HPA Axis Dysfunction, Chronic Stress & Nervous System Retraining

Image of the HPA Axis

The hypothalamic-pituitary-adrenal (HPA) axis is a central component of the body’s stress response system. It governs the release of cortisol, which helps manage acute stress. However, prolonged or repeated exposure to stress can lead to HPA axis dysfunction—a state of dysregulation that affects the brain, body, and emotional well-being.

Effects of Chronic Stress on the HPA Axis
When stress is chronic, the HPA axis can become either overactive or underactive. This may lead to sustained high cortisol levels or a flattened cortisol rhythm, impairing sleep, energy levels, immune function, and emotional regulation. HPA axis dysfunction has been linked to conditions such as depression, anxiety, PTSD, and chronic fatigue (Yaribeygi et al., 2017).

Therapy can support the resolution of HPA axis dysfunction and nervous system dysregulation by addressing the psychological and behavioral contributors to chronic stress responses. Specifically:

1. Regulation of Stress Response: Approaches like somatic experiencing and trauma-informed therapies help downregulate hyperaroused or hypoaroused states, thereby reducing chronic activation of the HPA axis.
2. Enhancing Interoception and Safety: Therapies that focus on bodily awareness and creating internal experiences of safety can shift the nervous system from survival modes (e.g., fight, flight, freeze) to regulation.
3. Processing Trauma: Addressing unresolved trauma can reduce maladaptive stress patterns that sustain dysregulation.
4. Developing Coping Skills: Therapy fosters resilience through emotional regulation, mindfulness, and adaptive coping strategies that reduce the intensity and duration of HPA activation.
5. Therapeutic Relationship: A safe, attuned therapeutic alliance can itself act as a corrective experience for relational and autonomic dysregulation.

Conclusion
Addressing HPA axis dysfunction requires a multidimensional approach, with nervous system regulation at its core. Regular use of these tools may support both physiological and psychological recovery, promoting resilience and mental clarity over time.

​References
Yaribeygi, H., Panahi, Y., Sahraei, H., Johnston, T. P., & Sahebkar, A. (2017). The impact of stress on body function: A review. EXCLI Journal, 16, 1057–1072. https://doi.org/10.17179/excli2017-480
Pascoe, M. C., Thompson, D. R., Jenkins, Z. M., & Ski, C. F. (2017). Mindfulness mediates the physiological markers of stress: Systematic review and meta-analysis. Journal of Psychiatric Research, 95, 156–178. https://doi.org/10.1016/j.jpsychires.2017.08.004
The Huberman Lab Podcast. Episode: "How to Control Your Stress Response" by Dr. Andrew Huberman. Accessed at: https://www.hubermanlab.com/episode/how-to-control-your-stress-response

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