Stress Management

stress-management

Verified by World Mental Healthcare Association

Stress management involves a large number of strategies and resources used to reduce the ill effects of stress. The purpose of stress management is to ensure psychological and physiological well-being and improve everyday functioning.

Subtopics

What Is Stress Management?

Stress is considered a normal human reaction. However, when it gets too intense and persistent it may significantly affect your ability to function every day. Stress management refers to the use of a range of techniques including psychotherapy, medication, and other coping skills to deal with the negative effects of stress and improve everyday functioning.

According to the World Health Organization, psychological stress is one of the most significant health problems in the 21st century. The American Psychological Association (APA) reported that approximately 284 million people worldwide are suffering from stress-related disorders.

Why is stress management important?

Acute and chronic stress can have a major psychological and physiological impact on our health and well-being. They can lead to aggravations of pre-existing or comorbid conditions, alterations in homeostasis, and extreme cases, death.

Research shows that the effects of stress can manifest physically, psychologically, emotionally, and behaviorally 1 Schneiderman, N., Ironson, G., & Siegel, S. D. (2005). Stress and health: psychological, behavioral, and biological determinants. Annual review of clinical psychology1, 607–628. https://doi.org/10.1146/annurev.clinpsy.1.102803.144141 . Thus, we need to adopt measures for stress relief that can help us function in our lives better.

Stress Management Techniques

One of the most commonly used stress management strategies is mindfulness. However, loads of other methods for stress reduction and relaxation exist today.

Let us take a look at some tools for stress management that are generally used by trained professionals:

1. Mindfulness-Based Stress Reduction (MBSR)

Mindfulness-Based Stress Reduction (MBSR) is a model that integrates mindfulness into clinical therapy. It is often known as an amalgamation of eastern and western healing techniques 2 Mindfulness-Based Stress Reduction (MBSR) – ProQuest. (n.d.). Www.proquest.com. Available from: https://www.proquest.com/openview/fef538e3ed2210c1201ef2a946faed43/1?pq-origsite=gscholar&cbl=29080 . MBSR focuses on providing skills centered around moment-focused, non-prejudiced awareness of one’s environment.

It typically entails an intensive 8-week intervention. Some of the techniques used in MBSR include body scan 3 Ussher, M., Spatz, A., Copland, C., Nicolaou, A., Cargill, A., Amini-Tabrizi, N., & McCracken, L. M. (2014). Immediate effects of a brief mindfulness-based body scan on patients with chronic pain. Journal of behavioral medicine37(1), 127–134. https://doi.org/10.1007/s10865-012-9466-5 which involves paying attention to each aspect of your body and autogenic training 4 Ernst, E., & Kanji, N. (2000). Autogenic training for stress and anxiety: a systematic review. Complementary therapies in medicine8(2), 106–110. https://doi.org/10.1054/ctim.2000.0354 which involves repeated visualizations of a certain thing to induce a state of relaxation.

According to a 2021 study 5 Worthen, M., & Cash, E. (2022). Stress Management. In StatPearls. StatPearls Publishing. Available from: https://www.ncbi.nlm.nih.gov/books/NBK513300/ , individuals with greater capacity for mindfulness are healthier and less likely to report complaints related to pain.

2. Cognitive Behavioral Therapy (CBT)

Cognitive behavioral therapy aims at identifying and reducing negative unhelpful thoughts that cause distress. CBT has been proven to be as effective as MBSR for treating self-reported anxiety and is an established method for stress management 6 Granath, J., Ingvarsson, S., von Thiele, U., & Lundberg, U. (2006). Stress management: a randomized study of cognitive behavioural therapy and yoga. Cognitive behaviour therapy35(1), 3–10. https://doi.org/10.1080/16506070500401292 .

In a 2018 study, stress-management-based cognitive-behavioral treatments were found to yield positive results for students suffering from anxiety sensitivity.

Read More About CBT Here

3. Interpersonal Psychotherapy (IPT)

Interpersonal psychotherapy is a short-term therapy that looks at emotional issues as a result of interpersonal relationship factors. IPT was found to be especially useful for the reduction of work-related 7 Schramm, E., Mack, S., Thiel, N., Jenkner, C., Elsaesser, M., & Fangmeier, T. (2020). Interpersonal Psychotherapy vs. Treatment as Usual for Major Depression Related to Work Stress: A Pilot Randomized Controlled Study. Frontiers in psychiatry11, 193. https://doi.org/10.3389/fpsyt.2020.00193 stress.

4. Hypnotherapy

Hypnotherapy is a technique wherein a state of deep relaxation 8 Vickers, A., Zollman, C., & Payne, D. K. (2001). Hypnosis and relaxation therapies. The Western journal of medicine175(4), 269–272. https://doi.org/10.1136/ewjm.175.4.269 is deliberately induced to increase suggestibility and find out the root causes of mental health issues. It is quite effective in reducing stress levels 9 ‌Alizamar, A., Ifdil, I., Fadli, R. P., Erwinda, L., Zola, N., Churnia, E., Bariyyah, K., Refnadi, R., & Rangka, I. B. (2018). The Effectiveness of Hypnotherapy in Reducing Stress Levels. Addictive Disorders & Their Treatment, 17(4), 191–195. https://doi.org/10.1097/adt.0000000000000140 and has proven to be useful in treating acute stress disorder 10 Bryant, R. A., Moulds, M. L., Nixon, R. D., Mastrodomenico, J., Felmingham, K., & Hopwood, S. (2006). Hypnotherapy and cognitive behaviour therapy of acute stress disorder: a 3-year follow-up. Behaviour research and therapy44(9), 1331–1335. https://doi.org/10.1016/j.brat.2005.04.007 when used in conjunction with cognitive behavioral therapy.

5. Relaxation Techniques

Relaxation techniques are the go-to therapy method for reducing the physical symptoms of stress 11 Giardino, N. D., McGrady, A., & Andrasik, P. (2007). Stress management and relaxation therapies for somatic disorders. In P. M. Lehrer, R. L. Woolfolk, & W. E. Sime (Eds.), Principles and practice of stress management (pp. 682–702). The Guilford Press. Available from: https://psycnet.apa.org/record/2007-14796-025 , such as increased blood pressure, headache, and hypertension. Some common relaxation techniques include progressive muscle relaxation 12 Toussaint, L., Nguyen, Q. A., Roettger, C., Dixon, K., Offenbächer, M., Kohls, N., Hirsch, J., & Sirois, F. (2021, July 3). Effectiveness of Progressive Muscle Relaxation, Deep Breathing, and Guided Imagery in Promoting Psychological and Physiological States of Relaxation. Evidence-Based Complementary and Alternative Medicine. Available from: https://www.hindawi.com/journals/ecam/2021/5924040/ , guided imagery, biofeedback-assisted relaxation 13 NCCIH. (2021, June). Relaxation Techniques for Health. NCCIH. Available from: https://www.nccih.nih.gov/health/relaxation-techniques-what-you-need-to-know , etc.

6. Medication

When non-pharmacological methods to manage stress do not work out, the use of medication is imperative. Chronic psychological stress is frequently treated with benzodiazepine, barbiturate, opioid, and cannabinoid-based doctor-prescribed medicinal drugs 14 Van Hedger, K., Bershad, A. K., & de Wit, H. (2017). Pharmacological challenge studies with acute psychosocial stress. Psychoneuroendocrinology85, 123–133. https://doi.org/10.1016/j.psyneuen.2017.08.020 .

Read More About Meditation Here

Stress Management Tips

When faced with a regular stressful situation, most of us try our best to reduce the negative impact that it may have on us by using the resources we have at our disposal 15 Can, Y. S., Iles-Smith, H., Chalabianloo, N., Ekiz, D., Fernández-Álvarez, J., Repetto, C., Riva, G., & Ersoy, C. (2020). How to Relax in Stressful Situations: A Smart Stress Reduction System. Healthcare (Basel, Switzerland)8(2), 100. https://doi.org/10.3390/healthcare8020100 . Some of the methods we employ are positive while others may be quite maladaptive.

Following are some research-backed stress management skills and strategies that can help you navigate day-to-day stress and function optimally:

1. Engage in physical exercise

Physical exercise involves any bodily activity that enhances and maintains physical fitness and overall health and wellness. Exercising outdoors or indoors, especially in groups, can facilitate socialization, group support, emotional resilience, and mental well-being 16 Stults-Kolehmainen, M. A., & Sinha, R. (2014). The effects of stress on physical activity and exercise. Sports medicine (Auckland, N.Z.)44(1), 81–121. https://doi.org/10.1007/s40279-013-0090-5 . A 2014 study found that regular exercisers are more resistant to the emotional effects of acute stress 17 Childs, E., & de Wit, H. (2014). Regular exercise is associated with emotional resilience to acute stress in healthy adults. Frontiers in physiology5, 161. https://doi.org/10.3389/fphys.2014.00161 , which in turn, may protect them against diseases related to chronic stress burden.

2. Practice Yoga

Stress management skills such as Yoga 18 Shohani, M., Badfar, G., Nasirkandy, M. P., Kaikhavani, S., Rahmati, S., Modmeli, Y., Soleymani, A., & Azami, M. (2018). The Effect of Yoga on Stress, Anxiety, and Depression in Women. International journal of preventive medicine9, 21. https://doi.org/10.4103/ijpvm.IJPVM_242_16 , QiGong, and Tai chi, are often inculcated into training routines to induce relaxation, calmness, and strength. These techniques are employed both individually and in groups 19 Büssing, A., Michalsen, A., Khalsa, S. B., Telles, S., & Sherman, K. J. (2012). Effects of yoga on mental and physical health: a short summary of reviews. Evidence-based complementary and alternative medicine : eCAM2012, 165410. https://doi.org/10.1155/2012/165410 to treat chronically ill patients.

Researchers suggest considering yoga as an alternative to medical treatment 20 Woodyard C. (2011). Exploring the therapeutic effects of yoga and its ability to increase quality of life. International journal of yoga4(2), 49–54. https://doi.org/10.4103/0973-6131.85485 for stress-related disorders. Yoga has been proven to foster a greater sense of well-being, increase feelings of relaxation, improve interpersonal relationships, as well as encourage an optimistic outlook on life.

3. Meditate

Meditation is the practice of focusing the mind 21 Sharma H. (2015). Meditation: Process and effects. Ayu36(3), 233–237. https://doi.org/10.4103/0974-8520.182756 to increase attention and awareness and attain a stable state—physically, mentally, and emotionally. It is practiced in a variety of cultures and especially gained a lot of popularity during the COVID-19 pandemic 22 Behan, C. (2020). The benefits of meditation and mindfulness practices during times of crisis such as COVID-19. Irish Journal of Psychological Medicine, 37(4), 256-258. doi:10.1017/ipm.2020.38 .

Research shows that meditation has been widely used in interventions for stress management and psychological well-being 23 Goyal, M., Singh, S., Sibinga, E. M., Gould, N. F., Rowland-Seymour, A., Sharma, R., Berger, Z., Sleicher, D., Maron, D. D., Shihab, H. M., Ranasinghe, P. D., Linn, S., Saha, S., Bass, E. B., & Haythornthwaite, J. A. (2014). Meditation programs for psychological stress and well-being: a systematic review and meta-analysis. JAMA internal medicine174(3), 357–368. https://doi.org/10.1001/jamainternmed.2013.13018 . It is believed to reduce stress, chronic pain, anxiety, and depression.

A 2012 study 24 Innes, K. E., Selfe, T. K., Brown, C. J., Rose, K. M., & Thompson-Heisterman, A. (2012). The effects of meditation on perceived stress and related indices of psychological status and sympathetic activation in persons with Alzheimer’s disease and their caregivers: a pilot study. Evidence-based complementary and alternative medicine : eCAM2012, 927509. https://doi.org/10.1155/2012/927509 also validated the benefits of meditation in reducing stress and improving sleep, mood, and memory among people suffering from chronic neurological disorders such as Alzheimer’s disease (AD).

4. Get a massage

Massage involves the manipulation of the body’s soft tissues to relieve stress or pain. It can either be applied by a masseuse or a self-massaging device. It is useful in reducing hormonal (cortisol, epinephrine, and norepinephrine) as well as physical (heart rate and blood pressure) manifestations of stress 25 Moraska, A., Pollini, R. A., Boulanger, K., Brooks, M. Z., & Teitlebaum, L. (2010). Physiological adjustments to stress measures following massage therapy: a review of the literature. Evidence-based complementary and alternative medicine : eCAM7(4), 409–418. https://doi.org/10.1093/ecam/nen029 . Research 26 Nazari, F., Mirzamohamadi, M., & Yousefi, H. (2015). The effect of massage therapy on occupational stress of Intensive Care Unit nurses. Iranian journal of nursing and midwifery research20(4), 508–515. https://doi.org/10.4103/1735-9066.161001 shows that massage therapy is most effective in relieving occupational stress.

5. Use natural supplements

Some “natural” methods 27 Bystritsky, A., Hovav, S., Sherbourne, C., Stein, M. B., Rose, R. D., Campbell-Sills, L., Golinelli, D., Sullivan, G., Craske, M. G., & Roy-Byrne, P. P. (2012). Use of complementary and alternative medicine in a large sample of anxiety patients. Psychosomatics53(3), 266–272. https://doi.org/10.1016/j.psym.2011.11.009 for stress management include:

  • Dietary stimulants such as caffeine
  • Aromatherapy
  • Complementary and alternative medicines such as Ayurveda and Homeopathy
  • Herbal teas, etc.

However, please consult with your healthcare provider before taking any of these supplements in case of allergies and other issues.

6. Leisure Activities

Engaging in hobbies and pleasurable activities 28 Pressman, S. D., Matthews, K. A., Cohen, S., Martire, L. M., Scheier, M., Baum, A., & Schulz, R. (2009). Association of enjoyable leisure activities with psychological and physical well-being. Psychosomatic medicine71(7), 725–732. https://doi.org/10.1097/PSY.0b013e3181ad7978 has also been linked to reduced stress levels. For example:

  • Listening to music
  • Spending time with friends
  • Reading
  • Creating art
  • Playing games, etc.

Quick Stress Relievers

Most of the strategies mentioned above can help you effectively manage your stress in the long run. However, at certain times we might need to instantly calm ourselves down when situations become too stressful to bear.

Here are some techniques for managing stress in the moment:

  • Use grounding techniques such as the 5-4-3-2-1 method
  • Take deep breaths using methods such as box-breathing, i.e., inhaling, holding, and exhaling your breath at equal intervals
  • Take a brisk walk
  • Take a shower
  • Count backward
  • Do a quick physical exercise, eg. skipping, running, jogging, etc.

Stress Management For Kids

Although stress management for adults is a more widely discussed topic, research has highlighted that school-age children often suffer from high levels of chronic stress 29 Lozada, M., Carro, N., Dʼadamo, P., & Barclay, C. (2014). Stress management in children: a pilot study in 7 to 9 year olds. Journal of developmental and behavioral pediatrics : JDBP35(2), 144–147. https://doi.org/10.1097/DBP.0000000000000026 that can go on to have a severely negative impact on their adult life. Children can experience stress due to many different reasons, including academics, parental conflict, peer bullying, and fights with friends.

A lot of the stress management techniques that are recommended to adults (for example, exercise and mindfulness) can also be used by children. Additionally, here are some steps for parents and caregivers to ensure that children can cope with stressors well:

  • Offer them support and let them know that you are always there to help
  • Monitor their screen time and exposure to media, as these may have adverse effects on their wellbeing
  • Try to encourage them even if they face failures and combat their negative thinking
  • Make sure they are engaged in physical activities and hobbies that give them pleasure
  • Be a role model to them, showing them how to positively manage stressful situations

Benefits Of Stress Management

Stress management techniques can not only help you deal with stressful situations better but also have several other long-term benefits.

Stress management can aid you in:

  1. Maintaining psychological well-being in the long run
  2. Developing life-skills
  3. Managing your anger, mood swings, frustration, etc.
  4. Enhancing your resilience
  5. Building confidence and empathy
  6. Developing sharper survival strategies in challenging situations
  7. Leading a happier and more fulfilling life

Takeaway

Stress is a large parcel of the fast-paced modern age. When ignored and unaddressed, it can lead to severe physiological and psychological disabilities and prevent you from living a fulfilling life. Stress management strategies should be availed to improve well-being and for everyday mindful functioning.

At A Glance

  1. Stress management refers to a wide range of techniques involving therapy, medication, and self-help strategies.
  2. Stress management is important because acute and chronic stress can lead to adverse long-term effects.
  3. Several therapeutic approaches are available for stress management, including mindfulness-based stress reduction, cognitive behavioral therapy, interpersonal therapy, hypnotherapy, etc.
  4. Medications such as benzodiazepines are sometimes recommended to treat severe stress.
  5. Certain coping strategies such as yoga, meditation, massage, and leisure activities can help reduce stress.
  6. Stress management includes the long-term benefits of improved psychological well-being, resilience, increased confidence and empathy, and the ability to lead a more fulfilling life.

Frequently Answered Questions (FAQs)

1. What are the 4 types of stressors?

The four common types of stressors involve time stress, anticipatory stress, situational stress, and encounter stress.

2. How can I avoid stress?

To avoid stress, one should adhere to the “4 As” of stress management: Avoid, Alter, Accept and Adapt.

3. How do I manage stress at work?

Various strategies can be used to deal with stress in the workplace. Some of them include a healthy approach toward work, developing social skills, setting deadlines, and being communicative.

4. How do I manage stress and anxiety?

Stress and related anxiety and depression can be managed with different types of stress management strategies like cognitive therapy, exercise, meditation, body scan, social skill development, and self-help strategies (developing hobbies, journaling, reading, etc.).

5. How does exercise best help manage stress, anxiety, and depression?

Exercise improves body movements and psychological resilience. It also helps facilitate socialization and group support for combating stress and maintaining mental well-being.

6. Is stress positive or negative?

Stress can be positive or negative depending on your situation. Mild amounts of stress caused by positive stressors (such as family events, holidays, etc.) boost creativity and productivity. But, severe stress caused by negative stressors (like grief, trauma, etc.) for a long period can be quite harmful.

References:

  • 1
    Schneiderman, N., Ironson, G., & Siegel, S. D. (2005). Stress and health: psychological, behavioral, and biological determinants. Annual review of clinical psychology1, 607–628. https://doi.org/10.1146/annurev.clinpsy.1.102803.144141
  • 2
    Mindfulness-Based Stress Reduction (MBSR) – ProQuest. (n.d.). Www.proquest.com. Available from: https://www.proquest.com/openview/fef538e3ed2210c1201ef2a946faed43/1?pq-origsite=gscholar&cbl=29080
  • 3
    Ussher, M., Spatz, A., Copland, C., Nicolaou, A., Cargill, A., Amini-Tabrizi, N., & McCracken, L. M. (2014). Immediate effects of a brief mindfulness-based body scan on patients with chronic pain. Journal of behavioral medicine37(1), 127–134. https://doi.org/10.1007/s10865-012-9466-5
  • 4
    Ernst, E., & Kanji, N. (2000). Autogenic training for stress and anxiety: a systematic review. Complementary therapies in medicine8(2), 106–110. https://doi.org/10.1054/ctim.2000.0354
  • 5
    Worthen, M., & Cash, E. (2022). Stress Management. In StatPearls. StatPearls Publishing. Available from: https://www.ncbi.nlm.nih.gov/books/NBK513300/
  • 6
    Granath, J., Ingvarsson, S., von Thiele, U., & Lundberg, U. (2006). Stress management: a randomized study of cognitive behavioural therapy and yoga. Cognitive behaviour therapy35(1), 3–10. https://doi.org/10.1080/16506070500401292
  • 7
    Schramm, E., Mack, S., Thiel, N., Jenkner, C., Elsaesser, M., & Fangmeier, T. (2020). Interpersonal Psychotherapy vs. Treatment as Usual for Major Depression Related to Work Stress: A Pilot Randomized Controlled Study. Frontiers in psychiatry11, 193. https://doi.org/10.3389/fpsyt.2020.00193
  • 8
    Vickers, A., Zollman, C., & Payne, D. K. (2001). Hypnosis and relaxation therapies. The Western journal of medicine175(4), 269–272. https://doi.org/10.1136/ewjm.175.4.269
  • 9
    ‌Alizamar, A., Ifdil, I., Fadli, R. P., Erwinda, L., Zola, N., Churnia, E., Bariyyah, K., Refnadi, R., & Rangka, I. B. (2018). The Effectiveness of Hypnotherapy in Reducing Stress Levels. Addictive Disorders & Their Treatment, 17(4), 191–195. https://doi.org/10.1097/adt.0000000000000140
  • 10
    Bryant, R. A., Moulds, M. L., Nixon, R. D., Mastrodomenico, J., Felmingham, K., & Hopwood, S. (2006). Hypnotherapy and cognitive behaviour therapy of acute stress disorder: a 3-year follow-up. Behaviour research and therapy44(9), 1331–1335. https://doi.org/10.1016/j.brat.2005.04.007
  • 11
    Giardino, N. D., McGrady, A., & Andrasik, P. (2007). Stress management and relaxation therapies for somatic disorders. In P. M. Lehrer, R. L. Woolfolk, & W. E. Sime (Eds.), Principles and practice of stress management (pp. 682–702). The Guilford Press. Available from: https://psycnet.apa.org/record/2007-14796-025
  • 12
    Toussaint, L., Nguyen, Q. A., Roettger, C., Dixon, K., Offenbächer, M., Kohls, N., Hirsch, J., & Sirois, F. (2021, July 3). Effectiveness of Progressive Muscle Relaxation, Deep Breathing, and Guided Imagery in Promoting Psychological and Physiological States of Relaxation. Evidence-Based Complementary and Alternative Medicine. Available from: https://www.hindawi.com/journals/ecam/2021/5924040/
  • 13
    NCCIH. (2021, June). Relaxation Techniques for Health. NCCIH. Available from: https://www.nccih.nih.gov/health/relaxation-techniques-what-you-need-to-know
  • 14
    Van Hedger, K., Bershad, A. K., & de Wit, H. (2017). Pharmacological challenge studies with acute psychosocial stress. Psychoneuroendocrinology85, 123–133. https://doi.org/10.1016/j.psyneuen.2017.08.020
  • 15
    Can, Y. S., Iles-Smith, H., Chalabianloo, N., Ekiz, D., Fernández-Álvarez, J., Repetto, C., Riva, G., & Ersoy, C. (2020). How to Relax in Stressful Situations: A Smart Stress Reduction System. Healthcare (Basel, Switzerland)8(2), 100. https://doi.org/10.3390/healthcare8020100
  • 16
    Stults-Kolehmainen, M. A., & Sinha, R. (2014). The effects of stress on physical activity and exercise. Sports medicine (Auckland, N.Z.)44(1), 81–121. https://doi.org/10.1007/s40279-013-0090-5
  • 17
    Childs, E., & de Wit, H. (2014). Regular exercise is associated with emotional resilience to acute stress in healthy adults. Frontiers in physiology5, 161. https://doi.org/10.3389/fphys.2014.00161
  • 18
    Shohani, M., Badfar, G., Nasirkandy, M. P., Kaikhavani, S., Rahmati, S., Modmeli, Y., Soleymani, A., & Azami, M. (2018). The Effect of Yoga on Stress, Anxiety, and Depression in Women. International journal of preventive medicine9, 21. https://doi.org/10.4103/ijpvm.IJPVM_242_16
  • 19
    Büssing, A., Michalsen, A., Khalsa, S. B., Telles, S., & Sherman, K. J. (2012). Effects of yoga on mental and physical health: a short summary of reviews. Evidence-based complementary and alternative medicine : eCAM2012, 165410. https://doi.org/10.1155/2012/165410
  • 20
    Woodyard C. (2011). Exploring the therapeutic effects of yoga and its ability to increase quality of life. International journal of yoga4(2), 49–54. https://doi.org/10.4103/0973-6131.85485
  • 21
    Sharma H. (2015). Meditation: Process and effects. Ayu36(3), 233–237. https://doi.org/10.4103/0974-8520.182756
  • 22
    Behan, C. (2020). The benefits of meditation and mindfulness practices during times of crisis such as COVID-19. Irish Journal of Psychological Medicine, 37(4), 256-258. doi:10.1017/ipm.2020.38
  • 23
    Goyal, M., Singh, S., Sibinga, E. M., Gould, N. F., Rowland-Seymour, A., Sharma, R., Berger, Z., Sleicher, D., Maron, D. D., Shihab, H. M., Ranasinghe, P. D., Linn, S., Saha, S., Bass, E. B., & Haythornthwaite, J. A. (2014). Meditation programs for psychological stress and well-being: a systematic review and meta-analysis. JAMA internal medicine174(3), 357–368. https://doi.org/10.1001/jamainternmed.2013.13018
  • 24
    Innes, K. E., Selfe, T. K., Brown, C. J., Rose, K. M., & Thompson-Heisterman, A. (2012). The effects of meditation on perceived stress and related indices of psychological status and sympathetic activation in persons with Alzheimer’s disease and their caregivers: a pilot study. Evidence-based complementary and alternative medicine : eCAM2012, 927509. https://doi.org/10.1155/2012/927509
  • 25
    Moraska, A., Pollini, R. A., Boulanger, K., Brooks, M. Z., & Teitlebaum, L. (2010). Physiological adjustments to stress measures following massage therapy: a review of the literature. Evidence-based complementary and alternative medicine : eCAM7(4), 409–418. https://doi.org/10.1093/ecam/nen029
  • 26
    Nazari, F., Mirzamohamadi, M., & Yousefi, H. (2015). The effect of massage therapy on occupational stress of Intensive Care Unit nurses. Iranian journal of nursing and midwifery research20(4), 508–515. https://doi.org/10.4103/1735-9066.161001
  • 27
    Bystritsky, A., Hovav, S., Sherbourne, C., Stein, M. B., Rose, R. D., Campbell-Sills, L., Golinelli, D., Sullivan, G., Craske, M. G., & Roy-Byrne, P. P. (2012). Use of complementary and alternative medicine in a large sample of anxiety patients. Psychosomatics53(3), 266–272. https://doi.org/10.1016/j.psym.2011.11.009
  • 28
    Pressman, S. D., Matthews, K. A., Cohen, S., Martire, L. M., Scheier, M., Baum, A., & Schulz, R. (2009). Association of enjoyable leisure activities with psychological and physical well-being. Psychosomatic medicine71(7), 725–732. https://doi.org/10.1097/PSY.0b013e3181ad7978
  • 29
    Lozada, M., Carro, N., Dʼadamo, P., & Barclay, C. (2014). Stress management in children: a pilot study in 7 to 9 year olds. Journal of developmental and behavioral pediatrics : JDBP35(2), 144–147. https://doi.org/10.1097/DBP.0000000000000026
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