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Articles on Dealing with Stress
Stress Management
Author: Cleaves M. Bennett MD FACP
Monday, January 07, 2008

How do we cope with stress? Do we curl up, like the cat, and simply relax? Or do we first check through the refrigerator, grab something, and then sit down in front of the television? What do you do to unwind?

Most of us have our own ways of dealing with stress. We have to. We want to cope with it, we can feel the need to do something about it. We really try hard to cope with it. But the ways we choose often aren't really helpful, especially in the long run. And they may even be hurtful. Let's take a look at some of the coping mechanisms we humans use:

Some people, when they're under a lot of stress, act out their anger and frustrations. We call that "letting off steam." They may yell, curse, stamp their feet, and lash out at people and things that are in their way. The upset they're feeling washes over, and upset other people all around them, in much the same way that a speedboat roaring by can rock all the other boats tied up in a marina.

There's really a myth in our society that we shouldn't suppress anger and frustration—that we should express them, we should "let it all out." And yet scientific studies show it doesn't really help that much, and it may even hurt. If you're under a lot of stress and you unleash your anger on the people around you, then they usually get upset too. So it comes right back at you. And things may tend to get quite heated—in fact it's like throwing gasoline on a fire.

Besides, if you do let your anger out, you have to go back the next day and apologize. And then what's your monthly bill at the florist going to look like?

Repressing your anger doesn't work too well either. It builds up inside you, and festers, and builds up some more—and when it finally bursts out the bad effects can be dramatic. No. Hiding your stress from yourself and others, and pretending that everything's fine, that it's all under control, simply isn't the way to go. That's like renting a pressure cooker, furnishing it, and moving in.

In the next chapter we'll be looking at ways to cope with stress that don't involve either dumping your stress on someone else or going around with it continually on the boil inside you. For now, let's look at a few other things we do to cope with stress—the things we may like to think work but don't really do the job. Some people deal with stress by drinking—beer, wine, martinis, whatever. If the stress is pretty constant, that means the drinking may need to be pretty constant too. The problem with alcohol is, if you feel good and happy and relaxed when you're drinking, you're not going to like it the next day when it's worn off. That simple fact can lead to morning drinking, and luncheon drinking, and secret drinking—a very costly habit. It's not good for your liver, it's not good for your pocketbook, it's not good for your friendships and relationships—in fact almost the only thing you know it's good for are the liquor stores. Some people use cigarettes, pipes, cigars, or chewing tobacco to deal with stress. I don't need to explain in much detail that none of these strategies are really good for you, do I?

A Japanese-American lady in our program who was trying to stop smoking told me she thought smoking reduced her stress, and it sure seemed to her that not smoking increased it. Now if she thinks that, she'll naturally continue to light up, fifty or sixty times a day. The truth is that nicotine is a stimulant. It doesn't relax you. It only adds to the problem of stress.

Some people use drugs--legal, prescription drugs, and illegal, social drugs. They use wake-up drugs, slow-down drugs, mellow-out drugs, feel-good drugs. Tranquilizers, sleeping pills, cocaine, grass. The more you have to do to yourself along those lines, the more you have to take to try to feel okay, the worse things get. That's the simple truth of the matter.

Some people use coffee. If your ENS is almost always on, if you're almost always a little worried, or stressed, or harassed, it's very likely that you don't sleep too well. You go to sleep with problems on your mind, and likely your sleep is none too restful.

So during the day you may feel sleepy—and that can produce anxiety just by itself. Let's see, I'm searching for a good analogy. It's almost as if you'd been asked to guard a group of bandits, and you had to watch them day and night. Oh they're tied up all right. But you know that if you ever fell asleep they'd somehow get you.

A lot of people walk around feeling like that. Something's going to get them. They drink coffee to stay awake, because if they get too sleepy something bad might happen, they might lose out on something. And by the time they go to bed, maybe they’ve had too much coffee for them to sleep well. So in the morning they feel sleepy again and have to drink more coffee. It's a vicious circle. Coffee is one common way that people deal with that anxiety—the worry that they may not be alert enough during the day.

Sleep is another way of coping with stress. Whenever I hear someone say, "My God, I'm sleeping nine or ten hours a day, and I don't know what's wrong, but I just don't feel rested"—that's stress. I know that right away. It's almost always stress, especially under the age of sixty.

It works like this: when we're asleep we're unconscious—and we don't have to listen to our worries or our thoughts or our concerns any more. So some of us try to sleep more than we need, to avoid having to deal with our problems. We're not really deliberately escaping, you understand. But it works out that way. And there's this great excuse.

"I'm tired, so I need more sleep."

But here's the problem. Using sleep this way may make you unconscious, but it's not necessarily restful to your body. As soon as you open your eyes in the morning, wham, you start worrying again. It's almost as if there is a little voice inside your head saying, "Good, I've been waiting for you to wake up," so it can start chewing on you again.

Eating is another way to cope with stress. It's a great way to distract yourself, and is soothing too. We all have our favorite snacks, milk, cookies, ice cream or maybe pizza. The problem here is that you're only distracted as long as you're actually eating—so you have to keep doing it, for it to work. The distraction doesn't last much beyond the last mouthful—so you have to keep putting stuff in. That means you may end up eating a whole lot more than you need—and a whole lot more than is good for you. Pretty soon your clothes are too tight and you can’t see your shoes any more.

Work, work, and more work can be another way of coping with stress. In fact anything that offers us a distraction can be a way of handling stresses—parties, vacations, loud music, even sex and conversation. People who have to be doing something all the time may well be trying to deal with stress-because if they ever sat down by themselves they'd worry. They'd fret. They'd stew. That's what work-a- holism is all about. And the party circuit, "life in the fast lane." And portable stereos—turn the music up loud enough and you can't hear yourself worry. But the worrying is still going on, whether you can hear it or not.

Ever notice how people can't stand to be bored? They'd rather be upset (or have almost any other negative feeling) than bored. Boredom is just being alone with our own thoughts—and that's no fun at all for most of us. Distractions can keep our minds from noticing what's bothering us, sure enough—but they don't usually manage to turn off the stress response. Of course a lot depends on the kinds of distractions you choose—horse racing or chamber music, roller coasters or a visit to the Botanical Gardens, Halloween II (the movie) or a picnic in the mountains, penny-a-point cribbage or a trip to Las Vegas to play the slots. Las Vegas is distracting all right—but it surely doesn't turn off the ENS!

So distraction may make us less aware of our suffering and, our stress, but the process usually just keeps going on inside, beating us up; raising our blood pressure, or making our stomachs ache, or setting us up for an infection or an invasion by cancer cells.

That's the bad news. Let's face it. As human beings we usually don't come up with very effective coping strategies for stress. And certainly, what's for sale and what's promoted as likely to make us feel good isn't always very effective either. But there is an answer.

The problem that most people have with the ENS is that it really is automatic. You've probably been in situations that seem to crop up over and over again. You can tell yourself each time, "I'm not going to get upset this time," and damn it, you get in there, and it happens all over again.

Not only that, but when you find yourself reacting in the same old way you may react to the fact that you're reacting. Lots of people do. When you get upset, you get upset about being upset into the bargain. When you get angry, you're annoyed with yourself for getting angry, too.

Does this ring a bell? Sound like you? Worse still, part of the anger we feel about being upset may express itself as indignation. "How dare they get me upset like this? I've got other things to do in my life. The last thing I need today is to feel this way. They're making me feel bad."

We feel as though our own feelings are an affront to us, and we put the blame out there, on the people we're upset with. We tell ourselves they made us angry. We don't want to take responsibility for our own feelings—and that leaves us pretty much powerless to change them. In effect we're behaving like machines. Someone presses one of our buttons, and away we go. Look out! But there is a way out of this one, too.

We'll be talking in the next chapter about what we can do to avoid stress and to cope with it more efficiently and healthfully. We'll be learning to switch the stress response off, right when it starts. And we’ll be learning not to always react in an automatic, machinelike way when things aren't going the way we wish they would.

Over the course of the program we'll learn to be a little more adaptable, a little less easily controlled by our situations. We'll begin to control circumstances that used to control us.

But before we start I'd like to say one last thing that's really important. I'd like to emphasize that although stress may be accompanied by emotions—I've been talking about anger and upsets and so on—it isn't always.

You may be the kind of person who has the stress response going off all the time, and your blood pressure shooting up—and still not perceive it, because you don't notice any emotional response or feeling. It's all buried deep inside.

There's some evidence (Science, 1979) that high blood pressure is a way to anesthetize yourself to these negative feelings and emotions. Hypertension can be a whole lot more silent and tolerable in the short run than a migraine or a temper tantrum.

Kids who have asthma attacks often don't realize they're responding to emotionally charged circumstances—they may not know there's any feeling involved—but if you ask their parents or their teachers the emotional nature of the response is often quite obvious to them. A number of people with diabetes can have their blood sugar levels go way up, without feeling any emotions connected with the process. And people with hypertension can run their blood pressure up a hundred points in upsetting situations—and not necessarily be able to tell they're experiencing stress. They may not be aware of any emotional response whatsoever.

With a "calm" enough act, we can even fool ourselves! This particular problem is one that biofeedback can really help with. With biofeedback training, you can literally watch your ENS turn on and off, on and off. You can see what's going on inside you, in terms of muscle tension, blood pressure, heart rate, skin temperature, galvanic skin response. (How moist your skin is), and brain waves. And when you can see (or hear) what's going on you can learn to do something about it. Joan was twenty-nine, a very pretty, slender, dark-haired girl who had it made. She had a good job, and ideal, supportive, loving circumstances-nothing amiss here. Yet she had hypertension— had had it since she was nineteen. And she'd driven all her doctors crazy because she wouldn't take any medicines. Sure enough, when I saw her in my office, she had a blood pressure of 180/110.

We tried diet. And on a very low sodium intake her blood pressure only dropped to about 155/105. So I told her the rest of it was a matter of stress. She gave me a look of disbelief. "Stress, Forget it," she said. "I don't have any stress. Do I look stressed? Do I have any reason to be stressed?" The answer to both these questions was no—and yet I knew the stress had to be there: her high blood pressure was telling me so. To cut a long story short, it turned out she had been a real nervous child and had even needed tranquilizers. Later her nervousness got buried. Then, years later, it surfaced again as hypertension, covered by a very good "calm act.” When she participated in biofeedback training she discovered how tense her muscles had been all along. The stress was there, but she just needed to recognize it.

Plenty of people simply don't know when they're under stress. It's a very, very common problem—and it's not something you should get all stressed out about. But it's something you should know and learn to deal with.

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