Stress Management

	Topic Overview
	Health Tools
	Frequently Asked Questions
	Causes of Stress
	Evaluating Stress
	Relieving Stress
	Avoiding Unnecessary Stress
	Professional Help
	Effects of Stress
	Other Places To Get Help
	Related Information
	References
	Credits

What happens when you are stressed?

Stress is what you feel when you have to handle more than you are used to. When you are stressed, your body responds as though you are in danger. It makes hormones that speed up your heart, make you breathe faster, and give you a burst of energy. This is called the fight-or-flight stress response.

Some stress is normal and even useful. It can help if you need to work hard or react quickly. For example, it can help you win a race or finish an important job on time.

But if stress happens too often or lasts too long, it can have bad effects. It can be linked to headaches, an upset stomach, back pain, or trouble sleeping. It can weaken your immune system, making it harder to fight off disease. If you already have a health problem, stress may make it worse. It can make you moody, tense, or depressed. Your relationships may suffer, and you may not do well at work or school.

What can you do about stress?

The good news is that you can learn ways to manage stress. To get stress under control:

• Find out what is causing stress in your life.
• Look for ways to reduce the amount of stress in your life.
• Learn healthy ways to relieve stress.

How do you figure out your stress level?

Sometimes it is clear where stress is coming from. You can count on stress during a major life change such as the death of a loved one, getting married, or having a baby. But other times it may not be so clear why you feel stressed.

It may help to keep a stress journal. Get a notebook and write down when something makes you feel stressed. Then write how you reacted and what you did to deal with the stress. Keeping a stress journal can help you find out what is causing your stress and how much stress you feel. Then you can take steps to reduce the stress or handle it better.

To find out how stressed you are right now, use this Interactive Tool: What Is Your Stress Level?

How can you reduce your stress?

Stress is a fact of life for most people. You may not be able to get rid of stress, but you can look for ways to lower it.

Try some of these ideas:

• Learn better ways to manage your time. You may get more done with less stress if you make a schedule. Think about which things are most important, and do those first.
• Find better ways to cope. Look at how you have been dealing with stress. Be honest about what works and what does not. Think about other things that might work better.
• Take good care of yourself. Get plenty of rest. Eat well. Do not smoke. Limit how much alcohol you drink.
• Try out new ways of thinking. When you find yourself starting to worry, try to stop the thoughts. Work on letting go of things you cannot change. Learn to say “no.”
• Ask for help. People who have a strong network of family and friends manage stress better.

Sometimes stress is just too much to handle alone. It can help to talk to a friend or family member, but you may also want to see a counselor.

How can you relieve stress?

You will feel better if you can find ways to get stress out of your system. The best ways to relieve stress are different for each person. Try some of these ideas to see which ones work for you:

• Exercise. Regular exercise is one of the best ways to manage stress. Walking is a great way to get started.
• Write. It can help to write about the things that are bothering you.
• Let your feelings out. Talk, laugh, cry, and express anger when you need to.
• Do something you enjoy. A hobby can help you relax. Volunteer work or work that helps others can be a great stress reliever.
• Learn ways to relax your body. This can include breathing exercises, muscle relaxation exercises, massage, aromatherapy, yoga, or relaxing exercises like tai chi and qi gong.
• Focus on the present. Try meditation, imagery exercises, or self-hypnosis. Listen to relaxing music. Try to look for the humor in life. Laughter really can be the best medicine.

Health tools help you make wise health decisions or take action to improve your health.

	Interactive tools are designed to help people determine health risks, ideal weight, target heart rate, and more.
	Interactive Tool: How Well Do You Bounce Back?
	Interactive Tool: What Is Your Stress Level?

Long-term (chronic) stress is the type of stress that causes the most serious problems. It is caused by a host of irritating hassles over a period of time, or an ongoing, difficult situation. Conditions that may lead to chronic stress include:

• Health problems, if you have a chronic illness such as heart disease, diabetes or arthritis.
• Emotional problems, such as unexpressed or uncontrolled anger, depression, grief, guilt, or low self-esteem.
• Relationship problems, if you do not have someone to share your feelings with, are having difficulty in a relationship, or feel that you have few friends.
• Your surroundings, if you live in a dangerous or uncomfortable area where overcrowding, crime, pollution, or noise is a problem.
• Your job, if you are unhappy with your work, or your work is dangerous or too demanding. For more information, see the topic Managing Job Stress.
• Your social situation, such as poverty, loneliness, or discrimination based on race, gender, age, or sexual orientation.
• Life cycle transitions and developmental stages, such as becoming a teenager, leaving home, or getting married.
• Conflicts with your belief system—your perceptions and beliefs about the world, life, and yourself. For instance, if you place a high value on family life but don't have the family life you want, you may feel stress.
• A child or teen, or other family member who is under stress because of physical or emotional problems.

Feeling the effects of stress is a normal part of life, especially when you are facing major challenges. But each person responds to stress differently. What causes a lot of stress for one person may not cause stress for someone else. That's because a large part of stress is a matter of perception—how you view a situation determines how much stress it causes you. Therefore, only you can best evaluate the amount of stress in your life and learn better ways to cope with it.

Ask yourself the following questions to learn what is causing you stress and how you respond:

What job, family, or personal stress do I have?

Chronic stress can be caused by an ongoing stressful situation such as:

• Family or relationship problems.
• Caring for a family member who is elderly, has chronic health problems, or is disabled. Caregiving is a major source of stress. For more information, see the topic Caregiver Tips.
• Job stress.
• A family member who is under stress.

Do I have recent major changes in my life?

Stress is an unavoidable part of life and can be good or bad. We routinely experience both types of stress when we go through life changes such as getting married, having a baby, or having a child move away from home.

To estimate your current stress level based on recent changes in your life, use this Interactive Tool: What Is Your Stress Level?

How am I coping with stress?

Some behaviors and lifestyle choices can interfere with the ways your body seeks relief from stress. For example, as you sleep, your body recovers from the stresses of the day. If you are not getting enough sleep or your sleep is frequently interrupted, you are losing a chance to recover from stress.

Your actions and behavior can be a sign of stress. Some people who face a lot of stress respond by smoking, drinking alcohol, or eating poorly. The health risks posed by these behaviors are made even worse by stress. Your body experiences stress-related wear and tear from two sources: the stress itself and the unhealthy habits you've developed to respond to stress. Evaluate how you respond to stress by identifying your positive and negative coping strategies. Use this coping strategies evaluation form (What is a PDF document?) to see how you respond to stress.

Do my beliefs cause me stress?

Some people feel stressed because their beliefs conflict with the way they are living their life. Examine your beliefs to see if conflict between what you believe and what your life is like causes you stress.

If you are not sure that you are stressed or are not sure what is making you feel the way you do, you need to discover what is causing stress. One way to do this is to keep a stress journal, a written record that can help you identify stressors so you can find better ways to cope with them.

Some of the most useful stress management skills you can learn are healthy coping strategies. Many of these can be done with little or no instruction. No one strategy is preferable—you need to find what works best for you. Using these techniques regularly until they become habits that are part of your lifestyle is the key. Use this coping strategies evaluation form (What is a PDF document?) to see how you respond to stress.

Ways to work through your emotions and relax your mind

• Writing. There is evidence that writing about stressful events and circumstances may help relieve stress and improve diseases linked to stress.¹ Write for 10 to 15 minutes a day about stressful events and how you felt. One way to use writing to deal with stress is to keep a stress journal. This can really help you identify the sources of stress in your life so that you can find better ways to cope with them.
• Expressing your feelings. Discussing how you feel with friends, family members, or a counselor is an important way of coping with and relieving stress. Laughing and crying are also natural ways to release tension and frustration. They are both part of a normal emotional healing process.
• Mindfulness activities. Mindfulness activities help relax your mind and are often combined with body-centered relaxation exercises.
  • Autogenic training consists of six standard exercises that make the body relax. For each exercise, you use visual imagination and verbal cues to relax your body in some specific way.
  • Self-hypnosis can open your mind to suggestions that can relieve stress or change the way you respond to stress.
  • Meditation focuses your attention on feeling calm and having a clear awareness about your life.
  • Guided imagery (visualization) is a method of using your imagination to help you relax and release tension caused by stress. Your body responds to the images in your mind. Use these simple imagery exercises for relaxing or renewing your energy when you need to relax.
  • Music therapy can relax your body, improve your mood, and change the pace of your day.
  • Humor therapy is becoming widely accepted as a tool for reducing stress and boosting the body's immune system.

Ways to relax your body

• Physical activity. Exercise can reduce stress and the stress response. Aerobic exercise—the kind that increases your heart rate, such as walking, running, bicycling, or swimming—is especially useful for counteracting the harmful effects of stress. Even everyday activities such as house cleaning or yard work can reduce your stress level if you do them vigorously. Stretching is also a good way to relieve muscle tension. Regular, moderate physical activity may be the single best approach to managing stress. For more information about becoming more active, see the topic Fitness.
• Doing something you enjoy. A meaningful activity helps relieve tension. This can be a hobby, such as gardening; a creative activity, such as writing, crafts, or art; or doing volunteer work for a cause that benefits others. Playing with and caring for pets also can help you relax. Although you may feel that you are too busy, making time to do something you like can help you relax and make you more productive in other areas of your life.
• Body-centered relaxation. Body-centered relaxation skills are especially useful for people who experience physical symptoms of stress. These skills include:
  • Breathing exercises, such as roll breathing, a type of deep breathing.
  • Progressive muscle relaxation, which reduces muscle tension by relaxing individual groups of muscles one by one.
  • Massage, such as a shoulder and neck massage. You can see a massage therapist, have a friend or family member give you a massage, or even give yourself a massage.
  • Aromatherapy, which uses the aroma-producing oils (essential oils) from plants to promote relaxation.
  • Yoga, tai chi, and qi gong, which are forms of exercise and meditation. They generally require initial instruction. Books and videos are available, and these activities can be done at home.
• Magnetic field therapy. Researchers believe treatment with magnetic fields may be useful for a number of health conditions, including problems related to stress. But not everyone agrees on this treatment. Some claims of how well it works are not based on science.

Because stress is unavoidable in life, it is important to find ways to reduce or prevent stressful incidents and decrease your negative reactions to stress. Following are activities to help you do this.

Managing time

Time management skills can allow you to spend more time with your family and friends and possibly increase your performance and productivity. This will help reduce your stress.

To improve your time management:

• Save time by focusing and concentrating, delegating, and scheduling time for yourself.
• Keep a record of how you spend your time, including work, family, and leisure time.
• Prioritize your time by rating tasks by importance and urgency. Redirect your time to those activities that are important and meaningful to you.
• Manage your commitments by not over- or undercommitting. Don't commit to what is not important to you.
• Deal with procrastination by using a day planner, breaking large projects into smaller ones, and setting short-term deadlines.

Build healthy coping strategies

It is important that you identify your coping strategies. One way to do this is by recording the stressful event, your reaction, and how you coped in a stress journal. With this information, you can work to change unhealthy coping strategies into healthy ones—those that help you focus on the positive and what you can change or control in your life. Use this coping strategies evaluation form (What is a PDF document?) to see how you respond to stress.

Lifestyle

Some behaviors and lifestyle choices affect your stress level. They may not cause stress directly, but they can interfere with the ways your body seeks relief from stress. Try to:

• Balance personal, work, and family needs and obligations.
• Have a sense of purpose in life.
• Get enough sleep, because your body recovers from the stresses of the day while you are sleeping.
• Eat a balanced diet for a nutritional defense against stress.
• Get moderate exercise throughout the week.
• Limit your consumption of alcohol.
• Don't smoke.

Social support

Social support from family, friends, and the community is a major factor in how we experience stress. Research shows a strong relationship between social support and mental and physical health.²

This type of support includes both emotional support such as love, trust, and understanding, as well as advice and concrete help such as time or money. Asking for help is not a sign of weakness. In fact, it can bring you closer to people you interact with every day, and it can significantly reduce your stress level. If you are feeling stressed, you can look for support from:

• Family members and friends.
• Programs offered through your school or job (for example, assistance programs or stress management courses).
• Colleagues at work, or people you interact with in other areas of your life (such as people who share your hobbies or other interests).
• A professional counselor. Be sure to see someone who has experience and credentials.
• Members or leaders of your church or religious organization.
• Support groups, if you have special circumstances such as providing care for someone who is elderly or has a chronic illness. Support groups may also be available on the Internet.

Changing thinking

When an event triggers negative thoughts, you may experience fear, insecurity, anxiety, depression, rage, guilt, and a sense of worthlessness or powerlessness. These emotions trigger the body's stress response, just as an actual threat does. Dealing with your negative thoughts and how you see things can help reduce stress. You can learn these techniques on your own or seek help from a professional such as a counselor or specialist.

• Thought-stopping helps you stop a negative thought to help eliminate stress.
• Disproving irrational thoughts helps you to avoid exaggerating the negative thought, anticipating the worst, and interpreting an event incorrectly.
• Problem solving helps you identify all aspects of a stressful event and find ways to deal with it.
• Changing your communication style helps you communicate in a way that makes your views known without making others feel put down, hostile, or intimidated. This reduces the stress that comes from poor communication. Use the assertiveness ladder to improve your communication style.

Treatment for other conditions

You may need treatment for other emotional conditions related to stress, such as anxiety, depression, or insomnia. Treatment may include medicines or professional counseling. See the appropriate topics in Related Information.

Stress can be overwhelming. If this is the case, you may want to seek outside help from a professional counselor or other health professional. This can help you find a number of approaches to reducing the symptoms of stress and help you decrease the stress in your life.

Professional help is available for the following therapies or techniques:

• Cognitive-behavioral therapy teaches you to be aware of how you perceive stress, helps you understand how your perception influences your reaction to it, and teaches you how to develop and maintain skills to deal with stress. (See tips for finding a counselor or therapist.)
• Biofeedback is a method of consciously controlling a body function that is normally regulated automatically by the body, such as skin temperature, muscle tension, heart rate, or blood pressure. Learning biofeedback requires several sessions in a biofeedback lab or other setting.
• Hypnosis by a hypnotherapist helps people accept suggestions that can help change their behavior. It is important to find a health professional with a lot of training and experience in hypnotherapy. Some psychologists, counselors, doctors, and dentists are experienced in hypnotherapy.

Stress can affect you both immediately (acute stress) and over time (chronic stress).

Tension is often the first signal of acute stress. Tense muscles are tight and feel "hard" to the touch. A tense mind makes you feel jumpy, irritable, and unable to concentrate. This could be your signal to do something about stress, both for your immediate comfort and to prevent the long-term effects of stress.

Symptoms of stress

Common symptoms of stress include:

• Rapid heartbeat.
• Headache.
• Stiff neck and/or tight shoulders.
• Backache.
• Rapid breathing.
• Sweating and sweaty palms.
• Upset stomach, nausea, or diarrhea.

You also may notice signs of stress in your thinking, behavior, or mood. You may:

• Become irritable and intolerant of even minor disturbances.
• Feel irritated or frustrated, lose your temper more often, and yell at others for no reason.
• Feel jumpy or exhausted all the time.
• Find it hard to concentrate or focus on tasks.
• Worry too much about insignificant things.
• Doubt your ability to do things.
• Imagine negative, worrisome, or terrifying scenes.
• Feel you are missing opportunities because you cannot act quickly.

Use this form to assess your stress style and examine how you physically and emotionally cope with stress. (What is a PDF document?)

Acute stress problems

Acute (short-term) stress is the body's immediate reaction to any situation that seems demanding or dangerous. Your stress level depends on how intense the stress is, how long it lasts, and how you cope with the situation. The body usually recovers quickly from acute stress, but it can cause problems if it happens too often or your body doesn't have a chance to return to normal. In people who have heart problems, acute stress can trigger an abnormal heartbeat (arrhythmia) and even a heart attack.

Life-threatening or traumatic events, such as sexual abuse or war experiences, can cause acute stress disorder or post-traumatic stress disorder (PTSD). For more information, see the topic Post-Traumatic Stress Disorder.

Chronic stress problems

Chronic stress can be the result of a host of irritating hassles or a long-term life condition, such as a difficult job situation or living with a chronic disease. In people who have higher levels of chronic stress, the stress response lasts longer. Over time, chronic stress can have an effect on:^{1, 3}

• The immune system. Under stress, the body becomes more vulnerable to illnesses, from colds and minor infections to major diseases. If you have a chronic illness such as AIDS, stress can make the symptoms worse.
• Cardiovascular disease. Stress is linked to high blood pressure, abnormal heartbeat (arrhythmia), problems with blood clotting, and hardening of the arteries (atherosclerosis). It is also linked to coronary artery disease, heart attack, and heart failure.
• Muscle pain. People who are stressed often have neck, shoulder, and low back pain. This may be caused by constant tension in the muscle because of stress. Stress also affects rheumatoid arthritis.
• Stomach and intestinal problems. Stress may be a factor in gastroesophageal reflux disease (GERD), peptic ulcer disease, and irritable bowel syndrome.
• Reproductive organs. Stress is linked to painful menstrual periods, decreased fertility, and erection problems.
• The lungs. Stress can make symptoms of asthma and chronic obstructive pulmonary disease (COPD) worse.
• Skin problems. Stress can make disorders such as acne or psoriasis worse.

Individual differences

How stress affects you depends on several things including:

• Inherited traits.
• Your experience with stress.
• How you perceive stress.
• Your coping strategies.
• Your social support.

Some people seem to stand up to or bounce back from stress better than others, and some even seem to thrive on stress—this is known as being stress-hardy or resilient.

To find out how well you cope with and recover from stress, use this Interactive Tool: How Well Do You Bounce Back?

Use this coping strategies evaluation form (What is a PDF document?) to see how you respond to stress.

When you understand how you deal with stress, you can make lifestyle changes to lower your stress level, help you cope with stress better, and help you recover from stress more quickly.

Organizations

• Alcohol Abuse and Dependence
• Anger, Hostility, and Violent Behavior
• Anxiety
• Depression
• Fitness
• Healthy Eating
• High Blood Pressure (Hypertension)
• Insomnia
• Physical Abuse, Sexual Abuse, or Rape
• Quitting Tobacco Use

Citations

1. Seymour DJ, Black K (2002). Stress in primary care patients. In FV DeGruy III et al., eds., 20 Common Problems in Behavioral Health, pp. 65–87. New York: McGraw-Hill.

2. Quick JD, et al. (1996). Social support, secure attachments, and health. In CL Cooper, ed., Handbook of Stress, Medicine, and Health, pp. 269–287. Boca Raton, FL: CRC Press.

3. Sadock BJ, Sadock VA (2003). Psychological factors affecting the medical condition and psychosomatic medicine. In Kaplan and Sadock's Synopsis of Psychiatry, 9th ed., pp. 822–826. Philadelphia: Lippincott Williams and Wilkins.

Other Works Consulted

• Dimsdale JE, et al. (2005). Stress and psychiatry. In BJ Sadock, VA Sadock, eds., Kaplan and Sadock's Comprehensive Textbook of Psychiatry, 8th ed., vol. 2, pp. 2180–2195. Philadelphia: Lippincott Williams and Wilkins.

• Kiecolt-Glaser JK, et al. (2003). Chronic stress and age-related increases in proinflammitory cytokine IL-6. Proceedings of the National Academy of Sciences of the United States of America, 100(15): 9090–9095.

• Motzer SA, Hertig V (2004). Stress, stress response and health. Nursing Clinics of North America, 39: 1–17.

• Murray MT, Pizzorno JE Jr (2006). Stress management. In JE Pizzorno Jr, MT Murray, eds., Textbook of Natural Medicine, 3rd ed., vol. 1, pp. 701–708. St. Louis: Churchill Livingstone.

• Spiegel H, et al. (2005). In BJ Sadock, VA Sadock, eds., Kaplan and Sadock's Comprehensive Textbook of Psychiatry, 8th ed., vol. 2, pp. 2548–2568. Philadelphia: Lippincott Williams and Wilkins.