The Impact of Psychological Stress on Wound Healing: Methods and Mechanisms


Beyond cognitive-behavioral therapy for fibromyalgia: addressing stress by emotional exposure, processing, and resolution

comment on the well-designed trial by Alda and colleagues reported in a recent issue of Arthritis Research and Therapy which demonstrated some benefits of cognitive-behavioral therapy (CBT) for fibromyalgia (FM). CBT in this and other studies provides statistically significant but rather modest benefits for FM. This may be because CBT does not directly address the high rates of victimization, post-traumatic stress disorder, and emotional avoidance experienced by a substantial number of patients with FM. Interventions that encourage emotional exposure, processing, and resolution of stressful or traumatic experiences and relationships hold potential for larger effects for many patients and need to be tested.


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.


Self-compassion, self-regulation, and health

Self and Identity

Volume 10, 2011 – Issue 3: Self- and identity-regulation and health


Self-compassion—treating oneself with kindness, care, and concern in the face of negative life events—may promote the successful self-regulation of health-related behaviors. Self-compassion can promote self-regulation by lowering defensiveness, reducing the emotional states and self-blame that interfere with self-regulation, and increasing compliance with medical recommendations. Furthermore, because they cope better with stressful events, people high in self-compassion may be less depleted by illness and injury and, thus, have greater self-regulatory resources to devote to self-care. Framing medical problems and their treatment in ways that foster self-compassion may enhance people’s ability to manage their health-related behavior and deal with medical problems.

Mindfulness, Self-Care, and Wellness in Social Work: Effects of Contemplative Training

Journal of Religion & Spirituality in Social Work: Social Thought

Volume 30, 2011 – Issue 3: Social Work, Spirituality, and Social Practices

The demands placed on human service workers in supporting people through challenging circumstances can contribute to high levels of stress and burnout. Self-care practices implemented regularly may decrease the impact of the high levels of stress while also serving as strategies for coping during particularly stressful times. The interconnections between contemplative practices, including mindfulness, as coping and preventative strategies for self-care practice among human service workers are beginning to emerge. We used a multimethod study to examine the effectiveness of eight weeks of contemplative practice training in increasing self-care, awareness, and coping strategies for 12 human service workers. Paired t-tests conducted on pre- and post-training scores on the Perceived Stress Scale and the Mindfulness Attention and Awareness Scale showed that mindfulness was significantly increased and that stress significantly decreased over the intervention. Thematic analysis from participant journaling and a focus group discussion suggests that time, permission, and place for learning and practicing mindfulness-based activities are necessary. A meditative model is presented to illustrate how enhanced awareness through mindfulness practice can increase self-care which can, in turn, positively affect the service human service workers provide to their clients.

Mindfulness Group Work: Preventing Stress and Increasing Self-Compassion Among Helping Professionals in Training

The Journal for Specialists in Group Work

Volume 37, 2012 – Issue 4

This study examined the effects a 6-week mindfulness group had on 31 college students who were intending to enter helping professions (e.g., nursing, social work, counseling, psychology, and teaching). Group activities included meditation, yoga, a body scan exercise, and qi gong. The group members completed the Perceived Stress Scale, the Mindfulness Attention Awareness Scale, and the Self-Compassion Scale at pre-pre, pre, post, and follow-up intervals. Perceived stress significantly decreased, and mindfulness and self-compassion significantly increased in response to the group. Group members’ comments on their experience are reported. Implications for future research and practice are explored.

Mindfulness, Self-Compassion, and Empathy Among Health Care Professionals: A Review of the Literature

Journal of Health Care Chaplaincy

Volume 20, 2014 – Issue 3


The relationship between mindfulness and self-compassion is explored in the health care literature, with a corollary emphasis on reducing stress in health care workers and providing compassionate patient care. Health care professionals are particularly vulnerable to stress overload and compassion fatigue due to an emotionally exhausting environment. Compassion fatigue among caregivers in turn has been associated with less effective delivery of care. Having compassion for others entails self-compassion. In Kristin Neff’s research, self-compassion includes self-kindness, a sense of common humanity, and mindfulness. Both mindfulness and self-compassion involve promoting an attitude of curiosity and nonjudgment towards one’s experiences. Research suggests that mindfulness interventions, particularly those with an added lovingkindness component, have the potential to increase self-compassion among health care workers. Enhancing focus on developing self-compassion using MBSR and other mindfulness interventions for health care workers holds promise for reducing perceived stress and increasing effectiveness of clinical care.