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Stress/anxiety? Psychology or medical science?

Bear in mind the fact that there are also strong physiological processes present in patients when treating stress/anxiety using a cognitive behavioural or other form of psychological intervention. When seeking to assist patients suffering with symptoms of stress/anxiety, is it possible that those who may choose to utilize a cognitive behavioural approach may be inclined to pay less attention to the physiological processes that are at work within their patient?  Psychotherapists are often very good at considering all of the thoughts, feelings and behavioural traits that may maintain an individual’s problem with stress/anxiety.  However, they may be less likely to pay equal attention to the biological aspects of their patient’s experiences believing this to be the role of the patients physician. Clearly, when one encounters the “fight or flight” response, their autonomic nervous system has been activated.  This will involve a complex process of neurotransmission and hormonal secretion culminating in the tangible sensation of physiological symptoms.  

According to Sapolsky et al., (1990) cumulative stress results in the buildup of Glucocorticoids which cause a consistently high level of metabolism which eventually lead to cell death.  This process has been found to be particularly damaging to the hippocampus region of the brain due to the fact that the hippocampus has a high number of Glucocorticoid receptors.  As the hippocampus is key to mediating both the psychological and physiological experiences of stress, a reduction in performance within this region may result in an increasing vulnerability to the experience of psychological and consequential physiological symptoms.  It is clear from this, that cumulative uncensored stress can have a damaging physiological impact upon the central nervous system in a way which could actually make a person more likely to experience an increasing susceptibility to stressful events and with greater intensity due to an inability of the hippocampus to appropriately regulate experiences.

With this in mind, one can suggest that psychotherapists should pay careful attention to the impact personal development may have played in the development of an individual’s neural networks and how inappropriate formation of such networks may influence that person’s predisposition towards frequency and intensity of symptoms.

Individuals that suffer from frequent panic and anxiety often express the concern that they are going “mad”.   Such individuals may well be fearful, believing that those physical symptoms that they experience are caused by a malfunction in the workings of their own minds.  If this were the case, one can imagine that it may be intensely reassuring to learn that such symptoms are not solely due to the influence of their minds and that the physical sensations that they may feel have a very real physiological basis and that one could interpret those symptoms as being the by-product of an error in the functions of the limbic system in much the same way as diabetes or hyperthyroidism is accepted as being the product of a limbic system malfunction.

In western civilization the medical model of illness continues to prevail and as a result it is likely that many patients may appreciate the certainty that a physiological explanation of symptoms can provide.  Having reassured the fearful patient, the psychotherapist adopting a collaborative ‘psycho-biological’ approach may find that the therapeutic relationship held with their patient improves as does the willingness on the part of their patient to engage in the physiological as well as the psychological components of treatment which of course we all accept is equally significant.

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