In our Ask a Doc series, we sit down physicians and other clinical experts across our networks, including at Allegheny Health Network, for a chat on an important health topic. In this edition, we’re talking about the scourge of stress with Dr. Betsy O’Neill.


Amanda Changuris (AC): Stress is a fact of life, and a completely healthy, normal response to less-than-ideal situations. Yet, according to the American Psychological Association’s Stress in America report, just 35% of us think we’re doing a good job of managing the stress.

Dr. Betsy O’Neill, as Medical Director of Employee Health Services for the Allegheny Health Network, what do you think the majority of us are missing when it comes to coping with stress?

Dr. Betsy O’Neill (DBO): When you ask people what they need to do to be a healthier person, they’ll say, “I need to eat better and I need to exercise more,” but they don’t really make the connection between stress and their health. They think of stress as something that makes them feel bad in their head, but they don’t really take it any further.

People need to know about the connection between stress and health and that being under a lot of stress all the time without a way to release it causes physical changes to the body that can ultimately make certain diseases (like heart disease or diabetes) more likely. It’s not only important for your mental health, but also for your physical health.

AC: So how can we get a handle on it and lower those health risks?

DBO: There are two ways to think about managing stress. One is to not sign on for any more stress than you need to. People create some of their own stress by setting unrealistic expectations, taking on too many tasks, volunteering for things they don’t have time for, not enlisting the help of coworkers or family members, or feeling like they have to do everything for themselves all the time. We also tend to think that if we don’t get something done to absolute perfection, people won’t accept us or love us, which isn’t true.

Then there’s also the stress that you can’t get rid of. Work is often stressful, our families are often stressful, we might have health issues or financial issues; there are things that we can’t necessarily make go away, so we need to find ways to cope with that.

Coping with Stress

AC: I can think of a few unhealthy ways to deal with stress — eating comfort food, smoking, going out for more than a few drinks — but there are plenty of healthy alternatives. What do you recommend?

DBO: There are breathing exercises you can do while you’re involved in a stressful event. If you’re caught in traffic and you’re going to be late or something very stressful just happened in a meeting at work, you can take three or four deeper breaths than usual and that can start to calm your body down.

There are even a lot of apps that you can use on a smartphone or tablet to de-stress, but I would caution everyone about the use of electronics. These devices are one of the things that increase our stress because people feel like they can’t ever turn them off and they always have to be available through them and always be checking what’s going on on them. There needs to be a period of the day when you’re not using them; not constantly checking, not constantly available.

My preference if people are going to use relaxation apps on a tablet or smartphone is to use the ones that are primarily auditory and that do not do a lot of things that are visual. For example, I listen to the audio only of relaxation postings I find on YouTube. You can also find similar results if you search for podcasts. You can find whatever length you have time for, whatever it is you like: ocean sounds, nature sounds, or someone leading you through a verbal relaxation exercise.

AC: Some people (cough — myself included — cough) have a hard time clearing their minds and relaxing like that. Do you have any tips for me them?

DBO: Sometimes you can do things to relax, things that are a little more active, like a few minutes of yoga, a few minutes of Tai Chi, or writing in a journal.

Journaling can help you track your stress levels.What I find works for me is almost every morning after my shower and before I come to work I do about five minutes of yoga. After that I read a couple of inspirational things. It takes me about five minutes to do that. And then I keep a journal in my bedroom and every day I write down three things I’m grateful for. And I think that gets my day off to a positive start. It takes me 10-12 minutes to do those three things. It’s a way of starting my day with relaxation activities. If I get to other things during the day that’s great, but if I don’t I already got a little bit of it. It’s an easy, great way to start my day.

People need to remember that doing some form of exercise — and it could be as simple as going for a 15-minute walk every day — is probably the most effective stress reliever there is. People do it because they want to lose weight, people do it because they’ve heard it’s good for their heart, but regular exercise is essential for mental health. That’s been proven time and time again in research studies with people who have anxiety, people with depression. Exercise is as effective or more effective than medication. People really need to appreciate that they need to exercise not just to fit into a dress or because it’s good for your heart, but because it’ll make you feel better.

Signs that Stress is Getting to Be Too Much

AC: A certain level of stress is healthy — even good for you — but how can we tell if our stress levels are crossing into unhealthy territory?

DBO: If you’re having trouble sleeping and there doesn’t seem to be another reason, if you’re eating all the time or not eating very much at all, if you feel irritable all the time, if you’re feeling more tired than usual — stress is really an energy zapper. It can also affect your ability to relate to other people, so pay attention if all of your relationships are feeling a little difficult. Those are all signs that stress is starting to get to you.

AC: Many people can turn to the activities we’ve discussed to ease their stress levels, but sometimes it’s not that easy. What do you suggest for those times when stress seems to be taking over and self-help isn’t enough?

DBO: Being able to share something that’s stressful with another person who’s experiencing the same thing — like another parent at school or another person in the neighborhood — that’s really helpful.

If that isn’t enough, you can think, “Is there someone in my circle who has some expertise who can help me?” Perhaps a minister.

Sometimes you need to think about a professional therapist of some kind, a psychologist or a social worker, to be evaluated to see if you need some help to figure out how to do a better job with this. Many employers have Employee Assistance Programs that provide confidential psychological support, often at no or low cost.

AC: Here’s a goal for all of you who are reading: Keep tabs on your stress levels this week (maybe even write it down in a journal) and get an idea for how well you’re managing it. If you’re like most Americans and feel stressed out to some degree, pick one of the activities Dr. O’Neill recommends and give it a try.

DBO: Luckily, even though stress can have harmful physical effects, there are simple things we can do even for a few minutes a day that can help counteract it. You don’t have to spend as much time doing stress management as you can spend getting stressed.