Hettler’s wellness model features six dimensions: physical wellness, occupational wellnessintellectual wellness, social wellness, emotional wellness, and spiritual wellness. This post discusses emotional wellness.

Emotional wellness involves the capacity to be aware of, to control, and to express one’s emotions and to handle interpersonal relationships judiciously and empathetically. This includes accepting feelings rather than denying them, coping with stress, and enjoying life despite its occasional disappointments and frustrations (University of CA, n.d.). Emotional wellness also includes awareness of and acceptance of the emotions of others.

Stress. Hungarian Hans Selye, a 29-year-old endocrinologist at McGill University, first wrote about stress in a short letter he sent to Nature magazine, which was subsequently published (Selye, 1936). Selye noted harmful agents (stressors) caused pathophysiologic changes that had common characteristics (stress response). Stress was the response of the body to demands placed on it by the stressors. A stressor is something that triggers the stress response and includes environmental factors (crowding, deadlines, noise), societal factors (family, friends, co-workers), situational factors (starting or losing a job, marriage, divorce), or chemical factors (stimulants such as caffeine).

Selye (1974) stated there are several types of stress, classified by how it is perceived by the individual as positive (eustress) or as negative (distress). How individuals respond to stressors is affected by their emotional reactions, their unique perceptions, and feelings of self-efficacy or their ability to complete required tasks or play specific roles within stressful situations. Eustress is perceived as positive and within our ability to meet the demands of the situation. Eustress helps keep us focused on a goal and improves our performance and our sense of personal satisfaction. Distress is perceived as negative and beyond our capacity to cope.

During stress, the sympathetic division of the nervous system prepares the body to confront the stressor, usually in a fight-or-flight response. The physiologic response to stress is the same, whether it is eustress or distress. Ways to reduce stress are listed next.

Managing Stress. Stress is a significant problem of our time and affects physical and mental health (WHO, 2005). Numerous evidence-based approaches to stress reduction exist that are easy to learn and to practice. These methods include diaphragmatic breathing, progressive muscle relaxation, guided imagery, mindfulness-based stress reduction (Varvogli & Darviri, 2011), expressive writing (Niles et al., 2014), and self-affirmations (Creswell et al., 2013). The next section includes a brief summary of various methods. Training in these techniques is available by qualified professionals and by instructional print/audio/audiovisual media. Massage and exercise are also effective methods of stress reduction (Engen et al., 2012; Kim & McKenzie, 2014).

1) Diaphragmatic breathing. Diaphragmatic breathing is voluntary, slow deep breathing with the abdomen expanding downward rather than the chest expanding upward during inhalation. Diaphragmatic breathing activates the relaxation response with the autonomic nervous system. Diaphragmatic breathing is also called abdominal/belly breathing or deep breathing.

2) Progressive muscle relaxation. Progressive muscle relaxation is alternately tensing and relaxing muscles, focusing on distinctions between the feelings of muscle tension and relaxation, while the eyes are closed. Muscles are tensed and relaxed in a sequential pattern, usually beginning in the legs, then the arms, abdomen, chest, and the face last. Tension is purposefully held for approximately 10 seconds and then released for 20 seconds within each muscle group before continuing with the next muscle group. The sequence should be performed two or three times.

3) Guided Imagery. Guided imagery is a facilitated exploration of an imagined safe, comfortable place. Guiding imagery also involves sensory recruitment of visual, auditory, olfactory, tactile, and kinesthetic qualities, while linking the relaxation of the imagery with the relaxed state experienced by the individual.

4) Mindfulness-based stress reduction. Mindfulness is focused attention given to present moments. The focus can be on any experience while purposefully paying attention to detail and being aware of surroundings, emotions, thoughts, and physical sensations. Both internal and external sensations are noted. Mindfulness can be performed while sitting quietly or while conducting activities of daily living such as strolling down a path or eating a sandwich.

5) Expressive writing. Expressive writing, as a stress reduction technique, uses written words to express feelings about stressful and traumatic situations. Expressive writing can be done daily as a 15- to 20-minute writing session or occasionally, with no feedback sought about what was written.

6) Self-affirmations. Self-affirmations are positive statements spoken or read silently and are designed to facilitate change in the individual using them. They can serve as inspiration, as well as reminders. Posting self-affirmations where they can be easily seen on a daily basis, such as a bathroom mirror, can reduce stress. They also can serve as focused attention on personal or professional goals. Rev. Reinhold Niebuhr’s serenity prayer is an example of a self-affirmation, which reads “God, grant me the serenity to accept the things I cannot change, the courage to change the things I can, and the wisdom to know the difference.”

Picture Credits:



Creswell, J. D., Dutcher, J. M., Klein, W. M., Harris, P. R., & Levine, J. M. (2013). Self-affirmation improves problemsolving under stress. PLoS ONE, 8(5), e62593.

Engen, D. J., et al. (2012). Feasibility and effect of chair massage offered to nurses during work hours on stress-related symptoms: A pilot study. Complementary Therapies in Clinical Practice, 18(4), 212–215.

Kim, J.-H., & McKenzie, L. A. (2014). The impacts of physical exercise on stress coping and well-being in university students in the context of leisure. Health, 6(19), 2570–2580.

National Wellness Institute. (n.d.). The six dimensions of wellness. Retrieved from

Niles, A. N., Haltom, K. E., Mulvenna, C. M., Lieberman, M. D., & Stanton, A. L. (2014).
Effects of expressive writing on psychological and physical health: The moderating role of emotional expressivity. Anxiety Stress Coping, 27(1).

Selye, H. (1936). A syndrome produced by diverse nocuous agents. Nature, 138(3479), 32.

Selye, H. (1974). Stress without distress. Philadelphia: Lippincott Williams & Wilkins.

University of California. (n.d.). Emotional wellness. Retrieved from https://wellness.ucr.edu/emotional_wellness.html.

Varvogli, L., & Darviri, C. (2011). Stress management techniques: Evidence-based procedures that reduce stress and promote health. Health Science Journal, 5(2), 74–89.

WHO. (2015). European region. Mental healthFacing challenges, building solutions.
Retrieved from http://www.euro.who.int/__data/assets/pdf_file/0008/96452/E87301.pdf.

View More: http://suzygphotography.pass.us/susan-salvoDr. Susan Salvo is a massage therapist, author, educator, researcher, explorer, and perpetual student. To learn more, check out the “About Susan” tab. You can contact Susan at susansalvo@hotmail.com.



Renee-Michele-headshot 2019 Dr. Michele Renee began her career as a massage therapist in 1998. After several inspiring and successful years, she expanded her scope of practice, first with chiropractic and later with a master’s degree in acupuncture. Today she runs a multidisciplinary clinic in Minneapolis, MN and serves as the Director of Integrative Care at Northwestern Health Sciences University. Drawing from many years of teaching and administration in the health sciences, Michele shares her varied experiences in education, patient care, and many paradigms of healing with health care practitioners across the US. She lives in beautiful Minneapolis, MN with her foster son and four furry friends. You can contact Michele at dr.renee@stockheart.com.