Stress Management 101

Danniece Bobeche, MSN, WHNP                                                                             Women’s Healthcare Nurse Practitioner                                                                      

Danniece Bobeche, MSN, WHNP Women’s Healthcare Nurse Practitioner

Guest Post, written by
Danniece Bobeche, MSN, WHNP

What is stress?  Where does it come from? What does it do to our minds and bodies?  These are age old questions without any clear cut answers.  First we need to understand the meaning and definition of stress as it plays out in our lives.

Stress Defined

Stress is sometimes described as an individual’s response to change.  This may include positive events such as marriage, retirement, or a new job, as well as negative, devastating losses or challenges that crop up in our lives. Some people tend to have daily dilemmas and stress over simple things in life. Job stress, economic woes, caring for loved ones all take their toll. Some levels of stress are thought to be beneficial; for example, seeing that crazy driver in your rear view mirror and changing lanes just in the nick of time. However, prolonged and unmanaged stress can have devastating consequences to our physical, mental and emotional well being.

Your stress may be linked to exogenous factors that are unalterable or difficult to eliminate, such as:

  • Death of a loved one
  • Disturbing world events
  • Taking care of a loved one
  • Divorce
  • Unpredictable life events
  • Employment related issues
  • Family dysfunction
  • Draining relationships

·Stress can also be triggered by any number of “fixable” variables including:

  • Poor diet
  • Lack of exercise
  • Misplacing the keys
  • Negative attitudes and feelings
  • Overextending your obligations
  • Electronic devices, social media and e-mail
  • Watching a sensational murder trial
  • Unrealistic expectations
  • Perfectionism
  • Misbehaving pets

 Cause and Effect

According to the American Academy of Family Physicians, up to 75 percent of office visits to family physicians are due to stress-related symptoms. The American Psychological Association states stress is linked to the six leading causes of death – heart disease, cancer, lung ailments, accidents, cirrhosis of the liver, and suicide. Stress can suppress our immune systems rendering us more susceptible to illnesses.  Premature aging is not just an effect of over exposure to  sunshine but can be directly correlated to major stress. The devastating effect of life’s stressors can put a real damper on our interpersonal relationships, as well. Other health related illnesses related to stress include headaches, insomnia, back pain, anorexia, constipation, diarrhea, peptic ulcers, chronic fatigue, weight loss, weight gain, depression, anxiety, and more.

Photo by Gabriella Fabbri

Photo by Gabriella Fabbri

Think of stress as a rubber band — if stretched to extreme, it will break; release the tension and it will return to its normal state. The old adage of “fight or flight” comes into play, some stressors we can change; others must be managed differently or eliminated altogether.

There are no standard tools to measure stress levels making this diagnosis difficult to quantify.  Although, stress does elevate the level of cortisol, a hormone produced by the adrenal glands.  Prolonged cortisol elevation attributes to adrenal fatigue, a very popular diagnosis which has gained lots of attention in recent times (another topic altogether).

Stress zaps all of our essential hormone levels, as one interesting research study revealed. A group of women in very powerful, executive positions were studied.  Their hormone levels were monitored daily while they were actively working as well as caring for their families.  The results showed diminished or depleted levels of circulating hormones.  The study continued by sending these “lucky” women to Tahiti for some much needed R&R.  Hormonal monitoring continued everyday while vacationing and revealed perfectly normal ranges. Duh, take away the stress triggers of daily living and all is well. I could have told you that without a study!

Coping with the Unavoidables                                                                        

When we encounter multiple or daily challenges that “stress us out” and cannot be eliminated, it is important to find coping mechanisms to avoid the known health consequences prolonged stress responses can cause. No two individuals react to the same stressors in the same manner.  Therefore, everyone has to determine what stresses them and the best coping skills to activate when things spiral out of control. Yes, that pint of Ben and Jerry’s or bottle of vino may provide a temporary euphoria but cause more harm than good in the long run.

Take some time to identify the things that push your buttons. Make a list and determine which of these factors are changeable and which can be altered. Other things in our lives that we cannot change (e.g., our families) have to be accepted and managed in a healthy fashion.  Unfortunately we can’t just eliminate the spouse or in-laws from the list; but we can choose to respond in a more effective manner.  If caring for a loved one or grieving a loss, seek relief from others.  Find a support group in your area and/or seek counseling.

Always find time for YOU. On a regular basis, I express to my patients the importance of taking some time for themselves.  Even if it is a 15-20 minute break to do something you’re passionate about, this time can be so effective in restoring your abilities to cope.  This brings to mind the instructions by flight attendants, if anyone even listens anymore. They instruct you to place the oxygen mask over your mouth and nose before trying to assist others.  OK, there you have it…….take some time each day to do something special just for YOU.  Tell the others in your life not to bother you unless the house is burning down.  The world will keep turning while you relax and recharge.

Keep it simple, Silly

Then there are stressors that can be altered, avoided, changed or even eliminated.  Here are just a few suggestions:

  • Eat more fresh fruits and veggies
  • Take a walk in the park or other scenic spot
  • Find one place for the keys and stick to it
  • Think positive
  • Just say NO (Thank you, Nancy Reagan)
  • Occasionally turn OFF the smart phone and computer
  • Turn off the TV
  • Expect nothing and never be disappointed
  • Delay self-imposed deadlines
  • Avoid draining relationships
  • Hire a dog whisperer
  • Try a little mental floss (Jimmy Buffett style)

Butterfly blue w yellow flower by Kevin TuckComplementary and Alternative Modalities

Complementary and Alternative Medicine (CAM) includes non-pharmaceutical therapies that may be used in addition to or instead of traditional, conventional medicine as we know it.  These alternatives have existed and been utilized in Eastern Medicine (Asian countries) for hundreds of years. The popularity of CAM has grown in the United States even being recognized and paid for by some insurance companies. There are many options to choose from, find one or several that sound appealing to you. More information about CAM can be accessed at

Therapeutic massage comes to mind as an all time stress buster in this category.  Just in case you are not fortunate enough to have a masseuse on retainer, there are several methods you can learn to practice on your own to combat the effects of stress. These techniques can be used anytime, anywhere, without cost or prescription and as often as you like. Restorative yoga is my favorite (think play “dead dog” for 30-45 minutes).  This special yoga technique and positioning can totally restore your ability to face the world with a fresh approach after just one session.  Meditation is the art of tuning everything/everyone out and is easy to learn. A great resource for this technique can be found at  Deep breathing exercises, progressive muscle relaxation, guided imagery are all wonderful paths to euphoria.  More information regarding relaxation techniques, including restorative yoga, can be accessed on the resources link at Aromatherapy, Hydrotherapy and Pet Therapy are other options for stress management on a daily basis; think candles, bubble bath/beach or petting the dog, not necessarily at the same time.  Touch therapy or physical contact has been shown to decrease cortisol (stress hormone) levels up to 53% according to recent studies.  Furthermore, regular sexual intimacy in emotionally healthy relationships can reduce stress and lengthen the lifespan significantly, according to The Longevity Project, a research study by Dr. Howard Friedman.  Biofeedback, facilitated by a professional, is also a great method for stress management if self-guided modalities fail or you need direction. Or simply try Music therapy (free, no Rx needed), as the University of Maryland found 30 minutes of listening to classical music has the same calming effect on the brain as a 10mg Valium. YES, please turn it up and tune out the stress!

Hormone Management

Because research has proven that our hormones can be severely altered by stress, you might consider the benefits of replacement.  Cortisol, pregnenolone, DHEA, and progesterone, as well as neurotransmitters, can be depleted by stress. There are safe options for treatment available but DO NOT TRY THIS AT HOME.  Seek competent medical advice from a qualified health professional before beginning any form of hormone replacement therapy.  It is important to have your hormone levels evaluated to determine imbalance and which replacements would be beneficial to you.  No two individuals are the same.  Doses vary and should be monitored by a healthcare provider specifically trained in this specialized area of healthcare.

Photo by Scott Snyder

Photo by Scott Snyder

Now that we have identified numerous tools to enhance those feel good endorphins, let’s get started …….

Find a comfortable spot to sit or recline, close your eyes, take in a full, deep breath — filling your lungs to capacity; as you exhale slowly and completely, relax all of your muscles and imagine that you are on a beautiful island or other magical destination, far from daily stress triggers. Now, CHILLAX!

Leave a comment


  1. Great information here! Thank you so much for sharing it!

  2. Very good information. I pretty much have generalized anxiety, but not chronic or severe. I saw something once that said when you release your deep breath, repeat the word “Release.” This is something that has helped me. Thank you for sharing this important information for people like me.

  3. Lori, as I discussed in my older post, “Stop The Anxiety Avalanche,” I’m no stranger to what it feels like to experience anxiety. There’s a video in that post that guides viewers through Breathing Meditation. Like you, I have found that relaxing and turning my attention to my breath helps me get back into the present moment and calm down. Using the “Release” or “Letting Go” mantras is helpful to me too.
    Thank you, so much, for stopping in and sharing a bit of your experience and insight!
    Many blessings,

  4. Wonderful info. Thanks for sharing

    • Thank you, lovely Poet, for reading and commenting! Have a wonderful New Year’s! Blessings, Sloan


Leave a Reply

Fill in your details below or click an icon to log in: Logo

You are commenting using your account. Log Out /  Change )

Google photo

You are commenting using your Google account. Log Out /  Change )

Twitter picture

You are commenting using your Twitter account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )

Connecting to %s

%d bloggers like this: