Learn how to manage stress for a healthy life.
- A little stress is good for the body and mind to grow and build resilience, but without good stress management techniques and regularly acknowledge emotions, normal stress can lead to symptoms of depression, anxiety, or excess stress.
- Healthy habits, including exercise, journaling, adequate sleep, and positive thinking, aid in stress management and emotional wellness.
By Bernadette Mazurek Melnyk, PhD, RN, CPNP/PMHNP, FAANP, FNAP, FAAN, and Susan Neale, MFA
This is the third installment in a series of articles on wellness. You can read the first two articles at myamericannurse.com/wellness101.
Picture yourself in a stress-free environment: you’re on a beach, listening to the gentle waves, with nothing to do but relax and enjoy the natural world around you. Bliss, right? Imagining emotional wellness when stress is absent isn’t hard. In the demanding world of nursing, though, we face more stress than ever. Burnout, compassion fatigue, depression, and poor work-life balance are at alarmingly high levels for nurses and other healthcare professionals. In response, the National Academy of Medicine has launched an Action Collaborative on Clinician Well-Being and Resilience, with the following three goals:
- improve baseline understanding of challenges to clinician well-being
- raise the visibility of clinician stress and burnout
- elevate evidence-based, multidisciplinary solutions that will improve patient care by caring for the caregiver.
Fortunately, being emotionally well doesn’t mean eliminating all stress from your life. That would be impossible—and boring. “A human being needs stress,” says Jack Groppel, cofounder of the Johnson & Johnson Human Performance Institute. Stress, when well managed, can help you grow and build resilience, just like exercise helps build muscles.
When you’re emotionally well, you can cope with stressors in healthy ways so that they don’t become overwhelming and interfere with your functioning or lead to unhealthy coping strategies, such as overeating, alcohol or drug use, or smoking. It also means you’re able to identify and express your feelings. Don’t ignore anxiety, sadness, depression, and anger. These emotions may be uncomfortable, but they’re important and they’re telling you something. Persistent anger or irritability, in particular, may be a sign of underlying anxiety or depression. If your feelings or emotions interfere with your ability to concentrate, engage fully in your work, or enjoy things you typically like to do, it’s time to seek help from a qualified mental health professional. Here are some ways to combat stress, reduce anxiety and depressive symptoms, and keep yourself on an even keel.
Cognitive-behavioral skills can help you promote mental health, build resilience, and deal with unavoidable stressors. They also can help reduce anxiety and depressive symptoms. These skills are based on components of cognitive-behavioral therapy (CBT), the gold standard evidence-based treatment for mild to moderate anxiety and depression. Cognitive-behavioral skills building (CBSB) begins with learning to recognize the relationship between what we think and feel and our behaviors.
Many of our emotions result from our thoughts. Negative thoughts are often followed by feelings of anxiety, stress, and depression. Negative thinking also can lead to unhealthy behaviors. This pattern is called the thinking, feeling, and behaving triangle. Most people don’t consider their thought patterns because they’ve become automatic or preprogrammed in the brain. The first step in CBSB is to learn the ABCs:
- Activating event—A stressful event occurs.
- Belief—The stressful event results in a negative belief or thought.
- Consequence—You feel emotionally bad or behave in an unhealthy way.
One key to emotional wellness is catching your automatic negative thoughts and turning them into positive ones. When you feel your mood change for the worse, or when you feel physical symptoms of anxiety—such as rapid heartbeat, headache, stomachache, and sweating—ask yourself, “What was I just thinking?” Many negative thoughts become automatic, like any other habit. We don’t choose them; they just happen.
Recognize triggers, change the script
Learn to recognize what triggers negative thoughts. Let’s say a car cuts you off in traffic. This activating event might provoke a negative automatic thought—“That careless driver could have just caused an accident”—sending your mood into a downward spiral. When you notice negative automatic thoughts, though, you can turn them around and rewrite them. You may want to write down ahead of time what you’d like to think in stressful situations, or you can simply encourage yourself to think positively in the moment.
So, the next time a car cuts you off in traffic and you start to have a negative thought, turn it into a positive one: “That person may be under a great deal of stress. Thank heaven, I’m safe.” This change buffers you from feeling stressed and anxious.
Practice, practice, practice
Thirty days is the time breaking an old habit or making a new one takes, including the way we think. With time and practice, you can change your thinking in response to the stressors in your life, and that will change how you feel. For the next 30 days, try monitoring your thoughts in response to activating events or stressors. Keep a journal of stressful events, the thought patterns that followed, how you felt and behaved, and what you’d like to think instead. Notetaking apps can help you store thoughts quickly.
Eventually, frustrating or challenging situations may start to feel like opportunities to practice CBSB. You’ll gain a feeling of control over these situations and soon you may feel better overall as fewer automatic negative thoughts present themselves.
More coping strategies
In addition to using CBSB to deal with stressful events that disrupt your emotional equilibrium, remember that the nine interconnected dimensions of wellness (physical, intellectual, emotional, social, spiritual, creative, career, financial, and environmental) can lend a hand in improving your emotional well-being, too. Here are more ways to relieve stress and feel better.
Start a journal. Keep track of stress symptoms you’re experiencing daily, such as anxiety, irritability, trouble sleeping or concentrating, or habits like nailbiting or overeating. Make a list of what might be causing you the most stress. Some of these stressors will be unavoidable, but others may be avoided or reduced. List ways you can remove these stressors from your day, including creative solutions. For example, you might choose a route to work that takes longer but is less stressful to drive. Setting aside a little extra time to avoid stress triggers is worth it. Journaling is a good way to express and release your emotions, too.
Engage in regular physical activity. Any activity helps to reduce cortisol buildup. (Cortisol has many negative effects on the brain and body.) If you’re short on time, stretch your muscles with a resistance band for a few minutes, go for a short walk, or learn a few simple yoga postures you can do anywhere. Remember, 30 minutes of physical activity 5 days a week is the evidence-based recommendation.
Use proprioceptive (body awareness) techniques. Try leaning against a wall or simply pressing your palms together. These moves give your mind a reassuring sense of where your body is positioned in space, which can be calming, and are easy to do even during a busy workday.
Get at least 7 hours of sleep each night. Sufficient sleep refreshes your mind and allows your body to repair and heal itself. Anything less than 7 hours results in increased cortisol production, and evidence shows a link between sleep and depression; an inability to fall asleep or stay asleep is one of the signs of depression.
Use abdominal breathing exercises. These exercises can help slow your heart rate and decrease your blood pressure. Try this: Breathe in through your nose for a slow count of five while your abdomen expands, then out through your mouth for a slow count of five and pull your abdomen in. On the breath in, think “I am calm”; on the breath out, think “I am blowing all stress out.” Just a few minutes of deep breathing can calm you down. You can work this into your meal break.
Think positive. Read a book about being positive (such as How Successful People Think: Change Your Thinking, Change Your Life by John C. Maxwell, The Power of Positive Thinking by Norman Vincent Peale, and How to Stop Worrying and Start Living: The Tested Methods for Conquering Worry by Dale Carnegie) for 5 to 10 minutes every morning to start your day off right and shield yourself from negativity during the day.
Stay in the present moment. Worry about the future and guilt about events in the past can cause stress. Learn how to stay in the present moment; for example, chew a piece of gum and count the number of chews it takes before the gum runs out of flavor. The book The Present: The Gift for Changing Times by Spencer Johnson is a great quick read that teaches the value of living in the present moment.
Meditate. Meditation can calm your mind and ease anxious, negative thoughts. Even a few minutes of visualizing a calm environment can release tension. Try a mobile phone app, such as Calm, to engage in guided imagery, or The Mindfulness App, which also has a health component.
Go outside. Enjoying nature can be a great way to relax, shed stress, and elevate your mood. If you’re stuck indoors for a while, use screen savers with calming outdoor images or listen to recordings of nature sounds in your car.
Disconnect to socially connect. Technology can be overwhelming, so regularly disconnect from the TV, phone, computer, and social media to stay connected with family and friends and to cultivate new relationships whenever possible. Talk to someone you trust about how you feel.
Get help. If you’re feeling overwhelmed and it’s interfering with your functioning, get help. Don’t feel ashamed if you need to see a mental health professional to help you strengthen your coping skills.
You can learn to cope positively with stressful or emotionally draining situations using the strategies outlined in this article, moving regularly, expressing your emotions, and letting go of guilt and worry. As the Dalai Lama once said, “The suffering from a natural disaster we cannot control, but the suffering from our daily disasters we can.” With these action tactics, you’ll feel more relaxed, healthier, and maybe even ready for new exciting challenges you’ll enjoy.
Both authors work at The Ohio State University in Columbus. Bernadette Mazurek Melnyk is the vice president for health promotion, university chief wellness officer, dean and professor in the College of Nursing, and professor of pediatrics and psychiatry in the College of Medicine. She is also a member of the research, data, and metrics working group for the National Academy of Medicine’s Action Collaborative on Clinician Well-Being and Resilience. Susan Neale is senior writer/editor of marketing and communications in the College of Nursing.
Parker-Pope T. How to build resilience in midlife. The New York Times. July 25, 2017.