Stress is pervasive in American society. In fact, stress levels have increased this year for the first time in a decade, according to a survey by the American Psychological Association.

All that tension isn’t just unpleasant—it’s unhealthy. “There’s evidence that people under chronic stress are more susceptible to the common cold and flu, and are at greater risk of developing depression and coronary heart disease,” says Sheldon Cohen, Ph.D., a professor of psychology at Carnegie Mellon University in Pittsburgh. “Under long-term stress, many of your body’s physical systems do not respond normally.”

While some modicum of stress may be unavoidable, you shouldn’t accept crippling stress as a fact of life. For most people, DIY strategies like learning to meditate, getting more sleep, and spending time in nature will help dial down the pressure. (Try these 7 ways to manage stress day-to-day.)

But sometimes the problem is more serious, when stress consistently impedes your happiness, balance, and daily function. You may notice you have trouble sleeping, an increased heart rate, irritability, and changes in appetite, says Vaile Wright, Ph.D., director of research and special projects at the American Psychological Association. 

That doesn’t mean there’s nothing you can do. Here’s what you need to know about how to manage the most severe forms of stress—and when there might be something more serious going on.

3 Ways to Relieve Serious Stress

If at-home stress management isn’t sufficient, you may need professional help. Ask your primary care doctor whether any of the following might be right for you:

1. Biofeedback. Via sensors attached to your body, you learn to control your heart rate, blood pressure, breathing, and even skin temperature. The goal is to increase awareness of how your body reacts to stress so that you can learn to exert some control over your response.

Small studies have shown that biofeedback seems to help relax people dealing with especially severe stress, including nursing students, postpartum women, factory workers, and people diagnosed with anxiety disorders.

2. Cognitive behavioral therapy. Commonly used as part of talk therapy, CBT involves “identifying unhelpful thoughts, feelings, and behaviors, and replacing them with more helpful ones,” Wright says. “You’re ­trying to turn unreasonably negative thoughts into realistic thoughts—not necessarily positive ones.”

Some research suggests that an intervention called cognitive behavioral stress management—which combines traditional CBT with training in relaxation techniques—may have lasting effects. In one study, women who had 10 weeks of these sessions after having surgery for early-stage breast cancer reported a better quality of life even a decade later than women who didn’t get the CBT.

3. Medication. “There’s not an anti-stress pill that we give and the stress goes away,” says Alexis Peraino, M.D., chief of women’s health at the California Health & Longevity Institute.

But if stress is so pervasive that you aren’t able to maintain your usual daily schedule (i.e., you have serious problems sleeping, eating, or working) your doctor might suggest trying anti­depressants or anti-anxiety medication. Even then, Peraino says, drugs should be just one piece of a comprehensive plan.

When It's Not Just Stress

In some cases, stresslike symptoms could actually be signs of a medical problem.

For example, if you suddenly experience chest pain or your heart starts racing, you break into a sweat, and feel nauseated and lightheaded, you could be having a stress-induced panic attack. But those could also be signs of a heart attack or arrhyth­mia, Peraino says. Head to an emergency room if you’re at all unsure.

Insomnia, tight muscles, back or neck pain, headaches, and fatigue can all be the result of significant stress, but they can signal medical problems as well. See your doctor if such symptoms persist.

The same applies if you have worsening abdominal pain or bloody stools, or you notice a change in your bowel movements. These can be stress-related or can signal an ulcer or a more serious problem, even cancer in rare cases. Schedule a checkup with your doctor so that he or she can evaluate you more fully.

Editor's Note: This article is adapted from a story that also appeared in the Consumer Reports on Health newsletter.