Stress: Can We Cope?

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stockbroker in a lowerkeyed office, and now devotes more time to hobbies. "Lining a coffin with gold," he says, "doesn't do the body any good."

Like thousands of other overwrought Americans, Ciment got professional help in learning to reduce and manage the stress in his life. At the California Institute for Behavorial Medicine in Beverly Hills, he underwent psychological counseling to change his Type A mindset, began an exercise program and learned to modify his diet. Programs like the one he attended have been booming in recent years. By one estimate, there are now more than 300 stress-management enterprises offering their services to hospitals, clinics and even corporations around the country, up from 120 last September. "Stress management has become a multimillion-dollar-a-year business," says Rosch of the American Institute of Stress.

Hospitals took the lead in treating stress by establishing clinics to help those for whom reducing tension was a matter of life and death: heart attack victims and severe hypertensives. Some of the advice offered to such patients is just plain common sense: quit smoking, lose weight, cut down on salt and caffeine (2½ cups of coffee will double the level of epinephrine in the blood), take vacations regularly and exercise. In some cases drugs are used, typically beta blockers like Inderal, which interfere with the action of certain stress hormones. But the core of most stress-management programs, and what makes them distinctive, is teaching patients how to relax.

The guru of therapeutic relaxation is Cardiologist Benson. Back in 1968 he was persuaded by practitioners of Transcendental Meditation to study the effects of the technique on the body. To his surprise, Benson found that TM could elicit dramatic physiological changes, including decreased heart rate, lower blood pressure and reduced oxygen consumption. Meditation, says Benson, sets off "a built-in mechanism that is the opposite of the fight-or-flight response." Practiced ten to 20 minutes once or twice daily, it has been shown, by Benson and others, to produce a lasting reduction in blood pressure and other stress-related symptoms. Thus it is a natural antidote to tension.

TM is only one of several techniques that can be used to produce what Benson has termed the "relaxation response." The effect can be achieved just by following four simple steps: assume a comfortable position, close your eyes, concentrate on a single word, sound or phrase, and cast off all other thoughts. Instead of using the traditional mantra of TM, Benson's patients are encouraged to select a sound or image that appeals to them personally. One of his Jewish patients focuses on the word shalom; a Greek chants "Kyrie eleison " (Lord have mercy upon us); a Catholic recites the prayer "Lord Jesus have mercy "; others evoke the response by listening to soothing tapes of ocean waves. "As long as one can become passively unaware of the outside world," says Benson, "the method is not important."

In fact, techniques like muscle relaxation, biofeedback, self-hypnosis, rhythmic breathing and exercise can also elicit the relaxation response. These methods are now widely used at U.S. hospitals and clinics to treat such stress-related problems as migraine and tension headaches, Raynaud's disease (a

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