Contents
So far, we have mainly talked about the intrapersonal factors that influence perception and the impact of stressful events on it. Emotional support and other people’s involvement also help to cope with stress. A divorce, the death of a loved one, or a serious illness is usually more devastating when you have to endure it alone. When examining Israeli parents who lost their son (during an accident or war), it was found that this loss was harder for those who were already divorced or widowed. Among such people, the mortality rate over the next 10 years was higher than among those parents who could share their grief with each other (Levav et al., 1988).
Numerous studies show that people with many social connections (marriage, friends, relatives, and company) live longer and are less susceptible to stress-related illnesses than people who have few social contacts for support (Cohen & Wills, 1985). Friends and family can provide support in many ways. They can build self-respect by loving us with all our problems. They can provide information or advice, keep company to distract from anxious thoughts, and provide financial or material assistance. All this contributes to reducing feelings of helplessness and increases confidence in their ability to cope with the situation.
Stress is easier to bear when its cause is shared by others. National catastrophes (floods, earthquakes, tornadoes, wars) often allow people to perform at their best (Nilson et al., 1981). When people work together to overcome a common enemy or achieve a common goal, the anxieties and conflicts of each individual are more likely to be forgotten. For example, during periods of heavy bombing of London during World War II, the number of people seeking help for their emotional problems dropped significantly.
Sometimes, however, family and friends can add to the stress. Downplaying the severity of a problem or blindly assuring that everything will be fine can cause even more anxiety than just a lack of support. A survey of graduate students who took critical exams found that realistic support from their marriage partners («I’m worried, but I know you’ll do your best») was more helpful than marriage partners’ denial of possible failure («I’m not worried, I know you will pass). In the latter case, the student had to worry not only about failing the exam, but also about losing respect in the eyes of the marriage partner (Mechanik, 1962). Sometimes people may make demands or create difficulties for the individual at the very time when he is trying to cope with other stressors (Rook, 1984). For example, a person caring for a terminally ill parent may develop depression if his or her siblings criticize and harass them for the way they do so (Nolen-Noeksema, Parker & Larson, 1994).
In times of stress, in addition to seeking positive social support, a person can learn other ways to reduce the negative effects of stress on the body and psyche. Below, we will discuss some of the behavioral and cognitive techniques that have been shown to help a person reduce the impact of stress, and then we will discuss in detail how they can be used to overcome Type A behavior and reduce the risk of coronary heart disease.
Rice. 14.8. Operant conditioning of blood pressure and heart rate. One group of subjects received biofeedback (light and tone) whenever their blood pressure and heart rate decreased at the same time (Group 1); the other group received the same feedback whenever their blood pressure and heart rate increased simultaneously (Group 2). During one session of conditioning, the subjects achieved effective control of both blood pressure and heart rate. The group that was reinforced for lowering both functions gained more and more control as they tried; the group reinforced for increasing both functions behaved less consistently (after: Schwartz, 1975).
Behavioral Methods
The following behavioral methods are available to help a person control their physiological responses to a stressful situation: biofeedback, relaxation training, and aerobic exercise.
Biofeedback. With the help of biofeedback, a person receives information (feedback) about the parameters of his physiological state and then tries to change this state. For example, in a procedure to learn to control tension headaches, electrodes are placed on the forehead so that any movement of the forehead muscles is electronically detected, amplified, and presented to the person as an audible feedback signal. When the muscles contract, the pitch of the tone increases, and when the muscles relax, it decreases. By learning to adjust the pitch, one also learns to keep the muscles relaxed (relaxation of the forehead muscles usually provides relaxation of the muscles of the skull and neck as well). After 4-8 weeks of biofeedback training, a person learns to recognize the oncoming tension and reduce it without feedback from the machine (Thorpe & Olson, 1997).
Relaxation training
Traditionally, the physiological processes controlled by the autonomic nervous system, such as heart rate and blood pressure, were thought to be automatic and not subject to volitional control. However, laboratory studies have shown that it is possible to learn to change the heart rate and blood pressure (Fig. 14.8). As a result of these studies, new procedures for the treatment of hypertension have emerged. In one such procedure, patients are shown a graph of their blood pressure while they are being tracked and taught how to relax different muscle groups. Patients are instructed to tense their muscles (for example, clench their fist or tense their abdomen), relax them, and note the difference in sensation. Starting with the muscles of the foot and ankle and moving through the body towards the muscles of the neck and face, patients learn to change muscle tension. This combination of biofeedback and relaxation training has proven effective in lowering blood pressure in some people (Mukhopadhyany & Turner, 1997).
Reviews of numerous studies using biofeedback and relaxation training to control headache and high blood pressure conclude that learning to relax is the most important variable (Thorpe & Olson, 1997). Some people learn to relax more quickly with biofeedback. Others learn to relax just as well by training muscle relaxation without any special biofeedback. The effect of relaxation training depends on the individual. For some people who forget to take their blood pressure medication, relaxation training is more suitable, and some who have learned to control blood pressure through relaxation eventually give up this procedure, believing that it takes too much time.
Meditation
Meditation is an effective technique for relaxation and reducing the level of psychological arousal. Nearly all studies on this phenomenon have shown significant reductions in respiratory rate, oxygen uptake, and carbon dioxide emissions. Heart rate also decreased, blood circulation stabilized, and blood lactate levels decreased (Dillbeck & Orme-Johnson, 1987). Changes in EEG activity were also observed; these changes in the electrical activity of the brain indicate that during meditation there is a decrease in the level of cortical excitation, reflecting a decrease in the level of mental activity (Femwick, 1987). Meditation has also been shown to be effective in helping people with chronic anxiety and in improving self-esteem (Snaith, 1998).
However, a leading expert in the field argues that the same effects can be obtained as a result of ordinary rest. Based on a detailed examination of the results of various studies, he concludes that between subjects who were offered either meditation or rest, there were no systematic differences in heart rate and breathing, oxygen consumption, blood circulation and other physiological parameters (Holmes, 1984,1985, 1985a, XNUMXb ). Thus, simply resting can provide a reduction in stress similar to that induced by meditation.
Physical exercise. Another important factor in managing stress is fitness. Those who regularly engage in aerobic exercise (any regular activity that raises their heart rate and increases oxygen consumption, such as jogging, swimming, or cycling) experience significantly lower pressure and lower heart rate during the stress response than those who do not exercise regularly (Taylor, 1999). It has also been found (Brown, 1991) that physically fit people are significantly less likely to fall ill after stressful events. Because of these findings, fitness has been incorporated into many stress management programs.
Cognitive Methods
People who have learned to control their physiological and emotional responses through biofeedback and relaxation training will find it more difficult to do the same in a real stressful situation, especially if they continue to behave in the same way that makes them tense. Therefore, another approach to stress management relies on changing the individual’s cognitive reactions in response to a stressful situation. Cognitive Behavior Therapy helps a person identify which stressful situations are causing their physiological or emotional symptoms and change the way they deal with those situations. For example, a person suffering from tension headaches is first asked to keep a diary of their occurrence, indicating the severity of each episode of pain and the circumstances in which it began. They are then taught to monitor their reactions to these stressful events and are asked to write down their feelings, thoughts, and behaviors before, during, and after the event. Following a period of self-observation, certain associations with situational variables (for example, criticism from superiors or employees), thoughts (“I can’t do anything right”), and emotional, behavioral and physiological reactions (depression, compliance and headache) are revealed.
The next step is to try to identify what personal expectations or beliefs might explain the headache response (for example: «I think I’m doing everything perfectly, so the slightest criticism upsets me,» or: «I judge myself severely, become depressed, and everything ends in a headache.» pain»). The last and most difficult stage is to try to change something in a stressful situation, idea about it or behavior in it. As options, you can suggest finding a less stressful job; recognize that a perfectionist attitude leads to unnecessary worry about mistakes, or learn to be more firm in your relationships with others.
Biofeedback, relaxation training, and cognitive therapy all help people regulate their physiological and emotional responses to stress. Some researchers suggest that acquired gains are better preserved over time if cognitive and behavioral therapy is combined (Holroyd, Appel & Andrasik, 1983). This is not surprising, since flexible coping skills are often needed to meet the complex demands of everyday life; to cope with some types of life stress, only the ability to relax may not be enough. Stress management courses often use a combination of biofeedback, relaxation training, and cognitive therapy.
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