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
- 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)
- 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.
Less stress without regard to treatment phase among people with cancer treated with acupuncture (weak evidence)
No evidence of additional benefit to massage therapy for stress during autologous tissue breast reconstruction among people treated with acupuncture
Less stress among people with cancer, including children, and also parents and caregivers of children with cancer receiving healing touch (preliminary evidence)
Less fatigue and pain among children with cancer and their parents and caregivers receiving healing touch (preliminary evidence)
Recommended in clinical practice guidelines ›
- Less stress or distress without regard to treatment phase among people with cancer treated with relaxation and other mind-body therapies
- Less stress or better coping skills during cancer treatment or intervention among people with breast cancer treated with relaxation, sometimes also with visualization
- Less tension or distress among hospitalized people with cancer or parents of hospitalized children with cancer treated with relaxation, sometimes also with guided imagery
- Less distress among people with cancer in hospice treated with interactive guided imagery and progressive muscle relaxation
In preparation for surgery, a protocol called enhanced recovery after surgery (ERAS) with an integrated traditional Chinese and Western medicine approach is linked to lower markers of stress after surgery among people with gastrointestinal tumors (preliminary evidence).
No evidence of benefit or evidence of harm
Stimulants such as ephedra, ginseng, and bitter orange can increase your stress response.
Further therapies used to manage stress that we haven’t reviewed for effectiveness or safety.
- Alpha-lipoic acid
- Breathing therapies
- Cranial electrotherapy stimulation
- Eye movement desensitization and reprocessing
- Lemon balm
- Lobelia (Indian tobacco)
- Magnolia bark and phellodendron
- Mimosa tree bark
- Music therapy
- Panax ginseng (Asian ginseng)
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
|1||American Institute of Stress. The Holmes-Rahe Stress Inventory. Viewed March 7. 2022.|
|2||Mayo Clinic Staff. Post-traumatic stress disorder (PTSD). Mayo Clinic. Viewed March 7, 2022.|
|3||Mayo Clinic staff. Caregiver stress: Tips for taking care of yourself. Mayo Clinic. March 22, 2022. Viewed May 24, 2022.|