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Depression & Stress
Managing Stress

Life is filled with stress, which can be short-term (acute) or long-term (chronic). Acute stress is the reaction to an immediate threat, commonly known as the fight or flight response. The threat can be any situation that is experienced as a danger. Frequently, however, modern life poses on-going stressful situations that are not short-lived and the urge to act (to fight or to flee) should be suppressed. Common chronic stressors might include: on-going highly pressured work, relationship problems, loneliness, and financial worries.

The stress response can be an asset for raising levels of performance during critical events such as a sports activity, an important meeting, or in situations of actual danger or crisis. However, if stress becomes persistent and low-level all parts of the body's stress apparatus (the brain, heart, lungs, vessels, and muscles) become chronically over- or under-activated. This can produce physical or psychological damage over time.

Studies suggest that severe stress is associated with the onset of depression or anxiety disorders (for more information on depression and anxiety disorders). Certainly, stress diminishes the quality of life by reducing feelings of pleasure and accomplishment, and relationships are often threatened.

Chronic stress has many negative physical side effects. Chronic stress increases the risk of heart problems, strokes, susceptibility to infections and gastrointestinal problems. Stress can also affect weight. Some people suffer a loss of appetite and lose weight while others develop cravings for salt, fat, and sugar to counteract tension and, thus, may gain weight. Tension-type headache episodes are highly associated with stress. The tensions of unresolved stress can also frequently cause insomnia, generally keeping the stressed person awake or causing awakening in the middle of the night or early morning. Stress can lead to diminished sexual desire and an inability to achieve orgasm in women. It can also cause temporary impotence in men. Stress has significant effects on the brain, particularly on memory. The typical victim of severe stress suffers loss of concentration at work and at home and may become inefficient and accident-prone.

Unfortunately, people under chronic stress often seek relief through drug or alcohol abuse, tobacco use, abnormal eating patterns, or passive activities, such as watching television. The damage these self-destructive habits cause under ordinary circumstances is compounded by the physiological effects of stress itself. And the cycle is self-perpetuating as these habits can lead to increased rather than reduced tension levels.

Treating Stress
Perhaps the best advice for treating stress can be found in the passage by Reinhold Niebuhr, “Grant me the courage to change the things I can change, the serenity to accept the things I can't change, and the wisdom to know the difference.” The process of learning to control stress is life-long, and will contribute to better physical and mental health.

In choosing specific strategies for treating stress, remember that stress can be positive at times. Appropriate and controllable stress provides interest and motivates the individual to greater achievement, while a lack of stress may lead to boredom and depression.

Also keep in mind that stress may play a part in making people vulnerable to illness. A physician or psychologist should be consulted if there are any indications of accompanying medical or psychological conditions, such as cardiac symptoms, significant pain, anxiety, or depression.

Often people succeed in relieving stress for the short-term but resort to previous ways of stressful thinking and behaving because of outside pressure or entrenched beliefs or habits. One major obstacle to reducing stress is the strong biologic urge for fight or flight itself. The idea of relaxation can feel dangerous, because it is perceived as letting down one's guard. Many people are afraid of being perceived as selfish if they engage in stress-reducing activities that benefit only themselves. The truth is that self-sacrifice may be inappropriate if the person making the sacrifice is unhappy, angry, or physically unwell. Many people believe that certain emotional responses to stress, such as anger, are innate and unchangeable features of personality. Research has shown, however, that with cognitive behavioral therapy, individuals can be taught to change their emotional reactions to stressful events.

A healthy lifestyle is an essential companion to any stress-reduction program. General health and stress resistance can be enhanced by a regular exercise, a diet rich in a variety of whole grains, vegetables, and fruits, and by avoiding excessive alcohol, caffeine, and tobacco.

It should be strongly noted that treating stress cannot cure medical problems. Any stress management program is not a substitute for standard medical treatments, but it can be a very important component in a medical regimen. Some evidence exists, for example, that stress management programs may reduce the risk of heart events by up to 75% in people with heart disease.

Cognitive-behavioral methods can be the most effective ways to reduce stress. They include identifying sources of stress, restructuring priorities, changing one's response to stress, and finding methods for managing and reducing stress.

The first step is to note activities that put a strain on energy and time, trigger anger or anxiety, or precipitate a negative physical response such as a sour stomach or headache. Also note positive experiences, such as those that are mentally or physically refreshing or produce a sense of accomplishment.

The next step is to attempt to shift the balance from stress producing to stress-reducing activities. Eliminating stress is rarely practical or feasible, but there are ways to reduce its impact. One study indicated that adding daily pleasant events has more positive effects on the immune system than reducing stressful or negative ones. In most cases, small daily decisions for improvement accumulate and help transform a stressed existence into a pleasant and productive one.

Methods to Reduce Stress
1. RECREATE. Consider relief options such as taking long weekends or vacations. Replace unnecessary time-consuming chores with pleasurable or interesting activities. In other words, make time for recreation. (This is as important as paying bills or shopping for groceries.)

2. EXPRESS YOUR FEELINGS. Feelings of anger or frustration when they not expressed leads to more stress. Expressing feelings does not mean venting frustration on waiters and subordinates, boring friends with emotional details, or wallowing in self-pity. The goal is to explain and assert one's needs to a trusted individual in a positive way. Direct communication may not even be necessary. Writing in a journal, writing a poem, or composing a letter that is never mailed may accomplish your purpose. Remember that learning to listen, empathize, and respond to others with understanding is just as important for maintaining the strong relationships necessary for reduced stress.

3. KEEP PERSPECTIVE AND LOOK FOR THE POSITIVE. Reversing negative ideas and learning to focus on positive outcomes helps reduce tension and achieve goals.

4. HAVE A SENSE OF HUMOR. Keeping a sense of humor during difficult situations is a common recommendation. Laughing releases the tension of pent-up feelings and helps you keep perspective. Research has shown that humor is a very effective mechanism for coping with acute stress. It is not uncommon for people to recall laughing intensely even during tragic events, such as the death of a loved one, and remembering how this laughter helped them to endure the emotional pain.

5. EXERCISE. Exercise is an effective distraction from stressful events. Usually, a varied exercise regime is more interesting, and thus easier to stick to. Start slowly. The key is to find activities that are exciting, challenging, and satisfying. As in other areas of stress management, making a plan and executing it successfully develops feelings of mastery and control, which are very beneficial in and of themselves.

6. STRENGTHEN OR ESTABLISH A SUPPORT NETWORK. Studies of people who remain happy and healthy despite many life stresses show that most have very good networks of social support. Many studies suggest that having a pet helps reduce medical problems aggravated by stress, including heart disease and high blood pressure.

7. PROFESSIONAL HELP AND MEDICATIONS. Stress can be a factor in a variety of physical and emotional illnesses, which should be professionally treated. Many stress symptoms are mild and can be managed by over the counter medications. A physician should be consulted, however, for physical symptoms that are out of the ordinary, particularly those which progress in severity or awaken one at night. A mental health professional should be consulted for unmanageable acute stress or for severe anxiety or depression. Often short-term therapy can resolve stress-related emotional problems.

8. RELAXATION TECHNIQUES. Since stress is here to stay, everyone needs to learn methods for invoking the relaxation response, the natural unwinding of the stress response. Relaxation lowers blood pressure, respiration, and pulse rates, releases muscle tension, and eases emotional strains. The following methods can be very effective:

  • Deep breathing
  • Meditation
  • Biofeedback
  • Massage
  • Muscle relaxation

If you, or someone you know, is suffering from chronic stress you can get help from a mental health professional. It's best to look for a professional who has specialized training in cognitive-behavioral therapy. 

If you don't know where your stress is coming from and need help pinpointing its source, NET (NeuroEmotionalTechnique) can help you identify and release unresolved stress. Learn more by clicking here.

Dr. Kathy Marshack can help you. She is accepting new clients and has a conveniently located office. If you live in the Portland, Oregon or Vancouver, Washington area (or can drive to this location) please call to set up your first appointment. See Therapy FAQs for more information. Please give us a call at (503) 222-6678 or (360) 256-0448 or email us at