a bias towards action. I moved my gym clothes beside my bed. When the alarm went off, I immediately put on my socks. This small action made the subsequent efforts much easier. That small action increased the frequency I went to the gym by over thirty percent.
When combating perceived stress and adrenal fatigue, try to frame your chores into choices. Create a small action you can take towards regaining control. This choice will make the subsequent choices easier.
To conclude, treatment of perceived stress’s effect on the adrenal fatigue or the HPA axis needs to be multifaceted. Using solely medication or supplements is not enough. You also need to internally shift your thinking towards focusing on that which is under your conscious control and then crafting an action plan to implement steps that regain control.
Now, I want to hear from you.
What do you use to combat stress?
Also published on Medium.