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Healthy Living October Issue
STRESS WITHOUT DISTRESS


Differentiating between "Stress" and "Stressor"

In dealing with stress, most of us already have two strikes against us. The very language we typically use to describe stress decreases our ability to deal with it most effectively. Most people define stress by what confronts them-by the problems and concerns that they have to deal with. Such an understanding makes us victims of whatever is going on around us. However, a huge body of research indicates that it is not what we have to deal with but rather how we deal with it that dictates the severity of stress in our lives. Simply put, to begin to understand the most fundamental aspects of stress, we must understand a critical distinction: the difference between "stressors" and "stress," as illustrated in Figure 1: Stressors and Stress.1

"Stressors" refer to outside forces, which are the problems and concerns that we must deal with in life. The term "stress" refers to the response of the individual to these stressors.

The first stressor on the list is the well-recognized environmental air pollution. Let us assume that you move from the country into a heavily polluted foreign city. Almost immediately you may begin coughing as a specific physical response to the physical stressor of air pollution. We see that stressors come at us on all aspects of our being. In addition to physical stressors, there are mental stressors. These may confront us in the form of deadlines or finances. The social environment presents its share of stressors; they may occur in the home, at school, on the job, or in the neighborhood. There are also spiritual stressors. These arise especially when our external circumstances or internal decisions conflict with our goals, values, or religious beliefs.



Good and Bad Stressors

A popular mistaken notion is that stressors are all bad. Some may be good in themselves, but may evoke a bad response. For example, I once heard a true story of a woman who died when she was being handed the grand prize check from a lucrative lottery. Her attitude was entirely positive, but the stress response was fatal.

Other more common happy events can be significant stressors. Family relationships, although they may be healthy and pleasant, can have periods of stress. Consider a family wedding. The preparations leading up to the wedding day provide intense stressors for all those intimately involved. Indeed, the wedding experience is an example of a joyful occasion that is also stressful. Another example is the stress associated with bringing a new child into the family.



Benefits of Stress

Some stress responses may be beneficial. Although most think of stress as something negative, Dr. Selye recognized both a good and a bad type of stress. Selye defined "distress" as the stress that was damaging or unpleasant,2 while the stress that resulted in pleasurable or satisfying experiences he called "eustress."3 Dr. Phillip Rice has pointed out that eustress can improve our sense of awareness, promote alertness, and can ultimately result in superior performance. His examples are the stresses of sports competition, a theatrical performance, or a wedding ceremony.4 This relationship was first published in 1908 by R. M. Yerkes and J. D. Dodson.5 The Yerkes-Dodson law or curve described a relationship between stress and performance.

The Yerkes-Dodson graph compares work pressure and job performance. In place of "work pressure" we could just as easily substitute the term "stressor." Regardless of what terms you use, work pressure can affect job performance in a negative or positive way. On the far-left side of the graph where work pressure is low, job performance is also low. The individual is not sufficiently challenged to be very productive. Moving toward the right, as the work pressure and challenge increase, job performance increases-finally to its maximum amount. This is labeled "optimum work pressure." Once a person reaches this optimal level of performance, adding more pressure will cause job performance to deteriorate. Ultimately, the very high pressure/high stress environment results in extremely poor performance. If maximal output is the goal, neither over-pressure nor under-pressure is optimal.

These observations illustrate that, contrary to popular opinion, stress and stressors are essential ingredients in our lives. In fact, they are necessary components of an efficient, useful, productive, and satisfying life. These insights provide an explanation for individuals who seem to thrive in the face of many external pressures. Not only are they productive and positive; they are also free of disease and have healthy interpersonal relationships.

In reality, each of us has our own Yerkes-Dodson curve. Some need a large amount of work pressure, challenge, or stress to achieve their optimal level of performance. This same level of stress would overwhelm others. Nonetheless, the principle is the same for all. We each do our best with a certain level of stress. Too little or too much stress is counterproductive.

A certain level of stress is also necessary in our social relationships and other aspects of our lives. We would not want to evade the pressures and stresses of life. They provide motivation and help us to accomplish more than we would otherwise. We all need to have a compelling reason to get up in the morning. If our coping mechanisms are intact, we will often be able to tolerate and even thrive on more pressure and become more efficient and productive.

One purpose of this chapter is to offer more powerful coping mechanisms. This may allow readers to tolerate more stressors, such that the increase will work for them instead of against them. As Rice put it, "The aim of stress management is not to eliminate stress entirely, but to control it so that an optimal level of arousal is present."6



List Your Top Ten Stressors

Many people today suffer from the impact of stress in their lives and need help in coping with it. One way that I have tried to help is by conducting stress management seminars. My typical format is to meet with the group one night per week for eight weeks. In the first meeting, I ask all the attendees to list their top ten stressors. The reason for this is simple. The very first step in learning to cope with stress is to recognize the significant stressors in one¡¯s life. The awareness that the stressor and the stress response are not identical is critical to objectively examining life¡¯s stressors. Those with a fatalistic attitude that potent stressors are unconquerable are more prone to deny the presence of the very stressors that they need to identify and address. For example, if I think mistreatment will likely make me ill, then I am more likely to deny that mistreatment exists, rather than to accept it and try to deal with it. On the other hand, if I recognize that my response to stressors is largely a personal choice, then I will be free to acknowledge the stressor and address it in a constructive way. Many people have not made a deliberate evaluation of the primary stressors in their lives. Identifying the ten leading stressors opens the way for planning a process to cope with them.

I would encourage each reader to write down his or her most significant stressors. The challenge in doing this exercise is to apply what we have seen up to this point; namely, stressors are not merely the mental trials that lead us to feel "stressed out." They include physical illness and social relationships. Death of a close family member is known to be one of the greatest stressors on the average individual and can have long-term implications. Even relatively mundane physical challenges like temperature can be stressful in the form of excessive heat or cold. In this case, recognizing that you are living in a climate that is a significant stressor for you may be the first step in changing to a different line of work, or making different living arrangements if you remain in that climate. Remember to also include those "good stressors."

Finances, whether in poverty or in wealth, can be stressors. Individuals of limited means often list finances as significant stressors. However, insightful wealthy people may recognize that finances are even greater stressors for them. They may feel great pressures in determining what to do with their money, how to invest it, and how to keep from squandering it. Others become plagued by a constant fear of returning to their former condition of poverty.



We will refer to your list of ten stresses in the next section.

Three Progressive Responses to Stressors

Our response to each of these stressors is in part a general response that occurs as a reaction to all types of stressors.7 This is what the stress pioneer, Dr. Hans Selye referred to as the "General Adaptation Syndrome." He popularized a view of what happens to a person when exposed to a stressor. Although many stress theorists have gone far beyond Selye¡¯s insights, his observations provide a good overview of the stress process. According to Selye¡¯s observations, an individual¡¯s reaction to a new stressor is predictable and progressive, moving through three stages.

As we explore these reactions, ask yourself if you can see any of them transpiring in your life. Particularly observe any association between the stressors on your list and these phases. Following that broader description of the stress process, you should be able to determine how important it is for you to master the stressors in your life.

The first phase is an alarm reaction. This is the body¡¯s "call to arms" and is sometimes called the acute or immediate stress response. Physical symptoms tend to predominate in this rather short-lived phase. If the stressor continues and the individual is able to cope with it, Phase II results. In this phase, the person is resisting the stressor. The acute body function changes of Phase I are mostly resolved at this point, and the person often appears to be coping well. Those who are able to cope with the stressor may remain in this stage in a healthy state of resistance.

Otherwise, as the stressor is resisted, there is an expense. Energy is expended as the person copes with the continued presence of the stressor. Such a phase can last for a prolonged period of time; as this stage progresses, coping may become more difficult, and mental and social effects of stress may surface. New physical responses may also arise. If the stressor continues to be present, it may ultimately push the person into Phase III, exhaustion. Once in this phase, if the stressor persists, disease or even death may be inevitable.



Body Responses to a Sudden Stressor

Upon sudden exposure to a stressor, the body automatically reacts to cause many simultaneous physical effects during Phase I. These effects are designed to help in dealing with the stressor. Let us illustrate how these effects serve such a useful purpose by imagining a situation where you are confronted by a stressor.

Assume that you are reading this book in your bedroom, and all of a sudden you notice a full-grown tiger beside your bed. The ferocious animal has apparently come out of nowhere, and now it is growling at you, eyeing you as if you look like a good meal. This is a far-fetched illustration, but it graphically illustrates a stressor. Immediately upon noticing the tiger, your body enters a state of alarm with a number of physical changes predominating. These changes are the result of far-reaching nervous system effects, called sympathetic nervous system activation. Physical Effects of a Sudden Stressor.9

These responses have often been referred to as the "fight or flight response"-gearing you up to either physically do battle with the stressor or run from it. Your blood pressure rises as your heart rate and the force of pumping increases. These changes allow for greater delivery of blood to your muscles so that they can be active in the physical response of either fighting or running from the stressor. While blood flow increases to the muscles that need to be active, the blood supply to other organs decreases. Since your intestinal system and kidneys can get by for a while with a reduced blood supply, the body decreases blood flow to those areas so that more blood is available for the active muscles. The pupils dilate or open up to take in more light. The bronchial tubes also open up to allow more air exchange in the lungs. (More oxygen, of course, will improve physical performance). Muscle strength increases. Sugar is released from the liver and overall metabolism is stimulated. Even mental activity is quickened.

As helpful as this alarm reaction would be in dealing with a tiger, many stressors in our lives do not call for such physical responses. Activation of Phase I may actually be counterproductive if the stressor is a deadline, financial pressure, or a home life challenge. The body is geared up for activity but physical responses will not be helpful.

Although mental activity is increased under the acute effects of stress, the mind may actually be less focused to make an intelligent decision. In fact, the mind often has even greater problems when a stressor persists and coping resources begin to diminish. In later stages of Phase II, you may begin to notice some of the more worrisome mental effects of stress. Similarly, under the persistent effects of a stressor, problems also tend to develop in your social relationships. Often these deleterious mental and social effects are closely related.



Mental and Social Responses to an Ongoing Stressor

Dr. Phillip Rice has described the mental and social effects of persistent job-related stress.10 His observations are generally applicable to any ongoing mental stressor.

Clearly, continued exposure to a stressor can result in a variety of both mental and social effects. An awareness of the great variety of ways that stress can take its toll can help us to be more understanding when we or others close to us are dealing with the ongoing effects of stress. All of the mental and social effects of stress are red flags that should be interpreted as indicators that Phase 3, Stage of Exhaustion, could be imminent. In fact, some of the more dramatic manifestations that I have pointed out-such as depression, or loss of control-may even indicate that Phase III has been reached. In such cases, immediate action to deal effectively with stressors is urgent. If you find yourself in such a situation, look carefully at your ten major stressors. You need to deal with these areas as soon as possible.



Spiritual Responses to an Ongoing Stressor

The likelihood of successfully dealing with ongoing stressors can be significantly enhanced by a strong spiritual basis in one¡¯s life. Unfortunately, persistent stress can also erode our spiritual moorings. Indeed, not only does stress affect our physical, mental, and social natures; stress can also affect the spiritual dimension of our character. It is interesting to note that some people seem "inoculated" from spiritual distress because of the belief system they espouse. Since I am a Christian, most of my experience with strong spiritual belief systems comes from a Christian perspective. I have noticed that there are some individuals who never seem distressed no matter what confronts them. In general, they have internalized biblical principles such as, "we know that all things work together for good to them that love God, to them who are the called according to His purpose." (Romans 8:28). Even when things that look bad happen to such individuals, they believe that some good will ultimately result.

On the other hand, there are people-including Christians-who have internalized other spiritual principles that are neither helpful nor biblical. One of these principles is the so-called "prosperity doctrine." This teaches that if a person is good enough (or has enough faith), then he or she will have benefits such as financial prosperity and healing from any physical disease. It is obvious how destructive ongoing stress can be to such a spiritual belief system. When a spiritual system can not integrate difficulty and adversity into a positive life outlook, then chronic stress can produce some distressing spiritual effects.

Those who believe that God will always prevent adversity may have difficulties that can cause them to question their values and faith. If their religion was the main influence in giving meaning and purpose to their life, then such questioning usually leads to a loss of these critical emotional bulwarks. Their faith may be blamed or abandoned in the face of the very difficulties that it was supposed to prevent. Solutions then must be looked for beyond the spiritual framework that they had once embraced. Ironically, this may be a very healthy-although distressing-process. It is often the case that significant spiritual distress indicates a faulty belief system and a need to re-evaluate the assumptions of spiritual convictions. Through such a process, many have come out of difficulties with a stronger and more enduring faith.

One of the classic examples of this is found in the 73rd chapter of Psalms. There the psalmist describes how he had espoused the doctrine of prosperity and experienced severe stress as he went through difficulty while "wicked" people prospered. He describes his severe spiritual distress in these terms: ". . . all the day long have I been plagued . . ." and ". . . it was too painful for me." However, his questioning causes him to re-examine his faith. As he reflects on God¡¯s revelation in "the sanctuary," he appreciates a new dimension to God¡¯s character and faith. He writes, "Until I went into the sanctuary of God; then understood I their end." He then understands how a just God can allow the wicked to prosper in this life and someone like him with faith to struggle. His burden is lifted and he ends the Psalm on a note of praise.

I find this Psalm very interesting because it depicts someone who, because of stress, questioned his faith in God but did not give it up. The individual only left the erroneous portions of his beliefs.

It is a tragedy that many individuals (especially, but not exclusively, younger individuals) have misunderstandings about God and the teachings of the Bible. When they have problems, they reject their faith rather than follow the Psalmist¡¯s example. If they would re-explore their faith in light of God¡¯s revelation in the Bible, which may prompt a departure from their former understanding of God, they may find answers to life¡¯s deepest problems. Spiritual discouragement resulting from ongoing stress demonstrates that a person is not coping well on a spiritual level. This is an indication of a need for a higher power that can integrate adversity into a healthy outlook on spiritual life.



Physiological Damage from an Ongoing Stressor

We have already examined the physical effects of sudden stress. Regarding an ongoing stressor that produces serious ongoing stress, the social, mental, and spiritual effects are often the most visible. Physical effects of the stress may be occurring invisibly, under the surface, only to explode in an acute illness or a dramatic life-threatening event. Some of those chronic effects are related to a weakening of the immune system; others may relate to an acceleration of atherosclerosis (hardening of the arteries).

There are many indications that chronic stress can be a cause of disease, a factor in intensifying an existing disease, or an impediment to the recovery from disease. There is no scientific measurement, however, such as a blood test, that can verify or measure a person¡¯s level of stress. All stress level indicators are subjective. As a result, one can never be certain in any specific case that a disease was caused by stress or that stress was even a factor in the causation or lack of recovery from a disease. However, I have seen certain cases in which there were definite indications pointing to stress as the cause of a disease. I have seen other cases in which stress appeared to be one of several causes, and still others in which stress appeared to hinder recovery from a disease. On the other hand, I have seen patients with cardiovascular disease, for example, in which stress did not seem to be involved. A classic example is the happy-go-lucky person who from all appearances leads a low stress life, yet smokes, fails to exercise, and eats unhealthfully. A heart attack may occur for obvious reasons, with no apparent involvement of stress.

Many times after a heart attack is diagnosed, the patient asks, "Could stress cause this?" I respond that stress can contribute to heart attacks. I also point out that even when stress is a factor it usually does not act alone. Typically, there are other underlying factors such as partially blocked arteries, an unhealthful diet, and perhaps high blood pressure and/or high cholesterol. Uncontrolled anger or some other reaction caused by stress could have triggered the heart attack. But such an emotional response would not likely have caused a heart attack if the heart¡¯s arteries had been free of cholesterol blockages. Many illnesses are known to be affected by stress. Stress Related Illnesses in the left hand column.11

I have seen many cases of heart disease and cancer in individuals who were dealing with major life stresses. After the death of a loved one, the surviving spouse has been found to have a greater risk of a heart attack, especially within six months of the loss.12 Similarly, in the context of bereavement, the remaining loved one may develop a fatal cancer-presumably because stress weakened his or her immune system. The most extensive research study that I have found on this subject observed over 1.5 million married Finnish persons for five years.13 The researchers concluded: "The results are consistent with the hypothesis that excess mortality after the death of a spouse is partly caused by stress."

Diabetes can be more difficult to control in patients under stress.14 Infectious diseases such as tuberculosis are more likely to spread and dominate the body if the immune system is weak; such weakened immunity can occur if the patient is unable to cope with stress.15

Ailments other than major illnesses are also stress-related. You do not have to be under an excessive amount of stress to develop any of these ailments. However, stress seems sufficient to increase the risk of these conditions or at least hasten their presentation in those genetically or environmentally predisposed.



Eight Keys to Successful Stress Management

There are many techniques that can be helpful in dealing with stress. However, I have identified eight key stress control or stress management measures that I believe are underutilized, but are of profound importance in helping us deal with stressors. Review the list of ten leading stressors that I encouraged you to write earlier. With these stressors in mind, look at the control measures presented below. See if you can identify ways to use these measures to address your most significant stressors.



Conclusion

To conclude this chapter, it is fitting to list the eight key measures to control stress that we have examined.

These eight key stress management principles have been invaluable in my life. They have also been a help to many who have attended my stress seminars. They may sound too simplistic, but that does not detract from their power. I am convinced that there are two reasons why many people who try to control stress fail in their attempt. First, they misunderstand the basics of the stress process and thus fail to address the stressors that are confronting them. Second, even when trying to confront their stressors, they do not use the basic key principles that I have enumerated as the foundation for successful control of our stresses. I would challenge you anew to openly assess your stressors and apply the principles presented in this chapter. You likely will be surprised as to how far they will go in helping you master stress-rather than allowing stress to master you.





References

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  2. Selye H. Stress Without Distress. Philadelphia, PA: Lippincott, 1974 p. 31.
  3. Selye H. The stress concept and some of its implications. In: Hamilton V, Warburton DM, editors. Human Stress And Cognition: An Information Processing Approach. New York, NY: Wiley, p. 70.
  4. Rice PL. Stress And Health: Principles And Practice For Coping And Wellness. Pacific Grove, CA: Brooks/Cole Publishing Company, 1987 p. 18-19.
  5. Yerkes RM, Dodson JD. The relation of strength of stimulus to rapidity of habit formation. Journal Comparative and Neurological Psychology 1908;18:459-482. As cited In: Rice PL. Stress And Health: Principles And Practice For Coping And Wellness. Pacific Grove, CA: Brooks/Cole Publishing Company, 1987 p. 19.
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  11. The American Institute of Stress. Stress-America¡¯s #1 Health Problem. Internet: http://www.stress.org/problem.htm (2/4/97).
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  13. Martikainen P, Valkonen T. Mortality after the death of a spouse: rates and causes of death in a large Finnish cohort. Am J Public Health 1996 Aug;86(8 Pt 1):1087-1093.
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