4.2-
Stress and Illness
A Biopsychosocial Perspective
You are encouraged to set yourself to be without distraction from your learning for the period of each lecture. For a self-paced lesson, a minimum of 15 minutes is recommended for each period. This is to enable you to adequately digest the instructions and content, to avoid misunderstanding and miscommunication, and to achieve meaningful learning.
The School of Health Sciences, Ngee Ann Polytechnic, Singapore
Part 1
Stress and Our Body
Stress and Our Body
"Stress-related disease emerges, predominantly, out of the fact that we so often activate a physiological system that has evolved for responding to acute physical emergencies, but we turn it on for months on end, worrying about mortgages, relationships, and promotions"
The stress response consists of a coordinated but complex system of physiological reactions that are called upon as needed. These reactions are beneficial at times because they prepare us to deal with potentially dangerous or threatening situations However, health is affected when physiological reactions are sustained, as can happen in response to ongoing stress. A number of studies have demonstrated that stress weakens the functioning of the immune system. Cardiovascular disorders are serious medical conditions that have been consistently shown to be influenced by stress and negative emotions, such as anger, negative affectivity, and depression. Other psychophysiological disorders that are known to be influenced by stress and emotional factors include asthma and tension headaches.
Psychophysiological Disorders
If the reactions that compose the stress response are chronic or if they frequently exceed normal ranges, they can lead to cumulative wear and tear on the body, in much the same way that running your air conditioner on full blast all day will eventually cause wear and tear on it.
For example, the high blood pressure that a person under considerable job strain experiences might eventually take a toll on his heart and set the stage for a heart attack or heart failure. Also, someone exposed to high levels of the stress hormone cortisol might become vulnerable to infection or disease because of weakened immune system functioning
Our hard-wired stress response is designed to give us the quick burst of heightened alertness and energy needed to perform our best. But stress isn’t all good. When activated too long or too often, stress can damage virtually every part of our body. Sharon Horesh Bergquist gives us a look at what goes on inside our body when we are chronically stressed.
Physical disorders or diseases whose symptoms are brought about or worsened by stress and emotional factors are called psychophysiological disorders. The physical symptoms of psychophysiological disorders are real and they can be produced or exacerbated by psychological factors (hence the psycho and physiological in psychophysiological). A list of frequently encountered psychophysiological disorders is provided in Table 1.
Stress and the Immune System
Immune System Errors
The immune system is the body’s surveillance system. It consists of a variety of structures, cells, and mechanisms that serve to protect the body from invading toxins and microorganisms that can harm or damage the body’s tissues and organs. When the immune system is working as it should, it keeps us healthy and disease free by eliminating bacteria, viruses, and other foreign substances that have entered the body .
Sometimes, the immune system will function erroneously.
For example, sometimes it can go awry by mistaking your body’s own healthy cells for invaders and repeatedly attacking them. When this happens, the person is said to have an autoimmune disease, which can affect almost any part of the body. How an autoimmune disease affects a person depends on what part of the body is targeted. For instance, rheumatoid arthritis, an autoimmune disease that affects the joints, results in joint pain, stiffness, and loss of function.
In addition, the immune system may sometimes break down and be unable to do its job. This situation is referred to as immunosuppression, the decreased effectiveness of the immune system. When people experience immunosuppression, they become susceptible to any number of infections, illness, and diseases.
For example, acquired immune deficiency syndrome (AIDS) is a serious and lethal disease that is caused by human immunodeficiency virus (HIV), which greatly weakens the immune system by infecting and destroying antibody-producing cells, thus rendering a person vulnerable to any of a number of opportunistic infections .
Let us look at some studies of Stress & the Immune System:
Hundreds of studies involving tens of thousands of participants have tested many kinds of brief and chronic stressors and their effect on the immune system (e.g., public speaking, medical school examinations, unemployment, marital discord, divorce, death of spouse, burnout and job strain, caring for a relative with Alzheimer’s disease, and exposure to the harsh climate of Antarctica). It has been repeatedly demonstrated that many kinds of stressors are associated with poor or weakened immune functioning
In one memorable experiment using this method, researchers interviewed 276 healthy volunteers about recent stressful experiences (Cohen et al., 1998). Following the interview, these participants were given nasal drops containing the cold virus (in case you are wondering why anybody would ever want to participate in a study in which they are subjected to such treatment, the participants were paid $800 for their trouble). When examined later, participants who reported experiencing chronic stressors for more than one month—especially enduring difficulties involving work or relationships—were considerably more likely to have developed colds than were participants who reported no chronic stressors
Other studies have demonstrated that stress slows down wound healing by impairing immune responses important to wound repair (Glaser & Kiecolt-Glaser, 2005). In one study, for example, skin blisters were induced on the forearm. Subjects who reported higher levels of stress produced lower levels of immune proteins necessary for wound healing (Glaser et al., 1999).
Stress and the Cardiovascular System
Many risk factors contributing to cardiovascular disorders have been identified. These risk factors include social determinants such as aging, income, education, and employment status, as well as behavioral risk factors that include unhealthy diet, tobacco use, physical inactivity, and excessive alcohol consumption; obesity and diabetes are additional risk factors.
Over the past few decades, there has been much greater recognition and awareness of the importance of stress and other psychological factors in cardiovascular health.
Indeed, exposure to stressors of many kinds has also been linked to cardiovascular problems; in the case of hypertension, some of these stressors include job strain, natural disasters, marital conflict, and exposure to high traffic noise levels at one’s home.
Stress and Asthma
Psychological factors appear to play an important role in asthma. People with asthma tend to report and display a high level of negative emotions such as anxiety, and asthma attacks have been linked to periods of high emotionality. In addition, high levels of emotional distress during both laboratory tasks and daily life have been found to negatively affect airway function and can produce asthma-like symptoms in people with asthma.
In one investigation, 20 adults with asthma wore preprogrammed wristwatches that signaled them to breathe into a portable device that measures airway function. Results showed that higher levels of negative emotions and stress were associated with increased airway obstruction and self-reported asthma symptoms.
Exposure to stressful experiences, particularly those that involve parental or interpersonal conflicts, has been linked to the development of asthma throughout the lifespan.
A longitudinal study of 145 children found that parenting difficulties during the first year of life increased the chances that the child developed asthma by 107% (Klinnert et al., 2001).
In addition, a cross-sectional study of over 10,000 Finnish college students found that high rates of parent or personal conflicts (e.g., parental divorce, separation from spouse, or severe conflicts in other long-term relationships) increased the risk of asthma onset (Kilpeläinen, Koskenvuo, Helenius, & Terho, 2002).
Further, a study of over 4,000 middle-aged men who were interviewed in the early 1990s and again a decade later found that breaking off an important life partnership (e.g., divorce or breaking off relationship from parents) increased the risk of developing asthma by 124% over the time of the study (Loerbroks, Apfelbacher, Thayer, Debling, & Stürmer, 2009).
How much does stress cost?
Job Stress and Health
Stress can be just as damaging to your health as poor nutrition or a sedentary lifestyle. Stress can lead to several health issues including sleep issues, heart problems, digestive problems, weight gain...etc. So, stress is really bad for your health. Learning to manage stress is not easy; it takes a lot of hard work. But, the payoff is worth it, a happier and healthier life.
School stress and health
Is the demanding schooling and education system in Singapore putting too much stress on students? The video below looks at how students in Singapore perceive stress from school.
The brain & stress
Stress isn’t always a bad thing; it can be handy for a burst of extra energy and focus, like when you’re playing a competitive sport or have to speak in public. But when it’s continuous, it actually begins to change your brain. Madhumita Murgia shows how chronic stress can affect brain size, its structure, and how it functions, right down to the level of your genes.
Consider the following questions as you move on to the next section.
In what way is stress different for people across different age groups? Who are most vulnerable?
How does stress in our lives influence our perception of health and illness?
What can we do to help our patients and family members manage stress?