What is stress

Stress is a normal psychological, physical and emotional reaction that people experience as they encounter changes in and demands of life ¹. Stress is a normal feeling – a small amount of stress can be good, motivating you to perform well ². However, multiple challenges daily, such as sitting in traffic, meeting deadlines and paying bills, can push you beyond your ability to cope. Furthermore, long-term stress may contribute to or worsen a range of health problems including digestive disorders, headaches, sleep disorders, and other symptoms. Stress may worsen asthma and has been linked to depression, anxiety, and other mental illnesses.

Your brain comes hard-wired with an alarm system for your protection. When your brain perceives a threat, it signals your body to release a burst of hormones that increase your heart rate and raise your blood pressure. This “fight-or-flight” response fuels you to deal with the threat.

Once the threat is gone, your body is meant to return to a normal, relaxed state. Unfortunately, the nonstop complications of modern life mean that some people’s alarm systems rarely shut off.

Some people use stress management or relaxation techniques (also called relaxation response techniques) to release tension and to counteract the ill effects of stress. Relaxation technique gives you a range of tools to reset your alarm system. It can help your mind and body adapt (resilience). Without it, your body might always be on high alert. Over time, chronic stress can lead to serious health problems.

Stress management or relaxation techniques often combine breathing and focused attention on pleasing thoughts and images to calm the mind and the body. Some examples of relaxation response techniques are autogenic training, biofeedback, deep breathing, guided imagery, progressive relaxation, and self-hypnosis. Mind and body practices, such as meditation and yoga, are also sometimes considered relaxation techniques.

Take the first step

Recognizing a problem is the first step toward solving it. By beginning to identify and understand the sources of your stress, you’ve taken the first step in learning to better manage it. Manage it, not eliminate it. Stress is a fact of life. And that’s OK. You can learn ways to handle it.

Don’t wait until stress damages your health, relationships or quality of life. Start practicing stress management and relaxation techniques today.

What’s the difference between normal stress and anxiety ?

Stress is the physical or mental response to an external cause, such as having a lot of homework or having an illness. A stressor may be a one-time or short-term occurrence, or it can happen repeatedly over a long time. Stress is a normal psychological and physical reaction to positive or negative situations in your life, such as a new job or the death of a loved one. Stress itself isn’t abnormal or bad. What’s important is how you deal with stress.

Anxiety is your body’s reaction to stress and can occur even if there is no current threat. Anxiety is part of stress. You may feel anxious before you take a test or walk down a dark street. This kind of anxiety is useful – it can make you more alert or careful. It usually ends soon after you are out of the situation that caused it. If that anxiety doesn’t go away and begins to interfere with your life, it could affect your health. For millions of people in the United States, the anxiety does not go away, and gets worse over time. You may have experience problems with sleeping, with your immune, digestive, cardiovascular, and reproductive systems, chest pains or nightmares. You may even be afraid to leave home. You also may be at higher risk for developing a mental illness such as an anxiety disorder or depression.

You may be at risk for an anxiety disorder if it feels like you can’t manage the stress and if the symptoms of your stress:

• Interfere with your everyday life.
• Cause you to avoid doing things.
• Seem to be always present.

Types of anxiety disorder include:

• Panic disorder
• Obsessive-compulsive disorder
• Post-traumatic stress disorder
• Phobias
• Generalized anxiety disorder

Treatment can involve medicines, therapy or both.

Common anxiety signs and symptoms include:

• Feeling nervous, restless or tense
• Having a sense of impending danger, panic or doom
• Having an increased heart rate
• Breathing rapidly (hyperventilation)
• Sweating
• Trembling
• Feeling weak or tired
• Trouble concentrating or thinking about anything other than the present worry
• Having trouble sleeping
• Experiencing gastrointestinal (GI) problems
• Having difficulty controlling worry
• Having the urge to avoid things that trigger anxiety

Stress vs. Anxiety

Stress	Both Stress and Anxiety	Anxiety
Generally is a response to an external cause, such as taking a big test or arguing with a friend. Goes away once the situation is resolved. Can be positive or negative. For example, it may inspire you to meet a deadline, or it may cause you to lose sleep.	Both stress and anxiety can affect your mind and body. You may experience symptoms such as: Excessive worry Uneasiness Tension Headaches or body pain High blood pressure Loss of sleep	Generally is internal, meaning it’s your reaction to stress. Usually involves a persistent feeling of apprehension or dread that doesn’t go away, and that interferes with how you live your life. Is constant, even if there is no immediate threat.

5 things you should know about stress

Everyone feels stressed from time to time. Stress is how your brain and body respond to any demand. Any type of challenge—such as performance at work or school, a significant life change, or a traumatic event—can be stressful.

1. Stress affects everyone

Everyone experiences stress from time to time. There are different types of stress—all of which carry physical and mental health risks. A stressor may be a one-time or short-term occurrence, or it can happen repeatedly over a long time. Some people may cope with stress more effectively and recover from stressful events more quickly than others.

Examples of stress include:

• Routine stress related to the pressures of school, work, family, and other daily responsibilities.
• Stress brought about by a sudden negative change, such as losing a job, divorce, or illness.
• Traumatic stress experienced during an event such as a major accident, war, assault, or natural disaster where people may be in danger of being seriously hurt or killed. People who experience traumatic stress may have very distressing temporary emotional and physical symptoms, but most recover naturally soon after.

2. Not all stress is bad

In a dangerous situation, stress signals the body to prepare to face a threat or flee to safety. In these situations, your pulse quickens, you breathe faster, your muscles tense, and your brain uses more oxygen and increases activity—all functions aimed at survival and in response to stress. In non-life-threatening situations, stress can motivate people, such as when they need to take a test or interview for a new job.

3. Long-term stress can harm your health

Coping with the impact of chronic stress can be challenging. Because the source of long-term stress is more constant than acute stress, the body never receives a clear signal to return to normal functioning. With chronic stress, those same lifesaving reactions in the body can disturb the immune, digestive, cardiovascular, sleep, and reproductive systems. Some people may experience mainly digestive symptoms, while others may have headaches, sleeplessness, sadness, anger, or irritability.

Over time, continued strain on your body from stress may contribute to serious health problems, such as heart disease, high blood pressure, diabetes, and other illnesses, including mental disorders such as depression or anxiety.

4. There are ways to manage stress

If you take practical steps to manage your stress, you may reduce the risk of negative health effects. Here are some tips that may help you to cope with stress:

• Be observant. Recognize the signs of your body’s response to stress, such as difficulty sleeping, increased alcohol and other substance use, being easily angered, feeling depressed, and having low energy.
• Talk to your health care provider or a healthcare professional. Don’t wait for your health care provider to ask about your stress. Start the conversation and get proper health care for existing or new health problems. Effective treatments can help if your stress is affecting your relationships or ability to work.
• Get regular exercise. Just 30 minutes per day of walking can help boost your mood and improve your health.
• Try a relaxing activity. Explore relaxation or wellness programs, which may incorporate meditation, muscle relaxation, or breathing exercises. Schedule regular times for these and other healthy and relaxing activities.
• Set goals and priorities. Decide what must get done now and what can wait. Learn to say “no” to new tasks if you start to feel like you’re taking on too much. Try to be mindful of what you have accomplished at the end of the day, not what you have been unable to do.
• Stay connected. You are not alone. Keep in touch with people who can provide emotional support and practical help. To reduce stress, ask for help from friends, family, and community or religious organizations.

5. If you’re overwhelmed by stress, ask for help from a health professional

You should seek help right away if you have suicidal thoughts, are overwhelmed, feel you cannot cope, or are using drugs or alcohol more frequently as a result of stress. Your doctor may be able to provide a recommendation. Resources are available to help you find a mental health provider (https://www.nimh.nih.gov/health/find-help).

Is stress always bad?

No, stress isn’t always bad. In fact, a little bit of stress is good. Most of us need to feel the pressure of wanting to do well. This is how you push yourself, whether it’s in sports, music, dance, work, or school. Also, many people need the stress caused by a deadline. Without it, you wouldn’t be able to finish projects or get to work or school on time.

If stress is so normal, why do I feel so bad?

With all the things that could happen to you in life, sometimes it’s easy to feel overwhelmed. Things that you can’t control are often the most frustrating. Maybe your parents are fighting. Maybe you’re having trouble with your social life. You can also feel bad when you put pressure on yourself. This could be pressure to get good grades or to get promoted at your job. A common reaction to stress is to criticize yourself. You may even get so upset that things don’t seem fun anymore. Life might look pretty grim. When this happens, it’s easy to think there’s nothing you can do to change things. But you can!

While you can’t always control the things that are stressing you out. But you can control how you react to them. The way you feel about things results from the way you think about things. If you change how you think, you can change the way you feel. Try some of these tips to cope with your stress:

• Take care of yourself. Eat well-balanced meals on a regular basis. Drink less caffeine. Get enough sleep, and exercise on a regular basis.
• Make a list of the things that are causing your stress. Think about your friends, family, school, and other activities. Accept that you can’t control everything on your list.
• Take control of what you can. For example, you may need to cut back your work hours. Or you might have to drop one of your activities after school.
• Give yourself a break. Remember that you can’t make everyone in your life happy all the time. And it’s okay to make mistakes now and then.
• Don’t over-commit yourself. If you’re already too busy, don’t promise to decorate for the school dance. If you’re tired and don’t want to go out, tell your friends you’ll go another night.
• Find someone to talk to. Talking to your friends or family can help. Talking about your feelings is the first step in learning to deal with them and starting to feel better. It gives you a chance to express your feelings. However, problems in your social life or family can be the hardest to talk about. If you feel like you can’t talk to your family or a friend, talk to someone outside the situation. This could be a religious leader, a school counselor, or your family doctor.

What are some things that don’t help you deal with stress?

There are safe and unsafe ways to deal with stress. It’s dangerous to try to escape your problems by using drugs and alcohol. Both can be very tempting, and your friends may offer them to you. Drugs and alcohol may seem like easy answers, but they’re not. Using drugs and alcohol to deal with stress just adds new problems, such as addiction, or family and health problems.

How can other people help with stress?

If someone you’re close to is feeling stressed there are lots of practical things you can do to support them – even though you probably can’t change the situation they’re in.

• Help them reflect on whether they are stressed. Often, people don’t notice that some physical symptoms and behavior (such as not being able to get to sleep, or drinking more than usual) are actually signs of stress. Sometimes you may be able to see it before they recognize it themselves. If you’ve noticed that someone seems particularly busy, anxious or unwell, you could gently let them know, and ask how you can help.
• Listen to how they are feeling. Having a chance to talk openly could help someone to feel calmer and more able to move forward. Just being there for them will probably help lots.
• Reassure them that stressful situations can pass. For someone who is in the middle of a stressful time, it can be hard to see an end point. Let them know that situations change and can get better.
• Help them identify their triggers. You can be specific about things you’ve observed, but try to stay open-minded and non-judgemental. Your perspective might be valuable, but your friend or family member could find this conversation stressful, and being patient will help.
• Help them address some causes of stress, if you can. You might be able to help your friend or family member look for support around issues like debt, housing problems or difficulties at work.
• Help them learn and practise relaxation techniques. You could help them research good relaxation techniques and find ways to practise them, such as a weekly yoga class, or setting aside time for breathing exercises at home. This might become something that you could do together.
• Support them to seek professional help. For example, you could help them contact their doctor, go with them to an appointment or do some research on mental health and wellbeing.
• Look after yourself. If someone around you is very stressed, you might become stressed too. If this happens, try to take a step back and look after your own wellbeing. Being calm and relaxed will make you more able to help someone else.

Main types of stress

Stress is your body’s reaction to the demands of the world. Stressors are events or conditions in your surroundings that may trigger stress. Your body responds to stressors differently depending on whether the stressor is new or short term — acute stress — or whether the stressor has been around for a longer time — chronic stress ³. Effective stress management involves identifying and managing both acute and chronic stress.

Acute stress

Also known as the fight-or-flight response, acute stress is your body’s immediate reaction to a perceived threat, challenge or scare. The acute-stress response is immediate and intense, and in certain circumstances it can be thrilling. Examples of acute stressors include having a job interview or getting a speeding ticket.

A single episode of acute stress generally doesn’t cause problems for healthy people. However, severe acute stress can cause mental health problems — such as post-traumatic stress disorder. It can also cause physical difficulties such as tension headaches, stomach problems or serious health issues — such as a heart attack.

Chronic stress

Mild acute stress can actually be beneficial — it can spur you into action, motivate and energize you. The problem occurs when stressors pile up and stick around. This persistent stress can lead to health problems, such as headaches and insomnia. The chronic-stress response is more subtle than is the acute-stress response, but the effects may be longer lasting and more problematic.

Stress and Disease

Although the exact role of stress in human diseases is not known, it is clear that stress can lead to particular diseases by temporarily inhibiting certain components of the immune system. Stress-related disorders include gastritis, ulcerative colitis, irritable bowel syndrome, hypertension, asthma, rheumatoid arthritis (RA), migraine headaches, anxiety, and depression. People under stress are at a greater risk of developing chronic disease or dying prematurely.

Interleukin-1, a substance secreted by macrophages of the immune system, is an important link between stress and immunity. One action of interleukin-1 is to stimulate secretion of adrenocorticotropic hormone (ACTH), which in turn stimulates the production of cortisol. Cortisol, a corticosteroid hormone, is produced by the adrenal cortex and is known to be involved in the response to stress suppression in the immune system. Increased serum cortisol levels have been observed in connection with clinical depression and psychological stress involving stressors such as hypoglycemia, illness, fever, trauma, surgery, fear, pain, physical exertion or extremes of temperature. In normal release, cortisol has widespread actions that help restore homeostasis after stress. Cortisol acts as a physiological antagonist to insulin by promoting gluconeogenesis, breakdown of lipids and proteins, and mobilization of extrahepatic amino acids and ketone bodies. This leads to increased blood glucose concentrations, resulting in increased glycogen formation in the liver ⁴. In chronic stress, prolonged cortisol secretion causes muscle wastage, hyperglycemia, and suppresses immune/inflammatory responses. Moreover, long-term exposure to cortisol results in damage to cells of the hippocampus that may cause impaired learning.

However, short-term exposure of cortisol helps to create memory, and constitutes the proposed mechanism for the storage of flash bulb memories. Furthermore, cortisol provide resistance to stress and inflammation and it also suppresses further production of interleukin-1. Thus, the immune system turns on the stress response, and the resulting cortisol then turns off one immune system mediator. This negative feedback system keeps the immune response in check once it has accomplished its goal. Because of this activity, cortisol and other glucocorticoids are used as immunosuppressive drugs for organ transplant recipients.

What happens in your body during stress

Biochemical Changes

The responses to stressors may be pleasant or unpleasant, and they vary among people and even within the same person at different times.

Your body’s homeostatic mechanisms attempt to counteract stress. When they are successful, the internal environment remains within normal physiological limits. If stress is extreme, unusual, or long lasting, the normal mechanisms may not be enough. In 1936, Hans Selye, a pioneer in stress research, showed that a variety of stressful conditions or noxious agents elicit a similar sequence of bodily changes. These changes, called the stress response or general adaptation syndrome, are controlled mainly by the hypothalamus.

The stress response occurs in three stages:

1. Stage 1: an initial Fight-or-Flight Response,
2. Stage 2: a Slower Resistance reaction, and eventually
3. Stage 3: Exhaustion.

Research on the stress response has shown that many of the physiological alterations associated with stress are brought about by centrally controlled biochemical changes – stressors stimulate the hypothalamus to initiate the stress response through the fight-or-flight response and the resistance reaction. During situations perceived as being acutely stressful, the 2 main pathways activated are:

1. The Hypthothalamus-Pituitary-Adreno Axis and
   
2. The Sympatho-Adreno-Medullary Axis.

Both axes are activated by the hypothalamus secreting corticotrophin-releasing hormone (CRH), which causes the pituitary gland to release adrenocorticotropic hormone (ACTH). In the more rapidly acting of these pathways, the Sympatho-Adreno-Medullary axis, ACTH stimulates the adrenal medulla to release the catecholamines epinephrine and norepinephrine ⁵. These stress-induced alterations are directly linked to a number of the physiological changes that take place in the body including increases in blood pressure, heart rate, respiration, and oxygen consumption.8 In the slower-acting HPA axis, blood-borne ACTH acts on the adrenal cortex to release cortisol. Once in the bloodstream, cortisol induces metabolic changes in the liver, resulting in increased glucose concentrations in blood and tissues. The increased glucose produces adenosine triphosphate (ATP) to repair damaged cells and enables metabolically active cells throughout the body to respond to the stressor ⁵.

Figure 1. Hypthothalamus-Pituitary-Adreno Axis and Sympatho-Adreno-Medullary Axis

Note: Responses to stressors during the stress response. Red arrows (hormonal responses) and green arrows (neural responses) in (a) indicate immediate fight-or-flight reactions; black arrows in (b) indicate long-term resistance reactions.

The Fight-or-Flight Response (Stage 1 of Stress)

The fight-or-flight response, initiated by nerve impulses from the hypothalamus to the sympathetic division of the autonomic nervous system (ANS), including the adrenal medulla, quickly mobilizes the body’s resources for immediate physical activity (see Figure 1 above). It brings huge amounts of glucose and oxygen to the organs that are most active in warding off danger: the brain, which must become highly alert; the skeletal muscles, which may have to fight off an attacker or flee; and the heart, which must work vigorously to pump enough blood to the brain and muscles. During the fight-or-flight response, nonessential body functions such as digestive, urinary, and reproductive activities are inhibited. Reduction of blood flow to the kidneys promotes release of renin, which sets into motion the renin–angiotensin–aldosterone pathway. Aldosterone causes the kidneys to retain Na+, which leads to water retention and elevated blood pressure. Water retention also helps preserve body fluid volume in the case of severe bleeding.

The Resistance Reaction (Stage 2 of Stress)

The second stage in the stress response is the resistance reaction (Figure 1b). Unlike the short-lived fight-or-flight response, which is initiated by nerve impulses from the hypothalamus, the resistance reaction is initiated in large part by hypothalamic releasing hormones and is a longer-lasting response. The hormones involved are corticotropin-releasing hormone (CRH), growth hormone–releasing hormone (GHRH), and thyrotropin-releasing hormone (TRH).

Corticotropin-releasing hormone (CRH) stimulates the anterior pituitary to secrete adrenocorticotropic hormone (ACTH), which in turn stimulates the adrenal cortex to increase release of cortisol. Cortisol then stimulates gluconeogenesis by liver cells, breakdown of triglycerides into fatty acids (lipolysis), and catabolism of proteins into amino acids. Tissues throughout the body can use the resulting glucose, fatty acids, and amino acids to produce ATP (adenosine triphosphate is the energy packets necessary for cells to function) or to repair damaged cells. Cortisol also reduces inflammation.

A second hypothalamic releasing hormone, growth hormone–releasing hormone (GHRH), causes the anterior pituitary to secrete growth hormone (GH). Acting  via insulin like growth factors (ILGF), GH stimulates lipolysis and glycogenolysis, the breakdown of glycogen to glucose, in the liver. A third hypothalamic releasing hormone, thyrotropin-releasing hormone (TRH), stimulates the anterior pituitary to secrete thyroid-stimulating hormone (TSH). TSH promotes secretion of thyroid hormones, which stimulate the increased use of glucose for ATP production. The combined actions of GH and TSH supply additional ATP for metabolically active cells throughout the body.

The resistance stage helps the body continue fighting a stressor long after the fight-or-flight response dissipates. This is why your heart continues to pound for several minutes even after the stressor is removed. Generally, it is successful in seeing you through a stressful episode, and your bodies then return to normal. Occasionally, however, the resistance stage fails to combat the stressor, and the body moves into the state of exhaustion.

Stage of Exhaustion (Stage 3 of Stress)

The resources of the body may eventually become so depleted that they cannot sustain the resistance stage, and exhaustion ensues. Prolonged exposure to high levels of cortisol and other hormones involved in the resistance reaction causes wasting of muscle, suppression of the immune system, ulceration of the  gastrointestinal tract, and failure of pancreatic beta cells. In addition, pathological changes may occur because resistance reactions persist after the stressor has been removed.

This puts you at increased risk of numerous health problems, including:

• Anxiety
• Depression
• Digestive problems
• Headaches
• Heart disease
• Sleep problems
• Weight gain
• Memory and concentration impairment

That’s why it’s so important to learn healthy ways to cope with the stressors in your life.

Figure 2. Comparative Impact of the Acute Stress and Relaxation Responses

Footnote: Central and Peripheral Nervous System Activities

Using blood pressure as an example, scientists show how acute stress and relaxation responses alter hypothalamus-pituitary-adrenal (HPA) and sympatho-adreno-medullary (SAM) axis activities. These responses introduce contrasting hormonal and signal molecule changes that in turn influence clinically significant conditions such as high blood pressure. Epi = epinephrine or adrenaline /  Ne = norepinephrine or noradrenaline / Sympatho-Adreno-Medullary (SAM) axis is the adrenal medulla to norepinephrine (noradrenaline) and epinephrine (adrenaline) / Cort = cortisol / NO = nitric oxide / HPA (hypothalamus-pituitary-adrenal) axis is the adrenal cortex to cortisol

Why you react to life stressors the way you do?

Your reaction to a potentially stressful event is different from anyone else’s. How you react to stressors in your life is affected by such factors as:

• Genetics. The genes that control the stress response keep most people on a fairly even keel, only occasionally priming the body for fight or flight. Overactive or underactive stress responses may stem from slight differences in these genes.
• Life experiences. Strong stress reactions sometimes can be traced to traumatic events. People who were neglected or abused as children tend to be particularly vulnerable to stress. The same is true of people who have experienced violent crime, airplane crash survivors, military personnel, police officers and firefighters.

You may have some friends who seem laid-back about almost everything and others who react strongly at the slightest stress. Most reactions to life stressors fall somewhere between those extremes.

Men: Consider this when life throws you a curveball

Experts who study humans who face stress (that would include everyone who breathes) have discovered something interesting: Men’s and women’s bodies respond differently to stressful life events.

Why is this important to know? Because understanding how you cope can improve what scientists call your resilience — your ability to rebound from a challenge or setback.

A number of studies have found that men display more evidence of the “fight or flight” response to stress. The theory is that as men evolved and faced physical challenges, their bodies adapted to overcome (fight) or escape (flight) the inevitable physical threats in their environment.

The fight or flight physical response helped your ancient ancestors survive a life-threatening attack from a possible predator situation. But that same heart-pumping, palm-sweating response is not so helpful for today’s stressors that are mostly psychological — say, during a job interview, giving a speech or negotiating with a moody teen.

In fact, fight or flight can put a real damper on your life and mood. Scientists have found that when faced with stressful tasks, the sections of the male brain associated with vigilance and negative emotions fire up, suppressing activity in the brain associated with positive emotion and pleasure.

How do men adapt?

Researchers have noticed several trends in how men tend to cope with stress. They may be less likely to:

• Report symptoms of stress
• Participate in stress-relieving activities
• Say that they need emotional support
• Have a strong, diverse emotional support network.

It’s important to point out that many men are aware of their stress level and work to manage it. The key is to understand how you respond to stress so you can develop an ongoing plan for resiliency.

Causes of stress

Everyone experiences stress, and sometimes that stress can feel overwhelming. Stress is usually a reaction to mental or emotional pressure. It’s often related to feeling like you’re losing control over something, but sometimes there’s no obvious cause. When you’re feeling anxious or scared, your body releases stress hormones such as epinephrine (adrenaline) and cortisol. This can be helpful for some people and stress might help you get things done or feel more motivated. But it might also cause physical symptoms such as a faster heartbeat or sweating. If you’re stressed all the time it can become a problem.

Feelings of stress are normally triggered by things happening in your life. If you know what’s causing your stress it might be easier to find ways to manage it.

Some examples of sources of stress include:

• Work – feeling pressure at work, unemployment or retirement
• Family – relationship difficulties, divorce or caring for someone
• Financial problems – unexpected bills or borrowing money
• Health – illness, injury or losing someone (bereavement)

Types of stressors in your life which involve:

• being under lots of pressure
• facing big changes
• worrying about something
• not having much or any control over the outcome of a situation
• having responsibilities that you’re finding overwhelming
• not having enough work, activities or change in your life
• times of uncertainty

Even significant life events such as buying a house, having a baby or planning a wedding could lead to feelings of stress.

There might be one big thing causing you stress, but stress can also be caused by a build-up of small pressures. This might make it harder for you to identify what’s making you feel stressed, or to explain it to other people.

You might find it hard to explain to people why you feel this way, but talking to someone could help you find a solution.

Why do certain things make me feel stressed?

The amount of stress you feel in different situations may depend on many factors such as:

• your perception of the situation – this might be connected to your past experiences, your self-esteem, and how your thought processes work (for example, if you tend to interpret things positively or negatively)
• how experienced you are at dealing with that particular type of pressure
• your emotional resilience to stressful situations
• the amount of other pressures on you at the time
• the amount of support you are receiving.

We’re all different, so a situation that doesn’t bother you at all might cause someone else a lot of stress. For example, if you’re feeling confident or usually enjoy public speaking, you might find that giving a speech in front of people feels comfortable and fun. But if you’re feeling low or usually prefer not to be the center of attention, this situation might cause you to experience signs of stress.

What kind of situations can cause stress?

Stress can be caused by a variety of different common life events, many of which are difficult to avoid. For example:

Personal

• illness or injury
• pregnancy and becoming a parent
• bereavement
• long-term health problems
• organizing a complicated event, like a wedding or group holiday
• everyday tasks such as travel or household chores.

Friends and family

• getting married or civil partnered
• going through a break-up or getting divorced
• difficult relationships with parents, siblings, friends or children
• being a carer for a friend or relative who needs lots of support.

Employment and study

• losing your job
• long-term unemployment
• retiring
• exams and deadlines
• difficult issues at work
• starting a new job.

Housing

• housing problems such as poor living conditions, lack of security or homelessness
• moving house
• problems with neighbors.

Money

• worries about money or benefits
• poverty
• debt.

Can happy events cause stress?

Some of the situations listed above are often thought of as happy events – for example, you might feel expected to be happy or excited about getting married or having a baby. But because they can bring big changes or make unusual demands on you, they can still be very stressful. This can be particularly difficult to deal with, because you might feel there’s additional pressure on you to be positive.

Signs and symptoms of stress

Stress can cause many different symptoms. It might affect how you feel physically, mentally and also how you behave. It’s not always easy to recognize when stress is the reason you’re feeling or acting differently.

Common effects of stress

Stress symptoms can affect your body, your thoughts and feelings, and your behavior. Being able to recognize common stress symptoms can give you a jump on managing them. Stress that’s left unchecked can contribute to many health problems, such as high blood pressure, heart disease, obesity and diabetes.

Common effects of stress on your body

• Headache
• Muscle tension or pain
• Chest pain
• Fatigue
• Change in sex drive
• Stomach upset
• Sleep problems

Common effects of stress on your mood

• Anxiety
• Restlessness
• Lack of motivation or focus
• Feeling overwhelmed
• Irritability or anger
• Sadness or depression

Common effects of stress on your behavior

• Overeating or undereating
• Angry outbursts
• Drug or alcohol abuse
• Tobacco use
• Social withdrawal
• Exercising less often.

Sometimes you try dealing with your stress, but you still feel like giving up. This is a danger sign. Stress can become too much to deal with. It can lead to such awful feelings that you may think about hurting—or even killing—yourself. When you feel like giving up, it may seem like things will never get better. Talk to someone right away. Talking about your feelings is the first step in learning to deal with them and starting to feel better.

Evaluate how you react to stress

One of the first steps toward good stress management is understanding how you react to stress — and making changes if necessary. Take an honest look at how you react to stress and then adopt or modify stress management techniques to make sure the stress in your life doesn’t lead to health problems.

Stress management skills often don’t come naturally. You can learn new stress management skills or modify your existing stress management skills to help you cope better, though.

First, take a look at how you react to stress. Some people seem to take everything in stride. Their naturally laid-back attitudes shine through, even in stressful situations. Another deadline? They can handle it. The dishwasher is leaking? No problem, it will be a simple repair. Others get anxious at the first sign of a stressful situation. Running late for a meeting? Time to panic! Stuck in a traffic jam? Let the cursing begin!

Here are some common but unhealthy reactions to stress. Do any of these describe your reactions? If you’re not sure, consider keeping a daily journal for a week or so to monitor your reactions to stressful situations.

• Pain. You may unconsciously clench your jaws or fists or develop muscle tension, especially in your neck and shoulders, all of which can lead to unexplained physical pain. Stress may also cause a variety of other health ailments, including upset stomach, shortness of breath, back pain, headaches and insomnia.
• Overeating. Stress may trigger you to eat even when you’re not hungry, or you may skip exercise. In contrast, you may eat less, actually losing weight when under more stress.
• Anger. Stress may leave you with a short temper. When you’re under pressure, you may find yourself arguing with co-workers, friends or loved ones — sometimes with little provocation or about things that have nothing to do with your stressful situation.
• Crying. Stress may trigger crying jags, sometimes seemingly without warning. Little things unrelated to your stress may leave you in tears. You also may feel lonely or isolated.
• Depression. Sometimes stress may be too much to take. You might avoid the problem, call in sick to work, feel hopeless or simply give up. Chronic stress can be a factor in the development of depression or anxiety disorders.
• Negativity. When you don’t cope well with stress, you may automatically expect the worst or magnify the negative aspects of any undesirable situation.
• Smoking. Even if you quit smoking long ago, a cigarette may seem like an easy way to relax when you’re under pressure. In fact, stress is a leading cause of having a smoking relapse. You may also find yourself turning to alcohol or drugs to numb the effects of stress.

When to seek help for stress

If you’re not sure if stress is the cause or if you’ve taken steps to control your stress but your symptoms continue, see your doctor. Your doctor may want to check for other potential causes. Or, consider seeing a professional counselor or therapist, who can help you identify sources of your stress and learn new coping tools.

Also, if you have chest pain, especially if it occurs during physical activity or is accompanied by shortness of breath, sweating, dizziness, nausea, or pain radiating into your shoulder and arm, get emergency help immediately. These may be warning signs of a heart attack and not simply stress symptoms.

How do I control stress-induced weight gain?

When you’re under stress, you may find it harder to eat healthy. Also, during times of particularly high stress, you may eat in an attempt to fulfill emotional needs — sometimes called stress eating or emotional eating. And you may be especially likely to eat high-calorie foods during times of stress, even when you’re not hungry.

To prevent weight gain during stress and reduce the risk of obesity, get a handle on your stress. When you feel less stressed and more in control of your life, you may find it easier to stick to healthy eating and exercise habits.

Try these stress management techniques to combat stress-related weight gain:

• Recognize the warning signs of stress, such as anxiety, irritability and muscle tension.
• Before eating, ask yourself why you’re eating — are you truly hungry or do you feel stressed or anxious?
• If you’re tempted to eat when you’re not hungry, find a distraction.
• Don’t skip meals, especially breakfast. If you’re in a hurry, grab a piece of fruit on the way out the door.
• Eat a healthy diet, such as whole grains and a variety of fruits and vegetables. Aim to include most food groups in your meals.
• Identify comfort foods and keep them out of your home or office.
• Keep a record of your behavior and eating habits so that you can look for patterns and connections — and then figure out how to overcome them.
• Learn problem-solving skills so that you can anticipate challenges and cope with setbacks.
• Practice relaxation skills, such as yoga, stretching, massage, deep breathing or meditation.
• Engage in regular physical activity or exercise.
• Get adequate sleep.
• Get encouragement from supportive friends and family.

If you try stress management techniques on your own but they don’t seem to be working, consider seeking professional help through psychotherapy or counseling.

How can I focus my attention and improve my concentration ?

Many people find it hard to focus, but it is a skill you can develop. To improve your focus:

• Reduce distractions. Turn off the TV, put down your phone and log out of your email account. Not convinced it’ll help? Eliminate noncritical screen time for two days and see how much more you get done.
• Plan for peaks and valleys. Are you a morning person? Then don’t squander that time on email. Instead, use it to tackle projects that require your full concentration. Save the afternoon for going through your inbox or catching up on your filing.
• Put it out of your mind. Too many mental notes make for a cluttered mind. All of that unfinished business can sap your mental energy. Put whatever’s on your mind on paper or capture it digitally. Think of it as off-site storage.
• Train your brain. Any skill worth having requires practice. Learning to focus is no different. Invest time in mastering attention training or meditation. Both are great ways to practice taming distractions and improving focus.

By sharpening your focus, you’ll not only get more done but also enjoy more flow — when you’re so absorbed in an activity that nothing else seems to matter. Flow can create a sense of fulfillment, engagement and even contentment.

How To Manage Stress – Stress Management Techniques

Stress management isn’t a first-aid kit you pull out only in emergencies. Rather, it’s a set of tools you can use every day to deal with the big and little issues that arise. It’s a good idea to keep your tools sharp and even to add a few to your collection from time to time.

Be prepared for setbacks. Don’t get discouraged if you occasionally fail to handle a stressful situation as well as you might like. Change takes time, and setbacks are part of the learning curve. Learn from the experience, and plan to clear that hurdle the next time. If you lapse back to your old ways, don’t give up. Focus on what you can do to regain control of the situation.

If you have stress symptoms, taking steps to manage your stress can have numerous health benefits.

Explore stress management strategies, such as:

• Regular physical activity
• Relaxation techniques, such as deep breathing, meditation, yoga, tai chi or getting a massage
• Keeping a sense of humor
• Socializing with family and friends
• Setting aside time for hobbies, such as reading a book or listening to music

Stress is more likely to rear its ugly head if you’re not taking care of yourself. So remember to put yourself first. These strategies can help you stay on course.

Aim to find active ways to manage your stress. Inactive ways you may use to manage stress — such as watching television, surfing the Internet or playing video games — may seem relaxing, but they may increase your stress over the long term.

And be sure to get plenty of sleep and eat a healthy, balanced diet. Avoid tobacco use, excess caffeine and alcohol intake, and the use of illicit substances.

Step #1 – Identify Your Stressors

The pace and challenges of modern life make stress management necessary for everyone. It is impossible to remove all of the stress from our everyday lives. Some stress, called eustress, prepares us to meet certain challenges and thus is helpful. Other stress, called distress, is harmful. Any stimulus that produces a stress response is called a stressor. A stressor may be almost any disturbance of the human body—heat or cold, environmental poisons, toxins given off by bacteria, heavy bleeding from a wound or surgery, or a strong emotional reaction.

Effective stress management starts with identifying your sources of stress and developing strategies to manage them. One way to do this is to make a list of the situations, concerns or challenges that trigger your stress response. Take a moment to write down some of the top issues you’re facing right now. You’ll notice that some of your stressors are events that happen to you while others seem to originate from within.

Know your triggers

To monitor your stress, first identify your triggers. What makes you feel angry, tense, worried or irritable ? Do you often get headaches or an upset stomach with no medical cause ?

It’s undeniable — life is full of stress. The kids are screaming, the bills are due and the pile of papers on your desk is growing at an alarming pace.

Some stressors, such as job pressures, relationship problems or financial concerns, are easy to identify. But daily hassles and demands, such as waiting in a long line or being late to a meeting, also contribute to your stress level.

Even essentially positive events, such as getting married or buying a house, can be stressful. Any change to your life can cause stress.

Understanding the types and sources of stress — short term and long term, internal and external — is an important part of stress management. So what stresses you out ?

Once you’ve identified your stress triggers, think about strategies for dealing with them. Identifying what you can control is a good starting point. For example, if stress keeps you up at night, the solution may be as easy as removing the TV and computer from your bedroom and letting your mind wind down before bed.

Other times, such as when stress is based on high demands at work or a loved one’s illness, you might be able to change only your reaction.

Don’t feel like you have to figure it out on your own. Seek help and support from family and friends, whether you need someone to listen to you, help with child care or a ride to work when your car’s in the shop.

Many people benefit from practices such as deep breathing, tai chi, yoga, meditation or being in nature. Set aside time for yourself. Get a massage, soak in a bubble bath, dance, listen to music, watch a comedy — whatever helps you relax.

Maintaining a healthy lifestyle will help you manage stress. Eat a healthy diet, exercise regularly and get enough sleep. Make a conscious effort to spend less time in front of a screen — television, tablet, computer and phone — and more time relaxing.

Stress won’t disappear from your life. And stress management needs to be ongoing. But by paying attention to what causes your stress and practicing ways to relax, you can counter some of the bad effects of stress and increase your ability to cope with challenges.

External stressors

External stressors are events and situations that happen to you. Some examples of external stressors include:

• Major life changes. These changes can be positive, such as a new marriage, a planned pregnancy, a promotion or a new house. Or they can be negative, such as the death of a loved one or a divorce.
• Environment. The input from the world around us can be a source of stress. Consider how you react to sudden noises, such as a barking dog, or how you react to a bright sunlit room or a dark room.
• Unpredictable events. Out of the blue, uninvited houseguests arrive. Or you discover your rent has gone up or that your pay has been cut.
• Workplace. Common stressors at work include an impossible workload, endless emails, urgent deadlines and a demanding boss.
• Social. Meeting new people can be stressful. Just think about going on a blind date, and you probably start to sweat. Relationships with family often spawn stress as well. Just think back to your last fight with your partner or child.

Strategies to manage external stressors include lifestyle factors such as eating a healthy diet, being physically active and getting enough sleep — which help boost your resiliency. Other helpful steps include asking for help from others, using humor, learning to be assertive, and practicing problem-solving and time management. Consider how you use your time and energy by focusing on activities that are important to you, paring down the number of activities you’re involved in, and saying no to new commitments.

Internal stressors

Not all stress stems from things that happen to you. Much of our stress response is self-induced. Those feelings and thoughts that pop into your head and cause you unrest are known as internal stressors. Examples of internal stressors include:

• Fears. Common ones include fear of failure, fear of public speaking and fear of flying.
• Uncertainty and lack of control. Few people enjoy not knowing or not being able to control what might happen. Think about how you might react when waiting for the results of a medical test.
• Beliefs. These might be attitudes, opinions or expectations. You may not even think about how your beliefs shape your experience, but these preset thoughts often set us up for stress. Consider the expectations you put on yourself to create a perfect holiday celebration or advance up the career ladder.

The good news is that we have the ability to control our thoughts. The bad news is that our fears, attitudes and expectations have been our companions for a long time and it often takes some effort to change them. Strategies to manage internal stressors include reframing your thoughts and choosing a positive mindset, challenging negative thoughts, using relaxation techniques, and talking with a trusted friend or counselor.

Step #2. Looking after your health

In addition to regular exercise, there are other healthy lifestyle choices that can increase your resistance to stress.

• Eat a healthy diet. When you’re stressed, it can be tempting to skip meals or eat too much of the wrong kinds of food. But what you eat, and when you eat, can make a big difference to how well you feel. Well-nourished bodies are better prepared to cope with stress, so be mindful of what you eat. Start your day right with breakfast, and keep your energy up and your mind clear with balanced, nutritious meals throughout the day.
• Reduce caffeine and sugar. The temporary “highs” caffeine and sugar provide often end in with a crash in mood and energy. By reducing the amount of coffee, soft drinks, chocolate, and sugar snacks in your diet, you’ll feel more relaxed and you’ll sleep better.
• Avoid alcohol, cigarettes, and drugs. Self-medicating with alcohol or drugs may provide an easy escape from stress, but the relief is only temporary. Don’t avoid or mask the issue at hand; deal with problems head on and with a clear mind.
• Get enough sleep. Stress can often make it difficult to sleep, and can cause sleep problems. Getting enough sleep can help you feel more able to deal with difficult situations.
  Adequate sleep fuels your mind, as well as your body. Feeling tired will increase your stress because it may cause you to think irrationally.

Relaxation

Deep breathing exercises, muscle relaxation exercises, yoga and meditation are some techniques that can relax the body and reduce stress.

Spending time with family for friends

Being with people you find uplifting, resolving personal conflicts, and talking about your feelings can help.

There is nothing more calming than spending quality time with another human being who makes you feel safe and understood. In fact, face-to-face interaction triggers a cascade of hormones that counteracts the body’s defensive “fight-or-flight” response. It’s nature’s natural stress reliever (as an added bonus, it also helps stave off depression and anxiety). So make it a point to connect regularly—and in person—with family and friends.

Keep in mind that the people you talk to don’t have to be able to fix your stress. They simply need to be good listeners. And try not to let worries about looking weak or being a burden keep you from opening up. The people who care about you will be flattered by your trust. It will only strengthen your bond.

Of course, it’s not always realistic to have a pal close by to lean on when you feel overwhelmed by stress, but by building and maintaining a network of close friends you can improve your resiliency to life’s stressors.

Do things you enjoy

If you feel unable to manage your stress alone or with support from loved ones, seek help from a counselor or health professional.

• Set aside leisure time. Include rest and relaxation in your daily schedule. Don’t allow other obligations to encroach. This is your time to take a break from all responsibilities and recharge your batteries.
• Do something you enjoy every day. Make time for leisure activities that bring you joy, whether it be stargazing, playing the piano, or working on your bike.
• Keep your sense of humor. This includes the ability to laugh at yourself. The act of laughing helps your body fight stress in a number of ways.
• Take up a relaxation practice. Relaxation techniques such as yoga, meditation, and deep breathing activate the body’s relaxation response, a state of restfulness that is the opposite of the fight or flight or mobilization stress response. As you learn and practice these techniques, your stress levels will decrease and your mind and body will become calm and centered.

Give yourself a break

Learning to be kinder to yourself in general can help you control the amount of pressure you feel in different situations, which can help you feel less stressed.

• Reward yourself for achievements – even small things like finishing a piece of work or making a decision. You could take a walk, read a book, treat yourself to food you enjoy, or simply tell yourself “well done”.
• Get a change of scenery. You might want to go outside, go to a friend’s house or go to a café for a break – even if it’s just for a short time.
• Take a break or holiday. Time away from your normal routine can help you relax and feel refreshed. Even spending a day in a different place can help you feel more able to face stress.
• Resolve conflicts, if you can. Although this can sometimes be hard, speaking to a manager, colleague or family member about problems in your relationship with them can help you find ways to move forward.
• Forgive yourself when you feel you have made a mistake, or don’t achieve something you hoped for. Try to remember that nobody’s perfect, and putting extra pressure on yourself doesn’t help.

Make lifestyle changes

There are some general changes that you can make to your lifestyle that could help you feel more able to cope with pressure and stressful situations.

• Practise being straightforward and assertive in communicating with others. If people are making unreasonable or unrealistic demands on you, be prepared to tell them how you feel and say no.
• Use relaxation techniques. You may already know what helps you relax, like having a bath, listening to music or taking your dog for a walk. If you know that a certain activity helps you feel more relaxed, make sure you set aside time to do it. See our pages on relaxation for lots more ideas.
• Develop your interests and hobbies. Finding an activity that’s completely different from the things causing you stress is a great way to get away from everyday pressures. If stress is making you feel lonely or isolated, shared hobbies can also be a good way to meet new people.
• Make time for your friends. When you’ve got a lot on this might seem hard, but it can help you feel more positive and less isolated. Chatting to friends about the things you find difficult can help you keep things in perspective – and you can do the same for them. Laughing and smiling with them will also produce hormones that help you to relax.
• Find balance in your life. You may find that one part of your life, such as your job or taking care of young children, is taking up almost all of your time and energy. Try making a decision to focus some of your energy on other parts of your life, like family, friends or hobbies. It’s not easy, but this can help spread the weight of pressures in your life, and make everything feel lighter.

Organize your time

Making some adjustments to the way you organize your time could help you feel more in control of any tasks you’re facing, and more able to handle pressure.

• Identify your best time of day, and do the important tasks that need the most energy and concentration at that time. For example, you might be a morning person or an evening person.
• Make a list of things you have to do. Arrange them in order of importance, and try to focus on the most urgent first. Some people find creating a timetable useful so they can plan when they can spend time on each task. If your tasks are work related, ask a manager or colleague to help you prioritise. You may be able to push back some tasks until you’re feeling less stressed.
• Set smaller and more achievable targets. When you’re under a lot of pressure it’s easy to set yourself large targets that are often unachievable. This can make you feel more stressed and if you don’t reach them, it can make you feel disappointed and frustrated. Setting smaller more achievable goals can make you feel in more control and you can see your achievements more easily.
• Vary your activities. Balance interesting tasks with more mundane ones, and stressful tasks with those you find easier or can do more calmly.
• Try not to do too much at once. If you take on too much, you might find it harder to do any individual task well. This can make you feel like you have even more pressure on you.
• Take breaks and take things slowly. It might be difficult to do this when you’re stressed, but it can make you more productive.
• Ask someone if they can help. For example, you could ask a friend or family member to help with some of your daily tasks so that you have more time to spend completing your tasks that are causing you to feel stressed.

Step #3. Get active

Virtually any form of physical activity can act as a stress reliever. Even if you’re not an athlete or you’re out of shape, exercise can still be a good stress reliever.

• Exercise can help keep depression and anxiety at bay. Exercising about 30 minutes a day can benefit your body and mind.

Physical activity can pump up your feel-good endorphins and other natural neural chemicals that enhance your sense of well-being. Exercise can also refocus your mind on your body’s movements, which can improve your mood and help the day’s irritations fade away. Consider walking, jogging, gardening, housecleaning, biking, swimming, weightlifting or anything else that gets you active.

Step #4. Eat a healthy diet

Eating a healthy diet is an important part of taking care of yourself. Aim to eat a variety of fruits and vegetables, and whole grains.

A diet rich in fruits, vegetables and whole grains can give you more energy to keep stress under control. Caffeine may give you a jolt of energy, but it will wear off quickly.

Avoid unhealthy habits. Some people may deal with stress by drinking too much caffeine or alcohol, smoking, eating too much, or using illicit substances. These can affect your health in unhealthy ways.

Step #5. Connect with others

When you’re stressed and irritable, your instinct may be to wrap yourself in a cocoon. Instead, reach out to family and friends and make social connections.

Social contact is a good stress reliever because it can offer distraction, provide support and help you tolerate life’s up and downs. So take a coffee break with a friend, email a relative or visit your place of worship.

Got more time ? Considering volunteering for a charitable group and help yourself while helping others.

Step #6. Laugh more

Whether you’re guffawing at a sitcom on TV or quietly giggling at a newspaper cartoon, laughing does you good. Laughter is a great form of stress relief, and that’s no joke. A good sense of humor can’t cure all ailments, but it can help you feel better, even if you have to force a fake laugh through your grumpiness. When you laugh, it not only lightens your mental load but also causes positive physical changes in your body. Laughter fires up and then cools down your stress response. So read some jokes, tell some jokes, watch a comedy or hang out with your funny friends.

Stress relief from laughter

A good sense of humor can’t cure all ailments, but data is mounting about the positive things laughter can do.

Short-term benefits

A good laugh has great short-term effects. When you start to laugh, it doesn’t just lighten your load mentally, it actually induces physical changes in your body.

Laughter can:

• Stimulate many organs. Laughter enhances your intake of oxygen-rich air, stimulates your heart, lungs and muscles, and increases the endorphins that are released by your brain.
• Activate and relieve your stress response. A rollicking laugh fires up and then cools down your stress response, and it can increase your heart rate and blood pressure. The result? A good, relaxed feeling.
• Soothe tension. Laughter can also stimulate circulation and aid muscle relaxation, both of which can help reduce some of the physical symptoms of stress.

Long-term effects

Laughter isn’t just a quick pick-me-up, though. It’s also good for you over the long term. Laughter may:

• Improve your immune system. Negative thoughts manifest into chemical reactions that can affect your body by bringing more stress into your system and decreasing your immunity. In contrast, positive thoughts can actually release neuropeptides that help fight stress and potentially more-serious illnesses.
• Relieve pain. Laughter may ease pain by causing the body to produce its own natural painkillers.
• Increase personal satisfaction. Laughter can also make it easier to cope with difficult situations. It also helps you connect with other people.
• Improve your mood. Many people experience depression, sometimes due to chronic illnesses. Laughter can help lessen your depression and anxiety and may make you feel happier.

Improve your sense of humor

Are you afraid you have an underdeveloped — or nonexistent — sense of humor? No problem. Humor can be learned. In fact, developing or refining your sense of humor may be easier than you think.

Put humor on your horizon. Find a few simple items, such as photos, greeting cards or comic strips, that make you chuckle. Then hang them up at home or in your office. Keep funny movies, books or comedy albums on hand for when you need an added humor boost. Look online at joke websites. Go to a comedy club.

Laugh and the world laughs with you. Find a way to laugh about your own situations and watch your stress begin to fade away. Even if it feels forced at first, practice laughing. It does your body good.

Consider trying laughter yoga. In laughter yoga, people practice laughter as a group. Laughter is forced at first, but it can soon turn into spontaneous laughter.

Share a laugh. Make it a habit to spend time with friends who make you laugh. And then return the favor by sharing funny stories or jokes with those around you.

Knock, knock. Browse through your local bookstore or library’s selection of joke books and get a few rib ticklers in your repertoire that you can share with friends.

• Know what isn’t funny. Don’t laugh at the expense of others. Some forms of humor aren’t appropriate. Use your best judgment to discern a good joke from a bad, or hurtful, one.

Laughter is the best medicine

Go ahead and give it a try. Turn the corners of your mouth up into a smile and then give a laugh, even if it feels a little forced. Once you’ve had your chuckle, take stock of how you’re feeling. Are your muscles a little less tense? Do you feel more relaxed or buoyant? That’s the natural wonder of laughing at work.

Step #7. Meditate

If stress has you anxious, tense and worried, consider trying meditation. Spending even a few minutes in meditation can restore your calm and inner peace.

Anyone can practice meditation. It’s simple and inexpensive, and it doesn’t require any special equipment.

And you can practice meditation wherever you are — whether you’re out for a walk, riding the bus, waiting at the doctor’s office or even in the middle of a difficult business meeting.

During meditation, you focus your attention and quiet the stream of jumbled thoughts that may be crowding your mind and causing stress. Meditation can instill a sense of calm, peace and balance that can benefit both your emotional well-being and your overall health.

Understanding meditation

Meditation has been practiced for thousands of years. Meditation originally was meant to help deepen understanding of the sacred and mystical forces of life. These days, meditation is commonly used for relaxation and stress reduction.

Meditation is considered a type of mind-body complementary medicine. Meditation can produce a deep state of relaxation and a tranquil mind.

During meditation, you focus your attention and eliminate the stream of jumbled thoughts that may be crowding your mind and causing stress. This process may result in enhanced physical and emotional well-being.

Elements of meditation

Different types of meditation may include different features to help you meditate. These may vary depending on whose guidance you follow or who’s teaching a class. Some of the most common features in meditation include:

• Focused attention. Focusing your attention is generally one of the most important elements of meditation.

Focusing your attention is what helps free your mind from the many distractions that cause stress and worry. You can focus your attention on such things as a specific object, an image, a mantra, or even your breathing.

• Relaxed breathing. This technique involves deep, even-paced breathing using the diaphragm muscle to expand your lungs. The purpose is to slow your breathing, take in more oxygen, and reduce the use of shoulder, neck and upper chest muscles while breathing so that you breathe more efficiently.

• A quiet setting. If you’re a beginner, practicing meditation may be easier if you’re in a quiet spot with few distractions, including no television, radios or cellphones.

As you get more skilled at meditation, you may be able to do it anywhere, especially in high-stress situations where you benefit the most from meditation, such as a traffic jam, a stressful work meeting or a long line at the grocery store.

• A comfortable position. You can practice meditation whether you’re sitting, lying down, walking, or in other positions or activities. Just try to be comfortable so that you can get the most out of your meditation. Aim to keep good posture during meditation.
• Open attitude. Let thoughts pass through your mind without judgment.

Benefits of meditation

Meditation can give you a sense of calm, peace and balance that can benefit both your emotional well-being and your overall health.

And these benefits don’t end when your meditation session ends. Meditation can help carry you more calmly through your day and may help you manage symptoms of certain medical conditions.

Meditation and emotional well-being

When you meditate, you may clear away the information overload that builds up every day and contributes to your stress.

The emotional benefits of meditation can include:

• Gaining a new perspective on stressful situations
• Building skills to manage your stress
• Increasing self-awareness
• Focusing on the present
• Reducing negative emotions
• Increasing imagination and creativity
• Increasing patience and tolerance

Meditation and illness

Meditation might also be useful if you have a medical condition, especially one that may be worsened by stress.

While a growing body of scientific research supports the health benefits of meditation, some researchers believe it’s not yet possible to draw conclusions about the possible benefits of meditation.

With that in mind, some research suggests that meditation may help people manage symptoms of conditions such as:

• Anxiety
• Asthma
• Cancer
• Chronic pain
• Depression
• Heart disease
• High blood pressure
• Irritable bowel syndrome
• Sleep problems
• Tension headaches

Be sure to talk to your health care provider about the pros and cons of using meditation if you have any of these conditions or other health problems. In some cases, meditation can worsen symptoms associated with certain mental and physical health conditions.

Meditation isn’t a replacement for traditional medical treatment. But it may be a useful addition to your other treatment.

Types of meditation

Meditation is an umbrella term for the many ways to a relaxed state of being. There are many types of meditation and relaxation techniques that have meditation components. All share the same goal of achieving inner peace.

Ways to meditate can include:

• Guided meditation. Sometimes called guided imagery or visualization, with this method of meditation you form mental images of places or situations you find relaxing.

You try to use as many senses as possible, such as smells, sights, sounds and textures. You may be led through this process by a guide or teacher.

• Mantra meditation. In this type of meditation, you silently repeat a calming word, thought or phrase to prevent distracting thoughts.

• Mindfulness meditation. This type of meditation is based on being mindful, or having an increased awareness and acceptance of living in the present moment.

In mindfulness meditation, you broaden your conscious awareness. You focus on what you experience during meditation, such as the flow of your breath. You can observe your thoughts and emotions, but let them pass without judgment.

• Qi gong. This practice generally combines meditation, relaxation, physical movement and breathing exercises to restore and maintain balance. Qi gong is part of traditional Chinese medicine.

• Tai chi. This is a form of gentle Chinese martial arts. In tai chi, you perform a self-paced series of postures or movements in a slow, graceful manner while practicing deep breathing.

• Transcendental Meditation. Transcendental Meditation is a simple, natural technique. In Transcendental Meditation, you silently repeat a personally assigned mantra, such as a word, sound or phrase, in a specific way.

This form of meditation may allow your body to settle into a state of profound rest and relaxation and your mind to achieve a state of inner peace, without needing to use concentration or effort.

• Yoga. You perform a series of postures and controlled breathing exercises to promote a more flexible body and a calm mind. As you move through poses that require balance and concentration, you’re encouraged to focus less on your busy day and more on the moment.

Everyday ways to practice meditation

Don’t let the thought of meditating the “right” way add to your stress. If you choose to, you can attend special meditation centers or group classes led by trained instructors. But you can also practice meditation easily on your own.

And you can make meditation as formal or informal as you like, however it suits your lifestyle and situation. Some people build meditation into their daily routine. For example, they may start and end each day with an hour of meditation. But all you really need is a few minutes of quality time for meditation.

Here are some ways you can practice meditation on your own, whenever you choose:

• Breathe deeply. This technique is good for beginners because breathing is a natural function.

Focus all your attention on your breathing. Concentrate on feeling and listening as you inhale and exhale through your nostrils. Breathe deeply and slowly. When your attention wanders, gently return your focus to your breathing.

• Scan your body. When using this technique, focus attention on different parts of your body. Become aware of your body’s various sensations, whether that’s pain, tension, warmth or relaxation.

Combine body scanning with breathing exercises and imagine breathing heat or relaxation into and out of different parts of your body.

• Walk and meditate. Combining a walk with meditation is an efficient and healthy way to relax. You can use this technique anywhere you’re walking, such as in a tranquil forest, on a city sidewalk or at the mall.

When you use this method, slow down your walking pace so that you can focus on each movement of your legs or feet. Don’t focus on a particular destination. Concentrate on your legs and feet, repeating action words in your mind such as “lifting,” “moving” and “placing” as you lift each foot, move your leg forward and place your foot on the ground.

• Read and reflect. Many people report that they benefit from reading poems or sacred texts, and taking a few moments to quietly reflect on their meaning.

You can also listen to sacred music, spoken words, or any music you find relaxing or inspiring. You may want to write your reflections in a journal or discuss them with a friend or spiritual leader.

• Focus your love and gratitude. In this type of meditation, you focus your attention on a sacred image or being, weaving feelings of love, compassion and gratitude into your thoughts. You can also close your eyes and use your imagination or gaze at representations of the image.

Building your meditation skills

Don’t judge your meditation skills, which may only increase your stress. Meditation takes practice.

Keep in mind, for instance, that it’s common for your mind to wander during meditation, no matter how long you’ve been practicing meditation. If you’re meditating to calm your mind and your attention wanders, slowly return to the object, sensation or movement you’re focusing on.

Experiment, and you’ll likely find out what types of meditation work best for you and what you enjoy doing. Adapt meditation to your needs at the moment. Remember, there’s no right way or wrong way to meditate. What matters is that meditation helps you reduce your stress and feel better overall.

Step #8. Learn To Assert yourself

You might want to do it all, but you can’t, at least not without paying a price. Learning to say no or being willing to delegate can help you manage your to-do list and your stress.

Saying yes may seem like an easy way to keep the peace, prevent conflicts and get the job done right. But it may actually cause you internal conflict because your needs and those of your family come second, which can lead to stress, anger, resentment and even the desire to exact revenge. And that’s not a very calm and peaceful reaction.

Take control of your surroundings. Is the traffic insane? Leave early for work or take the longer, less traveled route. Hate waiting in line at the corporate cafeteria? Pack your lunch and eat at your desk or in a break room.

Respectfully ask others to change their behavior. And be willing to do the same. Small problems often create larger ones if they aren’t resolved. If you’re tired of being the target of a friend’s jokes at parties, ask him or her to leave you out of the comedy routine. In return, be willing to enjoy his or her other jokes and thank him or her for humoring you.

Manage your time better. Lump together similar tasks — group your phone calls, car errands and computer-related tasks. The reward of increased efficiency will be extra time.

State limits in advance. Instead of stewing over a colleague’s nonstop chatter, politely start the conversation with, “I’ve got only five minutes to cover this.”

When and how to say no

Sure it’s easier to say yes, but at what price to your peace of mind? Here’s why saying no may be a healthier option for stress relief.

Why say no?

The number of worthy requests isn’t likely to lessen, and you can’t add more time to your day. Are you doomed to be over committed ? The answer is no, not if you’re willing to say no. It may not be the easy way, but it is a path to stress relief.

Keep in mind that being overloaded is individual. Just because your co-worker can juggle 10 committees with seeming ease doesn’t mean you should be able to be in several committees. Only you can know what’s too much for you.

Scale back. Cut back on your obligations when possible. While it may seem easier said than done, take a close look at your daily, weekly and monthly schedule and find meetings, activities, dinners or chores that you can cut back on or delegate to someone else.

Consider these reasons for saying no:

• Saying no isn’t necessarily selfish. When you say no to a new commitment, you’re honoring your existing obligations and ensuring that you’ll be able to devote high-quality time to them.
• Saying no can allow you to try new things. Just because you’ve always helped plan the company softball tournament doesn’t mean you have to do it forever.
• Saying no gives you time to pursue other interests.
• Always saying yes isn’t healthy. When you’re over committed and under too much stress, you’re more likely to feel run-down and possibly get sick.
• Saying yes can cut others out. On the other hand, when you say no, you open the door for others to step up. Or you can delegate someone to take over the task. They may not do things the way you would, but that’s OK. They’ll find their own way.

When to say no

Sometimes it’s tough to determine which activities deserve your time and attention. Use these strategies to evaluate obligations — and opportunities — that come your way.

• Focus on what matters most. Examine your obligations and priorities before making any new commitments. Ask yourself if the new commitment is important to you. If it’s something you feel strongly about, by all means do it. If not, take a pass.
• Weigh the yes-to-stress ratio. Is the new activity you’re considering a short- or long-term commitment? For example, making a batch of cookies for the school bake sale will take far less time than heading up the school fundraising committee. Don’t say yes if it will mean months of added stress. Instead, look for other ways to pitch in.
• Take guilt out of the equation. Don’t agree to a request you would rather decline out of guilt or obligation. Doing so will likely lead to additional stress and resentment.
• Sleep on it. Are you tempted by a friend’s invitation to volunteer at your old alma mater or to join a weekly golf league? Before you respond, take a day to think about the request and how it fits in with your current commitments. If you can’t sleep on it, at least take the time to think the request through before answering.

How to say no

“No”. See how simple it is to say one little word, allowing you to take a pass on tasks that don’t make the cut? Of course, there will be times when it’s just not that easy. Here are some things to keep in mind when you need to say no:

• Say no. The word “no” has power. Don’t be afraid to use it. Be careful about using wimpy substitute phrases, such as “I’m not sure” or “I don’t think I can.” These can be interpreted to mean that you might say yes later.
• Be brief. State your reason for refusing the request, but don’t go on about it. Avoid elaborate justifications or explanations.
• Be honest. Don’t fabricate reasons to get out of an obligation. The truth is always the best way to turn down a friend, family member or co-worker.
• Be respectful. Many good causes may land at your door, and it can be tough to turn them down. Complimenting the group’s effort while saying that you can’t commit shows that you respect what they’re trying to accomplish.
• Be ready to repeat. You may need to refuse a request several times before the other person accepts your response. When that happens, just hit the replay button. Calmly repeat your no, with or without your original rationale, as needed.

Saying no won’t be easy if you’re used to saying yes all the time. But learning to say no is an important part of simplifying your life and managing your stress. And with practice, you may find saying no gets easier.

Step #9. Get enough sleep

Sleep plays a vital role in good health and well-being throughout your life. Getting enough quality sleep at the right times can help protect your mental health, physical health, quality of life, and safety ⁶.

The way you feel while you’re awake depends in part on what happens while you’re sleeping ⁶. During sleep, your body is working to support healthy brain function and maintain your physical health. In children and teens, sleep also helps support growth and development.

The damage from sleep deficiency can occur in an instant (such as a car crash), or it can harm you over time. For example, ongoing sleep deficiency can raise your risk for some chronic health problems. It also can affect how well you think, react, work, learn, and get along with others.

There has been considerable debate in the scientific community about the importance of sleep, but some proposed functions of sleep are widely accepted:

1. Restoration, providing time for the body to repair itself;
2. Consolidation of memories;
3. Enhancement of immune system function; and
4. Maturation of the brain.

And the quality and amount of sleep you get can affect your mood, energy level, concentration and overall functioning. If you have sleep troubles, make sure that you have a quiet, relaxing bedtime routine, listen to soothing music, put clocks away, and stick to a consistent schedule.

The table below shows general recommendations for different age groups. This table reflects recent American Academy of Sleep Medicine recommendations that the American Academy of Pediatrics has endorsed.

Table 1. Recommended Amount of Sleep

Age	Recommended Amount of Sleep
Infants aged 4-12 months	12-16 hours a day (including naps)
Children aged 1-2 years	11-14 hours a day (including naps)
Children aged 3-5 years	10-13 hours a day (including naps)
Children aged 6-12 years	9-12 hours a day
Teens aged 13-18 years	8-10 hours a day
Adults aged 18 years or older	7–8 hours a day

[Source ⁶]

Step #10. Try yoga

With its series of postures and controlled-breathing exercises, yoga is a popular stress reliever. Yoga brings together physical and mental disciplines which may help you achieve peacefulness of body and mind. Yoga can help you relax and manage stress and anxiety.

Try yoga on your own or find a class — you can find classes in most communities. Hatha yoga, in particular, is a good stress reliever because of its slower pace and easier movements.

Step #11. Seek counseling

If new stressors are challenging your ability to cope or if self-care measures just aren’t relieving your stress, you may need to look for reinforcements in the form of therapy or counseling. Therapy also may be a good idea if you feel overwhelmed or trapped, if you worry excessively, or if you have trouble carrying out daily routines or meeting responsibilities at work, home or school.

Professional counselors or therapists can help you identify sources of your stress and learn new coping tools.

Cognitive Behavioral Therapy (CBT)

The Royal College of Psychiatrists defines cognitive behavioral therapy as a way of talking about:

• How you think about yourself, the world and other people
• How what you do affects your thoughts and feelings.

They say that CBT can help you to change how you think (the cognitive part) and what you do (the behavioral part). These changes can help you to feel better. Unlike some of the other talking treatments, it focuses on the “here and now” difficulties. Instead of focusing on the causes of your distress or symptoms in the past, it looks for ways to improve your state of mind now.

If you are not sure you want to commit to a long course of sessions with a clinical psychologist, there are various resources on the Internet which will provide an introduction to CBT or even a course of computer-aided CBT sessions:

• Developed by the Australian National University, MoodGYM (https://moodgym.com.au/) is a fun, free interactive web program that teaches the principles of CBT using flashed diagrams and online exercises. MoodGYM (https://moodgym.com.au/) demonstrates the relationship between thoughts and emotions, and works through dealing with stress and relationship break-ups, as well as teaching relaxation and meditation techniques. It consists of five modules (why you feel the way you do, changing the way you think, changing ‘warped’ thoughts, knowing what makes you upset, assertiveness and interpersonal skills training), an interactive game, anxiety and depression assessments, downloadable relaxation audio, a workbook and feedback assessment. Scientific trials have shown that using two or more modules is linked to significant reductions in depression and anxiety symptoms. These benefits last after 12 months. MoodGYM has won several IT and health awards, and has over 1,000,000 users worldwide. MoodGYM (https://moodgym.com.au/)

• Living Life to the Full (https://llttf.com/) is a free online life skills course for people feeling distressed. It aims to provide easy access to CBT skills in a way that cuts through jargon. It helps you understand why you feel as you do, and to learn new ways of improving how you feel, by making changes in your thinking, activities, sleep and relationships. The course is based on the idea of helping you to help yourself. It is supported by a series of CBT self-help workbooks that can be used between the e-learning sessions. These encourage you to put what you are learning into practice, and to stop, think and reflect on what you are learning. Living Life to the Full (https://llttf.com/)

• FearFighter (http://www.fearfighter.com/) delivers CBT over the internet, useful for those who may be concerned about the stigma associated with seeing a therapist. Taking only three months to complete, with minimal telephone support, FearFighter helps you improve even if you have virtually no computer skills. You are encouraged to use FearFighter as often as you wish but for at least once a week. It helps you identify specific problems, work on realistic treatment goals, and monitor achievement of those goals by repeated self-exposure. You get scheduled brief helpline support to a total of one hour over 10 weeks. FearFighter helps you to work out exactly what brings on your fear, so you can learn how to face it until it subsides. This is called exposure therapy. It consists of nine steps that need to be worked through one by one to obtain the greatest benefits. Like a therapist, FearFighter asks you to return every week to report on how you’ve been doing. You can ask it to print out questionnaires and graphs of your progress. It guides you through CBT as much as a therapist does.
  • Step 1: Welcome to FearFighter – Introduces the system, asks you to rate your problem on the Fear Questionnaire (FQ) and Work & Social Adjustment Scale (WSA), and asks about suicidal feelings and alcohol misuse.
  • Step 2: How to Beat Fear – Explains the principles of CBT, with case examples. You are asked to keep a daily record of your triggers.
  • Step 3: Problem Sorting – Helps you identify your triggers, shows you scenarios relevant to your problem, and helps you personalise your triggers and rate them on a 0-8 scale.
  • Step 4: How to Get a Helper – Explains the value of recruiting a CBT co-therapist and gives hints on how to find one.
  • Step 5: Setting Goals – Guides you through the process of setting good goals and tests them. You record and rate these on the system and can print personalised homework diaries.
  • Step 6: Managing anxiety – Offers a menu of coping strategies for use during CBT homework.
  • Step 7: Rehearsing Goals – Guides you on how to practise personal coping strategies during both imagined and live CBT homework.
  • Step 8: Carrying On – Reviews progress with the help of graphs, allows new goals to be devised, and offers feedback and advice.
  • Step 9: Troubleshooting – Offers a menu of tips on overcoming common sticking points in treatment.

You may have found that when you avoid things that make you panic or feel uncomfortable, the situation tends to get worse and worse. FearFighter can teach you how to face your fear until you adapt and no longer want to run away from it. It helps you learn to face the things that make you panic, such that, with time, you’ll find that, one by one, they’ll get easier.

Self-exposure therapy guided by computer is as effective as clinician-guided therapy and both are superior to relaxation to improve phobia/panic. FearFighter has been tested in four clinical trials and is as effective as the best CBT therapists.

Approved by the National Institute of Clinical Excellence (NICE), free access can only be prescribed by your doctor in England and Wales. FearFighter (http://www.fearfighter.com/)

Step #12. Keep a journal

Writing down your thoughts and feelings can be a good release for otherwise pent-up emotions. Don’t think about what to write — just let it happen. Write whatever comes to mind. No one else needs to read it, so don’t strive for perfection in grammar or spelling.

Just 10 to 20 minutes of quiet reflection may bring relief from chronic stress, as well as increase your tolerance to it. Listen to music, relax, and try to think of pleasant things or nothing at all. If you feel your muscles tense during your day, take a minibreak. Breathe deeply, inhale, pause for a second and then slowly exhale.

Just let your thoughts flow on paper — or computer screen. Once you’re done, you can toss out what you wrote or save it to reflect on later.

Step #13. Get musical and be creative

Listening to or playing music is a good stress reliever because it can provide a mental distraction, reduce muscle tension and decrease stress hormones. Crank up the volume and let your mind be absorbed by the music.

If music isn’t one of your interests, turn your attention to another hobby you enjoy, such as gardening, sewing, sketching — anything that requires you to focus on what you’re doing rather than what you think you should be doing. You can also try reading, crafts, tinkering with electronics, fishing, carpentry, music — things that you don’t get competitive or more stressed out about.

When you engage in something enjoyable, it can soothe and calm your restless mind.

Step #14. Spirituality and stress relief

Spirituality has many definitions, but at its core spirituality helps to give your life context. It’s not necessarily connected to a specific belief system or even religious worship. Instead, it arises from your connection with yourself and with others, the development of your personal value system, and your search for meaning in life.

For many, spirituality takes the form of religious observance, prayer, meditation or a belief in a higher power. For others, it can be found in nature, music, art or a secular community. Spirituality is different for everyone.

Taking the path less traveled by exploring your spirituality can lead to a clearer life purpose, better personal relationships and enhanced stress management skills.

Some stress relief tools are very tangible: exercising more, eating healthy foods and talking with friends. A less tangible — but no less useful — way to find stress relief is through spirituality.

How can spirituality help with stress relief?

Spirituality has many benefits for stress relief and overall mental health. It can help you:

• Feel a sense of purpose. Cultivating your spirituality may help uncover what’s most meaningful in your life. By clarifying what’s most important, you can focus less on the unimportant things and eliminate stress.
• Connect to the world. The more you feel you have a purpose in the world, the less solitary you may feel — even when you’re alone. This can lead to a valuable inner peace during difficult times.
• Release control. When you feel part of a greater whole, you may realize that you aren’t responsible for everything that happens in life. You can share the burden of tough times as well as the joys of life’s blessings with those around you.
• Expand your support network. Whether you find spirituality in a church, mosque or synagogue, in your family, or in nature walks with a friend, this sharing of spiritual expression can help build relationships.
• Lead a healthier life. People who consider themselves spiritual may be better able to cope with stress and may experience health benefits.

Discovering your spirituality

Uncovering your spirituality may take some self-discovery. Here are some questions to ask yourself to discover what experiences and values define you:

• What are your important relationships?
• What do you value most in your life?
• What people give you a sense of community?
• What inspires you and gives you hope?
• What brings you joy?
• What are your proudest achievements?

The answers to such questions can help you identify the most important people and experiences in your life. With this information, you can focus your search for spirituality on the relationships and activities in life that have helped define you as a person and those that continue to inspire your personal growth.

Cultivating your spirituality

Spirituality also involves getting in touch with your inner self. A key component is self-reflection. Try these tips:

• Try prayer, meditation, mindfulness and relaxation techniques to help focus your thoughts and find peace of mind.
• Keep a journal to help you express your feelings and record your progress.
• Seek out a trusted adviser or friend who can help you discover what’s important to you in life. Others may have insights that you haven’t yet discovered.
• Read inspirational stories or essays to help you evaluate different philosophies of life.
• Talk to others whose spiritual lives you admire. Ask questions to learn how they found their way to a fulfilling spiritual life.

Nurturing your relationships

Spirituality is also nurtured by your relationships with others. Realizing this, it’s essential to foster relationships with the people who are important to you. This can lead to a deepened sense of your place in life and in the greater good.

• Make relationships with friends and family a priority. Give more than you receive.
• See the good in people and in yourself. Accept others as they are, without judgment.
• Contribute to your community by volunteering.

Pursuing a spiritual life

Staying connected to your inner spirit and the lives of those around you can enhance your quality of life, both mentally and physically. Your personal concept of spirituality may change with your age and life experiences, but it always forms the basis of your well-being, helps you cope with stressors large and small, and affirms your purpose in life.

Step #15. Build skills to endure hardship

Resilience means being able to adapt to life’s misfortunes and setbacks. Test your resilience level and get tips to build your own resilience.

When something goes wrong, do you tend to bounce back or fall apart?

When you have resilience, you harness inner strength that helps you rebound from a setback or challenge, such as a job loss, an illness, a disaster or the death of a loved one. If you lack resilience, you might dwell on problems, feel victimized, become overwhelmed or turn to unhealthy coping mechanisms, such as substance abuse.

Resilience won’t make your problems go away — but resilience can give you the ability to see past them, find enjoyment in life and better handle stress. If you aren’t as resilient as you’d like to be, you can develop skills to become more resilient.

Adapting to adversity

Resilience is the ability to roll with the punches. When stress, adversity or trauma strikes, you still experience anger, grief and pain, but you’re able to keep functioning — both physically and psychologically. However, resilience isn’t about toughing it out, being stoic or going it alone. In fact, being able to reach out to others for support is a key component of being resilient.

Resilience and mental health

Resilience can help protect you from various mental health conditions, such as depression and anxiety. Resilience can also help offset factors that increase the risk of mental health conditions, such as being bullied or previous trauma. If you have an existing mental health condition, being resilient can improve your ability to cope.

Tips to improve your resilience

If you’d like to become more resilient, consider these tips:

• Get connected. Building strong, positive relationships with loved ones and friends can provide you with needed support and acceptance in both good times and bad. Establish other important connections by volunteering or joining a faith or spiritual community.
• Make every day meaningful. Do something that gives you a sense of accomplishment and purpose every day. Set goals to help you look toward the future with meaning.
• Learn from experience. Think of how you’ve coped with hardships in the past. Consider the skills and strategies that helped you through rough times. You might even write about past experiences in a journal to help you identify positive and negative behavior patterns — and guide your future behavior.
• Remain hopeful. You can’t change the past, but you can always look toward the future. Accepting and even anticipating change makes it easier to adapt and view new challenges with less anxiety.
• Take care of yourself. Tend to your own needs and feelings. Participate in activities and hobbies you enjoy. Include physical activity in your daily routine.
• Get plenty of sleep. Eat a healthy diet. Practice stress management and relaxation techniques, such as yoga, meditation, guided imagery, deep breathing or prayer.
• Be proactive. Don’t ignore your problems. Instead, figure out what needs to be done, make a plan, and take action. Although it can take time to recover from a major setback, traumatic event or loss, know that your situation can improve if you work at it.

Step #16. Positive thinking: Stop negative self-talk to reduce stress

Is your glass half-empty or half-full ? How you answer this age-old question about positive thinking may reflect your outlook on life, your attitude toward yourself, and whether you’re optimistic or pessimistic — and it may even affect your health.

Positive thinking helps with stress management and can even improve your health.

Indeed, some studies show that personality traits such as optimism and pessimism can affect many areas of your health and well-being. The positive thinking that usually comes with optimism is a key part of effective stress management. And effective stress management is associated with many health benefits. If you tend to be pessimistic, don’t despair — you can learn positive thinking skills.

Understanding positive thinking and self-talk

Positive thinking doesn’t mean that you keep your head in the sand and ignore life’s less pleasant situations. Positive thinking just means that you approach unpleasantness in a more positive and productive way. You think the best is going to happen, not the worst.

Positive thinking often starts with self-talk. Self-talk is the endless stream of unspoken thoughts that run through your head. These automatic thoughts can be positive or negative. Some of your self-talk comes from logic and reason. Other self-talk may arise from misconceptions that you create because of lack of information.

If the thoughts that run through your head are mostly negative, your outlook on life is more likely pessimistic. If your thoughts are mostly positive, you’re likely an optimist — someone who practices positive thinking.

The health benefits of positive thinking

Researchers continue to explore the effects of positive thinking and optimism on health. Health benefits that positive thinking may provide include:

• Increased life span
• Lower rates of depression
• Lower levels of distress
• Greater resistance to the common cold
• Better psychological and physical well-being
• Better cardiovascular health and reduced risk of death from cardiovascular disease
• Better coping skills during hardships and times of stress

It’s unclear why people who engage in positive thinking experience these health benefits. One theory is that having a positive outlook enables you to cope better with stressful situations, which reduces the harmful health effects of stress on your body.

It’s also thought that positive and optimistic people tend to live healthier lifestyles — they get more physical activity, follow a healthier diet, and don’t smoke or drink alcohol in excess.

Identifying negative thinking

Not sure if your self-talk is positive or negative? Some common forms of negative self-talk include:

• Filtering. You magnify the negative aspects of a situation and filter out all of the positive ones. For example, you had a great day at work. You completed your tasks ahead of time and were complimented for doing a speedy and thorough job. That evening, you focus only on your plan to do even more tasks and forget about the compliments you received.
• Personalizing. When something bad occurs, you automatically blame yourself. For example, you hear that an evening out with friends is canceled, and you assume that the change in plans is because no one wanted to be around you.
• Catastrophizing. You automatically anticipate the worst. The drive-through coffee shop gets your order wrong and you automatically think that the rest of your day will be a disaster.
• Polarizing. You see things only as either good or bad. There is no middle ground. You feel that you have to be perfect or you’re a total failure.

Focusing on positive thinking

You can learn to turn negative thinking into positive thinking. The process is simple, but it does take time and practice — you’re creating a new habit, after all. Here are some ways to think and behave in a more positive and optimistic way:

• Identify areas to change. If you want to become more optimistic and engage in more positive thinking, first identify areas of your life that you usually think negatively about, whether it’s work, your daily commute or a relationship. You can start small by focusing on one area to approach in a more positive way.
• Check yourself. Periodically during the day, stop and evaluate what you’re thinking. If you find that your thoughts are mainly negative, try to find a way to put a positive spin on them.
• Be open to humor. Give yourself permission to smile or laugh, especially during difficult times. Seek humor in everyday happenings. When you can laugh at life, you feel less stressed.
• Follow a healthy lifestyle. Aim to exercise for about 30 minutes on most days of the week. You can also break it up into 10-minute chunks of time during the day. Exercise can positively affect mood and reduce stress. Follow a healthy diet to fuel your mind and body. And learn techniques to manage stress.
• Surround yourself with positive people. Make sure those in your life are positive, supportive people you can depend on to give helpful advice and feedback.
• Avoid people who bother you. If you have a co-worker who causes your jaw to tense, put physical distance between the two of you. Sit far away at meetings or walk around his or her cubicle, even if it requires some extra steps.
• Negative people may increase your stress level and make you doubt your ability to manage stress in healthy ways.
• Practice positive self-talk. Start by following one simple rule: Don’t say anything to yourself that you wouldn’t say to anyone else. Be gentle and encouraging with yourself. If a negative thought enters your mind, evaluate it rationally and respond with affirmations of what is good about you. Think about things you’re thankful for in your life.

Here are some examples of negative self-talk and how you can apply a positive thinking twist to them:

Negative self-talk	Positive thinking
I’ve never done it before.	It’s an opportunity to learn something new.
It’s too complicated.	I’ll tackle it from a different angle.
I don’t have the resources.	Necessity is the mother of invention.
I’m too lazy to get this done.	I wasn’t able to fit it into my schedule, but I can re-examine some priorities.
There’s no way it will work.	I can try to make it work.
It’s too radical a change.	Let’s take a chance.
No one bothers to communicate with me.	I’ll see if I can open the channels of communication.
I’m not going to get any better at this.	I’ll give it another try.

Practicing positive thinking every day

If you tend to have a negative outlook, don’t expect to become an optimist overnight. But with practice, eventually your self-talk will contain less self-criticism and more self-acceptance. You may also become less critical of the world around you.

When your state of mind is generally optimistic, you’re better able to handle everyday stress in a more constructive way. That ability may contribute to the widely observed health benefits of positive thinking.

Step #17. Accept and Adapt

Accept

Sometimes you may have no choice but to accept things the way they are. For those times try to:

• Talk with someone. You may not be able to change a frustrating situation, but that doesn’t mean your feelings aren’t legitimate. Phone or schedule a coffee break with an understanding friend. You may feel better after talking it out.
• Forgive. It takes energy to be angry. Forgiving may take practice, but by doing so you will free yourself from burning more negative energy. Why stew in your anger when you could shrug and move on?
• Practice positive self-talk. It’s easy to lose objectivity when you’re stressed. One negative thought can lead to another, and soon you’ve created a mental avalanche. Be positive. Instead of thinking, “I am horrible with money, and I will never be able to control my finances,” try this: “I made a mistake with my money, but I’m resilient. I’ll get through it.”
• Learn from your mistakes. There is value in recognizing a “teachable moment.” You can’t change the fact that procrastination hurt your performance, but you can make sure you set aside more time in the future.

Adapt

Thinking you can’t cope is one of the greatest stressors. That’s why adapting — which often involves changing your standards or expectations — can be most helpful in dealing with stress.

• Adjust your standards. Do you need to vacuum and dust twice a week? Would macaroni and cheese be an unthinkable substitute for homemade lasagna?
• Redefine success and stop striving for perfection, and you may operate with a little less guilt and frustration.
• Practice thought-stopping. Stop gloomy thoughts immediately. Refuse to replay a stressful situation as negative, and it may cease to be negative.
• Reframe the issue. Try looking at your situation from a new viewpoint. Instead of feeling frustrated that you’re home with a sick child, look at it as an opportunity to bond, relax and finish a load of laundry.
• Adopt a mantra. Create a saying such as, “I can handle this,” and mentally repeat it in tough situations.
• Create an assets column. Imagine all of the things that bring you joy in life, such as vacation, children and pets. Then call on that list when you’re stressed.
• It will put things into perspective and serve as a reminder of life’s joys.
• Look at the big picture. Ask yourself, “Will this matter in a year or in five years?” The answer is often no. Realizing this makes a stressful situation seem less overwhelming.

Treatments for stress

Stress isn’t a medical diagnosis, so there’s no specific treatment for it. However, if you’re finding it very hard to cope with things going on in your life and are experiencing lots of signs of stress, there are treatments available that could help. These include:

• Psychotherapy also called “talk therapy”
• Ecotherapy
• Complementary and alternative therapies
• Medications

To access most treatments, the first step is usually to talk to your doctor or healthcare provider.

Psychological therapy

If you are struggling to cope, or the symptoms of your stress or anxiety won’t go away, it may be time to talk to a professional. Psychotherapy also called “talk therapy” and medication are the two main treatments for anxiety, and many people benefit from a combination of the two.

Talking with a trained professional can help you learn to deal with stress and become more aware of your own thoughts and feelings. Common types of psychotherapy which can help with stress are:

1. Cognitive behavioral therapy (CBT), which helps you understand your thought patterns, recognize your trigger points and identify positive actions you can take.
2. Mindfulness-based stress reduction, which combines mindfulness, meditation and yoga with a particular focus on reducing stress.

Debriefing

Critical incident stress debriefing is one of the most commonly considered interventions after a traumatic event ⁷. Classically, critical incident stress debriefing is carried out in 7 stages, as follows:

1. Introduction (purpose of the session)
2. Description of the traumatic event
3. Appraisal of the event
4. Exploration of the participants’ emotional reactions during and after the event
5. Discussion of the normal nature of symptoms after traumatic events
6. Discussion of ways of dealing with further consequences of the event
7. Discussion of the session and formulation of practical conclusions

It should be kept in mind that research efforts have not shown critical stress debriefing to be effective in preventing PTSD, depression, or anxiety. In some cases, if performed poorly, debriefing can even harm survivors by increasing arousal and overwhelming their defenses. Operational debriefing, which focuses on normalizing emotional response, informing patients of services available to them, and providing general support, is safer.

In engaging in a 1- to 2-session intervention after a traumatic event, there are several guidelines that should be followed to help avoid harm and maximize the chance of benefit, as follows:

• Provide trained individuals to perform the intervention
• Avoid ventilating feelings at high levels; this can lead to contagion and flooding rather than calming and improved ability to cope with feelings
• Do not pressure individuals to talk about things they do not want to talk about; respect their defenses, including denial

Critical tasks to cover include the following:

• Psychoeducation to help patients see that the feelings they are having are not a sign of weakness or mental illness but a normal reaction to a very disturbing situation
• Discussion of ways to improve coping skills, including getting adequate rest, recreation, food, and fluids
• Avoidance of excessive exposure to media coverage of the traumatic incident
• Discussion of common cognitive distortions, such as survivor guilt and fears that the world is totally unsafe
• Explanation of the signs and symptoms indicating that the survivor should get professional help

Cognitive-behavioral therapy

Whereas 70% of those receiving supportive therapy or no therapy after a traumatic event develop PTSD, only about 10-20% of those who receive cognitive-behavioral therapy (CBT) shortly after such an event develop PTSD ⁸. Moreover, patients who receive CBT with or without hypnosis report less reexperiencing and fewer avoidance symptoms than patients who receive supportive counseling. Individuals are aided by the following:

• Seeing that people are concerned about them
• Learning about the range of normal responses to trauma and hearing that their emotional reactions are normal responses to an abnormal event (rather than a sign of weakness or pathology)
• Being reminded to take care of concrete needs (eg, food, fluids, and rest)
• Cognitive restructuring (changing destructive schema to more constructive ones [see the Table below])
• Learning relaxation techniques
• Undergoing exposure to avoided situations either via guided imagery and imagination or in vivo
• Desensitization to painful memories via repeated controlled exposures and systematic desensitization

Current data suggest that if the resources are available, a course of CBT should be offered to those at high risk for developing PTSD. CBT should be performed by someone trained in the technique. Severe, relatively common destructive cognitions may arise after a traumatic event and may have to be addressed.

Brief school intervention

A brief school intervention lasts 1-2 hours and uses 4 therapists per class. A teacher is present, and parents are informed. The intervention includes the following steps:

• Introduce the therapists, and ask students to guess why they have come to the classroom
• Explain that therapists have come to talk about the disaster, and encourage students to share what they know for 10-30 minutes; validate correct information, and be calm
• Have children draw while therapists circulate, and ask students to tell them about their drawings
• Reassure students that their symptoms are normal and will ease; that people have different symptoms; that disasters are rare; and that teachers, parents, and counselors are available to help them
• Having students do a second drawing in which they depict a future and a positive state of the world is very important; the first picture is likely to focus on the trauma, their loss, and its effect on them; ideally, the second picture should show healing and restoration of normal life
• Thank the students and the teachers, and redirect their attention to learning.

Mindfulness therapy

Mindfulness is a technique you can learn which involves making a special effort to notice what’s happening in the present moment (in your mind, body and surroundings) – without judging anything. Mindfulness has roots in Buddhism and meditation, but you don’t have to be spiritual, or have any particular beliefs, to try it. Studies show that practising mindfulness can help to manage depression, some anxiety problems and feelings of stress. Some structured mindfulness-based therapies have also been developed to treat these problems more formally.

The way you think (and what you think about) can affect how you feel and act. For example, if you think or worry a lot about upsetting past or future events, you might often feel sad or anxious.

The theory behind mindfulness is that by using various techniques to bring your attention to the present (usually focusing on your body and your breathing), you can:

• Notice how thoughts come and go in your mind. You may learn that they don’t have to define who you are, or your experience of the world, and you can let go of them.
• Notice what your body is telling you. For example, tension or anxiety can often be felt in your body (such as in a fast heartbeat, tense muscles or shallow breathing).
• Create space between you and your thoughts, so you can react more calmly.

Mindfulness aims to help you:

• become more self-aware
• feel calmer and less stressed
• feel more able to choose how to respond to your thoughts and feelings
• cope with difficult or unhelpful thoughts
• be kinder towards yourself.

Many people find practising mindfulness helps them manage their day-to-day wellbeing, but it doesn’t always work for everyone.

Here are a few exercises you could try. You don’t need any special equipment:

• Mindful eating. This involves paying attention to the taste, sight and textures of what you eat. For example, when drinking a cup of tea or coffee you could focus on how hot and liquid it feels on your tongue, how sweet it tastes or watch the steam that it gives off.
• Mindful moving, walking or running. Notice the feeling of your body moving. You might notice the breeze against your skin, the feeling of your feet or hands against different textures on the ground or nearby surfaces, and the different smells that are around you.
• Body scan. This is where you move your attention slowly through different parts of the body, starting from the top of your head moving all the way down to the end of your toes. You could focus on feelings of warmth, tension, tingling or relaxation of different parts of your body.
• Mindful coloring and drawing. Focus on the colors and the sensation of your pencil against the paper, rather than trying to draw something in particular. You could use a mindfulness coloring book or download mindfulness coloring images.
• Mindful meditation. This involves sitting quietly and focusing on your breathing, your thoughts, sensations in your body and the things you can hear around you. Try to bring you focus back to the present if your mind starts to wander. Many people also find that yoga helps them to concentrate on their breathing and focus on the present moment.

Different things work for different people, so if you don’t find one exercise useful, try another. You can also try adapting them so that they suit you and are easier to fit in with your daily life.

Ecotherapy

Ecotherapy is a way of improving your wellbeing and self-esteem by spending time in nature. This can include physical exercise in green spaces or taking part in a gardening or conservation project. For example, doing things like growing food or flowers, exercising outdoors or being around animals can have lots of positive effects.

Spending time in nature has been found to help with mental health problems including anxiety and depression. For example, research into ecotherapy has shown it can help with mild to moderate depression. This might be due to combining regular physical activity and social contact with being outside in nature.

Being outside in natural light can also be helpful if you experience seasonal affective disorder (SAD), a type of depression that affects people during particular seasons or times of year. And people tell us that getting into nature has helped them with many other types of mental health problems.

Ecotherapy or spending time in green space or nature can:

• improve your mood
• reduce feelings of stress or anger
• help you take time out and feel more relaxed
• improve your physical health
• improve your confidence and self-esteem
• help you be more active
• help you make new connections
• provide peer support.

Grow or pick food

If you’re going fruit picking or foraging, be aware that not all wild plants are safe to eat. Before eating something you’ve picked yourself, make sure you know exactly what it is.

• Create a growing space. If you don’t have access to a garden, you could plant salad leaves or herbs in a window box or plant pot.
• Plant vegetables in your garden.
• Grow food together with others. Apply to share an allotment, or look for community gardens or food growing projects in your local area.
• Go fruit picking. Look for local farms or orchards that let you pick fruit to buy. You might also find fruit growing in urban spaces, for example wild blackberries.
• Learn to find edible plants, also known as food foraging. You could see if a foraging group meets in your local area. (The Woodland Trust website has more information on foraging.)

Bring nature inside

Save glass jars and use them to make mini gardens (also known as terrariums), using plants, soil, stones and anything else you’d like to include. Some people like to add seashells, or plastic toys or figurines.

• Buy flowers or potted plants for your home.
• Collect natural materials, for example leaves, flowers, feathers, tree bark or seeds – use them to decorate your living space or in art projects.
• Arrange a comfortable space to sit, for example by a window where you can look out over a view of trees or the sky.
• Grow plants or flowers on windowsills.
• Take photos of your favorite places in nature. Use them as backgrounds on a mobile phone or computer screen, or print and put them up on your walls.
• Listen to natural sounds, like recordings or apps that play birdsong, ocean waves or rainfall.

Do activities outdoors

If you’re going out on your own for longer than you usually would, or walking somewhere you don’t know well, plan ahead and remember to keep your safety in mind. If you can, let someone know where you’re going and for how long, and take your phone with you (making sure it’s fully charged).

• Take a walk in green space, such as a local park.
• Get creative. Draw or paint animals or nature scenes, or let them inspire a poem or song lyrics. If you enjoy writing in a journal, try doing this outside.
• Eat meals outdoors. Have a picnic in a local park, or simply sit in a garden. This might be something you could enjoy doing with other people.
• Watch the stars. Use a stargazing website, app or book to help you recognize different stars, or simply enjoy looking at the night sky. Give your eyes time to adjust, as it can take about 20 minutes before you can fully see stars in the dark.
• Try exercising outside. Run or jog through a local park, or do yoga outdoors. You could try it by yourself, or look for classes in your local area.
• Join a local walking or rambling group.
• Follow a woodland trail.
• Go beachcombing. Visit the seaside and search the shoreline for interesting things.
• Try geocaching. Geocaching involves looking for items in hidden outdoor locations, using a device such as a mobile phone or tablet.
• Be mindful in nature. Find things to see, hear, taste, smell and touch, like grass under your feet or the feeling of wind and sunlight. You could also listen to recordings of mindfulness exercises.

Connect with animals

• Watch out for wildlife. If you don’t live near open countryside, try visiting a local park to look for squirrels, fish, insects, ducks and other birds.
• Visit a local community or city farm. You might be able to help out by volunteering.
• Hang a bird feeder outside a window. If there’s space, you could build a small wooden nesting box on a tree or under a windowsill.
• Try birdwatching. You don’t need any special equipment.
• Try pet-sitting or dog walking. Offer to be a pet sitter in your local neighborhood, volunteer to walk dogs for an animal shelter, or ask to borrow a friend’s dog for occasional evening or weekend walks.
• Take part in a nature survey. This might involve counting birds, animals or insects in a particular time and place, or reporting individual sightings of wildlife.

Help the environment

• Go on a litter picking walk, for example, in the park or on the beach.
• Volunteer for a conservation project.
• Plant helpful seeds, such as berry bushes for garden birds or flowers to help bumblebees.
• Build an animal habitat, for example, build a hedgehog house or create a pond if you have enough space.

Complementary and alternative therapies

You may find certain complementary therapies help you manage feelings of stress. These might include:

• Yoga. Yoga is a mind-body practice that combines physical poses, controlled breathing, and meditation or relaxation. Yoga brings together physical and mental disciplines that may help you achieve peacefulness of body and mind. Yoga may help you relax and manage stress and anxiety, lower blood pressure and lower your heart rate. And almost anyone can do it.
• Meditation. Meditation can wipe away your day’s stress, bringing with it inner peace. Meditation is considered a type of mind-body complementary medicine. Meditation can produce a deep state of relaxation and a tranquil mind. Meditation has been practiced for thousands of years. Meditation originally was meant to help deepen understanding of the sacred and mystical forces of life. These days, meditation is commonly used for relaxation and stress reduction. During meditation, you focus your attention and eliminate the stream of jumbled thoughts that may be crowding your mind and causing stress. This process may result in enhanced physical and emotional well-being. Meditation can give you a sense of calm, peace and balance that can benefit both your emotional well-being and your overall health. And these benefits don’t end when your meditation session ends. Meditation can help carry you more calmly through your day and may help you manage symptoms of certain medical conditions.
• Acupuncture
• Aromatherapy. Aromatherapy uses essential oils (oils extracted from plants) for healing. Some people find that the smell (aroma) of particular oils helps them to relax, sleep better, relieve pain and improve low mood. For example, when used appropriately lavender and camomile essential oils are thought to be relaxing and help you sleep. The essential oils can be used in many different ways, such as in creams, oil burners, massaged in to the skin or by adding drops to a warm bath.
• Massage. Massage uses touch in a sensitive and respectful way, taking account of physical symptoms, wellbeing, and your lifestyle. There are lots of different types of massage therapy, such as Shiatsu, Indian head massage and aromatherapy massage.

Other relaxation techniques may include:

• Deep Breathing or Breathing Exercises: This technique involves focusing on taking slow, deep, even breaths.
• Tai chi. Tai chi helps reduce stress and anxiety. And it also helps increase flexibility and balance.
• Biofeedback-Assisted Relaxation: Biofeedback techniques measure body functions and give you information about them so that you can learn to control them. Biofeedback-assisted relaxation uses electronic devices to teach you to produce changes in your body that are associated with relaxation, such as reduced muscle tension.
• Guided Imagery: For this technique, people are taught to focus on pleasant images to replace negative or stressful feelings. Guided imagery may be self-directed or led by a practitioner or a recording.
• Music and art therapy
• Hydrotherapy
• Self-Hypnosis: In self-hypnosis programs, people are taught to produce the relaxation response when prompted by a phrase or nonverbal cue (called a “suggestion”).
• Progressive Relaxation. Progressive relaxation is also called Jacobson relaxation or progressive muscle relaxation, involves tightening and relaxing various muscle groups. Progressive relaxation is often combined with guided imagery and breathing exercises.

Medications

Feelings of stress are a reaction to things happening in your life, not a mental health problem, so there’s no specific medication for stress. However, there are various medications available which can help to reduce or manage some of the signs of stress.

For example, your doctor might offer to prescribe:

• sleeping pills or minor tranquillizers if you’re having trouble sleeping
• antidepressants if you’re experiencing depression or anxiety
• medication to treat any physical symptoms of stress, such as irritable bowel syndrome (IBS), or high blood pressure.

The use of medications to decrease arousal and insomnia may have a long-term impact.

Beta blockers (as well as alpha-adrenergic agents) may limit hyperarousal both initially and over the longer term ⁹. For extreme agitation, aggression, psychosis, or dissociation, an atypical neuroleptic or mood stabilizer may be needed.

Diphenhydramine and other medications may be helpful for improving sleep. Benzodiazepines, by limiting hyperarousal and fostering sleep, can be helpful in the initial stages; however, continuous administration may interfere with grieving and readaptation, because these agents can interfere with learning ¹⁰. Longer-acting agents are particularly beneficial when medication is administered at the emergency site and follow-up treatment is in short supply.

Selective serotonin reuptake inhibitors (SSRIs) can be helpful in dealing with the core symptoms (including anxiety, depression, withdrawal, and avoidance) and can play a central role in longer-term treatment. Current research indicates that SSRIs prazosin and propranolol may be helpful in the treatment of PTSD. Benzodiazepines are often used but present significant risks especially to the elderly, individuals with co-morbid substance abuse histories, and traumatic brain injury.

Comorbid conditions such as attention deficit hyperactivity disorder (ADHD) should be targeted. Reduction in even 1 disabling symptom (eg, insomnia or hyperarousal) may have a powerful positive impact on the individual’s ability to re-compensate.

What Are Relaxation Techniques ?

Relaxation techniques are an essential part of stress management. Because of your busy life, relaxation might be low on your priority list. Don’t shortchange yourself. Everyone needs to relax and recharge to repair the toll stress takes on your mind and body.

Relaxation techniques are a great way to help with stress management. Relaxation isn’t only about peace of mind or enjoying a hobby. Relaxation is a process that decreases the effects of stress on your mind and body. Relaxation techniques can help you cope with everyday stress and with stress related to various health problems, such as heart disease and pain.

Whether your stress is spiraling out of control or you’ve already got it tamed, you can benefit from learning relaxation techniques. Learning basic relaxation techniques is easy. Relaxation techniques also are often free or low cost, pose little risk, and can be done nearly anywhere.

Almost everyone can benefit from relaxation techniques, which can help slow your breathing and focus your attention. Common relaxation techniques include meditation, progressive muscle relaxation, tai chi and yoga. More-active ways of achieving relaxation include walking outdoors or participating in sports.

It doesn’t matter which relaxation technique you choose. Select a technique that works for you and practice it regularly.

Relaxation techniques include a number of practices such as progressive relaxation, guided imagery, biofeedback, self-hypnosis, and deep breathing exercises. The goal is similar in all: to produce the body’s natural relaxation response, characterized by slower breathing, lower blood pressure, and a feeling of increased well-being.

Meditation and practices that include meditation with movement, such as yoga and tai chi, can also promote relaxation.

Stress usually doesn’t just get better on its own. You may have to actively work on getting control of the stress in your life so that it doesn’t control you. When you first identify how you react to stressful situations, you then can put yourself in a better position to manage the stress, even if you can’t eliminate it. And if your current efforts at stress management aren’t working, try something new.

The benefits of relaxation techniques

When faced with numerous responsibilities and tasks or the demands of an illness, relaxation techniques may not be a priority in your life. But that means you might miss out on the health benefits of relaxation.

Practicing relaxation techniques can have many benefits, including:

• Slowing heart rate
• Lowering blood pressure
• Slowing your breathing rate
• Improving digestion
• Maintaining normal blood sugar levels
• Reducing activity of stress hormones
• Increasing blood flow to major muscles
• Reducing muscle tension and chronic pain
• Improving concentration and mood
• Improving sleep quality
• Lowering fatigue
• Reducing anger and frustration
• Boosting confidence to handle problems

To get the most benefit, use relaxation techniques along with other positive coping methods, such as thinking positively, finding humor, problem-solving, managing time, exercising, getting enough sleep, and reaching out to supportive family and friends.

Types of relaxation techniques

Health professionals such as complementary health practitioners, doctors and psychotherapists can teach various relaxation techniques. But if you prefer, you can also learn some relaxation techniques on your own.

In general, relaxation techniques involve refocusing your attention on something calming and increasing awareness of your body. It doesn’t matter which relaxation technique you choose. What matters is that you try to practice relaxation regularly to reap its benefits.

Types of relaxation techniques include:

Autogenic relaxation. Autogenic means something that comes from within you. In this relaxation technique, you use both visual imagery and body awareness to reduce stress. In autogenic training, you learn to concentrate on the physical sensations of warmth, heaviness, and relaxation in different parts of your body.

You repeat words or suggestions in your mind that may help you relax and reduce muscle tension. For example, you may imagine a peaceful setting and then focus on controlled, relaxing breathing, slowing your heart rate, or feeling different physical sensations, such as relaxing each arm or leg one by one.

Progressive muscle relaxation. This technique, also called Jacobson relaxation or progressive muscle relaxation, involves tightening and relaxing various muscle groups. Progressive relaxation is often combined with guided imagery and breathing exercises.

In this relaxation technique, you focus on slowly tensing and then relaxing each muscle group.

This can help you focus on the difference between muscle tension and relaxation. You can become more aware of physical sensations.

In one method of progressive muscle relaxation, you start by tensing and relaxing the muscles in your toes and progressively working your way up to your neck and head. You can also start with your head and neck and work down to your toes. Tense your muscles for about five seconds and then relax for 30 seconds, and repeat.

Visualization. In this relaxation technique, you may form mental images to take a visual journey to a peaceful, calming place or situation.

To relax using visualization, try to incorporate as many senses as you can, including smell, sight, sound and touch. If you imagine relaxing at the ocean, for instance, think about the smell of salt water, the sound of crashing waves and the warmth of the sun on your body.

You may want to close your eyes, sit in a quiet spot, loosen any tight clothing, and concentrate on your breathing. Aim to focus on the present and think positive thoughts.

Other relaxation techniques may include:

• Deep Breathing or Breathing Exercises: This technique involves focusing on taking slow, deep, even breaths.
• Massage
• Meditation
• Tai chi
• Yoga
• Biofeedback-Assisted Relaxation: Biofeedback techniques measure body functions and give you information about them so that you can learn to control them. Biofeedback-assisted relaxation uses electronic devices to teach you to produce changes in your body that are associated with relaxation, such as reduced muscle tension.
• Guided Imagery: For this technique, people are taught to focus on pleasant images to replace negative or stressful feelings. Guided imagery may be self-directed or led by a practitioner or a recording.
• Music and art therapy
• Aromatherapy
• Hydrotherapy
• Self-Hypnosis: In self-hypnosis programs, people are taught to produce the relaxation response when prompted by a phrase or nonverbal cue (called a “suggestion”).

Relaxation techniques take practice

As you learn relaxation techniques, you can become more aware of muscle tension and other physical sensations of stress. Once you know what the stress response feels like, you can make a conscious effort to practice a relaxation technique the moment you start to feel stress symptoms. This can prevent stress from spiraling out of control.

Remember that relaxation techniques are skills. As with any skill, your ability to relax improves with practice. Be patient with yourself. Don’t let your effort to practice relaxation techniques become yet another stressor.

If one relaxation technique doesn’t work for you, try another technique. If none of your efforts at stress reduction seems to work, talk to your doctor about other options.

Also, bear in mind that some people, especially those with serious psychological issues and a history of abuse, may experience feelings of emotional discomfort during some relaxation techniques. Although this is rare, if you experience emotional discomfort during relaxation techniques, stop what you’re doing and consider talking to your doctor or mental health provider.

What is tai chi?

Tai chi is an ancient Chinese tradition that, today, is practiced as a graceful form of exercise. It involves a series of movements performed in a slow, focused manner and accompanied by deep breathing.

Tai chi, also called tai chi chuan, is a noncompetitive, self-paced system of gentle physical exercise and stretching. Each posture flows into the next without pause, ensuring that your body is in constant motion.

Tai chi has many different styles. Each style may subtly emphasize various tai chi principles and methods. There are variations within each style. Some styles may focus on health maintenance, while others focus on the martial arts aspect of tai chi.

Tai chi is different from yoga, another type of meditative movement. Yoga includes various physical postures and breathing techniques, along with meditation.

Why try tai chi?

When learned correctly and performed regularly, tai chi can be a positive part of an overall approach to improving your health. The benefits of tai chi may include:

• Decreased stress, anxiety and depression
• Improved mood
• Improved aerobic capacity
• Increased energy and stamina
• Improved flexibility, balance and agility
• Improved muscle strength and definition

More research is needed to determine the health benefits of tai chi. Some evidence indicates that tai chi also may help:

• Enhance quality of sleep
• Enhance the immune system
• Help lower blood pressure
• Improve joint pain
• Improve symptoms of congestive heart failure
• Improve overall well-being
• Reduce risk of falls in older adults

Who can do tai chi?

Tai chi is low impact and puts minimal stress on muscles and joints, making it generally safe for all ages and fitness levels. In fact, because tai chi is a low impact exercise, it may be especially suitable if you’re an older adult who otherwise may not exercise.

You may also find tai chi appealing because it’s inexpensive and requires no special equipment. You can do tai chi anywhere, including indoors or outside. And you can do tai chi alone or in a group class.

Although tai chi is generally safe, women who are pregnant or people with joint problems, back pain, fractures, severe osteoporosis or a hernia should consult their health care provider before trying tai chi. Modification or avoidance of certain postures may be recommended.

How to get started with tai chi

Although you can rent or buy videos and books about tai chi, consider seeking guidance from a qualified tai chi instructor to gain the full benefits and learn proper techniques.

You can find tai chi classes in many communities today. To find a class near you, contact local fitness centers, health clubs and senior centers. Tai chi instructors don’t have to be licensed or attend a standard training program. It’s a good idea to ask about an instructor’s training and experience, and get recommendations if possible.

A tai chi instructor can teach you specific positions and breathing techniques. An instructor can also teach you how to practice tai chi safely, especially if you have injuries, chronic conditions, or balance or coordination problems. Although tai chi is slow and gentle, and generally doesn’t have negative side effects, it may be possible to get injured if you don’t use the proper techniques.

After learning tai chi, you may eventually feel confident enough to do tai chi on your own. But if you enjoy the social aspects of a class, consider continuing with group tai chi classes.

Maintaining the benefits of tai chi

While you may gain some benefit from a tai chi class that lasts 12 weeks or less, you may enjoy greater benefits if you continue tai chi for the long term and become more skilled.

You may find it helpful to practice tai chi in the same place and at the same time every day to develop a routine. But if your schedule is erratic, do tai chi whenever you have a few minutes. You can even practice the soothing mind-body concepts of tai chi without performing the actual movements when you are in a stressful situation, such as a traffic jam or a tense work meeting, for instance.

Support groups

Make connections, get help. If you’re facing a major illness or stressful life change, you don’t have to go it alone. A support group can help. Find out how to choose the right one.

Support groups bring together people facing similar issues, whether that’s illness, relationship problems or major life changes. Members of support groups often share experiences and advice. It can be helpful just getting to talk with other people who are in the same situation.

While not everyone wants or needs support beyond that offered by family and friends, you may find it helpful to turn to others outside your immediate circle. A support group can help you cope better and feel less isolated as you make connections with others facing similar challenges. A support group shouldn’t replace your standard medical care, but it can be a valuable resource to help you cope.

Understanding support groups

A support group is a gathering of people who share a common health concern or interest. A support group usually focuses on a specific situation or condition, such as breast cancer, diabetes, heart disease, addiction or long-term caregiving, for example.

Support groups are not the same as group therapy sessions. Group therapy is a formal type of mental health treatment that brings together several people with similar conditions under the guidance of a trained mental health provider.

Support groups may be formed by a lay person with the condition or by someone interested in it, such as a family member. In some cases, support groups may be formed by nonprofit organizations, advocacy organizations, mental health clinics or other organizations.

Support groups also come in a variety of formats, including in person, on the Internet or by telephone. They may be led by professional facilitators — such as a nurse, social worker or psychologist — or by group members.

Some groups are educational and structured. For example, the group leader may invite a doctor, psychologist, nurse or social worker to talk about a topic related to the group’s needs. Other support groups emphasize emotional support and shared experiences.

Benefits of support groups

Regardless of format, in a support group, you’ll find people with problems similar to yours. Members of a support group usually share their personal experiences and offer one another emotional comfort and moral support. They may also offer practical advice and tips to help you cope with your situation.

Benefits of participating in support groups may include:

• Feeling less lonely, isolated or judged
• Gaining a sense of empowerment and control
• Improving your coping skills and sense of adjustment
• Talking openly and honestly about your feelings
• Reducing distress, depression, anxiety or fatigue
• Developing a clearer understanding of what to expect with your situation
• Getting practical advice or information about treatment options
• Comparing notes about resources, such as doctors and alternative options.

Support group red flags

Not all support groups are a good match for you. Some may be driven by the interests of one or two members. Look for these red flags that may signal a problem with a support group:

• Promises of a sure cure for your disease or condition
• Meetings that are predominantly gripe sessions
• A group leader or member who urges you to stop medical treatment
• High fees to attend the group
• Pressure to purchase products or services
• Disruptive members
• Judgment of your decisions or actions

Be especially careful when you’re involved in Internet support groups:

• Keep in mind that online support groups are sometimes used to prey on vulnerable people.
• Be aware of the possibility that people may not be who they say they are, or may be trying to market a product or treatment.
• Be careful about revealing personal information, such as your full name, address or phone number.
• Understand the terms of use for a particular site and how your private information may be shared.
• Don’t let Internet use lead to isolation from your in-person social network.

How to find a support group

To find a support group:

• Ask your doctor or other health care provider for assistance. Your doctor, nurse, social worker, chaplain or psychologist may be able to recommend a support group for you.
• Search the Internet. Online support groups are available as email lists, newsgroups, chat rooms, blogs and social networking sites, such as Facebook.
• Contact local centers. Contact community centers, libraries, churches, mosques, synagogues or temples in your area and ask about support groups.
• Check your local listings. Look in your local telephone book or check your newspaper for a listing of support resources.
• Ask people you know with the condition. Ask others you know with the same illness or life situation for support group suggestions.
• Contact organizations. Contact a state or national organization devoted to your disease, condition or situation.

What support group, if any, you ultimately choose may depend largely on what’s available in your community, whether you have access to a computer or whether you’re able to travel.

Questions to ask before joining a support group

Each type of support group has its own advantages and disadvantages. You may find that you prefer a structured, moderated group. Or you may feel more at ease meeting less formally with a small group of people. Some people may prefer online support groups.

Ask these questions before joining a new support group:

• Is it geared toward a specific condition?
• Is the location convenient for regular attendance?
• What is the meeting schedule?
• Is there a facilitator or moderator?
• Is a mental health expert involved with the group?
• Is it confidential?
• Does it have established ground rules?
• What is a usual meeting like?
• Is it free, and if not what are the fees?
• Does it meet your cultural or ethnic needs?

Plan to attend a few support group meetings to see how you fit in. If the support group makes you uncomfortable or you don’t find it useful, try another one. Remember that even a support group you like can change over time as participants come and go. Periodically evaluate the support group to make sure it continues to meet your needs.

Also be aware that you may be at a different stage of coping or acceptance than are others in the support group. Or they may have a different attitude about their situation. While such a mix can provide rich experiences, it may also be unhelpful or even harmful. For instance, some in the group may be pessimistic about their future, while you’re looking for hope and optimism. Don’t feel obligated to keep attending the group if a conflict or group dynamic is upsetting — find another group or just sit out for a while.

Getting the most out of a support group

When you join a new support group, you may be nervous about sharing personal issues with people you don’t know. So at first, you may benefit from simply listening. Over time, though, contributing your own ideas and experiences can help you get more out of a support group.

But remember that support groups aren’t a substitute for regular medical care. Let your doctor know that you’re participating in a support group. If you don’t think a support group is appropriate for you, but you need help coping with your condition or situation, talk to your doctor about counseling or other types of therapy.

References

1. Stress. https://nccih.nih.gov/health/stress
2. Stress management. https://www.mayoclinic.org/healthy-lifestyle/stress-management/basics/stress-basics/hlv-20049495
3. Stress management. Mayo Clinic. https://www.mayoclinic.org/healthy-lifestyle/stress-management/in-depth/stress-management/art-20044151
4. Freeman S. Biological science. 2nd ed. Englewood Cliffs: Pearson Prentice Hall; 2005.
5. The concepts of stress and stress system disorders. Overview of physical and behavioral homeostasis. Chrousos GP, Gold PW. JAMA. 1992 Mar 4; 267(9):1244-52. https://www.ncbi.nlm.nih.gov/pubmed/1538563/
6. Why Is Sleep Important ? National Heart, Lung and Blood Institute. https://www.nhlbi.nih.gov/health/health-topics/topics/sdd/why
7. Bisson JI, Jenkins PL, Alexander J, Bannister C. Randomised controlled trial of psychological debriefing for victims of acute burn trauma. Br J Psychiatry. 1997 Jul. 171:78-81.
8. Scheeringa MS. CBT treatment of PTSD within the first month. Am J Psychiatry. 2007 Aug. 164(8):1267; author reply 1267-8.
9. Famularo R, Kinscherff R, Fenton T. Propranolol treatment for childhood posttraumatic stress disorder, acute type. A pilot study. Am J Dis Child. 1988 Nov. 142(11):1244-7.
10. Gelpin E, Bonne O, Peri T, Brandes D, Shalev AY. Treatment of recent trauma survivors with benzodiazepines: a prospective study. J Clin Psychiatry. 1996 Sep. 57(9):390-4.