what is the single most important thing we can do to manage your stress

a few years ago we moved her family to France for three months was a time the

European Cup football championships and So we would take our kids to a local bar to watch

the game on TV

watching the moods of people from different countries

swing from pure joy to total anxiety to despair and back again

was as entertaining as the game itself and I wondered if there is any scientific

analysis so how this can a stress affects people

it turns out there has been a study in the quarterfinal the 1996 championship

between the French and Dutch teams

a draw at the end of overtime resulted in a sudden death penalty shoot out

which is won by the French when researchers look back to see if there were health changes

on that day

it turned out there was a relative increase in the risk of death from a

heart attack by about

50 percent among the Dutch men on the day and the match compared with the five

days on either side in the match

there is no such effect on French men or woman from

either country for that matter so this story striking because it it's about one

event end and really one negative health outcomes

stress but in reality stress is very complex

multiple factors multiple outcomes physiologists sees stress increase blood

Heart rate or changes in the chemicals that modulate the immune system

pressure

the social worker sees vulnerability with the compromised social networks coping

and problem solving skills

the doctor sees increase visits estimated that up to 70 percent a

primary care visits are stress-related

worse health outcomes bad self treatment with alcohol and drugs

gateways to depression and anxiety and of course the worst quality of life

these perspectives represent the standard negative picture stress but

I believe we also see a positive side distress athletes were able to find a

stress level that is high but

but not too high for optimum performance executives are mothers or aid

workers who manage stress like a bicycle tire

they regulate enough pressure to keep rolling but not too much so that if

they hit a bump they explode

And to me this is really the most interesting question when we look at

stress and health under some people undergoing intense stress remain healthy

and even thrive in and what makes them stress resistant well I think the

answer it big include factors like how much control people feel they have in

their lives

their social network and I mean that the old sense of the word

openness to change attitudes like optimism self-care skills such as

exercising and

and humor and so on research on mental health

shows that we are sort of a bento box more severe mental health issues

in trying to figure out what works and what doesn't which is great but we've

done much less research and most common problem

stress and when it is steady its usually in the context of other diseases

so based on a current literature my pick for the single most effective treatment

for managing stress

is actually kind of a simple one change your thinking style

most people think stress is something that happens to us like a piece a steel

on a bridge that is constantly being stressed and then eventually stretched

this is a physical model but it's it's actually not a human model

that differences is stressed passes through a two-pound piece a tissue on

the top your face called your brain

so we see things like my job is stressful or my friend Sylvia is stressing

me out

but in fact we create the stress in our brains

your work or Sylvia isn’t stressful what you're thinking that brings a

stress your brain is

is a volume dial that can turn to stress out but

I think you can also track people think we're born a certain attitudes and and i

think is down but the truth is stress management is a skill that can be

Learned

doctor Mat Gulliksson and his colleagues and hoops

Sweden published a trial in 2011 in the Annals of Internal Medicine

falling over 400 people loosely woman that had significant her heart events such as

her attacker or bypass surgery

half the group received usual care and the other half got usual care plus

cognitive behavioral therapy or CBT

CBT has become an umbrella term

where you learn practical techniques such as problem solving relaxation and

and challenging common thinking trapped so for example

a negative filters so if five people say great job and one says nothing

and you think you blew it fortune-telling

I'm not going to that job interview that just reject me mind reading

a friend walks by without noticing any you assume he dislikes you now

polarizing are black and white thinking I feel might die if I bite into that piece a

cake

now I might as well eat the whole thing and so on

the thought record is then used to reframe your automatic thinking and a more

healthy thinking

as the American psychologist William James said over 100 years ago

the greatest weapon against stress is our ability to choose one thought

over another so the researchers want to see people could use these techniques to

reduce the daily experiences stress

time urgency and hostility in this so could that lead to better outcomes

so so not a drug not a diet not a stent

just changing the way you think the participants were followed for over seven

years

those that got the CBT had a forty-one percent reduction heart attacks

and at 28 percent lower death rate

the more CBT session a person attended the better they did

now another way to change your thinking style in order to reduce stress is

through the use of mindfulness techniques

mindful used to be more through it I will call the king by crowd but

the programs have actually become much more mainstream in fact my patient have

Heart attacks and chronic diseases now often taken mine from this course part

their treatment

and there's a growing evidence about its effectiveness a recent trial following

clinically depressed patients by doctor Zindel Segel College University of

Toronto is a good example

when the patient experience remission they were randomized to an

antidepressant

or placebo or mindfulness-based cognitive therapy

the results show that mindfulness was as protective against relapses medications

my sense is that the success from mindfulness is probably due to the fact that

combines many useful techniques for stress reduction

such as increased self-awareness involving a physical component like

breathing or muscle relaxation meditation

and perhaps most important in our busy world an emphasis on letting go of

distractions in being in the moment

mindfulness can give us ability to let go of worry and not get trapped in the anxious

leaped

perhaps less about changing the thought and in really more about choosing where

to place your attention

as a famous Austrian psychiatrist Victor Frankel pointed out between stimulus and

response

there's a space and I think mindfulness teaches us awareness so that space in

and that we have the power choice so another factor that the

research tells us that impacts your thinking style is your attitude

your outlook on life doctors Suzanne Kobasa and her colleagues from the University

Chicago look at this by following a natural experiment in the nineteen

eighties break up of the Ma Bell Telephone Company

the followed who coped well and who didn't and identified three key trait of those

who coped well

the first motion was commitment the stress resistant executives were

committed a different aspects of their lives

so even while facing uncertainty they stay committed to quality work in

engaging with family and friends their communities there

faith hobbies they saw

and I think we're committed to the bigger picture success

and this allowed them to weather the turbulence in in a specific area of

their lives

the second motion was control this is interesting

in that because its restructuring these executives actually had little control

in fact you might see their skill fighting stress is more about being a

let go of control

they could see that the sands were shifting and if they were too rigid in their

control over territory or department the main actually lose a bigger opportunity

or even their job other psychological research is focused on locus of

control or self efficacy

which is really the extent to which individuals believe they can control

events effected

and their competence or or ability to make change

the executives may have understood that a lot what was happening was out of their

control but they could adapt in

and I think you can choose and feel confident about what they could control

the third notion was change the stress resistant execs were able to limit their

self-importance and and see the change happening around them as a potential

stepping-stone

not a stumbling block

so as we come to the end of our story about what reduces stress

might be helpful to know that the research has shown that simply rating 0

distressed story

to make a big difference the act of giving coherence in

and I think reading your own personal narrative too stressful event in a

letter

can be an effective way of negating the stresses those events the classic

therapeutic letter writing exercise is writing a letter to somebody who

stresses you out

and then not posting it

finally like to leave you with this advice to improve your thinking style

think basics when I play tennis and things are going badly

which is often the case I forget about everything else to say

move your feet watch the ball that it

when things are stressful sometimes you need to keep it simple save yourself

I will keep a regular sleep routine I will avoiding crap

I will walk will mingle and and I think there's some early evidence for altruism

we're doing good as Abe Lincoln said

when I do good I feel good when I do bad I feel bad

and that is my religion and I’m often reminded about the power simplicity from

a

a lesson one of my patients taught me I did deliver bad news to him

and when I did he kind of shrugged his shoulders and said I’ll be ok

I followed the 90/10 rule 10 percent of how we do in life is based on what happens

to us and and ninety percent is how we respond

I think the same may be true stress to take a deep breath

think about your big picture commitment your sense of control

Your openness to change consider doing some homework on yourself refrain rethinking

redirect your attention maybe read a letter repeatedly the evidence shows

that people manage their stress well

they're better health outcomes for virtually any disease a may suffer from

and remember the challenges will always be out there that's life but

remember too that your thoughts and your added to our the key holders for the

stress you experience

not the traffic not your boss not your job not you neighbour

but you something you can improve your thinking

hope this helps thanks for listening

just

just