Stress

Mayo clinical psychologist Donald E. Williams, Ph.D, evaluates stress and its effects on health problems. We ask him for a few ideas on managing stress.

Oasis: What are the main things that cause stress in the modern home and workplace?

Williams: I should tell you right off the bat that I'm not a fan of labeling stress based solely on where it comes from. I understand that there are issues unique to the workplace or unique to the family and that we tend to call these 'work stress' or 'family stress.' However, in general, the thing to remember is that when environmental demands exceed our ability to cope, it creates stress. Stress can then create symptoms or problems, or exacerbate existing medical conditions.

Oasis: Do you believe people are easily able to recognize when this happens in their daily lives? It seems obvious ...

Williams: It does. But people respond differently. Some people are well aware that their demands are too high and therefore their stress is high. But others — people we (psychologists) or physicians see clinically — tend to respond to stress with bodily complaints or complaints of anxiety, depression, et cetera. They may get headaches. They may get chest pains. They go to their doctor, who may or may not recognize it as stress-related. The doctor may treat the symptoms, which is important, but treatment of symptoms may not get at the root cause. So, after appropriate medical evaluation of a patient's symptoms, we can alleviate those symptoms that are identified as stress-related.

Oasis: Is the environment always a factor? Can we make our own environments more stressful than need be?

Williams: Sure. We sometimes either knowingly or unknowingly can contribute to our own stress. But again, please go back to the first thing we talked about. If environmental demands are too high, regardless of our ability to cope, we have stress. And if our coping is insufficient or ineffective, regardless of demands, we have stress. That said, there are three basic ways we can intervene: 1) change our environment; 2) change how we cope, or 3) change both. There are a variety of ways to do that, but fundamentally that's what we are dealing with.

Oasis: Can you give an example of how someone can work on the coping side?

Williams: Let's take an example of stress that falls short of producing a serious or clinical problem. If a person is 'stressed out' and at risk for a health problem, things that we can do can range from simple relaxation training to working on exercise. Exercise is one of the best ways to manage stress. We also talk about proper nutrition, time management and anger management. A lot of this is the popular advice that most people have heard but don't follow or have trouble following consistently.

Oasis: How is time management, or mismanagement, related to stress?

Williams: Some people believe they are good time managers but probably are not. They take few breaks and may have many 'minor' health complaints. Others might say, 'I'm very busy, I get a lot done, but I'm stressed out at the end of the day.' These are the people who are probably not managing time well in terms of stress and behavioral health risks. Better time management would mean better management of stress and behavioral health risks. This, in turn, makes you more efficient at work.

So, there are many things — anger management, time management, relaxation training, exercise, proper nutrition — that can be very effective in helping a person who is stressed become more proficient in managing stress.

Oasis: And when these things don't work for people?

Williams: We might then engage them in cognitive behavioral therapy. This is much more individualized. We can work with people on changing how they think about stress and how they perceive stress. We can reframe their thinking in a much more positive way to minimize the negative effect of stress on their health. We can consider the possibility of other problems and help the patient attend to them as well.

Oasis: What's an example of reframing thinking?

Williams: A good example might be 'catastrophic thinking.' Something truly little or minor goes wrong during the work day, and the next thing you know the individual engaged in catastrophic thinking is feeling like he or she will be fired. If you sit down with this person and discuss what actually happened and how realistic the negative thinking is or isn't, the focus can be kept on the first little thing that happened — and the subsequent catastrophic thoughts can be ignored or at least the reaction can be limited.

Oasis: What are some techniques in anger management?

Williams: From a cognitive standpoint it's very similar to restructuring. We try to get the patient to look at the anger differently. The focus is to try to be aware of the anger and acknowledge it — and then to express it and react to it appropriately.

Oasis: For example, say I'm driving home from work and somebody honks at me. I find myself really angry — much more so than is reasonable?

Williams: I'd guess in that situation you are probably very aware of your anger. It would be a sign that your 'fuse' has grown too short, especially if it hasn't been so short in the past. You might be under pressure from something else. Since there may be a substantial cardiovascular risk from this type of anger, I would encourage you to acknowledge the anger and behave in a more appropriate way, such as exercising after work before you go home. I also could work with you cognitively to more appropriately express the anger or even learn why you have become so angry in that situation.