Stress Management

Stress is a natural automatic reaction of organisms to challenging or threatening stimuli, and stress management refers to techniques used to achieve stress reduction. ^[1] Stress management encompasses a wide range of techniques including breathing exercises, meditation, guided imagery, progressive muscle relaxation, biofeedback, cognitive behavioral therapy, and mindfulness. ^[1] In lifestyle medicine, stress management is one of the root-cause targets alongside nutrition, physical activity, sleep, and connectedness. ^[2]

The physiological reaction to psychological stress involves the hypothalamic-pituitary-adrenocortical and sympatho-adrenomedullary axes. ^[3] Stress can negatively affect cognition, including working memory, via the deleterious effect of glucocorticoids and catecholamines on brain regions such as the prefrontal cortex and hippocampus. ^[4] Meditation practice leads to decreased physiological markers of stress including cortisol, C-reactive protein, blood pressure, heart rate, triglycerides and tumour necrosis factor-alpha across a range of populations. ^[5] Mindfulness-based stress reduction is proposed to work by developing enhanced moment-to-moment awareness that reduces negative affect and improves coping. ^[6]

A systematic review and meta-analysis of 58 randomized controlled trials (combined N = 3508) found that stress management interventions outperformed control conditions in lowering cortisol with a medium positive effect size (g = 0.282). ^[7] In that analysis mindfulness and meditation and relaxation interventions were most effective at changing cortisol levels, while talking therapies had smaller, non-significant effects. ^[7] A meta-analysis of 29 studies (n = 2668) found mindfulness-based stress reduction moderately effective in healthy individuals, with large effects on stress and moderate effects on anxiety and depression. ^[8] A meta-analysis of randomized controlled trials found that meditation reduced systolic blood pressure and other physiological markers of stress compared with active controls. ^[5] The American College of Physicians clinical practice guideline gives mindfulness-based stress reduction a strong recommendation as a first-line nonpharmacologic option for chronic low back pain, based on moderate-quality evidence. ^[9]

Chronic stress predicts the occurrence of coronary heart disease and can increase the risk of recurrent events and mortality among patients with established coronary disease. ^[3] Durable chronic stress accelerates tumorigenesis and progression through dysfunction of the HPA axis and sympathetic nervous system, contributing to impaired immune function. ^[10] Lifestyle medicine that includes stress management can optimize the trajectory of aging and promote a compression of morbidity. ^[2]