How To Manage and Relieve Stress

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The Stress Response

The stress response is a physical bodily reaction to a stimulus, forming an integral mechanism of human evolution due to the advantage it provided us with to protect us from impending threats and potentially dangerous situations. In the modern era, many situations can cause a similar stress response, even if they may not be life-threatening. Stress is experienced due to the response of the brain. The hypothalamus acts as the command centre of the brain and regulates blood pressure, heart rate, breathing and the constriction and dilation of blood vessels in the lungs^[1]. The amygdala sends a distress signal to the hypothalamus, this in turn triggers the release of adrenaline (epinephrine) from the adrenal glands. This acts to increase heart rate and increase blood pressure, beginning the fight or flight response. An increase in blood flowing to all parts of the body alongside the combined effect of an increase in glucose puts the body in a state of ready alertness.

After the adrenaline spike has subsided the HPA axis (Hypothalamus, Pituitary gland and the Adrenal glands) kicks into gear. If there is no longer a perceived threat then the body returns to normal. If there is a continued perceived threat then the hypothalamus releases corticotropin-releasing hormone (CRH) which is received by the pituitary gland and in turn releases adrenocorticotropic hormone (ACTH). This stimulates the adrenal gland which then begins releasing cortisol, ensuring that the body remains in a state of alert. However, this system is not perfect, the HPA axis can be left producing cortisol even if the individual is experiencing persistently low-levels of stress. This chronic stress can lead to prolonged levels of elevated cortisol, alongside adrenaline which can cause damage to vessels and arteries when found as a persistent component in the bloodstream^[2].

Short-term Symptoms of High Stress Levels

Chronic stress can elicit a variety of notable symptoms that may vary in frequency and intensity from person to person. However, the World Health Organisation draw attention to some of the prominent symptoms associated with chronic stress^[3].

Long-term Risks Associated With Chronic Stress

Cardiovascular Disease (CVD)

Cardiovascular disease explains complications associated with heart and vessel tissue damage and pathology, consisting of chest pains (angina), atherosclerosis, stroke and heart attacks. Chronic stress has long been associated with increased risk of developing CVD. Long term workplace-stress and stress due to social isolation is reported to increase the risk of CVD by 30% and 50%, respectively^[4].

Burnout Syndrome

Burnout syndrome is a condition induced by exhaustion attributable to prolonged, severe emotional, psychological and physical overload. There is a reported link between burnout syndrome and depression, suggested to be incidental in some cases due to significant persistent emotional and psychological stress^[5]. However, in relation to stress causality, burnout syndrome is reported to be more consequential of workplace stress, whereas depression is linked in broader terms to life stress^[6].

Obesity

Chronic stress is reported to increase the risk of eating disorders such as binge eating disorder (BED) and consequently, rapid weight gain and obesity. This increased risk of BED and obesity is attributable to experienced negative affect (negative emotions), where a chronic stress response hyperactivates the brain, releasing glucocorticoids and insulin and the subsequent craving for calorie rich foods^[7].

Mental Health Problems

The onset of mental health issues such as depression and anxiety has long been associated with extended exposure to daily stressors. The medial prefrontal cortex (mPFC) is acknowledged as the moderator of cognition and emotion in response to stress related hormones; dysfunction of the mPFC due to chronic stress is reported to cause regulation issues and the possible onset of stress-induced psychiatric disease^[8].

Sexual Dysfunction

Stress-induced anxiety is associated with erectile dysfunction, however, cause and effect is not substantiated given that erectile dysfunction is also associated with instigating stress and psychiatric diseases^[9]. Furthermore, it is reported that women with chronic stress can experience increased levels of distraction during sex where high stress is associted with reduced feelings of sexual arousal^[10].

Managing and Coping with Stress

Diet

Dietary changes can help stabilise blood sugar and in turn, can be effective in helping to regulate and moderate stress^[11]:

Exercise

Constant regular exercise is imperative to anyone who feels a high level of stress. Exercise stimulates the release of endorphins, which create feelings of euphoria and happiness which positively contributes toward general well-being. Not only this but it is clinically proven to reduce symptoms of stress, anxiety and depression^[12]. You don’t have to run a marathon either, a simple brisk walk through a park can be enough to reduce symptoms of stress.

Meditation

Meditation has proven to be one of the most beneficial ways of reducing stress and improving your ability to notice the needs of your body. Once you have sufficient practice meditating, you should find that you are able to meditate almost anywhere.

Ensure that if you plan to meditate, that you are able to find a quiet place, where you are not going to be disturbed. Meditation requires you to find a position that you find comfortable (but not so much that you fall asleep!). The traditional position is to sit cross legged with both hands upturned and gently resting on the knees.

There are a number of different types of meditation, these focus on different aspects of mindfulness. For stress it is likely that concentrating on the feelings with the body would be most beneficial. To this end we shall be concentrating on the technique of Relaxation Meditation.

Relaxation Meditation is focused on ensuring that you are able to relax the muscles in your body and feel any points of tension within your body^[13].

1. First, you must focus on your breathing. Breathing in through the nose and out through the mouth in a continuous rhythmic pattern. Focus on the feeling of breathing, as the air enters through your nose, the expansion of the lungs and then exhalation through the mouth. Continue to focus on this until you feel you have established a rhythm, at which point you may close your eyes.
2. Take a moment to notice your surroundings, scents, sounds, feelings and tastes. Acknowledge these sensory stimuli one by one, focusing on a different one after a few breaths.
3. Next focus on your body, focusing on each muscle individually, looking for tension or discomfort. As you notice discomfort focus on this feeling and acknowledge any thoughts and feelings associated with it.
4. Continue with breathing rhythmically, visualising the tension leaving your body. Continue scanning your body from bottom to top.

Repetition of meditation daily, can substantially reduce symptoms of stress and form an effective long-term strategy.

Music

Listening to music that you like (regardless of whether you’re familiar with those particular songs) is a great way to relieve stress. The music shown to have the greatest effect on stress reduction is classical, ethereal, or other instrumental music with a slow tempo, as this lowers the heart rate, blood pressure and cortisol levels^[14]. Studies have shown music to reduce burnout, relieve depression and anxiety, increase self-esteem, and reduce both the sensation and distress of both chronic and postoperative pain^[15].