Coping with Stress
A single session designed to offer a stress coping skill
The session presents educational information and then the technique of abdominal breathing. The abdominal breathing technique is offered in this single session because it has:
- Rapid onset of effectiveness
- Can be done anywhere
- Is highly effective
- Is easy to do
I’m stressed out!
Yeah? Well I'm more stressed than you are!
How many times do we hear people speaking like this, almost as if being under a lot of stress is a badge of honor. However, what we now know about the effects of stress on mental and physical health makes it more appropriate to classify stress along with being overweight, being sedentary rather than physically fit, having high blood pressure, and being a smoker, for its danger to health.
Questions and Answers:
Q: What is stress?
A:
- Stress results when something that happens to you or something that you observe exceeds the capability of your mind to deal with the event effectively.
- You believe that you cannot cope with the demands or perceived consequences of the event
- When you cannot cope with the event, stress-reactive areas of your brain become activated and the concentration of stress hormones in blood increases causing:
- your heart to beat more rapidly
- your skin becomes sweaty
- you often feel nervous or even depressed
- your immune system decreases its ability to protect you from infection
- cholesterol deposits more readily into the blood vessels of your heart
- cells in your brain may become damaged
- Some aspects of the stress response are not always bad. If you were stressed because you saw a tiger running toward you, the changes in your body would help you flee to safety. Indeed, the response of the body to stress may be to increase the chance of escaping from danger.
Q: If the response to stress can be beneficial, why is stress considered a danger to health?
A: Among the side effects of the bodies response to stress are the following: blood vessels in the heart accumulate cholesterol deposits and become narrowed; the ability of the body to resist infectious disease decreases; the ability of the body to heal wounds decreases; and diseases such as psoriasis, multiple sclerosis, rheumatoid arthritis, and inflammatory bowel disease may become more active. There is even the suggestion that when we experience high levels of stress for long periods of time, some cells in our brains may be destroyed, with an associated decrease in mental function.
Q: If stress is capable of impairing our health why not just avoid it? For example, if someone is worried about being overweight they don’t have to eat foods that are high in saturated fats.
A: Sometimes we can avoid stress. If we know that someone is angry with us, we can avoid seeing them until they calm down. However, much of life’s stress is unavoidable. Divorce, losing one’s job, an angry employer, children that get into trouble, caring for a relative with a serious disease, preparing for an exam at school, are all examples of stress that cannot be avoided.
Q: If stress cannot be avoided, is there something that can be done to minimize the negative effect of stress on health?
A: Yes, there is. We call it the development of "buffering skills" that minimize the activation of the stress reactive areas of the brain. People who incorporate the buffering skills into their lives will have less stressor induced alteration of their health than individuals who do not. The principal buffers are:
- having a social support system that you enjoy and can depend upon
- being optimistic that things will go well for you and that problems that occur will not alter your basic belief that you are a good and well-liked person
- having a sense of humor so that you can find amusement in events and can even laugh at yourself (remember the old saying that “laughter is the best medicine”)
- being physically fit as appropriate for your age, rather than being sedentary
- having a belief system in religion or having a spiritual nature that allows you to relax and calm yourself when faced with stress.
Q: Why is it important to be concerned about coping with stress?
A: If we do not utilize the behaviors that can help to reduce the influence of stress on health, we increase our likelihood of developing illness. We may then turn to the health care establishment to take care of us. However, if we are to be more responsible for the quality of our own health by eating a healthy diet, managing our weight, exercising, and not smoking, we need to also be aware of how we cope with stress. Indeed, the more we do to keep ourselves healthy, the more likely it will be that we will go through the aging process being less dependent on care provided by others, we will maintain our joy of life and enjoy our families and friends and not be burden to them, and be able to contribute to the joy of others.
Q: I am concerned with my ability to cope with stress. What can I do about it?
A: There are behaviors that you can use to decrease the impact of stress on your health. The behaviors are discussed below. In addition, the UPMC Health Enhancement Program provides programs to help educate you and to help you develop the skills needed to reduce the impact of stress on your health.
The following focuses on a technique that you will be able to use to calm your mind, reduce the concentration of stress hormones in your blood, and contribute to an enhancement of your health.
You use this technique to find calmness and relaxation so that you can free your mind from mental chatter and experience serenity, peacefulness-a greater sense of clarity and purpose to make decsions and actions in our best interest.
Q: What is abdominal or diaphragmatic breathing?
A: Breathing provides oxygen to the blood stream and thereby to the entire cellular structure of the body. A healthy balance of oxygen (in-breath) and carbon dioxide (out-breath) is central to physical health. The diaphragm is a sheet-like muscle that separates the abdominal and chest cavities. When you inhale, the diaphragm lowers and expands the abdomen. Expanding the abdomen when you inhale drops the diaphragm and expands the size of the chest cavity. This increases the space that the lungs can expand into and increases the amount of air and oxygen that is inhaled. As we age, however, most of us start breathing more shallow and use the upper parts of our chest.
Q: What is the difference between abdominal/diaphragmatic breathing and chest breathing?
A: Whereas breathing from the chest delivers approximately a teacup of air to the lungs (about 500 ml), breathing from the abdomen delivers 4-6 liters of air to the lungs. Abdominal breathing can significantly increase the amount of air we take into the lungs and this makes a huge difference in the oxygenation of tissues throughout the body.
How we breathe also has an impact on our nervous system. Chest breathing stimulates the production of shorter, more "restless" beta waves in the brain. Full abdominal breath stimulates the longer, slower alpha waves associated with relaxation and calm mind states. For this reason, breathing from the abdomen/diaphragm is often helpful in eliciting relaxation and protecting the body from the harmful effects of stress. Fortunately, abdominal/diaphragmatic breathing rapidly calms your mind and is therefore useful when you need a quick calming effect.
Q: Abdominal/Diaphragmatic breathing is difficult. How do I learn to breathe this way?
A: You’re right. It is hard to change the way you breathe. Practice! You’ve had a lifetime of breathing incorrectly; it will take a while to learn to breathe correctly. Breathing is generally easier to practice initially when lying down, so practice at home lying down or sitting up.
Use the following to teach how to increase the volume of air flowing into the lungs. The essential point is that by pushing the abdominal wall out, the diaphragm will drop, increasing the space that the lungs can expand into. This maximizes the flow of air into the lungs and of oxygen into the blood.
Techniques for learning abdominal/diaphragmatic breathing:
- Put your right hand on your abdomen, right at the navel, and put your left hand on your chest, right in the center. You may find it helpful to close your eyes.
- Take a deeper inhalation than usual and focus on the rising of the abdomen as the lungs fill with air and the diaphragm flattens down, causing the belly to rise.
- Most of the movement should be in the lower hand; the other hand on the chest moves only slightly.
- The trick to shifting from chest to abdominal breathing is to make one or two full exhalations (pushes air out from bottom of lung, creating a vacuum that will pull in an abdominal breath on your next inhalation), pause, then inhale slowly.
- Nostril breathing is generally recommended (versus breathing through the mouth). Nostril breathing warms the breath, filters air, humidifies air, and allows for a larger volume of inhaled air.
Practice the above and, if time is available, review the Mini exercises below. It is important to emphasize that one needs to practice this technique to increase its effectiveness. It does not require a lot of deep breaths. 3-4 may be adequate.
The following can be used to help individuals use abdominal breathing:
"MINI" Relaxation Exercises
Mini relaxation exercises are focused breathing techniques that help reduce anxiety and tension immediately. You can do them with your eyes open or closed (but make sure your eyes are open when you are driving!)
You can do them any place, at any time; no one will know you’re doing them.
Ways to "do a mini"...
Switch to diaphragmatic breathing; if you are having trouble, try inhaling through your nose and exhaling through your mouth. You should feel your stomach rising about an inch as you breathe in, and falling about an inch as you breathe out. If this is still difficult for you, lie on your back or on your stomach; you will be more aware of your breathing pattern. Remember, it is impossible to breathe diaphragmatically if you are holding your stomach in! So... relax your stomach muscles.
MINI VERSION 1
Count very slowly to yourself from ten down to zero, one number for each breath. Thus, with the first diaphragmatic breath, you say "ten" to yourself, with the next breathe, you say "nine", etc. If you start feeling light-headed or dizzy, slow down the counting. When you get to "zero", see how you are feeling. If you are feeling better, great! If not, try doing it again.
MINI VERSION 2
As you inhale, count very slowly up to four; as you exhale, count slowly back down to one. Thus, as you inhale, you say to yourself "one, two, three, four," as you exhale, you say to yourself "four, three, two, one." Do this several times.
MINI VERSION 3
After each inhalation, pause for a few seconds; after you exhale, pause again for a few seconds. Do this for several breaths.
Good times to "do a mini"...
- while stuck in traffic...
- when put on "hold" during an important phone call
- in your doctor’s waiting room
- when someone says something which bothers you
- at all red lights
- waiting for a phone call
- in the dentist’s chair
- when you’re overwhelmed by what you need to accomplish
- in line
- when in pain