Stress: Four steps to survive and thrive Elizabeth A. Pector, M.D. September 2007 1. Claim it. Stress is a fact of life—your birthright! All living things, from amoebas to zookeepers, face stress—pressures that rouse them from a relaxed, peaceful blob-like state. If you are reading this, you are presumably alive, and therefore under stress. Embrace it! Some stress is good, and helps us grow stronger and wiser. Stress management doesn’t mean eliminating all stress so we can revert to blobbiness. Instead, it means learning to respond effectively to sudden surprises and ongoing challenges. Stressful situations trigger the “fight or flight” response. If you’re fighting a poisonous spider or fleeing a ferocious tiger, you want extra stress hormones—adrenaline and cortisol—rushing through your veins to jump-start you to action. But prolonged, constant high levels of stress hormones cause a host of physical problems. Every day, doctors see patients with symptoms linked to stress: fatigue, headache, sleep problems, chest pains, high blood pressure, shortness of breath, dizziness, digestive complaints, diabetes, muscle aches, frequent viral infections, or fluctuating appetite and weight. In addition to physical symptoms, stress in excess has negative mental, emotional and social effects. Stressed-out people often have concentration difficulties, mood swings, fear, frustration, irritability, and worry. They may avoid people or activities they used to enjoy. To help you cope with your stressors—the issues that contribute to your stress—let’s look at how to name, reframe and ultimately, tame them. 2. Name it. If you reduce a mess of stress into its basic elements, you can look at each piece individually and come up with a plan to manage it. We’ll use the acronym TWERP (Tasks, Worries, Expectations/Events, Roles, People) to classify stress factors. Situational stress usually includes two or more TWERPs, such as people, roles, and an event.
Tasks, To-do Lists, Time. Tasks include everything you need to accomplish each day. Your To-do list usually can be divided into lists of tasks for each sphere of your life: home, work, school, activities. Each of these secondary lists can then be prioritized: what’s most important on each list? What tasks could be trashed? How are you at time management: a time master, or a time waster? Keep in mind an over-scheduled life is urgent and rushed. Adults, like kids, need time for unstructured play, so build some down time into your schedule. Worries. Worries are fears that aren’t necessarily logical, but they occupy a lot of our waking (and attempted sleeping) moments and generate a lot of negative emotions: sadness, anger, doubt, despair. Financial worries are common. Some worries we can do something about. Others we can’t. Recall the serenity prayer: “God, grant me the serenity to accept the things I cannot change, courage to change those I can, and wisdom to know the difference.” List your worries honestly, no matter how silly they seem, and then divide them into three piles: what you can change, what you can’t, and what you might be able to change.
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Expectations & Events Expectations include what others expect of you, what you think they expect of you, and what you expect of yourself. Some are reasonable, some aren’t. Events are both predictable and unpredictable: “Stuff happens.” Sometimes you have control over the “stuff,” and sometimes it hits randomly out of the blue. Some events are at least partly positive: graduation from school, a wedding (or sometimes a divorce), a new child in the family, a job change, a move to a new city. Unfortunately, other events may be overwhelming and negative: crime, assault, a cancer diagnosis, a car accident, the death of a loved one. Some events occur repeatedly—workplace harassment, fights with a family member--and become “situations.” Situations can be broken down into Tasks, People, Roles/Responsibilities to help you analyze why they keep happening. Roles & Responsibilities Roles are job titles that describe your functions in life: Student, parent, child, spouse/partner, domestic engineer (“homemaker,”) customer service representative (“complaint department.”) Responsibilities are decisions or deeds that you own: the buck stops with you. While roles can’t be changed without major decisions, and no one else can make your decisions for you, some deeds can be delegated. People: near and far Humans are tangled in complex webs of relationships. This includes people near you every day, or near to your heart: family, intimate partners, friends, neighbors, teachers, co-workers, clients, etc. It also includes people far away in distance, time or affection. You may be separated from someone by relocation, death or divorce, but they still might have a profound impact on your life. Old relationships and patterns of relating often greatly affect our interactions here and now.
3. Reframe it Reframing involves looking at a situation in a more positive, less overwhelming way. I’m reminded of a Sister Hazel song …”If you want to be somebody else, Change your mind.” You can’t control everything that happens to you, but you can control how you respond to it. If you have felt like a powerless victim in life, identify some simple things you can change and take charge! You have more power than you think. Naming and itemizing your stressors is the first step in reframing stress: a “divide and conquer approach,” breaking a huge obstacle into a series of small stumbling blocks you climb up one by one. The second step in reframing is more difficult: “Lose your attitude.” Adopt a more positive, hardy outlook. Hardiness is a learned skill…and involves commitment to a goal, taking control of situations, and viewing challenge as an opportunity, not an obstacle. Most of us have heard the clichés, “When one door closes, another door opens.” Or “Inside every cloud is a silver lining.” Sometimes we have to look hard to find the new door or the silver…but trying to view a stressful circumstance as an opportunity rather than a curse makes it easier to accentuate the positive that’s hidden within a negative. It can take time and professional help to become skilled at seeing what you can do, instead of what you can’t do, about stress, and to learn to let go of the worries you can’t do anything about. Humor is another way to reframe things. Mark Twain once wrote “The secret source of humor is not joy, but sorrow.” In the same vein, Bill Cosby said “If you can find humor in it, you can survive it.” Take a break from battling stress--make time for fun, laughter, and hobbies.
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On a more serious note, you might adjust your viewpoint to be closer to reality: Lower your expectations in a job, or recognize that you can’t change another person. Sometimes reality clashes too radically with your values or abilities or others’ expectations, and you may need to make a major change to overcome the conflict. It is important to recognize this. People can bend and accommodate to a certain point. But if you try to live long-term with a situation that you feel is unlivable, you can count on continuing stress. Moving beyond the negative thoughts surrounding a traumatic event may seem as impossible as climbing Mt. Everest. Yet, just as many people have made it to the top of Everest with an experienced guide, so it is possible, with professional help and a similar amount of hard work, to climb out of despair following trauma. People often look back and see signs of personal growth in themselves after enduring great difficulty. As you struggle through a tough period in your life, be aware of your strengths. Ask people close to you to help you recognize your progress. 4. Tame it: Prepare, care, share, dare and be aware!
Prepare. If an upcoming event, confrontation or life change worries you, prepare by learning, practicing and visualizing. First, break the challenge down into small, manageable chunks. Read or analyze the task so you can understand and tackle it little by little. Next, practice meeting the challenge. Practice interviews, practice tests, public speaking classes, even wedding rehearsals help you master things that you at first consider daunting. Finally, prepare mentally by visualizing yourself succeeding at the task. It also helps to expect the unexpected. In John Lennon’s words, “Life is what happens while you’re busy making other plans.” Assemble emergency kits for home & car, allow extra time for traffic, plan for illness or interruptions. When you’re ready for anything, surprises are glitches, not catastrophes. Self-care: Since stress has physical, mental/emotional, spiritual and practical effects, selfcare means you need to take a whole-person approach to yourself. (Fix yourself while you fix your stress). You’re worth it! A physical exam and testing might be useful to reassure you and your doctor that any physical concerns are not due to an undiagnosed illness. Once you’ve ruled that out, follow common-sense advice and eat right (light in fat, sugar, salt and caffeine, heavy on whole grains, fruits, vegetables and lean protein.) Three regular meals and a couple of small snacks a day are often healthier than one or two larger meals. Even if you’re tired, work in some regular exercise and increase your activity by parking further from work, taking the stairs, etc. Many of my patients feel three to four times more energetic once they start exercising regularly. Set a goal of 20-30 minutes at a time, 3-5 days a week, but take a few steps toward the goal! Some suggestions: An after-dinner walk, lunchtime walk around your workplace, or a simple home-based workout with weights, an exercise tape, a treadmill or elliptical machine. Yoga or Tai Chi may accomplish exercise and relaxation training at the same time. Don’t forget sleep! It’s a wonderful restorative, and we’ve all heard about people who dreamed up the perfect solution to a problem that had dominated their waking moments for weeks. Talk to your doctor if poor sleep is a major difficulty for you. To optimize your mental and emotional health: First, take a deep breath and relax! It’s hard for most stressed people to calm down. Take a relaxation, meditation or yoga class, or work one on one with a counselor to learn a relaxation method that helps you. Massage also might help. Medication is sometimes needed for depression, anxiety or post-traumatic stress symptoms that seriously interfere with your ability to fulfill your basic daily tasks and
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responsibilities. Talk with a physician to see if you need such help. Likewise, if you have addiction problems--alcohol, drugs, smoking, food, gambling, spending, or anything else-seek professional help and/or peer support in a 12-step or other group program. It is hard to make needed changes if your thinking is impaired by cravings and uncontrolled impulses. For spiritual renewal, reflect on what values and goals are most important to you. People are usually less stressed when their work and relationships are in harmony with their deepest beliefs and when they feel their life has meaning. For some folks, prayer, spiritual readings, meditation, group worship or other religious practices help them stay centered on what really matters. Practical self-care may require changes in how you do things. For task- and responsibilityrelated issues, try to chop your to-do list down to manageable size, or delegate to others. Learn to “Just say No” or hit your delete key. Time-management or assertiveness seminars might be in order. For role dissatisfaction, consider classes to upgrade work skills, or to start or change a career. Don’t be afraid to imagine yourself doing something different for a living! Other hints: Eliminate clutter. Live within your means. Seek financial counseling to get debt under control. Share Some situations can’t be easily fixed on your own. We’ve mentioned a few in this article, including traumatic events and difficult relationships. For any situation involving other people, you may need to work with them in mediation or counseling to resolve conflicts. “A burden shared is a burden halved.” Share your burdens with realistic, positive-minded people in your social network, support groups dedicated to your concerns, or professionals. None of these approaches works for everyone. Sometimes a person’s family or acquaintances are part of the problem, or support groups are dominated by people with worse, better or different situations than yours. However, you might receive great comfort and practical tips from others, and can feel good when your insights help them in return. When you consider counseling or group options, seek a good fit for your personality and needs. Volunteering also may help you feel useful and put your problems in perspective. It may, or may not, be a good idea for you to help someone with issues like your own. Sometimes a new “cause” unrelated to your stress is easier. Dare to dream, and to decide. If you feel paralyzed with indecision, write down your possible choices, and the pros & cons of each choice. Talk through the points with a trusted advisor, and dare to choose! Some choices can be “unchosen” if they don’t work out, so take small steps first if you’re afraid of a big change. Be aware. Live in the moment, alert to what’s happening around you, as well as to signs of returning worries. Keep a journal or diary to chart your progress in taming your TWERPs. Review your successes and analyze your setbacks, so you are better prepared for the next stressor that comes along.
In the end, you will still have stress…but if you can master it before it masters you, you will thrive, and not merely survive!