Managing Stress and Wellness

Life always gives us exactly the teacher we need at every moment. This includes every mosquito, every misfortune, every red light, every traffi c jam, every obnoxious supervisor (or employee), every illness, every loss, every moment of joy or depression, every addiction, every piece of garbage, every breath.

Charlotte Joko Beck, Zen teacher and author

Managing Stress and Wellness

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Did this story “put life into perspective” for you? Certainly it is true that fewer health, fi nancial, family, work, or social problems would make life more secure and satisfying. However, not having any problems or any stress would leave you with no choices in life, which would be dull and uninteresting. A certain number of problems and stresses can be stimulating. While some stress is good and necessary, excessive stress can create physical problems and/or behavioral changes.

Do you know that you have the power within yourself to modify both the amount of stress in your life and your reaction to it? Some of you may need to make only a few minor adjustments in your daily life for stress to become more constructive and manageable. Some of you will have to make some radi- cal external changes (for example, change jobs) or internal changes (such as change some of your social requirements and/or attitudes).

Most people, who with courage and support undertake such changes, have only one regret: Th ey did not do it sooner. We would like to encourage you to begin considering what adjustments you may need to make in your daily life for stress to become more constructive and manageable.

Let’s begin by discussing what stress is and what causes it.

What Is Stress?

Even though there is no widely-accepted defi nition of stress, the following viewpoints are worthy of consideration. Hans Selye (1978) studied stress for over 40 years. He considered stress to be the demand made on an organism to adapt, cope, or adjust. Selye defi nes stress as the rate of wear and tear within

S tress is like spice—in the right proportion it enhances the fl avor of a dish. Too little produces a bland, dull meal; too much may choke you. The trick is to fi nd the right amount for you.

DONALD TUBESING

Think about this Management Consultant Ken Blanchard (1995) frequently uses the following story, originally told by Dr. Norman Vincent Peale, to “put life into perspective.”

One day I was walking down the street when I saw my friend George approaching. It was evident from his downtrodden look that he wasn’t overfl owing with the ecstasy and exuberance of human existence, which is a high-class way of saying George was dragging bottom.

Naturally, I asked him, “How are you, George?” While that was meant to be a routine inquiry, George took me very seriously and for 15 minutes he enlightened me on how bad he felt. And the more he talked, the worse I felt.

Finally I said to him, “Well, George, I’m sorry to see you in such a depressed state. How did you get this way?” Th at really set him off .

“It’s my problems,” he said. “Problems—nothing but problems. I’m fed up with problems. If you could get rid of all my problems, I would contribute $5,000 to your favorite charity.”

Well now, I am never one to turn a deaf ear to such an off er, and so I meditated, ruminated, and cogitated on the proposition and came up with an answer that I thought was pretty good.

I said, “Yesterday I went to a place where thousands of people reside. As far as I could determine, not one of them has any problems. Would you like to go there?”

“When can we leave? Th at sounds like my kind of place,” answered George.

“If that’s the case, George,” I said, “I’ll be happy to take you tomorrow to Woodlawn Cemetery because the only people I know who don’t have problems are dead.”

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the body. Stress has also been defi ned as the anxious or threatening feeling that comes when we interpret or appraise a situation as being more than our psychological resources can adequately handle (Lazarus 2006).

Which of the following would you call stressful?

1. Building a new home 2. Being audited by the IRS 3. Getting a promotion 4. Sitting in a dentist’s chair 5. Getting married 6. Taking an exam

All of these six life events are stressful because they require us to adapt and change in response to them, which taxes our mental and physical adap- tive mechanisms. Because positive or pleasurable events, such as getting a new home, can require as much adaptation on our part as negative or painful events, like being audited by the IRS, they can be equally stressful.

Stanford psychiatrist David Spiegel says, “Living a stress-free life is not a reasonable goal. Th e goal is to deal with it actively and eff ectively” (Cowley 1999). Is there a diff erence between good stress and bad stress?

Types of Stress

Hans Selye (1974) has described and labeled four basic types of stress:

1. Eustress is defi ned as good or short term stress that strengthens us for immediate physical activity, creativity, and enthusiasm. It is characterized as short-lived, easily identifi ed, externalized, and positive. Two examples would be an individual who experiences short-term stress by psyching up for the hundred-yard dash and an individual who is really excited about beginning a new project at work. Th e secret of positive stress is a sense of control. When we can make choices and infl uence the outcome of a situation, we meet the challenge successfully and return to a normal level of functioning relatively quickly. Th is is the happy feeling of “I did it!” 2. Distress is negative or harmful stress that causes us to constantly readjust or adapt. Distress occurs when we feel no control over outcomes; we see few or no choices; the source of stress is not clear; the stress is prolonged over a period of time, or several sources of stress exist simultaneously. However, not all negative events cause psychological distress. According to Richard Lazarus (2000), distress arises only when the stressor makes demands on the individual that exceed the individual’s ability to cope. Th erefore, distress is accompanied by feelings of tension, pressure, and anxiety rather than the concerted energy of eustress. 3. Hyperstress or overload occurs when stressful events pile up and stretch the limits of our adaptability. An example would be an individual who goes through a divorce, loses a parent, and then has a serious illness, all in the same year. It is when we have to cope with too many changes

S uccessful activity, no matter how intense, leaves you with comparatively few “scars.” It causes stress but little distress.

HANS SELYE

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Even positive or pleasurable events can be very stressful.

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at once or adapt to radical changes for which we are not prepared that stress can become a serious problem. 4. Hypostress or underload occurs when we are bored, lacking stimulation, or unchallenged. Th is type of stress frustrates our need for variety and new experiences. For example, having a job that does not have new challenges can cause constant frustration. Th is is considered negative stress. Hans Selye (1974) believes that people who enjoy their work, regardless of how demanding it may be, will be less stress-ridden than people who are bored with a job that makes few demands or is too repetitive. It is not the stress itself that is enjoyed but instead the excitement or stimulation of the anticipated rewards. If you are involved in something you like, you are much more likely to handle frustration, pressure, or confl ict eff ectively. Th is kind of stress is just not as “stressful.”

We have seen that some stress is necessary to give our lives variety and to challenge us to grow and expand our abilities, but too much stress, or the wrong kind, or at the wrong time, becomes debilitating.

As important as it is to understand what stress is, it is even more impor- tant to understand where the stress originates. When you determine what stress means for you, you have a choice of dealing with it more eff ectively or eliminating it completely.

Causes of Stress

Is it other people, your job, too many things to do, your fi nancial situation, pressure, illness? Stress consists of an event, called a stressor , plus how we feel about it, how we interpret it, and what we do to cope with it.

Common stressors include:

the setting in which we live other people places we go our daily routine family members our job time—too little, too much money school dating our given health condition a spoken word a certain event a simple thought

What about college students and their degree of stress? In early 2008, the Associated Press commissioned a survey of 2,253 undergraduate students, ages 18–24, and randomly chosen from 40 four-year schools around the country. Th e results of the survey conducted by Edison Media Research showed plenty of sources of stress, led by the seven in 10 students who attributed it to schoolwork and grades. Financial problems are close behind, while relationships and dating, family problems and extracurricular activities all are named by half as adding pressure.

S tress is like a violin string. If there’s no tension, there’s no music. But if the string is too tight, it breaks. You want to fi nd the right level of tension for you—the level that makes harmony in your life.

ALLEN ELKIN, MD

The daily routine is a common stressor.

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Th e results of the survey also revealed some gender and cultural diff erences. From schoolwork to dating, women were more likely than men to say they experienced pressure from virtually every potential source of distress in the survey. Six in 10 women and just four in 10 men indicated family issues caused problems, though the diff erences between the sexes in most areas were slimmer. And, whites reported more stress than blacks and Hispanics. What do you think about these results?

LIFE EVENTS. Two words best relate to the actual cause of stress: change and threat. Either or both can disturb the psyche. When workers lose their job, that is a signifi cant change and usually a threat to their ego, self-esteem, and even the material aspects of their life. Similarly, the loss of a spouse is a major change and may pose many diff erent threats.

On the other hand, there are positive events such as marital reconciliation and retirement which can also create changes and threats that must be faced. Th e changes that result from positive events, however, are generally not as diffi cult to cope with as the changes that result from negative ones.

Changes and threats oft en fall into three possible categories (Taylor and McGee 2000):

1. Anticipated Life Events. Examples might be graduation from high school and entering college, a job promotion, marriage, birth, and retirement.

2. Unexpected Life Events. Some examples might be a serious accident, separation from a spouse or someone we love, sudden death of a loved one, divorce, and fi nancial problems.

3. Accumulating Life Events. Th is would include a dead-end job, traffi c, deadlines and pressures, and on-going confl ict with friends or family members.

As you can see, some of the changes and threats above are major and some may be described as just the everyday circumstances of life. What about the daily hassles of living?

DAILY HASSLES. Some health psychologists believe information about daily problems provide a better clue to the eff ects of stress than major life events (Bottos and Dewey 2004). Richard Lazarus (2006), a leading psychologist who studies emotions and stress, calls these irritating and frustrating incidents that occur in our everyday transactions with the environ- ment—d aily hassles .

What about your own life? What are the biggest hassles? Are any of the following everyday problems or nuisances stressful for you: misplacing or losing things, having too many tasks to do, wasting time, or worrying about meeting high achievement stan- dards? Review Table 8.1 for a list of common hassles.

While traumatic life events, such as the death of a loved one or the loss of one’s job, are stressful and exert adverse eff ects on health, the minor hassles of daily life—perhaps because of their frequent, repetitive nature—may sometimes pile up until they eventually overwhelm you (Almeida 2005). Whatever their relative importance, both traumatic life events and daily hassles are important sources of stress for many individuals. Remember, stress eventually adds up.

H ave you ever felt that it’s the little things in life that get you down? Daily hassles may have a greater effect on our moods and health than do the major misfortunes of life.

RICHARD LAZARUS

Minor daily hassles can pile up and overwhelm you.

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354 Chapter 8 Managing Stress and Wellness

Now, consider this question: What causes some people to be devastated and others motivated by the same event? Aft er all, change by itself does not necessarily lead to stress reactions in all individuals (Nairne 2008).

COGNITIVE APPRAISAL. Modern stress theory agrees that what causes us stress is not what happens, but how we perceive or appraise the situation. To feel stress, it is necessary to 1) perceive there is some kind of demand or threat present, and 2) conclude that you may not have adequate resources available to deal with that threat (Lazarus 2000). For example, your fi rst reaction to potentially stressful situations, such as waiting in line, dealing with sloppy roommate, making a public speech, taking an exam, seeing a vicious animal, or being in a car accident, is to appraise the situation in terms of whether it harms, threatens, or challenges your physical or psychological well-being.

Remember, identical environmental events can lead to two very diff erent stress reactions, depending on how the event is interpreted. Consider an upcoming exam: everyone in the class receives the same test, but not everyone will feel the same amount of stress. Th ose people who are prepared for the exam—the people like you who studied—are likely to feel less stress. Again, you are perceiving the threat, but you have adequate resources to deal with it.

Oft en, our greatest source of stress is the tremendous pressure and anxiety that we create internally with our thoughts and feelings. Do you oft en worry about situations you cannot control? Do you oft en feel power- less and fail to see your available choices?

Since the way we interpret and label our experiences can serve either to relax or stress us, you will learn how to deal with stressful thoughts and feel- ings later in this chapter. However, one helpful technique seems appropriate to discuss at this time.

We can control our thoughts, so we would be wise to practice thought- stopping techniques in stressful situations. Th ought stopping , developed by Joseph Wolpe (1992), a noted behavior therapist, involves concentrating on

I have known a great many troubles, but most of them never happened.

MARK TWAIN

M an is not disturbed by events, but by the view he takes of them.

EPICTETUS

Table 8.1 Common Daily Hassles 1. Anxiety over tests and grades 2. Troubling thoughts about the future 3. Diffi culty relaxing 4. Concern about health 5. Not getting enough sleep 6. Concern about physical appearance 7. Misplacing or losing things 8. Not enough time to do the things you need to do 9. Being lonely 10. Interpersonal relationship problems 11. Traffi c delays 12. Financial status 13. Home maintenance chores, shopping, and preparing meals 14. Job dissatisfaction and/or concerns about job security 15. Wasting time in lines at the store, restaurant, or for appointments

Which one/s are hassles for you? What else represents a hassle for you?

I f you break your neck, if you have nothing to eat, if your house is on fi re—then you got a problem. Everything else is inconvenience.

ROBERT FULGHUM

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Chapter 8 Managing Stress and Wellness 355

I Am Your Master I can make you rise or fall. I can work for you or against you. I can make you a success or failure. I control the way that you feel and the way that you act. I can make you laugh . . . work . . . love. I can make your heart sing with joy . . . achievement . . . elation. . . . Or I can make you wretched . . . dejected . . . morbid. . . . I can make you sick . . . listless. . . . I can be as a shackle . . . heavy . . . attached . . . burdensome . . . lost forever unless captured by pen or purpose. I can be nurtured and grown to be great and beautiful . . . seen by the eyes of others through action in you. I can never be removed . . . only replaced. I am a THOUGHT Why not know me better?

Consider this . . . Consider this . . .

Internally Created Pressures

Do you expect problem-free living? Are you pessimistic and expect the worst from life? Do you compare your achievements, or lack of them, to those of others? Do you worry about situations you cannot control? Are you a perfectionist? Do you expect too much of yourself or others? Are you competitive and seem to turn every encounter into a win/lose situation? Are you a victim of “hurry sickness” and constantly expect yourself to perform

better and faster? Are you self-critical? Do you focus on your faults, rather than your strengths? Do you expect others, rather than yourself, to provide your emotional security? Do you assume you know how others feel and what they want from you, instead

of asking them? Do you feel powerless and fail to see your available choices?

Do any of these sound familiar to you?

the unwanted thoughts and, aft er a short time, suddenly stopping and empty- ing your mind. Th e command stop is generally used to interrupt the unpleas- ant thoughts. Th en, it is time to substitute thoughts that are reassuring and self-accepting. Th is technique, called cognitive restructuring , can turn off some of the negative chatter (Jacobs 2004). For example, you say, “I know I am going to survive this divorce,” rather than, “I will never make it without Joe.” One positive thought at a time can gradually shift the balance of your thinking from negative to positive.

Now, let’s see what happens to the body when stressful events and thoughts arise.

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The Effects of Stress

Dr. Hans Selye (1997), in his years as a stress-researcher, found that the body has a three-stage reaction to stress: Stage 1—Alarm; Stage 2—Resistance; and Stage 3—Exhaustion. He called these stages of chain of reactions to stress the general adaptation syndrome . We will discuss each of these reactions.

THE ALARM STAGE. Your body recognizes the stressor and prepares for fi ght or fl ight, which is done by a release of hormones from the endocrine glands. Th ese hormones cause an increase in the heartbeat and respiration, elevation in the blood sugar level, increase in perspiration, dilated pupils, and slowed digestion. According to Dr. Walter B. Cannon of the Harvard Medical School, you then choose whether to use this burst of energy for fi ght or fl ee.

THE RESISTANCE STAGE. Th is is a period of recovery and stabilization, dur- ing which the individual adapts to the stress. Consequently, the individual does what he or she can to meet the threat. Although it is true that the level of bodily arousal is not as high as it was in the alarm stage, it does remain higher than usual. Th is is nature’s way of giving us greater protection against the original stressor. Coping responses are oft en strongest at this point. Because the individual attempts to do what is necessary to meet the threat, the most eff ective behavior of which the person is capable of oft en comes forth. Oft en, people are so overwhelmed in the alarm stage that they simply cannot function. However, if there is eff ective functioning, it occurs in the resistance stage.

THE EXHAUSTION STAGE. Stress is a natural and unavoidable part of our lives, but it becomes a problem when it persists and becomes long term. Continu- ous stress will not enable the important resistance step to take place, and you will go from step one, alarm , directly to step three, exhaustion . When you remain exhausted because of continual exposure to stress, you become more receptive to physiological reactions and behavioral changes.

THE IMMUNE SYSTEM. Th e immune system is the body’s defense and surveillance network of cells and chemicals that fi ght off bacteria, viruses, and other foreign or toxic substances (Plotnik 2008). Have you ever gotten a cold, strep throat, or some other bacterial viral infection aft er a stressful period, such as when fi nal exams are over? Th is rather common experience of “coming down with something” illustrates how prolonged stressful experi- ences can decrease the eff ectiveness of your immune system. Th e primary weapons of the immune system are lymphocytes , which are specialized white blood cells that attack and destroy most of these foreign invaders. Stress can lower the immune response by either decreasing the number of lymphocytes in the bloodstream or by somehow suppressing the response of the lympho- cytes to foreign substances that have invaded the body.

It is important to note that short-term stress, under most circum- stances, actually boosts the immune system, functioning as an adaptive response for injury or infection. “It’s extreme, constant stress over a long period of time that impairs the immune system,” explains Monika Fleshner, a neuroimmunopsychologist at the University of Colorado in Boulder (Raeburn 2006).

Y ou go where your thoughts take you.

RICHARD LAZARUS

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Chapter 8 Managing Stress and Wellness 357

Physical Effects of Stress

In various ways, stress takes a heavy toll on our well-being. For example, more than three out of every fi ve doctor’s offi ce visits are for stress-related problems, and up to 90% of reported illnesses and disease is stress-related (Duff y and Atwater 2008). Furthermore, absenteeism and turnover in the workplace continue to rise at very high rates, and it has been reported that one of every three Americans has seriously considered quitting their jobs because of stress (Schultz 2005).

Chronic stress can contribute to higher risks for heart disease, increased progress of cancer and increased speed at which cancer may return, more susceptibility to develop a prediabetic condition, memory problems and Alzheimer’s, irritable bowl syndrome, peptic ulcers, etc. (Hall 2008).

Yet, before these more serious health problems can develop, your body has a natural way of telling you there is too much stress and tension in your life. Furthermore, most of us have a special physical organ or target area that lets us know when the stress is too great. Do you know what your special tar- get is? Once you have learned to tune into your own signals, you will be able to recognize stress when it starts, before it takes a toll on your body. Review table 8.2 for some of the physical eff ects of stress.

Behavioral Effects of Stress

Another measuring tool for you to help recognize excessive stress in yourself and others is through behavioral changes. Review these changes in Table 8.2 , Eff ects of Stress.

Table 8.2 Effects of Stress PHYSICAL

Headaches Rapid heart rate Vaginal discharges Dermatitis Impotence Dizziness Ulcers Indigestion Muscle spasms Asthma Diarrhea Hypertension Colitis Stomach aches Blurry vision Common colds Fatigue Burning stomach Skin rashes Aching back and limbs Vomiting Allergies Neck and shoulder tension Delayed menstruation Hyperventilation Excessive sweating

BEHAVIORAL

Nervous tics Clammy skin Nail biting Door slamming Withdrawal Grinding of teeth Fist clenching Depression Temper tantrums Insomnia Irritability Apathy Tears Acts of violence Changed smoking habits Frowning Impatience Worry Hair twisting Changed eating habits Boredom Jaw tightening Changed drinking habits Visible fears

Miller and Smith (1994); Davis et al. (2008).

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Evaluate this list in relationship to your own life and add any other behavioral changes you may experience that are not included here. Th is list can help you recognize imbalance and disharmony within and without, and that recognition is necessary if you are to eff ect a positive change for yourself.

Now that you know how to recognize physiological and behavioral eff ects of stress, is there anything else you need to be aware of?

Personality Types

Are you a stress seeker or a stress avoider? How do you perform under pres- sure? Is it possible to respond to the normal pressures and stress of life with vitality, meaning, and joy? What kind of lifestyle do you prefer to live: rushed, relaxed, or somewhere in between?

Research has indicated that there are basically three personality types in relation to stress, with each type diff ering in their abilities to eff ectively han- dle stress. Th ese types are Type A, Type B, and a combination of Type A and Type B . What behavioral characteristics do these types have?

TYPE A. Th ere has been a tremendous amount of research directed toward determining the correlation between heart disease and emotional stress. Among the fi ndings is evidence that there is an association between coronary artery and heart disease and a complex of emotional reactions which have been designated Type A Behavioral Pattern (Friedman and Rosenman 1982). Th ese researchers found that almost all of their cardiac patients had in com- mon a competitive, aggressive, ambitious, and stressful lifestyle.

Research on the link between Type A behavior and coronary disease indicates that the lethal core of the Type A personality is not time urgency. Attention is focusing on hostility and anger-prone tendencies , which fuel an aggressive, reactive temperament (Smith and Ruiz 2002; Rayl 2007).

Here are some other characteristics of the Type A behavioral pattern (Kleinke 2002):

A drive to succeed, coupled with impatience, irritability, and aggressiveness Trouble relaxing and is restless Perfectionist and seeks results now Feelings of pressure even when relaxed A constant clock watcher Ignores fatigue while doing strenuous work Th rives on stress; his or her work is never done

Only happy with a vigorous, fast-paced lifestyle Time pressures frequently create frustration and sometimes hostility

May appear nervous, scattered, and hyper Eats fast, walks fast, and talks fast

Furthermore, Dr. James Blumenthal (1999), professor of medical psy- chology at Duke University Medical Center, suggests that Type A people have a strong need to control events in their lives, including the behavior of people around them. Dr. Blumenthal also indicates that one reason Type A people

O ne striking thing we have discovered is that there are two main types of human beings: “racehorses” and “turtles.”

HANS SELYE

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Chapter 8 Managing Stress and Wellness 359

suff er so much from life stress is they have diffi culty accepting what they can and cannot control.

TYPE B. Th is behavior pattern (Friedman and Rosen- man 1982) is the opposite of the Type A. Type B peo- ple are seldom harried by the need to be involved in an ever-increasing series of activities in a continually decreasing amount of time. Here are some other char- acteristics of Type B people (Kleinke 2002):

Serious but easy going Patient and relaxed Enjoys leisure and opportunities to experiment and refl ect

Prefers a peaceful, steady, quiet, and generally tran- quil lifestyle

Not easily irritated Are less competitive than A’s Slower paced; feels no need to hurry May appear lethargic, sluggish, and bored Is a stress avoider; may avoid new challenges Speaks slowly, walks slowly, eats slowly Sometimes lacks the excitement, enthusiasm, and dynamism needed to

perform at peak levels under pressure

Type B people may have a tremendous drive, but they may not take the risks necessary for big rewards. When they do take the risks, their drive is coupled with time to ponder leisurely and weigh alternatives. It may sound like Type B people do not have a lot of stresses. However, if they are in a Type A environment that requires a great deal of structure, this can be very stressful to them.

Are you . . .

or somewhere in between? What kind of lifestyle do you prefer to live: rushed, relaxed, or a balance between the two?

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360 Chapter 8 Managing Stress and Wellness

WHICH TYPE ARE YOU? Most of us are either Type A or Type B, with varying degrees of Type A and B. It is estimated that about 40 percent of the popula- tion is Type A and 60 percent is Type B (Paulus et al. 2000).

You will be given an opportunity to complete a personality type inventory at the end of this chapter. Like most stress inventories, this one is somewhat fl awed because it does not give enough weight to individual diff erences. Be sure and take this into consideration when you look at your scores.

Actually, each of us is really the best judge of ourselves, and we can gradu- ally develop an instinctive feeling that tells us whether we are running above or below the stress level that suits us best. Do you know what your normal stress endurance level is? We encourage you to examine your own behavior in relation to stress, because the key to eff ective stress management is recog- nizing when stress becomes more debilitating than stimulating.

In the following section, we will discuss some negative and debilitating techniques of coping with stress.

Negative and Defensive Coping

Coping refers to active eff orts to master, reduce, or tolerate the demands cre- ated by stress (Weiten and Lloyd 2009). When we cope, we consciously think and make a decision to deal with the problems we face. However, we may cope in negative ways. We may drink too much, eat too much, worry too much, or even abuse medication and drugs.

Sometimes the stress, frustration, and confl ict of dealing with these prob- lems interferes with our ability to maintain a healthy self-concept. We become extremely sensitive to threats to our ego. We will do almost anything to avoid, escape, or shield ourselves from the anxieties elicited by these threats.

In order to protect our feelings of self-esteem and self-respect, we may unconsciously resort to various distortions of reality, frequently referred to as defense mechanisms (Freud 1936).

Defense mechanisms do not eliminate the problems that are the cause of anxiety, but they help us to hide or disguise our feelings and temporarily deal with anxiety or stress. Defense mechanisms have two primary characteristics. First, they distort and deny reality. Second, they operate unconsciously, so that we are unaware that we are using them . See table 8.3 for some examples of commonly used defense mechanisms.

Defense mechanisms are designed to help us escape the pain of anxiety in stressful situations. Most of us would have diffi culty maintaining our mental health without resorting to such defenses. However, the trouble is that these defenses can become common patterns of behavior for reacting to problems and stress.

Do you have a habit of using any of these defense mechanisms? Th ink of it like this: the more aware you are of the defense mechanisms you use and why you use them, the more likely will be your attempts to face your stressful situations in an open and honest manner. It is important for you to remember that although defense mechanisms off er you short-term relief, your discom- fort quickly returns. Why? Your problem has not been solved!

Speaking of problems for a moment, is there a diff erence in how men and women cope with problems and the normal stresses of living? Does cultural background have any infl uence in what events are perceived as most stressful? Let us look further at these two questions.

T he time to relax is when you don’t have the time for it. THE BEST OF BITS & PIECES

T he best years of your life are the ones in which you decide your problems are your own. You do not blame them on your mother, the ecology or the president. You realize that you control your own destiny.

ALBERT ELLIS

T he world breaks everyone and afterward many are stronger at the broken place.

ERNEST HEMINGWAY

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Chapter 8 Managing Stress and Wellness 361

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