What is stress

Stress is a normal psychological, physical and emotional reaction that people experience as they encounter changes in and demands of life ¹. Stress is a normal feeling – a small amount of stress can be good, motivating you to perform well ². However, multiple challenges daily, such as sitting in traffic, meeting deadlines and paying bills, can push you beyond your ability to cope. Furthermore, long-term stress may contribute to or worsen a range of health problems including digestive disorders, headaches, sleep disorders, and other symptoms. Stress may worsen asthma and has been linked to depression, anxiety, and other mental illnesses.

Your brain comes hard-wired with an alarm system for your protection. When your brain perceives a threat, it signals your body to release a burst of hormones that increase your heart rate and raise your blood pressure. This “fight-or-flight” response fuels you to deal with the threat.

Once the threat is gone, your body is meant to return to a normal, relaxed state. Unfortunately, the nonstop complications of modern life mean that some people’s alarm systems rarely shut off.

Some people use stress management or relaxation techniques (also called relaxation response techniques) to release tension and to counteract the ill effects of stress. Relaxation technique gives you a range of tools to reset your alarm system. It can help your mind and body adapt (resilience). Without it, your body might always be on high alert. Over time, chronic stress can lead to serious health problems.

Stress management or relaxation techniques often combine breathing and focused attention on pleasing thoughts and images to calm the mind and the body. Some examples of relaxation response techniques are autogenic training, biofeedback, deep breathing, guided imagery, progressive relaxation, and self-hypnosis. Mind and body practices, such as meditation and yoga, are also sometimes considered relaxation techniques.

Take the first step

Recognizing a problem is the first step toward solving it. By beginning to identify and understand the sources of your stress, you’ve taken the first step in learning to better manage it. Manage it, not eliminate it. Stress is a fact of life. And that’s OK. You can learn ways to handle it.

Don’t wait until stress damages your health, relationships or quality of life. Start practicing stress management and relaxation techniques today.

What’s the difference between normal stress and anxiety ?

Stress is a normal psychological and physical reaction to positive or negative situations in your life, such as a new job or the death of a loved one. Stress itself isn’t abnormal or bad. What’s important is how you deal with stress.

Anxiety is part of stress. You may feel anxious before you take a test or walk down a dark street. This kind of anxiety is useful – it can make you more alert or careful. It usually ends soon after you are out of the situation that caused it. But for millions of people in the United States, the anxiety does not go away, and gets worse over time. They may have chest pains or nightmares. They may even be afraid to leave home. These people have anxiety disorders.

Types of anxiety disorder include:

• Panic disorder
• Obsessive-compulsive disorder
• Post-traumatic stress disorder
• Phobias
• Generalized anxiety disorder

Treatment can involve medicines, therapy or both.

Common anxiety signs and symptoms include:

• Feeling nervous, restless or tense
• Having a sense of impending danger, panic or doom
• Having an increased heart rate
• Breathing rapidly (hyperventilation)
• Sweating
• Trembling
• Feeling weak or tired
• Trouble concentrating or thinking about anything other than the present worry
• Having trouble sleeping
• Experiencing gastrointestinal (GI) problems
• Having difficulty controlling worry
• Having the urge to avoid things that trigger anxiety

Main types of stress

Stress is your body’s reaction to the demands of the world. Stressors are events or conditions in your surroundings that may trigger stress. Your body responds to stressors differently depending on whether the stressor is new or short term — acute stress — or whether the stressor has been around for a longer time — chronic stress ³.

Acute stress

Also known as the fight-or-flight response, acute stress is your body’s immediate reaction to a perceived threat, challenge or scare. The acute-stress response is immediate and intense, and in certain circumstances it can be thrilling. Examples of acute stressors include having a job interview or getting a speeding ticket.

A single episode of acute stress generally doesn’t cause problems for healthy people. However, severe acute stress can cause mental health problems — such as post-traumatic stress disorder. It can also cause physical difficulties such as tension headaches, stomach problems or serious health issues — such as a heart attack.

Chronic stress

Mild acute stress can actually be beneficial — it can spur you into action, motivate and energize you. The problem occurs when stressors pile up and stick around. This persistent stress can lead to health problems, such as headaches and insomnia. The chronic-stress response is more subtle than is the acute-stress response, but the effects may be longer lasting and more problematic.

Effective stress management involves identifying and managing both acute and chronic stress.

Stress and Disease

Although the exact role of stress in human diseases is not known, it is clear that stress can lead to particular diseases by temporarily inhibiting certain components of the immune system. Stress-related disorders include gastritis, ulcerative colitis, irritable bowel syndrome, hypertension, asthma, rheumatoid arthritis (RA), migraine headaches, anxiety, and depression. People under stress are at a greater risk of developing chronic disease or dying prematurely.

Interleukin-1, a substance secreted by macrophages of the immune system, is an important link between stress and immunity. One action of interleukin-1 is to stimulate secretion of adrenocorticotropic hormone (ACTH), which in turn stimulates the production of cortisol. Corisol, a corticosteroid hormone, is produced by the adrenal cortex and is known to be involved in the response to stress suppression in the immune system. Increased serum cortisol levels have been observed in connection with clinical depression and psychological stress involving stressors such as hypoglycemia, illness, fever, trauma, surgery, fear, pain, physical exertion or extremes of temperature. In normal release, cortisol has widespread actions that help restore homeostasis after stress. Cortisol acts as a physiological antagonist to insulin by promoting gluconeogenesis, breakdown of lipids and proteins, and mobilization of extrahepatic amino acids and ketone bodies. This leads to increased blood glucose concentrations, resulting in increased glycogen formation in the liver ⁴. In chronic stress, prolonged cortisol secretion causes muscle wastage, hyperglycemia, and suppresses immune/inflammatory responses. Moreover, long-term exposure to cortisol results in damage to cells of the hippocampus that may cause impaired learning.

However, short-term exposure of cortisol helps to create memory, and constitutes the proposed mechanism for the storage of flash bulb memories. Furthermore, cortisol provide resistance to stress and inflammation and it also suppresses further production of interleukin-1. Thus, the immune system turns on the stress response, and the resulting cortisol then turns off one immune system mediator. This negative feedback system keeps the immune response in check once it has accomplished its goal. Because of this activity, cortisol and other glucocorticoids are used as immunosuppressive drugs for organ transplant recipients.

What happens in your body during stress

Biochemical Changes

The responses to stressors may be pleasant or unpleasant, and they vary among people and even within the same person at different times.

Your body’s homeostatic mechanisms attempt to counteract stress. When they are successful, the internal environment remains within normal physiological limits. If stress is extreme, unusual, or long lasting, the normal mechanisms may not be enough. In 1936, Hans Selye, a pioneer in stress research, showed that a variety of stressful conditions or noxious agents elicit a similar sequence of bodily changes. These changes, called the stress response or general adaptation syndrome, are controlled mainly by the hypothalamus.

The stress response occurs in three stages:

1. Stage 1: an initial Fight-or-Flight Response,
2. Stage 2: a Slower Resistance reaction, and eventually
3. Stage 3: Exhaustion.

Research on the stress response has shown that many of the physiological alterations associated with stress are brought about by centrally controlled biochemical changes – stressors stimulate the hypothalamus to initiate the stress response through the fight-or-flight response and the resistance reaction. During situations perceived as being acutely stressful, the 2 main pathways activated are:

1. The Hypthothalamus-Pituitary-Adreno Axis and
   
2. The Sympatho-Adreno-Medullary Axis.

Both axes are activated by the hypothalamus secreting corticotrophin-releasing hormone (CRH), which causes the pituitary gland to release adrenocorticotropic hormone (ACTH). In the more rapidly acting of these pathways, the Sympatho-Adreno-Medullary axis, ACTH stimulates the adrenal medulla to release the catecholamines epinephrine and norepinephrine ⁵. These stress-induced alterations are directly linked to a number of the physiological changes that take place in the body including increases in blood pressure, heart rate, respiration, and oxygen consumption.8 In the slower-acting HPA axis, blood-borne ACTH acts on the adrenal cortex to release cortisol. Once in the bloodstream, cortisol induces metabolic changes in the liver, resulting in increased glucose concentrations in blood and tissues. The increased glucose produces adenosine triphosphate (ATP) to repair damaged cells and enables metabolically active cells throughout the body to respond to the stressor ⁵.

Figure 1. Hypthothalamus-Pituitary-Adreno Axis and Sympatho-Adreno-Medullary Axis

Note: Responses to stressors during the stress response. Red arrows (hormonal responses) and green arrows (neural responses) in (a) indicate immediate fight-or-flight reactions; black arrows in (b) indicate long-term resistance reactions.

The Fight-or-Flight Response (Stage 1 of Stress)

The fight-or-flight response, initiated by nerve impulses from the hypothalamus to the sympathetic division of the autonomic nervous system (ANS), including the adrenal medulla, quickly mobilizes the body’s resources for immediate physical activity (see Figure 1 above). It brings huge amounts of glucose and oxygen to the organs that are most active in warding off danger: the brain, which must become highly alert; the skeletal muscles, which may have to fight off an attacker or flee; and the heart, which must work vigorously to pump enough blood to the brain and muscles. During the fight-or-flight response, nonessential body functions such as digestive, urinary, and reproductive activities are inhibited. Reduction of blood flow to the kidneys promotes release of renin, which sets into motion the renin–angiotensin–aldosterone pathway. Aldosterone causes the kidneys to retain Na+, which leads to water retention and elevated blood pressure. Water retention also helps preserve body fluid volume in the case of severe bleeding.

The Resistance Reaction (Stage 2 of Stress)

The second stage in the stress response is the resistance reaction (Figure 1b). Unlike the short-lived fight-or-flight response, which is initiated by nerve impulses from the hypothalamus, the resistance reaction is initiated in large part by hypothalamic releasing hormones and is a longer-lasting response. The hormones involved are corticotropin-releasing hormone (CRH), growth hormone–releasing hormone (GHRH), and thyrotropin-releasing hormone (TRH).

Corticotropin-releasing hormone (CRH) stimulates the anterior pituitary to secrete adrenocorticotropic hormone (ACTH), which in turn stimulates the adrenal cortex to increase release of cortisol. Cortisol then stimulates gluconeogenesis by liver cells, breakdown of triglycerides into fatty acids (lipolysis), and catabolism of proteins into amino acids. Tissues throughout the body can use the resulting glucose, fatty acids, and amino acids to produce ATP (adenosine triphosphate is the energy packets necessary for cells to function) or to repair damaged cells. Cortisol also reduces inflammation.

A second hypothalamic releasing hormone, growth hormone–releasing hormone (GHRH), causes the anterior pituitary to secrete growth hormone (GH). Acting  via insulin like growth factors (ILGF), GH stimulates lipolysis and glycogenolysis, the breakdown of glycogen to glucose, in the liver. A third hypothalamic releasing hormone, thyrotropin-releasing hormone (TRH), stimulates the anterior pituitary to secrete thyroid-stimulating hormone (TSH). TSH promotes secretion of thyroid hormones, which stimulate the increased use of glucose for ATP production. The combined actions of GH and TSH supply additional ATP for metabolically active cells throughout the body.

The resistance stage helps the body continue fighting a stressor long after the fight-or-flight response dissipates. This is why your heart continues to pound for several minutes even after the stressor is removed. Generally, it is successful in seeing you through a stressful episode, and your bodies then return to normal. Occasionally, however, the resistance stage fails to combat the stressor, and the body moves into the state of exhaustion.

Stage of Exhaustion (Stage 3 of Stress)

The resources of the body may eventually become so depleted that they cannot sustain the resistance stage, and exhaustion ensues. Prolonged exposure to high levels of cortisol and other hormones involved in the resistance reaction causes wasting of muscle, suppression of the immune system, ulceration of the  gastrointestinal tract, and failure of pancreatic beta cells. In addition, pathological changes may occur because resistance reactions persist after the stressor has
been removed.

This puts you at increased risk of numerous health problems, including:

• Anxiety
• Depression
• Digestive problems
• Headaches
• Heart disease
• Sleep problems
• Weight gain
• Memory and concentration impairment

That’s why it’s so important to learn healthy ways to cope with the stressors in your life.

Figure 2. Comparative Impact of the Acute Stress and Relaxation Responses

Footnote:

Central and Peripheral Nervous System Activities

Using blood pressure as an example, we show how acute stress and relaxation responses alter hypothalamus-pituitary-adrenal (HPA) and sympatho-adreno-medullary (SAM) axis activities. These responses introduce contrasting hormonal and signal molecule changes that in turn influence clinically significant conditions such as high blood pressure. Epi = epinephrine or adrenaline /  Ne = norepinephrine or noradrenaline / SAM axis is the adrenal medulla to Ne and Epi / Cort = cortisol / NO = nitric oxide / HPA (hypothalamus-pituitary-adrenal) axis is the adrenal cortex to Cort (cortisol)

Why you react to life stressors the way you do?

Your reaction to a potentially stressful event is different from anyone else’s. How you react to stressors in your life is affected by such factors as:

• Genetics. The genes that control the stress response keep most people on a fairly even keel, only occasionally priming the body for fight or flight. Overactive or underactive stress responses may stem from slight differences in these genes.
• Life experiences. Strong stress reactions sometimes can be traced to traumatic events. People who were neglected or abused as children tend to be particularly vulnerable to stress. The same is true of people who have experienced violent crime, airplane crash survivors, military personnel, police officers and firefighters.

You may have some friends who seem laid-back about almost everything and others who react strongly at the slightest stress. Most reactions to life stressors fall somewhere between those extremes.

Men: Consider this when life throws you a curveball

Experts who study humans who face stress (that would include everyone who breathes) have discovered something interesting: Men’s and women’s bodies respond differently to stressful life events.

Why is this important to know? Because understanding how you cope can improve what scientists call your resilience — your ability to rebound from a challenge or setback.

A number of studies have found that men display more evidence of the “fight or flight” response to stress. The theory is that as men evolved and faced physical challenges, their bodies adapted to overcome (fight) or escape (flight) the inevitable physical threats in their environment.

The fight or flight physical response helped your ancient ancestors survive a life-threatening attack from a possible predator situation. But that same heart-pumping, palm-sweating response is not so helpful for today’s stressors that are mostly psychological — say, during a job interview, giving a speech or negotiating with a moody teen.

In fact, fight or flight can put a real damper on your life and mood. Scientists have found that when faced with stressful tasks, the sections of the male brain associated with vigilance and negative emotions fire up, suppressing activity in the brain associated with positive emotion and pleasure.

How do men adapt?

Researchers have noticed several trends in how men tend to cope with stress. They may be less likely to:

• Report symptoms of stress
• Participate in stress-relieving activities
• Say that they need emotional support
• Have a strong, diverse emotional support network.

It’s important to point out that many men are aware of their stress level and work to manage it. The key is to understand how you respond to stress so you can develop an ongoing plan for resiliency.

Signs and symptoms of stress

Stress symptoms may be affecting your health, even though you might not realize it. You may think illness is to blame for that nagging headache, your frequent insomnia or your decreased productivity at work. But stress may actually be the culprit.

Common effects of stress

Indeed, stress symptoms can affect your body, your thoughts and feelings, and your behavior. Being able to recognize common stress symptoms can give you a jump on managing them. Stress that’s left unchecked can contribute to many health problems, such as high blood pressure, heart disease, obesity and diabetes.

Common effects of stress on your body

• Headache
• Muscle tension or pain
• Chest pain
• Fatigue
• Change in sex drive
• Stomach upset
• Sleep problems

Common effects of stress on your mood

• Anxiety
• Restlessness
• Lack of motivation or focus
• Feeling overwhelmed
• Irritability or anger
• Sadness or depression

Common effects of stress on your behavior

• Overeating or undereating
• Angry outbursts
• Drug or alcohol abuse
• Tobacco use
• Social withdrawal
• Exercising less often.

Evaluate how you react to stress

One of the first steps toward good stress management is understanding how you react to stress — and making changes if necessary. Take an honest look at how you react to stress and then adopt or modify stress management techniques to make sure the stress in your life doesn’t lead to health problems.

Stress management skills often don’t come naturally. You can learn new stress management skills or modify your existing stress management skills to help you cope better, though.

First, take a look at how you react to stress. Some people seem to take everything in stride. Their naturally laid-back attitudes shine through, even in stressful situations. Another deadline? They can handle it. The dishwasher is leaking? No problem, it will be a simple repair. Others get anxious at the first sign of a stressful situation. Running late for a meeting? Time to panic! Stuck in a traffic jam? Let the cursing begin!

Here are some common but unhealthy reactions to stress. Do any of these describe your reactions? If you’re not sure, consider keeping a daily journal for a week or so to monitor your reactions to stressful situations.

• Pain. You may unconsciously clench your jaws or fists or develop muscle tension, especially in your neck and shoulders, all of which can lead to unexplained physical pain. Stress may also cause a variety of other health ailments, including upset stomach, shortness of breath, back pain, headaches and insomnia.
• Overeating. Stress may trigger you to eat even when you’re not hungry, or you may skip exercise. In contrast, you may eat less, actually losing weight when under more stress.
• Anger. Stress may leave you with a short temper. When you’re under pressure, you may find yourself arguing with co-workers, friends or loved ones — sometimes with little provocation or about things that have nothing to do with your stressful situation.
• Crying. Stress may trigger crying jags, sometimes seemingly without warning. Little things unrelated to your stress may leave you in tears. You also may feel lonely or isolated.
• Depression. Sometimes stress may be too much to take. You might avoid the problem, call in sick to work, feel hopeless or simply give up. Chronic stress can be a factor in the development of depression or anxiety disorders.
• Negativity. When you don’t cope well with stress, you may automatically expect the worst or magnify the negative aspects of any undesirable situation.
• Smoking. Even if you quit smoking long ago, a cigarette may seem like an easy way to relax when you’re under pressure. In fact, stress is a leading cause of having a smoking relapse. You may also find yourself turning to alcohol or drugs to numb the effects of stress.

When to seek help for stress

If you’re not sure if stress is the cause or if you’ve taken steps to control your stress but your symptoms continue, see your doctor. Your doctor may want to check for other potential causes. Or, consider seeing a professional counselor or therapist, who can help you identify sources of your stress and learn new coping tools.

Also, if you have chest pain, especially if it occurs during physical activity or is accompanied by shortness of breath, sweating, dizziness, nausea, or pain radiating into your shoulder and arm, get emergency help immediately. These may be warning signs of a heart attack and not simply stress symptoms.

How do I control stress-induced weight gain?

When you’re under stress, you may find it harder to eat healthy. Also, during times of particularly high stress, you may eat in an attempt to fulfill emotional needs — sometimes called stress eating or emotional eating. And you may be especially likely to eat high-calorie foods during times of stress, even when you’re not hungry.

To prevent weight gain during stress and reduce the risk of obesity, get a handle on your stress. When you feel less stressed and more in control of your life, you may find it easier to stick to healthy eating and exercise habits.

Try these stress management techniques to combat stress-related weight gain:

• Recognize the warning signs of stress, such as anxiety, irritability and muscle tension.
• Before eating, ask yourself why you’re eating — are you truly hungry or do you feel stressed or anxious?
• If you’re tempted to eat when you’re not hungry, find a distraction.
• Don’t skip meals, especially breakfast. If you’re in a hurry, grab a piece of fruit on the way out the door.
• Eat a healthy diet, such as whole grains and a variety of fruits and vegetables. Aim to include most food groups in your meals.
• Identify comfort foods and keep them out of your home or office.
• Keep a record of your behavior and eating habits so that you can look for patterns and connections — and then figure out how to overcome them.
• Learn problem-solving skills so that you can anticipate challenges and cope with setbacks.
• Practice relaxation skills, such as yoga, stretching, massage, deep breathing or meditation.
• Engage in regular physical activity or exercise.
• Get adequate sleep.
• Get encouragement from supportive friends and family.

If you try stress management techniques on your own but they don’t seem to be working, consider seeking professional help through psychotherapy or counseling.

How can I focus my attention and improve my concentration ?

Many people find it hard to focus, but it is a skill you can develop. To improve your focus:

• Reduce distractions. Turn off the TV, put down your phone and log out of your email account. Not convinced it’ll help? Eliminate noncritical screen time for two days and see how much more you get done.
• Plan for peaks and valleys. Are you a morning person? Then don’t squander that time on email. Instead, use it to tackle projects that require your full concentration. Save the afternoon for going through your inbox or catching up on your filing.
• Put it out of your mind. Too many mental notes make for a cluttered mind. All of that unfinished business can sap your mental energy. Put whatever’s on your mind on paper or capture it digitally. Think of it as off-site storage.
• Train your brain. Any skill worth having requires practice. Learning to focus is no different. Invest time in mastering attention training or meditation. Both are great ways to practice taming distractions and improving focus.

By sharpening your focus, you’ll not only get more done but also enjoy more flow — when you’re so absorbed in an activity that nothing else seems to matter. Flow can create a sense of fulfillment, engagement and even contentment.

How To Manage Stress – Stress Management Techniques

Stress management isn’t a first-aid kit you pull out only in emergencies. Rather, it’s a set of tools you can use every day to deal with the big and little issues that arise. It’s a good idea to keep your tools sharp and even to add a few to your collection from time to time.

Be prepared for setbacks. Don’t get discouraged if you occasionally fail to handle a stressful situation as well as you might like. Change takes time, and setbacks are part of the learning curve. Learn from the experience, and plan to clear that hurdle the next time. If you lapse back to your old ways, don’t give up. Focus on what you can do to regain control of the situation.

If you have stress symptoms, taking steps to manage your stress can have numerous health benefits.

Explore stress management strategies, such as:

• Regular physical activity
• Relaxation techniques, such as deep breathing, meditation, yoga, tai chi or getting a massage
• Keeping a sense of humor
• Socializing with family and friends
• Setting aside time for hobbies, such as reading a book or listening to music

Stress is more likely to rear its ugly head if you’re not taking care of yourself. So remember to put yourself first. These strategies can help you stay on course.

Aim to find active ways to manage your stress. Inactive ways you may use to manage stress — such as watching television, surfing the Internet or playing video games — may seem relaxing, but they may increase your stress over the long term.

And be sure to get plenty of sleep and eat a healthy, balanced diet. Avoid tobacco use, excess caffeine and alcohol intake, and the use of illicit substances.

Step #1 – Identify Your Stressors

The pace and challenges of modern life make stress management necessary for everyone. It is impossible to remove all of the stress from our everyday lives. Some stress, called eustress, prepares us to meet certain challenges and thus is helpful. Other stress, called distress, is harmful. Any stimulus that produces a stress response is called a stressor. A stressor may be almost any disturbance of the human body—heat or cold, environmental poisons, toxins given off by bacteria, heavy bleeding from a wound or surgery, or a strong emotional reaction.

Effective stress management starts with identifying your sources of stress and developing strategies to manage them. One way to do this is to make a list of the situations, concerns or challenges that trigger your stress response. Take a moment to write down some of the top issues you’re facing right now. You’ll notice that some of your stressors are events that happen to you while others seem to originate from within.

Know your triggers

To monitor your stress, first identify your triggers. What makes you feel angry, tense, worried or irritable ? Do you often get headaches or an upset stomach with no medical cause ?

It’s undeniable — life is full of stress. The kids are screaming, the bills are due and the pile of papers on your desk is growing at an alarming pace.

Some stressors, such as job pressures, relationship problems or financial concerns, are easy to identify. But daily hassles and demands, such as waiting in a long line or being late to a meeting, also contribute to your stress level.

Even essentially positive events, such as getting married or buying a house, can be stressful. Any change to your life can cause stress.

Understanding the types and sources of stress — short term and long term, internal and external — is an important part of stress management. So what stresses you out ?

Once you’ve identified your stress triggers, think about strategies for dealing with them. Identifying what you can control is a good starting point. For example, if stress keeps you up at night, the solution may be as easy as removing the TV and computer from your bedroom and letting your mind wind down before bed.

Other times, such as when stress is based on high demands at work or a loved one’s illness, you might be able to change only your reaction.

Don’t feel like you have to figure it out on your own. Seek help and support from family and friends, whether you need someone to listen to you, help with child care or a ride to work when your car’s in the shop.

Many people benefit from practices such as deep breathing, tai chi, yoga, meditation or being in nature. Set aside time for yourself. Get a massage, soak in a bubble bath, dance, listen to music, watch a comedy — whatever helps you relax.

Maintaining a healthy lifestyle will help you manage stress. Eat a healthy diet, exercise regularly and get enough sleep. Make a conscious effort to spend less time in front of a screen — television, tablet, computer and phone — and more time relaxing.

Stress won’t disappear from your life. And stress management needs to be ongoing. But by paying attention to what causes your stress and practicing ways to relax, you can counter some of the bad effects of stress and increase your ability to cope with challenges.

External stressors

External stressors are events and situations that happen to you. Some examples of external stressors include:

• Major life changes. These changes can be positive, such as a new marriage, a planned pregnancy, a promotion or a new house. Or they can be negative, such as the death of a loved one or a divorce.
• Environment. The input from the world around us can be a source of stress. Consider how you react to sudden noises, such as a barking dog, or how you react to a bright sunlit room or a dark room.
• Unpredictable events. Out of the blue, uninvited houseguests arrive. Or you discover your rent has gone up or that your pay has been cut.
• Workplace. Common stressors at work include an impossible workload, endless emails, urgent deadlines and a demanding boss.
• Social. Meeting new people can be stressful. Just think about going on a blind date, and you probably start to sweat. Relationships with family often spawn stress as well. Just think back to your last fight with your partner or child.

Strategies to manage external stressors include lifestyle factors such as eating a healthy diet, being physically active and getting enough sleep — which help boost your resiliency. Other helpful steps include asking for help from others, using humor, learning to be assertive, and practicing problem-solving and time management. Consider how you use your time and energy by focusing on activities that are important to you, paring down the number of activities you’re involved in, and saying no to new commitments.

Internal stressors

Not all stress stems from things that happen to you. Much of our stress response is self-induced. Those feelings and thoughts that pop into your head and cause you unrest are known as internal stressors. Examples of internal stressors include:

• Fears. Common ones include fear of failure, fear of public speaking and fear of flying.
• Uncertainty and lack of control. Few people enjoy not knowing or not being able to control what might happen. Think about how you might react when waiting for the results of a medical test.
• Beliefs. These might be attitudes, opinions or expectations. You may not even think about how your beliefs shape your experience, but these preset thoughts often set us up for stress. Consider the expectations you put on yourself to create a perfect holiday celebration or advance up the career ladder.

The good news is that we have the ability to control our thoughts. The bad news is that our fears, attitudes and expectations have been our companions for a long time and it often takes some effort to change them. Strategies to manage internal stressors include reframing your thoughts and choosing a positive mindset, challenging negative thoughts, using relaxation techniques, and talking with a trusted friend or counselor.

Step #2. Get active

Virtually any form of physical activity can act as a stress reliever. Even if you’re not an athlete or you’re out of shape, exercise can still be a good stress reliever.

• Exercise can help keep depression and anxiety at bay. Exercising about 30 minutes a day can benefit your body and mind.

Physical activity can pump up your feel-good endorphins and other natural neural chemicals that enhance your sense of well-being. Exercise can also refocus your mind on your body’s movements, which can improve your mood and help the day’s irritations fade away. Consider walking, jogging, gardening, housecleaning, biking, swimming, weightlifting or anything else that gets you active.

Step #3. Eat a healthy diet

Eating a healthy diet is an important part of taking care of yourself. Aim to eat a variety of fruits and vegetables, and whole grains.

A diet rich in fruits, vegetables and whole grains can give you more energy to keep stress under control. Caffeine may give you a jolt of energy, but it will wear off quickly.

Avoid unhealthy habits. Some people may deal with stress by drinking too much caffeine or alcohol, smoking, eating too much, or using illicit substances. These can affect your health in unhealthy ways.

Step #4. Connect with others

When you’re stressed and irritable, your instinct may be to wrap yourself in a cocoon. Instead, reach out to family and friends and make social connections.

Social contact is a good stress reliever because it can offer distraction, provide support and help you tolerate life’s up and downs. So take a coffee break with a friend, email a relative or visit your place of worship.

Got more time ? Considering volunteering for a charitable group and help yourself while helping others.

Step #5. Laugh more

Whether you’re guffawing at a sitcom on TV or quietly giggling at a newspaper cartoon, laughing does you good. Laughter is a great form of stress relief, and that’s no joke. A good sense of humor can’t cure all ailments, but it can help you feel better, even if you have to force a fake laugh through your grumpiness. When you laugh, it not only lightens your mental load but also causes positive physical changes in your body. Laughter fires up and then cools down your stress response. So read some jokes, tell some jokes, watch a comedy or hang out with your funny friends.

Stress relief from laughter

A good sense of humor can’t cure all ailments, but data is mounting about the positive things laughter can do.

Short-term benefits

A good laugh has great short-term effects. When you start to laugh, it doesn’t just lighten your load mentally, it actually induces physical changes in your body.

Laughter can:

• Stimulate many organs. Laughter enhances your intake of oxygen-rich air, stimulates your heart, lungs and muscles, and increases the endorphins that are released by your brain.
• Activate and relieve your stress response. A rollicking laugh fires up and then cools down your stress response, and it can increase your heart rate and blood pressure. The result? A good, relaxed feeling.
• Soothe tension. Laughter can also stimulate circulation and aid muscle relaxation, both of which can help reduce some of the physical symptoms of stress.

Long-term effects

Laughter isn’t just a quick pick-me-up, though. It’s also good for you over the long term. Laughter may:

• Improve your immune system. Negative thoughts manifest into chemical reactions that can affect your body by bringing more stress into your system and decreasing your immunity. In contrast, positive thoughts can actually release neuropeptides that help fight stress and potentially more-serious illnesses.
• Relieve pain. Laughter may ease pain by causing the body to produce its own natural painkillers.
• Increase personal satisfaction. Laughter can also make it easier to cope with difficult situations. It also helps you connect with other people.
• Improve your mood. Many people experience depression, sometimes due to chronic illnesses. Laughter can help lessen your depression and anxiety and may make you feel happier.

Improve your sense of humor

Are you afraid you have an underdeveloped — or nonexistent — sense of humor? No problem. Humor can be learned. In fact, developing or refining your sense of humor may be easier than you think.

Put humor on your horizon. Find a few simple items, such as photos, greeting cards or comic strips, that make you chuckle. Then hang them up at home or in your office. Keep funny movies, books or comedy albums on hand for when you need an added humor boost. Look online at joke websites. Go to a comedy club.

Laugh and the world laughs with you. Find a way to laugh about your own situations and watch your stress begin to fade away. Even if it feels forced at first, practice laughing. It does your body good.

Consider trying laughter yoga. In laughter yoga, people practice laughter as a group. Laughter is forced at first, but it can soon turn into spontaneous laughter.

Share a laugh. Make it a habit to spend time with friends who make you laugh. And then return the favor by sharing funny stories or jokes with those around you.

Knock, knock. Browse through your local bookstore or library’s selection of joke books and get a few rib ticklers in your repertoire that you can share with friends.

• Know what isn’t funny. Don’t laugh at the expense of others. Some forms of humor aren’t appropriate. Use your best judgment to discern a good joke from a bad, or hurtful, one.

Laughter is the best medicine

Go ahead and give it a try. Turn the corners of your mouth up into a smile and then give a laugh, even if it feels a little forced. Once you’ve had your chuckle, take stock of how you’re feeling. Are your muscles a little less tense? Do you feel more relaxed or buoyant? That’s the natural wonder of laughing at work.

Step #6. Meditate

If stress has you anxious, tense and worried, consider trying meditation. Spending even a few minutes in meditation can restore your calm and inner peace.

Anyone can practice meditation. It’s simple and inexpensive, and it doesn’t require any special equipment.

And you can practice meditation wherever you are — whether you’re out for a walk, riding the bus, waiting at the doctor’s office or even in the middle of a difficult business meeting.

During meditation, you focus your attention and quiet the stream of jumbled thoughts that may be crowding your mind and causing stress. Meditation can instill a sense of calm, peace and balance that can benefit both your emotional well-being and your overall health.

Understanding meditation

Meditation has been practiced for thousands of years. Meditation originally was meant to help deepen understanding of the sacred and mystical forces of life. These days, meditation is commonly used for relaxation and stress reduction.

Meditation is considered a type of mind-body complementary medicine. Meditation can produce a deep state of relaxation and a tranquil mind.

During meditation, you focus your attention and eliminate the stream of jumbled thoughts that may be crowding your mind and causing stress. This process may result in enhanced physical and emotional well-being.

Elements of meditation

Different types of meditation may include different features to help you meditate. These may vary depending on whose guidance you follow or who’s teaching a class. Some of the most common features in meditation include:

• Focused attention. Focusing your attention is generally one of the most important elements of meditation.

Focusing your attention is what helps free your mind from the many distractions that cause stress and worry. You can focus your attention on such things as a specific object, an image, a mantra, or even your breathing.

• Relaxed breathing. This technique involves deep, even-paced breathing using the diaphragm muscle to expand your lungs. The purpose is to slow your breathing, take in more oxygen, and reduce the use of shoulder, neck and upper chest muscles while breathing so that you breathe more efficiently.

• A quiet setting. If you’re a beginner, practicing meditation may be easier if you’re in a quiet spot with few distractions, including no television, radios or cellphones.

As you get more skilled at meditation, you may be able to do it anywhere, especially in high-stress situations where you benefit the most from meditation, such as a traffic jam, a stressful work meeting or a long line at the grocery store.

• A comfortable position. You can practice meditation whether you’re sitting, lying down, walking, or in other positions or activities. Just try to be comfortable so that you can get the most out of your meditation. Aim to keep good posture during meditation.
• Open attitude. Let thoughts pass through your mind without judgment.

Benefits of meditation

Meditation can give you a sense of calm, peace and balance that can benefit both your emotional well-being and your overall health.

And these benefits don’t end when your meditation session ends. Meditation can help carry you more calmly through your day and may help you manage symptoms of certain medical conditions.

Meditation and emotional well-being

When you meditate, you may clear away the information overload that builds up every day and contributes to your stress.

The emotional benefits of meditation can include:

• Gaining a new perspective on stressful situations
• Building skills to manage your stress
• Increasing self-awareness
• Focusing on the present
• Reducing negative emotions
• Increasing imagination and creativity
• Increasing patience and tolerance

Meditation and illness

Meditation might also be useful if you have a medical condition, especially one that may be worsened by stress.

While a growing body of scientific research supports the health benefits of meditation, some researchers believe it’s not yet possible to draw conclusions about the possible benefits of meditation.

With that in mind, some research suggests that meditation may help people manage symptoms of conditions such as:

• Anxiety
• Asthma
• Cancer
• Chronic pain
• Depression
• Heart disease
• High blood pressure
• Irritable bowel syndrome
• Sleep problems
• Tension headaches

Be sure to talk to your health care provider about the pros and cons of using meditation if you have any of these conditions or other health problems. In some cases, meditation can worsen symptoms associated with certain mental and physical health conditions.

Meditation isn’t a replacement for traditional medical treatment. But it may be a useful addition to your other treatment.

Types of meditation

Meditation is an umbrella term for the many ways to a relaxed state of being. There are many types of meditation and relaxation techniques that have meditation components. All share the same goal of achieving inner peace.

Ways to meditate can include:

• Guided meditation. Sometimes called guided imagery or visualization, with this method of meditation you form mental images of places or situations you find relaxing.

You try to use as many senses as possible, such as smells, sights, sounds and textures. You may be led through this process by a guide or teacher.

• Mantra meditation. In this type of meditation, you silently repeat a calming word, thought or phrase to prevent distracting thoughts.

• Mindfulness meditation. This type of meditation is based on being mindful, or having an increased awareness and acceptance of living in the present moment.

In mindfulness meditation, you broaden your conscious awareness. You focus on what you experience during meditation, such as the flow of your breath. You can observe your thoughts and emotions, but let them pass without judgment.

• Qi gong. This practice generally combines meditation, relaxation, physical movement and breathing exercises to restore and maintain balance. Qi gong is part of traditional Chinese medicine.

• Tai chi. This is a form of gentle Chinese martial arts. In tai chi, you perform a self-paced series of postures or movements in a slow, graceful manner while practicing deep breathing.

• Transcendental Meditation. Transcendental Meditation is a simple, natural technique. In Transcendental Meditation, you silently repeat a personally assigned mantra, such as a word, sound or phrase, in a specific way.

This form of meditation may allow your body to settle into a state of profound rest and relaxation and your mind to achieve a state of inner peace, without needing to use concentration or effort.

• Yoga. You perform a series of postures and controlled breathing exercises to promote a more flexible body and a calm mind. As you move through poses that require balance and concentration, you’re encouraged to focus less on your busy day and more on the moment.

Everyday ways to practice meditation

Don’t let the thought of meditating the “right” way add to your stress. If you choose to, you can attend special meditation centers or group classes led by trained instructors. But you can also practice meditation easily on your own.

And you can make meditation as formal or informal as you like, however it suits your lifestyle and situation. Some people build meditation into their daily routine. For example, they may start and end each day with an hour of meditation. But all you really need is a few minutes of quality time for meditation.

Here are some ways you can practice meditation on your own, whenever you choose:

• Breathe deeply. This technique is good for beginners because breathing is a natural function.

Focus all your attention on your breathing. Concentrate on feeling and listening as you inhale and exhale through your nostrils. Breathe deeply and slowly. When your attention wanders, gently return your focus to your breathing.

• Scan your body. When using this technique, focus attention on different parts of your body. Become aware of your body’s various sensations, whether that’s pain, tension, warmth or relaxation.

Combine body scanning with breathing exercises and imagine breathing heat or relaxation into and out of different parts of your body.

• Walk and meditate. Combining a walk with meditation is an efficient and healthy way to relax. You can use this technique anywhere you’re walking, such as in a tranquil forest, on a city sidewalk or at the mall.

When you use this method, slow down your walking pace so that you can focus on each movement of your legs or feet. Don’t focus on a particular destination. Concentrate on your legs and feet, repeating action words in your mind such as “lifting,” “moving” and “placing” as you lift each foot, move your leg forward and place your foot on the ground.

• Read and reflect. Many people report that they benefit from reading poems or sacred texts, and taking a few moments to quietly reflect on their meaning.

You can also listen to sacred music, spoken words, or any music you find relaxing or inspiring. You may want to write your reflections in a journal or discuss them with a friend or spiritual leader.

• Focus your love and gratitude. In this type of meditation, you focus your attention on a sacred image or being, weaving feelings of love, compassion and gratitude into your thoughts. You can also close your eyes and use your imagination or gaze at representations of the image.

Building your meditation skills

Don’t judge your meditation skills, which may only increase your stress. Meditation takes practice.

Keep in mind, for instance, that it’s common for your mind to wander during meditation, no matter how long you’ve been practicing meditation. If you’re meditating to calm your mind and your attention wanders, slowly return to the object, sensation or movement you’re focusing on.

Experiment, and you’ll likely find out what types of meditation work best for you and what you enjoy doing. Adapt meditation to your needs at the moment. Remember, there’s no right way or wrong way to meditate. What matters is that meditation helps you reduce your stress and feel better overall.

Step #7. Learn To Assert yourself

You might want to do it all, but you can’t, at least not without paying a price. Learning to say no or being willing to delegate can help you manage your to-do list and your stress.

Saying yes may seem like an easy way to keep the peace, prevent conflicts and get the job done right. But it may actually cause you internal conflict because your needs and those of your family come second, which can lead to stress, anger, resentment and even the desire to exact revenge. And that’s not a very calm and peaceful reaction.

Take control of your surroundings. Is the traffic insane? Leave early for work or take the longer, less traveled route. Hate waiting in line at the corporate cafeteria? Pack your lunch and eat at your desk or in a break room.

Respectfully ask others to change their behavior. And be willing to do the same. Small problems often create larger ones if they aren’t resolved. If you’re tired of being the target of a friend’s jokes at parties, ask him or her to leave you out of the comedy routine. In return, be willing to enjoy his or her other jokes and thank him or her for humoring you.

Manage your time better. Lump together similar tasks — group your phone calls, car errands and computer-related tasks. The reward of increased efficiency will be extra time.

State limits in advance. Instead of stewing over a colleague’s nonstop chatter, politely start the conversation with, “I’ve got only five minutes to cover this.”

When and how to say no

Sure it’s easier to say yes, but at what price to your peace of mind? Here’s why saying no may be a healthier option for stress relief.

Why say no?

The number of worthy requests isn’t likely to lessen, and you can’t add more time to your day. Are you doomed to be over committed ? The answer is no, not if you’re willing to say no. It may not be the easy way, but it is a path to stress relief.

Keep in mind that being overloaded is individual. Just because your co-worker can juggle 10 committees with seeming ease doesn’t mean you should be able to be in several committees. Only you can know what’s too much for you.

Scale back. Cut back on your obligations when possible. While it may seem easier said than done, take a close look at your daily, weekly and monthly schedule and find meetings, activities, dinners or chores that you can cut back on or delegate to someone else.

Consider these reasons for saying no:

• Saying no isn’t necessarily selfish. When you say no to a new commitment, you’re honoring your existing obligations and ensuring that you’ll be able to devote high-quality time to them.
• Saying no can allow you to try new things. Just because you’ve always helped plan the company softball tournament doesn’t mean you have to do it forever.
• Saying no gives you time to pursue other interests.
• Always saying yes isn’t healthy. When you’re over committed and under too much stress, you’re more likely to feel run-down and possibly get sick.
• Saying yes can cut others out. On the other hand, when you say no, you open the door for others to step up. Or you can delegate someone to take over the task. They may not do things the way you would, but that’s OK. They’ll find their own way.

When to say no

Sometimes it’s tough to determine which activities deserve your time and attention. Use these strategies to evaluate obligations — and opportunities — that come your way.

• Focus on what matters most. Examine your obligations and priorities before making any new commitments. Ask yourself if the new commitment is important to you. If it’s something you feel strongly about, by all means do it. If not, take a pass.
• Weigh the yes-to-stress ratio. Is the new activity you’re considering a short- or long-term commitment? For example, making a batch of cookies for the school bake sale will take far less time than heading up the school fundraising committee. Don’t say yes if it will mean months of added stress. Instead, look for other ways to pitch in.
• Take guilt out of the equation. Don’t agree to a request you would rather decline out of guilt or obligation. Doing so will likely lead to additional stress and resentment.
• Sleep on it. Are you tempted by a friend’s invitation to volunteer at your old alma mater or to join a weekly golf league? Before you respond, take a day to think about the request and how it fits in with your current commitments. If you can’t sleep on it, at least take the time to think the request through before answering.

How to say no

“No”. See how simple it is to say one little word, allowing you to take a pass on tasks that don’t make the cut? Of course, there will be times when it’s just not that easy. Here are some things to keep in mind when you need to say no:

• Say no. The word “no” has power. Don’t be afraid to use it. Be careful about using wimpy substitute phrases, such as “I’m not sure” or “I don’t think I can.” These can be interpreted to mean that you might say yes later.
• Be brief. State your reason for refusing the request, but don’t go on about it. Avoid elaborate justifications or explanations.
• Be honest. Don’t fabricate reasons to get out of an obligation. The truth is always the best way to turn down a friend, family member or co-worker.
• Be respectful. Many good causes may land at your door, and it can be tough to turn them down. Complimenting the group’s effort while saying that you can’t commit shows that you respect what they’re trying to accomplish.
• Be ready to repeat. You may need to refuse a request several times before the other person accepts your response. When that happens, just hit the replay button. Calmly repeat your no, with or without your original rationale, as needed.

Saying no won’t be easy if you’re used to saying yes all the time. But learning to say no is an important part of simplifying your life and managing your stress. And with practice, you may find saying no gets easier.

Step #8. Get enough sleep

Sleep plays a vital role in good health and well-being throughout your life. Getting enough quality sleep at the right times can help protect your mental health, physical health, quality of life, and safety ⁶.

The way you feel while you’re awake depends in part on what happens while you’re sleeping ⁶. During sleep, your body is working to support healthy brain function and maintain your physical health. In children and teens, sleep also helps support growth and development.

The damage from sleep deficiency can occur in an instant (such as a car crash), or it can harm you over time. For example, ongoing sleep deficiency can raise your risk for some chronic health problems. It also can affect how well you think, react, work, learn, and get along with others.

There has been considerable debate in the scientific community about the importance of sleep, but some proposed functions of sleep are widely accepted:

1. Restoration, providing time for the body to repair itself;
2. Consolidation of memories;
3. Enhancement of immune system function; and
4. Maturation of the brain.

And the quality and amount of sleep you get can affect your mood, energy level, concentration and overall functioning. If you have sleep troubles, make sure that you have a quiet, relaxing bedtime routine, listen to soothing music, put clocks away, and stick to a consistent schedule.

The table below shows general recommendations for different age groups. This table reflects recent American Academy of Sleep Medicine recommendations that the American Academy of Pediatrics has endorsed.

Table 1. Recommended Amount of Sleep

Age	Recommended Amount of Sleep
Infants aged 4-12 months	12-16 hours a day (including naps)
Children aged 1-2 years	11-14 hours a day (including naps)
Children aged 3-5 years	10-13 hours a day (including naps)
Children aged 6-12 years	9-12 hours a day
Teens aged 13-18 years	8-10 hours a day
Adults aged 18 years or older	7–8 hours a day

[Source ⁶]

Step #9. Try yoga

With its series of postures and controlled-breathing exercises, yoga is a popular stress reliever. Yoga brings together physical and mental disciplines which may help you achieve peacefulness of body and mind. Yoga can help you relax and manage stress and anxiety.

Try yoga on your own or find a class — you can find classes in most communities. Hatha yoga, in particular, is a good stress reliever because of its slower pace and easier movements.

Step #10. Seek counseling

If new stressors are challenging your ability to cope or if self-care measures just aren’t relieving your stress, you may need to look for reinforcements in the form of therapy or counseling. Therapy also may be a good idea if you feel overwhelmed or trapped, if you worry excessively, or if you have trouble carrying out daily routines or meeting responsibilities at work, home or school.

Professional counselors or therapists can help you identify sources of your stress and learn new coping tools.

Cognitive Behavioural Therapy (CBT)

The Royal College of Psychiatrists defines cognitive behavioral therapy as a way of talking about:

• How you think about yourself, the world and other people
• How what you do affects your thoughts and feelings.

They say that CBT can help you to change how you think (the cognitive part) and what you do (the behavioral part). These changes can help you to feel better. Unlike some of the other talking treatments, it focuses on the “here and now” difficulties. Instead of focusing on the causes of your distress or symptoms in the past, it looks for ways to improve your state of mind now.

If you are not sure you want to commit to a long course of sessions with a clinical psychologist, there are various resources on the Internet which will provide an introduction to CBT or even a course of computer-aided CBT sessions:

• Developed by the Australian National University, MoodGYM (https://moodgym.com.au/) is a fun, free interactive web program that teaches the principles of CBT using flashed diagrams and online exercises. MoodGYM (https://moodgym.com.au/) demonstrates the relationship between thoughts and emotions, and works through dealing with stress and relationship break-ups, as well as teaching relaxation and meditation techniques. It consists of five modules (why you feel the way you do, changing the way you think, changing ‘warped’ thoughts, knowing what makes you upset, assertiveness and interpersonal skills training), an interactive game, anxiety and depression assessments, downloadable relaxation audio, a workbook and feedback assessment. Scientific trials have shown that using two or more modules is linked to significant reductions in depression and anxiety symptoms. These benefits last after 12 months. MoodGYM has won several IT and health awards, and has over 1,000,000 users worldwide. MoodGYM (https://moodgym.com.au/)

• Living Life to the Full (https://llttf.com/) is a free online life skills course for people feeling distressed. It aims to provide easy access to CBT skills in a way that cuts through jargon. It helps you understand why you feel as you do, and to learn new ways of improving how you feel, by making changes in your thinking, activities, sleep and relationships. The course is based on the idea of helping you to help yourself. It is supported by a series of CBT self-help workbooks that can be used between the e-learning sessions. These encourage you to put what you are learning into practice, and to stop, think and reflect on what you are learning. Living Life to the Full (https://llttf.com/)

• FearFighter (http://www.fearfighter.com/) delivers CBT over the internet, useful for those who may be concerned about the stigma associated with seeing a therapist. Taking only three months to complete, with minimal telephone support, FearFighter helps you improve even if you have virtually no computer skills. You are encouraged to use FearFighter as often as you wish but for at least once a week. It helps you identify specific problems, work on realistic treatment goals, and monitor achievement of those goals by repeated self-exposure. You get scheduled brief helpline support to a total of one hour over 10 weeks. FearFighter helps you to work out exactly what brings on your fear, so you can learn how to face it until it subsides. This is called exposure therapy. It consists of nine steps that need to be worked through one by one to obtain the greatest benefits. Like a therapist, FearFighter asks you to return every week to report on how you’ve been doing. You can ask it to print out questionnaires and graphs of your progress. It guides you through CBT as much as a therapist does.
  • Step 1: Welcome to FearFighter – Introduces the system, asks you to rate your problem on the Fear Questionnaire (FQ) and Work & Social Adjustment Scale (WSA), and asks about suicidal feelings and alcohol misuse.
  • Step 2: How to Beat Fear – Explains the principles of CBT, with case examples. You are asked to keep a daily record of your triggers.
  • Step 3: Problem Sorting – Helps you identify your triggers, shows you scenarios relevant to your problem, and helps you personalise your triggers and rate them on a 0-8 scale.
  • Step 4: How to Get a Helper – Explains the value of recruiting a CBT co-therapist and gives hints on how to find one.
  • Step 5: Setting Goals – Guides you through the process of setting good goals and tests them. You record and rate these on the system and can print personalised homework diaries.
  • Step 6: Managing anxiety – Offers a menu of coping strategies for use during CBT homework.
  • Step 7: Rehearsing Goals – Guides you on how to practise personal coping strategies during both imagined and live CBT homework.
  • Step 8: Carrying On – Reviews progress with the help of graphs, allows new goals to be devised, and offers feedback and advice.
  • Step 9: Troubleshooting – Offers a menu of tips on overcoming common sticking points in treatment.

You may have found that when you avoid things that make you panic or feel uncomfortable, the situation tends to get worse and worse. FearFighter can teach you how to face your fear until you adapt and no longer want to run away from it. It helps you learn to face the things that make you panic, such that, with time, you’ll find that, one by one, they’ll get easier.

Self-exposure therapy guided by computer is as effective as clinician-guided therapy and both are superior to relaxation to improve phobia/panic. FearFighter has been tested in four clinical trials and is as effective as the best CBT therapists.

Approved by the National Institute of Clinical Excellence (NICE), free access can only be prescribed by your doctor in England and Wales. FearFighter (http://www.fearfighter.com/)

Step #11. Keep a journal

Writing down your thoughts and feelings can be a good release for otherwise pent-up emotions. Don’t think about what to write — just let it happen. Write whatever comes to mind. No one else needs to read it, so don’t strive for perfection in grammar or spelling.

Just 10 to 20 minutes of quiet reflection may bring relief from chronic stress, as well as increase your tolerance to it. Listen to music, relax, and try to think of pleasant things or nothing at all. If you feel your muscles tense during your day, take a minibreak. Breathe deeply, inhale, pause for a second and then slowly exhale.

Just let your thoughts flow on paper — or computer screen. Once you’re done, you can toss out what you wrote or save it to reflect on later.

Step #12. Get musical and be creative

Listening to or playing music is a good stress reliever because it can provide a mental distraction, reduce muscle tension and decrease stress hormones. Crank up the volume and let your mind be absorbed by the music.

If music isn’t one of your interests, turn your attention to another hobby you enjoy, such as gardening, sewing, sketching — anything that requires you to focus on what you’re doing rather than what you think you should be doing. You can also try reading, crafts, tinkering with electronics, fishing, carpentry, music — things that you don’t get competitive or more stressed out about.

When you engage in something enjoyable, it can soothe and calm your restless mind.

Step #13. Spirituality and stress relief

What is spirituality?

Spirituality has many definitions, but at its core spirituality helps to give your life context. It’s not necessarily connected to a specific belief system or even religious worship. Instead, it arises from your connection with yourself and with others, the development of your personal value system, and your search for meaning in life.

For many, spirituality takes the form of religious observance, prayer, meditation or a belief in a higher power. For others, it can be found in nature, music, art or a secular community. Spirituality is different for everyone.

Taking the path less traveled by exploring your spirituality can lead to a clearer life purpose, better personal relationships and enhanced stress management skills.

Some stress relief tools are very tangible: exercising more, eating healthy foods and talking with friends. A less tangible — but no less useful — way to find stress relief is through spirituality.

How can spirituality help with stress relief?

Spirituality has many benefits for stress relief and overall mental health. It can help you:

• Feel a sense of purpose. Cultivating your spirituality may help uncover what’s most meaningful in your life. By clarifying what’s most important, you can focus less on the unimportant things and eliminate stress.
• Connect to the world. The more you feel you have a purpose in the world, the less solitary you may feel — even when you’re alone. This can lead to a valuable inner peace during difficult times.
• Release control. When you feel part of a greater whole, you may realize that you aren’t responsible for everything that happens in life. You can share the burden of tough times as well as the joys of life’s blessings with those around you.
• Expand your support network. Whether you find spirituality in a church, mosque or synagogue, in your family, or in nature walks with a friend, this sharing of spiritual expression can help build relationships.
• Lead a healthier life. People who consider themselves spiritual may be better able to cope with stress and may experience health benefits.

Discovering your spirituality

Uncovering your spirituality may take some self-discovery. Here are some questions to ask yourself to discover what experiences and values define you:

• What are your important relationships?
• What do you value most in your life?
• What people give you a sense of community?
• What inspires you and gives you hope?
• What brings you joy?
• What are your proudest achievements?

The answers to such questions can help you identify the most important people and experiences in your life. With this information, you can focus your search for spirituality on the relationships and activities in life that have helped define you as a person and those that continue to inspire your personal growth.

Cultivating your spirituality

Spirituality also involves getting in touch with your inner self. A key component is self-reflection. Try these tips:

• Try prayer, meditation, mindfulness and relaxation techniques to help focus your thoughts and find peace of mind.
• Keep a journal to help you express your feelings and record your progress.
• Seek out a trusted adviser or friend who can help you discover what’s important to you in life. Others may have insights that you haven’t yet discovered.
• Read inspirational stories or essays to help you evaluate different philosophies of life.
• Talk to others whose spiritual lives you admire. Ask questions to learn how they found their way to a fulfilling spiritual life.

Nurturing your relationships

Spirituality is also nurtured by your relationships with others. Realizing this, it’s essential to foster relationships with the people who are important to you. This can lead to a deepened sense of your place in life and in the greater good.

• Make relationships with friends and family a priority. Give more than you receive.
• See the good in people and in yourself. Accept others as they are, without judgment.
• Contribute to your community by volunteering.

Pursuing a spiritual life

Staying connected to your inner spirit and the lives of those around you can enhance your quality of life, both mentally and physically. Your personal concept of spirituality may change with your age and life experiences, but it always forms the basis of your well-being, helps you cope with stressors large and small, and affirms your purpose in life.

Step #14. Build skills to endure hardship

Resilience means being able to adapt to life’s misfortunes and setbacks. Test your resilience level and get tips to build your own resilience.

When something goes wrong, do you tend to bounce back or fall apart?

When you have resilience, you harness inner strength that helps you rebound from a setback or challenge, such as a job loss, an illness, a disaster or the death of a loved one. If you lack resilience, you might dwell on problems, feel victimized, become overwhelmed or turn to unhealthy coping mechanisms, such as substance abuse.

Resilience won’t make your problems go away — but resilience can give you the ability to see past them, find enjoyment in life and better handle stress. If you aren’t as resilient as you’d like to be, you can develop skills to become more resilient.

Adapting to adversity

Resilience is the ability to roll with the punches. When stress, adversity or trauma strikes, you still experience anger, grief and pain, but you’re able to keep functioning — both physically and psychologically. However, resilience isn’t about toughing it out, being stoic or going it alone. In fact, being able to reach out to others for support is a key component of being resilient.

Resilience and mental health

Resilience can help protect you from various mental health conditions, such as depression and anxiety. Resilience can also help offset factors that increase the risk of mental health conditions, such as being bullied or previous trauma. If you have an existing mental health condition, being resilient can improve your ability to cope.

Tips to improve your resilience

If you’d like to become more resilient, consider these tips:

• Get connected. Building strong, positive relationships with loved ones and friends can provide you with needed support and acceptance in both good times and bad. Establish other important connections by volunteering or joining a faith or spiritual community.
• Make every day meaningful. Do something that gives you a sense of accomplishment and purpose every day. Set goals to help you look toward the future with meaning.
• Learn from experience. Think of how you’ve coped with hardships in the past. Consider the skills and strategies that helped you through rough times. You might even write about past experiences in a journal to help you identify positive and negative behavior patterns — and guide your future behavior.
• Remain hopeful. You can’t change the past, but you can always look toward the future. Accepting and even anticipating change makes it easier to adapt and view new challenges with less anxiety.
• Take care of yourself. Tend to your own needs and feelings. Participate in activities and hobbies you enjoy. Include physical activity in your daily routine.
• Get plenty of sleep. Eat a healthy diet. Practice stress management and relaxation techniques, such as yoga, meditation, guided imagery, deep breathing or prayer.
• Be proactive. Don’t ignore your problems. Instead, figure out what needs to be done, make a plan, and take action. Although it can take time to recover from a major setback, traumatic event or loss, know that your situation can improve if you work at it.

Step #15. Positive thinking: Stop negative self-talk to reduce stress

Is your glass half-empty or half-full ? How you answer this age-old question about positive thinking may reflect your outlook on life, your attitude toward yourself, and whether you’re optimistic or pessimistic — and it may even affect your health.

Positive thinking helps with stress management and can even improve your health.

Indeed, some studies show that personality traits such as optimism and pessimism can affect many areas of your health and well-being. The positive thinking that usually comes with optimism is a key part of effective stress management. And effective stress management is associated with many health benefits. If you tend to be pessimistic, don’t despair — you can learn positive thinking skills.

Understanding positive thinking and self-talk

Positive thinking doesn’t mean that you keep your head in the sand and ignore life’s less pleasant situations. Positive thinking just means that you approach unpleasantness in a more positive and productive way. You think the best is going to happen, not the worst.

Positive thinking often starts with self-talk. Self-talk is the endless stream of unspoken thoughts that run through your head. These automatic thoughts can be positive or negative. Some of your self-talk comes from logic and reason. Other self-talk may arise from misconceptions that you create because of lack of information.

If the thoughts that run through your head are mostly negative, your outlook on life is more likely pessimistic. If your thoughts are mostly positive, you’re likely an optimist — someone who practices positive thinking.

The health benefits of positive thinking

Researchers continue to explore the effects of positive thinking and optimism on health. Health benefits that positive thinking may provide include:

• Increased life span
• Lower rates of depression
• Lower levels of distress
• Greater resistance to the common cold
• Better psychological and physical well-being
• Better cardiovascular health and reduced risk of death from cardiovascular disease
• Better coping skills during hardships and times of stress

It’s unclear why people who engage in positive thinking experience these health benefits. One theory is that having a positive outlook enables you to cope better with stressful situations, which reduces the harmful health effects of stress on your body.

It’s also thought that positive and optimistic people tend to live healthier lifestyles — they get more physical activity, follow a healthier diet, and don’t smoke or drink alcohol in excess.

Identifying negative thinking

Not sure if your self-talk is positive or negative? Some common forms of negative self-talk include:

• Filtering. You magnify the negative aspects of a situation and filter out all of the positive ones. For example, you had a great day at work. You completed your tasks ahead of time and were complimented for doing a speedy and thorough job. That evening, you focus only on your plan to do even more tasks and forget about the compliments you received.
• Personalizing. When something bad occurs, you automatically blame yourself. For example, you hear that an evening out with friends is canceled, and you assume that the change in plans is because no one wanted to be around you.
• Catastrophizing. You automatically anticipate the worst. The drive-through coffee shop gets your order wrong and you automatically think that the rest of your day will be a disaster.
• Polarizing. You see things only as either good or bad. There is no middle ground. You feel that you have to be perfect or you’re a total failure.

Focusing on positive thinking

You can learn to turn negative thinking into positive thinking. The process is simple, but it does take time and practice — you’re creating a new habit, after all. Here are some ways to think and behave in a more positive and optimistic way:

• Identify areas to change. If you want to become more optimistic and engage in more positive thinking, first identify areas of your life that you usually think negatively about, whether it’s work, your daily commute or a relationship. You can start small by focusing on one area to approach in a more positive way.
• Check yourself. Periodically during the day, stop and evaluate what you’re thinking. If you find that your thoughts are mainly negative, try to find a way to put a positive spin on them.
• Be open to humor. Give yourself permission to smile or laugh, especially during difficult times. Seek humor in everyday happenings. When you can laugh at life, you feel less stressed.
• Follow a healthy lifestyle. Aim to exercise for about 30 minutes on most days of the week. You can also break it up into 10-minute chunks of time during the day. Exercise can positively affect mood and reduce stress. Follow a healthy diet to fuel your mind and body. And learn techniques to manage stress.
• Surround yourself with positive people. Make sure those in your life are positive, supportive people you can depend on to give helpful advice and feedback.
• Avoid people who bother you. If you have a co-worker who causes your jaw to tense, put physical distance between the two of you. Sit far away at meetings or walk around his or her cubicle, even if it requires some extra steps.
• Negative people may increase your stress level and make you doubt your ability to manage stress in healthy ways.
• Practice positive self-talk. Start by following one simple rule: Don’t say anything to yourself that you wouldn’t say to anyone else. Be gentle and encouraging with yourself. If a negative thought enters your mind, evaluate it rationally and respond with affirmations of what is good about you. Think about things you’re thankful for in your life.

Here are some examples of negative self-talk and how you can apply a positive thinking twist to them:

Negative self-talk	Positive thinking
I’ve never done it before.	It’s an opportunity to learn something new.
It’s too complicated.	I’ll tackle it from a different angle.
I don’t have the resources.	Necessity is the mother of invention.
I’m too lazy to get this done.	I wasn’t able to fit it into my schedule, but I can re-examine some priorities.
There’s no way it will work.	I can try to make it work.
It’s too radical a change.	Let’s take a chance.
No one bothers to communicate with me.	I’ll see if I can open the channels of communication.
I’m not going to get any better at this.	I’ll give it another try.

Practicing positive thinking every day

If you tend to have a negative outlook, don’t expect to become an optimist overnight. But with practice, eventually your self-talk will contain less self-criticism and more self-acceptance. You may also become less critical of the world around you.

When your state of mind is generally optimistic, you’re better able to handle everyday stress in a more constructive way. That ability may contribute to the widely observed health benefits of positive thinking.

Step #16. Accept and Adapt

Accept

Sometimes you may have no choice but to accept things the way they are. For those times try to:

• Talk with someone. You may not be able to change a frustrating situation, but that doesn’t mean your feelings aren’t legitimate. Phone or schedule a coffee break with an understanding friend. You may feel better after talking it out.
• Forgive. It takes energy to be angry. Forgiving may take practice, but by doing so you will free yourself from burning more negative energy. Why stew in your anger when you could shrug and move on?
• Practice positive self-talk. It’s easy to lose objectivity when you’re stressed. One negative thought can lead to another, and soon you’ve created a mental avalanche. Be positive. Instead of thinking, “I am horrible with money, and I will never be able to control my finances,” try this: “I made a mistake with my money, but I’m resilient. I’ll get through it.”
• Learn from your mistakes. There is value in recognizing a “teachable moment.” You can’t change the fact that procrastination hurt your performance, but you can make sure you set aside more time in the future.

Adapt

Thinking you can’t cope is one of the greatest stressors. That’s why adapting — which often involves changing your standards or expectations — can be most helpful in dealing with stress.

• Adjust your standards. Do you need to vacuum and dust twice a week? Would macaroni and cheese be an unthinkable substitute for homemade lasagna?
• Redefine success and stop striving for perfection, and you may operate with a little less guilt and frustration.
• Practice thought-stopping. Stop gloomy thoughts immediately. Refuse to replay a stressful situation as negative, and it may cease to be negative.
• Reframe the issue. Try looking at your situation from a new viewpoint. Instead of feeling frustrated that you’re home with a sick child, look at it as an opportunity to bond, relax and finish a load of laundry.
• Adopt a mantra. Create a saying such as, “I can handle this,” and mentally repeat it in tough situations.
• Create an assets column. Imagine all of the things that bring you joy in life, such as vacation, children and pets. Then call on that list when you’re stressed.
• It will put things into perspective and serve as a reminder of life’s joys.
• Look at the big picture. Ask yourself, “Will this matter in a year or in five years?” The answer is often no. Realizing this makes a stressful situation seem less overwhelming.

What Are Relaxation Techniques ?

Relaxation techniques are an essential part of stress management. Because of your busy life, relaxation might be low on your priority list. Don’t shortchange yourself. Everyone needs to relax and recharge to repair the toll stress takes on your mind and body.

Relaxation techniques are a great way to help with stress management. Relaxation isn’t only about peace of mind or enjoying a hobby. Relaxation is a process that decreases the effects of stress on your mind and body. Relaxation techniques can help you cope with everyday stress and with stress related to various health problems, such as heart disease and pain.

Whether your stress is spiraling out of control or you’ve already got it tamed, you can benefit from learning relaxation techniques. Learning basic relaxation techniques is easy. Relaxation techniques also are often free or low cost, pose little risk, and can be done nearly anywhere.

Almost everyone can benefit from relaxation techniques, which can help slow your breathing and focus your attention. Common relaxation techniques include meditation, progressive muscle relaxation, tai chi and yoga. More-active ways of achieving relaxation include walking outdoors or participating in sports.

It doesn’t matter which relaxation technique you choose. Select a technique that works for you and practice it regularly.

Relaxation techniques include a number of practices such as progressive relaxation, guided imagery, biofeedback, self-hypnosis, and deep breathing exercises. The goal is similar in all: to produce the body’s natural relaxation response, characterized by slower breathing, lower blood pressure, and a feeling of increased well-being.

Meditation and practices that include meditation with movement, such as yoga and tai chi, can also promote relaxation.

Stress usually doesn’t just get better on its own. You may have to actively work on getting control of the stress in your life so that it doesn’t control you. When you first identify how you react to stressful situations, you then can put yourself in a better position to manage the stress, even if you can’t eliminate it. And if your current efforts at stress management aren’t working, try something new.

The benefits of relaxation techniques

When faced with numerous responsibilities and tasks or the demands of an illness, relaxation techniques may not be a priority in your life. But that means you might miss out on the health benefits of relaxation.

Practicing relaxation techniques can have many benefits, including:

• Slowing heart rate
• Lowering blood pressure
• Slowing your breathing rate
• Improving digestion
• Maintaining normal blood sugar levels
• Reducing activity of stress hormones
• Increasing blood flow to major muscles
• Reducing muscle tension and chronic pain
• Improving concentration and mood
• Improving sleep quality
• Lowering fatigue
• Reducing anger and frustration
• Boosting confidence to handle problems

To get the most benefit, use relaxation techniques along with other positive coping methods, such as thinking positively, finding humor, problem-solving, managing time, exercising, getting enough sleep, and reaching out to supportive family and friends.

Types of relaxation techniques

Health professionals such as complementary health practitioners, doctors and psychotherapists can teach various relaxation techniques. But if you prefer, you can also learn some relaxation techniques on your own.

In general, relaxation techniques involve refocusing your attention on something calming and increasing awareness of your body. It doesn’t matter which relaxation technique you choose. What matters is that you try to practice relaxation regularly to reap its benefits.

Types of relaxation techniques include:

Autogenic relaxation. Autogenic means something that comes from within you. In this relaxation technique, you use both visual imagery and body awareness to reduce stress. In autogenic training, you learn to concentrate on the physical sensations of warmth, heaviness, and relaxation in different parts of your body.

You repeat words or suggestions in your mind that may help you relax and reduce muscle tension. For example, you may imagine a peaceful setting and then focus on controlled, relaxing breathing, slowing your heart rate, or feeling different physical sensations, such as relaxing each arm or leg one by one.

Progressive muscle relaxation. This technique, also called Jacobson relaxation or progressive muscle relaxation, involves tightening and relaxing various muscle groups. Progressive relaxation is often combined with guided imagery and breathing exercises.

In this relaxation technique, you focus on slowly tensing and then relaxing each muscle group.

This can help you focus on the difference between muscle tension and relaxation. You can become more aware of physical sensations.

In one method of progressive muscle relaxation, you start by tensing and relaxing the muscles in your toes and progressively working your way up to your neck and head. You can also start with your head and neck and work down to your toes. Tense your muscles for about five seconds and then relax for 30 seconds, and repeat.

Visualization. In this relaxation technique, you may form mental images to take a visual journey to a peaceful, calming place or situation.

To relax using visualization, try to incorporate as many senses as you can, including smell, sight, sound and touch. If you imagine relaxing at the ocean, for instance, think about the smell of salt water, the sound of crashing waves and the warmth of the sun on your body.

You may want to close your eyes, sit in a quiet spot, loosen any tight clothing, and concentrate on your breathing. Aim to focus on the present and think positive thoughts.

Other relaxation techniques may include:

• Deep Breathing or Breathing Exercises: This technique involves focusing on taking slow, deep, even breaths.
• Massage
• Meditation
• Tai chi
• Yoga
• Biofeedback-Assisted Relaxation: Biofeedback techniques measure body functions and give you information about them so that you can learn to control them. Biofeedback-assisted relaxation uses electronic devices to teach you to produce changes in your body that are associated with relaxation, such as reduced muscle tension.
• Guided Imagery: For this technique, people are taught to focus on pleasant images to replace negative or stressful feelings. Guided imagery may be self-directed or led by a practitioner or a recording.
• Music and art therapy
• Aromatherapy
• Hydrotherapy
• Self-Hypnosis: In self-hypnosis programs, people are taught to produce the relaxation response when prompted by a phrase or nonverbal cue (called a “suggestion”).

Relaxation techniques take practice

As you learn relaxation techniques, you can become more aware of muscle tension and other physical sensations of stress. Once you know what the stress response feels like, you can make a conscious effort to practice a relaxation technique the moment you start to feel stress symptoms. This can prevent stress from spiraling out of control.

Remember that relaxation techniques are skills. As with any skill, your ability to relax improves with practice. Be patient with yourself. Don’t let your effort to practice relaxation techniques become yet another stressor.

If one relaxation technique doesn’t work for you, try another technique. If none of your efforts at stress reduction seems to work, talk to your doctor about other options.

Also, bear in mind that some people, especially those with serious psychological issues and a history of abuse, may experience feelings of emotional discomfort during some relaxation techniques. Although this is rare, if you experience emotional discomfort during relaxation techniques, stop what you’re doing and consider talking to your doctor or mental health provider.

What is tai chi?

Tai chi is an ancient Chinese tradition that, today, is practiced as a graceful form of exercise. It involves a series of movements performed in a slow, focused manner and accompanied by deep breathing.

Tai chi, also called tai chi chuan, is a noncompetitive, self-paced system of gentle physical exercise and stretching. Each posture flows into the next without pause, ensuring that your body is in constant motion.

Tai chi has many different styles. Each style may subtly emphasize various tai chi principles and methods. There are variations within each style. Some styles may focus on health maintenance, while others focus on the martial arts aspect of tai chi.

Tai chi is different from yoga, another type of meditative movement. Yoga includes various physical postures and breathing techniques, along with meditation.

Why try tai chi?

When learned correctly and performed regularly, tai chi can be a positive part of an overall approach to improving your health. The benefits of tai chi may include:

• Decreased stress, anxiety and depression
• Improved mood
• Improved aerobic capacity
• Increased energy and stamina
• Improved flexibility, balance and agility
• Improved muscle strength and definition

More research is needed to determine the health benefits of tai chi. Some evidence indicates that tai chi also may help:

• Enhance quality of sleep
• Enhance the immune system
• Help lower blood pressure
• Improve joint pain
• Improve symptoms of congestive heart failure
• Improve overall well-being
• Reduce risk of falls in older adults

Who can do tai chi?

Tai chi is low impact and puts minimal stress on muscles and joints, making it generally safe for all ages and fitness levels. In fact, because tai chi is a low impact exercise, it may be especially suitable if you’re an older adult who otherwise may not exercise.

You may also find tai chi appealing because it’s inexpensive and requires no special equipment. You can do tai chi anywhere, including indoors or outside. And you can do tai chi alone or in a group class.

Although tai chi is generally safe, women who are pregnant or people with joint problems, back pain, fractures, severe osteoporosis or a hernia should consult their health care provider before trying tai chi. Modification or avoidance of certain postures may be recommended.

How to get started with tai chi

Although you can rent or buy videos and books about tai chi, consider seeking guidance from a qualified tai chi instructor to gain the full benefits and learn proper techniques.

You can find tai chi classes in many communities today. To find a class near you, contact local fitness centers, health clubs and senior centers. Tai chi instructors don’t have to be licensed or attend a standard training program. It’s a good idea to ask about an instructor’s training and experience, and get recommendations if possible.

A tai chi instructor can teach you specific positions and breathing techniques. An instructor can also teach you how to practice tai chi safely, especially if you have injuries, chronic conditions, or balance or coordination problems. Although tai chi is slow and gentle, and generally doesn’t have negative side effects, it may be possible to get injured if you don’t use the proper techniques.

After learning tai chi, you may eventually feel confident enough to do tai chi on your own. But if you enjoy the social aspects of a class, consider continuing with group tai chi classes.

Maintaining the benefits of tai chi

While you may gain some benefit from a tai chi class that lasts 12 weeks or less, you may enjoy greater benefits if you continue tai chi for the long term and become more skilled.

You may find it helpful to practice tai chi in the same place and at the same time every day to develop a routine. But if your schedule is erratic, do tai chi whenever you have a few minutes. You can even practice the soothing mind-body concepts of tai chi without performing the actual movements when you are in a stressful situation, such as a traffic jam or a tense work meeting, for instance.

Support groups

Make connections, get help. If you’re facing a major illness or stressful life change, you don’t have to go it alone. A support group can help. Find out how to choose the right one.

Support groups bring together people facing similar issues, whether that’s illness, relationship problems or major life changes. Members of support groups often share experiences and advice. It can be helpful just getting to talk with other people who are in the same situation.

While not everyone wants or needs support beyond that offered by family and friends, you may find it helpful to turn to others outside your immediate circle. A support group can help you cope better and feel less isolated as you make connections with others facing similar challenges. A support group shouldn’t replace your standard medical care, but it can be a valuable resource to help you cope.

Understanding support groups

A support group is a gathering of people who share a common health concern or interest. A support group usually focuses on a specific situation or condition, such as breast cancer, diabetes, heart disease, addiction or long-term caregiving, for example.

Support groups are not the same as group therapy sessions. Group therapy is a formal type of mental health treatment that brings together several people with similar conditions under the guidance of a trained mental health provider.

Support groups may be formed by a lay person with the condition or by someone interested in it, such as a family member. In some cases, support groups may be formed by nonprofit organizations, advocacy organizations, mental health clinics or other organizations.

Support groups also come in a variety of formats, including in person, on the Internet or by telephone. They may be led by professional facilitators — such as a nurse, social worker or psychologist — or by group members.

Some groups are educational and structured. For example, the group leader may invite a doctor, psychologist, nurse or social worker to talk about a topic related to the group’s needs. Other support groups emphasize emotional support and shared experiences.

Benefits of support groups

Regardless of format, in a support group, you’ll find people with problems similar to yours. Members of a support group usually share their personal experiences and offer one another emotional comfort and moral support. They may also offer practical advice and tips to help you cope with your situation.

Benefits of participating in support groups may include:

• Feeling less lonely, isolated or judged
• Gaining a sense of empowerment and control
• Improving your coping skills and sense of adjustment
• Talking openly and honestly about your feelings
• Reducing distress, depression, anxiety or fatigue
• Developing a clearer understanding of what to expect with your situation
• Getting practical advice or information about treatment options
• Comparing notes about resources, such as doctors and alternative options.

Support group red flags

Not all support groups are a good match for you. Some may be driven by the interests of one or two members. Look for these red flags that may signal a problem with a support group:

• Promises of a sure cure for your disease or condition
• Meetings that are predominantly gripe sessions
• A group leader or member who urges you to stop medical treatment
• High fees to attend the group
• Pressure to purchase products or services
• Disruptive members
• Judgment of your decisions or actions

Be especially careful when you’re involved in Internet support groups:

• Keep in mind that online support groups are sometimes used to prey on vulnerable people.
• Be aware of the possibility that people may not be who they say they are, or may be trying to market a product or treatment.
• Be careful about revealing personal information, such as your full name, address or phone number.
• Understand the terms of use for a particular site and how your private information may be shared.
• Don’t let Internet use lead to isolation from your in-person social network.

How to find a support group

To find a support group:

• Ask your doctor or other health care provider for assistance. Your doctor, nurse, social worker, chaplain or psychologist may be able to recommend a support group for you.
• Search the Internet. Online support groups are available as email lists, newsgroups, chat rooms, blogs and social networking sites, such as Facebook.
• Contact local centers. Contact community centers, libraries, churches, mosques, synagogues or temples in your area and ask about support groups.
• Check your local listings. Look in your local telephone book or check your newspaper for a listing of support resources.
• Ask people you know with the condition. Ask others you know with the same illness or life situation for support group suggestions.
• Contact organizations. Contact a state or national organization devoted to your disease, condition or situation.

What support group, if any, you ultimately choose may depend largely on what’s available in your community, whether you have access to a computer or whether you’re able to travel.

Questions to ask before joining a support group

Each type of support group has its own advantages and disadvantages. You may find that you prefer a structured, moderated group. Or you may feel more at ease meeting less formally with a small group of people. Some people may prefer online support groups.

Ask these questions before joining a new support group:

• Is it geared toward a specific condition?
• Is the location convenient for regular attendance?
• What is the meeting schedule?
• Is there a facilitator or moderator?
• Is a mental health expert involved with the group?
• Is it confidential?
• Does it have established ground rules?
• What is a usual meeting like?
• Is it free, and if not what are the fees?
• Does it meet your cultural or ethnic needs?

Plan to attend a few support group meetings to see how you fit in. If the support group makes you uncomfortable or you don’t find it useful, try another one. Remember that even a support group you like can change over time as participants come and go. Periodically evaluate the support group to make sure it continues to meet your needs.

Also be aware that you may be at a different stage of coping or acceptance than are others in the support group. Or they may have a different attitude about their situation. While such a mix can provide rich experiences, it may also be unhelpful or even harmful. For instance, some in the group may be pessimistic about their future, while you’re looking for hope and optimism. Don’t feel obligated to keep attending the group if a conflict or group dynamic is upsetting — find another group or just sit out for a while.

Getting the most out of a support group

When you join a new support group, you may be nervous about sharing personal issues with people you don’t know. So at first, you may benefit from simply listening. Over time, though, contributing your own ideas and experiences can help you get more out of a support group.

But remember that support groups aren’t a substitute for regular medical care. Let your doctor know that you’re participating in a support group. If you don’t think a support group is appropriate for you, but you need help coping with your condition or situation, talk to your doctor about counseling or other types of therapy.

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