Topic Expert Roundup: We Can’t Be Aware Enough of Stress, Therapists Say

Welcome to April, as fitting a choice as any for Stress Awareness Month. (No? Taxes done yet?)

No one—not even the therapists who treat it—is immune to stress. Relatively few, in fact, are able to go 24 hours without experiencing it in some fashion, especially in the workplace. But if everyone deals with it, is it really that big of a deal?

Yes. Precisely because it’s such an omnipresent part of our lives, the toll stress exacts on our mental and physical health deserves our attention, concern, and best efforts to manage it. From heart disease to obesity to ulcers to dementia to depression and anxiety, stress can ignite or exacerbate a wide range of health issues. It interferes with sleep patterns, leaving us exhausted physically and less equipped to handle the challenges of the day. It weakens our immune systems, leaving us more vulnerable to colds and other illnesses. It can drive people to unhealthy coping strategies such as alcohol or drugs. It makes us irritable and impatient, which can wreak havoc on interpersonal relationships. And it’s costly to employers—one in four Americans admits to having taken a day off from work to manage stress.

We wanted to know what our Topic Experts think. Are Americans taking stress seriously enough? How have they seen stress manifest itself in clients, and what steps did they take to manage it? What can be done, realistically, to combat the destructive forces of everyday stress? Are we ultimately helpless?

Here’s what they had to say:

• Joyce McLeod Henley (codependency): “How do we manage stress in our ever-changing world? Many of us have multiple roles and never enough time to meet them all. Technology is advancing every day. I struggle with smart phones, Windows 8, and my hybrid car. Last week I was so stressed over them that I wanted to go back to 1980 in a time machine. That made me laugh, which helped. … Managing stress is a process that never ends during our lifetime. One of the best ways to handle stress is to exercise. When we are in a situation that we perceive as stressful, our body thinks we are in a life-or-death situation and we produce adrenaline to make us fast and strong. Most of the time, we don’t need it. Exercise will burn it off. (No wonder I want to smash the computer; it’s the adrenaline!) … Another thing that helps is to look at what we are thinking. If I thought, ‘Oh, no, I will never figure this out!’ that would just escalate the stress. If I think, ‘This is a pain, but I will figure it out—I always do,’ then my stress will be diffused. In fact, that did happen. After working with tech support and trips to T-Mobile and the Toyota dealer, everything is cool. … The last thing I try to do is to be aware of my breathing. When we are stressed, we don’t breathe out enough. So when stressed, I take four or five deep breaths, being sure to breathe in for a few seconds and out just as many seconds. … I hope that you find this helpful. For more info, please read my articles on managing anxiety.”
• Ruby Linhan (dissociation): “The first definition for stress offered by the dictionary on my desk begins with ‘a constraining force or influence’ and describes ways physical pressure can be applied to create tension or change. When I’m lifting weights, I’m placing stress on my body, and that’s good—it makes me stronger. When I’m emotionally hurt and I curl up and cry, my chest is constricted and my face is contorted. That’s stress too—expressing and experiencing those feelings is useful. But when people say ‘I’m stressed,’ I don’t think they’re talking about an experience that’s beneficial. I do wonder if they’re feeling anxious and/or scared. And I wonder if the world around them seems too close, too demanding, and they’ve lost the ability to push it back to a more comfortable distance. Perhaps they no longer (or never did) feel confident and powerful. Naomi Shihab Nye strikingly captures this desensitization to having our boundaries overrun in her poem How Far Is It to the Land We Left?:

On the first day of his life,
the baby opens his eyes,
and gets tired even doing that.
He cries when they place a cap on his head
Too much! Too much!
Later, the whole world will touch him,
and he won’t even flinch.

When people come to me saying they’re stressed out, I help them rediscover and maintain their boundaries with confidence and ease. Being overwhelmed doesn’t need to be part of the human condition, even in this day and age.”

• Tina Gilbertson (self-esteem): “There’s one huge stressor that most people don’t even realize they do to themselves. I’m talking about ignoring the way you feel. It takes a lot of energy to push feelings away once they’re triggered, and that stresses the body and mind. Those suppressed feelings don’t go away. They build up, and you end up either exploding on someone else in tears or harsh words, or imploding on yourself in depression or anxiety. Then you’ve got more stress than you started with. Just telling yourself how you feel in any given situation, and assuring yourself that your feelings are valid, takes the pressure off. You don’t need to share your feelings with anyone else if you don’t want to. But all your emotions, good and bad, should be allowed free rein inside you if you want to avoid unnecessary stress.”
• Shirley Katz (body image): “Stress is a catch-all term. One of the most important things we can do in effectively coping with it is identifying what is the source and what is the response. Most often, as research has shown, the labels we give to the issue at hand impact the way we respond. If we label something as out of our ability to deal with it, we cope poorly. Sometimes that isn’t an accurate assessment, but one we make nevertheless. When we are overwhelmed, and something is thrown at us that feels like too much, we need to take a moment to analyze in a logical manner what the source of the stressor is, and what resources we can draw on to effectively deal with it. If it is indeed out of our control, we may need some support in dealing with the emotions and the stress response that over time can lead to poor health and lessened ability to cope in general. If the stressor is something we can cope with, the most effective thing we can do is take charge, whether it means getting help, asking questions, expressing our boundaries, developing skills, making change, setting limits, etc. Effective coping is about appropriate labeling and taking action when we can, as well as accepting and effectively dealing with the emotions when we really can’t make action-based changes.”
• Kalila Borghini (spirituality): “I like to distinguish whenever possible when a client is experiencing the type of stress that is motivational in nature (i.e., the type that gets us to meet deadlines, pay bills on time, do taxes, look for a new job, and so on) and the stress that is debilitating. The latter I would describe as anxiety rather than stress. In its extreme forms, anxiety can be paralyzing. A good example of this is a panic attack which renders someone immobile. There are many options for treating stress, including examining how the client may be contributing to his/her own experience. Procrastination, for example, is guaranteed to trigger stress. Or overbooking to the point that it is impossible to meet expectations. In its less complex form, stress can be managed by meditation, exercise, good diet, getting outdoors, engaging in healthy distractions such as lunch with a friend, getting adequate rest, and so on. Stress that tips into the realm of anxiety is best dealt with by using various types of therapy and counseling, including cognitive behavioral therapy. Stress and anxiety also are effectively treated by medication which allows the body to recalibrate its biochemical responses. A good psychotherapist will work with the client to distinguish the difference between stress and anxiety. The treatment for anxiety is more complicated, in my opinion, and entails exploration of the underlying causes. This is beyond symptom relief and can lead to lasting and more effective management of the symptoms.”
• Roni Weisberg-Ross (abuse / survivors of abuse): “Stress is an unavoidable consequence of contemporary life. A certain amount of stress can be a positive motivator. Too much stress can overwhelm, paralyze and/or compromise health. While doing away with stress entirely is not possible, a significant amount of stress can be avoided or managed more efficiently by living a more conscious and thoughtful life. I divide stress into two spheres—the natural disaster or unforeseeable events (illness, accidents, death, divorce, and financial loss or ruin due to outside forces) and stress due to lack of planning or self-destructive tendencies. The former can be dealt with only after the fact; the latter can be modified or almost eradicated with skills training and honest insight. … Many of us have a tendency to not plan ahead—or ‘live by the seat of our pants.’ Many of us over-schedule our lives and try to please everyone, thereby always disappointing someone. While not excessively worrying, we do need to prepare ahead for survival—both financial and emotional—and always have a backup plan if things go awry. That forces us to imagine the worst possible scenario in most any situation and figure out how to survive it. While that may sound negative, it’s actually very comforting. When people sit in my office and express their deepest fears, I sometimes say, ‘OK, what if that did happen, what would you do?’ Instead of keeping the bogeyman in the closet, take it out, expose it, and defang it. It’s amazing how quickly that type of confrontation can lessen anxiety. … Remember, the only control we have in the world is over ourselves. Use that control wisely and become a powerful weapon for leading a less stressful life.”
• Lynn Somerstein (object relations): “Ouch, stress. I don’t think we pay enough attention or give enough respect to the vicious effect of stress on the body/mind. Stress leads to high blood pressure, obesity, and wears out the major organs of the body. Some ways we can relieve stress are: 1) recognize that uptight, worn out, girded-for-battle feeling; 2) take a break, go for a walk, learn deep breathing, meditate, go jogging, go swimming, see a movie, do art, yoga, whatever—do what feels relaxing to you; and 3) learn what causes you stress and take steps to change what you can and accept what you can’t. Don’t fight it.”
• Tammy Blackard Cook (grief, loss, and bereavement): “Stress manifests in myriad ways. Some clients come in with somatic complaints of lower GI troubles, heartburn, or nausea. Some come in with complaints about headaches, TMJ, or back problems. While some of these issues are biologically based, a lot of them may have originated with stress or simply be somatic manifestations of the stress we experience day to day. Other clients know simply that they feel ‘keyed up,’ anxious, unable to stop thinking, unable to sleep, or all of the above. All of us experiences stress differently, but I guarantee we all experience it, whether we notice it or not. … That brings me to my go-to for helping my clients deal with stress: mindfulness. If I can help clients begin to disconnect from their chronic thinking, their inability to see their experiences, thoughts, and feelings as separate from themselves, I can help them find freedom from stress. What do I mean? Generally, we experience something and we have a reaction, which has typically been conditioned in us over the years. So, we get cut off in traffic and we immediately go from relaxed to angry, red-faced, and foul-mouthed. It’s immediate; there’s no space between the trigger and our reaction. By training in mindfulness, we begin to notice what happens to us rather than just reacting—we learn to respond rather than react. It takes time, but we can eventually get to the place where when we are cut off in traffic, there’s a slight pause before we lapse into reactivity. In that pause, we notice what’s happening to us in that moment, how upset we are, and we might choose something different rather than continue in that thought stream. We might choose to take a deep breath instead, to remember that the other driver is also a human being who is flawed like us, to put some soothing music on the radio. You can choose. In that choice, there is a lot of freedom.”
• Jonathan Bartlett (relational psychotherapy): “I liken generalized anxiety to my experience of being a teacher for an unruly first-grade classroom. Sometimes the conflicting impulses of so many demands (outside and in) can appear truly ungovernable. Before any real work can be accomplished, my priority as lead teacher is to establish basic routines, rules, and consequences. Similarly, when the maelstrom of a client’s anxious mind is brewing, our first protocol is to establish calming thoughts, behaviors, and safety plans (including pharmaceutical support as needed). Such structure sets the stage for learning so that the real work of treating anxiety can then begin. … As first-grade teacher, I seek out the ringleaders of chaos, study them, discover the missing experiences that are driving them toward distraction, and supply it. As therapist, my treatment is to help uncover one specific component of a client’s distress at a time and offer constructive support. I work to befriend the dreaded feeling and help to organize the layers of its constitution. Together, clients and I tease out specific ‘calls to action’ that lay unfinished or perhaps have yet to be attempted. This is the work of therapy. Without anxiety, there would be far less work to do, yet far less accomplishment as well. Once a sense of accomplishment can be associated with the work of therapy, anxiety casts off much of the dread associated with it. It becomes possible to address one’s ongoing unmet needs while remaining aware of one’s general competence as a whole person.”
• Andra Brosh (divorce / divorce adjustment): “Most Americans don’t understand what stress is. They feel it in their bodies, become ill, overeat, and become emotionally overwhelmed without any connection to what’s behind it. I educate my clients about the symptoms of stress and how it manifests in their mind and body. I use research to convey the physiological and psychological effects, which empowers and motivates them to make the appropriate changes in their life. I also incorporate other forms of stress-reduction techniques, including mindfulness, guided imagery, relaxation, and concrete tools to manage feelings. Clients need to understand the sources of their stress to make realistic changes. The most obvious forms of stress surround finances or work, but long commutes, marital discord, lack of support, and not setting healthy boundaries are some of the most common stress inducers. Making even the smallest changes can make a huge difference in managing stress. Starting tomorrow, stress sufferers can change their diet, seek therapy, and add more pleasurable activities to their life to strike a greater balance.”
• Aylee Welch (body psychotherapy): “Stress is terribly hard on all aspects of a person’s well-being. It taxes the adrenal system, and over time can lead to serious problems. We all know of the risks of anxiety, high blood pressure, and heart attacks, but it also causes premature menopause and premenstrual difficulties in women and adrenal problems in men and women. The American lifestyle of long work hours and over-scheduled lives plays a large role in our stress level. I think it is important to question our lifestyle and adjust our work-relaxation ratios to make sure that our life is supporting rather than draining us. So much of how we live is taken for granted. Since the recession, many people have, out of necessity, created their own businesses out of things that they love to do and are having success creating a lifestyle that is supportive outside of what is the norm in corporate America and the cogs that support it. Sometimes making lifestyle choices out of the box can free us in other ways as well, allowing us to become aware of other things we do that may be status quo but not really fit who we are. Examining and making conscious our lifestyle choices is key to reducing stress. It also gives us the sense that we have some autonomy and control over our lives, which will further remedy stress. … Diet can also play a huge role in reducing stress. Fresh, organic foods and clean water mean that our systems don’t need to work overtime filtering pollutants; this reduces stress. … Of course, exercise and meditation are also very important in handling everyday stress. I once read that seven minutes of meditation leads to the same results as an hour of mediation if done on a regular basis. … Here’s to stress-free living!”
• Karla Helbert (grief, loss, and bereavement): “Stress, and its accompanying negative side effects, is one of the most pressing health crises of our time. Stress can impact us in a negative way physically, mentally, emotionally, and spiritually. Stress itself is not a bad thing; in fact, it can be a very good thing. Cortisol, the hormone associated with our bodies’ stress response, keeps us alert and responsive to threats and to challenges. It can save our lives. It can help us meet deadlines or perform well on tests and in other challenging situations. But because so many of us perceive and experience even nonthreatening events as stressful in our daily lives, we may live our days in a state of stress and can find it difficult to return to a neutral or calm state after the event or ‘threat’ is over. We can even react to our own thoughts as stressful and threatening events. Thoughts create feelings. If a thought is anxiety- and stress-filled—‘I’ll never make it on time!’ ‘He hates me!’ ‘This is a disaster!’—the accompanying feeling may be one of danger, distress, or emotional pain. Our bodies then respond physically with a stress response. Many clients I work with remain in a near-constant state of stress due to this cycle of thought/feeling/body response. This can manifest as tense muscles, anxiety, racing thoughts, depressed immune function, digestive problems, sleep issues, and the seeming inability to feel calm or peacefulness. … William James, one of America’s great founders of psychology, said, ‘The greatest weapon against stress is the ability to choose one thought over another.’ Mindfulness techniques and contemplative practices is one of the best ways that I have found to work with clients in reducing stress in their lives and changing the way we think.”
• John Sovec (LGBT issues): “For many people, stress is the invisible force that is affecting their life adversely, and they don’t even realize that stress is the reason they feel tired, overwhelmed, anxious, and quick to anger. Stress often has a cumulative effect that can cause not just psychological issues but also physical manifestations such as high blood pressure, inflammation, and heart disease. It is important for clients to realize that they are not helpless against stress, and that by addressing it in the moment, they have the ability to lessen the stress in their life. One of the first tools that I introduce to clients is how to manage their daily schedule, opening them up to the concept that a schedule does not own them but that they own the schedule. Looking through the calendar together, we identify commitments that are high priority, those that have been accepted through obligation, and those that are maintained by habit rather than by choice. By taking a no-nonsense look at their schedule, a client can gain an understanding of how they have choice in the commitments they make. Then we work together to open up some free time in the schedule as well as mark out time that is all theirs. A time where they can do something healing—take a walk, do some yoga, read a book, hang out in the garden. Whatever activity allows them to relieve some of the pressure to perform and open up some time to just be. Through this process, clients can begin to feel in charge of their life and take an active role in the process of relieving stress.”
• Blake Edwards (family therapy / family problems): “Whatever the reasons for or degree to which an individual is experiencing stress, self-responsibility remains at the core of being a healthy human being. Self-responsibility requires courage to sit in the anxiety that life has coincided for you and to act willingly, actively, and purposefully to identify the stress-inducing problem (if it has not been identified) and to learn how best to face the problem and learn to live well in the midst of the experience of stress, if not altogether gain control or resolution of it. If, for any reason, an individual experiencing stress is unable to initiate actions to resolve the problem—or to even identify the underlying problem—then it would be wise to accept help from other individuals, even a community of individuals, who may be equipped to provide support and direction. Additionally, a facilitative therapist in the midst to provide professional therapeutic support may be invaluable in spurring not only support but also new vision, new direction, and new hope.”
• Damon Constantinides (identity issues): “Many, if not most, of us live with a lot of stress on a daily basis. There are life stressors that we face such as death and loss, financial insecurity, or failing health; and then there are the stressful reactions we have to not having control over these situations. Our culture is set up to encourage us to feel like we don’t have enough or that we ourselves are not enough. I find that my challenge, both personally and with clients, is finding an alternative way of looking at stress. When a stressful situation is not something that my clients have control of, I encourage them to focus on how they think and feel about the stressful situation. A mindfulness and Buddhist psychology approach encourages us to accept our situation with awareness and compassion. I’ve found that this simple shift, from blaming ourselves for our inability to control the stressful situation to acknowledging our pain and helplessness, can provide much-needed space for self-acceptance and healing. It may seem like an oxymoron that to relieve stress we have to accept it, but this tool can provide a new lens to experience stress through which releases us from our own self-blame. This approach to stress understands it as a normal part of life that doesn’t have to control us. Instead, stress can be seen a useful tool for us to notice and be curious about—what can we learn about ourselves from our experience of stress?”
• Sara Rosenquist (postpartum depression): “Stress—what is it? You’ve heard about the ‘fight or flight’ response, no doubt. Well, stress is basically anything that gets that fight-or-flight response going. But few people know that ‘fight or flight’ is shorthand for fight, flight, freeze, feeding, and reproductive behavior (the ‘five Fs’ of survival). Reproductive behavior is actually much more than mating. Reproductive behavior includes tending and befriending—tending to young and reaching out to connect with a wider community. You see, we humans really are pack animals, hard-wired for safety in numbers. But we’ve evolved a stridently independent culture, a culture of rugged individualism that doesn’t square with the hard-wiring. … For decades, the zeitgeist that women have babies—ergo, postpartum depression must be caused by the hormonal changes that women go through during pregnancy and giving birth—has prevailed. But the truism that women give birth does nothing to explain or solve the problem that both men and women in our culture suffer clinical depression after bringing home babies, and do so at alarming rates. The data consistently show that about 15% of new moms (by birth or adoption) get postpartum depression. Dads do, too. In recent years, some impressive longitudinal data has shown that about 10% of new dads get depressed after bringing home a baby. So no, it’s not the hormones, folks—it’s our culture. Our culture purports to be ‘pro family’ but, in fact, it’s anything but. And having a baby, whether you cook one up yourself or you order in, blindsides moms and dads with changes they couldn’t anticipate and makes them depressed. Depression is very much a function of stress. … Still, there is good news. It is possible to get to know your own risks for depression (there are cognitive and interpersonal risks, and changes in either category will produce alterations at the biochemical level). It is possible to use self-awareness and plan social support in ways that prevent postpartum depression—and when prevention isn’t entirely possible, mitigate it.”
• Becki A. Hein (anxiety): “There are already literally thousands of articles and books about negative stress, where it comes from, and how to manage it. So with all this knowledge, why is stress still such a health problem? Why is it still either causing or exacerbating health problems such as heart disease, asthma, obesity, diabetes, gastrointestinal problems, headaches, back aches, anxiety, depression, and Alzheimer’s, to name a few? After countless conversations with clients, family and friends, I’ve come up with a few educated guesses as to why 75% to 90% of all doctor’s office visits are for stress-related complaints and illnesses. Guess No. 1: excuse-making. ‘I don’t have time.’ ‘I don’t want to do it by myself.’ ‘It’s hard, or boring, or expensive, or complicated.’ ‘I’m too old, or it’s too late.’ People put off exercising, eating healthy, meditating, and any other healthy activity using an amazing array of excuses. Guess No. 2: denial. People make excuses because they are in denial about the connection between their health problems and stress. They refuse to see the correlation between their chronic anger and their stomach or back problems, for example. It’s easier to avoid personal responsibility for health by believing that their body is ill because of fate or genetics or any other outside factors. It’s easier to take a pill than get up off the couch and walk around the block. The question is not how to reduce stress. It is: How are people going to finally accept the direct correlation of stress on health and take personal responsibility for maintaining their health?”
• Sarah Noel (person-centered / Rogerian): “Before we give stress too bad of a reputation, I want to take a moment to acknowledge the positive aspects of stress. Stress can propel us forward; for example, some level of stress is what pushes us to get out of bed in the morning and go about our day. Even excess amounts of stress can create a discomfort that can serve as a valuable cue to let us know something is wrong. Over the years, I’ve had many clients come in who weren’t really sure how to identify a presenting concern. They might simply indicate an increase in stress or anxiety that has distracted them at work and interfered in their relationships. Invariably, within a couple of sessions, themes start to emerge and we have a sense of what is causing the stress and can begin to work toward addressing it. … Certainly, I do not wish to minimize the deleterious effects of stress. Excess stress can compromise immune system functioning and, if it exists for a prolonged time period, can cause serious health issues. So when excess stress exists, it is important to address it. Exploring what is going on in therapy can help people identify and address the underlying causes of stress. As a complement to the process of therapy, yoga, meditation, massage, exercise, positive self-talk, eating well, and general self-care are all things that I find to be helpful in managing the day-to-day effects of stress.”
• Merle Bombardieri (fertility issues): “Stress is a huge problem. It causes chronic illness, makes chronic pain less tolerable, and distracts us from concentrating at work, thereby destroying productivity and making us unsafe. At home and in relationships with friends, it prevents us from truly listening, and from knowing ourselves well enough to communicate our thoughts to others. My clients and other people I talk to about stress often think they don’t know how to relax and therefore need training, or that they don’t have time to do relaxation techniques. Wrong, wrong, wrong. We would have time to relax if we watched less TV, tore ourselves away from our iPhones and emails. We are so addicted to our distractions that we’re not willing to pull away long enough to meditate, take a stroll, write in a journal, or listen to a visualization recording. It might help to think of yourself as a cat whose claws are digging into a tree that is about to be chopped down. Your well-being depends on pulling out those claws from distraction and finding safe and comfortable ground. One way to do this is to experiment with tiny relaxation breaks—a 5-minute meditation, walk, listening to music that makes you joyful, calling a beloved friend. Either/or thinking is the enemy of relaxation: ‘Either I’m going to do something for 30 minutes or more, or it’s not worth doing.’ Yet researchers tell us that in the first four minutes of a relaxation technique, our bodies are already functioning in relaxation mode, e.g. reduced oxygen consumption and heart rate. The difference between doing nothing to relax and spending a few minutes relaxing is enormous. … Researchers show that people who take the time to relax or to take breaks, naps, or vacations are more productive than the rest of us. They get more done in less time. Here’s an example from my own life: When I was writing my book, The Baby Decision, I would feel frustrated trying to write the beginnings and ends of chapters. I was better at advice than I was at transitions. Exhausted and frustrated, with limited child-care hours, I would argue with myself about whether I should take the time to meditate. Every time I tore myself away from my writing and began to meditate, my mind would easily fill with two or three sentences that were just what I needed and had no access to in my fierce, frantic approach to writing.”

What do you think? What causes stress in your life, and how do you deal with it? Please share your thoughts in the comments section below.

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