Managing Stress: What You Need to Know

Managing Stress

This brochure can help you learn more about managing stress. It doesn't replace regular medical checkups or advice from your health care team. Talk with your doctor about ways to manage stress.

What Is Stress?

Stress is your brain and body's response to a demand or challenge.

 Everyone faces some stress. You may feel stress when you take a test or go on a job interview. Stress can also help you react quickly in an emergency. These kinds of short-term stress are normal. 1,2
 What may cause stress for one person may not cause stress for another. For example, some people feel relaxed when driving a car while others become tense when they drive.
 Stress is not helpful when it affects your daily life and mood. Stressful situations or events that last a long time or do not go away can lead to serious health problems. 1

Post-traumatic stress disorder (PTSD)

Most people who have faced or witnessed a terrifying event, such as a natural disaster or serious accident, will recover from their symptoms naturally soon after. Those who keep having symptoms, such as bad dreams or angry outbursts, may

be diagnosed with PTSD. 3

If you are under a great deal of stress or feel you have PTSD, talk with your doctor.

Some facts about stress 4

 More than three-quarters of adults report they have symptoms of stress. For example, headache, feeling tired, or changes in sleep.

What adults are doing to manage stress:

44% of adults say they exercise or walk to manage stress

47% say they listen to music

 Nearly half of adults say they have laid awake at night because of stress in the past month.

More than onethird (37%) spend time with friends or family

What Happens When You're Stressed?

Your body is designed to experience and react to stress. It can help you survive a dangerous situation. 2

When you are in danger, stress tells your body to face the threat or flee to safety. 1

In response:

 Your pulse quickens
 You breathe faster
 Your muscles tense
 Your brain uses more oxygen and becomes more active

This stress response is called "fight or flight."

What are the effects of long-term (chronic) stress?

Stress can be unhealthy when you are faced with constant challenges without any relief. With long-term (chronic) stress, your body never gets a clear signal to return to normal. Over time, this causes wear and tear on your body—to your physical, mental, and

emotional health. 2

Stress that is not managed may contribute to health problems such as 1 :

 High blood pressure
 Heart disease
 Diabetes
 Depression and anxiety

Stress can also 2 :

 Lead to bad habits like smoking, drinking alcohol, or overeating
 Make a health condition worse
 Lead to emotional problems such as depression, anxiety, and panic attacks

Common Causes of Stress

Many events or situations can cause stress. 5 Some are positive, others are negative.

 Emotional issues—feeling troubled or angry, not being able to deal with your emotions
 Major life changes—death of a family member, losing a job, getting married, buying a house
 Workplace stress—demanding work, a tiring work schedule, feeling unsatisfied with your work
 Sense of control—the belief you do not have control over your life
 Support network—feeling lonely, being isolated from others, feeling a lack of friendship or support
 Family and relationships—being busy with children and family, caregiving for an elderly parent, conflict with loved ones
 Attitude and outlook—negative thoughts about life, difficulty accepting change
 Financial problems—difficulty paying bills, unexpected expenses
 Social situation—facing discrimination based on your race, gender, age, or sexual orientation 6

What Are the Warning Signs of Stress?

Feeling stress for too long, whether for hours, days, or months, sets off your body's warning system. There are many signs that stress may be affecting you. They can be physical and emotional. Stress warning signs tell you that something isn't right and that you may need help and extra care.

Some warning signs are 2,5 :

 Headaches
 Muscle tension in neck, face, or shoulders
 Grinding teeth, tightened jaw
 Upset stomach, diarrhea
 Acid reflux
 Chest pain, racing heart
 Trouble falling or staying asleep
 Having little or no energy
 Weight gain or loss
 Lack of concentration or focus
 Loss of appetite or overeating
 Memory problems or forgetfulness
 Short temper, being angry or irritable
 Sexual problems
 General aches and pains
 Feeling anxious, worried, or depressed
 Nail biting
 Increased number of colds

When you know the warning signs of stress, you can do something about them.

Healthy Ways to Manage Stress

Here are some things you can do to help manage stress. 7,8

Practice healthy lifestyle habits

 Eat a healthy, balanced diet.
 Be physically active.
 Get plenty of sleep.
 Avoid using drugs and alcohol to deal with stress.

Lighten your mood

 Take a 10-minute "time-out" to pamper yourself or relax.
 Keep a positive attitude. Think of all the good things in your life.

Take charge and manage your time

 Make a "to-do" list at the start of each day. Label each item: "A" (most important), "B" (important, but can be put off for a while), or "C" (can be put off).
 Combine errands and make only one trip. Double recipes when you cook; freeze the other half for later.
 Share tasks with others. Ask a co-worker to help you with a project. Ask a family member to help out with tasks at home.
 Practice saying "No." Try to say "yes" only for things that are important to you.

Watch for signs of stress

 Learn to identify and respond to stress early.
xxx  Think about what things make you feel stressed. Plan how you can handle them or work around them.
 If news events are causing you stress, take a break from listening to or watching the news.
 Laugh often and find reasons to feel cheerful.

Reach out to others

 Share your problems. Talk about how you're feeling and coping.
 Find comfort and support from family and friends.
 Recognize when you need more help. Talk with your doctor or a counselor.

Relaxation Exercises to Reduce Stress

Follow the steps below to feel more relaxed. You can try these alone or with a partner. 9,10

Deep breathing

Step 1: Get into a comfortable position. You can sit or lie down. Close your eyes and focus on your body and your breath.

Step 2: Take a deep, slow breath through your nose. Let your belly fill with air. Then breathe out. Relax and let all of the air go out through your nose.

Step 3: Place one hand on your belly and the other hand on your chest.

Muscle relaxation

Step 4: Breath in and out through your nose. Focus on shifting your breath so you can feel the rise and fall of your breathing in your belly more than your chest.

Step 5: Take three more slow, deep breaths as you focus on your belly rising and falling. Keep breathing fully and deeply as your breath slows and you become more relaxed.

When you focus on slowly tensing and relaxing each muscle group in your body, it can help you feel the difference between muscle tension and relaxation.

Step 1: Start by tensing and relaxing the muscles in your toes.

Step 2: Slowly work your way up to your neck and head.

Step 3: Tense your muscles for about 5 seconds and then relax for 30 seconds and repeat.

Note: You can also start with your head and neck and work down to your toes.

Action Plan

A personal plan for managing stress

Step 1: Please check the box for each action below that you want to take. Note that not all actions listed may apply to your personal situation.
Step 2: Select how confident you feel that you can take each action you choose. Circle a number from 1 to 10. A confidence level of 10 is the most confident and a 1 is the least confident.

Avoid stressful situations		1 2 3	4	5 6	7 8		9 10
 Avoid people or situations that bring me stress. Practice saying "no" when "yes" will lead to stress.	1	2 3	4	5	6 7	8	9	10
Make a "to-do" list at the start of each day.	1	2 3	4	5 6	7	8	9	10
Change the situation
 Share some of my tasks with others.	1	2 3	4	5 6	7	8	9	10
 Combine errands so that I make fewer trips.	1	2 3	4	5 6	7 8		9	10
 Think about the things that cause me stress and plan how I'll work around them.	1	2 3	4	5 6	7 8	9		10
Practice healthy lifestyle habits
 Be physically active.	1	2 3	4	5 6	7	8	9	10
 Eat healthy.	1	2 3	4	5 6	7 8	9		10
Get plenty of sleep.	1	2 3	4	5 6	7	8	9	10
 Avoid using drugs and alcohol to deal with stress.	1	2 3	4	5 6	7 8		9	10
Make time for fun and relaxation
 Take 10-minute "time-outs" to pamper myself or relax.	1	2 3	4	5 6	7	8	9	10
Reach out to people.	1	2 3	4	5 6	7	8	9	10
 Do something fun every day.	1	2 3	4	5 6	7	8	9	10

Step 3: Think about which action you'll begin first. Write down a specific step you'll take to start. For example, if you choose "Make time to relax," your goal might be: I will do some muscle relaxation exercises 3 times a week after dinner for 2 weeks.

_______________________________________________________________________________

Step 4: Please write the day and time that you will take this first step.

For example, Monday at 7:00 PM.

_________________________________________________

Managing Stress: What You Need to Know

Stress caused by short-term events is a normal part of life experienced by everyone.

Stressful events or situations that last a long time can lead to serious health problems.

Know the cause of your stress

Many events or situations can cause stress. Some are positive; others are negative:

 Your health
 Emotional issues
 Major life changes
 Workplace stress
 Sense of control
 Support network
 Family stress
 Attitude and outlook
 Financial problems

How stress can be harmful

Over time, too much stress can cause serious problems. Stress can affect how you think, act, and feel. It can:

 Make it harder for your body to fight illness
 Hurt your relationships with family, friends, and people you work with
 Lead to bad habits like smoking, drinking alcohol, or overeating
 Make a health condition worse
 Lead to emotional problems, such as depression, anxiety, and panic attacks

Post-traumatic stress disorder

 People who have faced or witnessed a terrifying event may develop post-traumatic stress disorder (PTSD)
 If you are under a great deal of stress or feel you have PTSD, talk with your doctor

Warning signs of stress

There are many signs that stress may be affecting you. They can be physical and emotional. Some warning signs are:

 Headaches
 Muscle tension
 Grinding teeth
 Upset stomach
 Acid reflux
 Chest pain, racing heart
 Difficulty falling or staying asleep
 Little or no energy
 Weight gain or loss
 Lack of concentration
 Loss of appetite or overeating
 Memory problems
 Short temper
 Sexual difficulties
 Aches and pains
 Feeling anxious, worried, or depressed
 Nail biting
 Increased frequency of colds

When you know the warning signs of stress, you can do something about them.

Healthy ways to reduce stress

 Practice healthy lifestyle habits
 Lighten your mood
 Take charge and manage your time
 Reach out to others for support
 Watch for signs of stress and respond early
 Do relaxation exercises, such as deep breathing and muscle relaxation

References

National Institute of Mental Health. 5 things you should know about stress. Accessed January 23, 2020. https://www.nimh.nih.gov/health/publications/stress/19-mh-8109-5-things-stress_142898.pdf
Cleveland Clinic. Stress. Accessed February 5, 2020. https://my.clevelandclinic.org/health/articles/11874-stress
National Institute of Mental Health. Post-traumatic stress disorder. Accessed April 21, 2020. https://www.nimh.nih.gov/health/topics/post-traumatic-stress-disorder-ptsd/index.shtml
Stress relief is within reach. American Psychological Association Web site. Accessed January 23, 2020. https://www.apa.org/topics/stress/
Segal J, Smith M, Segal R, Robinson L. Stress symptoms, signs, and causes. Helpguide.org Web site. Updated March 2020. Accessed April 21, 2020. https://www.helpguide.org/articles/stress/stresssymptoms-signs-and-causes.htm
Discrimination linked to increased stress, poorer health, American Psychological Survey Finds. American Psychological Association website. Published March 10, 2016. Accessed May 5, 2020. https://www.apa.org/news/press/releases/2016/03/impact-of-discrimination
Centers for Disease Control and Prevention, National Center for Injury Prevention and Control, Division of Violence Prevention. Coping with stress. Accessed January 27, 2020. https://www.cdc.gov/violenceprevention/suicide/copingwith-stresstips.html
Centers for Disease Control and Prevention. Lifestyle coach facilitation guide: post-core, stress and time management. Accessed February 10, 2020. https://www.cdc.gov/diabetes/prevention/pdf/postcurriculum_session12.pdf
Peterson AL. Decrease stress by using your breath. Accessed February 10, 2020. https://www.mayoclinic.org/healthy-lifestyle/stress-management/in-depth/decrease-stress-by-using-
your-breath/art-20267197
Mayo Clinic. Relaxation techniques: try these steps to reduce stress. Accessed February 10, 2020. https://www.mayoclinic.org/healthy-lifestyle/stress-management/in-depth/relaxation-technique/art20045368