*This is an article from the Spring 2023 issue of Contentment Magazine.
By Josh Briley, PhD, BCMAS, FAIS
In this issue, we are discussing the beneficial effects nature can have on stress levels. Going for a walk outside, exposing yourself to moderate amounts of sunlight, the smell of an ocean, or the sounds of a rainstorm are just some of the natural elements that have been shown to reduce both acute and chronic stress. As a part of an overall self-care plan, these natural elements can help diminish the emotional and physical risks of chronic stress levels.
But what if such interventions are not readily available? What if you live in a land-locked area and cannot easily go for a walk on the beach, or open your window and smell the ocean? What if you live in an area that is dark or cloudy for several days or weeks at a time? Or if you are already taking advantage of these natural elements and just need a little something extra to help reduce your chronic stress? Regardless of whether these apply to you, taking advantage of electromedical devices as an alternative or a supplement for the stress relieving benefits of nature can be beneficial. This article will not promote specific devices. Rather, it will discuss a few of the more common or most effective electromedical technologies that can provide similar stress relieving benefits as nature.
Sunlight, in moderation, has many benefits, both for physical and mental wellbeing. Sunlight can increase Vitamin D levels, which has both mood and physical health benefits. Cultures throughout history have known that prolonged periods of stormy weather have a negative impact on mood and stress levels compared to periods of ample sunshine. One of the many techniques this author recommends to clients who are struggling with anxiety and depression is to go outside and walk for at least 15 minutes. Clients who consistently follow this suggestion report feeling less stressed and more optimistic.
Photobiomodulation (PBM), more commonly known as “light therapy,” is the use of different wavelengths of light, including lasers, for health benefits. Research indicates PBM may have several beneficial effects on the body, including antioxidant and immune system effects that improve cardiac and circulatory functioning.1 PBM use is increasing in fields such as dentistry, diabetes management, and dermatology. PBM is also demonstrating promising treatments for nervous system disorders such as Major Depressive Disorder, Parkinson’s, traumatic brain injury (TBI), and spinal cord repair.1 There are PBM devices that are designed for use by healthcare practitioners, and those that are designed for home use. Do not attempt to use home-based light therapy devices to treat any disease without consulting a physician.
Perhaps the best-known type of light therapy is the use of full-spectrum sun lamps, also called light boxes. One contributing factor to Seasonal Affective Disorder may be the lack of sunlight in areas with harsh climates. This decrease in available sunlight has a negative impact on emotional wellbeing. Sun lamps are believed to help offset this lack of sunlight by providing light in similar frequencies as sunlight, and therefore providing similar benefits to sunlight to both emotional and physical wellbeing.
Infrared therapy is another type of light therapy. This approach uses light in the infrared spectrum to achieve the physical and emotional benefits of PBM treatment. Research demonstrates infrared light may be the most potent stimulus for the physical benefits of PBM.2 These benefits include reducing inflammation in the body. Infrared light has been shown to be an effective treatment option for wound healing, hair regrowth, pain reduction, and skin rejuvenation. Infrared therapy has also demonstrated benefits in reducing depression, anxiety, insomnia, and other emotional effects of chronic stress.
The auricular nerves, which carry sound from our ears to our brain, activate the limbic system in our brains, which are directly associated with emotional states. Therefore, noises in our immediate environment can evoke feelings of tranquility and safety, or of stress and danger. Many people relax quickly when they hear the sounds of water, whether a babbling brook or the rolling ocean waves. Gentle rainstorms can also generate sounds that promote feelings of relaxation. Hearing natural ambient sounds such as birds singing, a gentle wind, or leaves rustling promote calmness and has natural stress reduction properties. However, other sounds in nature, such as a sudden and complete cessation of all ambient animal noises, sharp cracks of thunder, or a loud roar or howl from a predator, instills a sense of stress and danger. In more urban areas, chaotic sounds such as those of traffic, construction, emergency vehicle sirens, and airplanes, create a sense of unrest and increase our stress responses, both physical and emotional.
Finding ways to escape the cacophony of urban noises is beneficial for both short-term and long-term stress management. While natural environments are best for this type of escape, such options may be limited for people living in large urban areas. Also, escaping to a quiet, natural area may not be possible during one’s workday. However, there are ways to use devices to achieve a similar effect.
Listening to music not only evokes emotional memories, but also results in a decrease in heart rate, warming of the skin, and an overall sense of well-being,3 which are all indications of profound reductions in stress levels. Music can also help to block out the more chaotic sound elements in the environment, further enhancing stress reduction. Massage therapists, spas, and many psychotherapists frequently use soft, pleasant music in their offices to enhance a sense of calm and reduction in the stress levels for visitors.
Electromedical devices, including the use of apps, can provide recordings or recreations of nature sounds. Recorded nature sounds have been shown to be more pleasant and reduce physiological effects of stress more than ambient urban noises or nonspecific ambient noise.4 The researchers suggested that one contributing factor to a faster recovery with recorded nature sounds is the pleasant association associated with such sounds.
Ambient sound frequencies have also been shown to have a beneficial effect on stress levels. It has long been known that loud, chaotic, and intrusive noises have a negative effect on stress management, productivity, and creativity. Low frequency ambient noise, however, has a calming effect on the nervous system and therefore can reduce immediate and long-term stress levels. Noise generators provide different sound frequencies, such as “white noise,” “brown noise,” “pink noise,” or “green noise,” that can induce relaxation. These noise generators can be standalone devices, but there are also apps, such as Calm and BetterSleep, that generate these frequencies as well. Many therapists utilize ambient noise generators both to provide a soothing soundscape for clients, but also to prevent what is said in the therapy room from being heard in the waiting room. It is believed that such noises can help block more disruptive background noises and therefore improve stress reduction and sleep. However, systematic reviews of this claim have found mixed evidence. For some people, such ambient background noise may improve quality and quantity of sleep, but others may find such noises disruptive to sleep.5
Additionally, subsonic and repetitive frequencies, such as binaural beats, can have a beneficial effect on the nervous system and physical effects on stress levels (including high levels of stress), ability to sleep and dream, and even focus or concentration.6 Al-Shargie et al. demonstrated quite profound stress reduction, even mitigating the response during a stress-inducing condition, when participants listened to 16 Hz binaural beats.6 Other repetitive frequencies have been shown to have a beneficial effect on relaxation, sleep, meditation, and emotional distress. This author utilized an isochronic tone of 20 Hz to aid in focus improvement during the writing of this article.
Brief exposure to either heat or cold can have a beneficial effect on stress reduction and mitigating the physical effects of stress. Cold temperature therapies have been shown to alleviate the physical effects of stress, reduce inflammation, and aid in recovery. Almost all of us, when treating the swelling associated with an injury, have been advised by our doctors to “ice it.” Additionally, “ice baths” are commonly used among athletes to reduce muscle inflammation and promote healing. Similarly, cryotherapy is gaining in popularity, availability, and acceptance to reduce pain and irritation, improve mood, and to reduce the inflammatory and oxidative effects of stress. Whole-body cryotherapy treatment (WBCT) has been shown to help reduce pain and/or inflammatory processes and improve quality of life.7 WBCT also significantly reduced depression8,9,10 and anxiety.9,10 WBCT significantly enhances the psychological and physical well-being of users, and consequently has a positive impact on their quality of life.10
Heat treatments can have similar physical and emotional benefits. Heating pads are commonly used to relieve short-term pain in backs, shoulders, and other parts of the body. Heating pads may also be utilized to promote relaxation in the muscles, which helps to directly counter the muscle tension that accompanies stress, especially periods of prolonged stress. By relaxing these taut muscles, an emotional relaxation often follows.
Saunas have long been used to aid in recovery after physical activity, for relaxation, and detoxifying the body. Heat treatment utilizing saunas was found to have several stress-reduction benefits for people in high stress occupations (such as law enforcement, firefighters, and military personnel).11 A single sauna bathing session improves metabolic functioning, blood pressure, cardiovascular function, and increases tolerance to future stressors.11 The benefits are increased with repetitive treatments.
Immersion in hot springs has been long known to have significant health benefits. A survey of visitors to a hot spring in Australia revealed most respondents reported improved health and sleep following bathing in the spring.12 Hot tubs or jacuzzis may have similar beneficial effects, adding the soothing effects of submersion in water to aid in relaxation and reduction of muscle pain or tension. Warm water immersion resulted in physiological changes that are indicative of stress-reduction and health benefits, including decrease in blood pressure, improved heart rate variability, and core body temperature.13 Such physiological improvements are also believed to have a positive effect on stress-reduction and mental wellbeing.
“Neuromodulation” is a general term referring to any technology that has a direct effect on the nervous system. These devices are medical devices to treat symptoms of anxiety, insomnia, and depression, among other mental health difficulties. Such mental health difficulties are often exacerbated by, or even primarily caused by, prolonged stress. Therefore, while not expressly cleared for stress management, these devices can alleviate the nervous system responses to stress and provide relief from the physical and emotional reactions to stress. While some neuromodulation devices require administration in a doctor’s office, there are hand-held devices that can be used by patients at home. Two such devices are vagal nerve stimulators and cranial electrotherapy stimulation (CES) devices.
Vagal nerve stimulators, once solely available through surgical implant, are now being designed as hand-held devices that can be utilized as needed. Vagal nerve stimulators work by activating the vagas nerve, which is the nerve that runs from the brain stem into the neck and abdomen. This nerve is involved in activating the parasympathetic nervous system (known as the “rest and digest” system, activating this system ceases activation of the sympathetic nervous system, the “fight or flight” system, which is often activated in response to stress). Vagal nerve stimulators activate the vagus nerve in an attempt to stop the fight or flight response and reduce both the physiological and emotional effects of chronic and/or severe stress.
Another hand-held neuromodulation technology is cranial electrotherapy stimulation (CES). CES devices are designed for home use. Although CES devices do require an order from a licensed health care provider in the U.S., they are over the counter in other countries, and treatments can be conducted by the patient in the comfort of their home at a time and place convenient for them. In the United States, CES is cleared by the FDA for anxiety, insomnia, and depression, which can result from chronic or severe stress. CES involves the conduction of microcurrent (in the microamp or milliamp range) across the head by the application of electrodes on the earlobes, over the ears, or temples (depending on the device). The current travels along the cranial nerves to the brain stem and then has a balancing effect on the nerves in the brain. An alpha state (a sense of tranquility) is automatically induced, and users report feeling very relaxed and calm at the end of a CES treatment. CES has been shown to improve the physical and emotional effects of stress, such as skin temperature, muscle tension, and pulse rate,14 as well as anxiety,15,16 insomnia,16,17,18 and depression.15,16,19
Incorporating natural elements into your self-care and stress management routines are best. Partly because our bodies are designed to be in nature, and partly because anything utilizing nature will incorporate multiple senses and have a cumulative effect on stress reduction. For example, a simple walk in the woods provides sunlight, pleasant scenery and sounds, fresh air, and movement. Each of these elements individually reduce stress and improve a sense of wellbeing, so the additive benefit of combining these elements increases the physical and emotional benefits exponentially. However, the use of electromedical devices can augment or be used as a short-term substitute for natural interventions to reduce stress and improve wellbeing. PBM, sound therapy, heat and cold therapies, and neuromodulation devices can provide similar physical and emotional benefits. Best of all, such electromedical devices can be used together with natural elements to enhance stress-relieving effects. For example, one can listen to music or take a walk in a park while conducting a CES treatment and experience a greater effect than either modality used separately. Electromedical devices are an effective, and possibly frequently overlooked, resource for effective stress management.
- Dompe, C., Moncrieff, L., Matt’s, J., Grzech-Leśniak, K., Kocherova, I., Bryja, A., Bruska, M., Dominiak, M., Mozdziak, P., Skiba, T., Shibli, J.A., Voploni, A.A., Kempisty, B., & Dyszkiewicz-Konwińska, M. (2020). Photobiomodulation – Underlying Mechanisms and Clinical Applications. Journal of Clinical Medicine (9),
- Glass, G.E. Photobiomodulation: A review of the molecular evidence for low level light therapy, Journal of Plastic, Reconstructive & Aesthetic Surgery, Volume 74, Issue 5, 2021, Pages 1050-1060, ISSN 1748-6815, https://doi.org/10.1016/j.bjps.2020.12.059.
- Salamon, E., Kim, M., Beaulieu, J., & Stefano, G.B. (2002). Sound Therapy Induced Relaxation: Down Regulating Stress Processes and Pathologies, BioSonic Enterprises. Retrieved March 5, 2023 from Microsoft Word – Sound Therapy Research – formatted.doc (lbdtools.com)
- Alvarsson, J.J., Wiens, S., & Nilsson, M.E. (2010). Stress Recovery during Exposure to Nature Sound and Environmental Noise, International Journal of Environmental Research and Public Health, 7, 1036-1046; https://doi.org/10.3390/ijerph7031036.
- Riedy, S.M., Smith, M.G., Rocha, S., & Basner, M. (2021). Noise as a Sleep Aid: A systematic review. Sleep Medicine Reviews, 55, https://doi.org/10.1016/j.smrv.2020.101385.
- Al-Shargie, F., Katmah, R., Tariq, U., Babiloni, F., Al-Mughairbi, F., & Al-Nashash, H. (2022). Stress Management Using fNIRS and Binaural Beats Stimulation, Biomedical Optics Express, 13, https://doi.org/10.13664/BOE.455907
- Vitenet, M. Tubez, F., Marreiro, A., Polidori, G., Taiar, R., Legrand, F., & Boyer, F.C. (2018). Effect of whole-body cryotherapy interventions on health-related quality of life in fibromyalgia patients: A randomized controlled trial, Complementary Therapies in Medicine, Volume 36, 6-8, ISSN 0965-2299, https://doi.org/10.1016/j.ctim.2017.10.011.
- Doets, J.J.R., Topper, M., & Nugter, A.M. (2021). A systematic review and meta-analysis of the effect of whole body cryotherapy on mental health problems, Complementary Therapies in Medicine, 63, https://doi.org/10.1016/j.ctim.2021.102783.
- Rymaszewska J, Ramsey D, Chładzińska-Kiejna S. Whole-body cryotherapy as adjunct treatment of depressive and anxiety disorders. Arch Immunol Ther Exp (Warsz). 2008 Jan-Feb;56(1):63-8. doi: 10.1007/s00005-008-0006-5. Epub 2008 Feb 5. PMID: 18250970; PMCID: PMC2734249.
- Szczepańska-Gieracha J, Borsuk P, Pawik M, Rymaszewska J. Mental state and quality of life after 10 session whole-body cryotherapy. Psychol Health Med. 2014;19(1):40-6. doi: 10.1080/13548506.2013.780130. Epub 2013 Mar 27. PMID: 23535078.
- Henderson KN, Killen LG, O’Neal EK, Waldman HS. The Cardiometabolic Health Benefits of Sauna Exposure in Individuals with High-Stress Occupations. A Mechanistic Review. International Journal of Environmental Research and Public Health. 2021; 18(3):1105. https://doi.org/10.3390/ijerph18031105
- Clark-Kennedy, J. & Cohen, M. (2017). Indulgence or therapy? Exploring the characteristics, motivations and experiences of hot springs bathers in Victoria, Australia. Asia Pacific Journal of Tourism Research, 22, 501-511. https://doi.org/10.1080/10941665.2016.1276946.
- Becker, Bruce E.; Hildenbrand, Kasee; Whitcomb, Rebekah K.; and Sanders, James P. (2009) “Biophysiologic Effects of Warm Water Immersion,” International Journal of Aquatic Research and Education: Vol. 3: No. 1, Article 4. DOI: https://doi.org/10.25035/ijare.03.01.04
- Heffernan, M. (1995). The Effect of a Single Cranial Electrotherapy Stimulation on Multiple Stress Measures. The Townsend Letter for Doctors and Patients, 147, 60-64. Presented at the Eighth International Montreux Congress on Stress, Montreux Switzerland, February 1996.
- Barclay, T.H. & Barclay, R.D. (2014). A Clinical Trial of Cranial Electrotherapy Stimulation for Anxiety and Comorbid Depression. Journal of Affective Disorders, 164, 171-177. Presented at the American Psychological Association National Conference, Honolulu, HI, July 2013.
- Morriss, R., Xydopoulos, G., Craven, M., Price, L., & Fordham, R. Clinical Effectiveness and Cost Minimisation Model of Alpha-Stim Cranial Electrotherapy Stimulation in Treatment Seeking Patients with Moderate to Severe Generalised Anxiety Disorder. Journal of Affective Disorders, 253, 426-437.
- Aseem, A. & Hussain, M.E. (2019). Impact of Cranial Electrostimulation on Sleep: A Systematic Review, Sleep Vigilance, 3, 101-112.
- Price, L.R., Briley, J., Hitching, R. (2020). A Meta-Analysis of Cranial Electrotherapy Stimulation in the Treatment of Insomnia. Annals of Psychiatry and Mental Health, 8.
- Price, L., Briley, J., Haltiwanger, S., & Hitching, R. (2021). A Meta-Analysis of Cranial Electrotherapy Stimulation in the Treatment of Depression. Journal of Psychiatric Research, 135, 119-134.