Stress is Unhealthy – Maybe
There is a lot of hype surrounding the unhealthy effects of chronic stress. An entire industry is devoted to ‘stress reduction’ as a way to ensure better health. Now there are reputable claims for scientific evidence and a mechanism of action for the adverse effects of stress on health. A 2008 literature review of 165 studies (http://www.ncbi.nlm.nih.gov/pubmed/18493231) purported to find an association between chronic stress and a higher incidence of cancer, poorer disease free survival with treatment and higher cancer mortality. Other reviews have linked poor would healing to elevated stress levels in both human and animal models. (http://www.ncbi.nlm.nih.gov/pubmed/19686881) (http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2780920/) So stress is bad, right?
Well, maybe. Many experts are skeptical of research claiming that our mental health can influence our physical health. James Coyne, PhD, director of the Behavioral Oncology Program, Abramson Cancer Center and professor of psychology in the Department of Psychiatry, University of Pennsylvania School of Medicine, has analyzed a range of studies to refute such claims. For instance, he described the gaping holes in a 2007 study claiming that, on average, less than four hours of psychotherapy was associated with a 10-year survival benefit among patients with gastrointestinal cancer. The major issue was that the study was not blinded, and patients who received psychotherapy also received more medical treatment overall. As Dr. Coyne wrote, “they were twice as likely to receive postoperative chemotherapy, five times as likely to receive radiotherapy, three times more likely to receive alternative treatments, and four times more likely to receive a combination of three treatments in the post-treatment period.”
Part of the problem with studies that focus on psychological stress as opposed to physical stress is there is not a coherent definition of what constitutes ‘stress’. When I’m faced with a critically ill trauma patient and don’t know exactly what his injuries are or how to treat him, I’m under stress. But is that different than the fear response experienced by a patient facing a major surgery? Psychologically yes, but physiologically our responses look similar – increased heart rate and respirations, widened pupils, dry mouth – the typical fight or flight response. And yet the studies that support a stress-illness link emphasize the latter circumstance as being more harmful. So called ‘controlled stress’ such as mine is actually a good response, heightening awareness, sharpening observation and inducing rapid thought associations according to a British study of professionals faced with unusual situations in their fields.
Finally, there is no solid evidence that self-reported stress has actual physical correlates. The physiologic fight or flight response can be measured, but many patients who report high stress levels have no evidence of measureable physiologic response to it. Well-controlled studies that include actual measures of physiologic response to self reported psychological stress are lacking.
I don’t doubt that stress influences a patient’s feeling of well-being and that can have a profound effect on their recovery from surgery. I am also prepared to accept that chronic hyper stimulation of the physiologic stress response affect interleukin and other immune modulators on a cellular level. Actual evidence that this has a measurable clinical effect is sparse.
There is certainly no harm in patients (or anyone) undergoing psychotherapy or counseling to help them deal with the effects of an illness. Learning relaxation techniques and engaging in stress reducing recreation or other pursuits enriches and improves our emotional and interpersonal lives. I relieve stress on the water, swimming and kayaking, and am better able to relate to my patients and family as a result. But I object to alternative medicine practitioners making claims, and worse, profiting from ‘treatments’ to reduce stress under the guise of treating or preventing illness.