Stress Relief, Stage One (July 7, 2015)


Stress is the red-headed stepchild of the medical and health professions. It’s ignored and neglected, and if you try to bring some serious focus to bear on it, it’s likely to slip between your hands and run and hide in a closet somewhere. And I say all that not just to flog the metaphor, but because it’s true.

We all know that we should eat right and exercise, and even the most ignorant of us has some idea what that entails. And as long as we’ve got even one toe on the path to those things, we’re healthier than we would be otherwise. Even if you’ve spent the weekend eating Little Debbies and binge-watching American Pickers, if you managed to eat some steamed broccoli and go for a 20-minute walk in there somewhere you’re better off than if you didn’t do so. (Although not much. Still, there's always next weekend.)

But I don’t know of anything similar in relieving stress. There are all kinds of quick fixes for momentary relaxation, many of them with some good research behind them (go for a walk, listen to music, “smooch spontaneously” – ok, probably not that one. No thanks to you, WebMD). But if there IS something similar for stress to what I just described for diet and exercise, we don’t know what it is. Our much-revered medical research establishment has let us down on this one. Or maybe it just can’t be done.

It’s not that stress hasn’t been studied – it has been, quite extensively. But when you try to boil all those discoveries and conclusions down to practical recommendations, they seem to fall into two categories. One is that quick fix category I just mentioned. The other is a course of some kind of behavioral modification and/or cognitive behavioral therapy, which would be great except that one of the biggest stressors we have right now is LACK OF TIME.

You can see how shifty a subject stress relief is from all this. There are no real good answers to relieving stress when we live our lives in a way that could almost have been designed by some mad psychiatrist to deliberately be as stressful as possible. But when  you realize that stress doesn't just take a lot of the enjoyment out of life, but also has ill effects on every aspect of our physical health – caving in to it is just not acceptable. There should be SOMETHING we can do short of retiring every weekend to an ashram or self-medicating ourselves into numbness. Shouldn’t there be?

Maybe a little more insight into the stress process might help. You can loosely break getting stressed down into three stages. (1) A stressor appears. (2) You perceive this as a threat to your wellbeing. (3) Your body begins a well-understood deluge of hormones to deal with the threat, and this continues on some level until the threat is gone. If the threat continues, so (on one level or another) does your reaction to it.

We could break in at each of these stages with a different type of intervention. And this IS where the different coping strategies for stress come in. (1) Get rid of the stressor itself. (Change job, move closer to work, get rid of all the mirrors in the house.) (2) Change the way you think about the stressor. (“I’ve decided that living without medical insurance just really empowers me.”) (3) Take various actions to deal with the cascade of cortisol and other hormones, and the series of short- and long-term changes they make. This is usually where medications, diet and supplements do their thing. [By the way, acupuncture works by intervening between stages (2) and (3) and diminishing the surge of cortisol that occurs when you perceive something as stressful. I highly recommend it as a coping strategy.]

So in essence you can either eliminate the stressor or change how you respond it. And at this point i would like to say that it appears to me that in the literature on stress, strategies for intervening at stage (1) are way underaddressed. It’s so taken for granted that we can’t or won't change our lives that techniques for doing so aren't even mentioned most of the time.

My thought is that we need to try to focus a little more on those supposedly unavoidable stressors. And by that I’m not advocating an increase in America’s gun violence. I mean that when I look at the self-help material out there, it mainly is talking about (2) and (3). Not that there’s anything wrong with that. But if you can do something with (1), the other stages will take care of themselves. And if it can be managed, isn't eliminating a source of stress much the best plan anyway? 

You are very much on your own when it comes to eliminating stressors, because everyone has different problems and different resources. Plus, something that most assuredly is NOT encouraged in the world today (and probably never has been) is to actually THINK. So try to think about the things that are stressing you out and how you might either change or get rid of them altogether. 

We don't actually do that much. We have a set of values that we rarely inspect, and are on a life trajectory that was mostly determined long ago. Each problem we encounter is treated like a barrier to be overcome or got around somehow, and we rarely think that maybe we should just back up and take a different turn at the last intersection, or maybe walk or take a bicycle instead.

Now, to do this effectively you have to get outside yourself to a certain extent. Here is a personal trick for that. Some years ago I noticed that if I ran into a issue that was giving me trouble, I'd pretend that it belonged to someone else and thought about what advice I would give them. That works frighteningly well sometimes.

Also, there were two suggestions I ran into in my reading on this subject that I thought might be helpful with this. One was simply to ask a trusted friend. I say “trusted” because although most friends could quickly and easily chirp out a long list of what you’re doing wrong with your life, a genuinely good friend will be more likely to present those insights in a palatable way. 

The other was to look at yourself, a course of action, a choice, etc. as though you were twenty years in the future remembering the situation.That puts you outside the confusion and conflicts that exist with it in the present and give you the same perspective that you will have someday as a wise old man or woman. And without the arthritis! 

There’s enough stress to deal with everyday without having to cope with one that you can eliminate. I wish you the best of luck and hope that this has helped in some way.

--dr. diane holmes
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