Stress inoculation --Epstein (1983) believes stress and anxiety are naturally reduced in daily life by repeatedly and gradually thinking about more and more upsetting aspects of a frightening situation. If the emotions become too intense, however, the fears may build instead of diminish. But if our anxiety responses remain within certain limits as we ruminate, we can reduce our fears by imagining over and over specific details of confronting our boss or jumping out of an airplane. It is a natural healing process. If true, it is another explanation for desensitization. We may not need to be deeply relaxed.

 What are the therapeutic implications of Epstein's notions? That we can reduce unrealistic fears by experiencing (in reality or in fantasy) the scary situation so long as the feared harm doesn't occur. We must fully experience the stimulus situation without distortion or defenses. So start with less scary aspects and work up to the most scary (like the desensitization hierarchy--see chapter 12). As we experience the stimulus and the fear, we come to realize that it is our view of the situation--our incorrect expectations--that make it so scary, not the actual stimuli. We learn to see the situation realistically. We gradually reduce the fear response--so that we can be fairly calm parachuting out of a plane at 10,000 feet. That is stress inoculation.

 For some people, stress inoculation is basically learning to "talk yourself down" or facing a stress and finding ways to handle it. For others (Meichenbaum & Cameron, 1983; Meichenbaum, 1985), "stress inoculation training" is a complex therapy process (see method #7 in chapter 12). It is a major part of Cognitive Behavior Therapy and involves (a) helping the patient become a better observer and a more accurate interpreter of incoming information. (b) Teaching stress management skills, such as social interaction, problem solving, and how to use self-instructions for relaxation, self-control, and praise (see method #2 in chapter 11). (c) Help in applying the various self-help skills in life. In short, this method is designed to be used by a therapist, although the techniques are similar to what you are learning in this book. In fact, written how-to instructions for stress inoculation were recently provided test-phobic students (Register, Beckham, May & Gustafson, 1991). The written material alone helped.

 Use "nervous energy" --channel the anxiety created by stress into constructive, beneficial activities, such as taking a course, preparing for a promotion, helping others, etc. Hans Selye believed that meeting challenges, like competing in sports or being active in a cause, produced "good stress" which gives us a rush or a "high" feeling. Good stress keeps us motivated and enthusiastic about life. So, Selye recommended that we expose ourselves to as many good stresses as we can handle, so long as we don't get over loaded. When a person becomes over loaded with good or bad stress, he/she should use the energy in a way that works off some tension, e.g. playing tennis, jogging, walking, doing aerobics, hard physical work, etc. In short, make stress work for you. Turn frustrating obstacles into exciting challenges.

 A related concept is that we need some stress--some pressure, not too much--to do our best. Every athlete knows that he/she needs keen competition to become his/her best. Every student should be aware that the quality of his/her education is, in large measure, determined by the motivation and ability of the competing students. The wise person seeks, welcomes, and uses this pressure to achieve his/her own highest potential.

 Develop psychological toughness --physical demands must be made on the body to develop strength, we must be exposed to bacteria and diseases to develop an immunity to them, and humans may need to be exposed to stresses and emotions before we develop coping mechanisms and toughness. Type A personalities with their hurried, competitive, tough, aggressive behavior are actually weak at coping with stress, their bodies take a long time to return to normal after becoming upset (and they have a lot more illness and die earlier). Dienstbier (1989) points out that people in very demanding and responsible positions develop very healthy reactions to stress, providing they are in control and have an opportunity to cope. If you give someone lots of responsibility and little power, however, they develop very unhealthy reactions, including feeling helpless.

 How do you develop toughness? By being repeatedly exposed to demanding situations while having the skills, power, courage, and confidence to deal with the challenges. It may help you become psychologically tough if you physically exercise, but I suspect you must gradually handle more and more stressful, difficult problems and interactions at work or in your personal life, not just in the gym. Thus, using relaxation methods to overcoming fears is only the beginning; true toughness and durability comes after hard knocks. As we discussed in Exposure above, our attitude has to change from "I can't stand it" to "I can handle it."

 Salvatore Maddi and Suzanne Kobasa (1984) studied healthy executives and tried to discover ways of increasing toughness. They found hardy people were (a) committed to their work (they, like self-actualizers, have a mission they believe in), (b) have a sense of control over what happens in their life, and (c) zestfully seek and take on challenges, feeling they will learn from the experiences. They seldom get sick. They were tough. Maddi and Kobasa then tried to teach less hardy managers to be psychologically tougher using three methods: problem-solving to reduce the stress (much like the chapter you are reading right now), focusing (for gaining awareness of hidden emotions, see method #5f in chapter 15), and self-improvement projects (to improve self-esteem and a sense of mastery). So, by learning self-help, you are getting tougher (IF you expose yourself to tough situations and come out a winner most of the time). You have to move on from just handling anxiety to taking the many risks involved in making lots of positive things happen in your life.

Reducing stress by acquiring helpful skills

 Skills training --if we feel inadequate, one solution is to become more adequate, even over-compensating for our real or imagined weakness. Chapter 13 provides a variety of skills which might reduce stress. Examples are: problem-solving ability, decision-making skills, social skills, assertiveness skills, empathy responding skills, time management skills, study skills, leadership skills, etc.

Cognitive methods of reducing stress

 Observational learning and modeling --watch a person similar to you handle the frightening situation. This is called "guided mastery" or modeling. Cognitive therapy has repeatedly shown that humans can learn to overcome fears by observing others, preferably not an expert and not a person overwhelmed with fear. If you wanted to be comfortable handling snakes, it wouldn't help much to watch a snake handler catch and milk rattle snakes. But watching a snake phobic person cautiously and nervously approach and briefly touch a harmless, pretty, little snake would help you, with encouragement, to do the same thing. Modeling is discussed in chapter 4.

 Cognitive treatment methods --if you change your assessment or interpretation of a scary situation, your emotions in that situation will often change. That is the basic idea of cognitive methods, but there is a wide, almost overwhelming variety of ways to alter your view or interpretation of a situation. Let's see if we can clear this up somewhat.

 Some cognitive methods consist of changing your self-talk and thinking, e.g. substituting constructive, positive self-statements for self-defeating statements to reduce your fears. As we just saw, this is the essence of stress inoculation, usually called a cognitive-behavioral method. There are certainly other methods, sometimes called cognitive, which involve learning how to think differently: learning problem-solving, skills, and planning methods; using paradoxical intention and flooding; developing healthy attitudes and toughness; and gaining insight. Some writers even differentiate between cognitive methods that simply change your thinking or automatic assumptions (changing "I will fail" to "I can handle it") and other cognitive methods that require you to challenge the logic or validity of your own ideas or conclusions or schemas ("feeling dizzy means I'm going to pass out"). The latter is considered by some to be "deeper" or real cognitive therapy.

 First, let's compare two different treatment approaches based on different theories. There is a squabble between conditioning and cognitive explanations of fears. You may need to understand these different theories in order to select the self-help method that best fits your condition. Each theory recommends somewhat different treatment methods, e.g. exposure to the scary situation vs. changing erroneous ideas (next 3 methods) or guided mastery. If phobias are largely conditioned physiological reactions, then you should be able to reduce the phobia response by exposing yourself for a long time to the harmless but frightening object or situation (although this alone would surely change your appraisal of the situation). But, if phobias are largely caused by your own erroneous beliefs or thinking, you would need to correct your appraisal of the situation, learn some skills useful in that situation, correct your false conclusions about the situation, and re-evaluate your ability to cope with that situation. A therapist, self-help guide, or ordinary person acting as a model would probably be helpful when using many cognitive techniques with strong fears or panic.

 Despite being very different theories, the treatment of fear based on conditioning and cognition have a lot in common. Both eventually require the frightened person to confront the frightening but harmless situation. This exposure will usually gradually extinguish the intense fear response and cause the person to think more realistically about the situation. Which is the critical change? The scientist needs to know. It doesn't matter much to the phobic, if his/her treatment method works. If the method you try doesn't work, just select another method.

 Is it possible that some fears are based more on conditioning and others are caused more by fantasies and faulty perceptions or thinking? Yes, very likely, although psychologists can't, at this time, tell one kind of fear from another. Joseph Wolpe used desensitization with a patient fearful of cockroaches. It didn't work. Then he learned that her husband was nicknamed "Cockroach" and that they had serious marital problems. After Wolpe did marital therapy, the relationship improved and the cockroach phobia went away without special treatment. Wolpe now believes about 1/3 of phobias are cognitive and don't benefit from desensitization, which he "invented." So, when we are distressed, we will just have to try different treatments and see what works best for us. Knowing the different theories, however, helps you find or devise different approaches to changing.

 Fortunately, the research to date indicates that both exposure to the frightening situation and correcting our faulty perceptions and conclusions are generally effective in reducing fears. As you consider the next three cognitive methods try to decide which would work best for you.

 Correcting faulty perceptions --validating or having our perceptions confirmed by others is sometimes a critical step. We are frequently not aware of our specific misperceptions, but we can, in most cases, learn to recognize our tendencies to distort, such as exaggerating our importance, denying our responsibility, expecting the worst, being overly optimistic, blaming ourselves, distrusting others, and other ways. If we are aware of our own perceptual biases, we must constantly check our impressions or views in that area with others. If we are not aware of our perceptual distortions, we must occasionally compare other people's honest assessments with our own to make sure we are seeing things accurately.

 If persons, who are afraid of spiders, see pictures of spiders paired equally often with a tone and a shock, they will strongly believe that they have seen spiders associated much more often with a shock than a tone (de Jong, Merckelbach, Arntz, & Nijmam, 1992). This distortion of reality does not occur in people who are unafraid of spiders. Thus, if you are phobic, you can not blindly accept "what you see with your own eyes." You must make systematic observations, keeping careful records. And you must check out your observations with others.

 Martin Seligman (1991) and many other researchers have shown that optimistic or pessimistic "explanatory style"--how you automatically see and explain things--influences many things, including how well you do in school and on the job, and even your general health. That is, optimists do better. So if you have a pessimistic, "I'm helpless," attitude, it needs to be changed (see chapters 6, 8, and 14). How? Test out your expectations. If you believe that you can do nothing that would help with a problem you have, try some approach anyhow and see if it fails. If it does, then make three or four more good efforts using a different attack, and see if they all fail. Likewise, if you believe that no one would help you or be honest with you, test out three or four people and see if your predictions are accurate. In time, you can develop a more optimistic attitude based on actual experience; look for the opportunities to learn and grow that are hidden in every problem.

 Cognitive therapy also uses distraction and "rational responses" as substitutes for depressing or catastrophic perceptions of the situation. Example: a person with a panic disorder may first experience nausea, then shakiness, heart racing, lack of breath, and finally panic. The accompanying thoughts are "I hope I don't get upset here," "I'm getting sick," "I'm having a heart attack!" "I'm going to die," "I've got to get out of here," and later "I'm a nervous wreck... I'm going crazy." The therapist might teach this person to reproduce the same physical symptoms by hyperventilating, to control the tension by distraction ("sit down, read the paper, and relax"), and to replace the catastrophic thinking with rational, reassuring thoughts: "I can prevent this panic attack," "my heart is beating fast but that is okay," etc. You can teach yourself these kinds of things.

 Helplessness and self-efficacy seem to be the opposite ends of the same dimension; increasing self-confidence in self-control is discussed in Planning self-improvement below and in method #9 in chapter 14. More details about correcting our faulty initial impressions are given in method #5 in chapter 14 (straight thinking). Another excellent but complex (realistic!) example of checking out our interpersonal perceptions is given by R. D. Laing (see method #7 in chapter 13).

 Changing the way we see the world is not a quick and easy process. You will have to check out your views in many situations over and over. It's hard but if your initial perception of reality is wrong, all your subsequent thoughts based on those impressions are faulty too. That's serious.

 Stop irrational thinking --after perceiving the current situation, we compare what is happening (as we see it) with what we want to happen or believe should be happening. When we, others, and the real world are not as good or as satisfying as we had hoped, we get upset. Thus, the Rational-Emotive therapist says it is our beliefs that cause stress, self-doubts, shame, depression, anger, and most emotions. We can learn to recognize our irrational demands and reactions when life doesn't work out as we would like. Examples:

 Rational-Emotive therapy techniques (method #3 in chapter 14) will help you to identify a variety of irrational ideas and to think logically. Example: "It would be awful if ___(Joe) ___ didn't like what I did" is a common thought. But someone not liking what you did is merely a temporary nuisance or disappointment, not an awful, catastrophic life event. Indeed, if you knew the person well, you might understand exactly why he/she doesn't like it (they are responding "lawfully" for them). It isn't the reaction you want, but you can handle it.

 We are all prone to automatically think "wouldn't it be awful if I got fired... if my lover wanted someone else... if I got cancer... " or even "if she/he turned me down after I asked her/him for a date... if I flunked this course... if I dented the car... if I said something silly... if my fly/blouse came open... " The truth is that life goes on and very few events are truly "awful," most unfortunate incidents are naturally occurring, often unavoidable, short-term inconveniences (see discussion of determinism in chapter 14). Also, most worries never happen! Many therapists ask clients to imagine the worst possible outcome in their situation, and then ask, "So what would happen, if that occurred?" Or, the therapist might ask, "What effect will this have on your life 1 or 5 years from now?" Usually there is a solution or some outcome that isn't entirely awful forever.

 Besides being upset if things don't go as we'd like, other common irrational ideas produce stress, such as "if anything could go wrong, I should worry about it a lot" and "if I or anyone does anything bad, we should be blamed for it and punished." These thoughts suggest we are striving for more control over the world than is possible. Others tell themselves, "I can't do anything about what happens." This also causes stress, because we see ourselves as having no control over the world.

 Perfectionists need to give up impossible goals (see chapter 6). Do the best you can and accept the outcome. Inspire and help others all you can and accept whatever happens to them too.

 The Rational-Emotive therapist tries to quickly identify the client's irrational expectations and ideas. He/she goes on to show the patient how unreasonable, foolish, and harmful these ideas are. Then the client is shown more reasonable ways to think (talking to him/herself) and is told it is his/her choice as to what beliefs to have, i.e. to be irrational and "upset" or rational and "at peace with the world."

There is nothing either good or bad, but thinking makes it so.
-William Shakespeare, Hamlet

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