Strategies for Stress Reduction, Part 2

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By Bruce Campbell

Note: Second of two articles on stress reduction in a four-part series on managing stress.)

Because stress has so many causes and is so pervasive in ME/CFS and fibromyalgia, we recommend creating a stress management plan that uses a variety of approaches.

The first article in this series suggested combining techniques for stress reduction with strategies for stress avoidance. The previous article focused on two approaches to stress reduction. This article describes 11 more.

1) Pleasurable Activities: Doing things that bring you pleasure can distract you from stress and reduce preoccupation with problems. Listening to or playing music or engaging in other artistic pursuits are good stress reducers. The same can be said of reading a good book, seeing an engrossing movie, spending time in nature and talking with a friend.

The key is to find an activity in which you can become absorbed. By immersing yourself, you interrupt the worry cycle, distract yourself from symptoms and experience some relaxing pleasure.

Here’s what a couple of people in our program report about the value of enjoyable activities:

"When I was first sick, I had a lot of guilt about not being a productive individual and thought I did not deserve any fun. Later I thought that because my stress was big, the stress reliever had to be big, too. What I finally learned was that fun was really key to helping me reduce my stress and that fun can come in many ways, big or small."

"Enjoyable activities are so very important to me to show me that I can have a good life even though I have CFS, things like hobbies, outings with a friend, having a friend over or shopping."

2) Exercise and Movement: Exercise is a natural stress reducer, since it causes your body to produce endorphins and other soothing body chemicals. A similar effect can be obtained through other forms of movement. If you are worried, just getting up and moving around can help break the spell.

3) Problem Solving: Taking practical steps to improve your situation can also help reduce anxiety and worry, as shown in the following example.

A member of one of our groups, who suffers from severe brain fog, reported that she had gone to the emergency room after taking her medications three times in one day.

Worried that brain fog might lead her to make the same mistake again, she asked her group for suggestions and adopted one of them: a pill box with compartments for each day of the week. She reported that the pillbox was a stress minimizer, greatly reducing her fear of repeating her mistake.

Another person in our program reported, “I have spent quite a bit of time analyzing my activities, everything from how long I stayed somewhere to ways to minimize pain in doing chores. From this analysis, I have tried many different ideas that have proved to be very helpful.”

4) Information: Educating yourself about CFS and FM can be a great stress reducer, as you replace fears with facts. Let me suggest three guidelines for your educational efforts:

Use multiple sources. No one person or organization has a monopoly on helpful ideas about CFS and FM. You can counteract the partial perspective of any one source by considering the ideas of several to many.
Ask whether the claims are credible. Some people prey on the desperation of patients, so be skeptical of those who promise recovery, particularly if those promises come with a big price tag. Be willing to experiment, but ask what risks are associated with a treatment and whether the likely gains are consistent with the cost.
View education as an ongoing task, but put limits on your inquiry. New developments occur from time to time, but breakthroughs are rare. After an initial intense period of educating yourself, you can probably ease off your research and focus on doing things to get better and spending less time keeping up on new developments.

5) Assertiveness: Speaking up for yourself, setting limits and saying “No” all help reduce stress. First, you avoid the stress that results from not expressing your needs and your feelings and, second, you avoid the stress to the body from doing things that intensify your symptoms.

Assertiveness can involve teaching your family and friends to respect your need for rest times and making your limits clear, for example by telling others how long you’ll talk on the phone or how much time you will spend at a party.

Also, it’s helpful to learn to delegate and to ask for help. Others often feel as helpless as you about your illness; asking them to help you in some specific way replaces the sense of helplessness with a feeling of accomplishment.

Learning assertiveness is often a gradual process, as you learn to advocate for yourself and set limits. One strategy is to be very specific in the requests you make or limits you set. For example, you might say at the start of a phone call, “I’m delighted to hear from you, but I’m afraid I’ll only be able to talk for 15 minutes.”

Assertiveness strategies can be simple. One person in our program communicates her Energy Envelope for the day to her family using a 1 to 10 scale, where 1 means “like I felt before I got sick” and 10 means “have to stay in bed all day.” When asked to do something, she may respond by saying, “No, I can’t do that. Today is a 7 day.”

Learning assertiveness implies accepting responsibility. One woman who was housebound when she joined our program says that for several years she blamed her family for not accepting her limits.

Then she realized that she always said "yes" to her family’s requests and that they believed her actions rather than her words. The solution was for her to set clear limits --for example, by saying how often she would babysit her grandchildren-- and sticking to them.

6) Journaling: Writing can be useful stress reducer. You might find it helpful to write out what’s bothering you as a way of venting frustration and lessening worry. Considerable research indicates that writing about traumatic or stressful events in a way that combines factual description and emotional reactions has positive health benefits.

Researcher James Pennebaker reports that many people in his studies have found the value of writing was in gaining insight. He says, “Rather than explaining that it felt good to get negative emotions off their chests, the respondents noted how they understood themselves better.”

Many of the studies of writing about difficult events involved people writing for 20 minutes or so each day for several days. For more, see Pennebaker’s book Opening Up.

Another approach to journaling is to write a list of positive events every day or several days a week in a gratitude journal. Summarizing the findings from scientific studies, a leading researcher says that those who practice grateful thinking "reap emotional, physical and interpersonal benefits."

People who regularly keep a gratitude journal report fewer illness symptoms, feel better about their lives as a whole, and are more optimistic about the future.

People in our groups who have used a gratitude journal often report that their mental attitude toward their illness and their life changed in a positive direction. For one person’s story, see the article The Healing Power of Gratitude.

For a model of a gratitude journal, see Sarah Ban Breathnach’s bookSimple Abundance Journal of Gratitude. For a summary of the health benefits of gratitude, see the article Counting Your Blessings: How Gratitude Improves Your Health.

7) Supportive Relationships: Good relations are a buffer against stress. Feeling connected to people who understand and respect you reduces anxiety and counteracts depression. Beyond that, talking to another person may help you clarify your situation or their response may enable you to see your life in a different, more constructive way.

You may receive such support from family members, friends, people with CFS and FM or others, such as therapists. Support also means practical assistance, which might include such things as shopping, cooking, bill paying or housecleaning.

8) Talking and Being Listened To: It is not surprising that, in a survey, talking to a friend was rated as the number one way to combat worry. Talking to someone you trust provides reassurance and connectedness to dispel worry. According to Edward Hallowell, in his book Worry, studies have shown that talking to another person changes what is happening in your brain at a physical level.

9) Laughter and Humor: Laughter is another good stress reducer. Watching a funny movie, reading a humorous book, looking at favorite cartoons or laughing with friends can be a great release. Like exercise, laughter promotes the production of endorphins, brain chemicals that produce good feelings and reduce pain.

Research suggests that it can strengthen the immune system, counteract depression and even provide a substitute for aerobic exercise. Short periods of laughter can double your heart rate for three to five minutes. A natural tension reducer, laughter produces relaxation for up to 45 minutes.

Here are two people’s comments:

"I keep a large collection of favorite comedy programs on tape. They are very easy to watch or listen to, and provide a great means of escape."

"Remember 'STRESSED' spelled backwards is 'DESSERTS'."

10) Solitude: For some people, just having time alone can be helpful. One person wrote, “I spend much of my time in quiet, relaxing activities such as reading, needlework, etc. If I have a day that does not allow me to participate in these activities to some minimal extent, I find myself extremely tense, stressed out and emotional.”

Another said, “I find that taking a walk helps if I can get outside and be alone to do it. If I can't, lying down in my bedroom which is very soothing (sage green walls, wood floors, candles lit) can also be great. I am an avid reader, so reading some fiction for pleasure helps me relax.”

11) Medications: Prescription medications can be helpful as part of a stress management program. As one person in our program wrote:

“I resisted the idea [of medications] for a long time, and now kick myself for having done so. [Zoloft] has helped level off my reactions to everyday stress and evened out my mood. Medications are not for everyone, but I've learned to keep my mind open to treating all aspects of my life and not relying on solely one approach.”