Life is filled with stress, which can be short-term (acute) or long-term (chronic). Acute stress is the reaction to an immediate threat, commonly known as the "fight or flight" response. The threat can be any situation that is experienced, even subconsciously or falsely, as a danger. Common stressors include noise, crowding, isolation, hunger, danger, and infection. Imagining a threat or remembering a dangerous event can also evoke a stress response. Frequently, however, modern life poses on-going stressful situations that are not short-lived such as difficult work or personal situations and against which the urge to actto fight or to fleemust be suppressed. Psychologic pressures such as relationship problems, loneliness, continual deadlines, or financial worries may be unrelenting and lead to chronic stress.
The body's stress response is somewhat like an airplane readying for take-off; virtually all systemsthe heart and blood vessels, the immune system, the lungs, the digestive system, the sensory organs and brainare modified to meet the perceived danger. Under most circumstances, once the threat has passed the response becomes inactivated and levels of stress hormones return to normala condition called the relaxation response.
The Physical Responses to Acute Stress.
Response in the Brain. Following a threat, the part of the brain called the hypothalamic-pituitary-adrenal
(HPA) system releases certain neurotransmitters (chemical messengers) called catecholamines, particularly those
known as known as dopamine, norepinephrine, and epinephrine (also called adrenaline). The HPA systems also
trigger the production and release of steroid hormones (glucocorticoids), including cortisolthe primary
stress hormone. Cortisol affects systems throughout the body. Catecholamines also activate an area inside the
brain called the amygdala, which apparently triggers an emotional response to a stressful event and also signals
the hippocampusa nearby area in the brainto store the emotionally loaded experience in long-term memory.
In primitive times, this combination of responses would have been essential for survival, when long-lasting
memories of dangerous stimuli (such as a large animal) would be critical for avoiding such threats in the future. During
a stressful event, catecholamines also suppress activity in areas at the front of the brain concerned with
short-term memory, concentration, inhibition, and rational thought. This sequence of mental events allows a person
to react quicklyeither to fight or to fleein emergency situations; however, this also hinders a person's ability
to handle complex social or intellectual tasks and behaviors.
The Response of the Heart, Lungs, and Circulation. The heart rate and blood pressure increase instantaneously in response to stressful situations. Breathing becomes rapid and the lungs take in more oxygen. Blood flow may actually increase 300% to 400%, priming the muscles, lungs, and brain for added demands. In addition, the spleen discharges red and white blood cells, allowing the blood to transport more oxygen.
The Response of the Immune System. The immediate effect of stress is to dampen parts of the immune system. In addition, certain factors in the immune systemincluding important white blood cellsare redistributed, much like marshaling soldiers to potentially critical areas. In the case of stress, these immune-boosting troops are sent to the body's front lines where injury or infection is most likely, such as the skin, the bone marrow, and the lymph nodes.
Response in the Mouth and Throat. During stress, fluids are diverted from nonessential locations, including the mouth, causing dryness and difficulty in talking. In addition, stress can cause spasms of the throat muscles, making it difficult to swallow and fight infection.
Response in the Skin. Stress commonly results in cool, clammy sweaty skin and in a tightening of the scalp that makes the hair seem to stand on end. The skin is cool because blood flow is diverted away so it can support the heart and muscle tissues. As a result, physical capacity is increased and blood loss is reduced in the event of injury.
Metabolic Response. Stress shuts down digestive activity, a nonessential body function during short-term periods of physical exertion or crisis.
In prehistoric times, the physical changes in response to stress were an essential adaptation for meeting natural threats. Even in the modern world, the stress response can be an asset for raising levels of performance during critical events such as a sports activity, an important meeting, or in situations of actual danger or crisis. But if the acute event is traumatic, if the body has an inefficient relaxation response, or if stressors accumulate over time, all parts of the body's stress apparatusthe brain, heart, lungs, vessels, and musclesbecome chronically over- or underactivated, causing physical or psychologic damage.
Psychologic Effects.
Certainly, stress diminishes the quality of life by reducing feelings of pleasure and accomplishment.
Relationships are often threatened, and there is always the danger that chronic stress might develop into more
serious psychologic problems, such as an anxiety disorder or depression. One study suggested that stress is
responsible for an increased incidence of death in a spouse whose partner has died within the previous six months.
Suicide, accidents, or alcohol-related events were likely causes of death in these cases; men were more at risk than women.
Heart Disease. Mental stress is as important a trigger for angina as physical stress and may even pose a higher risk for serious cardiac events-such as heart attacks. Incidents of acute stress often precede sudden heart-related deaths. A good example of this was the significantly increased incidence in sudden cardiac death during the 1996 Los Angeles earthquake; only a few of the deaths were related to physical exertion.
Stress can affect the heart in several ways. Sudden stress increases the pumping action and rate of the heart and causes the arteries to constrict, thereby posing a risk for blocking blood flow to the heart. The combination of these factors also increases the risk for rhythm disturbances. Stress causes blood to become stickier (possibly in preparation of potential injury), increasing the likelihood of an artery-clogging blood clot. Stress may signal the body to release fat into the bloodstream, raising blood-cholesterol levels, at least temporarily. In women, chronic stress may reduce estrogen levels, which are important for cardiac health. One study indicated that people who experience sudden increases in blood pressure caused by mental stress may, over time, be vulnerable to damage the inner lining of blood vessels, contributing to atherosclerosis. In one study, young adult children of parents with hypertension who were undergoing a mental stress test, showed significantly increased blood levels of the adrenaline and endothelin-chemicals known to constrict blood vessels. Another study measured stress levels and blood pressure periodically in people over 20 years. At the end of that period, men who measured highest on the stress scale were twice as likely to have high blood pressure as those with normal stress. The effects of stress on blood pressure in women were less clear.
Stroke.
In some people prolonged or frequent mental stress causes an exaggerated increase in blood pressure.
Over time, this effect has been linked to thickening of the carotid arteries, which carry blood to the front half of
the brain. Blockage and injury in these arteries are primary causes of stroke. (Thickening of these arteries is also
an indication of atherosclerosisor hardening of the arteriesa major cause of heart disease.) One study of
POWs from World War II found that their rate of stroke was more than 8 times that of other veterans, in spite of the
fact that other risk factors (such as high blood pressure and diabetes) were no different. One survey revealed
that men who were most bothered by stressful situations, such as waiting in line or problems at work, were
more likely to have strokes than those who did not report such distress.
Susceptibility to Diseases.
Some studies suggest that acute stressful events actually boost the immune system. If stress becomes
chronic, however, this hypersensitive immune response becomes
blunted. A number of studies have shown that
subjects under chronic stress have low white blood cell counts and are vulnerable to colds. In some studies, stress
that had the most negative impact on resistance to infection was from interpersonal conflicts, such as those at
work or in a marriage. Recent research even suggests that stressnot indoor pollutantsmay actually be a cause
of the so-called sick-building syndrome, which produces symptoms, such as eczema, headaches, asthma, and
sinus problems, in office workers. Evidence indicates, moreover, that a good deal more is at stake than just
resistance to mild illnesses. Stress has been shown to affect tumor formation in laboratory animals. In a now
well-knownif still controversialstudy of women with terminal breast cancer, those who participated in
programs offering emotional support and training in positive imaging lived twice as long as those who did not
participate. While there is no evidence that stress causes cancer, there is some data to support the belief that
emotional states influence the progression or regression of various diseases.
Digestive Problems.
Over the long term, prolonged stress can disrupt the digestive system, irritating
the large intestine and causing diarrhea, constipation, cramping, and bloating.
Excessive production of digestive acids in the stomach may cause a painful burning.
People used to believe that peptic ulcers were caused by stress, but it is now
known that most peptic ulcers are either caused by the H. pylori bacteria
or by the use of nonsteroidal anti-inflammatory medications-such as aspirin.
However, another digestive condition, irritable bowel syndrome(or spastic colon)
does appear to be strongly related to stress. With this condition, the large
intestine becomes irritated, and its muscular contractions are spastic rather
than smooth and wave like. The abdomen is bloated and the patient experiences
cramping and alternating periods of constipation and diarrhea.
Weight Problems.
Stress can have varying effects on body weight. Some people suffer a loss of appetite and lose weight.
In rare cases, stress may trigger hyperactivity of the thyroid gland, stimulating appetite but causing the
body to burn up calories at a faster than normal rate. Others, however, develop cravings for salt, fat, and sugar
to counteract tension and, thus, may gain weight. People under stress who respond in this way are at
particular risk for abdominal fata predictor of diabetes and heart problems.
Diabetes.
Chronic stress has been associated with the development of insulin-resistance, a condition in which
the body is unable to use insulin effectively to regulate glucose (blood sugar). Insulin-resistance is a
primary factor in diabetes.
Musculoskeletal Functions.
Chronic pain caused by arthritis and other conditions may be intensified by stress. Stress also contributes
to tension or muscle contraction headache, during which the pain is usually felt in the forehead, the back
of the head and neck, or both regions; it is described as a tight feeling, as if the head were in a vise. Soreness
in the shoulder or neck is common. Tension headaches can last minutes to days and may occur daily in
chronic headache states. (Migraine headaches, too, occur most often when patients are experiencing increased
levels of stress.) Back pain is also a common complaint. Some studies have clearly associated job
dissatisfaction and depression to back problems, although it is still unclear if stress is a direct cause of the back pain.
Sleep Disturbances.
It is essential for the person under stress to have a good night's sleep in order to rebuild the body's
resources and gain perspective on problems that are causing trouble. The tensions of unresolved stress,
however, frequently cause insomnia, generally keeping the stressed person awake or causing awakening in
the middle of the night or early morning.
Sexual and Reproductive Dysfunction.
Stress can lead to diminished sexual desire and an inability to achieve orgasm. Men may experience
erectile dysfunction; women may develop menstrual irregularities, and stress may even affect fertility. Stress
hormones also have an impact on the hypothalamus gland, which produces reproductive hormones.
Severely elevated cortisol levels can even shut down menstruation.
Maternal stress during pregnancy has been linked to a 50% higher risk for miscarriage. It is also associated with lower birth weights and increased incidence of premature birthsboth of which are risk factors for infant mortality. Researchers postulate that stress may cause physiologic alterations(such as increased adrenal hormone levels), that may interfere with normal blood flow to the placenta. In addition, stress is often accompanied by unhealthy behaviorbad diet and sedentary habitsthat can harm the developing fetus.
Memory, Concentration, and Learning.
The typical victim of severe stress suffers loss of concentration at work and
at home and may become inefficient and accident-prone. The hippocampus, which
is where memory cells in the brain are produced and stored, is highly activated
during the fight or flight response. Prolonged exposure to cortisolthe major
stress hormoneis now believed to actually damage brain cells in the hippocampus;
damage may result from long term exposure. Although some memory loss occurs
with age, stress may play an even more important role than simple aging. In
one study older people with low stress hormone levels tested as well as younger
people in cognitive tests: those with higher stress levels tested between 20%
and 50% lower. If stress is chronic or extremely severe, memory loss may become
permanent. Very severe and acute stress that causes post-traumatic stress disorder
(PTSD) is associated with physical changes in the brain. Two studies reported
that Vietnam veterans and women who suffered from sexual abuse, who suffered
PTSD, displayed up to 8% shrinkage in the hippocampus. It is not yet known if
this shrinkage is reversible. Severe stress may even break down the blood-brain
barriera physiological mechanism that helps protect the brain from toxins, bacteria
and other potentially harmful substances that may be carried in blood.
Skin.
Stress plays a role in exacerbating a number of skin conditions, including hives, psoriasis, acne, rosacea,
and eczema. Unexplained itching may also be caused by stress.
At some point in their lives virtually everyone will experience stressful events or situations that overwhelm their natural coping mechanisms. In a recent poll, 89% of respondents indicated that they had experienced serious stress in their lives. Many factors influence susceptibility to stress. One study targeted people most likely to have frequent mental stress compared to the general population. They included younger adults, women (in general) and working mothers in particular, Native Americans, divorced or widowed individuals, the unemployed, those who did not graduate from high school, and those with low incomes or no health insurance. In America, women who live in New York are most stressed, while people in South Dakota are least stressed.
Biologic or Genetic Factors.
Certain people, because of inherited or other physiologic factors, are more vulnerable than others to
the damaging effects of stress.
Unhealthy Response to Frequent Episodes. In some people, exposure to frequent episodes of stress can cause blood pressure spikes, which over time, may lead to heart disease.
Inability to Adapt to Nondangerous Stressors. In most people, repeated exposure to a specific nondangerous stressful situation (such as public speaking) eventually reduces the level of stress that occurs with such an event. In some people, however, stress hormones become elevated to the same degree with repeated exposure to the situation as they were to the first.
An Absent or Inadequate Relaxation Response. In some people, stress hormones remain elevated instead of returning to normal levels. This may occur in highly competitive athletes or people with a history of depression.
Differences in Response Activity. In some people, parts of the stress response may be underactive, causing other parts to overreact. For example, if the brain fails to produce enough cortisol, the immune system may overproduce certain factors that would have been suppressed by this stress hormone, and that can cause harm in excessive amounts. (Such abnormal responses may play a role in autoimmune diseases).
Age.
No one is immune to stress, although it may go unnoticed in the very young and old. Children are
frequent victims of stress, because they are usually unable to communicate accurately their feelings or responses
to events over which they have no control. As people age, the ability to achieve a relaxation response after
a stressful event may slow down, although not necessarily stop. Aging may simply wear out the systems
in the brain that respond to stress, so that they become inefficient. The elderly, too, very often are exposed
to major stressors such as medical problems, the loss of a spouse and friends, a change in a living
situation, and financial worries.
Personality.
Personality may make some people more or less vulnerable to the effect of stress. Type A
behavioraggressive, fast-paced, and angryhas long been used as an example of a negatively stressed personality.
When angry or stressed, such peopleboth men and womenoften experience exaggerated increases in
blood pressure, which may cause heart problems over time. Those with a sense of optimism, high self-esteem,
and confidence in controlling situations are, of course, much less vulnerable to the destructive effects of
stress than those with more negative personalities.
Isolation.
The lack of an established network of family and friends is another important
factor predisposing to stress disorders. Isolation also appears to put people
at risk for heart disease and psychologic disorders, such as depression. A number
of studies indicate that married people generally outlive their unmarried contemporaries.
One study showed that middle-aged men under severe stress who lacked emotional
support were five times more likely to die within a seven-year period than those
who had the same amount of stress but had close personal ties.
Ethnic Differences.
Ethnic differences in the stress response may exist. Researchers have found that under mental stress, arteries
in African Americans dilate to a lesser degree than those in whites. The finding may explain why
hypertension and its complications are more prevalent in blacks.
Factors at Work and at Home.
A number of studies are showing that conditions in the workplace are major contributors to stress. Stress
experienced as a result of the job is particularly likely to become chronic because it is such a large part of daily
life. And stress in turn reduces a worker's effectiveness by impairing concentration, causing sleeplessness, and
increasing the risk for illness, back problems, accidents, and lost time. Work stress can lead to harassment or
even violence while on the job. At its most extreme, it can place such a burden on the heart and circulation that it
may even be fatal. The Japanese even have a word for sudden death due to
overworkkaroushi.
Some studies indicate that people mostly likely to experience stress in the work place are those who feel they have no control over their circumstances. This is likely to occur in an organization that lacks effective communication and conflict-resolution methods; one that doesn't invite employees to participate in decision, or allow creativity, or where employees lack control over their responsibilities. In this age of downsizing, lack of job security is also a major cause of stress. Additional stressors include long hours, time spent away from home and family, office politics and conflicts between workers, wages that are not commensurate with levels of responsibility, and-in this competitive society-unrelenting and unreasonable demands for performance.
One study of people who work under demanding conditions suggested, however, that heart disease-including high blood pressure- attributed to work stress may be due to the way people cope with the stress, not to the direct effects of the job itself. People who are trying to deal with stress often resort to unhealthy habits including high-fat and high-salt diets, tobacco use, alcohol abuse, and a sedentary lifestyle. In one study, men were more apt to use alcohol or eat less healthily in response to stress, while women tended to have healthier ways of coping.
Working mothers, regardless of whether they are married or single, face higher stress levelsnot so much in the work place but at home. Such stress may also have a domino effect. A recent study shows that a boy's probability of childhood behavioral difficulties was increased with the number and type of family stressors encountered in the home. Depressed or aggressive mothers were particularly powerful sources of stresseven more important than poverty or overcrowding.
Anxiety Disorders.
The physical symptoms of anxiety disorders mirror many of those of stressincluding a fast heart rate,
rapid, shallow breathing, and increased muscle tension. Anxiety is an emotional disorder, however, and is
characterized by feelings of apprehension, uncertainty, fear, or panic. Some individuals with anxiety disorders
have numerous physical complaints, such as headaches, gastrointestinal disturbances, dizziness, and chest pain.
Severe cases of anxiety disorders are debilitating, and interfere with career, family, and social spheres.
Depression.
Depression can be a disabling condition, and, like anxiety disorders, may result from untreated chronic
stress. Depression also mimics some of the symptoms of stress, including changes in appetite, sleep patterns,
and concentration. Serious depression, however, is distinguished from stress by feelings of sadness,
hopelessness, loss of interest in life, and, sometimes, thoughts of suicide. Acute depression is also accompanied by
significant changes in the patient's functioning. Professional therapy may be needed in order to determine if depression
is caused by stress or if it is the primary problem.
Post-Traumatic Stress Disorder Symptoms.
Post-traumatic stress disorder (PTSD) is a reaction to a very traumatic event:
it is actually classified as an anxiety disorder. The event that precipitates
PTSD is usually outside the norm of human experience, such as intense combat
or sexual assault. The patient struggles to forget the traumatic event and frequently
develops emotional numbness and event-related amnesia. Often, however, there
is a mental flashback, and the patient re-experiences the painful circumstance
in the form of intrusive dreams and disturbing thoughts and memories, which
resemble or recall the trauma. Other symptoms may include lack of pleasure in
formerly enjoyed activities, hopelessness, irritability, mood swings, sleep
problems, inability to concentrate, and an excessive startle-response to noise.
Perhaps the best general approach for treating stress can be found in the elegant passage by Reinhold Niebuhr, "Grant me the courage to change the things I can change, the serenity to accept the things I can't change, and the wisdom to know the difference." In choosing specific strategies for treating stress, several factors should be considered. First, no single method is uniformly successful: a combination of approaches is generally most effective. Second, what works for one person does not necessarily work for someone else. Third, stress can be positive as well as negative. Appropriate and controllable stress provides interest and excitement and motivates the individual to greater achievement, while a lack of stress may lead to boredom and depression. Finally, stress may play a part in making people vulnerable to illness. A physician or psychologist should be consulted if there are any indications of accompanying medical or psychologic conditions, such as cardiac symptoms, significant pain, anxiety, or depression.
It is very important to note that no evidence exists that treating stress can cure medical problems, although a recent study indicated that stress management programs may reduce the risk of cardiac eventslike heart attackby up to 75% in people with heart disease. One study found it was even more effective than exercise (although exercise also reduced the risk.) Such programs should never be used alone to treat any medical condition.
One major obstacle to reducing stress is the fight or flight response itself; the very idea of relaxation feels threatening, because it is perceived as letting down one's guard. If stress is provoked by an over-demanding boss for instance, the subordinate may feel the need to remain in a psychologic state of fighting-readiness, even though there is no safe opportunity to express anger against the boss. Stress builds up, but the victim has the illusion, even subconsciously, that it is providing safety or preparedness, so does nothing to correct the condition. Often people succeed in relieving stress for the short-term but resort to previous ways of stressful thinking and behaving because of outside pressure or entrenched habits. It is essential to remember that reducing stress and keeping relaxed not only helps maintain health but gives the mind more opportunities for clearer thinking in order to initiate appropriate actions to get rid of the conditions causing stress. The process of learning to control stress is life-long, and will not only contribute to better health, but a greater ability to succeed on one's own agenda.
Cognitive-Behavioral Techniques.
Cognitive-behavioral methods are the most effective ways to reduce stress. They include identifying
sources of stress, restructuring priorities, changing one's response to stress, and finding methods for managing
and reducing stress.
Identifying Sources of Stress. It is useful to start the process of stress reduction with an informal inventory of daily events and activities. The first step is keep a diary noting which activities put a strain on energy and time, trigger anger or anxiety, or precipitate a negative physical response (e.g., a sour stomach or headache). Positive experiences should also be notedthose that are mentally or physically refreshing or produce a sense of accomplishment. While this exercise might itself seem stress producingyet one more choreit need not be done in painstaking detail. A few words accompanying a time and date will usually be enough to serve as reminders of significant events or activities. After a week or two, the stressed individual should try to identify two or three events or activities that have been significantly upsetting or overwhelming. Priorities and goals should then be carefully examined. Individuals should question whether the stressful activities meet their own goals or someone else's, whether they have taken on tasks that they can reasonably accomplish, and which tasks are in their control and which ones aren't.
Restructuring Priorities. The next step is to attempt to shift the balance from stress-producing to stress-reducing activities. A recent study indicated that daily pleasant events have positive effects on the immune system. In fact, adding pleasurable events has more benefit than simply reducing stressful or negative ones. This is important to realize because many difficult stressful situations, such as unpleasant working conditions, an unhappy family situation, or a significant loss, can't simply be rescheduled or wished away. When eliminating the stress is not practical, there may be ways to reduce its impact. If the problem is work-related and it is impossible to change jobs or cut back on hours, consider as many pleasant relief options as possible. Examples include taking long weekends or vacations, sending out resumes or working on transfers within the company, and planning pleasant diversions or physical exercise during lunch hours. If stress at home is the problem, plan times away, even if it is only an hour or two a week. Learn to replace time-consuming chores that aren't really necessary with activities that are pleasurable or interesting. Making time for recreation is as essential as paying bills or shopping for groceries. Many people are afraid of being perceived as selfish if they make decisions that benefit only themselves. The truth is that self-sacrifice may be inappropriate and even damaging if the person making the sacrifice is unhappy, angry, or physically unwell. In most cases, small daily decisions for improvement can accumulate and work to reconstruct a stressed existence into a pleasant and productive one.
Adjusting Responses to Stress. Many people believe that certain emotional responses to stress, such as the negative and aggressive Type A behavior associated with heart disorders, are innate features of personality. Research has shown, however, that individuals can be taught to change their emotional reactions to stressful events. Given the fixed nature of many major stresses, such as the loss of a loved one, chronic illness, or pressures from work, cognitive behavioral therapy, which teaches new ways of responding to stress, may be the most effective method of permanently reducing its effects.
Discuss Feelings. The concept of communication and "letting your feelings out" has been so excessively promoted and parodied that it has nearly lost its value as good psychologic advice. Nevertheless, feelings of anger or frustration that are not expressed in an acceptable way may lead to hostility, a sense of helplessness, and depression. Expressing feelings does not mean venting frustration on waiters and subordinates, boring friends with emotional minutia, or wallowing in self-pity. In fact, because certain chronically hostile individuals can experience harmful spikes in blood pressure when they are angry, some therapists strongly advise that just talkingnot venting anger without any progressis the best approach for these people. The primary goal is to explain and assert one's needs to a trusted individual in as positive a way as possible. Direct communication with another person may not even be necessary; writing in a journal or composing a letter that is never mailed may be sufficient. Expressing ones feelings is not enough, however. Learning to listen, empathize, and respond to others with understanding is just as important for maintaining the strong relationships necessary for emotional fulfillment and reduced stress.
Keep Perspective and Look for the Positive. Reversing negative ideas and learning to focus on positive outcomes helps reduce tension and achieve goals. For example, an individual who is alarmed at the prospect of giving a speech should first identify the worst possible outcomes (forgetting the speech, stumbling over words, humiliation, audience contempt), and its likelihood (probably very low or the speech wouldn't have been assigned in the first place). Then the stressed individual should envision a favorable result (a well-rounded, articulate presentation with rewarding applause). Then a plan should be developed to achieve the positive outcome (preparing in front of a mirror, using a video camera or tape recorder, relaxation exercises). It is helpful to remember previous situations that initially seemed negative but ended well.
Use Humor. Keeping a sense of humor during difficult situations is a common recommendation from stress management experts. Laughing releases the tension of pent-up feelings and helps keep perspective. Research has shown that humor is a very effective mechanism for coping with acute stress. It is not uncommon for people to recall laughing intensely even during tragic events, such as the death of a loved one, and to remember this laughter as helping them to endure the emotional pain.
Relaxation Techniques.
Since stress is here to stay, everyone needs to develop methods for invoking the relaxation responsethe
natural unwinding of the stress response. Relaxation lowers blood pressure, respiration, pulse rates, releases
muscle tension, and eases emotional strains. This response is highly individualized, but there are certain
approaches that seem to work, including: exercise, deep breathing, muscle relaxation, and meditation. No one should
expect a total resolution of stress from these approaches, but if done regularly, these programs can be very effective
[see Box].
Adapting Healthy Habits.
Unfortunately people under stress frequently seek relief through drug or alcohol
abuse, tobacco use, abnormal eating patterns, or passive activities-such as
watching television. The damage these self-destructive habits cause under ordinary
circumstances is compounded by the physiologic effects of stress itself. And
the cycle is self-perpetuating; a sedentary routine, alcohol abuse and smoking
promote heart disease, interfere with sleep patterns, and lead to increased
rather than reduced tension levels. General health and stress resistance can
be enhanced by eating well and by avoiding stresses such as alcohol, caffeine,
tobacco and junk food. Fats, simple sugars, and salt are known contributors
to health problems, including diabetes and heart disease. No evidence exists
that stress has any effect on vitamin needs or that vitamins have any benefits
against the effects of stress. Everyone, however, should certainly have a diet
rich in vegetable and fruits.
Exercise. Exercise in combination with stress management techniques is extremely important, and-for those with heart disease- can even reduce significantly the risk for a heart attack. As the body attains fitness its ability to withstand stress is enhanced. The heart and circulation are able to work harder for longer stretches. The muscles, ligaments, bones, and joints become stronger and more flexible. And the mind is often better able to cope with stress and stay on an even, happier keel. Studies show that employees who follow an active lifestyle need fewer sick and disability days than sedentary workers. Usually, a varied exercise regime is more interestingand thus easier to stick to. Start slowly. Strenuous exercise in people who are not used to it can be very dangerous and any exercise program should be discussed with a physician. In addition, half of all people who begin a vigorous training regime drop out within a year, so the key is to find activities that are exciting, challenging, and satisfying. Signing up for aerobics classes at a gym can help prompt regular exercise. Because it is so natural and convenient, brisk walking is an excellent aerobic exercise. Even short brisk walks can relieve bouts of stress. Swimming is another ideal exercise for many people including pregnant women, individuals with musculoskeletal problems, and those who suffer exercise-induced asthma. Yoga or Tai Chi can be very effective, combining many of the benefits of breathing, muscle relaxation and meditation while toning and stretching the muscles.
As in other areas of stress management, making a plan and executing it successfully develops feelings of mastery and control-which are very beneficial in and of themselves. Start small. Just 10 minutes of exercise three times a week can build a good base for novices. Gradually build up the length of these every-other-day aerobic sessions, to 30 minutes or more.
Strengthen or Establish a Support Network.
Studies of people who remain happy and healthy despite many life stresses conclude that most have very
good networks of social support. One study indicated that support even from strangers reduced blood pressure
surges in people undergoing a stressful event. Many studies suggest that having a pet helps reduce medical
problems aggravated by stress, including heart disease and high blood pressure.
Professional Help and Medications.
Stress can be a factor in a variety of physical and emotional illnesses, which should be professionally
treated. Many stress symptoms are mild and can be managed by over the counter medications, e.g., aspirin,
acetaminophen or ibuprofen for tension headache and antacids, and anti-diarrhea medications or laxatives for
mild stomach distress. A physician should be consulted, however, for physical symptoms that are out of the
ordinary, particularly those which progress in severity or awaken one at night. A mental health professional should
be consulted for unmanageable acute stress or for severe anxiety or depression. Often short-term therapy can
resolve stress-related emotional problems.
Reducing Stress at Work.
Many institutions within the current culture, while paying lip service to stress reduction, put intense
pressure on individuals to behave in ways that promote tension. Some experts argue that employers should be
held responsible for taking measures to prevent stress from work overload and should provide help to deal
with work-related stress. Treating stress has a number of benefits, not only for the individual but also for the
patient's employer. In one study, for example, in which a company set up a two-year stress management
educational program, the savings to the company in workmen's compensations costs were nearly $150,000, compared to
the cost of the program which was only $150 per participant for a total of $6,000.
Here are some tips: seek out someone in the Human Resources department or a sympathetic manager, and communicate concerns about job stress. Work with them in a non-confrontational way to improve working conditions, letting them know that productivity can be improved if some of the pressure is off. Establish or reinforce a network of friends at work and at home. Restructure priorities and eliminate unnecessary tasks. Learn to focus on positive outcomes. If the job is unendurable, plan and execute a career change. If this isn't possible, be sure to schedule daily pleasant activities and physical exercise during free time. Use stress reduction techniques described in this report. It is also helpful to keep in mind that the employers are victimized by the same stressful conditions they are imposing.
Deep Breathing.
During stress, breathing becomes shallow and rapid. Taking a deep breath is an automatic and
effective technique for winding down. Deep breathing exercises consciously intensify this natural physiologic
reaction and can be very useful during a stressful situation, or for maintaining a relaxed state during
the day. Inhale through the nose slowly and deeply to the count of ten, making sure that the stomach
and abdomen expand but the chest does not raise up. Exhale through the nose-slowly and completely-also
to the count of ten. To help quiet the mind, concentrate fully on breathing and counting through each
cycle. Repeat five to ten times and make a habit of doing the exercise several times each day, even when
not feeling stressed.
Muscle Relaxation.
Muscle relaxation techniques, often combined with deep breathing, are simple to learn and very
useful for getting to sleep. After lying down in a comfortable position without crossing the limbs, concentrate
on each part of the body, beginning with the top of the head and progressing downward to focus on all
the muscles in the body. Be sure to include the forehead, ears, eyes, mouth, neck, shoulders, arms and
hands, fingers, chest, belly, thighs, calves and feet. (Some individuals even imagine tensing and releasing
internal muscles once the external review is complete.) A slow, deep breathing pattern should be
maintained throughout this exercise. Tense each muscle as tightly as possible for a count of five to ten and then
release it completely; experience the muscle as totally relaxed and lead-heavy. Continue until the feet are
reached. In the beginning it is useful to have a friend or partner check for tension by lifting an arm and
dropping itthe arm should fall freely. Practice makes the exercise much more effective and produces
relaxation much more rapidly.
Meditation.
Meditation, used for many years in Eastern cultures, is now widely accepted in this country as a
relaxation technique. The goal of all meditative procedures, both religious and therapeutic, is to quiet
the mindessentially to relax thought. The practiced meditater can achieve a reduction in heart rate,
blood pressure, adrenaline levels, and skin temperature while meditating. A number of organizations, both
religious and nonreligious, teach meditation. The names of these organizations, along with
instructional books, can be found at public libraries. As in all relaxation exercises, the first step is to be as
physically comfortable as possible in a quiet place, preferably a semidark room isolated from noise or
distraction. One should be sitting up with the eyes closed concentrating on a simple image or sound. Some
methods suggest imagining a point of light behind the forehead and between the eyes. Other techniques, such
as transcendental mediation, assign mantraswords that have particular chanting soundswhich are
repeated silently. Anyone can make up a word or a sound; the only condition is that the word or sound
not be associated with a real thing that can divert the meditater from the internal process. When the
mind begins to wander, the meditater gently brings concentration back to the central image or sound.
Some recommend meditating for no longer than 20 minutes in the morning after awakening and then again
in early evening before dinner. Even once a day is helpful. Successful meditation results in deep
relaxation and can be very energizing. (One should probably not meditate before going to bed: some people
who meditate before sleep wake up in the middle of the night, alert and unable to return to sleep.) A
recent study showed that transcendental meditation was more effective in reducing blood pressure than
muscle relaxation in both men and women.
One technique requiring little adaptation in the daily schedule has been termed
mini-meditation. The method involves heightening awareness of the immediate
surrounding environment, thus redirecting the stress-provoking brain activity
into focusing on existing sensory input. One should first chose a routine activity
when alone. For example while washing dishes concentrate on the feel of the
water and dishes, allow the mind to wander to any immediate sensory experience
(sounds outside the window, smells from the stove, colors in the room). If the
mind begins to think about the past or future, abstractions or worries, redirect
it gently back. This redirection of brain activity from your thoughts and worries
to your senses disrupts the stress response and prompts relaxation. It also
helps promote an emotional and sensual
appreciation of simple pleasures already present in a person's life.
Biofeedback.
During biofeedback, electric leads are taped to a subject's head. The person is encouraged to
relax using methods such as those described above. Brains waves are measured and an auditory signal
is emitted when alpha waves are detecteda frequency which coincides with a state of deep
relaxation. By repeating the process, subjects associate the sound with the relaxed state and learn
to achieve relaxation by themselves.
Massage Therapy.
Massage therapy appears to slow down the heart and relax the body. Rather than causing
drowsiness, however, massage actually increases alertness. A number of massage therapies are available for
relaxing muscles, including the following: (1) shiatsu applies intense pressure to parts of the body and
can be painful, but people report deep relaxation afterward; (2) reflexology manipulates pressure points
in the hands and feet; (3) Swedish massage has been available for years and uses muscle manipulation.
National Institute of Mental Health
Room 15-C-05
5600 Fishers Lane
Rockville, MD 20857
call (800-421-4211) or on the Internet (http://www.nimh.nih.gov/)
National Alliance for the Mentally Ill (NAMI)
200 N. Glebe Rd.
Arlington, VA 22203-3754
call (800-950-6264) or on the Internet (http://www.nami.org/)
NAMI is a national grass roots organization providing ways for self-help and
support organizations to
individuals and families of people with psychologic disorders.
Association for the Advancement of Behavior Therapy
305 Seventh Avenue
16th Floor
New York, NY 10001
call (212-647-1890) or (800-685-AABT)
The association offers a list of behavior therapists, fact sheets on various
psychologic problems,
and methods for choosing a behavior therapist.
National Mental Health Association
1021 Prince St.
Alexandria, VA 22314-2971
call (703-684-7722) or on the Internet (http://www.nmha.org)
This organizations will give the names and numbers of regional chapters and
also provides information
on 200 mental health topics.
On the Internet
Mental Health Net (http://www.cmhc.com/)
Internet Mental Health (http://www.mentalhealth.com/)
is a free encyclopedia of mental health
information.
Transcendental Meditation
888-LEARN TM (532-7686)
(http://www.tm.org/)
Heart disease: The mind-body connection. Johns Hopkins Medical Letter: Health after 50. July 1997
Is worrying bad for your heart? A prospective study of worry and coronary heart disease in the
Normative Aging Study. Circulation, 2/18/97
Stress in employed women: Impact of marital status and children at home on neurohomone output and
home strain. Psychosomatic Medicine, July/August 1997
Protective and damaging effects of stress mediators. The New England Journal of Medicine, 1/15/98