Getting Out From Under Stress: Jerome Kiffer

Last Editorial Review: 10/23/2003

By Jerome Kiffer
WebMD Live Events Transcript

Stress may be an unavoidable part of life, but too much of it can cause physical and emotional problems. If you're stressed out, read about tips on stress management from psychologist Jerome Kiffer, MA, from The Cleveland Clinic.

The opinions expressed herein are the guest's alone. If you have questions about your health, you should consult your personal physician. This event is meant for informational purposes only.

Moderator: Thank you for joining us today, Jerry. Is stress really a problem or just a fact of modern life?

Kiffer: The answer is both. It is an increasingly more frequent problem of modern life and it is a problem for a greater majority of us. The problem of stress affects how we feel emotionally, physically, affects our quality of life, and those around us that we love can also feel the affects of our stress.

Member: What are some physical signs of stress?

Kiffer: The most frequent physical sign of stress is muscle tension and muscle tightness that can lead to pain, but all of us experience stress differently. Other common physical symptoms of stress involve stomach upset, cardiovascular reactions, and various other systems in the body.

Member: Can constant headaches be caused by stress?

Kiffer: Absolutely. The most frequent type of chronic headache is muscle contraction headache that is thought to be associated with chronic levels of muscle tension in the facial muscles and neck and shoulders. Even for migraine headaches, which involve blood vessels, a frequent trigger for this type of headache can be a stressful event.

Member: I'm trying to conceive and want to know if stress can affect my fertility.

Kiffer: That is possible. I work in a hospital setting where we do get referrals from the gynecologic department for couples that are having difficulty conceiving. And our approach in these situations is to identify any excessive stress reactions that are present in either partner. And often, by learning how to relax and managing stress, it increases the chances of conceiving.

Member: Could stress affect you sexually?

Kiffer: Yes it can. That is through two different mechanisms. One would be a psychological and emotional mechanism, which can result in either sexual performance difficulties or loss of interest in sex. And the other mechanism is a physical one, which is related to the chronic affects of high adrenaline in the body, which can make or result in poor sexual performance.

Member: Can stress make you susceptible to sickness and injury?

Kiffer: Yes. Again I preface a lot of my answers by stating that this comes from my experience of working in a medical setting and I am not a medical doctor nor can I make a diagnosis. But, stress can have an effect on the immune system. Research has shown that chronic levels of stress can reduce the parts of the immune system that fight infection. The end result is what we think of when we talk about a weak immune system; that is, one is more susceptible to viruses, bacteria, and our resistance is low. Additionally, when we are stressed, we typically are moving around too quickly for our own good and we end up bumping into things or are more susceptible to just minor injuries. This is just from trying to accomplish too much in too short a time.

Member: Can being depressed be caused by stress?

Member: What about moodiness?

Kiffer: First off, moodiness is certainly an emotional indicator of stress. We all know what it feels like to have too much to do, to have time demands placed on us that may seem unfair, and to have our normal sleep-wake patterns altered. In other words, stress can often lead to insomnia and poor sleep. That sets the stage for us being moody and irritable. Depression can be associated with long term, chronic levels of stress. Yet, I would say that depression is more associated with what we talk about as burnout. Burnout is the end result of long-term, unabated stress.

Member: I get angry very easily. A crashing computer, the dog chewing on a shoe, traffic jams all make me crazy. Is this a result of being stressed? I wasn't like this when I was younger.

Kiffer: This is a very typical scenario of being stressed and feeling stressed. It's interesting that as you describe what is going on in your life that it is related to our cultural emphasis on machines, technology; there is just so much to do. And when machines break down and dogs act up and people place a lot of demands on us, all of these external sources of pressure and will often result in lowering our threshold, our tolerance for stress, and we find ourselves then with a stress reaction. Stress reaction can take the form of physical symptoms, behavioral disturbances, and emotional upset.

Member: I awoke on 9/11 to the sound of a small plane flying overhead, turned on the morning news, and saw people jumping to their death from the WTC. I still feel a great deal of stress whenever I hear planes overhead. I understand the connection, but can't break the emotional response. Will I ever be able to hear planes without stressing out?

Kiffer: That's a good question that is related to PTSD (posttraumatic stress disorder). I'm not saying that that is what you have, but it is closely related to that. One of the major mechanisms of PTSD is the highly conditioned emotional response to an outside stimulus or event, in this case the airplane. What happens is that the brain has become so sensitive to the emotional reaction from Sept.11, that all it takes is the airplane to trigger those same emotions. This is what we call a recurrence or a repetitive remembering of that initial emotional response. It often takes a long time for the brain to unlearn that conditioned response. That period of time can be shortened by the use of certain medications as well as being involved in psychological therapy.

Member: Can stress be used in some positive way?

Kiffer: That is a great question. It certainly can be used in a positive way. We are now shifting this conversation away from what causes stress to how to transform stress into a positive outcome. The answer lies within us to cope with the stressful situation in a way that allows us to be challenged and respond productively rather than react in a negative way. When we have repeated negative reactions, the negative feelings accumulate and hence, we talk about feeling more and more stressed out. So to answer your question, yes, that is the challenge that we all face: How to view stress not as something to be avoided but something to be managed and dealt with in the most effective way possible.

Moderator: What are some of the techniques you use with your clients to manage their stress?

Kiffer: Again, I am coming out of a background of training in psychology and being associated in a hospital setting where people are primarily having physical stress reactions. In those cases, that is, for people with physical stress reactions, I routinely use relaxation training along with biofeedback training. I also encourage people to be involved in community classes in meditation, yoga, tai chi. Also, I encourage people to be involved in the spiritual side of meditation. This can take the form of being more involved in prayer and seeking out a spiritual director.

The other component of stress management interventions is what is called cognitive therapy. Cognitive therapy means that you pay attention to thought patterns and identify negative thoughts and irrational beliefs that contribute to perceiving the world as a very stressful or negative place. Cognitive therapy focuses on changing one's perception of the world. An example of this would be a situation where we have high expectations of how the world should be, the world does not meet our expectations, and the end result is a feeling of anger or frustration on our part. Cognitive therapy would suggest that we need to lower our expectations of the world and that will stop stress from even being generated. So I use a combination of relaxation techniques and cognitive therapy in trying to help people manage stress.

Member: What is the "breaking point" between stress we should be able to control ourselves and stress that needs professional help to deal with?

Kiffer: That's a tough question and I say that because we all do our darndest to manage stress in the best way possible given the tools that we have at hand. I would suggest that the breaking point of when to seek professional help is when the stress levels have resulted in an interference or impairment of a high magnitude in your life. We all have stress in our life; yet the degree to which it interferes with our life differs for each of us. The interesting thing about stress is that we can get used to it in our life. We can adapt to higher and higher levels of stress over a long period of time and [not] realize the toll it is taking in our life. Often times, it may be our significant other in our life that tells us how stressed out we are or how it is affecting our most basic loving relationships in our life. Other than that, it may take our medical doctor to also see the physical effects of stress and point that out to us.

Member: Because women are culturally taught to view themselves as caregivers, do you feel that women have an additional burden of stress to make sure that everyone else is okay, without caring for themselves?

Kiffer: Certainly our traditional roles in the culture have been for the women to be the primary caregivers. The role of the caregiver is to give care to everyone else first and herself last. That is a sure fire way to create stress. So the goal is to recognize what care giving duties we are willing to take on but to also take care of ourselves in the process. The extreme result of what you described is what I call the martyr syndrome, which is to give away all of one's time to other people and to deny your own personal needs to the point where it ends up hurting you. The important concept to remember here is balance; there is nothing wrong with being a caregiver. In fact, we probably need more people to be sensitive and give good care, but it has to be balanced with our own abilities and resources. In short, to answer your question, caregivers are the first group that needs to take care of themselves.

Member: I am completely aware of an overabundance of stress in my life right now. My workload is high and I have two children, one is high-needs. My youngest is speech-delayed and has Sensory Integration Dysfunction. Because of this, she has frequent meltdowns, which appear as a tantrum, multiplied by 10. She is only 2 1/2, and that makes going places difficult. There are many times when I am on the verge of tears. I have tried having a sitter and getting a night out, but end up feeling guilty and just want to be home with the kids. Sometimes I just want to scream. I feel like my life revolves around therapy and my children and have lost a sense of who I am and what I need. How do you control stress that is ongoing and will be ongoing?

Kiffer: Obviously, there are very real sources of stress in your life. Parenting stress is probably the most enduring, chronic source of stress. Obviously, you love your children very much since they are so involved in therapy and doctor's appointments. Also, you are having stress reactions and do need to take care of yourself. When stress is chronic and ongoing, it takes a sense of courage to persevere. I would suggest that this is a time when you need to identify your beliefs that you are doing a good job and that you can feel good about yourself as you provide care for your children. You also need to realize that you have to set limits and take time out for yourself whenever possible. This may only be done in your case by finding more resources and having greater help if that is possible.

Member: I am a 27-year-old male with fibromyalgia. I would like to know a few ways of helping to reduce the stress I experience because of this debilitating condition. Most of the stress is caused by my need to be the breadwinner in my family, but much of it is also caused by my family not understanding my pain and inability to perform at a normal level. Could you please offer me some tips to help reduce the stress level I am subjected to daily? It only makes my condition worsen.

Kiffer: I would like to address two parts to your question -- the need to be the breadwinner and that others don't understand what you are going through. In my experience with this kind of situation, there is usually a sleep problem that can perpetuate fibromyalgia so it is important that you have good sleep. Often, in trying to be the breadwinner, people can ignore their own body's first signs of stress and push themselves too hard. So, it is important to know what your limits are and have a healthy lifestyle that includes physical exercise and good sleep. Secondly, I would suggest that you discuss your feelings of not being understood with other family members. This can also be one source of stress where we are acting in certain ways to make other people happy. This is not always verbalized or articulated to those people in our life. The result being that we do all kinds of things for the people in our life, but don't get credit or recognition for it. When we don't feel recognized for the work we do, feelings of resentment are not far behind. It is important that you communicate more clearly with others in the family.


Negative emotions are more powerful than positive emotions. See Answer

Moderator: You mentioned physical exercise as important to a healthy lifestyle. What role can exercise play in dealing with stress?

Kiffer: Physical exercise is an extraordinary therapy for stress as well as depression. There is no doubt about it that the human body requires regular doses of exercise in order to function at its maximal capacity and to maintain health. Physical exercise is very important not only to maintain health but also to raise our tolerance for high levels of adrenaline that are triggered by stressful situations. In other words, I often see that people who do not exercise have a greater sensitivity to circulating levels of adrenaline compared with those people who exercise regularly.

Member: Can you use any technique to reduce the stress instantaneously if you feel stress at a particular moment?

Kiffer: A short exercise to reduce stress is something that I teach everybody that I work with. It usually involves changing your body posture. This would mean if you were sitting down that you are going to stretch out your legs, your arms, sit erect, and maybe move your shoulders around a little bit. It involves stretching your muscles and then relaxing them very deeply, letting them become very loose, and letting them drop to your sides if you can. Brief relaxation also involves taking slow abdominal breaths. After you have relaxed your muscles, taken a couple of deep breaths, then you need to mentally change your focus to something pleasant or neutral. The most frequent complaint I get from people when they are feeling stressed is that time is moving so fast. They feel so rushed. So I often ask people to think about slowing down time. I have them slow down their thinking. All of this can be done in 30 seconds and can be a useful way to reduce moments of intense stress.

Moderator: Have you ever used music to help cope with stress?

Kiffer: My relaxation tapes have music that accompanies my verbal instructions for relaxing. My suggestion is to use music that does not have lyrics. Especially, if you want music for pure relaxation, I highly recommend music without lyrics. I have looked at different types of research trying to find what type of music is most relaxing. The answer is there is no one universal piece of music that will produce relaxation. My opinion is that it is the individual's perception of music that determines whether it is relaxing. In other words, classical music might be relaxing for one person but slow jazz might be relaxing for another person. So my suggestion is to use whatever type of music you find comforting and that produces a mellow effect.

Member: Is the ultimate goal to eliminate stress completely from our lives, or do we need a little to get us out of bed in the morning?

Kiffer: Great question. There is no way to eliminate all stress from our life. The solution for having no stress in our life is when we are dead. So, we do need a little stress in our life. The unpredictability of life is the spice of life. We all like to be challenged and that is very important for our sense of self-esteem. So we need to find that right level of stress in our life where it is not so absent that our life is boring and where it not so high that we feel overwhelmed.

Moderator: We are almost out of time. Before we wrap up for today, do you have any final comments for us?

Kiffer: I was glad to respond to all of these great questions. Stress is unavoidable. I do not think we should avoid stress. We need to manage and control the stress levels in our life. We have heard from some people who have high levels.

Moderator: Unfortunately, we are out of time. Thanks for joining us, members, and thanks to Jerome Kiffer, MA, from The Cleveland Clinic, for being our guest. Please visit our message boards to chat with others about stress management. Goodbye and good health!

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