Chronic Stress, Cortisol Dysfunction, and Pain: A Psychoneuroendocrine Rationale for Stress Management in Pain Rehabilitation

Pain is a primary symptom driving patients to seek physical therapy, and its attenuation commonly defines a successful outcome. A large body of evidence is dedicated to elucidating the relationship between chronic stress and pain; however, stress is rarely addressed in pain rehabilitation. A physiologic stress response may be evoked by fear or perceived threat to safety, status, or well-being and elicits the secretion of sympathetic catecholamines (epinephrine and norepinepherine) and neuroendocrine hormones (cortisol) to promote survival and motivate success. Cortisol is a potent anti-inflammatory that functions to mobilize glucose reserves for energy and modulate inflammation. Cortisol also may facilitate the consolidation of fear-based memories for future survival and avoidance of danger. Although short-term stress may be adaptive, maladaptive responses (eg, magnification, rumination, helplessness) to pain or non–pain-related stressors may intensify cortisol secretion and condition a sensitized physiologic stress response that is readily recruited. Ultimately, a prolonged or exaggerated stress response may perpetuate cortisol dysfunction, widespread inflammation, and pain. Stress may be unavoidable in life, and challenges are inherent to success; however, humans have the capability to modify what they perceive as stressful and how they respond to it. Exaggerated psychological responses (eg, catastrophizing) following maladaptive cognitive appraisals of potential stressors as threatening may exacerbate cortisol secretion and facilitate the consolidation of fear-based memories of pain or non–pain-related stressors; however, coping, cognitive reappraisal, or confrontation of stressors may minimize cortisol secretion and prevent chronic, recurrent pain. Given the parallel mechanisms underlying the physiologic effects of a maladaptive response to pain and non–pain-related stressors, physical therapists should consider screening for non–pain-related stress to facilitate treatment, prevent chronic disability, and improve quality of life.



The Role of Self-compassion in Romantic Relationships

Self and Identity

Volume 12, 2013 – Issue 1

Self-compassion (SC) involves being kind to oneself when confronting personal inadequacies or situational difficulties, framing the imperfection of life in terms of common humanity, and being mindful of negative emotions so that one neither suppresses nor ruminates on them. The current study explored whether being self-compassionate is linked to healthier romantic relationship behavior, such as being more caring and supportive rather than controlling or verbally aggressive with partners. A total of 104 couples participated in the study, with self-reported SC levels being associated with partner reports of relationship behavior. Results indicated that self-compassionate individuals displayed more positive relationship behavior than those who lacked SC. SC was also a stronger predictor of positive relationship behavior than trait self-esteem (SE) or attachment style. Finally, partners were able to accurately report on each other’s SC levels, suggesting that SC is an observable trait.

Rumination and worry as mediators of the relationship between self-compassion and depression and anxiety


The mediating effects of rumination (with brooding and reflection components) and worry were examined in the relation between self-compassion and depression and anxiety. Two hundred and seventy-one nonclinical undergraduates completed measures of self-compassion, rumination, worry, depression and anxiety. Results showed that for the relation between self-compassion and depression, only brooding (rumination) emerged as a significant mediator. For anxiety, both brooding and worrying emerged as significant mediators, but the mediating effect of worry was significantly greater than that of brooding. The present results suggest that one way via which self-compassion has buffering effects on depression and anxiety is through its positive effects on unproductive repetitive thinking.


Personality and Individual Differences

Volume 48, Issue 6, April 2010, Pages 757-761