Stress Management

Understand Stress

Hans Selye, the father of stress theory, defined stress as “the nonspecific response of the body to any demand made upon it.” The “demand” can be a threat, a challenge or any kind of change which requires the body to adapt. The response is automatic and immediate.

Stress can be useful (“eustress”) when it helps us perform better, or it can be harmful (“distress”) when it causes upset or makes us sick. 

What Does the Stress Reaction Consist of?

The stress reaction results from an outpouring of adrenaline, a stimulant hormone, into the bloodstream. This, with other stress hormones, produces several changes in the body which are intended to be protective. The result often is called “the fight-or-flight response” because it provides the strength and energy to either fight or runs away from danger. 

The changes include an 

  1. Increase in heart rate 
  2. Increase in blood pressure 
  3. Faster breathing (hyperventilation)
  4. Tensing of muscles  
  5. Increased mental alertness 
  6. The sensitivity of sense organs (scanning and vigilance)
  7. Increased blood flow to the brain, heart and muscles 
  8. Less blood to the skin, digestive tract, kidneys and liver (which is least needed in times of crisis)

Besides, there is an increase in blood sugar, fats and cholesterol (for extra energy) and a rise in platelets and blood clotting factors (to prevent haemorrhage in case of injury). 

Common Symptoms of Stress

Manifestations of stress are numerous and varied we can group them into four categories  

  1. Physical: fatigue, headache, insomnia, muscle aches/stiffness (especially neck, shoulders and low back), heart palpitations, chest pains, abdominal cramps, nausea, trembling, cold extremities, flushing or sweating and frequent colds.
  2. Mental: decrease in concentration and memory, indecisiveness, mind racing or going blank, confusion, loss of sense of humour.
  3. Emotional: anxiety, nervousness, depression, anger, frustration, worry, fear, irritability, impatience, short temper.
  4. Behavioral: pacing, fidgeting, nervous habits (nail-biting, foot-tapping), increased eating, smoking, drinking, crying, yelling, swearing, blaming and even throwing things or hitting.

Causes of Stress

Stress can be classified into External or Internal causes.

External stressors include:

  1. Physical environment: noise, bright lights, heat, confined spaces. 
  2. Social: rudeness, bossiness or aggressiveness on the part of someone else. 
  3. Organizational: rules, regulations, “red tape,” deadlines. 
  4. Major life events: the death of a relative, lost job, promotion, new baby. 
  5. Daily hassles: commuting, misplacing keys, mechanical breakdowns. 

Internal stressors include:

  1. Lifestyle choices: caffeine, not enough sleep, overloaded schedule. 
  2. Negative self-talk: pessimistic thinking, self-criticism, over-analyzing. 
  3. Mind traps: unrealistic expectations, taking things personally, all-or-nothing thinking, exaggerating, rigid thinking. 
  4. Stressful personality traits: Type A; Perfectionist, workaholic, pleaser. 

It is important to note that most of the stress that most of us have is self-generated. This is a paradox because so many people think of external stressors when they are upset (it is the weather, the boss, the children, the spouse, and the stock market), recognizing those internal ones are to be managed first. 

Ways to Master Stress

The following are some categories that can help master stress: 

  1. Change lifestyle habits.
  2. Decrease caffeine (coffee, tea, colas, and chocolate). 
  3. Well-balanced diet. 
  4. Decrease the consumption of junk food (wafers, oily stuff). 
  5. Eat slowly. 
  6. Regular exercise (at least 30 minutes, three times per week). 
  7. Adequate sleep (figure out what you need, and then get it). 
  8. Leisure time (do something for yourself every day). 
  9. Relaxation exercises (e.g., meditation, self-hypnosis). 
  10. Change stressful situations.
  11. Time and money management. 
  12. Assertiveness. 
  13. Problem-solving. 
  14. Possibly leaving a distressing job or a relationship. 
  15. Change your thinking.
  16. Look at things more positively. 
  17. See problems as opportunities. 
  18. Refute negative thoughts. 
  19. Keep a sense of humour. 

Techniques to Handle Stress

1.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). For example, if you know in advance when you have to work overtime or stay late, you will take it more in stride than when it is dropped on you at the last minute. 

2. Reframing

This is one of the most potent and creative stress reducers. Reframing is a technique used to change the way we look at things to feel better about them. We all do this inadvertently at times. The key to reframing is to recognize that there are many ways to interpret the same situation.

It is like the age-old question: Is the glass half empty or half full? The answer, of course, is that it is both or either, depending on your point of view. 

For example, a woman’s boss was acting critical and domineering towards her. “Assuming your boss is not just evil or malicious, why do you think she might be acting like this?” Answers included, “She is probably insecure,” “She is under a lot of pressure,’ and “She is having personal problems.” Performing this exercise helped the patient step outside herself and looked at other possible interpretations of her boss’s behaviour. After that, her upset was considerably decreased. 

In fact, after such a discussion, some patients feel more compassion than anger for the person who is bothering them. 

Note that reframing does not change the external reality but simply helps the person view things differently and less stressfully. 

3. Belief Systems

A lot of stress results from our beliefs. We have thousands of premises and assumptions about all kinds of things that we hold to be the truth. 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 behaviour that results from them. For example, if you believe that work should come before pleasure, you are likely to work harder and have less leisure time than you would otherwise.

 If you believe that people should meet the needs of others before they reach their own, you are likely to neglect yourself to some extent. 

These are just opinions, but they lead to stressful behaviour. Helping people uncover the unconscious assumptions behind their actions can help get them to change. 

The second way beliefs cause stress is when they conflict with those of other people. 

We can do much for patients by getting them to articulate their beliefs and then to label them as such. Next, we need to help them acknowledge that their assumptions are not truth but rather opinions and, therefore, they can be challenged.

Lastly, we can help patients revise their beliefs or at least admit that the beliefs held by the other person may be just as valid as their own. 

This is a mind-opening exercise and usually diminishes the upset the patient was experiencing. 

4. 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. We can do much for patients by allowing them to ventilate or encouraging them to do so. We can also help by urging them to develop a support system (a few trusted relatives, co-workers or friends to talk to when they are upset or worried). 

Another form of ventilation that many patients find helpful is writing.

When patients are angry, we can suggest them to write a letter to the person at whom they are vexed. These letters are not for sending; they should be destroyed once they are written – unread.  The value is in expressing the feelings and getting them out.  Rereading the letter would explode the anger again. 

5. Humour

Humour is a fantastic stress reducer, an antidote to upsets. Laughter relieves tension. We often laugh hardest when we are tensed. Humour is an individual thing – what is funny to one individual may be hurtful to another.  It would be beautiful when the person can poke fun at themselves. 

We can also do this with patients, but have to be careful and respectful in what we say.  If you think of something funny that may help the patient, say it, but it should not be offensive. When it is done sensitively, laughter is great gifts to people you care. 

6. Diversion and distraction

Take a time-out (anything from a short walk to a vacation) to get away from the things that are bothering you. This will not resolve the problem, but it gives you a break and a chance for your stress levels to decrease. Then, you can return to deal with issues feeling more rested and in a better frame of mind.