70 Managing Stress

How can I help handle my stress?

Everyone has to deal with stress. There are steps you can take to help you handle stress in a positive way and keep it from making you sick. Try these tips to keep stress in check:

Develop a new attitude

• Become a problem solver. Make a list of the things that cause you stress. From your list, figure out which problems you can solve now and which are beyond your control for the moment. From your list of problems that you can solve now, start with the little ones. Learn how to calmly look at a problem, think of possible solutions, and take action to solve the problem. Being able to solve small problems will give you confidence to tackle the big ones. And feeling confident that you can solve problems will go a long way to helping you feel less stressed.
• Be flexible. Sometimes, it’s not worth the stress to argue. Give in once in awhile or meet people halfway.
• Get organized. Think ahead about how you’re going to spend your time. Write a to-do list. Figure out what’s most important to do and do those things first.
• Set limits. When it comes to things like work and family, figure out what you can really do. There are only so many hours in the day. Set limits for yourself and others. Don’t be afraid to say NO to requests for your time and energy.

Relax

• Take deep breaths. If you’re feeling stressed, taking a few deep breaths makes you breathe slower and helps your muscles relax.
• Stretch. Stretching can also help relax your muscles and make you feel less tense.
• Massage tense muscles. Having someone massage the muscles in the back of your neck and upper back can help you feel less tense.
• Take time to do something you want to do. We all have lots of things that we have to do. But often we don’t take the time to do the things that we really want to do. It could be listening to music, reading a good book, or going to a movie. Think of this as an order from your doctor, so you won’t feel guilty!

Take care of your body

• Get enough sleep. Getting enough sleep helps you recover from the stresses of the day. Also, being well-rested helps you think better so that you are prepared to handle problems as they come up. Most adults need 7 to 9 hours of sleep a night to feel rested.
• Eat right. Try to fuel up with fruits, vegetables, beans, and whole grains. Don’t be fooled by the jolt you get from caffeine or high-sugar snack foods. Your energy will wear off, and you could wind up feeling more tired than you did before.
• Get moving. Getting physical activity can not only help relax your tense muscles but improve your mood. Research shows that physical activity can help relieve symptoms of depression and anxiety.
• Don’t deal with stress in unhealthy ways. This includes drinking too much alcohol, using drugs, smoking, or overeating.

Connect with others

• Share your stress. Talking about your problems with friends or family members can sometimes help you feel better. They might also help you see your problems in a new way and suggest solutions that you hadn’t thought of.
• Get help from a professional if you need it. If you feel that you can no longer cope, talk to your doctor. She or he may suggest counseling to help you learn better ways to deal with stress. Your doctor may also prescribe medicines, such as antidepressants or sleep aids.
• Help others. Volunteering in your community can help you make new friends and feel better about yourself.

How can I cope with stress?

The effects of stress tend to build up over time. Taking practical steps to maintain your health and outlook can reduce or prevent these effects. The following are some tips that may help you to cope with stress:

• Seek help from a qualified mental health care provider if you are overwhelmed, feel you cannot cope, have suicidal thoughts, or are using drugs or alcohol to cope.
• Get proper health care for existing or new health problems.
• Stay in touch with people who can provide emotional and other support. Ask for help from friends, family, and community or religious organizations to reduce stress due to work burdens or family issues, such as caring for a loved one.
• Recognize signs of your body’s response to stress, such as difficulty sleeping, increased alcohol and other substance use, being easily angered, feeling depressed, and having low energy.
• Set priorities-decide what must get done and what can wait, and learn to say no to new tasks if they are putting you into overload.
• Note what you have accomplished at the end of the day, not what you have been unable to do.
• Avoid dwelling on problems. If you can’t do this on your own, seek help from a qualified mental health professional who can guide you.
• Exercise regularly-just 30 minutes per day of gentle walking can help boost mood and reduce stress.
• Schedule regular times for healthy and relaxing activities.
• Explore stress coping programs, which may incorporate meditation, yoga, tai chi, or other gentle exercises.

Meditation and Health

Many people practice meditation for a number of health-related purposes. A 2007 national government survey found that 9.4% of respondents had used meditation in the past 12 months.

What is meditation?

The term meditation refers to a group of techniques which may be practiced for many reasons, such as to increase calmness and physical relaxation, to improve psychological balance, to cope with illness, or to enhance overall wellness. Most types of meditation have four elements in common:

• A quiet location. Meditation is usually practiced in a quiet place with as few distractions as possible. This can be particularly helpful for beginners.
• A specific, comfortable posture. Depending on the type being practiced, meditation can be done while sitting, lying down, standing, walking, or in other positions.
• A focus of attention. Focusing one’s attention is usually a part of meditation. For example, the meditator may focus on a mantra (a specially chosen word or set of words), an object, or the sensations of the breath.
  Having an open attitude during meditation means letting distractions come and go naturally without judging them.

How can meditation affect my health?

It is not fully known what changes occur in the body during meditation; whether they influence health; and, if so, how. Research is under way to find out more about meditation’s effects, how it works, and diseases and conditions for which it may be most helpful.

The National Center for Complementary and Alternative Medicine (NCCAM) is the federal government’s lead agency for scientific research on complementary and alternative medicine (CAM). Some recent NCCAM-supported studies have been investigating meditation for relieving stress in caregivers for elderly patients with dementia and for relieving asthma symptoms.

Is meditation right for me?

Meditation is considered to be safe for healthy people but if you are thinking about using meditation practices to prevent asthma attacks, to control high blood pressure, to reduce arthritis pain, or for any other medical reason, be smart.

Relaxation Techniques

Relaxation techniques include a number of practices such as progressive relaxation, guided imagery, biofeedback, self-hypnosis, and deep breathing exercises. The goal is similar in all: to consciously produce the body’s natural relaxation response, characterized by slower breathing, lower blood pressure, and a feeling of calm and well-being.

Relaxation techniques (also called relaxation response techniques) may be used by some to release tension and to counteract the ill effects of stress. Relaxation techniques are also used to induce sleep, reduce pain, and calm emotions. This fact sheet provides a general overview of relaxation techniques and suggests sources for additional information.

About Relaxation Techniques

Relaxation is more than a state of mind; it physically changes the way your body functions. When your body is relaxed breathing slows, blood pressure and oxygen consumption decrease, and some people report an increased sense of well-being. This is called the “relaxation response.” Being able to produce the relaxation response using relaxation techniques may counteract the effects of long-term stress, which may contribute to or worsen a range of health problems including depression, digestive disorders, headaches, high blood pressure, and insomnia.

Relaxation techniques often combine breathing and focused attention on pleasing thoughts and images to calm the mind and the body. Most methods require only brief instruction from a book or experienced practitioner before they can be done without assistance. These techniques may be most effective when practiced regularly and combined with good nutrition, regular exercise, and a strong social support system.

Some relaxation response techniques include:

• Autogenic training. When using this method, you focus on the physical sensation of your own breathing or heartbeat and picture your body as warm, heavy, and/or relaxed.
• Biofeedback. Biofeedback-assisted relaxation uses electronic devices to teach you how to consciously produce the relaxation response. Biofeedback is sometimes used to relieve conditions that are caused or worsened by stress.
• Deep breathing or breathing exercises. To relax using this method, you consciously slow your breathing and focus on taking regular and deep breaths.
• Guided imagery. For this technique, you focus on pleasant images to replace negative or stressful feelings and relax. Guided imagery may be directed by you or a practitioner through storytelling or descriptions designed to suggest mental images (also called visualization).
• Progressive relaxation. (also called Jacobson’s progressive relaxation or progressive muscle relaxation). For this relaxation method, you focus on tightening and relaxing each muscle group. Progressive relaxation is often combined with guided imagery and breathing exercises.
• Self-Hypnosis. In self-hypnosis you produce the relaxation response with a phrase or nonverbal cue (called a “suggestion”). Self-hypnosis may be used to relieve pain (tension headaches, labor, or minor surgery) as well as to treat anxiety and irritable bowel syndrome.

Mind and body practices, such as meditation and yoga are also sometimes considered relaxation techniques. You can read more about these practices in the National Center for Complementary and Alternative Medicine’s (NCCAM) fact sheets Meditation: An Introduction and Yoga for Health: An Introduction.

Use of Relaxation Techniques for Health in the United States

People may use relaxation techniques as part of a comprehensive plan to treat, prevent, or reduce symptoms of a variety of conditions including stress, high blood pressure, chronic pain, insomnia, depression, labor pain, headache, cardiovascular disease, anxiety, chemotherapy side effects, and others.

According to the 2007 National Health Interview Survey, which included a comprehensive survey of complementary and alternative medicine (CAM) use by Americans, 12.7 percent of American adults used deep-breathing exercises, 2.9 percent used progressive relaxation, and 2.2 percent used guided imagery for health purposes. Most of those people reported using a book to learn the techniques rather than seeing a practitioner.
To understand how consciously producing the relaxation response may affect your health, it is helpful to understand how your body responds to the opposite of relaxation—stress.

When you’re under stress, your body releases hormones that produce the “fight-or-flight response:” Heart rate and breathing rate go up and blood vessels narrow (restricting the flow of blood). This response allows energy to flow to parts of your body that need to take action, for example the muscles and the heart. However useful this response may be in the short term, there is evidence that when your body remains in a stress state for a long time, emotional or physical damage can occur. Long-term or chronic stress (lasting months or years) may reduce your body’s ability to fight off illness and lead to or worsen certain health conditions. Chronic stress may lead to high blood pressure, headaches, stomach ache, and other symptoms. Stress may worsen certain conditions, such as asthma. Stress also has been linked to depression, anxiety, and other mental illnesses.

In contrast to the stress response, the relaxation response slows the heart rate, lowers blood pressure, and decreases oxygen consumption and levels of stress hormones. Because relaxation is the opposite of stress, the theory is that voluntarily creating the relaxation response through regular use of relaxation techniques could counteract the negative effects of stress.

Status of Research on Relaxation Techniques

In the past 30 years, there has been considerable interest in the relaxation response and how inducing this state may benefit health. Research has focused primarily on illness and conditions in which stress may play a role either as the cause of the condition or as a factor that can make the condition worse.

Currently, there is some evidence that relaxation techniques may be an effective part of an overall treatment plan for some disorders, including:

• Anxiety. Studies have suggested that relaxation may assist in the treatment of phobias or panic disorder. Relaxation techniques have also been used to relieve anxiety for people in stressful situations, such as when undergoing a medical procedure.
• Depression. In 2008, a major review of the evidence for relaxation in the treatment of depression found that relaxation techniques were more effective than no treatment for depression, but not as effective as cognitive-behavioral therapy.
• Headache. There is some evidence that biofeedback and other relaxation techniques may be helpful for relieving tension or migraine headaches. In some cases, these mind and body techniques were more effective than medications for reducing the frequency, intensity, and severity of headaches.
• Pain. Some studies have shown that relaxation techniques may help reduce abdominal and surgery pain.

The results of research on relaxation to promote overall health or well-being or to treat other health conditions have been mixed or unclear. These conditions include:

• High blood pressure. A 2008 review of evidence for relaxation in the treatment of high blood pressure found some evidence that progressive muscle relaxation lowered blood pressure a small amount. However, the review found no evidence that this effect was enough to reduce the risk of heart disease, stroke, or other health issues due to high blood pressure. In a recent randomized controlled trial, 8 weeks of relaxation response/stress management was shown to reduce systolic blood pressure in hypertensive older adults, and some patients were able to reduce hypertension medication without an increase in blood pressure.
• Asthma. Several reviews of the literature have suggested that relaxation techniques, including guided imagery, may temporarily help improve lung function and quality of life and relieve anxiety in people with asthma. A more recent randomized clinical trial of asthma found that relaxation techniques may help improve immune function. More studies are needed to confirm this finding.
• Nausea. Relaxation techniques may help relieve nausea caused by chemotherapy.
• Fibromyalgia. Although some preliminary studies report that using relaxation or guided imagery techniques may sometimes improve pain and reduce fatigue from fibromyalgia, more research is needed.
• Irritable bowel syndrome. Some studies have indicated that relaxation techniques may prevent or relieve symptoms of irritable bowel syndrome (IBS) in some participants. One review of the research found some evidence that self-hypnosis may be useful in the treatment of IBS.
• Heart disease and heart symptoms. Researchers have looked at relaxation techniques for the treatment of angina and the prevention of heart disease. When a cardiac rehabilitation program was combined with relaxation response training in a clinic, participants experienced significant reductions in blood pressure, decreases in lipid levels, and increases in psychological functioning when compared to participants’ status before the program. Although studies have shown that relaxation techniques combined with other lifestyle changes and standard medical care may reduce the risk of recurrent heart attack, more study is needed.
• Insomnia. There is some evidence that relaxation techniques can help in treating chronic insomnia.

Researchers have found some evidence on the effectiveness of relaxation techniques for:

• Temporomandibular disorder. (pain and loss of motion in the jaw joints). A review of the literature found that relaxation techniques and biofeedback were more effective than placebo in decreasing pain and increasing jaw function.
• Ringing in the ears. Use of relaxation exercises may help patients cope with the condition.
• Smoking cessation. Relaxation exercises may help reduce the desire to smoke.
• Overactive bladder. Bladder re-training combined with relaxation and other exercises may help control urinary urgency.
• Nightmares. Relaxation exercises may be effective in treating nightmares of unknown cause and those associated with posttraumatic stress disorder.
• Hot flashes. Relaxation exercises involving slow, controlled deep breathing may help relieve hot flashes associated with menopause.

Researchers have found no significant change in outcomes from relaxation techniques used during cardiac catheterization. However, patients experienced less distress prior to the procedure. Future research may investigate whether this has any long-term effect on outlook and recovery.

Many of the studies of relaxation therapy and health have followed a small number of patients for weeks or months. Longer studies involving more participants may reveal more about the cumulative effects of using relaxation techniques regularly.

Side Effects and Risks

• Relaxation techniques are generally considered safe for healthy people. There have been rare reports that certain relaxation techniques might cause or worsen symptoms in people with epilepsy or certain psychiatric conditions, or with a history of abuse or trauma. People with heart disease should talk to their doctor before doing progressive muscle relaxation.
• Relaxation techniques are often used as part of a treatment plan and not as the sole treatment for potentially serious health conditions.

If You Are Thinking About Using Relaxation Techniques for Health

• Do not use relaxation techniques as a replacement for conventional care or to postpone seeing a doctor about a medical problem.
• Ask about the training and experience of the practitioner or instructor you are considering for any complementary alternative medicine practice.
• Look for published research studies on relaxation for the health condition in which you are interested. Remember that some claims for using relaxation therapies may exceed the available scientific evidence.
• Tell all your health care providers about any complementary and alternative practices you use. Give them a full picture of what you do to manage your health. This will help ensure coordinated and safe care.

What Is Resilience?

Resilience is the ability to:

• Bounce back
• Take on difficult challenges and still find meaning in life
• Respond positively to difficult situations
• Rise above adversity
• Cope when things look bleak
• Tap into hope
• Transform unfavorable situations into wisdom, insight, and compassion
• Endure

Resilience refers to the ability of an individual, family, organization, or community to cope with adversity and adapt to challenges or change. It is an ongoing process that requires time and effort and engages people in taking a number of steps to enhance their response to adverse circumstances. Resilience implies that after an event, a person or community may not only be able to cope and recover, but also change to reflect different priorities arising from the experience and prepare for the next stressful situation.

• Resilience is the most important defense people have against stress.
• It is important to build and foster resilience to be ready for future challenges.
• Resilience will enable the development of a reservoir of internal resources to draw upon during stressful situations.

Research (Aguirre, 2007; American Psychological Association, 2006; Bonanno, 2004) has shown that resilience is ordinary, not extraordinary, and that people regularly demonstrate being resilient.

• Resilience is not a trait that people either have or do not have.
• Resilience involves behaviors, thoughts, and actions that can be learned and developed in anyone.
• Resilience is tremendously influenced by a person’s environment.

Resilience changes over time. It fluctuates depending on how much a person nurtures internal resources or coping strategies. Some people are more resilient in work life, while others exhibit more resilience in their personal relationships. People can build resilience and promote the foundations of resilience in any aspect of life they choose.

What Is Individual or Personal Resilience?

Individual resilience is a person’s ability to positively cope after failures, setbacks, and losses. Developing resilience is a personal journey. Individuals do not react the same way to traumatic or stressful life events. An approach to building resilience that works for one person might not work for another. People use varying strategies to build their resilience. Because resilience can be learned, it can be strengthened. Personal resilience is related to many factors including individual health and well-being, individual aspects, life history and experience, and social support.

Along with the factors listed above, there are several attributes that have been correlated with building and promoting resilience.

The American Psychological Association reports the following attributes regarding resilience:

• The capacity to make and carry out realistic plans
• Communication and problem-solving skills
• A positive or optimistic view of life
• Confidence in personal strengths and abilities
• The capacity to manage strong feelings, emotions, and impulses

What Is Family Resilience?

Family resilience is the coping process in the family as a functional unit. Crisis events and persistent stressors affect the whole family, posing risks not only for individual dysfunction, but also for relational conflict and family breakdown. Family processes mediate the impact of stress for all of its members and relationships, and the protective processes in place foster resilience by buffering stress and facilitating adaptation to current and future events. Following are the three key factors in family resilience (Wilson & Ferch, 2005):

• Family belief systems foster resilience by making meaning in adversity, creating a sense of coherence, and providing a positive outlook.
• Family organization promotes resilience by facilitating flexibility, capacity to adapt, connectedness and cohesion, emotional and structural bonding, and accessibility to resources.
• Family communication enhances resilience by engaging clear communication, open and emotional expressions, trust and collaborative problem solving, and conflict management.

What Is Organizational Resilience?

Organizational resilience is the ability and capacity of a workplace to withstand potential significant economic times, systemic risk, or systemic disruptions by adapting, recovering, or resisting being affected and resuming core operations or continuing to provide an acceptable level of functioning and structure.

• A resilient workforce and organization is important during major decisions or business changes.
• Companies and organizations, like individuals, need to be able to rebound from potentially disastrous changes.
• The challenge for the incorporation of resilience into a workplace is to identify what enhances the ability of an organization to rebound effectively.

Measuring workplace resilience involves identifying and evaluating the following:

• Past and present mitigative mechanisms and practices that increase safety
• Past and present mitigative mechanisms and practices that decrease error
• Necessary redundancy in systems
• Planning and programming that demonstrate collective mindfulness
• Anticipation of potential trouble and solutions to potential problems

(Adapted from Wilson & Ferch, 2005)

What Is Community Resilience?

Community resilience is the individual and collective capacity to respond to adversity and change. It is a community that takes intentional action to enhance the personal and collective capacity of its citizens and institutions to respond to and influence the course of social and economic change. For a community to be resilient, its members must put into practice early and effective actions so that they can respond to change. When responding to stressful events, a resilient community will be able to strengthen community bonds, resources, and the capacity to cope. Systems involved with building and maintaining community resilience must work together.

How Does Culture Influence Resilience?

Cultural resilience refers to a culture’s capacity to maintain and develop cultural identity and critical cultural knowledge and practices. Along with an entire culture fostering resilience, the interaction of culture and resilience for an individual also is important. An individual’s culture will have an impact on how the person communicates feelings and copes with adversity. Cultural parameters are often embedded deep in an individual. A person’s cultural background may influence one deeply in how one responds to different stressors. Assimilation could be a factor in cultural resilience, as it could be a positive way for a person to manage his/her environment. However, assimilation could create conflict between generations, so it could be seen as positive or negative depending on the individual and culture. Because of this, coping strategies are going to be different. With growing cultural diversity, the public has greater access to a number of different approaches to building resilience. It is something that can be built using approaches that make sense within each culture and tailored to each individual.

What Factors Promote Resilience?

Resilience involves the modification of a person’s response to a potentially risky situation. People who are resilient are able to maintain high self-esteem and self-efficacy in spite of the challenges they face. By fostering resilience, people are building psychological defenses against stress. The more resources and defenses available during a time of struggle, the better able to cope and bounce back from adverse circumstances people will be. A person’s ability to regain a sense of normalcy or define a new normalcy after adverse circumstances will be partially based on the resources available to him/her. Resilience building can begin at any time. Following is information regarding applicable ways to implement resilience practices, as well as situations that could inhibit resilience, situations that enhance resilience, and people who help facilitate the growth of resilience.
Resilience

(Adapted from Kelly, 2007)

How Is Personal Resilience Built?

Developing resilience is a personal journey. People do not react the same way to traumatic events. Some ways to build resilience include the following actions:

• Making connections with others
• Looking for opportunities for self-discovery
• Nurturing a positive view of self
• Accepting that change is a part of living
• Taking decisive actions
• Learning from the past

The ability to be flexible is a great skill to obtain and facilitates resilience growth. Getting help when it is needed is crucial to building resilience. It is important to try to obtain information on resilience from books or other publications, self-help or support groups, and online resources like the ones found in this resource collection.

What Can Be Done to Promote Family Resilience?

Developing family resilience, like individual resilience, is different for every family. The important idea to keep in mind is that an underlying stronghold of family resilience is cohesion, a sense of belonging, and communication. It is important for a family to feel that when their world is unstable they have each other. This sense of bonding and trust is what fuels a family’s ability to be resilient. Families that learn how to cope with challenges and meet individual needs are more resilient to stress and crisis. Healthy families solve problems with cooperation, creative brainstorming, openness to others, and emphasis on the role of social support and connectedness (versus isolation) in family resiliency. Resilience is exercised when family members demonstrate behaviors such as confidence, hard work, cooperation, and forgiveness. These are factors that help families withstand stressors throughout the family life cycle.

How Is Community Resilience Fostered?

Fostering community resilience will greatly depend on the community itself and involves the community working as a whole toward preparedness. It is the capacity for the collective to take preemptive action toward preparedness. Community resilience involves the following factors:

• Connection and caring
• Collective resources
• Critical analysis of the community
• Skill building for community members
• Prevention, preparedness, and response to stressful events

Resilience is exercised when community members demonstrate behaviors such as confidence, hard work, cooperation, and resourcefulness, and support of those who have needs during particular events. These are factors that help communities withstand challenging circumstances. There are other tips about how to foster community resilience in this resource collection.

Developing resilience is a personal journey. All people do not react the same to traumatic and stressful life events. An approach to building resilience that works for one person might not work for another. People use varying strategies. Resilience involves maintaining flexibility and balance in life during stressful circumstances and traumatic events. Being resilient does not mean that a person does not experience difficulty or distress. Emotional pain and sadness are common in people who have suffered major adversity or trauma in their lives. Stress can be dealt with proactively by building resilience to prepare for stressful circumstances, while learning how to recognize symptoms of stress. Fostering resilience or the ability to bounce back from a stressful situation is a proactive mechanism to managing stress.

Coping With Stress

After experiencing an event that is especially frightening—including personal or environmental disasters, or being threatened with an assault—people sometimes have a strong and lingering reaction to stress. Getting the right care and support can put problems in perspective and help stressful feelings and symptoms subside.

Everyone—adults, teens, and even children—experiences stress at times. Stress can be beneficial by helping people develop the skills they need to cope with and adapt to new and potentially threatening situations throughout life. However, the beneficial aspects of stress diminish when it is severe enough to overwhelm a person’s ability to cope effectively.

Sometimes after experiencing a traumatic event that is especially frightening—including personal or environmental disasters, or being threatened with an assault—people have a strong and lingering reaction to stress. Strong emotions, jitters, and sadness or depression may all be part of this normal and temporary reaction to the stress of an overwhelming event. But when the symptoms of stress are intense or last too long, it can cause people to feel overwhelmed and reduce their ability to cope.

Common reactions to a stressful event can include:

• Disbelief and shock
• Tension and irritability
• Fear and anxiety about the future
• Difficulty making decisions
• Feeling numb
• Losing interest in usual activities
• Loss of appetite
• Nightmares and reoccurring thoughts about the event
• Anger
• Increased use of alcohol and drugs
• Sadness and depression
• Feeling powerless
• Crying
• Sleep difficulties
• Headaches, back pains, and stomach problems
• Difficulty concentrating

Feeling emotional and nervous or having trouble sleeping and eating can all be normal reactions to stress.

Getting the right care and support can put problems in perspective and help stressful feelings and symptoms subside in a few days or weeks.

Here are some tips for getting the right care and support in difficult times.

• Avoid drugs and alcohol. Drugs and alcohol may seem to help with the stress temporarily; in the long run they create additional problems that compound the stress you are already feeling.
• Find support. Ask for help from a parent, friend, counselor, doctor, or pastor. Talk with them about the stress you feel and problems you face.
• Take care of yourself.
  • Eat a healthy, well-balanced diet
  • Exercise on a regular basis
  • Get plenty of sleep
  • Give yourself a break if you feel stressed out

Sidebar: Stress is a condition that is often characterized by symptoms of physical or emotional tension. It is a reaction to a situation where a person feels threatened or anxious. Stress can be positive (e.g., preparing for a wedding) or negative (e.g., dealing with a natural disaster).

Tips for Coping With Stress

Mass tragedies, including school shootings, workplace violence, and community violence affect different people in different ways. People exposed to these events can experience physical reactions, such as increased heart rate and difficulty breathing, as well as emotional reactions, such as frightening thoughts and painful feelings. Common responses can include:

• Feeling a sense of loss, sadness, frustration, helplessness, or emotional numbness
• Having nightmares or difficulty falling or staying asleep
• Avoiding things that remind you of the event
• Having no desire for food or a loss of appetite
• Having difficulty concentrating
• Feeling nervous or on edge
• Feeling irritable or crying easily

If you or someone you know experiences any of these feelings after a traumatic event, get support from your family, friends co-workers, and others who offer support. Talk with others about your feelings and take care of yourself by sticking to your normal routine. Avoid using alcohol and drugs. Staying active, helping other people, or volunteering in your community can also help you feel better.

Keep in mind that returning to the way you felt before the event may take some time. Helping and healing can begin at the time of the event but may need to continue over a period of time. If problems continue or you have trouble managing your feelings, talk to a psychologist, social worker, or professional counselor.