Counseling Patients on Stress Management

December 2013, Vol 1, No 2 - Inside Mental Health
Shannon Irene Burke, PharmD

Stress is something that most people deal with on a routine basis. In some instances, stress is seen as good, because it provides the drive and energy to accomplish goals. However, prolonged stress that goes unaddressed or untreated can lead to a host of side effects that can affect physical, emotional, and mental health.

When you are speaking with patients, it is impor­tant to identify what triggers their stress. Is it an internal stressor, such as an infection, illness, or excessive worry? Or is it an external stressor, such as an abusive relationship, pain, or deteriorating working conditions? Identifying the root cause of your patients’ stress will help you to steer them in the right direction for stress management.

How Stress Affects the Body

By demonstrating how stress affects the different systems in the body, you can convey to your patient its profound and lasting effects. For example, acute stress can cause the heart rate to increase, resulting in more forceful contractions of the heart muscle. Blood vessels then dilate as more blood is pumped to other organs in the body. Over time, the continuous dilation of the coronary arteries and prolonged stress on the cardiovascular system may lead to an increased risk of having a heart attack.

Stress can also trigger muscles to tense, resulting in headaches and migraines. What many people do not know is that chronic stress can also cause changes in cortisol levels, which impacts many systems, including the reproductive system. In men, this can result in decreased testosterone levels and sperm count, potentially resulting in such consequences as impotence. In women, cortisol changes can lead to irregularities in the menstrual cycle and decreased sexual desire.1-3

Stress can also alter a person’s emotions, resulting in mood and behavioral fluctuations that can affect work and family relationships. Examples include decreased work efficiency or productivity, hiding poor performance from others, excessive defensiveness or suspiciousness, problems with communication and sharing, social withdrawal, and isolation.1-3

Stress Management Techniques

Once the patient has identified that there is a problem, there are many strategies available to reduce stress that do not include medication. Some examples of stress management mechanisms are as simple as restructuring one’s priorities and making some simple lifestyle changes.

Exercising is a great way to reduce stress, because it releases endorphins in the brain, benefiting the patient’s overall physical health, and acting as a distraction from the stressors. Cognitive behavioral therapy is another option that includes identifying the sources of patients’ stress, restructuring their priorities, changing their response to stress, and then finding methods for managing and reducing their stress.

Relaxation techniques are a helpful way to reduce stress and can help patients work through stressful situations. Some examples of relaxation techniques include deep breathing exercises, meditation, biofeedback, and massage therapy.

Finally, sometimes the easiest way to reduce stress is to adhere to healthy habits. Encourage your patients to invite humor into their lives. Although finding humor in a stressful situation is not easy, laughing has been proven to reduce stress hormone levels. You can also suggest that patients express their feelings with family and friends, try to accept that there are things in life that cannot be changed, try not to sweat the little things in life, help others, and get enough sleep.2-4

Warn Your Patients about Natural Remedies

Herbal remedies claim to help lower stress, but their clinical effects have not been proven. As pharmacists, it is important that we stress to our patients that any herbal medications they take can interact with their disease states, as well as any medications they take for those disease states, potentially causing devastating side effects.

One natural remedy is aromatherapy, specifically lavender, which has been recognized to have a calming effect. However, some patients should be cautious when using this herb, because some of the lavender oils have ingredients that have been linked to skin allergies. Another natural remedy is the herb valerian because of its sedating properties; however, it also can have deleterious effects, such as altering the effects of other sedatives or causing vision changes and abnormal heart rhythms.

Kava has been frequently used for stress, but in recent years it has been shown to cause liver damage. Patients should be wary of over-the-counter (OTC) products that promise quick-fix cures, and they should always consult with their physician before starting any new medications.3

Prescription Medications for Anxiety Should Be Used as a Last Resort

There will be some patients who attempt lifestyle modifications and OTC medications but do not achieve adequate results. While coping methods and preventive measures are always preferred, there are prescription medications available to treat anxiety. These include benzodiazepines and antidepressants, such as tricyclic antidepressants, selective serotonin reuptake inhibitors, and serotonin-norepinephrine reuptake inhibitors. Beta-blockers are used off-label as well, along with hydroxyzine and barbiturates. Because of the potential for abuse, however, barbiturates are rarely used today.

It is important for the patient to understand the difference between stress and anxiety, and that while medications are helpful for many health conditions, stress is not typically one of them.3

Most important, make sure that your patient understands that there is no “quick fix” for stress. Regardless of the remedy that the patient chooses, it will take time—and sometimes several rounds of trial and error—to adequately control the symptoms of stress. Encourage your patients to keep you updated on their progress and to check in with you regularly so that you can continue to assist them in managing their stress.


  1. The American Institute of Stress. 50 Common Signs and Symptoms of Stress. Fort Worth, TX: The American Institute of Stress. Accessed November 3, 2013.
  2. Simon H. Stress. Baltimore, MD: University of Maryland Medical Center. 2013. Accessed November 3, 2013.
  3. American Heart Association. Fight Stress with Healthy Habits. Dallas, TX: American Heart Association. 2011. Accessed November 3, 2013.
  4. American Heart Association. Four Ways to Deal with Stress. Dallas, TX: American Heart Association. 2011. Accessed November 3, 2013.
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