- Stress Management
- Professional Help or Self-Help?
- The Process of Change
- Stress Management Techniques
- Coping Skills
- Diet and Nutrition
To avoid the problems associated with stress, people need to
manage their stress. Before they can manage their stress,
however, they need to decide whether they need professional
help or whether self-help is enough. Once people
decide on a source of help, regardless of the source of the help
and the stress management techniques involved, a series
of steps are involved in the process of change.
Help or Self-Help?
When trying to manage stress, it is often difficult for people
to decide whether self-help will be enough or whether they should
seek professional help. In practice, people usually turn to
self-help instead of professional help. The public appears to be
very accepting of self-help resources (128; 169).
Self-help is not always the best way to manage stress, though.
Sometimes professional help is necessary. Professional help is
probably necessary if self-help fails or does not offer any
worthwhile solution or if the problems associated with stress
develop into mental disorders or physical illness.
When people realize that they do in fact need to seek
professional help, how do they know what type of professional to
turn to? A wide range of professionals is available to people
with stress-related problems, ranging from medical doctors to
mental health professionals. A medical doctor, such as a general
practitioner or a specialist, is a good choice when stress leads
to symptoms that may indicate physical illnesses. A mental health
professional, such as clinical psychologist or a psychiatrist,
is a good choice when stress leads to symptoms that may indicate
a mental disorder. Clinical psychologists and psychiatrists along
with other mental health professionals like counseling
psychologists can also provide assistance with stress
management in general, not just with mental disorders that may
accompany stress. Other mental health professionals like marriage
and family counselors, social workers, nurses, clergypersons, and
telephone crisis counselors may also be able to provide some
assistance with stress management.
Clinical or counseling psychologists usually earn a Ph.D.,
doctor of philosophy, (or sometimes a Psy.D., doctor of
psychology, or Ed.D, doctor of education.) in psychology.
Psychiatrists earn an M.D., medical doctor, degree. Compared to
psychiatrists, clinical psychologists tend to focus more on the
aspects of mental disorders that involve problematic thoughts,
feelings, and actions and problems with relationships with other
people. They also usually receive more extensive training in
therapy. Psychiatrists, however, tend to view mental disorders as
medical problems that should be treated with drugs and typically
receive less training in actual therapy (13; 99).
Whether a clinical psychologist or a psychiatrist or both is more
appropriate, depends on a person's specific problems. Whereas
clinical psychologists and psychiatrists often deal with mental
disorders, counseling psychologists customarily deal with
adjustment issues and issues related to employment that are
encountered by relatively healthy people (13).
It is also important to realize that, if people need to seek
professional help from a mental health professional, it does not
necessarily mean that they are "crazy." Although many
mental health professionals do treat people with mental disorders
that people generally associate with being "crazy,"
such as schizophrenia, many mental health professionals help
people with other problems associated with stress. In fact, some
mental health professionals specialize in stress management and
see people who only need help with stress. Furthermore, it is
important to remember that any legitimate professional is also a
great resource for a person who wants advice on how to avoid the
problems associated with stress.
B. The Process of
Five stages are involved in changing behaviors that contribute
to health-related problems, such as the problems associated with
- Precontemplation: People do not notice a problem
and have no intention of changing it any time soon.
- Contemplation: People realize they have a problem
behavior that should be changed and are seriously
thinking about changing it.
- Preparation: People have a strong intention to
change it, have specific plans for changing it, and have
already taken preliminary steps toward changing it.
- Action: People are successfully working on
changing the problem behavior.
- Maintenance: People take steps to make sure the
new behavior remains and the problem behavior does not
Although progress through these stages may appear simple and
straightforward, it usually is not. People usually cycle through
these stages several times before they are able to stay in the
maintenance stage (130). Whether people are able to
move from one stage to the next depends a great deal on decisional
balance, the relative impact of the advantages and
disadvantages on the decision about whether to change a behavior
or leave it as it is (132).
C. Stress Management
Countless stress management techniques have been used for
stress management. These techniques usually involve cognitive-behavioral
approaches, relaxation, exercise, diet
and nutrition, and/or medication.
Cognitive-behavioral approaches to stress management attempt
to change stress-related thoughts, feelings, and actions.
Cognitive-behavioral techniques traditionally have been used
within the context of three types of therapies: cognitive
restructuring, coping skills therapies, and problem-solving
therapies (Mahoney & Arnkoff, as cited in 44).
More recently, however, the same principles have been
incorporated into self-help methods.
The goal of cognitive restructuring is to establish patterns
of thinking that are more adaptive (44) and less
stress provoking. Examples of cognitive restructuring are rational-emotive
therapy (50), rational behavior therapy (104),
cognitive therapy (16, 18, 19, 20), self-instructional
training (Meichenbaum, as cited in 44, 111, 112),
and structural psychotherapy (74).
A fundamental concept in rational-emotive therapy is the ABC
model. According to this model, consequences (C;
i.e., stress responses) occur as a result of beliefs (B;
i.e., appraisals) about antecedents (A; i.e.,
stressors). The main purpose of rational-emotive therapy is to is
identify irrational beliefs (i.e., stress-provoking appraisals)
and reveal why they do not make sense (50). A unique
feature of rational-emotive therapy is the philosophical emphasis
of its major goals (44):
- Social interest
- Tolerance of self and others
- Acceptance of uncertainty
- Commitment to vital interests
- Scientific thinking
- Realistic expectations in life (51).
Rational behavior therapy is essentially the same as
rational-emotive therapy, but it lacks the obvious philosophical
emphasis of rational-emotive therapy and focuses on neuropsychophysiology
(psychological relevance of brain functioning) and learning
theory (44). A central concept in rational behavior
therapy is that rational self-talk, which originates in the left
hemisphere of the brain, is converted by the right hemisphere of
the brain into appropriate emotional behavioral reactions (104).
Both rational behavior therapy and self-instructional training
involve self-talk, but self-instructional training involves a
specific type of self-talk, self-instruction. The idea
behind self-instructional training is that commands made to
oneself can be used in basic behavioral modification processes
like reinforcement (receiving a reward for desired
behavior) (Meichenbaum, as cited in 44). Clients are
taught six types of skills:
- Problem definition
- Problem approach
- Attention focussing
- Coping statements
- Error-correcting options
- Self-reinforcement (Kendall & Bemis, as cited in
In cognitive therapy, people learn to replace distorted
appraisals of events with more realistic appraisals (44).
Ten principles underlie cognitive therapy:
- Principle No. 1: It is based on a continuously
developing description of the client and his or her
- Principle No. 2: It requires a good relationship
between the therapist and the client.
- Principle No. 3: It emphasizes that the therapist
and the client should work together and actively
- Principle No. 4: It is goal orientated and problem
- Principle No. 5: It initially emphasizes the
present, focussing on current problems and current
- Principle No. 6: It strives to teach the client to
be his or her own therapist and emphasizes relapse
- Principle No. 7: It aims to be time limited,
involving a limited number of sessions.
- Principle No. 8: The sessions are structured.
- Principle No. 9: It teaches clients to identify,
evaluate, and respond to dysfunctional thoughts and
- Principle No. 10: It uses a variety of techniques
to change thoughts, feelings, and actions (20).
In particular, clients are taught the following skills:
- Monitoring automatic thoughts
- Recognizing the relations between thoughts, feelings, and
- Testing the validity of automatic thoughts
- Substituting more realistic thoughts for distorted
- Learning to identify and change the underlying
assumptions or beliefs that make themselves more likely
to engage in faulty thinking patterns (Kendall &
Bemis, as cited in 44)
Structural psychotherapy is similar to cognitive therapy, but
requires that an understanding of the development of and current
role of the clients knowledge of himself or herself and the world
be established (74).
Coping Skills Therapies
The goal of coping skills therapies is to develop a set of
skills designed to help people cope with a variety of stressful
situations (44). Examples of coping skills therapies
are systematic rational restructuring (68; 69),
anxiety-management training (159), and stress
inoculation training (111; 112; Meichenbaum, as cited in
The purpose of systematic rational restructuring, an extension
of systematic desensitization (reducing fears through
gradual exposure to feared stimuli paired with positive coping
experiences (13)), is to provide clients with more
effective coping abilities by teaching them how to change the
thoughts that occur automatically in anxiety-provoking
situations. Systematic rational restructuring consists of five
- Exposure to anxiety-provoking situations through imagery
- Self-evaluation of anxiety level
- Monitoring of anxiety-provoking thoughts
- Rational reevaluation of the anxiety-provoking thoughts
- Self-evaluation of anxiety level following the rational
reevaluation (Godfried, as cited in 44)
Though anxiety-management training, clients learn to use
relaxation and competency skills to control anxiety without
paying any attention to the anxiety-provoking stimuli (159).
Clients visualize anxiety-provoking scenes that may be unrelated
to their specific problem and then practice relaxation skills and
imagine responding intelligently (158).
The rationale for stress inoculation training is that, if
clients can learn how to cope with mild levels of stress, they
will be prepared for or "inoculated" against
uncontrollable levels of stress (44). Stress
inoculation training consists of three stages:
- Conceptualization phase: Therapists establish a
working relationship with clients and help them
understand the nature of stress.
- Skills acquisition and rehearsal phase:
Clients develop and rehearse a variety of coping skills,
such as relaxation, cognitive restructuring, problem
solving, and self-instruction.
- Application and follow-through phase: Clients
practice using their coping skills in response to real or
imagined stressors (112).
The goal of problem-solving therapies is to develop general
strategies for solving a wide range of problems. Problem-solving
therapies are essentially a combination of cognitive
restructuring and coping skills therapies (44). In
general, problem-solving therapy involves fives stages:
- General orientation or "set":
a vague familiarity with the problem
- Problem definition and formulation: determining
exactly what the problem is
- Generation of alternatives: coming up with
several possible ways to try to solve the problem
- Decision making: deciding which method to use to
try to solve the problem
- Verification: evaluating how well the chosen
method worked to solve the problem (47)
Examples of problem-solving therapies are personal science (Mahoney,
as cited in 44) and self-control therapy (65;
Personal science teaches clients to use the skills used by
researchers to solve problems. The mnemonic SCIENCE represents
seven basic skills:
- S: Specify general problem area
- C: Collect data
- I: Identify patterns or sources
- E: Examine options
- N: Narrow and experiment
- C: Compare data
- E: Extend, revise, and replace (Mahoney, as
cited in 44)
Self-control therapy uses a variety of techniques to teach
clients how to correct six potential deficits in self-control
behavior across three phases of self-control that relate to
depression. In the self-monitoring phase, potential
deficits include selectively paying attention to negative events
and selectively paying attention to immediate instead of delayed
consequences of behaviors. In the self-evaluation phase,
potential deficits include being overly critical of oneself and
inaccurate conclusions about responsibility. In the self-reinforcement
phase, potential deficits include not rewarding oneself
sufficiently and punishing oneself too much (65; 133).
The purpose of relaxation techniques is to reduce stress
responses. Sometimes it is easy to relax just by getting a
massage, listening to calming music, or admiring peaceful works
of art. Similarly, simple environmental or ergonomic changes in
people's lives can be relaxing by allowing their interactions
with specific objects and their surroundings in general to be
less strenuous. Other times, however, people have trouble
relaxing and need to learn relaxation techniques. Relaxation
techniques include progressive muscle relaxation, autogenic
relaxation, meditation, the relaxation response,
diaphragmatic breathing, biofeedback, self-hypnosis.
Progressive muscle relaxation is accomplished by focusing on
muscle groups one at a time and tensing them for a few seconds,
releasing the tension, and focusing on the resulting feelings of
relaxation (23; 83).
Autogenic relaxation is accomplished by focusing on blood flow
and tense muscle groups and suggesting to oneself that he or she
is becoming more relaxed and warm (13).
In most types of meditation, people use special techniques to
focus their attention on one thing until they stop thinking about
anything and experience nothing but "pure awareness" (21).
People who meditate seem to have fewer problems associated with
stress, such as general anxiety, high blood pressure, and
insomnia (15). The relaxation response is a
stripped-down version transcendental meditation, a form of
mediation in which attention is focused on softly repeating a
specific vocalization (the mantra). The relaxation
response isolates this aspect of transcendental meditation (13),
and has been shown to reduce the stress hormones levels (21;
Diaphragmatic breathing is sustained, slow, rhythmical,
breathing that emphasizes the use of the diaphragm (54).
It can be thought of as a special way of breathing with your
stomach area instead of your chest area.
With biofeedback, special equipment records stress-related
physiological activity in people like heart rate, blood pressure,
and muscle tension and relays this information back to them as a
tone that changes frequency or a meter reading. The person uses
this information to learn to control these physiological
processes and reduce the stress responses (Budzynski &
Stoyva, as cited in 23)
Self-hypnosis is exactly what it sounds like, hypnotizing
oneself. Self-hypnosis can be used to give oneself suggestions of
relaxation. Hypnosis is a highly relaxing state in which people
are more responsive to suggestions (90). People
display five main changes while under hypnosis:
- Reduced planfulness: They do not initiate actions as
- Attention is redistributed: They tend to pay attention
exclusively to the voice of the hypnotist (which is their
own voice during self-hypnosis).
- Improved ability to fantasize: They are better able to
vividly imagine scenes or to relive remembered events.
- Better role-taking ability: It is easier for them to act
like other types of people, such as people of different
ages or the opposite sex.
- Reduced reality testing: They are less likely to question
the truthfulness of statements and are more willing to
accept apparent distortions of reality (77; 78).
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Aerobic exercise, weight lifting, yoga,
and tai chi are examples of forms of exercise that can
help with stress.
Aerobic exercise uses the large muscle groups in continuous,
repetitive motions and involves increased oxygen intake and
increased breathing and heart rates. Aerobic exercises include
the following types of exercise:
- Brisk walking
- Jumping rope (177)
An exercise program aimed at improving physical fitness should
include aerobic exercise 3 to 4 times a week for 20 to 30 minutes
preceded and followed by a 5- to 10-minute warm-up and cool-down
period, respectively (6; 152).
Weight lifting can be used to enhance muscular strength
or muscular endurance. Muscular strength is how much
force muscles can exert, and muscular endurance is how long
muscles can work before getting too tired (10).
Strength training involves lifting heavier weights for fewer
repetitions. Endurance training involves lifting lighter weights
for more repetitions (42). An exercise program aimed
at improving physical fitness should include strength training
with 8 to 12 repetitions of 8 to 10 types of lifts at least twice
a week (American College of Sports Medicine, as cited in 10).
Yoga involves aspects of meditation and special physical and
breathing techniques used to control bodily processes like heart
rate and blood pressure (99). It is one of the six
orthodox systems of Indian philosophy (136). Yoga is
not a religion, though; it is a way of life, combining the body,
mind, and spirit (54).
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Tai chi (also called tai chi chuan) is a style of
martial art based on the Chinese philosophy of Taoism. According
to tai chi principles, everything in the universe is made up of
two opposing yet united forces, yin and yang.
Tai chi movements are intended to build up the Qi, the
intrinsic energy that runs throughout the body along pathways
know as meridians. The object is to harmonize the body
and mind and become aware of internal conflicts that may be
causing tension (54; 102).
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4. Diet and
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and nutrition products available through Stress Less!
Switching to a diet that is healthier can relieve stress for
people who do not already have a healthy diet already, especially
for people who are overweight. No dietary secrets or miracle
diets can lead to long-term stress reduction (or weight loss).
People just need to eat right (54). The following
recommendations may be helpful for people who want to improve
- Eat more fresh fruits and vegetables, enough so that
fresh fruits and vegetables make up 50% to 75% of your
- Avoid processed foods and all foods that are stressful
for the body, such as artificial sweeteners, carbonated
soft drinks, chocolate, eggs, fried foods, junk foods,
pork, red meat, sugar, white flour products, foods
containing preservatives or heavy spices, and chips and
similar snack foods.
- Try getting rid of dairy products from your diet for 3
weeks. Then, slowly add them back into your diet and see
if stress responses coincide with them.
- Avoid caffeine.
- Avoid alcohol, nicotine, and mood-altering drugs.
- Follow a monthly fasting program, but make sure you know
what you are doing! (11)
Additionally, the following herbs are useful for relief from
stress and problems associated with stress:
- Lemon balm is a general remedy for stress and
helps with stress-related digestive problems.
- Damiana is a general remedy for stress and helps
with anxiety and depression after long-term stress.
- Skullcap is a general remedy for stress and
helps with headaches and panic attacks.
- St. John's wort is a general remedy for stress,
depression in particular.
- Motherwort helps with panic attacks.
- Linden helps with panic attacks and a fast or
irregular heart beat.
- Dan shen help with a fast or irregular heart
- Valerian helps with chronic anxiety and
- Codonopsis helps with nervous exhaustion, muscle
tension, and headaches.
- Ginseng (also called panax ginseng) and
Siberian ginseng help with short-term stress.
- Withania helps with long-term stress and
recovery from illness and fatigue. (34)
- Catnip causes drowsiness.
- Chamomile is a gentle relaxant and helps with
stress-related digestive problems.
- Hops helps with nervousness and restlessness.
- Kava kava relaxes the mind and the rest of the
- Passionflower is calming.
- Polygala root is soothing and calming.
- Sour jujube seed is soothing and calming. (11)
Regarding herbs, it is important to remember that they can
interact with medications that people may be taking and may have
adverse sideeffects for some people. Advice from a professional,
such as a physician or an herbalist, should be sought before
Over-the-counter pain relievers are used frequently by many
people to relieve the pain of some problems associated with
stress (13). Regarding prescription drugs for stress, amitriptyline,
an antidepressant drug, has been used to treat tension headaches (113).
Additionally, a wide variety of prescription drugs are used to
treat mental disorders and physical illnesses associated with
stress. Anxiety and depressive disorders, for instance, are often
treated with antianxiety agents and antidepressants,
respectively. Examples of antianxiety agents are as follows:
- Meprobamate (and other beta-blockers)
Examples of antidepressants are as follows:
- Heterocyclic (or multicyclic) antidepressants (HCAs):
tricyclic antidepressants (TCAs), maprotiline, and
- Selective serotonin reuptake inhibitors (SSRIs)
- Monoamine-oxidase inhibitors (MAOIs)
- Atypical antidepressants: bupropion, nefazodone
trazodone, venlafaxine (105)
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