red adirondack chairs in the snow

Feeling stressed out lately? I know exactly what you mean. The holiday season is here, traffic is worsening, and serious health issues abound. Stress, a term we associate with a state of negative emotional disruption, is linked to all sorts of physical and psychological harms that range from heart disease to depression and from addictive coping behaviors to premature death.1,2,3,4,5 But although stress is universal, it’s a uniquely subjective experience — situations that I find stressful are likely quite different than yours.

Historically, the fight-or-flight stress response brought on by facing a real or imagined threat has ensured our survival. But stress in the modern world is no longer triggered by the sight of an attacking saber-toothed tiger and is more likely to sneak up on us through our smartphones.6 And for many, the time crunch and tensions of the holidays can sprinkle an unwanted dash of nutmeg on the eggnog.7

Struggles with Stress

The stress response can be triggered by both good and bad experiences. “Good” stress (eustress) is associated with happy, positive feelings that occur when you receive a job promotion or look forward to hosting a festive event. “Bad” stress (distress) can bring negative thoughts and anxieties, as when facing your first holiday season after losing a loved one or suddenly being diagnosed with a life-threatening illness. Many times, feelings of stress occur when individuals feel overwhelmed by circumstances beyond their control,8 which can happen anytime, anywhere.

Workplace stress in America is estimated to account for up to $190 billion in direct and indirect costs annually, and is thought to contribute to as many as 120,000 deaths per year.9 And not only does stress from personal and occupational sources appear to influence the onset of chronic diseases such as diabetes, cancer, and Alzheimer disease,10,11 but a recent study found that people diagnosed with a stress disorder experienced a 36% increased risk of developing an autoimmune disease over the subsequent 10-year period.12 Fortunately, although there is evidence that genetics play a role in how individuals respond to stressful situations and that early-life experiences further modify those responses for good or ill,13,14,15 adaptive coping skills can be learned.

The Gift of Resilience  

The ability to maintain a positive frame of mind during stressful events and bounce back well from adversity is called resilience, which can be strengthened with practice or re-learned entirely if the slings and arrows of outrageous fortune have worn yours down. Resilience is best developed by creating a spectrum of strategies you can draw upon when stress strikes, and variously involves giving yourself some space, taking action to solve problems, and reaching out to others for support as the need arises.

Some experts recommend that you can reduce the perception of stress and enhance health and longevity by building a positive attitude and strengthening social bonds (think mindfulness, meditation, and meaningful interaction).4,16,17,18 Others note the importance of getting some exercise, as physical activity improves resilience across cultures even in the presence of serious illness.19,20 And turning to trusted resources both in person and online for help when you need it can smooth out stress and strengthen resilience as well. No matter which strategy you choose, the MDGuidelines team wishes you a happy, healthy, and stress-free holiday season.



  1. Kivimäki, M., and A. Steptoe. “Effects of Stress on the Development and Progression of Cardiovascular Disease.” Rev. Cardiol. 15 (2018): 215-229.
  2. S., and R.A. Khan. “Chronic Stress Leads to Anxiety and Depression.” Ann Psychiatry Ment Health. 5 1 (2017): 1091.
  3. J.L. “Epigenetics of Stress, Addiction, and Resilience: Therapeutic Implications.” Mol Neurobiol. 53 1 (2016): 545-560.
  4. Okely, J.A., A. Weiss, and C.R. Gale. “The Interaction Between Stress and Positive Affect in Predicting Mortality.” J Psychosom Res. 100 (2017): 53-60.
  5. Renzaho, A.M.N., et al. “Stressful Life Events and the Onset of Chronic Diseases among Australian Adults: Findings from a Longitudinal Survey.” Eur J Public Health. 24 1 (2014): 57-62.
  6. Kuss, D.J., et al. “Problematic Mobile Phone Use and Addiction Across Generations: The Roles of Psychopathological Symptoms and Smartphone Use.” J Technol Behav Sci. 3 3 (2018): 141-149.
  7. “Stress, Depression, and the Holidays: Tips for Coping.” Mayo Clinic. 16 Sep. 2017. Mayo Foundation for Medical Education and Research (MFMER). 1 Dec. 2018.
  8. “Occupational Health: Stress at the Workplace.” World Health Organization. 2018. WHO. 1 Dec. 2018.
  9. Blanding, M. “Workplace Stress Responsible For Up To $190B In Annual U.S. Healthcare Costs.” Harvard Business School Working Knowledge. 26 Jan. 2015. Forbes Media, LLC. 1 Dec. 2018.
  10. Chiriac, V.F., A. Baban, and D.L. Dumitrascu. “Psychological Stress and Breast Cancer Incidence: A Systematic Review.” Clujul Med. 91 1 (2018): 18-26.
  11. Justice, N.J. “The Relationship Between Stress and Alzheimer’s Disease.” Neurobiol Stress. 8 (2018): 127-133.
  12. Song, H., et al. “Association of Stress-Related Disorders With Subsequent Autoimmune Disease.” JAMA. 319 23 (2018): 2388-2400.
  13. Buchanan, T.W., and W.R. Lovallo. “The Role of Genetics in Stress Effects on Health and Addiction.” Curr Opin Psychol. 27 (2018): 72-76.
  14. Navrady, L.B., et al. “Genetic and Environmental Contributions to Psychological Resilience and Coping.” Wellcome Open Res. 3 (2018): 12.
  15. Daskalakis, N.P., et al. “The Three-hit Concept of Vulnerability and Resilience: Towards Understanding Adaptation to Early-life Adversity Outcome.” Psychoneuroendocrinology. 38 9 (2013): 1858-1873.
  16. Rutten, B.P.F. “Resilience in Mental Health: Linking Psychological and Neurobiological Perspectives.” Acta Psychiatr Scand. 128 1 (2013): 3-20.
  17. Saslow, L.R., M. Cohn, and J.T. Moskowitz. “Positive Affect Interventions to Reduce Stress: Harnessing the Benefit While Avoiding the Pollyanna.” In: Positive Emotion: Integrating the Light Sides and Dark Sides. Eds. J. Gruber and J.T. Moskowitz. New York: Oxford University Press, 2014. 515-532.
  18. Zhang, Y., and B. Han. “Positive Affect and Mortality Risk in Older Adults: A Meta-analysis.” Psych J. 5 2 (2016): 125-138.
  19. Bernstein, E.E., and R.J. McNally. “Exercise as a Buffer Against Difficulties with Emotion Regulation: A Pathway to Emotional Wellbeing.” Behav Res Ther. 109 (2018): 29-36.
  20. Matzka, M., et al. “Relationship between Resilience, Psychological Distress and Physical Activity in Cancer Patients: A Cross-Sectional Observation Study.” PLoS One. 11 4 (2016): e0154496. 1 Dec. 2018.


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