Stress is a universal phenomenon, which has been the focus of much investigation over the past five decades. Much has been discovered about the physiological responses to stress. This review examines the concept of stress in relation to its effect on wound healing. An online literature search was carried out using the databases Medline, Cinahl and Pubmed and the key words stress and wound healing, and stress and leg ulceration. The rationale for specifically examining leg ulceration resulted from the author's interest in this wound type and also the volume of associated literature on the topic published to date. Stress has been demonstrated to have an adverse effect on a variety of natural resistance responses and specific immunological modifications in animal and man alike, causing, for example, reduced inflammatory response, susceptibility to infection and decreased cytokine production (Cohen et al, 1988; Sheridan et al, 1991). Stress and its effects on growth factor regulation have led theorists to examine whether stress adversely affects wound healing (Glaser et al, 1999). Much of the research as examined acute wounds, although causal inferences may be drawn from the wealth of qualitative research examining the effects of venous ulceration. To date, very little has been conducted in the relatively new area of stress and wound healing. Further investigations are required to prove that stress elicits an immunological response affecting the biological markers of wound healing and thus validates the theory that stress may have a negative impact on healing itself. Causal relationships may be postulated between stress and healing in leg ulceration.

Objective The cognitive behavior model of voice hearing suggests individuals who have lower self‐esteem, perceive themselves to be of low social rank, and hold negative beliefs about their voices, are more distressed by their voices. Self‐compassion may help reduce voice‐related distress through the activation of positive self and social mentalities. The aim of the present study was to examine the role of self‐compassion in variables within the cognitive behavior model. Method Measures assessing self‐compassion, negative affect, self‐esteem, voice malevolence, omnipotence, and distress were administered to a sample of clinical voice hearers (N = 53). Results Correlation and mediation analyses were conducted. Higher self‐compassion was associated with lower negative affect, voice malevolence, omnipotence, and distress. Voice malevolence was found to mediate the relationship between self‐compassion and voice distress. Self‐compassion was a stronger predictor of these constructs than self‐esteem. Conclusion Improving self‐compassion may have significant clinical benefits in reducing voice‐related distress.

There are two schools of thought of how wound contraction occurs. Some researchers argue that myofibroblasts have contractile properties, whereas others propose that fibroblasts exert the force needed to achieve contraction.

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