Why stress matters and how do we manage it? 

So, we have been talking about how the severity of the pandemic been causing fear and uncertainties in many individuals and that these stressful responses do not serve us towards positivism as a whole. Getting informed about the situation of disease and adhere to the imposed measures are vital to protect your health and the health of your loved ones. However, a constant search and hunt on the viral information and news can negatively impact your health. Many reports often contain words like outbreak, pandemic, and quarantine, left alone the ever-increasing number of cases reported locally and worldwide. All these can cause anxiety and even panic to individuals. While the concern is valid, it detracts us from what is most important: how to stay healthy. This article will discuss the basic physiology on how stress can impact our immune system and hopefully this can encourage you to start monitoring and managing your stress level in a healthy manner in order to protect yourself and the people around you.

Psycho- Neuro- Immunology

Needless to explain further, this is an established field of study looking at the relationship between our mind and the immune system. Studies have acknowledged the effects of psychological pain on many health conditions, primarily through the mechanism of increased inflammation.[1] The importance of proper stress management and reduction should not be overlooked. The state of mind, brain physiology, and immune system are closely intertwined. In fact, one simply cannot expect the body’s stress response having no impact on the immune system. In regards to immune function, while some small degree of stress may be healthy for normal functioning and even beneficial for immunity, chronic and low-grade stress without coping strategies can suppress immune function.[2] This again, illustrates the importance for us to manage our stress throughout this trying season of Covid-19, that is likely to last for a while.

Stress Immune Response

From my previous writing, we touched on some essential concepts and immune system being one of them.

In regards to fighting against invaders, a healthy immune function should be one that can efficiently execute a properly regulated inflammatory responses. After managing with the invaders, the immune system should then resolve back to its surveillance mode and do not over-create inflammatory molecules that can potentially harm the host.

Referencing to first part of the description above in previous article, a well balanced and regulated immune system is critically important to carry out its functions. An improper inflammatory responses from the immune system in individuals dealing with chronic stress may put them in higher vulnerability to common cold[3]. Throughout the years, many studies have demonstrated that human subjects with a high stress index were shown to be more susceptible to infection with common cold viruses[4]. Interestingly, stress also affects both respiratory disease susceptibility and severity[5].

As for the second part of the description mentioned above, the immune system must return to its “non pro-inflammatory” or surveillance state once the infections/invaders had been dealt with. The balance between the inflammatory and non-inflammatory response is generally coordinated by specialized immune cells called T regulatory cells. Problem is that stress can often disrupt proper immune regulation and its implications have been documented in various diseases of immune dys-regulation[6]. Moreover, even a brief mental stress event in healthy adults can cause significant reduction of the T regulatory cells [7],further emphasizing the connection between the mind, brain and immune function.


Complexity made Simple

So, basically the orchestration of a coordinated immune response requires activation of the inflammatory phase, proper regulation of immune cells, and resolution of these activities to induce tissue repair and return of normal surveillance. Generally speaking, if there are mistakes anywhere along this process, abnormal inflammation may be prolonged with implication to the person’s health. And stress is capable to disrupt this beautiful symphony!

Now, have you ever thought about what are the perfect ingredients to stress the body? Another word, why are people so stressed out over covid-19. The picture below speaks a thousand word. A novel threat that is unpredictable and uncontrollable quickly alert the body to go into stress. This is exactly what we are dealing with SARS-CoV-2 virus. While this is a natural response, it is worth managing it rationally for the benefit of ourselves, and our loved ones.



Simple Strategies to Manage Stress

  1. Avoid Information Overload – News and information about the virus are everywhere. It is tempting to look for the information but beware that many of these information are emerging and may contains errors and inaccuracies.[8] Realizing and acknowledging the fact that even experts in the field do not have all the answers can help you to avoid unnecessary stress and anxiety.
  2. Practice Deep Breathing/ Yoga / Qi Gong – Studies have found that several practices such as yoga, meditation, mindfulness, tai chi, qigong, relaxation response, and breath regulation may result in favorable gene expression patterns that benefit immune regulation.[9,10]
  3. Mindfulness Meditation – In a period of heavy uncertainty it is important that we all make time in our day to center ourselves while resetting our mind and body. You may want to try and pick up daily mindfulness meditation as it can help provide enormous positive impact on mental health.[9,10]
  4. Gentle Exercise – Some exercises may also be able to help you to overcome or reduce your stress and anxiety level. Another word, exercise may increase stress resistance by producing neuroplasticity at multiple sites of the brain. [12]
  5. Practice Gratitude – Why spend time in worry ? This can be the best time for you to start practicing to count on your blessings. With this, it helps to remind ourselves the positive elements in life and, if your gratitude is shared, this may have a ripple effect of increased positivism.[13]
  6. SleepSee next article
  7. Laugh / Cry – As interesting as it may sound, laughing [14]may increase your natural killer cells activity. Watching some comedy shows or funny videos may be a good idea to de-stress yourself at home during this period. At the same time, taking time to address some emotional distress may be helpful to manage your stress level, even if that involves “crying” out the problem.

Hopefully, with some simple stress management strategies, we can all face our daily challenges with calmness and rationale during this period.

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*Please note: Due to the novelty of COVID-19, there is no absolute research data being published in regards to the effectiveness of dietary or lifestyle interventions for its prevention or treatment. Your individual and unique circumstances during this challenging time are well respected and empathized.The above information /  recommendations are not specific to COVID-19 and are not intended to replace medical consultation with your healthcare provider.

*Reminder: You should always seek medical advice immediately from clinic or hospital if experience signs and/or symptoms related to Covid-19.

  1. Ader R. Psychoneuroimmunology. ILAR J. 1998;39(1):27-29.
  2. Segerstrom SC, Miller GE. Psychological stress and the human immune system: a meta-analytic study of 30 years of inquiry. Psychol Bull. 2004;130(4):601-630.
  3. Cohen S, Janicki-Deverts D, Doyle WJ, et al. Chronic stress, glucocorticoid receptor resistance, inflammation, and disease risk. Proc Natl Acad Sci U S A. 2012;109(16):5995-5999.
  4. Klein TW. Stress and infections. J Fla Med Assoc. 1993;80(6):409-411
  5. Aich P, Potter AA, Griebel PJ. Modern approaches to understanding stress and disease susceptibility: a review with special emphasis on respiratory disease. Int J Gen Med. 2009;2:19-32.
  6. Marshall GD Jr. The adverse effects of psychological stress on immunoregulatory balance: applications to human inflammatory diseases. Immunol Allergy Clin North Am. 2011;31(1):133-140.
  7. Freier E, Weber CS, Nowottne U, et al. Decrease of CD4(+)FOXP3(+) T regulatory cells in the peripheral blood of human subjects undergoing a mental stressor. Psychoneuroendocrinology. 2010;35(5):663-673.
  8. Hubner AY, Hovick SR. Understanding risk information seeking and processing during an infectious disease outbreak: the case of Zika virus. Risk Analysis. 2020.
  9. Buric I, Farias M, Jong J, Mee C, Brazil IA. What is the molecular signature of mind-body interventions? A systematic review of gene expression changes induced by meditation and related practices. Front Immunol. 2017;8:670.
  10. Li QZ, Li P, Garcia GE, Johnson RJ, Feng L. Genomic profiling of neutrophil transcripts in Asian qigong practitioners: a pilot study in gene regulation by mind-body interaction. J Altern Complement Med. 2005;11(1):29-39.
  11. Stubbs B, Vancampfort D, Rosenbaum S. An examination of the anxiolytic effects of exercise for people with anxiety and stress-related disorders: a meta-analysis. Psychiatry Res. 2017;249:102-108.
  12. Greenwood BN, Fleshner M. Exercise, stress resistance, and central serotonergic systems. Exerc Sport Sci Rev. 2011;39(3):140-149.
  13. https://emmons.faculty.ucdavis.edu/gratitude-and-well-being/
  14. The elevation of natural killer cell activity induced by laughter in a crossover designed study. Int J Mol Med. 2001 Dec;8(6):645-50.
  15. Institute of Functional Medicine, American academy of Anti Aging.


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