Stress Management Can Save You Money!

An increasing number of studies, including randomized clinical trials, point to safe and relatively inexpensive interventions that can improve cardiovascular health outcomes and reduce the need for more expensive medical treatments.

A study of patients with heart disease found that psychosocial interventions reduced the risk of further cardiac events by 75 percent, compared to the patients who were given only standard medical care and medications. A sample of 107 patients with heart disease was randomly divided into three groups (standard medical care, exercise, and stress management) and followed for up to five years for the incidence of myocardial infarction, bypass surgery, and angioplasty. The stress management group showed a marked difference compared to the other two groups: only 10 percent experienced these clinical conditions, versus 21 percent in the exercise group and 30 percent in the standard - care group.

An important component of psychological preparation for surgery involves giving patients positive physiological suggestions and imagery. In a randomized, placebo - controlled, double - blind clinical trial, 335 patients were given one of four different audiotapes to listen to before and during surgery. The placebo group listened to a tape with a neutral white noise. Only one experimental tape produced statistically significant benefits; it contained guided imagery, music, and specifi c suggestions of diminished blood loss and rapid healing. The patients who listened to this tape experienced a 43 percent reduction in blood loss and were able to leave the hospital more than a day earlier than the other groups.

The Chronic Disease Self - Management Program, developed jointly by Stanford University and Kaiser Permanente, includes educational group sessions for patients with chronic disease. The intervention consists of a patient handbook and seven weekly two - hour small - group sessions that focus on developing practical skills to cope with common symptoms and emotions. In a randomized clinical trial of 952 patients, those who participated in the course, compared to the wait - listed control subjects, demonstrated significant improvements at six months in weekly minutes of exercise, self - reported health, health distress, fatigue, and disability. They also had fewer hospitalizations and spent an average of 0.8 fewer nights in the hospital. Assuming that a day in the hospital costs a thousand dollars, the health care savings were approximately $750 per participant — more than ten times the cost of the program.

Not only does stress management appear to reduce the long - term chances that heart patients will have another cardiac event, a new analysis by the Duke University Medical Center and the American Psychological Association demonstrates that this approach also provides an immediate and significant cost savings.

The medical outcomes in this study were notable. Patients in both the exercise group and the standard - care group averaged 1.3 cardiac events — bypass surgery, angioplasty, heart attack, or death — by the fifth year of the follow - up. Those in the stress management group, in contrast, averaged only 0.8 such events during the same period.

The research team found a financial benefit of stress management strategies within the first year of the study. The average cost for the patients who utilized stress management were $1,228 per patient during the first year, compared to $2,352 per patient for those who exercised and $4,523 per patient for those who received standard medical care.

Moreover, the researchers found that the financial benefit of stress management was maintained over time. The average cost rose to only $9,251 per patient during the fifth year for those who used stress management strategies, compared to $15,688 per patient for those who exercised and $14,997 per patient for those who received standard medical care. The average cost per patient per year during the five years was $5,998 for those who used stress management, $8,689 for those who exercised, and $10,338 for those who received standard medical care.

Thus, the benefits of stress management seem to exceed the benefits of both exercise and standard medical care in the reduction of cardiac events and in financial costs.

There is now a large body of research that links stress to heart disease, and there is an equally impressive and growing body of evidence of the effectiveness of stress management for successfully treating heart disease. Thus, it seems prudent that clinical interventions should better refl ect the emerging evidence of the effi cacy and cost - effectiveness of stress management for the treatment of heart disease. Stress management techniques such as B - R - E - A - T - H - E should be an integral part of evidence - based, cost - effective, high - quality health care.

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What is stress?

So what is stress? It is one of those terms that mean so many things to different people. For the purposes of this book, it may be a good idea if we have a common understanding. In this chapter we shall provide you with a definition of stress, highlight the difference between pressure and stress, and explain the biology of stress.

Simple definition

There are many definitions of stress. The one we have found useful is:

Stress occurs when pressure exceeds your perceived ability to cope.

So it is not just external pressure, such as reaching deadlines, that triggers stress, but whether you believe that you can cope with a situation that you perceive as important or threatening.

Obviously, the more experienced or skilled you are at a particular activity, such as giving presentations or completing projects on time, the less likely you are to become stressed.

But in many jobs there is constantly high pressure to perform, and no breathing space at all. Under pressure employees start working longer hours, taking work home, and in extreme cases work in their holidays to achieve work targets and deadlines. A time may come when, literally, the person passively accepts one project too many and then realizes he or she just can’t cope any more. We often hear the phrase, ‘the straw that breaks the camel’s back’, but this is very relevant to the field of stress prevention, as we will highlight shortly.

Of course, if you do not perceive that the problem is important or threatening, then even if you do not successfully deal with it, you are unlikely to become stressed.

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Top 5 Causes of Stress

As we race through life at breakneck speed, the list of stressful triggers that are linked to cardiac disease is growing. Some of the first reported examples of emotional stressors related to heart disease were depression, anger, and hostility. There ’ s a large body of research from the early 1950s that demonstrates this relationship. More recently, however, because of our fast - paced, multitasking lifestyles, many other emotional triggers have been found to be damaging to the heart. Here are some examples:

Repressing your feelings

Marital arguing patterns, for example, have been shown to be detrimental to cardiovascular health, particularly in women. The women who repressed their feelings of resentment and anger toward their husbands had a higher risk of heart attack than those who were more open and expressive of their feelings.

Panicking

Panic attacks were also recently found to be linked to the risk of heart attack. In one study, the women who experienced at least one full - blown panic attack had a signifi cantly increased risk of heart attack and stroke.

Experiencing an earthquake

The Northridge earthquake that struck Los Angeles in 1994 was one of the strongest ever recorded in North America. There was a sharp increase in the number of deaths from cardiovascular disease immediately after this event, and the researchers postulated that emotional stress from the quake was the cause. Similar data were observed after a major earthquake in Japan.

Worrying while you work

Ten thousand British government workers with long - term job stress were followed for twelve years. This study was the fi rst to show that on - the - job stress could cause cardiovascular disease, either directly, from the stress itself, or indirectly, by leading stressed employees to adopt unhealthy lifestyles (such as smoking or heavy drinking). The study found that those with chronic job stress had a 68 percent higher chance of having a heart attack, developing angina, or dying from heart disease.

Having unhappy (or too happy?) holidays

In a twelve- year study conducted in Los Angeles, researchers showed that cardiac death rates were consistently higher in the winter months and peaked at Christmas and New Year ’ s. Specifi cally, December 25 and January 1 are the deadliest days of the year for heart attacks and sudden cardiac death. The researchers hypothesized that the peak in cardiac deaths during the holidays might be a result of emotional stress, overindulgence, or both.

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Can Aromatherapy Cure Panic and Anxiety?

Many people strongly advocate aromatherapy to deal with panic and anxiety. Lavender can have an especially calming and soothing effect when you smell it. You can find essential oil of lavender at many stores. Keep it handy and take a sniff when you start feeling anxious.

Try putting a few drops of lavender essence oil into some oil (olive or grape seed oil will do) and rub on your body. Keep a prepared mixture in a dark glass bottle for when you need it. You can even prepare several bottles, with a small one to carry with you.

Other essential oils known to help panic and panic attacks are helichrysum, frankincense, and marjoram. Smell each of them, and use what smells best to you, or a combination of your favorite oils mixed in olive or grape seed oil.

You may want to prepare yourself BEFORE a panic attack happens. When you're not in a panicked state, make a list of the things that you're afraid will happen. Then write out calming things that tell you the opposite of your fears.

Then you can repeat these things to yourself when the panic starts to come. Prepare a list of things to do in case of panicked feelings, and it will be ready for you when you need it. Fill it with lots of soothing messages and ideas of calming things to do. I find this to be a very helpful tool and am never without my small notebook that has these positive affirmations in it.

Panic can be a very scary thing to go through, especially if you're alone. Preparing for when the panic comes can really help reduce the panic, and even sometimes help to prevent it.

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Imagine Having A Panic Attack

Imagine having a panic attack as like standing on a cliff's edge. The anxiety seemingly pushes you closer to falling over the edge. To be rid of the fear you must metaphorically jump. You must jump off the cliff edge and into the anxiety and fear and all the things that you fear most.

How do you jump? You jump by wanting to have a panic attack. You go about your day asking for anxiety and panic attacks to appear.

Your real safety is the fact that a panic attack will never harm you. That is a medical fact. You are safe, the sensations are wild but no harm will come to you. Your heart is racing but no harm will come to you. The jump becomes nothing more than a two foot drop! It’s perfectly safe.

Anxiety causes an imbalance in your life whereby all of the mental worry creates a top-heavy sensation. All of your focus is moved from the center of your body to the head. Schools of meditation often like to demonstrate an example of this top-heavy imbalance by showing how easily the body can lose its sense of center.

The key to overcoming panic attacks is to relax. That’s easy to say but difficult to do. A good way to do this is to concentrate on your breathing making sure it is slow and steady. One of the first signs of a panic attack is difficult breath. When you focus on making those breaths even, your heart rate will slow down and the panic will subside.

Breathing more slowly and deeply has a calming effect. A good way to breathe easier is to let all the air out of your lungs. This forces your lungs to reach for a deeper breath next time. Continue to focus on your out-breath, letting all the air out of your lungs and soon you'll find your breathing is deeper and you feel calmer.

Ideally, you want to take the focus off the fact that you are having a panic attack. Try to press your feet, one at a time, into the ground. Feel how connected and rooted they are to the ground.

An even better way is to lie down with your bottom near a wall. Place your feet against the wall (your knees are bent) and press your feet one at a time into the wall. If you can breathe in as you press your foot against the wall, and breathe out as you release it, it will be more effective. You should alternate between your feet. Do this for 10 - 15 minutes or until the panic subsides.

Use all of your senses to take full notice of what you see, hear, feel, and smell in your environment. This will help you to remain present. Panic is generally associated with remembering upsetting events from the past or anticipating something upsetting in the future. Anything that helps keep you focused in the present will be calming. Try holding a pet; looking around your room and noticing the colors, textures, and shapes; listening closely to the sounds you hear; call a friend; or smell the smells that are near you.

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How to Deal with Panic Attacks?

If you have panic attacks, it may help to comfort you that you are not alone! You’re not even one in a million. In America, it is estimated that almost 5% of the population suffer from some form of anxiety disorder.

For some, it may be the infrequent panic attacks that only crop up in particular situations-like when having to speak in front of others, while, for other people, it can be so frequent and recurring that it inhibits them from leaving their home. Frequent panic attacks often develop into what medical physicians refer to as an “anxiety disorder.”

There are many ways of coping with an anxiety disorder. Some may not work for you, but others just might. It helps to know some of the most common coping techniques for dealing with panic attacks when they begin.

Your first step is to recognize when a panic attack is about to begin. When you have enough of them, you start to really pay attention to the tingling sensation, the shortness of breath, and the disconnection from the real life around you.

Many people I talk to wonder what that disconnection is like. They have a hard time understanding it. Those of us who have panic attacks are all too familiar with it. It’s like you can look at a solid object and see that it is there. You know it’s there, but a part of your mind doubts that it really IS there.

You may find yourself reaching out to touch that object just to be sure. You feel like you’re not a part of the world around you. It’s as if you are just a spectator in your own life with no control over anything around you.

Believe me, this is a horrible feeling.

So how do you start trying to combat your panic attacks? What if I told you the trick to ending panic and anxiety attacks is to WANT to have one. That sounds strange, even contradictory, doesn’t it? But the want really does help push it away.

Does this mean that you should be able to bring on a panic attack at this very moment? Absolutely not! What it means is that when you are afraid of something – in this case a panic attack – it will more than likely appear and wreak havoc. When you stand up to the attack, your chances of fending it off are much greater.

If you resist a situation out of fear, the fear around that issue will persist. How do you stop resisting–you move directly into it, into the path of the anxiety, and by doing so it cannot persist.

In essence what this means is that if you daily voluntarily seek to have a panic attack, you cannot have one. Try in this very moment to have a panic attack and I will guarantee you cannot. You may not realize it but you have always decided to panic. You make the choice by saying this is beyond my control whether it be consciously or sub-consciously.

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Panic Attacks and What I Went Through

One of the unfortunate outcomes from suffering from excessive stress and anxiety is a physical reaction of your body to the situation. It’s like your body is telling you that you need to rest for a moment. Except when you’re having a panic attack, it’s anything BUT restful.

I had my first panic attack while my friend and I were driving home from a St. Louis Rams football game. We were about 30 miles from our home when I began to feel a bit “off”. I was having trouble breathing, my body felt disconnected, and my heart was beating at what seemed like 90 miles an hour.

I pulled the van off to the side of the highway and got out hoping to “walk it off”. But it didn’t work. No matter what I tried, I couldn’t catch my breath. I felt like I was dying. I remember saying over and over again, “Please not now. I’m not ready.” It was horrifying.

The good news is that I wasn’t dying – obviously! But that night began a terrible journey for me into how my body reacted to excessive stress and anxiety. Since then, I have had many panic attacks, but I also learned how to recognize that one might be coming on and how to control it. I’m not always able to get hold of it completely and will occasionally fall into full-blown panic mode, but it’s a lot better than it was.

So, let’s look at the signs that you might be having a panic attack. The following list gives tell-tale warning signs of an oncoming panic attack.

1. Palpitations
2. A pounding heart, or an accelerated heart rate
3. Sweating
4. Trembling or shaking
5. Shortness of breath
6. A choking sensation
7. Chest pain or discomfort
8. Nausea or stomach cramps
9. De-realization (a feeling of unreality)
10. Fear of losing control or going crazy
11. Fear of dying
12. Numbness or a tingling sensation in your face and limbs
13. Chills or hot flashes

You would be surprised at how many people go to the hospital emergency room completely sure that they’re having a heart attack only to find out that it’s a panic attack.

They’re that intense!

It’s very difficult for your loved ones to imagine or even understand what you are going through when you have a panic attack. They may lose patience with you, tell you to “get over it”, or think you’re faking. It may help if you show them the following scenario.

You are standing in line at the grocery store. It’s been a long wait but there’s only one customer to go before you make it to the cashier. Wait, what was that?

An unpleasant feeling forms in your throat, your chest feels tighter, now a sudden shortness of breath, and what do you know—your heart skips a beat. “Please, God, not here.” You make a quick scan of the territory—is it threatening?

Four unfriendly faces are behind you and one person is in front. Pins and needles seem to prick you through your left arm, you feel slightly dizzy, and then the explosion of fear as you dread the worst. You are about to have a panic attack.

There is no doubt in your mind now that this is going to be a big one. Okay, time for you to focus. You know how to deal with this – at least you hope you do! Start breathing deeply - in through the nose, out through the mouth.

Think relaxing thoughts, and again, while breathing in, think “Relax,” and then breathe out. But it doesn’t seem to be having any positive effect; in fact, just concentrating on breathing is making you feel self-conscious and more uptight.

Maybe if you just try to relax your muscles. Tense both shoulders, hold for 10 seconds, then release. Try it again. Nope, still no difference. The anxiety is getting worse and the very fact that you are out of coping techniques worsens your panic. If only you were surrounded by your family, or a close friend were beside you so you could feel more confident in dealing with this situation.

Now, the adrenaline is really pumping through your system, your body is tingling with uncomfortable sensations, and now the dreaded feeling of losing complete control engulfs your emotions. No one around you has any idea of the sheer terror you are experiencing. For them, it’s just a regular day and another frustratingly slow line at the grocery store.

You realize you are out of options. It’s time to run. You excuse yourself from the line looking embarrassed as it is now that it is your turn to pay. The cashier is looking bewildered as you leave your shopping behind and stroll towards the door. 

There is no time for excuses—you need to be alone. You leave the supermarket and get into your car to ride it out alone. You wonder whether or not this one was the big one. The one you fear will push you over the edge mentally and physically. Ten minutes later the panic subsides. It’s only 11:00 in the morning, how in the world can you make it through the rest of your day?

If you suffer from panic or anxiety attacks, the above scenario probably sounds very familiar. It may have even induced feelings of anxiety and panic just reading it. In fact, it was difficult for me just to write it!

The particular situations that trigger your panic and anxiety may differ. Maybe the bodily sensations are a little different. What’s important to realize is that panic attacks are very real to the people who are having them and they should never be pushed off to the side.

I remember one evening at home when I was by myself watching one of my favorite television programs. I thought I was in a safe place. There was no obvious trigger and I felt completely relaxed. Out of nowhere, I began having symptoms of a panic attack. The four walls of my living room were closing in around me. I couldn’t breathe and felt like I was dying.

I stepped out on my front porch for some fresh air and began deep breathing exercises. The symptoms eventually went away, but it left me wondering why exactly I had that attack. There was no obvious reason, no stressful situation, and no indicator that a panic attack might be impending.

That’s the strange thing about panic. Sometimes your mind can play tricks on you. Even when you think you’re in no danger of having a panic attack, your brain might be feeling differently. That’s the scary part. The good part is that there are ways you can combat panic attacks and cope much better when you find yourself in that situation.

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