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By Bruce Campbell

Stress can be a challenge for anyone, but it can be doubly difficult for people with ME/CFS or fibromyalgia. Chronic illness adds new stressors to the common challenges of everyday life. The new stresses include the discomfort of symptoms, isolation, financial pressure, strained relationships and uncertainty about the future.

And if that was not enough, ME/CFS and fibromyalgia are very stress-sensitive illnesses, which seem to reset our "stress thermostat" so that the effects of a given level of stress are greater than they would be for a healthy person.

In summary, not only are your stresses multiplied because you are ill, you are more vulnerable to the effects of stress. All this makes stress management a central challenge to living successfully with chronic illness.

Managing Stress: Two Approaches

Like other aspects of ME/CFS and fibromyalgia, stress is a part of the illness that can be managed. And it is an area in which there can be a big payoff for your efforts, because the effects of stress on symptoms and on quality of life is so great.

By using stress management techniques such as those described in this article and the next one, you can learn how to interrupt the cycle in which symptoms and stress reinforce one another.

In responding to stress, there are two major approaches that may be helpful: stress reduction and stress avoidance. The first involves retraining yourself, learning how to respond differently to stressors so that they do not have the same effect as in the past.

The second approach is preventive, taking measures to avoid stressful circumstances. Because stress is so pervasive in chronic illness, we recommend you use a variety of techniques to combat it, experimenting to find which are most effective for you.

Stress Reduction

Often, how we view and react to a stressor determines how much stress we experience. For example, if you worry in response to an increase in symptoms, you may tense your muscles. Muscle tension can create pain, draining energy and causing fatigue. By learning to relax, you can lessen muscle tension and ease symptoms.

This is one example of how to reduce the impact of stressors by changing your response. The rest of this article shows you how to use relaxation as a stress reducer. The next article will describe six other ways to reduce stress and also describe ways to prevent stress.

Relaxation offers a profound antidote to stress. When we become stressed in the face of challenge, we often respond with a fight-or-flight reaction. Adrenaline flows and we feel charged up. If the challenge is short-lived, the initial reaction is followed by relaxation.

If, however, you feel yourself to be under constant threat, as you may if you are always in pain, your body stays in a state of tension. Relaxation counteracts the effects of the fight-or-flight response.

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.

Relaxation Techniques

The techniques described below illustrate several different approaches to relaxation. They are useful both for stress reduction and for managing pain. Because we are different, some techniques work well for one person and other techniques work better for another.

In particular, techniques using imagery seem very helpful to some people, but not useful to others. You might try several techniques to see what works for you. Also, you may find that a particular technique works for a while, then becomes ineffective.

If that happens, try something else. Also, you may find less formal approaches can helpful as well. These include exercise, baths and hot tubs, massage and acupuncture, and listening to relaxation tapes.

It usually takes several weeks of practice to develop skill in using a technique, so allow some time before expecting results. To be fair, you should practice four or five times a week, setting aside for each session ten to 20 minutes when you won't be disturbed.

Relax by Focusing on Your Breathing
When we are under tension and stressed out, our breathing can become shallow or we may hold our breath. Breathing in a deep, relaxed way can reduce your tension and help you relax. Here's one way to do that, by focusing on your breath. You can use it alone as a stress reduction technique or in combination with other practices, such as those you will read about below.

Sit or lie down in a quiet place where you won't be disturbed for a few minutes. Focus your attention on your breathing. Take in a long, slow breath through your nose, hold it one or two seconds, then breathe out through your mouth. The key idea is to concentrate your attention on your breathing, keeping it slow and easy.

If you discover that your mind has wandered and your are thinking about something else, just return your attention to your breath. As you breathe in a slow and easy way, you should feel your body relax and a sense of calmness replace anxiety. If you feel dizzy, stop the technique and breathe normally.

Once you feel confident about using this technique, you might try using it whenever you feel under tension or notice that your breathing has become shallow. For example, it might help you calm down when you are caught in traffic, stuck in line, or in a 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. Simply noticing your breathing can often reduce anxiety.

Sometimes even taking one deep breath and letting it out slowly can reduce anxiety. But do not use this technique if it distracts you from paying attention to the task at hand, such as driving.

The Body Scan
The body scan is a technique helps you relax your whole body. It is associated with Jon Kabat-Zinn, the director of the Stress Reduction Clinic at the University of Massachusetts Medical Center. He recommends that you do it lying down, but any comfortable position is OK. You begin by spending a few minutes focusing on your breath, visualizing it going deeply into your body and then out again.

After several minutes, direct your attention to the toes of one foot, becoming aware of any sensations you feel there. You do not try to relax your toes, but rather just concentrate your attention on that part of your body. Paradoxically, that is often sufficient to bring about relaxation. If you find your mind has wandered, bring your attention back to your breathing and to the bottom of your foot.


After 20 seconds or so, move your attention to the bottom of the foot. Again, don't try to relax it, just become aware of any sensations that might be present. Then move on to the top of the foot, the ankle and the calf. When your mind wanders, bring it back to your breath and to the part of your body you are focusing on.

Gradually work through your whole body, moving up one leg to the hip, then doing the other leg starting with the toes. Then move on to the stomach, chest and back, followed by the hands, arms and shoulders. Lastly, focus on the neck, jaw, mouth, eyes, scalp.

The technique has two keys: 1) focus your attention on one body part at a time without consciously trying to relax it; and 2) return your attention to the body when your mind wanders.

This technique can also be used for falling asleep, because it helps distract you from thoughts and worries by keeping your attention on your body.

The Relaxation Response
A technique for creating a state of deep rest is the relaxation response, a tool developed by Dr. Herbert Benson of Harvard. To elicit the relaxation response, you need to do two things.

First, you repeat a word, sound, phrase, prayer, image or physical movement. He calls this an object or mental device to focus on. You can repeat a word or sound (like "relax" or "One"), say a prayer, look at a symbol like a flower, or concentrate on a feeling such as peace or love.

Second, you adopt what Benson calls a passive attitude. This is the most important element. As you focus on your mental device, you will experience distracting thoughts, images or feelings. And you may be surprised by how difficult it is to keep your mind focused. But don't worry. It is natural to lose your mental focus; everyone does.

When you find that you have become distracted, simply return to your point of focus. You might consider refocusing yourself by first moving your attention to your breath and then returning to your point of focus. Do this whenever you discover that your attention has drifted away from your point of focus. This non-judgmental response to distractions is the heart of the relaxation response.

How can you know if you have successfully elicited the relaxation response? Benson suggests that you will become aware that you are in a pleasant state like the feeling you might have lying on the beach on a warm summer day or the sense of detached relaxation you feel just before falling asleep.

Follow these steps to elicit the relaxation response.

1. Get comfortable. Go to a quiet place where you won't be disturbed, assume a comfortable posture and close your eyes. (Sitting is generally preferable, but not required.)

2. Relax your body. Beginning at your feet and moving gradually up to your head, relax the muscles in your body. You might include in your scan of the body your feet, ankles, calves, thighs, stomach, chest, back, hands, arms, shoulders, neck, jaw, mouth, eyes, scalp.

3. Become aware of your breathing. Spend a short time following your breath. Feel it come in through your nose and go out through your mouth.

4. Concentrate on your point of focus. On each out-breath, say your chosen word or focus on your chosen symbol or feeling.

5. Continue for ten to 20 minutes. If you find yourself distracted from your point of focus, return your attention to your breathing and your focus word or phrase. When you finish, sit quietly for a few minutes.