STRESS AND HEALTH: Psychological, Behavioral, and Biological Determinants
Find out how mental health can affect physical health, what lifestyle factors influence this and about A clear distinction is often made between 'mind' and ' body'. Psoriasis is an auto-immune condition commonly triggered by stress. Yet, a recent report from the British Association of Dermatologists (BAD) highlighted that. The relationship between stress, depression, anxiety and physical health is complicated. Recent advances in neuroscience, medicine and psychiatry have. The study did exhibit some degree of connection between health and stress, and of this supported the hypothesis that stress, anxiety, depression, and physical.
While related to stress, depression is, nonetheless, a distinctly different construct [ 23 ]. At this time, no paper has attempted to synthesize the evidence both for and against the effects of mental stress on exercise behavior.
The aim of this review is to fill this gap in the literature and to identify factors that may moderate the relationship, which may help to identify both populations vulnerable to the effects of stress and mechanisms responsible for the relationship.
Contrary to the view of stress as an impinging stimulus, other definitions provide a glimpse into what systems are challenged and how the human organism reacts. Stress may be defined as a state of threatened homeostasis, which is counteracted by adaptive processes involving affective, physiological, biochemical, and cognitive—behavioral responses in an attempt to regain homeostasis [ 2627 ].
Stress reactions are always followed by recovery processes, which may be compromised when stressors are severe, prolonged, or unaccustomed [ 2829 ]. This may be manifested in the dysregulation of active processes of adaptation, or allostasis, resulting in cumulative wear and tear of the body, also known as allostatic load [ 2431 ].
Typically, this has been utilized to explain how chronic stressors relate to physiological maladaptations in middle and later life [ 32 ]; however, mounting evidence also implicates traumatic childhood experiences, stressors that have a reverberating impact for decades [ 3334 ]. Therefore, stressful events appear to accumulate from the earliest days of life, and this cumulative adversity may have a profound impact on a wide range of health outcomes [ 35 ].
Lazarus and Folkman [ 36 ] provide a transactional cognitive component to stress with their concept of appraisal, which indicates that individuals only perceive stress when a challenge or event is both threatening and of such a nature that the individual is unable to cope.
In this viewpoint, objective demands and subjective appraisals may differentially impact health behaviors. It is important to note, however, that some stressors may be appraised as positive [ 2437 ]. Cognitive models of the stress concept have recently been overshadowed by new research on the integrated role of the brain particularly centers of emotion and memory as a regulator of stress processes [ 24 ].
Stress has been strongly implicated in the pathogenesis of coronary heart disease [ 39 ] and the incidence of acute myocardial infarctions [ 40 ]. Those under high stress are less likely to survive cardiac events [ 41 ]. Alterations in the immune system by stress are well-established [ 42 ], and those who report high levels of stress are more likely to become infected [ 43 ].
The nervous system is also compromised during times of undue stress [ 4445 ]. Stress is associated with a host of mental symptoms as well, including cognitive dysfunction, dementia [ 46 ], and excessive fatigue [ 134748 ]. While stress may have a direct effect on health e. For instance, stress is related to declining physical function over time [ 51 ] and obesity [ 52 - 54 ], which contributes to cardiovascular disease.
Furthermore, delays in recovery from exercise [ 29 ] and dampened muscular and neural adaptations are observed with chronic stress [ 5556 ]. It is of no wonder that individuals under high stress are much more likely to incur greater healthcare costs [ 57 ].
Also implicit in this definition is that PA is a physical stressor, though not necessarily an uncomfortable one.
The Effects of Stress on Physical Activity and Exercise
These definitions connote that PA behaviors are specific to a person, situation, and context. Also, they suggest that these concepts are quantified in terms of mode, frequency, duration, and intensity [ 60 ]. As suggested earlier, those who exercise have lesser rates of depression, negative affectivity, and anxiety [ 1011 ]. In terms of psychological stress, similar patterns are observed in cross-sectional, prospective, and experimental studies. Exercise is associated with less subjective stress, a finding that has been observed in numerous populations from athletes to older adults to veterans with post-traumatic stress disorder [ 67 - 78 ].
Physical health and mental health
While it is equivocal whether those who exercise have fewer life events [ 79 - 81 ], there is an association between exercise and fewer daily hassles [ 82 ]. It appears that the quantity of calories expended is most important.
For instance, Aldana et al. However, the intensity of exercise may play a key role as those who participated in exercise that was of a moderate intensity exhibited approximately half the amount of perceived stress as those who reported no exercise [ 83 ]. Smoking has a negative impact on both mental and physical health. Many people with mental health problems believe that smoking relieves their symptoms, but these effects are only short-term.
Nicotine in cigarettes interferes with the chemicals in our brains. Dopamine is a chemical which influences positive feelings, and is often found to be lower in people with depression. Long-term health conditions and mental health The promotion of positive mental health can often be overlooked when treating a physical condition. Psoriasis is one such condition in which the effects go beyond the visual signs and symptoms, impacting psychological wellbeing and quality of life.
The physical and psychological impacts can be cyclically linked: Do you need urgent help? If your mental or emotional state quickly gets worse, or you're worried about someone you know - help is available.
Stressed people, for instance, might seek more outside contact and thus be exposed to more viruses. Therefore, in a more controlled study, people were exposed to a rhinovirus and then quarantined to control for exposure to other viruses Cohen et al. Those individuals with the most stressful life events and highest levels of perceived stress and negative affect had the greatest probability of developing cold symptoms.
In a subsequent study of volunteers inoculated with a cold virus, it was found that people enduring chronic, stressful life events i. Human Immunodeficiency Virus The impact of life stressors has also been studied within the context of human immunodeficiency virus HIV spectrum disease. Inflammation, the Immune System, and Physical Health Despite the stress-mediated immunosuppressive effects reviewed above, stress has also been associated with exacerbations of autoimmune disease Harbuz et al.
Evidence suggests that a chronically activated, dysregulated acute stress response is responsible for these associations. Recall that the acute stress response includes the activation and migration of cells of the innate immune system.
This effect is mediated by proinflammatory cytokines. During periods of chronic stress, in the otherwise healthy individual, cortisol eventually suppresses proinflammatory cytokine production. But in individuals with autoimmune disease or CHD, prolonged stress can cause proinflammatory cytokine production to remain chronically activated, leading to an exacerbation of pathophysiology and symptomatology.
With cortisol unable to suppress inflammation, stress continues to promote proinflammatory cytokine production indefinitely. Although there is only preliminary empirical support for this model, it could have implications for diseases of inflammation. For example, in rheumatoid arthritis, excessive inflammation is responsible for joint damage, swelling, pain, and reduced mobility.
Stress is associated with more swelling and reduced mobility in rheumatoid arthritis patients Affleck et al. Similarly, in multiple sclerosis MSan overactive immune system targets and destroys the myelin surrounding nerves, contributing to a host of symptoms that include paralysis and blindness.
Again, stress is associated with an exacerbation of disease Mohr et al. Even in CHD, inflammation plays a role. The immune system responds to vascular injury just as it would any other wound: Immune cells migrate to and infiltrate the arterial wall, setting off a cascade of biochemical processes that can ultimately lead to a thrombosis i. Elevated levels of inflammatory markers, such as C-reactive protein CRPare predictive of heart attacks, even when controlling for other traditional risk factors e.
Interestingly, a history of major depressive episodes has been associated with elevated levels of CRP in men Danner et al. Inflammation, Cytokine Production, and Mental Health In addition to its effects on physical health, prolonged proinflammatory cytokine production may also adversely affect mental health in vulnerable individuals. During times of illness e. It was once thought that these symptoms were directly caused by infectious pathogens, but more recently, it has become clear that proinflammatory cytokines are both sufficient and necessary i.
Sickness behavior has been suggested to be a highly organized strategy that mammals use to combat infection Dantzer Symptoms of illness, as previously thought, are not inconsequential or even maladaptive. On the contrary, sickness behavior is thought to promote resistance and facilitate recovery.
- The Effects of Stress on Physical Activity and Exercise
- STRESS AND HEALTH: Psychological, Behavioral, and Biological Determinants
For example, an overall decrease in activity allows the sick individual to preserve energy resources that can be redirected toward enhancing immune activity. Similarly, limiting exploration, mating, and foraging further preserves energy resources and reduces the likelihood of risky encounters e.
Furthermore, decreasing food intake also decreases the level of iron in the blood, thereby decreasing bacterial replication. Thus, for a limited period, sickness behavior may be looked upon as an adaptive response to the stress of illness. Much like other aspects of the acute stress response, however, sickness behavior can become maladaptive when repeatedly or continuously activated.
Many features of the sickness behavior response overlap with major depression. Indeed, compared with healthy controls, elevated rates of depression are reported in patients with inflammatory diseases such as MS Mohr et al.
Granted, MS patients face a number of stressors and reports of depression are not surprising. However, when compared with individuals facing similar disability who do not have MS e.
In both MS Fassbender et al. Thus, there is evidence to suggest that stress contributes to both physical and mental disease through the mediating effects of proinflammatory cytokines. McEwen has also suggested that cumulative increases in allostatic load are related to chronic illness. These are intriguing hypotheses that emphasize the role that stressors may play in disease. The challenge, however, is to show the exact interactions that occur among stressors, pathogens, host vulnerability both constitutional and geneticand such poor health behaviors as smoking, alcohol abuse, and excessive caloric consumption.
Evidence of a lifetime trajectory of comorbidities does not necessarily imply that allostatic load is involved since immunosenescence, genetic predisposition, pathogen exposure, and poor health behaviors may act as culprits.
It is not clear, for example, that changes in set point for variables such as blood pressure are related to cumulative stressors per se, at least in healthy young individuals.How Stress and Anxiety Hurt Your Health
Thus, for example, British soldiers subjected to battlefield conditions for more than a year in World War II showed chronic elevations in blood pressure, which returned to normal after a couple of months away from the front Graham In contrast, individuals with chronic illnesses such as chronic fatigue syndrome may show a high rate of relapse after a relatively acute stressor such as a hurricane Lutgendorf et al.
Nevertheless, by emphasizing the role that chronic stressors may play in multiple disease outcomes, McEwen has helped to emphasize an important area of study. Psychopharmacological approaches have also been suggested Berlant In addition, writing about trauma has been helpful both for affective recovery and for potential health benefit Pennebaker However, the presence of sleep problems or hypercortisolemia is associated with poorer response to psychotherapy Thase The combination of psychotherapy and pharmacotherapy seems to offer a substantial advantage over psychotherapy alone for the subset of patients who are more severely depressed or have recurrent depression Thase et al.
For the treatment of anxiety, it depends partly on the specific disorder [e. Antidepressants such as selective serotonin reuptake inhibitors also show efficacy in anxiety Ballenger et al. Psychosocial interventions, such as cognitive-behavioral stress management CBSMhave a positive effect on the quality of life of patients with chronic disease Schneiderman et al. Such interventions decrease perceived stress and negative mood e.
Psychosocial interventions also appear to help chronic pain patients reduce their distress and perceived pain as well as increase their physical activity and ability to return to work Morley et al. There is also some evidence that psychosocial interventions may have a favorable influence on disease progression Schneiderman et al.
Morbidity, Mortality, and Markers of Disease Progression Psychosocial intervention trials conducted upon patients following acute myocardial infarction MI have reported both positive and null results. Most of these studies were carried out in men. Thus, because primarily white men, but not other subgroups, may have benefited from the ENRICHD intervention, future studies need to attend to variables that may have prevented morbidity and mortality benefits among gender and ethnic subgroups other than white men.
Psychosocial intervention trials conducted upon patients with cancer have reported both positive and null results with regard to survival Classen A number of factors that generally characterized intervention trials that observed significant positive effects on survival were relatively absent in trials that failed to show improved survival. In one study that reported positive results, Fawzy et al. The intervention also significantly reduced distress, enhanced active coping, and increased NK cell cytotoxicity compared with controls.
These variables associated with disease progression include distress, depressed affect, denial coping, low perceived social support, and elevated serum cortisol Ickovics et al.
Those in the intervention condition showed lower distress, anxiety, and depressed mood than did those in the control condition as well as lower antibody titers of herpesviruses and higher levels of T-helper CD4 cells, NK cells, and lymphocyte proliferation Antoni et al. Improvement in perceived social support and adaptive coping skills mediated the decreases in distress Lutgendorf et al.
All creatures face threats to homeostasis, which must be met with adaptive responses. Our future as individuals and as a species depends on our ability to adapt to potent stressors. At a societal level, we face a lack of institutional resources e. At an individual level, we live with the insecurities of our daily existence including job stress, marital stress, and unsafe schools and neighborhoods.
These are not an entirely new condition as, in the last century alone, the world suffered from instances of mass starvation, genocide, revolutions, civil wars, major infectious disease epidemics, two world wars, and a pernicious cold war that threatened the world order.
Although we have chosen not to focus on these global threats in this paper, they do provide the backdrop for our consideration of the relationship between stress and health. It is clear that all of us are exposed to stressful situations at the societal, community, and interpersonal level. How we meet these challenges will tell us about the health of our society and ourselves. In contrast, if stressors are too strong and too persistent in individuals who are biologically vulnerable because of age, genetic, or constitutional factors, stressors may lead to disease.
This is particularly the case if the person has few psychosocial resources and poor coping skills. In this chapter, we have documented associations between stressors and disease and have described how endocrine-immune interactions appear to mediate the relationship.
We have also described how psychosocial stressors influence mental health and how psychosocial treatments may ameliorate both mental and physical disorders. There is much we do not yet know about the relationship between stress and health, but scientific findings being made in the areas of cognitive-emotional psychology, molecular biology, neuroscience, clinical psychology, and medicine will undoubtedly lead to improved health outcomes.
Cardiovascular changes during naturally elicited fighting behavior in the cat. Psychosocial influences on ovarian, endocrine and ovulatory function in Macaca fascicularis.
A dual pathway model of daily stressor effects on rheumatoid arthritis. Angst J, Vollrath M. The natural history of anxiety disorders. Cognitive behavioral stress management intervention buffers distress responses and elevates immunologic markers following notification of HIV-1 seropositivity. Cognitive-behavioral stress management reduces distress and hour urinary free cortisol output among symptomatic HIV-infected gay men.