Acknowledgement

Thanks to Diana DelCampo, our Child Development & Family Life Specialist, for providing content for the the Children / Adolescents and stress section of this page.

What is stress?

From a psychological point of view, stress can be defined as the perception that your circumstances have exceeded your capacity to cope (creating a threat to your being).

From a physiological point of view (regarding the internal physical functioning of the body), stress can be defined as a state of internal imbalance where there is an over activation of the fight or flight response. The fight or flight response, triggered by a threat to your being, is an involuntary physiological response of: increased blood flow, heart rate, blood pressure, breathing rate, and metabolism. This physiological response prepares us for conflict (fight) or escape (flight).

Over activation of the flight or fight response can be both by degree (that is, the activation is too intense for the situation; the situation does not warrant such a high level of activation) and/or by duration (i.e., the fight or flight response becomes chronic; it continues when it should have been, at some point, deactivated or "turned off"). Chronic activation of the fight or flight response increases risk for hypertension (high blood pressure). Hypertension can lead to heart attack or stroke.

Stress and illness

As mentioned in the section above, chronic activation of the fight or flight response increases the risk for hypertension, which in turn increases the risk for heart attack or stroke. Additionally, numerous studies have shown that chronic stress can suppress the immune system (the system which helps us to fight off illness and disease).

Besides high blood pressure and heart disease, some other specific disorders, among others, that stress plays a role in (or is suspected of playing a role in) are

• ulcers
• migraine and tension headaches
• TMJ syndrome (painful problems of the lower jaw)
• arthritis
• asthma and allergies
• backache
• cancer
• mental illness (schizophrenia, anxiety disorders, and depression)

Positive stress (called "eustress")

Some stress, called eustress, is good and healthy for you. For example, having an acute stressful response to an immediate threat such as quickly moving out of the way (flight) when a moving object is about to hit you is protective. Or, as another example, having an appropriate amount of stress before competing in a sports event can enhance one's performance by sharpening the senses and physiological functioning. It's the inappropriate stress of overblown intensity or chronic activation that we want to manage.

Children / Adolescents and stress

Recognizing stress in children:

The most frequent signs that children are stressed are changes in behavior and a regression of behavior. For example young children who are already toilet trained my have more toileting accidents. Middle school children who love school may say they have stomachaches and say they do not want to go to school. Teens who were previously loving and open may stop talking and withdraw from family members.

Some causes or sources of stress:

• Changing schools
• Problems with peers
• Injury or illness
• Move to a new home
• Parental divorce
• Death of loved one
• Constant fatigue or conflict with close friend or family member

What can parents do to help child deal with stress?:

• Be sensitive and recognize child's problem
• Protect child from stressor
• Show affection like hugs and kisses
• Spend quality time with child
• Teach child how to solve problems
• Encourage laughter, fun, exercise, and healthy eating
• Let child express feelings
• Have consistency and order in child's daily routine

Find out more about children / adolescents and stress by visiting the applicable web sites listed and described in the Web Resources section below.

Managing stress

There are different strategies for managing stress. Three very practical strategies are:

• Relaxation / Self-regulation techniques
• Exercise
• Healthy Diet

See these individual sections below for more information on them.

Also, see the Web Resources section below for more information on the different strategies for managing stress including tips for managing stress and for other information about stress.

Relaxation / Self-regulation techniques

Relaxation / Self-regulation techniques counteract the over activation of the fight or flight response. Whereas the fight or flight response includes increased blood flow, heart rate, blood pressure, breathing rate, and metabolism, the relaxation response includes decreased heart rate, blood pressure, breathing rate, and metabolism. Also, whereas blood flow, heart rate, blood pressure, breathing rate, and metabolism are considered "autonomic" (that is, involuntary), through relaxation and self /regulation techniques, one can make the involuntary voluntary, that is, one can voluntarily control these functions (for example, slow them down); hence the name "self-regulation."

The following are Relaxation / Self-regulation techniques. Essential to all of them is diaphragmatic breathing (which, in practical terms, means breathing with your belly and not your chest). Your diaphragm, which is a large, dome-shaped muscle at the base of your lungs, allows you the breath most efficiently when at rest.

Hatha Yoga

For our purposes, I'll use the following definition of hatha yoga:

"gentle stretching and strengthening exercises, done very slowly, with moment-to-moment awareness of breathing and of the sensations that arise as you put your body into various configurations known as posture" (Kabat-Zinn, 1990, p.95).

Research has demonstrated a variety of health benefits from hatha yoga, including reducing stress.

I suggest that, if you wish to learn hatha yoga, you find a good yoga instructor. Still, you can get an idea about the various Yoga Postures.

Hatha yoga has been very popular in the U.S. and hatha yoga classes can be found in many communities. Check your yellow pages under "yoga" and ask around at community centers to find out where classes may be taught in your area.

For a good article from the Mayo Clinic that will tell you more about what Hatha yoga is and its benefits, visit Yoga Article.

Biofeedback

Biofeedback uses sensitive instruments to measure, amplify and provide feedback (via sounds or lights) on various physiological processes going on in your body such as blood flow, muscle tension, brainwave activity, sweat gland activity, and heart rate. This feedback is used to help one become aware of and manipulate what's going on in the body.

Relaxation strategies, such as the use of relaxing imagery or Progressive Relaxation (see below), are coupled with the biofeedback provided by the biofeedback machine. From this biofeedback, a person learns to associate certain thoughts and actions with the desired change in their physiological responses.

The use of biofeedback is beneficial for overall stress management as well as for treating specific illness, diseases, and disorders including (but no limited to):

• insomnia
• TMJ
• headaches
• constipation
• urinary incontinence
• irritable bowl syndrome
• Raynaud's disease
• ulcers
• colitis
• muscle spasm

Progressive Relaxation

Progressive Relaxation, another self-regulation strategy, is a series of exercises in which one contracts (tenses) and then relaxes various muscle groups in the body, progressing from one muscle group to another throughout the entire body. By consciously tensing muscles, one recognizes more readily what it feels like to have the muscles tense, helping to more readily recognize tense muscles when you're normally (and unconsciously) tensing them. Also, the exaggerated contrast of tension versus relaxation helps one to feel what it's like to have the muscles relaxed.

Autogenic Training

Autogenic training, another relaxation technique, uses body awareness and diaphragmatic breathing to elicit the Relaxation Response. Six sequential stages of Autogenic training include:

• focusing on sensations of heaviness throughout the arms and legs
• focusing on sensations of warmth throughout the arms and legs
• focusing on sensations of warmth and heaviness in the heart area
• focusing on breathing
• focusing on sensations of warmth in the abdomen
• focusing on sensations of coolness in the forehead

With the focus, one repeats phrases to create the desired effect. For example: when focusing on sensations of heaviness throughout the arms and legs, one would repeatedly say "My arms and legs are heavy." As is essential in all relaxation techniques, diaphragmatic breathing is coordinated with the exercises.

Meditation

When speaking about stress management, meditation is considered a method of self-regulation that has, as one benefit, the elicitation of the relaxation response (see discussion about the Relaxation Response under the Relaxation / Self-regulation techniques section above). In both my personal and professional opinion, meditation is one of the most effective methods in reducing stress, and is perhaps essential in any stress management program.

Meditation, as is being used in this discussion, is a process of stilling the mind and quieting the body, of bringing a detached witnessing awareness "of bare attention" to the present moment. Meditation, as is being used in this discussion, does not mean contemplation or to reflect on or ponder over something (as it is usually defined in the dictionary). That's contemplation, not meditation.

Meditation is a process of focusing attention and concentrating the mind:

1. On a single object such as the sensation of the breath at one's nostril tips (the warmth of the breath as you exhale and the coolness of the breath as you inhale) or at the rising and falling of the belly (as you inhale and exhale, respectively); also, as one focuses on the breath, one can also repeat an internal auditory sound, such as internally saying "in" on the inbreath (or "rising" as the belly rises) and "out" on the outbreath (or "falling" as the belly falls) or
2. On the rising and passing away (coming and going) of (a) sense "objects," that is, sounds, tastes, sights, smells, and body sensations and (b) thoughts and feelings or
3. The interplay of #1 and #2 above: one focuses on the breath; then as thoughts, feelings, and sensations arise, one mentally notes them in a non-judgmental, objective, witnessing way (e.g., "hearing") and returns to the breath, over and over again.

One can conceptualize #1 above as focusing the mind through a narrow lens or like a laser beam (on the breath) and #2 above as focusing the mind through a wide-angle lens. Common to both is focused attention of the mind in a non-judgemental, witnessing way. One objectively investigates the mind's process/workings.

During the meditation process, when thoughts, feeling, and sensations arise, one simply notices them and returns to concentrating on the breath. For example, while focusing on the breath, one hears a sound and mentally notes "hearing" and then simply returns to focusing on the breath. The practice involves not getting caught up in a discursive thinking process... that is, not getting caught up in the mind's process of thinking about the past, present or future. In this process, thoughts and the thinking process slow down and one comes to a state of bare perception, to a non-judgmental witnessing perspective, of all that comes and goes in the field of consciousness. One learns to "detach" and not get caught up in discursive thinking about the past, present, or future. As a result, in time:

• the Relaxation Response is elicited
• brain activity slows down (as can be measured by an EEG, or electroencephalogram)
• a state of calm, tranquility, and peace is experienced.

Also note: During sitting meditation, the head, neck and torso should be straight and fairly erect with the chest/heart area open, so breathing can be free and unhindered and so that there isn't any pressure on the internal organs of the midsection. Smooth, quiet, natural, diaphragmatic breathing should be done (using the belly as a baby does), not chest breathing.

Exercise

Exercise is a nice complement to self-regulation strategies that work with the breath and the activity of the mind. Exercise works with, and focuses on, the body.

Exercise helps to relieve tension from the body, especially in the musculoskeletal system (muscles and bones). Muscle tension results from an impulse to act on something, which is not actually acted upon. For example, we encounter a stressor (such as an argument or work assignment that is stressful) and get geared up to fight or flight and do neither; instead, we remain in place and possibly internalize the stress. Unrelieved stress will cause a build up of tension in our muscles, which in turns creates more stress, and a vicious cycle ensues. Thus, it is beneficial to relieve this build up through some means, such as through physical exercise/activity.

As tension is unreleased impulse or impulses to act, exercise allows us to express or release the blocked up tension. Both aerobic activity (e.g., jogging or brisk walking) and stretching (e.g., hatha yoga) allows for this release.

Healthy Diet

Diet and nutrition play an important role in staying healthy. A healthy person will be more robust against, and resilient to, stressors she may encounter. Conversely, poor diet can compromise one's constructive response to stress.

A poor diet (including eating too much) will create internal stress, such as stressing the digestive system and other organs in the body.

Inadequate nutrition can wreak havoc on the body's metabolism due to an insufficient supply of "fuel" for energy. If the body doesn't get an adequate and consistent supply of fuel for energy, this is in itself a stressor, upsetting internal systems including the digestive and nervous systems.

Excessive intake of stimulants, such as sugar, caffeine, and salt, can also create an up-and-down, unhealthy, and unbalanced cycle in the body (that is, an initial phase of increased energy followed by a crash).

Simply stated: An unhealthy diet will create an imbalance in the body. When there is an imbalance in our mind and body, stress happens. Additionally, a poor diet can make one less robust and resilient to stressors.

Sources

Herbert, J. (1997). British Medical Journal. Stress, the brain, and mental illness, v315 n7107, pp. 530-6.

Benson, H. (1976). The Relaxation Response. HarperTorch (publisher).

J. Greenberg (2003). Comprehensive Stress Management (8th edition); McGraw-Hill (publisher).

Prepare Respond Recover.com. Children's Needs page.

North Carolina Cooperative Extension Service's Stress in Children page.

Kabat-Zinn, J. (1990). Full catastrophe living: using the wisdom of your body and mind to face stress, pain, and illness. New York: Dell Publishing.

Harvey, J. (editor) (1988). The quiet mind: techniques for transforming stress. Pennsylvania: The Himalayan Press.

Web Resources

Good page here on various stress management techniques and strategies, including ones I both discussed on this web page and did not discuss (from Mind Tools).

From Hooah4Health (a U.S. Army page), a Stress Management page discussing topics such as:

• Stress Basics
• Exercise and Stress
• Diet
• Stress Awareness
• Stress Management

Here are some audio tapes for guided meditation or relaxation which you can find at the Himalayan Institute store page:

• Learn to Meditate by Rolf Sovik, Psy.D.
• Guided Meditation for Beginners by Swami Rama*
• Guided Relaxation and Breathing by Rolf Sovik, Psy.D. (New Mexico Extension Faculty/Staff can check this item out from our Extension Home Economics library; call David O'Brien at 505-646-1018 or e-mail him at daobrien@nmsu.edu with your request.)

Check out the Mayo Clinic's Stress Center, which offers some good information about stress and its management.

From MedlinePlus, this Stress page offers lots of web links to information about stress and its management, including (but not limited to) information about:

• stress and the workplace
• coping with stress
• stress and family
• tips for reducing stress
• pregnancy and stress
• children and stress
• teens and stress

Oklahoma State University's Environmental Health & Safety Department has an Stress through Mindfulnesswith lots of links to other sources about stress and its management.

An excellent article by David B. Posen, MD entitled, Stress Management for Patient and Physician. In this online article in the Canadian Journal of Continuing Medical Education (April 1995), Dr. Posen discusses stress and provides 10 practical strategies for managing it.

From the University of Minnesota's Extension Service, like the name implies, Keep Children Talking, discusses stress in children and provides some tips for parents.

Another good KidsHealth page for parents about Childhood Stress. I can't say enough about the KidsHealth web page…so much good information on so many topics. Also, check out the What is Stress? and Stress for the younger ones.