Archive for December 4th, 2011

Stress Management

During the busyness of the holiday season it can be important to take time to relax and center oneself. Provided is some information on stress and exercises you can try at home to relieve and manage it.


What is Stress?

Stress is the perception, the way one views, a threat to one’s well being, and the perception that one cannot cope 3. The American Psychological Association defines stress as, “any uncomfortable emotional experience accompanied by predictable biochemical, physiological and behavioral changes”5.

While some levels of stress can be beneficial and give you the drive you need to complete certain tasks, large amounts of stress can have negative effects.

According to the American Psychological Association there are several types of stress:

Acute stress is the most common type of stress, which is caused by “demands and pressures of the recent past and anticipated demands and pressures of the near future” 5. It is short term and can be thrilling in small amounts.

Most common symptoms – emotional distress; tension headaches, back pain, jaw pain, and muscular tensions; stomach, gut, and bowel problems like heartburn, gas, diarrhea, and constipation; can lead to elevation in blood pressure, increased heart rate, sweaty palms, heart palpitations, dizziness, migraine headaches, cold hands and feet, shortness of breath, and chest pain 5.

Episodic acute stress occurs in people when they suffer from acute stress frequently. Commonly these people describe themselves as having “a lot of nervous energy” or being “worry warts.”

Symptoms include – “persistent tension headaches, migraines, hypertension, chest pain, and heart disease”. Treatment is usually needed and involves intervention and professional help 5.

Chronic stress, “comes when a person never sees a way out of a miserable situation” and “the individual gives up searching for solutions.” It can be caused by ignoring and poorly managing every day stressors, involvement or exposure to traumatic events, stress of poverty and economic hardship, and dysfunctional families 5.

When gone on untreated, it can cause “anxiety, insomnia, muscle pain, high blood pressure, and a weakened immune system”1. These health conditions are serious, causing people to wear down, and even cause death.

Stress and the body

Physiologic Effects of Stress (Physical effects on the body)

In response to a perceived threat, or stress, the body initiates a cascade of events in the body that is started by the nervous system, most commonly known as the fight or flight response. It prepares the body for physical activity to either deal with the perceived threat or run away. The cascade of events stimulates various responses in the body due to hormones released, including:

  • Increased muscle tension
  • Increased heart rate, blood pressure, and respiratory rate
  • Heightened awareness of the environment
  • Shifting of blood to the large muscle groups

Continued exposure to stress can cause negative effects on the body, such as:

  • Decreased immune function
  • Increased risk of cardiovascular disease
  • Tension headaches
  • Pain, increases pain perception in older adults
  • Insomnia
  • Gastrointestinal complaints 3

Psychological Effects of Stress

Psychologically stress is shown through negative moods, “such as anxiety, depression, hostility, and anger. These emotions (mood states) can in turn negatively influence a person’s ability to concentrate and effectively problem solve”3.

Social and Behavioral Effects of Stress

Often times when people are feeling stressed they respond with unhealthy behaviors, including changes in eating patterns (over or under eating), large amount of alcohol consumption, smoking, or even abusing drugs. People may also be prone to socially isolate themselves at times even though it has been shown that social support has been shown to have positive effects on a person in times of stress 3.


When choosing to disconnect due to stress, a person can feel a loss from their life’s meaning and purpose. They can also choose to withdraw from religious affiliation and activities 3.


Managing Stress

It is necessary to find healthy ways to cope and manage stress in one’s life. Listed here are several stress management techniques with examples of how to implement them into your life.

Cognitive Therapy

Cognitive therapy “helps individuals reappraise or reevaluate their thinking…the intent of the intervention is to change or restructure the distortions in thinking patterns that cause stress” 3. It is a short term intervention to help an individual change negative thoughts and replace them with rational and more positive feelings.


Recognizing automatic thoughts, feelings, and physical reactions that occur in response to a stressful situation can help a person change these to more positive beliefs.

  1. Stop what you are doing (helps to break the cycle of escalating negative thoughts)
  2. Take a deep breath (helps to release physical tension, promotes relaxation)
  3. Reflect:
    1. Physically, how do I feel?
    2. Emotionally, how do I feel?
    3. What were my automatic thoughts?

Another exercise that can be used to recognize automatic thoughts, feelings, and physical reactions is the vertical arrow exercise:

  1. Identify a stressful situation
  2. Ask yourself why it is a stressful situation
  3. Ask yourself, “if that is true, why is it so upsetting?”
  4. Continue to use this to question thoughts until you are able to see a positive way to face the stressful situation

Exercise for developing an affirmation, or encouraging belief, about stressful situations:

  1. Identify a stressful situation – i.e. work, family, or health
  2. Decide how you would like to feel in the situation and what you would like to see happen
  3. Make the goal into a first-person statement, in the present, and in the positive – i.e. “I am confident in my work” or “I am becoming healthy and strong”
  4. Repeat this affirmation throughout the day

Over time the affirmations developed during this exercise will become a second nature and help reduce stress in these situations 3.

Journaling is a great way to keep track of thoughts and feelings when using these exercises. It allows you to examine life’s events and put them into perspective. With journaling it is important to not simply whine or complain about the event but to reflect on what happened, how it made you feel, and problem solve.


Eastern approaches to exercise, such as yoga therapy and Tai Chi, are useful in promoting health, decreasing stress, and increasing well-being. The various breathing patterns and postures are used to provide relaxation. Many exercise facilities offer classes for these therapies.

Yoga Therapy is the use of “yoga postures, controlled breathing, relaxation, meditation, and nutrition to release muscular and emotional tension, improve concentration, increase oxygen levels in the blood, and assist the body in healing itself” 4.

Tai Chi is a movement exercise that “enhances coordination, balance and breathing, and promotes physical, emotional, and spiritual well-being”4.


Relaxation techniques and practices offer many benefits such as:

  • Decrease in anxiety about stressful situations
  • Decrease muscle tension
  • Decrease fatigue and improve quality of sleep
  • Improve sense of well being
  • Decrease pain and increase the effectiveness of pain medications 3

Examples of relaxation techniques include:

  • Meditation
  • Autogenic Training
  • Muscle Relaxation


Mediation is the practice of focusing your mind while maintaining a passive attitude. There are many practices of mediation and each one centers on creating relaxation and a sense of calmness.


Mindful Breathing Meditation I (Lying Down)

  1. Lie on the floor, on the couch, or in bed
  2. Place your hands on your abdomen
  3. Close your eyes and feel the movement of your body with every rise and fall of the breath
  4. Take deep breaths in and out
  5. With each inhale, repeat, in your mind, “Breathing in, I am aware of breathing in” (may shorten to “In”)
  6. With each exhale, repeat, in your mind, “Breathing out, I am aware of breathing out” (may shorten to “Out”)
  7. Try this for 15 to 20 minutes

Mindful Breathing Meditation II (Sitting Down)

  1. Find a comfortable chair or spot on the floor in a quiet place
  2. Focus on a point on the floor in front of you and gently lower your lids until they are almost closed
  3. Focus your attention on your breathing
  4. Take deep breaths in and out
  5. With each inhale, repeat, in your mind, “Breathing in, I am aware of breathing in” (may shorten to “In”)
  6. With each exhale, repeat, in your mind, “Breathing out, I am aware of breathing out” (may shorten to “Out”)
  7. Continue to bring your attention to your breath, allowing any thoughts, feelings, or awareness to pass through
  8. Try this for 15 to 20 minutes 3

Meditative Prayer – take a prayer, read it aloud to yourself, and pause after each line so that you can slowly repeat it silently to yourself. Provided is a prayer by Saint Francis of Assisi.

Lord, make me an instrument of thy peace.

Where there is hatred, let me sow love;

Where there is injury, pardon;

Where there is doubt, faith;

Where there is despair, hope;

Where there is darkness, light;

Where there is sadness, joy.


O divine Master, grant that I may not so much seek

To be consoled as to console,

To be understood as to understand,

To be loved as to love;

For it is in giving that we receive;

It is in pardoning that we are pardoned;

It is in dying to self that we are born to eternal life.

Prayers from the Bible are also great sources to mediate on, such as Psalm 23:

The Lord Is My Shepherd

I shall not want.

He maketh me to lie down in green pastures:

He leadeth me beside the still waters.

He restoreth my soul:

He leadeth me in the paths of righteousness for his name’s sake.


Yea, though I walk through the valley of the shadow of death,

I will fear no evil:

for thou art with me;

Thy rod and thy staff they comfort me.


Thou preparest a table before me in the presence of mine enemies:

Thou anointest my head with oil;

my cup runneth over.

Surely goodness and mercy shall follow me all the days of my life:

And I will dwell in the house of the Lord forever.

Autogenic Training

Autogenic training is the process of giving yourself commands that result in physiological responses, or physical changes. These commands are meant to be self healing and promote relaxation 3.

Provided is a series of autogenic training exercises designed to help reverse the physiological effects of stress and help you relax. Think about each statement for about 30 to 40 seconds. Practice these exercises while seated in a comfortable chair or while lying down. These exercises are provided from the American Holistic Nursing Association.

Statement Number 1

My arms are heavy.  My left arm is heavy.  My right arm is heavy.  Both of my arms are heavy.

Repeat each part of this statement to yourself several times, slowly and rhythmically.  It is helpful to visualize your arms as being heavy, to feel them sinking into your lap or against the chair or the floor.

Statement Number 2

My legs are heavy.  My right leg is heavy.  My left leg is heavy.  Both of my legs are heavy.

Think about your legs being heavy and relaxed, with the muscles being loose and limp not tight or restricted.  Feel the weight of your legs.

Statement Number 3

My arms are warm.  My right arm is warm.  My left arm is warm.  Both arms are warm.

Visualize warmth taking over your arms.  You may want to imagine your arms being suspended in warm water or being warmed by the sun.

Statement Number 4

My legs are warm.  My right leg is warm.  My left leg is warm.  Both of my legs are warm.

Again, visualize your legs being warmed in the sun or suspended in a tub of warm water.

Statement Number 5

My heartbeat is calm and regular.

For some people, it is helpful to place your hand over your heart so that you can establish what the heart rate is and its regularity.  Then, passively think about your heart rate being calm and regular.

Statement Number 6

My breathing is calm and regular.

You may want to think about your breathing being deep and easy so that you have full, deep breathing, producing a calming sensation.  Passively think about this.  Don’t force changes in breathing patterns.

Statement Number 7

My solar plexus is warm.

The solar plexus is located in the mid-section of your body, the area below the chest and just above the abdominal area.  Visualize your body floating just below the surface of very pleasant warm water or being warmed by the sun shining on this region of your body.  Think about this passively.

Statement Number 8

My forehead is cool.

Here again, you want to use visualization.  Picture a cool breeze blowing on your face, calming your forehead.  Or you may want to picture a cool moist cloth being placed on your forehead.


My arms and legs are heavy.

My arms and legs are warm.

My heartbeat is calm and regular.

My breathing is calm and regular.

My solar plexus is warm.

My forehead is cool.

When you are ready, take a deep, cleansing breath; let is out; gradually stretch your arms, legs, fingers, toes, neck; and focus on being alert and relaxed.


Progressive Muscle Relaxation

When you become stressed, the body reacts by increasing muscle tension. Progressive Muscle Relaxation is a process of tensing muscle groups to focus on this sensation and then slowly releasing the tension. The process allows you to deepen the experience of comfort.

When using Progressive Muscle Relaxation you work all the major muscle groups in the body. It is recommended to follow this sequence when progressing through the muscle groups:

Right foot

Right lower leg and foot

Entire right leg

Left foot

Left lower leg and foot

Entire left leg

Right hand

Right forearm and hand

Entire right arm

Left hand

Left forearm and hand

Entire left arm



Neck and shoulders


Note: If you are left-handed, you might want to begin with your left foot, and so on 6.


Step One: Tension

  1. Focus your mind on the muscle group
  2. Inhale and simply squeeze the muscles as hard as you can for about 8 seconds, i.e. squeezing your right hand or tightening your abdomen

Step Two: Releasing the Tension

  1. After the 8 seconds, quickly release the tension from the muscle group
  2. As you are doing this exhale and feel all the tightness and pain flow out of the muscles

The American Holistic Nursing Association provides some tips when practicing this technique:

  • Always practice full PMR in a quiet place, alone, with no electronic distractions, not even background music.
  • Remove your shoes and wear loose clothing.
  • Avoid eating, smoking, or drinking. It’s best to practice before meals rather than after, for the sake of your digestive processes.
  • Never practice after using any intoxicants.
  • Sit in a comfortable chair if possible. You may practice lying down, but this increases the likelihood of falling asleep.
  • If you fall asleep, give yourself credit for the work you did up to the point of sleep.
  • If you practice in bed at night, plan on falling asleep before you complete your cycle. Therefore, consider a practice session at night, in bed, to be in addition to your basic practice.
  • When you finish a session, relax with your eyes closed for a few seconds, and then get up slowly. (Orthostatic hypotension—a sudden drop in blood pressure due to standing up quickly—can cause you to faint.) Some people like to count backwards from 5 to 1, timed to slow, deep breathing, and then say, “Eyes open. Supremely calm. Fully alert.”


Imagery by definition is the process of taking “internal experiences of memories, dreams, fantasies, inner perceptions, and visions, sometimes involving one, several, or all of the senses, serving as the bridge for connecting body, mind, and spirit” (HN 295).

Imagery is a technique that can be used to provide a sense of relaxation and harmony when facing stressful situations. Guided imagery is when another person reads a script that helps you to imagine and create a relaxing atmosphere. An example is provided below.

Beach Imagery

“For a few moments allow yourself to take several nice, long, deep breaths. Notice the cool air coming in, filling your lungs, and the soothing warm air going out. Just let all your thoughts float away as you bring your attention to your breathing… in and out. You might mentally scan your body and notice if you’re holding any tension in your muscles. If you are, just gently let all that tension melt away with every out breath. Bring your attention to your breathing, in and out… in and out… let yourself feel more and more comfortable sitting where you are.

In your mind’s eye you see yourself descending down a long, narrow, wooden stairway towards a beautiful, inviting beach. Your bare feet feel the rough weathered steps, and with each step, you feel more and more tension gently melting away from your body. As you continue down the stairway, you notice how the bright white sand stretches down the shoreline as far as you can see. The ocean is a deep shade of blue with the fine white crests of the waves sweeping towards the shore. You reach the end of the stairway and step down, sinking into the warm soothing sand. As you rub the sand lightly between your toes, a soothing sensation of relaxation gently melts through your entire body. The roaring sounds of the sea’s surf, the waves crashing over each other, calm your mind and allow you to feel even more relaxed.

You begin walking slowly towards the edge of the water and notice the warm sun on your face and shoulders. The salty smell of the sea air invigorates you, and you take in a deep breath… breathe slowly out… and feel more relaxed and refreshed. Finally, you reach the water’s edge and you gladly invite the waves to flow over your toes and ankles. You watch the waves glide smoothly towards you, gently sweeping around your feet, and the trails of sea water that flow slowly back out again. The cool water feels soft and comforting as you enjoy a few moments allowing yourself to gaze out on the far reaching horizon. Overhead, you notice two seagulls gracefully soaring high above the ocean waters, and you can hear their soft cries becoming faint as they glide away. And all of these sights, sounds, and sensations allow you to let go and relax more and more.

After a moment you begin strolling down the beach at the water’s edge. You feel a cool gentle breeze pressing lightly against your back, and with every step you feel yourself relaxing more and more. As you walk down the beach you notice the details of sights and sounds around you, and soothing sensations of the sun, the breeze, and the sand below your feet.

As you continue your leisurely walk down the beach, you notice a colorful beach chair resting in a nice peaceful spot where the powdery soft sand lies undisturbed. You approach this comfortable looking beach chair, then you sit down, lie back, and settle in. You take in a long deep breath, breathe slowly out, and feel even more relaxed and comfortable resting in your chair. For a few moments more, let yourself enjoy the sights and sounds of this beautiful day on the beach. And, when you feel ready, you can gently bring your attention back to the present… still letting yourself feel nice and comfortable sitting where you are” 6.

Music Therapy

Music Therapy is the systematic use of music to produce a sense of relaxation and desired changes in thoughts and feelings. Music causes various experiences for each person, so when using music to relax, the idea is visualize peaceful settings that match to the music.

It is important to select appropriate music to promote positive outcomes. Each person has different music that they find pleasing and relaxing, so it is important that you choose what works best for you 3.


  1.  Alvord, Ph.D., Mary K., Karina W. Davidson, Ph.D., Jennifer K. Kelly, Ph.D., and Kevin M. McGuiness, Ph.D. “Understanding Chronic Stress.” American Psychological Association. Web. 29 Nov. 2011. <;.
  2. American Psychological Association. Stress in America Findings. Rep. 2010. Print.
  3. Dossey, Barbara Montgomery., and Lynn Keegan. “Nutrition.” Holistic Nursing: a Handbook for Practice. Fifth ed. Sudbury, MA: Jones and Bartlett, 2009. Print.
  4. “Managing Stress.” American Holistic Nurses Association. Web. 29 Nov. 2011. <;.
  5. Miller, Ph.D., Lyle H., and Alama Dell Smith, Ph.D. “Stress: The Different Kinds of Stress.” American Psychological Association. Web. 29 Nov. 2011. <;.
  6. “Stress Exercises.” American Holistic Nurses Association. Web. 29 Nov. 2011. <;.

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