Seek support --talk about your concerns with a friend, someone in a similar situation, a teacher, or a professional counselor. Share your feelings. A supportive, nonevaluative friend lowers our blood pressure during stressful tasks. Type A middle-aged males with few friends were three times (69% vs. 17%) more likely to die than Type A's with friends (Orth-Gomer & Unden, 1990)--but do tense, sickly, dying males just not attract friends or do friends improve our health? In any case, it seems likely that we are less afraid and have more courage when someone is with us holding our hand (Rachman, 1978).
It has been estimated that 85% of us have struggled through some stressful experience in the last five years. Mates are our most likely source of support, then relatives and friends, then less likely co-workers, parents, and children. If professionals are consulted, it's most likely to be the family physician and clergy. Talking with anyone is a good first step but neither (MD nor minister) may be good choices for extensive help; physicians primarily give drugs, seldom information about how to cope; some clergy specialize in building guilt, not reducing stress. For the most competent professional help with anxiety, go to your Mental Health Center for treatment or call and ask them to recommend a good private practitioner.
Currently, many millions of Americans are in support or self-help groups dealing with over 350 different kinds of problems. Self-help, sometimes called mutual help, groups are a growing source of help. AA was one of the first such groups, then women's consciousness-raising groups caught on in the 1960's. Now there are self-help groups for almost every conceivable problem. They often limit admission to people who have personally had the problem being discussed; usually no professionals or "experts" are admitted. This makes it clear that your improvement is your job, not in the hands of a "doctor." Members of the groups share experiences, exchange practical information or advice, and provide emotional support. Members feel better about themselves by helping each other. Often the groups are so helpful that members become intensely involved and dedicated. It is comforting to be truly welcomed and understood by fellow sufferers. There is no charge.
Science is just beginning to evaluate the effectiveness of different sources of support for different problems. A famous 10-year study at Stanford found that cancer patients who participated in a support group lived twice as long as those who didn't meet with a group. Groups no longer have to meet face-to-face; within the last five years, four research publications have documented the effectiveness of online cancer support groups. Likewise, drug abuse prevention groups run by older students (but still peers) get better results than teacher-led groups. Many self-help group members are veterans of drug treatment and psychotherapy; many believe they have gotten much more from self-help groups than from professionals. The Self-Help Sourcebook Online summarizes more research suggesting groups provide help also with diabetes, heart problems, child abuse, mental illness (to both the patient and the family), children of alcoholics, and other disorders or difficult circumstances.
Self-help or mutual-helping groups provide many benefits: suggestions about how to cope, a chance to learn from others' experience, support and encouragement, meaningful and needed friendships, and a reduction of guilt (by finding others like yourself), and an increase in hope (Hodgson & Miller, 1982). Another major advantage of mutual-helping groups is that they are not only a source of support but they are also a place where the helpee can become the helper. It's probably as beneficial to be a helper as to be a helpee, maybe more so (Killilea, 1976). For more information about such groups refer to Lieberman and Borman's (1979) Self-help Groups For Coping With Crises.
But the early data suggest that social support is not always helpful (although usually it is), that the "supporter" can be drained and the "supportee" pressured, that many poor people prefer isolation to exposure to a middle class helper, that relatives (e.g. 20% of the mothers of young mothers) may be intrusive and bossy, that the best source of support depends on the problem, that it is not the amount of support but the nature of the help that counts, and that it may not be the actual support so much as believing that dependable support is available if and when it is needed that does the most good. There are even times that you shouldn't help a friend: when he/she doesn't want help, when he/she has enough help already (you should especially avoid interfering with therapy), when he/she is doing something you consider morally wrong, when he/she asks for but never takes your advice, and when he/she is using you.
One study illustrates the complexity of deciding "when will support help?" Veiel (1993) found that depressed women who had been hospitalized but were now recovered were harmed by post-hospital stays at home surrounded by close family support. The more relatives and fewer friends they had and the more they stayed at home and didn't work outside the home, the more likely these women were to become depressed again. It is not clear what caused the detrimental effects, but we shouldn't conclude that support is always helpful. Note that similar depressed women discharged from the hospital before full recovery benefited from family support (as did recovered women who worked and both recovered and unrecovered men). The important point is: some friendships and group interactions are harmful. For instance, groups of depressed people who merely share the misery of their lives and neglect self-help may prolong each other's depression. Likewise, there is clear evidence (Dishion, McCord & Poulin, 1999) that interactions between delinquent adolescents lead to more trouble with the law, drug use, violence, and even maladjustment as an adult. Science is slowly discovering when and what kind of "support" is unhelpful. Just as all therapy may not be helpful, all socializing is not helpful either.
What does this mean for self-help? First, don't hesitate to seek help if you need it. And, don't hesitate to offer help. If a friend of yours is having a hard time, avoiding him/her is far more often a mistake than a wise decision. So, reach out and show your friend your concern, then observe to see if he/she wants your help and in what ways. You don't think you can help others? There are organizations that specialize in teaching practical ways of becoming a better helper, one-on-one or in a group. Try Re-Evaluation Counseling or Co-Counseling. Both encourage a simple, believable way of helping and being helped, based on the benefits of expressing strong feelings safely, called discharging. Second, if the first group or source of help you reach out to doesn't seem to be beneficial, quickly try another source of help. Caution: going to a group with much more severe handicaps than you have, can be traumatic. Another Caution: interacting at length with people who have habits and attitudes you do not want to acquire is probably unwise. Thirdly, one group, no matter how good, probably won't be the best source of help with all the problems you might face in a life-time. Fourthly, self-help groups do not provide all the help you need; you may need professional help (see Find a Therapist) and you must use self-help methods outside your group (Tessina, 1993).
In effect, you are changing your environment by seeking new sources of support or help. Sometimes new viewpoints are necessary; intimate friends (lovers, best friends, parents) may be too involved to be good helpers. Beyond family, friends, physician, and clergy, there is a bewildering array of possible sources of support, especially now that the Internet is so popular. Just as it is difficult to know about and to locate available self-help books, so it is difficult to know the government supported agencies and the private self-help groups that offer help in hundreds of problem areas. If you want to try a local support group, start by calling your local Mental Health Center for information. Sometimes the local newspaper and phone directory lists groups. Also, the local United Fund and library might have a list of self-help groups. Perhaps easiest and best is to look up Self-Help Sourcebook Online which is a great resource to help you find local groups by location and by disorder/problem. You can also write or call American Self-Help Clearinghouse, St. Charles-Riverside Medical Center, Denville, NJ 07834 (Phone: 1-201-625-7101). If there isn't a local group of interest to you, this organization will help you establish your own self-help group. The National Self-Help Clearinghouse, 25 West 42nd St., New York, NY 10036 (Phone: 1-212-642-2944) is also helpful. A book by Wuthnow (1994) provides information about the pros and cons of joining a support group. Likewise, there are articles and studies discussing the advantages, disadvantages, and effectiveness of online self-help groups. Also, see Dr. Suler and StormKing. Go to "http://mentalhelp.net/" or to Google and search for "effectiveness of self-help groups."
People have been drawn by the millions to groups--perhaps appropriately called communities--on the Internet. How do you find the best ones for you since there are thousands? I like the Websites where there are several groups dealing with a variety of problems, such as Mental Earth Community or Grohol Forums. Listings of online support groups are provided by SupportPath, Support Groups, Support4Hope, and by Liszt. Many of the major medical Web sites and sites for specific psychological problems, like depression, panic disorder, battered women, rape victims, STD victims, etc. have their own online discussion groups. Likewise, AOL has its own Online Psych. Everyone could find a group of interest.
A few of the supportive agencies and groups in regard to stress are:
- Local Mental Health Centers; Alcohol and Drug Abuse Centers. Professionals work in these agencies; make use of them. Fees are based on ability to pay.
- Local Alcoholics Anonymous (AA), and Al-Anon or Alateen for relatives of alcoholics. These are self-help groups; no professionals and no charge. See alcoholism in chapter 4 for Web sites.
- Local and online self-help groups based on AA principles: Gamblers Anonymous, Overeaters Anonymous, Neurotics Anonymous, Psychotics Anonymous, Parents Anonymous (for abusive parents), and others. See chapter 4 for possible Web sites.
- Local and online groups for phobic, abused, abusing, depressed, manic-depressive, schizophrenic, obsessive-compulsive, workaholic, sex addicted, over spending, etc. persons.
- Local and online groups for people who are going through as crisis, such as death of a spouse or child, divorce of parents, suicide by a relative, being fired, being dumped, suffering AIDS, serious injury, mastectomy, vanished children, etc.
- Local diet and exercise clinics (see comments in chapter 4); online dieting and eating disorders groups. See chapter 4.
- Parents without Partners, Big Brother/Sister Organizations, Scouts, local sports-recreation programs, Foster Grandparents, and others.
- Department of Family and Children Services, especially to investigate child abuse; Welfare Departments; Food Stamp Program.
- Women's organizations such as Women's Centers for abused women, Women Against Rape, Day Care Cooperatives, university programs in Adult Reentry and Woman Studies, Family Planning Centers, YWCA, Displaced Homemakers (employment services), Professional Women's Organizations, Equal Rights Organizations and others.
- Organizations for the aged include Gray Panthers, Foster Grandparents, Visiting Nurses Associations (for health care at home), Elder Hostel Program (travel and education), Senior Citizen Centers, Council on Aging or state Department of Aging, Meals-on-Wheels have free meals for the elderly, and volunteer programs at nursing homes and hospitals and so on.
- For employment problems: Employee Assistance Programs, state Employment Office, Job Training Programs, Displaced Worker Projects, Occupational Safety and Health Hot Lines, community colleges offer various technical skills courses, and there are many occupational-professional-union organizations.
- Personal growth groups, Marriage Improvement Programs, encounter groups, workshops or courses on interpersonal communication or specific concerns, self-help classes, etc.
- Many support groups are focused on specific health problems: cancer, heart disease, leukemia, loss of a child, mentally and physically handicapped children, etc. See the health Web sites given later in this chapter.
Warnings: A few self-help groups, similar to religious cults, become dominated by a highly controlling leader who demands loyalty to him/her or to the group. Be leery of any group that attempts to control your life. Likewise, avoid groups which offer mystical experiences, such as talking with the dead or curing physical diseases, or which specialize in uncovering repressed memories, such as childhood sexual abuse or past lives.
Attacking the emotional (stress, fear, anxiety) parts of the problem
Relaxation training --one obvious way to counter stress and anxiety is to learn to do the opposite, to relax. 2,500 years ago, Chinese philosophers, who believed suffering was a part of existence, suggested a way to avoid frustration: give up your wants and ambitions! They made a good point but Westerners find it hard and undesirable to be goalless. Besides the Buddhist's way, there are many other ways to relax: (a) progressive (Jacobson, 1964) or deep-muscle relaxation, (b) stretching or breathing exercises, (c) cue-controlled relaxation (pairing relaxation with a word like "relax" and using the word as a command when needed), (d) suggested relaxation of the body ("you are getting relaxed, your arms are getting warm and heavy..."), (e) suggested relaxation fantasies ("you are on a warm, sunny beach..."), (f) cognitive and sensory tasks ("listen to this story...think about your vacation...concentrate on..."), (g) meditation or Benson's method of relaxing, and (h) biofeedback. Methods of relaxing are described in chapter 12. Of course, there is also exercising, having sex, sleeping, reading, watching TV, socializing, and diverting attention to pleasant tasks.
Since we each respond to stress in a different way--some worry, some get mad, some get stomach or headaches, etc.--we each need to find our own way to relax. Ask yourself if your anxiety is more physical or mental. When you are anxious, if it is mostly physical, your heart will speed up, you'll feel tense, perspire, freeze up, hands or knees will shake, hands are cold and damp, stomach will get upset, and you need to go to the bathroom. If your anxiety is mostly mental, your mind can't concentrate, you have scary thoughts, worry a lot but can't make decisions, and become obsessed with the problem you face. If your reaction to stress is mostly physical, try relaxing your physical body by exercising, deep muscle relaxation, stretching, taking a bath, getting a massage, etc. If your reaction is mostly mental, try relaxation fantasies, meditation, cognitive tasks, reading, TV, calming self-instructions, pleasant fantasies, etc. Haney and Boenisch (1987) will help you find relief.
There is accumulating evidence that the effects of relaxation, no matter how achieved, last for a couple of hours beyond the 15 to 20 minute relaxation training period. This is true for exercise too. The exact mechanism for this is not clear, however. The relaxation may linger on or the stressed person may learn to briefly re-relax themselves throughout the day. The latter view is suggested by Stoyva and Anderson (1982) who contend that chronically anxious-psychosomatic-insomniac patients have lost their ability to rest. Biofeedback confirms this theory somewhat since anxious people maintain physiological tension and psychological uptightness much longer than other people. Thus, the best approach may be to teach ourselves how to relax every few hours during stressful days.
We may even be able eventually to develop a more relaxed personality. Try to stay calm. Attend closely to what others say and do. Don't interrupt. Talk less and speak softly, slowly, and in a gentle manner. Don't get angry, just try to understand the other person's viewpoint. Say enough to show you are empathic. Breathe slowly and smile a lot. But don't be phony.
Relaxation methods have helped with many kinds of stresses--general anxiety, Type A personality, and psychosomatic disorders. Many of the professional treatment programs emphasize frequent relaxation of the muscles and reducing mental strain, such as self-criticism, worry, and the excessive demands that we make of ourselves ("do the laundry, fix the car, prepare a speech..."). Indeed, one study indicated that relaxation does not occur because we relax our muscles but rather because we relax our brain and stop sending out "try harder messages" to our body (Stilson, Matus, & Ball, 1980). How to relax by changing our thoughts is described in chapter 14. Some of us apparently need to relax muscles, others need to stop certain thoughts, others need to exercise, others need to sleep more or better, others need to cuddle and have a massage, others need to read or listen to music, i.e. "different strokes for different folks." If you don't know what you need to relax, try different approaches (see chapters 12 and 14). Don't use smoking, drinking, bingeing, and coffee as a way to relax.
Some self-help approaches may, at first, seem unlikely to work. For instance, say, you want to reduce your tension and anxiety, to escape the pressures you are feeling. What probably seem to you most likely to be effective are techniques that would help you calm down and relax. And those methods are certainly reasonable choices, but research has shown that having positive experiences and feelings decrease our negative emotions, including stress, anxiety, depression, anger and dependency. So, an anxious person might also want to focus on increasing the positive events and feelings in their life. This could include planning and doing interesting things, stopping to "smell the roses," looking for the positive aspects of your situation, reading and practicing positive self-changes (more optimism, more happiness, higher self-esteem, greater toughness), taking pride in planning and using ways to handle the anxiety, having more fun, seeking more and deeper social contact and support, etc. There are many ways to get where you want to go--be open-minded but make use of research-based self-help methods.
Desensitization --a method that must be considered for overcoming unreasonable or excessive fears. This well researched procedure is based on the belief that a strong relaxation response can gradually overpower and inhibit a fear response to a particular stimulus. The desensitization method involves first relaxing, then imagining mildly scary situations, and works up to relaxing in the most scary (but not actually dangerous) situations. This is a painless method of reducing anxiety or fear reactions because you must stay deeply relaxed throughout the entire process. It avoids all stressful actual confrontations with the scary situation, being done entirely in one's imagination. So it is easy to carry out and always available--it just takes fantasy (see in vivo and Exposure for versions that require confronting the real situation). The method was developed by a psychiatrist, Joseph Wolpe (1958), and based on classical conditioning, using the same principles as Watson and Jones in the 1920's.
Extensive research has evaluated desensitization, indicating it is an effective method, but powerful placebo or suggestion effects are just about as effective, suggesting the method may not add a lot beyond the expectation of improvement. Wolpe (1980) has claimed that the method is also helpful with many psychosomatic disorders because it reduces the underlying anxiety. No competent self-helper should overlook desensitization as described in chapter 12; it is potentially useful in any situation with any unwanted emotion.
Flooding and venting feelings --experiencing and releasing intense emotions is thought to be beneficial in a variety of ways. First of all, Freud sought intense emotional reactions in therapy, called abreactions. These repressed memories usually involved very painful early childhood experiences. The patient would relive these experiences and as a result gain insight into the source of his/her current problems. With this new understanding, the fear, neurotic behavior, or psychosomatic complaint will go away, supposedly. Primal therapy, which uncovers the hurts of birth and early childhood, is based on the same assumptions. The newer therapies by John Bradshaw and others, which reclaim and nurture the hurt inner child, also relive the disappointments of childhood. In a sense, like desensitization, this is confronting the inner sources of fears and traumas, usually from childhood and often well repressed (see the end of this list).
Secondly, Stampfl & Levis (1967) developed a treatment method that involved telling phobic patients horror stories that aroused their intense fears. It was called implosive therapy and is now known as imaginal flooding. The idea is for a phobic person to imagine scary situations and experience the fear as intensely as possible. Usually the therapist vividly describes the scary scenes, deliberately frightening the patient as much as possible (he/she is told the purpose). The phobic person continues imagining the stressful scenes for a long time. Gradually the emotional reaction to the ghastly images declines. Eventually the patient is imagining the terrifying fantasies but not responding with fear. In this way, much like cue exposure for compulsives, the connection between a stimulus (flying) and a response (fear) was broken, i.e. unlearned. And, the patient has learned that he/she can stand intense fears.
Thirdly, another way to reduce a fear using flooding is to place yourself in the actual frightening situation until the fear "runs down." As in Exposure, the confrontation could result in a strong fear response initially that gradually declines. Suppose you had a fear of heights or elevators. Getting on an elevator might be terrifying but if you stay on it all day, you learn three things: (a) nothing terrible happens (beyond the initial stress and possible motion sickness), (b) by the end of several hours you are going up and down without fear, and (c) you are not weak, you can stand stress, you can master the fear. Flooding is the treatment of choice for agoraphobia.
Fourthly, a similar approach, using flooding, involves the paradoxical intention of trying to increase a fear or anxiety. For example, a female student in my class had a fear of the dark, particularly coming home and imagining that someone was lurking in the dark to assault her. She had never been attacked but it was a serious and long-standing fear. First, she tried self-desensitization. It did little good. Then she decided that whenever these scary fantasies started, instead of resisting them she would try to see just how scary she could make them. Much to her surprise, after trying to really scare herself a few times, the fears diminished. It seemed to her as though the unwanted fantasies went away (gave up?) as soon as they lost the power to upset her.
People who have panic attacks often think they are going to faint or are having a heart attack and will die. So, therapists using paradoxical intention may ask the patients to exaggerate their symptoms, e.g. they might be instructed to become frightened and sweat or to faint or to try to bring on a heart attack. Of course, these dire expectations, that phobics desperately try to avoid, can't ordinarily be produced even when they try hard to do so. So, people can learn to "take charge" of their symptoms and, thus, the attacks lose their power to scare the victim.
Lastly, see the extensive discussion of catharsis in chapter 7. It is commonly thought that getting feelings off your chest is helpful, especially sadness and anger. Certainly many people find it helpful to "have a good cry" or to admit openly that they are nervous and to "let go" of those feelings. Telling others about our fears and doubts may be the first step to finding out we aren't weird and to overcoming the stress.
Note: Don't use flooding alone, have a friend with you who understands your problem and the method you are using.