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Stress and the Typical Male

typical-male Although all men are fully capable of experiencing the full range of human emotions and can face a variety of challenges, certain issues can occur more frequently in men than they do in women. Among the challenges that occur more frequently in men, the most common are self-medication through the use of alcohol or other substances, anger management, impulse control, and problems with emotional and sexual intimacy.

For many men, the healthy expression of stressful negative feelings can be a challenge. The typical male relies very heavily on a “logical or rational” approach to most emotional or psychological issues. Often from childhood, men have been accustomed to think that emotional vulnerability equals weakness and that it should be avoided as much as possible. Given this mindset, it is understandable that for many men it is objectively difficult to share with others how they are truly feeling. For some, it may even be difficult to read their own emotions correctly, to know for themselves how they are really feeling about certain issues. Issues arise that may require an adjustment of these beliefs and attitudes, as for example in the inability to connect, to open up in relationships, or in knowing how to be sensitive.

When this complex set of stress-inducing emotions are routinely avoided, repressed or denied, some problematic behaviors can result. Mismanaged emotions and feelings often produce addictions, compulsions, and avoidance. One of the most common ways of expressing hurt or emotional pain is anger; for other men, working longer hours helps them avoid relationship challenges; for others, superficial intimacy takes the place of genuine connection; other men resort to addictive substances and compulsive behaviors to “take the edge off” or avoid the full experience of negative feelings.

There are many counselors who specialize in working with men’s issues. The right counselor can help identify and work through avoidance, repression and denial in a way that appeals to men’s desire to approach issues in a logical, rational and goal-oriented way, while providing guidance toward learning about the values and benefits of emotional intelligence.

Type A and Hi-Tech: A Dangerous Mix

Tower of Babel by Bruegel at Stresshacker.comWhat does the relentless push of technology into our lives do to our ability to manage stress and to our health in general? It depends on the personality. For individuals who have a type A personality, multiple e-mail addresses available from any platform, high-speed anywhere Internet access, smart mobile phones, tablets, and e-readers have enabled even greater flexibility and mobility in teleworking and telecommuting. In effect, traditional boundaries between the different roles at work, in the family, at leisure have been blurred or even removed.

In addition to the advancing technology, economic conditions have made short-term employment, work on time-limited projects, and working two or even three part-time jobs simultaneously increasingly more common.

Type A individuals claim that this new rhythm of life has produced beneficial effects in terms of greater task variety and flexibility. Thanks to these ubiquitous and always-on hardware devices and the software tools they provide, there often is no break of continuity between work and non-work states, between being somewhere dedicated to work activities and being somewhere else, where relationships or relaxation are possible. Again, for the type A personality, this is just fine–at least in theory and by their own admission.

Type A Individuals Thrive…At Their Own Peril?

Type A personality is characterized by an extreme sense of time urgency, frequent impatience with one’s self and others, high competitiveness, and more frequent aggression and/or hostility (either in the form of overt outbursts, or constricted and internalized through tight behavioral control). Clinical evidence indicates that there is at least an increased risk of stress in these individuals due to their proneness to work overload, disruption of natural circadian patterns, role conflicts, lack of time for relationships, for sufficient rest and energy replenishment through sleep or relaxation activities.

This particular personality type, given the current availability of communication and connection devices, appears to thrive in this environment that promotes maximum efficiency, high productivity, a faster pace of work output, and competitiveness.

Is this a competitive advantage for individuals who happen to possess these personality traits, or is this a potential problem? Apparently, higher productivity and efficiency are desirable outcomes. From a business efficiency point of view, they most definitely are. This may explain why significant technological resources are being devoted by an increasing number of companies toward making this always-on-the-job state of affairs a reality for their employees. It is seen as a competitive advantage over other companies (which are fewer and fewer) that shut down at a reasonable hour and do not work on weekends.

Most type A individuals proclaim to “love” this uninterrupted access to the marketplace and the instantaneous availability that is demanded of them.

There are however potentially serious health consequences, unless the individual can set and maintain reasonable and appropriate boundaries.

Type A personality have long been known to be at risk in terms of elevated blood pressure, increased heart rate, higher blood lipids, and near-continuous catecholamine (stress hormone) output. Intensive, frequent, and sustained activation of these physiological stress responses can contribute to the atherosclerotic process and to blood clotting. This prolonged state of arousal can cause, with type A behavior, an elevated risk of myocardial infarction. A longitudinal study by Barefoot et al., found that medical students with high scores on the Cook-Medley hostility scale of the Minnesota Multiphasic Personality Inventory (MMPI)–which would indicate type A personalities– had a six fold increase in mortality when followed up 25 years later, mainly due to coronary heart disease.

The negative psychosocial and socioeconomic factors in which type A behavior appears to thrive is associated with increased risk of serious illness and mortality because of the elevated activity of the hypothalamic-pituitary-adrenocortical (HPA) system and the increased secretion of the stress hormone cortisol. A very high workload, such as regularly working more than 10 hours of overtime per week, is also associated with markedly elevated cortisol levels. Prolonged and sustained activity of the HPA system is related to a series of endocrine and metabolic effects, causing, among other things, increased storage of fat in the abdominal region.

It is a mixed blessing, to say the least, for type A personality to see modern technology facilitate and indeed augment their relentless rhythm of activity. Is the risk really worth the reward?

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.

Worst Stress Relievers: Pain Medication

painmeasurementscale Who is to say for sure how much pain I have right now, I had yesterday morning, or will have this afternoon?   Only I can know for sure the pain I am feeling—and I can lie, to myself and to others.  Herein lies the greatest challenge of addiction to pain medication. There is no objective measuring tool for pain. The best we can do is to ask the person to rate his or her own pain on a scale of 1 to 10, with all the accuracy that can be expected from such a subjective assessment, which isn’t very much because pain can always feel more intense than it actually is, physically or sometimes just psychologically.

The sad result of the greater availability of pain medication, its greater potency, the beneficial effects felt by the individual by taking what amounts to a legal hit of morphine is an ever increasing number of people who are dying from abusing or misusing pain medication.  Among some groups, deaths from prescription drug overdoses are more than ten times higher than they were in the late 1960s. These are the results of an age-period-cohort analysis using data from the US Vital Statistics and the US Census, available online.

In the absence of significant pain, prescription painkillers are ingested because of their very powerful relaxing effects on the central nervous system and for the sensations of well-being that characterize their action. The presence of hydrocodone, which is the equivalent of synthetic opium, in these drugs makes them highly addictive. The first signs of a painkiller overdose include loss of appetite, nausea, vomiting, stomach pain, sweating, and confusion or weakness. Later symptoms may include pain in the upper stomach, dark urine, and yellowing of the skin or the whites of the eyes. Overdose symptoms may also include extreme drowsiness, pinpoint pupils, cold and clammy skin, muscle weakness, fainting, weak pulse, slow heart rate, coma, blue lips, shallow breathing, or no breathing.

The rapid increase in mortality due to accidental poisoning that has been observed since 2000 is almost tenfold for whites and threefold for blacks over the study period. This appears to result at least in part from the coming of age of baby boomers who, as they age, are becoming addicted to prescription medications, most especially pain killers. The majority of prescription drug abuse involves painkillers, according to the Drug Enforcement Administration. In the US, Vicodin (containing acetaminophen and hydrocodone) is the most commonly abused prescription drug.

The greatest proportion of overdoses appears to occur in people in their 40s and 50s. While in 1968 about one per 100,000 white women in their early 50s died from accidental poisoning, the number has risen to 15 per 100,000 in 2007. Among black women of the same age, accidental poisoning deaths increased from about two per 100,000 to almost 17 per 100,000.

getty_rm_photo_of_woman_taking_prescription_pain_medication What’s the fix for this nationwide epidemic?  In the absence of an objective pain measure, it is hard to imagine how anyone can take exception to the screams of pain that can come from someone who is in the process of becoming addicted to pain medication, or already is.  Many doctors have taken the no-hassle course of prescribing, rather than questioning the veracity of the patient’s pain.  Many other medical practitioners, such as dentists and surgeons, have taken to dispensing large quantities of “samples” to patients who have had even the simplest procedure, “just in case you feel any pain.”  Of course, the patient takes the stuff, the pain (if any) goes away, and the powerful effects of the drug go to work by inducing a high that feels incredibly good. At this point, and in many sad cases, only a few short steps separate the patient from the addict.

More recently, the DEA has cracked down on pharmacies and doctors, with the intent of reducing the supply of these medications. More needs to be done to stop the flow, but also and most especially to educate the public on the potential addictive nature of these substances. They do work extremely well against pain, but at what cost?

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}

Why Hardiness Is Faster Than Competitiveness

aaBruegel_HuntersSnowDo you know someone who deals with stress by working harder and faster to produce more in a shorter time? These so-called type A personalities appear to have a stronger than average sense of urgency, can be more highly competitive, and may be frequently and more easily angered when things don’t go their way. Stress reduction and stress management is perhaps one of their most urgent needs, yet these individuals are perhaps the least likely to take the time to learn effective self-management techniques.

Unfortunately, as discussed in our recent post on the impact of stress on the heart, type A personalities suffer from a significantly higher rate of cardiovascular disease than type B personalities. The former may be more successful at getting things done faster. Type B’s may be slower and somewhat less effective, but they can play and relax without guilt, are much less hostile and unlikely to exhibit excessive competitiveness.

Hardiness Matters More Than Speed

The evidence for the difference in health outcomes between type A and type B originally came from groundbreaking research by S. C. Kobasa of the University of Chicago. Dr. Kobasa looked at personality as a conditioner of the effects of stressful life events on illness by studying two groups of middle- and upper-level 40- to 49-year-old executives. One group of 86 individuals suffered high stress without falling ill, whereas the other group of 75 individuals became sick after experiencing stressful life events.

The results of the study showed that, unlike the high stress/high illness executives, the type B group was characterized by more hardiness, a stronger commitment to self-care, an attitude of vigorousness toward the environment, a sense of meaningfulness, and an internal locus of control. These “slower-paced” individuals appear to view stressors as challenges and chances for new opportunities and personal growth rather than as threats. They report feeling in control of their life circumstances and perceive that they have the resources to make choices and influence events around them. They also have a sense of commitment to their homes, families, and work that makes it easier for them to be involved with other people and in other activities.

SH_Rcmds_smAccording to Herbert Benson and Eileen Steward, authors of Wellness Book: The Comprehensive Guide to Maintaining Health and Treating Stress-Related Illness, the incidence of illness is much lower in individuals who have these stress-hardy characteristics and who also have a good social support system, exercise regularly, and maintain a healthy diet.

[amtap book:isbn=0671797506]

This is a stress management book well worth reading, because it specifically targets hardiness and better stress management with type A personalities in mind. It is the Stresshacker Recommended selection for this month.

How To Deal With 6 Personalities Under Stress

Pisa%20-%20Piazza%20dei%20Miracoli%20-%202How does each personality style tend to handle a significant stressor? And, if we happen to be the spouse, significant other, sibling or friend of any of these, what is the best way to interact with them while they are under severe stress? To answer these questions, it is necessary to understand their most relevant characteristics, the most likely meaning of the stressor to each style, the most likely feelings or responses evoked among other people that interact with them, and tips on the management of this interaction.

The Dependent Personality Style

Relevant Characteristics Under Stress: May become needy, demanding, clingy. May be unable to reassure self and will seek reassurance from others.
Meaning Attributed to the Stressor: Threat of being abandoned and left all alone. 
Feelings Evoked: May make others feel powerful and needed. May also make them feel overwhelmed and annoyed.
Management Tips: Reassure within limits, mobilize other supports, reward personal efforts toward independence, avoid the temptation to withhold all help.

The Obsessive Personality Style

Relevant Characteristics Under Stress: Meticulous, orderly; likes to feel in control; very concerned with right/wrong approach.
Meaning Attributed to the Stressor: Dangerous loss of control over body, emotions, impulses.
Feelings Evoked: May elicit admiration for their attention to detail; may also provoke anger—a “battle of wills” due to their perfectionistic approach.
Management Tips: Provide choices to increase their sense of control, provide detailed information, focus on a collaborative approach that avoids the battle of wills.

The Histrionic Personality Style

Relevant Characteristics Under Stress: Entertaining, melodramatic.
Meaning Attributed to the Stressor: May fear loss of love or loss of attractiveness.
Feelings Evoked: May make others feel anxiety, impatience, off-putting dramatic gestures.
Management Tips: Try to strike a balance between warmth and formality, maintain clear boundaries, encourage them to discuss fears, avoid confronting them head-on.

The Masochistic Personality Style

Relevant Characteristics Under Stress: “Perpetual victim,” self-sacrificing martyr, may expect negative outcomes.
Meaning Attributed to the Stressor: May view the stressor as conscious or unconscious punishment.
Feelings Evoked: May provoke anger, hate, frustration, helplessness, self-doubt.
Management Tips: Avoid excessive encouragement, share their pessimism (albeit without agreeing).

The Paranoid Personality Style

Relevant Characteristics Under Stress: Guarded, distrustful, quick to blame or counterattack, sensitive to slights.
Meaning Attributed to the Stressor: Proof that the world is against them.
Feelings Evoked: Anger, feeling attacked or accused, defensiveness. 
Management Tips: Avoid assuming a defensive stance, acknowledge their feelings without disputing them, maintain interpersonal distance, do not confront irrational fears.

The Narcissistic Personality Style

Relevant Characteristics Under Stress: Arrogant, devaluing, vain, demanding.
Meaning Attributed to the Stressor: May view it as a threat to self-concept of perfection and invulnerability; may be shame evoking.
Feelings Evoked: May cause others to feel anger, a desire to counterattack, activate feelings of inferiority.
Management Tips: Resist the desire to challenge their sense of entitlement, provide opportunities for them to show off, offer appropriate advice if requested.

Getting Better for Absolute Beginners

PalmIsland_EN-US349499969Getting better is the goal of every stress management program… and every other program, plan, treatment, intervention we may choose to undertake. But what does getting better mean? Are there some specific characteristics to recovery that would clearly indicate that we have succeeded? These important questions, for one reason or another, often are either not asked or not fully replied to, leaving us wondering where all that effort went and whether it was really worth our time and investment.

The Meaning of Not Doing Well

Before we attempt to define the specifics of getting better, let’s clarify the characteristics of not doing well.  In the case of chronic stress, two criteria can be used to reliably define its severity: subjective distress and level of functioning. The first, subjective distress, indicates how much we are bothered by the condition. Chronic stress can produce bothersome physical symptoms (gastrointestinal problems, fibromyalgia, skin rashes, headaches) and distressing psychological problems (irritability, anger, sleeplessness, poor concentration, memory loss). When these signs appear, it can be said that an individual’s subjective distress has risen to levels that go beyond just feeling pressured and have escalated to affecting multiple aspects of the mind and the body.

The second major indicator, level of functioning, can be gauged by examining personal productivity, balance between work and family life, quality of significant close relationships, and social connectivity. When problems appear in these areas, ranging from interpersonal difficulties to the inability to keep a consistent work schedule or to take care of tasks and chores that could be previously accomplished, one’s level of functioning is said to be impaired. Impairment of functioning can be somewhat of a subjective measure, and for this reason it is often helpful to compare our own perception of how well we are functioning under severe stress to the perception of those around us, as they may be able to give us a more balanced assessment.

Getting Better

As recently described by Dr. Marianne Farkas of the Center for Psychiatric Rehabilitation at Boston University at the Refocus on Recovery 2010 conference, getting better can generally be defined as, “the deeply personal and unique development of new meaning and purpose as one grows beyond the catastrophe… reclaiming a meaningful life… a long-term journey with many dimensions [which] include re-engaging in life, finding a niche or major role, developing secondary roles, reawakening hope, [and] developing a sense of purpose…”

In practical terms, this definition comes down to two essentials: the individual feels better (about meaning and purpose of life, hopefulness, and motivation) and functions better (by re-engaging in more meaningful and productive activities, and adding new roles and dimensions). Thus, the two hallmarks of feeling poorly, distress and impaired functioning, are both mitigated or reversed to fully express the reality that the person is indeed free of distress and capable of functioning at or near optimum levels.

Some indicators of having successfully overcome chronic stress:

  • A return to prior levels of happiness, enjoyment of life, and positive outlook
  • An increase in energy levels and the ability to apply energy toward productive activities
  • The ability to manage personal resources in a way that takes into account the need to replenish them before reaching exhaustion, e.g. better nutrition, more regular sleep patterns
  • A significant reduction or disappearance of the physical symptoms of stress, without the need for medication, alcohol, nicotine, or illegal substances
  • The restoration or improvement in the quality of interpersonal connections
  • A noticeable increase in self-esteem, feelings of well-being, a sense of empowerment

Using the two measures of well-being, distress and level of functioning, can be a quick and simple way of gauging different aspects of our life. Wherever distress is detected, or a stress reaction is taking place, there is an indication that something is not right and requires our attention. Likewise, detecting a reduced level of functioning at work, in leisure or in interpersonal relations should not be overlooked, as it indicates that our resources are dangerously depleted and must be restored.

A Woman’s Stress Relief: Tend-and-befriend

ElGreco on Stresshacker.com Reaching out vs. retreating appears to be what distinguishes the instinctual reaction to stress between men and women. For women, the choice between fight or flight in the presence of a stressor applies less frequently than tend-and-befriend.

Whereas the typical male is more likely to narrow his response to stress down to a decision whether to fight the stressor directly and aggressively or retreat from it by way of an emotional withdrawal, most women choose to turn to family and friends by tending to or cultivating connections. Forming a network of support appears to be an innate characteristic of females also among primates, intended as a form of protection for themselves and their offspring. Clearly, the assumption is that there is more safety in numbers than in trying to make it alone in potentially dangerous situations.

Most women naturally construct a more intimate and complex social network than men do, and when they are stressed, in danger, or in times of change, they can turn to this network for support. Thus, they are more likely to seek out the company of other women and less likely to flee the stressor by withdrawing or isolating or to fight it directly and single-handedly, as most men appear to do.

This natural response to the stress reaction, moderated by a support system such as tend-and-befriend, might help explain why women live an average of five years longer than men. Men are also capable of creating complex social networks (now enormously facilitated by technological connectivity), but male-created social networks may lack the necessary level of intimacy or remain underutilized as a coping mechanism.

The Science Behind Tend-and-befriend

Research being conducted at UCLA under a grant by the National Science Foundation on Biopsychosocial Bases of Social Responses to Threat indicates that, in times of danger, most people seek positive social relationships that may provide safety for themselves and their offspring.  This and prior research by Dr. Shelley Taylor at UCLA’s Social Neurosciences Lab suggests that the hormone oxytocin and other opioid peptides produced in the body stimulate these responses, most especially in women. Oxytocin in particular appears to function as a social thermostat that monitors the availability of social resources and prompts the seeking of additional connections when needed.

Stress Relief: Taking Charge or Letting Go?

David_Marat Chronic stress can produce a feeling of being overwhelmed. It makes it difficult to shift perspective and see the stressor from a different angle. Rather than seeing stress as a useful signal and address the cause of it, the tendency is to focus on the stress reaction itself as something that can be just pushed away. The results are often the very opposite of what is intended: rather than going away, stress continues as a flashing light on the dashboard that just won’t shut off, while its cause continues to wreak havoc on the mind, the spirit and the body.

It doesn’t have to be this way. Taking responsibility for finding a solution to the stressor is the answer, of course. But how can it be done if all that we can see and feel are the emotional and physical symptoms of the stress reaction? The following are proven ways that can help in shifting perspective from the signal (stress) to its cause, the stressor itself.

Take Charge, List, and Delegate

When I ask general audiences if they can control their stress level to make it work for them, no more than half say they can. If I ask audiences of pilots or neurosurgeons the same question, they all say they can. –Esther M. Sternberg, M.D.

Airline pilots are trained to use the stress response as a useful way to monitor their own behavior. When a pilot flies an airplane through a storm, her heart races, her breath becomes shallow, and her attention is intensely focused on the job at hand. The pilot experiences to the fullest the physiological arousal that defines stress, without necessarily labeling the situation as stressful. Having done this before, the pilot knows what to expect, takes full charge of flying the aircraft and remains in control. On the other hand, the passengers aboard the aircraft may be far more uncomfortable because the plane is bouncing around and there isn’t anything they can do about it. They are stressed, and their racing heart, shallow breath, and intense focus on every bounce and every noise of the plane is coupled with the feeling of being at the mercy of the elements and in the hands of the pilot. Two similar situations, two very different stress reactions. The difference? Being able to take control.

Whenever possible, a shift of perspective can be facilitated by taking charge and exercising a greater control over our choices. When we believe we might be able to control a situation, and step up to try and resolve it, chances are that the very act of acting on it reduces our stress levels. We are finally doing something about it, and it feels good. Have you noticed how the toothache seems to go away, at least to some extent, when we arrive at the dentist’s office? Or our problems take a different, and often less dramatic tinge, when we open up and just talk to someone about them?

Another useful technique for making use of stress signals instead of being overwhelmed by them is to make a list of the stressors that need to be addressed, and front-load it with the ones that can be taken care of quickly. As we check off accomplishments, the feeling of being in control rises and stress begins to ease. It is also useful to take the list a step further and classify each stressor into one of three categories:

  1. Stressors that can be eliminated by making a choice, e.g. taking time off from work, saying no to another request, getting out of a noisy environment.
  2. Stressors that can be reduced or modified, e.g. working on a relationship problem, cutting down on caffeine, lightening the work load.
  3. Stressors that cannot be eliminated or reduced and therefore have to be managed, e.g. working through a loss and the grief caused by it, searching for a job, taking care of our own or a loved one’s illness.

A third technique is delegating, not just to coworkers but also to children, spouse, and friends. This may be difficult, as it appears to contradict the previous suggestion of taking charge of the situation. While taking control is a good stress reliever, it requires moderation and good judgment. One’s anxious need to be in direct personal control of everything at all times, or at least attempting to gain it, can create a stress of its own. Our finite resources of time, energy, and motivation can become exhausted. Anxious control ceases to be a step toward resolving our stressors, and can simply become an attempt to reduce our anxiety about getting everything done. Delegating is the answer.

Accepting That Life Is…Well…Stressful

No one can control everything. A child’s schedule may inevitably conflict with a work deadline. Bad weather may flood the picnic. There are literally thousands of situations when one task interferes with another, is interrupted, must be postponed, or ends up producing unexpected results. Is this because of poor control skills? Sometimes that is the case, but more often than not life is just full of surprising and unexpected turns.

Chronic stress can have a physical impact on the body. Interrupting the sequence of stressful moments with moments of calm and relaxation, i.e. letting go instead of taking control, can lessen that impact. This letting go may at times feel counterintuitive but it produces results. When a series of crushing deadlines looms at work, we can take some time off in between them. A weekend at the beach or the mountains can do wonders for the equilibrium. Distracting oneself with something soothing, such as cooking, knitting, or breaking out the watercolors can bring a smile to our face and a balm to the soul. And if taking off an entire afternoon is just not in the cards, just getting out for a walk can be a powerful stress reliever. Even a short stroll can make a difference.

Can Comfort Food Reduce Stress?

MammothHotSprings_EN-US66686672 When eating is a way to tame anxiety instead of hunger, it is an emotion-driven behavior that adds calories, fat, cholesterol and inches to the waistline, while providing at best a temporary relief to feelings of stress and anxiety. So what is emotional eating, does it relieve stress or can it do more harm than good? In this post, we’ll take a look at its symptoms, learn how to distinguish it from real hunger, and how to prevent it from ruining our diet, our mood and our health by stopping it or simply bringing it under control.

How to Recognize Emotional Eating

The normal physiological response to emotional distress caused by a stressor is a noticeable loss of appetite. The stress reaction is a complex physiopsychological mobilization of resources that also causes the blood flow to be temporarily diverted from the digestive system to other parts of the body where it is most urgently needed to activate the fight or flight response, i.e. the musculature and the cardiovascular system. Thus, under normal functioning, the stomach contracts and hunger is reduced during times of stress and anxiety.

When there is an increase in appetite under stress, it may look like a real need for food, but in reality there are several differences between emotional hunger and physical hunger. The most significant difference is the speed at which the urge to eat is felt: emotional hunger appears suddenly or in a matter of minutes, while physically appropriate hunger occurs more gradually.

The next most significant difference is in the type of food that is usually craved during bouts of emotional eating. Specific high-calorie, high-fat and sugar foods, such as pizza, cookies or ice cream, are often the only foods that will satisfy the emotional need. When the appetite is caused by real physiological hunger, there is more willingness to eat a variety of different foods, even ones that we do not ordinarily like as much but that happen to be available (broccoli, Brussels sprouts, day-old soup). 

A third difference is in the way emotional hunger triggers the anxiety to eat right away, whereas normal physical hunger very seldom has an anxiety component attached to it. Another difference is in the way emotional hunger appears to shut off our natural ability to regulate the amount of food we eat at any one sitting, i.e. the ability to stop when the stomach is full. When eating to satisfy an emotional need, there is higher likelihood that the eating will continue until all the food is consumed. Last but not least, guilt often accompanies emotional eating. Physical hunger is very seldom associated with negative emotions such as guilt or regret.

Is Emotional Eating Just a Problem for the Waistline?

In theory, a simple food fix in times of high stress and anxiety does not appear to be a problem. Indeed, occasional use of food to self-soothe and comfort negative feelings is a proven remedy that has been known since the beginning of time. However, the prolonged recourse to food to assuage emotional needs carries significant health risks, chief among them an increase in levels of cortisol, insulin, and lipids, which over time can lead to obesity and the development of metabolic syndrome.

The repeated use of food to alter negative emotions, unfortunately, tends to become less effective over time. This is due to physiological changes that take place, but principally due to the ineffectiveness of food as a coping mechanism. At best, comfort food can act as a distraction from worry. Often, comfort food becomes a metaphor of the “hunger” for the emotional closeness with significant others that could provide the comfort and help that would truly benefit the individual under stress.

How to Stop or Control Emotional Eating

When emotional eating becomes a habit while losing its ability to reduce stress and anxiety, there are ways to manage it and eventually stop it entirely. This is often possible without counseling or medication, but the latter may become necessary when emotional eating has become compulsive and the person simply does not have the psychological resources to bring it under control. The following suggestions may be helpful and worth a try, before seeking professional help.

  • Recognize emotional eating, distinguish it from real hunger, and learn what triggers it.
  • Improve the quantity and quality of sleep by napping or getting to bed earlier. Tiredness may increase the need for an energy boost. Take a nap or go to bed earlier instead.
  • Use an effective stress management program, such as as yoga, exercise, meditation or relaxation techniques. Reducing stress is often the key to eating only when hungry.
  • Give yourself a hunger reality check by asking, “Is my hunger physical or emotional?” Check when you ate the last time, and calculate whether you should be hungry now. Give time to the sudden craving to pass, while trying to make sense of it.
  • A food diary where you note what and how much you eat may be very helpful in establishing the connection between stress, mood changes, sudden cravings, and emotional eating. Awareness is often the first step toward developing options and making better choices.
  • Connect to a support network. When food is a substitute for companionship, friendship, and interpersonal connections, it is more likely to be the one comfort that is readily available. It is a better approach to reach out to family, friends, colleagues or a support group.
  • Boredom can be a powerful trigger of emotional eating. You may snack healthy (low-fat, low-calorie, fresh fruit, vegetables with fat-free dip, unbuttered popcorn) or not at all by choosing to take a walk, watch a movie, play with your pet, listen to music, read, surf the Internet or call a friend.
  • If nothing but comfort food is available and you recognize it clearly as triggered by stress or anxiety, try to practice moderation by dividing the bag of chips into smaller portions and eating only one or two servings. Eating only four bites, according to studies at the Food and Brand Laboratory of Cornell University, may be sufficient to create a positive memory of food that is recalled as just as good an experience than eating the whole thing.

eClass 5: Stress and Emotional Intelligence

3060893791_b4015ba15e_o We’re social creatures, and the life best lived often depends on our ability to create and maintain healthy relationships. Success, happiness, and the ability to give and receive love all hinge on our relationship skills. Most of us do a good job with relationships at the start. But why do we so often stumble down the road? Why do relationships develop into such stressful problems? Can emotional intelligence help?

Emotions are the building blocks of each relationship in our lives, and the power of those emotions cannot be overstated. Runaway emotions can override our thoughts and profoundly influence our behavior. Emotional intelligence (EQ) is the ability to recognize, control, and effectively communicate our own emotions, and to recognize the emotions of other people. Emotional intelligence skills enable us to use emotional building blocks to construct a solid foundation for communication. Well-developed emotional intelligence is a better predictor of success in all areas of life (and particularly in relationships) than the traditional measurement of high cognitive intelligence, or IQ.

At the foundation for all verbal and nonverbal communication, emotional intelligence can:
•    Empower us to build healthy new relationships
•    Help us strengthen existing relationships
•    Help us better understand other people
•    Help us better understand ourselves
•    Enhance our ability to communicate effectively

A Simple EQ Test

What is your current EQ level? Most of us have relationship problems at times with coworkers, acquaintances, friends, relatives, or other people about whom we care. Our emotional intelligence is a set of key relationship skills that help us establish strong relationships and deal with relationship problems.

Find your emotional intelligence skill level by answering “true” or “false” to the questions in this quick relationship quiz.

1.    I hold eye contact with the person to whom I am speaking.
2.    I am comfortable with pauses when others are experiencing emotion.
3.    I sense when someone feels troubled before being told.
4.    I am comfortable with my feelings of sadness, joy, anger, and fear.
5.    I pay attention to my emotions when making decisions.
6.    I have no problem expressing my emotions to others.
7.    I can reduce my stress to a comfortable level.
8.    I enjoy laughing, playing, or kidding around.
9.    I don’t feel threatened by disagreements.
10.    When others are speaking, I listen to them rather than working on my reply.

Answering “true” to at least 7 of these questions indicates a good grasp of the skills that will strengthen relationships and help avoid relationship problems. Less than 7 “true” answers indicates that there is a need for additional skills building to raise emotional intelligence ability. It is important to learn the key skills to use in improving our current relationships, and to forge strong new ones—in both our personal life and the workplace.

The 5 Crucial EQ Skills

While every relationship is unique, there are five areas of emotional intelligence that are of vital importance to building and maintaining healthy relationships:

1.    The ability to manage stress in relationships

Stress shuts down our ability to feel, to think rationally, and to be emotionally available to another person, essentially blocking good communication until both parties feel safe enough to focus on one another. This damages the relationship. Being able to regulate stress allows us to remain emotionally available. The first step in communicating with emotional intelligence is recognizing when stress levels are out of control and returning quickly, whenever possible, to a relaxed and energized state of awareness.

2.    The ability to recognize and manage emotions

Emotional exchanges hold the communication process together. These exchanges are triggered by basic emotions, including anger, sadness, fear, joy, and disgust. To communicate in a way that grabs or engages others, we need to access our emotions. However, our emotions may be distorted, or unavailable, due to the influence of our earliest childhood relationships (chronic stress, i.e. high allostatic load). But they can and must be restored.

3.    The ability to communicate nonverbally

The most powerful forms of communication contain no words, and take place at a much faster rate than speech. Using nonverbal communication is the way to attract others’ attention and keep relationships on track. Eye contact, facial expression, tone of voice, posture, gesture, touch, intensity, timing, pace, and sounds that convey understanding engage the brain and influence others much more than our words alone.

4.    The ability to use humor and play in relationships

Playfulness and humor help us navigate and rise above difficult and embarrassing issues. Mutually shared positive experiences also lift us up, help us find inner resources needed to cope with disappointment and heartbreak, and give us the will to maintain a positive connection to our work and our loved ones. Humor can be a powerful stress reduction and relaxation technique.

5.    The ability to resolve conflicts in relationships

The way we respond to differences and disagreements in personal and professional relationships can create hostility and irreparable rifts, or it can initiate the building of safety and trust. Our capacity to take conflict in stride and to forgive easily is supported by our ability to manage stress, to be emotionally available, to communicate nonverbally, and to laugh easily.

Emotional intelligence skills can have a dramatic effect on our relationships at home and at work. As we acquire each one of these abilities, we will increase our overall EQ level and our ability to master the next skill. In the end, we will get to know a newly empowered individual—our social self—and become very comfortable with our ability to attract the respect and affection of others.

Seeing Stress Anew Between Two Covers

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A fresh perspective on stress doesn’t come easy, given the explosion of self-help books and manuals on the subject that have been published in the last few years. Reading something truly illuminating and new about stress and how to manage it is a rare find. One of the few books that manages to be informative, practical and refreshingly new at the same time is Stress Management: A Comprehensive Guide to Wellness by Dr. Edward Charlesworth and Dr. Ronald Nathan, first published in 1982 and now in its fourth edition.

A pocket-sized 400+ pages little manual of treasures, the book includes chapters that explain stress in everyday language, teach relaxation in an engaging style, address the issue of special stressors, and puts it all together in a captivating and surprisingly simple stress management formula that is sure to be feasible by just about anyone. It earns the nod as Stresshacker Recommended book for this week.

[amtap book:isbn=0345468910]

PMR For Absolute Beginners

The Tao of Progressive Muscle Relaxation (PMR)

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The Science of PMR

Anxiety and stress-induced tension consists of subjective, behavioral, and physiological components that interact to create a complex physical and emotional experience. When a stressor is perceived, it can cause fear, anxiety or nervousness. The thoughts preceding or accompanying these sensations may add additional tension that further amplifies the stress reaction. This increases discomfort and physiological activation in a continuing spiral that may cause panic, negative thoughts, and a variety of other behavioral and physiological symptoms.

PMR is a way of reducing the arousal provoked by the stress reaction. When muscle activity is reduced with PMR, there is a corresponding reduction in nervous system activity. This is due to the negative feedback from the muscles to the brain (more specifically, the ascending reticular activation system and the hypothalamus). Resting muscles send little or no feedback information to the brain structures; the lack of feedback results in a decrease in autonomic activation. As muscle tension drops, heart rate and blood pressure are also lowered.

PMR is just one way of achieving a state of deep relaxation. There are many other ways to relax, some good (biofeedback, controlled breathing, autogenic training, stretch-based relaxation, and quiet meditation), and some not so good (alcohol, nicotine, drugs), all of which capitalize on the same psychophysiological mechanisms.

The advantages that PMR has over all other methods is that it is easy to learn, requires no equipment, and can be practiced any time and virtually anywhere.

The PMR Tensing-Relaxing Sequence

PMR is learning to tense and relax groups of muscles in your body, while at the same time learning the sensations that go with tension and relaxation. So, in addition to learning how to relax, you will also learn to recognize the sensations that go with tension and relaxation in everyday situations.

Learning relaxation skills is like learning any other skill, such as swimming or golfing or riding a bicycle. So, in order to get better at relaxing, you will need to practice doing it just as you would practice other skills. PMR simply involves learning the skill; there is nothing magical or mysterious about it. Let’s see how it works.

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Do You Know the Answer to These 10 Critical Questions About Stress?

vanGogh_1888_YellowHouseWhat questions come to mind when we think about stress depends on our relationship with it. If we consider stress as our mortal enemy, then our questions will revolve around the fear of its effects, ways of getting rid of it or at least greatly reducing it, and how we can best distract our mind and tame our symptoms. If, on the other hand, we consider stress as our ally, a friend that warns us when something or someone requires our attention by turning on certain body signals, then our questions will be entirely different. They will revolve around ways of using it to our advantage, toward understanding its precious and vital function, and how best to accept and honor its purpose. Here are the 10 most important questions about stress.

10 Questions About Stress

  1. Is stress always bad?
    No, not always. However stress can be bad, even dangerously bad. It starts out in childhood, as we become aware of the world and its dangers. If it is misunderstood, not explained, ignored or abused, stress can grow with us into something to be feared, avoided, to run from. It can become a constant yet unwanted companion, albeit a greatly misunderstood one. A relationship with stress is thus set up that is entirely adversarial. Its power as a warning system and as a motivator is overlooked. Stress is always bad when, in this way, it becomes a disease.
  2. What is the prevalence of stress in humans?
    It is 100%. Every man, woman and child who ever lived, now lives or will ever live experiences stress. This is not because we are cursed with it, but because we are blessed by its helpful action. In the presence of any stressor, real, imagined or impending, our body instinctively mobilizes for action, helping us better protect and defend ourselves, our loved ones, our property and our values. Without it, we would be inert, uncaring, detached and defenseless individuals.
  3. What are the variations and severity of stress?
    There are two kinds of stress: the stress reaction and chronic stress. The stress reaction is the immediate arousal that occurs in the presence of danger; it rises rapidly, peaks, and subsides after a time; afterwards, the mind and body return to their normal relaxed state. The stress reaction can be more or less intense, and more or less prolonged, depending on the severity of the stressor and on its resolution. Chronic stress is simply a persistence of the stress reaction, which continues at or near its peak without return to the normal relaxed state. The severity of chronic stress depends on the stressor that first triggered it and the continuing stressors that maintain it, and on the lack of any real resolution. Chronic stress is what most people refer to when they complain of suffering from stress.

    A day without stress is like, you know, night. –Anonymous

  4. Can chronic stress be prevented?
    Yes, stress can be prevented from becoming chronic, especially in children and young adults. Adults and elderly people have a more difficult time preventing stress from becoming chronic. What is most helpful in prevention is understanding its function and learning to appreciate its value. People who do best are the ones who view a stress-free life not only as the absence of symptoms, but as one that is rich in exercise, balanced nutrition, effective time management, good decision-making skills, appropriate releases of energy and emotion, and strong relationships.
  5. What are the most common stress triggers?
    The most frequent and severe stressors, or stress triggers, are associated with our interpersonal relationships (beginnings, ongoing difficulties, losses) and our physical health. Others that can be very severe but less common are natural disasters, accidents, conflict, or crime. In general, change is a stressor, as are most transitions from one phase of life or age to the next. Work and financial demands are also frequently associated with stress reactions.
  6. Are there ways for parents to reduce the risk of their children developing chronic stress? 
    Yes, through educating themselves about the function, benefits and dangers of stress, and passing this knowledge along to their children. There is no better time to learn about how to accept and make the best use of the stress reaction than in childhood and young adolescence, although it can be learned at any age.
  7. What are the risks associated with stress? 
    The risks associated with stress are minimal if the stress reaction is allowed to occur and take its normal course, and if stressors are addressed and resolved in a timely manner. Chronic stress, however, carries biological, psychological and social consequences. It can result in severe illness, especially to the cardiovascular and immune systems. It can significantly worsen the prognosis of psychological disorders such as depression, anxiety, bipolar disorder, borderline personality disorder and many others. Lastly, chronic stress can have a significantly adverse impact on relationships, at work and at home, by augmenting the effects of anger, fatigue, or irritability. It can also diminish productivity and lead to poor decision-making.
  8. Can stress be cured? 
    No, the stress reaction cannot be cured because stress itself is not a disease. Stress is a natural and helpful reaction to a danger that mobilizes our defenses. It is impossible to “cure” stress if it means attempting to eliminate it; it would be tantamount to trying to eliminate fear, or joy, or surprise from our lives. On the other hand, chronic stress must be addressed and treated adequately to avoid its most serious consequences to our health, our mind, and our relationships.
  9. What questions should I ask my physician about stress?
    The two most important questions to ask are 1) How seriously has chronic stress affected my physical health (heart, blood pressure, cholesterol, and digestive system being the most vulnerable), and 2) What changes do I need to make to reduce my chronic stress back to a normal stress reaction.
  10. What can I do to reduce my risk of chronic stress?
    There are many different stress management programs available, perhaps even too many to consider them all. Often, lack of success with them prevents their continued application. Often lack of time or motivation are the problem. Often, acute stress itself prevents us from being able to choose an adequate treatment. In many cases, it is advisable to get some external help that facilitates the process. In those cases, a good coach is the ingredient that makes it possible to discover, develop and make the best use of our natural ability to manage stress.