Stress Management 101

This article, entitled "Stress Management 101," provides an overview of what stress is, how it hurts us and ways to lower it. Much of this article was inspired by information gleaned from Dr. Fred Luskin and Dr. Kenneth Pelletier in their book, Stress Free for Good, and from Harvard professor Tal Ben-Shahar during his talk on PBS, "Happiness 101." Specific references are cited when possible.

What is stress?

Stress comes in many shapes and sizes. It can manifest as sleepless nights or low grade, chronic tension in the back and neck. For some, it can contribute to serious psychological and physical illnesses.

But, what exactly is this thing we call "stress?" Hans Selye, the founding father of the stress concept, defined it as "the nonspecific (that is, common) result of any demand upon the body, be the effect mental or somatic" (Goldberger and Breznitz, 1993). In modern times, many people see stress as something to be avoided. But, the day to day stress we all face that involves getting up in the morning, brushing our teeth and taking care of our daily responsibilities is a simple fact of life. A moderate amount of stress isn't actually a bad thing. However, excessive and unrelenting stress - the kind that results in physical or psychological damage - is something we should all aspire to minimize.

The concept of "stress" is a subjective one. What may be seen as "stressful" to one person, can be experienced as benign by another. Two giants in the field of stress research, former UC Berkeley psychology professor Richard Folkman and Susan Lazarus, professor of integrative medicine at UCSF (1991), note that “cognitive appraisal” - how we perceive and interpret a situation - is a critical element in the stress and coping response.

In their analysis, Lazarus and Folkman identify two stages in the appraisal process. First, we determine what is at stake in the matter (i.e., how important is this, what kind of impact will it have, etc.). Then, we assess what can be done about it (i.e., do I have the tools to solve this problem or not?). If something is seen as threatening to our well-being, and as uncontrollable (i.e., we don't have the resources to handle the problem), it's likely to impact us in a more negative fashion. Alternatively, if we view the situation as "challenge," rather than a "threat," and we can identify tools that will help us, then the event will likely be experienced as less stressful. Thus, interpretation - how we choose to view a problem - is an important variable in the stress response.

Later in this article, we'll explore ways to lower stress, including cognitive strategies that can impact how we relate to difficult circumstances. But first, let's take a more in-depth look at exactly how stress can hurt us.

Fight-Flight-Freeze

When exposed to a threat, a complex alarm system gets triggered in the body, which includes the release of stress hormones, including adrenaline and cortisol. This state of high-alert is often referred to as the "fight or flight" response, a term first coined in 1915 by former Harvard Medical School professor Walter Cannon. More recently, this model been broadened to include the concept of "freezing," especially when it pertains to traumatic experiences.

In the face of a serious threat, we as humans, like all vertebrates, are wired to respond in one of these three ways. "Fighting" involves getting angry, gearing up for a confrontation and then doing everything in our power to protect ourselves. "Fleeing" is when we run away from or avoid whatever we perceive as threatening. "Freezing" is when we're stuck, uncertain of how to proceed, and can also include a feeling of being on guard or hypervigilant.

These ancient and reflexive responses are particularly helpful when, say, you're alone in the jungle and a hungry lion is chasing you. However, in modern times, most of us don't face this particular type of challenge. Unfortunately, however, our bodies often react in a similar fashion, whether the danger is real or simply perceived. When our spouse gets upset at us or if we're running late to an important meeting, our body and mind can respond as if we're facing an actual life or death situation.

How stress hurts us

As mentioned previously, low levels of stress and periodic periods of higher stress aren't that bad for us. However, if our nervous system is constantly on high-alert, this will eventually take a toll on our body and mind.

As Dr. Fred Luskin and Dr. Kenneth Pelletier (2005) noted in Stress Free for Good, the fight-flight-freeze stress response results in the following:

--Increased heart rate to pump more blood to your muscles, resulting in higher blood pressure

--Faster breathing to give you more oxygen

--Muscular tensing in preparation for action

--Reduced blood flow to the prefrontal cortex of the brain (executive functioning, reasoning ability)

--Increased blood flow to the limbic region of the brain (area that mediates emotion, highly reactive)

--Cessation of digestion process to divert blood flow to brain and muscles, which can result in abdominal discomfort and even irritable bowel syndrome

--Increased sweat to cool off and "become lighter in preparation for a potential confrontation"

--Pupil dilation, increased sense of hearing and smell to enhance performance in the face of the threat

--Increased inflammation in the arteries around your heart

--Decreased immune function

--Narrowing of focus on the immediate danger to maximize survival, resulting in decreased ability to identify other possible solutions

From reading this list, it's clear that being in fight-fight-freeze mode on a frequent basis can contribute to a variety of problems. The Mayo Clinic concurs that chronic activation of the stress response, including overexposure to stress hormones, increases the risk of developing heart disease, digestive problems, sleep difficulties, obesity, depression and memory problems.

In addition, Marvin Stein, MD and Andrew Miller, MD (1993) noted that there's considerable research indicating a relationship between stress and tumor development in animals. Though such findings in humans are more controversial, additional research shows that chronic stress can increase the risk of adult onset diabetes, suppress growth in children and inhibit reproduction by contributing to erectile dysfunction and menstruation problems (Stanford University, 2007).

Research also shows that members of low socioeconomic groups have poorer health than groups of higher status, and that “stressful life events” have been identified as a factor contributing to this problem (Lupien, King, Meaney, and McEwen, 2001).

Ways to reduce stress

So, the bad news about how chronic stress can hurt us is clear. The good news is that there are many scientifically supported strategies that can help us manage and reduce stress. As stress expert Robert Sapolsky, PhD. has noted, it's important to be practical and experiment with different techniques to see what works best for you; what may be relaxing for one person, can actually be stress inducing to another. For most people, getting into a routine - practicing stress management techniques on a regular basis - will be most beneficial.

1.) Exercise: regular exercise is one of the best things we can do to combat stress. Exercise increases the production of endorphins, the body's natural opiate-like chemicals that make us feel good. It also can reduce cortisol (stress hormone) levels in the blood. In addition, it can help clear the mind of thought patterns related to worry and anger that may be contributing to stress. Exercise is so powerful that Duke University researchers found that walking a mere 30 minutes per day was as effective as medication for treating depression.

2.) Belly Breathing: also known as diaphragmatic or deep breathing is a simple, yet powerful tool for stress management (Luskin and Pelletier, 2005). How do you do it? Start by placing one hand on your stomach, then slowly inhale, filling your belly with air, as if you're inflating a balloon. Then, slowly exhale. Feel the rise and fall of your belly as you do this. You can practice this for 20-30 seconds at random intervals throughout the day or use this as a tool before stressful interactions.

When we're highly-stressed, in the fight-flight-freeze mode, breathing is shallow and quick (a sign that the sympathetic nervous system is doing its job). Taking slow, deep breaths from the belly engages the parasympathetic nervous system - the part of the nervous system responsible for relaxing our bodies and minds. When we do this, we essentially send a message to our brains that we're no longer in danger, which allows us to settle down and feel more at ease.

3.) Slow Down and Simplify: trying to cram too much into one day or taking on more responsibilities than we can handle is a recipe for high stress and burnout. While our culture values multitasking, busyness and speed, our bodies and minds do not. On a side note, an interesting study out of the UK shows that multitasking actually makes us less efficient, by lowering IQ (fortunately, this is only temporary!).

Learn to delegate, ask for help and say "no" more. This is an especially important message for women who are conditioned to be the caretakers of the world, often at their own expense. Look at your schedule and distinguish between "needs" and "wants." Choose to keep doing the things you absolutely "need" to and let go of some of the "wants" that are more optional. Slowing down helps lower blood pressure and increases one's sense of enjoyment by living more in the moment (Luskin and Pelletier, 2005)

Tal Ben-Shahar, professor and author of the bestseller Happier, teaches the most popular course in the history of Harvard entitled "Positive Psychology" (the course popularity shows how much people are craving tools to help increase happiness and manage stress). He stresses the importance of taking regular breaks, noting that micro (15 minutes after every 2 hours of work), mezzo (1 day off per week) and macro breaks (vacations), are correlated with increased happiness, better productivity and more creative thinking.

4.) Mindfulness Practices: "mindfulness" is an ancient spiritual practice that involves paying attention to the present moment, with a sense of non-judgment and acceptance for whatever arises. Mindfulness can be cultivated through a variety of practices, including mindful breathing, eating, walking and really, just about any activity. Mindfulness-Based Stress Reduction (MBSR) is a popular program developed by Jon Kabat-Zinn, PhD., that includes mindfulness meditation, yoga, group discussions, and other exercises designed to develop one’s awareness. Studies suggest that MBSR offers many benefits, including lowered stress levels and a reduction in medical symptoms (Williams, Kolar, Reger, and Pearson, 2001), lowered anxiety and improved immune function (Davidson, 2003).

Mindfulness helps us live in the present moment more. When we're in a highly stressed state, we're often worried about the future or fixating on something that happened in the past. Next time you find yourself feeling stressed out, ask yourself how you feel about the present moment; you'll often find that you actually feel ok, that it's the future or past you're concerned about. To learn more about mindfulness, check out karunaweb's article: "Mindfulness: What It Is and How To Do It"

5.) Play: Just like kids, adults need ample time to "play" in order to feel happy and balanced on both a physical and emotional level.

The National Institute of Play, founded by Stuart Brown, MD, notes that "play is the gateway to vitality...it generates optimism, seeks out novelty, makes perseverance fun, leads to mastery, gives the immune system a bounce, fosters empathy and promotes a sense of belonging and community...The prevalence of depression, stress related diseases, interpersonal violence, the addictions, and other health and well being problems can be linked, like a deficiency disease, to the prolonged deprivation of play."

Play covers a wide range of activities, including sports, music, arts and crafts, gardening and simply hanging out with friends and laughing. Researchers have categorized play into seven types known as attunement play; body play and movement; object play; social play; imaginative and pretend play; storytelling-narrative play; transformative and creative play. Click here to learn more about this fascinating research on the science of play.

6.) Cognitive Restructuring: is a fancy term associated with cognitive-behavioral therapy (CBT) that refers to the process of changing your thoughts. The underlying assumption in CBT is that it's not our circumstances per se that cause emotional suffering, but it's how we interpret those situations. We always have a choice in terms of how we view something and how we talk to ourselves about it. We're more likely to experience negative emotions and behaviors if we're faced with a difficult situation and we say to ourselves, "I can't handle this." Alternatively, if we stop, take a deep breath and say, "I may not have the solution to this problem right now, but I'm determined to find a way," we're likely to feel less overwhelmed and be in a better position to take effective action.

Research shows that having a "sense of control" is a key component of emotional well-being. When under stress, identifying ways to take action and think about the situation differently can instill a sense of control. On the other hand, sometimes life presents circumstances which are beyond our control, that we can't "do" anything about. In these situations, it can be helpful to have an attitude of acceptance. Tara Brach, psychologist and bestselling author of Radical Acceptance: Embracing Your Life with the Heart of a Buddha, recommends the practice of "saying yes" to experiences, no matter how unpleasant. As she notes, an attitude of resistance, or "saying no" to experiences actually increases tension. The point here isn't to condone harmful experiences, like abuse, but is about maintaining an attitude of acceptance in the moment when difficulties arise.

7.) Be Grateful: similar to cognitive restructuring, choosing to focus on things you appreciate can have a significant impact on your mood and stress level. As Luskin and Pelletier note (2005, p.80), "appreciation takes advantage of our parasympathetic nervous system to reduce the stress response and trigger our optimal performance zone. Looking for things to appreciate reduces stress and actually retrains our nervous system to make it easier to relax."

There's research out of UC Davis that supports the benefits of gratitude practices. For example, writing in a weekly gratitude journal was correlated with greater emotional and physical well-being; more optimism; and greater effectiveness in one's life with regards to goal attainment. They note that "grateful people report higher levels of positive emotions, life satisfaction, vitality, optimism and lower levels of depression and stress." Tal Ben-Shahar, PhD., recommends writing down 5 things you're grateful for each night to help increase happiness and lower stress; try it for yourself and see how it makes you feel.

8.) Connect Socially: according to U-Chicago psychology professor John Cacioppo, "loneliness leads to higher rises in morning levels of the stress hormone cortisol, altered gene expression in immune cells, poorer immune function, higher blood pressure and an increased level of depression.”

Human beings are social creatures. In addition to food, water and shelter, we all need a certain amount of social contact to survive and feel a sense of community and belonging. Some need more social contact, while others need less. Dealing with life's demands in isolation can be very draining and stressful. In addition, negative emotional states tend to be maintained or exacerbated in isolation. Therefore, it's important to maintain positive relationships. Emphasis on the 'positive' here, as unhealthy relationships obviously increase stress levels, so they're best to be avoided.

In the article "Awakening from the Trance of Unworthiness," psychologist Tara Brach writes that "our most fundamental sense of well-being is derived from the conscious experience of belonging." This excellent article discusses the importance of connection from a Buddhist psychology perspective and is well-worth reading.

9.) General Self-Care: while basic self-care may sound like an obvious component of stress management, it's often easily neglected when we're leading busy lives. Good nutrition that includes plenty of fruits and vegetables, along with limited consumption of sugar, caffeine and alcohol, contributes to more balanced mood states and better energy levels. Getting an adequate amount of sleep each night is also critical for our well-being and thinking ability - which can help us better solve the problems within our control. Most adults need between 7-9 hours to get ample rest. It's important to pay attention to how much sleep you need to recharge, as each person's body is different.

Also, let your reading of this information be a reminder to take care of any outstanding health-care needs, such as medical appointments or trips to the dentist that you've been putting off. In addition to directly addressing your health needs, checking these appointments off your to-do list will free up some mental energy that you may be expending on worries about your health or simply keeping track of these appointments.

10.) Physical Relaxation: when we're contending with chronic, daily stressors, our muscles get accustomed to feeling tense. The body-mind connection is such that our sense of physical well-being impacts our emotions and vice-versa. Deliberately relaxing the body is an excellent antidote to the stress response. One way to do this is through massage or other forms of bodywork. Yoga or other forms of gentle stretching can be quite helpful.

"Progressive muscle relaxation" is an excellent stress management tool. Follow the steps below. You can spend anywhere from 5 - 20 minutes doing this exercise.

1.) Find a comfortable posture either sitting or lying down. Notice what your body feels like at the start of this exercise, by scanning from head to toe, noting any particular sensations (e.g., tightness in the back, warmth in your legs, tingling in the toes).

2.) Take a few deep breaths, allowing your mind to quiet.

3.) Starting from the bottom of your body, clench your foot muscles by curling your toes and tightening all the muscles in your feet. Clench your muscles as tightly as possible for 30 seconds (or more), noticing what this feels like. Then release slowly, allowing the tension to dissipate. Notice how your feet feel now, compared to when tensing.

4.) Next, clench the muscles in your legs, tightening the calf, quadricep and hamstring areas. Again, hold this as tightly as possible for at least 30 seconds, then gently let go. Notice the feeling of relaxation.

5.) Proceed to the other muscle groups, one at a time, holding and then releasing. Go to the stomach area; followed by shoulders/arms and then hands.

6.) After this, tilt your neck back, hold for 30 seconds. Then tilt the neck to each side (left, right, forward), again holding for 30 seconds or more at a time.

7.) Then, tighten all the muscles in your face, by wrinkling your forehead, squinting your eyes and tightening the muscles around your mouth. Hold and release.

8.) Once you've tensed and released each specific group of muscles, try to tight all of them - your entire body - at the same time. Again, hold this for 30 seconds or longer, then let go. Notice how your body feels now, compared to when you first started the exercise.

Reminder: practice!

As noted previously, try these methods on for size, to see what works best for you. Practicing stress management techniques on a regular basis is important. This will build up your "psychological immunity," helping you respond more skillfully to what life brings your way.