Stress and Burnout

By Dr. Carolyn Ross

Part 1 | 2

Psychological Counseling
A psychologist or psychotherapist can help you deal with the emotional and behavioral aspects of stress. They can evaluate symptoms based on your self-report, their observation, life-events scale and a genogram. A genogram is a tool similar to doing a family tree with questions asked that reveal conflicts and issues between family members. Treatment may include educational material to clarify the difference between stress, burnout and tedium, and strategies to deal with stress. Individual therapy may include self-hypnosis, supportive therapy, assertiveness training and homework assignments. Cognitive therapy helps you change the way you think about people or situations. Couples or family counseling may be appropriate to assist in making changes in relationships to decrease symptoms.

Traditional Chinese Medicine (TCM)
A TCM practitioner aims to restore balance to the body. When the body's energy is flowing properly to all tissues of the body, a person is better able to deal with stress and its effects. The TCM practitioner will diagnose the effects of stress on the different body systems. They may recommend an herbal medicine if necessary or acupuncture one to two times per week.

Chiropractic Care & Therapeutic Massage
A spine that is properly aligned enhances functioning of the nervous system to help it manage the stress response better. When stress does occur, tense, tight muscles create pain and biomechanical problems. Chiropractic care can provide symptomatic relief and treatment.

Therapeutic massage increases circulation, relieves muscle tension, and relaxes and elongates tight muscles. It also stimulates production of the 'feel good' brain chemicals, serotonin and endorphins, and decreases production of stress hormones. It thus invokes the relaxation response so desirable in managing stress.

Nutrition and Exercise
The family of B vitamins features prominently in managing the body's stress response. Chronic stress can thus deplete these vitamins, which must be replaced daily since they are not stored in the body. Also, the very foods which are often used to deal with stress tend to heighten its symptoms: fat, sugar, caffeine and alcohol. Try to stay clear of these in favor of more vegetables, fruits, whole grains and legumes complemented by some lean protein. In addition, you may wish to take a multiple vitamin containing the B vitamins.

Regular exercise can help to make you more stress hardy and aids in the elimination of the stress hormones. Aerobic exercise sessions of at least 20 minutes in duration at a moderate level of intensity will serve you best. The ideal would be to get some exercise most days, but try not to drop below three days per week.

Learning to meditate can provide you with a very powerful tool in coping with stress. Meditation calms the mind and body, enhancing production of the parasympathetic relaxation hormones. Research has also shown that certain types of meditation, when regularly practiced, produce lower incidence of disease, reduced physiological aging, improved brain functioning, better rest, and improved job satisfaction and relationships.

Self-help Techniques

Begin by paying attention to your body's communication system. Try taking your 'stress temperature'. On a scale of one to ten (with ten being the most intense), what number stress do you feel? When you identify that your number is greater than a five, it's time to employ one of the following techniques:
Deep breathing: Execute a full, deep inhalation through your nostrils. Relax your belly muscles to allow your lungs to fill fully. Then slowly exhale through your mouth, letting your stomach and chest collapse. Repeat until you are feeling calmer. (Try breathing in to the count of 4 and out to the count of 8.)

Sensory focus: Use your senses to tune in to what is going on around you (thus directing the focus outside yourself). Pay attention to a leaf for a few moments, listen to the sounds that exist right now, notice the smells, touch your cheeks as you would a baby, and so on.

Affirmations: Make short, positive statements such as "I can handle this" when you are confronted with an unexpected event. Or, if you are already feeling anxious, try "I am relaxed" or "I am calm."

Focusing: Sit upright in a comfortable position holding a small, sentimental object in the palm of your hand. Focus only on that object, allowing no outside thoughts as you breathe deeply for one to two minutes. Notice that your breathing has slowed and you feel calmer.

Progressive muscle relaxation: Sitting or lying comfortably, take a few deep breaths. Then tense and relax the following body parts, in order: face, shoulders, back, abdomen, pelvis, thighs, calves and feet. Then shake your hands and imagine any remaining tension flowing out through your fingertips.

Blow some bubbles: Go to the store and buy yourself a bottle of bubbles to carry with you. When you notice that you are feeling stress, take out your bubbles and blow them, focusing more on the 'out' breath. The out breath is the relaxation, the letting go response. Symbolically bubbles represent your troubles floating away.

Contributors to Stress/Burnout
Carolyn Coker Ross, MD, MPH; Barbara Whiteside, RN, CNP; Johanna Appel, DC; Julie Martin, MS; Dorothy Miller, RN; Connie Saindon, MA, MFCC; Jacqueline Zhang, LAc, MD (China

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