Stress Management 101
March 29, 2014
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This post provides a scientific overview of the the stress response and practical ways to lower it, synthesizing material from several experts in stress management and positive psychology, including Dr. Fred Luskin, Dr. Kenneth Pelletier (Source: Stress Free for Good), and Tal Ben-Shahar, (PBS talk “Happiness 101“).

Sections in this article:
What is Stress
Fight-Flight-Freeze Response
How Stress Hurts Us
10 Ways to Reduce Stress

What is stress?


Stress comes in many shapes and sizes. It can manifest as sleepless nights, chronic fatigue, low grade tension in the body, and foggy thinking. At its most extreme, it can contribute to serious psychological and physical illness, like heart disease, diabetes and major depression.

But, what exactly is this thing we call “stress?” Hans Selye, MD, a pioneer in the study of stress, defined it as “the nonspecific (that is, common) result of any demand upon the body, be the effect mental or somatic” (Goldberger and Breznitz, 1993).

Neuroendocrinologist and Stanford University professor Robert Sapolsky writes that “a stressor is anything in the outside world that knocks you out of homeostatic balance.”

As you can see, the “stress” concept is a fairly subjective one. What may be seen as “stressful” to one person, can be experienced as benign by another.  Thoughts, beliefs, and mitigating factors, like social support and socio-economic status help answer the question, “What is it that makes psychological stress stressful”? (Sapolsky, 2013).

Two giants in the field of stress research, former UC Berkeley psychology professor Richard Folkman and Susan Lazarus, professor of integrative medicine at UCSF (1991), note that “cognitive appraisal” – how we perceive and interpret a situation – is a critical element in the stress and coping response.

In their analysis, Lazarus and Folkman identify two stages in this cognitive appraisal process. First, a determination is made about what’s at stake in the matter (i.e., how significant is the stressor, what kind of impact will it have on my life, etc.). Then, we assess what can be done about it (i.e., do I have the tools to solve this problem or not? Is this something within my control?). If something is seen as a serious threat to our well-being, and as uncontrollable (i.e., that we don’t have the resources to handle the problem), then it will feel more stressful. Alternatively, if we view the situation as a “challenge,” rather than a “threat,” and we can identify tools to help us cope or solve the problem, then the event will (likely) be experienced as less stressful. Thus, interpretation – how we view a problem – is an important variable in the stress response.

In modern times, many people see stress as something to be avoided. But, the day to day stress we all face that involves getting up in the morning, brushing our teeth and taking care of our daily responsibilities is a simple fact of life. A moderate amount of stress isn’t actually a bad thing (and it’s often simply known as stimulation). However, excessive and unrelenting stress – the kind that results in physical or psychological damage – is something we should all be minimizing.

Later in this article, we’ll explore practical ways to lower stress, including cognitive strategies that can impact how we relate to difficult circumstances. But first, let’s take a more in-depth look at exactly how stress is harmful.

Fight-Flight-Freeze


When exposed to a threat, a complex alarm system gets triggered in the body, that includes the release of stress hormones like adrenaline and cortisol. This state of high-alert is often referred to as the “fight or flight” response, a term first coined in 1915 by former Harvard Medical School professor Walter Cannon. More recently, this model been broadened to include the concept of “freezing,” especially when it pertains to traumatic experiences.

In the face of a “serious threat” – however that may be defined by the individual – we as humans, like all vertebrates, are wired to respond in one of these three ways. “Fighting” involves getting angry, gearing up for a confrontation and then doing everything in our power to protect ourselves. “Fleeing” is when we run away from or avoid whatever we perceive as threatening. “Freezing” is when we’re stuck, uncertain of how to proceed, and can also include a feeling of being on guard or hypervigilant.

These ancient and reflexive responses are particularly helpful when, say, you’re alone in the jungle and a hungry lion is chasing you. However, in modern times, most of us don’t face this particular type of challenge. Unfortunately, however, our bodies can still get triggered in the same manner to psychological stressors, whether the “threat” is real or imagined.  When our spouse gets upset at us or if we’re running late to an important meeting, our central nervous system can respond as if we’re facing a dangerous situation, depending on how we relate to those experiences (note: sometimes anger can be highly triggering if there’s a threat of violence, but often anger or disappointment from another gets filtered through a lens that makes it seem more threatening than it is).

How stress hurts us


Low levels of stress and periodic periods of higher stress aren’t that bad for us. However, if our nervous system is constantly on high-alert, this will eventually take a toll on our body and mind.

As stress management experts Dr. Fred Luskin and Dr. Kenneth Pelletier (2005) discuss in Stress Free for Good, the fight-flight-freeze stress response results in the following:

1.) Increased heart rate to pump more blood to your muscles, resulting in higher blood pressure

2.) Faster breathing to give you more oxygen

3.) Muscular tensing in preparation for action

4.) Reduced blood flow to the prefrontal cortex of the brain (which impacts executive functioning and reasoning ability)

5.) Increased blood flow to the limbic region of the brain (the highly reactive area that mediates emotion)

6.) Cessation of digestion process to divert blood flow to brain and muscles, which can result in abdominal discomfort and even irritable bowel syndrome

7.) Increased sweat to cool off and “become lighter in preparation for a potential confrontation”

8.) Pupil dilation, increased sense of hearing and smell to enhance performance in the face of the threat

9.) Increased inflammation in the arteries around your heart

10.) Decreased immune function

11.) Narrowing of focus on the immediate danger to maximize survival, resulting in decreased ability to identify other possible solutions

From reading this list, it’s clear that being in “fight-fight-freeze” mode on a frequent basis isn’t a good thing.  Numerous studies abound demonstrating the link between chronic stress (which includes overexposure to stress hormones) and increased risk heart disease, digestive problems, sleep difficulties, obesity, depression, diabetes, reproductive disorders and memory problems.

In addition, there’s considerable research indicating a relationship between stress and tumor development in animals (Stein and Miller, 1993). Although such findings in humans are more controversial, there is a link between stress induced behaviors, like smoking or excessive alcohol use, and an increased risk of cancer.

10 Ways to reduce stress


So, the bad news about chronic stress is clear. But, the good news is that there are many scientifically supported strategies that can help us manage and reduce stress. As stress management expert Robert Sapolsky, PhD. has noted, it’s important to be practical and experiment with different techniques to see what works best for you; what may be relaxing for one person, can actually be stress inducing to another. For most people, getting into a routine – practicing stress management techniques on a regular basis – will be most beneficial.  With some of these stress management strategies, you’ll find instant relief, where you feel better right away; with others, you need to give them ample time to determine the overall benefit to your individual physiology.

1.) Exercise: regular exercise is one of the best things we can do to combat stress. Exercise increases the production of endorphins, the body’s natural opiate-like chemicals that make us feel good. It also reduces blood levels of the stress hormone cortisol. In addition, it can help clear the mind of thought patterns related to worry and anger that may be contributing to stress. Exercise is so powerful that Duke University researchers found that walking a mere 30 minutes per day was as effective as medication for treating depression.

2.) Belly Breathing: also known as diaphragmatic or deep breathing, this is a simple, yet powerful tool for stress management (Luskin and Pelletier, 2005). How do you do it?  Start by placing one hand on your stomach, then slowly inhale, filling your belly with air, as if you’re inflating a balloon.  Try to fill your stomach area with a deep breath, rather than expanding your chest area as you inhale.  You can count to 3 on the inhale.  Then, slowly exhale. Feel the rise and fall of your belly as you do this. You can practice this for a total of 20-30 seconds at random intervals throughout the day or use this as a tool before stressful interactions.

When we’re highly-stressed, in fight-flight-freeze mode, breathing is shallow and quick (a sign that the sympathetic nervous system is doing its job). Taking slow, deep breaths from the belly engages the parasympathetic nervous system – the part of the nervous system responsible for relaxing our bodies and minds. When we do this, we essentially send a message to our brains that we’re no longer in danger, which allows us to settle down and feel more at ease.

3.) Slow Down and Simplify: trying to cram too much into one day or taking on more responsibilities than we can handle is a recipe for high stress and burnout. While our culture values multitasking, busyness and speed, our bodies and minds do not. On a side note, an interesting study out of the UK shows that multitasking actually makes us less efficient, by lowering IQ (fortunately, this lowering is only temporary!).

Learn to delegate, ask for help and say “no” more. This is especially important for women who are conditioned to be the caretakers of the world, often at their own expense. Look at your schedule and distinguish between “needs” and “wants.” Choose to keep doing the things you absolutely “need” to and let go of some of the “wants” that are more optional. Slowing down helps lower blood pressure and increases one’s sense of enjoyment by living more in the moment (Luskin and Pelletier, 2005)

Tal Ben-Shahar, professor and author of the bestseller Happier, taught the most popular course in the history of Harvard entitled “Positive Psychology” (the course popularity shows how much people are craving tools to help increase happiness and manage stress). One of the things he emphasizes, when it comes to stress management, is the the importance of taking regular breaks, which can be classified into 3 types:

  • Micro (e.g., taking a 15 minute break after every 2 hours of work)
  • Mezzo (e.g., taking 1 day off per week)
  • Macro (e.g., taking vacations each year)

Research shows that taking these types of breaks on a regular basis is correlated with increased happiness, better productivity and more creative thinking.  Obviously, not everybody has the luxury of taking regular breaks and time off from work, but do the best you can.  At a minimum, look at taking breaks, even if they’re small, as incredibly valuable to your physical and psychological health.  And, be mindful of what you do on your break: choose things that are restful and rejuvenating, rather than overly stimulating or draining.  For example, if you work on a computer all day, taking a break by surfing the web is probably not going to be as refreshing as taking a walk or nap.

4.) Mindfulness Practices: mindfulness meditation is an ancient spiritual practice that involves paying attention to the present moment, with a sense of non-judgment and acceptance for whatever arises. Mindfulness can be cultivated through a variety of practices, including mindful breathing, eating, walking and really, just about any activity.

Mindfulness-Based Stress Reduction (MBSR) is a popular program developed by Jon Kabat-Zinn, PhD., Professor of Medicine at UMass Medical School, that includes mindfulness meditation, yoga, group discussions, and other exercises designed to develop one’s awareness. Studies suggest that MBSR offers many benefits, including lowered stress levels and a reduction in medical symptoms (Williams, Kolar, Reger, and Pearson, 2001), lowered anxiety and improved immune function (Davidson, 2003).

Mindfulness helps us live in the present moment more. When we’re in a highly stressed state, we’re often worried about the future or fixating on something that happened in the past. Next time you find yourself feeling stressed out, ask yourself how you feel about the present moment. You’ll often find that you actually feel OK, that it’s the future or past you’re concerned about. You can rest easy in this awareness of the “OK” quality of the present. This is relaxing and can free up the mind for engaging in more effective problem-solving, when necessary.

To learn more about mindfulness, read: What is Mindfulness?

5.) Play: Just like kids, adults need ample time to “play” in order to feel happy and balanced on both a physical and emotional level.

The National Institute of Play, founded by Stuart Brown, MD, notes that “play is the gateway to vitality…it generates optimism, seeks out novelty, makes perseverance fun, leads to mastery, gives the immune system a bounce, fosters empathy and promotes a sense of belonging and community…The prevalence of depression, stress related diseases, interpersonal violence, the addictions, and other health and well being problems can be linked, like a deficiency disease, to the prolonged deprivation of play.”

Play covers a wide range of activities, including sports, music, arts and crafts, gardening and simply hanging out with friends and laughing. Researchers have categorized play into seven types known as: attunement play; body play and movement; object play; social play; imaginative and pretend play; storytelling-narrative play; transformative and creative play. Click here to learn more about this fascinating research on the science of play.

6.) Cognitive Restructuring: is a fancy term associated with cognitive-behavioral therapy (CBT), one of the most widely studied and efficacious forms of psychotherapy, that refers to the process of changing your thoughts to more rational and self-supportive ones. The underlying assumption in CBT is that it’s not our circumstances per se that cause emotional suffering, but it’s how we interpret those situations. We always have a choice in terms of how we view something and how we talk to ourselves about it. We’re more likely to experience negative emotions and behaviors if we’re faced with a difficult situation and we say to ourselves, “I can’t handle this.” Alternatively, if we stop, take a deep breath and say, “I may not have the solution to this problem right now, but I’m determined to find a way,” we’re likely to feel less overwhelmed and be in a better position to take effective action.

Research shows that having a “sense of control” is a key component of emotional well-being. When under stress, identifying ways to take action and thinking about the situation from different angles can instill a sense of control. On the other hand, sometimes life presents circumstances which are beyond our control, that we can’t “do” anything about. In these situations, it can be helpful to have an attitude of acceptance.

Tara Brach, psychologist and bestselling author of Radical Acceptance: Embracing Your Life with the Heart of a Buddha, recommends the practice of “saying yes” to experiences, no matter how unpleasant. As she notes, an attitude of resistance, or “saying no” to experiences actually increases tension. The point here isn’t to condone things that are harmful, like violence or substance abuse; it’s about maintaining an attitude of acceptance in the moment when difficulties arise, by essentially saying, “Ok, this is what I have to deal with right now.  I don’t like it, but it’s my present reality.”

7.) Be Grateful: similar to cognitive restructuring, choosing to focus on things you appreciate can have a significant impact on your mood and stress level. As Luskin and Pelletier note (2005, p.80), “appreciation takes advantage of our parasympathetic nervous system to reduce the stress response and trigger our optimal performance zone. Looking for things to appreciate reduces stress and actually retrains our nervous system to make it easier to relax.”

There’s research out of UC Davis that supports the powerful benefits of gratitude/appreciation practices. For example, writing in a weekly gratitude journal was correlated with:

  • Greater emotional and physical well-being
  • Higher levels of optimism
  • More effectiveness in one’s life with regards to goal attainment

The UC Davis Emmons Lab notes that “Grateful people report higher levels of positive emotions, life satisfaction, vitality, optimism and lower levels of depression and stress. The disposition toward gratitude appears to enhance pleasant feeling states more than it diminishes unpleasant emotions. Grateful people do not deny or ignore the negative aspects of life.”

Try this practice by writing down 3 or saying aloud to another 3 things you’re grateful for each day.  Notice how this makes you feel in the moment and after doing for a week or two.  This simple practice can actual feel quite transformative.

8.) Connect Socially: according to U-Chicago psychology professor John Cacioppo, “loneliness leads to higher rises in morning levels of the stress hormone cortisol, altered gene expression in immune cells, poorer immune function, higher blood pressure and an increased level of depression.”

Human beings are social creatures. In addition to food, water and shelter, we all need a certain amount of social contact to survive and feel a sense of community and belonging. Some need more social contact, while others need less. Dealing with life’s demands in isolation can be very draining and stressful. In addition, negative emotional states tend to be maintained or exacerbated in isolation. Therefore, it’s important to maintain positive relationships. Emphasis is on the ‘positive’ here, as unhealthy relationships obviously increase stress levels, so they’re best to be avoided.

In the article “Awakening from the Trance of Unworthiness,” psychologist Tara Brach writes that “our most fundamental sense of well-being is derived from the conscious experience of belonging.” This excellent article discusses the importance of connection from a spiritual perspective and is well-worth reading.

9.) General Self-Care: while basic self-care may sound like an obvious component of stress management, it’s easily neglected when we’re leading busy lives. Good nutrition that includes plenty of fruits and vegetables, along with limited consumption of sugar, caffeine, alcohol and other toxic substances, contributes to more balanced mood states and energy levels.

Getting an adequate amount of sleep each night is also critical for our physical, emotional and cognitive well-being.  Make getting a good night’s sleep a basic part of your stress management routine.  When we’re rested, we have the mental and physical energy to better meet life’s demands.  Besides the obvious benefits of this, thinking more clearly about ways to solve problems also increases our sense of control – a mitigating factor in the stress response. Most adults need between 7-9 hours of sleep to feel recharged. It’s important to pay attention to how much sleep you need in particular, as each person’s body is different.

Also, let your reading of this information be a reminder to take care of any outstanding healthcare needs, such as medical appointments that you’ve been putting off. In addition to directly addressing your health needs, checking these appointments off your to-do list will free up some mental energy that you may be expending on worries about your health.

10.) Physical Relaxation: when we’re contending with chronic, daily stressors, our muscles get accustomed to feeling tense and painful. As everybody knows, the state of one’s body impacts the mind, and vice-versa. Deliberately relaxing the body is an excellent antidote to the stress response. Yoga, gentle stretching, massage or other forms of bodywork can be quite helpful with decreasing tension.  And, they’re fun!

Reminder: practice, you’re worth it!

As noted previously, try these methods on for size, to see what works best for you.  Don’t necessarily expect a quick fix, but trust in the fact that putting effort in these areas will lead to good things.  Remember: you are worth taking care of, so take your health and wellbeing seriously.


  1. I suffered from Panic Disorder for years. The belly breathing was the best thing I ever learned to combat the physical sensations of anxiety. One thing my therapist told me that still plays in my head when I’m doing my breathing exercises is this, and it’s totally true: Your body cannot be simultaneously hyper stressed and super relaxed. I enjoyed the biofeedback type feelings that this sentence gave me as I practiced breathing and felt myself relaxing. Thanks for sharing.

  2. Thanks for sharing, Meghan. This is a perfect example of the power of belly breathing (aka – deep breathing and diaphragmatic breathing). When something like this is practiced on a regular basis, the amount of stress hormones coursing through one’s body are reduced, thereby lowering one’s baseline panic/fear/anxiety threshold. And, you don’t have to do it for very long — just 10-30 seconds at a time, whenever you feel “stressed” (i.e., scared, worried, angry, etc.) Proper breathing also circulates more oxygen in the bloodstream, which enhances the functioning of the nervous system – also making one less prone to a dramatic stress response.

  3. Yes.

    Getting enough sleep – sounds so simple, but is probably one of the most underutilized and important things we can do to stay healthy. In a culture that values (or is addicted to) productivity, earning money, and entertainment, sleep often falls surprisingly low on many people’s priority list. I believe that assessing and treating a patient’s sleep hygiene should be more emphasized in the greater health care and self-care endeavors.

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