Stress Management as a Path Toward Wholeness – Page 4

Clinical Practice

The Use of Holistic Health and Stress-Management Frameworks

As we have seen, dealing with the concept of distress and how it manifests itself in people’s lives is a very complicated picture. Not only is there a near-infinite number of possible stressors interacting with each other in complicated ways, but also there are an equal number of possible dysfunctional reactions to these stressors since besides the stereotypic stress response there are unique individual reactions as well. Clearly this situation calls for a holistic approach, and so stress management has become a large part of the clinical practice of holistic health. In its beginnings, holistic health was predominantly a model of wellness, and it continues to embrace the idea of helping people move in the direction of a very high level of wellness. Now the framework has also expanded to include treating the whole person when that person is ill. As we have seen, people are most often ill owing to stress- induced disease processes or accidents, so the holistic framework and stress management in its comprehensive sense are excellent mates.

There are certain aspects of human potential that can form a basis for a holistic philosophy of stress-management practice. The first aspect is that human beings move naturally toward a state of wellness of wholeness. When the clinical practitioner believes this about human beings, he or she can then see stressors as blocks that inhibit people from their natural movement toward wellness. In other words, the essence of the clinical work is to help remove the impediments, and there is no necessity to worry about what direction a client will move toward once he or she has mastered the unblocking process. Occasionally a client will give up one stressful situation and take up another as if to replace the first, but this is unusual. Even in instances, when the client is ready to let go of the replacement block or distress, he or she will move toward wellness rather toward illness. A second important aspect of human potential is that human beings have a virtually unlimited capacity for self-awareness. This is indeed fortunate because it provides a continuous avenue for detecting distress at earlier and earlier stages and in various, even subtle, forms, so that it can be deactivated and replaced with a relaxation response.

Self-awareness allows choices. Once we are aware of a stressful situation, we then must choose whether to handle it so that we experience distress, experience no harmful stress, or experience eustress.

A third quality of human potential is that human beings are capable of taking responsibility for their healing and their health status. This is an aspect of humanness which the medical model has often not honored. Instead, a condescending relationship with patients has been set up. In working with clients from a holistic stress-management philosophy, I have often spontaneously been called “coach” by several clients, and I was pleased at their recognition of the guiding rather than dictating position I have taken with them. From this position, clients are free to take the majority of the responsibility for their own state of health by learning as much as they wish about the functioning of their bodies and minds, about the effects of distress, and about how to cope with these effects. They are then able to feel a great deal of respect for themselves and their achievements and at having mastered their own destinies. The fourth aspect of human potential which is important in a holistic stress-management framework is that human beings have the ability to regulate the status of their own health. Research in the field of biofeedback has gathered convincing data on this aspect of human potential. These biofeedback research data are rapidly refuting the ideas of only a few years ago that there are many functions of our minds and bodies that we cannot control. It is now clear that we can learn to control an almost unlimited number of body functions. An exciting new area of research is that of consciousness research, which is investigating theories that are both ancient and new concerning the control we can demonstrate over our bodies and our minds by utilizing meditative and visual-imaging methods in directing our energy. Self-healing and the use of Therapeutic Touch with the intent to help or heal are examples of this ability to direct the mind’s energy. In these instances, persons can learn to accurately assess health problems and direct energy in such a way as to relieve these problems or even resolve them.

Applications of Holistic Health and Stress-Management Theories

In the following section, clinical work with three clients suffering from serious stress illnesses will be presented. Caution has been taken to change some of the identifying data so that these clients’ anonymity is preserved.

Anita

Anita, age 54, has been referred by her neurologist and has a history of 18 years of migraine headaches. She has had several complete neurologic workups over the years, including a brain scan, and no organic findings have been discovered. Both Anita and her doctor are concerned about the serious side-effects of the massive amounts of a very strong pain medication she has been taking.

A 2-hour assessment interview is scheduled with Anita, and during that session information is gathered in such a way that a holistic approach to her stress management can begin. A fairly detailed history is taken of her ability to cope with stressors from childhood to the present. The history reveals patterns of high sensitivity to stressors in which she has many times tried to be a buffer between people or has habitually repressed her own hostility during stressful situations. She has tried very hard to please her husband, her children, and the extended family, as well as her friends. This pattern of trying to please people has, in Anita’s case, been useful to her husband’s career as a United States Senator because Anita has been a very able crowd-pleaser at fund- raisers and campaign dinners, during speeches, and in general public-relations appearances. Anita has devoted herself to her family and to her husband’s career, but is now beginning a phase of distress because her two children are adolescents and discuss their plans for college in the near future. She is struggling with what role or roles she wants to play now that the most active period of motherhood is coming to an end, and she is finding herself becoming aware of feeling unfulfilled in her role as helper in her husband’s career. Anita is a perfectionist and obsesses about the details of her life-role decisions. She feels uncertain whether she will make the “right decisions so that everyone is happy.”

During the initial interview, Anita’s nutritional status is checked and she answers questions about food allergies. Questions about exercise are met with groans because Anita does not like to exercise but does have some awareness of her need to begin an exercise program. A biofeedback evaluation is done and familiar results are found. Her hand temperature while at rest is 76.4°F and drops during situational stress. Her muscle tension at rest measures higher than normal and increases significantly during situational stress. These data lead to the conclusion that her headaches are a combination of migraine and tension headaches. During the initial session Anita is started on a biofeedback hand-warming training program. This is done with many clients with various stress ailments because it elicits a general relaxation response. Hand-warming is a specific treatment for migraine headaches. First the client learns to warm his or her hands at will using the biofeedback instruments and then is able to do this anywhere at any time without use of the biofeedback equipment. The client is then helped to be more aware of the subtle onset signs of a headache, and when one of these signs is noticed, the client warms his or her hands very quickly into the 90°F range. In most instances, the headache is aborted at that point by a mechanism that is still not fully understood. Anita is given this information as well as some time to practice relaxation and hand- warming with the biofeedback instrument. She is also given the tape “Suggestions for General Relaxation” to take home with her and is instructed to practice with the tape between two to six times each day. A small thermometer is also sent home with Anita so that she can utilize a very simple but effective form of biofeedback in practicing her hand-warming methods.

During subsequent visits, Anita is taught how to use acupressure points to help relieve pain should she allow a headache to occur. She is also helped to pay more attention to a diet which was recommended to her by a nutritionist and which involves eliminating sugar and chocolate from her food intake and adding vitamin B and C supplements. For exercise, Anita is helped to decide to take a dance class so that exercising will not prove to be a boring, lonely endeavor. She is also referred to an excellent medical massage therapist for weekly massages with special attention to the upper back, neck, and scalp muscles. After the biofeedback, massage therapy, nutritional program, and exercise program are established, psychotherapy is begun with Anita to help her become more assertive, to help her let go of her perfectionism, and to help her deal in depth with her distress about her goals in life and the meaning of her life. Some sessions for couples’ therapy are initiated to help Anita and her husband sort out her new role in his career. Anita and her husband are able to redefine this new role in a satisfactory way. The redefinition includes sorting out which speaking engagements, public appearances, interviews, and other public contacts for her husband’s political campaign are minimally necessary for Anita to fill. Anita’s high motivation to be free of her headaches and to enjoy a finer quality of life is an asset to this holistic approach to her therapy, and she is able to complete her therapy in 8 months, becoming essentially headache-free. A 1-year follow-up report from Anita indicates that she has been able to follow her therapeutic regimen successfully and is feeling a high level of energy and wellness

Susan

Susan is referred by her physician for stress-management therapy after she sees a television program about biofeedback and its use with Raynaud’s disease. Susan suffers from Raynaud’s disease secondary to lupus erythematosus. She is aware that her hands become a dusky bluish-black color and her fingers are in significant pain when she is in specific stressful situations. She is a housewife and the mother of four adolescents, and she is already in psychotherapy to handle the depression and distress that have accompanied her battle with lupus. Susan is a highly motivated client because she is faced with the possibility of having to have one or more of her fingers amputated should the circulation in the fingers become poor enough to cause a gangrenous condition. She and her husband have decided not to move to a warmer climate because they feel at home in the metropolitan area in which they live, and so she is excited to learn of a method of handling her reaction to stressors in her life that would help her substitute hand-warming and a general relaxation response for her typical distress responses.

Susan is advised to take the stress-management and meditation course since she is already in psychotherapy. She does this and practices with the “Suggestions for General Relaxation” tape 6 times each day. A hand-warming thermometer is sent home with her so that she can get feedback on the actual temperature rise in her hands as she learns to relax and warm her fingers. Susan’s psychotherapist is amazed that Susan is willing to learn general relaxation along with the hand-warming because she has had difficulty convincing Susan to alter her schedule to allow relaxation time. Susan proves to be a real expert at warming her hands within a few days of practice and easily warms her hands into the 90°F range at will. She continues to work at developing a “warm hand consciousness,” that is, being aware at some level of her consciousness to keep her hands warm while she’s awake and to give herself strong suggestions before she goes to sleep that she will be able to maintain warmth in her hands during the night. Meanwhile, Susan’s diet and exercise were investigated. Susan is already very careful of her diet and takes appropriate vitamin and mineral supplements. She was taught exercises that would energize her, tone her muscles, and improve her circulation without causing her more pain and distress, and she is able to continue with this program. After she completed the stress- management and meditation course, Susan decided to be seen once every 3 or 4 months for office visits as a way to keep her motivation high and to check in for any new methods she might learn to relax and maintain warmth in her fingers.

Jack

Jack is 42 years old. He was referred for stress-management therapy by his friend after he suffered his first heart attack. Jack is a very hard-working lobbyist, and he has been working as much as 18 to 20 hours a day when Congress is in session. He has been working for the same lobbying group for 12 years and has been in an intense pattern of competing with his boss and getting annoyed with his staff if they are not as quick and hard-working as he is. Because Jack is accustomed to being a high achiever, he also applies this personality trait to achieving well in his stress- management therapy.

A biofeedback evaluation indicates that Jack has extremely high muscle tension; work with the electromyograph biofeedback instrument begins immediately. Jack is given the “Suggestions for General Relaxation” tape to practice with at home and at work. True to his nature, Jack decides to run the show at work and manages to get the entire staff to listen with him to the relaxation tape during their lunch break. The results delight him and he claims that people are getting along with much less friction than before and that even he and his boss are less competitive and negative toward each other. Jack has been in a pattern of ignoring his fatigue and the biofeedback helps him to be more aware of his body and its needs for rest. He is able, because of his fear of another heart attack, to pay more attention to his body’s signals for the need for relaxation, and he makes a significant change in his daily routine. Jack is also referred for massage therapy and finds these sessions extremely helpful to him for body relaxation and awareness as well as for learning more about how he can move his body in ways that will relieve muscle tension as it builds during the week. Jack is already seeing a nutritionist for guidance and is in a cardiac rehabilitation program for constant monitoring and guidance of his exercise. He is an avid reader and is given a bibliography on stress management. He reports that he has learned a great deal from his reading. We also explore his attitudes and beliefs about working hard and high achievement and find that Jack is able to let go of some of his more strenuous goals for his career in favor of living a longer and higher-quality life.

Summary

As we have seen in this chapter, dysfunctional reactions to stressors in our lives are perhaps the major cause for illness and accidents. A clear trend is developing in the health professions to pay more attention to dysfunctional attempts to handle stressors. Fortunately, there are some rather uncomplicated ways of deactivating a distress response and substituting a general relaxation response. Many of these methods of stress management can be learned quickly and practiced outside the health-care setting, with the health-care professional taking a teaching and consultation role more than a direct care role with clients. Direct care roles, however, remain very important and include delivering the services of biofeedback, psychotherapy, massage therapy, acupressure therapy, and Therapeutic Touch. More than delivering the services, what seems to be important in helping people learn to cope with life stressors is the context of the helping relationship. Incorporating Therapeutic Touch into the practice of stress-management therapy allows a new dimension of the helping relationship to emerge. Teaching clients how to use Therapeutic Touch with their family members and friends is also a way to enrich the quality of life and reduce the experience of distress.

The implications of this new interest in stress and its management for professional education and clinical practice in nursing are many. These include the need to learn in detail the psychophysiology of responses to stress and the thousands of ways stress reactions can manifest themselves in people’s lives. It is important to learn the major ways that have been shown to be helpful in managing stress as well as ways to help a person discover his or her own methods of managing stress. Being an expert in stress management is an important part of playing a successful professional role with clients. When one is able to deliberately evoke a relaxation response and experience a calming and healing silence in meditation, then one can be an expert teacher and consultant as well as a healer. No matter what specialty area of nursing is practiced, knowledge about stress and the ability to act as teacher and consultant to clients about their stress problems will be invaluable in the future.

References

Selye H: Stress Without Distress, p 14. New York, The New American Library, 1974
Selye H: The Stress of Life, 2nd ed, p 38. New York, McGraw-Hill, 1978
Brallier LW: The nurse as holistic health practitioner. Nurs Clin North Am 13, No. 4:643-655, 1976
Brallier LW: Holistic health practice-expanding the role of the psychiatric- mental health nurse. In Community Mental Health Nursing: an Ecological Perspective, pp 219-228. St Louis, CV Mosby, 1980