Warning signs and ways to manage stress

Warning signs and ways to manage stress

Feeling stressed? You’re not alone. Stress happens to everyone, and these days we have plenty of occasions to feel it.

“Stress is a response to something that has occurred or to some kind of pressure you feel,” says Angela Nolz, a Sanford Health integrated health therapist in Luverne, Minnesota. “But stress is not the same as anxiety. Anxiety, considered a clinical disorder, is a dread or fear that’s persistent and ongoing but may not have a trigger.”

Some people experience a higher level of stress than others, and stress can be detrimental physically and mentally.

“I’ve never met anybody that hasn’t ever experienced stress,” Angela says. “But not everybody experiences anxiety.”

Angela discusses some warning signs of stress and high stress, as well as some ways people can manage stress when they recognize it.

What causes stress?

Everyone’s life circumstances are unique to them, but Angela does see some common sources of stress.

  • Finances: Finances can be a significant cause of stress when a person is on a fixed income or has lost a job .
  • Work: Work itself can be a source of stress, especially if the work doesn’t feel purposeful or feels too limited. Lacking a sense of direction in a career and not knowing what kind of work you want to do can also result in stress.
  • Relationships: Discord in a close relationship, like a partnership, is a common stressor that Angela sees.
  • Parenting: Parenting can produce stress at any time and no matter how old the children are.
  • Life changes: Life adjustments add stress, such as the transition to college, having a baby, getting married, helping aging parents or losing a family member or close friend.
  • Illness: A chronic health condition such as cancer, diabetes, heart disease or obesity can add stress. Trying to decide the steps to take to improve health can feel overwhelming. Angela says a team-based approach to care at Sanford Health helps identify and address when someone with an illness feels under stress.
  • Differing opinions: Communicating with those who have differing political views also may add stress. “It seems like we’ve lost the ability to seek first to try to understand each other,” Angela says. “… We’ve lost the ability to connect and communicate and just love each other, even if we have some differing opinions.”

What can stress do to us?

“We have a breakdown of physical, emotional and behavioral things that we’ll see when people have an influx of stress,” says Angela.

Muscle tension

Physically, stress can show up in people as muscle tension, she says. They might have pain in their lower back, shoulders or neck, or have headaches.

“When our stress goes up, our body can experience stress through those different kinds of reactions.”

Stomach and heart issues

Stomach issues also may be traced to stress. “Kids will sometimes present with a stomachache when there’s some stressful things going on in their lives, and they maybe don’t have the words,” Angela says.

Ongoing stress could lead to stomach ulcers and also be associated with heart issues. As part of her job, Angela visits with cardiac rehab patients about their stress level.

“If I meet with somebody that identifies that their stress has been fairly low, their healing process typically goes a little bit better,” she says. For patients who have had significant ongoing stress, she helps find new strategies for coping with their stress.

Emotional and behavioral issues

Emotionally, stress can result in feelings of irritability, impatience, guilt, nervousness, helplessness or lack of control.

Behaviorally, stress may lead to changes in eating and sleeping habits, forgetfulness, anger, aggressiveness, social withdrawal or substance abuse.

If people start to develop substance abuse disorders, by using alcohol as a coping mechanism, for example, significant physical health issues appear, too, says Angela.

Ultimately, high stress can interfere with how people function in life and take care of their basic needs. It can be detrimental to their work, relationships and parenting abilities. And if stress is ongoing and symptomatic, it could rise to the level of clinical anxiety.

How can we prevent and handle stress?

Angela sees living a healthy lifestyle as key to helping people prevent and handle stress.


Staying on a sleep schedule helps you get a good quality, and quantity, of sleep. Angela recommends going to bed and waking up at the same time every day. Maintain a bedtime routine. Stop looking at screens an hour before bedtime. Use your sleep space only for sleeping.

“If we’re doing our work on our laptops, then our brain associates our bed with doing work,” Angela says.

Keep a schedule during the daytime, too. Angela recommends exercising at certain times and eating at certain times.


For movement, find things you enjoy doing to help prevent and handle stress. Angela urges people to go outside.

Families can enjoy visiting parks, hiking, riding bikes, rollerblading, riding scooters, or simply playing. Even adults can enjoy playing games like kickball.

Stay hydrated

Also make sure you’re eating well and drinking enough water, Angela says.

Connect with others

Connection is another key to less stress.

“That is vital,” says Angela. “We are truly a species that needs connection.” Check in with loved ones. Be purposeful about communicating with friends and family .”

Angela also suggests finding a volunteerism outlet – whatever might engage you. Your kids could enjoy it, too. It's one way she reduces her stress. “It’s being able to be part of the greater good – to be able to support my family but also my community and my patients.”

Be sure to know yourself and the healthy boundaries you need to set as well. If you’re prone to agreeing to do too many things and feel like one more would just add stress or resentment, it’s OK to say no.

I feel stressed right now. What can I do?

“If it’s stress in this very moment, the best thing you can do is some meditation and mindfulness, so some deep breathing,” Angela says.

Deep breathing

  1. She teaches people to practice a four/seven/eight breath process:
  2. Breathe in as you count to four.
  3. Hold your breath as you count to seven.
  4. Release your breath as you count to eight.
  5. “Doing that three times in a row can help to oxygenate the blood and helps to bring that cortisol level down,” Angela says. “Cortisol is a stress hormone in the body.”


She also suggests a mindfulness practice using the senses. Pay attention to only one sense for a short period of time. She gives the example of an Altoid mint.

“Just pay attention to your sense of taste while that mint dissolves. It only takes about three minutes for that to happen,” she said. But that’s long enough to calm the brain.

Great outdoors

Entering nature can help in the moment – no park necessary. Just step out the door and notice the flowers, or grass, or insects, or trees, or breeze, or clouds, or the sun’s warmth.

Even just saying the words, “I feel stressed,” or whatever emotion you feel, can help, Angela says. Or write down your feelings if you don’t want to say them out loud.


Gratitude can help, too. “If we can take a moment in the middle of stress to be grateful for something, that helps us to reset,” Angela says .

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