STRESS! Have control over how you react

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STRESS! `Important thing to remember is have control over how you react'

SITTING AMONG the papers, Rolodex, notebooks and files on Danielle Seery-Smith's desk is a little rubber moose with big floppy antlers. During the course of each hectic workday, whenever she happens to glance at the moose, she pauses for a few seconds to take a deep breath.

The moose is Ms. Seery-Smith's cue to relax. It doesn't take away the demands of her job or the day-to-day annoyances she faces. But it does remind her to stop several times each day and check how her body is reacting to that day's aggravations.

"Feeling stress can affect your body in dozens of different ways," says Ms. Seery-Smith, a stress management instructor and medical screening coordinator with the National Center for Health- Fitness at American University in Washington. "The muscles in your shoulders, your jaws, your face tense up; you hold your breath or breathe shallowly; your heart beats faster; your blood pressure rises.

"All this can be going on, and you don't even realize it unless you stop for a minute and make yourself aware of how your body is reacting."

That's where the cue to relax comes in. Any object will do.

"Your cue should be something that stands out from the rest of the stuff in the room," she says. "You have to train yourself, every time you look at that object, to take a few seconds and do a quick relaxation technique, whether it's deep breathing or stretching -- whatever.

"You should get to the point where stopping to relax for a few seconds whenever you look at your cue becomes as much a part of your regular routine as brushing your teeth."

THOUGH RELYING on cues to relax may seem simplistic, the idea behind the technique is what's essential -- that you, not outside events, control how extensively stress affects your life. The central message of stress management programs, no matter what specific techniques are involved, is that everyone can take steps each day to reduce stress levels.

Remembering that stress is the response to situations or events -- and not the situations or events themselves -- is the first step in learning to cope with stress, according to Donald Tubesing, author of Kicking Your Stress Habits and president of a Minnesota-based consulting company that produces training materials and programs for stress management instructors.

"Sitting in traffic, for example, is not stressful in and of itself," he says. "It's our perception of the situation that can make it stressful."

"You have a choice of how much time and energy you're willing to spend on each of the numerous situations and problems you face every day. If you get stuck in traffic, you can work yourself up, and grip the steering wheel and curse and yell at anyone who beeps their horn. Or you could view the time you're sitting there as the only uninterrupted 15 minutes you'll have all day. You could use the time to do some quick relaxation techniques, listen to music, think about what you'll do after work that day.

"Either way, the problem itself does not change -- you're going to be stuck in traffic the same amount of time. The important thing to remember is you have control over how you react and, therefore, you can control how stressed you become."

CHOOSING HOW to focus your energy is a key to controlling stress, according to Dr. Robert Eliot, a cardiologist who directs the Institute of Health Management and Stress Medicine in Englewood, Colo., and author of Is It Worth Dying For?

"We not only choose whether we're going to let something upset us, we choose how much energy the situation is worth," Eliot says. "Look at the energy you expend on a scale of 1 to 10. Then, when you're confronted with a situation that could lead to stress, decide whether it's worth a lot of your energy, a nine or 10, or just a little energy, a two or three.

"I offer people two rules. Rule No. 1: Don't sweat the small stuff. Rule No. 2: It's all small stuff."

Eliot is only half-joking. Sixteen years ago, at the age of 43, he suffered a heart attack, which he largely attributes to the stress he says he allowed to build up in his daily life.

YOU SHOULD ALSO keep in mind that not all stress is bad, says Glenn Schiraldi, a stress management instructor with the health education department at the University of Maryland and author of a stress management self-help book, Facts to Relax By.

The stress response, sometimes described as the "fight or flight" response, helps us in dangerous situations that require quick physical activity. The physiological responses -- a faster heart rate, tense muscles, increased blood pressure, rapid breathing, the release of certain chemicals, such as adrenalin, and increased blood flow to major muscles -- enable us to function during life-threatening situations.

Our bodies experience stress whenever we feel threatened, whether the threat is physical or not.

Every day we face dozens of situations -- or "stressors" -- that can threaten our ability to function at our best: The car won't start, the boss snaps at us, the stop at the bank takes an hour, a conversation with a friend ends in a disagreement. When stressors build up over the course of a day, the body continually gears itself up to deal with the situation.

"When the stress response is set off repeatedly over a short time period, the body doesn't have adequate time to adjust or return to normal between each stressor, and the result is a buildup or an accumulation of stress," says John Curtis, founder and director of the University of Wisconsin Stress Management Institute, which trains health care providers to teach stress management classes.

And since the stressors of everyday life are not going to go away, Curtis says, people must learn to adjust their responses to situations.

IF IT'S LATE morning and you have a 4 p.m. deadline on a project, for example, you can choose how to use the adrenalin your body is producing, Curtis says.

"You can make the choice to put all your energy into worrying about whether you're going to make the deadline and what will happen if you don't," he says. "Or you can take two minutes to relax, tell yourself that you'll get the job done, and then put out all your energy into doing the work."

If you use a lot of energy becoming stressed about everyday occurrences, you're not going to have enough energy left when you need it to deal with larger issues, like the break-up of a relationship or an illness in the family, Eliot says.

As Seery-Smith says: "There's no question there are a lot of things in our environment that can lead to stress. But the choice of how to respond is ours. We have a lot more control over stress than we realize."

Stress and the 21st Century Woman

While in today's modern society men and women are equally likely to be exposed to stress and stressful life events, stress may affect their health in different ways. Women are more likely to develop stress-related illnesses such as depression whereas men are more likely to develop cardiac disease.

"Depression is two times more common in women than it is in men," said Dr. Diana Koszycki, Research Director of the Stress and Anxiety Clinical Research Unit at the uOttawa Institute for Mental Health Research housed at Royal Ottawa Hospital. While stress is an important risk factor for depression in both men and women, their response to stress varies depending on the stressor. Men are more likely to become depressed after divorce or work or financial difficulties. Women are particularly sensitive to events in their social network and are more likely to become depressed if there are ongoing conflicts in relationships or when a loved one dies.

Stress does not directly cause people to develop stress-related mental disorders. Stress interacts in a very complex way with genetic, biological, psychological factors as well as early life experiences to increase a person's susceptibility to developing stress-related mental disorders. Certain psychological characteristics such as pessimistic thinking, low self-esteem, or use of ineffective coping strategies can influence how someone reacts to stress. Genetic factors also appear to play an important role. Recent research indicates that people with a short version of the serotonin transporter gene are at higher risk for depression following life stress than those with the long version. Early stressful life experiences can cause enduring changes in brain development and enhance responsiveness to stress in adulthood by programming the sensitivity of the brain's stress axis. Some researchers have suggested that women's increased susceptibility to depression following stressful life circumstances may be attributed to gender differences in brain-based responses to the effects of stress.

Dr. Koszycki, who has conducted ground-breaking research in the area of stress and anxiety, will be giving a public lecture on the impact stress has on women on Thursday, June 29 at the Royal Ottawa Hospital.

"Stress can be a good thing, it motivates us to accomplish things and avoiding stress may in fact mean we become less resilient to it," she said. "Stress is part of life and something we have to deal with from the moment we are born until we die. If we have dealt with stress in the past and learned the valuable lessons it teaches us, we will be better prepared to cope with it."

Dr. Koszycki added that people have different thresholds for stress and self-awareness and knowledge about how much stress a person can manage is key to successful stress management.

Stress affects both the mind and the body. Symptoms of stress include difficulty concentrating, problems with sleep, increased anxiety, depression, impatience and even heart attacks or strokes.

"We need to teach children how to deal with stress and if we are not coping well with stress, we need to examine our lives to determine whether changes need to be made," Dr. Koszycki said. "There is no magic pill. I encourage my patients to make changes in their lives, which could include lifestyle changes, changes in their thinking and changes to their environment, to help them better manage their stress."

Dr. Koszycki will discuss the signs of stress and the stress- depression connection and provide some concrete ways of managing stress including meditation, exercise and relaxation techniques.