Stress At Home and How To Manage It

Songs of Self-focus, Social Alienation, Misery

aaKandinsky_YellowRedBlueListening to the lyrics of the most popular songs being played on the radio or downloaded from the web provides an increased understanding of important psychological characteristics of the U.S. population—and of how these characteristics may change in the future. Words used in popular song lyrics are a cultural product that changes along with cultural changes in the individual psychological traits of the population for which the songs are written and by which they are consumed. A new study conducted on U.S. song lyrics published between 1980 and 2007 shows the influence of this heretofore understudied cultural product in ways that reflect psychological transformations in their authors and listeners. The results show that, over a time span of 27 years, changes have occurred in the frequency of words related to self-focus, social disconnection, anger, antisocial behavior, and misery vs. the frequency of words related to other-focus, social interactions, and positive emotion.

black-eyed-peas-2The results of the study, conducted by researchers from the universities of Kentucky, Georgia, and San Diego State provide consistent evidence in support of the hypothesis that popular U.S. music lyrics now include more words related to a focus on the self with an increase in the use of first-person singular pronouns and fewer first-person plural pronouns over the last 27 years. Popular song lyrics now include fewer words related to social interactions and positive emotions, which parallels evidence in other studies showing increases in U.S. loneliness and psychopathology over time. Words related to anger and antisocial behavior have also increased significantly, which appears to reflect increases in narcissism and social rejection that are conducive to heightened anger and antisocial behavior. To arrive at these results, the researchers analyzed song lyrics for the 10 most popular U.S. songs (according to the Billboard Hot 100 year-end chart) for each year between 1980 through 2007, for a total of 88,621 words.

RihannaChanges in popular music lyrics appear to closely mirror increases in narcissism and self-focus. Just as people report more frequent instances of loneliness and social isolation over time (feelings of loneliness and social isolation in the United States rose 250% between 1985 and 2004), popular song lyrics have progressively included fewer words related to social interactions. Correspondingly, the use of angry and antisocial song lyrics has increased over the same time span, to such an extent that the tone and content of popular songs has become increasingly more angry and antisocial over time.

Other longitudinal data appear to support the findings in the song lyrics. For example, scores on the widely-administered Minnesota Multiphasic Personality Inventory (MMPI) clinical scales, which measure mental health, have increased approximately one full standard deviation between 1938 and 2007. In particular, scores on the depression scale have risen by 0.66 standard deviation units between 1938 and 2007. This would indicate that more people meet diagnostic criteria for major depressive disorder in recent generations as compared to their predecessors.

Lady-GagaU.S. culture is continuously inundated with cultural products which are delivered through a wide variety of media and are increasingly consumed in isolation. Americans listen to popular music, view billboards, and watch TV programs and movies—in increasing numbers, they do these activities alone. The evidence that changes in cultural products reflect generational changes in psychological characteristics is not surprising. Given the ubiquity of cultural products, in spite of the ongoing controversy over whether the media induce or reflect cultural changes, we need a better understanding of how cultural changes over time influence personality traits, goals, and emotions. It appears that, at least on the basis of song lyrics, things aren’t looking up at all for social connection, altruism, and positive emotions.

A New Stressor: FOMO

Sm-bandwagonThe power of communication has been unleashed on the Internet as never before. It is now possible to know almost instantly what is happening around the world, to broadcast one’s ever-changing “status” to real or virtual friends and acquaintances, to express oneself endlessly in 160-character increments, to blog multiple times a day one’s erudite or inane musings to an audience that can number in the tens of thousands. Everyone has the power to become a “brand” and many have done so to great lengths, baring their life and its inspiring or sordid details without regard for privacy, confidentiality or simple reserve. With this phenomenon, new stressors are born, old ones are better overcome, and still others morph into more or less ominous sources of anxiety.

Take for example the ability to know, via Facebook, Twitter, Foursquare and Instagram, the whereabouts and activities of our immediate and extended social network. It is possible to know, just by virtue of swiping the screen of a smartphone, who’s out, who’s dining with whom and where, who’s at the club or the sports arena—often with photos and videos of the event as it unfolds in some sort of electronic play by play. Truly fascinating glimpses of reality in some cases, not so interesting and even banal in many others.

One of the newest stressors originated by this type of instant access is “fear of missing out,” or FOMO. It is a bizarre reversal of social anxiety, the particularly debilitating condition which causes people to reluctantly withdraw from interpersonal contact due to stress overload. In FOMO, the stress comes from the anxiety provoked in recipients of instant messages by the awareness that others are socially involved at that very minute, while they are supposedly missing out on something fun and interesting. In other words, being at home, at work, or otherwise “not there,” not doing the things others are doing and that are being portrayed in the photo or video or described in the message, is sufficient to produce anxiety, which perhaps could be referred to as non-social in nature.

texting-while-drivingFOMO is a close cognate of that other need to be connected at all times, for which there may already be an acronym of which I am not aware, yet. Being “out of touch” means not having 24×7 access to email, IM, social media—and that’s simply too horrible to contemplate. Voice calls are becoming an endangered species, as people seem to prefer, in increasingly greater numbers, to text or post. The stress of not having access, no rhyme intended, can be fiercely acute. Its excesses bear on the ridiculous, and increasingly more often, on the tragic—as in the train operator in the San Fernando Valley who wrecked his passenger train while texting to his friends. For the growing number of car accidents caused by this technological distraction there is already an acronym, TWD or texting while driving.

Appraisal: The WYSIWYG of Stress

LindauHarbor_EN-US1129072404From the cave to the modern city, survival has depended on the ability to quickly and reliably distinguish between harmless and dangerous situations. Today, distinctions are often subtle, complex, and abstract. The ability to make these distinctions has been made possible by the evolution of the prefrontal areas of our brain, which are capable of symbolic representation and can derive new knowledge about the self, world and the future through experience. This complex process of evaluation and distinction is called cognitive appraisal.

The cognitive appraisal of possible harm or loss, threat, and challenge is intimately implicated in the stress reaction. In recognizing harm or loss, we assess that some measure of physical or psychological damage has already occurred, e.g., an injury or an illness, some damage to our well-being or self-esteem, or the loss of a loved or valued person. In evaluating a threat, we assess damage or loss that has not yet occurred but that is anticipated, or perceived as likely to occur. Harm or loss that has already occurred is always suffused with threat because every serious injury or significant loss is also full of negative implications for the future. Challenges are often perceived as threats as every challenge, either psychological or physical, calls for the mobilization of our coping resources.

Stressed_WomanThus, in this process of appraisal, we come up with an assessment of the seriousness of the situation that is before us. What we see or do not see determines the level of physiopsychological arousal and how we will respond. The idea that our emotional and behavioral response to a stressor is determined by the meaning we attribute to an event or situation has a long tradition in Western thought. The Roman philosopher Epictetus famously stated, "Men are disturbed not by things, but by the views which they take of things.” A few centuries later, the same idea was expressed by William Shakespeare in Hamlet, "There is nothing either good or bad, but thinking makes it so" (Act II, Scene 2, line 259).

The immediate outcome of appraisal, whether of a threat or a challenge, is the notion that something must be done to manage the situation, because it is serious enough to warrant our attention. This first level of assessment is often referred to as primary appraisal. Subsequently, and often almost without pause, our task becomes that of evaluating what might and can be done, a second level of processing that we call secondary appraisal. While neither is more important than the other, secondary appraisal activity is crucial in the choice we make between fight or flight, i.e., between approach and avoidance. The WYSIWYG of appraisal is that, in most cases, what we see in the situation is how we choose to respond to it. Whereas some will see in a particular event nothing but a nuisance, others will see the same event as a dangerous threat.

Primary Appraisal: How Serious Is the Stressor?

What determines the quality of our primary assessment of a situation or event are its novelty, its predictability, and event uncertainty. Also important are time factors, such as the imminence, the duration, and the temporal uncertainty of the stressor. Additionally, primary appraisal is affected by the ambiguity of the stressor and by the timing of stressful events in our life cycle.

Generally, the more imminent a stressful event, the more urgent and intense our process of primary appraisal will be, as for example in deciding whether or not to step out of the path of an oncoming truck. The less imminent an event, the appraisal process becomes more deliberate and thus more complex, as in deciding whether to take a new job. Ambiguity is unfortunately a salient characteristic of many of today’s stressors. Greater ambiguity signifies that more factors can shape the meaning of the situation, and vice versa.

The timing of stressful events as they happen throughout our life cycle can also affect the quality of our appraisal. Many life events, such as the death of a child, are more significant and turn into crises because they occur "off time." Off time events are more threatening because they are often completely unexpected and therefore pose a challenge for which no preparation or anticipatory coping was possible.

Secondary Appraisal: Can I Handle It?

BearAttackOur individual assessment of a situation leads to an appraisal of our possible responses. When our vital interests appear to be at stake, secondary appraisal takes front and center and we can become literally and figuratively frozen in place, as we feel the enormous pressure of producing the right response.

Individual temperament, upbringing, personality, life experiences, and prior traumas play a leading role in determining the quality of our secondary appraisal.

A stress-prone individual is primed to make extreme, one-sided, absolute, and global judgments. Because the appraisals tend to be extreme and one-sided, the behavioral responses also tend to be extreme. A hostility-prone individual may be primed to react to a relatively minor slight by another as if it were a criminal offense and, consequently, will be inclined to attack the other verbally or physically. A person who is susceptible to fear reactions may interpret an unfamiliar noise as a gunshot or the start of an earthquake and will have an unstoppable urge to escape. A depression-prone individual may hear an otherwise humorous comment as a rejection and will want to withdraw.

In the primitive world of an instinctual stress reaction, the complexity, variability, and diversity of human experiences are lost and quickly reduced to a few crude categories. It is do or die, eat or be eaten, a survival of the quickest and strongest. In a more mature world of cognition, stimuli are analyzed along many dimensions or qualities, appraisals are quantitative rather than categorical, and are relativistic rather than absolutistic. When it comes to stressors, what you see can be just exactly what you get.

Angry? Aggressive? All You Need Is a Prayer

Pisa%20-%20Piazza%20dei%20Miracoli%20-%202Pray for Those Who Mistreat You: Effects of Prayer on Anger and Aggression is the descriptive title of a study published a few days ago in the peer-reviewed journal, Personality and Social Psychology Bulletin. According to its authors, Dr. Ryan H. Bremner of the University of Michigan, Ann Arbor, Michigan, Dr. Sander L. Koole of VU University, Amsterdam, The Netherlands, and Dr. Brad J. Bushman of Ohio State University at Columbus, prayer has a surprisingly strong and near instantaneous effect in reducing anger and aggression.

The study consisted of three experiments, which tested the hypothesis that the act of intentionally praying for others can significantly reduce anger and aggression after a provocation. In the first experiment, provoked participants who prayed for a stranger reported feeling their anger subside, whereas other participants who just focused their thoughts on a stranger did not report any lessening of their anger.

People often turn to prayer when they’re feeling negative emotions, including anger. We found that prayer really can help people cope with their anger, probably by helping them change how they view the events that angered them and helping them take it less personally.—Brad Bushman, Ohio State University.

In the second experiment, provoked participants who prayed for the individual who had angered them were less aggressive toward that person than were participants who just thought about the person who had angered them. In the third experiment, provoked participants who prayed for a friend in need reported acting less aggressively and feeling less anger than did people who simply thought about a friend in need.

These results are consistent with recent evolutionary theories, which suggest that religious practices can promote cooperation among unrelated people or in situations in which reciprocity would be highly unlikely. Also consistent with these findings are those previously published on Stresshacker about the connection between faith and stress, and that between longevity and spirituality.

Stuck On Wide Open: Emotional Dysregulation

domesticviolenceEmotional regulation is perhaps the most dramatically visible and the prototypical feature of an individual’s personality. Many people appear to be mostly in command of their emotions at critical moments, while others appear to be particularly (and sometimes explosively) reactive to environmental and interpersonal challenges. In general, affective or emotional instability, inordinate bursts of anger, intense efforts to avoid real or perceived abandonment, and unstable interpersonal relationships point to an underlying attribute of emotional dysregulation. This set of features has been popularized as belonging to “drama queens,” or persons who tend to react to every situation in an overdramatic or exaggerated manner.

Sometimes, instances of emotional dysregulation in children (“acting out” behaviors) or in adults under the most severe stressors can be viewed as the only available response in circumstances in which overwhelmingly strong emotion must be expressed, such as in the context of an emotionally abusive family environment or in times of great personal upheaval.

DramaQueen1A large body of research suggests that alcohol use can increase underlying emotional disturbance and disrupt cognitive functions that are very important in emotional self-regulation. Support for this hypothesis comes from studies that find associations between alcohol use and short- and long-term emotional change. In the short term, alcohol can disrupt emotional stability by effectively removing barriers against violence, verbal abuse, and inappropriate behaviors. In the long term, alcohol dependence and addiction can create a false persona in which it becomes difficult if not impossible to distinguish between the individual’s genuine personality traits and those modified or instigated by alcohol use.

Emotional disorders, particularly when they are characterized by pervasive emotional dysregulation, are often characterized by high negative emotionality and low positive emotionality. A significant challenge in trying to downregulate negative emotions is to become less vulnerable to negative or distressing emotions, with the objective of increasing calmness and resilience in stressful situations.

To achieve better emotional regulation, biological change and contextual change are needed. Biological change is achieved by reducing individual reactivity to emotional stimuli. Even when this reactivity may be due to genetic dispositions (temperament) and early developmental experiences (nurture), most people can learn ways to better control their emotional expression. There is a combination of skills and interventions that is particularly helpful in promoting biological homeostasis and emotional stability. These include treating any underlying physical illness that may have a negative effect on mood, balancing nutrition and eating to replenish and maintain physical resources, staying off non-prescribed mood-altering substances, getting sufficient but not excessive sleep, and getting adequate physical exercise.

Contextual change refers to learning and practicing emotional resiliency, which is the ability to minimize negative effects of stressful events and situations, and to maximize the positive effects of positive outcomes and opportunities. The skill of resiliency is learned and reinforced by intentionally accumulating positive life events, i.e., making a conscious and deliberate catalog of what’s positive in one’s life and referring to it often until it is present and readily available in time of need. It also consists of developing practical skills that build a sense of generalized mastery and promote self-esteem, e.g., completing school, obtaining additional job training, taking an assertiveness course, and the like.

What Causes (And Cures) Emotional Dysregulation

The amygdala has been implicated in emotional dysregulation, aggressive behavior, and psychiatric illnesses such as depression. Anxiety disorders and dysregulation may be the result of too much activity in the amygdala and not enough activity in the prefrontal cortex (PFC), which is the executive center of the brain that sets boundaries of behavior and responds to criteria of calm, assertiveness, and emotional regulation.

BDNFStress, coupled with a genetic vulnerability, decreases the production of brain-derived neurotrophic factor (BDNF). BDNF is a protein that acts on the nervous system by helping the survival of existing neurons and promoting the growth and differentiation of new neurons and synapses. A reduction in BDNF production causes a thinning of neuronal structures, which can results in emotional disturbance. These structural changes make the prefrontal limbic governing system vulnerable to disruption and dysregulation. Thus, emotional stress, loss, or  other significant psychological factors cause the system to lose self-regulation.

Treatments such as antidepressant medications, lithium, electroconvulsive therapy, exercise, psychotherapy and good social support can reverse this process, increase the production of BDNF, renew neuronal growth, build more resilient self-regulating circuits, and return the individual to a healthy mood.

Disorders of Emotional Dysregulation

PTSD, or posttraumatic stress disorder, is characterized by very significant emotional dysregulation. Its sufferers experience unwarranted arousal—often caused by stimuli processed Depressed-Soldier-02outside of conscious awareness—and exhibit an exaggerated startle response, vivid intrusive thoughts, and flashbacks and nightmares related to past traumatic events. PTSD victims may frantically try to avoid physical or psychological reminders of their trauma, and may experience dissociative symptoms or emotional numbing. PTSD is a disorder of emotional dysregulation characterized by excessive fear, triggered by a severe and often life-threatening traumatic event.

Borderline personality disorder (BPD) is characterized by emotional dysregulation, the temporary but frequent inability to change or regulate emotional cues, experiences, actions, verbal responses, and nonverbal expressions. Individuals with BPD experience greater emotional sensitivity, greater emotional reactivity, and slower return to normal levels of arousal after intense stimulation.

Frontal lobe disorders, which have become rather common among combat survivors, are the product of traumatic brain injury and are characterized by emotional dysregulation, attention deficit, impulsivity, lack of inhibition,  poor insight, impaired judgment, and low motivation. These frontal-subcortical disorders can result not only from war zone trauma, but also from infection, cancer, stroke, and neurodegenerative disease. Explosive violence, often directed at family members, is a common occurrence, particularly in individuals in whom impulsivity, disinhibition, and emotional dysregulation are the most dominant features.

Finally, obsessive-compulsive disorder (OCD) is characterized by emotional as well as cognitive dysregulation, brought on by a disruption of both the “thinking” prefrontal and the “feeling” paralimbic networks.

In these and other disorders that feature emotional dysregulation, it is interesting to note that the anatomic structures that are affected have emotional as well as cognitive functions. This coincidence highlights once again the close interdependence of affective and cognitive operations in the human brain. We can’t feel deeply without thinking intensely, and vice versa.

Ultimate Stressors: A Complete Upheaval

minamisanrikuThe unexpected convergence of catastrophic events that generated widespread damage, loss and destruction in Japan readily meets the dictionary’s definition of disaster. The common characteristics underlying natural disasters such as earthquakes, tsunamis, hurricanes, and man-made ones such as terrorist attacks or nuclear accidents are the virtually total lack of anticipation, limited preventive planning and, subsequently, the drama of human vulnerability.

A few typical phases of disaster are readily discernible, regardless of the type of disaster or its location: an initial impact characterized by shock, fear, and anxiety; an heroic phase, characterized by survivors reaching out in concerted effort to prevent further loss of life and property; a honeymoon phase, within 2 weeks to 2 months after the disaster, when survivors are buoyed up by an outpouring of support, services and supplies. Later, a disillusionment phase may follow, when hopeful expectations give way to resentment as promises of substantial help are broken or snarled by red tape. Finally, a reconstruction phase, which may last several years, characterized by the affected communities’ efforts to rebuild and by individuals coming to grips with their personal losses.

japan-nuclear-reactor-meltdownThe goal of stress reduction and trauma management programs is to help survivors achieve their pre-disaster level of functioning. The majority of individuals exposed to a mass disaster will experience acute stress that may be short-lived and does not develop into a clinically diagnosable disorder, especially if rescue is rapid and effective (as in the recent case of the trapped Chilean miners) and reconstruction or restoration can happen in a relatively short time. However, a substantial portion of individuals exposed to traumatic events will experience clinically significant stress and subsequent mental health problems. These include Acute Stress Disorder, Posttraumatic Stress Disorder (PTSD), depression, chemical abuse and dependence, and anxiety disorders. In the Japanese situation, the rebuilding of families, homes and businesses may turn out to be painfully slow due to the obliteration of entire communities by the tsunami, which increases the likelihood of significant mental health consequences. On the other hand, the Banda Aceh, Indonesia experience shows that even after a near-total erasure of structures by the tsunami of 2004, a community will begin to come back to life—albeit after many years of continuous and painstaking reconstruction.

bandaAcehSome of the most frequently observed behaviors that occur following a disaster include intrusive reactions (efforts to process traumatic events), avoidance reactions (efforts to minimize distressing memories), and physical arousal reactions (efforts to keep the body prepared to survive additional threats). Intrusive reactions occur through recurring dreams about the event, persistent thoughts and images, and the experience of a continued sense of fear and danger. Avoidance reactions manifest as the survivor’s reluctance and resistance to discuss the event, to think about the event, or to revisit any reminders associated with the event. Physical arousal reactions include increased anxiety, hypervigilance, psychomotor agitation, difficulty sleeping, and concentration problems. All these post trauma reactions following a disaster of large magnitude should not be considered abnormal or necessarily indicative of mental health problems or of the need for continued treatment.

katrina_goes12In the best cases, first aid psychological support during major disasters takes place immediately after the event and may last up to one week. In the first critical days, rescuers engage survivors in conversations to determine whether they may be at greater risk for ongoing problems. An effort may also be made to identify survivors that are more likely to be at risk for further mental health problems, such as individuals with pre-existing personality and psychiatric disorders, those who exhibit the severest symptoms, those who lack social support, those who have a history of interpersonal difficulties, and those who have been previously exposed to trauma. Psychological first aid consists of a set of procedures that facilitate a survivor’s adaptive coping, and is based on the premise that safety, calm, self-efficacy, connectedness and hope must be promoted. In the initial, critical phase it is vital to provide survivors with human contact and engagement, physical and emotional safety and comfort, environmental stabilization, information, practical assistance, connections with social supports, information on available help, and linkage with collaborative services.

9-11In the second phase, after the first week and up to one month after the disaster, the primary goal of psychological aid is to promote anxiety management, further reduce stress, and begin the process of restoring normal functioning. This is accomplished through the development of targeted services such as psychoeducation, psychotherapy, skills enhancement, cognitive restructuring, and relaxation training. Care givers also remain alert to any signs of the development of mental health issues, such as derealization (a belief that the world has become strange or unreal), depersonalization (an unnatural feeling of detachment from one’s body), and flashbacks. In the final phase of recovery, taking place within 1 month and 3 months after the event, psychological care is provided to those in need—often for years afterwards.

The convergence of multiple disasters onto a finite geographic region at the expenses of the a limited number of individuals may appear as capable of affecting a specific locale only. In reality, as Chernobyl, Katrina, 9/11 and Banda Aceh have demonstrated, the repercussions quickly have a planetary impact. Stress is no longer a local phenomenon.

Japan-QuakeThanks to instantaneous communication and the transmission of color images via multiple media channels, the experience is quickly shared by the entire planet. This also means that stress is radiated from the epicenter of the disaster outward to all who view and hear it, thus creating intrusive, avoidance, and arousal reactions on a global scale. Moreover, the economic and political consequences of disaster are immediately felt by the financial markets, at the fuel pump, and even in the supermarket aisle.

The world of stress has never been so small.

Worst Stress Relievers: Alcohol

aaManet_1882_BarFoliesBergeresMany people, including clinicians, researchers, and social and problem drinkers believe that drinking alcohol is somewhat effective as a temporary stress reliever. The relaxing effect of alcohol on the central nervous system, its disinhibiting and empowering effects on social impulses, and its perceived beneficial action on physical and emotional pain are often suggested as reasons why people begin and maintain their drinking, despite its abuse potential, side effects, and medium- to long-term ill effects on health. Conger (1951) proposed the Tension Reduction Hypothesis, which posits that alcohol can reduce tension and that people learn to drink alcohol to avoid or reduce unpleasant stress. Clinical observations and studies appear to support this theory.

Individual differences in the effects of alcohol on stress

Individual differences in stress-reducing effects of alcohol vary greatly. Where one individual may feel immediate relaxation from a relatively small amount of alcohol, others find that the initial effect of drinking actually increases their level of arousal. Gender, personality traits, drinking history, and a family history of alcoholism are factors that play a role in these very different responses. Individuals whose personality is characterized by sensation seeking or impulsivity traits are at increased risk for developing alcohol-related problems. Some researchers have suggested alcohol produces enhanced anxiolytic effects on these personalities, and thus increases the reinforcement value of drinking. Although no uniformity of results has been shown in these studies, they offer at least some support for this hypothesis.

From the mid-1960s through the mid-1970s, several experimental studies analyzed the effects of alcohol on stress among alcoholic participants. Although these studies were impressive for their intensive monitoring of participants over extended periods of time, the reliability of the results was limited by the small number of participants. The most reliable and valid studies confirmed an association between alcohol consumption and improved emotional states, e.g., reduction of stress levels, among these alcoholic participants.

Situational factors in stress reduction by alcohol

Situational or transient circumstances may modulate the effects of alcohol on stress. Alcohol appears to reduce stress more frequently when consumed while experiencing a pleasant, distracting activity such as a party or watching television, less so if consumed without distraction. 
There also appears to be a temporal relationship between drinking and the experience of a stressor. Alcohol consumed after a stressor has occurred, e.g., upon returning home after a stressful day, appears to be less effective in reducing stress. On the other hand, if alcohol is consumed prior to experiencing the stressor, e.g., drinking just prior to attending a party, its relaxing effects appear to be more prominent.

Cognitive stress-reducing effects of alcohol

Other hypotheses attribute the anxiety and stress-reducing effect of alcohol to its pharmacological effects on information processing. One theory views alcohol as an agent that narrows an individual’s perception of immediate stress cues and reduces cognitive abstracting capacity. This mechanism of action has the result of restricting attention to the most proximal and immediate aspects of experience. In other words, alcohol reduces the range of awareness (and thus of anxiety and worry) to such an extent that the perception of stressors is greatly reduced.

How might alcohol reduce stress?

Alcohol affects the autonomic nervous system as well as the neuroendocrine system, in particular the hypothalamic-pituitary-adrenal (HPA) pathway that is responsible for the mobilization of the organism during the stress reaction. The HPA axis is also instrumental in regulating immune protection by stimulating the production of cytokines that control inflammatory process and fight infection by pathogens.

The multifarious avenues of  communication among the neuroendocrine, immune, and nervous systems are so complex and ramified that alcohol impacts all systems, in both feed-forward and feedback directions. Alcohol is one of the few substances that readily crosses the blood-brain barrier, which permits it to have direct access to brain cells—with significant deleterious effects. Alcohol increases the resting heart rate, but it can also produce a paradoxical decrease in blood pressure in both humans and animals, much like stress, whose impact on heart rate and blood pressure is inconsistent.

The bottom line on stress reduction and alcohol

A relationship between alcohol and the physiological arousal of stress is undeniable, although the nature of this association is complex, controversial and far less than positive. The most reliable research has shown that the effects of alcohol on stress vary greatly depending on the psychophysiological characteristics of the individuals studied, their environment, the alcohol dose, the nature of the stressor, and the timing of the intake of alcohol and the stressful experience. Thus, while we can say that stress, alcohol, and alcohol addiction can form an interrelated complex, the nature of this relationship cannot be construed as ultimately beneficial. The relative ease and frequency of addiction to alcohol, the ineffectiveness of many strategies for prevention and treatment of alcohol abuse, and the variable benefits of alcohol as a relaxant pose a significant challenge to the widespread idea that alcohol may be an effective stress reliever.

Sigmund Freud: What a Funny Guy!

freud-of-the-pampas_357025Sigmund Freud lived and worked in the Austrian capital, Vienna until the Nazi Anschluss of 1938 placed him and his family in great peril. Freud was allowed to leave Austria with his family through the intercession of his patients Princess Marie Bonaparte and William Bullitt, and diplomatic pressure by the United States. One condition imposed by the Germans for his safe conduit was that Freud state that he had been treated with due respect. In response, Freud is reported to have declared, ‘‘I can heartily recommend the Gestapo to anyone.”

Freud viewed humor as an outlet for discharging psychic energy and reducing the emotional impact of negative events. He regarded humor as one of the most adaptive defense mechanisms.

The essence of humor is that one spares oneself the affects to which the situation would naturally give rise and overrides with a jest the possibility of such an emotional display. Freud, S. (1916)

In his groundbreaking study of humor, Jokes and Their Relation to the Unconscious, Freud hypothesized that jokes and dreams serve to satisfy our unconscious desires. Jokes provide their unique pleasure by allowing a temporary release of inhibitions and permitting the safe expression of sexual, aggressive, playful, or cynical instincts that would otherwise remain hidden and inexpressible. Laughter is the release of defensive tension that has been aroused by the circumstances that precede it. Tension can be elicited by behaviors, feelings or thoughts associated with anger and sexuality—in situations where their expression would be inappropriate. When ego defenses that inhibit their expression become unnecessary, as when the joke’s punch line is revealed, the energy that would be normally suppressed can be released in laughter.

There are two ways in which the process at work in humor may take place. Either one person may himself adopt a humorous attitude, while a second person acts as spectator, and derives enjoyment from the attitude of the first; or there may be two people concerned, one of whom does not himself take any active share in producing the humorous effect, but is regarded by the other in a humorous light. To take a very crude example: when the criminal who is being led to the gallows on a Monday observes, ‘Well, this is a good beginning to the week’, he himself is creating the humor; the process works itself out in relation to himself and evidently it affords him a certain satisfaction. Freud, S. (1928)

Freud also wrote “Humor” (1928), a brief paper in which humor is distinguished from wit and comicality, whereby humor represents an internalized form of forgiveness that changes one’s perspective and provides some relief from emotions associated with disappointments and failures. Likewise, humor permits the reinterpretation of failures as being of lesser importance or seriousness than initially believed, thereby transforming such failures, said Freud, into “mere child’s play.”

Stress and the Female Brain Advantage

drlouannbrizendineIn 1994, Louann Brizendine, a neuropsychiatrist at the University of California, established the Women’s Mood and Hormone Clinic in San Francisco—one of very few such institutions in the world—and focused her attention on the etiology and functioning of the female nervous system.

In 2007, she published The Female Brain as the culmination of her 20 years of research and a compendium of the latest findings from a range of disciplines. It is a fascinating and, in some ways, startling revelation of the most noteworthy particularities that characterize the human female brain.

Size Does Matter… and So Does Density

Women and men have very nearly the same number of brain cells, even though the female brain is about 9% smaller than men’s. This fact had been known for some time and had been, more or less jokingly, interpreted as meaning that women were not as smart. Dr. Brizendine reveals a much simpler explanation: women’s brain cells are more tightly packed into the skull.

To further dispel any notion of masculine brain superiority, she says, women have 11% more language and hearing neurons than men and a larger hippocampus, the area of the brain that is most closely associated with memory. Much more developed in female brains than male’s is also the circuitry for observing emotion on other people’s faces. Dr. Brizendine concludes that, when it comes to speech, emotional intelligence, and the ability to store richer and more detailed memories, women appear to possess a richer brain endowment and thus a natural advantage.

The amygdala in males, on the other hand, has far more processors than in females, which could explain men’s greater intensity in perceiving danger and their higher proneness to aggression. The male body is much quicker to mobilize to anger and take violent action in reaction to an immediate physical danger.

Are women not as capable of reacting to danger? Dr. Brizendine says that a woman’s brain is as capable to perceive danger or deal with life-threatening situations, but that it mobilizes the body’s resources in quite a different way. The female brain appears to be wired to perceive greater stress over the same event than a man’s. This greater arousal and more forceful stress reaction appears to be a natural way to ensure adequate protection against all possible risks to her children or family unit. Brizendine suggests that this ancestral reason may account for the way a modern woman may view unpaid bills as catastrophic and naturally perceive them more intensely threating to the family’s very survival.

[amtap book:isbn=0767920104]

MRI scans have pushed knowledge much higher by allowing the observation of the workings of the brain in real time. The brain lights up in different places depending on whether it is stimulated by love, looking at faces, solving a problem, speaking, or experiencing anxiety. What lights up, where and when, is different between men’s and women’s brains. Women use different parts of the brain and different circuits to accomplish the same tasks, including solving problems, processing language, and generally experiencing the world.

This is a fascinating book for the scientist and the novice alike, well worth reading. It is the Stresshacker Recommended selection for this month.

The History of Stress In Very Small Bites: 6

HansSelyeBy far the most important figure in the history of the concept of stress as applied to human behavior is Hans H. B. Selye (1907-1982), who is credited with starting modern research into the concept itself and its physiopsychological manifestations. In 1950, in addressing the American Psychological Association convention, Selye introduced his theory of stress reaction, which has since become the standard model of stress. In 1956, he published The Stress of Life, in which he elaborated his stress theory and perfected its definition of physiopsychological stress as “the nonspecific response of the body to any demand made upon it,” which could be a real or perceived threat, challenge, danger or change that requires the body and the mind to adapt.

Selye’s research made important contributions to psychology, biology and medicine. He had begun his work in 1926 when, as a second year medical student, Selye noticed many similarities among patients who, in spite of suffering from very disparate diseases, all seemed to have many symptoms in common. He would later describe this constellation of common symptoms as a syndrome, ‘‘the syndrome of just being sick.” 

His discovery of the stress response was a byproduct of his research on the effect of hormone injections in rats. Noticing that many of the rats became sick after receiving the injections and that the same sickness struck a control group of rats injected only with a neutral solution containing no hormones, he had the intuition that the rats could be having a reaction to the trauma of being injected rather than to the hormones. Selye surmised that being handled and injected caused high levels of sympathetic nervous system arousal in the rats, which eventually developed health problems such as ulcers. Selye coined the term "stressor" to label the traumatic stimulus that acted psychologically on the mind while at the same time producing a physical effect.

In refining his theory of the stress reaction, which he dubbed the General Adaptation Syndrome, Selye identified three distinct stages. The alarm reaction is the first stage, which occurs when the organism first becomes aware of the stressor. In the second stage of recovery or resistance, the organism mounts a response to the stressor, by mobilizing resources, using energy and repairing itself. The third stage of exhaustion occurs if the organism is unable to put an end to the stressor. This third stage also signals the onset of chronic stress.

With remarkable insight, Selye sliced the concept of stress into four variants. These he called eustress (the good stress caused by positive and exciting stressors), distress (the harmful stress caused by unpleasant or negative stressors), hyperstress (caused by stressors so overwhelming that they overcome all abilities of the body to adapt), and hypostress (the mildest stressors that barely cause a physical and psychological reaction, while still being noticeable).

The History of Stress In Very Small Bites: 4

robert-hooke-1It was towards the end of the 17th century that the word stress came to assume a technical meaning through the writing of English natural philosopher, architect and universal genius Robert Hooke. Hooke’s work was, among his many areas of interest, focused on how bridges and other man-made structures could be made larger and capable of bearing heavy loads without collapsing.

It is thanks to Hooke’s law of elasticity (1675) that the words load (the demand placed on the structure), stress (the area affected by the demand), and strain (the change in form that results from the interaction between load and stress) came into usage.

The study of stresses and tension (another word generated within this context) eventually produced the idea that the workings and architecture of the human body were much like the machines and structures that were being invented and constructed during this time. This idea spawned another idea that profoundly influenced the way we think about stress. The idea followed the concept of the body as a machine to its logical conclusion: If mechanical structures are subject to wear and tear, and the body is built and behaves in a similar fashion, then so would the body suffer the impact of the wear and tear of life.

Humor: The All-Natural Remedy Against Stress

GinettoA stress reaction to challenging people and situations may be expressed by anger, hostility, aggression or seething inward rage. These instinctive reactions have their obvious drawbacks, but are altogether too common. There are other, more adaptive and sublimated responses (see this post for a complete list) that can turn angry reactions into assertiveness, the ability to effectively stand up for one’s rights, to engage in a respectful and yet passionate discussion of opposing points of view, an energy-releasing all-out workout at the gym, or humor. There is an abundance of evidence that proves the therapeutic value of humor. When used appropriately, this 100% natural remedy against stress is an adaptive, cathartic release of tension, a safe outlet for hostility and anger, and an effective defense against depression. Moreover, humor not only indicates emotional intelligence but also causes healthy neurological, immunological and physical changes. The mere act of laughter immediately increases muscular and respiratory activity, elevates the heart rate and stimulates the production of anti-stress hormones.

What Psychologists Say About Humor

American psychologist and psychotherapist Gordon Allport, in his research The Nature of Prejudice reported that 94% of people he questioned said their sense of humor was either average or above average. Allport stated that “the neurotic who learns to laugh at himself may be on the way to self-management, perhaps to cure” (p. 280).

American existential psychologist and author Rollo May, in Existence, suggested that humor has the function of “preserving the sense of self. . . It is the healthy way of feeling a ‘distance’ between one’s self and the problem, a way of standing off and looking at one’s problem with perspective” (p. 54).

mans-search-for-meaning-viktor-franklAustrian neurologist, psychiatrist and Holocaust survivor Viktor Frankl, in his best-selling autobiographical Man’s Search for Meaning, shared as his learned experience that, “to detach oneself from even the worst conditions is a uniquely human capability.” He specified that this distancing of oneself from aversive situations derives “not only through heroism . . . but also through humor” (p. 16–17).

American physician and psychologist Raymond Moody (Glimpses of Eternity and Life After Loss: Conquering Grief and Finding Hope), noted for his well-researched studies on grief, loss and the possibility of an after-life, also pointed to the ability to detach oneself as intrinsic to humor: “A person with a ‘good sense of humor’ is one who can see himself and others in the world in a somewhat distant and detached way. He views life from an altered perspective in which he can laugh at, yet remain in contact with and emotionally involved with people and events in a positive way” (p. 4).

What Is Humor?

Humor is expressed in many ways: verbally (a funny story, joke, stand-up routine), visually (a mime’s movements, funny faces and gestures) or behaviorally (slapstick, pie-in-the-face comedy). It can be triggered by a book, hours-long stage or film productions or by just a few words, as in this very short story,

A passenger carried his own bomb onto a plane. When questioned by the TSA, he said that it was for his own safety, because the odds of there being two bombs on the same plane are virtually nil.

What makes this story humorous? The stress-relieving fun of it lies in the entirely natural and universal human need to seek safety and reassurance, which is however expressed by integrating two contradictory beliefs, no matter how absurd the result. In fact, it is the absurdity or incongruity of the synthesis that is the essence of humor.

Humor is therefore a mental capacity, the skill of discovering, expressing, or appreciating the ludicrous or absurdly incongruous. Its effectiveness, i.e. the difference between funny and inappropriate, depends on the incongruity between what we expect to happen or to be said and what we perceive with our senses. Not all incongruity is humorous: in addition to being there, the incongruous must also be meaningful or appropriate, and must be at least partially resolved.

Humor and Human Development

BabyLaughingIn developmental psychology, humor is a form of play expressed by the manipulation of images, symbols, and ideas. Humor can be detected in infants of about 18 months of age who have acquired the ability to manipulate symbols and objects. Some believe that humor may be present in infants as young as four months old if humor is defined as the ability to perceive incongruities in a playful way and accept them without distress.

From a very early age, humor serves a number of social functions. Beginning in early adolescence and into young adulthood, humor can be an effective coping strategy, can reinforce interpersonal connections, or can be used to test the status of relationships.

One of the most important signs of a healthy self-esteem and maturity is the ability to laugh at one’s own shortcomings and mistakes. Most prominently in adulthood, humor is often used to express forbidden feelings or attitudes in a socially acceptable way, a device at least as old as the Renaissance fool or court jester who was, up to a point, allowed to speak of unpleasant truths and openly mock those in positions of authority.

Humor and Mental Health

Flirt_DepressionIt is a recognized fact in mental health practice that the presence of humor in a person’s narrative is a healthy way of reducing anxiety and indicates the ability of reasserting mastery over a situation. Conversely, one of the clear signs of depression is the inability to appreciate or use humor in any situation.

A judicious use of humor ushers in the opportunity to detach from the most painful aspects of a situation, albeit briefly, and exercise some control over its impact by laughing at the seemingly inescapable predicament. This dynamic, psychological attempt at regaining control by interjecting an element of incongruity is concretized in this popular German witticism about two contrasting points of view, “In Berlin, the situation is serious but not hopeless; in Vienna, the same situation is hopeless but not serious.”

{tab=Humor and Pain}
pain-signA 2005 study by Zweyer and Velker conducted at the Department of Psychology, Section on Personality and Assessment of the University of Zurich, 56 female participants were assigned randomly to three groups, each having a different task to pursue while watching a funny film: (1) get into a cheerful mood without smiling or laughing, (2) smile and laugh extensively, and (3) produce a humorous commentary to the film. Their pain tolerance was measured using a cold presser device before, immediately after, and 20 minutes after the film. Results indicated that pain tolerance increased for participants from before to after watching the funny film and remained high for the 20 minutes. Participants low in trait seriousness had an overall higher pain tolerance. Subjects with a high score in group 1 showed an increase in pain tolerance after producing humor while watching the film whereas subjects with a low score showed a similar increase after smiling and laughter during the film.

{tab=Humor and Immunity}

ilovebacteriaThe functions of the immune system that are essential for good health are known to be strongly affected by psychological experiences. Stressful events often result in immunosuppression, which leaves the body highly vulnerable to illnesses. Dillon, Minchoff, and Baker (1985) hypothesized that if stress and negative emotions can cause immunosuppression, it may also be true that humor, a positive emotional state, may be a potential enhancer of the immune system. In testing their hypothesis, they found that laughter induced by a humorous video caused a measurable and significant increase in concentrations of salivary immunoglobulin A (S-IgA), which is often described as the first line of defense against upper respiratory infection. Later research by Dillon and Totten (1989) replicated and expanded on these findings. Working with a group of mothers who were breastfeeding their infants, they found a strong relationships between humor and S-IgA.

Further connections between humor and immune system functioning were established by Lefcourt, Davidson, and Kueneman  in 1990, who found that the presentation of humorous material resulted in increased concentrations of S-IgA. When the humorous material was universally rated by participants as being highly funny (they used the video “Bill Cosby Live” for this research), S-IgA concentrations of most participants increased. However, when the humorous material produced variation in funniness ratings (when they used Mel Brooks and Carl Reiner’s “2000-Year-Old Man” video), larger increases were found only among some of the participants.

Changes in immune system activity with laughter are not restricted solely to immunoglobulin A concentrations. Berk et al., in their 1988 study, reported that mirthful laughter while watching a humorous film was associated with increased spontaneous lymphocyte blastogenesis (production of white cells) and increased natural killer cell activity.

Because immunosuppression appears to commonly occur in stressful circumstances when negative emotions are triggered, these findings would suggest that humor reduces negative emotions and/or increases positive emotions, with a corresponding beneficial effects on the functions of the immune system.

{tab=Humor and Stress}
climate-change-bears
In addition to interacting with immune system functioning, humor has also been found to influence physiological responses associated with stress. In a landmark study, Berk et al. (1989) examined the effects of humor on neuroendocrine hormones that are involved in classical stress responses. The study participants were asked to watch a 60-minute humorous video during which blood samples were taken every 10 minutes. A control group of people who were not watching the funny video were asked to enjoy 60 minutes of “quiet time” during which they were exposed to neutral stimuli. Blood samples were tested for the presence of eight hormones which usually change during stressful experiences, such as corticotrophin (ACTH), cortisol, beta-endorphin, 3,4-dihydroxyphenylacetic acid (dopac, a metabolite of the neurotransmitter dopamine), epinephrine, norepinephrine, growth hormone, and prolactin. Five of the eight hormones were found to have measurably decreased among participants who watched the funny video, while they remained virtually unchanged in the control group.

The importance of humor in prolonged stress situations, and its effectiveness as a stress-reducer, can hardly be overemphasized. The ability to laugh, not only with others but also at oneself, is a vital skill of survival that promotes better adaptation to adversity. Former prisoners of war have claimed that single instances of a humorous circumstance made them feel better for weeks to months later. A remarkable example of how humor can serve as an emotion-focused coping response in highly stressful circumstances is the case of Brian Keenan, whose powerful book An Evil Cradling: The Five-Year Ordeal of a Hostage describes the way in which he and other hostages in Lebanon used humor to survive their incredible ordeals during five years of captivity.

{/tabs}

I’m Bored: Does This Mean I’m Stressed?

aaEscher_RelativityBoredom, like pain, is an entirely subjective experience mediated by personality, needs, wants, past history and contingent upon one’s perceptions of the experience, and thus very difficult to describe with precision and quantify. The state of boredom has been variously described as a dullness of the mind, mental inertia, sloth, or ennui. Its characteristic features are a lack of interest in the ordinary and a lack of delight in the extraordinary. The forcibly approximate label of boredom often changes into something more precise when it can be examined without prejudice. Often, there’s an unpleasant or stressful feeling lurking in the shadows just behind boredom. Individual perception and the subjective assessment of a situation play a significant role, as the following little parable illustrates.

Sometime ago, in the Middle Ages, a traveler approached a group of stonecutters and asked, ‘‘What are you doing?’’ The first responded, ‘‘I’m cutting stone. It’s dull work but it pays the bills.’’ The second stonecutter said, ‘‘I’m the best stonecutter in the land. Look at the smoothness of this stone, how perfect the edges are.’’ The third man pointed to a foundation several yards away and said, ‘‘I’m building a cathedral.’’

Boredom is perhaps most vividly experienced at work, although its impact is rather more ubiquitous. When a work task (be it that of the chief executive or the firefighter) does not provide the opportunity to sufficiently use or develop one’s skills and abilities, most individuals can feel undervalued and underutilized, and therefore bored.

Boredom, Stress and Aggression

In time, boredom may result in apathy and lead to poor morale, irritation, depression, job dissatisfaction, and absenteeism. In more sustained cases, the stress of frustrated ambition, unfulfilled goals, and unmet expectations can cause reactions that degenerate into destructive behaviors. Examples of destructive coping strategies against boredom include workplace vandalism, sabotage, alcohol and drug abuse, and binge-eating habits.

Perhaps the most important source of aggression and destructiveness today is to be found in the “bored” character. Boredom, in this sense, is not due to external circumstances such as the absence of any stimulation, as in the experiments in sensory deprivation or in an isolation cell in prison. It is a subjective factor within the person, the inability to respond to things and people around him with real interest. In some respects, the bored character resembles those in chronic, neurotic depressed states. There is a lack of appetite for life, a lack of any deep interest in anything or anybody, a feeling of powerlessness and resignation; personal relations–including erotic and sexual ones–are thin and flat, and there is little joy or contentment. Yet, in contrast to the depressed, chronically bored persons do not tend to torture themselves by feelings of guilt or sin, they are not centered around their own unhappiness and suffering, and their facial expressions are very different from those of depressed persons. They have little incentive to do anything, to plan, and at most can experience thrill but no joy. To use another concept, they are extremely alienated. For these reasons it seems preferable to establish the concept of the chronically bored character as distinct from the depressed character. Milder forms of characterological boredom are usually not conscious, as long as the boredom can be compensated for by ever-changing stimuli. This seems to be the case with a large number of people in industrial society for whom the compulsive consumption of cars, sex, travel, liquor or drugs has this compensatory function, provided that the stimuli either have a strong physiological effect, like liquor and drugs, or are constantly changing: new cars, new sexual partners, new places to travel to, etc. This consumption pattern keeps people from nervous–and industry from economic–breakdowns, and precisely for this reason they are addicted to consumption. — The Theory of Aggression, written by Eric Fromm to introduce his book The Anatomy of Human Destructiveness, first published in The New York Times Magazine, February 1972.

The Time Dimension of Boredom

lastminuteResearch studies on boredom have uncovered that easily bored individuals generally perceive time as passing very slowly, paradoxically, even when they are busy performing a task. It is not surprising to learn that institutionalized individuals, whose days are highly regulated and monotonous, say they experience time as painfully slow. Individuals suffering from depression often say in clinical interviews that they perceive a slowing of time. Cancer patients, who experience high levels of anxiety, have been found to routinely overestimate the duration of treatments and report that hours and days never seem to go by fast enough. In general terms, these studies highlight the distress felt in situations when individuals are not emotionally or cognitively engaged, which draws attention away from meaningful thoughts and actions and focuses it on the passage of time.

Is Ours the Age of Boredom?

It has been said that today’s pervasive boredom is a manifestation of cultural disenchantment. The great danger of boredom, as Fromm surmised, is that it can lead to pursuing irrational thrills in an attempt to relieve it. German philosopher Martin Heidegger, best known for his existential and phenomenological explorations of the concepts of being and time, sought to explain boredom not as a subjective intrapsychic experience whose possible causes might be a matter of interest to psychology, but as a mood in which time becomes the focus of attention. Heidegger distinguished between three forms of boredom: The first, being bored by something, is the most common and easiest to understand. In the second, becoming bored with something, it is not always easy to determine what it is that is boring. The third, when nothing in particular is boring per se, is a profound, unexplainable boredom with existence itself.

In profound boredom, utter anonymity of self, wholesale meaninglessness of world, and total unrelatedness are fused together to create an existential extreme.—Martin Heidegger

Boredom, Stress and Health

Chronic boredom, and the chronic stress it provokes, are associated with undesirable health outcomes. Boredom often complicates and sometimes compromises the course and treatment of physical and mental illnesses that require extended care in treatment facilities. A recent study by McWelling identified sustained boredom as a contributor to the onset of postpsychotic mood disturbances, increased risk-taking and substance seeking behaviors, the exacerbation of positive symptoms such as paranoia and hallucinations, changes in distractibility and overall cognitive efficiency, and a hypohedonic state of highly generalized lack of interest. Who said that boredom is not stressful?

The History of Stress in Very Small Bites: 2

descartesIn the 17th century, French philosopher Rene Descartes, without addressing the concept of stress reaction in his writings, nonetheless had a profound impact on psychology, the new scientific pursuit of many of his contemporaries who were beginning to understand the impact of psychological stress on human functioning.

Descartes’ thoughts also touched on the relationship between mind and body. In his view, mind and body were clearly separated, although he recognized that the body could somehow influence the mind, or vice versa. In particular, as Descartes put it, 

…as regards the soul and the body together, we have only the notion of their union, on which depends our notion of the soul’s power to move the body, and the body’s power to act on the soul and cause its sensations and passions (Descartes, R., Oeuvres de Descartes, 11 vols., eds. Charles Adam and Paul Tannery, Paris: Vrin, 1974-1989.)

georgebeardAn important contributor to the understanding of psychological stress was the noted American physician George Beard (1839–1883), a specialist in diseases of the nervous system. Beard hypothesized that the newly imposed demands of the Industrial Revolution on 19th century life may cause an overload of the nervous system.

He variously labeled this overload as neurasthenia, a weakness of the nervous system, or nervous exhaustion. This condition, very much equivalent to our modern understanding of chronic stress, was characterized by Beard has exhibiting symptoms of severe anxiety, unexplained fatigue, and irrational fears—a state of affairs that caused an inability of the individual’s nervous system to meet the demands of daily life.

Disaster! 9 Critical Crisis Management Skills

aaCezanne_BendOfRiverDisaster strikes…an event with sufficient impact to produce significant emotional reactions, and one that can carry significant consequences. In the range of our ordinary experience, such an event may be extremely unusual. Perhaps it is the first time that we have been in a car wreck, an earthquake, a flood, lost our job, missed the mortgage payment, or discovered a very unpleasant and unexpected truth about a person or a situation. The first time, any of these events constitute a serious crisis, with wide-ranging impact. The second or third time, these events continue to be real crises but may be approached with enhanced skills and capability to cope with their aftermath.

Whenever and however often these critical and extremely stressful events may occur, a few outcomes can be predicted as very likely to be experienced by most people. First, there will be potential and actual traumatic reactions to the event or incident, either immediate or somewhat delayed. Expecting no reaction or minimal reaction is unlikely, and a severely restricted reaction or no reaction at all may be a sign of poor cooping skills, an attempt to deny the impact of the stressor, or to minimize its seriousness. Second, there will be acute manifestations of stress (some purely psychological, other physical, or a combination of both) that must be managed and mitigated. Third, the stressful event may have an impact on the individual’s ability to function in his/her usual occupation, school, or even in carrying out daily routines. Fourth, the stressor may be of such magnitude and effect that short-term psychological or medical treatment may be necessary. Fifth, the best mitigating effects are produced by family support, peer group support and continued interaction in the workplace; isolating is an instinctive reaction when in emotional pain, but it is proven to be counterproductive when dealing with a severe stressor.

In critical incidents or severe stress situations, the first 24-72 hours after the event are the most crucial. It is important to provide to others or seek out for oneself a reduction in the intense reactions to the traumatic event. While it is normal and expected to have a stress reaction, even severe, people should be facilitated in their return to their routine as quickly as feasible. In this respect, re-establishing access to one’s social network prevents isolation and reduces anxiety. In recognizing similarities to others, being understood and supported while in pain, and not being judged or criticized for their reaction, people often are better able to cope with the challenges of troubled times.

Here are 9 ways of managing acute stressors that have been proven to work:

  1. Reaction. Allowing ourselves to have an appropriate reaction that is physical (e.g., crying), psychological (feeling upset), and social (reaching out for help), without much concern for how our grief or sorrow may “damage” our image with others. An attempt to look strong and to show no emotion in the face of a significant stressor may work in the short term, but if the reaction to its impact is not allowed to take place, this may create a situation of chronic stress over time.
  2. First Aid. Psychological “first aid,” education and follow-up are important. Talking to trained peers, chaplains, and/or mental health professionals may be just what is needed in the critical first few days following the incident. Longer term counseling or medical help may be needed to manage any anxiety or mood disorders (such as depression) that could be triggered by the stressor.
  3. Comfort. The basic human needs to be comforted and consoled when in distress and being protected from further threat or distress, as far as is possible, are important. This may mean moving away from the scene of the incident at least for a time. It is not unusual to need and benefit from a few days out of town visiting welcoming family members or very close friends, following a disastrous event or a major personal crisis.
  4. Basic Needs. Immediate care is needed to address any physical necessities caused by the severe incident. In the case of a natural disaster, shelter, food and warmth become critically important and take precedence over psychological interventions.
  5. Reality Testing. Seeking goal orientation and support for specific reality-based tasks (“reinforcing the concrete world”) is important in mitigating the effects of a severe stressor that may make the individual feel like “the world is coming to an end” or “this is too much to even comprehend” and any severe symptoms of derealization or detachment.
  6. Relationships. It is important to facilitate the reunion with loved ones from whom the individual has been separated. If this disruption of relationship occurs, reuniting parent and child, or spouses, or siblings, is critically important. If an immediate reunion is not possible, providing good information as to the loved ones’ whereabouts and health is the next best thing.
  7. Talking. At the earliest opportunity, the telling of the “trauma story” and the expression of feelings as appropriate for the particular individual should be facilitated. Even though not everyone may be willing to go into details as to what happened, at least not right away, providing the earliest opportunity to say what happened and what it means to the person affected is critically important.
  8. Ongoing Support. If the individual seems to be “lost” in the magnitude of the event, linking the person to systems of support and sources of help that will be ongoing is never a bad idea. The key is the continuity of support. For some incidents or severe stressors such as the loss of a loved one, this support may need to continue for weeks and months to come.
  9. Regaining Mastery. Eventually, after all the critical “first aid” interventions have been taken care of, the goal becomes the restoration of some sense of mastery, a regaining of control over one’s life, a new beginning and the ability to deal effectively with the new situation created by the incident. The memory of what happened will most certainly never go away, but its traumatic impact on distress and functioning is meant to fade over time, when new ways of coping have been successfully put in place.