Stress

Overview

What Is It?

Stressors are the external events, including pressures in people's lives, such as divorce, marriage, children, and work and money pressures. The experience of stress, however, is related to how you respond to these stressors.

Stress can be your friend or your foe. When stress fuels the spark of personal achievement, it can work to your benefit by making you more perceptive and productive, acting as a motivator and even making you more creative. But when stress flames out of control—as it often does for many of us—it can take a terrible toll on your physical and emotional health, as well as your relationships.

While stress is not considered an illness, it can cause specific medical symptoms, sometimes serious enough to send you to the emergency room or your health care professional's office. According to the American Psychological Association's 2010 Stress in America survey, the majority of Americans report living with moderate or high levels of stress. And on average, those who report their health as fair or poor have more stress (an average stress rating of 6.2 on a 10-point scale) compared with those who rate their health as excellent or very good (an average stress rating of 4.9 on a 10-point scale).

In today's fast-paced world, women are experiencing more stress at every stage of their lives than ever before. Juggling job pressures, family schedules, money issues, career and educational advancement and child and elder-care concerns are only a few of the common stressors confronting women.

Stressors are the external events, including pressures in people's lives, such as divorce, marriage, children, work and money. The experience of stress, however, is related to how you respond to these stressors. One person's stressor can be another person's motivator.

You can learn to manage how you respond to stressors through relaxation, meditation, some forms of psychotherapy and exercise, among other methods. However, you can also work to reduce the stressors in your life, such as learning to say no to some commitments, simplifying your life or leaving a bad job or relationship. Sometimes techniques that are originally designed to simply reduce your stress response and improve coping (for example, meditation and psychotherapy) can lead you to choose to reduce the stressors in your life because you begin to see more clearly what needs to change.

Working mothers, regardless of whether they are married or single, face higher stress levels—both in the workplace and at home. The National Institute for Occupational Safety and Health (NIOSH), the US agency responsible for conducting research and making recommendations for the prevention of work-related illness and injury, provides these statistics regarding stress in the workplace:

• 40 percent of workers reported their jobs were very or extremely stressful
• 25 percent view their jobs as the number one stressor in their lives
• 75 percent of employees believe that workers have more on-the-job stress than a generation ago
• 29 percent of workers felt quite a bit or extremely stressed at work
• 26 percent of workers said they were "often or very often burned out or stressed by their work."

Stress has been linked with a variety of physical ailments from headache to depression to symptoms that mimic a heart attack. The balance between stressors and your ability to cope with them, however, can determine your mental health. When the stressors in your life match your coping abilities, you feel stimulated, engaged and appropriately challenged. Too many stressors in your life that overwhelm your attempts to cope can result in depression or anxiety.

Depression can feel like a pervasive sense of hopelessness, a feeling of wanting to give up, tearfulness or a sadness that does not seem to go away after a couple weeks. Anxiety can feel like a chronic state of feeling "keyed up" or "on edge." Some people who are depressed or anxious have physical symptoms, such as changes in sleep or appetite (too much or too little).

Chronic depression and anxiety have been linked to other physical problems, such as cardiovascular disease, chronic pain, hypertension and diabetes. If you notice symptoms of depression or anxiety, it is important to get them treated. Your health care professional or mental health professional can help.

Regardless of your physical or mental symptoms, talk about the stress in your life with your health care professional. A thorough assessment by your health care team will help determine the cause of these symptoms. You may find that stress has triggered an illness, such as high blood pressure.

Stress and Your Body

Research indicates that women's biological response to stress is to "tend and befriend"; this is, make sure the children are safe and then network with other women in stressful times. Men's biological reaction to stress is to go into the "flight-or-fight" mode. Studies indicate that the hormone oxytocin, which has a calming effect, is released during stressful times in both men and women.

Estrogen may enhance oxytocin release, while testosterone may diminish it; this may be one reason that women seem to seek social support more often then men when under stress. However, women have also been socialized from an early age to look to their social group, particularly their female friends, for support when under stress, whereas men tend to engage in activities, such as exercise or even using substances, when under stress.

During stress, hormones including adrenaline and cortisol flood the body, resulting in:

• an increased need for oxygen
• increased heart rate and blood pressure
• constricted blood vessels in the skin
• tensed muscles
• increased blood sugar levels
• increased clotting ability of blood
• spilling of stored fat from cells into the bloodstream
• constriction of bowel and intestinal muscles

All this can strain your heart and artery linings. In fact, if you already have coronary heart disease, stress might lead to chest pain, called angina. Plus, the increased tendency for blood to clot during stress may lead to a clot in your coronary arteries, causing a heart attack.

Other physical dangers of stress include stomach problems as your bowel and intestinal muscles constrict and depression and anxiety. While stress doesn't cause these mental illnesses, it can activate them in people who may already be prone to them.

Stress can also cause what has been termed "toxic weight gain." Cortisol, a hormone released when you're under stress, is an appetite trigger. That's why so many women eat more—and less-than-healthy food—when under a lot of stress. Those extra calories are converted to fat deposits that gravitate to the waistline. These fat deposits, called visceral fat, are associated with life-threatening illnesses such as heart disease, diabetes, high blood pressure, stroke and cancer. Chronically high levels of cortisol may stimulate the fat cells inside the abdomen to fill with more fat. As you age, this expanding waistline can be life threatening.

Too much stress can also affect your immune system, weakening it and making you more susceptible to colds, coughs and infections.

Other symptoms of stress include muscular tension, headaches, gastrointestinal illnesses and sleeping more or less than normal.

Stress Triggers

It is important to distinguish between the acute stress response—when your heart beats faster and your breath comes faster as you get a rush of adrenalin—and the chronic stress response, in which you are continually under stress.

This chronic stress response is the one that causes the most problems as it literally wears out your body functions, leading to disease. That's because our physical stress response was designed for emergency situations, such as fleeing an attacking animal, not for the everyday stressors we experience in modern society.

You may feel stressed in response to external or internal triggers, such as stressors in your life or your own way of relating to yourself. These include:

• trauma or crises
• small daily hassles
• conflicts or unpleasant people
• barriers that prevent you from reaching your goals
• feeling little control over your life
• excessive or impossible demands from others
• noise
• boring or lonely work
• irrational ideas about how things should or must be; perceiving that life is not unfolding as you think it should
• believing you are helpless or can't handle a situation
• drawing faulty conclusions like "they don't like me" or "I'm inferior to them," or having unreasonable fears of dire events such as "I'll be mugged"
• pushing yourself to excel and/or failing to achieve a desired goal
• assigning fault for bad events, for example, placing blame on yourself or on others
• realizing you may have been wrong but wanting to be right
• overreacting to current stress as a result of intense stress years earlier, especially in childhood

Stress is an individualized experience. What may be stressful to you may not affect someone else. Your past experience, other stressors in your life and even heredity can affect what you experience as stressful.

Diagnosis

If you are suffering from stress, you may be experiencing a variety of symptoms that feel severe enough to prompt you to see a health care professional. These include:

• headaches
• frequent upset stomach, indigestion, gas pain, diarrhea or appetite changes
• feeling as though you could cry
• muscular tension
• tightness in your chest and a feeling as though you can't catch your breath
• feeling nervous or sad
• irritability and anger
• having problems at work or in your normal relationships
• sleep disturbance: either insomnia or hypersomnia (inability to sleep or sleeping too much)
• apathy—lack of interest, motivation or energy
• mental or physical fatigue
• frequent illness
• hives or skin rashes
• tooth grinding
• feeling faint or dizzy
• ringing in the ears
• disruptions in your menstrual cycle or unusually severe PMS or menopausal symptoms

There is no specific test to diagnose stress. Typically, your health care professional conducts a variety of tests (which may include a personal and family health history, blood and urine tests and other assessments) to rule out various medical conditions.

Because your symptoms may be similar to those of depression, your health care professional should also evaluate your mental state to determine if you may be suffering from a depressive or anxiety disorder. Symptoms associated with stress, anxiety and sleeplessness, for example, typically subside when the stress triggering them subsides. When these same symptoms are caused by depression or another mood disorder, however, they may not go away without medication or therapy.

If stress is identified as the culprit for your symptoms, you may want to ask your health care professional for stress management strategies and consider ways to control the stressors in your life—before your health is affected.

Treatment

Reducing or eliminating the things that cause stress and changing how you react to it are the safest and most effective ways to treat stress. No single method of stress management is always successful, so you might want to try a variety of approaches. It's also important that you treat any medical symptoms stress exacerbates. However, keep in mind that treating the stress may not cure the medical problem.

Reducing stress can be difficult. Often, people succeed in relieving stress in the short term but return to old stress-producing habits. Plus, personal responsibilities don't alwayslend themselves to stress-reducing tactics. The process of learning to control or redirect stress is lifelong, but working to master it will improve your lifelong health.

Cognitive-behavioral therapy, which helps you substitute desirable responses and behavior patterns for undesirable ones, is one proven way to reduce stress. It is very important that you learn cognitive-behavioral coping skills from a professional. They include:

• Identifying sources of stress. You may want to keep a stress diary in which you record stressful occasions, incidents that triggered anger or anxiety or that caused a physical response like a sour stomach or headache. Jot down the time of day and the circumstances that led to these feelings, then try to identify the types of events or activities that caused them. See if you can alter or avoid these circumstances.
• Restructuring priorities. Examine your priorities and goals to determine which stressful activities or situations you can get rid of. For instance, replace time-consuming chores that aren't really necessary (like ironing) with more pleasurable or interesting activities.
• Find ways to balance the stress inducers you can't eliminate—like unpleasant working conditions, an unhappy family situation or a significant loss—by including stress-reducing activities in your day. Studies have shown that such activities can positively affect your immune system. Making time for recreation and stress reduction is as essential as paying bills or shopping for groceries.
• Adjusting your responses to stress. Because you can't simply wish some stresses away—you can't just quit your job or walk out on your family, for example—you have to learn how to respond to stress to reduce its effects. These include:
  • Discussing your feelings. If you don't discuss your feelings of anger or frustration, you may feel hopeless and depressed. Becoming aware of your feelings can help you assert yourself when it's important. You can do this in a positive way, by writing a letter or calmly discussing your feelings with the other person. Asserting yourself in a negative way (yelling and behaving aggressively, for example) is only counterproductive. It's also important that you learn to listen, empathize and respond to others with understanding. If you can't talk to a trusted friend, try writing in a journal or composing a letter.
  • Keeping your perspective and looking for the positive. Think of the worst possible outcome to a situation that is stressing you and assess the likelihood of it occurring (usually small). Then, envision a positive outcome and develop a plan to achieve that outcome. It's also helpful to remember past situations that initially seemed negative but ended well.
  • Using humor. Stress management experts often recommend that people keep a sense of humor during difficult situations. Laughing releases the tension of pent-up feelings and helps maintain your perspective on the situation.

In addition to cognitive-behavioral methods to approaching stress, learning a relaxation technique—the natural unwinding of the stress response—can also help. A stress management specialist can teach you some relaxation techniques, including:

• Deep breathing. When you're under stress, your breathing becomes shallow and rapid. Taking a deep breath is an effective technique for winding down. Inhale through your nose slowly and deeply to the count of 10, making sure your stomach and abdomen expand but your chest does not rise. Exhale through your nose, also to the count of 10. Concentrate fully on the breathing and counting. Repeat five to 10 times. The goal is to take three inhales and three exhales per minute, for a total of three deep breaths.
• Relax your muscles. Sitting anywhere, even at your desk, relax your shoulders, let your arms drop to your side, rest your hands on top of your thighs, relax your legs, and don't forget your jaw muscles, which often tense with stress. Close your eyes and breathe deeply. You can also do this lying in bed. Beginning with the top of your head and progressing downward, tense and then relax the muscles in your body one by one while maintaining a slow, deep breathing pattern.
• Passive stretches. Allow gravity to help you relax and stretch your muscles. Relax your neck and let your head fall forward to the right. Then let it drop even more as you breathe slowly. Do the same with your shoulders, arms and back.
• Visualization. Remember a relaxing time or place like a lakeside picnic or a beautiful beach scene. Close your eyes for a few minutes and picture it in your mind.
• Meditation. The goal of meditation is to quiet your mind, to relax your thoughts and increase your awareness. Meditation can also reduce your heart rate, blood pressure, adrenaline levels and skin temperature. It involves concentrating on a simple image or sound while sitting in a comfortable position away from distractions. It can involve cultivating an open awareness or a more loving attitude toward yourself and others. Meditation can also help you become more aware of your priorities so you can make more productive choices in your life.
• Electromyographic Biofeedback (EMG). During this totally painless process conducted in a health care professional's office, you learn to reinforce your relaxation skills using methods such as those described earlier. Electromyograph biofeedback measures the electrical activation that signals muscles to contract. Electromyographic biofeedback training helps you relax overly contracted muscle groups to help reduce tension. As training continues, you learn to use the information from the instruments to discriminate between tension and relaxation. By repeating this process, you learn to associate the sound with the relaxed state and to achieve this state of relaxation by yourself without the machine.
• Massage therapy. This approach slows the heart and relaxes the body. Rather than causing drowsiness, however, massage actually increases alertness

Your health care professional will probably discuss other issues with you, such as the necessity of:

• Maintaining healthy habits. People who are coping with chronic stress often resort to unhealthy habits including high-fat and high-salt diets, tobacco use, alcohol abuse and a sedentary lifestyle.
• Avoiding stimulants like tobacco (which contains nicotine) that make you feel calm in the short run, but actually rev up your nervous system. The addictive characteristics of some stimulants like nicotine can leave you anxious until your next fix.
• Getting regular aerobic exercise. Even a brisk walk can reduce levels of stress hormones in your blood. At least 30 minutes a day (or two 15-minute sessions) most days of the week is best, but even three times a week offers benefits. In addition, as you get fitter, your body is better able to withstand stress and your mind to cope with stress and stay on an even, happier keel. Start slowly. Strenuous exercise in people who are not used to it can be very dangerous. You should first discuss any exercise program with your health care professional.
• Strengthening or establishing a support network. Even a pet can help reduce medical problems aggravated by stress. Studies of people who remain happy and healthy despite many life stresses conclude that most have very good social support networks.
• Reducing stress at work. Try establishing a network of friends there, seeking out a sympathetic manager, or schedule daily pleasant activities and physical exercise during free time. For additional support, schedule an appointment with an Employee Assistance Program clinician, if your company offers that benefit. These programs provide professional counselors who can give you and your family confidential assessment and counseling.

Prevention

You can't simply wish away stressful events from your life. The key is to handle the stress appropriately. The following may enhance your ability to manage stressful events in your life:

• Eat a balanced, nutritious diet. General health and stress resistance can be enhanced by eating well and by avoiding alcohol, caffeine, tobacco and junk food.
• Exercise regularly. Exercise promotes emotional well-being as well as physical fitness.
• Schedule your time more effectively using a calendar and to-do lists, prioritizing activities and realizing you can't do everything.
• Learn how to say no to requests that add extra burdens and can wreak havoc on your day.
• Insist on help with regular chores.
• Balance work and play by planning time for hobbies and recreation—activities that relax your mind and temporarily take you away from your stresses. Even diversions like taking a warm shower, going to a movie or taking a walk can help.
• Practice relaxation exercises every day, including visualization, deep muscle relaxation, meditation and deep breathing.
• Rehearse for stressful events. Imagine yourself feeling calm and confident in an anticipated stressful situation. You will be able to relax more easily when the situation arises.
• Let yourself laugh and cry. Laughter makes your muscles go limp and releases tension, so try to keep a sense of humor. Tears can help cleanse the body of substances that accumulate under stress.
• Talk out troubles. It sometimes helps to talk with a friend, relative or spiritual leader. Another person can help you see a problem from a different point of view.
• Help others. Because we concentrate on ourselves when we're distressed, sometimes helping others is the perfect remedy for whatever is troubling us.
• Learn acceptance when a difficult problem is out of your control, which is better than worrying and getting nowhere.
• Develop and maintain a positive attitude. View changes as positive challenges, opportunities or blessings.

You don't need to do all of these. Some may work for some people and others for other people. The key is to use the ones that work for you. Some of these become more effective with practice. If you are feeling especially overwhelmed, seek help. There is no need to suffer and there are trained people out there to help.

Facts to Know

1. According to the American Psychological Association's 2010 Stress in America survey, the majority of Americans report living with moderate or high levels of stress. And on average, those who report their health as fair or poor have more stress in their lives (an average stress rating of 6.2 on a 10-point scale) compared with those who rate their health as excellent or very good (an average stress rating of 4.9 on a 10-point scale).
2. Working mothers, in particular, are among the people most likely to experience stress, particularly when they do not have a lot of support from others.
3. Stress takes a toll on your body. Stress can cause stress hormones such as adrenaline and cortisol to flood your system. These hormones cause your heart rate and blood pressure to rise, your muscles to tense, your blood sugar levels to increase and other physical symptoms.
4. The effects of stress may lead to actual medical illnesses, including heart problems, stomach problems and headaches.
5. While stress doesn't cause mental illnesses like depressive disorders or anxiety disorders, it can lead to feelings of depression and anxiety. It can precipitate mental illnesses in people predisposed to them, particularly if left untreated.
6. Symptoms of stress include irritability, sleep disturbances, appetite changes, muscular tension, apathy, fatigue, headache and frequent illness.
7. Stress can be brought about by external factors such as conflicts in your relationships, job pressures and even traffic. In addition, internal factors—such as a desire for perfection, a feeling of helplessness, blaming yourself for things that are out of your control or intense worry—also cause stress.
8. The ways you react to stressful situations can be relearned. You can use cognitive-behavioral approaches in which you identify sources of stress and work to minimize them and adjust your responses to the stresses you can't eliminate.
9. Relaxation techniques help dispel stress and can cause adrenaline and cortisol levels in your blood to decrease. These techniques include deep breathing, muscle relaxation, stretching, visualization, meditation and biofeedback.
10. A nutritious diet and regular exercise not only prepare your body to withstand the physical effects of stress, but strengthen your mind to cope with stress and stay on an even keel.
11. According to the National Institute for Occupational Safety and Health, the U.S. agency responsible for conducting research and making recommendations for the prevention of work-related illness and injury, 40 percent of workers reported their job was very or extremely stressful.

Questions to Ask

Review the following Questions to Ask about stress so you're prepared to discuss this important health issue with your health care professional.

1. Could I have an underlying medical condition that could be causing my feelings of stress and anxiety?
2. Could some medication I'm taking be causing my feelings of stress and anxiety?
3. Has my stress caused or exacerbated physical or mental illness that needs to be dealt with medically, separately from the stress itself?
4. If the stress is left untreated, what will happen to my mental and physical health?
5. Can you refer me to a mental health professional who can teach me how to best manage and control my stress?
6. Can you teach me relaxation techniques or refer me to someone who can?
7. Can you refer me to an effective stress management class or workshop?
8. How can exercise and adequate sleep help me manage my stress?
9. How can meditation help? Can you teach me this technique or refer me to someone who can?
10. I have an upset stomach/diarrhea/headaches/stiff neck nearly every day. Could this be stress? And if so, what are some of the other signs of stress?
11. What substances should I stay away from if I'm having problems with stress? If alcohol relaxes me, why shouldn't I drink when I feel stressed?
12. What should I do if my stress becomes too overwhelming for me to cope with?

Key Q&A

Lifestyle Tips

1. Eat your way to calm
   In general it's a good idea, but particularly during times of stress, to skip the simple sugars and starches, such as potato chips, cakes and ice cream. According to the APA 2010 Stress in America poll, more than half of Americans (51 percent) reported overeating or eating unhealthy foods in response to stress, and one-third (33 percent) said they eat to manage stress. Seek healthier comfort foods as alternatives, such as nonfat or low-fat yogurt instead of ice cream and carrot sticks or nuts instead of potato chips. And avoid coffee and other caffeinated food and drinks. They not only increase levels of certain stress hormones, they also mimic their effects in the body such as increasing heart rate. Load up on vegetables and other high-fiber foods. Not only do they keep your gastrointestinal tract working during high-stress periods (and help you avoid constipation), but the nutrients they provide lend an extra dollop of protection against chronic stress. Choose complex carbohydrates—oatmeal, whole grains, nuts and beans. Their steady release of sugar keeps your blood sugar levels steady and induces the brain to release more of the mood-enhancing chemical serotonin.
2. Coping with fear and anxiety about war, terrorism and other public threats
   If you're worried about unknown danger, turn it into something known. Educate yourself on the current situation and recommendations from the federal government and public health authorities. Make reasonable plans to take safety precautions, and then think about something else. Leave the television and radio off if they're increasing your anxiety. Get involved in activities that are familiar and rewarding, such as hobbies, yard work, cleaning something, playing a sport or going to the movies. Talk to your friends and family. Plan a weekend getaway. Don't drink or smoke to compensate for anxiety because these activities ultimately do not make stress go away and can damage your health.
3. Try writing out your stress
   If you are under stress or recovering from a traumatic event, could keeping a daily journal help? Studies of college students suggest that it may. Students were told to write of their experiences at college for 20 minutes a total of three times over a two-week period, but half were instructed to write about their deepest feelings and tie them together at the end of the journal entry. The other half simply wrote of their day and what they could do better. After testing, the students who wrote about their deepest feelings had better memory and higher GPAs, both immediately after the experiment and in the subsequent semester, than those who didn't. In addition, the students in the deep feelings writing group who chose to write about a negative event had fewer problems with intrusive, negative thoughts.
4. When both partners are stressed
   Learn to recognize the signs of stress in each other. Don't take everything that either of you say or do too seriously if you're both stressed. Use good-natured humor to relieve the tension. Avoid criticism or negativity. Be flexible. Gentle touching, a mutual foot rub, backrubs or baths are all likely to help. Do stretches that involve two people. Take turns with chores. Plan a strategy for the week, with both of you sharing the load. Be realistic about what you can accomplish, and set priorities. Give each other opportunities to talk and for quiet time. Get enough sleep.
5. Reduce stress at work
   Get enough sleep, exercise regularly and eat nutritional meals to best prepare for coping with work-related stress. Avoid or cut back on alcohol, smoking, caffeine and sugar. Drink water to stay hydrated. Come in a little early and use planning techniques and prioritizing to manage your time. Anticipate that not everything will happen on schedule, and build in buffer time. Delegate if you can. Look for creative ways to solve problems or work around them rather than simply getting angry. Get to know your coworkers a little better. Get up and walk around periodically if you have a desk job. If your job is really not a good match, consider looking for a new one. Sometimes changing the situation is the answer. But consider this as a last resort.
6. Help your child cope with stress
   Manage your own stress, because your child is sensitive to your anxiety. Make time to spend with your child one-on-one, in a quiet environment without distractions. Ask your child to talk to you, and even if the conversation doesn't focus on your child's worries or concerns, listen carefully. Spend time in outdoor or indoor activities with your child. Encourage a regular schedule with enough time for sleep and balanced meals. Teach your child assertiveness and problem-solving techniques to replace too-passive or too-aggressive behavior. Encourage your child to build a network of friends. Make your home a welcoming place.

Organizations and Support

For information and support on coping with Stress, please see the recommended organizations, books and Spanish-language resources listed below.

American Institute of Stress
Website: https://www.stress.org
Address: 124 Park Ave.
Yonkers, NY 10703
Phone: 914-963-1200
Email: stress125@optonline.net

American Psychological Association
Website: https://www.apa.org/
Address: 750 First St., NE
Washington, DC 20002
Hotline: 1-800-374-2721
Phone: 202-336-5500

American Self-Help Group Clearinghouse
Address: 375 E. McFarlan St.
Dover, NJ 07801
Hotline: 1-800-367-6274
Phone: 973-989-1122

Emotions Anonymous
Website: https://www.emotionsanonymous.org
Address: EA International Service Center
P.O. Box 4245
St. Paul, MN 55104
Phone: 651-647-9712
Email: infodf3498fjsd@emotionsanonymous.org

Heal Within, an element of InnerSite, Inc.
Website: https://www.healwithin.com
Address: 208 S. Louise
Glendale, CA 91205
Phone: 818-551-1501
Email: lizab@healwithin.com

Pulmonary Hypertension Association
Website: https://www.phassociation.org
Address: 801 Roeder Road, Suite 400
Silver Spring, MD 20910
Hotline: 1-800-748-7274
Phone: 301-565-3004
Email: adrienne@phassociation.org

Women's Health Initiative (WHI)
Website: https://www.whi.org
Address: 2 Fred Hutchinson Cancer Research Center 1100 Fairview Ave N, M3-A410
PO Box 19024
Seattle, WA 98109
Phone: 800-218-8415
Email: helpdesk@whi.org

Books

10 Steps to Take Charge of Your Emotional Life: Overcoming Anxiety, Distress, and Depression Through Whole-Person Healing
by Eve A. Wood, M.D.

Calm at Work: Breeze Through Your Day Feeling Calm, Relaxed and in Control
by Paul Wilson

The Food and Feelings Workbook: A Full Course Meal on Emotional Health
by Karen R. Koenig

MindWalks: 100 Easy Ways to Relieve Stress, Stay Motivated, & Nourish Your Soul
by Mary H. Frakes

RealAge Makeover: Take Years Off Your Looks and Add Them to Your Life
by Michael F. Roizen

Relaxation and Stress Reduction Workbook
by Martha Davis, Elizabeth Robbins Eshelman, Matthew McKay and Patrick Fanning

Relax: You May Only Have a Few Minutes Left: Using the Power of Humor to Overcome Stress in Your Life and Work
by Loretta LaRoche

The 6 Stress Points in a Woman's Life
by Kevin Leman

Stress: Living and Working in a Changing World
by George Manning, Kent Curtis, and Steve McMillen

Stress Management Sourcebook: Everything You Need to Know
by J. Barton, Phd Cunningham

Take Back Your Life: Smart Ways to Simplify Daily Living
by Odette Pollar

The Women's Concise Guide to Emotional Well-Being
by Karen J. Carlson M.D., Stephanie A. Eisenstat M.D., and Terra Ziporyn Ph.D.

The Worry Cure: Seven Steps to Stop Worry from Stopping You
by Robert L. Leahy

Your Body Speaks Your Mind: Decoding the Emotional, Psychological, and Spiritual Messages That Underlie Illness
by Deb Shapiro

Spanish-language resources

Medline Plus: Stress
Website: https://www.nlm.nih.gov/medlineplus/spanish/stress.html
Address: US National Library of Medicine
8600 Rockville Pike
Bethesda, MD 20894
Email: custserv@nlm.nih.gov

American Academy of Family Physicians
Website: https://es.familydoctor.org/prevencion-y-bienestar/bienestar-emocional/salud-mental/