Stress Management

What are the Benefits of Managing Stress?

Stress management is important for individual well-being and our quality of life; it can also improve our productivity and academic and work performance.

Moreover, high levels of stress are also a public health concern, as it's been associated with serious health conditions, including Coronary Heart Disease, cancer, diabetes, and even Alzheimer's disease.

Since most of us won't be able to eliminate stressful situations from our life, it's important to know what strategies could help us manage the effects of stress.

What are the Ways to Manage Stress?

We will look at stress management techniques, including drug therapy and psychological interventions and how they work. Below are the specific ways of managing stress that we'll cover.

Drug therapies:

• Use of benzodiazepines in stress management.
• Use of beta blockers in stress management.

Psychological interventions:

• Use of biofeedback in stress management.
• Stress Inoculation Therapy (SIT).

Drug Therapies in Managing Stress and Anxiety

Drug therapy is one of the stress management tools. Certain medications can act to reduce the body's physiological stress response and trigger a relaxation response instead. The two drug categories used to manage the physiological effects of stress are Benzodiazepines and beta-blockers.

Benzodiazepines work by affecting the GABA and serotonin neurotransmitters.

Different types of neurotransmitters in the body are responsible for different functions, e.g. serotonin is associated with feelings of happiness. The type of neurotransmitter present has different effects on neurons, i.e. they could be excitatory (increase activity) or inhibitory (reduce activity).

GABA is an inhibitory neurotransmitter which controls our behavioural responses as well as the physiological processes of our body. By enhancing GABA transmission, benzodiazepines reduce physiological arousal (decrease blood pressure, slow breathing, etc.) and cause relaxation and sedation.

Adrenaline is responsible for heightened physiological arousal when experiencing the fight-or-flight response. It is transported to the heart, where it fuels the beta receptors, increasing blood pressure and heart rate.

Beta-blockers stop adrenaline from binding to beta receptors, keeping the body from heightened states of arousal in response to stress.

Fig. 2 - Stress can be pharmacologically managed with benzodiazepines or beta-blockers, which target the physiological stress response.

The effectiveness of benzodiazepines has been supported in studies. However, it's not always more effective in reducing anxiety than other medications.

Psychological Stress Management Strategies

Psychological stress management interventions include Stress Inoculation Therapy and biofeedback. Both of these stem from the cognitive behavioural approach and follow a stepwise process.

Stress Management: Stress Inoculation Therapy

Meichenbaum (1975) developed Stress Inoculation Therapy (SIT) based on the techniques used in cognitive behavioural therapies. Sit is used for stress and anxiety management.

SIT offers three steps to managing stress and anxiety:

1. Conceptualisation stage: the patients are guided to help individuals analyse different aspects of the stressor and understand how it affects their lives and how they respond to it.

2. Skill learning and rehearsing stage: the patient is taught some stress coping strategies, including relaxation techniques, practising control, etc.

3. Practical application: the patient puts the newly acquired knowledge to the test while engaging with real-life situations. The patient is taught to perceive any setbacks from the real-world situation as challenges rather than failures.

Stress Management: Biofeedback

This intervention requires the use of devices that monitor one's arousal, indicated, for example, by increased muscle tension.

The technology allows people to monitor their physiological response in real-time and learn to downregulate it using feedback from the device consciously.

Three types of technology are often used in biofeedback. And some of these include:

• Skin conductance response (SCR) for measuring sweating.

• Electromyogram (EMG) for measuring muscle tension due to stress.

• Electroencephalogram (EEG) for measuring brain activity.

• Electrocardiogram (ECG) for measuring heart rate.

Biofeedback interventions involve eight to ten sessions, which may require follow-ups. Each session lasts around an hour, and improvement begins approximately after the ninth or the tenth session.

Fig. 3 - Biofeedback requires access to specialist technology and allows better control of the body's physiological stress response.

How Effective are the Psychological Interventions?

Jay & Elliot (1990) tested the effectiveness of SIT in a sample of parents whose children had leukaemia and had to undergo medical procedures.

• The parents were either assigned to SIT condition or observed their child receiving cognitive-behavioural therapy treatment.

Based on the parents' behaviour, self-reported anxiety and physiological measures of stress, the researchers concluded that SIT reduced parents' anxiety and increased their self-esteem.

Scharff et al. (2002) investigated the effects of biofeedback in a sample of 36 children and adolescents suffering from migraines.

• There were three conditions: stress management and a hand-warming biofeedback condition, a hand-cooling biofeedback condition and a control condition.

The researchers found that hand-warming biofeedback effectively reduced migraines in the sample, lasting approximately six months after the treatment.

But how do the two approaches compare? Holroyd et al. (1977) compared the effectiveness of coping skills and biofeedback in 31 patients with chronic tension headaches.

• They were assigned either to a cognitive coping skills intervention (similar to SIT), biofeedback training or a control condition.

In this study, cognitive stress coping intervention produced superior effects in reducing tension headaches than biofeedback.

Compare Techniques for Managing Stress

Let's look at how drug therapies and psychological interventions compare.

Gender Differences in Stress Management

Individual differences and other factors should be considered when considering what intervention we should use for stress management. For instance, there might be gender differences in how we cope with stress.

Peterson et al. (2006) investigated how men and women suffering from infertility coped with stress. He highlighted that women used behaviours or had specific traits, e.g. they were often confrontational, accepted the situation, sought social support and engaged in avoidance.

On the other hand, men preferred distancing and engaging in self-controlling and problem-solving behaviours.

Men's behaviour was more in line with problem-focused coping, while women preferred emotion-focused coping.

According to Tayler et al. (2000), women's responses to stress are better characterised by the tend-and-befriend response rather than a fight-or-flight response. The theory suggests that women can regulate their distress levels by focusing on nurturing and maintaining their and their offspring's safety.

This ability to regulate the stress response through caring and attachment is linked to oxytocin and how it affects women's physiology.

Tayler et al. (2000) suggested that oxytocin reduces the effect of cortisol levels (stress hormone) in women, which helps them maintain their stress levels, showing that adverse effects of stress may last longer in males compared to females.