Coping with stress

Anne Gallo, M.S., Sarah Miller, R.N., Diana Zuckerman, Ph.D., and Monica Purmalek

coping with stress, ways to reduce stress levels, stress

Can stress make you sick?  The answer is a resounding yes.  If you want to know how to handle stress, it helps to know what stress is, how it affects your body, and what you can do about it.

What is Stress?

Anything that an individual perceives as a problem can cause stress.  When we perceive a problem and don’t have the resources (or believe we don’t) to cope with it, we can experience stress.  Stressors can be physical, such as an illness or injury, or emotional, such as family, job, or financial problems.  Stress is a reaction to a situation where a person feels threatened or anxious.1  According to Dr. Esther Sternberg, director of the Integrative Neural Immune Program at the National Institute of Mental Health, our body’s response to stress is natural and adaptive.2  Even if the body has a natural way to handle stress, chronic stress may be harmful to our health, resulting in both psychological and biological changes that increase our chances of becoming ill.

Stress Hormones

When faced with stress (for example a physical threat), your body reacts with a “fight or flight reaction” to enable you to fight back or run away from danger.  The adrenal glands release the hormone epinephrine (adrenaline) and the neurotransmitter norepinephrine into the blood stream.  The adrenal glands also release corticosteroid hormones that release fatty acids for energy, causing digestion to stop, blood sugar levels to rise, and the heart to pump more blood to the muscles.

At the same time, the pituitary gland releases a hormone that stimulates the release of cortisol.  In the short term, cortisol helps the body divert energy to muscles and organs that are needed to avoid danger.  However, the same hormones that help defend the body in the short-term can hurt it when produced for longer periods. Because one action of cortisol is to suppress the immune system, chronic stress causes wounds to heal more slowly than normal and leaves the body prone to infections.  This is why chronic stress is also associated with gastrointestinal conditions such as ulcers and irritable bowel syndrome. Since cortisol changes blood sugar and heart rate, cortisol is also associated with diseases of the cardiovascular system, including hypertension, stroke, and heart disease.


Telomeres are caps that we all have on the end of our DNA.  As we age, we slowly lose small bits of our telomeres and they become shorter.  Therefore, measuring the length of a telomere can tell us the “real age” of a person’s cells.  Several studies have found that people who are under chronic stress tend to lose length on their telomeres more rapidly.  For example, one study found that caregivers of people with Alzheimer’s disease not only had poorer immune function, but that their telomeres were shortening more rapidly.3  In other words, the stress of caring for an Alzheimer’s patient was permanently aging their cells.

Another study found that otherwise mentally and physically healthy adults who had a history of being mistreated as children had shorter telomeres.4  This suggests that it’s not always possible to “reverse” the damage stress causes to our cells and that stress at a young age may have life-long effects.

Women and Stress

Studies show that women and men cope with stress differently.5  The friendships and other social support systems that are more common in women may help them cope more effectively with stress, enhancing their immune response and resistance to diseases.6  Studies have shown that women with breast cancer who have strong social supports have significantly longer life spans than women who do not.7  Interestingly, researchers found that social support provided by women is more effective at lowering blood pressure responses to stress in both males and females than support from men.

On the negative side, scientists find that women are two times more likely to develop depression in reaction to the stress in their lives.8  Working women are often under considerable stress as they try to balance work, marriage, and children. Some experts have found that chronic stress can cause a chemical imbalance that can lead to depression.9  In addition, those who care for sick and elderly family members are usually women. Studies indicate that these caregivers have high cortisol levels and therefore weakened immune systems.10

What Causes Stress?

It is unclear how much of the stress response is determined genetically and how much can be controlled by the individual. Genetics play a part in determining someone’s stress response, as does an individual’s experience with stress and their learned perceptions of specific events or situations as stressful. So, the way we see ourselves and others, our methods of handling stress, and our genetic makeup all affect the immune system and therefore our health.Not everyone is the best judge of what reduces his or her own level of stress. For example, smokers depend on cigarettes to relax, but the nicotine in cigarettes does exactly the opposite. Watching TV may feel relaxing, but depending on the program and on how TV interferes with sleeping or other responsibilities, it may sometimes increase stress and decrease the ability to cope with stress.  Here are some tips you can try to help you deal with stress.

Tips to Reduce Stress

Experts indicate that there are many different ways to manage our levels of stress.  It is important to keep in mind that different strategies work for different people. You can try to manage stress levels by meditation, exercise, and doing things that you find relaxing.  The most effective stress-reduction measure for many people, however, is exercise. Physical exertion causes your body to release endorphins which can make you feel better while also boosting your immune system.

If you need something to help you reduce stress in the moment, try taking slow and deep breaths. Slow breathing has been shown to have a calming effect that can lower blood pressure, reduce muscle tension, and decrease heart rate.

Our eating habits can affect our immune systems’ response to stress. A balanced diet emphasizing fresh fruits, vegetables, legumes, raw nuts and seeds, and whole grains can help the body respond better to stress. Reducing caffeine can also help. Studies have found that blood pressure during stress is higher if caffeine has been consumed.11   This suggests that people who have a high intake of caffeine might experience more stress and produce more stress hormones.

Getting enough sleep is also important.  (To find out why you should get enough sleep, read here).  Many Americans get only 7 hours of sleep a night, but research indicates that most adults and children do better with 8-9 hours; in fact, most teens in a sleep lab sleep more than 9 hours each night if given the opportunity.  It can be a vicious cycle: lack of sleep can make an individual more susceptible to stress, and stress often interferes with the ability to sleep.

Researchers have also linked the inability to identify and express emotions to a number of health conditions.12  Expressing emotions to members of a support system or even writing down feelings can help.  Try talking to others, whether friends, family, a counselor, or a professional, if you are having trouble managing your stress.

Bottom Line

It’s worth making the effort to think through how stress affects your life.  If you’re aware of how physical and emotional stresses affect your body, you will be better prepared to cope with stressful situations, modify the way you react to them, feel better, and live longer. It is important to remember that often we can’t do it all on our own – in that case, try seeking help from a professional.

If you or someone you know needs immediate help, please contact the one of the following crisis hotlines:
Disaster Distress Helpline: 1-800-985-5990
National Suicide Prevention Lifeline: 1-800-273-TALK
Youth Mental Health Line: 1-888-568-1112

For more information, we recommend Dr. Esther Sternberg’s book, The Balance Within: The Science Connecting Health and Emotions (Holt, Times Imprint).

Also, check out our Survival Guides for Working Moms for more tips and research based information about coping with stress.

  1. Coping With Stress. Centers for Disease Control and Prevention. Centers for Disease Control and Prevention, 09 Apr. 2013. Web. 15 July 2013. <>.  
  2. Butts, C., and E. Sternberg. Neuroendocrine Factors Alter Host Defense by Modulating Immune Function. Cellular Immunology 252.1-2 (2008): 7-15.  
  3. href=”,”>Damjanovic AK, href=”,”>Yang Y, href=”,”>Glaser R, href=”,”>Kiecolt-Glaser JK, href=”,”>Nguyen H, href=”,”>Laskowski B, href=”,”>Zou Y, href=”,”>Beversdorf DQ, href=”,”>Weng NP; Accelerated telomere erosion is associated with a declining immune function of caregivers of Alzheimer’s disease patients; Journal of Immunology, 2007, 179(6), pp. 4249-54.  
  4. href=”,”>Tyrka AR, href=”,”>Price LH, href=”,”>Kao HT, href=”,”>Porton B, href=”,”>Marsella SA, href=”,”>Carpenter LL; Childhood maltreatment and telomere shortening: Preliminary support for an effect of early stress on cellular aging; Biological Psychiatry, 2010, 68(6) pp. 531-4.  
  5. Matud, M. Gender Differences in Stress and Coping Styles. Personality and Individual Differences 37.7 (2004): 1401-415.  
  6. Hobfoll, Stevan E., Carla L. Dunahoo, Yossef Ben-Porath, and Jeannine Monnier. Gender and Coping: The Dual-axis Model of Coping. American Journal of Community Psychology 22.1 (1994): 49-82.  
  7. Funch, Donna P., and James Marshall. The Role of Stress, Social Support and Age in Survival from Breast Cancer. Journal of Psychosomatic Research 27.1 (1983): 77-83.  
  8. Nolen-Hoeksema, Susan. Gender Differences in Depression. Current Directions in Psychological Science 10.5 (2001): 173-76.  
  9. McEwen, Bruce S. Early Life Influences on Life-long Patterns of Behavior and Health. Mental Retardation and Developmental Disabilities Research Reviews 9.3 (2003): 149-54.  
  10. Bauer, Moisés E., Kavita Vedhara, Paula Perks, Gordon K. Wilcock, Stafford L. Lightman, and Nola Shanks. Chronic Stress in Caregivers of Dementia Patients Is Associated with Reduced Lymphocyte Sensitivity to Glucocorticoids. Journal of Neuroimmunology 103.1 (2000): 84-92.  
  11. Lane, James D., and Redford B. Williams. Cardiovascular Effects of Caffeine and Stress in Regular Coffee Drinkers. Psychophysiology 24.2 (1987): 157-64.  
  12. Gross, James J., and Ricardo F. Muñoz. Emotion Regulation and Mental Health. Clinical Psychology: Science and Practice 2.2 (1995): 151-64.