Ten Tips to Reduce Stress

Adapted from Stress Management for Patient and Physician by David B. Posen, MD, originally printed in The Canadian Journal of Continuing Medical Education, April 1995.

For the 18th consecutive year, April 2010 has been designated Stress Awareness Month. During this thirty day period, health care professionals and health promotion experts across the country will join forces to increase public awareness about both the causes and cures for our modern stress epidemic.

Sponsored by The Health Resource Network (HRN), a non-profit health education organization, Stress Awareness Month is a national, cooperative effort to inform people about the dangers of stress, successful coping strategies, and harmful misconceptions about stress that are prevalent in our society.

Perhaps the most common cause of ill health in our society, stress probably underlies as many as 70% of all visits to family doctors. Stress can contribute or mimic just about any symptom; however, most is physical, mental, emotional, and behavioral. The causes of stress are multiple and varied, but they can be classified in two general groups: external and internal. External stressors can include relatives getting sick or dying, jobs being lost, or people criticizing or becoming angry. However, most of the stress that most of us have is self-generated (internal). We create the majority of our upsets, indicating that we cause most of our own stress and, therefore, can do something about it.

To master stress, you must figure out what you are doing that is contributing to your problem and change it. These changes fall into four categories: change your behavior, change your thinking, change your lifestyle, and/or change the situations you are in. There are many ways to relieve stress, from going for a walk to quitting your job. The following is a list of ten practical and down-to-earth strategies. Some are simple and can be implemented quickly; others are a bit more involved. All are feasible and beneficial.

1.  Decrease or Discontinue Caffeine
2.  Regular Exercise
3.  Relaxation/Meditation
4.  Sleep
5.  Time-outs and Leisure
6.  Realistic Expectations
7.  Reframing
8.  Belief System
9.  Ventilation/Support Systems
10. Humor

Decrease or Discontinue Caffeine
In terms of “bang for the buck,” it is hard to beat this simple intervention. Many do not realize that caffeine (coffee, tea, chocolate, and cola) is a drug, a strong stimulant that actually generates a stress reaction in the body. One warning, however, is to wean off caffeine gradually to avoid potential migraine-type withdrawal headaches.

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Regular Excersie
As a way of draining off stress energy, nothing beats aerobic exercise. Stress is the body’s reaction to factors or triggers such as a demanding boss, a sick child or rush-hour traffic. It is the fight-or-flight response in the body, mediated by adrenaline and other stress hormones, and comprised of such physiologic changes as increased heart rate and blood pressure, faster breathing, muscle tension, dilated pupils, dry mouth, and increased blood sugar. Our bodies go into a state of high energy but there is usually no place for that energy to go.

Exercise is the most logical way to dissipate this excess energy and can be channeled into forms of exercise such as a brisk walk, a run, a bike ride, aerobics classes, dancing, as well as others. Regular exercise can drain off ongoing stress and keep things under control. For chronic or acute stress, exercise is an essential ingredient in any stress reduction program.

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Relaxation/Meditation
Another way to reduce stress in the body is through certain disciplines which fall under the heading of relaxation techniques. In a relaxed state, all the physiologic events in the stress reaction are reversed: pulse slows, blood pressure falls, breathing slows, and muscles relax.

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Sleep
As mundane as it sounds, sleep is an important way of reducing stress. Chronically stressed individuals almost all suffer from fatigue, and people who are tired do not cope well with stressful situations. These dynamics can create a vicious cycle. The three criteria of successful sleep are waking refreshed, good daytime energy, and waking naturally before the alarm goes off in the morning.

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Time-outs and Leisure
Many otherwise rational people think nothing of working from dawn to dusk without taking intermissions, and then wonder why they become distressed. The two major issues are pacing and work/leisure balance.

Pacing has two components: monitoring your stress and energy level, and then pacing yourself accordingly. It is about awareness and vigilance; knowing when to extend yourself, and when to ease up, as well as acting on the information your body gives you. Periodic time-outs such as power naps, meditation, daydreaming, social interludes, or a short walk, are good investments of time that pays itself back quickly in increased productivity and reduced stress.

Leisure is one of the most pleasant stress relievers ever invented. It’s strange that people resist it so much (e.g., feeling selfish, guilty). Leisure time and levels of distress are inversely proportional – the less leisure, the more stress.

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Realistic Expectations
A common source of stress is unrealistic expectations. People often become upset about something, not because it is innately stressful, but because it does not concur with what they expected. When expectations are realistic, life feels more predictable and, therefore, more manageable. There is an increased feeling of control because you can plan and prepare yourself (physically and psychologically).

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Reframing
This is one of the most powerful and creative stress reducers. Reframing is a technique used to change the way you look at things in order to feel better about them. The key to reframing is to recognize that there are many ways to interpret the same situation. It is helpful to reframe a stressful situation by looking for the positives in a negative situation and understanding the behavior of other people. Looking at things from a different perspective offers the ability to reframe the situation and feel better emotionally as a result.

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Belieft Systems
A lot of stress results from our beliefs. We have literally thousands of premises and assumptions about all kinds of things that we hold to be the truth. We have beliefs about how things are, how people should behave, and about ourselves. Most of our beliefs are held unconsciously so we are unaware of them. This gives them more power over us and allows them to run our lives.

Beliefs cause stress in two ways. The first is the behavior that results from them. Uncovering the unconscious assumptions behind our actions can be helpful in allowing us to change, therefore reducing stress. The second way beliefs cause stress is when they are in conflict with those of other people. It is important to realize that beliefs held by others may be just as valid as our own. This mind-opening experience is helpful in diminishing stress.

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Ventilation/Support System
There is an old saying that “a problem shared is a problem halved.” People who keep things to themselves carry a considerable and unnecessary burden. Ventilating to a member of our support system such as a few trusted relatives, co-workers or friends, and encouraging others to vent to us, allows for a necessary stress release. Another form of ventilation that many find helpful is writing.

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Humor
Humor is a wonderful stress reducer, an antidote to upsets. Laughter relieves tension. In fact, we often laugh the hardest when we have been feeling the most tense. Humor can literally diffuse tense situations and can help you cope better through stressful periods. Laughter has been shown to lower blood pressure, reduce stress hormones, increase muscle flexion, and boost immunity. Laughter can also trigger the release of endorphins, the body's natural painkillers (The Laughter-Immune Connection: New Discoveries, Lee S. Berk, DPH, Humor and Health Journal, vol. 5, no. 5, 1996).

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