Life never really lets up. Constant change, whether major or minor, can challenge our physical and psychological capacities to adjust. Few things illustrate that better than the current coronavirus pandemic that has upended life everywhere, leaving millions out of work and more than 140,000 people dead in the U.S. But no matter the source of stress or how debilitating it might become, there are proven strategies — based on research, the experiences of ordinary people, and the expertise of mental health professionals — that can help cope with even the most traumatic experiences and translate them into positive growth and even resilience.
Most Stressful Life Changes
In 1967, researchers Thomas Holmes and Richard Rahe combed through more than 5,000 patients' medical records, finding a correlation between stressful life events and illness. The correlation was so strong that they ranked the stressfulness of these events on a 100-point scale that is still used today.
The 10 most stressful life events on the Holmes and Rahe Stress Scale are:
1. Death of a spouse or child: 100
2. Divorce: 73
3. Marital separation: 65
4. Imprisonment: 63
5. Death of a close family member: 63
6. Personal injury or illness: 53
7. Marriage: 50
8. Dismissal from work: 47
9. Marital reconciliation: 45
10. Retirement: 45
According to this system, you can calculate your cumulative stress levels by totaling the point value for every event that's happened to you in the past year. A score of more than 300 indicates an 80% likelihood of illness; 150 to 299, a 50% chance; and less than 150, a 30% probability.
Stress and Trauma
Stress is the common denominator of all of life's challenges. It is our natural emotional response to both positive and negative change, driving us to adapt our thinking and/or behavior as necessary. When too much change happens within a short period of time, however, it can engender feelings of helplessness, low self-esteem, and development of anxiety, depression, or physical illness. Adapting to the new developments can become so stressful that it narrows our ability to think clearly and enjoy life.
One particularly acute stress reaction is trauma, broadly defined by the American Psychological Association as an emotional response to a terrible event. Any event can become traumatic if it elicits intense, even subjective fear for one's life and a sense of helplessness, to which our malleable, "neuroplastic" brains adapt. These brain changes, including overactivity in the fear center and deregulation of areas responsible for memory and emotion, can become ingrained in people who have experienced trauma, preventing them from moving forward. If trauma-related symptoms persist for more than a month and are severe enough to interfere with daily life and relationships, they may be classified as post-traumatic stress disorder. Even without a clinical diagnosis of PTSD, trauma is a debilitating experience, but one that can be overcome by facing the trauma and integrating it into a broader sense of self.
Cope, Don't Avoid
Steering clear of memories and reminders — sometimes called triggers — of stressors may provide immediate relief from anxiety, but in the long term, it reinforces the avoidance, disruptive thoughts, and lack of focus characteristic of PTSD. The more effective approach to managing stress is realizing that you're in control of your life and emotions, a tough sell after experiences of trauma.
Different coping methods work for different people. The best strategy is generally to incorporate many techniques and maintain flexibility for different emotions and situations. Common coping mechanisms include:
- Lowering expectations
- Taking responsibility for the situation
- Challenging previously held beliefs
- Viewing the problem from a religious or spiritual perspective
- Expressing distressing emotions
- Maintaining emotionally supportive relationships
- Asking others for help
When the process of overcoming trauma seems monumental, focus on these minor, positive steps you can take along the way.
Lowering expectations and challenging old beliefs are two coping methods that fall under the wider label of "reframing," a key psychological tactic by which people can steer difficult emotions toward positive outcomes. Perspective and comparisons play an important part in the reframing process, so focusing on the positives of your situation can make a real difference, leading to gratitude and growth. "When life throws something major at you, it's easy to feel like suddenly nothing is going your way," says Adina Mahalli, a certified mental health consultant, family care specialist, and blogger. "In order to face the challenge, don't let your mind turn everything into a disaster. Practice gratitude on the small things in life to help you deal with the actual issue rather than all the little insignificant ones that block your light."
Develop Physical Coping Strategies
Coping strategies can also be more concrete physical activities. Shift your focus away from worries and engage in stress-reducing activities like meditation, sports, vacations, and simple rest periods, which can have a profound effect on the ability to recover from stress and trauma. Some common such tools for reducing stress:
Behavioral activation, a common component in depression and PTSD treatments, is based on the principle that behavior can affect mood. The idea behind this concept is to identify goals that align with the life you want, and then work toward accomplishing those goals when you start to feel anxious or stressed. When someone with PTSD thinks they can't focus on anything but their fear or trauma, intentionally focusing on something else proves them wrong, and the brain readjusts.
Self-monitoring is a concept that many coping techniques use as a starting point. When feeling overwhelmed, breathe deeply and take stock of your senses. One helpful tool for this is biofeedback, which uses therapist-administered technology to measure emotional response indicators such as heart rate and muscle tension. "There's an unrealistic expectation for us to just 'bounce back' after facing adversity," Mahalli says. "Tackling life's unexpected challenges is a lot easier when you recognize that you might need a 'time-out' from reality to just care for yourself."
Self-soothing is the simple act of a task that provides relaxation and involves manipulating bodily signals to the desired effect of relaxation.View a treasured photo, throw a ball for the dog, bask in sunlight, trace fingertips across your own skin — any activity that involves one or more of the five senses with calming associations can qualify as self-soothing.
Deep breathing — alone or as part of exercises like yoga and tai chi — is another proven method for relieving stress. It is easy to learn and deploy in any situation.
Progressive muscle relaxation, or PMR, alternates between tensing and relaxing different muscle groups throughout the body. Relaxing your muscles becomes easier after having gone to the opposite extreme, and signals your mind to relax as well.
Finally, physical exercise and time outdoors are major boosters of mental health. Evidence shows that just a 10-minute walk each day can measurably relieve anxiety and depression, and two hours in nature each week can increase overall happiness.
Many self-monitoring and self-soothing methods double as mindfulness techniques. Anxiety, in its many forms, centers on expectations, and mindfulness helps us shed those expectations to confront emotions and sensory information without judgement or preconceptions.
There's a growing body of data showing the effectiveness of mindfulness-based approaches for reducing stress and treating PTSD. Meditation's effects on the brain appear to counteract the neurological cycle of PTSD by increasing activity in the hippocampus and prefrontal cortex away from the amygdala, the fear center. A functional MRI brain imaging study of Afghanistan veterans with PTSD showed that mindfulness-based exposure therapy led to greater interaction and connectivity between "opposing" brain areas — pivotal to critical problem-solving and the purposeful shifting of attention.
Mindfulness can also help you accept a situation and feel less like it needs to be suppressed or "fixed," which promotes satisfactory coping. For example, jazz musician and writer Adam Cole says a major help in dealing with his mother's death was "the realization that my coping is ongoing. It never stops. I may get better at dealing with it, may know more about it, may have healed and matured, but I will never get over this trauma."
Get a Hold on Time Management
Mindfulness, behavioral activation exercises, and other coping methods work to reduce stress by refocusing on what you can control: First and foremost, your time. Recognizing when you can afford to take a break from daily demands in favor of personal needs and hobbies should be a priority. Prioritize yourself; be honest about your limits; delegate responsibilities when possible; and break down big tasks into smaller ones you can accomplish in one sitting. Remember that self-care is an essential counterbalance for successfully handling life's stressors.
Avoid Unhealthy Coping Methods
Avoiding unhealthy coping mechanisms can be just as important as engaging in healthy ones. Unfortunately, PTSD appears to raise the risk of unhealthy behaviors such as smoking, drinking, lack of exercise, anxious eating, and excessive screen time. What all these coping methods have in common is that they provide temporary relief in the short-term but risk addiction, self-neglect, and other mental and physical problems in the long-term.
Get a Good Night's Sleep
Rest is essential to strong mental health, making anxiety-based disorders that interfere with sleep a real Catch-22. In one study, nearly half of Vietnam veterans with PTSD reported trouble falling asleep, while 91% said they had trouble staying asleep. It's important to address sleep problems like these before they compound into other issues. Improve sleep by sticking to a schedule; avoiding exercise, caffeine, alcohol, or heavy meals in the evening; practicing PMR or controlled breathing before bed; refraining from TV or smartphones in bed; and using white noise or ear plugs to block distractions.
According to the U.S. Department of Veterans Affairs, the most highly recommended treatments for PTSD are trauma-focused psychotherapies, using regular personalized sessions to confront and process the trauma in a safe setting.
One type of trauma-focused therapy with proven success is prolonged exposure therapy, which involves talking about trauma with a provider and facing previously avoided feelings and activities. Also effective for phobias, PE operates on the level of fear extinction, gently forcing people to face triggers. In addition to talking about the trauma, some PE techniques focus on recreating the experience in other ways, including writing about it or visualizing it.
Two other forms of psychotherapy with positive research support are cognitive processing therapy (CPT), which involves reframing negative thoughts about the experience with a provider, and eye movement desensitization and reprocessing (EMDR), wherein patients process their trauma while focusing on a repetitive motion or sound similar to the calming rhythms central to REM sleep, physical activity, and mindfulness exercises.
Engaging in one or more of these treatments can help navigate challenging emotions and situations without shrinking the scope of your life's experiences. Don't assume any one resource will do all the work — stress is a holistic problem and requires a holistic approach, so experiment with different methods to find the path forward.
Use Art Therapy
Personal expression of stress is an important facet of trauma-focused psychotherapies, and one that can be replicated outside of clinical settings. In one study, trauma-focused art therapies were shown to reduce PTSD symptoms significantly more than treatment as usual at a psychiatric inpatient facility for adolescents. Journaling and other forms of expressive writing have been reliably found to promote positive health outcomes such as reducing body tension, strengthening immune function, and restoring focus, especially for people with PTSD.
Resilience is the psychological quality that makes us adept at adapting to whatever life throws our way and coming back stronger for it. So what makes someone resilient? Research shows that resourcefulness, an optimistic outlook, college education, and positive parental relationships all positively predict a person's resilience. Milana Perepyolkina, an author and blogger at Gypsy Energy Secrets, says she learned from her father some of the resiliency she'd later need in moving on from his loss. "He taught me how to be patient and creative, to love others unconditionally, and to live each day with an incredible passion for life."
It's important to note that resilience is not an inborn trait but a skill you can learn, even after trauma has occurred. Sophia Reed, a marriage therapist, suffered a sudden job loss while foreclosing on a home. "Once you go through something like that ... whenever stressful times comes my way, I can handle it, because I have survived worse," she says.
Rely on Social Support
Perhaps the most crucial indicator of resilience and ability to cope with stress is a strong social support system. A solid network of close relationships has been associated with both a decreased likelihood of PTSD and improved outcomes for those who already have it. Maintaining close relationships and spending time with others, whether talking candidly, doing a shared activity, or just sitting together in silence, is part of the healing process. Others can't "fix" stress, but asking for help and having an understanding ear can make a difference.For those who don't already have a strong support network, group therapy is an option. Although it's not a substitute for individual therapy, sharing struggles with people who are experiencing the same problems can provide validation, reduce a sense of shame around your emotions, and increase self-esteem as you, in turn, help others. There's research to suggest that helping others is a strong predictor of positive PTSD outcomes.
Seek Meaning and Post-Traumatic Growth
Post-traumatic growth is shorthand for the positive psychological consequences of struggling and coping with a traumatic event. In contrast to PTSD, PTG goes hand in hand with a greater appreciation of life, a deeper sense of personal strength, more intimate relationships with others, and spiritual enhancement. According to research, the key factors that promote resilience and PTG all relate to the perception of meaning in life before, during, and after a traumatic event.
In other words, there are silver linings to be found in the aftermath of even the most horrific and stressful experiences, but only by confronting and creating meaning from them.