Stress reaches your heart, skin and pain nerves, and that doesn’t make symptoms imaginary

Key takeaways

• In a University of Colorado Boulder trial, 66% of people with long-term back pain who had pain reprocessing therapy were pain-free or nearly so afterward, compared with 20% after a placebo shot and 10% with usual care, and the therapy group still had less pain five years later¹¹⁵.
• The National Institute of Neurological Disorders and Stroke says the symptoms of functional neurological disorder are genuine and come from changes in how brain networks work⁸.
• In the 52-country INTERHEART study, people who reported constant stress at work or at home had about twice the odds of a first heart attack¹¹.
• A famous 2007 study suggested hotel housekeepers’ blood pressure fell just because they learned their work counted as exercise, but only seven hotels were randomized, and a later repeat reportedly found no significant difference¹³¹⁴.
• Mind-based care works best alongside medical care: see a clinician about new or unusual symptoms, and call or text 988 in a crisis⁴.

In a trial run at the University of Colorado Boulder, 151 adults who had lived with back pain for an average of 10 years got one of three treatments¹. Some received usual care. Some got a placebo shot in the back, and they were told it was a placebo. The rest got pain reprocessing therapy, a talk-and-movement treatment¹.

The therapy group saw a physician once, then had eight one-hour sessions, twice a week for four weeks¹. They learned how the brain helps produce chronic pain, then rehearsed movements they had feared while practicing reading the sensations as safe².

The results were striking. Two in three people in the therapy group (66%) finished at 0 or 1 on a 10-point pain scale, meaning gone or nearly gone¹. Only one in five placebo patients got there, and one in ten with usual care¹. Most therapy patients held on to their relief a year later, and brain scans showed pain-processing areas reacting less².

The researchers were careful about what that means. Lead author Yoni Ashar likened this kind of pain to a false alarm². Senior author Tor Wager stressed that the pain is real; if its causes lie in the brain, he said, so may its solutions².

That is the core of mind-body science. Thoughts and feelings change the body through paths you can measure. Mind-based care can ease some very physical symptoms. And “mind over matter” still has limits worth knowing.

Your mind reaches your body by nerves, hormones and immune signals

Scientists can trace several routes from a stressful thought to a physical change.

Nerves. Chronic stress switches on the fight-or-flight response, which raises blood pressure, according to the American Heart Association (AHA)³. Stress hormones also tense your muscles and speed your pulse, MedlinePlus explains⁴. Our article on the autonomic nervous system covers these nerve pathways.

Hormones. Under stress, the brain triggers a hormone chain that ends with cortisol from the adrenal glands⁵. A companion article on the stress response covers how that system works.

Immune signals. Stress is tied to inflammatory messengers such as IL-6 and TNF-alpha, which promote inflammation⁵. The AHA notes that chronic stress can trigger low-grade inflammation, and that emotional distress may make artery plaque more likely to rupture³.

The brain itself. A 2017 study in The Lancet, described by the AHA, linked higher activity in the amygdala, a brain area that reacts to threat, to inflamed arteries and changes in the bone marrow³.

Habits. Mood shapes behavior. People with a stronger sense of purpose tend to smoke less, move more and control their blood sugar better, the AHA notes³.

Our article on the mind-body connection covers stress and the immune system in more depth.

Pain: a false alarm can sometimes be retrained

Pain is one of the clearest places to see the mind and body working together. In 2019, about 20.4% of U.S. adults had chronic pain, and 7.4% had pain that limited their life or work on most days, according to the National Center for Complementary and Integrative Health (NCCIH)⁶.

The Boulder researchers estimated that about 85% of chronic back pain is “primary,” meaning doctors can’t find a specific cause in the back¹. Fear of movement and the belief that pain means injury can keep it going¹.

Pain reprocessing therapy, or PRT, targets those beliefs. Its pieces include evidence that the pain is coming from the brain’s alarm system, guided reappraisal during feared movements, help with hard emotions, and practice building positive feelings and self-compassion¹.

The results were large, but they come from one trial. Participants were mostly White and college-educated, with low to moderate pain, and the therapists were experts in the method¹.

The same team followed up five years later, reaching 113 of the 151 participants¹⁵. Pain was still lower in the therapy group: 55% were pain-free or nearly so, compared with 26% of the placebo group and 36% of the usual-care group¹⁵.

Several authors also had financial ties to the approach. PRT’s developer, therapist Alan Gordon, directs the Pain Reprocessing Therapy Center and was one of two therapists who delivered it in the trial¹. Another author co-owns a chronic-pain company, Freedom From Chronic Pain Inc., and the lead author has been paid by the PRT center¹¹⁵. Funding came from National Institutes of Health grants plus several foundations, including the Psychophysiologic Disorders Association, and community donations¹.

Pain neuroscience education, which teaches people how the nervous system produces pain, sends a similar message. The trial’s authors noted that it usually lacks the guided practice with feared movements that PRT adds¹.

Older mind-body methods have broader support. In a trial of 342 adults with chronic low-back pain, mindfulness-based stress reduction (MBSR) and cognitive behavioral therapy (CBT) each beat usual care at six months and one year⁷. The two worked about equally well⁷. By two years, only a modest edge for CBT on daily function remained⁷.

PRT is not meant for pain from a fresh injury or an active disease². That kind of pain needs medical care first.

Functional neurological disorder: real symptoms, changed brain function

Few conditions show the stigma around mind-body illness as sharply as functional neurological disorder, or FND.

NINDS describes FND as a problem with how brain networks work, not with the brain’s structure, which is why standard scans often look normal⁸. Symptoms vary widely: seizure-like episodes, tremors, weakness, trouble walking, numbness, and problems with vision or speech⁸.

The agency leaves no room for the old suspicion. The symptoms are genuine, NINDS says, and people don’t create them deliberately⁸. Some doctors wrongly assume faking, it adds, and that can leave patients feeling stigmatized⁸.

The condition was once called conversion disorder⁹. Women are affected more often, and depression, anxiety or post-traumatic stress disorder frequently come along⁸. In adults, psychological stress and childhood adversity raise the risk, though not everyone with FND has that history⁸.

A good diagnosis rests on positive signs, not just normal tests. One example is Hoover’s sign, a bedside test for functional leg weakness⁸.

Treatment usually pairs physical therapy with psychotherapy, such as CBT⁸. NINDS says people with functional seizures should not take anti-seizure medicines, which don’t treat these episodes and might worsen symptoms⁸. If you already take one, don’t stop on your own; talk with the prescriber. MedlinePlus adds that learning about FND, and understanding that the symptoms are real, can itself help⁹.

The research is still young. A 2022 NIH study page noted that psychotherapy for functional movement problems has not been well studied¹⁰. Relapses are common, but early diagnosis and treatment can help⁸.

The heart: stress shows up in heart attack statistics

The INTERHEART study compared 11,119 people who had a first heart attack with 13,648 similar people who hadn’t, in 52 countries¹¹. It was published in The Lancet in 2004.

People who reported constant stress at work, or constant stress at home, had about twice the odds of a heart attack¹¹. Severe money worries, a recent major life event and depression each raised the odds by roughly a third to a half¹¹. The pattern held across regions, ethnic groups, men and women¹¹.

INTERHEART was a case-control study, meaning people were asked about their lives after their heart attacks. That design shows a strong link but can’t prove that stress caused each event.

In 2021, an AHA scientific statement pulled together this kind of research. It tied depression, chronic stress, anxiety, anger, pessimism and dissatisfaction with life to heart risk³. Optimism, purpose, gratitude and resilience were tied to better heart health³.

The writing group was careful about cause and effect. It flagged weak measuring tools, possible confounding and reverse causation, where poor health drives low mood rather than the other way around¹². Dr. Glenn Levine, who chaired the writing group, said the data suggest that psychological treatments could reduce heart risk, which is not the same as proof¹².

The statement urged clinicians to screen heart patients for depression and anxiety and to treat the whole person, not just the disease³. Our mind-body connection article covers depression after a heart attack and broken heart syndrome.

Skin and gut: two organs that talk back

Your skin is not a passive wrapper. A 2025 review in Dermatology Review describes how skin cells make their own versions of stress hormones, which can fuel inflammation⁵. Stress also releases nerve chemicals that can stir up oil glands and acne⁵.

The same review lists psoriasis, eczema, acne and seborrheic dermatitis among conditions that stress can worsen⁵. It notes that stress can weaken the skin’s barrier and slow wound healing⁵. MedlinePlus also lists skin problems such as acne and eczema among the possible effects of long-term stress⁴.

The street runs both ways. Itchy, visible skin disease can drag down mood and quality of life, which can add more stress⁵.

Psychological care looks helpful but unproven. The review cites a study in which CBT eased depression, anxiety and stress in skin conditions such as psoriasis, plus a mindfulness trial in psoriasis with positive results. It reports few numbers and calls for more research⁵.

For the gut, NCCIH says gut-directed hypnotherapy may help irritable bowel syndrome⁶. Our gut-brain article covers the many trials of brain-based therapies for IBS.

A famous expectation study, re-examined

In 2007, Harvard researchers Alia Crum and Ellen Langer published a study of 84 female hotel room attendants¹³. In four of seven hotels, staff learned that their daily work already met the Surgeon General’s recommendations for an active lifestyle. They also got a handout estimating the calories each task burned¹³.

Four weeks later, the informed group had lost about 2 pounds and their systolic blood pressure had dropped about 10 points, compared with the control group¹³. The housekeepers reported no change in exercise or diet¹³. The finding became a classic example of mindset changing the body.

The study has real weak points, and the authors named several¹³. Behavior was self-reported, so unrecorded changes in eating or activity can’t be ruled out. The informed group was younger. And there is no accepted model of how a mindset alone would change the body¹³.

Critics add a design problem: whole hotels, not individual workers, were assigned to each group¹⁴. With only seven hotels, something about one workplace could sway the result. A 2024 critique in The Skeptic also reports that an attempted repeat of the study in 2011 found no difference between groups¹⁴.

Expectations do shape how people feel, and our placebo article covers that research. But this study can’t show that believing your chores are exercise will lower your blood pressure. Rating: Not enough evidence.

What mind-body care can and can’t do

Mind and body practices are generally safe for healthy people when done properly, NCCIH says, but people with health conditions or who are pregnant may need to adapt or skip some⁶. NCCIH also warns against using an unproven practice to put off seeing a provider about chronic pain⁶.

A mind-body treatment can ease a symptom without explaining it. If CBT eases your back pain, it does not rule out a disease that needs other care. If you have new or unusual symptoms, MedlinePlus advises contacting your provider⁴.

The word “psychosomatic” was meant to describe mind and body working together. Yet people with conditions like FND are still sometimes treated as if they were faking⁸. The research above points the other way: when stress or fear shapes a symptom, the symptom is still physical, and it can respond to physical and psychological care combined²⁸.

That idea fits natural health’s oldest conviction, that a person is one whole. The AHA’s Levine said much the same in 2021: doctors need to treat the whole person, not just a disease³.

A mind-body map: where the evidence stands

Body system	How the mind gets involved	Mind-based care	Evidence rating
Back (primary chronic pain)	Pain alarm in the brain, fear of movement1	Pain reprocessing therapy	Promising but early: one trial, with five-year follow-up; developer involved115
Back (chronic low-back pain)	Pain beliefs, fear of movement1	MBSR or CBT	Strong evidence for modest benefit67
Brain and nerves (FND)	Changed brain-network function8	Physical therapy plus psychotherapy	Promising but early810
Heart	Fight-or-flight, blood pressure, inflammation3	Stress and mood care alongside heart care	Strong evidence of a link311; Not enough evidence that stress care prevents heart attacks12
Skin	Skin’s own stress hormones, inflammation5	CBT, mindfulness with skin care	Promising but early5
Gut (IBS)	Gut-brain nerve and hormone signals	Gut-directed hypnotherapy	Rated in our gut-brain article; NCCIH says it may help6
Fitness and weight	Expectations	Mindset reframing alone	Not enough evidence1314

How to talk with your doctor about stress and symptoms

Many people worry that mentioning stress will get their symptoms brushed off. These steps keep the conversation on track.

1. Lead with the symptom. Say when it started, how often it happens and what makes it better or worse.
2. Name stress as one possible factor, not the answer. Try: “I’ve been under a lot of stress, and I’d like to know whether that could be part of this, and what else we should rule out.”
3. Ask what has been ruled out. Then ask which signs should bring you back sooner.
4. If you hear “it’s stress” or “it’s functional,” ask how they know. Try: “Is this based on specific exam findings, or mainly on normal tests?” FND, for example, has positive signs on exam⁸.
5. Ask about tested options. For chronic back pain, MBSR, CBT and physical approaches all have evidence⁶⁷.
6. Set a follow-up. Agree on when you’ll check in and what would change the plan.

Questions readers ask

The bottom line

Mind and body aren’t separate systems. Stress and fear travel through nerves, hormones and immune signals, and they show up in pain, the heart, the skin and the gut. That’s why mind-based care can ease very physical symptoms, sometimes dramatically.

The same research shows the limits. Mind-based care isn’t a cure for disease, one striking trial isn’t the last word, and some famous findings haven’t held up. Use mind-body care as a partner to medical care, and never accept “it’s all in your head” as the end of the conversation.

Related reading

• Stress can reach your immune cells, but positive thinking still can’t cure cancer
• Placebos ease how you feel but rarely change what doctors measure
• Your gut and brain really talk, but many mood claims started in mice
• What to say when a doctor isn’t taking you seriously
• The vagus nerve has FDA-approved treatments, while the viral hacks are untested

Sources

1. Ashar YK, Gordon A, Schubiner H, et al. “Effect of Pain Reprocessing Therapy vs Placebo and Usual Care for Patients With Chronic Back Pain: A Randomized Clinical Trial.” JAMA Psychiatry, 2022;79(1):13-23. doi:10.1001/jamapsychiatry.2021.2669. doi.org
2. Marshall L. “Pain reprocessing therapy” trial news release. CU Boulder Today, University of Colorado Boulder, Sept. 29, 2021 (university press release). colorado.edu
3. American Heart Association News. “The Head Is Connected to the Heart – and Can Influence Health” (on Levine GN, et al., Circulation, 2021). American Heart Association, Jan. 25, 2021. heart.org
4. MedlinePlus. “Stress and Your Health.” U.S. National Library of Medicine, reviewed 2026. medlineplus.gov
5. Astrid C, Dharmaningputri NGAA, Putri MK, Rumaisyah A, Pamela RD. “Management of Primary Psychocutaneous Disorders: The Role of Inflammation in Skin-Psyche Interactions.” Dermatology Review, 2024;111(5):358-365 (published 2025). termedia.pl
6. National Center for Complementary and Integrative Health. “Chronic Pain and Complementary Health Approaches: Usefulness and Safety.” NIH, updated 2023. nccih.nih.gov
7. National Center for Complementary and Integrative Health. “Two Mind and Body Practices for Chronic Low-Back Pain Better Than Usual Care Alone” (on Cherkin DC, et al., JAMA, 2016 and 2017). NIH. nccih.nih.gov
8. National Institute of Neurological Disorders and Stroke. “Functional Neurologic Disorder.” NIH, reviewed March 2026. ninds.nih.gov
9. MedlinePlus. “Functional Neurological Disorder.” U.S. National Library of Medicine, reviewed 2024. medlineplus.gov
10. National Institute of Neurological Disorders and Stroke. “Treatment of Functional Movement Disorders With Psychotherapy.” NIH clinical trial page, reviewed 2022. ninds.nih.gov
11. Rosengren A, Hawken S, Ôunpuu S, et al. “Association of Psychosocial Risk Factors With Risk of Acute Myocardial Infarction in 11,119 Cases and 13,648 Controls From 52 Countries (the INTERHEART Study): Case-Control Study.” The Lancet, 2004;364(9438):953-962. experts.mcmaster.ca
12. TCTMD. “Soft Stuff, Hard Data: AHA Tallies Evidence Linking Psychological Health and CVD.” Cardiovascular Research Foundation, 2021. tctmd.com
13. Crum AJ, Langer EJ. “Mind-Set Matters: Exercise and the Placebo Effect.” Psychological Science, 2007;18(2):165-171. dash.harvard.edu
14. Hall M. “Hotels and Houseplants: Why We Should Doubt Ellen Langer’s Mind-Over-Matter Miracles.” The Skeptic, June 26, 2024. skeptic.org.uk
15. Ashar YK, et al. “Pain Reprocessing Therapy vs Placebo and Usual Care for Patients With Chronic Back Pain: 5-Year Follow-Up of a Randomized Clinical Trial.” JAMA Psychiatry, 2025;82(10):1049-1051 (research letter). pubmed.ncbi.nlm.nih.gov