Stress Management for Client and Clinician

December 17, 2015

Regardless of the context, stress is a part of human life. Whether it is finals week, a deadline at work, a personal issue, or financial pressure, an inability to manage stress can have negative implications on an individual’s physical, emotional, and mental well-being. However, stress can also be a powerful motivator when handled appropriately. That said, stress management techniques are not innate in each individual; they take awareness and practice. Below are some suggestions on coping with stress from both a personal and clinical perspective.

Change the way you perceive stress

How you think about stress dictates how it affects you physically. A body of research in Britain called “The Whitehall studies” examined 30,000 adults over the duration of eight years. Those with high levels of stress who viewed stress as harmful were 43% more likely to die from stress-related causes. However, those that had high levels of stress but did not view stress as harmful were less likely to die from stress-related causes. In fact, their percentage was lower than people that did not even have a high level of stress. In short, changing the way you look at stress changes your body’s response to it. One can view stress as the body’s way of rising to the occasion, enhancing your performance ability and motivating you to act.  Conor Liston, a postdoctoral research fellow in neurosciences, states “If you think of stress in terms of arousal—being awake and alert and oriented to changes in the environment—this is a good thing for learning.” Stress is a physiological reaction of the nervous system which heightens alertness and enables better performance and effectiveness. It is our body’s way of self-regulating and handling high-pressure situations. With the right coping skills, stress reactions can be an important indicator and tool for effectiveness and accomplishment.

Social Support

Believe it or not, we are biologically programmed to have human-to-human contact and be a part of a social support system. One of the physical responses to stress in the body is the release of the hormone oxytocin. Not only does this hormone encourage human connection (this is the hormone released in new mothers and enhanced by social contact), but it also heals the cardiovascular system from the effects of stress.   This means that having a strong social support system not only benefits you emotionally, but actually helps your body heal physically from stress reactions. During high-stress periods, more than ever, it is important to maintain healthy communication with family and friends. Reliance on a social support system precipitates a healthy and positive stress response both emotionally and physically.

Practice Mindfulness/Meditation

Jon KabatZinn, founder of MBSR (mindfulness-based stress reduction), describes mindfulness as “paying attention in a particular way: on purpose, in the present moment and non-judgmentally” and “the intentional cultivation of non-judgmental moment-to-moment awareness.” An ever-growing body of research literature cites a plethora of benefits attributed to the regular practice of mindfulness and/or meditation. Physiological changes, including reduction in cortisol levels, decreased blood pressure, and improved immune responses have been correlated with regular meditation (Creswell et al., 2009 and Fang et al., 2010).

A study from Harvard asserts that, on average, our minds are lost in thought about 47% of the day. In addition, this sort of mind-wandering is associated with higher levels of dissatisfaction with life. Meditation, for just 10 minutes a day, can have a lasting effect. Many people attempt to meditate, but give up quickly out of frustration. This frustration often stems from the belief that in order to meditate effectively they have to stop thoughts completely. This is not necessary and is, in fact, extremely difficult to do. Instead of viewing meditation as elimination of thought, view it as observation of thought. Thoughts come and pass, but instead of getting completely drawn into and lost in them, try to step back and become the quiet observer. It is as if you are lying on the grass on a beautiful day, watching the clouds pass. Now imagine those clouds are your thoughts. You can become aware of them, observe them from afar without judgement, and then watch them pass. Allow your thoughts to come and go without actually entertaining or involving yourself in them.   In short, don’t try so hard, and don’t judge the process.

For Clinicians

When it comes to environmentally triggered acute stress, such as academic stress during final exams, complex treatment modalities that require in-depth assessments, psychoeducation or multiple sessions are not practical. Of course, ideally, the client will continue therapy after the crisis situation is over, but most individuals and families who seek clinical services are doing so in response to a crisis. It is important to remember that those clients who have a maladaptive thought process or emotional reactivity that causes the stress to affect them in a more substantial and detrimental way will benefit from further treatment. In-depth Cognitive Behavioral Therapy, for example, would provide an opportunity to delve into core assumptions and beliefs rather than more topical maladaptive automatic thoughts.   CBT, however, is a relatively short treatment model in comparison to others, usually involving 6-14 sessions.

Each person reacts to outside stimuli in a unique way; this reaction is a manifestation of their biology, education level, social environment, experiences in life, trauma, past and current relationships, etc. An individual with Social Phobia, for instance, will most likely experience exacerbated symptoms in stressful situations. Someone with a history of substance abuse might be more inclined to rely on drugs and alcohol to control stress symptoms which often only exacerbates the problem.

Techniques such as reframing, thought-stopping, visualization and peer-to-peer support can be useful techniques for a student to use. They will most likely have a strong psychoeducational component: breath-work, meditation, time-management techniques, goal-setting and prioritizing. Additional self-care suggestions include physical activity, sufficient sleep, and adequate nutrition. It is important to encourage clients to maintain personal relationships and continue with regular social activities and spiritual practices. As always, clients have innate strengths and coping mechanisms that should be emphasized and exploited in a positive way.