Stress and Addiction: When a Robust Stress Response Indicates Resiliency.
Stress and Addiction: When a Robust Stress Response Indicates Resiliency.
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DOI：
10.1097/psy.0000000000000520
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发表时间：
2018-01
影响因子：
3.3
通讯作者：
alʼAbsi M
中科院分区：
文献类型：
--
作者：
alʼAbsi M
压力反应研究传统上集中在对压力的过度反应可能对健康产生不利影响的想法上。越来越多的证据表明，对压力的反应减弱和恢复延迟也可能是有问题的。本文综述了下丘脑-垂体-肾上腺皮质（HPA）轴、内源性阿片系统（EOS）和心血管系统的应激反应在高血压、疼痛感知和成瘾行为中的作用。在过去的二十年里，我们实验室进行的多种评估方法和压力范式的结果与其他研究人员的研究和现有的理论相结合。研究表明，对压力的过度生物和生理反应以及减弱的疼痛感知与高血压和心血管疾病的风险有关。这项研究补充了将减少压力反应与增强疼痛敏感性和不适联系起来的工作。多项研究还表明，减弱的应激反应与戒断症状的加重和尼古丁成瘾的复发有关。证据表明重要的主持人（即，性别、人格特征和早期生活逆境）以及HPA和EOS相关机制在改变应激反应中的作用。我们将这些发现整合到一个概念模型中，强调在成瘾和复发的背景下，强大的压力反应应被视为弹性的标志。迟钝的应激反应可能表明长期的生理失调，可能导致心血管疾病、疼痛感知和成瘾性疾病的有害后果。在评估应激反应失调的临床意义时，应考虑多种个体和情境因素对失调的影响。
Stress reactivity research has traditionally focused on the idea that exaggerated responses to stress may have adverse effects on health. Accumulating evidence suggests that attenuated responses to stress and delayed recovery may also be problematic. This review focuses on the role of the stress response of the hypothalamic-pituitary-adrenocortical (HPA) axis, the endogenous opioid system (EOS), and the cardiovascular system in hypertension, pain perception, and addictive behaviors. Results from multiple methods of assessment and stress paradigms conducted in our laboratory over the past two decades are integrated with research from other investigators and with existing theories. Research indicates that exaggerated biological and physiological responses to stress and attenuated pain perception are associated with hypertension and risk for cardiovascular diseases. This research complements work linking reduced stress responses with enhanced pain sensitivity and discomfort. Multiple studies have also demonstrated that an attenuated stress response is linked to exacerbation of withdrawal symptoms and relapse in nicotine addiction. Evidence indicates important moderators (i.e., sex, personality traits, and early life adversity) and HPA- and EOS-related mechanisms in the altered response to stress. We integrate these findings in a conceptual model emphasizing that robust stress responses in the context of addiction and relapse should be considered as a marker of resiliency. A blunted stress response may indicate long-term physiological dysregulation that could usher harmful consequences for cardiovascular disease, pain perception and addictive disorders. The impact of dysregulation is influenced by multiple individual and situational factors that should be considered in evaluating the clinical significance of stress response dysregulation.