An introduction to Stress management and its role in healthy aging & HRT


What is stress and why do we need to manage it?

Health care costs in the United States are skyrocketing. A large part of this increase can be attributed to the fact that many Americans do not practice preventive medicine by making a serious effort to reduce the stresses in their lives.

Although the occurrence of stressful situations is an inevitable fact of life, one over which you have little control, how you react to the stressor is in your control. In other words, a “stressor” is not stressful unless you deem it to be. We therefore experience stress when we believe there is a threat to our health and well being and we determine that there is an imbalance between the demands being made on us and the psychological and physical resources available to us. We can therefore experience stress in positive situations that require us to adapt such as marriage and having children as well as negative situations such as increased work demands, being fired from a job and the death of a loved one.

Although many people believe it is “chique” to be stressed, unmanaged stress is a contributor to many physical as well as emotional problems. It is therefore important for us to be able to manage our stress more effectively since we can’t always prevent taxing events from happening.

Some of the common signs and symptoms of stress!

Although we all experience stress in different ways, there are certain signs that are most frequently reported. These signs fall into two major categories; physical/behavioral signs and emotional signs. If we become aware of our own stress symptoms, we will be more effective in dealing with them sooner rather than later. What follows is a list of some of the most experienced symptoms of stress.

The physical/behavioral symptoms include; muscular tension, muscle spasms and tics, rapid heart beat, shortness of breath and high blood pressure, cold hands and feet, backaches, headaches and neck aches, stomach problems, indigestion, irritable bowel and ulcers, feeling fatigued, irritable, decreased ability to concentrate, insomnia and changes in eating behavior. Since these physical symptoms may be related to physical problems, you should consult with your medical doctor before you assume that your symptoms are purely stress-related.

The emotional symptoms include; anxiety in a variety of situations not limited to the stressful situation, depression, hopelessness and a strong urge to cry without specific incident, withdrawal from social interactions and avoidance of previously enjoyed activities, powerlessness and decreased self esteem, hostility, anger and resentment, fears, phobias and unwanted thoughts.

Learning to become more aware of your own stress symptoms is the first major step in the stress management and healing process. It is often helpful to monitor your daily symptoms in a stress diary where you match the stressful events with the symptom experienced.

For example; you may find that if you are stuck in early morning traffic you may experience irritability and headaches. In this case it will be important to use these symptoms as a cue that you have to begin managing that stress more effectively when it happens.

What are the sources of stress?

Stress is experienced from three general sources; the environment, your body and your thoughts. Although you have some control over your environment and your body, you have much more control over your thoughts or the way you appraise/think about a “stressor.”

The ability to be able to view situations as either threats or challenges will have important effects on the stress management process which will be addressed in the stress management section. What follows at this point is a list of commonly reported sources of stress within the three general categories.

The environment constantly requires us to meet demands and challenges and can therefore be a potential source of stress. For example, we experience natural disasters, traffic, time pressures, work and interpersonal demands.

In addition we may have to adjust to changes in financial status, job changes and the loss of a loved one. Although we have some ability to prevent some of these stressors, such as leaving earlier to prepare for lost time in traffic, we have no ability to prevent a natural disaster and our efforts need to go to preparing for it instead.

Your body is another potential source of stress since it requires you to adapt to the physiological changes it makes. Some examples include; changes that occur in adolescence, phase of life changes brought on by hormonal fluctuations and the aging process.

In addition, the onset of illness, improper nutrition and lack of sleep and exercise can contribute to the stress response. Once again, some of these sources we have more of an ability to control and change. For example, we have more control over our ability to eat well and exercise than we have over the natural aging process.

The third general source of stress, our thoughts, is the one over which we have the most control. Your brain interprets messages from the environment all the time. Your interpretations of these events determine whether or not you will feel stressed. For example, if you interpret your bosses silence as proof that he is displeased with your work, you are more likely to experience stress than you would if you interpreted it as something unrelated to you or even neutral until you had more information to the contrary. Stress producing thoughts are often catastrophic, black and white, overgeneralized, supported by few facts and over personalized.

Richard Lazarus, a prominent researcher in the area of stress, believes that stress begins with your thought about or appraisal of a situation. If you constantly view situations as difficult or dangerous and if you believe that you don’t have the physical and emotional resources with which to handle the situation, you are much more likely to experience stress. A significant part of stress management therefore focuses on how to change your appraisals so situations are viewed as challenges versus dangerous threats.

What are the consequences of unmanaged stress?

We all know that stress is something that doesn’t feel good to us physically and emotionally. What is even more compelling is what happens below the surface each time we experience stress.

Stress researcher Hans Selye, determined what happens internally each time we experience something as threatening or stressful. According to Selye, when we perceive a threat in the environment the thinking part of the brain sends an alarm message to the nervous system via the hypothalamus. The nervous system then makes changes in the body that prepare you to handle the perceived danger ahead.

These changes include increases in heart rate and blood pressure as well as pupil dilation. In addition, there are hormones and chemicals secreted such as adrenaline, that give the body the necessary push to be able to manage the threat ahead. Although there are situations in which these adrenaline surges are very helpful in helping us mobilize, the constant adrenaline surges due to repeatedly perceived threats, have a toxic effect on the body.

For example, recurrent adrenaline surges inhibit some of the other important functions in the body including growth and tissue repair, digestion and the immune response.

Just as the thinking part of your brain is responsible for turning the stress response on, you can turn it off by changing the threatening appraisals you are making. Once you are able to determine that a threat does not exist or that it can be effectively managed, your thinking brain stops sending panic messages to the nervous system. As a result of this reappraisal, the hormones and chemicals cease to be released and the body returns to normal.

Bringing the body back to an “un-stressed” state is very important since almost every system in the body can be damaged by stress. Although our bodies are adaptive and can recover from periodic stressors, chronic stress has serious consequences. We experience the consequences of stress on three important levels; physically, emotionally and behaviorally. What follows is a description of the specific consequences in these three categories.

Physically, the body is likely to develop a stress-related disease as a result of the stress toxins that are released. For example, chronic stress can lead to cardiovascular disease by elevating blood pressure, damaging the heart and arteries and increasing blood sugar. Respiratory conditions such as asthma and bronchitis can result from stress-triggered changes in the lungs.

When stress inhibits the body’s digestive functions, diseases such as ulcers, colitis and chronic diarrhea can occur.

In addition, stress contributes to inhibited growth of tissue and bone which can lead to decalcification and osteoporosis. The immune system is also inhibited by the reduced efficiency of the white blood cells, making the body more susceptible to disease. Increased muscle tension, fatigue and headaches are additional consequences of chronic stress.

The second category of consequences of chronic stress is the emotional consequences. Depression can result form chronic stress due to the constant release and depletion of norepinephrine.

What also contributes to the depression is the thought that life is terrible and that it is never going to get better. What then results is a feeling of helplessness and ineffectiveness, feeling like a failure and a reduction in self-confidence. Individuals who are depressed are also likely to withdraw from relationships and isolate themselves which often increases the intensity of the depression.

In addition, anxiety and fearfulness are commonly felt emotions if someone is constantly perceiving threats around the corner. In addition, individuals who are chronically stressed are likely to exhibit increased cynicism, rigidity, sarcasm and irritability since they believe that their situation is not likely to improve.

Chronic stress also has significant behavioral consequences. The behavioral consequences often result from the innate survival urge we have to seek relief, to fight or to flee. Unfortunately, these relief seeking behaviors eventually become problematic.

For example, “addictive behaviors” can result from the repeated efforts to soothe or escape the painful stress. Alcohol, drugs, smoking and overeating are often seen as tools to help manage the stress even though their effects are short lived and the consequences of chronic use are destructive to the body and mind.

Unfortunately the mind’s ability to deny the long term consequences in order to fill the short term need to escape, perpetuates the problem and increases the excessive use behavior. Similarly, procrastination, poor planning, excessive sleeping and the avoidance of responsibility are examples of behaviors used by stressed individuals to temporarily flee from the pain.

What is most significant about these behaviors is their ability to generate additional problems that are as severe as the original stressor. For example, procrastination or avoidance of the management of a stressor only serves to increase anxiety and exacerbate the stress experience.

The stress consequences reviewed above suggest that in addition to being physically and psychologically distressing, they reduce the likelihood of effective goal reaching. The rationale for properly managing and coping with the stress is for health protection in the future as well as making the present more productive and satisfying.

Techniques used to manage stress effectively!

Since stress is an inevitable fact of life that we can’t always prevent, our efforts need to be focused on coping with stress more effectively. What follows is a description of a three pronged approach to stress management which includes behavioral/practical techniques, relaxation techniques and cognitive/thinking techniques.

The behavioral/practical approaches to stress management include exercise and eating a healthy, balanced diet which includes selections from the basic food groups. In addition, it is recommended that one avoid the excessive use of alcohol, caffeine and sugar which contribute to fatigue and vulnerability to mood swings.

It is also important to allow the body to rest and replenish to help inoculate the body against future stress. Building this stress resistance also includes scheduling time for leisure and pleasure which provides for a more balanced, fulfilling life. Anticipating and preparing for recurrent stressors by managing time, setting priorities and limits, delegating responsibility, and not procrastinating are helpful stress reducing strategies. These techniques are effective stress management tools because their utilization is within our control.

The relaxation approaches to stress management include a variety of techniques designed to help you effectively manage the body/mind tension.

Progressive muscle relaxation is an active form of relaxation where you individually contract the major muscle groups of your body for about five seconds and then you relax the individual muscle groups for a five second hold. The contrast experienced by this exercise relieves muscle tension and relaxes the body.

Some of the more passive relaxation approaches include listening to music, reading and using saunas and hot tubs to relieve tension. Techniques used to relax the mind include meditation and visual imagery. Meditation teaches you how to clear the mind of stressful and distracting thoughts by focusing the mental energy on positive coping thoughts. Visual imagery is designed to help the individual visualize him/herself coping effectively with a stressor that was previously experienced as overwhelming.

The behavioral and relaxation approaches described above are necessary but not sufficient conditions for stress management. The third prong to stress management, the cognitve or thinking approach, is essential to effective coping with stress.

The cognitive or thinking approaches are an integral part of coping effectively with stress and now the primary focus of many stress management programs. Since it has been determined that we can turn off the stress response by changing our threatening/dangerous event appraisals to appraisals that help us view these events as manageable challenges, we have a direct link to controlling the stress response.

The first step in the cognitive approach is to identify our thoughts or internal dialog that is negative, perfectionistic, black and white, rigid and demanding. In other words, you are more likely to experience stress if you believe that you, the world and other people “should or must” behave in a manner consistent with your demands and standards.

For example, you are likely to experience stress if you believe that the world and your life should be stress free and that you do not have the resources to handle stress if it does occur. In addition, demands of perfection on yourself and on others important to you, increases the chance of feeling stressed since these expectations are unrealistic and rigid. After identifying your stress producing thoughts you are then able to move onto the second step in the cognitive approach; recognizing the consequences of this negative, rigid dialog.

The motivation to change the stress producing dialog comes from the determination that there are serious consequences that result form these negative, rigid thoughts. When you talk to yourself in a defeated, pessimistic or rigid way, you deny your ability to cope and are not likely to manage situations effectively or meet goals you set.

In addition, perfectionistic demands are experienced as appropriately unrealistic and contribute to a “why bother” attitude. This attitude reduces the likelihood that you will address these demands since it is a realistic fact that no one or nothing is ever perfect. Once you are convinced that the dialog is negative and counterproductive, you are ready to move on to the third step in the cognitive approach; challenging and replacing the negative internal dialog with a healthier, more productive internal dialog.

This important step in the reappraisal process requires that you challenge your rigid dialog by asking yourself a series of questions about that rigid dialog. For example, “Why must I perform perfectly in order to believe I am a valuable human being?”

In addition, “Does that demand for perfection increase my anxiety and reduce the likelihood that I perform well at all?” “What would I feel like and would I be more motivated if I changed my demand for perfection to a desire to do well?”

Another example of this reappraisal process can be seen in the area of criticism and rejection.

A negative internal dialog that would create stress in this area is “I am worthless because I was rejected and this proves that no one will ever love me.” A healthy challenge to this belief would be, “How does the opinion of this person reflect my personal worth?’ “How does it follow that this rejection will lead to future rejections?” It is also important to add, ” Even if I were to get rejected repeatedly, could I work to make desired changes in my personality without condemning myself or feeling worthless?” By replacing the negative, rigid dialog with more realistic, flexible dialog, you are more likely to feel healthier emotionally and behave more rationally and productively.

The behavioral, relaxation and cognitive techniques described above, have been determined to be effective ways to manage and cope more effectively with stress. The techniques give the control back to the individual and empower him/her to manage the inevitable stressors that will occur in life.


By reading this introduction to stress management you have taken the first significant step to improving your physical as well as emotional well being. You have addressed the concern that chronic stress has significant physical, emotional and behavioral consequences and that the management of this stress needs to be an immediate and constant priority. Although we can’t always control what happens to us, we can take important steps to cope with our stress and manage it more effectively. With practice, these behavioral/relaxation and cognitive techniques will be easier to perform and the benefits of their utilization will be indisputable. Good luck on your stress management journey ahead, and remember that improved health and well-being are within your grasp.