A Guide to Taming Stress

Key Strategies to Curb Chronic Stress

10/05/17  Portland, Ore.

Taming Stress

By Maya Seaman, illustrations by Michelle Leigh
Published by SagaCity Media and the Center for Women's Health

Stress is poorly defined, but we all know it when we feel it," says Nicole Cirino, a reproductive psychiatrist and director of the Women's Mental Health and Wellness Program at OHSU's Center for Women's Health. "Almost all of the body systems can be affected by stress: the circulatory system, the heart, the blood vessels, our immune system, our lungs, our digestive system, our brain—they all gear up to meet with perceived danger."

Historically, this "perceived danger" meant a threat to our lives (think caveman running from a saber-tooth tiger), and the body's immediate response is to power an escape by releasing cortisol and adrenaline, sending us into fight-or-flight survival mode. But what happens when there's no escaping the sabertooth, and the threat of it pouncing just lingers day and night?

Women face that same kind of tension today, only the tiger now takes the form of alarming headlines about the uncertainty of affordable health care and access to women-specific services, or society's expectation that women flawlessly juggle family, career, and finances, while also maintaining an ideal body. Add common internal stressors like perfectionism, guilt, shame, and intense worry, and you have a recipe for debilitating chronic stress.

Johanna Nesse, a family nurse practitioner at OHSU, thinks this issue comes down to a lack of social power. "Historically, women have not had a lot of control over their lives," says Nesse. "One in four women will experience a rape or an attempted rape in their life, and 22 percent will experience intimate partner violence." In late 2016, she also saw patients with increased worry surrounding the presidential election. "There were practical concerns about continued access to health coverage and to contraception that they can afford," she recalls. "I did have a big rush on IUDs around November and December.

For women balancing family with a full-time job, stress spikes even higher. "Working mothers specifically experience the reported highest levels of stress compared to other populations," says Dr. Cirino. In the United States, we have limited maternal and parental leave options, so women are often responsible for caring for a young child, rejoining the workforce full time, and being financially responsible for their family."

The problem with this accumulation of stress is that the body doesn't always distinguish between life threatening external threat and internal worry. In both cases, its adaptive response is to produce more cortisol, which can lead to serious problems. "When cortisol is chronically elevated, it has adverse effects on your body," explains Dr. Cirino. "It can decrease our immune response so we can get more illnesses, we're more susceptible to infections and cardiovascular conditions, but we're also susceptible to having a mental illness like depression or anxiety."

The good news is that even in the face of overwhelming expectations, uncertainty, and worry, women can make a conscious effort to reduce their stress by making a few simple changes in their daily lives. "Half the battle is recognizing that your poor physical health is related to your stress, and identifying the areas that you do have some control over," says Nesse.


According to Dr. Brian Frank, a family medicine practitioner at OHSU, healthy eating is key to lowering stress levels—especially by avoiding foods that cause cortisol spikes, such as simple sugars and carbohydrates. Instead, set yourself up for success by pre-planning healthful meals. "Keep almonds in your bag, keep out a bowl of fruit or vegetables—just something you can snack on before you're in the moment when you desperately need to grab whatever's there," he says. 

Dr. Frank also suggests adding stress-busting foods high in magnesium and vitamin C, like leafy green vegetables and citrus fruits—but beware of the juice hype. "We somehow got convinced that juicing things is healthy, but what it does is remove all the fiber, which is the more healthful part of the plant, and it just leaves the sugar," he warns. "Eating whole fruits is great;drinking just the juice will cause those sugar spikes."

But however you choose to eat, Dr. Frank says that self-kindness is essential. "A huge contributor to stress is body image and the guilt that comes with categorizing certain foods as 'good' or 'bad'," he says. "As much as possible, try to separate the notion of health from weight—if you can appreciate the joy of eating, it can make mealtime something to look forward to instead of something to stress about."


The linchpin of a good day is often a good night's sleep, but when stressful thoughts encroach upon restful slumber, the effects can snowball. "I think a lot of women get caught in this catch-22 of 'I know I should be sleeping, but mind is racing with all the things I have to do,' so coming into a restful space to sleep is something a lot of women get stuck on," says Dr. Chloe Ackerman, a psychologist at OHSU. In her experience, lack of sleep can lead to fatigue, appetite changes, poor memory, irritability, trouble concentrating, and depression—all things that can compound stress.

Her solution? Treat sleep like a job. "You plan to go to work at 8 a.m. and you're going to clock out at 5 p.m.—you should have sleep and self-care in your schedule the same way you have any other obligation," she says. "If you're not taking care of yourself, then you're not going to be able to take care of anyone else. That's a trap a lot of women fall into—they feel guilty of what they perceive as putting themselves before others." Another solution involves using the bedroom for only sleep and sex, which trains your brain to think of the bedroom as a place to start winding down. (Of course, that requires saying goodnight to TV, social media, and work emails before climbing into bed.)


Running stressExercise is not only a healthy outlet for stress, but also an active treatment," says Dr. Rachel Bengtzen, a sports medicine and emergency medicine physician at OHSU. Her prescription of movement as medicine not only combats the effects of stress and anxiety by promoting a positive feedback loop of endorphins, but reduces heart attack, stroke, depression, and cancer risks. She says women should aim for 30 minutes of moderate exercise most days of the week, at an effort level that meets what she calls the sing-talk-test—if you're out on a jog and can comfortably talk with your running buddy but don't have the breath to sing to them, that's the sweet spot.

Bengtzen also recommends making exercise an obligation. "It starts as a paradigm shift where exercise becomes a mandatory part of the day—it's not optional," she says. "To do that, you have to build it into your activities of daily living." If you're having trouble finding a 30-minurte chunk in your day, she suggests breaking it up with something as simple as parking 15 minutes away from your office and walking the rest of the way, maintaining a sing-talk pace.


It takes a lot more than the occasional massage to fully contend with chronic stress. Dr. Yunpeng Luo, licensed acupuncturist and doctor of oriental medicine at the OHSU Center for Women's Health, believes establishing a mind body connection is the first step to wellness, and recommends his patients incorporate a meditative yoga, qigong, or tai chi practice into their self-care. "I believe stress management is comprehensive—you have to do more than rely on one thing," he says. When combined with acupuncture and Chinese herbal medicine, the benefits of alternative therapies include hormone regulation, decreased stress, and increased mindfulness. 


Humans have the unique ability to stress themselves out using only thoughts. Catastrophizing, worrying, and over-thinking can all lead to an unnecessary bump in cortisol, but practicing mindfulness can help you recognize and move past negative thoughts. "Mindfulness just points to the ability to be present and aware of what's happening both internally and externally in an open and nonjudgmental fashion," explains Kimberly Carson, mindfulness educator and yoga therapist at OHSU. "Part of the mindfulness practice is training ourselves to be aware of our inner dialogue, because certain types of dialogue patterns can stir up the physiology and create a cascade [that triggers a] stress reaction."

Mindfulness practice usually starts with stabilizing the attention through focusing on your breath, or by doing a "body scan," which involves releasing tension in each individual part of your body. When your mind starts to wander, bring your attention back to your breath or any new sensations you feel. With practice, you can learn to ease your reaction to life's stressors and reduce unnecessary cortisol production.

People who practice mindfulness 10-20 minutes a day report decreased stress and increased quality of life, as well as decreased depression and anxiety, improved sleep patterns, and pain reduction. "People also report experiencing relationship improvement," says Carson. "Mindfulness can improve relationship functioning by teaching couples to be more present with themselves as well as with each other."


In this fast-paced, modern world, it's normal to feel worried or panicked from time to time—but severe chronic stress can negatively impact your health in many ways. Luckily, simple tools like sleep hygiene, exercise, and mindfulness can help you shrink that looming saber-tooth tiger down to a sleepy kitten.