Anxiety, pressure and worry have been recorded as human concerns since the first writings of history, but only since the 1940's has its relationship to disease been popularly discussed. Since then stress has been accused of causing almost every known disease or health problem. It is not clearly established whether stress is a direct cause of coronary artery disease and heart attacks or if it is a complication which adds to the risk when other factors are present. It is known that psychological stress can cause arteries to constrict and spasm and that effectively dealing with stress has a beneficial effect on both physical and emotional health.

There are many ways to deal with stress. It's difficult to avoid many of the sources of stress that we are exposed to. We can't always change situations that are highly stressful at work, at home and even at play, as they are often beyond our control. Healing Heart support groups address the issue by learning how to better handle the stress we encounter. This places more emphasis on assuming control of our own lives. It puts the responsibility for dealing with stress on ourselves, the one force in this world we each have the power to change.

To deal with stress first we must determine what is the source. There are many different kinds of stress and any combination of them may affect us. On its simplest level, stress is any situation which makes demands on us that are greater than our capability to deal with at the time. This can affect us physically, when our efforts fail to accomplish what we attempt. It can also be psychological, when pressures can disturb our emotional balance. For some it may cause discomfort, for others it may lead to misery and helplessness, and for a few, the loss of their ability to function at all.

How we see a situation or problem usually determines the stress we experience. The same situation that one person considers pleasant can be threatening to another. Going to the top of a high open structure makes me uncomfortable, and as I get closer to the edge, I feel more anxious and can't wait to get back down to ground level. If I look down, I get even more uncomfortable, so I try to focus on anything other than the height. To another person, height may not be the slightest unnerving. It may even be enjoyable. We can learn how to look at stress causing factors in different ways, training ourselves to be less affected by them. We can learn how to change the way we see ourselves as we relate to stressful conditions, reducing and even eliminating their influence.

One of the most common sources of stress is change. Most of us can remember the stress we went through during the physical and emotional changes in our teens. We saw our body change and demands were made on us in emotions, responsibility, obligations and more. Like it or not, change is part of life. Nothing is as stable or as permanent as we might prefer. A new boss, a new relationship, a new baby, a different assignment, a crippled car, a sudden new pain are changes that can threaten our delicate balance and can make us anxious. Even small changes can bring discomfort; the change of an actor in a TV program, a change in the taste of a food or soft drink, or a new pair of shoes. How we recognize and how we deal with these factors will determine what amount of stress they cause us. Find out what is causing your stress and understand how you are reacting to it.

In doing this kind of self-evaluation on myself, I found that I had been using denial to avoid recognizing causes of my stress. When I had to dash across a street or move large amounts of dirt in my garden, I had a cold tightening pressure in my chest. It hurt, but I didn't want to deal with the possibility of what it could be. So I quickly forgot it. When my physician asked me if I had any chest pains, I answered no . I told myself that I hadn't, that what I felt was a temporary muscle cramp or strain. It was my way of dealing (very poorly) with that stress. I was avoiding the problem. Denying reality could have cost me my life!

Avoidance can have many forms. When we shut off our feelings, hiding them from others and ourselves, we can pretend they don't exist. We focus on other things, occupy ourselves with things to keep us busy, or do things to get people to react to other aspects of our behavior (from positive ones like making ourselves useful and needed to negative ones like being argumentative and hostile). Avoidance can be a positive way of dealing with some things, but it needs to be recognized and then examined to find out if the avoidance we are using is productive in dealing with the stress. Some people will use drugs, including alcohol and tobacco, or even abuse food, to cope with their distress or try to hide from it. This might be useful if that made the problem go away, but since it doesn't deal with the source of the stress, it may even make it worse. Dr. Jon Kabat-Zinn says it well, The healthy alternative to being caught up in this self-destructive pattern is to stop reacting to stress and start responding to it .

Back in the earliest dawn of our civilization stress factors were simple: confronting a large animal, a battle with another tribe, a fight for a warm cave. To react to threat, our body produces substances to keep us alert and keep our heart beat and blood pressure elevated. When faced with a threat, our ancestors had the choice of either defending themselves or trying to get away from the threat as quickly as possible. This is called the fight-or-flight reaction. It was appropriate for situations that brought about stress at that time, but in the complex world we live in today, fight- or-flight may not only be inappropriate, but it may also be harmful. This reaction still happens automatically, and unless we train ourselves to find other ways to deal with threats, we often continue to react in an unproductive way.

Learning to respond appropriately to stress, rather than reacting, requires the ability to focus; to center one's consciousness. Like some forms of meditation, it is a skill that is built with practice, and becomes easier and more automatic with time. Replacing the immediate fight-or-flight reaction with an appropriate response requires being aware of your reactions, as well as understanding their source. Being upset, losing your cool or wanting to take some kind of action is part of the reaction, and it needs to be replaced with a calmer, more peaceful activity before it can be controlled. Centering on some regular, rhythmic activity is often a way to recover. Many people concentrate on their breathing, listening to the sound of each breath and concentrating on the lungs filling and emptying.

Imaging is another technique for preventing automatic reactions from taking control. As an unpleasant situation begins to fill you with discomfort, try picturing a particularly pleasant experience. I remember the feeling I had the first time I climbed to the top of a mountain and looked down at the clouds, waterfalls and shaded valleys below. It was a special moment, not just because I made it to the top, but because I was seeing it for the first time and for the joy it gave me. In everyone's life there are many experiences that when remembered and focused upon, will bring a feeling of peace or satisfaction. When you feel a negative reaction to stress coming on, choose a pleasant, soothing image and let yourself go to that place again.

The different images we tend to create for ourselves are a real barrier to understanding who we really are. Some people call this a role, since it is often not who we really are, but who we think we must be. The roles we play differ according to the demands made on us. As a parent, we may be the authority; as an employee, we may feel we are without power, that we cannot avoid being pushed around.

A good way to get a better handle on the various roles you take in a typical day is to write down all the titles you have. Son/daughter, sister/brother, parent, spouse, breadwinner, caretaker, patient, companion, worker, boss, taxpayer, repair person, messenger, chauffeur, listener, stabilizer, spender, buddy, fun-maker and more. After you have a list of your roles, write down what is required to assume each role. Is the authority part of being a parent something you have special skills in, or are you assuming a posture , a pose to convince others (and maybe yourself) that you are capable in that role?

Often we assume roles to keep us from having to deal with our lack of confidence or ability in another role. People who let their job keep them away from home to the point where their spouse complains may be uncertain about their role at home. For this person, the job role may be familiar, comfortable and rewarding, but that may not be the case in other roles. Sometimes, when a role is unclear or uncomfortable, a person avoids it. The example of the husband who comes home from work, watches TV, works on his car or goes out for recreation with his friends, and never seems to be there when he's at home, might be a case of not accepting or feeling comfortable in the husband/parent role. If a particular role gives a person power, the temptation to stay in that place as much as possible may become like an addiction. Power is much like a drug, the more one has, the more one seems to need. Focusing on how to empower ourselves and less on the need to exert power over others can often lower stress levels considerably.

Another interesting way to assess the roles we assume is to ask others to let us know what roles they see us in. Rather than have them tell you, and risk an argument, you might ask them to write these down. Ask them to describe the way you perform these roles after they list them, with all the positive and negative behaviors they find for you in each role. Be sure you really want to hear this, sometimes the information you get may add to your stress. Seeing the difference between the way others see us and the way we see ourselves can help us put our behavior in perspective. Once you have a clearer idea of your roles, you can begin to use that information to see how you deal with stress in each role; whether you are reacting or responding. You can use these to learn better ways of reducing stress.

Interpersonal stress, comes from the way we deal with others. Even though there is a stress potential whenever we relate with other people, research findings show that we live longer and have less heart disease when we live with others than when we are alone. Yet some people avoid relationships, keeping as much to themselves as possible, perhaps since some of their past interactions were unsuccessful. We all have our strengths and weakness in interpersonal skills, and it is important to know that we can learn to improve them, leading to greater success and lower interpersonal stress.

There's a popular that t-shirt bears this caption: Insanity is inherited, you get it from your children. This may give parents a smile, but most people believe much of our behavior is genetically determined. We pick up behavior patterns from our family and friends early in our life, but they are more often learned than inherited. We do what we've seen others do, even though we may not realize what we have seen. Sometimes we continue to do it even when we know it doesn't work. Ironically, when the way we deal with a machine isn't productive, we usually change our approach. Most of us are a lot less flexible when it comes to dealing with people, and as a result, we give ourselves unneeded stress.

When we see people who are commonly impolite, hostile or aggressive, we're usually seeing people who aren't secure about their own feelings and have a poor understanding of what is expected of them. They may feel a need to control the situation, even though they know they will get a negative reaction from others. As a form of interpersonal communication, it isn't functional or beneficial, but it may give them the feeling that they are in control. If we react, we play into their hands. If we respond, without getting caught up in their behavior, we keep our own stress under control, and they find that their actions won't work with us.

I Hate You!
A powerful technique, active listening, comes from Dr. Thomas Gordon's Effectiveness Training courses. It simply means to summarize what you've heard the other person say and tell that person what you think you heard. In my private practice I remember a family with a young son who, when he was denied anything he wanted, in this case an expensive radio, would yell, "I hate you. I want a new family. I don't like anybody in this house. Nobody loves me. I want a new radio". I doubt if he had any idea what he was saying, except that he wanted the radio. He'd keep it up until they'd either give up - and give him what he wanted - or react in some way they would be sorry about later and then, perhaps out of guilt, give him the radio. After the parents understood how to respond to his attempts to get them to react, they learned to respond with statements like "I understand you're upset that you can't have the radio ". The boy's puzzled response to that was "Yeah, I sure want that radio". Seeing that there would be no reaction, he went off peacefully to play with something else. The parents did not have to give in to his demands, did not scold him for wanting something expensive and avoided conflict that might have led to bad feelings on both sides. The emotional climate in their home became much more comfortable for everyone.

Effective interpersonal communications also requires a willingness to listen to the other person. Not just to hear the words, but to consider the feelings, meanings and needs of others. In disputes when labor confronts management, both sides have a set picture of the other side, and they know what they want to give and take. At first, extreme positions are often taken, but as the sides negotiate, they get closer to a compromise. The negotiators themselves are rarely as rigid as the people they represent. They might ask, with sincere interest, about the other negotiator's family, and share news of their own. That doesn't mean they weaken their position or give anything away. Experienced negotiators know that differences between them will eventually be settled, so they seldom allow personal feelings to interfere. They can settle major issues without creating an additional burden of personal stress. We all can learn to deal with difficult issues with a minimum of stress. We have to learn how to respond appropriately rather than react emotionally.

Often our words, especially when emotions are high, are inflammatory reactions. They can escalate into damaging exchanges and are likely to bring fiery words that will be later regretted. Instead of dealing with the issues that caused the emotions, the emotional reactions themselves burn and scar, often taking the focus from the issue that set it off. An extinguisher is needed at that time, sounding something like I never looked at it that way before. Let me think about it. or You've got a really good point there and Let's work together on this, we can probably settle it. Controlling the flames is not always possible, but fires that are not fed with fuel soon burn themselves out. You can usually avoid escalating the situation by keeping quiet or possibly going (calmly and courteously) to another room.

I remember having a person become even angrier at me when I said I'm sorry, I hadn't looked at it from your point of view before . When I asked her later why she got even madder when I apologized, she said that she had her arguments all ready and was frustrated when she didn't get to use them. We have to be ready to back down, take what is offered, and go on from there. A rigid position is often a reflection of a rigid person. When the stress of the wind pushes it, the tree that doesn't bend, breaks. We can learn to be like bamboo, to bend when pushed, and survive.

Job stress is much like any other kind of stress, except we may deal with it in different ways. When things get so difficult at work that we can't handle it, we may develop injuries and illnesses that keep us away. When people face stress at work, they often feel they have to take it to protect their job and continue to earn a living. They complain to their friends, family and co-workers, but the stress remains unchanged. At times, some of this stress may be intentionally caused by bosses who believe that they can get more from their workers when they are uncertain and uncomfortable. To effectively deal with job stress, the first step is to identify the source of the pressure. Next, a list of potential ways of relieving the problem (and the possible consequences of actually doing them) can be made. Consulting with others who care about what happens to you is helpful in choosing any plan of action (which can include doing nothing).

Americans have another type of stress that is less often found in other parts of the world, our preoccupation with time. To many, there isn't enough time in the day to get everything done. Others can't find enough to do to fill their day. Almost everybody wears a watch. Many people wear one 24 hours a day, even in the shower or while sleeping. As strange as it seems, a good way to deal with not having enough time is to set aside a portion of your day for doing absolutely nothing. That doesn't mean sitting down and thinking about all the things you have to do or what you'd like to do, but doing and thinking absolutely nothing. If that sounds impossible, you might benefit from a class in meditation, because that is a process meditation teaches.

The Power of Stress
A patient was sent to me who developed a paralysis of his right arm. He had been a bricklayer for 35 years, but years of drinking had caught up with him and he could no longer lay a straight line of bricks. He wasn't getting much work and he knew he wasn't doing a good job. One day he awoke and found he couldn't raise his right arm above his waist. When x-rays and other tests found no reason for his paralysis, he was sent to me for diagnosis and recommendations. After exploring his feelings, emotions and concerns, I convinced his union to hire him as a job site inspector, a job he did well. Within a month he had gradually regained the full use of his arm. He had not been faking, his stress had been so great that his body reacted, causing his paralysis. Headaches, back pain and other disabling conditions can have stress as their source.

We often add stress to our lives by letting the events of the world affect us. Stories in the newspaper, on TV or the radio can make us angry, anxious and confused. We often forget that we have control over the on-off switch - we don't have to let these bother us. For a day with less stress try a suggestion of Dr. Andrew Weil in his book Spontaneous Healing. Take a "newsfast". Avoid all news sources, radio, TV, newspapers and newsmagazines for the whole day. You can still read the comics and other fun features, but let go of the news. (The world will be pretty much the same tomorrow, even without you knowing what happened.) If your one day newsfast made you feel better or lowered your stress levels, try it once every week. You can later increase it to twice a week - or as many days a week as you like. .

To become aware of the types of stress you encounter and how you are dealing with them, you can keep a list of all the stressful events of the day. A pocket-size notebook is a good place to enter it. Instead of waiting until later and possibly forgetting many important situations, you should jot down each episode as it occurs for at least a week. As you later look over your list, you'll recognize patterns of behavior that you never noticed before. It can help you to focus on the situations that need to be dealt with differently, and the patterns will often indicate the way to change. If you find a number of different things you'd like to modify, choose only one and work on that until you feel you've made progress, then go on to a second area. Don't try to deal with more than one at a time.

If you don't have enough time to learn how to deal with stress and to center your awareness to bring you a sense of calm and to revitalize your mind and body, will you have enough time later to be taken by ambulance to a hospital, to spend days there and weeks at home recovering from that heart attack or stroke? A few minutes invested now may pay dividends for a lifetime.

When you start to get caught up in the rat-race, this thought may help put life in perspective:

The past is gone,
The future is yet to be.
Today is a gift,
That's why we call it
The Present.

Next: Meditation

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©1994, 1996, 2002
Dr. Neal Pinckney
Healing Heart Foundation