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Medically reviewed by Julia Halstead-Cleak, MA Clinical Psychology (UJ) on 1 September 2021

Written by Tammy Baikie

Stress is a physical and mental state of emergency. Virtually no aspect of life is spared. If you get stuck in that state of lockdown, it takes an equally comprehensive and coordinated effort to get back to normal. That’s where holistic stress management comes in. But before getting to that, you need to understand the complex network of defences marshalled by the autonomic nervous system. As the word “auto” suggests, this controls the parts of our biology – including blood pressure, breathing and digestion – that largely run on autopilot without us consciously managing them.

With its two modes – the sympathetic “fight-or-flight” and the parasympathetic “rest-and-digest”– the autonomic nervous system works like a pendulum. A strong swing to the sympathetic side downregulates the parasympathetic, and vice versa. Faced with a threat, your sympathetic system triggers a cascade of hormones to ready body and mind for that life-saving sprint for the hills or battle. That means diverting resources away from functions that are not essential to immediate survival, such as immune, digestive, reproductive and growth processes. The fact that some systems are being continually taxed while others are deprived is why you feel such extensive effects and you need a holistic approach to stress management.

As the stress hormones cortisol and epinephrine (adrenalin) flood the body, blood pressure, pulse and heart rate increase in order to carry oxygen and fuel to major muscles. At the same time, temporary insulin resistance[1] ensures that sugars are not stored but instead available to power physical action and the brain. An inflammatory response prevents dirt and germs from getting into any potential wounds.

This finely tuned and instantaneous chain reaction evolved to protect us from immediate, physical threats, such as a sabre-tooth tiger or axe-wielding enemy. Today, our most common stressors are very different. Professional, financial and family pressure don’t require a primed cardiovascular system and muscles.

By the same token, the recalibration of the brain for snap emotional responses rather than higher cognitive function may save a soldier’s life in combat, but can be problematic in a corporate environment or delicate family situation.

Stress recalibrates the brain for snap emotional responses rather than higher cognitive function. That may save a soldier’s life in combat, but can be problematic in a corporate environment or delicate family situation.

Skirmishes with man or beast are quickly over and the survivor returns to a “rest-and-digest” state. But the autonomic system doesn’t distinguish between danger to life and limb – a car cutting in front of you on the road – and a more existential threat, such as financial pressure. As a result, modern-day worries often keep the pendulum unnaturally suspended at the sympathetic end of its arc. Cortisol levels don’t subside; immune and digestive systems remain suppressed. Eventually, chronic stress can lead to burnout, which the WHO defines as exhaustion accompanied by feelings of cynicism towards your job and reduced professional efficiency.

Chronic stress is thought to contribute not only to the biggest burdens on global healthcare – heart disease, high blood pressure, type 2 diabetes and obesity – but also to gastrointestinal problems and asthma. In addition to tipping you into depression and other mood disorders, stress can impair the very cognitive functions that are most needed in the face of 21st century pressures. A recent study that compared severely stressed workers with more relaxed peers not only found that their memories, ability to focus and process emotions as well as their decision-making skills were poorer, but their brains were also structurally different[2].

Because of its central role in stress-related conditions, the hormone cortisol has gotten a lot of bad press. But it’s important to understand that stress is more complex and far-reaching than cortisol alone. In fact, a research review highlights striking differences between higher cognitive functions, including working memory and mental agility, in people who were actually stressed versus those who simply took a cortisol tablet[3].

What’s more, brief experiences of stress can have an upside. Depending on whether you’re creating, banking or recalling a memory and the cortisol release phase that coincides with, you may have more or less trouble with the process. During the earlier rapid cortisol phase, the formation of new memories is promoted, but retrieving old ones can be hampered[4].

Despite its advantages in small doses, stress – and the dangerous chronic variety in particular – is becoming a pandemic. Profmed’s Stress Index indicates that South African professionals felt the pressure on them grow between 2018 and 2019. This reflects the situation globally where stress levels are at a new high.

How stress impacts all your functioning

Clearly, stress cannot and should not be brushed aside. As you can see it affects all of you – body and mind. That’s why you need holistic stress management to get the pendulum moving towards that much-needed parasympathetic response.

Following the trail of research takes you on a tour of what science has discovered about stress in six broad areas. This gives not only you a better understanding of your responses to it but also feeds into a holistic stress management approach to treating it.

1. Chronic stress and your mind

The science emphasises that stress is a response to a “perceived” threat. While the effects already described should leave no doubt that stress is not just “in your head”, people react differently to being pushed out of their comfort zones. So it makes sense that the best holistic stress management programme for you may not be the same as your colleague’s.

Stress can impair your decision making as much as a blood alcohol level of 0.08% – the legal limit in the U.S.

Remember that chronic stress often means you may not be at your sharpest. A great example illustrating this as well as the perceived and personal nature of chronic stress is a study conducted on Australian jockeys. A key factor driving their emotional exhaustion (a measure of chronic work stress) was the perception that the rewards they received failed to match their high-risk jobs and punishing schedules[5]. Strikingly, the pressure they were under was found to impair their decision making as much as a blood alcohol level of 0.08%[6]. At that level in the U.S., you’re legally considered drunk and are not permitted to drive.

By consulting with a psychologist, you get a set of fresh, expert eyes on the way stress affects your physical and mental health as well as your relationships. Together, you can then develop a better understanding of what sends you into a spiral and how to pull yourself out of it. There is evidence that helpful information reduces blood pressure more effectively than more generalised forms of social support[7]. In other words, talking to a professional is not just about creating your personal holistic stress management programme, it is also the first step towards feeling calmer.

2. Chronic stress and your senses

Faced with potential bodily harm, the sympathetic nervous system heightens the senses, tuning you into anything that could signal an attack. This enhanced sensory processing comes at the cost of the ability to focus. Researchers at the Ruhr University of Bochum found that cortisol not only sends attention flitting distractedly from one thing to another but also blocks perceptual learning[8].

There is evidence that pleasurable sensory experiences can be very effective ways to unwind. As part of a study in the Netherlands, stressed nurses who care for dementia patients made use of a multisensory room to facilitate stress management. During twice weekly sessions, members of the treatment group spent 30 minutes in the room lit by special equipment and scented with an aromatherapy oil of their choice, where they listened to their preferred music and handled pre-selected tactile stimuli. After these multi-sensory experiences, the nurses’ pulse rates were lower indicating reduced anxiety. What is more, they not only reported improved mood and feeling less agitated, but also being more caring toward their patients and creative in solving on-the-job problems[9].

Music in particular has proven effective not only in lowering physical signs of stress, such as cortisol levels, heart rate and blood pressure, but also easing the emotional upset that takes the form of worry, restlessness and nervousness. This is because music engages the reward system in the brain through the release of dopamine[10].

3. Chronic stress and your biology

One of the most powerful neurotransmitters that dials back stress is oxytocin[11]. Its myriad benefits range from counteracting cortisol, lowering blood pressure, decreasing sensitivity to pain, stimulating gastrointestinal hormones such as insulin, boosting learning and wound healing as well as even acting as an antidepressant. All in all, oxytocin is largely to thank for the warm fuzzy feelings at the heart of wellbeing. Affectionately known as the “love hormone”, it’s stimulated by thinking, smelling, hearing or seeing, and above all, touching someone we love. As long as the relationship is warm, oxytocin is released.

Skin contact in the form of stroking, light touch and warm temperatures also trigger its release. So it’s unsurprising that massage offers similar benefits. Interestingly, both the individual giving and receiving the treatment experience a surge in oxytocin.

Reflexology is another touch therapy. In contrast to the larger movements performed during massage, reflexology uses small, focused movements concentrated on the hands and feet with the aim of benefiting related areas of the body and health. Although research into reflexology has not been of the highest quality and is still considered inconclusive, there are indications that this therapy may be effective in activating a parasympathetic response by reducing blood pressure, heart rate and stress markers[12].

Whether it’s through quality time with loved ones or a touch therapy, getting your oxytocin flowing is an important part of holistic stress management.

4. Chronic stress and your body

Exercise is a powerful tool in your holistic stress management tool kit. Why? Because it works on so many different fronts to tone down the sympathetic response. Part of its varied benefits can be attributed to the many different forms of physical activity. While high-intensity training is associated with the flood of feel-good endorphins responsible for the depression- and anxiety-busting runner’s high, low-intensity workouts are great at curbing cortisol and make you less sensitive to stress[13]. Best of all, exercise can make you more resilient to the effects of stress[14].

A less immediately obvious benefit is that certain physical practices put a pin in rumination. This endless chewing over your worries is what puts the chronic into stress. It not only makes the stressful experience seem worse than it really was[15], but can also prolong the sympathetic response even after the situation is resolved[16]. A small trial successfully correlated a drop in blood pressure with a reduction in rumination[17]. Which is why certain experts believe that by switching off that mental replay and focusing your attention on the present moment, yoga, mindfulness and meditation defuse stress. The upshot is better control of your emotions and attention[18].

Some researchers believe that the same mechanism is at work in releasing the muscle tension that plagues anxiety sufferers. Although stiffness is strongly associated with anxiety, scientists don’t understand the relationship between the two. Whether stretching and muscle relaxation helps to take your mind off your worries or is in fact treating a symptom, there’s no argument over its effectiveness[19].

5. Chronic stress and your eating habits

Nowadays, the broader public is also increasingly aware of the role of processed, sugary food in obesity, diabetes and heart disease. But it’s worth digging deeper into the links between stress and diet.

For many stressed people, the fridge has an irresistible pull. Study participants whose cortisol spikes were higher when faced with daily hassles, also tended to snack more[20]. To compound matters, chronic stress creates a vicious cycle where you not only crave more fatty, sugary foods, but are also more likely to gain weight[21].

The interplay between stress and the gut doesn’t end there. The fact that your bowels are home to trillions of microbes adds a whole new layer of interactions. Called the microbiome, these communities of bacteria and other organisms not only help us absorb nutrients and minerals, but also interact with the immune and hormonal systems. More and more research is turning up connections between an impoverished or unbalanced microbiome and a host of aliments.

Although not an ailment as such, stress is very much in the mix. Mice raised in sterile conditions so that there are no microorganisms anywhere on or inside them, experienced bigger fluctuations in stress hormones than their non-sterile brothers and sisters. The conclusion is that the gut bacteria of the “regular” mice shaped their hormonal profile[22]. And it doesn’t end there. Stress can also alter the composition of the microbiome through inflammation, creating a kind of feedback loop[23]. Considering the many other conditions and diseases where the microbiome plays a role, it’s clear that a holistic approach to stress management has implications for many other conditions.

Because organisms in the digestive tract are involved in metabolising the precursors of neurotransmitters such as serotonin and dopamine, they can also affect mood and depression[24]. A Belgian study made a strong case for this gut-brain axis by showing that depression sufferers had lower counts of two kinds of gut bacteria[25].

To boil things down, what you eat affects the microbiome, and the microbiome affects how you respond to stress. While it’s important to remember that antibiotics and pollution, among other things, also impact gut microbes, food can be powerful medicine. All the food groups – protein, carbohydrates and fats – contribute to a healthy gastro-intestinal tract, but fibre is where it’s at when it comes to stress. That’s because gut bacteria produce short-chain fatty acids when they break down fibre. Short-chain fatty acids strengthen the colon lining, making it harder for particles of food and bacteria to crossover into the bloodstream[26]. A symptom of chronic stress, foreign particles escaping through a “leaky gut” triggers chronic inflammation, which is associated with depression.

6. Chronic stress and sleep

Sleep is a mystery. We know that it’s absolutely essential to health – going without sleep for long enough will eventually kill you. Just why that is, isn’t clear.

Since sleep is pretty much the opposite of stress, it’s a good litmus test for the level of strain you’re taking. If you’re tossing and turning on a regular basis, it’s time to check your stress level. Not that it’s likely to have escaped you. Often your inability to fall asleep is tied up in the endless stream of thoughts, plans and worries associated with whatever form of stress has you in its vice-like grip. And the following day, you feel more on edge, which only makes things harder the next night. That’s because stress and lack of sleep are a two-way street. Insufficient rest makes it harder to cope with stress and stress makes it harder to sleep. Breaking that cycle is integral to holistic stress management.

Yet again cortisol is a culprit. But only because it’s the wrong hormone at the wrong time. Cortisol is vital to getting you up and going in the morning. In healthy, unstressed people, cortisol levels bottom out at around midnight but gradually start rising after that to peak at around 9am. Melatonin, the sleep hormone, follows an inverse cycle – peaking at midnight and dropping off to a low in the morning. When cortisol is at full-on air-raid siren, it drowns out melatonin’s lullaby.

Getting a good night can help you cope better with stress beyond simply ensuring you’re rested. The reasons can be found in the alternating stages of non-rapid eye movement (NREM) and rapid-eye movement (REM) sleep. REM is associated with dreaming and in many ways brain activity is closer to that of wakefulness than during NREM sleep. A study has shown that people who had longer bouts of REM sleep after a traumatic event didn’t go on to develop post-traumatic stress disorder, while those who had several very short episodes did. Which leads sleep scientists to believe that extended REM is vital to processing traumatic memories and integrating them into the stories of our lives[27].

Sleep deprivation lets anxiety off the leash by shutting down the medial prefontal cortex and leaving your emotional centres to go into overdrive.

NREM or deep sleep is equally valuable as it has a direct impact on anxiety. Recent research shows that after being deprived of sleep, the medial prefrontal cortex, which is responsible for keeping anxiety on a leash, shuts down. At the same time the brain’s deeper emotional centres go into overdrive[28]. The scenario is a bit like a car without brakes and a brick on the accelerator pedal. Deep (NREM) sleep restores that control mechanism so that you are better able to regulate your body and mind’s response to causes of anxiety.

So how do you get that elusive good night’s rest? Sleep hygiene is a series of habits aimed at walling off your bedtime from the rest of life. This is necessary because many aspects of modern existence compromise the length and quality of your sleep. TVs and digital devices, for instance, are big no-nos before bed. The reason is that melatonin production is stimulated by fading light and artificial light suppresses it. Blue light – which screens emit a significant amount of – has the most powerful effect. In an experiment where people watched documentaries on a smartphone in bed, sleep was delayed most by viewing with a blue filter and second longest without a filter. Using an orange filter produced the shortest time between lights out and loss of consciousness[29].

Coffee and alcohol should also be avoided. While coping strategies – from accepting and sitting with feelings, through emotional awareness, to problem solving – can be beneficial to reducing stress, it’s better to plan these activities earlier in the day to protect sleep[30].


You have to admire the way the stress response coordinates mental functions and alertness, the body, senses and biology as well as eating and digestion in bid to ensure survival. Just because this “rescue mission” is conducted by the autonomic nervous system doesn’t mean you are powerless to intervene. There are lots of effective therapies and techniques that complement each other to provide holistic stress management. Many of these treatments are on offer at Oxford Healthcare Retreat.

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