Warning signs and ways to manage stress

Try these techniques to prevent stress from leading to health problems

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, said Angela Nolz, a Sanford Health integrated health therapist in Luverne, Minnesota. But stress is not the same as anxiety, she explained. Anxiety, considered a clinical disorder, is a dread or fear that’s persistent and ongoing but may not have a trigger.

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

Some people experience a higher level of stress than others, and stress can be detrimental physically and mentally. Nolz discusses some warning signs of stress and high stress, as well as some ways people can help manage stress when they recognize it.

What causes stress?

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

  • Finances: Finances can be a significant cause of stress, especially during the COVID-19 pandemic when some people are out of work or furloughed from work.
  • 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 Nolz sees.
  • Parenting: Parenting can certainly produce stress at any time, but particularly during a pandemic that has disrupted school and typical activities.
  • 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. Nolz said a team-based approach to care at Sanford Health helps identify and address when someone with an illness feels under stress.
  • The pandemic: Right now, the whole world is under a new layer of stress because of COVID-19, Nolz said. On top of a person’s everyday stressors, the pandemic piled on factors such as layoffs, challenges for essential workers, school closings, school openings, staying healthy — and the search for toilet paper.
  • 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,” Nolz said. “… 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,” Nolz said.

Muscle tension

Physically, stress can show up in people as muscle tension, Nolz said. 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,” she said.

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,” Nolz said.

Ongoing stress could lead to stomach ulcers and also be associated with heart issues. As part of her job, Nolz 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 said. 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, Nolz said.

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 manage stress?

Nolz sees living a healthy lifestyle as key to helping people prevent and manage stress.


Staying on a sleep schedule helps you get a good quality, and quantity, of sleep. Nolz 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,” Nolz said.

Keep a schedule during the daytime, too, Nolz recommends: Exercise at certain times, eat at certain times.


For movement, find things you enjoy doing to help prevent and handle stress. Nolz urges people to go outside. “Nature is not closed,” she said.

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, Nolz said.

Connect with others

Connection is another key to less stress.

“That is vital,” Nolz said. “We are truly a species that needs connection.” Check in with loved ones. Be purposeful about communicating with friends and family via a phone call, FaceTime, Zoom or whatever works best.

Nolz also suggests finding a volunteerism outlet — whatever might engage you. Your kids could enjoy it, too. It’s one way Nolz 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,” Nolz said.

Deep breathing

She teaches people to practice a four/seven/eight breath process:

  1. Breathe in as you count to four.
  2. Hold your breath as you count to seven.
  3. Release your breath as you count to eight.

“Doing that three times in a row can help to oxygenate the blood and helps to bring that cortisol level down,” Nolz said. 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, Nolz said. 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,” Nolz said.

Ultimately, Nolz said, remember that it’s not selfish to take care of yourself. And intentionally connecting with others, especially during a pandemic, will help you and them.

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Posted In Behavioral Health, Health Information, Healthy Living, Luverne, Symptom Management, Workplace Health