> ## Content Index > Fetch the complete content index at: https://elonmuscular.com/llms.txt > Use this file to discover other available public pages before exploring further. # Switch Off Your Stress - URL: https://elonmuscular.com/protocol-switch-off/ - Published: 2026-09-27T15:57:06.000Z - Updated: 2026-10-12T07:29:55.000Z - Description: Tracks stress score (pss-10). 27 moves, every one with its trial. - Author: Elon Muscular - Tags: Calm, Protocol [The library](https://elonmuscular.com/library/) / Calm # Switch Off Your Stress Stressed out Also called Chronic stress, Always stressed, Can't relax, Wired and tired 3 min plan64 min with every studyUpdated Sep 27, 2026 Who it's forA man who is wired and tired, carries work home, and cannot switch off at night. [Plan](#pr2-plan)[Track](#pr2-track)[Studies](#pr2-studies) Your number Stress score (PSS-10) Judge the page at week 8. On this page [Tonight](#pr2-tonight)[The plan](#pr2-plan)[How you'll know](#pr2-know)[Why this happens](#pr2-why)[Week by week](#pr2-week)[What to track](#pr2-track)[Doses at a glance](#pr2-doses)[Deep dives](#pr2-deep)[The studies](#pr2-studies)[Words on this page](#pr2-words) ## Tonight 1. Take the stress score (PSS-10) and write it down 2. Set tomorrow’s finish time, and put the work phone away after it 3. Five minutes of slow breathing, in for 4 and out for 6, before bed ## The plan ALWAYS ONA GAP TO RECOVERLOADRECOVERYLOADRECOVERY **Figure 1.** Stress needs a gap to recover in. Always on, the load outweighs the recovery; cut the load and add recovery, and the see-saw levels. 27 moves, in order, after 3 checks. Tap any row to see how. ### Check first The number to measure: the stress score (PSS-10)The number to track: ten questions, once a monthCheck ### The number to measure: the stress score (PSS-10) For: Knowing where you stand A 10-question score for how stressed your last month felt. Lower is better. #### How to check 1. Answer the 10 questions about the last month. 2. Write the score down. It runs from 0 to 40. 3. Repeat every 4 weeks, same day. Watch the trend. What it is 10 questions When Every 4 weeks How often For as long as you run the page Reading the number Tracks the trend A review of 19 studies found the 10-question stress score easy to use and reliable. ¹ Asian nursing research, 2012\. The study is under The science, below. The science In detail Ten questions about the last month, such as how often you felt nervous and stressed, or that things were piling up. Each is scored 0 to 4, so the total runs 0 to 40\. Take it today, then every four weeks. Found **Scored 0 to 40.** A review of 19 studies of the scale: it is easy to use and holds up as a measure. The 10-question version measured better than the longer and shorter ones. Why Chronic stress becomes normal, so you stop seeing it. A score on paper every month shows whether the moves below are lowering it, and gives a doctor a number instead of a feeling. How it is done Ten questions; Every four weeks; Today, then every 4 weeks #### The study Overall, the PSS is an easy-to-use questionnaire with established acceptable psychometric properties. [PMID 25031113](https://pubmed.ncbi.nlm.nih.gov/25031113/?ref=elonmuscular.com) · Review of the psychometric evidence of the perceived stress scale. · Asian nursing research, 2012 The sentence around it …Conclusion Overall, the PSS is an easy-to-use questionnaire with established acceptable psychometric properties. In general, the psychometric properties of the 10-item PSS were found to be superior to those of the 14-item PSS The sentence around it In general, the psychometric properties of the 10-item PSS were found to be superior to those of the 14-item PSS, while those of the 4-item scale fared the worst.… Rule-out test: the GAD-7 worry scoreRule out an anxiety disorder: seven questions, onceCheck ### Rule-out test: the GAD-7 worry score For: Worry about everything A 7-question score that shows how much the worry has hold of you, and whether it is easing. #### How to check 1. Answer the 7 questions about the last 2 weeks. 2. Write the score down. It runs from 0 to 21. 3. A score of 10 or more: see your doctor and run [Stop worrying](https://elonmuscular.com/protocol-stop-worrying/). ##### 7 questions Over the last 2 weeks, how often have you been bothered by the following problems? 1. Feeling nervous, anxious or on edge 2. Not being able to stop or control worrying 3. Worrying too much about different things 4. Trouble relaxing 5. Being so restless that it is hard to sit still 6. Becoming easily annoyed or irritable 7. Feeling afraid as if something awful might happen **Each one:** Not at all 0 · Several days 1 · More than half the days 2 · Nearly every day 3 The window Last 2 weeks What the score means **5-9** Mild anxiety (cutpoint 5)**10-14** Moderate anxiety (cutpoint 10)**15-21** Severe anxiety (cutpoint 15)**\>=10** Recommended cutpoint for further evaluation when screening for anxiety disorders What it is 7 questions When Today, then at the review How often Once, then at week 8 Reading the number The line is 10 In the first study the score caught it 89% of the time. Across 48 studies, a score of 10 or more caught 64%. ¹ Archives of internal medicine, 2006\. The study is under The science, below. The science In detail Seven questions about worry and nerves over the last two weeks, each scored 0 to 3\. Take it once today. A score of 10 or more means the stress may be an anxiety disorder: take it to your doctor and run [Stop worrying](https://elonmuscular.com/protocol-stop-worrying/). Found **Score of 10: the line.** In the first study, checked against a mental health professional’s interview, the best cut point caught the worry disorder 89% of the time. Pooled across 48 studies, a score of 10 or more caught 64% and correctly cleared 91% of those without it. Why Stress that never switches off can be generalized anxiety, which has its own treatments. This score is how a doctor tells the two apart. How it is done Seven questions; Today, then at the review; Today, and at the review #### The studies A cut point was identified that optimized sensitivity (89%) and specificity (82%). [PMID 16717171](https://pubmed.ncbi.nlm.nih.gov/16717171/?ref=elonmuscular.com) · A brief measure for assessing generalized anxiety disorder: the GAD-7\. · Archives of internal medicine, 2006 The sentence around it A cut point was identified that optimized sensitivity (89%) and specificity (82%). At the recommended cut-off of 10 or higher (or the closest available cut-off), the GAD-7 questionnaire yielded a summary sensitivity of 0.64 (95% CI 0.56 to 0.72) and a summary specificity of 0.91 (95% CI 0.87 to 0.93) in detecting generalised anxiety disorder. [PMID 40130828](https://pubmed.ncbi.nlm.nih.gov/40130828/?ref=elonmuscular.com) · Generalized Anxiety Disorder 7-item (GAD-7) and 2-item (GAD-2) scales for detecting anxiety disorders in adults. · The Cochrane database of systematic reviews, 2025 The sentence around it At the recommended cut-off of 10 or higher (or the closest available cut-off), the GAD-7 questionnaire yielded a summary sensitivity of 0.64 (95% CI 0.56 to 0.72) and a summary specificity of 0.91 (95% CI 0.87 to 0.93) in detecting generalised anxiety disorder. Rule-out test: the PHQ-8 mood scoreRule out depression: eight questions, onceCheck ### Rule-out test: the PHQ-8 mood score For: Flat as well as wired An 8-question score that shows how low you are, and whether it is lifting. #### How to check 1. Answer the 8 questions about the last 2 weeks. 2. Write the score down. 3. A score of 10 or more: see your doctor and run [Low mood](https://elonmuscular.com/protocol-low-mood/). ##### 8 questions Over the last 2 weeks, how often have you been bothered by any of the following problems? 1. Little interest or pleasure in doing things 2. Feeling down, depressed, or hopeless 3. Trouble falling or staying asleep, or sleeping too much 4. Feeling tired or having little energy 5. Poor appetite or overeating 6. Feeling bad about yourself -- or that you are a failure or have let yourself or your family down 7. Trouble concentrating on things, such as reading the newspaper or watching television 8. Moving or speaking so slowly that other people could have noticed? Or the opposite -- being so fidgety or restless that you have been moving around a lot more than usual **Each one:** Not at all 0 · Several days 1 · More than half the days 2 · Nearly every day 3 The window Last 2 weeks What the score means **0-4** None-minimal**5-9** Mild**10-14** Moderate**15-19** Moderately severe**20-24** Severe**\>=10** Current depression likely: a score of 10 or more is the validated cutpoint What it is 8 questions When Today, then at the review How often Once, then at week 8 Standard practice Review how a treatment is working 2 to 4 weeks after starting it, and track it with a standard score such as the PHQ-9. Reading the number The line is 10 In 6,000 people, a score of 10 or more picked up major depression 88% of the time. ¹ Journal of general internal medicine, 2001\. The study is under The science, below. The science In detail Eight questions about the last two weeks, each scored 0 to 3\. Take it once today. A score of 10 or more means the stress may be depression: take it to your doctor and run [Low mood](https://elonmuscular.com/protocol-low-mood/). Found **Score of 10: 88% caught.** 6,000 people took it, and 580 were checked against a full interview. A score of 10 or more caught major depression 88% of the time. Scores of 5, 10, 15 and 20 mark mild, moderate, moderately severe and severe. Why Long stress can slide into depression: flat, no interest, no energy, not just wired. That needs its own treatment, and this score is how a doctor spots it. How it is done Eight questions; Today, then at the review; Today, and at the review #### The study a PHQ-9 score > or =10 had a sensitivity of 88% and a specificity of 88% for major depression [PMID 11556941](https://pubmed.ncbi.nlm.nih.gov/11556941/?ref=elonmuscular.com) · The PHQ-9: validity of a brief depression severity measure. · Journal of general internal medicine, 2001 The sentence around it …Using the MHP reinterview as the criterion standard, a PHQ-9 score > or =10 had a sensitivity of 88% and a specificity of 88% for major depression.… PHQ-9 scores of 5, 10, 15, and 20 represented mild, moderate, moderately severe, and severe depression, respectively. The sentence around it PHQ-9 scores of 5, 10, 15, and 20 represented mild, moderate, moderately severe, and severe depression, respectively. ### Free habits 1Train most daysMove most days, aerobic first, lift twice a weekStrong evidence ### Train most days For: Everyone Exercise is one of the strongest ways to burn off stress. Even short, easy sessions count. #### What to do 1. Walk briskly, jog, cycle or swim most days. 2. Lift weights twice a week. 3. Short and easy counts. Build up from there. How much Most days When Earlier in the day How long Every week What happened in the studies Less anxiety Across 1,079 trials, exercise cut anxiety, aerobic work the most. Short, easy sessions counted. ¹ British journal of sports medicine, 2026\. The study is under The science, below. Watch out Build up gradually to avoid injury. The science In detail Move most days: brisk walking, jogging, cycling or a class, and lifting twice a week. Aerobic work did the most, and short, easy sessions counted. Train earlier in the day if a late session keeps you up. Found **Small drop in anxiety.** An umbrella of 1,079 trials and 79,551 people: exercise cut anxiety symptoms by a moderate effect, aerobic work the most. In six trials, exercise cut anxiety symptoms more than control, by a moderate effect. Why Training burns off the stress chemistry that a wired day leaves running, and it trains the body to come down after a spike. It is also one of the surest routes to deeper sleep. #### The studies Exercise reduced depression (standardised mean difference (SMD)=-0.61, 95% CI -0.69 to -0.54) and anxiety (SMD=-0.47, 95% CI -0.59 to -0.36) symptoms, with aerobic exercise demonstrating the most substantial impact on both depression and anxiety symptoms. [PMID 41667154](https://pubmed.ncbi.nlm.nih.gov/41667154/?ref=elonmuscular.com) · Effect of exercise on depression and anxiety symptoms: systematic umbrella review with meta-meta-analysis. · British journal of sports medicine, 2026 The sentence around it Exercise reduced depression (standardised mean difference (SMD)=-0.61, 95% CI -0.69 to -0.54) and anxiety (SMD=-0.47, 95% CI -0.59 to -0.36) symptoms, with aerobic exercise demonstrating the most substantial impact on both depression and anxiety symptoms. Exercise significantly decreased anxiety symptoms more than control conditions, with a moderate effect size (Standardized Mean Difference=-0.582, 95%CI -1.0 to -0.76, p=0.02). [PMID 28088704](https://pubmed.ncbi.nlm.nih.gov/28088704/?ref=elonmuscular.com) · An examination of the anxiolytic effects of exercise for people with anxiety and stress-related disorders: A meta-analysis. · Psychiatry research, 2017 The sentence around it Exercise significantly decreased anxiety symptoms more than control conditions, with a moderate effect size (Standardized Mean Difference=-0.582, 95%CI -1.0 to -0.76, p=0.02). [The deep dive on this](https://elonmuscular.com/resistance-training/) 2Protect the sleepSeven to eight hours, at the same timesStrong evidence ### Protect the sleep For: Everyone Better sleep lowers stress and anxiety. Fix the sleep and the wired feeling often eases with it. #### What to do 1. Sleep 7 to 8 hours. 2. Wake at the same time every day. 3. Lying awake wired? Run [Deeper sleep](https://elonmuscular.com/protocol-deeper-sleep/) too. How much 7 to 8 hours When Same wake time daily How long For good What happened in the studies Less depression and anxiety In 65 trials with 8,608 people, depression and anxiety fell when sleep got better. The more sleep improved, the more mood did. ¹ Sleep medicine reviews, 2021\. The study is under The science, below. Watch out Sleeping 9 hours or more and still tired is a question for a doctor. The science In detail Seven to eight hours, the same wake time seven days a week. Screens and work off an hour before bed. If you lie awake wired, run [Deeper sleep](https://elonmuscular.com/protocol-deeper-sleep/) beside this page. Found **g = 0.63 on depression.** Sixty-five trials, 8,608 people: when a treatment improved sleep, depression fell by a medium effect. Anxiety and rumination fell with it. The more sleep improved, the more mood did. Why A short night turns up the brain’s alarm and weakens the brake on it the next day, so the same email feels twice as big. Stress then cuts the next night short. Fixing sleep breaks the loop from one end. Watch Nine hours or more a night that does not refresh is a doctor's question, not a reason to sleep in. #### The study Improving sleep led to a significant medium-sized effect on composite mental health (g+ = -0.53), depression (g+ = -0.63), anxiety (g+ = -0.51), and rumination (g+ = -0.49) [PMID 34607184](https://pubmed.ncbi.nlm.nih.gov/34607184/?ref=elonmuscular.com) · Improving sleep quality leads to better mental health: A meta-analysis of randomised controlled trials. · Sleep medicine reviews, 2021 The sentence around it Improving sleep led to a significant medium-sized effect on composite mental health (g+ = -0.53), depression (g+ = -0.63), anxiety (g+ = -0.51), and rumination (g+ = -0.49), as well as significant small-to-medium sized effects on stress (g+ = -0.42), and finally small significant effects on positive psychosis symptoms (g+ = -0.26).… We also found a dose response relationship, in that greater improvements in sleep quality led to greater improvements in mental health. The sentence around it We also found a dose response relationship, in that greater improvements in sleep quality led to greater improvements in mental health. [The deep dive on this](https://elonmuscular.com/sleep/) 3CaffeineCount it, then cut it well under 400 mg a dayModerate evidence ### Cut the caffeine For: Coffee to get through the day Caffeine pushes up the same jitters stress runs on. Count it, then cut it. #### What to do 1. Count every coffee, tea, cola, energy drink and pre-workout for a week. 2. Cut to well under 400 mg a day, and none after midday. 3. Step down over 1 to 2 weeks. How much Well under 400 mg When None after midday How long Taper over 1 to 2 weeks Standard practice Coffee, tea, cola and energy drinks contain caffeine, which can disrupt sleep and make anxiety harder to control. For most adults, 400 mg a day is the level not generally linked to harm. What happened in the studies More caffeine, more anxiety In 14 studies, caffeine raised anxiety, and most of all above 400 mg a day. ¹ Frontiers in psychology, 2024\. The study is under The science, below. Watch out Cutting fast brings a headache for a few days. Step it down. The science In detail Count the coffee, tea, cola, energy drinks and pre-workout for a week. Then cut it well under 400 mg a day, and none after midday. Step down over a week or two to dodge the headache. Found **Anxiety up, most above 400 mg.** Fourteen studies, 546 people: caffeine raised anxiety, moderately at low doses and steeply at high doses. The rise was largest above 400 mg. Why Caffeine blocks the tiredness signal and pushes adrenaline up. That is the wired half of wired and tired, and a late cup steals the deep sleep that would have fixed the tired half. Watch Cutting fast from a high intake brings headache and tiredness for a few days. Taper it. #### The study In terms of overall effect, the results of the meta-analysis showed that caffeine intake increased the risk of anxiety \[SMD = 0.94, 95% Cl = (0.28, 1.60), p < 0.05\]. [PMID 38362247](https://pubmed.ncbi.nlm.nih.gov/38362247/?ref=elonmuscular.com) · Caffeine intake and anxiety: a meta-analysis. · Frontiers in psychology, 2024 The sentence around it In terms of overall effect, the results of the meta-analysis showed that caffeine intake increased the risk of anxiety \[SMD = 0.94, 95% Cl = (0.28, 1.60), p < 0.05\]. low-dose caffeine intake moderately increased the risk of anxiety \[SMD = 0.61, 95%Cl = (0.42, 0.79), p < 0.05\], whereas high-dose caffeine intake had a highly significant increase in the risk of anxiety \[SMD = 2.86, 95%Cl = (2.50, 3.22), p < 0.05\] The sentence around it …After suspecting that dose size might be responsible for the heterogeneity by sensitivity analysis, we performed subgroup analysis according to dose size and found that low-dose caffeine intake moderately increased the risk of anxiety \[SMD = 0.61, 95%Cl = (0.42, 0.79), p < 0.05\], whereas high-dose caffeine intake had a highly significant increase in the risk of anxiety \[SMD = 2.86, 95%Cl = (2.50, 3.22), p < 0.05\].… [The deep dive on this](https://elonmuscular.com/caffeine/) 4Drink less to come downCount the drinks, then cut a levelStrong evidence ### Drink less to come down For: Everyone Alcohol feels like relief tonight and drags your mood down tomorrow. #### What to do 1. Count your drinks for a week. 2. Then cut back a level, from most nights to some. 3. Drinking to come down every night? Run [Drinking less](https://elonmuscular.com/protocol-drinking-less/) too. How much One level less When Every week How long A year Standard practice Try not to use alcohol, cigarettes, gambling or drugs to relieve stress. They can all make mental health worse. What happened in the studies Better mental health In 1,383 people followed for a year, every step down in drinking came with better mental health. A bigger cut meant a bigger gain. ¹ Alcoholism, clinical and experimental research, 2017\. The study is under The science, below. Watch out If you drink every day and shake without it, stopping suddenly is a medical danger. See a doctor first. The science In detail Count the drinks for a week, then cut a level: from most nights to some, from some to few. The smaller glass, every round. A month off if the count surprises you. Found **1,383 people, one year.** 1,383 people, one year: every step down the risk-drinking ladder came with fewer alcohol consequences and better mental health, at the end of treatment and a year on. A bigger step meant a bigger gain. Why Alcohol calms for an hour and then rebounds. It breaks the second half of the night and leaves the next day more wired, so the drink starts to feel like the only way to switch off. Cutting the count breaks that loop. Watch Physical dependence, where cutting abruptly is a medical event and not a plan #### The study Any reduction in \[…\] risk drinking level during treatment was associated with significantly fewer alcohol-related consequences and improved mental health at the end of treatment and for up to 1 year posttreatment. [PMID 28019652](https://pubmed.ncbi.nlm.nih.gov/28019652/?ref=elonmuscular.com) · Clinical Validation of Reduced Alcohol Consumption After Treatment for Alcohol Dependence Using the World Health Organization Risk Drinking Levels. · Alcoholism, clinical and experimental research, 2017 The sentence around it …Results Any reduction in \[…\] risk drinking level during treatment was associated with significantly fewer alcohol-related consequences and improved mental health at the end of treatment and for up to 1 year posttreatment. A greater reduction in \[…\] risk drinking level predicted a greater reduction in consequences and greater improvements in mental health. The sentence around it A greater reduction in \[…\] risk drinking level predicted a greater reduction in consequences and greater improvements in mental health. [The deep dive on this](https://elonmuscular.com/cutting-down-drinking/) 5Put a hard stop on the workdayA finish time, notifications off, one day a week with no workModerate evidence ### Put a hard stop on the workday For: Work in your head all evening Set a finish time and a day off, and keep work out of them. Switching off is the recovery. #### What to do 1. Pick a finish time and stick to it. 2. Notifications off after it, and the work phone in a drawer. 3. Keep one full day a week with no work at all. How much A set finish time When Every workday How long Every week Standard practice Workers also have the right to 11 hours of rest between working days. They also get 24 hours a week without any work. What happened in the studies Less exhaustion, better sleep Across 86 publications, people who switched off after work slept better and were less exhausted. ¹ Frontiers in psychology, 2016\. The study is under The science, below. The science In detail Pick a finish time and keep it. Notifications off after it, the work phone in a drawer, and no email checks in bed. Keep at least one full day a week with no work. Write tomorrow’s first task down before you stop, so your head can let go of it. Found **d 0.36 on switching off.** Eighty-six publications, 38,124 people: those who switched off from work after hours had less exhaustion, better sleep and more wellbeing. Thirty studies of programs to help people switch off: they worked, and longer programs worked better. Why Stress needs a gap to recover in. Work thoughts, the email check and the half-read message keep the stress response running after you leave. A hard stop gives the body its off-switch back. #### The studies results indicated average positive correlations between detachment and self-reported mental (i.e., less exhaustion, higher life satisfaction, more well-being, better sleep) and physical (i.e., lower physical discomfort) health [PMID 28133454](https://pubmed.ncbi.nlm.nih.gov/28133454/?ref=elonmuscular.com) · A Meta-Analysis on Antecedents and Outcomes of Detachment from Work. · Frontiers in psychology, 2016 The sentence around it …With regard to outcomes, results indicated average positive correlations between detachment and self-reported mental (i.e., less exhaustion, higher life satisfaction, more well-being, better sleep) and physical (i.e., lower physical discomfort) health, state well-being (i.e., less fatigue, higher positive affect, more intensive state of recovery), and task performance (small to medium sized effects).… Interventions showed a significant positive effect on detachment from work ( d = 0.36) on average. [PMID 34096763](https://pubmed.ncbi.nlm.nih.gov/34096763/?ref=elonmuscular.com) · Interventions for improving psychological detachment from work: A meta-analysis. · Journal of occupational health psychology, 2021 The sentence around it Interventions showed a significant positive effect on detachment from work ( d = 0.36) on average. 6Talk it through with someoneTell one person, and keep regular contactModerate evidence ### Talk it through with someone For: Carrying it alone Tell one person what is going on. Company is a built-in brake on stress. #### What to do 1. Tell one person what is going on this week. 2. Book something regular: a weekly call, training with a friend. How much One person When This week How long Every week Standard practice Try talking about your feelings to a friend, family member or health professional. What happened in the studies Cortisol response cut In a stress test, having a best friend there first cut the stress hormone response. ¹ Biological psychiatry, 2003\. The study is under The science, below. The science In detail Tell one person what is going on: a friend, a brother, a partner, a colleague you trust. Not to fix it, just to say it out loud. Book the regular things that keep you in touch: a weekly call, training with a friend, a team. Found In a controlled stress test, having a best friend there beforehand cut the cortisol response to the stress. In over 100,000 people, confiding in others was one of the few habits the genetic analysis backed as protective against depression. Why Company is a built-in brake on the stress response. Saying the problem out loud also shrinks it, and another person can see what you have stopped seeing. #### The studies Salivary free cortisol levels were suppressed by social support in response to stress. [PMID 14675803](https://pubmed.ncbi.nlm.nih.gov/14675803/?ref=elonmuscular.com) · Social support and oxytocin interact to suppress cortisol and subjective responses to psychosocial stress. · Biological psychiatry, 2003 The sentence around it …Results Salivary free cortisol levels were suppressed by social support in response to stress. confiding in others (odds ratio=0.76, 95% CI=0.67, 0.86) [PMID 32791893](https://pubmed.ncbi.nlm.nih.gov/32791893/?ref=elonmuscular.com) · An Exposure-Wide and Mendelian Randomization Approach to Identifying Modifiable Factors for the Prevention of Depression. · The American journal of psychiatry, 2020 The sentence around it confiding in others (odds ratio=0.76, 95% CI=0.67, 0.86), television watching time (odds ratio=1.09, 95% CI=1.05, 1.13), and daytime napping (odds ratio=1.34, 95% CI=1.17, 1.53).… 7Get outside, somewhere greenTwo hours a week somewhere greenModerate evidence ### Get outside, somewhere green For: Stuck indoors Two hours a week in green space. It lowered stress, both felt and measured. #### What to do 1. Find a park, woods or water nearby. 2. Spend 2 hours a week there, in one go or spread out. 3. Leave the phone in your pocket. How much 2 hours a week When Any time How long Every week What happened in the studies Stress down, felt and measured In 12 studies, time in nature lowered stress. In 19,806 people, 2 hours a week was where health and wellbeing rose. ¹ Complementary therapies in medicine, 2020\. The study is under The science, below. The science In detail Two hours a week in a park, woods, by water or in the hills, in one go or spread over several visits. Walk, sit, or train there. Leave the phone in your pocket. Found **120 minutes a week.** A review of twelve studies: time in nature lowered physical stress markers in all seven that measured them, and perceived stress in five of six. In a survey of 19,806 people, two hours a week or more was where health and wellbeing rose. Why Green space pulls attention outward without effort, which rests the part of the brain that stays on alert. Heart rate and stress hormones come down with it. #### The studies Nature exposure has been widely shown to have a positive effect in reducing stress, both perceived and physiologic. [PMID 33066853](https://pubmed.ncbi.nlm.nih.gov/33066853/?ref=elonmuscular.com) · Effect of nature exposure on perceived and physiologic stress: A systematic review. · Complementary therapies in medicine, 2020 The sentence around it …Conclusions Nature exposure has been widely shown to have a positive effect in reducing stress, both perceived and physiologic. the likelihood of reporting good health or high well-being became significantly greater with contact ≥120 mins [PMID 31197192](https://pubmed.ncbi.nlm.nih.gov/31197192/?ref=elonmuscular.com) · Spending at least 120 minutes a week in nature is associated with good health and wellbeing. · Scientific reports, 2019 The sentence around it …Compared to no nature contact last week, the likelihood of reporting good health or high well-being became significantly greater with contact ≥120 mins (e.g.… 8Six breaths a minuteSix breaths a minute, ten to twenty minutes a dayStrong evidence ### Six breaths a minute For: Wound up Slow breathing switches your body out of fight-or-flight. It is the fastest way to calm down. #### What to do 1. Breathe in for 4 seconds and out for 6. 2. Do it 10 to 20 minutes a day, and any time you feel wound up. How much 10 to 20 minutes When Daily, and when stressed How long 4 weeks to judge What happened in the studies Large drop in stress In 24 studies, slow breathing cut stress and anxiety a lot. Done at home, it also lowered depression. ¹ Psychological medicine, 2017\. The study is under The science, below. Watch out If you feel dizzy or tingly, breathe more gently. The science In detail Six breaths a minute: in for four, out for six. Ten to twenty minutes a day, and any time you are wound up. A strap or a wearable that shows the heart rate while you breathe closes the loop. The trials found under twenty minutes a day worked best. Found **g = 0.83 against control.** Twenty-four studies, 484 people: a large drop in self-reported stress and anxiety against control. Eighteen studies, 1,352 people, run at home: depression down by a medium effect and HRV up by the same. Why Breathing near six a minute puts the breath in phase with the blood-pressure reflex, and the heart swings wide with each breath. That swing is the vagal brake being used. Used daily, it stays stronger between sessions. Watch Dizziness or tingling means you are blowing off too much carbon dioxide. Breathe lighter, not deeper. #### The studies The between-groups analysis comparing biofeedback to a control condition yielded Hedges' g = 0.83. [PMID 28478782](https://pubmed.ncbi.nlm.nih.gov/28478782/?ref=elonmuscular.com) · The effect of heart rate variability biofeedback training on stress and anxiety: a meta-analysis. · Psychological medicine, 2017 The sentence around it The between-groups analysis comparing biofeedback to a control condition yielded Hedges' g = 0.83. Meta-analysis showed a medium effect size of HRV-B for improving both depression (g = - 0.41 \[- 0.049, - 0.772\], p = 0.026, I 2 = 72.623%, k = 10) and HRV (g = 0.443, \[0.718, 0.167\], p = 0.002, I 2 = 56.81%, k = 10) compared to control conditions. [PMID 41310318](https://pubmed.ncbi.nlm.nih.gov/41310318/?ref=elonmuscular.com) · Efficacy and Methodology of Remote Heart Rate Variability Biofeedback Interventions for Mental Health: A Systematic Review and Meta-Analysis. · Applied psychophysiology and biofeedback, 2026 The sentence around it Meta-analysis showed a medium effect size of HRV-B for improving both depression (g = - 0.41 \[- 0.049, - 0.772\], p = 0.026, I 2 = 72.623%, k = 10) and HRV (g = 0.443, \[0.718, 0.167\], p = 0.002, I 2 = 56.81%, k = 10) compared to control conditions. [The deep dive on this](https://elonmuscular.com/lab-slow-paced-breathing-hrv-biofeedback/) 9The eight-week mindfulness courseThe eight-week course, or ten minutes a dayStrong evidence ### The eight-week mindfulness course For: Always on An 8-week course that trains your mind to notice the stress and let it pass. #### What to do 1. Join an 8-week mindfulness course, or use a guided recording. 2. Practice 10 minutes a day between classes. 3. Keep sits short and daily. How much One class a week When Daily practice How long 8 weeks What happened in the studies Large drop in stress In 29 studies with 2,668 people, the 8-week course cut stress a lot, and the gains held months later. ¹ Journal of psychosomatic research, 2015\. The study is under The science, below. Watch out Keep sits short. Long silent retreats can stir distress. The science In detail An eight-week mindfulness course, one class a week, with daily home practice from recordings. Or ten minutes a day of the same exercises. It trains you to notice the wind-up early and let it pass. Found **Large effect on stress.** Twenty-nine studies, 2,668 people: the course had large effects on stress and moderate effects on anxiety, low mood and distress. The gains held at an average of 19 weeks later. Why Stress runs ahead into what might go wrong. The practice brings attention back to what is in front of you, again and again, and the body’s alarm settles with it. Watch Keep the sits short and daily. Long silent retreats can stir distress. #### The study Results suggested large effects on stress, moderate effects on anxiety, depression, distress, and quality of life [PMID 25818837](https://pubmed.ncbi.nlm.nih.gov/25818837/?ref=elonmuscular.com) · Mindfulness-based stress reduction for healthy individuals: A meta-analysis. · Journal of psychosomatic research, 2015 The sentence around it Results suggested large effects on stress, moderate effects on anxiety, depression, distress, and quality of life, and small effects on burnout.… The obtained results were maintained at an average of 19 weeks of follow-up. The sentence around it The obtained results were maintained at an average of 19 weeks of follow-up. [The deep dive on this](https://elonmuscular.com/lab-mbsr/) 10Yoga, twice a weekTwice a week, breath leading the posesModerate evidence ### Yoga, twice a week For: Tense and wired Yoga lowers stress and the stress hormone, with the breath leading the moves. #### What to do 1. Take a class twice a week, or do 30 minutes at home. 2. Keep it up for 8 to 12 weeks. How much 30 minutes When Twice a week How long 8 to 12 weeks What happened in the studies Large drop in stress In 17 trials, yoga and tai chi cut stress a lot. In 42 trials, yoga lowered the stress hormone cortisol. ¹ Journal of clinical medicine, 2018\. The study is under The science, below. Watch out Strains and overuse injuries. Ease into it. The science In detail A class twice a week, or thirty minutes at home with the breath leading the poses. The trials ran eight to twelve weeks. Found **g 0.80 on stress.** Seventeen trials of yoga and tai chi: stress fell by a large effect, and heart rate variability shifted toward the calming side. Across 42 trials, yoga lowered evening and waking cortisol and resting heart rate against active control. Why Slow breathing and long holds tip the nervous system toward its calming branch, the loading is real training, and the attention is meditation. It is three moves from this page in one hour. Watch Rare serious neurovascular & structural events #### The studies and stress level (Hedge's g = -0.80, 95% CI -1.17 to -0.44, p < 0.001, I2 = 68.54%) [PMID 30384420](https://pubmed.ncbi.nlm.nih.gov/30384420/?ref=elonmuscular.com) · Effects of Mind⁻Body Exercises (Tai Chi/Yoga) on Heart Rate Variability Parameters and Perceived Stress: A Systematic Review with Meta-Analysis of Randomized Controlled Trials. · Journal of clinical medicine, 2018 The sentence around it and stress level (Hedge's g = -0.80, 95% CI -1.17 to -0.44, p < 0.001, I2 = 68.54%).… Interventions that included yoga asanas were associated with reduced evening cortisol, waking cortisol, ambulatory systolic blood pressure, resting heart rate [PMID 28963884](https://pubmed.ncbi.nlm.nih.gov/28963884/?ref=elonmuscular.com) · Yoga, mindfulness-based stress reduction and stress-related physiological measures: A meta-analysis. · Psychoneuroendocrinology, 2017 The sentence around it Interventions that included yoga asanas were associated with reduced evening cortisol, waking cortisol, ambulatory systolic blood pressure, resting heart rate, high frequency heart rate variability, fasting blood glucose, cholesterol and low density lipoprotein, compared to active control.… [The deep dive on this](https://elonmuscular.com/yoga/) 11Progressive muscle relaxationTense and release, feet to face, fifteen minutesModerate evidence ### Progressive muscle relaxation For: Tight all over Tense each muscle, then let it go. It teaches your body what off feels like. #### What to do 1. Lie or sit somewhere quiet. 2. Tense one muscle group for a few seconds, then let it go. 3. Work up from feet to face, 15 to 20 minutes. How much 15 to 20 minutes When Daily or before bed How long Every day What happened in the studies Cortisol down In 58 trials, relaxation was one of the two best ways to lower the stress hormone cortisol. ¹ Psychoneuroendocrinology, 2024\. The study is under The science, below. The science In detail Lie or sit somewhere quiet. Tense one muscle group hard for a few seconds, then let it go and notice the difference. Work up from the feet to the face. Fifteen to twenty minutes, daily or before bed. Found **g 0.35 on cortisol.** Fifty-eight trials, 3,508 people: stress management lowered cortisol, and relaxation and mindfulness did the most. In a trial, one guided relaxation session cut cortisol against sitting quietly. Why Stress lives in the body as much as the head: a tight jaw, shoulders, gut. Tensing and releasing teaches you what "off" feels like, so you can find it again on demand. #### The studies Mindfulness and meditation (g = 0\. 345) and relaxation (g = 0\. 347) interventions were most effective at changing cortisol levels [PMID 37879237](https://pubmed.ncbi.nlm.nih.gov/37879237/?ref=elonmuscular.com) · Effectiveness of stress management interventions to change cortisol levels: a systematic review and meta-analysis. · Psychoneuroendocrinology, 2024 The sentence around it Mindfulness and meditation (g = 0\. 345) and relaxation (g = 0\. 347) interventions were most effective at changing cortisol levels, while mind body therapies (g = 0.… a brief relaxation exercise led to experimental subjects having significantly lower levels of post-intervention salivary cortisol (p = .036) [PMID 16385425](https://pubmed.ncbi.nlm.nih.gov/16385425/?ref=elonmuscular.com) · The impact of abbreviated progressive muscle relaxation on salivary cortisol and salivary immunoglobulin A (sIgA). · Applied psychophysiology and biofeedback, 2005 The sentence around it …Results indicated that a brief relaxation exercise led to experimental subjects having significantly lower levels of post-intervention salivary cortisol (p = .036) and significantly higher levels of post-intervention sIgA concentration (p < .001) and secretion rate (p < .001) than control subjects.… ### Over the counter 12Ashwagandha300 to 600 mg a day, eight weeksModerate evidence ### Ashwagandha root extract For: Stressed and wired A calming herb that lowers stress and anxiety. #### What to do 1. Take 300 to 600 mg of root extract a day, at night. 2. Give it 8 weeks. 3. Stop at any yellowing of the eyes or skin. How much 300 to 600 mg When At night How long 8 weeks Standard practice Some ashwagandha products may help stress. It may be safe for up to 3 months. Rare liver injury is reported, and it is not advised with autoimmune or thyroid disorders. In the US it is sold as a supplement, not approved as a drug. What happened in the studies Large drop in anxiety In 12 trials with 1,002 people, anxiety and stress both fell a lot compared with a dummy pill. ¹ Phytotherapy research, 2022\. The study is under The science, below. Watch out Stomach upset and sleepiness. Stop if your eyes or skin turn yellow. Not with a thyroid or autoimmune condition, or with sedatives, without a doctor. The science In detail 300 to 600 mg a day of root extract, for eight weeks before you judge it. Take it at night: it sedates a little. Beside the daily moves, not in place of them. Found Twelve trials, 1,002 people: anxiety and stress both fell against placebo, by large effects, with the stress effect sitting between 300 and 600 mg a day. Five trials on sleep: sharper mornings and less anxiety on top. Why It is the most-tested herb for stress: across 12 trials against a placebo, stress and anxiety scores fell. A second review of five trials found better sleep, and better sleep feeds back into lower stress. Watch Stomach upset, diarrhea, vomiting and drowsiness in some. Rare cases of liver injury: stop at once at yellow eyes or skin, or dark urine. Not with an autoimmune or thyroid disorder, and stop before surgery. It may interact with medicines for diabetes, blood pressure and thyroid, with immune-suppressing drugs, sedatives and seizure medicines. Avoid with hormone-sensitive prostate cancer. The safety data run to about three months. The doses the studies used**300 to 600 mg** *where the stress effect sat in the dose curve* 300 to 600 mg600 mg and over, for sleep stress at dose of 300-600 mg/d [PMID 36017529](https://pubmed.ncbi.nlm.nih.gov/36017529/?ref=elonmuscular.com) #### The studies Ashwagandha supplementation significantly reduced anxiety (SMD: -1.55, 95% CI: -2.37, -0.74; p = .005; I 2 = 93.8%) and stress level (SMD: -1.75; 95% CI: -2.29, -1.22; p = .005; I 2 = 83.1%) compared to the placebo. [PMID 36017529](https://pubmed.ncbi.nlm.nih.gov/36017529/?ref=elonmuscular.com) · Does Ashwagandha supplementation have a beneficial effect on the management of anxiety and stress? A systematic review and meta-analysis of randomized controlled trials. · Phytotherapy research, 2022 The sentence around it …We found that Ashwagandha supplementation significantly reduced anxiety (SMD: -1.55, 95% CI: -2.37, -0.74; p = .005; I 2 = 93.8%) and stress level (SMD: -1.75; 95% CI: -2.29, -1.22; p = .005; I 2 = 83.1%) compared to the placebo. Ashwagandha extract was also found to improve mental alertness on rising and anxiety level [PMID 34559859](https://pubmed.ncbi.nlm.nih.gov/34559859/?ref=elonmuscular.com) · Effect of Ashwagandha (Withania somnifera) extract on sleep: A systematic review and meta-analysis. · PloS one, 2021 The sentence around it Ashwagandha extract was also found to improve mental alertness on rising and anxiety level [The deep dive on this](https://elonmuscular.com/ashwagandha/) 13Vitamin B6A daily B-complex, B6 at 10 mg or lessModerate evidence ### A B-vitamin complex For: Run down and stressed A daily B-complex lowered stress in trials. Keep the B6 in it low. #### What to do 1. Take a B-complex with at least 3 B vitamins, at the label dose, with food. 2. Check the label: 10 mg of B6 a day or less, across everything you take. 3. Give it at least 4 weeks. How much Label dose When Daily, with food How long At least 4 weeks Standard practice Men need 1.4 mg of vitamin B6 a day. Do not take more than 10 mg a day from supplements unless a doctor advises it. 200 mg or more a day can cause loss of feeling in the arms and legs. What happened in the studies Stress down In 16 trials with 2,015 people, daily B vitamins lowered stress more than a dummy pill. ¹ Nutrients, 2019\. The study is under The science, below. Watch out Too much B6, 200 mg a day or more, can numb your arms and legs. Keep it to 10 mg a day or less from supplements. Niacin can cause flushing. The science In detail A daily B-complex with at least three of the B vitamins, at the label dose, for at least four weeks. Keep vitamin B6 from supplements at 10 mg a day or less. Beside the daily moves, not in place of them. Found **Small drop in stress.** Sixteen trials, 2,015 people: daily B vitamins lowered stress against placebo, across 958 people in the stress analysis. Eleven of the 18 papers found a benefit to mood or a part of it. Why The B vitamins run the steps that turn food into energy and build the brain’s signaling chemicals, serotonin and GABA among them. A low intake leaves those steps short, and topping it up is the aim. Watch Vitamin B6 at 200 mg a day or more can cause loss of feeling in the arms and legs (peripheral neuropathy). Keep it to 10 mg a day or less from supplements unless a doctor advises more. Check every product you take, since B6 is in many. High-dose B3 (niacin) causes flushing. Bright yellow urine from B2 is harmless. #### The study B vitamin supplementation benefited stress ( n = 958, SMD = 0.23, 95% CI = 0.02, 0.45, p = 0.03) [PMID 31527485](https://pubmed.ncbi.nlm.nih.gov/31527485/?ref=elonmuscular.com) · A Systematic Review and Meta-Analysis of B Vitamin Supplementation on Depressive Symptoms, Anxiety, and Stress: Effects on Healthy and 'At-Risk' Individuals. · Nutrients, 2019 The sentence around it …Regarding individual facets of mood, B vitamin supplementation benefited stress ( n = 958, SMD = 0.23, 95% CI = 0.02, 0.45, p = 0.03).… Eleven of the 18 articles reported a positive effect for B vitamins over a placebo for overall mood or a facet of mood. The sentence around it Eleven of the 18 articles reported a positive effect for B vitamins over a placebo for overall mood or a facet of mood. [The deep dive on this](https://elonmuscular.com/vitamin-b6/) 14Lavender OilThe oral lavender capsule, 80 mg a dayModerate evidence ### Lavender oil capsules For: Tense and anxious A lavender oil capsule that eased anxiety in trials, without making you drowsy. #### What to do 1. Take one 80 mg lavender oil capsule a day. 2. Not the diffuser or pillow spray. 3. Give it 10 weeks. How much 80 mg When Once a day How long 10 weeks What happened in the studies Anxiety down Across trials, lavender eased anxiety more than a dummy pill or no treatment. ¹ Asian nursing research, 2021\. The study is under The science, below. Watch out Burping and stomach upset. It may add to sedatives or sleeping pills. The science In detail The oral lavender oil capsule, 80 mg once a day, for ten weeks before you judge it. Not the diffuser oil or the pillow spray. It calms without making you drowsy. Found **g 0.72 on anxiety.** Across trials of lavender, anxiety fell by a moderate to large effect against placebo or no treatment. The oral capsule trials ran 80 mg a day for ten weeks. Why Its main constituents damp calcium entry at the nerve ending, so less excitatory signal is released. That is a similar target to pregabalin, at a gentler strength. Watch Burping, stomach upset and a lavender aftertaste. It may add to the effect of sedatives and sleeping pills. #### The study Lavender was superior to placebo or no treatment in reducing anxiety (Hedges' ĝ = -0.72, 95% confidence interval \[CI\] -0.90 to -0.55, p value <.001) [PMID 34775136](https://pubmed.ncbi.nlm.nih.gov/34775136/?ref=elonmuscular.com) · Effects of Lavender on Anxiety, Depression, and Physiological Parameters: Systematic Review and Meta-Analysis. · Asian nursing research, 2021 The sentence around it …Results Lavender was superior to placebo or no treatment in reducing anxiety (Hedges' ĝ = -0.72, 95% confidence interval \[CI\] -0.90 to -0.55, p value <.001), depression (Hedges' ĝ = -0.43, 95% CI, -0.59 to -0.27, p value <.001), and systolic blood pressure (Hedges' ĝ = -0.23, 95% CI, -0.41to -0.05, p value = .01).… [The deep dive on this](https://elonmuscular.com/lavender-oil/) ### Next steps 15Stress Without BurnoutStress Without Burnout: a 66-day guided quest, seven lessonsStrong evidence ### Stress Without Burnout For: Want to fix it yourself A guided quest built on the methods tested in trials: seven lessons over 66 days, one skill at a time, with the stress diary each evening. #### What to do 1. Lesson 1: map your stress. What you can change, what you cannot. 2. Lessons 2 and 3: solve one thing you can change, step by step. 3. Lessons 4 and 5: relax the body, and ride what you cannot change. 4. Lesson 6: switch off at the end of the workday, and say no to one thing. 5. Lesson 7: write the letter and your slip plan. Judge it on day 66. How much Seven lessons When A lesson every five days How long 66 days [Start the quest: Stress Without Burnout](https://elonmuscular.com/quest-stress-without-burnout/) What happened in the studies Large drop in stress In a trial of 264 people, a 7-lesson self-guided course cut stress a lot at 7 weeks. It held at 6 months. ¹ Occupational and environmental medicine, 2016\. The study is under The science, below. The science In detail Start the guided quest, built on the methods tested in trials and worked through on your own. A lesson opens every five days or more, each with a short exercise for real days. Map your stress, solve what you can change in two parts, and relax the body. Ride what you cannot change, switch off and say no. Then come the letter and the slip plan. Found **d 0.96 on stress.** In a trial of 264 people, a seven-lesson self-guided online course cut stress by a large effect at 7 weeks. It held at 6 months. Across 26 comparisons, courses of 5 to 8 weeks did best. Why Much of chronic stress is the story the mind tells about the load: all urgent, all on you, all going wrong. The course splits the load into what you can change and what you cannot, and gives you a skill for each. #### The studies The iSMI participants showed a significantly higher reduction in perceived stress from baseline to post-treatment at 7 weeks (d=0.96, 95% CI 0.70 to 1.21) and to the 6-month follow-up (d=0.65, 95% CI 0.40 to 0.89) [PMID 26884049](https://pubmed.ncbi.nlm.nih.gov/26884049/?ref=elonmuscular.com) · Self-guided internet-based and mobile-based stress management for employees: results of a randomised controlled trial. · Occupational and environmental medicine, 2016 The sentence around it …Results The iSMI participants showed a significantly higher reduction in perceived stress from baseline to post-treatment at 7 weeks (d=0.96, 95% CI 0.70 to 1.21) and to the 6-month follow-up (d=0.65, 95% CI 0.40 to 0.89) compared to the WLC.… medium-long interventions (5-8 weeks) were moderately effective (Cohen d=0.59; 95% CI 0.45-0.74) [PMID 28213341](https://pubmed.ncbi.nlm.nih.gov/28213341/?ref=elonmuscular.com) · The Benefit of Web- and Computer-Based Interventions for Stress: A Systematic Review and Meta-Analysis. · Journal of medical Internet research, 2017 The sentence around it …With regard to the length of the intervention, short interventions (≤4 weeks) showed a small effect size (Cohen d=0.33, 95% CI 0.22-0.44) and medium-long interventions (5-8 weeks) were moderately effective (Cohen d=0.59; 95% CI 0.45-0.74) [The deep dive on this](https://elonmuscular.com/lab-cbt/) 16Solve it or ride it, fifteen minutes a dayFifteen minutes a day: solve one problem or ride one feelingModerate evidence ### Solve it or ride it, fifteen minutes a day For: Too much on your plate Sort the load into what you can change and what you cannot. Solve one, ride one. #### What to do 1. List everything weighing on you. Mark each one: can change, or cannot. 2. Can change: define it, write 3 possible fixes, pick one, do the first step today. 3. Cannot change: name the feeling out loud, breathe slowly, and let it peak and pass. 4. Next day, check what worked and pick the next one. How much 15 minutes When Daily How long Every day What happened in the studies Worry, sleep, exhaustion better In the self-guided trial, these skills also eased worry, sleep problems and exhaustion, and helped people switch off from work. ¹ Occupational and environmental medicine, 2016\. The study is under The science, below. The science In detail The two core skills of the self-guided course, as a daily routine. Fifteen minutes: list what is weighing on you, sort each one into can change or cannot change, then solve one or ride one. Found In the self-guided trial, the course also improved worry, sleep, emotional exhaustion, switching off from work and the skill of handling feelings, all against a waiting list. Across 26 studies, self-guided stress programs worked better than control. Why Stress stays high when every problem feels open and every feeling feels like an order. Solving one real problem shrinks the load; naming a feeling and letting it peak and pass takes its grip away. #### The studies Significant differences with small to moderate effect sizes were also found for depression, anxiety, emotional exhaustion, sleeping problems, worrying, mental health-related quality of life, psychological detachment, emotion regulation skills and presenteeism, in favour of the experimental group. [PMID 26884049](https://pubmed.ncbi.nlm.nih.gov/26884049/?ref=elonmuscular.com) · Self-guided internet-based and mobile-based stress management for employees: results of a randomised controlled trial. · Occupational and environmental medicine, 2016 The sentence around it Significant differences with small to moderate effect sizes were also found for depression, anxiety, emotional exhaustion, sleeping problems, worrying, mental health-related quality of life, psychological detachment, emotion regulation skills and presenteeism, in favour of the experimental group. Our results suggest that self-guided stress management programs may be effective when compared to control conditions [PMID 35242591](https://pubmed.ncbi.nlm.nih.gov/35242591/?ref=elonmuscular.com) · Effects of self-guided stress management interventions in college students: A systematic review and meta-analysis. · Internet interventions, 2022 The sentence around it …Discussion Our results suggest that self-guided stress management programs may be effective when compared to control conditions ### Early research 17Rhodiola roseaRhodiola, 200 mg twice a day, morningsEarly evidence ### Rhodiola extract For: Wired and tired Early research: a herb for a stressful, burned-out stretch. Stress, anxiety and low mood fell in a trial. #### What to do 1. Take 200 mg twice a day, before breakfast and before lunch. 2. Never in the evening. It keeps you up. How much 200 mg, twice When Morning and midday How long 2 to 8 weeks Standard practice Rhodiola is possibly safe for up to 12 weeks. Side effects include dizziness, headache, insomnia and dry mouth, and an interaction with losartan has been reported. It is sold as a supplement, not approved as a drug. What happened in the studies Early signal In 80 people over 14 days, anxiety, stress, anger and low mood all fell. ¹ Phytotherapy research, 2015\. The study is under The science, below. Watch out Can make you jittery and wreck your sleep if taken late. Dizziness and headache. On blood pressure pills, ask a doctor first. The science In detail Early research. 200 mg twice a day, before breakfast and before lunch, for two to eight weeks through a hard stretch. Never in the evening: it stimulates. Found **mood up at 14 days.** Eighty people, fourteen days, against no treatment: self-rated anxiety, stress, anger, confusion and low mood all fell, and total mood rose. A hundred people, eight weeks: fatigue fell most in the first week and kept falling. Why Rosavins and salidroside together shape the stress response and the cell's energy pathways. Its best evidence is in fatigue, which is why it belongs to the flat, tired man more than the wired one. Watch Dizziness, headache, trouble sleeping, and a dry mouth or extra saliva. It has interacted with losartan, a blood pressure drug. The safety data run to about twelve weeks. The doses the studies used**400 mg** *two 200 mg tablets: before breakfast, before lunch* 400 mg 2 × 200 mg dose [PMID 26502953](https://pubmed.ncbi.nlm.nih.gov/26502953/?ref=elonmuscular.com) #### The studies the experimental group demonstrated a significant reduction in self-reported, anxiety, stress, anger, confusion and depression at 14 days and a significant improvements in total mood [PMID 26502953](https://pubmed.ncbi.nlm.nih.gov/26502953/?ref=elonmuscular.com) · The Effects of Rhodiola rosea L. Extract on Anxiety, Stress, Cognition and Other Mood Symptoms. · Phytotherapy research, 2015 The sentence around it …Relative to the controls, the experimental group demonstrated a significant reduction in self-reported, anxiety, stress, anger, confusion and depression at 14 days and a significant improvements in total mood.… The fatigue symptoms continued to decline further, with statistically significant improvement at week 8. [PMID 28219059](https://pubmed.ncbi.nlm.nih.gov/28219059/?ref=elonmuscular.com) · Rhodiola rosea in Subjects with Prolonged or Chronic Fatigue Symptoms: Results of an Open-Label Clinical Trial. · Complementary medicine research, 2017 The sentence around it The fatigue symptoms continued to decline further, with statistically significant improvement at week 8. [The deep dive on this](https://elonmuscular.com/rhodiola-rosea/) 18L-TheanineL-theanine, 200 mg a dayEarly evidence ### L-theanine For: Wired on coffee Early research: a calming compound from tea. Anxiety, mood and sleep improved in a 4-week trial. #### What to do 1. Take 200 mg a day. 2. Or 200 to 400 mg a day through a stressful stretch. 3. Give it 4 weeks. How much 200 mg When Daily How long 4 weeks to judge What happened in the studies Early signal In a 4-week trial, 200 mg a day improved anxiety, mood and sleep scores against a dummy pill. ¹ Nutrients, 2019\. The study is under The science, below. Watch out Mild headache, drowsiness or nausea in some. The science In detail Early research. 200 mg a day for four weeks, or 200 to 400 mg a day through a stressful stretch. It comes from tea, and it takes the edge off caffeine without dulling you. Found **Anxiety, mood, sleep better.** A four-week trial of 200 mg a day: anxiety, low mood and sleep scores all improved against placebo. A review of nine trials: 200 to 400 mg a day may ease stress and anxiety under stressful conditions. Why It resembles glutamate closely enough to sit on its receptors and slow its transport, which damps excitatory signaling without sedation, and it raises GABA alongside. Watch Mild transient side effects (Headache, drowsiness, nausea) The doses the studies used**200 mg a day** *four weeks: anxiety, mood and sleep scores better* 200 mg a day200 to 400 mg a day L-theanine (200 mg/day) [PMID 31623400](https://pubmed.ncbi.nlm.nih.gov/31623400/?ref=elonmuscular.com) #### The studies For stress-related symptoms, Self-rating Depression Scale, State-Trait Anxiety Inventory-trait, and Pittsburgh Sleep Quality Index (PSQI) scores decreased after L-theanine administration ( p = 0.019, 0.006, and 0.013, respectively). [PMID 31623400](https://pubmed.ncbi.nlm.nih.gov/31623400/?ref=elonmuscular.com) · Effects of L-Theanine Administration on Stress-Related Symptoms and Cognitive Functions in Healthy Adults: A Randomized Controlled Trial. · Nutrients, 2019 The sentence around it For stress-related symptoms, Self-rating Depression Scale, State-Trait Anxiety Inventory-trait, and Pittsburgh Sleep Quality Index (PSQI) scores decreased after L-theanine administration ( p = 0.019, 0.006, and 0.013, respectively). supplementation of 200-400 mg/day of L-THE may assist in the reduction of stress and anxiety in people exposed to stressful conditions [PMID 31758301](https://pubmed.ncbi.nlm.nih.gov/31758301/?ref=elonmuscular.com) · The Effects of Green Tea Amino Acid L-Theanine Consumption on the Ability to Manage Stress and Anxiety Levels: a Systematic Review. · Plant foods for human nutrition (Dordrecht, Netherlands), 2020 The sentence around it …Our findings suggest that supplementation of 200-400 mg/day of L-THE may assist in the reduction of stress and anxiety in people exposed to stressful conditions.… [The deep dive on this](https://elonmuscular.com/l-theanine/) 19The long sighDouble breath in, long breath out, five minutesEarly evidence ### The long sigh For: Quick calm Early research: two breaths in, one long breath out, for five minutes. It lifted mood more than meditation in a trial. #### What to do 1. Breathe in through the nose, then top it up. 2. Breathe out slowly through the mouth. 3. Repeat for 5 minutes. How much 5 minutes When Daily or before How long A month to judge What happened in the studies Early signal In a one-month trial, five minutes a day of long sighs lifted mood more than meditation. ¹ Cell reports. Medicine, 2023\. The study is under The science, below. The science In detail Early research. Breathe in through the nose, then top it up with a second short breath in. Let it all out slowly through the mouth, longer than the breath in. Repeat for five minutes, once a day or when you feel the wind-up. Found **Mood up more than meditation.** A one-month trial of daily five-minute breathing: the long-exhale sigh lifted mood more and slowed breathing more than the same time of mindfulness meditation. Why A long breath out slows the heart through the vagus nerve. Weighting each breath to the exhale moves the body toward calm faster than breathing evenly. #### The study breathwork, especially the exhale-focused cyclic sighing, produces greater improvement in mood (p < 0.05) and reduction in respiratory rate (p < 0.05) compared with mindfulness meditation [PMID 36630953](https://pubmed.ncbi.nlm.nih.gov/36630953/?ref=elonmuscular.com) · Brief structured respiration practices enhance mood and reduce physiological arousal. · Cell reports. Medicine, 2023 The sentence around it …Using a mixed-effects model, we show that breathwork, especially the exhale-focused cyclic sighing, produces greater improvement in mood (p < 0.05) and reduction in respiratory rate (p < 0.05) compared with mindfulness meditation.… Daily 5-min cyclic sighing has promise as an effective stress management exercise. The sentence around it Daily 5-min cyclic sighing has promise as an effective stress management exercise. [The deep dive on this](https://elonmuscular.com/lab-cyclic-sighing-physiological-sigh/) 20Holy basil (tulsi) extractHoly basil extract, 125 mg twice a dayEarly evidence ### Holy basil (tulsi) extract For: Wired and tired Early research: a traditional stress herb. In a trial it lowered the stress score and the stress hormone. #### What to do 1. Take a standardized extract, 125 mg twice a day. 2. Give it 8 weeks. 3. On other medicines, ask a pharmacist first. How much 125 mg twice a day When Morning and evening How long 8 weeks What happened in the studies Early signal Across 24 studies, tulsi gave favorable results, psychological stress among them, with no serious side effects. ¹ Evidence-based complementary and alternative medicine, 2017\. The study is under The science, below. Watch out No serious side effects in the studies, but they were short. On other medicines, ask a pharmacist first. The science In detail Early research. A standardized holy basil leaf extract, 125 mg twice a day in the trial, for eight weeks before you judge it. Beside the rest of the page, not in place of it. Found **Stress score and cortisol down.** A review of 24 human studies of tulsi: all reported good outcomes, psychological stress among them, with no serious side effects. An eight-week trial of 125 mg twice a day lowered the stress score and hair cortisol against a placebo. Why It is one of the traditional adaptogens, the plants used to help the body handle stress. In the trial, the stress hormone came down with the stress score. Watch The studies reported no serious side effects, but the trials are short. On other medicines, ask a pharmacist first. #### The study The reviewed studies reinforce traditional uses and suggest tulsi is an effective treatment for lifestyle-related chronic diseases including diabetes, metabolic syndrome, and psychological stress. [PMID 28400848](https://pubmed.ncbi.nlm.nih.gov/28400848/?ref=elonmuscular.com) · The Clinical Efficacy and Safety of Tulsi in Humans: A Systematic Review of the Literature. · Evidence-based complementary and alternative medicine, 2017 The sentence around it The reviewed studies reinforce traditional uses and suggest tulsi is an effective treatment for lifestyle-related chronic diseases including diabetes, metabolic syndrome, and psychological stress. All studies reported favourable clinical outcomes with no studies reporting any significant adverse events. The sentence around it All studies reported favourable clinical outcomes with no studies reporting any significant adverse events. 21MagnesiumMagnesium, 300 mg a dayEarly evidence ### Magnesium For: Diet low in magnesium Early research: magnesium lowered stress scores in an 8-week trial. #### What to do 1. Eat magnesium foods first: spinach, nuts, whole wheat bread. 2. If you add a supplement, 300 mg a day. 3. Stay at 400 mg a day or less. How much 300 mg a day When Daily How long 8 weeks Standard practice Men need 300 mg of magnesium a day, and a varied diet should give it. Taking 400 mg or less a day from supplements is unlikely to cause harm. More than 400 mg can cause diarrhea. What happened in the studies Early signal In an 8-week trial of 264 people, stress scores fell by about 42% on magnesium. ¹ PloS one, 2018\. The study is under The science, below. Watch out Over 400 mg a day can cause diarrhea. With kidney disease, ask a doctor first. The science In detail Early research. 300 mg of magnesium a day, the trial dose, for eight weeks. Stay at 400 mg a day or less from supplements. Eat the foods first: spinach, nuts, whole wheat bread. Found **Stress score down 42%.** In an eight-week trial of 264 people, stress scores fell by about 42% on magnesium alone, and by 45% with vitamin B6 added. Why Magnesium is used in turning food into energy and in nerve signaling. Topping up a low intake is the aim, and the stress score came down with it. Watch More than 400 mg a day for a short time can cause diarrhea. With kidney disease, do not take it without a doctor. #### The study both treatment arms substantially reduced DASS-42 stress subscale score from baseline to Week 8 (Mg-vitamin B6, 44.9%; Mg 42.4%) [PMID 30562392](https://pubmed.ncbi.nlm.nih.gov/30562392/?ref=elonmuscular.com) · Superiority of magnesium and vitamin B6 over magnesium alone on severe stress in healthy adults with low magnesemia: A randomized, single-blind clinical trial. · PloS one, 2018 The sentence around it …Results In the modified intention-to-treat analysis (N = 264 subjects), both treatment arms substantially reduced DASS-42 stress subscale score from baseline to Week 8 (Mg-vitamin B6, 44.9%; Mg 42.4%); no statistical difference between arms was observed (p>0.05).… These findings suggest oral Mg supplementation alleviated stress The sentence around it …Conclusions These findings suggest oral Mg supplementation alleviated stress 22Omega-3Fish oil, working up to 2 g a dayEarly evidence ### Omega-3 fish oil For: Tense and anxious Early research: fish oil may ease anxiety, most at about 2 g a day. #### What to do 1. Take fish oil with food. 2. Work up to about 2 g of omega-3 a day. 3. Give it 8 weeks. How much About 2 g When With food How long 8 weeks What happened in the studies Early signal In 23 trials with 2,189 people, omega-3 lowered anxiety symptoms, most at about 2 g a day. ¹ BMC psychiatry, 2024\. The study is under The science, below. Watch out Irregular heartbeat risk rises at higher doses. On a blood thinner, ask a doctor first. The science In detail Early research. Fish oil with food, working up to about 2 g of omega-3 a day, for at least eight weeks. Beside the rest of the page, not in place of it. Found **Medium effect per gram a day.** Twenty-three trials, 2,189 people: each gram a day of omega-3 lowered anxiety symptoms by a moderate effect, with the greatest gain at 2 g a day. Nineteen trials: omega-3 might help reduce clinical anxiety. Why Omega-3 fats are built into brain cell membranes and shift the body toward less inflammatory signaling, which chronic stress pushes up. Watch Irregular heartbeat (atrial fibrillation) risk rises with higher doses. On a blood thinner, or before surgery, ask the doctor first: it can add to bleeding. Fishy burps and loose stools. #### The studies Each 1 gram per day supplementation with omega-3 fatty acids resulted in a moderate decrease in anxiety symptoms (SMD: -0.70, 95%CI: -1.17, -0.22; GRADE = low). [PMID 38890670](https://pubmed.ncbi.nlm.nih.gov/38890670/?ref=elonmuscular.com) · Efficacy and safety of omega-3 fatty acids supplementation for anxiety symptoms: a systematic review and dose-response meta-analysis of randomized controlled trials. · BMC psychiatry, 2024 The sentence around it Each 1 gram per day supplementation with omega-3 fatty acids resulted in a moderate decrease in anxiety symptoms (SMD: -0.70, 95%CI: -1.17, -0.22; GRADE = low). This review indicates that omega-3 PUFAs might help to reduce the symptoms of clinical anxiety. [PMID 30646157](https://pubmed.ncbi.nlm.nih.gov/30646157/?ref=elonmuscular.com) · Association of Use of Omega-3 Polyunsaturated Fatty Acids With Changes in Severity of Anxiety Symptoms: A Systematic Review and Meta-analysis. · JAMA network open, 2018 The sentence around it …Conclusions and relevance This review indicates that omega-3 PUFAs might help to reduce the symptoms of clinical anxiety. [The deep dive on this](https://elonmuscular.com/omega-3/) 23Saffron ExtractSaffron extract, 30 mg a dayEarly evidence ### Saffron extract For: Stress with low mood Early research: a spice extract that eased anxiety and low mood in trials. #### What to do 1. Take 15 mg of a standardized saffron extract twice a day. 2. Use a standardized extract. Saffron is often faked. 3. Give it 6 weeks. How much 30 mg a day When 15 mg twice a day How long 6 weeks What happened in the studies Early signal Across 23 studies, saffron eased anxiety and low mood more than a dummy pill. ¹ Nutrition reviews, 2019\. The study is under The science, below. Watch out Mild stomach upset or headache. Stay at the trial dose. On an antidepressant, ask a doctor first. The science In detail Early research. A standardized saffron stigma extract, 30 mg a day as 15 mg twice a day, for six weeks. A standardized extract only: saffron is often faked. Found **g 0.95 on anxiety.** Twenty-three studies: saffron had a large effect on anxiety symptoms against placebo, and on low mood too. Why Crocin and crocetin carry it, and crocetin is small enough to cross into the brain, where it acts on serotonin and stress signaling. Watch Mild stomach upset or headache in some. High doses of the spice itself are unsafe; stay at the trial dose. On an antidepressant, tell the doctor first. #### The study Saffron had a large positive effect size when compared with placebo for depressive symptoms (g = 0.99, P < 0.001) and anxiety symptoms (g = 0.95, P < 0.006). [PMID 31135916](https://pubmed.ncbi.nlm.nih.gov/31135916/?ref=elonmuscular.com) · Effect of saffron supplementation on symptoms of depression and anxiety: a systematic review and meta-analysis. · Nutrition reviews, 2019 The sentence around it Saffron had a large positive effect size when compared with placebo for depressive symptoms (g = 0.99, P < 0.001) and anxiety symptoms (g = 0.95, P < 0.006). Saffron could be an effective intervention for symptoms of depression and anxiety The sentence around it …Conclusions Saffron could be an effective intervention for symptoms of depression and anxiety [The deep dive on this](https://elonmuscular.com/saffron-extract/) 24PhosphatidylserinePhosphatidylserine, 400 mg a dayEarly evidence ### Phosphatidylserine For: Stress-hormone spikes Early research: a nerve-cell fat that blunted the stress-hormone surge in trials. #### What to do 1. Take 400 mg a day. 2. Give it 3 weeks through a hard stretch. 3. On a blood thinner, ask a doctor first. How much 400 mg a day When Daily How long 3 weeks What happened in the studies Early signal In two trials against a placebo, daily phosphatidylserine blunted the stress-hormone surge, and distress fell. ¹ Stress (Amsterdam, Netherlands), 2004\. The study is under The science, below. Watch out Stomach upset or poor sleep in some. On a blood thinner, ask a doctor first. Soy allergy: avoid the soy kind. The science In detail Early research. 400 mg a day of a soy-derived phosphatidylserine complex for three weeks, the dose that worked best in the mental-stress trial. Take it through a hard stretch, beside the rest of the page. Found **Cortisol surge blunted.** In a trial against a placebo, three weeks at 400 mg a day blunted the stress-hormone and cortisol rise to a public-speaking stress test, and distress fell while it rose on placebo. Why It is a fat in every nerve cell membrane. Taken daily, it seems to turn down the brain-to-adrenal signal that fires cortisol under stress. Watch Stomach upset and trouble sleeping in some. On a blood thinner, ask the doctor first: it may add to bleeding. With a soy allergy, avoid the soy-derived kind. #### The study Treatment with 400 mg PAS resulted in a pronounced blunting of both serum ACTH and cortisol, and salivary cortisol responses to the TSST [PMID 15512856](https://pubmed.ncbi.nlm.nih.gov/15512856/?ref=elonmuscular.com) · Effects of soy lecithin phosphatidic acid and phosphatidylserine complex (PAS) on the endocrine and psychological responses to mental stress. · Stress (Amsterdam, Netherlands), 2004 The sentence around it Treatment with 400 mg PAS resulted in a pronounced blunting of both serum ACTH and cortisol, and salivary cortisol responses to the TSST the group treated with 400 mg PAS showed decreased distress The sentence around it …While the placebo group showed the expected increase in distress after the test, the group treated with 400 mg PAS showed decreased distress.… [The deep dive on this](https://elonmuscular.com/phosphatidylserine/) 25Lemon balm extractLemon balm extract, 600 mg before a stressful stretchEarly evidence ### Lemon balm extract For: A stressful stretch ahead Early research: a calming herb extract that raised calm during a stress test. #### What to do 1. Take 600 mg of a standardized extract about an hour before. 2. Not with sedatives, sleeping pills or alcohol. 3. No driving until you know how it hits. How much 600 mg When About an hour before How long One dose What happened in the studies Early signal In a trial against a placebo, one 600 mg dose of lemon balm made people calmer during a stress test. ¹ Psychosomatic medicine, 2004\. The study is under The science, below. Watch out It can make you less alert: care driving. Not with sedatives or alcohol. Thyroid condition: ask a doctor first. The science In detail Early research. A standardized lemon balm leaf extract, 600 mg in one dose, the dose that eased stress in the trial, about an hour before a stressful stretch. Not with sedatives or alcohol. Found **Calmer under stress.** In a trial, one 600 mg dose eased the low mood from a stress test and raised calmness. Across the trials, lemon balm lowered anxiety scores against placebo, without serious side effects. Why Its rosmarinic acid slows the breakdown of GABA, the brain’s main brake, so the brake stays on a little longer. Watch Calming, and it can lower alertness: no driving until you know how it hits. Not with sedatives, sleeping pills or alcohol. With a thyroid condition or on thyroid pills, ask a doctor first. #### The studies the 600-mg dose of Melissa ameliorated the negative mood effects of the DISS, with significantly increased self-ratings of calmness [PMID 15272110](https://pubmed.ncbi.nlm.nih.gov/15272110/?ref=elonmuscular.com) · Attenuation of laboratory-induced stress in humans after acute administration of Melissa officinalis (Lemon Balm). · Psychosomatic medicine, 2004 The sentence around it …Results The results showed that the 600-mg dose of Melissa ameliorated the negative mood effects of the DISS, with significantly increased self-ratings of calmness and reduced self-ratings of alertness.… lemon balm significantly improved mean anxiety and depression scores compared with the placebo [PMID 34449930](https://pubmed.ncbi.nlm.nih.gov/34449930/?ref=elonmuscular.com) · The effects of lemon balm (Melissa officinalis L.) on depression and anxiety in clinical trials: A systematic review and meta-analysis. · Phytotherapy research, 2021 The sentence around it …Based on meta-analysis results, lemon balm significantly improved mean anxiety and depression scores compared with the placebo (SMD: -0.98; 95% CI: -1.63 to -0.33; p = 0.003), (SMD: -0.47; 95% CI: -0.73 to -0.21; p = 0.0005) respectively, without serious side effects.… 26Write tomorrow’s list before bedFive minutes on tomorrow’s list at bedtimeEarly evidence ### Write tomorrow’s list before bed For: Head racing at night Early research: write a specific to-do list at bedtime. People fell asleep faster. #### What to do 1. Five minutes before bed, write what you need to do next. 2. Make it specific. 3. Close the notebook until morning. How much 5 minutes When At bedtime How long Every night What happened in the studies Early signal In a sleep-lab trial, writing a 5-minute to-do list at bedtime helped people fall asleep faster. ¹ Journal of experimental psychology. General, 2018\. The study is under The science, below. The science In detail Early research. Five minutes before lights out, write a specific list of what you need to do in the next few days. The more specific, the better. Then close the notebook and leave it for the morning. Found **Asleep faster.** In a sleep-lab trial, writing a to-do list for five minutes at bedtime got people to sleep faster than writing about what they had already done. The more specific the list, the faster they fell asleep. Why Open tasks keep the mind scanning at night. Putting them on paper tells the brain they are held somewhere, so it can stop rehearsing them. #### The study Participants in the to-do list condition fell asleep significantly faster than those in the completed-list condition. [PMID 29058942](https://pubmed.ncbi.nlm.nih.gov/29058942/?ref=elonmuscular.com) · The effects of bedtime writing on difficulty falling asleep: A polysomnographic study comparing to-do lists and completed activity lists. · Journal of experimental psychology. General, 2018 The sentence around it Participants in the to-do list condition fell asleep significantly faster than those in the completed-list condition. The more specifically participants wrote their to-do list, the faster they subsequently fell asleep The sentence around it The more specifically participants wrote their to-do list, the faster they subsequently fell asleep ### With a doctor Everything in this group is a decision for you and a doctor who has your history. It is here so you walk in knowing what to ask for. 27Book your doctorBook the doctor, take the diaryStrong evidence ### Book your doctor For: Getting help Seeing a doctor is a move, not a failure. It unlocks the strongest treatments. #### What to do 1. Book a doctor's appointment. 2. Bring your diary: stress scores, caffeine, drinks, sleep. 3. Ask for a blood pressure check, and bloods if the list says so. How much One appointment When This week How long Then as advised What happened in the studies Half as likely to get help For the same symptoms, men were about half as likely to have a diagnosis. What got men in: plain information and role models. ¹ Journal of affective disorders, 2022\. The study is under The science, below. The science In detail Book your doctor if the stress score has not moved by week 8, if you are struggling to cope, or if any line in the When to see a doctor list fits. Take the diary: the stress scores, the GAD-7 and PHQ-8, the caffeine, the drinks, the sleep. Ask for a blood pressure check. Found **odds 0.54 of a diagnosis.** In the national survey, men were about half as likely as women to hold a professional diagnosis for the same symptoms. The treatments that got men through the door used role models, plain information about symptoms, services signposted, and content built on responsibility and strength. Why Men seek help from a mental-health professional at the same rate as women once they are in front of one. Where they fall behind is in getting there at all. The binding constraint is contact, not willingness. #### The studies Odds of professional diagnosis were lower for men compared with women (adjusted odds ratio \[AOR\] 0.54, 95 % confidence intervals \[CI\] 0.47-0.62). [PMID 36155230](https://pubmed.ncbi.nlm.nih.gov/36155230/?ref=elonmuscular.com) · Associations between sociodemographic characteristics and receipt of professional diagnosis in Common Mental Disorder: Results from the Adult Psychiatric Morbidity Survey 2014\. · Journal of affective disorders, 2022 The sentence around it Odds of professional diagnosis were lower for men compared with women (adjusted odds ratio \[AOR\] 0.54, 95 % confidence intervals \[CI\] 0.47-0.62). Key processes that improved help-seeking attitudes, intentions, or behaviors for men included using role models to convey information, psychoeducational material to improve mental health knowledge, assistance with recognizing and managing symptoms, active problem-solving tasks, motivating behavior change, signposting services, and, finally, content that built on positive male traits (e.g., responsibility and strength). [PMID 31184251](https://pubmed.ncbi.nlm.nih.gov/31184251/?ref=elonmuscular.com) · Improving Mental Health Service Utilization Among Men: A Systematic Review and Synthesis of Behavior Change Techniques Within Interventions Targeting Help-Seeking. · American journal of men's health, 2019 The sentence around it …Regarding quality assessment, three were scored as "strong," five as "moderate," and one as "weak." Key processes that improved help-seeking attitudes, intentions, or behaviors for men included using role models to convey information, psychoeducational material to improve mental health knowledge, assistance with recognizing and managing symptoms, active problem-solving tasks, motivating behavior change, signposting services, and, finally, content that built on positive male traits (e.g., responsibility and strength). [The deep dive on this](https://elonmuscular.com/men-and-help-seeking/) ## How you'll know it's working Track Stress score (PSS-10) How to track Ten questions about the last month, scored 0 to 40\. Take it today, then every four weeks, same day. Write the score in the diary. When to judge Judge the page at week 8, the end of the mindfulness course or a stress course. Slow breathing is judged at 4 weeks, a supplement at 8. New Heroes The full library. Elon answers every weekday. [Join New Heroes.](https://elonmuscular.com/join/) Cancel anytime. ## Why this happens You are wired all day and tired all the time. Work follows you home, the phone never stops, and when you finally lie down your head keeps going. On a man it often shows in the body: a tight jaw and shoulders, a racing heart, a short fuse and short sleep. Then one more coffee in the morning and one more drink at night to get through it. ### The alarm Stress switches on adrenaline and cortisol to get you through a hard moment. Chronic stress is that alarm left on, with no gap to reset. Caffeine, drink and short sleep all keep it on. ### The off-switch The body has a brake: the calming branch of the nervous system. Slow breathing, relaxation, training, green space and company all press on it, and it gets stronger with daily use. ### The load Some of the stress is the load, and some is the story about it. A hard stop on work cuts the load; the self-help course or mindfulness changes the story. When it has become anxiety or depression, a doctor leads. Less caffeine and drinkSleep protectedTraining most daysWired all dayA calmer baselineSlow breathingRelaxation, yogaGreen space, companyNo gap to recoverA body that comes downA hard stop on workThe self-help stresscourseMindfulnessAlways onStress you can put downA head thatswitchesoffA head thatswitchesoffA head thatswitchesoffA head thatswitchesoffThe alarmThe off-switchThe loadLess caffeine and drinkSleep protectedTraining most daysWired all dayA calmer baselineSlow breathingRelaxation, yogaGreen space, companyNo gap to recoverA body that comes downA hard stop on workThe self-help stress courseMindfulnessAlways onStress you can put downA head that switches offA head that switches offA head that switches offA head that switches offThe alarmThe off-switchThe load **Figure 2.** How the moves lead to A head that switches off. The dotted orange boxes are the things to cut back. ## Week by week Why this order Rule out a disorder first, then the daily moves, then a structured course, then the doctor if the score has not moved. 02468101214161820Weeks from the startStress score, every 4 weeksTraining, sleep, caffeine,drinkHard stop on workSlow breathing, dailyMindfulness or the stresscourseThe reviewYour doctor, if the scoreis flatReview, week 20048121620Weeks from the startStress score, every 4 weeksTraining, sleep, caffeine, drinkHard stop on workSlow breathing, dailyMindfulness or the stress courseThe reviewYour doctor, if the score is flatReview, week 20 **Figure 3.** The plan by week: navy bars keep going, orange bars are the moves you add, white bars are checks and decisions. The starburst marks the review at week 20. Swipe sideways to see the whole table | When | Add | Why then | | --------------------------------- | ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- | ------------------------------------------------------------------------------------------------------- | | Today | The stress score, the GAD-7 and the PHQ-8\. Chest pain or fainting with a racing heart: 911. | Safety first, then the numbers that decide whether this is stress or a disorder with its own treatment. | | If a rule-out score is 10 or more | A GAD-7 of 10 or more: see your doctor and run [Stop worrying](https://elonmuscular.com/protocol-stop-worrying/). A PHQ-8 of 10 or more: see your doctor and run [Low mood](https://elonmuscular.com/protocol-low-mood/). Keep this page going beside it. | An anxiety disorder or depression has its own plan and medicines, and a doctor should lead. | | Week 0 | Training most days. Caffeine counted and cut, drinks counted and cut, a fixed wake time. A finish time on work, one day a week off. One person told. Two hours outside a week. | These turn the alarm down and give the body a gap to recover in. They feed each other. | | Week 1 | Slow breathing daily. Start the eight-week mindfulness course or the 7-week self-help stress course, and the daily solve-or-ride routine. | The structured courses are the strongest moves on the page. Start one this week. | | Week 4 | The stress score again. Judge the breathing. Add yoga or relaxation if the body still feels tight, and ashwagandha if you want a supplement. | The first month shows which moves are landing. | | Week 8, the review | This stress score against the first. Down: keep going. Flat, or the rule-out scores have risen: book your doctor. | The mindfulness course and the stress courses run about eight weeks, so this is where to judge them. | | Any week | Nerves before one big event: [Stay calm](https://elonmuscular.com/protocol-calm-under-pressure/). Worry about everything: [Stop worrying](https://elonmuscular.com/protocol-stop-worrying/). Replaying the day on a loop: [Stop overthinking](https://elonmuscular.com/protocol-stop-overthinking/). Lying awake: [Deeper sleep](https://elonmuscular.com/protocol-deeper-sleep/). | Each rides with chronic stress, and each has its own page. | ## What to track One number: the stress score (PSS-10), every four weeks. Lower is better. Read the trend over two or three scores, not one. The diary covers a week: days trained, caffeine, drinks, hours slept, the time work stopped, and one line on the worst moment of the day. If the score has not moved by week 8, the order above says what to do next. ### The diary, one week Swipe sideways to see the whole table | Day | Trained today? | Caffeine, mg | Drinks | Hours slept | Work stopped at | | --- | -------------- | ------------ | ------ | ----------- | --------------- | | Mon | | | | | | | Tue | | | | | | | Wed | | | | | | | Thu | | | | | | | Fri | | | | | | | Sat | | | | | | | Sun | | | | | | - The stress score every four weeks: judged at the review, week 8. - The GAD-7 and PHQ-8 today and at week 8: a rise to 10 or more is a doctor's visit, not a column to watch. - Caffeine and drinks a day: the two columns that move first and fastest. - The time work stopped, and days trained out of seven: the habits that hold the gains. - If you wear a tracker, the weekly average of morning heart rate variability. It tends to rise as stress falls. It is a check, not a move. - A blood pressure reading at a pharmacy or your doctor. 140/90 or higher is a doctor's visit. ## Doses at a glance The amounts the studies used, move by move. The label or your doctor sets your dose. Swipe sideways to see the whole table | Move | What the studies used | When | How long | Study | | ------------------------------------------------------- | ---------------------------------------- | -------------------------------- | ----------------------------- | ------------------------------------------------------------------------------- | | [1\. Train most days](#e1) | Most days; lift twice a week | Earlier in the day | Every week | [PMID 41667154](https://pubmed.ncbi.nlm.nih.gov/41667154/?ref=elonmuscular.com) | | [2\. Protect the sleep](#e2) | 7 to 8 hours | Same wake time, seven days | Always | [PMID 34607184](https://pubmed.ncbi.nlm.nih.gov/34607184/?ref=elonmuscular.com) | | [3\. Cut the caffeine](#e3) | Well under 400 mg | None after midday | Taper over 1 to 2 weeks | [PMID 38362247](https://pubmed.ncbi.nlm.nih.gov/38362247/?ref=elonmuscular.com) | | [4\. Drink less to come down](#e4) | One risk level down | Count first, then cut | Every week | [PMID 28019652](https://pubmed.ncbi.nlm.nih.gov/28019652/?ref=elonmuscular.com) | | [5\. Put a hard stop on the workday](#e5) | A set finish time | Every workday | Every week | [PMID 28133454](https://pubmed.ncbi.nlm.nih.gov/28133454/?ref=elonmuscular.com) | | [6\. Talk it through with someone](#e6) | One person, this week | Weekly | Every week | [PMID 14675803](https://pubmed.ncbi.nlm.nih.gov/14675803/?ref=elonmuscular.com) | | [7\. Get outside, somewhere green](#e7) | Two hours a week | One long visit or several short | Every week | [PMID 33066853](https://pubmed.ncbi.nlm.nih.gov/33066853/?ref=elonmuscular.com) | | [8\. Six breaths a minute](#e8) | Six breaths a minute | 10 to 20 minutes, daily | Every day; judge at 4 weeks | [PMID 28478782](https://pubmed.ncbi.nlm.nih.gov/28478782/?ref=elonmuscular.com) | | [9\. The eight-week mindfulness course](#e9) | One class a week, daily practice | Daily | 8 weeks | [PMID 25818837](https://pubmed.ncbi.nlm.nih.gov/25818837/?ref=elonmuscular.com) | | [10\. Yoga, twice a week](#e10) | A class, or 30 minutes | Twice a week | 8 to 12 weeks | [PMID 30384420](https://pubmed.ncbi.nlm.nih.gov/30384420/?ref=elonmuscular.com) | | [11\. Progressive muscle relaxation](#e11) | 15 to 20 minutes | Daily, or before bed | Every day | [PMID 37879237](https://pubmed.ncbi.nlm.nih.gov/37879237/?ref=elonmuscular.com) | | [12\. Ashwagandha root extract](#e12) | 300 to 600 mg root extract | Night | 8 weeks | [PMID 36017529](https://pubmed.ncbi.nlm.nih.gov/36017529/?ref=elonmuscular.com) | | [13\. A B-vitamin complex](#e13) | A B-complex, label dose | Daily, with food | At least 4 weeks | [PMID 31527485](https://pubmed.ncbi.nlm.nih.gov/31527485/?ref=elonmuscular.com) | | [14\. Lavender oil capsules](#e14) | Oral extract 80 mg | Once a day | 10 weeks | [PMID 34775136](https://pubmed.ncbi.nlm.nih.gov/34775136/?ref=elonmuscular.com) | | [15\. Stress Without Burnout](#e15) | Seven lessons and a 2-minute daily diary | A lesson every five days or more | 66 days | [PMID 26884049](https://pubmed.ncbi.nlm.nih.gov/26884049/?ref=elonmuscular.com) | | [16\. Solve it or ride it, fifteen minutes a day](#e16) | 15 minutes | Daily, before the evening | Every day | [PMID 26884049](https://pubmed.ncbi.nlm.nih.gov/26884049/?ref=elonmuscular.com) | | [17\. Rhodiola extract](#e17) | 200 mg twice a day | Before breakfast and lunch | 2 to 8 weeks | [PMID 26502953](https://pubmed.ncbi.nlm.nih.gov/26502953/?ref=elonmuscular.com) | | [18\. L-theanine](#e18) | 200 mg a day | Daily | 4 weeks | [PMID 31623400](https://pubmed.ncbi.nlm.nih.gov/31623400/?ref=elonmuscular.com) | | [19\. The long sigh](#e19) | Five minutes | Daily, or before you go on | A month to judge | [PMID 36630953](https://pubmed.ncbi.nlm.nih.gov/36630953/?ref=elonmuscular.com) | | [20\. Holy basil (tulsi) extract](#e20) | 125 mg twice a day, the trial dose | Morning and evening | 8 weeks | [PMID 28400848](https://pubmed.ncbi.nlm.nih.gov/28400848/?ref=elonmuscular.com) | | [21\. Magnesium](#e21) | 300 mg a day, the trial dose | Daily | 8 weeks | [PMID 30562392](https://pubmed.ncbi.nlm.nih.gov/30562392/?ref=elonmuscular.com) | | [22\. Omega-3 fish oil](#e22) | About 2 g a day | With food | 8 weeks | [PMID 38890670](https://pubmed.ncbi.nlm.nih.gov/38890670/?ref=elonmuscular.com) | | [23\. Saffron extract](#e23) | 30 mg standardized extract | 15 mg twice a day | 6 weeks | [PMID 31135916](https://pubmed.ncbi.nlm.nih.gov/31135916/?ref=elonmuscular.com) | | [24\. Phosphatidylserine](#e24) | 400 mg a day, the trial dose | Daily | 3 weeks | [PMID 15512856](https://pubmed.ncbi.nlm.nih.gov/15512856/?ref=elonmuscular.com) | | [25\. Lemon balm extract](#e25) | 600 mg, the trial dose | About an hour before | One dose | [PMID 15272110](https://pubmed.ncbi.nlm.nih.gov/15272110/?ref=elonmuscular.com) | | [26\. Write tomorrow’s list before bed](#e26) | 5 minutes | At bedtime | Every night | [PMID 29058942](https://pubmed.ncbi.nlm.nih.gov/29058942/?ref=elonmuscular.com) | | [27\. Book your doctor](#e27) | One appointment | This week | Once, then as the doctor says | [PMID 36155230](https://pubmed.ncbi.nlm.nih.gov/36155230/?ref=elonmuscular.com) | ## Deep dives Each of these has its own page in the library, with its risks, its doses and every study. - [**Train most days**Move most days, aerobic first, lift twice a week](https://elonmuscular.com/resistance-training/) - [**Protect the sleep**Seven to eight hours, at the same times](https://elonmuscular.com/sleep/) - [**Cut the caffeine**Count it, then cut it well under 400 mg a day](https://elonmuscular.com/caffeine/) - [**Drink less to come down**Count the drinks, then cut a level](https://elonmuscular.com/cutting-down-drinking/) - [**Six breaths a minute**Six breaths a minute, ten to twenty minutes a day](https://elonmuscular.com/lab-slow-paced-breathing-hrv-biofeedback/) - [**The eight-week mindfulness course**The eight-week course, or ten minutes a day](https://elonmuscular.com/lab-mbsr/) - [**Yoga, twice a week**Twice a week, breath leading the poses](https://elonmuscular.com/yoga/) - [**Ashwagandha root extract**300 to 600 mg a day, eight weeks](https://elonmuscular.com/ashwagandha/) - [**A B-vitamin complex**A daily B-complex, B6 at 10 mg or less](https://elonmuscular.com/vitamin-b6/) - [**Lavender oil capsules**The oral lavender capsule, 80 mg a day](https://elonmuscular.com/lavender-oil/) - [**Stress Without Burnout**Stress Without Burnout: a 66-day guided quest, seven lessons](https://elonmuscular.com/lab-cbt/) - [**Rhodiola extract**Early research: rhodiola, 200 mg twice a day, mornings](https://elonmuscular.com/rhodiola-rosea/) - [**L-theanine**Early research: L-theanine, 200 mg a day](https://elonmuscular.com/l-theanine/) - [**The long sigh**Early research: double breath in, long breath out, five minutes](https://elonmuscular.com/lab-cyclic-sighing-physiological-sigh/) - [**Omega-3 fish oil**Early research: fish oil, working up to 2 g a day](https://elonmuscular.com/omega-3/) - [**Saffron extract**Early research: saffron extract, 30 mg a day](https://elonmuscular.com/saffron-extract/) - [**Phosphatidylserine**Early research: phosphatidylserine, 400 mg a day](https://elonmuscular.com/phosphatidylserine/) - [**Book your doctor**Book the doctor, take the diary](https://elonmuscular.com/men-and-help-seeking/) ## The studies Every study behind this page, newest first. - [Effect of exercise on depression and anxiety symptoms: systematic umbrella review with meta-meta-analysis.British journal of sports medicine, 2026\. PMID 41667154](https://pubmed.ncbi.nlm.nih.gov/41667154/?ref=elonmuscular.com) - [Efficacy and Methodology of Remote Heart Rate Variability Biofeedback Interventions for Mental Health: A Systematic Review and Meta-Analysis.Applied psychophysiology and biofeedback, 2026\. PMID 41310318](https://pubmed.ncbi.nlm.nih.gov/41310318/?ref=elonmuscular.com) - [Generalized Anxiety Disorder 7-item (GAD-7) and 2-item (GAD-2) scales for detecting anxiety disorders in adults.The Cochrane database of systematic reviews, 2025\. PMID 40130828](https://pubmed.ncbi.nlm.nih.gov/40130828/?ref=elonmuscular.com) - [Caffeine intake and anxiety: a meta-analysis.Frontiers in psychology, 2024\. PMID 38362247](https://pubmed.ncbi.nlm.nih.gov/38362247/?ref=elonmuscular.com) - [Effectiveness of stress management interventions to change cortisol levels: a systematic review and meta-analysis.Psychoneuroendocrinology, 2024\. PMID 37879237](https://pubmed.ncbi.nlm.nih.gov/37879237/?ref=elonmuscular.com) - [Efficacy and safety of omega-3 fatty acids supplementation for anxiety symptoms: a systematic review and dose-response meta-analysis of randomized controlled trials.BMC psychiatry, 2024\. PMID 38890670](https://pubmed.ncbi.nlm.nih.gov/38890670/?ref=elonmuscular.com) - [Brief structured respiration practices enhance mood and reduce physiological arousal.Cell reports. Medicine, 2023\. PMID 36630953](https://pubmed.ncbi.nlm.nih.gov/36630953/?ref=elonmuscular.com) - [Does Ashwagandha supplementation have a beneficial effect on the management of anxiety and stress? A systematic review and meta-analysis of randomized controlled trials.Phytotherapy research, 2022\. PMID 36017529](https://pubmed.ncbi.nlm.nih.gov/36017529/?ref=elonmuscular.com) - [Effects of self-guided stress management interventions in college students: A systematic review and meta-analysis.Internet interventions, 2022\. PMID 35242591](https://pubmed.ncbi.nlm.nih.gov/35242591/?ref=elonmuscular.com) - [Associations between sociodemographic characteristics and receipt of professional diagnosis in Common Mental Disorder: Results from the Adult Psychiatric Morbidity Survey 2014.Journal of affective disorders, 2022\. PMID 36155230](https://pubmed.ncbi.nlm.nih.gov/36155230/?ref=elonmuscular.com) - [Improving sleep quality leads to better mental health: A meta-analysis of randomised controlled trials.Sleep medicine reviews, 2021\. PMID 34607184](https://pubmed.ncbi.nlm.nih.gov/34607184/?ref=elonmuscular.com) - [Interventions for improving psychological detachment from work: A meta-analysis.Journal of occupational health psychology, 2021\. PMID 34096763](https://pubmed.ncbi.nlm.nih.gov/34096763/?ref=elonmuscular.com) - [Effect of Ashwagandha (Withania somnifera) extract on sleep: A systematic review and meta-analysis.PloS one, 2021\. PMID 34559859](https://pubmed.ncbi.nlm.nih.gov/34559859/?ref=elonmuscular.com) - [Effects of Lavender on Anxiety, Depression, and Physiological Parameters: Systematic Review and Meta-Analysis.Asian nursing research, 2021\. PMID 34775136](https://pubmed.ncbi.nlm.nih.gov/34775136/?ref=elonmuscular.com) - [The effects of lemon balm (Melissa officinalis L.) on depression and anxiety in clinical trials: A systematic review and meta-analysis.Phytotherapy research, 2021\. PMID 34449930](https://pubmed.ncbi.nlm.nih.gov/34449930/?ref=elonmuscular.com) - [An Exposure-Wide and Mendelian Randomization Approach to Identifying Modifiable Factors for the Prevention of Depression.The American journal of psychiatry, 2020\. PMID 32791893](https://pubmed.ncbi.nlm.nih.gov/32791893/?ref=elonmuscular.com) - [Effect of nature exposure on perceived and physiologic stress: A systematic review.Complementary therapies in medicine, 2020\. PMID 33066853](https://pubmed.ncbi.nlm.nih.gov/33066853/?ref=elonmuscular.com) - [The Effects of Green Tea Amino Acid L-Theanine Consumption on the Ability to Manage Stress and Anxiety Levels: a Systematic Review.Plant foods for human nutrition (Dordrecht, Netherlands), 2020\. PMID 31758301](https://pubmed.ncbi.nlm.nih.gov/31758301/?ref=elonmuscular.com) - [Spending at least 120 minutes a week in nature is associated with good health and wellbeing.Scientific reports, 2019\. PMID 31197192](https://pubmed.ncbi.nlm.nih.gov/31197192/?ref=elonmuscular.com) - [A Systematic Review and Meta-Analysis of B Vitamin Supplementation on Depressive Symptoms, Anxiety, and Stress: Effects on Healthy and 'At-Risk' Individuals.Nutrients, 2019\. PMID 31527485](https://pubmed.ncbi.nlm.nih.gov/31527485/?ref=elonmuscular.com) - [Effects of L-Theanine Administration on Stress-Related Symptoms and Cognitive Functions in Healthy Adults: A Randomized Controlled Trial.Nutrients, 2019\. PMID 31623400](https://pubmed.ncbi.nlm.nih.gov/31623400/?ref=elonmuscular.com) - [Effect of saffron supplementation on symptoms of depression and anxiety: a systematic review and meta-analysis.Nutrition reviews, 2019\. PMID 31135916](https://pubmed.ncbi.nlm.nih.gov/31135916/?ref=elonmuscular.com) - [Improving Mental Health Service Utilization Among Men: A Systematic Review and Synthesis of Behavior Change Techniques Within Interventions Targeting Help-Seeking.American journal of men's health, 2019\. PMID 31184251](https://pubmed.ncbi.nlm.nih.gov/31184251/?ref=elonmuscular.com) - [Effects of Mind⁻Body Exercises (Tai Chi/Yoga) on Heart Rate Variability Parameters and Perceived Stress: A Systematic Review with Meta-Analysis of Randomized Controlled Trials.Journal of clinical medicine, 2018\. PMID 30384420](https://pubmed.ncbi.nlm.nih.gov/30384420/?ref=elonmuscular.com) - [Superiority of magnesium and vitamin B6 over magnesium alone on severe stress in healthy adults with low magnesemia: A randomized, single-blind clinical trial.PloS one, 2018\. PMID 30562392](https://pubmed.ncbi.nlm.nih.gov/30562392/?ref=elonmuscular.com) - [Association of Use of Omega-3 Polyunsaturated Fatty Acids With Changes in Severity of Anxiety Symptoms: A Systematic Review and Meta-analysis.JAMA network open, 2018\. PMID 30646157](https://pubmed.ncbi.nlm.nih.gov/30646157/?ref=elonmuscular.com) - [The effects of bedtime writing on difficulty falling asleep: A polysomnographic study comparing to-do lists and completed activity lists.Journal of experimental psychology. General, 2018\. PMID 29058942](https://pubmed.ncbi.nlm.nih.gov/29058942/?ref=elonmuscular.com) - [An examination of the anxiolytic effects of exercise for people with anxiety and stress-related disorders: A meta-analysis.Psychiatry research, 2017\. PMID 28088704](https://pubmed.ncbi.nlm.nih.gov/28088704/?ref=elonmuscular.com) - [Clinical Validation of Reduced Alcohol Consumption After Treatment for Alcohol Dependence Using the World Health Organization Risk Drinking Levels.Alcoholism, clinical and experimental research, 2017\. PMID 28019652](https://pubmed.ncbi.nlm.nih.gov/28019652/?ref=elonmuscular.com) - [The effect of heart rate variability biofeedback training on stress and anxiety: a meta-analysis.Psychological medicine, 2017\. PMID 28478782](https://pubmed.ncbi.nlm.nih.gov/28478782/?ref=elonmuscular.com) - [Yoga, mindfulness-based stress reduction and stress-related physiological measures: A meta-analysis.Psychoneuroendocrinology, 2017\. PMID 28963884](https://pubmed.ncbi.nlm.nih.gov/28963884/?ref=elonmuscular.com) - [The Benefit of Web- and Computer-Based Interventions for Stress: A Systematic Review and Meta-Analysis.Journal of medical Internet research, 2017\. PMID 28213341](https://pubmed.ncbi.nlm.nih.gov/28213341/?ref=elonmuscular.com) - [Rhodiola rosea in Subjects with Prolonged or Chronic Fatigue Symptoms: Results of an Open-Label Clinical Trial.Complementary medicine research, 2017\. PMID 28219059](https://pubmed.ncbi.nlm.nih.gov/28219059/?ref=elonmuscular.com) - [The Clinical Efficacy and Safety of Tulsi in Humans: A Systematic Review of the Literature.Evidence-based complementary and alternative medicine, 2017\. PMID 28400848](https://pubmed.ncbi.nlm.nih.gov/28400848/?ref=elonmuscular.com) - [A Meta-Analysis on Antecedents and Outcomes of Detachment from Work.Frontiers in psychology, 2016\. PMID 28133454](https://pubmed.ncbi.nlm.nih.gov/28133454/?ref=elonmuscular.com) - [Self-guided internet-based and mobile-based stress management for employees: results of a randomised controlled trial.Occupational and environmental medicine, 2016\. PMID 26884049](https://pubmed.ncbi.nlm.nih.gov/26884049/?ref=elonmuscular.com) - [Mindfulness-based stress reduction for healthy individuals: A meta-analysis.Journal of psychosomatic research, 2015\. PMID 25818837](https://pubmed.ncbi.nlm.nih.gov/25818837/?ref=elonmuscular.com) - [The Effects of Rhodiola rosea L. Extract on Anxiety, Stress, Cognition and Other Mood Symptoms.Phytotherapy research, 2015\. PMID 26502953](https://pubmed.ncbi.nlm.nih.gov/26502953/?ref=elonmuscular.com) - [Review of the psychometric evidence of the perceived stress scale.Asian nursing research, 2012\. PMID 25031113](https://pubmed.ncbi.nlm.nih.gov/25031113/?ref=elonmuscular.com) - [A brief measure for assessing generalized anxiety disorder: the GAD-7.Archives of internal medicine, 2006\. PMID 16717171](https://pubmed.ncbi.nlm.nih.gov/16717171/?ref=elonmuscular.com) - [The impact of abbreviated progressive muscle relaxation on salivary cortisol and salivary immunoglobulin A (sIgA).Applied psychophysiology and biofeedback, 2005\. PMID 16385425](https://pubmed.ncbi.nlm.nih.gov/16385425/?ref=elonmuscular.com) - [Effects of soy lecithin phosphatidic acid and phosphatidylserine complex (PAS) on the endocrine and psychological responses to mental stress.Stress (Amsterdam, Netherlands), 2004\. PMID 15512856](https://pubmed.ncbi.nlm.nih.gov/15512856/?ref=elonmuscular.com) - [Attenuation of laboratory-induced stress in humans after acute administration of Melissa officinalis (Lemon Balm).Psychosomatic medicine, 2004\. PMID 15272110](https://pubmed.ncbi.nlm.nih.gov/15272110/?ref=elonmuscular.com) - [Social support and oxytocin interact to suppress cortisol and subjective responses to psychosocial stress.Biological psychiatry, 2003\. PMID 14675803](https://pubmed.ncbi.nlm.nih.gov/14675803/?ref=elonmuscular.com) - [The PHQ-9: validity of a brief depression severity measure.Journal of general internal medicine, 2001\. PMID 11556941](https://pubmed.ncbi.nlm.nih.gov/11556941/?ref=elonmuscular.com) ## Words on this page Standardized mean difference (SMD) A way to put results measured on different scales onto one scale. About 0.2 is a small effect, 0.5 medium and 0.8 large. 95% CI The range the true result probably sits in. The narrower the range, the surer the result. Meta-analysis Many studies pooled into one result. RCT A randomized controlled trial: people put by chance on the treatment or on a dummy version. PMID A study's ID number in PubMed, the public index of medical research. Strong, moderate and early evidence Strong: many human trials agree. Moderate: human studies point the same way. Early: the first small human studies. PSS-10 The Perceived Stress Scale: ten questions on how stressed the last month felt, scored 0 to 40. GAD-7 A seven-question score for constant worry. Ten or more is the usual line for a doctor’s look. PHQ-8 A eight-question score for low mood. Ten or more is the usual line for a doctor’s look. Cortisol A stress hormone. It rises to meet a challenge and should fall after it. HRV Heart rate variability: the beat-to-beat swing in heart rate. Higher usually means the calming side is working. Mindfulness Training attention to stay with what is happening now, and to let thoughts pass. Adaptogen A plant said to help the body handle stress, ashwagandha and rhodiola among them. The stress score tonight, a finish time for tomorrow, and five minutes of slow breathing. Training, sleep and a structured course do the heavy lifting, and a doctor comes next if the score has not moved by week 8\. Everything else is added one at a time and judged on the score. ## Not this? Try - [**Stay Calm Under Pressure**nerves before one big event](https://elonmuscular.com/protocol-calm-under-pressure/) - [**Stop Worrying All the Time**when the stress is constant worry](https://elonmuscular.com/protocol-stop-worrying/) - [**Sleep Deeper**wired at night, tired all day](https://elonmuscular.com/protocol-deeper-sleep/) - [**Stop Overthinking**replaying the day on a loop](https://elonmuscular.com/protocol-stop-overthinking/) - [**Lift Your Mood**when stress slides into low mood](https://elonmuscular.com/protocol-low-mood/) When to see a doctor - A racing or pounding heart with chest pain, breathlessness or fainting, or chest pain that spreads to the arm, neck or jaw: call 911\. Never assume it is only stress. - Blood pressure of 140/90 or higher at a check, or 135/85 or higher at home: see your doctor. Stress over a long period raises the risk. - Needing a drink or sleeping pills to come down every night: see your doctor. If you shake, sweat or feel anxious when you stop drinking, get medical help before you stop. - Worry about many things, most days, that you cannot control, for six months or more, or a GAD-7 of 10 or more: see your doctor, and run [Stop worrying](https://elonmuscular.com/protocol-stop-worrying/). - Low mood, no interest or enjoyment, and no energy for weeks, or a PHQ-8 of 10 or more: see your doctor, and run [Low mood](https://elonmuscular.com/protocol-low-mood/). - A racing heart, weight loss, feeling hot and shaky with it: ask for a thyroid blood test. On thyroid pills, the dose may be too high. - On a stimulant medicine, ADHD drugs such as methylphenidate among them: new tension, anxiety or a racing heart is a reason to call the doctor. Cut energy drinks and pre-workout, and tell the doctor what you took. - Coming off anabolic steroids can bring anxiety, low mood and broken sleep: tell the doctor what you used. - Loud snoring, gasping at night and tired all day: ask about sleep apnea, which also affects mood. - Struggling to cope, or the things you are trying are not helping: see your doctor. I am not a doctor. This is not medical advice. This is self-education. Every dose on this page is the one a trial or a label used, quoted from the source. It is not a prescription. Talk to a physician who has your history before anything in the With a doctor group. New Heroes The full library. Elon answers every weekday. [Join New Heroes.](https://elonmuscular.com/join/) Cancel anytime.