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    Stress Management

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    Contributed by Singapore General Hospital


    Stress is the "wear and tear" our bodies experience as we adjust to our continually changing environment. Whether we like it or not, stress is part and parcel of life. It can affect us both physically and emotionally and can create positive or negative feelings.

    Stress can be good and we call this positive stress. Positive stress helps us to concentrate, focus and it can also literally help us to survive. Our physical stress response helps us to meet challenging situations and is an automatic and essential fact of life. Positive stress helps compel us to action; it can result in a new awareness and an exciting new perspective.

    Our physical reaction to stress is always the same, but with negative stress, our body stays geared up and doesn’t relax. The over-arousal distresses us and causes performance to decline. This approach to stress is illustrated in the "inverted U" graph. (Fig.1). When stress becomes chronic and ongoing, our physical and emotional health can suffer.

    According to the graph, our performance peaks when there is optimal arousal but performance decreases when the arousal level is too high. What is crucial to realise is that each one of us has a different stress requirement for optimal performance.


    The causes of stress are coined as stressors. This occurs in two forms: external and internal.

    External stressors include major life events such as job loss, loss of a loved one or demands placed by the physical environment such as the excessive lighting or noise.

    Internal stressors occur within us. We add internal stressors to our lives for example, if we have unrealistic expectations, negative self talks or choose a lifestyle where there is excessive caffeine and alcohol and constant lack of sleep.


    Stress may affect us physically, mentally, emotionally and behaviourally. The signs and symptoms include:

    • Physical: fatigue, headache, insomnia, muscle aches/stiffness (especially neck, shoulder and low back), heart palpitations, chest pains and nausea.
    • Mental: decrease in concentration and memory, indecisiveness, mind racing or going blank, confusion and loss of humour.
    • Emotional: anxiety, nervousness, depression, anger, frustration, worry, fear, irritability, impatience and short temper.
    • Behavioural: pacing, fidgeting, increased eating, smoking, drinking, crying, yelling, blaming and even throwing things or hitting.


    Managing Stress

    How can we manage stress better? Just as there are many sources of stress, there are many ways of managing it. However, all require work toward change: changing the source of stress and/or changing your reaction to it.

    1. Be aware of your stressors and your emotional and physical reactions.

    • Understand more about stress itself.
    • Don’t ignore your distress. Determine what are the things that distress you.
    • Determine how your body responds to the stress. Do you become nervous or physically upset?

    2. Recognise what you can change.

    • Change your stressors by avoiding or eliminating them completely.
    • Reduce their intensity or frequency.
    • Shorten your exposure to stress (take a break, leave the stressful environment).

    3. Reduce the intensity of your emotional reactions to stress.

    • Are you expecting to please everyone? Trying saying "NO" at times.
    • Try to see the stress as something you can cope with rather than something that overpowers you.

    4. Moderate your physical reactions to stress.

    • Try slow, deep breathing exercises. (see description below) They will bring your heart rate and respiration back to normal.
    • Relaxation techniques such as the Jacobson’s Progressive Relaxation Therapy can reduce muscle tension.
    • Using biofeedback can help you gain voluntary control over muscle tension, heart rate, and blood pressure.
    • Massage and applying heat to the tensed muscles improve blood circulation and helps the muscles to relax.

    5. Lead a healthy lifestyle.

    • Exercise for cardiovascular fitness three to four times a week (exercises such as walking, swimming, cycling, or jogging are good).
    • Eat well-balanced, nutritious meals.
    • Maintain your ideal weight.
    • Avoid nicotine, excessive caffeine, and other stimulants.
    • Get enough sleep and be as consistent with your sleep schedule as possible.

    6. Stay emotionally well

    • Establish some mutually supportive friendships/relationships.
    • Recognise and accept your own feelings and limitations.
    • Pursue realistic goals that are meaningful to you, rather than goals others have for you that you do not share.
    • Make time to relax and enjoy yourself. Be kind to yourself.

    Deep Breathing Exercise

    The deep breathing exercise is a simple yet effective technique in stress management. It is useful in replacing the rapid, shallow breathing caused by stress with long, deep breaths using all of your lung capacity. This simple exercise, done 1-2 minutes several times a day, may relieve many stressful feelings.

    • Take in a slow breath into your lungs, through your nose and out through your mouth.
    • You don’t have to take deeper breath than usual. Just the depth with which you normally breathe.
    • Slow down your breathing rate gradually. You can do this by breathing in and counting 1 – 2 – 3 before breathing out. You should aim to breathe at a rate of about 12 to 14 breaths in a minute.
    • Relax the muscles around your neck and your shoulders.
    • Continue these breathing control exercises for about 5 – 10 minutes or until you are no longer breathless.

    Need indepth information ?

    Access our Conditions & Treatments sections for related topics on High Blood Pressure.

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