Remember the tale “The Lady or the Tiger?” As it ends, the hero is standing before two identical doors: one conceals a beautiful maiden; the other, a ferocious tiger. He must open one of the doors—the choice is his—but he has no way of knowing which will bring forth the lady and which will unleash the tiger.

I am sometimes reminded of this story when a patient is describing one of the symptoms of chronic stress: headaches, indigestion, ulcers, tight muscles, high blood pressure, or some combination of these. When I point out that the symptom is stress-related, the patient seems resigned—stress is such a constant in most people’s lives that all the doors seem to have tigers lurking behind them. Most people who find their way to my office know the fight-or-flight response is hardwired into our nervous system, and many have come to accept a constant feeling of tension as normal, even inevitable.

Like the hero in the story, we have a choice.

It isn’t. Like the hero in the story, we have a choice. There is another response to the challenges of everyday living—another door—also hardwired into our nervous system. And unlike the hero, whose destiny rests with chance, we can discover which door is which. A general understanding of how the nervous system responds to stress, coupled with training in three simple techniques, makes it possible for us to distinguish one door from the other. Practicing these techniques gives us the power to open the lady’s door while keeping the tiger’s door firmly closed.

Unleashing the Tiger

The autonomic nervous system controls the body’s involuntary processes: respiratory rate, heart rate, blood pressure, gastric juice secretion, peristalsis, body temperature, and so on. It has two main branches: sympathetic and parasympathetic. When we feel stressed, our brain activates the sympathetic nervous system—the fight-or-flight response we’ve all heard so much about. This response causes the adrenal medulla to secrete adrenaline, a hormone that circulates in the bloodstream affecting almost every organ.

Adrenaline revs up the body to survive a threat to life and limb: The heart pumps faster and harder, causing blood pressure to spike and respiration to increase and move primarily into the chest. Airways dilate to bring more oxygen into the body; blood sugar rises to provide a ready supply of fuel; some blood vessels constrict to shunt blood away from the skin and the core of the body, while others dilate to bring more blood to the brain and limbs.

The result? A body pumped up to fight or run and a hyper-alert mind. When we find ourselves face-to-face with a tiger, this stress response dramatically increases our chances of surviving. Once the threat has passed, our sympathetic nervous system calms down and homeostasis is reestablished.

We need mild sympathetic nervous system stimulation to get us out of bed in the morning, to focus, to plan. We need a bit more to speak or perform in front of a group, for example, but we need it at full throttle only to meet a life-threatening situation. The problem is that many of us have lost our capacity to regulate our fight-or-flight reaction, and full-throttle activation is almost constant. The source of our stress is psychological rather than physical—a perception that something crucial to us is threatened. We worry about the future, our jobs, our relationships, our finances, or getting stuck in traffic, but even though the perceived threat is psychological, it triggers the archaic survival response.

We find ourselves in a constant state of tension.

The upshot? We find ourselves in a constant state of tension, poised to fight or flee, with stress hormones washing through our bodies almost continuously. You can see the consequence if you consider what happens when adrenaline floods the body: elevated blood pressure, rapid shallow breathing, high blood sugar, and indigestion. Adrenaline makes our platelets stickier, so our blood will clot quickly if we are wounded, which increases our chances of surviving a physical injury. However, chronically sticky platelets are apt to clot and create blockages in our arteries, thus setting the stage for a heart attack or stroke.

The damage doesn’t end there. When we are constantly in fight-or-flight mode, the adrenal cortex secretes cortisol, a steroid whose job is to help us adapt to a prolonged emergency by ensuring that we have enough fuel. Cortisol acts on the liver and muscle tissues, causing them to synthesize sugars (glucose) and fats and release them into the bloodstream. Excess sugar in the bloodstream leads to diabetes, and excess fat to high cholesterol/high triglycerides. Both conditions boost our chances of developing heart disease. Cortisol has been the focus of a lot of research on stress in the last decade and is now linked to multiple disease states including insulin resistance and diabetes, osteoporosis, thyroid dysfunction, and even memory loss.

Sounds grim, doesn’t it? It is. A chronically activated sympathetic nervous system keeps the body under constant pressure. If we ignore the early warning symptoms—tight shoulders, digestive upset, recurring headaches, a tendency to lose our temper or become easily upset—sooner or later the tiger will tear us up.

Rather than living under the tyranny of a ramped-up sympathetic nervous system, we can learn to trigger the parasympathetic system instead—the rest-and-digest response. Just as the fight-or-flight response automatically kicks in when danger threatens, the rest-and-digest response automatically responds to our sense of equilibrium. When it is activated, our heart rate drops, our blood pressure falls, and our respiration slows and deepens. Blood flow to the core of the body is reestablished—this promotes good digestion, supports the immune system, and infuses us with a sense of well-being.

We enter this state unconsciously when we’re enjoying a vacation, in the throes of a hearty laugh, or in deep sleep. It feels good, and it offers a much-needed respite from the hectic pace we set for ourselves. But, unfortunately, we have come to accept stress as the norm and to expect the feeling of relaxed well-being to come about only sporadically—and so it does. We release the tiger a dozen times a day, even though the other door is also there in every moment. Once we learn to open it at will, we can override the harmful habit of triggering our stress response, by activating the rest-and-digest component of our nervous system instead.

Meeting the Lady

I use a variety of natural therapies in my medical practice to minimize chronic stress. The three that are simplest and most accessible are exercise, diaphragmatic breathing, and relaxation. Exercise generally loosens physical tension and dissipates the pent-up energy that the stress response fosters. Deep breathing and systematic relaxation nourish and strengthen the parasympathetic nervous system, so that the rest-and-digest response is activated and in time becomes our normal mode. With that in mind, let’s look at some ways we can open Door Number Two.


Many of my patients say that exercise is their primary stress-reducing strategy. Moving—walking, biking, swimming, sailing, gardening, weight training—metabolizes the flood of sugar and fats in the bloodstream, which are the by-products of chronic stress. It helps us work out the muscular gripping in our shoulders, neck, back, and hips deposited by the strain and intensity of our busy lives. Psychologically, exercise provides a positive change as well: we shift our focus from the worries of the day to our bodies in motion. If we sustain the activity for 20 minutes or longer, our bodies release endorphins and neurotransmitters that elevate mood and combat depression and anxiety.

These are the immediate benefits, but exercise also has a more long-lasting effect on our ability to cope with stress. Studies show that when we are fit, we have more resilience. For example, in response to a stressor, blood pressure will rise both in people who are aerobically fit and in those who are not, but blood pressure normalizes much more quickly in those that have more aerobic endurance. So exercise not only helps us shake off today’s stress, it provides a buffer against tomorrow’s difficulties.

The key to exercising regularly is to choose something you like to do—an activity that is relatively easy to fit into your life. That’s why walking is so popular. Make a small plan (walk for 20 minutes at lunch), and then do it. If it helps you stay committed, enlist a friend to go with you. Friendship is also stress-reducing!

Diaphragmatic Breathing

Most babies and young children breathe deeply and fully—their relaxed bellies rise and fall with their breath because they are using the dome-shaped diaphragm muscle that separates the chest and abdominal cavities to move the air in and out of their lungs. This is the natural, healthy way to breathe. As we grow up, however, we are taught to constrict our abdomens, and that training, coupled with an unconscious tendency to tighten the belly when we experience stress, disrupts the natural flow of our breath. With the abdomen pulled in, the breath is confined to the upper portion of the lungs (from about the nipple line up). And because the body registers this breathing pattern as a stress response, it reinforces the fight-or-flight reaction.

The first step in reversing our chronic stress response is to learn (again!) to breathe the way we were born to breathe.

Of all the processes regulated by the autonomic nervous system (heart rate, blood pressure, secretion of gastric juices, peristalsis, body temperature, etc.), only breathing can be controlled consciously. And in this simple act, we access our body’s ability to calm down and regulate and repair itself. Over time, regular diaphragmatic breathing is correlated with resilience, strong immunity, balanced metabolism, and good health. This is why the first step in reversing our chronic stress response is to learn (again!) to breathe the way we were born to breathe.

Diaphragmatic Breathing in Practice

Diaphragmatic breathing is the most reliable way to calm the sympathetic nervous system and unwind. Imagine lying on the beach, eyes closed, listening to the rhythmic sound of the waves. That’s the feeling we are seeking no matter where we find ourselves.

If you have not been trained in diaphragmatic breathing, here’s a way to start:

  • Lie comfortably on your back.
  • Rest one hand on your chest, and the other on your abdomen.
  • Take a few breaths and notice which hand moves more (your chest or your belly).
  • Close your eyes and let the body relax completely.
  • Let the breath deepen.
  • As you allow the breath to move into the abdomen, you will feel your belly rise with each inhalation, and fall with each exhalation.
  • As you inhale, feel yourself being filled with fresh energy.
  • As you exhale, feel any residual tension draining away.
  • Continue following the inhalation and exhalation, relaxing more deeply with every breath.
  • You have shifted your mind from thinking to feeling. Relax and experience the physical sensations of breathing.
  • Stay in this state for 5 to 15 minutes (the longer, the better), resting your attention in the breath.
  • Practice every day until this deep, slow, belly breathing once again becomes a habit.

In time, you will begin to experience your breath as a regulator of your nervous system. As long as you are breathing deeply and from the diaphragm, you will discover that you can access a feeling of calm and balance even when confronted with an unpleasant situation. And you will also notice that when your breath becomes shallow, anxiety creeps in, your muscles tighten, and your mind begins to race and spin. When this agitated breathing is prolonged, your outlook on life becomes unsettled and defensive. Once you know this from your own experience, you can make a different choice.

Systematic Relaxation

Diaphragmatic breathing is an excellent way to begin to calm our mind and nervous system. But when we have spent years unconsciously flinging open the door to the tiger’s cage, we need to do more. Because we have created neural patterns of reactivity, we see tigers where there are none.

Daily periods of relaxation are a must. When I tell my patients this, many of them say they relax while they watch TV or read or knit or socialize. But while these activities distract the mind from its usual worries and so provide some mental relief, they do little to undo the negative effects of a chronically activated sympathetic nervous system. Studies show that reading or watching a hilarious movie can lower blood pressure. These leisure activities do shift us away from the stress response, but if the next day we return to a work situation that is chronically unpleasant, we are still at risk for heart disease, diabetes, high cholesterol, digestive disorders, and other problems—and our shoulders are still tense!

Systematic relaxation encourages us to withdraw our attention from the drama of our life, let go of our memories, plans, worries, and fantasies.

To reverse well-established habits of holding tension in our body and fear in our mind we need a practice that trains our nervous system to be less reactive—one that convinces our mind that there are hardly any tigers out there. Systematic relaxation is that practice. It offers a structure for consciously releasing tension from head to toe while remaining anchored in diaphragmatic breathing.

There are many methods of relaxing systematically, all of which involve moving our attention through the body in a methodical fashion while resting and breathing deeply. Systematic relaxation encourages us to withdraw our attention from the drama of our life, let go of our memories, plans, worries, and fantasies, and focus instead on our body and breath. When worry and other stressors intrude, we bring our mind back to the breath and the process of relaxation. This is the opposite of checking out: the mind is simultaneously relaxed and focused. By stimulating the parasympathetic system, relaxation practices strengthen immunity and support the body’s ability to heal. Relaxation is known to improve acne, maintain normal weight, decrease heart disease, sharpen memory, decrease depression, and help us make good decisions. In short, it supports and protects us on every level.

Systematic Relaxation in Practice: Tension-Relaxation

Although stress makes us tense, much of this tension is unconscious. We contract our jaw, shoulders, or buttock muscles when we feel anxious, hurried, or irritated, without even realizing it. A systematic tension-relaxation exercise is a good way to begin undoing this habit: it first brings our attention to the sensation of a contracted muscle and then to a relaxed muscle. This makes it easier to notice when a muscle is gripping. The first step in learning to release tension is to notice it. When done every day for a week or more, this practice demonstrates that it is possible to relax chronically tenses muscles.
If you would like to try it, here are the steps:

  • Lie comfortably on your back.
  • Relax and breathe deeply for a minute or two.
  • When you’re ready to begin the practice, inhale, open your eyes wide, open your mouth and stretch the tongue out and down.
  • As you exhale, relax your eyes, retract your tongue, close your mouth, and rest for 2 breaths.
  • Repeat.

Feel a wave of relaxation move through the body.

  • On the next inhalation, tense all the muscles in your face, pulling them toward the tip of the nose.
  • Release the tension as you exhale and relax for 2 breaths.
  • Repeat.
  • Gently close your eyes and keep them closed throughout the rest of the exercise.
  • Roll your head gently side to side several times.
  • On an inhalation, tense the right arm by making it as long as possible, and spread the fingers wide.
  • Exhale and release.
  • Take 2 breaths and do the same thing with the left arm.
  • Repeat on both sides.
  • Next, tense the hips and buttocks on an inhalation.
  • Exhale, release, and relax for 2 breaths. Repeat.
  • Inhale and tense the right leg by making it as long as possible, flex the foot, and spread the toes.
  • Exhale while releasing the tension and relax for 2 breaths.
  • Repeat on the left side, again relaxing for 2 breaths.
  • Repeat with both legs.
  • Relax and breathe, allowing the body to be soft and heavy.

Starting at your feet, feel a wave of relaxation move through the body from the toes, through the legs, torso, arms, neck, and head.

In the End

Exercise, diaphragmatic breathing, and systematic relaxation help us calm our mind, so we can discriminate between what is real and what is not—between what is truly life-threatening and what is merely our habit of overreacting. Once we begin to see that almost everything that triggers our fight-or-flight response is a habitual overreaction, we can begin to make different choices. Instead of overreacting to an unpleasant event, for example, we can cushion the jarring effect on our nervous system by consciously breathing from the diaphragm.

Your health will improve—to say nothing of your outlook on life.

This is likely to prove challenging in the beginning. When your spouse or a coworker snaps at you, you may find yourself halfway into an angry retort before you notice you have switched to chest breathing. Stop and remind yourself to breathe from the diaphragm and to find a neutral vantage point. This skill comes with time, but it comes more quickly when you are getting regular exercise, practicing diaphragmatic breathing every day, and taking time for a systematic relaxation practice. As you choose to activate your rest-and-digest response consciously and continuously, you will find yourself in fight-or-flight mode only when, for instance, your car skids on a patch of ice, or the cat knocks over a candle and sets the curtains on fire. Your health will improve—to say nothing of your outlook on life. You have learned to choose the right door.

Source: From Yoga International magazine, February/March 2004. Reprinted with permission.

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