Cognitive-Behavioral Techniques
Cognitive-behavioral methods are the most effective ways to reduce stress. They include identifying sources of stress, restructuring priorities, changing one’s response to stress, and finding methods for managing and reducing stress. This approach my be particularly helpful when the source of stress is chronic pain or other chronic diseases.

Identifying Sources of Stress. It is useful to start the process of stress reduction with a diary that keeps an informal inventory of daily events and activities. While this exercise might itself seem stress producing (and yet one more chore), it need not be done in painstaking detail. A few words accompanying a time and date will usually be enough to serve as reminders of significant events or activities.

 
• The first step is to note activities that put a strain on energy and time, trigger anger or anxiety, or precipitate a negative physical response (eg, a sour stomach or headache).  
• Also note positive experiences, such as those that are mentally or physically refreshing or produce a sense of accomplishment.  
• After a week or two, try to identify two or three events or activities that have been significantly upsetting or overwhelming.

Questioning the Sources of Stress. Individuals should then ask themselves the following questions:

 
• Do these stressful activities meet their own goals or someone else’s?  
• Have they taken on tasks that they can reasonably accomplish?  
• Which tasks are in their control and which ones aren’t?

Restructuring Priorities: Adding Stress Reducing Activities. The next step is to attempt to shift the balance from stress-producing to stress-reducing activities. Eliminating stress is rarely practical or feasible, but there are many ways to reduce its impact. One study indicated, in fact, that adding daily pleasant events has more positive effects on the immune system than reducing stressful or negative ones. In most cases, small daily decisions for improvement accumulate and reconstruct a stressed existence into a pleasant and productive one.

Consider as many relief options as possible. Examples include the following:

 
• Take long weekends or, ideally, vacations.  
• If the source of stress is in the home, plan times away, even if it is only an hour or two a week.  
• Replace unnecessary time-consuming chores with pleasurable or interesting activities.  
• Make time for recreation. (This is as essential as paying bills or shopping for groceries.)