Using Mindfulness To Cope With Stress
(This is an excerpt from a University Of Metaphysical Sciences course at www.umsonline.org,
please feel free to visit the school website)
Introduction
Effects Of Stress
What Is Chronic Stress?
What Is Mindfulness?
Types Of Things One Can Become More Mindful Of With Practice
Research On Mindfulness
Starting A Mindfulness Practice
Things That Interfere With Mindfulness
CBT & Mindfulness
Rational Emotive Therapy
TYPE A & TYPE B Personalities
A List Of Coping Skills/Relaxation Skills That You Can Use
Exercises
Conclusion
Written by Katy Wilson, M.D.
Introduction
This is the written form of the two hour class I usually give in person. If you become inspired to add a mindfulness practice into your own life, you may wish to start by setting aside 15 minutes per day. Experiment to see what combination of activities provide you with the most useful experiences (yoga, exercise, meditation, tai chi, reflecting on various topics, reading or writing funny material, listening to your favorite music, walking in nature, etc.) You will find that even though stress is a normal reaction to today's era of fast paced living, it can be dealt with through various methods. First, let us look at what stress is.
What Is Stress?
Stress can be defined as any change to which you have to adapt. Some say that the pace of change in modern society is accelerating and hence the amount of stress we are bombarded with is also accelerating. Clearly there are some stressors that we cannot avoid (see below) in which case we can focus on how best to cope. There are many stressors that we can have some impact on (minimize, reduce, eliminate, avoid, anticipate, plan for, decrease frequency/intensity of… and some stressors that we bring on ourselves (unrealistic expectations, negative thoughts, catastrophisizing…). (more on this in "CBT" section). It is how we cope with/react to it that determines how it affects us. How we experience stress depends on a number of individual factors such as our personality, beliefs, past experiences, current life situation, physical health, quality of our relationships, number of commitments and responsibilities we carry, our perceptions of others and expectations others have of us, number of traumatic events...
Some scientists define stress as any force that impairs the stability of the system and causes the system to respond in order to re-establish homoeostasis.
Common Stressors: (in no particular order)
- conflict w/boss, co-workers, clients
- death of a loved one
- hunger, thirst, fatigue, sleep deprivation (dehydration causes nausea, fatigue, headaches, dizziness, dry mouth; sleep deprivation causes irritability, poor concentration, drowsiness; hunger causes drowsiness, irritability)
- relationship discord/dissatisfaction with spouse
- conflicts w/in-laws, children, parents, friends
- acute illness or injury in self or loved one
- chronic illness or pain in self or loved one
- being "out-of-shape" (de-conditioned) (causes increased fatigue, pain, poor posture, increased risk of injury and pain and illnesses, increased likelihood of self-esteem and body image difficulties: all of these things can lead to irritability, depressed mood, anxiety…
- being a parent or caregiver
- substance abuse (intoxication and withdrawal) (even caffeine has substantial effects on the body including increased "stress response" effects like heart rate, respiratory rate, alertness, insomnia, increase tendency toward anxiety and irritability… HALT (hungry, angry, lonely, tired) as states which trigger substance use)
- losing a friend or family member
- financial
- moving
- sell, buy, refinance, remodel, build a home
- job change (termination, promotion, layoff)
- sexual difficulties, marriage, divorce, separation
- retirement
- pregnancy, gaining a new family member
- habit of always running late (and setting oneself up for added stress; an excellent antidote is to change your morning routine and arrive at work 15 minutes early and use 10 of those minutes organizing your work day—this will help minimize time spent stressed during the day wondering what to work on next; practice arriving places early and using the extra time to relax, read, daydream, practice mindfulness, etc.)
- wondering/worrying about what other people are thinking
- taking on too many obligations (another common and changeable stressor… especially seems common for women to have a difficult time saying "no" and setting boundaries and limits on their time and not leaving enough time for self-care (exercise, relaxation, play, sleep, meals) and time with closest loved ones)
- having unrealistic expectations for yourself
- having unrealistic expectations for others
- being overly sensitive to criticism, being perfectionistic
- being pessimistic
- lacking self-contentment
- caffeine withdrawal: (see also reference list): nausea, muscle stiffness, difficulty concentrating, irritability, restlessness, headaches, chills/hot flashes, fatigue; note that caffeine use causes diuresis/dehydration, anxiety, jitteriness, facial flushing, tachycardia, diaphoresis, osteoporosis, twitching, tremor, agitation and even seizures)
Negative emotions and thoughts can themselves cause the stress response. Examples of negative ("unpleasant") emotions include fear, anger, jealousy, disappointment, shame, embarrassment, failure, restless, impatience, numbness, irritability… More examples of negative thoughts will be discussed later in the CBT section.
Some psychologists emphasize the word CHANGE on lists of stressors. For example: have you experienced a significant CHANGE in the amount of time you spend caring for others? Have you experienced a significant CHANGE in the number of hours you work? Others add the idea that even positive change (wedding, birth of child, promotion…causes stress.
Take a moment to think about what your current stressors are and reflect on which ones are modifiable; you may want to jot them down and/or circle the ones above that may apply to you. This will be included in the exercise section.
Using Mindfulness To Cope With Stress: Index >>
Effects Of Stress
Most of you already know that stress can be detrimental to health (both physical and emotional). Many different statistics are cited which support this. One figure is that 43% of all adults in the US suffer some adverse effects from stress; 75-90% of all doctor visits are due to stress—related ailments and more than 50% of deaths in the US have been associated with the effects of stress and the unhealthy behaviors some use to cope, such as smoking, alcohol, drug use and overeating. The physical effects of stress have been associated with exacerbation of a large number of health problems including cardiovascular disease (angina, heart attacks), hypertension, substance abuse disorders, heartburn, migraines, tension headaches, back pain, insomnia, TMJ, peptic ulcer disease, chronic fatigue, irritable bowel syndrome, autoimmune disorders, immune suppression, impaired memory, depression, infertility, asthma, impaired concentration and reduced healing after surgery.
How Does Stress Affect The Body?
The body has evolved a system to respond to immediate threats to its survival ("acute stressor") such as being attacked by a predator. The system includes hormones and neurotransmitters which together cause a cascade of events in the body called the "Fight or Flight" response. Some of the hormones involved include adrenaline (aka epinephrine or EPI), noradredenaline (norepinephrine) and cortisol. NE also functions as a neurotransmitter in the Autonomic Nervous System (ANS) which regulates a number of internal functions such as heart rate, respiratory rate and digestion. The ANS has two main opposing branches called the Sympathetic Nervous System (SNS) and the Parasympathetic Nervous System (PNS). The SNS is associated with the "Fight or Flight" (stress) response while the PNS is associated with calming back down after the threat is gone (relaxation response).
"Fight or Flight" or "Stress" Response
When a threat to survival (such as attack by a predator) appears, it causes a number of physical effects which are needed to allow us to FIGHT or FLEE to survive. These effects include heightened mental alertness, pupil dilation, increased heart rate, increased blood pressure, increased respiratory rate, increased blood sugar, increased blood flow to large muscles, increased rate of clotting (to make an injury more survivable,) fluid retention (to reduce risk of shock during injury), decreased blood flow to digestive tract, hyper vigilance to ones' surroundings, increased muscle tension, decreased blood flow to non-essential organs such as the immune system and small muscles in hands, feet and lips.
Physical Effects of "Stress"
- racing heart, palpitations
- nausea
- dizziness & lightheadedness
- rapid, shallow breathing & hyperventilation
- sweating, flushing
- muscle tension
- tremor
- numbness & tingling in hands, feet and lips
- jaw clenching
- headache
- back ache, neck ache
The initial (alarm) phase of the fight or flight response may last approximately 15 minutes while the EPI and NE are being degraded and eliminated from the blood stream. If another threat comes along (or the same threat is still there) then more NE and EPI are released and the response is perpetuated.
The Relaxation Response is initiated by the Parasympathetic Nervous System when the threat is gone and this causes many of the opposite effects in order to re-establish homeostasis (reach baseline again). These effects include decreased heart rate, decreased blood pressure, decreased respiratory rate, decreased muscle tension, restored normal clotting time and decreased mental alertness/hyper-vigilance.
In physically stressful/threatening situations, the threat causes us to physically exert ourselves (by fighting or running) and this physical exercise may help discharge the "nervous energy," and decrease muscle tension and restore calm. In modern days, most of the stressors we experience are not physical threats and don't invoke a surge of physical activity. Instead we try to cope with the stress mentally. This may be all the more reason, as studies show, that exercise helps relieve stress. With our modern sedentary lifestyles, finding time for exercise is even more important.
Another component to the stress response is the cortisol system. Cortisol is a steroid hormone secreted by the pituitary gland in response to stress. The pituitary gland is signaled by the brain (through the hypothalamus via the "HPA Axis"—hypothalamus-pituitary-adrenal gland axis) that a threat exists, which causes the pituitary gland to release cortisol. Cortisol is known to affect many systems in the body including immune function, inflammation and wound healing. Its role is being studied in depression, obesity, dementia and many other conditions. Take a moment to identify which physical effects you experience next time you are under stress. You may want to jot them down or circle them above.
Using Mindfulness To Cope With Stress: Index >>
What Is Chronic Stress?
Both components of the stress response (cortisol and the "fight or flight" response) will continue, rather than diminishing, if the brain perceives that the threat to survival ("stressor") still exists. This is a key point because our mindset can affect whether we perceive that a threat actually exists and/or persists. You'll notice that many stressors are not actual threats to survival, although they are stresses to our comfort levels. Without being aware of it, we may be automatically (unconsciously or "mindlessly") MISPERCEIVING or MISINTERPRETING a stressor as more threatening. Our thoughts themselves can trigger and perpetuate the stress response. (such as the thought "oh no, my boss frowned at me, he must be angry or disappointed in me I wonder if my job is on the line" or "oh no, that guy just cut me off in traffic, I better close the gap and ride his bumper to show him that wasn't cool and not let anyone else cut me off" or "oh no, the power just went out; I bet it will stay out for days," etc.) Our emotions can also trigger the stress response, especially uncomfortable emotions such as fear, anger, loneliness, boredom, restlessness, and shame even if we are not paying attention to the emotion.
This is where mindfulness comes in. When we are able to be aware (mindful) of what our mind is thinking, sensing and feeling we can notice if the threatening thoughts are realistic and if they are serving a useful purpose. Are they helping us survive? Or are they over-reactions which are causing us to have chronically elevated stress hormones and harming our health? When the latter is true, what can we about it?
Using Mindfulness To Cope With Stress: Index >>
What Is Mindfulness?
- focusing the mind on one thing to the exclusion of others to practice being able to choose where you want to direct your attention
- noticing distracting stimuli non-judgmentally and allowing them to pass by like leaves on a stream
- noticing that the mind tends to focus on negatives from the past or anxieties about the future although they are not happening now and during those moments you are missing out on experiencing the present moment
- developing the ability to have awareness of what your focus is on and to gently direct it back on to what you choose.
- Learning to be in control of what your mind is on instead of letting your mind be in control; achieving a state of attention and awareness of your present experiences
- Observing while experiencing whatever is on your mind—becoming "aware" or "mindful" of your thoughts, emotions, and sensations in the present moment. Observe, and describe with words in a non-judgmental way. Notice that thoughts, emotions and sensations are transient and they ebb and flow; notice this flow
- Thich Nhat Hanh (Vietnamese Monk) defines mindfulness as "keeping one's consciousness alive to the present reality"
Mindful Attitude: Jon Kabat-Zinn, Ph.D. (see reference list) writes about the components of a "Mindful Attitude"
- Non-judging, patience
- "beginner's mind" (willingness to see everything as if for the first time—free of expectations based on past experiences and receptive to new possibilities)
- trust in yourself and your ability to become more fully yourself and not trying to become someone else
- acceptance (for example, of things we can't change, of the need to work towards changing or improving the things we can, of the choices we've made in the past, of ourselves…)
- letting go (for example, being able to let go of the need to respond immediately to non-urgent needs of others while you are attending to your own—for example, unplugging the phone during relaxation, exercise and/or mindfulness practice… also being able to let go of negative thoughts quickly rather than holding onto them by dwelling on them)
- commitment
- self-discipline and intention
Using Mindfulness To Cope With Stress: Index >>
Types Of Things One Can Become More Mindful Of With Practice
- caffeine
- sleep deprivation
- alcohol (intoxication, withdrawal, disturbance to sleep)
- poor posture (can impair deep breathing, increase pain)
- full stomach/overeating
- out of shape/de-conditioned/shortness of breath/low energy
- drugs
- high stress lifestyle
- lack of sense of meaning/purpose
- lack of self-soothing skills, rewards, positive reinforcement
- poor ability to delay gratification
- sedentary lifestyle
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Research On Mindfulness
Jon Kabat-Zinn, Ph.D. developed the first Mindfulness-Based Stress Reduction program at University Of Massachusetts in 1979. He does research on the health benefits. At his center, MBSR has been found to have a large number of positive effects including:
- decrease in stress
- decrease in stress-related symptoms
- decrease in pain
- decrease in insomnia
- increase ability to relax
- increase self-esteem/self-efficacy
- decrease substance abuse
- decrease anxiety and panic
- decrease blood pressure
- decrease heart rate
- decrease respiratory rate
- decrease cholesterol
- change in brain waves (EEG) (increase alpha and theta waves in both waking and sleeping)
- decrease rate of relapse of chronic pain and anxiety up to 4 years after learning MBS
Dr Mehmet Oz, director of Complementary Medicine Program at the New York Presbyterian Medical Center, and host of "Second Opinion with Dr. Oz" on the Discovery Channel, has found that:
- mindful intention is crucial to healing
- having a sense of meaning/purpose aids healing
- soothing music during surgery aids healing
- guided imagery can alter bleeding rates (the mind can affect clotting) and aid healing
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Starting A Mindfulness Practice
First, attend to comfort: clothes, temperature, quiet, comfortable seat…Turn ringers/phones/beepers off and listen to silence or soothing music. When beginning the practice, it is easiest in a low-stimulation environment… once one feels able to achieve an inward focus there, one can begin to practice it in more stimulating environments (for example, in nature and eventually even in stressful environments such as work)
Set aside at least 15 minutes every day. The more often your practice, the more quickly you will notice benefits. Thich Nhat Hanh recommends devoting an entire day every week. Some mindfulness retreats like the one I attended include a day of silence (free of any talking/interacting with others). This gives people permission to focus only on themselves and practice mindfulness.
Some of us enjoy incorporating mindfulness into daily rituals. I personally enjoy a few moments of mindfulness every morning when I wake up while still laying in bed. I specifically allow myself to notice my physical state (feeling warm, comfortable, relaxed) and use that to affect my thoughts and emotions ("I am so lucky to feel well" "I am so warm and cozy here" "I am going to savor these moments now before I get up and get on with my day"). Many also practice mindfulness during exercise routines by paying attention to physical sensations, thoughts and emotions. They take pleasure in noticing strength and flexibility and in the awareness that they are taking good care of themselves. They may also notice a lift in emotions and energy during and/or after the workout. We can achieve a deep relaxation and sense of well-being if we add stretching and relaxation at the end of a workout.
Types Of Mindfulness Practices
The number of ways to incorporate mindfulness is limited only by our creativity and effort. It is best to start with a specific activity, practice that, and then once comfortable with it try branching out. The most common one to start with is a sitting practice while focusing on the breath. Other practices include eating a small item such as a piece of fruit (noticing sensations of holding it, viewing it, the sensations in mouth, swallowing, food passing down the esophagus into stomach etc.) walking, focusing on a mantra, daily activities (ironing, dishwashing, playing with a child or pet—doing it as mindfully as you can, being as connected to it as you can, doing it as well as you can, focusing on the moment).
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Things That Interfere With Mindfulness
- caffeine
- sleep deprivation
- alcohol (intoxication, withdrawal, disturbance to sleep)
- poor posture (can impair deep breathing, increase pain)
- full stomach/overeating
- out of shape/de-conditioned/shortness of breath/low energy
- drugs
- high stress lifestyle
- lack of sense of meaning/purpose
- lack of self-soothing skills, rewards, positive reinforcement
- poor ability to delay gratification
- sedentary lifestyle
Using Mindfulness To Cope With Stress: Index >>
CBT & Mindfulness
Cognitive Behavioral Therapy is a form of psychotherapy that focuses on recognizing the connections between thoughts, feelings, behaviors and symptoms (such as anxiety and depression) and changing our automatic negative thoughts. CBT emphasizes being one's own scientist on themselves (their symptoms, thoughts, behaviors) which involves them becoming more AWARE (mindful) of their thoughts, feelings, and urges. The treatment includes learning, practicing and mastering relaxation/soothing skills and then gradual exposure to stressful stimuli with systematic desensitization. This means practicing the relaxation skills during exposure to a stressor (such as imagining driving across a bridge) and then once able to tolerate that, increase the magnitude of the stress (such as riding as a passenger over a bridge and eventually driving across). The other component is "cognitive restructuring" in which people learn to recognize their thoughts and practice replacing them with more useful ones, noticing the effect that their thoughts have on their mood and their stress level.
- Automatic negative thinking/conditioned response: One can use mindfulness practices to become more aware of their automatic/conditioned responses and their effects, and can use mindfulness to practice countering these responses with more realistic, balanced and self-respectful responses. Some automatic negative thoughts include: "if Bobby doesn't want to date me it must mean I'm undesirable to everyone" "nothing good ever happens to me" "everyone else loves their life" "everyone else has an easier life" "if everyone around me isn't having a good time it is my responsibility" "if Bobby doesn't talk much and scowls around me it must mean he doesn't like me"
- Things aren't done "to you." Things happen in the world and we can determine how we perceive them, interpret them, and respond to them
- Type A and type B personality styles (including using type A traits to charm subconscious to be more type B)
- Focus of control: Where does one perceive control to exist? Internally? Externally? One can use mindfulness to refocus our attention on the things that we can control. Choose how you want to use your energy and time (maybe not trying to convince someone of something or change their opinion)
- Black and white thinking: i.e., "I'm either perfect or a failure." "It is good or it is bad."
- Worst-case scenario analysis—imaginal exposure: imagining yourself surviving and coping with the worst-case scenario (or doing the task in a calm competent matter-of-fact manner) and being able to imagine feeling good about getting through it (e.g., testifying in court, giving a toast)
- Thought stopping and self-talk, learned optimism
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Rational Emotive Therapy
Albert Ellis (1953) created Rational Emotional Therapy. RET is a school of psychotherapy that teaches people to recognize their negative/irrational/self-defeating thoughts and the effect that these thoughts have on their emotions.
Tenets Of RET:
- you are responsible for your own emotions and behaviors
- your harmful emotions and unhealthy behaviors are a product of your irrational thoughts
- you can learn more realistic views with practice and let them become a part of you
- you'll experience a deeper acceptance of yourself and an improved quality of life
Some common "automatic negative thoughts" include:
- it is necessary (and possible) to please most of the people most of the time (and have unfailing approval/love/positive attention)
- it is necessary (and possible) to be unfailingly competent and nearly perfect
- it is intolerably horrible when things don't go our way
- the past determines the future
- happiness can be achieved with inactivity, passivity and leisure
- we are helpless and cannot control or change the way we feel
- it is necessary to be more focused on others' needs than one's own
- when people disapprove of you it means you are unworthy, wrong or bad
- there is such a thing as a perfect person and a perfect relationship
- your worth as a person is measured by how much you achieve or produce
- anger is always bad and destructive
- others should be able to know what we need/want without us telling them
- I should/can wait to start a new behavior until I have the motivation (instead of realizing that often motivation follows behavior)
- Life is supposed to be ("fair," "easy," "fun"). All the time spent otherwise it is terrible all the time.
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TYPE A & TYPE B Personalities
Dr. Meyer Friedman and Dr. Ray Rosenman, both cardiologists, developed this concept and researched the physical effects of these two personality types. According to their research, people with Type A personalities are two to three times more likely to have angina, high cholesterol, heart attacks and sudden death. They also found that tax accountants have faster clotting blood during the first 2 wks of April!
| TYPE As | TYPE Bs |
|---|---|
| Achievement oriented | Being more than doing |
| Unrealistic deadlines | Reasonable deadlines |
| In a hurry/can't relax | Relaxed |
| Impatient | Not hurried |
| Aggressive | Less assertive |
| Push beyond own limits Talk faster | Know and observe own limits |
| Less latency | Talk more slowly, more pauses |
| Breathe faster and shallower | Pacifists |
| Feel guilty about unwinding | Enjoy/relish unwinding |
| Uptight body language | Relaxed body language |
| Multitask | Methodical approach |
| Competitive/aggressive | Not over-competitive |
Using Mindfulness To Cope With Stress: Index >>
A List Of Coping Skills/Relaxation Skills That You Can Use
- Assertiveness of self
- Exercise/fitness
- Balance of immediate and delayed gratification
- Time management, including naming targets, goals and how one spends their, changing that to fit goals (include down-time, self-care time) also analyzing ways of using time better—get to work 15 minutes early to organize/strategize/make to do list/say hello, etc. Leave early, ample time to get places, find a way of enjoying the time in the car.
- Self-hypnosis
- Affirmations
- Posture
- Breathing techniques
- Autogenic training
- Progressive muscle relaxation
- Yoga, tai chi
- Meditation
- Nutrition, hydration (room temperature water), herbal tea, green tea
- Instant calm
- Visualization, imagination, imaginal exposure
- Humor
- Music
- Art
- Hobbies (gardening, pets etc.)
- Massage
- Play/babysit/pet sit
- Share a talent with others (craft, voice, and other skills)
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Exercises
Mindfulness Exercise #1
While sitting take an inward focus, notice your posture, relax your shoulders, sit up straight, feet on floor, hands relaxed in lap, notice your breathing, count your breaths with inhalation and exhalation—"one, one; two, two; etc. up to ten then start over, see what you notice; if you notice your mind wandering, make note of what it focuses on— thoughts, sensations, emotions. Some practitioners including Thich Nhat Hanh, advocates the use of a phrase to help focus the mind, for example "I am breathing in a long breath, I am breathing out a long breath" or "I am calming my mind as I inhale…" or "I am releasing my tension as I inhale…"
Mindfulness Exercise #2
While sitting up straight, inward focus, one hand on abdomen below belly button and one on upper chest, slow deep breaths, notice if chest or abdomen expands, try abdominal breathing, noticing if inhalation or exhalation takes longer, noticing any pauses, try slowing down exhalation slightly more than inhalation…. if dizzy, lightheaded, tingling in hands, feet, around lips; feelings of uncertainty this may indicate "over-breathing," hyperventilation from shallow rapid breathing. Pause and then start breathing more slowly, especially prolonging the exhalation phase. Notice the flow. Notice your thoughts, sensations and feelings. Notice if there are any recurrent ones. Notice if your mind wanders to memories of the past or thoughts of the future that for that cause you to lose connection with your present experience. Notice if your breathing changes (or any other physical sensations change) as your thoughts change… notice if you feel more relaxed and less physical tension as you breathe slowly and esp. slow on the exhalation; notice if when you refocus off of negative thoughts onto your breath if it slows and your emotion changes)
Mindfulness Exercise #3
Inward focus, sitting up straight, shoulders relaxed, notice your breathing. Take slow abdominal breaths, slowly and gently roll your head in small circles in one direction, then the other. Return to neutral. Roll your shoulders forward in gentle slow circles, then reverse the direction. Return to a relaxed position. Notice your breathing, notice your posture, and notice your heart. Focus your attention on your torso, then your spine, then your legs and feet, then your arms and hands. Pause anywhere you notice tension and try to allow it to relax on exhalation. Consider the use of a sound, word or affirmation to focus on, such as, "I am relaxing in this moment," during exhalation. Consider the use of a visual image or sensation, such as imagining inhaling clear fresh air and energy into the abdomen and exhaling tension along with the spent breath.
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Conclusion
Mindfulness is all about becoming present in every moment, the now. This is where all stress can be addressed and handled in a rational format. If the mind is in the future, one is not being mindful, and therefore the stress is evident in the worry about how things might turn out. If the mind is in the past, the stress is evident in the worry about what was done and what its effects are. Only in the present can true peace be found, and the behaviors of the human condition become clear. Mindfulness is a way to find one's path back to the present moment where all motives, all behaviors, all needs, all reactions and anything that needs to be changed can be observed in a rational and non-emotive format. Only then is change possible, and stress can be eliminated. Most stress can be attributed to being non-present. Almost always, this has to do with worry about the future or people who aren't even in one's present environment in the moment. So become mindful, come back to the present, and be at ease!