Stress Management

Causes of Stress

A lot of things can cause stress. You may feel stress when you go on a job interview, take a test, or run a race. These kinds of short-term stress are normal. Long-term (chronic) stress is caused by stressful situations or events that last over a long period of time, like problems at work or conflicts in your family. Over time, chronic stress can lead to severe health problems.

Personal problems that can cause stress

• Your health, especially if you have a chronic illness such as heart disease, diabetes, or arthritis
• Emotional problems, such as anger you can't express, depression, grief, guilt, or low self-esteem
• Your relationships, such as having problems with your relationships or feeling a lack of friendships or support in your life
• Major life changes, such as dealing with the death of a parent or spouse, losing your job, getting married, or moving to a new city
• Stress in your family, such as having a child, teen, or other family member who is under stress, or being a caregiver to a family member who is elderly or who has health problems
• Conflicts with your beliefs and values. For example, you may value family life, but you may not be able to spend as much time with your family as you want.

Social and job issues that can cause stress

• Your surroundings. Living in an area where overcrowding, crime, pollution, or noise is a problem can create chronic stress.
• Your social situation. Not having enough money to cover your expenses, feeling lonely, or facing discrimination based on your race, gender, age, or sexual orientation can add stress to your life.
• Your job. Being unhappy with your work or finding your job too demanding can lead to chronic stress. Learn how to manage job stress.
• Unemployment. Losing your job or not being able to find work can also add to your stress level.

Post-traumatic stress

You may need help dealing with stress if you have faced a life-threatening or traumatic event such as rape, a natural disaster, or war. These events can cause acute stress disorder or post-traumatic stress disorder (PTSD). For more information, see the topic Post-Traumatic Stress Disorder.

Effects of Stress

Stress causes changes in your body. It also affects your emotions.

How stress affects the body

Common symptoms of stress include:

• A fast heartbeat.
• A headache.
• A stiff neck and/or tight shoulders.
• Back pain.
• Fast breathing.
• Sweating, and sweaty palms.
• An upset stomach, nausea, or diarrhea.

Over time, stress can affect your:

• Immune system. Constant stress can make you more likely to get sick more often. And if you have a chronic illness such as AIDS, stress can make your symptoms worse.
• Heart. Stress is linked to high blood pressure, abnormal heartbeat (arrhythmia), blood clots, and hardening of the arteries (atherosclerosis). It's also linked to coronary artery disease, heart attack, and heart failure.
• Muscles. Constant tension from stress can lead to neck, shoulder, and low back pain. Stress may make rheumatoid arthritis worse.
• Stomach. If you have stomach problems, such as gastroesophageal reflux disease (GERD) or irritable bowel syndrome, stress can make your symptoms worse.
• Reproductive organs. Stress is linked to low fertility, erection problems, problems during pregnancy, and painful menstrual periods.
• Lungs. Stress can make symptoms of asthma and chronic obstructive pulmonary disease (COPD) worse.
• Skin. Skin problems such as acne and psoriasis are made worse by stress.

An extreme reaction to stress is a panic attack. A panic attack is a sudden, intense fear or anxiety that may make you feel short of breath, dizzy, or make your heart pound. People who have panic attacks may feel out of control, like they are having a heart attack, or are about to die. Panic attacks may happen with no clear cause, but they can be brought on by living with high levels of stress for a long time. For more information on panic attacks, see the topic Panic Attacks and Panic Disorder.

How stress affects your thoughts and emotions

You might notice signs of stress in the way you think, act, and feel. You may:

• Feel cranky and unable to deal with even small problems.
• Feel frustrated, lose your temper more often, and yell at others for no reason.
• Feel jumpy or tired all the time.
• Find it hard to focus on tasks.
• Worry too much about small things.
• Feel that you are missing out on things because you can't act quickly.
• Imagine that bad things are happening or about to happen.

How stress affects you depends on many things, such as:

• Your personality.
• What you have learned from your family about responding to stress.
• How you think about and handle stress.
• Your coping strategies .
• Your social support.

The type of stress matters

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

Acute (short-term) stress is the body's instant response 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.

Most of the time, your body recovers quickly from acute stress. But stress can cause problems if it happens too often or if your body doesn't have a chance to recover. In people with heart problems, acute stress can trigger an abnormal heartbeat (arrhythmia) or even a heart attack.

Chronic (long-term) stress is caused by stressful situations or events that last over a long period of time. This could include having a difficult job or dealing with a chronic disease. If you already have a health problem, stress can make it worse.

Measuring Stress

Feeling stress is a fact of life for most people. But it affects everyone differently. What causes stress for you may not be stressful for someone else. That's because how you view a situation affects how much stress it causes you. Only you can figure out whether you have too much stress in your life.

Ask yourself these questions to find out what is causing your stress:

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

Stress can be caused by an ongoing personal situation such as:

• Problems in your family or with a relationship.
• 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 Quick Tips: Reducing the Stress of Caregiving.
• Your job.
• Dealing with a family member who is under stress.

Have you had any recent major life changes?

Life changes such as getting married, moving to a new city, or losing a job can all be stressful. You can't always control these things, but you can control how you respond to them.

Do your beliefs cause you stress?

Some people feel stress because their beliefs conflict with the way they are living their life. Examine your beliefs, such as your values and life goals, to find out if you have this kind of conflict in your life.

How are you coping with stress?

Your lifestyle choices can prevent your body from recovering from stress. For example, as you sleep, your body recovers from the stresses of the day. If you're not getting enough sleep or your sleep is often interrupted, you lose the chance to recover from stress.

The way you act and behave can also be a sign of stress. Some people who face a lot of stress react by smoking, drinking too much alcohol, eating poorly, or not exercising. The health risks posed by these habits are made even worse by stress.

Your body feels stress-related wear and tear in two ways: the stress itself and the unhealthy ways you respond to it.

Ways to Relieve Stress

The best way to manage your stress is to learn healthy coping strategies. You can start practicing these tips right away. Try one or two until you find a few that work for you. Practice these techniques until they become habits you turn to when you feel stress. You can also use this coping strategies form to see how you respond to stress.

Stress-relief techniques focus on relaxing your mind and your body.

Ways to relax your mind

• Write. It may help to write about things that are bothering you. Write for 10 to 15 minutes a day about stressful events and how they made you feel. Or think about tracking your stress. This helps you find out what is causing your stress and how much stress you feel. After you know, you can find better ways to cope.
• Let your feelings out. Talk, laugh, cry, and express anger when you need to. Talking with friends, family, a counselor, or a member of the clergy about your feelings is a healthy way to relieve stress.
• Do something you enjoy. You may feel that you're too busy to do these things. But making time to do something you enjoy can help you relax. It might also help you get more done in other areas of your life. Try:
  • A hobby, such as gardening.
  • A creative activity, such as writing, crafts, or art.
  • Playing with and caring for pets.
  • Volunteer work.
• Focus on the present. Meditation and guided imagery are two ways to focus and relax your mind.
  • Meditate. When you meditate, you focus your attention on things that are happening right now. Paying attention to your breathing is one way to focus. Mindfulness-based stress reduction is one form of meditation that is very helpful with managing stress and learning how to better cope with it.
    • Stress Management: Doing Meditation
  • Use guided imagery. With guided imagery, you imagine yourself in any setting that helps you feel calm and relaxed. You can use audiotapes, books, or a teacher to guide you.
    • Stress Management: Doing Guided Imagery to Relax

Ways to relax your body

• Exercise. Regular exercise is one of the best ways to manage stress. Walking is a great way to get started. Even everyday activities such as housecleaning or yard work can reduce stress. Stretching can also relieve muscle tension. For more information about becoming more active, see the topic Fitness.
• Try techniques to relax. Breathing exercises, muscle relaxation, and yoga can help relieve stress.
  • Breathing exercises. These include roll breathing, a type of deep breathing.
    • Stress Management: Breathing Exercises for Relaxation
  • Progressive muscle relaxation. This technique reduces muscle tension. You do it by relaxing separate groups of muscles one by one.
    • Stress Management: Doing Progressive Muscle Relaxation
  • Yoga, tai chi, and qi gong. These techniques combine exercise and meditation. You may need some training at first to learn them. Books and videos are also helpful. You can do all of these techniques at home.
    • Stress Management: Practicing Yoga to Relax

You might like to try a combination of these techniques.

• Stress Management: Relaxing Your Mind and Body

In addition to practicing these skills, you might also try some other techniques to reduce stress, such as massage or music therapy.

Ways to Avoid Stress

Stress is a part of life, and you can't always avoid it. But you can try to avoid situations that can cause it, and you can control how you respond to it. The first step is knowing your own coping strategies. Try tracking your stress to record stressful events, your response to them, and how you coped.

After you know what is causing your stress, try making some changes in your life that will help you avoid stressful situations. Here are a few ideas:

Manage your time

Time management is a way to find the time for more of the things you want and need to do. It helps you decide which things are urgent and which can wait. Managing your time can make your life easier, less stressful, and more meaningful.

• Stress Management: Managing Your Time

Look at your lifestyle

The choices you make about the way you live affect your stress level. Your lifestyle may not cause stress on its own, but it can prevent your body from recovering from it. Try to:

• Find a balance between personal, work, and family needs. This isn't easy. Start by looking at how you spend your time. Maybe there are things that you don't need to do at all. Finding a balance can be especially hard during the holidays.
  • Quick Tips: Reducing Holiday Stress
• Have a sense of purpose in life. Many people find meaning through connections with family or friends, jobs, their spirituality, or volunteer work.
• Get enough sleep. Your body recovers from the stresses of the day while you are sleeping. If your worries keep you from sleeping, keep a notepad or your cell phone by your bed to record what you are worried about—to help you let it go while you sleep. For example, if you are worried you might forget to run an errand the next day, make a note so that you can stop worrying about forgetting.
  • Insomnia: Improving Your Sleep
• Adopt healthy habits. Eat a healthy diet, limit how much alcohol you drink, and don't smoke. Staying healthy is your best defense against stress.
• Exercise. Even moderate exercise, such as taking a daily walk, can reduce stress.

Get support

Support in your life from family, friends, and your community has a big impact on how you experience stress. Having support in your life can help you stay healthy.

Support means having the love, trust, and advice of others. But support can also be something more concrete, like time or money. It can be hard to ask for help. But doing so doesn't mean you're weak. If you're feeling stressed, you can look for support from:

• Family and friends.
• Coworkers, or people you know through hobbies or other interests.
• A professional counselor. (See tips for finding a counselor or therapist.)
• People you know from church, or a member of the clergy.
• Employee assistance programs at work, or stress management classes.
• Support groups. These can be very helpful if your stress is caused by a special situation. Maybe you are a caregiver for someone who is elderly or has a chronic illness.
  • Quick Tips: Reducing the Stress of Caregiving

Change your thinking

Stressful events can make you feel bad about yourself. You might start focusing on only the bad and not the good in a situation. That's called negative thinking. It can make you feel afraid, insecure, depressed, or anxious. It's also common to feel a lack of control or self-worth.

Negative thinking can trigger your body's stress response, just as a real threat does. Dealing with these negative thoughts and the way you see things can help reduce stress. You can learn these techniques on your own, or you can get help from a counselor. Here are some ideas:

• Cognitive-behavior therapy (CBT) helps you cope with a problem by changing the way you think. How you think affects how you feel. To learn more, see the topic Stop Negative Thoughts: Choosing a Healthier Way of Thinking.
  • Stop Negative Thoughts: Getting Started
• Problem solving helps you identify all aspects of a stressful event, find things you may be able to change, and deal with things you can't change.
• Assertive communication helps you express how you feel in a thoughtful, tactful way. Not being able to talk about your needs and concerns creates stress and can make negative feelings worse.
  • Stress Management: Reducing Stress by Being Assertive

Setting a Goal to Reduce Stress

Setting a goal in three steps

If you're ready to reduce stress in your life, setting a goal may help. Try following these three steps:

1. Find out what creates stress for you. Try tracking your stress to record stressful events, your response to them, and the coping strategies you used. If you have a smartphone, you can download a free stress-tracking app to help you monitor your stress. If you don't have a smartphone, you can use a spreadsheet on your computer. Or pencil and paper work, too. The important thing is to keep track of your stress so that you can both learn what is causing it and work toward managing it.
2. Think about why you want to reduce stress. You might want to protect your heart and your health by reducing stress. Or maybe you simply want to enjoy your life more and not let stress control how you feel. Your reason for wanting to change is important. If your reason comes from you—and not someone else—it will be easier for you to make a healthy change for good.
3. Set a goal. Think about a long-term and a short-term goal to reduce stress in your life.

Examples of how to set goals

• Sheila is a customer service manager for a computer company. She's also the mother of two young kids. Between her job and chores at home, she feels overwhelmed by all the demands on her. She can't remember the last time she took a lunch break at work or took a class at the gym. While she's lying awake at night, she is worrying about getting everything done. Sheila's long-term goal: Find a better balance between personal, home, and family needs. Short-term goal: Take a 15-minute walk each night.
  • Stress Management: Managing Your Time
• Ray is a pretty easygoing guy most of the time. But he gets stressed over small things. If a problem comes up at work, he spends the whole night thinking about it over and over. He feels anxious wondering how he could have handled things better. Ray knows he needs to let go of these events and move on. Ray's long-term goal: Practice positive thinking when stressful events come up. Short-term goal: Try breathing and relaxation exercises when he feels stressed.
  • Stop Negative Thoughts: Getting Started
  • Stress Management: Relaxing Your Mind and Body
• Marta is a full-time caregiver for her elderly mother, who has Alzheimer's disease. Marta can't remember the last time she took a vacation or even met a friend for coffee. Her sister helps with care sometimes but is often too busy. Marta finds herself getting frustrated easily. She needs a break. Marta's long-term goal: Involve her sister more in caregiving. She also plans to find respite care so she isn't providing all the caregiving on her own. Short-term goal: Attend a caregiver support group every week.
  • Quick Tips: Reducing the Stress of Caregiving

Tips for staying on track

• Plan for setbacks. Make a personal action plan by writing down your goals, any possible barriers, and your ideas for getting past them. By thinking about these barriers now, you can plan ahead for how to deal with them if they happen.
• Get support. Tell family and friends your reasons for wanting to change. Tell them that their encouragement makes a big difference to you in your goal to reduce stress. Your doctor or a professional counselor can also provide support. A counselor can help you set goals and provide support in dealing with setbacks. (See tips for finding a counselor or therapist.)
• Pat yourself on the back. Don't forget to give yourself some positive feedback. If you slip up, don't waste energy feeling bad about yourself. Instead, think about all the times you've avoided getting stressed by making changes.

If You Need More Help

Stress can be hard to deal with on your own. It's okay to seek help if you need it. Talk with your doctor about the stress you're feeling and how it affects you. A licensed counselor or other health professional can help you find ways to reduce stress symptoms. He or she can also help you think about ways to reduce stress in your life.

A counselor or health professional is useful for:

• Cognitive-behavioral therapy (CBT). CBT teaches you to be aware of how you perceive stress. It helps you understand that the way you think about stress affects your response to it. CBT helps you create and use skills to deal with stress. (See tips for finding a counselor or therapist.)
• Biofeedback. This technique teaches you how to use your mind to control skin temperature, muscle tension, heart rate, or blood pressure. All of these things can be affected by stress. Learning biofeedback requires training in a special lab or a doctor's office.
• Hypnosis. With hypnosis, you take suggestions that may help you change the way you act. It's important to find a health professional with a lot of training and experience. Some psychologists, counselors, doctors, and dentists know how to use hypnosis.

Treatment for other health problems

You may need treatment for other emotional problems related to stress, such as anxiety, depression, or insomnia. Treatment may include medicines or professional counseling.