Stress - The No.1 Killer

Description of Stress

Without stress, life would be dull and unexciting. Stress adds flavor, challenge and opportunity to life. Too much stress, however, can seriously affect your physical and mental well-being. A major challenge in today's stress-filled world is to make the stress in your life work for you instead of against you.
During a stressful situation, the brain signals the release of stress hormones. These chemical substances trigger a series of responses that gives the body extra energy: blood-sugar levels rise, the heartbeat speeds up and blood pressure increases. The muscles tense for action. The blood supply is diverted away from the gut to the extremities to help the body deal with the situation at hand.

Stress is with us all the time. It comes from mental or emotional activity, as well as physical activity. It is unique and personal to each of us. So personal, in fact, that what may be relaxing to one person may be stressful to another. For example, if you are an executive who likes to keep busy all the time, "taking it easy" at the beach on a beautiful day may feel extremely frustrating, nonproductive and upsetting. You may be emotionally distressed from "doing nothing."

Too much emotional stress can cause physical illness, such as high blood pressure, ulcers or even heart disease. Physical stress from work or exercise is not likely to cause such ailments.

The important issue is learning how our bodies respond to these demands. When stress becomes prolonged or particularly frustrating, it can become harmful - causing distress or "bad stress." Recognizing the early signs of distress and then doing something about them can make an important difference in the quality of your life and may actually influence your survival.

Stress and Disease

Because the stress response couples physiological and emotional responses, it seems probable that stress can translate frustration into physical illness, but the precise mechanisms by which this occurs are not known. In some situations, as with tension headaches or upset stomachs, the connections appear fairly clear. On the other hand, both headaches and bellyaches can occur with no emotional provocation whatsoever.

The chain of causation is even less clear when it comes to more chronic and serious conditions, such as heart disease, hypertension, diabetes and cancer. The list of diseases linked to stress is almost endless, and includes asthma, allergies, rheumatoid arthritis, ulcers, ulcerative colitis and migraine headaches, among many others.

An important distinction that needs to be made. Any of these chronic illnesses can be made harder to bear by a stress-laden situation or an emotionally inadequate response on the part of the patient. On the other hand, it is no longer possible to credit older theories that specific emotional experiences or reactions actually cause these various diseases. On the whole, it seems most likely that stress plays a non-specific role in disease by throwing off the body's natural ability to heal itself.

Self Care

When stress occurs, it is important to recognize and deal with it. Here are some suggestions for ways to handle stress. As you begin to understand more about how stress affects you as an individual, you will come up with your own ideas on how to ease the tension.

Try physical activity. When you are nervous, angry or upset, release the pressure through exercise or physical activity. Running, walking, playing tennis or working in your garden, are just some of the activities you might try. Physical exercise will relieve that "up tight" feeling, relax you, and turn the frowns into smiles. Remember, your body and your mind work together.

Share your stress. It helps to talk to someone about your concerns and worries. Perhaps a friend, family member, teacher or counselor, can help you see your problem in a different light. If you feel your problem is serious, you might seek professional help from a psychologist, psychiatrist or social worker. Knowing when to ask for help may help to avoid more serious problems later.

Know your limits. If a problem is beyond your control and cannot be changed at the moment, don't fight the situation. Learn to accept what is for now, until such time when you can change it.

Take care of yourself. You are special. Get enough rest and eat well. If you are irritable and tense from lack of sleep, or if you are not eating correctly, you will have less ability to deal with stressful situations. If stress repeatedly keeps you from sleeping, you should ask your doctor for help.

Make time for fun. Schedule time for both work and recreation. Play can be just as important to your well-being as work; you need a break from your daily routine to just relax and have fun.

Be a participant. One way to keep from getting bored, sad, and lonely is to go where it's all happening. Sitting alone can make you feel frustrated. Instead of feeling sorry for yourself, get involved. Offer your services to a neighborhood or volunteer organizations. Help yourself by helping other people. Get involved in the world and the people around you, and you will find they will be attracted to you. You're on your way to making new friends and enjoying new activities.

Check off your tasks. Trying to take care of everything at once can seem overwhelming, and as a result, you may not accomplish anything. Instead, make a list of what tasks you have to do and do them one at a time, checking them off as they're completed. Give priority to the most important ones and do those first.

Must you always be right? Do other people upset you - particularly when they don't do things your way? Try cooperation instead of confrontation; it's better than fighting and always being "right." A little give and take on both sides will reduce the strain and make you both feel more comfortable.

It's OK to cry. A good cry can be a healthy way to bring relief to your anxiety, and it might even prevent a headache or other physical consequence. Take some deep breaths; they also release tension.

Create a quiet scene. You can't always get away, but you can "dream the impossible dream." A quiet country scene, painted mentally or on canvas, can take you out of the turmoil of a stressful situation. Change the scene by reading a good book or playing beautiful music to create a sense of peace and tranquillity.

Avoid self-medication. Although you can use drugs to relieve stress temporarily, drugs do not remove the conditions that caused the stress in the first place. Drugs, in fact, may be habit-forming and create more stress than they relieve. They should be taken only on the advice of your doctor.

The best strategy for avoiding stress is to learn how to relax. Unfortunately, many people try to relax at the same pace that they lead the rest of their lives. For a while, tune out your worries about time, productivity, and "doing it right." You will find satisfaction in just being, without striving. Find activities that give you pleasure and that are good for your mental and physical well-being. Forget about always winning and focus on relaxation, enjoyment, and health. Be good to yourself.

Source: www.healthscout.com

Depression

Depressive illnesses often interfere with normal functioning and cause pain and suffering not only to those who have a disorder, but also to those who care about them. Serious depression can destroy family life as well as the life of the ill person. But much of this suffering is unnecessary.

Most people with a depressive illness do not seek treatment, although the great majority even those whose depression is extremely severe can be helped. Thanks to years of fruitful research, there are now medications and psychosocial therapies such as cognitive/behavioral, "talk" or interpersonal that ease the pain of depression.

Unfortunately, many people do not recognize that depression is a treatable illness. If you feel that you or someone you care about is one of the many undiagnosed depressed people in this country, the information presented here may help you take the steps that may save your own or someone else's life.

WHAT IS A DEPRESSIVE DISORDER?

A depressive disorder is an illness that involves the body, mood, and thoughts. It affects the way a person eats and sleeps, the way one feels about oneself, and the way one thinks about things. A depressive disorder is not the same as a passing blue mood. It is not a sign of personal weakness or a condition that can be willed or wished away. People with a depressive illness cannot merely "pull themselves together" and get better. Without treatment, symptoms can last for weeks, months, or years. Appropriate treatment, however, can help most people who suffer from depression.

TYPES OF DEPRESSION

Depressive disorders come in different forms, just as is the case with other illnesses such as heart disease. This pamphlet briefly describes three of the most common types of depressive disorders. However, within these types there are variations in the number of symptoms, their severity, and persistence.

Major depression is manifested by a combination of symptoms (see symptom list) that interfere with the ability to work, study, sleep, eat, and enjoy once pleasurable activities. Such a disabling episode of depression may occur only once but more commonly occurs several times in a lifetime.

A less severe type of depression, dysthymia, involves long-term, chronic symptoms that do not disable, but keep one from functioning well or from feeling good. Many people with dysthymia also experience major depressive episodes at some time in their lives.

Another type of depression is bipolar disorder, also called manic-depressive illness. Not nearly as prevalent as other forms of depressive disorders, bipolar disorder is characterized by cycling mood changes: severe highs (mania) and lows (depression). Sometimes the mood switches are dramatic and rapid, but most often they are gradual. When in the depressed cycle, an individual can have any or all of the symptoms of a depressive disorder. When in the manic cycle, the individual may be overactive, overtalkative, and have a great deal of energy. Mania often affects thinking, judgment, and social behavior in ways that cause serious problems and embarrassment. For example, the individual in a manic phase may feel elated, full of grand schemes that might range from unwise business decisions to romantic sprees. Mania, left untreated, may worsen to a psychotic state.

SYMPTOMS OF DEPRESSION AND MANIA

Not everyone who is depressed or manic experiences every symptom. Some people experience a few symptoms, some many. Severity of symptoms varies with individuals and also varies over time.

Depression
Persistent sad, anxious, or "empty" mood
Feelings of hopelessness, pessimism
Feelings of guilt, worthlessness, helplessness
Loss of interest or pleasure in hobbies and activities that were once enjoyed, including sex
Decreased energy, fatigue, being "slowed down"
Difficulty concentrating, remembering, making decisions
Insomnia, early-morning awakening, or oversleeping
Appetite and/or weight loss or overeating and weight gain
Thoughts of death or suicide; suicide attempts
Restlessness, irritability
Persistent physical symptoms that do not respond to treatment, such as headaches, digestive disorders, and chronic pain
Mania
Abnormal or excessive elation
Unusual irritability
Decreased need for sleep
Grandiose notions
Increased talking
Racing thoughts
Increased sexual desire
Markedly increased energy
Poor judgment
Inappropriate social behavior

CAUSES OF DEPRESSION

Some types of depression run in families, suggesting that a biological vulnerability can be inherited. This seems to be the case with bipolar disorder. Studies of families in which members of each generation develop bipolar disorder found that those with the illness have a somewhat different genetic makeup than those who do not get ill. However, the reverse is not true: Not everybody with the genetic makeup that causes vulnerability to bipolar disorder will have the illness. Apparently additional factors, possibly stresses at home, work, or school, are involved in its onset.

In some families, major depression also seems to occur generation after generation. However, it can also occur in people who have no family history of depression. Whether inherited or not, major depressive disorder is often associated with changes in brain structures or brain function.

People who have low self-esteem, who consistently view themselves and the world with pessimism or who are readily overwhelmed by stress, are prone to depression. Whether this represents a psychological predisposition or an early form of the illness is not clear.

In recent years, researchers have shown that physical changes in the body can be accompanied by mental changes as well. Medical illnesses such as stroke, a heart attack, cancer, Parkinson's disease, and hormonal disorders can cause depressive illness, making the sick person apathetic and unwilling to care for his or her physical needs, thus prolonging the recovery period. Also, a serious loss, difficult relationship, financial problem, or any stressful (unwelcome or even desired) change in life patterns can trigger a depressive episode. Very often, a combination of genetic, psychological, and environmental factors is involved in the onset of a depressive disorder. Later episodes of illness typically are precipitated by only mild stresses, or none at all.

Depression in Women
Women experience depression about twice as often as men.1 Many hormonal factors may contribute to the increased rate of depression in women particularly such factors as menstrual cycle changes, pregnancy, miscarriage, postpartum period, pre-menopause, and menopause. Many women also face additional stresses such as responsibilities both at work and home, single parenthood, and caring for children and for aging parents.

A recent NIMH study showed that in the case of severe premenstrual syndrome (PMS), women with a preexisting vulnerability to PMS experienced relief from mood and physical symptoms when their sex hormones were suppressed. Shortly after the hormones were re-introduced, they again developed symptoms of PMS. Women without a history of PMS reported no effects of the hormonal manipulation.6,7

Many women are also particularly vulnerable after the birth of a baby. The hormonal and physical changes, as well as the added responsibility of a new life, can be factors that lead to postpartum depression in some women. While transient "blues" are common in new mothers, a full-blown depressive episode is not a normal occurrence and requires active intervention. Treatment by a sympathetic physician and the family's emotional support for the new mother are prime considerations in aiding her to recover her physical and mental well-being and her ability to care for and enjoy the infant.

Depression in Men
Although men are less likely to suffer from depression than women, 6 million men in the United States are affected by the illness. Men are less likely to admit to depression, and doctors are less likely to suspect it. The rate of suicide in men is four times that of women, though more women attempt it. In fact, after age 70, the rate of men's suicide rises, reaching a peak after age 85.

Depression can also affect the physical health in men differently from women. A new study shows that, although depression is associated with an increased risk of coronary heart disease in both men and women, only men suffer a high death rate.2

Men's depression is often masked by alcohol or drugs, or by the socially acceptable habit of working excessively long hours. Depression typically shows up in men not as feeling hopeless and helpless, but as being irritable, angry, and discouraged; hence, depression may be difficult to recognize as such in men. Even if a man realizes that he is depressed, he may be less willing than a woman to seek help. Encouragement and support from concerned family members can make a difference. In the workplace, employee assistance professionals or worksite mental health programs can be of assistance in helping men understand and accept depression as a real illness that needs treatment.

PSYCHOTHERAPIES
Many forms of psychotherapy, including some short-term (10-20 week) therapies, can help depressed individuals. "Talking" therapies help patients gain insight into and resolve their problems through verbal exchange with the therapist, sometimes combined with "homework" assignments between sessions. "Behavioral" therapists help patients learn how to obtain more satisfaction and rewards through their own actions and how to unlearn the behavioral patterns that contribute to or result from their depression.

Two of the short-term psychotherapies that research has shown helpful for some forms of depression are interpersonal and cognitive/behavioral therapies. Interpersonal therapists focus on the patient's disturbed personal relationships that both cause and exacerbate (or increase) the depression. Cognitive/behavioral therapists help patients change the negative styles of thinking and behaving often associated with depression.

Psychodynamic therapies, which are sometimes used to treat depressed persons, focus on resolving the patient's conflicted feelings. These therapies are often reserved until the depressive symptoms are significantly improved. In general, severe depressive illnesses, particularly those that are recurrent, will require medication (or ECT under special conditions) along with, or preceding, psychotherapy for the best outcome.

HOW TO HELP YOURSELF IF YOU ARE DEPRESSED

Depressive disorders make one feel exhausted, worthless, helpless, and hopeless. Such negative thoughts and feelings make some people feel like giving up. It is important to realize that these negative views are part of the depression and typically do not accurately reflect the actual circumstances. Negative thinking fades as treatment begins to take effect. In the meantime:

- Set realistic goals in light of the depression and assume a reasonable amount of responsibility.
- Break large tasks into small ones, set some priorities, and do what you can as you can.
- Try to be with other people and to confide in someone; it is usually better than being alone and secretive.
- Participate in activities that may make you feel better.
- Mild exercise, going to a movie, a ballgame, or participating in religious, social, or other activities may help.
- Expect your mood to improve gradually, not immediately. Feeling better takes time.
- It is advisable to postpone important decisions until the depression has lifted. Before deciding to make a significant transition change jobs, get married or divorced discuss it with others who know you well and have a more objective view of your situation.
- People rarely "snap out of" a depression. But they can feel a little better day-by-day.
- Remember, positive thinking will replace the negative thinking that is part of the depression and will disappear as your depression responds to treatment.
- Let your family and friends help you.

How Family and Friends Can Help the Depressed Person
The most important thing anyone can do for the depressed person is to help him or her get an appropriate diagnosis and treatment. This may involve encouraging the individual to stay with treatment until symptoms begin to abate (several weeks), or to seek different treatment if no improvement occurs. On occasion, it may require making an appointment and accompanying the depressed person to the doctor. It may also mean monitoring whether the depressed person is taking medication. The depressed person should be encouraged to obey the doctor's orders about the use of alcoholic products while on medication. The second most important thing is to offer emotional support. This involves understanding, patience, affection, and encouragement. Engage the depressed person in conversation and listen carefully. Do not disparage feelings expressed, but point out realities and offer hope. Do not ignore remarks about suicide. Report them to the depressed person's therapist. Invite the depressed person for walks, outings, to the movies, and other activities. Be gently insistent if your invitation is refused. Encourage participation in some activities that once gave pleasure, such as hobbies, sports, religious or cultural activities, but do not push the depressed person to undertake too much too soon. The depressed person needs diversion and company, but too many demands can increase feelings of failure.

Do not accuse the depressed person of faking illness or of laziness, or expect him or her "to snap out of it." Eventually, with treatment, most people do get better. Keep that in mind, and keep reassuring the depressed person that, with time and help, he or she will feel better.

Source:
This brochure is a new version of the 1994 edition of Plain Talk About Depression and was written by Margaret Strock, Public Information and Communications Branch, National Institute of Mental Health (NIMH). Expert assistance was provided by Raymond DePaulo, MD, Johns Hopkins School of Medicine; Ellen Frank, MD, University of Pittsburgh School of Medicine; Jerrold F. Rosenbaum, MD, Massachusetts General Hospital; Matthew V. Rudorfer, MD, and Clarissa K. Wittenberg, NIMH staff members. Lisa D. Alberts, NIMH staff member, provided editorial assistance.

NIH Publication No. 00-3561
Printed 2000

Fritz Perls - Gestalt Therapy

Albert Ellis

Carl Rogers

Dr.William Glasser on Choice Theory

You Can Never Change Your Spouse

William Glasser's Choice Theory

Post Traumatic Stress Disorder

Post traumatic stress disorder (PTSD) is a pathological anxiety that usually occurs after an individual experiences or witnesses severe trauma that constitutes a threat to the physical integrity or life of the individual or of another person.

The individual initially responds with intense fear, helplessness, or horror. The person later develops a response to the event that is characterized by persistently reexperiencing the event, with resultant symptoms of numbness, avoidance, and hyperarousal. These symptoms result in clinically significant distress or functional impairment. To meet the full criteria for PTSD, these symptoms should be present for a minimum of 1 month following the initial traumatic event.

The events experienced may be natural disasters, violent personal assaults, war, severe automobile accidents, or the diagnosis of a life-threatening condition. For children, a developmentally inappropriate sexual experience may be considered a traumatic event, even though it may not have actually involved violence or physical injury.

PTSD can also be caused by experiencing, witnessing, or being confronted with an event involving serious injury, death, or threat to the physical integrity of an individual, along with a response involving helplessness and/or intense fear or horror. The more severe the trauma and the more intense the acute stress symptoms, the higher the risk for PTSD. When these events involve an individual with a physiologic vulnerability based on genetic (inherited) contributions and other personal characteristics, PTSD results. These personal characteristics include prior exposure to trauma, childhood adversity (eg, separation from parents), and preexisting anxiety or depression.

Researchers have identified factors that interact to influence vulnerability to developing PTSD. These factors include the following:

- Characteristics of the trauma exposure itself - Proximity to, severity of, and duration of exposure to the trauma

- Characteristics of the individual - Prior trauma exposures, family history or prior psychiatric illness, and sex (Women are at greatest risk for many of the most common assertive traumas.)

- Posttrauma factors - Availability of social support, emergence of avoidance or numbing, hyperarousal, and reexperiencing symptoms.


PTSD can be acute (symptoms lasting less than 3 months), chronic (symptoms lasting more than 3 months), or of delayed onset (6 months elapses from event to symptom onset).

When a family member is diagnosed with PTSD, the entire family may be affected. Members may experience shock, fear, anger, and pain because of their concern for the victim. Living with family members who have PTSD does not cause PTSD. Yet, it can cause some similar symptoms, such as feelings of alienation from and anger toward the victim. Other family members may find it difficult to communicate with a person with PTSD. Sleep disturbance and abuse (physical and substance) may occur among family members.

Families should engage in counseling if anger, addiction, or problems in school or work become issues. Stress and anger management and couples' therapy are possibilities. Families should try to maintain their outside relationships and should continue to be involved in pleasurable activities.

- From www.emedicine.com

Not "Just Friends"

Just because infidelity in increasingly common doesn't mean that most people understand it. So much of the advice on television shows and in popular books about how to affair-proof your marriage is misleading. In fact, much of the conventional wisdom about what causes affairs and how to repair relationships is misguided.

Popular thinking about infidelity - the therapy that deals with it - is clouded by myths. The facts, which my research and clinical experience prove, are much more surprising and thought-provoking than unfounded popular and clinical assumptions. Here are a few truths that you will learn from this book:

Assumption: Affairs happen in unhappy or unloving marriages.
Fact: Affairs can happen in good marriages. Affairs are less about love and more about sliding across boundaries.

Assumption: Affairs occur mostly because of sexual attraction.
Fact: The lure of an affair is how the unfaithful partner is mirrored back through the adoring eyes of the new love. Another appeal is that individuals experience new roles and opportunities for growth in new relationships.

Assumption: A cheating partner almost always leaves clues, so a naive spouse must be burying his or head in the sand.
Fact: The majority of affairs are never detected. Some individuals can successfully compartmentalize their lives or are such brilliant liars that their partner never finds out.

Assumption: A persona having an affair shows less interest in sex at home.
Fact: The excitement of an affair can increase passion at home and make sex even more interesting.

Assumption: The person having an affair isn't "getting enough" at home.
Fact: The truth is that the unfaithful partner may not be giving enough. In fact, the spouse who gives too little is at greater risk than the spouse who gives too much because he or she is less invested.

Assumption: A straying partner finds fault with everything you do.
Fact: He or she may in fact become Mr. or Mrs. Wonderful in order to escape detection. Most likely, he or she will be alternately critical and devoted.

- An excerpt from Not "Just Friends" by Shirley P. Glass, Ph.D.