Can you remember a time when you felt stressed leading up to a big life event and then afterwards felt like a weight had been lifted? This process – the ramping up of the stress response and then feeling this settle back down – shows completion of the “stress cycle”.

Some stress in daily life is unavoidable. But remaining stressed is unhealthy. Chronic stress increases chronic health conditions, including heart disease and stroke and diabetes. It can also lead to burnout or depression.

Exercise, cognitive, creative, social and self-soothing activities help us process stress in healthier ways and complete the stress cycle.

What does the stress cycle look like?

Scientists and researchers refer to the “stress response”, often with a focus on the fight-or-flight reactions. The phrase the “stress cycle” has been made popular by self-help experts but it does have a scientific basis.

The stress cycle is our body’s response to a stressful event, whether real or perceived, physical or psychological. It could be being chased by a vicious dog, an upcoming exam or a difficult conversation.

The stress cycle has three stages:

• stage 1 is perceiving the threat
• stage 2 is the fight-or-flight response, driven by our stress hormones: adrenaline and cortisol
• stage 3 is relief, including physiological and psychological relief. This completes the stress cycle.

Different people will respond to stress differently based on their life experiences and genetics.

Unfortunately, many people experience multiple and ongoing stressors out of their control, including the cost-of-living crisis, extreme weather events and domestic violence.

Remaining in stage 2 (the flight-or-flight response), can lead to chronic stress. Chronic stress and high cortisol can increase inflammation, which damages our brain and other organs.

When you are stuck in chronic fight-or-flight mode, you don’t think clearly and are more easily distracted. Activities that provide temporary pleasure, such as eating junk food or drinking alcohol are unhelpful strategies that do not reduce the stress effects on our brain and body. Scrolling through social media is also not an effective way to complete the stress cycle. In fact, this is associated with an increased stress response.

Stress and the brain

In the brain, chronic high cortisol can shrink the hippocampus. This can impair a person’s memory and their capacity to think and concentrate.

Chronic high cortisol also reduces activity in the prefrontal cortex but increases activity in the amygdala.

The prefrontal cortex is responsible for higher-order control of our thoughts, behaviours and emotions, and is goal-directed and rational. The amygdala is involved in reflexive and emotional responses. Higher amygdala activity and lower prefrontal cortex activity explains why we are less rational and more emotional and reactive when we are stressed.

There are five types of activities that can help our brains complete the stress cycle. https://www.youtube.com/embed/eD1wliuHxHI?wmode=transparent&start=0 It can help to understand how the brain encounters stress.

1. Exercise – its own complete stress cycle

When we exercise we get a short-term spike in cortisol, followed by a healthy reduction in cortisol and adrenaline.

Exercise also increases endorphins and serotonin, which improve mood. Endorphins cause an elated feeling often called “runner’s high” and have anti-inflammatory effects.

When you exercise, there is more blood flow to the brain and higher activity in the prefrontal cortex. This is why you can often think more clearly after a walk or run. Exercise can be a helpful way to relieve feelings of stress.

Exercise can also increase the volume of the hippocampus. This is linked to better short-term and long-term memory processing, as well as reduced stress, depression and anxiety.

2. Cognitive activities – reduce negative thinking

Overly negative thinking can trigger or extend the stress response. In our 2019 research, we found the relationship between stress and cortisol was stronger in people with more negative thinking.

Higher amygdala activity and less rational thinking when you are stressed can lead to distorted thinking such as focusing on negatives and rigid “black-and-white” thinking.

Activities to reduce negative thinking and promote a more realistic view can reduce the stress response. In clinical settings this is usually called cognitive behaviour therapy.

At home, this could be journalling or writing down worries. This engages the logical and rational parts of our brain and helps us think more realistically. Finding evidence to challenge negative thoughts (“I’ve prepared well for the exam, so I can do my best”) can help to complete the stress cycle.

3. Getting creative – a pathway out of ‘flight or fight’

Creative activities can be art, craft, gardening, cooking or other activities such as doing a puzzle, juggling, music, theatre, dancing or simply being absorbed in enjoyable work.

Such pursuits increase prefrontal cortex activity and promote flow and focus.

Flow is a state of full engagement in an activity you enjoy. It lowers high-stress levels of noradrenaline, the brain’s adrenaline. When you are focussed like this, the brain only processes information relevant to the task and ignores non-relevant information, including stresses.

4. Getting social and releasing feel-good hormones

Talking with someone else, physical affection with a person or pet and laughing can all increase oxytocin. This is a chemical messenger in the brain that increases social bonding and makes us feel connected and safe.

Laughing is also a social activity that activates parts of the limbic system – the part of the brain involved in emotional and behavioural responses. This increases endorphins and serotonin and improves our mood.

5. Self-soothing

Breathing exercises and meditation stimulate the parasympathetic nervous system (which calms down our stress responses so we can “reset”) via the vagus nerves, and reduce cortisol.

A good cry can help too by releasing stress energy and increasing oxytocin and endorphins.

Emotional tears also remove cortisol and the hormone prolactin from the body. Our prior research showed cortisol and prolactin were associated with depression, anxiety and hostility.

Action beats distraction

Whether it’s watching a funny or sad movie, exercising, journalling, gardening or doing a puzzle, there is science behind why you should complete the stress cycle.

Doing at least one positive activity every day can also reduce our baseline stress level and is beneficial for good mental health and wellbeing.

Importantly, chronic stress and burnout can also indicate the need for change, such as in our workplaces. However, not all stressful circumstances can be easily changed. Remember help is always available.

If you have concerns about your stress or health, please talk to a doctor.

If this article has raised issues for you, or if you’re concerned about someone you know, call Lifeline on 13 11 14 or Kids Helpline on 1800 55 1800.

Theresa Larkin, Associate professor of Medical Sciences, University of Wollongong and Susan J. Thomas, Associate professor in Mental Health and Behavioural Science, University of Wollongong

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Opioids are commonly prescribed when you’re discharged from hospital after surgery to help manage pain at home.

These strong painkillers may have unwanted side effects or harms, such as constipation, drowsiness or the risk of dependence.

However, there are steps you can take to minimise those harms and use opioids more safely as you recover from surgery.

Which types of opioids are most common?

The most commonly prescribed opioids after surgery in Australia are oxycodone (brand names include Endone, OxyNorm) and tapentadol (Palexia).

In fact, about half of new oxycodone prescriptions in Australia occur after a recent hospital visit.

Most commonly, people will be given immediate-release opioids for their pain. These are quick-acting and are used to manage short-term pain.

Because they work quickly, their dose can be easily adjusted to manage current pain levels. Your doctor will provide instructions on how to adjust the dosage based on your pain levels.

Then there are slow-release opioids, which are specially formulated to slowly release the dose over about half to a full day. These may have “sustained-release”, “controlled-release” or “extended-release” on the box.

Slow-release formulations are primarily used for chronic or long-term pain. The slow-release form means the medicine does not have to be taken as often. However, it takes longer to have an effect compared with immediate-release, so it is not commonly used after surgery.

Controlling your pain after surgery is important. This allows you get up and start moving sooner, and recover faster. Moving around sooner after surgery prevents muscle wasting and harms associated with immobility, such as bed sores and blood clots.

Everyone’s pain levels and needs for pain medicines are different. Pain levels also decrease as your surgical wound heals, so you may need to take less of your medicine as you recover.

But there are also risks

As mentioned above, side effects of opioids include constipation and feeling drowsy or nauseous. The drowsiness can also make you more likely to fall over.

Opioids prescribed to manage pain at home after surgery are usually prescribed for short-term use.

But up to one in ten Australians still take them up to four months after surgery. One study found people didn’t know how to safely stop taking opioids.

Such long-term opioid use may lead to dependence and overdose. It can also reduce the medicine’s effectiveness. That’s because your body becomes used to the opioid and needs more of it to have the same effect.

Dependency and side effects are also more common with slow-release opioids than immediate-release opioids. This is because people are usually on slow-release opioids for longer.

Then there are concerns about “leftover” opioids. One study found 40% of participants were prescribed more than twice the amount they needed.

This results in unused opioids at home, which can be dangerous to the person and their family. Storing leftover opioids at home increases the risk of taking too much, sharing with others inappropriately, and using without doctor supervision.

How to mimimise the risks

Before using opioids, speak to your doctor or pharmacist about using over-the-counter pain medicines such as paracetamol or anti-inflammatories such as ibuprofen (for example, Nurofen, Brufen) or diclofenac (for example, Voltaren, Fenac).

These can be quite effective at controlling pain and will lessen your need for opioids. They can often be used instead of opioids, but in some cases a combination of both is needed.

Other techniques to manage pain include physiotherapy, exercise, heat packs or ice packs. Speak to your doctor or pharmacist to discuss which techniques would benefit you the most.

However, if you do need opioids, there are some ways to make sure you use them safely and effectively:

• ask for immediate-release rather than slow-release opioids to lower your risk of side effects
• do not drink alcohol or take sleeping tablets while on opioids. This can increase any drowsiness, and lead to reduced alertness and slower breathing
• as you may be at higher risk of falls, remove trip hazards from your home and make sure you can safely get up off the sofa or bed and to the bathroom or kitchen
• before starting opioids, have a plan in place with your doctor or pharmacist about how and when to stop taking them. Opioids after surgery are ideally taken at the lowest possible dose for the shortest length of time.

If you’re concerned about side effects

If you are concerned about side effects while taking opioids, speak to your pharmacist or doctor. Side effects include:

• constipation – your pharmacist will be able to give you lifestyle advice and recommend laxatives
• drowsiness – do not drive or operate heavy machinery. If you’re trying to stay awake during the day, but keep falling asleep, your dose may be too high and you should contact your doctor
• weakness and slowed breathing – this may be a sign of a more serious side effect such as respiratory depression which requires medical attention. Contact your doctor immediately.

If you’re having trouble stopping opioids

Talk to your doctor or pharmacist if you’re having trouble stopping opioids. They can give you alternatives to manage the pain and provide advice on gradually lowering your dose.

You may experience withdrawal effects, such as agitation, anxiety and insomnia, but your doctor and pharmacist can help you manage these.

How about leftover opioids?

After you have finished using opioids, take any leftovers to your local pharmacy to dispose of them safely, free of charge.

Do not share opioids with others and keep them away from others in the house who do not need them, as opioids can cause unintended harms if not used under the supervision of a medical professional. This could include accidental ingestion by children.

For more information, speak to your pharmacist or doctor. Choosing Wisely Australia also has free online information about managing pain and opioid medicines.

Katelyn Jauregui, PhD Candidate and Clinical Pharmacist, School of Pharmacy, Faculty of Medicine and Health, University of Sydney; Asad Patanwala, Professor, Sydney School of Pharmacy, University of Sydney; Jonathan Penm, Senior lecturer, School of Pharmacy, University of Sydney, and Shania Liu, Postdoctoral Research Fellow, Faculty of Medicine and Dentistry, University of Alberta

This article is republished from The Conversation under a Creative Commons license. Read the original article.