We need affection to thrive. Research has shown that people who regularly give and receive affection live longer, are healthier, and report a higher quality of life than those who do not. Even having a plant to take care of has been shown to improve health. Gentle, caring touch is therapeutic. One study showed that elders who were taught to massage infants gained benefits for themselves- including increased self-esteem and decreased depression -- from giving massages, while the babies gained by receiving them.

Be generous with your warmth and affection. A kind smile, a handshake, a gentle hug, and saying, "I'm glad to see you," are simple tokens, but mean a lot.

Be willing to ask for affection when you need it. Wanting affection isn't the same as wanting sex. It can be as simple as asking for a hug, or sharing the sofa with a friend. Don't be so sensitive to rejection that you are afraid to ask.

If you are in a relationship where there is no affectionate give and take, talk with your partner about it and see what can be done about filling this important need for both of you. Ask what you could do to restore a feeling of affection with your partner. If necessary, seek professional relationship counseling.

If you don't have a partner, initiate contacts with people you think could become good friends. Get involved in a social activity that you genuinely like. Consider getting a pet. Studies indicate that single people who have pets are happier, healthier, and live longer than single people who don't. The point is, you need affection to resist the ravages of stress - whether it comes from a friend, a family member, or a pet!

Gentle caring touch positively affects stress. Research shows that touch can cause significant changes in physiology for mammals. A horse's heart rate goes down when touched by his trainer. In humans, the effects of massage are quite powerful. Premature babies who received regular massage gained 47% more weight and were hospitalized fewer days than babies who weren't massaged regularly. Massage has been shown to reduce chronic pain conditions such as fibromyalgia, lower back pain and migraines. It can lower blood pressure, reduce asthma attacks in children, and reduce anxious and depressed moods. It has been shown to reduce cortisol levels that dampen immune function and increase natural killer cell activity in HIV-positive adults. Pregnant women who received daily massage for a month reported lower anxiety and depression and had lower stress hormone levels (cortisol and norepinephrine), less sleep disturbance, and fewer complications.

Human connection protects us both psychologically and physically.  A study by researchers at Massachusetts General Hospital in Boston found that patients with relatives living within 50 miles had more successful hospital stays and fewer deaths than did patients without family. Hopefully, family means unconditional membership in an emotional support system that knows - and accepts - you for who you really are. Family members are often our oldest, closest and most trusted friends. For the most part, family can be counted on to provide concrete and practical help in times of crises. While family relationships can be trying at times, family support is one of the best means we know of reducing stress.

  If you have family nearby that you're not close to, see what you can do about strengthening your bond with them. It could help them as much as it helps you. If you are geographically separated from your family, use the telephone or electronic mail to keep in touch and exchange the benefit of emotional support, counseling, and advice.

The family or tribal group has been the basic unit of human connection until modern times when jobs and education often mean moving far away. You may need to create or join a new "family unit".Some religious or fraternal organizations create intentional communities with the specific goal of mutual aid. If you have no family nearby to rely on, see if your friends will adopt you into theirs. Even an honorary membership in a family can help you enjoy the benefits of belonging to this powerful emotional support group.  Cultivate close friendships that include celebrating holidays as well as assistance during times of need. A close group of friends can create family-like relationships and traditions. You can honor these strong friendships that are "like family" with personal loyalty and commitment, especially during difficult times.

One important way to increase your endurance and stress resistance is to get more exercise. Often, when people are under stress, they discontinue those activities they most need, such as exercise and recreation. Exercise leads to fitness and fit people handle stress better. Exercise also improves mood. Forty minutes of fast-paced walking can decrease anxiety for up to four hours. And there's no age limit for exercise. Remember how it felt to drain off your excess energy during recess in elementary school? Well, you may be older now, but you never outgrow your need for recess.

Consistent moderate exercise improves circulation to every system of the body. It strengthens the heart, raises lung capacity, improves overall circulation, and lowers cholesterol. Blood vessels are toned to bring blood more efficiently to the muscles, brain, and all other organs. Exercise helps control weight, decreases the need for insulin in diabetics, and reduces conditions associated with hypertension. Sweating excretes sodium deposits and other wastes from the skin.

As you exercise, your muscle strength and flexibility increase.  This improves your posture and balance, and reduces the risk of muscle or joint injuries. Healthy muscles have fewer cramps and release tension more readily. Upper body exercise reduces headaches caused by neck and shoulder tension. Most lower back pain is caused by spasm of the broad muscles of the back, pulling the spinal column out of line, pinching nerves or cramping muscles of the lower back. Anyone who has suffered a backache knows how stressful it can be.

The best kinds of activity for counteracting the effects of stress are continuous, rhythmic, aerobic exercise such as running, walking, cycling, or swimming. Resistance training such as lifting weights is good for strength development. Stretching, balancing and calming exercises such as yoga and tai chi are especially good for calming the mind. Most importantly, exercise should be based on an activity you enjoy, so you'll be more likely to stick with it. Almost anything that makes you sweat will help improve your fitness level and reduce tension. A recommended goal is to move your body at least 30 minutes per day with added strength training three times a week.

Try joining an exercise group or find someone to go walking with you regularly. Check out a health, swim, or racquet club. Find your early morning TV exercise channel. Consider hiking, skiing, walking, dancing, or bicycling. Take the stairs when possible. Have your exercise become a social activity. You'll push yourself a little harder if you have company. Search your local magazines for recreational opportunities built around community sports or other activities. Or call your community athletic organization or municipal recreation department for information on recreational facilities and activities.

There is no age or ability limit for exercise. Recent studies on weight lifting in the elderly have shown remarkable improvements in fitness for men and women in their 80s and 90s with better mobility and fewer falls. People with physical disabilities enjoy competing in Special Olympics, wheelchair races, or wheelchair dancing. If they can do it, so can you.

By all means, get started with an exercise program, but start slowly and don't overdo. If you're badly out of condition, you may want to seek professional advice from an exercise physiologist, fitness coach, physical therapist, or your physician.

Ways to make exercise a habit:

To make anything a habit, do it
To not make it a habit, do not do it
To unmake a habit, do something else in place of it. Epictetus 60-110 AD

So, you're still smoking.  You probably already know the health risks of cigarette smoking, and that it is the number one preventable cause of heart disease and lung disease. People who care about you may have asked you to quit. You know you need to quit and probably want to, but it's not easy.

Nicotine is psychologically, physically, and behaviorally addictive. Don't try to quit cigarettes all at once. Deal with each of the addictive components separately and give yourself time. There are three elements you need to take into account to be successful.

First the psychological: What have been your reasons for continuing to smoke? Why have you wanted to quit? How do the two conversations within you balance out? Does the discomfort of quitting seem to outweigh the pleasures of smoking? Is it hard to believe you can actually quit after all these years? Can you imagine the pleasures of breathing deeply with clear lungs, perhaps exercising more, and feeling good when you wake up? Do you think about the example you set for children in your life? Do cigarettes feel like a friend? Your particular pros and cons may do battle within you on a regular basis. Psychologists call this the "decisional balance" of the costs and benefits of change. One way to quit smoking is to keep in mind the positive gains of not smoking. Many people highlight the difficulties of quitting and become discouraged. Instead, you'll find it more effective to focus on the pleasures of controlling your cigarette habit: the feeling of clear lungs and throat, the fresh smell of your house and clothing, or the fact that a sweetheart will want to kiss you again.

Another psychological part of smoking is your identity as a smoker. Who did you learn to smoke with? What were the early associations to smoking? Being cool? Being like your parents or big brother? A rebellious act? For some people, giving up cigarettes means saying goodbye to early memories and associations, to an identity. Becoming a non-smoker may seem like betraying a group to which you once belonged. It is easier to quit once you've acknowledged those feelings. Begin to think of yourself as a non-smoker who just happens to still light up.

To Do: First, make a personal decision to quit. Your intention to quit will help with the steps along the way. Make two lists: the pros and cons of smoking and of not smoking. Take a good hard look at your reasons for smoking. Are they valid? What would it feel like to be a non-smoker? Take a look at your reasons to quit. Let these benefits become clearer and clearer to you. Begin to tilt your "decisional balance" in favor of quitting.

Next, the physical: You may smoke because you think it relaxes you. Nothing could be farther from the truth. Nicotine is an insidious poison that produces an artificial stress response involving lungs, heart, and the immune system.  Nicotine increases heart rate and blood pressure, blood platelet adherence (stickiness) and vasoconstriction. This results in abnormally active clotting of the blood and accounts for increased risk of stroke and heart disease (a blood clot in the coronary arteries is a major cause of heart attacks). The risk of heart attack decreases 50% within 24 hours of quitting smoking, due to reversal of these effects.   In the lungs, smoking causes local irritation and slows the movements of the cilia (tiny hair like cells) which clean the lungs. It also depletes your scarce stores of vitamins B and C, which are important to your nervous and immune systems.

You can break the physical addiction either "cold turkey" or by gradual withdrawal. Most people find nicotine reduction easier, followed by a "quit date" for stopping altogether.

To chart your nicotine consumption, use a chart to keep a record of when and how much you smoke each day. Fold it small enough to fit into your cigarette pack. Every time you light up, mark the hour of the day on that day's record. At the end of the week, record the number of cigarettes per day.  Notice the time of day you smoke the most cigarettes. Become aware of the locations and situations where you're most likely to light up.

You can reduce the amount of nicotine you inhale by switching to a lower-level brand, cutting cigarettes in half before smoking, putting the cigarette out sooner or inhaling less. You can reduce the number of cigarettes you smoke by waiting longer between cigarettes, pausing a while before lighting up to see if an "urge" will pass, or drinking ice water instead. This gradual reduction in nicotine level lowers your physiological dependence, lessening the intensity of withdrawal symptoms. Using a nicotine patch or nicotine gum helps some people. Two months of the antidepressant Zyban® has recently been shown to help 30% of smokers quit for at least a year. Do not underestimate the physical addiction part. It is another piece the tobacco companies have deliberately manipulated to keep people smoking. They have wanted your money and not cared about your health for too long! You can outsmart them!

When you have withdrawal symptoms, ride them out as best you can, knowing that irritability, restlessness, difficulty concentrating, and craving for nicotine will pass with time. They are minor compared to enduring cardiac bypass surgery, emphysema, or lung cancer.

Lastly, behavioral addiction: Start to tackle the behavioral elements of the addiction by cutting down on the number of cigarettes smoked or by not smoking at all in those places and situations where you don't smoke much any way. Keep cutting back, and recording, for the next two weeks. Now, set time periods for yourself in which you are going to stop smoking. Start with an hour or two and gradually lengthen the time between cigarettes until you can comfortably go several hours without smoking. These are "quit smoking" practice sessions.

Many smokers believe that smoking helps them to reduce stress. Smoking has evolved into a little ritual: you stop whatever else you're doing, get out a cigarette, light it, breath in, and watch the smoke curl up and away.  Lighting up is automatic with a cup of coffee, when the phone rings, or after an argument. At work, it means leaving the office, going outdoors to stand with other smokers and chat. The place, the time, or the feelings are the triggers that say, "Time to light up." When you plan to stop smoking, it is important to find other ways to relax, take a break, or to concentrate. Learning muscle relaxation skills and deep breathing may help you take that break without a cigarette. At work, you can still go outdoors - to stretch, take a quick walk and breathe in fresh air, walking past the people still smoking.

Reward yourself for progress.  Keep the money you save on unsmoked cigarettes separate for a special treat.  The greatest reward is your sense of pride in resisting addiction to cigarettes.

Finally, set a "quit date" for yourself. Announce the date to friends and family. Hopefully, they'll be delighted to support you. The social support is an added inducement to stay with your efforts to quit. Learn to tolerate the urge to light up. If you wait five minutes, and concentrate on taking long breaths of clean air, the urge usually passes. For the most difficult times, substitute other behaviors, such as drinking water or chewing gum, which are incompatible with smoking.

When you do stop smoking, you'll probably do it on your own. If you need extra help for your special issues around smoking, talk with a professional who specializes in helping people get off nicotine. The Internet also has many resources, chat lines etc.

Persistent Quitting
If you don't make it the first time, quit again right away. Look on your initial attempt as a trial run that will make it easier next time. The best predictor for successful quitting is the number of attempts you make. It's an indication of your persistence to quit. It may take seven or eight tries. Believe that you can do it. Millions have quit in spite of the tobacco companies' seductive ad campaigns. Enlist your support system; ask for help from everyone you know. Keep track of the number of cigarettes you pass up each week. Reward yourself for small and large gains. In any case, keep on quitting. Change your identity from a smoker to a non-smoker. Allow yourself to let go of the rituals of smoking forever.

Things To Do:

Because smoking is such a high risk factor for good health there are many resources to help you quit. Please use them.

In taking five or more alcoholic drinks a week you are increasing your vulnerability to stress and may be creating artificial stress for yourself. Reducing your alcohol intake is one of the best moves you can make for your overall physical and mental health. Some people tend to drink the most during periods of high stress. Just when they need their wits about them to deal with high priority problems, they fog their minds with alcohol, making it harder to think clearly and respond appropriately to demands and pressures. Others drink to unwind after a busy day, to shift gears from the high energy, intense activity of work to the slower paced, relaxed, easier evening mood. Yet, that sense of relief from stress and tension is quite brief, and the side effects can cause diminished mental ability and poor health. Even in the short run, alcohol chews up your body's precious stores of vitamins B and C, impairing the functioning of your nervous and immune systems. In the long run, alcohol increases stress by releasing stress hormones and creating a chemical imbalance leading to increased arousal, tension, and anxiety. In addition, alcohol is a central nervous system depressant, increasing the likelihood of depressed mood. Cutting back on alcohol will increase your resistance to stress; managing your stress will help you cut back on alcohol.

Alcohol is psychologically, physically, and behaviorally addictive.  Don't try to quit alcohol all at once. Just be alcohol free one day at a time. Deal with each of the components separately and give yourself time.

First, are you willing to cut back? Begin by asking yourself if you use alcohol as a self-medication for your physical reactions to stress. Instead, try unwinding with exercise or 20 minutes of yoga or deep muscle relaxation exercises at the end of your day. Have a non-alcoholic drink first to quench your thirst. Use an ounce jigger to measure your liquor and water, soda or tonic to dilute the alcohol. Increase the number of alcohol free days. Find other ways of relaxing in social or tense times. Limit yourself to one drink on social occasions. Start by having a few alcohol-free days.  Then make a commitment to be alcohol free for a day, a week or a month. If this doesn't work, you may have a more serious problem with alcohol and need more specific support to stop, like counseling or help from Alcoholics Anonymous (AA).

For information on some basic techniques to help keep your mind calm and body quiet while you're quitting, try our TOOLSsection and pick out the techniques you think will be most useful to you. 

Teamwork makes life go smoothly and easily, whether it's on the basketball court or handling domestic chores and problems. Teams don't just happen, though; they require good communication. When the home team is working smoothly, home becomes a safe harbor in a stressful world. When it's not, home can become a source of stress itself. You have to talk with teammates openly, honestly, respectfully, and assertively. They need to do the same. If you want problems solved, you must talk about them.

Otherwise, in the absence of regular communication, daily hassles become chronic sources of resentment. Roommates have particular difficulty with this one. If roommates fail to do their share of household cleaning, are late paying their share of the bills, or borrow tools or clothing without asking, household tension can develop into icy silence. What started out as friendship turns into animosity, because of fear of confrontation.

A regular monthly "house meeting" is an opportunity to address such issues without personal attacks. Similarly, families need a regular forum to discuss assignment of chores, schedules, and the allocation of money. Some couples meet together each week to talk about concerns, schedules, or finances to see how they stand. Friday night or Sunday afternoon dinners offer other opportunities to bring up routine family organizational topics. Such meetings do not preclude on-the-spot problem solving, but they may prevent the accumulation of inequities that could cause problems later.

If you have trouble speaking up when you need to, try establishing a special time to talk. Let the other parties know ahead of time the topics you want to cover, so there are no surprises. Let each person speak fully before the other responds.  Reflect or "mirror" your understanding of the other's position before launching into your own point of view.  Take a break if things become heated and come back to the discussion later if need be. Stick to the original topic. Don't digress into old history or other issues.

If you still have trouble speaking up, you might think about professional counseling and/or assertiveness training. See TOOLS section for information on communication skills, assertiveness, active listening, and relationship enhancement.

You need more fun in your life. Recreation is just what it says it is -- re-creation. Doing something for fun is not only enjoyable, it's a potent way to improve your stress resistance and recover from the effects of stress on mind and body. Stress Directions' research indicates that people who "always" - as opposed to those who "never" -- do something for fun at least once a week experience less stress from the demands and pressures of family, feel better about themselves, have less marital turmoil, and suffer fewer physical and mental symptoms of stress. A half smile relaxes muscle tension in the face; a hearty laugh relaxes the whole body and brings fresh air into the lungs.  Games take our minds off of worries and let that part of the brain relax.

One of the important treatments for low mood is increasing pleasurable events. These activities may be as simple as a walk, a favorite food or CD, playing board games or watching comic videos. It may mean planning a major vacation trip or all sorts of things in between. A chance to get silly is an extra benefit. The important idea is to balance work and worry with play.

Make a quick list of ten things you enjoy.  Do one or two each week, then add ten more.

If you have difficulty having fun at least once a week, think about what's holding you back and consider getting support for changing your mind. For example, do you think having fun is frivolous or sinful? Do you think you don't deserve to have fun? As one client put it "What if I waste all that time being happy?" If so, explore these questions with family, friends or a counselor.

You say you have trouble organizing your time. If you have too much to do in too little time, you have a sure-fire recipe for stress. You can't make more time, but you can make better use of what time you have. Those who manage their time effectively have far less stress and fewer symptoms of stress. The three P's central to effective time management are:

• PRIORITIZE -- Spend time on things that are important to you; set priorities on how to use your time through goal setting and project planning.
  
  
• PLAN-- Plan time to handle your priorities. Decide on a schedule, know the times of day you function best, set realistic deadlines, and take time daily to think, relax, and exercise.
  
  
• PROTECT --Most of all, protect your time. Avoid unwanted demands and time wasters. Learn to delegate tasks, utilize teamwork, and enlist support.

Watch out for the biggest time waster of all: PROCRASTINATION. Procrastination is a mix of perfectionism, overestimation of the difficulty of the task, and undervaluing the rewards. Fear of failure and criticism, low frustration tolerance, guilt and helplessness also contribute. Don't wait until you feel motivated: act! Motivation will follow when you see the results of your actions, and this will propel you onward.

Getting started is often the most difficult part. To help you get going, try the "15- minute rule." It's simple: don't plan to work for several hours on your project. Decide only to do fifteen-minute segments at a time.You can do more than you think you can in a short period. At the end of fifteen minutes, if you are working well, you can decide to continue for another fifteen minutes. If, however, you want to stop, you may.  One of Murphy's Laws states: "The task expands to fill the time allotted to it." In any case, after 15 minutes you will know what needs to be done next. When you decide to quit for the time being, reward yourself for what you accomplished, rather than berate yourself for what you left undone. Driving yourself with anxiety will only increase your avoidance of the task the next time.

For help with time management and overcoming procrastination go to TOOLS section.

You report you drink more than three cups of caffeinated beverages per day. You should cut back to one or two. Over the years we've seen a lot of "stress" clients for whom caffeine, not stress, was the problem. The caffeine in one or two cups of coffee improves performance and efficiency and reduces fatigue. Too much caffeine, though, disrupts peak performance, damages your health and increases your susceptibility to stress. It makes you irritable and nervous, and disrupts your sleep and digestion. Very high doses of caffeine produce a condition indistinguishable from an anxiety attack. It can also increase blood pressure and heart rate. Caffeine also can cause constriction of the blood vessels, contributing to certain types of migraine headache.

Caffeine is a powerful stimulant. It releases large amounts of the major stress hormone, adrenaline, from the adrenal glands. Your body responds to caffeine-released adrenaline in the same way it reacts to stress-released adrenaline. When you consider that a large mug of strong coffee releases enough adrenaline to triple the amount circulating in your blood stream, you start to realize you're drinking stress by the mugful several times a day. Add to that the fact caffeine has a half-life of four to six hours (that means it takes that long for your body to metabolize half of your dose of caffeine) and you start getting a picture of what it can do to you. Caffeine can stay in your system for hours, causing adrenaline release that creates an artificial stress response. This can keep you "wired" and tense for hours, interfering with sleep. It also destroys those vitamins B and C so vital in the functioning of your nervous and immune systems.

Fifty to 200 milligrams (mg) of caffeine can produce these pharmacological actions, depending on your sensitivity to caffeine. 250 mg. is considered a "large" pharmacological dose and is enough to triple the circulating levels of adrenaline in your system. Many people in the course of a day easily exceed this dosage. For example, three cups of coffee, two over-the-counter headache tablets, and one caffeinated cola drink consumed in one morning is approximately 500 mg. of caffeine.  

Brewed coffee is only one source of caffeine, containing about 150 milligrams (mg) per cup. Instant coffee has about 100 mg. Caffeine is present in tea (60-75mg), certain cola drinks (50mg) , many prescription and over-the-counter medications, and chocolate -- to name a few.  Check the label to be sure. 

Caffeine is a highly addictive drug. Habitual users develop a tolerance for it. They need more and more caffeine for the same effect, resulting in a physical and psychological dependence. Abrupt caffeine withdrawal can cause lethargy, irritability, headache, feelings of tension and low mood. Don't try to quit caffeine "cold turkey." Instead, put yourself on a gradual withdrawal schedule taking about a month to really "kick the habit." How? Use a simple principle of behavioral medicine: gradually change your behavior. Continue to drink the same number of cups of coffee each day but gradually substitute decaffeinated coffee for the late afternoon and evening cups. Finally switch to decaf for all but the first cup of the day. In the meantime, explore herbal teas, juice and flavored waters. You can develop healthy habits in the place of ones that add to your overall stress.
 

You need to take more quiet time during the day. For some of us, the strategy for stress management is to go even faster to get everything done. This works in the short run, and is a good strategy in a crisis. Unfortunately, most of us also have a breaking point when efficiency turns to ineffectiveness, fatigue, and burnout.

One of the most effective stress reducers is the ability to slow down temporarily or stop all activity so that your mind and body can rest briefly. The ability to slow down during the day indicates that you can let go of the pressures of tasks left undone, and do something for yourself. After a renewal period, you can be on the go again.

Your quiet time may be a 15 minute break mid-morning, having lunch by yourself, or sitting quietly for a few minutes at the end of the day. If you work long hours, it may mean a walk or a brief nap before the "second shift." Outside of work it may be reading the newspaper or a magazine, gardening, sitting doing nothing, listening to music, or taking a long bath. Fifteen or 20 minutes of quiet time twice a day slows your metabolism, lowers your blood pressure, reduces your heart rate and rests your mind and body. To get the most from quiet time, do something that completely rests your mind and your muscles, and gives you a better perspective on life. Meditation, auto suggestion exercises, guided imagery, yoga and progressive muscle relaxation are the activities that yield the most powerful effects.

If you think you can't take time to relax, either you're too busy for your own good, or you have a mistaken view of efficiency. Taking quiet time can recharge mind and body, increase your energy level, and raise your general level of efficiency and effectiveness. Recharging your batteries sometime during the day is an investment in health, happiness, and productivity.

In the TOOLS section of the web site is information on how to do a complete muscle relaxation exercise, how to quiet the mind, how to use autogenic suggestion to calm yourself, and a general discussion on self-regulation. An example of auto suggestion for relaxation is:  Sit quietly with your eyes half closed. Silently and slowly say to yourself, "Let my arms feel heavy and relaxed. .. Let my legs feel heavy and relaxed...Let my breathing be gentle and even...Let my mind become calm and quiet...with fewer and fewer thoughts.

Stress Factors Section

Factor scores are based on a mathematical analysis that looks for patterns across items of the Stress Navigator. These scores offer additional information about the nature of the stress you're experiencing and about the stress issues that cut across the various parts of your life.

You're not having much of problem with acute stress, and that's great. What's not so great is that you are having big problems with chronic stress.

Chronic stress is a serious problem for you. Chronic stress is difficult to recognize for what it is because it has probably been around so long that you no longer notice it. Chronic stressors are those situations that last for months or years. It may be a kind of stress that you carry around inside. Assuming "that's just the way things are," you may not do anything about it.

At best, chronic, grinding stress will make life miserable; it may seem like there's no relief in sight. At its worst, chronic stress impairs the immune system, making you vulnerable to frequent colds, influenza, and infections. It can also damage your hormonal system making you prey to arthritic joint pain, thyroid dysfunction, or menstrual difficulties in women. . In short, there's very little good to be said about chronic stress. It makes life miserable and can ruin your health if unchecked.

Chronic stress conditions can be reversed, but it takes time, patience, and persistence. Because chronic stress rarely goes away on its own, you might want to see a professional to help you identify these stressors and help start an action plan to get them under control. In the meantime, it is important that you take the time to take good care of yourself

On top of your elevated level of chronic stress, there are other factors that you should be aware of in your stress profile. The first of these is Personal Loss.

Personal loss with its grief and mourning are stressful. Your personal loss contributes to your overall pattern of stress to a great degree. While it's difficult enough to bear loss, the grief and mourning that accompany it can be just as painful. You may experience all the phases of loss: disbelief --"This can't be happening!", bargaining - "Isn't there anything I can do to undo what is done?", unreasonable anger -- cursing the fates, deep and often painful sadness that feels like it will never end, and eventually, acceptance. Accepting the finality of loss is difficult, but, in the end, necessary. Don't avoid or hurry through your period of grief and mourning. It takes time to work through and it's often painful. But it's the only way. Allow the support of others to sustain you during this time.

Talking to friends and relatives can help you get through your grief and mourning, but sometimes it takes a little more. You might want to talk to a counselor, minister, priest, or rabbi about your grief. You can seek solace and refuge in your faith if you are a religious person. Or, try to get a broader philosophical perspective on loss and change as a necessary part of life. For more on improving mental control go to Tools section.

Stress arising from Marital Turmoil is an element of your stress pattern you might want to address.

Right now, you're experiencing a lot of stress from the turmoil in your marriage or primary love relationship. When your relationship is going well, it is a source of contentment and happiness that helps insulate you from the stresses and strains of the workaday world. When it's not, life can be miserable. You're not only deprived of a source of happiness and contentment, your marital difficulties generate their own stress. It's important that you do something about it before things become worse.

Marital turmoil has a way of affecting everyone in the family: children, parents, friends, and even distant relatives. Getting things back to "normal" isn't easy. It takes the commitment and effort of both partners, and it sometimes even requires professional help. Professional impartiality and objectivity can enhance communication and bring a note of reality - and fairness -- to the proceedings. For more on relationship and interpersonal skills go to our Tools section.

Powerlessness is a third point in your stress profile.

A pervasive sense of powerlessness shapes your stress profile. You seem to feel that a lot of things are outside of your control: your finances, personal freedom, bodily functions, employment status, personal relationships, and where you live. Things just seem to happen to you and you feel powerless to do anything about it. It's a very stressful feeling and can lead to anxiety or depressed mood. Taking even small actions to deal with your concerns can make a difference. For more on improving mental control and taking action go to our Tools section.

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Sources of Demands and Pressures Section

This section of your Stress Navigator report tells you where your stress comes from in your life and gives you some ideas on what you can do to make these life areas less stressful. Your stress appears to be rooted in at least  three areas of your life.

Your family is the number one source of stress in your life. 
Family life is a major source of stress for you. The most common sources of family stress are holidays or vacations, disciplinary problems with children, family conflict around household chores or money, sibling rivalry or increased arguments with family members. Certain family developments can also be a strain such as the birth of a child, inability to have children, caring for elder relatives, changes in work schedules, or a family member moving in or out. Particularly difficult sources of stress include marital or sexual difficulties, someone with special needs, issues associated with divorce or violence.

High family stress is particularly difficult because it is so personal and often has deep emotional overtones -- leftovers from earlier family experiences. Conflicts over simple issues, like chores or finances, can have symbolic meaning. And when differences appear - because of family obligations, expectations, lack of or differences in communication, or conflicting values - it can feel like the people closest to you are very far away.  Remember, the past does not control the future. You can set a new direction for your family and work to achieve it.

Stress in general can also increase family and relationship stress. When we are under stress, there is a tendency to become more self focused and self protective and less conscious of others' needs or concerns. Communication breaks down and everyone feels neglected. Small irritations become large. Misunderstandings escalate. Unfortunate words are spoken.  If your family stress is greater because of financial or work stress, you may need to address those first.

Structural changes -- illness, birth, death, divorce, unemployment, remarriage, or caring for elderly or special needs relatives  bring with them stresses that can feel overwhelming. While most of us eventually make the necessary adjustments and learn to deal with the new family structure, initially, change can be very hard to accept.

There are a number of ways to alleviate family stress. First, take care of yourself before assisting others. Find ways to get your own needs met directly - whether it is more rest, time with your partner, or quiet time alone. Then, spend more time with family members so issues can be dealt with as they come up, a little at a time, rather than on the fly between crises. Develop firm limits and expectations of children. Overindulging children because you are too stressed to discipline them consistently only creates more stress in the future. Teach other family members how to take care of household chores and expect them to help.

Learn to deal with - and solve - problems as a family. This involves several steps:

• Identifying the problem
• Generating several possible solutions
• Picking a plan
• Implementing the plan
• Following up on the details
• Reevaluating how things are going.

If you don't have good results using your own problem-solving skills, seek help. Family therapy, assertiveness training, and parental training, are all good options if you have difficulty managing family stress on your own. Family life can - and should -- be a source of support and a powerful antidote to stress in other parts of your life. If it's derailed, do whatever you can to get things back on track.

For information on various skills (such as communication and assertiveness skills) that help reduce family stress, go to our Tools section.

A secondary source of stress for you is your environment. Environmental stress comes from problems with traffic and transportation; difficulty with neighbors, roommates, a landlord or tenant; environmental pollution and deterioration. It also includes adjusting to a new neighborhood, problems with schools, lack of recreation facilities, and in-home construction.

Finding a solution to environmental stressors may seem daunting because it usually involves getting other people -- your roommate, your boss, your neighbors, or your governor -- to take action, too. That doesn't mean you shouldn't try. Nor does it mean you can't be effective. One way to start is to "think globally; act locally." You can start this idea easily at home: Begin by fixing up one room; make it a beautiful and serene haven. Expand from that success to the community; mobilize local resources to help make the neighboring environment less stressful. Lobby officials at the state or federal level to reduce stress in the larger environment.

It takes work, skill, and patience. But the result -- a less-stressful environment - is worth it.

Your job is the number three source of stress in your life.

You need to address your job stress because it may be affecting your health and how well you do your job. Research shows that moderate amounts of motivation/pressure keep us alert and improve task performance. Stress increases performance up to a point but then performance deteriorates. Just what that point is depends on who you are and the type of task you are asked to do. The more a task requires complex mental ability, the more stress inteferes with performance.   Jobs requiring judgement, decisionmaking and creativity are much more susceptibile to a decrease in performance. Routine jobs that require less thought can tolerate more stress and are best done at the end of the day when you  are not at your best.

The economic and employment volatility of recent years has created uncertainty and frustration for many employees. The most common work stressors are pressured deadlines, setting and meeting work goals, long hours, fear of error and management indifference to employee conditions or concerns. The most stressful activities are work-related travel and dangerous working conditions. Burnout, poor job fit and traumatic events on the job may add to your particular job stress. And your job stress can have significant consequences for your mental and physical health. Scientific studies have linked job stress to hypertension and coronary heart disease as well as to general fatigue, irritability, and emotional distress.

If it feels like there are too many demands at work, check first to see if you are putting some of those demands on yourself. A personality trait that tends towards unnecessary perfectionism can add a great deal to the workload. Next, see which demands you can say no to, or defer to a later time. Sort the tasks into A, B, and C categories. "A" tasks are those that absolutely need to get done, done well, and on time. "B" tasks are those that are important to complete when you can, and are completed in a "good enough" fashion. "C" tasks are those that may only get done when there is down time or may never get done. If they are really important, they'll move up into an "A" or "B" category.

If a supervisor or coworker is placing excessive demands on you, explore whether or not you can say, "No, I won't be able to get to that for a while," or, "Which job should I drop to take care of this new assignment?" At least, buy a little time by saying, "I'm not sure how that is going to fit into the schedule." These assertive responses begin to set up a dialog about allocation of resources and setting of priorities.

The most stressful type of job has a combination of three factors: many demands, little control over the work, and low social support.  The jobs with the least strain combine high control over the work, and high social support with moderate demands.

High control in a job means you have the authority to make decisions based on your skills and creativity, and the opportunity to keep learning and developing new skills. Decision authority means you have freedom to influence decisions and can choose how to perform your work. An assembly-line atmosphere that reduces workers' skills and influence can produce passivity, learned helplessness, and lack of participation at work, in the community, and even in politics. Increasing your participation, self-esteem, motivation to learn, and sense of accomplishment will lead to greater job satisfaction.

Some questions to ask yourself: What parts of the job do I control? Am I ready to learn something new that might change things? Is there opportunity for creative thinking or action? Have I underestimated my ability to make certain decisions? Then experiment for a few days on taking more control at work. An important step in getting control of job stress is asking for a written job description. It is also important to polish your job skills including skills in organization, goal setting, time management, self assertion, communication, conflict resolution, interpersonal and social skills. As you further develop these skills, you'll be in a much better position to deal effectively with stress on the job.

Workplace social support makes a difference. Having a supportive supervisor, coworkers that you respect and are friendly with, and a sense that upper management is supportive of employees can make difficult and demanding work worthwhile. If lack of social support on the job is an issue for you, ask yourself whether this situation is something you can alter. Can you initiate more social contact yourself? Are you supportive to others? Is there a specific interpersonal problem you could tackle? Do you have at least one friend on the job that is supportive?  If not, can you get support for your work or career in the community?  Business or professional groups may offer contacts and the opportunity to meet people who may be helpful.

 For your particular work concern, begin by deciding if you can alter, avoid or accept any part of your situation and then develop a plan of action for reducing stress in the situation. You might alter the situation by using good communication skills to work things out with your supervisors or coworkers. You could alter the situation by negotiating a clear job description with the company and making sure they honor it. If you have tried to resolve the stress situation to no avail, it may be better to avoid it when possible. Limit your contact with difficult coworkers, only speaking with them in brief polite exchanges and communicating as much as possible by memo.

Job stress doesn't always have to affect your health and performance. You can  practice mental calming and physical relaxation strategies so you don't get so tense. Or stop personalizing situations as much. Develop a broad perspective of time or your personal value. This can help you tolerate a particular aspect of the job that is onerous.

Go to our Tools section for more information on how you can develop skills such as conflict resolution, time management, and assertiveness for more effective management of job stress and burnout.

Stress Symptoms Section

This section of your Stress Navigator report addresses the symptoms that are causing you distress and discomfort. The more susceptible you are to stress and the higher the stress levels you're experiencing, the more likely you are to experience symptoms. The most effective ways of dealing with stress symptoms are to take better care of yourself, so you are less susceptible to stress, to find ways to reduce stress at its source, and to treat your symptoms.

Have you had a recent medical check up?

This report is not a substitute for good medical care. The mind can only help so much with health-related difficulties. Sometimes symptoms usually associated with stress have other causes; it may require a medical examination to determine if this is the case.

In our Tools section, we offer you a number of behavioral techniques for dealing with stress-related symptoms. These techniques can help to relieve the discomfort and distress of your symptoms. But there are no substitutes for proper medical attention and care. If you have high scores on particular stress symptoms, see your doctor. Stress may well be the culprit, but let your doctor help determine that.

Your stress symptoms are primarily physical in nature.

Your immune system appears to be a primary target for the stress in your life.
Colds, the flu, allergies, infections or generally feeling unwell suggest that your immune system is not operating at its best. Stress can make the immune system either under- or overreact. Stress precipitates and/or worsens many infectious, malignant, allergic, and autoimmune diseases. Long term, chronic stress has a way of eroding your immuno-competence and making you vulnerable.  This relationship is quite complex, with environmental, genetic, and exposure factors playing a role. Just because there is a link between stress and illness does not mean you should blame yourself for being sick.

Perhaps the biggest problem with chronic, grinding stress is that it's been around so long you've gotten used to it and no longer recognize it for what it is. When you do, you may think there's not much you can do about it. But there's a lot you can do to manage the most chronic stress situations effectively to let your immune system heal. You just can't do them all at once. Things didn't get the way they are overnight and they're not be resolved quickly either. Go at it piecemeal. Develop an action plan that lets you deal with those things you can change within the next four-to-six weeks and ignore the things you can't change right now.

Things to do:

• Don't try to work when you're sick. Take time out to rest and restore body and mind so you can work more effectively when you're ready A few days in bed will help with more than just your current symptoms. Not only will the rest help your immune system recover, it will give you the energy to deal with stress problems more effectively.
• Take time out every day to relax. If you can take 15-20 minutes out to just sit with your eyes closed and let your body relax, you'll be rewarded with increased energy and stamina. Taking time out to relax also lets your immune system restore itself so that it functions more effectively.
  
• Review the Susceptibility to Stress part of this report to see what you can do to make yourself more stress resistant.
• Stay connected to the important people in your life.  Social support is proven to help conquer illness.
  
• It's important to control chronic stress before your immune competence goes beyond its limit and you succumb to more serious and debilitating diseases. Take better care of yourself to make yourself less susceptible to the stress and reduce stress at its source so that it doesn't continue to grind you down.
• The stress that may be causing your immune problems has probably been in your life for a long time and it may take major life adjustments to get it under control. You may need to consult a stress management professional to do that. Remember though, there may be other causes for your symptoms that have a medical basis. Our behavioral recommendations should be used in addition to medical recommendations you have received.
• See our Tools section for scripts on progressive muscle relaxation and autogenic imagery. They can help a lot with immune difficulties..

In addition to your other symptoms, you seem to be experiencing hormonal or endocrine symptoms, possibly from stress.
Stress seems to be having a prominent effect on your endocrine system. It's not just any stress. It's the wear and tear from long-term pressures that can interfere with the normal functioning of the endocrine or hormonal system, in ways that can be quite debilitating. If you're a woman, it may show up as premenstrual difficulties or as menstrual irregularities. No matter what your sex, however, chronic stress can contribute to serious endocrine problems such as arthritis, diabetes, thyroid dysfunction, infertility (male and female), skin rashes, and debilitating general fatigue.

One of the body’s responses to stress is the release of regulatory hormones from the pituitary and cortisol from the adrenal glands. In the short term, these biochemical responses are beneficial, releasing sugars, adjusting insulin, boosting the immune system and protecting against inflammation and allergies. Chronic or intense stress disrupts this delicate balance of biochemistry. Sex hormones can become inhibited. A genetic predisposition for diabetes or other endocrine problems may become activated.

Chronic stress is a serious matter and should be taken care of as soon as possible. You can get a start by taking better care of yourself to make yourself less susceptible to stress. You should also reduce stress at its source, so that it doesn't continue to grind you down.

Stress that causes hormonal problems is the result of long-term pressures and may require major life adjustments to control. You may need to consult a stress management professional to do that. Remember though, there may be other causes for your symptoms that have a medical basis. Most endocrine difficulties also require medical attention. Our behavioral recommendations should be used in addition to medical recommendations you have received.

See our TOOLS section for scripts on progressive muscle relaxation and autogenic imagery. Though they are no substitute for medical care, these exercises can help a lot with hormonal problems.

Your third highest group of symptoms is related to the parasympathetic nervous system.

Your parasympathetic nervous system (PNS) takes care of the details in the body like regulating heart rate, digestion, excretion of bodily waste, and sexual functions. Physical overarousal associated with acute stress can cause PNS symptoms such as indigestion, heartburn, "acid stomach," gas, diarrhea, constipation, irritable bowel syndrome, colitis, difficulties with urination, and sexual dysfunction.  Examples are the “butterflies”, nausea or diarrhea some people experience before public speaking engagements or the inability to respond sexually due to performance pressures.

 The parasympathetic nervous system is part of your autonomic nervous system. It usually decreases arousal, and slows you down again after a stressful reaction. After the body speeds up, it needs "brakes" to signal it to slow down. If you are unable to slow down or relax, PNS complaints may eventually appear. The other piece of the autonomic nervous system, the sympathetic nervous system (SNS), increases physiological arousal and is responsible for "speeding things up". Between them, they handle the general housekeeping of the body and do so fairly automatically. (Hence the term autonomic.)

Under duress, gastrointestinal needs for oxygen are partially postponed.  Oxygen is partially directed away from the digestive tract to the large muscles, in preparation for “fight or flight”.  Digestion slows down or stops. When stress passes, and you quiet down through deep breathing and muscle relaxation, the flow of vital oxygen increases to your gastrointestinal tract and function returns to normal.

If you have experienced prolonged or severe stress without periods of recovery or relaxation, the gastrointestinal tissue or muscles can become sensitized to overactivation. Then, even when the irritation is minimal, symptoms can occur. Symptoms can persist long after the stress that caused them has vanished. If specific symptoms run in your family, you may have a genetic predisposition to those types of disorders. A prior illness or irritation may also weaken tissue; later, acute stress may affect the weak link. 

Things to do:

•  See your physician if PNS symptoms are frequent or persistent
• Avoid excessive use of over the counter medications to treat the symptoms.  They can interfere with long term healing.
  
• Practice progressive muscle relaxation (PMR) to learn how to slow down your body when it becomes overly excited.
  
• Set aside quiet time and simple relaxation before and after eating
  
• Use gentle self-suggestions such as "Let my stomach become calm and quiet."
  
• Learn deep breathing as a quick way to increase oxygen to the digestive tract.
• Develop other self-soothing practices: yoga, Tai Chi, mental control of worry, mental  imagery, and self-hypnosis. These techniques help to quiet your body so that tissues are not over stimulated and can gradually return to normal, healthy functioning.
• Consider hypnosis or biofeedback if your symptoms are persistent or severe. An expert therapist can teach you how to use these strategies for optimal quieting of this part of your body.
  
• See our TOOLS section for details on PMR and mental imagery and other strategies for self-regulation of the body.