A Mayo Clinic Doctor’s Advice: Science-backed Ways to Manage Stress and Anxiety During a Crisis

A five-part series dedicated to workers on the front line.

Dear friends,

At the time of this writing, it seems the entire world is in crisis. Nearly every person from every part of the globe is affected by the COVID-19 virus. For the first time in our collective memories, we are united against one foe:  an invasive virus that crosses all borders.  

The worst of times usually reveals the best in people. Health-care workers around the world are shining examples of courage, dedication, and hope. Every day, in every nation, countless nurses, doctors, health-care staff, and other frontline workers are doing their best to care for patients and save lives. Our hearts and thanks go out to all of them.

During this time period, the stress level is immense. And you don't need to be a first responder or a frontline worker to feel it.

The good news is there are things you can do to offset the effects of stress and reduce anxiety. What follows are some research-backed tactics that will help you stay healthy and manage stress in this time of crisis.

Please take care of yourselves and each other.

In health,

Dr. Bauer

This article is the second installment in a five-part series on boosting immunity and resilience, created by Brent Bauer, MD, Director of Research, Integrative Medicine Program at Mayo Clinic.


Quick ways to manage the effects of stress

Decades of research show that stress triggers or aggravates a wide range of health problems, including compromised immune function, cognitive decline, migraines, cardiovascular disease, and gastrointestinal disorders.1

The following three practices can help you feel less stressed. Incorporating one or more of these techniques into your schedule, even for just a few minutes daily, can help you manage stress.

1. Meditation

Meditation focuses attention on deep, relaxed breathing, with the goal of increasing awareness of the present moment and developing inner peace.2 Research tells us that meditation is remarkably effective for managing stress. It can also improve symptoms in patients with cancer, fibromyalgia, asthma, and hypertension.2 In fact, regular meditation practice literally re-wires your brain by increasing the area of the brain that regulates emotions.3 Individuals who sit quietly in meditation for just one hour weekly report that they are more content and joyful.4 

Scientists have found that meditation induces changes in the body's nervous system that help us move from "fight-or-flight" to "rest-and-digest," a calmer state in which the heart slows and the digestive tract speeds up.2

Three types of mediation are easy to practice at home, work, outside, or whenever you can carve out a few minutes each day.

  • Walking Meditation. This practice focuses the mind deliberately on actions typically done without thinking. Called "kinhin" in the Zen tradition, walking meditation improves a person's ability to focus effectively on the present moment.5 
    • Try it: Find a place where you can take 10-15 steps. Walk slowly and naturally with no exaggerated movements. Concentrate on the soles of your feet. Feel your body weight shift as you step. Relax your arms and focus on your breathing. Practice this short-walking meditation for 10 minutes daily.
  • Transcendental Meditation. A wealth of research supports the idea that transcendental meditation improves health outcomes, including lowering cholesterol, decreasing stress, and lowering blood pressure.6
    • Try it: Sit in a chair or on the floor in loose clothing. Relax your arms and shoulders. Notice your breathing, allowing it to slow gradually. In your mind, repeat your mantra, or use "so, hum": Think "sooo" as you inhale, "hummm" as you exhale. As stray thoughts intrude, gently return your mind to your mantra breathing.
  • Mindfulness Meditation. Deliberately focusing on – and learning to accept – the current moment helps alleviate not just anxiety, but also impacts depression, pain, and helps overcome addictions like smoking.7
    • Try it: Stand on the ground or floor – preferably with bare feet. Breathe with awareness. Close your eyes and bring your attention to your feet. How do they feel pressed against the earth or floor? Notice the textures and sensations in the soles of your feet. Spend several minutes in stillness.1

A Mayo Clinic mind-body counselor offers a brief meditation here.

2. Guided Imagery

Guided imagery has been used as a healing tool by many cultures throughout history. Researchers know that imagery turns on a relaxation response in individuals who feel uncomfortable, stressed, or overwhelmed.2 Using positron emission tomography (PET) scanning, they can show that simply visualizing an image can have the same effect on the brain as experiencing the real thing.2 

Try it:

  1. Relax. Wearing loose clothing, sit or lie in a quiet place and take slow, deep breaths. Clear your mind of random thoughts.
  2. Concentrate. Focus on your breathing. When a disruptive thought enters your mind, accept it and re-focus on your breathing.
  3. Visualize. Now form a mental image, ideally a calm and peaceful setting that you love. Add details to your mental image, such as a warm breeze, gurgling water, or clouds in the sky.
  4. Affirm. By combining a positive message – just a simple word or phrase – with your mental image, you engage both sides of your brain and deepen the experience. It also stores the positive message in your brain so you can recall it easily later.2

 

3. Muscle Relaxation

This simple muscle relaxation exercise is easy to do anywhere. It clears your mind and eases anxious feelings within minutes. It also helps reduce stress and headaches, and lowers blood pressure.9-11

Try it: Sit or lie down in a quiet place where you can be free from interruptions. Wear loose clothing. Beginning with your feet, move up through your body to your head, tensing each muscle group for about five seconds, then relaxing the muscles for 30 seconds. Repeat once, then move to the next muscle group. The session should last about 10 minutes; repeat twice daily for greatest benefit.

Follow this guided progressive muscle relaxation exercise.

You might not be able to clear your mind – but you can focus it.

Mind-wandering is common in each of these quiet practices. But as an unwelcome thought intrudes, simply accept it and return your attention to your breathing. Remind yourself that, in this moment, you are safe and connected to friends and family.

Experiment to see which of the three techniques you most enjoy, and which one provides you with the most stress relief. Taking just 10 minutes of your day to calm and center yourself can reap major benefits in health and wellbeing.

Supplements that manage stress

In addition to practicing stress management tactics, research shows that several nutritional supplements can help manage anxious feelings.   

1. Ashwagandha

In Ayurvedic and Traditional Chinese Medicine, ashwagandha has long been used as an adaptogen. Adaptogenic herbs are believed to increase the body’s resistance to stress by acting as stabilizers or normalizers.11,12 Cortisol is known as the stress hormone because of the role it plays in the body's stress response. If your cortisol level is high, then an adaptogen can help return cortisol to a normal level; and if your cortisol level is normal, an adaptogen can help maintain it.

A recent double-blinded, randomized, and placebo-controlled study examined the stress-reducing effects of ashwagandha root extract. The participants were healthy adults, ages 18-55, and self-identified as being "stressed" on the Perceived Stress Scale (PPS). Sixty male and female participants received either 125-mg or 300-mg capsules of ashwagandha or an identical placebo twice daily for eight weeks.

Significant reductions in PSS scores were recorded in participants taking the ashwagandha supplement. In addition, participants taking the ashwagandha showed a reduction in cortisol levels measured before, during, and after the study.12  Consider an adrenal adaptogen supplement that contains ashwagandha.

2. Hemp

Most people associate hemp with marijuana. And although both are classified as a Cannabis plant, they are used for different reasons. Compounds from industrial hemp, called phytocannabinoids, are used in clothing, paper, nutritional supplements, cosmetics, foods, biofuels, and bioplastics. They have negligible levels of the psychoactive compound tetrahydrocannabinol (THC; less than 0.3 percent by law). Marijuana cultivars, on the other hand, are bred for their THC content and used primarily for recreational and medicinal purposes.

Phytocannabinoids are plant-based, naturally-occurring chemical compounds that influence the system in the body called the endocannabinoid system (ECS). The ECS is involved in multiple physiological processes, including mood, pain sensation, appetite, and memory.

Research is showing that some of the non-psychoactive phytocannabinoids in industrial hemp products support the ECS to promote relaxation.13  Consider a hemp oil supplement that contains a broad spectrum of phytocannabinoids.

During stressful times, it is often difficult to pause and take care of yourself. But that's when it's most important to practice stress management techniques like the ones above. Fitting in a few minutes throughout your day can help. The key is to find something you like and build on it. Brent Bauer, M.D.

 


An important note: No dietary supplement can diagnose, treat, cure or prevent any disease, including COVID-19. With the ongoing COVID-19 pandemic, it is especially important to understand that no dietary supplement, no diet, and no lifestyle modifications – other than the recommended social distancing and hygiene practices – can prevent you from being infected with the COVID-19 virus. No current research supports the use of any dietary supplement to protect you from being infected with the COVID-19 virus.


References

  1. Goldberg S, Tucker R, Greene P, et al. Mindfulness-based interventions for psychiatric disorders: A systematic review and meta-analysis. Clin Psychol Rev 2018;59:52-60.
  2. Yaribeygi H, Panahi Y, Sahraei H, et al. The impact of stress on body function: A review. EXCLI J 2017;16:1057-1072.
  3. Bauer B, Kermott C, Millman M. Mind-body medicine. In: Mayo Clinic: The Integrative Guide to Good Health. Birmingham, AL: Oxmoor House; 2017.
  4. Luders E, Toga A, Lepore N, Gaser C. The underlying anatomical correlates of long-term meditation: Larger hippocampal and frontal volumes of gray matter. Neuroimage 2009;45:672-678.
  5. Fredrickson B, Cohn M, Coffey K, et al. Open hearts build lives: Positive emotions, induced through loving-kindness meditation, build consequential personal resources. J Pers Soc Psychol 2008;95:1045-1062.
  6. Trautwein F, Kanske P, Bockler A, Singer T. Differential benefits of mental training types for attention, compassion, and theory of mind. Cognition 2020;194:104039.
  7. Walton K, Schneider R, Nidich S. Review of controlled research on the transcendental meditation program and cardiovascular disease. Cardiol Rev 2004;12:262-266.
  8. Li Y, Wang R, Tang J, et al. Progressive muscle relaxation improves anxiety and depression of pulmonary arterial hypertension patients. Evid Based Complement Alternat Med 2015; doi.org/10.1155/2015/792895.
  9. Minen M, Adhikari S, Seng E, et al. Smartphone-based migraine behavioral therapy: a single-arm study with assessment of mental health predictors. NPJ Digit 2019;2:46. 
  10. Kep D. The effect of progressive muscle relaxation techniques to decrease blood pressure for patients with hypertension in Mataram. Prim Health Care 2018;8:309. doi: 10.4172/2167-1079.1000309.
  11. Ashwagandha. Natural Medicines Database. https://naturalmedicines.therapeuticresearch.com/ [Accessed March 31, 2020]
  12. Salve J, Pate S, Debnath K, Langade D. Adaptogenic and anxiolytic effects of ashwagandha root extract in healthy adults: A double-blind, randomized, placebo-controlled clinical study. Cureus 2019;11(12):e6466.
  13. Russo E. Taming THC: potential cannabis synergy and phytocannabinoid‐terpenoid entourage effects. Br J Pharmacol 2011;163.7:1344-1364.

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