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There is no simple definition of stress. Some health experts define it by focusing on the physiological changes in the body. Some focus on the symptoms you experience. Still others focus on the situations that trigger these responses.

Health experts do agree that some stress is essential for human survival. Stress can raise your energy level, make you feel challenged and cause the physiological changes required to deal with the situation. This is called, "Positive stress."

What are my body's reactions to stress?
When you perceive or anticipate a threatening or stressful situation, part of your nervous system (the sympathetic nervous system) becomes activated. and releases a number of chemicals including: adrenaline and noradrenaline to get you geared up for action.

The sympathetic nervous system raises your blood pressure. It directs blood flow less to your fingers, skin and toes and more to the large muscles in your arms and legs where it is needed for action.

The released chemicals also increase your heart beat and breathing rates. This ensures that additional oxygen - which is necessary for fast action - is delivered to your body. As a result, you may feel pumped up. Sometimes chronic stress has the opposite effect: you feel fatigued. In extreme cases, you may temporarily feel dizzy or confused, experience blurred vision or numbing of your fingers and toes.

When your body no longer needs this level of activation, another part of the nervous system (the parasympathetic nervous system), takes over and restores a relaxed feeling. If this restoration does not happen immediately, don't worry . It sometimes takes a little time.

What is negative stress?
Some people define " negative stress" as what you experience when you have faced the physical and emotional challenges, but you remain geared up and your stress responses continue beyond normal or necessary levels. Others define "negative stress" as an experience in which the demands of the situation exceed the perceived ability to cope with them.

Negative stress can be furthered by poor stress management and ineffective coping skills

What is the relationship between stress and heart disease?
Less is known about how stress affects heart disease, than about some of the other risk factors which include: cigarette smoking, hypertension, cholesterol levels, family history, diabetes, obesity, and physical inactivity.

Whether stress acts as an independent risk factor or merely aggravates the other risk factors, has yet to be determined. Nevertheless, health experts agree that stress increases the risk of heart disease.

Adrenaline and the other hormones that help you to spring into action during stress, can also increase muscle tension, slow digestion, constrict and dilate your body's arteries, and cause your liver to deliver cholesterol and fat (triglyceride) into the bloodstream. The levels of a certain hormone (testosterone) may increase, which can reduce HDL cholesterol ("good" cholesterol) levels.

Repeated release of these chemicals over time, may cause wear and tear on your heart and blood vessels and eventually lead to heart disease and stroke.

The rise in heart rate and blood pressure during stress may increase your heart's need for oxygen while simultaneously reducing its supply. The heart's arteries (coronary arteries) usually dilate during stress in order to deliver blood to needed body parts as quickly as possible. If you suffer from atherosclerosis ("hardening of the arteries"), your coronary arteries may be unable to dilate sufficiently under stress.

Stress may promote several of the factors that lead to blood clots (thrombosis) of the arteries leading to the heart (coronary arteries).

Certain chronic responses to stress have been associated with heart disease. Two of these responses are hostility and cynicism. If you are chronically hostile and/or cynical, you are more likely to manifest larger increases in heart rate, blood pressure, and stress hormones in response to non-social stressors than are individuals with low hostility.

Depression, and to a lesser extent, anxiety, have been associated with coronary artery disease. Health experts are revising their previously held image of the coronary-prone individual as time-pressured, impatient, and work-driven. Now, they view people who harbor negative emotions, such as depression, anxiety, hostility, or aggression, at higher risk for heart disease.

If you have recent, short-lived depression, you are at a lower risk than someone who has long-standing depression. Your risk may be lowered if you have the support of family and friends

How can I control negative stress?
The stressful events in your life and your behavioral reactions are unique to you. You can learn to modify your appraisal of potentially stressful situations and how you deal with them. You can even exercise some control over your physical reactions. These changes can lead to enhanced health and well-being.

If you would like to manage stress in a healthful way, you must be able to recognize it. First, you should identify which events trigger stress-related symptoms in you. Next, you can ascertain your habitual ways of responding to stress. Then you can learn to develop and substitute more effective coping skills when needed

The first step to healthy management of stress is to identify your personal stressors. The American Heart Association notes the following events and situations as potential triggers of stress:

Life events: marriage, death of a family member or close friend, moving or relocating, birth or adoption of a baby, major financial setback, new job, being fired or laid off, major change in job demands (promotion or demotion), retirement, natural disaster, divorce or separation, crime, major illness of self of family member, major change in spouse's job, and changed living arrangements (addition or subtraction of family members).

Physical stressors: pollution, excessive noise, physical disability or handicap, weather extremes, sleep deprivation, physical injury, lack of rest or relaxation, smoking, excessive drinking, inappropriate drug use, obesity, overeating or junk food, rapid dieting or under-eating, excessive exercise, chronic pain, excessive travel (airplanes, time zones, heavy luggage, unfamiliar bed).

Daily hassles: time pressure, too many responsibilities, traffic or commute, deadlines, conflicts with co-workers, conflicts with spouse; difficulties with children; difficulties with elderly parents; being disorganized at work or home; home upkeep or maintenance; car upkeep or maintenance; household chores; financial problems.

What are typical physical symptoms of stress?
One approach to help you identify your personal stressors is to pay close attention to your body's reactions.. Potential reactions to stress include:

Migraine or tension headaches; back, neck, shoulder aches or tension; fatigue, fingernail biting or nervous tics, insomnia, restlessness (foot-tapping, finger-drumming); lowered sex drive, digestive upsets (acid, gas, diarrhea, constipation); breathing changes ("air hunger", shallow breathing, sighing); teeth-grinding or jaw clenching; sweaty or cold hands; and excess perspiration.

What are other signs of stress?
Another approach to determining your personal stressors, is to pay attention to your thinking. Are you forgetful, distracted? Do you have trouble concentrating? Are your thoughts pessimistic? Are you less creative, indecisive, inefficient? Are you cynical or hostile? Is your self-esteem or morale low?

Next, assess your feelings. How does the situation make you feel? Are you frustrated, depressed, anxious, bored, angry, resentful, apathetic, irritable, intolerant?

Finally, consider your behavior. Are you getting into accidents? Are you abusing substances? Are you withdrawn, disorganized, unable to function as before? Are you engaging in compulsive behaviors (inappropriate eating, shopping, gambling, sex, television watching)?

What are common coping approaches to stress?
The following is a list of coping responses suggested by The American Heart Association. To cope with stress, you can:

  • Listen to music , watch TV, movies, read
  • Write (journal, lists)
  • Get information, ask for help,
  • Attend play, lecture, symphony,
  • Play sports, alk, run or other exercise, stretch
  • Active problem-solving,
  • Pray, meditate, do yoga,
  • Engage in hobby,
  • Look on the bright side,
  • Go outdoors, enjoy nature,
  • Engage in humor, laughter, play,
  • Get more rest, get a massage,
  • Straighten or organize environment,
  • Confront situation,
  • Get away (vacation, trip, camping),
  • Engage in deep breathing,
  • Talk it over with friends,
  • Talk to a therapist, listen to relaxation tapes, read self-help books,
  • Bathe, shower, go in hot tub

Are there drugs I can take to manage stress?
Your doctor may prescribe a medication for relief of stress. These medications include Valium (diazepam) and Xanax (alprazolam). Tranquilizers are advisable only for short periods of time, because they are habit forming. You run the risk of becoming dependent on them.

Your doctor may suggest an antidepressant for stress and anxiety such as Tofranail, Elavil or Nardil.

What can I do to better manage stress?.
You can manage stress by attacking one or more of its components. You can remove or alter the stressor; you can change your perception of the stressful event; you can reduce your physiological reactions; or you can employ alternative coping strategies.

Common stress reduction techniques include: relaxation training, biofeedback assisted relaxation (heart rate feedback), cognitive and behavior therapies, progressive muscle relaxation, meditation, and breathing exercises. If you utilize a combination of approaches you increase your chance of successfully managing stress.

What is progressive muscle relaxation?
Progressive muscle relaxation is a technique you can use to relax your body. This is an effective coping strategy which also impacts on your physiological reactions. The American Heart Association suggests the following technique:

Get into a comfortable position with your head and neck supported. Close your eyes and tense each muscle group listed below to about 25%-50% of maximum tension. Hold the tension for a few seconds as you continue to breathe, then slowly release the tension as you focus on the pleasant contrast between tight and relaxed muscles.: (1) hands and arms; (2) face; (3) neck and shoulders; (4) stomach and abdomen; (5) buttocks and thighs; ((6) calves; (7) toes.

Then, sit quietly for several minutes and enjoy the feeling of a relaxed body before you slowly open your eyes.

What is relaxed breathing?
Relaxed, deep, or abdominal breathing is a technique that helps you to calm down emotionally.

  1. Lie down on your back. Loosen tight clothing.
  2. Inhale through your mouth. Exhale through your nose.
  3. As you inhale, extend your abdomen. As you exhale, pull it in.
  4. As you inhale, mentally count slowly from one to four. As you exhale count from one to six or eight.

Initially, you may want to place your hand on your abdomen to actually feel the inhalations and exhalations, until your deep breathing comes naturally.

Relaxation techniques (muscle relaxation, deep breathing and meditation) reduce your likelihood of suffering from certain heart disease (ischemic heart disease) and the likelihood of undergoing a fatal heart attack.

If you have undergone heart surgery (coronary artery bypass surgery and coronary angioplasty)., you can use these relaxation techniques to enhance and improve your emotional recovery.


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