Mood, disposition and disorder

In a previous post I referred to suicide as a “mood-specific” behavior, and I feel the need to clarify this statement. I wrote that nobody suicides when they’re in a happy mood, suggesting that if people in a depressed mood can “ride out” the mood without doing something lethal, the urge to end their lives will pass when their mood changes. Moods are transient emotional states that can be prolonged by irrational thinking and by ruminating.

Thoughts such as “My life is my problem; the only way to solve my problem is to end my life” can seem logical to a person in a depressed mood. When the mood passes, the person will likely recognize the thought as irrational – or at least as one that doesn’t have to be acted on immediately. Suicide hotlines have prevented many impulsive (mood specific) suicides by helping people to not act on suicidal impulses and to ride out the depressed mood – or to sober up. This principle doesn’t apply to suicidal people who experience chronic depression.

While moods aren’t enduring emotional states, dispositions are. We each have a unique disposition or set of dispositions. For instance, we’re each disposed to be somewhere on the continuum between optimism and pessimism – glass half full vs. glass half empty. I don’t know whether one’s disposition is a result of nature or nurture, or some combination of the two. Other adjectives I’ve heard used to describe disposition include gloomy, chipper, pushy, cranky, generous, stingy, passive and aggressive. They are a component of our personality. As a psychological construct, disposition has so many variables that it’s hard to precisely define or to measure, so these are just my opinions. Dispositions tend to be enduring traits, but that’s not to say that they can’t change over the course of one’s life. For instance, I think that people who’ve tended to be distrustful of others can learn to be more trusting, given enough positive experiences with trustworthy people.

When anxiety and depression are chronic emotional states that seriously affect our functioning, they’re diagnosable as psychiatric disorders. There’s considerable scientific evidence that there’s a biological basis for such disorders, although irrational thinking patterns can exacerbate them. The key to distinguishing  pathological states of anxiety and depression is impairment. Even during the saddest times in my life, my sleep and appetite weren’t seriously affected, and I was able to function adequately. I cried but didn’t have crying spells, and have never come close to attempting suicide. (I’m  not taking credit for this; I consider myself very fortunate.) During my year-long employment in an extremely stressful job, I suffered sleep loss; but my sleep improved immediately after I quit the job.

People who suffer from chronic anxiety and depression often get blamed for their symptoms, because they’re not understood as the symptoms of a chronic mental disorder. Because of the widespread stigma attached to mental illness, many people don’t feel the empathy they might feel for someone with a debilitating physical disorder. And people who suffer from these mental illnesses often blame themselves, telling themselves they “should be” able to control their symptoms. Others self-medicate with alcohol and other drugs that might give them short-term symptom relief, but only add drug dependency to their list of problems.

It’s hard enough to have a mental illness and to have to deal with societal stigma; but in addition, mentally ill persons are increasingly neglected in this country. The mental health system is shamefully under-funded, which explains why so many people with mental illnesses are homeless, why hospital Emergency Departments all over the country are swamped with people who are experiencing a psychiatric crisis, and why jails and prisons have become major providers of mental health services.

Everybody experiences anxiety and depression, and most of us learn how to cope with these transient conditions, because they’re not overwhelming or disabling. But some people with chronic anxiety and/or depression can’t cope without help from social support systems, whether in the form of professional services or community resources – family and otherwise – that recognize mental illnesses as treatable conditions, and provide needed help.

I’m taking a break for a couple of weeks, but will be back with a new post in early June. In the meantime, you can access other things I’ve written at my website: jeffkoob.com. It features links to my books, samples of my artwork, and a short story, “Demon Radio.”

It’s only Monday if you think it is

This post is one of my occasional philosophical departures from my usual subject matter. Although it isn’t specifically about rational thinking (which I’ve written about in previous posts), it is about mental habits and how they can shape our experience. I even intend to examine what “is” is.

Things that we know and experience through our senses are phenomena: rain, wind, temperature, the day/night cycle, seasons, etc. Mental concepts – noumena – such as justice, authority, honor, nationality and race don’t exist in the same way rain exists. For one thing, they’re not Absolutes; they mean different things to different people. And yet we often act as if certain noumena were as real as rain. Race used to be thought of as a biologically-based reality. Now we know that it’s a social construct based on culture and tradition. All homo sapiens belong to the human race, despite variations in outward appearances.

Days, months and years are all phenomenal, based on planetary rotation, the lunar cycle, and the earth’s orbit around the sun, respectively. The convention of the week, however is noumenal – it isn’t based on any natural phenomenon. The seven-day week has long been the standard way of sub-dividing months throughout the industrialized world, and most of us organize how we spend our time using this noumenal convention.  “Monday” (for instance) is a social construct.  But it’s only Monday if you think it is.

Try this thought experiment: Imagine waking up on the beach, alone, on a desert island. You’ve been delirious with a fever and don’t know how long you were “out of it,” so you’ve lost track of what day it “is.” You have no sensory way of determining it, and it doesn’t even matter in any practical way whether it “is” Monday or Tuesday, because you’re not on anybody’s schedule. Will you arbitrarily choose a day of the week as your baseline and keep track of what day it “is”? Or will you adopt a different mode of thinking and just live each day on the island, without having to give it a name?

Even though it’s just a mental construct that most of us buy into, the day of the week may control our actions and thoughts, and even our moods. You might hear someone who works Monday through Friday complain about having the blues “because it’s Monday.” He’ll predictably perk up five days later because it “is” Friday, the start of the weekend (another noumenal concept). Which brings us to the question of what “is” is.

“Is” can be used to cite a phenomenal reality (it is raining), a noumenal belief (it is Monday), or to state a quality or property of a thing (the apple is red) – the Aristotelean “is of equivalency.” In the first instance, regardless of what I may believe, I’ll get wet if I step outside when it’s raining. As regards the second instance, wars have been fought over where, exactly, the border between two countries “is.” In the third instance, if one person in a room says “It is hot in here” and another person in the room says “No, it’s not,” one of them has to be wrong. What “is” is the basis of many a dispute, whether interpersonal or international. Such disputes can be avoided by dropping the pretense of objective truth implied by an “is of equivalency,” and “subjectivising” the statements: “I’m hot.”/ “I’m not.” No conflict about what “is.” Whether or not Sally “is” pretty can be viewed as a matter of subjective opinion, not of objective fact. Beauty is, after all, in the eye of the beholder.

E-prime – English that omits all forms of “is” – is a tool for learning about the linguistic traps that can be set by its use. Nobody has ever suggested that E-prime should replace English. (It’s often more precise than English, but doesn’t lend itself to poetic word formulations.) But try writing without using is/am/are/were etc. and it will help you to appreciate how much you tend to unconsciously objectivise things you believe to be true or important.

Here are some translations of English sentences into E-prime: English – She is pretty. E-prime – I find her attractive/pretty. English – This is really difficult.  E-prime – I really have a hard time doing this. English – Look, it’s a UFO! E-prime – I can’t identify that flying object. English – Time is money. E-prime – Earning money correlates to a high degree with the way you spend your time. English – This is Monday. E-prime – Because of the social convention of the seven-day week, most people think of today as Monday. English – He is a liar. E-prime – He lies a lot. English – God is love. E-prime – I believe in God as the embodiment of love.

There’s some overlap in the ideas I’ve written about here and my previous posts on rational thinking and cognitive behavior therapy. Linguistic conventions can make us prisoners of language. Wittgenstein wrote, “The limits of my language are the limits of my universe.”

Some irrational self-talk involves the “is of equivalency.” The thought “I am a Loser” presupposes that people are either Winners or Losers and might mean any of several things to different people. It might mean “I think that I lose more often than I should” or it might mean “I’m destined to fail, no matter what I do.” In either case it’s an irrational simplification that can’t help anyone to achieve their goals. “Being a Loser” is a self-limiting noumenal notion.

It’s only Monday (or Tuesday, etc.) if you think it is. Monday isn’t real in the same way that rain is real.

 

Relapse Prevention, Part 2

In my last post I wrote about triggers for relapse and the importance of having a relapse prevention plan, if you’re trying to establish and maintain a clean-and-sober lifestyle. The relapse prevention curriculum I developed in at the University Hospital of the West Indies in Jamaica included modules on stress  management, anger management, and rational thinking – all topics I’ve covered in previous posts. In this post I’ll be writing about other aspects of recovery from addiction.

I’ve met people with serious substance abuse problems who were too  proud to admit that they needed help in their recovery. (“I’m man enough to do it on my own!”) I’ve also known drug abusers who couldn’t imagine talking to other people – especially strangers – about addiction-related things they’d done and were ashamed of. But I’ve never met a recovering addict who got and stayed clean-and-sober without help from others, either in the form of professional help, or peer support groups such as AA. The road to recovery isn’t a road to walk alone.

Although I never saw him staggering drunk, my own father was an alcoholic. A military man who prided himself on his self-control, he once went for a year without drinking, to “prove” his ability to control his drinking. He went for exactly 365 days without a drink, but he hated every day of his self-imposed sobriety. It’s a condition known in the recovery community as “dry drunk.” As planned, on Day 366 he resumed drinking, moderately at first. But within weeks he was back to hiding bottles and drinking at the level he’d been drinking before his year of “white knuckle” sobriety.

There are individuals, I’m told, who’ve regained control of their excessive drinking and become moderate “social drinkers” – but I’ve never met one. “Someday I’ll be able to drink again” is a dangerous thought for people in recovery. Addicts are notorious for irrational thinking and self-deception. Many a relapse starts with thoughts like “I’ll allow myself one beer on my birthday” or “I can still shoot pool with my drinking buddies at the bar, and just drink sodas.” One of the arguments for attending Twelve Step meetings is that in time you’ll come to recognize your own rationalizations, by listening to other addicts who’ve come to recognize their own bullshit. Twelve Step meetings are all about getting real with other addicts who they know won’t judge them, because they’ve been there, done that, themselves.

Some friends and family of addicts don’t want to support their recovery, for a variety of reasons. Other well-meaning people who care about an addicted friend of family member become enablers. With the best of intentions, they try to shield their friends or  loved ones from the natural consequences of their addictions. They think they’re being helpful, but they’re simply enabling the person to continue drinking or using. In order to truly help, enablers need to learn to practice tough love – to stop attempting to rescue the person, and to let them suffer the natural consequences of their substance abuse. A mother practicing tough love won’t bail her son out of jail, because she knows from experience that if she does, he’ll be shooting up again within hours of his release.

Most recovering addicts come to the realization at some point in their recovery that they not only have to stop their drug-of-choice, but all intoxicating substances. I’ve known a number of crack and opioid addicts who initially believed that they could substitute alcohol and/or cannabis for their drug-of-choice, only to find that it was just a bridge back to their preferred drug. Cravings are one of the most common triggers for relapse, and getting high or intoxicated doesn’t improve anyone’s judgment or ability to resist cravings.

In my last post I mentioned euphoric recall (addicts dwelling on memories of the good times they’d had drinking and drugging, before getting addicted) as a trigger. This is one form of rumination, but addicts can also ruminate about how much they’d like to get high right now. This kind of thinking activates cravings that lead to relapses.

I’ve had some personal experience with this, as a recovering nicotine addict. What I found was that when I ruminated on how good it would feel to light up a cigarette, I relapsed time and again. Eventually I was able to identify my ruminations as a predictable relapse trigger, and to stop dwelling on thoughts about how I’d like to have a smoke. I still have occasional situation-specific cravings for tobacco, but I no longer feed the initial thought with more thoughts, and the cravings only last for a few seconds. After years of being  nicotine-free, the long-term rewards of being a non-smoker outweigh any momentary cravings I might have to light up again.

What you’re “supposed to feel”

No matter what kind of family or culture we were born into, we got instructed on what we should feel under this or that circumstance. Some of the instructions came in the form of admonitions (“Of course you love him, he’s your father!”) and some in the form of role modeling. As children, we learn a lot from the behaviors we observe being demonstrated by those around us.

Real love is rooted in a naturally-occurring feeling we have for another person, but love is institutionalized in a variety of ways. New mothers are “supposed to” love their babies, but this isn’t always the case. It may be a hormonal thing, as with post-partum depression, or it might be that the child was conceived by rape; but a mother who doesn’t spontaneously feel love for her newborn is usually judged or blamed. Children are “supposed to” love their parents, but not all parents are worthy of their children’s love.

We all have feelings about our feelings. We may feel ashamed for having been afraid, or angry at ourselves for being depressed. A number of people I worked with over the course of my career felt terribly guilty for not loving a parent or other close relative who had neglected and/or abused them. We can’t choose what we authentically feel about anyone, and nobody has the authority to tell you what you’re “supposed to” feel. Real loving feelings either arise spontaneously, or they don’t. It’s not something we owe someone just because we’re blood relatives.

Gestalt guru Fritz Perls said that most people are socialized to be phony. Ideally, a kiss is a genuine expression of affection or love. But many times in some families, children are told to hug and kiss a relative because (s)he’s kin, whether or not the child feels affection or love for that person. Kissing may become a hollow social ritual, performed because it’s expected. In some family situations, a child may be expected to kiss someone who has abused or neglected them, or whom they find “creepy.” In some cultures a child may be required to kiss a dead relative at a funeral. This sort of thing can be a traumatic experience. It can be a perversion of what a kiss is meant to express. You can’t make yourself love someone any more than you can make someone love you. But you might be put in a position where you feel you have to fake it. When Perls called a behavior phony, he wasn’t judging the client; he was observing that the behavior wasn’t an authentic expression of feeling.

I’ve worked with couples in loveless marriages who reflexively claim to love one another, because that’s what’s expected, when they haven’t felt love for their partner in a long time. It’s not always black and white, however. Observing my father’s parents as a youth, I came to understand the term “love/hate relationship.” Love and hate can be closely allied, and it’s been suggested that the opposite of love isn’t hate, but indifference.

Relationships can be emotionally nourishing or, at the other end of the continuum, they can be toxic. People can change, and family systems can change. Often the goal of family therapy is to change the family system and to promote reconciliation between family members. But this isn’t always possible. Bad marriages can be terminated by divorce, but your parents will always be your parents – for better or for worse. I’ve worked with people who’ve tried time and again to reconcile with family members, only to find that the relationship remains toxic to them despite their best efforts. If a client had gotten to the point where they’d concluded that a family relationship would never be anything but painful for them, I’d suggest that she had the option to “divorce” that relative. It’s a sad happenstance, but it’s sometimes necessary for healing to begin.

I’ve also suggested that not all “kinfolk” need be blood-related, that you might have brothers and sisters you haven’t met yet. There are several people in my life that I consider “found” brothers and sisters. Someone who was abused or neglected by a parent might later find a nourishing relationship with an “other mother” or with a man who feels like the father he wishes he’d had. I’ve seen it happen. The mere fact of blood relationships doesn’t necessarily confer lifelong obligations, and certainly not the obligation to feel a certain way about a member of your birth family. We feel what we feel, and there’s no “should.” Rational thinking can free us from the tyranny of “shoulds.”

Dialectical Behavior Therapy, Part 1

For two years I worked in a Dialectical Behavior Therapy (DBT) program at Columbia Area Mental Health Center. The program director was Dr. Sherri Manning, trained by Dr. Marsha Linehan, who had devised DBT for people (mostly women) diagnosed with Borderline Personality Disorder (BPD). People with that diagnosis are notoriously difficult to treat, and DBT provided the first effective, empirically validated therapy for that disorder.  Working in a DBT program requires the study of Dr. Linehan’s groundbreaking textbook, Cognitive-behavioral Treatment of Borderline Personality Disorder and the accompanying Skills Training Manual for  Treating Borderline Personality Disorder.  Every clinician in a DBT program is a member of the “consultation team,” which supports the team members in their challenging work.

Borderline Personality Disorder is characterized by extreme emotional dysregulation, or imbalance. Personality disorders are  diagnosed on Axis II of the DSM (the “Bible” of psychodiagnosis), apart from Axis I diagnoses like depression, anxiety disorders and schizophrenia. According to Dr. Linehan, all people with BPD have an underlying Axis I pathology, but have also experienced trauma that has shaped their behavior in persistent, dysfunctional ways. People with the disorder are often suicidal, and frequently engage in self-destructive behavior, including drug abuse and/or self-mutilation. They go to extremes in over-valuing and then rejecting significant others – sometimes in the same day. Dr. Linehan describes them as living in Hell and not knowing there’s a way out.

In order to be accepted in a DBT program, the client has to sign a year-long treatment agreement, to be renewed at year’s end if the client wants to stay in the program. She agrees to keep a daily diary card, charting moods, thoughts, and behaviors; and agrees to keep individual and group therapy appointments. Participation in the program is contingent on living up to the terms of the treatment agreement, and the client also agrees to other specified contingencies, which I’ll write about later. In the DBT program I worked in, patients were seen once a week for individual therapy and twice a week for skills training group sessions. Although individual therapy plays an important role in DBT, the skills training groups are at its heart. There’s no processing of issues in these sessions, but rather the presentation of skills by the group leaders, and coaching in their use.

One of the skills taught to DBT therapists is radical validation. Whereas I might equivocate if someone said I’d yelled at them, under normal circumstances (i.e. “I didn’t yell, I raised my voice because I felt frustrated.”), if a client in the program accused me of yelling at her, I’d validate her perception and immediately apologize for yelling. People with the BPD diagnosis are frequently blamed for things they can’t control. Many have never heard validating messages like, “You didn’t choose to be like this. If you knew better ways of  dealing with your pain, you’d use them. I believe in you and your ability to create a better life for yourself.”

Four modules are taught in DBT skills training groups: Core Mindfulness, Interpersonal Effectiveness, Emotion Regulation, and Distress Tolerance. Group leaders are trained in specific techniques to facilitate skill acquisition, strengthening and generalization. There are a lot of handouts and homework assignments. The groups reinforce what the clients are learning by keeping their daily diary cards. DBT is a cognitive-behavioral therapy in that it helps clients to learn the connections between emotions, thoughts and behaviors, and to apply that knowledge. A primary goal of the therapy is to help the clients achieve balance in their lives.

Marsha Linehan studied meditation with a Buddhist roshi (master) and a contemplative Catholic priest, and mindfulness is at the core of DBT skills training. Group members are taught that there are three primary states of mind: reasonable mind, emotion mind, and wise mind -the last of which is an integration of the first two. That they have a wise mind is a revelation to most clients. Being in the state of wise mind adds intuitive knowing to emotional experiencing and logical analysis. It’s explained as, “learning to be in control of your mind, instead of letting your mind control you.” One of the skills taught in the Core Mindfulness module is how to be mindful without judging.

The Interpersonal Effectiveness module helps clients to learn how to ask for things they want and how to say “no.”  It teaches them to prioritize and self-validate in setting relationship boundaries. It teaches “what” and “how’ skills for getting reasonable things you want and not caving-in to pressure to do things you don’t want to do. The Emotion Regulation module helps clients to learn the role of emotions, positive and negative, and to deal with them in a balanced manner. It teaches them how to build positive experiences and avoid negative experiences, and to feel a sense of agency in their reactions to emotions. The Distress Tolerance module teaches such skills as distraction, self-soothing, and improving the moment. It includes thinking skills and physical techniques for tolerating stress without responding in extreme, self-destructive ways. It teaches the concept of “radical acceptance” of things that can’t be changed.

After finishing the Distress Tolerance module, the group starts on Core Mindfulness again; so group members get multiple exposures to all four modules. I personally think that the skills taught in DBT groups can also help people with other diagnoses. I’ll continue to write about DBT in my next post.

 

Anger Management II

My father was an Army officer and a strict disciplinarian, but he was a gentle man by nature and never spanked me when he was angry – except once.  When I committed a spanking offense such as lying, he might get angry, but would order me to go to my room and wait. By the time he came to administer the punishment,  he’d have calmed down, and would hug me soon afterward, to let me know all was forgiven and that he loved me. He did the same with my brother and sister. Spankings were few and far between in the Koob household, and none of us children were ever called “bad” or “stupid.” None of us were ever slapped or beaten.

I’m extremely grateful to have grown up in a loving family, with minimal use of corporal punishment. But I’m also grateful that my father slipped that one time and spanked me, not because of something I’d done, but because he was angry. I still remember the feelings of helplessness and rage that accompanied the physical pain. I’m grateful because my father’s slip gave me a taste of what it’s like to be physically abused, and it heightened my empathy for victims of abuse. In my career as a therapist I would work with many men, women and children who grew up in families where physical and emotional abuse was commonplace. One of the most common “invisible scars” of abuse is  residual anger.  Sometimes a reservoir of accumulated rage erupts as angry or destructive acting-out; sometimes the rage is repressed, and manifests as depression.

People who have temper problems usually came by them honestly. If some – or many – of the adult role models in a child’s social environment are physically and/or verbally violent, violence can become normalized. Violence is a sad legacy in some families, passed on from generation to generation. But it only takes one generation to break the chain of family violence, and I’ve been privileged to work with parents who were determined not to do to their children what was done to them by their own parents.

I’ve taught anger management to many parents who were ordered into counseling by family courts, as well as people who entered counseling voluntarily because they had anger issues to deal with. I’ve also taught anger management to groups of cops, parents, teachers, and Marine Corps drill sergeants. I started my group presentations by talking about the origins of anger control problems, the importance of parents role-modeling the non-violent resolution of conflicts, and my guidelines for spanking.

It is sometimes possible to raise a child well, without using physical pain as a teaching tool. But if a parent finds it necessary to use corporal punishment, it should be the punishment-of-the-last-resort. If you have to spank a child frequently, it’s not working; find out what does. Finally, never inflict pain on your child when you’re angry. All you will teach him or her is to role-model that it’s okay to hit when you’re angry. After a calmly-administered spanking, make sure the child understands why you felt the need to spank in this instance, and express your love, verbally or with a hug. If you slip, like my father did, you owe the child an apology.

Learning anger management doesn’t mean you won’t get angry anymore. Everybody gets angry sometimes- except maybe the Dalai Lama. My definition of practicing anger management is that you can still make good decisions, no matter how angry you are. You don’t do or say things you’ll regret later. As with stress management, the first step in learning to manage your anger is a self-assessment. Knowing the “why” of your anger problem isn’t as important as knowing the “whats.”

How does your anger typically manifest? Aggression, passive-aggression? Physical harm to self or others? Verbal aggression? How does your anger management problem affect your life? What are the predictable triggers  for your anger reactions? What are your cues? (Physical signs that you’re angry, such as a rapid heartbeat or a flushed face.) Once you’ve completed your assessment, you’re ready to try out whatever physical and mental anger management techniques you think might help you to change your behavior.

Physical anger management. If one of your cues for anger is rapid breathing, you can learn breath control. If muscle tension is a cue, you can learn to relax the muscles you typically tense when you’re angry. The key is becoming mindful of your triggers and cues. You can learn to physicalize your anger in a non-threatening and non-destructive manner, jogging, or doing pushups, or working out on a punching bag. If you can walk away from the situation that triggered you, you might be able to regain your cool quickly. Other factors in physical anger management are  adequate sleep and good nutrition.

Mental anger management. I’ve already written several posts about rational thinking, and think it’s the key to mental anger management. If I give situations and other people the power to “make me mad,” I’ve placed the locus of control outside of myself; I blame externals for my anger and for my behavior when I’m angry. If my locus of control is internal, I understand that I generate and sustain my own anger in response to things that happen (or don’t happen) in my life, and can control my behavior no matter how angry I am. If I know that someone is trying to trigger me, I can deny him the satisfaction. People who don’t rise to the bait can’t be hooked.

I’ve had the advantage of going through a “plebe system” at The Citadel – a military academy – which is like nine months of boot camp in the armed forces. I’ve had the experience, multiple times, of having an upperclassman scream in my face, or make me do pushups until I collapsed in a pool of sweat. Although I wanted to punch some of my antagonists, or curse them and walk away, I had to remind myself that this wasn’t personal. If I wanted to graduate from The Citadel, it was something I had to endure for my freshman year. I now see that, like boot camp, it was a stress inoculation,  and a preparation for combat.

Anger is a universal experience, and isn’t necessarily a bad thing. It’s fully justified in some situations, and may even help us to survive, as with a soldier in combat. Practicing anger management means knowing that you’re in control, even when angry.

Stress Management

We’ve all heard that prolonged stress negatively impacts our health, but stress isn’t necessarily a bad thing. Dr. Hans Selye, one of the pioneers of stress management, said that stress can be “the spice of life or the kiss of death.” He labeled negative stress distress and positive stress eustress. If we choose to ride a rollercoaster, or to scale a cliff, or watch a horror movie, we’re choosing to experience stress. Stress is an unavoidable fact of life, and a stress-free life would be an uneventful life – boring. Sexual excitement is a form of stress, and we all enjoy an adrenaline rush from time to time, especially if we chose the stimulus that triggered it.

Our autonomic nervous system, which regulates automatic behaviors, has two branches: sympathetic and parasympathetic. Both are involved what Dr. Selye called the “fight or flight” response. Activation of the sympathetic response gears us up, preparing us to fight or flee, whether or not we’re in danger. Heartbeat and breathing instantly become more rapid,  delivering more oxygenated blood to the brain and the extremities. Blood pressure and blood sugar rise, muscles tense in anticipation of action, and you may experience a jolt of adrenaline. After the event or situation that triggered the sympathetic response is past, the parasympathetic branch kicks in, reversing the fight or flight response and allowing us to “rest and digest.” We’re told not to go swimming right after eating a meal, because our blood flow has been re-directed from our extremities to our gut, increasing the possibility of a muscle cramp.

The fight or flight response evolved to help our ancestors to avoid being eaten and to hunt dangerous prey. If you’re a soldier in a combat zone, or a cop, or a firefighter, you may experience it on a regular basis. But although only a few of us in modern society frequently face physical peril – other than heavy traffic – we respond to perceived existential threats, even if we’re not actually in immediate danger. Combinations of financial, social and environmental stressors (How am I going to pay the rent? Is my wife being unfaithful?) can result in a high level of distress, sometimes manifesting as anxiety.

Anxiety is similar to fear, although the causes might be multiple and may not be immediate physical threats. A person having an anxiety  attack may experience their fight or flight response as paralyzing. Once you’ve had one, your fear of having another one becomes yet another stressor in your life. If you only occasionally have fight or flight reactions, stress may not be a significant factor in your health. But if you have them frequently, your health may be affected. But frequent fight or flight reactions aren’t the only stress-related threat. Chronic overstress – having more on your plate than you can handle – can kill.

Stress management doesn’t mean eliminating stress. It means controlling the amount of stress in your everyday life and, where possible, eliminating stressors. There are both physical and mental aspects to stress management. But first you need to identify the sources of stress in your life, your triggers for stress reactions, and how stress affects you.

If you need to practice stress management, start with an inventory of your stress factors: job security and satisfaction, finances, safety, residential issues, and personal relationships. Think of how you might be able to reduce unwanted stress in each area. It may mean some tough choices. Then list the kinds of situations and events that tend to trigger stress reactions. Being aware of your stress triggers may help you to prepare for them or learn ways to avoid them. Become more aware of how you typically respond to stress triggers and overstress. Do you somaticize (physicalize) it into headaches or bellyaches or backaches? Do you stay angry or depressed? Do you worry excessively? Anxiety has many faces , including free-floating (generalized) anxiety, panic attacks, and phobias – including social phobias. After doing this analysis of the role of stress in your life, you’re ready to look at physical and mental stress management techniques.

Physical stress management techniques include breath control, learning to relax your muscles, meditation, self-hypnosis, yoga, exercise, good nutrition, and adequate sleep. Avoid self-medicating with alcohol or other drugs. If you’ve listed rapid breathing as a stress symptom, you can learn to slow your breathing when you’re under stress. This helps to bring the fight or flight response under your control. There are many techniques for relaxing tense muscles, and relaxing the body tends to simultaneously relax the mind. I used to teach clients a method of focusing on the sensations in each of the muscle groups of the body in turn, tensing and relaxing each muscle group until they became aware that they could relax them at will by focusing on the changing sensations. It’s a form of mindfulness.

Learning time management or anger management might be part of your stress management plan. The best single mental stress management I’m aware of – besides meditation, which calms both body and mind – is rational thinking. (I’ve previously published several posts on rational thinking as a learnable skill.) Any stressful situation can be made more stressful by the way we think about it, and the effects of stressors in our lives can be minimized by thinking about them rationally. Failing to achieve something you wanted to achieve doesn’t make you “a Failure.”  Telling yourself that you’ll never get over a loss can be a stress-inducing self-fulfilling prophesy. Thinking that they “can’t stand” something has never helped anyone to cope with distress.

Some stressors can be minimized or overcome, others can be tolerated until circumstances change, by developing coping skills. We can all learn to manage our stress to some degree, if we understand it for what it is and make a conscious effort to control its effect on our lives. Coming up with your own personalized stress management plan and implementing it can help you to become more resilient in times of adversity, and might add years to your life.