The terms "eustress" and "distress" are widely used throughout the scientific literature. As of February 2020, 203 items in the Web of Science show up in a search for "eustress," however, there are almost 16 400 items found in a search for the term "distress." Based on the reasoning in this article, however, it is believed there is no such thing as eustress or distress. The adaptation reaction of an organism under stress is not intrinsically good or bad, and its effect on health or performance depends on a plethora of other interactions of the body with the environment as well as on the history of such interactions. The vagueness of the terms "eustress/distress" has historically led to vast differences in the perception and application of the terms across disciplines. While psychology or sociology perceive eustress as something inextricably linked to positive perception and enhanced cognition, biomedicine perceives eustress as generally associated with better survival, health, or increased longevity, no matter how the event is perceived. In this paper, the authors review the current understanding of the term "eustress" in different fields, discuss possible implications of its misleading use, and suggest that the term may be replaced by "stress" only.

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Eustress and Distress: Neither Good Nor Bad, but Rather

the Same?

Julie Bienertova-Vasku,* Peter Lenart, and Martin Scheringer

The terms "eustress" and "distress" are widely used throughout the scientific

literature. As of February 2020, 203 items in the Web of Science show up in a

search for "eustress," however, there are almost 16 400 items found in a

search for the term "distress." Based on the reasoning in this article, however,

it is believed there is no such thing as eustress or distress. The adaptation

reaction of an organism under stress is not intrinsically good or bad, and its

effect on health or performance depends on a plethora of other interactions of

the body with the environment as well as on the history of such interactions.

The vagueness of the terms "eustress/distress" has historically led to vast

differences in the perception and application of the terms across disciplines.

While psychology or sociology perceive eustress as something inextricably

linked to positive perception and enhanced cognition, biomedicine perceives

eustress as generally associated with better survival, health, or increased

longevity, no matter how the event is perceived. In this paper, the authors

review the current understanding of the term "eustress" in different fields,

discuss possible implications of its misleading use, and suggest that the term

may be replaced by "stress" only.

1. The Eustress Paradox: Everyone Talks About It

but No One Really Knows What It Is

Nowadays, the term "stress" is used in so many contexts that it is

extremely difficult to provide a simple explanation of the mean-

ing of this term. The interpretation of the term "stress" is highly

Prof. J. Bienertova-Vasku, P. Lenart, Prof. M. Scheringer

Research Centre for Toxic Compounds in the Environment

Faculty of Science, Masaryk University

Kamenice 5, building A29, 625 00, Brno, Czech Republic

E-mail: julie.dobrovolna@recetox.muni.cz

P. Lenart

Department of Experimental Biology

Faculty of Science, Masaryk University

Kamenice 753/5, 625 00, Brno, Czech Republic

Prof. M. Scheringer

Institute of Biogeochemistry and Pollutant Dynamics

ETH Zurich

Universitätstrasse 16, 8092, Zürich, Switzerland

The ORCID identification number(s) for the author(s) of this article

can be found under https://doi.org/10.1002/bies.201900238

© 2020 The Authors. BioEssays published by WILEY Periodicals, Inc..

This is an open access article under the terms of the Creative Commons

Attribution License, which permits use, distribution and reproduction in

any medium, provided the original work is properly cited.

DOI: 10.1002/bies.201900238

dependent on the field, with possible

meanings including "reaction" (physiol-

ogy), "negatively perceived factor or situ-

ation" (psychology), or environmental fac-

tors affecting the cell or organ or body

(biology). While some of these meanings

denote external factors, others denote the

reaction of the body, a situation that con-

fusion and also a gap in understanding

between the humanities and biomedicine.

The term "stress" is also often used in clin-

ical medicine as a pool of risk factors for

various diseases that include a psychoso-

matic component or as an explanation for

diseases whose pathophysiology is poorly

understood. Clinicians sometimes operate

with "good stress" and "bad stress" concepts

that aim rather to denote the intensity of a

stressor than the nature of the bodily reac-

tion to the stressors.

The primary field, which we refer to in

the present paper, is therefore, the public

health/pathophysiology of human diseases

and possibly clinical medicine/psychology.

In these fields, the terms "eustress/distress" are widely used and

often misinterpreted. The paper is therefore oriented to disease-

associated phenotypic trajectories and intends to explain the mis-

conceptions in the use of stress from this viewpoint.

Overall, the eustress/distress paradigm is used in many fields

and contexts and the theory behind it substantially differs across

fields. To understand the intended meaning of this ubiquitous

term, we first need to understand its history,too. To avoid further

confusion, mainly with notions of stress used in evolutionary bi-

ology and ecology, we strictly refer to stress in humans and its

clinical/psychological implications.

Initially, the syndrome that would soon be called "stress"[1] cov-

ered the non-specific response of an organism to a wide range

of environmental factors including physical, chemical, and bi-

ological ones, under the wide umbrella of "general adaptation

syndrome." In fact, Hans Selye published his 1936 article un-

der the title "A syndrome produced by diverse nocuous agents"

and described multiple manifestations of the defined syndrome,

including thymicolymphatic involution, gastric ulcers, lipid dis-

charge from the adrenal gland, and loss of chromaffinity in the

medulla, that Selye established as a unifying non-specific adap-

tive response to various kinds of agents. The word "stress" first

occurred in human and animal physiology in 1946. In 1975 John

W. Mason suggested that Selye's work (influential as it was) had

led many researchers logically to assume that usage of the term

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"stress," in a biological sense, began historically with Selye's

publications— an idea that Mason rejects.[2] One way or another,

it was Hans Selye who introduced the term "stress" to the gen-

eral public and who incessantly explained its meaning to a broad

audience around the world.

It took Hans Selye almost 4 decades to specify that not all stress

reactions are equivalent, and that observed differences may be the

outcome of not just a varying intensity of stressors themselves

but also of differences in the subject's perception and physiolog-

ical response that go deeper than just the inherent reactivity of

the human body. Selye, often prone to create new names and con-

cepts, although not always very consistent in using them, intro-

duced the terms "distress" and "eustress" in the early 1970s in

order to distinguish whether the stress response was initiated by

negative, unpleasant stressors, or positive stimulating factors.[3]

At that time, he came to the understanding that the division of

stress into eustress and distress provided a major distinction and

discovery relevant not only to the relatively small research com-

munity but also to the general public, and he published his find-

ings in a book specifically focused on this theoretical concept. In

this book, Stress without Distress [3] and the subsequent autobio-

graphic The Stress of My Life: A Scientist's Memoirs,[4] he started to

emphasize that "stress is not what happens to you, but how you

react to it."[3,4 ]

While Hans Selye considered the definition of eustress and

distress the crucial findings of his whole scientific career, little

attention has been paid to the eustress–distress differentiation

in the scientific literature ever since. While there is a large body

of evidence on distress and its effects on human and animal

health, papers focusing on the effect of eustress are scarce, as

well as papers dealing with the differentiation between eustress

and distress. Moreover, some authors hold the view that the

attention paid to eustress definitions and the application of the

theoretical knowledge to practice is completely insufficient[5,6 ]

and consider the whole concept incomplete and in need of

revision.[5]

The basic idea of Hans Selye in 1974 was that negative stress,

that is, distress, suggests the individual would experience nega-

tive emotions and physiologically measurable adverse effects on

physical levels, such as most of the psychosomatic phenomena,

while positive stress or eustress would stimulate the individual

to feel happy or motivated. While there is no problem in under-

standing the negative effects associated with distress, it is quite

unclear what Hans Selye had in mind when defining eustress,

as we discuss in more detail in the next section.

To evaluate the prevalence of the terms "eustress" and "dis-

tress" in the scientific literature, we conducted a search in the

Web of Science (WoS). As of February 6, 2020, there was a total of

276 items in the WoS in response to a search for "eustress," while

there are 246 726 WoS items when the search is for "distress."

First, this shows that in particular "distress" is a very common

term. Second, although the number of direct hits for "eustress"

is small, the usage of "distress" automatically implies the notion

of eustress, otherwise, one would just call it stress. We conclude

that, given the widespread use of at least "distress," a critical

discussion of the terms eustress/distress will be useful. The fol-

lowing sections focus mainly on definitions of eustress/distress

and then present implications and recommendations for their

usage.

2. First, the Criteria for Eustress/Distress Have

Always Been Poorly Defined

We quote from Selye's paper from 1976:[6, p.15]

In everyday life we must distinguish two types of stress effects,

namely, eustress (from the Greek eu or good – as in euphony, eu-

phoria, eulogy) and distress (from the Latin dis or bad – as in disso-

nance, disease, dissatisfaction). Depending upon conditions, stress

is associated with desirable or undesirable effects. In view of these

conditions it is also quite obvious that there cannot be different types

of stress, although the effects of stressors are almost invariably dif-

ferent.

However, in the same year Selye wrote elsewhere:[7 , p.74]

We must, however, differentiate within the general concept of stress

between the unpleasant or harmful variety, called distress…and eu-

stress…During both eustress and distress the body undergoes virtu-

ally the same non-specific responses to the various positive or neg-

ative stimuli acting upon it. However, the fact that eustress causes

much less damage than distress graphically demonstrates that it

is "how you take it" that determines, ultimately, whether one can

adapt successfully to change…

In the work of Hans Selye, there is sometimes uncertainty

as to whether eustress refers to the action of positive stressors

from the surrounding environment or the positive reaction of the

body itself. This conflation of cause and reaction inevitably leads

to misconceptions and misunderstandings when the terms "eu-

stress" or "positive stressors" are used because sometimes they

denote simply the factors promoting positive perception of an

event, whereas in other situations they denote the positive bodily

reaction or positive perception of that reaction.

Contrary to this limited approach, others, for example, Milsum

et al., provide a wider definition of eustress as a "full system that

includes the psycho-social dimensions."[8] In the work by Mil-

sum et al., "stressors" are defined as potential producers of stress,

and are illustrated in the physical, psychological, and social do-

mains, while so called "destressors" are similarly considered to

act in the opposite direction and mainly associated with lifestyle.

However, even though the concept by Milsum et al. incorporates

the idea of complex homeostatic relationships within the body,

it does not say much specifically on how to quantitatively dis-

tinguish eustress from distress or, even more important, how

to measure it. Furthermore, Milsum's framework adds a further

layer of confusion to the definition of eustress because, contrary

to the original concept, he considers eustress to be a condition

rather than a process. Lazarus et al.,[1] on the contrary, employ

an idea of cognitive input into the final reaction, suggesting

that eustress is a positive cognitive response to the cognitive

evaluation of a situation that can change during the time a

stressor is present. Edwards and Cooper go even further and

consider eustress the positive discrepancy between perception

and expectations (highly subjective to an individual).[9] However,

the cognitive appraisal as well as emotional aspects of the stress

response do not make it possible to explain the whole spectrum

of stress reactions as we will discuss further. For example, the

exposure to accumulating pollutants within the body may be

associated with significant cellular/tissue stress and may lead

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to decreased longevity, but may not be associated with either

cognitive appraisal or emotional response.

The third approach to defining eustress, which is highly prag-

matic and currently dominating, was developed on the basis of

the Yerkes–Dodson law and suggests that eustress is beneficial

for performance until the optimum level is reached and after

this peak performance declines, a process that is associated with

distress.[10] However, defining eustress simply by peak perfor-

mance may be too simplistic because it is easy to find many ex-

amples of stimulants that can increase peak performance, but

are very detrimental in the long run, for example, metham-

phetamine, cocaine etc.[11,12 ]

Here we consider three different scenarios to demonstrate that

the term "beneficial" is very interchangeable and can be perceived

in very different ways:

Scenario 1 refers to a case of 25-year-old man exposed to a

rollercoaster ride. While the ride itself can be perceived as pleas-

antly exciting, the changes in pressure gradients in brain vas-

culature cause a dormant brain aneurysm to rupture, and the

man dies shortly after the ride finished. While the whole event

of the ride was perceived in a pleasant elating way, the overall ef-

fect of the ride on the health of an individual is catastrophic both

from a long-term as well as short-term perspective. The individ-

ual perception of the roller-coaster ride as a pleasant experience

has nothing to do with "adversity" of the consequent health out-

come. The good-or-bad nature of the bodily reaction to the roller-

coaster ride can be determined only when the final outcome is

known.

Scenario 2 refers to a 40-year-old banker working in invest-

ment banking and maximizing his working performance. This

banker frequently abuses cocaine, is sleep-deprived and suffers

from a huge workload, but is also very successful and rich. Even

though cocaine abuse is generally considered adverse for human

health, it helps the banker maximize his performance to a level

that is above what average human physiology would allow. The

banker dies at the age of 47 of myocardial infarction, which is a

risk he accepted at the very beginning of his career. Can we con-

sider cocaine abuse distressing at this point? While it may have

reduced his lifetime, it also enhanced performance and improved

his socioeconomic status. It seems intuitive to define the bene-

fits based on longevity, as most of us want to live long. However,

if we trade longevity for increased performance or success, this

definition becomes moot.

Scenario 3 refers to a 25-year-old man who is mobbed at work.

While mobbing will definitely be perceived as distressing and un-

pleasant, leaving our individual with significant psychiatric mor-

bidity, the presence of our individual in the given working group

still gives him good access to resources for his work that makes

the presence in the group more attractive to him. The presented

individual seeks professional help, and with this help, he sub-

stantially improves his strategies and subsequently is capable of

diverting the whole mobbing impact from himself while taking

on exercising classes and substantially losing abundant weight.

While undoubtedly, the mobbing was perceived by our individual

as negative and induced the bodily reactions that we generally as-

sociated with "negative" stress, from the long-term perspective

the whole ordeal led to personal growth and improvement both

in health and performance. Again, we are unable to decide on

whether the whole situation was "good or bad," without having

knowledge on the final outcome or at least without having a cer-

tain timeline that would make it possible for us to decide on the

long-term and short-term effects.

The most common problem with the definition of eustress

stems from the fact that many authors use the term "stress" in-

terchangeably to designate a reaction to a stressor as well as the

stressor itself. The same problem affects eustress: in the origi-

nal meaning, eustress is a positive reaction to a stressor, not the

cause of this reaction (i.e., the stressor itself).

3. Second, Even If We Employ the Concept of

Eustress Being Defined Based on Performance, a

Demarcation Line between Eustress and Distress

Is Practically Non-Existent

The conflation of eustress with positive emotional perception of

an event or enhanced cognitive performance leads to highly het-

erogeneous results of similar study designs. This is even further

complicated by the fact that emotions, as well as cognitive per-

formance, can change over the time during which the stressor

exerts its effects. From a physiological perspective, it seems that

the body does not develop two separate reactions, but only one

with the resulting phenotype being shaped not only by the pa-

rameters of the stressors, but also by the inherent characteristics

of the individual as well as by his or her position on the aging

timeline.

The ultimate point of debate lies in the fact that the good or

bad character of the response occurs only in retrospect when the

reaction has led to health outcomes. This is inherently later than

the event itself (whatever the event is), so at the time of the reac-

tion, it is simply impossible to decide whether the reaction serves

its purpose (whatever this purpose is, e.g., enhanced longevity

or increased performance) or not. In our previous work, we pre-

sume that the human phenotype, including all aspects of health

or diseases, develops as a combined effect of three main factors,

genetics, environmental stimuli, and aging. However, the devel-

opment of these phenotypes over time is not random but follows

a certain trajectory, for example, before a healthy individual starts

to manifest a full spectrum of symptoms for a given disease they

have to first develop several transitory phenotypes in a logical and

causal fashion.[13]

From this perspective, the term eustress will make sense only

when assessing one such trajectory at a time, but it does not make

sense when all trajectories leading to an infinite number of differ-

ent health outcomes are considered at the same time. For exam-

ple, the given adaptation reaction can lead to one adverse health

outcome, but can be protective toward another health outcome at

the same time, which makes it impossible to decide on the sin-

gle nature of the beneficiality of the reaction at a single moment.

A good example of this may be glycemic control. Stress hyper-

glycemia is common in critically ill patients and appears to be a

marker of disease severity.[14] Even though blood glucose at ad-

mission as well as mean glucose level during a hospital stay are

strongly associated with patient outcomes in some patients, a crit-

ical review of the literature shows that the tight glycemic control

in both ICU and non-ICU patients do not always improve health-

care outcomes.[15] It can be therefore speculated that while on one

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trajectory the levels of glycemia may be positively associated with

reduced survival of an individual, the increased levels of blood

sugar can be actually protective and adaptive response enhancing

the survival on another one. The actual decision on whether the

achieved levels of glycemia were good or bad for the patient can be

only made in retrospection and depend on the knowledge of the

actual outcome (survival yes or no) as well as on knowledge of the

etiology of the disease. From the perspective of the performance-

oriented theories of stress, it is impossible to draw conclusions

on the actual performance achieved without the knowledge of the

final outcome.

However, the most important problem of the eustress concept

is that reactions to many stressors can be described as eustress

or distress based purely on a considered time point. A good ex-

ample of this is a reaction to a common stressor in academic life:

tight deadlines. Upon hearing about a new tight deadline, many

people experience discomfort or even anxiety, at this time point,

the reaction of organisms to tight deadlines could be classified

as distress. However, close to the deadline itself, it is common

to report increased productivity, and thus at this time point, the

reaction of organisms to tight deadlines could be classified as

eustress. Immediately after the deadline, the situation changes

again as work under pressure made people feel exhausted and

even reduced their productivity, at this time point the reaction of

organisms to tight deadlines could be again classified as distress.

Furthermore, a long-term effect of stress induced by tight dead-

lines is likely detrimental on health as well as performance, that

is, distress.[16]

So far, it has not been generally possible to define a clear

line between what is eustress in terms of a beneficial reaction

of the body and distress perceived as bodily reaction leading to

illness. Such a reaction should be, in that case, drawn for every

future phenotype separately, as a trajectory from one phenotype

may continue toward multiple future phenotypes, and it is

impossible to estimate the future phenotype without knowledge

of the intercalated phenotypes. More clearly, one phenotype

may be beneficial from the perspective of one future illness,

while it may be highly disadvantageous from the perspective of

another.

4. Third, No Attempts Have Been Made to

Distinguish Eustress from Distress Based on the

Strength of the Stress Response or Based on

Intensity of Stressor

Centuries ago, the father of toxicology, Phillipus von Hohenheim

(also known as Paracelsus[16]), concluded that it is the dose that

makes the poison.[17] Despite the dearth of scientific data in the

1500s, Paracelsus suggested that anything can be toxic in high

doses and, conversely, that many poisons are not toxic in low

doses. This applies well to different sorts of factors eliciting stress

responses as well as their combinations. It has been suggested

that the response to stress in the human brain may switch from

enhanced resistance to increased vulnerability with a shift in ei-

ther stressor dose or duration. The dose and duration are gener-

ally the key elements to exposure to substances from the environ-

ment and detrimental effects from any substance or other type of

stressor should not be generally attributed to the "harmfulness"

of the substance without precise knowledge of exposure, as it is

often the case.

In contrast to Selye's idea of clearly distinguished good and bad

effects of stress, we believe that stress produces a string of phe-

notypic trajectories that are potentially good or bad, based on the

final health outcome that we are investigating. In other words, the

phenotypes produced due to stressors of varying intensity, type,

and duration are not clearly good or bad as their nature depends

on the retrospective interpretation based on our knowledge of the

final outcome. However, this final outcome has been inevitably

shaped not only by these investigated stressors, but also by all

preceding and following stressors as well as by the inherent char-

acteristics of the organism, hence rendering an interpretation of

any single stressor's effects nearly impossible. A good example is

immunization. Animals as well as humans immunized against

a deadly pathogen such as rabies, smallpox, are able to survive

infection by this pathogen, often even without any symptoms,

while their non-immunized counterparts are killed by the same

pathogen. Therefore, the same stressor can have widely different

effects.

To provide a clear resolution of the good-or-bad effects of

stress, it seems imperative:

1) Not to assess a single phenotype in relation to a single stressor

but to provide a string of phenotypes linked to the investigated

health outcome.

2) To provide an alignment of these trajectories that involve cer-

tain stressors or health outcomes of interest into pipeline

models that better describe the link between possible stres-

sor and late health outcome and that will involve not only ex-

posure to the stressor, but also knowledge about the lifetime

pathway of health of an individual, including his/her inher-

ited traits as well as detailed history of previous events rel-

evant for a given health outcome with the individual aging

information.

3) Not to mistake the beneficial nature of a stressor for its low

intensity and short duration (hormesis—all factors can be fa-

tal at certain intensity), and not to mix short- and long-term

effects of a stressor.

4) Not to mix eustress with positive effects of previous exposure

to stressor, known as preconditioning. If we follow the origi-

nal meaning of the concept of stress derived from the general

adaptation syndrome, it follows that eustress should also be

general, that is, it should exert a generally positive effect on

duration and/or quality of life (again without clearly defining

what positive means here). On the other hand, precondition-

ing should provide specific protection against specific stimuli

or, in specific tissues, no matter what the consequent effects

are. For example, a short duration of ischemia is known to

protect the heart against the adverse effect of longer period

ischemia;[18] however, that does not mean the short duration

of ischemia generally has positive effects.

5. Conclusions and Speculations

Based on the available body of evidence, we believe there is no

such thing as eustress. The adaptation reaction is not good or

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bad, and its effect on longevity or performance depends on a

plethora of other interactions of the body with the surrounding

environment (not only with the stressor itself) as well as on

the whole history of these interactions since conception, or

even before that at the level of gametes. We therefore propose

that the term eustress should be abandoned as confusing

and should be replaced by universal use of the term stress

instead.

A recent paper with the key word "distress" is titled "Associa-

tion of prenatal maternal psychological distress with fetal brain

growth, metabolism, and cortical maturation." In this title, the

change of "distress" to "stress" would not change the meaning

the paper conveys.[19] Moreover, even in psychology, the change

of "distress" to simply "stress" does not seem to pose necessar-

ily a problem, as can be demonstrated by replacing "distress"

in the title of a recent paper on "Associations between maternal

physiology and maternal sensitivity vary depending on infant dis-

tress and emotion context" with "stress," again without substan-

tial change in meaning.[20]

Acknowledgements

The project was supported by the CETOCOEN PLUS

(CZ.02.1.01/0.0/0.0/15_ 003/0000469) project of the Ministry of Ed-

ucation, Youth and Sports of the Czech Republic. The project was also

supported by the RECETOX Research Infrastructure (LM2015051 and

CZ.02.1.01/0.0/0.0/16_ 013/0001761). Furthermore, P.L. received support

from the Brno Ph.D. Talent competition.

Conflict of Interest

The authors declare no conflict of interest.

Author Contributions

J.B.-V. and P.L. co-developed the central idea. M.S. provided supervision

and stimulating questions. All authors co-wrote the manuscript.

Keywords

disease, environment, eustress, health, preconditioning, stress

Received: December 5, 2019

Revised: March 18, 2020

Published online:

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Wilkins, Philadelphia 1974 .

[4] H. Selye, The Stress of My Life: A Scientist's Memoirs , 1st ed., McClel-

land and Stewart, Toronto 1977 .

[5] D. L. Nelson, B. L. Simmons, in Emotional and Physiological Processes

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[6] H. Selye, Stress in Health and Disease , Butterworths, Boston 1976 .

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[8] J. H. Milsum, Behav. Sci. 1985, 30, 179.

[9] J. R. Edwards, C. L. Cooper, Soc. Sci. Med. 1988 ,27, 1447.

[10] H. Benson, R. L. Allen, Harv. Bus. Rev. 1980, 58, 86.

[11] K. I. Bolla, F. R. Funderburk, J. L. Cadet, Neurology 2000 ,54, 2285.

[12] S. L. Simon, C. P. Domier, T. Sim, K. Richardson, R. A. Rawson, W.

Ling, J. Addict. Dis. 2001 ,21, 61.

[13] P. Lenart, M. Scheringer, J. Bienertova-Vasku, BioEssays 2019 ,41 ,

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[14] P. E. Marik, R. Bellomo, Crit. Care 2013, 17, 305.

[15] J. Gunst, A. De Bruyn, G. Van den Berghe, Curr. Opin. Anaesthesiol.

2019, 32, 156.

[16] T. W. Colligan, E. M. Higgins, J. Workplace Behav. Health 2006, 21,89.

[17] M. A. Ottoboni, The Dose Makes the Poison: A Plain–Language Guide

to Toxicology, Wiley-Blackwell, New York 1997 .

[18] E. K. Iliodromitis, A. Lazou, D. T. Kremastinos, Vasc. Health Risk

Manag. 2007, 3, 629.

[19] Y.Wu,Y.C.Lu,M.Jacobs,S.Pradhan,K.Kapse,L.Zhao,N.Niforatos-

Andescavage, G. Vezina, A. J. du Plessis, C. Limperopoulos, JAMA

Network Open 2020, 3, e1919940.

[20] M. E. Augustine, E. M. Leerkes, J. Fam. Psychol. 2019, 33, 412.

BioEssays 2020, 1900238 © 2020 The Authors. BioEssays published by WILEY Periodicals, Inc.

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... This biopsychosocial reaction is part of daily life. A positive reaction (ie, eustress) allows for learning and development of functional strategies, while a negative reaction (ie, distress) disrupts a person's stability and becomes harmful [6]. Different coping strategies have been modeled in mental health research, by isolating and analyzing the behavioral, cognitive, and affective processes that subjects use during threatening events in order to control, diminish, tolerate, and/or minimize their impact on physical and psychological well-being [7]. ...

... The DASS-21 has been shown to be a reliable and valid measure for assessing the mental health of the Portuguese-speaking [46] and French-speaking [47] populations. 6. The psychological impact of COVID-19, which will be measured using the Impact of Event Scale-Revised (IES-R) developed by Weiss and Marmar [48]. ...

Background: Higher-education students are particularly vulnerable to both everyday stressors and mental health problems. Public health emergencies may generate a range of unforeseen potential stressors for vulnerable individuals and communities. The current pandemic has apparently led to an increase in psychiatric symptoms among these students. Objective: The goal of this study is to characterize the psychological impact of the COVID-19 pandemic among Portuguese and Swiss higher-education students. Methods: This project will use a mixed methods sequential explanatory design in Portugal and Switzerland, with two consecutive phases. During Phase I, a quantitative study will assess the psychological responses of higher-education students during the COVID-19 pandemic. A convenience sampling method will be used for collecting information from students. The association between variables will be determined with univariable and multivariable analyses. During Phase II, qualitative data will be collected in order to understand the determinants of psychological stress and the strategies adopted by students as a result of the COVID-19 pandemic, as well as to identify their opinions and feelings about the teaching-learning process during quarantine. In this phase, participants will be selected using a maximum-variation sampling method. Data from focus group discussions will be coded and inductively analyzed using a thematic analysis approach. Finally, quantitative and qualitative results will be merged during interpretation to provide complementary perspectives. Results: This paper describes and discusses the protocol for this mixed methods study, which will be completed in December 2021. This study was formally approved by the local ethics committee (CE/IPLEIRIA/22/2020) in Portugal and authorized by the Swiss Association of Research Ethics Committees, swissethics (CER-VD-2020-02889). Conclusions: This research can contribute to the development of teaching tools and methods that reinforce positive mental health strategies, hope, and adaptive coping among students, and to the development of a class on mental health interventions in the context of catastrophic and traumatic events. This project will also help government stakeholders as well as health and education professionals safeguard the psychological well-being of students facing an expanding COVID-19 pandemic.

... We also urge stress researchers to consider how observed neuro-immune changes compare to other model systems within and beyond that context. It is also worth considering if these changes are entirely detrimental, or if they might reflect an adaptive, or even beneficial (i.e., eustress) response to unstable conditions [222,223]. ...

Microglia are emerging as critical regulators of neuronal function and behavior in nearly every area of neuroscience. Initial reports focused on classical immune functions of microglia in pathological contexts, however, immunological concepts from these studies have been applied to describe neuro-immune interactions in the absence of disease, injury, or infection. Indeed, terms such as 'microglia activation' or 'neuroinflammation' are used ubiquitously to describe changes in neuro-immune function in disparate contexts; particularly in stress research, where these terms prompt undue comparisons to pathological conditions. This creates a barrier for investigators new to neuro-immunology and ultimately hinders our understanding of stress effects on microglia. As more studies seek to understand the role of microglia in neurobiology and behavior, it is increasingly important to develop standard methods to study and define microglial phenotype and function. In this review, we summarize primary research on the role of microglia in pathological and physiological contexts. Further, we propose a framework to better describe changes in microglia1 phenotype and function in chronic stress. This approach will enable more precise characterization of microglia in different contexts, which should facilitate development of microglia-directed therapeutics in psychiatric and neurological disease.

... The ROS level that induces senescence is at the upper level of oxidative eustress. However, Bienertova-Vasku and Scheringer argued that both terms (eustress and distress) were rather the same, and suggested replacing them by "stress" alone (41). We prefer to retain "oxidative stress". ...

  • Kamonchanok Chuenwisad
  • Pimkanya More-krong
  • Praween Tubsaeng
  • Chanchai Boonla Chanchai Boonla

Oxidative stress, a well-known cause of stress-induced premature senescence (SIPS), is increased in patients with calcium oxalate (CaOx) kidney stones (KS). Oxalate and calcium oxalate monohydrate (COM) induce oxidative stress in renal tubular cells, but to our knowledge, their effect on SIPS has not yet been examined. Here, we examined whether oxalate, COM, or urine from patients with CaOx KS could induce SIPS and telomere shortening in human kidney (HK)-2 cells, a proximal tubular renal cell line. Urine from age- and sex-matched individuals without stones was used as a control. In sublethal amounts, H2O2, oxalate, COM, and urine from those with KS evoked oxidative stress in HK-2 cells, indicated by increased protein carbonyl content and decreased total antioxidant capacity, but urine from those without stones did not. The proportion of senescent HK-2 cells, as indicated by SA-βgal staining, increased after treatment with H2O2, oxalate, COM, and urine from those with KS. Expression of p16 was higher in HK-2 cells treated with H2O2, oxalate, COM, and urine from those with KS than it was in cells treated with urine from those without stones and untreated controls. p16 was upregulated in the SA-βgal positive cells. Relative telomere length was shorter in HK-2 cells treated with H2O2, oxalate, COM, and urine from those with KS than that in cells treated with urine from those without stones and untreated controls. Transcript expression of shelterin components (TRF1, TRF2 and POT1) was decreased in HK-2 cells treated with H2O2, oxalate, COM, and urine from those with KS, in which case the expression was highest. Urine from those without KS did not significantly alter TRF1, TRF2, and POT1 mRNA expression in HK-2 cells relative to untreated controls. In conclusion, oxalate, COM, and urine from patients with CaOx KS induced SIPS and telomere shortening in renal tubular cells. SIPS induced by a lithogenic milieu may result from upregulation of p16 and downregulation of shelterin components, specifically POT1, and might contribute, at least in part, to the development of CaOx KS.

... Cette citation dénote ainsi le caractère quotidien de cette affection non pathologique le plus souvent, qui émane d'un grand nombre de facteurs extérieurs, affection qui peut aussi être décrite comme un état de pression psychologique prolongée sur le sujet[48].Le stress est donc une des conséquences de la perturbation du bien-être du sujet et va générer de l'appréhension concernant une situation à venir. Il est également important de mentionner que selon certaines théories, il existerait deux types de stress[49] : l'Eustress, générateur de motivation et d'excitation ayant pour origine des facteurs positifs, et son contraire le Distress considéré comme un mauvais stress, générateur de peur, d'appréhension. On voit ainsi que la présence de stress n'est pas ...

  • Tafsut Tagnithammou Tafsut Tagnithammou

Le travail de cette thèse porte sur une nouvelle architecture d'assistance pour la solution de mobilité Gyrolift. Ce fauteuil roulant verticalisateur est l'intégration d'un module robotique sur une base gyropodique. Le dispositif offre un déplacement aussi bien assis que debout aux utilisateurs de fauteuils roulants.D'abord, nous présentons le concept du Gyrolift avec une comparaison aux différentes solutions concurrentes. Ce dispositif est une forme d'orthèse qui offre une position debout avec les différents avantages physiologiques et psychologiques : amélioration de la fonction respiratoire, de la circulation sanguine, de la consolidation des os et une autonomie augmentée.Une relation d'interaction Homme-Machine s'établit entre l'utilisateur et son Gyrolift. De par sa nouveauté, une appréhension peut être provoquée. Cet état émotionnel peut perturber l'équilibre et le bien-être du conducteur. Nous abordons cette problématique tout en montrant qu'un stress peut être ressenti par les utilisateurs du Gyrolift.Ensuite, nous proposons une chaîne d'acquisition qui permet d'estimer l'état émotionnel du conducteur. De manière non-invasive, nous observons la variabilité de la fréquence cardiaque en utilisant une caméra grâce au principe de la photopléthymographie.La solution proposée a été testée dans des conditions statiques et quasi-dynamiques afin de simuler l'utilisation du Gyrolift. Elle permet d'établir si l'utilisateur est "stressé" ou "relaxé". Nous avons présenté les résultats obtenus. Les travaux de recherche menés démontrent que l'utilisation d'une caméra pour estimer l'activité cardiaque d'une personne est possible afin de déterminer son état émotionnel.Enfin, nous proposons une architecture de contrôle réactive pour le contrôle du Gyrolift. Elle permet d'assister, d'optimiser et de sécuriser l'utilisateur. Nous avons défini les différentes fonctionnalités du dispositif qui sont : la verticalisation ; la gestion de l'équilibre ; la gestion des béquilles pour le transfert ; gestion de l'autonomie et intégration de la partie contrôle via un boîtier de commande. Une hiérarchisation des fonctionnalités a été établie selon les cas d'usage.Cette architecture est embarquée sur le prototype pré-industriel du Gyrolift qui sera commercialisé au courant de l'année 2021.

... 11 This type of stress is a complex interaction between risk factors, warning signs, protective factors and the history of the individual. 12 Mild to moderate levels of stress frequently promote individual motivation and growth, but excessive stress often leads to decreased functioning and distress. Individuals considering suicide frequently experience a point at which stress overloads their innate ability to manage and cope effectively. ...

  • Mark A Dixon
  • Steven M Hyer
  • David L Snowden

Suicide is significant public health concern within the United States. Research results are mixed about the effectiveness of universal screening and interventions with patients who are at-risk for suicide. Primary care is a logical intervention point to mitigate risk among patients in each of these areas. The Department of Veterans Affairs and Department of Defense have developed comprehensive guidelines for the assessment and management of suicidal patients. This approach involves specific screening tools, risk stratification by categories and interventions used by clinicians to help reduce risk levels in their patients. This article aims to provide a model, built on the principles of these guidelines, which primary care physicians can use to identify, assess and intervene with patients who are at-risk for suicide.

  • Megan Hebdon
  • Miranda Jones
  • Sara Neller
  • Lee Ellington Lee Ellington

Millennial caregivers, born between 1981 and 1996, are an understudied caregiver group. They experience stress-related consequences of caregiving and are unique in their developmental stage and generational norms. The purpose of this study was to understand the context of caregiving and stressors for these caregivers. In total, 42 caregivers were recruited through Research Match and social media platforms. Caregivers completed online surveys with open-ended response questions and 15 caregivers completed semistructured interviews. Data were analyzed deductively and inductively using the Stress Process Model as a framework. Millennial caregivers described uncertainty and disruption as overarching experiences. Stressors related to balancing caregiving, work, and family responsibilities were most prominent. Caregivers reported needing support from friends/family, health care team members, community, and work/governmental policy. Mental health treatment was identified as most helpful for managing stress. Millennial caregivers have distinctive contexts that impact their caregiving needs. Caregiving interventions must take these needs into consideration.

Significance: Atherosclerosis and its complications, such as acute coronary syndromes, are the leading causes of death worldwide. A wide range of inflammatory processes substantially contribute to the initiation and progression of cardiovascular disease (CVD). In addition, epidemiological studies strongly associate both chronic stress and acute psychosocial stress with the occurrence of CVDs. Recent Advances: Extensive research during recent decades has not only identified major pathways in cardiovascular inflammation but also revealed a link between psychosocial factors and the immune system in the context of atherosclerosis. Both chronic and acute psychosocial stress drive systemic inflammation via neuroimmune interactions and promote atherosclerosis progression. Critical Issues: The associations human epidemiological studies found between psychosocial stress and cardiovascular inflammation have been substantiated by additional experimental studies in mice and humans. However, we do not yet fully understand the mechanisms through which psychosocial stress drives cardiovascular inflammation; consequently, specific treatment, although urgently needed, is lacking. Future Directions: Psychosocial factors are increasingly acknowledged as risk factors for CVD and are currently treated via behavioral interventions. Additional mechanistic insights might provide novel pharmacological treatment options to reduce stress-related morbidity and mortality.

Today, an improved understanding of cancer cell response to cellular stress has become more necessary. Indeed, targeting the intracellular pro-oxidant/antioxidant balance triggering the tumor commitment to cell demise could represent an advantageous strategy to develop cancer-tailored therapies. In this scenario, the present study shows how the peel extract of mango—a tropical fruit rich in phytochemicals with nutraceutical properties—can affect the cell viability of three colon cancer cell lines (HT29, Caco-2 and HCT116), inducing an imbalance of cellular redox responses. By using hydro-alcoholic mango peel extract (MPE), we observed a consistent decline in thiol group content, which was accompanied by upregulation of MnSOD—a mitochondrial scavenger enzyme that modulates the cellular response against oxidative damage. Such an effect was the consequence of an early production of mitochondrial superoxide anions that appeared after just 30 min of exposure of colon cancer cells to MPE. The effect was accompanied by mitochondrial injury, consisting of the dissipation of mitochondrial membrane potential and a decrease in the level of proteins localized in the mitochondrial membrane—such as voltage-dependent anion-selective channel (VDAC1), mitofilin, and some members of Bcl-2 family proteins (Mcl-1, Bcl-2 and Bcl-XL)—with the mitochondrial release of apoptogenic factors (cytochrome C and AIF). The analysis of the cytotoxic effects exerted by the different constituents of MPE (gallic acid, mangiferin, citric acid, quinic acid, pentagalloyl glucose, and methyl gallate) allowed us to identify those phytochemicals responsible for the observed anticancer effects, sustaining their future employment as chemopreventive or therapeutic agents.

INFINITY project EU Report (https://h2020-infinity.eu/) This document provides an evaluation of the potential impacts of the use of immersive technologies on the users: potential positive impacts as well as potential negative impacts. We have conducted literature analysis in the different topics and present a report of what has been previously described in various fields, including investigation activities when available. We consider impacts on 3 dimensions: cognition, health, and well-being. I am the author of section 3 "ERGONOMIC RISKS OF VIRTUAL REALITY FOR LAW ENFORCEMENT AGENCIES"

Importance Prenatal maternal stress is increasingly associated with adverse outcomes in pregnant women and their offspring. However, the association between maternal stress and human fetal brain growth and metabolism is unknown. Objective To identify the association between prenatal maternal psychological distress and fetal brain growth, cortical maturation, and biochemical development using advanced 3-dimensional volumetric magnetic resonance imaging (MRI) and proton magnetic resonance spectroscopy (1H-MRS). Design, Setting, and Participants This cohort study prospectively recruited pregnant women from low-risk obstetric clinics in Washington, DC, from January 1, 2016, to April 17, 2019. Participants were healthy volunteers with a normal prenatal medical history, no chronic or pregnancy-induced physical or mental illnesses, and normal results on fetal ultrasonography and biometry studies. Fetal brain MRI studies were performed at 2 time points between 24 and 40 weeks' gestation. Exposures Prenatal maternal stress, anxiety, and depression. Main Outcomes and Measures Volumes of fetal total brain, cortical gray matter, white matter, deep gray matter, cerebellum, brainstem, and hippocampus were measured from 3-dimensional reconstructed T2-weighted MRI scans. Cortical folding measurements included local gyrification index, sulcal depth, and curvedness. Fetal brain N-acetylaspartate, creatine, and choline levels were quantified using 1H-MRS. Maternal stress, depression, and anxiety were measured with the Perceived Stress Scale (PSS), Edinburgh Postnatal Depression Scale (EPDS), Spielberger State Anxiety Inventory (SSAI), and Spielberger Trait Anxiety Inventory (STAI). Results A total of 193 MRI studies were performed in 119 pregnant women (67 [56%] carrying male fetuses and 52 [44%], female fetuses; maternal mean [SD] age, 34.46 [5.95] years) between 24 and 40 gestational weeks. All women were high school graduates, 99 (83%) were college graduates, and 100 (84%) reported professional employment. Thirty-two women (27%) had positive scores for stress, 31 (26%) for anxiety, and 13 (11%) for depression. Maternal trait anxiety was associated with smaller fetal left hippocampal volume (STAI score: –0.002 cm³; 95% CI, –0.003 to –0.0008 cm³; P = .004). Maternal anxiety and stress were associated with increased fetal cortical gyrification in the frontal lobe (β for SSAI score: 0.004 [95% CI, 0.001-0.006; P = .002]; β for STAI score: 0.004 [95% CI, 0.002-0.006; P < .001]; β for PSS score: 0.005 [95% CI, 0.001-0.008; P = .005]) and temporal lobe (β for SSAI score: 0.004 [95% CI, 0.001-0.007; P = .004]; β for STAI score: 0.004 [95% CI, 0.0008-0.006; P = .01]). Elevated maternal depression was associated with decreased creatine (EPDS score: –0.04; 95% CI, –0.06 to –0.02; P = .005) and choline (EPDS score: –0.03; 95% CI, –0.05 to –0.01; P = .02) levels in the fetal brain. Conclusions and Relevance This study found that the prevalence of maternal psychological distress in healthy, well-educated, and employed pregnant women was high, underappreciated, and associated with impaired fetal brain biochemistry and hippocampal growth as well as accelerated cortical folding. These findings appear to support the need for routine mental health surveillance for all pregnant women and targeted interventions in women with elevated psychological distress.

Most contemporary models of disease development consider the interaction between genotype and environment as static. The authors argue that because time is a key factor in genotype–environment interaction, this approach oversimplifies the pathology analysis and may lead to wrong conclusions. In reviewing the field, the authors suggest that the history of genotype–environment interactions plays an important role in the development of diseases and that this history may be analyzed using the phenotype as a proxy. Furthermore, a theoretical and experimental framework is proposed based on the assumption that phenotypes do not change from one to another randomly but are interconnected and follow certain phenotype trajectories. It then follows that analysis of such phenotype trajectories might be useful to predict the future phenotypes including the onset of disease. In addition, an analysis of phenotype trajectories can be subsequently used to choose better control subjects in comparative studies reducing noise and bias in studies investigating disease mechanisms. Besides genetic constitution and environmental factors, the biological age, history of previous phenotypes, and interactions of these factors affect the formation of an organism's phenotype. While each of these factors often is studied separately, the authors propose a concept of how to understand and study all these factors together.

Individual differences in maternal sensitivity to infant distress were examined by testing whether mothers' physiological responses interacted to predict sensitivity differently in a fear task relative to an anger task, and based on the level of distress displayed by the infant. Mothers' (N = 208) physiological arousal (skin conductance level [SCL] arousal) and physiological regulation (respiratory sinus arrhythmia [RSA] withdrawal/augmentation) were measured during a baseline task and while interacting with their 1-year-old infants during tasks that elicited infant fear and infant anger. Infant negative affect and maternal sensitivity were assessed during these interactions, and mothers later reported on their perceptions of infant distress during the tasks. Results indicated that the mother SCL arousal × RSA change interaction predicted sensitivity only with infants who displayed higher distress, and in a different pattern across tasks. In the fear task, for mothers of infants displaying higher distress, SCL arousal related to greater sensitivity only for mothers who displayed RSA withdrawal. In the anger task, for mothers of infants displaying higher distress, SCL arousal related to greater sensitivity only for mothers who displayed RSA augmentation. Further, although infants displayed similar levels of distress in each task, maternal SCL arousal, sensitivity, and perceptions of distress differed across tasks. These results suggest that contextual cues and infant distress cues both contribute to associations between mothers' physiological responses and maternal sensitivity.

  • Jan Gunst
  • Astrid De Bruyn
  • Greet Van den Berghe

Purpose of review: Critically ill patients usually develop hyperglycemia, which is associated with adverse outcome. Controversy exists whether the relationship is causal or not. This review summarizes recent evidence regarding glucose control in the ICU. Recent findings: Despite promising effects of tight glucose control in pioneer randomized controlled trials, the benefit has not been confirmed in subsequent multicenter studies and one trial found potential harm. This discrepancy could be explained by methodological differences between the trials rather than by a different case mix. Strategies to improve the efficacy and safety of tight glucose control have been developed, including the use of computerized treatment algorithms. Summary: The ideal blood glucose target remains unclear and may depend on the context. As compared with tolerating severe hyperglycemia, tight glucose control is well tolerated and effective in patients receiving early parenteral nutrition when provided with a protocol that includes frequent, accurate glucose measurements and avoids large glucose fluctuations. All patient subgroups potentially benefit, with the possible exception of patients with poorly controlled diabetes, who may need less aggressive glucose control. It remains unclear whether tight glucose control is beneficial or not in the absence of early parenteral nutrition.

  • Paul E Marik Paul E Marik
  • Rinaldo Bellomo

Stress hyperglycemia is common in critically ill patients and appears to be a marker of disease severity. Furthermore, both the admission as well as the mean glucose level during the hospital stay is strongly associated with patient outcomes. Clinicians, researchers and policy makers have assumed this association to be causal with the widespread adoption of protocols and programs for tight in-hospital glycemic control. However, a critical appraisal of the literature has demonstrated that attempts at tight glycemic control in both ICU and non-ICU patients do not improve health care outcomes. We suggest that hyperglycemia and insulin resistance in the setting of acute illness is an evolutionarily preserved adaptive responsive that increases the host's chances of survival. Furthermore, attempts to interfere with this exceedingly complex multi-system adaptive response may be harmful. This paper reviews the pathophysiology of stress hyperglycemia and insulin resistance and the protective role of stress hyperglycemia during acute illness.

This chapter proposes a more holistic approach to understanding work stress by incorporating eustress, the positive response to stressors. We begin by casting the study of eustress as part of a contemporary movement in both psychology and organizational behavior that accentuates the positive aspects of human adaptation and functioning. We discuss the development of the concept of eustress, and provide extensive evidence, both psychological and physiological, for the purpose of developing an explicit construct definition. An exploratory study of hospital nurses is presented as an initial test of our holistic model of stress. We conclude by asserting that there must exist a complement to coping with distress such that rather than preventing or resolving the negative side of stress, individuals savor the positive side of stress.

  • Hans Selye

Stress is "the nonspecific response of the body to any demand made upon it," that is, the rate at which we live at any one moment. All living beings are constantly under stress and anything, pleasant or unpleasant, that speeds up the intensity of life, causes a temporary increase in stress, the wear and tear exerted upon the body. A painful blow and a passionate kiss can be equally stressful.

  • Richard S. Lazarus

The 2 main tasks of this article are 1st, to examine what a theory of emotion must do and basic issues that it must address. These include definitional issues, whether or not physiological activity should be a defining attribute, categorical versus dimensional strategies, the reconciliation of biological universals with sociocultural sources of variability, and a classification of the emotions. The 2nd main task is to apply an analysis of appraisal patterns and the core relational themes that they produce to a number of commonly identified emotions. Anger, anxiety, sadness, and pride (to include 1 positive emotion) are used as illustrations. The purpose is to show the capability of a cognitive-motivational-relational theory to explain and predict the emotions. The role of coping in emotion is also discussed, and the article ends with a response to criticisms of a phenomenological, folk-theory outlook.