Stress is a common experience in our lives. However, what do we know about the impact of stress other than it being not good for us? Part of that answer depends on the type of stress that is experienced and how we respond to that stress. This post examines different types of stress, who gets stressed, how our bodies respond to stress, and lastly what treatments help us manage stress.
The Different Types of Stress
There are many different forms of stress that we can encounter. The most common form of stress is called acute stress, which is when we are presented with a specific, contained event or demand. For example, getting into a minor car accident on the way to work, meeting a one-time deadline for a project at work, or even riding on a roller coaster.
As you can see, while we commonly associate stress with negative events such as a car accident, stress can also be the result of positive events such as roller coasters, wedding planning, or getting a promotion.
When we are presented with an acute stressor, our bodies have the fight, flight, or freeze response. This is controlled by the sympathetic nervous system, which leads to our pupils dilating, our heart rate increasing, reduction of peripheral vision, dilation of blood vessels for muscles, etc.
This fight, flight, or freeze response in an evolutionary sense is supposed to help us survive the stressor. If we were encountering a bear in the woods or had to fight off members of a rival tribe, this response would come in handy by having our body focus on functions that increase the chance we will live to see another day. Thankfully there is not much negative impact on our bodies when we experience these short-term, infrequent stressors, and we can recover fairly quickly.
Unfortunately, in modern society we are often presented with stressors that are not going to physically harm us, yet still cause this same stress response. This becomes particularly problematic when this stress response is chronic (i.e., long-lasting) as opposed to acute. Think about long-term mortgages, student debt, marriage problems, and difficult supervisors. When we are in these prolonged fight, flight, or freeze states it takes a toll on us (discussed below).
A book called Why Zebras Don’t Get Ulcers (which admittedly is still on my reading list, but has been highly recommended by several people), talks about this phenomenon of stress, fight or flight responses, and the impact of this stress on the body comparing stress responses in animals and humans. The book discusses why in general animals do not experience illnesses due to stress like humans do.
Another type of stress that has not been mentioned yet is called traumatic stress, which occurs after traumatic events such as a car accident, sexual violence, a natural disaster, or abuse. This post does not talk about the impact of traumatic stress as traumatic stress profoundly impacts individuals in different ways than nontraumatic stress does. However, suffice it to say that as severe of an impact chronic stress can have on the body, traumatic stress can do so even more even if the traumatic event only occurs once.
Now that we have covered some of the different types of stress, let us look at who tends to experience more stress.
Who Gets Stressed?
Based on national surveys given in 1983, 2006, and 2009, Cohen and Janicki-Deverts  looked at who feels the most stressed in the United States. As one might expect, stress was higher for individuals who were unemployed and lower for retired individuals. Stress was higher for women than for men, and perceived stress increased as age, education level, and income level decreased. Racial minorities reported more stress than White individuals, however, in this study this relationship was no longer significant when other factors were taken into account.
During the economic downturn in 2008-2009, the researchers found that stress increased little, with the exception for White, middle-aged, college educated men with full time jobs. This is a bit surprising, but perhaps the economic downturn felt more salient for members of this group or perhaps this group had relatively more to lose than others which caused additional stress.
Overall, this study indicates that those with less privilege (i.e., racial minorities, women, lower socioeconomic status) experience more stress than those with more privilege (i.e., White individuals, males).
This study is consistent with other research that has found increased levels of stress amongst minority individuals. Indeed the minority stress model has found that being of minority status often results in additional stress, particularly when a person is the target of prejudice and discrimination.
These bodies of research show that stress is not experienced to the same degree by different groups. The next question then is, what are the effects of stress on the body?
The Impact of Stress on the Body
Stress can impact us in a variety of ways, including our bodies, our behavior, and our emotions. Common physical reactions to stress include headaches, chest pains, muscle tension, fatigue, reduced sex drive, and stomach problems.
Stress can change our behaviors including leading us to eat more or less than normal, having difficulty falling or staying asleep, increasing our substance use (e.g., alcohol, tobacco, marijuana), exercising less, having more difficulty concentrating, and spending less time with others.
Stress can also change our emotional functioning by increasing our levels of irritability, anxiety, and depression, which all make it more difficult to manage stressors in our lives. Stress can also contribute to work burnout which makes it difficult to feel engaged and motivated at work.
A concept called allostatic load helps us understand the impact of stress on the body. Allostatic load is the impact on the body as it is exposed to stress and the corresponding lifestyle changes that often come with exposure to stress such as smoking cigarettes, eating too much, drinking alcohol, and having poor sleep quality.
Adapted from McEwen 1998
Allostatic load is influenced by many things including genetics and traumatic experiences such as abuse and neglect. These factors can change how adaptively an individual can react to stressful events and regulate her or his response to stress, including emotional and behavioral responses.
As such, allostatic load is impacted not only by how frequently someone experiences stressors, but also how effectively that person can manage stress. Think about the long-term impact on the body for an individual who smokes cigarettes or eats a bunch of junk food each time he or she experiences stress, as opposed to someone to goes for a run or calls a friend on the phone.
Let us look a little closer at how exactly stress impacts us where it matters, in our brain.
Impact of Chronic Stress on the Brain
As discussed in Marin et al. , stress causes physical responses in the brain. Importantly, the hypothalamic-pituitary-adrenal (HPA) axis, which consists of three brain structures, releases stress hormones called glucocorticoids. In humans, these glucocorticoids are primarily composed of cortisol.
The HPA axis is regulated by three other brain structures, the hippocampus, the amygdala, and the medial (middle) prefrontal cortex. The amygdala, which is important for our ability to detect emotional content including fear, activates the HPA axis. The hippocampus and prefrontal cortex, in contrast, inhibit the HPA axis. The hippocampus is important for memory, particularly long-term memory, and the prefrontal cortex is involved with many different functions including planning, inhibiting responses, emotion regulation, attention, and short-term memory.
The hippocampus in particular appears to play an important role in regulating the HPA axis and is important for disorders such as depression, posttraumatic stress disorder (PTSD), and Alzheimer’s disease.
The review by Marin and colleagues discusses the impact of chronic stress and mental health . As discussed in the review, the mental health conditions that are most commonly studied in relation to chronic stress are depression, posttraumatic stress disorder, and burnout. In addition, cortisol appears to be related to Alzheimer’s disease.
The commonality between these different disorders is the impact of chronic stress on cognitive functioning. Thus, exposure to chronic stress actually makes us less able to think and reason as well as before. While some of these effects can likely be reversed, some of the cognitive deficits are likely permanent.
One explanation for this is called the ‘neurotoxicity hypothesis,’ which states that high levels of cortisol (due to stress) for long periods of time negatively impact the HPA axis regulation and also negatively impact the hippocampus and consequently memory performance. This negative change in the hippocampus then places individuals at risk for developing mental health problems and cognitive problems.
Pretty serious stuff, what is a person to do to manage life's stressors?
Ways to Manage Your Stress
We know that chronic stress has a negative impact on our bodies and can even cause structural changes in the brain. So what are some ways to manage stress?
A review of interventions to help employees manage work stress found that the best interventions were individually targeted as opposed to interventions conducted at an organizational level or a mixed individual-organizational approach .
Specifically, cognitive-behavioral individual interventions appeared to be the most effective, especially for the employee’s mental health. However, there was some support found for organizational interventions that target exercise as a way to reduce absenteeism. Overall, the review notes that more quality research needs to be conducted to determine which interventions work best to improve employee health and functioning.
A separate review and meta-analysis examined interventions targeting stress in college students . These researchers found that cognitive, behavioral, and mindfulness interventions were effective in reducing stress in college students, and also appeared to reduce depression and even cortisol levels.
Taken together, these reviews support the use of cognitive-behavioral therapy (CBT) techniques to help individuals manage stress. The great thing about CBT is that once you learn the techniques, you can continue to use them on your own, even after the therapy has ended.
What specific strategies could be helpful in managing stress? Well as discussed in a separate post, yoga can be a great way to not only manage stress but also improve physical fitness. Practicing mindfulness or meditation can also be a great way to manage stress and there are many resources online and phone apps that can help walk you through mindfulness exercises if you have never practiced them before.
If yoga and mindfulness sound a little too “New Age” for you (I get it, I used to think the same thing, although I am a convert now), plain ole physical exercise can do the job, whether it is going for a walk around the block or playing your favorite sport.
Other suggestions include spending time with friends (although do not spend the whole time venting about your stress, that can be counter-productive), listening to music, taking a hot bath, or even using a coloring book. There are plenty of suggestions and you are really limited only by your imagination regarding ways to destress.
Make sure your destress strategies are not focusing solely on activities that negatively impact the body such as spending all day watching TV on the couch or eating comfort foods. Most things in moderation are fine, but also make sure to include things that are healthy for you such as exercise and spending time with friends or family.
Many people do not realize the many different forms of stress we experience on a daily basis and the impact this stress has on us mentally and physically. Stress can have a heavy toll on our bodies that in general we can be quite unaware of. Make sure to prioritize your well-being by engaging in destressing strategies that work for you. Maybe it is cooking a meal, watching a movie with a friend, or going on a nature walk. The important thing is that chronic stress negatively impacts us and we have to be proactive about staying mentally and physically healthy.
Now if you find you are very overwhelmed with stressful events in your life, seeing a professional, such as a CBT therapist, can be very beneficial. This therapist can help you problem solve ways to reduce stress in your life, learning positive strategies to cope with stress, and help you change some thinking patterns that may be contributing to your stress.
Stress is a topic that no matter the length of the post, there is always going to be more to talk about. This post provided an overview of stress, including the ways stress can impact us, and hopefully helped encourage each of us to continue practicing good stress reduction strategies as part of healthy living. Thanks as always for reading Clinically Relevant Insights.
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 Cohen, S., & Janicki-Deverts, D. (2012). Who's stressed? Distributions of psychological stress in the United States in probability samples from 1983, 2006, and 2009. Journal of Applied Social Psychology, 42(6), 1320-1334. doi:10.1111/j.1559-1816.2012.00900.x
 Marin, M., Lord, C., Andrews, J., Juster, R., Sindi, S., Arsenault-Lapierre, G., . . . Lupien, S. J. (2011). Chronic stress, cognitive functioning and mental health. Neurobiology of Learning and Memory, 96(4), 583-595. doi:10.1016/j.nlm.2011.02.016
 Bhui, K. S., Dinos, S., Stansfeld, S. A., & White, P. D. (2012). A synthesis of the evidence for managing stress at work: A review of the reviews reporting on anxiety, depression, and absenteeism. Journal of Environmental and Public Health, 2012, 1-21. doi:10.1155/2012/515874
 Regehr, C., Glancy, D., & Pitts, A. (2013). Interventions to reduce stress in university students: A review and meta-analysis. Journal of Affective Disorders, 148(1), 1-11. doi:10.1016/j.jad.2012.11.026