Stress has become a ubiquitous part of modern life. It is a state of physical, emotional, or mental tension that results from the pressures of everyday life. However, stress is not just a minor annoyance; it can have severe and far-reaching consequences for our health, including increased risk of heart disease, cancer, stroke, respiratory disorders, and even suicide. A study by George Slavich, a clinical psychologist at the University of California, Los Angeles, revealed that his father’s sudden death had a profound impact on his mental and emotional well-being. The experience highlighted a paradox between what he knows stress is doing to the brain and body, and how little attention it gets in clinical care. Despite decades of research, stress remains a major concern. According to David Almeida, a developmental psychologist at Pennsylvania State University, stress has increased globally during the recession of 2007 to 2009 and the COVID-19 pandemic. Polls show that globally, including in the United States, stress hasn’t gone back down to previous levels. The problem is not just that stress is on the rise, but also that it is often misunderstood. People tend to be aware of their stress, but they often don’t know what to do about it. A physician might recommend leaving a stressful job, engaging in talk therapy, or eating and sleeping better, but those options are not always possible. In fact, many of the individuals who face the greatest stressors also face the greatest barriers to treatment. A key issue is that stress is not just a single event, but a complex process. When the body perceives a threat, stress hormones, including cortisol, flood the bloodstream. Muscles tense and blood sugar levels rise. The heart beats faster and stronger, and blood vessels dilate, shuttling extra oxygen through the body to help you think and move quicker. The immune system is put on call for rapid healing and recovery. However, this fight-or-flight response has not evolved to cope with the numerous stressors of modern life. There is an evolutionary mismatch happening right now, says Almeida. Issues arise when the body fails to control the on–off switch, and stress becomes problematic if the body overreacts to situations that are not life-threatening, anticipates a stressor too soon, or dwells on negative feelings after the stressor has passed. Stress assessments tend to rely on self-reported symptoms, such as anxiety or trouble sleeping, plus, in some cases, on measurements of blood pressure, cortisol levels, or heart rate. However, these tools are not always sufficient. An elevated cortisol level or heart rate could be explained by exercise or a cup of coffee, says Almeida. To better understand stress, researchers are investigating a broad array of self-reported measures, including past stress and trauma exposure, as well as data on neurotransmitters, hormones, genetics, gene expression, gut bacteria, inflammatory markers, glucose levels, lipid function, and metabolites. These data are now easier to obtain, often with affordable at-home tests. The COVID-19 pandemic has spurred the creation of simple-to-use devices to collect blood, saliva, and stool samples. Wearables are also being developed to continuously assess physical activity, sleep, heart rate, heart rate variability, vestibular balance, and galvanic skin response. Sensors under development aim to detect real-time levels of cortisol and other stress hormones through sweat. The influx of data could help researchers to understand how stress contributes to long-term health problems and offer guidance in the clinic. Currently, there are no clinical cut-offs that indicate harmful stress. By contrast, a health-care provider concerned about cardiovascular disease can measure levels of C-reactive protein, a marker of inflammation, to determine whether a person is at an elevated risk and whether they’d benefit from further testing and treatment. A variety of interventions are already available to fight bad stress. Robust clinical trials show that cognitive behavioral therapy, breathing exercises, social support, exercise, and time spent in nature can alter how a person thinks, acts, and responds to stress. Cognitive behavioral therapy has been shown to reduce how much people dwell on negative feelings after a stressor and help a person reframe their perception of an upcoming stressful event. Other tools that can help a body overwhelmed by stress include beta blockers, anti-inflammatory drugs, and omega-3 fatty acids. However, part of the challenge going forward will be to match the treatment to the individual. Men and women tend to differ in their responses to stress, and people whose microbiome is out of balance can experience an exaggerated stress response. Children who experience abuse or chronic neglect can also be predisposed to a maladaptive stress response later in life. An early-life traumatic experience can lead to a belief that the world is an unpredictable and unsafe place, says Slavich. In conclusion, stress is a complex and multifaceted issue that requires a comprehensive approach. By understanding the good, bad, and everything in between, we can take steps to manage and mitigate its effects on our health. With the help of emerging assessment tools, basic advances in stress science, and a range of interventions, we can transform the way we think about and address stress in clinical care.

1. Stress is not just a minor annoyance; it can have severe and far-reaching consequences for our health.
2. Stress remains a major concern, despite decades of research, with stress levels increasing globally during the recession of 2007 to 2009 and the COVID-19 pandemic.
3. Stress is often misunderstood, with people not knowing what to do about it, and many facing the greatest barriers to treatment.
4. Stress is a complex process, not just a single event, but a cascade of physiological and emotional responses.

“Stress is not just a minor annoyance; it can have severe and far-reaching consequences for our health.