14.3 Stress Management: Dealing with It

Most college students (92%) say they occasionally feel overwhelmed by the tasks they face, and over a third say they have dropped courses or received low grades in response to severe stress (Duenwald, 2002). No doubt you are among the lucky 8% who are entirely cool and report no stress. But just in case you’re not, you may be interested in our exploration of stress management techniques: ways to counteract psychological and physical stress reactions directly by managing your mind and body, and ways to sidestep stress by managing your situation.

Mind Management

Stressful events are magnified in the mind. If you fear public speaking, for example, just the thought of an upcoming presentation to a group can create anxiety. And if you do break down during a presentation (going blank, for example, or blurting out something embarrassing), intrusive memories of this stressful event could echo in your mind afterward. A significant part of stress management, then, is control of the mind.

Repressive coping

Some people are good at deliberately ignoring negative events or thoughts after they occur, and their functioning may be improved as a result. However, those who are not as good at repressing this negative information may do better trying rational coping.

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Controlling your thoughts is not easy, but some people do seem to be able to banish unpleasant thoughts from the mind. This style of dealing with stress, called repressive coping, is characterized by avoiding situations or thoughts that are reminders of a stressor and maintaining an artificially positive viewpoint. Everyone has some problems, of course, but repressors are good at deliberately ignoring them (Barnier, Levin, & Maher, 2004). So, for example, when repressors suffer a heart attack, they are less likely than other people to report intrusive thoughts of their heart problems in the days and weeks that follow (Ginzburg, Solomon, & Bleich, 2002).

Like Elizabeth Smart, who for years after her rescue focused in interviews on what was happening in her life now, rather than repeatedly discussing her past in captivity, people often rearrange their lives in order to avoid stressful situations. Many victims of rape, for example, not only avoid the place where the rape occurred, but may move away from their home or neighborhood (Ellis, 1983). Anticipating and attempting to avoid reminders of the traumatic experience, they become wary of strangers, especially men who resemble the assailant, and they check doors, locks, and windows more frequently than before. It may make sense to try to avoid stressful thoughts and situations if you’re the kind of person who is good at putting unpleasant thoughts and emotions out of mind (Coifman et al., 2007). For some people, however, the avoidance of unpleasant thoughts and situations is so difficult that it can turn into a grim preoccupation (Parker & McNally, 2008; Wegner & Zanakos, 1994). For those who can’t avoid negative emotions effectively, it may be better to come to grips with them. This is the basic idea of rational coping.

Rational coping

Extremely stressful events, such as rape, are not only acute stressors but often have lasting psychological consequences. Fortunately, there are effective techniques for learning to cope with such events that can lead to improved psychological health.

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Rational coping involves facing the stressor and working to overcome it. This strategy is the opposite of repressive coping and so may seem to be the most unpleasant and unnerving thing you could do when faced with stress. It requires approaching, rather than avoiding, a stressor in order to lessen its longer-term negative impact (Hayes, Strosahl, & Wilson, 1999). Rational coping is a three-step process: acceptance, coming to realize that the stressor exists and cannot be wished away; exposure, attending to the stressor, thinking about it, and even seeking it out; and understanding, working to find the meaning of the stressor in your life.

When the trauma is particularly intense, rational coping may be difficult to undertake. In rape trauma, for example, even accepting that the rape happened takes time and effort; the initial impulse is to deny the event and try to live as though it had never occurred. Psychological treatment may help during the exposure step by helping victims to confront and think about what happened. Using a technique called prolonged exposure, rape survivors relive the traumatic event in their imagination by recording a verbal account of the event and then listening to the recording daily. In one study, rape survivors were instructed to seek out objectively safe situations that caused them anxiety or that they had avoided. This sounds like bitter medicine indeed, but it is remarkably effective, producing significant reductions in anxiety and symptoms of posttraumatic stress disorder compared to no therapy and compared to other therapies that promote more gradual and subtle forms of exposure (Foa et al., 1999).

The third element of rational coping involves coming to an understanding of the meaning of the stressful events. A trauma victim may wonder again and again: Why me? How did it happen? Why? Survivors of incest frequently voice the desire to make sense of their trauma (Silver, Boon, & Stones, 1983), a process that is difficult, even impossible, during bouts of suppression and avoidance.

Reframing

Changing the way you think is another way to cope with stressful thoughts. Reframing involves finding a new or creative way to think about a stressor that reduces its threat. If you experience anxiety at the thought of public speaking, for example, you might reframe by shifting from thinking of an audience as evaluating you to thinking of yourself as evaluating them, and this might make speech giving easier.

Writing about your deepest thoughts and feelings has been shown to have a range of beneficial health effects. Just make sure you keep your journal in a safe place.

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Reframing can be an effective way to prepare for a moderately stressful situation, but if something like public speaking is so stressful that you can’t bear to think about it until you absolutely must, the technique may be not be usable. Stress inoculation training (SIT) is a reframing technique that helps people to cope with stressful situations by developing positive ways to think about the situation. For example, in one study, people who had difficulty controlling their anger were trained to rehearse and reframe their thoughts with phrases like these: “Just roll with the punches, don’t get bent out of shape,” “you don’t need to prove yourself,” “I’m not going to let him get to me,” “it’s really a shame he has to act like this,” and “I’ll just let him make a fool of himself.” Anger-prone people who practiced these thoughts were less likely to become physiologically aroused in response to laboratory-based provocations, both imaginary and real. Subsequent research on SIT has revealed that it can be useful, too, for helping people who have suffered prior traumatic events to become more comfortable living with those events (Foa & Meadows, 1997).

Reframing can take place spontaneously if people are given the opportunity to spend time thinking and writing about stressful events. In an important series of studies, Jamie Pennebaker (1989) found that the physical health of college students improved after they spent a few hours writing about their deepest thoughts and feelings. Compared with students who had written about something else, members of the self-disclosure group were less likely in subsequent months to visit the student health center; they also used less aspirin and achieved better grades (Pennebaker & Chung, 2007). In fact, engaging in such expressive writing was found to improve immune function (Pennebaker, Kiecolt-Glaser, & Glaser, 1988), whereas suppressing emotional topics weakened it (Petrie, Booth, & Pennebaker, 1998). The positive effect of self-disclosing writing may reflect its usefulness in reframing trauma and reducing stress.

Body Management

Stress can express itself as tension in your neck muscles, back pain, a knot in your stomach, sweaty hands, or the harried face you glimpse in the mirror. Because stress so often manifests itself through bodily symptoms, bodily techniques such as meditation, relaxation therapy, biofeedback, and aerobic exercise are useful in its management.

Meditation

Meditation is the practice of intentional contemplation, and it can also temporarily influence brain activity and enhance the sense of well-being.

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Meditation is the practice of intentional contemplation. Techniques of meditation are associated with a variety of religious traditions and are also practiced outside religious contexts. The techniques vary widely. Some forms of meditation call for attempts to clear the mind of thought, others involve focusing on a single thought (e.g., thinking about a candle flame), and still others involve concentration on breathing or on a mantra (a repetitive sound such as om). At a minimum, the techniques have in common a period of quiet.

Aung San Suu Kyi, the leader of the Myanmar opposition party who was awarded the Nobel Peace Prize in 1991, endured house arrest from 1989 until 2010. She has said that daily meditation helped her through this difficult time by improving her mood, awareness, and clarity.

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Time spent meditating can be restful and revitalizing. Beyond these immediate benefits, many people also meditate in an effort to experience deeper or transformed consciousness. Whatever the reason, meditation does appear to have positive psychological effects (Hölzel et al., 2011). Many believe it does so, in part, by improving control over attention. The focus of many forms of meditation, such as mindfulness meditation, is on teaching ourselves how to remain focused on, and accepting of, our immediate experience. Interestingly, experienced meditators show deactivation in the default mode network (which is associated with mind wandering; see Figure 5.6 in the Consciousness chapter) during meditation relative to non-meditators (Brewer et al., 2011). Even short-term meditation training administered to college undergraduates has been shown to improve the connectivity between parts of the brain involved in conflict monitoring and cognitive and emotional control, and to do so via increased myelination (perhaps due to increased neuron firing) and other axonal changes (see the Neuroscience and Behavior chapter; Tang et al., 2012). Taken together, these findings suggest that meditators may be better able to regulate their thoughts and emotions, which may translate to a better ability to manage interpersonal relations, anxiety, and a range of other activities that require conscious effort (Sedlmeier et al., 2012).

Relaxation

Imagine for a moment that you are scratching your chin. Don’t actually do it; just think about it and notice that your body participates by moving ever so slightly, tensing and relaxing in the sequence of the imagined action. Edmund Jacobson (1932) discovered these effects with electromyography (EMG), a technique used to measure the subtle activity of muscles. A person asked to imagine rowing a boat or plucking a flower from a bush would produce slight levels of tension in the muscles involved in performing the act. Jacobson also found that thoughts of relaxing the muscles sometimes reduced EMG readings when people didn’t even report feeling tense. Our bodies respond to all the things we think about doing every day. These thoughts create muscle tension even when we think we’re doing nothing at all.

These observations led Jacobson to develop relaxation therapy, a technique for reducing tension by consciously relaxing muscles of the body. A person in relaxation therapy may be asked to relax specific muscle groups one at a time or to imagine warmth flowing through the body or to think about a relaxing situation. This activity draws on a relaxation response, a condition of reduced muscle tension, cortical activity, heart rate, breathing rate, and blood pressure (Benson, 1990). Basically, as soon as you get in a comfortable position, quiet down, and focus on something repetitive or soothing that holds your attention, you relax.

Relaxing on a regular basis can reduce symptoms of stress (Carlson & Hoyle, 1993) and even reduce blood levels of cortisol, the biochemical marker of the stress response (McKinney et al., 1997). For example, in individuals who are suffering from tension headache, relaxation reduces the tension that causes the headache; in people with cancer, relaxation makes it easier to cope with stressful treatments; in people with stress-related cardiovascular problems, relaxation can reduce the high blood pressure that puts the heart at risk (Mandle et al., 1996).

Biofeedback

Wouldn’t it be nice if, instead of having to learn to relax, you could just flip a switch and relax as fast as possible? Biofeedback, the use of an external monitoring device to obtain information about a bodily function and possibly gain control over that function, was developed with this goal of high-tech relaxation in mind. You might not be aware right now of whether your fingers are warm or cold, for example, but with an electronic thermometer displayed before you, the ability to sense your temperature might allow you (with a bit of practice) to make your hands warmer or cooler at will (e.g., Roberts & McGrady, 1996).

Biofeedback gives people access to visual or audio feedback showing levels of psychophysiological functions such as heart rate, breathing, brain electrical activity, or skin temperature that they would otherwise be unable to sense directly.

PHOTO BY CHARLES BALDWIN OF EAST CAROLINA UNIVERSITY/COURTESY DR. CARMEN RUSSONIELLO

Biofeedback can help people control physiological functions they are not likely to become aware of in other ways. For example, you probably have no idea right now what brain-wave patterns you are producing. In the late 1950s, Joe Kamiya (1969), a psychologist using the electroencephalograph (also called the EEG and discussed in the Neuroscience and Behavior chapter), initiated a brain-wave biofeedback revolution when he found that people could change their brain waves from alert beta patterns to relaxed alpha patterns and back again when they were permitted to monitor their own EEG readings.

Recent studies suggest that EEG biofeedback (or neurofeedback) is moderately successful in treating brain-wave abnormalities in disorders such as epilepsy (Yucha & Gilbert, 2004), and in teaching people to down-regulate activity in regions of the brain involved in the strong emotional responses seen in some forms of psychopathology (Hamilton et al., 2010). Often, however, the use of biofeedback to produce relaxation in the brain turns out to be a bit of technological overkill and may not be much more effective than simply having the person stretch out in a hammock and hum a happy tune. Although biofeedback is not a magic bullet that gives people control over stress-induced health troubles, it has proven to be a useful technique for things like increasing relaxation and decreasing chronic pain (Palermo et al., 2011). People who do not benefit from relaxation therapy may find that biofeedback provides a useful alternative.

Aerobic Exercise

Exercise is helpful for the reduction of stress, unless, like John Stibbard, your exercise involves carrying the Olympic torch on a wobbly suspension bridge over a 70-meter gorge.

AP PHOTO/MATT DUNHAM

A jogger nicely decked out in a neon running suit bounces in place at the crosswalk and then springs away when the signal changes. It is tempting to assume that this jogger is the picture of psychological health: happy, unstressed, and even downright exuberant. As it turns out, the stereotype is true: Studies indicate that aerobic exercise (exercise that increases heart rate and oxygen intake for a sustained period) is associated with psychological well-being (Hassmen, Koivula, & Uutela, 2000). But does exercise cause psychological well-being, or does psychological well-being cause people to exercise? Perhaps general happiness is what inspires the jogger’s bounce. Or could some unknown third factor (neon pants?) cause both the need to exercise and the sense of well-being? As we’ve mentioned many times, correlation does not always imply causation.

To try to tease apart causal factors, researchers have randomly assigned people to aerobic exercise activities and no-exercise comparison groups and have found that exercise actually does promote stress relief and happiness. One recent meta-analysis (a quantitative review of existing studies) compiled data from 90 studies including over 10,000 people with chronic illness who were randomly assigned either to exercise or a no-exercise condition, and found that people assigned to the aerobic exercise condition experienced a significant reduction in depressive symptoms (Herring et al., 2012). Other recent meta-analyses have come to similar conclusions, showing, for instance, that exercise is as effective as the most effective psychological interventions for depression (Rimer et al., 2012), and that exercise even shows positive physical and mental health benefits for individuals with schizophrenia (Gorczynski & Faulkner, 2011). Pretty good effects for a simple, timeless intervention with no side effects!

The reasons for these positive effects are unclear. Researchers have suggested that the effects result from increases in the body’s production of neurotransmitters such as serotonin, which can have a positive effect on mood (as discussed in the Neuroscience and Behavior chapter) or from increases in the production of endorphins (the endogenous opioids discussed in the Neuroscience and Behavior and Consciousness chapters; Jacobs, 1994).

Beyond boosting positive mood, exercise also stands to keep you healthy into the future. Current U.S. government recommendations suggest that 30 minutes of moderately vigorous exercise per day will reduce the risk of chronic illness (Dietary Guidelines Advisory Committee, 2005). Perhaps the simplest thing you can do to improve your happiness and health, then, is to participate regularly in an aerobic activity. Pick something you find fun: Sign up for a dance class, get into a regular basketball game, or start paddling a canoe—just not all at once.

Situation Management

After you have tried to manage stress by managing your mind and managing your body, what’s left to manage? Look around and you’ll notice a whole world out there. Perhaps that could be managed as well. Situation management involves changing your life situation as a way of reducing the impact of stress on your mind and body. Ways to manage your situation can include seeking out social support, religious or spiritual practice, and finding a place for humor in your life.

Social Support

The wisdom of the National Safety Council’s first rule—“Always swim with a buddy”—is obvious when you’re in water over your head, but people often don’t realize that the same principle applies whenever danger threatens. Other people can offer help in times of stress. Social support is aid gained through interacting with others. One of the more self-defeating things you can do in life is fail to connect to people in this way. Just failing to get married, for example, is bad for your health. Unmarried individuals have an elevated risk of mortality from cardiovascular disease, cancer, pneumonia and influenza, chronic obstructive pulmonary disease, and liver disease and cirrhosis (Johnson, Backlund, et al., 2000). More generally, good ongoing relationships with friends and family and participation in social activities and religious groups can be as healthy for you as exercising and avoiding smoking (Umberson et al., 2006). Social support is helpful on many levels:

• An intimate partner can help you remember to get your exercise and follow your doctor’s orders, and together you’ll probably follow a more healthy diet than you would all alone with your snacks.
• Talking about problems with friends and family can offer many of the benefits of professional psychotherapy, usually without the hourly fees.
• Sharing tasks and helping each other when times get tough can reduce the amount of work and worry in each other’s lives.

CULTURE & COMMUNITY: Land of the free, home of the…stressed?

Chances are that you, your parents, grandparents, or someone further back in your family immigrated to the United States. Many families have moved to the United States in pursuit of a better life. Are things immediately better after the move to a new land, or does the process of picking up and moving to a strange land increase stress and lead to negative health consequences?

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To answer these questions, Joshua Breslau and colleagues (2007) used survey data from large representative samples of English-speaking Mexicans residing in either the United States or Mexico to examine rates of anxiety and mood disorders throughout their lives. They found that the presence of an anxiety disorder while living in Mexico predicted immigration to the United States (i.e., if you are anxious in Mexico, you are more likely to move to the United States). In addition, they also learned that moving to the United States increased the likelihood of developing an anxiety or mood disorder, and of having more persistent anxiety. The authors interpreted these results as support for the “acculturation stress” hypothesis, which suggests that living in a foreign culture increases stress (due to trouble with communication, knowledge of local customs, etc.) and decreases social support, which together increase the risk of negative health outcomes. The highest risk of experiencing a mental disorder after moving to the United States was observed for children ages 0–12 years old when they moved, suggesting that this early disruption can be especially difficult. Interestingly, the increased risk of mental disorders among recent immigrants has been observed in other studies (perhaps due to stress), but those studies also consistently show that U.S. immigrants have lower levels of mental disorders than those born in the United States (which is among the highest in the world in rates of mental disorders, as described in the Psychological Disorders chapter; Borges et al., 2011; Breslau & Chang, 2006). So moving to a new country and culture can be very stressful, perhaps in part due to the stress and health levels of those in your new environment.

Women are more likely than men to respond to stress with a “tend-and-befriend” style in which they seek out social contact and cooperative relationships. The commonality of this response style may partly explain the success of the television show Sex and the City, in which four young women helped one another through many difficult times (the fabulous outfits didn’t hurt either).

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The helpfulness of strong social bonds, though, transcends mere convenience. Lonely people are more likely than others to be stressed and depressed (Baumeister & Leary, 1995), and they can be more susceptible to illness because of lower-than-normal levels of immune functioning (Kiecolt-Glaser et al., 1984). Many first-year college students experience something of a crisis of social support. No matter how outgoing and popular they were in high school, newcomers typically find the task of developing satisfying new social relationships quite daunting. New friendships can seem shallow, connections with teachers may be perfunctory and even threatening, and social groups that are encountered can seem like islands of lost souls (“Hey, we’re forming a club to investigate the lack of clubs on campus—want to join?”). Not surprisingly, research shows that students reporting the greatest feelings of isolation also show reduced immune responses to flu vaccinations (Pressman et al., 2005). Time spent getting to know people in new social situations can be an investment in your own health.

The value of social support in protecting against stress may be very different for women and men: Whereas women seek support under stress, men are less likely to do so. The fight-or-flight response to stress may be largely a male reaction, according to research on sex differences by Shelley Taylor (2002). Taylor suggested that the female response to stress is to tend-and-befriend by taking care of people and bringing them together. Like men, women respond to stressors with sympathetic nervous system arousal and the release of epinephrine and norepinephrine; but unlike men, they also release oxytocin, a hormone secreted by the pituitary gland in pregnant and nursing mothers. In the presence of estrogen, oxytocin triggers social responses: a tendency to seek out social contacts, nurture others, and create and maintain cooperative groups. After a hard day at work, a man may come home frustrated and worried about his job and end up drinking a beer and fuming alone. A woman under the same type of stress may instead play with her kids or talk to friends on the phone. The tend-and-befriend response to stress may help to explain why women are healthier and have a longer life span than do men. The typical male response amplifies the unhealthy effects of stress, whereas the female response takes a lesser toll on her mind and body and provides social support for the people around her as well.

Religious Experiences

Many people spend a significant amount of time in quiet prayer, reflection, and contemplation. National polls indicate that over 90% of Americans believe in God, and most who do, pray at least once per day. Although many who believe in a higher power believe that their faith will be rewarded in an afterlife, it turns out that there may be some benefits here on Earth as well. An enormous body of research has examined the associations between religiosity (affiliation with or engagement in the practices of a particular religion) and spirituality (having a belief in and engagement with some higher power, not necessarily linked to any particular religion), and positive health outcomes. The helpful effects of religiosity and spirituality have been observed in a wide range of areas including lower rates of heart disease, decreases in chronic pain, and improved psychological health (Seybold & Hill, 2001).

Why do people who endorse religiosity or spirituality have better mental and physical health? Is it divine intervention? Several testable ideas have been proposed. Engagement in religious/spiritual practices, such as attendance at weekly religious services, may lead to the development of a stronger and more extensive social network, which has well-known health benefits. Those who are religious/spiritual also may fare better psychologically and physically as a result of following the healthy recommendations offered in many religious/spiritual teachings. That is, they may be more likely to follow dietary restrictions, restrain from the use of drugs or alcohol, and endorse a more hopeful and optimistic perspective of daily life events, all of which can lead to more positive health outcomes (Seeman, Dubin, & Seeman, 2003; Seybold & Hill, 2001). On balance, many claims made by some religious groups have not been supported, such as the beneficial effects of intercessory prayer (see FIGURE 14.4). Psychologists are actively testing the effectiveness of various religious and spiritual practices with the goal of better understanding how they might help to explain, and improve, the human condition.

Figure 14.4: Pray for me? To test whether praying for someone in their time of need actually helped them, researchers randomly assigned 1,802 patients about to undergo cardiac bypass surgery to one of three conditions: those told that they may be prayed for and were; those told that they may be prayed for and weren’t; and those told that they definitely would be prayed for and were. Unfortunately, there were no differences in the presence of complications between those who were or were not prayed for. To make matters worse, those who knew they would be prayed for and were, experienced significantly more complications than the other two groups (Benson et al., 2006).

Humor

When Andrew Mason, CEO of the Internet company Groupon, left his position, his resignation letter read: “After four and a half intense and wonderful years as CEO of Groupon, I’ve decided that I’d like to spend more time with my family. Just kidding—I was fired today.” He went on to add, “I am so lucky to have had the opportunity to take the company this far with all of you. I’ll now take some time to decompress (FYI I’m looking for a good fat camp to lose my Groupon 40, if anyone has a suggestion), and then maybe I’ll figure out how to channel this experience into something productive.” This seems like a textbook case of using humor to mitigate stress, which is why we put it, um, you know where.

JUSTIN LANE/EPA/NEWSCOM

Wouldn’t it be nice to laugh at your troubles and move on? Most of us recognize that humor can diffuse unpleasant situations and bad feelings, and it makes sense that bringing some fun into your life could help to reduce stress. The extreme point of view on this topic is staked out in self-help books with titles such as Health, Healing, and the Amuse System and How Serious Is This? Seeing Humor in Daily Stress. Is laughter truly the best medicine? Should we close down the hospitals and send in the clowns?

There is a kernel of truth to the theory that humor can help us cope with stress. For example, humor can reduce sensitivity to pain and distress, as researchers found when they subjected volunteers to an overinflated blood pressure cuff. Participants were more tolerant of the pain during a laughter-inducing comedy audiotape than during a neutral tape or instructed relaxation (Cogan et al., 1987).

Humor can also reduce the time needed to calm down after a stressful event. For example, men viewing a highly stressful film about three industrial accidents were asked to narrate the film aloud, either by describing the events seriously or by making their commentary as funny as possible. Although men in both groups reported feeling tense while watching the film and showed increased levels of sympathetic nervous arousal (increased heart rate and skin conductance, decreased skin temperature), those looking for humor in the experience bounced back to normal arousal levels more quickly than did those in the serious story group (Newman & Stone, 1996).

If laughter and fun can alleviate stress quickly in the short term, do the effects accumulate to improve health and longevity? Sadly, the evidence suggests not (Provine, 2000). A study titled “Do Comics Have the Last Laugh?” tracked the longevity of comedians in comparison to other entertainers and nonentertainers (Rotton, 1992). It was found that the comedians died younger—perhaps after too many nights on stage thinking, I’m dying out here.