Stressed Out, Part II: Managing Stress

If you read the first article in our Stress series, Stressed Out: The Behavior and Biology of Stress, you may have become more intimately acquainted with the biological processes behind stress than you ever imagined! Many of us can identify with the feelings associated with stress and anxiety, particularly in this age of multi-tasking, economic downturn, and increasingly present technology (which is not in and of itself a bad thing, but it does make it difficult to put the work day to rest after getting home at night). While it’s valuable – and, in many ways, necessary – to understand the biological underpinnings of stress, and how our bodies react to and are affected by stress, there is one burning question that remains: “How do I cope with it?”

People vary widely in the ways in which they respond to stressful circumstances – in other words, how they cope with stress.

When we are bombarded with a constant stream of stressful situations — from financial worries to the stresses of new parenthood, to long-term health issues — we may react to these situations in various ways. Some events are obviously more stressful than others, but some days even small things – like the daily commute to work or school – can set us over the edge. As mentioned in the first part of the series, the stress response has both behavioral and biological components: not only do we feel stress mentally (and as many of us know, it’s not a pleasant sensation), but there is also a purely physical part to it, which can leave us feeling run-down, tired, and a victim of many of the health issues described earlier (like heart, weight, and sexual problems).

People vary widely in the ways in which they respond to stressful circumstances – in other words, how they cope with stress. This installment will discuss the different aspects of the coping process and the various ways in which people cope, as well as outline some of the more effective methods for dealing with stress – methods that have been shown to be effective both throughout millennia of tradition and in the current research. These methods include exercise, meditation, yoga, and Cognitive Behavioral Therapy (CBT).

When we encounter a stressful situation in life, whether it’s a traffic jam or being fired from a job, we are bound to have some thoughts about it. And we are likely to react in some way. How people deal with stress varies a lot from person to person, as you may have noticed from observing your friends and family (and yourself) in action. Some people seem to take stressful situations in stride, tackling them head-on and appearing more or less unruffled. In contrast, others may react to a stressful event by shutting down, feeling powerless, or avoiding the situation altogether.

The coping response is actually a two-part process: the first involves our appraisal of the situation at hand (our initial reaction) and the second part is how we cope with it (what actions we take to respond to it). People who appraise situations positively or neutrally ("No problem; I can handle this.") tend to be less stressed out about them and react more productively. Those whose first thoughts are negative, however ("Oh no! How am I going to handle this? I'll never get it all done!"), the coping response will be stress-induced, and, most likely, it will be less appropriate and less productive as a result.

Some people seem to take stressful situations in stride, tackling them head-on and appearing more or less unruffled. In contrast, others may react to a stressful event by shutting down, feeling powerless, or avoiding the situation altogether.

Take, for instance, a person being let go from his or her job. This is clearly a stressful situation and likely to make anyone feel low. Even so, there are a many different ways to appraise and then cope with the situation, and the example below outlines just two of the possible methods. Person A might have the initial reaction, “being let go is not a reflection on me, it’s just a fallout of these rotten economic times.” He or she might then respond by beginning a full-fledged job search after taking a few days off to enjoy their freedom. This person’s appraisal and coping methods are both positive, and ultimately lead to a productive action plan. Person B, on the other hand, might have a very different reaction and response process: he might think to himself something along the lines of, “I was fired because I wasn’t good at my job. I think it is really that they didn't like me. Now no one will hire me.” These negative emotions actually add fuel to the stress response, and therefore affect the coping process negatively, making it difficult to write a compelling resume or cover letter. Feeling inadequate or powerless in the situation, this person might respond to the challenge by avoiding action (a job search), rather than embracing it.

It is important to observe how you respond in stressful situations, and note whether your first reaction tends to involve positive or negative feelings. Some therapies, like cognitive behavior therapy (or CBT, discussed below) work to identify and change people’s appraisal and coping methods, and turn negative thoughts and reactions into positive ones.

For many of us, however, we are just feeling stressed out by the daily challenges and chores of life: an annoying boss, the kids’ report cards, house repairs, and minor health concerns. When these feelings build up, regardless of how good we are at coping, we may need a little help relaxing and retooling. The methods below – exercise, yoga, and meditation – aim to do just this.

A simple way to reduce your stress level may be to add exercise to your routine, if you don’t already do so. (Always check with your doctor first, if you’re concerned about the safety of beginning an exercise routine.) Though it may not sound appealing at first glance, getting active is a tried-and-true method for reducing tension and feeling better all over. Exercise has been shown to improve mood and overall well-being in a variety of ways. Studies throughout the years have linked exercise to reduction of stress, anxiety, and depression in both healthy individuals as well as those dealing more severe forms of stress due to serious and chronic illness. (See, for example, our recent news story on this effect.)

For many of us, however, we are just feeling stressed out by the daily challenges and chores of life: an annoying boss, the kids’ report cards, house repairs, and minor health concerns. When these feelings build up, regardless of how good we are at coping, we may need a little help relaxing and retooling.

First of all, exercise is just good for overall health – period. It helps keeps one’s heart rate, blood pressure, and cholesterol at healthy levels, and, of course, it helps one build muscle and reduce weight, if desired. The bodily benefits alone can make you feel better physically, which in turn can improve your self-image and self-confidence. These benefits in and of themselves may help ward off stress, depression, and that overall “blah” feeling that we all experience at some time or another, but particularly when stress has worn us down.

Exercise is also known to increase levels of endorphins, those little chemicals in the brain that just make us feel good all over. Endorphins are a type of opioid compound, released from the hypothalamus and pituitary gland, and are related to morphine in their action and in their pain-killing effect. It takes a fairly vigorous bout of exercise to experience what many of us know as “runner’s high,” so don’t expect to get an endorphin rush from a leisurely walk around the block, but moderate exercise, even a walk around the block, can help reduce the day's tensions.

Exercise can just be a nice way to relax and unwind after a long day of work. It lets us clear our minds of the daily grind and provides a good release for the tensions that build up over the day or week.

Meditation has been used by numerous cultures over the centuries for a variety of benefits, including stress reduction. Many people are discovering the benefits of meditation, as it has been integrated more and more into main-stream culture and serves as an antidote to the fast, 24/7 pace of daily life. There are many different types of meditation used to tackle everyday stress. These include mantra meditation, in which one mentally repeats a specific, calming word; guided meditation, in which a teacher helps you visualize and guides you to a relaxing place; Tai Chi, which is based on ancient Chinese martial arts and uses very slow movements to relax and connect the mind and body; and mindfulness meditation, which involves increasing one’s awareness of the present, rather than feeling overpowered by everyday stresses.

An increasingly popular and well-studied mindfulness meditation method is called Mindfulness-Based Stress Reduction (MBSR, which was originally developed by Dr. Jon Kabat-Zinn at the University of Massachusetts Medical School. The MBSR program has been shown to be effective in reducing stress and anxiety, both in healthy people and those who are suffering from illness and chronic pain. Through the program, people learn to become more aware or “mindful” of their situations, and approach the problems and sources of stress in their lives deliberately and effectively. The alternative, which many of us may identify with, is to react “mindlessly,” which is said to involve “a loss of awareness resulting in forgetfulness, separation from self, and a sense of living mechanically”. For example, reacting “mindlessly” to a stressful situation like a job loss might involve one feeling helpless, inadequate, depressed, and incapable of fixing the situation. But reacting “mindfully” might involve a different kind of thought process. Rather than being consumed by the negative thoughts, it is important to acknowledge them, so that one can move on. For example, in a mindful reaction, you might think to yourself, “yes, it’s hard – and a little scary – to be unemployed. It’s natural to feel discouraged, but these feelings will pass when I begin looking for something new and find a good lead to pursue.” In other words, a mindful reaction would involve acknowledging your angry, depressed, and anxious feelings, but taking an overview of them and approaching the situation somewhat more dispassionately and critically, so that you remain in charge of your feelings rather than the other way around. That way you can move forward, actively and productively.

Rather than being consumed by the negative thoughts, it is important to acknowledge them, so that one can move on.

Several studies have looked at the effectiveness of the program, and have found that it does appear to reduce stress, anxiety, and depression in those who enrolled in an eight-week MBSR course. In one study, stress symptoms were reduced in premed and medical school students, and another study found that cancer patients scored lower on measures of stress, depression, and anger after completing an MBSR program. Finally, one study found that in breast and prostate cancer patients, not only were stress symptoms reduced after taking part in the program, but the authors also say that the program may have also led to “possibly beneficial changes in hypothalamic-pituitary-adrenal (HPA) axis functioning,” the system that governs the stress response. (See Part I of our stress series for a full description of this system.)

Meditation-Based Stress Reduction programs are offered at various institutions across the country, and may be worth looking into if you are interested in learning about the benefits of meditation in stress-reduction. The University of Massachusetts Medical School’s Center for Mindfulness website offers a search feature to locate MBSR programs in your area: http://www.umassmed.edu/cfm/mbsr/.

Another method that has gained popularity as a means of stress reduction is yoga, the ancient practice that originated in India thousands of years ago and strong ties to meditation as well as offering a form of exercise. It focuses on strengthening the mind-body connection: the name actually comes from a Sanskrit word meaning “union,”(yuj) which underlines this link between mind and body. Popular yoga uses various poses or “postures” (some more complex than others) to stretch and strengthen the body, as well as controlled breathing which is also considered an important way to gain control over one’s body and mind, and achieve a sense of peace in both. Although the postures and breathing exercises are the central elements practiced in today’s yoga, classic yoga actually incorporates eight foundations thought to lead to enlightenment and calm (these include acting morally, living healthily, withdrawal from the senses, concentration, contemplation, and reaching higher consciousness. There are several forms of yoga, including the popular Bikram, Kundalini, and Ananda. For more information about yoga and its health benefits, see the National Institutes of Health (NIH) yoga website: http://nccam.nih.gov/health/yoga/introduction.htm.

Though the exact ways in which yoga improves health and reduces stress aren’t fully understood, there has been some research illustrating the effects. One recent study of men and women who all worked for a large corporation and were stressed out when the study began looked at how effectively yoga reduced their stress (this study also evaluated cognitive behavior stress reduction techniques, discussed below). Participants who took 10 sessions of yoga over a four-month period were less stressed after completing the program. Their heart rate, blood pressure, and levels of the stress hormone cortisol were all much lower after they had completed the course. Psychologically they were in better shape, too. They reported lower levels of stress and felt less anger at the study’s end. The participants rated their quality of life as better than before they started the yoga. Results like these show that there was a real biological benefit to the yoga sessions, in addition to the participants’ perceived changes in moods and overall well-being (their personal ratings of stress, anger, and well-being).

Other research has shown yoga to be effective in reducing stress, not only in the normally stressed-out individual, but also among people battling the stresses associated with high blood pressure, epilepsy, and cancer.

Many gyms, spas, YMCAs, and other facilities offer yoga in wide range of skill levels. It may be worth looking into joining a class to see if its benefits help you reduce and cope better with the stress in your life.

Cognitive Behavioral Therapy, or CBT, is a used to address and alleviate persistent feelings of stress. The goal of this form of therapy, which is a blend of cognitive therapy and behavioral therapy, is to identify the specific thought-processes that are creating problems, and to figure out ways for the individual to learn to react to the stressors in one’s life more productively. People who are particularly prone to feelings of stress sometimes feel that they cannot cope effectively with the everyday pressures in life, let alone more serious stressors that life throws at them. Sometimes we get caught in vicious cycles of thought processes that are unhealthy or destructive. CBT seeks to stop the vicious cycle by helping the patient identify the triggers and processes involved in the cycle, and then learn to stop them in their tracks.

If you turn these negative, stressed-out feelings inward, thinking only, "Oh, I am so stressed out!" you are likely to feel unable to act, which might well affect your ability to approach the issue energetically and effectively.

In a person who is prone to, or overwhelmed by, feelings of stress, a particular stimulus – for example, a boss suddenly moving a deadline closer – may elicit a specific, routine pattern of response. Your reaction to this stressful “curveball” may begin with significant anxiety, causing an exaggerated stress response. If you turn these negative, stressed-out feelings inward, thinking only, "Oh, I am so stressed out!" you are likely to feel unable to act, which might well affect your ability to approach the issue energetically and effectively (which, in our example, would involve tackling the task and meeting the new deadline).

In this case, CBT might address the person’s tendency to feel daunted and overpowered by the situation at hand, and instead try to redirect these thoughts in a more positive manner – into feelings of capability and productivity, rather than inertia and inactivity. Whatever the specific behavior, the goal of CBT is to address both the thoughts (cognitive) a person has when stressed and the behaviors (responses) that follow. For example, the person overwhelmed by a looming deadline might say to himself, "I'll get it done; I always do. If there is really a problem after I get into it, I can deal with it then. No point in worrying from the start." They might be counseled to set up a timetable and step-by-step plan to achieve the goal.

Cognitive Behavior Therapy has been shown to be effective in reducing the stresses associated with everyday life as well as the more severe forms, like post-traumatic stress disorder. In the study mentioned earlier in the article, which compared CBT to yoga as a means of stress-reduction in company workers, the results showed that it was equally as effective as yoga in reducing the symptoms of stress – both psychological and physiological – that the participants experienced at the study’s outset.

If you are interested in exploring CBT to address the ways in which you handle stress, or other issues in your life, it is best to speak with your health care provider about finding a specialist in your area.

There are many ways to reduce stress, and finding the method that works for you is a good first step. Rather than stomaching the issues in one’s life, it is important to work actively to alleviate the stresses and find effective ways to cope with them.

It is useful to find simple ways to take one’s mind off stressor and reduce the immediate physical tension connected to stress in the short-term (such as a jog around the block), it is also necessary to explore methods that will help you cope with the issues in the longer-term. If you are uncertain about what methods will work best for you, it may be best to speak with your health care provider (either general practitioner or mental health care provider) about good first steps to take.

Here are some additional methods that may be effective in reducing stress:

• Make a point of taking slow, deep breaths
• Enjoy a massage
• Listen to music
• Find a new hobby or pursue an old one
• Take a little break from the routine (take a walk through the park, go see a movie, treat yourself to a nice dinner out, or even a cup of coffee)

These little de-stressors may not solve the problems that face you, but they are likely to put you in a more productive frame of mind by relieving the immediate stress response. Then, try to come up with one (or three or four) small things you can do to help your situation. When you have accomplished one of them – perhaps calling a friend about a possible job lead, or going to the hardware store to find the parts to fix a broken faucet – give yourself a pat on the back for having taken action to relieve your stress. This form of acknowledgment will begin to build your confidence and help you chip away at the thought patterns that may contribute to your experience of stress.

Because stress is both a physical response and a mental one, how you think about it and how you go about discharging the physiological arousal associated with it can really make a difference in keeping it under control.