What are the strategies for managing stress?

From the Guidelines

Managing stress effectively requires a multi-faceted approach, and I strongly recommend starting with cognitive behavioral therapy (CBT) as the most effective strategy, as evidenced by a Cochrane systematic review including 28 RCTs showing that CBT interventions favorably address anxiety, depression, and mood disturbance 1.

Immediate Relief Strategies

For immediate stress relief, techniques such as deep breathing exercises, progressive muscle relaxation, and mindfulness meditation can be practiced anywhere. These methods help in reducing the physiological aspects of stress by lowering cortisol and adrenaline levels.

Long-term Lifestyle Changes

For daily stress management, it's essential to establish a regular exercise routine of at least 30 minutes most days, prioritize 7-8 hours of quality sleep, and maintain a balanced diet rich in fruits, vegetables, whole grains, and lean proteins while limiting caffeine, alcohol, and processed foods. Time management techniques like prioritizing tasks, breaking large projects into smaller steps, and learning to say "no" to additional commitments can prevent stress buildup.

Social Connection and Professional Help

Social connection is crucial, so regularly spending time with supportive friends and family is highly recommended. For persistent stress, considering professional help through CBT, which typically involves 8-12 weekly sessions to develop coping strategies, is advisable. While medications aren't first-line for everyday stress, those with severe anxiety might discuss options like SSRIs (such as sertraline 25-200mg daily) or short-term benzodiazepines with their healthcare provider, as suggested by various studies including those on mental health competencies for pediatric practice 1.

Additional Recommendations

Other recommendations include teaching enhanced organization strategies, encouraging patients to do the most cognitively demanding tasks at the time of day when energy is highest, providing information about relaxation and stress management skills, and recommending daily physical activity, as outlined in a systematic review of rehabilitation and exercise recommendations in oncology guidelines 1. Mindfulness-based stress reduction and cognitive training are also beneficial, as indicated by a review on eular revised recommendations for the management of fibromyalgia 1.

Key Points

• Start with CBT for effective stress management.
• Practice immediate relief strategies like deep breathing and mindfulness meditation.
• Adopt long-term lifestyle changes including regular exercise, quality sleep, and a balanced diet.
• Foster social connections and consider professional help when needed.
• Explore additional recommendations such as organization strategies and physical activity.

From the FDA Drug Label

Diazepam is indicated for the management of anxiety disorders or for the short- term relief of the symptoms of anxiety. Anxiety or tension associated with the stress of everyday life usually does not require treatment with an anxiolytic Diazepam may be used for managing anxiety disorders or for the short-term relief of anxiety symptoms. However, it is stated that anxiety or tension associated with everyday life stress usually does not require treatment with an anxiolytic.

• Key points:
  • Diazepam is indicated for anxiety disorders
  • Not typically used for everyday life stress 2

From the Research

Stress Management Techniques

• Mindfulness-based stress reduction is a potentially viable method for managing stress, as it combines mindfulness meditation and yoga in an 8-week training program 3
• Informal mindfulness practices, such as brief and informal mindfulness exercises, can also be effective in reducing stress, anxiety, and depression symptoms, and enhancing well-being 4
• Diaphragmatic breathing is another technique that has been shown to be effective in reducing physiological and psychological stress in adults 5

Nutrition and Stress

• A good nutritional status is important for maintaining normal body function and preventing or mitigating the dysfunction induced by internal or external factors, including stress 6
• Certain micro- and macronutrients, such as eicosapentaenoic acid, docosahexaenoic acid, alpha-tocopherol, magnesium, and folic acid, have been shown to have a positive role in preserving normal brain function and mental well-being, and may help to reduce stress and anxiety 6

Mindfulness-Based Interventions

• Mindfulness-based interventions (MBIs) have been shown to be effective in improving many biopsychosocial conditions, including depression, anxiety, stress, insomnia, addiction, psychosis, pain, hypertension, weight control, cancer-related symptoms, and prosocial behaviors 7
• MBIs are relatively safe, but ethical aspects should be considered, and more research is needed to confirm their efficacy on different problems and populations 7