Worried Sick

sketch of man in suit falling
Illustration by Nathan Wagoner

As an instructor of English at Penn State, I require first-year students to give an least one oral presentation during the semester. And while my intentions are noble, for I truly believe that addressing an audience coherently is an important ability, I often end up feeling more like the Marquis de Sade than Glenda the Good Witch. For at least ten percent of the students, the experience lands them in a mental territory somewhere between agonizing and excruciating. Oral surgery without Novocain would be preferable. Otherwise healthy, talkative kids get up in front of the class and quietly freak out. They turn ashen, or completely red, lose the ability to make eye contact or even to raise their heads. Some sweat, some stutter, and others produce sounds akin to silverware stuck in a garbage disposal. Their discomfort is so palpable that I and everyone else in the room can feel their pain.

Public speaking, as a producer of stress, ranks right up there with making a major lifestyle change. It's not uncommon for these elocutionophobes to make postspeakus comments, like, "I almost lost it," or, "I think I'm going to be sick." Research in the last decade has shown that stress can indeed make people sick—at least in terms of making them more susceptible to illness and disease. In 1991, psychologist Sheldon Cohen at Carnegie Mellon University produced a seminal study linking stress to having an impaired immune system. Other studies have linked longterm stress to heart disease and high blood pressure.

The term stressed out has become such an ingrained part of our national lexicon that it even has its own entry in Webster's dictionary. Yet the relationship between emotional and mental stress and physical ailments is relatively new in the study of medicine—when you consider that the Greek physician Hippocrates was practicing thousands of years ago. In the 1930s, Austrian physician and endocrinologist Hans Selye pioneered stress research and devoted 50 years of his life to studying the causes and consequences of stress. When Selye was asked to give a paper in France, he discovered that no word existed in the French language to describe his work, so they invented one: Le stress. The same thing happened in Germany, which led to the coining of the phrase Der stress.

Selye defined stress as the body's response to any physical or emotional demands made upon it. Bumping into a sharp-edged table causes pain. Sitting on the beach on a hot day makes us sweat. Running uphill forces the heart to pump faster. Having a fight with a spouse raises your blood pressure. Facing an intruder in the middle of the night increases adrenaline flow. Selye identified these demands as "stressors" and postulated that a life filled with such stressors could wreak havoc on the body.

Today, in this age of herbal remedies like St. John's Wort and pharmaceuticals like Prozac, we take stressors and the need for stress busters for granted. Yet, according to Peter Gianaros, a graduate student in psychobiology at Penn State, research on mind-body connections is underreported in the popular press and underappreciated in biomedical studies.

Gianaros, an energetic guy with short-cropped black hair and an easy smile, sits casually on a table in a small windowless room filled with sophisticated computers and audio and video equipment. He holds a recent issue of the journal, Psychophysiology, containing an article, "Making the Case for Psychophysiology During the Era of Molecular Biology," which surveyed major newspapers and books for ten years looking for the words "genetic" and "stress." This article, he says, not only shows how research on stress and health pales in comparison to media coverage of molecular biology, but illuminates a rift in biology today: "Everywhere you turn," says Gianaros, "you see another story on how you can't escape your genes. It seems like people have stopped talking about the things you can change—your behaviors, lifestyle, attitudes. It's almost as if we've given in to genetic destiny and forgotten that we have some control over our lives and health."

Gianaros has long been interested in how our emotional lives affect our wellbeing. As an undergraduate at the University of Florida, he worked with a team of researchers who developed a method to determine the emotional state of different populations of people. By using electrodes placed under the eyes, he was actually able to measure the "startle response" of individuals who were startled with white noise while looking at pleasant photos, like babies and desserts; unpleasant photos, like war scenes and accidents; and neutral photos, like filing cabinets and bowls. He found that anxious people have a high startle response, while calm people have a lower response and that these differences in psychological reactions are stable over long periods of time. Now at Penn State, Gianaros is taking his research further by investigating the physical effects of stress and anxiety. He is working in the lab of assistant professor Karen Quigley, where both graduate and undergraduate students investigate the effects stressful situations have on systems of the body that function on automatic pilot.

Making up a large part of the central nervous system, the autonomic (or involuntary) nervous system is made up of the sympathetic system and the parasympathetic system, which are controlled by the nerves that branch out from the spinal cord. In an equal partnership, both systems function in a wonderfully integrated manner. During sleep, the parasympathetic system slows the heart rate and stimulates the organs of the digestive tract. In waking hours, the sympathetic system dominates during times of high stress or excitement, stimulating the heart rate, dilation of blood vessels to the muscles, and subduing the digestive system. Gianaros wants to find out how the autonomic system functions when people experience "speech anxiety," the sheer terror many of us have felt when faced with difficult communication confrontations. In order to determine speech anxiety's effects, Gianaros has borrowed a high-tech spaceage methodology called impedance cardiography and a low-tech but highly effective circular vection drum, used by Penn State professor Robert M. Stern for groundbreaking research on motion sickness and nausea.

In the same windowless room, Gianaros and two undergraduate fellowship students from other universities are preparing electrodes and measuring devices to test a volunteer's autonomic responses to his experience in the circular vection drum, also called an optokinetic drum. The volunteer, a student in an introductory psych course trying to bring his grade up a few points by being a research subject, sits inside the drum in an adjoining room where his every motion is captured on video. The drum, made of sheet metal, is about the size of a 55-gallon barrel. The inside of the drum is painted with black-and-white vertical stripes. The person inside the drum remains stationary while the drum rotates, resulting in a mixed message being sent to the brain. The optical nerve reports motion, while the body's vestibular nerve says, You're not moving. These contradictory signals cause 66 percent of the people who experience the drum to become nauseous.

The stomach, like all other organs in the body, emits an electrical impulse, which can be recorded in a manner similar to the way in which the electrocardiogram, or EKG, traces the activity of the heart. The stomach's rhythms, detected by electrodes placed over the subject's stomach, are recorded in a tracing called the electrogastrogram (EGG), which, like the EKG, shows a wavy line reaching peaks and dropping to valleys. Everyone who reports motion sickness shows increased and more erratic peaks and valleys in the electrical output of the stomach, called tachygastria or gastric dysrhythmia.

At the same time, the subject is hooked up with a blood-pressure cuff, a belt to determine respiration, and other electrodes at the neck and the breastbone. A technique called impedance cardiography, developed by NASA 30 years ago, measures cardiac output. Says Gianaros, "In impedance cardiography, a high-frequency electrical current is passed along the upper body, and it measures changes in impedance, or resistance, in the signal due to blood being ejected into the aorta by the left ventricle." In short, impedance cardiography is an easy, noninvasive way to assess sympathetic nervous system activity at the level of the heart.

The subject sits in the rotating drum for several minutes while a baseline is determined. The computers and EGG are click-ing and whirring away. The test begins and Gianaros and the students observe the subject on a black-and-white TV screen, wondering if he will last the full 16 minutes of the test. Every minute he is asked if he feels dizzy or sick. He says no, but his response is shaky. And though he does look queasy during the last few minutes, he doesn't ask to have the drum turned off. When the test is over, and he is de-elec-troded, Gianaros shows him the readings, where his blood pressure and heart rate increased, and he gives a cursory macho nod, seeming annoyed that he hadn't been able to control the readings.

The experiments in the vection drum are only a part of Gianaros' research. In the first part of his study, he also used impedance cardiography, but in relation to speech anxiety. The subjects were again wired and tested in a calm situation then given this scenario: Your roommate has just stolen money from you, and you have five minutes to prepare what you're going to say. In each instance, the subjects faced with this unpleasant confrontational situation showed increases in blood pressure, pulse rate, and tachygastria. In fact, the physiological response to this speech task paralleled that caused by motion sickness. So, when one who suffers speech anxiety says, "I feel sick," he or she may be speaking quite literally.

But what does motion sickness have to do with stress? According to Gianaros, plenty.

Though some may find it remarkable that speech anxiety can be so intense as to cause the same symptoms as motion sickness, Gianaros says, "The more important issue is not how you react to stress, but how you recover from it. People who recover slowly from stress and ruminate for long periods of time over negative events are at risk for cardiovascular diseases. The old standbys—deep breathing, visualization, meditation, massage, yoga, biofeedback, spending time with loved ones, and especially exercise—are all known to be calming and reduce stress, if only we make time for them."

Another known way of fending off stress is simply by being in control of situations. Or, as Suzanne Weinstein says, having the perception of being in control. Weinstein is also working in Quigley's lab, now as a postdoctoral fellow, and is also using impedance cardiography to study the physical effects of stress. "There's a classic study done in the '70s that shows how having control affects health," says Weinstein. "People living in a nursing home who had control over their environment, in terms of being able to make choices about what they ate or what activities they participated in, not only lived longer but were healthier. The whole issue of control is complex. Some people define it as being able to manipulate an environment, other define it as having a choice. And still some assume that having control is always positive, which it isn't."

In Weinstein's study, volunteers were again hooked up to electrodes that measured autonomic responses like heart rate and blood pressure. But instead of being strapped inside a rotation drum, her subjects were asked to play a video game. The video task, similar to the Atari tennis game (popular a few decades ago and ancient by modern cyberstandards) measured not only skill but effort—the amount of force the participants exerted when pressing the buttons. They also wore headphones that emitted annoying blasts of white noise. In one situation, they were told that their performance on the game controlled the noise, and in another situation, they were told that the blasts were random, and they could do nothing about it. Those who felt they were in control exhibited more stable blood pressure and heart rate.

Previous studies have indeed shown that people are less stressed the more they feel in control of situations. Weinstein also notes previous research had not considered the amount of effort one puts into trying to control a situation. High effort that paid off with high control—participants feeling as though they were indeed positively influencing the white noise—produced a drop in blood pressure.

"This is a leap from the data, but in trying to think about the experiment in real life terms," says Weinstein, "say I'm trying to get my son dressed in the morning. I could postulate that if I put a lot of effort into making him get ready on time, and he does, meaning that I feel as though I have control over the situation, then my blood pressure should be lower. However, if I say, ‘David, you need to be dressed by the time the kitchen alarm goes off,' and he isn't, then my blood pressure should rise."

Though Weinstein's study looked only at control and effort, she wonders why psychological factors predict hypertension. "One of the interesting things I discovered in this study," she says, "is that having control is not a positive experience for everyone. Some of the participants said they felt more stressed out when they could control the white noise because if they didn't control it well enough, they felt as though they were ëbeing punished' for their poor performance."

The idea of one's sense of control being a dimension of personality was first put forth by psychologist Julian Rotter in 1966. He classified people into two categories: individuals with an external locus of control and those with an internal locus. Externals are basically fatalists, believing their lives to be controlled by fate, luck, or other external factors. Internals, on the other hand, are self-determinists. In the past 30 years, research has shown that control is, as Weinstein says, a complex issue. Recent research has focused on how this attitude affects health, and studies have shown that internals are more likely to seek healthcare information and lead healthier lives.

Weinstein's study also tested for locus of control by asking participants whether or not they felt their lives were determined by fate or will. She found that people who felt they had control over their own lives performed better in her test, thus lowering their blood pressure. Though she readily admits that "the whole issue of control is pervasive, and I'm only looking at one small piece," perhaps the belief in one's control over the chaotic world around us can lead to a healthier world within us.

Peter J. Gianaros is a doctoral candidate in psychology in the College of the Liberal Arts, 602 Moore Bldg., University Park, PA 16802; 814-863-3373; gianaros@psu.edu. He is on a fellowship from the National Institute of Mental Health. Suzanne Weinstein is a postdoctoral fellow at the Center for Developmental and Health Genetics in the College of Health and Human Development, 101 Amy Gardner House, University Park, PA 16802; 814-865-1717; swd107@psu.edu. Their adviser is Karen Quigley, Ph.D., assistant professor of psychology in the College of the Liberal Arts, 519 Moore Bldg., University Park, PA 16802; 814-863-6023; ksq1@psu.edu. Gigi Marino is a freelance writer and an instructor in the Penn State Department of English.

Last Updated January 01, 2000