There is growing evidence that stress is a major factor in maintaining health and well-being. Health means more than the absence of illness. In China and in ancient Greece health was thought of as being in balance with nature. The vital task was seen as maintaining equilibrium in the face of extensive demands. The World Health Organization (WHO) definition of health is a state of complete physical, mental and social well being.
It seems increasingly clear that the naive notion that a germ automatically leads to illness is no longer acceptable, although much of the lay public subscribes to the theory. Today we know that the idea of a single external cause, such as a germ, is oversimplified. The presence of the germ does not always cause the illness. The vulnerability of the person or the host animal is a major factor and that vulnerability is influenced by such factors as immunity and stress levels. So the cause of illness is not quite as simple as we once thought.
Stress vs. Distress
Another important distinction that came out of the seminal work of Hans Selye is between stress and distress. Both involve demands on the person to adapt to a challenging event. However, when we appraise the situation as being something we can handle it can be an exhilarating experience. When a person appraises the event as beyond their ability or as exceeding resources the situation is experienced as distress. Another way to look at it is that stress is positive and distress is negative. It is a valuable distinction since many people believe all stress is bad for you. It is not.
The diathesis-stress theory
The diathesis-stress theory of the origin of certain illnesses holds that we are born with certain biological predispositions but that whether or not an illness manifests itself is dependent on the level of stress one experiences and the resources one can use to overcome the stress. For example, although a person may have inherited a genetic deficiency in metabolizing alcohol, whether that person becomes an alcoholic or not also depends on the types and levels of stress they experience. Another person may have inherited a problem with glucose metabolism; however, it is factors such as the level of stress, or a sedentary life style or a combination of the two that result in development of type 2 diabetes. We may be born with certain vulnerabilities; it is stress that tips us into active illness.
Impact of stress on illnesses
Certain ailments have been recognized for some time as being influenced by stress. The most common example is intestinal distress such as indigestion and colitis. Other disorders like migraine, tension headaches, high blood pressure, arthritis and certain skin disorders may also be influenced by stress. In some instances, stress emotions seem to make an ailment worse, while in others stress may be a factor in bringing on illness. Research increasingly supports the hypothesis that stress may have at least some impact on many diseases.
There are several reasons for believing that stress contributes to the development of cardiovascular disease. First, stress emotions increase the level of low-density blood cholesterol and this leads to clogging of the arteries of the heart. Second, stress emotions result in maladaptive coping behaviors such as smoking, drinking and overeating, which can damage the heart and surrounding vessels. Finally, stress emotions result in the release of powerful hormones which result in increases in heart rate and blood pressure. One of these stress emotions is anger, and anger expressed in the form of hostility is known to increase the risk of cardiovascular disease.
Several hypotheses are being explored in the role of emotions in cancer. Again stress emotions may play an indirect role leading the person to smoke or drink excessively. More direct influence is attributed to a tendency to suppress or deny emotions. There is some evidence that those who suppress emotions are more susceptible to cancer. Again the mediating factor is hormonal activity.
At the 2002 meeting of the American Psychological Association a group-based stress management study was presented that indicated that group stress management training could lower blood glucose levels in Type 2 diabetes. Patients that received instruction regarding the health consequences of stress and instruction in the use of cognitive and behavioral skills such as deep breathing and recognition of major life stresses as well as instruction in progressive muscle relaxation lowered their glucose levels more than patients that did not have stress management training. Thirty-two percent of the patients receiving stress management lowered their A1C glucose levels by one percent or more as compared to 12% of the patients who did not receive this training. This modest change is larger than the half percent change that has been associated with significant reduction in microvasclar complications that can accompany out of control diabetes. While this change might move someone with tightly controlled diabetes to near normal levels; even those diabetics with poorer control would benefit from the reduction in glucose levels with fewer diabetic complications.
In summary, if you are a type 2 diabetic, learning to manage stress should have special health consequences for you. Although this was a group program, if none is available in your area, individual stress reduction strategies should be beneficial, especially if you have a friend or family member trying to learn stress management with you.
Stress and the immune system
The immune system has been called our liquid nervous system. With our growing knowledge of the human body has come an increasing conviction that stress may be a factor in susceptibility to colds, flu, mononucleosis and other infectious illnesses. It appears that some of the hormones secreted in the presence of stress emotions impair or weaken the immune process by reducing the number of disease-fighting components such as lymphocytes (white cells) thus leaving us more vulnerable to infection. This may be one of the reasons why so many people die within a year or so of their spouse’s death. Recently there has been research into why some HIV positive patients develop full blown AIDS while others do not. One interesting finding is that patients with a more effective style of coping with stress seem to have stronger resistance as a result. It is now reasonable to hypothesize that stress emotions increase secretion of certain hormones. These hormones weaken the immune system and that weakness results in an increased likelihood of infectious illness.
Recent research indicates that brief time-limited stress that may be viewed as a challenge (e.g. passing an exam, good performance in sports, solving a difficult puzzle under pressure) may actually enhance the body’s immune response. However, chronic stress seems to reduce the effectiveness of the immune system and thus make the person more susceptible to diseases.