In the 12^th century, the Rambam (Moshe ben Maimon, Maimonides), addressed the interconnection of the mind, body and spirit. He recognized that an ill person's thoughts and beliefs affected both his emotional state and physical experience. He did not believe in amulets, and yet, he wrote in his Laws of the Sabbath that a patient who believed that charms or talisman were healing should be allowed to wear them, even on Shabbat, because it might reduce his distress. In The Art of Healing, the Rambam wrote: “One should never forget to strengthen the patient's vitality with nourishing food, and to strengthen the spiritual powers with fragrant odors, music, and by telling him happy stories that expand the heart and distract his mind with things that make him and his friends laugh.”

In his book, Mind-Body Unity: A New Vision for Mind-Body Science and Medicine (published by Johns Hopkins University Press, 2004), Henry Dreher describes mind-body interconnectedness as a “dynamic communication network,” whose goal is constantly to monitor adjustments that need to be made in order to maintain health and wellbeing. As the Rambam would probably concur, Mr. Dreher found that this communication network can be disrupted by stress. He concludes that how an individual copes or “self-regulates” can contribute to either a balanced healthy state or to an outcome of symptoms such as somatic symptoms, or manifest illness, irritability, mood changes, struggle with focusing and problem solving, and relationship difficulties.

Stress is the body's attempt to adapt or cope with the changes and challenges of life. It is an automatic biological response to life demands made on an individual, and it has physiological and psychological ramifications. These demands come from both external and internal sources. Examples of external sources are: challenges that come from work, family, health challenges, environmental toxins, traffic jams, or just lost keys. Examples of internal sources are: body sensations, self-imposed demands and unrealistic expectations.

To complicate matters, stress comes in two flavors. There is good stress, called eustress. Eustress enhances life with a sense of vibrancy and excitement, heightens alertness, and contributes to feeling competent and confident in one's ability to be creative and productive.

Bad stress, on the other hand, contributes to a person feeling powerless, inadequate, overwhelmed or out of control.

Interestingly, individuals often respond differently to the same stressor of demand of the moment. For example, a tennis match is a good stressor for a person who enjoys the physical challenge. It can be a bad stressor for the person who is over-invested in winning to the exclusion of enjoying the game.

Another way to say this is that how a stressor is perceived or interpreted affects one's experience. Thoughts, attitudes, beliefs, and expectations affect the way one perceives and interprets stress and specific stressors. What one person perceives as dangerous may be a generally accepted fact, or it may be unique to that person based on his prior experiences and how those experiences were processed.

Most salient to the stress experience are two parts of the autonomic nervous system: sympathetic nervous system and parasympathetic nervous system.

The sympathetic division continuously evaluates safety and danger levels by processing sensory information from the environment as well as from the sensations from the body. A threat of danger, real or imagined, triggers a biological cascade of hormones and biochemicals in milliseconds. This is called the fight or flight response, and happens before an individual even becomes cognitively aware of the danger. This is why a person can jump out of the path of an oncoming car before thinking about what is happening.

Physical signs of the activation of the fight or flight reflex are: increased heart rate and blood pressure level, quicker and more shallow breathing, muscle tension, more acute hearing and vision, and cold hands and feet because blood is directed away from the extremities as well as the digestive and reproductive systems in order to flow into the large muscles that assist in fighting or fleeing.

The parasympathetic system controls the psychophysiological state of relaxation. It is triggered by the resolution of the threat or danger. The body returns to a balanced state. This means that heart rate slows, blood pressure returns to normal levels, and the respiratory, circulatory, digestive, and reproductive systems resume optimal functioning. The muscles relax and the person feels relaxed and calm.

Activation of fight/flight/freeze (trauma response) happens reflexively. However, the parasympathetic response can be automatic following the resolution of threat or danger, or controlled by the person via mind/body skills, such as relaxation breathing, visualization, music, prayer and others.

Knowing that we can voluntary trigger the parasympathetic nervous system when we are stressed is very important. It means that we have the ability to learn skills that will mitigate the effects of bad stress, as well as prolonged or chronic stress. To review, these effects include: somatic symptoms (headaches, stomachaches), manifested illness, irritability, mood changes, struggles with focusing and problem solving, and relationship difficulties.

Our quality of life is greatly affected by our social environment and relationships. We all need good relationships for healthy development and growth. The Torah, as well as psychological literature, highlight that safety (environmental, intrapsychic, interpersonal) is the required necessity for healthy social experiences. Safety is expressed in loving emotional connection, gentle touch, eye contact, soft voice, and responsiveness to verbally and non-verbally expressed needs. This sounds simple, but is complicated by several factors.

Our early experiences (and the beliefs, attitudes, thoughts, expectations, and instinctive responses that emerge from it), mostly exist on an unconscious level. They create what Freud called a “filter” or “psychic screen”. John Bowlby called it an “internal model of the world.” This filter determines what we perceive. It serves to monitor information taken in and then given meaning. If the filter misreads danger or safety, meaning that if the fight or flight response is triggered when there is no threat, or is nullified when the individual is indeed in jeopardy, the consequential responses can place the individual at high risk of physical, emotional and social consequences. Freud understood that, under stress, people can instinctively retreat to old and unconscious ways of responding. Many of these responses were learned in childhood and adolescence by observing how parents and significant others handled life stresses. Some responses are based on how difficult and painful experiences were processed and given meaning.

Fortunately, there are many skills that can be learned that can help us cope with stress, challenges, or stressors that emerge from accurately perceived life experience or “faulty filters.”

Self-awareness is a foundational skill. Self-awareness is the skill and ability to perceive our outer and inner worlds. We practice and develop this skill by sitting quietly and non-judgmentally observing our sensations, thoughts, feelings, attitudes, beliefs, and what we notice in our environment as they emerge in moment to moment experiences. Over time, we learn about ourselves and how we perceive, give meaning to and respond to situations that make demands of us, challenge us, and stress us. This awareness opens the door to change and growth. Sometimes this skill is also called “mindfulness practice.”

Reflective function is another key skill. It is the ability to think about one's feelings, thoughts, and intentions and to see how they are connected to expectations and behaviors. It is also the ability to recognize that another person also has feelings, thoughts, and intentions that are connected to their expectations and behaviors. In order to have good relationships, we need to understand both ourselves and others, and make choices that bring us the outcomes we want.

Self-regulation skills, also known as mind/body skills, allow us to monitor our physical and emotional states and identify them as aroused, depressed or balanced. Mind/body skills include: relaxation breathing, self-awareness, mindfulness, meditation, prayer, visualization, self hypnosis, movement and exercise, music, and journaling. Use of these skills can empower us to cope with stressors and return the mind/body to a relaxed, balanced state. This is the state in which safety can be experienced, and which best enables psychophysiological wellbeing and full participation in treasured and needed relationships.

Chana Simmonds, MSW, LCSW specializes in couples and sex therapy, infertility, perinatal and postpartum anxiety and depression, and parenting. She maintains a private practice in Teaneck, NJ.