Ten guidelines for a healthy life: Korean Medical Association statement (2017).
December 15, 2017 148 p (in English)

doi: https://doi.org/10.26604/979-11-5590-078-9-93510-8

Managing Stress

Managing Stress

Stress: If you can’t avoid it, tame it!

Summary

◆ Background

Excessive stress is a cause of physical and mental illness, and it reduces our quality of life. Therefore, stress management and coping strategies are essential to improve health in modern society.

◆ Purpose

To help people improve their physical and mental health by providing stress management techniques for everyday life.

◆ Contents

1. The power of positivity: Get rid of stress

How one views stress is important; hence, if it is impossible to change your circumstances, you should change your way of thinking about your circumstances to minimize the adverse effects of stress.

2. Find your own coping strategies for stress

If you can’t avoid stress, you should cope with it by reducing your negative responses to stress through techniques including abdominal breathing, stretching, and meditation.

3. The vitality of your life: Engage in leisure activities at least once per week

Enjoying a hobby in your free time reduces stress; therefore, it helps you maintain emotional stability and improves your quality of life.

◆ Expected impact

To provide people with coping strategies for unavoidable stress in everyday life and to minimize the adverse effects of stress by encouraging people to put these strategies into practice.

Keywords: Stress, Optimism, Happiness, Leisure activity, Exercise

Best practices to follow

1. The power of positivity: Get rid of stress

2. Find your own coping strategies for stress

3. The vitality of your life: Engage in leisure activities at least once per week

Fact Sheet ➊

The power of positivity: Get rid of stress

1.1 Change your way of thinking to reduce stress

Changing your way of thinking under stressful circumstances is not about changing the circumstances themselves, but about changing the way we think about our circumstances. The intensity of human stress is determined not by the circumstances that people face but by their thoughts about their circumstances. With half a glass of water, some would say, “The glass is half empty!” while others would say, “The glass is half full!” People can think from either a negative perspective or a positive perspective in any given circumstance. Furthermore, it is essential to grasp and thoroughly evaluate negative thoughts that are caused by stress, rather than to strive to get rid of such thoughts [1]. Changing excessively negative or absurd thoughts into positive and rational ones is a reliable way to rid oneself of difficult, burdensome emotions.

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1.2 The positive engine of the mind: Improve self-esteem

A simple way to assess the level of your self-esteem is to reflect on your reaction to advice or criticism. If you become hurt or angry when you receive minor advice that a person would normally disregard, your self-esteem is low. The importance of self-esteem lies in the tremendous influence it has on your life, both present and future. Self-esteem is the combination of self-confidence (i.e., confidence that other people regard you favorably), and self-efficacy (i.e., the belief that you have the ability to complete your goals). You might think that your achievements can improve your self-esteem, but it is the other way around; self-esteem is the starting point of all achievements. Solid self-esteem is the cornerstone of successful experiences, and such experiences strengthen your self-esteem. Furthermore, even if you fail sometimes, self-esteem helps you to overcome failure by allowing you to cherish yourself without losing your initiative and courage. Moreover, there are successful people with low self-esteem. They have a false sense of strong self-esteem on the outside; hence, they are always made anxious by the thought that they are not loved by others, and they continue to be anxious even when they accomplish socially-valued achievements, striving to receive personal attention. They are obsessed with power rather than people, and they often cannot bear indifference or criticism from others. Even if it is not a matter of false self-esteem, when one is furious about something minor at a mall or a restaurant and says, for example, “Do you know who I am?” it is highly likely to be because of low self-esteem. In short, a person becomes angry at minor things due to diminished self-confidence and heightened self-anxiety.

There are 2 ways to foster solid self-esteem, just as if you were to engage in muscle training: self-acceptance and positive thinking. Self-esteem is not built by perfection. To thoroughly take care of your responsibilities is a good thing, but obsessive perfectionism is evidence of anxiety about oneself. Self-acceptance is the ability to accept that you and your life are imperfect. Everyone can feel inferior. During your life, you are likely to meet people who are better than you in some particular area. In such cases, you should embrace common sense; as you have your own strengths, that person also has his or her own strengths. This rationalization is self-acceptance. In addition, self-esteem comes from a subjective perspective. When you maintain a positive perspective of yourself through self-acceptance by cherishing your strengths, you will build strong self-esteem.

People often equate stress management with an effort to either reduce or avoid stress, yet neither of those strategies is easy to accomplish. Rather than trying to reduce stress, maintaining strong self-esteem so that we can accept stress as a natural part of our lives is a more effective strategy. Taking seasonal trips can be an effective way to cultivate self-acceptance and positive thinking. When you are able to escape your busy, everyday life and reflect on your life, you will be able to counteract negativity and regain positivity in your life.

Fact Sheet ➋

Find your own coping strategies for stress

2.1 Reduce negative physical and mental stress responses through coping strategies

Excessive stress is a cause of illness, but an appropriate amount of stress is the source of energy you need to improve your quality of life. If you have your own coping strategies for stress, such as meditation, deep breathing, stretching, or music, stress can be your everyday life partner instead of your enemy.

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One of the ways to reduce a negative stress response is meditation, which involves looking at your life and yourself as they are. Meditation practice helps to focus one’s mind on the present by turning the mind’s focus from the outer world to the inner one. In the past, meditation had a religious or philosophical purpose. However, life has become much more complicated since the industrialization of the 1950s. As a solution for life’s problems, meditation has become a common way to relieve the pain of reality on an existential level.

To meditate, start by observing and controlling your breathing through breathing meditation, which refers to focusing on your breathing for 10 minutes, twice a day. In the beginning, you should practice in a quiet, comfortable place, and gradually train yourself to concentrate on breathing anywhere, at any time. Concentration is like a muscle; hence, your ability to concentrate is enhanced by constant practice. According to research, regular 10-minute meditation sessions have the following effects. Among the elderly, systolic blood pressure was found to decrease by 11 mmHg and diastolic blood pressure by 6 mmHg. Additionally, the smoking rate was found to decrease by 13%, and substance abuse was found to decrease. Other reported effects include a 30% lower cholesterol level, social and psychological stress reduction, a 33% lower risk of cardiovascular disease after a year, an 11% decrease in the incidence of stroke or myocardial infarction among the elderly, an increased ability to exercise, and a decrease in the total mortality rate.

2.2 Cope well with anger, a cause of heart disease

Anger management is a difficult task. However, if you suppress anger and keep it in your mind, it will grow like well-fermented, aged kimchi. Hence you need to strive to resolve anger each time it arises. Here are a few basic tips for anger management in everyday life, although they are not magnificent philosophical solutions. First, if you feel angry, you should observe your feelings for a day or so instead of expressing them. When you are in an excited state, you may show an excessively aggressive response. Thus, you may hurt yourself and others involved, or get angry at small things if you immediately express your anger in this state. Research shows that married couples fight more on an empty stomach because people have low blood sugar when they are hungry. In such a case, there is no need to get angry—just having a meal will reduce your anger.

If you are still angry after observing your emotions for a day or more, you should consider whether it is worth expressing your anger with the other party. Expressing anger to another person can also negatively affect one’s own mental state; hence, if that person is not worth your energy, you should express your anger by keeping away from the person or trying not to think about that person. When you act out your anger, you make an effort to hurt the other party as badly as you have suffered. However, your anger can actually make the other person feel more at ease. As acting out your anger is not mature, the other person could rationalize his or her own mistakes by thinking that you pretended to be kindly disposed to them when you really were not.

If it is important to express your anger, you should explain the behavior that upset you to the other party as specifically as possible. Your relationship with the person will not improve if you rudely express your anger by saying, “You’re weird and hopeless,” or, “What is wrong with your family?” without pointing out the specific cause of your anger. Doing so will only hurt yourself more.

Here is an example of a counseling experience. A woman hated that her boyfriend got along well with younger female coworkers. Even though she talked about the issue with her boyfriend many times, she and her boyfriend could not resolve the problem; they fought a lot and they eventually ended up on the brink of a break-up. The psychiatrist recommended that the woman not vaguely talk about the problem with her boyfriend, but specifically write down 2-3 things that bothered her on paper and ask her boyfriend to promise not to do them. An example of such an item was, ‘Unless the meeting is work-related, you should not meet with younger women privately.’ The patient doubted the psychiatrist’s recommendation, but the psychiatrist insisted on it, telling her that it wouldn’t hurt to try since she was thinking about breaking up with her boyfriend anyway. Later, their relationship improved and they remained together. The woman was surprised that her boyfriend listened to her requests; before that, even though she had gotten angry about the same thing a number of times, the boyfriend did not originally understand what she was so angry about. Additionally, keep in mind that when you talk about upsetting things, you should give compliments too; for example, “I really like this about you. But, when you do that, it upsets me.” In this way, you can motivate the other party to change in a positive way by making the person feel good about him or herself. Consequently, a compliment could help increase the person’s self-esteem, which could then encourage the person to become an even better person.

2.3 Cope well with excessive anxiety, the thief of happiness

Anxiety is an emotional response that contributes to survival, but excessive anxiety disrupts one’s life. For example, a student without any anxiety about exams will not get a good test grade. This idea illustrates optimal stress theory. The proper amount of stress makes our brain function most effectively.

However, when anxiety becomes excessive, it impedes cognitive function and makes a person unhappy. Such stress affects the secretion and circulation of digestive juices and the distribution of blood in the vessels, and these factors influence gastrointestinal function. Namely, stress causes epigastric tightening, which leads to sudden indigestion or diarrhea. More specifically, the esophagus, stomach, small intestine, and large intestine regulate themselves through numerous nerves and hormones as they steadily ‘converse’ with the brain. External stimuli such as sight or smell, as well as the functions of the central nervous system, including feelings and thoughts, influence biological processes, including sensation, movement, inflammation, and secretions of the gastrointestinal tract. Furthermore, various stimuli that arise from inside the gastrointestinal tract have an influence on feelings, behaviors, or pain recognition in the central nervous system. Thus, a person’s stomach and large intestine function like a stress litmus test that can warn the body before a person even recognizes stress.

Therefore, if your anxiety is excessive, you should try to reduce it, but reducing anxiety is a harder task than you may think because the mind, which controls emotions, does not respond to self-talk. Thus, no matter how many times you tell yourself not to worry, your efforts may be futile or make you feel even more uneasy.

In order to brush aside the stress that causes you too much anxiety, speaking to yourself is not enough. Instead, letting your heart feel the peace of the moment is the key to doing so. One great way of doing this is to have a face-to-face, warm, empathetic conversation [2]. To see why this is effective, keep in mind that it is not possible to have warm conversations with your friends in the middle of combat. Thus, when you engage in warm, empathetic communication, your mind believes that the war is over, which helps to reduce signs of anxiety. Furthermore, breathing in nature and moving your body can help significantly reduce anxiety. For example, at lunchtime, making time for a 10-minute walk, even if it is short, with a cup of coffee as you look at the sky and your surroundings will help. Obviously, it is not possible to enjoy such relaxation in combat situations. If you relax, your mind becomes less anxious. For the same reason, immersing yourself in cultural activities greatly helps to reduce excessive signs of anxiety.

It is well known that enjoying people, nature, and culture helps reduce signs of anxiety; however, isn’t it the case that the reason we want to live even when we often feel anxious is to enjoy people, nature, and culture? Although it may seem easy, this is a surprisingly hard task. You get used to your work because the neural network of your brain that is related to your work is activated. In a similar manner, you should continuously enjoy people, nature, and culture so that the relaxation circuitry in your brain is able to activate itself. A well-trained person can regain enough energy—the equivalent of the energy from a trip to Jeju Island for 9 nights and 10 days—from a 10-minute walk during lunch.

Fact Sheet ➌

The vitality of your life: Engage in leisure activities at least once per week

3.1 Engage in at least one hobby in your free time

In our life, oil is a necessary commodity. If business activities are the gasoline of life, leisure activities are the lubricant. To illustrate, you need gasoline to start up a car at first; however, lubricant is just as important because the car would break down without it, as its engine would become stiff in the long run. Leisure activities enrich the mind and prevent depression [3]. Etymologically, leisure time means “time for enlightenment through self-cultivation.” The Latin word “licere”, which means “to be free,” evolved into the French word “laisser,” which means “be allowed,” and eventually become today’s English word, “leisure.” The Latin word “licere” also is the source of the modern English words “liberty” and “license” [4]. To be clear, spend at least 1 hour a week engaged in leisure activities, and give yourself the free time necessary for inner satisfaction. Any hobby will suffice.

Leisure time includes physical or mental activities that an individual chooses freely when pursuing the enjoyable aspects of life, including rest, pleasure, satisfaction, and joy. Leisure activities not only reduce mental and physical fatigue and regenerate energy, but also help one find emotional stability by reducing stress, desire, complaints, conflicts, frustration, and emotional anxiety in one’s social life [5]. From a socio-psychological perspective, as opposed to the variety, number, or intensity of the leisure activities you choose, the level of engagement and enjoyment you experience while participating in leisure activities is closely related to one’s quality of life. Therefore, there is no set answer for which leisure activity is best or how long you need to engage in it. Below, we discuss a range of leisure activities, but you should focus on finding the right hobby for you.

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First, physical activities require you to use your body as a form of expression; such activities include playing sports, playing games, and dancing. Second, social activities stem from a motivation for interpersonal interactions and may include events such as picnics, parties, or social gatherings. Third, cultural activities are based on arts and history; this category includes activities involving art, music, theater, and folk traditions. Fourth, nature activities take place outdoors, and the aim of participating in them is to be in contact with the natural world; this category includes fishing, camping, hiking, and learning about nature. Fifth, mental activities may include reading and creativity; the main motivation here is self-expression or intellectual stimulation. Again, any activity is fine. Find a hobby in which you can immerse yourself and enjoy your time.

3.2 To cut down on drinking and smoking, have a hobby

A hobby is both an ‘ability’ and an ‘activity’ that allows you to enjoy nature, arts, and culture. Having a hobby that you are passionate about can become a valuable substitute for other comforts in your life, which makes it easier to quit alcohol and cigarettes; otherwise, you may be likely to go back to drinking and smoking when things get tough, even after you have made intense efforts to quit. Use the energy you spend struggling with alcohol and cigarettes on your hobby instead. You should not use a hobby simply as a means to quit drinking and smoking; instead, engaging in a hobby should be the goal in itself. Exercise should also be an enjoyable hobby and not be considered a chore, because then you are more likely to make it a consistent habit, without getting burned out.

Work, relationships, and the freedom to relax and enjoy a hobby are the 3 elements of happiness, and it is important to have a balance of all 3 elements in your life. During counseling sessions, when a psychiatrist asks patients who feel depressed and lack interest and motivation, “Do you have a hobby?”, even though they have led an exemplary life, many reply, “I don’t know how to have a good time,” or, “I don’t have free time.” They consider work a means of survival, so it is more important than having a hobby. Hence, they have missed the opportunity to acquire the necessary skills to console their minds and to enjoy the beauty of the world. As you get better at your work over time, you also need to have a hobby to foster your ability to enjoy the beauty of the world. When looking up at the blue sky, each person is inspired differently. Sometimes, you may fear that your work might go wrong, but there is no need to worry. When you enjoy yourself, you will be able to work joyfully and succeed in what you do.

3.3 Tips for recharging a tired mind: Disconnect to connect

Burnout syndrome is a state in which the mind is totally exhausted. When a person has burnout syndrome, there are 3 clear problems. First, all motivation is lost. You do not want to work. No matter how hard you try to encourage yourself, you are not motivated. Second, the syndrome causes a low sense of achievement. It is hard for you to feel satisfaction even if you work hard and reach a goal. Third, you experience a notable decline in your ability to empathize with others. Empathy is the ability to console others and to be consoled by others. When you are tired, you are normally reenergized by receiving warm support from others; instead, when affected by burnout syndrome, you may fall into a mental state in which you are not able to accept support, let alone provide it to others.

The stress system in the brain becomes very strongly activated due to the effort it takes to process overflowing amounts of external information; this is the state of the human brain today. If the stress system is constantly activated, and there are no outlets for it to recharge, the brain will become exhausted and burnout will occur. Thus, disconnection training should be done to cut off our brain’s connection to external information for 10 minutes in a day. When you leave the battlefield against external information for a while, your emotional battery has a chance to charge itself fully. Here are some tips on how to disconnect.

1 Breathe deeply 3 times and feel the flow of your breath

After arriving at work, focus on feeling the flow of your breath and pay attention to your mind while your computer is booting up, before a meeting, or while you are waiting for the coffee you ordered.

2 Have a meal and savor it in a quiet place.

Slow eating, in which you feel the color, smell, and movement of a grain of rice, greatly helps to concentrate on the inner world.

3 Take a daily 10-minute walk while contemplating.

When you feel the free movement of your body, the brain releases tension, so you can relax as you reflect on your thoughts.

4 Have a healing conversation with a friend once a week.

A tired and anxious mind has no room for the relaxation you need to reflect. There is no better consolation than having an empathetic conversation.

5 Watch a sad movie or go to an art exhibition once a week.

Stimulating your mind by appreciating something pleasant and fun is a way of changing your mood. If you can mindfully change your emotions often, you will tend to reflect less on the sadness in your life.

6 Read 3 poems a week.

The human mind is moved by metaphor, not logic. Being familiar with metaphor helps you obtain insights into your mind.

7 Leave your smartphone at home and take a day trip by train.

Gazing out a train window has a meditative effect. In doing so, your mind and your ability to reflect will grow.

References

1 

B Fredrickson T Joiner Positive emotions trigger upward spirals toward emotional wellbeing Psychol Sci 2002 13 172 175

2 

D Howe Empathy: What it is and why it matters JK Lee Seoul Forest of Knowledge 2013

3 

Iso-Aholas The social psychology of leisure and recreation Dubuque, Iowa Wm. C. Brown Company Publisher 1980

4 

HB Gwak Leisure cultures Seoul Daewangsa 2005

5 

YC Kwon An introduction to social education Seoul Kyoyookbook 1994

Notes

[1] Contributing associations:

The Korean Academy of Family Medicine

Korean Neuropsychiatric Association

The Korean Society of Neurogastroenterology and Motility