The information provided by Advanced Healthcare for Women and E. Daniel Biggerstaff, III, M.D. is for informational purposes only. As each woman is unique, do not rely on this information for diagnosis and treatment. We cannot guarantee the accuracy of the content and advise that you see a qualified Health Care Professional for individual needs and care.

STRESS IN WOMEN

Stress is much more prevalent in today’s world than that of our parents or grandparents.  Global competition, along with a striving for a higher standard of living, results in a fast-paced environment and a complex lifestyle.  For most, there are not enough hours in the day to get everything done that needs to be done.  The result is STRESS.

For a number of reasons, women are more susceptible to this “stress phenomenon” than their male counterparts.  The traditional roles of women as wives and mothers have evolved into new roles – single mothers, students, and employees/employers.  In many instances today’s woman assumes multiple roles at the same time such as wife, mother, student and employee.  The result is “not enough hours in the day.”  To make the situation even worse, the male partner (if there is one) may not have shifted his traditional role to help around the house and with the children. Regarding the single mother, the numbers have increased from 5% of all households in the 1940’s to over 20% currently. 

The biological effects of stress are multiple and complex.  Especially with acute stress, increased levels of adrenalin cause the “flight or fight” response.  The heart rate increases, blood pressure goes up, and tremor may result.  Excess cortisol from the adrenal glands interferes with normal glucose (sugar) metabolism in the brain.  The brain needs rich sources of glucose to function – lack of glucose makes it hard to think. With chronic stress there is reduced production of endorphins by the brain.  Endorphines are chemically related to morphine and make us feel good – not enough endorphins, and we do not feel good.

As a result of the chemical effects of stress, physical problems may include:

The emotional toll of stress may result in depression, anxiety and mood swings, poor self- image, and dysfunctional relationships.  Bottom line, you do not feel good.  As a consequence, you do not get enough sleep; have poor eating habits; frequently use alcohol in excess, smoke too much, and may abuse drugs; do not get enough exercise; and are at increased risk for disease.

The treatment of stress involves either eliminating source of the stress or changing the way the stress affects us, or both. Elimination of the source of stress may require getting a new job or getting a new partner.  This is not often a practical, or even possible, alternative. Very few jobs have no stress. Be careful when making this choice to prevent “jumping from the frying pan into the fire.” If the stress source is teenage children, we do not have the opportunity to “trade them in.” 

If the source of the stress cannot be eliminated, we must change the way stress affects us. This is done through carefully planned lifestyle change.  Lifestyle change is not something that can be accomplished casually.  A commitment with careful planning and careful follow-through is necessary.  To change the way stress affects us, we must:

1. Take control.

2. Develop a positive attitude.

3. Eat healthily, avoid drugs and tobacco, and consume alcohol in moderation.

4. Use regular physical activity to relieve tension.

5. Get adequate sleep.

6. Take a break.

7. Be social and spiritual.  A medical study several years ago looked at patients who had recently suffered a heart attack.  Those who participated in regular spiritual (religious) activity were 50% less likely to die within 6 months than those who did not.  The same thing applied to those who participated in regular social activities.  Those who were both social and spiritual had a chance of dying that was even lower.

The process to carry out life style change includes,

• Set goals, in writing.

• Set a date.

• Use positive self-statements.

• Keep a log.

Success in this process can only be achieved with positive thoughts, words, and actions.

1. Setting goals – Goals must be positively stated, must be realistic, should be challenging, should be well defined and concrete, and must be written.  Examples of personal goals include lose weight, quit smoking, become physically fit, get a new job, buy a house, get a high-school/college degree, play a fiddle, go on a well-deserved vacation, or spend more time with family (partner, child, grand-child).  Make the time to write down a list of your personal goals.  Once you have your list, write a list for each goal describing the benefits of making this lifestyle change and the drawbacks of making this lifestyle change.  If your goal is to lose weight, your list may look like this:

Benefits of Making Lifestyle Changes           Drawbacks of Making Lifestyle Changes

Decrease Stroke (Heart) Risk                         Cannot Eat Fast Food

Look Good                                                     Cost of New Wardrobe

Be Able To Play with Children                      Extra Time Needed To Cook

Do this exercise for each of your goals.  Please do it in writing.  Just thinking about it is much less effective than putting it into writing.

Next, write down each goal with the steps to meet each goal.  It may be helpful to separate your goals into short-term (30-90 days), intermediate-range (3-12 months), and long-term goals (1 year or more).  Some of your goals may fit into more than one category.  Lets again use the example of weight loss.  This goal would fit into all three categories of short-term, intermediate-range, and long-term goals.  Steps to accomplish weight loss might include:

Step 1 – Change eating habits

• Read a book on healthy eating, such as The Zone Diet

• Consult a dietician

• Avoid fast food items

• Take a lunch to work

• Buy healthy snacks such as fruits and vegetables

Step 2 – Get a physical examination to make sure there are no medical conditions

  contributing to difficulty losing weight such as diabetes or thyroid disease and to             

  make sure there are no contraindications to exercise.

Step 3 – Develop an exercise program

• Consult a certified trainer

• Begin an exercise program slowly and work up to some form of exercise 5-7 days per week

• Set a daily time for exercise that is most convenient

• Get a partner – regular exercise is easier with a partner.

2.   Set a date to begin working towards you goal(s).  This will help get you psyched and assist in making a commitment.  You are worth it!

3.   Write positive self-statements for each goal. Write down five self-statements for each goal chosen.  Always use “I” and always use the present tense.  With weight loss as your goal, examples of positive self-statements are:

• I am becoming more healthy.

• I am eating healthily.

• I am exercising regularly.

• I am avoiding unhealthy snacks.

• I am losing weight.

At least daily, read your positive self-statements.  This is especially helpful if you are not feeling good about yourself.   The concept of “the power of positive thinking” really works.

4.      Keep a log of your activities – when and why you do something.  For example:

1. Exercise – when, how much, and what keeps you from doing it.  It is medically dangerous (increased risk of heart attack) to exercise infrequently.

2. Healthy eating – three-day log of what you eat and drink including quantities and reasons for eating (hunger, stress, boredom).

3. Your thoughts – reinforce positive thoughts and free your mind of negative thoughts.

5.      Realize that SUCCESS = positive thoughts, words, and actions.

·         “I will,” not “I will try.”

·         “I choose to change things,” not “I cannot change things.” 

A quote from the late Ghandi reiterates the importance of being positive in everything you think, say, and do.  “Keep my words positive, for they become my behavior.  Keep my behavior positive, for it becomes my habits.  Keep my habits positive, for they become my values.  And keep my values positive, for they become my destiny.”

Time spent on lifestyle change always results in more time to do things you need and want to do.

Certain things will increase the likelihood of success with lifestyle change.

1. ·     Take small steps to achieve big goals.  An old Chinese saying puts it well – “a journey of a thousand miles begins with the first step.”

2. ·     Take time for relaxation.  This includes relaxing your mind.  See below for a recommended exercise in “mindfulness.”

3. ·     Visualize the results of your efforts.  Taking a few moments every day to see your “new you” will reinforce your efforts.  “See” yourself after your weight loss, “see” the new healthy you with exercise, “see” yourself playing with children or grand children, etc.

4. ·     Avoid the “apple in the garden.”  You cannot eat what you do not have in the house.  If you have a sweet tooth, avoid buying chocolate ice cream on a regular basis.

5. ·     Change things, habits, and brands.  If you are stopping smoking, take a walk around the block after dinner rather than smoking a cigarette.  Change to a different brand.  Get rid of ashtrays.  

6. ·     Do not deny yourself.  Initially, do not deny yourself something you like.  I could eat a BLT sandwich every night before bed but would be as big around as I am tall if I did this.  Instead, I will eat a BLT maybe once a month.  Allowing myself this indulgence occasionally without significantly affecting my weight.

7. ·     Fight the urge.  It has been shown if you “fight an urge” for 10 minutes, it will go away, at least temporarily.

8. ·     Reward yourself.  With weight loss, go by yourself a new outfit that you look really good in.

9. ·     Accept the hard work.  Something worth doing takes hard work.  You are worth it.

10. ·     Forgive yourself.  We are humans and make human mistakes.  Forgive yourself and get on with your “new” life.

11. ·     Get a partner.  Lifestyle change is much easier with a partner, a friend or a family member, that supports what you are doing – such as exercise.

12. ·     Have a contingency plan.  If you walk outside for exercise, have the appropriate clothing for inclement weather.

13. ·     Be positive – think, say, and do.

Remember, this is not a dress rehearsal.  This is the first day of the rest of your life.  Have a great day!

Mindfulness Exercise.  Relaxation is as important as physical exercise and is frequently neglected in many wellness programs.  Set aside 10 minutes a day (or 10 minutes twice a day if possible), and find a quiet place where you will not be interrupted. While standing upright, close your eyes. It is easier to breathe more deeply, slowly and relaxed if you are standing.

1. Keep your head upright, as if the crown of your head were being supported by a string.

2. Let your shoulders relax a little with your arms comfortably by your sides.

3. Keep your back straight.

4. Bend your knees just enough so you are not stiff-legged.

5. Rock your pelvis forward ever so slightly. At first this posture may feel a little awkward and tiring, but with a little practice, it makes relaxation easier and more effective.

6. Take a deep, slow relaxing breath through your nose with your mouth closed   and with your tongue resting gently against the roof of your mouth.  Then part your lips slightly and exhale slowly through your mouth.

7. With each breath, expand your lungs, largely through diaphragm breathing rather than by expansion of your chest wall. The best way to do this is by letting your stomach relax and letting it “poke out” a little as you inhale. Repeat this breathing exercise several times. 

8. Then take two shorter breathes in to fill your lungs and still exhale in one continuous motion. Repeat several times. 

9. Once you are comfortable with this, it is time to add a repetitive thought to your breathing to enhance the relaxation process. The purpose is to unclutter your mind. Let’s say you choose “one,”  “two” and “three”  (you can choose any letters, numbers, objects, etc. - anything that works for you). As you inhale, think “one”, “two” and as you exhale think “three.”  Repeat slowly. During the exercise, outside thoughts will come to your mind; just let them pass through and go back to “one,” “two” and “three.”  With regular practice, gradually work up to approximately 10 minutes per session.  Open your eyes, and have a great day!  Just as regular exercise is necessary for physical conditioning, so is regular practice for mental relaxation and treatment of stress.

               E. Daniel Biggerstaff, III, MD    August 2005