Is your stress interfering with your injury healing?
Have you ever felt like your injury is taking longer to heal than it should?
Do you feel like it takes you overall longer to recover than your friends?
Mental and emotional stress could be the explanation. Read on to learn how your stress may be interfering with your body’s healing capacity.
What is stress?
Before I explain how mental and emotional stress affects injury healing, let’s get a clearer understanding of what stress is so that you can make an honest self-assessment.
Stress = the body’s physical, mental, and/or emotional reaction
to any change that requires an adjustment or response.
Did you catch that? Any change. This means that stress can even be something positive! If it causes a change or reaction, that is a stress response. Of course, negative stress has greater implications because it tends to linger but one cannot dismiss the impact that exciting events have on our lives: it is still stress.
There are also different types of stress: acute stress, episodic acute stress, and chronic stress.
Acute stress is a relatively brief incident that triggers increased heart rate, elevated blood pressure, anxiety, sadness, or irritability. The symptoms subside when the stress eases.
Episodic acute stress is when there are very regular episodes of acute stress causing one to live in a state of overall tension. Symptoms are similar to acute stress but occur often and will begin to accumulate.
Chronic stress is the type of strain that wears one down over years. This occurs due to serious life problems that are beyond one’s control, such as poverty, war, racism, or psychological damage due to trauma.
Take a moment to reflect on your life and your mental and emotional state:
How stressed are you overall?
How often?
What things do you stress about?
What type of stress do you have?
How long does the stress response last?
How long have you been living in your current state?
Remember, account for both positive and negative stressors. While this is a subjective assessment, your perception of your stress is actually what matters in this case. If you think you are stressed, that will make you stressed. This is especially true if you have episodic acute and chronic stress – you experience increasingly more aspect of life through that “stress lens.” Take the time you need to reflect on this because as you will soon learn, it could be affecting you more than you realize.
Does mental and emotional stress really affect healing?
YES! The research is pretty robust on this matter. Here are some really interesting findings on the impact of stress on healing (I included many so feel free to skip ahead if you get bored):
· Greater fear or distress before surgery has been associated with poorer outcomes such as longer hospital stays, more post-operative complications, and higher incidences of rehospitalization. (1,2)
· In a study on patients who underwent coronary artery bypass graft surgery, those who were more optimistic were less likely to be rehospitalized. (3) Conversely, those with more depr3ssive symptoms had higher rates of infection and poorer wound healing. (4)
· In a study of older adults with chronic lower leg wounds, those with the highest levels of depression and anxiety were 4 times more likely to be categorized in the delayed healing group. Furthermore, destress predicted wound healing outcomes over and above differences in sociodemographic variables and medical status. (5)
· In an experimental study, individuals who were family dementia caregivers took 24% longer to heal a small skin wound than matched controls. (6)
· In an experimental study on twenty-four healthy young men, higher perceived stress on the day of a skin biopsy was strongly associated with slower wound healing. (7)
· An experimental study on dental students revealed that wounds on their hard palate (in their mouths) healed on average 40% more slowly during examinations than during summer vacation. (8)
· In an experimental study on married couples, the discussion of a marital disagreement delayed wound repair. Furthermore, those who had more hostile interactions healed at 60% of the rate of those who engaged in low hostility discussions. (9)
· Individuals who had difficulty controlling the expression of their anger were 4.2 times more likely to be classified as slow healers than those who reported superior anger control in a study on blister wounds. (10)
There is even evidence on the other end of this spectrum – reducing psychological stress improves healing outcomes:
· Meta-analyses of clinical studies demonstrate that behavioral stress management interventions before surgery have been correlated with better post-operative outcomes. (11,12)
· In a study on older adults, those who exercised healed their skin wounds faster than those who did not exercise. (13)
· In a study on rodents, those who were housed in pairs healed from a skin biopsy wound faster than those housed alone. (14)
How does something psychological affect the physical?
In the initial inflammatory stage of injury, there are a series of events that are critical. If they don’t happen correctly, success in the later stages of healing is greatly affected. Yes, inflammation is GOOD in this stage. It is a result of all of the necessary cells and factors coming to the injury site so they can work their magic. Below is a simplified explanation of how the psychological affects the physical from a physiology stand point…
…Lastly, a more indirect effect…
Now what?!
First off, I need to say that I am not a psychologist so my advice on managing stress will be incomplete. However, managing stress is something that comes into play in my practice so I do have a tidbit of advice: prioritize what is most valuable to you, then cut the fluff and simplify. Be okay with saying “no” or “not right now.” Give mental and emotional attention to the things that truly matter – don’t sweat the small stuff. Remember what is most important in your life and always ask yourself does that commitment or thought contribute to those primary values.
Don’t forget the tried and true management strategies like exercise, deep breathing, meditation, sleep, and support. Each of these have legitimate science backing them up as being effective stress reducers.
I am in no way trying to oversimply this effort – this is difficult and something I work on daily. But I have truly found that my injury recovery rate AND that of my clients are notably better when they are less stressed, not over-booked in life, and focused on what is actually important. The science plays out, folks, less stress = improved healing.
References
1. Kiecolt-Glaser, J.K., Page, G.G., Marucha, P.T. et al. Psychological influences on surgical recovery: perspectives from psychoneuroimmunology. Am Psychol. 1998; 53: 1209–1218
2. Rosenberger, P.H., Jokl, P., and Ickovics, J. Psychosocial factors and surgical outcomes: an evidence-based literature review. J Am Acad Orthop Surg. 2006; 14: 397–405
3. Scheier, M.F., Matthews, K.A., Owens, J.F. et al. Optimism and rehospitalization after coronary artery bypass graft surgery. Arch Intern Med. 1999; 159: 829–835
4. Doering, L.V., Moser, D.K., Lemankiewicz, W. et al. Depression, healing, and recovery from coronary artery bypass surgery. Am J Crit Care. 2005; 14: 316–324
5. Cole-King, A. and Harding, K.G. Psychological factors and delayed healing in chronic wounds. Psychosom Med. 2001; 63: 216–220
6. Kiecolt-Glaser, J.K., Marucha, P.T., Malarkey, W.B. et al. Slowing of wound healing by psychological stress. Lancet. 1995; 346: 1194–1196
7. Ebrecht, M., Hextall, J., Kirtley, L.G. et al. Perceived stress and cortisol levels predict speed of wound heating in healthy male adults. Psychoneuroendocrinology. 2004; 29: 798–809
8. Marucha, P.T., Kiecolt-Glaser, J.K., and Favagehi, M. Mucosal wound healing is impaired by examination stress. Psychosom Med. 1998; 60: 362–365
9. Kiecolt-Glaser, J.K., Loving, T.J., Stowell, J.R. et al. Hostile marital interactions, proinflammatory cytokine production, and wound healing. Arch Gen Psychiatry. 2005; 62: 1377–1384
10. Gouin, J.P., Kiecolt-Glaser, J.K., Malarkey, W.B. et al. The influence of anger expression on wound healing. Brain Behav Immun. 2008; 22: 699–708
11. Johnston, M. and Vogele, C. Benefits of psychological preparation for surgery: a meta-analysis. Ann Behav Med. 1993; 15: 245–256
12. Montgomery, G.H., David, D., Winkel, G. et al. The effectiveness of adjunctive hypnosis with surgical patients: a meta-analysis. ([table of contents])Anesth Analg. 2002; 94: 1639–1645
13. Emery, C.F., Kiecolt-Glaser, J.K., Glaser, R. et al. Exercise accelerates wound healing among healthy older adults: a preliminary investigation. J Gerontol A Biol Sci Med Sci. 2005; 60: 1432–1436
14. Glasper, E.R. and Devries, A.C. Social structure influences effects of pair-housing on wound healing. Brain Behav Immun. 2005; 19: 61–68