May 31, 2001 -- Think stress is all in your head? Think again: It may also be surging through your arteries, resulting in high blood pressure. But new research shows that a program of stress management, supervised by professionals and tailored to individual needs, can help lower that high blood pressure.
Reducing psychological stress and improving a person's ability to cope with anger -- a principal component of stress -- appears to lower blood pressure in people with high blood pressure, say Wolfgang Linden, PhD., and colleagues at the department of psychology at the University of British Columbia, Vancouver.
Twenty-seven men and women with high blood pressure received 10 hours of individualized stress management training under the supervision of professional therapists. Treatment was tailored to the individual, but was guided by the principles of "cognitive-behavior therapy" -- a structured treatment that focuses on changing thoughts, beliefs, and assumptions about stress and anger.
Measurements of blood pressure were obtained using monitors that are fitted to the individual, allowing assessment of blood pressure throughout a 24-hour day. Results were compared to 33 patients with high blood pressure who did not receive the stress management program.
Blood pressure was significantly reduced in the group receiving treatment, while there was no change in the group that did not participate in the program. What's more, when the program was offered to individuals who originally did not receive it, their blood pressure dropped too, Linden and colleagues report.
The study appears in the April 23 edition of the Archives of Internal Medicine.
Experts say that the relationship between stress and physical symptoms such as high blood pressure is well known. But tackling stress and reducing those symptoms is not necessarily a do-it-yourself task, they say.
Michael Mogadam, MD, assistant professor of medicine at Georgetown University School of Medicine in Washington, tells WebMD that the most critical components of stress are hostility, anger, and depression -- or HAD, for short.
And he distinguishes HAD from the so-called "Type A" personality who thrives on achievement and doing as many tasks at one time as possible. It's not the Type A person, but the person with a lifelong store of hostility, anger, and depression, who is most susceptible to the kind of stress that can wreak havoc with blood pressure and health, he says.
And while there are some things individuals can do by themselves to control HAD, many people will require the help of professionals. Self-help strategies may work for some common everyday stresses, but they are unlikely to have an effect on the kind of stress that causes high blood pressure and heart disease, he says.
"We assume everything is do-it-yourself," Mogadam says. "HAD is a chronic, continuing, ongoing process. No one gets HAD just from their wife or boss or job, but from a combination of many things over many years."
For that reason, the first step for the highly stressed person is to recognize that he or she has a problem requiring help. And Mogadam says doctors frequently fail to ask about the symptoms of HAD, even though many of their patients have a host of physical problems related to stress.
"Patients need to face the reality that they have a disease, and it needs intervention by an expert," Mogadam says. "The longer you dismiss it, the more entrenched it becomes."
Harvard psychiatrist Edward Hallowell, MD, agrees. "This is a growing and hugely underappreciated area of medicine," he tells WebMD. "Any primary care doctor and many specialists will tell you that their waiting rooms are full of people who are worried and stressed-out. There is an epidemic of toxic worry."
Echoing Mogadam, Hallowell says toxic worry is as serious, but as treatable, as high blood pressure. And just as with the treatment of high blood pressure, the goal of treating toxic worry is not to do away with it altogether, but to bring it within a normal range.
"Some worry is normal," Hallowell says. "If you don't worry at all, that's called denial."
Since many people spend 35-40 hours a week or more at their job, the workplace is naturally a prominent source of stress. In collaboration with Harvard Business School Publishing, Hallowell has crafted strategies for managing the more routine kinds of workplace worry, which left unaddressed could help make you sick.
He offers eight tips for managing workplace worry that can be found at Harvard ManageMentor, an online product of Harvard Business School Publishing.
- Learn to distinguish between positive stress and toxic worry. Positive stress can give you the energy you need to get the job done. Toxic worry only drags you down, making it hard to achieve even small tasks.
- Do a reality check. Find out if your worry has any basis in fact. Toxic worry can distort the real situation. Check to make sure things are really as bad as they seem. Even when there is an actual problem, it may be easier to solve than you think.
- Talk with friends or colleagues you trust. They can help you see things differently. Connect with those you know will reassure you, not those who might exaggerate your concerns.
- Take positive action to correct the problem. Don't be a victim of worry and stress. Brooding about the problem gets you nowhere. Fix the problem if you can! If not, then make the problem more manageable by making small corrective changes.
- Get help from the right sources -- people who have the information you need. Often you don't have the information or tools necessary to attack a problem. Instead of worrying, take control by getting the help you need. Find out who the authority is and where you should look for answers.
- Take care of your body. Exercise daily, eat healthy foods, and get enough sleep. Worry and stress put a heavy strain on your body. Taking good care of yourself physically not only reduces the level of tension your body is coping with, but it gives you more energy to deal with the problem itself!
- Relax whenever and wherever you can. Practice relaxation techniques whenever you start to feel the first signs of tension, worry, or stress. While quick exercises that you can do almost anywhere are helpful, find the time and space for longer, more meditative relaxation -- these exercises are more beneficial in the long run.
- Let worries go. If there's nothing you can do about a problem (or nothing more, if you already worked on it) -- if it's simply out of your control --then you have to let the worry go. Blow it away, and start a new project, read a different book, walk another path.
Hallowell says that once you have identified toxic stress, the most important course of action is to find someone for support. "Don't worry alone," he cautions. "You don't have to solve the problem, but you do have to share it with someone."
The importance of making connections with other people in relieving stress underscores what Hallowell calls "the human moment" in any workplace situation. "When someone smiles at you at the water cooler, you would be amazed at how much Prozac that is worth," he says.