Effective stress management techniques

By Ned Rubin, PhD

General practitioners agree that at least half of their patients suffer from physical or emotional problems either caused by stress or aggravated by it. When we perceive a threat that we feel we cannot cope with, our body's physiology reacts automatically with the fight or flight stress response. It is the Sympathetic Nervous System – part of the autonomic nervous system – that puts the mind-body system on red alert. The primitive part of the brain – the hypothalamus – floods our body with the stress hormones, adrenaline and noradrenalin, our heart pumps faster, our muscles tense, our blood pressure rises and we start to perspire. Our body is primed either to fight or to flee and it may be a factor in disease causation.

Not all stress is bad for us

In short manageable bursts, stress is good for us. It gives us a zest for life, a 'buzz' and sense of fulfillment – the challenge of a new job, project or romance – and it can help us to excel in our performance and realize our potential. A totally stress-free life would be dull and boring. Too little stress is just as unhealthy as too much stress. Feeling mildly stressed when carrying out a project or assignment often compels us to do a good job, focus better, and work energetically. Likewise, exercising can produce a temporary stress on some body functions, but its health benefits are indisputable. It is only when stress is overwhelming, or poorly managed, that its negative effects appear.

An important goal for those under stress is the management of life stresses. Elimination of stress is unrealistic, since stress is a part of normal life. It's impossible to completely eliminate stress, and it would not be advisable to do so. Instead, we can learn to manage stress so that we have control over our stress and its effects on our physical and mental health.

The key is to tell the difference between the healthy stimulus of a challenge, and excessive stress – a constant feeling of being under too much pressure – which causes fatigue, distress and eventually, disease. If the warning signs are ignored, excessive stress can lead to emotional and physical exhaustion and eventually, mental breakdown (e.g. depression or suicide) or physical breakdown (e.g. heart attack or stroke).

However, stress is a very individual matter. We each have different stress thresholds. What is challenging and stimulating for one person might be overwhelming for another. It is not the source of stress itself but our perception of the situation and our perception of our ability to cope with it that determine whether it is distressing.

In modern life, most of the threats that we face are mental and emotional rather than physical, e.g. the threat of redundancy or the breakdown of a relationship. The body reacts with the 'fight or flight' response but we cannot fight or run away, so we have no chance to use up the adrenaline. We feel wound up but have no way to release the hormones and restore our physical and emotional balance. The strain of being constantly on red alert depletes our immune system and can lead to illness or burnout.

Who is most susceptible to stress?

Stress comes in all forms and affects people of all ages and all walks of life. No external standards can be applied to predict stress levels in individuals -- one need not have a traditionally stressful job to experience workplace stress, just as a parent of one child may experience more stress related to parenting than a parent of several children. The degree of stress in our lives is highly dependent upon individual factors such as our physical health, the quality of our interpersonal relationships, the number of commitments and responsibilities we carry, the degree of others' dependence upon and expectations of us, the amount of support we receive from others, and the number of changes or traumatic events that have recently occurred in our lives.

Some generalizations, however, can be made. People with strong social support networks (consisting of family, friends, religious organizations, or other social groups) report less stress and overall improved mental health in comparison to those without these social contacts. People who are poorly nourished, who get inadequate sleep, or who are physically unwell also have reduced capabilities to handle the pressures and stresses of everyday life and may report higher stress levels. Some stressors are particularly associated with certain age groups or life stages. Children, teens, working parents, and seniors are examples of the groups who often face common stressors related to life transitions.

People who are providing care for elderly or infirm loved ones may also experience a great deal of stress as caregivers. Having a loved one or family member who is under a great deal of stress often increases our own stress levels as well.

What are the symptoms and effects of excess stress or "out-of-control" stress?

Manifestations of excess or poorly managed stress can be extremely varied. While many people report that stress induces headaches, sleep disturbances, feelings of anxiety or tension, anger, or concentration problems, others may complain of depression, lack of interest in food, increased appetite, or any number of other symptoms. In severe situations, one can experience overwhelming stress to the point of so-called "burnout", with loss of interest in normal activities.

Scientific studies have shown that psychological stress may worsen the symptoms of almost every known medical condition. Examples of conditions in which stress may worsen the intensity of symptoms include cardiovascular diseases, asthma, multiple sclerosis, chronic pain, acne, and depression. While stress alone is not a cause of cardiovascular disease or high blood pressure, it may actually worsen the progression of these diseases in many people.

Stress also has effects on the immune system. While some studies show that acute short-term stresses may actually be able to boost the body's immune response, chronic (long-term) stress has the effect of "wearing down" the immune system, leading to an increased susceptibility to colds and other infections. Scientific studies have also shown that stress can decrease the immune response to vaccinations and prolong wound healing.

What can I do to better manage stress?

In general, stress is related to both external and internal factors. External factors include your physical environment, your job, relationships with others, your home, and all the situations, challenges, difficulties, and expectations you're confronted with on a daily basis. Internal factors determine your body's ability to respond to, and deal with, the external stress-inducing factors. Internal factors which influence your ability to handle stress include your nutritional status, overall health and fitness levels, emotional well-being, and the amount of sleep and rest you get.

Managing stress, therefore, can involve making changes in the external factors which confront you or with internal factors that strengthen your ability to deal with what comes your way.

What are some effective stress-management techniques?

Exercise

Physical exercise not only promotes overall fitness, but it helps you to manage emotional stress and tension as well. For one thing, exercise can emotionally remove one temporarily from a stressful environment or situation. Being fit and healthy also increases your ability to deal with stress as it arises.

Relaxation and meditation

There are many ways to use structured relaxation and meditation techniques to help control stress and improve your physical and mental well-being. While some types of meditation and relaxation therapies are best learned in a class, it's also possible to learn meditation techniques on your own. There are literally hundreds of different types of relaxation methods ranging from audio CDs to group martial arts and fitness classes. The following are only examples of the types of structured programs available that can increase our capacity for relaxation:

• Autogenic training: Developed in the early 20th century, this technique is based upon passive concentration and awareness of body sensations. Through repetition of so-called autogenic "formulas" one focuses upon different sensations, such as warmth or heaviness, in different regions of the body. Autogenic training has been used by physicians as a part of therapy for many conditions. Popular in Europe (where it is even covered by some insurance plans), this method is currently gaining acceptance in the U.S. No particular physical skills or exercises are involved; however, people desiring to learn this technique must be prepared to invest time and patience. Since this technique is slightly more complex than some relaxation methods, a course is generally the best way to learn the method.
• Biofeedback: Biofeedback is one method of learning to achieve relaxation, control stress responses, or modify the body's reactions through the use of monitoring equipment that provides information from the body which would normally not be available. This method is based upon the principle first advanced in the early 1960s that the autonomic nervous system (the part we don't consciously use) is trainable. For example, instruments can be used to measure heart rate, blood pressure, brain activity, stomach acidity, muscle tension, or other parameters while people experiment with postural changes, breathing techniques, or thinking patterns. By receiving this feedback, one can learn to identify the processes that achieve the desired result, such as reduction in heart rate and blood pressure. Biofeedback is used by many practitioners for a variety of psychological and physical conditions. Because the technique involves the use of measuring devices, it can only be performed by a professional.
• Imagery: Imagery, sometimes referred to as guided imagery, is the use of pleasant or relaxing images to calm the mind and body. By controlling breathing and visualizing a soothing image, a state of deep relaxation can occur. This method can be learned by anyone and is relatively easy to try out.
• Meditation techniques: Ranging from practices associated with specific religions or beliefs to methods focusing purely on physical relaxation, meditation is one of the most popular techniques to achieve physical and mental relaxation. There are thousands of different types of meditation, and many can be learned on your own. The meditative state is one in which there is a deep centering and focusing upon the core of one's being; there is a quieting of the mind, emotions, and body. The meditative state can be achieved through structured (as in a daily practice of a routine) or unstructured (for example, while being alone outdoors) activities. While teachers of meditative arts are readily available, some techniques can be learned though books or online tutorials.
  
  A form of meditation popularized in the last few decades is TM, or transcendental meditation. TM has the goal of achieving transcendental consciousness, or the simplest form of awareness. It is practiced for 15-20 minutes in the mornings and evenings and is relatively easy to learn. Numerous classes and teaching materials are available for beginners.
  
  Another variant of a meditation technique has gained popularity in the U.S. since its description in the 1970s by Harvard physician Herbert Benson. This technique involves generation of the so-called relaxation response through the repetition of a word of phrase while quietly seated, 10-20 minutes per day. Designed to evoke the opposite bodily reaction to the stress response (or "fight or flight" reaction), this method carries no religious or spiritual overtones. Its value has been documented in the reduction of blood pressure and other bodily stress responses. Like other forms of meditation, it can be learned on one's own, but time and practice are required to elicit the desired relaxation state.
• Progressive muscle relaxation:Progressive muscle relaxation is a method developed in the 1930s in which muscle groups are tightened and then relaxed in succession. This method is based upon the idea that mental relaxation will be a natural outcome of physical relaxation. Although muscle activity is involved, this technique requires no special skills or conditioning, and it can be learned by almost anyone. Progressive muscle relaxation is generally practiced for 10-20 minutes a day. As with the relaxation response, practice and patience are required for maximum benefits.
• Qigong: The martial art qigong is an ancient Chinese health-care system that combines physical training (such as isometrics, isotonics, and aerobic conditioning) with Eastern philosophy and relaxation techniques. There are many different kinds of qigong, including medical qigong. Some forms are practiced while standing, sitting, or lying down; others involve structured movements or massage. Over 70 million Chinese practice some form of qigong daily. Qigong has been used for centuries in China for the treatment of a variety of medical conditions. Learning qigong involves time, commitment, patience, and determination, and learning from a master or group is advisable. Since this technique involves physical exertion, check with your doctor before beginning, particularly if you have a chronic medical condition or are over 40 years old.
• Tai chi: Like qigong, tai chi is a Chinese martial art. It has been termed a kind of "meditation in motion" and is characterized by soft, flowing movements that stress precision and force. Also known as tai chi chuan, this method is thousands of years old. As with qigong, training from a master is necessary to learn the art of tai chi. Again, since motion and force are required, check with your doctor before beginning training.
• Yoga: There are many forms of yoga, an ancient Indian form of exercise based upon the premise that the body and breathing are connected with the mind. The practice of yoga is thought to be over 5,000 years old. One goal of yoga is to restore balance and harmony to the body and emotions through numerous postural and breathing exercises. Yoga, which means "joining" or "union" in Sanskrit, has been called the "search for the soul" and the "union between the individual and the divine." Among the benefits of yoga are increased flexibility and capability for relaxation. No special level of conditioning is required; yoga can be learned by nearly anyone. Classes, books, and videos are widely available. Those with special or chronic physical conditions will want to get clearance from their doctor before beginning.

Other stress-management strategies

Time management

Good time-management skills are critical for effective stress control. In particular, learning to prioritize tasks and avoid over-commitment are critical measures to make sure that you're not overscheduled. Always using a calendar or planner, and checking it faithfully before committing to anything, is one way to develop time-management skills. You can also learn to identify time-wasting tasks by keeping a diary for a few days and noticing where you may be losing time.

For example, productivity experts recommend setting aside a specific time (or multiple times) each day to check and respond to email and messages rather than being a continual slave to incoming information. Banishing procrastination is another time-management skill that can be learned or perfected.

Organizational skills

If your physical surroundings (office, desk, kitchen, closet, car) are well-organized, you won't be faced with the stress of misplaced objects and clutter. Make it a habit to periodically clean out and sort through the messes of paperwork and clutter that accumulate over time.

Support systems

People with strong social support systems experience fewer physical and emotional symptoms of stress than their less-connected counterparts. Loved ones, friends, business associates, neighbors, and even pets are all part of our social networks. Cultivating and developing a social support network is healthy for both body and mind.

How can I get help with stress management?

If you feel you can't manage stress on your own or you are faced with unbearable stress, remember that there are resources to help.

• Check in with your doctor. Stress can take its toll on your body, increasing your susceptibility to infections and worsening the symptoms of practically any chronic condition. Stress alone can also be a cause of numerous physical symptoms. Your physician will be able to assess the effects that stress may be having on your physical functioning and can recommend ways to combat these negative influences. Remember to be honest about the extent of stress you are experiencing. In severe cases of short-term life stress, your doctor can talk with you about the possibility of medications to help alleviate the short-term symptoms. Your doctor is also an excellent referral source should you decide to seek a counselor or therapist.
• Consider counseling. Stress-management counseling is offered by various types of mental-health professionals. Stress counseling and group-discussion therapy have proven benefits in reduction of stress symptoms and improvement in overall health and attitude. Counseling doesn't have to be a long-term commitment, but some people will benefit from a series of stress-counseling sessions from a qualified therapist. He/she can help you identify the problem areas in your life and work on strategies to control your most stressful moments or situations. The very act of talking to an impartial and supportive observer can also be a great way to unleash tension and worry.
• Spend time with those you love. Countless studies show that people with a balanced, happy social support structure (consisting of friends, family, loved ones, or even pets) experience fewer stress-related symptoms and are better stress managers than people without social support. Your loved ones are also in an excellent position to observe your lifestyle and offer suggestions and help when you need it.
• Take a course. Many relaxation programs, meditation techniques, and methods for emotional and physical relaxation are actually learned processes that can be acquired most quickly through a class or course with a competent instructor. An added benefit is that you will meet others with similar goals and interests.