What is Distress?


In medicine, distress is an aversive state in which a person is unable to completely adapt to stressors and their resulting stress and shows maladaptive behaviours.

It can be evident in the presence of various phenomena, such as inappropriate social interaction (e.g., aggression, passivity, or withdrawal).

Distress is the opposite of eustress, a positive stress that motivates people.

Risk Factors

Stress can be created by influences such as work, school, peers or co-workers, family and death. Other influences vary by age.

People under constant distress are more likely to become sick, mentally or physically. There is a clear response association between psychological distress and major causes of mortality across the full range of distress.

Higher education has been linked to a reduction in psychological distress in both men and women, and these effects persist throughout the aging process, not just immediately after receiving education. However, this link does lessen with age. The major mechanism by which higher education plays a role on reducing stress in men is more so related to labour-market resources rather than social resources as in women.

In the clinic, distress is a patient reported outcome that has a huge impact on patient’s quality of life. To assess patient distress, a Hospital Anxiety and Depression Scale (HADS) questionnaire is most commonly used. The score from the HADS questionnaire guides a clinician to recommend lifestyle modifications or further assessment for mental disorders like depression.


People often find ways of dealing with distress, in both negative and positive ways. Examples of positive ways are listening to music, calming exercises, colouring, sports and similar healthy distractions. Negative ways can include but are not limited to use of drugs including alcohol, and expression of anger, which are likely to lead to complicated social interactions, thus causing increased distress.

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Who was Hans Selye?


János Hugo Bruno “Hans” Selye CC (Hungarian: Selye János; 26 January 1907 to 16 October 1982) was a pioneering Hungarian-Canadian endocrinologist who conducted important scientific work on the hypothetical non-specific response of an organism to stressors.

Although he did not recognise all of the many aspects of glucocorticoids, Selye was aware of their role in the stress response. Charlotte Gerson considers him the first to demonstrate the existence of biological stress.

Hans Selye in the 1970s
Hans Selye in the 1970s.


Selye was born in Vienna, Austria-Hungary on 26 January 1907 and grew up in Komárom (the town with Hungarian majority in present day Slovakia was cut by the Treaty of Trianon in 1920). Selye’s father was a doctor of Hungarian ethnicity and his mother was Austrian. He became a Doctor of Medicine and Chemistry in Prague in 1929 and went on to do pioneering work in stress and endocrinology at Johns Hopkins University, McGill University, and the Université de Montréal. He was nominated for the Nobel Prize in Physiology or Medicine for the first time in 1949. Although he received a total of 17 nominations in his career, he never won the prize.

Selye died on 16 October 1982 in Montreal, Quebec, Canada. He often returned to visit Hungary, giving lectures as well as interviews in Hungarian television programs. He conducted a lecture in 1973 at the Hungarian Scientific Academy in Hungarian and observers noted that he had no accent, despite spending many years abroad. His book The Stress of Life appeared in Hungarian as Az Életünk és a stressz in 1964 and became a bestseller. Selye János University, the only Hungarian-language university in Slovakia, was named after him. Selye’s mother was killed by gunfire during Hungary’s anti-Communist revolt of 1956.

Stress Research

Selye’s interest in stress began when he was in medical school; he had observed that patients with various chronic illnesses like tuberculosis and cancer appeared to display a common set of symptoms that he attributed to what is now commonly called stress. After completing his medical degree and a doctorate degree in organic chemistry at the German University of Prague, he received a Rockefeller Foundation fellowship to study at Johns Hopkins in Baltimore and later moved to the Department of Biochemistry at McGill University in Montreal where he studied under the sponsorship of James Bertram Collip. While working with laboratory animals, Selye observed a phenomenon that he thought resembled what he had previously seen in chronic patients. Rats exposed to cold, drugs, or surgical injury exhibited a common pattern of responses to these stressors (A stressor is a chemical or biological agent, environmental condition, external stimulus or an event seen as causing stress to an organism).

Selye initially (circa 1940s) called this the “general adaptation syndrome” (at the time it was also called “Selye’s syndrome”), but he later rebaptised it with the simpler term “stress response”. According to Selye the general adaptation syndrome is triphasic, involving an initial alarm phase followed by a stage of resistance or adaptation and, finally, a stage of exhaustion and death (these phases were established largely on the basis of glandular states). Working with doctoral student Thomas McKeown (1912-1988), Selye published a report that used the word “stress” to describe these responses to adverse events.

His last inspiration for general adaptation syndrome came from an experiment in which he injected mice with extracts of various organs. He at first believed he had discovered a new hormone, but was proved wrong when every irritating substance he injected produced the same symptoms (swelling of the adrenal cortex, atrophy of the thymus, gastric and duodenal ulcers). This, paired with his observation that people with different diseases exhibit similar symptoms, led to his description of the effects of “noxious agents” as he at first called it. He later coined the term “stress”, which has been accepted into the lexicon of most other languages.

Selye argued that stress differs from other physical responses in that it is identical whether the provoking impulse is positive or negative. He called negative stress “distress” and positive stress “eustress“.

The system whereby the body copes with stress, the hypothalamic-pituitary-adrenal axis (HPA axis) system, was also first described by Selye.

Selye has acknowledged the influence of Claude Bernard (who developed the idea of milieu intérieur) and Walter Cannon’s “homeostasis”. Selye conceptualised the physiology of stress as having two components: a set of responses which he called the “general adaptation syndrome”, and the development of a pathological state from ongoing, unrelieved stress.

While the work attracted continued support from advocates of psychosomatic medicine, many in experimental physiology concluded that his concepts were too vague and unmeasurable. During the 1950s, Selye turned away from the laboratory to promote his concept through popular books and lecture tours. He wrote for both non-academic physicians and, in an international bestseller entitled The Stress of Life (1956). From the late 1960s, academic psychologists started to adopt Selye’s concept of stress, and he followed The Stress of Life with two other books for the general public, From Dream to Discovery: On Being a Scientist (1964) and Stress without Distress (1974).

He worked as a professor and director of the Institute of Experimental Medicine and Surgery at the Université de Montréal. In 1975 he created the International Institute of Stress, and in 1979, Selye and Arthur Antille started the Hans Selye Foundation. Later Selye and eight Nobel laureates founded the Canadian Institute of Stress.

In 1968 he was made a Companion of the Order of Canada. In 1976, he was awarded the Loyola Medal by Concordia University.

Controversy and Involvement with the Tobacco Industry

Although it was not widely known at the time, Selye began consulting for the tobacco industry starting in 1958; he had previously sought funding from the industry, but had been denied. Later, New York attorney Edwin Jacob contacted Selye as he prepared a defence against liability actions brought against tobacco companies. The companies wanted Selye’s help in arguing that the recognized correlation between smoking and cancer was not proof of causality. The firm offered to pay Selye $1000 to make a statement supporting this claim. He agreed but refused to testify. Tobacco industry lawyers reported that Selye was willing to incorporate industry advice when writing about smoking and stress. One lawyer advised him to “comment on the unlikelihood of there being a mechanism by which smoking could cause cardiovascular disease” and to emphasize the “stressful” effect that anti-smoking messages had on the US population.

Publicly, Selye never declared his consultancy work for the tobacco industry. In a 1967 letter to “Medical Opinion and Review”, he argued against government over-regulation of science and public health, implying that his views on smoking were objective: “I purposely avoided any mention of government-supported research because, being too largely dependent upon it, I may not be able to view the subject objectively. However, I do not use … cigarettes so let these examples suffice.” In June 1969, Selye (then director of the Institute of Experimental Pathology, University of Montreal) testified before the Canadian House of Commons Health Committee against anti-smoking legislation, opposing advertising restrictions, health warnings, and restrictions on tar and nicotine. For his testimony Selye was funded $50 000 per year for a 3-year “special project”, by William Thomas Hoyt (executive of Council for Tobacco Research) with another $50,000 a year pledged by the Canadian tobacco industry. His comments on smoking were used worldwide, Philip Morris (Tobacco company) used Selye’s statements on the benefits of smoking to argue against the use of health warnings on tobacco products in Sweden. Similarly, in 1977 the Australian Cigarette Manufacturers quoted Selye extensively in their submission to the Australian Senate Standing Committee on Social Welfare.

In 1999, the United States Department of Justice brought an anti-racketeering case against 7 tobacco companies (British American Tobacco, Brown & Williamson, Philip Morris, Liggett, American Tobacco Company, RJ Reynolds, and Lorillard), the Council for Tobacco Research, and the Tobacco Institute. As a result, the industry’s influence on stress research was revealed.

This page is based on the copyrighted Wikipedia article <https://en.wikipedia.org/wiki/Hans_Selye >; it is used under the Creative Commons Attribution-ShareAlike 3.0 Unported License (CC-BY-SA). You may redistribute it, verbatim or modified, providing that you comply with the terms of the CC-BY-SA.

What is Eustress?


Eustress means beneficial stress – either psychological, physical (e.g. exercise), or biochemical/radiological (hormesis).

The term was coined by endocrinologist Hans Selye, consisting of the Greek prefix eu- meaning “good”, and stress, literally meaning “good stress”.

It is the positive cognitive response to stress that is healthy, or gives one a feeling of fulfillment or other positive feelings. Selye created the term as a subgroup of stress to differentiate the wide variety of stressors and manifestations of stress.

Eustress is not defined by the stress or type, but rather how one perceives that stressors (e.g. a negative threat versus a positive challenge). Eustress refers to a positive response one has to a stressor, which can depend on one’s current feelings of control, desirability, location, and timing of the stressor. Potential indicators of eustress may include responding to a stressor with a sense of meaning, hope, or vigour. Eustress has also been positively correlated with life satisfaction and well-being.

Refer to Distress.


Eustress occurs when the gap between what one has and what one wants is slightly pushed, but not overwhelmed. The goal is not too far out of reach but is still slightly more than one can handle. This fosters challenge and motivation since the goal is in sight. The function of challenge is to motivate a person toward improvement and a goal. Challenge is an opportunity-related emotion that allows people to achieve unmet goals. Eustress is indicated by hope and active engagement. Eustress has a significantly positive correlation with life satisfaction and hope. It is typically assumed that experiencing chronic stress, either in the form of distress or eustress, is negative. However, eustress can instead fuel physiological thriving by positively influencing the underlying biological processes implicated in physical recovery and immunity.


Occupational eustress may be measured on subjective levels such as of quality of life or work life, job pressure, psychological coping resources, complaints, overall stress level, and mental health. Other subjective methodological practices have included interviews with focus groups asking about stressors and stress level. In one study participants were asked to remember a past stressful event and then answer questionnaires on coping skills, job well-being, and appraisal of the situation (viewing the stressful event as a challenge or a threat). Common subjective methodologies were incorporated in a holistic stress model created in 2007 to acknowledge the importance of eustress, particularly in the workplace. This model uses hope, positive affect, meaningfulness, and manageability as a measure of eustress, and negative psychological states, negative affect, anxiety, and anger as a measure of distress. Objective measures have also been used and include blood pressure rate, muscle tension, and absenteeism rates. Further physiological research has looked for neuroendocrine changes as a result of eustress and distress. Research has shown that catecholamines change rapidly to pleasurable stimuli. Studies have demonstrated that eustress and distress produce different responses in the neuroendocrine system, particularly dependent on the amount of personal control one feels over a stressor.

Compared with Distress

Distress is the most commonly referred to type of stress, having negative implications, whereas eustress is usually related to desirable events in a person’s life. Selye first differentiated the two in an article he wrote in 1975. In this article Selye argued that persistent stress that is not resolved through coping or adaptation should be known as distress, and may lead to anxiety, withdrawal, and depressive behaviour. In contrast, if stress enhances one’s functioning it may be considered eustress. Both can be equally taxing on the body, and are cumulative in nature, depending on a person’s way of adapting to the stressor that caused it. The body itself cannot physically discern between distress or eustress. Differentiation between the two is dependent on one’s perception of the stress, but it is believed that the same stressor may cause both eustress and distress. One context that this may occur in is societal trauma (e.g. the black death, World War II) which may cause great distress, but also eustress in the form of hardiness, coping, and fostering a sense of community. The Yerkes–Dodson model demonstrates the optimum balance of stress with a bell curve (shown in the image in the top right).[17] This model is supported by research demonstrating emotional-coping and behavioural-coping strategies are related to changes in perceived stress level on the Yerkes-Dodson Curve. However, the Yerkes-Dodson Curve has become increasingly questioned. A review of the psychological literature pertaining work performance, found that less than 5% of papers supported the inverted U-shaped curve whereas nearly 50% found a “negative linear” relationship (any level of stress inhibits performance).


Much of the research on eustress has focused on its presence in the workplace. In the workplace, stress can often be interpreted as a challenge, which generally denotes positive eustress, or as a hindrance, which refers to distress that interferes with one’s ability to accomplish a job or task.

Research has focused on increasing eustress in the workplace, in an effort to promote positive reactions to an inevitably stressful environment. Companies are interested in learning more about eustress and its positive effects to increase productivity. Eustress creates a better environment for employees, which makes them perform better and cost less. Occupational stress costs the United States somewhere in between 200 and 300 billion dollars per year. If this were eustress instead of distress, these companies would retain this money and the US economy could improve as well. Stress has also been linked to the six leading causes of death: “disease, accidents, cancer, liver disease, lung ailments, suicide.” If workers get sick and/or die, there is obviously a cost to the company in sick time and training new employees. It is better to have productive, happy employees. Eustress is necessary for achievement. Eustress is related to well-being and positive attitudes and thus increases work performance.

Techniques such as Stress Management Interventions (SMI) have been employed to increase occupational eustress. SMI’s often incorporate exercise, meditation, and relaxation techniques to decrease distress and increase positive perceptions of stress in the workplace. Rather than decrease stress in the workplace, SMI techniques attempt to increase eustress with positive reactions to stressful stimuli.


Eustress is primarily based on perceptions. It is how you perceive your given situation and how you perceive your given task. It is not what is actually happening, but a person’s perception of what is happening. Eustress is thus related to self-efficacy. Self-efficacy is one’s judgement of how they can carry out a required task, action or role. Some contributing factors are a person’s beliefs about the effectiveness about their options for courses of action and their ability to perform those actions. If a person has low self-efficacy, they will see the demand as more distressful than eustressful because the perceived level of what the person has is lower. When a person has high self-efficacy, they can set goals higher and be motivated to achieve them. The goal then is to increase self-efficacy and skill in order to enable people to increase eustress.


When an individual appraises a situation as stressful, they add the label for distress or eustress to the issue at hand. If a situation induces eustress, the person may feel motivated and can experience flow. Positive psychologist, Mihaly Csikszentmihalyi, created this concept which is described as the moments when one is completely absorbed into an enjoyable activity with no awareness of surroundings. Flow is an extremely productive state in which an individual experiences their prime performance. The core elements are absorption, enjoyment and intrinsic motivation.

Flow is the “ultimate eustress experience – the epitome of eustress”. Hargrove, Nelson and Cooper described eustress as being focused on a challenge, fully present and exhilarated, which almost exactly mirrors the definition of flow. Flow is considered a peak experience or “the single most joyous, happiest, most blissful moment of your life.”


There are several factors that may increase or decrease one’s chances of experiencing eustress and, through eustress, experiencing flow:

  • Stress is also influenced by hereditary predispositions and expectations of society. Thus, a person could already be at a certain advantage or disadvantage toward experiencing eustress.
  • If a person enjoys experiencing new things and believes they have importance in the world, they are more likely to experience flow.
  • Flow is negatively related to self-directedness, or an extreme sense of autonomy.
  • Persistence is positively related to flow and closely related to intrinsic motivation.
  • People with an internal locus of control, have an increased chance of flow because they believe they can increase their skill level to match the challenge.
  • Perfectionism, however, is negatively related to flow. A person downplays their skill levels therefore making the gap too big, and they perceive the challenge to be too large to experience flow. On the opposite end of perfectionism, however, there are increased chances of flow.
  • Active procrastination is positively related to flow. By actively delaying work, the person increases the challenge. Then once the challenge is matched with the person’s high skill levels, the person can experience flow. Those who passively procrastinate or do not procrastinate do not have these same experiences. It is only with the purposeful procrastination that a person is able to increase the challenge.
  • Mindset is a significant factor in determining distress versus eustress. Optimistic people and those with high self-esteem contribute to eustress experiences. The positive mindset increases the chances of eustress and a positive response to stressors. Currently, the predominant mindset toward stress is that stress is debilitating. However, mindsets toward stress can be changed.

This page is based on the copyrighted Wikipedia article <https://en.wikipedia.org/wiki/Eustress >; it is used under the Creative Commons Attribution-ShareAlike 3.0 Unported License (CC-BY-SA). You may redistribute it, verbatim or modified, providing that you comply with the terms of the CC-BY-SA.