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Russo CharlesCharles Russo M.D., FACCWhat stresses us out? There are many people in lower socioeconomic conditions without good hygiene or living conditions that have real problems with survival and, therefore, stress. For the most part, in this country, most of us do not have this real, palpable stress of day-to-day survival, although we may feel that we do and therein lies the rub.

So what causes stress for the most of us? There are many reasons that may come to mind such as the school bully, the bullying boss or spouse, fear of job security, fear of mounting bills or fear of rejection by family, friends or associates. There are also various psychological stressors such as poor body image, low self esteem and our own neurotic tendencies. As I said in the first article of this series some of these are real but others are just perceived.

One of my favorite examples of stress that is perceived is what is called "Toxic Stress". I know this well because I am a daily practitioner of it and I am betting that some of you will recognize this in yourselves. If you were waiting in line at the supermarket and screaming in your head at the cashier who is having friendly conversation with the customers because she should be taking care of business and moving the line along, then you have toxic stress. If you are sitting in your car and 1 microsecond after the light changes your hand is on the horn and your yelling at the people on the left and the right of you, then you have toxic stress. Sound familiar?

So what are the modulators of stress and what can we do about them? Predictability definitely affects stress. If the situation is known it is certainly in most instances less stressful than the unknown. However, as we will see in all of these modulators of stress everything is conditional and situational. What do I mean by that? Well, if the end of the world is predictable and known I do not think any kind of stress modification is going to help that situation.

A second modulator of stress is control. However, control only works in mild to moderate stress situations and not in high stress situations. Also control can be good if you can make an impact on the situation but it can be bad in a no-win situation. So that, for instance, if you are a paramedic in an emergency situation and you have trained to handle that situation and feel confident in your abilities it will be less stressful.

A third modulator of stress is an outlet for your frustration. Again, as before this can have positive or negative connotations such as running to relieve stress or doing breathing exercises versus ranting at a colleague, your child or your spouse as an outlet for your frustration.

A fourth modulator of stress is your social support. As with the other modulators of stress this can be a positive or a negative. If you are alone, finding solace in a social, community or church group may help. However, if that network of friends or social circumstances is the cause of your stress then that is not a good thing.

A fifth modulator of stress is your mental outlook or attitude in any given situation. This is the most personal of the modulators. We all know people who are Mr. or Mrs. Sunshine even when the world is falling down around them. Sometimes we admire them for this quality and at other times we just want to shake them back to reality. But, in general, a positive mental attitude, the thought that the glass is half-full instead of half empty, is a plus in most situations

So what do we do about chronic stress? What are the best ways to deal with these modulators of stress in a positive way? Obviously, in situations that are predictable we can try and gain control and put our best foot forward with or without the help of others to positively impact the situation. I know that this is a great platitude but with practice, by being mindful (aware of the situation that you are in and your part in it) you can eventually be more reasoned in any situation. There is an old medical saying, when in a crisis take your own pulse first.

The best way to manage stress in our lives is with regular learned activities that are constantly practiced and refined. This will increase our focus, our creativity, our self-awareness and promote relaxation. These are usually very individual, personal and can even be situational. Most of these activities involve some form of contemplation, meditation or prayer with or without a physical aspect associated with it such as yoga or Tai Chi but it can also be purely physical such as any aerobic activity that just takes your mind off the stress of the day such as jogging, bicycle riding or swimming.

The best techniques are those that can be practiced silently for a few seconds even in the middle of the situation that is stressful. Obviously, going out for a run during a stressful situation will not do. However, having said that it is often these physical techniques that allow your body and mind to be more quiet at rest and perhaps more receptive to the other mental techniques or even just awareness of the situation and your part in it, that is all you need to get through the crisis.

Charles Russo M.D., FACC, is Board certified in internal medicine and cardiovascular disease. He lives in Fort Lauderdale with his wife and 4 children and obtained his medical degree from New York Medical College with his Cardiology degree from the University of Miami and has advanced degrees in nuclear Cardiology and Lipidology (the study of blood fats).


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