Stress and Health: Research and Clinical Applications

American Journal of Clinical Hypnosis, Jan 2003 by Handel, Daniel L

Stress and Health: Research and Clinical Applications D.T. Kenny, J.G. Carlson, F.J. McGuigan & J.L. Sheppard. Amsterdam: Harwood Academic Publishers (2000). xiii 467 pages. $68. Reviewed by: Daniel L. Handel, M.D., National Institutes of Health

This is the first of a series of texts dedicated to the examination of current research on health, illness prevention, and biomedical issues. The chapters of this text were largely drawn from contributions to the First International Congress on Stress and Health, a five-day meeting held in Sydney, Australia in October, 1996.

The chapters are organized into six sections, which include an introductory section; a section on the biological, physiological and psychological bases for stress; a third section that broadly deals with the health consequences of stress; a fourth section on the management of stress and stress-related disorders; a fifth section on stress, cardiovascular disease and cancer; and a final section dealing with occupational stress.

The chapters' authors are widely known in their areas of expertise, and there is a strong international flavor. The second section on the basis of stress begins with a rather profound discussion by Giardino et al. on the concept of homeostasis in the stress response. The authors challenge the idea of homeostasis as a steady state, rather positing that homeostasis is best thought of as a healthy state of variation within a system. Disease or injury results from a disturbance in this state of constant oscillation and variability. We are left with the intriguing concept that a return to complexity and variability in response to stress results in a return to health; thus treatments that may promote oscillatory patterns and behavioral complexity promote health. In the third chapter, Gevirtz reviews the stress response, explains the related functions of the autonomic and immune systems, and demonstrates the limitations of defining stress as a set of primitive physiological reactions that results from a perceived threatening situation. Gevirtz maintains that the stress response has evolved even as man has evolved socially, such that a simple autonomic arousal model is now insufficient. He demonstrates the interconnectedness of the immune and the autonomic systems, which is built upon in the subsequent treatment section. This chapter further delineates the biochemical and neurochemical basis for the stress response, and offers a model or metaphor that, if simplified, can be taught to patients seeking a biological model for their stress-related illness. He ends with the possible relationship of chronic stress to myofascial pain, asthma, and psychophysiological disorders.

Kenny, author of the fourth chapter, provides a psychodynamic developmental model for susceptibility to stress disorders that is based on attachment theory. Simply stated, those who have not formed adequate healthy attachments in childhood tend to develop unhealthy, inadequate coping strategies in challenging situations. Given that adult life is full of perceived challenges, these individuals then are less resilient. Their vulnerability to stress is thought also due, in part, to feelings of incompetence and due to the inability to adequately use supportive relationships as adults.

The third section, on health consequences of stress, contains three chapters that fit together somewhat poorly. The first of these on chronic pain, details well the neural basis for chronic pain, demonstrating how this condition is not "all in the head". Tracey and colleagues demonstrate that neuroplasticity-that is, how the neurological system actually changes dynamically in the face of ongoing pain stimuli-modifies both structure and function within the nervous system. This leads to peripheral nerves that respond differently to the same stimuli over time, to a spinal cord that responds entirely differently to incoming stimuli, both painful and nonpainful, and to a cortex (the "thinking brain") that processes and interprets incoming information differently. It becomes apparent that these perturbations in the system beget a very different perception of one's body and of one's sense of pain and suffering. This process also encourages a more sympathetic, less judgmental appreciation for the experience of the chronic pain patient. The chapter ends with an expertly written treatise that adds into this mix the very real contribution of stress to pain modulation, reviewing the research on opioid and nonopioid pathways for internal modulation of painful experience, with further discussion on how stress can heighten pain perception, and how pain experience can heighten stress and anxiety. This chapter presents well the complexity of this literature, while offering a model for understanding it that is helpful to the clinician.

Rosch's chapter on stress and aging offers a thought provoking discussion on this relationship. He submits tantalizing evidence on the production of oxidants in response to stress, and links this to the known role of this same family of chemicals to aging and senescence, while also providing epidemiological and anthropological evidence in support of the premise that stress accelerates aging.