How does chronic stress affect the body?

Summary

Podcast Summary: "How Does Chronic Stress Affect the Body?"

Podcast: What's That Rash? (ABC Australia)
Host(s): Norman Swan & Jacinta Boaler
Date: July 14, 2026

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Overview

This episode addresses Daniel’s question about the physiological effects of chronic stress—especially in the context of Autism Spectrum Disorder (ASD). Dr. Norman Swan and Jacinta Boaler explore the differences between acute and chronic stress, the body’s responses, social determinants like control, and practical, evidence-based ways to manage and reduce unhealthy stress. The episode also touches on the broader societal implications of chronic stress and effective strategies for individuals.

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Key Discussion Points & Insights

1. Understanding Stress: Acute vs. Chronic

[01:56–04:44]

• Jacinta frames the conversation by differentiating between everyday life stress and chronic stress, which has distinct effects on the body.

• Norman shares a personal childhood roller coaster trauma to illustrate acute stress:

  • Physical responses: adrenaline surge, elevated heart rate, dry mouth, rapid breathing, and especially a loss of control.
  • Quote:
    • “I was filled with fear... my dominant memory of it [was] feeling totally out of control in a situation which had unknown risk.” – Norman [04:44]

• The concept of locus of control is introduced:

  • Perceived control in a stressful event dramatically affects the body’s stress reaction.
  • “This is this concept of locus of control, like where you feel like the control over the situation you find yourself in sits.” – Jacinta [05:23]

2. Chronic Stress: The Body’s Lingering Alarm

[05:39–10:33]

• Chronic stress triggers the same bodily responses as acute stress, but at a lower, persistent level:

  • Slightly raised blood pressure, increased heart rate, activation of hormone systems (e.g., cortisol), low-level systemic inflammation.
  • The brain’s “dumb” subconscious scans for threat and signals preparedness, even when there’s no real danger.

• Chronic activation, meant for “saber-toothed tiger moments,” is harmful when prolonged.

Social Science Insights: The Whitehall Study

• Sir Michael Marmot’s Whitehall Study on British civil servants found that lack of control (“locus of control”) explained why people lower in job hierarchies had worse health outcomes.
• “When [Marmot] factored in locus of control, the gap significantly disappeared... one of the significant factors that dictated premature death and premature disability.” – Norman [10:33]

3. Health Consequences of Chronic Stress

[12:10–13:08]

• Repeated or unremitting stress contributes to:

  • Cardiovascular disease, diabetes, obesity, possibly cancer.
  • Behavioral changes: increased likelihood of smoking, excess alcohol use, unhealthy eating.

• Inflammation is a factor, but harm also results from elevated blood pressure, pulse, hormonal imbalance, and altered behaviors.

4. Control, Burnout, and Social Determinants

[13:08–14:39]

• Burnout (not a formally defined medical condition) is essentially chronic work-related stress, often driven by lack of control—bad management, unattainable goals, poor job fit.

• Solutions can include workplace advocacy, seeking job realignment, or cognitive behavioral therapy (CBT).

• Broader interventions:

  • Social policies that improve people’s autonomy, reduce disadvantage, and support financial security reduce stress at a population level.

5. Practical Strategies for Managing Stress

[15:15–18:24]

• CBT and professional psychological support can help restructure thinking and coping mechanisms, especially for individuals with ASD.
• You don’t have to solve stress by yourself; seeking help is encouraged.
• Quote:
  • “Even though I've talked about taking control, sometimes... you just need some assistance.” – Norman [15:15]

The ‘PRAISES’ Framework for Life Balance

[15:54–17:29]

• PRAISES = Physical, Recreational, Artistic, Intellectual, Spiritual, Employment, Social.
• Ask yourself: Am I meeting my needs in each area? Gaps can signal sources of chronic stress.
  • “If you sort of look and kind of go do I feel like I'm getting what I need from each of these facets to sort of assess your life balance.” – Jacinta [16:23]
• Being employed is generally protective for health, though poor job fit can contribute to stress.
  • “Overwhelmingly, the evidence is that it's good to have a job and being out of work is really bad for your health.” – Norman [17:13]

6. Big-Picture Takeaways

[17:54–18:54]

• Tailor strategies to the individual. Evidence-based therapy with feedback is most effective.
• Societal interventions such as green spaces, community connection, quality employment, and social safety nets can reduce chronic stress on a larger scale.
  • “There's nothing like having money in your pocket to have a reduced level of stress.” – Norman [18:41]

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Notable Quotes & Memorable Moments

• “You were four. There wasn't like a penguin saying, you must be at least this tall to get on this ride…” – Jacinta [04:18]
• “My adrenaline was pumping out, my heart rate was going up, my mouth was dry...” – Norman [04:44]
• “Your immune system gets ready to defend against attack. It doesn't know what the attack is... that's called inflammation.” – Norman [06:34]
• “We intuitively know that this idea of control over our lives, the ability to make decisions, is really important.” – Norman [11:10]
• “If we're talking about structural problems and we need structural solutions to them, not just... go into a cupboard and take 10 deep breaths.” – Jacinta [14:39]
• “So it's evidence based therapy with a feedback loop to see how you go.” – Norman [17:54]

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Timestamps for Important Segments

• 01:56 – Listener question: How does chronic stress show up in the body?
• 03:43 – Norman’s personal story illustrating acute stress
• 05:23 – Discussion of loss of control and its link to stress
• 07:41 – Physiological mechanisms of chronic stress
• 10:33 – Whitehall Study and locus of control as a predictor of health outcomes
• 12:24 – Links between chronic stress and major health outcomes
• 13:08 – Chronic stress in the workplace and the concept of burnout
• 15:54 – PRAISES approach to life balance/self-assessment
• 17:54 – Practical approaches for individuals and broader societal recommendations

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Closing Thoughts & Summary

• Chronic stress is physiologically similar to acute stress, but its long-term, lower-level activation of the body’s stress systems leads to serious health risks.
• Perceived and actual loss of control (“locus of control”) is a major driver of harmful chronic stress.
• Management requires both individual strategies—often with professional help—and societal change to reduce disadvantage and promote autonomy.
• Achieving balance across diverse life domains (PRAISES) can offer actionable steps for assessing and managing stress.
• For people with additional complexities, like ASD, seeking expert guidance is not only acceptable, but recommended.

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For further questions, listeners are invited to write to thatrashbc.netau.

Transcript

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[Norman]

I oh, let's go. I oh, let's go.

[Jacinta Boaler]

ABC Listen, podcasts, radio, news, music and more.

[Norman]

If this thing is built, it will be a miracle to behold.

[Jacinta Boaler]

One of science's biggest promises.

[Norman]

It would be like the Wright Brothers moment.

[Jacinta Boaler]

Governments, spies, billion dollar investments and scientific rivalries.

[Norman]

The control that's required is rivaled only by what God did in creating the universe.

[Jacinta Boaler]

Will quantum computers change everything. I'm Jacinta Boaler. Search for SC Friction. Dead and alive on ABC Listen or wherever you get your podcasts. So, Norman, what is your go to when you need to de stress and decompress?

[Norman]

I walk outside and scream. No. Sometimes I feel like doing that. Yeah, you've got to. It's true. You've got to have something that you do that. So for me, it's exercise. I just go into exercise mode and do something that really gets my sweat going and I'm forced to think about that and nothing else. So it's a distraction. It's almost like mindfulness where you're doing something that you've just got to focus on.

[Jacinta Boaler]

Make your body scream so loudly that your brain can't hear anything else.

[Norman]

Yeah. And stop listening to podcasts in my head when I'm doing it so that my head is clear.

[Jacinta Boaler]

No podcast. You heard it here on what's that Rash.

[Norman]

The show that answers the health questions is simply everyone's asking.

[Jacinta Boaler]

Well, today's question, Norman, comes from Daniel. He's asking about stress, but he's asking about chronic stress. Daniel says, I love the show. I was wondering if you could do an episode on physiological reactions to stress. I deal with chronic stress in my life due to asd, Autism Spectrum disorder. Daniel says, I was hoping you could tell us why these things pop up, as in health conditions, what things stress is likely to cause and what are the best ways to reduce stress or maintain healthy stress levels. So, yes, let's talk stress today.

[Norman]

Yeah, let's talk.

[Jacinta Boaler]

So when I think about people talking about feeling stressed, it's like, oh, I'm so stressed. Work is busy. I'm a parent, I'm trying to sort aged care for my own parents, et cetera. The sort of, like, busy life that we lead. But that is quite distinct from chronic Stress and the way it shows up in our body is pretty different.

[Norman]

It is. And we have this idea that stress is bad, but we need stress in our lives. We need stress to perform. We need stress to get us going, and you can't avoid it. So what we're talking about here is your response to stress, and some people are addicted to it. You'll go on the Big Dipper at the fun fair because you just like that feeling of acute stress.

[Jacinta Boaler]

Could we say people also do things like write books and do documentaries and multiple podcasts and they like that too.

[Norman]

I can't imagine who you're talking about there, but you know, hypothetically. Yes, indeed. But the issue with stress is always how you respond to it and whether it's product productive or not, or whether it gets in the way of life.

[Jacinta Boaler]

Okay, well, if we talk about acute stress, the idea of going on a roller coaster, which honestly sounds quite fun, what is happening in my body? Oh, really?

[Norman]

I'll tell you a story. I put it down to a childhood experience. My father, who was not the most attentive of fathers. He was a lovely person, but he wasn't the most attentive of fathers. He wasn't used to kids. He took me to a fun fair and he knew this guy there who ran this ride and he thought I was 4 years old and he thought this was going to be the best ride. And it was one of these incredibly fast up and down things. And he put me on it by myself because there's no way he'd go on it. And I was completely terrified. And he thought I was waving at him in joy as I went by rather than in total fear.

[Jacinta Boaler]

You were four. There wasn't like a penguin saying, you must be at least this tall to get on this ride or something like that.

[Norman]

Totally ignored. And as a result, I've never gone on one of these rides ever again in my whole life.

[Quaker Advertiser]

Wow.

[Jacinta Boaler]

So you're telling me about your childhood trauma. Really are getting to the heart of it today.

[Norman]

We are. So that sort of stress I don't like.

[Jacinta Boaler]

Okay, let's unpack it though. Tiny Norman, four year old, you on a roller coaster. My heart is breaking. What kind of hormones were happening in your body? What sort of processes were going on in you in that moment?

[Norman]

My adrenaline was pumping out, my heart rate was going up, my mouth was dry. I was probably breathing up. I mean, I can go back to that event in full Technicolor and I was filled with fear. And interestingly, and relevant to our conversation today about Answering Daniel's question, probably what caused the most fear was I was in a situation which I could not control. I did not fully understand and I didn't know how it was going to end. I didn't know when it was going to end. And that's my dominant memory of it feeling totally out of control in a situation which had unknown risk.

[Jacinta Boaler]

Interesting. So this is this concept of locus of control, like where you feel like the control over the situation you find yourself in sits. So do I have control over what's happening to me in this moment? Or does someone or something else. And that's a really important part of our reaction to stress.

[Norman]

It is. And we can come back to Daniel's situation with Autism Spectrum disorder, because it could well be that what's happening with Daniel is that his autism Spectrum disorder kind of dislocates him from an ability to control situations or situations are imposed on him which are unfair or unreasonable, which give a sense of loss of control and therefore stress, rather than necessarily it being a stress causing condition in its own right, it's the mushroom cloud around it that causes the response to stress. So you've got this acute stress, which is designed for, in a hunter gatherer situation, recognizing danger and being alert to it, and your body being prepared to fight or run away. So that's why your blood goes to your brain, blood goes to the organs in your abdomen rather than to your skin. So your skin feels cold and clammy, your heart rate goes up, your blood pressure goes up, all ready for action. And indeed a whole series of hormones get into action as well, including hormones which alert your immune system. Because when you're getting ready for that sort of acute response to a stressful situation, your immune system gets ready to defend against attack. It doesn't know what the attack is. And that's called the innate immune system. It's kind of a dumb part of the immune system where it just is like this barrage of artillery firing at anything and everything and anything. And that's called inflammation. And that's also fired up in the acute stressful situation.

[Jacinta Boaler]

That is so interesting, this immune response, which I suspect is foreshadowing of what we can sort of see when chronic stress is in the mix. So look, obviously tiny baby Norman went on a roller coaster that probably lasted two or three minutes, longest two or three minutes of your life, and then you got off and you then were able to decompress from that. But what we're talking about today is chronic stress. How does that lower level stress compare to that really intense, high level stress of a fixed term prospect.

[Norman]

Your brain, the subconscious brain, is essentially a dumb organ which is a.

[Jacinta Boaler]

You're calling a lot of my body systems dumb today, Norman. I don't mind if I like it.

[Norman]

Mine too, mine too. And it's this dumb organ which is really there to. It's not that dumb. But you know, what I'm saying is you don't have your conscious brain on top. And what it's there is to survey your environment for threats and then tell the body independent of your conscious brain to get ready for action or relax or whatever it is that's going on. And so your brain recognizes threats in your environment. Now what chronic stress is, is it's very much the same bodily response as acute stress, but at a very much lower level. So the same things get triggered. The brain picks up a problem in your world and it says to the rest of the body, hey guys, something's going on here, don't really understand what it is, but we'd better get ready for action. So blood pressure go up a little bit, pulse go up a little bit. Immune system get ready for action. Just your inflammation goes up a bit. Hormones that might be involved in helping us use calories or what have you, you get ready for action like cortisol and so on, and your body gets into this alert stage which is very low level, but it's still triggering a system that was originally designed for short bursts when a saber toothed tiger came towards you or you were in a fight. But this is prolonged and the question is, what triggers chronic stress? Because everybody's felt it from time to time. It's not a nice feeling. And it is pernicious. And I'll give you an idea of how pernicious it is. Professor Sir Michael Marmot, an expatriate Australian researcher at University College London, inherited a study called the Whitehall Study. And that's a study of British civil servants looking at why the Secretary at the top of the scale. People might remember, yes Minister and yes Prime Minister, while the Sir Humphreys at the top died later in life and were healthier than people at the bottom of the civil service. Why was there this health gradient? And what he found was you can explain the health gradient by think that, you know, like cholesterol, like your level of education and so on. That explains a lot of the gradient, but it doesn't explain all of it. So there was still a gap after you took into account all the things that you knew were risk factors for dying younger and sicker and what they factored in was locus of control that you just mentioned. Where do I feel my life is controlled and my decision making is control? Is it within me or is it somewhere else, as you said, or something else? And when he factored in locus of control, the gap significantly disappeared. In other words, he found one of the significant factors that dictated premature death and premature disability.

[Jacinta Boaler]

So this is like a social determinant of health?

[Norman]

It is.

[Jacinta Boaler]

So it's not the whole picture because maybe you mentioned cholesterol and that sort of thing, there's other things that might play into it, but it's part of the reason why we see poorer health outcomes in people who have poorer backgrounds or less advantage.

[Norman]

That's right. Aboriginal communities have known about this for a long time without necessarily having read the literature. Nothing about me, without me. Aboriginal community controlled health organizations. Control is a big issue. Control is a big issue with older people. You hear multiple stories. Daughters, usually daughters going into the elderly parents house, it's a mess, and saying, mum, dad, you need somebody to come in and help, or maybe you need to go into sheltered accommodation, the daughter gets thrown out the house, don't come near us again talking of that sort of talk, because they feel they're going to lose control. So we intuitively know that this idea of control over our lives, the ability to make decisions, is really important. So what is it about chronic stress? So the Late Professor Bruce McEwen at Rockefeller University took Michael Marmot's work and other people's work, also Len Gray at Berkeley, and said, well, what is going on? He called it allostatic load. He argued you need stress, but when it goes overboard in terms of chronic stress, he called it allostatic load. And he showed, particularly in animal models, that high allostatic load was bad for your health. Increased the risk of coronary heart disease, probably cancer, diabetes, obesity and a whole host of other problems. And you shouldn't be surprised about that because the brain and the body are one and the brain controls a lot of basic functions in the body.

[Jacinta Boaler]

So you've mentioned a couple of diseases there. Part of Daniel's question was about the why these things happen in the body and what's most likely stress is causing. Is all of the health harm coming from inflammation?

[Norman]

No, it's not. It comes from raised blood pressure, raised pulse hormone systems that get switched on, but also it changes our behaviour. So you're possibly more likely to smoke, you're possibly more likely to drink alcohol in excess to actually treat the chronic stress and to try to make you feel better. So it changes you behaviourally as well as it does metabolically.

[Jacinta Boaler]

It's useful to know this information and you mentioned before some of the health conditions that can crop up from it. It's also kind of disheartening to hear that this feeling that chronic stre a can be so harmful. If you know you're living under it, then that's a fear. But then also to hear that one of the big drivers is not having control, which means by definition there really isn't much you can do about it.

[Norman]

Well, that's not true if I respectfully disagree with my long standing co host. So let's take the job situation. I think Michael Marmot called it job strain. A lot of people call it burnout. Now there's no medical condition called burnout, but that doesn't mean that the feelings you get in a job can be significant. But burnout is really a manifestation of chronic stress. And there have been studies about what determines this feeling of chronic stress in the workplace that some people call burnout. And it could be that you've got a lousy boss who's micromanaging you and not allowing you to make your own decisions and set goals. It could be that there's unreasonable goals being set for you. It could be that the job you thought you were going into was not the job that turned out. It could be that you're a square peg in a round hole. And there are various solutions for this which sometimes work and sometimes don't. Going to your supervisor, telling them about it and seeking changes right down to maybe you are square pegging round hole and you're just in the wrong job for your skill set, in which case you need to look around for another job or the company needs to find you another place. So there are ways through this cognitive behavioral therapy can help talk you through that. And social policy such as reducing disadvantage without taking away decision making capacity from people. In other words, strengthening their decision making capacity in an environment where you actually have more financial control of your life will also reduce chronic stress. And that's possibly the hardest thing of all to change.

[Jacinta Boaler]

I mean that's the thing, right? If we're talking about structural problems and we need structural solutions to them, not just sort of like go into a cupboard and take 10 deep breaths. We need things like social safety nets so that people don't find themselves in such incredible chronic stress situations that maybe there are state based solutions for. There's an interesting piece of wording in Daniel's question which I really like. They asked what the best way is to reduce stress, slash maintain healthy stress levels is sort of understanding that some stress is healthy and figuring out how to, yeah, I guess find your equilibrium within yourself, within your control.

[Norman]

And I think that for somebody like Daniel and you've got autism spectrum disorder, then it can be quite hard to solve it for yourself. And that's where an experienced clinical psychologist who's well trained in evidence based therapies like cognitive behavioral therapy can actually work things through for you and help you see things with a more objective light. And you shouldn't necessarily think you've got to solve all this for yourself. Even though I've talked about taking control, sometimes you've got to have a strategy for doing it which requires a bit of cognitive restructuring which very hard for any of us to do. And sometimes you just need some assistance.

[Jacinta Boaler]

So maybe we could talk about some practical things you can do to maybe assess your stress levels. There's one approach that I've seen Norman called the praises approach because healthcare loves an acronym. This one relates to physical, recreational, artistic, intellectual, spiritual, employment and social as sort of facets of your life. And if you sort of look and kind of go do I feel like I'm getting what I need from each of these facets to sort of assess your life balance.

[Norman]

So what's under physical things like going

[Jacinta Boaler]

out and instead of screaming into the void, maybe going for a big hard bike ride or a walk. So that's P what about R Relaxation Recreational for me I'm looking at some of these going there's some overlap between maybe what you do for recreation that's physical or a is artistic. So this idea of creative pursuits or appreciating the creativity of others, so maybe doing some bad art or maybe enjoying listening to music. Again it's a bit of a spectrum. I feel like the colours sort of bleed into each other and I intellectual. So learning or indirect learning. S is spiritual, the idea of connection beyond just your individual or family. So religion is the obvious one with spiritual but maybe also connection to your community and E E is employment like you say, that's often a source of stress for people.

[Norman]

And just before you go on, overwhelmingly the evidence is that it's good to have a job and being out of work is really bad for your health. It's life shortening employment can be a source of stre but overwhelmingly employment is a source of health and wellbeing.

[Jacinta Boaler]

And then finally S social which again maybe you could fit it into some of the other categories but then we wouldn't be Spelling praises. So we sort of needed it there. Time spent with people who are important to you, like your family, social connection, really important for a takeaway for Daniel. People like Daniel who are kind of going, I think that the amount of stress that I'm under is not good for me. What do I do about it? Do we have some sort of like take home messages here?

[Norman]

I think somebody in Daniel's situation, I've said it already, but I think someone in Daniel's situation where there's a level of complexity about your life, you might just need some help to understand what's going on. What are the core areas that you need to address and how psychologically to frame your thinking so that you can deal with them more productively. And then somebody to hold your hand a little bit through that where you can experiment and then get some feedback and do that. So it's evidence based therapy with a feedback loop to see how you go.

[Jacinta Boaler]

And then as we were saying before, some societal level things that we can do, valuing things like green spaces, third spaces for connection, lifting up social connection, maybe social prescribing, understanding just how toxic chronic stress can be and what we can do as a society to help guard against it.

[Norman]

And high levels of employment of good quality work that's well appreciated and well managed. Having money in your pocket. There's nothing like having money in your pocket to have a reduced level of stress.

[Jacinta Boaler]

Well, Daniel, excellent question. It's been really fun going through it. I hope it's been useful to you. If you have a question you want to ask, ask. Our email address is thatrashbc.netau and we've

[Norman]

been bombarded by our call out following our motion sickness episode.

[Jacinta Boaler]

Yeah, so we spoke about motion sickness. I feel like we knew going into that that everyone was gonna have their own sort of patented N equals one motion sickness remedy. We've got so many. So Marjorie said this reminded me of a story my Scottish dad told me in World War II. He was a radio air gunner in the RAF and during his flying times over Europe, he suffered from terrible motion sickness until his dad sent him several tins of powdered glucose. Anyway, Marjorie says it did the trick for him. Although he was shot down over the English Channel and was a prisoner of war for two years, he survived the war, married an Aussie girl and moved to Australia very happily. Hence one of his two daughters is sending you this email. Marjorie, if your dad has written a memoir, I want to read it. That sounds like a real adventure.

[Norman]

And Marjorie wasn't the only Person mentioning sugar helping.

[Jacinta Boaler]

A lot of people like hard candies. Actually, we got quite a few emails saying that. Aaron says, I was in the Australian Navy in my twenties and my seasickness while crossing the Pacific did not stop. I tried the wrist straps. So we talked about the wrist straps, Norman, and basically wrote them off as a placebo effect. Anyway, Aaron says, I thought they weren't working, but when I took them off, it got worse. Aaron says I ended up transferring to submarines. On the surface, I still felt ill, but once underwater, the symptoms went away.

[Norman]

So in addition to sugar, we also had a lot of people riding in in defence of wristbands.

[Jacinta Boaler]

Anyway, Mary said a friend of mine who's now a doctor was told during her medical degree to lean into the turns to combat motion sickness.

[Norman]

Or some others said, actually you just pretend to drive. So you're sitting in the seat and you're pretending to drive.

[Jacinta Boaler]

I think I do that. I think I do that as well. You sort of like brace yourself in the same way as if you were driving.

[Norman]

I certainly do that when one of my children are Dr. That's right.

[Jacinta Boaler]

Maker says. After enduring countless car rides, my sister and I requiring frequent vomit stops on the sides of highways, my father declared one day, I love this so much that if you sat on newspaper, the electrical currents from the car would be blocked and the motion sickness cured. Of course, behold, the newspaper cure worked. And every car trip began with us covering the back seat with sheets of the West Australian.

[Norman]

It's really the most appropriate use of the West. Anyway, put your bum on it. There's only one other use of the west, which I won't say because in polite company I shouldn't say, who's polite

[Jacinta Boaler]

in this company anyway? They say, of course, this only lasted till we were old enough to begin questioning the science, but it shows the power of the placebo.

[Norman]

Indeed.

[Jacinta Boaler]

Unless there really was something to do with the electrical currents or the West. Okay, one more, one more. Ken says, my father was a doctor and a keen boatie. He never got motion sickness. His recommended cure for motion sickness was sit under a tree.

[Norman]

Oh, really useful when you're on the high sea. Yeah, great.

[Jacinta Boaler]

Ken says the rest of us never found that funny like he did as we continued to heave over the side.

[Norman]

Keep your mail coming in. We love it.

[Jacinta Boaler]

We do love it. Send it written on the back of the West Australian if you like. Our email address is thatrashbc.netau and feel

[Norman]

free to defend the West Australian, I'm sure being unfair.

[Jacinta Boaler]

We love all journalism here.

[Norman]

Scenic.

[Jacinta Boaler]

See you then.