The Physical Effects of Stress

Everyone experiences stress. It is a natural part of life, and a little bit of stress might have some benefits.¹However, too much stress can lead to an array of negative effects on the body and mind. In addition to the psychological impact of stress, research has demonstrated that it can exacerbate many chronic conditions and even impair immunity. Stress is frequently associated with flare-ups of acid reflux, asthma, eczema, and headaches and can to lead to more frequent infections and prolonged healing times. Even though these relationships are well established, patient education on stress management may be underused.

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As a health care provider in the retail health setting, I encounter upper respiratory infection visits and chronic condition exacerbations regularly. Sometimes, I see the same patients come in more frequently with minor infections or recall that they have been getting sick more often and do not understand why. At some point, I ask patients about their life, sleep, and work habits or whether they had any stressful life events recently. Many times, patients will divulge that they have been under emotional stress. For example, they may have recently experienced a breakup, lost a loved one, or had some other psychological stressor. Or, if it is not psychological stress, it is physical. They will confess to not sleeping enough, running marathons, working the graveyard shift or 2 jobs, or suffering from various other physical stressors. I take this confession as an opportunity to talk about stress management, as this directly relates to the frequent colds or poor healing wounds. Research has shown that psychological stress can increase the risk of colds and respiratory infections.²Results from one study found that when people are under severe stress for “1 month but less than 6 months, [it] doubles a person’s risk of a cold”³and that “when people are under this type of stress for more than 2 years, their risk of contracting a cold quadruples.”³

ASTHMA ATTACKS AND ECZEMA FLARE-UPS

Asthma and eczema can have numerous triggers, but stress is one that can be readily overlooked. Given the time constraints of modern appointments, providers may be quick to prescribe and slow to investigate and educate. Although it can be easy for some patients to identify triggers, such as exercise, smoke, and allergens like cats, stress is insidious. Patients may not be fully aware of their own mental state of being. Results from a study of children with asthma found that “the experience of an acute negative life event (eg, the death of a close family member) increased the risk of a subsequent asthma attack by nearly 2-fold. Children exposed to high levels of acute and chronic stress showed a 3-fold increase in the risk for an attack in the 2 weeks that followed the acute event.”⁴

It is important to take a moment to discuss lifestyle, triggers, and the benefits of journaling to monitor the condition. This can help uncover potential environmental problems and psychosocial stressors, thus potentially reducing the risk of future flare-ups. It is during these types of conversations that I have often discovered that patients can be under severe emotional stress and would also benefit from cognitive behavioral therapy and/ or counseling. This holistic approach can help treat physical conditions as well as help improve a patient’s psychological well-being.

ACID REFLUX AND IRRITABLE BOWEL SYNDROME

Just as stress can worsen asthma and eczema, it can do the same for gastrointestinal disorders. With patients presenting with a chief complaint of constipation, diarrhea, or gastroesophageal reflux disease (GERD) symptoms, it is important to discuss lifestyle. This includes exercise, healthy sleeping habits, stress reduction techniques, and even counseling or medication to reduce the levels of anxiety or stress.⁵For patients suffering from chronic levels of high stress, this can mean taking more drastic measures such as changing careers and jobs or identifying an underlying mental health disorder, such as depression, generalized anxiety disorder, or posttraumatic stress disorder (PTSD). The results of a study published in 2009 by the American College of Gastroenterology found that in the population studied, patients with GERD had higher rates of anxiety disorders, depression, and PTSD.⁶Treatment of these mental health disorders is critical in the treatment of GERD symptoms.

CONCLUSION

Regardless of how fast modern medicine wants us to move through patient visits, it is important to not forget to take a holistic, whole-person approach, even with seemingly minor episodic conditions. Taking the time to discuss lifestyle and therapeutic techniques may have a far-reaching impact. It may mean extending the length of the visit or recommending follow-up visits to address underlying problems. This extra time spent with patients could improve patient outcomes and, counter to the belief held by many health care organizations, even save health care dollars.7 ®

Sara Marlow, MSN, RN, PHN, FNP-C, is a licensed and board-certified family nurse practitioner, a public health nurse, an adjunct assistant professor of health policy, and a doctor of nursing practice student at the University of California, San Francisco. She was the spring 2015 health policy fellow at the American Association of Nurse Practitioners’ Government Affairs Office in Washington, DC.

References

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2. Cohen S, Tyrrell DA, Smith AP. Psychological stress and susceptibility to the common cold.N Engl J Med. 1991;325(9):606-612. doi: 10.1056/NEJM199108293250903.
3. Brody JE. A cold fact: high stress can make you sick.New York Times. May 12, 1988. nytimes. com/1998/05/12/science/a-cold-fact-high-stress-can-make-you-sick.html. Accessed March 1, 2018.
4. Chen E, Miller GE. Stress and inflammation in exacerbations of asthma.Brain Behav Immun. 2007;21(8):993-999. doi: 10.1016/j.bbi.2007.03.009.
5. Song EM, Jung HK, Jung JM. The association between reflux esophagitis and psychosocial stress.Dig Dis Sci. 2013;58(2):471-477. doi: 10.1007/s10620-012-2377-z.
6. Bankhead C. ACG: link found among stress, GERD, mental disorders.MedPage Today. medpagetoday. com/meetingcoverage/acg/16728. Published October 30, 2009. Accessed March 2, 2018. 7. Haas DA, Krosner YC, Mukerji N, Kaplan RS. Delivering higher value care means spending more time with patients. Harv Bus Rev. hbr.org/2014/12/delivering-higher-value-care-means-spending-more-time- with-patients. Published December 26, 2014. Accessed on March 2, 2018