By Lauren M. Smith, PhD, LP and Erin Kauffman, MS, LPC
It has been more than two years since the global COVID-19 pandemic was declared (can you believe it?), and many of us are now starting to see how this stressor, in addition to all the others in our daily lives, has impacted our functioning.
Stress is an emotional response to an event or challenge that causes a cascade of neuroendocrine and hormonal responses in the body. The body responds to stress through “fight,” “flight,” or “freeze” states. Over time, these responses can affect the body in a multitude of ways—and can even contribute to chronic illness.
Stress has long been known to impact our immune response. Several groundbreaking studies in the 1990s showed that stress increased the likelihood that individuals would catch a cold after being exposed to the cold virus. In fact, individuals who reported that they were chronically stressed were twice as likely to get sick from the common cold. The findings indicated that interpersonal stressors and being unemployed were particularly significant in the development of colds. Stress is also linked to two leading causes of illness: heart disease and cancer.
The effect of multiple stressors over time is additive or “compounding.” Situational stressors can compound stress experienced over a lifetime, and these together can have long-term impacts on the body.
The pandemic, for example, has introduced a level of stress to our lives that we may not have experienced before. A stressor of this magnitude can influence chronic illness symptoms as the body struggles (unsuccessfully) to “turn off” its response to stress. You may have experienced a worsening of your spondyloarthritis (SpA) symptoms at some point during the past two years, which may be attributable to this phenomenon.
The nervous system works as a negative feedback loop, which means that when the stress-regulating hormone cortisol is high enough, the system will shut off and return to baseline. When stress is chronic, the body becomes resistant to signals that turn off the nervous system. This can lead to one of two responses. For some individuals, the nervous system gets stuck in the “on” position, which causes a person to experience anger, anxiety, restlessness, panic, or hyperactivity. For others, the nervous system may get stuck in the “off” position; these individuals experience depression, disconnection, and fatigue.
New research from chronic illness trauma studies shows that stress not only alters the nervous system, but it also alters the genetic functions that regulate how our nervous system and other organ systems work. This means that early childhood experiences—including physical, psychological, and emotional environments—shape the activity of genes involved in the regulation of our internal systems. How we respond to experiences such as trauma and potential perceived threats such as infections and toxins is, in some ways, predetermined by our nervous and organ systems.
Think of chronic illness as a volcano—it is often unpredictable and can disrupt life in many ways if unmanaged. Managing a chronic illness holistically starts with understanding how lifestyle factors help shape long-term health, with the goal of being able to recognize when your volcano is headed toward “eruption.” Eruption of symptoms can look very different from person to person. The chronic pain that is often associated with chronic illness can be related to hyperirritability of the nervous system. This hypersensitivity causes nerve sensitization that can lead to increased pain signals, and tension that causes muscle spasms or reduced blood flow. Finding ways to manage and reduce stress can help decrease the frequency and duration of flares, and reduce the overall impact of chronic illness.
Techniques for reducing stress include:
Reducing the impact of chronic illness requires a multifaceted approach. When you consider ways to improve your health, be kind to yourself, and start slow. Making changes slowly and over time can lead to long-term benefits in the future.
One strategy that offers significant benefit for relatively low effort is engaging in relaxation or mindfulness practices. You may find that starting or ending your day with focused relaxation is enough to make significant changes in your life. Finding just five to 10 minutes each day for mindfulness can lead to profound benefits. Studies on meditation and relaxation in individuals with chronic illness have found reduced levels of anxiety, pain, and depression with enhanced mood and self-esteem.
Exercise has been linked to a reduction in chronic illness symptoms and markers in addition to contributing to the prevention of certain diseases. Exercise can reduce pain and improve physical function and quality of life. Exercise can also enhance sleep, protect and improve brain function, develop or maintain bone, muscle and other connective tissues, and promote a healthy immune system. Yoga is a mind-body practice that combines physical movement of the body with meditation and breathing. Research on yoga indicates that it helps lower stress and anxiety and can also reduce risk factors for chronic diseases. Finding ways to add exercise into your daily life can lead to significant changes in how you feel physically and mentally. Be creative and start small if you are not currently physically active. One way to start an exercise program is to find ways to be more active throughout the day, such as walking, taking stairs, or lifting small weights. (SAA offers our exercise program, “Back in Action, Again,” developed specifically for those with SpA.)
Sleep is often the first thing that is sacrificed when we are stressed or busy. In addition, sleep can be disrupted by chronic pain. Not getting enough sleep is also linked to an increase in chronic pain, which creates a vicious cycle. Sleep duration of less than six hours has been linked to obesity, depression, anxiety, and cardiovascular disease. Making sleep a priority by reducing screen and computer time can help improve your quality of sleep. Research shows that sleep impacts the immune response, which we know is linked to chronic illness.
Smoking just one cigarette per day can increase the risk of heart disease, while quitting will reduce your risk of disease by 36%. Research indicates that nicotine promotes inflammation throughout the body, which is a marker for chronic illness. Most “smoke breaks” have two aspects: taking a break from a situation and breathing. Taking a walk and breathing can create healthier coping in stressful situations. Many people find that they attempt to quit smoking several times before they fully quit. Be kind to yourself if it takes time and several attempts.
A healthy diet is linked to a notable reduction in risk for chronic illness. For some people, simply making a significant dietary change can be enough to lessen the impact of a chronic disease, or go into remission. Changing how you eat can reduce inflammation and calm the nervous system. Finding an eating plan that works for you is most important, so read about different foods and see what fits your individual needs. Working with a registered dietician can help.
If these techniques do not improve your symptoms, it is not because something is wrong with you or that you are to blame for your illness. Bodies are complex and so are the lifelong effects of adversity and environmental stressors.
Doing therapeutic work with a mental health professional around attachment or other types of trauma can ease the states of fight, flight, and freeze that may perpetuate symptoms. One benefit of healing wounds from childhood is that it improves relationships we have as adults with our spouses, colleagues, children, friends, and family. It also helps us connect more with ourselves as self-love improves. Even if you have not experienced significant trauma in your life, you may have experienced smaller, cumulative traumas. The more you learn about trauma, the more you can develop tools for healing.
Additional research in trauma work indicates that adverse events disengage the part of our nervous system that regulates, calms, and supports health. If you have noticed an increase in your symptoms, new symptoms, or have chronic illness and nothing else has worked, you may want to work with your nervous system from a trauma point of view. Addressing stress and chronic illness through a trauma lens can provide additional tools and options, even if you only implement some of them.
There is growing recognition that managing chronic illness is multifaceted and a marriage of many different factors. Paying attention to the innate capacity of our own bodies can allow us to process what arises. Taking small steps to change our relationship to stress and cope differently can have significant effects on chronic illness symptoms. Practicing these new skills creates the opportunity to come up with new ideas for coping. We can then start to “unhook” from old patterns in our nervous systems and respond to stressful situations with choice rather than reactivity.
Shifting attention to the positive and giving ourselves grace and kindness can go a long way. It is our hope that these approaches can change your relationship to your chronic illness and pain, and reduce the impact they have on your life.
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