- Decrease or discontinue caffeine
. Most people do not think of coffee, cola or chocolate as the source of a powerful drug that actually generates a stress reaction in the body. Dr. Posen advises his patients that the best way to observe the effect of caffeine is to get it out of the system long enough to see if there is a difference in how they feel. Three weeks is adequate for this purpose. He reports that 75 to 80 percent of his patients notice a benefit. They feel more relaxed, less jittery or nervous, sleep better, have more energy (a paradox, since caffeine is a stimulant), less heartburn and fewer muscle aches. One warning, however. You must wean yourself gradually or you will get migraine-type headaches from caffeine withdrawal. Dr. Posen suggests decreasing by one drink per day until you reach zero, then abstain for three weeks.
- Regular exercise
. It goes without saying that exercise is an essential ingredient in any stress reduction program.
- Relaxation/meditation
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- Sleep
. Sleep is an important way for reducing stress. Chronically stressed patients almost all suffer from fatigue, and people who are tired do not cope well with stressful situations. Most people know their usual sleep requirement (the range is five to 10 hours per night; the average being seven to eight), but a surprisingly large percentage of the population is chronically sleep deprived. Dr. Gregg Jacobs of the Mind/Body Institute at Deaconess estimates that 20 to 40 percent of the adult population complain of insomnia. But, paradoxically, he suggests that the most common explanation is poor sleep scheduling. One of the most important ways to improve your sleep is to reduce your time in bed. It is common for poor sleepers to extend their time in bed, especially after a restless night, in order to "catch up" on sleep. However, the more time you spend in bed, the more difficulty you will have falling asleep and the lighter and poorer your sleep will be. By reducing that time, he says, you will also be drowsier at bedtime, and can consolidate and deepen your sleep, and make it easier to fall asleep and sleep more deeply the next night.
- Time-outs and leisure
. No one would expect a football or basketball player to play an entire game without taking breaks. It's just as irrational to expect yourself to be working from dawn to dusk without taking intermissions. Dr. Posen suggests two aspects, pacing and balance. Pacing involving monitoring your stress and energy level and then pacing yourself accordingly. It is about awareness and vigilance; knowing when to extend yourself and when to ease up. It is also about acting on the best information your body gives you. The other key to pacing is taking periodic time outs. Dr. Ernest Rossi wrote The 20-Minute Break, a book that extols the virtues of a short recess every couple of hours throughout the day. Just as we have cycles of deep sleep and dream sleep throughout the night, we also have cycles of energy throughout the day, peaks of energy and concentration interspersed with troughs of low energy and inefficiency. Dr. Rossi terms these "ultradian rhythms" because they happen many times per day (as opposed to the 25-hour circadian rhythm). The main point of his book is that we need to watch for these troughs and take 20 minute recovery breaks when they occur, as opposed to working through them and building up stress. Dr. Posen advises that a mid-morning break, lunch, a mid-afternoon break and supper divide the day into roughly two hour segments. These time-outs can include power naps, meditation, daydreaming, a social interlude, a short walk, a refreshment break, a change to low concentration tasks, or listening to music. He reports, "Since I have started to work with this biologic pattern (instead of resisting it), the results have been pleasing. Like the catnap, it is simply a good investment of time that pays itself back quickly with increased productivity and reduced stress."
Work-leisure balance is also important. Dr. Posen asks his patients to think of their lives (excluding sleep time) in four compartments (work, Family, community, and self) and then to assess what percentage of their time and energy in an average week goes to each part. He explains, "There is no normal range but I become concerned when work is over 60 percent and/or when self is less than 10 percent. We all require time to meet our own needs and when that is neglected, trouble usually follows." The word leisure is derived from the Latin word licere which means "permission". The main reason so many people lack leisure time is that they don't give themselves permission to make the time to enjoy it.
- Realistic expectations
. People often become upset about something because it does not concur with what they expected, Dr. Posen comments. Take, for example, the experience of driving in slow-moving traffic. If it happens in rush hour, you expect it and you may not like it, but it will not surprise or upset you. However, if it occurs on a Sunday afternoon, especially if it makes you late for something, you are more likely to be stressed by it. When expectations are realistic, life feels more predictable and more manageable. There is an increased feeling of control because you can plan and prepare yourself (physically and psychologically) for it. Often, a reality check on your expectations, of situations and self, is necessary to avoid the stress from your negative experiences.
- Reframing
. Reframing is a technique used to change the way you look at things in order to feel better about them. Dr. Posen remarks, "We all do this inadvertently at times. For example, many people viewed the baseball strike as a personal disaster whereas others immediately realized they were going to save a lot of time and money by not hotfooting it down to the ballpark." The key to reframing is to recognize that there are many ways to reinterpret the same situation, like the age-old question, "Is the glass half empty or half full?" He explains, "The message of reframing, is that there are many ways of seeing the same thing, so you might as well pick the one you like."
- Belief systems
. Much of our stress results from our beliefs, thousands of premises and assumptions about all kinds of things that we hold to be the truth. A good percentage of these beliefs are not objective truths, however. They are opinions based on the way a person is raised. We have beliefs about how things are, how people should behave, and about ourselves. Some people believe, "If you want something done right, you have to do it yourself." They do not delegate well and tend to get overloaded. Most of our beliefs are held unconsciously, so we are not aware of them. That gives them the power to run our lives. Uncovering the assumptions behind our actions is often a good way to locate the reasons that we become stressed or experience conflict.
These beliefs sometimes also trigger automatic thoughts which precipitate negative moods and emotions. These are knee-jerk responses to a perceived stressor: quick, fleeting, and unreasoned. You believe them unconditionally without really being aware of them, and because they feel so right, develop what Dr. Donald Meichenbaum calls a confirmatory bias, meaning we selectively perceive or attend to things that fit our point of view and confirm our negative mood. One technique helps us to change the automatic way we think in stressful situations: stop, breathe, and reflect. That is, examine the cascade of automatic self-talk against a reality check, and identify the thoughts which are associated with the mood. That helps to reduce the negative emotions.
- Ventilation/support system
. There is an old saying, "a problem shared is a problem halved." People who have relationships and social support feel considerably more stress-hardy than their counterparts who feel isolated and misunderstood. Another form of ventilation that many people feel helpful is writing, for example, in a private journal. Most recently, psychologist James Pennybaker demonstrated how beneficial this process can be. He studied volunteers, half of whom were encouraged to write about their most traumatic experiences for 20 minutes a day. After just four days, those who wrote about their experiences and their feelings about them showed much greater immune cell activity than the others, showing how valuable it is for health reasons to deal with problems and the feelings around them.
- Humor
. Humor is a wonder stress reducer. Laughter relieves tension. In fact, people often laugh hardest when they are feeling the most tense. Dr. Posen cites an example from his patients. He recalls an executive who felt besieged from several directions at once: customer demands, telephone calls, and staff members who needed his help. The man said he started using a phrase which helped him cope and gave him a laugh, "I love it when they fight over me!" In this case, he generated his own humor and reduced his upset.
The mind and body are integrated through behavior. Individuals can manage a significant amount of their stress by paying attention to those habits and tendencies that keep them stress-prone, vulnerable to situations that call out the fight-or-flight response. Dr. David Posen, a Family physician who consults on stress management for firms such as IBM, Motorola and Peat Marwick, suggests 10 practical strategies that he has found helpful for himself and his patients:
