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You've heard the advice over and over again: You can maximize the success of your fight against disease by minimizing stress. Likewise, excess stress can inhibit your body's ability to heal and your immune system's ability to suppress illness. It seems simple enough. But when it comes to stress-inducing events, only the death of a spouse or close family member, a divorce or jail term outweigh being diagnosed with a serious or life-threatening illness. All the negative effects of life's demands and pressures are lumped together under the umbrella we call stress. It is aggravated by the uncertain prognosis and lifestyle changes that usually accompany illness or surgery. Whether you are dealing with lupus or heart disease, cancer or arthritis, you know that pain, physical limitations and decisions regarding treatment can cause frustrations which exacerbate stress levels of day-to-day living. What was once manageable now seems insurmountable after a heart attack or organ transplant. While you might be tempted to ignore stress, Valerie R. Houghton, LMFCC, of San Jose, California, who has counseled people with critical illnesses for 20 years, advises against it. "By applying some practical tools, you will not only decrease the level of stress in your life and improve your emotional state, you also increase your chances of survival and improve the quality of your life, such as a better night's sleep or less pain." Stress is the perception of a threat to your physical or psychological well-being and the feeling that you are powerless and unable to control that threat. It is usually associated with some unexpected change in the status quo, such as a traffic detour, a job reassignment, or a serious illness. But, according to Valerie Houghton, while you may be unable to alter the situation producing the stress, you can change your perception of it and choose a more appropriate response. The keys to changing your perception to combat the negative effects of life's demands and pressures are found in your stress reduction toolbox on the following page. They include adjusting your priorities and attitude, practicing mindfulness, and relaxation techniques. As with any new tools, it takes practice to learn to use them to their maximum effectiveness. You will find some to be more useful than others, and some to be awkward at first, but effective after repeated use. The tools that work well for you won't necessarily help someone else, and vice versa. It's important for you to dig through the box, determine which tools can help you most and put them to work. "What if, instead of running a tape projecting the worst outcome imaginable, we stop, relax and use mindfulness to deal with the pain? It's my experience, and that of many of my students, that by reducing your stress level you can reduce physical pain." Katie Allen, RN of Berkeley, California teaches breathing awareness and restorative yoga to people with cancer and other life-threatening conditions. She describes how her experience with cancer led her to incorporate mindfulness into her classes to help students deal with pain. "Pain is physically stressful but is also emotionally stressful because we might associate it with previous experiences, even surgery," she began. "But what if we change the way we react to the first signal of pain?" she continued. "What if, instead of running a tape projecting the worst outcome imaginable, we stop, relax and use mindfulness to deal with the pain? It's my experience, and that of many of my students, that by reducing your stress level you can reduce physical pain." Allen says pain control is only one of the benefits of stress management and laments that it often takes a critical illness to motivate people to learn ways to minimize their stress. "If everyone could realize that what is precious about life is here and now, not somewhere in the future, we would all have healthier, happier, more meaningful lives."

Your STRESS Reduction Toolbox
Tools to minimize the physical and emotional effects of stress

LIGHTEN UP: Don't take yourself or those around you too seriously. Cultivate your sense of humor and joy.

• Volunteer to serve your community. It doesn't take a lot of time or strength to read to kindergartners for an hour a week, but it will take your mind off your problems and fears.
• Adopt a pet. Besides providing companionship and a nonjudgemental ear, pets lift our spirits. Has walking been prescribed to control your blood pressure? A dog will make sure you get out every day.
• Cultivate a garden. Whether you prefer flowers or vegetables, take pleasure in nurturing the plants, watching them bear fruit or flowers and then share your harvest.
• Indulge yourself, especially when you are preparing for a treatment or struggling to get through a trying time. Get a professional pedicure, take a bubble bath, lunch at an outdoor cafe or spend an afternoon browsing in a bookstore.
• Take a class, just for the fun of it. Quilt making, conversational French, painting, Chinese cooking: whatever your choice, don't take it too seriously.
• Adjust your attitude. Tell yourself that just for now you will leave behind your expectations and preconceived notions. Consider the possibility that, no matter how bleak your situation seems, the end result will be a good one.
• Look at your priorities and learn to let go. Ask yourself if being right or controlling every situation is more important than improving your health. Let the other driver take the parking place; save your energy for destroying cancer cells.
• Be mindful. Focus your attention on what you are experiencing moment to moment. Let go of expectations, and quiet the inner voice that says, "should," "must," "always," "ought" or "never."

FIND A RELAXATION TECHNIQUE: Many programs teach various ways to experience inner peace and tranquillity, thus relieving stress. The common threads of these tools are repetition and a passive disregard of everyday thoughts. You can take some classes or rent videos to find the practice that takes you to the quiet place where healing can occur, and then do it every day. Try:

• Breathing, especially diaphragmatic or abdominal breathing.
• Meditation.
• Visualization or guided imagery.
• Restorative (or passive) yoga.
• Meditative prayer.
• Progressive muscle relaxation.
• Tai Chi or Qigong (Chinese movement programs).

LOOK AT YOUR EVERYDAY LIFE: Examining and perhaps changing a number of behaviors in your day-to-day life can help.

• Identify situations you find most stressful and prepare a plan for dealing with them.
• Watch your diet, limiting caffeine, alcohol and sugar.
• Engage in regular aerobic exercise to build up your body's ability to resist stress and improve sleep.
• Prescription and over-the-counter drugs can cause distress and anxiety. This can include everything from some non-steroidal anti-inflammatory drugs and muscle relaxants to certain antidepressants, antihistamines, antihypertensives and antiviral medications. Check with your doctor or pharmacist if you feel that anxiety might be a side effect of your medication.
• Find someone in whom you can confide, sharing sorrows as well as joys. If you are uncomfortable talking to your family, friends, or clergyman about stressful issues in your life, ask your doctor to refer you to a therapist.

RESOURCES: Your local hospital and adult education center probably offer a variety of classes aimed at stress reduction, while your library has books, audio and video tapes to help you design your own program. Here are a few resources to get you started.

• Relax and Renew by Judith Lasater, PhD, PT, Rodmell Press, 1995
• The Relaxation Response by Herbert Benson, MD, Avon Books, 1975
• The Wellness Book by Herbert Benson, MD and Eileen Stuart, RN, MS, Fireside, 1992
• Yoga Journal, published by California Yoga Teachers' Association,
• Berkley, California

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