Excessive Stress
Tawnya Ward, ND
*Last edited for links May 2021
Recently many members of our communities are being affected by novel and potentially magnified stressors. These stresses are often social (or lack of social connectedness), workplace, financial, or health-related. Excessive stress has the potential to wreak havoc on one’s wellbeing. Drs Eric Chan (ND) and Tawnya Ward (ND) for the better part of a decade and a half have worked with their patients to help modulate stress response, to better promote wellness.
Adverse outcome examples potentially associated with excessive stress:
weight gain, obesity [1, 2, 3]
sleep disruptions [4]
alteration or impaired executive functioning [5, 6]
immune changes [7, 8, 9, 10, 11, 12]
increased inflammatory markers/responses [13, 14]
susceptibility to infections and cancer, worse cancer outcomes [15, 16, 17, 18, 19]
increased cardiovascular disease risk [20, 21, 22, 23, 24]
increased autoimmune disease incidence (e.g. rheumatoid arthritis, lupus, multiple sclerosis, Graves' disease) [25, 26]
increased risk of neurodegenerative disorders, dementia [27, 28]
pain, [29] fear and anxiety increasing pain [30, 31]
microbiome alternations (e.g. transient reductions lactobacilli )[32, 33]
Loneliness potential adverse outcomes:
higher risk cardiovascular mortality, increased peripheral resistance & blood pressure [34, 35]
poor social relationships & increased coronary heart disease and stroke risk [36]
increased inflammation (IL-6, fibrinogen, CRP) [37, 38, 39]
Activities that may be helpful to reduce stress response:
exercise [40]
mindfullness, [41, 42, 43] meditation [44, 45]
deep breathing [46, 47, 48]
yoga, tai chi [49, 50, 51, 52]
art [53, 53, 55]
listening to or playing enjoyable music [56, 57, 58, 59, 60]
time in nature, forest bathing [61, 62, 63, 64]
gardening [65, 66]
adequate sleep, good sleep hygiene [67, 68, 69]
reaching out, spending time with others (e.g. online, phone), quality social connections [70]
Other treatments that may be recommended as a part of a comprehensive individualized plan:
dietary modifications, optimizing nutrition
botanicals
amino acids
probiotics, dietary changes to promote beneficial microbiome
vitamins and minerals (oral and/or intravenous)
acupuncture, acupressure
Note: All recommendations are individualized after a thorough case-history, complaint-oriented physical exam (unless unable at this time due to limitations of telemedicine or phone consult during COVID-19 pandemic restrictions), and indicated labs. None of the above potentially stress reducing activities or potential treatments are meant to be used as specific recommendations, nor is the information presented here intended to diagnose or treat any condition.
Call our office to book to an initial consult or follow-up (current patients) 604-275-0163.
COVID-19 Update
Note that we are not attempting to treat, prevent or cure COVID-19.
Please follow all BC CDC & government recommendations.
We commend our patients and the general public for adhering to public health guidelines with social distancing. Together we can flatten the curve.
References
1. Tomiyama AJ1. (2019). Stress and Obesity. Annu Rev Psychol. 2019 Jan 4;70:703-718. doi: 10.1146/annurev-psych-010418-102936. Epub 2018 Jun 21.
2. Roberts CJ1, Campbell IC, Troop N. (2014). Increases in weight during chronic stress are partially associated with a switch in food choice towards increased carbohydrate and saturated fat intake. Eur Eat Disord Rev. 2014 Jan;22(1):77-82. doi: 10.1002/erv.2264. Epub 2013 Oct 4.
3. Russell G1, Lightman S2. (2019). The human stress response. Nat Rev Endocrinol. 2019 Sep;15(9):525-534. doi: 10.1038/s41574-019-0228-0. Epub 2019 Jun 27.
4. Almojali AI1, Almalki SA2, Alothman AS2, Masuadi EM3, Alaqeel MK4. (2017). The prevalence and association of stress with sleep quality among medical students. J Epidemiol Glob Health. 2017 Sep;7(3):169-174. doi: 10.1016/j.jegh.2017.04.005. Epub 2017 May 5.
5. Shields GS1, Sazma MA2, Yonelinas AP2. (2016). The effects of acute stress on core executive functions: A meta-analysis and comparison with cortisol. Neurosci Biobehav Rev. 2016 Sep;68:651-668. doi: 10.1016/j.neubiorev.2016.06.038. Epub 2016 Jun 28.
6. Butler K1, Klaus K1, Edwards L1, Pennington K2. (2017). Elevated cortisol awakening response associated with early life stress and impaired executive function in healthy adult males. Horm Behav. 2017 Sep;95:13-21. doi: 10.1016/j.yhbeh.2017.07.013. Epub 2017 Aug 2.
7. McGregor BA1,2, Murphy KM1,3, Albano DL1, Ceballos RM1,2. (2016). Stress, cortisol, and B lymphocytes: a novel approach to understanding academic stress and immune function. Stress. 2016;19(2):185-91. doi: 10.3109/10253890.2015.1127913.
8. Dhabhar FS1. (2018). The short-term stress response - Mother nature's mechanism for enhancing protection and performance under conditions of threat, challenge, and opportunity. Front Neuroendocrinol. 2018 Apr;49:175-192. doi: 10.1016/j.yfrne.2018.03.004. Epub 2018 Mar 26.
9. Glaser R1, Kiecolt-Glaser JK. (2005). Stress-induced immune dysfunction: implications for health. Nat Rev Immunol. 2005 Mar;5(3):243-51. doi: 10.1038/nri1571.
10. Padro CJ1, Sanders VM2. (2014). Neuroendocrine regulation of inflammation. Semin Immunol. 2014 Oct;26(5):357-68. doi: 10.1016/j.smim.2014.01.003. Epub 2014 Jan 31.
11. Dhabhar FS1, Malarkey WB, Neri E, McEwen BS. (2012). Stress-induced redistribution of immune cells--from barracks to boulevards to battlefields: a tale of three hormones--Curt Richter Award winner. Psychoneuroendocrinology. 2012 Sep;37(9):1345-68. doi: 10.1016/j.psyneuen.2012.05.008. Epub 2012 Jun 22.
12. O'Connor DB1, Walker S, Hendrickx H, Talbot D, Schaefer A. (2013). Stress-related thinking predicts the cortisol awakening response and somatic symptoms in healthy adults. Psychoneuroendocrinology. 2013 Mar;38(3):438-46. doi: 10.1016/j.psyneuen.2012.07.004. Epub 2012 Jul 31.
13. Nancy A. Melville. (2020). Worry, Anxiety Tied to Increased Inflammation. Medscape. April 07, 2020. https://www.medscape.com/viewarticle/928287
14. Yeager MP1, Guyre CA2, Sites BD3, Collins JE4, Pioli PA4, Guyre PM4. (2018). The Stress Hormone Cortisol Enhances Interferon-υ-Mediated Proinflammatory Responses of Human Immune Cells. Anesth Analg. 2018 Aug;127(2):556-563. doi: 10.1213/ANE.0000000000003481.
15. Dhabhar FS1. (2009). Enhancing versus suppressive effects of stress on immune function: implications for immunoprotection and immunopathology. Neuroimmunomodulation. 2009;16(5):300-17. doi: 10.1159/000216188. Epub 2009 Jun 29.
16. Shin KJ, Lee YJ, Yang YR, Park S, Suh PG1, Follo MY, Cocco L, Ryu SH. (2016). Molecular Mechanisms Underlying Psychological Stress and Cancer. Curr Pharm Des. 2016;22(16):2389-402.
17. Spiegel D1. (2012). Mind matters in cancer survival. Psychooncology. 2012 Jun;21(6):588-93. doi: 10.1002/pon.3067. Epub 2012 Mar 21.
18. Russell G1, Lightman S2. (2019). The human stress response. Nat Rev Endocrinol. 2019 Sep;15(9):525-534. doi: 10.1038/s41574-019-0228-0. Epub 2019 Jun 27.
19. Dhabhar FS1. (2014). Effects of stress on immune function: the good, the bad, and the beautiful. Immunol Res. 2014 May;58(2-3):193-210. doi: 10.1007/s12026-014-8517-0.
20. Esler M1. (2017). Mental stress and human cardiovascular disease. Neurosci Biobehav Rev. 2017 Mar;74(Pt B):269-276. doi: 10.1016/j.neubiorev.2016.10.011. Epub 2016 Oct 14.
21. Kivimäki M1, Kawachi I. (2015).Work Stress as a Risk Factor for Cardiovascular Disease. Curr Cardiol Rep. 2015 Sep;17(9):630. doi: 10.1007/s11886-015-0630-8.
22. Cohen BE1, Edmondson D2, Kronish IM2. (2015). State of the Art Review: Depression, Stress, Anxiety, and Cardiovascular Disease. Am J Hypertens. 2015 Nov;28(11):1295-302. doi: 10.1093/ajh/hpv047. Epub 2015 Apr 24.
23. Wirtz PH1, von Känel R2. (2017). Psychological Stress, Inflammation, and Coronary Heart Disease. Curr Cardiol Rep. 2017 Sep 20;19(11):111. doi: 10.1007/s11886-017-0919-x.
24. Chinnaiyan KM1. (2019). Role of stress management for cardiovascular disease prevention. Curr Opin Cardiol. 2019 Sep;34(5):531-535. doi: 10.1097/HCO.0000000000000649.
25. Sharif K1, Watad A1, Coplan L2, Lichtbroun B2, Krosser A2, Lichtbroun M2, Bragazzi NL3, Amital H1, Afek A4, Shoenfeld Y5. (2018). The role of stress in the mosaic of autoimmunity: An overlooked association. Autoimmun Rev. 2018 Oct;17(10):967-983. doi: 10.1016/j.autrev.2018.04.005. Epub 2018 Aug 14.
26. Song H1,2, Fang F2, Tomasson G3,4,5, Arnberg FK6,7, Mataix-Cols D8,9, Fernández de la Cruz L8, Almqvist C2,10, Fall K11,2, Valdimarsdóttir UA1,2,12. (2018). Association of Stress-Related Disorders With Subsequent Autoimmune Disease. JAMA. 2018 Jun 19;319(23):2388-2400. doi: 10.1001/jama.2018.7028.
27. Song H1,2,3, Sieurin J3, Wirdefeldt K3,4, Pedersen NL3,5, Almqvist C3,6, Larsson H3,7, Valdimarsdóttir UA2,3,8, Fang F9. (2020). Association of Stress-Related Disorders With Subsequent Neurodegenerative Diseases. JAMA Neurol. 2020 Mar 9. doi: 10.1001/jamaneurol.2020.0117. [Epub ahead of print]
28. Megan Brooks. (2020). Stress-Related Disorders Tied to Future Neurodegenerative Disease. Medscape. March 12, 2020 https://www.medscape.com/viewarticle/926719
29. Hannibal KE1, Bishop MD2. (2014). Chronic stress, cortisol dysfunction, and pain: a psychoneuroendocrine rationale for stress management in pain rehabilitation. Phys Ther. 2014 Dec;94(12):1816-25. doi: 10.2522/ptj.20130597. Epub 2014 Jul 17.
30. Lumley MA1, Cohen JL, Borszcz GS, Cano A, Radcliffe AM, Porter LS, Schubiner H, Keefe FJ. (2011). Pain and emotion: a biopsychosocial review of recent research. J Clin Psychol. 2011 Sep;67(9):942-68. doi: 10.1002/jclp.20816. Epub 2011 Jun 6.
31. Lucchetti G1, Oliveira AB, Mercante JP, Peres MF. (2012). Anxiety and fear-avoidance in musculoskeletal pain. Curr Pain Headache Rep. 2012 Oct;16(5):399-406. doi: 10.1007/s11916-012-0286-7.
32. Knowles SR1, Nelson EA, Palombo EA. (2008). Investigating the role of perceived stress on bacterial flora activity and salivary cortisol secretion: a possible mechanism underlying susceptibility to illness. Biol Psychol. 2008 Feb;77(2):132-7. Epub 2007 Oct 2.
33. Galley JD, Nelson MC, Yu Z, Dowd SE, Walter J, Kumar PS, Lyte M, Bailey MT1. (2014). Exposure to a social stressor disrupts the community structure of the colonic mucosa-associated microbiota. BMC Microbiol. 2014 Jul 15;14:189. doi: 10.1186/1471-2180-14-189. (murine/mouse model)
34. Xia N1, Li H1,2,3. (2018). Loneliness, Social Isolation, and Cardiovascular Health. Antioxid Redox Signal. 2018 Mar 20;28(9):837-851. doi: 10.1089/ars.2017.7312. Epub 2017 Oct 23.
35. Hawkley LC1, Thisted RA, Masi CM, Cacioppo JT. (2010). Loneliness predicts increased blood pressure: 5-year cross-lagged analyses in middle-aged and older adults. Psychol Aging. 2010 Mar;25(1):132-41. doi: 10.1037/a0017805.
36. Valtorta NK1, Kanaan M1, Gilbody S1, Ronzi S2, Hanratty B3. (2016). Loneliness and social isolation as risk factors for coronary heart disease and stroke: systematic review and meta-analysis of longitudinal observational studies. Heart. 2016 Jul 1;102(13):1009-16. doi: 10.1136/heartjnl-2015-308790. Epub 2016 Apr 18.
37. Nersesian PV1, Han HR2, Yenokyan G3, Blumenthal RS4, Nolan MT5, Hladek MD6, Szanton SL7. (2018). Soc Sci Med. 2018 Jul;209:174-181. doi: 10.1016/j.socscimed.2018.04.007. Epub 2018 Apr 30.
38. Steptoe A1, Owen N, Kunz-Ebrecht SR, Brydon L. (2004). Loneliness and neuroendocrine, cardiovascular, and inflammatory stress responses in middle-aged men and women. Psychoneuroendocrinology. 2004 Jun;29(5):593-611.
39. Jaremka LM1, Fagundes CP, Peng J, Bennett JM, Glaser R, Malarkey WB, Kiecolt-Glaser JK. (2013). Loneliness promotes inflammation during acute stress. Psychol Sci. 2013 Jul 1;24(7):1089-97. doi: 10.1177/0956797612464059. Epub 2013 Apr 29.
40. Stubbs B1, Vancampfort D2, Rosenbaum S3, Firth J4, Cosco T5, Veronese N6, Salum GA7, Schuch FB8. (2017). An examination of the anxiolytic effects of exercise for people with anxiety and stress-related disorders: A meta-analysis. Psychiatry Res. 2017 Mar;249:102-108. doi: 10.1016/j.psychres.2016.12.020. Epub 2017 Jan 6.
41. O'Reilly GA1, Cook L, Spruijt-Metz D, Black DS. (2014). Mindfulness-based interventions for obesity-related eating behaviours: a literature review. Obes Rev. 2014 Jun;15(6):453-61. doi: 10.1111/obr.12156. Epub 2014 Mar 18.
42. Janssen M1, Heerkens Y1, Kuijer W1, van der Heijden B2,3,4, Engels J1. (2018). Effects of Mindfulness-Based Stress Reduction on employees' mental health: A systematic review. PLoS One. 2018 Jan 24;13(1):e0191332. doi: 10.1371/journal.pone.0191332. eCollection 2018.
43. Shapiro SL1, Schwartz GE, Bonner G. (1998). Effects of mindfulness-based stress reduction on medical and premedical students. J Behav Med. 1998 Dec;21(6):581-99.
44. Pascoe MC1, Thompson DR2, Jenkins ZM3, Ski CF4. (2017). Mindfulness mediates the physiological markers of stress: Systematic review and meta-analysis. J Psychiatr Res. 2017 Dec;95:156-178. doi: 10.1016/j.jpsychires.2017.08.004. Epub 2017 Aug 23.
45. Carlson LE1, Speca M, Patel KD, Goodey E. (2004). Mindfulness-based stress reduction in relation to quality of life, mood, symptoms of stress and levels of cortisol, dehydroepiandrosterone sulfate (DHEAS) and melatonin in breast and prostate cancer outpatients. Psychoneuroendocrinology. 2004 May;29(4):448-74.
46. Perciavalle V1, Blandini M2, Fecarotta P3, Buscemi A2, Di Corrado D4, Bertolo L2, Fichera F2, Coco M5. (2017). The role of deep breathing on stress. Neurol Sci. 2017 Mar;38(3):451-458. doi: 10.1007/s10072-016-2790-8. Epub 2016 Dec 19.
47. De Couck M1, Caers R2, Musch L3, Fliegauf J4, Giangreco A4, Gidron Y5. (2019). How breathing can help you make better decisions: Two studies on the effects of breathing patterns on heart rate variability and decision-making in business cases. Int J Psychophysiol. 2019 May;139:1-9. doi: 10.1016/j.ijpsycho.2019.02.011. Epub 2019 Mar 1.
48. Hayama Y1, Inoue T. (2012). The effects of deep breathing on 'tension-anxiety' and fatigue in cancer patients undergoing adjuvant chemotherapy. Complement Ther Clin Pract. 2012 May;18(2):94-8. doi: 10.1016/j.ctcp.2011.10.001. Epub 2011 Nov 9.
49. Gothe NP1, Keswani RK2, McAuley E2. (2016). Yoga practice improves executive function by attenuating stress levels. Biol Psychol. 2016 Dec;121(Pt A):109-116. doi: 10.1016/j.biopsycho.2016.10.010. Epub 2016 Oct 26.
50. Pascoe MC1, Thompson DR2, Ski CF3. (2017). Yoga, mindfulness-based stress reduction and stress-related physiological measures: A meta-analysis. Psychoneuroendocrinology. 2017 Dec;86:152-168. doi: 10.1016/j.psyneuen.2017.08.008. Epub 2017 Aug 30.
51. Eda N1, Ito H2, Shimizu K3, Suzuki S4, Lee E4, Akama T1. (2018). Yoga stretching for improving salivary immune function and mental stress in middle-aged and older adults. J Women Aging. 2018 May-Jun;30(3):227-241. doi: 10.1080/08952841.2017.1295689. Epub 2017 Apr 3.
52. Saeed SA1, Cunningham K1, Bloch RM1. (2019). Depression and Anxiety Disorders: Benefits of Exercise, Yoga, and Meditation. Am Fam Physician. 2019 May 15;99(10):620-627.
53. Walsh SM1, Radcliffe RS, Castillo LC, Kumar AM, Broschard DM. (2007). A pilot study to test the effects of art-making classes for family caregivers of patients with cancer. Oncol Nurs Forum. 2007 Jan;34(1):38.
54. Diamond S1, Shrira A2. (2018). Psychological vulnerability and resilience of Holocaust survivors engaged in creative art. Psychiatry Res. 2018 Jun;264:236-243. doi: 10.1016/j.psychres.2018.04.013. Epub 2018 Apr 7.
55. Sandmire DA1, Rankin NE2, Gorham SR3, Eggleston DT1, French CA1, Lodge EE1, Kuns GC1, Grimm DR1. (2016). Psychological and autonomic effects of art making in college-aged students. Anxiety Stress Coping. 2016 Sep;29(5):561-9. doi: 10.1080/10615806.2015.1076798. Epub 2015 Aug 28.
56. Linnemann A1, Ditzen B2, Strahler J1, Doerr JM1, Nater UM3. (2015). Music listening as a means of stress reduction in daily life. Psychoneuroendocrinology. 2015 Oct;60:82-90. doi: 10.1016/j.psyneuen.2015.06.008. Epub 2015 Jun 21.
57. Uedo N1, Ishikawa H, Morimoto K, Ishihara R, Narahara H, Akedo I, Ioka T, Kaji I, Fukuda S. (2004). Reduction in salivary cortisol level by music therapy during colonoscopic examination. Hepatogastroenterology. 2004 Mar-Apr;51(56):451-3.
58. Ventura T1, Gomes MC, Carreira T. (2012). Cortisol and anxiety response to a relaxing intervention on pregnant women awaiting amniocentesis. Psychoneuroendocrinology. 2012 Jan;37(1):148-56. doi: 10.1016/j.psyneuen.2011.05.016. Epub 2011 Jun 25.
59. Thoma MV1, La Marca R, Brönnimann R, Finkel L, Ehlert U, Nater UM. (2013). The effect of music on the human stress response. PLoS One. 2013 Aug 5;8(8):e70156. doi: 10.1371/journal.pone.0070156. Print 2013.
60. Ploukou S1, Panagopoulou E2. (2018). Playing music improves well-being of oncology nurses. Appl Nurs Res. 2018 Feb;39:77-80. doi: 10.1016/j.apnr.2017.11.007. Epub 2017 Nov 4.
61. Bowler DE1, Buyung-Ali LM, Knight TM, Pullin AS. (2010). A systematic review of evidence for the added benefits to health of exposure to natural environments. BMC Public Health. 2010 Aug 4;10:456. doi: 10.1186/1471-2458-10-456.
62. Han JW1, Choi H2, Jeon YH3, Yoon CH4, Woo JM5,6, Kim W7,8. (2016). The Effects of Forest Therapy on Coping with Chronic Widespread Pain: Physiological and Psychological Differences between Participants in a Forest Therapy Program and a Control Group. Int J Environ Res Public Health. 2016 Feb 24;13(3). pii: E255. doi: 10.3390/ijerph13030255.
63. Chun MH1, Chang MC1, Lee SJ2. (2017). The effects of forest therapy on depression and anxiety in patients with chronic stroke. Int J Neurosci. 2017 Mar;127(3):199-203. doi: 10.3109/00207454.2016.1170015. Epub 2016 Apr 10.
64. Cordoza M1, Ulrich RS1, Manulik BJ1, Gardiner SK1, Fitzpatrick PS1, Hazen TM1, Mirka A1, Perkins RS2. (2018). Impact of Nurses Taking Daily Work Breaks in a Hospital Garden on Burnout. Am J Crit Care. 2018 Nov;27(6):508-512. doi: 10.4037/ajcc2018131.
65. Westlund S1. (2015). 'Becoming human again': Exploring connections between nature and recovery from stress and post-traumatic distress. Work. 2015;50(1):161-74. doi: 10.3233/WOR-141934.
66. Van Den Berg AE1, Custers MH. (2011). Gardening promotes neuroendocrine and affective restoration from stress. J Health Psychol. 2011 Jan;16(1):3-11. doi: 10.1177/1359105310365577. Epub 2010 Jun 3.
67. Chen PH1, Kuo HY, Chueh KH. (2010). Sleep hygiene education: efficacy on sleep quality in working women. J Nurs Res. 2010 Dec;18(4):283-9. doi: 10.1097/JNR.0b013e3181fbe3fd.
68. Nédélec M1,2, Halson S3, Delecroix B4,5, Abaidia AE4,5, Ahmaidi S6, Dupont G4,5. (2015). Sleep Hygiene and Recovery Strategies in Elite Soccer Players. Sports Med. 2015 Nov;45(11):1547-59. doi: 10.1007/s40279-015-0377-9.
69. van Dalfsen JH1, Markus CR2. (2018). The influence of sleep on human hypothalamic-pituitary-adrenal (HPA) axis reactivity: A systematic review. Sleep Med Rev. 2018 Jun;39:187-194. doi: 10.1016/j.smrv.2017.10.002. Epub 2017 Oct 18.
70. Holt-Lunstad J1, Smith TB, Layton JB. (2010). Social relationships and mortality risk: a meta-analytic review. PLoS Med. 2010 Jul 27;7(7):e1000316. doi: 10.1371/journal.pmed.1000316. “Data across 308,849 individuals, followed for an average of 7.5 years, indicate that individuals with adequate social relationships have a 50% greater likelihood of survival compared to those with poor or insufficient social relationships. The magnitude of this effect is comparable with quitting smoking and it exceeds many well-known risk factors for mortality (e.g., obesity, physical inactivity).”