Reducing everyday stress: what the evidence supports

How this ranking works

Stress is first of all a normal response. Pulse and breathing rise, and the body releases energy. It becomes a problem when recovery fails to follow. Every method in this article targets that recovery.

The order follows the strength of the evidence, not how well a method works for any one person. At the top is what has been tested in many randomised trials with many participants. Further down is what is plausible but rests on smaller or less rigorous studies. A method lower on the list is not bad, only less firmly proven. In practice, the method that helps most is the one you actually keep doing.

Strongest evidence: exercise

The largest overview comes from Australia. In 2023 a team led by Ben Singh analysed 97 reviews covering 1,039 trials and 128,119 participants. Physical activity reduced symptoms of depression, anxiety and psychological distress compared with usual care, with medium effects. Healthy adults were among the groups that benefited most.

Two details from the same paper are useful in daily life. Higher intensity activity was linked to greater improvements. And long programmes worked no better than short ones, if anything slightly worse. So there is no need to plan for months before it pays off. One caveat belongs here: many of the reviews analysed had methodological weaknesses. The direction is still clear.

In practice this means brisk walking, cycling, swimming or strength training, enough to leave you slightly out of breath. If you rarely exercise, start small, for example with a daily walk at a brisk pace.

Good evidence: mindfulness with a set programme

This does not mean any app, but mainly MBSR (Mindfulness-Based Stress Reduction). It is an eight-week course of meditation, body awareness and gentle yoga. In 2015 Bassam Khoury and colleagues pooled 29 studies with 2,668 healthy adults. MBSR was moderately effective against stress, anxiety and low mood. On average the effect was still present 19 weeks after the course ended.

The breakdown is revealing: the effect on perceived stress was large, the effect on burnout only small. Anyone who is already burnt out probably needs more than a course. In Germany many statutory health insurers subsidise certified courses in mindfulness, yoga or muscle relaxation. In the UK, ask your GP about NHS talking therapies and local courses. Check with your insurer first.

Plausible and free: sleep and slow breathing

Sleep and stress affect each other in both directions. Stressed people sleep worse, and poor sleepers cope worse with stress. Studies that change only sleep and then measure stress are rare. Cognitive behavioural therapy for insomnia, by contrast, is well established. In Germany it is the recommended first treatment, ahead of sleeping pills. What you can do yourself: a fixed wake-up time, at weekends too, and a bed that is never your workplace. Whether an evening massage helps you fall asleep is covered in Massage before bed.

Slow breathing is the quickest method on this list. In 2018 Andrea Zaccaro and colleagues searched for studies on breathing techniques of fewer than ten breaths per minute in healthy people. Of 2,461 papers found, only 15 met the criteria. These showed higher heart rate variability, a sign of more activity in the calming branch of the nervous system. Participants reported more relaxation and less arousal, anxiety and anger. The evidence base is narrow, but the exercise is simple: breathe in for four seconds, out for six, for five minutes. That gives six breaths per minute. How to breathe into your belly while doing so is shown in Tight diaphragm.

Less studied: muscle relaxation and social contact

In progressive muscle relaxation after Jacobson, you tense individual muscle groups one after another for five to ten seconds and then consciously let go. The method has been used in clinics and courses for decades. There are many studies on it, but most are small, and a convincing sham exercise hardly exists. That is why it sits here and not higher up. Its advantage: once learnt, it needs no equipment and takes about a quarter of an hour.

That people with close relationships cope better with strain is shown mainly by observational studies. Whether the contact makes the difference, or whether healthier people simply find it easier to keep in touch, cannot be separated this way. Talking to someone you trust about what weighs on you still carries no risk.

Massage: measurable, but brief

In 2004 Christopher Moyer and colleagues analysed 37 randomised trials of massage. A single massage reduced momentary anxiety, blood pressure and heart rate. They found no effect on negative mood, on pain measured straight away or on cortisol levels. This is the honest no in this article: the common claim that massage lowers the stress hormone cortisol is not supported by this analysis. Over a course of massages, trait anxiety and depression fell the most. The paper is more than 20 years old, and the individual studies were small.

Massage is therefore a tool for the moment, not a foundation. It works well as a quiet half hour after a full day, ideally combined with slow breathing. At the NAIPO Relax Lounge on Ballindamm you book a private room with a massage chair, a screen and Dolby Atmos sound, for 30 minutes or an hour. Both Hamburg locations are listed under NAIPO Relax Lounge. For home use there are massage devices for neck, back and feet. What has been studied on massage chairs specifically is summarised in the massage chair research review.

When to seek help

Self-help has limits. See a doctor or psychotherapist if any of the following applies:

• You have slept badly on most nights for several weeks.
• You have felt exhausted for weeks, even after days off or a holiday.
• Low mood, loss of pleasure or lack of drive last longer than two weeks.
• You regularly need alcohol, sleeping pills or sedatives to switch off.
• Palpitations, chest pressure, dizziness or breathlessness occur. Have this checked physically before putting it down to stress.

The first point of contact is your GP. In Germany, the appointment service on 116117 arranges a slot in a psychotherapy consultation. For sudden severe chest pain or thoughts of taking your own life, call 112 at once. The German crisis line Telefonseelsorge is free and available around the clock on 0800 111 0 111. In the UK, call NHS 111 for urgent advice and 999 in an emergency; Samaritans are free and available around the clock on 116 123.

Frequently asked questions

What helps fastest against acute stress?

A few minutes of slow breathing or a short, brisk walk. Neither needs any equipment, and both work almost anywhere.

Does massage lower cortisol?

Not in the meta-analysis by Moyer. What fell after a single session was momentary anxiety, pulse and blood pressure.

How much exercise is needed?

The World Health Organization recommends 150 to 300 minutes of moderate activity per week for adults. Some activity is better than none, even if you stay below that.

Sources

• Singh B, Olds T, Curtis R et al. (2023): Effectiveness of physical activity interventions for improving depression, anxiety and distress: an overview of systematic reviews. British Journal of Sports Medicine. doi:10.1136/bjsports-2022-106195
• Khoury B, Sharma M, Rush SE, Fournier C (2015): Mindfulness-based stress reduction for healthy individuals: a meta-analysis. Journal of Psychosomatic Research. doi:10.1016/j.jpsychores.2015.03.009
• Zaccaro A, Piarulli A, Laurino M et al. (2018): How breath-control can change your life: a systematic review on psycho-physiological correlates of slow breathing. Frontiers in Human Neuroscience. doi:10.3389/fnhum.2018.00353
• Moyer CA, Rounds J, Hannum JW (2004): A meta-analysis of massage therapy research. Psychological Bulletin. doi:10.1037/0033-2909.130.1.3

This article does not replace medical advice.