As a psychiatrist and physician, I find it ironic that I've been asked to write about stress reduction for lawyers.

Let me see ... play in traffic, get into many arguments, drink lots of booze ... no, no, that would be wrong. Try again.

Many treatises on stress reduction begin with exercise; I will give it brief mention here and then move quickly along. Some people find various versions of physical exercise helpful in reducing stress if practiced in moderation and with self-compassion. Many forms of exercise do not really reduce sympathetic nervous system arousal (the fight-or-flight response), and that is what you really want to do.

Meditation in motion

Hatha yoga (the yoga of postures and movement) and tai chi involve some physical exercise and can reduce the stress response. It is important to learn and to do these with the proper mindset. If they are done like American calisthenics, they will be next to useless for stress reduction. Learning from bona fide teachers at such places as the Himalayan Institute is a good idea. If a teacher "stresses" feeling "the burn," you're in trouble.

Both yoga and the Taoist tradition that gave birth to tai chi have elaborate breathing practices. In the yogic parlance, this is termed pranayama. Prana refers to breath and life energy, which is also the meaning of chi. These practices can be very helpfull for stress reduction. Suggested books to read would include James Hewitt's "The Complete Yoga Book" and "Yoga for Dummies" by George Feuerstein, Larry Payne and Lilias Folan.

Meditation of one form or another can be very useful. Meditation can be thought of as an attentional exercise that shifts one's state of consciousness into a more inward direction. There can be somewhat different effects, depending on the nature of the attentional exercise and the focus of the meditation (sound, visual foci, centers in the body, the stream of consciousness itself). Almost all decrease sympathetic nervous-system activity and arousal, which is what you want.

There are two major groupings of meditation methods: focusing and awareness. Focusing meditations teach you to aim your attention at one object of attention, such as a word (for example, "om," "peace" or "one"), a visual object (perhaps a candle flame, picture or mandala), or a body part (for example, one's navel or forehead). Awareness meditations, such as zazen or vipassana, have one focus on the stream of consciousness or thoughts, without letting oneself get bogged down in any single thought or topic.

Both types can be beneficial. I recommend reading about the subject and then getting "good enough" training. It is possible to "do it wrong" and just spin your wheels. Some helpful books are "Meditation For Dummies" (book and CD edition) by Stephan Bodian; "The New Three Minute Meditator: 30 Simple Ways to Unwind Your Mind Anywhere Anytime" by David Harp; and "Wherever You Go, There You Are: Mindfulness Meditation in Everyday Life" by Jon Kabat-Zinn.

In addition to the forms of meditation that decrease sympathetic nervous-system arousal, some specialized forms affect heart-rate variability and the interrelationship between the heart and the limbic or "emotional" center of the brain.

In the Buddhist tradition, there is a specialized meditative practice called metta, or "loving kindness meditation." An organization called Heartmath has adapted, modified and streamlined these practices into a useful protocol that reduces stress and promotes feelings of well-being. These practices have been shown to optimize the physiologic measure termed heart-rate variability. The organization has put out a number of books, such as: "The HeartMath Solution: The Institute of HeartMath's Revolutionary Program for Engaging the Power of the Heart's Intelligence" by Doc Lew Childre and Howard Martin and "Transforming Stress: The Heartmath Solution for Relieving Worry, Fatigue, and Tension" by Doc Childre and Deborah Rozman. The organization also has a Web site at heartmath.org. And Heartmath markets a consumer-friendly biofeedback device called the Emwave that helps people learn the practice and physiologically measure their progress.

Powerful imagination

Some people choose to learn self-hypnosis or to use guided-imagery texts or recordings to relieve their stress. Physiologically and phenomenologically, these two modalities are equivalent. Consciousness is initially shifted to a more inward state by focusing attention. This is correlated with increasing alpha brainwave output (the meditative state).

Next, one's imagination is activated. When imagination is activated following focusing, this increases theta brain waves and the power of the imagination. If the imagery is relaxing in nature, there is a magnified effect - the relaxation from the change in consciousness is added to the relaxation from the imagery, and relaxation from the amplified imagination. You can seek out a hypnotist for training in self-hypnosis and/or consult books. I suggest Anna Wise's "High Performance Mind" and "Self-Hypnosis" by Brian Alman and Peter Lambrou.

For those that need more help, there's a modality called biofeedback that involves using equipment to monitor physiologic activity and for training people to "chill out."

There are two basic forms: peripheral biofeedback, which works on such measures as pulse, blood pressure, skin temperature and skin conductance, and brain-wave biofeedback, or neurotherapy. The only practitioner of both in Western New York that I'm familiar with is Judy Chiswell in Williamsville.

In a related method, there are tapes and CDs that can help direct you in meditation and help alter your consciousness. Of these, I particularly recommend the CDs made by the Monroe Institute. They have a sound technology called "hemi-sync" which is a type of a more general phenomenon called entrainment. In entrainment, the sensory input (in addition to whatever words or music or sounds are present on the CD) helps to shift one's brainwaves - and, therefore, consciousness and physiology - to more relaxed states. For more information, see hemi-sync.com or toolsforhealth.com.

Currently, Dr. Athalie Joy and I are giving a 10-session workshop on stress reduction and related topics, called "Brain Works." It's possible that we may offer versions of this in the future.

Dr. Jonathan Holt is a clinical associate professor of psychiatry at the University at Buffalo and medical consulting psychiatrist for both Kaleida Health and the Roswell Park Cancer Institute. He can be reached at jholt@kaleidahealth.org or 859-2929.