Stress regulation
Stress is part of life and, in some situations, a useful response. When it becomes frequent or prolonged, it can affect sleep, mood, recovery and how we feel and function day to day.
That is why we look not only at whether stress is present, but at how it is perceived, the context in which it happens and how it evolves over time.
Prolonged stress is also part of health.
Acute stress is a normal response to the different demands of daily life. The problem arises when exposure to stress is prolonged or when we feel that the resources available are not enough to cope with those demands.
Prolonged exposure to stress is associated with different health outcomes1,2 and can coexist with changes in sleep,3 mood, recovery and wellbeing. Understanding the context in which it happens is therefore as important as following its intensity over time.
The aim is not to eliminate stress, but to understand its presence, its context and how it evolves.
What is asked and what is measured.
PSS-4, perceived stress
A brief questionnaire about perceived stress and the sense of control over the demands of the last few weeks.4 It allows changes to be followed over time.
Hooper index: stress and mood
The Hooper index follows dimensions such as stress, mood, fatigue and sleep.5 Here we look mainly at stress and mood, relating them to the other pillars.
Heart rate variability
Heart rate variability (HRV) is influenced by many factors, including sleep, training, alcohol6 and stress.7 When available, its trend over time can add context to the rest of the information.
Cortisol and DHEA-S
When lab results for these markers exist, they can become part of the health history. Their interpretation depends on the clinical context, the method and the laboratory's reference values.
CBI, burnout
The Copenhagen Burnout Inventory assesses different dimensions of exhaustion, including personal and work-related burnout.8 It is an assessment instrument, not a diagnosis.
Reported signs
Muscle tension, irritability, difficulty switching off, persistent worry or changes in sleep can add context to how the person feels.
None of these pieces is read alone.
Perceived stress gains context when it is followed over time and related to sleep, mood and life events.
Wearable data such as HRV, when available, can add information, but it is influenced by many factors and should not be interpreted in isolation.
Physical symptoms or changes in wellbeing also need to be understood in each person's context; they should not be automatically attributed to stress.
The platform organises and presents the information. Interpreting the whole belongs to the health professional.
Habits that help regulate stress.
Slow breathing
Slow, controlled breathing practices can help reduce physiological activation and promote relaxation.9
Time in contact with nature
Spending time in green spaces and outdoors is associated with benefits to wellbeing and lower levels of perceived stress.10
Breaks and recovery
Create moments of pause and respect periods of rest. Short breaks between tasks are associated with more energy and less fatigue.11 Recognising persistent signs of overload helps you notice when more than a break is needed.
What people ask about stress.
Is stress really bad for your health?
Acute stress is a normal response. The problem is prolonged exposure: in the review by Kivimäki and Kawachi (2015), different forms of prolonged work stress were associated with about 10% to 40% higher risk of coronary heart disease and stroke. These are observational studies, which do not show causation on their own, and prolonged stress often coexists with changes in sleep.
Does slow breathing work?
Slow, controlled breathing practices can reduce physiological activation and promote relaxation (Zaccaro et al., 2018). Time in green spaces and short breaks between tasks are also associated with less perceived stress and less fatigue.
How is stress followed?
With brief, validated instruments: the PSS-4 for perceived stress, the Hooper Index for stress, mood, fatigue and sleep, and the CBI for burnout; heart rate variability comes in when there is a wearable. None is a diagnosis, and the reading belongs to the appointment, in the person's context.
What is burnout and how is it assessed?
The Copenhagen Burnout Inventory (CBI) assesses dimensions of exhaustion, including personal and work-related burnout (Kristensen et al., 2005). It is an assessment instrument, not a diagnosis; persistent signs of overload are a reason for more than a break.
References (11)
- Kivimäki M, Kawachi I. Work stress as a risk factor for cardiovascular disease. Curr Cardiol Rep. 2015;17(9):630. doi:10.1007/s11886-015-0630-8
- McEwen BS. Protective and damaging effects of stress mediators. N Engl J Med. 1998;338(3):171-179. doi:10.1056/NEJM199801153380307
- Kalmbach DA, Anderson JR, Drake CL. The impact of stress on sleep: pathogenic sleep reactivity as a vulnerability to insomnia and circadian disorders. J Sleep Res. 2018;27(6):e12710. doi:10.1111/jsr.12710
- Cohen S, Kamarck T, Mermelstein R. A global measure of perceived stress. J Health Soc Behav. 1983;24(4):385-396.
- Hooper SL, Mackinnon LT. Monitoring overtraining in athletes: recommendations. Sports Med. 1995;20(5):321-327. doi:10.2165/00007256-199520050-00003
- Pietilä J, et al. Acute effect of alcohol intake on cardiovascular autonomic regulation during the first hours of sleep in a large real-world sample of Finnish employees: observational study. JMIR Ment Health. 2018;5(1):e23. doi:10.2196/mental.9519
- Kim HG, Cheon EJ, Bai DS, Lee YH, Koo BH. Stress and heart rate variability: a meta-analysis and review of the literature. Psychiatry Investig. 2018;15(3):235-245. doi:10.30773/pi.2017.08.17
- Kristensen TS, Borritz M, Villadsen E, Christensen KB. The Copenhagen Burnout Inventory: a new tool for the assessment of burnout. Work Stress. 2005;19(3):192-207.
- Zaccaro A, et al. How breath-control can change your life: a systematic review on psycho-physiological correlates of slow breathing. Front Hum Neurosci. 2018;12:353. doi:10.3389/fnhum.2018.00353
- Corazon SS, Sidenius U, Poulsen DV, Gramkow MC, Stigsdotter UK. Psycho-physiological stress recovery in outdoor nature-based interventions: a systematic review of the past eight years of research. Int J Environ Res Public Health. 2019;16(10):1711. doi:10.3390/ijerph16101711
- Albulescu P, Macsinga I, Rusu A, Sulea C, Bodnaru A, Tulbure BT. "Give me a break!" A systematic review and meta-analysis on the efficacy of micro-breaks for increasing well-being and performance. PLoS One. 2022;17(8):e0272460. doi:10.1371/journal.pone.0272460
The references describe results observed in populations. They do not determine what happens to each person. Individual interpretation belongs to the health professional.
Caring for health means thinking long term.
In the appointment, we look at your health, movement and context to define an approach suited to your needs.