Stress management is the amelioration of stress and especially chronic stress often for the

purpose of improving everyday functioning.

Stress produces numerous symptoms which vary according to persons, situations, and
severity. These can include physical health decline as well as depression.Subsequent studies
of stress in humans is caused by distinct, measureable life stressors, and further, that these life
stressors can be ranked by the median degree of stress they produce (leading to the Holmes
and Rahe Stress Scale). Thus, stress was traditionally conceptualized to be a result of external
insults beyond the control of those experiencing the stress. More recently, however, it has
been argued that external circumstances do not have any intrinsic capacity to produce stress,
but instead their effect is mediated by the individual's perceptions, capacities, and
understanding.

Models of stress management

Transactional model
Richard Lazarus and Susan Folkman suggested in 1984 that stress can be thought of as
resulting from an “imbalance between demands and resources” or as occurring when
“pressure exceeds one's perceived ability to cope”. Stress management was developed and
premised on the idea that stress is not a direct response to a stressor but rather one's resources
and ability to cope mediate the stress response and are amenable to change, thus allowing
stress to be controllable.[3]
In order to develop an effective stress management programme it is first necessary to identify
the factors that are central to a person controlling his/her stress, and to identify the
intervention methods which effectively target these factors. Lazarus and Folkman's
interpretation of stress focuses on the transaction between people and their external
environment (known as the Transactional Model). The model contends that stress may not be
a stressor if the person does not perceive the stressor as a threat but rather as positive or even
challenging. Also, if the person possesses or can use adequate coping skills, then stress may
not actually be a result or develop because of the stressor. The model proposes that people
can be taught to manage their stress and cope with their stressors. They may learn to change
their perspective of the stressor and provide them with the ability and confidence to improve
their lives and handle all of types of stressors.
Health realization/innate health model
The health realization/innate health model of stress is also founded on the idea that stress
does not necessarily follow the presence of a potential stressor. Instead of focusing on the
individual's appraisal of so-called stressors in relation to his or her own coping skills (as the
transactional model does), the health realization model focuses on the nature of thought,
stating that it is ultimately a person's thought processes that determine the response to
potentially stressful external circumstances. In this model, stress results from appraising
oneself and one's circumstances through a mental filter of insecurity and negativity, whereas
a feeling of well-being results from approaching the world with a "quiet mind," "inner
wisdom," and "common sense".[4][5]
This model proposes that helping stressed individuals understand the nature of thought—
especially providing them with the ability to recognize when they are in the grip of insecure
thinking, disengage from it, and access natural positive feelings—will reduce their stress.
Psychological resilience

"Resilience" in psychology is the positive capacity of people to cope with stress and
adversity. This coping may result in the individual “bouncing back” to a previous state of
normal functioning, or using the experience of exposure to adversity to produce a “steeling
effect” and function better than expected (much like an inoculation gives one the capacity to
cope well with future exposure to disease). [1] Resilience is most commonly understood as a
process, and not a trait of an individual.[2]

STRESS AND DISEASE

Stress and Disease: For thousands of years, people believed that stress made you sick. Up
until the nineteenth century, the idea that the passions and emotions were intimately linked to
disease held sway, and people were told by their doctors to go to spas or seaside resorts when
they were ill. Gradually these ideas lost favor as more concrete causes and cures were found
for illness after illness. But in the last decade, scientists like Dr. Esther Sternberg, director of
the Integrative Neural Immune Program at NIH's National Institute of Mental Health
(NIMH), have been rediscovering the links between the brain and the immune system.

The Immune System and the Brain

When you have an infection or something else that causes inflammation such as a burn or
injury, many different kinds of cells from the immune system stream to the site. Dr. Sternberg
likens them to soldiers moving into battle, each kind with its own specialized function. Some
are like garbage collectors, ingesting invaders. Some make antibodies, the "bullets" to fight
the infectious agents; others kill invaders directly. All these types of immune cells must
coordinate their actions, and the way they do that is by sending each other signals in the form
of molecules that they make in factories inside the cell.
"It turns out that these molecules have many more effects than just being the walkie-talkie
communicators between different kinds of immune cells," Dr. Sternberg says. "They can also
go through the bloodstream to signal the brain or activate nerves nearby that signal the brain."
These immune molecules, Dr. Sternberg explains, cause the brain to change its functions.
"They can induce a whole set of behaviors that we call sickness behavior. . . . You lose the
desire or the ability to move, you lose your appetite, you lose interest in sex." Scientists can
only speculate about the purpose of these sickness behaviors, but Dr. Sternberg suggests that
they might help us conserve energy when we're sick so we can better use our energy to fight
disease.

Impact on disease

Chronic stress can significantly affect many of the body's immune systems, as can an
individual's perceptions of, and reactions to, stress. The term psychoneuroimmunology is used
to describe the interactions between the mental state, nervous and immune systems, as well as
research on the interconnections of these systems. Immune system changes can create more
vulnerability to infection, and have been observed to increase the potential for an outbreak of
psoriasis for people with that skin disorder.[9]
Chronic stress has also been shown to impair developmental growth in children by lowering
the pituitary gland's production of growth hormone, as in children associated with a home
environment involving serious marital discord, alcoholism, or child abuse.[10]
Chronic stress is seen to affect parts of the brain where memories are processed through and
stored. When people feel stressed, stress hormones get over-secreted which affects the brain.
This secretion is made up of glucocorticoids, also known as cortisol, which are steroid
hormones that the adrenal gland releases.[11]
Studies of female monkeys at Wake Forest University (2009) discovered that individuals
suffering from higher stress have higher levels of visceral fat in their bodies. This suggests a
possible cause-and-effect link between the two, wherein stress promotes the accumulation of
visceral fat, which in turn causes hormonal and metabolic changes that contribute to heart
disease and other health problems.[12]

STRESS AND EMOTIONS

Emotions are our feelings inside your head that makes you feel sad, happy, mad, and so on.
I'm happy.   Emotion, in its most general definition, is an intense mental state that arises...
Stress effects our moods by changing our attitudes and our thinking. Someone could be
happy one minute and have a disagreement with a friend the next minute and end up very
hurt or disappointed.No matter how much one tries to act "emotioneless", to follow prudence
only, it is impossible not to feel emotions. Emotions can be suppressed voluntarily, but we
can never "turn them off" at full. Whenever we are under stress the limbic system is activated
and it is one of the major centers responsible for emotions and feelings.

It is very important to mention that the effects of stress on emotions are as much
physiological as psychological. Hormones have direct effect on emotions and no matter what
our attitude toward the stressor is, emotions may be greatly affected just by the availability of
a certain hormone. Fear triggered by adrenaline is one example.
The effects of stress on emotions are complex and not fully understood. There is a myriad of
theories explaining emotions, and the link between consciousness and brain physiology is
still not understood
Behavior modification:
Behavior modification is the use of empirically demonstrated behavior change techniques to
improve behavior, such as altering an individual's behaviors and reactions to stimuli through
positive and negative reinforcement of adaptive behavior and/or the reduction of maladaptive
behavior through its extinction, punishment and/or therapy.

The first use of the term behavior modification appears to have been by Edward Thorndike in
1911. His article Provisional Laws of Acquired Behavior or Learning makes frequent use of
the term "modifying behavior".[1] Through early research in the 1940s and the 1950s the term
was used by Joseph Wolpe's research group.[2] The experimental tradition in clinical
psychology[3] used it to refer to psychotherapeutic techniques derived from empirical
research. It has since come to refer mainly to techniques for increasing adaptive behavior
through reinforcement and decreasing maladaptive behavior through extinction or
punishment (with emphasis on the former). Two related terms are behavior therapy and
applied behavior analysis. Emphasizing the empirical roots of behavior modification, some
authors[4] consider it to be broader in scope and to subsume the other two categories of
behavior change methods. Since techniques derived from behavioral psychology tend to be
the most effective in altering behavior, most practitioners consider behavior modification
along with behavior therapy and applied behavior analysis to be founded in behaviorism.
While behavior modification encompasses applied behavior analysis and typically uses
interventions based on the same behavioral principles, many behavior modifiers who are not
applied behavior analysts tend to use packages of interventions and do not conduct functional
assessments before intervening.
Martin and Pear indicate that there are seven characteristics to behavior modification, [4] They
are:
 There is a strong emphasis on defining problems in terms of behavior that can be
measured in some way.
 The treatment techniques are ways of altering an individual's current environment to
help that individual function more fully.
 The methods and rationales can be described precisely.
 The techniques are often applied in everyday life.
 The techniques are based largely on principles of learning – specifically operant
conditioning and respondent conditioning
 There is a strong emphasis on scientific demonstration that a particular technique was
responsible for a particular behavior change.
 There is a strong emphasis on accountability for everyone involved in a behavior
modification program.
TIME MANAGEMENT
Time management is the act or process of exercising conscious control over the amount of
time spent on specific activities, especially to increase efficiency or productivity. Time
management may be aided by a range of skills, tools, and techniques used to manage time
when accomplishing specific tasks, projects and goals. This set encompasses a wide scope of
activities, and these include planning, allocating, setting goals, delegation, analysis of time
spent, monitoring, organizing, scheduling, and prioritizing. Initially, time management
referred to just business or work activities, but eventually the term broadened to include
personal activities as well. A time management system is a designed combination of
processes, tools, techniques, and methods. Usually time management is a necessity in any
project development as it determines the project completion time and scope.

Categorization

Stephen R. Covey has offered a categorization scheme for the hundreds of time management
approaches that they reviewed:

 First generation: reminders based on clocks and watches, but with computer
implementation possible; can be used to alert a person when a task is to be done.
 Second generation: planning and preparation based on calendar and appointment
books; includes setting goals.
 Third generation: planning, prioritizing, controlling (using a personal organizer, other
paper-based objects, or computer or PDA-based systems) activities on a daily basis.
This approach implies spending some time in clarifying values and priorities.
 Fourth generation: being efficient and proactive using any of the above tools; places
goals and roles as the controlling element of the system and favors importance over
urgency.[1][2]
Time management literature can be paraphrased as follows:

 "Get Organized" - paperwork and task triage

 "Protect Your Time" - insulate, isolate, delegate
 "Set gravitational goals" - that attract actions automatically
 "Achieve through Goal management Goal Focus" - motivational emphasis
 "Work in Priority Order" - set goals and prioritize
 "Use Magical Tools to Get More Out of Your Time" - depends on when written
 "Master the Skills of Time Management"
 "Go with the Flow" - natural rhythms, Eastern philosophy
 "Recover from Bad Time Habits" - recovery from underlying psychological problems,
e.g. procrastination

More unconventional time usage techniques, such as those discussed in "Where Did Time
Fly,"[3] include concepts that can be paraphrased as "Less is More," which de-emphasizes the
importance of squeezing every minute of your time, as suggested in traditional time
management schemes.
In recent years, several authors have discussed time management as applied to the issue of
digital information overload, in particular, Tim Ferriss with "The 4 hour workweek",[4] and
Stefania Lucchetti with "The Principle of Relevance"[5]

ADDITIONAL COPING TECHNIQUES

The psychological definition of coping is the process of managing taxing circumstances,
expending effort to solve personal and interpersonal problems, and seeking "to master,
minimize, reduce or tolerate stress" or conflict.

Coping strategies
In coping with stress, people tend to use one of the three main coping strategies: either
appraisal-focused, problem-focused, or emotion-focused coping.[1]
Appraisal-focused strategies occur when the person modifies the way they think, for
example: employing denial, or distancing oneself from the problem. People may alter the way
they think about a problem by altering their goals and values, such as by seeing the humor in
a situation.[citation needed]
People using problem-focused strategies try to deal with the cause of their problem. They do
this by finding out information on the problem and learning new skills to manage the
problem.
Emotion-focused strategies involve releasing pent-up emotions, distracting oneself, managing
hostile feelings, meditating, using systematic relaxation procedures, etc.[which?]
Typically, people use a mixture of all three types of coping, and coping skills will usually
change over time. All these methods can prove useful, but some claim that those using
problem-focused coping strategies will adjust better to life.[4]
Men often prefer problem-focused coping, whereas women can often tend towards an
emotion-focused response. Problem-focused coping mechanisms may allow an individual
greater perceived control over their problem, while emotion-focused coping may more often
lead to a reduction in perceived control. Certain individuals therefore feel that problem-
focused mechanisms represent a more effective means of coping.[5]
"Resilience" in psychology is the positive capacity of people to cope with stress and
adversity. This coping may result in the individual “bouncing back” to a previous state of
normal functioning, or using the experience of exposure to adversity to produce a “steeling
effect” and function better than expected (much like an inoculation gives one the capacity to
cope well with future exposure to disease). [1] Resilience is most commonly understood as a
process, and not a trait of an individual.[2]

Resilience can be described by viewing:

1. good outcomes regardless of high-risk status,
2. constant competence under stress,
3. recovery from trauma,[34] and
4. using challenges for growth that makes future hardships more tolerable.

Diaphragmatic Breathing
Another related simple and effective method for releasing body tension is diaphragmatic
breathing, which involves breathing deeply from your diaphragm (a muscle located at the
base of your abdomen). Adults tend to breathe in a very shallow way, using only the upper
part of the chest. This tendency is exacerbated during times of stress, as breathing becomes
even more shallow and rapid. Deep, slow diaphragmatic breathing releases tension from the
muscles by improving the flow of oxygenated blood throughout our bodies.
You can experience the difference between shallow breathing and deep breathing by trying
this exercise:
 Lie down on a bed or on the floor. Bend your knees and relax your toes. Keep your
spine straight. If necessary, put a small pillow under your lower back for support.
 Place one hand on your abdomen and one on your chest (or use magazines or light
books in place of your hands).
 Inhale slowly and deeply. Pay attention to which hand (or book or magazine) moves
the most. Shallow breathing causes the hand on the chest to move the most. Deep,
diaphragmatic breathing causes the hand on your abdomen to move the most.
 Continue breathing deeply for 5 or 10 minutes. Concentrate on moving the hand on
your abdomen more than the hand on your chest.
Once you have mastered the diaphragmatic breathing technique, you can use it any time (and
any place) you feel the need to release stress.

PROGRESSIVE Relaxation method

Progressive muscle relaxation (or PMR) is a technique for reducing anxiety by
alternately tensing and relaxing the muscles. It was developed by American physician
Edmund Jacobson in the early 1920s.[1] Jacobson argued that since muscle tension
accompanies anxiety, one can reduce anxiety by learning how to relax the muscular
tension. PMR entails a physical and mental component.
The physical component involves the tensing and relaxing of muscle groups over the
legs, abdomen, chest, arms and face. With the eyes closed and in a sequential pattern, a
tension in a given muscle group is purposefully done for approximately 10 seconds and
then released for 20 seconds before continuing with the next muscle group.
The mental component focuses on the difference between the feelings of the tension and
relaxation. Because the eyes are closed, one is forced to concentrate on the sensation of
tension and relaxation. In patients with anxiety, the mind often wanders with thoughts such as
"I don't know if this will work" or "Am I feeling it yet." If such is the case, the patient is told to
simply focus on the feelings of the tensed muscle. Because of the feelings of warmth and
heaviness are felt in the relaxed muscle after it is tensed, a mental relaxation is felt as a result.
With practice, the patient learns how to effectively relax and deter anxiety when it becomes at
an unhealthy level where an anxiety attack would otherwise occur.[2]
Jacobson trained his patients to voluntarily relax certain muscles in their body in order to
reduce anxiety symptoms. He also found that the relaxation procedure is effective against
ulcers, insomnia, and hypertension. There are many parallels with autogenic training, which
was developed independently. The technique has also proven effective in reducing acute
anxiety in people with Schizophrenia.[3]
Jacobson's Progressive Relaxation has remained popular with modern physical therapists.
Progressive relaxation involves alternately tensing and relaxing the muscles. [4] A person using
PMR may start by sitting or lying down in a comfortable position. With the eyes closed, the
muscles are tensed (10 seconds) and relaxed (20 seconds) sequentially through various parts
of the body. The whole PMR session takes approximately 30 minutes. As this is a technique,
practice with PMR does make perfect and will usually not work effectively as it should the
first couple of times.
Patients with generalized anxiety disorder who first try PMR with anxiety may become
frustrated, feel rushed, or feel an increase in anxiety for various reasons such as being afraid
to "let your guard down." As with doing anything new, this is to be expected and simply
practiced again once or twice a day.[5]

Autogen training
Autogenic training is a relaxation technique developed by the German psychiatrist Johannes
Heinrich Schultz and first published in 1932. The technique involves the daily practice of
sessions that last around 15 minutes, usually in the morning, at lunch time, and in the
evening. During each session, the practitioner will repeat a set of visualisations that induce a
state of relaxation. Each session can be practiced in a position chosen amongst a set of
recommended postures (for example, lying down, sitting meditation, sitting like a rag doll).
The technique can be used to alleviate many stress-induced psychosomatic disorders
Schultz emphasized parallels to techniques in yoga and meditation. It is a method for
influencing one's autonomic nervous system. Abbe Faria and Emile Coue are the forerunners
of Schultz. There are many parallels to progressive relaxation. In 1963 Luthe discovered the
significance of "autogenic discharges", paroxistic phenomena of motor, sensorial, visual and
emotional nature related to the traumatic history of the patient, and developed the method of
"Autogenic Abreaction". His disciple Luis de Rivera, a McGill trained psychiatrist,
introduced psychodynamic concepts[1] into Luthe's approach, developing "Autogenic
Analysis" as a new method for uncovering the unconscious.
Example of an autogenic training session
1. Sit in the meditative posture and scan the body
2. "my right arm is heavy"
3. "my arms and legs are heavy and warm" (repeat 3 or more times)
4. "my heartbeat is calm and regular" (repeat 3 times)
5. "my solar plexus is warm" (repeat 3 times)
6. "my forehead is cool"
7. "my neck and shoulders are heavy" (repeat 3 times)
8. "I am at peace" (repeat 3 times)
9. Finish part one by cancelling[vague]
10. Start part two by repeating from step 2 to cancelling
11. Start part three by repeating from step 2 to cancelling

ADDITIONAL RELAXATION TECHNIQUES

A relaxation technique (also known as relaxation training) is any method, process,
procedure, or activity that helps a person to relax; to attain a state of increased calmness; or
otherwise reduce levels of anxiety, stress or anger. Relaxation techniques are often employed
as one element of a wider stress management program and can decrease muscle tension,
lower the blood pressure and slow heart and breath rates, among other health benefits.[1]
Uses
People use relaxation techniques for the following reasons, among others:

 Anger management  High blood pressure

 Anxiety attacks  Immune system support
 Cardiac health  Insomnia
 Depression  Pain management
 General well-being  Stress management
 Headache

Techniques
Various techniques are used by individuals to improve their state of relaxation. Some of the
methods are performed alone; some require the help of another person (often a trained
professional); some involve movement, some focus on stillness; while other methods involve
different elements.
Certain relaxation techniques known as "formal and passive relaxation exercises" are
generally performed while sitting or lying quietly, with minimal movement and involve "a
degree of withdrawal".[2] These include:
 Autogenic training
 Biofeedback
 Deep breathing
 Meditation
 Zen Yoga
 Progressive Muscle Relaxation
 Power-nap
 Pranayama
  Visualization
 Yoga Nidra

Movement-based relaxation methods incorporate exercise such as walking, gardening, yoga,

Tai chi, Qigong, and more. Some forms of bodywork are helpful in promoting a state of
increased relaxation. Examples include massage, acupuncture, the Feldenkrais Method,
reflexology and self-regulation.
Some relaxation methods can also be used during other activities, for example,
autosuggestion and prayer. At least one study has suggested that listening to certain types of
music, particularly New Age music and classical music, can increase feelings associated with
relaxation, such as peacefulness and a sense of ease. [3] Some find humour to be helpful.[citation
needed]

A technique growing in popularity is flotation therapy, which is the use of a float tank in
which a solution of Epsom salt is kept at skin temperature to provide effortless floating.
Research in USA and Sweden has demonstrated a powerful and profound relaxation after
twenty minutes. In some cases, floating may reduce pain and stress and has been shown to
release endorphins.

EXERCISE
Physical exercise is any bodily activity that enhances or maintains physical fitness and
overall health and wellness. It is performed for various reasons. These include strengthening
muscles and the cardiovascular system, honing athletic skills, weight loss or maintenance and
for enjoyment. Frequent and regular physical exercise boosts the immune system, and helps
prevent the "diseases of affluence" such as heart disease, cardiovascular disease, Type 2
diabetes and obesity.[1][2] It also improves mental health, helps prevent depression, helps to
promote or maintain positive self-esteem, and can even augment an individual's sex appeal or
body image, which again is also linked with higher levels of self-esteem. [3] Childhood obesity
is a growing global concern[4] and physical exercise may help decrease the effects of
childhood obesity in developed countries.

Types of exercise

Physical exercises are generally grouped into three types, depending on the overall effect they
have on the human body:

 Flexibility exercises, such as stretching, improve the range of motion of muscles and
joints.[6]
 Aerobic exercises, such as cycling, swimming, walking, skipping rope, rowing,
running, hiking or playing tennis, focus on increasing cardiovascular endurance.[7]
 Anaerobic exercises, such as weight training, functional training, eccentric training or
sprinting, increase short-term muscle strength.[8]

Categories of physical exercise

 Strength training
  Agility training
 Eccentric Training

Sometimes the terms 'dynamic' and 'static' are used. 'Dynamic' exercises such as steady
running, tend to produce a lowering of the diastolic blood pressure during exercise, due to the
improved blood flow. Conversely, static exercise (such as weight-lifting) can cause the
systolic pressure to rise significantly (during the exercise).

Categories of general physical skills

Physical exercise is used to improve physical skills.

Physical skills fall into the following general categories, per CrossFit:[9]

 Cardiovascular/respiratory endurance
 Stamina
 Strength
 Flexibility
 Power
 Speed
 Coordination
 Agility
 Balance
 Accuracy

Benefits

Physical exercise is important for maintaining physical fitness and can contribute positively
to maintaining a healthy weight, building and maintaining healthy bone density, muscle
strength, and joint mobility, promoting physiological well-being, reducing surgical risks, and
strengthening the immune system.
Exercise also reduces levels of cortisol.[citation needed] Cortisol is a stress hormone that builds fat
in the abdominal region, making weight loss difficult. [citation needed] Cortisol causes many health
problems, both physical and mental.[10]

Excessive exercise

Exercise is a stressor and the stresses of exercise have a catabolic effect on the body—
contractile proteins within muscles are consumed for energy, carbohydrates and fats are
similarly consumed and connective tissues are stressed and can form micro-tears. However,
given adequate nutrition and sufficient rest to avoid overtraining, the body's reaction to this
stimulus is to adapt and replete tissues at a higher level than that existing before exercising.
The results are all the training effects of regular exercise: increased muscular strength,
endurance, bone density, and connective tissue toughness.