Stress: A Healthcare Challenge
Although stress responses evolved as adaptive processes, Selye observed in 1956, severe, prolonged stress responses might lead to tissue damage and disease. Chronic stress disrupts nearly every system in the body. There is a substantial body of research connecting stress to cardiovascular disease (Lambert, 2010), the future manifestation of hypertension related to the individual‘s response to stress (Spruill, 2010), metabolic syndrome (Kyrou, 2006), obesity (Brunner, 2007), and emotional overeating (Adam, 2007). Stress also fuels approximately 50% of depression cases through disturbance of the HPA axis and increased cortisol levels (Nemeroff, 2005). In addition, biological markers associate the immunoendocrinological disturbance brought by stress to infertility (Li, 2011). There is also data relating the role of stress in infectious disease (Pedersen, 2010) and cancer (McGregor, 2009), and leaving a person vulnerable to many other mental and physical health problems. Given the negative impact of stress at intrapersonal and somatic level, it is important for healthcare professionals, governments and organizations to treat stress at all 4 levels in the cliff analogy.
Level 1: at the bottom of the cliff
Someone who is at the bottom of the cliff as a result of stress would be someone who has already developed the myriads of health issues caused by or exacerbated by chronic stress. For example, it would someone who has had a heart attack or stroke, who has heart disease, diabetes, obesity or high blood pressure. It would also be someone who has developed mental health issues, such depression, anxiety, substance abuse disorder or eating disorder.
The focus at this stage should be to treat the illness itself. For example, if someone has had a heart attack or stroke due to stress the intervention would be to save him from dying from the heart attack or stroke followed by all the necessary treatments to help him with recovery. If someone has developed major depressive disorder due to stress the intervention would be to treat him/her for the depression using psychotherapy techniques such as cognitive behavioral therapy or mindfulness-based cognitive therapy or pharmacological ways such as prescribing antidepressants, or a combination of the two. After the actual health problem has been treated, stress reduction techniques discussed in levels 2-4 would be added to prevent him from falling down the “cliff” in the future. Stress reduction techniques may also be added in conjunction with treatment of the health problem itself to compliment and / or speed up the treatment.