Stress Reduction

Definition

Stress is the body's normal response to anything that disturbs its natural physical, emotional, or mental balance. Stress reduction refers to various strategies that counteract this response and produce a sense of relaxation and tranquility.

Purpose

Although stress is a natural phenomenon of living, stress that is not controlled and that continues for a long period of time can seriously compromise health. For this reason, stress must be understood, managed and appropriately reduced. Several very different strategies and therapies are available that help with relaxation and stress management.

Precautions

Stress reduction can only present a problem if an individual attributes an actual, serious condition or disease to being simply a stress-related response and avoids consulting a physician.

People who have undergone a severe trauma (criminal assault, combat, natural or transportation disaster, etc.) may experience symptoms of posttraumatic stress disorder (PTSD) or acute stress disorder (ASD). These disorders are defined by their temporal connection to a traumatic event in the patient's life, and are characterized by a cluster of anxiety and dissociative symptoms. They interfere with the patient's normal level of functioning, and require some form of supportive therapy. People who experience a sense of detachment or unreality, emotional numbing, a general feeling of being dazed, amnesia for part of the traumatic event, or similar symptoms should consult a medical doctor in addition to using other approaches to stress reduction.

Description

Everyone encounters stress every day. Although most people think of it as something negative that happens to them, in fact stress itself is really neither good nor bad but is neutral or nonspecific. Stress may be internal (from within ourselves) or external (such as noise from the environment) and does not always result from something unpleasant. A certain amount of stress in our lives is actually essential to being sufficiently stimulated to meet the challenges of everyday life, but when stress is constant and acute, it can have dangerous consequences. Since stress is both natural and unavoidable, it is necessary to understand it and to learn how to deal with it, particularly how to reduce it.

The specific and immediate cause of stress is called the stressor. A stressor can be something dramatic or terrible, such as a violent experience or the death of a loved one, or it can be a positive and rewarding event, like marriage or a promotion. The stressor can be internal, such as feelings of guilt or anger felt in a relationship, or it can be external, such as a natural disaster or the ordinary rigors and frustrations of commuting. It can also have a physical source, like simple exercise or hard work, or it can be strictly mental, like worry. Our bodies react the same way physiologically no matter what the source and reasons for stress might be.

From a physical standpoint, the body reacts to stress in a standard and predictable manner. When stress occurs, the brain immediately receives nerve impulses. These impulses initiate an automatic sequence carried out by the body's sympathetic nervous system: it begins with stimulation of the brain's hypothalamus, which sends nerve impulses to both the adrenal and the pituitary glands. Also called the "fight or flight" response, this automatic physiological process is known to have evolved in humans and animals to enable them to cope with sudden life-threatening emergencies. When faced with a major stressor, the body's biochemistry instantly hurtles into a ready mode that marshals all the possible resources necessary to either escape or do battle. Thus, the adrenal glands located on top of the kidneys provide an instant surge of adrenaline, the body's rocket fuel, quickening the heart rate and blood flow and providing every cell with extra oxygen. They also release cortisol or hydrocortisone, causing an increase in both amino acids (the building blocks of proteins) and blood sugar. These will be needed if tissue repair must take place. Finally, the pituitary gland at the base of the brain releases a variety of hormones, endorphins among them, that act as natural painkillers and permit the body to do things it ordinarily cannot do. Thus, at just about the same time a stressor is recognized by the body, the heart and breathing rate spikes, the pupils dilate to let in more light, perspiration increases and digestion slows, and the body is aroused, energized, and temporarily feels no pain. This sequence of events allows individuals to do whatever is required to save themselves, whether it is to flee from a predator or engage in combat and fend off an attack.

While these automatic physiological responses served early man well and were essential to survival of the species, today's men and women rarely must literally fight for their lives or dodge and elude a predator. Yet their bodies' automatic response to stress has remained unchanged in a radically changed, modern world. Whether caveman or corporate executive, when the fight-or-flight response kicks in, a three-stage process begins. Stage one is the alarm stage in which the body releases hormones and prepares for extreme physical action. Resistance is stage two in which the body attempts to resist yet adapt to the stress and to repair any damage done. The final stage, exhaustion, occurs if the stress remains constant. It is especially dangerous since stage one's physical response may begin all over again. The persistence of stress and stage three's exhaustion is the point at which disease can occur. The body may then experience severe debilitating conditions like migraine, heart irregularities, and mental illness. The body's functions may even shut down altogether.

Although different individuals may have different levels of tolerance to stress, chronic stress will eventually wear down even the strongest of people. Prolonged stress can cause biochemical imbalances that weaken the immune system and invite serious illness. Overall, stress that persists is known to interfere with digestion and, more seriously, alter brain chemistry, create hormonal imbalances, increase heart rate, raise blood pressure, and negatively affect both metabolic and immune function. It is also important to recognize that although stress itself is not a disease, it can worsen any number of already serious physical conditions. Many physicians feel that chronic stress can so overtax an individual's physical resources and ways of coping that cancer, stroke, and heart disease can occur. While long-term stress can seriously affect one's quality of life and lead to major, sometimes fatal, diseases, prolonged stress also results in the everyday miseries of headache and allergy, digestive disorders and fatigue, irritable bladder and impotence, insomnia, anxiety, depression, and simple aches and pains. Researchers exploring the connection between stress and susceptibility to colds exposed stressed individuals (who had experienced a death in the family, become divorced, or had recently moved) to cold viruses and then tested for antibodies a month later. Results indicated that severely stressed individuals were four times more likely to become infected.

It follows that if stress can cause or contribute to illness, then reducing stress should have the opposite effect and perhaps even encourage healing. Probably the most important step toward reducing the stress in everyone's life is to understand the nature of stress and to learn how to condition ourselves to be able to gain some control over it. Being able to recognize that we are stressed is probably the first step toward understanding. Of the many signs and symptoms that alert us, some are obvious and require only common sense to recognize. Short-term noticeable effects of stress include sweaty palms and other types of perspiration, dilated pupils, and difficulty in swallowing ("a lump in the throat"). Tightness in the chest is another stress signal as are stomach problems and some skin conditions. Stress that is the result of prolonged anxiety (a sense of apprehension) often results in feelings of panic or actual trembling, fatigue, insomnia, and shortness of breath, heart palpitations and dizziness, and sometimes simple irritability. Although none of these symptoms is pleasant, they are relatively minor compared to the silent but much more serious internal effects that can lead to immune-related disorders and even cancer and heart disease.

Fortunately, stress and the negative effects it creates can be reduced by a wide variety of therapeutic approaches. When successfully applied, many of these therapies or strategies can both reduce stress and reverse its damage. Before selecting a particular therapy, it is important to be able distinguish bad or unhealthy stress from the type that is not bad. Researchers have found that the most important variable among types of stress is an individual's sense of control in a given situation. The least harmful stress scenario is one in which an individual has a sufficient degree of control or some idea of predictability. Put simply, predictable pain is less stressful because individuals know when to relax (gaining relief from pain as well as protecting themselves from its damaging effects). But when individuals have no warning of pain, they are in a state of constant stress. An example from daily life might be the difference between the stress experienced by top executives who are in control of their fate and their middle-level managers who are not. The former can pick and choose when to enter or engage a stressful situation or problem, but the latter have no control nor any ability to predict when such a situation will arise and are constantly on alert or in a state of anxiety.

For those with little control over situations that make them anxious, there are basically two ways to deal with their stress. One is to remove or at least reduce the stressor, and the other is to increase their resistance to it. Although there are many strategies to achieve each of these, all of them can be reduced to some variation of a single simple concept—relaxation. While there is no one single technique or therapy for everyone to use to manage and reduce stress, there is certainly some combination of lifestyle change, diet, exercise, and relaxation that will allow all types of individuals to better manage the stress in their lives. Although relaxation is at the core of most stress reduction methods, it is not something that everyone can fully achieve without assistance and guidance. Interestingly, our modern life experiences often do not provide us with the coping skills needed to deal with stressful stimuli, and increasingly, people find that simple relaxing is something that they must learn how to do.

Fortunately, there are a number of relaxation therapies that enable the willing individual to achieve deep, beneficial relaxation. In fact, there are almost too many from which to choose. A 1997 book on stress remedies cowritten by the editors of Prevention magazine and published by Rodale Press is organized alphabetically and lists fifty-nine separate stress-reducing techniques and subjects, from Acceptance to Yoga. These and many other methods of reducing stress can be grouped into the following general categories: mind-body therapies, body work and movement therapies, and herbal-based diets and natural regimens. Many of the specific techniques in these categories can be part of a self-help or self-care approach, although some require the help of an experienced practitioner.

Therapies that focus on the mind/body connection are based on the fact that thinking and emotions can have physical effects on the body. These techniques encourage the individual to take control and learning how to cope with stressors rather than trying to eliminate them. Such therapies range from individual counseling and meditation or involvement with a support group to the mystery of guided imagery and the technology of biofeedback. They all have the common goal of evoking the physiological relaxation response, in which a person can achieve such beneficial internal results as lowering blood pressure and decreasing gastric acid secretion.

Body work and movement therapies include techniques ranging from dance therapy and the gentleness of massage to reflexology and the rigors of rolfing. Body work is based partly on the therapeutic power of human touch and can also include manipulation, realignment, and posture correction. Movement therapies are a particular form of physical exercise, although they attempt to do much more than simply get a person into shape. Most usually emphasize the mind/body connection and strive to put people in better touch with both their bodies and their feelings. Body work and movement therapies can be as vigorous as deep tissue manipulation or as simple and minimal as the Alexander technique's light posture corrections.

Herbal remedies for stress are usually part of a larger system of natural, holistic medicine. Whether Chinese traditional medicine, its counterpart from India, or the homeopathy of the West, all these systems of natural medicine have a holistic focus and emphasize the need for inner balance. All demonstrate how the individual's physical, emotional, mental, and spiritual states are connected and use natural substances as part of the treatment for reducing stress. Such therapies range from the occasional purging (cleansing) of Ayurvedic medicine to the sleep-inducing properties of chamomile tea. They also can include the use of cayenne to relieve pain, fragrant essential oils from flowers to evoke a pleasing response and relieve tension, or aloe vera to soothe burned skin.

A list of some of the more common therapies and techniques available for reducing stress includes:

• Acupuncture. Insertion of needles at certain spots under the skin for the purpose of attaining balance by either releasing blocked energy or draining off excess energy.
• Alexander technique. Improving the alignment of head, neck, and back claims to achieve efficient posture and movement.
• Aromatherapy. Massage with essential oils from flowers claims to affect mood and produce a sense of well-being.

• Art therapy. Creating something allows free expression and results in feelings of achievement and mood change.
• Autogenic training therapy. A form of deep meditation or self-hypnosis.
• Autosuggestion therapy. A form of verbal therapy involving repetition of a positive idea.
• Ayurvedic medicine. A complete system of daily living based on awareness of one's particular constitution.
• Behavioral therapy. A variety of psychotherapies that are based on changing ourselves by retraining.
• Bach flower therapy. Herbal remedies that are prepared from flowers acting energetically to soothe the mind and body.
• Bioenergetics. A practice that encourages sudden release of tensions by crying or kicking.
• Biofeedback. Monitoring rates of body functions and using data to influence and gain control over autonomic functions.
• Breathing for relaxation. Stylized breathing technique to control and lower body functions.
• Counseling. Work with a therapist trained in talking-based therapy.
• Dance movement therapy. Freedom of expression through movement.
• Feldenkrais method. Slow, light movements alter habits and reeducate neuromuscular system.
• Flotation therapy. Floating in a soundproof tank with no external stimulation.
• Guided imagery. Creating a mental picture of what is desired. Also called Creative imagery or Visualization.
• Herbal medicine. Uses substances derived from plants as treatment instead of synthetic drugs.
• Homeopathy. Uses minute doses of plant, animal, and mineral substances to stimulate the body's natural healing.
• Hydrotherapy. Use of water internally and externally for healing purposes.
• Hypnotherapy. Hypnosis in order to identify and release patterns that keep an individual from a personal balance point.
• Kinesiology. Uses muscle testing to correct imbalances in the body's "energy system." Also called Touch for Health.
• Massage. Use of touch and manipulation to soothe. Can also employ vigorous deep tissue manipulation.
• Meditation. Deep, relaxed, receptive, and focused concentration on a single object, sound, or word.
• Music therapy. Playing or listening to music to create an emotional reaction.
• Naturopathy. A complete health care system that uses a variety of natural healing therapies.
• Psychotherapy. A talking-based therapy with a mental health professional to get at the root of a conflict, modify behavior and disruptive negative thought patterns.
• Reflexology. Manipulation of zones of the feet that relate to the major organs, glands, and areas of the body.
• Rolfing. Vigorous manipulation of the body's connective tissue to restore "balance."
• Shiatsu. Traditional Japanese finger pressure massage therapy.
• Sound therapy. Uses sound waves to slow the body's autonomic system.
• Tai chi chuan. System of slow, continuous exercises based on rhythm and equilibrium.
• Yoga. System of exercises that combines certain positions with deep breathing and meditation.

These and many other techniques, systems, and therapies are available to the person searching for some way to reduce and manage the stress of everyday life. Some methods are very simple and can be easily learned, while others are high-tech and often involve a practitioner. A search for common elements among most of these stress-reducing systems reveals several obvious strategies that nearly everyone can employ on their own. However, it is important to know and recognize the signals of stress. Further, it is easier to resist the negative effects of stress by eating properly and getting sufficient sleep and exercise.

Nearly all stress-reducing systems are geared to evoking some degree of beneficial mind/body relaxation, and most include some version of the following:

• mental time out
• deep breathing
• meditation and singular focus
• gentle, repetitive exercise

The best stress reduction system is the one that works for the individual. Whether stress can be relieved by laughter, mellow music, repetition of a single word, self-massage, vigorous activity, or simply by doing everyday chores in a mindful state of heightened awareness, it is important that stress be recognized and managed every day. Studies have shown that regular relaxation eventually makes the body less responsive to its stress hormones and acts as a sort of natural tranquilizer. People can build their own immune defense against the stress response.

Many companies have introduced workplace stress management programs to improve their employees' health. These programs typically include instruction on emotional refocusing or restructuring, and have been shown to be beneficial in reducing the participants' blood pressure, heart rate, and other signs of emotional upset. In addition, stress management programs designed for persons in specific high-stress occupations (medicine, law enforcement, emergency response, etc.) have proved to be effective in reducing burnout and helping members of these professions cope with the specific stresses of their respective jobs.

An additional general strategy for handling stress in family life or the workplace is the cultivation of a group of character traits that has been termed "psychological hardiness." These traits include believing in the importance of what one is doing; believing that one has some power to influence the immediate situation; and viewing life's changes as positive opportunities rather than as threats. These qualities are sometimes referred to as the "3 Cs," which stand for commitment, control and challenge. Approaches to stress reduction that enhance these qualities are especially beneficial to people.

Newer trends in stress reduction

One trend in stress reduction in the early 2000s is the development of stress management programs or stress reduction strategies tailored to specific categories of people, often defined by their occupation or by a chronic health condition. For example, journalists who cover traumatic events are increasingly recognized as susceptible to developing posttraumatic stress disorder. With regard to specific diseases, stress management programs have been pioneered as of 2004 for patients with asthma or lupus erythematosus.

Another new trend in stress reduction is the development of programs designed for communities as well as individuals. After the events of September 11, 2001, many mental health professionals recognized that acts of terrorism or mass violence affect large groups of people, and that psychiatric interventions need to address stress as a group experience as well as an individual one.

Risks

All relaxation-based therapies to reduce stress are virtually free of serious risk.

Normal results

Learning how to manage stress has the short-term benefits of giving people some sense of control in their lives, providing them with positive coping strategies, and making them more relaxed and healthier. The long-term benefits can be a stronger immune system, proper hormonal balance, and reduced susceptibility to such serious, life-threatening diseases as heart disease and cancer.

Resources

BOOKS

American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 4th ed., revised. Washington, DC: American Psychiatric Association, 2000.

Beers, Mark H., MD, and Robert Berkow, MD., editors. "Anxiety Disorders." In The Merck Manual of Diagnosis and Therapy. Whitehouse Station, NJ: Merck Research Laboratories, 2004.

Beers, Mark H., MD, and Robert Berkow, MD., editors. "Psychiatry in Medicine." In The Merck Manual of Diagnosis and Therapy. Whitehouse Station, NJ: Merck Research Laboratories, 2004.

Pelletier, Kenneth R., MD. The Best Alternative Medicine, Part I. "Spirituality and Healing." New York: Simon & Schuster, 2002.

PERIODICALS

Collins, P. A., and A. C. Gibbs. "Stress in Police Officers: A Study of the Origins, Prevalence and Severity of Stress-Related Symptoms Within a County Police Force." Occupational Medicine (London) 53 (June 2003): 256-264.

Czech, T. "Journalists and Trauma: A Brief Overview." International Journal of Emergency Mental Health 6 (Summer 2004): 159-162.

Greco, C. M., T. E. Rudy, and S. Manzi. "Effects of a Stress-Reduction Program on Psychological Function, Pain, and Physical Function of Systemic Lupus Erythematosus Patients: A Randomized Controlled Trial." Arthritis and Rheumatism 51 (August 15, 2004): 625-634.

Lambert, V. A., C. E. Lambert, and H. Yamase. "Psychological Hardiness, Workplace Stress and Related Stress Reduction Strategies." Nursing and Health Sciences 5 (June 2003): 181-184.

Macy, R. D., L. Behar, R. Paulson, et al. "Community-Based, Acute Posttraumatic Stress Management: A Description and Evaluation of a Psychosocial-Intervention Continuum." Harvard Review of Psychiatry 12 (July-August 2004): 217-228.

McCraty, R., M. Atkinson, and D. Tomasino. "Impact of a Workplace Stress Reduction Program on Blood Pressure and Emotional Health in Hypertensive Employees." Journal of Alternative and Complementary Medicine 9 (June 2003): 355-369.

Ritchie, E. C., M. Friedman, P. Watson, et al. "Mass Violence and Early Mental Health Intervention: A Proposed Application of Best-Practice Guidelines to Chemical, Biological, and Radiological Attacks." Military Medicine 169 (August 2004): 575-579.

Sotile, W. M., and M. O. Sotile. "Beyond Physician Burnout: Keys to Effective Emotional Management." Journal of Medical Practice Management 18 (May-June 2003): 314-318.

Wright, R. J. "Alternative Modalities for Asthma That Reduce Stress and Modify Mood States: Evidence for Underlying Psychobiologic Mechanisms." Annals of Allergy, Asthma and Immunology 93, no. 2, Supplement 1 (August 2004): S18-S23.

ORGANIZATIONS

American Institute of Stress. 124 Park Avenue. Yonkers, NY 10703. (914) 963-1200. 〈http://www.stress.org〉.

American Psychiatric Association (APA). 1400 K Street, NW, Washington, DC 20005. (888) 357-7924. 〈http://www.psych.org〉.

Center for Mindfulness. University of Massachusetts Medical Center, 55 Lake Avenue North, Worcester, MA 01655. (508) 856-2656. 〈http://www.umassmed.edu/cfm〉.

National Institute of Mental Health (NIMH) Office of Communications. 6001 Executive Boulevard, Room 8184, MSC 9663, Bethesda, MD 20892-9663. (866) 615-NIMH or (301) 443-4513. 〈http://www.nimh.nih.gov〉.

OTHER

National Institute of Mental Health (NIMH). Anxiety Disorders. NIH Publication No. 02-3879. Bethesda, MD: NIMH, 2002.

KEY TERMS

Adrenal gland— A pair of glands that rest on the top of each kidney that produce steroids, such as sex hormones and those concerned with metabolic functions.

Amino acid— Organic acids that are the main components of proteins and are synthesized by living cells.

Antibody— A type of protein produced in the blood in response to a foreign substance that destroys the intruding substance; it is responsible for immunity.

Burnout— An emotional condition marked by tiredness, loss of interest, or frustration that interferes with job performance. Burnout is usually regarded as the result of prolonged stress.

Chronic— Long-term or frequently recurring.

Debilitating— Weakening, or reducing the strength of.

Dilate— To enlarge, open wide, or distend.

Endorphins— A group of proteins with powerful pain-killing properties that originate naturally in the brain.

Holistic— That which pertains to the entire person, involving the body, mind, and spirit.

Hydrocortisone— A steroid hormone produced by the adrenal glands that provides resistance to stress.

Hypothalamus— A part of the brain that controls some of the body's automatic regulatory functions.

Immune function— The state in which the body recognizes foreign materials and is able to neutralize them before they can do any harm.

Impotence— The inability of the male to engage in sexual intercourse because of insufficient erection.

Insomnia— Inability to sleep under normal conditions.

Metabolic function— Those processes necessary for the maintenance of a living organism.

Neuromuscular— Relating to nerve and muscle or their interaction.

Physiological— Dealing with the functions and processes of the body.

Pituitary gland— A gland at the base of the brain responsible for growth, maturation, and reproduction.

Sympathetic nervous system— That part of the autonomic nervous system that affects contraction of muscles and blood vessels. Stimulation of this system by a stressor triggers the production of hormones that prepare the body for fight or flight

Therapeutic— Curative or healing.