Coming to Grips with Stress

tress: It's the buzzword of the 90s, especially among women who do too much. Few human conditions receive so much credit...and so much blame. “I work better under stress,” is the refrain of many successful professional women. Yet for a harried single mother trying to juggle a career and two small children stress can add up to a severely debilitating problem.

What exactly is this universal challenge called stress? In broad, general terms, it's any event that forces us to adapt to a new set of circumstances. For practical purposes, however, it's broken down into specific situations called stressors.

Stressors range from minor to major, and can include daily annoyances, pressures at home or on the job, marital discord, emergencies, accidents, illness and injury—even hostile weather conditions. It's important to remember that joyous occasions as well as difficult ones can be stressful. Without stress, our existence would lack the ups and downs that give life its substance and meaning. Too little of it leads to boredom; too much can undermine your health.

When confronted with a stressful situation, your body responds with a chain of biochemical reactions that can affect your entire system. Any real or imagined emergency sets in motion a series of changes designed to enable you to “fight or flee” the “danger.” Responding to complex triggers from the brain, the adrenal glands release adrenaline and other hormones. Immediately, your heart rate and blood pressure increase, your pupils dilate, and you feel a heightened sense of alertness.

There are three stages in this stress response: alarm, resistance, and exhaustion. During the alarm phase, when you first notice a stressor, you may perspire and feel flushed. Muscles in your stomach and limbs may tighten. During emergencies, some people feel a surge of extraordinary strength that allows them to do things they never could before.

In the resistance phase, the release of other hormones works to bring the body back to normal. Then, as you recover from the stressful episode, you'll probably feel exhausted.

The stress response we experience during an emergency is a normal reaction to an abnormal incident: The body has safely and naturally protected itself from danger. But unrelieved, unremitting stress keeps your body in a constant state of alert and can seriously affect your health.

How Much Stress Is Too Much?

There's no clear­cut answer. The same type of stress may cause problems for one woman and have no effect on another. Richard Rahe, a pioneering stress researcher, estimated the degree of difficulty people have in adjusting to certain stressful changes in their lives. He rated these experiences in “Life Change Units” (LCUs), with scores ranging from 25 for a change in political beliefs or a minor illness to 105 for the death of a spouse or child. The higher your total LCUs during a given period, the more careful you should be to handle your stress appropriately. (See table nearby.)

Keep in mind, though, that the LCU of a stressful event varies from one woman to the next. Recent studies have shown that while pleasant events certainly cause stress, unpleasant ones take on an even greater toll. Some people can handle major stressors successfully while life's constant little hassles find them unable to cope. What looms as a challenge for one person strikes another as a mild annoyance.

It's Not All in Your Head

The changes your body undergoes in reaction to stressors may produce symptoms that can literally make you sick. When unrelenting or frequently repeated stressors overwhelm your personal coping skills, you can develop symptoms of illness or experience a worsening of pre­existing symptoms.

Stress can affect your body's immune response, and make you more vulnerable to illness. Clinical studies show a relationship between stress and resistance to infection: For example, there is evidence that people under stress are more prone to contract common colds. But physical reactions to stress are highly individual. Medical experts aren't certain why one woman under stress gets stomachaches, while another has headaches. Many doctors and researchers now believe that environmental factors combined with a woman's genetic make­up and her innate coping skills determine her personal reaction to stress.

Therefore, it's important to understand the way your body reacts to stress. If you experience any of these symptoms frequently, it's quite possible that stress is the culprit.

• Cardiovascular irregularities
• Digestive disorders
• Sleep difficulties
• Menstrual problems
• Migraines and headaches
• Neck aches and back spasms
• Skin disorders—
  hives, acne, and other rashes

Stress can also cause or aggravate such potentially destructive or unhealthy behavior as smoking, drinking, nail­biting, forgetfulness, an increased or decreased desire to eat, and nervousness.

Cardiovascular Irregularities

According to a recent study, stress plays a role in the development of heart disease, especially in postmenopausal women. Older women who took stressful mental tests had higher blood pressures and heart rates than did men or younger women. Researchers who monitored all three groups as they went about their daily activities noted that postmenopausal women were three times as likely to respond to stress with episodes of abnormal heart function. This finding is especially important for middle­aged or elderly women whose arteries are already clogged.

• How to help yourself: Employ the stress­ reduction techniques and follow the dietary suggestions outlined at the end of this chapter. Ask your doctor whether you are a candidate for estrogen­replacement therapy, since the estrogen loss that follows menopause may make the heart more vulnerable to the effects of stress.

Digestive Disorders

The chemical reactions unleashed by stress have a direct effect on the digestive tract, and women are far more likely than men to seek medical help for stomach and bowel complaints. There are a number of digestive ailments that have close links to stress.

Nonulcer dyspepsia (NUD) , a catchall term for stomach cramps and discomfort that can't be linked to a specific cause, is a common digestive disorder in women. Not a true disease, NUD is difficult to diagnose because neither blood tests, nor physical exams or X­rays can confirm its existence. When gastrointestinal tests fail to indicate a more serious condition, your doctor may say you have NUD.

• How to help yourself: Try over­the­ counter remedies such as Mylanta or Maalox. During times of stress, resist the impulse to change your eating habits, but make certain your diet is well­balanced. See your doctor if symptoms persist or worsen.

Irritable Bowel Syndrome (IBS), or “spastic colon,” is thought to affect up to 19 percent of Americans; 85 percent of IBS­sufferers are women. Symptoms include moderate to severe cramping, bloating, and bouts of constipation and diarrhea. IBS may be stress­triggered.

• How to help yourself: If you experience chronic stomach discomfort, see your doctor or a specialist in gastroenterology. He or she will most likely conduct a series of tests to rule out other disorders, including lactose sensitivity, parasitic diseases, allergic reactions, ulcerative colitis, and Crohn's disease. Physicians sometimes prescribe antispasmodic drugs such as Donnatal and Bentyl, or low doses of antidepressants, to ease spasms. A high­fiber diet can relieve constipation.

Ulcers are diagnosed through endoscopy and barium x­rays. For years doctors thought stress produced ulcers and made them worse. Now, however, medical experts agree that a bacterium is the initial cause of most ulcers.

• How to help yourself: Your doctor may prescribe a medication such as Zantac, Tagamet or Pepcid to reduce the amount of hydrochloric acid your stomach produces. He or she may also advise you to cut down on alcohol; caffeine; carbonated beverages; and rich, fried, or fatty foods. The recommended cure, however, is a course of antibiotics. One new therapy combines two antibiotics and Pepto­Bismol. Ninety percent of women treated this way experience relief, and after treatment, their ulcers rarely recur.

Sleep Disorders

Insomnia, the inability to fall or stay asleep easily, is one of the most common signs of stress, and perhaps one of the most difficult to avoid. It is a double threat for the already stressed­out woman who especially needs the restorative energy that comes with a good night's sleep.

• How to help yourself: Most women experience an occasional sleepless night, and this is no cause for alarm. But if sleeplessness persists for more than a few days, follow these helpful do's and don'ts:

DO:

• Eat dinner early; make it light on fat and heavy on complex carbohydrates.
• Check with your doctor to see if your medications are a problem. Over­the­counter cold remedies and diet pills can cause wakefulness.
• Try a glass of warm milk.
• Set yourself a regular sleep schedule: Go to bed and arise at the same time every day.
• Take a warm, relaxing bath a couple of hours before bedtime.
• Employ the relaxation exercises described later in this chapter.
• Exercise in the afternoon.
• Aim for a peaceful evening; save conflicts with family members for the daylight hours.
• Leave yourself some “wind­down” time for an hour or two before you go to bed.

DON'T:

• Drink alcoholic beverages in an attempt to get sleepy. You'll only disrupt your sleep pattern.
• Read, work, or watch television in bed.
  If you can't sleep, get up and go to another room.
• Have a heavy meal close to bedtime.
• Let a night or two of insomnia upset you. Worrying about sleep only makes it harder.

Fatigue

Fatigue is often a way of life for busy working women and mothers. It can come from chronic, unrelieved stress; sleep­deprivation; or a variety of illnesses.

If you feel constant fatigue, first determine whether you are getting all the sleep your body needs. Sleep restores the body, allowing it to repair damage caused by stress and other factors. Women who lead stressful lives actually need more sleep than do other women because their bodies demand more sleep recovery time. Sleep­deprived women show diminished mental alertness and performance; over time, unchecked fatigue can lead to depression and illness.

FIGHT OR FLIGHT

Faced by a threat, your body responds with a complex cascade of chemicals. The hypothalamus, alerted by the brain, pumps out a specialized hormone that ultimately prompts the two adrenal glands (perched atop the kidneys) to release the energizing hormone known as adrenaline. The result — faster pulse, higher blood pressure, sharpened awareness — is the “fight or flight” response we call stress.

Are you getting enough sleep? “Yes” answers to the following questions are a sign that you're not.

• Do you need an alarm to wake up?
• Do you hit the snooze button regularly?
• Do you fall asleep quickly? (Women who get enough sleep take about 15 minutes to fall asleep; sleep­deprived women fall asleep within about five minutes.)
• Do you find yourself falling asleep during the day?

A vacation is a good time to determine how much sleep you need. After three or four days, note how long you sleep naturally. This is the amount of sleep your body needs to get consistently, whether it's 4, 8 or 10 hours.

• How to help yourself: Determine how much sleep you need, then make a point of getting it regularly. Follow the suggestions for insomnia if you have trouble falling or staying asleep. Take short naps if at all possible. Eat a well­balanced diet with plenty of fresh fruits and vegetables and schedule at least three brisk 20 to 30­minute walks each week.

Menstruation, Infertility, and Pregnancy

When a woman undergoes prolonged stress, her levels of estrogen and progesterone can decrease. This can sometimes lead to decreased sex drive and menstrual irregularities such as delayed periods or none at all.

The menstrual cycle is also subject to physical stressors: The menses of women athletes are often irregular and sometimes cease during times of excessive training, as do those of women who suffer from two serious eating disorders: anorexia and bulimia. There is also evidence to support the fact that women who suffer stress may be more likely to experience the uncomfortable symptoms of PMS.

Can stress affect fertility? When women have trouble conceiving, it can be a stressful time—especially for those undergoing high­tech fertility treatments. Such women get little comfort from well­meaning people who suggest they “just relax and let nature take its course.” For them, there's good news: 80 to 90 percent of the time, infertility has a physiological cause. Stress does enter the picture, however, for women whose severe stress causes a decrease in hormonal levels or irregular menstrual cycles.

Stress during pregnancy can be dangerous to both mother and baby. A study conducted at the University of Texas indicated that certain chemicals released during times of stress (epinephrine and norepinephrine) can lead to uterine and cervical changes, interfering with oxygen and blood flow to the developing child. Women who had an especially difficult time coping with stress during their pregnancies were more likely to have babies that were born prematurely or at a low birth weight.

• How to help yourself: Moderate, regular exercise (a brisk, 20­ to 30­minute walk three times a week is ideal) has been found to relieve many menstrual and PMS discomforts, including cramps and bloating. Some medical experts also suggest that certain vitamins, E, for example, can be useful in lessening symptoms of PMS. Avoid or lessen your intake of salt, sugar, alcohol, caffeine, and fat. If symptoms persist, see your doctor. During pregnancy, make certain to get the best prenatal care available and follow your obstetrician's advice about rest, exercise, and diet. Make certain to tell your doctor if you're under unusual stress.

Migraines and Other Headaches

Migraines and other headaches are frequently due to stress­related factors. Reactions to stress that can trigger headaches include: muscle tension, constriction of blood flow, teeth­grinding, and even congested sinuses.

• How to help yourself: A mild to moderate headache will usually respond to over­the­counter pain medication; avoid products containing aspirin if you have a sensitive stomach. Your dentist can fit you with a plastic mouth guard to help you stop grinding your teeth at night. True migraine headaches—pain that causes nausea and keeps you in bed for hours—present a more formidable treatment challenge. See your doctor. He or she may prescribe special migraine medications or refer you to a pain clinic for sophisticated treatment. (See chapter 14, “Taking Control of Headache” for additional details.)

Back and Neck Aches

When stress produces muscle tension, painful spasms in the neck and back can result. Some 80 percent of us will experience neck or back pain at some point during our lives. Your posture, the chair you use, the type of work you do, and your muscle tone can all effect your susceptibility to back and neck pain.

• How to help yourself: Hot showers, massages, heating pads, and over­the­counter analgesics are usually enough to relieve simple, temporary back and neck pain. Take preventative measures: Include stretching exercises in your daily routine and use a well designed chair. Learn how to lift and carry heavy objects properly; remember to always bend your knees, not your back. It's better to get help carrying a heavy object than to seek help for an injury. When back pain is persistent, severe, or incapacitating, it's time to see your doctor. He or she may prescribe muscle relaxants or other medication, or may refer you to specialist.

Skin Disorders

Stress can cause or exacerbate a broad variety of skin conditions, including acne, hives, lichen planus (itchy, flat purplish bumps on your wrists, forearms, abdomen, and back), neurodermatitis, and psoriasis. Since so many other factors—including allergies, prescription and over­the­counter medications, and overexposure to the sun—can also affect the skin, the best first step is to seek the advice of a good dermatologist whenever you are troubled with a persistent, uncomfortable skin rash, eruption, or inflammation.

Coping With Stress

To alleviate your stress­related problems you must first understand your personal reaction to stress. Each woman has her individual stress threshold. What pushes one woman to distraction may be ignored—or even welcomed—by another. For example, a high powered woman executive might find a vacation away from the office extremely stressful. Even the absence of stress can be stressful. Many middle­aged women have a particularly hard time coping with the “empty nest” syndrome that hits when children grow up and leave home.

Stress can be, if not a silent killer, at least, a silent challenge to peaceful, healthy living. Still, it's worth remembering that stress has its good points too. It can work as an alarm system to protect you against serious damage. Highly stressful situations can even add spice, dimension, and excitement to your life. Most important, keep in mind that life's most joyous occasions—the birth of a baby, college entrance, a wedding, a new job or a promotion—can all create stress that strains your psyche, yet still be well worth the strain.

To cope with stress you must first recognize your own limits. Know what stressors disturb you. Be aware of times in your life that are particularly stressful. If you experience a few major stressful events within a short period of time, be extra­gentle with yourself. Acknowledge that you're going through a difficult time. Try to gain control of the situation by asking yourself, “How can I change this?” Make time to rest and relax. Adopt a program of healthy eating and exercising. Choose the coping strategies that suit you best.

Diet

There's no substitute for a well­balanced diet to help your body handle the ravages of stress. While researchers have yet to prove a connection between psychological stress and the need for vitamin supplements, nutritionists often recommend a diet high in vitamins C, E, and B.

Whether you take these supplements or not, follow these tips for a healthy, stress­ fighting diet.

Include...

• Raw fruits and vegetables
• Complex carbohydrates (new dietary guidelines suggest 6 to 11 servings a day)
• More fish and poultry
• A good breakfast every day
• Low­fat foods

Be sparing with...

• Refined sugar
• Salt
• Alcoholic and caffeinated beverages
• Fatty and fried foods

Coping Strategies

The best way to manage severe or chronic stress is to treat yourself tenderly. Acknowledge that you're going through a difficult time, then reward yourself. Self­indulgence isn't selfish, it's essential to your well­being. Choose from this list of personal rewards—or add your own—when you're stressed­out:

Take a...

• Walk
• Vacation
• Break
• Nap
• Course (in something not job­related)

Make time to...

• Play
• Garden
• Go shopping (the window variety will do)
• Read
• Laugh
• Cry
• Make love
• Watch a movie, a play, TV—or the sunset
• Exercise

Biofeedback

Biofeedback is an ideal way to learn how to manage moderate to severe stress. It is a painless, electronic process that takes in and processes information about your body's involuntary response to stressors, then relays it back to you so you can learn to modify these previously unwitting reactions. Though it sounds complicated, biofeedback is a simple way to help you learn how to relax.

Biofeedback has been found to be particularly helpful for dealing with migraines, muscle tension and spasms, teeth grinding, and stress­related effects on the circulatory system.

Relaxation Exercises

When you feel caught in a particularly stressful situation, try this special breathing exercise:

1. Sit as comfortably as possible in a chair or on the floor. Dim the lights if you can.

2. Inhale deeply, through your nose. Expand your lungs with air as fully as possible. Visualize the air coming through the top of your head, down all the way to the bottom of your lungs.

3. Breathe out slowly through your nose. Visualize the air rising slowly up through your body and out through the top of your head.

4. Repeat until calm.

Meditation

Meditation is a way of relaxing and emptying the mind of all outside stimuli. It has been practiced for centuries, and is frequently recommended today as an excellent way to ease stress. There are many techniques. One approach you might want to try is called the Benson Relaxation Response.

Before you begin:

• Plan to make meditation a regular part of your daily routine. Set aside 10 to 20 minutes each day at the same time, if possible. Before breakfast is a good time.

While you meditate:

• Sit quietly in a comfortable position.
• Eliminate distractions and interruptions during the period you'll be meditating.
• Commit yourself to a specific length of time and try to stick to it.
• Pick a focus word or short phrase that's firmly rooted in your personal belief system. A nonreligious person might choose a neutral word like one, peace, or love. Others might use the opening words of a favorite prayer from their religion.
• Close your eyes.
• Relax your muscles.
• Breathe slowly and naturally, repeating your focus word or phrase silently as you exhale.
• Assume a passive attitude. Don't worry about how well you're doing. When other thoughts come to mind, simply say, “Oh, well,” and gently return to the repetition.
• Continue for 10 to 20 minutes. You may open your eyes to check the time, but do not use an alarm. After you finish: Sit quietly for a minute or so, at first with your eyes closed and later with your eyes open. Do not stand for one or two minutes.
• Plan for a session once or twice a day.

You may try some of the other stress­reducing techniques and therapies that many find effective. They include visualization, yoga, dance and art therapy, and massage.

Listening to Yourself

Many people under stress make matters worse by telling themselves things like “I'll never make it,” and “it always happens to me.” Take time to sort out what you're really thinking. If your reactions are self­defeating or causing additional stress, make a deliberate effort to change them. Tell yourself “I've gotten through tough situations before, and I'll get through this one.” Though it may seem unlikely that this will make a difference, some people find that it really does help them cope.

If All Else Fails

There is no rule that says you must deal with stress single­handedly. If a major problem like a chronic disease is causing you stress, seek out a support group or a workshop. And if you feel overwhelmed by multiple stressors, remember that there's nothing wrong with seeing a good doctor or therapist.