Having completed this lesson, you will be able to:

• Describe two strategies therapists can use for stress reduction.

Traffic jams, bills to pay, relationship problems, health concerns, eating on the run, work pressures, and other demands trigger the body’s flight or fight response and may lead to physical symptoms like headaches, teeth grinding, fatigue, insomnia, muscular aches, anxiety, depression, mood swings, forgetfulness, poor concentration, and a negative attitude. Unrelieved stress clearly takes both a mental and physical toll and often contributes to serious conditions including severe anxiety attacks and clinical depression.²⁵

Therapists must carefully monitor their own stress level and take steps to avoid burnout. When interacting with a client, a therapist who thinks things such as “You think your stress level is high?” “I’m sick of listening to people complain about their muscle tension all day long!” or “If you could feel the adhesion in my rhomboids you would give me the massage!” is overly stressed. Therapists must take care of themselves to be in the right frame of mind and body to provide the best care to their clients.

To reduce stress, one of the first steps is to become aware of your own stressors and your body’s emotional and physical reactions to these stressors. Each person is different. A situation that causes extreme stress for one may have little effect on another, because a wide variety of factors influences how people respond to an event.²⁶ Memories, associations, expectations, thought processes, and body sensations contribute to the nervous system’s reaction. Consider an example of someone experiencing road rage, when another driver’s actions cause intense anger and physical symptoms such as a “knotted” stomach and dry mouth. Because the body is wired to survive at all costs, it treats a threat like THREAT! and danger like DANGER!²⁷ But people can become aware of this and learn to moderate their emotional and physical reactions so that a minor threat, like an annoying driver, is treated as a minor threat—not as a life-and-death situation. Spend some time listing the things in your life that you find stressful. When you know your stressors, you can use some of these stress-reducing behaviors:

1. Breathe: When an event triggers a stress reaction, focus on your breathing. Take slow, deep breaths, and pay attention to your breathing pattern until the reaction subsides.
2. Relaxation techniques: Practice relaxation techniques (described below) to reduce muscle tension and build body awareness.
3. Build reserves: Build up physical and emotional reserves with a nutritious diet, regular exercise, and regular sleep. Develop supportive friendships and participate in social events to give life greater emotional and spiritual meaning.
4. Delegate: When feeling stressed, alert a loved one or friend to your feelings and delegate some responsibilities at work or home. For instance, if you are the one who always does the shopping and prepares the food, it can relieve some of your stress if your partner picks up these responsibilities for a week. The key is to be able to recognize stress and ask for help.
5. Reschedule: It may be necessary to reorganize your schedule to maintain a more balanced life. This involves learning to say no to others and planning time for relaxation. Prioritize your tasks and delegate less important tasks to other people, or simply eliminate them altogether if they are not really important.
6. Write it down: Writing down the events of the day in a journal helps put things in perspective. This exercise also supports a proactive thought process that leads to better organization and problem solving.
7. Seek professional help: If your stress noticeably affects your health, causes feelings of desperation (e.g., a desire to run away, quit school, leave a relationship that is fundamentally sound, quit a job, etc.), or leads to anxiety attacks, regular tearfulness, or depression, it is time to seek professional help. Mental health professionals can help you better identify your stressors, the history behind them that gives them power, and ways to overcome them and manage your life with less stress in the future.

Relaxation Strategies

Two simple, effective methods for decreasing stress are progressive relaxation and meditation. Both involve deep, slow breathing patterns that help the body unwind and balance.

Progressive Relaxation

To practice progressive relaxation, lie in a comfortable position without crossing your arms or legs, and focus on your breathing to create a slow, deep breathing pattern. Inhale through your nose while counting to ten and expanding your abdomen. Hold the breath for one second, and exhale through your nose on a count of ten. Inhale and exhale in this pattern five times.

Beginning with your head, tense your facial muscles as tightly as possible and count to five. Release the muscles completely, and sense the muscles feeling heavy and still. Work down your entire body tensing muscle groups and then relaxing them. After the head, move to the neck, chest, arms and hands, abdomen, back, thighs and gluteals, lower legs, and feet. After relaxing each set of muscles, scan the body for any areas of remaining tension and ask those areas to relax completely. Repeat the slow breathing exercise. Gently move the body to come out of its deeply relaxed state. Try using progressive relaxation directly before bed or as a pick-me-up in the late afternoon.

Meditation

Meditation has been used for thousands of years in Eastern cultures as a way to quiet the mind and reach heightened states of consciousness. Meditation is widely accepted as a way to promote mental clarity and relax. Sit upright on the floor with legs crossed, or sit upright on a straight-backed chair with both feet flat on the floor. Close your eyes and focus on slowly inhaling and exhaling. If you have an idea or thought, simply label it as “thinking” and return your focus to breathing. It’s helpful to think of thoughts as just thoughts, removing the power they sometimes hold over us. In a meditation session, a thought such as “I am selfish” might surface. If you dismiss it as “just thinking,” some of its power will dissipate as you return to focusing on your breath. This type of meditation works well in the morning as a means of getting the day off to a good start. You can also use it anytime to relax, though it may cause disturbed sleep if used directly before bed.

Mindfulness during simple and regular activities is a type of meditation. It involves an increased awareness of your immediate environment and immediate experience. For example, while taking a bath, focus on the sensation of the water, the sound the water makes as it moves in the tub, the dampness in the air from steam, the smell of the water, and the color of the water. If you begin to think about some worry, a task that needs completion, what’s going to happen tomorrow, or what happened during the day, focus attention again on a sensory contemplation of the water. This disrupts stressful thoughts, leads to greater relaxation, and helps promote an appreciation of simple pleasures. Stress and its effect on the human body are discussed in detail in Chapter 5 (The Therapeutic Nature of Massage).

Stress and Massage

We already know that massage activates the parasympathetic nervous system, which balances out the sympathetic nervous system once a danger has passed, and helps the body to unwind and recuperate. The parasympathetic nervous system slows the body’s heart rate and is associated with relaxed breathing patterns. It stimulates the formation and release of urine and the activity of the digestive system so that the body can nourish and detoxify itself. This response is important for reducing all types of stress and allowing the body’s chemistry to normalize. Massage also helps the body normalize levels of cortisol and epinephrine. As noted earlier in this chapter, massage lowers cortisol and has a balancing action on the adrenal glands^{177, 178} Massage has been shown to reduce epinephrine levels and quench the fight-or-flight response in patients about to undergo surgery.¹⁷⁹ It has also normalized epinephrine levels (and other chemicals) in depressed adolescent mothers.¹⁸⁰ Massage is a key stress management tool that helps the body return to normal homeostasis and optimal function.