R   E     A    L          A    G   E  

Stress Reduction

HEALTHY MIND, YOUNGER PERSON


What's long been suspected has now been proven by scientific study: Emotional well-being helps you stay healthy and younger longer. Which emotional factors help keep you young? Which life events will cause age-promoting stress, and what can be done to offset the risk? Realize that the mind and body work together. Happiness and stress-free living will help keep your RealAge young.


For years, having a type-A personality was seen as the cause of stress-induced illness. Now we know that stress-induced illness comes only from the things that stress you even if they don't seem to be the things that stress other people. Life events as different as the loss of a family member, moving to a new town, or financial troubles can all cause stress, but they have to be dealt with in different ways. Reducing stress in your life can give back thirty of the thirty-two years that major life events can take away.


Difficulty rating: Most difficult


People who live with others, who have lots of friends, and who stay involved in social activities live longer, happier, healthier lives. During non-stressful times, living with three or more people or having many close friends can make you two years younger than those who don't have this support network. During extremely stressful times, it can keep you as
much as thirty years younger.


Difficulty rating: Moderately difficult


Rich or poor, living beyond your means can be one of the most troubling day-to-day stresses. All that worrying about money can make you old. Learn how to plan your finances so you don't live beyond your means. Reducing financial stresses can reduce your RealAge by as much as eight years.


Difficulty rating: Moderately difficult


I bet you never knew school could make you younger! But the fact is, keeping your mind active helps keep your body young. Your mind is like a muscle: You need to exercise it. By using your brain, you can become more than 2.5 years younger.


Difficulty rating: Moderate


We often put off dealing with the emotional upsets in our lives, whether it's recovering from our parents' divorce when we were children or recovering from our own as adults. By not confronting these traumas, we often suffer needlessly, and it affects our health. If the social networks you have aren't enough to help you with the emotional conflicts you face, no matter what they are, seeking professional help through a psychiatrist, counsellor, or therapist can make your RealAge eight to sixteen years younger than it otherwise would be.


Difficulty rating: Most difficult


Feeling harried? Not enough hours in the day? Don't you sometimes wish that the phone would just stop ringing? Most Americans are stressed. There is nothing like a day of too many hassles to make you feel that you are ageing faster than you should. There is no doubt that too much stress does indeed age you. Stress is linked to ageing of both the arterial and immune systems. Also, people under stress are more likely to get into accidents or suffer other hazards that can cause them to age.


Stress is a normal part of life and can be good for us and necessary. However, too much stress turns normally useful bodily reactions into damageing overreactions. Stress overload can cause the brain to trigger an over-release or imbalance of 'stress hormones' that can lead to physiologic problems in the long run. Prolonged stress decreases our ability to control our cardiovascular responses, which increase blood pressure and age our arteries. The same neurotransmitter that keeps us alert and able to respond quickly in times of danger causes us to be overtaxed by the constant release of stress hormones. This constant excess actually decreases our ability to sense trouble, prevent accidents, and avoid confrontations. And stress suppresses the immune response, increasing our risk of catching infections or developing more serious diseases. In other words, stress stimulates many of the conditions that cause early ageing.


Almost all of us are juggling too many commitments that can cause age-inducing stress. You can prevent the needless ageing by learning to manage your day-to-day stresses and to develop safety networks that you can rely on when a major stress-inducing event occurs.


More than half of us will have a 'major life event'—a death, a divorce, a job loss or job change, an illness in the family, financial difficulties, relocation, involvement in a lawsuit, or other serious trauma—-within any one year. The occurrence of one major life event makes you about five RealAge years older during the time the event is going on and for at least one year (and probably two years) afterward. Two major life events in one year can raise your RealAge by as much as sixteen years, and three major life events in one year can increase your RealAge by more than thirty-two years for at least the following year. All of us have some stress in our lives, and during our lifetime, each of us will suffer a major life event at least once, if not many times. The question is not whether we will suffer stress but how we manage it.


The Nature of  'Stress'


What exactly is stress? How does it manifest physiologically? Stress is more than just the feeling that there's too much to do, too little time to do it, and too many hassles along the way. Stress is a very complex set of physiologic and psychological reactions. Dr. Hans Selye, one of the earliest researchers to study stress, defined it as 'the nonspecific response of the body to any demand made on it.' Simply put, stress is the body's reaction when it anticipates the need for extra energy. Almost anything can provoke this reaction: an injury, working under a deadline for a crazy boss, not sleeping enough, or not eating regular meals. Even laughing stresses the body.


Despite popular beliefs, stress is not purely mental; it is also physiologic. When we are stressed, our bodies release a flood of adrenaline, cortisone, and other stress hormones that induce physiologic changes. The heart pounds and blood pressure rises. Our rate of breathing increases, and we feel more alert. Blood races to the brain and heart and moves away from the kidneys, liver, stomach, and skin. Our blood sugar level rises, as do the amounts of fats and cholesterol in our bloodstream. The amount of clotting factors and platelets in the blood increases. All this is part of the 'fight-or-flight' response: The body is energizing itself for danger. The question is, how prolonged and damaging will our stress be?


Fleeting stress responses may be good for us. These survival responses cause us to jerk our hand off a burning pan or to jump aside when a car comes too close. These fleeting stresses do not age us. The problem arises when we


The RealAge Effect of Stress


Major life events cause ageing. Twenty-eight percent of Americans undergo one major life event in any given year, 15 percent will undergo two, and 13 percent will have three or more.

A major life event consists of experiences such as the death or illness of a loved one (especially a spouse or a child), divorce, a major illness, moving to a new locale, being the target of a lawsuit, losing or beginning a job, and financial instabilities like bankruptcy.



are in a constant fight-or-fllght state.


During chronic stress, our bodies are in a continuous state of siege. The same systems that help us when we are in danger by responding for the moment and then shutting back down are now in overdrive. Imagine a car. The more you rev the engine, the faster you use up the gas. With stress, the faster you rev your body, the more quickly you age. Physically, chronic stress alters the immune responses, causing a decrease in the production of beneficial T cells and B cells. Chronic stress also raises blood pressure.


Studies have shown that the relationship between stress and ageing are marked. A recent study published in the Journal of the American Medical Association found that stress was linked to increased levels of myocardial ischemia, reduced blood flow to the heart. Although doctors have long suspected that stress might cause a narrowing of the arteries, this study provided the first proof that stress also narrowed arteries acutely to the point of hazard. People who experienced a lot of stress also had more periods of ischemia and a correspondingly higher risk of heart attack or abnormal heart rhythms.


Not only does stress cause arterial ageing that increases blood pressure, but it also causes the release of neurotransmitters that elevate the heart rate, pushing blood pressure higher still. As you know, high blood pressure accelerates arterial ageing. Recent research at Johns Hopkins University indicated that people who score high on mental 'stress tests'-—not just the physical treadmill stress tests normally used to detect heart strain—-were more than twenty times more likely to develop heart and arterial diseases. Individuals who had 'hot' reactions—who were more likely to get agitated or frustrated by life events— had twenty times the rate of arterial ageing, as measured by the incidence of heart attacks and strokes, of people who had 'cool' reactions.


Stress doesn't just age your arterial system. As I mentioned, prolonged exposure to the neurotransmitters that your body releases during periods of stress can age the immune system as well. How do researchers measure this type of ageing? A study of health care workers found that those with especially stressful jobs had a lower level of antibody production than did those in less stressful positions. Furthermore, prolonged exposure to chronic stress depletes our bodies of important vitamins, such as vitamin C, vitamin D, and the B-complex vitamins, including folate. Stress also appears to increase our rate of bone loss, causing a depletion of bone density. Finally, overexposure to stress hormones, which at first heighten perceptiveness, can decrease perceptiveness over time, thus raising the risk of accidents and acts of violence—for example, the freeway confrontations called 'road rage.'


Different stresses affect people in different ways, and not everyone is stressed by the same things. Some doctors are the image of calmness when treating life-threatening traumas in the emergency room but become utterly flustered when tending to the daily tasks of running their offices. Some people love a good argument, and others will do anything to avoid one. Often type-A personalities, those who are always pushing themselves to run, run, run, become more stressed when they try to stop type-A behaviors. Relaxing or 'letting go' makes them anxious. The trick is to identify what stresses you and then develop strategies for avoiding stressful situations or, if they can't be avoided, figuring out how to handle them in ways that reduce your own stress levels.


Most stress is tied to the individual's perception of an event. One person might find skydiving exhilarating, whereas another may find it terrifying. Both feel stress from the event, but one feels good stress, called 'eustress' for the euphoric reaction; and the other, bad stress, or 'distress.' One person may love to go to parties, finding working the crowd or meeting new people fun and relaxing, but another person may find it nerve-racking. The level of stress we feel has a lot to do with our subjective interpretation of what is happening to us. One of the ways of changing our stress levels is to try to change our perception of an event.


I was in a major Chicago department store a few years ago on Christmas Eve. It was closing time, and my son and I were the last ones to get in line. It wasn't really a line-—-most shoppers were crowded around the register area, pushing and shoving. The salesperson was still ringing up sales an hour after the store had closed. When I finally reached the register, imagining what it would be like to spend the day heading off a surge of harried shoppers, I said to her, 'You must be glad this day's over. Talk about stressful.' The woman laughed and said, 'I love my job. In how many other jobs do you have people fighting over you?' I had to laugh, and I certainly admired her. She was in one of the most stress-inducing jobs ('point-of-service' jobs, such as cashiering during the Christmas rush, are among the most stressful), yet she didn't let the stress get to her. Rather than see the surge of customers as a negative stress, she considered it a positive situation: all these people fighting over her. Her ability to change her perception of the event meant that she did not age from that day's push, like she would have if she had found it stressful.


Measuring the Effects of Stress


The symptoms of stress fall into four categories: physical, mental, emotional, and behavioral. 


Physical signs of stress include frequent headaches, trouble sleeping, sore and stiff muscles, nausea or upset stomach, diarrhea or constipation, a general sense of fatigue, and increased susceptibility to illness. Mental symptoms of stress include the inability to concentrate, confusion, and a lack of clarity. Also, stressed individuals are often indecisive and lose their sense of humor. On an emotional level, stress makes us anxious, nervous, and irritable. We may be quick to anger, impatient with others, or depressed. Behaviors indicative of stress include fidgeting, pacing, or feeling that you can't sit still. On the other hand, you can also feel sluggish or avoid work because it seems too daunting.


There are two basic kinds of stress. The first is ongoing, low-level stress, such as job pressures or juggling work and children. Then there are those one-of-a-kind stresses that are harder to plan for—the death of a loved one, the sudden loss of a job, or a divorce. Although we know that both kinds of stress age us, it has been much easier for researchers to measure the ageing impact of the big one-time event because there are clear 'before' and 'after' periods to measure. It is clear, for example, that the death of a spouse has a significant RealAge impact. Widows and widowers have reduced levels of important immune system B and T cells, as well as low antibody production, for more than a year after the loss of their partners. And both widows and widowers are much more likely to suffer a major health event after such a loss. It is not uncommon for a person who has been married for a long time to die soon after his or her spouse dies, the death of one causing overnight ageing of the other.


Researchers have also been successful in measuring the impact of stress and increased ageing during and after natural disasters because there is a clear set of dates from which to detect changes in the rates of heart attacks and death. For example, demographic studies have shown that the rate of heart attacks (in particular, severe or fatal heart attacks) increases dramatically in the days after a major earthquake. And in the days after the bombings in the Gulf War, the heart attack rate surged in Israel. Although the studies didn't investigate the more general impact on ageing, we can presume a higher incidence of strokes and other ageing-related events as well. In another poignant example, a recent study published by the National Cancer Institute found that the psychological stress associated with the diagnosis of breast cancer caused the levels of immune cells, such as T cells and natural killer cells, to plummet, putting patients at an even greater risk. In these instances, it is clear that stress affects ageing. That is why we can say that one major life event can age you by as much as five years during the time it is going on and for at least one year (and probably longer) afterward.


In measuring long-term, ongoing stresses, researchers have had a harder time quantifying their impact on our ageing processes. Not because such stresses are any less real, but because there are no defined starting and stopping points. Furthermore, ongoing stresses seem to be open to a more subjective interpretation. Although everyone finds the death of a loved one stressful, not everyone finds the same aspects of family life or work life stressful. There is certainly evidence that ongoing low-level stresses make us older. For example, people who are severely dissatisfied with their jobs are also more likely to suffer heart attacks.


For these kinds of recurrent and chronic stresses, it is important to identify the things you find stressful. You must learn how to avoid them or how to plan for them in such a way that they won't stress you. For example, studies have indicated that most people have significant stress reactions the first time they speak in front of a crowd. Approximately 90 percent of the people who do a lot of public speaking become accustomed to it and no longer have stress responses. However, 10 percent still have that initial stress response no matter how much public speaking they do.


Which leads to the next question: How can you reduce your level of stress? First I will discuss some simple, healthy habits that may help reduce stress. Then I will describe how to manage stress in relation to some of the bigger concerns-—your family and social relationships, your work, your finances, and your level of education.


General Habits That Reduce Stress


Let's begin with a few simple changes in physical habits. One of the best ways to reduce stress is to exercise. Think about it: Stress causes our bodies to build up extra energy, preparing them for fight or flight. Exercise burns energy and reduces our stress levels. Exercise metabolizes stress hormones in our blood and increases levels of our bodies' built-in anti-anxiety hormones, making us feel calmer. Exercise makes us more efficient and energetic, so we feel less overwhelmed by the stresses we do face. For example, just walking regularly can increase the level of beta-endorphins (hormones that help the body feel pleasure) in the brain, decrease anxiety and tension, and elevate one's mood. And exercise-—especially aerobic exercise—helps you divert energy from worrying and anxiety.


Relaxation techniques, biofeedback, and mental imagery also seem to reduce the effects of stress. Combination programs like yoga that include both body stretching and mind relaxation can be especially effective in easing emotional and physical tensions. One simple technique is visualization. Close your eyes, relax your muscles, and imagine yourself some place far away from the chaos around you. Imagine yourself on a beach or in a mountain meadow, feel the warmth of the sun on your skin, and let your muscles feel soft and heavy. Relax into them. Breathe deeply. Feel the tension dissipate. 


A healthier diet and a regular schedule also help lower stress levels, making you younger in this way, too. Our favorite food vices—-sugar, salt, and caffeine— may actually elevate stress levels. So can cigarette smoking and excess alcohol. Focus, too, on getting enough sleep. Even though you think you don't have time for a full night's sleep, you will be much more productive if you are well rested. And the tasks at hand won't seem nearly so overwhelming.


One thing that many people find stressful is the sense that they don't have any control over a given situation, especially when they have many demands on their time. If that's happening to you, try to figure out what you can do to make yourself feel more in control. How can you make the situation work for you, instead of being controlled by everyone else's needs? At work, be more proactive in defining your responsibilities. If the boss talks to you only when something goes wrong, make a habit of frequently telling him or her what you've done right. It may change the tone of your interactions and make your job feel less stressful. Finally, if you believe that you have too many tasks to do at home, evaluate which ones are necessary and which ones aren't. See if you can develop a plan for simplifying your tasks. Or explain your frustrations to your family and ask if they can pitch in to help.


Now let's consider some simple changes in mental habits that help us manage everyday stress.


1. Learn to recognize the conditions that stress you and note your reactions to those conditions. Naming the problem is the first step toward solving it.


2. Try to think about the situation you find stressful from a different perspective. Is it really that bad? Is there another way of looking at the problem? Remember the saleswoman at Christmas. When people are putting too many demands on you, just imagine that they're fighting over you.


3. If you can't avoid a stress-producing situation, approach it in a calculated way, taking steps to avoid the stresses.


4. If a certain kind of event always makes you agitated, try to think of ways to change the context. What can you do to prepare for that event, so you don't have to go through the same old thing? If you find Thanksgiving at Aunt Thelma's stressful, don't go, or invite her to your place instead. Just because something's always been done a certain way doesn't mean you have to keep on doing it that way.


5. If certain individuals are causing you undue stress, whether it's your boss or your teenagers, stop for a moment and try to put yourself in their shoes. If they keep doing something that drives you crazy, ask yourself why they do it. What do they get out of it? By understanding their motivations and perspective, you will be better prepared to develop a strategy for reducing the stresses these individuals cause you.


6. Develop coping skills. Learn to take a time-out when you start to feel your anxiety rise.


7. If you find that interactions with a-particular person are stressing you, talk to that person about it. Don't be accusatory. Just let him or her know that a certain way of interacting is stressful to you. Maybe together you can develop a new way of interacting so you do not stress one another. An interaction that is stressful for one person is usually stressful for the other.


Social Networks: Ties for Life, or Laughing the Years Away with Friends


Although for years scientists discredited the effect of social factors on biological health, study after study has confirmed the importance of social connections. It has been shown repeatedly that the effect of interpersonal relationships on stress responses is not only psychological but also physiologic. These ties can actually affect the number of immune cells you have, which in turn can affect your resistance to disease and cancer. Social connections make your immune system younger and reduce stress.


As people age, their social relationships often change. In general, our social supports increase through our lives as we move into our fifties. Then, the neighborhood changes. Friends move away to warmer climates, our children grow up and start their own lives, and we experience 'empty-nest syndrome.' By the time we reach our sixties, our social networks have often begun to decrease. After a lifetime of looking forward to retirement, many people feel lonely and isolated once they no longer have a daily routine. It can be such a subtle change that they are not even aware that it's happening.


I have heard numerous stories from some of my older patients, who, after much consideration and worry, decided to sell the family house and move into a retirement community—not a nursing home, but a place that provides both apartments and nursing and other types of care if need be. The new residents go grumbling off to the 'old-age home,' complaining about being 'turned out to pasture.' Suddenly—and I have seen this happen many times—it's as if these individuals have gotten a new lease on life. Now, instead of being isolated, they have a whole social world around them, full of activities and new companions to share them with. One friend told me that after his ninety-year-old father moved into such a community, his father went from being the one who always complained his son never came to see him to being the one who was always too busy. 'Sorry, John,' he would tell his son, 'Friday's the day we go to the vineyards for a wine tasting. Saturday we're putting together the community newsletter, and Sunday Madeline's having a brunch. It'll have to be next week.' Moving out of an isolated house into a place where there is a social world really can make people younger.


Although, clearly, such places are not for everyone, and most of us are happy staying in our homes, I think the example is illustrative. It demonstrates in qualitative terms what we already know in quantitative terms—that having social connections in our lives makes us younger. Norman Cousins claimed that laughter could cure illness. In many ways, you can laugh yourself to youth. Being social isn't just frivolous, but vital to our health—and youth.


If you don't have many social contacts, think about building them. How? Invite your neighbor over for dinner. Use the telephone to stay in touch with people who live far away. In an Age Reduction double-dip, exercise with a friend. Learn to use e-mail to contact old friends and try chat groups on the Internet. The Internet is a way that people who are largely housebound can make themselves younger. My ninety-two-year-old father has a whole variety of people he talks to every day on the Web. It's one of the things that keeps his RealAge seventy-six years young!


No more strong, silent, types. Joining a group is one of the best ways to reduce stress. A church, volunteer organization, athletic team, community group, or social group—anything that gets you together with other people on a regular basis—can help make you younger. Nothing ages you like going through a major life event alone. Find people to talk to about your problems. Turn to your family and friends. Don't worry about worrying them; they will worry more if you don't tell them what is going on.


If you can't find people who seem to understand your problem, consider groups where you might find people who would understand. For example, a friend of mine became very stressed when his elderly mother developed Alzheimer's disease. Since the illness is remarkably unpredictable, his mother would behave erratically, at times intelligible but at other times incoherent. Sometimes she would be angry for no apparent reason, and other times she would simply start to cry. My friend found the unpredictability incredibly difficult to bear, yet he had to spend an enormous amount of time taking care of her. He also felt isolated; not only was he watching his mother decline, but most of his friends couldn't relate to his situation. His mother's doctor suggested that he go to a program offered by his hospital for relatives of Alzheimer's patients. There he learned what to expect from the disease. More important, he met other people who were dealing with the same situation. Together they could talk about how it felt to watch a parent slowly lose his or her identity. He found the group a great comfort, and it helped him get a different perspective on the disease. When his mother got suddenly angry, he knew that she wasn't angry with him; this was a manifestation of the disease. Learning not to take things she said personally reduced a lot of his anxiety and stress.


There are countless examples of the causal relationship between social ties and stress reduction—a combination that equals the promotion of youth. Learn to value your social relationships and do not sacrifice them to work or other obligations. And do not forget the most important social relationship: the person you choose to spend your life with……..


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