Stress is an integral part of everyday living. While stress by itself is not inherently a negative experience, prolonged stress can be quite harmful to the immune system, the adrenals, and the heart. Each individual’s reaction to the same stressor can be positive or negative. Using the Life Stress Questionnaire will help you to determine the role that stress may play in your present health problems. Because we all react differently to the same stressors, this scale is only a rough indicator of stress in your life. Staying informed about the spread of viruses and the measures that you can take to protect your health and the health of your loved ones is critical. However, spending too much time researching viruses can negatively impact your sense of well-being and compromise your physical health. Reports often contain words like outbreak, pandemic, and quarantine that can stir up a lot of anxiety—and even panic. Growing uncertainty about the virus’s impact in the US has many people feeling worried or stressed. While the concern is warranted, it detracts from what is most important: staying healthy.
Did you know that chronic stress and anxiety can actually make you more likely to catch a cold or become ill?[1] It’s no surprise that stress has negative impacts on a person’s health; after all, no one likes to be stressed! But reducing stress isn’t just good for your mental health, it also improves your body’s immune response. Some common negative ways of coping with stress are: overeating, smoking, and alcohol or drug abuse.

Why Stress Matters for Immune Function
In modern life, stress can feel constant and omnipresent. The human body perceives and responds to stress both psychologically and physiologically. Stressful events can cause emotional feelings of unhappiness or being overwhelmed. Often, stress is accompanied by very real physical reactions: rapid heartbeat, sweating, muscle pain, and digestive difficulties.[2] Psychological stress can also dramatically increase inflammation in the body.[3] This is because your body—and more specifically your brain—is triggered to produce stress hormones that send signals throughout the nervous system. When the body is responding to stress, it reallocates energy to fight an imminent danger. While this can have short-term immune benefits, chronic stress reduces immune function.[4] Thus your body’s natural ability to fight off infections is lowered.
Stress, immunity, and disease progression have reciprocal relationships. A powerful way for you to reduce your risk and stay healthy is to practice management techniques, which researchers suggest have  potentially powerful effects on your immune system.[5]

Six Strategies to Reduce Stress
Reducing stress can improve your overall health, especially during these uncertain times. Try a few of these mindfulness and management techniques to help support your immune system.
Avoid Information Overload: Improving time management by prioritizing and organizing your daily responsibilities will
decrease the total stress load. Improving your communication skills in your important family or job related relationships can improve the quality of your life by decreasing your total stress load. While it can be tempting to hunt for all of the available information, emerging research may contain errors or inaccuracies that will be addressed over time. Even experts recognize that they don’t know enough about emerging infectious diseases.[6] By taking a deep breath and acknowledging that no one has all the answers, you can avoid unwanted stress and anxiety.

• Tip—set appropriate boundaries for researching the virus by limiting yourself to 30 minutes per day

Practice Gratitude: In times of uncertainty and worry, negative thoughts can dominate. Practicing gratitude can help your mind remember the positive elements of your life and, if your gratitude is shared, may have a ripple effect of increased positivity.

• Tip—write an email, text, or letter to someone who has had a positive impact on your life
• Tip—keep a running list of things you are grateful for on a daily basis

Try Meditating: It is very difficult to calm the mind and the body during stress unless you have developed some helpful relaxation techniques, such as meditation, breathing, or prayer. Only 5 minutes daily are needed to start improving your reaction to stress. A very helpful paperback book by Joan Borysenko, Minding the Body, Mending the Mind, might be a good way to start a meditation program. There are hundreds of other books that may also be helpful. The important thing is to develop a program that works for you, perhaps every morning for 5 minutes before you shower. Breathing exercises can accompany meditation or be a stand-alone stress-reduction technique (see handout on breathing techniques). For some people, daily mindfulness meditation has an enormous positive impact not only on mental health but also on physical health.

• Tip—there are many free videos and apps for mindfulness meditation; experiment to find what works for you

Create a Homecoming Routine: Make it a habit to wash your hands as soon as you return home. That’s the first step. Afterward, create a comfortable environment in your home that washes away the stress of your day.

• Tip—light a candle (or use an essential oil diffuser) for calming aromatherapy
• Tip—make your home lively with music you enjoy, and decorate with items that bring you happiness

Celebrate Good Habits: Infectious diseases like the flu and other viruses are going to persist, so when you are able to make positive change in your daily habits, take a moment to recognize yourself. Whether that’s eating a new vegetable every day, adding a D vitamin to your routine, or adopting elbow-to-elbow greetings, take a moment be positive. Many common foods and beverages do not support your body during periods of stress, whether small or large. Eating high-quality, nutrient-dense foods enables you to deal with stress in a more positive way. It is most important to restrict intake of refined sugars and starches, caffeine, alcohol, and known allergic foods. Unrefined whole grains, fruits, vegetables, legumes, nuts, essential fats, and quality proteins that are low in saturated fat are all part of a healthy, nutrient-dense dietary program.

Exercise: A regular exercise program helps to generate a greater sense of well-being, accompanied by
increased energy, improved sleep, and improved coping skills. A cardiovascular program, yoga, tai chi, or daily walking are all examples of the many types of exercise that may help you to de-stress your life. See the handout on exercise for ideas on starting an exercise program. In addition to distracting you from anxiety, exercise also changes your brain function and can decrease stress.[7] Exercise can increase expression of feel-good neurotransmitters like serotonin.[8]

• Tip—whether you love to dance, hit a punching bag, walk, swim, juggle, or do yoga, find something you personally enjoy
• Tip—make it bite-sized, doing small increments of movement throughout the day tied to your routines, such as dancing while boiling water or doing lunges while brushing your teeth
• Tip—if possible, work out near nature, whether that’s a few trees in a city park or at a beach

Thoughts about viruses may be overwhelming for some. If you or someone you know begins to exhibit depressive symptoms or has thoughts of suicide, please call the National Suicide Prevention Lifelife (https://suicidepreventionlifeline.org) at 1-800-273-8255. Crisis counselors are available 24/7 to provide free and confidential support to those experiencing emotional distress or crisis.

Prolonged stress may lead to exhaustion of your adrenal glands, which play a critical role in helping you to deal with stress. Adrenal exhaustion becomes a vicious cycle that includes depression, fatigue, feelings of anxiety, and lowered resistance to illness. It is in your best interest to prevent adrenal exhaustion from occurring by developing healthy stress-management techniques.
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REFERENCES
[1] 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. doi:10.1073/pnas.1118355109.
[2] Yaribeygi H, Panahi Y, Sahraei H, Johnston TP, Sahebkar A. The impact of stress on body function: A review. EXCLI J. 2017;16:1057-1072. doi:10.17179/excli2017-480.
[3]Liu YZ, Wang YX, Jiang CL. Inflammation: the common pathway of stress-related diseases. Front Hum Neurosci. 2017;11:316. doi:10.3389/fnhum.2017.00316.
[4] Dhabhar FS. The short-term stress response—mother nature’s mechanism for enhancing protection and performance under conditions of threat, challenge, and opportunity. Front Neuroendocrinol. 2018;49:175-192. doi:10.1016/j.yfrne.2018.03.004.
[5] Schakel L, Veldhuijzen DS, Crompvoets PI, et al. Effectiveness of stress-reducing interventions on the response to challenges to the immune system: a meta-analytic review. Psychother Psychosom. 2019;88(5):274-286. doi:10.1159/000501645.
[6] Hubner AY, Hovick SR. Understanding risk information seeking and processing during an infectious disease outbreak: the case of Zika virus. Risk Analysis. 2020. doi:10.1111/risa.13456.
[7] 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. doi:10.1016/j.psychres.2016.12.020.
[8] Greenwood BN, Fleshner M. Exercise, stress resistance, and central serotonergic systems. Exerc Sport Sci Rev. 2011;39(3):140-149. doi:10.1097/JES.0b013e31821f7e45.