Controlling Stress to Prevent Stroke

Can preventing or managing stress lower my risk of stroke?

How you perceive a potentially stressful situation and how you respond to it, both emotionally and physically, determines how stress affects your health. It is impossible to completely avoid or eliminate stress in your life, and some stress is actually good for you, helping you to meet a challenging deadline or even avoid a falling object. It is the frequent or chronic stress that takes its toll on your health. This is why learning to cope with stress is more important than trying to prevent it altogether.

The strategies you use to manage your physical and behavioral response to stress—like exercising, relaxing, good nutrition, and not smoking—can have a lasting benefit on your overall health. A 7-year study of more than 20,000 adults (57% were women) found that those who adapted better to stressful events had a lower risk of stroke than those who had a harder time adapting, suggesting that the better you're able to manage your response to stress, the more your health will benefit.¹⁶

How can I manage my stress?

There are a variety of ways to reduce and manage your physical and emotional response to stress:

Identify your stressors—The first step in learning how best to manage your stress is to identify the major sources of stress in your life, when they tend to happen, and how you react to each stressor. You can try keeping a stress diary in which you write down situations where you've felt stressed, the circumstances leading to them, and how your responded.

Recognize stress you can control and can't control—Ask yourself if this is a stressor you can avoid, such as turning the TV news off if it's only making you anxious. If you're stressed about something out of your control, such as a natural disaster or an act of terrorism, change how you react to it by finding healthy and positive ways of coping with it physically and emotionally, including educating yourself about the current situation and making plans on what precautions you can take.

Exercise—Healthy exercise, such as walking, is the natural stress reliever; it reduces the amount of stress hormones that your body releases in response to stressful situations. Exercise can help you relax and improve your sleep, especially when done 3 to 6 hours before bedtime to allow your body enough time to cool down and relax.

Relaxation—Relaxation exercises involve the flexing and releasing of major muscle groups. Breathing exercises in which you consciously slow and deepen your breathing to help you relax also helps to reduce stress. Start by taking a deep breath and releasing it as you count to 10.

Sleep—You should try to get 6 to 8 hours of sleep a night. Lack of sleep can increase the level of stress hormones.

Healthy diet—Good nutrition can help you deal with the effects of stress.

Social support—Finding social support either from friends and family or through a support group can be helpful. People with good social support report less stress compared to those without a good support network.

Time to yourself—Women tend to put others before themselves. Remember to make some time for yourself, especially when you're feeling stressed, to relax and replenish energy. Learn to say "No," even if only to take enough time off for a long, hot bath.

Avoid unhealthy response to stress—Abusing alcohol, tobacco, or food doesn't help with stress; it only makes it worse.

Counseling—If you need further help dealing with stress, consider counseling (individually or in group therapy) to learn how to reduce your stress symptoms and improve your health.

For More Information

Medline Plus - Managing Stress
www.nlm.nih.gov/medlineplus/tutorials/managingstress/htm/index.htm

American Heart Association – How Can I Manage Stress?
www.americanheart.org/downloadable/heart/110167971464923%20HowCanIManageStress.pdf

References

1. Surtees PG, Wainwright NWJ, Luben RN, Wareham NJ, Bingham SA, Khaw KT. Psychological distress, major depressive disorder, and risk of stroke. Neurology. March 4, 2008;70(10):788-794.
2. McEwen BS. Protective and Damaging Effects of Stress Mediators. N Engl J Med. January 15, 1998;338(3):171-179.
3. Matthews KA, Owens JF, Kuller LH, Sutton-Tyrrell K, Lassila HC, Wolfson SK. Stress-Induced Pulse Pressure Change Predicts Women's Carotid Atherosclerosis. Stroke. August 1, 1998;29(8):1525-1530.
4. Paterniti S, Zureik M, Ducimetiere P, Touboul P-J, Feve J-M, Alperovitch A. Sustained Anxiety and 4-Year Progression of Carotid Atherosclerosis. Arterioscler Thromb Vasc Biol. January 1, 2001;21(1):136-141.
5. Everson SA, Lynch JW, Kaplan GA, et al. Stress-Induced Blood Pressure Reactivity and Incident Stroke in Middle-Aged Men Editorial Comment : Something Old and Something New. Stroke. June 1, 2001;32(6):1263-1270.
6. Reich R, Nussbaum K. Working Women Count! A Report to the Nation: US Department of Labor - Women's Bureau; 1994.
7. Hellerstedt WL, Jeffery RW. The association of job strain and health behaviours in men and women. Int J Epidemiol. June 1, 1997;26(3):575-583.
8. Laflamme N, Brisson C, Moisan J, Milot A, Masse B, Vezina M. Job strain and ambulatory blood pressure among female white-collar workers. Scand J Work Environ Health. Oct 1998;24(5):334-343.
9. Gallo WT, Bradley EH, Falba TA, et al. Involuntary job loss as a risk factor for subsequent myocardial infarction and stroke: Findings from The Health and Retirement Survey. Am J Ind Med. 2004;45(5):408-416.
10. Lundberg U, Frankenhaeuser M. Stress and workload of men and women in high-ranking positions. J Occup Health Psychol. 1999;4(2):142-151.
11. Brisson C, Laflamme N, Moisan J, Milot A, Masse B, Vezina M. Effect of Family Responsibilities and Job Strain on Ambulatory Blood Pressure Among White-Collar Women. Psychosom Med. March 1, 1999;61(2):205-213.
12. Haynes SG, Feinleib M. Women, work and coronary heart disease: prospective findings from the Framingham heart study. Am J Public Health. February 1, 1980;70(2):133-141.
13. Brown DE, James GD, Mills PS. Occupational Differences in Job Strain and Physiological Stress: Female Nurses and School Teachers in Hawaii. Psychosom Med. July 1, 2006;68(4):524-530.
14. Engström G, Khan FA, Zia E, et al. Marital Dissolution Is Followed by an Increased Incidence of Stroke. Cerebrovasc Dis. 2004;18(4):318-324.
15. Stewart J, and the Social Environment working group. Economic Status. John D. and Catherine T. MacArthur Research Network on Socioeconomic Status and Health [December 2002; http://www.macses.ucsf.edu/Research/Social%20Environment/notebook/economic.html. Accessed April 28, 2008.
16. Surtees PG, Wainwright NWJ, Luben RL, Wareham NJ, Bingham SA, Khaw K-T. Adaptation to Social Adversity Is Associated With Stroke Incidence: Evidence From the EPIC-Norfolk Prospective Cohort Study. Stroke. May 1, 2007;38(5):1447-1453.