In my final unit of Master’s study, I have become increasingly aware of the important role that the amygdala plays in stress-management and anxiety-reduction.

The healthcare environment can be a particularly stressful place and nurses are frequently faced with time constraints, ethical dilemmas, and a need to perform under pressure.

Job Stress and Nursing Burnout

Each person interprets stress differently which for some may be positive and others could be as a threat (Jennings, 2008). Job-stress is a health concern as well as a workplace hazard (Jennings, 2008).

In 1960, Menzies ‘identified four sources of anxiety among nurses: patient care, decision-making, taking responsibility, and change’ (cited in Jennings, 2008). Whereas job-stress for nurses can relate to ‘physical labor, human suffering, work hours, staffing, and interpersonal relationships’ (Jennings, 2008).

It is thought that job-stress for nurses may be increasing as a result of the increasing use of technology, healthcare cost rises, and disorder in the healthcare setting (Jennings, 2008).

Nursing ‘burnout’ may result from chronic stress; burnout is common to directly interpersonal working roles such as in nursing (Jennings, 2008). Burnout is described as a ‘syndrome characterised by emotional exhaustion, de-personalisation, and reduced personal accomplishment’ (Jennings, 2008).

Unfortunately for nurses, work- and family- life cannot be completely separated and the collective stressors related to multi-tasking between work, raising children as the primary care-giver, and marital relationships can make nurses prone to burnout and stress (Jennings, 2008).

Job-stress and burnout do not only affect the nurses individually, but also the healthcare organisations (Jennings, 2008). Health problems can arise from the physiologic reactions to neuroendocrine stress responses (Jennings, 2008). Evidently, this can lead to absenteeism, staff turnover and subsequently diminished quality of care for clients (Jennings, 2008). Thereby, it is imperative that healthcare organisations transform the working environment to a place that fosters job-satisfaction, client safety, and well-being for all stakeholders (Jennings, 2008).

Neuroplasticity to Retrain the Amygdala

An interesting perspective was raised by Bergland (2013), in which he highlighted that neuroplasticity is usually discussed in terms of building new pathways, but perhaps it is necessary to consider facilitating the breakdown of negative/unwanted neural pathways in conditions such as anxiety.

Retraining the Amygdala - Neuroplasticity to Retrain the Amygdala Brain

Neuro-imaging has shown increased amygdala activation for various anxiety disorders (Shin & Liberzon, 2010). The Calm Clinic (n. d.) describes the amygdala as a ‘set of small, almond-shaped clusters of nuclei near the base of your brain’. The amygdala triggers the fight or flight response when it senses danger due to either emotional or environmental triggers (Calm Clinic, n. d.).

More about the amygdala (Calm Clinic, n. d.):

It is part of the brain that reacts rather than thinks
‘Its role is not to figure out why you are afraid, but to alert you if bad memories support a fight or flight reaction, and, if they do, to cause that fight or flight reaction to take place.’ (Calm Clinic, n. d.)
Therefore it may not be possible to talk yourself out of the stress response
Fear exposure may desensitise the amygdala
‘Because thoughts and memories trigger your amygdala, you are also stuck with bodily sensations you don’t like.’ (Unlearning Anxiety, 2017)

Anxiety Chain Reaction

The Calm Clinic (n. d.) outlines the following example of the chain reaction of anxiety:

An emotional or environmental trigger (e.g. an obsessive negative thought)
Amygdala reacts with fight or flight (e.g. you may feel like you need to run away)
Adrenal action (e.g. epinephrine is released in the bloodstream and bodily processes ‘speed up’)
Blood sugar level increases for fast energy use as a result of the epinephrine
Shaking occurs due to increased energy and to ‘encourage the blood to reach the extremities of the body’
Pounding heart as a result of the epinephrine and increased heart rate
Flushing reportedly results from blood unused by the muscles
Increased respiratory rate for oxygenation
Chest discomfort from increased demand on the heart and lungs

How May We Be Able to Retrain the Amygdala?

Retraining behaviours and memories – behaving without anxiety and reframing memories to become more positive (Unlearning Anxiety 2017)
Teach the amygdala that a conditioned reaction is not a threat to your safety (Unlearning Anxiety 2017)
Healthy eating and exercise may prevent health complications of stress/anxiety or make you feel more able to cope (Calm Clinic n. d.)
Visit https://www.unlearninganxiety.com/tools/ for more information on Mindfulness, Acceptance Commitment Theory (ACT), Dialectical Behaviour Therapy, and Positive Psychology and these can help to manage anxiety

Interesting quote by Unlearn Anxiety (2017):

‘Leonardo di Caprio voluntarily walked into OCD for his job. Yes, that’s right. After his role in ‘The Aviator’, Leonardo developed OCD for about a year. To put this in context, it means that he sensitised his own amygdala. That’s how plastic the human brain is. Then, after getting treated with mindfulness, he again re-wired his brain to cure his OCD. He then de-sensitised his amygdala. His experience was like a switch to alter his brain – on-off, on-off. Self-directed neuroplasticity. Conclusion? NEVER tell youself that anxiety is lifelong’

Note: All of the above information should be used for increased understanding, but not for treatment – please seek medical and psychological support and guidance from qualified professionals to manage stress, anxiety and other concerns regarding your wellbeing.

Please call: 000 for urgent assistance or for a less urgent example, consult support services such as Nurse & Midwife Support, Lifeline and Beyondblue or visit your GP.

References

Bergland, C 2013, ‘The size and connectivity of the amygdala predicts anxiety’, in Psychology Today, viewed 2 September 2017, https://www.psychologytoday.com/blog/the-athletes-way/201311/the-size-and-connectivity-the-amygdala-predicts-anxiety.
Calm Clinic (n. d.), How the amygdala affects anxiety, Calm Clinic, viewed 2 September 2017, http://www.calmclinic.com/anxiety/amygdala.
Jennings, BM 2008, ‘Work Stress and Burnout Among Nurses: Role of the Work Environment and Working Conditions’, in: Hughes RG, (editor), Patient Safety and Quality: An Evidence-Based Handbook for Nurses. Rockville (MD): Agency for Healthcare Research and Quality (US), 2008 Apr, Chapter 26 viewed 3 October 2017, https://www.ncbi.nlm.nih.gov/books/NBK2668/.
Shin, LM & Liberzon, I 2010, ‘The Neurocircuitry of Fear, Stress, and Anxiety Disorders’, Neuropsychopharmacology, vol. 35, no. 1, pp. 169–91, viewed 3 October 2017, http://doi.org/10.1038/npp.2009.83.
Unlearning Anxiety 2017, Anxiety & the amygdala, Unlearning Anxiety, viewed 2 September 2017, https://www.unlearninganxiety.com/amygdala/.

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