Importance of Control

0ca3p4uqxcaezm5sbcamyhjjwca2mnuldcazu6gl3ca3ksr6jcagx1argcaeurabeca3ig8azcarzlqq0ca8f92m3cayx7cp6calutl4zcargwg02ca42s0zbcabyfabicav3f9nfcaxm4ai8caskz8neEllen Langer is one of the pioneers in the study of perceived control. Some of her most important findings come from field experiments with collaborator Judith Rodin which were conducted in nursing homes for the elderly. These studies pointed out the significant physical and mental gains that can be achieved in elderly people in institutional settings if they are given a sense that they are at least partially in control of their own lives by being able to choose some of their daily activities. Research has shown that perceived control is crucial not only for one’s psychological well-being but also for one’s physical health. Furthermore there is evidence that believing that one has control may be even more important than actually being able to make the overt responses to cause the desired outcome.

Langer’s theory suggests that conditions that allow people in situations governed by chance to behave as if skills count, benefit from an illusion of control. Skill-related behaviors such as: making choices, thinking about the task and possible strategies to be use, exerting effort while working on the task, learning about the materials and responses to be made, and competing with other people to evaluate ability, reduce a sense of helplessness. This perception gives individuals in a chance situation, in which they have no objective influence on outcome, an illusion of control. In this situation people became motivated to master their environment and to avoid the negative consequences of feeling like they are not in control. They perceive the simultaneous occurrence of chance and skill elements as clouding the difference between the two; and that their behavior is not “irrational” rather it is viewed as a possible opportunity for gain. People tend to make judgments about the causes of events and see themselves as having the ability to determine what will happen if an outcome is positive, even as they ignore the objective reality that they are overestimating the probability of success.

In short, people need to believe that they have some control over what happens to them. While there may be millions of losers in every big lottery, there are also winners. And there really are exceptional people, like the young mountain climber who amputated his own arm to free himself when a boulder imprisoned his arm in an accident. He climbed down a steep incline and walked six miles to safety when he surely would have died otherwise. There are also people like Lance Armstrong who overcame cancer and became the first person to ever win the grueling Tour de France bicycle race six times. There really are heroes. We need to believe that we too can beat the odds and overcome enormous obstacles that would crush lesser mortals. That mountain climber and Lance Armstrong believed they could control events when others might not do so.

According to Langer and her colleagues there are two kinds of control:

Primary control involves changing a situation. Owning our behavior and becoming more resilient requires that we realize that we are the authors of our lives. Instead of always trying to change everyone else we should ask what is it that I can do to change the situation? It is not just the elderly in nursing homes who benefit from feeling like they have some control of their daily activities, it is us all. Research supports the importance of personal control as a major factor in our physical and emotional well-being. A sense of control fosters optimism and optimism can be protective. Primary control means changing the situation.

Secondary control involves how we view a situation. Even in situations that we cannot directly change we can determine how we think about it. Even when faced with major life challenges like serious illness, death of a loved one, divorce, loss of employment and natural disasters a lot of what happens to us emotionally and physically is determined by how we look at the situation. Secondary control means changing the way we view the situation and how we feel about it.


Type A Behavior and Anger

imagesType A people are described as competitive, goal-oriented, productive, ambitious, leaders in the making who are in a hurry. They are competent and determined to be successful—and frequently are. The problem is that they are also likely to be hostile and angry.

The specific aspects of a Type A individual that continue to be related to heart disease are explosive reactions, competitiveness, impatience, irritability and hostility. Lumped together these traits equal anger.

It is the tendency to be angry and hostile that results in the Type A paradox: the anger that drove you to triumph over all obstacles to reach professional heights is the same behavior that puts you at risk for serious illness and death. Closer examination suggests that the crux of the matter is motivation. Type As seek excellence to prove their worth. Type B people, on the other hand, can also achieve personal success but do so because the process is enjoyable to them. Type Bs feel secure inside and do not need hostility or competition to succeed.

While discussions about adrenaline and noradrenaline—two of the stress hormones associated with the sympathetic nervous system (SNS); its opposite, the parasympathetic nervous system (PNS) is less frequently discussed. This is unfortunate since the parasympathetic nervous system is vital for survival. When activated the parasympathetic nervous system released a compound called acetylcholine to any tissues served. Once inside of a cell acetylcholine has the ability to neutralize adrenaline. Most organs involved in the fight or flight response receive input from both the sympathetic and parasympathetic nervous systems. The PNS can put the brakes on the fight or flight physiological changes. It cools us down and calms us. It puts the brakes on anger.

In a series of studies carried out in Japan it was discovered that Type A men, especially those with high hostility levels, have weaker parasympathetic nervous systems than men with low hostility levels. An effective PNS can help counter the effects of the SNS which results in the heart working less hard and lowering the risk for developing heart disease.

There is also research that indicates that the immune system may be weaker in hostile people. The immune system is thought to play an important role in helping keep us cancer free, especially in the action of “natural killer cells” which can kill tumor cells that form in the body. A study involving low and high hostility scoring med students indicated a reduction in the natural killer cells in the blood of high hostility students during high-stress exam periods.

In summary, hostile Type A people are wired differently. Their SNS is activated at the slightest provocation while nonhostile people’s SNS show relatively small responses to even strong stimuli. The end result is that hostile people spend more time under the influence of an aroused nervous system which can set the stage for the development of heart disease because of repeated exposure to elevated cardiac demands, increased mobilization of cholesterol into the blood, and increased clumping of platelets while the immune system functions are decreased. This difference in exposure may account for the increased death rates seen in aggressive Type A individuals.

Heart disease

If your immediate impulse when faced with having to wait in traffic or in a long line at the grocery checkout, or dealing with a recalcitrant computer is to start blaming people, and getting angry you are slowly killing yourself. Your anger has turned into hostility and you are at increased risk from death from many causes.

Research indicates that high hostility levels in older men are strongly related to the development of heart disease. Hostility appears to be a greater risk factor than high cholesterol levels, smoking, and being overweight. Furthermore the older men in this study with the highest levels of hostility were at the greatest risk of developing heart disease. This increase in risk appeared to be independent of insulin levels, body mass index, waist-to-hip ratio, triglyceride levels and blood pressure. In other words, being highly hostile appeared to be more closely related to the development of heart disease than the more commonly thought of risk factors and the higher the hostility level the greater the likelihood of developing heart disease.

Constant chronic feelings of anger, hostility and aggression raise the risk of developing arteriosclerosis and coronary heart disease as much as five times the normal rate. Suppressing anger is not a major contributor to heart disease; over-experiencing and over-expressing anger is the villain.


Research has indicated that anger causes high blood pressure in hostile people in much the way salt increases blood pressure in people who already have high blood pressure.

Anger is a poison for hostile people. In a research study that examined the effect of harassment on men trying to perform a mental test, ONLY highly hostile men showed increases in blood pressure and blood flow to the muscles. Men who scored low on the hostility scale did not demonstrate these physiological changes. The high hostility group also reported much higher levels of anger and irritation afterward than the less hostile men. In a second study the high hostility men were shown to also have a larger increase in stress hormones than the less hostile men. This closer connection between anger and physiological hyperactivity can be one of the explanations why hostile people have more health problems. Hostile people need to control their anger if they want to avoid increasing their risk for health problems.

Social costs of anger

It is no fun being around someone who is constantly angry. Hostile, angry people are not happy. Not only do hostilely angry people hurt their spouses but they also hurt their children. While they may not resort to physical violence, verbal abuse is common and extremely detrimental to the children. If nothing else anger can reduce the intimacy in personal relationships as your partner and other family members become more guarded in their interactions with you.

Hostile individuals also report more stress in the interpersonal aspects of work. They are less satisfied with their jobs and have a negative view of work relationships. In addition, an aggressive interpersonal style sabotages the goodwill of subordinates and lowers the probability of work goals being met. Colleagues begin to avoid the hostile employee resulting in the chronically angry individual feeling isolated.

Many hostile people blame everyone else for their social problems. This is unfortunate because lack of a social support system is one of the paths a hostile person can take to serious disease. Angry people frequently have cynical attitudes toward others and are unable to recognize or utilize support when it is available; especially if the offers for help are judged inferior because of their overly demanding expectations. When genuine attempts to help are shunned or ridiculed it only worsens the situation, pushing others further and further away.

Finally, angry people tend to drink, smoke and eat more than their less angry counterparts. Without a social network of people to dampen these tendencies the probability of serious health consequences seems inevitable.

Learning To Relax

Attention Focus and Relaxation Page

Harry L. Mills, Ph.D.

There is growing evidence that one of the most important factors in development and treatment of emotional disorders is attention. In anxiety a bias develops and patients attend to certain events more than others. Or they turn attention inward rather than outward toward the world in which they live.

Patients tend to think that their attention is the slave of events in the world around them. Events control attention. In our daily routine we are bombarded with sights and sounds. When we try to rest we often find wave after wave of thoughts and worries constantly intruding. Wells and his colleagues (Wells, 2001) developed a simple exercise that teaches the patient how much control they can exert over attention. In LTC this exercise can be done outside the building at least initially. Participants are asked to focus on a fixed visual point. Then the therapist identifies a series (3 to 9) of sounds and asks the patient to focus on those sounds. Then the patient is told to switch to each sound on their own. This procedure is less effective with those with hearing impairment. With such patients I use switching attention to visual cues. The important aspect is to show the patient that the focus of attention is under volition and need not be a slave to events. Also they prove to themselves that they can choose to extract attention from internal events to the external world.

Many patients simply try to suppress a thought or image. That leads to frustration. I usually try another simple experiment. I tell them no matter what they do they are NOT to think of an elephant. They usually smile. And I say the lesson is that you can only replace a thought with another thought or an image with another image. And the only way to get out of their head is to focus on some specific sound or visual cue in the world out there. We are meant to live in the world and not in our heads.

Meditation is a special form of attending. Everyone has meditated but may not know they have done so. However, when the word is used one may think of saffron robes and bearded gentlemen in contorted positions. If so that is too bad. Meditation is simply putting one’s mind at ease and using special methods of attention. It is a skill and is tied to no particular religious point of view. And it is a skill that can be learned.

While many still viewed meditation as an activity for kooks, Dr. Hebert Benson, a cardiologist at Harvard Medical School and Deaconess Hospital in Boston, decided to study it systematically. As a result of his research, meditation has enjoyed widespread acceptance in the west. School teachers meditate, CEOs meditate, and people concerned about anxiety are making meditation a part of their lives.

Mindfulness is a word that means focusing attention, in a non-judgmental and accepting way, on what we are doing right now, not on what happened yesterday or what might happen tomorrow. One way to learn more about mindfulness is to focus on the experience of eating a favorite food. Many people use an orange cut into wedges for this exercise. Others people prefer to use a mango or even candy or raisins. To introduce mindfulness have your patient pick a favorite food and then try this exercise:

· Take a few deep breaths and relax the body.

· Scan the body and release tensions.

· Let go of the past and the future, and bring attention to the present moment.

· Let the attitude be open and receptive.

· Take a moment to appreciate where the orange (mango, or raisin) came from; look carefully at its color, texture, shape.

· Notice the aroma.

· See, as if for the first time, how it is formed.

· Eat one section of orange, piece of mango, candy or raisin at a time, very slowly, as if one had never tasted this food before.

· How does one chew? On one side of the mouth, the other, or both? How many times do one chew before swallowing? Above all do not hurry.

· Whenever one notice any distraction from the moment-to-moment experience of eating, stop, take a deep breath, and then continue.

· Allow feelings of enjoyment to arise as one experience the pleasure of eating mindfully.

This exercise shows what the experience of eating is like when one attends completely to what one are doing. That is a better introduction to mindfulness than talking about it for hours. Once your patient has tried this or a similar exercise select with them some activities during the next week during which they can try to attend completely to what they are doing at the time they are doing it. It can be as simple as sitting. Or it can be while eating. Thoughts will intrude and the patient should be led to expect that. But then return attention to what they are doing.

Thomas Marra (2005) suggests a mnemonic to teach mindfulness: ONE MIND

· One thing in the moment

· Focus on the now

· Pay attention to the environment

· Pay attention the immediate moment

· Increase the senses of touch, taste, vision and hearing

· Take a non-judgmental stance

· Describe in words that are descriptive

There are two posters that I put up in the patients room:



Americans like to stay busy and judge everything by the numbers. If we are not running from event to event we feel guilty. Meditation requires pausing for at least a brief time each day. It involves sitting still and focusing attention on what happens when sitting still.

One of the best introductions to meditation to your patients is with meditative breathing since breathing properly is a key to relaxing. Have the patient try these steps:

  • Put on comfortable loose clothing. Sit down on the floor in a comfortable position. Or, sit in a chair with good back support.
  • Scan the body for tension. Notice any tension just imagine it is draining away and being replaced by relaxation.
  • Just begin to breathe through the nostrils in a relaxed way. Breathe from the abdomen. Some people imagine a balloon just under their belly button that inflates and then deflates.
  • As one inhale count one. Exhale slowly. Then on the next inhale count two. County silently up to ten.
  • If one find distracting thoughts just return to the count.
  • Keep the focus on breathing, attending to each in breath for its full duration and each out breath for its full duration, as if one were riding the waves of oner own breathing.
  • Every time one notice that one’s mind has wandered off the breath, notice what it was that took one away and then gently bring attention back to the belly and the feeling of the breath coming in and out.
  • If the mind wanders away from the breath a thousand times, then the “job” is simply to bring it back to the breath every time, no matter what it becomes preoccupied with.
  • Become aware of thoughts and feelings at these moments, just observing them without judging them.
  • After one have completed the count to ten one can add a word like ONE or CALM or AMEN as one exhales.

Dr. Benson, has made a study of the counterbalancing mechanisms of the body’s stress reaction. He discovered that while the fight-or-flight response is part of the hard wired response to stress, there is an opposite response, he called the relaxation response. The relaxation response causes the body to calm itself. Metabolism decreases, heart rate decreases, blood pressure decreases, breathing rate decreases and muscle tension decreases. Dr. Benson has discovered that the relaxation response can be elicited by a number of techniques including:

  • Diaphragmatic breathing
  • Meditation
  • Yoga
  • Body scan exercise
  • Mindfulness meditation
  • Repetitive exercise
  • Progressive muscle relaxation
  • Imagery
  • Repetitive prayer

Those who elicit the relaxation response regularly, such as on a daily basis, report these kinds of changes:

  • Improved sleep
  • Decrease in stress-related symptoms
  • Decrease in anxiety
  • Increase in concentration and awareness
  • Greater self-acceptance
  • Enhanced performance and efficiency.
  • Freedom from compulsive worrying, self- criticism, negative thoughts

There are the basic steps in learning to elicit the relaxation response:

· A mental focusing device, such as attending to your breathing, or repeating a word, phrase, prayer, sound, to help shift the mind from everyday worries. He suggest use of the word ‘one’ or ‘calm’ as a device.

· Gently direct the mind back to relaxation exercise when you getting caught up in a train of thought. Keep a passive attitude toward distractions.

Possible instructions for patients to elicit the relaxation response include:

Step 1: Pick a focus word, phrase, image, or prayer.

Step 2: Sit quietly in a comfortable position.

Step 3: Close your eyes.

Step 4: Relax your muscles.

Step 5: Breathe slowly and naturally, and as you do, repeat your focus word or phrase as you exhale.

Step 6: Do not worry about how well you are doing. When other thoughts come to mind, simply say to yourself, “Oh well,” and gently return to the repetition.

Step 7: Continue for ten to twenty minutes.

Deep breathing is the body’s natural way to relax. We seem to know how to breathe as children but as we grow up, we forget. We tend to breathe in a very shallow way in the upper part of the chest. Try these instructions with your patients:

  • Lie down on a bed or on the floor. Bend your knees and relax your toes. Keep your spine straight. If need be put a small pillow under your lower back for support.
  • Scan your body for tension. Imaging the tension just draining away.
  • Place on hand on your abdomen and one on your chest.
  • Inhale slowly and deeply. Notice which hand moves the most. For many people it is the hand on the chest.
  • Continue breathing deeply. Concentrate on moving the hand on your abdomen more than the hand on your chest.
  • Continue this for 5 or 10 minutes. This is a way to learn abdominal breathing and to learn to breathe yourself into relaxation.

Before getting into mindfulness and deeper methods you may want to lay a foundation by introducing relaxation in its more basic forms as with this excellent starter script (1992, Lusk):

  • Begin by closing your eyes…and releasing the air in your lungs.
  • Take in a full, deep breath through your nose, allowing your lungs to fill up completely, letting the air go all the way in…and then sighing it out through your open mouth. Release all of the tiredness, tension, and negativity with your breath.
  • Take in another deep breath…And sigh it out. Take your time…Breathing in…and out.
  • Pause for 20 seconds
  • Now let you breath return to normal.
  • In a minute or so, I will begin to count from 1 to 10. As I count up, you will slowly begin tensing all the muscles throughout your body: your arms and legs, your torso and back, your shoulders and face. At the count of 5, your body will be half way to being tense all over.
  • By the count of 10, you will feel tension and tightness throughout your entire body.
  • Then I will count backwards from 10 to 1. As I count down, you will slowly release the tension in your body. By the count of 5, you will be half way to being completely relaxed. At the count of 1, your body will be completely relaxed. Then you will take in a big breath and then sigh it out.
  • Now sense how your body feels as it presses firmly against the floor. Become aware of how your body is feeling right now—your legs, back, arms, and head. You are becoming acutely aware of how you are feeling in your physical body right now. Physically…how your body feels to you. Just become aware.
  • Let’s begin. 1…add a little tension…2…add some more…3…4…5…you are half way there…6…7…8…9…and 10.
  • You are all the way there now. Feel the tension. Know it and experience it completely so that you will be able to recognize muscular tension and tightness later on.
  • 9…relax a little bit…8…a little bit more…7…6…5…and you are half way there…4…3…2…and 1.
  • Dissolve and release all of the muscular tensi9on and tiredness. Let go completely…Experience the feeling of being completely relaxed and calm…Soak it in…Learn to recognize the feeling of relaxation.
  • If you still feel some muscular tension, you will find that you can relax even more if your mind gives your body permission to relax. Let those spots relax now by mentally giving yourself permission to relax…It’s OK to relax…Just let it go.
  • Take in a long, deep breath and sigh it out, letting the air rush out through your open mouth. Keep the air out of your body until you are no longer comfortable, then take in another deep breath and sigh it out completely…Notice that you can relax more and more, each time you exhale.
  • Pause for 20 seconds
  • Now let your breath return to normal.
  • Notice that you feel as if you are sinking into the floor. Let the floor support and hold you, safely and securely.
  • Your body feels as if it is being supported entirely by the floor. Every time you breathe out, feel more and more relaxed, calm, and serene.
  • Now draw your attention to your mind…Notice what thoughts are drifting through your mind right now…Let your mind and thoughts become silent and still so that you can begin to center in and concentrate more.
  • If your mind begins to wander, gently bring your attention back to the sound of my voice or to the motion of your breathing.
  • Now notice how your emotional self is feeling right now. What kind of mood are you in? Try not to judge your mood, just recognize and accept what you are naturally experiencing at this moment.
  • Each time you exhale, notice that you feel more and more settled and are feeling a sense of harmony and balance occurring within your body, mind, mood, and spirit. Feel this sense of balance within your body…mind…and emotions.
  • Start to picture the room you are in…the walls, the ceiling, the floor.
  • Describe different aspects of the room.
  • When you can picture the room completely, open your eyes and stretch.

A great way to start with most patients (other than those with COPD) is with this basic breathing exercise (1992, Lusk):

  • Close your eyes…Focus your mind on your breath…Just follow the air as it goes in…and as it goes out.
  • Feel it as it comes in…and as it goes out…If your mind begins to wander, just bring it back to your breath.
  • Feel your stomach rise…your ribs expand…and your collar-bone rise…Breathe in naturally and slowly.
  • On your next exhalation, release all the air from your lungs without straining…Let it all go…Let it all out…Prepare your lungs to receive fresh oxygen.
  • Now take in a full, deep breath and let the air go to the bottom of your lungs…Feel your stomach rise…your chest expand, and the collar-bone area fill.
  • Now empty your lungs from top to bottom…Let all the air out…Compress your stomach to squeeze out all the stale air and carbon dioxide. Squeeze out every bit of air…Let it all go.
  • Take in another deep breath…As you breathe in, your diaphragm expands and massages all the internal organs in the abdominal area…aiding your digestion.
  • Breathe out…Relax…Feel the knots in your stomach untie…Let go.
  • Breathe in…Your diaphragm is stimulating your vagus nerve, slowing down the beating of your heart…relaxing you.
  • Breathe out…Let it all go…relax…relax more and more…Breeathing heals you…calms you…soothes you.
  • Breathe in again, fully and completely. Oxygen is entering your blood stream, nourishing all your organs and cells…protecting you.
  • Breathe out…Release all the poisons and toxins with your breath. Your breath is cleansing you…healing you.
  • Breathe in.
  • Now imagine exhaling confusion…and inhaling clarity.
  • Imagine exhaling darkness…and inhaling light.
  • Imagine exhaling hatred…and inhaling love.
  • Exhaling anxiety… and inhaling peace.
  • Exhaling selfishness…and inhaling generosity.
  • Exhaling guild…and inhaling forgiveness.
  • Exhaling weakness…and inhaling courage.
  • Breathe in through your nose and sigh out through your mouth. Let the air stay out of your lungs as long as it is comfortable, and then take another breath.
  • Let your breath return to its normal and natural pace. Continue to breathe in slowly, smoothly, and deeply…Your breathing is steady, easy, silent.
  • Each time you exhale…allow yourself to feel peaceful…calm…and completely relaxed…If your mind wanders, bring your attention back to your breath.

· Stretch and open your eyes, feeling refreshed, rejuvenated and alert.

Another good way to start relaxation training is with a body scan like this (1992, Lusk):

  • Begin taking deep breaths. With every inhalation, fill your body with positive energy…With every exhalation, feel all of the negative energy being released from your body.
  • Continue to breathe deeply, focusing on bringing in the positive energy as you breathe in, and letting go of the negative energy as your breath is released.
  • Now focus your attention on your body, all the different parts of your body…You will begin to do a “body check” that will bring you in touch with your physical body and create and awareness of your body parts.
  • First focus on your feet and legs…Breathe in positive energy to your feel and legs, and breathe out negative thoughts and energy.
  • Now focus on your thighs and hips…breathe in positive energy to your thighs and hips, and breathe out negative thoughts and energy.
  • Move up your body and focus on your buttocks and abdomen. Breathe in positive energy to your buttocks and abdomen, and breathing out negative thoughts and energy.
  • Now bring your focus to your upper and lower arms and hands. Breathe in positive energy to your neck, head, and hair… Breathe out negative thoughts and feelings.
  • Focus on your face, and particularly your eyes, nose, and mouth…Breathe in positive energy to these areas and breathe out negative thoughts and feelings.
  • How do you feel about your feet, calves, and upper legs? Do they feel heavy and sluggish?…tense?…or maybe light and relaxed?…Get in touch with the feelings you have towards your fet, calves, and upper legs.
  • Move your concentration up to your hips and buttocks, and again, get in touch with the feelings you have for your buttocks and hips. Do they feel heavy and fat?…perhaps strong and smooth?
  • Draw your attention on up to you abdominal area…then to your chest…and upper back…Now to your shoulders, arms, neck, and head…How do these areas of your body feel to you?
  • Once you have taken enough time to do a body check and have thought about how you are feeling, begin again. But this time repeat silently after me a positive affirmation for each body part and for each area of your body. If your mind begins to wander or if you deny or doubt the affirmation, acknowledge your discomfort to yourself and then bring you attention back to the affirmation and repeat it silently and as confidently as you can.
  • As you continue to practice positive self-talk through affirmations, you will begin to see a shift in your mindset and begin to create positive, healthy body affirmations that become a regular part of your psyche.
  • My feet are a wonderful support for my body…I take care of them and respond to their needs.
  • Repeat this affirmation silently to yourself to give participants time to say the affirmation silently to themselves. Repeat this for each affirmation.
  • My calves, knees, and thighs are strong and beautiful and give me sound support for the rest of my body… They are just right the way they are…My legs take me where I want to go…I move with coordination, grace and ease…My legs are just right for who I am.
  • My hips and buttocks are smooth and strong…I take care of them and respond to their needs…I take care of them and respond to their needs…I take care of my hips and buttocks by exercising and eating well…My hips and buttocks are just right for me right now.
  • My back is healthy, strong yet flexible…My spine give me all the support I need, and it feels good, strong, and healthy.
  • My stomach and chest are just right for who I am…My stomach and chest are a positive expression of my health and well-being…My digestive system digests my food and nourishes my body…My heart is strong and beats in perfect rhythm.
  • My shoulders, arms, and hands suit my needs just the way they are…My arms are strong…My hands express my talents to their fullest…They allow me to touch others in my special and unique way…They allow me to be touched by others in a positive way.
  • My neck support my head and my head is perfectly balanced upon neck and shoulders…My hair is healthy and strong…My eyes see clearly and sparkle with my inner beauty…My nose allows me to breathe deeply and energizes my body with each breath…My ears hear clearly and allow me to appreciate the sounds of life…My mind is sharp and my thoughts are positive.
  • My attitudes and perceptions about myself are positive…I honor my body and make choices that are healthy and respectful of myself…Every day in every way, I am better and better…I continue to create a health centered approach to living that nurtures every part of me.
  • Continue to bathe yourself with positive affirmations, personalizing each thought to your own needs.
  • Pause for 1 minute
  • Now bring your attention back to your whole body…Let y9ur attention sweep up from your feet to your torso and shoulders and down your arms, over to your hips and up your back to your neck, head, and face. Breathe fully and deeply once again. On the inhalation, bring positive energies into your body. On the exhalation, feel the positive energies spreading throughout your entire being.
  • Let your breath return to normal. Silently count from 5 to 1, stretch and then open your eyes. 5…4…3…2…1…Stretch and then open your eyes.

Autogenic Training is a form of relaxation developed in Europe and which uses phrases the patient says to themselves related to sensations like heaviness as part of the script (1992, Lusk):

  • Prepare yourself to relax now. Prepare yourself to experience calm…to feel quiet…to know peace. Find a comfortable position…Begin to sink down…and be supported by your surrounding environment.
  • Close your eyes now…and focus on breathing naturally. Inhale…and fill yourself with life-giving air. Exhale…and relax…allowing your body to sink…breathing in…and breathing out.
  • Begin to withdraw your thoughts from your surroundings…and to center your focus inward on the peace…and the stillness…within you. Prepare yourself with an attitude of passive attention…alert but quiet…aware…yet at peace.
  • And…making nothing happen…you let of the tension of controlling anything…you watch the relaxation you feel spread to all parts of your being.
  • And you breathe in…easily…and breathe out naturally. Part of the rhythm…of all life.
  • And you focus on your breathing. As you breathe in…you say to yourself…”I am.” As you breathe out…you say to yourself…”relaxed.”
  • I am…relaxed.
  • I am…relaxed.
  • I am…relaxed.
  • I am…calm.
  • I am…comfortable.
  • I am…relaxed.
  • I am…relaxing…into the supports around me. My mind is quiet. My whole body is relaxed.
  • I am…at peace.
  • I notice…my quiet.
  • I notice…my peace.
  • I notice…my calm.
  • I think about my right hand…I allow my right hand to become heavy with my breathing…My right hand is becoming heavy…My right hand is heavy…and relaxed.
  • I allow the heaviness of my hand to spread up my arm…I think about my right arm…I allow my right arm to become heavy with my breathing. My right arm is becoming heavy…My right arm is heavy…and relaxed. My right hand and arm are heavy and relaxed.
  • I think about my left hand…I allow my left hand to become heavy with my breathing…My left hand is becoming heavy…My left hand is heavy…and relaxed.
  • I allow the heaviness of my hand to spread up my left arm…I think about my left arm…I allow my left arm to become heavy with my breathing…My left arm is becoming heavy…My left arm is heavy and relaxed.
  • My left hand and arm are heavy and relaxed. I think about both of my hands and arms…I allow both hands and arms to become relaxed…and heavy…with my breathing.
  • My hands and arms are heavy. My hands and arms are heavy and relaxed. I continue to breathe deeply…rhythmically.
  • I allow the heaviness of my hands and arms…to spread down my back to my right leg and foot…I feel the weight of my body…and my back. My hands are warm and heavy…My back is relaxed. My legs and feet are becoming heavy.
  • Pause
  • I think about my right foot…I allow my right foot to become heavy with my breathing…My right foot is becoming heavy…My right foot is heavy…and relaxed.
  • I allow the heaviness to spread to my leg…I think about my right leg…I allow my right leg to become heavy with my breathing…My right leg is becoming heavy…My right leg is heavy…and relaxed.
  • My right foot and leg are heavy and relaxed.
  • I allow the heaviness of my foot and leg…to spread across my hips…and down my left leg to my left foot.
  • I think about my left foot…I allow my left foot to become heavy with my breathing…My left foot is heavy…and relaxed.
  • I allow this heaviness to spread to my leg…I think about my left leg…I allow my left leg to become heavy with my breathing…My left leg is becoming heavy…My left leg is heavy…and relaxed.
  • I think about my feet and legs…I allow both feet and legs to become relaxed and heavy…My feet and my legs are becoming heavy…My feet and my legs are heavy…and relaxed.
  • I imagine tiny weights attached to my arms and legs…making my arms and legs heavy…gently pulling my arms and legs down…My arms and legs are sinking…relaxing.
  • Both of my legs are heavy. Both of my arms are heavy.
  • My hands and my arms are heavy…and relaxed. My feet and my legs are heavy…and relaxed.
  • My hands and arms…feet and legs…are heavy…and relaxed.
  • I am comfortable.
  • I am…quiet.
  • I am…at ease.
  • My body is in tune with my mind…and connected by my breathing.
  • I am…heavy.
  • I am…relaxed.
  • I am…quiet.
  • I feel the energy flowing…through my arms to my hands…through my legs to me feet.
  • I am alive.
  • I am refreshed.
  • I am relaxed.
  • I feel a freshness of spirit.
  • Pause
  • Continue with a visualization exercise or say the following:
  • Now prepare to open your eyes. Take a deep breath…and open your eyes…slowly…while you remain fully relaxed.
  • Now gently stretch…but remain relaxed. Begin preparing yourself to return to your world…relaxed…and refreshed.
  • Your eyes are open…You are aware of your surroundings…but you remain relaxed…and calm. You prepare to move on…with you as you move on with your day.

Introducing a visualization like the following can deepen relaxation (1992, Lusk) :

  • Take in a long, deep breath…Hold it…Now slowly and completely exhale. Allow your jaw and shoulders to drop as you exhale.
  • Visualize the following, allowing your mind to roam freely in its own way.
  • Imagine you are on vacation. No cares, no worries. You feel completely free from your usual daily pressures and hassles.
  • You are walking along the water’s edge on a quiet, secluded, warm ocean beach…You are dressed comfortably and are either alone or with someone close to you, whichever you prefer. As you stroll along the water’s edge, you feel the coolness of the damp sand under your feet…and hear the gentle rolling of the waves…Under your arm you carry a rolled up towel.
  • You turn away from the water and look at the soft, white warm sand. You pick a spot where you can be alone and still…You put down your towel, and using it as a pillow, you lie down on the soft, pleasantly warm sand.
  • You feel the warmth of the and on your back, your legs, and your arms.
  • You notice the deep blue of the late morning sky. It is completely clear, except for one wispy cloud near the horizon over the water.
  • You feel the gentle warmth of the sand beneath…You feel utterly relaxed and still. For the next several minutes, continue to experience this place, allowing your mind to wander as it wishes. Enjoy this very pleasant sensation of stillness, warmth, and quiet.
  • Pause for 2 minutes
  • And now imagine getting up…gathering up your towel…walking back to the water’s edge. Again, you experience the cool, damp, sand underfoot…You continue on along the beach, feeling alert, refreshed, peaceful, and renewed. You give yourself credit for this positive experience.
  • Now bring your attention back to the present. Draw a deep breath. Open your eyes.

Or try these elements (1992, Lusk):

  • Make yourself as comfortable as possible. Close your eyes and become aware of which parts of your body are feeling tense and which parts are relaxed.
  • Now take a few deep breaths, taking the air in through your nose, holding it momentarily…and then slowly exhaling through your nose…And with each exhale, you will find yourself relaxing more and more deeply, more and more completely.
  • Take the air in and let the air out. Allowing yourself to relax…relax…relax.
  • In a few moments, I am going to describe a very vivid scene in which you will picture yourself walking along a beach. I want you to imagine this scene as though you ar there experiencing not only the sights, but the sounds, smells, tastes, and touches.
  • It is a bright summer day. It is late in the day. You decide to go for a walk along the beach. The sun is radiating warmth and comfort as it shine boldly. The sky is crystal clear without a cloud in sight. The grains of sand beneath your feet shine from the sunlight and warm the soles of your feet. The sound of the waves beating against the shore echoes in the air.
  • You feel the warm, light breeze brush against your face as you walk onward. Far off in the distance, you can hear the cries of sea gulls…You watch them glide through the sky, swoop down into the sea, and then fly off once again.
  • As you walk further along the shore, you decide to rest. You sit down on a mound of pure white sand and gaze out at the sea, staring intently at the rhythmic, methodical motion of the waves rolling into the shore.
  • Each wave breaks against the coast…rises slowly upward along the each, leaving an aura of white foam, and then slowly retreats back out to sea, only to be replaced by another wave that crashes against the shore…works its way up the beach…then slowly retreats back out to sea.
  • With each motion of the wave as it glides in and as it glides out, you find yourself feeling more and more relaxed, more and more calm…more and more serene.
  • The waves are gliding in…and the waves are gliding out…You feel more and more calm…Continue to watch the waves glide in…and out.
  • Now, as you stare off into the distance, you see that the sun is beginning to sink into the horizon. The sun is sinking down and you feel more and more relaxed as you see its movement going down…down…down.
  • The sky is turning brilliant colors of red…orange…yellow…green…blue…and purple…As the sun sets, sinking down…down…down…into the horizon, you feel very relaxed and soothed. You watch the sun as it sinks down…down…down.
  • The beating of the waves, the smell and taste of the sea, the salt, the cries of the gulls, the warmth against your body—all these sights, sounds, and smells leave you feeling very soothed, very calm, very serene.
  • Relax…relax…relax.
  • Pause
  • In a few moments, I will count from one to three. When I reach the count of three, your eyes will open and you will feel completely refreshed and totally relaxed.
  • 1…2…3.

Appraisals and Stress

images[2] Richard Lazarus conducted research on stress and emotions for four decades. He found a link between appraisals and stress. An appraisal is an evaluation of the significance of what is going on between the person and the environment in terms of that person’s well being. Appraisals establish the meaning of an encounter for us. At its simplest level, it is a quick assessment of what is going on and then what we can do about it. If we confront a snake, the first appraisal may be that it will harm us (e.g. it kills) and quickly, on the heels of that appraisal, we evaluate what we can do about it (e.g. move quickly away). These appraisals are instantaneous and automatic.

In understanding the role of emotions in regulation of stress the distinction between a primary and a secondary appraisal is most helpful. A primary appraisal is an evaluation of whether something (e.g. a snake) is of relevance to our well-being. What is our stake in the event (e.g. not being bitten)? A Secondary appraisal is an evaluation of our options for coping and expectations about what will happen.

Another key concept in understanding our capacity for self-regulation is coping. It is defined as activity to manage demands that tax or exceed our resources. When demands exceed our resources we experience stress. There are two important types of coping:

· Action-focused – which involves making changes in the environment (e.g. killing a snake

· Emotion-focused – which involves changing the way we interpret or we experience the event (e.g. “Oh, it’s not poisonous.”)

It is useful to view stress as having four stages:

Stage 1- Environmental demand

Stage 2- Perception or appraisal of the demand

Stage 3- Physical and psychological response to stress

Stage 4- Behavioral consequence or performance

An event in the environment makes a demand on the person. That demand is not automatically a source of stress unless the person views the event as a threat or that an adequate response may stretch the capacity of the person. In Stage 3 the body may show signs of increased tension and arousal (e.g. increased heart rate, perspiration, rapid breathing) and a flood of thoughts. Finally the person acts in a way that may either reduce the level of tension or increase it further, and the cycle renews at Stage 1. If the behavior succeeds in meeting the demand, the person will approach similar demands in the future with greater confidence. Learning is very important in determining our response to stress.

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Conflicts at Work

6ca927zw4caknem8tcau9uqzecaue3baacaji4bi5caf2tttvcaadp4tocaopqjrlcanza3ngca47k0h9cabn9x3zcalszn22ca9kuss3caw59564ca1j1nzfcagq7j2ocatewibucapi7bzkcanh40n51Conflict may be described as a situation in which one person feels that another person has harmed or is about to harm something you care about. Such conflicts may involve incompatibility of goals, differences in interpretation of facts, and disagreements over expectations.

These conflicts can occur at a full range of intensities and levels from more subtle forms of disagreement to violent acts.

The traditional view of conflict, that all conflict in relation to group behavior was bad, prevailed into the 1930s and 1940s. The prevailing solution was to identify the causes of the conflict and correct them to improve group and organizational performance.

More recently conflict is seen as a natural occurrence. Some conflict is inevitable. Proponents say conflict cannot be eliminated and that conflict may even be beneficial in certain circumstances.

Conflict may be either constructive or destructive. Conflict is of three types. They are:

  • Task conflict – divergent views as to the task itself
  • Relationship conflict –disagreements between people or groups
  • Process conflict – differing views on how the work gets done

By its nature low to moderate task conflict can be productive because it encourages the discussion of ideas that can facilitate groups working better together. For process conflict to be productive it must be kept at a low level. It can become counterproductive when turf battles break out, or when it increases the time needed to complete tasks or results in employees working at cross purposes.

Relationship conflicts are almost always dysfunctional because friction and hostilities between people increase the likelihood of personality clashes while decreasing the understanding needed for completion of organizational tasks.

The research literature suggests that within organizations structural factors and individual value differences are greater sources of conflict than communication problems. For example when people work together but pursue different goals conflicts arise. While managers may incorrectly attribute the problem to communication issues further communication efforts only worsen the situation.

The definition of a conflict is important because it delineates a possible set of solutions. Emotions are also important because positive feelings increase the tendency to see possible relationships among elements of a problem and encourage taking a broader view of the situation. Negative emotions tend to result in over simplification of the issues, reduce trust and encourage negative interpretations the behavior of others.

Conflict management techniques include:

  • Problem solving – face to face meetings to identify and resolve conflicts
  • Superordinating goals – a shared goal is created that cannot be achieved unless both parties cooperate
  • Expanding resources – when a conflict is caused by a scarcity of a resource, such as opportunities for advancement, or the potential to make more money, etc., opening up additional opportunities may provide a solution
  • Avoidance – pulling out of a conflict or containing a conflict
  • Smoothing – emphasizing common interests and minimizing differences
  • Compromise – each party is willing to give up something of value
  • Authoritative command – management uses its authority to settle the conflict
  • Altering human variables – using behavioral change techniques to alter behaviors and attitudes that result in conflict
  • Altering structural variables – change the formal organizational structure and interaction patterns for conflicting parties, i.e., transfer employees, redesign jobs, coordinate positions, etc.

Learning to manage conflict can significantly improve resilience to stress at work..

Stress and Health

5catdz8jzcaw3aackcazenv9mcabottr6caopqlifcao4qirqca4bwmqccaa8nn1hcaho32l4ca80lhhkca2voyzaca584yijcar59fr1cai16fetca8yolnfcax3z7clca7l4gj9ca9nw0sdcar6padvThere is growing evidence that stress is a major factor in maintaining health and well-being. Health means more than the absence of illness. In China and in ancient Greece health was thought of as being in balance with nature. The vital task was seen as maintaining equilibrium in the face of extensive demands. The World Health Organization (WHO) definition of health is a state of complete physical, mental and social well being.

It seems increasingly clear that the naive notion that a germ automatically leads to illness is no longer acceptable, although much of the lay public subscribes to the theory. Today we know that the idea of a single external cause, such as a germ, is oversimplified. The presence of the germ does not always cause the illness. The vulnerability of the person or the host animal is a major factor and that vulnerability is influenced by such factors as immunity and stress levels. So the cause of illness is not quite as simple as we once thought.

Stress vs. Distress

Another important distinction that came out of the seminal work of Hans Selye is between stress and distress. Both involve demands on the person to adapt to a challenging event. However, when we appraise the situation as being something we can handle it can be an exhilarating experience. When a person appraises the event as beyond their ability or as exceeding resources the situation is experienced as distress. Another way to look at it is that stress is positive and distress is negative. It is a valuable distinction since many people believe all stress is bad for you. It is not.

The diathesis-stress theory

The diathesis-stress theory of the origin of certain illnesses holds that we are born with certain biological predispositions but that whether or not an illness manifests itself is dependent on the level of stress one experiences and the resources one can use to overcome the stress. For example, although a person may have inherited a genetic deficiency in metabolizing alcohol, whether that person becomes an alcoholic or not also depends on the types and levels of stress they experience. Another person may have inherited a problem with glucose metabolism; however, it is factors such as the level of stress, or a sedentary life style or a combination of the two that result in development of type 2 diabetes. We may be born with certain vulnerabilities; it is stress that tips us into active illness.

Impact of stress on illnesses

Certain ailments have been recognized for some time as being influenced by stress. The most common example is intestinal distress such as indigestion and colitis. Other disorders like migraine, tension headaches, high blood pressure, arthritis and certain skin disorders may also be influenced by stress. In some instances, stress emotions seem to make an ailment worse, while in others stress may be a factor in bringing on illness. Research increasingly supports the hypothesis that stress may have at least some impact on many diseases.

There are several reasons for believing that stress contributes to the development of cardiovascular disease. First, stress emotions increase the level of low-density blood cholesterol and this leads to clogging of the arteries of the heart. Second, stress emotions result in maladaptive coping behaviors such as smoking, drinking and overeating, which can damage the heart and surrounding vessels. Finally, stress emotions result in the release of powerful hormones which result in increases in heart rate and blood pressure. One of these stress emotions is anger, and anger expressed in the form of hostility is known to increase the risk of cardiovascular disease.

Several hypotheses are being explored in the role of emotions in cancer. Again stress emotions may play an indirect role leading the person to smoke or drink excessively. More direct influence is attributed to a tendency to suppress or deny emotions. There is some evidence that those who suppress emotions are more susceptible to cancer. Again the mediating factor is hormonal activity.

At the 2002 meeting of the American Psychological Association a group-based stress management study was presented that indicated that group stress management training could lower blood glucose levels in Type 2 diabetes. Patients that received instruction regarding the health consequences of stress and instruction in the use of cognitive and behavioral skills such as deep breathing and recognition of major life stresses as well as instruction in progressive muscle relaxation lowered their glucose levels more than patients that did not have stress management training. Thirty-two percent of the patients receiving stress management lowered their A1C glucose levels by one percent or more as compared to 12% of the patients who did not receive this training. This modest change is larger than the half percent change that has been associated with significant reduction in microvasclar complications that can accompany out of control diabetes. While this change might move someone with tightly controlled diabetes to near normal levels; even those diabetics with poorer control would benefit from the reduction in glucose levels with fewer diabetic complications.

In summary, if you are a type 2 diabetic, learning to manage stress should have special health consequences for you. Although this was a group program, if none is available in your area, individual stress reduction strategies should be beneficial, especially if you have a friend or family member trying to learn stress management with you.

Stress and the immune system

The immune system has been called our liquid nervous system. With our growing knowledge of the human body has come an increasing conviction that stress may be a factor in susceptibility to colds, flu, mononucleosis and other infectious illnesses. It appears that some of the hormones secreted in the presence of stress emotions impair or weaken the immune process by reducing the number of disease-fighting components such as lymphocytes (white cells) thus leaving us more vulnerable to infection. This may be one of the reasons why so many people die within a year or so of their spouse’s death. Recently there has been research into why some HIV positive patients develop full blown AIDS while others do not. One interesting finding is that patients with a more effective style of coping with stress seem to have stronger resistance as a result. It is now reasonable to hypothesize that stress emotions increase secretion of certain hormones. These hormones weaken the immune system and that weakness results in an increased likelihood of infectious illness.

Recent research indicates that brief time-limited stress that may be viewed as a challenge (e.g. passing an exam, good performance in sports, solving a difficult puzzle under pressure) may actually enhance the body’s immune response. However, chronic stress seems to reduce the effectiveness of the immune system and thus make the person more susceptible to diseases.