Stress: A Part of Our Lives; A Factor in Our Health; A Potential for Growth and Change (Part 1)

Editor’s Note: This is part one of an excellent review of how stress affects our lives and our health. Part II is available here.

Donald M. Friedman, MD
Donald M. Friedman, MD

Stress is definitely a part of our lives.  It is often unavoidable and can sometimes be overwhelming.  As life has become more complicated, especially in this age of new technology, stress can certainly play more of a role in how we think, how we act, and how we feel.

It’s no secret that chronic stress can have an adverse effect on one’s health.  In fact, some studies have shown that as high as 75-90% of visits to doctors in the United States are related in some way to stress.  One of the major problems is that many people are not even aware of the extent to which they are under stress, or if they are, don’t know how to adapt to it, lessen it, learn from it, positively change because of it, or see how being in the moment can help one cope with it.  Stress as a force in our society has reached epidemic proportions and the time is ripe, more than ever before, to realize that we must change ourselves rather than rely on the change of external circumstances to achieve a state of wellness.

So what actually is stress?  As stated in Wellness Book: The Comprehensive Guide to Maintaining Health and Treating Stress-Related Illnes by Herbert Benson, M.D. and Eileen M. Stuart, R.N., M.S., “Stress is the perception of a threat to one’s physical or psychological well being and the perception that one is unable to cope with that threat.” (p.180)  Many have pointed out that stress can actually be difficult to define because that “perception” can be different for different people.

What can be stressful, anxiety provoking, and disruptive for one person can be seen as a challenge and a stimulating motivation to another.  In fact, Dr. Hans Selye, a well respected Canadian physiologist who performed stress research in the 1940’s, showed that to a certain extent stress can be useful in helping people both accomplish goals and be productive.  Stress can also be protective.  In potentially harmful and threatening situations, it elicits the fight or flight response that can help us react in a way to promote our safety.  The downside is when stress becomes constant, chronic, and overwhelming, the body and mind lose their ability to cope with challenges presented, and one’s function begins to decrease.  But there is also some hope in Dr. Selye’s conclusions.

As quoted in a book by Stephan Rechtschaffen, M.D.  and Marc Cohen, M.A., Vitality and Wellness, Dr. Selye concluded, “It’s not stress that kills us, it is our reaction to it.” (p.37)  This implies that we can have some input into how stress affects us and how we deal with it.  So it is important to explore what resources we have and can develop to help us cope in an increasingly stressful world.

Before looking at these resources, it is essential to be aware how stress can affect our bodies, mental functioning, and behavior.  The basic problem is well summarized in The Wellness Book with the statement, “Our difficulty in the twentieth century is that many of the stresses we face (relationships, work, family, money, etc.) are not amenable to the physical reaction of fight or flight, yet the physiology elicited by the stress remains the same.  In these situations, however, the physical response has no way to dissipate.” (p.180)  If you can’t discharge the effects of the increased adrenaline from the stress reaction, your body and emotions remain stimulated long after an incident or situation is over.  This can affect how you feel physically and emotionally and also how you act.  It’s certainly well know that stress can cause physical symptoms such as headache, backache, rashes, and GI symptoms, as well as emotional symptoms such as anxiety and depression.

Stuart, Webster, and Welk-Federman also talk about “The negative stress cycle” where “an event perceived as stressful or threatening can cause physical or psychological symptoms.  These in turn increase our stress.” (p181)  Thus, the symptoms caused by stress can themselves cause stress.

Stress alters the balanced equilibrium and stability of the body.  Many feel that this creates an opportunity for a disease to start or the worsening of the symptoms of a disease already present.  In fact, there are a number of diseases that healthcare professionals agree are either caused by or related to stress.  These include back pain or neck pain unrelated to physical abnormalities, peptic ulcers, GI diseases such as inflammatory bowel disease, menstrual problems, alcohol or drug abuse, some skin diseases, sexual dysfunction, temporomandibular  joint disease, depression, asthma, hypertension, stroke, heart disease, autoimmune diseases such as lupus, and some cancers. (List from Vitality and Wellness, p47-48)  Clearly, it is as important to deal with the stresses that may precipitate and exacerbate an illness as it is to deal with the illness itself.  The two are so intertwined that stress reduction management can be an important part of the treatment.

In dealing with stress, first and foremost you must become aware that you even have stress in your life.  Unrecognized stress can certainly affect your health.  However, as Rechtschaffen and Cohen discuss, “Sadly, many people don’t realize how affected they are by stress until they crash, physically, psychologically, emotionally, or even spiritually.” (Vitality and Wellness p44-45)

They go on to comment that this may happen when people lead such an overactive life with constant activity or stimulation that stress occurs more frequently because of the overactivity.   To compound it, the pace of the lifestyle may make it easier to avoid paying attention when stress occurs.  Also, the authors mention that people who are unaware of their true feelings and needs and don’t take time for introspection may not be aware of the stress in their lives.  And finally, those who don’t pay attention to the physical and emotional warning signs of stress (such as increased muscle tension, unexplained headaches, anxiety, difficulty concentrating, depression) may get to the point where they don’t function well at all or start acting inappropriately, such as angry outbursts or withdrawal, or even develop signs and symptoms of an illness.  Rechstchaffen and Cohen conclude that “When we are unaware that we are living with stress, the pressure on our minds, bodies, emotions, and spirits begins to feel ‘normal.’  Even though it’s not normal, our ability to adapt in order to survive makes it seem as though it is.” (p.46 Vitality and Wellness)  But eventually, the adaptation can break down, resulting in maladaptive behavior or frank physical or emotional illness.

 

Also, it is important to recognize the triggers that can produce stress, such as conflicts at work, interactions with a boss, marital or relationship disagreements, financial issues, a vacation, or any thought or memory that can bring on a stress reaction.  Awareness of the triggers can start you thinking about better ways to manage the stress, diminish its effects, or even devise ways to remove the stresses altogether.  If you are not aware of the triggers, you may not exert as much control over the situation and react more emotionally to the trigger with irrational or automatic behavior.

 

But often there are stresses that we cannot change.  That is when how we react to the stress becomes of key importance.  In The Wellness Book, the authors of the “Managing Stress” chapter state, “If you recognize that stress is our perception of a threat, and our reaction to the perception, then logically we can do something to manage our perceptions and reactions.  You cannot always control or change a situation, but you can retain control over the way you react to and think about stress.” (p184)  This implies, as already mentioned, that how you react to stress you can’t control can determine how disruptive the stress becomes.   Along these lines, the authors of Vitality and Wellness quote Sir John Templeton’s book, Worldwide Laws Of Life: 200 Eternal Spiritual Principles and five of his principles that promote effective ways to lessen stress through self awareness (p.53):

1     All sunshine makes a desert – you must have balance and variety in your life.

2     Minds are like parachutes – they are at their best when they are open to new perspectives, ideas, and information.  See every situation as an opportunity to learn.

3     Laughter is the best medicine – laughter is a good way to deal with stress. Laughter not only helps one to cope, but can heal as well.

4     Defeat isn’t bitter if you don’t swallow it – failing something doesn’t mean you’re a failure.  Mistakes are an opportunity to learn and be more successful.

5     You get back what you give out – the emotions you give out and the way you express yourself can determine what you get back from others and the universe.  If you broadcast negativity, you get negativity back; if you are positive and compassionate, there is a good chance you’ll attract that into your life.

These insights can make stress more bearable and also help deal with the challenges the stresses present.  Again, the attitude and approach one has toward stress can help determine how well one adjusts to the stress and how that stress affects one’s well being.

The concept of “stress hardiness” is also discusses in Vitality and Wellness (p.57)  The term was coined by Dr. Suzanne Kobasa in the 1980’s when she studied employees of a big corporation.  Those people who had the following characteristics, the “Four C’s”, had a more positive approach to stress, less stress-related illnesses, and less absenteeism from work.  The “Four C’s” that were associated with “stress hardiness” were:

  1. Control – people who had more of a sense of control in their lives and of situations around them.  They had confidence in their ability to deal with stress
  2. Challenge – stress was viewed as a challenge that could promote learning and growth.
  3. Commitment — they were committed to their work and to the people who were important to them.  These people had more of a sense of purpose and were more willing to embrace change as a means of determining their future.
  4. Closeness – “stress hardy” people had strong relationships and a good solid support system and did not feel isolated.

These characteristics were felt to help reduce stress and promote good health and wellness.  Again, Dr. Kobasa’s work underscores that no one can avoid stress, but the tools and attitude and life-approach tactics one has can help one avoid the potential adverse effects of stress.

As can be surmised, high self-esteem underlies stress hardiness as well.  Those who have healthy and positive views of themselves and their abilities fare better in coping with stress.  Stuart, Webster, and Wells-Feldman comment that “Self-esteem is a measure of how good or bad you feel about yourself and how you see yourself in the world.  This mental picture is called to mind when you access your ability to succeed in any endeavor.  This image influences your plans, decisions, moods, and behavior….(Low) self-esteem is based on your judgment of yourself not on other people’s assessment of your value…The underlying fear is being exposed as inferior to others, and eventually, as unable to cope with new situations.” (The Wellness Book, p.219-20)  People with low self-esteem often try to please other people and comply with the standards of those other people.  Criticism is seen as a diminishment of self-value, and perfection is often the goal.  Low self-esteem itself produces stress.  It keeps one from trying new things, finding solutions for present problems, and feeling confident and optimistic about the future.

 

Low self-esteem usually has its origins in what one is taught as a child and the early life experiences one has.  In terms of improving self-esteem, not only for the purpose of enhanced mental health, but also for better stress coping skills, the authors in The Wellness Book suggest that taking control of your life and deciding that the negative messages you may have received in childhood no longer apply to your adult self is essential; you have the right to challenge the assumptions you may have been given about yourself (p224-26)  Some people can do this on their own, and others may benefit from discussing these issues in psychotherapy.  Self-acceptance and a sense of humility towards yourself are also crucial for developing high self-esteem.

Realizing that mistakes and failures are part of the human experience and are sources of learning and growth and possible eventual success increases one’s stress hardiness.  Changing one’s thinking and attitude about oneself is not easy and requires time to happen, but even small changes and advances can make a difference.  How you view yourself can have a major effect on how you cope with the stresses of your life.

Learning what stress can teach you is another effective way of confronting and coping with stress.  Rechstchaffen and Cohen in Vitality and Wellness describe a technique called “dialoguing” where one can sit in a quiet place and have a conversation with yourself about a particular stress you may be having in your life (p.49)  Choosing the stress that bothers you the most or has the biggest effect on your life, consider that the stress may be trying to give you a message.

The authors suggest asking “Why are you here?” or “What do you want to tell me?” or any other question that may come to mind.  Listen for answers, write them down, and respond in your mind to those answers to see if more information comes into your awareness.  This process may give you insight into the stress itself and the role it plays in your life.  Rechstchaffen and Cohen comment, “Knowing something more about (the stress) expands the number of choices you can make to help manage and eliminate that stress.” (p.47)  Confronting the stress in this relaxed way may help you understand better its power to affect you, the triggers it pushes, unrecognized resources you may have that can help you deal with the stress, and how stepping back in a more objective way can help you find solutions for the stress more easily.  If we cannot learn from our stresses, they will continue to haunt and control us rather than offer us an opportunity to grow and live our lives more fully.

An extremely important way to deal with stress is making a conscious effort to be aware of the present moment and actually be in the present moment.  Next month, the rest of this column will be devoted to this subject, because living in the present moment is a key part of stress reduction.

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