Disclaimer: This literature review has been written by a student and not our expert nursing writers. View professional sample literature reviews here.

Any opinions, findings, conclusions, or recommendations expressed in this literature review are those of the author and do not necessarily reflect the views of NursingAnswers.net. This literature review should not be treated as an authoritative source of information when forming medical opinions as information may be inaccurate or out-of-date.

Stress: The Risk Factors, Physiological Implications, and the Techniques to Reduce it

Info: 3538 words (14 pages) Nursing Literature Review
Published: 4th Nov 2020

Reference this

Tagged: stress

Stress: The Risk Factors, Physiological Implications, and the Techniques to Reduce it


      Stress is something that affects each person, but it is also unique to each individual. One event can be stressful for one person, but not elicit emotions for another. This, along with many other factors, makes stress a problematic word to describe. Stress can be defined as either a stimulus, such as a threatening situation, or a response. Someone who views stress as a stimulus believes that stress is an unpleasant event; however, someone who assumes that stress is a response would view stress as the physical, emotional, or mental strain or tension that accompanies a situation. While there is confusion behind the definition of stress, scientists and health professionals do agree "that stressors are the threatening stimuli that trigger coping adjustments in a person, and that stress is the process by which a person both appraises and responds to events that are judged to be challenging or threatening" (Straub 2019).

Get Help With Your Nursing Literature Review

If you need assistance with writing your nursing literature review, our professional nursing literature review writing service is here to help!

Find out more

      Hans Selye was the scientist that discovered the stress response in 1934. Selye was an endocrinologist that worked with ovary extract in hopes of identifying a new hormone. Selye set up an experiment in which he gave daily injections of the extract to laboratory rats and recorded changes in their behavior and health. After several months of the experiment, he discovered that the rats had developed bleeding ulcers, shrunken thymus glands, and enlarged adrenal glands. At first, Selye was excited because he believed he discovered the physiological effects that were the result of the ovary extract. However, he examined the situation more carefully and reworked the experiment with a control group that was given saline injections. He noticed that at the end of the new experiment, both the control rats and the rats that were given ovary extract had the same symptoms: bleeding ulcers, enlarged adrenal glands, and shrunken thymus glands. Selye discovered that this is because the rats were stressed out and experiencing the stress response. This led Selye to develop his general adaptation syndrome that is still implemented today

 (Straub 2019). Selye's discovery of the stress response and the general adaptation syndrome sparked new research efforts that explore the risk factors of stress, physiological implications of stress, stress-reducing techniques, and many more issues. 


      Multiple risk factors contribute to a person’s susceptibility to stress like a predisposing genetic factor, certain personality traits, environmental factors, varying levels of general self-efficacy, a person's socioeconomic status. Researchers from the University of Illinois at Urbana- Champaign examined how genetics and the environment affect the Big Five personality traits and perceived stress, both concurrently and longitudinally. They examined and used two different twin studies for their statistical analysis. Study 1 was from the National Longitudinal Study of Adolescent to Adult Health, and the second study was a twin study from the Midlife in the United States Survey. Study 1 showed that around 70% of the association found between the Big Five personality traits and perceived stress was because of genetic influences. The second study showed that genetic influences are related to the continuity in perceived stress, while nonshared environmental influences were associated with changes in perceived stress. The study goes on to state that "the genetic components in conscientiousness and neuroticism made substantial contributions to the genetic link between personality traits and perceived stress across both studies” (Lue et al. 2017). This study clearly shows that genetics, environment, and personality traits play a role in a person’s vulnerability to stress.

           Similarly, another study published by the BMC investigated the effects of general self-efficacy, an individual's belief in his or her ability to execute a specific task, on the effects of stress. This study was a cross-sectional survey that used over 800 nurses in China and investigated the relationship between general self-efficacy and stress while looking at job-related burnout. The study showed that stress was the most important factor when it comes to job-related burnout and that individuals who had low general self-efficacy and either the personality type of introversion or high neuroticism had stronger burnout when they faced stressful situations compared to counterparts. Most importantly, the study concluded that general self-efficacy moderates stress in burnout nurses who had the personality type of extroversion or neuroticism. The study proves that having general self-efficacy can affect how a person handles stress, along with providing further evidence that personality types do affect how predisposed a person is to stress (Yao et al. 2018). 

           Along the lines of the previously mentioned studies, an article published by the Journal of Urban Health explored how pregnancy and postpartum quality of life of adolescents and young mothers living in urban areas are affected by urban social stress and violence, both are which environmental factors. The study is a secondary data analysis of a previous prospective cohort study of almost 300 expectant young mothers that were recruited at OBGYN clinics. The results of the study state that higher urban social stress, due to factors like stressful life events, discrimination, family stress, and neighborhood problems, predicted lower mental and physical quality of life during pregnancy. This mental and physical degradation is a sign that the adolescences and young mothers are experiencing stressful events that could be due to the environmental factors that they live in (Willie et al. 2016). 

           Furthermore, a study published in the Psychophysiological journal investigated the relationship between socioeconomic status and hemodynamic recovery from mental stress. The study included 200 men and women that were separated into higher, intermediate and lower socioeconomic status groups. The participants' blood pressure and hemodynamic properties were measured throughout the study. The study states that blood pressure increased during two stressful behavior tasks through the increase in cardiac index and total peripheral resistance. After a 45-minute post-task recovery period, participants' cardiac index fell below the baseline levels; however, peripheral resistance remained elevated. Interestingly, during the recovery period, peripheral resistance changes varied among individuals with various socioeconomic statuses. Specifically, there were higher levels of total peripheral resistance in reactive low-status participants. The study states that the results are consistent with the thought that disturbances of stress-related autonomic processes, like blood pressure, peripheral resistance, and cardiac index, are related to socioeconomic status, showing that a low socioeconomic status can be a risk factor for a person’s predisposition to stress (Steptoe et al. 2003). These four studies show that various factors play a role in how susceptible a person is to stress. If one or more of these factors lead a person to exhibit an abnormally large amount of stress, there are physiological implications that will affect that person.


           Stress affects the body in a multitude of ways. For example, stress has adverse effects on cardiovascular disease, the metabolic syndrome, and sleep, while having varying effects on the immune system. A study published in the Stress and Health journal examined the connection between psychological stress and cardiovascular disease risk factors that include blood pressure, blood lipids, and obesity. The study showed that perceived stress significantly affects male's diastolic blood pressure, total cholesterol, and the ratio of total cholesterol and high-density lipoprotein (HDL) cholesterol. Likewise, but not completely similar, psychological stress affected women's low-density lipoprotein (LDL) cholesterol, total cholesterol/HDL ratio, body mass index, waist circumference, and waist-hip ratio. While the two genders have slightly different results, the study states that they both work together to prove that perceived stress is an independent factor that affects cardiovascular disease risk factors, even after controlling for other significant life-style related predictors (Sarkar and Mukhopadhyay 2008). 

           Likewise, a prospective study examined the relationship between work stres and the metabolic syndrome, a cluster of symptoms that include "abdominal obesity, atherogenic dyslipidemia (raised triglycerides, small low density lipoprotein particles, and low concentrations of high density lipoprotein cholesterol), high blood pressure, insulin resistance (with or without glucose intolerance) and prothrombotic and proinflammatory states)” (Chandola 2006). These clusters of symptoms that make up the metabolic syndrome increases a person risk of heart disease and type 2 diabetes. This study followed over 10,000 men and women from London. The study found a dose-response relationship that is independent of other related risk factors between exposure to work stress and the risk of metabolic syndrome. The study states that employees who have chronic work stress were twice as likely to have the metabolic syndrome than those who did not experience work stress. This study shows, once again, that stress is related to an increased risk of damaging health effects that can lead to diseases like heart disease and type 2 diabetes (Chandola 2006). 

           Furthermore, a systematic review examined the effects of stress on sleep through the use of polysomnographic measures, which records brain waves, oxygen levels in the brain, heart rate, and breathing. The study showed that experimental stresses resulted in a decrease in slow-wave sleep, REM sleep, and sleep efficiency, while stress was also shown to be associated with an increasing number of awakenings. The implication of this study is not just sleep itself, but also on memory. Both slow-wave sleep and REM sleep are associated with memory consolidation and learning. While the majority of the study was limited to experimental stressors, the effects of post-traumatic stress disorder (PTSD) were explored. The study states that are multiple reports that suggest that PTSD patients have an increased number of awakenings and a decrease in sleep efficiency, which is the percentage of time spent asleep while in bed. The study shows that whether a person has a psychological disorder like PTSD or not, stress is detrimental to their sleep (Kim and Dimsdale 2007). 

           In continuation, stress also has effects on the immune system; however, its effects are not as clear cut as its effects on cardiovascular disease, the metabolic syndrome, and sleep. Stress's effect on the immune system is dependent upon what type of stress it is, either if it is acute or chronic. A meta-analysis of more than 300 empirical articles investigated the relationship between psychological stress and the immune system. The study states that acute stress was associated with an increase in the number of natural killer cells and large granular lymphocytes, both of which show an upregulation of natural immunity; however, acute stress is associated with a downregulation of some functions of specific immunity. Next, brief naturalist stressors, such as a participant being given an exam, showed to be associated with suppression of cellular immunity while having preservation of humoral immunity, both of which are divisions of the immune system. Finally, the study stated that chronic stressors were associated with the suppression of both the cellular and humoral immunity. While the study shows that the acute and brief naturalist stressors have mixed effects on the two divisions of the immune system, the study clearly shows that chronic stress has a detrimental effect on both divisions of the immune system, weakening a person's ability to fight diseases (Segerstrom and Miller 2004).  These four studies show that stress is detrimental to people’s health and that scientist and health professionals need to find stress-reducing techniques.


      As mentioned previously, stress has negative effects on people’s health and there are predisposing factors that affect how likely were to experience it. Fortunately, health professionals and scientists have discovered multiple techniques that reduce stress in individuals. Examples of stress-reducing techniques include the implementation of social support, the use of mindfulness-based stress reduction therapy, the utilization of neurofeedback training, and the practice of diaphragmatic breathing techniques. A research team in Turkey investigated the relationship between social support and coping with stress in women who were being treated for breast cancer through the use of a descriptive and cross-sectional study with 100 women at a training and research hospital. The data was collected through an information form that covered sociodemographic and disease characteristics, the Scale of Ways of Coping with Stress, and the Multidimensional Scale of Perceived Social Support. The researchers discovered that people who were primary school graduates and who did not undergo surgery had a significantly lower ability to cope with stress. They also found a negative correlation between the women's ability to cope with stress and age; however, they found a positive correlation between women's ability to cope with stress and their perceived social support from their family, as well as the total score of perceived social support. This study clearly shows that if a person believes that they have social support, then they can cope with stress more effectively than someone who lacks social support. (Ozdemir and Arslan 2018). 

           In addition to this research, another study tested the effectiveness of mindfulness-based stress reduction (MBSR) on depression, anxiety, and psychological distress, which are associated with symptoms of stress, in people who are affected by different chronic somatic diseases. MBSR is a treatment for psychological distress, depressive symptoms, and anxiety that focuses on the practice of mindfulness, which is the skill to "non-judgmentally observe emotions, sensations, or cognitions" (Bohlmeijer et al. 2010). This study created a systematic review and meta-analysis of eight published, randomized controlled outcome studies that focused on MBSR. The meta-analysis showed that MBSR had a small effect on depression, .26, anxiety, .47, and psychological distress, .32; however, when lower quality studies were excluded, a .24 effect size on anxiety was found. Regardless of the decrease in correlation due to exclusions of some studies, the study did conclude that MBSR does have a small effect on depression, anxiety, and psychological distress in people who have chronic somatic diseases (Bohlmeijer et al. 2010). 

           Furthermore, a randomized controlled trial was produced to examine the effects of neurofeedback training on stress relief among financial employees. Neurofeedback training is a biofeedback technique that allows a person to modulate their brain rhythms. The thought behind neurofeedback training is if the person can detect changes through the use of electroencephalography (EEG), then they can recognize the brain patterns that are associated with stress and change their thought process to change the brain waves, therefore, reducing their stress. After a period of training on how to utilize the neurofeedback technique, the study stated that the participants were able to change certain brain patterns, proving the neurofeedback worked. This study proved that neurofeedback is an effective way to improve factors that contribute to work stress like work ethic, attention, memory, efficiency, and work execution (Liu and Cha 2018).

            Finally, the breathing practice that is known as diaphragmatic breathing has been proven to help reduce stress. Diaphragmatic breathing is the process through which a person focuses on contracting the diaphragm and expanding the belly in order to breathe deeper and control their respiration rate, which is believed to reduce stress. In a study published by the frontiers of Psychology, researchers set up a randomized controlled trial to explore the effects of diaphragmatic breathing. Forty participants were either assigned to be in the breathing intervention group, which were trained over 20 sessions on how to practice diaphragmatic breathing, or the control group. The results showed that there was a significant relationship between diaphragmatic breathing and cortisol levels, the hormone that is associated with stress. The participants that were trained in diaphragmatic breathing technique had significantly lower cortisol levels after their training session, showing that diaphragmatic breathing is effective in reducing levels of cortisol (Ma et al. 2017). These four studies show that while stress is detrimental to a person's health, there are ways to reduce the stress levels a person has. 


           While defining stress is a difficult task for scientists to agree upon, scientists can agree that stress has specific risk factors, physiological implications, and ways to be reduced. Stress risk factors include genetics, personality types, environment, socioeconomic status, and general self-efficacy. If one or more of these risk factors leads a person to have a detrimental amount of stress, the person can have harmful physiological implications like an increased risk of cardiovascular disease and the metabolic syndrome, while also suffering from the effects of a lower immune system and lack of quality sleep. While people may be predisposed to stress and feel the harmful effects of stress, there are proven ways to reduce this stress. Studies have shown that social support, MBSR, neurofeedback, and diaphragmatic breathing all can help reduce perceived levels of stress. With stress being such a universal concern and having wide-spread health implications, more research is needed to determine how to prevent it and treat it even better. 

Literature Cited

1. Bohlmeijer E, Prenger R, Taal E, Cuijpers P (2010). The effects of mindfulness-based stress

reduction therapy on mental health of adults with a chronic medical disease: A meta-

analysis. Journal of Psychosomatic Research 68: 539-544.

2. Chandola T, Brunner E, Marmot M (2006). Chronic stress at work and the metabolic syndrome: prospective study. BMJ 332: 521-525

3. Kim EJ, Dimsdale JE (2007). The effect of psychosocial stress on sleep: a review of polysomnographic evidence. Behav Sleep Med 5: 256-278.

4.  Liu C, Cha H (2018). A randomized controlled trail for solving job stress of financial employees based on neurofeedback training. NeuorQuantology 16: 91-96.

5. Luo J, Derringer J, Briley DA, Roberts BW (2017). Genetic and environmental pathways underlying personality traits and perceived stress: concurrent and longitudinal twin studies. European Journal of Personality, Eur. J. Pers. 31: 614-629.

6. Ma X, Yue ZQ, Gong ZQ, Zhang H, Duan NY, Shi YT, Wei GX, Li YF (2017). The effect of

diaphragmatic breathing on attention, negative effect and stress in healthy adults.

Frontiers in Psychology 8: 1-12.

7. Ozdemir D, Arslan FT (2018). An investigation of the relationship between social support and

coping with stress in women with breast cancer. Psycho-Oncology 27: 2214-2219.

8. Sarkar S, Mukhopadhyay (2008). Perceived psychosocial stress and cardiovascular risk: observations among the Bhutias of Sikkim, India. Stress and Health 24: 23-24.

9. Segerstrom SC, Miller GE (2004). Psychological stress and the human immune system: a meta-analytic study of 30 years or inquiry. Psychol Bull 130: 601-630.

10. Steptoe A, Willemsen G, Kunz-Ebrecht S, Owen N (2003). Socioeconomic status and hemodynamic recovery from mental stress. Psychophysiology 40: 184-192.

11. Straub RO (2019). Health Psychology: A Biopsychosocial Approach. Macmillan International Higher Education. Pages 91-92.

12. Willie TC, Powell A, Kershaw T (2016). Stress in the city: influence of urban social stress and violence on pregnancy and postpartum quality of life among adolescent and young mothers. Journal of Urban Health: Bulletin of the New York Academy of Medicine 93: 19-35.

13. Yao Y, Zhao S, Gao X, An Z, Wang S, Li H, Li Y, Gao L, Lu L, Dong Z (2018). General self-efficacy modifies the effect of stress on burnout in nurses with different personality types. BMC Health Services Research 18: 667.


Cite This Work

To export a reference to this article please select a referencing stye below:

Reference Copied to Clipboard.
Reference Copied to Clipboard.
Reference Copied to Clipboard.
Reference Copied to Clipboard.
Reference Copied to Clipboard.
Reference Copied to Clipboard.
Reference Copied to Clipboard.

Related Services

View all

Related Content

All Tags

Content relating to: "stress"

Stress may be defined as the physical and emotional response to excessive levels of mental or emotional pressure, which may arise from issues in both the working and personal life. Stress may cause emotional symptoms such as anxiety, depression, irritability or low self-esteem.

Related Articles

DMCA / Removal Request

If you are the original writer of this literature review and no longer wish to have your work published on the NursingAnswers.net website then please: