The DOI matches its Crossref record; 214 of the 216 references it cites were found in a registry or an index.
Uncertainty and stress: Why it causes diseases and how it is mastered by the brain
Open accessAbstract
The term 'stress' - coined in 1936 - has many definitions, but until now has lacked a theoretical foundation. Here we present an information-theoretic approach - based on the 'free energy principle' - defining the essence of stress; namely, uncertainty. We address three questions: What is uncertainty? What does it do to us? What are our resources to master it? Mathematically speaking, uncertainty is entropy or 'expected surprise'. The 'free energy principle' rests upon the fact that self-organizing biological agents resist a tendency to disorder and must therefore minimize the entropy of their sensory states. Applied to our everyday life, this means that we feel uncertain, when we anticipate that outcomes will turn out to be something other than expected - and that we are unable to avoid surprise. As all cognitive systems strive to reduce their uncertainty about future outcomes, they face a critical constraint: Reducing uncertainty requires cerebral energy. The characteristic of the vertebrate brain to prioritize its own high energy is captured by the notion of the 'selfish brain'. Accordingly, in times of uncertainty, the selfish brain demands extra energy from the body. If, despite all this, the brain cannot reduce uncertainty, a persistent cerebral energy crisis may develop, burdening the individual by 'allostatic load' that contributes to systemic and brain malfunction (impaired memory, atherogenesis, diabetes and subsequent cardio- and cerebrovascular events). Based on the basic tenet that stress originates from uncertainty, we discuss the strategies our brain uses to avoid surprise and thereby resolve uncertainty.
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“Psychological and neural mechanisms through which uncertainty-inducing stressors elicit negative mental states, particularly anxiety, and may lead to psychopathology have been extensively described in the literature [31,35,36,57,119,120], and these models are broadly relevant in the present context.”
From Impact of Media-Induced Uncertainty on Mental Health: Narrative-Based Perspective. (2025) · cites this paper as [120]
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“While sustained vigilance represents the initial adaptive response under conditions of uncertainty [35,120], it can develop into hypervigilance, that is, increased attention to threatening or potentially threatening stimuli.”
From Impact of Media-Induced Uncertainty on Mental Health: Narrative-Based Perspective. (2025) · cites this paper as [120]
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Cites
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The free-energy principle: a unified brain theory?
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“All of these long-lasting effects of persistently activated stress reactions are called ‘allostatic load’ (McEwen, 1998).”
InfluentialSelf-citationRao, R. P. N., & Ballard, D. H. (1999) · Nature Neuroscience · doi:10.1038/4580 · Cited by 5,483 · cited 1×
“It has been shown that both perceptual inference and learning can be described as a minimization of free energy or the suppression of prediction errors (Friston, 2005; Rao and Ballard, 1999).”
Physiology and neurobiology of stress and adaptation: central role of the brain
McEwen, B. S. (2007) · Physiological Reviews · doi:10.1152/physrev.00041.2006 · Cited by 5,429 · cited 3×
“In the short run, increased vigilance or anxiety in a hostile environment may be adaptive; however, when the danger passes and the behavioral state and the changes in neural circuitry become chronic, which get ‘stuck’, such maladaptation may require an external intervention to get it ‘unstuck’, as is the case for chro…”
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Friston, K. (2005) · Philosophical Transactions of the Royal Society B: Biological Sciences · doi:10.1098/rstb.2005.1622 · Cited by 4,578 · cited 1×
“It has been shown that both perceptual inference and learning can be described as a minimization of free energy or the suppression of prediction errors (Friston, 2005; Rao and Ballard, 1999).”
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Cited by
Sorted by citations
REBUS and the anarchic brain: Toward a unified model of the brain action of psychedelics
Carhart-Harris, R. L., & Friston, K. J. (2019) · Pharmacological Reviews · doi:10.1124/pr.118.017160 · Cited by 1,180
“…(Carhart-Harris, 2018a), exemplified by findings of increased brain complexity/entropy (Schartner et al., 2017) and decreased modular differentiation (Petri et al., 2014), provides an iconic image of dysregulated global brain function under psychedelics, with the 5-HT2AR as the trigger point.”
BackgroundEarly life stress and development: potential mechanisms for adverse outcomes
Smith, K. E., & Pollak, S. D. (2020) · Journal of Neurodevelopmental Disorders · doi:10.1186/s11689-020-09337-y · Cited by 500
“There is now a wealth of research in adults demonstrating that individual variability in neurobiological responses to stress is informed through the assessment of factors that shape perceptions and interpretations of stress [10, 179, 180].”
BackgroundSmith, K. E., & Pollak, S. D. (2020) · Perspectives on Psychological Science · doi:10.1177/1745691620920725 · Cited by 379
“This extended activation alters brain architecture in regions such as the PFC, amygdala, and hippocampus, which undermines adaptive regulation and coping (Peters et al., 2017).”
BackgroundAn Active Inference Approach to Interoceptive Psychopathology
Paulus, M. P., Feinstein, J. S., & Khalsa, S. S. (2019) · Annual Review of Clinical Psychology · doi:10.1146/annurev-clinpsy-050718-095617 · Cited by 394
“…attentional bias toward threat (Hakamata et al. 2010), increased worry and self-related cognitions, dysfunctional learning about bodily states over time (Van den Bergh et al. 2017), and increased allostatic load leading to increased stress and mental illness (Peters et al. 2017, Sterling 2014).”
BackgroundLevin, M. G. (2019) · Frontiers in Psychology · doi:10.3389/fpsyg.2019.02688 · Cited by 334
“…Castelfranchi, 2009; Stepp, 2009; Shemesh et al., 2010; Stepp and Turvey, 2010; Mossbridge et al., 2012; Dhar et al., 2013; Goel and Mehta, 2013; Bohm et al., 2016; De Berker et al., 2016; Katz and Springer, 2016; Peters et al., 2017; Wilson et al., 2017; Gagliano et al., 2018; Katz et al., 2018).”
Background
Metadata
- Authors
- Peters, A., McEwen, B. S., & Friston, K.
- Affiliations
- University of Lübeck (DE)
- Rockefeller University (US)
- Wellcome Centre for Human Neuroimaging (GB)
- Corresponding author
- Peters, Achim
- Venue
- Progress in Neurobiology
- Publisher
- Elsevier BV
- Published
- 2017-09
- Volume
- 156
- Pages
- 164-188
- ISSN
- 0301-0082 (ISSN-L)
- OpenAlex
- W2618517468
- Cited by
- 652
- References
- 216
- Citations by year
- 2026: 53 · 2025: 65 · 2024: 82 · 2023: 90 · 2022: 97 · 2021: 103 · 2020: 74 · 2019: 48 · 2018: 32 · 2017: 8
- FWCI
- 4.96
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- Locations
- Progress in Neurobiology (publishedVersion, cc-by-nc-nd)
- PubMed (publishedVersion)
- UCL Discovery (University College London) (submittedVersion)
- Topics
- Life Sciences › Neuroscience › Cognitive Neuroscience › Embodied and Extended Cognition
- Life Sciences › Neuroscience › Behavioral Neuroscience › Stress Responses and Cortisol
- Life Sciences › Neuroscience › Cognitive Neuroscience › Memory and Neural Mechanisms
- Keywords
- uncertainty, stress, free energy principle, information theory, entropy (information theory), surprise, brain energy metabolism, allostasis, allostatic load
- MeSH terms
- Animals, Brain, Diabetes Mellitus, Humans, Memory Disorders, Stress, Psychological, Uncertainty, Atherosclerosis
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