The Importance of Stress Management in Autoimmune and Immune-Mediated Inflammatory Conditions

Autoimmune and immune-mediated inflammatory conditions such as rheumatoid arthritis, lupus, multiple sclerosis, inflammatory bowel disease (including Crohn’s disease and ulcerative colitis), and psoriasis are often understood primarily in terms of immune dysfunction. In many of these conditions, the immune system becomes dysregulated and initiates a continuous inflammatory response, sometimes targeting the body’s own tissues directly, and in other cases reacting excessively to internal or environmental triggers. Over time, this ongoing inflammation can lead to pain, fatigue, tissue damage, organ involvement, and a significant reduction in quality of life.

What is less widely recognized but increasingly supported by research, is the central role that chronic stress plays not only in emotional wellbeing, but in the progression and deterioration of these immune-mediated conditions themselves. Managing stress in autoimmune and immune-mediated inflammatory disorders is not just an optional 'wellness addition', or merely about improving coping skills; it's a fundamental aspect of disease management that can impact inflammatory activity, the frequency of flare-ups, symptom severity, and long-term health outcomes.

How stress and the immune system influence one another

The immune system does not operate in isolation. It's tightly interwoven with the nervous and endocrine systems, particularly the stress response system. When the body perceives threat, whether physical, emotional, or psychological, it activates the sympathetic nervous system and the hypothalamic-pituitary-adrenal (HPA) axis. In the short term, this response is adaptive, mobilizing energy and immune activity to protect the organism.

However, in chronic stress, this system remains persistently activated. Over time, stress hormones such as cortisol and adrenaline lose their regulatory effectiveness. Rather than reducing inflammation, cortisol resistance can occur, resulting in heightened production of pro-inflammatory cytokines (tiny chemical messengers that immune cells use to talk to each other, especially to trigger or calm inflammation). In autoimmune conditions, where the immune system is already dysregulated, this shift can amplify immune attacks on the body’s own tissues. In other words, chronic stress does not merely coexist with autoimmune disease, it can actively fuel the inflammatory processes that drive it.

How chronic stress contributes to disease deterioration

Ongoing stress can contribute to autoimmune deterioration through several interconnected pathways.

First, stress increases systemic inflammation. Psychological stress has been shown to elevate inflammatory markers such as C-reactive protein (CRP) and interleukin-6 (IL-6), both of which are associated with disease activity in conditions like rheumatoid arthritis. Elevated inflammation increases joint damage, pain, stiffness, and fatigue, accelerating physical deterioration.

Second, stress disrupts immune regulation. Under chronic stress, the immune system becomes less precise. Regulatory T-cells, which normally help prevent autoimmune attacks, may become less effective, while inflammatory pathways become overactive. This imbalance can increase the frequency and severity of disease flares.

Third, stress impairs tissue repair and healing. The body’s ability to recover from inflammation, micro-injuries, or immune assaults depends on periods of physiological safety and restoration. Chronic stress keeps the body in a survival state, reducing cellular repair, slowing healing, and prolonging inflammatory responses.

Finally, stress affects pain perception and nervous system sensitization. Ongoing stress can increase central sensitization, where the nervous system becomes consistently over-responsive, intensifying pain and sensory signals even with minimal or no current tissue damage, resulting in a heightened reactivity to pain signals. This means that even when disease activity appears stable, individuals may experience worsening pain, fatigue, and sensitivity, further contributing to disability and distress.

Why emotional stress matters even when the disease is "physical"

Many people with autoimmune conditions are told, explicitly or implicitly, that stress shouldn’t matter because their illness is biological. This false separation between mind and body can lead individuals to dismiss emotional stress as irrelevant, or worse, feel blamed when stress is mentioned at all. In reality, emotional stress is a physiological event. Experiences such as chronic pressure, unresolved trauma, relational conflict, grief, or prolonged uncertainty activate the same biological pathways as physical threats. For someone with an autoimmune condition, repeated emotional stressors can continually provoke immune activation, even in the absence of visible triggers. This means that unmanaged stress can worsen disease expression, increase symptom burden, and contribute to faster functional decline.

Stress management as disease protection

Effective stress management in autoimmune conditions is not about eliminating stress or staying positive. It's about supporting nervous system regulation and restoring balance to immune function.

Practices that reduce physiological stress such as mindfulness-based approaches, trauma-informed therapy, gentle movement, adequate rest, and supportive relationships, can lower inflammatory activity and reduce flare frequency. Psychological interventions have been shown to improve pain, fatigue, immune markers, and quality of life in people with rheumatoid arthritis and related conditions. Importantly, stress management also improves treatment outcomes. Individuals with better stress regulation often respond more effectively to medical treatments, adhere more consistently to treatment plans, and experience fewer secondary complications such as depression, sleep disturbance, and cardiovascular risk.

A necessary part of whole-person care

Autoimmune and immune-mediated inflammatory conditions place the body in a constant state of internal conflict. When chronic stress is layered on top of this, the system is pushed further into dysregulation, increasing wear and tear over time. Addressing stress is therefore not an optional extra; it's a protective strategy that supports immune balance, reduces inflammatory load, and helps preserve physical functioning. Recognizing the role of stress does not diminish the biological reality of autoimmune disease. Instead, it expands our understanding of how interconnected systems influence health and opens the door to more compassionate, effective, and sustainable care. Managing stress is about giving the body the conditions it needs to heal, stabilize, and resist further deterioration.

If this is something you’ve been affected by, please leave a comment below. If there’s something important you’d like to add, please do so. I'd love to hear from you.

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Dr. Ingela Thuné-Boyle is a licensed Practitioner Health Psychologist and a Doctor in Behavioural Medicine who specializes in improving the quality of life of people struggling with long-term health problems, chronic pain and trauma. She runs a private online (telehealth) practice at www.ingelathuneboyle.com. You can find out more about her background [here], and more about her approach to therapy [here].

📩 Contact: For therapy or other enquiries, you can contact her at info@ingelathuneboyle.com.

Please note: Advice given in this blog is not meant to take the place of therapy or any other professional advice. The opinions and views offered by the author is not intended to treat or diagnose, nor is it intended to replace the treatment and care that you may be receiving from a licensed physician or mental health provider. The author is not responsible for the outcome or results following their information and advice on this blog.