Relaxing in today’s stressful world

EARLIER THIS week, a 22-year-old nursing graduate was brought by her worried parents to our clinic for recurrent episodes of chest pains, palpitations, general numbness of the body and shortness of breath. On one occasion, her extremities became stiff and her parents thought she was having a seizure.

After doing the preliminary evaluation, we didn’t think it was necessary to proceed with further laboratory tests since it was quite obvious that her symptoms were mainly anxiety-related. From time to time during her medical interview and physical examination, she also showed rapid and shallow breathing which intensified her symptoms. She was suffering from Hyperventilation Syndrome or HS, which is actually a manifestation of a panic or anxiety disorder.

HS can actually mimic a myriad of heart, lungs and nerve disorder. Some of these patients are even admitted to intensive care units when the admitting physician would rather err on the safe side while waiting for the results of laboratory exams.

Psychological in nature

Since HS is mainly psychological in origin, some call it behavioral breathlessness or psychogenic dyspnea which means that the seeming difficulty of breathing is just anxiety-induced. Hyperventilation or fast, shallow breathing is considered as the consequence, rather than as the cause of the condition.

HS can actually be a presentation of panic disorder, and their symptoms may overlap considerably. Around half of patients with panic disorder manifest hyperventilation as part of their symptom presentation.

Patients with HS and panic disorder have a lower threshold for the fight or flight response, which is the natural response to any form of severe stress. Individuals may differ in their response to stress. In stress-susceptible patients, even minor causes of stress can trigger the syndrome. On the other hand, some can handle even severe forms of stress quite well without any evidence of “distress” in their body. The initiating stress stimulus may be the same or similar in different individuals, but their respective responses to the stressor may be expressed differently.

Aside from the physical symptoms, mental symptoms that would indicate that one’s stress is getting the better part of him or her include constant worrying, difficulty in concentrating and making decisions, forgetfulness, lack of creativity, and loss of sense of humor.

Emotional symptoms are anger even over trivial matters, anxiety, depression, feeling powerless, mood swings, irritability and negative thinking. Behavioral signs include bossiness, compulsive eating, critical attitude of others, impulsive decisions, explosive actions, and increased use of alcohol or drugs.

Our nurse-patient was apparently stressed by her not being able to land a job since she passed the nursing board exams two years ago. Apparently, she’s under pressure because being the eldest in the family, she was expected to help out in the schooling of her younger siblings. We reminded her that if she remained like that, all the more would she not be able to find a job.

Skill of relaxation

In today’s world, one should learn the skill of relaxation or calming one’s body and mind. Experts say that relaxing is a learned skill, and for it to be effective, one must make a commitment to practice it regularly. Sitting back and being quiet do not necessarily lead to relaxation. One must regularly initiate an active process involving techniques that calm one’s body and mind. True relaxation involves being sensitive to one’s response to stressors, and one’s basic needs for peace, self-awareness and thoughtful reflection.

Experts recommend the following simple techniques. This may take around 15 minutes, but it’s time well spent to get one on the healthy track.

1. Relaxing breathing. This can be an instant natural tranquilizer when one is anxious or under severe stress. One should imagine a spot just below one’s navel. He should breathe into that spot quickly through the nose, filling the abdomen with air. The air should fill one’s chest from the abdomen up, then gradually exhale through pursed lips, like slowly deflating a balloon.

2. Progressive muscle relaxation. One sits in a quiet corner and focuses on one’s thoughts and breathing. He takes a few relaxing breaths as described above. He then mentally scans his body, noticing areas that feel tense or cramped. He releases the tension in these areas. He rotates his head in a slow, smooth, circular motion once or twice. While doing this, he thinks of a happy occasion, person or any thought that brings him happiness and peace of mind. He takes another relaxing breath.

3. Mental imagery relaxation. This provides a “mental escape”—away from it all, when the stress becomes overwhelming. As one relaxes in one’s chair, one fills his mind with all pleasant thoughts visualizing the desired outcome of a stressful event. He visualizes the outcome as if it’s already happening. He does his “self-talk,” with positive affirmations about oneself. This is similar to the internalization being done by artists before a performance.

4. Relax to music. A relaxing, soothing music can complement all relaxation techniques. Some use music with coaching instructions telling one what to do and think of while relaxing.

5. Biofeedback. This may be done through devices which measure temperature, heart rate, muscle tension and other vital signs as a person attempts to relax. Knowing these vital signs teaches one to monitor one’s body as it relaxes. It literally teaches one to gain active control in making the body relax. One can use it to abort migraine headaches, palpitations, and help control elevation of the blood pressure.

One should try to determine which relaxing techniques one finds effective for himself/herself and practice them once or twice daily when under stress, or as a preemptive measure when under stress-provoking situations. This can help anyone relax, and can save several trips to the psychiatrist for psychotherapy.