Introduction
Chronic stress is a pervasive issue that significantly impacts mental and physical well-being. It is defined as a prolonged state of physiological and psychological arousal that results in an increased allostatic load, or the cumulative wear and tear on the body. Chronic stress has been linked to health issues such as hypertension, heart disease, anxiety, and depression. The constant activation of the stress response system can eventually impair immune function, disrupt sleep patterns, and even alter brain structures over time. Although many experience chronic stress, Black women are uniquely affected due to systemic inequities, historical trauma, and cultural expectations (Wallace, Moore, & Roller, 2023). Stereotypes such as the “Strong Black Woman” and the “Angry Black Woman” further compound these stressors, often leading to emotional suppression and overextension.
Note: While this article focuses on Black women, clinicians should be aware that similar patterns may occur among other marginalized groups, whose experiences also reflect intersecting oppressions and heightened stress exposures).
Contributing Factors to Chronic Stress
This article examines three interrelated contributors to chronic stress. It is important to note that these factors do not operate in isolation; rather, they often interact in complex ways that exacerbate stress and undermine overall well-being. Unhealed trauma, poor boundaries, and disorganized lifestyles can feed into one another, contributing to strained relationships and reinforcing patterns of stress that are difficult to break.
Unhealed Trauma
Unhealed trauma refers to past traumatic experiences that have not been fully processed, resulting in persistent hypervigilance, emotional suppression, and dysregulated stress responses. These unresolved wounds may originate in childhood or stem from later life experiences, leaving individuals vulnerable to a constant state of alertness and internal distress.
Integrated Approach
A comprehensive, trauma-informed care model is recommended for addressing unhealed trauma. This approach emphasizes safety, trust, and empowerment, and it serves as an umbrella for various evidence-based interventions. For example:
- Trauma-Informed Care: Establishes a supportive environment that prioritizes the client’s sense of safety and collaboration. By recognizing common triggers and avoiding re-traumatization, clinicians can create spaces where clients feel secure enough to engage in the healing process.
- Evidence-Based Modalities: Interventions such as Eye Movement Desensitization and Reprocessing (EMDR) (Shapiro, 2018) and Emotion-Focused Therapy (EFT) (Greenberg & Goldman, 2019) help clients process and integrate traumatic memories. These methods facilitate the reduction of the emotional intensity associated with trauma, allowing for healthier emotional regulation.
- Psychoeducation: Often incorporated within these treatment models, psychoeducation helps clients understand how trauma impacts biological systems such as the HPA axis and the sympathetic nervous system. Explaining the physiological basis of their symptoms normalizes clients’ experiences, reduces stigma, and fosters a sense of control over their reactions.
By emphasizing that these elements work together rather than operating as isolated strategies, clinicians can develop an integrated model that effectively addresses the multifaceted nature of trauma. This unified approach not only targets the symptoms but also promotes long-term healing and resilience.
Poor Boundaries
Poor boundaries describe difficulties in setting and maintaining personal limits. This challenge often leads to overextension, emotional depletion, and compromised self-care. For many Black women, cultural and familial expectations may have reinforced the notion that self-sacrifice is necessary for community or family well-being, further blurring personal limits.
Interventions
To help clients develop healthier boundaries, consider the following interventions:
- Assertiveness Training: This intervention teaches clients to express their needs clearly and respectfully. Techniques such as role-playing and the DESC model (Describe, Express, Specify, Consequences; Alberti & Emmons, 2017) empower clients to communicate effectively while maintaining self-respect. Assertiveness training reinforces that setting limits is a form of self-care rather than selfishness.
- Boundary Mapping: A collaborative process that uses visual tools—such as boundary wheels or Venn diagrams—can help clients identify and define their personal limits. This exercise often reveals patterns shaped by past experiences and societal pressures, enabling clients to redraw boundaries that reflect their current needs and values.
- Processing Guilt: For many, asserting boundaries can trigger intense feelings of guilt, especially for those socialized to prioritize others’ needs. Cognitive restructuring techniques and metaphors like “you can’t pour from an empty cup” help reframe these feelings. By understanding that self-preservation is essential, clients can overcome guilt and affirm their right to set limits.
Disorganized Lifestyles
A disorganized lifestyle is characterized by chaotic routines, poor time management, and inconsistent structures. Such disorganization contributes to feelings of overwhelm and unpredictability, making it challenging for individuals to manage day-to-day stress effectively.
Interventions
To restore structure and reduce stress, clinicians might implement:
- Time Management Skills: Introducing tools like time-blocking and the use of organizational aids (e.g., planners or digital apps) can help clients allocate their time more efficiently. Research shows that structured scheduling can reduce anxiety by providing clear expectations for each day (Macan et al., 1990).
- SMART Goals: Utilizing the SMART framework (Specific, Measurable, Achievable, Relevant, Time-bound) enables clients to break larger objectives into manageable steps. This method creates a sense of progress and control, which is essential for overcoming the paralysis often associated with chaotic lifestyles.
- Routine Building: Encouraging clients to establish consistent daily patterns—such as fixed morning rituals or regular exercise—can help reduce decision fatigue and enhance mental clarity. Tools like habit trackers serve as visual reinforcers, celebrating small victories and maintaining momentum toward a more organized life.
Considerations for Psychologists
When working with clients affected by chronic stress, especially Black women, it is crucial to adopt a culturally informed and empathetic approach. Key considerations include:
- Recognize the Impact of Historical and Cultural Trauma: Understanding that intergenerational trauma and systemic oppression shape how stress is experienced helps clinicians contextualize a client’s symptoms and responses. Acknowledging these factors is essential in building trust and rapport.
- Address Cultural Stereotypes: Cultural schemas, such as the Strong Black Woman (SBW), may promote emotional suppression and overextension. Clinicians should explore how these stereotypes influence behavior and challenge them by encouraging clients to see vulnerability as a strength rather than a weakness.
- Foster a Safe Therapeutic Environment: Creating a space where clients feel validated and comfortable expressing their full range of emotions is critical. This involves active listening and addressing microaggressions that may occur within or outside the therapeutic setting.
- Acknowledge Other Marginalized Groups: While this article centers on Black women, other marginalized populations face similar stressors. Clinicians should remain open to adapting culturally informed interventions for diverse groups, ensuring that all clients receive tailored and sensitive care.
Conclusion
Chronic stress significantly affects clients’ quality of life and is particularly acute among marginalized populations. By addressing the interconnected factors of unhealed trauma, poor boundaries, and disorganized lifestyles through a unified, culturally informed approach, psychologists can empower clients to manage stress effectively. Tailoring interventions to the unique experiences of Black women—and by extension, other vulnerable groups—can promote resilience and long-term well-being. Ongoing research and clinical training are essential for refining these approaches and ensuring that therapeutic practices evolve to meet the complex needs of diverse populations.
References
Alberti, R. E., & Emmons, M. L. (2017). Your perfect right: Assertiveness and equality in your life and relationships (10th ed.). New Harbinger Publications.
Greenberg, L. S., & Goldman, R. N. (2019). Emotion-focused therapy: Coaching clients to work through their feelings. American Psychological Association.
Macan, T. H., Shahani, C., Dipboye, R. L., & Phillips, A. P. (1990). College students’ time management: Correlations with academic performance and stress. Journal of Educational Psychology, 82(4), 760-768.
Shapiro, F. (2018). Eye movement desensitization and reprocessing (EMDR) therapy: Basic principles, protocols, and procedures (3rd ed.). Guilford Press.
Wallace, D., Moore, C. P., & Roller, K. (2023). Black girls are taught to survive: Historical trauma and the Strong Black Woman’s embodiment. International Body Psychotherapy Journal, 22(1), 16–30.
Alana Atchison, PsyD, ABPP
Board Certified in Clinical Psychology
Correspondence: alanaatchisonpsyd@gmail.com