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Stress Management

A Comprehensive Guide to Wellness

Written by Edward A. CharlesworthAuthor Alerts:  Random House will alert you to new works by Edward A. Charlesworth and Ronald G. NathanAuthor Alerts:  Random House will alert you to new works by Ronald G. Nathan

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Synopsis|Excerpt

Synopsis

Are you among the 95 million Americans who suffer from stress during these trying times? Revised and comprehensive, this invaluable guide helps you identify the specific areas of stress in your life–familial, work-related, social, emotional–and offers proven techniques for dealing with every one of them. New material includes information on how men and women differ in response to stress, updated statistics on disorders and drugs, the ways terrorism and the information age impact stress, the key benefits of spirituality, alternative medicine, exercise, and nutrition. Stress Management will help you

• test your personal responses to daily stress– and chart your progress in controlling it
• learn specific techniques for relaxation– from “scanning” to “imagery training”
• discover how to deal with life’s critical moments without stress
• embark on a program to improve your physical health as a major step toward stress management
• discern which types of stress must be reduced and which kinds you can turn into positive motivation

Excerpt

Learning About Stress and Your Life

The real voyage of discovery consists not in seeking new lands, but seeing with new eyes.

–Marcel Proust

One

How Do You Respond to Stress?

The awareness that health is dependent upon habits that we control makes us the first generation in history that to a large extent determines its own destiny.

—Jimmy Carter

Stress and Our Ancestors

We live in a new age of anxiety, century of stress, and era of terrorism. Once the name Columbine brought to mind only a beautiful mountain flower and September 11 was just another day on the calendar. The history books that our grandchildren read will speak of the alarming increases in health and social problems related to the tensions and stress of our times. You may well ask, has man always been nervous and anxious? The plays of Shakespeare included many examples of the stress response. One of the most respected medical textbooks of the 1600s gave excellent descriptions of anxiety states. In fact, our nervous responses can be traced to the prehistoric cave dweller.

Imagine a cave dweller sitting near a small fire in the comfort of a cave. Suddenly, in the light of the fire, up comes the shadow of a saber-toothed tiger. The body reacts instantly. To survive, the cave dweller had to respond by either fighting or running. A complex part of our brains and bodies called the autonomic nervous system prepared the cave dweller for fight or flight. This nervous system was once thought to be automatic and beyond our control. Here is a partial list of the responses set up by the autonomic nervous system and how you may recognize them from your own experience.

1.Digestion slows and blood is redirected to the muscles and the brain. It is more important to be alert and strong in the face of danger than to digest food. Have you ever felt this as butterflies in your stomach?

2.Breathing gets faster to supply more oxygen for the needed muscles. Can you remember trying to catch your breath after being frightened?

3.The heart speeds up and blood pressure soars, forcing blood to parts of the body that need it. When was the last time you felt your heart pounding?

4.Perspiration increases to cool the body and release a scent signaling preparation for a fight. This allows the body to burn more energy and warns others of danger. Do you use extra deodorant when you know you are going to be under stress?

5.Muscles tense to prepare for rapid action and form muscle “armor” to slow tooth, fist, or spear. Have you ever had a stiff back or neck after a stressful day?

6.Chemicals are released to make the blood clot more rapidly. If injured, this clotting can reduce blood loss. Have you noticed how quickly some wounds stop bleeding?

7.Sugars and fats pour into the blood to provide fuel for quick energy. Have you ever been surprised by your strength and endurance during an emergency?

The cave dweller lived in the jungle or the wilderness and faced many environmental stressors. Often these were immediate, life-threatening events involving dangerous animals or human enemies. For the cave dweller, this fight-or-flight response was very valuable for survival.

Stress and Our Modern World

We have the same automatic stress responses that the cave dweller used for dangerous situations, but now we are seldom faced with a need for fight or flight. If a cat is threatened, it will arch its back. A deer will run into the bush. When we are threatened, we brace ourselves, but we often struggle to contain our nervous reactions because the threat is not usually one of immediate physical harm. Bosses, budgets, audiences, deadlines, and examinations are not life-threatening, but sometimes we feel as though they are.

Smaller stressors and briefer stress responses can add up to hundreds a day. These can be parts of our lives that we hardly notice and almost take for granted. If you work in an office, stress may accumulate with every ring of the telephone and every meeting you squeeze into your already busy day. If you are a homemaker, all the endless tasks you alone have to complete can mount up just as quickly and take just as much of a toll as those faced in the office.

Our ability to think of the past and imagine the future is still another way in which stress responses can be triggered at any time and in any place. In addition, distance is no longer a buffer. Turning on a television or a computer makes us instantly aware of wars, famine, disasters, political unrest, economic chaos, and frightening possibilities for the future.

The rate of change in our lives is accelerating. We need only to read Alvin Toffler’s classic Future Shock or James Gleick’s Faster: The Acceleration of Just About Everything to realize that the unexpected has become a part of our everyday lives. These unexpected situations are not ones we can overcome physically. Tigers are seen primarily in zoos, but it is as if we see their stripes and sharp teeth manifested in all too many ways in our everyday world.

Not only do we seem to trigger our stress response more often, but also most situations do not provide an outlet for the extra chemical energy produced by our bodies. The fight-or-flight response is not useful for most of the stress situations in modern life because we have few physical battles to fight and almost no- where to run. In the past, the demands for fulfilling basic needs for food and safety made good use of our heightened arousal. Today, few of these outlets are available.

We are influenced not by “facts” but by our interpretation of facts. —Alfred Adler



Physical Stress Versus Emotional Stress

When we think about what has happened or what might happen, we cannot run from our anxieties or physically attack our fears. We are undergoing emotional stress. The body has only limited ways of using the output of its various stress reactions to cope with emotional stress.

Physical stress is different from emotional stress. Even exercise triggers a stress response. In fact, for many years, scientists relied on the research in exercise physiology as a basis for understand- ing the effects of both psychological and physical stress upon the body. Although the effects of physical and emotional stress are similar, we now know that there are differences between them. Many hormones are elevated during the stress response. Three of them are norepinephrine, epinephrine, and cortisol. Norepinephrine and epinephrine are more commonly known as adrenaline. In response to a physical stressor, such as extremes in environmental temperature or stress induced by exercise, there is primarily an increase in norepinephrine. There is also a small increase in epinephrine. In response to a psychological or emotional stressor, there is also an increase in cortisol. To understand the effects of stress, we need to study the effects of each hormone that is secreted in response to a stressor. In general, norepinephrine has the greatest effect in increasing heart rate and blood pressure. Epinephrine has the greatest effect in releasing stored sugar. All of these actions tend to aid in preparation for vigorous physical activity. Cortisol acts to aid in preparation for vigorous physical activity, but it is also triggered by emotional stress. Unfortunately, one of its functions is to break down lean tissue for conversion to sugar as an additional source of energy. Cortisol also blocks the removal of certain acids in the bloodstream. When cortisol is elevated in the blood for prolonged periods of time, it causes ulcerations in the lining of the stomach because of increased acid formation. In addition, cortisol strains the brain’s cellular functioning, or, as one doctor explains, “it fries the brain.” Man, once the victorious predator, is now preying upon himself. —Hans Selye

Other Effects of Emotional Stress

Even if we could somehow burn off all the chemicals produced by emotional stress, upsetting psychological distress can interfere with productivity, learning, and interpersonal relationships. If our stress reactions increase, we become less and less able to handle even minor stress. Usually our ability to interact with and understand other people is also disrupted. We can exhaust our adaptive energy reserves and become more susceptible to diseases. It is clear that for life in the twenty-first century, our fight-or-flight and emotional stress mechanisms are often both unnecessary and harmful.

Balancing Emergency and Maintenance Systems

The autonomic nervous system has two divisions. One division is called the sympathetic nervous system and the other is the parasympathetic nervous system. Let’s return to the caveman sitting in front of his fire. The caveman’s response to the tiger included increased heart rate and breathing. These responses were automatic and controlled by the sympathetic nervous system. The parasympathetic nervous system influences the body in ways that are almost the exact opposite of those of the sympathetic nervous system. For example, the parasympathetic nervous system decreases heart rate, slows breath- ing, retards perspiration, and accelerates stomach and gastro- intestinal activity for the proper digestion of food.

Caesar did not merit the triumphal car more than he that conquers himself.

—Ben Franklin

If the sympathetic division can be thought of as an emergency system, the parasympathetic division can be thought of as a maintenance system. This maintenance system is responsible for the conservation and replenishment of energy. Scientists have evidence to sug- gest that our parasympathetic nervous system can be activated through relaxation procedures such as are used in stress management training programs. Maybe we can all learn to replace fight-or-flight responses with what have been called stay-and-play responses.

Hans Selye and the General Adaptation Syndrome

Dr. Hans Selye is often referred to as the “father of stress research.” His pioneering work demonstrated that every demand on the body evokes not only physiological responses specific to the demand but also the nonspecific and uniform stress responses we have already discussed. Selye called the non-specific reactions to stress the general adaptation syndrome. It consists of three stages: alarm reaction, resistance, and exhaustion.

During the alarm reaction, the stressor activates the body to prepare for fight or flight. Both electrical and hormonal signals are involved in mobilizing the energy needed for an emergency. Heart rate, breathing, and perspiration increase. The pupils of the eyes dilate. Adrenaline and cortisol are released. Stored energy floods the bloodstream.

According to Selye, if the stress is strong enough, death may result during the alarm reaction. In fact, the immune response is suppressed as energy is devoted to fight or flight.

During the resistance stage of adaptation to stress, the signs of the alarm reaction are diminished or nonexistent. The im- mune system bounces back and resistances to noxious stimuli and illnesses such as infectious diseases increase above their normal level. Hormones that reduce inflammation from injuries also increase.

If the stressful stimuli or responses persist, the stage of resistance is followed by a stage of exhaustion. By this stage, the exposure to a stressor has nearly depleted the organism’s adaptive energy. The signs of the initial alarm reaction reappear, but they do not abate. Resistance decreases, vulnerability increases, and illness or death may follow.

The general adaptation syndrome has great importance as an early theory linking stress and disease. It stimulated much research contributing to our understanding of stress and resistance as factors in every illness. Stress may interfere with our ability to resist most diseases, but we now also know that the ability to manage stress adaptively can be learned. When this skill is used, stress is enjoyed as a challenge rather than dreaded as a threat.

Hope is the feeling you have that the feeling you have isn’t permanent.

—Jean Kerr

Female Stress and the Tending Instinct

Most of our biological understanding of the stress response is based on research using male rats because the hormones of female rats fluctuate rapidly and complicate the results. Prior to the government’s mandate in 1995 that human research studies had to include both sexes, less than 20 percent of the participants in biological stress research were women. In addition, men conducted most of this research. Shelley E. Taylor, a UCLA psychologist, recognized that this male bias might be one of the few “big mistakes left in science.”

The fight-or-flight response might describe the male’s life- saving response to attack, but this arousal might be only part of the solution for females with offspring. Flight by a mother would be impaired with children in tow and could be fatal for children left unprotected. The fight might be necessary but could be fatal to the mother and her young. Evading detection and creating a community with strength in numbers might be far safer.

Taylor proposed a “tending instinct” for women that is revealed in a biologically based “tend-and-befriend response.” This nurturing and protecting response is principally supported by oxytocin, a hormone that is best known for prompting labor and milk production. Other hormones include endogenous opioid peptides, popularly known for initiating the “runner’s high.” On the other side, androgen hormones, such as testosterone, regulate male aggression. Joining forces and watching out for one another is important for survival of both men and women, but it may be more critical for the “nurturer sex.”

After reviewing thirty scientific studies of what men and women do in response to many different kinds of stress, Taylor concluded that all research revealed women turning to friends, neighbors, and relatives more than men did. Primitive behavior reflects the same bonds. Female primates share their food, groom each other, babysit, and join to defend their young.

The tend-and-befriend response is an exciting new discovery. Research about the response is in its infancy compared to that on the fight-or-flight response, but the implications for stress and its management are many. We have already seen how the fight-or-flight response can help or harm. It may surprise you that the tend-and-befriend response can also help or harm. Thus, women reap the benefits but also pay the cost of both stress responses.

Stress and Disease

If your doctor has recommended that you relax or take it easy, you may be suffering from a stress-related disorder. It is estimated that up to 75 percent of all visits to physicians are from people with a stress-related problem. Stress may be a major factor in causing hypertension and coronary heart disease, migraine and tension headaches, and immune and asthmatic conditions. Stress may lead to harmful habits such as smoking, drinking, or overeating, which have been shown to cause or intensify still other diseases. Stress is also suspected to aggravate chronic backache, arthritis, allergies, diabetes, hyperthyroidism, vertigo, and multiple sclerosis.

Dermatologists find that stress is a factor in many skin disorders such as hives, eczema, and dermatitis. It has also been strongly associated with many gastrointestinal disorders, including irritable colon and gastritis. Some of the excess hormones that the adrenal glands release during repeated stress responses can interfere with your body’s immunity to infection. You may then become more susceptible to bacteria and viruses such as the flu virus.

Stress and Mental Health

Stress not only affects our bodies, but it also affects the way we think, feel, and interact with others. Have you ever come home after an unusually stressful day feeling irritable and still thinking about problems at work? At such times, your family already knows without asking that you had a hard day.

Sometimes we pass our irritability along to others. The stock market drops, for example, and the boss blows up at her secretary for not doing enough work. The secretary goes home and screams at his children for being too loud. The children scold their dog for being bad, when the dog just wanted to play. Do you have any idea what happened to the cat when the dog finally caught it? Stress can disrupt our lives as it ripples from person to person and even person to pet.

The gender we chose for the boss and secretary in the last paragraph may seem an awkward attempt at political correctness, but in this edition the change was necessary to reflect fascinating new research results. A study questioned children about their parents’ behavior toward them and compared their answers with reported workday events by their parents. It showed that on days when one or both of their parents were stressed at work, the children felt picked on or left alone by the fathers and hugged or played with by their mothers. The results support that the gender differences and stress responses, with men fighting or fleeing and women tending or befriending the children, are real.

The effects of long-term stress on our mental health can be devastating. Most of us can bounce back from a bad day at work, school, or home, but we may be unable to do so if stress continues day after day. Under long-term stress, our personalities may change.

We may suffer from depression and feel hopeless, helpless, and worthless. Occasionally we may feel tense and explosive. Sometimes we find ourselves compulsively repeating meaningless tasks in an attempt to control our lives. At times, we act impulsively without thinking about the consequences. At other times, we have exaggerated fears of such simple acts as leaving our house, traveling by airplane, or riding in an elevator.

The changes we experience after long-term stress may have many causes. These causes may be very complex or as simple as learning an unhealthy response. Whether the cause is simple or complex, the problem physical or mental, stress can intensify our difficulties.

The healthy, the strong individual, is the one who asks for help when he needs it. Whether he’s got an abscess on his knee or his soul.

—Rona Barrett

Some of the disorders initiated or intensified by stress may affect women more than men. One explanation is women’s tend-and-befriend response. For example, twice as many women suffer from depression as men. Women are especially prone to depression after a death of a child, when children leave the home, and during separation, divorce, or other isolating events. In addition, there are dangers for women in caregiving. Women tend to the aging, ill, and disabled more often than men. Over half of caregivers work outside the home, and many need to quit their jobs to allow for the more than ten hours a day caregiving consumes. For elderly caregivers it can put their lives at risk, especially if they can’t ask for help and time off. Almost 60 percent become depressed, develop cardiovascular diseases, or become vulnerable to illnesses such as the flu. In fact, a University of Pittsburgh study showed that the chances of an elderly caregiver dying in a four-year period were 60 percent higher than those without such responsibilities.

The Current Score in the Stress Arena

We have begun to tackle the age of anxiety, but we still have an enormous task ahead. Stress is clearly winning at this time. Here are some of the current scores in the arena of stress. They may be categorized as the three D’s: disorders, drugs, and dollars.

DISORDERS

67 million Americans have some form of major heart disease or blood-vessel disease.

1 million Americans die from a heart attack every year.

69 million Americans have high blood pressure.

18 million Americans are alcoholics.

31 million people have diabetes associated with obesity and physical inactivity.

108 million adults are either obese or overweight.

300,000 preventable deaths annually are caused by modifiable, behavioral patterns.

DRUGS

6 billion doses of tranquilizers are prescribed each year.

4 billion doses of muscle relaxants are prescribed each year.

4 billion doses of antidepressants are prescribed each year.

5 billion doses of painkillers are prescribed each year.

4 million people are abusing prescription drugs (pain relievers, stimulants, sedatives, or tranquilizers).

DOLLARS (AND DAYS)

$300 billion is lost annually by American industry from stress-related reasons (lost time, extra costs for health insurance, and the costs of replacing employees).

$246 billion is lost annually by American industry from alcoholism and drug abuse.

$200 billion annually is spent for treatment and lost productivity from obesity-related illness.

$100 billion is lost annually to American businesses (through healthcare expenses and lost productivity) from chronic pain.

132 million workdays a year are lost because of stress-related absenteeism and lost productivity

Sources: Office of Applied Studies, Substance Abuse and Mental Health Services Administration, U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, and National Center for Health Statistics

These numbers may seem impersonal. They do not reflect the pain and suffering of the victims of stress and their loved ones.

Never face facts; if you do, you’ll never get up in the morning. —Marlo Thomas

Healthy Stress

Not all stress is harmful. As a source of motivation and energy, stress can spur us on to creative work, and it can enrich our pleasurable activities. Hans Selye made this clear in his book Stress Without Distress. We even pay for stress when we go on a roller coaster ride, go to the track, or see a scary movie.

There is an important difference between life’s stimulating thrills and its overwhelming anxieties. This is why it is best to manage stress responses rather than try to remove them. Let’s begin the journey.

How This Book Is Organized

Each chapter in this book introduces information or a technique that research or clinical work has shown to be an effective way to understand or manage stress. We have selected stress management concepts and skills that people have been able to learn in relatively short periods of time. In fact, the hundreds of people whom we have helped to become successful stress managers chose the skills you will learn. Some skills are more difficult to learn than others and are best learned after some easier ones have been mastered. We have arranged the material to help you build on skills that are found in the earlier chapters of this book.

How to Use This Book

Most of the individuals and groups that we counsel and train are taught one technique each session. We explain the method and give participants instructions so they can practice the skill during the session. Most of the relaxation procedures, such as those in Section 2, have immediate positive effects. After the session, the participants are encouraged to practice the new technique every day during the next week. This practice usually enables them to learn the skill and begin receiving some of its benefits by applying it in stressful situations.

To get the most from this book, we recommend that you progress through it like a workbook and practice one procedure at a time. Many hospitals and clinics now teach stress management to individuals or groups. You may be using this book as part of such a program. If a psychologist or other qualified professional is guiding your training, follow his or her recommendations. Basic mastery of this stress management program from start to finish takes several weeks to several months of practice. Very few people can learn to use and enjoy stress management skills effectively in less time.

On the other hand, as psychologists, we know that people vary widely in the way they learn and change. Perhaps you have already learned ways through earlier training or experimentation to recognize your stressors and to relax your body quickly and deeply. If so, you may want to skim the next chapter as well as the chapters in Section 2 and start learning some of the skills in the remain- ing chapters. Some people will want to practice a few skills while reading through this book and come back to master the skills they found most useful. If you decide not to follow our recommendations to practice one skill at a time, try to look back over what you have learned successfully in the past and use the same approach in learning to manage stress.

You can only cure retail, but you can prevent wholesale.

—Brock Chisholm

Some people may prefer to read this material as a book rather than using it as a workbook. If you enjoy reading a book from cover to cover, we invite you to do so. In some ways, this would be like reading a good cookbook. Perhaps you would try out some of the recipes for stress management or save one for a special occasion. Maybe you would put some of the recipes in a convenient place and at a later time plan your strategy for coping effectively with a stressful situation.
Praise

Praise

“Witty, relaxed yet disarmingly effective.”
West Coast Review of Books

“In language that is easy to understand, and in specific steps that are easy to follow, this book presents virtually all the essential ingredients that promote mental and physical well-being.”
–ARNOLD A. LAZARUS, PH.D., Distinguished Professor Emeritus of Psychology, Rutgers University

“Extremely readable, and the contents notably support the title.”
–RAY H. ROSENMAN, M.D., cardiologist, co-author of Type A Behavior and Your Heart

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