Integrative Lifestyle Medicine: Practical Stress Management Strategies for Clinicians and Patients

stress management

Don’t miss our upcoming webinar, “Social Isolation, Occupational Disruption, & Mental Health in COVID-19,” on July 15, 2021, at 5:00 pm Eastern time.

Stress is defined as “any physical, physiological, or psychological force that disturbs equilibrium.”1 Psychological stress may increase due to a personal (or global) healthcare crisis, conflict with others, bankruptcy, marital discord, battle, abuse, and self-doubt. Stress often manifests in physical symptoms, impacting the cardiovascular system, immune system, gastrointestinal system, and cognition.2

Practical Integrative Medicine Stress Management Strategies

The following simple, evidence-based strategies, rooted in integrative medicine, may help your patients (and you) manage stress:

  • Try yoga, tai chi, qigong.3, 4 The MedBridge HEP library includes yoga and tai chi exercises you can assign to patients as part of their treatment plan.
  • Use aromatherapy (such as lavender).5
  • Engage in outdoor physical activities such as walking, hiking, or biking.6
  • Engage in outdoor activities such as gardening.7
  • Participate in hobbies such as reading, pottery, painting, and playing music.8, 9
  • Play with pets.10
  • Get a massage.11
  • Get involved in social activities such as volunteering, coaching, and community dancing.12, 13
  • Listen to music.14, 15
  • Smile and laugh more by watching comedy movies or television shows.16

A Sample Self-Care Strategy for Personal or Clinical Use

Progressive muscle relaxation (PMR) is a widely used self-care technique initially developed by Dr. Edmund Jacobson, MD, PhD, in the 1920s and 1930s. The method may be over 70 years old, but it has plenty of supporting science for a variety of medical conditions.17, 18, 19

To utilize PMR effectively, let’s start by teaching our patients diaphragmatic breathing. The technique, also known as belly breathing, is an effective breathing strategy used in yoga, meditation, tai chi, and qigong. To perform this breathing strategy, have the patient inhale through their nose as if they are trying to smell a flower, then have them breathe out as if they are trying to make the candles on their birthday cake flicker but not blow out.

Let’s go through a brief 10-step PMR routine for patient care:

  1. Start by sitting or lying down.
  2. Gently close your eyes and think about your favorite vacation place or a place of comfort.
  3. Initiate slow diaphragmatic breaths or belly breathing.
  4. Wrinkle your forehead for five seconds and relax with two diaphragmatic breaths.
  5. Frown for five seconds and relax with two diaphragmatic breaths.
  6. Press your lips together for five seconds and relax with two diaphragmatic breaths.
  7. Shrug your shoulder upward for five seconds and relax with two diaphragmatic breaths.
  8. Continue the same progressive tightening and relaxation breathing sequence for your arms, thighs, and calf muscles.
  9. Finally, smile lightly and think about all the positive things in your life.
  10. Slowly open your eyes and enjoy the rest of your day.

Alternatively, you can use this technique just before you drift off to sleep.

Learn more about including stress management into your practice with these resources:

You can also check out these MedBridge courses on managing stress:

  1. Venes, D. (2017). Taber’s Cyclopedic Medical Dictionary, 23rd edition. Philadelphia, PA: F.A. Davis Company.
  2. Yaribeygi, H., Panahi, Y., Sahraei, H., Johnston, T. P., & Sahebkar, A. (2017). The impact of stress on body function: A review. EXCLI Journal, 16, 1057–1072.
  3. Pascoe, M. C., Thompson, D. R., & Ski, C. F. (2017). Yoga, mindfulness-based stress reduction and stress-related physiological measures: a meta-analysis. Psychoneuroendocrinology, 86, 152–168.
  4. Zou, L., Sasaki, J. E., Wei, G. X., Huang, T., Yeung, A. S., Neto, O. B., & Chen, K. W., et al (2018). Effects of mind-body exercises (tai chi/yoga) on heart rate variability parameters and perceived stress: a systematic review with meta-analysis of randomized controlled trials. Journal of Clinical Medicine, 7(11), 404.
  5. Chen, P. J., Chou, C. C., Yang, L., Tsai, Y. L., Chang, Y. C., & Liaw, J. J. (2017). Effects of aromatherapy massage on pregnant women's stress and immune function: a longitudinal, prospective, randomized controlled trial. Journal of Alternative and Complementary Medicine (New York, N.Y.), 23(10), 778–786.
  6. Lawton, E., Brymer, E., Clough, P., & Denovan, A. (2017). The relationship between the physical activity environment, nature relatedness, anxiety, and the psychological well-being benefits of regular exercisers. Frontiers in Psychology, 8, 1058.
  7. Thompson, R. (2018). Gardening for health: a regular dose of gardening. Clinical Medicine (London), 18(3), 201–205.
  8. 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 Medicine, 71(7), 725–732.
  9. Abbing, A., de Sonneville, L., Baars, E., Bourne, D., & Swaab, H. (2019). Anxiety reduction through art therapy in women. Exploring stress regulation and executive functioning as underlying neurocognitive mechanisms. PloS One, 14(12), e0225200.
  10. Pendry, P. & Vandagriff, J. L. (2019). Animal visitation program (AVP) reduces cortisol levels of university students: a randomized controlled trial. AERA Open, 5(2), 233285841985259.
  11. Meier, M., Unternaehrer, E., Dimitroff, S. J., Benz, A. B. E., Benetele, U. U., Schorpp, S. M., & Wenzel, M., et al. (2020). Standardized massage interventions as protocols for the induction of psychophysiological relaxation in the laboratory: a block randomized, controlled trial. Scientific Reports, 10, 14774.
  12. Poulin, M. J. (2014). Volunteering predicts health among those who value others: two national studies. Health Psychology, 33(2), 120–129.
  13. Olvera, A. E. (2013). Cultural dance and health: a review of the literature. American Journal of Health Education, 39(6), 353–359.
  14. Umbrello, M., Sorrenti, T., Mistraletti, G., Formenti, P., Chiumello, D., & Terzoni, S. (2019). Music therapy reduces stress and anxiety in critically ill patients: a systematic review of randomized clinical trials. Minerva Anestesiologica, 85(8), 886–898.
  15. Gallego-Gómez, J. I., Balanza, S., Leal-Llopis, J., García-Méndez, J. A., Oliva-Pérez, J., Doménech-Tortosa, J., & Gómez-Gallego, M., et al. (2020). Effectiveness of music therapy and progressive muscle relaxation in reducing stress before exams and improving academic performance in nursing students: A randomized trial. Nurse Education Today, 84, 104217.
  16. Louie, D., Brook, K., & Frates, E. (2016). The laughter prescription. American Journal of Lifestyle Medicine, 10(4), 262–267.
  17. Liu, K., Chen, Y., Wu, D., Lin, R., Wang, Z., & Pan, L. (2020). Effects of progressive muscle relaxation on anxiety and sleep quality in patients with COVID-19. Complementary Therapies in Clinical Practice, 39, 101132.
  18. Tian, X., Tang, R. Y., Xu, L. L., Xie, W., Chen, H., Pi, Y. P., & Chen, W. Q. (2020). Progressive muscle relaxation is effective in preventing and alleviating of chemotherapy-induced nausea and vomiting among cancer patients: a systematic review of six randomized controlled trials. Supportive Care in Cancer, 28(9), 4051–4058.
  19. Melo-Dias, C., Lopes, R. C., Cardoso, D., Bobrowicz-Campos, E., & Apóstolo, J. (2019). Schizophrenia and Progressive Muscle Relaxation - A systematic review of effectiveness. Heliyon, 5(4), e01484.