Stress, defined as the physiological and psychological response to perceived threats to homeostasis, is a common feature in clinical populations and a driver of multiple somatic and psychiatric comorbidities[1][2]. Chronic stress exposure is associated with dysregulation of the hypothalamic–pituitary–adrenal (HPA) axis, autonomic imbalance, and downstream effects on metabolic, cardiovascular, and immune systems[3][4]. Effective stress management in clinical practice requires an evidence-based, multimodal approach integrating assessment, targeted psychosocial interventions, behavioral medicine techniques, and when appropriate, pharmacologic strategies[5][6].
Clinical assessment of stress should combine history, validated rating scales, and, when indicated, physiological measurements:
A stepped-care model is practical for most clinical settings: initial screening and low-intensity interventions (education, brief CBT-based techniques, exercise prescriptions), with escalation to specialist psychotherapies, structured group programs (MBSR), or pharmacotherapy for non-responders[5:1][15:1]. Collaborative care models improve engagement and outcomes for stress-related disorders in primary care[27].
Emerging research focuses on multimodal biomarkers (salivary cortisol diurnal profiles, HRV analytics, inflammatory signatures) to phenotype stress responses and predict treatment response[3:3][10:2][30]. Digital health tools (ecological momentary assessment, wearable HRV trackers) enable real-world monitoring and personalized intervention delivery; rigorous validation studies are ongoing[31].
Research priorities include precision phenotyping of stress subtypes, integration of multimodal biomarkers with clinical data, scalable delivery of evidence-based psychotherapies (digital or group formats), and trials of combined behavioral–pharmacologic strategies for high-risk populations[30:1][31:2].
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