Cold, Clammy Hands and Hot Reactivity

Have you ever had the experience of shaking someone’s hand only to find it ice cold and clammy? If that person had a reason to be nervous (such as a young man meeting his future in-laws for the first time), then there wouldn’t necessarily be any reason to be concerned—but what if that person wasn’t in a situation that might make him nervous?

Cold, clammy hands are the result of what cardiologists call “total peripheral resistance.” In most cases, peripheral resistance is nothing to be alarmed about. When your heart contracts, it sends blood into your arteries. Peripheral resistance occurs when the blood moves from the arteries into the arterioles (small blood vessels branching off from arteries) and then into the capillaries where the oxygen and nutrients are transferred from the blood to your body’s tissues. That normal resistance of blood moving from a large vessel into smaller vessels results in normal blood pressure.

When a person is nervous or under stress, the heart beats faster, which sends much more blood into the arteries. Additionally, one of your body’s normal stress responses is the contraction of the peripheral circulation (the smaller vessels) and the expansion of core circulation (the larger vessels).

The diminished circulation is accompanied by increased sweating—particularly of the palms of your hands and soles of your feet. Thus, you get cold, clammy hands when you’re nervous or under severe stress.

Everyone has occasion to be nervous from time to time. However, when a person’s anxiety is constantly disproportionate to the situation, the total peripheral resistance is constant and it becomes a problem because of chronic wear and tear on the cardiovascular system, which is obviously accompanied by a chronic increase in blood pressure.

Such a person is known as a “hot reactor.” These are ordinary people who are out of touch with the messages their bodies are trying to send to them. A hot reactor’s cardiovascular system is literally taking a beating. The effect is like driving your car with one foot pushing the accelerator while the other is on the brakes.

Approximately 20 percent of the population are true hot reactors.

Are You a “Hot Reactor”?

Dr. Robert Eliot, considered the father of psychoneurocardiology, defined a hot reactor as someone who demonstrates “extreme cardiovascular reactions to standardized stress tests.” Dr. Eliot observed that hot reactors exhibit disproportionately high heart rate and blood pressure responses in exercise testing situations.

Back in 1982, I was a young, driven, ambitious, and aggressive cardiologist. I wondered if I might be a hot reactor. I wanted to make sure I was behaving constructively rather than self-destructively, so I signed up at the Life Stress Simulation Laboratory in Omaha, Nebraska, where cardiologists were using technology originally developed by NASA to measure the effects of emotional stress on the body.

They tested me like they did the astronauts. My hands were plunged into ice water and I was asked left and right brain questions in an effort to trigger a physical response. I “passed” with flying colors—cool as ice on the inside, and my blood pressure didn’t budge. I was not a hot reactor.

Intrigued by the procedure, I went home and set up my own hot reactivity lab, where I did 200 tests from 1985 to 1989. Here’s how this noninvasive procedure works:

Tracking your heart rate beat by beat, computers tap directly into your emotional and physiological state by using a technique called “impedance cardiography”—which measures cardiac output, blood pressure, and systemic resistance. You are taken from quiet, restful periods through a series of increasingly challenging mental tasks that include math calculations, quizzes, and video games that demand keen visual perception and manual dexterity—all simulating controlled competition.

It’s likely that your reactivity profile generated in this lab setting reflects your response to stress in the real world. Armed with the knowledge that a poor profile could indicate a risk of developing cardiovascular disease, you could then take steps to correct hot reactions to stress. Generally, however, a simple treadmill stress test will give you the information you need.

The normal response to a treadmill, step, or bicycle stress test is for both the heart rate and systolic blood pressure to rise proportionately and incrementally as each workload is introduced. This response indicates your body’s ability to generate the extra energy that is needed to meet the increased workload. The diastolic pressure (the lower number) is expected to stay the same or lower.

During a normal treadmill evaluation, the heart rate rises in the first minute of each two- to three-minute stage and then levels off. A high-sustained heart rate may simply indicate a poor level of physical conditioning (in other words, you’re out of shape).

However, in hot reactors, the elevated heart rate is associated with a disproportionately high blood pressure response in the first stage of exercise. In other words, an exaggerated response to the first stage of exercise stress testing may be a sign of hot reactivity.

You may be sufficiently in touch with your body to recognize a sudden heat flush, headache, anxiety, or cold sweaty palms as exaggerated nervous system responses. However, some people are completely out of touch with their bodies and may not realize they are having hot reaction responses. Here are some strategies you can use to help tone down your reactions to stress, especially if you’re a hot reactor but even if you just suffer from an occasional peripheral resistance.

Take These Steps to “Turn Down the Heat”

• Boost your fitness level through an exercise program, such as walking daily. You don’t have to train like an athlete. Just maintain a regular 15- to 30-minute walking program three to five times a week. If you’d like to include sports or recreational activities, that’s great, too. Tennis, golf, skiing, swimming and similar activities enhance your cardiovascular fitness and temper your reaction to stress. Remember, almost any type of aerobic exercise will help relieve depression, tension, and anxiety while increasing your sense of self-control.
• If you’re one of the people who is aware of your body’s distress signals, try this “body scan” technique. Starting at the top of your head, observe areas of tension or tightening as you move your focus down your body. Are your shoulders raised up around your neck like you’re poised for a fight, or are they slumped forward under the load of your concerns? Close your eyes and form a mental picture of your body as you slowly scan from head to toe.
• Use mental imagery or meditation to induce states of relaxation. When you recognize stress in your body, focus on your breathing, and imagine a relaxing, pleasant experience. One of my patients, for example, combats stress by visualizing herself lying in a meadow of flowers. Sometimes she can even “smell the flowers.” Through instant visualization, she actually creates a meditative state and, thus, a calming response.
• If you suspect you’re a hot reactor, you need to take responsibility for your body. Remember, by learning to identify your body’s distress signals, you can reduce stress and maximize your heart’s health.

Other Ways to Cool a Hot Reactor

• If you’re fatigued, take a nap or a break.
• Learn to say “no” when you mean no.
• Take vacations and honor your leisure time.
• If you have an emotion, experience it, but don’t editorialize on it. For example, if you are sad, be sad, but don’t get angry at yourself for feeling sad.
• Beware of your negative self-talk. If you are being negative, turn it around into some form of optimism. Almost all stressors can be “re-worded.”
• When you confront stressful situations that you can’t change, try to just “go with the flow.”
• Don’t make mountains out of mole hills—and remember, they’re all mole hills in the end anyway.

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