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Subduing stress: A physiology-based approach

Stress can influence disease development and exacerbation—but managing it effectively can reduce its effects. To promote our own wellness, we need to develop strategies to reduce the effects of stress and protect against it.

How you perceive stress is important. Researchers Richard Lazarus and Susan Folkman proposed that stress is a two-way street involving both the production of stress by the environment and the response of the person subjected to it. So, in a sense, stress is a series of transactions between the individual and the environment.

Stressful events have an interactive effect with our immune system, physical and mental health, and future responses to stress. Lazarus’ model asserts that our emotions are determined by our appraisal of the stressor. Based on our personal characteristics and experiences, we evaluate how harmful or challenging the stressor is (cognitive appraisal) and to what degree we feel capable of responding to it. If the stressor seems manageable, its physical effects are reduced. (See Cognitive appraisal of stress: Two phases.)

Stress may cause illness if the threat overwhelms our ability to respond, as during an acute trauma, an unresolved chronic exposure, or cumulative exposure to stress. But if you’ve used effective coping strategies in the past, you’re likely to be able to cope with similar situations effectively in the future with diminished health consequences.

Making connections: Stress, disease, and wellness

Stress-related diseases may include cardiovascular disease, metabolic syndrome, diabetes, and obesity. Evidence also suggests stress plays a role in tumor formation, depression, mental illness, and autoimmune disorders (including systemic lupus erythematosus, rheumatoid arthritis, and inflammatory bowel disease). These conditions are intimately connected with chemical messengers that relay information about the physical and emotional environment to and from the brain, immune system, and endocrine system.

Although the traditional medical model is beneficial in treating chronic disease symptoms, it may be insufficient when it comes to systemic dysregulation. The theory that the stress response and immune systems communicate with one another has revolutionized our concepts of disease and wellness and led to development of, and continued interest in, the connections between physiology and our thoughts and emotions. It has also opened exciting new avenues for exploring disease development and progression. Perhaps more important, it has helped healthcare practitioners, researchers, and patients envision new pathways to wellness and healing.


New interventions and prevention methods exist for treating the whole body rather than just disease signs and symptoms. Knowing how dysregulated stress responses and systems contribute to disease empowers us to identify and engage in behaviors that may stabilize or return a dysregulated system to a more properly functioning state. Instead of operating from a pathogenic model that focuses on symptom management, we can focus on a holistic perspective that helps us see how certain behaviors contribute to health and wellness, which in turn may help stave off disease.

Effective stress-management strategy

Here are three basic steps for managing stress effectively:

1. Change the stressor. Determine if you can eliminate what’s causing stress. For instance, perhaps you could ask your mother-in-law not to come for a 3-week visit. Of course, she may come even if you ask her not to.Unfortunately, we don’t always have control over our stressors.

2. Change how you feel about the stressor. We can’t always change how we feel about a stressful situation, but it’s worth a try. For example, you might feel better about your mother-in-law’s visit if you planned a pleasant trip with her to the farmer’s market or asked her to teach you that family recipe you’ve been meaning to make.

3. Change how your body responds to the stressor. Choose to manage the stress. Consider meditating, exercising, listening to music,getting a massage—whatever it takes to reduce your stress. (See Ways to manage stress.)

Here are more examples of techniques you can use to manage your stress.

Focus on breathing

Take a 3- to 5-minute break to focus on your breathing. Yoga and meditation start with breath work, and that begins with awareness. Put your hand on your belly and focus on breathing with your abdominal muscles. First exhale, putting just a little effort into getting out the air. Then allow the air to come back into your lungs easily, using the vacuum you’ve created by exhaling. Allow breathing to happen; watch it gently move your chest and belly as you inhale oxygen and exhale toxins. To help you be a calmer nurse, take a moment during your shift to breathe and focus between patient rooms (perhaps while washing your hands).

Keep a journal

Journaling can be an effective way to relieve stress, purge your feelings, and explore your thoughts in a reflective way. Buy a journal—or, if you prefer typing to writing longhand, set up a journaling file on your computer. You may want to journal daily or only on a whim; you’ll soon learn which you prefer.

Start by writing a few words to describe your day. No matter how stressful your day has been, end the entry by describing something for which you are grateful. Expressing gratitude has been shown to improve immune function and change our perceptions of negative experiences. Remember—our body’s stress responses are influenced by our perceptions, so try to change how you feel about what’s stressful. Use journaling to explore your feelings and thoughts related to the stressors in your life.

Journaling can be an excellent stress-management method for people with disabilities and those unable to perform yoga or exercise. On the other hand, journaling may not be the best choice if you’ve returned to school. In that case, you may find the additional writing overwhelming—the last thing you want to do when trying to get through a graduate program. Like any stress-management approach, journaling should never add stress.

Do what you enjoy

No matter which stress-reducing method you use, plan to include enjoyment in your life. Write this goal on your calendar, tell others of your “enjoyment plan,” and choose to do it intentionally.

Make this as important as anything else on your to-do list. Be creative and spend time every day doing an activity you love, whether it’s walking in nature, gardening, meditating, drawing, coloring, listening to music, or playing with your dog. These activities help you get out of the cognitive whirlwind in your head during or after a stressful day. As you do what you love, be aware of your thoughts and feelings. Gently redirect yourself back to the current moment, mindful of the right now.

Intentionally set aside worrying, reviewing what happened yesterday and imagining what might happen tomorrow. The benefits of being mindful—being in the moment—have been shown not just to reduce the impact of stress on health and to improve health, but also to increase happiness and the quality of life.

For more reading on mindfulness, try Jon Kabit-Zinn’s book, Wherever You Go, There You Are: Mindfulness Meditation in Everyday Life“The little moments,” he points out, “they aren’t little.” We spend too much time chewing on what happened yesterday or fretting about what will happen tomorrow.

Instead, right in this moment, breathe. Be aware of what you see, hear, taste, smell, and feel. Acknowledge the “right now.” Managing your stress makes a demanding nursing career and a complicated life more manageable.

Debra Rose Wilson is an associate professor at Tennessee State University in Nashville and a contributing faculty member at Walden University in Minneapolis, Minnesota. Dana M. Dillard is an associate faculty member at Ashford University in Clinton, Illinois, and a telecommunicator specialist with the Illinois State Police.

Selected references

Gold PW. The organization of the stress system and its dysregulation in depressive illness. Mol Psychiatry. 2015;20(1):32-47.

Gu L, Xu L, Zhang X, et al. Correlation of circulating glucocorticoid-induced TNFR-related protein ligand levels with disease activity in patients with systemic lupus erythematosus. Clin Dev Immunol. 2012;2012:265868.

Holmes TH, Rahe RH. The social readjustment rating scale. J Psychosom Res. 1967;11(2):213-21.

Kabat-Zinn J. Wherever You Go, There You Are: Mindfulness Meditation in Everyday Life. 10th ed. New York, NY: Hachette Books; 2005.

Katz DA, Sprang G, Cooke C. The cost of chronic stress in childhood: Understanding and applying the concept of allostatic load. Psychodyn Psychiatr. 2012;40(3):469-80.

Lazarus RS, Folkman S. Stress, Appraisal, and Coping. New York, NY: Springer Publishing Co.; 1984.

Pecoraro N, Dallman MF. Hypothalamic-Pituitary-Adrenal (HPA) Axis. In: Fink G, ed. Stress Science: Neuroendocrinology. San Diego, CA: Academic Press; 2010; pp. 331-9.

Selye H. The Stress of Life (rev. ed.). New York, NY: McGraw-Hill; 1984.

Vinson GP, Whitehouse BJ, Hinson JP. Adrenal Cortex. In: Fink G, ed. Stress Science: Neuroendocrinology. San Diego, CA: Academic Press; 2010; pp. 137-44.

Wilson DR. Stress management for adult survivors of childhood sexual abuse: a holistic inquiry. West J Nurs Res. 2010;32(1):103-27.

Wilson DR, Dillard DM. Eating better to help manage chronic stress. Am Nurse Today. 2013;8(9):60-2. 

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