One of the most challenging problems in dealing with stress and anxiety is a challenge of meeting it head on. When I tell people they need to manage their own stress, it means recognizing the conditions that caused them stress, recognizing that they are in stress, and then taking action to reduce that stress level. You can choose your reaction to mental and psychological stressors. A lot of people view psychological stress as a kind of external thing. But psychological stress doesn’t quite work that way.

All stress is a reaction or response to a particular set of conditions or circumstances. The best example of this is in physiology. If you run or exercise there is an increased demand for energy and oxygen to feed your muscles and circulatory system so your body responds by increasing your heart rate and breathing.  Another example is when someone turns up the thermostat and it gets too hot. You sweat and look for ways to cool yourself.

Psychological stress is both similar and different. When confronted with a threat or stressful situation, your body responds by secreting hormones that trigger your fight or flight response. These get your body ready to deal with that threat-fight or flight, but unlike the physiological example, the mental and psychological stress requires you to step back and evaluate the threat to choose the correct response rather than merely react instinctively. Your mental, emotional and psychological processes are much more complex and nuanced. Sometimes you cannot run or fight, you have to stay put and do your job, and this requires that you understand your own responses to stress.

The most important point here is to remember that stress is a reaction, and to respond to mental/psychological/emotional stresses you can and should choose how to react.

You have probably known people who thrive in one type of environment and struggle in another. The current stay-at-home restrictions are a perfect example. The extrovert who need lots of contact with people are going crazy, while the introverts are perfectly happy not to have social demands on them.  But it requires a certain level of self-knowledge to choose your reactions.

If you are aware of the conditions that cause you to respond with the stress reaction, then you can take some actions to mitigate your stress response. The most effective mitigation tactic is to learn to invoke the relaxation response – a physiologic response that you can control.

And, the best way to do that, is to learn to control your breathing.

There are many examples and strategies on how to do this, probably the best known is the practice of yoga. When doing a difficult yoga pose, the student must learn to focus on their breathing, to “breath through it,” rather than huff and puff frantically until the instructor goes on to the next pose. The sport of biathlon requires athletes to combine cross-country skiing with shooting. After skiing several kilometers, they need to be able to stop, control their breathing, aim a rifle, and shoot at several targets. Besides being physically fit, they must be able to slow their breathing so it does not interfere with their aiming and shooting.

One technique used by Navy SEALs is called four-square breathing. It works by alternately breathing in deeply and holding your breath a moment before breathing out. Once you breathe out, you hold before immediately breathing in again. The idea is to take slower, deeper breaths which tends to relax your muscles and your psyche. If you practice this fairly frequently, you can become good at invoking what is a natural and physiologic relaxation response that counters the stress response.

Follow this pattern of breathing and counting slowly.

  • Four count deep inhale. Say to yourself, “Breathe in, 2, 3, 4.”
  • Four count hold. Say to yourself, “Hold, 2, 3, 4.”
  • Four count exhale. Say to yourself, “Breathe out, 2, 3, 4.”
  • Four count hold. Say to yourself, “Pause, 2, 3, 4.”

Use this tool when you take breaks during your work day (you are taking breaks, right?) It should help with managing your level of stress. Give it a try.


Paul Hammer, MD is a psychiatrist in the Psychiatry & Behavioral Health Department at Island Hospital. He earned his Medical Doctorate from the Uniformed Services University of the Health Sciences, Bethesda, MD. He went on to complete his psychiatry internship at the National Naval Medical Center in Bethesda and his residency at the Naval Medical Center in San Diego, CA. For information or appointments, call Psychiatry & Behavioral Health at (360) 299-4297.

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Published on April 15, 2020