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Abstract
Purpose: According to the World Health Organization, stress is a significant problem of our times and affects both physical as well as the mental health of people. Stress is defined as a situation where the organism‘s homeostasis is threatened or the organism perceives a situation as threatening. Stress coping methods are the cognitive, behavioral and psychological efforts to deal with stress. Method: After a thorough literature review in major databases (MEDLINE, Scopus, Science Direct) the following techniques were identified and are presented and briefly discussed here: progressive muscle relaxation, autogenic training, relaxation response, biofeedback, emotional freedom technique, guided imagery, diaphragmatic breathing, transcendental meditation, cognitive behavioral therapy, mindfulness-based stress reduction and emotional freedom technique. Conclusion: These are all evidence-based techniques, easy to learn and practice, with good results in individuals with good health or with a disease.
Keywords: Stress, stress management techniques, evidence based techniques
Introduction
Stress is a fact of everyday life. When people reach out for help, they are often dealing with circumstances, situations, and stressors in their lives that leave them feeling emotionally and physically overwhelmed. Many people feel that they have very little resources or skills to deal with the high levels of stress they are experiencing.
Here my paper gives information and education about stress, the effects of stress, and the most popular stress management and relaxation tech-niques that are being used today. This information could be helpful for people who want to learn how to react to stress in a more constructive, proactive way and benefits of stress reduction and relaxation techniques can be best noticed after they have been practiced regularly over a period of time.
Although we all talk about stress, it often isn’t clear what stress is really about. Many people consider stress to be something that happens to them, an event such as an injury or a job loss. Others think that stress is what happens to our body, mind, and behavior in response to an event (E.g. heart pounding, anxiety, or nail biting). While stress does involve events and our response to then, these are not the most important factors. Our thoughts about the situations in which we find ourselves are the critical factor
When something happens to us, we automatically evaluate the situation mentally. We decide if it is threatening to us, how we need to deal with the situation, and what skills we can use. If we decide that the demands of the situation outweigh the skills we have, then we label the situation as “stressful” and react with the classic “stress response.” If we decide that our coping skills outweigh the demands of the situation, then we don’t see it as “stressful.
Stress can come from any situation or thought that makes you feel frustrated, angry, or anxious. Everyone sees situations differently and has different coping skills. For this reason, no two people will respond exactly the same way to a given situation. Additionally, not all situations that are labeled “stressful” are negative. The birth of a child, being promoted at work or moving to a new home may not be perceived as threatening. However, we may feel that situations are “stressful” because we don’t feel fully prepared to deal with them. Stress is a normal part of life. In small quantities, stress is good; it can motivate you and help you become more productive. However, too much stress, or a strong response to stress can be harmful. How we perceive a stress provoking event and how we react to it determines its impact on our health. We may be motivated and invigorated by the events in our lives, or we may see some as “stressful” and respond in a manner that may have a negative effect on our physical, mental, and social well-being. If we always respond in a negative way, our health and happiness may suffer. By under-standing ourselves and our reaction to stress-provoking situations, we can learn to handle stress more effectively. In the most accurate meaning, stress management is not about learning how to avoid or escape the pressures and turbulence of modern living; it is about learning to appreciate how the body reacts to these pressures, and about learning how to develop skills which enhance the body’s adjustment. To learn stress management is to learn about the mind-body connection and to the degree to which we can control our health in a positive sense.
Sources of Stress
We can experience stress from four basic sources:
The Environment – the environment can bombard you with intense and competing demands to adjust. Examples of environmental stressors include weather, noise, crowding, pollution, traffic, unsafe and substandard housing, and crime.
Social Stressors – we can experience multiple stressors arising from the demands of the different social roles we occupy, such as parent, spouse, caregiver, and employee. Some examples of social stressors include deadlines, financial problems, job interviews, presen-tations, disagreements, demands for your time and attention, loss of a loved one, divorce, and co-parenting.
Physiological – Situations and circumstances affecting our body can be experienced as physiological stressors. Examples of physiological stressors include rapid growth of adoles-cence, menopause, illness, aging, giving birth, accidents, lack of exercise, poor nutrition, and sleep disturbances.
Thoughts – Your brain interprets and perceives situations as stressful, difficult, painful, or pleasant. Some situations in life are stress provoking, but it is our thoughts that determine whether they are a problem for us.
Types of Stressors
Situations that are considered stress provoking are known as stressors. Stress is not always a bad thing. Stress is simply the body’s response to changes that create taxing demands. Many professionals suggest that there is a difference between what we perceive as positive stress, and distress, which refers to negative stress. In daily life, we often use the term “stress” to describe negative situations. This leads many people to believe that all stress is bad for you, which is not true.
Positive stress has the following characteristics:
• Motivates, focuses energy
• Is short-term
• Is perceived as within our coping abilities
• Feels exciting
• Improves performance
Negative stress has the following characteristics:
• Causes anxiety or concern
• Can be short or long-term
• Is perceived as outside of our coping abilities
• Feels unpleasant
• Decreases performance
• Can lead to mental and physical problems
It is somewhat hard to categorize stressors into objective lists of those that cause positive stress and those that cause negative stress, because different people will have different perceptions and reactions to particular situations. However, by generalizing, we can com-pile a list of stressors that are typically experienced as negative or positive to most people, most of the time.
Examples of negative personal stressors can include:
The death of a partner
Filing for divorce
Losing contact with loved ones
The death of a family member
Hospitalization (oneself or a family member)
injury or illness (oneself or a family member)
Being abused or neglected
Separation from a spouse or committed relationship partner
Conflict in interpersonal relationships
Bankruptcy/money problems
Unemployment
Sleep problems
Children’s problems at school
Legal problems
Excessive job demands
Job insecurity
Conflicts with team mates and supervisors
Lack of training necessary to do a job
Making presentations in front of colleagues or clients
Unproductive and time-consuming meetings
Examples of positive personal stressors might include:
Receiving a promotion at work
Starting a new job
Marriage or commitment ceremony
Buying a home
Having a child
Moving
Taking or planning a vacation
Holiday seasons
Retiring
Taking educational classes or learning a new hobby
Internal Sources of Stress and Anxiety
Stressors are not always limited to situations where some external situation is creating a problem. Internal events such as feelings, thoughts, and habitual behaviors can also cause negative stress.
Common internal sources of distress include:
• Fears (e.g., fears of flying, heights, public speaking, chatting with strangers at a party)
• Repetitive thought patterns
• Worrying about future events (e.g., waiting for medical test results or job restructuring)
• Unrealistic or perfectionist expectations
Habitual behavior patterns that can lead to stress include:
• Over scheduling
• Failing to be assertive
• Failing to set and maintain healthy boundaries
• Procrastination and/or failing to plan ahead
Behaviors:
Avoiding situations where experiencing anxiety might occur
Leaving situations when feelings of anxiety begins to occur
Trying to do things perfectly or trying to control events to prevent danger
Moods:
Nervous
Irritable
Anxious
Panicky
Thoughts:
Overestimation of danger
Underestimation of your ability to cope
Underestimation of help available
Worries and catastrophic thoughts
Stressors can contribute to our feelings of anxiety. Examples of stressors that contribute to feelings of anxiety might include trauma (being abused, being in an accident, war); illness or death, things we are taught (“snakes will bite you”); things we observe (an article in the newspaper about a plane crash); and experiences that seem too much to handle (giving a speech, job promotion or termination, having a baby)
The thoughts that accompany anxiety involve the perception that we are in danger or that we are threatened or vulnerable in some way. A threat of danger can be physical, mental, or social. A physical threat occurs when you believe that you will be physically hurt (e.g., a snake bite, a heart attack, being hit). A social threat occurs when you believe you will be rejected, humiliated, embarrassed, or put down. A mental threat occurs when something makes you worry that you are going crazy or losing your mind.
The perception of the threats varies from person to person. Some people, because of their life experiences, may feel threatened very easily and will often feel anxious. Other people may feel a greater sense of safety or security. Certain life experiences such as growing up in a chaotic home with volatile surroundings may lead a person to conclude that the world and other people are dangerous.
The perception of danger and sense of vulnerability may have helped a person survive as a child. Being able to recognize danger and its early warning signs are critical to one’s emo-tional and physical survival. Some may have developed a very fine ability to spot and respond to dangerous situations.
As an adult, it may become important to evaluate whether or not its possible that one is over-responding to danger and threat. Perhaps the people in their adult life are not as threatening as the people in their childhood. One might consider whether or not their resources and abilities to cope as an adult open new and creative ways of responding to threat and anxiety.
Anxious Thoughts
Anxious thoughts are future oriented and often predict catastrophe. Anxious thoughts often begin with, “What if…” and end with a disastrous outcome. Anxious thoughts frequently include images of danger as well. For example, a man with a fear of public speaking may, before a talk, think, “What if I stumble over my words? What if I forget my notes? What if people think I’m a fool and don’t know what I am talking about?” He may have an image of himself standing frozen in front of the crowd. These thoughts are all about the future and predict a dire outcome.
Signs and Symptoms of Stress Overload
It is important to learn how to recognize when your stress levels are “out of control” or having an adverse effect. The signs and symptoms of stress overload can be almost any-thing. Stress affects the mind, body, and behavior in many ways, and everyone experiences stress differently.
Three common ways that people respond when they are overwhelmed by stress are:
An angry or agitated stress response. You may feel heated, keyed-up, overly emotional, and unable to sit still.
A withdrawn or depressed stress response. You shut down, space out, and show very little energy or emotion.
Both a tense and frozen stress response. You “freeze” under pressure and feel like you can’t do anything. You look paralyzed, but under the surface you may feel extremely agitated.
The following lists some of the common warning signs and symptoms of stress. The more signs and symptoms you notice in yourself, the closer you might be to feeling stress overload.
Cognitive Symptoms:
• Memory problems
• Inability or difficulty concentrating
• Poor judgment
• Seeing only the negative
• Anxious, racing, or ruminating thoughts
• Constant worrying
Emotional Symptoms:
• Moodiness
• Irritability or short-tempered
• Agitation, inability to relax
• Feeling overwhelmed
• Sense of loneliness or isolation
• Depression or general unhappiness
Physical Symptoms:
• Aches and pains, muscle tension
• Diarrhea or constipation
• Nausea, dizziness, or butterflies in the stomach
• Chest pain or rapid heartbeat
• Loss of sex drive
• Frequent colds
• Shallow breathing and sweating
Behavioral Symptoms:
• Eating more or less
• Sleeping too much or too little
• Isolating yourself from others
• Procrastinating or neglecting responsibilities
• Using alcohol, cigarettes, or drugs to relax
• Nervous habits (nail biting, pacing)
Keep in mind that the signs and symptoms of stress also can be caused by other psycho-logical and medical problems. If you’re experiencing any of the warning signs of stress, it’s important to see a doctor for an evaluation. Your doctor can help you determine whether or not your symptoms are stress related.
Effects of Stress
Stress is difficult for professionals to define because it is a highly subjective phenomenon that differs for each of us. Things that are distressful for some individuals can be pleasurable for others. We also respond to stress differently. Some people blush, some eat more while others grow pale or eat less. There are numerous physical as well as emotional responses as illustrated by the following list of 50 common signs and symptoms of stress.
Common Signs and Symptoms of Stress
• Frequent headaches, jaw clenching or pain
• Gritting, grinding teeth
• Stuttering or stammering
• Tremors, trembling of lips, hands
• Neck ache, back pain, muscle spasms
• Light headedness, faintness, dizziness
• Ringing in the ears
• Frequent blushing, sweating
• Dry mouth, problems swallowing
• Cold or sweaty hands, feet
• Frequent colds, infections
• Rashes, itching, hives, “goose bumps”
• Unexplained or frequent allergy attacks
• Heartburn, stomach pain, nausea
• Excess belching, flatulence
• Constipation, diarrhea
• Difficulty breathing, sighing
• Sudden attacks of panic
• Chest pain, palpitations
• Frequent urination
• Low sexual drive or performance
• Excess anxiety, worry, guilt, nervousness
• Increased anger, frustration, hostility
• Depression, frequent or intense mood swings
• Increased or decreased appetite
Stress Relieving Techniques
Mindfulness
Meditation that cultivates mindfulness can be particularly effective at reducing stress, anxi-ety, depression, and other negative emotions. Mindfulness is the quality of being fully engaged in the present moment, without over-thinking or analyzing the experience. Rather than worrying about the future or dwelling on the past, mindfulness meditation switches the focus on what is happening right now. Mindfulness meditation is not equal to zoning out. It takes effort to maintain your concentration and to bring it back to the present moment when your mind wanders or you start to drift off. But with regular practice, mind-fulness strengthens the areas of the brain associated with joy and relaxation. Mindfulness provides a potentially powerful antidote to the common causes of daily stress such as time pressure, distraction, agitation, and interpersonal conflicts.
How to do a Mindfulness Exercise
Find a comfortable place to sit. It can be on a chair or on the floor, but do not slump or slouch. Keep your posture straight but relaxed, making sure you are not rigid or stiff.
Focus on your breathing.
Concentrate your attention completely on your breathing. Become aware of the sensa-tions inside your air passages as the air enters the nose. Just become aware of that feeling as your breath goes in and out. Do not attempt to influence or check your breathing; just let it happen naturally. Marvel at the quality and precision of internal sensations that are normally ignored. Wonder at how deeply you can sense the air inside you. Just allow yourself time to be aware of the air going in and out, nothing else. Keep your mind on your breathing; become your breathing. When thoughts come into your mind, that’s o.k. Just examine the thoughts for what they are, as if they were some strange animal that wandered into your sight. When these thoughts come into your mind, allow them to wander off on their own and wish them well on their way. Do not get involved in the thought. Just notice that it is there and return your focus to your breathing. Treat each thought as a guest. When a thought or feeling arises, simply observe and acknowledge it. There is no need to interpret it or to use it. You might wonder where it came from, what caused it to surface now, what purpose it serves. Notice it like a precious jewel, turning it this way and that. If you feel yourself drifting away on a thought then just return and refocus on your breathing. Use your breathing as the anchor for your mindfulness.
Stay in the moment as long as you can. Continue to focus on your breathing. Aim to clear your mind completely for 5 minutes. With practice you will be able to extend the time to twenty minutes or more.
Notice the repeating thoughts. As you progress you will come to recognize that the same thoughts are appearing, over and over, even in your calmest moments. Notice them and let them pass by, returning your attention to your breath.
The following mindfulness meditation techniques can also be helpful for stress relief.
Body Scan – Body scanning promotes mindfulness by focusing your attention on various parts of your body. Like progressive muscle relaxation, you can start with your feet and work your way up. However, instead of tensing and relaxing your muscles, you simply focus on the way each part of your body feels, noticing any sensations without labeling then as “good or bad”.
Walking Meditation – You don’t have to be seated or still to practice mindfulness. In walk-ing meditation, mindfulness involves being focused on the physicality of each step; the sensation of your feet touching the ground; the rhythm of your breath while moving, and feeling the wind against your face.
Mindful Eating – If you reach for food when you feel stressed, or you gulp your meals down in a rush, try eating mindfully. Sit down at the table and focus your full attention on the meal. This means no T.V., reading the newspaper, or eating on the run. Eat slowly, tak-ing time to concentrate on each bite, noticing the texture and taste of the food.
Ten Simple Ways You Can Practice Mindfulness Each Day:
As you awaken in the morning, bring your attention to your breathing. Instead of let-ting your mind spin off into yesterday or today, take mindful breaths. Focus on your breathing, and sense the effects of breathing throughout your body.
Instead of hurrying to your usual routine, slow down and enjoy something special about the morning; a flower that bloomed, the sound of the birds, the wind in the trees.
On the way to work or school, pay attention to how you walk, drive or ride the transit. Take some deep breaths, relaxing throughout your body.
When stopped at a red light, pay attention to your breathing and enjoy the landscape around you.
When you arrive at your destination, take a few moments to orient yourself. Breathe consciously and calmly, relax your body, then begin.
When sitting at your desk or keyboard, become aware of the subtle signs of the physi-cal tension and take a break or walk around.
Use the repetitive events of the day (the ringing telephone, a knock at the door, walk-ing down the hall) as cues for a mini-relaxation.
Walk mindfully to your car or bus. Can you see and appreciate something new in the environment? Can you enjoy walking without rushing?
As you return home, consciously make the transition into your home environment. If possible, after greeting your family or housemates, give yourself a few minutes alone to ease the transition.
As you go to sleep, let go of today and tomorrow. Take some slow, mindful deep breaths.
Self-Massage techniques:
Scalp Soother – Place your thumbs behind your ears while spreading your fingers on top of your head. Move your scalp back and forth slightly by making circles with your finger-tips for 15-20 seconds.
Easy on the Eyes – Close your eyes and place your ring fingers directly under your eye-brows, near the bridge of your nose. Slowly increase the pressure for 5-10 seconds, then gently release. Repeat 2-3 times.
Sinus Pressure Relief – Place your fingertips at the bridge of your nose. Slowly slide your fingers down your nose and across the top of your cheekbones to the outside of your eyes. Repeat 3-4 times.
Shoulder Tension Relief – Reach one arm across the front of your body to your opposite shoulder. Using a circular motion, press firmly on the muscle above your shoulder blade. Repeat on the other side.
38 Stress Busters
Start off your day with breakfast.
Occasionally change your routine by meet-ing a friend or co-worker for breakfast. Allow time to relax and enjoy it.
Find some time during the day to meditate or listen to a relaxation CD.
Instead of drinking coffee all day, switch to fruit juice.
Organize your work - set priorities.
Don't try to be perfect. Don't feel like you must do everything.
Avoid trying to do two, three, or more things at a time.
Develop a support network.
If possible, reduce the noise level in your environment.
Always take a lunch break (preferably not at your desk)
Optimize your health with good nutrition, sleep and rest.
Get regular exercise.
Celebrate birthdays and other holidays. Turn more events into special occasions.
Look at unavoidable stress as an avenue for growth and change.
Avoid people who are "stress carriers."
Avoid people who are "negaholics."
Don't watch the 11 p.m. news.
Give yourself praise and positive strokes.
Develop a variety of resources for gratifica-tion in your life, whether it's family, friends, hobbies, interests, special week-ends or vacations.
Treat yourself to "new and good things."
Be assertive. Learn to express your needs and differences, to make requests, and to say "no" constructively.
Seek out the emotional resources available to you such as co-workers, partner, friends and family.
Don't be afraid to ask questions or to ask for help.
Allow extra time to get to appointments.
Take deep breaths when you feel stressed.
Try to find something funny in a difficult situation.
Take an occasional "mental health day."
Adopt a pet.
Take a mindful walk.
Understand that we do not all see or do things in the same way.
Practice mindfulness - learn to live in the moment.
Become a less aggressive driver.
Show kindness and consideration. Open a door for someone, pick up litter, etc.
When stressed, ask yourself "Is this really important?" and "Will this really matter a year from now?"
Resist the urge to judge or criticize.
Become a better listener.
Be flexible with change - things don't always go as we planned.
If spiritual, pray; speak to God, a higher power, or your inner guide.