Ten Keys to
Successful Coping
7:
Manage Stress
By Bruce Campbell
Stress can be a challenge for anyone, but it can be
doubly difficult for people with CFIDS or fibromyalgia. On the one
hand, chronic illness intensifies stress. Being ill adds new stressors
to those you were already confronting. And if that was not enough, CFIDS
and fibromyalgia are very stress-sensitive illnesses. Not only are your
stresses multiplied because you are ill, you are more vulnerable to the
effects of stress.
Even moderate amounts of stress can greatly intensify
CFIDS and fibromyalgia symptoms, creating a feedback loop in which your symptoms and your
response to them intensify one another. If you feel under stress, for
example, your body is likely to become tense, increasing your pain. The
pain in turn can make you feel more stressed. Ongoing stresses
like those in CFIDS and FM are particularly debilitating,
making stress management a central challenge to living successfully with
chronic illness.
Using stress management strategies, you can learn how
to interrupt the cycle in which symptoms and stress intensify one
another. We’ll look at this topic from two perspectives: stress
reduction and stress avoidance.
Stress Reduction
Stress reduction means learning how to
respond differently to stressful situations and events. Here are seven
ways to reduce stress.
Relaxation
Relaxation offers a profound antidote
to stress. Relaxation means letting go. Physically, it involves
releasing muscle tension and breathing more slowly and regularly.
Emotionally, it consists of nurturing a sense of equanimity. Mentally,
it means observing and releasing worry-filled thoughts.
Physically-relaxing activities counteract both the physical and the
emotional aspects stress. Through relaxation, you can reduce muscle
tension and anxiety. Relaxation is also very helpful for pain control.
Resting can reduce stress. Combining rest with a relaxation procedure or
meditation can be an even more effective means of stress reduction. (For
step-by-step instructions on six relaxation techniques, see the chapter
on stress management
in our course text.)
Problem-Solving
Taking practical steps to improve your situation can
also help reduce anxiety and worry. As one member of our groups said,
“I try to work out a practical plan for the things that are bugging me
that I feel I can change. Sometimes the problems seem overwhelming, but
the advice of tackling one thing at a time really works.”
Positive Experiences
Doing things that are enjoyable can be a stress
reducer. Positive experiences counteract the thought that illness means
only suffering. Also, pleasurable activities lower the frustration of
being ill while distracting you from your symptoms. Examples of positive
experiences include exercise and movement, journaling, talking and being
listened to, music and the arts, laughter and humor, and solitude.
Mental Adjustments
Our thoughts can be another source of stress. One such
cause of stress is having unrealistic or inappropriate expectations. For
example, we may hold ourselves to housecleaning standards that may no
longer make sense. (For more, see the article "Taming
Stressful Thoughts.")
Assertiveness
Speaking up for yourself can be a
stress reducer in a number of ways. Saying ‘no’ can help you avoid
doing things that would intensify your symptoms. Also, presenting your
position rather than stuffing it can replace frustration with action.
Support
Being ill is both inherently stressful
and isolating. Having people in your life who understand and respect you
is a balm to the soul. Just being listened to and feeling connected to
others is healing. Beyond that, talking may help you clarify your
situation or their response may enable you to see your life in a
different and more constructive way. Family members may provide such
support and you may also find it through developing relationships with
fellow patients. Support also means practical assistance, which might
include such things as shopping, cooking, bill paying or housecleaning.
Medications
Prescription medications may be
helpful for some patients as part of a stress management program.
Stress Avoidance
Stress avoidance is preventive, using
self-observation to learn how stress affects you and then taking
measures to avoid stressful circumstances. For example, you may notice
that when you hit a limit, any further activity will intensify your
symptoms. In such circumstances, rest can reduce the stress on your
body. Planned rest can be an effective stress avoidance strategy. Having
good relationships are a buffer against stress. People with supportive
relationships have lower anxiety and depression.
The main ways that people in our
groups prevent stress are by avoiding stress triggers and by using
routine or scheduling.
Avoidance of stress triggers
We may have particular circumstances
in our lives that “set us off.” If we can identify these stress
triggers, we may be able to avoid them or reduce their impact. You might
think of triggers in the categories of people, substances and
situations.
Some patients find interactions with
particular people are the cause of disabling stress. Responses they have
made include talking with the person, limiting contact, getting
professional help with the relationship, and ending the relation. Food,
chemicals and other substances can trigger symptoms. By identifying and
avoiding specific foods or other substances you may be able to avoid
relapses. In terms of situations, if you are particularly sensitive to
light or noise or crowds or experience sensory overload in other ways,
avoiding those situations can help you control symptoms.
Scheduling and Routine
Novelty is another source of stress.
It takes more energy to respond to a new situation than it does to
something familiar. Given our limited energy, saving it for healing is
desirable. One way to do that is through making your life predictable.
Some patients have done that through routine: living their lives
according to a schedule. They have been able to reduce the surprises and
emotional shocks in their lives, and thereby reduce their stress. By
knowing what to expect, they have reduced pressures on themselves. Any
steps in the direction of giving predictability to life is likely to
lower stress.
Many of the pacing strategies
described in Key 3 are also effective stress
reducers. Scheduling activity based on priorities, timing activity for
the best hours of the day, and staying within known limits all help
control stress.
A Few Ideas for Getting Started
Here are a few ideas if you would like to experiment
with new ways to control stress.
Create Positive Experiences
Doing things that are enjoyable can be a great stress reducer. For
example, seeing a movie, spending time in nature, listening to music,
taking a bath, getting a massage or reading can distract from stress and
reduce preoccupation with symptoms. Exercise is a natural stress
reducer, because it causes your body to produce endorphins. Just getting
up and moving around can break a mood of worry.
Practice Relaxation Through Breathing
When we are under tension and stressed out, our breathing can become
shallow. Becoming aware of your breathing and deliberately breathing in
a deep and easy manner is a technique you can use to help you relax. You
might try it when caught in traffic, stuck in line, or when in an heated
discussion. The basic principle is to focus on your breathing in order
to slow down anxious or negative thoughts and to reduce the adrenaline
flowing through your body.
To practice this type of breathing, focus your
attention on your breath. Take in a long, slow breath through your nose,
hold it one or two seconds, then breathe out through your mouth. As you
exhale, you can say a calming word to yourself, like “relax.” The
idea is to focus your attention on your breathing, keeping it slow and
easy. As you breathe in this way, you should be able to feel your body
relax and a sense of calmness replace your anxiety. To avoid becoming
dizzy, keep your breathing slow and easy.
You may be able to achieve some benefits from a less
formal procedure than the one just outlined. Simply noticing your
breathing can often reduce anxiety. If you feel yourself worrying, tell
yourself your are going to shift your attention to your breathing.
Sometimes even taking one deep breath and letting it out slowly can
reduce anxiety.
Develop a Routine
Any steps you take that give predictability to your life are likely to
lower your stress. So choose some part of your life that is not
consistent and give it a schedule. You might begin by bringing routine
to your sleep, having a consistent time at which you go to bed and get
up. Or you might take a rest at a set time each day or eat at a regular
hour. Or get dressed on a schedule each day. One student who regulated
her day by having scheduled times for going to bed and waking up, eating
meals, resting, exercising and watching TV said: “I know it sounds
boring, but I swear it helps.”
In Summary
Relaxation techniques --such as meditation, deep
breathing, the use of imagery or listening to music or soothing sounds
from nature-- offer a way to help us change our habitual ways of
responding to stressors and to reduce our habitual stress level. Stress
avoidance enables us to prevent stress.
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