Overview

Stress can be your friend or your foe. When stress fuels the spark of personal achievement, it can work to your benefit by making you more perceptive and productive, acting as a motivator and even making you more creative. But when stress flames out of control—as it often does for many of us—it can take a terrible toll on your physical and emotional health, as well as your relationships.

While stress is not considered an illness, it can cause specific medical symptoms, sometimes serious enough to send you to the emergency room or your health care professional’s office. According to the American Psychological Association’s 2010 Stress in America survey, the majority of Americans report living with moderate or high levels of stress. And on average, those who report their health as fair or poor have more stress (an average stress rating of 6.2 on a 10-point scale) compared with those who rate their health as excellent or very good (an average stress rating of 4.9 on a 10-point scale).

In today’s fast-paced world, women are experiencing more stress at every stage of their lives than ever before. Juggling job pressures, family schedules, money issues, career and educational advancement and child and elder-care concerns are only a few of the common stressors confronting women.

Stressors are the external events, including pressures in people’s lives, such as divorce, marriage, children, work and money. The experience of stress, however, is related to how you respond to these stressors. One person’s stressor can be another person’s motivator.

You can learn to manage how you respond to stressors through relaxation, meditation, some forms of psychotherapy and exercise, among other methods. However, you can also work to reduce the stressors in your life, such as learning to say no to some commitments, simplifying your life or leaving a bad job or relationship. Sometimes techniques that are originally designed to simply reduce your stress response and improve coping (for example, meditation and psychotherapy) can lead you to choose to reduce the stressors in your life because you begin to see more clearly what needs to change.

Working mothers, regardless of whether they are married or single, face higher stress levels—both in the workplace and at home. The National Institute for Occupational Safety and Health (NIOSH), the US agency responsible for conducting research and making recommendations for the prevention of work-related illness and injury, provides these statistics regarding stress in the workplace:

• 40 percent of workers reported their jobs were very or extremely stressful
• 25 percent view their jobs as the number one stressor in their lives
• 75 percent of employees believe that workers have more on-the-job stress than a generation ago
• 29 percent of workers felt quite a bit or extremely stressed at work
• 26 percent of workers said they were “often or very often burned out or stressed by their work.”

Stress has been linked with a variety of physical ailments from headache todepression to symptoms that mimic a heart attack. The balance between stressors and your ability to cope with them, however, can determine your mental health. When the stressors in your life match your coping abilities, you feel stimulated, engaged and appropriately challenged. Too many stressors in your life that overwhelm your attempts to cope can result in depression or anxiety.

Depression can feel like a pervasive sense of hopelessness, a feeling of wanting to give up, tearfulness or a sadness that does not seem to go away after a couple weeks. Anxiety can feel like a chronic state of feeling “keyed up” or “on edge.” Some people who are depressed or anxious have physical symptoms, such as changes in sleep or appetite (too much or too little).

Chronic depression and anxiety have been linked to other physical problems, such ascardiovascular disease, chronic pain, hypertension and diabetes. If you notice symptoms of depression or anxiety, it is important to get them treated. Your health care professional or mental health professional can help.

Regardless of your physical or mental symptoms, talk about the stress in your life with your health care professional. A thorough assessment by your health care team will help determine the cause of these symptoms. You may find that stress has triggered an illness, such as high blood pressure.

Stress and Your Body

Research indicates that women’s biological response to stress is to “tend and befriend”; this is, make sure the children are safe and then network with other women in stressful times. Men’s biological reaction to stress is to go into the “flight-or-fight” mode. Studies indicate that the hormone oxytocin, which has a calming effect, is released during stressful times in both men and women.

Estrogen may enhance oxytocin release, while testosterone may diminish it; this may be one reason that women seem to seek social support more often then men when under stress. However, women have also been socialized from an early age to look to their social group, particularly their female friends, for support when under stress, whereas men tend to engage in activities, such as exercise or even using substances, when under stress.

During stress, hormones including adrenaline and cortisol flood the body, resulting in:

• an increased need for oxygen
• increased heart rate and blood pressure
• constricted blood vessels in the skin
• tensed muscles
• increased blood sugar levels
• increased clotting ability of blood
• spilling of stored fat from cells into the bloodstream
• constriction of bowel and intestinal muscles

All this can strain your heart and artery linings. In fact, if you already have coronary heart disease, stress might lead to chest pain, called angina. Plus, the increased tendency for blood to clot during stress may lead to a clot in your coronary arteries, causing a heart attack.

Other physical dangers of stress include stomach problems as your bowel and intestinal muscles constrict and depression and anxiety. While stress doesn’t cause these mental illnesses, it can activate them in people who may already be prone to them.

Other physical dangers of stress include stomach problems, as your bowel and intestinal muscles constrict, as well as depression and anxiety. While stress doesn’t cause these mental illnesses, it can activate them in people who may already be prone to them.

Stress can also cause what has been termed “toxic weight gain.” Cortisol, a hormone released when you’re under stress, is an appetite trigger. That’s why so many women eat more—and less-than-healthy food—when under a lot of stress. Those extra calories are converted to fat deposits that gravitate to the waistline. These fat deposits, called visceral fat, are associated with life-threatening illnesses such as heart disease, diabetes, high blood pressure, stroke and cancer. Chronically high levels of cortisol may stimulate the fat cells inside the abdomen to fill with more fat. As you age, this expanding waistline can be life threatening.

Too much stress can also affect your immune system, weakening it and making you more susceptible to colds, coughs and infections.

Other symptoms of stress include muscular tension, headaches, gastrointestinalillnesses and sleeping more or less than normal.

Stress Triggers

It is important to distinguish between the acute stress response—when your heart beats faster and your breath comes faster as you get a rush of adrenalin—and the chronic stress response, in which you are continually under stress.

This chronic stress response is the one that causes the most problems as it literally wears out your body functions, leading to disease. That’s because our physical stress response was designed for emergency situations, such as fleeing an attacking animal, not for the everyday stressors we experience in modern society.

You may feel stressed in response to external or internal triggers, such as stressors in your life or your own way of relating to yourself. These include:

• trauma or crises
• small daily hassles
• conflicts or unpleasant people
• barriers that prevent you from reaching your goals
• feeling little control over your life
• excessive or impossible demands from others
• noise
• boring or lonely work
• irrational ideas about how things should or must be; perceiving that life is not unfolding as you think it should
• believing you are helpless or can’t handle a situation
• drawing faulty conclusions like “they don’t like me” or “I’m inferior to them,” or having unreasonable fears of dire events such as “I’ll be mugged”
• pushing yourself to excel and/or failing to achieve a desired goal
• assigning fault for bad events, for example, placing blame on yourself or on others
• realizing you may have been wrong but wanting to be right
• overreacting to current stress as a result of intense stress years earlier, especially in childhood

Diagnosis

If you are suffering from stress, you may be experiencing a variety of symptoms that feel severe enough to prompt you to see a health care professional. These include:

• headaches
• frequent upset stomach, indigestion, gas pain, diarrhea or appetite changes
• feeling as though you could cry
• muscular tension
• tightness in your chest and a feeling as though you can’t catch your breath
• feeling nervous or sad
• irritability and anger
• having problems at work or in your normal relationships
• sleep disturbance: either insomnia or hypersomnia (inability to sleep or sleeping too much)
• apathy-lack of interest, motivation or energy
• mental or physical fatigue
• frequent illness
• hives or skin rashes
• tooth grinding
• feeling faint or dizzy
• ringing in the ears
• disruptions in your menstrual cycle or unusually severe PMS or menopausal symptoms

There is no specific test to diagnose stress. Typically, your health care professional conducts a variety of tests (which may include a personal and family health history, blood and urine tests and other assessments) to rule out various medical conditions.

Because your symptoms may be similar to those of depression, your health care professional should also evaluate your mental state to determine if you may be suffering from a depressive or anxiety disorder. Symptoms associated with stress, anxiety and sleeplessness, for example, typically subside when the stress triggering them subsides. When these same symptoms are caused by depression or another mood disorder, however, they may not go away without medication or therapy.

If stress is identified as the culprit for your symptoms, you may want to ask your health care professional for stress management strategies and consider ways to control the stressors in your life-before your health is affected.

Treatment

Reducing or eliminating the things that cause stress and changing how you react to it are the safest and most effective ways to treat stress. No single method of stress management is always successful, so you might want to try a variety of approaches. It’s also important that you treat any medical symptoms stress exacerbates. However, keep in mind that treating the stress may not cure the medical problem.

Reducing stress can be difficult. Often, people succeed in relieving stress in the short term but return to old stress-producing habits. Plus, personal responsibilities don’t alwayslend themselves to stress-reducing tactics. The process of learning to control or redirect stress is lifelong, but working to master it will improve your lifelong health.

Cognitive-behavioral therapy, which helps you substitute desirable responses and behavior patterns for undesirable ones, is one proven way to reduce stress. It is very important that you learn cognitive-behavioral coping skills from a professional. They include:

Identifying sources of stress.

You may want to keep a stress diary in which you record stressful occasions, incidents that triggered anger or anxiety or that caused a physical response like a sour stomach or headache. Jot down the time of day and the circumstances that led to these feelings, then try to identify the types of events or activities that caused them. See if you can alter or avoid these circumstances.

Restructuring priorities.

Examine your priorities and goals to determine which stressful activities or situations you can get rid of. For instance, replace time-consuming chores that aren’t really necessary (like ironing) with more pleasurable or interesting activities.

Find ways to balance the stress inducers you can’t eliminate

like unpleasant working conditions, an unhappy family situation or a significant loss—by including stress-reducing activities in your day. Studies have shown that such activities can positively affect your immune system. Making time for recreation and stress reduction is as essential as paying bills or shopping for groceries.

Adjusting your responses to stress.

Because you can’t simply wish some stresses away-you can’t just quit your job or walk out on your family, for example-you have to learn how to respond to stress to reduce its effects. These include:

• Discussing your feelings. If you don’t discuss your feelings of anger or frustration, you may feel hopeless and depressed. Becoming aware of your feelings can help you assert yourself when it’s important. You can do this in a positive way, by writing a letter or calmly discussing your feelings with the other person. Asserting yourself in a negative way (yelling and behaving aggressively, for example) is only counterproductive. It’s also important that you learn to listen, empathize and respond to others with understanding. If you can’t talk to a trusted friend, try writing in a journal or composing a letter.
• Keeping your perspective and looking for the positive. Think of the worst possible outcome to a situation that is stressing you and assess the likelihood of it occurring (usually small). Then, envision a positive outcome and develop a plan to achieve that outcome. It’s also helpful to remember past situations that initially seemed negative but ended well.
• Using humor. Stress management experts often recommend that people keep a sense of humor during difficult situations. Laughing releases the tension of pent-up feelings and helps maintain your perspective on the situation.

In addition to cognitive-behavioral methods to approaching stress, learning a relaxation technique-the natural unwinding of the stress response-can also help. A stress management specialist can teach you some relaxation techniques, including:

• Deep breathing. When you’re under stress, your breathing becomes shallow and rapid. Taking a deep breath is an effective technique for winding down. Inhale through your nose slowly and deeply to the count of 10, making sure your stomach and abdomen expand but your chest does not rise. Exhale through your nose, also to the count of 10. Concentrate fully on the breathing and counting. Repeat five to 10 times. The goal is to take three inhales and three exhales per minute, for a total of three deep breaths.
• Relax your muscles. Sitting anywhere, even at your desk, relax your shoulders, let your arms drop to your side, rest your hands on top of your thighs, relax your legs, and don’t forget your jaw muscles, which often tense with stress. Close your eyes and breathe deeply. You can also do this lying in bed. Beginning with the top of your head and progressing downward, tense and then relax the muscles in your body one by one while maintaining a slow, deep breathing pattern.
• Passive stretches. Allow gravity to help you relax and stretch your muscles. Relax your neck and let your head fall forward to the right. Then let it drop even more as you breathe slowly. Do the same with your shoulders, arms and back.
• Visualization. Remember a relaxing time or place like a lakeside picnic or a beautiful beach scene. Close your eyes for a few minutes and picture it in your mind.
• Meditation. The goal of meditation is to quiet your mind, to relax your thoughts and increase your awareness. Meditation can also reduce your heart rate, blood pressure, adrenaline levels and skin temperature. It involves concentrating on a simple image or sound while sitting in a comfortable position away from distractions. It can involve cultivating an open awareness or a more loving attitude toward yourself and others. Meditation can also help you become more aware of your priorities so you can make more productive choices in your life.
• Electromyographic Biofeedback (EMG). During this totally painless process conducted in a health care professional’s office, you learn to reinforce your relaxation skills using methods such as those described earlier. Electromyograph biofeedback measures the electrical activation that signals muscles to contract. Electromyographic biofeedback training helps you relax overly contracted muscle groups to help reduce tension. As training continues, you learn to use the information from the instruments to discriminate between tension and relaxation. By repeating this process, you learn to associate the sound with the relaxed state and to achieve this state of relaxation by yourself without the machine.
• Massage therapy. This approach slows the heart and relaxes the body. Rather than causing drowsiness, however, massage actually increases alertness

Your health care professional will probably discuss other issues with you, such as the necessity of:

• Maintaining healthy habits. People who are coping with chronic stress often resort to unhealthy habits including high-fat and high-salt diets, tobacco use, alcohol abuse and a sedentary lifestyle.
• Avoiding stimulants like tobacco (which contains nicotine) that make you feel calm in the short run, but actually rev up your nervous system. The addictive characteristics of some stimulants like nicotine can leave you anxious until your next fix.
• Getting regular aerobic exercise. Even a brisk walk can reduce levels of stress hormones in your blood. At least 30 minutes a day (or two 15-minute sessions) most days of the week is best, but even three times a week offers benefits. In addition, as you get fitter, your body is better able to withstand stress and your mind to cope with stress and stay on an even, happier keel. Start slowly. Strenuous exercise in people who are not used to it can be very dangerous. You should first discuss any exercise program with your health care professional.
• Strengthening or establishing a support network. Even a pet can help reduce medical problems aggravated by stress. Studies of people who remain happy and healthy despite many life stresses conclude that most have very good social support networks.
• Reducing stress at work. Try establishing a network of friends there, seeking out a sympathetic manager, or schedule daily pleasant activities and physical exercise during free time. For additional support, schedule an appointment with an Employee Assistance Program clinician, if your company offers that benefit. These programs provide professional counselors who can give you and your family confidential assessment and counseling.

Prevention

You can’t simply wish away stressful events from your life. The key is to handle the stress appropriately. The following may enhance your ability to manage stressful events in your life:

• Eat a balanced, nutritious diet. General health and stress resistance can be enhanced by eating well and by avoiding alcohol, caffeine, tobacco and junk food.
• Exercise regularly. Exercise promotes emotional well-being as well as physical fitness.
• Schedule your time more effectively using a calendar and to-do lists, prioritizing activities and realizing you can’t do everything.
• Learn how to say no to requests that add extra burdens and can wreak havoc on your day.
• Insist on help with regular chores.
• Balance work and play by planning time for hobbies and recreation—activities that relax your mind and temporarily take you away from your stresses. Even diversions like taking a warm shower, going to a movie or taking a walk can help.
• Practice relaxation exercises every day, including visualization, deep muscle relaxation, meditation and deep breathing.
• Rehearse for stressful events. Imagine yourself feeling calm and confident in an anticipated stressful situation. You will be able to relax more easily when the situation arises.
• Let yourself laugh and cry. Laughter makes your muscles go limp and releases tension, so try to keep a sense of humor. Tears can help cleanse the body of substances that accumulate under stress.
• Talk out troubles. It sometimes helps to talk with a friend, relative or spiritual leader. Another person can help you see a problem from a different point of view.
• Help others. Because we concentrate on ourselves when we’re distressed, sometimes helping others is the perfect remedy for whatever is troubling us.
• Learn acceptance when a difficult problem is out of your control, which is better than worrying and getting nowhere.
• Develop and maintain a positive attitude. View changes as positive challenges, opportunities or blessings.

You don’t need to do all of these. Some may work for some people and others for other people. The key is to use the ones that work for you. Some of these become more effective with practice. If you are feeling especially overwhelmed, seek help. There is no need to suffer and there are trained people out there to help.

Facts to Know

1. According to the American Psychological Association’s 2010 Stress in America survey, the majority of Americans report living with moderate or high levels of stress. And on average, those who report their health as fair or poor have more stress in their lives (an average stress rating of 6.2 on a 10-point scale) compared with those who rate their health as excellent or very good (an average stress rating of 4.9 on a 10-point scale).
2. Working mothers, in particular, are among the people most likely to experience stress, particularly when they do not have a lot of support from others.
3. Stress takes a toll on your body. Stress can cause stress hormones such as adrenaline and cortisol to flood your system. These hormones cause your heart rate and blood pressure to rise, your muscles to tense, your blood sugar levels to increase and other physical symptoms.
4. The effects of stress may lead to actual medical illnesses, including heart problems, stomach problems and headaches.
5. While stress doesn’t cause mental illnesses like depressive disorders or anxiety disorders, it can lead to feelings of depression and anxiety. It can precipitate mental illnesses in people predisposed to them, particularly if left untreated.
6. Symptoms of stress include irritability, sleep disturbances, appetite changes, muscular tension, apathy, fatigue, headache and frequent illness.
7. Stress can be brought about by external factors such as conflicts in your relationships, job pressures and even traffic. In addition, internal factors-such as a desire for perfection, a feeling of helplessness, blaming yourself for things that are out of your control or intense worry-also cause stress.
8. The ways you react to stressful situations can be relearned. You can use cognitive-behavioral approaches in which you identify sources of stress and work to minimize them and adjust your responses to the stresses you can’t eliminate.
9. Relaxation techniques help dispel stress and can cause adrenaline and cortisol levels in your blood to decrease. These techniques include deep breathing, muscle relaxation, stretching, visualization, meditation and biofeedback.
10. A nutritious diet and regular exercise not only prepare your body to withstand the physical effects of stress, but strengthen your mind to cope with stress and stay on an even keel.
11. According to the National Institute for Occupational Safety and Health, the U.S. agency responsible for conducting research and making recommendations for the prevention of work-related illness and injury, 40 percent of workers reported their job was very or extremely stressful.

Key Q&A

1. I feel so distressed that I have recurrent thoughts of suicide or death. Is this stress? What should I do?You should seek care or crisis intervention immediately. These types of thoughts are more indicative of a depressive disorder than stress, but your health care professional can assess your situation, give you a diagnosis and recommend treatment.
2. What causes stress?What causes a person to experience stress is different for different people; what may be one person’s stressor can be an exciting motivator to another person. However, this doesn’t mean one person is weak and the other is strong. That being said, some common causes of stress are changes in your life like marriage, divorce, a new job or the birth of a child; trauma or crises, like illnesses, death of a loved one, or a traumatic event like a burglary; excessive demands on you and your time; conflicts or unpleasant people; small daily hassles; barriers that prevent you from reaching your goals; feeling little control over your life; and boring or lonely work.
3. Sometimes when I feel stressed out, I feel a pain or tightness in my chest. What is this and what should I do?You need to seek care immediately to rule out heart disease or to begin treatment for any heart-related illness you might have. While you might not have a physical illness, you do need to have this symptom diagnosed. If you don’t have a serious illness-rather the stress in your life is causing this symptom-you need to address this issue so your health doesn’t deteriorate further.
4. Is stress an illness?While stress is not itself considered an illness, it is a common cause of specific medical symptoms from high blood pressure to muscle aches and stomach ulcers. According to the American Psychological Association (APA), in 2010, 51 percent of people surveyed reported fatigue, 40 percent reported headaches, 49 percent reported lack of motivation or energy, and 56 percent reported irritability or anger as a result of stress.
5. Who’s most likely to suffer from stress?According to the APA, women report higher levels of stress than men, and women are less likely to think they are doing enough to manage the stress in their lives. On a 10-point scale, 28 percent of women report an average stress level of eight, nine or 10, versus 20 percent of men. In addition, those most likely to report frequent mental stress include younger adults, working mothers, divorced or widowed individuals, the unemployed and those with low incomes.
6. What are the effects of stress?Stress can cause symptoms of a variety of physical and mental illnesses and make you more susceptible to other illness. Some specific symptoms of stress include feeling anxious, depressed or irritable; stomach upset, diarrhea or appetite changes; muscular tension; headaches; mental or physical fatigue and apathy; sleep disturbances and frequent minor illnesses.
7. Can I avoid stress?You probably can’t completely avoid stressful situations, but you can alter your reaction to those situations, resulting in far fewer physical symptoms of stress and negative results. With enough “tools,” some stress may actually feel motivating.
8. Are there treatments for stress?While you can’t necessarily control the events that cause you stress, you can control how you manage the stress. Cognitive-behavioral methods, a form of psychological treatment that is used to help you substitute desirable responses and behavior patterns for undesirable ones, are the most effective ways to reduce stress. These methods include identifying sources of stress and then altering or avoiding these circumstances; restructuring your priorities and goals; and adjusting your responses to stress by discussing your feelings, keeping your perspective, looking for the positive and using humor. In addition, learning relaxation techniques-the natural unwinding of the stress response-can be helpful. Finally, working with someone to change your life in ways that reduce the external stressors is also helpful. Improving how you cope with stress as well as reducing stressors in your life go hand in hand. Mental health professionals can help you do both of these things.

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