Daily Habits for Reducing Stress and Improving Performance19 min read

Occasionally I get stressed, I think we all do, if you don’t you are some sort of superhuman. And, usually, this stress is ok. A tough test, an important argument; stress usually helps us perform better. Sometimes, however, it can become too much; the stress can build to the point where it begins to hinder performance.

There is an inverted-U-shaped relationship between stress levels and cognitive performance.⁸

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When we get stressed beyond that hump, the top of the upside-down U, our brain starts to fizzle and our performance suffers.

This post will discuss 3 evidence-supported interventions to combat stress that you can implement daily.

These are not only what I think are best, but are supported heavily in academic journals. There is no particular weighting to each of these interventions.

For video insert intro here: “If you don’t me my name is zach and I’m an MS3 (make a big deal out of this) in Philadelphia.

As a disclaimer, I am not a medical professional and nothing in this post is medical advice. These are just articles and tactics that I have found personally helpful and the literature supports. I am definitely biased here, I looked for articles to support my arguments, so, even though I am referencing highly reputed academic journals, you should take everything I say with a hint of skepticism. Check out my sources, maybe you will disagree with me or the researchers. Also, I do not mention eating or sleeping properly, which are extremely important, because this post would become way too long.

What is Stress?

Let’s start with what stress is:

Stress is defined as a state of threatened or perceived by the individual as threatened homeostasis and it is re-established by a complex repertoire of behavioural and physiologic adaptive responses of the organism.¹

More simply it’s our body’s response to a perceived threat.

The World Health Organization reports stress as the second most frequent health problem, impacting one-third of employed people in the European Union.²

Stress has been associated with cardiovascular disease⁴, obesity⁵, and depression.^6,7

More interestingly, studies in humans show actual physical changes to the brain (specifically the hippocampus and amygdala) when exposed to stress for certain periods of time.^9,10

So how can we fight excess stress? Let’s start with mindset.

Positive Mindset

I want to eliminate some misconceptions about a positive mindset. A positive mindset does not mean ignorance of the bad and over-emphasis on the good. The best way to think about it is that you are approaching unpleasantness in a more positive way, “hmm this workout is very hard and my legs are tired as shit, but that’s ok it means I am getting stronger,” or something like that. It does not mean ignoring that a relative died or you failed a test, that would be dumb. It just means thinking about or processing these events in different ways.

Positive thinking is assosciated with physical changes in the amygdala and hippocampus when humans practice it.^9,10

For the sake of brevity, I will focus on three aspects of having a positive mindset, that you can focus on daily. This is the longest section as I feel it is the most important.

• Eliminating Negative Thinking
• Focusing on Positive Thinking
• Self-Esteem

Eliminating Negative Thinking

One of the most important things you can do, when a negative thought arises is identify it. The other day I was stuck in traffic and my mind immediately went to, “this sucks, why is everyone so slow, why would anyone buy one of those cube cars?” Normally, this thought would permeate my brain and that’s that; the status quo. However, remembering I was working on this post, I thought about my thought. Crazy right?

I identified my negative thought. Nothing else. It helped. Some more specific ways negative thought pops up that I like to look out for:

1. Filtering: magnifying and only focusing on the negative parts of what is going on. Not the positive ones. I just played an amazing game of tennis, my forehand, backhand, and volleys were all amazing. But my serve was weak and that’s all I could think about.
2. Personalizing: everything is your fault (sorry Jocko sometimes things can actually not be your fault). My friends were supposed to meet me for coffee, they had to cancel, which immediately means that they hate me and no longer want to be friends with me.
3. Worst-Case Scenario: The worse is going to happen. You spill your coffee in the morning. Therefore, the rest of the day has been determined to be a “bad day.”

Any of these sound familiar? They do to me.

Step 1: Identify it.

What is this thought popping into my head? Is it negative? Am I being reasonable about this negative thought? Can I just identify this thought and not attach emotion to it as either a “good” or “bad” thing?

Step 2: Spin it positive.

Is there something positive about the negative thought I just had? Can “this seems really hard,” become, “this is an amazing opportunity to learn and grow stronger.”

…everything can be taken from a man but one thing: the last of the human freedoms – to choose one’s attitude in any given set of circumstances, to choose one’s own way.

Victor Frankl – Man’s Search For Meaning

Take Action: What is one thing you constantly negatively think about, the gym? A tough commute? Pick one thing. The next time you are doing this thing pay super close attention to your thoughts. Can you identify the negative thought? Can you turn it into a positive thought?

Bottom Line: Negative thinking tends to be the status quo, identify it and turn it into a positive thought.

Focusing on Positive Thinking

Positive thinking is where we want to be. Hopefully, some of our negative thoughts are becoming positive thoughts. Maybe we can grasp onto that positive thought a little bit longer, or, if we want to go really wild, maybe we can even begin to notice new positive things.

Here are some ways we can find these new positive things, but, remember. We are only “finding” them because they were lost to us. In reality, these positive things were always there.

1. Notice your surroundings and mind, what’s good?: That breeze feels nice, I never noticed that beautiful artwork over there, how cool is it to have a hot shower. (This is a form of meditation, more on that later…)
2. Be open to humor: Smile and laugh especially in difficult times. Find the humor, maybe you even make someone else smile?
3. Surround yourself with positive people: You are the average of the 5 people you surround yourself with the most, ever heard that? I think it is an accurate statement. This doesn’t necessarily mean eliminating negative people from your life (though more often than not this is the best option), it could mean having a chat. Talking about how you are trying to be more positive with this person. Relaying how you feel down when negativity or complaining is the mainstay of conversation between you two and how you are trying to change.

Bottom Line: Notice the positive things around you, there are so many of them.

Self-Esteem

This is a hugely important one. Epidemiological studies (fancy word for looking at certain health aspects and their relation to specific populations) show an association between self-esteem on global health and life expectancy.¹¹

Low self-esteem and depression are also strongly related.¹²

How can this affect you in the day-to-day? Well, if you have low self-esteem maybe you hide away from friends, stop trying new things, or avoid challenges. This strategy will help you feel safe initially, but, in the long term, this is a losing strategy.

Constantly avoiding these things will reinforce the fear and anxiety around these challenging situations and establishes an unhealthy way to cope with challenge.

Similar to negative thoughts, one way to improve self-esteem is to identify the negative beliefs you have about yourself.

Step 1: Take out a piece of paper and identify a negative belief you have about yourself. “I’m too ugly to meet someone special,” or “I’m too stupid to take on this new challenge.”

Step 2: Prove these negative beliefs wrong with evidence. “Someone commented the other day on how nice I look. I feel very attractive when I wear this piece of clothing.” and “My parents and friends often ask me for advice on X. I seem to excel more than my peers at Y.”

Step 3: Go confidence crazy, write some more things that you’re good at.

Some other things I find helpful:

• Journal what you did well at the end of the day (I’ll sum this up at the end with a daily super-journal strategy)
• “Fake it til’ you make it,” usually works.
• Give yourself a challenge and work towards that goal, exercise is a great one to choose.
• Start saying “no.” You are important. Your time is valuable, be purposeful with your precious time.

You are not required to set yourself on fire to keep others warm.

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Bottom Line: Believe in yourself. Write 5 positive things about yourself every day (these can be specific accomplishments or more general).

Exercise

In one study college students participating in certain activities were questioned on mood and anxiety before and after class.¹³ Specifically:

• Swimmers had an unusually positive before-swim mood and reported less tension and confusion after swimming
• Yoga participants were significantly less anxious, tense, depressed, angry, fatigued, and confused after class than before.

This is just the tip of the iceberg.

In a randomized controlled trial, 134 patients with heart disease were given routine medical care (control), normal care plus exercise (35 minutes 3 times per week for 16 weeks), or usual care plus weekly 1.5-hour stress management training for 16 weeks. Let’s focus on the exercise arm. General distress, depression, and physical characteristics of the heart were measured.¹⁴

One result that stood out to me was the Left Ventricular Ejection Fraction (LVEF), which is how much blood the left ventricle of your heart can squeeze to your body over the amount of blood that enters the left ventricle of your heart.

LVEF showed significant improvement in those who exercise. That means the percentage of oxygenated blood in the heart that the heart can squeeze out to your body, giving your body oxygen and other things, was significantly improved with a mere 35 minutes 3 times a week; 1 hour and 45 minutes of exercise a week, for 4 months, is associated with more oxygenated blood going throughout your body. Depression and anxiety also showed a significant improvement.

The researchers concluded:

Exercise reduced emotional distress and improved markers of cardiovascular risk more than usual medical care alone.

Blumenthal et. al. 2005

Some other good things exercise does:

• Releases endorphins (feel-good neurotransmitters)
• Digestive and immune benefits
• Mood improvement

Ok so exercise is good. How do we start doing it?

The American Heart Association recommends at least 150 minutes per week of aerobic activity (brisk walking or tennis doubles) or 75 minutes per week of vigorous aerobic activity (running or tennis singles). A combination of aerobic and vigorous aerobic activity is preferable. They also recommend muscle-strengthening training at least 2 days a week, less time sitting, and increasing intensity of all of the above as you can.¹⁵

Step 0: STAY SAFE, talk to your doctor and start slowly if you haven’t exercised in a while or have health concerns, I want to reiterate again this isn’t medical advice in any way just interesting research I have found that personally has helped me.

Step 1: Identify one form of exercise that sound like fun this could be: walking, playing a sport, swimming, group fitness classes, yoga, climbing stairs, dancing, gardening, or having imaginary ninja battles with that evil apple staring at you from the corner of the room.

Step 2: Schedule it and commit to doing it at least five times a week for a month. Many sources recommend SMART goals (specific, measurable, attainable, relevant, and time-limited goals). This could be something like walking five times a week, every day after lunch for 30 minutes, for a month.

Bottom Line: Start exercising.

Meditation

Meditation can be practiced by anyone, anywhere, at any time. Before we talk about the how let’s talk about the why (with some papers of course).

22 patients with a generalized anxiety disorder or panic disorder were assessed before and during meditation-based stress reduction (MBSR) programs that took place over eight weeks. Self-ratings and therapist ratings were gathered during and three months following treatment. 20/22 (91%) of the patients showed significant reductions in anxiety and depression.¹⁷

Amazingly, at a three-year follow-up of 18/22 of the participants, 18/18 (100%) maintained their originally observed clinical improvements in every outcome measure. That’s huge! These outcomes included anxiety, depression, and panic analysis. (18) 10/18 patients continued to practice formal mindfulness, while 16/18 continued to practice the informal technique of Awareness of Breathing in Daily Life.¹⁸

Meditation is some powerful stuff.

It is important to note, however, that the technique used, MBSR, is a standardized and intensive program. Researchers need standardized methods so they can verify and test ideas against other researchers. MBSR, however, is a form of meditation. Other forms of mediation aren’t necessarily inferior or superior to MBSR, it is just a common method used when conducting experiments and treatment.

But, 22 patients isn’t enough to come to a generalizable conclusion, and most people don’t suffer from clinically significant forms of anxiety or panic. What about stress management in healthy people, does it still work? Let’s get Meta.

In a meta-analysis looking at ten studies, researchers concluded MBSR is able to reduce stress levels in healthy people.¹⁹

Ok, we’re good on the why. So let’s look at the how.

Breathing

Here’s something I do when I have very little time but want to calm down. I sometimes do this in between sections of my very important exams like my MCAT or Step 1 exam. It’s called the 4-7-8 breathing technique.

1. Breath out completely through my mouth making a whooshing sound.
2. Close my lips and inhale silently through my nose for 4 seconds.
3. Hold the breath for seven seconds.
4. Breath out through my mouth, making the whooshing sound, for 8 seconds.
5. Repeat this 4 times.

I nearly always feel better and, I haven’t tested it, but I bet I perform better after doing it as well.

Use of a similar breathing exercise in 60 healthy participants aged 17-19 yr. resulted in significant changes in parasympathetic activity (the opposite of sympathetic, which is “fight-or-flight”) as measured by various heart outcomes (20 – if you want to check out the specific breathing exercise used you can go here).

Progressive Muscle Relaxation (PMR)

PMR is exactly that, progressively relaxing each muscle in your body after tensing each one.

There is a well-written guide here from the University of Michigan or audio version here (I often use Calm or Headspace).

Basically, what I like to do, is start from my head and then progressively work down my body tensing and then relaxing each body part in a meditation position. This position could be sitting on pillow, in a chair, or laying down. It may go something like this:

The tensing phase is 4 to 10 seconds and post-tense relaxing phase is 10-20 seconds.

1. Wrinkle my forehead into a deep frown then relax
2. Close my eyes very tightly then relax
3. Smile as widely as I can then relax
4. Press my lips tightly together
5. and so on…
6. Finishing with clenching the toes then relaxing

Other Meditation

This is what is classically thought of as meditation and what I do. Although both of the above, and many other techniques mentioned here, are also meditation.

My daily meditation routine is usually a mindfulness meditation and is as follows:

I meditate 20 minutes a day directly after I shower in the morning. I built this habit by starting small (5 minutes a day) and “habit-stacking.” Habit-stacking is a technique introduced to me by Atomic Habits where you add a new habit directly after something you do regularly. I shower every morning, so I just meditated after I showered – easy. My meditation habit is “stacked” on top of my already stable shower habit.

Currently, I use Insight Timer and set it for 20 minutes with a one-minute warm-up. I sit on a cushion and cup my hands together with a straight back. The first thing I do is take 3 deep breaths, in through the nose, and out through the mouth. The next 5 minutes I spend doing a mini body scan from my head to my toes and then I just start counting my breaths. Usually, I get distracted and lose count but I try and bring myself back and just keep going from where I left off. I focus on the breath going in and out of the tip of my nostrils. I usually get up to 130 and then let everything go. I let the concentration go and watch the fireworks show behind my eyes.

I would like to build to 20 minutes in the evening as well.

When I was first starting I did a 10-15 minute guided meditation on Calm or Headspace every day. These are great and where I recommend complete newbies start. These taught me the basics of meditations and kept me consistent (the hardest part of starting a new habit).

Under recommended resources at the end of this post, I have some specific courses within each app that I liked.

Bottom Line: Meditation has been practiced for thousands of years for a reason and is a cornerstone of many therapies today. Try to meditate 10 minutes a day at least.

Summary and Taking Action

Stress is our body’s response to a perceived threat, but, sometimes, the stress response goes on overdrive. We begin stressing way more than we should and our performance suffers.

Some of the best ways to reduce stress are:

• Developing a positive mindset
  • Eliminating negative thoughts
  • Having more positive thoughts
  • Boosting your self-esteem
• Exercise
• Meditation

Daily integration of even one of these can provide significant benefits. I always exercised, but meditation and a positive mindset are things that I am working on and trying to get better at now.

This was a lot of information, how do you start taking action and de-stressing? I don’t know the best way, the only thing I know is what worked for me and what the research recommends.

I’m going to list various “action-taking” options. If you are doing none of these things I would pick one and try and stick with it for a month. Don’t overload yourself with trying to do everything at once. If you already do one of these things pick another one to add on, or maybe improve on what you are already doing.

Track your progress, use the SMART goal system, and reap the rewards.

1. The Positivity Journal: Buy a journal. Every morning, as soon as you wake up, write two things you are grateful for; two things that are good in your life. Then, before bed, write two things you accomplished that day, two things you did well, two reasons you are a bad-ass.
2. Exercise: Pick two exercises you like (maybe walking and lifting weights) and do those a total of 5 times a week for 30 minutes. This may mean on Monday, Wednesday, and Friday you go for a 30-minute walk, and on Tuesday and Thursday, you lift weights for 30 minutes. I understand it’s hard to find time, but this is your life, your body, and your mind we are talking about here.
3. Meditation: Pick a meditation (guided, mantra, mindfulness, qi jong, tai chi) and do it 5 minutes every day. Notice how you feel before and after you do it. Slowly build up to 10 minutes.

Bottom Bottom Line: Adopting a positive mindset, exercising, and meditating are great ways to reduce stress and improve performance.

Recommended Resources

*None of these links are sponsored in any way, just what I have personally found to be helpful.

• Headspace – A fantastic application that I use daily or every other day. Try the first intro to meditation courses
• Calm – An equally fantastic application as headspace that I use daily or every other day. Try the 30 days “How to Meditate” course
• Nike Run Club App – I use this whenever I Run, it’s a new habit for me that seems to be sticking thanks to this app.

Sources

1. Varvogli, Liza, and Christina Darviri. “Stress management techniques: Evidence-based procedures that reduce stress and promote health.” Health science journal 5.2 (2011): 74.
2. WHO. Facing the Challenges, Building Solution. Report from the WHO European Ministerial Conference.
3. McEwen, Bruce S. “Central effects of stress hormones in health and disease: Understanding the protective and damaging effects of stress and stress mediators.” European journal of pharmacology 583.2-3 (2008): 174-185.
4. Lambert, Gavin, et al. “Stress reactivity and its association with increased cardiovascular risk: a role for the sympathetic nervous system?.” Hypertension 55.6 (2010): e20-e20.
5. Kyrou, I., and C. Tsigos. “Hypothalamicpituitary-adrenal axis, cytokines and metabolic syndrome.” Obesity and Metabolism 2 (2006): 116-126.
6. Nemeroff, Charles B., and Wylie W. Vale. “The neurobiology of depression: inroads to treatment and new drug discovery.” Journal of Clinical Psychiatry 66 (2005): 5.
7. Lupien, Sonia J., et al. “Effects of stress throughout the lifespan on the brain, behaviour and cognition.” Nature reviews neuroscience 10.6 (2009): 434-445.
8. Lupien, Sonia J., and Bruce S. McEwen. “The acute effects of corticosteroids on cognition: integration of animal and human model studies.” Brain research reviews 24.1 (1997): 1-27.
9. Hölzel, Britta K., et al. “Stress reduction correlates with structural changes in the amygdala.” Social cognitive and affective neuroscience 5.1 (2010): 11-17.
10. Pruessner, Jens C., et al. “Self-esteem, locus of control, hippocampal volume, and cortisol regulation in young and old adulthood.” Neuroimage 28.4 (2005): 815-826.
11. Pruessner, Jens C., et al. “Effects of self‐esteem on age‐related changes in cognition and the regulation of the Hypothalamic‐Pituitary‐Adrenal Axis.” Annals of the New York Academy of Sciences 1032.1 (2004): 186-194.
12. Sowislo, Julia Friederike, and Ulrich Orth. “Does low self-esteem predict depression and anxiety? A meta-analysis of longitudinal studies.” Psychological bulletin 139.1 (2013): 213.
13. Berger, Bonnie G., and David R. Owen. “Stress reduction and mood enhancement in four exercise modes: Swimming, body conditioning, hatha yoga, and fencing.” Research quarterly for exercise and sport 59.2 (1988): 148-159.
14. Blumenthal, James A., et al. “Effects of exercise and stress management training on markers of cardiovascular risk in patients with ischemic heart disease: a randomized controlled trial.” Jama 293.13 (2005): 1626-1634.
15. https://www.heart.org/en/healthy-living/fitness/fitness-basics/aha-recs-for-physical-activity-in-adults
16. https://www.mayoclinic.org/healthy-lifestyle/stress-management/in-depth/exercise-and-stress/art-20044469
17. Peterson, Linda Gay, and Lori Pbert. “Effectiveness of a meditation-based stress reduction program in the treatment of anxiety disorders.” Am J Psychiatry 149.7 (1992): 936-943.
18. Miller, John J., Ken Fletcher, and Jon Kabat-Zinn. “Three-year follow-up and clinical implications of a mindfulness meditation-based stress reduction intervention in the treatment of anxiety disorders.” General hospital psychiatry 17.3 (1995): 192-200.
19. Chiesa A, Serretti A. Mindfulness-based stress reduction for stress management in healthy people: a review and meta-analysis. J Altern Complement Med. 2009 May;15(5):593-600. doi: 10.1089/acm.2008.0495. PMID: 19432513.
20. Pal GK, Velkumary S, Madanmohan. Effect of short-term practice of breathing exercises on autonomic functions in normal human volunteers. Indian J Med Res. 2004;120(2):115-21