A stage model of stress and disease
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In this article, we argued that the term stress has served as a valuable heuristic, helping researchers to integrate traditions that illuminate different stages of the process linking stressful life events to disease. We provided a short history of three traditions in the study of stress: the epidemiological, psychological, and biological. The epidemiological tradition focuses on defining which circumstances and experiences are deemed stressful on the basis of consensual agreement that they constitute threats to social or physical well-being. The psychological tradition focuses on individuals’ perceptions of the stress presented by life events on the basis of their appraisals of the threats posed and the availability of effective coping resources. The biological tradition focuses on brain-based perturbations of physiological systems that are otherwise essential for normal homeostatic regulation and metabolic control. The foci of these three traditions have informed elements of a stage model of disease, wherein events appraised as stressful are viewed as triggering affective states that in turn engender behavioral and biological responses having possible downstream implications for disease.
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Stress plays a pivotal role in the development of mental disorders.
“Research has revealed that stress plays a pivotal role in the development of mental disorders (1)”
From Reducing neuroendocrine psychosocial stress response through socio-emotional dyadic but not mindfulness online training (2024) · cites this paper as [1]
Stressful events can trigger affective responses like worry and anxiety, altering the functions of the HPA axis and the SAM system, which can lead to poor health decisions such as decreased exercise, poor sleep, increased smoking, and alcohol consumption, ultimately increasing disease risk.
“Stressful events can trigger affective responses like worry and anxiety, altering the functions of the HPA axis and the sympathetic–adrenal–medullary (SAM) system. This can lead to poor health decisions, such as decreased exercise, poor sleep, increased smoking, and alcohol consumption, which ultimately increase disease risk.”
From Comprehensive review of chronic stress pathways and the efficacy of behavioral stress reduction programs (BSRPs) in managing diseases. (2024) · cites this paper as [80]
A study of over 136,000 citizens showed a significant correlation between high stress levels and increased tobacco consumption.
“A study of over 136,000 citizens showed a significant correlation between high stress levels and increased tobacco consumption [79,80,81,82].”
From Comprehensive review of chronic stress pathways and the efficacy of behavioral stress reduction programs (BSRPs) in managing diseases. (2024) · cites this paper as [80]
The pathway from stress to disease involves environmental demands, perceived stress, negative emotional responses, poor health behaviors, and physiological changes, culminating in a heightened risk of disease onset or progression.
“The pathway from stress to disease involves environmental demands, perceived stress, negative emotional responses, poor health behaviors, and physiological changes, culminating in a heightened risk of disease onset or progression.”
From Comprehensive review of chronic stress pathways and the efficacy of behavioral stress reduction programs (BSRPs) in managing diseases. (2024) · cites this paper as [80]
Smokers often relapse after cessation programs, citing stress as a major factor.
“Smokers often relapse after cessation programs, citing stress as a major factor.”
From Comprehensive review of chronic stress pathways and the efficacy of behavioral stress reduction programs (BSRPs) in managing diseases. (2024) · cites this paper as [80]
The capacity to regulate emotions effectively can mitigate the risk of depression associated with genetic predisposition to stress.
“However, the capacity to regulate emotions effectively can mitigate this risk.”
From Comprehensive review of chronic stress pathways and the efficacy of behavioral stress reduction programs (BSRPs) in managing diseases. (2024) · cites this paper as [80]
Genetic predispositions, such as carrying a short allele in the 5-HTTLPR, are linked to an increased risk of depression in stressful environments.
“For example, genetic predispositions, such as carrying a short allele in the 5-HTTLPR, are linked to an increased risk of depression in stressful environments.”
From Comprehensive review of chronic stress pathways and the efficacy of behavioral stress reduction programs (BSRPs) in managing diseases. (2024) · cites this paper as [80]
In a study of 205 children aged 9-15, those who were genetically predisposed to higher stress levels exhibited more depressive symptoms.
“In a study of 205 children aged 9–15, those who were genetically predisposed to higher stress levels exhibited more depressive symptoms.”
From Comprehensive review of chronic stress pathways and the efficacy of behavioral stress reduction programs (BSRPs) in managing diseases. (2024) · cites this paper as [80]
A study involving 265 parents of children with hematological cancer or solid tumors revealed that parents' perceptions of their child's pain and their own stress levels were influenced by their attitudes towards analgesics.
“For instance, a study involving 265 parents of children with hematological cancer or solid tumors revealed that parents’ perceptions of their child’s pain and their own stress levels were influenced by their attitudes towards analgesics.”
From Comprehensive review of chronic stress pathways and the efficacy of behavioral stress reduction programs (BSRPs) in managing diseases. (2024) · cites this paper as [80]
At-risk children who practiced effective emotion regulation did not show heightened depressive symptoms.
“Crucially, at-risk children who practiced effective emotion regulation did not show heightened depressive symptoms, demonstrating that emotion regulation is a powerful tool for resilience.”
From Comprehensive review of chronic stress pathways and the efficacy of behavioral stress reduction programs (BSRPs) in managing diseases. (2024) · cites this paper as [80]
Parents with a lower educational attainment reported higher stress and more negative views on pain management, due to misconceptions about analgesic use.
“Parents with a lower educational attainment reported higher stress and more negative views on pain management, due to misconceptions about analgesic use.”
From Comprehensive review of chronic stress pathways and the efficacy of behavioral stress reduction programs (BSRPs) in managing diseases. (2024) · cites this paper as [80]
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- Authors
- Cohen, S., Gianaros, P. J., & Manuck, S. B.
- Affiliations
- Carnegie Mellon University (US)
- University of Pittsburgh (US)
- Corresponding author
- Cohen, Sheldon
- Venue
- Perspectives on Psychological Science
- Publisher
- SAGE Publications
- Published
- 2016-07
- Volume
- 11
- Issue
- 4
- Pages
- 456-463
- ISSN
- 1745-6916 (ISSN-L)
- 1745-6924
- PMC
- PMC5647867
- OpenAlex
- W2500340790
- Cited by
- 549
- References
- 77
- Citations by year
- 2026: 43 · 2025: 82 · 2024: 82 · 2023: 81 · 2022: 64 · 2021: 67 · 2020: 69 · 2019: 21 · 2018: 28 · 2017: 10 · 2016: 2
- FWCI
- 12.99
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Perspectives on Psychological Science (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Heart, Lung, and Blood Institute (R01HL089850)
- National Center for Complementary and Integrative Health (R01AT006694)
- Topics
- Life Sciences › Neuroscience › Behavioral Neuroscience › Stress Responses and Cortisol
- Health Sciences › Health Professions › General Health Professions › Health, psychology, and well-being
- Social Sciences › Psychology › Clinical Psychology › Resilience and Mental Health
- Keywords
- stress, stress and disease, life events, stress appraisal, coping, physiological stress response, homeostatic regulation, affective states, history of stress research, psychological stress, biological stress
- MeSH terms
- Humans, Models, Psychological, Stress, Psychological
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