Stress in health and disease is medically, sociologically, and philosophically the most meaningful subject for humanity that I can think of (Selye ,2012)

What is stress?

Stress arises as a response to neutral stimuli known as stressors (Dedovic et al., 2009). Stressors may be external (e.g. major life changes, work deadlines) or internal (e.g. negative thoughts, unrealistic expectations) factors which challenge the body’s homeostasis (balance). When the body encounters stressors, various psychological and physiological processes are invoked; the perceived threat is assessed and the body accordingly determines and activates the appropriate biological and behavioural responses in an attempt to neutralise the stressors. This process is collectively referred to as stress response.

The limbic system is the part of the brain involved in vital functions such as behavioural and emotional regulation, memory, learning and motivation (Rajmohan & Mohandas, 2007). Threat assessment is processed in the amygdala, which then sends a message to the hypothalamus, which in turn communicates to the rest of the body via the automatic nervous system (ANS). The ANS controls involuntary bodily functions such as breathing, heart rate and digestive processes (Waxenbaum et al., 2020), and is comprised of two subsystems: the sympathetic nervous system (SNS), involved in ‘Fight or Flight’ responses, and the parasympathetic nervous system (PSNS), commonly referred to as the ‘Rest and Digest’ system. Short-term (or acute) stress responses are produced by the Fight or Flight response via the sympathomedullary pathway (SAM), whereas long-term (or chronic) stress is regulated by the Hypothalamic Pituitary-Adrenal (HPA) system (McLeod, 2010).

Stress response theories

The endocrinologist Hans Selye was the first to popularise the term ‘stress, defining the phenomenon as “a nonspecific response of the body to any demand made upon it” (1976, p. 137). Selye’s General Adaptation Syndrome (GAS) (1936) (later renamed as ‘Stress Theory’) presents the stress response from a biological and adaptive perspective, noting a triphasic physiological process of Alarm (acute manifestations), Resistance (acute manifestations subside, but body remains on high alert) and Exhaustion (resources are depleted and the body becomes susceptible to negative effects of chronic stress such as fatigue and burnout).

Lazarus and Folkman (1984) subsequently proposed the Transactional Model of Stress and Coping, describing the psychological component of stress response outlined as a process of Appraisal, Response and Adaptation. The Cognitive-Mediational Theory (1991) further elaborates that an individual’s stress response is influenced by a dual phase of cognitive appraisal, suggesting individual differences as a differential component of stress response. Primary appraisal is the process whereby the significance of the stressor is determined, and this is followed by secondary appraisal, whereby the individual assesses the options/ability for coping with the stressor.

Coping responses

Lazarus and Folkman (1984) differentiate between two types of coping responses; Emotion-focused coping occurs where an individual deems the cause of stress to be outside of their control, and therefore coping responses focus on controlling the emotional response. Problem-focused coping, on the other hand, focuses on the source of the stress, aiming to neutralise the direct cause. Problem-focused strategies are considered to be most effective overall as they deal with the root cause of the issue. A meta-analysis of coping strategies found that emotion-focused strategies are often less beneficial with regard to health outcomes (Penley et al., 2002), with emotion-focused coping (or palliative coping) often linked with maladaptive (unhealthy) approaches such as substance misuse and emotion suppression. However, healthy emotion-focused strategies such as journaling (Cheng et al., 2015) or meditation (Bostock et al., 2019) can be helpful where neutralising the direct source of the stress is beyond an individual’s control. Age and gender have been linked to differential coping strategies, with females and younger age demographics demonstrating tendencies for palliative strategies (Billings & Moos, 1981; Jenzer et al., 2019).

Impact of stress

Stress response is a complex evolutionary system tasked with maintaining the body’s homeostasis and promoting adaptation. In the short-term, stress responses may result in positive outcomes such as increased performance and motivation; this type of response is referred to as eustress (Quick et al., 1997; Simmons & Nelson, 2011). However, research suggests that after a certain point, the positive effects of stress reverse. Excessive, prolonged stress will result in diminished performance over time – this effect is known as the ‘Yerkes-Dodson Law’ (1908).

Chronic stress is linked with detrimental psychological and physiological outcomes such as cardiovascular disease, high blood pressure, muscular pain and fatigue, as well as mental health issues such as anxiety and depression (Hassard et al., 2018; Kivimäki et al., 2002; Russell et al., 2018; Stansfeld & Candy, 2006). Moreover, chronic stressors such as the COVID-19 pandemic may deplete coping resources for individuals, increasing stress reactivity and negative emotional responses to stress (Nelson & Bergeman, 2021). Heightened and prolonged stress reactivity can have severe long-term implications for health resulting in dysregulation of the physiological stress response system, contributing to mental and physical health issues which in turn exacerbate the negative effects of stress (Kiecolt-Glaser et al., 2020).

Managing stress

The impact of stress on overall health is significant, and therefore understanding stress and developing adaptive coping strategies are central to well-being. Below are some helpful tips to combat stress:

1. Get enough quality sleep

Sleep is proven to have a significant impact on stress, mood and emotional resilience (American Psychological Association [APA], 2014).

2. Disconnect from technology & screens

Allocate ‘power-down’ periods. Try reading a book before bed or do some breathing exercises in the morning before checking your email.

3. Eat a balanced diet

Healthy nutritional choices can enhance concentration, mood and memory (Harvard Health Publishing, 2012; Selhub, 2020).

4. Practise yoga and meditation 

Proven to modulate the effects of stress through regulating breathing, improving mood and lowering blood pressure and heart rate (Penn Medicine, 2020).

5. Breathe

Deep breathing communicates with PSNS, which controls our relaxation response to calm signals to the ANS. Deep breathing is shown to lower blood pressure, reduce heart rate and decrease stress, centre our mental focus, improve sleep quality, boost energy and fortify our self-awareness.

6. Exercise

A powerful, natural mood booster and an effective way of reducing stress through the release of chemical endorphins in the brain (Harvard Health Publishing, 2020).

7. Reach out to friends and family

The stress-buffering hypothesis suggests that social support positively influences the effects of chronic stress and crisis (Cohen et al., 2000). Interacting with others boosts feelings of well-being and decreases feelings of depression.

8. Take time in nature

Studies have shown that walking in the woods can improve blood pressure, sleep duration and boost mental health as well as reducing risk of type 2 diabetes, cardiovascular disease and stress (Twohig-Bennett, 2018).

9. Mindfulness

 Focusing one’s awareness on the present moment, while calmly acknowledging and accepting one’s feelings, thoughts, and bodily sensations.

Stress Management Courses

References

Quick, J. C., Quick, J. D., Nelson, D. L., & Hurrell Jr, J. J. (1997). Preventive stress management in organizations. American Psychological Association.

Lazarus, R. S., & Folkman, S. (1984). Stress, appraisal, and coping. Springer.

Lazarus, R. S. (1991). Emotion and adaptation. Oxford University Press.

Cohen, S., Underwood, L. G., & Gottlieb, B. H. (Eds.). (2000). Social support measurement and intervention: A guide for health and social scientists. Oxford University Press.