The Physiology of Stress – Worry and Anxiety

    Worry and anxiety are being recognized for their major role in health problems. The number one cause of death in America is heart disease. Auto-immune issues combined are most often not life threatening, but can severely compromise one’s quality of life. 

    Stress is widely considered to be the number one cause of heart disease, and is likely at the root of auto-immune problems.

    Stress is a broad term; relative to heart disease & auto-immune issues, more specific words for stress are worry and anxiety. Certainly, nothing causes the heart more dis-ease than worry and anxiety. Also, worry and anxiety, to some degree, always inhibit the immune system.

    I have been practicing massage therapy for 35 years and teaching physiology for 31 years. In my practice I have noticed in virtually all of my clients a compromised resiliency in the deep muscles, the ones that support and stabilize the joints. This is an across-the-board phenomenon applying to everyone, varying in degree but ever-present. Its onset seems to happen between the ages of 7 to late teens. Relaxing this hyperactive support and stability reflex varies from client to client, as does how much that reflex relaxes and how long that lasts. This deep, intrinsic over-supporting and -stabilizing reflex seems to be directly hooked to emotions. (In her book “Molecules of Emotion” author Candace Pert describes the mechanisms through which every cell in our bodies are constantly informed of our current emotions.)

    All thoughts and feelings have a muscular response. Put another way, it is impossible for any thought or feeling to not have a muscular response, a muscular reaction. 

    Thus, worry & anxiety have two major physiological properties: 1) increase muscle tension, and 2) inhibit the immune system.

Increase Muscle Tension

    All thoughts that result in worry and/or anxiety are thoughts that are perceived by the mind as threats, varying only in degree. All threats engage the ‘fight or flight’ response (termed the Sympathetic response). This means that our muscles increase their tone in preparation for either fighting the threat or running from the threat. The problem here is that in our culture and society, we usually do neither of these things; we don’t fight, nor do we run away. We make decisions on how to deal (or not) with the issues, and when resolution at some point happens, that threat is usually replaced with another threat, with many threats often overlapping. 

Note: in discussing the Sympathetic response, ‘fight or flight’ describes half of the response. Two more aspects of the Sympathetic response are ‘freeze and fold’. When the odds against us are overwhelming enough, our evolutionary response is to ‘freeze’, go into a state of muscular tetany (resulting in immobility) in an attempt to become unnoticed and ready to fight or flee if immobility doesn’t work. “Fold’ is a phenomenon where fight or flight are no longer options and death seems inevitable. We collapse muscularly, our awareness is changed drastically, and physical pain is not felt. For a thorough study of this aspect of the Sympathetic response see the excellent books, “In An Unspoken Voice…” by Peter Levine and  “The Polyvagal Theory” by Michael Porges. For this article, I will oversimplify and use the common ‘fight or flight’ terminology.

    The accompanying rise in muscle tone as a threat response can increase or decrease, but seldom totally goes away. Massage therapists call this situation hypertonicity. Chronically hyper-toned muscles increase blood pressure simply because it is harder to pump blood through a tight muscle than it is a relaxed muscle. Keep in mind that chronic hypertonicity is a body-wide phenomenon. Some muscles will be tighter than others, but all skeletal muscles will be involved to some degree. The heart has to pump harder to keep the body supplied with fresh blood. (An interesting aspect to this scenario is that the body isn’t producing more discernible or functional ‘work’ here; the extra effort is being put into compressing the joints, making them tougher and stiffer, setting the stage for osteoarthritis.) 

   The Immune System

    Part of the ‘wired-in’, evolutionary response to threats is to inhibit the immune system. There was a very good reason for this phenomenon. While we were engaged in fighting or fleeing for our lives, if we got injured it was not the time to heal or repair; all available energy was dedicated to survival. During the ‘fight or flight’ Sympathetic response, the immune system was temporarily inhibited until the threat was over, and we either survived or did not. If we did, and made it to safety, then the ‘rest, digest, and heal’ (termed Para-sympathetic) response took over. Thus, the transition from Sympathetic to Parasympathetic was, much more than less, an on-off phenomenon. 

    The problem here is that, in our current culture and society, the threat commonly never completely leaves, it only varies in intensity. We are not designed for this set of circumstances.

  Palpable vs Non-Palpable Threats

    Let’s distinguish here between palpable threats and non-palpable threats. Palpable threats are real threats, such as someone malevolently coming at you with a knife or your car skidding on ice, or getting separated from your tribe’s hunting group and finding yourself around wolves who are clearly considering attack.  These are things to be legitimately afraid of, and the last is an example of what the fight or flight response evolved to cope with. In these circumstances, hyper-toned muscles and an inhibited immune system make sense, as does focused and narrowed attention, increased heart rate, selective hearing, and many more subtle aspects of the Sympathetic response.

    There is a gender and racial difference here to make clear, as is an occupational difference. For women and people of color, the possibility of very palpable threats are virtually ever-present, and a variation of the same applies to law enforcement and the military. For all of us, the possibility of random violence certainly exists. For women and non-white people in our culture, that possibility is a constant presence, and a Sympathetic response is natural and appropriate, as it is for police and soldiers. 

    Unique to our times is the pandemic. There are two types of circumstances Covid-19 presents in our context: personal health and personal finances. Personal health is always a source of worry and anxiety when it is threatened or compromised. The practical measures to be taken in all health threats is to minimize the risk. In general that means diet, hydration and exercise. In Covid that means taking the protective measures recommended in all viral exposure situations. 

    Personal financial stability is an altogether different palpable threat, and is covered below in a discussion about creating career options. Unique to the pandemic is that career options have changed drastically in many fields, and creativity in coming up with new career and financial options is essential.

    Conversely, non-palpable threats are not real threats. If I’m running late for an appointment I’d much rather be on time for, I can be threatened by a red traffic light. My body will go into the Sympathetic response to the exact degree that I feel worried and anxious about the delay. And, note that my body is going to do nothing about this situation in terms of fight or flight. I am going to sit in my car, with my muscles tense, my immune system inhibited, my heart rate increased, my focus narrowed, and more. This response is of absolutely no practical use in the current situation, in the face of a non-palpable threat. Quite the contrary, it is almost completely counter-productive. To deal with a non-palpable threat, I would be better served by a relaxed body, with a broad perspective considering more information, options, and alternatives.

            Here is the conundrum: 

We’re not wired for this. We’re wired to treat non-palpable threats the same as palpable threats. 

            Let’s go a giant step further: 

We could not have evolved with worry nor anxiety operating at anywhere near the level we experience today.

    Evolution seems to not make that kind of a mistake. If we evolved feeling worry and anxiety with any regularity, evolution would have made the distinction between palpable and non-palpable threats, and would not engage the Sympathetic response in the face of a non-palpable threat. It makes evolutionary sense that the opposite response would happen, the Parasympathetic response would be engaged to help with clear thinking and a broader view of the current situation.

    Here are two looks at non-palpable threats.

    A client of mine had a 15 year-old daughter who was having anxiety attacks, and as part of the steps they were taking they scheduled massages. During a session she talked about things that made her anxious, and said that a big one was peer gossip about her on social media. Her mother asked how that might affect her daughter physically. We discussed the connection between emotions and deep, intrinsic reflexes. I asked her daughter if she respected or admired the people who were talking about her. She thought for a moment and said no, she didn’t. I suggested the bigger question was not why others are talking about her, but why she cared what people whom she did not respect had to say regarding her. Physiology suggests that, while I may be interested in what others think of me, I don’t care what others think of me. The difference is the difference between a Parasympathetic response and a Sympathetic response, between curiosity and worry/anxiety.

    Another example is getting dressed. Whom am I getting dressed for? Certainly, I will dress for a particular occasion. Beyond that, if I choose my clothes based on what I believe others will think of my look and judge me, I am certain to experience worry and anxiety. Conversely, if I choose the clothes I want to wear, the ones that feel good to me at that time, and trust my choices, I will not experience worry nor anxiety.

Physiology’s Circumstances

    For most of our evolution (actually 99.7% of it), time would have meant very little beyond daytime, nighttime, and the seasonal changes. We, like all other things alive, had to move to survive. One third of our motor neurons and all of our sensory neurons are dedicated to interpreting space so we can operate in it. [“Job’s Body”, Deane Juhan; p.197]

    An example of the pervasiveness of this evolutionary physiology can be observed from the common experience of walking down a flight of stairs and thinking there is another step but there isn’t. We all experience an odd moment in which all thought is suspended until we figure out where we are. It is, in fact, impossible to think, when that occurs. Those sensory neurons interpreting space have the ability to suspend thought, and nothing else does. That’s how much priority interpreting space has. 

    In our culture and society (.3% of our evolutionary time-frame), space priority has given way to time priority. We organize most of our days around time, and space is often someplace I go to serve my time (pun semi-intended).

    We have no neurons dedicated to time. Time is a concept to our minds. Again, we’re not neurologically wired for time to be a top priority. Focusing on time inevitably encourages worry and anxiety. It has us focused on the future (or the past) as opposed to paying attention to the space I’m in, the present. In our culture, it can become a reflex to worry about the future and regret the past, and our emotions are always one with our thoughts.  As humankind, our evolutionary timeline goes back some 3 million years. Our concern with future time began with the Agricultural Revolution 10,000 years ago. For 2,990,000 years we operated one way, and for 10,000 years we have been operating another.

Physiology’s Suggestions

Space and Time

    In this context, physiology suggests I pay more attention to the space around me, and use time as a tool to organize my space. 

    For example, let’s say I’m done with my work at 5, I’m going to have dinner on the table at 7:30, and I have groceries to buy for it. For the next 2 1/2 hours I have no time considerations, I can totally focus on moving through space to accomplish all that I need to. Plan my route, pay attention to the space I’m traveling through to the store, imagine the meal I’m making and select what I’d like, pay attention to the trip home, construct the meal and eat. Now I can check in with time again and organize what’s next.

    For most of us, we would spend a substantial amount of those 2 1/2 hours thinking of other times and places, often focusing on worry and anxiety. We occupy our space while our minds run a litany of time-based worries, anxieties, and frustrations.

    In our culture, we have to pay attention to time. In the big picture, physiology suggests I use time as a tool, rather than as a mandate. 

Cause and Effect

    We are in a cause and effect universe. Something is caused, it has an effect and that causes something else. This plays out emotionally also. Our perceptions cause feelings and emotions, and they directly effect physiological responses. The short of this dynamic is if I feel I am willfully causing something, I will be engaged in the process, and I can feel some level of security; the physiology will play out more Para-sympathetically. However, when I feel I am at the effect of circumstances, that will engage worry and anxiety, and that will definitely be a Sympathetic, fight-or-flight response. 

    Physiology suggests that in the face of feeling that I am at the effect of present circumstances, cause something.

    For example, a client of mine was working a job that required 60 plus hours a week of her time. For her, the pay was okay for sustaining her modest lifestyle. The work was mildly interesting to her, but the work circumstances were not, and she was powerless in the situation to improve it. She felt trapped in the job and completely at the affect of her circumstances. Her musculature was generally tight, though she responded to massage very well. She was interested in any suggestions I might have. 

    We talked about things that interested her, and soon came to the idea that she thought she had a good singing voice, and a ‘bucket list’ idea she had was to sing on a public performance level of some sort, preferably for pay. I suggested she prepare a few songs and go to karaoke nights and see what kind of response she got. If she wanted to continue, she could use that to find a working band looking for a singer, and at the same time study and practice piano to eventually be able to accompany herself solo and in a band. She’s doing those things, and in the meanwhile actively found another job with better hours and circumstances. She began causing things and circumstances, became more engaged in creating personally appealing journeys, and is finding more satisfaction in daily living. Her body has become more compliant and resilient.

    In his book “Job’s Body” author Deane Juhan points out that worry and anxiety are feeling states, and must be replaced with another feeling or they will simply return. In other words, deciding to stop feeling worried and anxious cannot last for long unless I focus on something else. This fits very well with the cause and effect idea. Physiology suggests that, in the face of worry and anxiety, I shift my perspective to something I can do, something I can cause, something that feels like I am moving myself forward, that I am going somewhere. Thus, one of the best tactics is becoming engaged in creating something, something that resonates within.


    Here is the crux of the matter that physiology is suggesting: 

            Trust myself in all matters & in all things all the time.

    If I lived that way, I would not have a Sympathetic response to non-palpable threats, and I would not experience worry nor anxiety. None of us ever knows for certain how life will play out for us, so there ultimately is no reason not to trust our choices and decisions. 

    To minimize worry and anxiety, there is a retraining that must take place, and it is a retraining of perspective, how I look at things. Our society and culture pressure all of us into not believing in ourselves by convincing us we need something or someone other than ourselves in order to function effectively. A retraining here is to believe that I will assess what is pertinent to current situations, make my choices, see how it plays out, and make my next choices. The background belief is trust in myself, because, ultimately, there is no one else to trust.

    Many of us seek counseling of one type or other to help get perspective. A primary goal of counseling appears to be to help a person consider a different point of view, a different way of looking at life and its circumstances. For various reasons, our culture has us functioning outside our design, and becoming fluid with the ability to change and even adapt different perspectives is a valuable skill to practice and acquire. A broader perspective with more options can support a more Parasympathetic experience. 

    This concept works equally well from the body to the mind. Effective bodywork can literally show the body a different point of view, and this can facilitate the changes we’re discussing here. ‘BodyMind’ describes our totality, and everything effects and affects all aspects of us. Our bodies and our minds are always in synchronized step with one another, each effecting/affecting the other. A multi-faceted BodyMind approach will have the most thorough impact.

    Physiology then leads to this:

            Why I do what I do is who I am.

    Whenever we do (or not do) things, no matter how important or unimportant they may seem to us, we will have a feeling, an emotion about the idea behind doing them, the thought that ‘sponsors’ our thoughts and ideas. That feeling, that emotion will have a security/threat identity, varying in degree but not in choice. The  Parasympathetic – Sympathetic (rest, digest, and heal vs. fight or flight) response is a continuum, not an option. We are always somewhere on that continuum. The effect the position on the continuum has on muscle tone can be traced through the neuromuscular connections, with the effects described above. Through the muscle tone, power is applied to connective tissues. How fluid and resilient or thick and resistant the connective tissue is will be a one-to-one reflection of the emotions, averaging out over time. The resilience / resistance state of our connective tissue describes how we move, reflects how we think, and so defines our body. 

    Thus, ‘why I do what I do is who I am’, and my body right now is the physical reflection of all my thoughts and emotions to this point in time and space.

    The corollary is if I don’t know why I do what I do, then I do not know who I am. A  perspective to practice here would be noticing the things I do and choices I make that lead to both satisfactory and non-satisfactory outcomes, and be able to say why I made the choices I made, and decide if that describes the person I am ultimately choosing to be. The more clearly I know why I do what I do, the more clearly I know who I am.

    Of course, this requires that I be honest with myself, and note that honesty is not a hallmark of our culture and society. They suggest, when the chips are down, lie. It is easy for many of us to routinely operate in this manner; lying runs rampant in many relationships of all types, personal and professional. 

            If I tell a lie, I am saying to myself that my truth is not safe; I can only feel threatened in that circumstance, and I will feel worried and anxious. 

    We as individuals can choose otherwise. 

    Physiology suggests I always say my truth and deal right then and there with the results.

    Many of us are exploring alternatives to mainstream cultural perspectives, ideas and products. There are plenty geared toward aiding those goals, ranging from self-care practices like meditation, massage, restorative exercise and movement (yoga, tai-chi, and more that increase flexibility and strength without over-stressing the joints). There are many alternatives to pharmaceutical drugs such as natural and sustainable foods, CBD products, essential oils, and many more that boost the immune system with no negative side effects. We seem to be steadily heading to new sources of energy that are sustainable while non-polluting. We can surely use all the help we can get to counter the cultural directive of self-doubt, worry and anxiety. 

    We can more easily move into the state of self-trust with the help of other people, places, and things. We are all in this together, and more and more of us are appreciating that fact and putting major efforts into correcting our cultural and societal problems.

    Here we have been looking at what our inherited, evolutionary physiology suggests we may change in ourselves in order to enjoy a healthy and functional body. We have seen that physiology suggests a change in personal perspectives in order to avoid worry and anxiety sabotaging our natural self-healing reflexes. These are core-level thinking habits and practices that must happen on an individual level, since, in the final analysis, all of life is a solitary journey, and it turns out that the physiology of trust in one’s self celebrates that. 


“Job’s Body”, Deane Juhan

“Molecules of Emotion”, Candace Pert

“Sapiens”, Yuval Harari

“In An Unspoken Voice…”,  Peter Levine 

“The Polyvagal Theory”,  Michael Porges



Chuck LaFrano