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| Source: http://stressrelease.com and http://www.stress.org.uk/ Feelings
Of Warmth I
Can't Do It Fear If
you checked 3 or more from each response list, ask yourself: Is
the fear of an anxiety attack limiting my involvement in life? WHAT IS STRESS? The stress response of the body is somewhat like an airplane readying for take-off. Virtually all systems (eg, the heart and blood vessels, the immune system, the lungs, the digestive system, the sensory organs, and brain) are modified to meet the perceived danger.External and Internal Stressors People can experience either external or internal stressors.
Acute or Chronic Stress Stressors can also be defined as short-term (acute) or long-term (chronic).Acute Stress. Acute stress is the reaction to an immediate threat, commonly known as the fight or flight response. The threat can be any situation that is experienced, even subconsciously or falsely, as a danger. Common acute stressors include:
Chronic Stress. Frequently, however, modern life poses on-going stressful situations that are not short-lived and the urge to act (to fight or to flee) must be suppressed. Stress, then, becomes chronic. Common chronic stressors include:
WHAT IS THE EFFECT OF ACUTE STRESS? The best way to envision the effect of acute stress is to imagine oneself in a primitive situation, such as being chased by a bear.The Brain's Response to Acute Stress In response to seeing the bear, a part of the brain called the hypothalamic-pituitary-adrenal (HPA) system is activated.Release of Steroid Hormones. The HPA systems trigger the production and release of steroid hormones ( glucocorticoids), including the primary stress hormone cortisol. Cortisol is very important in marshaling systems throughout the body (including the heart, lungs, circulation, metabolism, immune systems, and skin) to deal quickly with the bear. Release of Catecholamines. The HPA system also releases certain neurotransmitters (chemical messengers) called catecholamines, particularly those known as known as dopamine, norepinephrine, and epinephrine (also called adrenaline).
Response by the Heart, Lungs, and Circulation to Acute Stress As the bear comes closer, the heart rate and blood pressure increase instantaneously.
The Immune System's Response to Acute Stress The effect on the immune system from confrontation with the bear is similar to marshaling a defensive line of soldiers to potentially critical areas.
The Acute Response in the Mouth and Throat As the bear gets closer, fluids are diverted from nonessential locations, including the mouth. This causes dryness and difficulty in talking. In addition, stress can cause spasms of the throat muscles, making it difficult to swallow.The Skin's Response to Acute Stress The stress effect diverts blood flow away from the skin to support the heart and muscle tissues. (This also reduces blood loss in the event that the bear catches up.) The physical effect is a cool, clammy, sweaty skin. The scalp also tightens so that the hair seems to stand up.Metabolic Response to Acute Stress Stress shuts down digestive activity, a nonessential body function during short-term periods of physical exertion or crisis.The Relaxation Response: the Resolution of Acute Stress Once the threat has passed and the effect has not been harmful (ie, the bear has not eaten or seriously wounded the human), the stress hormones return to normal. This is known as the relaxation response. In turn, the body's systems also normalize.WHAT ARE THE NEGATIVE EFFECTS OF STRESS? In prehistoric times, the physical changes in response to stress were an essential adaptation for meeting natural threats. Even in the modern world, the stress response can be an asset for raising levels of performance during critical events such as a sports activity, an important meeting, or in situations of actual danger or crisis. If stress becomes persistent and low-level, however, all parts of the body's stress apparatus (the brain, heart, lungs, vessels, and muscles) become chronically over- or under-activated. This may produce physical or psychologic damage over time. Acute stress can also be harmful in certain situations.Stress-related conditions that are most likely to produce negative physical effects include:
Psychologic Effects of Stress Studies suggest that the inability to adapt to stress is associated with the onset of depression or anxiety. In one study, two-thirds of subjects who experienced a stressful situation had nearly six times the risk of developing depression within that month. Some evidence suggests that repeated release of stress hormone produces hyperactivity in the hypothalamus-pituitary-adrenal axis and disrupts normal levels of serotonin, the nerve chemical that is critical for feelings of well-being. Certainly, on a more obvious level, stress diminishes the quality of life by reducing feelings of pleasure and accomplishment, and relationships are often threatened.Heart Disease Mental stress is as major a trigger for angina as physical stress. Incidents of acute stress have been associated with a higher risk for serious cardiac events, such as heart rhythm abnormalities and heart attacks, and even death from such events in people with heart disease.Stress activates the sympathetic nervous system (the automatic part of the nervous system that affects many organs, including the heart). Such actions and others may negatively affect the heart in several ways:
Stroke One survey revealed that men who had a more intense response to stressful situations, such as waiting in line or problems at work, were more likely to have strokes than those who did not report such distress. In some people prolonged or frequent mental stress causes an exaggerated increase in blood pressure. In fact, a 2001 study has linked for the first time a higher risk for stroke in adult Caucasian men and elevated blood pressure during times of stress.Susceptibility to Infections Chronic stress appears to blunt the immune response and increase the risk for infections and may even impair a person's response to immunizations. A number of studies have shown that subjects under chronic stress have low white blood cell counts and are vulnerable to colds. And once any person catches a cold or flu, stress can exacerbate symptoms. People who harbor herpes or HIV viruses may be more susceptible to viral activation following exposure to stress. Even more serious, some research has found that HIV-infected men with high stress levels progress more rapidly to AIDS when compared to those with lower stress levels. (In some studies, stressful events most linked with a higher incidence of infections were interpersonal conflicts, such as those at work or in a marriage.)Immune Disorders The contradictory effects of stress on the immune system can have mixed effects on autoimmune diseases (which are those that are caused by inflammation and damage from immune attacks on the body). For example, eczema, lupus, and rheumatoid arthritis may demonstrate changes ranging from improvement to deterioration in response to stress. A 2001 study reported that short-term stress appears to have no negative effect on multiple sclerosis, but chronic stress is a major risk factor for flare-ups.Cancer Current evidence does not support the idea that stress causes cancer. Nevertheless, some animal studies suggest that lack of control over stress (not simply stress itself) had negative effects on immune function and contributed to tumor growth. And, two small studies on melanoma and breast cancer patients reported improved survival with therapies that offered emotional support. Other research has not detected similar survival benefits, but support groups still have great value in reducing stress in patients with terminal cancer.Gastrointestinal Problems The brain and the intestine are strongly related and mediated by many of the same hormones and nervous system. (Indeed, some research suggests that the gut itself has features of a primitive brain.) It is not surprising then that prolonged stress can disrupt the digestive system, irritating the large intestine and causing diarrhea, constipation, cramping, and bloating. Excessive production of digestive acids in the stomach may cause a painful burning.Irritable Bowel Syndrome. Irritable bowel syndrome (or spastic colon) is strongly related to stress. With this condition, the large intestine becomes irritated, and its muscular contractions are spastic rather than smooth and wave like. The abdomen is bloated and the patient experiences cramping and alternating periods of constipation and diarrhea. Sleep disturbances due to stress can further exacerbate irritable bowel syndrome. Peptic Ulcers. It is now well established that most peptic ulcers are either caused by the H. pylori bacteria or by the use of nonsteroidal anti-inflammatory (NSAID) medications (such as aspirin and ibuprofen). Nevertheless, studies still suggest that stress may predispose someone to ulcers or sustain existing ulcers. Some experts, in fact, estimate that social and psychologic factors play some contributing role in 30% to 60% of peptic ulcer cases, whether they are caused by H. pylori or NSAIDs. In any case, some experts believe that the anecdotal relationship between stress and ulcers is so strong that attention to psychological factors is still warranted. Inflammatory Bowel Disease. Although stress is not a cause of inflammatory bowel disease (Crohn's disease or ulcerative colitis), there are reports of an association between stress and symptom flare-ups. One study, for example, found that while short term (past month) stress did not significantly exacerbate ulcerative colitis symptoms, long term perceived stress tripled the rate of flare-ups compared to patients who did not report feelings of stress. Eating Problems Stress can have varying effects on eating problems and weight.Weight Gain. Often stress is related to weight gain and obesity. Many people develop cravings for salt, fat, and sugar to counteract tension and, thus, gain weight. Weight gain can occur even with a healthy diet, however, in some people exposed to stress. And the weight gained is often abdominal fat, a predictor of diabetes and heart problems. In a 2000 study, lean women who gained weight in response to stress tended to be less able to adapt to and manage stressful conditions. The release of cortisol, a major stress hormone, appears to promote abdominal fat and may be the primary connection between stress and weight gain in such people. Weight Loss. Some people suffer a loss of appetite and lose weight. In rare cases, stress may trigger hyperactivity of the thyroid gland, stimulating appetite but causing the body to burn up calories at a faster than normal rate. Eating Disorders . Anorexia nervosa and bulimia nervosa are eating disorders that are highly associated with adjustment problems in response to stress and emotional issues. Diabetes Chronic stress has been associated with the development of insulin-resistance, a condition in which the body is unable to use insulin effectively to regulate glucose (blood sugar). Insulin-resistance is a primary factor in diabetes. Stress can also exacerbate existing diabetes by impairing the patient's ability to manage the disease effectively.Pain Researchers are attempting to find the relationship between pain and emotion, but the area is complicated by many factors, including effects of personality types, fear of pain, and stress itself.Muscular and Joint Pain. Chronic pain caused by arthritis and other conditions may be intensified by stress. (According to a study on patients with rheumatoid arthritis, however, stress management techniques do not appear to have much effect on arthritic pain.) Psychologic distress also plays a significant role in the severity of back pain. Some studies have clearly associated job dissatisfaction and depression to back problems, although it is still unclear if stress is a direct cause of the back pain. Headaches. Tension-type headache episodes are highly associated with stress and stressful events. (Sometimes the headache doesn't even start until long after a stressful event is over.) Some research suggests that tension-type headache sufferers may actually have some biological predisposition for translating stress into muscle contraction. Among the wide range of possible migraine triggers is emotional stress (although the headaches often erupt after the stress has eased). One study suggested that women with migraines tend to have personalities that over-respond to stressful situations. Sleep Disturbances The tensions of unresolved stress frequently cause insomnia, generally keeping the stressed person awake or causing awakening in the middle of the night or early morning.Sexual and Reproductive Dysfunction Sexual Function. Stress can lead to diminished sexual desire and an inability to achieve orgasm in women. Stress response can also cause temporary impotence in men. Part of the stress response involves the release of brain chemicals that constrict the smooth muscles of the penis and its arteries. This constriction reduces the blood flow into and increases the blood flow out of the penis, which can prevent erection.Premenstrual Syndrome. Some studies indicate that the stress response in women with premenstrual syndrome may be more intense than in those without the syndrome. Fertility. Stress may even affect fertility. Stress hormones have an impact on the hypothalamus gland, which produces reproductive hormones. Severely elevated cortisol levels can even shut down menstruation. One interesting small study reported a significantly higher incidence of pregnancy loss in women who experienced both high stress and prolonged menstrual cycles. Another reported that women with stressful jobs had shorter periods than women with low-stress jobs. Effects on Pregnancy. Old wives' tales about a pregnant woman's emotions affecting her baby may have some credence. Maternal stress during pregnancy has been linked to a 50% higher risk for miscarriage. It is also associated with lower birth weights and increased incidence of premature births, both of which are risk factors for infant mortality. One study suggested that stress experienced by expectant mothers can even influence the way in which the baby's brain and nervous system will react to stressful events. Stress may cause physiologic alterations, such as increased adrenal hormone levels or resistance in the arteries, that may interfere with normal blood flow to the placenta. Memory, Concentration, and Learning Stress has significant effects on the brain, particularly on memory. The typical victim of severe stress suffers loss of concentration at work and at home and may become inefficient and accident-prone. In children, the physiologic responses to stress can clearly inhibit learning. Although some memory loss occurs with age, stress may play an even more important role than simple aging in this process. In one study older people with low stress hormone levels tested as well as younger people in cognitive tests: those with higher stress levels tested between 20% and 50% lower.Effect of Acute Stress on Memory. Studies indicate that the immediate effect of acute stress impairs short-term memory, particularly verbal memory. In one interesting 2000 study, subjects took pills containing either cortisone (a stress hormone) or a placebo (a dummy pill). Those taking the cortisone performed significantly worse on memorization tests than those taking the placebo pill did. In an earlier study, when individuals were subjected to four days of stress, verbal memory was also impaired. Fortunately, in such cases, memory is restored after a period of relaxation. Effect of Chronic Stress on Memory. Studies have strongly associated prolonged exposure to cortisol (the major stress hormone) to shrinkage in the hippocampus, the center of memory. For example, two studies reported that groups who suffered from post-traumatic stress disorder (Vietnam veterans and women who suffered from sexual abuse) displayed up to 8% shrinkage in the hippocampus. It is not yet known if this shrinkage is reversible. Other Disorders Allergies. Research suggests that stress, not indoor pollutants, may actually be a cause of the so-called sick-building syndrome, which produces allergy-like symptoms, such as eczema, headaches, asthma, and sinus problems, in office workers.Skin Disorders. Stress plays a role in exacerbating a number of skin conditions, including hives, psoriasis, acne, rosacea, and eczema. Unexplained itching may also be caused by stress. Unexplained Hair Loss (Alopecia Areata). Alopecia areata is hair loss that occurs in localized (or discrete) patches. The cause is unknown but stress is suspected as a player in this condition. For example, hair loss often occurs during periods of intense stress, such as mourning. Teeth and Gums. Stress has now been implicated in increasing the risk for periodontal disease, which is disease in the gums that can cause tooth loss. Self-Medication with Unhealthy Lifestyles People under chronic stress frequently seek relief through drug or alcohol abuse, tobacco use, abnormal eating patterns, or passive activities, such as watching television. The damage these self-destructive habits cause under ordinary circumstances is compounded by the physiologic effects of stress itself. And the cycle is self-perpetuating; a sedentary routine, an unhealthy diet, alcohol abuse, and smoking promote heart disease, interfere with sleep patterns, and lead to increased rather than reduced tension levels. Drinking four or five cups of coffee, for example, can cause changes in blood pressure and stress hormone levels similar to those produced by chronic stress. Animal fats, simple sugars, and salt are known contributors to health problems. WHO IS AT RISK FOR CHRONIC STRESS OR STRESS-RELATED DISEASES? General Factors that Increase Susceptibility At some point in their lives virtually everyone will experience stressful events or situations that overwhelm their natural coping mechanisms. In one poll, 89% of respondents indicated that they had experienced serious stress in their lives. Many factors influence susceptibility to stress.Conditions that Influence the Effects of Stress. People respond to stress differently depending on different factors:
Effects in Childhood Animal studies report that rats that have been exposed to maternal grooming (ie, positive physical affection by the mother) have lower stress hormone levels in adulthood. Depressed or aggressive mothers are particularly powerful sources of stress in children, even more important than poverty or overcrowding. Children are frequent victims of stress because they are often unable to communicate their feelings accurately or their responses to events over which they have no control.
Stress in the Elderly As people age, the ability to achieve a relaxation response after a stressful event becomes more difficult. Aging may simply wear out the systems in the brain that respond to stress, so that they become inefficient. The elderly, too, are very often exposed to major stressors such as medical problems, the loss of a spouse and friends, a change in a living situation, and financial worries.Caregivers Caregivers of Family Members. Studies show that caregivers of physically or mentally disabled family members are at risk for chronic stress. Spouses caring for a disabled partner are particularly vulnerable to a range of stress-related health threats including influenza, depression, heart disease, and even poorer survival rates. Caring for a spouse with even minor disabilities can induce severe stress. (Intervention programs that are aimed at helping the caregiver approach the situation positively can be very helpful at reducing stress and helping the caregiver maintain a positive attitude.) Wives experience significantly greater stress from caregiving than husbands, and, according to a 2000 study, tend to feel more negative about their husbands than caregiving husbands feel about their wives. Specific risk factors that put caregivers at higher risk for severe stress or stress-related illnesses include the following:
Angry Personalities People who are less emotionally stable or have high anxiety levels tend to experience specific events as more stressful than others. Some experts describe an exaggerated negative response to stress as "catastrophizing" the event (turning it into a catastrophe). An overly angry or hostile response to stressful situations may be dangerous to the heart, but studies are mixed.
The lack of an established network of family and friends predisposes one to stress disorders and stress-related health problems, including heart disease and infections. And, a 2000 study reported that older people who maintain active relationships with their adult children are buffered against the adverse health effects of chronic stress-inducing situations, such as low income or lower social class. One study suggested this may be because people who live alone are unable to discuss negative feelings and so relieve their stress. Work Risk Factors According to one survey, 40% of American workers describe their jobs as very stressful. Job-related stress is particularly likely to become chronic because it is such a large part of daily life. And, stress in turn reduces a worker's effectiveness by impairing concentration, causing sleeplessness, and increasing the risk for illness, back problems, accidents, and lost time. Work stress can lead to harassment or even violence while on the job. At its most extreme, stress that places such a burden on the heart and circulation may be fatal. The Japanese even have a word for sudden death due to overwork, karoushi. In fact, a number of studies are now suggesting that job-related stress is as great a threat to health as smoking or not exercising.Among the intense stressors at work are the following:
An Absent or Inadequate Relaxation Response In some people, stress hormones remain elevated instead of returning to normal levels. This may occur in highly competitive athletes or people with a history of depression.Biologic Factors In a 1999 study scientists reported the discovery of a small protein in the brain (orphanin FQ/nociceptin) that plays an important role in the stress response. Animals with a genetic deficiency in this protein are unable to manage stress response and exhibit over-anxious behavior in response to new situations. Future research may reveal similar findings in humans.WHAT OTHER CONDITIONS HAVE THE SAME SYMPTOMS AS STRESS? Anxiety Disorders The physical symptoms of anxiety disorders mirror many of those of stress, including a fast heart rate; rapid, shallow breathing; and increased muscle tension. Anxiety is an emotional disorder, however, and is characterized by feelings of apprehension, uncertainty, fear, or panic. Unlike stress, the triggers for anxiety are not necessarily or even usually associated with specific stressful or threatening conditions. Some individuals with anxiety disorders have numerous physical complaints, such as headaches, gastrointestinal disturbances, dizziness, and chest pain. Severe cases of anxiety disorders are debilitating, and interfere with career, family, and social spheres.Depression Depression can be a disabling condition, and, like anxiety disorders, may result from untreated chronic stress. Depression also mimics some of the symptoms of stress, including changes in appetite, sleep patterns, and concentration. Serious depression, however, is distinguished from stress by feelings of sadness, hopelessness, loss of interest in life, and, sometimes, thoughts of suicide. Acute depression is also accompanied by significant changes in the patient's functioning. Professional therapy may be needed in order to determine if depression is caused by stress or if it is the primary problem.Post-Traumatic Stress Disorder Symptoms Post-traumatic stress disorder (PTSD) is a reaction to a very traumatic event: it is actually classified as an anxiety disorder. The event that precipitates PTSD is usually outside the norm of human experience, such as intense combat or sexual assault. The patient struggles to forget the traumatic event and frequently develops emotional numbness and event-related amnesia. Often, however, there is a mental flashback, and the patient re-experiences the painful circumstance in the form of intrusive dreams and disturbing thoughts and memories, which resemble or recall the trauma. Other symptoms may include lack of pleasure in formerly enjoyed activities, hopelessness, irritability, mood swings, sleep problems, inability to concentrate, and an excessive startle-response to noise.WHAT ARE THE GENERAL GUIDELINES FOR REDUCING STRESS? Perhaps the best general approach for treating stress can be found in the elegant passage by Reinhold Niebuhr, "Grant me the courage to change the things I can change, the serenity to accept the things I can't change, and the wisdom to know the difference." The process of learning to control stress is life-long, and will not only contribute to better health, but a greater ability to succeed in one's own agenda.When to Seek Professional Help for Stress Stress can be a factor in a variety of physical and emotional illnesses, which should be professionally treated. Many stress symptoms are mild and can be managed by over the counter medications (eg, aspirin, acetaminophen, or ibuprofen for tension headache and antacids and anti-diarrhea medications or laxatives for mild stomach distress). A physician should be consulted, however, for physical symptoms that are out of the ordinary, particularly those which progress in severity or awaken one at night. A mental health professional should be consulted for unmanageable acute stress or for severe anxiety or depression. Often short-term therapy can resolve stress-related emotional problems.Considerations for Choosing a Strategy for Reducing Stress In choosing specific strategies for treating stress, several factors should be considered.
Overcoming Obstacles to Treatment Often people succeed in relieving stress for the short-term but resort to previous ways of stressful thinking and behaving because of outside pressure or entrenched beliefs or habits.
Stress Reduction and Effects on Health It should be strongly noted that treating stress cannot cure medical problems. Any stress management program is not a substitute for standard medical treatments, but it can be a very important component in a medical regimen. Some studies have reported the following:A 2001 study reported that treatments that reduce psychological distress after a heart attack appeared to improve long-term outlook. Some evidence exists that stress management programs may reduce the risk of heart events (eg, heart attack) by up to 75% in people with heart disease. One study found that stress management programs are more effective than exercise in reducing heart risks (although exercise is also protective). A 2001 study reported that stress management techniques along with methods for coping with anger were associated with lower blood pressure. In one 2001 study, patients with chronic daily tension headache who were given tricyclics reported greater improvement after a month than those who were taught stress management techniques. The combination of the two approaches worked even better. And at six months, stress management was as effective as the antidepressants in improving headaches. WHAT ARE SOME SPECIFIC STRESS REDUCTION METHODS? Healthy Lifestyle Healthy Diet. A healthy lifestyle is an essential companion to any stress-reduction program. General health and stress resistance can be enhanced by a regular exercise, a diet rich in a variety of whole grains, vegetables, and fruits, and by avoiding excessive alcohol, caffeine, and tobacco.Exercise. Exercise in combination with stress management techniques is extremely important for many reasons:
Cognitive-Behavioral Techniques Cognitive-behavioral methods are the most effective ways to reduce stress. They include identifying sources of stress, restructuring priorities, changing one's response to stress, and finding methods for managing and reducing stress. This approach my be particularly helpful when the source of stress is chronic pain or other chronic diseases.Identifying Sources of Stress. It is useful to start the process of stress reduction with a diary that keeps an informal inventory of daily events and activities. While this exercise might itself seem stress producing (and yet one more chore), it need not be done in painstaking detail. A few words accompanying a time and date will usually be enough to serve as reminders of significant events or activities.
Consider as many relief options as possible. Examples include the following:
Expressing feelings does not mean venting frustration on waiters and subordinates, boring friends with emotional minutia, or wallowing in self-pity. In fact, because blood pressure may spike when certain chronically hostile individuals become angry, some therapists strongly advise that just talking, not simply venting anger, is the best approach, especially for these people. The primary goal is to explain and assert one's needs to a trusted individual in as positive a way as possible. Direct communication may not even be necessary. Writing in a journal, writing a poem, or composing a letter that is never mailed may be sufficient. Expressing one's feelings solves only half of the communication puzzle. Learning to listen, empathize, and respond to others with understanding is just as important for maintaining the strong relationships necessary for emotional fulfillment and reduced stress. Keep Perspective and Look for the Positive. Reversing negative ideas and learning to focus on positive outcomes helps reduce tension and achieve goals. The following steps using an example of a person who is alarmed at the prospect of giving a speech may be useful:
Reducing Stress on the Job Many institutions within the current culture, while paying lip service to stress reduction, put intense pressure on individuals to behave in ways that promote tension. Some experts argue that employers should be held responsible for taking measures to prevent stress from work overload and should provide help to deal with work-related stress. Treating stress has a number of benefits, not only for the individual but also for the employer. In one study, for example, in which a company set up a two-year stress management educational program, the savings to the company in workmen's compensations costs were nearly $150,000, compared to the cost of the program which was only $150 per participant for a total of $6,000. A study in Japan indicated that the most popular approaches for reducing stress in the work place were educational and consultation programs for each individual worker. Stress prevention methods that only involved management were inadequate.In general, however, few workplaces offer stress management programs, and it is usually up to the employee to find their own ways to reduce stress. Here are some suggestions:
Strengthen or Establish a Support Network Studies of people who remain happy and healthy despite many life stresses conclude that most have very good networks of social support. One study indicated that support even from strangers reduced blood pressure surges in people undergoing a stressful event. Many studies suggest that having a pet helps reduce medical problems aggravated by stress, including heart disease and high blood pressure.Relaxation Techniques Since stress is here to stay, everyone needs to develop methods for invoking the relaxation response, the natural unwinding of the stress response. Relaxation lowers blood pressure, respiration, and pulse rates, releases muscle tension, and eases emotional strains. This response is highly individualized, but there are certain approaches that seem to work. Combinations are probably best. For example, in a study of children and adolescents with adjustment disorder and depression, a combination of yoga, a brief massage, and progressive muscle relaxation effectively reduced both feelings of anxiety and stress hormone levels. No one should expect a total resolution of stress from these approaches, but if done regularly, these programs can be very effective. [See Table.]
WHERE ELSE CAN INFORMATION ABOUT STRESS BE OBTAINED? ABOUT WELL-CONNECTED Well-Connected reports are written and updated by experienced medical writers and reviewed and edited by the in-house editors and a board of physicians, including faculty at Harvard Medical School and Massachusetts General Hospital. The reports are distinguished from other information sources available to patients and health care consumers by their quality, detail of information, and currency. These reports are not intended as a substitute for medical professional help or advice but are to be used only as an aid in understanding current medical knowledge. A physician should always be consulted for any health problem or medical condition. The reports may not be copied without the express permission of the publisher.Board of Editors Harvey Simon, MD, Editor-in-Chief, Associate Professor of Medicine, Harvard Medical School; Physician, Massachusetts General HospitalStephen A. Cannistra, MD, Oncology, Associate Professor of Medicine, Harvard Medical School; Director, Gynecologic Medical Oncology, Beth Israel Deaconess Medical Center Masha J. Etkin, MD, PhD, Gynecology, Harvard Medical School; Physician, Massachusetts General Hospital John E. Godine, MD, PhD, Metabolism, Harvard Medical School; Associate Physician, Massachusetts General Hospital Edwin Huang, MD, Gynecology, Harvard Medical School, Physician, Massachusetts General Hospital Daniel Heller, MD, Pediatrics, Harvard Medical School; Associate Pediatrician, Massachusetts General Hospital; Active Staff, Children's Hospital Paul C. Shellito, MD, Surgery, Harvard Medical School; Associate Visiting Surgeon, Massachusetts General Hospital Theodore A. Stern, MD, Psychiatry, Harvard Medical School; Psychiatrist and Chief, Psychiatric Consultation Service, Massachusetts General Hospital Nidus Information Services Cynthia Chevins, PublisherBruce Carlson, Business Development Manager Carol Peckham, Editorial Director © 2001 Nidus Information Services, Inc., 41 East 11th Street, 11th Floor, New York, NY 10003 or email office@well-connected.com or on the Internet at www.well-connected.com.
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