Factors of the environment that trigger this reaction are called stressors. Examples include noises, aggressive behavior, a speeding car, scary moments in movies, or even going out on a first date. The more stressors we experience, the more stressed we tend to feel. Stress slows normal bodily functions, such as the digestive and immune systems. All resources can then be concentrated on rapid breathing, blood flow, alertness, and muscle use.
How we react to a difficult situation will affect how stress affects us and our health. A person who feels they do not have enough resources to cope will be more likely to have a stronger reaction, and one that can trigger health problems. Stressors affect individuals in different ways. Some experiences that are generally considered positive can lead to stress, such as having a baby, going on a trip, moving to a nicer house, and being promoted.
This is because they often involve a major change, extra effort, new responsibilities, and a need for adaptation. They are also steps into the unknown. The person wonders if they will cope. A persistently negative response to challenges can have a detrimental effect on health and happiness. However, being aware of how you react to stressors can help reduce the negative feelings and effects of stress, and to manage it more effectively. The APA recognizes three different types of stress that require different levels of management. This type of stress is short-term and is the most common way that stress occurs.
Acute stress is often caused by thinking about the pressures of events that have recently occurred, or upcoming demands in the near future. For example, if you have recently been involved in an argument that has caused upset or have an upcoming deadline, you may feel stress about these triggers. However, the stress will be reduced or removed once these are resolved. It does not cause the same amount of damage as long-term, chronic stress. Short-term effects include tension headaches and an upset stomach , as well as a moderate amount of distress. People who frequently experience acute stress, or whose lives present frequent triggers of stress, have episodic acute stress.
A person with too many commitments and poor organization can find themselves displaying episodic stress symptoms. These include a tendency to be irritable and tense, and this irritability can affect relationships. Individuals that worry too much on a constant basis can also find themselves facing this type of stress.
This type of stress can also lead to high blood pressure and heart disease. Ongoing poverty, a dysfunctional family, or an unhappy marriage can cause chronic stress. It occurs when a person never sees an escape from the cause of stress and stops seeking solutions. Sometimes, it can be caused by a traumatic experience early in life. Chronic stress can continue unnoticed, as people can become used to it, unlike acute stress that is new and often has an immediate solution.
It can become part of an individual's personality, making them constantly prone to the effects of stress regardless of the scenarios they come up against. People with chronic stress are likely to have a final breakdown that can lead to suicide, violent actions, heart attacks , and strokes. We all react differently to stressful situations.
What is stressful to one person may not be stressful to another. Almost anything can cause stress. For some people, just thinking about something or several small things can cause stress. Some situations will affect some people and not others. Past experience can impact how a person will react. Sometimes, there is no identifiable cause.
Mental health issues, such as depression , or an accumulated sense of frustration and anxiety , can make some people feel stressed more easily than others. Some people experience ongoing stress after a traumatic event, such as an accident or some kind of abuse. This is known as post-traumatic stress disorder PTSD. Those who work in stressful jobs, such as the military or the emergency services, will have a debriefing session following a major incident, and they will be monitored for PTSD. A study suggested that the stressors experienced by parents, such as financial troubles or managing a single-parent household, can lead to obesity in their children.
Behaviors linked to stress include :. Diagnosis is complex. It depends on many factors. Questionnaires, biochemical measures, and physiological techniques have been used, but these may not be objective or effective. The most direct way to diagnose stress and its effects on a person is through a comprehensive, stress-oriented, face-to-face interview.
Treatment includes self-help and, in instances where the stress is caused by an underlying condition, certain medications. Some insurance providers cover this type of treatment, but be sure to check before pursuing this treatment. Doctors will not usually prescribe medications for coping with stress, unless the patient has an underlying illness, such as depression or a type of anxiety.
In such cases, an antidepressant may be prescribed. However, there is a risk that the medication will only mask the stress, rather than help you deal and cope with it. Antidepressants can also have adverse effects. Developing some coping strategies before stress hits can help an individual manage new situations and maintain physical and mental health. If you are already experiencing overwhelming stress, seek medical help.
Here are a few lifestyle choices you can take to manage or prevent the feeling of being overwhelmed. Exercise : Studies have shown that exercise can benefit a person's mental and physical state. Reducing intake of alcohol, drugs, and caffeine : These substances will not help prevent stress, and they can make it worse.
They should be cut out or reduced. Nutrition : A healthy, balanced diet with plenty of fruit and vegetables helps maintain the immune system at times of stress. A poor diet will lead to ill health and additional stress. Prioritizing : Spend a little time organizing your to-do list to see what is most important. Then focus of what you have completed or accomplished for the day, rather than what you are yet to finish. Time : Set aside some time each day just for yourself. Use it to organize your life, relax, and pursue your own interests.
Breathing and relaxation : Meditation, massage, and yoga can help. Breathing and relaxation techniques can slow down the system and help you relax. Breathing is also a central part of mindfulness meditation. Talking : Talking to family, friends, work colleagues, and your boss about your thoughts and worries will help you "let off steam. Acknowledging the signs : A person can be so anxious about the problem that is causing the stress that they do not notice the effects on their body. Noticing symptoms is the first step to taking action. People who experience work stress due to long hours may need to "take a step back.
Find your own destressor : Most people have something that helps them relax, such as reading a book, going for a walk, listening to music, or spending time with a friend or a pet. Joining a choir or a gym helps some people. Establishing support networks : The APA encourage people to develop networks of social support, for example, by talking to neighbors and others in the local community, or joining a club, charity, or religious organization.
Even if you are not feeling stressed now, being part of a group can prevent stress from developing and provide support and practical help when hard times come. Online social networking can help, as long as it does not replace face-to-face contact.
It can allow you to stay in touch with friends and family who are far away, and this can reduce anxiety. If the stress is affecting your daily life, you should seek professional help. A doctor or psychiatric specialist can often help, for example, through stress management training.
Techniques for stress management can be gained from self-help books, online resources, or by attending a stress management course. A counselor or psychotherapist can connect an individual who has stress with personal development courses or individual and group therapy sessions. Article last updated by Adam Felman on Tue 28 November All references are available in the References tab. How stress affects your health. Manage stress: Strengthen your support network. Nabi, H. Increased risk of coronary heart disease among individuals reporting adverse impact of stress on their health: the Whitehall II prospective cohort study.
From an empirical point of view, research on CATs and health-restoring arts interventions is metaphorically speaking in its infancy or adolescence. Drawing from experiential knowledge of individual practitioners a grand literature base of case studies and clinical recommendations has developed, with an only recently growing number of evidence-based studies that provide generalizable, and transferable data [ 37 , 38 ].
CATs are used world-wide in a variety of contexts with many different populations. In addition to creative arts therapists, there are artists offering creative interventions to the patients in health institutions. They most often work without a therapeutic professional background, but also use the potential of the arts in order to foster health.
To do justice to the heterogeneity of creative arts intervention studies in health care, this review includes studies on all CATs as well as arts art, music, dance and drama interventions. Mere arts interventions include interventions conducted by, for example, an artist no licensed creative arts therapist as well as single session interventions that not necessarily have a therapeutic intention. Both, CATs and arts intervention studies are referred to collectively as creative arts interventions. To understand creative arts interventions, and to strengthen their development for instance by identifying indications and contraindications, it is indicated to inspect them in various applied contexts.
The systematic review at hand provides an overview of evidence-based studies on stress management and stress prevention through creative arts interventions. Its goal is to promote a dialogue with various health practitioners and institutions on the potential and limitations of creative arts interventions in the context of stress prevention. To the knowledge of the authors this review is the first on the topic. In a systematic data base search, we collected empirical studies from —, which investigated CATs or arts interventions in the context of stress prevention.
The cutoff date for the search was the third of August In addition, we contacted experts in the field and asked them to hand in studies until the end of See Figure 1 for an overview of the search and study selection process. Only studies published in peer-reviewed journals were included. Flow-Chart of the data base search on creative arts interventions for stress prevention. The systematic data base search yielded studies. Studies were scanned following the PICOS principle patient, intervention, control, outcome, study design [ 39 ].
To stay in the context of prevention and avoid an overlap with creative arts interventions for acute disorders, for example, in the area of mental health, only studies targeting healthy individuals or people at risk were included. Studies were excluded, if they did not analyze arts interventions in a preventive context.
We included both adults and minors, because both groups have been found to be affected by stress. After the first round of exclusions on the base of these criteria, 86 studies remained. Aside from studies that specifically applied CATs, we also included studies, which provided arts interventions art, dance, music or drama with a group of participants, see reasoning for this decision above.
In Table 1 CATs are demarcated from mere arts interventions by color coding: clinical studies of CATs are colored green, single session studies of CATs and studies on arts interventions are colored black. Single-session interventions conducted by CATs or other professions were rated as mere arts interventions, because those studies do not fulfill the criterion of containing a therapeutic process with a therapeutic relationship. Interventions neither had to be standardized, nor had to have the same duration.
This heterogeneity reflects the variability of creative arts interventions in practice. Fifty-three studies remained. We included studies of evidence levels Ia—III. Evidence levels were defined according to the Agency for Healthcare Research and Quality AHRQ [ 40 ], rated by the first author and confirmed by the fourth author. Case studies were excluded. Qualitative, quantitative, as well as mixed method studies were included, as long as their method was clearly stated in the qualitative realm, e. After checking the remaining studies for those criteria, 32 studies remained. Five studies were handed in by experts after the cut-off date and thoroughly checked for the criteria named above.
In total, we analyzed and compared 37 studies. Table 1 summarizes content, sample, and intervention characteristics, design, research methods, and results of the studies identified [ 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 , 67 , 68 , 69 , 70 , 71 , 72 , 73 , 74 , 75 , 76 , 77 , 78 ].
In total, 37 studies met our inclusion criteria, 11 studies There were no studies on DT or drama interventions that met the inclusion criteria. In total, subjects were included: took part in AT or art interventions for stress management, in MT or musical interventions, and in DMT or dance interventions. Most participants were women see Table 1. Some studies did not display demographic data of their samples, and were omitted in the respective calculations.
Duration times of interventions varied from single sessions on one day to weekly sessions for 10 weeks. Due to the great heterogeneity of interventions and the lack of reported effect sizes in many of the single studies, we did not calculate an overall effect size for the arts modalities. Due to space limitations only the most central qualitative and quantitative results of the included studies are displayed.
Table 2 gives an analytical overview of the numbers of respective studies by arts modality. As presumed earlier, most of the studies were conducted and published after Only five studies No meta-analysis evidence level Ia was found on CATs or arts interventions for stress management and stress prevention. Five studies Most of the studies 16; With eight studies, AT provided Within the arts modalities Most therapy intervention studies with several intervention sessions were found in MT 11 out of 20 and one in DMT 1 out of 6.
In AT, only studies on effects of artistic activities or single-session interventions were found. Overview of the reviewed studies. Evidence levels are defined according to AHRQ [ 40 ]. Active art interventions , such as drawing or working with clay significantly reduced stress and anxiety in eight out of eleven studies [ 42 , 44 , 45 , 46 , 49 , 50 , 51 , 52 ].
None of the studies analyzed the effects of continuous interventions specifically defined as AT, Three studies [ 46 , 51 , 52 ] reported significant positive mood changes. Two studies [ 47 , 48 ] did not find a significant stress reduction or mood changes. Two studies [ 43 , 51 ] stated that stress reduction depended on the content of the art work: positive content induced stress reduction, negative content did not.
Two of the studies [ 45 , 50 ] used physical measures cortisol level [ 45 ]; pulse and blood pressure [ 50 ] to operationalize stress. MT or musical interventions reduced stress and anxiety in 16 of 20 studies 10 on MT, 6 on music interventions [ 53 , 54 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 65 , 66 , 67 , 68 , 70 , 72 ].
Four studies one of MT, three on music interventions [ 53 , 61 , 68 , 70 ] reported reductions in cortisol level, as a physical measurement of stress, and two studies both on MT [ 53 , 58 ] found a decrease of sleeping problems through musical interventions. Four studies one on MT, three on music interventions [ 55 , 59 , 64 ] did not find a significant reduction of their stress outcomes. All studies analyzing DMT or dance interventions found a significant reduction of stress signs or stress coping abilities in their subjects. Only one of the studies analyzed the effects of DT.
In all but two studies [ 75 , 76 ] stress was measured by different self-evaluation tests. In the two other studies, stress was tested with saliva samples for cortisol levels. Four studies [ 73 , 74 , 75 , 76 ] furthermore reported a decrease in anxiety levels and negative affect. In total, stress was significantly reduced in 30 out of 37 included studies Eleven out of twelve Recently, besides being an important part in clinical health care practice, creative arts interventions have become an important area of integrative medicine research.
Despite the novelty of CATs, a notable evidence-base on the efficacy of creative arts interventions in various contexts and with many different populations is emerging. In the context of stress prevention, the quality of efficacy studies analyzing creative arts interventions is high. Similar to other health care contexts, MT and music interventions contribute the highest quality studies. This can be attributed to the comparably early establishment of MT, its specific focus on group therapy as well as its comparably low psychoanalytic and high empirical orientation see [ 25 ].
CATs and creative arts interventions seem to have a positive impact on perceived stress and stress management. This may be due to certain therapeutic mechanisms that researchers assume to be relevant for all creative arts therapies.
It remains mostly unclear how these therapeutic mechanisms interact or whether they are active in all clients and contexts. Their empirical validation is a task for future research. Very few of the studies clearly reported all necessary statistics needed for the calculation of effect sizes. Some did not even report the full demographic data.
This high heterogeneity might be the biggest problem of the young academic field. The high heterogeneity of interventions and measures makes the application of meta-analyses difficult. This is true not only across creative arts interventions but also within each single arts modality art, music, dance, drama. It might thus be worth looking at specific and common features of the individual CATs, delineating them from mere arts interventions and starting to relate them to features of populations and contexts. This may be a good way to find out, what is specific about each arts modality, and which contexts they work best in indications and contraindications; see for example [ 25 , 78 , 79 , 80 ].
Demarcating core characteristics and mechanisms of CATs or arts interventions individually also helps to choose an adequate control group for intervention studies. Finally, finding commonalities across creative arts interventions could help clarify the benefit they bring to the health system and its agents. Patients already acknowledge these benefits, and the evidence-base on creative arts interventions is in the process of being built. National Center for Biotechnology Information , U.
Journal List Behav Sci Basel v. Behav Sci Basel. Published online Feb Koch 1, 2. Find articles by Lily Martin.
Find articles by Renate Oepen. Find articles by Harald Gruber. Sabine C. Author information Article notes Copyright and License information Disclaimer. Received Dec 7; Accepted Feb This article has been cited by other articles in PMC. Keywords: creative arts therapies, arts interventions, art, music, dance, drama, stress management, prevention, systematic review. Stress as a Preparation to Act Stress is the most widespread disease of the modern age. Box 1 Overview of the four main modalities of CATs.
Methods In a systematic data base search, we collected empirical studies from —, which investigated CATs or arts interventions in the context of stress prevention. Open in a separate window. Figure 1. Process of the Systematic Study Search The systematic data base search yielded studies. The compositional elements of shape, size and color are of particular importance. Mercer et al. Sandmire et al. Smolarski et al.
Inducing a negative mood 2. Randomized allocation to three groups: Group A: drawing happiness acting out a positive mood Group B: drawing current stress acting out a negative mood Group C: tracing and coloring a simple drawing control group, distraction strategy , 1 single session Mood State: Profile of Mood States POMS two-factorial ANOVA with repeated measures 3 groups; time: baseline, pre-post-treatment Sig. Walsh et al. Differences between groups were not sig. Qualitative results: Music therapeutic Intervention helped subjects to relax and to recharge energy. Du Rousseau et al. Goff et al.
Nature Sounds vs. Murphy et al. Improvement of heart rate and respiratory rate see Tables 6—9, pp. Rider et al. PMR and GI visualization of imaginative images ; 5 times a week over 3 months Adrenal Corticosteroid Stress hormones : Urine samples, temperature measurements; Taylor-Johnson Temperament Analysis, State-Trait Anxiety Inventory, Torrance Test of Creativity, Circadian Type Questionnaire t -tests Reduction of circadian amplitude and corticosteroid temperature rhythms during music listening; The average corticosteroid level did not improve sig.
Playing the piano shows the biggest effects. Regular tango dance with partner and music 2. Tango dance with partner without music 3. Dance without partner but with music 4. The effect was dependent on the music, but not on the partner. West et al. Hatha Yoga 2. African Dance 3. CG: goal-directed movement improvisation to the same music.
Results Table 1 summarizes content, sample, and intervention characteristics, design, research methods, and results of the studies identified [ 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 , 67 , 68 , 69 , 70 , 71 , 72 , 73 , 74 , 75 , 76 , 77 , 78 ]. Table 2 Overview of the reviewed studies. Note: The bold numbers stand for total numbers.
Discussion Recently, besides being an important part in clinical health care practice, creative arts interventions have become an important area of integrative medicine research. Author Contributions S. Conflicts of Interest The authors declare no conflict of interest. References 1. Korczak D.
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