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Anxiety Disorders


Generalized Anxiety  |  Fears  |  Insomnia  |  Obsessive-Compulsive Disorder
Panic Attacks and Agoraphobia  |  Post Traumatic Stress Disorder
Social Phobia  |  Stress Management  |  Worry
Trichotillomania (hair pulling)  |  Health Anxiety and Hypochondriasis


Stress Management

What is Stress?

Stress is a natural, physiological response that involves a complex interaction between our mind, body, and environment.  Stress is not inherently bad.  In fact, we need a certain, optimal level of stress in order to remain alert and perform well.

Ideally, stress prepares us to take action by activating our sympathetic nervous system and improving mental focus.  If we are too relaxed (i.e., not stressed enough), then we’re likely to be less motivated and less primed for physical action, thus inhibiting our ability to respond well to a situation.  If we are under too much stress, we also suffer as our body stiffens and we lose our mental edge. 

When Stress is a Problem?

The problem occurs when we experience too much stress.  We overtax the natural resources of our body both physically and mentally.  Chronic, high levels of stress have been associated with many serious physical and psychological difficulties, including insomnia, cardiovascular disease, hypertension, obesity, depression, and anxiety disorders. 

In a recent survey (American Psychological Association 2007), nearly half of all Americans believe that their level of stress has increased over the past five years.  In fact, nearly one-in-three Americans report experiencing extreme levels of stress, which negatively impact health and well-being, work, and relationships. 

What are the Warning Signs of Too Much Stress?

Due to the complex nature of stress and its effect on us, there are many potential warning signs.  Every person has a different response to overwhelming stress based on his/her genetic predispositions, life history, and current thoughts, feelings, and behaviors.

Warning signs of too much stress can include the following:

PHYSICAL

BEHAVIORAL

PSYCHOLOGICAL

Muscle tension

Hurrying

Irritability

Headaches

Increased accidents

Decreased emotional control

Exhaustion/fatigue

Decreased productivity

Often worried

Weight changes

Increased consumption of alcohol or drugs

Feeling overwhelmed

Sleep disturbances

Unhealthy eating patterns

Easily frustrated

Teeth grinding

Isolation

Poor concentration

Frequent bouts of illness

Cigarette smoking

Forgetfulness

Stomach aches

Procrastination

Thoughts of running away

Hypertension

Conflicts with others

Loss of sense of humor

Sweating or trembling hands

Restricted breathing

Difficulty making decisions

Sexual dysfunction

 

Crying spells

Diarrhea or constipation

 

Intense bouts of anger

Back pain

 

 

Restlessness

 

 

Indigestion

 

 

What Causes Stress?

There are three kinds of stress-producing factors, which can be categorized as (1) objective, (2) subjective, and (3) interactive. 

Objective factors:

Many events and circumstances are naturally stressful.  Losing a loved one or having a medical illness, for example, contribute a certain amount of stress to our lives.  Even positive events, like a job promotion or wedding, can cause stress.  However, the amount or degree of stress that we experience varies from person to person, typically due to subjective factors.

Subjective factors:

Our thoughts about our experiences play a significant role in determining whether or not something is stressful and the resultant amount of stress that we experience.  Running late for an appointment, for example, we can ruminate about how it’s unfair and unacceptable, which increases our stress.  Alternatively, we can accept that it’s happening and consider other thoughts, such as the possibility of rescheduling the appointment or even what we’re going to have for dinner.  At such times however, we need to be particularly aware of possible stress-producing thoughts and make deliberate efforts to ensure that our thinking is balanced and reasonable. 

Interactive factors:

The way that we interact with the world around us also plays a significant role in our experience of stress.  Our behavior helps shape our experience of stress and how others might respond to us.  For example, if we wake-up five minutes before we’re supposed to be at work, then we’re going to experience more stress than if we wake-up an hour or two in advance.  Also, the ways in which we care for ourselves (or don’t) influence our level of stress.  Countless studies have detailed the benefits of physical exercise, which also helps us better manage stress.  Diet also is important:  a balanced repertoire of whole foods is much healthier than a steady diet of alcohol, processed foods, and sweets.

What is the Most Common Misconception about Stress?

One common misconception involves looking for a single cause for our anxiety and stress.  While we can experience a single traumatic event that causes us to feel overwhelmed, more typically it is caused by an accumulation of different stressors.  Metaphorically, we can compare stress to pouring water in a glass.  The glass can only hold a specific amount of water, and when it reaches the top it spills over.  When it spills, we blame what was immediately poured into the glass, rather than the water that has accumulated over time.  Our perception of stress works the same way:  we look at what immediately preceded our experience of stress-related symptoms, and seek to assign blame.  Often, this event or situation seems “too small” to have caused such a significant reaction, but it is simply the final drop to a glass that has been filled to the brim by other stressors. 

What is the Underlying Physiological Process?

We all have an acute, physiological response to stress.  Activation of the sympathetic nervous system and the release of hormones from the adrenal gland promote a series of physiological responses, including increased heart rate, muscle tension, alertness, increased respiration rate, decreased GI activity, and an inhibited inflammatory response.  In the short run, these changes are designed to help us confront a stressor by priming our body to fight or flee.  Over the long-term however, chronic and sustained activation of the stress response can have damaging effects on the body. 

What are Some Relaxation Techniques?

There are many behavioral techniques available for people who want to manage stress better.  Common strategies include diaphragmatic breathing, progressive muscle relaxation, meditation, relaxation, mindfulness practices, autogenic training, and visualizations.  Typically, our responses to these exercises are idiosyncratic:  what works for you might not work for someone else, and vice versa.  As a result, it is important to try different techniques and see what’s most helpful for you.

Can Medication Help?

Medication, like an anti-anxiety drug or a homeopathic remedy, can provide some relief from the physically deleterious effects of stress.  Benzodiazepines, for example, essentially shut down the sympathetic nervous system, which effectively counteracts the stress response.  Medication, however, does not change how we mentally or behaviorally manage stress.  As illustrated earlier, how we think about something and how we deal with it make a huge impact on how much stress we have.

How does Cognitive Behavioral Therapy (CBT) Help?

The initial phase of CBT involves a thorough assessment of the thoughts, actions, and circumstances that influence the amount of stress that you experience.  Based on our life history, we tend to interpret events and respond to them in characteristic ways.  Typically, for people under stress, such interpretations involve a perception of danger or threat combined with a challenge to our ability to cope with the situation. 

Based on the assessment, the therapist  helps the patient develop a strategic plan to help better manage his/her stress.  Such a plan will involve approaches to modify stress-producing thoughts and improve coping capabilities.  Suppose someone who suffers from perfectionism (“I’m not good enough”) and spends evenings watching T.V.  He or she could benefit from (1) therapeutic interventions to reduce the unrealistic expectations, (2) instruction in relaxation exercises, and (3) integration of an exercise regimen.  Imagine another person who catastrophizes job set-backs (“I’m going to be fired!”) and engages in emotional eating.  He or she could benefit from (1) exercises to challenge the automatic thoughts (e.g., examining the evidence for/against being fired to something) and (2) instructions in diaphragmatic breathing and mindful eating at meal times.  As you can see, plans for stress management work best when they’re tailored to a person’s particular needs, issues, and resources.  During treatment, the therapist and patient consistently evaluate the effectiveness of these different interventions and make adjustments as necessary.

If you’re interested in learning more about stress management or meeting with a psychologist to discuss CBT options, please contact us at 212-308-2440.

Recommended Readings:

Anxiety Free: Unravel Your Fears Before They Unravel You by Robert L. Leahy
The Worry Cure: Seven Steps to Stop Worry from Stopping You by Robert L. Leahy

Clinicians may find the following books on cognitive behavioral therapy to be helpful in treating anxiety:
 
Leahy, R. L., Holland, S. J., & McGinn, L. K. - Treatment Plans and Interventions  for Depression and Anxiety Disorders (2nd ed.)
Leahy, R. L. - Cognitive Therapy Techniques
Sookman, D. and Leahy, R. L. - Treatment Resistant Anxiety Disorders: Resolving Impasses to Symptom Remission

Sample Chapters from Guilford Press


This excerpt is posted with permission of Guilford Publications, Inc. and is subject to copyright law and restricted from further use. No part of this excerpt may be reproduced, stored in a retrieval system or transmitted in any form or by any means (electronic, photocopying, recording or otherwise) without prior written permission of the publisher. To obtain permission please contact Guilford Publications, Inc. at the address below or e-mail: permissions@guilford.com This book may be ordered directly from Guilford Publishing at http://www.Guilford.com


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Keywords: stress, stress management, relaxation techniques.

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