Stress Management and Treatment
By Harold L. Burke, Ph.D.
Stress management information, treatments, resources, and helpful hints
All of us may feel stressed or overwhelmed at times; this is a normal part of living. However, these feelings, whether acute or chronic, may be excessive and unhealthy. Sometimes you may recognize you are under stress when you feel that you are being “pushed” beyond your coping skills, and sometimes you may not even be aware of it. Stress may occur if you are suffering from a chronic illness or have just had surgery. Your body still reacts to this kind of event by physiological stress responses which can have the same effect as the more conscious type of stress. In any case, you should seek professional help if the effects are sufficiently severe as to cause significant distress or to interfere with occupational, social, or other functioning. Although there is no actual mental disorder known as “stress disorder,” stress can precipitate or amplify the harmful effects of mood disorders, other mental disorders, or “physical” illnesses. At the very least, acute stress can cause you to be anxious, to feel overwhelmed, and to have difficulty thinking or remembering. At the worst, chronic stress can have serious effects on overall health (see below). Fortunately, there is much stress information about stress management and stress treatment on the Web and in libraries. There are numerous treatments for decreasing both acute and chronic stress including alternative, holistic treatments. The Brain Therapy Center provides information, psychological and neuropsychological assessment, treatment, current research information, and helpful tips.
What symptoms are suggestive of chronic stress?
Feeling tense or on edge
Having excessive muscular tension/chronic pain (e.g., headache)
Being unusually hyper-reactive, irritable, or angry
Having difficulty sleeping
Feeling chronic physical fatigue
Feeling “burned-out,” overwhelmed, or mentally exhausted
Diminished ability to think, concentrate, or remember information
Feeling depressed or anxious
Of course, these symptoms may well represent a more specific medical or mental illness and should be checked by a medical professional. If you choose to see a psychologist, for example, she/he may well recommend that you also have an exam by your physician to rule out a specific medical illness. Even if a specific illness or disorder does exist, chronic stress may also be present and may make the symptoms of the illness worse. In fact, illness itself can be a significant stressor.
What are some causes of stress?
Working too hard without breaks. This applies to almost any time scale. That is, stress can be caused by working for many months without a holiday and/or by working too many days without resting (e.g., on Sunday). Stress can occur even throughout the day by your failing to take a short restful break every 90 minutes or so.
Insufficient or abnormal sleep. Americans now sleep one hour less than they did 100 years ago. Many Americans stay up late watching television, get up early, and have a long commute. According to sleep experts, people simply are not getting sufficient sleep. In addition, they often have erratic sleep schedules with late nights and much less sleep on the weekends. The “Monday morning blues” are very real and are not just due to a person’s dread of returning to work.
Major life stressors (e.g., death of a loved one, divorce, job loss). Even major positive changes (e.g., job change) can be stressful because the nervous system may still react as if there is a crisis
Minor hassles. Studies have shown that “minor” hassles on a daily basis without countering them with stress-reduction techniques may have even more deleterious effects than major stressors because they occur frequently and are additive.
Physical illness, particularly if chronic. Surgery or hospitalization can also be stressful.
What are some of the harmful effects of chronic stress?
Chronic stress can depress cognitive functioning leading to problems with attention and concentration, memory, decision-making, and abstract thinking. Chronic stress has been found to cause serious effects in the body in general and in the brain in particular. Chronic stress causes excessive amounts of cortisol to be produced from the adrenal cortex which in turn causes damage to arteries with subsequent increased risk of myocardial infarction (MI, heart attack) and stroke and damage to the hippocampus (an area critical for memory and for controlling levels of cortisol). In addition, excessive cortisol interferes with deep sleep and with the production of brain-derived neurotropic factor (BDNF) and growth hormone (GH) — chemicals which the body needs for optimal functioning. Furthermore, virtually every aspect of the immune system is depressed by excessive amounts of cortisol. White blood cells are literally decreased in number and in function. This is why individuals often get sick when stressed.
What are some treatments for stress?
Relaxation exercises/techniques. There are many variations of these exercises, but all of them produce what physiologists call “the relaxation response.” The parasympathetic nervous system predominates, the individual’s autonomic system is not in an emergency mode, and the body is in a more rebuilding, “healing” mode. This is not the same as sleeping although sleeping is also a type of rebuilding activity. One component that is common to most of these techniques is relaxed, deep, slow, and unforced breathing.
Cognitive therapy. This form of psychotherapy helps patients to replace dysfunctional, inaccurate thoughts and images (causing the experience of stress) with thoughts and images that are more accurate and that decrease stress. This often involves a technique known as “reframing” in which one learns to view or think about a stressor or stressful situation in a different light that is less stressful. In addition, the therapist will also help the patient to find ways of decreasing or removing stressors. Sometimes this is the easiest thing to do if it is logistically feasible.
EEG biofeedback (also known as neurofeedback). This is a cutting-edge technology that uses operant conditioning (reinforcement) to alter brain waves. EEC biofeedback provides information to patients about their nervous systems so that they can self-regulate more effectively. This regulation can help the body achieve homeostasis and balance. In turn, patients are very often able to become more relaxed physically and to experience less stress. Neurofeedback is FDA approved for relaxation.
Medical hypnosis. Particularly when performed by a licensed mental health professional such as a clinical psychologist, hypnosis assists the client in entering an extremely relaxed but focused state so that subconscious processes of healing can occur. This relaxed state not only reduces immediate stress, but it also reduces chronic stress.
Relaxation exercises/techniques. You may attempt these on your own. However, when first learning these exercises/techniques, it is usually preferable to have some assistance from a mental health professional or other professional trained in such methods. There are many variations of these exercises, but all of them produce what physiologists call “the relaxation response.”
The parasympathetic nervous system predominates, the individual’s autonomic system is not in an emergency mode, and the body is in a more rebuilding, “healing” mode. This is not the same as sleeping although sleeping is also a type of rebuilding activity. One component that is common to most of these techniques is relaxed, deep, slow, and unforced breathing.
Try this exercise. Find a quiet place where you will not be disturbed for at least 10 minutes, and turn down the lights if possible. Loosen your clothing and take off or loosen your shoes. Assume a comfortable sitting position with your relaxed hands resting on your thighs, and close your eyes. Focus on slow, relaxed breathing; and breathe through your nose if possible. When inhaling, let your abdomen push outward so that your diaphragm can settle down allowing the lungs to fully expand. For the first few minutes, try the following routine. Inhale to the count of 2 and exhale to the count of 4. Inhale to the count of 3 and exhale to the count of 6.
Inhale to the count of 4 and exhale to the count of 8. Repeat this routine. At first you may find that your counting lasts longer than your inhalations or exhalations. This is because you may be used to breathing faster and more shallowly. However, with practice you will be able to do this. When you are inhaling, focus and form images of the air flowing through your air passages. When exhaling, form images of tension leaving your body.
In this exercise, notice that the exhalations are twice as long as the inhalations. This is to keep you from hyperventilating. However, if you do find that you are feeling dizzy or lightheaded or that your fingers are feeling numb or tingling, you are probably hyperventilating and should slow down or temporarily discontinue the exercises.
After the formal counting portion, continue the exercise with slow, unforced, deep breathing while also “transporting” yourself to a tranquil place in the following manner: Form images of the most beautiful, relaxing, tranquil, peaceful place you know. First just focus on the sights (with both a panoramic view and then finer details), then hear the sounds, then feel the tactile sensations, then smell the pleasant odors or taste any pleasant tastes, and finally experience all of these sensations combined. You may be amazed how relaxed and refreshed you will feel after only 10-15 minutes.
Ultradian breaks. Take these breaks approximately every 90 minutes. Drs. David Lloyd and Ernest Rossi have compiled scientific evidence in their book Ultradian Rhythms in Life Processes that the body experiences regular rhythms such that various processes wax and wane over approximately a 90-minute period. This applies to many processes including the ability to concentrate and perform optimally.
When these processes are at their “low” points, your body may signal that it needs a break for restitution. Such signals may include muscle tension or soreness, the need to stretch or move around, a feeling of restlessness, or difficulty concentrating or thinking. Heed these by taking an ultradian break such as stretching, walking around, or doing the above relaxation exercise. When a person ignores such signals on a daily basis, the body begins to experience stress.
Meditation/Prayer. Apart from specific religious or philosophical beliefs associated with different types of meditation or prayer, these experiences can have a very calming and healing effect. Entering into the spiritual domain in a world that has become very stressful for many of us is something we should all do more often.
Exercise, particularly aerobic exercise. This exercise does not have to be intense. Even 10 minutes of walking will increase your energy for 60-120 minutes and improve your mood. If possible, do 10 minutes of gentle stretching, 20 minutes of aerobic exercise, and 5-10 minutes of stretching as a cool down. Do this at least three times per week, but remember that the level of intensity does not make that much difference. Research has found that such exercise increases deep sleep and decreases stress reactivity. Even a slow, relaxed walk or a visit to a beautiful location can reduce stress. However, such relaxed exercise should be done regularly. Yoga and Tai Chi are two forms of exercise that can be quite stress reducing, and they also have additional health benefits.
Calming activities. Enjoying beautiful music, especially certain classical compositions, can help to reduce stress. People have found for hundreds of years that slow classical music, especially from the Baroque period, reduces the experience of stress and renews the spirit. Of course, you may know some beautiful pieces of music that may not be considered “classical music” but that may have a relaxing effect on you. In addition, there are numerous commercial tapes that have been produced for the express purpose of inducing relaxation. Some of these have music; some have sounds such as ocean waves. A good example of such music may be found at http://www.soundfeelings.com. This music was composed by Howard Richman, a well-known pianist, piano teacher, and composer.
Sleep. Getting sufficient amounts of quality sleep will help you cope with stress more effectively because your brain will have received the appropriate respite and restitution it requires. Chemicals such as neurotransmitters, hormones, and proteins are often synthesized during sleep. The improper balance of these chemicals makes the body more vulnerable to the effects of stress noted above. Practicing good sleep hygiene may help you achieve and maintain restorative sleep. Specifically, get sufficient amounts of sleep, keep a regular sleep schedule, avoid stimulants (e.g., coffee, tea, chocolate) late in the day, exercise regularly, and avoid activities in the bedroom that may interfere with sleep (e.g., making business contacts on the telephone, working on your laptop in bed). Conversely, taking excessive over-the-counter sleep aids is not a good answer; they can make things worse. Taking benzodiazepines (such as Xanax®) on a chronic basis is usually not the answer. They can make the insomnia and stress symptoms worse if you stop taking them; you may become dependent on them; and they can impair your cognition, memory, and reaction time. A published study has shown that even relatively low doses of alprazolam (Xanax®) can impair driving, divided attention, and reaction time. Seeking advice from a physician, improving sleep habits, and exercising regularly can improve your sleep and decrease symptoms of stress.
Again, several of the above treatments/techniques can be done on your own or with the help of a teacher and without the help of a mental health professional. However, seeking help from a licensed mental health professional (e.g., a clinical psychologist) may be necessary if your stress is causing significant difficulties; and seeing such a professional has several advantages. First, she/he can assess exactly what is causing your stress and can help you decide what is the best treatment modality/technique for you based on your particular personality, etc. Second, most mental health professionals can utilize several different stress-reduction techniques and can integrate such techniques with other psychotherapeutic modalities that may be necessary for optimal results.
At the Brain Therapy Center, our staff specializes in several treatment modalities including individual psychotherapy, neurofeedback, and exercise/diet consultation.