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PSYCHOTHERAPY AND STRESS MANAGEMENT
Asghar Dadkhah, Ph.D.

1Associate Professor, University of Welfare and Rehabilitation
A part of the challenges of daily life are hassles, irritants, stressors, life events and
changes. A health promotion approach is utilized to address the prevention,
management andhttp://ravan-usb.blogfa.com/post-24.aspx early intervention for stress management and also to promote
positive mental and psychological health. Health promotion is the science and art
of helping people to change their lifestyle in order to achieve the optimal health
level, reestablishing the harmony of each of the human existence levels.
Health promotion in different human existence levels:
On the physical level, represented by the human body, harmony and balance
can be achieved by doing regularly physical exercises, having a balanced
nutrition, by avoiding excesses in eating habits and avoiding the consume of
dangerous substances.
On the emotional level balance is achieved through proper stress
management and assistance during the emotional crises.
On the social level (also part of the emotional level) harmony is achieved by
building and maintaining a proper support network. This network is composed
from friends, family members, colleagues or other members from various
communities that can help you during difficult moments.
On the intellectual level (the concrete mental level) balance is established by
having a general education and a continuous professional evolution, which is
often accompanied by a defined, fulfilling and continuously developing career.
On the intuitive / creative level (or the intuitive mental plane) by
re-establishing and continuing development of intuition, creativity and
capacity of anticipation of future events.
1 This is a part of study in fellowship period in Kyushu University, Japan, 2003-4.
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On the inner level balance can be attained through the recovery and future
development of the self-esteem that leads to the capacity of dreaming and of
transforming those dreams in reality. These projects will bring balance to our
inner level if they will be directed to a universal good cause.
On a spiritual level, harmony will be reached by the presence of sentiments of
love, approval and hope along with charity actions directed to helping every
body around us.
Stages of the prophylaxis of getting ill:
In the primary prophylaxis stage (suitable for the healthy and unstressed
individual) the illness can be prevented before any unhealthy signs appear,
the strategy consists of the following types of activities:
–Promotion of Health through: Physical exercise, Healthy Nutrition,
Adaptability to unexpected and difficult conditions, Relaxation, Balance
between work and family, Flexible work schedule, Attention paid to the growth
of the children and The prevention of Illnesses care for the elderly parents,
and adoption of children
-Preventing of getting hurt or intoxicated through Accidents investigations,
Workplace monitoring for igienic conditions, Evaluations of professional and
domestic risks. Preventing of getting ill through Stress management, Health
education, stopping smoking, maintaining a proper weight, Evaluation of the
illnesses risks (American Journal of Health Promotion).
In the secondary stage in the prophylaxis of getting ill (when a person reacts
to a stressing event), it concentrates on the reestablishing health when
physiological symptoms that occur before losing the health state or just after
the beginning of the illness process.
In the third stage of prophylaxis (or the resistance to stress stage) the
recovery of the persons which are already experiencing the resistance to
stress stage is focused. Resistance to stress is characterized by the
attenuation of the chronic stress symptoms as a response to a strong will that
cause various hormones to be released in order to mask the stress responses.
The purpose of the recovery is to bring the person in the second (reaction to
stress) and then first category (Optimal health state). This can be achieved
through Stress management, Restoration of the vitality consumed by stress,
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Reestablish of the work – rest balance, along with the pleasurable activities
and imposed activities balance, Recovery of the physiological reserves of the
organism through a special nutrition program designed by specialists after the
interpretation of the results of the clinic and Para clinic medical tests.
People that are getting through this stage have a physical and psychological
healthy appearance. However this is artificially stimulated through the means
of happiness hormones that are activated in order to mask an acute stress.
The main objective of the forth type of illness prophylaxis (or the stress
induced breakdown) is to limit the consequences of the clinical effects which
already appeared. This is achieved through self help and self care programs.
Management of the handicap can be done through Modifications of the
professional roles, Recovering and therapy centers at the workplace,
Professional rehabilitation and help for professional recovery, Special
assistance programs for those with long term handicaps and those with
irreversible chronic diseases, and Careful monitoring of the industrial hygiene
Influence of stress on physical and psychological well being
The influence of stress on physical and psychological well being is well
documented. Stress has been implicated in heart disease, eating disorders,
stroke, insomnia, ulcers, accident proneness, cancer, decreased immunity,
chronic headaches, diabetes, depression, substance abuse, chronic pain,
irritable bowel syndrome and chronic fatigue. In fact, estimates are that 50 to
80 percent of all physical disorders have psychosomatic or stress related
origins (Rice, 1992).
What is stress?
Stress is a complex, dynamic process of interaction between a person and his or
her life. It is the way we react physically, mentally, and emotionally to the various
conditions, changes, and demands of life. People react differently to Stress. How
you react depends on your strategies for coping with Stress, your previous
experience with Stress, your genetic makeup, and your level of social support and
how you view your social support. The greatest factor, however, is how you
perceive Stress and control its outcome. What is Stressful to one person may not
affect another. Stress can result from a string of specific events, the general
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conditions in your life, life cycle transitions and developmental stages, or conflict
with your belief system.
Signs of Stress
The signs of Stress can be physical or mental. Some people call this "storing"
Stress in the body (physical) or in the mind (mental).
Common physical symptoms of Stress include:
• Rapid heartbeat.
• Headache.
• Stiff neck and/or tight shoulders.
• Backache.
• Rapid breathing.
• Sweating and sweaty palms.
• Upset stomach, nausea, or diarrhea.
You also may notice signs of Stress in your thinking, behavior, or mood. You may:
• Become irritable and intolerant of even minor disturbances.
• Feel irritated or frustrated, lose your temper more often, and yell at others
for no reason.
• Feel jumpy or exhausted all the time.
• Find it hard to concentrate or focus on tasks.
• Worry too much about insignificant things.
• Doubt your ability to do things.
• Imagine negative, worrisome, or terrifying scenes.
Feel you are missing opportunities because you cannot act quickly.
Stress is a fact of everyday life - a fact you cannot deny. Any change in your
life demands that you adapt to it. Most people think of all stressful
occurrences as being negative in nature (dis-stress), such as physical or
psychological injury, illness, or the death of a loved one. However, stress can
also be positive in nature. For example, falling in love, changing jobs, getting
a new home or a promotion are stressful situations, which, if properly
managed, are positive and motivating.
Stress management refers to various efforts used to control and reduce the
tension that occurs in these situations.
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Stress management involves making emotional and physical changes. The
degree of stress and the desire to make the changes will determine the
level of change that will take place.
Stress Management Strategies
The following are tips on how to maintain a healthier lifestyle and to prepare
you to cope with the stress of everyday living.
1. Structure each day to include a minimum of 20 minutes of
aerobic exercise.
2. Eat well balanced meals, more whole grains, nuts, fruits and
vegetables. Substitute fruits for desserts.
3. Avoid caffeine. The substance may aggravate anxiety, insomnia,
nervousness and trembling.
4. Reduce refined sugars. Excess sugars cause frequent fluctuation
in blood glucose levels, adding stress to the body's physiological
functioning.
5. Reduce alcohol and drugs. These substances may add to
headaches and swelling, decrease coping mechanisms and add
to depression.
6. Get a least 7 hours of sleep nightly.
7. Spend time each day with at least one relaxation technique -
imagery, daydreaming, prayer, yoga or meditation.
8. Take a warm bath or shower.
9. Go for a walk.
10.Get in touch! Hug someone, hold hands, or stroke a pet. Physical
contact is a great way to relieve stress.
Stress in Family
Perhaps the first thing to realize about stress is that it's not always a bad thing
to have in families. In fact it can make family life exciting--being busy,
working, playing hard, competing in contests, being involved in community
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activities, and even arguing when you don't agree with other family members.
Stress means change. It is the force exerted on a family by demands.
If we think of a bridge, stress results from putting weight on the bridge. This
usually can be managed since the supports under the bridge are designed to
withstand pressure (or stress) from traffic on the bridge. This assumes that
the supports are in place, and are numerous and strong enough to withstand
stress on the structure, even over time.
Sometimes in a family, this is not true. The structure can't hold up under the
pressure and there is a crisis. Since the supports are not strong enough to
withstand the pressure, the structure collapses. This can happen to families
just as it happens to bridges.
Stress, therefore, is simply pressure put on the family. It results from change
and can be good or bad. Crisis, however, is a point of acute imbalance
between pressure and supports. This imbalance is so severe that the family
structure collapses and is immobilized for a time. The family can no longer
function. For a time no one goes to work; no one cooks or even wants to eat;
and no one performs the usual family tasks.
Habilitation
It has been estimated by WHO that around 5-7% of the world's population
have a physical sensory and/or mental impairment leading to
disabilities of various degrees. The international year of disabled people
in 1981 followed by a decade of the same topic, created a growing
awareness that people with a disability should have equal rights and
opportunities to other citizens of a nation. Several governments and
humanitarian organizations have taken up the challenge of
rehabilitation in developing countries.
Relieving Stress:
One of the first skills to learn in managing Stress is how to relieve Stress with
healthy coping strategies. Many of these coping strategies can be done with little
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or no instruction. No one coping strategy is preferable; you need to find the one
that works the best for you. Using them regularly is the key. They include:
• Physical activity. Physical activity can reduce Stress and the Stress
response. Aerobic exercise—the kind that increases your heart rate, such
as walking, running, bicycling, or swimming—is especially useful for
counteracting the harmful effects of Stress. Stretching is also a good way to
relieve muscle tension. Regular, moderate physical activity may be the
single best approach to managing Stress. For more information about
becoming more active, see the topic Fitness.
• Writing. There is increased evidence that writing about Stressful events
and circumstances can help relieve Stress and improve diseases that Stress
may affect.2 Write for 10 to 15 minutes a day about Stressful events and
how you felt.
• Talking about your feelings. By expressing your feelings to others (in a
positive, respectful way), you will be able to understand and cope with
them better.
• Laughing and crying. Laughing and crying are natural ways to relieve
Stress and release tension. They are both part of your emotional healing
process.
• Finding an activity that you enjoy. A meaningful activity helps relieve
tension. This can be a hobby, such as gardening, or a creative activity, such
as writing, crafts, or art. Playing with and caring for pets also can help you
relax.
Body-centered relaxation
Body-centered relaxation skills that help the body relax are useful for those who
experience mainly physical symptoms of Stress. These skills include:
• Breathing exercises, such as roll breathing.
• Progressive muscle relaxation, which reduces muscle tension by relaxing
individual muscle groups.
• Massage, such as a shoulder and neck massage.
• Aromatherapy, which uses the aroma-producing oils (essential oils) from
plants to promote relaxation.
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• Yoga, tai chi, and qi gong, which are forms of exercise and meditation. They
generally require initial instruction.
Mindfulness activities
Mindfulness activities help relax the mind and are often combined with
body-centered relaxation exercises.
• Autogenic training is used to return the body to a normal state after the
Stress response.
• Self-hypnosis can open the mind to suggestions that can relieve Stress or
change the way a person responds to Stress.
• Meditation focuses your attention on feeling calm and having a clear
awareness about your life.
• Guided imagery (visualization) is a method of using your imagination to
help you relax and release tension caused by Stress. Your body responds to
the images in your mind. Use these simple imagery exercises for relaxing or
renewing your energy when you need to relax.
• Music therapy can relax your body, improve your mood, and change the
pace of your day.
• Humor therapy is becoming widely accepted as a tool for reducing Stress
and boosting the body's immune system.
Breathing exercises for relaxation
The way you breathe affects your whole body. Full, deep breathing is a good way
to reduce tension, feel relaxed, and reduce Stress.
Roll breathing
The object of roll breathing is to develop full use of your lungs and get in touch
with the rhythm of your breathing. It can be practiced in any position, but it is best
to learn it lying on your back, with your knees bent.
1. Place your left hand on your abdomen and your right hand on your chest.
Notice how your hands move as you breathe in and out.
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2. Practice filling your lower lungs by breathing so that your left hand goes up
when you inhale and your right hand remains still. Always inhale through
your nose and exhale through your mouth.
3. When you have filled and emptied your lower lungs 8 to 10 times, add the
second step to your breathing: inhale first into your lower lungs as before,
and then continue inhaling into your upper chest. As you do so, your right
hand will rise and your left hand will fall a little as your abdomen falls.
4. As you exhale slowly through your mouth, make a quiet, whooshing sound
as first your left hand and then your right hand falls. As you exhale, feel the
tension leaving your body as you become more and more relaxed.
5. Practice breathing in and out in this manner for 3 to 5 minutes. Notice that
the movement of your abdomen and chest is like rolling waves rising and
falling in a rhythmic motion.
Practice roll breathing daily for several weeks until you can do it almost anywhere,
providing you with an instant relaxation tool any time you need one.
Clearing your head
Clearing your head is good for relieving neck tension or when you have too much
on your mind.
1. Begin with several very slow neck rolls. With your chin on your chest, or
close to it, roll your head up and to the right, slowly inhaling until your head
is leaning back and your chin is pointing towards the sky. If you have
arthritis of the neck (cervical spine) or other diseases of the spine, do not
point your chin to the sky.
2. Hold your breath for just a few seconds in this position.
3. As you roll your head down, slowly exhale until your chin is back on your
chest.
4. Repeat, this time rolling your head to the left.
Neck (cervical spine) symptoms in rheumatoid arthritis
When rheumatoid arthritis affects the neck joints, particularly those located at the
top of the spine, spinal cord complications can occur.
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• Bones affected by rheumatoid arthritis may dislocate and press on the
spinal cord.
• Pressure can cause numbness, pain, tingling, weakness, loss of bowel or
bladder control, and unusual head and neck sensations.
• Pressure may also obstruct blood flow through the blood vessels in the
spinal cord.
Neck pain along with weakness, numbness, or tingling of hands, feet, legs, or
arms is the most common symptom of possible pressure on the nerve
(compression of the spinal cord). Although compression of the spinal cord is fairly
rare, if untreated it can lead to paralysis.
Progressive muscle relaxation
The body responds to Stress with muscle tension, which can cause pain or
discomfort. Progressive muscle relaxation reduces muscle tension and general
mental anxiety. Progressive muscle relaxation often helps people get to sleep.
Meditation
Meditation is the practice of focusing your attention on feeling calm and having a
clear awareness about your life. During meditation, you may focus on a single
image, sound, mantra (words spoken or sung in a pattern), or your own breathing.
Or, you may not focus on a single purpose but rather may try to let all thoughts,
feelings, sounds, or images just pass through your mind.
Meditation usually involves slow, regular breathing and sitting quietly for 15 to 20
minutes. It can produce a state of relaxation that reduces heart rate, slows
breathing, and lowers blood pressure.
Massage therapy
Massage involves applying pressure to the soft tissues of the body, such as the
muscles. The theory is that massage may be helpful in reducing tension and pain,
improving circulation, and encouraging relaxation. Massage is usually done by
applying pressure with the hands, but it can also be done using the forearms,
elbows, or feet. Massage techniques can affect the muscles, circulation, nervous
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system, and other systems of the body. There are at least 80 different types of
massage. Some are gentle, and some are very active and intense.
Deep tissue massage is more active and intense. It is used to treat long-lasting
(chronic) muscle tension. Slow strokes are applied (with the fingers, thumbs, and
elbows) using intense pressure to reach deeper layers of the muscles than those
reached with a Swedish massage technique.
Some people feel that massage works because the touch is healing. Touch also
communicates a sense of caring.
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