Stress can be defined as “the process in which environmental demands tax or exceed the adaptive capacity of an organism, resulting in psychological and biological changes that may place persons at risk for disease.”1 Stress has been linked to greater severity and duration of infectious and immune-related diseases and chronic conditions such as diabetes and cardiovascular disease.2 According to the World Health Organization, stress is the second most frequent health problem worldwide.3

Despite the commonness and destructive sequelae of stress, Americans are not receiving adequate stress management guidance from their health care providers, according to a recent study of 2,020 U.S. adults released by the American Psychological Association in February 2013.4 Although 32% of respondents said it is “very” or “extremely” important to talk with their clinicians about stress management, only 17% reported that these conversations actually took place, and more than half (53%) said their clinicians gave them little or no support for stress management.4 

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“Millennials” (ie, individuals between ages 18 and 33) reported the most difficulty in managing stress and in receiving health care that met their needs. Only one-quarter of those with chronic illness reported receiving stress management support from their health care providers compared to those without chronic illness—despite having more consultations than their healthier counterparts.

Insufficient Training a Factor

An important reason why clinicians might not be providing sufficient stress management guidance is that they lack education in how to do so. A 2003 study2 of 210 primary care providers found that while 90% of participants believed stress management was important in improving health outcomes, 45% “rarely” or “never” discussed stress management with their patients, with more than two-thirds (76%) reporting that they lacked confidence in their stress counseling abilities and 42% reporting that they received no instruction regarding stress and health outcomes during their medical education.2

Counseling Patients About Stress Management

Health care providers should be vigilant in looking for potential symptoms of stress (eg, changes in menstrual cycle or sex drive, erectile dysfunction, fatigue, depression, sadness, nervousness or anxiety, headaches, irritability, anergia, apathy, muscular tension, teeth grinding, chest tightness, and gastric symptoms, such as upset stomach or indigestion) and inquiring about potential stress in patients presenting with these symptoms. Clinicians need a variety of options to recommend to their patients.5