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Embodying psychological thriving: physical thriving in response to stress - Thriving: Broadening the Paradigm Beyond Illness to Health
Journal of Social Issues, Summer, 1998 by Elissa S. Epel, Bruce S. McEwen, Jeannette R. Ickovics
A discussion of psychological thriving in response to stress would not be complete without a description of the physiological correlates of such experiences. Throughout time, societies have believed in the interdependence of mind and body, and research is beginning to demonstrate their interactions empirically. Most health psychology research explores how negative emotions, cognitive variables, and stressors influence disease. However, there has been limited focus on how psychological responses to adversity can lead to enhanced health or physical thriving.
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Psychological thriving in response to a stressor is defined as the acquisition of greater self-confidence and skills or the effective mobilization of resources moving beyond homeostasis (O' Leafy & Ickovics, 1995). Physical thriving can be similarly defined as changes that lead to enhanced health. As Carver (this issue) describes, psychological thriving occurs when it is least expected. Similarly, under conditions of stress, one would expect a physically weakened system, but positive physiological changes can occur - often in the context of psychological thriving. In physiological terms, this translates into greater restorative (i.e., anabolic) processes than destructive (i.e., catabolic) processes at work.
This article describes how psychological thriving can lead to physical thriving and reviews a neglected body of research suggesting that it is possible to improve physical health through the process of coping effectively with stressors. In fact, there are unique pathways of developing physical resilience that actually require exposure to stressors, which can be called a toughening-up process. Toughening is a term first applied to rats who became more hardy after being exposed to stressors (Miller, 1980). An analogy to this toughening-up process is building muscle, where one needs to break down muscle initially to build a stronger muscle than before. As we describe in detail below, toughening up after a stressor may involve initial short-term catabolic processes, followed by greater anabolic processes, which can improve physical health.
We draw from psychoneuroendocrine research to show that in response to stressors, certain styles of cognitive appraisal and perceptions of control can transform the effects of stress arousal from potentially damaging to health enhancing. Thus, the chain of events from perception of stress to physiological response can shape one's current state of health. Finally, we present new data from a study of cortisol responses to a chronic laboratory stressor that begins to validate resilient profiles of stress reactivity as a micro-level index of enhanced health.
Defining Physical Thriving: Physical Thriving Is Not Merely the Opposite of Physical Decline
The study of psychological thriving, as described in this issue, shows that thriving may be specific to only some dimensions of psychological well-being. For example, one could feel great distress in response to the diagnosis of terminal illness or the death of a spouse, but at the same time be adjusting well and even growing psychologically (see Massey, Cameron, Ouellette, & Fine, this issue; O'Leary & Ickovics, 1995; Zisook & Shuchter, 1991). Therefore, psychological health can be independent of psychological distress. Physical health is often measured by the mere absence of disease. However, like psychological health, physical thriving can be independent of disease, and in certain cases can even coexist with signs of disease. For example, a person with multiple sclerosis or an amputated limb may become a marathon runner (Hansen, Bayer, & Ickovics, 1998) and thus have excellent health on some dimensions, such as physical fitness, while still having a chronic disease or disability. Physical thriving is defined here as any physiological changes brought about as a result of facing stressors that leave one with greater physiological resilience than she or he had before facing adversity. We can also identify thriving as when the stressor is a disease or other health threat, and one remains more healthy than expected, given the physiological challenge. So physical thriving can refer both to enhanced health and to one's health status above the expected baseline in response to a stressor.
Stress can serve as a catalyst for physical changes, advancing one's physical state toward either health or disease. After facing stress, a healthy responding system may become more resilient, whereas a weakened system may be unable to grow following the stressor. It is important to identify measures of enhanced health and restorative activity (growth and repair) to better assess dynamic indices of health and identify psychological factors related to enhanced health.
Positive physical changes could be the result of behavior, such as increased exercise or other self-care behaviors, or changes in physiology mediated by stress-responsive hormones, which are the focus of this article. The most direct way psychological factors affect health is through the neuroendocrine response systems, which affect the functioning of nearly every physiological system at all stages of life. We review selective research on the psychoneuroendocrinology of stress, which offers some clues on how to identify and predict healthy physiological responses to stressors.
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