Managing Stress

We all know what stress feels like. The jittery stomach and sweaty palms when you walk into an important job interview. The soaring blood pressure when you're stuck in an endless traffic jam. The adrenaline coursing through your body when you get into a heated argument.

Stress is a normal reaction to threats, changes in routine, or long-term challenges. Some stress can be positive: it can give us a burst of energy to meet a deadline or stimulate creativity and resourcefulness. But stress that is constant or prolonged -- high-pressure work, relationship problems, financial worries, a loved one's illness -- can wreak havoc on your emotional balance and raise your risk of chronic illness.

How do I recognize if I'm under too much stress?

Each of us has a different threshold for stress. For some, buying a house or changing careers might be overwhelmingly stressful, while others might relish the change. It's important to get a handle on what you personally find stressful and how you react to stress.

"I always try to help people only worry about things they can control -- often a lot of what really drains people is worry over things which they can't control," says Michael Potter, MD, a family practice physician and researcher at UCSF Medical School in San Francisco. "That doesn't take care of everything, but if you can decide only to be worried about things you can personally influence or control, you have a much better chance of succeeding in reducing your stress levels."

If you're concerned that you might be feeling too much stress, look for physical, emotional or behavioral red flags that persist over time.

Physical symptoms of stress include:

• Insomnia
• Chronic fatigue
• Headaches
• Grinding teeth
• Muscle tics
• Stomachaches
• Constipation or diarrhea
• Backaches
• Neck pain
• Shortness of breath
• High blood pressure
• Skin problems, such as hives
• Reduced sexual desire

Emotional and behavioral symptoms of stress include:

• Alcohol or drug abuse
• Overeating
• Not eating
• Gaining or losing a lot of weight
• Difficulty concentrating
• Impaired short-term memory
• Deteriorating productivity at home, work, or school
• Poor outlook on the future
• Difficulty maintaining positive personal relationships
• Frequent mood swings
• Unproductive worry
• Short temper or anger
• Sadness, anxiety, or depression

"Life has its ups and downs," says clinical psychologist Jonathan C. Smith, Ph.D., a professor of psychology at Roosevelt University in Chicago and founding director of the Roosevelt University Stress Institute (now the Mindfulness Initiative). "Look for symptoms that are severe and last a long time. Ask yourself, 'Am I in a situation that could realistically trigger continued stress?'"

Are there unhealthy ways to deal with stress?

It's human nature to try to "self-medicate" or distract ourselves with other activities when we're feeling stressed. Watching a lot of television, overeating, abusing alcohol or drugs, or drinking cup after cup of coffee, among other habits, might bring temporary relief but fail to lessen stress in any meaningful way. In fact, these common behaviors are self-defeating because they only increase stress over the long haul, both physically and emotionally.

What these distractions amount to is avoidance, Smith says -- dancing around the real-life problems that are at the root of stress. Instead, take the time to evaluate the pressures in your life and how your stress might be better managed. Try to control your stress rather than allowing stress to control you.

I'm finding it impossible to relax, even after I get off work. How can I manage my stress?

The good news is that small changes can make a big difference. Altering your daily routine, your diet and your outlook on life can make a lasting impact on how you handle stress.

"To undo deep stress, it's not enough to take a hot bath, go to a ball game, or listen to the radio," says Smith, author of several books on relaxation and stress management. It's important to unwind more fully. Relaxation lowers blood pressure, slows breathing and pulse rates, releases muscle tension and produces a sense of well-being. What's more, research shows that relaxation training bolsters the body's immune system and its ability to heal injuries and fight illness, including heart disease and diabetes.

Until recently most stress experts thought that different relaxation techniques were essentially the same and interchangeable. "The old thinking is that one size fits all, but it's a mistake to use only one technique," Smith says. "Instead, each type of relaxation seems to cover a different type of skill and may help different types of problems."

Here are seven relaxation techniques to explore:

Deep breathing exercises. Breathe deeply into your belly, slowly and evenly, without raising your chest. Slowly count to ten as you inhale through your nose. Feel your stomach rise and hold it for a second. Slowly count to ten as you exhale through your nose. Repeat five to ten times. (You can also visualize your breath as it moves through your body. Imagine each time you inhale and exhale you are taking in more relaxation and letting out more tension.)

Progressive muscle relaxation. Lie down in a comfortable position without crossing your arms or legs. Focus your mind on a specific part of your body, such as your shoulders. Tense up those muscles for ten seconds, then go completely limp for three seconds. Experience the muscle as relaxed and lead-heavy. Go through each muscle group, starting either with the head or with the toes. Maintain deep, slow breathing.

Self-suggestion. Repeat to yourself suggestions that are intended to help you relax -- for example, "My body feels warm and heavy," or "My heart is beating evenly." Repeat the phrases very passively while focusing on your body and breathing deeply and evenly.

Imagery and visualization. Quietly and passively imagine soothing images, calming places or relaxing activities. Visualizing images or memories that evoke serenity, happiness or joy can help de-activate the stress response and replace negative emotions with positive ones.

Massage therapy. Therapeutic massage slows down the heart and relaxes the body. There are a number of massage therapies, including Swedish (a standard technique that manipulates the muscles); Shiatsu (in which intense pressure is applied to parts of the body); and Reflexology (based on acupuncture points).

Yoga. Yoga is an ancient system of relaxation, exercise, and healing with origins in Indian philosophy. Yoga combines the benefits of breathing, muscle relaxation, and meditation while toning and stretching the muscles through a series of postures or poses. Yoga has been shown in numerous studies to relieve stress and stress-related conditions. Practicing yoga can also elevate mood and improve concentration. There are several types of yoga, which can be practiced alone or with a group.

Meditation. Meditation is the centuries old practice of quieting the mind to achieve a state of restful alertness. Like yoga, meditation has been shown to relieve stress and fatigue and can boost creativity and the ability to focus. You can start with just two or three minutes a session, and if you choose, gradually build up to 10 or 20 minutes a day as you get more proficient. It may be difficult at first to learn to relax the mind, but don't be discouraged. Try mindfulness meditation, which focuses on the breath: Sit upright with your spine straight, cross-legged on the floor or sitting on a chair with your feet on the floor, uncrossed. With your eyes closed or gently looking a few feet ahead, observe the inhalation of the breath. When your mind naturally wanders, simply note it and return to your breath. With practice, the focus turns to a deeper, broader awareness.

Besides relaxation techniques, what else can help me deal with too much stress?

Keeping a stress journal

Keeping a stress journal can help you identify stressful events, as well as your reactions and ways of coping. It's not necessary to record each event in painful detail; just a few words and the date will do. Also write down positive experiences that leave you feeling exhilarated or give you a sense of accomplishment.

After you've kept the journal for a couple weeks, take a look at two or three events that were especially upsetting. Ask yourself what you might have done differently to cope with the problem. Were your coping strategies healthy or unhealthy? How can you do better next time? Come up with as many remedies as possible to problems that trigger stress and choose which solutions you can put into practice.

Defining the stressful problem clearly and brainstorming creative, alternative solutions can also help you take back some measure of control. Studies show that taking charge in this way can boost your body's ability to deal with the stress. People who directly confronted their stress-inducing problem significantly raised their concentrations of immune cells, reported a study by Ohio State University researchers.

Thinking realistically

Your perceptions influence how you react to stress. Says Smith, the stress expert from Roosevelt University: "Confront your negative, distorted thinking and re-think it. Ask yourself, is my thinking illogical or impractical? Does it fly in the face of good sense and logic? Do I really have to be perfect in everything?" Do some reality checking with friends or family members. If you feel you need more help dealing with exaggerated fears and worries or negative self-talk, it may be a good idea to seek the help of a professional therapist.

Having some gazpacho

Eating a diet rich with antioxidant vegetables may also be a key component to reducing stress. According to a study published in the Journal of Nutrition, volunteers who ate two bowls of gazpacho soup (a cold soup made of vegetables, including tomatoes) every day were found to have a marked decrease in stress molecules circulating in their bloodstream. High levels of these stress chemicals over time make your body more vulnerable to illness and chronic disease.

Making healthy lifestyle changes

Regular exercise and adequate sleep will go a long way toward easing your stress and boosting your ability to cope with life's challenges. Try also to cut back on alcohol, caffeine and sugar, and if you smoke cigarettes, it's a good idea to quit.

I still feel like my life is spinning out of control. What are some other tips for reducing stress?

• Try to look at change as a positive challenge, not a threat.
• Work to resolve conflicts with other people.
• Get away from your daily stresses through hobbies, sports, or social activities that you enjoy.
• Develop friendships or other forms of social support.
• Share your feelings and ask for help if you need it. Don't try to cope alone.
• Give yourself positive feedback and go easy on self-criticism.
• Get organized and plan ahead.
• Slow down. Take one thing at a time, rather than trying to juggle everything at once.
• Be realistic about what's possible. Learn to compromise.
• Practice acceptance.
• Practice gratitude.
• Enjoy yourself. Look for the humor in difficult situations.

When should I go for professional help?

If your physical or psychological symptoms of stress persist for more than two months, and a good attempt at stress management doesn't seem to help, the next step is to see a qualified mental health professional for a consultation.

References

Interview with Jonathan C. Smith, Ph.D., professor of psychology at Roosevelt University, Chicago and founding director of Roosevelt University Stress Institute.

Stressed Out? Have Some Cold Vegetable Soup. U.S. Dept of Agriculture.

Stress: Coping with Everyday Problems. National Mental Health Association.

Stress: How to Cope Better with Life's Challenges. American Academy of Family Physicians.

Top Ten Strategies for Wildly Successful Stress Management. The University of North Carolina at Chapel Hill Counseling and Psychological Service.

Stress Management: Ten Self-Care Techniques. Virginia Polytechnic Institute and State University.

Stress and Your Health. The National Women's Health Information Center.

Meditation: Stress Management from the Inside Out. Jeffrey P. Miner, Ph.D.

Stress-Busting Techniques: Scientific Findings. National Women's Health Report.

Yoga. Harvard Medical Schools Consumer Health Information.

Stress Management in Reducing Heart Disease, statement by Peter Kaufmann, Ph.D., National Heart, Lung and Blood Institute, National Institutes of Health, before the Subcommittee on Labor, Health and Human Services, Education, and Committee on Appropriations.

Effects of stress reduction on carotid atherosclerosis in hypertensive African Americans. Stroke, 31(3):56B-73.

Stress Management Can Help Control Glucose in Type 2 Diabetes. Duke University Medical Center news release.

Stress Management and Exercise Training in Cardiac Patients with Myocardial Ischemia. Archives of Internal Medicine, Vol. 157(19), pp. 2213-2223.