In our previous lecture, we discussed several methods that are helpful in reducing the potential for stress 📉😰 and, thereby, benefiting health 🏥. These methods take advantage of the stress-moderating effects of social support 👥❤️, personal control 🎮, exercise 🏃♂️, being well organized 📋, and being prepared 📝 for an impending stressor. In this lecture we will consider ways to reduce the reaction to stress 📉 once it has begun.
Reducing Stress Reactions: Stress Management 🧘♂️
People acquire coping skills 💪 through their experiences, which may involve strategies they have tried in the past 📚 or methods they have seen others use 👀. But sometimes the skills they have learned are not adequate 📉 for a current stressor 😰 because it is so strong 💥, novel 🆕, or unrelenting ⏳. In some cases, the approaches they have acquired reduce stress in the short run ⏱️—as alcohol 🍺 or cigarette smoking 🚬 can do—but are not adaptive ❌ and increase stress 📈 in the long run ⏳. These problems in coping often arise in individuals whose potential for stress is high 📈 because of a lack of social support 👥❌, personal control 🎮❌, and so on; but coping problems also happen among people whose potential for stress is relatively low 📉. When people cannot cope effectively 💪, they need help in learning new and adaptive ways 🔄 of managing stress 😰.
Many techniques are available to help individuals manage stress 🛠️. These stress management techniques are mainly psychological 🧠, but pharmacological approaches 💊 are also used sometimes under medical supervision 🧑⚕️.
Medication 💊💉
Of the many types of drugs 💊 physicians 🧑⚕️ prescribe to help patients manage stress 😰, we will consider two: Benzodiazepines and Beta-blockers.
Both of these drugs reduce physiological arousal 📉 and feelings of anxiety 😰. Benzodiazepines appear to work by activating a neuro-transmitter ⚡ that decreases neural transmission 🧠 in the central nervous system. Beta-blockers appear to block the activity of sympathetic neurons 🧠 in the peripheral nervous system that are stimulated by epinephrine and nor-epinephrine.
Beta-blockers cause less drowsiness 😴 than benzodiazepines, probably because they act on the peripheral 🔄 rather than central nervous system 🧠. Using drugs 💊 to manage stress should be only a temporary measure ⏱️, either to help during an acute crisis 💥, such as in the week or two following the death 💔 of a loved one, or while the patient learns new psychological methods 🧠 for coping. But more and more people are relying on drugs 💊 for long-term control ⏳ of their stress 😰 and emotions 😢.
Behavioral and Cognitive Methods 🧠🧍♂️
Psychologists 👨🔬 have developed methods they can train people to use in coping with stress 💪. Some of these techniques focus mainly on the person's behavior 🧍♂️, and some emphasize the person's thinking processes 🧠. People who use these methods usually find them helpful 👍.
Relaxation 🧘♂️😌
The opposite of arousal is relaxation 😌—so relaxing should be a good way to reduce stress 📉. "Perhaps so," you say, "but when stress appears 😰, relaxing is easier said than done." Actually, relaxing when under stress is not so hard to do when you know how 🎯. One technique people can learn to control their feelings of tension is called progressive muscle relaxation 🧘♂️ (or just progressive relaxation), in which they focus their attention 👀 on specific muscle groups while alternately tightening 💪 and relaxing these muscles 😌.
The idea of teaching people to relax their skeletal muscles 💪 to reduce psychological stress 😰 was proposed many years ago by Edmund Jacobson 👨🔬 (1938). He developed a device 🔧 to measure electrical activity ⚡ in muscle fibers. Using this device, he found that people would reduce the tension 📉 in their muscles when simply asked to "sit and relax 🪑😌." He later found that muscle tension 💪 could be reduced much more if the subjects were taught to pay attention 👀 to the sensations as they tense and relax 🔄 individual groups of muscles. Research findings 📊 indicate that one reason muscle relaxation 🧘♂️ reduces psychological stress is that the technique tends to arouse pleasant thoughts 💭🙂 in the person.
Although there are various versions of the progressive muscle relaxation technique 🔄, they each outline a particular sequence 📋 of muscle groups for the person to follow. For example, the sequence might begin with the person relaxing the hands 🤲, then the forehead 🤔, followed by the lower face 😊, the neck 🦴, the stomach 🏃♂️, and, finally, the legs 🦵. For each muscle group, the person first tenses the muscles 💪 for 7—10 seconds ⏱️, and then relaxes them 😌 for about 15 seconds ⏱️; paying attention 👀 to how the muscles feel. This is usually repeated for the same muscle group two or three times 🔄 in a relaxation session, which generally lasts 20 or 30 minutes ⏰. The relaxation technique works best in a quiet 🤫, non-distracting setting with the person lying down 🛏️ or sitting on comfortable furniture 🪑.
Stress management has been applied mainly with adults 🧑, but children 👶 also experience stress 😰 without being able to cope effectively 💪. Fortunately, many behavioral and cognitive methods are easy to learn 📚 and can be adapted so that an adult can teach a young child 👶 to use them. Relaxation exercises 🧘♂️ provide a good example. An adult could start by showing the child what relaxing is like by lifting and then releasing the arms and legs 🤲🦵 of a rag doll 🧸, allowing them to fall down ⬇️. Then, the adult would follow a protocol 📋, or script, giving instructions to relax 😌. When children 👶 and adults 🧑 first learn progressive muscle relaxation, they sometimes don't actually relax their muscles 💪 when told to do so. Instead of letting their arms and legs fall down ⬇️, they move them down 🔄.
They also sometimes tense more muscles than they are asked to ⚠️—for example, tightening facial muscles 😬 when they are supposed to tense only hand muscles 🤲. These errors should be pointed out and corrected ✅. Often, after individuals have thoroughly mastered the relaxation procedure 🎯, they can gradually shorten the procedure 📉 so they can apply a very quick version ⚡ in times of stress 😰, such as when they are about to give a speech 🎤. This quick version might have the following steps: (1) taking a deep breath 🌬️, and letting it out 😮💨; (2) saying to oneself 💭, "Relax, feel nice and calm 😌"; and (3) thinking about a pleasant thought 💭🙂 for a few seconds ⏱️. In this way, relaxation methods 🧘♂️ can be directly applied to help people cope with everyday stressful events 😰.
Research 📊 has demonstrated that progressive muscle relaxation 🧘♂️ is highly effective 👍 in reducing stress 📉. What's more, people who receive training 📚 in relaxation show less cardiovascular reactivity ❤️📉 to stressors 😰 and stronger immune function 🛡️📈.
Systematic Desensitization 📉😰
Although relaxation 🧘♂️ is often successful by itself in helping people cope 💪, it is frequently used in conjunction with systematic desensitization, a useful method for reducing fear 😱 and anxiety 😰. This method is based on the view that fears are learned 📚 by classical conditioning 🔔—that is, by associating a situation or object with an unpleasant event ⚠️. This can happen, for example, if a person associates visits to the dentist 🦷 with pain 🤕, thereby becoming "sensitized" 😰 to dentists.
According to Joseph Wolpe 👨🔬, an originator of the desensitization method, the reversal comes about through the process of counter-conditioning 🔄, whereby the "calm" response 😌 gradually replaces the "fear" response 😱. Desensitization has been used successfully ✅ in reducing a variety of children's 👶 and adults' 🧑 fears, such as fear of dentists 🦷, animals 🐕, high places 🏔️, public speaking 🎤, and taking tests 📝.
Stimulus Hierarchy 📊
An important feature of the systematic desensitization method is that it uses a stimulus hierarchy 📊—a graded sequence 🔄 of approximations to the conditioned stimulus, the feared situation 😱. The purpose of these approximations is to bring the person gradually 📉 in contact with the source of fear 😰 in about 10 or 15 steps 📋. To see how a stimulus hierarchy might be constructed 🛠️, we will look at the one in the following example that deals with the fear of dentists 🦷😱.
Example of a Stimulus Hierarchy for a Fear of Dentists 🦷😱
- Think about being in the dentist's waiting room 🪑, simply accompanying someone else who is there for an examination 👥.
- Look at a photograph 📷 of a smiling person 😊 seated in a dental chair 🦷.
- Imagine this person calmly 😌 having a dental examination 🔍.
- Think about calling 📞 the dentist for an appointment 📅.
- Actually call 📞 for the appointment.
- Sit in a car 🚗 outside the dentist's office 🏢 without having an appointment.
- Sit in the dentist's waiting room 🪑 and hear the nurse 👩⚕️ say, "The hygienist is ready for you."
- Sit in the examination room 🏥 and hear the hygienist say, "I see one tooth 🦷 the dentist will need to look at."
- Hear and watch the drill 🔧 run, without its being brought near the face 👤.
- Have the dentist 🧑⚕️ pick at the tooth 🦷 with an instrument 🔧.
- See the dentist lay out the instruments 🔧, including a syringe 💉 to administer an anesthetic.
- Feel the needle 💉 touch the gums.
- Imagine having the tooth 🦷 drilled 🔧.
- Imagine having the tooth 🦷 pulled 🩸.
As you can see, some of the steps involve real-life 🌍, or in vivo, contacts with the feared situation 😱 and some do not. Two types of non-real-life contacts, of varying degrees, can be included. One type uses imaginary situations 💭, such as having the person think about calling 📞 the dentist. The other involves symbolic contacts 🖼️, such as by showing pictures 📷, films 🎬, or models of the feared situation.
The systematic desensitization procedure starts by having the person do relaxation exercises 🧘♂️. Then the steps in a hierarchy 📊 are presented individually 🔢, while the person is relaxed 😌 and comfortable. The steps follow a sequence from the least 1️⃣ to the most fearful 🔟 for the individual. Each step may elicit some wariness 😟 or fear behavior 😱, but the person is encouraged to relax 😌. Once the wariness at one step has passed and the person is calm 😌, the next step in the hierarchy 📊 can be introduced.
Completing an entire stimulus hierarchy 📊 and reducing a fairly strong fear 😱 can be achieved fairly quickly ⚡—it is likely to take several hours ⏰, divided into several separate sessions 📅. In one study with dental-phobic 😱 adults who simply imagined 💭 each step in a hierarchy, the procedure successfully reduced their fear ✅ in six 1 1/2-hour sessions ⏰. Individual sessions for reducing fears in children 👶 are usually much shorter than those used with adults 🧑, especially for a child who is very young 👶 and has a short attention span 👀.
Biofeedback 🖥️📊
Biofeedback is a technique in which an electromechanical device 🖥️ monitors the status of a person's physiological processes 🫀, such as heart rate ❤️ or muscle tension 💪, and immediately reports that information 📊 back to the individual. This information enables the person to gain voluntary control 🎮 over these processes through operant conditioning 🔔. If, for instance, the person is trying to reduce neck-muscle tension 💪 and the device 🖥️ reports that the tension has just decreased 📉, this information reinforces 👍 whatever efforts the individual made to accomplish this decrease.
Biofeedback has been used successfully ✅ in treating stress-related health problems 😰🏥. For example, an experiment was conducted with patients suffering from chronic muscle-contraction headaches 🤕. Those who were given biofeedback 🖥️ regarding muscle tension 💪 in their foreheads later showed less tension 📉 in those muscles and reported having fewer headaches 🤕📉 than subjects in control groups. What's more, these benefits continued at a follow-up after 3 months ⏳. Biofeedback seems to be about as effective as progressive muscle relaxation methods 🧘♂️ for treating headache 🤕.
Modeling 👥🎭
People learn not just by doing 🧍♂️, but also by observing 👀. They see what others do and the consequences of the behavior these models perform. As a result, this kind of learning is called modeling, and sometimes "observational" 👁️ or social learning.
People can learn fears 😱 and other stress-related behavior by observing fearful behavior in other individuals 👥. In one study 📚, children 👶 (with their parents' 👨👩👧 permission) watched a short film 🎬 showing a 5-year-old boy's reaction to plastic figures of the cartoon characters Mickey Mouse 🐭 and Donald Duck 🦆. In the film when the boy's mother showed him the Mickey Mouse figure 🐭, he screamed 😱 and withdrew; but when she showed him the Donald Duck figure 🦆, he remained calm 😌 and displayed no distress. While the subjects watched the film 🎬, physiological measures 📊 of stress 😰 were taken, confirming that the children were more aroused ⚡ while watching the episode with Mickey Mouse 🐭 (fearful 😱) than while watching the one with Donald Duck 🦆. After the children watched these scenes, they each participated in a task that involved the two figures from the film 🎬. At this time, they tended to avoid the Mickey Mouse figure 🐭 (the stressful one ⚠️) in favor of Donald Duck 🦆.
Since people can learn stressful reactions 😰 by observing these behaviors in others 👥, modeling should be effective in reversing this learning 🔄 and helping people cope with stressors 💪, too. A large body of research 📚 has confirmed that it is ✅. The therapeutic use of modeling is similar to the method of desensitization 📉: The person relaxes 😌 while watching a model calmly 😊 perform a series of activities arranged as a stimulus hierarchy 📊—that is, from least to most stressful 😰. The modeling procedure can be presented symbolically 🖼️, using films 🎬 or videotapes 📹, or in vivo 🌍, with real-life models 👥 and events.
Approaches Focusing on Cognitive Processes 🧠💭
Because stress 😰 results from cognitive appraisals 🧠 that are frequently based on a lack of information ❌, misperceptions 👁️, or irrational beliefs 💭, some approaches to modify people's behavior and thought patterns 🔄 have been developed to help them cope better 💪 with the stress they experience. To achieve this goal 🎯, these methods guide people toward what Arnold Lazarus 👨🔬 (1971) has called a "restructuring" 🔄 of their thought patterns or "Cognitive Restructuring" 🧠.
Cognitive restructuring 🧠 is a process by which stress-provoking thoughts 💭😰 or beliefs are replaced 🔄 with more constructive ✅ or realistic 🎯 ones that reduce the person's appraisal of threat ⚠️ or harm 🤕.
Rational-Emotive Therapy (RET) 🧠💬
A widely known approach that focuses on cognitive restructuring is rational-emotive therapy (RET), which was developed by Albert Ellis 👨🔬. RET is based on the view that stress 😰 often arises from faulty ❌ or irrational 🤪 ways of thinking 💭. These ways of thinking affect stress appraisal processes 🧠, increasing the appraisal of threat ⚠️ or harm 🤕.
To illustrate how irrational thoughts 💭 can increase stress 😰 and lead to psychological problems 🤕, consider the case of a college baseball player ⚾, nicknamed "Bart," who was not hitting up to expectations 📉, and was very depressed 😞 about his poor performance. In talking with Bart 💬, it quickly became apparent that his own expectations were unrealistic ❌. For instance, Bart wanted to hit the ball ⚾ so hard that it would literally be bent out of shape 🔨 (if someone happened to find it in the next county 🗺️!). After a particularly bad batting session 📉, he would go home 🏠 and continue to practice until he was immobilized with exhaustion 😫. Simply put, he believed that if an athlete was not performing well 📉, this could only mean he was not trying hard enough 💪.
Bart's therapy involved progressive muscle relaxation 🧘♂️ and cognitive methods 🧠 to help him realize two important things 2️⃣. First 1️⃣, although motivation 💪 and desire do increase performance 📈, they do so only up to a point ⚡, after which additional motivation impair performance 📉. Second 2️⃣, although hitting very well ⚾ is nice 👍, hitting moderately well 📊 is not "terrible" ❌ or "intolerable" 😰. These realizations restructured 🔄 Bart's thinking 🧠 about his performance, and his batting average increased dramatically 📈. Similar methods can help people reduce irrational thoughts 💭 that lead to their debilitating feelings of anxiety 😰 and depression 😞.
There are other approaches also to manage stresses 😰 that include Meditation 🧘♀️, Hypnosis 😵💫, and Massage 💆♂️. These approaches are and can be used in conjunction with the techniques described above. But we will not go into the details of these approaches here.