critical thinking name two strategies for managing stress

An official website of the United States government

The .gov means it’s official. Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

The site is secure. The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

• Publications
• Account settings

Preview improvements coming to the PMC website in October 2024. Learn More or Try it out now .

• Advanced Search
• Journal List
• Medicine (Baltimore)
• v.99(35); 2020 Aug 28

Effect of a critical thinking intervention on stress management among undergraduates of adult education and extramural studies programs

Charity chinelo okide.

a Department of Adult Education and Extra-Mural-Studies

Chiedu Eseadi

b Department of Educational Foundations, University of Nigeria, Nsukka, P.M.B

Ifeyinwa O. Ezenwaji

Moses o. ede, rosemary ogochukwu igbo.

c Faculty of Education, Alex Ekwueme Federal University Ndufu-Alike Ikwo

Uzoamaka Lucynda Koledoye

Nwakaego ebele ekwealor, chioma osilike, nkechi mercy okeke, ngozi justina igwe, ruphina u. nwachukwu, lambert peter ukanga.

d Department of Philosophy, University of Nigeria, Nsukka, P.M.B., Enugu State

Mulii Falaremi Olajide

e Department of Adult Education and Community Development, Ibrahim Badamasi Babangida University, Lapai, Niger State

Anthonia Ekanibe Onuorah

f Department of Guidance & Counselling, Enugu State University of Science and Technology, Enugu State, Nigeria

Patrick Ujah

Lambert k. ejionueme, godwin c. abiogu, michael eskay, christian s. ugwuanyi.

g Postdoctoral fellow, School of Education Studies, Faculty of Education, University of the Free State, Bloemfontein, South Africa.

The objective of this study was to examine the effect of a critical thinking intervention (CTI) on stress management among undergraduates of adult education and extramural studies programs.

A total of 44 undergraduates were randomly sorted into experimental and waitlist control groups. We used the Perceived Stress Scale for data collection at the pre-test, post-test, and follow-up stages. We used unpaired t and paired t- tests to analyze the data collected. SPSS version 22.0 was used for the data analyses (SPSS Inc., Chicago, IL).

It was shown that the CTI was effective in reducing the mean stress of the participants compared to the control group both in the post-test ( t [42] = −22.453, P  < .001) and follow-up periods ( t [42] = −34.292, P  < .001). There were statistically significant changes in the mean stress of participants in the experimental group from the pre-test to post-test phases ( t [23] = 26.30, P  = .000, r = .08], and from pre-test to follow-up( t [23] = 37.10, P  = .000, r = .30). The mean stress of the participants in the experimental group from post-test to follow-up signified the sustained positive influence of the CTI on the mean stress ( t [23] = 2.41, P  = .000, r = .46) of the undergraduates.

Conclusion:

This study adds to the literature by showing that a CTI is a valuable strategy for stress reduction in a university environment. Given that the CTI demonstrated the ability to reduce stress among undergraduates enrolled in adult education and extramural studies programs, we hope that similar interventions will be adopted to manage and prevent stress among students in other departments and disciplines.

1. Introduction

Stress is a growing problem among undergraduates at many universities. It affects both their health and academic performance. [ 1 ] Studies have shown that stress is highest for final-year students. [ 2 ] Another study showed that third-year students exhibited a considerable difference in stress levels from both first- and final-year students. [ 2 ] It was recorded that high achievers were less stressed than low achievers. [ 2 ] Studies also found that 97.7% of undergraduate students used Facebook as a tool for curbing stress. [ 3 ] Studies on undergraduate medical students showed that 3.12% reported experiencing no stress, 55.6% reported mild to moderate stress, and 41.2% had experienced severe stress. [ 4 ] In a study on 300 students of a Nigerian university, 94.7% had experienced a high level of stress, while 5.3% had experienced a low level of stress. [ 5 ] Another study in Nigeria found that 94.2% of undergraduate trainees were stressed; the major stressors identified were excessive academic workload (82.3%), inadequate holidays (76.4%), and insufficient time for recreation (76.2%). [ 6 ] In this respect, the objective of this study was to examine the effect of a critical thinking intervention (CTI) on stress management among undergraduates of an adult education and extramural studies programs at Nigerian universities.

Critical thinking is the ability to evaluate information and experiences in an objective manner; it contributes to health by helping individuals be aware of and assess factors that control thoughts and behavior. [ 7 ] A critical thinking intervention aims to inculcate a series of critical thinking skills relevant to solving personal and professional problems. Studies have revealed a significant relationship between critical thinking and stress, with the indication that as critical thinking improves, so does an individual's ability to handle stress. [ 7 ] Studies further indicated that it is important for students to acquire critical thinking skills through the national education system. [ 8 ] Thus, through a critical thinking intervention program, undergraduates of adult education and extramural studies programs can learn how to apply critical thinking skills in stressful situations while they are learning. Therefore, it was hypothesized that a critical thinking intervention would have a significant positive effect on stress management among undergraduates of adult education and extramural studies programs at Nigerian universities.

A randomized controlled trial was conducted in line with the ethical principles of the WMA Declaration of Helsinki. The Faculty of Education Research Ethics Committee at the first author's institution approved the research. All students included in this study provided written informed consent. From a sample of 350 undergraduates of adult education and extramural studies programs approached to take part in the study, a total of 44 were randomly sorted into experimental and waitlist control groups using computer-generated random numbers. [ 9 ] An a priori statistical power of .72 with an effect size of .80 showed that a sample of 40 participants would be adequate for a two-tailed t-test analysis, as determined using G∗power 3.1 (see Fig. ​ Fig.1 1 ). [ 10 ] The participants’ allocation to the experimental and control groups is shown in Figure ​ Figure2. 2 . The inclusion criteria were high perceived stress as ascertained using the 10-item Perceived Stress Scale (PSS) [ 11 ] and consent to participate. Participants received and completed the PSS at the pre-test, post-test, and follow-up stages. The PSS items (Cronbach's α = .734) were rated on a scale ranging from ‘never’ to ‘very often’. [ 11 ]

Sample size calculation with the aid of Gpower.

Enrollment/eligibility flowchart.

The CTI for stress lasted for 6 weeks (2 hours, twice per week). A 4-week follow-up was performed three months after the intervention was concluded. The CTI encompassed strategies for building critical thinking skills that included Socratic questioning, [ 12 ] generating, reasoning, analyzing, inferring, evaluating, and interpreting. [ 13 ] Borun et al's 5-step framework (determine learning objectives; teach through questioning; practice before assessment; review, refine, and improve; and provide feedback and assessment of learning) for teaching critical thinking to students was adapted to help the researchers effectively guide the study participants towards thinking critically. [ 14 ] Using these procedures, the participants were equipped with critical thinking skills that would enable them to deal with stress. We used unpaired and paired t- tests to analyze the collected data. Blinding was performed using procedures described in previous randomized controlled trials. [ 15 , 16 ] There were no cases of dropout or withdrawal, and no reports of adverse effects from the intervention. SPSS version 22.0 was used for all analyses (SPSS Inc., Chicago, IL).

Table ​ Table1 1 shows that there was no significant difference in the number of male and female undergraduate students who participated in the study ( P  = .072). However, there were significant differences in the age ( P  = .000) and tribe of the participants ( P  = .020).

Demographic characteristics of the participants.

The between-group analysis, as seen in Table ​ Table2, 2 , showed that the pre-test mean stress of the participants in the experimental group (34.67 ± 2.82) did not differ significantly from that of those in the control group (34.65 ± 2.64, t [42] = .020, P  = .984). The post-test showed that the mean stress of the participants in the experimental group (14.21 ± 2.79) differed significantly from that of those in the control group (32.40 ± 2.52, t [42] = -22.453, P  < .001). Similarly, the follow-up assessment showed that the mean stress rating of the participants in the experimental group (12.96 ± 1.85) differed significantly from that of those in the control group (32.10 ± 1.83, t [42] = -34.292, P  < .001). This suggests that the CTI had a significant positive effect on stress management among undergraduates from adult education and extramural studies programs. Figure ​ Figure3 3 further elucidates the significant mean change in stress across groups.

Results of independent samples t-test for the difference in mean stress of the experimental and control groups’ participants at pretest, posttest and follow-up.

Significant mean change in stress across the groups.

The within-group analysis, seen in Table ​ Table3, 3 , revealed significant positive changes in the mean stress of participants in the experimental group from the pre-test to post-test stages( t [23] = 26.30, P  = .000, r = .08), and pre-test to follow-up stages ( t [23] = 37.10, P  = .000, r = .30). The mean stress of participants in the experimental group from post-test to follow-up further demonstrated the sustained positive influence of the CTI on mean stress ( t [23] = 2.41, P  = .000, r = .46) among undergraduates in the experimental group.

Paired t test for the difference in the mean stress of the experimental group participants at pretest, posttest and follow-up.

4. Discussion

The purpose of this study was to examine the effect of a critical thinking intervention on stress management among undergraduates of adult education and extramural studies programs. The findings showed that at the pre-test assessment stage, a high level of stress was found among the study participants in both the treatment and control groups. However, after the intervention program, it was shown that the critical thinking intervention was significantly effective in reducing stress among the participants. Taking into consideration the evidence that critical thinking intervention is significantly effective in reducing students’ stress, we would like to emphasize that previous research has supported the fact that as critical thinking increases, individuals’ ability to deal with stress often increases as well. [ 7 ]

Although one previous study reported an insignificant relationship between critical thinking and stress coping strategies, the investigators did acknowledge that this outcome could have been due to the nature of the questionnaire utilized and, perhaps, the respondents’ erroneous estimation of their critical thinking skills and stress coping strategies. [ 8 ] Thus, there should be an objective estimation of students’ skills in any given category such as application, analysis, synthesis, and evaluation, which require the kind of higher-order thinking that characterizes critical thought. [ 17 ] Also, interventions for improving critical thinking skills should help students develop an understanding of how to make consistent observations by having them work through demanding examples and develop a checklist based on their own collective judgment. [ 18 ] Interventions for improving critical thinking and stress management may benefit midwifery students, as it has been observed that up to 73% of them experienced stress during the program, with academic and psychosocial problems being among the main sources of stress. [ 19 ]

More so, critical thinking interventions for stress management should equally involve medical students, as positive outcomes; positive student feedback; improved psychological health; improved physiological and immunologic health markers; improved quality of life, spirituality, and empathy; improved psychological states of mind; increased awareness about stress, its effects, and its management; and an improved ability to cope effectively and positively with stress have all been observed. [ 20 ]

This study has added to the literature by showing that CTI is a valuable strategy for stress reduction in a university environment. One of the aims of the CTI approach is to decrease erroneous thinking and increase rational thinking through the inculcation of relevant critical thinking skills. The outcome of this study has implications for school counseling and philosophically oriented interventions in the future. There is a need for school counselors to collaborate with philosophy educators to develop other therapeutic frameworks based on the CTI approach to help undergraduate students deal with academic stress. Given that CTI demonstrated a significant outcome in reducing stress among undergraduates of adult education and extramural studies programs, we hope that similar interventions will be adopted to manage and prevent stress among students in other departments and disciplines.

Even though this study demonstrated a significant effect by a CTI on stress reduction, its limitations have to be acknowledged. The participants resided in Southeast and South-South Nigeria; therefore, the results cannot be generalized to all undergraduates of adult education and extramural studies programs in other parts of the country. In addition, our sample size was small, which could affect the generalizability of our findings. A larger number of participants should be utilized in future CTI studies.

5. Conclusion

This study added to the literature by showing that a critical thinking intervention is a valuable strategy for stress management in a university environment. The CTI demonstrated a significant effect on stress management among undergraduates of adult education and extramural studies programs. Therefore, we hope that similar interventions will be adopted as a way to manage the stress experienced by students in other departments and disciplines.

Author contributions

Conceptualization: Charity Chinelo Okide, Ifeyinwa O. Ezenwaji, Uzoamaka Lucynda Koledoye, Nwakaego Ebele Ekwealor, Chioma Osilike, Ngozi Justina Igwe, Ruphina U. Nwachukwu, Lambert Peter Ukanga, Godwin C. Abiogu, Michael Eskay, Christian S. Ugwuanyi.

Data curation: Charity Chinelo Okide, Ifeyinwa O. Ezenwaji, Rosemary Ogochukwu Igbo, Uzoamaka Lucynda Koledoye, Nwakaego Ebele Ekwealor, Chioma Osilike, Nkechi Mercy Okeke, Ngozi Justina Igwe, Ruphina U. Nwachukwu, Lambert Peter Ukanga, Mulii Falaremi Olajide, Anthonia Ekanibe Onuorah, Lambert K. Ejionueme, Michael Eskay, Christian S. Ugwuanyi.

Formal analysis: Charity Chinelo Okide, Ifeyinwa O. Ezenwaji, Moses O. Ede, Rosemary Ogochukwu Igbo, Uzoamaka Lucynda Koledoye, Chioma Osilike, Nkechi Mercy Okeke, Ngozi Justina Igwe, Ruphina U. Nwachukwu, Lambert Peter Ukanga, Mulii Falaremi Olajide, Anthonia Ekanibe Onuorah, Lambert K. Ejionueme, Patrick Ujah, Godwin C. Abiogu, Michael Eskay, Christian S. Ugwuanyi.

Funding acquisition: Charity Chinelo Okide, Ifeyinwa O. Ezenwaji, Moses O. Ede, Rosemary Ogochukwu Igbo, Uzoamaka Lucynda Koledoye, Nwakaego Ebele Ekwealor, Chioma Osilike, Nkechi Mercy Okeke, Ngozi Justina Igwe, Ruphina U. Nwachukwu, Lambert Peter Ukanga, Mulii Falaremi Olajide, Anthonia Ekanibe Onuorah, Lambert K. Ejionueme, Patrick Ujah, Godwin C. Abiogu, Michael Eskay, Christian S. Ugwuanyi.

Investigation: Charity Chinelo Okide, Ifeyinwa O. Ezenwaji, Moses O. Ede, Rosemary Ogochukwu Igbo, Uzoamaka Lucynda Koledoye, Nwakaego Ebele Ekwealor, Chioma Osilike, Nkechi Mercy Okeke, Ngozi Justina Igwe, Ruphina U. Nwachukwu, Lambert Peter Ukanga, Mulii Falaremi Olajide, Anthonia Ekanibe Onuorah, Lambert K. Ejionueme, Patrick Ujah, Godwin C. Abiogu, Michael Eskay, Christian S. Ugwuanyi.

Methodology: Charity Chinelo Okide, Ifeyinwa O. Ezenwaji, Moses O. Ede, Rosemary Ogochukwu Igbo, Uzoamaka Lucynda Koledoye, Nwakaego Ebele Ekwealor, Chioma Osilike, Nkechi Mercy Okeke, Ngozi Justina Igwe, Ruphina U. Nwachukwu, Lambert Peter Ukanga, Mulii Falaremi Olajide, Anthonia Ekanibe Onuorah, Lambert K. Ejionueme, Patrick Ujah, Godwin C. Abiogu, Michael Eskay, Christian S. Ugwuanyi.

Project administration: Charity Chinelo Okide, Ifeyinwa O. Ezenwaji, Moses O. Ede, Rosemary Ogochukwu Igbo, Uzoamaka Lucynda Koledoye, Nwakaego Ebele Ekwealor, Chioma Osilike, Nkechi Mercy Okeke, Ngozi Justina Igwe, Ruphina U. Nwachukwu, Mulii Falaremi Olajide, Anthonia Ekanibe Onuorah, Lambert K. Ejionueme, Patrick Ujah, Godwin C. Abiogu, Michael Eskay, Christian S. Ugwuanyi.

Resources: Moses O. Ede, Rosemary Ogochukwu Igbo, Nwakaego Ebele Ekwealor, Nkechi Mercy Okeke, Ruphina U. Nwachukwu, Mulii Falaremi Olajide, Patrick Ujah, Michael Eskay, Christian S. Ugwuanyi.

Software: Charity Chinelo Okide, Ifeyinwa O. Ezenwaji, Rosemary Ogochukwu Igbo, Nwakaego Ebele Ekwealor, Chioma Osilike, Ngozi Justina Igwe, Ruphina U. Nwachukwu, Lambert Peter Ukanga, Mulii Falaremi Olajide, Anthonia Ekanibe Onuorah, Lambert K. Ejionueme, Patrick Ujah, Godwin C. Abiogu, Michael Eskay, Christian S. Ugwuanyi.

Supervision: Charity Chinelo Okide, Ifeyinwa O. Ezenwaji, Uzoamaka Lucynda Koledoye, Chioma Osilike, Nkechi Mercy Okeke, Ngozi Justina Igwe, Ruphina U. Nwachukwu, Mulii Falaremi Olajide, Anthonia Ekanibe Onuorah, Lambert K. Ejionueme, Godwin C. Abiogu, Michael Eskay, Christian S. Ugwuanyi.

Validation: Charity Chinelo Okide, Ifeyinwa O. Ezenwaji, Uzoamaka Lucynda Koledoye, Nwakaego Ebele Ekwealor, Chioma Osilike, Nkechi Mercy Okeke, Lambert Peter Ukanga, Anthonia Ekanibe Onuorah, Godwin C. Abiogu, Christian S. Ugwuanyi.

Visualization: Ifeyinwa O. Ezenwaji, Rosemary Ogochukwu Igbo, Uzoamaka Lucynda Koledoye, Ngozi Justina Igwe, Mulii Falaremi Olajide, Patrick Ujah.

Writing – original draft: Charity Chinelo Okide, Ifeyinwa O. Ezenwaji, Moses O. Ede, Uzoamaka Lucynda Koledoye, Nkechi Mercy Okeke, Ngozi Justina Igwe, Ruphina U. Nwachukwu, Lambert Peter Ukanga, Godwin C. Abiogu, Michael Eskay, Christian S. Ugwuanyi.

Writing – review & editing: Charity Chinelo Okide, Ifeyinwa O. Ezenwaji, Moses O. Ede, Rosemary Ogochukwu Igbo, Uzoamaka Lucynda Koledoye, Nwakaego Ebele Ekwealor, Chioma Osilike, Nkechi Mercy Okeke, Ngozi Justina Igwe, Ruphina U. Nwachukwu, Lambert Peter Ukanga, Mulii Falaremi Olajide, Anthonia Ekanibe Onuorah, Lambert K. Ejionueme, Patrick Ujah, Michael Eskay, Christian S. Ugwuanyi.

Abbreviations: CTI = critical thinking intervention, PSS = perceived stress scale, r = correlation.

How to cite this article: Okide CC, Eseadi C, Ezenwaji IO, Ede MO, Igbo RO, Koledoye UL, Ekwealor NE, Osilike C, Okeke NM, Igwe NJ, Nwachukwu RU, Ukanga LP, Olajide MF, Onuorah AE, Ujah P, Ejionueme LK, Abiogu GC, Eskay M, Ugwuanyi CS. Effect of a critical thinking intervention on stress management among undergraduates of adult education and extramural studies programs. Medicine . 2020;99:35(e21697).

The authors have no conflicts of interest to disclose.

The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.

Relaxation Techniques for Stress Relief

Quick stress relief.

• How to Stop Worrying and End Anxious Thoughts

Stress Relief Guide

Social support for stress relief, 12 ways to reduce stress with music, surviving tough times by building resilience, coping with financial stress.

• Online Therapy: Is it Right for You?
• Mental Health
• Health & Wellness
• Children & Family
• Relationships

Are you or someone you know in crisis?

• Bipolar Disorder
• Eating Disorders
• Grief & Loss
• Personality Disorders
• PTSD & Trauma
• Schizophrenia
• Therapy & Medication
• Exercise & Fitness
• Healthy Eating
• Well-being & Happiness
• Weight Loss
• Work & Career
• Illness & Disability
• Heart Health
• Childhood Issues
• Learning Disabilities
• Family Caregiving
• Teen Issues
• Communication
• Emotional Intelligence
• Love & Friendship
• Domestic Abuse
• Healthy Aging
• Aging Issues
• Alzheimer’s Disease & Dementia
• Senior Housing
• End of Life
• Meet Our Team

What is stress management?

• Identify the causes
• Replace unhealthy coping strategies
• Practice the 4 As

Avoid unnecessary stress

Alter the situation, adapt to the stressor.

• Accept the things you can't change

Move more during your day

• Time management
• Reach out and connect

Make time for fun and relaxation

Maintain balance with a healthy lifestyle.

• Reducing stress in the moment

Stress Management Techniques & Strategies to Deal with Stress

While it may seem like there’s nothing you can do about stress in your life, there are healthy steps you can take to destress and regain control.

It may seem like there’s nothing you can do about stress—no way to avoid it and no way to de-stress completely when it hits. The bills won’t stop coming, there will never be more hours in the day, and your work and family responsibilities will always be demanding. But the truth is, you have a lot more control over stress than you may think. In fact, the simple realization that you’re in control of your life is the foundation of stress management.

Managing stress is all about taking charge: of your thoughts, emotions, schedule, environment, and the way you deal with problems. The ultimate goal is a balanced life, with time for work, relationships, relaxation, and fun—plus the ability to hold up under pressure and meet challenges head on.

Stress management involves using various techniques and coping strategies to improve the way you react to stressful things in your life and build resilience . But it’s not one-size-fits-all. That’s why it’s important to experiment and find out what works best for you. Whether you’re looking to reduce your overall stress levels, avoid unnecessary stressors in your life, or deal with stress in the moment, the following stress management techniques and strategies can help.

Why does stress management matter?

If you’re living with high levels of stress, you’re putting your entire well-being at risk. Stress wreaks havoc on your emotional equilibrium, as well as your overall physical and mental health. It narrows your ability to think clearly, function effectively, and enjoy life.

Identify the causes of stress in your life

Stress management starts with identifying the sources of stress in your life. This isn’t as straightforward as it sounds. While it’s easy to identify major stressors such as changing jobs, moving, or going through a divorce, pinpointing the sources of chronic stress can be more complicated.

It’s all too easy to overlook how your own thoughts, feelings, and behaviors contribute to your everyday stress levels. Sure, you may know that you’re constantly worried about work deadlines, but maybe it’s your procrastination, rather than the actual job demands, that is causing the stress.

To identify what’s really stressing you out, look closely at your habits, attitude, and excuses:

• Do you explain away stress as temporary (“I just have a million things going on right now”) even though you can’t remember the last time you took a breather?
• Do you define stress as an integral part of your work or home life (“Things are always crazy around here”) or as a part of your personality (“I have a lot of nervous energy, that’s all”)?
• Do you blame your stress on other people or outside events, or view it as entirely normal and unexceptional?

Until you accept responsibility for the role you play in creating or maintaining it, your stress level will remain outside your control.

Keep a stress journal

A stress journal can help you identify the regular stressors in your life and the way you deal with them. Each time you feel stressed, make a note of it in your journal or use a stress tracker on your phone. As you keep a daily log, you will begin to see patterns and common themes. Write down:

• What caused your stress (make a guess if you’re unsure).
• How you felt, both physically and emotionally.
• How you acted in response.
• What you did to make yourself feel better.

Replace unhealthy coping strategies with healthy ones

Think about the ways you currently manage and cope with stress in your life. Your stress journal can help you identify them. Are your coping strategies healthy or unhealthy? Many of us cope with stress in ways that make us feel better temporarily—but compound the problem in the long run.

Unhealthy ways of dealing with stress

• Using alcohol or drugs to relax .
• Bingeing on junk or comfort food.
• Zoning out for hours on your phone or TV.
• Withdrawing from friends, family, and social activities.
• Sleeping too much.
• Filling up every minute of the day to avoid facing problems.
• Taking out your stress on others
• Procrastinating.

If your methods of coping with stress aren’t contributing to your greater emotional and physical health, it’s time to find healthier ones. No single method works for everyone or in every situation, so experiment with different stress management techniques and strategies. Focus on what makes you feel calm and in control.

Practice the 4 As of stress management

There are many healthy ways to reduce stress or cope with its effects, but they all require change. You can either change the situation or change your reaction. When deciding which option to choose, it’s helpful to think of the four As: avoid , alter , accept , or adapt .

Not all stress can be avoided, and it’s not healthy to avoid a situation that needs to be addressed. But you may be surprised by the number of stressors in your life that you can eliminate.

Learn how to say “no.” Know your limits and stick to them. Whether in your personal or professional life, taking on more than you can handle is a surefire recipe for stress.

Avoid people who stress you out. If someone consistently causes stress in your life, limit the amount of time you spend with that person, or end the relationship.

Take control of your environment. If the evening news makes you anxious, turn off the TV. If traffic makes you tense, take a longer but less-traveled route. If going to the market is an unpleasant chore, do your grocery shopping online.

Avoid hot-button topics . If you get upset over religion or politics, cross them off your conversation list. If you repeatedly argue about the same subject with the same people, stop bringing it up or excuse yourself when it’s the topic of discussion.

Pare down your to-do list. Analyze your schedule, responsibilities, and daily tasks. If you’ve got too much on your plate, distinguish between the “shoulds” and the “musts.” Drop tasks that aren’t truly necessary to the bottom of the list or eliminate them entirely.

If you can’t avoid a stressful situation, try to alter it. Often, this involves changing the way you communicate and operate in your daily life.

Express your feelings instead of bottling them up. If something or someone is bothering you, communicate your concerns in an open and respectful way. If you don’t voice your feelings, resentment will build and the stress will increase.

Be willing to compromise. When you ask someone to change their behavior, be willing to do the same. If you both are willing to bend at least a little, you’ll have a good chance of finding a happy middle ground.

Be more assertive.  Don’t take a backseat in your own life. Deal with problems head on, doing your best to anticipate and prevent them. If you’ve got an exam to study for and your chatty roommate just got home, say up front that you only have five minutes to talk.

Find balance. All work and no play is a recipe for burnout. Try to find a balance between work and family life, social activities and solitary pursuits, daily responsibilities and downtime.

If you can’t change the stressor, change yourself. You can adapt to stressful situations and regain your sense of control by changing your expectations and attitude.

Reframe problems. Try to view stressful situations from a more positive perspective. Rather than fuming about a traffic jam, look at it as an opportunity to pause and regroup, listen to your favorite radio station, or enjoy some alone time.

Look at the big picture. Take perspective of the stressful situation. Ask yourself how important it will be in the long run. Will it matter in a month? A year? Is it really worth getting upset over? If the answer is no, focus your time and energy elsewhere.

Adjust your standards. Perfectionism is a major source of avoidable stress. Stop setting yourself up for failure by demanding perfection. Set reasonable standards for yourself and others, and learn to be okay with “good enough.”

Practice gratitude. When stress is getting you down, take a moment to reflect on all the things you appreciate in your life , including your own positive qualities and gifts. This simple strategy can help you keep things in perspective.

Accept the things you can’t change

Some sources of stress are unavoidable. You can’t prevent or change stressors such as the death of a loved one, a serious illness, or a national recession. In such cases, the best way to cope with stress is to accept things as they are. Acceptance may be difficult, but in the long run, it’s easier than railing against a situation you can’t change.

Don’t try to control the uncontrollable. Many things in life are beyond our control, particularly the behavior of other people. Rather than stressing out over them, focus on the things you can control such as the way you choose to react to problems.

Look for the upside. When facing major challenges, try to look at them as opportunities for personal growth. If your own poor choices contributed to a stressful situation, reflect on them and learn from your mistakes.

Learn to forgive. Accept the fact that we live in an imperfect world and that people make mistakes. Let go of anger and resentments. Free yourself from negative energy by forgiving and moving on.

Share your feelings. Expressing what you’re going through can be very cathartic, even if there’s nothing you can do to alter the stressful situation. Talk to a trusted friend or make an appointment with a therapist.

Speak to a Licensed Therapist

BetterHelp is an online therapy service that matches you to licensed, accredited therapists who can help with depression, anxiety, relationships, and more. Take the assessment and get matched with a therapist in as little as 48 hours.

When you’re stressed, the last thing you probably feel like doing is getting up and exercising. But physical activity is a huge stress reliever—and you don’t have to be an athlete or spend hours in a gym to experience the benefits. Exercise releases endorphins that make you feel good, and it can also serve as a valuable distraction from your daily worries.

While you’ll get the most benefit from regularly exercising for 30 minutes or more, it’s okay to build up your fitness level gradually. Even very small activities can add up over the course of a day. The first step is to get yourself up and moving. Here are some easy ways to incorporate exercise into your daily schedule:

• Put on some music and dance around.
• Take your dog for a walk .
• Walk or cycle to the grocery store.
• Use the stairs at home or work rather than an elevator.
• Park your car in the farthest spot in the lot and walk the rest of the way.
• Pair up with an exercise partner and encourage each other as you work out.
• Play ping-pong or an activity-based video game with your kids.

Using mindful rhythmic exercise to manage stress

While just about any form of physical activity can help burn away tension and stress, rhythmic activities are especially effective. Good choices include walking, running, swimming, dancing, cycling, tai chi, and aerobics. But whatever you choose, make sure it’s something you enjoy so you’re more likely to stick with it.

While you’re exercising, make a conscious effort to pay attention to your body and the physical (and sometimes emotional) sensations you experience as you’re moving. Focus on coordinating your breathing with your movements, for example, or notice how the air or sunlight feels on your skin. Adding this mindfulness element will help you break out of the cycle of negative thoughts that often accompanies overwhelming stress.

Learn to manage your time better

Poor time management can cause a lot of stress. When you’re stretched too thin and running behind, it’s hard to stay calm and focused. Plus, you’ll be tempted to avoid or cut back on all the healthy things you should be doing to keep stress in check, like socializing and getting enough sleep. The good news: there are things you can do to achieve a healthier work-life balance.

Don’t over-commit yourself. Avoid scheduling things back-to-back or trying to fit too much into one day. All too often, we underestimate how long things will take.

Prioritize tasks. Make a list of tasks you have to do, and tackle them in order of importance. Do the high-priority items first. If you have something particularly unpleasant or stressful to do, get it over with early. The rest of your day will be more pleasant as a result.

Break projects into small steps. If a large project seems overwhelming, make a step-by-step plan. Focus on one manageable step at a time, rather than taking on everything at once.

Delegate responsibility. You don’t have to do it all yourself, whether at home, school, or on the job. If other people can take care of the task, why not let them? Let go of the desire to control or oversee every little step. You’ll be letting go of unnecessary stress in the process.

Reach out and connect to people who make you feel good

There is nothing more calming than spending quality time with another human being who makes you feel safe and understood. In fact, face-to-face interaction triggers a cascade of hormones that counteracts the body’s defensive “fight-or-flight” response. It’s nature’s natural stress reliever (as an added bonus, it also helps stave off depression and anxiety). So make it a point to connect regularly—and in person—with family and friends.

[Read: Social Support for Stress Relief]

Keep in mind that the people you talk to don’t have to be able to fix your stress. They simply need to be good listeners. And try not to let worries about looking weak or being a burden keep you from opening up. The people who care about you will be flattered by your trust. It will only strengthen your bond.

Of course, you may not always have someone close by to lean on when you feel overwhelmed by stress, but by building and maintaining a network of close friends you can improve your resiliency to life’s stressors.

Tips for building relationships

• Reach out to a colleague at work.
• Help someone else by volunteering .
• Have lunch or coffee with a friend.
• Ask a loved one to check in with you regularly.
• Call or email an old friend.
• Go for a walk with a workout buddy.
• Schedule a weekly dinner date.
• Meet new people by taking a class or joining a club.
• Confide in a clergy member, teacher, or sports coach.
• Join a support group—either in-person or via on online therapy platform .

Beyond a take-charge approach and a positive attitude, you can reduce stress in your life by carving out “me” time. Don’t get so caught up in the hustle and bustle of life that you forget to take care of your own needs. Nurturing yourself is a necessity, not a luxury. If you regularly make time for fun and relaxation, you’ll be in a better place to handle life’s stressors.

Set aside leisure time. Include rest and relaxation in your daily schedule. Don’t allow other obligations to encroach. This is your time to take a break from all responsibilities and recharge your batteries.

Do something you enjoy every day. Make time for leisure activities that bring you joy, whether it be stargazing, playing the piano, or working on your bike.

Keep your sense of humor. This includes the ability to laugh at yourself. The act of laughing helps your body fight stress in a number of ways.

Take up a relaxation practice. Relaxation techniques such as yoga, meditation, and deep breathing activate the body’s relaxation response , a state of restfulness that is the opposite of the fight or flight or mobilization stress response. As you learn and practice these techniques, your stress levels will decrease and your mind and body will become calm and centered.

In addition to regular exercise, there are other healthy lifestyle choices that can increase your resistance to stress.

Eat a healthy diet . Well-nourished bodies are better prepared to cope with stress, so be mindful of what you eat. Start your day right with breakfast, and keep your energy up and your mind clear with balanced, nutritious meals throughout the day.

Reduce caffeine and sugar. The temporary “highs” caffeine and sugar provide often end with a crash in mood and energy. By reducing the amount of coffee, soft drinks, chocolate, and sugar snacks in your diet , you’ll feel more relaxed and you’ll sleep better.

Avoid alcohol, cigarettes, and drugs. Self-medicating with alcohol or drugs may provide an easy escape from stress, but the relief is only temporary. Don’t avoid or mask the issue at hand; deal with problems head on and with a clear mind.

Get enough sleep. Adequate sleep fuels your mind, as well as your body. Feeling tired will increase your stress because it may cause you to think irrationally.

Tips for reducing stress in the moment

When you’re frazzled by your morning commute, stuck in a stressful meeting at work, or fried from another argument with your spouse, you need a way to manage your stress levels right now . That’s where quick stress relief comes in.

The fastest way to reduce stress is by taking a deep breath and using your senses—what you see, hear, taste, and touch—or through a soothing movement. By viewing a favorite photo, smelling a specific scent, listening to a favorite piece of music, tasting a piece of gum, or hugging a pet, for example, you can quickly relax and focus yourself.

[Read: Quick Stress Relief]

Of course, not everyone responds to each sensory experience in the same way. The key to quick stress relief is to experiment and discover the unique sensory experiences that work best for you.

More Information

• Special Health Report - Special Health Report from Harvard Medical School on Stress. (Harvard Health)
• Tolerating Distress - Workbook and information sheets to help you manage feelings of distress. (Centre for Clinical Interventions)
• How To Relax (Video) - Video to help you ease stress. (Mind)
• Trauma- and Stressor-Related Disorders. (2013). In Diagnostic and Statistical Manual of Mental Disorders . American Psychiatric Association. Link
• Can, Yekta Said, Heather Iles-Smith, Niaz Chalabianloo, Deniz Ekiz, Javier Fernández-Álvarez, Claudia Repetto, Giuseppe Riva, and Cem Ersoy. “How to Relax in Stressful Situations: A Smart Stress Reduction System.” Healthcare 8, no. 2 (April 16, 2020): 100. Link
• Norelli, Samantha K., Ashley Long, and Jeffrey M. Krepps. “Relaxation Techniques.” In StatPearls . Treasure Island (FL): StatPearls Publishing, 2021. Link
• Toussaint, Loren, Quang Anh Nguyen, Claire Roettger, Kiara Dixon, Martin Offenbächer, Niko Kohls, Jameson Hirsch, and Fuschia Sirois. “Effectiveness of Progressive Muscle Relaxation, Deep Breathing, and Guided Imagery in Promoting Psychological and Physiological States of Relaxation.” Evidence-Based Complementary and Alternative Medicine 2021 (July 3, 2021): e5924040. Link
• Unger, Cynthia A, David Busse, and Ilona S Yim. “The Effect of Guided Relaxation on Cortisol and Affect: Stress Reactivity as a Moderator.” Journal of Health Psychology 22, no. 1 (January 1, 2017): 29–38. Link
• Singh, Karuna. “Nutrient and Stress Management.” Journal of Nutrition & Food Sciences 6, no. 4 (2016). Link
• Katsarou, Alexia L., Marios M. Vryonis, Athanassios D. Protogerou, Evangelos C. Alexopoulos, Apostolos Achimastos, Dimitrios Papadogiannis, George P. Chrousos, and Christina Darviri. “Stress Management and Dietary Counseling in Hypertensive Patients: A Pilot Study of Additional Effect.” Primary Health Care Research & Development 15, no. 1 (January 2014): 38–45. Link
• Errisuriz, Vanessa L., Keryn E. Pasch, and Cheryl L. Perry. “Perceived Stress and Dietary Choices: The Moderating Role of Stress Management.” Eating Behaviors 22 (August 1, 2016): 211–16. Link
• Choi, Dong-Woo, Sung-Youn Chun, Sang Ah Lee, Kyu-Tae Han, and Eun-Cheol Park. “Association between Sleep Duration and Perceived Stress: Salaried Worker in Circumstances of High Workload.” International Journal of Environmental Research and Public Health 15, no. 4 (April 2018): 796. Link
• Blaxton, Jessica M., Cindy S. Bergeman, Brenda R. Whitehead, Marcia E. Braun, and Jessic D. Payne. “Relationships Among Nightly Sleep Quality, Daily Stress, and Daily Affect.” The Journals of Gerontology: Series B 72, no. 3 (May 1, 2017): 363–72. Link
• Saleh, Dalia, Nathalie Camart, Fouad Sbeira, and Lucia Romo. “Can We Learn to Manage Stress? A Randomized Controlled Trial Carried out on University Students.” PLOS ONE 13, no. 9 (September 5, 2018): e0200997. Link
• Loprinzi, Paul D., and Emily Frith. “Protective and Therapeutic Effects of Exercise on Stress-Induced Memory Impairment.” The Journal of Physiological Sciences: JPS 69, no. 1 (January 2019): 1–12. Link
• Salmon, P. “Effects of Physical Exercise on Anxiety, Depression, and Sensitivity to Stress: A Unifying Theory.” Clinical Psychology Review 21, no. 1 (February 2001): 33–61. Link

More in Stress

The power of the relaxation response to reduce stress and boost mood

Using your senses to relieve stress on the spot

How to Stop Worrying

Self-help strategies for anxiety relief

Quick tips for when you’re short on time

Using close relationships to manage stress and improve well-being

Fill your life with music that reduces daily stress

Tips for overcoming adversity

Tips on dealing with money worries

Professional therapy, done online

BetterHelp makes starting therapy easy. Take the assessment and get matched with a professional, licensed therapist.

Help us help others

Millions of readers rely on HelpGuide.org for free, evidence-based resources to understand and navigate mental health challenges. Please donate today to help us save, support, and change lives.

Stress Management: Strategies from Psychology for Better Well-Being

Categories Stress Management

Stress is an inevitable part of everyday life. It often feels like something we can’t avoid–and sometimes it might feel like something we are powerless to do anything about. We know we are going to experience stress, and the truth is that there are times when we can do little to avoid it. What we can do, however, is develop more effective ways of dealing with it. 

The effects of stress on our minds and bodies are difficult to overstate. Our daily lives are filled with challenges and psychological stressors . Work, family, relationships, money, health–it all adds up. And that doesn’t include how we are inundated with other stressors every time we scroll through social media or turn on the news. War, climate change, political upheaval, and social unrest add to our ever-growing list of stress sources. 

Stress is everywhere, so finding effective ways to manage and mitigate it is essential. The good news is that psychologists have found a wealth of stress management strategies to help people deal with the things that trigger their body’s stress response. 

In this article, we’ll explore proven techniques such as deep breathing, meditation, mindfulness, and more, all backed by psychological research. Once equipped with the tools you need, you’ll be better able to tackle stress head-on.

Table of Contents

Deep Breathing

Deep breathing can be such an effective tool for managing stress that some researchers have described it as literally life-changing. It’s a practice deeply rooted in psychology, known for its immediate calming effect.

When we feel stressed and anxious, it triggers the body’s fight-or-flight response. The result is that we tend to take short, quick, shallow breaths. It changes the balance in the body and can ultimately prolong feelings of stress and anxiety.

To combat this, we need to activate the parasympathetic nervous system. This system induces the relaxation response, slowing and calming the mind and body.

You can accomplish this by taking slower, deeper breaths. There are many ways to do this, but abdominal breathing is a good place to start. 

Take a deep breath that causes your ribcage and belly to expand as you inhale. Once you fully inhale, slowly exhale.

Mediation is a practice that can be a valuable tool for managing stress. By meditating, you can achieve a deep state of calm and relaxation.

How exactly does meditation work? It involves fully focusing your attention on the present moment. As you meditate, you focus your mind on your breath. It’s not about clearing or emptying your mind. Instead, it’s about focusing your attention and gently bringing your focus back to your breath if your mind does happen to wander. 

It can help you become more present in the moment and heighten self-awareness. In doing so, you can better understand your stress triggers and reactions, paving the way for more effective stress management strategies.

Meditation can also help enhance emotional resilience. It does this by fostering a non-judgmental and compassionate mindset. 

This means that when you approach a stressful situation, you can do so with a more balanced perspective. The emotions you might normally experience during a stressful situation seem less intense and overwhelming.

Mediation doesn’t just produce short-term effects when it comes to stress management. Time and practice can help your body better regulate the overall stress response. 

You’ll feel more in tune with your emotions and thought patterns, which allows you to take proactive steps to deal with the things that are causing stress in your life. In this way, meditation is a powerful, holistic approach to stress management that can have lasting, positive effects on your overall well-being. It takes time and effort, but the rewards are well worth it.

Mindfulness

You hear a lot about mindfulness these days, but it’s much more than a buzzword; it’s a powerful tool for well-being and stress management with a solid research foundation.  It involves intentionally focusing your attention on the present moment without judgment. 

When you engage in mindfulness, you can gain greater awareness and clarity about your thoughts, emotions, and bodily sensations. This can be very useful when it comes to dealing with stress. Sometimes, the best way to circumvent stress is to figure out what’s causing it, how you’re reacting to it, and what intrusive thoughts you have that might make it worse.

Mindfulness can help you learn to recognize your stress triggers and thought patterns that create anxiety. Once you understand those triggers and thoughts, you can take steps to deal with them.

But mindfulness can also fight stress in other ways. By adopting a less reactive and accepting approach to our experiences, we are less likely to respond to them with feelings of anxiety and stress. Once you do that, you can develop healthier coping strategies.

Regular mindfulness practice is known to lower stress hormones in the body, such as cortisol, leading to improved overall emotional well-being and resilience in the face of life’s challenges. 

Cognitive Behavioral Therapy

Cognitive-behavioral therapy (CBT) is an evidence-based therapeutic approach that can be highly effective for managing stress. CBT operates based on a simple premise:  our thoughts, feelings, and behaviors are all interconnected.

The goal of CBT is to help you identify and change the negative or unrealistic thought patterns that worsen feelings of stress. 

During a CBT session, you’ll work with a therapist to pinpoint the thought patterns and cognitive distortions that are wreaking havoc on your well-being. A therapist then uses a process known as cognitive restructuring to challenge and replace them with more rational and balanced ones.

This can lead to immediate reductions in anxiety, but it can also help you develop coping skills to apply to future situations.

Other benefits of CBT include:

• Boosting problem-solving skills (so you can look for solutions that will reduce stress)
• Realistic goal setting (so you can find manageable ways of achieving things without getting too stressed)
• Emotional regulation skills (so you can feel less overwhelmed in the face of stress)

Learning more about how your thoughts, emotions, and behaviors are connected can help you feel more in control of your life and stress. CBT can be an excellent stress management tool; fortunately, there are plenty of great ways to access it today. 

Traditional face-to-face therapy is one option, but you might also consider online therapy through various online platforms or even mobile apps that allow you to engage in self-directed cognitive behavioral therapy.

Research has also shown that CBT can be an effective tool for managing stress-related mental health conditions, including anxiety, depression, and substance use.

Exercise is obviously great for your physical health, but it can also be a powerful and accessible tool for stress management. When we engage in physical activity, our bodies release endorphins, natural mood lifters that can promote well-being and relaxation. 

You can think of endorphins as your body’s natural stress relievers! They make you feel good and help reduce anxiety and tension. 

Research has even found that exercise can be an effective tool for preventing and treating anxiety.

Regular exercise also helps you:

• Sleep better (critical for managing stress!)
• Release tension (helping you blow off all that pent-up frustration and energy)
• Find a distraction (instead of ruminating and worrying, you can focus on moving your body)

Not only that, regular exercise also improves overall physical health, which, it turns out, is also important for managing stress. When your body is in better condition, you become more resilient to the potentially damaging effects of stress.

Social Support

Human connection is a fundamental need for all people, which is why social support is so important when it comes to managing stress. Research has shown that having a network of friends, loved ones, and other support people can create a sort of buffer against the negative effects of stress.

Talking to people we trust about the things causing us stress can help us understand our emotions and get a better perspective on the situation. During times of stress, we can also turn to others to gain the validation, support, connection, and sometimes help that we need.

Different types of stress require different types of support. Sometimes, we just need a supportive person who is willing to listen. In other cases, we might need someone to help us with everyday tasks or to solve the problems we are having.

 When individuals share their concerns and challenges with trusted confidants, it allows them to vent emotions and gain perspective, which can be highly therapeutic. In times of stress, friends and loved ones often offer encouragement, validation, and a sense of connection, reinforcing one’s sense of belonging and self-worth. This, in turn, can foster emotional resilience, as individuals know they are not facing stressors alone and have a support system to rely on.

Knowing that we can count on others for help when we need it can also provide a sense of security and safety. Stress seems a lot less overwhelming when we feel safe, secure, and supported.

Time Management

Effective time management can also be an important stress management tool, particularly in today’s fast-paced world. If you’re like many people, stress often happens when you feel like you don’t have enough time to do everything you want to do. (Like juggling work, family, relationships, and all the self-care practices we need to do to stay mentally healthy!)

When we learn to prioritize our tasks and allocate our time wisely, we can feel less pressure. Instead of being overwhelmed by looming deadlines, we can look at our goals, break them into manageable chunks, and create reasonable schedules that don’t leave us stressed and overcommitted. 

By managing our time effectively, we can plan our time in ways that minimize last-minute rushing to meet deadlines. It also allows us to give ourselves enough time for what we must and want to do.

In other words, we can create a schedule that gives us time to relax and lead a more balanced, less stressful life.

Time management strategies that can help include the following:

• Skip multitasking (which often creates mental clutter and stress), and try focusing on one task at a time. 
• Prioritize and tackle important tasks when you know you’ll have a clear mind and time to focus.
• Try time blocking , which involves allocating a specific amount of time to work on a specific task.
• Eliminate distractions by ensuring your workplace is comfortable and clear of things that might create mental stress. 

Self-Compassion

Self-compassion involves treating oneself with the same kindness and understanding you would extend to someone else. It can cultivate better mental well-being and be a vital tool for tackling stress.

Compassion for yourself can help undo some of the devasting effects of stress. Instead of criticizing yourself, for example, you might treat yourself with kindness. Rather than being angry with how you did, you might respond in a way that is gentler, less intense, and less stress-invoking.

Self-compassion can also help you foster a more balanced view of stressful situations. Instead of engaging in cognitive distortions, like catastrophizing or using all-or-nothing thinking, you can approach the situation with a more realistic perspective. You’ll also have greater empathy for yourself and others.

When you feel compassion toward yourself, it’s easier to acknowledge that everyone faces difficulties at some point. This way of looking at situations can reduce self-blame and perfectionism, which are common sources of stress. 

Humor is last, but certainly not least, on our list of stress management techniques. Laughter can be a remarkable (and often underappreciated) way of coping with the stress we face each and every day. It has the power to almost instantly boost our mood and mood and change how we perceive stress. 

How? When we laugh, our bodies release endorphins, those natural feel-good chemicals. Endorphins help us feel relaxed and promote a sense of overall well-being. 

This physiological reaction can be a powerful way to counteract the physical and emotional toll stress takes.

Finding humor can also be a way to take a mental break from our stressors. After all, it’s hard to feel worried or anxious when you are laughing. By creating a distance from our worries, we can return to the problem with a fresher, less reactive perspective.

Humor can also create a sort of buffer against stress. Sharing a laugh with friends, family, or colleagues can strengthen those social bonds that are so critical to mental wellness. It can create stronger bonds and a greater resilience to adversity. 

Laughing and finding humor in situations can help help you to develop a more positive mindset. When we feel optimistic about life, we are less likely to be affected by stressful situations. 

Fortunately, there are plenty of ways to bring humor into your life, whether you enjoy reading humourous stories, watching comedies, or just hanging out with a friend who brings out your more lighthearted, humorous side.

The Bottom Line

In our modern, fast-paced world, stress management is not a luxury but a necessity for maintaining mental and physical health. The field of psychology offers a treasure trove of strategies and techniques, each backed by research and designed to improve overall well-being. Making these stress management practices a part of your regular self-care routine allows you to face stress head-on, leading to a healthier, happier, and more fulfilling life.

Allen AB, Leary MR. Self-compassion, stress, and coping . Soc Personal Psychol Compass . 2010;4(2):107-118. doi:10.1111/j.1751-9004.2009.00246.x

Kandola A, Stubbs B. Exercise and anxiety . Adv Exp Med Biol . 2020;1228:345-352. doi:10.1007/978-981-15-1792-1_23

León-Pérez JM, Cantero-Sánchez FJ, Fernández-Canseco Á, León-Rubio JM. Effectiveness of a humor-based training for reducing employees’ distress . Int J Environ Res Public Health . 2021;18(21):11177. doi:10.3390/ijerph182111177

Nakao M, Shirotsuki K, Sugaya N. Cognitive-behavioral therapy for management of mental health and stress-related disorders: Recent advances in techniques and technologies . Biopsychosoc Med . 2021;15(1):16. doi:10.1186/s13030-021-00219-w

Zaccaro A, Piarulli A, Laurino M, et al. How breath-control can change your life: A systematic review on psycho-physiological correlates of slow breathing . Front Hum Neurosci . 2018;12:353. doi:10.3389/fnhum.2018.00353

• Bipolar Disorder
• Therapy Center
• When To See a Therapist
• Types of Therapy
• Best Online Therapy
• Best Couples Therapy
• Best Family Therapy
• Managing Stress
• Sleep and Dreaming
• Understanding Emotions
• Self-Improvement
• Healthy Relationships
• Student Resources
• Personality Types
• Guided Meditations
• Verywell Mind Insights
• 2024 Verywell Mind 25
• Mental Health in the Classroom
• Editorial Process
• Meet Our Review Board
• Crisis Support
• Signs of Burnout
• Stress and Weight Gain
• Stress Reduction Tips
• Self-Care Practices
• Mindful Living

18 Effective Stress Relief Strategies

How to Relieve Stress Now and in the Future

Elizabeth Scott, PhD is an author, workshop leader, educator, and award-winning blogger on stress management, positive psychology, relationships, and emotional wellbeing.

Rachel Goldman, PhD FTOS, is a licensed psychologist, clinical assistant professor, speaker, wellness expert specializing in eating behaviors, stress management, and health behavior change.

• Short-Term Strategies
• Long-Term Strategies
• Problem-Focused Coping
• Next in How Stress Impacts Your Health Guide 5 Types of Self-Care for Every Area of Your Life

From minor challenges to major crises, stress is part of life. And while you can't always control your circumstances, you can control how you respond to them. When stress becomes overwhelming or chronic, it can affect your well-being. That's why it's essential to have effective stress relievers that can calm your mind and body. 

Some effective stress management techniques include:

• Guided imagery
• Progressive muscle relaxation
• Deep breathing
• Going for a walk
• Aromatherapy
• Healthy diet
• Stress relief supplements
• Leisure activities
• Positive self-talk
• Evaluating priorities
• Social support
• Eliminating stressors

Highly Effective Tips for Relieving Stress

There isn't a one-size-fits-all option when it comes to stress relief, however. What works for one person might not work for another.

And what works for you at home might not be an option when you're at work or in the community (dancing around your living room might be helpful but dancing in the grocery store might not be). 

So it's important to have a variety of stress relief tools at your disposal. Then, you'll be able to pick a strategy that works best for your current circumstances. 

Fast-Acting Stress Relief Strategies

What strategies can relieve stress fast? A number of helpful techniques, such as deep breathing and meditation, are fast-acting tools that you can do anywhere, anytime.

Whether you're about to be interviewed for a job or you're feeling overwhelmed by your child's behavior at the playground, it's important to have some stress reduction tools that can lower your stress right now.

The best short-term strategies:

• Can be performed anywhere
• Take very little practice to master
• Provide immediate relief

Try Guided Imagery

Guided imagery is like taking a short vacation in your mind. It can involve imagining yourself being in your "happy place"—maybe picturing yourself sitting on a beach, listening to the waves, smelling the ocean, and feeling the warm sand underneath you.

Guided imagery can be done with a recording where you listen to someone walk you through a peaceful scene. Or, once you know how to do it yourself, you can practice guided imagery on your own. 

Simply close your eyes for a minute and walk yourself through a peaceful scene. Think about all the sensory experiences you engage in and allow yourself to feel like you're really there. After a few minutes, open your eyes and return to the present moment.

Meditation brings short-term stress relief as well as lasting stress management benefits. There are many different forms of meditation to try–each one is unique and brings its own appeal.

You might develop a mantra that you repeat in your mind as you take slow deep breaths. Or, you might take a few minutes to practice mindfulness, which involves being in the moment. Simply pay attention to what you see, hear, taste, touch, and smell.

When you're focused on the here-and-now, you won't be able to ruminate about something that already happened and you can't worry about something in the future. Meditation and mindfulness take practice, but it can make a big difference in your overall stress level as it brings you back to the present.

Practice Progressive Muscle Relaxation

Progressive muscle relaxation involves relaxing all the muscles in your body, group by group. To practice, you can start with a few deep breaths.

Then, practice tightening and relaxing each muscle group, starting with your forehead and moving down to your toes. 

With practice, you'll learn to recognize tension and tightness in your muscles and you'll be able to relax more easily. Each time you practice, however, you should experience a feeling of relaxation sweeping through your body. 

Focus on Breathing

Just focusing on your breath or changing the way you breathe can make a big difference to your overall stress level. Breathing techniques can calm your body and your brain in just a few minutes.

The best news is that no one around you will know you're doing them. So whether you're in a stressful meeting or you're sitting in a crowded theater, breathing exercises could be key to reducing your stress.  

While there are many different breathing exercises, like karate breathing , a few simple ones include:

• Breathe in through your nose and watch your belly fill with air. Count slowly to three as you inhale. Hold for one second, and then slowly breathe out through your nose as you count to three again.
• Breathe in through your nose and imagine that you're inhaling peaceful, calm air. Imagine that air spreading throughout your body. As you exhale, imagine that you're breathing out stress and tension. 

Take a Walk

Exercise is a fantastic stress reliever that can work in minutes. Taking a walk allows you to enjoy a change of scenery, which can get you into a different frame of mind, and brings the benefits of exercise as well.

So whether you just need to take a stroll around the office to get a break from a frustrating task or you decide to go for a long walk in the park after work, walking is a simple but effective way to rejuvenate your mind and body.

Get a Hug From a Loved One

Physical touch can do a lot to relieve your stress. Hugging a loved one can be especially beneficial.

When you hug someone, oxytocin (also known as the "cuddle hormone") is released. Oxytocin is associated with higher levels of happiness and lower levels of stress.

Oxytocin also causes a reduction in blood pressure. It reduces the stress hormone norepinephrine and can produce a sense of relaxation. 

So don't be afraid to ask a loved one for a hug if you need it. It's good for both of you and it can be one of the simplest forms of stress relief available.

Enjoy Aromatherapy

Aromatherapy has real benefits for stress relief—it can help you to feel energized, more relaxed, or more present in the moment.

Emerging research suggests certain scents can alter brain wave activity and decrease stress hormones in the body.

So whether you enjoy candles, diffusers, or body products, consider incorporating some aromatherapy into your day. 

Create Artwork

Getting in touch with your creative side may have been easy for you during childhood, but it's not too late to pick it up again if you’ve lost touch with your penchant for artwork.

If you aren't into drawing or painting, consider coloring in a coloring book. Adult coloring books have risen in popularity, and for good reason—coloring can be a great stress reliever.

Research consistently shows that coloring can have a meditative effect. One study found that anxiety levels decline in people who were coloring complex geometric patterns, making it a perfect outlet for stress reduction.

Long-Term Stress Relief Strategies

What can you do to calm mental stress over the long term? Certain habits can promote resilience to stress and increase overall wellness. For example, those who  exercise  or meditate regularly tend to become less stressed in the face of a difficult challenge.

So it's important to create a lifestyle that will help you ward off stress and deal with challenges in a healthy way. 

Eat a Balanced Diet

A poor diet can bring greater reactivity toward stress.  Emotional eating and reaching for high-fat, high-sugar foods can provide a temporary sense of relief that adds to your long-term stress.

Refined carbs, like cookies and potato chips, can cause a spike in blood sugar. When your blood sugar crashes, you might experience more stress and anxiety.

Consuming a healthy diet can help you combat stress over the long haul. Foods like eggs, avocado, and walnuts support mood regulation and energy balance. 

Try Stress Relief Supplements

Some vitamins and supplements may have benefits for stress relief. What vitamins help with stress? A daily multivitamin may help address nutritional deficits and ensure you get the necessary vitamins and minerals to feel your best. Other supplements that may help relieve stress include:

• Melatonin : This natural hormone can help regulate your body's circadian rhythm. Improving sleep can help you feel less stressed.
• Ashwagandha : This adaptogenic herb is thought to help improve the body's resilience to mental and physical stress.
• L-theanine : This amino acid has been shown to help reduce stress, promote relaxation, and improve sleep quality.
• B vitamins : Some research indicates that B vitamins may help lower homocysteine levels, reduce stress, and improve mood.

Make Time for Leisure Activities

Leisure activities can be a wonderful way to relieve stress. Yet, many people feel as though their lives are too busy for hobbies, games, or extra fun.

But building time for leisure into your schedule could be key to helping you feel your best. And when you feel better, you'll perform better, which means leisure time may make your work time more efficient.

Whether you find joy in caring for a garden or you like making quilts, hobbies and leisure are key to living your best life.

Develop a Positive Self-Talk Habit

The way you talk to yourself matters. Harsh self-criticism, self-doubt, and catastrophic predictions aren't helpful. If you're constantly thinking things like, "I don't have time for this," and "I can't stand this," you'll stress yourself out.

It's important to learn to talk to yourself in a more realistic, compassionate manner. When you call yourself names or doubt your ability to succeed, reply with a kinder inner dialogue.

Positive self-talk can help you develop a healthier outlook. And an optimistic and compassionate conversation can help you manage your emotions and take positive action. 

Practice Yoga

Yoga combines physical movement, meditation, light exercise, and controlled breathing—all of which provide excellent stress relief.

And while you're likely to reap immediate benefits from a single yoga session, you're likely to receive long-term benefits if you incorporate it into your life in a consistent way. 

Yoga offers a variety of physical, psychological, and spiritual benefits. To get started, you might take a class, enroll in an online program, or use an app to help you begin practicing.

Express Gratitude

Gratitude helps you recognize all the things you have to be thankful for. Whether you're grateful for a sunny day or thankful you arrived at work safely, think about all the good things you have in life.

Gratitude also reminds you of all of the resources you have to cope with stress, which can be quite empowering. 

Studies  also show grateful people enjoy better mental health, lower stress, and a better quality of life.

So whether you decide to make it a habit to identify what you're grateful for as you sit around the dinner table or you decide to write down three things you're grateful for in a gratitude journal every day, make gratitude a regular habit. 

Prioritize Exercise

Physical activity is key to managing stress and improving mental health. And the best news is, there are many different kinds of activities that can reduce your stress.

Join a gym, take a class, or exercise outside. Keep in mind that there are many different ways to get more physical activity in your day too.

Walking, strength training, kayaking, hiking, and spin class are just a few different examples of ways you can get stress relief.

Problem-Focused Coping Stress Relief.

Most stress relievers focus on changing your emotions. But sometimes, you won't necessarily get relief until you change the environment. 

This is referred to as problem-focused coping (as opposed to emotion-focused coping ). Problem-focused coping involves taking steps to remove the stressor from your life (as opposed to changing how you feel about the stressor).

Reassess Your To-Do Lists

If you're trying to squeeze 20 hours worth of work into 16 hours, you're going to feel stressed. Reducing your workload could be key to helping you get through the day feeling better.

Whether that means stepping away from a committee you joined or it involves hiring someone to complete some of your household chores for you, 

Honing your time management skills can allow you to minimize the stressors that you experience, and better manage the ones you can't avoid.

When you are able to complete everything on your "to do" list without the stress of rushing or forgetting, your whole life feels easier.

Obtain Social Support

Having supportive people in your life is the key to stress management. If you lack emotional support and friendship, it's important to get it.

That may mean reaching out to your existing network. Perhaps confiding in a family member or distant friend can help you become closer and it may give you the social support you need.

You may also need to expand your network. Join an organization, attend a support group, or get professional help if you lack supportive people in your life. 

Cut out Things That Add to Your Stress

Sometimes, the best way to reduce your stress is to cut something out of your life. Get rid of the things that are adding to your stress so you can experience more peace. 

Watching the news, being constantly connected to your digital devices, drinking alcohol, and consuming too much caffeine are just a few of the things that may add more stress to your life. Making some changes to your daily habits could be instrumental in helping you feel better.

A Word From Verywell

Finding the best stress relief strategies may take some experimenting. Some strategies may take practice too.

But it's important to keep looking for the tools that will help you manage life's inevitable ups and downs in a healthy way. Keeping stress at a manageable level is important for your overall well-being.

Jallo N, Ruiz RJ, Elswick RK, French E. Guided imagery for stress and symptom management in pregnant African American women. Evid Based Complement Alternat Med . 2014;2014:840923. doi:10.1155/2014/840923

Burke A, Lam CN, Stussman B, Yang H. Prevalence and patterns of use of mantra, mindfulness and spiritual meditation among adults in the United States . BMC Complement Altern Med . 2017;17(1):316.  doi:10.1186/s12906-017-1827-8

Novais PG, Batista Kde M, Grazziano Eda S, Amorim MH. The effects of progressive muscular relaxation as a nursing procedure used for those who suffer from stress due to multiple sclerosis. Rev Lat Am Enfermagem . 2016;24:e2789.  doi:10.1590/1518-8345.1257.2789

Russo MA, Santarelli DM, O'rourke D. The physiological effects of slow breathing in the healthy human . Breathe (Sheff) . 2017;13(4):298-309. doi:10.1183/20734735.009817

Ma X, Yue ZQ, Gong ZQ, et al. The effect of diaphragmatic breathing on attention, negative affect and stress in healthy adults. Front Psychol . 2017;8:874.  doi:10.3389/fpsyg.2017.00874

Sharma A, Madaan V, Petty FD. Exercise for mental health. Prim Care Companion J Clin Psychiatry . 2006;8(2):106.

Uvnäs-moberg K, Handlin L, Petersson M. Self-soothing behaviors with particular reference to oxytocin release induced by non-noxious sensory stimulation . Front Psychol . 2014;5:1529. doi:10.3389/fpsyg.2014.01529

Sowndhararajan K, Kim S. Influence of Fragrances on Human Psychophysiological Activity: With Special Reference to Human Electroencephalographic Response. Sci Pharm . 2016;84(4):724-751.  doi:10.3390/scipharm84040724

Burke A, Lam CN, Stussman B, Yang H. Prevalence and patterns of use of mantra, mindfulness and spiritual meditation among adults in the United States. BMC Complement Altern Med . 2017;17(1):316. doi:10.1186/s12906-017-1827-8

Nguyen-rodriguez ST, Unger JB, Spruijt-metz D. Psychological determinants of emotional eating in adolescence. Eat Disord . 2009;17(3):211-24. doi:10.1080/10640260902848543

Sanford LD, Suchecki D, Meerlo P. Stress, arousal, and sleep . Curr Top Behav Neurosci . 2015;25:379-410. doi:10.1007/7854_2014_314

Lopresti AL, Smith SJ, Malvi H, Kodgule R. An investigation into the stress-relieving and pharmacological actions of an ashwagandha (Withania somnifera) extract: A randomized, double-blind, placebo-controlled study . Medicine (Baltimore) . 2019;98(37):e17186. doi:10.1097/MD.0000000000017186

Baba Y, Inagaki S, Nakagawa S, Kaneko T, Kobayashi M, Takihara T. Effects of l-theanine on cognitive function in middle-aged and older subjects: A randomized placebo-controlled study . J Med Food . 2021;24(4):333-341. doi:10.1089/jmf.2020.4803

Young LM, Pipingas A, White DJ, Gauci S, Scholey A. A systematic review and meta-analysis of B vitamin supplementation on depressive symptoms, anxiety, and stress: Effects on healthy and 'at-risk' individuals . Nutrients . 2019;11(9):2232. doi:10.3390/nu11092232

Qian XL, Yarnal CM, Almeida DM. Does leisure time moderate or mediate the effect of daily stress on positive affect? An examination using eight-day diary data. J Leis Res . 2014;46(1):106-124.

Francis AL, Beemer RC. How does yoga reduce stress? Embodied cognition and emotion highlight the influence of the musculoskeletal system. Complement Ther Med . 2019;43:170-175.  doi:10.1016/j.ctim.2019.01.024

Wunsch K, Wurst R, Von dawans B, Strahler J, Kasten N, Fuchs R. Habitual and acute exercise effects on salivary biomarkers in response to psychosocial stress. Psychoneuroendocrinology . 2019;106:216-225. doi:10.1016/j.psyneuen.2019.03.015

Armstrong K, Dixon S, May S, Patricolo GE. Anxiety reduction in patients undergoing cardiac catheterization following massage and guided imagery .  Complementary Therapies in Clinical Practice . 2014;20(4):334-338.

Lee M-K, Lim S, Song J-A, Kim M-E, Hur M-H. The effects of aromatherapy essential oil inhalation on stress, sleep quality and immunity in healthy adults: Randomized controlled trial .  European Journal of Integrative Medicine . 2017;12:79-86.

Light KC, Grewen KM, Amico JA. More frequent partner hugs and higher oxytocin levels are linked to lower blood pressure and heart rate in premenopausal women .  Biological Psychology . 2005;69(1):5-21.

Nakata A, Takahashi M, Irie M, Ray T, Swanson NG. Job Satisfaction, Common Cold, and Sickness Absence among White-collar Employees: A Cross-sectional Survey.  Industrial Health , September 2010.

Wilson C. Neurons linking breathing and stress found .  New Scientist . 2017;234(3120):16.

By Elizabeth Scott, PhD Elizabeth Scott, PhD is an author, workshop leader, educator, and award-winning blogger on stress management, positive psychology, relationships, and emotional wellbeing.

Mental Health at Cornell

Resources for student & campus wellbeing, stress management strategies.

Stress Management

Stress is an automatic response to demands, pressures, and/or competing priorities. Stress is a normal part of life. Not all stress is bad. Some stress can motivate people and help them focus on achieving their goals. But too much stress, or stress carried too long, can activate a person’s “fight or flight” response, which, if left unchecked, can decrease their ability to function. Importantly, people’s responses to stress vary.

The x axis is depicting the continuum of stress from a low level of stress to a high level of stress and the y axis is depicting the continuum of performance, from a low level of performance to a high level of performance.

The graph shows that a low to moderate level of stress (represented by the green zone on the graph) can be productive. Students in this green zone experience low to moderate levels of stress as motivating and can help them focus on what they have to get done. To stay in this green, healthy tension zone, people can manage their stress with activities that replenish the physical, mental, and emotional energy lost to stress.

Peak performance is when someone is at their very best: they are feeling energized, grounded, and focused on the important task at hand like taking an exam, giving a presentation, or having an important conversation with someone. Peak performance is time limited, and can be achieved when you have a manageable amount of stress that acts as a motivator. Once the task is completed, it is important to take a break and do something less intense or something that helps to replenish your energy and reduce the level of stress bringing you back into the green, healthy tension zone.

The yellow zone of the stress continuum represents the point of diminishing returns when someone has been carrying stress for too long, or attempting to stay at peak performance and continuing pushing forward without taking purposeful, restorative breaks. A person in this yellow zone may think they are working efficiently but actually their performance level is declining and they feel fatigued or out of balance or they may even start to feel overwhelmed by what they need to get done.

Too much stress, or stress carried for too long, can push someone into the orange or red zones of the stress continuum which is where someone is experiencing anxiety, exhaustion and burn out because their level of stress is too high.

Causes of distress

In general, distress occurs when the amount of stress exceeds the resources (both internal and external) one has to handle it. Most distress comes from the actual or perceived loss of important mental health elements (e.g., connection, status, health, meaning, control, identity). A person’s level of internal and external resources for coping varies widely based on personality, mindset, level of privilege and oppression, and cultural factors. For one student, a failing paper grade may be brushed off, while for another, a failing paper grade may be experienced as threatening their sense of self-worth, compromising access to financial aid, or bringing shame/embarrassment on their family. How distress appears on the surface can vary greatly between people. You may notice one or more signs and decide that something is clearly wrong. Or you may just have a “gut feeling” that something’s amiss. Either way, you should take these signs – and your intuition – seriously. Stress Management Tips  

• Take care of yourself: Prioritize sleep. Eat nutritious foods each day. Get some regular exercise. Create a routine of regular self-care practices that work for you.
• Connect with others : Having a strong social support network made up of friends and family members helps to buffer against stress.
• For undergraduate students: Cornell’s Learning Strategies Center is an excellent resource for learning to be more organized and efficient with the time you have.
• Let go of perfectionism : No one hits it out of the ballpark every time. We’re all human. Try to be understanding with yourself as you would be with a friend or colleague.
• Be mindful of social media : Social media can help us keep in touch with people near and far, but it can also cause frustration, procrastination, and it’s easy to lose track of time while using social media. Consider limiting your time spent on social media.
• Keep things in perspective : Ask yourself - what’s the worst thing that could happen? And what is the likelihood of that happening? Remember, no matter how bad (or good) things are right now, the only constant is change. 
• Reframe negative thoughts : Learn to talk back to and stop negative self-talk, and give yourself some credit for your abilities and accomplishments. Learn from mistakes and view them as opportunities for growth.
• Get out in nature: Research shows that spending even short periods of time in nature can improve memory, ability to concentrate, and reduce overall stress and improve your sense of well-being. Explore the Cornell Botanic Gardens or find a new spot using naturerx.cornell.edu
• 5-minute stress busters
• Study Breaks & Stress Busters

How it works

For Business

Join Mind Tools

Article • 8 min read

Critical Thinking

Developing the right mindset and skills.

By the Mind Tools Content Team

We make hundreds of decisions every day and, whether we realize it or not, we're all critical thinkers.

We use critical thinking each time we weigh up our options, prioritize our responsibilities, or think about the likely effects of our actions. It's a crucial skill that helps us to cut out misinformation and make wise decisions. The trouble is, we're not always very good at it!

In this article, we'll explore the key skills that you need to develop your critical thinking skills, and how to adopt a critical thinking mindset, so that you can make well-informed decisions.

What Is Critical Thinking?

Critical thinking is the discipline of rigorously and skillfully using information, experience, observation, and reasoning to guide your decisions, actions, and beliefs. You'll need to actively question every step of your thinking process to do it well.

Collecting, analyzing and evaluating information is an important skill in life, and a highly valued asset in the workplace. People who score highly in critical thinking assessments are also rated by their managers as having good problem-solving skills, creativity, strong decision-making skills, and good overall performance. [1]

Key Critical Thinking Skills

Critical thinkers possess a set of key characteristics which help them to question information and their own thinking. Focus on the following areas to develop your critical thinking skills:

Being willing and able to explore alternative approaches and experimental ideas is crucial. Can you think through "what if" scenarios, create plausible options, and test out your theories? If not, you'll tend to write off ideas and options too soon, so you may miss the best answer to your situation.

To nurture your curiosity, stay up to date with facts and trends. You'll overlook important information if you allow yourself to become "blinkered," so always be open to new information.

But don't stop there! Look for opposing views or evidence to challenge your information, and seek clarification when things are unclear. This will help you to reassess your beliefs and make a well-informed decision later. Read our article, Opening Closed Minds , for more ways to stay receptive.

Logical Thinking

You must be skilled at reasoning and extending logic to come up with plausible options or outcomes.

It's also important to emphasize logic over emotion. Emotion can be motivating but it can also lead you to take hasty and unwise action, so control your emotions and be cautious in your judgments. Know when a conclusion is "fact" and when it is not. "Could-be-true" conclusions are based on assumptions and must be tested further. Read our article, Logical Fallacies , for help with this.

Use creative problem solving to balance cold logic. By thinking outside of the box you can identify new possible outcomes by using pieces of information that you already have.

Self-Awareness

Many of the decisions we make in life are subtly informed by our values and beliefs. These influences are called cognitive biases and it can be difficult to identify them in ourselves because they're often subconscious.

Practicing self-awareness will allow you to reflect on the beliefs you have and the choices you make. You'll then be better equipped to challenge your own thinking and make improved, unbiased decisions.

One particularly useful tool for critical thinking is the Ladder of Inference . It allows you to test and validate your thinking process, rather than jumping to poorly supported conclusions.

Developing a Critical Thinking Mindset

Combine the above skills with the right mindset so that you can make better decisions and adopt more effective courses of action. You can develop your critical thinking mindset by following this process:

Gather Information

First, collect data, opinions and facts on the issue that you need to solve. Draw on what you already know, and turn to new sources of information to help inform your understanding. Consider what gaps there are in your knowledge and seek to fill them. And look for information that challenges your assumptions and beliefs.

Be sure to verify the authority and authenticity of your sources. Not everything you read is true! Use this checklist to ensure that your information is valid:

• Are your information sources trustworthy ? (For example, well-respected authors, trusted colleagues or peers, recognized industry publications, websites, blogs, etc.)
• Is the information you have gathered up to date ?
• Has the information received any direct criticism ?
• Does the information have any errors or inaccuracies ?
• Is there any evidence to support or corroborate the information you have gathered?
• Is the information you have gathered subjective or biased in any way? (For example, is it based on opinion, rather than fact? Is any of the information you have gathered designed to promote a particular service or organization?)

If any information appears to be irrelevant or invalid, don't include it in your decision making. But don't omit information just because you disagree with it, or your final decision will be flawed and bias.

Now observe the information you have gathered, and interpret it. What are the key findings and main takeaways? What does the evidence point to? Start to build one or two possible arguments based on what you have found.

You'll need to look for the details within the mass of information, so use your powers of observation to identify any patterns or similarities. You can then analyze and extend these trends to make sensible predictions about the future.

To help you to sift through the multiple ideas and theories, it can be useful to group and order items according to their characteristics. From here, you can compare and contrast the different items. And once you've determined how similar or different things are from one another, Paired Comparison Analysis can help you to analyze them.

The final step involves challenging the information and rationalizing its arguments.

Apply the laws of reason (induction, deduction, analogy) to judge an argument and determine its merits. To do this, it's essential that you can determine the significance and validity of an argument to put it in the correct perspective. Take a look at our article, Rational Thinking , for more information about how to do this.

Once you have considered all of the arguments and options rationally, you can finally make an informed decision.

Afterward, take time to reflect on what you have learned and what you found challenging. Step back from the detail of your decision or problem, and look at the bigger picture. Record what you've learned from your observations and experience.

Critical thinking involves rigorously and skilfully using information, experience, observation, and reasoning to guide your decisions, actions and beliefs. It's a useful skill in the workplace and in life.

You'll need to be curious and creative to explore alternative possibilities, but rational to apply logic, and self-aware to identify when your beliefs could affect your decisions or actions.

You can demonstrate a high level of critical thinking by validating your information, analyzing its meaning, and finally evaluating the argument.

Critical Thinking Infographic

See Critical Thinking represented in our infographic: An Elementary Guide to Critical Thinking .

You've accessed 1 of your 2 free resources.

Get unlimited access

Discover more content

Book Insights

Work Disrupted: Opportunity, Resilience, and Growth in the Accelerated Future of Work

Jeff Schwartz and Suzanne Riss

Zenger and Folkman's 10 Fatal Leadership Flaws

Avoiding Common Mistakes in Leadership

Add comment

Comments (1)

priyanka ghogare

Sign-up to our newsletter

Subscribing to the Mind Tools newsletter will keep you up-to-date with our latest updates and newest resources.

Subscribe now

Business Skills

Personal Development

Leadership and Management

Member Extras

Most Popular

Latest Updates

Pain Points Podcast - Presentations Pt 2

NEW! Pain Points - How Do I Decide?

Mind Tools Store

About Mind Tools Content

Discover something new today

Finding the Best Mix in Training Methods

Using Mediation To Resolve Conflict

Resolving conflicts peacefully with mediation

How Emotionally Intelligent Are You?

Boosting Your People Skills

Self-Assessment

What's Your Leadership Style?

Learn About the Strengths and Weaknesses of the Way You Like to Lead

Recommended for you

Developing personal accountability.

Taking Responsibility to Get Ahead

Business Operations and Process Management

Strategy Tools

Customer Service

Business Ethics and Values

Handling Information and Data

Project Management

Knowledge Management

Self-Development and Goal Setting

Time Management

Presentation Skills

Learning Skills

Career Skills

Communication Skills

Negotiation, Persuasion and Influence

Working With Others

Difficult Conversations

Creativity Tools

Self-Management

Work-Life Balance

Stress Management and Wellbeing

Coaching and Mentoring

Change Management

Team Management

Managing Conflict

Delegation and Empowerment

Performance Management

Leadership Skills

Developing Your Team

Talent Management

Problem Solving

Decision Making

Member Podcast

• Search Menu
• Sign in through your institution
• Browse content in Arts and Humanities
• Browse content in Archaeology
• Anglo-Saxon and Medieval Archaeology
• Archaeological Methodology and Techniques
• Archaeology by Region
• Archaeology of Religion
• Archaeology of Trade and Exchange
• Biblical Archaeology
• Contemporary and Public Archaeology
• Environmental Archaeology
• Historical Archaeology
• History and Theory of Archaeology
• Industrial Archaeology
• Landscape Archaeology
• Mortuary Archaeology
• Prehistoric Archaeology
• Underwater Archaeology
• Zooarchaeology
• Browse content in Architecture
• Architectural Structure and Design
• History of Architecture
• Residential and Domestic Buildings
• Theory of Architecture
• Browse content in Art
• Art Subjects and Themes
• History of Art
• Industrial and Commercial Art
• Theory of Art
• Biographical Studies
• Byzantine Studies
• Browse content in Classical Studies
• Classical History
• Classical Philosophy
• Classical Mythology
• Classical Literature
• Classical Reception
• Classical Art and Architecture
• Classical Oratory and Rhetoric
• Greek and Roman Epigraphy
• Greek and Roman Law
• Greek and Roman Archaeology
• Greek and Roman Papyrology
• Late Antiquity
• Religion in the Ancient World
• Digital Humanities
• Browse content in History
• Colonialism and Imperialism
• Diplomatic History
• Environmental History
• Genealogy, Heraldry, Names, and Honours
• Genocide and Ethnic Cleansing
• Historical Geography
• History by Period
• History of Agriculture
• History of Education
• History of Emotions
• History of Gender and Sexuality
• Industrial History
• Intellectual History
• International History
• Labour History
• Legal and Constitutional History
• Local and Family History
• Maritime History
• Military History
• National Liberation and Post-Colonialism
• Oral History
• Political History
• Public History
• Regional and National History
• Revolutions and Rebellions
• Slavery and Abolition of Slavery
• Social and Cultural History
• Theory, Methods, and Historiography
• Urban History
• World History
• Browse content in Language Teaching and Learning
• Language Learning (Specific Skills)
• Language Teaching Theory and Methods
• Browse content in Linguistics
• Applied Linguistics
• Cognitive Linguistics
• Computational Linguistics
• Forensic Linguistics
• Grammar, Syntax and Morphology
• Historical and Diachronic Linguistics
• History of English
• Language Acquisition
• Language Variation
• Language Families
• Language Evolution
• Language Reference
• Lexicography
• Linguistic Theories
• Linguistic Typology
• Linguistic Anthropology
• Phonetics and Phonology
• Psycholinguistics
• Sociolinguistics
• Translation and Interpretation
• Writing Systems
• Browse content in Literature
• Bibliography
• Children's Literature Studies
• Literary Studies (Asian)
• Literary Studies (European)
• Literary Studies (Eco-criticism)
• Literary Studies (Modernism)
• Literary Studies (Romanticism)
• Literary Studies (American)
• Literary Studies - World
• Literary Studies (1500 to 1800)
• Literary Studies (19th Century)
• Literary Studies (20th Century onwards)
• Literary Studies (African American Literature)
• Literary Studies (British and Irish)
• Literary Studies (Early and Medieval)
• Literary Studies (Fiction, Novelists, and Prose Writers)
• Literary Studies (Gender Studies)
• Literary Studies (Graphic Novels)
• Literary Studies (History of the Book)
• Literary Studies (Plays and Playwrights)
• Literary Studies (Poetry and Poets)
• Literary Studies (Postcolonial Literature)
• Literary Studies (Queer Studies)
• Literary Studies (Science Fiction)
• Literary Studies (Travel Literature)
• Literary Studies (War Literature)
• Literary Studies (Women's Writing)
• Literary Theory and Cultural Studies
• Mythology and Folklore
• Shakespeare Studies and Criticism
• Browse content in Media Studies
• Browse content in Music
• Applied Music
• Dance and Music
• Ethics in Music
• Ethnomusicology
• Gender and Sexuality in Music
• Medicine and Music
• Music Cultures
• Music and Religion
• Music and Culture
• Music and Media
• Music Education and Pedagogy
• Music Theory and Analysis
• Musical Scores, Lyrics, and Libretti
• Musical Structures, Styles, and Techniques
• Musicology and Music History
• Performance Practice and Studies
• Race and Ethnicity in Music
• Sound Studies
• Browse content in Performing Arts
• Browse content in Philosophy
• Aesthetics and Philosophy of Art
• Epistemology
• Feminist Philosophy
• History of Western Philosophy
• Metaphysics
• Moral Philosophy
• Non-Western Philosophy
• Philosophy of Science
• Philosophy of Action
• Philosophy of Law
• Philosophy of Religion
• Philosophy of Language
• Philosophy of Mind
• Philosophy of Perception
• Philosophy of Mathematics and Logic
• Practical Ethics
• Social and Political Philosophy
• Browse content in Religion
• Biblical Studies
• Christianity
• East Asian Religions
• History of Religion
• Judaism and Jewish Studies
• Qumran Studies
• Religion and Education
• Religion and Health
• Religion and Politics
• Religion and Science
• Religion and Law
• Religion and Art, Literature, and Music
• Religious Studies
• Browse content in Society and Culture
• Cookery, Food, and Drink
• Cultural Studies
• Customs and Traditions
• Ethical Issues and Debates
• Hobbies, Games, Arts and Crafts
• Natural world, Country Life, and Pets
• Popular Beliefs and Controversial Knowledge
• Sports and Outdoor Recreation
• Technology and Society
• Travel and Holiday
• Visual Culture
• Browse content in Law
• Arbitration
• Browse content in Company and Commercial Law
• Commercial Law
• Company Law
• Browse content in Comparative Law
• Systems of Law
• Competition Law
• Browse content in Constitutional and Administrative Law
• Government Powers
• Judicial Review
• Local Government Law
• Military and Defence Law
• Parliamentary and Legislative Practice
• Construction Law
• Contract Law
• Browse content in Criminal Law
• Criminal Procedure
• Criminal Evidence Law
• Sentencing and Punishment
• Employment and Labour Law
• Environment and Energy Law
• Browse content in Financial Law
• Banking Law
• Insolvency Law
• History of Law
• Human Rights and Immigration
• Intellectual Property Law
• Browse content in International Law
• Private International Law and Conflict of Laws
• Public International Law
• IT and Communications Law
• Jurisprudence and Philosophy of Law
• Law and Politics
• Law and Society
• Browse content in Legal System and Practice
• Courts and Procedure
• Legal Skills and Practice
• Primary Sources of Law
• Regulation of Legal Profession
• Medical and Healthcare Law
• Browse content in Policing
• Criminal Investigation and Detection
• Police and Security Services
• Police Procedure and Law
• Police Regional Planning
• Browse content in Property Law
• Personal Property Law
• Study and Revision
• Terrorism and National Security Law
• Browse content in Trusts Law
• Wills and Probate or Succession
• Browse content in Medicine and Health
• Browse content in Allied Health Professions
• Arts Therapies
• Clinical Science
• Dietetics and Nutrition
• Occupational Therapy
• Operating Department Practice
• Physiotherapy
• Radiography
• Speech and Language Therapy
• Browse content in Anaesthetics
• General Anaesthesia
• Neuroanaesthesia
• Browse content in Clinical Medicine
• Acute Medicine
• Cardiovascular Medicine
• Clinical Genetics
• Clinical Pharmacology and Therapeutics
• Dermatology
• Endocrinology and Diabetes
• Gastroenterology
• Genito-urinary Medicine
• Geriatric Medicine
• Infectious Diseases
• Medical Oncology
• Medical Toxicology
• Pain Medicine
• Palliative Medicine
• Rehabilitation Medicine
• Respiratory Medicine and Pulmonology
• Rheumatology
• Sleep Medicine
• Sports and Exercise Medicine
• Clinical Neuroscience
• Community Medical Services
• Critical Care
• Emergency Medicine
• Forensic Medicine
• Haematology
• History of Medicine
• Browse content in Medical Dentistry
• Oral and Maxillofacial Surgery
• Paediatric Dentistry
• Restorative Dentistry and Orthodontics
• Surgical Dentistry
• Medical Ethics
• Browse content in Medical Skills
• Clinical Skills
• Communication Skills
• Nursing Skills
• Surgical Skills
• Medical Statistics and Methodology
• Browse content in Neurology
• Clinical Neurophysiology
• Neuropathology
• Nursing Studies
• Browse content in Obstetrics and Gynaecology
• Gynaecology
• Occupational Medicine
• Ophthalmology
• Otolaryngology (ENT)
• Browse content in Paediatrics
• Neonatology
• Browse content in Pathology
• Chemical Pathology
• Clinical Cytogenetics and Molecular Genetics
• Histopathology
• Medical Microbiology and Virology
• Patient Education and Information
• Browse content in Pharmacology
• Psychopharmacology
• Browse content in Popular Health
• Caring for Others
• Complementary and Alternative Medicine
• Self-help and Personal Development
• Browse content in Preclinical Medicine
• Cell Biology
• Molecular Biology and Genetics
• Reproduction, Growth and Development
• Primary Care
• Professional Development in Medicine
• Browse content in Psychiatry
• Addiction Medicine
• Child and Adolescent Psychiatry
• Forensic Psychiatry
• Learning Disabilities
• Old Age Psychiatry
• Psychotherapy
• Browse content in Public Health and Epidemiology
• Epidemiology
• Public Health
• Browse content in Radiology
• Clinical Radiology
• Interventional Radiology
• Nuclear Medicine
• Radiation Oncology
• Reproductive Medicine
• Browse content in Surgery
• Cardiothoracic Surgery
• Gastro-intestinal and Colorectal Surgery
• General Surgery
• Neurosurgery
• Paediatric Surgery
• Peri-operative Care
• Plastic and Reconstructive Surgery
• Surgical Oncology
• Transplant Surgery
• Trauma and Orthopaedic Surgery
• Vascular Surgery
• Browse content in Science and Mathematics
• Browse content in Biological Sciences
• Aquatic Biology
• Biochemistry
• Bioinformatics and Computational Biology
• Developmental Biology
• Ecology and Conservation
• Evolutionary Biology
• Genetics and Genomics
• Microbiology
• Molecular and Cell Biology
• Natural History
• Plant Sciences and Forestry
• Research Methods in Life Sciences
• Structural Biology
• Systems Biology
• Zoology and Animal Sciences
• Browse content in Chemistry
• Analytical Chemistry
• Computational Chemistry
• Crystallography
• Environmental Chemistry
• Industrial Chemistry
• Inorganic Chemistry
• Materials Chemistry
• Medicinal Chemistry
• Mineralogy and Gems
• Organic Chemistry
• Physical Chemistry
• Polymer Chemistry
• Study and Communication Skills in Chemistry
• Theoretical Chemistry
• Browse content in Computer Science
• Artificial Intelligence
• Computer Architecture and Logic Design
• Game Studies
• Human-Computer Interaction
• Mathematical Theory of Computation
• Programming Languages
• Software Engineering
• Systems Analysis and Design
• Virtual Reality
• Browse content in Computing
• Business Applications
• Computer Security
• Computer Games
• Computer Networking and Communications
• Digital Lifestyle
• Graphical and Digital Media Applications
• Operating Systems
• Browse content in Earth Sciences and Geography
• Atmospheric Sciences
• Environmental Geography
• Geology and the Lithosphere
• Maps and Map-making
• Meteorology and Climatology
• Oceanography and Hydrology
• Palaeontology
• Physical Geography and Topography
• Regional Geography
• Soil Science
• Urban Geography
• Browse content in Engineering and Technology
• Agriculture and Farming
• Biological Engineering
• Civil Engineering, Surveying, and Building
• Electronics and Communications Engineering
• Energy Technology
• Engineering (General)
• Environmental Science, Engineering, and Technology
• History of Engineering and Technology
• Mechanical Engineering and Materials
• Technology of Industrial Chemistry
• Transport Technology and Trades
• Browse content in Environmental Science
• Applied Ecology (Environmental Science)
• Conservation of the Environment (Environmental Science)
• Environmental Sustainability
• Environmentalist Thought and Ideology (Environmental Science)
• Management of Land and Natural Resources (Environmental Science)
• Natural Disasters (Environmental Science)
• Nuclear Issues (Environmental Science)
• Pollution and Threats to the Environment (Environmental Science)
• Social Impact of Environmental Issues (Environmental Science)
• History of Science and Technology
• Browse content in Materials Science
• Ceramics and Glasses
• Composite Materials
• Metals, Alloying, and Corrosion
• Nanotechnology
• Browse content in Mathematics
• Applied Mathematics
• Biomathematics and Statistics
• History of Mathematics
• Mathematical Education
• Mathematical Finance
• Mathematical Analysis
• Numerical and Computational Mathematics
• Probability and Statistics
• Pure Mathematics
• Browse content in Neuroscience
• Cognition and Behavioural Neuroscience
• Development of the Nervous System
• Disorders of the Nervous System
• History of Neuroscience
• Invertebrate Neurobiology
• Molecular and Cellular Systems
• Neuroendocrinology and Autonomic Nervous System
• Neuroscientific Techniques
• Sensory and Motor Systems
• Browse content in Physics
• Astronomy and Astrophysics
• Atomic, Molecular, and Optical Physics
• Biological and Medical Physics
• Classical Mechanics
• Computational Physics
• Condensed Matter Physics
• Electromagnetism, Optics, and Acoustics
• History of Physics
• Mathematical and Statistical Physics
• Measurement Science
• Nuclear Physics
• Particles and Fields
• Plasma Physics
• Quantum Physics
• Relativity and Gravitation
• Semiconductor and Mesoscopic Physics
• Browse content in Psychology
• Affective Sciences
• Clinical Psychology
• Cognitive Neuroscience
• Cognitive Psychology
• Criminal and Forensic Psychology
• Developmental Psychology
• Educational Psychology
• Evolutionary Psychology
• Health Psychology
• History and Systems in Psychology
• Music Psychology
• Neuropsychology
• Organizational Psychology
• Psychological Assessment and Testing
• Psychology of Human-Technology Interaction
• Psychology Professional Development and Training
• Research Methods in Psychology
• Social Psychology
• Browse content in Social Sciences
• Browse content in Anthropology
• Anthropology of Religion
• Human Evolution
• Medical Anthropology
• Physical Anthropology
• Regional Anthropology
• Social and Cultural Anthropology
• Theory and Practice of Anthropology
• Browse content in Business and Management
• Business Strategy
• Business History
• Business Ethics
• Business and Government
• Business and Technology
• Business and the Environment
• Comparative Management
• Corporate Governance
• Corporate Social Responsibility
• Entrepreneurship
• Health Management
• Human Resource Management
• Industrial and Employment Relations
• Industry Studies
• Information and Communication Technologies
• International Business
• Knowledge Management
• Management and Management Techniques
• Operations Management
• Organizational Theory and Behaviour
• Pensions and Pension Management
• Public and Nonprofit Management
• Strategic Management
• Supply Chain Management
• Browse content in Criminology and Criminal Justice
• Criminal Justice
• Criminology
• Forms of Crime
• International and Comparative Criminology
• Youth Violence and Juvenile Justice
• Development Studies
• Browse content in Economics
• Agricultural, Environmental, and Natural Resource Economics
• Asian Economics
• Behavioural Finance
• Behavioural Economics and Neuroeconomics
• Econometrics and Mathematical Economics
• Economic Systems
• Economic Methodology
• Economic History
• Economic Development and Growth
• Financial Markets
• Financial Institutions and Services
• General Economics and Teaching
• Health, Education, and Welfare
• History of Economic Thought
• International Economics
• Labour and Demographic Economics
• Law and Economics
• Macroeconomics and Monetary Economics
• Microeconomics
• Public Economics
• Urban, Rural, and Regional Economics
• Welfare Economics
• Browse content in Education
• Adult Education and Continuous Learning
• Care and Counselling of Students
• Early Childhood and Elementary Education
• Educational Equipment and Technology
• Educational Strategies and Policy
• Higher and Further Education
• Organization and Management of Education
• Philosophy and Theory of Education
• Schools Studies
• Secondary Education
• Teaching of a Specific Subject
• Teaching of Specific Groups and Special Educational Needs
• Teaching Skills and Techniques
• Browse content in Environment
• Applied Ecology (Social Science)
• Climate Change
• Conservation of the Environment (Social Science)
• Environmentalist Thought and Ideology (Social Science)
• Natural Disasters (Environment)
• Social Impact of Environmental Issues (Social Science)
• Browse content in Human Geography
• Cultural Geography
• Economic Geography
• Political Geography
• Browse content in Interdisciplinary Studies
• Communication Studies
• Museums, Libraries, and Information Sciences
• Browse content in Politics
• African Politics
• Asian Politics
• Chinese Politics
• Comparative Politics
• Conflict Politics
• Elections and Electoral Studies
• Environmental Politics
• Ethnic Politics
• European Union
• Foreign Policy
• Gender and Politics
• Human Rights and Politics
• Indian Politics
• International Relations
• International Organization (Politics)
• International Political Economy
• Irish Politics
• Latin American Politics
• Middle Eastern Politics
• Political Methodology
• Political Communication
• Political Philosophy
• Political Sociology
• Political Theory
• Political Behaviour
• Political Economy
• Political Institutions
• Politics and Law
• Politics of Development
• Public Administration
• Public Policy
• Quantitative Political Methodology
• Regional Political Studies
• Russian Politics
• Security Studies
• State and Local Government
• UK Politics
• US Politics
• Browse content in Regional and Area Studies
• African Studies
• Asian Studies
• East Asian Studies
• Japanese Studies
• Latin American Studies
• Middle Eastern Studies
• Native American Studies
• Scottish Studies
• Browse content in Research and Information
• Research Methods
• Browse content in Social Work
• Addictions and Substance Misuse
• Adoption and Fostering
• Care of the Elderly
• Child and Adolescent Social Work
• Couple and Family Social Work
• Direct Practice and Clinical Social Work
• Emergency Services
• Human Behaviour and the Social Environment
• International and Global Issues in Social Work
• Mental and Behavioural Health
• Social Justice and Human Rights
• Social Policy and Advocacy
• Social Work and Crime and Justice
• Social Work Macro Practice
• Social Work Practice Settings
• Social Work Research and Evidence-based Practice
• Welfare and Benefit Systems
• Browse content in Sociology
• Childhood Studies
• Community Development
• Comparative and Historical Sociology
• Economic Sociology
• Gender and Sexuality
• Gerontology and Ageing
• Health, Illness, and Medicine
• Marriage and the Family
• Migration Studies
• Occupations, Professions, and Work
• Organizations
• Population and Demography
• Race and Ethnicity
• Social Theory
• Social Movements and Social Change
• Social Research and Statistics
• Social Stratification, Inequality, and Mobility
• Sociology of Religion
• Sociology of Education
• Sport and Leisure
• Urban and Rural Studies
• Browse content in Warfare and Defence
• Defence Strategy, Planning, and Research
• Land Forces and Warfare
• Military Administration
• Military Life and Institutions
• Naval Forces and Warfare
• Other Warfare and Defence Issues
• Peace Studies and Conflict Resolution
• Weapons and Equipment

• < Previous chapter
• Next chapter >

15 Cognitive-Behavioral Approaches to Stress Management

Sarah L. Mann, Department of Psychology, and Institute for Health, Health Care Policy, and Aging Research, Rutgers, The State University of New Jersey

Richard J. Contrada, Department of Psychology, and Institute for Health, Health Care Policy, and Aging Research, Rutgers, The State University of New Jersey

• Published: 09 July 2015
• Cite Icon Cite
• Permissions Icon Permissions

This chapter provides an overview of cognitive-behavioral stress management techniques, which include some of the most effective available means of stress reduction. We begin by briefly outlining major themes and approaches in the scientific study of stress and summarizing key constructs in psychologically oriented stress science. We then provide an overview of three major cognitive-behavioral stress management techniques: progressive muscle relaxation, breathing therapies, and guided imagery. The chapter concludes with a discussion of some of the contemporary scientific and clinical issues in cognitive-behavioral stress management, focusing on the advancement of research into physiological and cognitive mechanisms and the application of these stress management methods in institutional settings.

For the lay public, stress is a highly familiar and reasonably well-understood phenomenon. The word “stress” and its variants are used frequently in conversation and various media. And although it is understood that stress can mean different things for different people, and despite significant differences between ethnic groups and across cultures, there is a good deal of commonality that runs through these meanings. Most people know (or think they know) what “stress” is, and its causes, manifestations, and consequences make up at least the outlines of a shared folk understanding of stress. Moreover, while a certain amount of stress is seen as an unavoidable aspect of life, there are many well-recognized ways of minimizing stress and its negative consequences, ranging from mental and behavioral activity of the individual to the functions performed by major social institutions such as medicine, religion, and the family, and to myriad commercial products marketed for their supposed stress-reducing properties.

In the field of stress science, things are less clear. To be sure, there is substantial agreement about what stress is, why it occurs, and how it affects the person. Indeed, the field of stress has shown considerable development and increased sophistication in the time since its inception. But there is ambiguity and controversy about definitional matters, regarding the relative importance of different aspects of stress, and concerning our understanding of the origins, immediate effects, and long-term consequences of stress. In part, this state of affairs reflects the fact that stress has been studied within different scientific disciplines and from various perspectives within those disciplines. As a consequence, what we demonstrably know about ways to avoid and to reduce stress, and about the benefits of doing so, is limited, qualified, and subject to debate. As such, understanding and managing stress are currently active and productive areas of inquiry, and they can be rewarding areas of involvement for basic research and clinical intervention.

This chapter provides an overview of the state of the art of cognitive-behavioral stress management. Cognitive-behavioral approaches have seen steady improvement and include some of the most effective means of stress reduction that are currently available. These techniques and the theoretical and empirical work on which they are based are highly compatible with the dominant perspectives in basic theory and research in the field of psychological stress, although these two bodies of work are not as well integrated as one might imagine.

We begin with a brief outline of major themes and approaches to the scientific study of stress and a summary of the current status of the main stress-related constructs employed by psychologically oriented stress scientists. Next, we provide a heuristic overview of a few major stress management techniques that fall within this perspective: progressive muscle relaxation, breathing therapies, and guided imagery. The chapter concludes with a discussion of some of the major conceptual and clinical issues in contemporary work on the cognitive-behavioral management of stress.

Theoretical Bases of Cognitive-Behavioral Stress Management

Effective stress management techniques reflect advances in at least two bodies of research. They are grounded in basic stress science, and they are developed, evaluated, and refined in research applying specific techniques in specific populations to address specific stress-related problems. Although it is useful to distinguish these two research areas, they are not entirely separable; for example, theoretical propositions regarding basic stress processes may be evaluated through experimental manipulations that incorporate elements of stress management techniques, and stress management research in specific populations and problem areas can and often should be designed in a way that informs basic stress science. With that caveat in mind, this section discusses some of the developments and challenges of basic stress research that have particular relevance to advancing the development and clinical implementation of methods for cognitive-behavioral stress management.

Environmental Stressors

Much stress involves stressors, that is, threatening or demanding environmental events and conditions that are ongoing, recalled, or anticipated. A major stream of stress research that emerged early on has focused on the experience of individual environmental events, or clusters of events, the demands or adjustments they require, and their relationship with negative mental or physical outcomes. An event-focused perspective remains a discernible paradigm for contemporary stress science ( Cohen, Kessler, & Gordon, 1997 ). Accumulating research findings have increased understanding of the kinds of environmental events that activate stress responses. These include major events such as war, terrorism, natural and technological disasters, and other potentially traumatizing occurrences ( Norris, Friedman, & Watson, 2002 ); more common social and environmental events such as divorce, bereavement, and physical illness ( Anderson, Wethington, & Kamarck, 2011 ); routine, daily stresses encountered, for example, in the workplace and the home ( Almeida, Stawski, & Cichy, 2011 ); and even more temporally circumscribed events that describe moment-to-moment experience ( Schiffman, Stone, & Hufford, 2008 ).

An environmental focus also characterizes research on stressful conditions examining the impact of longer term exposures to ongoing circumstances of social life such as work ( Pandey, Quick, Rossi, Nelson, & Martin, 2011 ) and the marital relationship ( Kiecolt-Glaser & Newton, 2001 ); persistent features of the physical environment, including population density ( Baum, 1987 ) and noise ( Glass & Singer, 1972 ), stressors that are found together in certain geographic locations such as inner cities ( Anderson & Armstead, 1995 ); demands and constraints created by organizations ( Weinberg & Cooper, 2011 ; Zapf, Dormann, & Frese, 1996 ); life as experienced within different socioeconomic strata ( Marmot & Brunner, 2005 ); and the experience of chronic medical conditions and the demands of illness management ( Baum, Herberman, & Cohen, 1995 ; Nezu, Nezu, & Xanthopoulos, 2011 ).

Cognitive Appraisal and Coping Processes

For the most part, exposure to the events and conditions outlined earlier bears only a probabilistic relationship with negative outcomes. There are large, systematic individual differences in how different people respond, with some showing negative effects, some not, and others even showing benefits such as personal growth as a consequence of the encounter. Stress and its consequences appear to arise out of the relationship between environmental demands and constraints, on the one hand, and the adaptive resources of the individual, on the other. It is an imbalance in this equation that creates stress-related problems in living that require clinical intervention. This premise, referred to as a transactional model of stress, seems necessary as a means of accounting for individual differences in both the short-term response and the long-term adaptive outcome of even the more extreme stressful events and conditions. It forms a basic assumption of a theory of psychological stress formulated by Richard S. Lazarus and his collaborators ( Lazarus, 1966 ; Lazarus & Folkman, 1984 ; Smith & Lazarus, 1993 ).

The work of Lazarus and others concerning psychological processes that mediate the impact of exposure to stressful events and conditions represents a second major stream of stress research apart from that associated with the environmental approach described earlier. The psychological and environmental approaches are often integrated, but the two are separable and often pursued somewhat independently. The psychological perspective has placed a heavy emphasis on the processes of cognitive appraisal and coping ( Lazarus & Folkman, 1984 ). Appraisal is a cognitive-evaluative process in which the individual judges the actual or potential impact of perceived events and conditions on his or her physical or mental well-being. Stress-promoting appraisals include the perception that harm or loss has already occurred, the threat of future harm or loss, and challenge, a mixed state that contains elements of threat in combination with the opportunity for positive outcomes. It is possible to distinguish a primary appraisal process, in which harm and loss are evaluated, from a secondary appraisal process, in which resources and options for coping are evaluated. Coping refers to mental and behavioral activity aimed at dealing directly with the person-situation imbalance that gave rise to a stressful appraisal, sometimes referred to as problem-focused coping, or at managing its impact on the person, sometimes referred to as emotion-focused coping. Several alternative conceptualizations have also been proposed that make different kinds of distinctions among various coping responses ( Skinner, Edge, Altman, & Sherwood, 2003 ).

The Stress Response

Following exposure to demanding events and conditions and appraisal of harm/loss, threat, or challenge, there follow biological, psychological, and behavioral changes that, taken together, may be referred to as the stress response. A focus on biological aspects of the stress response constitutes a third major stream of stress research. It has its origins in the work of Walter B. Cannon (1929) on the fight-or-flight response, which emphasized the impact of physical emergencies, such as the presence of a predator, in activating sympathetic adrenomedullary activity as manifested by elevations in circulating levels of the catecholamines, epinephrine and norepinephrine, which are now recognized as major stress hormones. These substances (especially epinephrine) are secreted by the adrenal medullae, a pair of endocrine glands, and their heightened production is accompanied by increased activity of the sympathetic branch of the autonomic nervous system for which norepinephrine is a major neurotransmitter. Physiological consequences of this increased endocrine and nervous system activity include cardiovascular, respiratory, and other adjustments whose effects in mobilizing energy that support vigorous muscle activity confer survival advantage in situations of immediate physical danger.

A biological perspective on stress became crystallized and was given impetus as a result of the work of Hans Selye (1956) . Selye described stress as a specific biological response that is nonspecifically elicited by a variety of noxious stimuli. This response, referred to as the general adaptation syndrome, features activity of the cortices of the adrenal glands, and it is described in terms of a triphasic pattern of alarm, resistance, and exhaustion marked by a rise and fall in the production of corticosteroids, most notably cortisol, a major stress hormone in humans. Selye popularized the use of the term “stress” and brought the stress concept to the attention of psychologists.

Biological activity produced by stress processes is not confined to mobilization of adrenal medullary and cortical activity, heighted sympathetic nervous system tone, and associated cardiovascular and metabolic changes. It may not be much of an exaggeration and certainly has heuristic value to think of the biological stress response as organism wide. Depending upon the severity and duration of exposure to the stressor, and on the nature of ensuing psychological responses, changes may be seen throughout the body.

Much has been learned about the brain mechanisms that mediate psychological processing of stressful events and conditions and that regulate behavioral and peripheral physiologic responses ( Dedovic, D’Aguiar, & Pruessner, 2009 ; Gianaros & O’Connor, 2011 ), and about the effects of stress on the brain ( Sapolsky, 1996 ). In short, acute stress induces neurochemical changes, including increased release of glucocorticoid hormones and the neurotransmitters dopamine and norepinephrine, which help shift the brain “from slow, thoughtful PFC [prefrontal cortical] regulation to the reflexive and rapid emotional responses of the amygdala and related subcortical structures” ( Arnsten, 2009 , p. 411). This regulatory shift often proves adaptive for facing mortal threats, but it can become problematic when circumstances instead require careful, controlled decision making. When chronic stress prolongs these neurochemical processes, they cause structural changes to the PFC and to subcortical structures such as the amygdala and hippocampus ( Cerqueira, Mailliet, Almeida, Jay, & Sousa, 2007 ; Leuner & Gould, 2010 ; Roozendaal, McEwen, & Chattarji, 2009 ). Over time, these changes can effectively weaken the PFC’s regulatory capacities while strengthening the subcortical stress response, leaving the organism vulnerable to heightened and prolonged responses to future stressors ( Arnsten, 2009 ).

In addition to these stress-related neurological changes, psychophysiologists have documented stress-related changes in major physiologic systems, including electrodermal, respiratory, and skeletomotor systems, among other responses ( Cacioppo, Tassinary, & Berntson, 2007 ). With regard to autonomic nervous system (ANS) processes that mediate many end-organ responses to stress, parasympathetic activity, and interactions between the sympathetic and parasympathetic branches of the ANS, also figure prominently in the bodily response to stressful encounters ( Berntson et al., 1994 ; Berntson, Norman, Hawkley, & Cacioppo, 2008 ; Porges, 2009 ). And immunological/inflammatory responses to stress have received much attention, especially in light of their potential role in the development of acute infectious and chronic physical disease ( Segerstrom & Miller, 2004 ) and in the production of emotional states through immune-to-brain pathways ( Dantzer, O’Connor, Freund, Johnson, & Kelley, 2008 ).

Stress Moderators

Exposure to stressors and the psychological and biological responses that ensue do not occur in a vacuum. These processes are potentially shaped by a large number of factors that increase or decrease exposure to stressors and the magnitude of the stress response. Often referred to as stress moderators, they include aspects of the context in which stress occurs, including social, physical, organizational, and sociocultural factors, and characteristics of the person, including age, gender, and other sociodemographic variables, as well as personality, intellectual capabilities, and mental and physical health. Stress moderators that reduce exposure to stressors or that modulate the effects of such exposures may be conceptualized as coping resources in that they inform, guide, and otherwise support the efforts of an individual to minimize stressful exposures and to manage their impact.

Stress Outcomes

At the individual level, consequences of stress may include unpleasant emotional reactions, including anxiety, anger, and sadness; development and exacerbation of mental and physical health problems; impairments in cognitive functioning; poor performance in a variety of domains, including occupational and academic activities; inability to manage physical illness and to benefit from associated rehabilitation regimens; and the acquisition of or relapse in behavioral problems, including unhealthy eating and use of nicotine, alcohol, and other substances. These outcomes may have negative consequences for social units ranging from married couples and families to companies, corporations, and the military. The wide scope and potential importance of the many possible negative outcomes of stress provide a strong rational and considerable impetus for developing improved methods of stress management.

Specific Techniques

Progressive muscle relaxation, brief history.

The technique of progressive muscle relaxation (PMR) was developed by the physiologist Edmund Jacobson and was based on two key psychophysiological innovations of his early career. First, in collaboration with A. J. Carlson, he found that the degree of psychological tension a patient was experiencing could be measured physiologically in terms of amplitude of the individual’s knee-jerk reflex, and that when the patient relaxed, the reflex amplitude decreased ( Jacobson, 1974 ). Second, working with Bell Telephone Laboratory scientists, Jacobson helped to improve the technology for measuring tension in electrical muscle action potentials, making these recordings easier, more direct, and unprecedentedly precise. This new technology, quantitative electromyography (EMG), provided him with a new method of exploring mind-body relations, which he used to document covert connections between mental life and the activity of the skeletal muscles.

Jacobson’s subsequent investigations using EMG revealed that in a relaxed person, thoughts elicited measurable, low-amplitude responses in muscle groups corresponding to the person’s mental activity. Thoughts of limb movements produced small EMG bursts in relevant muscles of the corresponding limb, whereas mental imagery or verbalizations registered EMG activity in the eye and the speech muscles, respectively. Jacobson summarized the resulting model of the mind-body connection in his description of thinking as “a series of acts, quite similar to the organism’s overt relations to the environment but differing in that images more or less replace the direct sensory experiences, while the muscular tensions consist of relatively feeble contractions, with little or no effect on the environment” ( Jacobson, 1974 , p. 195). Based on this view, Jacobson developed progressive muscle relaxation as a course of training for relaxing the mind and body simultaneously by becoming highly sensitive to subtle skeletal muscle contractions and able to relax specific sites of tension at will.

Theoretical and Empirical Bases

In clinical practice, PMR can be used either to help to control or to alleviate stress-related conditions—including both cognitive and somatoform symptoms—or to reduce susceptibility to this kind of problem. The technique utilizes the body’s neuromuscular connections as a means of voluntarily decreasing physical and psychological stress. A key premise is that information is relayed from the skeletal muscles to the brain through neuromuscular circuits that project to the reticular formation. This central brain stem structure is involved not only in aspects of motor control but also in regulating autonomic activity (via connections with the hypothalamus) and cardiovascular control ( Bernhaut, Gelhorn, & Rasmussen, 1953 ; Gelhorn, 1958 ; Gelhorn & Keily, 1972 ). Thus, sustained muscle tension effectively increases excitatory inputs to brain regions that can trigger a variety of physiological stress reactions via the sympathetic nervous system.

When a tense person relaxes his or her muscles, feedback loops connecting the muscles, the brain, and the sympathetic nervous system convey fewer excitatory impulses, with the result of calming the mind and body. Trainees in PMR learn to become sensitive to trace levels of muscle tension, called control signals , which reflect and reinforce their psychological stress. By becoming attuned to these control signals, people can develop refined abilities to allow specific tensed, or contracted, groups of muscle fibers to lengthen, thereby “relaxing away” both the muscle tension and the associated stress.

Furthermore, within the psychophysiological model on which PMR is based, slight muscle tensions are thought to play an important role in generating thoughts and emotions. Covert contractions of the speech musculature have been recorded during many kinds of verbal cognition, including silent reading, verbal meditation, and silently processing the answer to a question ( McGuigan, 1978 ; McGuigan, Culver, & Kendler, 1971 ). Similarly, mental visualization is associated with subtle movements of the eye muscles. The PMR model posits an intimate link between these mental and muscular activities, such that thoughts are generated by the rapid interactions between the brain and the particular skeletal muscles relevant to the thought content. In this view, decreasing muscle tension not only decreases widespread physiological arousal but also quiets the mind by reducing the neuromuscular reverberations that give rise to cognitive activity. Over the long term, individuals highly skilled at PMR develop automaticity, so that the release of unwanted physical tension and psychological stress becomes unconscious and effortless.

Current Practice

As its name suggests, PMR training systematically progresses through several muscle groups in a set order, typically beginning with the hands/arms, then moving to the feet/legs, trunk, neck, eyes, and speech musculature, though additional areas of focus can be added, depending on the learner’s needs ( McGuigan & Lehrer, 2007 ). The process begins with large muscle groups, where contractions are easiest to recognize and to control, and proceeds to smaller muscles in which sensation is fainter and voluntary control more challenging. During hour-long training sessions, the learner is guided in recognizing the control signal in each muscle group, one at a time. The process involves focusing on the subtle differences in proprioceptive sensation that occur as the muscles tense and relax during a simple repeated movement ( McGuigan & Lehrer, 2007 ). The goal is to learn to sense the precise timing, location, and sensation of the control signal involved in initiating movements in each muscle group, and then to learn to relax the muscles involved completely. Although it is not always possible in practice, progress in treatment can be measured by comparing the learner’s EMG profiles to her earlier, baseline recordings and/or to a standard set of goal measures representing normal, or normotensive, levels of muscle tension ( McGuigan & Lehrer, 2007 ).

Preparation

To minimize distractions, training should take place in a quiet, dimly lit, uncluttered room, but the location need not be soundproof or completely distraction-free, given that the goal is to be able to relax under normal circumstances ( McGuigan & Lehrer, 2007 ). The learner requires a pillow as well as a comfortable place to lie down, such as a couch, a recliner, a cot, or a rug. The learner should also be encouraged to wear comfortable, loose-fitting clothing to subsequent sessions ( McGuigan & Lehrer, 2007 ).

First Session

As described by McGuigan and Lehrer (2007) , the clinician begins by explaining the basic functioning of the muscles—as they tense, the fine fibers that comprise them contract and shorten, and when they relax, the fibers lengthen—and its relevance for PMR training: By repeatedly tensing and relaxing a specific set of muscle fibers while attending to the sensations involved, the learner will become better able to pinpoint focal areas of tension and relax it away. The learner should also be advised not to expect instant mastery; PMR is a skill that takes significant time and practice to develop. The duration of a full course of PMR varies depending on the learner’s starting point and therapeutic goals; Jacobson’s full basic course lasts for 13 weeks and requires at least 1 hour of daily practice ( Jacobson, 1964 ). The learner should be made aware that treatment outcome depends in large part on diligence with the prescribed practice between clinical sessions. Jacobson and others have outlined specific training and practice schedules, but the technique also allows for flexibility in the number and frequency of meetings with the therapist.

At the start of each session, the learner should be encouraged to adopt a frame of mind that is training focused and as free from other concerns as possible during the 1-hour session. The learner begins by lying down with her arms at her sides with her eyes open. After several minutes and without concerted effort, she should gradually allow her eyes to close by simply letting the muscle fibers around the eyes slowly relax and lengthen. The learner lies with eyes closed for a few minutes, then at the therapist’s gentle instruction, steadily flexes the left wrist to raise the hand up to be approximately perpendicular to the resting surface. She holds this position for a minute or two, paying careful attention to the sensations it produces in order to localize the control signal , the precise origin point of the muscle contraction. The learner is not told where to seek the control signal (in this case, the dorsal surface of the forearm), and she may be unsure at first what kind of signal or sensation it is. Still, the therapist should not give detailed instruction but should act as a guide through the trial-and-error training process. If the learner misidentifies other tensions as the control signal, she is not corrected, only encouraged to continue searching. The therapist aims to keep the focus on the learner and her independence; she must identify and eliminate (relax away) the control signal herself, which will become easier with practice.

After holding her left hand in the tensed position for a few minutes and attending to the muscle tension, at the therapist’s direction the learner allows the hand and wrist muscles to go slack for a few minutes. Rather than purposely moving the hand down, the learner should be encouraged simply to let the tension go, allow the muscles to stop working, or “let the power go off.” It may be difficult at first to avoid “trying to relax,” and it should be emphasized that relaxation requires no effort in itself; rather, a cessation of prior efforts allows the muscle fibers at the control signal site to lengthen and the hand to fall. For this reason, terminology that denotes effortful behavior like “relaxation exercise” and “relaxation response” is discouraged ( McGuigan & Lehrer, 2007 ). This sequence is repeated two more times during the session. The therapist then ends the meeting by discussing the learner’s progress, answering questions, and prescribing a practice schedule for the interval between sessions.

Subsequent Sessions

Later sessions take the same form as the first. With the therapist’s guidance, the learner focuses on a single control signal during the hour-long session, repeating and studying the tense-and-relax sequence three times. As training proceeds through the different areas of the body, each region is broken down into smaller muscle groups for study over several days, with each day highlighting a single movement and corresponding control signal. There are minor variations between practitioners in the order in which training progresses; Jacobson’s traditional sequence is outlined in Table 15.1 . Days 1 through 7 in this table show how the musculature in the left arm is studied through a series of small, specific movements.

In sessions focused on generalized or residual tension (see Table 15.1 , Day 7), the learner focuses on recognizing and releasing the continuous, low-level muscle contraction throughout a larger region. To study this kind of tension, the learner very gradually stiffens all muscles in this region, in this case the left arm, increasing to a maximum level of muscle contraction over about 15 minutes. The learner holds and observes this tension for roughly 30 to 60 seconds, then very gradually relaxes the whole arm over the remainder of the session. The emphasis on distinguishing localized control signals from generalized tension is a hallmark of Jacobson’s method that is not typically included in abbreviated versions of PMR ( McGuigan & Lehrer, 2007 ).

Sessions near the end of the training sequence focus on the especially subtle control signals in the eyes and the speech musculature. The vision- and speech-related components of the program are each followed by a set of sessions training these respective muscle groups to regulate associated cognitive activity. That is, after training to relax the muscles of the eye region, the learner spends 9 days learning to recognize and release similar covert tensions that occur in association with mental imagery. Likewise, after training to relax the speech musculature by purposely moving, tensing, and releasing these muscles, the learner then applies this skill to detect control signals in these muscles that occur during silent, verbal thought. These components of training are considered critical to gaining control of stressful thoughts and emotions.

The goal of PMR is not to eliminate all sources of tension but to become a skilled interpreter of the body’s control signals in order to release unwanted tension and stress. When the learner becomes proficient at recognizing and eliminating these signals at will, she can then learn to distinguish the tension’s “process,” a term for the felt muscle contraction itself, from its “meaning,” which refers to the reason for the contraction, such as the thought content associated with the reverberations of specific neuromuscular circuits. If the learner experiences unexpected muscle tension or contractions during training, the first therapeutic priority is for the learner to observe carefully, localize, and describe these sensations. The therapist then guides the learner in considering why those tensions occur where they do, in association with particular kinds of thoughts or feelings. Addressing these issues is not always quick or straightforward; nonetheless, understanding the tension’s meaning, perhaps by discovering its link to a particular worry or memory, often facilitates muscle control. Along these same lines, understanding the meaning of muscle tension associated with particular thoughts and emotions is said to provide a mechanism for controlling these mental events. In this view, relaxing the muscles in a neuromuscular circuit where unwanted thoughts or emotions originate stops the circuit’s reverberation, which eliminates the thoughts or feelings.

Abbreviated Progressive Muscle Relaxation

As described earlier, classical PMR training is lengthy and requires much practice. Although there is no shortcut to gaining the level of mastery that is possible through a full training program, its briefer version, known as abbreviated progressive muscle relaxation (APMR), has also been found to be beneficial ( Bernstein, Carlson, & Schmidt, 2007 ). The first shortened form of Jacobson’s training was developed by the psychiatrist and pioneer of behavior therapy Joseph Wolpe (1958) , who took an interest in relaxation as a component of his systematic desensitization approach to anxiety treatment. Over the next decade, other psychologists interested in treating anxiety continued to adapt Jacobson’s relaxation methods, shortening them further and providing learners with more overt guidance. These changes, first described and formalized by Gordon Paul (1966) and by Douglas Bernstein and Thomas Borkovec (1973) , allowed PMR to be incorporated into a range of behavioral treatments for anxiety.

In practice, APMR proceeds very similarly to classical PMR. After explaining the therapeutic process and rationale, the therapist guides the learner through a series of tense-and-relax cycles focused on particular muscle groups. A key difference in APMR is that, while PMR devotes whole sessions to studying single control signals within major muscle groups, APMR proceeds through a sequence of 16 major muscle groups in each 45-minute session, using shorter tense-and-relax cycles (see Table 15.2 ). APMR is also more flexible than traditional PMR, so if an individual has trouble with the method of tensing described in a particular APMR program, the therapist is encouraged to work with the learner to devise a more feasible way of tensing and releasing the target muscles ( Bernstein, Carlson, & Schmidt, 2007 ).

Another important difference from traditional PMR methods is that in APMR the learner is generally discouraged from speaking during the relaxation period, since verbal exchanges can distract the learner from his physical sensations, and there is no need to confirm the location of control signals. Before beginning the first session’s relaxation training, the therapist and the learner should establish simple signals to guide their progression through the 16 muscle groups. When explaining the method, the therapist should not only describe the tense-and-relax procedure and the muscle sequence to be followed but should also establish with the learner exactly what instructions will be given, what the learner should do in response, and how the learner will signal silently that the target muscles are completely relaxed. For example, the therapist might explain that each instruction will end with the word “now” (e.g., “Tense the muscles in your right hand and forearm by making a tight fist now ”), and that the word “now” is the learner’s cue to tense or relax those muscles all at once, not gradually. The therapist and the learner should also arrange a comfortable way for the learner to signal that the muscles are fully relaxed without speaking or creating unnecessary muscle tension, such as by lifting the index finger on one hand that is visible to the therapist ( Bernstein, Carlson, & Schmidt, 2007 ). The therapist should briefly work through each of the tense-and-release procedures with the learner before training begins, demonstrating each procedure, observing and coaching the learner as needed, and proceeding in the same order to be used during the session. This guided practice will help ensure that the learner understands the method and put him at ease during relaxation.

Relaxation training begins with the learner reclining comfortably. The therapist asks the learner to focus attention on sensations in the first muscle group, allowing the rest of the body to relax. Using the established instruction, the therapist asks the client to tense the target muscles. They should remain tensed for about 5–7 seconds (or shorter for the muscles of the feet and others that cramp easily), while the therapist suggests ways to focus on the sensations. At the end of the tension interval, the therapist uses the established cue to tell the learner to relax all the muscles completely at once. During the relaxation interval (30 to 40 seconds), the therapist again gently suggests ways of concentrating on the sensations of relaxation in the relevant muscles. In this way, the therapist guides the learner through tensing and relaxing each muscle group twice, allowing a slightly longer relaxation interval of 45 to 60 seconds during the second repetition, before proceeding to the next muscle group. If, after two repetitions with a particular muscle group, the learner has not signaled complete relaxation, the process can be repeated up to four or five times, at which point it is appropriate to try an alternate solution (see Bernstein, Borkovec, & Hazlett-Stevens, 2000 ).

During the tensing and relaxing intervals, the therapist should use suggestions that help the learner to observe sensory changes (e.g., “Notice what it’s like to feel the muscles pulling tight” or “Focus on the feeling in these muscles as they become more relaxed”) rather than prescriptive or descriptive statements about what the learner should feel (e.g., “Your muscles are feeling deeply relaxed now”). Using passive suggestions helps show the learner how to become a passive but keen observer of these sensations. It also keeps the focus on the learner’s own experience and avoids the possibility that the therapist’s statements will not match what the learner feels—if, for example, he is having trouble relaxing—which can create needless tension ( Bernstein, Borkovec, & Hazlett-Stevens, 2000 ).

At the session’s end, one way for the therapist to ease the learner out of the relaxed state is by instructing him to move his feet and legs on the count of 4, hands and arms on 3, head and neck on 2, and to sit up on 1, and then counting backward slowly from 4 to 1. The therapist should then ask open-ended questions to encourage the learner to discuss thoughts and questions about the experience. When the learner has mastered this method of deep relaxation, perhaps after several sessions and regular daily practice, he can move on to progressively shorter relaxation sequences that combine the original 16 muscle groups into 7 groups, then into only 4 groups. Using the same tense-and-relax procedure with these larger muscle groups allows the learner to achieve deep relaxation more quickly. The learner then can move on to releasing tension by systematically, vividly recalling the sensations of muscle relaxation, first while focusing attention on the now-familiar muscle groups in sequence, then by learning to associate the sensations of relaxation with a slow count to 10. By the end of the training, then, the learner should be able to relax thoroughly in the time it takes to focus the mind and make this mental count.

The goal of this comprehensive but less intense training also differs, in part, from that of traditional PMR. Both methods teach similar ways of achieving deep relaxation by systematically lowering autonomic activation. But unlike traditional PMR, APMR focuses on developing the learner’s ability to notice and voluntarily release unwanted tension, placing little emphasis if any on achieving automaticity and muscle-mediated control of stressful thoughts.

Empirical Support

Several decades of research has provided ample evidence for the benefits of both the traditional and the abbreviated PMR techniques for reducing stress, and for improving a variety of psychiatric and somatoform problems to which stress contributes. Jacobson (e.g., 1938 , 1970 ) documented successful applications of his method for treating nervous hypertension, acute and chronic insomnia, fatigue, cyclothymia, dysthymia, hypochondria, obsessive-compulsive disorder, and several other anxiety problems resembling generalized anxiety disorder or panic (then termed “anxiety neuroses”), as well as essential hypertension, tension headaches, esophageal spasms, several bowel disorders, and convulsive tics.

More recent reviews have bolstered many of Jacobson’s findings, consistently supporting the effectiveness of PMR techniques (including APMR) for stress, generalized anxiety, specific anxieties and phobias, hypertension, and tension headaches ( Borkovec & Sides, 1979 ; Carlson & Hoyle, 1993 ; Hyman, Feldman, Harris, Levin, & Molloy, 1989 ; King, 1980 ; Lehrer, 1982 ; Lehrer & Woolfolk, 1984 ). Newer studies of PMR have continued to support these conclusions (see Bernstein, Carlson, & Schmidt, 2007 ), while expanding the list of conditions that PMR can help to improve. In recent years, it has been shown to reduce anxiety and boost well-being for patients with schizophrenia ( Vancampfort et al., 2011 ); reduce chronic pain associated with osteoarthritis ( Gay, Philippot, & Luminet, 2002 ) and cancer ( Tatrow & Montgomery, 2006 ); decrease behavioral problems in Alzheimer’s patients ( Suhr, Anderson, & Tranel, 1999 ); and increase adherence to sleep apnea treatment ( Wang, He, Wang, Liu, & Tang, 2012 ); among other benefits.

Issues for Future Research

Given the substantial support for PMR’s effectiveness, one important area for future research involves finding new ways of deploying the technique, for example, applying it more cost-effectively and combining it with newer therapies that may provide added benefits. Although individual PMR training has been shown to achieve larger effect sizes on average than group sessions ( Carlson & Hoyle, 1993 ), recent work suggests that even a single, large-group training session can significantly reduce anxiety and speed recovery from a brief stress exposure ( Rausch, Gramling, & Auerbach, 2006 ). Extensions of this training model could reduce stress in institutional settings such as workplaces ( Hahn, Binnewies, Sonnentag, & Mojza, 2011 ) and psychiatric facilities ( Hall & Long, 2009 ).

One way in which PMR is being combined with new stress management approaches is its incorporation into computer-supported and computer- delivered therapies. One computer-assisted group treatment for social phobia utilizes palmtop computers to prompt APMR practice and guide clients through the process ( Przeworski & Newman, 2004 ). Palmtop computers and smartphones offer an efficient means of enhancing group PMR therapies with individualized follow-up, which may improve long-term adherence to practice. PMR is also being combined with virtual-reality exposure therapy for phobias ( Muhlberger Herrmann, Wiedemann, Ellgring, & Pauli, 2001 ) and delivered virtually with immersive video ( Mezo, Hall, Duggan, & Noël, 2011 ).

The period in which evidence supporting PMR’s efficacy has accumulated has also seen major advances in psychophysiology and neuroscience, allowing researchers to pursue a more rigorous and detailed account of its mechanisms of action ( Conrad & Roth, 2007 ). These studies often have focused on healthy volunteers, examining physiological correlates of APMR and their possible contributions to stress relief. Findings include evidence of decreases in salivary cortisol ( Pawlow & Jones, 2002 , 2005 ); higher salivary concentration and secretion rate of immunoglobulin A, an antibody critical to mucosal immunity ( Pawlow & Jones, 2005 ); and an increased threshold in the nociceptive flexion reflex, a spinal reflex used to study pain processing ( Emery, France, Harris, Norman, & VanArsdalen, 2008 ). At the same time, evidence for its theoretical rationale—particularly pertaining to treatment of anxiety—has been characterized as “mixed at best” ( Conrad & Roth, 2007 , p. 259). For example, contrary to the assumptions of PMR, patients with panic disorder or generalized anxiety disorder do not consistently show elevated muscle tension and autonomic activation. Because relatively few studies of PMR’s effectiveness have included thorough measures of muscle tension, the possibility remains that its effects are largely or entirely cognitive, based on developing a sense of personal control and confidence through the training process. A more precise dismantling of the cognitive and psychophysiological mechanisms of PMR for specific conditions will contribute significantly to the development of a coherent theoretical framework for explaining shared mechanisms of mind-body interventions ( Taylor, Goehler, Galper, Innes, & Bourguignon, 2010 ).

Western medical and psychological practice tends to regard respiratory changes as signs or symptoms of a health problem, and numerous treatments and therapies have been devised to correct respiratory malfunctions. In contrast, in some areas of the East and particularly in India, breathing techniques have been used for millennia as a means of improving the functioning of many physiological systems as well as for spiritual purposes ( Chandra, 1994 ).

Archaeological evidence suggests that well- developed yogic methods of breath control were used to promote spiritual and physical health as early as 3000 B.C. ( Rowland, 1953 ). The breathing techniques collectively known as pranayama incorporate several key features that remain important to various types of yoga practice, which have also been incorporated into some Western cognitive-behavioral stress management therapies ( Chandra, 1994 ). These features include enhancing abdominal or diaphragmatic breathing, and two additional approaches—prolonging exhalation to slow and regularize breathing, and imposing resistance during inhalation and exhalation (described later). Due, in part, to the evidence that purposeful, systematic changes in breathing can affect physiological and psychological arousal, many forms of relaxation training and therapy incorporate controlled breathing techniques. These include progressive relaxation ( Bernstein & Borkovec, 1973 ), autogenics ( Luthe, 1969–1973 ), stress-inoculation training ( Meichenbaum, 1977 ), many forms of yoga practice ( Iyengar, 1966 ), tai chi and qigong ( Liao, 1990 ), and Zen meditation ( Kapleau, 1965 ).

Respiration is the only involuntary vital function that is also subject to direct, intentional control ( Ley, 2003 ). Breathing has pervasive psychophysiological influences, including cardiovascular and neurological effects, so voluntary respiratory control can significantly reduce (or increase) states of physical and psychological tension. Likely because breathing is readily modifiable and has rapid mental and physical effects, it has been ranked as the most popular stress management method ( Umezawa, 2001 ). In this context, it is important to consider the reciprocal relationships between breathing and other body systems: Relaxing slows breathing and lengthens exhalation pauses. Conversely, willfully practicing these respiratory changes often reduces tension. Thus, respiration serves as both an indicator of stress and a potential regulator thereof ( van Dixhoorn, 2007 ).

Several complementary perspectives contribute to the therapist’s view of breathing difficulty or dysregulation. The first of these perspectives centers on the primary functions of breathing ( van Dixhoorn, 2007 ). The most common lay understanding focuses on ventilation, the movement of air in and out of the lungs, primarily for the metabolic purposes of gas exchange. Along with its life-sustaining purpose, respiration also serves a necessary, less-recognized role in speech. Consequently, psychosocial factors may cause or exacerbate some kinds of breathing difficulties, and vice versa ( De Peuter et al., 2004 ).

A second perspective focuses on breathing rhythm and mechanics as physiological regulators ( van Dixhoorn, 2007 ). Respiration causes pressure changes that facilitate circulation of blood, lymph, and cerebrospinal fluid, and it is linked to heart rate through oscillatory feedback systems ( Hirsch & Bishop, 1981 ). Parts of the respiratory anatomy affect posture and weight bearing as well as voluntary motor coordination. Additionally, recent evidence suggests that the neural circuits through which perceptual information affects the hypothalamic-pituitary-adrenal axis may simultaneously shape breathing patterns ( Abelson, Khan, & Giardino, 2010 ).

The third perspective, emphasizing breathing as an information source in self-perception, is especially important in breathing therapies ( van Dixhoorn, 2007 ). Internal respiratory feedback can reflect or instill a sense of either unrest or relaxation, linking one’s internal state with an appraisal of the immediate environment. Individual variations in sensitivity to this feedback can have significant clinical implications. Among patients with severe asthma, those less attuned to breathing sensations may be more vulnerable to serious attacks ( Kikuchi et al., 1994 ), while less sensitive patients with asthma or chronic obstructive pulmonary disease (COPD) risk delaying self-medication until a breathing problem becomes urgent ( Noseda, Schmerber, Prigogine, & Yernault, 1993 ). Respiratory hypersensitivity is also associated with clinical problems, as patients with panic disorder or hypochondriasis may detect small changes in airway resistance more accurately than do nonpatient controls ( Ehlers, 1997 ). Respiratory sensitivities also influence whether patients report breathing problems and how helpful they find breathing therapies.

Types of Breathing

Chest breathing , or costal breathing, involves movement of the chest wall outward and upward with each draw of breath. This type of breathing, which may be shallower and less regular than other types, is likely to be associated with high-arousal states and is typically more efficient during exercise than at rest ( Patel, 1991 ). Clavicular breathing involves maximum-capacity inhalation that completely fills the lungs. It gets its name from the clavicles, or collar bones, which rise slightly at the end of a full inhalation when the tops of the lungs expand. Clavicular breathing happens only when the body struggles to meet its need for oxygen; it may be seen in patients suffering from chronic bronchitis or asthma ( Patel, 1991 ). Abdominal breathing , or diaphragmatic breathing, principally relies on the movements of the diaphragm, a thin, strong muscle sheet that extends across the bottom of the rib cage and separates the thoracic and abdominal cavities. In this type of breathing, which is often used in yoga practice and in relaxation therapies, the diaphragm contracts downward with each breath, the abdominal muscles relax upward, and the lungs expand, drawing in air. During exhalation, the diaphragm relaxes and abdominal muscles contract. Abdominal breathing involves a focus on limiting the upper ribs’ movement during each breath and instead pushing out the upper abdominal wall ( Chandra, 1994 ).

No single standard defines the optimal way of breathing. While slow deep breathing is healthy in some conditions and should not cause feelings of dyspnea, this does not imply that it is always, or usually, the best way to breath. Instead, functional breathing is most often variable, changing with little or no effort in response to circumstances ( van Dixhoorn, 2007 ; Ley, 1994 ). Many of the therapeutic techniques described next aim to promote this responsiveness to visual, auditory, or kinesthetic stimuli. Breathing can also be too irregular, however, as when people with high anxiety alternate between rapid breaths and deep sighs ( Wilhelm, Gevirtz, & Roth, 2001 ). The goal of breathing-focused stress management is to eliminate undue respiratory effort while balancing the emphases on the stability versus the flexibility of the breathing pattern according to the individual’s needs.

Finally, although practicing the techniques learned during therapy sessions is extremely important, healthy breathing should happen effortlessly and outside conscious regulation in most circumstances. Therefore, it is equally necessary for the patient to stop practicing and take time to self-observe, with the therapist’s guidance, how physical and mental sensations change or persist when conscious regulation of breathing stops. In this respect, therapeutic techniques that involve short periods of controlled breathing followed by relinquishment of control to self-observe one’s relaxed mental and physical states resemble the earlier described tense-and-relax cycles of progressive muscle relaxation ( van Dixhoorn, 2007 ). These two types of therapy also take similar approaches to imparting their self-regulatory skills and techniques: In both cases, the therapist seeks to present instructions to the patient in a manner that is “more like an invitation for the system to respond favorably than [as] a dominant influence” ( van Dixhoorn, 2007 , p. 296).

Breathing Techniques

The technique of timing breathing includes several methods of regulating the rate or pace of respiration, typically for the purpose of focusing attention on taking slow, deep breaths. This technique is based on the idea that slowed breathing facilitates relaxation, reduces hyperventilation, or both ( van Dixhoorn, 2007 ). One way of keeping time is to count silently along with each breath, so that the duration of each inhalation and exhalation corresponds to the same rhythmic count with each breathing cycle. For example, counting at a rate that corresponds to comfortable breathing, one might count from 1 to 4 while slowly drawing breath for 4 seconds, and then continue the count from 5 to 8 while smoothly exhaling for 4 seconds. If keeping count is distracting, a count of “1, 1, 1 …” can also be used ( Benson, 1993 ). These approaches can also be applied to lengthen inhalation and/or exhalation, by slightly and gradually increasing the count per breath in 1-second (or one-digit) increments, perhaps inhaling for a 1 to 5 (rather than 1 to 4) count, then exhaling from 6 to 10 (rather than 5 to 8) while maintaining the prior pace of the count, and always taking care not to induce labored breathing or discomfort.

Similar methods help lengthen breathing by focusing attention on the exhalation pauses, those transitional moments between the end of an exhalation and the beginning of the next inhalation that emerge during relaxed breathing. Modifying the count to include exhalation pause (“in, 2, 3, out, 2, 3, pause, 2, 3”), or simply maintaining a silent, rhythmic recitation of “in … out … pause…. ” in synch with the breathing cycle, can help the patient notice and become accustomed to these points of transition. Another version of this approach that often promotes feelings of calm and control is to focus on both types of transition in the breathing cycle—when the air in the system reverses direction after an exhalation as well as after an inhalation. Though the practice is less common, timing techniques can also be used to encourage faster, shallower breaths to help break a habit of persistent, effortful deep breathing or to demonstrate to patients with medically unwarranted anxieties about airflow that a feared decrease in ventilation is not dangerous ( van Dixhoorn, 2007 ).

When a less direct regulatory approach than the timing method is needed, linking movement to breathing can be a helpful strategy, relying on the regulation of movements to regularize breathing indirectly. Rhythmic movements, such as running, walking, and many forms of aerobic exercise, tend to synchronize with breathing. When this kind of concurrence emerges, slowing or speeding up the movement tends to have a similar effect on respiration. Thus, simple rhythmic movements can be used as a mechanism to facilitate changes in breathing patterns without requiring the patient’s conscious attention to each breath. Jan van Dixhoorn suggests several movements that tend to become coupled to breathing, which can then be systematically slowed to affect the respiratory rate indirectly, such as “rolling the hands or arms in and out, moving the head up and down, pressing the fingers together and relaxing them, [or] flexing and extending the feet” (2007, p. 299). Walking more slowly than usual also has this effect on breathing, as long as it is not so slow as to become effortful ( van Dixhoorn, 2007 ). If a more direct focus on breathing is desirable (or at least is not contraindicated), breathing cycles can also be paired with the tense-and-release cycles of abbreviated progressive muscle relaxation. Tensing while inhaling is typical, but the reverse pairing of tensing with exhaling is more difficult and therefore can be especially useful for focusing attention on these bodily states ( van Dixhoorn, 2007 ).

Several methods of monitoring air passage can also be used to regulate and focus attention on breathing ( van Dixhoorn, 2007 ). Pursed-lips breathing, which involves mouth breathing through the lips while keeping them very gently pressed together, adds resistance to the air and thereby helps to maintain open airways, improving ventilation. Pursed-lips breathing tends to increase tidal volumes and to result in longer exhalation times, so it is important that while using this technique patients inhale slowly and gently, rather than gasping, to maintain a relaxed, focused state. To prevent hyperventilation, this technique should be used for only about 5 to 6 breaths in succession before taking a break and returning to normal breathing through the nose. Another method of monitoring air passage is simply to slow inhalation through the nose. This method poses less risk of hyperventilation than mouth breathing, while maintaining the benefits of increased tidal volumes and greater involvement of the whole body in the slow, steady drawing of breath. The attention-focusing and stress-alleviating potential of this technique can be enhanced by pairing it with imagery. The patient can be guided in imagining the air passing in through the nose and flowing down the throat, into the lungs and chest, and even pervading the rest of the body.

A robust literature developed over several decades shows that voluntary control of breathing can affect physiological and psychological arousal ( Ley, 1994 ). One facet of this research examined direct effects of breathing regulation on psychophysiological measures of experimentally induced arousal. Voluntarily slowed breathing ( McCaul, Solomon, & Holmes 1979 ) and prolonged exhalation relative to inhalation ( Cappo & Holmes, 1984 ) have been associated with lower levels of physiological (e.g., electrodermal response, finger pulse volume) and self-reported arousal. In contrast, hyperventilation has been shown to increase subjective anxiety and its psychophysiological correlates ( Thyer, Papsdorf, & Wright, 1984 ), an effect that may be enhanced in individuals with either high trait anxiety or anxiety sensitivity ( Sturges, Goetsch, Ridley, & Whittal, 1998 ). However, in a more recent study, various breathing instructions tested in a 3-hour session—for example, attending to breathing, or anti-hyperventilation techniques of breathing more slowly, shallowly, or both—had no significant psychophysiological effects. Homeostatic mechanisms counteracted most effects of purposeful control of breathing ( Conrad et al., 2007 ). These authors noted that different instructions, additional practice, and combining instructions with feedback may induce greater physiological changes, and that cognitive training mechanisms underlying breathing-based relaxation also contribute to its efficacy.

Breathing-focused therapies are also incorporated into medical treatment, with the goal of decreasing stress associated with chronic illness ( Gilbert, 2003 ). Given that relaxed, responsive, effortless breathing can have widespread physiological benefits—less upper-body muscle tension, more stable blood chemistry, a more healthful balance of sympathetic–parasympathetic nervous system activation, and improved oxygenation in the lungs—changes in breathing may also improve some medical symptoms ( Gilbert, 2003 ). Many studies investigating this potential have focused on cardiovascular diseases (e.g., essential hypertension, angina, functional chest disorder, and cardiac rehabilitation), as well as COPD, and some therapies appear to be beneficial (see Gilbert, 2003 for a review).

One clinical trial randomly assigned 156 myocardial infarction patients to one of two rehabilitation programs: exercise training alone or exercise plus six sessions of breathing-focused relaxation therapy. Breathing therapy initially was associated with enhanced effects of exercise and improved well-being ( van Dixhoorn et al., 1989 ), and these patients later showed improved return to work and a 50% lower incidence of cardiac medical events ( van Dixhoorn & Duivenvoorden, 1999 ; van Dixhoorn & White, 2005 ). At 5-year follow-up these patients showed a 31% lower rehospitalization rate than those who rehabilitated with only exercise, offsetting the relaxation therapy costs ( van Dixhoorn & Duivenvoorden, 1999 ).

Future research promises to improve the use of breathing therapies for stress by developing increasingly precise ways of measuring respiration outside the laboratory and integrating these measures with other physiological indicators of stress. One such technology operates via personal computer to detect the pace of the user’s breathing. The system uses two pairs of small microphones to detect respiratory activity; it eliminates environmental noise from the respiratory signal, and then streams the data to the computer with a latency of less than 5 milliseconds ( Leskovsek et al., 2011 ). The small, noninvasive device requires no external power supply, suggesting it could be incorporated easily into ecologically valid studies of stress or breathing-focused interventions in the workplace, or used to provide feedback during patients’ real-world practice of breathing exercises.

Along similar lines, as the use of breathing therapies becomes more common in the context of medical treatment, there is growing interest in the ability to “prescribe” a precise course of breathing exercises that a patient can accurately follow at home. Devices supporting this kind of treatment have existed for decades, but they are becoming much smaller, more cost-effective, and easier for patients to use, and better able to provide physicians and researchers with precise data about patients’ treatment adherence and respiratory changes over time (e.g., Gavish, 2010 ). Other technologies that can help expand the use and understanding of breathing therapies include a wireless, wearable stress monitor that combines heart rate and respiratory information based on spectral density measures ( Choi, Ahmed, & Gutierrez-Osuna, 2012 ), and a system for measuring mental stress more precisely by distinguishing the influences of breathing on heart rate variability ( Choi & Gutierrez-Osuna, 2011 ). These innovations will not only make gathering data on respiration and stress easier and more precise but will also aid researchers in studying breathing techniques in the naturalistic circumstances where they might be productively applied.

Guided Imagery

Therapeutic uses of imagery may seem second nature because people commonly use imagery for psychological benefit—for motivation, escapism, or simply planning activities—without consciously considering its effects ( Hatler, 1998 ). Therapeutic imagery has roots in the earliest psychotherapies, but Freudians typically relied on patients’ spontaneous imagery. In contrast, the French psychotherapist Robert Desoille created a technique for directing patients’ mental imagery. In his “guided day dream method,” developed in the 1920s, the therapist described a series of six narratives or “themes” to the patient ( Klapish, 1973 ; Schoettle, 1980 ). Each session focused on one theme, which set the patient as the protagonist in an archetypal story thought to facilitate access to unconscious conflicts (e.g., diving into a shipwreck for treasure). The patient elaborated and described this “experience,” then the patient and therapist would later discuss the “day dream’s” significance. A similar guided affective imagery method, developed by the German psychiatrist Hanscarl Leuner in the late 1940s, involved a series of 10 psychoanalyst-guided visualizations ( Leuner, 1969 ). These scenarios were likewise symbolic but less story-directed to maximize their projective potential. Some of them, like being in a meadow or near a babbling brook, remain popular in relaxation therapies.

Around the same time, the South African psychiatrist Joseph Wolpe (1969) was refining his systematic desensitization treatment for phobias—quite a different enterprise from imagery-driven psychoanalysis, but one that similarly used mental imagery therapeutically. His treatment, which became foundational to behavior therapy, relied on “imaginal exposures” to the phobic stimulus, in which the therapist guided the patient through increasingly frightening imagined encounters with the feared object or situation. Each exposure was coupled with Jacobsonian progressive muscle relaxation to help the patient remain calm. Informed by laboratory research on conditioning, Wolpe based this method on his reciprocal inhibition theory: the idea that because the body cannot be simultaneously relaxed and anxious, patients could face fears by learning to relax during frightening encounters. Though Wolpe used imagery to induce fears, he was a pioneering proponent of its power in treating anxiety. Modern cognitive-behavioral therapies still use imagery as a form of practice for facing anxiety-provoking situations ( Ronen, 2011 ).

Clinical experience has long suggested a close relationship between imagery and emotion, but evidence has been limited and widely dispersed until recently ( Hackmann, Bennett-Levy, & Holmes, 2011 ). Early research showed that people who considered themselves “good” rather than “poor” imagers had stronger psychophysiological responses to highly active or affective (fear, anger) visualizations, and their responses showed more enhancement with training ( Miller et al., 1987 ). These findings were interpreted in support of a bioinformational theory ( Lang, 1979 ), in which recreating or recalling emotional images elicits the same patterns of neural activity as the imagined experiences would ( Denis, Mellet, & Kosslyn, 2004 ; Kosslyn, Ganis, & Thompson, 2001 ; Lang, Greenwalk, Bradley, & Hamm, 1993 ). Although findings associating imagery with specific psychophysiological responses are mixed, and some clinical populations have shown different response patterns from controls (see Vianna, Naqvi, Bechara, & Tranel, 2009 ), imagery’s potential for exerting stronger therapeutic emotional change than verbal thought has prompted direct experimental comparisons.

Holmes, Matthews, and colleagues presented participants with verbal descriptions of brief scenarios, each of which began with an emotionally ambiguous premise then resolved in either a neutral or an emotionally charged way ( Holmes & Matthews, 2005 ; Holmes, Mathews, Dalgleish, & Mackintosh, 2006 ). In each experiment, participants in the verbal condition focused on the meanings of the words describing the scenarios, while those in the imagery condition imagined the scenarios. Between the two, those who imagined the events showed stronger emotional responses ( Holmes & Matthews, 2005 ; Holmes et al., 2006 ). In another paradigm, participants viewed picture–word pairs in which each word suggested either a negative or a benign interpretation of its associated picture ( Holmes, Coughtrey, & Connor, 2008 ). In one condition, participants thought of sentences using each picture–word pair; those in the other condition imagined combining each pair ( Holmes et al., 2008 , p. 401). Again, participants who used imagery showed stronger emotional responses than did those who combined the pairs verbally.

One evolutionary explanation for imagery’s emotional power may be relevant to its therapeutic use. Öhman and Mineka (2001) suggested that the neural circuitry supporting fear constitutes an evolved module highly sensitive to perceptual stimuli, such as images, necessary for identifying threats. They proposed that this module operates largely outside conscious control, including regulation by verbal thoughts, because its evolutionary development long predates conscious thought and language ( Öhman & Mineka, 2001 ). In this view, if guided imagery helps patients to replace stress-inducing mental images with calming ones, it may promote relaxation through neural and somatic mechanisms that are less responsive to conscious control.

Guided imagery can be incorporated into a wide variety of therapeutic approaches to stress management, and it has often been studied in combination with other relaxation methods. One reason for its broad use and frequent combination with other techniques is that, to a greater extent than some other relaxation methods (e.g., Jacobson’s progressive muscle relaxation training program), the specific content and method of guided imagery can be tailored to suit the individual patient’s needs. Another reason is that imagery and relaxation may have reciprocally enhancing effects, so that imagery helps to deepen relaxation, which in turn facilitates immersion in a vivid, imagined scene ( Hatler, 1998 ).

Many practitioners who use guided imagery rely on scripts, which are standardized written scenarios that can be read verbatim or can provide starting points for more improvised guided imagery sessions. Practitioners can acquire them from numerous bookstores and Web sites (also see sample scripts in Hatler, 1998 ; Tusek & Cwynar, 2000 ), or they may choose to personalize their scripts, either by revising existing ones for particular patients or problems or creating entirely new scripts. Particularly for less experienced clinicians, using a script can help to ensure that the patient experiences the clinician’s guidance during the session as soothing, effortless, and consistent. The scripts themselves can vary from highly individualized to relatively generic, so long as they include cues to help patients elaborate on the evoked mental images with their own most relaxing, personally resonant sensory details. Some clinicians find it useful to create several basic scripts pertaining to the kinds of problems they typically treat and to modify them as needed in their work with individual patients ( Hatler, 1998 ). The scripts can also be provided to the patient for use outside of therapy sessions, either in written form (for use with a close other) or as an audio recording.

During the guided imagery session, the therapist should speak in a soothing, gentle tone that will foster the patient’s personal reflections ( Hatler, 1998 ). The script may begin with a brief physical relaxation procedure, such as a form of deep breathing or muscle relaxation, conducted with eyes closed ( Tusek & Cwynar, 2000 ). This process serves as an induction, or a transitional phase, to help the patient enter a different mental state ( Battino, 2007 ). During this time, the patient is encouraged to focus on the present moment and begin letting go of racing thoughts and nagging concerns, instead bringing to mind any images that evoke a sense of peace and restfulness. The patient should remain in a comfortable, relaxed position (seated, reclining, or supine), with eyes closed for the duration of the guided imagery session, in order to focus on the imagined sensations and limit distractions from the physical environment.

An important goal of guided imagery that can inform the clinician’s selection or creation of scripts is to help the patient to envision and to experience a special imagined place that serves as a sanctuary from stress and anxiety ( Hatler, 1998 ). For some patients, this place may be a natural environment, while others may prefer a familiar park or a favorite room. Ideally, the patient should choose his own location where he feels completely safe and calm, since a scene chosen by the therapist may have adverse associations for the patient ( Hatler, 1998 ), though some generic locations such as a beach or a meadow may provide a helpful starting point for beginners or patients who have difficulty creating images.

During the session, the therapist’s language should reinforce the patient’s sense of being protected and at ease in this place, while helping him focus on the soothing sensory qualities of the experience. Rich, absorbing imagery should include not only what the patient sees in this environment but also what he hears, smells, and perhaps tastes, and how these aspects of the experience make him feel. Positive imagery confers stronger emotional benefits when it is imagined from a first-person perspective rather than a third-person or observer perspective ( Holmes et al., 2008 ); focusing on a variety of sensory experiences may help the patient develop and maintain a first-person perspective that places him within the imagined experience. Additionally, scripts that carefully use repetition and pauses can also help to deepen patients’ relaxation and provide opportunities to develop their imagery independently ( Hatler, 1998 ). The general tenor of the script should convey feeling of courage and calm, with a focus on accepting lessons learned from past experiences and moving forward in life with substantial personal capabilities on which to draw ( Tusek & Cwynar, 2000 ). Themes of finding and developing inner resources can support a sense of self-efficacy that contributes to patients’ ability to manage daily stress independently through effective self-care ( AGI, 2011 ).

After the person is oriented and comfortable in the imagined place, some scripts may include an encounter with a guide who supports the patient through the imagery experience and can serve as a source of strength and wisdom ( Hatler, 1998 ; Tusek & Cwynar, 2000 ). The guide can be a loved one, a close friend, a past or present mentor, or even a beloved pet, a favorite animal, or an immaterial spiritual presence. If the script features a guide, it should help to instill a sense of the guide as a trusted companion in the imagined experience or as a watchful, protective presence who can provide help if it is needed. In some cases, patients may discover this kind of supportive, imagined presence on their own, even when they are not explicitly included in the script ( Tusek & Cwynar, 2000 ). The use of imagined guides or protectors is just one means of facilitating the patient’s ability to draw on his own inner resources for creative problem-solving and resilience ( AGI, 2011 ). Guided imagery techniques in which patients are encouraged to interact with a guide or with other figures, including symbolic representations, are sometimes called interactive guided imagery techniques ( Heinschel, 2002 ). Although this approach has been studied less often than guided imagery that lacks a clear interactive component, the boundary between these types is not always clear, and both appear to have beneficial effects ( Heinschel, 2002 ).

Another common technique for enhancing the guided imagery experience is to combine it with soothing music played in the background at a low to moderate volume ( Tusek & Cwynar, 2000 ). Music has a long history of therapeutic use to reduce stress, anxiety, and pain, as it seems to help distract from negative thoughts and promote a soothing mental escape from pressing concerns ( Nilsson, 2008 ). A recent meta-analysis of music-assisted stress reduction therapies conducted in medical, university, and occupational settings found consistently positive results and noted that “music-assisted verbal suggestion” was one of two procedures producing the largest average effect sizes in stress reduction measures among the 22 studies examined ( Pelletier, 2004 ). For clinicians who wish to incorporate music into the guided imagery experience, this paper also describes the most effective selections for relaxation as typically including “a slower tempo, low pitches…. regular rhythmic patterns, no extreme changes in dynamics, and no lyrics” ( Pelletier, 2004 , p. 209). If the script describes a particular natural setting, such a being on a beach or near a stream, recordings of the sounds of that environment can also enhance the experience ( Tusek & Cwynar, 2000 ), particularly for patients who find it difficult to conjure or maintain vivid mental images.

Finally, it is important to bear in mind that the broadly flexible uses of guided imagery for relaxation and stress management differ significantly from its more restrained and programmatic uses in treating psychological disorders. Imagery is a powerful treatment tool, and different imagery-based techniques have been developed and tested for many specific disorders. Consequently, practitioners must ensure that a particular therapeutic use of guided imagery for stress management is appropriate for the individual patient and is not contraindicated by existing psychopathology ( Harding, 1996 ). Several types of problems that may preclude the use of guided imagery for relaxation include posttraumatic stress disorder or other trauma-related stress, obsessive-compulsive disorder, severe anxiety or phobias, dissociative disorders, and hallucinations or delusions, among others (for additional information, see Arthbhnott, Arbuthnott, & Rossiter, 2001 ; Courtois, 2001 ; Harding, 1996 ).

Relatively little cognitive-behavioral therapy- based research has investigated effects of positive mental imagery ( Hackmann, Bennett-Levy, & Holmes, 2011 ). One review of imagery’s uses in symptom management noted five studies in which guided imagery reduced stress in medically healthy individuals ( Eller, 1999 ). Another more recent study of an imagery intervention for people with dysphoria showed that generating positive images in response to picture-word prompts led to mood improvements and related cognitive and behavioral changes that remained evident 24 hours later ( Pictet, Coughtrey, Mathews, & Holmes, 2011 ).

Additional evidence from sports psychology and health psychology has demonstrated guided imagery’s value for stress management. Studies of many athletic activities, including basketball, weight lifting, archery, skating, and military parachute jumps, among others, suggest that mental imagery can help athletes reduce anxiety ( Jones & Stuth, 1997 ; Vadoa, Hall, & Moritz, 1997 ). Researchers have also examined the content of athletes’ self-generated imagery and documented links between particular types of imagery, athletes’ mental states (e.g., confidence, anxiety), and performance ( Jones & Stuth, 1997 ; Monsma & Overby, 2004 ; Vadoa, Hall, & Moritz, 1997 ).

Guided imagery also has a substantial history in medicine, especially as practiced by nurses as an adjuvant therapy to reduce patients’ stress ( Stephens, 1993a ). One transdiagnostic application is its use for pain management across a variety of medical conditions ( McCaffery, 1989 ; Stephens, 1993a ). Cognitive mechanisms potentially contributing to this effect include providing distraction, enhancing relaxation, and inducing a state of autohypnosis ( Stephens, 1993a ); however, like many stress management therapies, its underlying mechanisms are not well understood.

Closely related to its potential contributions to medical symptom management, imagery offers psychological benefits, helping patients manage anxiety and muster the inner resources required to undergo difficult treatments. Many uses of imagery in medical contexts, such as problem reframing, regaining a sense of control in life, facing one’s limitations, and developing the strength to make major lifestyle changes ( Stephens, 1993b ), map clearly onto therapeutic goals of cognitive-behavioral therapists and clients. One study of imagery focused on the intersection of its medical and psychotherapeutic uses involved adding imagery-supported relaxation to prenatal care to reduce maternal stress. Use of a CD-recorded guided imagery intervention for 12 weeks was associated with a significant reduction in the women’s state anxiety ( Jallo, Bourguignon, Taylor, Ruiz, & Goehler, 2009 ).

The study of positive guided imagery as a technique for relieving stress and promoting relaxation has generated much research ( Jones & Stuth, 1997 ; Stephens, 1993a , 1993b ), but few studies have systematically examined its use in combination with other cognitive-behavioral interventions, making this an important and likely area of future growth ( Hackmann, Bennett-Levy, & Holmes, 2011 ). One productive new avenue of research with likely implications for the use of imagery in stress management is the development of computerized cognitive bias modification (CBM; Hackmann, Bennett-Levy, & Holmes, 2011 ; Koster, Fox, & MacLeod, 2009 ). CBM is a computer-based training method designed to help individuals decrease negative biases in information processing and promote more adaptive interpretations. Imagery-based CBM uses a paradigm similar to the earlier described experimental task ( Holmes et al., 2006 ), in which participants heard and envisioned brief descriptions of ambiguous scenarios that then resolved in either a neutral or a positive way. The CBM programs present similarly ambiguous scenarios in repeated trials to help train people with depression to make positive, imagery-supported interpretations more habitually. The investigators suggest that practice with positive-imagery CBM may be most helpful for people who tend to interpret ambiguous everyday situations negatively.

Scientific and Clinical Issues in Cognitive-Behavioral Stress Management

Physiological and cognitive mechanisms.

The abundance of stress management and relaxation techniques considered “cognitive-behavioral” raises questions about these varied methods’ mechanisms of action. Like the refinement of the techniques themselves, the study of their mechanisms has developed within the parallel areas of basic stress science and clinical, efficacy-focused comparisons of treatments for specific stress-related pathologies. Research in both areas was initially framed by a decades-old question: To what extent are the effects of the different techniques mediated by common or modality-specific processes ( Lehrer, Carr, Sargunaraj, & Woolfolk, 1994 ; Smith, Amutio, Anderson, & Aria, 1996 )?

This question spurred the development of several theories. First, Benson’s (1975) “relaxation response” model suggests that all relaxation techniques have the same complex of generalized physiological effects, resulting in reduced levels of arousal. In contrast, Davidson and Schwartz (1976) proposed a technique-specific model that distinguished between the effects of somatic, cognitive, and behavioral relaxation methods. A third model then integrated elements of the first two, describing a reduction in physiological activity common to all techniques (consistent with Benson’s “relaxation response”) on which particular techniques’ specific cognitive or somatic effects were then “superimposed” ( Schwartz, Davidson, & Goleman, 1978 ).

Consistent with the third, integrative model, Lehrer and colleagues’ extensive meta-analysis of the comparative effectiveness research found both generalized physiological effects of relaxation and technique-specific advantages in many direct treatment-based comparisons ( Lehrer et al., 1994 ). To minimize bias due to methodological differences, they analyzed the consistency of significant effects across studies rather than comparing effect sizes. Technique-specific advantages were more likely when the techniques being compared showed a clear contrast between modalities (e.g., PMR versus mantra meditation), and when one of the techniques “directly pinpoint[ed] the system being assessed at outcome” ( Lehrer et al., 1994 , p. 386). More broadly, findings from many controlled studies of various relaxation techniques’ physiological effects (e.g., cardiovascular functioning, glucose tolerance, lipid profiles, and neuroendocrine functioning) are consistent with the general notion that these practices promote a healthy state of dynamic equilibrium (e.g., Gaab et al., 2003 ; see Taylor et al., 2010 for a review).

Although biological mechanisms for stress management techniques are not yet well understood, research into the physical and mental workings of both stress and relaxation has implicated some relevant central and peripheral pathways. These approaches often highlight the complex reciprocal connections between the brain, as the “the central mediator and target of stress resiliency and vulnerability processes” and other body systems, which undergo wear and tear in modulating dysregulated threat responses ( McEwen & Gianaros, 2011 , p. 432).

The neuroscientific study of relaxation has often focused on various meditation techniques. Within this area, findings on the neurocognitive effects of focused attention methods, which combine attentional control (e.g., focusing on breath) and lowered physiological arousal, may help to inform future research into other cognitive-behavioral approaches, including those discussed earlier in this chapter. In this relatively young research area, the heterogeneity in the studied states, control populations, and tasks ( Slagter, Davidson, & Lutz, 2011 ) makes the findings to date difficult to synthesize (see Cahn & Polich, 2006 for a review). Nonetheless, a number of studies have described potentially beneficial effects of regular focused attention meditation on brain structures involved in sustained attention, as well as on proficient attentional processing abilities ( Lutz et al., 2008 ; Slagter, Davidson, & Lutz, 2011 ). As research in this area progresses, studies linking the structural and functional changes in the brain that are associated with relaxation practices may provide important insights into their cognitive and physiological mechanisms.

Other researchers have focused on cognitive changes associated with regular use of cognitive-behavioral relaxation techniques, including the development of a common set of skills across techniques as well as technique-specific effects. The common skills theorized to be important to all types of cognitive-behavioral relaxation training include focusing attention (directing and sustaining attention on simple stimuli), passivity (slowing or stopping purposeful, analytic thought), and receptivity (becoming open to unfamiliar subjective states; Smith, 1990 ). Furthermore, the various focused attention meditation techniques are thought to bolster not only sustained attention but the crucial attention-regulating skills of remaining aware of distractions without losing focus, disengaging from distractions, and returning attention to the object of focus ( Slagter, Davidson, & Lutz, 2011 ). Neuroimaging studies suggest that, with practice, these meditation techniques may produce broad, lasting improvements in sustained attention along with a practice-dependent decrease in the effort required to exert this cognitive control ( Slagter, Davidson, & Lutz, 2011 ).

These and other cognitive changes that may come with relaxation practice help to deepen the experience of relaxation, and they may bring about other therapeutic cognitive effects as well. Over the long term, for example, the learning process and regular practice required to utilize most cognitive-behavioral relaxation techniques may also have implicit effects on the client’s values and beliefs ( Smith et al., 1996 ). Because new techniques present clients with challenges that cannot be met successfully through greater striving and pressure, these techniques may provide an opportunity to break stress-increasing mental patterns and to develop healthier approaches to tasks and goals. As Smith and colleagues (1996) describe, training-specific realizations, such as “ ‘relaxation works better if I stop worrying about practicing perfectly’ [may] evolve into more encompassing personal philosophies (‘I’m an okay person and don’t have to be perfect to be accepted’)” (p. 65). As a counterpoint to these potentially technique-general cognitive effects, practitioners of the different techniques have described qualitatively distinct relaxation states (e.g., joyful, distant, calm, aware, limp) depending on their preferred technique ( Smith et al., 1996 ). This finding suggests that relaxation-induced psychological changes may follow an integrative model similar to the physiological changes, yielding a combination of generalized and technique-specific effects. As research on the physiological and cognitive substrates of these interventions progresses, it potentially will provide clinicians with increasingly practical guidance for choosing the most suitable techniques, as well as insights about when and whether particular approaches can be productively combined.

Applications in Institutional Settings

Examining the mechanisms of action underlying cognitive-behavioral approaches to stress management necessarily focuses attention on the processes taking place within the minds and bodies of practitioners. As noted earlier in the chapter, however, the development and clinical application of these techniques also has been significantly informed by research into stressful environmental conditions. Much of this work has incorporated Lazarus and colleagues’ transactional view of stress, in which stress is caused by the perception of disparities between the environmental demands on an individual and his or her ability to marshal adaptive resources (e.g., Lazarus, 1995 ). Over the last few decades, many institutions have become more aware of the functional and financial costs of operating as high-stress environments ( Pelletier & Lutz, 1990 ; Weinberg & Cooper, 2011 ). Consequently, some organizations, including workplaces, and hospitals, have used cognitive-behavioral stress management techniques to address these issues, at the levels of primary stress prevention and secondary interventions for managing stress symptoms ( McGregor & Antoni, 2009 ; McVicar, 2003 ; Richardson & Rothstein, 2008 ; van der Hek & Plomp, 1997 ).

Research into workplace stress management suggests that organization-specific interventions designed by a professional who takes into account feedback from employees at all levels about workplace stressors are especially effective at fostering a positive, collective approach to stress management ( Giga, Cooper, & Faragher, 2003 ). Because an intensive, highly customized approach will not be practical for all workplaces, however, it is important to note that more cost-effective implementation methods can also be helpful. For example, small group interventions teaching several cognitive-behavioral stress management techniques have been shown to be as effective when they are led by paraprofessionals from participating organizations (employees briefly trained by a clinical psychologist) as they are when led by a clinical psychologist ( de Jong & Emmelkamp, 2000 ). This dissemination model, in which paraprofessionals without advanced psychotherapy credentials are trained to administer evidence-based interventions, has been supported empirically in other areas of cognitive-behavioral practice (e.g., Craske et al., 2011 ). In the workplace, as well as other institutional settings, it could help to reduce the costs and complications of providing supportive, therapeutic interventions for stress.

Whether a workplace custom-designs its stress management program or adopts an existing approach, it will be useful to consider which types of techniques have proven useful in occupational settings. One recent meta-analysis of workplace stress management programs found approaches that allot time to relaxation training during the workday to be less effective on average than interventions that teach adaptive ways of appraising and responding to stressful workplace situations and encourage employees to practice these skills on the job ( Richardson & Rothstein, 2008 ). This finding suggests that teaching employees to cope with job stress effectively as it occurs may be a more suitable workplace goal than helping them to minimize or avoid stressors ( Meurs & Perrewé, 2011 ).

Hospitals can be highly stressful environments for staff and patients alike. Concerns about burnout, shiftwork effects, and understaffing among hospital nurses have led to a number of studies of occupational stress in this population (see Edwards & Burnard, 2003 ; McVicar, 2003 for reviews). Comparing separate, contemporary literature reviews that focused, respectively, on mental health nurses and nurses in medical hospitals suggests that the sources of nurses’ stress in both hospital environments are well characterized, but translating this knowledge into rigorous studies of effective interventions has proven difficult. Notably, most interventions documented in these studies have focused on individual-level changes, which the authors suggest may not be adequate without addressing some key sources of stress at the organizational level. On the other hand, incorporating relaxation and stress management techniques into patient care has shown some notable benefits for those managing chronic illnesses as well as those undergoing major procedures ( Baum, Herberman, & Cohen, 1995 ; Ludwick-Rosenthal & Neufeld, 1988 ; Nezu, Nezu, & Xanthopoulos, 2011 ). One area in which promising in-hospital applications of these techniques have been widely documented is the use of relaxation interventions to manage presurgical stress (reviewed in Johnston, 1993 ; Powell et al., 2010 ), which for some patients has been shown to hasten patients’ recovery and improve quality of life after surgery.

Conclusions

This overview of muscle relaxation, breathing, and guided imagery illustrates recent developments in cognitive-behavioral approaches to stress management. These and other techniques have generated evidence of efficacy with regard to a number of stress outcomes of importance to a variety of clinical populations. Refinements in technique have been accompanied by adaptations that take advantage of handheld electronic devices and address the need to incorporate stress management into various institutional settings.

Abelson, J. L. , Khan, S. , & Giardino, N. ( 2010 ). HPA axis, respiration and the airways in stress—a review in search of intersections.   Biological Psychology , 84 (1), 57–65.

Google Scholar

Academy for Guided Imagery (AGI). (2011). How guided imagery works . Retrieved March 2012, from http://www.academyforguidedimagery.com/whatisguidedimagery/howimageryworks/index.html

Almeida, D. M. , Stawski, R. S. , & Cichy, K. E. ( 2011 ). Combining checklist and interview approaches for assessing daily stressors: The Daily Inventory of Stressful Events. In R. J. Contrada & A. Baum (Eds.), The handbook of stress science: Biology, psychology, and health (pp. 583–596). New York: Springer.

Google Preview

Anderson, N. B. , & Armstead, C. A. ( 1995 ). Toward understanding the association of socioeconomic status and health: A new challenge for the biopsychosocial approach.   Psychosomatic Medicine , 23 , 3726–3751.

Anderson, B. , Wethington, E. , & Kamark, T. W. ( 2011 ). Interview assessment of stress exposure. In R. J. Contrada & A. Baum (Eds.), The handbook of stress science: Biology, psychology, and health (pp. 565–582). New York: Springer.

Arbuthnott, K. D. , Arbuthnott, D. W. , & Rossiter, L. ( 2001 ). Guided imagery and memory: Implications for psychotherapists.   Journal of Counseling Psychology , 48 (2), 123–132.

Arnsten, A. F. ( 2009 ). Stress signaling pathways that impair prefrontal cortex structure and function.   Nature Reviews Neuroscience , 10 (6), 410–422.

Battino, R. ( 2007 ). Guided imagery: Psychotherapy and healing through the mind–body connection . Carmarthen, Wales: Crown House.

Baum, A. ( 1987 ). Social density and perceived control as mediators of crowding stress in high-density residential neighborhoods.   Journal of Personality and Social Psychology , 52 (5), 899–906.

Baum, A. , Herberman, H. , & Cohen, L. ( 1995 ). Managing stress and managing illness: Survival and quality of life in chronic disease.   Journal of Clinical Psychology in Medical Settings , 2 (4), 309–333.

Benson, H. ( 1975 ). The relaxation response . New York: Morrow.

Benson, H. ( 1993 ). The relaxation response. In D. J. Goleman & J. Gurin (Eds.), Mind body medicine (pp. 233–257). Yonkers, NY: Consumer Reports Books.

Bernhaut, M. , Gelhorn, E. , & Rasmussen, A. T. ( 1953 ). Experimental contributions to the problem of consciousness.   Journal of Neurophysiology , 16 , 21–35.

Bernstein, D. A. , & Borkovec, T. D. ( 1973 ). Progressive relaxation training: A manual for the helping professions . Champaign, IL: Research Press.

Bernstein, D. A. , Borkovec, T. D. , & Hazlett-Stevens, H. ( 2000 ). New directions in progressive relaxation training: A guidebook for helping professionals . Westport, CT: Praeger.

Bernstein, D. A. , Carlson, C. , & Schmidt, J. E. ( 2007 ). Progressive relaxation: Abbreviated methods. In P. M. Lehrer & R. L. Woolfolk (Eds.), Principles and practice of stress management (3rd ed. pp. 88–124). New York: Guilford Press.

Berntson, G. G. , Cacioppo, J. T. , Binkley, P. E. , Uchino, B. N. , Quigley, K. S. , & Fieldstone, A. ( 1994 ). Autonomic cardiac control. III. Psychological stress and cardiac response in autonomic space as revealed by pharmacological blockades.   Psychophysiology , 31 , 599–608.

Berntson, G. G. , Norman, G. J. , Hawkley, L. C. , & Cacioppo, J. T. ( 2008 ). Cardiac autonomic balance versus cardiac regulatory capacity.   Psychophysiology , 45 (4), 643–652.

Borkovec, T. D. , & Sides, J. K. ( 1979 ). Critical procedural variables related to the physiological effects of progressive relaxation: A review.   Behaviour Research and Therapy , 17 , 119–125.

Cacioppo, J. T. , Tassinary, L. G. , & Berntson, G. (Eds.). ( 2007 ). Handbook of psychophysiology (3rd ed.). New York: Cambridge University Press.

Cahn, B. R. , & Polich, J. ( 2006 ). Meditation states and traits: EEG, ERP, and neuroimaging studies.   Psychological Bulletin , 132 , 180–211.

Cannon, W. ( 1929 ). The sympathetic division of the autonomic system in relation to homeostasis.   Archives of Neurology and Psychiatry , 22 , 284–294.

Cappo, B. M. , & Holmes, D. S. ( 1984 ). The utility of prolonged respiratory exhalation for reducing physiological and psychological arousal in non-threatening and threatening situations.   Journal of Psychosomatic Research , 28 (4), 265–273.

Carlson, C. R. , & Hoyle, R. ( 1993 ). Efficacy of abbreviated progressive muscle relaxation training: A quantitative review.   Journal of Consulting and Clinical Psychology , 61 , 1059–1067.

Cerqueira, J. J. , Mailliet, F. , Almeida, O. F. , Jay, T. M. , & Sousa, N. ( 2007 ). The prefrontal cortex as a key target of the maladaptive response to stress.   Journal of Neuroscience , 27 (11), 2781–2787.

Chandra, F. A. ( 1994 ). Respiratory practices in yoga. In B. H. Timmons & R. Ley (Eds.), Behavioral and psychological approaches to breathing disorders (pp. 221–232). New York: Plenum Press.

Choi, J. , Ahmed, B. , & Gutierrez-Osuna, R. ( 2012 ). Development and evaluation of an ambulatory stress monitor cased on wearable sensors.   Information Technology in Biomedicine , 16 (2), 279–286.

Choi, J. , & Gutierrez-Osuna, R. ( 2011 ). Removal of respiratory influences from heart rate variability in stress monitoring.   Sensors Journal, IEEE, 11(11), 2649–2656.

Cohen, S. , Kessler, R. C. , & Gordon, L. U. ( 1997 ). Strategies for measuring stress in studies of psychiatric and physical disorders. In S. Cohen , R. C. Kessler , & L. U. Gordon (Eds.), Measuring stress: A guide for health and social scientists (pp. 3–26). New York: Oxford University Press.

Conrad, A. , Müller, A. , Doberenz, S. , Kim, S. , Meuret, A. E. , Wollburg, E. , & Roth, W. T. ( 2007 ). Psychophysiological effects of breathing instructions for stress management.   Applied Psychophysiology and Biofeedback , 32 (2), 89–98.

Conrad, A. , & Roth, W. T. ( 2007 ). Muscle relaxation therapy for anxiety disorders: It works but how?   Journal of Anxiety Disorders , 21 , 243–264.

Courtois, C. A. ( 2001 ). Commentary on “Guided imagery and memory:” Additional considerations.   Journal of Counseling Psychology , 48 (2), 133–135.

Craske, M. G. , Stein, M. B. , Sullivan, G. , Sherbourne, C. , Bystritsky, A. , Rose, R. D. , … Roy-Byrne, P. ( 2011 ). Disorder-specific impact of coordinated anxiety learning and management treatment for anxiety disorders in primary care.   Archives of General Psychiatry , 68 (4), 378–388.

Dantzer, R. , O’Connor, J. C. , Freund, G. G. , Johnson, R. W. , & Kelley, K. W. ( 2008 ). From inflammation to sickness and depression: When the immune system subjugates the brain.   Nature Reviews Neuroscience , 9 , 46–57.

Davidson, R. J. , & Schwartz, G. E. ( 1976 ). Psychobiology of relaxation and related states. In D. Mostofsky (Ed.), Behavior modification and control of physiological activity . Englewood Cliffs, N J: Prentice-Hall.

De Peuter, S. , Van Diest, I. , Lemaigre, V. , Verleden, G. , Demedts, M. , & Van den Bergh, O. ( 2004 ). Dyspnea: the role of psychological processes.   Clinical Psychology Review , 24 (5), 557–581.

de Jong, G. M. , & Emmelkamp, P. M. J. ( 2000 ). Implementing a stress management training: Comparative trainer effectiveness.   Journal of Occupational health Psychology , 5 (2), 309–320.

Dedovic, K. , D’Aguiar, C. , & Pruessner, J. C. ( 2009 ). What stress does to your brain: A review of neuroimaging studies.   Canadian Journal of Psychiatry , 54 (1), 6–15.

Denis, M. , Mellet, E. , & Kosslyn, S. M. ( 2004 ). Neuroimaging of mental imagery . Hove, UK: Psychology Press.

Edwards, D. , & Burnard, P. ( 2003 ). A systematic review of stress and stress management interventions for mental health nurses.   Journal of Advanced Nursing , 42 (2), 169–200.

Ehlers, A. (1997). Perception of heartbeats and airway resistance in hypochondriasis . Paper presented at the 3rd European Congress of Psychophysiology. Konstanz, Germany. May 29–31.

Eller, L. S. ( 1999 ). Guided imagery interventions for symptom management.   Annual Review of Nursing Research , 17 , 57–84.

Emery, C. F. , France, C. R. , Harris, J. , Norman, G. , & VanArsdalen, C. ( 2008 ). Pain reduction effects of progressive muscle relaxation training on nociceptive flexion reflex threshold in healthy young adults: A randomized trial. Pain , 138 , 375–379.

Gaab, J. , Blättler, N. , Menzi, T. , Pabst, B. , Stoyer, S. , & Ehlert, U. ( 2003 ). Randomized controlled evaluation of the effects of cognitive–behavioral stress management on cortisol responses to acute stress in healthy subjects. Psychoneuroendocrinology , 28 , 767–779.

Gavish, B. ( 2010 ). Device-guided breathing in the home setting: Technology, performance and clinical outcomes.   Biological Psychology , 84 (1), 150–156.

Gay, M-C. , Philippot, P. , & Luminet, O. ( 2002 ). Differential effectiveness of psychological interventions for reducing osteoarthritis pain: A comparison of Erickson hypnosis and Jacobson relaxation.   European Journal of Pain , 6 , 1–6.

Gelhorn, E. ( 1958 ). The physiological basis of neuromuscular relaxation.   Archives of Internal Medicine , 102 , 392–399.

Gelhorn, E. , & Keily, W. F. ( 1972 ). Mystical states of consciousness: Neurophysiological and clinical aspects.   Journal of Nervous and Mental Disease , 154 , 399–405.

Gianaros, P. J. , & O. Connor, M-F. ( 2011 ). Neuroimaging methods in human stress science. In R. J. Contrada & A. Baum (Eds.), The handbook of stress science: Biology, psychology, and health (pp. 543–564). New York: Springer.

Giga, S. I. , Cooper, C. L. , & Faragher, B. ( 2003 ). The development of a framework for a comprehensive approach to stress management interventions at work.   International Journal of Stress Management , 10 (4), 280–296.

Gilbert, C. ( 2003 ). Clinical applications of breathing regulation beyond anxiety management.   Behavior Modification , 27 (5), 692–709.

Glass, D. C. , & Singer, J. E. ( 1972 ). Urban stress: Experiments on noise and social stressors . New York: Academic Press.

Hackmann, A. , Bennett-Levy, J. , & Holmes, E. A. ( 2011 ). Oxford guide to imagery in cognitive therapy . New York: Oxford University Press.

Hahn, V. C. , Binnewies, C. , Sonnentag, S. , & Mojza, E. J. ( 2011 ). Learning how to recover from job stress: Effects of a recovery training program on recovery, recovery-related self-efficacy and well-being.   Journal of Occupational Health Psychology , 16 , 202–216.

Hall, L. , & Long, C. G. ( 2009 ). Back to basics: Progressive muscle relaxation (PMR) training for women detained in conditions of medium security.   Journal of Forensic Psychiatry and Psychology , 20 (3), 481–492.

Harding, S. ( 1996 ). Relaxation: With or without imagery?   International Journal of Nursing Practice , 2 , 160–162.

Hatler, C. W. ( 1998 ). Using guided imagery in the emergency department.   Journal of Emergency Nursing, 24(6), 518–522.

Heinschel, J. A. ( 2002 ). A descriptive study of the interactive guided imagery experience.   Journal of Holistic Nursing , 20 (4), 325–346.

Hirsch, J. A. , & Bishop, B. ( 1981 ). Respiratory sinus arrhythmia in humans: How breathing pattern modulates heart rate.   American Journal of Physiology: Heart and Circulatory Physiology , 241 (4), H620–H629.

Holmes, E. A. , Coughtrey, A. E. , & Connor, A. ( 2008 ). Looking at or through rose-tinted glasses? Imagery perspective and positive mood.   Emotion , 8 (6), 875–879.

Holmes, E. A. , & Mathews, A. ( 2005 ). Mental imagery and emotion: A special relationship ? Emotion , 5 (4), 489–497.

Holmes, E. A. , Mathews, A. , Dalgleish, T. , & Mackintosh, B. ( 2006 ). Positive interpretation training: Effects of mental imagery versus verbal training on positive mood.   Behavior Therapy , 37 (3), 237–247.

Hyman, R. B. , Feldman, H. R. , Harris, R. B. , Levin, R. F. , & Molloy, G. B. ( 1989 ). The effects of relaxation training on clinical symptoms: A meta-analysis.   Nursing Research , 38 , 216–220.

Iyengar, B. ( 1966 ). Light on yoga . New York: Schocken.

Jacobson, E. ( 1938 ). Progressive relaxation (2nd ed.). Chicago: University of Chicago Press.

Jacobson, E. ( 1964 ). Self-operations control: A manual of tension control . Chicago: National Foundation for Progressive Relaxation.

Jacobson, E. ( 1970 ). Modern treatment of tense patients . Springfield, IL: Thomas.

Jacobson, E. ( 1974 ). Progressive relaxation (3rd ed., rev.). Chicago: University of Chicago Press.

Jallo, N. , Bourguignon, C. , Taylor, A. G. , Ruiz, J. , & Goehler, L. ( 2009 ). The biobehavioral effects of relaxation guided imagery on maternal stress.   Advances in Mind-Body Medicine , 24 (4), 12–22.

Johnston, M. , & Vögele, C. ( 1993 ). Benefits of psychological preparation for surgery: A meta-analysis.   Annals of Behavioral Medicine , 15 (4), 245–256.

Jones, L. , & Stuth, G. ( 1997 ). The uses of mental imagery in athletics: An overview.   Applied and Preventive Psychology , 6 (2), 101–115.

Kapleau R. P. ( 1965 ). The three pillars of Zen . New York: Doubleday.

Kiecolt-Glaser, J. K. , & Newton, T. L. ( 2001 ). Marriage and health: His and hers.   Psychological Bulletin , 127 (4), 472–503.

Kikuchi, Y. , Okabe, S. , Tamura, G. , Hida, W. , Homma, M. , Shirato, K. , & Takishima, T. ( 1994 ). Chemosensitivity and perception of dyspnea in patients with a history of near-fatal asthma.   New England Journal of Medicine , 330 (19), 1329–1334.

King, N. J. ( 1980 ). Abbreviated progressive muscle relaxation. In M. Hersen , R. M. Eisler , & P. M. Miller (Eds.), Progress in behavior modification (pp. 147–182). New York: Academic Press.

Klapish, N. ( 1973 ). Introduction to Desoilleșs methods of “guided day dream.”   The Israel Annals of Psychiatry and Related Disciplines , 11 (4), 330–343.

Kosslyn, S. M. , Ganis, G. , & Thompson, W. L. ( 2001 ). Neural foundations of imagery.   Nature Reviews Neuroscience , 2 , 635–642.

Koster, E. H. , Fox, E. , & MacLeod, C. ( 2009 ). Introduction to the special section on cognitive bias modification in emotional disorders.   Journal of Abnormal Psychology , 118 , 1–4.

Lang, P. J. ( 1979 ). A bio-informational theory of emotional imagery.   Psychophysiology , 16 (6), 495–512.

Lang, P. J. , Greenwalk, M. K. , Bradley, M. M. , & Hamm, A. O. ( 1993 ). Looking at pictures: Affective, facial, visceral, and behavioral reactions.   Psychophysiology , 30 , 261–273.

Lazarus, R. S. ( 1966 ). Psychological stress and the coping process . New York: McGraw-Hill.

Lazarus, R. S. ( 1995 ). Psychological stress in the workplace. In R. Crandall & P. L. Perrewe (Eds.), Occupational stress: A handbook (pp. 3–14). Boca Raton, FL: CRC Press.

Lazarus, R. S. , & Folkman, S. ( 1984 ). Stress, appraisal, and coping . New York: Springer.

Lehrer, P. M. ( 1982 ). How to relax and how not to relax: A re-evaluation of the work of Edmund Jacobson: 1.   Behaviour Research and Therapy , 20 , 417–428.

Lehrer, P. M. , Carr, R. , Sargunaraj, D. , & Woolfolk, R. L. ( 1994 ). Stress management techniques: Are they all equivalent, or do they have specific effects?   Biofeedback and Self-Regulation , 19 , 353–401.

Lehrer, P. M. & Woolfolk, R. L. ( 1984 ). Are stress reduction techniques interchangeable or do they have specific effects? A review of the comparative empirical literature. In R. L. Woolfolk & P. M. Lehrer (Eds.), Principles and practice of stress management (pp. 404–477). New York: Guiliford Press.

Leskovsek, M. , Ahlin, D. , Cancer, R. , Hosta, M. , Enova, D. , Pusenjak, N. , & Bunc, M. ( 2011 ). Low latency breathing frequency detection and monitoring on a personal computer.   Journal of Medical Engineering and Technology , 35 (6–7), 322–329.

Leuner, B. , & Gould, E. ( 2010 ). Structural plasticity and hippocampal function.   Annual Review of Psychology , 61 , 111–140.

Leuner, H. ( 1969 ). Guided affective imagery (GAI): A method of intensive psychotherapy.   American Journal of Psychotherapy , 23 (1), 4–22.

Ley, R. ( 1994 ). Breathing and the psychology of emotion, cognition, and behavior. In B. H. Timmons & R. Ley (Eds.), Behavioral and psychological approaches to breathing disorders (pp. 81–95). New York: Plenum Press.

Ley, R. ( 2003 ). Respiratory psychophysiology and the modification of breathing behavior.   Behavior Modification , 27 (5), 603–606.

Liao, W. ( 1990 ). T’ai chi classics . Boston, MA: Shambhala.

Ludwick-Rosenthal, R. , & Neufeld, W. J. ( 1988 ). Stress management during noxious medical procedures: An evaluative review of outcome studies.   Psychological Bulletin , 104 (3), 326–342.

Luthe, W. (Ed.). (1969– 1973 ). Autogenic therapy (Vols. 1–6 ). New York: Grune & Stratton.

Lutz, A. , Slagter, H. A. , Dunne, J. D. , & Davidson, R. J. ( 2008 ). Attention regulation and monitoring in meditation.   Trends in Cognitive Science , 12 , 163–169.

Marmot, M. , & Brunner. E. ( 2005 ). Cohort profile: The Whitehall II study.   International Journal of Epidemiology , 34 , 251–256.

McCaffery, M. ( 1989 ). Nursing management of the patient with pain (3rd ed.). Philadelphia: J. P. Lippincott.

McCaul, K. D. , Solomon, S. , & Holmes, D. S. ( 1979 ). Effects of paced respiration and expectations on physiological and psychological responses to threat.   Journal of Personality and Social Psychology , 37 (4), 564.

McEwen, B. S. , & Gianaros, P. J. ( 2011 ). Stress- and allostasis-induced brain plasticity.   Annual Review of Medicine , 62 , 431–645.

McGregor, B. A. , & Antoni, M. H. ( 2009 ). Psychological intervention and health outcomes among women treated for breast cancer: A review of stress pathways and biological mediators.   Brain, Behavior, and Immunity , 23 , 159–166.

McGuigan, F. J. ( 1978 ). Cognitive psychophysiology: Principles of covert behavior . Englewood Cliffs, NJ: Prentice Hall.

McGuigan, F. J.   Culver, V. L. , & Kendler, T. S. ( 1971 ). Covert behavior as a direct electromyographic measure of mediating responses.   Conditional Reflex , 6 , 145–152.

McGuigan, F. J. , & Leherer, P. M. ( 2007 ). Progressive relaxation: Origens, principles, and clinical applications. In P. M. Lehrer & R. L. Woolfolk (Eds.) Principles and practice of stress management (3rd ed. pp. 57–87). New York: Guilford Press.

McVicar, A. ( 2003 ). Workplace stress in nursing: A literature review.   Journal of Advanced Nursing , 44 (6), 633–642.

Meichenbaum, D. ( 1977 ). Cognitive-behavior modification . New York: Plenum.

Meurs, J. A. , & Perrewé, P. L. ( 2011 ). Cognitive activation theory of stress: An integrative theoretical approach to work stress.   Journal of Management , 37 (4), 1043–1068.

Mezo, P. G. , Hall, J. , Duggan, C. M. , & Noël, V. A. ( 2011 ). An initial comparison of live instruction and immersive video modes of progressive muscle relaxation.   Journal of Technology in Human Services , 29 (3), 212–223.

Miller, G. A. , Levin, D. N. , Kozak, M. J. , Cook, E. W. , III, McLean, A. , Jr., & Lang, P. J. ( 1987 ). Individual differences in imagery and the psychophysiology of emotion.   Cognition and Emotion , 1 (4), 367–390.

Monsma, E. V. , & Overby, L. Y. ( 2004 ). The relationship between imagery and competitive anxiety in ballet auditions.   Journal of Dance Medicine and Science , 8 (1), 11–18.

Muhlberger, A. , Herrmann, M. J. , Wiedemann, G. C. , Ellgring, H. , & Pauli, P. ( 2001 ). Repeated exposure of flight phobics to flights in virtual reality.   Behaviour Research Therapy , 39 (9), 1033–1050.

Nezu, A, M. , Nezu, C. M. , & Xanthopoulos, M. S. ( 2011 ). Stress reduction in chronically ill patients. In R. J. Contrada & A. Baum (Eds.), The handbook of stress science: Biology, psychology, and health (pp. 475–486). New York: Springer.

Nilsson, U. ( 2008 ). The anxiety- and pain-reducing effects of music interventions: A systematic review.   AORN Journal , 87 (4), 780, 782, 785–794, 797–807.

Norris, F. H.,   Friedman, M. J. , & Watson, P. J. ( 2002 ). 60,000 disaster victims speak: Part II. Summary and implications of the Disaster Mental Health Research.   Psychiatry: Interpersonal and Biological Processes , 65 (3), 240–260.

Noseda, A. , Schmerber, J. , Prigogine, T. , & Yernault, J. C. ( 1993 ). How do patients with either asthma or COPD perceive acute bronchodilation?.   European Respiratory Journal , 6 (5), 636–644.

Öhman, A. , & Mineka, S. ( 2001 ). Fears, phobias, and preparedness: Toward an evolved module of fear and fear learning.   Psychological Review , 108 (3), 483–522.

Pandey, A. , Quick, J. C. , Rossi, A. M. , Nelson, D. L. , & Martin, W. ( 2011 ). Stress and the workplace: 10 years of stress science, 1997–2007. In R. J. Contrada & A. Baum (Eds.), The handbook of stress science: Biology, psychology, and health (pp. 137–150). New York: Springer.

Patel, C. ( 1991 ). The complete guide to stress management . New York: Plenum Press.

Paul, G. L. ( 1966 ). Insight versus desensitization in psychotherapy . Palo Alto, CA: Stanford University Press.

Pawlow, L. A. , & Jones, G. A. ( 2002 ). The impact of abbreviated progressive muscle relaxation on salivary cortisol.   Biological Psychiatry , 60 (1), 1–16.

Pawlow, L. A. , & Jones, G. A. ( 2005 ). The impact of abbreviated progressive muscle relaxation on salivary cortisol and salivary immunoglobulin A (sIgA).   Applied Psychophysiology and Biofeedback , 30 (4), 375–387.

Pelletier, C. L. ( 2004 ). The effect of music on decreasing arousal due to stress: A meta-analysis.   Journal of Music Therapy , 41 (3), 192–214.

Pelletier, K. R. , & Lutz, R. ( 1990 ). Healthy people—healthy business: A critical review of stress management programs in the workplace. In J. E. Fielding , A. S. Baum , & S. M. Weiss (Eds.), Health at work (pp. 189–204). New York: Psychology Press.

Pictet, A. , Coughtrey, A. E. , Mathews, A. , & Holmes, E. A. ( 2011 ). Fishing for happiness: The effects of generating positive imagery on mood and behaviour.   Behaviour Research and Therapy , 49 (12), 885–891.

Porges, S. W. ( 2009 ). Stress and parasympathetic control. In G. Fink (Ed.), Stress science: neuroendocrinology (pp. 306–312). San Diego, CA: Academic Press.

Powell, R. , Bruce, J. , Johnston, M. , Vogele, C. , Scott, N. , Shehmar, M. , & Roberts, T. ( 2010 ). Psychological preparation and postoperative outcomes for adults undergoing surgery under general anaesthesia (Protocol).   Cochrane Database of Systematic Reviews, 8. doi: 10.1002/14651858.CD008646.

Przeworski, A. , & Newman, M. G. ( 2004 ). Palmtop computer-assisted group therapy for social phobia.   Journal of Clinical Psychology , 60 (2), 179–188.

Rausch, S. M. , Gramling, S. E. , & Auerbach, S. M. ( 2006 ). Effects of a single session of large-group meditation and progressive muscle relaxation training on stress reduction, reactivity, and recovery.   International Journal of Stress Management , 13 (3), 273–290.

Richardson, K. M. , & Rothstein, H. R. ( 2008 ). Effects of occupational stress management intervention programs: A meta-analysis.   Journal of Occupational Health Psychology , 13 (1), 69–93.

Ronen, T. ( 2011 ). The positive power of imagery: Harnessing client imagination in CBT and related therapies . Malden, MA: Wiley-Blackwell.

Roozendaal, B. , McEwen, B. S. , & Chattarji, S. ( 2009 ). Stress, memory and the amygdala.   Nature Reviews Neuroscience , 10 (6), 423–433.

Rowland, B. ( 1953 ). The art and architecture of India . Pelican history of art. Melbourne: Penguin Books.

Sapolsky, R. ( 1996 ). Why stress is bad for your brain.   Science , 273 , 749–750.

Schiffman, S. , Stone, A. A. , & Hufford, M. R. ( 2008 ). Ecological momentary assessment.   Annual Review of Clinical Psychology , 4 , 1–32.

Schoettle, U. C. ( 1980 ). Guided imagery—a tool in child psychotherapy.   American Journal of Psychotherapy , 34 (2), 220–227.

Schwartz, G. E. , Davidson, R. J. , & Goleman, D. T. ( 1978 ). Patterning of cognitive and somatic processes in the self-regulation of anxiety: Effects of meditation versus exercise.   Psychosomatic Medicine , 40 , 321–328.

Segerstrom, S. C. , & Miller, G. E. ( 2004 ). Psychological stress and the human immune system: A meta-analytic study of 30 years of inquiry.   Psychological Bulletin , 130 (4), 610–630.

Selye, H. ( 1956 ). The stress of life . New York: McGraw-Hill.

Skinner, E. A. , Edge, K. , Altman, J. , & Sherwood, H. ( 2003 ). Searching for the structure of coping: A review and critique of category systems for classifying various ways of coping.   Psychological Bulletin , 129 , 216–269.

Slagter, H. A. , Davidson, R. J. , & Lutz, A. ( 2011 ). Mental training as a tool in the neuroscientific study of brain and cognitive plasticity.   Frontiers in Human Neuroscience , 5 (17), 1–12.

Smith, C. A. , & Lazarus, R. S. ( 1993 ). Appraisal components, core relational themes, and the emotions.   Cognition and Emotion , 7 , 233–269.

Smith, J. C. ( 1990 ). Cognitive behavioral relaxation training: A new system of strategies for treatment and assessment . New York: Springer.

Smith, J. C. , Amutio, A. , Anderson, J. P. , & Aria, L. A. ( 1996 ). Relaxation: Mapping an uncharted world.   Biofeedback and Self-Regulation , 21 (1), 63–90.

Stephens, R. ( 1993 a). Imagery: A strategic intervention to empower clients—Part I–Review of research literature. Clinical Nurse Specialist , 7 (4), 170–174.

Stephens, R. L. ( 1993 b). Imagery: A strategic intervention to empower clients—Part II–A practical guide.   Clinical Nurse Specialist , 7 (5), 235–240.

Sturges, L. V. , Goetsch, V. L. , Ridley, J. , & Whittal, M. ( 1998 ). Anxiety sensitivity and response to hyperventilation challenge: Physiologic arousal, interoceptive acuity, and subjective distress.   Journal of Anxiety Disorders , 12 (2), 103–115.

Suhr, J. , Anderson, S. , & Tranel, D. ( 1999 ). Progressive muscle relaxation in the management of behavioral disturbances in Alzheimer’s disease.   Neuropsychological Rehabilitation , 9 (1), 31–44.

Tatrow, K. , & Montgomery, G. H. ( 2006 ). Cognitive behavioral therapy techniques for distress and pain in breast cancer patients: A meta-analysis.   Journal of Behavioural Medicine , 29 , 17–27.

Taylor, A. G. , Goehler, L. E. , Galper, D. I. , Innes, K. E. , & Bourguignon, C. ( 2010 ). Top-down and bottom-up mechanisms in mind-body medicine: Development of an integrative framework for psychophysiological research.   Explore (NY), 6(1), 29–41.

Thyer, B. A. , Papsdorf, J. D. , & Wright, P. ( 1984 ). Physiological and psychological effects of acute intentional hyperventilation.   Behavioral Research and Therapy , 22 (5), 587–590.

Tusek, D. L. , & Cwynar, R. E. ( 2000 ). Strategies for implementing a guided imagery program to enhance patient experience.   AACN Clinical Issues , 11 (1), 68–76.

Umezawa, A. ( 2001 ). Facilitation and inhibition of breathing during changes in emotion. In Y. Haruki , I. Homma , A. Umezawa , & Y. Masaoka (Eds.), Respiration and emotion (pp. 139–148). Tokyo: Springer Verlag.

Vadoa, E. A. , Hall, C. R. , & Moritz, S. E. ( 1997 ). The relationship between competitive anxiety and imagery use.   Journal of Applied Sport Psychology , 9 (2), 241–253.

Vancampfort, D. , De Hert , M., Knapen , J., Maurissen , K., Raepsaet , J., Deckx , S. , … Probst, M. ( 2011 ). Effects of progressive muscle relaxation on state anxiety and subjective well-being in people with schizophrenia: A randomized controlled trial.   Clinical Rehabilitation , 25 (6), 567–575.

van der Hek, H. , & Plomp, H. N. ( 1997 ). Occupational stress management programmes: A practical overview of published effect studies.   Occupational Medicine , 47 (3), 133–141.

van Dixhoorn, J. , & Duivenvoorden, H. J. ( 1999 ). Effect of relaxation therapy on cardiac events after myocardial infarction: A 5-year follow-up study.   Journal of Cardiopulmonary Rehabilitation , 19 (3), 178–185.

van Dixhoorn, J. , Duivenvoorden, H. J. , Staal, A. , & Pool, J. ( 1989 ). Physical training and relaxation therapy in cardiac rehabilitation therapy assessed through a composite criterion for training outcome.   American Heart Journal , 118 (3), 545–552.

van Dixhoorn, J , & White, A. R. ( 2005 ). Relaxation therapy for rehabilitation and prevention in ischemic heart disease: A systematic review and meta-analysis.   European Journal of Cardiovascular Prevention and Rehabilitation , 12 , 193–202.

van Dixhoorn, J. J. ( 2007 ). Whole-body breathing. In P. M. Leher , R. L. Woolfolk , & W. E. Sime (Eds.), Principles and practice of stress management (3rd ed., pp. 291–332). New York: Guiliford Press.

Vianna, E. P. M. , Naqvi, N. , Bechara, A. , & Tranel, D. ( 2009 ). Does vivid emotional imagery depend on body signals?   International Journal of Psychophysiology , 72 (1), 46–50.

Wang, W. , He, G. , Wang, M. , Liu, L. , & Tang, H. ( 2012 ). Effects of patient education and progressive muscle relaxation alone or combined on adherence to continuous positive airway pressure treatment in obstructive sleep apnea patients.   Sleep Breath , 16 (4), 1049–1057.

Weinberg, A. , & Cooper, C. ( 2011 ). The challenge of stress in modern organizations. In R. J. Contrada & A. Baum (Eds.), The handbook of stress science: Biology, psychology, and health (pp. 151–166). New York: Springer.

Wilhelm, F. H. , Gevirtz, R. , & Roth, W. T. ( 2001 ). Respiratory dysregulation in anxiety, functional cardiac, and pain disorders: Assessment, phenomenology, and treatment.   Behavior Modification , 25 (4), 513–545.

Wolpe, J. ( 1958 ). Psychotherapy by reciprocal inhibition . Palo Alto, CA: Stanford University Press.

Wolpe, J. ( 1969 ). The practice of behavior therapy . New York: Pergamon Press.

Zapf, D. , Dormann, C. , & Frese, M. ( 1996 ). Longitudinal studies in organizational stress research: A review of the literature with reference to methodological issues.   Journal of Occupational Health Psychology , 1 (2), 145–169.

• About Oxford Academic
• Publish journals with us
• University press partners
• What we publish
• New features  
• Open access
• Institutional account management
• Rights and permissions
• Get help with access
• Accessibility
• Advertising
• Media enquiries
• Oxford University Press
• Oxford Languages
• University of Oxford

Oxford University Press is a department of the University of Oxford. It furthers the University's objective of excellence in research, scholarship, and education by publishing worldwide

• Copyright © 2024 Oxford University Press
• Cookie settings
• Cookie policy
• Privacy policy
• Legal notice

This Feature Is Available To Subscribers Only

Sign In or Create an Account

This PDF is available to Subscribers Only

For full access to this pdf, sign in to an existing account, or purchase an annual subscription.

Appointments at Mayo Clinic

• Stress management
• Stress basics
• Stress relief
• Relaxation techniques

The pace and challenges of modern life make stress management necessary for everyone.

To monitor your stress, first identify your stress triggers. What makes you feel angry, tense, worried or irritable? Do you often get headaches or an upset stomach with no medical cause? Is it hard to focus or do you have trouble sleeping at night?

Some stressors, such as job pressures, relationship problems, a busy schedule or financial concerns, are easy to identify. Recently many people have had to deal with issues related to the COVID-19 pandemic as well. But daily hassles and demands, such as waiting in a long line or being late to a meeting, also contribute to your stress level.

Even essentially positive events, such as getting married or buying a house, can be stressful. Any change to your life can cause stress.

Once you've identified your stress triggers, think about strategies for dealing with them. Identifying what you can and can't control is a good starting point. For example, if stress keeps you up at night, the solution may be as easy as removing the TV and computer from your bedroom and letting your mind wind down before bed.

Other times, such as when stress is based on high demands at work or a loved one's illness, you might be able to change only your reaction.

Don't feel like you have to figure it out on your own. Seek help and support from family and friends, whether you need someone to listen to you, help with child care or a ride to work when your car is being repaired.

Manage your time and prioritize your tasks and commitments. Within reason, set the agenda for your time and energy. Figure out what's most important or what commitments you can say no to. Get rid of commitments that aren't important.

Many people benefit from practices such as deep breathing, tai chi, yoga, meditation, mindfulness or being in nature. Set aside time for yourself. Get a massage, soak in a bubble bath, dance, listen to music, watch a comedy — whatever helps you relax.

Maintaining a healthy lifestyle will help you manage stress. Eat a healthy diet, exercise regularly and get enough sleep. Make a conscious effort to spend less time in front of a screen — television, tablet, computer and phone — and more time relaxing.

Avoid using alcohol or drugs to manage stress.

Stress won't disappear from your life. And stress management needs to be ongoing. But by paying attention to what causes your stress and practicing ways to relax, you can counter some of the bad effects of stress and increase your ability to cope with challenges. You can reduce your stress level, improve your quality of life, improve your ability to focus, have better relationships and improve your self-control. If your stress gets worse, you might find it helpful to talk to a mental health professional.

There is a problem with information submitted for this request. Review/update the information highlighted below and resubmit the form.

From Mayo Clinic to your inbox

Sign up for free and stay up to date on research advancements, health tips, current health topics, and expertise on managing health. Click here for an email preview.

Error Email field is required

Error Include a valid email address

To provide you with the most relevant and helpful information, and understand which information is beneficial, we may combine your email and website usage information with other information we have about you. If you are a Mayo Clinic patient, this could include protected health information. If we combine this information with your protected health information, we will treat all of that information as protected health information and will only use or disclose that information as set forth in our notice of privacy practices. You may opt-out of email communications at any time by clicking on the unsubscribe link in the e-mail.

Thank you for subscribing!

You'll soon start receiving the latest Mayo Clinic health information you requested in your inbox.

Sorry something went wrong with your subscription

Please, try again in a couple of minutes

• How stress affects your health. American Psychological Association. https://www.apa.org/topics/stress/health. Accessed Dec. 8, 2021.
• Manage stress. MyHealthfinder. https://health.gov/myhealthfinder/topics/health-conditions/heart-health/manage-stress. Accessed Dec. 6, 2021.
• What is stress management? American Heart Association. https://www.heart.org/en/healthy-living/healthy-lifestyle/stress-management/what-is-stress-management. Accessed Dec. 7, 2021.
• Managing stress. National Alliance on Mental Illness. https://www.nami.org/Your-Journey/Individuals-with-Mental-Illness/Taking-Care-of-Your-Body/Managing-Stress. Accessed Dec. 8, 2021.
• Stress. National Center for Complementary and Integrative Health. https://www.nccih.nih.gov/health/stress. Accessed Dec. 6, 2021.
• AskMayoExpert. Stress management and resiliency (adult). Mayo Clinic; 2021.
• Stress and your health. U.S. Department of Health & Human Services. https://www.womenshealth.gov/mental-health/good-mental-health/stress-and-your-health. Accessed Dec. 9, 2021.
• Seaward BL. Essentials of Managing Stress. 5th ed. Jones & Bartlett Learning; 2021.

Products and Services

• A Book: Mayo Clinic Book of Home Remedies
• A Book: Mayo Clinic on High Blood Pressure
• A Book: Mayo Clinic Family Health Book, 5th Edition
• Newsletter: Mayo Clinic Health Letter — Digital Edition
• A Book: Live Younger Longer
• A Book: Mayo Clinic Handbook for Happiness
• A Book: Mayo Clinic Guide to Pain Relief
• A very happy brain
• Alternative cancer treatments: 11 options to consider
• Being assertive
• Bridge pose
• Caregiver stress
• Cat/cow pose
• Child's pose
• Stress and your health
• COVID-19 and your mental health
• Does stress make rheumatoid arthritis worse?
• Downward-facing dog
• Ease stress to reduce eczema symptoms
• Ease stress to reduce your psoriasis flares
• Forgiveness
• Headaches and stress
• Job burnout
• Learn to reduce stress through mindful living
• Manage stress to improve psoriatic arthritis symptoms
• Mayo Clinic Minute: Meditation is good medicine
• Mindfulness exercises
• Mountain pose
• New School Anxiety
• Positive thinking
• Seated spinal twist
• Standing forward bend
• Stress hair loss
• Stress and high blood pressure
• Stress relief from laughter
• Stress relievers
• Stress symptoms
• Support groups
• Tips for easing stress when you have Crohn's disease
• Guided meditation video

Mayo Clinic does not endorse companies or products. Advertising revenue supports our not-for-profit mission.

• Opportunities

Mayo Clinic Press

Check out these best-sellers and special offers on books and newsletters from Mayo Clinic Press .

• Mayo Clinic on Incontinence - Mayo Clinic Press Mayo Clinic on Incontinence
• The Essential Diabetes Book - Mayo Clinic Press The Essential Diabetes Book
• Mayo Clinic on Hearing and Balance - Mayo Clinic Press Mayo Clinic on Hearing and Balance
• FREE Mayo Clinic Diet Assessment - Mayo Clinic Press FREE Mayo Clinic Diet Assessment
• Mayo Clinic Health Letter - FREE book - Mayo Clinic Press Mayo Clinic Health Letter - FREE book
• Healthy Lifestyle

Your gift holds great power – donate today!

Make your tax-deductible gift and be a part of the cutting-edge research and care that's changing medicine.

10 New Strategies for Stress Management

Research studies suggest we have more tools than we realize..

Posted January 19, 2017 | Reviewed by Ekua Hagan

• What Is Stress?
• Find counselling to overcome stress

Did you know you have a large number of capacities you are not using at full throttle?

There is a lot more you can do to manage your stress than you think. Much of it resides in building up your inner capacities.

I’ll review 10 of the best research-based strategies for managing stress. Many of these are tried-and-true tools you will know, and others will be new to you. What is especially new is the connection with your inner capacities, known as character strengths, which can help you with each strategy.

Strength tip : Use your strengths of critical thinking and hope to look at any negative situation in a fresh way. You might tap into hope to see how there are benefits to the stressor. You might deploy critical thinking to examine the situation from multiple, detailed angles. This will help you see pros and cons, positives and negatives.

Strength tip : The essential strength you use when planning is prudence. You can learn to thinking prudently. Use your prudence to take stock each morning on the work tasks you’d like to accomplish, the household tasks you must get done, and the fun activities you want to do.

Strength tip : Any relaxation strategy involves use of your self-regulation strength. This strength involves taking control of your breathing and creating a greater feeling of calmness in your body’s physiology. In turn, such self-regulation has a positive impact on your racing mind and your worries of the day.

Strength tip : Each of the 24 character strengths can be the subject of this activity — in other words, something highly valued. Prior to an upcoming stressor, reflect on how much you value one of your character strengths.

Strength tip : The challenge is to consider how you will use your best quality in a new way. For a list of ideas, see this post . This strategy helps you widen how you think about and how you act from your strengths.

Strength tip : Choose one or two of your top strengths. Reflect on whether you are using the strength in an optimal, healthy way each day. Consider times when you overuse or underuse the strength and how you might bring the strength into greater balance.

Strength tip : Find yourself uncertain how to be more forgiving? Set up a “letting go” practice, starting with little things. When someone cuts you off in traffic or seems to ignore your “hello” at work, take a specific approach of "practicing letting go." For example, when something little-but-distressing happens, pause, take two slow breaths of fresh air, and then say to yourself “it’s OK, I can move on.”

Strength tip : Try “ the mindful pause ” which is a simple, 2-step approach in which you pause before or during a stressor and attentively breathe for 15 seconds, followed by one question for yourself — how might I use one of my character strengths right now? Take positive action with any character strength that pops up.

Strength tip : Start by setting up a nightly practice. Write down three things you are grateful for each night and explain why you believe they happened. Do not repeat anything on your list from day to day. If you keep up this activity in the long run, you will have hundreds of examples of gratitude by the end of the year!

Strength tip : For whichever group you fall into, use character strengths as your topic — write about how you used a character strength in doing an enjoyable activity (e.g., I used my strength of zest to infuse my team with energy and enthusiasm during the softball game yesterday). Or, write positive affirmations using your strengths (e.g., I am a kind and fair-minded person when I go out of my way to help my work colleagues when they are struggling).

VIA Institute on Character: Take the free, scientific survey of character strengths .

Epstein, R. (2011, September/October). Fight the frazzled mind. Scientific American Mind . www.scientificamerican.com/article.cfm?id=fight-the-frazzled-mind

Freidlin, P., Littman-Ovadia, H., & Niemiec, R. M. (2017). Positive psychopathology: Social anxiety via character strengths underuse and overuse. Personality and Individual Differences, 108 , 50-54. DOI: dx.doi.org/10.1016/j.paid.2016.12.003

Gander, F., Proyer, R.T., Ruch, W., & Wyss, T. (2013). Strength-based positive interventions: Further evidence for their potential in enhancing well-being and alleviating depression. Journal of Happiness Studies, 14 , 1241–1259. doi:10.1007/s10902-012-9380-0

Hames, J. L., & Joiner, T. E. (2012). Resiliency factors may differ as a function of self-esteem level: Testing the efficacy of two types of positive self-statements following a laboratory stressor. Journal of Social and Clinical Psychology, 31 (6), 641-662.

Niemiec, R. M. (2014). Mindfulness and character strengths: A practical guide to flourishing. Cambridge, MA: Hogrefe.

Niemiec, R. M. (2017). Character strengths interventions: A field-guide for practitioners. Cambridge, MA: Hogrefe.

Peterson, C., & Seligman, M. E. P. (2004). Character strengths and virtues: A handbook and classification. New York: Oxford University Press and Washington, D.C.: American Psychological Association.

Rosmarin, D. H., Pargament, K. I., Pirutinsky, S., & Mahoney, A. (2010). A randomized controlled evaluation of a spiritually-integrated treatment for subclinical anxiety in the Jewish community. Journal of Anxiety Disorders, 24 , 799-808.

Rosmarin, D. H., Pirutinsky, S., Greer, D., & Korbman, M. (2015). Maintaining a grateful disposition in the face of distress: The role of religious coping. Psychology of Religion and Spirituality . doi: http://dx.doi.org/10.1037/rel0000021

Seligman, M. E. P., Steen, T. A., Park, N., & Peterson, C. (2005). Positive psychology progress: Empirical validation of interventions. American Psychologist, 60 , 410–421. http://dx.doi.org/10.1037/0003-066X.60.5.410

Toussaint, L., Shields, G. S., Dorn, G., & Slavich, G. M. (2016). Effects of lifetime stress exposure on mental and physical health in young adulthood: How stress degrades and forgiveness protects health. Journal of Health Psychology, 21 (6), 1004-1014. doi:10.1177/1359105314544132J

Wood, A. M., Linley, P. A., Matlby, J., Kashdan, T. B., & Hurling, R. (2011). Using personal and psychological strengths leads to increases in well-being over time: A clongitudinal study and the development of the strengths use questionnaire. Personality and Individual Differences, 50 , 15-19.

Ryan M. Niemiec, Psy.D. , is the education director at the VIA Institute on Character.

• Find Counselling
• Find a Support Group
• Find Online Therapy
• United Kingdom
• Asperger's
• Bipolar Disorder
• Chronic Pain
• Eating Disorders
• Passive Aggression
• Personality
• Goal Setting
• Positive Psychology
• Stopping Smoking
• Low Sexual Desire
• Relationships
• Child Development
• Self Tests NEW
• Therapy Center
• Diagnosis Dictionary
• Types of Therapy

At any moment, someone’s aggravating behavior or our own bad luck can set us off on an emotional spiral that threatens to derail our entire day. Here’s how we can face our triggers with less reactivity so that we can get on with our lives.

• Emotional Intelligence
• Gaslighting
• Affective Forecasting
• Neuroscience

Workplace Stress Management: 11 Best Strategies & Worksheets

An American Psychological Association survey found that 31% of staff felt stressed out during their workday (cited in Tetrick & Winslow, 2015).

Help is available. Workplace stress management and wellness programs can help reduce the degree and impact of stress and restore an employee’s depleted psychological resources (Tetrick & Winslow, 2015).

This article explores what we mean by workplace stress management and introduces mechanisms and activities that can provide relief and help staff cope.

Before you continue, we thought you might like to download our three Stress & Burnout Prevention Exercises (PDF) for free . These science-based exercises will equip you and those you work with with tools to manage stress better and find a healthier balance in your life.

This Article Contains:

What is workplace stress management, how to prevent stress at work: 3 strategies, 2 helpful coping mechanisms for employees, stress relief at work: 3 worksheets to reduce stress, 3 activities & worksheets to cope with stress, how to craft prevention programs & workshops, assessing stress: 4 questionnaires & scales, best stress-relief tools from positivepsychology.com, a take-home message.

The relationship between the workplace and our psychological, cognitive, and physiological responses to stress is complex, impacted by “a broad set of occupational and work demands as well as environmental stressors” (Quick & Henderson, 2016, p. 2).

And yet, our stress response at work can typically be attributed to one of the following four workplace demands (Quick & Henderson, 2016):

• Task demands Job insecurity, workload, occupation, etc.
• Role demands Role conflict and ambiguity
• Physical demands Workplace, lighting, and temperature
• Interpersonal demands Staff density, leadership style, and personality conflicts

Workplace stress management (WSM) has been significantly influenced by the theory of preventive stress management, introduced in 1979, which proposes that it is not the stimuli that decide the degree of stress experienced by the individual, but the individual’s response to those stressors (Hargrove, Quick, Nelson, & Quick, 2011).

Over the years, many theoretical frameworks and organizational wellness programs that fall under the umbrella term of WSM have been proposed to understand occupational stress and employee wellbeing. WSM aims to understand specific stressors and take positive steps to reduce their effects (Tetrick & Winslow, 2015).

WSM interventions are typically divided into three types:

• Primary Proactive and involved in preventing stress and promoting employee wellbeing (including wellness programs, conflict management, etc.)
• Secondary Proactive and reactive, to help remove risk factors (including coping skills, employee fitness programs, job redesign)
• Tertiary Reactive, for employees who need help (including counseling, employee assistance programs, and Cognitive-Behavioral Therapy)

Stress interventions include (modified from Tetrick & Winslow, 2015):

• Cognitive-behavioral interventions Primary and secondary interventions. Changing cognitions and reinforcing active coping skills .
• Relaxation techniques Secondary and tertiary interventions. Physical and mental relaxation techniques to help cope with the consequences of stress.
• Multimodal programs Secondary interventions. Acquiring passive and active coping skills. They consist of a combination of approaches, including relaxation and cognitive-behavioral skills.
• Organization-focused interventions Mostly primary interventions, but some considered secondary. Organizational development and job redesign.
• Individual-level interventions Secondary or tertiary interventions, including relaxation, meditation, and cognitive-behavioral skills training.
• Organizational-level interventions Primary and secondary interventions, including changing working conditions and employee participation.
• Systems approach Primary and secondary, combining individual and organizational interventions.

Such interventions are often used in combination to prevent, reduce, and cope with stress.

While many of the following strategies appear simple, they require focus and commitment. Others foster a new mindset and change how we relate to work and occupational stress.

1. Controlling your stress

Our brains are constantly flooded with increasing demands and information, causing us stress and reducing our ability to focus and solve problems.

There are many steps we can take to avoid or reduce stress, including promoting positive emotions, taking physical care of our brain, and becoming more organized (modified from Hallowell, 2014).

• Ensure you get adequate sleep (don’t eat late at night and reduce caffeine and alcohol intake).
• Enjoy a balanced diet and stay hydrated.
• Exercise throughout the week and get time away from your desk, preferably in nature.
• Schedule regular catch-ups with people you value.
• Break large tasks into smaller ones.
• Maintain a tidy work environment.
• Schedule some ‘think time’ in your busy schedule.
• Allocate time for lunch and take it away from your desk.
• Recognize when you do your best work. Plan your most demanding tasks for those times.
• Walk around more, stand, or listen to music, depending on what works best for you.
• Set reminders for a ‘hard stop’ at the end of the workday.

2. When you feel overwhelmed

• Slow yourself down. When stressed, we often move into panic mode.
• Take time to perform a calming exercise.
• Move around. Walk outside or head to the break room/kitchen.
• Ask for help. Seek out people you trust.

3. Managing your energy

Demanding jobs, long hours, and increasing workloads can leave us feeling emotional, disengaged, stressed, and exhausted (Schwartz & McCarthy, 2014).

Creating a series of habits , practices, and rituals can promote your physical, emotional, mental, and spiritual energy (modified from Schwartz & McCarthy, 2014).

Physical energy

• Recognize times in the day when you feel tired or unable to concentrate. Step away from the desk, meet colleagues, or perform something interesting.
• Aim to focus for 90 to 120 minutes at a time, taking regular breaks.
• Eat smaller, lighter meals during the day to maintain energy.

Emotional energy

• Practice abdominal breathing to manage negative emotions , such as irritability, anxiety, and impatience.
• Express gratitude and appreciation for others while adopting self-compassion for yourself.
• Use a reverse lens to see a situation from the other person’s point of view. Use a long lens to consider how we might look at the issue in six months. Use a wide lens to consider the bigger picture.

Mental energy

• Switch off email and move phones away to perform high-concentration tasks.
• Schedule specific times in the day to answer and respond to emails.
• At the end of each day, make a list of key actions for tomorrow.

Spiritual energy

• Identify when you perform at your best. What strengths do you enjoy using, and how can you use them more often?
• On your commute home, or the last 20 minutes of your day when working remotely, relax. This may mean sitting mindfully or listening to music before returning to home life.
• Recognize your core values. Reflect on whether you are using and showing them to others around you. Find opportunities to be your authentic self.

We all have finite limits before reducing energy levels and increasing stress interrupt what we can achieve. Investing in healthy work habits can maintain productivity and performance throughout the day.

Download 3 Free Stress & Burnout Prevention Exercises (PDF)

These detailed, science-based exercises will equip you or your clients with tools to manage stress better and find a healthier balance in their life.

Download 3 Stress & Burnout Prevention Exercises Pack (PDF)

By filling out your name and email address below.

• Email Address *
• Your Expertise * Your expertise Therapy Coaching Education Counseling Business Healthcare Other
• Comments This field is for validation purposes and should be left unchanged.

How we experience and handle stress changes its cognitive, emotional, and behavioral impact (Crum & Crum, 2018). The following two coping mechanisms offer practical approaches for managing stress in the workplace and can be implemented with little training.

Mindfulness

Research has confirmed the success of mindfulness at reducing perceived stress and emotional exhaustion, and improving sleep quality and job satisfaction (Tetrick & Winslow, 2015).

While we may sometimes think of mindfulness as passive and accepting, it is often the first step toward growth and change. While incredibly valuable for handling life stresses, it is also powerful enough to enrich positive and happy times in our lives (Shapiro, 2020).

Mindfulness expert Shauna Shapiro (2020) considers three points essential to mindfulness:

• Intention – why we pay attention
• Attention – attending to the present
• Attitude – how we pay attention (compassion, kindness, etc.)

A review of the literature confirms that mindfulness is a powerful and cost-free approach to coping with stress (Shapiro, 2020).

Reframing stress

While we are familiar with the negative impacts of stress, we sometimes forget that achieving a stress-free life is unlikely and, perhaps, impossible (Crum & Crum, 2018).

We must recognize that some degree of stress is crucial to our personal and professional growth. Stress reminds us that something is important to us, that we care.

People who adopt a “stress is enhancing” mindset rather than a “stress is debilitating” mindset perform better and experience fewer negative health consequences (Crum & Crum, 2018).

But how do we see stress differently?

We can rethink stress using the following three steps (Crum & Crum, 2018; Crum, Salovey, & Achor, 2013):

• See it Rather than deny stress, you must recognize and name the stress you are facing.

“I am stressed about my job interview.” “I am stressed about finals.”

Acknowledging stress can help you move brain activity from being automatic and reactive to conscious and deliberate.

• Own it Recognize that what you are stressing about must be important to you. “Owning this realization unleashes positive motivation” (Crum & Crum, 2018, p. 73).
• Use it Stress is not designed to kill us, but to boost our mind and body, and prepare for the challenge ahead. By reframing your stress response as something positive, such as eustress , you can use your heightened energy and awareness to improve your performance.

Even with long-term, chronic stress at work, you can recognize opportunities for learning, growth, or the motivation to change yourself or your situation. While it may not always be possible, if you can find a way to embrace stress, it can become a “powerful tool for helping you overcome the inevitable challenges that can – and will – arise” (Crum & Crum, 2018, p. 75).

Identifying Your Stress Resources

Your resources (internal and external) provide a potentially limitless amount of support that will sustain you during challenging times and stressful situations (Niemiec, 2019).

The Identifying Your Stress Resources worksheet helps you recognize your resources and identify how they can support your strengths.

Stress Decision Framework

Decision-making takes time. The effect of weighing up pros and cons uses up precious resources and risks adding to an already stressful workload.

The Stress Decision Framework worksheet helps you put decision-making in context, aiming for a good enough , not perfect , decision (Armstrong, 2019).

Vicious Versus Virtuous Stress Thinking

Stress is a choice, yet it is often perpetuated by negative (vicious) cycles of thinking (Armstrong, 2019).

It doesn’t have to be this way.

Using a cognitive-behavioral approach, it is possible to reframe unhelpful beliefs and thinking, and adopt a virtuous cycle of thinking.

The Vicious Versus Virtuous Stress Thinking worksheet helps you compare unhelpful and helpful thinking regarding an event (Armstrong, 2019).

The cost of workplace stress – and how to reduce it – Rob Cooke

Coping with stress can often be about gaining control of what is – or, more importantly, what we perceive to be – within our control. The following activities and exercises can help.

One-Hour Stress Plan

When we feel overwhelmed, we get stressed, which can damage our focus and cloud our thinking. “Working within a limited time frame is important because the race against time keeps you focused” (Bregman, 2014, p. 157).

Use the One-Hour Stress Plan worksheet when stressed to plan and work through what you can in 60 minutes. At the end of the hour, you will have progressed and can repeat the exercise as many times as you like (modified from Bregman, 2014).

Stress as a Stimulus for Change

Sometimes stress is a good indication that something in your life needs to change.

The Stress as a Stimulus for Change worksheet can capture what you wish to change in your life and begin the transformation process .

Workplace Mindfulness

Mindfulness can be a powerful way to adopt a state of loving-kindness about yourself and others, and has significant benefits to how you handle stress (Shapiro, 2020; Tetrick & Winslow, 2015).

The Workplace Mindfulness worksheet can help decrease stress and improve workplace satisfaction through a series of simple questions asked when relaxed and present.

Instead, a multimodal approach should be considered when crafting prevention programs and workshops (Tetrick & Winslow, 2015).

Most likely, it will be necessary to put in place learning and education that are both proactive and reactive.

Proactive interventions

Focus on preventing stress (removing risk factors) and promoting positive actions for all employees.

Interventions are likely to include:

• Conflict management
• Employee wellness
• Job redesign and the organization of work
• Coping skills
• Employee fitness programs (for employees with known risk factors)

Reactive interventions

Focus on helping employees who need assistance.

• Cognitive-Behavioral Therapy
• Rehabilitation after illness or returning to work
• Employee assistance programs

A multimodal approach combines multiple intervention styles and techniques, and can be rolled out across the organization while focusing on the individual (Tetrick & Winslow, 2015).

The following questionnaires measure a respondent’s current degree of stress and assess their risk of experiencing future stress.

Perceived Stress Scale

The Perceived Stress Scale is one of the most widely used measures of the perception of stress (Cohen, 1994; Cohen & Williamson, 1988).

The 10 questions are answered with a rating between 0 (never) and 4 (very often).

For example:

In the last month, how often have you been upset because of something that happened unexpectedly?

In the last month, how often have you felt nervous and “stressed”?

Life Events and Difficulties Schedule (LEDS) and Stress and Adversity Inventory (STRAIN)

LEDS is a structured interview used to assess stressor exposure over a lifetime. It has since been turned into an online version known as STRAIN (Crosswell & Lockwood, 2020).

“Both measures provide a comprehensive assessment of stressor exposures across the lifespan” (Crosswell & Lockwood, 2020, p. 2) and can be valuable for research and therapy.

Stress Mastery Questionnaire (SMQ)

The American Institute of Stress offers the SMQ as an online self-assessment of stress risk.

The results, plus a 66-page Stress Mastery Guide and Workbook , provide a personalized stress risk profile that can help you lead a less stressed, more enjoyable life.

You’ll find a range of powerful stress-related interventions and assessment tools available throughout our site. Check out the following for some of our favorites:

• Radical Acceptance of a Distressing Situation This worksheet presents a sequence of eleven questions to help clients reflect on a current or past distressing situation and work toward radically accepting the reality of that event.
• Changing Physical Habits This worksheet helps clients reflect on their vulnerabilities and routines surrounding aspects of their physical health and consider steps to develop healthier habits.
• Coping With Stress This two-part exercise invites clients to list experienced physiological and emotional symptoms of stress and brainstorm strategies to reduce, cope with, or eliminate these sources of stress.
• Coping: Stressors and Resources This worksheet helps clients identify past, present, and future stressors and link them with coping resources they can use to overcome them.
• Squeeze and Release This group activity helps participants discover the energizing potential of positive stress, known as eustress , which can help improve motivation, performance, and emotional wellbeing.
• 13 Stress-Relief Books About the Science of Managing Anxiety This article provides an excellent selection of stress-relief books .
• 17 Stress & Burnout Prevention Exercises If you’re looking for more science-based ways to help others manage stress without spending hours on research and session prep, check out this collection of 17 validated stress-management tools for practitioners . Use them to help others identify signs of burnout and create more balance in their lives.

Our physical and mental wellbeing, work environment, and the demands of our job all impact our degree of stress. They also influence our performance and productivity in the workplace.

Reducing stressors and managing their impact by adopting effective coping mechanisms help us regain a sense of control (Quick & Henderson, 2016).

According to Angela Armstrong (2019), stress is a choice. Appropriate workplace stress management (personal and organizational) helps us identify ways to control what we can and learn how to see things differently when we cannot.

With the right mindset, seeing stress as enhancing, we can increase our motivation and see challenges as opportunities for growth rather than debilitating obstacles (Crum et al., 2013).

There are powerful tools to help. In recent years, mindfulness in particular has become increasingly popular for stress reduction, helping individuals to confront situations “in an accepting, nonjudgmental manner” (Tetrick & Winslow, 2015, p. 8).

Why not review some strategies, techniques, and tools in this article and identify what can help you, your employees, or your clients manage the impact of stress or turn it into something positive and life enhancing?

We hope you enjoyed reading this article. Don’t forget to download our three Stress & Burnout Prevention Exercises (PDF) for free .

• Armstrong, A. (2019). Resilience club: Daily success habits of long-term high performers . Rethink Press.
• Bregman, P. (2014). A practical plan when you feel overwhelmed. In HBR guide to managing stress at work (pp. 27–50). Harvard Business Review Press.
• Cohen, S. (1994). Perceived Stress Scale . Mind Garden. Retrieved September 1, 2021, from https://www.mindgarden.com/documents/PerceivedStressScale.pdf
• Cohen, S., & Williamson, G. (1988). Perceived stress in a probability sample of the United States . In S. Spacapan & S Oskamp (Eds.), The social psychology of health . Sage.
• Crosswell, A. D., & Lockwood, K. G. (2020). Best practices for stress measurement: How to measure psychological stress in health research. Health Psychology Open , 7 (2).
• Crum, A., & Crum, T. (2018). Stress can be a good thing if you know how to use it. In HBR’s 10 must reads: On mental toughness (pp. 71–75). Harvard Business Review Press.
• Crum, A. J., Salovey, P., & Achor, S. (2013). Rethinking stress: The role of mindsets in determining the stress response. Journal of Personality and Social Psychology , 104 (4), 716–733.
• Hallowell, E. M. (2014). Overloaded circuits. In HBR guide to managing stress at work (pp. 27–50). Harvard Business Review Press.
• Hargrove, M. B., Quick, J. C., Nelson, D. L., & Quick, J. D. (2011). The theory of preventive stress management: A 33-year review and evaluation. Stress and Health: Journal of the International Society for the Investigation of Stress , 27 (3), 182–193.
• Niemiec, R. (2019). Strength-based workbook for stress relief: A character strengths approach to finding calm in the chaos of daily life . New Harbinger.
• Quick, J., & Henderson, D. (2016). Occupational stress: Preventing suffering, enhancing wellbeing. International Journal of Environmental Research and Public Health , 13 (5), 459.
• Schwartz, T., & McCarthy, C. (2014). Manage your energy not your time.  Harvard Business Review Press.
• Shapiro, S. L. (2020). Rewire your mind: Discover the science + practice of mindfulness . Aster.
• Tetrick, L. E., & Winslow, C. J. (2015). Workplace stress management interventions and health promotion. Annual Review of Organizational Psychology and Organizational Behavior , 2 (1), 583–603.

Share this article:

Article feedback

What our readers think.

I’m looking for an active stress avoidance / proactive approach to a stress-free work experience. This article appears to focus on alleviating the effects of stress rather than designing a work experience that removes it, and/or deals with those in positions of power in the workplace who rely on others for results and enforce this through control techniques, resulting in high employee stress, since the techniques are seldom nice, polite, sustainable or implemented with the employee’s long term well being in mind. I need workplace strategies that negate those manipulations and exploitations put in place by the hierarchy to simply get more work from employees, no matter what. Engagement surveys, annual reviews, and many workplace methodologies are in fact trojan horses. Please advise, many thanks Alvin Zest

Thanks for your comment; I completely understand where you’re coming from. Many of the dominant approaches to addressing strain, stress, and high work demands in organizations are largely reactive and center on ‘undoing’ the harm (i.e., stress) done to employees after it’s already done, rather than being proactive and creating conditions that prevent the harm in the first place. However, more research is coming out that’s looking at these proactive strategies.

Research is a long way from identifying a complete solution, but I would encourage you to look into the research and efforts by a researcher named Sharon Parker and her colleagues at the Center for Transformative Work Design. Some of the videos on this page might begin pointing you in the right direction and highlight the path research has taken so far.

I hope this helps.

– Nicole | Community Manager

Let us know your thoughts Cancel reply

Your email address will not be published.

Save my name, email, and website in this browser for the next time I comment.

Related articles

Company Culture: How to Create a Flourishing Workplace

Company culture has become a buzzword, particularly in the post-COVID era, with more organizations recognizing the critical importance of a healthy workplace. During the Great [...]

Integrity in the Workplace (What It Is & Why It’s Important)

Integrity in the workplace matters. In fact, integrity is often viewed as one of the most important and highly sought-after characteristics of both employees and [...]

Neurodiversity in the Workplace: A Strengths-Based Approach

Promoting diversity, equity, and inclusion (DEI) in the workplace is a priority for ethical employers who want to optimize productivity and leverage the full potential [...]

Read other articles by their category

• Body & Brain (50)
• Coaching & Application (58)
• Compassion (25)
• Counseling (51)
• Emotional Intelligence (23)
• Gratitude (18)
• Grief & Bereavement (21)
• Happiness & SWB (40)
• Meaning & Values (26)
• Meditation (20)
• Mindfulness (44)
• Motivation & Goals (45)
• Optimism & Mindset (34)
• Positive CBT (30)
• Positive Communication (22)
• Positive Education (47)
• Positive Emotions (32)
• Positive Leadership (19)
• Positive Parenting (16)
• Positive Psychology (34)
• Positive Workplace (37)
• Productivity (18)
• Relationships (43)
• Resilience & Coping (38)
• Self Awareness (21)
• Self Esteem (38)
• Strengths & Virtues (32)
• Stress & Burnout Prevention (34)
• Theory & Books (46)
• Therapy Exercises (37)
• Types of Therapy (64)

Download 3 Free Work & Career Tools Pack (PDF)

• Email This field is for validation purposes and should be left unchanged.

Download 3 Work & Career Exercises Pack (PDF)