Managing your stress response

Top practices and therapies for managing your stress

Therapies and practices we have reviewed—the effects of these practices and therapies are described below.

Further therapies recommended in clinical practice guidelines include biofield therapies:

Learn more about practice guidelines from expert medical groups.

Symptoms of stress

Stress can exhibit as distressemotional, social, spiritual, or physical pain or suffering that may cause a person to feel sad, afraid, depressed, anxious, or lonely; people in distress may also feel that they are not able to manage or cope with changes caused by normal life activities or by having a disease, such as cancer or other symptoms.

If you experience anxiety, depression, sleep disruption or other symptoms, and you think stress may be contributing to them, you may need to address both your symptoms and the underlying stress to find relief and wellness.

Find information about assessing and communicating distress to your health care team including tools to help measure your distress.

Stress inventory: creating a stress score

The Holmes-Rahe Stress Inventory assigns a score to the top stressors in people’s lives to assess their risk of developing a stress-induced breakdown.1American Institute of Stress. The Holmes-Rahe Stress Inventory. Viewed March 7. 2022. If you use this inventory and find that you have a high risk, we encourage you to take your result and your concerns to your oncology team to work with you on managing your stress responses.

Post-traumatic stress disorder or other serious conditions

Post-traumatic stress disorder (PTSD) frequently develops after traumatic experiences. If you, either as a person with cancer or a caregiver, have a risk factor for PTSD, or you have symptoms of PTSD or any other symptoms of serious mental health issue, we encourage you to notify your cancer care team as soon as possible. Symptoms include these:2Mayo Clinic Staff. Post-traumatic stress disorder (PTSD). Mayo Clinic. Viewed March 7, 2022.

  • Intrusive memories
  • Avoidance
  • Negative changes in thinking and mood
  • Changes in physical and emotional reactions
  • Suicidal thoughts

What practices and therapies can help with stress?

Stress can be both mental/emotional and physical. We assess the evidence for various practices and therapies related to stress among people with cancer. We provide summaries here, but full details are on the therapy review pages.

As research evidence is often incomplete, learning how integrative experts manage stress can be informative. See How do integrative experts manage stress ›

Therapies and practices which are beneficial in some situations may show no benefit in others.

Self-care practices to manage stress

All of the other 7 Healing Practices can help you manage your stress response. We share those that are supported by research evidence.

Stress, anxiety, depressive symptoms, and food choices are all related. Interventions to improve food choices are linked to fewer depressive symptoms and stress. The reverse might also be true.

Eating Well: mixed evidence of food’s connection to stress

Lower stress response among people eating a specific whole-grain food (preliminary evidence)significant effects in small or poorly designed clinical studies OR conflicting results in adequate studies but a preponderance of evidence of an effect (this is the CancerChoices definition; other researchers and studies may define this differently)

Similar advantage from unhealthy or healthy “comfort” foods on physical markers of stress among women eating either healthy or unhealthy food choices in response to stress (preliminary evidence)

Higher stress responses among people consuming caffeine and lower stress responses with decaffeinated drinks (preliminary evidence)

No evidence of an effectoverall, one or more studies did not demonstrate that a treatment or intervention led to an expected outcome; this does not always mean that there is no effect in clinical practice, but that the studies may have been underpowered (too few participants) or poorly designed. Larger, well-designed studies provide more confidence in making assessments. on stress among people following a vegan/vegetarian diet in a large combined analysis of studies

Moving More: modest evidence

Lower physical markers of stress among people practicing exercise or movement (modest evidence)significant effects in at least three small but well-designed randomized controlled trials (RCTs), or one or more well-designed, mid-sized clinical studies of reasonably good quality (RCTs or observational studies), or several small studies aggregated into a meta-analysis (this is the CancerChoices definition; other researchers and studies may define this differently)

Sleeping Well: preliminary evidence

Higher levels of stress among people with lung cancer with poor sleep quality (preliminary evidence); improving your sleep quality may help you manage stress

Creating a Healing Environment: modest evidence

Faster stress-recovery processes in laboratory experiments and better self-reported health conditions among people listening to positive soundscapes (modest evidence)

Sharing Love and Support: good and modest evidence

Less distress among people with higher levels of social support (good evidencesignificant effects in one large or several mid-sized and well-designed clinical studies (randomized controlled trials (RCTs) with an appropriate placebo or other strong comparison control or observational studies that control for confounds) (this is the CancerChoices definition; other researchers and studies may define this differently))

Fewer symptoms of posttraumatic stress and more posttraumatic growth positive psychological change experienced as a result of adversity and other challenges among adults with cancer with higher levels of social support (modest evidence)

Loneliness and isolation are stressorschallenging situations. Feeling supported and loved can help you manage these stressors and others.

Complementary therapies to manage stress

We present complementary therapies supported by evidence for managing stress. Those with the best evidence are presented first. Details of research evidence are on our reviews of each therapy.

A therapy may show a stronger effect or have more evidence in some situations than in others.

Therapies with good or modest evidence of benefit

Good evidencesignificant effects in one large or several mid-sized and well-designed clinical studies (randomized controlled trials (RCTs) with an appropriate placebo or other strong comparison control or observational studies that control for confounds) (this is the CancerChoices definition; other researchers and studies may define this differently) indicates a relatively high degree of confidence that the therapy is linked to the outcomes as noted. Modest evidencesignificant effects in at least three small but well-designed randomized controlled trials (RCTs), or one or more well-designed, mid-sized clinical studies of reasonably good quality (RCTs or observational studies), or several small studies aggregated into a meta-analysis (this is the CancerChoices definition; other researchers and studies may define this differently) means several smaller or at least one large study have found the effect described.

Guided imagery: mixed evidence

Guided imagery is often used with relaxation techniques. Different effects are found in different circumstances.

Less stress or tension during radiotherapy among people treated with relaxation training and imagery (modest evidence)

Preliminary evidence:

  • Less distress among people recently diagnosed with cancer participating in progressive muscle relaxation with guided imagery
  • Better levels of stress hormones after surgery among people treated with guided imagery and relaxation
  • Less stress after cancer treatment among people treated with imagery
  • Less less tension among parents of hospitalized children with cancer participating in progressive muscle relaxation and guided imagery

No effect: preliminary evidence of no effect on distress among people with cancer and with pain treated with relaxation and visualization training

Support groups and interventions: modest and preliminary evidence

Less stress or distress among women with breast cancer participating in an in-person group (modest evidence)

Fewer symptoms of stress among women with breast cancer receiving a supportive community-based workbook-journal (preliminary evidence)

Tai chi or qigong: good evidence

Lower markers of stress among people with cancer practicing tai chi or qigong (good evidence)

Time in nature or forest bathing: modest evidence

Lower risk of stress-related disorders among people with dense vegetation near their residences (modest evidence)

Less stress and annoyance among people listening to nature-based sounds (modest evidence)

Yoga: good to weak evidence

Less psychological stress or distress among people with cancer practicing yoga (good evidence)

Less stress before chemotherapy among people with cancer participating in laughter yoga (preliminary evidence)

Less psychological distress among caregivers for people with cancer practicing Vinyasa yoga (weak evidence)

Therapies with preliminary or weak evidence of benefit

Preliminary evidencesignificant effects in small or poorly designed clinical studies OR conflicting results in adequate studies but a preponderance of evidence of an effect (this is the CancerChoices definition; other researchers and studies may define this differently) typically indicates that not much research has been published so far, although the outcomes may be meaningful. Weak evidenceone or more case studies, supported by animal evidence OR small treatment effects of limited clinical significance OR studies with no controls OR weak trends of effects (this is the CancerChoices definition; other researchers and studies may define this differently) may mean that the effects are small or that only very preliminary research has been published.

Acupuncture Learn moreSee Less
Healing touch Learn moreSee Less
Polarity therapy Learn moreSee Less
Relaxation techniques Learn moreSee Less
Preparing for surgery Learn moreSee Less
No evidence of benefit or evidence of harm

Stimulants such as ephedra, ginseng, and bitter orange can increase your stress response.

Further therapies

Further therapies used to manage stress that we haven’t reviewed for effectiveness or safety.

  • 5-HTP 
  • Alpha-lipoic acid
  • Ashwagandha 
  • Breathing therapies
  • Chamomile 
  • Cranial electrotherapy stimulation
  • Eye movement desensitization and reprocessing
  • Hops
  • Hypnotherapy
  • L-theanine
  • L-tyrosine 
  • Lavender
  • Lemon balm
  • Lobelia (Indian tobacco)
  • Magnesium
  • Magnolia bark and phellodendron
  • Meditation
  • Mimosa tree bark
  • Music therapy
  • Panax ginseng (Asian ginseng) 
  • Passionflower
  • Phosphatidylserine
  • Propranolol ›
  • Rhodiola rosea 
  • Schisandra
  • Siberian ginseng (Eleutherococcus senticosus
  • Valerian
  • Vervain (verbena)
  • Vitamin B₁ (thiamine) 
  • Vitamin B₅ (pantothenic acid) 
  • Vitamin C ›

Recommendations especially for caregivers with stress

These practices and approaches are recommended specifically for caregivers.3Mayo Clinic staff. Caregiver stress: Tips for taking care of yourself. Mayo Clinic. March 22, 2022. Viewed May 24, 2022.

  • Accept help
  • Focus on what you are able to provide
  • Set realistic goals
  • Get connected
  • Join a support group
  • Seek social support
  • Set personal health goals
  • See your doctor if you’re having trouble sleeping
Missy Hall conducts a sound bath meditation to calm the nervous system

Resources

Helpsy Health

Website and app that brings a virtual nurse to help you manage symptoms and side effects

Access the website

Cancer.Net

From the American Society of Clinical Oncology

Managing Stress

HeartMath

Free mobile app, but full functionality requires purchase of a sensor to provide heart rate variability coherence feedback

Relieving Stress and Anxiety

Keep reading

Authors

Laura Pole, RN, MSN, OCNS

Senior Clinical Consultant
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Laura Pole is senior clinical consultant for CancerChoices. Laura is an oncology clinical nurse specialist who has been providing integrative oncology clinical care, navigation, consultation, and education services for over 40 years. She is the co-creator and co-coordinator of the Integrative Oncology Navigation Training at Smith Center for Healing and the Arts in Washington, DC. Laura also manages the “Media Watch Cancer News That You Can Use” listserv for Smith Center/Commonweal. In her role as a palliative care educator and consultant, Laura has served as statewide Respecting Choices Faculty for the Virginia POST (Physician Orders for Scope of Treatment) Collaborative as well as provided statewide professional education on palliative and end-of-life care for the Virginia Association for Hospices and Palliative Care.

For CancerChoices, Laura curates content and research, networks with clinical and organizational partners, brings awareness and education of integrative oncology at professional and patient conferences and programs, and translates research into information relevant to the patient experience as well as clinical practice.

Laura sees her work with CancerChoices as a perfect alignment of all her passions, knowledge and skills in integrative oncology care. She is honored to serve you.

Laura Pole, RN, MSN, OCNS Senior Clinical Consultant

Nancy Hepp, MS

Lead Researcher and Program Manager
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Ms. Hepp is a researcher and communicator who has been writing and editing educational content on varied health topics for more than 20 years. She serves as lead researcher, program manager, and writer for CancerChoices. Her graduate work in research and cognitive psychology, her master’s degree in instructional design, and her certificate in web design have all guided her in writing and presenting information for a wide variety of audiences and uses. Nancy’s service as faculty development coordinator in the Department of Family Medicine at Wright State University also provided experience in medical research, plus insights into medical education and medical care from the professional’s perspective.

Nancy Hepp, MS Lead Researcher and Program Manager

Last update: October 15, 2022

Last full literature review: November 2021

CancerChoices provides information about integrative in cancer care, a patient-centered approach combining the best of conventional care, self care and evidence-informed complementary care in an integrated plan cancer care. We review complementaryin cancer care, complementary care involves the use of therapies intended to enhance or add to standard conventional treatments; examples include supplements, mind-body approaches such as yoga or psychosocial therapy, and acupuncture therapies and self-care lifestyle actions and behaviors that may impact cancer outcomes; examples include eating health-promoting foods, limiting alcohol, increasing physical activity, and managing stress practices to help patients and professionals explore and integrate the best combination of conventionalthe cancer care offered by conventionally trained physicians and most hospitals; examples are chemotherapy, surgery, and radiotherapy and complementary therapies and practices for each person.

Our staff have no financial conflicts of interest to declare. We receive no funds from any manufacturers or retailers gaining financial profit by promoting or discouraging therapies mentioned on this site.

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