Managing Stress

What is Stress?
In medicine, stress is either an applied force or system of forces that tends to strain or deform the body, the resisting force set up in a body as a result of an externally applied force, or a physical or psychological stimulus that can produce mental or physiological reactions that may lead to illness.

Stress can be defined as the sum of physical and mental responses to an unacceptable disparity between real or imagined personal experience and personal expectations. By this definition, stress is a response which includes both physical and mental components. Mental responses to stress include adaptive (good) stress, anxiety, and depression. Where stress enhances function (physical or mental) it may be considered good stress. However, if stress persists and is of excessive degree, it eventually leads to a need for resolution, which may lead either to anxious (escape) or depressive (withdrawal) behaviour.

Stress behaviour and emotions are sometimes regarded as problematic inappropriate responses to threatening situations in modern civilised society; however, stress is a) a powerful internal communication to raise awareness, and b) a source of energy, although the raw emotional and physical energies may have to be transformed to a more useful form before they are directly useful.

Stress releases powerful neurochemicals and hormones that prepare us for action (to fight or flee). If we don't take action, the stress response can lead to health problems. Prolonged, uninterrupted, unexpected, and unmanageable stresses are the most damaging types of stress.

Many of our ways in dealing with stress -- drugs, pain medicines, alcohol, smoking, and eating -- actually are counterproductive in that they can worsen the stress and can make us more reactive (sensitive) to further stress.

Stress can be best managed by regular exercise, meditation or other relaxation techniques, structured time outs, and learning new coping strategies to create predictability in our lives. The management of stress depends mainly on the willingness of a person to make the changes necessary for a healthy lifestyle.

Definition of stress simplified: think earthquake.

How does the body's response to stress works?
While the complete story is not fully known, scientists understand much about how the response to stress works. The two main systems involved are the hypothalamic-pituitary-adrenal (HPA) axis and the sympathetic nervous system (SNS). Triggered (activated) primarily by an area in the brain stem (lowest part of brain) called the locus coeruleus, the SNS secretes epinephrine and norepinephrine. The five most important concepts to remember about these two systems are that:


 * 1) They are governed by a feedback loop to regulate their response. (In a feedback loop, increased amounts of a substance--e.g., a hormone--inhibits the release of more of that substance, while decreased amounts of the substance stimulate the release of more of that substance.)
 * 2) They interact with each other.
 * 3) They influence other brain systems and functions.
 * 4) Genetic (inherited) variability affects the responses of both systems. (That is, depending on their genes, different people can respond differently to similar stresses.
 * 5) Prolonged or overwhelming responses of these systems can be harmful to an individual.



Stress Management
If we think about the causes of stress, the nature of the stress response, and the negative effects of some types of stress (prolonged, unexpected, or unmanageable stress), several healthy management strategies become clear. A first step in stress management is exercise. You see, since the stress response prepares us to fight or flee, our bodies are primed for action. Unfortunately, however, we usually handle our stresses while sitting at our desk, standing at the water cooler, or behind the wheel stuck in traffic. Exercise on a regular basis helps to turn down the production of stress hormones and neurochemicals. Thus, exercise can help avoid the damage to our health that prolonged stress can cause. In fact, studies have found that exercise is a potent antidepressant, anxiolytic (combats anxiety), and sleeping aid for many people.

For centuries in Eastern religious traditions, the benefits of meditation and other relaxation techniques have been well known. Now, Western medicine and psychology have rediscovered that particular wisdom, translated it into simple non-spiritual methods, and scientifically verified its effectiveness. Thus, 1 or 2 20-30 minute meditation sessions a day can have lasting beneficial effects on health. Indeed, advanced mediators can even significantly control their blood pressure and heart rate as well.

Elimination of drug use and no more than moderate alcohol use are key to the successful management of stress. We know that people, when stressed, seek these outlets, but we also know that many of these substances sensitize (make even more responsive) the stress response. As a result, small problems produce big surges of stress chemicals. What's more, these attempts with drugs and alcohol to mask stress often prevent the person from facing the problem directly. Consequently, they are not able to develop effective ways to cope with or eliminate the stress.

In fact, even prescription drugs for anxiety, such as diazepam (Valium), lorazepam (Ativan), or alprazolam (Xanax), can be counterproductive in the same way. Therefore, these medications should only be used cautiously under the strict guidance of a physician. If, however, stress produces a full-blown psychiatric problem, like posttraumatic stress disorder (PTSD), clinical depression, or anxiety disorders, then psychotropic medications, particularly the selective serotonin reuptake inhibitors (SSRIs), are extremely useful. Examples of SSRIs include sertraline (Zoloft), paroxetine (Paxil), or fluoxetine (Prozac).

We know that chronic or uninterrupted stress is very harmful. It is important, therefore, to take breaks and decompress. Take a lunch break and don't talk about work. Take a walk instead of a coffee break. Use weekends to relax, and don't schedule so many events that Monday morning will seem like a relief. Learn your stress signals. Take regular vacations or even long weekends or mental-health days at intervals that you have learned are right for you.

Create predictability in your work and home life as much as possible. Structure and routine in your life can't prevent the unexpected from happening. However, they can provide a comfortable framework from which to respond to the unexpected. Think ahead and try to anticipate the varieties of possibilities, good and bad, that may become realities at work or home. Generate scenarios and response plans. You may find that the "unexpected" really doesn't always come out of the blue. With this kind of preparation, you can turn stress into a positive force to work for your growth and change.

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