DEAR Behavioral Health Program
The Behavioral Wellness Program (BWP) is based on the DEAR Behavioral Health System. The sources and symptoms of stress are unique to each individual and there is not an ultimate solution that eliminates all behavioral health risks at once. A finely tuned assessment leads to individually tailored solutions. Using a four-step process, we empower you to improve the quality of your life – whether you are concerned with only one stress situation or overwhelmed by many. We provide the information, motivation and support you need to make real-life changes.
Four Steps to Stress Control:
- Discovery: Take the Personal Stress Navigator, our interactive online assessment. Identify your sources and symptoms of stress and those personal resources and health behaviors that predict resiliency to stress and its consequences. Get a clear picture of the problem and you are on the way to fixing it.
- Engagement: Read your personal report that highlights high-risk areas. The report steers you to extensive Recommended Resources that give you solutions tailored to your unique problems with stress.
- Action: When you are ready to take action on one or more identified issues, we guide you through a process of writing down the benefits, barriers, supports and next steps necessary to reach your goals. We make action easier by providing you with model action plans you can tailor just for you.
- Reward: This is what it’s all about – a healthier, happier, more productive life for you, increased productivity and lower benefits costs for your employer, and fewer and less expensive claims for the health insurer. The employer receives (1) a more productive work force, (2) identification and resolution of organizational inefficiences, (3) coordination with Disease Management programs, and (4) lower-health care costs. The combined savings mean a win, win, win for all the stakeholders in your behavioral health.
The Effects of Stress in Your Life
Stress can affect your health, your thinking and your relationships. Your overall energy level, your ability to concentrate to solve problems and your patience with others are all affected by stress. Your body may also react over time with headaches, muscle tension, cardiovascular or stomach problems, or decreased resistance to colds and other illnesses.
If you’re feeling the effects of stress at home, on the job, almost anywhere, you’re not alone. According to the federal government, 44 percent of adult Americans suffer some adverse effects from stress. A poll of family physicians reports 75 to 90 percent of all doctor’s visits are for stress-related ailments and complaints.
Stress is expensive. We all pay a stress tax whether we know it or not. Right now, health-care costs account for 12 percent of our Gross Domestic Product, escalating yearly at a dizzying rate. In terms of lost hours due to absenteeism and reduced productivity, stress costs American businesses more than $300 billion annually, or $7,500 per worker, per year.
Even though stress is a major problem, it’s still a necessary, even desirable component of a well-rounded life. Exciting or challenging events such as the birth of a child, completion of a major project at work, or moving to a new city generate as much or more stress than tragedy or disaster, but, somehow, it’s different. Without stress, life would be dull. The trick is keeping it under control.
Stress can be mysterious and confusing, and there are many myths and misconceptions about what it is and what it isn’t. Let’s dispense with some of the most prevalent myths and misunderstandings.
Myths and Misunderstandings about Stress
Stress is a puzzle to most people, and many myths and misunderstandings have grown up around it. One of the more common is that stress is the same for everyone. In fact, stress is different for each of us. What is stressful for one person may not be stressful for another; each of us responds to stress in entirely different ways.
Myth #2 Stress is always bad for you.
According to this view, zero stress makes us happy and healthy. In fact, the only time you have zero stress is when you’re dead. Stress can be the kiss of death or the spice of life. The issue, really, is keeping it under control. Controlled stress makes us productive and happy; uncontrolled stress can hurt or even kill you.
Myth #3: Stress is everywhere, so you can’t do anything about it.
In fact, you can plan your life so stress doesn’t overwhelm you. Effective planning involves setting priorities and working on simple problems first, solving them and going on to the more complex difficulties. When stress gets out of control, it’s difficult to prioritize where to devote your energies. All your problems seem to be equal and stress seems to be everywhere.
Myth #4: The most popular techniques for controlling stress are the best ones.
No universally effective stress control technique exists. We are all different; our lives are different; our situations are different; and our reactions are different. Only a comprehensive program tailored to the individual’s needs is going to work.
Myth #5: No symptoms, no stress.
Absence of symptoms does not mean the absence of stress. In fact, camouflaging symptoms with medication may deprive you of the signals you need for reducing stress-related strain on your physiological and psychological systems.
Myth #6: Only major symptoms of stress require attention.
This assumes that the “minor” symptoms, such as headaches or heartburn, may be safely ignored. Wrong again. Minor symptoms of stress are the early warnings that your life is getting out of hand. They indicate that you need to do a better job of managing stress.
Stress: Performance Booster, Performance Buster
Stress influences your performance, both on and off the job. The trick is to keep stress under control so that it’s a performance booster rather than a performance buster. The figure on the left shows the impact of stress on performance. Numerous studies have shown that when stress is low performance is also low. Performance increases with increasing stress, but only up to the point called the stress/performance (SP) threshold. Once past the SP threshold, performance deteriorates progressively as stress increases. Your stress levels can actually get so high you may have difficulty performing at all.
To make things even more complicated, the SP threshold changes according to how much you have to think to perform a task. Recent research has shown that tasks requiring concentration, integration of information from different sources, and decision making have lower SP thresholds than tasks that require application of acquired knowledge or manual tasks. The figure at right illustrates the fact that it takes less stress to interfere with a manager’s performance than it does to interfere with a knowledge or production worker’s.
The Four Faces of Stress
Acute Stress, Episodic Acute Stress, Chronic Stress and Post-Traumatic Stress
Stress comes in four distinct flavors, each a worse problem than the last. Stress management is complicated and confusing because there are different types of stress – acute, episodic acute, chronic , and traumatic – each with its own characteristics, symptoms, time course, and treatment approaches.
Acute Stress is the most common form of stress. It’s what comes most readily to mind when we think about stress. Acute stress comes from demands and pressures of the recent past and anticipated demands and pressures of the near future. Acute stress is thrilling and exciting in small doses, but too much is exhausting. A fast run down a challenging ski slope, for example, is exhilarating early in the day. That same ski run late in the day is taxing and wearing. Skiing beyond your limits can lead to falls and broken bones. By the same token, overdoing on short-term stress can lead to psychological distress, tension headaches, upset stomach, and other symptoms.
Episodic Acute Stress occurs in people who suffer acute stress frequently, whose lives are so out of control they are studies in chaos and crisis. They’re always in a rush, but always late. If something can go wrong, it does. They take on too much, have too many irons in the fire, and can’t organize the slew of self-inflicted demands and pressures clamoring for their attention.
Chronic Stress is the grinding stress that wears people down day after day, month after month, and year after year. Chronic stress destroys bodies, minds, and lives. It wreaks havoc through long-term attrition. It’s the stress of poverty, of dysfunctional families, of being trapped in an unhappy marriage, or in a despised job or career. It’s the stress the never-ending “troubles” have brought the people of Northern Ireland, that the tensions of the Middle East have brought Arab and Jew, and the endless ethnic rivalries have brought the people of Eastern Europe and the former Soviet Union.
Traumatic Stress. If not handled properly at the outset, overpowering trauma – accidents, rape, verbal, physical, psychological, or sexual abuse, being in the presence of extreme violence, a brush with death, natural disasters (hurricanes, earthquakes, floods, landslides), death of a loved one, imprisonment – can become a special kind of chronic stress known as post-traumatic stress disorder (PTSD).
Fortunately, acute stress symptoms are recognized by most people. It’s the laundry list of what is going wrong in their lives right now: the auto accident that crumpled the car fender, the loss of an important contract, a deadline they’re rushing to meet, their child’s occasional problems at school, fights with one’s spouse, etc. Because it is short-term, acute stress does not have enough time to do the extensive damage associated with long-term stress. The most common symptoms of acute stress are:
- Emotional distress – some combination of anger or irritability, anxiety, and depression, the three stress emotions.
- Muscular problems including tension headache, back pain (upper and lower), jaw pain (TMJ, temporo-mandibular joint), the muscular tensions that lead to pulled muscles, and tendon and ligament problems.
- Stomach, gut, and bowel problems such as heartburn, acid stomach, ulcers, flatulence, diarrhea, constipation, and irritable bowel syndromes.
- Transient over-arousal leads to temporary elevations in blood pressure, rapid heart beat, sweaty palms, heart palpitations, dizziness, migraine headaches, cold hands or feet, shortness of breath and chest pain.
Acute stress can crop up in anyone’s life. The symptoms are highly treatable and manageable, in eight to twelve weeks, using self-regulation techniques and resources.
Episodic Acute Stress
It is common for people with episodic acute stress reactions to be over-aroused, short-tempered, irritable, anxious, and tense. Often, they describe themselves as having “a lot of nervous energy.” Always in a hurry, they tend to be abrupt and sometimes their irritability comes across as hostility. Interpersonal relationships deteriorate rapidly when others respond with real hostility. The world becomes a very stressful place for them. The symptoms of episodic acute stress are the symptoms of frequent bouts of over-arousal:
- Persistent tension headaches
- Migraine headaches
- Chest pain
- Heart disease
- Gastrointestinal problems
Treating episodic acute stress requires intervention on a number of levels, generally professional help, and may take many months.
Chronic stress sets in when a person can’t see a way out of a miserable situation. It’s the stress of unrelenting demands and pressures for interminable periods. With no hope, the individual gives up searching for solutions.
Some chronic stresses stem from traumatic, early childhood experiences that become internalized and remain forever painful and present. Such experiences profoundly affect personality. A view of the world, or belief system, is created that causes unending stress for the individual (e.g., the world is a threatening place, people will find out you are a pretender, you must be perfect at all times). When personality or deep-seated convictions and beliefs must be reformulated, recovery requires active self-examination, often with professional help.
The worst aspect of chronic stress is that people get used to it. They forget it’s there. People are immediately aware of acute stress because it’s new; they ignore chronic stress because it’s old, familiar, and, sometimes, almost comfortable.
Chronic stress kills through suicide, violence, heart attack, stroke, and, perhaps, even cancer. People wear down to a final, fatal breakdown. Because physical and mental resources are depleted through long-term attrition, the symptoms of chronic stress are difficult to treat and may require extended medical as well as behavioral treatment, therapy, and stress management. Many chronic stress situations can only be addressed through group or community efforts where individuals must act together to create alternatives.
Trauma is defined as experiencing or witnessing life-threatening events such as war, natural disasters, serious accidents, or violent personal assaults such as rape. Threats to psychological or social integrity can also be traumatic. Most survivors of trauma return to normal within about six months. However, for some people, the intense reactions persist or may even worsen over time.
People experiencing Post-Traumatic Stress Disorder (PTSD) often have intrusive memories of events associated with the trauma in the form of flashbacks or nightmares, and have physical symptoms of over-arousal, along with extreme emotional outbursts to minor events. They may also experience the opposite: emotional numbness and loss of feeling. They may avoid reminders of the event and show extreme distress when exposed to the reminders or triggers. Problems with concentration, controlling impulses, decision making, and memory can intefere with daily life.
Several factors increase the stress of an acute traumatic event. For instance, if the trauma occurred because of a deliberate act of aggression as opposed to an accident (having a leg broken by someone else versus breaking a leg in a skiing accident) stress is much more severe and overpowering. If the trauma results in ongoing stress, such as a lawsuit, an injury that does not heal and requires modification of activities (such as an auto accident resulting in chronic, debilitating back pain), stress contains the worst features of both PTSD and chronic stress.
There is both acute and chronic stress in cases where the trauma is repeated and there is little hope of escape (prisoners of war, soldiers in war, child abuse victims, hostages in a criminal activity, or a kidnapping). Where the trauma was inflicted by a supposedly protective person or loved one (intrafamilial battering or verbal or sexual abuse, abuse by teacher, counselor, pastor, police officer or other person with public responsibilities), the stress is compounded by loss of trust. Long-term psychological consequences such as depression, anxiety, behavioral disorders, emotional numbing, or suicidal impulses are not unusual. The more exacerbating factors present, the worse the stress.
Victims of trauma may need to tell their stories time and time again to a trauma team, other survivors, family, friends, reporters, or anyone who will listen. With each repeated telling, the victim puts the experience a little more in perspective. Writing an impact statement about how the trauma affected them is another scientifically documented way to reduce PTSD. By reliving the experience, bit by bit, the impact of the trauma decreases proportionally. Traumatic stress can also be reduced by community support. Hostages, for instance, need to feel they have not been forgotten, that somebody cares and is loyal. Community support provides hope and a feeling that help is available or on the way. Family “hostages” of abusive families, for instance, need to feel the presence of shelters and self-help groups even if they are not yet ready to leave the situation.
A personal, political or religious belief system that explains the trauma also helps. If a loved one dies for one’s country or god, you are injured severely while doing something you love, or you find a sense of meaning in the experience, the trauma is somehow lessened. Victims reveal their belief systems with comments like, “It wasn’t my time to die. God wasn’t ready for me yet. There is something more for me to do in this life. I have another chance.” Victims injured for a cause in which they deeply believe, such as political or religious freedom, do not suffer the same psychological trauma as victims for whom an event is meaningless.
How to Cope
Write about what it means to you that the traumatic event occurred. How did it affect you beliefs about yourself, others and the world. How did it affect your sense of trust, safety, relationships and intimacy.
Write a full account of the trauma, including details, your thoughts and feelings at the time. Allow yourself to feel your feelings. Reread your story several time, revising the narrative as new thoughts or feelings arise.
Read more about managing feelings in the section on Cognitive Therapy.
If you are feeling stuck and unable to make the progress you want, find a counselor who is trained in Emotional Processing Therapy for further help.
The Biobehavioral Model of Stress
We define stress as the state of dynamic tension created when you respond to perceived demands and/or pressures from outside and from within yourself. These demands and pressures build up till they trigger the stress response and the release of adrenaline and cortisol. In our graphic above, the person looks at external demands and pressures, indicating the role played by perception. How you interpret a situation determines how it affects you. When Demands and Pressures get out of hand, the stress response becomes either too intense, occurs too frequently, or continues for too long.
Stress makes itself felt through a range of Physical and Mental Symptoms that make things even worse by becoming sources of demand and pressure in and of themselves. Note: The Image Map above can be used to learn more about how stress affects your body, and your life.
Overcoming stress and getting control of your life can be a tough and complicated proposition. Not only are there different types of stress, each with its own patterns of causation, duration, symptoms, and treatment, but in many instances they have to be dealt with all at once. Chronic stress, for instance, can be aggravated by acute and episodic acute stress. You may have to struggle with all three simultaneously. If that’s the case, start with the easiest to control, acute stress.
Why? First of all, acute stress is something you can do something about; it’s going on at the moment; and it’s the easiest kind of stress to handle. Secondly, you reduce your total burden of stress every time you eliminate something, giving you more time to heal or take care of other stress issues. Most importantly, you learn how to handle stress by starting with the easiest problems. This makes you feel you are not helpless against a mysterious and omnipotent enemy.