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Stress Management

Work, deadlines, bills, homework, chores... and the list goes on. The demands of daily life pull us in all different directions, requiring time and energy that we don’t always have. At some point, just maintaining a to-do list becomes a to-do of its own. When these demands grow out of hand, they may lead to the all-too-familiar feeling of stress.

Stress is insidious. When stress goes unchecked, its symptoms linger and chip away at both physical and mental health. Many grow used to the constant feeling of stress pressing down on them, while others wear their stress as a badge of honor.

That being said, it’s okay to have some stress. A healthy level of stress pushes people to take care of their responsibilities, without keeping them up at night or damaging their health. The goal isn’t to eliminate all stress—it’s to keep stress at levels that are helpful, rather than harmful.

In this guide, we provide an overview of stress, its symptoms, and how it presents in daily life. Then, we will introduce 5 strategies for managing stress in a healthy way.

What is Stress?

Stress is a feeling of being tense, overwhelmed, worn out, or exhausted. A small amount of stress can be motivating, but too much stress makes even small tasks seem daunting. Symptoms can range from mild (e.g., headaches and stomachaches) to severe (e.g., anxiety and depression).

Acute vs. Chronic Stress

Acute stress is brief but intense. Short-term stressors—such as giving a speech, getting into an argument, or studying for an exam—cause acute stress.

Chronic stress, on the other hand, is long-lasting. The symptoms may not be as intense in the moment, but the long-term effects are more severe. Long-term stressors—such as a difficult job, an unhealthy relationship with frequent arguing, or financial difficulties—cause chronic stress.

The symptoms of acute stress, such as sweating, irritability, and headaches, are disruptive in the moment. The symptoms of chronic stress might go unnoticed in the moment, but cause serious long-term health problems.

Note: Those with chronic stress often become accustomed to the discomfort, and the feeling of stress becomes their new “normal”. However, the negative health effects persist.

Symptoms of Stress

Stress causes physical, emotional, and behavioral symptoms. Some people will have an easy time identifying their symptoms, and connecting them with stress. Others—especially those who have had chronic stress for years and years—will need more guidance before recognizing their symptoms as stress-related.

Acute Symptoms
symptoms that occur before or during a stressful situation
Physical Emotional / Cognitive Behavioral
  • Asthma
  • Headaches
  • Migraines
  • Back pain
  • Sweating
  • Nausea
  • Indigestion
  • Chest pain
  • Fatigue
  • Worry
  • Irritability
  • Anger
  • Loss of motivation
  • Difficulty concentrating
  • Mood instability
  • Decreased sex drive
  • Memory problems
  • Nail biting
  • Constant thoughts about stressors
  • Restlessness
  • Teeth grinding
  • Disrupted sleep, diet, and exercise
  • Interpersonal conflict
  • Social withdrawal
  • Substance use
  • Procrastination
Chronic Symptoms
symptoms and consequences of long-term stress
  • Sleep disorders
  • Weakened immune system
  • Poor diet and exercise habits
  • Heart disease
  • Anxiety disorders
  • Skin diseases
  • Depression
  • Memory impairment
  • Substance use
References: 1, 3, 6, 9, 11, 12, 13, 15

Stress Management Strategies

Build Resilience

Resilience refers to the ability to handle stress when it arises, and to protect oneself against future stress. Research has shown that there are a number of qualities that contribute to resilience, including social support, optimism, sense of humor, spirituality, self-esteem, and adaptability (7, 10). Many of these qualities can be fostered in therapy.

Here are a few ways to build resilience:

Using social support can help reduce stress. Social support may come from friends, family, or community organizations. Identify current and potential sources of social support. For help doing so, try the social support worksheet:

Positive journaling can foster optimism, which contributes to stress resilience. Positive journaling involves writing about daily positive experiences. It tends to be easy to remember negative experiences, but it takes more work to recall and appreciate positive experiences. Positive journaling is a great way to appreciate these experiences. For a journal template, try the positive journal packet:

Showing gratitude can increase self-esteem, which contributes to resilience. There are a number of ways to show gratitude, including gratitude journaling, telling someone “thank you”, and visiting someone you appreciate. Check out the following gratitude resources:

Tip: Resilience isn’t built overnight. Just like with any other skill, it comes with time and practice.

Relaxation Techniques

Relaxation techniques, such as deep breathing and progressive muscle relaxation, are a fundamental part of stress management (5, 14). These techniques trigger the relaxation response, which counters the body’s stress response.

This section focuses on how relaxation skills fit into stress management treatment. For information, instructions, and resources about specific techniques, see our guide on the subject:

Relaxation techniques not only provide immediate stress relief, but the effects also generalize. This means the benefits of relaxation continue to be felt long after the exercise is complete. These techniques work best when done regularly and during times of calm, rather than exclusively when stress is at its peak.

Begin by teaching and practicing relaxation skills in session, then developing a routine that includes daily relaxation. Practicing only in session is not enough—relaxation skills must be used outside of therapy to be effective in the long-term.

Tips for Making Relaxation a Habit
  • Model relaxation practice by starting or ending every session with a relaxation technique. This also reinforces the positive effects associated with practicing relaxation.
  • Assign daily relaxation practice as homework. Reinforce the importance of the homework by following up at the start of every session, and discussing the experience.
  • Plan where relaxation can fit into a daily routine. It may help to set an alarm as a reminder, or connect relaxation practice with another activity. For example, practicing deep breathing for 10 minutes after each meal.
  • Keep practicing even if the positive effects are small. The benefits of relaxation accumulate and grow with practice.

Time Management

Too much to do, and too little time. Balancing responsibilities and fitting them into a busy schedule is a common stressor. Time management skills can reduce the mental burden of juggling tasks, and increase the likelihood that everything gets done (4).

Time Management Tips
  • Use a to-do list or appointment book. Writing down your responsibilities has a number of benefits. Not only will it ensure you don’t forget anything, it also reduces stress by allowing you to drop your mental to-do list.
  • Prioritize your tasks. Focus on completing the most important, and the quickest tasks, first. If you have a few “to-dos” that will only take five minutes, knock them out quickly for the peace of mind.
  • Break large tasks into smaller pieces. It’s easy to feel overwhelmed when you have a really big task before you. Breaking big tasks into small pieces will help you get started, which is often the hardest part. For example, writing a paper can be reduced to pieces such as doing research, preparing an outline, and writing an introductory paragraph.
  • Limit distractions. Spend a few days recording how much time you spend on distractions such as social media or TV. Then, cut out the distractions you don’t actually enjoy, and schedule time for the ones you do enjoy. Always set an alarm so you know when to get back to work.
  • If you can’t limit your distractions, get away from them. If you know that you will succumb to distractions, get away from them. Create clear boundaries between work and play by putting up a “Do Not Disturb” sign on your door, turning off your phone, or going to a coffee shop without a TV. Everyone is different in this regard— make the changes you need to focus.
  • Give yourself time between tasks. Plan on arriving to appointments 15 minutes early, and bring something to do in case you find yourself waiting. Scheduling some buffer time will help to reduce your stress when things inevitably run long.
  • Let yourself be less than perfect. If you try to complete every task to perfection, some of your other responsibilities won’t get done at all. Focus on completing everything to an acceptable level, and then go back to improve upon your work if you have time.
Download Worksheet

Self-Care

When stress is at its worst, hobbies, relationships, and free time are neglected. As a result, stress worsens. This creates a cycle where self-care is neglected, and stress grows.

“Self-care” refers to your favorite activities that help you relax, have fun, or feel energized. These could include talking with a friend, going for a walk, reading, listening to music, or whatever else you enjoy. The important part of self-care is not so much what you do—it’s just that you do it.

To start, the Self-Care Assessment can be used to explore current self-care habits while giving ideas of where self-care can be improved:

Self-Care Tips
  • Self-care means taking time to do things you enjoy. Usually, self-care involves everyday activities that you find relaxing, fun, or energizing. These activities could be as simple as reading a book, or as big as taking a vacation.
  • Self-care also means taking care of yourself. This means eating regular meals, getting enough sleep, caring for personal hygiene, and anything else that maintains good health.
  • Make self-care a priority. There will always be other things to do, but don’t let these interrupt the time you set aside for self-care. Self-care should be given the same importance as other responsibilities.
  • Set specific self-care goals. It’s difficult to follow through with vague goals, such as “I will take more time for self-care”. Instead, set specific goals, such as “I will walk for 30 minutes every evening after dinner” (8).
  • Make self-care a habit. Just like eating one apple doesn’t eliminate health problems, using self-care just once won’t have much effect on reducing stress. Choose activities that you can do often, and that you will stick with.
  • Set boundaries to protect your self-care. You don’t need a major obligation to say “no” to others—your self-care is reason enough. Remind yourself that your needs are as important as anyone else’s.
  • A few minutes of self-care is better than no self-care. Set an alarm reminding you to take regular breaks, even if it’s just a walk around the block, or an uninterrupted snack. Oftentimes, stepping away will energize you to work more efficiently when you return.
  • Unhealthy activities don’t count as self-care. Substance use, over-eating, and other unhealthy behaviors might hide stress temporarily, but they cause more problems in the long run.
  • Keep up with self-care, even when you’re feeling good. Doing so will keep you in a healthy routine. Plus, self-care might be part of the reason why you’re feeling good!
Download Worksheet

Not sure what to do? Use the Activity List worksheet to get some ideas.

Cognitive Restructuring

Stress is caused by our thoughts about a situation, not by the situation itself. Two people in the exact same situation might have different levels of stress (or no stress at all), just because of how they think about it (2).

Oftentimes, the thoughts that cause stress are irrational or exaggerated, but we respond to them as if they are factual (2). Irrational thoughts that lead to stress may look like the following:

“I’ll never get through this.”
“I have to be perfect all the time.”
“If I don’t get an A on the test, I’m a total failure.”

The process of identifying and changing these irrational thoughts is called cognitive restructuring. See our guide and worksheets on cognitive restructuring to learn specific techniques:

Other stress management resources:

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