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STRESS MANAGEMENT - SPECIAL REFERENCE TO EXECUTIVES AND ELDERLY
Hl Dhar
Director, Medical Research Centre, Bombay Hospital Trust, Mumbai 400 020.
Stress is a common denominator of all mental illness but mostly occurs as a non-specific response to prepare for appropriate coping with actual or anticipated threat. It is originated in hypothalamus. Any situation that upsets our normal and peaceful life can be stressful and the age between 40 and 50 is the critical period. Among others three most important signs of stress are absenteeism, accidents and alcoholism.
First step toward management should be counseling. Therapy if necessary should be aimed at terminating identifiable stressful stimuli. In severe cases short term administration of anxiolytics may be necessary. Regular relaxing exercises, meditation and yoga are helpful in preventing relapse. However, regular practice of meditation is the best technique for stress free life.
INTRODUCTION
Stress is an activator of a massive conditioned non-specific reaction to prepare for appropriate coping with an actual or anticipated threat.[1] Stress may be of two types : 1) Eustress (Eu means pleasant) is a stress of achievement, triumph and exhilaration. 2) Distress is a stress of disappointment, inadequacy, defeat and helplessness. If you do some thing as an obligation to others, it leads distress. Rapid and widespread introduction of new office technology has been accompanied by growing concern about the effects of the technology on the health and safety of the workers specially on video display technology (VDT) which in addition to other health problems may lead to visual impairment and stress.[2]
Stress is the "wear and tear" our bodies experience as we adjust to our continually changing environment; it has physical and emotional effects creating positive and negative feelings. As a positive influence, stress can compel us to action; it can result in a new awareness and exciting new perspective. As a negative influence, it can result in feelings of distrust, rejection, anger and depression, which in turn can lead to health problems such as headaches, stomach upset, rashes, insomnia, ulcers, high blood pressure, heart disease and stroke.[3]
Sources of stress
Hate causes stress whereas love eliminates it. Stress occurs when the body prepares itself over and over again for an activity such as combat or escape that really never takes place. Stress is originated in hypothalamus which controls the centre for fight and flight response. In response to perceived threat of any kind hypothalamus releases corticotropin releasing factor resulting in secretion of ACTH by pituitary which in turn releases corticoids from adrenal cortex and adrenaline and noradrenaline by adrenal medulla.
Reaction to stress
Any situation that upsets our normal and peaceful life can be stressful - too much change in too short a time exerts its toll on the body’s adaptive capabilities. Stress is part of living but all stress is not detrimental. In fact, much of the joy and punch in life produces stress. Stress producing changes seem to occur most frequently between the ages of 20 and 30. But the tenacity of stress may be greater as one ages and that tolerance (resistance) to stress decreases with age. The years between 40 and 50 may be the critical ones.
The three ‘As’ are the most obvious signs of stress - absenteeism, accidents and alcoholism - frequently exhibited by executives which lowers managerial efficiency and adversely affects corporate performance. Stress is not a killer but adds to the loss incurred by the company in terms of lowered efficiency and medical bills. Situations that upset our normal and peaceful life can be stressful but stress is avoidable. Most of us have adapted to it in such a way that we are no longer aware of its effects.
Coping with stress
Katz et al [4] reported "ego’s defenses are obviously able to buffer the individual from threat with great efficiency" and even to block expected biochemical reactions. So far no reliable test has been found that can measure defenses and that can predict what an individual will do under certain stressful circumstances.[5] However, responses are highly specific. Studies indicate that adequate methods of coping include humour, anticipation, rationalization and philosophing.[6]
MANAGEMENT
Evidence suggests that the impact of a stressful event, physical or social - psychological is modulated by the expectations, perception and the unique meaning given the stressor by the subject and that the reaction of any individual to stress is regulated by a sense of one’s own and vulnerability and perception of the capability to cope with, adjust to, or overcome the source of trouble.[7]
The first step in management is to identify the operative stressors. If they are purely environmental, a counseling approach may do more good than depth oriented psychotherapy. Therapy is best focussed on terminating, if possible, any identifiable stressful stimuli. Where it is essential to live with and adapt to a stressful environment, the person will need to desensitize to its effects and develop ways of modifying or eliminating its most harmful elements. In severe reactions psychotherapy may be necessary. Hypnosis and temporary administration of an anxiolytic medication may be helpful. The objective is to bring the patient back to realistic appraisal of the situation. If possible, one should avoid anxiolytics especially in addictive personalities. Should they have to be prescribed, their use must be terminated as rapidly as possible so that the patient does not become dependent on them.
A prime goal in dealing with chronic intermittent stress is evolving defenses aimed at a more constructive adaptation and if possible, the elimination of the sources of tension. Regular relaxing exercises, meditation or self hypnosis can help a person avoid resorting to tranquillizers, hypnotics, alcohol and smoking.[4,5]
Transcendental meditation (TM) has been shown to reduce anxiety and tension.[8] A statistical meta-analysis conducted at Stanford University of all available studies (146 independent outcomes) indicated that the effect of Maharishi’s Transcendental Meditation programme on reducing trait anxiety was much greater than that of all other meditation and relaxation techniques, including progressive muscle relaxation. Analysis showed that these positive results could not be attributed to subject expectation, experimenter bias or quality of research design.
Professionals in general and executives in particular are always under stress and strain due to increased mental exercise including decision making and management of large number of personnel involved, in addition to routine activities often spread over many hours. Recently workshops have been conducted on TM in Mumbai for business executives.[9] TM gives a person the ability to stay calm even when under a lot of pressure, as the mind relaxes from an excited to a relaxed state during TM.[10]
Recently, ‘Saral Meditation’[11] based on TM but without Mantra and aimed at self awareness has been shown to reduce tension[12] including blood pressure and heart rate in addition to significant increase in intelligence and performance.
Preventive Measures in Elderly
A question often asked relates to the value of prevention. There is a good deal of evidence that anticipating impending stress may be helpful in dealing with it when it comes. For instance retirement is a risk factor in coronary heart disease,[13] job related dissatisfactions are also a risk factor that may lead to a decision to leave one’s work as the lesser of two evils. Cultivating proper attitudes toward retirement may prove to be a saving grace. A conception of retirement as a worthy reward for years of dedicated work helps overcome the stressful conviction that it is a punishment for growing old. Where the individual faces an inevitable loss, behavioural practice sessions with role playing and encouraging the person to verbalize feelings may serve a valuable purpose. There is evidence that regular exercise and other measures including change in life style[10] to improve physical fitness help individuals cope better with a high proportion of life changes like divorce, death of a loved one and switching jobs.[14]
REMEDY
Meditation is the best technique for stress free life. Meditation is not a path of information but a path of transformation, not the path of knowing but the path of becoming. It is said five perversions (lust, anger, greed, attachment and ego) of mind create stress in the body like mental tension, migraine, high blood pressure, heart attack, diabetes, constipation, sleeplessness etc. Meditation develops virtues of chastity rather than lust, forgiveness rather than anger, detachment rather than attachment, generosity rather than greed, humility rather than ego. When the mind is detached from aforesaid five weaknesses, peace of mind automatically surfaces, balance of mind and state of well being are experienced resulting in life free from stress.
Yoga : Studies have shown that regular practice of integrated type of yoga[15] can not only prevent the development of various psychosomatic disorders but also improve a person’s resistance and ability to endure stressful situations more effectively.[16]
REFERENCES
1.Selye H. Stress and psychology. Am J Psychology 1956; 113 : 423.
2.Dinoff MJ, Happ A, Crane P. Visual fatigue and occupational stress in VDT Operators. Human Factors 1981; 23 : 4.
3.Stress management. Your infertility home on the net. IVF com, Atlanta, GA, USA. 2000.
4.Katz JL, Weiner H, Gallagher TF, Hellman L. Stress, distress and ego defenses. Arch Gen Psychiatry 1970; 23 : 131-42.
5.Stress and its management in the technique of psychotherapy (ed) Lewis R Wolberg, 4th ed, part 2. Grune and stratton. New York. 1998; (sec 59) : 1138-47.
6.Vaillant GE. Theoretical hierarchy of adaptive ego mechanisms. A 30 year follow up of 30 men selected for psychological health. Arch Gen Psychiatry 1971; 24 : 107.
7.An integrative review of some research on social psychological factors in stress. In Monat A, Lazarus RS (eds) : stress and coping. New York : Columbia University Press. 1977; 67-76.
8.Scientific research of Maharishi’s Transcendental Meditation and TM Sidhi program. A review. Maharishi International University, Fairfield. 1993; 16.
9.Meditation is like a mental bath for stressed out. The Times of India, 8th July 200.
10.Dhar HL, Joshi SV. Life style modifications in professionals - need of the hour. Medicine Millennium Update (ed) Amio sarma, Association of Physicians of India - Assam Chapter. 2000; 1-9.
11.Dhar HL. Saral Meditation. Bombay Hospital Journal 2000; 42 (4) : 605-7.
12.Shah A, Joshi SV, Mehrotra PP, Mahadik UD, Potdar Naina, Dhar HL. Saral meditation - effect on intelligence and performance. Ind J Med Sc 2001 (Press).
13.Gonzales ER. Retiring may predispose to fatal heart attack. JAMA 1980; 243 : 13-14.
14.Science News. August 2, 1980; 130.
15.Dhar HL. Meditation and health. Bombay Hosp J 1997; 39 (4) : 738-41.
16.Udupa KN. Disorders of stress and their management by yoga. Varanasi, Banaras University, India. 1978.
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