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Stress –
Changing the way we react

January 2009 – Vol. 13, No. 1

Editors: Janet M. Pollard, MPH; and Carol A. Rice, Ph.D., R.N.

“In today’s fast-paced and ever-connected world, stress has become a fact of life. Stress can cause people to feel overwhelmed or pushed to the limit.”¹ “One-third of Americans are living with extreme stress, and nearly half of Americans (48 percent) believe that their stress has increased over the past five years. Stress is taking a toll on people – contributing to health problems, poor relationships, and lost productivity at work….”²

We all have stressors in our lives – changes, opportunities, or challenging situations that cause our bodies and emotions to react with stress. Some short-term stress can be positive – causing us to deal constructively with daily problems or meet challenges or deadlines. But, when stress remains long-term – chronically or continuously – it can be damaging both emotionally and physically.³ “Stress is what you experience when the level of your stressors exceeds your ability to cope.”⁴ “When stress overwhelms our coping resources, our bodies and minds suffer.”⁵

Our Stress Response: The body’s reaction

“Stress sets off an alarm in the brain, which responds by preparing the body for defensive action. The nervous system is aroused and hormones are released to sharpen the senses, quicken the pulse, deepen respiration, and tense the muscles. This response (sometimes called the fight or flight response) is important because it helps us defend against threatening situations. The response is preprogrammed biologically. Everyone responds in much the same way, regardless of whether the stressful situation is at work or home.

Short-lived or infrequent episodes of stress pose little risk. But when stressful situations go unresolved, the body is kept in a constant state of activation, which increases the rate of wear and tear to biological systems. Ultimately, fatigue or damage results, and the ability of the body to repair and defend itself can become seriously compromised. As a result, the risk of injury or disease escalates.”⁶

“The problem with the stress response is that the more it’s activated, the harder it is to shut off. Instead of leveling off once the crisis has passed, your stress hormones, heart rate and blood pressure remain elevated.”⁵ In fact, “recent research suggests that anywhere from 60 to 90 percent of illness is stress-related. The physical wear and tear of stress includes damage to the cardiovascular system and immune system suppression. Stress compromises your ability to fight off disease and infection, throws your digestive system off balance, makes it difficult to conceive a baby, and can even stunt growth in children.”⁵ “Prolonged exposure to stress increases your risk of everything from heart disease, obesity, and infection to anxiety, depression, and memory problems.”⁵

To change the negative consequences of stress, we need to change how we react or respond to the stressors in our lives.

Though everyone responds much the same way with a bodily stress response, “all stressed people do not share the same symptoms and feelings.”³ Signs and symptoms may include headache, tense muscles, shaking hands, insomnia, heartburn, etc. Feelings may include nervousness, fearfulness, confusion, worry, irritability, hostility, inability to concentrate, etc.³

Whatever the symptoms or feelings that go along with stress, knowing the warning signs and symptoms of stress (PDF) and changing how we react to stress is key. Though we can sometimes avoid an event or thing that leads to stress, this is often not possible. Often, the best way to deal with stress is to change how we react to it.⁷ To begin to make these changes, it is important to:

identify sources of stress that we can eliminate, and
seek out effective strategies for coping with stress.⁴

Identifying Stress Sources: 3 categories of stress

Part of managing stress is knowing what is causing your stress. When you notice any of the warning signs or symptoms of stress (PDF), take note of what may be causing them. Though some causes of stress are obvious (e.g., death in the family, relationship problems, divorce, debt, traffic, etc.), others are not (e.g., happy occasions like marriage, having a baby, and other sources like noise or uncomfortable living conditions).

It can be helpful to classify stressors into categories to help you identify what may be causing stress in your life. Take a look at these categories as you think about where your stress comes from:

Take a few moments to think about and even write down (if that helps) the areas that concern you. If you find it difficult to categorize what’s going on your life one way, try another. Use any method that works for you to begin to understand what’s causing the stress in your life. Then you can begin to find strategies that work for you to effectively manage the stress in your life.

Stress-Buster Strategies: Find what works for you

Before we discuss strategies, let’s talk about what may be required to make them work. Some strategies (like counting to 10) can be done immediately, while others (like organizing) will take time. The common thought is, “I have no time.” No doubt that is true for many of us and part of our stress. Like anything we want to accomplish, we have to commit to doing it, so we must decide if it is worth it to make the time to make these strategies work. Taking the time (for instance, to organize or plan) can ultimately save you time and reduce your stress. You will want to set priorities and do some of these strategies in small steps to accomplish your final goal of reducing the stress in your life.

Emergency Stress Stoppers

First, when you have those moments where you need immediate help – try these emergency stress stoppers.⁸ Try these strategies to deal with stress on the spot, like in a traffic jam, when you lose your keys, or in a stressful conversation or confrontation:

Count to 10 before you speak.
Take 3–5 deep breaths, or try a more concentrated deep breathing exercise (PDF).
Go for a walk.
Walk away from the situation, and say you’ll handle it later.
Don’t be afraid to say “I’m sorry” if you make a mistake.
Drive in the slower lane, or avoid busy roads (if possible) to stay calm while driving.
Begin the day by breaking bigger problems down into smaller ones (e.g., answer one letter or phone call/message per day, instead of dealing with everything at once).⁸

A Wellness Approach

“Stress is a part of life, but the healthier you are, the better able you are to manage stress when it happens.”⁹ “Everyone gets stressed. When stress strikes, you want your body to be able to handle it. Stress can wear your body down, mentally and physically. But a healthy body can cope with stress better than an unhealthy one. There are several important things you can do to keep your body healthy.”¹⁰ Let your lifestyle include the following five stress-busters:

Get or stay active. “Exercise is a good way to deal with stress because it’s a healthy way to relieve your pent-up energy and tension.”⁷ When your body is under stress all the time, “it’s as though your body gets ready to jump out of the way of the car, but you’re sitting still. Your body is working overtime, with no place to put all the extra energy. This can make you feel anxious, afraid, worried, and uptight.”⁷ “When you become stressed, your body releases extra chemicals such as glucose and adrenaline—the fight or flight response. Physical activity helps burn up these extra chemicals so your body can return to normal. It also helps you stay healthy by keeping your bones and muscles strong, helping you sleep better, and warding off chronic illness like diabetes and heart disease.”¹⁰ “It also helps you get in better shape, which makes you feel better overall.”⁷ “Try to get at least 30 minutes of physical activity on most days of the week and more whenever you can.”¹⁰
Eat a healthy diet. That means lots of fruits, vegetables, and whole grains; choosing lean meats; and eating less sugar, refined and processed foods, and saturated fats. If you drink alcohol, limit it to 1 drink/day for women and 2 drinks/day for men. If you smoke, try to quit. You might also want to limit caffeine intake if it seems to make you jittery or keeps you from a good night’s sleep.
Get enough sleep. “Sleep is as important as nutrition and exercise when preparing for peak performance”⁹ in your day. “Consistent sleep is critical for a healthy life. Although we all need varying amounts of sleep, if we do not get enough sleep, everything from our immune system to our ability to learn and remember information will be negatively affected.”⁹ “Not getting enough sleep also increases stress and can make you less able to handle stressful situations. Regardless of age, most adults need about eight hours of restful sleep a night. But sometimes stress keeps you awake, making matters worse. If you have trouble sleeping, there are some things you can try to help you sleep better. Try taking a bath before bed; avoid alcohol, caffeine, nicotine, and heavy meals near bedtime; and rearrange your room to avoid distractions like light and noise. If these ideas don’t work and you still have trouble sleeping for three weeks or longer, talk to your doctor.”¹⁰
Have a healthy attitude. “Have you ever noticed how the exact same situation can stress one person out, while it might not affect another person at all? This difference can usually be explained by the way each individual thinks about the situation. Changing the way you think can help you manage stressors in your life.”⁹ “Emulate people who are naturally resistant to stress. Some people weather devastating experiences with uncanny serenity. By studying them, researchers have discovered that they share distinctive habits of mind.”¹¹ Stress-resistant people tend to:
- Focus on immediate issues rather than global ones. (Don’t focus on the past – it’s over, and don’t worry about the future – focus on what needs to be done right now.)
- Share an optimistic explanatory style –
  - They assume their troubles are temporary (“I’m tired today”) rather than permanent (“I’m washed up”) and specific (“I have a bad habit”) rather than universal (“I’m a bad person”).
  - They credit themselves when things go right, while externalizing their failures (“That was a tough audience,” not “I gave a wretched speech”).¹¹

View the stressful situation. How bad is it? Can you get through it it?¹⁰ “Try to look at change as a positive challenge, not as a threat.”⁷ Frame the words you say to yourself about the situation in a positive way – “I can do this if I take it one step at a time” or “things will work out,” rather than “I can’t do this, I hate it when this happens,” or everything is going wrong.”¹²

Find enjoyment in life. Try to find one thing to do each day that you enjoy – even if it’s just for 15 minutes. Doing things you enjoy is a natural way to fight stress.¹³ See this link for ideas.

Prepare, Prioritize, Realize, and Organize

Preparing, prioritizing, and organizing may take some time, but they are excellent strategies that help you reduce stress and manage your busy lifestyle.

Prepare. “Prepare to the best of your ability for events you know may be stressful, such as a job interview.”⁷ Many good major changes can take their toll on your stress level. If you plan on graduating, taking a new job, and having a baby all at the same time, you are in for a lot of good changes, but they are overwhelming changes when they happen together. Plan out these events and changes as best you can.³

Prioritize. Part of preparing is also prioritizing what needs to be done – whether for the day or for a major event, like a wedding. “Set priorities. List the things you must get done in a day. Be realistic. Writing down how much time you expect each activity to take helps. The most important things go at the top of your list. Focus on getting those done during your high-energy time of day. Bump the less important tasks to the next day or week if you can’t get to them. And don’t beat yourself up if you don’t. Remind yourself that there are only so many hours in a day, and you’re doing the best you can.”¹⁴

Realize your limitations. Say no if you need to. “Learn how to say no to new responsibilities that you are not sure you can fulfill. It is easier to refuse to do something than to get caught in the middle of something you cannot accomplish. It is healthier for you and fairer to the persons involved in the extra responsibilities.”³ “It might feel uncomfortable at first. But taking on too much and failing is more stressful than ‘passing’ on a request in the first place. Work on shedding the perfection impulse. Don’t expect perfection from yourself or others.”¹⁵

Organize. Getting organized can take time, but it can go a long ways in reducing stress. “You can waste a lot of time looking for things you’ve misplaced, trying to make plans or decisions at the last minute, or putting things off for later. Clean up your desk and office by making places to store things—file cabinets, notice boards, in- and out-boxes, ‘to read’ and ‘bill-paying’ trays—even a shredder! Make files, update your rolodex, and organize your pantry and drawers so you can find things more easily. Putting in some extra time to get organized will save you a lot of time in the long run. And don’t try to do all of your organizing in one day.”¹⁴ Click here for some ideas to get you started (PDF).

Stay focused; multi-task when you can, and delegate work when possible (without overloading someone else).

Avoid, Communicate, Resolve

Some of the most difficult areas to deal with stress involve close, personal relationships or daily contacts, such as co-workers. To resolve stressful situations requires good communication.

Avoid controllable stressors. “Many stressful situations can be under your control. You can avoid them completely. For instance, if shopping with your spouse stresses you, then agree not to shop together.”³ The thing about avoiding such situations is that it requires communication. You have to communicate the problem area with your spouse. If the office party brings stress, you may simply and politely be able to say “no thank you,” but interpersonal relationships require more.

Improve communication and resolve conflict. “You can significantly prevent relationship stress at home and at the workplace if you listen carefully, smile, admit if you are wrong, give compliments, and express your thoughts and feelings assertively.”³ “Since conflict is inevitable, what’s important is how we respond to conflict. Some options are hurtful or destructive to us or others, and some options are compassionate and productive. There are many options for responding to conflict:

Some options are passive, such as withdrawing, ignoring, avoiding, or giving in.
Some options are aggressive, such as threatening, intimidating, yelling, demanding, or pressuring.
Other options are assertive, such as negotiating, compromising, or seeking help/mediation (an outside person to facilitates or helps work it out). The assertive options are generally the hardest to master but the most important if the goal is genuine problem solving and an improved relationship.”⁹

Seek outside help. A trusted family member or friend can be a great support during times of stress. A strong social support network can be critical in helping you through tough times.¹⁶ Ask for help in doing things that might overwhelm you. You may be surprised to find that many people genuinely want to help. Chances are, some of them have gone through the same thing and may have found some solutions.³ If stress seems extreme, uncontrollable, or you feel trapped in a situation, however, seek help from an advisor, clergy, counselor, doctor, or other professional who can assist you.^17,18

Changing Your Reaction: Improving physical and mental health

Understanding how our bodies respond to stress; identifying our personal stressors; using strategies such as emergency stress stoppers, the wellness approach, and organizational and interpersonal skills can be useful tools for reducing the stress in our lives and keeping us healthy in mind and body. “Any stress that keeps occurring can lead to getting sick more often; problems concentrating, sleeping, and eating; high blood pressure and heart disease; and anxiety and depression. In other words, left alone, stress can be bad for both your physical and mental health. That’s why you want to get control of your stress before it controls you. The time and energy you spend managing your stress will pay off in the long run.”¹⁵ For more information on how stress and stress hormones affect the body and mind, see these important resources.

This document is meant for educational purposes only and is not intended to replace the advice of your doctor or other health care provider.

References:

American Psychological Association (2004). Stress tip sheet [on-line]. Retrieved June 19, 2008. From http://www.apahelpcenter.org/articles/article.php?id=166.
American Psychological Association (2004). Stress a major health problem in the U.S. [on-line]. Retrieved June 19, 2008. From http://www.apahelpcenter.org/articles/article.php?id=165.
National Library of Medicine (2007). X-plain: Managing stress – reference summary [on-line]. Retrieved June 19, 2008. From http://www.nlm.nih.gov/medlineplus/tutorials/
managingstress/htm/index.htm.
Mayo Clinic (2008). Stress assessment [on-line]. Retrieved June 19, 2008. From http://mayoclinic.com/health/stress-assessment/SR00029.
HelpGuide (2007). Understanding stress: Signs, symptoms, causes, and effects [on-line]. Retrieved June 19, 2008. From http://www.helpguide.org/mental/stress_signs.htm.
National Institute for Occupational Safety and Health (2008). Stress…at work [on-line]. Retrieved June 19, 2008. From http://www.cdc.gov/niosh/stresswk.html.
American Academy of Family Physicians (2008). Stress: How to cope better with life’s challenges [on-line]. Retrieved June 19, 2008. From http://familydoctor.org/online/famdocen/home/common/
mentalhealth/stress/167.htm.
American Heart Association (2007). Emergency stress stoppers [on-line]. Retrieved June 19, 2008. From http://www.americanheart.org/presenter.jhtml?identifier=3047933.
University of Georgia (2008). Managing stress: A guide for college students – a wellness lifestyle approach. Retrieved June 19, 2008. From http://www.uhs.uga.edu/stress/wellnesslifestyle.html.
American Association of Retired Persons (2008). Managing stress: Healthy bodies fight stress better. Retrieved June 19, 2008. From http://www.aarp.org/health/staying_healthy/
stress/a2003-03-11-care.html.
Dartmouth College (2001). Managing your stress and anxiety [on-line]. Retrieved June 19, 2008. From http://www.dartmouth.edu/~acskills/success/stress.html.
American Heart Association (2007). Positive self-talk [on-line]. Retrieved June 19, 2008. From http://www.americanheart.org/presenter.jhtml?identifier=3047930.
American Heart Association (2007). Finding pleasure [on-line]. Retrieved June 19, 2008. From http://www.americanheart.org/presenter.jhtml?identifier=3047935.
American Association of Retired Persons (2008). Managing stress: Manage stress by managing your time [on-line]. Retrieved June 19, 2008. From http://www.aarp.org/health/staying_healthy/stress/
a2003-03-11-strategies.html.
American Association of Retired Persons (2008). Managing stress: Handling your stress [on-line]. Retrieved June 19, 2008. From http://www.aarp.org/health/staying_healthy/stress/
a2003-03-11-handle.html.
Mayo Clinic (2006). Social support: Reduce stress: Tap this tool to reduce stress [on-line]. Retrieved June 19, 2008. From http://www.mayoclinic.com/print/social-support/SR00033.
American Association of Retired Persons (2008). Managing stress: When stress gets the best of you [on-line]. Retrieved June 19, 2008. From http://www.aarp.org/health/staying_healthy/stress/
a2003-03-11-gettinghelp.html.
American Heart Association (2007). Managing stress [on-line]. Retrieved June 19, 2008. From http://www.americanheart.org/presenter.jhtml?identifier=360.

Stress – Changing the way we react