Managing Stress (from The Fibromyalgia Help Book)
By Jenny Fransen, R.N. and I. Jon Russell, •
June 6, 1996
(Editor's Note: Healthwatch recommends "The Fibromyalgia Help Book" as an excellent guide to managing FMS and improving the quality of life with FMS.)
Fibromyalgia syndrome is a complex dysfunction of the central nervous system. Stress does not cause FMS, although it does aggravate symptoms. Even in cases where FMS symptoms occurred after a major stressful event, the disturbance that caused FMS was present prior to that event.
Living with FMS adds a tremendous amount of stress to daily life. In addition to normal stresses, the person with FMS endures daily pain, fatigue, physical limitations, concentration or memory impairment, and other difficulties. Trying to work and carry on a normal life with severe pain and fatigue is very stressful.
Researchers at the University of Texas Medical School in San Antonio found that people with FMS experienced greater stress related to everyday inconveniences than did people with rheumatoid arthritis even though the two groups were otherwise similar. Daily frustrations ranged from waiting in line to lacking funds for medical care. Stress aggravates symptoms of fibromyalgia and causes flare-ups.
Lessening the stress of daily frustrations may help reduce flare-ups and the overall pain of FMS. When the source of stress cannot be reduced or eliminated, the response to stress should be changed to avoid making the symptoms worse.
Stress creates a physiological reaction in the body called "fight-or-flight." This reaction allows the body to fight off attackers or flee from dangerous situations. Adrenaline (known as epinephrine) and noradrenaline (norepinephrine) flow into the blood system causing physical changes. The heart and lungs work harder and blood pressure increases. Reaction time is quicker. Muscles tense and gastric secretions increase. These reactions help you to adapt quickly in an emergency. The fight-or-flight response is automatic and allows your body to protect and defend itself from threat of danger.
These stress hormones are not needed during the normal stress of life. In fact, these chemicals are destructive if produced on a daily basis.
We do not know whether people with FMS achieve normal elevation of adrenaline and noradrenaline under stressful situations, but there was no significant difference in blood or 24-hour urine excretion of these hormones in people with or without FMS. On the other hand, a study in San Antonio found lower than normal amounts of these hormones in spinal fluid of people with FMS.
Reacting versus responding
Stress comes not only from what happens to you, but also from your reaction to events. Many people develop a stress response style during early childhood.
Some people react instantly, even to a minor annoyance, with intense emotion as though a crisis were occurring. They see catastrophe in normal, everyday happenings. This type of panic thinking actually increases stress levels. If a situation is interpreted as a crisis, the body will react with the fight-or-flight response. Other people do not panic, but respond thoughtfully. They evaluate it as a non-emergency situation and choose an appropriate response that doesn't produce further stress.
Creating time and space
When possible, put time and space between a stressful event and your reaction. Don't allow yourself to become tense, angry, or disappointed. Find a quiet place to sit and consider your options. Make a list of ways to respond. Find an excuse to get away and let your mind relax with music or an enjoyable activity. Postpone your reaction until the following day. A delay induces clarity in your response.
People who push the panic button can learn to change the way they think. Your inner "self-talk" has a powerful influence on the amount of stress you experience. When you control your self-talk, you begin to control the level of emotional stress.
To control your self-talk, you must first be aware of your thoughts. Stop negative, panic thinking and replace it with positive thoughts. When you "hear" yourself thinking in a negative way, repeat "stop" over and over. Then consciously substitute positive self-talk.
AN EXAMPLE OF CHANGING NEGATIVE SELF-TALK
Negative thought: How can that child be so careless. She broke my flower pot!
Helpful thought: Oh well, it's only clay. I can replace it. It's not the end of the world.
It takes time to change self-talk. First become aware, then learn to stop negative thoughts, and then substitute a more positive response
HELPFUL SELF-TALK FOR LOWERING STRESS
It's a difficult problem, but I can do my best under the circumstances.
This isn't the end of the world.
We'll get through this one step at a time.
I can handle this. I've done it before and I can do it again.
No one is going to die because of this. It isn't a life or death situation.
A year from now this isn't going to matter.
It's okay if it's not perfect. It isn't that important.
I can let this go. It isn't worth spending my energy being frustrated and angry.
Most people are more aware of their surroundings than they are of what is going on inside. Tension within the body to cope with pain can be habitual and does not require your conscious awareness.
Before you can lower physical stress levels, you must learn to become aware of internal stress and tension. "Body scanning" is taking a mental tour through your body to notice tension, stress, and pain. Take an inventory of your head, neck, shoulders, arms, hands, chest, back, hips, thighs, knees, ankles, and feet. Where is there tension and pain? Most people with FMS try to avoid feeling their pain, which can be a good way to cope with it. To reduce pain, however, a body inventory shows you where tension needs to be reduced.
As you regularly practice body scanning, you'll discover that some body parts are routinely under stress. The neck and shoulders commonly hold tension. People in pain assume postures that further aggravate pain. During body inventory, note specific postures or ways you hold your body that may aggravate you FMS.
Mindfulness meditation places emphasis on staying in the present moment. It focuses on awareness of your thoughts, feelings, sensations, and interaction with the environment. Researchers find that mindfulness meditation, combined with cognitive behavior techniques, reduces pain and fatigue for people with FMS. In these studies, meditation was practiced 20 minutes, twice a day. Herbert Benson's "relaxation response" technique was used to achieve deep muscle relaxation. Mindfulness meditation is widely recognized, and classes are available through behavioral medicine clinics and community programs. People who fail to find improvement with medication may find mindfulness meditation useful.
A stress journal may identify specific events that lead to stress. Keep a three-day record of stressful events and your reactions. Include activities, interactions, emotions, conflicts, and annoyances, not matter how big or small. Your reaction to the stress may be more stressful than the event itself. For example, getting angry at a police officer for giving you a ticket is probably less stressful than your anger and fuss afterward.
Some sources of stress will be easy to resolve or eliminate, such as fixing a broken drawer in your desk or replacing a depleted household item. Other stress factors will be more difficult to reduce or change. A list of daily stress factors can guide you in creating a stress management program. Begin by altering your reaction to the smallest issues. List possible solutions to difficult issues that may include marital problems, chemical dependency in the family, or unresolved differences with a coworker. These issues may require the intervention of a counselor. Professional support can be helpful in reducing difficult stress issues. The stress inventory at the end of this chapter will help you identify major stress issues and how to manage them successfully.
Relationships and activities worksheet
A life stress worksheet may help you identify the stress issues of activities and people in your life. This may show you where to reduce or terminate your involvement in some activities or relationships that no longer harmonize with current goals and plans. Once you evaluate the problems and stress a person or activity create, continued involvement may not be worth the aggravation.
After critically reviewing your life, do you find stress factors that do not provide enough positive gains? Can you eliminate or reduce your involvement?
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