Managing stress

Your heart is racing, you feel a bit nauseous and lightheaded. Your breathing is shallow. You’re waiting to give your presentation and wishing you had never agreed to do it. Is this familiar to you? This and many other such moments which may produce similar symptoms of anxiety and stress are part of our daily lives.

‘Stress’ is a general term used to describe anything that causes a disruption of our equanimity and internal homeostasis. The term was coined by Hans Selye, a Hungarian physician, about 50 years ago. He later described what is commonly referred to as the ‘general adaptation response’, the response of the body to demands placed upon it. Stress induces bodily responses to the hormones such as cortisol, adrenalin and norepinephrine released during a stressful event/stimulus. Over time, if chronic and unresolved stress persists, these hormonal changes followed by the body’s physiological response can lead to ulcers, high blood pressure, arteriosclerosis, arthritis, depression, autoimmune disorders and allergic reactions.

There are varying degrees of stress — from mild anxiety before giving a presentation to acute stress during and following a car crash, loss of a loved one, loss of job, divorce or moving house.

What is stressful for one person may not be so for another. You may find your work environment or public speaking stressful while someone else may not. So it is highly individual and often dependent on your tolerance for pressure and ability to manage it.

The ‘stressor’ is the event which causes the stress. It may be another person/behaviour, an event or even just your own thoughts. The ‘stress response’ is your body’s physiological response to the hormones released during stress and the symptoms you feel during that time. It is hardwired in us and causes a cascade of changes in our body like a racing heart, shallow breathing and sweaty palms.

The ‘fight/flight/freeze’ response is our behavioural response to the stressor. We may either move away from the stressful experience, or stand and get aggressive or we may freeze, unable to respond. There is no such thing as a stress-free life. We will all be faced with stressful events to varying degrees throughout our lives.

Some stress is necessary and even important. Too little stress leads to boredom. In fact, the right amount of stress can help us grow, challenge us and keep us engaged and focused. Some people are able to grow from their stress leading to what is called post-traumatic growth. In the short term, stress hormones improve our immunity, motivation, ­cognition, focus and drive. The problems begin when we are faced with unrelenting stress, especially when unresolved in the background. Ill health, poverty, trauma, death etc are often beyond our control and causes of great stress.

However, many of the stressors in our modern-day lives are created by the way society is constructed and our response to it. Think, for instance, of our definition of success (money, name, fame) and societal pressure to achieve this success, consumerism, our need for more material stuff, pleasing people, constant comparison to others and our sense of not being enough… these and many more such perceived demands placed on us are unnecessary stressors that are self-created.

The first thing to do to manage stress is recognise it and differentiate between the stress that is good for you, that which is unnecessary and that which is beyond your control. The stress you feel before a deadline, an important meeting or presentation can be the driving force to better performance. Even the stress from a painful event can be embraced as a stimulus for change and growth.

The next thing to do is articulate clearly the exact emotion you are feeling. Stress is a very general and vague word that is often misused. When you say ‘I’m stressed at work”, if you think more deeply about it you may want to rephrase that as, ‘I am disappointed and not satisfied at work’. This careful articulation of your emotions can help you deal better with the real problem in the long term.

To manage the immediate stress response (the racing heart, anxiety etc), breath is the key. These symptoms are the result of your sympathetic nervous system being stimulated causing arousal. Learning appropriate breathing techniques can help alleviate these unpleasant symptoms almost instantly. Your breath controls your nervous system. Breathing the right way will help stimulate the para-sympathetic nervous system which calms you down.

The term ‘“relaxation response’ was coined by Dr Herbert Benson, cardiologist and founder of Harvard’s Mind/Body Medical Institute. The response is defined as your personal ability to encourage your body to release chemicals that signals your brain to make your muscles relax, slow the heart and increase blood flow to the brain.

His studies in the 1960s and 1970s showed that meditation promotes better health, especially in individuals with high blood pressure. People who meditate regularly experience lower stress levels, increased wellbeing, and a lower resting heart rate. The relaxation response is essentially the opposite reaction to the ‘fight or flight’ stress response.

There are many methods to elicit the relaxation response including breathing, visualisation, progressive ­muscle ­relaxation, acupuncture, massage, breathing techniques, prayer, meditation, tai chi, qi gong, and yoga, chanting or prayer.

Breathing exercise is the fastest way to control the physiological response to stress. Here are four simple breathing techniques you can choose from:

• Deep inhale and exhale – Breathe deeply through the nose and exhale through pursed lips. Repeat several times.
• Alternate nostril breathing – Practised in yoga and called Nadi Sodhan, this method involves using your ring finger and thumb to close alternate nostrils as you breathe in through the left nostril, close that nostril and breathe out through the right nostril. Next, alternate by breathing in through the right nostril and out through the left.
• Double inhale – otherwise called physiological sigh is a two quick inhales (without an exhale in between) followed by a long exhale.
• Long exhales or the 4-7-8 breathing popularised by Dr Andrew Weil — breath in for a count of 4, hold the breath for a count of 7 and exhale for a count of 8.

In the long term, managing stress and facing life with equanimity requires many things.

• Regular breathing practices (even twice a day for 5 minutes helps)
• Meditation – Use an app like Calm or Mindspace to begin with if you want to be initiated into meditation. Regular (even short) practice is important to reap the benefits of meditation.
• Non-sleep deep rest (NSDR): ­Practices like Yoga Nidra fall under the category of NSDR. This is a guided meditation (you can find on YouTube) that will help you to relax deeply. It is a simple practice that is exactly what it sounds like: you are not actually sleeping, but you are slowing down your thought-flow and brain wave frequency, ­permitting your brain and body to rest deeply.

Dr Andrew Huberman, a neurobiologist at the Stanford School of Medicine, has come up with the term ‘non-sleep deep rest’ to describe these techniques that are scientifically proven to recharge your brain.

–              Regular exercise — any form of exercise helps regulate stress on the long term. Consistency matters.

–              Regular good quality sleep. 7–8 hours of good quality sleep is important for good mental health and managing stress.

–              Changing your stress mindset. View stress as an opportunity for growth. Use it as a stepping board to challenge yourself.

–              Improved social connectedness. Research has shown that when you have robust connections with other people who support you in life, stress is mitigated and more manageable.

While stress in life is a given, how you respond to its immediate effects and long-term consequences are not. Using your breath to control the immediate effects of stress can circumvent the unpleasant symptoms that are created by the stress hormones. Creating daily disciplines like exercise, meditation, breathing and sleep can help prime the parasympathetic nervous system to respond better to stress. The most important aspect of managing stress however could be your stress mindset which can actually create post-traumatic growth.

The author is a lifestyle medicine physician. sheela.nambiar@gmail.com  www.drsheelanambiar.com