Medical Editor: Leslie J. Schoenfield, MD, PhD
Stress is simply a fact of nature -- forces from the outside world affecting the individual. Hence, all living creatures are in a constant interchange with their surroundings (the ecosystem), both physically and behaviorally. This interplay of forces, or energy, is of course present in the relationships between all matter in the universe, whether they are living (animate) or not living (inanimate). However, there are critical differences in how different living creatures relate to their environment. These differences have far reaching consequences for survival. Because of the overabundance of stress in our modern lives, we usually think of stress as a negative experience. But from a biological point of view, stress can be neutral, negative, or positive.
Stress has driven evolutionary change (the development and natural selection of species over time). Thus, the species that adapted best to the causes of stress (stressors) have survived and evolved into the plant and animal kingdoms we now observe. Man, because of the evolution of the human brain, especially the part called the neo-cortex, is the most adaptive creature on the planet. This adaptability is largely due to the changes and stressors that we have faced and mastered. Therefore, we, unlike other animals, can live in any climate or ecosystem, at various altitudes, and avoid the danger of predators. Moreover, most recently, we have learned to live in the air, under the sea, and even in space, where no living creatures that we know of have ever survived.
So, How can we manage stress?
If we think about the causes of stress, the nature of the stress response, and the negative effects of some types of stress (prolonged, unexpected, unmanageable), several healthy management strategies become clear. First, exercise. You see, since the stress response prepares us to fight or flee, our bodies are primed for action. Unfortunately, however, we usually handle our stresses while sitting at our desk, standing at the water cooler, or behind the wheel stuck in traffic. Exercise on a regular basis helps to burn off and use up the stress hormones and neurochemicals. Thus, exercise can help avoid the damage to our health that prolonged stress can cause. In fact, studies have found that exercise is a potent anti-depressant, anxiolytic (combats anxiety), and sleeping pill for many people, without taking any pills.
For centuries in Eastern religious traditions, the benefits of meditation and other relaxation techniques have been well known. Now, Western medicine and psychology have rediscovered that particular wisdom, translated it into simple non-spiritual methods, and scientifically verified its effectiveness. Thus, one or two 20 to 30 minute meditation sessions a day can have lasting beneficial effects on health. Indeed, advanced meditators can even significantly control blood pressure and heart rate as well.
Elimination of drug use and no more than moderate alcohol use are key to the successful management of stress. We know that people, when stressed, seek these outlets. But, we also know that many of these substances sensitize (make even more responsive) the stress response. As a result, small problems produce big surges of stress chemicals. What's more, these attempts with drugs and alcohol to mask stress often prevent the person from facing the problem directly. Consequently, they are not able to develop effective ways to cope with or eliminate the stress.
In fact, even prescription drugs for anxiety, such as diazepam (Valium), lorazepam (Ativan), or alprazolam (Xanax), can be counterproductive in the same way. Therefore, these medications should only be used cautiously under the strict guidance of a physician. If, however, stress produces a full blown psychiatric problem, like posttraumatic stress disorder (PTSD), clinical depression, or anxiety disorders, then psychotropic medications, particularly the SSRIs, are extremely useful. Examples of the SSRI (selective serotonin reuptake inhibitor) medications include sertraline (Zoloft), paroxetine (Paxil), or fluoxetine (Prozac).
We know that chronic or uninterrupted stress is very harmful. It is important, therefore, to take breaks and decompress. Take lunch and don't talk about work. Take a walk instead of a coffee break. Use weekends to relax and don't schedule so many events that Monday morning will seem like a relief. Learn your stress signals. Take regular vacations, or even long weekends or mental health days, at intervals that you have learned are right for you.
Create predictability in your work and home life as much as possible. Structure and routine in your life can't prevent the unexpected from happening. However, they can provide a comfortable framework from which to respond to the unexpected. Think ahead and try to anticipate the varieties of possibilities, good and bad, that may become realities at work or home. Generate scenarios and response plans. You may find that the "unexpected" really doesn't always come out of the blue. With this kind of preparation, you can turn stress into a positive force to work for your growth and change.