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Stress and Health

A special issue of International Journal of Environmental Research and Public Health (ISSN 1660-4601).

Deadline for manuscript submissions: closed (31 December 2017) | Viewed by 139392

Special Issue Editors


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Guest Editor
School of Psychology, University of Surrey, Guildford, UK
Interests: stress; health; fatigue

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Guest Editor
School of Psychology, University of Surrey, Guildford, UK
Interests: understanding how exposure to physical and social environmental factors, such as noise, traffic and crowding causes stress in humans and how exposure to restorative (in particular natural) environments can promote recovery from stress and mental fatigue

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Guest Editor
1. Faculty of Health and Welfare Sciences, Østfold University College, 1757 Halden, Norway
2. Centre for Digital Forensics and Cyber Security, Tallinn University of Technology, 12616 Tallinn, Estonia
Interests: human factors; cyber defence; cyber security; decision-making; metacognition

Special Issue Information

Dear Colleagues,

Stress is a major issue and a global health phenomenon. It is ubiquitous in that it appears to affect people indiscriminately. Prolonged or repeated stress is known to negatively impact health and wellbeing, with resulting economic, societal and individual costs. We know a lot about the causes of stress but much remains unknown about the progression from stress to illness or how we assess and explain this process. One contributing factor that is starting to be recognised is the role of physical and psychological recovery. The term recovery is complex but it implies a return to some pre-existing baseline, and speed of recovery appears to be as important in the stress-illness process, than the nature of the acute stressor itself. Recovery is in fact a dynamic process, and not a static construct (Zijlstra, F. R. H., Cropley, M., & Rydstedt, L. W. (2014). From recovery regulation: an attempt to reconceptualize ‘recovery from work’. Stress and Health, 30, 244–252. doi: 10.1002/smi.2604.). To date, the term recovery, however, has not been well conceptualized and may be examined from different perspectives. For example, environmental restoration may specifically focus on the role of different environmental factors on promoting recovery from stress, while the biological perspective may examine physiological factors such as heart rate variability or cortisol secretion. Moreover, factors that promote recovery may also be part of the cause of stress. This Special Issue is concerned with understanding how we can aid recovery or prevent the build-up of stress in humans. This publication has a broad remit as we aim to capture and include papers from biological, cognitive, environmental, health, social, occupational, and neuro-psychology. Recovery is, therefore, not limited to one perspective and different perspectives are welcome. Empirical and theoretical papers are encouraged, as are papers that have utilized or developed new methodologies. Laboratory and field work will be considered as being of equal importance.

Prof. Dr. Mark Cropley
Prof. Dr. Stefan Sütterlin
Dr. Birgitta Gatersleben

Guest Editors

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Keywords

  • Stress
  • Recovery
  • Restoration
  • Prevention
  • Environmental stress

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Published Papers (13 papers)

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Research

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21 pages, 2254 KiB  
Article
Relationship between Burnout and Body Mass Index in Senior and Middle Managers from the Mexican Manufacturing Industry
by Oziely Daniela Armenta-Hernández, Aidé Maldonado-Macías, Jorge García-Alcaraz, Liliana Avelar-Sosa, Arturo Realyvasquez-Vargas and Miguel Angel Serrano-Rosa
Int. J. Environ. Res. Public Health 2018, 15(3), 541; https://doi.org/10.3390/ijerph15030541 - 17 Mar 2018
Cited by 12 | Viewed by 7215
Abstract
This research relates Burnout Syndrome (BS) with the Body Mass Index (BMI) among middle and senior managers of the Mexican manufacturing industry. Even though BS incidence is high in the Mexican industrial population, few systematic studies have explored BS and its relationship with [...] Read more.
This research relates Burnout Syndrome (BS) with the Body Mass Index (BMI) among middle and senior managers of the Mexican manufacturing industry. Even though BS incidence is high in the Mexican industrial population, few systematic studies have explored BS and its relationship with other health problems, such as obesity. The goal of this research is to determine the relationship between BS and the BMI in employees with normal weight, overweight, and obesity. We present three structural equation models to relate BS and the BMI. The BMI ranges were determined according to the parameters (normal weight, overweight, and obesity) proposed by the World Health Organization (WHO). The sample includes 361 employees that voluntarily answered a 31-item questionnaire. We measure the levels of BS using the Maslach Burnout Inventory–General Survey (MBI-GS) and analyze anthropometric and sociodemographic data from the participants. Then, we determine the relationships between the variables through structural equation models and estimate the direct, indirect, and total effects in the three models, which show acceptable reliability. As main findings, the normal weight model has a larger explanatory power than the overweight and obesity models. The same research hypotheses were tested and the effects of BS on the BMI differ across the three models. Such results are presented by taking into account that obesity and overweight require additional factors, such as genetic factors and personal eating habits, to be better explained. Full article
(This article belongs to the Special Issue Stress and Health)
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19 pages, 1985 KiB  
Article
An Experimental Exploration of the Effects of Exposure to Images of Nature on Rumination
by Sarah Elizabeth Golding, Birgitta Gatersleben and Mark Cropley
Int. J. Environ. Res. Public Health 2018, 15(2), 300; https://doi.org/10.3390/ijerph15020300 - 9 Feb 2018
Cited by 21 | Viewed by 6980
Abstract
Exposure to natural environments has been shown to have beneficial effects on mood. Rumination is a thinking style associated with negative mood, and sometimes depression, and is characterized by repetitive, intrusive thoughts, often with a negative emotional element. This study investigated whether exposure [...] Read more.
Exposure to natural environments has been shown to have beneficial effects on mood. Rumination is a thinking style associated with negative mood, and sometimes depression, and is characterized by repetitive, intrusive thoughts, often with a negative emotional element. This study investigated whether exposure to nature, operationalized using photographs presented as a slideshow, could aid reduction in levels of state rumination. An experimental, within-between (Time x Condition) participant design was used; participants (n = 58) undertook a presentation task designed to induce rumination and influence mood. Participants were then randomly allocated to either: watch a slideshow of a natural environment, watch a slideshow of an urban environment, or wait patiently with no distractions. Data were collected at baseline, after the presentation, and after the slideshow. Environmental exposure had no effect on levels of rumination or negative mood, but did have a significant effect on levels of positive mood, ‘being away’, and ‘fascination’. Positive mood declined in those who saw the urban slideshow, but remained the same in those who saw the nature slideshow, whilst levels of being away and fascination were highest in those who saw the nature slideshow. This study extends previous restorative environment research by exploring the effects of nature on rumination. Full article
(This article belongs to the Special Issue Stress and Health)
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12 pages, 315 KiB  
Article
Organizational and Occupational Stressors, Their Consequences and Coping Strategies: A Questionnaire Survey among Italian Patrol Police Officers
by Daniela Acquadro Maran, Massimo Zedda and Antonella Varetto
Int. J. Environ. Res. Public Health 2018, 15(1), 166; https://doi.org/10.3390/ijerph15010166 - 21 Jan 2018
Cited by 36 | Viewed by 7706
Abstract
Background: Traditionally, workers employed in police forces have been found to be exposed to a high risk of distress. Several studies reported that the main stressors were associated more with organizational aspects, whilst other researchers underlined that the main stressor were associated [...] Read more.
Background: Traditionally, workers employed in police forces have been found to be exposed to a high risk of distress. Several studies reported that the main stressors were associated more with organizational aspects, whilst other researchers underlined that the main stressor were associated more with operational issues. The aim of this research was to investigate operational and organizational stressors, their consequences also in terms of anxiety and the coping strategies adopted. Methods: We compared Patrol Police Officers working in the Operational Service (Outdoor Patrol Officers) and those in the Interior Department (Indoor Patrol Officers) in the same Municipal Police force. Results: The results revealed that both Outdoor Patrol Officers and Interior Patrol Officers suffered from organizational and occupational stressor. Outdoor Patrol Officers appeared more willing to use different coping strategies, whereas Indoor Patrol Officers used avoidance strategies. This allows Outdoor Patrol Officers to explore new responses and approaches to deal with situations which—owing to the type of work—it is impossible to change. Outdoor Patrol Officers appeared better equipped to change their attitude to work than Indoor Patrol Officers. Conclusion: Interventions on both organizational and operational stressors would improve the quality of Patrol Police Officers’ working life and have positive repercussions on the service offered to the general public. Full article
(This article belongs to the Special Issue Stress and Health)
354 KiB  
Article
Contact to Nature Benefits Health: Mixed Effectiveness of Different Mechanisms
by Mathias Hofmann, Christopher Young, Tina M. Binz, Markus R. Baumgartner and Nicole Bauer
Int. J. Environ. Res. Public Health 2018, 15(1), 31; https://doi.org/10.3390/ijerph15010031 - 25 Dec 2017
Cited by 24 | Viewed by 8706
Abstract
How can urban nature contribute to the reduction of chronic stress? We twice measured the concentration of the “stress hormone” cortisol in the hair of 85 volunteer gardeners (six months apart), relating cortisol level change to (self-reported) characteristics of their recreational activities. Both [...] Read more.
How can urban nature contribute to the reduction of chronic stress? We twice measured the concentration of the “stress hormone” cortisol in the hair of 85 volunteer gardeners (six months apart), relating cortisol level change to (self-reported) characteristics of their recreational activities. Both time spent in nature and physical activity led to decreases in cortisol, while time spent being idle led to an increase. At high levels of present stressors, however, the relationship for time spent in nature and for idleness was reversed. Time spent with social interaction had no effect on cortisol levels. Our results indicate that physical activity is an effective means of mitigating the negative effects of chronic stress. The results regarding the time spent in nature and time spent being idle are less conclusive, suggesting the need for more research. We conclude that if chronic stress cannot be abolished by eradicating its sources, public health may take to measures to reduce it—providing urban nature being one effective possibility. Full article
(This article belongs to the Special Issue Stress and Health)
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988 KiB  
Article
Ovsiankina’s Great Relief: How Supplemental Work during the Weekend May Contribute to Recovery in the Face of Unfinished Tasks
by Oliver Weigelt and Christine J. Syrek
Int. J. Environ. Res. Public Health 2017, 14(12), 1606; https://doi.org/10.3390/ijerph14121606 - 20 Dec 2017
Cited by 21 | Viewed by 10646
Abstract
Unfinished tasks have been identified as a significant job stressor that impairs employee recovery after work. Classic experimental research by Ovsiankina has shown that people tend to resume yet unfinished tasks to satisfy their need for closure. We apply this notion to current [...] Read more.
Unfinished tasks have been identified as a significant job stressor that impairs employee recovery after work. Classic experimental research by Ovsiankina has shown that people tend to resume yet unfinished tasks to satisfy their need for closure. We apply this notion to current working life and examine supplemental work after hours as a means to achieve peace of mind. We investigate how progress towards goal accomplishment through supplemental work may facilitate recovery in terms of psychological detachment, relaxation, autonomy, and mastery experiences. We conducted a week-level diary study among 83 employees over a period of 14 consecutive weeks, which yielded 575 observations in total and 214 matched observations of unfinished tasks, supplemental work during the weekend, progress, and recovery experiences. Unfinished tasks were assessed on Friday. Supplemental work and recovery experiences were assessed on Monday. Multilevel modeling analyses provide evidence that unfinished tasks at the end of the work week are associated with lower levels of detachment at the intraindividual level, tend to relate to lower relaxation, but are unrelated to autonomy and mastery. Progress towards finishing tasks during the weekend alleviates the detrimental effects of unfinished tasks on both kinds of recovery experiences. Supplemental work is negatively linked to detachment, but largely unrelated to the other recovery experiences. Full article
(This article belongs to the Special Issue Stress and Health)
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606 KiB  
Article
Stress-Induced Endocrine and Immune Dysfunctions in Caregivers of People with Eating Disorders
by Ángel Romero-Martínez and Luis Moya-Albiol
Int. J. Environ. Res. Public Health 2017, 14(12), 1560; https://doi.org/10.3390/ijerph14121560 - 13 Dec 2017
Cited by 8 | Viewed by 4694
Abstract
Caregivers have to cope repeatedly with acute stressors in their daily lives, and this is associated with disturbances in the hypothalamic–pituitary–adrenal (HPA) axis and the immune system. Such disturbances could contribute to the development of health problems in informal caregivers of people with [...] Read more.
Caregivers have to cope repeatedly with acute stressors in their daily lives, and this is associated with disturbances in the hypothalamic–pituitary–adrenal (HPA) axis and the immune system. Such disturbances could contribute to the development of health problems in informal caregivers of people with chronic illnesses, such as eating disorders (EDs). The main objective of this study was to examine endocrine (salivary cortisol levels (Csal)), immune (immunoglobulin-A (IgA)), and psychological (anxiety, mood, and anger feelings) responses to an acute psychological stressor in a sample of informal caregivers of individuals with EDs compared to a sample of non-caregivers. In addition, it also aimed to analyze the potential relationship of the aforementioned endocrine and immune response parameters with psychological variables in the caregivers. Caregivers had lower Csal and IgA levels at all assessment points except baseline. Moreover, they also exhibited lower Csal and IgA responses and greater worsening of mood in response to acute psychosocial stress than the non-caregivers, which suggests that caregivers had dampened endocrine and immune reactivity to acute stress. On the other hand, endocrine and immune parameters were unrelated to psychological variables. These findings advance our understanding of how a chronically stressed population reacts to acute stress, and should be considered for the development of effective interventions focused on stress management that could help caregivers to reduce their stress levels, which, in turn, would improve their health. Full article
(This article belongs to the Special Issue Stress and Health)
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520 KiB  
Article
Trait Rumination Predicts Elevated Evening Cortisol in Sexual and Gender Minority Young Adults
by Peggy M. Zoccola, Andrew W. Manigault, Wilson S. Figueroa, Cari Hollenbeck, Anna Mendlein, Alex Woody, Katrina Hamilton, Matt Scanlin and Ryan C. Johnson
Int. J. Environ. Res. Public Health 2017, 14(11), 1365; https://doi.org/10.3390/ijerph14111365 - 9 Nov 2017
Cited by 11 | Viewed by 5435
Abstract
Stress may contribute to illness through the impaired recovery or sustained activity of stress-responsive biological systems. Rumination, or mental rehearsal of past stressors, may alter the body’s stress-responsive systems by amplifying and prolonging exposure to physiological mediators, such as cortisol. The primary aim [...] Read more.
Stress may contribute to illness through the impaired recovery or sustained activity of stress-responsive biological systems. Rumination, or mental rehearsal of past stressors, may alter the body’s stress-responsive systems by amplifying and prolonging exposure to physiological mediators, such as cortisol. The primary aim of the current investigation was to test the extent to which the tendency to ruminate on stress predicts diminished diurnal cortisol recovery (i.e., elevated evening cortisol) in a sample of sexual and gender minority young adults. Participants included 58 lesbian, gay, bisexual, and transgender young adults (Mage = 25.0, SD = 4.1) who completed an initial online survey that assessed trait rumination and current depressed mood. Participants completed daily evening questionnaires and provided salivary cortisol samples at wake, 45 min post-wake, 12 h post-wake, and at bedtime over seven consecutive days. Trait rumination predicted significantly higher cortisol concentrations at bedtime, but was unrelated to other cortisol indices (e.g., morning cortisol, diurnal slope, total output). The association with trait rumination was not accounted for by daily negative affect, and was largely independent of depressed mood. These results have implications for identifying and treating those who may be at risk for impaired diurnal cortisol recovery and associated negative health outcomes. Full article
(This article belongs to the Special Issue Stress and Health)
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523 KiB  
Article
Chronic Stress in Young German Adults: Who Is Affected? A Prospective Cohort Study
by Ronald Herrera, Ursula Berger, Jon Genuneit, Jessica Gerlich, Dennis Nowak, Wolff Schlotz, Christian Vogelberg, Erika Von Mutius, Gudrun Weinmayr, Doris Windstetter, Matthias Weigl and Katja Radon
Int. J. Environ. Res. Public Health 2017, 14(11), 1325; https://doi.org/10.3390/ijerph14111325 - 31 Oct 2017
Cited by 10 | Viewed by 8749
Abstract
We aimed to prospectively assess changes in chronic stress among young adults transitioning from high school to university or working life. A population-based cohort in Munich and Dresden (Germany) was followed from age 16–18 (2002–2003) to age 20–23 (2007–2009) (n = 1688). [...] Read more.
We aimed to prospectively assess changes in chronic stress among young adults transitioning from high school to university or working life. A population-based cohort in Munich and Dresden (Germany) was followed from age 16–18 (2002–2003) to age 20–23 (2007–2009) (n = 1688). Using the Trier Inventory for the Assessment of Chronic Stress, two dimensions of stress at university or work were assessed: work overload and work discontent. In the multiple ordinal generalized estimating equations, socio-demographics, stress outside the workplace, and job history were additionally considered. At follow-up, 52% of the population were university students. Work overload increased statistically significantly from first to second follow-up, while work discontent remained constant at the population level. Students, compared to employees, reported a larger increase in work overload (adjusted odds ratio (OR): 1.33; 95% confidence interval (95% CI): 1.07, 1.67), while work discontent did not differ between the groups. In conclusion, work overload increases when young adults transition from school to university/job life, with university students experiencing the largest increase. Full article
(This article belongs to the Special Issue Stress and Health)
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1604 KiB  
Article
Coping with Fear of and Exposure to Terrorism among Expatriates
by Nicholas J. Beutell, Marianne M. O’Hare, Joy A. Schneer and Jeffrey W. Alstete
Int. J. Environ. Res. Public Health 2017, 14(7), 808; https://doi.org/10.3390/ijerph14070808 - 19 Jul 2017
Cited by 10 | Viewed by 9301
Abstract
This paper examines existing research on the impact of terrorism on expatriate coping strategies. We consider pre-assignment fear of terrorism, in-country coping strategies, and anxiety and posttraumatic stress disorder (PTSD) associated with repatriation. The extant research is small but growing. Our model for [...] Read more.
This paper examines existing research on the impact of terrorism on expatriate coping strategies. We consider pre-assignment fear of terrorism, in-country coping strategies, and anxiety and posttraumatic stress disorder (PTSD) associated with repatriation. The extant research is small but growing. Our model for expatriate coping at the pre-departure, in-country, and repatriation stages includes strategies specific to each stage. Preparation using proactive coping, systematic desensitization, problem and emotion focused coping, social support, and virtual reality explorations are recommended. Selecting expatriate candidates who are well-adjusted, emotionally intelligent, and possessing good coping skills is essential for successful assignments in terror-prone regions. Full article
(This article belongs to the Special Issue Stress and Health)
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739 KiB  
Article
The Buffer Effect of Therapy Dog Exposure on Stress Reactivity in Undergraduate Students
by Alexandra J. Fiocco and Anastasia M. Hunse
Int. J. Environ. Res. Public Health 2017, 14(7), 707; https://doi.org/10.3390/ijerph14070707 - 30 Jun 2017
Cited by 38 | Viewed by 16578
Abstract
Stress is an insidious health risk that is commonly reported among university students. While research suggests that dog exposure may facilitate recovery from a stress response, little is known about the buffer effect of dog exposure on the stress response to a future [...] Read more.
Stress is an insidious health risk that is commonly reported among university students. While research suggests that dog exposure may facilitate recovery from a stress response, little is known about the buffer effect of dog exposure on the stress response to a future stressor. This study examined whether interaction with a therapy dog could reduce the strength of the physiological stress response when exposed to a subsequent stressor. Sixty-one university students were randomly assigned to either a therapy dog (TD, n = 31) or a no-dog control (C, n = 30) group. The stress response was measured by electrodermal activity (EDA) in response to the Paced Auditory Serial Addition Test (PASAT). Participants also completed questionnaires that assessed pet attitude, general stress levels, and affect. Analyses of covariance (ANCOVAs) showed that increase in EDA was significantly more pronounced in the C group than in the TD group (p < 0.01). Pet attitudes did not modulate the buffer effect of therapy dog exposure. Results suggest that therapy dog exposure may buffer the stress response in university students, which has implications for the promotion of a viable stress management program on university campuses. Full article
(This article belongs to the Special Issue Stress and Health)
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293 KiB  
Article
Association between Excessive Use of Mobile Phone and Insomnia and Depression among Japanese Adolescents
by Haruka Tamura, Tomoko Nishida, Akiyo Tsuji and Hisataka Sakakibara
Int. J. Environ. Res. Public Health 2017, 14(7), 701; https://doi.org/10.3390/ijerph14070701 - 29 Jun 2017
Cited by 135 | Viewed by 21285
Abstract
The aim of this study was to investigate the relationship between mobile phone use and insomnia and depression in adolescents. A cross-sectional study was conducted on 295 high school students aged 15–19 in Japan. Insomnia and depression were assessed using Athene Insomnia Scales [...] Read more.
The aim of this study was to investigate the relationship between mobile phone use and insomnia and depression in adolescents. A cross-sectional study was conducted on 295 high school students aged 15–19 in Japan. Insomnia and depression were assessed using Athene Insomnia Scales (AIS) and the Center for Epidemiologic Studies Depression Scale (CES-D), respectively. Mobile phones were owned by 98.6% of students; 58.6% used mobile phones for over 2 h per day and 10.5% used them for over 5 h per day. Overall mobile phone use of over 5 h per day was associated with shorter sleep duration and insomnia (OR: 3.89 [[95% CI: 1.21–12.49]), but not with depression. Mobile phone use of 2 h or more per day for social network services (OR: 3.63 [[1.20–10.98]) and online chats (OR: 3.14 [[1.42–6.95]), respectively, was associated with a higher risk of depression. Mobile phone overuse can be linked to unhealthy sleep habits and insomnia. Moreover, mobile phone overuse for social network services and online chats may contribute more to depression than the use for internet searching, playing games or viewing videos. Full article
(This article belongs to the Special Issue Stress and Health)

Review

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27 pages, 397 KiB  
Review
Generalized Unsafety Theory of Stress: Unsafe Environments and Conditions, and the Default Stress Response
by Jos F. Brosschot, Bart Verkuil and Julian F. Thayer
Int. J. Environ. Res. Public Health 2018, 15(3), 464; https://doi.org/10.3390/ijerph15030464 - 7 Mar 2018
Cited by 140 | Viewed by 20358
Abstract
Prolonged physiological stress responses form an important risk factor for disease. According to neurobiological and evolution-theoretical insights the stress response is a default response that is always “on” but inhibited by the prefrontal cortex when safety is perceived. Based on these insights the [...] Read more.
Prolonged physiological stress responses form an important risk factor for disease. According to neurobiological and evolution-theoretical insights the stress response is a default response that is always “on” but inhibited by the prefrontal cortex when safety is perceived. Based on these insights the Generalized Unsafety Theory of Stress (GUTS) states that prolonged stress responses are due to generalized and largely unconsciously perceived unsafety rather than stressors. This novel perspective necessitates a reconstruction of current stress theory, which we address in this paper. We discuss a variety of very common situations without stressors but with prolonged stress responses, that are not, or not likely to be caused by stressors, including loneliness, low social status, adult life after prenatal or early life adversity, lack of a natural environment, and less fit bodily states such as obesity or fatigue. We argue that in these situations the default stress response may be chronically disinhibited due to unconsciously perceived generalized unsafety. Also, in chronic stress situations such as work stress, the prolonged stress response may be mainly caused by perceived unsafety in stressor-free contexts. Thus, GUTS identifies and explains far more stress-related physiological activity that is responsible for disease and mortality than current stress theories. Full article
(This article belongs to the Special Issue Stress and Health)

Other

Jump to: Research, Review

11 pages, 799 KiB  
Perspective
Stress and Alterations in the Pain Matrix: A Biopsychosocial Perspective on Back Pain and Its Prevention and Treatment
by Pia-Maria Wippert and Christine Wiebking
Int. J. Environ. Res. Public Health 2018, 15(4), 785; https://doi.org/10.3390/ijerph15040785 - 18 Apr 2018
Cited by 37 | Viewed by 10030
Abstract
The genesis of chronic pain is explained by a biopsychosocial model. It hypothesizes an interdependency between environmental and genetic factors provoking aberrant long-term changes in biological and psychological regulatory systems. Physiological effects of psychological and physical stressors may play a crucial role in [...] Read more.
The genesis of chronic pain is explained by a biopsychosocial model. It hypothesizes an interdependency between environmental and genetic factors provoking aberrant long-term changes in biological and psychological regulatory systems. Physiological effects of psychological and physical stressors may play a crucial role in these maladaptive processes. Specifically, long-term demands on the stress response system may moderate central pain processing and influence descending serotonergic and noradrenergic signals from the brainstem, regulating nociceptive processing at the spinal level. However, the underlying mechanisms of this pathophysiological interplay still remain unclear. This paper aims to shed light on possible pathways between physical (exercise) and psychological stress and the potential neurobiological consequences in the genesis and treatment of chronic pain, highlighting evolving concepts and promising research directions in the treatment of chronic pain. Two treatment forms (exercise and mindfulness-based stress reduction as exemplary therapies), their interaction, and the dose-response will be discussed in more detail, which might pave the way to a better understanding of alterations in the pain matrix and help to develop future prevention and therapeutic concepts. Full article
(This article belongs to the Special Issue Stress and Health)
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