The New England Journal of Medicine, widely considered to be the foremost general medical journal in the United States, published a major article in January of 1998 detailing the multi-system damage that chronic stress can inflict on the human body. In addition to heart disease and immune-system dysfunction, the study cited memory loss, insulin resistance, and decreased bone-mineral density (osteoporosis, which leads to weakness of bone and increased likelihood of fractures).
High levels of cortisol can increase appetite and lead to obesity. Prolonged cortisol secretion can trigger increased insulin production. Insulin, a powerful appetite stimulant, also causes increased fat storage, particularly around the waist. In a study at Yale University, women who stored fat primarily in their abdomens were compared to women who stored fat mostly in their hips. The women with abdominal fat reported feeling more threatened by stressful tasks and having more stressful lives. They also produced significantly higher levels of cortisol than the other groups of women. Interestingly, fat cells deep in the waist area are very rich in stress hormone receptors, and a Harvard Medical School study found that abdominal fat was positively correlated with an increased risk of coronary heart disease.
Stress can suppress the reproductive system and impair fertility. The production of the male and female sex hormones, testosterone, estrogen, and progesterone, can be inhibited as well. Prolonged HPA axis activation also inhibits the secretion of growth hormone, essential for normal growth.
Numerous studies have linked stress—especially chronic stress—to depression and increased incidences of suicide attempts. These patients also have higher levels of CRH, the hypothalamic stress substance. Other medical and psychological conditions associated with elevated CRH include obsessive-compulsive disorder, anorexia nervosa, several types of anxiety syndromes, alcoholism, diabetes, thyroid disorders, and certain forms of insomnia.
Chapter Five
POST TRAUMATIC STRESS DISORDER
Posttraumatic stress is one particular subtype of stress, an especially powerful and disruptive one that seems to be increasingly common in our violent world. So many of us have been exposed to overwhelming stressors that seem to be out of our control. These traumatic events can be sudden and massive, such as the September 11, 2001, terrorist attacks; or chronically invasive, such as sexual or physical abuse. They can be caused by humans (violence and war); by accidents (fires, airplane or automobile crashes); or by nature (hurricanes, earthquakes, tornadoes). It is our reactions to these events that cause us so much pain and misery, and which tend to be physically and psychologically similar.
Shock, anxiety, guilt, chronic irritability, and depression frequently occur as a result of posttraumatic stress disorder. A high incidence of substance abuse can also result, along with insomnia, nightmares, an exaggerated startle response, and a myriad of psychosomatic disorders. Impairment of concentration; flashbacks; feelings of confusion and despair; low self-esteem; fear of losing control; and the persistent, intrusive fear that the traumatic event or events will recur are also common. Finally, posttraumatic reactions have a significant association with certain psychiatric disorders.
Researchers estimate that 40 to 60 percent of women treated for serious eating disorders such as anorexia and bulimia have memories of traumas in their pasts. In one research study, among crime victims with posttraumatic stress, 41 percent experienced sexual dysfunction, 82 percent had depression, 27 percent manifested obsessive-compulsive symptoms, and 18 percent suffered from phobias.
About 25 to 30 percent of individuals witnessing or experiencing a traumatic event will exhibit significant symptoms of posttraumatic stress disorder. Without treatment, 50 percent of these people will suffer for decades from these symptoms. Time, by itself, is not the perfect healer.
The statistics regarding stress-related events and costs are truly alarming. A 1996 Prevention magazine survey found that 75 percent of Americans experience “great stress” at least once weekly, and 33 percent report feeling this way more than twice a week. A consensus of research surveys estimates that 75 to 90 percent of all visits to primary-care physicians are for stress-related problems. One million employees are absent on an average workday due to stress-related symptoms. Seventy-eight percent of Americans describe their jobs as being stressful, and stress costs American industries approximately $300 billion annually. Sixty to eighty percent of accidents on the job are related to stress, and violent workplace incidents are frequently caused by this condition. Data from Canada and the United Kingdom indicate very similar statistics. Stress, obviously, knows no boundaries.
Because most physicians do not have the time or resources to help discover and eliminate the sources of the stress, they often prescribe medication—often multiple medications—to treat their patients. All drugs have side effects, potentially worsening problems rather than alleviating them. Many medicines used for treating stress and anxiety are addicting, further exacerbating the condition. It seems as if we are constantly shuttling between the frying pan and the fire.
For many years, physicians have been prescribing anxiolytic drugs, especially the benzodiazepines (Valium, Librium, Xanax, Tranxene, Dalmane, Serax, Ativan, and so on) for symptoms of anxiety or insomnia. These medicines, differentiated primarily by how long they linger in the body, frequently produce side effects such as drowsiness, decreased energy, dry mouth, constipation, impairment of coordination, and mental confusion. They are also habit-forming, and withdrawal from these medicines must be carefully monitored. Usually they are tapered off very gradually to prevent an abstinence syndrome.
Antidepressant medicines have been widely utilized to treat various types of depression. At first, the tricyclic antidepressants (Elavil, Tofranil, Sinequan, Pamelor, Norpramin, and so on) were the most commonly used. Because of the high incidence of side effects, however, these antidepressants have been supplanted by a newer generation of mood-elevating medicines that work primarily on the serotonin system. These antidepressants (such as Prozac, Paxil, Celexa, Effexor, and Zoloft) have fewer side effects, yet enough to cause significant discomfort or noncompliance nevertheless.
Medications to treat symptoms of anxiety and depression can be a valuable adjunctive treatment, but all medicines cause side effects that must be monitored. In general, the use of medicines without concomitant training in relaxation techniques, and without the insight and understanding that therapy or meditation can provide, will not yield the greatest effectiveness.
Traditional treatments such as individual or group psychotherapy have always been useful in alleviating symptoms of stress. Obviously these techniques require the participation of a well-trained therapist. In addition to the understanding that therapy provides, learning effective communication skills will transfer to other interpersonal encounters and will promote more effective, supportive interactions. The feeling of social isolation diminishes, enhancing self-esteem and further facilitating the therapeutic process. Support groups provide similar advantages and healing opportunities.
I still prescribe medications, particularly antidepressants, for some of my patients because these drugs can elevate mood and improve concentration. However, I always combine their use with meditation, self-relaxation, and stress-reduction practices. This allows me to use the medicines in lower dosages and for a far shorter duration. I have noticed that patients do much better when combining stress reduction and medication than with drugs alone. They also feel more empowered and more in control, because they are learning techniques and approaches that will minimize future episodes, both in severity and duration.
Just about all of my patients use relaxation and stress-reduction exercises, such as those on the CD in this book.
If you are currently in therapy or using prescription drugs, do not alter your medication regimen or therapy schedule without discussing these matters with your physician or therapist.
Chapter Six
A FEW CLINICAL CASES
Considerable medical research has been conducted in
the field of psychoneuro-immunology—the mind/body connection—in particular, the effects of stress reduction on the immune system. For example, studies at the University of Miami have shown that maintaining an optimistic attitude is positively correlated with optimal adjustment and less distress during the period following breast cancer surgery. Relaxation training and other stress-management techniques employed over a ten-week period after the surgery resulted in improved psychological and biological functioning. These improvements lasted up to one year or longer after the ten-week trial period ended. The women who participated in the stress-reduction and relaxation protocol showed decreases in depression, “an increased sense of meaning in life, improved social relationships, and a general re-prioritizing of life matters.”
According to Dr. Michael Antoni, the director of the Center for Psycho-Oncology Research at the Sylvester Comprehensive Cancer Center at the University of Miami:
“In parallel with these psychological changes, we have observed that … participants show decreases in adrenal ‘stress’ hormones such as cortisol. These cortisol reductions were greatest in women who reported the largest psychological changes. … Reductions in cortisol may be important for women with breast cancer, as elevated cortisol levels are associated with decreases in several aspects of immune system functioning. This is relevant since immune surveillance of new cancer cells may protect against the development of metastatic disease.”
A patient of mine, a woman in her 40s who had breast cancer and a subsequent lumpectomy, could not tolerate chemotherapy because of overwhelming and disabling side effects. We practiced deep relaxation techniques and healing visualizations, and her threshold for pain and discomfort was altered by these practices. She learned to concentrate very deeply and learned how to shut out the discomfort of chemotherapy. Her oncologist was then able to raise her dosage into the therapeutic range, and her cancer went into remission.
Did the remission result from the chemotherapy, from the relaxation techniques and the healing visualization exercises, or from the combination? It really doesn’t matter. She improved dramatically, and remains well 14 years after the initial surgery.
Medical-research studies on cardiac disease have found that a combination of moderate exercise, proper diet, and the practice of stress-reduction techniques can actually reverse blockages in coronary artery disease. Interestingly, when diet and exercise regimens were followed, but a stress-reduction approach was not practiced, there was a diminution in the progression of the heart disease, but the coronary blockages were not reversed. When stress-reduction techniques were added, a real reversal of the cardiac damage occurred.
Studies such as these provide profound implications for the role of stress-reduction practices in the prevention and the reversal of serious medical illnesses. If reversal of illness can occur, then it is never too late to begin learning techniques to minimize and eliminate stress.
Twelve years ago, a prominent cardiologist referred one of his patients to me. The year before, the patient had suffered a severe heart attack. Ed was only 51 years old. Because the cardiac damage was extensive, the leisure activities he liked to engage in were mostly forbidden now. He loved to scuba dive, but his cardiologist prohibited him from diving because of underwater pressure gradients. Ed was an avid deep-sea boater and fisherman, but his cardiologist restricted this, too, concerned that Ed might be too far from a hospital in case the need for emergency treatment arose.
Ed was understandably anxious about another myocardial infarction because he barely had enough cardiac function to live. He tired quickly when walking. Previously a heavy smoker, he considered resuming his smoking habit to relieve his omnipresent anxiety. Ed was becoming more and more depressed, and he had a sense of impending doom. Small stressors were magnified, both at home and at work. He was short-tempered with his wife and his colleagues at work, and they were becoming more and more frustrated with him. The antianxiety medicines his doctors had prescribed were not really helping. His cardiac medications seemed only to stem the tide. He was not recuperating well at all. When I first saw him, Ed was a wreck.
We began therapy, scheduling weekly sessions in my office. I gave Ed a stress-reduction CD and asked him to use it daily at home. He began using the CD twice daily, rather quickly mastering the physical-relaxation component. Soon he even began light exercise on a stationary bicycle, pedaling as he listened to the CD. When he finished exercising, he’d listen again.
Within weeks, Ed’s exercise tolerance had noticeably increased. Within months, his cardiac disease had begun to reverse. His anxiety had virtually disappeared, and the urge to smoke had vanished. His relationships at home and at work dramatically improved.
Ed’s cardiologist was amazed at his progress and lifted the boating restrictions. He began to refer many of his patients to me, looking for similar miracles. But I knew that Ed’s progress was not a miracle. By practicing diligently, he had learned how to enter a deep level of relaxation, how to eliminate stress and anxiety, and how to allow the natural healing power of his body and mind to cure his illness.
Twelve years later, Ed remains in excellent health, without any recurrence of his previously progressive coronary artery disease. A significant portion of his heart muscle has regenerated. In addition, he has been able to achieve and maintain a sense of inner peace and calm in his everyday consciousness, even when he’s not meditating or practicing with the CD. His perspective about life—what is important and what is not—has changed for the better. He is much happier now.
Smoking cessation is another important area that benefits from the practice of stress-reduction techniques. It is not necessary to enumerate the harmful effects of primary and secondhand tobacco use. Lung cancer, emphysema, heart disease, and premature aging of the skin are only a few of the serious medical consequences of chronic smoking. In helping smokers kick the habit, the success rate of stress-reduction techniques is significant. Not only are people freed of their addictions, but the health benefits are enormous, both to the smoker and to those around them.
Chapter Seven
STRESS AND WORRY
There are innumerable sources of stress stemming from events that we cannot control. But we do have control over our reactions to these events. Unfortunately, we spend more time worrying than we do trying to gain understanding and perspective.
We have so many worries. We worry about money, yet we know that money is only a tool, a means to an end. What we really want is happiness, a bit of security in our lives, some modicum of joy. Happiness, security, and joy are inner states. They are free; money cannot purchase them. Worry is merely a habit—and a negative, unpleasant habit at that. Worry will not change anything, nor will it bring you those things that you really need and desire. And money will not bring you happiness. I have treated many extremely wealthy people in my psychotherapy practice, and many of them have been miserable and unhappy. Money is a neutral thing, neither good nor bad. What you do with money creates its value.
We worry about success and failure, yet we cannot really define these concepts. Is a poor person who is happy and who has wonderful, loving relationships a failure? Is a rich person who has terrible relationships and no love in his life a success? Our cultures have defined success and failure for us, and the definitions have been deficient. So what is the point in worrying about success?
We worry too much about what other people think of us—about their opinions, judgments, and criticisms. Yet their opinions are based on the same cultural values as those measuring money and defining success. Once again, we are worrying about nothing.
All other apprehensions fall into the same paradigm. Worrying cannot effect positive change or growth. It will not change the future. Planning for the future is useful, but worrying is not. This is a useless habit, a conditioned response we have acquired from our parents, our teachers, and our communities. Intellectually we all know this, but old habits are difficult to break. If we could only stop worrying so much, how much happier
we all would be! We would experience much less stress in our lives.
The irony is that, when observed from a more detached perspective, this type of stress is an illusion. It is not real. We create it ourselves. And we all know this.
Events or perceptions that have the capacity to induce stress reactions in us are subjective and relative. An occurrence that traumatizes you may not affect me at all, or vice versa. An event that caused you considerable stress last year may hardly register this year, because your attitude or perspective may have changed in that period of time. You may even enjoy the experience this time around or perceive it as an exciting challenge rather than a threat, trauma, or stressor. It is quite simply all in the eye of the beholder. Our free will determines our reaction to these events. Will we react with fear, or with confidence and optimism? The choice is ours to make: stress or confidence, fear or love, anxiety or inner peace.
I have been a guest on hundreds of television shows in many countries. Now, I rarely become anxious about appearing on even the most popular national programs, yet I still vividly remember the anxiety I felt before appearing on television the very first time. It was on a small local program that, on a good night, hardly anyone watched. My heart was palpitating. My voice, I am sure, was shaky. My hands trembled. What changed?
Well, the only difference was my understanding. On that night, I was concerned with how I looked; how I sounded; what people, especially my friends and family, would think; and how my colleagues would regard me. With time and experience, I have come to see my role as a teacher, not a performer. What I have to say is much more important than how I look. I try to present what I have learned and what my patients and workshop participants have taught me so the viewer can share in the knowledge. I am no longer concerned with what the host or my friends think, as long as I am really trying my best to teach and help others. As soon as I realized that this was my purpose, anxiety and stress melted away.
Eliminating Stress- Finding Inner Peace Page 2