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					Stress: The Aroused State That Can Be Recognized, Understood And Managed

HAROLD M. DAVIS, M.D. HMD Consulting, LLC hdavismd@optonline.net

STRESS: THE AROUSED STATE THAT CAN BE RECOGNIZED, UNDERSTOOD, AND MANAGED

The Age of Anxiety—Paying The Price Today we live in a fast pace, ever-changing, and demanding world that can lead to mind-body overload. Stress has become the buzzword of the twenty-first century and looms high as a topic of concern in the general public, Corporate America, government, and academic communities. We are all exposed to an ever-growing body of reporting that stress, in addition to being the “spice of life,” is also the cause of many of our modern day problems. The issues presented have ranged from considering stress as a significant factor in many disease states once believed to be rooted primarily in physical causes; its possible causative role in the disruption of the American family; the prime generator of disease and discontent amongst our youth, who are using drugs at record levels to blunt the pressures of life; and possibly the factor responsible for the decrease in the productive capacity of the American work force. Stress, stress, and more stress have become the emotional environment in which we live. Today, the business community appears to be particularly concerned about the impact of stress on workers’ health. American business is paying heavily for the alarming increase in stress-related disorders. Alcoholism, heart disease, ulcers, hypertension, non-prescription drug abuse, accidents, suicide, and an increase in emotional disorders have become commonplace amongst American workers and their family members. Alarmingly, all indicators suggest that there is no letting up in the incidence of stress-related disorders. In 2004 the tab to American business in absenteeism, diminished productivity, and health-related expenses was over $200 billion and a loss of 300 million working days. We, as individuals, are also paying our share of the health bill. With increases in deductibles and higher levels of expense participation being shifted to American workers and dependents, we are all paying an increasing percentage of these costs. There is strong evidence that corporations and other work environments may, in large part, be responsible for many of their own problems, e.g., their deadline oriented and stress generating ways of operating. Add to this the loss of thousands of jobs resulting from the outsourcing of manufacturing functions to foreign countries, which supply cheap labor. In addition, intense mergers and acquisitions activity, resulting in corporations gobbling each other up and

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becoming larger and larger companies with fewer and fewer workers operating them, is adding to the work load and stress level of the average American. These factors, however, are but part of the story. There are also significant pressures that result from our being an increasingly mobile society, requiring accelerated orientation and accommodations to new surroundings and people. Disintegration of the extended family, which historically has provided support and emotional rooting for Americans, is also a major stressor. Rapid technology changes, information overload, the demands of raising children in these confusing times, and the usual daily pressures of life provided by our stimulus rich society add to the burden of living. And if this is not enough the fear of AIDS, war, the natural disasters in Southeast Asia, as we are seeing, is enough to unsettle an entire nation. These pressures compound the pressures of work and life, often with costly results to the individual, organization, family, and society at large. Is it any wonder then that our era has been called the “Age of Anxiety”? “Stress-Guard” Yourself! Notwithstanding this rather gloomy picture, there is hope for us all in preventing the ravages that can result from a life filled with too much stress. What I am suggesting is that although we may not be able to “stress-proof” our lives, we can “stress-guard” our minds and bodies from the effects of too much stress. The secret is to understand stress, its manifestations, and what we can, and should, do to manage it. The first point to establish is that stress is neither bad nor good. It is a fact of life. It is what we make of a potentially stressful situation that will determine what effect it will have on us, physically, emotionally, and psychologically. When dealing with stress, it can, in actuality, be our worst enemy or our best friend. In most situations confronted, control is entirely within our hands, or more appropriately, in our minds in handling stress. In the inimitable words of Pogo, “We have met the enemy -- and they are us”. First and foremost, therefore, stress is not something that is done to us, but what we “allow” it to do. The Stress Response Let us, therefore, consider this dynamic force called stress and see if we can learn to become more aware of its presence and potential to generate negative health effects. It is also important to recognize the situations or conditions that cause high stress levels, and personal variables, which make us susceptible to experiencing frequent and intensive stress reactions. Lastly, we will consider some methods such as mind-sets, attitudes and behavior patterns that will allow us to modify and modulate the stress response. This will enable us to live happier, healthier, and more productive lives.

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Fundamental to understanding the stress response is an awareness of that which generates stress, i.e., stressors. Basically, a stressor is any force or influence, external or internal to the individual, perceived as threatening a vital goal or need of the individual. This force or influence can lead to a series of predictable stressful reactions, both physical (increase in heart rate, blood pressure, respiration, and muscle tension), and various psychological states, such as anxiety, depression, confusion, and disengagement from reality. This latter manifestation of the stress response is referred to as cognitive disruption, which results in the total immobilization of the individual when dealing with an intense stress reaction. The physiology of the stress response was worked out in 1909 by the Harvard physiologist, Walter Cannon, who developed his now famous “fight or flight” theory. Cannon reported that whenever early man was exposed to a threatening situation, such as an attack by a saber-toothed tiger, the body geared up to deal with it. Stress-responsive hormones, in particular adrenaline, pour into the bloodstream, speeding up heart rate and raising blood pressure and muscle tension in preparation for action. Respiration increases to supply additional oxygen and to eliminate carbon dioxide. Attention is concentrated, pupils dilate for improved vision and blood clotting ability increases in anticipation of a wound. This reaction prepared early man to protect himself. If the odds looked good, he fought, if not, he fled. The stress response, therefore, has its basic origins in survival. Although the stimulus today is not likely to be a saber-toothed tiger, but rather a divorce, death of a loved one, higher production quotas, commuting, a letter from the IRS, job loss, difficulty in a love relationship, deadlines or a reprimand from a supervisor, we respond, physically, emotionally, and chemically as did early man. We, however, are not allowed to fight or flee in most situations, such as fight our supervisor or subordinates, walk away from family responsibilities, or flee from an assignment or argument. To do so would be considered a grossly inappropriate response in our modern society, which demand that we cope with ever-changing demand situations. Nonetheless, while our mind is trying to figure out what to do about a stress-provoking situation, our body is working on its own to get us out of it. It is also important to note that the stimulus (stressor) does not have to be immediate to cause arousal. Just anticipate any situation that is unpleasant or uncertain and the stress response will go off. Cannon’s work dealt primarily with noxious stimuli, such as noise, vibration, and heat extremes, which resulted in the stress reaction. Some thirty years later, however, Dr. Hans Selye, considered the leading authority on modern day stress, investigated the effects of psychological conflict and concluded, “that there is virtually no difference between stress reactions resulting from physical causes and stress reactions resulting from emotional problems.” Selye viewed the stress response as “the body’s non-specific response to any demand on it.” Selye referred to his mind-body coping system as the “general adaption syndrome,”

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which holds that when exposed to a stressor, the body and mind will either adapt to the demands of the situation or the defense system will break down. Interesting, Selye did not regard the stress response as intrinsically good or bad and categorized stress into three groups: normal stress, negative stress, and good stress or eustress. Fundamentally, stress at its best primes us for peak performance in our work, home, social and community roles and raises our interest in the world. At its worst, stress can interfere with our ability to think clearly or act productively. The Stress-Disease Connection It is known that stress aggravates a variety of illnesses, physical and mental, but does it actually cause disease? Considerable data support that there is a clear relationship between both repetitive acute stress reactions and chronic unresolved stress and their causative role in the initiation of various disease states. Numerous animal studies demonstrate that when animals are put into crowded cages, mates separated, undergo maze training or exposed to irregular and unpredictable stimuli, noxious or otherwise, that various abnormal physical and behavioral states develop. Likewise, studies in high stress professions, such as air-traffic controllers, have demonstrated a high incidence of hypertension, excessive drug use, ulcers and infections resulting from their jobs. Similarly, studies conducted on workers at the Kennedy Space Center in the 1960’s, a high stress and deadline oriented environment, demonstrated a cardiac death rate 50% greater than age-matched controls, as well as a 75% divorce rate and a percapita consumption of alcohol that was the highest in the nation. Yale University researchers have reported that stressful life events often precede the development of mental depression in patients admitted for psychiatric treatment. Additionally, a study conducted on blue-collar workers facing job loss demonstrated a suicide rate three times the national average. Stress has also been shown to be a causative or contributing variable in conditions such as cancer, lung disease, altered immunological status and musculoskeletal conditions. Presently, it is believed that stress, to some degree, may be operative in approximately 70% of medical conditions treated today. It is also interesting to note that as women have won their place in all areas of the labor force, they are beginning to manifest many of the physical and psychological diseases commonly seen in their male counterparts. As the saying goes, “you’ve come a long way baby,” but I would add, “Where are you going?”

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Clustering of Life Events Change and the demands placed on us to accommodate change appear to be a primary stressor to many of us and may be the root cause of many of our modern day problems. This has been amply demonstrated in the work of two scientists, Holems and Rahe, who developed the Social Readjustment Rating Scale. This scale represents various aspects of work, social and individual life and predicts the growing likelihood of illness following periods of high change and demands in one’s life. Not all of the changes considered were negative. Many events were ordinary aspects of life, such as job advancement, marriage, taking out a mortgage, or management changes. Each of the events represented on the scale can bring about a significant change in the individual’s life pattern, which would require adaptive or coping behavior. The important factor was CHANGE, desirable or undesirable, in an ongoing lifestyle that required adjustment. These researchers found that illness, both physical and psychological, generally followed a clustering of events in a short time span that required significant life adjustments. Change demands, therefore, may cause disruptions in our usual pattern of living, working and definitions of self. Whether or not we are conscious of it, these change demands trigger reactions in our psychological, emotion, physical, and chemical states. These reactions must be acknowledged and readjusted or we will succumb to the debilitating stress that they may generate. The more often we trigger the stress response, the more likely our latent tendencies to become ill or emotionally disturbed will manifest themselves. It should be emphasized, however, that people vary in their ability to accommodate change demand situations. Change or its accommodation, therefore, is not, in and of itself, bad. It is what we make of the situation, i.e., how we internalize and personally interpret the accommodation required, referenced against our sense of security and inventory of coping abilities, that will determine its impact on us. A significant stress-guarding strategy, therefore, is to avoid clustering of events that require considerable amounts of adjustment. Also, whenever possible, pace the demands made on your time, energy, and emotions. Stress and the Workplace Stressors peculiar to the work place have been singled out as an area of extensive research, since so much of our sense of self, aspirations and social roles are shaped in this environment. It has been determined that almost every possible situation or event in the workplace can be a source of stress to someone at sometime. Frequently, a situation and its direct opposite are both potential stressors: work overload or work underload, which can come about when an individual is quantitatively given too much or too little to do; or qualitatively, when an individual is not qualified or over qualified to perform the tasks required. Task ambiguity and task rigidity are also potent potential stressors and result when there is confusion of WHO is to perform a task, WHAT

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is expected and HOW the task is to be done. Overly restrictive working conditions can also be potent stressors when they do not allow for personal approaches to be used to accomplish a task. No promotion and overpromotion can be sources of stress, as well as extreme role conflict resulting from either multiple reporting relationships or ill-defined organizational priorities. Extreme amounts of responsibility, especially for people, or too little responsibility; constant change in office activity or no change in office routine; ongoing contact with individuals who are stress carriers; and social isolation are significant stressors. The latter can occur in work situations that require constant interaction with equipment, e.g., computers. Frequent deadlines or no closure on projects presented as priorities; frequent meetings and hostile organizational environments have also been isolated as significant stressors to workers. Additional occupational stressors that have been identified are low social support from supervisors and co-workers with resultant negative competition amongst workers and excessive displays of one-upmanship. Decreased participation in decisions, perceived sexism by females, racism by people of color, and age discrimination by older workers can add to the stress load of individuals and organizations. These occupational stressors can lead to chronic job dissatisfaction and attendant disease states. Decreased job performance, increased absenteeism, drug abuse on and off the job, and less commitment to the job, group, and corporation can result. Marked disturbances in family and social relationships may occur as well as total BURN OUT. This last condition, BURN OUT, has attracted considerable attention over the past few decades. Burn out generally manifests itself as a decrease in creativity, interest, initiative, mental dullness and chronic frustration. Burn out is, in effect, a manifest state of excessive and unresolved stress. Do you identify with this state or any of the occupational stressors mentioned? Do you see it manifested in family members, co-workers or other significant relationships? If you do, then some workable and personally acceptable resolution of the problem is required, NOW! Person-Environment Fit The stress inherent in these situations is determined primarily from imbalances in person-environment fit. P-E fit is defined as the interaction between an individual’s psychosocial characteristics and objective environmental conditions and demands. A healthy fit in any accommodation or demand situation contains the proper amount of stress to stimulate optimal performance and generates a sense of self-worth and fulfillment for the individual. This fit, however, is determined by the situation, i.e., its context, which is made up by the type, pace, and intensity of the demands made and the personal characteristics of the

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individual, such as life history, learned coping behaviors, training, value system, medical and psychological status. These personal characteristics determine the stress-guarding ability or vulnerability of the individual and the potential for any particular change-demand-accommodation situation to generate unhealthy stress. Therefore, stress-induced disease or lack thereof, is determined by the dynamic interaction between the stressor, be it physical or psychological, external or internal, and the individual’s inventory of personal characteristics. The stress experience is not stressor-independent of these personal variables. Put simply, it is what we, and our inventory of personal characteristics, make of the situation, and not solely what the situation or stressor makes of us! Extra-Organizational Stressors As discussed, the work environment can be a significant stressor to the individual, but importantly, only if we let it be so. This environment is but a part of the picture that represents our lives. We are, in actuality, a complication of multiple identities, roles, loyalties, and responsibilities determined by the various environments in which we operate. The major extra-organizational environments that also require accommodation to change demands are our home, social and community spheres. These environments, as does the work environment, shape us and demand emotional energy allocations. Depending on the demands made, the pacing of these demands and our acceptance of them, referenced against the personal characteristics discussed earlier, will determine how health disrupting or enhancing these environments can be for us. Also, a major disruption in any one these “significant environments” can lead to a disruption in one or all of the other environments. We all know of cases where family dissatisfaction unsettled an individual’s work life and vice versa. The major settings for behavior (work, home, social and community) form an integrated whole of forces, which impinge upon and shape or deform us. Work, although significant in our lives, is not and should not be singled out as the primary or only potential stressor in our lives. Social Support -- A Significant Guard It should also be noted that although these environments for behavior and personal identity can be potential stressors, they could also serve as strong buffers against stress, in particular, by the quality of the social support they can provide. SOCIAL SUPPORT HAS BEEN IDENTIFIED AS THE SINGLE BEST PSYCHOLOGICAL MECHANISM FOR MANAGING STRESS! Interestingly, although social support from friends and co-workers is of considerable importance, the social support derived from a loved one or supervisor is of particular importance in the life of the individual in the maintenance of emotional and, thereby, physical health.

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Organizations, families, and communities that provide reliable and easily accessible social support for its members will frequently show significantly lower rates of physical and psychological disruptions in its members when compared to similar settings that do not provide support. This support should also be consciously and continuously marketed by these significant settings as an intrinsic and clearly identifiable component of their character. Support should be extended in an unqualified manner and not be made available only to a few or only in circumstances of dire need. All interactions with these environments should constantly remind the individual that he or she is accepted, valued, and a significant member of the group. Insofar as the work environment is concerned, companies and other work environments lacking in strong social support for its employees will intensify the impact of stress generators inherent in its operations. Similarly, families that do not provide support for its members will drive individuals outside the family for support or relief from stress which may take the form of extramarital affairs, drugs, etc. Stress Addict As mentioned earlier, the fight or flight reaction, i.e., stress response, is a basic defense mechanism used by our ancestors and, today, by ourselves to enhance our chances for survival when exposed to a real or perceived threat. Generally, for most of us, when the stressor is managed or accommodated, the stress response abates. Researchers, however, have identified a chronically stressed and stress prone personality type, where stress appears to be a way of life, a kind of “stress addict” or “adrenaline-dependent personality.” This individual is referred to as the Type A personality. Type A individuals have been characterized as compulsive, competitive, impatient, time urgent and unable to relax without a sense of guilt. They are “Hot Reactors,” demonstrating free floating anxiety, aggressive characters, hostility, isolation, intolerance of others and a nagging fear that they may not be accomplishing more than others. Of particular importance is the finding that Type A’s may be 2-3 times more likely to develop heart disease when compared to Type B individuals. This latter group, i.e., Type B’s, are the direct opposite of Type A’s and do not demonstrate their characteristics, e.g., they are able to relax without guilt and seek out others for work and social activities. Research suggests that this increased risk for heart disease in type A’s is independent of other risk factors, such as smoking, hypertension, or elevated cholesterol levels. Type A’s have also been shown to demonstrate a major maladaptive coping behavior, the suppression of physiological and psychological symptoms. As a result, Type A individuals are frequently unable to detect the presence of external or internal strain. It has been suggested that these individuals blunt recognition of health imbalances, emotional and physical, so as not to be detracted from their self-professed reason for being, work.

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Type A’s are potent stress carriers and often are regarded as significant stressors to co-workers and family members. Additional studies report that the work environment, not only enhances, but also rewards Type A behavior because of the individuals supposed mastery and control of challenges. It should be noted, however, that Type A individuals have not, in fact, been confirmed to be more capable or productive than Type B individuals. They just “appear” to be more capable and committed because of their behavior and preoccupation with work. If you identify this personality characteristic in yourself or your significant others, you should take a serious look at the situation and work on changing this character profile. You or they may be unconsciously digging a hole so deep that you have in fact buried yourself. The Joys That Life Can Bring What we have discussed so far is that stress is a fact of life, and given all the good that it can do, a necessary part of life. Too much stress, however, can lead to our undoing and robs us of the joys that life can bring. Instead of interesting challenges that allow for growth and actualization of self, a life burdened with continuous stress can be a living hell. You, however, hold the key to the potential prisons of life’s experience. As mentioned, stress is not something that is done to us, but more so, what we do to ourselves. A life without some stress is either monotonous or death itself. When you find that you cannot control or eliminate stress, “go with the flow.” When necessary, be like a blade of grass that bends in a strong wind and survives. Not like an old oak that is uprooted and dies because it stubbornly fights against the force of the wind. We all have a stake in how we fare in handling the potential stressors in our life. The organization has a huge stake in its human resources, the workers who generate the bottom line. Although a potential prime generator of stress for workers, companies can also serve as significant support systems for employees and, in turn, be appreciated all the more for providing the support. This support will return itself a thousand fold in the form of more dynamic, resilient, committed, caring, and productive work force. Just as Corporate America sees the logic of preventive equipment maintenance, it can apply these same principles and practices in the form of preventive employee maintenance. Just as it understands how overworked and poorly maintained equipment can fail and be expensive to replace, it should readily understand how many of the person-environment discrepancies discussed earlier can also lead to employee failure and expensive replacement costs. Organizations should, therefore, evaluate their operations for unhealthy stress generators and, where necessary, get their houses in order. This is a legitimate business concern, as important to the corporation’s survival as determining its business objectives and product lines. Families should also understand the significant roles they can play in the emotional, physical and

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psychological health of its members and should constantly look for ways to enhance “support-giving” to family members. We as individuals should understand, however, that the workplace is not necessarily the problem. We are also part of the equation and, therefore, an important and necessary part of the solution. We have to take responsibility for our lives because in the end it is our lives that are affected by unhealthy stress. We should not be tempted to use the common excuse to look outside ourselves to find the fault, but look within to find the strength and the answers. We must become more aware of our feelings, both physical and emotional, and safeguard ourselves against the destructive potential of unsolved stress. It is the fortunate person that honestly knows when he or she is off balance, and can bring into play an inventory of effective stabilizing mechanisms and strategies to resolve problems. Remember, you determine your fate, and if it’s any comfort to you, there are not more saber-toothed tigers to threaten our survival, only emotional shadows that look like them. Stress Management Strategies Outlined below are some stress management and “go with the flow” techniques, attitudes and behaviors that you, co-workers, and family members can use to achieve and maintain happier, healthier and more productive lives: • Develop an appropriate attitude concerning stress. Stress does not have to lead to “distress.” When managed appropriately, stress can be that burst of energy and creativity that allows you to perform at your peak. Don’t sweat the small stuff. When looked at clearly, the majority of life’s challenges are small stuff. Develop a positive and loving attitude about yourself. Become one of your best friends. Take responsibility for your life and be the prime determinant of what happens in your life. Increase your internal locus of control and discontinue deterministic, fatalistic, or magical thinking.

• • •

• Develop self-control and learn to modulate your responses (physical,
emotional, and psychological) to potential stressful situations. Why give all when some will do? The challenges of life do not all require an all or none reaction, some effort in the middle zone might do just fine.

• Determine your priorities and values. • When you cannot say,” NO”, try, “NOT NOW.”
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• Develop a positive attitude about challenges and change demand situations in
your work, home, social and community environments as opportunities for growth.

• Increase your awareness of yourself—physical, emotional and spiritual. • Develop mutually beneficial support systems within the various “significant
environments” that you function in. Remember that no one should be an island unto them self, and that a functioning support system is probably our most important means for stress management.

• Put LOVE in your life. Love in your family, friends, co-workers, career,
community, and, most importantly, yourself.

• Structure stress interactions — avoid stress clustering. Pick the size, number
and timing of your battles!

• Minimize unpredictability in your life. Plan, today, to take action against
ambiguous roles, role conflict, and overload-underload situations. MAXIMIZE YOUR PERSON-ENVIRONMENT FIT!

• When confronting a potential stressor, perform stress analysis. The situation
may not be that bad. Give yourself time to think before you enter a stressful situation because you might not be able to do so while in the thick of the problem.

• Learn to be comfortable with the decisions you make. Take the burden of
always having to be absolutely right and perfect off your back. When you make a mistake, live with it and learn from it. Remember, genius is a storehouse of mistakes.

• Practice focusing on the present and not on the dim past or unknown future.
The past has taken care of itself and we have time on our side to deal with the future.

• “HOT REACTOR” Type A’s-beware! Take some time out to smell the roses. • Develop mental discipline and apply yourself to the task at hand. • Develop effective time-management skills. • DON’T RELY ON DRUGS AS A STRATEGY TO DEAL WITH LIFE. Drugs
lead to blurring of reality, decreases your ability to use prior knowledge to
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help solve current problems, and decreases your ability to grow from the experiences of life.

• Avoid negative re-enforcement groups and “stress-guard” yourself against
stress carriers.

• Bridge the relationship gap. Get to know your co-workers, family members
and renew friendships with people in your community.

• Be honest and forthright, but diplomatic, in your interactions with others. Let
others know your true feelings, desires and aspirations. You have a right to be yourself.

• Don’t bottle up your anger because the container could be your heart. • Have an open mind when dealing with others. Learn to listen. • Do something that will enhance your organizational, family, social and
community stature. Develop yourself!

• Take time out to relax and enjoy the world and people around you. Give
yourself a treat everyday!

• Learn relaxation techniques such as meditation, progressive muscle
relaxation, deep breathing, etc. Listen to music or read that book you have been putting off until your next vacation.

• TAKE ALL OF YOUR ALLOTTED VACATION TIME. YOU DESERVE AND
NEED IT.

• Develop an appropriate work concept. Remember that our work roles have a
great deal to do with our sense of self, goals and purpose. satisfying work is a very healthy thing for all of us to do. Performing

• Develop realistic goals for yourself, and take the necessary steps to
accomplish them.

• Resolve any differences between what you want and what you need. A
large gap in these areas can lead to a continued state of dissatisfaction and frustration.

• Develop good health habits.

Get appropriate amounts of sleep, eat a balanced diet and incorporate regular exercise into your life. Establish a meaningful relationship with your doctor.

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• DO NOT USE STRESS AS AN EXCUSE TO FAIL BUT A STIMULUS TO
GROW.

Suggested Reading: The Relaxation Response, Herbert Benson, M.D., Avon Books 1975. Managing Stress, Leon Warshaw, M.D., Addison-Weekly Session Occupational Stress, Addison-Wealey Publishing Co., 1979 Life after Stress, Martin Shaffer, Contemporary Books, Inc. Chicago, IL Copyright 1983.

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