Methods of Managing Distress Reactions
As you have seen in the previous section on evaluating stressors and their effects on the individual, stressors converge from the past, from the present, and even from thoughts of the future, and are of physical and psychologic origins. Stressors also interact with each other, so that helping a client unravel various stressors in order to become clear about them and manage them in a way that allows both equanimity and growth can be very challenging to the stress-management professional. Certainly the stress syndrome is not something to be approached in a narrow, specialized manner. Following the model used in my clinical practice, this discussion of methods of managing stressors is from a holistic theoretical framework. Therefore, we will be looking at physical, psychologic, spiritual, and environmental methods of managing stress. For a more detailed description of the philosophy and conceptual framework of holistic health and stress management in nursing practice, the reader is referred to the articles “The Nurse as Holistic Health Practitioner” and “Holistic Health Practice-Expanding the Role of the Psychiatric-Mental Health Nurse.”‘3.4
The basic goals of stress management therapy are (1) to help the client learn to elicit the relaxation response and (2) to help the client learn to exchange chronic stressful patterns of thought and behavior for ones which bring about peaceful and satisfying coping. Fortunately, there are many physical methods of eliciting the relaxation response although individuals vary widely in their ability to utilize any given method for this purpose. For instance, some people find that active participation in running, swimming, tennis, or sexual encounters elicits deep relaxation, whereas others find that therapeutic massage, biofeedback, meditation, or even daydreaming are methods of choice to combat stress. Still others watch their diet very carefully so that their bodies are not stressed by foods to which they are allergic or by too much sugar, too many preservatives, or too much in the way of stimulants, such as caffeine, nicotine, alcohol, or other drugs. Therapeutic Touch is another method that is often very helpful in eliciting the relaxation response. In the case of stress management, it is wise to become an expert at many of these activities so that a wide range of choices is possible. Perhaps biofeedback is the best example of a deliberate attempt to counter the harmful side-effects of the stress response. Biofeedback provides a technological way to allow people to gain control over their own bodily functioning. For instance, an instrument measures muscle tension or the temperature of a finger and then feeds back this information about the body’s status to the client in visual and auditory forms; the client then relaxes and uses passive volition and visualization as ways of influencing his or her muscle tension and hand temperature. When a client can “hear” his or her muscle tension, he or she is then able to learn to control the degree of muscle relaxation he or she wishes to acquire. The same is true of hand temperature. Deliberately relaxing and redistributing blood flow into the peripheral parts of the body, such as the hands and feet, and relaxing muscles are ways to initiate a relaxation response. This involves, with mediation through the hypothalamus, the deactivation of the sympathetic nervous system and activation of the parasympathethic nervous system. The “fight or flight” syndrome, which was set off in the body by the reaction to a stressor, is now countered directly by the relaxation response. Biofeedback methods which help people thoroughly learn the relaxation response include instructions in various ways of breathing so that the body is well- oxygenated and the muscles of respiration are relaxed; various forms of autosuggestion so that constant messages are given to the self to relax, be calm, be comfortable; and the use of visualization or visual imagery. Imagery, that is, seeing a picture in the mind’s eye, appears to be a powerful method of directing the body with the mind. Throughout history, many theories and schools of self-healing have also taught visual imagery methods. Biofeedback readings often change significantly when a person is able to construct a clear visual image of himself or herself in a relaxed environment (such as at the seashore with the waves lapping rhythmically and the warm sun shining its relaxing and energizing rays on the muscles of the body). Imagery can also be symbolic. For instance, biofeedback readings will also change in a positive direction if clients are able to construct clear symbolic representations of relaxation, such as seeing a piece of spaghetti as very loose and flexible or a feather floating in the air as representations of their muscles relaxing or the whole body feeling relaxed and light. Home practice of biofeedback methods of eliciting the relaxation response include listening to relaxation tapes and practicing various forms of meditation.
Biofeedback and meditation, as well as psychotherapy, are excellent methods of aiding people who are in psychologic distress. Physical insult to the body may elicit the General Adaptation Syndrome, but, most often, stressors in our current culture are of a psychologic nature and can lead to very serious stress reactions and disease processes. Psychologic states such as anxiety states, depression and chronic frustration, fear, resentment, anger, and worry can all lead to a dysfunctional adaptive response which, in turn, leads to physical illness. Poor self-esteem is another cause of being vulnerable to maladaptive stress responses in a chronic way. Failure to grieve losses properly is another cause of chronic distress and physical ailments. Utilizing biofeedback and meditation as ways of training the mind and body to elicit the relaxation response at will often helps a person be able to think more clearly about his or her psychologic reactions to stressors. These reactions most often are due to traumatic experiences during one’s lifetime which were not resolved and are continually activated by new similar situations. Mind and body then become habituated to reacting in a stressful manner before the event or person being reacted to can be seen with uncluttered vision.
A comprehensive way of practicing psychotherapy with people in psychologic distress is to pay attention to both the cognitive and emotional components of the stress reaction. It is important for a client to look at his or her cognitive processes or the way he or she thinks about problematic situations. Often chronic negative attitudes and beliefs are found which are held more out of habit than reason. When these are corrected and replaced by positive attitudes and beliefs, the number and intensity of stress reactions decrease significantly. Attitudes toward one’s self are extremely important in managing stress well. Keeping one’s expectations of one’s self and others at a reasonable level is important, as is the ability to be flexible and objective about one’s self in certain instances. Being clear on what one wants at any given time and being able to take assertive action toward getting what one wants are important skills to have so that one does not unwittingly assume a victim role or a role that is so passive as to lead to constant disappointment and consequent distress.
Emotionally speaking, it is important to be able to let go of negative emotions in some way rather than harboring these and causing one’s self distress. For example, one may help a client let go of chronically dysfunctional emotional reactions by enabling the client to release the old emotions through crying, screaming, or even laughter. The ability to interact emotionally with other people, with genuine love and good will and without an inordinate amount of emotional dependence, is also very important. A fine sense of humor is often a good tool in handling emotional stressors, and it is also an indicator that a person is distress-free enough to see the humorous or positive side of life situations. The spiritual aspects of managing stress are very important and often neglected. Spiritual refers to our ability to rise beyond psychologic maturity into a realm of sensing that allows us to connect with a strongly positive force. This force or energy helps us make contact with and more fully develop our courage, our ability to genuinely love, our wisdom, and our compassion. This transcendental experience has been known by many names throughout history. Perhaps the most common contemporary term for the part of one’s self that is involved and being developed by this experience is the “higher self.” Often people who have spent much of their lives in a chronically distressed state find that they have developed a fairly unconscious philosophy of life that either includes debilitating spiritual values or spiritual values that they have outgrown. Others who have suffered chronic disease may have never clearly formulated any spiritual values and may never have been clearly in touch with that part of themselves. These are the clients who report a sense of purposelessness in life, a sense of having no goals; and a sense of life being an “empty stage” or even a “bad joke.” It is interesting that the process of being still and focusing one’s mind in meditation is so often of great help to people who are out of touch with their own spiritual side. It seems that the silence and focusing of meditation allow not only the mind and body to experience the relaxation response, but also allow the person to go “deeper” into himself or herself to gather senses, ideas, and feelings in a new way for what his or her life is about. Since we all react from a stance or a philosophical position about life whether or not we have consciously formulated this, being clear about one’s life philosophy and spiritual beliefs can often add a sturdiness or a reserve energy to one’s mental and emotional states. This reserve energy provides more stamina and less vulnerability to intense or prolonged stressors.
In our contemporary society, each decade has led to a greater concern about the stress factors in our environment. Pollution, chemicals used for processing foods, noise, overcrowding, economic problems, and many other important conditions make our active and bountiful culture also a place of very high distress. Usually it is people who compose the most impactful parts of our environment, and therefore social stresses are included in this section of discussion. Most people who are distressed complain that either family or work situations are sources of great upheaval for them. In these instances, it is very important to throughly review with the client details of the social environment which is distressing. Often the discovery is made that clients are playing dysfunctional roles in these situations or are reacting habitually in a distressful way because they are unable to see how to change their part in some of the patterned interactions. Typically, either at home or at work, stressful situations develop around issues of power and influence, over issues of emotional closeness and distance, and over the distribution of work among the people involved. There can also be severe value system conflicts among people who have more than a healthy amount of negative attitudes about themselves and others and so tend to be defensive. Helping clients take responsibility for themselves and let go of trying to change others in the environment is often a step forward in stress reduction. Deciding whether or not to stay in each of these environments is also a helpful decision-making process. Other aspects of the physical environment are perhaps more easily dealt with. For instance, the home and office may be assessed to see that the living space is actually comfortable and enhances relaxation. Perhaps more space is needed, or more calming colors are needed within that space. Perhaps more comfortable furniture, a reduction in noise, or an increase in ways to provide more physical safety would be significantly helpful. Sunlight, temperature, and ventilation are also important factors in encouraging the maintenance of a relaxation response rather than a stress response.
An Educational Model of Stress Management
Some years ago in my independent practice as a psychotherapist and biofeedback therapist, I noticed that I was repeatedly teaching clients stress-management skills. Attuned to the holistic health concepts of self- responsibility and learning self-help health skills for both self-treatment and preventive purposes, I decided that many of the basic stress- management skills I was teaching to clients individually could be taught in a short course to a small group. I opened this to the community in general, hoping to attract people who were essentially well and who wanted to learn stress-management skills to stay well. What I have found is a potpourri of people who range from those interested in prevention to those who are in a terminal phase of cancer and who want to learn to manage the tremendous amount of distress and pain which often accompanies that life situation.
The course I am describing is called “Stress Management and Meditation.” It is a 4-session course of 2-hour meetings and is designed to integrate cognitive and experiential material. One of the major tools to help students learn to elicit the relaxation response is a cassette tape I recorded, called “Suggestions for General Relaxation.” Each student is given a copy of this cassette and is instructed to listen to it several times each day as homework practice between classes. This tape is similar to many relaxation tapes that I had recorded for people in biofeedback therapy. It is designed to help people learn to relax while staying alert. In the course, many forms of relaxation and meditation are taught so that people are given a choice as to which forms of activity or focusing of the mind are most likely to elicit the relaxation response for them. Biofeedback readings are taken at the beginning of the first class and again at the end of the course so that students can actually see their progress in terms of a decrease in muscle tension and an increased ability to raise the skin temperature of the hands. Attitudes and belief systems are discussed, as well as philosophical and spiritual issues as they relate to stress management. Other educational approaches to teaching stress-management methods have been workshops, lectures, and individual and group stress evaluations and referrals. In each of these formats, the goal of helping people learn as many ways as possible to deactivate the stress response, which involves the sympathetic nervous system, and activate the relaxation response, which involves the parasympathetic nervous system, is kept as a primary task.