Myths & Facts: Stress

Most people associate the term “stress” with its negative effects. And, while most of the time stress can be harmful, triggering unwanted side effects, in other circumstances, stress can be beneficial. A nearly universal human experience, stress can be broken down into two types: acute and chronic. Acute stress is short-term and occurs in situations such as having a fight with a loved one or doing something new and exciting. Chronic stress such as losing a job, dealing with an unhappy relationship or having money problems often lasts for weeks or months and can often go unrecognized and lead to serious health problems.¹ Importantly, stress can be either eustress or distress. Eustress occurs in response to daily living activities such as getting married, getting a promotion, having a baby and winning money, and it comes with positive connotations. Distress, on the other hand, also occurs in response to daily living activities such as getting divorced, getting injured or having financial problems, but it has negative connotations.²

Just about everyone is affected by stress at some time in their lives, but some demographics experience higher rates of stress than others, including ethnic minorities, women, single parents and people responsible for their family’s healthcare decisions. According to the American Institute of Stress:³

• About 33 percent of people report feeling extreme stress.
• Seventy-seven percent of people experience stress that affects their physical health.
• Seventy-three percent of people have stress that impacts their mental health.
• Forty-eight percent of people have trouble sleeping because of stress.

What’s more, the association reports that for about half of all Americans, levels of stress are getting worse instead of better.

What are the reasons for this current high rate of stress? The American Psychological Association conducts an annual Stress in America survey to measure attitudes and perceptions of stress among the general public and to identify leading sources of stress, common behaviors used to manage stress and the impact of stress on people’s lives. In its 2022 survey, the top sources of stress were the rise in prices of everyday items due to inflation (e.g., gas prices, energy bills, grocery costs, etc.) (cited by 87 percent), followed by supply chain issues (81 percent), global uncertainty (81 percent), Russia’s invasion of Ukraine (80 percent) and potential retaliation from Russia (e.g., in the form of cyberattacks or nuclear threats) (80 percent).²

Clearly, Americans need some coping mechanisms to deal with the stress they are experiencing. Yet, perhaps the key to successfully handling stress is to understand what is fact and what is fiction.

Separating Myth from Fact

Myth: Stress is always bad.

Fact: The assumption has always been that stress is bad. But, as mentioned previously, it has been found that, in some circumstances, stress can be beneficial. For instance, acute stress and eustress cause a release of epinephrine (endorphins) that makes it easier to perform tasks and enhances performance and problem-solving skills. Epinephrine can also help prepare the body to handle a threat or flee for safety by increasing pulse, breathing rate and muscle tension. In addition, acute stress can motivate people to complete a project or take a test. In one study, researchers tracked 2,804 participants for just over a week. Prior to the study, all participants completed a cognition test. Then, participants were interviewed nightly for eight consecutive nights. Researchers asked participants questions about their chronic conditions, physical symptoms, mood and the number of stressors they experienced during the day, as well as how many positive experiences they had within the previous 24 hours. Approximately 10 percent of the participants who did not report experiencing stress during the study period were more likely to experience positive moods and less likely to have chronic health conditions. On the other hand, those same participants scored lower on the cognition test than those who did experience stress during the study, equating to a cognitive decline of approximately eight years of aging. And, participants who did not report any stress also experienced fewer positive events than those who did report stress, and they were less likely to give or receive emotional support. “I think there’s an assumption that negative events and positive events are these polar opposites, but in reality, they’re correlated,” said senior author of the study David M. Almeida, a professor of human development and family studies at Penn State.⁴

On the other hand, studies show that chronic, or long-term, stress can negatively affect every system in the body. Indeed, chronic stress can become debilitating and can increase the risk of serious health complications. Research also shows that people who don’t have enough coping mechanisms have a strong reaction to stress that can cause health problems.⁴ Chronic stress can lead to high blood pressure, heart disease, diabetes, obesity, depression and anxiety, skin problems such as acne or eczema, post traumatic stress disorder, sleeping difficulties, stomach upset and menstrual problems.¹ And, long-term chronic stress can be a contributing factor in many leading causes of death, including heart disease, cancer, lung disease, accidents, cirrhosis of the liver and suicide. It can also lead to substance abuse.³

Myth: Stress is universal, affecting everyone the same way.

Fact: Everyone reacts differently to stressful situations. In fact, the circumstances that lead to stress are not the cause of the stress, but rather how a person reacts to the circumstances. Some people who experience several stressors are able to handle them without leading to a severe stress reaction, while others suffer a severe reaction to only one stressor. For instance, one person might get stressed out by a high-pressure job, while another may thrive on it.⁵

Myth: People are only stressed if symptoms are apparent.

Fact: Just because a person isn’t experiencing symptoms doesn’t mean that person isn’t stressed. For instance, medication can mask the symptoms of stress. And, a person may not “feel stressed” emotionally. In fact, even though stress is a psychological effect, most people experience physiological more than psychological symptoms.⁶

Myth: Most symptoms of stress are obvious.

Fact: While some common signs of stress on mental health such as mood swings, rapid speech or socially withdrawing are obvious, other symptoms such as excessive worrying, anxiety and depression may not be apparent to others.⁷

There are also symptoms that many may not consider related to stress but are. For instance, stress can cause acne. One study found that individuals with higher stress scores also had a higher acne severity. In fact, it’s known that stress can trigger corticotropin-releasing hormone and sebum — the oily substance on people’s skin — both of which can cause acne. Other not-so-obvious symptoms that may be caused by stress include a low sex drive (chronic stress can cause even lower testosterone levels and sperm production in males); menstrual irregularities such as a late or skipped period; an inability to recall details in the moment or remember things long-term; and even amplified allergies.³ Physicians can help their patients to recognize both the mental effects of stress, as well as the common physical side effects.⁷ (See Common Effects of Stress on Mental Health and Physical Side Effects of Stress.)

Myth: Stress is not dangerous or life-altering.

Fact: Chronic stress, which causes
anxiety, can impact a person’s life expect-ancy. In one meta-analysis, researchers found that an estimated five million deaths each year are attributed to mood and anxiety disorders worldwide.⁸ Another study that assessed mortality risk in people with anxiety disorders found that anxiety significantly increased mortality risk. In this cohort study with more than 30 million person-years of follow-up, researchers found the risk of death by natural and unnatural causes was significantly higher among individuals with anxiety disorders compared with the general population.⁹

Myth: Stress can cause disease.

Fact: Stress doesn’t cause disease. Rather, it increases the risk of developing diseases such as cancer and irritable bowel syndrome. According to the National Cancer Institute, psychological stress can increase the risk of harmful and maladaptive coping mechanisms such as overeating, drinking alcohol or smoking, all of which increase the risk of cancer. And ulcers, which are often thought to be caused by stress, are actually caused by taking too much aspirin or nonsteroidal anti-inflammatory drugs to combat stomach upset that is often caused by stress. Ulcers can also lead to gastrointestinal disorders such as irritable bowel syndrome.⁷

Myth: Stress can be diagnosed.

Fact: Stress is subjective, so there is no standardized test, outside of laboratory research settings, to formally diagnose stress. Again, what feels very stressful for one person may not cause high levels of stress for another. Only the person experiencing stress can determine how severe it feels. However, questionnaires can be used to assess an individual’s stress level and how it is affecting that person’s lifestyle. If a stress-related disorder is suspected, a physician can evaluate for physical symptoms.

It’s important to note that stress is not a psychiatric diagnosis, but it is closely linked to mental health. In fact, stress can cause mental health problems and exacerbate existing problems. In these cases, a mental health expert can address the psychological symptoms.¹⁰

Myth: Stress can’t be prevented.

Fact: Actually, there are many strategies people can employ to help handle stress better, including:11

• Relaxation activities such as meditation, yoga, tai chi, breathing exercises and muscle relaxation
• Eating right, exercising and getting enough sleep
• Staying positive and practicing gratitude
• Accepting that not all situations can be controlled
• Learning to say no to additional responsibilities when too busy
• Staying connected with people who are calm and who can provide emotional support

Myth: People don’t need to seek treatment for stress.

Fact: Since stress can lead to serious health problems, individuals who are suspected to be suffering from stress should seek treatment. Doctors don’t typically prescribe medication to cope with stress; however, they do prescribe it to treat an underlying illness such as depression or an anxiety disorder.

The most successful treatments target the source of the stress rather than its side effects. These treatments focus on:³

• Identifying the signs of stress
• Getting plenty of sleep and exercise
• Practicing relaxation skills
• Setting goals and establishing priorities
• Spending time with others

Biofeedback has been studied for its effect on reducing stress with positive results. One study that sought to determine whether a biofeedback-based stress management tool (consisting of rhythmic breathing, actively self-generated positive emotions and a portable biofeedback device) reduces physician stress found it to be a simple and effective stress-reduction strategy. In the study, 40 staff physicians (23 men and 17 women) from various medical practices (one from primary care, 30 from a medical specialty and nine from a surgical specialty) were recruited by means of electronic mail, regular mail and posters placed in the physicians’ lounge and throughout the hospital.

Physicians in the intervention group were instructed to use a biofeedback-based stress-management tool three times daily. Participants in both the control and intervention groups received twice-weekly support visits from the research team over 28 days, with the intervention group also receiving reinforcement in the use of the stress-management tool during these support visits. During the 28-day extension period, both the control and the intervention groups received the intervention, but without intensive support from the research team. Stress was measured with a scale developed to capture short-term changes in global perceptions of stress for physicians (maximum score 200).

Results showed the mean stress score declined significantly for the intervention group (change -14.7, standard deviation [SD] 23.8; p = 0.013) but not for the control group (change -2.2, SD 8.4; p = 0.30). The difference in mean score change between the groups was 12.5 (p = 0.048). The lower mean stress scores in the intervention group were maintained during the trial extension to day 56. And, the mean stress score for the control group changed significantly during the 28-day extension period (change -8.5, SD 7.6; p < 0.001).¹²

Integrative treatments can be extremely helpful for treating stress. These include:¹³

• Meditation and mindfulness-based stress reduction (MBSR). These therapies are proven to help reduce anxiety and depression. MBSR draws on the principles of meditation to help individuals become more aware of how negative thoughts impact physical feelings. Research shows the benefits of MBSR are reduced stress and worrying, improved memory and focus, fewer emotional ups and downs, greater resilience and improved relationships.
• Cognitive behavioral therapy (CBT). CBT is a type of talk therapy focused on pinpointing and questioning negative thoughts. Research shows CBT is more effective in reducing mental health symptoms than using medication alone.
• Acupuncture. This ancient Chinese practice involves using tiny needles to stimulate the nervous and immune systems. Research shows it helps support conventional treatment for a range of problems that include stress, chronic pain and digestive disorders.
• Massage. Studies show massage helps treat a variety of stress-related disorders, including anxiety and insomnia. And, while one massage is effective, a series of massage treatments is even more effective.

Dispelling the Myths Now

According to the American Institute of Stress, Americans are one of the most stressed out groups of people in the world, with the current stress level experienced by Americans 20 percentage points higher than the global average. And, stress levels are only increasing. It’s well-established that stress can cause physiological and psychological health issues that may result in disease and shortened lifespan. Therefore, it’s important to dispel any myths about stress and how it impacts individuals, but also how it can be managed and treated.