Managing Stress

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 reported to help manage stress are listed below.

Symptoms of stress

One possible way that stress can be expressed is through anger. Both people with cancer and those caring for them can become angry, with the potential for abuse or even violence.¹Mejri N, Lajnef I et al. Intimate partner violence after cancer diagnosis: an SOS call. Supportive Care in Cancer. 2023 Jan 9;31(2):103. We encourage you to reach out for help if you find yourself or your partner is becoming angry and not managing your anger response well.

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.²American 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:³Mayo Clinic Staff. Post-traumatic stress disorder (PTSD). Mayo Clinic. Viewed March 7, 2022.

What practices and therapies can help with stress?

Both self-care practices and some complementary therapies can help you manage your stress response.

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.

Practices and therapies with good or modest evidence of benefit for managing stress

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 that the practice or therapy is linked to the outcomes described with reasonable certainty. 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 the practice or therapy may be linked to the outcomes described, but with a lower degree of certainty.

The evidence for these effects is described in the reviews available through the image links.

Less distress among people recently diagnosed with cancer participating in progressive muscle relaxation with guided imagery (preliminary evidence)

Less stress after cancer treatment among people treated with imagery (preliminary evidence)

Less tension among parents of hospitalized children with cancer participating in progressive muscle relaxation and guided imagery (preliminary evidence)

No evidence of an effect on distress among people with cancer and with pain participating in relaxation and visualization training in a preliminary study

Not specific to cancer

• Better levels of stress hormones after surgery among people treated with guided imagery and relaxation (preliminary evidence)

• Less perceived stress among healthy volunteers treated with probiotics (not specific to cancer) (modest evidence)
• A lower marker of stress 5 to 7 days after elective orthopedic or colorectal surgery among elderly people treated with probiotics (not specific to cancer) (preliminary evidence)

One-on-one peer support: Insufficient (conflicting) evidence of less distress among women with cancer or at risk of cancer receiving one-on-one peer support

Supportive community-based workbook-journal: fewer symptoms of stress among women with breast cancer receiving a supportive community-based workbook-journal (preliminary 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) means the practice or therapy may be linked to the outcomes described, although substantial uncertainty remains. 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 a high degree of uncertainty remains about the links between the practice or therapy and the outcomes described.

No evidence of an effect on managing stress

Moderate body weight loss ›

Distress is linked to increased body mass index (BMI) and greater waist circumference. However, a combined analysis of studies found no evidence of an effect of moderate weight loss (about 8 pounds) on self-reported stress among overweight or obese adults. We don’t know if more or less weight loss than that has an effect.

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.

Recommendations especially for caregivers with stress

These practices and approaches are recommended specifically for caregivers.⁴Mayo Clinic staff. Caregiver stress: Tips for taking care of yourself. Mayo Clinic. March 22, 2022. Viewed May 24, 2022.

Helpful links

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