Stress management and prevention applications to daily life, 2nd edition

Brief ContentsA Personal Introduction: From the Authors to the Readers xi About the Authors xix Part I Understanding the Nature of Stress 1 1 The Meaning of Stress 3 2 The Body’s Reactio

Stress Management and Prevention

Stress Management and Prevention

Applications to Everyday Life

Second Edition

JEFFREY A KOTTLER and DAVID D CHEN

First Published 2011

by Routledge Taylor & Francis Group

711 Third Avenue, New York, NY 10017 www.routledge-ny.com

Simultaneously published in the UK

by Routledge

2 Park Square, Milton Park, Abingdon, Oxon OX14 4RN www.routledge.co.uk

Routledge is an imprint of the Taylor & Francis Group, an informa business

© 2011 Taylor & Francis The right of Kottler, Jeffrey A to be identified as author of this work has been asserted by him/her

in accordance with sections 77 and 78 of the Copyright, Designs and Patents Act 1988.

All rights reserved No part of this book may be reprinted or reproduced or utilised in any form

or by any electronic, mechanical, or other means, now known or hereafter invented, including photocopying and recording, or in any information storage or retrieval system, without permission

in writing from the publishers.

Trademark notice: Product or corporate names may be trademarks or registered trademarks,

and are used only for identification and explanation without intent to infringe.

Library of Congress Cataloging-in-Publication Data

Kottler, Jeffrey A.

Stress management and prevention : applications to everyday life / Jeffrey Kottler and David Chen — 2nd ed.

p cm.

Includes bibliographical references and index.

ISBN 978-0-415-88500-3 (pbk : alk paper) 1 Stress management—Textbooks.

I Chen, David D II Title.

RA785.K68 2011 616.9 ′8—dc22

2011003326

British Library Cataloguing in Publication Data

A catalogue record for this book is available from the British Library ISBN: 978-0-415-88500-3 (pbk)

ISBN: 978-0-415-80928-0 (ebk) Typeset by Graphicraft Limited, Hong Kong Printed and bound in the USA by Transcontinental on acid-free paper.

Brief Contents

A Personal Introduction: From the Authors to the Readers xi

About the Authors xix

Part I Understanding the Nature of Stress 1

1 The Meaning of Stress 3

2 The Body’s Reactions to Stress 29

3 Sources of Stress across the Lifespan 57

4 Adaptive and Maladaptive Behavior 85

5 Individual and Cultural Differences 115

Part II Strategies of Stress Management and Prevention 139

6 Challenging Stressful Thinking 141

7 Problem Solving and Time Management 171

8 Psychological and Spiritual Relaxation Methods 203

9 Physical Methods for Stress Reduction 231

10 Preparing for the Future: College and Occupational Stress 259

11 Care of the Self: Nutrition and Other Lifestyle Issues 283

12 Stress and Conflict in Relationships 307

Part III Strategies of Synthesis and Prevention 335

13 Resilience and Stress 337

14 Optimal Functioning to Make Your Changes Last 363

Glossary 393

Credits 399

Index 401

v

A Personal Introduction: From the Authors to the Readers xi

A Personal Introduction from the Authors xii

David Chen’s Personal Introduction xii Jeffrey Kottler’s Personal Introduction xiii

Summary xv

A Note to Our Fellow Instructors xvii

About the Authors xix

Part I Understanding the Nature of

Stress 1

1 The Meaning of Stress 3

What Is Stress Anyway? 4 Meanings of Stress 5 What’s in a Name? 6 How Is Stress a Problem? 8 Stress as a Stimulus or Response 9

A Selected History of Stress Research 9

Ancient Contributions 9 Modern Era 10

General Adaptation Syndrome 11 Allostasis 12

Stage 1: Life Situations/Chronic Stressors 21 Stage 2: Perception and Evaluation 21 Stage 3: Stress Response 22

Stage 4: Consequences 22

Summary 23 Question for Review 24 Selected Answers 24 Review Activities 24 References and Resources 26

2 The Body’s Reactions to Stress 29

The Battle Within 30 Nervous System 31 Initiation and Control of the Stress Response 33 The Brain and Stress 34

The Autonomic Nervous System and Stress 38 The Endocrine System 38

The Immune System 42 Immunity and Stress 42 The Cardiovascular System 44 The Gastrointestinal System 46 The Musculoskeletal and Skin Systems 47 The Reproductive System 48

Not All Doom and Gloom 48 Summary 50

Questions for Review 52 Selected Answers 52 Review Activities 52 References and Resources 54

3 Sources of Stress across the Lifespan 57

Developmental Tasks 58 Developmental Stages and Major Stressors 58 Transactional Model of Stress 60

Stress in Childhood 62

Prenatal and Infant Stress 63 Stress in Elementary-School-Age Children 63 How Children Cope with Stress 64

Stress in Adolescence 65

Peer Relationships 66 Academics and School 66 Unusual Stressors 67 How Teenagers Cope with Stressors 67

Stress in Young Adulthood 68

Friendships and Tribal Affiliations 68 Selecting a Life Partner 69

College and Stress 70 When Stress Leads to Suicide 71 Sex, Drugs, Rock and Roll 72 Career Selection and Stress 74

vii

Stress during Middle Adulthood 74

The Family Life Cycle 76

Stress in Later Adulthood 77

References and Resources 81

4 Adaptive and Maladaptive Behavior 85

Theoretical Models of Coping and Adaptation 86

Psychoanalytic Model 86

Humanistic Model 88

Behavioral Model 89

Cognitive Model 90

Emotional Responses to Stress 91

Fears and Phobias 91

Anxiety and Panic Disorders 94

References and Resources 113

5 Individual and Cultural Differences 115

Personality and Stress 115

States versus Traits 116

Type A Personality 117

Helpless and Hopeless Personality 119

Repressive Personality 121

Codependent Personality 121

Addressing Codependency Issues 124

Gender and Stress 125

Gender Differences in Stress Responses 125

Gender Stereotypes and Gender Role Stressors 126

Feminine Gender Role and Stressors 126

Male Gender Role and Stressors 127

Gender Differences in Stress-Related Disorders and

Coping Strategies 128

Culture and Stress 128

Culture and the Types of Stressors

Experienced 128

Culture and the Appraisal of Stressors 130

Culture and the Choice of Coping Strategies 131

References and Resources 137

Part II Strategies of Stress Management

and Prevention 139

6 Challenging Stressful Thinking 141

An Ambitious Promise 142 Most Stress Is Self-Inflicted 143 Creating Meaning 145

Cognitive Theory in a Nutshell 146

A: Activating Event 147 C: Emotional Consequence 147 B: Irrational Belief 147

The Power of Language 155 Keeping a Thought Journal 155 Reframing 157

Ceasing Disturbing Thoughts 159 When Challenging Stressful Thoughts Doesn’t Work 161

Summary 162 Questions for Review 163 Selected Answers 164 Review Activities 165 References and Resources 168

7 Problem Solving and Time Management 171

Problems without Solutions 171 Differences between Concern and Worry, and Why it Matters 172

Problem Solving and Stress 174 Barriers to Effective Problem Solving 175 Developing Problem-Solving Skills 176

Problem Orientation 176 Problem-Solving Style 177

Time Management and Stress 183

The Value of Time 184 Six Principles for Time Management 187

Procrastination 189 Causes of Procrastination 191 Overcoming Procrastination 192

Strategies for Time Management 194

Do Less, Not More 195 Figure Out What’s Getting in the

Get a Calendar 196 Make a List and Check it Twice 197 Figure Out Where You Waste Time 197 Make the Best of “Down Time” 197 Make Some Necessary Cuts 197 Find Balance 197

Pay Others to Do the Work 200 Stop Complaining 200

Summary 200 Questions for Review 201 References and Resources 201

8 Psychological and Spiritual Relaxation Methods 203

Prevention, Treatment, and Coping With Stress 204 Three Common Elements of Relaxation

Techniques 205

Element 1: The Mind–Body Connection 205 Element 2: Altered States of Consciousness 205 Element 3: Enhanced Internal Locus of

Control 208 Guided Imagery 209 Types of Guided Imagery 210 How to Perform a Therapeutic Imagery Session 212

How Does Guided Imagery Work? 213 Autogenic Training 214

Meditation and Mindfulness 215 Types of Meditation 216

Elements of Meditative Practice 219 Benefits of Meditation 220

Seeking Serenity through the Spiritual Path 222 The Power of Prayer 223

Summary 225 Questions for Review 226 Selected Answers 226 Review Activities 226 References and Resources 228

9 Physical Methods for Stress Reduction 231

The Cost of Progress 232 Physical Exercise 233 Exercise and Stress Reduction 233 Kinds of Exercise 234

Principles for Improving Fitness Levels 237 Progressive Muscle Relaxation 239

PMR Technique 240 Clinical Benefits and Cautions 241

Breathing 244

The Process of Breathing 245

Yoga 247

Background on Yoga 247 Fundamental Concepts of Yoga 248

Tai Chi 249

Foundations of Tai Chi 249 Principles of Tai Chi Movement 250 Metaphorical Lessons of Tai Chi 251

Summary 254 Questions for Review 254 Review Activities 254 References and Resources 255

10 Preparing for the Future: College and Occupational

Stress 259

The Nature of College Stress 260

Academics 261 Finances 261 Social and Intimate Relationships 261 Choice of a Career 263

Being a Nontraditional Student 264 Being a Minority College Student 265

Developing Effective Study Habits 266 Study Habits for Improved Performance 267

Habit 1: Identify Clear Goals and Intentions 267

Habit 2: Make it Easy to Work 268 Habit 3: Make Learning Fun 269 Habit 4: Maximize Your Resources 270 Habit 5: Improve Your Memory 270 Habit 6: Demonstrate What You’ve Learned 272

Occupational Stress 273

Symptoms of Occupational Stress 274 Sources of Occupational Stress 274 Reducing Stress on the Job 276 Burnout: A Special Form of Occupational Stress 277

Summary 279 Questions for Review 279 Review Activity 280 References and Resources 280

11 Care of the Self: Nutrition and Other Lifestyle Issues 283

Portrait of a Lifestyle 283 Assessing Lifestyle Dimensions 284 Technological Intrusions 286 Diet, Nutrition, and Stress 287 Eating Problems Nationwide and on College Campuses 287

The Stress and Eating Cycle 288 Foods that Can Exacerbate Stress 289 Warding Off Stress through Proper Nutrition 290 Designing a Balanced Diet 293

Eating Healthfully: A Summary of Suggestions 293

Smoking and Tobacco Use 294

Why Is Smoking So Harmful? 294 How to Stop Smoking 295

Responsible Use of Alcohol 295

Dealing with Alcohol Abuse 296

Sleep 297

What Helps You to Sleep Better? 299

Managing Your Finances 299

Spend Less Than You Earn and Save the Rest 300 Start Investing Early 301

Keep Your Credit Clean 301 Avoid Credit Card Interest 301 Buy What You Need Instead of What You Want 301

Summary 302 Questions for Review 302 Selected Answers 302 Review Activities 303 References and Resources 304

12 Stress and Conflict in Relationships 307

Effects of Conflict on Your Body and Mind 308 Functions of Conflict 309

Getting Your Attention 309 Power and Control 310 Conflict Regulates Distance 310 Conflict Promotes Reflection and Growth 311

Working through Relationship Conflicts 312

Dealing with Emotional or Interpersonal Abuse 313

Dealing with Sexual Harassment 314

Date Rape 315

Preventing Assaults 316

Improving Your Relationship Skills 317

Listening with Focused Attention 318

References and Resources 334

Part III Strategies of Synthesis and

Prevention 335

13 Resilience and Stress 337

Resilience and Stress 338

Resilience in Adulthood and Later Life 339

Factors Underlying Human Resilience 341

Protective Factors 341

The Hardy Personality 342

The Toughening Factor 344

Learned Optimism 345

Emotional Resilience 346

Strategies for Developing Resilience 347

Learning from Failures 348

Processing Failures Effectively 349

Practice the Principle of Giving Up and

Letting Go 349

Let Go of the Material World 350

Let Go of the Past 351

Let Go of Dysfunctional Beliefs 352

Boost Your Hardy Perception of Life 353

Embrace Paradoxical Traits 354

Develop Higher Levels of Emotional Intelligence 355

Strengthen the Biological Factor of Resilience 356

Summary 357 Questions for Review 357 Selected Answers 357 Review Activities 358 References and Resources 359

Toward Peak Performance: From Stress to Success 372

Strategic Planning 373 Self-Initiatives 374 Mental Conditioning 374 Rehearse under Stress 375 Scenario Planning 375 Perseverance, Perseverance, Perseverance 376

Making Changes Last 377

What Sabotages Lasting Change 378 Social Support System 380

Suggestions for a Positive Stress Management and Prevention Program 381

Ask for Help if You Can’t Manage on Your Own 382

A Review of Things You Learned 385

A Final Summary and Some Honest, Realistic Parting Messages 386

Questions for Review 388 Selected Answers 388 Review Activity 389 References and Resources 390

Glossary 393

Credits 399

Index 401

A Personal Introduction:

From the Authors to the Readers

The usual approach to the subject of stress is that it is altogether a bad thing that must be

“managed,” if not eliminated, at all costs Texts contain methods for reducing stress,

such as deep breathing, meditation, hypnosis, exercise, yoga, journaling, self-talk,

biofeedback, time management, and visualization—to mention a few of the options

Many students who have taken courses such as this have made significant changes in

their lives as a result of what they learned Among those who continue practicing their

stress management and prevention skills, most would agree that it required significant

time, energy, and commitment to make the changes last over time

The reality is that most people don’t stick with diets, exercise programs, or stressreduction plans for very long That is one reason why there is always a new best-selling book

on the market that promises immediate, dramatic results—with little effort Similarly,

a few years after you graduate from college, little that you learned will stick with you

One reason for this is a lack of relevance of the content to your personal interests and

goals Another is that the material may not have been introduced to you in a way that was

compelling or interesting

K E Y Q U E S T I O N S

l Why is it so difficult to maintain important changes in your life, especially

those related to your health?

l In which classes have you learned the most? What contributed to that

learning that still remains a permanent part of your life?

l What have been the most critical incidents that have occurred in your life and

how have they impacted the choices you have made, as well as those you are considering in the future?

l After reading the personal stories of the authors, what might you expect from

what will follow?

You may never have a learning experience that is more directly related to your

success and satisfaction in life than this class on stress management Our goal is to assist

your instructor so that this experience will not only teach you some new skills to reduce

the stress in your life in the present and the future, but also help you approach the

inevitable pressures in life in such a way that you can perform at peak levels—whether

in school, on the job, or in the relationships that mean the most to you

xi

You already know, from previous experience, what it takes not only to learn thing, but to make it part of who you are and the ways you function characteristically Inorder for the methods in this class to become a permanent part of your repertoire, severalfactors must be operating:

some-1. You must actively engage with the content You can’t just read about the

sub-ject, or listen to lectures about it; you must think critically about the materialand try it out for yourself

2. You must personalize and adapt the learning to your particular needs With

anything that you read it is legitimate for you to ask yourself what this has to

do with your life You are the one who must figure out ways to take these ideasand apply them in ways that mean the most to you

3. Practice and rehearsal are a necessary part of any systematic learning gram At first, new skills seem awkward and time-consuming Over time, with

pro-diligence and effort, they become as easy for you as driving a car (which onceseemed awkward and frustrating) In order for you to be willing to devote thetime and energy into practicing new skills, without increasing your stress lev-els, you’ll need to feel as if the effort is worth the outcome

4. Finally, you need a support system to reinforce your efforts It may be fairly

difficult for you to undertake new behaviors unless you are surrounded by thosewho support what you are doing That is one distinct advantage of having class-mates who are part of this same journey

With these cautions in mind, we invite you to keep an open mind to the ideas that will

be presented to you, as well as to think critically and realistically about what you are prepared to do in your life, and what you are not You certainly have enough stressfulcircumstances that you don’t need additional burdens, or commitments, unless they can

be demonstrated to lighten your load significantly We aim to show you how to do that—

not just from solid theory and research, but also based on your own experiences

A Personal Introduction from the Authors

A textbook such as this not only involves presentations of content, but also engages you

in a process This is, after all, a very personal subject: we are talking about those timeswhen you are most vulnerable and most helpless If we expect you to reflect honestly onthose instances when you feel most flooded by anxiety (as well as what you can do aboutit), then we must be willing to do the same to earn your trust and respect Our expertise

in the areas of health, psychology, counseling, and stress is informed not only by ourprofessional research and practice, but also by our personal histories

David Chen’s Personal Introduction

I first felt attracted to the subject of stress management because I experienced so muchstress in my life At age 23, I came to pursue my graduate studies in America with only

$200 in my pocket and no contacts here I left behind my family and my wife whom I hadmarried just a few weeks prior to boarding the plane I was totally alone and utterlyunsure about my future

After several days spent recuperating from jet lag and adjusting to my new home inrural Florida, a new semester started I was scheduled to take four graduate classes thatwere intense and demanding I worked my heart out for these courses, each of whichrequired a huge term paper (in English rather than Mandarin!) I spent seven consecutivesleepless nights cranking out those papers Although I was pleased to receive excellentgrades, I also began to experience chest pains, as well as difficulty breathing I medicated

myself with aspirin and tried to take it easy, and noticed some relief of symptoms Later,

I began jogging regularly and playing basketball, which helped immensely

My stress started to build again about the time I completed my graduate studies

First, we found out that my wife was pregnant with our first child Second, I began my

first teaching job and had to prepare four conference presentations simultaneously On

the inside, I felt almost paralyzed with stress, but I behaved as if I had everything under

control After all, that is what a Chinese man is supposed to do

During this time, I stopped exercising and began eating junk food because it wascheap and convenient I recognized the same symptoms of breathlessness that I had

experienced earlier After strolling for a few minutes, I started to feel light-headed and

experienced increasing chest pains I fell to the ground, clutching my chest, in the throes

of what I believed was a massive heart attack

I recovered that evening, figuring it had been a false alarm When the symptomsreturned the following morning, my wife drove me immediately to the hospital We had

no health insurance and very little money, so the thought of paying the hospital bill only

added to my sense of impending doom By the time the doctor came in to see me, I burst

out sobbing I cried so hard that I couldn’t speak

After consulting with several specialists, as well as a psychologist, I eventuallylearned that my heart-attack-like symptoms were induced by severe stress Until I learned

to control these symptoms, I would remain vulnerable to stomach ailments as well as

other distressing feelings

This experience got my attention like nothing else could I began to examine theways I conducted my life, especially my tendency to procrastinate I had been a com-

petitive athlete in China, but had virtually given up exercise after arriving in America

because I was so driven to succeed academically Within days after the hospital visit,

I started practicing tai chi, a form of moving meditation that we will teach you later in

stomach problems Rather than surrendering, however, I decided to apply what I had

been learning all these years about health I knew that, in order to deal with severe stress

like this, I had to take care of my body, my mind, and my soul Most of what you will

read in this book I have tested personally and have applied to my own life

Most people who know me would be quite surprised to discover that I have apropensity toward stress reactions I appear calm and relaxed most of the time I never

raise my voice I teach classes in tai chi and stress management so I would appear to be

the embodiment of a stress-free life Yet people have no idea how long, and how hard,

I have struggled to get to this point I’d like to think that I am the kind of teacher (and

author) who really can practice what I preach to others

Jeffrey Kottler’s Personal Introduction

I was sitting in a restaurant for the usual family dinner on Sundays, which was usually

somewhat unpleasant for me because I would be grilled by my parents about my

marginal grades thus far in college I had not yet found my stride as a student and was

struggling in my first year academically and socially I felt lost Sitting at the dinner

table, I ignored the conversation going on around me I was lost in my own despair,

considering the prospect of another empty week ahead of me

“Hey, she’s a cute one,” I heard my father say I looked up and could see him grinning, pointing toward the waitress who had just taken our order This was totally

humiliating: my father was always scouting young women for me, concerned that it had

been quite a while since I’d had a girlfriend

Watching the waitress walk away, I thought to myself that she was beautiful, not to

mention totally inaccessible—at least to me I viewed waitresses as goddesses They

David Chen has found that tai chi helps him keep his life in balance in

a number of ways, both mentally and physically This ancient Chinese martial art, conducted in slow motion, builds strength, agility, and self-discipline As a form of

“moving meditation,” each action requires such total focus that any worries, concerns, or apprehensions are left behind David teaches tai chi not only to help students build their physical balance but also to improve confidence and a sense

of inner peace.

One way that Jeffrey Kottler keeps stress at bay is through outdoor, adventure activities that focus his mind, challenge his physical capabilities, and keep him in top shape This might include aerobic activities such as running and bicycling, but also trekking, climbing, surfing, and similar sports that require total concentration and leaving worries behind He is pictured here summiting Mt Rainier

in Washington state.

always struck me as so composed, so in control of their domain I’d been admiring resses my whole life, but they’d always been too old, too tall, and too intimidating Then

wait-it occurred to me at that moment that this particular wawait-itress was probably about my age

I also realized that the only reason she seemed tall (as all waitresses did) was that shewas standing and I was sitting down Gosh, I thought, wouldn’t it be great if I had thecourage, the gumption, to approach a young woman like that? If only

And so went my self-recriminations Every day I saw women I found attractive butcould never imagine approaching one of them, much less connecting with one Instead,riddled with anxiety, I’d start to feel the onset of a panic attack at the very prospect ofapproaching such an alluring person What would I say? She’d probably say no anyway,

so what’s the point? My self-esteem was already so fragile that there was no way I couldput myself in greater jeopardy

So the dialogue continued inside my head as I watched the waitress serving hertables with such grace and poise I pretended to follow the conversation at my own table,nodded my head when required, but still kept wondering what it would be like to be thekind of person who had the confidence to do what he really wanted, who could suppresshis anxiety to the point where it would no longer incapacitate him

It seemed to come from nowhere—this insight that would forever change my life

I thought about the prospect of going back to my room at school, spending all night tasizing about this waitress and what we might have shared together I would beat myself

fan-up over my spinelessness I would replay all the things I could have done, should havedone, if only I could manage my stress But it was hopeless I would never be able But then I had the most amazing revelation I realized, with crushing assurance,that nothing this woman could possibly say to me could be any worse than what I wouldsay to myself after I returned home If, by some miracle, I did have the courage toapproach her and to hang out, what was the worst possible thing that could happen? Shecould say no—that was about it I supposed she could spit in my face, or laugh hysteri-cally at my audacity to think I was good enough to go out with her, but even I realizedthat that was highly unlikely It was far more reasonable to expect that she wouldpolitely, even sensitively, decline my invitation Period And would that really be so bad,especially when compared to the alternative—leaving without even trying?

It was like someone, or something else, was controlling my body when I roseslowly from my seat and walked toward the station where the waitresses were foldingnapkins and gossiping (or whatever they do when they are alone)

I took a deep breath, my heart pounding so hard it could feel my ears vibrating, and

in the most awkward way imaginable simply blurted out, “Hey, would you go out withme?”

Needless to say, the waitress was a bit taken aback and politely declined But here’sthe amazing thing: rather than feeling devastated by the rejection, I felt this amazingsense of power I felt giddy with the realization that nothing she could say to me, or thatany woman could say, could be worse than what I did to myself If this was the worst thatcould happen, heck, what had I been waiting for all these years?

I walked back to the table as if I was floating on a cloud, with a huge grin on myface I looked up and saw that everyone in my family had been watching me, wonder-ing what I had been up to When they saw my goofy expression, one of my brothersimmediately started teasing me: “Jeffrey has a girlfriend Jeffrey has a girlfriend.” I wasfeeling so good I just ignored him, and everyone else

Dinner continued and I reworked in my head all the details of the interaction withthe waitress I was puzzled: what had made the difference? Had I really overcome a life-time of inhibition to start taking constructive risks? Or was this just a one-time fluke?

I decided to test my new-found courage by approaching not just one other waitress in the restaurant, but two of them! Again, my awkward and abrupt approach resulted in the same outcome but I didn’t care This was an exercise in surviving rejection and learning

to live with it so I didn’t care how they responded; it was all about how I handled the ation afterwards I learned during that dinner that ignoring my stress, or rather keeping itunder manageable control, could potentially change my whole life

situ-I’d like to say that the following week I went back to college and everything workedout as I hoped, completely reversing a lifetime of compliance and risk avoidance I did

have some setbacks and, at times, reverted to old habits But by the time that year was

over I had refashioned myself into a new person

My interest in managing stress began during that family dinner The first step was

to overcome my fear of rejection Next came a series of lifestyle changes: I started

exer-cising regularly and developed strength and perseverance I became a marathon runner

and took up other sports that I could do at my own pace I started taking all kinds of

con-structive risks—physical ones, but also emotional risks Eventually, I decided on a career

as a psychologist because I so enjoyed speaking in the language of emotion

Now, many years later, I am proud to say that although there are still times that

I feel recurrent episodes of stress and anxiety, I have the skills and training to manage

these feelings so they do not stop me from meeting my goals

I have climbed mountains and faced death in wilderness areas while lost on myown I have given speeches to an audience of thousands—in languages that are not my

own I have appeared on national talk shows before live audiences I have approached

many people who absolutely terrify me but still intrigue me enough to make it

worth-while to put myself on the line I cannot say—I can never say—that I ever conquered my

anxieties But I can say that I have learned to keep them under control

S U M M A R Y

In this introduction to the text, we have tried to be honest and realistic regarding what

lies ahead We can’t imagine that there is any class you could ever take that could be

more valuable and transformative than one that teaches you to prevent and manage

stress Such skills not only will help you to be more productive and perform at higher

levels in all areas of your life, but, just as importantly, will help you to enjoy more what

you are doing and how you are living

Our personal introductions were intended to demonstrate that although we areexperts in the area of stress, conducting research in this area and teaching the class for

many years, we are also works in progress We so enjoy studying this area because we

find it so personally relevant We hope our own stories intrigue and inspire you enough

to trust that what we have to offer has been tested not only by research in the field, but

by our own experiences As much as possible, we try to practice what we will teach you

No matter what you view as your own strengths or weaknesses, no matter what yourpersonality is like, or your life experiences, or what you have endured or suffered, or

how you feel vulnerable, you can make great strides in your personal functioning This

study of stress management will teach you what you need to know to function more

effectively in every aspect of your life

F O R R E F L E C T I O N

Note: This is the first of many reflective exercises and activities that you will

be asked to complete throughout this book They are intended to help you put into practice the principles associated with lasting change In other words, if you want the things you learn in this class to stick with you over your lifetime, rather than merely memorize them and forget them after the semester is over, then

it is critical for you to apply the ideas to your own life This means taking an active part in reflecting on the content and making it relevant to your particular situation Personalizing the concepts and applying the principles to your daily life will help you make changes in your own life.

In the personal stories of your authors, we disclosed a few of the critical incidents of our lives that have most shaped who we are, including career

and personal lifestyle choices Note below several of your most significant

life experiences that influenced you, for better or worse.

A N O T E T O O U R F E L L O W

I N S T R U C T O R S

You would no doubt agree that teaching stress management is among the most

enjoy-able and fulfilling assignments anyone could ever imagine We are privileged to teach

students life skills that that are not only designed to help them improve their academic

success and life satisfaction, but will be incredibly helpful throughout their lives Yet this

is also a very challenging class to structure because of the immense breadth of content

that must be covered, spanning the fields of health, physiology and anatomy, psychology

and other social sciences Within a single semester we introduce students to significant

theory, research, and practice related to the ways that stress intersects with so many aspects

of their daily lives We also have the ambitious goal that we want students to actually

internalize many of the ideas, skills, and techniques so that they can apply them in a

variety of situations and contexts

We have created a book that students will not only enjoy reading, but that will alsoencourage them to incorporate what they learn into their lives long after the course is

over When teaching this course, we have found time and time again that the material

often doesn’t stick, which is frustrating because we firmly believe that this could be the

single most important class in the entire curriculum, one that will stick with them long

after they graduate To help achieve this goal, we have incorporated many exercises and

activities throughout the book, especially those designed to make students active

learn-ers, applying concepts immediately to their own lives Many additional activities and

other resources can be found on the book’s companion website and accessed through

your course management systems

Some of the main features you will find in the book and on the website include:

• Keeping with our theme of encouraging students to really incorporate theseskills into their lives, readers will hear a number of different voices throughout

the book Each of us speaks directly to the readers in several Voice of the

Authors boxes in which we describe stressful moments from our own lives and

describe what we have learned from them

• Similarly, the Voice of Stress boxes give readers different perspectives on life stressful situations Additional Voice of Stress Management boxes present

real-success stories from people who have overcome significant stressors or difficultperiods in their lives, offering tips and mini-strategies from the real world

• Each chapter begins by presenting a series of Key Questions that will be addressed, and concludes with a brief Summary section.

• For Reflection exercises are scattered throughout each chapter, and give the

reader an opportunity to pause and reflect on the book material, making

connec-tions to her own experiences Selected Answers to one or two of these exercises

can be found at the end of each chapter

• Other chapter-ending features include additional Review Activities and

Ques-tions for Review, both designed to test the student’s retention of the material

covered in the chapter

Instructors who adopt the text are encouraged to make use of the robust ancillaryresources designed to make the course even more engaging and memorable, all of which

can be accessed at www.routledgementalhealth.com/stress-management As a

qualified adopter, you will have:

✓ Powerpoint lecture slides that can be modified to fit your own teaching styleand approach All of the photos, figures, and illustrations included in the textare also made available

✓ A chapter-by-chapter Instructor’s Manual that includes Student Objectives and

a detailed Chapter Outline

✓ A Test Bank featuring a variety of exam question types, broken down for eachchapter

✓ A sample syllabus to help organize your course and lesson plans

✓ Additional activities and exercises that can either be assigned or incorporatedinto review sessions

Also housed on this companion website

(www.routledgementalhealth.com/stress-management) are original video and audio programs that complement the text At the

site, Students and Instructors can both access the following media resources, at no tional cost:

addi-Video:

• A brief Introduction by David Chen

• Eleven videos of real students discussing stressful situations in their own livesand how they dealt with them

• An additional video segment features author David Chen telling his own sonal story

• Breathing Meditation for Awareness

• Progressive Muscle Relaxation

About the Authors

Jeffrey A Kottler is professor of counseling at California State University, Fullerton.

He is the author of over 80 books which have been translated into 15 languages Some

of his best known works are: On Being a Therapist, Making Changes Last, Travel That

Can Change Your Life, The Last Victim, Changing People’s Lives While Transforming

Your Own, The Assassin and the Therapist, and Divine Madness; he has also written

dozens of textbooks for practicing psychotherapists and teachers

Jeffrey has been a practicing psychologist for 35 years, specializing in stress andadjustment issues He has been a Fulbright Scholar in Peru, Thailand, and Iceland, as

well as working extensively in Australia, New Zealand, and throughout the world He is

Founder of Empower Nepali Girls (www.EmpowerNepaliGirls.org), which is devoted to

preventing sex slavery in Nepal by supporting the education of girls at risk who could

not otherwise attend school Most recently he has been working with students to study

the experiences of stress in a half dozen countries around the world

David D Chen is an associate professor of kinesiology at California State University,

Fullerton He has authored and coauthored numerous research articles in the areas of

motor learning, sport psychology, and tai chi His research interests include human

per-formance under stress, feedback strategies in motor skill learning, and self-regulated

learning He has taught or is teaching motor development, motor learning and control,

stress management, advanced studies in teaching human movement, sport psychology,

and tai chi

xix

Understanding the

Nature of Stress

• 1 The Meaning of Stress

• 2 The Body’s Reactions to Stress

• 3 Sources of Stress across the Lifespan

• 4 Adaptive and Maladaptive Behavior

• 5 Individual and Cultural Differences

I

2

The Meaning of Stress

It is Monday morning and the sun is just beginning to peek over the horizon, casting

a dim shadow through the slats of the window blinds In the mostly darkened roomyou can see the barest outline of a body sitting at a desk with his head cradled in hisarms, resting near a laptop The surface of the desk is littered with papers, cups half-

filled with coffee, crushed cans of caffeinated energy drinks, and the remnants of pizza

crust If you look closer you can see that the person, although half-dead to the world, is

not quite sleeping: his eyes are barely open, red and blurry It has been a long night without

sleep and Blaine has been prepping for an exam scheduled that morning, as well as a

paper due in the afternoon

Somehow, some way, Blaine has got to regain some energy to get through the day,

stay awake through his classes, and then show up for his part-time job It’s been

espe-cially tough lately with money so tight and getting worse He can’t afford to miss a day

of work or he’ll risk lowering his main source of income With problems of their own,

his parents are in no position to help him much

To make matters even more challenging, Blaine and his girlfriend have been fightinglately She complains that they never seem to have much time to be together anymore

—and when they do hang out, he is so tired that all he wants to do is watch TV or play

computer games In addition, he just hasn’t been feeling well lately Headaches have

been occurring with greater frequency He isn’t sleeping well—when he finds the time to

sleep at all His grades are slipping because he can’t find the time to study as much

as he’d like About the only thing that gives Blaine some relief is drinking beer with

friends, but then he has trouble waking up the next morning to make his early class

He wonders how he will ever dig himself out of this hole

Although this scenario is not exactly uncommon among college students, we hopethat it isn’t too familiar to you Unlike some people you may know whom stress has

buried beyond recovery, Blaine actually made significant progress in regaining control

of his life A friend had recommended that he take a stress management class so they

could coordinate their schedules As it happened, Blaine agreed, mostly because it was

offered at a convenient time and seemed like an easy grade But once he began learning

about the cumulative effects of stress on his body and well-being, Blaine began

experi-menting with some of the methods introduced in class and his text More than anything

else, it was the social support he felt from others in the class that encouraged him to

incorporate the new stress reduction strategies into his life

Regardless of your particular age, gender, socioeconomic background, major, family situation, and the college you are attending, managing stress effectively is perhaps

the single most important skill to get the most from your experience and perform at the

1

1

3

K E Y Q U E S T I O N S I N T H E C H A P T E R

l What are the different ways that stress can be defined and conceptualized?

l What are the different ways that people respond to adversity in their lives?

l How can you assess the signs and symptoms of stress as they occur in yourself and others?

l Stress is ordinarily thought of as a fairly negative state, something to be avoided whenever possible But how can stress be highly functional and operate as a survival mechanism?

l What is the general adaptation syndrome (GAS) and how does it function during times of stress?

l What is the primary goal of stress management? Can such a program completely eliminate stress?

l What are major sources of stress and how are they recognized?

l How do you interpret the following statement: “Stress is not what exists on the outside, but how you perceive a situation on the inside?”

highest level Among “nontraditional” adult students, who represent one-third of collegeenrollment, there are added challenges to balance school with jobs, family, and personalresponsibilities (Giancola, Grawitch, & Borchert, 2009) According to a number of surveys

of college students conducted by the Associated Press (2009), the American College

Health Association (2009), and the Chronicle of Higher Education (2008), 85% report

that stress is a major problem and the single greatest obstacle to success Apart fromactual performance in classes and grades achieved, excessive stress affects almost everyaspect of life satisfaction In recent times, economic problems have led to cutbacks inclasses, staff, faculty, and services on campus Scholarships have been reduced during atime when three-quarters of all students graduate with debt (Berg-Gross & Green, 2010)

Stress means different things to different people To some, it represents a completebreakdown in their lives; to others, it means a minor annoyance that is best ignored, ortolerated; and in some circumstances, stress means an opportunity to rise to new levels

of performance in a variety of areas Some people tolerate stress reasonably well, somefall apart, and others hardly seem to notice the pressure in the first place

What Is Stress Anyway?

This may seem like a rather obvious question Everyone knows what stress is, or at the

very least, knows when they are experiencing it firsthand or witnessing its effects onsomeone close to them

Stress is that feeling when you can’t seem to sit still, when your thoughts are racingand you feel out of control Your body feels tense, as if tied into a knot You feel revved

up but can’t figure out where to direct your energy Time pressures weigh down on you

Concentration seems difficult

Intense pressure: you feel it in your neck, in your back, in your belly You noticeyour jaw muscles are clenched There is, perhaps, a throbbing in your head Your heartrate has increased, and your hands feel clammy

This is stress, or at least some of the symptoms As you will learn, there are manyothers that you will learn to recognize, and understand how they develop There are alsodifferent kinds of stress, some of which break down your body and mind while othersactually help you perform at peak levels

One definition of stress is that it represents both a psychological and a

physio-logical reaction to a real or perceived threat that requires some action or resolution It

is a response that operates on cognitive, behavioral, and biological levels that, when sustained and chronic, results in significant negative health effects (Linden, 2005)

Stress is, therefore, what happens when life exerts pressure on us, but also the way it

makes us feel According to landmark brain researcher Bruce McEwen (McEwen, 2002;

McEwen & Wingfield, 2010), it is both a stimulus and a response.

A more humorous (and perhaps accurate) description of stress is offered by Elkin(1999, p 24) as the condition created when “your mind overrides the body’s basic desire

to choke the living daylights out of some idiot who desperately deserves it” (Note: There

is a high likelihood that your friends and family are going to ask what you are learning

in “that stress class you are taking.” Please offer them the first definition rather than the

second one.)

Stress is actually a survival mechanism, programmed a long time ago, to increaseinternal awareness of danger and transform all the body’s resources to a heightened state

of readiness It is, essentially, the experience of perceived attack It doesn’t matter

whether the threat is real or not; the autonomic nervous system (think “automatic”)

is activated This system works well only when it turns itself on and off within a

reason-able period of time so as to not wear out its welcome (and deplete your energy)

Unfortunately, half of all Americans report significant stress in their lives Even more

disturbingly, according to a recent survey, most people don’t intend to do anything about

it (Schuler, 2006)

There is a fairly good possibility that you are experiencing some degree of stress inyour life right now, perhaps this very minute How do you know when you are stressed?

Stress responses have some common symptoms and signs, but they are also highly

indi-vidualized, impacting your body, your internal thoughts, your emotional reactions, and

your behavior (see Table 1.2 later in the chapter)

Stress symptoms are the body’s way of getting your attention to tell you: Look,

you’ve got to get your act together I’m a little tired of you running me ragged I’m going

to annoy you until you do something about this situation And if you don’t pay attention

to me, well then, I’ll just have to figure out more ways to get to you.

If your body could talk to you, it might communicate this message The problem isthat stress symptoms are not always obvious and direct; sometimes they can become

disguised or rather subtle and their messages somewhat clouded

Meanings of Stress

Trey thought he had things under control He was well organized and intentional in

almost everything he did He had a plan for his life and clear ideas about just how he

wanted to reach his goals

In addition to his college courses, Trey had a good job and was well respected atwork There were opportunities for advancement within the company and almost no limit

to how far he could rise, especially after he completed his degree He was involved in a

long-term relationship with Mia, whom he had been seeing since they were both sixteen

Trey was doing well in school, enjoyed a good social life with friends, and was ting along well with his family He was in good health, exercised regularly, and—except

get-for a fondness get-for Hawaiian pizza with extra ham—monitored his diet

So it was all the more surprising, given how well everything seemed to be going inhis life, that he suddenly (or maybe it was gradually—he couldn’t remember) started to

lose control First the headaches started, and this was highly unusual for him; he was

almost never sick He tried to ignore them and, when that didn’t work, starting eating up

to a dozen aspirin a day to reduce the throbbing

Eventually, Trey decided to visit his doctor, but after a thorough physical exam,

no physiological cause was found His blood pressure was a little high, as was his

cholesterol, but otherwise he was in reasonably good shape

“They seem to be stress headaches,” the doctor suggested to him “Are you under alot of pressure lately?”

Trey shrugged “Not really,” he replied “Everything is going pretty well in my life

I’ve got everything under control.” These were the mantras of his life, his trademark

responses every time anyone asked him how things were going Indeed, Trey was much

admired by friends and family alike for his calm, controlled demeanor and ability to keepthings under control.

Here is the key question: what is the particular meaning of Trey’s stress symptoms?

Later, when he was asked this question by a friend who had taken a stress managementclass, all Trey could do was shake his head in frustration

It turned out that Trey’s strengths were also his weaknesses He was absolutelyrelentless in his desire to maintain control and keep everything on course to follow hisplan He would be graduating in two years (19 months to be exact) He and his girlfriendwould then get married and have four children, two of each gender By then he would be

a regional manager for the company They’d own a home in a particular neighborhoodthat appealed to him He even knew what kind of car he wanted once he had achieved hissuccess

So, what’s the problem? And why would a stress response like headaches emergejust when things seemed to be so under control? What was the meaning of stress inTrey’s life? How were these symptoms trying to get his attention to look at something hewas ignoring? (See For Reflection 1.1.)

Avoiding the situation did not work for Trey, nor did medicating himself first withaspirin and later with increasing quantities of beer The headaches worsened Then othersymptoms developed, including a skin rash

It took some time before Trey confronted what was going on in his life He realizedeventually that he so over-structured and controlled his life so he didn’t ever have tothink about where he was headed and whether, in fact, he actually wanted to reach thegoals that he had declared As it turned out, he was very fond of his girlfriend but he didn’t love her, and he certainly didn’t want to spend the rest of his life with her But for years he hadn’t wanted to hurt her feelings He wanted to do the right thing, so thatmeant continuing to live a lie

And this great job he had, and bright future with the company? He never reallywanted to be in business That was the influence of his father, who was so proud of him

Now that he realized it, Trey had no idea what he wanted to do with his life because ithad never seemed like he had a choice

Now that the headaches had forced him to stop doing what he was doing, Trey hadthe opportunity to actually consider where he was headed and whether he really wanted

to go there Once he discovered the particular meaning of stress in his life, the headacheswent away (although the skin rash stuck around for almost a year afterwards, a residualreminder to follow through on his new commitments) Finding meaning in stress is thusnot just an academic exercise but often is absolutely necessary to put life challenges inperspective and allow you to restore feelings of well-being after experiencing disap-pointment or trauma (Fontana & Rosenheck, 2005)

What’s in a Name?

Stress is the name given to the pressure that cracks bridges or the force that places strain

on an object or body It is synonymous with tension, fatigue, failure, trauma, or

diffi-culty The word is derived from the Middle English stresse, meaning “hardship,” and the Old French estrece, meaning “oppression.” More often than not, the subject of stress is

thought of in the most negative terms possible—it is something to be managed, or atleast tolerated, but rarely understood

The term has cropped up in medicine since the seventeenth century, recognized byphysicians as the cause of physical illnesses that might result from social pressure Itcame into common usage during the 1950s when a Canadian biologist, Hans Selye, firstpublished a book that adapted the concept of strain on physical structures from engineer-ing to describe what happens to the human body during times of crisis In retrospect, Selyedidn’t much like the term after it became popular—much preferring “strain”—but bythen it was too late (you can’t exactly issue a word recall)

F O R R E F L E C T I O N 1 1

What ideas might you have as to what stress could mean in Trey’s life? What

might he be ignoring that needs attention? What are the principal repeating

themes in this narrative?

Given that control and (over)planning are such an ingrained part of Trey’s life,

is it any wonder that this might suppress other desires and dreams that he does

not allow himself to think about?

There are several important questions that are useful in identifying the meaning

of disguised or subtle stress Consider each of them in response to Trey’s

situation.

1 What does Trey need to look at that he might be ignoring?

2 How are the stress symptoms capturing Trey’s attention?

3 What might the symptoms be communicating to him?

4 What would it be like if he tried doing something else, or followed another

path?

Think of a situation in your own life in which you feel perplexed by chronic

symptoms of distress that won’t go away no matter what you do Ask yourself

some of the same questions that you applied to Trey’s case: what particular

meaning does the problem have in the larger context of your life? In other

words, what function might it be serving to get you to examine something

important that you might be ignoring?

The seventeenth century of Rousseau, Descartes, and Locke was called the “Age ofReason”; poet and essayist W H Auden announced in his Pulitzer-Prize-winning verse

of the same name that the twentieth century was the “Age of Anxiety.” This catchphrasesoon became popular, resulting in dozens of books about how to find the balanced life

during a time with so much daily pressure In 1983, the cover of Time magazine

proclaimed that we now live in an “Age of Stress.” Our lives are “consumed by demandsfor our resources and threats to our well being” (Hobfoll, 1998)

Judging by the hundreds of books and thousands of articles published each year

on the subject, stress has become the obsession of our time Doctors warn about the epidemic of health problems that result from excessive stress Employers worry aboutthe effects on absenteeism and work productivity Relationship experts cite stress as amain factor in divorce and other interpersonal conflicts

The problem of stress has become so pervasive that people flock to courses on stressmanagement, meditation, and yoga Individuals hire personal trainers and join healthclubs, while businesses hire consultants to reduce stress in the workplace Stress hasbecome the universal challenge of our time, the condition that can suck the fun out of lifeand kill us just as surely as any plague we faced in ancient times

How Is Stress a Problem?

It has been estimated that 75% to 90% of all visits to a primary care physician arebecause of stress-related disorders (Rosch, 1991) These include stomach ailments, tension headaches, high blood pressure, addictions, and almost any other disease you canthink of Stress is linked to the six leading causes of death in North America (see ForReflection 1.2)

Answers are at the end of the chapter.

Nine out of ten adults report that they have experienced serious stress at some time

in their lives; almost half of these people say that their symptoms were serious enough todisrupt their lives Some people experience stress to the point where they cannot functionwell on a daily basis, cannot enjoy a decent night’s sleep, and feel ravaged by the effects

in such a way that their relationships are impaired and their productivity compromised

Consider yourself fortunate if you are managing to cope reasonably well with thestresses you face in your life Rest assured that there will come a time in the near futurewhen you will be tested in ways you never imagined Preparation is the key to preventingserious problems; hence, the purpose of this text is to equip you with those skills you willfind so helpful during times of crisis

Stress as a Stimulus or Response

In both the physical and psychological worlds, stress implies a judgment that something

is damaged as a result of extreme pressure For our purposes, in talking about stress in

relation to human functioning, it is most often thought of as either a stimulus or a

response In the first case, stress is the description we give for someone or something

that is putting pressure on us to do something that feels beyond comfortable limits It is

an external pressure (“Could you help me write this paper?”), event (earthquake), or

incident (car accident) that produces a response

In the second case, with stress as a response, it represents the result of internal

or external pressure Regardless of what happened in the outside world, the internal

mechanisms of the body and mind activate stressful reactions

In both instances, you can see a clear linkage between something that happens in

the world and how the person responds afterwards Stressors are those stimuli in the

environment or daily life that result in perceived pressure Perception is a key factor in

this definition because people respond in such different ways to exactly the same stimuli

For instance, imagine the following: your instructor announces that she has changed the

requirements of the course and now expects you and all your classmates to come up in

front of the room and tell a story about the time you each felt most stressed in your life

We’re willing to bet that some people might respond to this invitation with abject terror

(“Oh my gosh! I can’t do that!”) And yet, there are a few others who would rub their

hands together with glee, thinking to themselves: “What fun! That sounds so interesting.”

There are some stressors that would likely produce anxiety in almost anyone (death

of a loved one, catastrophic illness, divorce in the family, loss of a job, failing a class)

and others that depend on a number of factors including a person’s prior experiences and

history, personality style, resources available, and resilience Regardless of these variables,

research consistently finds that certain life events act as stressors to produce extreme

emotional reactions that include anxiety, depression, and other negative emotions

TABLE 1.1 Stress as a Stimulus or a Response

Stimulus

• She’s stressing me out with her

demands.

• The deadline is putting stress on me.

• This class is so stressful the way the

instructor organizes things.

Response

• I am so stressed after the exam.

• I feel the stress in my shoulders and

my neck.

• When you said that, you made me

so upset afterwards.

A Selected History of Stress Research

It is only relatively recently in human history that stress has become a major issue of

dis-cussion—in the previous centuries people usually died before the ravages of

stress-related illnesses could take a toll Yet stress has been with us since the first humans dealt

with the life-threatening challenges of hunting—and avoiding being the hunted

Ancient Contributions

Our ancestors developed coping mechanisms to handle the stressors specific to their

times In a Chinese medical classic, Yellow Emperor’s Classic on Internal Medicine,

written more than 2,000 years ago, the principles of moderation and balance in living

were presented Just as adherence to these guidelines would promote health, their

violation was believed to cause sickness

On the other side of the world, at about the same time, the Greek physician andfather of modern medicine, Hippocrates (460 –377 bc), observed that the experience

of disease offers some benefits in that the pathos (suffering) is always followed by the response of the body and the ponos (the toil of being sick) Hippocrates was also

among the first to observe that emotional stress might put pregnant women at risk formiscarriages and so cautioned them to remain as calm as possible

in that both require the process of converting stored energy through a combustion process in order to move some mechanical parts to generate motion To explain how aliving organism could move itself without any external assistance, he developed the

concept of internal environment that caused the step-by-step processes living

organ-isms employ in moving themselves

Bernard believed that complex living organisms depend on both the external

environ-ment and the internal environenviron-ment Based on his thinking, one major function of the

internal environment was to keep the body constant in the face of the changing external

environment through various chemical and physical responses This concept of

home-ostasis states that all the physiological systems work in unison to keep the internal

envir-onment stable and balanced If the body’s core temperature, for example, should movebeyond relatively small established limits, then immediate efforts are made to lower thetemperature through sweating, or raise it through shivering Likewise, if the body shouldbecome activated during an emergency, it will attempt to stabilize itself after the emergency has passed

About the same time that Bernard was exploring the nature of balance within thebody, Charles Darwin was sailing around the Galapagos Islands in South America, chart-ing the nature of evolution Based on his years of study—first of the ways that animalsdeveloped adaptive responses to their environment, and later applying these observations

to humans—Darwin was among the first to theorize that fear and stress are useful or otherwise they would have extinguished themselves a long time ago According to evolutionary theory, fear responses are passed on from one generation to the next becausethey serve as a survival mechanism Darwin further noted that humans could display arange of stress/fear emotional responses, describing the behavioral changes that takeplace, including facial expressions and physiological changes

A few decades later, into the twentieth century, Sigmund Freud presented the most coherent theory of emotions, making a clear distinction between fear and anxiety

The former could very well be part of what Darwin considered adaptive stress, while

“neurotic anxiety” is a chronic condition of permanent apprehension Freud eventuallydeveloped a whole theory of psychological disturbance based on the conscious andunconscious fears that motivate behavior

A contemporary of Freud’s, Walter Cannon (1932), was the first physiologist

to begin talking about stress in the context of emotional responses He worked with thehomeostasis concept developed by Bernard, that humans develop coping mechanisms

to keep the internal environment constant and secure the integrity of the cells and organsinside

Cannon’s contributions went far beyond the mechanisms of how the nervous andendocrine systems regulate internal stability He believed that psychological disturbancesand emotional distress can compromise the system in such a way that it fails to respondappropriately and can compromise health He also gave a name for the stress response

that becomes activated during perceived threats: the fight-or-flight reaction This will

be discussed in detail a little later in the chapter

General Adaptation Syndrome

Hans Selye, an endocrinologist (someone who studies the glandular system) from

Canada, built on the work of Cannon and others to give the area of stress research greater

legitimacy Selye is recognized as one of the parents of stress research, a title that he

earned through the most serendipitous of circumstances

In the early stages of his career, Selye was investigating hormonal processes byinjecting rats with various chemical substances Alas, he may have had a brilliant mind

but less than nimble dexterity He was terribly inept at injecting his rats, at times

mis-handling them, even dropping them accidentally, then chasing them around the lab Once

he relocated his subjects, he discovered that they had suffered a number of physiological

changes that were different from those that had not been terrorized: their immune

systems malfunctioned and they developed ulcers Much to his surprise, Selye learned

that psychological trauma could actually stress the body to the point that it makes rats

(and humans) sick

Selye experimented with placing the rats under various challenging environmentalconditions He subjected some to Sahara-Desert-like conditions, and others to a simu-

lated Arctic environment He introduced toxins into their cages and tried isolation, then

extreme crowding Eventually, a consistent pattern of bodily changes emerged The rats’

adrenal glands became enlarged from overwork Other organs such as the thymus,

spleen, and lymph nodes changed dramatically Selye called this consistent pattern of

changes in response to demands in the external environment the general adaptation

syndrome (GAS) This means that when someone is stressed by a crisis, perceived

danger, or threat, the brain activates more than 1,000 different chemical responses to

deal with the situation (see Figure 1.1)

Brain becomes more alert

• Stress hormones can affect memory

and cause neurons to atrophy and die

• Headaches, anxiety, and depression

• Disrupted sleep

Digestive system slows down

• Mouth ulcers or cold sores

Heart rate increases and blood pressure rises

• Persistently elevated blood pressure and

heart rate can increase potential for blood

clotting and risk of stroke or heart attack

• Weakening of the heart muscle and

symptoms that mimic a heart attack

Adrenal glands produce stress hormones

• Cortisol and other stress hormones can

increase central or abdominal fat

• Cortisol increases glucose production in

the liver, causing renal hypertension

Breathing quickens

• Increased susceptibility to colds and respiratory infections

Skin problems such as eczema and psoriasis

Immune system is depressed

• Increased susceptibility to infection

• Slower healing

Digestive system slows down

• Upset stomach

Reproductive system

• Menstrual disorders in women

• Impotence and premature ejaculation in men

Muscles tense

• Muscular twitches or nervous tics

Immediate response to stress

Effects of chronic or prolonged stress

Other possible effects of chronic stress

FIGURE 1.1 General adaptation syndrome.

The general adaptation syndrome (see Table 1.2) goes through three phases, if necessary, each one activated if the previous stage fails to be adequate The first phasesignals an alarm reaction—the fight-or-flight response described earlier This is a short-term, quickly mobilized system to deal with threats as quickly as possible The secondphase is initiated once the body realizes that this will not be a sprint, but a marathon.

Long-term reactions are launched to try to keep the system functioning in the face ofenduring assaults At this juncture, either homeostasis is restored or the third phasebegins Finally, exhaustion sets in with the body systems depleted This explains, in part,why people subjected to long-term stress develop various illnesses and chronic prob-lems: their defenses have been breached

The result of Hans Selye’s research was not all bad news He also discovered that

an animal’s ability to handle stress could be enhanced if it was repeatedly exposed to

mild or moderate challenges presented at incrementally higher levels This is exactly the

strategy that is now used by psychologists to treat phobias using systematic

desensitiza-tion Someone who is irrationally afraid of mice, for example, would be gradually

exposed to tiny, non-threatening cartoon character mice, perhaps even Mickey Mouse

Using relaxation training (described later in this book), the subject is taught to stay calmwhile increasing tolerance for progressively more stressful stimuli This could include aphotograph of a mouse, then a movie of a mouse, then a mouse in a cage at the far end

of the room, then a mouse being held by someone else, until such time as the person canactually hold the mouse himself

We can strengthen our capacity to deal with stressors in the future by preparing andtraining for them This is just what coaches and performance experts try to do with athletes

so that they can remain in Phase 1 of their GAS without suffering lingering side-effects

It can be concluded from Selye’s findings, and subsequent research, that exposure

to stressors can have long-term consequences, which are harmful and even life-threatening

or in some circumstances can be beneficial Other investigators have since found that theextent to which the stressor impacts the body for better or worse depends not only on theintensity and magnitude of the stressor, but also on how we perceive the stressor and ourability to cope with it (Ganzel, Morris, & Wethington, 2010)

Allostasis

The concept of homeostasis developed by Cannon implies that once the balance isrestored, the body will return to its static and unchanged pre-stress state Selye pointedout that chronic stress brings certain costs to the organism when its resources for copingare depleted

TABLE 1.2 Stages in the General Adaptation Syndrome

Phase 1: Alarm reaction The body’s first exposure to the stressor that disrupts its homeostasis starts a series of physiological reactions through the autonomic and endocrine systems The endocrine system will produce corticosteroids that will supply the body with resources to fight

or flee Unfortunately, these corticosteroids may weaken the immune system.

Phase 2: Resistance The continued presence of the stressor will activate the stage of resistance during which the purpose is to sustain life and make necessary adaptations as long as the required fuel and biochemical material are available It is like a gun that keeps firing over and over until it runs out of ammunition, or the shooter’s finger cramps to the point it can

no longer function.

Phase 3: Exhaustion

If the stressor remains present (or is believed to be present), the body will deplete

its stored energy to the point that it is no longer capable of mounting any resistance.

Mental and physical energy are on empty Exhaustion sets in Permanent damage will result, leading to illness or even death.

Noting the cost of achieving this homeostatic balance in the face of stressors,

Sterling and Eyer (1988) coined the term allostasis to mean the combined physiological

and psychological adaptation to the experience of threats or adversities In other words,

the body will experience wear and tear and decreased capability to cope with future

stressors as long as the threats continue and the need to maintain homeostasis still exists

Bruce McEwen, a renowned neuroendocrinologist, expanded the idea of allostasis by

creating the concept of allostatic load to describe what happens when the same adaptive

(GAS) system that was designed to protect us actually tears us apart (McEwen & Stellar,

1993; McEwen & Wingfield, 2010) The allostatic load comes out of balance when there

is a systemic malfunction that occurs either by repeated exposure to perceived threat, or

poor health and lifestyle choices on the part of an individual This would be like

some-one constantly revving the engine of a car to the highest RPM, overheating the engine,

and never changing the oil or adding lubrication

McEwen (2002) cites the example of spawning salmon as an extreme case of whatcan happen when the allostatic load becomes excessive Chinook salmon of Alaska will

swim up to 60 miles per day, upriver, against the current, even jumping up waterfalls, in

order to lay and fertilize their eggs During this heroic and improbable journey, the

salmon rely on every possible reserve of hormones and energy to complete their task In

the end, the constant stress on their system, plus the draining of their reserves, kills them

They literally die of overstress

This phenomenon of death from overstress occurs within our own species as well,mostly in the form of suicide Some of our most creative geniuses imploded as a result

of internal and external pressures that pushed them over the limit of what they could

stand In studies of such lives (Jamison, 1993; Kottler, 2006), of innovators in art (Mark

Rothko, Vincent Van Gogh, Arshile Gorky), literature (Sylvia Plath, Virginia Woolf,

Ernest Hemingway), and music (Pyotr Tchaikovsky, Kurt Cobain), it can be found that

consistent exposure to chronic stress, combined with feelings of perfectionism, often

leads talented people to drain their reserves like salmon

The concept of allostasis has further enriched our understanding of adaptive anisms in the face of life’s threats or traumas It emphasizes that even minimal stressors

mech-can cause long-term damage to your health when they endure, demanding ongoing

coping responses from the body

Responses to Stress

There are a number of ways that people respond to stressful situations in their lives,

depending on their personalities, their cognitive style (characteristic thinking patterns),

their background and prior experiences, their gender and ethnicity, and a host of other

factors These responses may be grouped according to physiological reactions (covered

in Chapter 2), emotional reactions (reviewed in Chapters 3 and 4), cognitive reactions

(discussed in Chapter 6), and systemic reactions (presented in Chapter 12) Stress responses

occur on multiple levels, and within many systems, in the body and mind (see Table 1.3)

TABLE 1.3 Major Responses to Stress

Physiological Cognitive Emotional Behavioral

Heart palpitations Impaired memory Fear Crying

Sweating Disorientation Worry Rage

Dry mouth Unrealistic demands Panic Withdrawal

Fatigue Disasterizing Guilt Substance abuse

Insomnia Illogical thinking Anger Self-medication

Nausea Externalized blame Denial Impulsiveness

Dizziness Obsessiveness Hopelessness Phobias

Loss of appetite Loss of humor Numbness Hyperactivity

High blood pressure Suicidal ideation Depression Lethargy

Personality traits Surrender Despair Aggression

Weight loss or gain Excessive fantasies Impatience Rambling

Biologist Robert Sapolsky (2004) talks about the uniquely human response to danger as compared to herd animals Whereas zebras become stressed only during times

of immediate threat from a predator, we are the only species that gets upset over thefuture We spend more time worrying about things we can’t control than we do actuallypreparing to meet the challenges Imagine a zebra, or a penguin for that matter, thinking

F O R R E F L E C T I O N 1 3

How do you know when YOU are stressed?

Everyone reacts to stress in different ways, even if there are some common signs and symptoms Some people have difficulty sleeping or lose their appetites, while others sleep too much and go on eating binges Some people have thoughts of doom and gloom, imagining the worst, and others keep an upbeat state of mind.

Review Table 1.3, then consider how you characteristically respond to stress in your life, in the past as well as the present.

What are your typical reactions?

Where do you feel stress in your body?

What is the usual way that you think when first confronted with a crisis or stressful situation?

How do you respond emotionally to stress? Which feelings are dominant?

How do you typically behave when confronted with stress? If you are inclined to

“act out,” or respond dysfunctionally in some way, what does that look like?

about where she is going to vacation during spring

break, and how she’s going to pay for it You get

the point: animals do experience stress when they

are subjected to life-threatening situations but we

are the only species that literally kills ourselves out

of imagined fears

Fight-or-Flight Response

There you are stalking your prey Outfitted in your

recently acquired skins made from a mammoth

you killed the previous week (with others from

your clan), you are hot on the trail of a woolly

rhino that had been spotted by scouts You are fleet

on your feet and an excellent spear-thrower At 19,

you are rather experienced and old compared to

others among your people, where the average life

expectancy is in the early twenties

Like any self-respecting member of thePaleolithic Era, you are rather hairy and squat (but

good news: so is your spouse) You are hiding

behind a huge boulder, club in hand, ready to

attack any animal that might come through your ambush spot Your senses are

height-ened, especially your senses of smell and sight and hearing Because of this state of

hyperarousal, you hear the soft rustling of foliage on a cliff above your head Your heart

begins pounding in your chest but you force yourself to remain still and calm You

slowly turn your head and glance upward Your worst fear has been confirmed: a

saber-toothed tiger appears to be stalking you, ready to pounce In your last conscious thought,

you notice that one of the cat’s eight-inch-long teeth is chipped at the end, not that this

observation will do you much good

If we could freeze this moment, and glimpse inside the body of this hunter from20,000 years ago, we would observe a number of changes taking place Within the span

of a few seconds, the hunter (let’s call her Pela) has a decision to make: she has one of

two choices in order to save herself—to run or to fight Whatever Pela chooses—and her

life depends on making the right choice—her body is preparing itself for either option

And it turns out that this fight-or-flight response is going to give her every advantage

possible under the circumstances either to escape the danger or to win this battle

Now, if you could manually customize the systems of Pela’s body (or anyone else’s under similar circumstances), what might you do to give her the best chances of

survival? (See Table 1.4.)

She is going to need maximum sensory acuity

The eyes dilate to better perceive danger, increase

night vision, and judge distances The blood

pres-sure increases, along with the heart rate, to deliver

more nutrients to the muscles that will be needed

during a sprint or a battle (that is why her heart is

pounding in her chest) Muscles tense in

prepara-tion for a quick movement, to either dodge an

attack or get out of the way Pela starts breathing

heavily, pumping as much oxygen into the blood

supply as possible The body begins to perspire

freely, cooling off the skin and core body

temper-ature so that things don’t overheat with all the fuel

that is being burned The endocrine system kicks

in and provides a surge of adrenaline that will

aug-ment strength And finally, serum glucose levels

FIGURE 1.2 Contemporary human beings retain the same physiological responses to stress that were present in our Stone Age ancestors.

TABLE 1.4 Summary of Major Fight-or-flight Responses

1 Eye dilation

2 Increased blood pressure

3 Increased heart rate

4 Muscle tension

5 Heavy breathing

6 Sweating

7 Adrenaline surge

8 Increased serum glucose

9 Release of free fatty acids

10 Vasodilation of arteries in arms and legs

11 Digestive system shuts down

12 Inhibition of sexual desire and reproductive capability

13 Immune system shuts down

14 Blood coagulation

spike to supply sugar, a fast energy source This is supplemented with a release of freefatty acids that help sustain endurance.

As if it is not amazing enough that the body can turn on these systems when needed,Pela’s body also shuts down those systems that won’t be needed during the next few critical minutes, saving energy and increasing endurance Arteries restrict to preventexcessive bleeding if Pela should be wounded The digestive system shuts down sinceshe is not planning on a snack or bowel movement during the next few minutes Likewise

hormones related to sex and reproduction are inhibited, since sex is the last thing on

her mind at this moment The immune system will not be needed either during this temporary emergency Lastly, the blood thickens so as to provide maximum coagulation

in the event of a wound

It turns out that this was a false alarm Much to Pela’s relief, the long-toothed cathad already eaten a meal earlier in the day, so rather than pouncing he had been moreinterested in finding a nice spot in the sun to take a nap

Pela sighs with relief and then an interesting phenomenon takes place: once giventhe “danger over” signal, all the body’s systems begin to return to normal This home-ostasis will take time to complete but eventually things will return to previous levels

As Pela backs slowly away, her breathing returns to normal and the danger signalsshut down She does notice, however, that her palms are so sweaty she can barely gripher club Her legs and arms are shaking from the surge of adrenaline still coursingthrough her arteries Her stomach feels queasy from having been shut down

Does any of this sound familiar? It is exactly what happens during an encounter

with stress Picture approaching an attractive classmate you like Imagine that theinstructor announces a pop quiz for which you are minimally prepared Recall walking

in the dark and being startled by a weird sound In each case, your body receives a dangersignal from the hypothalamus, that part of your brain that alerts the appropriate systems

to prepare for a potential threat

The only problem is that most of the time in contemporary life we get false alarms

We aren’t really facing life-threatening dangers, even if it sometimes feels that way Ourculture has evolved over thousands of years but our neurological systems are essentiallythe same as they were during Pela’s time They still see saber-toothed tigers and woollyrhinos behind every rock We mentioned earlier how Walter Cannon described this sur-vival response almost a hundred years ago by observing the ways that animalsrespond to perceived threat All the bodily systems just described become activated inresponse to a danger signal (a human scream, the sight of a predator, the smell of fireburning, the taste of poison), and they remain engaged until such time that they are giventhe “all clear” signal However, it doesn’t matter to the body whether the danger is real

or just seems that way It could be an actual threat, or a hallucination of one: the bodyreacts the same way

Twenty thousand or more years later, our culture has evolved significantly Ourlifespan has increased from 23 years to nearly 85 We have moved from caves into con-dos Now about the only danger of predators we face is from our own kind in certainparts of the city that are to be avoided if possible

Recall what happens when the brain turns on the danger signal that sets in motionall the physiological changes needed to fight or flee What happens if this system,designed for brief flashes, stays on almost all the time? More specifically, what happens

if your immune system is suppressed for long periods of time while you fight imaginarybattles during a sleepless night of worry? What are the effects of straining the body’ssystem in ways for which it was never designed? The answer is that you can become sick

Types of Stress: The Good, the Bad, and the Ugly

Like most phenomena that have been identified and studied, stress comes in different flavors

There is short-term stress—the kind activated by a sudden threat or danger Imagine,

for example, that you are driving in traffic and another car swerves into your lane, or asituation in which you are asked to make an impromptu presentation in front of a large

audience Under such circumstances, you will no

doubt feel the familiar surge of a stress-hormone

response, activating the fight-or-flight system

described earlier This is usually followed by

deac-tivation producing a relaxation response, at

which point you begin to calm down and all

sys-tems return to normal Short-term arousal like this

does not usually create problems; if anything, it

keeps the system in working order, so to speak

Long-term stress is another story altogether.

This is when the system is turned on at high

vol-ume, and then remains that way even when the

ini-tial danger has passed There is the sort of wear

and tear on the body and mind you would expect

when a mechanism that was designed for “sprints”

is told that it has to run a “marathon.” Invariably,

parts start to break down and the system fails This

is a different sort of marathon than practiced by

those who use running as one of many ways to

manage their stress, burning off excess energy,

dis-tracting them from worries, and better conditioning their bodies (see Voice of Stress

V O I C E O F S T R E S S M A N A G E M E N T 1 1

Note: Throughout the text there are a number of “voices” that speak about

struggles with stress, as well as ways that people manage the challenges

they face.

Thirty-year-old female teacher

I would say that I am a bit insecure I am often concerned with how others see

me and feel that they may judge me I get nervous really easily I have been

successful in coping with the stress in my life, but I used to let it rule my life.

After getting divorced a few years ago, I felt lost and lonely I joined a group

for people coping with divorce It really helped to talk about what I was going

through and hear that others had similar problems I also took up running It

was a wonderful way for me to focus my attention on something other than all

the things that I worry about When I run, I look at my surroundings and simply

enjoy being out and active It’s a great way for me to release my tension I even

started running marathons!

My insecurities are still there but I am just able to escape them with more

frequency I run six days per week and feel exhilarated each time I have a new

circle of friends with similar interests It is wonderful to have others with whom

to share my sport Many of my fellow runners find that it is a great way to

relieve the stress caused by their hectic lifestyles Of all the things I have done to

relieve stress, running has really been the most rewarding for me Besides the

exercise, most of all it is a mental break.

Distress Neustress Eustress

Pop quiz for which Poor economic news Supportive friends cheer you are unprepared in another state you on during a game

Distress is what you usually associate with the word “stress.” This is the destructive

and harmful sort that means trouble, especially if it moves beyond acute arousal to achronic condition Distress occurs when our ability to cope with stressors is insufficient

Distress causes anxiety and confusion and decreases your performance in daily activities

Distress is often associated with stressful events that occur unexpectedly Even whengood news strikes too suddenly, it may shock the recipient and cause stress Distress alsomay occur when you try to manage too many things simultaneously and lose control

of the situation The degree to which you feel you can control your life influences thevalence of stress

Neustress is, just like it sounds, rather neutral It has little impact, or lasting effects,

one way or the other It might be upsetting for others, in another location or context, buthas little measurable effect on your life Alternatively, you might find yourself in a performance situation in which the added presence of an audience is below your radarbecause you are concentrating so hard on your job

Eustress is the kind of stress that inspires or motivates you to go beyond present

levels of functioning This is what happens with the so-called “clutch” hitter in baseball,

or the “pressure player” in other sports: the presence of an audience, combined with highstakes on the line, motivates the athlete to unparalleled performance The same could betrue for artists, actors, writers, and others who are required to perform under pressure

Eustress stimulates the systems of the body to function at peak levels; this can even

be the case for the kind of growth that can take place for some people after a crisis ortrauma (Orloff, 2009) It should therefore make sense that although moderate doses ofstress can be good for you in creating excitement, enhanced attention, improved perfor-mance, or healthy competitive instincts, the other side of the coin—boredom—is almostnever desirable At the very least, stress signifies intense engagement with life and whatyou are doing whereas boredom means you don’t find meaning or purpose in activities

or daily life (Oz, 2010)

Sources of Stress

Another way to categorize stress is based on the source Typically, stress can be vated by (1) an external source, (2) an internal source, or (3) the interaction of internaland external sources In addition, stress can be manifested as a physical sensation(pounding heart), a psychological experience (feelings of panic), as well as biochemicaland other processes

acti-Physical stress occurs when the human body is affected by sleep deprivation,

over-working, excessive physical exertion, physical injury or trauma, viral or bacterial

3. Increased blood and oxygen flow brings more nutrients and hormones that can

be mobilized This can create high blood pressure over time

4. Blood vessels constrict to prevent bleeding in the event of injury In a chronicstate, a person can experience dizziness, blackouts, headaches, and skin lesions

5. The liver produces and distributes sugar and nutrients in order to provide energy

to combat the perceived danger Over time, hypoglycemia or diabetes can result

Hans Selye coined a number of specific terms to distinguish between “good” stressand “bad” stress Like most things in life, too much is not particularly healthy The term

hyperstress means an excessive amount that overloads the system, while hypostress is

not enough to keep the body tuned and ready for action

There are three additional kinds of stress that Selye identified in an effort to coverthe range of possible meanings:

infections, inflammation, physical disease, or chronic pain It is under such

circum-stances that the body begins to lose functioning and to break down

Psychological stress is often used synonymously with mental stress or emotional

stress because they share many common features Psychological stressors are related to

how we interpret the events in our life; they are determined by our values, beliefs,

atti-tudes, and philosophies of life Given the same situation, different people may react very

differently due to their outlooks on life Emotional reactions such as anger, fear, low

self-esteem, and hostility are also influenced by our beliefs The good news is that you

can change your thoughts (Chapter 6), thereby changing your reactions to the events in

your life The bad news is that some thought patterns have been deeply engrained in your

psyche and they require a consistent effort to be modified

Psychosocial stress arises from interactions with people and the society in whichyou live Individuals must make constant adjustments to the demands imposed on them

by the environment and culture, especially during times of economic, environmental,

political, and social challenges Think about how the effects of a recession, natural

disaster, crowding, trauma, war, poverty, abuse, family conflict, neglect, or other factors

can create tremendous stress

In addition to these sources of stress, there are biochemical triggers that result from

excessive use of substances such as sugar, nicotine, caffeine, or alcohol, as well as food

preservatives Stress reactions can also be activated from exposure to substances in the

environment such as mold, dust, allergens, industrial pollutants, environmental toxins,

pesticides, and automobile exhausts We can suffer chemical stress from using

contami-nated foods, such as tuna that contains mercury or shellfish that is laden with cadmium

It is important to be able to identify the sources of stress in your life, and their origins, before you can develop a plan to prevent and manage the negative effects This

is easier said than done considering that there are often complex interactions between all

the sources For example, I (Jeffrey) once worked with a man in psychotherapy who was

having panic attacks characterized by uncontrollable feelings of losing control His heart

would begin racing, his breathing would accelerate and he felt on the verge of passing

out Even more disturbing, there was no identifiable trigger that would begin the cycle;

the episodes would begin suddenly without warning

Whereas sometimes this condition can be treated with medication, the preferred firststrategy is to use counseling to identify the underlying problems that are being brought

to attention Although the man was very grateful for our work together over a period of

several months in which he learned a lot about himself, the symptoms were never really

reduced I only learned from him months later that these so-called panic attacks were

actually the result of a leaky furnace in his home!

It is important for you to have an accurate picture of not only what you find moststressful in your life, but also the origins and causes of these challenges This takes con-

siderable investigation and commitment to find out

Self-Assessment of Stress

This book emphasizes prevention as well as treatment of the stress problem It is far

preferable to minimize risk for the future rather than waiting until it is too late

As a general rule, the earlier you can detect signs of danger, the more likely you can

do something to avoid it If you have advance warning that there is a traffic pile-up on

the highway ahead of you, you can begin to reduce your speed and prepare for a sudden

stop If you know that that you are going to be asked to make a toast at a wedding, you

can think about what you want to say, rehearse your speech, and visualize things you

want to remember Early warnings can be just as helpful in stress prevention If you can

learn to recognize some of the earliest signs of chronic stress, then you are in a far

better position to take remedial steps to make needed changes in your thinking,

beha-vior, or lifestyle What are the sorts of things you might look for? The answer depends,

in part, on what is normal for you

Overview of Stress Management and Prevention

Understanding the nature and meaning of stress is an important part of implementing acomprehensive program of stress management and prevention You have learned alreadythat stress is a dynamic process that consists of a stressor and stress response You havealso learned that a stressor can be any severe challenge, real or imaginary, that disrupts normal functioning This can be anything from a flat tire to traveling to a foreign land

Management of stress involves neutralizing or reducing the magnitude of yourresponses to stressors, while prevention focuses on shaping, modifying, or eliminatingstressors in the first place The first part of the text is devoted to understanding the nature

of stress while the second and third parts will be devoted to interventions

The model of stress management and prevention presented in this text (see Figure 1.3) is based on the research of many professionals, all of whom conclude thatmultiple and varied techniques are required that address all facets of the problem Ourmodel depicts a four-stage process of stress development Before each stage of stressdevelopment occurs, you have the power either to prevent its occurrence in the first place or, at the very least, to reduce its momentum The best scenario is when you can

F O R R E F L E C T I O N 1 4

Self-assessment of stressors

Identify the top five stressors in your life Describe how you have coped with them Rank how effective you’ve been in dealing with these situations (1 = least effective; 5 = most effective).

Stressors in my life Coping strategies Ranking

prevent a full-blown stress episode by stopping it in its embryonic stage The

second-best situation occurs when you have developed sufficient coping mechanisms that the

demand for change can be easily met Once the perceived threat is met, the body’s alarm

will be turned off and homeostasis will be restored

Stage 1: Life Situations/Chronic Stressors

Before a major event disrupts your life, you need to do everything you can to prevent the

formation of a stressor You may have heard the saying, “Discipline weighs ounces

while regret weighs tons.” An exam is a major stressor for those who are unprepared and

for whom it may have a serious consequence,

while it may be a minor annoyance, or even a fun

challenge, for those who are prepared

No matter how hard you try, certain ties and traumatic events will inevitably occur in

adversi-your life In most cases, you will not have a choice

about whether you are subjected to the stressors

but you can choose, to some extent, how you

respond to them Obviously, a pleasant stressful

situation such as getting married (eustress) will be

handled with more ease than a negative stressor

like a divorce (distress)

In this first stage it is critical that you have anaccurate and comprehensive view of the stressors

in your life, as well as the characteristic ways you

respond to them It is important to know where and

how you are most vulnerable

Stage 2: Perception and Evaluation

As mentioned earlier, people will perceive the

same stressor in a variety of ways and, therefore,

react to it differently An event will be

overwhelm-ing to one person and exhilaratoverwhelm-ing to another For

Situations that are anxiety provoking for some are extremely enjoyable for others Many politicians, comedians, and public speakers absolutely love to appear on stage in front of huge crowds The familiar stress responses only arouse them

to perform at a higher level If they are successful in their work and healthy, then they have learned to quickly restore a level of relaxation as soon as the event

is over.

Stage 1: Life situations /Chronic stressors Stage 2: Perception and evaluation Stage 3: Stress response Stage 4: Consequences

some people, the fear of speaking in front of a group is greater than that of death Otherslive to get up on stage in front of a crowd.

Your perception of a situation or a chronic stressor also depends on your ity type, your resilience, life experience, health status, and mental and emotionalresources In general, healthy, competent, and optimistic people will cope with stressmore successfully than those who tend toward pessimism and negativity (Brooks andGoldstein, 2003)

personal-In this second stage, it is critical for you to have a solid background in the theory,research, and mechanisms of stress so that you can better prepare yourself for what liesahead

Stage 3: Stress Response

This stage will demonstrate an individual’s emotional, psychological, and physiologicalresponses to the perception of the stressor The magnitude of the responses from theendocrine and autonomic nervous systems depends on the perception of the response

Your major task, in the face of stress, is to reduce pressure and release excessive cal and psychological tension through a number of options (such as meditation, exercise,and other relaxation techniques described later in the book) It is not enough to merelyknow how to apply stress management and prevention strategies; you will have to prac-tice and rehearse them on a daily basis so they will become part of your repertoire whenyou need them most

In this textbook we advocate a holistic and comprehensive approach to stress vention and management What does this mean? The following principles will allow you

pre-to learn and apply the concepts of stress prevention and management more effectively

1. Prevention is more effective than management Prevention is a more proactive

approach since you start to change your living habits before you have serioushealth issues Prevention is also cheaper than treatment, as it is well knownhow expensive it is to treat a serious disease Once stressors strike, manageyour reactions to them and tap all your resources to deal with them; don’t allowthem to become a chronic condition that wreaks havoc on your body

2. Small changes can lead to big effects Mathematician and meteorologist

Edward Lorenz coined the term “the butterfly effect” to refer to the notion that

a butterfly flapping its wings in a remote place such as Beijing, China maycause a hurricane in Texas, USA (Hilborn, 2004) In other words, smallchanges in the initial condition of a system can lead to a chain of events thatwill produce large-scale alterations to the system If you apply this idea tostress prevention and management, a small change in your lifestyle may have along-term benefit to your longevity and well-being Since many of your healthhabits are deeply engrained, it can take considerable effort to initiate and main-tain changes But starting small will eventually lead to a fundamental change