What Is Stress?

Stress is the emotional and physical strain caused by our response to pressure
from the outside world. Common stress reactions include tension, irritability,
inability to concentrate, and a variety of physical symptoms that include
headache and a fast heartbeat.

It's almost impossible to live without some stress. And most of us wouldn't want
to, because it gives life some spice and excitement. But if stress gets out of
control, it may harm your health, your relationships, and your enjoyment of life.

Examples of "overload" situations are common in today's world:

 You and your spouse both work full time while you are raising your family.
At the same time, your parents are retired, in ill health, and are dependent
on your help with shopping and running errands.
 You are a single person living alone, and your salary isn't rising as fast as
the rate of inflation. It's getting harder each month to pay the bills.
 You are a divorced parent and share the custody of your children with your
former spouse. But the friction between the two of you on matters
concerning the children is becoming more bitter and more frequent.
 The expectations and competition at your workplace is becoming fierce.
You find yourself coming in early, staying late, and taking on more work
than you can handle.

Managing stress involves learning about:

 How stress affects the mind and body

 How to identify the warning signs of stress
 How to develop good stress-management techniques
 When to seek professional help

What Are The Signs Of Stress?

Stress can cause both mental and physical symptoms. The effects of stress are
different for different people.

The mental symptoms of stress include:

  Tension
 Irritability
 Inability to concentrate
 Feeling excessively tired
 Trouble sleeping

The physical symptoms of stress include:

 Dry mouth
 A pounding heart
 Difficulty breathing
 Stomach upset
 Frequent urination
 Sweating palms
 Tight muscles that may cause pain and trembling

What Causes Stress?

We may think of stressful events as unpleasant ones, such as losing a job or
having difficulties at home or at school. But changes for the better can also cause
stress, like a new baby, a wedding, and a new house.

In an ideal world, maybe we could get away from stressful situations, or change
them. Too often we can't do that - but we can learn to control our response to
those situations. And we can develop techniques that will reduce the effects of
stress on our mental and physical health.

Here are some different life events that are identified as stressful. They are rated
on the "Holmes-Raye" scale, which scores them according to the stress they
cause (the higher the number, the greater the stress).

 Death of a spouse - 100 points

 Divorce - 73 points
 Marriage - 50 points
 Pregnancy - 40 points
 Buying a house - 31 points
  Christmas - 12 points

How Does Stress Affect The Body?

To understand what stress does to us, imagine you lived tens of thousands of
years ago, at a time when humans were threatened by hungry animals such as
saber-toothed tigers and wolves. Our caveman ancestors had to be able to react
instantly, either by fighting the beasts or running away.

So humans evolved the ability to respond to a stressful situation instantly, by

preparing the body for "fight or flight." Under sudden stress, you will get a burst of
exceptional strength and endurance, as your body pumps out stress hormones:

 Your heart speeds up

 Blood flow to your brain and muscles increases up to 400 percent
 Your digestion stops (so it doesn't use up energy that's needed elsewhere)
 Your muscle tension increases
 You breathe faster, to bring more oxygen to your muscles

Sometimes we can still benefit from this "fight or flight" response - like the case of
a mother whose child was pinned under a concrete slab during a tornado. Under
stress, she found the strength to lift the huge slab with her bare hands, even
though it later took three men to move it.

But much of the time in modern life, the "fight or flight" response won't help. Yet
those stress hormones still flood your system, preparing you for physical action.
And if you are under stress frequently, it can harm your physical health.
How Stress Can Hurt Us
It has been estimated that two-thirds of all visits to physicians are for stress-
related problems. Recent evidence indicates that the physical changes
associated with stress may contribute to the leading causes of death - heart
disease and cancer.

The effects of stress include the following:

 Stress can cause chronic fatigue, digestive upsets, headaches, and back
pain.
 Stress can affect the blood cells that help you fight off infection, so you are
more likely to get colds and other diseases.
 Constant stress can increase blood pressure and can increase the risk for
stroke.
 Stress can increase the danger of heart attacks, particularly if you are
often angry and mistrustful.
 Stress can make an asthma attack worse.
 Stress triggers behaviors that contribute to death and disability, such as
smoking, alcoholism, drug abuse, and overeating.
 Stress can lead to diminished sexual desire and an inability to achieve
orgasm.
 Stress makes it harder to take other steps to improve health, such as
giving up smoking or making changes in diet.
Dealing With Stress
One method of stress management is called the TARP method, and it has been
proven effective for many. A tarp is a protective cover thrown over something - a
car or boat, for example - to protect it from the elements. Likewise, the TARP
method offers a form of protection, too - protection against the distressing and
sometimes harmful effects of stress.

The TARP method teaches simple techniques that can be used any time,
anywhere, to control your response to stressful situations. It consists of four
steps:

 T is for "Tune in" - Get into the habit of noticing early signs of stress.
 A is for "Analyze" - Think about the source or causes of your stress.
 R is for "Respond" - Deal with the cause of your stress, and its effects on
you.
 P is for "Prevent" - Develop good stress-reduction habits for a healthier
lifestyle.

In addition to the TARP method, other activities and methods also can help
manage stress.

"Tune in"
Tuning in is important, because if you don't tackle your stress early, it can
interfere with your sense of well being and your health almost before you know it.
And the effects of stress often get worse as time goes on.

Whenever you notice yourself feeling the beginnings of stress - for example,
when you feel irritable, tense, distracted, or fatigued - scan yourself for signs of
stress.

How-To Information:

Follow these four steps to scan yourself for

signs of stress:

1. Scan yourself for physical signs of stress,

 starting with your head and working down. For
example:

 Do you have muscle tension?

 Do you have sweaty palms?
 Do you have rapid breathing or rapid
pulse?

2. Scan your behavior for signs of stress. For

example:

 Are you pacing or fidgeting?

 Is your voice too tense, too loud or too
quiet?

3. Scan your emotions, remembering some

feelings that may be in the background. For
example:

 Do you feel nervous, moody, depressed?

 Do you feel frustrated?
 Do you feel lonely?

4. Scan your thoughts and thinking patterns. For

example:

 Are your thoughts always turning to your

worries?
 Are you having trouble with concentration
or memory?

Learning to spot signs of stress instantly can take practice. But if you make a
point of scanning your body, behavior, feelings, and thoughts regularly, it will get
easier.

Nice To Know:
 Some people may find that a single sign will
always tip them off that they are under stress.
For example, they may notice that they always
start to sweat, or tap a foot, or talk fast. Other
people may have a "menu" of warning signs, any
one of which could alert them to the beginning of
stress.

"Analyze"
Once you know how to "tune in" to your signs of stress, you will be better able to
analyze the situations that are stressful to you. These "stressors," as they are
called, could be either external or internal.

External stressors are things and events outside your body that can make you
feel threatened or out of control. For example:

 Physical irritants like noise, pollution, heat, or humidity

 Work demands or conditions
 Frightening events, like narrowly escaping a traffic accident
 Social or family demands, changes, or problems

Internal stressors result from one's own attitudes and thinking patterns. For
example:

 Do you always talk to yourself with words like "should, must, and ought?"
 Do you feel like a failure if you are late, or if things don't go as planned?
 Do you have "me last" syndrome, feeling you have to look after everyone
else's needs before you think of your own?
 Do you feel worthless unless everyone likes you all the time?
 Are you guilty of "awful-izing," which means always expecting the worst?
For example, if family members are late, do you often imagine they are
injured or dead?

Need To Know:
 Sometimes, your body itself can cause stress.
For example, it is stressful to have to live with
constant backache or other nagging sources of
pain. Or, if you are not sleeping well (perhaps
because of stress), you may be more stressed
than ever the next day because you are so tired.

How-To Information:

A stress diary can be helpful in the analyzing

stage. For one week, write down all the stressors
you can identify. Don't leave anything out. Here's
an example:

How-To Information:

A stress diary can be helpful in the analyzing stage. For one week, write down all
the stressors you can identify. Don't leave anything out. Here's an example:

Monday
mad at Jimmy, too slow getting off to
school
7:30 am

traffic jam; thinking about mistake I

8:00 am made yesterday in Peterson
proposal

too much work; John keeps on giving

8:30 am
me more

9:30 am worried about cost of fixing car

10:05 tense about making the phone call to

am Jimmy's school
 10:20 terrible noise from street-repair crew;
am headache

When you have about a week's worth of diary entries, study them. See which of
them are caused by external events (for example, other people making you late)
and which are mostly caused by your own way of thinking or feeling (for example,
you are worried about something that may never happen).

In some cases, you may find that stress is caused by a combination of internal
and external factors. For example, you might be worried about the cost of fixing
the car, and make it worse by blaming yourself for not earning more money.

Sometimes, just by keeping a stress diary you will be able to see solutions to
problems that have been bothering you. For example:

 If the commute is a major source of stress, try a different way of getting to

work.
 If you are worried about your future at work, discuss this with your
supervisor; you may find your worries are groundless.
 If you are always rushed, you may be able to work out better ways to
manage your time.
 If your children are upsetting you at a certain time of day, have a family
conference and agree on a different way of doing things.

Unfortunately, we often cannot simply remove the cause of our stress. But we
can change the way we deal with it, both in the short term (as "first-aid") and in
the long term (developing a stress-resistant lifestyle).

"Respond"
"Responding" in the days of early man meant fighting the source of stress or
running away from it. Your body will still produce a physical "alarm response" that
pumps stress hormones through your body, tensing your muscles and
speeding up your heart. This "alarm response" in most cases doesn't do us any
good - and it can be harmful.
You can learn to turn off the alarm response and regain control. You can learn to
respond calmly, and deal actively and positively with your stress, whether it is
caused by outside or internal factors.

Four useful techniques for responding calmly are:

1. Time out. A brief time out is the simplest possible approach to stress:

 Stop the activity (or the conversation) that was causing you stress.
 If you can move away, go to another room, or go for a short walk.
 If you can't move away, count to 10 silently before you speak again.

2. Breathing. You can often tell if people are under stress because of the way
they are breathing. For example, customs officers have noticed that smugglers
are the people taking fast, shallow breaths. If you learn to control your breathing,
it will help you regain control over the effects of stress.

 Watch babies breathing; their abdomens expand when they breathe in.
 Watch a tense adult breathing; there may be no movement of the
abdomen. All the work is being done by the chest.

Abdominal breathing can be very soothing, because it slows you down. It is also
efficient, bringing a good supply of oxygen to your brain. Prepare for stressful
times by practicing your breathing now:

 Check your breathing pattern by putting one hand on your chest and one
hand on your stomach. If your lower hand moves and your top hand does
not, you are doing abdominal breathing. But if your top hand moves and
your bottom one does not, you are doing chest breathing.
 To do abdominal breathing, get your stomach relax. Breathe in deeply,
then breathe all the air out. Let your lungs fill with air again naturally, while
your stomach expands.
 Practice this "belly breathing" whenever you have spare time (for example,
while you are driving).
 Whenever you are stressed, worried, or tense, use your breathing to help
calm yourself down. Take a deep breath and quietly let it go out
completely, then let your abdomen expand as the air comes back into your
lungs. Keep noticing your abdominal breathing for another few breaths.

For a variation on this breathing technique, try "10-to-one countdown" breathing:

  Start with abdominal breathing, letting all the breath out and then allowing
your abdomen to expand as your lungs fill up again.
 When you breathe out again, say "10," letting go of tension as if it is being
carried out of your body with the air.
 Next time you breathe out, say "nine," and so on, all the way down to
"one."
 When you get to "one," start again.
 Each time you breathe out, tell yourself you are letting go of tension.
 Many people repeat this sequence slowly for a period of 15 to 20 minutes.
They find that with each new countdown, they reach a deeper level of
relaxation.

When we are under stress, we often feel things are happening too fast. Another
technique, called slow-down breathing, can help you get settled down and in
control. It starts with abdominal breathing, and uses cue words to help you focus
and clear your mind. Examples of cue words are:

 As you breathe in, silently say "calm"

 As you breathe out, silently say "smiling"
 As you breathe in, say "present"
 As you breathe out, say "now"

Practice breathing techniques for five or 10 minutes until you get the feel of it,
then again several times a day for a few moments. Then it will be instantly ready
to use as a "mini-tranquilizer" whenever you notice yourself starting to feel tense
or out of control.

3. Progressive muscle relaxation. This technique will help you get rid of the
muscle tension that is a major sign of uncontrolled stress, and which can lead to
headaches, back pain, and muscle pulls. It is based on the principle that muscles
go to a deeper level of relaxation after they have been tensed.

 Lie on the floor or on a firm bed, or sit in a chair that has good head
support.
 Close your eyes and breathe deeply two or three times.
 Next, tighten up the muscles of different parts of your body in turn; keep
them tight while you count silently to five; then let go and imagine the
tension going out as you relax and smooth the muscles.
  Start with your face. Squint your eyes, tighten your teeth and jaw, and
wrinkle your forehead. Feel the tension while you count silently to five, and
then let go of it. Feel the warmth of relaxation coming to your face.
 Next, pull your shoulders up until they nearly touch your ears. Feel the
tension while you count silently to five. Then let go.
 Now progress through the rest of your body, tightening muscles while you
count slowly to five, then letting the tension go. Start with your stomach
and chest muscles, then your lower abdomen, buttocks, and thighs. Finish
with your lower legs, curling up your toes and tightening calf muscles to
feel the tension in your foot, ankle, calves, and knee.
 When you have finished, notice the tension and release in all your
muscles. Breathe deeply a few times, and feel relaxed, refreshed, and
comfortable.

4. Thought-stopping. This is a good technique for dealing with stress that

comes from your own negative feelings. When you notice negative thoughts, just
say "stop!" to yourself. It may sound too simple to be effective - but it works, even
though you may have to repeat the word several times until the negative
thoughts are interrupted.

Sometimes, using mental images can help you stop the negative thoughts:

 Imagine that the negative thoughts are coming from a tape recorder, and
that you can push the "stop" button or turn down the volume to zero.
 Imagine sticky paper that catches your negative thoughts as they fly about.
 Imagine a "stop" sign that blocks your negative thoughts.
 Imagine a box that your negative thoughts get trapped in.
 Imagine you are driving through a car wash that washes the thoughts
away.

Need To Know:

And the secret is...

The secret to making these four "respond"

techniques work is to practice them several times
a week, until you feel comfortable. Then use
them. And don't give up on them too soon. All too
often, people will only try something a couple of
 times and give up after a few days. It may take a
while before you are getting the full benefit of
these techniques.

"Prevent"
There are simple things you can do to help your body and mind withstand stress.
These will help you improve your immune system, your energy level, your self-
esteem, and your sense of well-being.

1. Relaxation. Relaxing regularly will help prevent stress.

 Set aside just 15 minutes every day, whether you are feeling stressed or
not.
 Go through whatever relaxation procedures work best for you. Techniques
such as yoga and stretching can be effective, as can progressive muscle
relaxation.

2. Regular exercise. If you know people who run, swim, or bicycle regularly, you
may notice that they have less stress than others. When your body is in first-
class condition, your mind and emotions will also benefit. Regular exercise is one
excellent way to "stress-proof" yourself, or at reduce the bad effects of stress.

Exercise can make you look better, sleep better, concentrate better, and
withstand disease better. It will also improve your mood and make you feel better
about yourself. The best exercise for stress-proofing is aerobic activity, which
uses your whole body. This includes jogging, bicycling, brisk walking, cross-
country skiing, aerobic dancing, swimming, rowing, skating, and stair-stepping.

 If you are not used to exercise, start with walking. Walk briskly for about 20
minutes, three times a week.
 As you get in shape, take longer walks, or switch to a more vigorous form
of activity.
 If you don't have access to a lake, mountain, or country road to row, ski, or
bike on, substitute on machines at home or in a gym. But whenever you
can, get out into nature. The quietness and change of scene will help your
stress levels.
 Need To Know:

Some exercise safety tips:

 If you are over age 35 and not used to

vigorous exercise, check with a doctor
before you start, or stick to walking.
 Begin every exercise session slowly
(including walks), and don't speed up until
your muscles are warm.
 Don't race. Take the talk test. If you don't
have enough spare breath to hold a
conversation, slow down.
 At the end of your exercise session, walk
around slowly for a while to cool down.

3. Eating right. You will be much better able to withstand stress if your body
feels good, and it can't feel good if you don't feed it properly.

 Make sure you have three good meals a day, with plenty of fruit,
vegetables, and filling food like bread, rice, or noodles.
 If you get hungry between meals, plan for a nutritious snack like fruit,
yogurt, or a bagel. If you take a snack to work with you, you won't be
tempted by junk food.

Eating well will give you a sense of control that can help to reduce your stress
levels, as well as making you feel good physically.

4. Chemicals: alcohol and drugs. People may be tempted to take a drink or

drugs to deal with stress. It doesn't help. Alcohol may seem to calm you down,
but it only masks the symptoms of stress for a while. Excessive alcohol (and
drugs) will give you a rebound; you are likely to feel more stressed than ever
when the effects wear off.

One or two drinks a day, such as a glass of wine or beer with dinner, usually
won't harm you. If you are regularly drinking much more than that, cut down - and
if that is hard to do, get some help.

5. Tobacco. People often say that a cigarette "calms their nerves," but tobacco is
really a stimulant. If you are afraid that quitting would cause you too much stress,
talk to your doctor about prescribing a nicotine patch or gum to help ease the
difficulty of withdrawal. Patches or gum work best if you also join a quit-smoking
group or use a good self-help program that helps you learn to be a nonsmoker. In
the long run, you will become a calmer person if you stop smoking.

For more information about how to stop smoking, go to Smoking: How To Stop.

6. Caffeine. People have different reactions to caffeine, and most people can
take two or three cups of coffee or tea a day without trouble. But you might try
cutting down your caffeine intake, to see if you are less jumpy. (If you get a
headache for a few days, don't worry; that's a normal withdrawal symptom, and it
will go away within a week.)

Other Ways To Manage Stress

In addition to the relaxation practices described in the "TARP" method, there are
many activities and methods that can help manage stress. These include:

 Humor
 Hobbies
  Meditation
 Biofeedback
 Massage therapy

Humor
Many stress-management experts recommend keeping a sense of humor during
difficult situations. Laughing releases muscle tension and helps a person
maintain perspective.

Activities as simple as watching a funny movie, listening to a tape of a

comedian's routine, or sharing time with a humorous friend can provide a
psychological lift and relieve stress.

Hobbies
Regular leisure activities are important in reducing stress. Many people benefit
from making time for positive leisure pursuits rather than, for example, spending
time watching television in the evening (although that, too, can be relaxing to
some degree).

Relaxing hobbies include gardening, painting, bicycling, photography, carpentry,

collecting, and many others. In order to obtain the most relaxation and
enjoyment, the satisfaction should come in doing the hobby, not in the results. An
individual who pursues gardening for relaxation may not grow prize-winning
vegetables, but they can be eaten. An amateur photographer may not sell
photographs, but they can be admired by friends and family.

Meditation
Used for many years in Eastern cultures, meditation is becoming more widely
accepted in the U.S. as a relaxation technique. Meditation reduces heart rate,
blood pressure, adrenaline levels, and skin temperature.

There are a variety of meditation techniques that share a common goal: to

achieve relaxation by clearing the mind of stressful outside interferences.
Meditation involves achieving a state of consciousness in which the individual
focuses on a single thing, such as a key word, sound, or image.
Meditation techniques rely on quiet surroundings, sitting still, and a repetitive
mental pattern. Various techniques are taught in instruction books and through
religious and nonreligious organizations.

Biofeedback
Biofeedback provides a way for people to learn to control activities over which
they normally have no awareness, such as heart rate and muscle tension. It is
considered by many health professionals to be a valuable therapeutic tool for
reducing stress. Biofeedback involves no discomfort and no risk.

Biofeedback relies on sensitive electronic equipment. Sensors are placed on the

body at various locations to measure skin temperature and muscle activity. The
sensors are attached to a monitor that detects fluctuations when a person is
anxious and displays signals in the form of beeps or light flashes. By watching
the monitor, a person learns to control these stressful responses.

Massage Therapy
Massage is the gentle practice of manipulating the body's tissues in order to
soothe and heal. It is one of the most ancient of the healing arts, and more
people today are relying on it for natural, drug-free relief from the effects of busy,
overstressed lives. Massage can relax the entire body and provide new energy
that lingers long after the massage is over.

A number of research studies have shown that massage reduces heart rate,
lowers blood pressure, increases blood circulation and lymph flow, relaxes
muscles, improves range of motion, and increases the production of endorphins,
which are the body's own natural painkillers. There are a number of massage
therapy techniques, including Swedish massage and Shiatsu.

Massages can be for the full body or particular areas of the body, such as the
back and shoulders. Some people choose to wear some clothing during a
massage; others prefer to undress or use a dressing gown. During a massage,
the person is warmly covered, and only the part of the body on which the
therapist is working is uncovered.

Need To Know:
A word about medication

Medication can be useful for dealing with short

periods of acute stress, where the anxiety is
severe and disabling, to help people regain
control and begin coping. It can relieve
symptoms temporarily, but it does not address
the underlying problem.