Stress-Free Stress Management

Last Editorial Review: 12/27/2004

WebMD Live Events Transcript

Does the thought of managing your stress cause you even more stress? Before you decide that the cure is worse than the disease, check out our discussion about getting the upper hand on your stress. Jay Winner, MD, author of Stress Management Made Simple, joined us on Nov. 11, 2004, to talk about it.

The opinions expressed herein are the guests' alone and have not been reviewed by a WebMD physician. If you have questions about your health, you should consult your personal physician. This event is meant for informational purposes only.

Dr. Winner, managing stress seems so complicated, as if it will just add another layer of stress.

You're correct, yet it is extremely important to manage your stress. Stress is associated with a wide variety of medical problems including heart disease, obesity, IBS, headaches, high blood pressure, and the list goes on and on.

Almost any medical problem can be made worse by stress. Workplace stress causes about 1 million U.S. employees to miss work each day, and a recent national study listed stress as the number one impediment to academic success.

So our goal today, as my book title suggests, Stress Management Made Simple, is to go ahead and make stress management simple. Four of the things I'd like to go over today, include:

  • Learning to relax. Whenever you have a free five minutes, wouldn't it be great to be able to relax during that time and relieve some of your tension?
  • Learning to practice relaxation throughout the day. Sometimes, for instance, when our boss is yelling at us, we don't have that free five minutes. We need to respond right away. So we need to learn to practice relaxation even when we don't have that spare five minutes.
  • Learning to change your thoughts. Two people can be in exactly the same circumstance, and one will be very stressed and the other will not be. One of the differences is how we think about things.
  • Learning to keep life in perspective. As a physician, I may have one patient totally stressed out because of a remodel to his or her mansion, and the next patient is doing well emotionally despite his diagnosis of terminal pancreatic cancer. So we need to learn to keep life in perspective.
"Workplace stress causes about 1 million U.S. employees to miss work each day, and a recent national study listed stress as the number one impediment to academic success."

Can you please explain "changing your thoughts."

Let's start by talking about a concept called reframing. If you are in a difficult situation, changing the way you think about it may improve your level of stress. For an easy example, you could just think, "this is a difficult situation" could be reframed to "what a challenge."

Let's go over two important examples. Many people get stressed waiting in line. Let's pretend you are at the grocery store in a rush, so you pick out the shortest line. Then you start noticing the line next to you is moving like a jet plane and yours is moving like a turtle in mud. You start getting irritated at the cashier and perhaps at the person in front of you. How can we reframe waiting?

Let's start by realizing that most of us indeed are very busy. Most of the time, there are demands on our time. This time of waiting could be reframed as time to take a break from your busy day. A break where there aren't all these demands.

During this time in line, you could focus on your breath, list the things in life for which you're grateful, talk to your neighbor in line, or perhaps read a magazine. (Maybe even one of those magazines you would never really buy.) If you're waiting in traffic, perhaps you can listen to some relaxing music.

Another stressful situation is dealing with rude people. Whenever I teach a stress management class, I do an experiment. I ask the people in the class to raise their hands if they have ever been rude in their lives. Of course, everyone raises their hands.

The next question is, when you're rude, raise your hand if you're at your happiest and feeling your best. For the second question, no one raises their hand. So for these thousands of people in my classes, consistently when people are rude, they are suffering in one way or another.

When the bank teller or work associates are rude to you next time, keeping in mind that this person is likely suffering will increase your empathy, decrease your hostility, and decrease your stress. In addition to reframing, sometimes it's good to replace what's called catastrophizing thoughts with more realistic thoughts.

For instance, when there is a relatively "minor" event (compared with things like your life and health) that does not go well, people may think things like "This is a nightmare, this is horrible, or this is a catastrophe." Instead, you may benefit from replacing that thought with a more realistic thought such as, this is unfortunate. There are some examples for changing your thoughts, and there are many more.

How does keeping things in perspective reduce our stress?

There are several ways to keep things in perspective that do bring down the level of stress. The first way is through gratitude.

In a quote, Dale Carnegie pointed out that most of us wouldn't sell our eyes for a million dollars, or our legs or hands. If we add up what we do have, including our health, and our family, we wouldn't sell that for all the gold in the world.

Many of the things that we get stressed about on a day to day basis are small in comparison. Throughout the day, I recommend people list perhaps five things in life that they are grateful for. That helps keep our relatively smaller stresses in order. Finding purpose in what you are doing also helps with stress.

That means both looking for work in occupations you feel make a difference, but it also means appreciating the difference you make to your friends, coworkers and clients in the things you are currently doing. Keeping a sense of humor is another way to keep things in perspective. One more way is realizing that we don't always know what is best.

For instance, one person was driving on an eight hour trip to move all their belongings to their new house. They found that the trailer was not compatible with the truck they'd rented. Because of this, they were quite upset that they'd need to do an extra 15-hour round trip. As they were on their drive, the truck had a blow out and the person could safely negotiate to the side of the road.

Later, he found out, that if he had the trailer in place and had the blow out, the trailer would have likely jack knifed, and he may have had serious injury or death. As Helen Keller said, "When one door closes, another opens." But we often look so long at the closed door that we do not see the one which has opened for us.

Being grateful is a big thing, I think. Keeping up with the Joneses is hugely stressful!

Correct, clarifying your values is important. Putting too much emphasis on material things will lead to excess stress. Learning to simplify is an important stress management life skill.

"Different experts recommend different amounts of time to spend with these relaxation exercises. I feel there's benefit even if you do them for just a few minutes a day."

Dr. Winner, how does a person simply learn to relax?

One of my favorite relaxation exercises is a type of meditation whereupon you start by focusing on your breath. When people are anxious, they tend to breathe with what is called the accessory muscles, including the muscles in their chest and neck.

I would like people to start with breathing using their diaphragm which is the muscle between the chest and abdomen. As you focus on diaphragmatic breathing, your abdomen goes out with each breath in. As you do relaxation exercises like this for five minutes, you certainly will have many thoughts. Those thoughts can be considered part of the exercise. As opposed to resisting the thoughts, gently let them pass by and focus your attention back on the breath.

The next step can be a body scan, in which you relax one body part at a time, slowly traveling from your feet to your head. Some people also like to use a repetitive phrase, and when their thoughts wander, they gently bring themselves back to the phrase.

Learning this type of exercise just by reading about it is difficult for many people. That's why there's a free six minute relaxation exercise you can listen to by going to The first relaxation exercise there leads you through an exercise similar to the one that I just talked about.

What causes me the most stress is lack of time, so making time to do things like breathing and stretching exercises or whatever seems stressful in itself. Just how much time do you have to spend to get any benefit from stress reduction techniques?

Many of these techniques really don't add any significant amount of time. In fact, if you are less stressed, in the long run you will likely be more time efficient.

Different experts recommend different amounts of time to spend with these relaxation exercises. I feel there's benefit even if you do them for just a few minutes a day. They can be done in your car, when you first wake up in the morning, when you are holding your young child, or even when you're walking.

As I mentioned, other activities, such as changing your thought process, putting relaxation throughout your day, and keeping life in perspective, take virtually no time.

I know the image of stress reduction is calm and quiet with New Age music playing. Is cranking up the rock-and-roll and singing in my car helpful in the long run, or is it like smoking a cigarette to calm your nerves -- it works, but isn't good for you?

Your strategy indeed is helpful. The title of my book is Stress Management Made Simple, not getting rid of stress, because stress is an inherent part of life.

If you can imagine being a cave man seeing a saber-toothed tiger over your left shoulder, your heart would race, your pupils would dilate, and your blood would be deviated from your gastrointestinal tract to your muscles. You would be, in effect, ready to fight the saber-toothed tiger, or if you were a little smarter cave man or cave woman, run.

Stress is not necessarily bad; stress is just the flight/fight response. If we have no adrenaline flowing, no energy, we would probably perform certain things more poorly. Once we increase the adrenaline to a certain point, our performance may improve. Yet, of course too much stress will impair our performance.

I talk about this to introduce you to the concept EUSTRESS, which is good stress. Bad stress is felt as anxiety, agitation, and worry. Eustress is felt as excitement and enthusiasm.

One way to actually convert distress into eustress is to use the energy. So some people relax to relaxing music, but turning up the music, singing and/or dancing, can also be a good way to deal with stress. Interestingly, if you say the word eustress slowly out loud, it sounds like, "use stress.

Does the old 'count to ten' method really work if you feel you're about to burst?

Delaying a response until you calm down may be helpful. I think this question emphasizes the need for learning how to relax through the day when you don't have that whole few minutes to do a relaxation exercise.

I would like to introduce a concept called mindfulness. We all know that the present moment can only be one way. Yet from the very beginning of the morning, we may wake up and say to ourselves, I wish the alarm wasn't going off now, I wish my spouse or children would be acting differently, and perhaps, as we head on the road, I wish I wasn't in this traffic jam.

Let's compare this to when life is at its best, when we have what we call peak experience, that sense of flow. If you think of a peak experience, perhaps walking hand in hand with your spouse on the beach watching the sunset, you are not thinking, this would be okay if only there were more pink in the left hand corner and more orange in the other corner. You are enjoying the sunset as it unfolds.

The question is how can we put more of that enjoying the present moment, or mindfulness, into our day. When you start having thoughts such as, "I wish I wasn't in this traffic jam," don't resist but gently let it go, and focus on the next diaphragmatic breath -- just as you might do with the relaxation exercise I described.

There's another optional step. Many people tense a muscle group such as their neck, shoulders or jaw when they get stressed. If you know what muscle group you tend to stress, you can relax that muscle group as the next step. In only a few seconds, you can go through these three steps of letting the thought go, focusing on a breath, and relaxing a muscle group.

Imagine that if you did that many times a day, the stress level would not get the chance to build to a higher, higher and higher level and you would not get the problems associated with prolonged stress. One of the reasons I like this relaxation exercise is that it's not only a relaxation exercise; it's also a tool to practice this mindfulness or this way of learning to relax throughout the day.

Do people teach mindfulness as a class?

There are several stress management classes throughout the country, and many of them do teach mindfulness. Some of these concepts may be difficult for some people to understand fully just by reading about them. That is why I felt it was important for me to include two audio CDs in Stress Management Made Simple.

"Many people use a meditation to help them get to sleep at night. To feel better in the morning, some people visualize jumping out of bed energetic first thing in the morning."

Are there things we can do before going to sleep to make stress better so that we wake up more relaxed?

There are multiple things to do to help out with insomnia. Many people use a meditation to help them get to sleep at night. To feel better in the morning, some people visualize jumping out of bed energetic first thing in the morning.

Insomnia is an interesting problem, in that the harder you try to get to sleep the more trouble you often have. Obviously there are several things you want to do to avoid insomnia:

  • Steer clear of too much caffeine at night
  • Avoid heavy meals right before bedtime
  • Make your bedroom a comfortable place to sleep

In addition to that, if you are trying to get to sleep for 20 or 30 minutes, it may be better to get out of bed, go to another room and read a boring book until you start feeling drowsy again. I think that, along with trying a meditation, are two of the more important hints. For more details, there's a chapter in my book and a specific relaxation exercise for insomnia.

How do you know when stress has tipped over into depression?

Clinical depression is a medical problem that consists of a variety of signs and symptoms. If one is sad not just some of the time but most of the time, that is one key to clinical depression. Some other symptoms include:

Another symptom is called anhedonia, meaning lack of enjoyment. If activities or hobbies that used to bring one pleasure no longer do, then you may be depressed.

If you have any question that you, a family member or friend, may have clinical depression or an anxiety disorder, I strongly encourage you to discuss this with your health care provider or a mental health professional.

Dr. Winner, do you have any final words for us?

Thank you very much for joining me in this discussion. Stress can exacerbate almost any medical problem. If you do not treat the stress, you are only treating part of the problem. I encourage you to continue exploring this area, and I wish all of you much peace, health and happiness.

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