Learning to Identify Causes of Stress

Life is full of minor stresses. Your son spills a glass of milk. Your daughter can’t find her shoes. The dog throws up on the carpet. The mailman delivers another bill. Your husband announces he can’t make it home to coach the soccer team. The car won’t start. You’re going to be late. You already have a headache – and you haven’t even left for work!

Juggling the demands of home, family and career is a constant challenge. No wonder people feel stressed. What most of us fail to realize is that we are in control of our lives. By taking charge of our lives, we can manage stress  and create a better balance between family, work and fun. But it may take a little digging to determine the true source of your stress. Sometimes the real source of stress hides in our thoughts, feelings or behaviors. For example, the stress you feel about meeting job deadlines may have more to do with your procrastination than actual work volume.

Before you can successfully decrease stress, you have to accept responsibility for your part in creating it. Keeping a stress journal can help you and your psychiatrist identify stressors and discover patterns in your response to stress. It’s the first step to learning how to effectively manage stress.

• Every day note stressful situations or episodes and their cause.
• Write down how the incident made you feel physically and emotionally.
• Note  how your response. 
• Record anything you did that made you feel better. 

Periodically review your stress journal for patterns that indicate coping strategies, including smoking or drinking, over- or under-eating, spending hours on the computer or watching TV, withdrawing, using pills or drugs to relax, sleeping too much, procrastinating, over-scheduling to avoid dealing with problems, or taking your stress out on others.

Once you and your psychiatrist identify your stress triggers and responses, you can work to either change the situation by avoiding or altering the stressor or change your reaction to it by adapting to or accepting the stressor. Try to determine and employ the stress control strategy that makes you feel calmest and most in control.

Next time: Stress management strategies you can use

Risk Factors for Mental Health Problems

This week we’ve been talking about the activities and behaviors that make for good mental health (see our July 13 and 15, 2009 posts). Throughout our lives, many forces shape our emotional well-being, both internal and external. Particular events in our lives, genetic and biological factors, and childhood experiences impact our ability to develop and maintain good mental health. And sometimes life throws us a curve ball and a combination of stressful events can overburden our ability to cope emotionally, triggering anxiety, depression or other mental health conditions.

Researchers have found specific risk factors that can impact mental health. Some, like unaddressed childhood issues, slowly chip away at our ability to cope with life’s problems, creating difficulties years after the actual events took place. Others, like the death of a parent, child or spouse, overwhelm our defenses by the sheer enormity of the event and its impact on our life. Being aware of the following potential risk factors can help us maintain good mental health:

• Lack of connection to a primary caretaker during childhood can have lifelong repercussions. Feelings of loneliness, isolation, confusion, lack of safety or abuse felt as a child can negatively color our behavior into adulthood.
• Serious trauma, death of a parent, war, hospitalization, tragic accidents and other devastating events, particularly during early childhood, can have a  traumatic effect on emotional development.
• Learned helplessness can undermine our faith in our ability to cope with life’s problems. Negative experiences or comments can undermine our confidence in our ability to exert control over our life.
• Chronic or disabling illness can isolate you from other people, denying you the necessary social support of friends and family.
• Medication side effects can affect mental health, particularly in the elderly who generally take multiple medications, creating the potential for problematic drug interactions.
• Alcohol and drug abuse can both cause and exacerbate preexisting mental health problems. Substance abuse can serve as a trigger for latent emotional conditions.

The risk factors that negatively impact our mental health can be counteracted by supportive relationships, a healthy lifestyle, stress management techniques and emotional coping strategies. You may need professional psychiatric help to regain good mental health, but you can improve your psychological well-being. If efforts to improve your mental health have been unsuccessful, it’s time to see a professional psychiatrist and get the help you need.

Learning to Control Anger

Anger is one of our most basic survival instincts. We use anger to protect ourselves from threat and defend ourselves against attack. But losing control of our anger can be physically and psychologically destructive. There are three basic ways people deal with anger:

• Expressing angry feelings assertively but without aggression is the healthiest way to deal with anger. Passion is fine, but not force. Expressing our needs is crucial to our well-being at any time, but particularly when we’re angry. We become angry when we perceive that our needs are not being met in some way. The ability to clearly tell others what we need and how we are feeling is the first step toward getting our needs met. The process helps dissipate and resolve anger as we compromise with others and develop a plan to meet our needs. However, it’s important to be respectful of the needs and boundaries of others.
• Suppressing anger can take two forms.  The most direct form of suppression is when we deny ourselves a way to express and thereby release our anger. When anger is internalized, it can fester and grow, becoming destructive. Redirection is another way of suppressing anger. Rather than confront the source of our anger directly, we channel angry energy into a more constructive activity, such as brisk walking, jogging, sports, house cleaning, gardening, etc. While not addressing the source of our anger or resolving it, redirection provides a non-confrontational release for angry feelings. However, without expression and resolution, anger will return and can become pathological. Suppressed anger can lead to chronic high blood pressure, anxiety, depression, passive-aggressive behavior or a hostile attitude.
• Calming techniques help us calm down and allow our anger to subside. Self-help techniques like meditation, deep breathing, guided imagery and muscle relaxation can be used to help us regain control of our physical and emotional responses to anger, allowing us to let go of anger.

People who are unable to express their anger or unable to  develop effective methods of resolving anger or whose inability to control their anger is affecting their personal relationships may need help learning to control and manage their anger from a board-certified psychiatrist trained in cognitive-behavioral therapy.

Road Rage: Losing Control of Anger

The orange cones are out and the length of your morning commute just doubled. It’s summer in America when construction crews seem to shut down miles of highway to work on one tiny 10-foot section at a time. Slowly snaking traffic plays havoc with your schedule, creating stress and anxiety. You worry about being late for work or an appointment or picking up the kids from daycare; but you can’t make the traffic move any faster, which creates more stress. Then there are the annoying drivers who try to whiz past you on the berm, and those infuriating idiots who streak by in the ever-narrowing left lane to dart into line ahead of you. When traffic snarls, it’s not long before frustrated drivers start snarling too!

We call it road rage and make jokes about it, but mixing anger with highway traffic isn’t funny; it’s a dangerous combination and not just because it so often leads to traffic accidents. Anger makes your heart rate and blood pressure go up. Anger also increases the levels of your “energy” hormones, adrenalin and noradrenalin. While completely normal and entirely human, when anger gets out of hand it can be physically and psychologically destructive.

Aggression is the body’s instinctive response to anger. It’s an ingrained survival instinct that protects us from threat and allows us to defend ourselves, our family and our home — our car — from attack. Anger is a basic survival skill that ensured our ancestors could escape wild beasts and protect themselves from marauding tribes. In today’s world where the predators are less physical and more complex, raw anger can be more of a hindrance than a help in navigating life.

Some people are quicker to anger than others and some lose control of their anger more easily than others. Researchers believe genetics may be a factor, but they are also looking for a physiological trigger, most likely a portion of the brain that governs anger or a chemical imbalance in the brain that causes some people to act more violently than others. The laws and customs of modern society limit the rein we can give our anger, but events, people and orange cones on a crowded summer highway can send anger spinning out of control if we’re not careful. Today, learning to control anger has become a necessary survival skill.

Next time: Learning to Control Anger

College Graduation: Living without a Net!

Taking those first steps into the “real world” can be an anxious time for college graduates. The thrill of achievement can be overwhelmed by new responsibilities as collegiates take their first fledging steps into adulthood. Finding a job, renting an apartment, managing finances, moving away from friends and family — college graduation is a time of many life-changing events. While many collegiates will have already shouldered some of these adult responsibilities, most have done so with a parental safety net in place to protect them from the inevitable misstep. Now that they’ve graduated, they’re living without a net for the first time.

Stepping out into the real world and taking on adult responsibilities is exciting, but it can also be a little scary and intimidating. The uncertain economy and high unemployment rate only add to the normal anxiety that surround the monumental changes that follow college graduation.

“Change can be frightening, but it is important to remember that it happens to everyone all the time,” psychologist Dr. David Palmiter said in an article on the American Psychological Association’s online Help Center. “Know that the new experiences and challenges you face will help you grow and discover your own path.”

The APA offers several tips for coping with post-graduation anxiety:

• Act. Taking action is empowering. Set goals, determine the steps necessary to achieve them, and get started!
• Attitude. Stay positive. Focus on what you can do and what you have to offer. Banish negative thinking.
• Resilience. Life has its ups and downs. Strive to turn negative experiences into opportunities to learn and improve.
• Connect. Stay connected to friends, family and professors. Turn to your support system when you need help or guidance.
• Discover. Take advantage of new opportunities, new friendships and new experiences to expand your horizons and discover all that you are and can be.

If the strain of moving out on your own starts to interfere with your ability to perform daily tasks or you find it hard to face your responsibilities, don’t be afraid to ask for help from a licensed psychiatrist. Cognitive-behavioral therapy can help you develop positive strategies to tackle the responsibilities of adulthood and move forward with your life.

Can Insomnia Be Inherited?

A new study presented at Sleep 2009, the 23rd Annual Meeting of the Associated Professional Sleep Studies, suggests that insomnia may be inheritable. The study of 1,436 eight- to 16-year-old twins found that the same genes that impact depression and anxiety affect adolescent insomnia. Study results are consistent with the results of similar studies connecting insomnia to depression and anxiety in adults. Shared genetic effects suggest a probable genetic link between the three disorders.

According to an online article posted on the Science Blog, lead author Phillip Gehrman, assistant professor of psychiatry at the University of Pennsylvania School of Medicine, said researchers had expected to find a sleep-specific genetic indicator and were surprised to instead find a shared indicator with depression and anxiety. A number of previous studies have indicated a causal connection between insomnia and depression/anxiety. Chronic insomnia can lead to the development of depression or anxiety, and depression or anxiety can cause insomnia. The discovery that the same genetic effect links all three conditions sheds new light on their interconnectedness.

Periodic sleeplessness is normal, generally lasting only a few days and going away on its own without treatment. However, more intense levels of insomnia lasting several weeks can be triggered by stress. Such chronic insomnia will not go away without treatment and can cause serious short- and long-term health problems when left untreated. If you or your child exhibit chronic insomnia — sleep problems that last for more than a week — you should be screened for depression and anxiety. Likewise, those diagnosed with depression or anxiety may also need to be treated for insomnia. 

In another study reported at Sleep 2009, cognitive behavioral therapy was shown to help alleviate chronic insomnia. By learning to identify thoughts and patterns that interfered with sleep, nearly 60% of study participants aged 14 to 81 were able to alleviate insomnia and decrease or stop using sleep medication. Even when depression and anxiety exacerbate insomnia, researchers found cognitive behavioral therapy to be an effective method of treating chronic insomnia. To find out more about cognitive behavioral therapy, visit the Marks Psychiatry website.

Combating Dangerous Pattern Perceptions

Perceiving patterns where none exist, a psychological phenomenon called pattern perception, is a mental coping mechanism used by many people to combat uncertainty when events spin their lives out of control (see our June 10 post). It’s a phenomenon that’s on the rise in these times of economic uncertainty where rising unemployment, catastrophic investment losses, mortgage foreclosures, and a host of other worrisome factors have shattered people’s faith in their ability to control their future.

That loss of control generates an extreme anxiety that can impel people to create and act on connections and associations between innocuous, unrelated events, according to research published in the journal Science. In a series of experiments conducted by Jennifer Whitson of the University of Texas-Austin McCombs School of Business and Adam Galinsky of Northwestern University’s Kellogg School of Management, researchers found that people can trick themselves into seeing nefarious conspiracies behind government pronouncements or business announcements.

Structure and order have a calming effect on our psyches while chaos generates anxiety that can lead to panic or depression. The desire for order can become so overwhelming that people fantasize connections between events to bring order to a world that they feel has become dangerously chaotic.

“Feelings of control are so important to people that a lack of control is inherently threatening,” Galinsky explained. “While some misperceptions can be bad or lead one astray, they’re extremely common and most likely satisfy a deep and enduring psychological need.”

The danger comes when people believe in or act on the imaginary patterns they have created. Illusory stock market trends can lead to poor investment decisions and increased financial anxiety. Imagined conspiracies between co-workers can increase job stress to intolerable levels. Delusional thinking can cause marital stress and jeopardize personal relationships. Fantasized government agendas can lead to paranoia and panic.

Exerting phantom control over chaotic events in our lives through pattern perception can hide a very real need for psychiatric help in coping with anxiety, panic disorders or depression. The combination of cognitive-behavioral therapy and psychodynamic therapy practiced by Atlanta psychiatrist Dr. Tracey Marks is effective in helping people find healthy ways to cope with and mitigate the uncertainties that pervade life today without resorting to harmful pattern perception.

Is Uncertainty Making Us More Superstitious?

The need to feel that we are in control of our lives is so basic to our sense of well being that many people may be finding safe harbor from uncertainty in superstitious thinking. When any aspect of our life spins out of control, as it has for many during these uncertain economic times, our need for control and order is so compelling that we will trick ourselves into finding patterns where none exist to stave off a growing sense of unease and anxiety. We may see trends in stock market activity or find unintended meanings in business meetings or impose hidden agendas on government announcements — all in an attempt to bring order to chaos. 

Human “desire to combat uncertainty and maintain control through structure can sometimes be so all consuming that people trick themselves into seeing and believing things that simply do not exist,” explains David Butcher of ThomasNet Industrial Market Trends in an online article about compelling new research published in the journal Science.

In a series of experiments conducted by Jennifer Whitson, assistant professor at the McCombs School of Business at the University of Texas-Austin and Adam Galinsky, Morris and Alice Kaplan Professor of Ethics and Decision in Management at the Kellogg School of Management at Northwestern University, lack of control caused study participants to “see images in noise, form illusory correlations in stock market information and even perceive conspiracies and develop superstitions,” Butcher noted.

“The less control people have over their lives, the more likely they are to try and regain control through mental gymnastics,” Galinsky said. In one experiment, people were shown pages of random dots, half formed images, half did not. Nearly half of study participants found discernible shapes in the dots without images. Finding patterns even when there were none had a calming effect on study participants and made them feel more in control.

Researchers applied the same principle to stock market investment. Study participants were given an equal ratio of positive to negative information about two companies. Those told that the market was volatile placed more weight on negative comments, determining investment to be riskier than it actually was. In another experiment, participants who lacked control were quick to find conspiracies lurking behind ordinary events. For example, in a story of a worker passed over for promotion, participants blamed co-worker sabotage.

On Friday: Conclusions

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