Dr. Jon Kabat-Zinn, in his classic book on mindfulness meditation, "Wherever You Go, There You Are," recalls a poster of a seventy-ish yogi, Swami Satchitananda, in full white beard riding atop a surfboard with the caption, "You can't stop the waves, but you can learn to surf."

That is also the nature of stress in our lives. The goal is not to try to eliminate stress, but to find a comfortable balance between too much and too little. Too much and we feel like we're jumping out of our skin. We become anxious, distracted, irritable. Too little stress and we feel bored or listless.

You can say that the art of stress management is the ongoing practice of keeping ourselves at a level of stimulation that is healthy and enjoyable. To achieve this is indeed a practice. You cannot go to the health club and expect to build muscles in one week.

So, where do you begin? Start with the practice of incorporating simple breathing exercises into your daily regimen. The breath is simply one of the most effective tools we have to manage stress. Taking deep, slow breaths helps to center and ground us, particularly when agitated.

Try this simple exercise at least once a day. Sit comfortably, back straight and take a slow, deep inhale to a count of four. Then, breathe out gently to a count of eight, imagining a feather floating to the ground. Do 5 cycles.

You can also use this exercise while waiting for an elevator, a train or before a big presentation. With regular practice, you will begin to notice short and long- term benefits like a new calmness and subtle changes in how you respond to stress.

Ask yourself these questions:

• Where in your body does stress begin? For some, it's in the stomach, for others in the neck or back.
• Can you feel the sensation of stress moving, rising or falling in your body? At what level of stress do you cross that "no going back to calm" line?
• What situations trigger a stressful response? What makes you irritable? I recommend starting a journal to note these trigger points. Awareness is the key.

Breathing exercises, and other suggestions below, help us get more in touch with these parts of our "inner climate". The good news is that you can transform your reactions to stressors to more productive responses if you commit yourself to the practice. We all have the capacity for this self-awareness and transformation. Even "Type A's"!

Here, then, are seven categories that help to manage stress. You don't have to reinvent the wheel. You may already enjoy doing many of these things, but not associate them with stress management. Even if you add just one idea to your daily regimen, you will be taking an important step forward to a more peaceful and healthful life.

1. Relaxation
• Breathing exercises
• Meditation
• Listen to music
• Watch comedies
• Read for pleasure
2. Body Work
• Exercise
• Yoga, Tai Chi Practice
• Get enough sleep
• Get a massage
• Energy work on body
3. Creative Expression
• Play!
• Paint
• Write
• Play an instrument
• Garden
4. Nutrition
• Eat healthfully
• Vitamins: especially the B Vitamins
• Supplements (see a nutritionist)
5. Create a Support Group
• Family
• Friends
• Community, both secular and spiritual
6. Spirituality
• Prayer
• Meditation
• Volunteer Work
7. Short-Term Counseling
• Dream work
• Guided Visualization
• Emotional Release

Surgery is not generally on most people's wish lists for holiday breaks. Yet, many people do schedule surgery of all types during vacations to give themselves extra time to recuperate. Every surgery, large or small, is stressful. Managing your stress can affect the outcome of your surgery since stress depresses the immune system and provokes fear and its attendant chemical implications, which often complicate recovery.

Researchers at Harvard and U.C. Davis have documented the benefits of preparing for surgery and reducing pre-operative stress. People who are mentally and physically prepared for surgery generally experience an easier surgery because the body is more relaxed. The more relaxed you are, the fewer complications you have. Relaxed patients are reported to endure less pain, need less medication and have shorter hospital stays.

Many people going in for surgery do so passively, unaware that taking charge of the experience can be tremendously beneficial. Similarly, many doctors haven't been trained to help patients prepare mind and body for the anxiety-filled days and weeks before surgery. Preparation that reduces anxiety can make a critical difference in the surgical outcome and the recovery.

For me, the need to prepare for surgery was quite unexpected. A routine, annual check-up revealed some troubling results and my doctor recommended surgery within the next few months.

As a psychotherapist who practices with a mind/body approach, I decided to use this experience as an experiment and scheduled my procedure six weeks hence. My goal was to concentrate on aspects of my physical, emotional and spiritual self to see if I could make a difference with the stress and fear I was feeling. Here's what I learned.

• Learn to Breath More Effectively. Breathing exercises clearly had a relaxing effect for me in my most anxious moments. When tense, breathing becomes shallow, relegated to one's upper chest. Full, deep, slow breaths were not only calming but also allowed the emotions that I had been suppressing to come to the fore. (See my article on stress management for simple breathing exercises.)
  
  
• Feel Your Feelings. By getting in touch with sadness, anger and fear rather than suppressing or denying them, I had the chance to work with each feeling by myself and with my therapist. For example, when anger arose about my surgery and the sudden change the surgery forced in my career plans, I discovered that laughter, triggered by listening to comedy albums, relaxed me.
  
  As I expressed each emotion, I found that stress lifted for a time until the next feeling emerged. It was quite freeing to discover that cycling through a feeling completely often led to a relaxed state. Over the weeks, with repeated practice, I was surprised to discover that I actually was able to feel peaceful and even joyful after articulating and releasing my feelings.
  
  
• Draw on Your Dreams. I recorded all my dreams in a dream journal. This exercise paid big dividends. One night, I had an astonishing dream that led me to believe that I would get through the surgery successfully. In the midst of tumult, it was extremely important to find an inner sense of guidance and this dream provided it. So, too, guided visualization exercises, a form of "waking dreaming," helped me imagine the surgery going smoothly and reduced my fear of uncertainty and the unknown.
  
  
• Get In Shape. I decided to train as if I were going to run a 5k race. I reasoned that if my body were in shape, the trauma would be better absorbed. I ran on the treadmill every day, ate healthfully, made sure I took a good regimen of vitamins and supplements and got a weekly massage.
  
  
• Create A Support Group. You don't have to go through surgery alone though managing the information you decide to share is important. I asked family members, friends and my spiritual community for prayers over the six-week preparation period and especially on the morning of surgery. Just knowing that I had so much support buoyed me in my worst moments and effectively balanced my anxiety.
  
  
• Educate Yourself. Gather information about your condition on the Internet or in the Library. Ask your surgeon what s/he will allow you to bring into the OR with you (e.g. tape player, music, affirmations). Try to meet your anesthesiologist beforehand. Get to know the policies and procedures of the pathology slide department. Request copies of all tests and pathology reports for your files. Donate your own blood before your surgery.
  
  
• Connect With Spirit. Meditation, prayer and asking God to help bring into being the desired outcome, instilled confidence, hope and a sense of safety in the midst of uncertainty.

Pragmatically speaking, most people may not be willing or able to spend six weeks preparing for surgery as I did. Know that, essentially, anything that brings you relaxation will result in pre- and post-surgery benefits, even if you begin just a few days prior to surgery. Don't reinvent the wheel. Start with things you already enjoy. Listen to calming music. See funny movies. Paint. Sew. Dance. Imagine yourself full of life and energy. If possible, add one new practice like deep breathing or guided visualization to your daily regimen.

How did I fare? The morning of my surgery, I walked into the OR with a 110/80 blood pressure. My pulse was 65. I was feeling relaxed and confident. My stress was in the "green" zone. I introduced myself to the surgical team and asked them to talk to me as if I were awake. Taking some deep breaths, headset with calming music in place, I signaled the anesthesiologist to begin. My surgery went easily and I was home on my way to a complete recovery within a week.

Don works with individuals and families preparing for surgery. Also, contact Don for a preparation for surgery workshop at your hospital or organization. 212-288-1929

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Last Updated 6/25/2008

Copyright © Don Cohen 2001-2008