Key 7: Manage Stress
(From the series Ten Keys to Successful Coping: 2001)
By Bruce Campbell
Stress can be a challenge for anyone, but it can be doubly difficult for people with ME/CFS or fibromyalgia.
On the one hand, chronic illness intensifies stress. Being ill adds new stressors to those you were already confronting. And if that was not enough, ME/CFS and fibromyalgia are very stress-sensitive illnesses.
Not only are your stresses multiplied because you are ill, you are more vulnerable to the effects of stress.
Even moderate amounts of stress can greatly intensify ME/CFS and fibromyalgia symptoms, creating a feedback loop in which your symptoms and your response to them intensify one another. If you feel under stress, for example, your body is likely to become tense, increasing your pain.
The pain in turn can make you feel more stressed. Ongoing stresses like those in ME/CFS and FM are particularly debilitating, making stress management a central challenge to living successfully with chronic illness.
Using stress management strategies, you can learn how to interrupt the cycle in which symptoms and stress intensify one another. We'll look at this topic from two perspectives: stress reduction and stress avoidance.
Stress Reduction
Stress reduction means learning how to respond differently to stressful situations and events. Here are seven ways to reduce stress.
Relaxation
Relaxation offers a profound antidote to stress. Relaxation means letting go. Physically, it involves releasing muscle tension and breathing more slowly and regularly. Emotionally, it consists of nurturing a sense of equanimity. Mentally, it means observing and releasing worry-filled thoughts.
Physically-relaxing activities counteract both the physical and the emotional aspects stress. Through relaxation, you can reduce muscle tension and anxiety. Relaxation is also very helpful for pain control. Resting can reduce stress. Combining rest with a relaxation procedure or meditation can be an even more effective means of stress reduction.
Problem-Solving
Taking practical steps to improve your situation can also help reduce anxiety and worry. As one member of our groups said, "I try to work out a practical plan for the things that are bugging me that I feel I can change. Sometimes the problems seem overwhelming, but the advice of tackling one thing at a time really works."
Positive Experiences
Doing things that are enjoyable can be a stress reducer. Positive experiences counteract the thought that illness means only suffering. Also, pleasurable activities lower the frustration of being ill while distracting you from your symptoms.
Examples of positive experiences include exercise and movement, journaling, talking and being listened to, music and the arts, laughter and humor, and solitude.
Mental Adjustments
Our thoughts can be another source of stress. One such cause of stress is having unrealistic or inappropriate expectations. For example, we may hold ourselves to housecleaning standards that may no longer make sense.
Assertiveness
Speaking up for yourself can be a stress reducer in a number of ways. Saying ‘no' can help you avoid doing things that would intensify your symptoms. Also, presenting your position rather than stuffing it can replace frustration with action.
Support
Being ill is both inherently stressful and isolating. Having people in your life who understand and respect you is a balm to the soul. Just being listened to and feeling connected to others is healing. Beyond that, talking may help you clarify your situation or their response may enable you to see your life in a different and more constructive way.
Family members may provide such support and you may also find it through developing relationships with fellow patients. Support also means practical assistance, which might include such things as shopping, cooking, bill paying or housecleaning.
Medications
Prescription medications may be helpful for some patients as part of a stress management program.
Stress Avoidance
Stress avoidance is preventive, using self-observation to learn how stress affects you and then taking measures to avoid stressful circumstances. For example, you may notice that when you hit a limit, any further activity will intensify your symptoms.
In such circumstances, rest can reduce the stress on your body. Planned rest can be an effective stress avoidance strategy. Having good relationships are a buffer against stress. People with supportive relationships have lower anxiety and depression.
The main ways that people in our groups prevent stress are by avoiding stress triggers and by using routine or scheduling.
Avoidance of Stress Triggers
We may have particular circumstances in our lives that "set us off." If we can identify these stress triggers, we may be able to avoid them or reduce their impact. You might think of triggers in the categories of people, substances and situations.
Some patients find interactions with particular people are the cause of disabling stress. Responses they have made include talking with the person, limiting contact, getting professional help with the relationship, and ending the relation. Food, chemicals and other substances can trigger symptoms.
By identifying and avoiding specific foods or other substances you may be able to avoid relapses. In terms of situations, if you are particularly sensitive to light or noise or crowds or experience sensory overload in other ways, avoiding those situations can help you control symptoms.
Scheduling and Routine
Novelty is another source of stress. It takes more energy to respond to a new situation than it does to something familiar. Given our limited energy, saving it for healing is desirable. One way to do that is through making your life predictable.
Some patients have done that through routine: living their lives according to a schedule. They have been able to reduce the surprises and emotional shocks in their lives, and thereby reduce their stress. By knowing what to expect, they have reduced pressures on themselves. Any steps in the direction of giving predictability to life is likely to lower stress.
Many of the pacing strategies described in Key 3 are also effective stress reducers. Scheduling activity based on priorities, timing activity for the best hours of the day, and staying within known limits all help control stress.
A Few Ideas for Getting Started
Here are a few ideas if you would like to experiment with new ways to control stress.
Create Positive Experiences
Doing things that are enjoyable can be a great stress reducer. For example, seeing a movie, spending time in nature, listening to music, taking a bath, getting a massage or reading can distract from stress and reduce preoccupation with symptoms.
Exercise is a natural stress reducer, because it causes your body to produce endorphins. Just getting up and moving around can break a mood of worry.
Practice Relaxation Through Breathing
When we are under tension and stressed out, our breathing can become shallow. Becoming aware of your breathing and deliberately breathing in a deep and easy manner is a technique you can use to help you relax.
You might try it when caught in traffic, stuck in line, or when in an heated discussion. The basic principle is to focus on your breathing in order to slow down anxious or negative thoughts and to reduce the adrenaline flowing through your body.
To practice this type of breathing, focus your attention on your breath. Take in a long, slow breath through your nose, hold it one or two seconds, then breathe out through your mouth. As you exhale, you can say a calming word to yourself, like "relax."
The idea is to focus your attention on your breathing, keeping it slow and easy. As you breathe in this way, you should be able to feel your body relax and a sense of calmness replace your anxiety. To avoid becoming dizzy, keep your breathing slow and easy.
You may be able to achieve some benefits from a less formal procedure than the one just outlined. Simply noticing your breathing can often reduce anxiety. If you feel yourself worrying, tell yourself your are going to shift your attention to your breathing. Sometimes even taking one deep breath and letting it out slowly can reduce anxiety.
Develop a Routine
Any steps you take that give predictability to your life are likely to lower your stress. So choose some part of your life that is not consistent and give it a schedule. You might begin by bringing routine to your sleep, having a consistent time at which you go to bed and get up.
Or you might take a rest at a set time each day or eat at a regular hour. Or get dressed on a schedule each day. One student who regulated her day by having scheduled times for going to bed and waking up, eating meals, resting, exercising and watching TV said: "I know it sounds boring, but I swear it helps."
In Summary
Relaxation techniques --such as meditation, deep breathing, the use of imagery or listening to music or soothing sounds from nature-- offer a way to help us change our habitual ways of responding to stressors and to reduce our habitual stress level. Stress avoidance enables us to prevent stress.
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