Let’s Talk About Stress—and Stress Research

Stress is a part of life for everyone, and when it comes in short bursts, it’s not necessarily bad. Our natural “fight-or-flight” response can help us mobilize our resources to meet a challenge. But when stress persists (chronic stress), it can lead to both mental and physical health problems. In fact, longstanding evidence from multiple areas of research demonstrates that chronic stress acts like a toxin, permeating our organs and cells and triggering a negative cascade on our hormones, sleep, muscles, metabolism, immune system, and inflammatory responses. And chronic systemic inflammation is emerging as a key factor underlying more than half of all deaths from chronic diseases including heart disease, cancer, diabetes, chronic kidney disease, and nonalcoholic fatty liver.

Chronic stress has long been a focus of research for the National Center for Complementary and Integrative Health (NCCIH), and the interplay between the effects of stress on the mind and the body is an important area of research to me, personally. Many NCCIH-supported studies have looked at the potential role of complementary and integrative health interventions in helping people manage stress and its consequences. Let’s look at one area of research—the effect of stress management interventions on people who are living with a long-term health condition.

With funding from NCCIH, a group of researchers led by Dr. Lori Scott-Sheldon, who was then with The Miriam Hospital in Rhode Island, performed a series of systematic reviews on stress management for people with chronic diseases. The reviews looked at both psychological and physical effects of the interventions, and their findings were promising. For example:

• A review of studies on stress management interventions for adults with heart failure showed improvements in anxiety, depressive symptoms, quality of life, and exercise capacity in people who participated in these interventions. 
• A review on mindfulness-based interventions for people living with HIV/AIDS showed reductions in anxiety and depressive symptoms and improved quality of life. 
• A review of the evidence on yoga interventions for people living with HIV/AIDS showed improvements in perceived stress, positive affect, and anxiety. 
• A review on mindfulness-based interventions for adults with cardiovascular disease showed improvements in anxiety, depression, distress, perceived stress, and systolic blood pressure. 
• And finally, a review of yoga interventions for people with type 2 diabetes linked participation in yoga with improvements in measures of glycemic control (HbA1c and both fasting and postprandial [after eating] blood glucose) and in several risk factors for complications of diabetes—blood lipids, body mass index, waist/hip ratio, and cortisol levels (a measure related to the body’s stress response). 

The diabetes review doesn’t give us final answers about the value of yoga, though, for two reasons: First, all the studies included in the review were performed outside the United States (most of them in India), and findings obtained in one population may not apply to another. Second, the studies were of only low-to-medium methodological quality, and some important study details were not available.

Fortunately, new research supported by NCCIH may help fill these gaps. Dr. Beth Bock, also of The Miriam Hospital, is leading rigorous NCCIH-funded studies to evaluate the potential role of yoga in diabetes management in U.S. populations, and this work is in progress now. An earlier pilot study showed that the yoga intervention Dr. Bock is testing was highly feasible and acceptable among people with diabetes and that it produced improvements in both psychosocial measures and blood glucose.

Whether or not we face major challenges in our lives the way that people with diabetes or other chronic health problems do, we all need to recognize the importance of stress and the impact it may be having on us. Addressing stress isn’t just about feeling better; it’s about fundamentally promoting health. We can all benefit from learning methods to mitigate stress that have well-documented beneficial effects on inflammation, oxidative stress, stress hormones, blood pressure, blood sugar, and sleep. Some of these tools, such as deep breathing and relaxation techniques, are easy to learn and can help “press reset on stress”—anytime, anywhere.  And doing so can have cumulative effects—preventing stress from building up during the day, and giving us a better night’s sleep and more energy the next day for physical activity, which itself helps relieve stress. Think of it as a “positive snowball” effect, leading to better health. 

And for those of us in the research community, including NCCIH, learning more about how to prevent, manage, and mitigate stress—and how best to put existing stress management tools into practice—will continue to be a high priority. 

Press Reset on Stress, [1.21 MB PDF] 

Additional Resources

• Stress Fact Sheet
• Feeling Stressed? Ways To Improve Your Well-Being (NIH News in Health)
• Stress Reset Video (The Healthy US Collaborative)