How to Handle Extreme Stress

US News

There's a silver lining to our day-to-day stress. It's so familiar to us--the irritation of traffic and adrenaline of deadlines--that we, hopefully, have learned how to cope. Ideally, we've got a healthy outlet, a favorite walk or a trusted friend to relieve the accumulation of life's little pressures.

But what about the really hard stuff--the realization of fears we rarely dare to voice, if at all? When the scan comes back with bad news, or a loved one suffers a devastating accident; then what? How does one cope with the kind of trauma that levels life in an instant?

According to experts in extreme stress, some strategies work much better than others. A key objective for anyone in stress is managing his or her "fight-or-flight" response--the evolutionary instinct that readies our bodies for danger with the energy and focus to battle a predator or run away. Unlike animals, whose response to danger subsides once the threat does, humans have the capacity to recall the trauma and fear for the future, says Steven Southwick, co-author of "Resilience: The Science of Mastering Life's Greatest Challenges" and professor of psychiatry, post-traumatic stress disorder and resilience at the Yale Medical School and the Yale Child Study Center. "We can keep ourselves stressed 24/7, and unfortunately stress can cause all sorts of problems," including, for example, injuring the very part of the brain that turns off the stress response, Southwick says.

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According to David Spiegel, associate chair of psychiatry and behavioral sciences at Stanford University School of Medicine and director of its Center on Stress and Health, people in extreme stress should keep these key points in mind:

1. Make a prioritized checklist of what needs to be addressed and tackle each item sequentially;

2. Don't be afraid to ask people for help;

3. Know your limits, and guard them;

4. Rest--take breaks, get lots of sleep, and "practice self-soothing";

5. Maintain a healthy diet and exercise routine.

In addition, the following strategies can provide comfort and relief:

1. Express your feelings. "Don't fight your emotions. Think of them as your friend, not your enemy," says Spiegel. There's a misconception among some that containing one's emotions contains the problem or that they "need to be strong" for their families by putting up a stoic front, Spiegel says. That not only doesn't work--it backfires. People end up "wasting energy fighting themselves," he says. Plus, releasing emotions brings people together, which is precisely what's needed in times of trauma.

2. Find social support. "People who are socially isolated have a two-fold elevation in all-cause mortality," Spiegel says, calling social isolation as much of a risk to one's health as smoking or high cholesterol. "And yet, when people get sick or in trouble, they often lose social support rather than gain it," he says. Spiegel, who runs support groups for women diagnosed with breast cancer, says such groups provide an opportunity to share experiences and advice. Everywhere else in life, that woman may feel like an outsider, the one with a "death sentence." But in the support group, "you belong."

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Due to his research, Southwick has become so convinced of the power of social support that he now works with his patients to draw a diagram of their social networks, examining each individual involved to ensure that they are trusted and reliable. "Strength comes from social networks," he says. "We're all social beings."

3. Find a way to relax. Whether it's prayer, meditation or deep relaxation techniques, these acts offer a powerful antidote to stress. "You really can't be tense and relaxed at the same time. They're opposites," says Carol Goldberg, psychologist and host and producer of the New York-area TV show "Dr. Carol Goldberg and Company." She suggests, for example, visualizing a calming scene, repeating a soothing mantra or deep breathing from the diaphragm to boost oxygen supply and help rid yourself of carbon dioxide. "It's something that you always have within you. You don't have to get any equipment ... You can just close your eyes, and take some deep breaths."

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4. Face your fears. "Most of us have a very difficult time doing that because it's unpleasant," Southwick says. However, "if you want to be resilient, sooner or later, you're going to have to face those things, or some of those things." In fact, "avoidance is at the heart of all anxiety disorders," he says. When veterans address post-traumatic stress disorder with a therapist, they expose themselves to theirs to try to make peace with them.

The trick is to reframe fear and face it before it devolves into a state of panic, which shuts down the part of the brain responsible for rational thinking. To conquer fear, you have to learn about it and understand it. And then, "when you do approach the fear, try to do it with someone who you really trust."

5. Find a role model. "We tend to learn through imitation," Southwick says. Look to others who successfully negotiate challenges, ask them about their coping skills, and try them out yourself. For example, if that person calls a friend during times of stress, you might consider that tactic.

For his part, Southwick has found role models in the research for his book. A young woman with spina bifida who won a gold medal for swimming in the Paralympics is one of them. She not only excelled in college, graduating with honors, but she swam an average of 26 miles a week. These days, when Southwick goes swimming, he often thinks of her as he's wrapping up his mile of laps, and says to himself: "What, are you kidding? Twenty-six miles a week ... I keep going."

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