Key 7: Manage Stress

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By Bruce Campbell

(Note: From the series Ten Keys to Successful Coping: 2005.)

Stress can be a challenge for anyone, but it is doubly difficult for people with CFS or fibromyalgia. First, CFS and FM add new stressors to those you were already confronting, things like the discomfort of symptoms, isolation, financial pressure, strains on relationships and uncertainty about the future.

In addition, CFS and fibromyalgia seem to make people more sensitive to stress than before. It is as if the conditions reset a "stress thermostat," intensifying the effects of a given level of stress. Even moderate amounts of stress can greatly intensify symptoms. In sum, CFS and FM both multiply your stresses and make you more vulnerable to the effects of stress.

Because the effects of stress on quality of life are so great, the use of stress management techniques can produce a big payoff. We'll look at this topic from two perspectives: stress reduction and stress avoidance. Before starting that discussion, however, let me suggest that you use multiple stress management techniques.

It's common for people in our classes to report that they use several forms of relaxation (such as deep breathing, meditation, listening to relaxation tapes and massage) in combination with other strategies, such as having a regular routine and avoiding stressful situations.

Stress Reduction

Stress reduction means learning how to respond differently to stressful situations and events. Often, how we view and react to a stressor determines how much stress we experience. For example, worry in response to an increase in symptoms may lead to muscle tension.

Muscle tension can create pain, which in turn drains energy and causes fatigue. By learning to relax, we can reduce muscle tension and short-circuit the process. This is one example of how to reduce the impact of stressors by changing our response. You'll find below descriptions of seven ways to reduce stress.

1) Relaxation: Relaxation offers a profound antidote to stress. Relaxing activities counteract both the physical and the emotional aspects stress. Through relaxation, you can reduce muscle tension and anxiety.

Relaxation is also very helpful for pain control. Resting can reduce stress. Combining rest with a relaxation procedure or meditation can be an even more effective means of stress reduction. (For step-by-step instructions, see the article Stress Reduction: Five Practical Techniques.)

2) 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."

3) 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.

4) 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. You can reduce stress by changing your expectations. For more, see the article Taming Stressful Thoughts.

5) 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 suffering in silence enables you to replace frustration with action.

6) Support: Being ill is both 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 the response you get from others 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.

7) 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, which was discussed in the article on pacing, earlier in this series, can be an effective stress avoidance strategy. Having good relationships, as discussed in the next article, 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 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, noise or crowds or experience sensory overload in other ways, avoiding those situations or limiting your exposure to them 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 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 pacing strategies 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 you are under tension and stressed out, your breathing can become shallow. Becoming aware of your breathing and deliberately breathing in a deep and easy manner helps you relax.

You might try it when caught in traffic, while you are waiting in line at the grocery store, or when you are 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 goal 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 anxiety. To avoid becoming dizzy, keep your breathing slow and easy.

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 your meals at the same times every day. 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 and other stress reduction techniques offer a way to help you change your habitual ways of responding to stressors and to reduce your normal stress level. Stress avoidance enables you to prevent stress.