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
Stress can show up 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.
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.
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.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.
- Intrusive memories
- Negative changes in thinking and mood
- Changes in physical and emotional reactions
- Suicidal thoughts
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.
Moving More: modest and preliminary evidence
Lower physical markers of stress among people participating in exercise or movement (modest evidence)
Less perceived stress during active surveillance among people with prostate cancer participating in high-intensity interval training (preliminary evidence)
Creating a Healing Environment: modest evidence
Not specific to cancer:
- 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
Loneliness and isolation are stressorschallenging situations. Feeling supported and loved can help you manage these stressors and others.
Not specific to cancer:
- Less distress among people with higher levels of social support (good evidence)
- Fewer symptoms of posttraumatic stress and more posttraumatic growth among adults with cancer with higher levels of social support (modest evidence)
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 (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)
Probiotics and prebiotics: mixed evidence
Not specific to cancer:
- No evidence of an effect on stress among people with symptoms of stress treated with probiotics in a combined analysis of studies (not specific to cancer)
- 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)
Support groups and interventions: modest and preliminary evidence
In-person group: Less stress or distress among women with breast cancer participating in an in-person group (modest evidence)
Online groups: Insufficient (conflicting) evidence of an effect on stress or distress among women with breast cancer participating in an online support intervention
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)
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
Not specific to cancer:
- 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) 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.
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.
Not specific to cancer:
- A lower stress response among people eating a specific whole-grain food (preliminary evidence)
- Higher stress responses among people drinking beverages with caffeine and lower stress responses with decaffeinated drinks (preliminary evidence)
- Similar effects on physical markers of stress among women eating either healthy or unhealthy food choices in response to stress (preliminary evidence)
- Interventions to reduce depressive symptoms and mental stress could result in healthier food choices (preliminary evidence)
- No evidence of an effect on stress among people following a vegan/vegetarian diet in a large combined analysis of studies
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 or distress without regard to treatment phase among people with cancer treated with relaxation and other mind-body therapies (preliminary evidence)
Less stress or better coping skills during cancer treatment or intervention among people with breast cancer treated with relaxation, sometimes also with visualization (preliminary evidence)
Less tension or distress among hospitalized people with cancer or parents of hospitalized children with cancer treated with relaxation, sometimes also with guided imagery (preliminary evidence)
Less distress among people with cancer in hospice treated with interactive guided imagery and progressive muscle relaxation (preliminary evidence)
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 an effect on managing stress
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 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)
- Rhodiola rosea
- Siberian ginseng (Eleutherococcus senticosus)
- 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.4Mayo 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||Mejri N, Lajnef I et al. Intimate partner violence after cancer diagnosis: an SOS call. Supportive Care in Cancer. 2023 Jan 9;31(2):103.|
|2||American Institute of Stress. The Holmes-Rahe Stress Inventory. Viewed March 7. 2022.|
|3||Mayo Clinic Staff. Post-traumatic stress disorder (PTSD). Mayo Clinic. Viewed March 7, 2022.|
|4||Mayo Clinic staff. Caregiver stress: Tips for taking care of yourself. Mayo Clinic. March 22, 2022. Viewed May 24, 2022.|