Stress management is extremely important for our mental and physical health. Many psychological and physical conditions are partially caused by or made worse by stress. When we are stressed-out we are not thinking rationally (brain imaging confirms this), and when we are not thinking rationally we are essentially on autopilot—letting our emotional thinking guide us. When we are reacting emotionally or automatically, we are usually not acting in accordance with our values, or our best interests (our long-term goals)—or in the best interests of others.
There is no single stress management technique that works for everyone. In this document I present several evidence-based techniques in hopes that you will find at least a couple that work for you. In the process of exploring these techniques you will likely find that some do not work for you, and you may even find that some seem counter-productive. Don’t get discouraged. It is extremely likely that at least one of these techniques will be helpful. If you are struggling to find a technique that helps, or if you are having difficulties applying them to your life, we can go over these more in therapy.
How you respond to stress might play a role in determining which techniques work well for you. Some people need to “ground themselves” to get out of negative thinking or distressing emotions before they can do anything else. If that’s the case for you, you might want to start with the grounding exercises first (these are the first exercises listed below).
As you try these techniques out you might want to keep a journal of your responses to help you decide which techniques work best for you. Journaling will also help you to regularly incorporate these techniques into your life. Some people use these techniques as-needed, whereas others find they get the most value from doing them regularly. It is your choice to use them however best fits your needs and circumstances. I do, however, recommend that you at least try using them regularly (daily, if possible) at first, so you can get figure out how to best employ them in your life.
Grounding Exercises
We often get lost in negative thinking. Sometimes we “ruminate” on these negative thoughts—that is, we go over and over them in our heads and we get stuck.
We may be stuck on what we should have done in the past, or things we wish we wouldn’t have done, or we may beat ourselves up about things we don’t like about ourselves. We may get stuck in feelings of anger, anxiety, or depressive thoughts—like hopelessness or meaninglessness. Our rumination may also be about the future—worrying about what might happen to ourselves or those we care about.
In order to get out of this mode of thinking, we need to “ground” ourselves in the present moment. Grounding is one of the first steps in mindfulness.
When we are grounded in awareness of the present we aren’t overwhelmed with rumination on the past, or worries about the future. Further, when we are grounded, we may delay our reactions (that is, we stop acting automatically or impulsively without thinking rationally), and we may stop ourselves from automatically engaging with or identifying with all of our thoughts, desires, and emotions. Grounding gets us to a place where we can examine our thoughts more objectively to see if they might be irrational, or self-defeating.
5 Things Grounding Technique
To quickly ground yourself in the present moment, try to bring your attention to:
5 things you can see.
4 things you can feel.
3 things you can hear.
2 things you can smell; or think of two things you like to do or are looking forward to.
1 thing you can taste; or think of one thing you like about yourself.
After performing this exercise, you are more likely to be able to take a “detached” perspective on your beliefs, thoughts, desires, and emotions. In other words, you can look at them like an objective or scientific outside observer would. From this perspective you can choose to simply allow your thoughts to pass like a cloud in the sky (by delaying your reaction to them and not engaging with them or identifying with them), or, if they occur frequently, you may choose to challenge the underlying beliefs or assumptions that cause them to arise (see: common thinking errors).
If the above doesn’t appeal to you, another simple grounding technique involves simply counting to 30 before we act. The basic idea is the same. We are taking some time to allow our mind to settle before we act.
Grounding Mantras
Mantras are something we repeat over and over to pull us out of intrusive thoughts, distressing emotions (and emotional thinking), pain, or rumination. Mantras also help to foster mindfulness practice by bringing our attention to our values, goals, and our sense of meaning or purpose. Below are some examples of mantras you might use. (Feel free to create your own if these do not appeal to you; these are just examples. You can draw from your own philosophy of life or your spiritual views to create your own mantras.)
- “I deserve compassion and kindness.” (Or, “All beings, including myself, deserve compassion and kindness.”)
Explanation: This mantra is derived from the Karaniya Metta Sutta in Buddhism—”In gladness and in safety, May all beings be at ease. Whatever living beings there may be; Whether they are weak or strong, omitting none, The great or the mighty, medium, short or small, The seen and the unseen, Those living near and far away, Those born and to-be-born — May all beings be at ease! Let none deceive another, Or despise any being in any state. Let none through anger or ill-will Wish harm upon another. Even as a mother protects with her life Her child, her only child, So with a boundless heart Should one cherish all living beings; Radiating kindness over the entire world: Spreading upwards to the skies, And downwards to the depths; Outwards and unbounded, Freed from hatred and ill-will. Whether standing or walking, seated or lying down Free from drowsiness, One should sustain this recollection.”
- “Pain/emotion is just a signal that I can choose to disregard.”
Explanation: We don’t want to suppress emotion or pain; these signals can be very valuable to us, but after we process and understand what they are signaling, we can use mindfulness to disengage from them. We may not be able to do this completely, but we can strive for the ideal of near-complete mastery over pain/emotions that certain exceptional individuals seem to demonstrate.
- “My mind is creating this; it is not necessarily reality.”
Explanation: This mantra is derived from the latter portion of verse one in the Stoic Enchiridion by Epictetus—”You are but an impression, and not at all what you seem to be.” It reminds us to keep in mind that what we are thinking or perceiving is not necessarily the way things really are, rather, they are impressions, or the way our minds are interpreting things. This idea is summarized well by the aphorism which states “Don’t believe everything you think.”
- “Focus on what is in my control; let go of (or accept) what is not.”
Explanation: This mantra is also derived from verse one of Enchiridion. This concept is known as the dichotomy of control, or the idea that there are things we can control (examples: our beliefs, our choices or reactions, our preparation) and things we cannot control (examples: what others think or do; most events in the world). We cannot control what others think or do, or most of what happens in the world, but we can control our reactions to these things; we can choose to think in ways that distress ourselves by worrying about things outside our control, or we can choose to let go of things outside of our control.
General Stress Management
4 in / 6 out breathing
Deep, intentional breathing is another way to ground yourself in the present moment. 4 in / 6 out breathing can activate your parasympathetic nervous system (the nervous system that is involved in relaxation and digestion), which slows your heart rate, decreases your blood pressure, and slows the release of stress hormones like adrenaline and cortisol. After just a few minutes of 4 in / 6 out breathing you may start to notice that your stress or anxiety is decreasing, and that you are better able to think calmly and rationally.
- Breathe in through your nose for 4 seconds. If your nasal passages are congested you may breathe in through your mouth, however, it is best to breathe through your nose if you can. (Breathing through your nose humidifies and warms the air much more than breathing through your mouth, and you lose less moisture to the external environment.)
- Exhale through your mouth for 6 seconds. If you find it hard to exhale for a full 6 seconds, try pursing your lips like you are using a straw to limit the amount of air you exhale.
Progressive Muscle Relaxation
Progressive muscle relaxation (PMR) is an evidence-based technique that has been shown to be effective with sleeping problems and stress management (Liu et al., 2020; Touissaint et al., 2021). This technique has the added benefit of teaching you to become aware of muscle tension in your body. As you release muscle tension your physiological responses to stress will decrease, and you will likely notice that you become more calm and relaxed psychologically. Combining this technique with 4 – 6 breathing makes it even more effective.
How to practice PMR:
- Lay down and get comfortable. Remove restrictive clothing and start 4 – 6 breathing.
- Start by tensing the muscles in your feet and toes. Hold the tension for 10 seconds and then relax. Focus on the sensations of relief and relaxation that result.
- Progressively move up the muscle groups in your body. Hold tension in each muscle group for 10 seconds and relax for at least 30 seconds before moving to the next group. The order should look similar to this: feet, ankles, calves, thighs, buttocks, abdomen, chest, hands, arms, jaw.
With any exercise used for sleep issues it is important to remember that your goal should be relaxation only—not sleep. If we make sleep our goal, we are paradoxically less likely to achieve it. This is because we put pressure on ourselves to fall asleep, which causes or increases anxiety.
Mindfulness Meditation
Sit in a comfortable position, somewhere quiet (if possible). After you get comfortable, close your eyes and just relax.
When you are ready, pick an anchor to focus your attention on. Most people use their breath as an anchor, but you can use just about anything: a sound, bodily sensations (as long as this is not distressing—for individuals with health anxiety this anchor could trigger anxiety), a beautiful location you remember. If you choose to use your breath as an anchor you can just breathe normally or use the 4 – 6 method described above.
One thing you will notice is that your mind will wander away from your anchor. This is to be expected. Mindfulness meditation shows us how our minds wander—how they jump from thought to thought, and how we are not in full control of what thoughts come into our consciousness.
Whenever your mind wanders take note of this and simply observe what the mind is doing. Try to think of yourself as a scientific or objective observer that is looking at your conscious experience from the outside, taking note of what is going on in your mind. View your thoughts like clouds passing through a sky. Just like clouds they are temporary and always changing in subtle ways. After you have noted them and observed them, allow them to pass, just like clouds, and bring your attention back to your anchor.
One benefit of mindfulness meditation is that it allows us to practice becoming aware of our negative thoughts and emotions, and to interrupt the cycle of our problematic responses to them. When we learn to take note of distressing thoughts, we can non-judgmentally observe them and gently direct our attention back to what we were doing or an anchor—instead of engaging with them or identifying with them. When we develop this awareness, we can stop automatically reacting to negative thoughts and emotions by engaging in problematic behaviors, engaging in rumination, or starting an emotional cascade that leads to anxiety, depression, anger, etc. By bringing our attention back to our anchor and the present moment we can get out ruminating over the past or worrying about the future.
Mindfulness exercises have also been shown to improve focus. In mindfulness meditation we learn to gently guide our wandering mind back to the task at hand.
When you are first trying out meditation start with 3 minutes a day. You can gradually increase your time if you find meditation to beneficial. Most people aim for around 10 minutes a day.
If you experience any distress with meditation try a different stress management technique or seek an experienced and qualified meditation guide to help you get started.
Mindfulness meditation is good practice for integrating practical mindfulness into your life. Please see our page on practical mindfulness.
Light Exercise
Light exercise—especially exercise that gets you into a rhythmic “flow” state—can be very effective at relieving stress. Vigorous exercise, on the other hand, can increase stress and distressing emotions (it’s better to save vigorous exercise for when we are not stressed out). Some examples of light exercise: jogging; walking / hiking; dancing; rowing; cycling; target archery; swimming.
Mindfulness practices can be incorporated into your exercise for added benefit. For example, use the sensations in your body (e.g., your feet on touching the ground; the feeling of water moving on your body) as an anchor to pull you out of negative rumination (excessive worrying or going over distressing memories / thoughts over and over). When your mind wanders back to distressing thoughts gently bring it back to the present moment using your anchor.
Visualization
Imagine a beautiful place, or recall a place where you have been previously, that made you feel happy and calm. Using music or nature / environment sounds can help with your visualization practice. Don’t just picture this place in your mind, try to incorporate all of your senses into the experience. Imagine or remember the smells, the way things felt, the tastes, sounds, etc. If your mind wanders—and it will—gently bring it back to your place. Incorporating 4 – 6 breathing with this exercise can make it even more relaxing. Aim for 10 or 15 minutes.
Self-massage
Massage has been shown to have many benefits, from stress relief to physical therapy for all kinds of injuries. Even a few minutes of self-massage can help to lower blood pressure, heart rate, and respiration rate—which, in turn, calms one’s mental state.
You can try a variety of massage techniques for self-massage: drumming with the edge of your hand or cupped hands; deep kneading with thumbs, gentle kneading with fingertips, gentle strokes with fingertips or with a pencil / capped pen, etc. You can also purchase curved self-massagers for massaging your back.
Some areas to concentrate on: the inside of your palms / hands; the soles of your feet; calf muscles; thighs; shoulders; chest; back and sides of neck; jaw; temples.
Self-massage may also be helpful if you are experiencing sleep difficulties.
Anxiety and Panic Attack Management
Engage the Mammalian Diving Reflex
Most mammals, including humans, have a reflex to cold water that allows us to slow our breathing and heart rate. This is known as the mammalian diving reflex. The cold water has to come into contact with our face (below our eyes, specifically) to work. When we lower our heart rate and our respiration rate our signs and symptoms of anxiety tend to decrease, as well.
To perform this technique, immerse your face in a large bowl of ice water for 3o seconds. Alternatively, place ice water in a plastic bag and hold against your face while holding your breath for 8 to 10 seconds. A bag of containing something like frozen peas will work, as well.
CAUTION: This technique slows heart rate. If you have any cardiovascular problems check with your doctor before trying this technique.
References:
Godek D., Freeman, A.M. (2022) Physiology, Diving Reflex. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan. Available from: https://www.ncbi.nlm.nih.gov/books/NBK538245/
Liu, K., Chen, Y., Wu, D., Lin, R., Wang, Z., & Pan, L. (2020). Effects of progressive muscle relaxation on anxiety and sleep quality in patients with COVID-19. Complementary therapies in clinical practice, 39, 101132. https://doi.org/10.1016/j.ctcp.2020.101132
Toussaint, L., Nguyen, Q. A., Roettger, C., Dixon, K., Offenbächer, M., Kohls, N., Hirsch, J., & Sirois, F. (2021). Effectiveness of Progressive Muscle Relaxation, Deep Breathing, and Guided Imagery in Promoting Psychological and Physiological States of Relaxation. Evidence-based complementary and alternative medicine : eCAM, 2021, 5924040. https://doi.org/10.1155/2021/5924040