Risk and Resilience in Coping With Chronic Life Stress

Abstract

This review discusses evidence-based perspectives on risk and resilience in coping with chronic life stress. Future directions for inquiry and practice also are addressed.

Despite being charged with addressing patients’ stress-related ailments, practitioners commonly struggle to manage their own work and family challenges.

Chronic life stress has long been identified as a significant threat to health and well-being. Unfortunately, the context of fast-paced modern life fraught with unremitting, often competing, pressures, virtually assures that nearly everyone must reckon with stress to some extent.^1-12 Not surprisingly, health providers are no exception. Despite being charged with addressing patients’ stress-related ailments, practitioners commonly struggle to manage their own work and family challenges.^13-17

Notwithstanding the generally harmful effects of persisting stress, considerable individual variability also has been documented.^18-22 Accordingly, recent efforts have intensified to identify and better understand the relationships between chronic life stress and potentially pathophysiological processes, with a growing appreciation for the mediating role of psychosocial influences.^{5,10,11,19,23-29} Clearly, an exhaustive examination of the voluminous stress and coping literature is beyond the scope of the present review. However, the present discussion highlights provocative recent findings illustrating some of the complex biopsychosocial influences on stress risk and resilience.

The Developmental Context

Evidence increasingly points to the prenatal and early postnatal milieu as a key contributor to lifelong health trajectories, including stress vulnerability.^30,31 To cite just a handful of the many relevant reports in this regard, myriad prenatal factors have been implicated in physiological derangements that remodel stress responsiveness in ways that heighten susceptibility for disease across the lifespan. For instance, imbalanced high-protein, low-carbohydrate maternal diets during pregnancy have been linked with numerous near-term and long-term hazards for children such as less fetal growth, higher adult blood pressure, and heightened cortisol reactivity to psychological stress.^32-34 Other research has raised the possibility that maternal anxiety during pregnancy may adversely influence fetal development.^35,36 Postnatally, chronic exposure to parental distress (such as negative emotions and psychopathology), family conflict, and/or family disorganization represent enduring developmental stressors for many children,with health-detrimental psychoneuroimmunological repercussions.^6,30,37,38

Managing Life Demands

Individual propensities for appraising and managing stressful circumstances may either buffer or exacerbate perceived stress. Indeed, individual differences in appraisal and coping repeatedly have been identified as critical mediators of stress risk or resilience. Specifically, during prolonged stressful encounters, subjective interpretations of demands and efforts to cope with them influence emotions and physiology for better or worse.^{5,23,24,39-41}

Despite the historical focus on the merits of problem-focused over emotion-focused coping (efforts directed at managing the situation vs managing the associated emotional distress, respectively), more recent perspectives have accentuated the advantages of a broad repertoire of flexible coping skills targeted to specific challenges as they arise during prolonged stressful encounters.^24,41-43 Generally, coping strategies that enhance feelings of personal control and help refresh psychological resources tend to support stress resilience, whereas avoidance coping may raise risk.^{20,21,24,40,42}

Notwithstanding widespread acknowledgment that coping preferences develop and evolve in response to many interacting forces,^42,44-46 the potential role of gender has become an active area of inquiry that has generated many interesting findings.^47-49 One of the most consistent involves women’s inclination to cope by ruminating. This tendency to keep chewing over events in a negatively biased way may increase stress vulnerability and other psychoneuroimmunological risks.* By comparison, there is some suggestion that men may be somewhat more prone to cope by distancing from stress-related negativity. ⁵⁰ Clearly, this area merits more attention.

Social Support

The salubrious effects of social interactions have long been recognized. Generally, active involvement with others across a variety of social contexts bolsters coping efforts and supports stress resilience.^24,28,47,51

However, beyond this lustrous veneer, social relationships are not always experienced as an unalloyed good and may even provoke chronic stress with its attendant pathophysiological sequelae.^30,47 Indeed, emerging findings have demonstrated the interpersonal transmission of negative emotional states in diverse relationships ranging from child–caregiver dyads to marital partners.^38,42,46

In a similar vein, other interpersonally oriented research has underscored the health-detrimental consequences of social stigma and prejudice as chronic stressors for all too many members of socially disenfranchised groups.^52,53 Much more remains to be learned about the many facets of social relationships and the processes by which different interpersonal interactions may compromise or promote stress and its management.^38,42,46,47

Quality of Life

Stress develops in the broader context of life, emerging from and impinging on complex human beings “where they are,” so to speak, including their extant quality of life. Over the years, an accumulation of evidence has suggested myriad processes through which chronic stress may jeopardize quality of life, such as by complicating the management of existing medical conditions and derailing adherence with self-care regimens.^{4,8-10,19,54-56}

Moreover, despite the potentially stress-buffering effects of healthy lifestyle habits, lapse and relapse commonly occur in the midst of demanding circumstances.^7,8,57 During extended stressful experiences, health promoting behaviors such as exercise and prudent eating may give way to sleeplessness, substance use, fast-food meal substitutes, and, in some cases, sexual risk-taking, all of which may exacerbate risk.^1,8,9,58

Ameliorating the Effects of Chronic Life Stress

For any individual, the cumulative effect of prolonged stress exposure depends on a complex web of interacting biopsychosocial influences. Rather than hitting a blank slate, stressful events are encountered by complex human beings who bring to the situation a full complement of risk and resilience factors with multifaceted biological, psychological, and social roots. These robust individual differences underscore the need for multidisciplinary interventions that address the biobehavioral factors most relevant to each person.^4,10,18,30