Stress is part of being human. It is the body’s built-in alarm system, helping people stay alert, meet deadlines and respond to threats. In short bursts, that stress response can even be useful.
But when stress lingers—day after day—it can start to wear on the mind and body. Chronic stress has been linked to sleep problems, anxiety and depression symptoms, higher blood pressure and other health concerns. It can also make it harder to stick with healthy routines, from movement and nutrition to social connection. Learning to spot your early warning signs, understanding what is driving them and maintaining practical coping strategies can help lower the risk of stress-related complications.
The AMA’s What Doctors Wish Patients Knew™ series gives physicians a platform to share what they want patients to understand about today’s health care headlines and how to take charge of their health through preventive care.
In this installment, Brian Chaney, MD, a family medicine physician and medical director of provider alignment, quality and utilization management at Baptist Health, took time to discuss what patients need to know about managing stress.
Baptist Health is part of the AMA Health System Member Program, which provides enterprise solutions to equip leadership, physicians and care teams with resources to help drive the future of medicine.
Stress is a natural reaction
“Stress is something that we all experience, but a lot of people don’t realize how it affects physical and mental health,” said Dr. Chaney. “A little stress is good. It helps us meet our daily challenges, but when it becomes constant, then that’s when it can really take its toll on us.”
“For defining stress, it’s our body’s natural response to what we perceive as challenges or threats,” he said, noting “we have this fight or flight system and that activates hormones, cortisol and adrenaline.”
“Almost everyone is familiar with adrenaline. People may not be as familiar with the term cortisol, but this is what helps us stay alert and helps us perform under pressure,” Dr. Chaney explained. “Everyday stress is short term, it’s situational—things like meeting a deadline or handling traffic—and once the trigger or the event resolves, then typically the stress resolves.
“And having that everyday stress during the event can actually enhance our performance. It helps us to do well,” he added. “But then contrast that to chronic stress that persists for weeks or months and keeps the body in this high alert mode almost constantly. So, you really don't have time to recover.”
“It's when you're in that state of chronic stress and you're not able to recover that you start to see harm physically and mentally,” Dr. Chaney said.
Stress can affect your physical health
“Physically, stress can affect almost every system. For the musculoskeletal system, it can cause tension headaches, you can see back pain or other muscle pain,” said Dr. Chaney. “When we look at the cardiovascular system, it can cause high blood pressure and heart disease or even lead into diabetes if you’re on the border for developing diabetes already.”
Stress can also “affect the immune system because as we're under chronic stress and we get less sleep, that can weaken our immune system and then that gives us greater risk of infections,” he said, noting “if you're under chronic stress, you tend to stay sick more frequently than when not under the chronic stress.”
Chronic stress contributes to cognitive issues
When it comes to the impact of chronic stress, it also affects mental health through “anxiety, depression, irritability and cognitive issues like poor concentration and memory lapses,” said Dr. Chaney, emphasizing “we're more likely to make mistakes when we're under a constant state of stress.”
Cognitive issues associated with chronic stress often include “memory lapses, lack of attention to detail, overlooking certain things,” he said. “It could even lead to safety issues if you’re under chronic stress and you have a memory lapse and you’ve just cooked something, you forget to turn off the stove, you could start a fire.
“There are just so many things because you’re in this constant state of stress and it’s almost like you’re rushing to get through things because your systems are constantly activated,” Dr. Chaney added. “You're in this fight or flight state, so you're rushing around doing things and that's when you forget those fine details that can lead to safety problems and just cause more issues.”
Poorly managed stress can lead to behavioral issues too
“When you have long-term activation of these stress hormones—like adrenaline and cortisol—it increases your risk for heart disease, diabetes, digestive disorders, sleep problems and mental health conditions,” Dr. Chaney emphasized. “But when we go a little bit further in depth on the mental health conditions, we look at behavioral consequences.”
“Behaviorally, chronic stress can lead to substance misuse because a lot of people will turn to substances to help deal with their stress,” he said. “We can also see social withdrawal and people tend to become more isolated and avoid others.”
“We also start to see burnout. You always hear about burnout in health care, but burnout can happen in any profession, even at home and in life itself,” Dr. Chaney said.
Stress worsens disease control
While stress affects everyone, “people with chronic conditions—such as heart disease, diabetes, digestive disorder, sleep problems—will have less disease control with stress,” said Dr. Chaney. “So if you already have diabetes and you're under constant stress, your diabetes is going to worsen.
“You could be compliant with diet and exercise, but if you're under a lot of stress, your sugar can run high,” he added. “If you already have heart disease, then added stress can progress the heart disease, make it worse, cause chest discomfort.”
“The big risk factor is the people that already have those conditions. But then we also have to look at caregivers and high stress professionals because they face an elevated burnout risk and immune suppression,” said Dr. Chaney. “I touched on doctors and health professionals, but teachers, business executives, any high stress professional is at risk.”
“And then parents and caregivers at home. That extends not only to parents with children, but to people who are taking care of elderly parents or other family members,” he said.
Be aware of symptoms of stress
“It’s hard to know when a symptom is stress versus when it's not with physical signs. We see headaches, muscle tension, chest pain, digestive issues, fatigue, but at the same time, you don't want to assume that if you're having chest pain that it's stress related,” said Dr. Chaney. “If you're having chest pain, chest pressure, you have to get that checked out because you can't assume that it's stress, even though stress can cause that.”
“If you're having headaches, it could be a stress headache, but it could also be from a migraine or from a brain tumor or onset of early stroke-type symptoms,” he said. “It’s important to be aware of these symptoms and know that they help to identify stress. But at the same time, if you experience those symptoms, you shouldn't assume that it's only stress.”
Try relaxation techniques for stress
For stress management, “there are relaxation techniques you can practice,” said Dr. Chaney. For example, “we can practice deep breathing and meditation.”
“You can also do guided imagery where we’re using our imagination to create calming, positive mental images,” he said, emphasizing “that can help reduce stress.”
Additionally, you can also try box breathing, which is a simple technique to calm the nervous system. This involves Inhaling for four counts, holding for four, exhaling for four and holding again for four. Repeat this cycle to reduce stress and improve focus.
Exercising can help reduce stress too
“There are physical techniques such as regular aerobic exercise, yoga or tai chi that can help with managing stress,” said Dr. Chaney. That is because “all of those exercises can reduce cortisol and improve mood.”
“Exercise is just so important to everything we do,” he said, which is why “it's important that we stay active.”
Practice gratitude to manage stress
“There are cognitive techniques you can follow to reduce stress,” said Dr. Chaney. “One cognitive behavioral therapy strategy is practicing gratitude, which is really more than just saying thank you.”
“Gratitude is really a mindset and looking for the positive in every day,” he said. “If we practice gratitude, it helps calm our stress a little and reframe negative thoughts.”
“So much is about perspective and if we just try to reframe and see things in a positive manner and be more optimistic and less pessimistic, that helps lower our stress levels,” Dr. Chaney said.
Find a stress reduction technique that works for you
At the end of the day, though, stress management varies from person to person—what might work for one person may not work for another. For example, some people might find painting or reading to be great stress relievers while others enjoy hikes and yoga.
“It’s important to find something you like to do and take time for yourself every day and do that,” said Dr. Chaney. “That helps you cope significantly.”
Set up boundaries to protect your well-being
“Boundaries help protect mental health and prevent burnout. We have to learn to say no,” Dr. Chaney said. “I know that’s very hard for a lot of people because most of us want to be helpful and we want to help people and we get asked to do so many different things and it’s hard to say no, but we have to learn to say no without guilt.”
“When we’re saying no, we’re saying yes to our own well-being and prioritizing our own mental health,” he said. To set boundaries you can “schedule personal time like any other appointment. Even if you have to schedule it from this time to this time—maybe it’s an hour every day that you’re going to paint a picture, go for a walk, sit down and spend time with your kids—whatever it is that gives you joy that can remove you from whatever stressor you’re currently experiencing, that’s very important.
“You can fill every minute of your day with some task that needs to be done, and you’ll always feel like you’re behind,” said Dr. Chaney. “But regardless of that feeling, you have to take a certain block of time each day to do something that you enjoy because that joy then is what will reduce your stress and re-energize you to pick up and carry on.”
Take a break from social media
“We talk about mindfulness and dealing with stress and taking time for yourself,” said Dr. Chaney, “but a lot of people have the habit of taking a break from a task and scrolling social media.”
“Does that really give them a break? No. It can create more stress, which is not good,” he said. That is why “it’s very important to do something for yourself that is not social media.”
If stress becomes persistent, talk to your doctor
“Again, some stress is good. The situational stress is normal,” said Dr. Chaney. “We all feel stress every day, but if that stress becomes persistent, if it’s overwhelming, if it’s interfering with your daily life, if you can’t get through your normal daily activities because of stress, then it’s probably time to talk to your doctor.”
“If you notice physical symptoms—sleep disruption, chest pain, turning to substance use for coping—those can all be indicators that you should talk to your doctor about stress,” he said. “Even with the physical symptoms, if you're experiencing those and you feel like you're not under stress, it's probably a good idea to get those checked out because you could already have some underlying health condition, and a little bit of stress is just magnifying it.”
There are resources for stress management
“And that list continues to grow,” said Dr. Chaney. For example, the Centers for Disease Control and Prevention has some stress management tools. The American Institute of Stress has resources available.”
Additionally, “there is a growing number of apps that aim to help with stress management such as Happify and Headspace,” he said.
Happify is a science-based mobile platform that uses positive psychology, mindfulness and cognitive behavioral therapy techniques through games, activities and tracks. This helps to improve emotional well-being, reduce stress and build resilience.
Meanwhile, Headspace is an app that offers a guide for mindfulness, meditation and mental well-being. It offers guided exercises, sleep tools, focus music and even workout content to help users manage stress, improve focus and build healthier habits.
“There are just so many, but you have to choose one that works for you,” Dr. Chaney. “While the apps can help you manage stress, you still have to know what is causing your stress and how to reduce that.”
“And if you’re still having chronic stress, you might need to get professional help and see your doctor, but doing your own cognitive behavioral therapy techniques at home can help,” he said, noting “there are different behavioral therapy resources and techniques available online, so go to your favorite search engine and search for stress management tools. There are a number of resources available and most are free.”
Start with one small step
“The biggest hurdle to many things is starting. You just have to start,” said Dr. Chaney. “If you're feeling overwhelmed and you don't know where to start, you just have to start with some small step. Maybe it's five minutes of deep breathing, maybe it's a short walk.
“If you don't know what to do, you don't know where to start, just walk away and go for a five-minute walk or practice gratitude. Maybe you write down one thing you're grateful for when you feel stressed,” he added. “Then the next time you come back, you can write down something else and you start to develop this list of reflections that you can come back to when you need to practice some gratitude.”
Stress is not a sign of weakness
“It's important to know that stress is normal. We all have stress. It's not a sign of weakness,” Dr. Chaney said. “A lot of people think that they just need to learn to deal with this and they feel like if they're reaching out for help, that it's a sign of weakness that they can't cope.
“But it's really not a sign of weakness. It's a true biological response and sometimes if we've been under chronic stress for a while and those hormone balances get off, we need to seek professional help to get those hormone balances back in line with where they need to be,” he added. “So, stress is more of a chemical process and your body's response. It's not that you are mentally weak.”
“Managing stress is preventive medicine—managing your stress helps protect your heart health, it helps protect your mental health, your overall quality of life,” said Dr. Chaney. That is why it is important “to view stress management as part of routine care like diet and exercise.
“We all know about diet and exercise and the importance of that, but stress management is just as important as those two items,” he added. “It has to be a part of our everyday actions.”
