Stress Management Lecture Notes
Most lectures are from the books Why Zebras Don’t get Ulcers by Robert M Sapolsky and Learned Optimism by Martin Seligman

INTRO TO STRESS
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• Our current pattern of disease would be unrecognizable to our great-grandparents (or most other mammals) = heart disease, cancer, cerebrovascular disorders
• Stress can bring on or worsen diseases
• Why do we adapt to some stressors, while others make us sick? Why is there variation from person to person?
• What is the stress response designed for –vs- stressors of modern life. Humans can have long term anticipation
• Stress response accidentally discovered by Hans Selye in the 1930’s because he was inept at handling lab rats. Studied hormone responses and injected them, but not well. From the trauma they had enlarged adrenal glands, peptic ulcers, and shrunken immune tissue
• Body has similar responses to a broad array of stressors
--- Rapid mobilization of energy from storage sites
--- Heart rate, breathing and blood pressure rise
--- Digestion, growth, reproduction inhibited
--- No energy to immune system
--- Pain reception blunted
--- Senses become sharper
--- Memory changes
--- Blood to working muscles only
--- Pupils dialate
• Spending all your resources on the stress response means you don’t have energy for other vital functions

PERSONALITY AND STRESS
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Why is stress stressful?
• Perception and appraisal of the stressor can greatly change the reaction to it
• Outlets for frustration
--- Rats who could run over and bite another rat after being shocked showed lower levels of stress
--- Punching a wall, take a run, hobby
--- Even imagining outlets helps
--- Exercise provides your body with the outlet that it was preparing for
• Social support
--- Put a primate through something unpleasant and it gets a stress response. Put it in a room with other primates and, if those primates are strangers, the stress response gets worse. If they are friends it is decreased.
--- Those with spouses or close friends have longer life expectancies. When a spouse dies, the risk of dieing increases.
• Predictability
--- Knowing exactly when it will start and end
--- Nazi blitzkerig bombings of England: London was bombed every night like clockwork. Suburbs were bombed sporadically (fewer stressors but less predictability). More ulcers were reported from those in the suburbs. But, by the 3rd month of the bombing, all hospitals reported that ulcer rates were back to normal.
--- However, too much predictability can lead to boredom and stress
--- Exceptions:
How predictable is the stressor in the absence of warning? Advance warning for very rare or very frequent stressors are less effective. So, if you get warning that a meteor is going to crush your car it isn’t soothing. Or, if you are warned that there will be traffic during rush hour in the city, this isn’t overly soothing either
How far in advance of the stressor does the warning come? Too much or too little doesn’t help. Or, if the incident is terrible, no warning can help… it may make it worse.
• Control
--- Or at least the perception of it
---Locus of control
--- Place two people in adjoining rooms and expose both to intermittent noxious, loud noises; the person who has a button and believes that pressing it will decrease the likelihood of more noise is less hypertensive. In one variation of the study, subjects with the button who did not bother to press it did just as well as those who actually pressed it.
• Perception of things getting worse
--- In one study, parents of sick children were told that their children had a 25% chance of survival. They showed only moderate rise in stress response. Why? Because the children were all in remission from cancer when the chances of death were much higher.

Junkies, Adrenaline junkies and Pleasure
• Sometimes we pay good money to be stressed (horror movies, roller coasters, bungee jumping). Stress can feel great sometimes. Some people even get addicted to stress and risk taking
• A stressful situation can be exhilarating depending on how much predictability and control there is.
--- You can’t tickle yourself
--- If you can’t predict or control the tickle it tickles
--- But usually you can’t be tickled by someone you have bad feelings towards
• Dopamine is released (causing pleasure) during short term, transient stressors
• Dopamine is also produced in anticipation of a reward – and the reward is almost an afterthought. The appetitive stage (anticipation) vs consummatory stage (reward). So, dopamine can fuel the behavior – this is also how gratification postponement works
• If the reward is likely, but not guaranteed, the dopamine levels are even higher.
• This is why gambling is so tempting. Further, great effort goes to manipulating people into thinking that casinos are benign environments where the outcome is likely to be a positive one
• CONTROL AND PREDICTABILITY exist in extreme sports and things like bungee jumping, roller coasters, horror movies etc
• Adrenaline junkies may release low amounts of dopamine… or maybe their receptors are less receptive to it. No one knows for sure, but there are atypical versions of dopamine receptors in people with addictive personalities.
• ADDICTION of all types is characterized by tolerance
--- Dopamine levels in hungry rats that are fed increase 50-100%. Dopamine levels from taking cocaine increase a thousand fold.
--- Early on, addiction is about anticipation of effects, then there is a transition to needing the drug, then it is to avoid the negative consequences of not having it.
--- There is still an element of uncertainty in anticipation which feeds the addiction like mad (will I score, will I get caught)
--- Context dependent relapse

Personality, Temperament, and their stress-related consequences
• In primates, the lowest glucocorticoid levels are found in males who:
--- are best at telling the difference between threatening and neutral interactions;
--- who take the initiative if the situation is clearly threatening;
--- who are best at telling whether they won or lost, and, in the later case, who are most likely to make someone else pay for the defeat
• Type A Personality
• 1960’s = Type A Personality = competitive, overachieving, time pressured, impatient, hostile
• Friedman and Roseman (cardiologists) concluded many of their heart disease clients were type A --- Actually, this was discovered by the upholstery guy who found that he was replacing the chairs in the cardiology dept much more often than other departments. He mentioned it to Frieman, who dismissed him. Freiman came to the same conclusion years later. The name of the upholsterer is still not known. Photo of the chairs on p330
• P326 has a photo of the parking lot of the Type A personality support group where all the cars are backed into the places.
• But later this was debunked – actually, of those who have heart disease, type A is associated with the highest rate of survival
• Now hostility is believed to be the determining stressor… and exacerbated by NOT expressing it
• Mainly the hostile respond abnormally to SOCIAL stressors, where tests show same responses in, say, math
• Rats are nocturnal and don’t like light. Shine a bright light in the cage over the food, and they will hover in the corner with anxiety. (Anxiety is when they are still trying to get to the food, depression is when they give up.)

STRESS AND PHYSICAL ILLNESS
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Heart attacks (#1 killer in the US)
• Stress elevates the heart rate and constructs the blood vessels, which results in high blood pressure (like a garden hose)
• Blood flow to digestion, skin and kidneys is reduced
• At artery branch points the inner lining of the vessel starts to tear, scar and pit. Gunk gets under the lining and gets stuck, thickening the walls.
• Chronic turning on of stress response increases the plaque
• Hear attacks generally come from years of degeneration, but sudden heart attacks can happen after and extreme event (happy or sad). For example, in the 91 Gulf War, more Israelies died from cardiac death from fright (elderly) than from SCUD missles.
• Rage, ecstasy, grief and triumph all have similar cardiovascular reactions.
• Voodoo death (Wade Davis) resulting from a Shaman hex. “Psychophysiological death” = the overworked sympathetic system ruptures blood vessles (but in some cases the shaman may have killed them).
• Some personality types are prone to viewing life’s ambiguities as stressful and are at higher risk
• 1960’s = Type A Personality = competitive, overachieving, time pressured, impatient, hostile
• Friedman and Roseman (cardiologists) concluded many of their cardiac clients were type A
• But later this was debunked – actually, of those who have heart disease, type A is associated with the highest rate of survival
• Now hostility is believed to be the determining stressor… and exacerbated by NOT expressing it
• Mainly the hostile respond abnormally to SOCIAL stressors, where tests show same responses in, say, math

Metabolism
• Putting $ in the bank scenario (diversigy finds, save for emergencies, don’t dip into savings, don’t liquidate too often because there is a fee)
• Excess of protein, sugars and fat are stored in fat cells, muscles and liver. Insulin regulates this process and is responsible for metabolic future
• Sympathetic response decreases insulin and we dip into the reserves
• Constantly breaking down proteins can cause muscles to slightly atrophy over time
• Stress increases the risk of adult onset diabetes, one of the most common diseases in the west
-----Type 1 – juvenile – not enough insulin secreted
-----Type 2 – adult – failure of cells to respond to insulin. Extra glucose and free fatty acids in the blood cause plaque in arteries, gum up kidneys, can cause little strokes, and can casue protein chains in the eyes (cataracts)
• Stress’s affect on diabetes = even more glucose and fatty acids go into the blood
• Adult diabetes affects 15% of people over 65. It triples the rates of heart disease in men and is a leading cause of blindness. 7th leading cause of death

Digestion and Ulcers
• Digestion takes huge amounts of energy, it stops during stress (dry mouth, etc)
• Water is poured into the small intestine and removed in large intestine
• Peptic (stomach) ulcers can sometimes arise in just days if there is an extreme stressor, but is most likely formed over time
• Stomach spends a lot of energy not eating itself. In stress, less protective mucus is secreted. When digestion resumes, it isn’t protected at first. So, several periods of transient stress can be more harmful than one extended one
• Decreased immune system fails to protect stomach against potentially harmful bacteria
• Bowels empty under extreme stress (diarrhea)
• Irritable bowel syndromes are the most common gastrointestinal diseases and the most common stress related disorder. 75% of us will have some form of it at some point (ie before wedding)
• Appetite is stimulated after stressor to replenish reserves, but is surpressed during the stressor. So, a long, sustained stressor may lead to no appetite, while several short stressful events can lead to overeating

Growth
• In extreme cases of abuse and neglect, a child’s growth is stunted “stress dwarfism”
• 10 century, king Fredrick 2 of Sicily, to solve a debate about which is the natural language of humans, locked several infantsin a room. They were kept warm and fed, but had no human interaction. They all died. Maybe of stress dwarfism.
• German orphanages post WWII (controlled environment). Fraulein Grun was nice and the kids grew normally. Fraurlein Schwartz was mean and her kids grew slower. Then Schwartz replaced Grun and the place she left had an increase in growth and the place she went showed a decrease
• JM Barrie = Peter Pan (barely 5 feet, unconsummated marriage). His older brother died and his mother was devastated. He never “grew up”
• In one study touching premature babies made them grow 50% faster than the control group
• Stress increases the chances of osteoporosis and sketetal atrophy
• Harlow (monkeys and surrogate moms)

Sex and reproduction
• In both sexes, extreme exercise or stress affects the sex drive
• Compartmentalized = body taking sympathetic tone but the parasympathetic system is sill working in the sex organs. Orgasms are sympathetic nervous system
• Impotency and premature ejaculation are stress related problems.
• Women can have periods disrupted
• Repeated stress in pregnancy can cause fetal asphyxiation

Psycho immunology
• An artificial rose can trigger an allergic response
• Not only does stress halt immune system, but it actively disassembles it… tissues shrink
• One theory is that immune system is suppressed so you don’t look vulnerable in an emergency (ie zebras being eaten when tagged with paint by scientists)
• Of parents of kids kille din way, 10 years later, there were higher mortality rates in those already widowed or divorced (Isreal Yom Kippour war)
• Depressive episodes increase risk of dieing of cancer
• Rats with tumors put in stressful situations (ie on record player top) had tumor grow much faster
• It isn’t to say that stress management cures cancer or that it is your fault if you are sick
• 1890’s SIDS theory = due to large thymus. But actually the thynmus was normal bc their “normal” came from the poor who were subjected to more stress. Throats of infants were radiated to shrink the thymus as a preventative measure and fave many cancer

Pain
• Stress induced analgesia
• Runners high
• Recovery rates are higher for patients in rooms with views
• Pain is important for survival
• Nerves can be distracted, massage, acupuncture, scratching a bug bite. Chronic back pain is now relieved by attaching a stimulator to their hop and buzzing.
• With similar injuries 80% of civilians (and 1/3 of soldiers) requested morphine. Soldiers were actually relieved to be alive and getting help.

 

CULTURE AND STRESS
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The View From the Bottom
• If you want to see an example of chronic stress, study poverty. There is a great lack of control and predictability with poverty. Can’t plan for the future… lack of outlets… lack of social support
•· Studies show that the deleterious effects of unemployment on health begin not at the time a person is laid off, but when the mere threat of it first occurs
• We can’t consider disease outside the context of the person who is ill… we also can’t consider it outside the context of the society in which that person has gotten ill, and the person’s place in that society
• In subordinate male baboons, resting levels of glucocorticoids (products of sympathetic nervous system response) are significantly higher than among dominant individuals. And, when a real stressor comes along, their glucocorticoid response is smaller and slower than in dominant individuals. And when it’s all passed, their recovery appears to be delayed.
• Chronically activated stress-response appears to be a marker of being low ranking in lots of other animal species as well. (rats, mice, hamsters, guinea pigs, wolves, rabbits, pigs, even fish)
• Some species don’t necessarily have higher stress responses in subordinate members – scientists speculate this is because, basically, it isn’t so bad (ie violent) to be subordinate in those species
•· There are many studies about dominant humans. One defined dominant as ones who, in interviews, are hostile, competitive, quick speaking and who interrupt the interviewer. Other studies measured physiological responses of individuals who were directly competing against each other. Others looked at endocrine correlates of rank competition in the military.
•· The “executive stress syndrome” is mostly a myth. People at the top give ulcers, rather than get them. Middle management is more likely to succumb to stress-related diseases.
•· Measuring rank in humans is difficult because they may rank differently in different parts of their lives. Difficult to know which one makes up their “identity”. People put spin in their heads about rank.
• One study showed that guys who win at some sort of competitive interaction typically show at least a small rise in their circulating testosterone levels – unless they consider the win to have come from sheer luck
• Socioecomonic status (SES) is measured by a combination of income, occupation, and housing conditions.
--- 6-8 year old kids in low SES brackets tend to already have elevated glucocorticoid levels. This is true throughout life
• poverty is associated with increases risks of cardiovascular disease, respiratory disease, ulcers, rheumatoid disorders, phychiatric diseases, and many types of cancer
•· Is this because of a lack of access to health care? Well, maybe that is part of it. But people with low SES are also more likely to get diseases that aren’t necessarily preventable with healthcare access (juvenile diabetes, rheumatoid arthritis)
• Also, maybe this is partially because low SES people drink and smoke more, have more trouble affording healthy food, get less exercise, are more likely to be obese, to live near a polluted area, to not have a car with airbags, etc. Last, but not least, a lack of education in health related matters may also be a piece.
•· BEING poor versus FEELING poor. Amazingly, feeling more poor than others around you is shown to be just as good of a predictor of stress related diseases
•· “social capital” vs “financial capital”. Social capital is , for example, demonstrated in a community where there is a lot of volunteerism and numerous organizations that people can join which make them feel like they’re part of something bigger than themselves. Where people don’t lock their doors. There isn’t a large income discrepancy. The lower the social capital, the worse the physical health of the community. social isolation is a factor in this finding.
• Where does our capitalistic society rank?

 

OPTIMISM
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STRESS AND MENTAL HEALTH
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Stress and Depression
• Martin Seligman called depression the “common cold of psychopathology”. 5-20% of us will suffer major, incapacitating depression at some point, causing us to be either hospitalized, medicated or nonfunctional for a significant length of time. By the year 2020, depression is projected to be the second leading cause of medical disability on earth.
• Major symptoms of depression:
--- Anhedonia (or dysphoria) – inability to feel pleasure
--- Great feeling of grief and guilt (obsessive guilt about the depression itself
--- Delusion
--- Psychomotor retardation (moving and speaking slowly)
--- Early morning wakening, different sleep patterns,
--- Vegetative
--- Elevated levels of glucocorticoids
--- Memory problems
--- Can be rhythmical
• Even though they are outwardly blah, they are actually a tightly coiled spool of wire (tense, straining, fighting a major internal battle)
• Biology of depression
--- Abnormal levels of norepinerhrine, serotonin, and dopamine.
--- Selective Serotonin Reuptake Inhibitors SSRI’s help keep serotonin in the synapse
--- The “pleasure pathway” (which has to do with dopamine) is less active in depressives
--- The anterior cingulated cortex (ACC) connects the cortex t the limbic system. When it is cut, in a surgical procedure called a cingulotomy), there is an improvement. The ACC has to do with negative messages and is more active in depressives.
o In one study where a subject was instructed to play a video game with 2 other people and the other people started excluding them, the ACC was activated. In another version of the study, where the subject was told that this was due to an electronic failure, the ACC was not activated.
• Genetics and depression
--- Growing up in a poor family, an abusive family, a persecuted family, can all increase the risk of depression running through that family without genes having anything to do with it
--- Two siblings (who share about 50% of each other’s genes). If one has a history of depression, the other as a 25% above average chance of getting it. In identical twins (with almost 100% of the same genes), the chances are about 50% above average
• Stress and depression
--- Those who are prone to depression experience stressors in a higher than expected rate. Those undergoing a lot of life stressors are more likey than average to succumb to a major depression, and people sunk in their first major depression are more likely than average to have undergone recent and significant stress.
--- Stress can trigger the first few depressive episodes, but after that they become rhythmic despite external stressors
--- genetics can make you predisposed to depression – depending how that gene interacts with a certain environment. It makes you more vulnerable to a stressful environment.
• Learned helplessness:
--- a rat who can recently been exposed to repeated and uncontrollable stressors cannot then learn a simple task.
--- Learned helplessness looks much like depression (dysphoria, psychomotor retardation, vegetative symptoms, disorganization of sleep architecture).
--- Antidepressants help speed the recovery.
--- It takes surprisingly little in terms of uncontrollable unpleasantness to make humans give up and become helpless
--- Loss of a parent to death, divorce of parents, being a victim of abusive parenting – all make the child at risk for depression years later

Anxiety Disorders - are characterized by an overactive Sympathetic Nervous System (stress) Response
* Generalized Anxiety Disorder
* Obsessive-Compulsive Disorder (OCD)
* Panic Disorder
* Post-Traumatic Stress Disorder (PTSD)
* Social Phobia (or Social Anxiety Disorder)
* Specific Phobia
* Agoraphobia

more about anxiety disorders here

 

UNUSUAL COPING STRATEGIES
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• click HERE to download lecture notes about the Stockholm Syndrome (.doc file)

• click HERE for notes about Freud's defense mechanisms (.doc file)

 

SUBSTANCE ABUSE
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History of Drug Law in America

· 1794 – George Washington imposed the whiskey tax to raise money for the army. This lead to a rebellion
· In the 1800’s products such as cocaine cigarettes and opium syrup for babies were common
· The FDA was created to give warnings about the effects
· At the turn of the century, the first drug restriction law was in San Francisco and banned smoking opium (targeted at Chinese)
· 1914 – Harrison Narcotics Tax Act (by the way, scientifically, “narcotic” means something that makes you tired or lazy as in “narcolepsy”, so stimulants shouldn’t be in this category).
· 1920 The 18th Amendment– the sale, manufacture and transport of alcohol were illegal (the “Temperence” movement was also big in Europe, but alcohol was never banned.)
--- side note: media campaigns said “we need our grain to feed our soldiers overseas… drinking alcohol supports the enemy.” Interestingly, we here similar rhetoric today regarding the middle east and heroin
· With the growth of organized crime in association with alcohol, prohibition was lifted in 1933
· 1930’s – Federal Bureau of Narcotics – Harry Anslinger (infamous character) – needed new demon now that alcohol was legal… which was marijuana. “Reefer Madness” and other propaganda added to it becoming illegal
· 1970 Controlled Substance Act – replaced all previous drug laws and targeted certain drugs. Drug Enforcement Administration was created.
· 1984 Comprehensive Crime Control Act – established guidelines for penalties
· Substances are not something that the constitution allows federal authority over, but the “Commerce Clause” is actually what allows the jurisdiction. Because drugs are trafficked between states (and internationally), there is federal legislation. This was challenged in 2005 by California – if you grow pot in your yard for yourself for medical purposes and the state says it is okay, shouldn’t it be legal? The supreme court ruled 3 to 6 that it was not. By the way, pot is currently classified as having “no medical benefit” by the government.

What determines abuse potential?

· Pharmacology (some are more adherently addictive –ie meth)
· Quantity
· Route of administration
· Psychological (are you surrounded by partying?) and Sociocultural (do you use it to cope with stress?) context

Quitting
· Tell everyone
· Have a ritual or special
· Plan for relapse
· Recognize what you get from it and replace those needs

Tobacco
· Most poisonous substance
· Can hallucinate and die from some routs of administration (but cant really OD from smoking it)
· Shamen use it in many cultures
· It gives calm and focus
· Tar in smoke is hazardous – light cigarettes aren’t better for you, neither are organic ones
--- By the way, cloves are not any better for you. Actually, the clove oil numbs your lungs and throat so you can actually be smoking harsher tobacco and not know it
--- Hookas and water pipes cool the smoke but don’t purify (tar is not water soluble)
· Nicotine is bad for the cardio vascular system even when it isn’t smoked
· Try to quit with a patch, nasal spray, gum or inhailer
· It is possible that Native Americans cultivated it before food
· Product placement in movies is higher than ever. In the 60’s after the surgeon general’s report smoking in movies decreased.
· Why do we like it?
--- Social or solitary
--- A break
--- Focus on breath
--- Glamorous?

Alcoholism
· Correlates between personality and alcoholism
--- Low frustration levels
--- Impulsivity
--- Low anger control
--- Resent authority
--- Family problems
· 3% of abusers become dependent
· binge drinking is defined by 5 drinks in a short time
· not much scientific evidence for “addictive personality”
· Medication “antibuse” makes you will if you drink… but you have to TAKE IT
· Genitics – there is an especially high correlation from father to son. Also seen in adoption studies (most adoption studies are done in Sweeden)
· AA is difficult to study. It works for some… mostly social sort of people
· Controlled drinking vs cold turkey

Harm Reduction

Use vs. abuse vs. dependence

MANAGING STRESS/ SELF CARE
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• Successful aging
---- Doing nothing more than handling a rat for 15 minutes a day for the first few years of life… and the handled rat is spared the entire feed forward cascade of hippocampal damage, memory loss and elevated glucocorticoid levels
---- Traits in youth that contribute to successful aging: no smoking, minimal alcohol use, lots of exercise, normal body weight, absence of depression, a warm stable marriage, and mature resilient coping style
---- Tremendous benefits to being respected in old age
• Coping with Catastrophic Illness – a study of parents of children dieing of cancer and their coping strategies. Here are some coping styles associated with lower physical stress responses:
---- One important variable was the ability of parents to displace a major worry onto something less threatening. (ie: when taking a break from the hospital “what if she dies without me” vs “what is the nurse doesn’t have time to read her a bedtime story”).
---- A second variable had to do with denial. (Ie: denying relapse was possible.) Though it should be noted that these parents had the greatest stress response when the child did relapse.
---- A final variable was whether the parent has a structure of religious rationalization to explain the illness. (ie: God choose us)
• Differences in vulnerability to learned helplessness. Even in the face of setbacks, those with lowest stress responses still had the perception that they were in control of their own destiny. Ie; “This is awful, but it isn’t the entire world.”
• We can’t control our infancy, our genes or our parents’ socioeconomic status. The first thing we can do is emphasize what we can change. Exercise will lower blood pressure and resting heart rate and increase lung capacity, just to mention a few things. Psychotherapy can help Type A’s to not only change behaviors, but also cholesterol profiles, risk of heart attack
• Sheer repetition of certain activities can change the connection between your behavior and activation of your stress-response. In one study of Norwegian soldiers learning to parachute, they were examined over the course of the training. At the time of their first jump, they were all terrified - and had been for hours prior. After time, the stress response was only turned on less strongly and only at the time of the jump.
• CONTROL and chronic pain. When patients have the power to self dispense morphine (by pressing a button), their consumption went down. Why? Added control and predictability was given to them.
• CONTROL in nursing homes. When staff encouraged the residents during tasks, performance improved. When staff helped, performance decreased.
• Nursing home and pain studies are encouraging: if manipulating such psychological variables can work in these trying circumstances, it certainly should for the more trivial psychological stressors that fill out daily lives.
• Another nursing home study: residents received visits from college students. Some came by on a random schedule, some came by on a schedule that the residents picked, some came by on a schedule they choose. All residents had reductions in stress levels. BUT the interesting part is what happened after the study ended: in all groups, when the visits stopped, they fell below the level they had started at in the beginning of the study!
• EXERCISE
---- Decreases risk of various metabolic and cardiocascular diseases, therefore decreases the opportunity for stress to worsen those diseases./
---- Exercise improves mood. This could be due to the secretion of beta-endorphin. In addition, it gives a sense of achievement. But it only blunts the stress response for a few hours to a day after the exercise session.
---- It relieves stress in the way the stress response was built for.
---- Exercise may not reduce stress if you don’t want to do it… ie: hard labor can cause stress
---- Studies are quite clear that aerobic exercise is better than anaerobic exercise for health
---- Needs to occur on a REGULAR BASIS
• MEDITATION on a regular, sustained basis (15-30minutes daily), reduces stress responses. Studies are clear in showing physiological benefits while someone is meditation, but is less clear that the good effects persist for long afterwards. Is the good health of meditators due to their meditation, or are people with healthy lifestyles attracted to meditation in the first place?
• Less stress = More control, more predictability, more outlets, more social support! Physical stressor = you want to activate a stress response; but not with psychological stressor. Basal conditions = as little glucocorticoid secretion as possible… but in a real stressor you want as much as possible. Onset of stress = you want rapid activation and then rapid recovery when it is over
• The realm of stress management is mostly about techniques to help deal with challenges that are less than disastrous.
• INTERNAL LOCUS OF CONTROL AND POSITIVE OUTLOOK – is good to a certain extent, but not if you don’t live in the privileged, meritocratic world in which one’s efforts truly do have something to do with the rewards one gets
• SOCIAL SUPPORT – Throwing someone who has been isolated into a social situation can be very stressful also. Don’t confuse social support with socializing.
---- Often, one of the strongest stress-reducing qualities of the social support is the action of GIVING social support –to be needed. Ina world of stressful lack of control, an amazing source of control we all have is the ability to make the world a better place, one act at a time
• RELIGION AND SPIRITUALITY
---- The studies about religion and health are controversial. It is religion itself that is responsible for the good health? It has been correlated with lower cardiovascular disease and depression. But most evidence is about healthy people staying healthy – not sick people staying alive or recovering faster
---- Being religious typically gets you a religious community and thus social support, meaningful social roles, good role models, social capital, etc. Also, you are less likely to drink, smoke and engage in dangerous behavior.
---- Religion adds control and predictability to life, if I do X, Y will happen. Plus, if something goes wrong, there is an explanation. Also, if God prefers someone who acts/dresses/etc like you, there is even more control
• COGNITIVE FLEXIBILITY - during times of stress, finding the resources to try something new is really hard and is often just what’s needed.
• 80% of stress reduction is accomplished with the first 20% of effort. It’s not going to happen until you decide it’s really time to change. For example, clinically depresses people feel significantly better simply by scheduling a first appointment to see a therapist. On a certain level, it doesn’t matter which technique you use.
• SUMMING IT UP
---- Hope for the best and let that dominate most of your emotions, but at the same time let one small piece of you prepare for the worst
---- Seek control when appropriate (Grant me the serenity to accept the things I cannot change, courage to change the things I can, and wisdom to know the difference… by Reinhold Niebuhr)
---- It generally helps to seek predictable, accurate information
---- Find an outlet for frustrations and do it REGULARLY
---- Find social affiliation and support