NEWS

Stress and Stress Management

This article explains the sources and symptoms of stress. It also teaches us stress management techniques to help us cope with stressful situations.
In everyday life, we face pressures from many sources. Stress can be defined as an external pressure that exceeds our resources to cope with it. It can also be a physical and psychological response to events perceived as a threat to one's sense of well-being.

Good and Bad Stress

Not all stress is harmful. In fact, it can be desirable, and even essential, to have some amount of stress in life. Research has shown that, within certain limits, an individual's performance improves with an increased level of stress. For example, an athlete is able to run faster under the stress of competition. A student studying for examinations is able to think quicker and stay alert because of the stress of impending examinations. Stress can bring out the best in us. Like a violin string that needs to be tuned to a certain tension in order to produce a beautiful sound, we can stretch our potential to perform at our optimum. However, if the string is stretched too tightly, it will snap. If it is too loose, it may not produce any sound or produce sound of poor quality.

Similarly, if we are not under any stress, we may not achieve our fullest potential, or our performance will be lackluster. If we are under too much stress, our performance can suffer. Hence, we need an optimum level of stress to bring out the best in us.

Sources of Stress

Predictable stressors
The following are some examples of predictable stressors.

1 Work
While work can provide immense satisfaction, it can also bring about stress. Examples of factors that can cause stress at work include lack of control over our work environment, too much work and too little time, inability to master new technology, threat of retrenchment, unclear goals, lack of feedback regarding job performance and unsupportive bosses.

2 Financial
Financial stress can result from economic recession, inflation, high prices for housing, inability to pay mortgages or medical bills and being unemployed.

3 Family problems
Family problems can also give rise to stress. Some common family problems are marital conflicts, disobedient children, being apart from spouse who is working overseas, in-law issues , difficult neighbours, children who get into trouble with the law and spouse who is addicted to alcohol.

Unpredictable stressors
Some stressors may not be predictable, for example, illness of spouse, death of spouse, meeting with an accident and being retrenched.

Life events
There has been considerable research demonstrating the impact of life events on physical and mental disorders. Two researchers, Thomas Holmes and Richard Rahe, observed that life events tended to cluster or increase in intensity prior to the onset of disease. They have found that death of spouse ranks as the most stressful event followed by divorce and separation. However, there are life events like marriage, moving house and having a baby, which are of neutral impact. But even these neutral events may be stressful, for instance, if the baby falls sick, or when the newly-wed couple has difficulty adjusting to life together. Some positive events, such as getting promoted at work, may have an adverse effect as promotion means increase in responsibilities.

Personality and Stress
A person's reaction to stress is determined to a great extent by his or her personality. Personality traits reflect the sum total of the way we habitually think, feel and behave in a given situation. There are certain personality traits which make a person more susceptible to stress.

Obsessional personality
These individuals are perfectionists and set high standards for themselves and others. They are rigid and react poorly to changes in their living environment.

Anxious personality
This person is a worrier who gets anxious over minor problems. He or she often overestimates the magnitude of his problems and underestimates his or her coping abilities.

'Type A' personality
The Type A personality was first described by two cardiologists - Friedman and Rosenman - who noted that individuals with such personalities were more susceptible to suffer from heart attacks. Typical Type A persons are ambitious, impatient, hard driving, competitive, have great sense of time urgency, often perform two or more tasks simultaneously, are restless, hostile, evaluate people or events in a suspicious manner, and are irritable.

Stress Reactions - Are They Automatic and Inevitable?
Stressors do not automatically lead to stress reactions. Different people react differently to the same stressors. Why is this so? The answer lies in the perception of the situation. We have seen that whether a person feels stressed depends on whether he thinks or perceives he can cope with the situation.

Perceptions
Perceptions of one's ability to cope depends on certain factors such as personality, intelligence, the role of teachers, parents, childhood experiences, one's coping skills and social support. Our personality influences the way we habitually think, feel and react to stressful situations.

The influence of negative perceptions
Cheng was given a difficult task by his immediate superior. Thoughts such as 'I'm sure to fail', 'he's all out to make life miserable for me' and 'people can't be trusted' caused him to perceive that he had inadequate coping resources and could expect little help from others. Understandably he felt stressed.
On the other hand, Leong interpreted the same situation differently, telling himself: 'I will try my best', 'I have performed the task before, I should be able to do it again' and 'even though I made mistakes, I am now wiser and have learnt not to make the same mistakes'. While Leong tackled the assignment confidently and accomplished his goals, Cheng became easily discouraged, postponed carrying out his duties, made careless mistakes and earned the displeasure of his superior.

Stress and Your Health
When a person is under threat or danger, his or her body undergoes biochemical changes which prepare him or her to face up to the threat/danger ('fight') or, if the threat/danger is perceived to be impossible to overcome, to escape ('flight').

Regardless of the source of stress, the body reacts in the following manner. The hormone adrenaline is secreted into the blood stream. It causes the heart to beat faster and blood pressure to rise. The rate of breathing quickens, the pupils of the eyes dilate, the muscles tense up in preparation for physical activity, digestion stops, perspiration increases to cool down the body and the extremities turn cold. These responses are known as the 'fight or flight response'.

Medical conditions
Those who have chronic stress may suffer from hypertension, migraine headaches, ulcers or diarrhoea. For females, stress may result in irregular menstrual periods and a failure to ovulate. For males, stress may give rise to impotency, whereas a loss of libido (sexual desire) can happen to both genders. In the respiratory system, stress can worsen the symptoms of bronchial asthma and bronchitis. Stress causes a decrease in the secretion of the hormone insulin which may in turn result in the onset of diabetes. Stress also inhibits tissue repair and reduces calcium content of bones, thus giving rise to osteoporosis. This in turn results in an increase in susceptibility to fractures. In addition, stress can inhibit the immune response and therefore cause one to be more susceptible to catching colds. Persons with impaired immune responses are also more prone to developing cancers. Prolonged stress response can worsen conditions such as arthritis, chronic pain and diabetes.

Psychiatric conditions
Stress has also been shown to trigger psychiatric disorders such as depression, anxiety, panic disorders, phobias, sleep problems, alcohol and drug dependency.

The Tell Tale Signs of Stress
Most people are able to tell when they are under stress because they are able to recognise at least some of the tell tale signs of stress. These can be broadly categorised into physical, emotional and behavioural signs.

Stress Management Techniques

Know where your stress comes from
Identifying the source of your stress is the first step in overcoming it. Keeping a stress diary is one way of helping yourself to identify sources of stress. Record situations which cause you to be stressed and the persons involved in your stressful experience. This should be done at the end of each day. After four weeks, review your diary to note any recurrent stressful situations and the individuals involved. Next, make a plan to deal with the situations.

Time management
'There is so much to do and I have no time' is the common complaint we often hear. All of us are given 24 hours in a day. The person who best manages his or her time will be able to achieve the most in the given time. Hence, time management techniques are of vital importance in coping with our hectic lifestyle.

Plan what you want to do each day. This may require you to spend some time each evening or before starting work each morning to work out a timetable of the day's activities. List things you want done, then assign them in order of priority, for instance, high, medium and low priority. Tackle those of higher priority and unpleasant tasks first when you are most fresh.

Don't procrastinate on decisions. Work which is postponed tends to pile up, causing you to be tensed and worried. Delegate work if possible. Don't entertain the belief that they cannot accomplish the job as competently or as efficiently as you.

Clear all irrelevant materials from your work table. Only have what is required for the immediate tasks at hand. A desk piled high with partially finished work adds to the stress of having so much to do, and gives others an impression that you are terribly disorganised.

Develop communication skills
Good communication skills are of vital importance at work, in the home and in every sphere of human interaction. Some people have natural abilities in communication while others will have to put in effort to develop the skill.

Assertiveness
Many problems at work result from a lack of assertiveness. We don't know how to stand up for ourselves. Some develop an aggressive stance, while others don't know how to say 'no', thus allowing others to take advantage of them. Assertiveness can be learnt. In learning to become more assertive, pay attention to the following: make appropriate eye contact, use a firm voice, avoid using 'hmms' and 'huhs' which make you sound unsure. You may want to rehearse what you wish to say for each scenario in which you will like to be more assertive.

Social support
We need friends, family members and colleagues to help encourage us and to lend us a listening ear. Studies have shown that people living in close-knit communities have a lower rate of developing heart attacks. Support from work supervisors and colleagues can improve morale and productivity. Spend time to build up relationships with family and friends, join support groups, religious groups, professional associations, community clubs or voluntary welfare organisations. In this way you will not feel isolated.

Share your feelings
It is beneficial to find a trusted confidant to share your frustrations with. Putting your feelings into words is a great way to gain emotional relief.

Physical exercise
There are many advantages to taking regular exercise. It prevents heart disease, improves stamina, reduces high blood pressure, helps you to relax, reduces obesity, tones your muscles and improves your figure.

Listen to music
Many studies have demonstrated the effectiveness of music in reducing anxiety and inducing a relaxed state of mind. Several studies have in fact demonstrated the positive effect of music on the immune response.

Anger management
Anger-provoking thoughts typically involve blaming others for deliberately causing you to be angry and judging others as breaking rules of reasonable behaviour, but you can choose how you respond. The following steps will help you cope better with your anger.

1 Relax. When you get angry, your arousal levels are high. Relaxation lowers your level of arousal. It requires regular practice. Details of relaxation training will be described later.

2 Make a list of stressful events that make you angry.

3 Deal with each situation by using rational thinking to counteract the angry thoughts. When we get angry, there are two types of statements which trigger our anger - 'should' and 'blame' statements.
(a) Countering 'should' statements: When we are angry, we tend to use 'should' statements such as 'he should have been more considerate'. Remember, other people do not necessarily have to agree with your rules of appropriate behaviour. They may have their own rules and feel perfectly justified in behaving the way they do. Think of more rational thoughts, for example, 'they are doing the best they can' and 'they are doing what they think is in their best interest'.

(b) Countering 'blame' statements: It is very easy to blame others for the distress we feel. Blame assumes that the suffering we have to go through is there because others did it to you. You may want to use the following positive statements to help you cope with blame:
(i) They are not doing this on purpose to annoy me.

(ii) No one can mind read that his or her actions are likely to irritate me.

(iii) I don't have to be a helpless victim in this situation.

(iv) I am also to be blamed for the way he behaved towards me.

4 Think cool thoughts. Remind yourself of the following: (a) getting angry won't solve the problem; (b) I am in control when I stay cool; (c) step back from the situation; don't take it so seriously; and (d) speak slowly and refrain from attacking the other party. Avoid sarcasm.

Relaxation techniques
Relaxation and tension cannot co-exist simultaneously in your body. Relaxation of your muscles reduces pulse rate, blood pressure and the rate of respiration. When a person is anxious, his muscles are in a state of tension. Relaxing the tensed muscles reduces anxiety.

1 Sit or lie down in a comfortable position. Slowly breathe in and then breathe out. Close your eyes. Check your body for any areas of tension and consciously relax the tensed areas.

2 The tension relaxation method involves tensing each muscle group for seven seconds and then releasing the tension for 15 seconds. Visualise a peaceful scene such as a garden or a lake in your mind. Imagine that you are at this scene, tell yourself to relax and let go of the tension in your body. You may want to purchase tapes, videos or CDs to learn more about relaxation techniques.

Neutralise negative irrational thoughts
Select a situation that consistently generates negative emotions, for example, anxiety or sadness. Write down your negative thoughts about the event. Dispute your irrational thoughts using the following techniques by asking yourself:

1 What is the evidence for the falseness of this idea? For example, what is the evidence that shows that I am good for nothing?

2 Is there any evidence for the truth of this idea? For example, is there evidence that I am an asset to others?

3 What is the worst thing that can happen? Often a person is frightened by what he or she thinks may happen, but if he or she carefully considers the worst possible consequences, the situation may not be as bad as it appears to be.

Spiritual pursuits
One of the most important ways to deal with stress is to have a religious belief. Religious faith gives a person courage and inner strength to cope with the challenges and adversities in life.

Conclusion
We have presented an overview of stress, its nature, sources, effects and several stress relieving measures. You are encouraged to try out some of these techniques and to regularly use those that work for you. By implementing effective anti-stress strategies, stress need not be feared. Stress management is important for better mental as well as physical health. By effectively managing stress, there is a good chance of preserving our mental and physical health despite the adversities that we face in the course of our busy and stressful lives.

Associate Professor Leslie Lim
Senior Consultant, Department of Psychiatry Singapore General Hospital