Ask the NP: Stress Management Techniques

with Dr. Elizabeth Markovich, DNP


Dr. Elizabeth Markovitch

Dr. Elizabeth Markovich

Stress is an integral part of everyday living. While stress by itself is not inherently a negative experience, prolonged stress can be quite harmful to the immune system, the adrenals, and the heart. Each individual’s reaction to the same stressor can be positive or negative. Using the Life Stress Questionnaire will help you to determine the role that stress may play in your present health problems. Because we all react differently to the same stressors, this scale is only a rough indicator of stress in your life.

Some common negative ways of coping with stress are: overeating, smoking, and alcohol or drug abuse. Hopefully, you have found more positive ways to deal with the stress in your life: exercise, meditation, breathing exercises, improving time management, healthy diet, and improving the quality of the important relationships in your life.


Positive Ways to Deal with Stress

Exercise – A regular exercise program helps to generate a greater sense of well-being, accompanied by increased energy, improved sleep, and improved coping skills. A cardiovascular program, yoga, tai chi, or daily walking are all examples of the many types of exercise that may help you to de-stress your life.

Meditation – It is very difficult to calm the mind and the body during stress unless you have developed some helpful relaxation techniques, such as meditation, breathing, or prayer. Only 5 minutes daily are needed to start improving your reaction to stress. A very helpful paperback book by Joan Borysenko, Minding the Body, Mending the Mind, might be a good way to start a meditation program. There are hundreds of other books that may also be helpful. The important thing is to develop a program that works for you, perhaps every morning for 5 minutes before you shower. Breathing exercises can accompany meditation or be a stand-alone stress-reduction technique.

Life Issues – Improving time management by prioritizing and organizing your daily responsibilities will decrease the total stress load. Improving your communication skills in your important family or job-related relationships can improve the quality of your life by decreasing your total stress load.

Healthy Diet – Many common foods and beverages do not support your body during periods of stress, whether small or large. Eating high-quality, nutrient-dense foods enables you to deal with stress in a more positive way. It is most important to restrict intake of refined sugars and starches, caffeine, alcohol, and known allergic foods. Unrefined whole grains, fruits, vegetables, legumes, nuts, essential fats, and quality proteins that are low in saturated fat are all part of a healthy, nutrient-dense dietary program.

Prolonged stress may lead to exhaustion of your adrenal glands, which play a critical role in helping you to deal with stress. Adrenal exhaustion becomes a vicious cycle that includes depression, fatigue, feelings of anxiety, and lowered resistance to illness. It is in your best interest to prevent adrenal exhaustion from occurring by developing healthy stress-management techniques.

Mindful Breathing

Mindfulness can help with stress management

Mindfulness can help with stress management

Shallow breathing may lead to tension and fatigue. Breathing with your diaphragm tends to reduce stress and improve energy.

Abdominal breathing, also known as diaphragmatic breathing, is a powerful way to decrease stress by activating relaxation centers in the brain. The abdominal expansion causes negative pressure to pull blood into the chest, improving the venous flow of blood back to the heart.

  • Find a comfortable place to sit or lie down, with your feet slightly apart, one hand on your abdomen near the navel, and the other hand on your chest.
  • Gently exhale the air in your lungs through your mouth, then inhale slowly through your nose to the count of 4, pushing out your abdomen slightly and concentrating on your breath. As you breathe in, imagine warm air flowing all over your body. Hold the breath for a count of at least 4 but not more than 7.
  • Slowly exhale through your mouth while counting to 8. Gently contract your abdominal muscles to completely release the remaining air in the lungs.
  • Repeat until you feel deeply relaxed for a total of 5 cycles. You may be able to do only 1 or 2 cycles at first.
  • Once you feel comfortable with your ability to breathe into the abdomen, it is not necessary to use your hands on your abdomen and chest.

There may be an added benefit of lowering blood pressure when you place your tongue on the ridge of the roof of your mouth, just behind your teeth.

Elizabeth Markovich is the main clinician and owner of Integrative Healthcare, a primary care practice with emphasis on holistic and functional medicine. She completed her Doctor of Nursing Practice degree at Florida State University. She lives in Tallahassee, Florida with her husband Martin.

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