Cognitive-behavioral methods are the most effective ways to reduce stress. They include identifying sources of stress, restructuring priorities, changing one's response to stress, and finding methods for managing and reducing stress.
Identifying Sources of Stress. It is useful to start the process of stress reduction with an informal inventory of daily events and activities. The first step is to keep a diary noting which activities put a strain on energy and time, trigger anger or anxiety, or precipitate a negative physical response (eg., a sour stomach or headache). Positive experiences should also be noted, such as those that are mentally or physically refreshing or produce a sense of accomplishment. While this exercise might itself seem stress producing and yet one more chore, it need not be done in painstaking detail. A few words accompanying a time and date will usually be enough to serve as reminders of significant events or activities. After a week or two, the stressed individual should try to identify two or three events or activities that have been significantly upsetting or overwhelming. Priorities and goals should then be carefully examined. Individuals should question whether the stressful activities meet their own goals or someone else's, whether they have taken on tasks that they can reasonably accomplish, and which tasks are in their control and which ones aren't.

Restructuring Priorities.

The next step is to attempt to shift the balance from stress-producing to stress-reducing activities. A recent study indicated that daily pleasant events have positive effects on the immune system. In fact, adding pleasurable events has more benefit than simply reducing stressful or negative ones. This is important to realize because many difficult stressful situations, such as unpleasant working conditions, an unhappy family situation, or a significant loss, can't simply be rescheduled or wished away. When eliminating the stress is not practical, there may be ways to reduce its impact. If the problem is work-related and it is impossible to change jobs or cut back on hours, consider as many pleasant relief options as possible. Examples include taking long weekends or vacations, sending out resumes or working on transfers within the company, and planning pleasant diversions or physical exercise during lunch hours. If stress at home is the problem, plan times away, even if it is only an hour or two a week. Learn to replace time-consuming chores that aren't really necessary with activities that are pleasurable or interesting. Making time for recreation is as essential as paying bills or shopping for groceries. Many people are afraid of being perceived as selfish if they make decisions that benefit only themselves. The truth is that self-sacrifice may be inappropriate and even damaging if the person making the sacrifice is unhappy, angry, or physically unwell. In most cases, small daily decisions for improvement can accumulate and work to reconstruct a stressed existence into a pleasant and productive one.

Adjusting Responses to Stress.

Many people believe that certain emotional responses to stress, such as the negative and aggressive Type A behavior associated with heart disorders, are innate features of personality. Research has shown, however, that individuals can be taught to change their emotional reactions to stressful events. Given the fixed nature of many major stresses, such as the loss of a loved one, chronic illness, or pressures from work, cognitive behavioral therapy, which teaches new ways of responding to stress, may be the most effective method of permanently reducing its effects.

Discuss Feelings.

The concept of communication and letting your feelings out  has been so excessively promoted and parodied that it has nearly lost its value as good psychologic advice. Nevertheless, feelings of anger or frustration that are not expressed in an acceptable way may lead to hostility, a sense of helplessness, and depression. Expressing feelings does not mean venting frustration on waiters and subordinates, boring friends with emotional minutia, or wallowing in self-pity. In fact, because certain chronically hostile individuals can experience harmful spikes in blood pressure when they are angry, some therapists strongly advise that just talking not venting anger without any progress is the best approach for these people. The primary goal is to explain and assert one's needs to a trusted individual in as positive a way as possible. Direct communication with another person may not even be necessary; writing in a journal or composing a letter that is never mailed may be sufficient. Expressing ones feelings is not enough, however. Learning to listen, empathize, and respond to others with understanding is just as important for maintaining the strong relationships necessary for emotional fulfillment and reduced stress.

Keep Perspective and Look for the Positive.

Reversing negative ideas and learning to focus on positive outcomes helps reduce tension and achieve goals. For example, a person who is alarmed at the prospect of giving a speech should first identify the worst possible outcomes (forgetting the speech, stumbling over words, humiliation, audience contempt) and their likelihood of happening (probably very low or that speaker wouldn't have been selected in the first place). The next step is to envision a favorable result (a well-rounded, articulate presentation with rewarding applause). Then a plan should be developed to achieve the positive outcome (preparing in front of a mirror, using a video camera or tape recorder, relaxation exercises). It is helpful to remember previous situations that initially seemed negative but ended well.

Use Humor.

Keeping a sense of humor during difficult situations is a common recommendation from stress management experts. Laughing releases the tension of pent-up feelings and helps keep perspective. Research has shown that humor is a very effective mechanism for coping with acute stress. It is not uncommon for people to recall laughing intensely even during tragic events, such as the death of a loved one, and to remember this laughter as helping them to endure the emotional pain.

Relaxation Techniques

Since stress is here to stay, everyone needs to develop methods for invoking the relaxation response, the natural unwinding of the stress response. Relaxation lowers blood pressure, respiration, and pulse rates, releases muscle tension, and eases emotional strains. This response is highly individualized, but there are certain approaches that seem to work, including exercise, deep breathing, muscle relaxation, and meditation. No one should expect a total resolution of stress from these approaches, but if done regularly, these programs can be very effective.

Adopting Healthy Habits

People under chronic stress frequently seek relief through drug or alcohol abuse, tobacco use, abnormal eating patterns, or passive activities, such as watching television. The damage these self-destructive habits cause under ordinary circumstances is compounded by the physiologic effects, of stress itself. And, the cycle is self-perpetuating; a sedentary routine, an unhealthy diet, alcohol abuse, and smoking promote heart disease, interfere with sleep patterns, and lead to increased rather than reduced tension levels. Drinking four or five cups of coffee, for example, can cause changes in blood pressure and stress hormone levels similar to those produced by chronic stress. Animal fats, simple sugars, and salt are known contributors to health problems. General health and stress resistance can be enhanced by a diet rich in a variety of whole grains, vegetables, and fruits and by avoiding stresses such as alcohol, caffeine, and tobacco.

Exercise.

Exercise in combination with stress management techniques is extremely important, and for those with heart disease can even reduce significantly the risk for a heart attack. As the body attains fitness its ability to withstand stress is enhanced. The heart and circulation are able to work harder for longer stretches. The muscles, ligaments, bones, and joints become stronger and more flexible. And the mind is often better able to cope with stress and stay on an even, happier keel. Studies show that employees who follow an active lifestyle need fewer sick and disability days than sedentary workers. Usually, a varied exercise regime is more interesting, and thus easier to stick to. Start slowly. Strenuous exercise in people who are not used to it can be very dangerous and any exercise program should be discussed with a physician. In addition, half of all people who begin a vigorous training regime drop out within a year, so the key is to find activities that are exciting, challenging, and satisfying. Signing up for aerobics classes at a gym can help prompt regular exercise. Because it is so natural and convenient, brisk walking is an excellent aerobic exercise. Even short brisk walks can relieve bouts of stress. Swimming is another ideal exercise for many people including pregnant women, individuals with musculoskeletal problems, and those who suffer exercise-induced asthma. Yoga or Tai Chi can be very effective, combining many of the benefits of breathing, muscle relaxation and meditation while toning and stretching the muscles.
As in other areas of stress management, making a plan and executing it successfully develops feelings of mastery and control, which are very beneficial in and of themselves. Start small. Just 10 minutes of exercise three times a week can build a good base for novices. Gradually build up the length of these every-other-day aerobic sessions to 30 minutes or more.

Strengthen or Establish a Support Network

Studies of people who remain happy and healthy despite many life stresses conclude that most have very good networks of social support. One study indicated that support even from strangers reduced blood pressure surges in people undergoing a stressful event. Many studies suggest that having a pet helps reduce medical problems aggravated by stress, including heart disease and high blood pressure.

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