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Chapter 5: Stress, Trauma, Anxiety, Fears and
Psychosomatic Disorders 
All our lives long, every day and every hour we are engaged in the process of
accommodating our changed and unchanged selves to changed and unchanged
surroundings; living, in fact, is nothing less than this process of accommodation; when we
fail in it a little we are stupid, when we fail flagrantly we are mad, when we suspend it
temporarily we sleep, when we give up the attempt altogether we die.
-Samuel Butler, The Way of All Flesh
Empty your mind of all thoughts.
Let your heart be at peace...
Each separate being in the universe
returns to the common source.
Returning to the source is serenity...
When you realize where you come from,
you naturally become tolerant, disinterested,
amused, kindhearted as a grandmother,
dignified as a king...
you can deal with whatever life brings you,
and when death comes, you are ready.
-Lao-tzu, The Book of The Way, 500 B.C., translated by Stephen Mitchell
We have studied in chapters 3 and 4 about values to guide our
lives and about how to control our behavior. In chapters 5 to 8, we
turn our attention to four generally unwanted, unpleasant emotions--
stress, depression, anger, and dependency. First, we will study stress,
anxiety, and fears, because these are the most common emotional
problems. 
                                                                                                       
Stress, Trauma, Anxiety, Fears, and Psychosomatic Disorders 
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Signs of stress
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Sources and types of stress
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Dealing with trauma
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Becoming absorbed with one’s wounds
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Theories explaining stress and anxiety
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Operant conditioning and stress
 
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Psychoanalytic theories of anxiety
Psychological defense mechanisms
Unconscious causes of fear
Summary of the effects of stress
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Ways of handling stress and anxiety
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Confront the stressful situation
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Stress inoculation
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Develop toughness and skills
 
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Treatment of specific anxiety-based problems
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Insomnia and burnout
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Anxiety, fears, and phobias (books and sites)
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Pain--headaches
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Overview
Anxiety or tension is our body's way of telling us that something is
going wrong and we need to correct it. It is an absolutely essential
signal, necessary for our survival and well being. If primitive humans
did not have food, the anxious anticipation of hunger motivated them
to find food. If a worker hasn't been productive yet today, the fear of
criticism from a supervisor or co-worker helps him/her get busy. If I
am driving a little too fast on a rainy night on tires with 70,000 miles
on them, my concern about safety slows me down. These are valid
reasons for feeling that action is needed to avoid trouble. 
Isn't it wonderful that we have a built-in automatic warning
system? Yes, except when the system goes awry. Sometimes the
expectation of trouble or danger is wrong; we exaggerate the
problems or become tense for no good reason. At other times, the
warning is accurate but nothing can be done, and we fret needlessly
about our inability to change the situation. Sometimes, we have this
stress alarm going off, but we don't know what is wrong. In each of
these cases, we are psychologically and bodily all tensed up to run or
fight an enemy, but the real enemy (the creator of the scary situation)
is us. 
Obviously, a major problem is telling the difference between
realistic, helpful tensions, fears, or worries and unrealistic, unhealthy
nervousness. This is because we all could start fretting about some
possibly stressful event at almost any time. Risks are all around us.
Thus, unrealistic worries are over-reactions to a tolerable situation or a
prolonged over-reaction to a threatening situation that can not be
avoided. But how can you be sure a situation won't cause trouble? You
can't. How can you be sure you won't handle the problem any better if
you worried about it a lot more? You can't be. However, we can learn
to recognize extreme over-reactions, e.g. being terrified while flying or
obsessing for hours about an insoluble problem. But a little worry
about crashing while flying is realistic and some thought is necessary
to know that you can't do much about a problem. So, how much time
should you devote to a particular problem? There isn't an exact
answer; that's why some of us let anxiety overwhelm us. 
Instead of an over-reaction, some people under-react to a risk.
They dismiss or deny it. They never get serious at work or prepare for
a "bad spell;" they die on rain-soaked highways. Maybe they are
unaware of the danger; maybe they just prefer to not think about it;
maybe the situation is so threatening that they are scared witless, and
shove awareness of the problem out of their mind. Both over-reactors
and under-reactors to a threat are poorly prepared to deal with it.
Both need to learn to react differently. This chapter deals more with
over-reactors than with under-reactors. 
Everyone has some anxiety
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The complexity, confusion, and commonness of anxiety is reflected
in the many words in the English language for anticipated troubles:
tension, feeling on edge, up-tight, hassled, nervous, jittery, jumpy,
wound up, scared, terrified, insecure, pressured, alarmed, anxious,
worried, dreading what might happen, uncertain, vulnerable,
apprehensive, edgy, troubled, and many more. Anxiety is one of the
most common symptoms seen in a psychologist's or psychiatrist's
office. Mental Help Net provides several articles about stress
The broadest definitions of stress include the entire complex
sequence of events: (1) the event that requires some change (external
or mental; real or imaginary), (2) internal processes (perception,
interpretation of the event, learning, adaptation, or coping
mechanisms), (3) emotional reactions (our feelings) and (4) other
behavioral-bodily reactions (nervousness, sweating, stumbling over
words, high blood pressure, and all the medical conditions mentioned
below). In a more limited usage, stress is the upsetting situation and
strain is the mental and physical reactions. However, most of us use
the term stress loosely for both the threatening situation and the
anxious reaction. 
Stress may refer to meeting any "demand" made of us, even good,
reasonable, enjoyable ones. Thus, the experienced jogger meets the
demands of running five miles and thoroughly enjoys it. A person
given a promotion is delighted even though it means more
responsibility and work. Doing well in school involves the stress of
learning what you need to know to get high grades on tests. No one
could work and raise a family without stress. How could anyone strive
for a high, competitive goal or make sacrifices in order to live
according to his/her values without experiencing stress? And, surely,
stress is part of self-discovery, growth, and using all of one's potential,
because these efforts open us up to failure when we find our
limitations. Even the most wonderful events of life--loves, friendships,
family, sex, travels, holidays--add stress because these situations
require us to cope and adapt. So, some writers speak of "good" stress
and "bad" stress. We all have both. 
In everyday speech, however, we usually find other words, rather
than anxiety or fear, for the hard work, uncertainty, and tension
associated with doing a good job at work, in school, or in our
relationships. We may say, "it's a hard job but he/she is handling it,"
rather than "his/her job is making him/her highly anxious." When we
use the phrase "he is anxious" or "insecure" or "she is nervous" or
"jumpy," we usually mean things aren't going well, the person is close
to loosing control or threatened with failure. Therefore, words which
imply the amount of anxiety and stress being experienced become a
commonly accepted index--a barometer--of how well we are coping.
Indeed, very high anxiety is an aspect of most psychological
breakdowns or disorders. So, the stress-related words mentioned
above usually communicate to others that we are having serious
difficulty handling some situation. 
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What other emotions and/or terms are closely related to stress?
Fears are when you feel scared in specific situations. Some are
fears of real dangers; a fear of speeding or fighting or driving while
drunk is healthy. Other fears, also called phobias, are not realistic;
phobias of heights, flying, bugs, enclosed places, open spaces, or of
speaking to groups are all over-reactions to the actual risks involved.
Panic reactions are sudden, overwhelming fear reactions, often without
an obvious external cause, usually involving rapid breathing, heart
palpitations, fear of dying, and a frantic attempt to get to safety.
Anxiety is an unpleasant tension state, something like fear, in
certain circumstances but not associated with a specific
stimulus, perhaps not with an external event at all. One might be
generally anxious at work, meeting people, taking a class, or in many
other situations; yet, no specific aspect of those situations is the
identifiable source of the fear. 
Because stress, fears, and anxiety are so unpleasant, you might be
tempted to seek total relaxation in undemanding situations. Actually,
the leisurely, effortless life style is not possible or even desirable for
most of us. As I have already made clear, if you seek to do your best,
to do new things, to stretch your capabilities, you will be challenged
and stressed. Many of us are good students, good workers, or good
religious folks partly because we are scared not to be. Many
outstanding athletes, students, managers, scholars, professionals, and
others obtain part of their drive by overcompensating for feelings of
inadequacy. 
As we have mentioned, the forewarnings of trouble help us cope
and achieve. Thus, tension must, in many ways, be valued and
welcomed. Psychologists don't yet know which achievements could
have been accomplished without stress (demands from the
environment and upon oneself), perhaps almost none. Thus, it seems
likely that the better adjusted among us are constantly both reducing
some of their unneeded anxieties and increasing other beneficial
anxieties. It is a skillful, cogent person who can orchestrate his/her life
into a pleasant and productive symphony of high and low stresses.
Thus far, psychology has focused mostly on lowering high anxiety for
good reason: it is a serious and fairly common problem. 
The diagnosis of Generalized Anxiety Disorder (GAD) is a chronic,
debilitating condition consisting of excessive worry, disruptive anxiety,
and distressful tension that has lasted for at least 6 months and
maybe for years. It is the second most common psychiatric disorder
(after depression); about 5% of the world's population suffers this
disorder. Even in developed countries, however, less than 20% of
sufferers get proper treatment. It is treatable, but many MDs have
trouble diagnosing it and are uncertain how to treat it. GAD frequently
results in sleeplessness, irritability, poor concentration, and fearful
hyper-vigilance. There may be a variety of other symptoms including
fatigue, muscle tension, sweating, heart palpitations, stomach trouble,
diarrhea and others. 
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As we will see later, anxiety and depression are frequently and
closely associated. Intense anxiety is also a part of or connected with
many burdensome psychological or physiological conditions and
psychiatric disorders. For instance, some aspect of anxiety
accompanies neurotic disorders, including somatoform or somatization
or conversion (a physical problem with a psychological cause),
psychogenic pain, hypochondriasis (fear and excessive complaints of
bodily disease), dissociative reactions (amnesia, sleepwalking, multiple
personality), factitious conditions (faking an illness), obsessive-
compulsive disorders, phobias, and other disorders. See an abnormal
psychology text for a detailed description of these disorders. Some of
these problems are dealt with in the last section of this chapter. 
New Research about Fears, Panic, and Anxiety
Behaviors associated with anxiety, e.g. panic reactions, phobias,
and worries, are paradoxical since these behaviors, although
unpleasant, keep on occurring over and over, perhaps for months or
years. Being by their very nature unwanted, distressing, self-punishing
acts or experiences, why don't those behaviors gradually go away--
extinguish? Why don't people just stop or escape the behaviors? If you
were hurting yourself by holding your hand near a stove burner, you'd
stop. Why don't you stop getting uselessly scared or worried? The
usual answer given by psychologists is that the panic, compulsion,
phobia, or worry may be a useful warning that something is wrong or
they actually reduce our level of anxiety or stress in some way. That
"relief" is powerful enough, we must assume, that it overrides the
unpleasantness of the act or experience, such as compulsion, fear, or
worry. 
Psychologists are gradually learning more about the creation of
intense physiological stresses (more so in some people than in others)
that require rather extreme ("neurotic") acts/feelings, such as intense
fears or compulsions, to lessen the tension or dis-ease. Apparently,
something in an individual's history makes him/her more prone to use
an excessive (and neurotic) tension-reduction method, such as a
compulsion, prolonged worry, or a repeated obsession that becomes a
part of a disorder. 
First of all, it is obvious that anxiety disorders are not easily
stopped. Indeed, they often become chronic, presumably because they
produce some pay off, some benefit, such as worry or fretting may
help us feel we have done our best to deal with a scary situation. It
might surprise you how common anxiety disorders are. For reasons we
don't clearly understand, certain kinds of anxiety disorders, such as
panic attacks and phobia of insects or small animals, occur much more
often in women than in men. Perhaps the new research summarized
below will provide some hints as to why these disorders develop more
often in women. These gender differences start early--by age 6, girls
are twice as likely to feel anxious as boys or, at least, they admit
feeling anxious. 
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Research in the last decade or so (much of this information is
taken from Barlow, 2000) has shown that anxiety reactions are not
just simple conditioned responses (like Little Albert's learned fear
reaction to the rat), not just some chemical imbalance (like a physician
might have us believe), and not just some cognitive misjudgment of
the danger involved (as the Cognitive therapist would tell you).
Emotions, in general, have apparently evolved over eons to help us
survive, partly by helping us to be mindful of dangers and to help us
communicate with others. Likewise, some emotion-based symptoms
seem to be inherited from recent ancestors. However, although feeling
stress is the nature of our species, emotional responses can certainly
be modified by an individual's life experiences and by the species
evolution. For instance, some (but not all) fear responses have
apparently evolved to enable us to instantly respond (fight or flee) to
an immediate danger; the nerve impulses tend to go straight from the
eye or ear to our primitive emotional brain, then to the muscles,
bypassing the thoughts ("cognition") in the brain's cortex. Most
people's fear of snakes is like this. 
In contrast with the instant reaction of many fears and panic,
anxiety is usually quite cognitive, i.e. how we see a situation
determines how we feel about it. Barlow says anxiety results from
perceiving one's self as helpless and feeling unable to cope with an
anticipated danger or problem. A fear of public speaking might be an
example--you aren't going to be physically hurt but your pride and
self-esteem may be damaged. Anxiety, thus, involves constant
tension--vigilance, expecting trouble, and sensing, perhaps wrongly,
that we will be unable to handle a possible danger. He suggests a
better term might be "anxious apprehension." Anxiety is future-
oriented cognition, e.g. "I will mess things up in the future because
that is what I have done in the past." (Note: depression tends to be a
past-oriented disorder, "because of my past losses or guilt, I feel
bad.") It is important to realize that you may not be aware of the
specific trigger or cue that sets off the "danger alert." Also, one may
not have specific notions about exactly how he/she will be inadequate
in coping with the problem. In the more extreme cases, all these dire
expectations of disasters and failures to cope may become chronic and
intense, interfering with effective coping by the brain. The panicking
brain no longer effectively thinks of solutions; concentration is lost. 
Human emotions are not simple. Several things are happening
when we are anxious, unreasonably afraid, or excessively scared:
primitive alarms are being set off inappropriately, previous trauma has
conditioned us to over-respond, and our estimate of the true risks
involved has gotten confused. Of course, it is sometimes necessary
and healthy to respond to true threats with fight, flight, or freeze
responses. But what happens when real threats are actually present
but quite unlikely to happen? Some of us mis-calculate and become
overly fearful and panicky. As the anxiety becomes intense, we often
try to handle it in a couple of ways: (1) we avoid the frightening
situation (avoiding it may be self-defeating or lead to
rituals/compulsions and denial) or (2) we uselessly and excessively
worry (which ironically often produces more anxiety, not less) and our
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body tightens. Both worry and body tension are central features of a
Generalized Anxiety Disorder (GAD). 
As the result of research, fear reactions are now seen by
psychologists as quite different from anxiety responses, although they
may feel similar. In the past, fear and anxiety were usually seen as a
very similar physiological response, except that fear was set off by a
specific triggering external situation and anxiety was a persistent
autonomic response to a vague general external situation or to an
unknown internal trigger. Today, however, fear and panic reactions are
thought to result largely from primitive animal reflexes to danger, i.e.
the old fight, flight, or freeze responses that have helped us and our
primitive animal ancestors survive for millions of years. 
Panic is, in part, like an automated fear reaction, except we don't
usually understand what sets off a panic attack. Panic attacks have a
cognitive aspect too. Barlow, while explaining panic attacks, has
described "false alarms" that contribute to major panic reactions. Panic
disorders--the feeling of impending doom--seem to be a complex
result of (a) primitive innate biological alarm reactions (emotionality)
which generally evolved over eons but also "run in families," (b) our
learned psychological coping mechanisms (such as learning that a
panic attack gets the attention of others or gets us back to a safe
place), and (c) the life stresses we are experiencing (such as a concern
that one might lose his job or a lover might leave). Panic may be
complex but it is not an uncommon experience--between 10% and
15% of Americans have reported a panic reaction within the last year.
So, while the primitive, automatic response may be the crux of fears
or panic, they often also have a cognitive part too. 
In the 1980's, the general concept of neurotic disorders was
discarded and replaced with more specific labels, such as anxiety,
mood, somatoform and other disorders. Yet, central to all these
disorders is negative affect (fear, sadness, disappointment); the same
medicines work on all or most of them; the same behavioral
treatments work with most of them; the disorders tend to increase or
are relieved together. So, now Barlow argues that anxiety and
depression have so many of the same features that both
disorders need to be studied and understood together (back to a
broad, general neurotic label?). He maintains that anxiety and
depression both result from (1) genetic contributions (about 1/3 to 1/2
of the total causes; commonly, families are seen as nervous, tense,
high strung), (2) early childhood experiences, like rejection or abuse,
that sensitize us to certain adolescent or adult stresses, and (3)
psychological vulnerabilities or personality tendencies that direct
certain individuals toward a specific disorder, like social anxiety, panic
disorder, phobias, obsessions or compulsions, suspiciousness,
aggressiveness and irritability, unhappiness, pessimism,
disorganization and impulsivity, and many others. Of course, each of
these specific disorders has unique characteristics, but they have a
similar basic underlying emotion, namely, strong negative and tense
feelings. 
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In Barlow's (2001) new experimentally-based book, the crux of
anxiety is described as being an anticipation of trouble and feeling
unable to control events in one's life. This suggests that one's sense
of self-control (or Bandura's self-efficacy) is of vital importance. Note
that "normal" people often believe they have more control over events
than they really have (an exaggerated sense of mastery to quell our
fears?). Many experiments with animals deprived of control have
immediately produced agitation and intense tension. Also,
psychological experiments studying the much later impact of early
experiences, like animals allowed to control their food and water
supply vs. animals having plenty to eat and drink but no control, have
demonstrated marked and complex influences on the adult animal's
behavior (less emotionality, fewer fears, less stress hormones,
different brain organization, more adventurous exploratory behavior).
An interesting and surprising contrast is that early physical trauma did
not produce as much adult emotionality in animals (there is some
reason to doubt that this holes true in humans). Apparently, gaining a
sense of mastery or learning one is able to handle problems early in
life, e.g. in monkeys who get good mothering and social support when
young, seems to protect the adult from serious anxiety. So, learn your
self-help lessons well. 
Okay, now we are getting to the crux of this book--self-control and
self-confidence. But how does a sense of control develop in humans?
Barlow (2000) points out two characteristics of parenting that develop
a child's sense of control. Attentive parents, who promptly respond
to the young child's needs, wishes, cries, etc., build a sense of safety
and an "I-can-get-things-done" expectation. Likewise, encouraging
parents, who are less over-protective and let the child explore and
handle situations in his/her own way, foster more independence, more
security, and more self-confidence in the child. Parental over-
control does the opposite, leading to less of a sense of self-control in
the child (more of an "externalizer"--see chapter 8), to seeing the
world as a more dangerous place requiring constant vigilance and help
from others, and to feeling more anxiety and depression, perhaps
throughout life (unless some self-changes are made or intervention is
provided later in life). Thus, in addition to the genes, the learned sense
of mastery or self-control determines, in large part, the amount of
stress, anxiety or tension we feel. However, there is at least one more
important factor--beginning to think of some situation or condition as
particularly dangerous. 
Although fears are generally based on primitive automatic
emotional reactions, more intense panic and specific fears occur when
we feel particularly vulnerable--open to being seriously hurt. Some of
this vulnerability may be genetic tendencies but much is probably
learned, often at an early age. How are these dangers, these "Wow,
that scares the hell out of me!" reactions, learned? Sometimes, we see
the actual results of a real danger--a heart attack, an auto accident,
someone going crazy--and we vividly imagine that might happen to us.
Examples: Panic attacks often are exacerbated by the scary thoughts
that the tightness in my chest and high anxiety means I'm dying from
a heart attack, going to faint, going crazy, etc. Such thoughts greatly
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increase the panic. Sometimes, we are given specific instructions by
others to expect danger, e.g. some social phobics have been told that
interacting with others can be disastrous--"they will think you are
stupid or weird," "you can't trust them," "you'll make a fool of
yourself," etc. Sometimes, we have started to think in a certain way
(the source may be totally unknown--a TV, movie, book, or just our
own fantasy as a child) that implies some situation is dangerous.
Examples of this might be: "Oh, what I just said sounded really
selfish... dumb... critical... " which grows into "I'm going to mess up
when I talk to them," "I'm not good at socializing," "I can't think of
anything to say," or "I get really uptight and start to sweat when I try
to talk to someone." We can create, in effect, our own dangers, and
may be especially prone to do that if we are given certain genes and
childhood experiences. 
Unfortunately, as a self-helper you can not un-do many of the
early origins of your anxieties--your genes, your traumatizing
childhood experiences, or the mistaken but frightening ideas you
developed as a child. What you can do now is (1) learn the skills
that will help you cope, (2) armed with those coping techniques,
expose yourself to the scary situations to learn that they will not result
in a catastrophe, and (3) work diligently to test out your anxiety-
producing ideas and correct your false beliefs that make your life less
happy or unproductive. The rest of this chapter will help you learn
useful self-change methods for coping with fears and for developing a
realistic sense of mastery. Chapter 12 contains several methods for
reducing fears and anxiety. Also, chapter 6, is about dealing with
depression, and chapter 14, is about changing your pessimistic or
negative thoughts. For interpersonal concerns, see chapters 9 and 10.
All these chapters will be of further help in the long process of learning
self-control. 
An overview of this chapter: we will first consider the signs of
stress and the sources of stresses. Then, we will review several
theories that attempt to explain why and how stress occurs, why there
are such different individual reactions to the same situation, and what
the consequences (beneficial and harmful) of prolonged stress are.
Lastly, we will discuss controlling our anxiety. Many specialized Web
sites will be given there. 
The major purpose of this chapter is to give you more
understanding of stress so you can handle it better. At the end of this
chapter there are descriptions of several methods for managing stress,
fears, anxiety, and specific psychological disorders. You may need to
refer to chapters 12 and 14, and other chapters to find the details of
how to carry out specific self-help methods for reducing anxiety. 
A Case Study: Jane--difficulty speaking in front of groups 
From grade school through high school Jane avoided speaking up
in class or any public speaking. She wasn't shy; in fact she was
outgoing and popular. She was comfortable with friends. Even in front
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of crowds, as a cheer leader, she was usually at ease, feeling confident
of her talent, as long as she didn't have to speak. But answering
questions in class was hard. Talking to teachers and older people was
not easy for her. And when she had to speak in front of class, she felt
very nervous, both before the speech and especially during it. She got
tense, her voice quavered, she forgot what she wanted to say, her
knees got weak, she thought she would really mess up. (Fear of
speaking before a group is the most common fear; 41% of U.S. adults
have it [Wallace, Wallechinsky & Wallace, 1977].) 
Jane really wanted to be an actress and majored in Theater and
Speech-Communication in college. She knew she had to conquer the
speech phobia. She tried and tried to confront the fears by talking in
certain classes. Her determination to overcome stage fright also
motivated her to prepare carefully for small parts in plays. She even
tried out for the debate team but didn't make it. Later she had a
chance to appear on the campus radio as a news announcer. She was
scared but she did it. 
Eventually, as a senior, Jane became one of the anchorpersons on
the campus TV news. She was very attractive; other students seemed
envious; she gained confidence. A few months after she graduated,
she found work as a TV reporter for a small station. It was scary but
two years later she was co-anchor of the local evening news. As she
became more experienced, she noticed an interesting thing
happening--she became less and less uptight while performing but she
remained very anxious and disorganized before going on the air. There
was almost a panic reaction, difficulty concentrating, dry mouth, and
an upset stomach as she prepared to read the news. When it was air
time, she settled down. It surprised her to discover that many
seasoned professionals experience intense stress prior to performing.
(The great violinist, Isaac Stern, reportedly goes to the stage
sometimes muttering to himself, "I can't play. I'm no good." Perhaps
that is one reason why so many performers use drugs.) 
Signs of Stress
The first task is to recognize what stress (or fear or anxiety) is--to
become aware if and when you have it. Ask yourself these questions:
Are you often tense, uptight, and unable to relax? Do setbacks disturb
you a lot? Do you overlook the small pleasures in life? Do you fret and
worry a lot? Do you have many self-doubts and self-criticism? Does
your anger flare up more than it used to? Do you have trouble
sleeping? Do you feel tired or experience pain? Are you under pressure
and/or restless? Answering "yes" to any one of these questions may
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mean you are over-stressed. Answering "yes" to 5 or 6 of these 9
questions may double your risk of developing high blood pressure. 
A brief list of signs would include: 
1.
Psychophysiological responses--muscles tight or aching,
nervous tics like in the eyelid, hands unsteady, restlessness,
touching yourself repeatedly, clearing your throat, frequent
colds, pain, upset stomach, sweating, skin problem or itch, stiff
posture, holding things tightly, strong startle response,
headaches, high blood pressure, ulcers, heart disease, colitis,
hemorrhoids, rashes, diarrhea, or frequent urination. These are
somatoform disorders. 
2.
Behavioral-emotional signs--hyperactivity, walking or talking
faster, in a hurry, irritation with delays, panicky, blushing,
getting tongue-tangled, avoiding people, nervous habits
(strumming fingers, eating, smoking, drinking), changing habits
(becoming less or more organized), poor memory, confusion,
stumbling over words, inattentiveness, excessive worrying,
preoccupation with a certain situation, holding a grudge,
irritability, crying, obsessive thoughts, compulsive actions,
outbursts of emotions, bad dreams, apathy, etc. These are
anxiety reactions. 
3.
Tiredness and lack of energy--general lack of interest, bored,
watching TV and falling asleep, humorless, sleeping a lot,
insomnia, can't get going, sighing, and moving slowly. (Or,
sometimes, too much energy, as mentioned above.) 
4.
Anxiety intrudes on our consciousness or cognition in many
ways: excessive preoccupation with the threatening person or
situation, a desperate striving to understand why someone
behaved the way they did, repeatedly obsessing about the
upsetting event, unstoppable pangs of emotion (loss, anger,
jealousy, guilt, longing, etc.), excessive vigilance and startle
reactions, insomnia and bad dreams, aches and pains and other
unwanted sensations. Plus all the words mentioned above in
the introduction that reflect the subjective feelings we have,
including nervous, up tight, scared, apprehensive, etc. 
Naturally, no one has all these signs. Having only a few may mean
nothing; yet, having only one to an extreme may be a sign of serious
stress. You probably have a pretty good idea about how anxious you
are; if not, discuss it with someone. There are over 100 personality
tests of stress, anxiety, fears, self-doubt, risk-taking, etc., which could
help you assess your emotional dis-ease (Aero & Weiner, 1981).
Chapter 15 provides a journal approach to discovering your unique
sources of stress. One of the best known tests of stress is the Type A
Personality Test from Friedman and Rosenman (1974) which asks how
often you experience racing against the clock, hating to be late, hating
to wait, losing your temper when pressured, irritated by other's
mistakes, speaking in a loud critical voice, being competitive, rushing
to do something quickly, feeling guilty if not working, etc. How often
13
do you do these things? If a lot, you are likely to be a tense,
competitive, ambitious, irritable Type A. 
Because stress and anxiety are complex reactions (including
feelings, actions, thoughts, and physiology), these emotional states
can and have been measured many ways: self-ratings, observation by
others, psychological tests, behavioral signs, and physiological or
medical tests. The trouble is (1) each person has their own unique way
of responding to stress, i.e. heart rate may increase but no stomach
distress may occur in one person and the opposite pattern in another
person equally stressed. (2) There is very little agreement among
these measures, e.g. a person may rate him/herself as anxious but not
appear anxious to others nor respond with stress on the physiological
measures, like GSR (perspiration), blood pressure, or muscle tension.
This is a major problem in studying stress scientifically. (3) The
concepts of stress and anxiety are so broad and vague that general
measures of anxiety do not predict very well how people behave or
feel nor do such measures explain psychological problems or help a
therapist develop a treatment plan. Being "anxious" roughly means
"I'm having some problems" but more specifics must be known to
diagnose and correct a particular disturbance. You may need to go
deeper and find out exactly what is causing your stress. There are
many possible causes which you need to know about before deciding
what causes your anxiety.
Sources and Types of Stress
External Situations that Lead to Stress
Changes cause stress
Almost any change in our lives is a stressor because there is a
demand on us to deal with a new situation. This is Hans Selye's view,
who has spent a life-time studying stress (1982). There are thousands
of external causes of stress. Moreover, we can be overstressed when
there are too many demands at school or work or interpersonally, and
we can be understressed when there is "nothing to do" and we feel like
we aren't getting anywhere. As mentioned before, there are bad
stresses and good stresses. Here are some bad stresses (the
percentages estimate the difficulty in managing that particular stress
relative to death of a spouse, which is 100%): a spouse dies (100%),
we get divorced (73%), have a serious illness (53%), we lose our job
(47%), change occupations (36%), have more arguments with our
spouse (35%), and so on. These are good stresses: when we fall in
love and get married (50%), reconciliate after a separation (45%),
retire (45%), have a baby (39%), buy a house (31%), get promoted
(29%), have an unusual success (28%), graduate (26%), find new
14
friends (18%), and take a vacation (13%). The more of these major
life changes--good and bad--that have occurred in your life during the
last year or two, the greater the chances of your becoming physically
or emotionally ill (Holmes & Rahe, 1967). Other researchers have
found that having just one close, confiding relationship protects
us from many of these stresses.
Alvin Toffler (1970) wrote a best seller, Future Shock, putting forth
the idea that technology was producing such rapid change that people
felt unable to keep up with and handle the accelerating flow of
information and choices. We are in a mobile society with few
permanent relationships. Today almost everything is disposable, even
our jobs and friends. We give them up and move on. Certainly,
computers, robots, and cheap foreign labor may threaten our jobs. On
the other hand, I would suggest that an equal amount of stress or
frustration is caused by changes being made too slowly rather than too
fast, i.e. racial prejudice and greed don't go away fast enough, we'd
like to make some changes at work but can't, or the slow driver in
front of us drives us crazy--see frustration and conflict below. 
Siegelman (1983) and others speculate that change is upsetting
because we are leaving a part of our selves behind. Any change
involves a loss of the known--a giving up of a reality that has given
meaning to our lives. We are also afraid we won't get the things we
want after the change is made. No wonder changes are resisted.
Siegelman and others also believe that there is an opposite force to
the resistance to change. Of course, many of us seek change; there is
an urge to master new challenges, to explore the unknown, to test
ourselves. And she says, "Mastering the anxiety of venturing promotes
new levels of growth." How do you see yourself? As wanting things to
stay comfortable and the same or more as wanting things to change?
This is probably an important personal characteristic to be aware of
and to consider if you need to change this attitude. 
Daily hassles cause stress
Lazarus and Folkman (1984) believe the little daily hassles rather
than the major life events bother us the most, causing mental and
physical problems. The research at the University of California at
Berkeley investigated the hassles of college students, middle-aged
whites, and health professionals. Each group had some similar hassles:
losing things, concern about physical appearance, and too many things
to do. But each group had different concerns too: middle-aged persons
worried about chronic money matters, professionals fretted about
continuing pressures at work, and students were stressed by wasting
time, not doing as well as they would like, and loneliness. Note, these
are not major life changes, but chronic conditions. 
Stress may come from constant, steady tension in a relationship,
continuing lack of friends, no interest or excitement day after day, or
inability to find meaning in life, as well as from the big, awful eruptions
in life discussed above. Also, the little unexpected occurrences and
15
disruptions, like a flat tire, an uninvited visitor, a headache, a long
form to be filled out, etc. cause stress too. Lazarus's little hassles were
found to be more related to physical health than Holmes and Rahe's
major life events. So, both big and little events create stress; you
need to be aware of both. And, in fact, as Lazarus points out, health
can better be viewed as a result of effective or ineffective coping
rather than as simply a result of stress in the environment. You may
not be able to avoid stress, but you can learn to cope. 
Frustrations, threats, and conflicts cause stress
Stressors may be real or imaginary, past or future obstacles or
stumbling blocks, i.e. frustrations. If something (or someone) has
interfered with our "smooth sailing" in the past, it is called a
frustration or a regret. It may upset us and depress us. If the
obstacle is expected in the future, it is called a threat. This may be an
accurate or an unrealistic expectation; in either case it causes anxiety
and worry. A common human dilemma is when our own inner wishes,
needs, or urges push us in different directions. This is a conflict
Psychologists have described five major types of conflict that may
help you understand your stress: 
(1) Approach-avoidance conflict --we both want and don't want
something. Examples: any temptation, like sweets, we like it but want
to avoid it. You find someone physically attractive but their personality
turns you off. You'd love to teach useful psychology to high school
students but the pay is low. In this kind of situation, any decision you
make has some disadvantage. It's "damned if I do and damned if I
don't." 
Furthermore, there is frequently an additional feature that makes
this conflict more difficult to deal with, namely, the attraction is
stronger than the avoidance at a distance (otherwise we'd just leave it
alone and forget it) and avoidance is stronger than attraction when we
get close to the attractive object. So, we are caught in a trap. It is like
being strongly attracted to a glorious person whom we fear may not be
interested in us. Thus, we tend to approach him/her and then just as
we are about to ask him/her to do something with us, we get "cold
feet" and run away, then come back again and so on. So often this
happens in love relationships; there is a quarrel and a break up, but at
a distance they miss each other and remember the good times and
end up getting back together, only to find the other person is still a
jerk; they fight again and leave, and over and over. Caught in this
kind of bind, the stressful oscillating between approaching and
avoiding may go on for a long time. 
Note: frustration is like an approach-avoidance conflict except
there is a barrier in the way instead of the goal itself having negative
qualities that keep us away. For example, it is a conflict when low pay
makes us hesitate to take a high school psychology teaching job. It is
a frustration when the barrier to high school teaching is the fact that
16
there are no jobs available. Age, gender, and lack of things, like
money, ability, and motivation, are common barriers causing
frustration. Adolescence has been called a time of storm and stress. In
the early teen years, we are considered too young to drive, drink, go
steady, work, stay out late, have sex, etc. As a young woman, it is not
considered appropriate by many others if you want to work as a
carpenter or truck driver, to be a senator or governor or president,
play on the boy's football team, or be as loud and dirty-talking and
heavy-drinking as males your age. The time when we would most like
to have a new, expensive sports car is when we are 16 and have no
money. Many of us would love to be a great singer but can't carry a
tune. There are endless frustrations to be handled. 
(2) Approach-approach conflict --we have two or more good
choices but can't have them both. Examples: you have two good job
offers, two or three kinds of cars you'd like to buy, two interesting
majors to choose between, two possible dates and so on. This kind of
conflict is usually easily resolved; we just make a choice. A few people
become afraid they have made a mistake as soon as they decide.
Many may briefly think later: "Of all sad words of tongue or pen, the
saddest are these, 'it might have been'." 
Making the choice among two or several good, exciting alternatives
may be done carefully and cautiously by an unusually conscientious
person; yet, the decision usually poses no big threat, unless one is
hoping for a guaranteed perfect outcome. Others might make the
same decisions casually or even impulsively. Of course, carrying out
our preferred choices among good alternatives may involve
considerable stress. When we go off to our favorite college, stress
goes with us. When we decide to marry the person we love most in the
world, we are anxious. When we try to excel in our favorite sport,
there is tension. Each of us may have our own optimal level of tension
as we achieve the goals we set for ourselves in life. 
(3) Avoidance-avoidance conflict --we have two or more
alternatives but none of them seems desirable. It's a "no win"
situation, like approach-avoidance conflicts, except no choice looks
appealing. Examples: we have a choice of studying a hard, boring
chapter or doing poorly on an exam tomorrow. Suppose a woman
becomes pregnant but doesn't want to have the baby and doesn't
believe in abortion. We may be in an unhappy relationship but be
afraid to leave. Suppose a parent or a spouse constantly disapproves
of everything we do, but we can't or don't want to leave. These are
very uncomfortable situations to be in. Often we try to escape:
students drop courses, children run away from home, the young
woman puts off deciding what to do about the pregnancy until she has
to have the baby. Procrastinating or running away from the problem
may only make things worse. At other times, escape is a reasonable
choice, e.g. Erica Jong (1977) writes in How to Save Your Own Life
about a woman in an unhappy marriage who became so afraid of
failure that she couldn't get out of bed. Divorce saved her. 
17
(4) Double or multiple approach-avoidance conflict --we are
faced with many choices, each with complex positive and negative
aspects. This is like conflicts (1) and (3) combined. The real world is
like this sometimes: There is a good movie on (but you might flunk a
quiz tomorrow); there is a lot of studying to do (but it's all so boring);
there is a chance you could meet someone interesting at the pizza
parlor (but it's too many calories); there is a job opening in your
hometown (but it might be a serious mistake to quit college). All have
their appeal; all have disadvantages; and you have only a few minutes
in which to make many decisions like this every day. 
(5) Avoidance-approach conflict --some ordinarily avoidable
goals are so enticing (opposite of 1) that once you get close you can't
stop: you can't stop with one cashew; a sexually attractive and willing
partner may be impossible to resist once you get into bed. Emotions
are like this--anger can be contained until we get to the boiling point,
then we let go full force. Or, we may avoid someone or some activity
or food thinking we don't like them, but once we get closer to them we
find out we like them. 
Being aware of the different types of conflicts could help you
recognize troublesome situations in your own life. Such conflicts might
be the source of stress and anxiety. Having a philosophy of life
(chapter 3) and good decision-making skills (chapter 13) will help
resolve the conflicts. 
Other external and internal sources of stress
Shaffer (1982) lists 9 external and 10 internal sources of stress.
The external ones are noise, polluted air, poor lighting, overcrowding,
unpleasant relationships, uninteresting work or poor conditions, life
changes (see above), too much or too little responsibility, and too
many "rules." The internal sources are poor diet, little exercise,
physical strain on the body, rushing or being unable to adjust to the
pace of others, experiencing conflict or taking things too seriously,
sexual frustration, finding little meaning in life, nervous symptoms,
and taking no time for yourself. 
A "source" of one emotion (anxiety, sadness, anger, dependency)
can be another emotion. There is strong evidence that certain
emotions go together, e.g. anxiety and depression, so it is wise to look
for both feelings even though you are aware of only one. Sometimes
one emotion, say anger, is so disturbing that it is denied (see defense
mechanisms), but the simmering hostility can produce great anxiety
which may keep us awake at night and stressed out during the day. In
that case, focusing on reducing the restlessness may not effectively
relieve the anger. You may have to dig out all the feelings. 
If you are looking for the sources of your stress, you should
consider all the above mentioned external and internal sources, but
there are still many more ways to get stressed. Especially neglected in
our discussion, thus far, are the cognitive sources (unreasonable
18
expectations, faulty thinking, scary fantasies, and negative self-
concept) and unconscious processes (internal wars between parts of
our personality and glimpses of taboo urges). We'll cover these in the
next two major sections. 
Prolonged and Intense Stress 
Early research on psychological stress focused on extreme
conditions: combat, concentration camps, nuclear accidents, loss of
loved ones, and serious injury. Or, focus was on extreme responses to
stress: psychosis, incapacitating anxiety, bleeding ulcers, high blood
pressure, heart conditions, etc., which become stressful conditions
themselves. Fortunately, most of us don't have to deal with such
serious conditions, but we all have some stress. 
Later research has studied the impact of stress on work and skills
or on morale. To some extent, mild to moderate anxiety increases our
performance, especially on simple, easy tasks that we know well. Of
course, intense stress usually screws everything up; however, some
people "keep their cool" responding to failure or a serious challenge
with more determination and effort, and doing better. Most of us get
"nervous" and clutch up or give up, especially if the task is very
complex. 
It is common to assume that men are more "bothered" by
problems at work, while women are more troubled by problems with
the children or by marital conflicts. But, if women work full-time
outside the home, they are as stressed by problems at their work as
men are. Likewise, men are as disturbed by difficulties with the
children as women are. The emotional reactions to marital problems
are complex: men and women are in general equally concerned about
their marriages. However, when wives are securely employed and
financially independent, men are more concerned with marital
problems than women are. If women are economically dependent,
they are more troubled by marital conflicts. Actually, your level of
concern about your marriage depends on your commitment to and
your dependence on the marriage. Other studies suggest that males
and females tend to react differently to certain stresses, e.g. men and
women respond about equally to a storm, like a hurricane, but women
respond more intensely than men to a nasty family fight (Adler, 1993).
We are learning new things about our reaction to stress all the time;
there is a lot more to discover. 
General Adaptation Syndrome--GAS
Almost 50 years ago a young physician, Hans Selye (1974),
noticed that sick people often had a series of symptoms, no matter
what was wrong. He called it "the syndrome of just being sick." It
seems to be the body's way of defending itself against attack by
disease or stress of any kind. Three stages are involved in what is now
called the general adaptation syndrome or GAS. First, is the alarm
stage: the body responds with panic--a "fight or flight" reaction. The
19
hormones flow, the heart beats faster, we breathe harder, we sweat,
our senses are more alert, we are ready for protective action--running
or attacking. One can see how this reaction surely helped our species
survive for millions of years in the wild. But as we experience this
defense today in the form of fear, anxiety, panic, anger, sadness, etc.,
we lose some of our mental alertness and organization. So a
frightened speaker, being more prepared to run than talk, loses
his/her train of thought or stumbles over his words. The nervous
worker being watched by his/her supervisor fumbles with his tools. 
If the stress continues, our body enters the second stage, called
resistance. Our body must stop being in a state of alarm; our body
can't take it. So, the body attempts to adjust to the stress. We calm
down a little, but the body is still working overtime; we may become
more accustomed to being stressed but our concentration and
decisions continue to be poor. 
If the stress is very long-lasting (days, weeks, and months), our
resistance is further worn down and our bodies become exhausted in
the third stage. We don't have the energy to continue the adaptation
to the stress. The body gives up--parts may have been damaged,
particularly the heart, kidneys, and stomach. We may die. Voodoo
deaths may occur this way. Commonly, psychosomatic disorders
(psychologically caused physical disorders) occur: fatigue, hysteria,
aches and pains, high blood pressure, skin rashes, etc. Often we have
trouble getting along with others. Mentally we may experience
hopelessness, exhaustion, confusion or perhaps a serious mental
disorder. 
Prolonged stress is a very serious matter.
 
The mystery of the long-term effects of intense stress
A cluster of research findings demonstrate the incredible
consequences of childhood traumas (sometimes, not always). It has
long been known that people who lost a parent during childhood were
more prone to depression as adults. The 5 and 10-year harmful effects
of divorce on the children has been well substantiated, and the
"sleeper effects" of divorce (such as a fear of intimacy) may occur 10
or 15 years later (see discussion in chapter 10). Children, who's
parents divorced, even die 4 to 6 years before children who haven't
gone through a divorce. That's incredible. Soldiers who were prisoners
of war were 8 times more likely to have had a stroke 50 years later
than buddies who were not prisoners. Women who were sexually
20
abused as children have a smaller hippocampus than unviolated
women; thus, stress seems to change our brains, our cardiovascular
systems, our immune systems, and our hormonal systems. So, when
"stressed out" as an adult, the original source may have been years
ago or even in your childhood (brilliant! except Freud said that 100
years ago). 
About 40% of 10 to 16-year-olds report some sort of trauma in
childhood--physical or sexual assault, kidnapping, etc. These
traumatized children have more stress symptoms, sadness, and
difficulty in school than non-traumatized children (Boney-McCoy &
Finkelhor, 1995). That's why therapists explore your history. 
Unfortunately, we scientists don't know how these continuing over-
reactions to stress are maintained over the years (see psychodynamics
section later). Of course, theorists speculate, e.g. some think intense
stress is primarily a chemical-physiological reaction which permanently
alters our body, especially the hypothalamus, pituitary gland, adrenal
glands and their various hormones, causing the hypersensitive
reactions to ordinary stress. Drugs might be developed to fix these
problems. Others think psychological (learned) processes are
responsible and need to be changed. 
Jeffery Young (1990) has suggested that early maladaptive
schemas or ways of thinking develop early in life. Such schemas,
especially after experiencing high stress, might include ideas that I will
be abandoned, that others may deceive or hurt me, that I won't get
enough love, that I can't handle life, that I can't be happy without a
particular person's love, that I am basically defective and others won't
like me, that my wants and feelings are unimportant, that I am
entitled to anything I want, that I don't need to or can't control my
emotions or behavior, and so on. Our particular schemas form the core
of our self-concept, so they resist change. And, the maladaptive
schemas from childhood could cause depression, over-reactions to
stress (like divorce), physiological changes, high blood pressure and
strokes, etc. years later. We are a long way from knowing how to
prevent these long-range consequences. Quite possibly the
physiological development and psychological processes (conditioning
and cognitive) constantly interact and share the blame. Give science
another 25 years and we will understand these new mysteries well
enough to "treat" the causes. For now, we can do our best with what is
known by exploring additional psychological theories about handling
serious trauma. Later, we will consider more theories about coping
with general anxiety. 
Dealing with Trauma
21
Trauma has recently become a renewed concern for patients and
therapists. Of course, handling catastrophes is a problem as old as
mankind because our history has been filled with trauma--disease,
injury, storms, starvation, fears, arguments, war, abuse, death, etc. In
addition, over 100 years ago, Freud started finding sexual abuse
frequently among his psychologically troubled patients. A decade or so
later, doubting that incest could be that common, he concluded that
the reported sexual activity had probably not really happened but was
a fantasy connected with the developmentally important attraction
that naturally occurs between daughter and father or son and mother,
which he called the Electra Complex and the Oedipus Complex. In
time, other internal conflicts and dynamics also became concerns to
Freudian therapists, such as Inferiority Complex and various defense
mechanisms (see later in this chapter), and for nearly a century verbal
psychiatric treatment has focused on resolving these internal problems
related to childhood development. 
Of course, external traumas, such as accidents and disasters, have
often required treatment and/or support from friends. But two fairly
recent events have re-focused attention on external stresses: (1) the
Vietnam War with its Post-traumatic Stress Disorder (PTSD) and drug
addiction and (2) the research confirmation of Freud's original
observation of actual sexual abuse of children. Interest in drug
treatment developed with the war and the drug counterculture (1966-
1973). Likewise, a huge revival of interest in the long-term
consequences of childhood abuse started soon after Multiple
Personality, Adult Children of Alcoholics, and other disorders were
found to be associated with childhood abuse. This completed the cycle
of therapeutic interest back to coping with external trauma. A
remarkable online history of PTSD Literature has been written by Lisa
Beall of Auburn University. 
Note: The way the term "trauma" is used here and elsewhere may
be confusing in several ways. I and others usually use the word
trauma in a very broad, general sense--to me it merely means a very
disturbing, stressful experience; it may be intense for a long time or
only moderately upsetting for a few days or weeks. Moreover, as I use
it, the traumatic stress may come from a real external threat
(upsetting physical or psychological circumstances) or from one's
interpretation or even false perceptions of circumstances, dangers and
faults (a subjective experience). However, the specific APA Manual
diagnosis of Post-Traumatic Stress Disorder is limited, according to
many diagnosticians, to people who have been in serious jeopardy and
experienced intense fear, persons who have personally been exposed
to possible death and escaped or been intimately involved with a loved
one in such a dire situation. Therefore, because of this diagnostic
restriction, "trauma" in the diagnosis of PTSD applies to soldiers who
have been in combat, holocaust victims, rape and violent abuse
victims or their loved ones, cancer patients or their loved ones, serious
accident survivors or their loved ones, and so on. In contrast, to me
"trauma" includes assorted non-life-threatening events, including
death or suicide of a child or loved one, a very stressful divorce, a
debilitating disease, difficult childbirth, natural disasters, a failure or
22
loss of a job, and many other stressful conditions. For a child, a
"trauma" might involve neglect, excessive punishment (e.g.
spankings), sexual abuse, emotional abuse (e.g. "you are stupid...
mean... worthless"), sibling abuse or rivalry, serious accidents,
observing domestic violence, bullying and social rejection, and many
other conditions. The "experts" argue about the appropriateness of
PTSD being restricted to life-threatening situations but that is the way
the APA Diagnostic & Statistical Manual-IV reads for now. Other
diagnoses are adequate to describe the psychological disruptions
caused by non-life-threatening events or thoughts. Just keep in mind
that PTSD, as a formal psychiatric diagnosis, involves a very restricted
kind of trauma, but the term PTSD itself is often used casually by
doctors and patients to refer to the aftermath of almost any trauma. 
There are other major problems with the idea of trauma causing
some long-term psychological problem. First, is the fallacy of the
single cause, i.e. the tendency to overlook that the victim may have
lacked the adaptive coping skills that were needed to handle the crisis,
i.e. the individual may have had a predisposing vulnerability to some
traumatic situation. Second, the identified traumatic event may have
been merely a part of a complex "sick" environment, as when
childhood sexual abuse occurs in a generally unhealthy family
environment which had failed to provide the child with the confidence
and skills to recognize, confront or avoid the abusive situation or to
deal with it after the abuse was ongoing. Gold (2000) elaborates on
this perspective. This idea is not "blaming the victim" in any way; it is
clarifying the complexity of most situations. Third, as will be discussed
at length in the next section, there are mental, emotional,
physiological, conditioning and other processes at work in the
intervening time between the trauma and the emotional consequences
weeks, months, or years later. It would be foolish to neglect these
psychological or physiological processes; they are crucial in the causal
explanatory chain and in therapy. Labeling one specific trauma as
"the" cause of a disorder is likely to be sloppy thinking that leads to
over-simplification and the perpetuation of ignorance. 
Many types of traumas may have major effects on your
psychosocial development (see Table 9.2). Examples: if a child is
neglected or mistreated, the child's need for a safe, nurturing human
attachment is denied, and distrust or withdrawal or irritability may
result. If the neglect or abuse interacts in certain ways with the child's
personality or temperament, a variety of intense emotions may result
at the time of abuse and years or decades later-fears, panic, anger,
shame, guilt, depression, submissive dependency, etc. In turn, such
feelings may have impact on many aspects of life, especially
relationships, both connected and seemingly unconnected with the
trauma. Let's look at some of the other consequences of trauma. 
If the trauma involves actions by others (or external events) or if
one's own actions result in fears, rage, shame or other painful
memories, the way some people cope is to unconsciously push the
unpleasant thoughts and feelings "out of mind." This denial or
23
forgetting is now called dissociation (Freud called it repression). In
addition, memories very often become distorted over time; a house we
remember as big seems small to us as adults; bad memories may
become more pleasant; and good or normal events can be "awfulized."
Intensely unpleasant repressed emotions or memories, called
"flashbacks," sometimes keep erupting uncontrollably, set off by
"triggers." 
Nightmares often occur after a trauma; pessimism may develop;
victims may expect the trauma or some other disaster to happen
again, including their own death. Of course, most children will avoid
any reminders of the trauma. Many times the child appears
emotionally numb, as though he/she has no feelings. Sometimes,
though, children have a need to re-enact the trauma situation over
and over in play. They may try to get the story to end differently. 
The self seems, on rare occasions, to try to reduce the internal
stress and/or shame arising from certain trauma by doing some self-
destructive things, such as self-blaming, even self-injuring, feeling
helpless or depressed, using alcohol or drugs, etc. Finally, the effects
of trauma can have huge, sometimes strange, impact on our
interpersonal relationships, including unconsciously repeating an
aspect of the trauma over and over in other relationships (e.g. being
abandoned), bonding with an abuser, or becoming over-dependent,
withdrawn, distrustful, vulnerable, controlling, or hostile. Allen (1995)
provides a good insight-oriented summary of these possible
consequences of trauma. 
The two most common diagnoses associated with serious traumas
are Post-traumatic Stress Disorders (PTSD) and Dissociative Identity
Disorders (DID). PTSD has serious impact on your life, usually in three
major symptom areas: hyperexcitability (anxiety and over-responding
to stimuli), reexperiencing (flashbacks and nightmares), and social
withdrawal or emotional remoteness (numbing). Thus, it has
similarities with the "shell shock" of W.W.I and the "combat fatigue" of
W.W.II. About 30% of Vietnam veterans have suffered PTSD at some
time after the war. About 45% of rape victims still have PTSD
symptoms after three months and are in danger of the symptoms
becoming chronic. PTSD often combines with other psychiatric
disorders that frequently follow overwhelming trauma, such as anxiety
and panic, depression, addictions, psychosomatic and personality or
adjustment problems (Allen, 1995). It is important to note, however,
that PTSD, DID, and other lasting emotional reactions are not
inevitable following horrendous trauma. Some very strong, healthy,
resilient people were terribly abused as children. We know very little,
thus far, about why some survive, even thrive, and why some continue
to suffer. 
The DID reaction is characterized by detaching (forgetting) a part
of one's experience, usually a very stressful series of events, from the
center of one's awareness. Often the traumatic childhood experience
involves sadistic, bizarre or sexual mistreatment by a parent or
24
principal caretaker. The dissociation of the experience serves an
obvious purpose; it blocks out painful or shaming experiences,
memories, or "states of mind." If you are overwhelmed by a bad
experience, avoiding it or repressing it or detaching from it is one way
to escape. In this situation, you mentally create another reality. Early
in childhood, this avoiding or "tuning out" or "spacing out" can become
a habit, potentially a very unhealthy one. Sometimes when people
dissociate they feel like they are observing themselves from outside
their bodies or they may feel depersonalized (like a robot) or sense
others as being mechanical and/or the environment as unreal. While
these are unusual mental adjustments to intense trauma, all of us
"tune out" parts of our experience at times, e.g., we might fantasize to
escape a boring lecture. And, we all have many different states of
mind, jolly and optimistic sometimes, crabby at other times. The old
label of Multiple Personality has been discarded by therapists because
the term implies more than one or several complete and independent
personalities. It is better to think of ourselves as having only one
personality, even though our total personality may be complicated and
split into different states of mind. These different states, some called
alternate personalities or "alters," are frequently in conflict with each
other but they are still part of the person's total personality, not a
separate person. The experience of DID has been described in detail
by victims (Cohen, Giller, & Lynn, 1991). Several articles are here:
10% of all psychiatric patients have DID. Heated controversies have
centered on how often DID occurs and on the extent to which some
therapists may subtly suggest to the patient that he/she has multiple
personalities, thus, facilitating the development of another disabling
disorder. 
What are the treatments for these unhealthy reactions to trauma?
Both insight therapists and cognitive-behavioral therapists would
provide a safe, supportive treatment setting and then gently
encourage the patient to talk about their traumatic experiences, to
gradually re-experience without undue stress the life events that
previously caused them stress and lead to dissociation. Proceeding too
quickly may "re-traumatize" the patient. For the insight therapist, the
goal is to make sense of your reactions to the trauma. This means
helping the patient learn about how stress, fears and reactions to
trauma, including dissociation, are developed and how the
unwanted/unhealthy reactions can be reduced. Of course, eventually
the PTSD and DID patients must not only face the past but also learn
to cope (avoid panicking) with current life stresses. 
DID patients need to reduce their dread of their dissociated states.
By gradually exploring each dissociated part and discussing their
feelings about it, they become familiar and more comfortable with all
their "states of mind." Resolving the different views and desires among
these parts or states of mind ("alters"), a process called integration, is
an important but not easy task, usually requiring the help of a
therapist. The current approach of insight therapists is to avoid a
catharsis or abreaction (a reliving) of the traumatic experience.
25
Instead, the therapist helps the victim develop, after the fact, an
emotional toughness so he/she can tolerate ("becoming able to
stand") thinking of the awful abuses he/she has suffered.
Unfortunately, the ideal treatment by an insight therapist involves
hospitalization, then outpatient treatment for a long time, perhaps a
year or more, costing well over $10,000. So, aside from the wealthy
and the well insured, few victims can afford traditional long-term
insight therapy. There are shorter treatments, of course, and, to a
limited extent, things you can do to help yourself. 
There are therapists who tend to assume that one major trauma is
the central cause of almost all the patient's troubles. Therapy then
often involves reviewing the patient's life and exploring how the
original trauma--a death, abuse, rejection--led to his/her distressful
experiences. The trauma, even if the events are only vaguely
remember, becomes the way of explaining the client's life and, thus,
the focus of repeated analysis in prolonged therapy. Other therapists
seem to view the traumatic event as a distressing memory that needs
to be desensitized, which they set about doing in rather direct,
behavioral ways (see stopping bad memories in chapter 14). Then
they go on to helping the patient cope with his/her life problems in
whatever ways they can without repeated attention to the original
trauma. No doubt both approaches are right for some people but do
we know which people need which treatment? 
What other approaches might help? As Judith Herman (1992) has
emphasized, the first task is to stop any currently ongoing trauma, to
protect the person from self-harm, and help them maintain normal
functions, including work and social contacts. Major life changes may
be necessary to avoid some trauma, such as leaving an abusive
partner or an abusive family (see chapter 7), leaving your home and
country if you are a political refugee, etc. These kinds of major life
changes can be difficult and scary. Also, your trauma may upset
others. For instance, a husband of a woman, who has been raped, may
not be able to listen to her terrifying experience for long without
becoming enraged himself, no longer listening to her feelings and
needs. She may experience his reaction as rejection and that could
make her emotional state worse. But talking to an understanding,
empathic person is usually beneficial (avoid people who continue to
dramatically emphasize endlessly the horrible enraging aspects of your
experience, thus strengthening your traumatic reactions). The helper
may be a therapist, a devoted accepting friend, or someone who has
recovered from a similar experience. Talking helps you get rid of
bottled-up feelings (yet, remember, one should probably avoid an
intense emotional discharge of feelings; it isn't necessary--a very
gradual process of disclosing your feelings over a period of weeks or
months is thought to be better). The idea may not be so much to drain
out all the negative feelings, as described in Method #10 in chapter
12, but rather to gain control over the feelings. Talking and expressing
your feelings also gives you an opportunity to "make sense of" the
trauma or, at least, to feel heard and accepted. You are making the
painful memories safe to think about (you will recognize this as a
desensitization process-see chapter 12). When you can tolerate most
26
of the bad experiences in your past, i.e. when you can accept yourself
and all that has happened to you, you will probably no longer have
PTSD or DID. 
The last 25 years have seen heated controversies among
professionals over "repressed memories," often involving beliefs that
child sexual abuse caused adult problems, and "false memories,"
usually about sexual abuse memories prompted by probing, suggestive
questions by therapists. Other related arguments were about the use
of probing therapies and hypnosis to uncover the truth about childhood
causes of adult problems. A short history of these hot topics can be
found in Frederick C. Crews lengthy review of two books, one on each
side: Remembering Trauma by Richard McNally and Memory, Trauma
Treatment, and the Law by Brown, Schaflin, & Hammond (see
The Cognitive-Behavioral therapies involve using learning-based
techniques to actively change emotions and behaviors, without lengthy
exploration of the patient's history, trauma, or understanding. Using
these approaches, Marcia Linehan (1993) has researched and
developed an extensive individual therapy/psychoeducational
treatment program for Borderline Personality Disorders, which often
have a history of trauma, dissociation, and intense, poorly controlled
emotions. Many of her treatment methods are self-help methods: role
playing for learning new social skills, teaching problem solving skills,
all found in different parts of this book. Other self-help methods may
also be helpful: understanding reinforcement (especially negative
accepting bad experiences, positive attitudes, and many insight
techniques, including writing a history of your life or "the story" of
your disorder repeatedly. Of course, other kinds of therapy may help
too: Group therapy or online discussion groups, Family Therapy,
medication, and some of the newer techniques, such as TIR
(http://www.healing-arts.org/tir/), for dealing with stress and trauma. 
Since one of the central features of a trauma experience is feeling
helpless, learning ways to increase your self-control--your mastery of
the situation--is an antidote to helplessness and hopelessness. In
addition to the self-mastery techniques mentioned above, this sense of
"I can handle it" can partly be achieved by simply involving your self in
more fun or constructive activities. Getting deeply absorbed in
challenging but doable work, recreation, or something intellectual is
satisfying-a process called "flow." Flow is when you are performing at
your best and loving it (Csikszentmihalyi, 1991). Learning that you can
overcome barriers and problems in your life is a powerful step; this
feeling of "self-efficacy" can replace discouragement and shame with
pride and hope. However, strong emotional reactions often involve
complications, e.g. some people who have been traumatized find
therapy to be very difficult, even highly traumatic. Partly this is
27
because insight therapies ask you to think and talk about upsetting
experiences and Cognitive-Behavioral therapies often involve
confronting or re-exposing yourself to disturbing situations. Many
traumatized persons remain fragile for years and easily triggered into
an unpleasant emotional state over which they have little control.
Thus, therapists are cautious and self-helpers must be too. 
It is even possible that being capable and successful, being found
attractive, having intense pleasure and a lot of fun, or almost any
experience, even relaxation, can become a "trigger" which arouses
anxiety, guilt, depression, self-criticism, or other negative feeling. In
such cases, fun activities and achievements may need to be increased
gradually. Improving other ordinary activities, such as sleep, exercise,
improving eating habits, working more effectively, etc., etc. will also
improve self-esteem and mood. Allen (1995) cautiously suggests that
even self-hypnosis and biofeedback can increase one's feeling of
being in self-control. Serious as reactions to trauma are, they are not
impossible to handle. However, professionals disagree on several
points, especially the degree helpers should probe to uncover
repressed memories and the importance of the victim forgiving the
abuser (see chapter 7). These are difficult decisions. Also, depending
on your symptoms and situation, it may be important to cope with
general anxiety and stress (see the rest of this chapter), shame
(chapter 6), anger (chapter 7), addictions (chapter 4), and other
problems common after a trauma. 
The better general Web sites for understanding and coping with
trauma include Trauma Central
(http://home.earthlink.net/~hopefull/home.html), Enpsychlopedia
(http://enpsychlopedia.com) and search for Traumatic Stress, David
Baldwin's Trauma Information Pages (http://www.trauma-pages.com/
and http://www.trauma-pages.com/disaster.php), National Center for
PTSD (http://www.ncptsd.org/), APA Managing Traumatic Stress
(http://www.apa.org/practice/traumaticstress.html), Dissociative
DID and “alters” (http://www.psycom.net/mchugh.html), Gentle
Touch Web (http://www.gentletouchsweb.com/) (includes messages,
stories, links for all kinds of survivors), Traumatic Stress Studies
(http://www.istss.org/), Mental Health Matters-DID
(http://www.mental-health-matters.com/), MHN-Trauma
(http://mentalhelp.net/poc/center_index.php/id/109), PTSD Resource
Center (http://www.ncptsd.va.gov/), The Re-Experiencing Experience
(http://twhj.com/), and MHN-DID
growing number of specialized Web sites, such as Inpsyte Trauma
Psychology (http://www.inpsyte.ca/) (about childhood sexual abuse)
and Bully Online (http://www.bullyonline.org/stress/ptsd.htm). Other
very large Websites are available, such as Hope E. Morrow
(http://home.earthlink.net/~hopefull/), and Gift from Within
(http://www.giftfromwithin.org/), that cite national organizations and
have good articles on several kinds of trauma: 9/11/01, homicides,
28
crime, military service, auto accidents and others. Support groups are
available at Abuse-Free Mail Lists (http://blainn.cc/abuse-free/). 
Naturally, since we are dealing with serious disorders, often with
unclear origins, most of the many books in this area are written for
therapists doing treatment. However, I've already cited a couple of
good, easily understood books in this area, Allen (1996) and Herman
(1992, 1997). Other clearly self-help oriented books for trauma
survivors are available--Rosenbloom, Williams & Watkins (1999),
Schiraldi (1999), and Matsakis (1996). Again, many books are
specialized (and may, therefore, be more triggering): Terr (1992),
Chase (1990), Freyd (1998) and Cameron (1996) describe the horrors
of some children's abuse, followed by amnesia or Multiple Personality
Disorder. Regina (1999) focuses on serious medical problems.
Alderman & Marshal (1998) and Olson (1997) describe ways of coping
with multiple personalities. Colodzin (1997) gives practical advice to
war veterans and Matsakis (1996) offers specific help to veterans'
wives. Davis (1991) also offers general help and advice to spouses of
trauma victims. Flannery (no date) addresses PTSD victims and their
families. Alexander (1999) and Gordon, Farberow & Maida (1999)
provide counselors, parents, teachers and others with advice about
identifying and helping traumatized children. Excellent research-based
comprehensive reviews of traumatic stress following disasters or abuse
are given in recent books: Van Der Kolk, McFarlane & Weisaeth
(1999), Gist & Lubin (1999), Levine (1997), Saigh & Bremner (1999),
and Figley (1998). There is a wealth of information in this area. 
Please see chapter 7 in this book for domestic violence, physical
child abuse, and rape. See chapter 9 for child sexual abuse and incest.
See chapter 10 for date rape. 
Remember, victims of serious trauma often make desperate,
sometimes self-defeating, efforts to cope with the intolerable stress.
These efforts, including repression, self-blame, self-injury, traumatic
bonding, addictions, somatization (conversion of stress into physical
symptoms), dissociation, multiple personalities, and other defenses,
are unconscious and, unfortunately, they can create almost as many
problems as they solve. These paradoxical emotional reactions by
clients, such as the "damaged goods" reactions of some incest and
rape/abuse victims, may arouse troubling and confusing responses in
their therapists and their families. Coffey (1998) has a book that might
be read by traumatized clients, their friends and family, and the
therapist; it presents diverse professional opinions and advice about
the distressing memories. Extensive therapy, family support, and well
directed self-help will all probably be needed. 
The psychodynamics of trauma reactions 
There is a strong natural tendency to think of the actual traumatic
experience as being "the" cause of the subsequent psychological
distress and disorders that may last for years. Examples: A highly
abusive parent is assumed to "cause" the child's high anxiety, bad
29
dreams, social withdrawal and, even as an adult, an inability to get
and hold a job. Combat experiences in which buddies are blown up
seem to "cause" nightmares, flashbacks, and a variety of long-term
health problems requiring repeated VA hospitalizations. Sexual abuse,
with threats of death if the "secrets" were told, from 8 to 12 certainly
might "cause" social anxiety, an avoidance of men, and a very
negative self-concept resulting in suicidal depression and self-injury in
middle age. The original trauma in these cases is assumed all too often
to provide a full explanation of all that happens, almost like magic
stretching over months or years. There must be processes that
mediate between the traumatic events and the long-range
psychological consequences. The better we understand the precise
processes, the better we can cope with prolonged trauma reactions.
This section discusses the internal dynamics--the mental processes
making adjustment better or worse, the emotional/physiological
reactions, the development or lack of coping skills--that play an
important role in the way we handle traumas over time. 
Research by Goenjian (2000) shows that very serious, life
threatening events are more likely than lesser events to produce long-
lasting traumatic reactions (time doesn't abate some intense post-
traumatic stress symptoms but depression tends to fade). Yet, most
victims, perhaps 70% to 95% or more, recover from trauma in time
without any treatment. We don't yet know exactly how they recover,
they seem able to "put it behind them." But because people have this
resilience, many crisis workers believe that psychological
interventions--debriefing, telling what happened, counseling--do not
do much good for most people in a crisis. Often trauma victims are too
concerned with finding their family, surviving, grieving deaths, getting
away from their abuser, etc. to be involved in therapy and telling a
stranger their experiences. Yet, the people who will continue to have
psychological reactions for months or years can be helped by a
therapist helping them repeatedly confront the distressing memories,
according to Richard Bryant at the University of New South Wales. He
has found that two warning signs indicate a high possibility of PTSD
later: (1) high physiological arousal, such as a heart rate over
90/minute, and (2) psychological reactions of high agitation and re-
experiencing the trauma. Only 1 in 4 victims show these warning signs
and if they are given brief (re-exposure) therapy, 85% or so of the
high-risk group will never have PTSD. So, for that 25%, therapy is
very beneficial. However, debriefing of everyone exposed to certain
disasters may be unnecessary. 
Keep in mind, over half of us by the time we are 20 have suffered
at least some trauma. Researchers estimate that at least 60% of men
and 50% of women experience a serious trauma, yet only between 5%
and 10% of us have diagnosable PTSD or DID or other disorders
years later as a result of a specific trauma. While we largely recover,
there are so many traumas in life that lots people are carrying scars
from old traumas and, at the same time, still hurting somewhat from
more recent distresses. Repeated trauma may toughen some but old
hurts sensitize many others. That is the human condition. Only a few
of us continue to suffer greatly from the same traumas others recover
30
from. Such trauma might be children observing domestic violence, a
couple going through a bitter divorce, a person nearing retirement but
losing his/her job, etc. Not that these aren't bad experiences, but the
point is that most people are not crushed by similar experiences; some
even become stronger ("what doesn't kill me, makes me stronger").
Thus, the important question is: What makes some of us prone to
serious disruption by trauma while others have the means to handle
it? (While we are considering cognitive factors, we should keep in mind
that some intense fear responses seem to be permanent while others
fade--see conditioning in the next section.) 
Peterson and Moon (1999) agree that a catastrophe, such as
combat, auto accident, cancer, rape, divorce, death of a loved one,
etc., and a mental state, including various ways of coping or
catastrophizing, combine to produce an individual's unique emotional
reaction to a crisis. It should be helpful to distinguish (a) the inevitable
stress and disappointment accompanying a traumatic event from (b)
the victim's unhealthy cognitive or physiological reactions which
exacerbate the emotional stress reactions. It seems likely that the
bigger and more threatening you perceive the catastrophe to be and
the less control you feel you have over its consequences, the more
upsetting the situation is likely to seem to you. These are similar to
the psychological/cognitive conditions that give rise to depression,
pessimism, low self-esteem, anger, and other emotions (see later
chapters). 
Peterson and Moon give some advice about avoiding or coping with
catastrophes: (1) guard against unjustified optimism--instead of
thinking "Oh, I'll be safe," we can, for example, prevent or reduce auto
accidents by recognizing and acting to avoid the true risks of drinking,
speeding, tailgating, road rage, sleepiness, cell phones, neglecting
seat belts, children fighting, and believing you are a super driver at
high speeds. (2) One can shift one's thinking from pessimism to
realistic optimism (see learned optimism). There are self-
administered programs (Fresco, Craighead, Sampson & Koons, 1997)
for thinking in less catastrophic ways which might also result in
reduced trauma reactions. (3) As discussed above, after a catastrophe,
debriefing can reduce the chances of PTSD developing in the most
vulnerable 25%. Support groups usually help. Also, specific cognitive-
behavioral programs have been written, e.g. for rape survivors (Foa,
Hearst-Ikeda & Perry, 1995), to reduce the long-term emotional
trauma. (4) Finally, chronic anxiety, such as in stress or panic
reactions or PTSD, and overly helpless, depressive, or pessimistic
thoughts can be treated with Insight therapy, Cognitive or Rational-
Emotive therapy, and perhaps Exposure therapy. Other therapy
techniques, such as positive reappraisal, distancing, and some of the
techniques used with chronic pain, seem to also be effective. So, our
response directly to trauma can be reduced. And, we can also have
some control over the intensity of our long-term unwanted reactions to
trauma. 
31
To illustrate the dynamic influence of our thought processes
consider the evidence that some children may have, in effect,
"traumatized themselves" by misunderstanding even positive
comments made to them at an early age. Likewise, two soldiers can
crawl over the same horribly mutilated dead bodies of their buddies
and one goes right on fighting effectively but the other is incapacitated
with fear and confusion. We must learn the answers as to why this
happens in both cases in order to help others and ourselves cope with
trauma. What mental processes and traits reduce or intensify our
catastrophizing? 
After a harrowing experience with profound traumatic shock,
distress, and disintegration, how do people pull themselves back
together? Janoff-Bulman (1999) says that our basic beliefs are
shattered and have to be rebuilt. What are these fundamental
assumptions? (1) That our part of the world is a good place. (2) That
our world is just; that good things happen to good people and bad to
bad; that we usually deserve what happens to us; that life events are
within our control. (3) That we are always good, decent, and capable
(we over-estimate our strengths and overlook our weaknesses; we
claim responsibility for positive outcomes.) Because of these beliefs--
really often deceptive illusions--we feel safe and complacent (these
beliefs help us cope with depression and self-doubts). When a
catastrophe strikes, however, these cherished beliefs are recognized
as false...lies and self-deceptions. Thus, crisis workers, who
themselves may suffer Secondary Traumatic Stress
(http://www.isu.edu/~bhstamm/TS.htm), hear repeatedly "I never
thought this could happen to me!" As Ernest Becker has said "seeing
the world as it really is is devastating and terrifying..." for both the
victim and the rescuer. 
Recovery from trauma is a complex process. We try to forget; we
withdraw from others; we become emotionally numb and, as much as
possible, cognitively push the experience out of awareness. But, bad
dreams, nightmares, anxiety, and spontaneous reliving ("flashbacks")
of the experience break through our defenses. We feel a great need to
understand what happened and why. We compare our experience with
others--often we decide "It could have been worse." We so want to get
back to our old comfortable beliefs that often we start to wonder if we
may have been partly responsible for the distressing event. Janoff-
Bulman explains some victims' tendency to self-blame as a rather
desperate step towards recovery. How does this happen? By feeling
partly responsible for what happened, it restores to the victim some
sense of control over the world (Note: this is not the only possible
cause of self-blame). Also, this sense of personal control ("maybe I
could have done something"), even if totally inaccurate, reduces the
sense of uncontrollability of the world. Some self-blamers blame their
badness (which can become quite destructive psychologically); other
self-blamers blame their actions; both gain a little sense of control.
Trauma survivors review the events over and over; gradually many
may tend to see some benefits or some meaning coming from the
experience (Tedeschi & Calhoun, 1998). Sometimes, the victim
believes he/she suffered for a purpose or the crisis gave them a
32
purpose in life and made them stronger. Successful survivors
eventually get back their basic beliefs somewhat like their original
ones, only not as positive and confident. They are generally positive
but admit that bad things can and do happen. Some develop a better
appreciation of life--they see that life's pain and sadness in the valleys
accentuate the glorious joy at the mountain tops. Others remain
negative, pessimistic, and bitter, ruminating over and over about how
terrible things have been and will be. 
Supplementing the comforting beliefs are excuses, those little
cognitive dynamics used by most of us to help us feel better about
ourselves (Snyder, 1983, 1999). But some individuals handle their
view of reality and their negative self-concepts very differently. Some
depressed or self-critical people actually think in ways that increase
their "blame" for mistakes, perhaps exaggerating the stupidity of their
actions, while attributing their successes to others. Presumably, in this
case, increasing blame validates and supports the person's negative
beliefs about themselves and, thus, is paradoxically satisfying. A
negative person, expecting to screw up, may also take some strange
satisfaction in his/her manipulation of reality when an OK behavior is
perceived as a foolish mistake and support for his/her negative self-
appraisal. A very different kind of person may get a pay off from
distorting reality in such as way to enhance one's belief in self-esteem
and self-control or to increase hope. These internal mental processes
are mostly automatic or unconscious, not intentional coping.
Personality-oriented theorists/researchers describe these kinds of
internal manipulations of the perception of reality designed to
strengthen or alter positive or negative self-concepts. The process is
called "Reality Negotiation." 
Another view of the world that I favor is determinism. This is, as
much as possible, an accurate objective view of causes, not a
distortion of reality. A determinist gives up trying to assign blame or
credit... and gives up looking for great mystical purposes or meaning
in the trauma. There probably isn't a special reason or a message from
God behind every occurrence (see Kushner, 1981). The causes of
many events are so complex and remote (far away) that the event
couldn't have been anticipated or prevented. Many things happen
without anyone being able to figure out exactly why they happened
(examples given above: the self-criticism of some 3 or 4-year-olds or
the permanent fear/panic reactions following the inability to breathe).
In determinism one simply assumes that everything could be seen as
the natural unfolding of the laws of nature or behavior, if we were
smart enough to know the causes and effects of all events leading to
the trauma. Frequently, such a deterministic view radically alters our
conception of why something, especially something terrible, has
happened. It encourages us to realistically assess the actual causes of
an event and the background sources of those causes. Thinking of all
things as being lawful, including how to change and cope, may also
help us find solutions to our problems and/or ways to accept what has
happened. It was lawful, no matter how awful it felt. 
33
Given the right circumstances, there is little doubt that reviewing
and thinking through traumatic events that have happened to us can
be very therapeutic. What are the favorable conditions? With an
empathic therapist or friend who encourages gradual disclosure and
understanding of the events and feelings, as might be done by an
insight therapist or a therapist using TIR (http://www.healing-
arts.org/tir/). (Try to avoid talking to people who fuel the fires of
hatred and self-blame.) There are also many reports and studies
documenting the healing that frequently comes through writing (in
detail or over and over) about stressful, traumatic experiences--see
When traumatized, we are, of course, highly emotional. The task
isn't to stop emoting; we need our emotions. We need to be able to
handle our emotions--to be aware of them, to control certain excessive
emotions that make us irrational and to increase other emotions that
motivate us to act wisely, and to understand and use our feelings
effectively. For instance, learned optimism helps us overcome
helplessness and to see solutions. Optimism may also help us accept
some setbacks, failures, and faults, especially if we can make up for
want we have done. As in depression, the pessimist can learn to
identify his/her negative thoughts and challenge them. Also, life skills,
like problem-solving and self-change, can be acquired. Hope and
confidence go up when you get things done, make good decisions, and
communicate well (all learnable skills!). Wise persons have observed
that crises, even awful ones, often offer opportunities and benefits (in
the middle of a really bad situation, you are likely to resent being told
this, but in time you might see some truth to it). If you can come to
see some possible "silver lining," it will help. 
Trauma reactions are exhausting, causing us to lose our self-
control much like in learned helplessness. We need to regain some
control. It is usually important to talk to trusted, empathic, non-
directive friends, often telling our story over and over again. Maybe
see a counselor. A change of environment, sleep, having a good time
with friends, and just rest are often helpful. Many things can reduce
the effects of trauma. There are many books and Web sites to read.
There are many sources of help and many things to learn. We need a
concrete, doable plan to cope and improve our lives. An assorted list of
Safe Horizon (http://www.safehorizon.org/index.php) services
provide help to persons who have been assaulted, stalked, abused,
beaten up, robbed, and so on. 
Becoming Absorbed with One’s Wounds
Some people can't remember the original trauma that started their
psychological crises; other people can't forget the major trauma in
their life. This section is about the people whose bad memories or
thoughts are the dominant theme of their minds. In some instances,
34
bad memories seem to feed on themselves...our remembering old
hurts/fears arouses emotions which call up more bad memories in an
unending circle. It is an unhappy condition to be in. Most people would
say, if your thoughts center on old wounds that make you unhappy,
scared, angry, or physically sick, then you need to find a way to
change those thoughts or reduce those memories. 
Warning: The following paragraphs contain ideas that may seem
critical and blaming or, at least, unsympathetic to a long-suffering
person with deep wounds. If you are such a person, you may not want
to read this section now. However, if you feel ready to read it, keep in
mind that the author cited below is describing an unconscious process,
not an intentional manipulation of others. 
There is an old concept in psychiatry that certain symptoms may
yield some "secondary gain"--some more or less unconscious payoff--
for the patient. But, how could having depressing, upsetting thoughts
or seeing oneself as weak, sick, abused, or dependent yield some
psychological gain to the distressed person? Possible answers are
offered by writers in a currently popular area of study called
woundology--the study of emotional wounds. Wounds are frequently
an aspect of Post-Traumatic Stress Disorders, depression, dependency,
long-term anger, forms of anxiety, and many other conditions. 
A recent writer, Caroline Myss (1997), who gives herself the
revealing label of "energy medicine intuitive," has described at length
how some suffering people can become almost completely immersed
in the trauma and define themselves in terms of their wounds. When
this happens to us, she says it is very difficult to heal ourselves and
escape our own personal hole of misery. Myss offers many workshops
to persons with long-term disorders. In this setting, she has been
taken aback by the degree to which the many people seem to define
themselves--their whole being--in terms of the assumed source of
their troubles. Examples of the self-descriptions: "I am an incest
victim," "I am a cancer victim," "I am an alcoholic," "I am a
Borderline," and so on. Their minds seem to be filled with ruminations
about their stressful history, their resulting current symptoms, and
their interpersonal contacts (mostly therapists, caretakers, support
groups, and sympathetic friends with similar pasts or problems). See
the discussion of Woundology in the next section. 
When Myss has tried to suggest to these people that they may be
unduly preoccupied with their trauma and in this way avoiding or
resisting mending their problems by changing or getting out of their
current situations, they would usually get pissed-off at her. They felt
offended...that she unfairly blamed them for their own problems. That
reaction is certainly understandable. They are deeply hurt and trying
to get better. But what if Dr. Myss's theory is sometimes true? Some
suffering people see themselves as innocent victims having nothing to
do with causing the upsetting situation. (Of course, some others
assume too much blame and guilt, rather than too little. See Guilt and
35
Yet, as Myss explains, if a person has had terrible experiences,
suffers deeply troubling, intrusive memories, and is burdened with the
symptoms of some psychiatric disorder, these consequences can
become powerfully effective forces for influencing--even manipulating-
-others. Example: if your history and psychological troubles get the
attention of others and lead to positive relationships with caring
helpers, new friendships, nurturing support groups, then your
"symptoms" are yielding important, valued payoffs. Understandably,
under these conditions, one might unconsciously resist changing one's
situation, including getting better. Getting better often involves
becoming self-reliant, leaving support groups, stopping therapy,
changing friends, and moving on. Big, sometimes scary changes are
required. No wonder we sometimes cling to the familiar, even if it
involves being emotional and having unpleasant memories. This
clinging to what we know is not something to be ashamed of; it is
done unconsciously and it is very understandable. 
When we get pre-occupied with our histories of wounds and bad
times...and obsessed with the troubles we are suffering now, our
energy is sapped--we have little time or motivation to learn new
coping skills for changing our thoughts, emotions, behaviors. Just
sharing our troubles and history with someone, especially someone
who listens empathetically is a wonderfully gratifying experience. Many
psychotherapy patients know the discomfort and sense of loss when
they leave a therapist or a treatment group that has seen us through
hard times. Yet, just sharing our history is often not enough to heal
us. Often we have to become mindful of alternative ways of being. We
have to make hard choices. We need to learn new ways to change
ourselves and our situation. We have to see the advantages of
changing, even if we have to give up some behaviors and symptoms
that have "served us well." Our energy needs to be used in different
ways. 
Besides possible secondary gain, some bad memories help us
make sense of what has happened to us. Oh, I'm feeling and acting
this way because of these awful things that happened to me.
Understanding why bad things have happened to us is important. If
our explanations "ring true" and aren't challenged by others, then they
serve our need to understand and we tend to keep them and repeat
the how-I-got-upset theme over and over, often in the form of bad,
disturbing memories. Of course, if our explanations are uncomplicated
and tend to place the blame on someone else (or the responsibility on
some external event), then our conscience might especially like them.
Some examples: "I distrust women because I have been badly hurt
and dumped three times." This man's attitude toward women appears
to be entirely blamed on his three former lovers, as though he had
nothing to do with the breakups. Likewise, many of our explanations of
our problems are overly simple and absolve us of responsibility--"I'm
an insecure person because my dad died when I was in the third grade
and mom married a self-centered creep" or "I'm totally messed up
because my brother abused me from the time I was 6 or 7 to when I
was in high school." The causes of our troubles are almost always
more complex than implied by these quotes. 
36
Note: In no way should you think that repeated bad memories or
thoughts are entirely the result of secondary gain. One doesn't
ordinarily have disturbing thoughts, high stress, bad dreams, and
other symptoms just to get attention and support. Life is much more
complicated than that. Nevertheless, it would be foolish to believe that
there are never any payoffs derived from others discovering that
someone's life has been difficult and traumatic. 
As we become more aware of the possible pay offs for having our
bad memories and for believing our own explanations so firmly, we
may become able to consider more complex and realistic explanations
and to appreciate the intricate development of our problems over time.
With a more open-minded approach, you may find new factors that
could contribute to your understanding. As an illustration, see
Becoming Open-minded in chapter 15 and read about the fallacy of
the single cause in chapter 14. Reality is complex. If you believe
someone else is entirely responsible for your problems, you may not
want to think differently but a better understanding of determinism
and forgiveness might add to your perspective. 
This increase in awareness, however, may become personally
threatening. You might want to avoid thinking so much about the
causes. You may feel very mixed about the idea of your personal traits
and needs contributing to the bad situation. It is tempting to give up
trying to understand but you may suspect it is important to realistically
understand the traumatic situation and your reaction to it. Hope and
optimism are important parts of changing your thinking and yourself.
It isn't just the occurrence of bad happenings that obsess us, it can
also be the loss of highly desired situations. Examples: "I hate getting
old and wrinkled," "I'm very unhappy being single and alone," "I hate
becoming so fat," etc. The Rational-Emotive approach can help you
identify your "awfulizing" or unreasonable expectations that are
making you frustrated and unhappy. 
Myss (1997), who is not a psychologist, suggests there are five
major false beliefs, misconceptions, or myths that cause people to be
unable or unmotivated to heal their wounds: 
First myth: My life has to be organized around my wound
experiences. Consequences--My bad experiences have completely
changed my life. My wounds define my life. Every one of my life
problems is interpreted and explained in light of my wounds.
Therefore, I need to be with people who understand me and my bad
experiences. As a result, most of my human contacts are with people
who are especially understanding of my wounds. 
Since dwelling on the history of wounds can be disabling and
seriously hamper one's hopes of recovery, one should ask him/herself:
Does this first myth dominate my life? Do people show a lot more
understanding and become nicer to me when I share my problems or
37
story? Am I aware that I sometimes actually use my history of wounds
to influence someone? Could I commit myself to changing? 
Second myth: Without my wound, I'd be all alone. Consequences--
If I recovered from this trauma, I would have to be more independent,
more on my own, and less in need of help. In short, I'd be
overwhelmed and lonely. Changing is scary--adopting a different
personality, thinking about different things, finding a new group of
friends. Maybe things are pretty good the way they are, at least I'm
not isolated and helpless. Oh, besides, I'm sure my new
therapist...support group...meds...self-help book... is going to get me
through this. 
Do some reality checking by asking yourself: Are my emotional
wounds the basis for most of my relationships? Could I be depending
on other people's caring nature or even on their codependency? Why
am I so afraid of changing? Could I find greater satisfaction and
security by developing solutions to my problems and unhappiness? 
Third myth: My awful and painful life means that I am sick.
Consequences--My constant awareness of my wound is never going to
go away. I'm doomed to stay this way. This pain serves no purpose. It
is just making things miserable for me. 
Ask yourself: Am I really sick--and permanently sick? Where does
this pessimism come from? Can I see how I unconsciously used my
trauma to control people? to change a conversation? as an excuse? to
identify with others? to get sympathy? Was that "sick" or just trying to
meet my needs as best I could? Have my wounds become an
addiction? Am I afraid of becoming healthy? Could I now change and
get to a better place, like others have done? Can my pain and
unhappiness become a motivation to change and find a better life? Can
I use some self-change methods? 
Fourth myth: All emotional problems are the result of traumatic
experiences. To get better, the primary wound--what started it all--has
to be uncovered, brought into full consciousness. Some awful, horribly
damaging experience must be buried deep in my unconscious. If I
don't know the cause for certain, I can't get better. 
Ask yourself: Why must you know the one original wound? How do
you know there was one? Isn't it likely that many other life
experiences besides trauma, including your own thoughts and
emotions, have contributed to your wounds? Even if you were terribly
abused as a child, is that likely to be the only cause of some problem
as an adult, such as low self-esteem? Didn't someone else model low
self-esteem? Didn't you have skills and assets that have gone
unrecognized? Weren't there other failures and disappointments
throughout life that may have contributed to the low self-esteem? Can
you now find and use some of your good traits and values, and, in this
way, become more self-accepting? 
38
Also ask: Did some good come from your wounds and the healing
process thus far? Have you gained any deeper understanding of
yourself or of the person(s) or events that caused your wounds? Do
these deeper understandings help you think of forgiving some of the
wrongs and wrong-doers? Can you see how "putting it behind you" or
forgiving someone could help you escape constant victimhood? 
Fifth myth: At this point in life I am held prisoner by my wounds. I
can't change. My situation is hopeless. Why try if changing is
impossible? 
Ask yourself: Could it be that believing you can't change makes it
easier for you to escape the pressure to change and the hard work of
changing? If you realized that thousands of studies show that people
can change, would you be more optimistic? Would it be helpful if you
knew more about how people with problems and backgrounds like
yours have changed? Can you find ways to be more understanding,
more loving, and more positive about the future, even if it involves
scary changes? 
Summing up
Bad memories and thoughts can't be entirely erased but you can
reduce their frequency and stop them from dominating your life. Also,
if a mental image (memory of some event) has been connected with a
strong emotion--fear, sadness, anger, guilt or whatever--there are
methods of reducing the emotional reactions so that one can have the
thought without the intense emotion. These methods would include
desensitization, autobiography, and TIR (http://www.healing-
arts.org/tir/). Also, see Stopping bad memories
A variety of other specific techniques have already been
mentioned, but more importantly you should carefully consider all five
of the major aspects of any problem--the behavior involved (the
repetition of disturbing thoughts), the emotions aroused (unhappiness,
anger or rage, stress, dependency), the skills you need to learn to use
(interpersonal relations), the thoughts that are involved (pessimism,
self-esteem, irrational ideas, straight thinking), and ways to gain
insight (open-mindedness, self-analysis, autobiography). I hope you
will be motivated enough to learn a lot about yourself and about the
many methods for coping with the treacherous and catastrophic
phases of life. 
Finally, I want to be absolutely clear that support groups
and psychotherapy are wonderful sources of help. Please make full
use of them. The point of this section is that these therapies are
not permanent solutions to be used for the rest of your life. Within
a matter of several months, these sources of valuable help should
have delivered their benefits. My aim would be to help you get on
with life.
39
Theories Explaining Stress and Anxiety
Each person's stress-level is not just the result of the problems
that have accidentally occurred in their lives recently. It is more
complicated than that (please see New Research in the first section of
this chapter). For one thing we are surely, to some extent, in control
of how many and what kind of problems come along. More
importantly, as individuals we respond to a problem or stressor very
differently. Examples: being dumped crushes some of us while others
are happily dating someone else in a week or so. Being fired makes
some of us feel very incompetent while others are certain they can get
a better job. Having a handicap makes some of us think we were
meant to be inferior while others become obsessed with becoming
superior and do. Our theories must explain these enormously different
reactions to stresses. There are several relevant theories and each one
has something to teach us about self-help. We will briefly review four
explanations of fear and anxiety: constitutional, learning-behavioral,
cognitive-humanistic, and psychoanalytic. 
Constitutional factors--genes and physiology 
It is easy to overlook our biological inheritance but our genes
influence our health and our behavior from birth to death. Recent
studies of identical twins have yielded impressive results. For example,
blood pressure is estimated to be 60-65% inherited; only 35-40% is
determined by diet, exercise, learned stress responses, smoking, and
other environmental factors. There is pretty good evidence that
children of parents with serious psychiatric disorders (schizophrenia
and manic-depression) have a somewhat (not greatly) higher risk of
having the same problems. If one identical twin becomes
schizophrenic, there is a 50% chance the other twin will too. As
mentioned before, more schizophrenic children are born in late winter
and early spring. We don't know why. 
Most personality traits do not seem to be inherited, but there is
one exception--shyness (discussed at the end of the chapter). It has
also been reported that male abusers in a family in England have an
abnormal gene on the X chromosome. However, it is a very rare
abnormality; thus, not accounting for all the anger in the world. And,
some men in the family had the defective gene but were not abusive. 
In terms of other inherited traits, the activity level of 3 and 4-day-
old infants is slightly related to the anxiety level experienced by the
mother during the pregnancy. Hyperactive parents are several times
more likely to have a hyperactive child. Disorders, such as migraine
headaches and asthma, also seem to be inherited. Perhaps
physiological and chemical processes, like hypoglycemia and
proneness to alcoholism or epilepsy, are partly genetic. Identical twins
are frequently similar in terms of enuresis, menstrual complaints, and
nervous habits, like nail biting, or mannerisms, like rubbing their chin;
40
they even describe their anxiety in very similar words, even if they
have been reared completely apart. The power of the genes seems to
be amazing, but we have to guard against exaggerating the role of
genes. 
Frustrations make us upset and making difficult decisions creates
anxiety (see conflicts described above). Pavlov's (see chapter 4,
classical conditioning) dogs had a "nervous breakdown" when forced to
distinguish between a circle paired with food and an ellipse that got
closer and closer to being a circle but was not paired with food. Like
Pavlov's dogs, many judgments we have to make are hard, e.g. is my
spouse joking or serious, is my friend irritated or not? It seems to be
"dog nature" and "human nature" to be stressed when we are
confused and don't know what to do. 
Having an unusual or surprising experience also causes stress.
Donald Hebb found that chimpanzees had no fears until 4 months of
age. After that, familiar objects and unfamiliar objects (except for a
few, like snakes) caused no stress. But familiar objects shown in
unfamiliar ways caused fears, e.g. seeing a life-like model of a
person's head without the body is a scary experience for monkeys.
Most humans are also stressed by viewing a dead or mutilated body. 
Pavlov's dogs and Hebb's chimps acquired these stress or fear
responses without any prior painful learning experiences being
involved. It appears that these reactions are innate in animals.
Likewise, protective reactions are instinctive, e.g. baby rats freeze
(with terror?) when a cat appears. Over 50% of parents of water
phobic children (aged 3 to 8) claim that their child had always been
afraid of water without any traumatic initial experience. Certain
animals learn certain fears very quickly and others very slowly, e.g. a
monkey immediately learns to fear a snake by seeing another monkey
terrified by a snake but does not learn to fear a flower in the same
way. This may be true for humans too. Perhaps other fears, like
speaking in front of groups or encountering a snake, are also partly
built into many humans at birth. 
Just because you may have inherited a problem, such as being shy
or hypertensive, does not mean that you are helpless. It does mean
that, compared to others, you may require more effort--relaxation or
practice or desensitization or correcting one's thinking--to overcome
your constitutional tendency of fear, hyperactivity, speech anxiety, or
whatever. 
Since drugs (legal and illegal) influence our mood and stress
responses, it suggests that internal chemical factors, such as our
hormones, might influence our emotions too. The high percentage of
women who feel differently before their period further suggests this is
true. Indeed, it is important that every woman plot her feelings and
moods to determine if there is a cycle involved. 
41
Recent physiological research suggests that fears do not
necessarily involve the cerebral cortex; sensory nerves in animals,
involving hearing, go directly to the amygdala which triggers
adrenaline (fear reaction). This may help explain how we humans (if
we are wired the same way) can be scared without knowing why. 
Operant and cognitive theories about anxiety 
Feeling stress and anxiety may involve all three kinds of learning--
classical, operant, and observational (see chapter 4). Remember Little
Albert and classical conditioning? The loud "bang" was paired with the
rat a few times and Albert became afraid (a little) of the rat.
Obviously, this occurs; many people have been hurt in certain
situations, like auto accidents or climbing on something, and
developed a fear (many, of course, do not learn a serious fear in the
same situation). But psychologists are learning that classical
conditioning in humans is far more complex than just pairing a neutral
stimulus (S) with a situation (UCS) that automatically arouses a
reaction, like pain, fear, saliva, attraction, etc. Let's learn a little more
about that. 
Researching the development of fears is difficult because
psychologists can't experiment with people and try to produce a
phobia. It wouldn't be ethical. Instead, clients come to therapists with
full blown fears; often they are unable to tell us how their fears
developed. On the other hand, if you asked a psychologist how a fear
could be created, he/she probably would suggest pairing something
painful (shock) or scary (loud noise) with a harmless object (say a
basketball). This is a classical conditioning procedure, but it is not
likely to work. Remember: if Little Albert had been a little older,
Watson's method (classical conditioning) would not have worked. If
Watson had tried to condition fear to a white block of wood instead of
a white rat, it wouldn't have worked (see last chapter). The CS-UCS
connection (ball with shock) proposed by the psychologist is not
reasonable; it isn't believable that a basketball will shock you, so
reason can override conditioning. But, if you are told (and believed)
that the basketball is filled with a dangerous gas which might explode
if electrical shocks disturb the air within 10 feet of the ball, you would
probably respond with fear if you were shocked holding the basketball
and, later, you might fear the basketball alone. Many of our fears
seem reasonable to us, but not to others. 
A particularly fascinating study about creating fears was done 30
years ago by Campbell, Sanderson & Laverty (1964). Working in a
medical setting with medical students as subjects, they paired a simple
stimulus--a light or a tone--with a common drug (scoline, used in
surgery) that stopped muscle action for about one minute. A person's
reaction to temporary paralysis is panic, mostly sheer terror at not
being able to breathe (even though they know what will happen). Two
results were noteworthy: (1) the conditioning took only one trial, i.e.
the panic reaction occurred every time the light or tone alone came on
after that, even though there is no "rational" connection between a
42
light and being paralyzed. It was one trial learning, just like in a
serious accident. (2) The terror response never diminished. Naturally
the experimenters tried to remove the fear. But they couldn't. They
followed, according to learning theory at the time, the extinction
procedure of presenting the conditioned stimulus--light or tone--
without the unconditioned stimulus--the drug. They provided 100
extinction trials. The fear response did not diminish! The conclusion at
the time was that fears may not go away, maybe they are just
overridden with stronger relaxed responses. 
The old conception of classical conditioning was that an association
was learned when a CS and an UCS were paired together several
times. That is still the essence of classical conditioning. But, thirty
years ago we assumed the mind had nothing to do with this
conditioning process. Today, experts say the CS arouses expectancies
about the UCS (actually we develop a mental representation of the
UCS) and then, as we have experience with the UCS, we evaluate and
develop different reactions to the UCS which, of course, influences the
final conditioned response (CR). Clearly, a lot of mental events
influence the CS-UCS connection. 
According to Davey (1992), the new theories suggest a
conditioning-cognitive sequence is like this: 
1
2
3
4
5
Conditioned
Stimulus
(CS)
Outcome
Expectations
Cognitive
conception of the
Unconditioned
Stimulus (UCS)
Evaluation
of the UCS
Response
(CR)
Conditioned
Response
(CR)
Steps 2 and 4 are places where cognitive factors can affect the
conditioned response (CR). How is this done? Consider this example, if
your lights dim slightly before a very loud noise, what you think all this
means makes a great difference in how you respond. If you think the
dimming lights and noise means an earthquake is occurring or that
your house is falling on you or the electrical system may set the house
on fire, you will probably have a strong panic reaction. If, with a little
experience, you learn that your huge new sound system dims the
lights right before your favorite music blasts forth, you will soon be
having a pleasant reaction to the dimming lights. If someone had told
you to expect the lights to dim, your startle or fear response would be
slight even the first time. If you believe the dimming of the lights is
perfectly normal and poses no danger, you have a different reaction
than if you believe you have overloaded the circuit and caused a fire
hazard. Beyond all this cognitive influence on a classically conditioned
response, recent research has found that experience with the UCS (in
this case an unexpected loud sound blast) without the dimming lights
(during the daytime) can affect your conditioned reaction too. Being
told by an expert that loud sounds damage your hearing permanently
will also influence your conditioned reaction. Likewise, observing your
reactions to the CS or the UCS as well as using various coping
strategies can alter your conditioned response (CR) to the conditioned
43
stimulus (CS). So it is far from a simple mechanical reaction. That
huge brain wasn't added to your spinal cord for nothing. 
Since many experiences and thoughts will influence how we
cognitively evaluate the UCS, and, in turn, change our CR, it is
possible that Campbell, Sanderson & Laverty could have reduced the
medical students' fear response to the light by administering the
paralyzing drug (UCS) 100 times (instead of the CS--the light) so that
the subjects would become less frightened by the drug's paralyzing
effects. Perhaps, if the subjects had been told and shown that it was
impossible for the drug to be administered again, the fear response to
the light would have declined rapidly. Perhaps, if the subjects had
been told that they could overcome the fear reaction to the light and
given training for doing so (with the light being left on while they
"talked themselves down"), their response to the light would have
become less intense. Also, if the light had been presented many times
before the drug was administered, the reaction to the light may have
been easier to extinguish. Science is just beginning to learn more
about how cognitions interact with conditioning. Cognitive methods are
a new tool for expanding self-control in many areas. Some fears are
unreasonable and harmful, some are reasonable and helpful, e.g. the
anorexic's totally unreasonable fear of food making her fat and the
heart attack victim's reasonable and helpful fear of high fat food. In
time, the anorexic can change her mind about her body and the
person with a heart condition can forget to watch his diet. 
There are many other mysteries about fears. New conditioning
theories help explain these things. Question: How do some people
become phobic without ever having a painful or traumatic experience?
Many people are afraid of snakes or mice but have never been bitten.
Almost no one who is afraid of flying has been hurt in a plane crash.
Lazarus (1974) reported that only 3 percent of his phobic patients
could recall an actual event that might have caused their fear. Rimm,
et al. (1977) found 50%. Actually, persons who are physiologically
unable to feel pain still become anxious and fearful just like the rest of
us (Derlega & Janda, 1981); why is this? Answer: Davey provides this
example of a fear of public transportation developing without obvious
trauma: you see an unknown person die of a heart attack on a city
bus, so the connection is made but it has no effect on you until much
later when your father dies of a heart attack, after which you become
very afraid of riding the bus. Research also confirms that simply
thinking about all the horrible things that could happen in a scary
situation, say giving a speech, can increase your fear response.
Similarly, as we will see in a later section, you can learn fears from
models or family traits and never have any painful experience
yourself; these vicarious experiences presumably change your
"outcome expectancies." 
Question: Why do many people have a truly traumatic experience,
like a very painful dental treatment, but never get phobic about going
to the dentist? Answer: If you went to the dentist several times before
experiencing serious pain, that might prevent a CR of fear. Also, a fear
44
may not develop if you are able to deny that the UCS (the root canal)
was awful, in the same way the dying person denies he/she will die.
Various mental strategies help us neutralize a threat or UCS, e.g. we
minimize a stress ("Lots of people suffer more") and/or push it out of
our awareness ("Just forget about it, it isn't worth getting upset about,
think positively"). Giving people information about scary medical
procedures can reduce their fear or panic them. It is not possible to
cleanly separate conditioning from cognition. 
Operant conditioning and stress 
Obviously, some fears have payoffs, i.e. immediate positive
reinforcement. Fears of the dark get attention from parents at bedtime
or some one to hold our hand walking in the dark. A fear of dealing
with a banker or other authority may get someone else to intervene
for you. Fears may get sympathy. (Of course, many fears are fun, e.g.
hide-and-seek, the roller-coaster, the spook-house, the horror movie,
etc.) 
More often negative reinforcement is involved in fear development
(see chapter 4). Fears are self-developing if you run away from and/or
avoid the frightening situation. Let's take a fear of elevators as an
example. Suppose you have an important appointment on the 69th
floor. But you fear heights, especially in elevators. So, you get more
and more anxious as you approach the building. Walking towards the
elevator, you think of the height, the long fall and the terrible accident
if the elevator fell, and you imagine what it would be like if there were
a fire at the same time... Your mind goes crazy. You are so sweaty and
scared you can hardly push the "up" button. Then, before the elevator
opens, you say to yourself, "I'm not going through this kind of hell;
forget this." You may not even notice it, but as you walk away from
the elevator, you feel a great relief, enormous stress has been taken
away. This relief is negative reinforcement. Of what? Of what you were
just doing! Being terrified of elevators and running away. So, you will
be even more afraid of elevators in the future. 
The possibility that running away from a fear strengthens it has
important implications to all of us (beyond the old rule about climbing
back on a horse as soon as possible after being thrown). Every time in
a lecture you are unclear about something but decide not to ask about
it in class, are you learning to be afraid of asking questions? Every
time you want to talk to someone or go to a party but decide it would
be more comfortable not to do it, are you increasing your shyness or
your anxiety at the next party? This theory doesn't explain the origin
of an irrational fear, only the growth. Later in this chapter we will see
that it is usually important to expose your self to a fear, not avoid it.
Still, there is much more to understand about the care and keeping of
fears. 
45
Thoughts and emotions
Humans have always had to cope with fears and self-doubts.
William James, 90 years ago, emphasized the importance of the sense
of self--the "me" as I see me in terms of "Who am I?", "What do I do?"
and "What do I feel?" Likewise, more recently Carl Rogers, Abraham
Maslow and other humanists have attributed a central role to the
self-concept, which is another aspect of the cognitive dimension. We
want to feel good about ourselves which usually involves being
accepted by others. We strive to express our true selves--to actualize
our best selves. According to self theory, stress in part comes from
conflicts (1) between our actual self and our ideal self, (2) between
conscious and unconscious perceptions or needs, and (3) between our
view of reality and incoming evidence about reality. Epstein (1982)
adds two more stress-producing conflicts: (4) between differing beliefs
or values we hold and (5) between our belief of what is and what
should be. So, values and doing or being right affect our stress level. 
We all strive to make sense of our existence. Since we can
influence our future, we feel some responsibility for our lives.
According to the Existentialist anxiety comes from the threat of
nonbeing--death and from the dread of having to change (thus, a part
of you dies) to become something different. Fears are attacks from the
outside, whereas anxiety reflects an internal threat to our very
essence as a person. Anything that questions our values, anything that
alienates us from others or from nature, and anything that challenges
our ideas about the meaning of life causes anxiety. According to this
theory, anxiety is not learned, we are born with it, it is the nature of
humans. Serious anxiety reduces our ability to guide our lives and we
end up feeling life is meaningless; that is called existential anxiety
For decades, the Adlerians have contended that over-demanding
parents produce anxious, insecure children, perhaps because the
children never succeed in becoming what they "should be" in the eyes
of the parent. Many years ago, a study showed that the closer a boy's
self-concept was to his mother's ideal, the less anxious he was
(Stewart, 1958). Very recently, addiction counselors have
contended that addictions of all kinds are a way of diverting our
attention away from a deeper concern, usually self-doubts and low
self-esteem. If a person sees him/herself as defective, insecure,
"nervous" or fragile, it seems likely that they are going to experience
more stress and respond less effectively than a secure person. See
chapter 14 for ways to change your self-concept and expectations of
yourself. 
Eighty years ago, Morton Prince suggested that a phobic person
was afraid of having a panic reaction, rather than being fearful of the
situation, such as heights, trains, or open spaces. In short, our
expectations produced our fears. 
46
Our greatest fear is fear itself.
-Franklin D. Roosevelt
Fear brings more pain than the pain it fears.
Several more recent theorists (Bandura, 1977; Ellis and Harper,
1975) believe we can think or imagine ourselves into almost any
emotional state. They say our thinking--our cognition--produces our
feelings, not classical conditioning. The focus in this section will be on
our inner experience--our thoughts--interacting with the external
world to generate anxiety or calm. 
Past experience determines our view and evaluation of events,
others, and our selves, including our beliefs about our ability to handle
certain situations. Our beliefs and interpretations of the frightening
situation determine our actions and feelings to it. But the process is
complex. For instance, cognitive or social learning theorists believe
there are several steps involved: first we must perceive the situation
including our gut responses (our perception may be realistic or
distorted), second we evaluate the situation (as important or minor;
awful or good), third we assess our ability to handle the situation, and
finally we decide what to do and respond with feelings and actions.
Let's study this process in more detail to see how it results in fear. 
The cognitive theory is clearly a very different notion from stress
based on an inborn impulse, an innate need, an automatic reaction, or
conditioning (like Little Albert). This theory is also different from
Freud's unconscious processes, although some of the cognitive
processes may be semiconscious. Cognitive theory returns the mind to
a central role in psychology; it contends that our conscious cognitions
(thinking) largely determine what we do and feel. Our minds work in
wondrous ways and may be rational (accurate) or irrational (wrong),
as we will now see from many examples. 
How thinking can produce stress and fears in several ways
Within current psychology theory, cognitive explanations of stress
are fairly new, at most 20 to 25 years old. So, the theories are not
well integrated and organized, as yet. I will start with a brief, crude
overview of how we think our way into being upset (when there is little
rational reason for the fear). Then I will give you some more detailed
explanations and examples of specific kinds of thinking that produces
or reduces stress. Finally, near the end of the chapter we will
summarize the methods used to correct the thinking that causes
irrational distress. 
This is an overview. More-intense-than-necessary fears, worries,
self-doubts, anxiety, etc. may be caused 
47
by merely observing someone else--a model--who has
excessive fear or nervousness, and learning to respond the
same way (see discuss of modeling in chapter 4), 
by learning to distort incoming perceptions so that the situation
is made to look worse than it is by these faulty perceptions,
e.g. blushing may interpreted as making a fool out of yourself
or speaking too softly to be heard may cause the listener to
frown which is then interpreted as disapproval, 
by applying certain unreasonable personal beliefs or
expectations to the perceived situation so that
disappointments, anger, and/or a sense of inadequacy are
immediately created by these irrational thoughts, e.g. thinking
that others will think you are unattractive or believing that brief
pauses in your speech will bore the listener, 
by acting on a variety of faulty conclusions an excessively
stressful situation may have long-range consequences, e.g. by
falsely believing we are boring or can't answer the other
person's questions, we abruptly terminate the interaction or by
having fantasies of some horrible outcome which literally scares
us "out of our wits," we do poorly and the situation gets out of
our control or by self-critically using this stressful incident and
failure experience to further lower our self-concept, a serious
self-esteem problem develops, etc., etc. There are an infinite
number of false beliefs; every human has some, many have
many. 
These are some of the basic ideas of cognitive theory. There are
many different kinds of thoughts that cause stress and fears. Cognitive
processes have become the main focus of psychological treatment in
the last 15 years or so. 
Observational learning and cognition
In chapter 4, we saw that one could learn to be aggressive from
watching a model. In a similar way, we can learn fears too (Bandura &
Rosenthal, 1966) from watching a fearful person. If a parent has an
obvious fear, say fear of flying or of storms or of dealing with
authorities, his/her children are likely to assume there are great risks
involved and be afraid of these things also. I once saw a client who's
entire family had a fear of heights, especially docks over water. They
passed it on, via modeling, from generation to generation. 
Cognitive theory says both reasonable and unreasonable fears
(phobias) are based on thoughts. Of course, it is logical thought that
enables us to distinguish between rational fears and irrational fears,
but for the frightened person this differentiation is difficult. Yet, our
survival depends on cognition--recognizing real dangers, like driving
while drinking or smoking while lying in bed or going into business
with a dishonest partner. But, why do so many of us learn to greatly
fear less dangerous situations, such as asking an attractive person for
a date. Could it be a crushing blow to our ego even if the person who
turns us down hardly knows us? (No, if we are secure; yes, if we are
48
overly self-critical.) Somehow the ordinarily rational cognitive
processes run amuck and exaggerate the dangers, as when beginning
spelunkers think the cave will crash down on them or speakers fear
the audience will think they are dumb or people avoid revealing their
personal opinions and intimate feelings. Let's see how this might
happen. 
Most phobias are groundless and excessive, such as a fear of
harmless bugs, dirt, worms, meeting people, speaking to a large
group, and heights. Hauck (1975) suggested that these harmless
situations are associated with fantasies of horrible consequences (like
the fear of elevators). Thus, our own scary ideas become the "pain"
paired with the situation to produce a fear reaction. For example, the
shy person thinks about meeting someone and then imagines not
knowing what to say and becoming terribly embarrassed. And, thus,
he/she becomes even more shy. Likewise, most of us have at least a
mild fear of the dark. Relatively few people have been attacked in the
dark, no one by ghosts or monsters. Yet, at age 3 or 4 (as soon as our
imagination develops enough) we begin fantasizing scary creatures
lurking in the dark. Our own fantasies create our fear of the dark. 
We can easily forgive the child who is afraid of the dark. The real tragedy is when adults
are afraid of the light.
Of course just saying "fears come from irrational thinking" is not a
very complete explanation of behavior. The question is: "why and how
do we learn to think irrationally?" Bandura (1977) says false beliefs
come (a) from faulty perception (like believing your black neighbors
are more violent than your white ones because TV News picture more
blacks as criminal suspects) and (b) from faulty conclusions based on
insufficient evidence (like believing that this airplane you are boarding
is likely to crash because you have seen some terrible crashes on TV
lately). But why the faulty perceptions and conclusions? There are lots
of ways for our thinking to become irrational, so we will discuss this in
some detail. Also, in chapter 6 we will learn more about how
depression and low self-esteem seems to be produced by negative
self-evaluative thoughts; in chapter 7 we will see how anger may be
produced by negative thoughts about others, etc. (But which comes
first, the idea or the emotion? Cognitive theory says the idea, but it is
hard to believe that emotions have no role to play in producing some
of the irrational thinking in the first place, right?) 
Faulty perceptions and irrational reactions  
Anxiety and fears may result from how we perceive and react to
situations. It may help to separate the faulty perceptions, i.e. learned
49
biases or distortions that take place in the process of perceiving the
situation, from the irrational ideas, i.e. almost instant irrational
reactions we have to that situation, such as "they shouldn't be doing
that" or "I should be doing better than this" or "I can't do anything
about this mess." 
The faulty perceptions occur when our erroneous expectations,
fears, or wishes alter how we see other people and ourselves. We have
a certain mental "set" before the event happens which causes us to
see the situation in a certain way--we give it our own slant. Examples:
a person desperately wants to have a good relationship with his/her
lover, and fails to see the lover's loss of positive feelings and interest.
A person wants to please others so much that he/she isn't even aware
of his/her own needs. A person expects to be inadequate and so sees
only his/her weaknesses and doesn't see his/her strengths or
opportunities. A person has a pessimistic outlook, so every event is
seen as the beginning of a catastrophe. A person has a severe self-
critic, so every action he/she takes is seen as something to be
ashamed of. Many of these faulty perceptions, called "maladaptive
schemas" by Young (1989), arise from emotions or needs and
obviously cause stress. 
The irrational ideas are often an instantaneous judgment that
what is happening shouldn't be happening. Thus, Albert Ellis refers to
"musturbation," i.e. believing that things must go the way I want them
to, and if they don't, I have a right to get terribly upset. This demand
for things--everyone love me, I be successful, don't blame or hurt me-
-is certainly going to produce stress, especially when the demands
aren't met. These demands surely arise from a long history and a
complex variety of emotions, thoughts, needs, fears, and hopes. These
cognitive-emotional demands that life unfold differently produce, in
turn, many new and disturbing emotions. This theory, which is the
basis of Rational-Emotive therapy, will be described extensively in the
next chapter and in methods #3 and #11 in chapter 14. 
Can we handle it?
As mentioned before, the same stressor, such as having to give a
speech, is perceived and responded to very differently by different
people. Jane would want to get out of doing it, be unable to think of
anything worthwhile to say, and be certain that she would mess up
and say stupid things. Another person with no more speaking
experience might be thrilled, be eager to begin gathering material, be
sure she has important things to say, and fantasizes doing well (in
spite of some anxiety). The event has very different meaning to these
two women; their expectations of themselves and others are entirely
different. 
Life is 10% what you make of it and 90% how you take
it.
50
Bandura (1986) as well as Richard S. Lazarus (1984) and his
colleagues believe that stress and anxiety primarily arise when we
believe we can't handle the approaching problem. Obviously, this
involves an appraisal of the nature and seriousness of the threat in
comparison to the kind and strength of coping mechanisms we think
we are capable of using. We can be scared because the stressor
(problem) is seen as overwhelming or because we believe we have no
way to escape or solve the problem. The questions we ask ourselves
are: 
1. Is something important to me at stake? If yes, am I in trouble?
These are complex judgments. But the answers can center on three
areas: (a) seeing the harm as already done, "This is awful, I can't give
a speech," or (b) foreseeing possible losses, "Yes, a threat of _____
severity is coming" or (c) seeing the situation as a challenge, "Giving
the speech will be hard work and scary but it's a real opportunity,
which I can handle." 
All other factors being equal, a threatened person, like Jane, would
probably do more poorly and be more stressed than a less threatened
person. However, as we mentioned earlier and will see in the next
paragraph, that isn't necessarily the case. It is possible that the more
anxious person would work harder on the speech than a more
confident person, and as a result of the thorough preparation do
exceedingly well and feel fairly confident during the speech. In short,
the perceived threats are reduced by seeing solutions (see next step). 
2. "What can be done about this threat?" Coping refers to our
attempts to manage external and internal demands or stress; it
includes our thoughts, attitudes, skills and actions. This book is filled
with coping skills. Our estimate of our own ability to cope is based on
many factors, including previous experience in similar situations,
exposure to self-help information and effective teachers, self-
confidence and risk-taking in general, awareness of how well your
personal coping skills compare to others', and faith in support from
others (Holroyd & Lazarus, 1982). Self-efficacy is discussed later and
extensively in method #9 in chapter 14. 
Some of us are risk-takers and some are not. Siegelman (1983) writes
about risk-taking in important areas of our lives, such as careers and
relationships. Risk-taking is a psychological process involving decision-
making, attitudes about change, self-concept, and fear of failure. She
describes three kinds of risk-takers: (a) Anxious ones who make big
decisions only with difficulty, after lots of time, effort, indecision and
worry. (b) Balanced ones who make big decisions carefully, focusing
on getting a good outcome and not preoccupied with failing or being
perfect. They are flexible, giving more time to important decisions and
handling situations differently. (c) Careless ones who make big
51
decisions quickly and with unjustified optimism. They deny their
anxiety and don't think much about the situation before or afterwards.
If you take risks, which type fits you best? Obviously, too much fear
inhibits us too much and too little fear doesn't inhibit us enough. 
Decision-making is known to deteriorate under intense or prolonged
stress; we become confused and irrational emotions may take over
(Janis & Mann, 1977). See chapter 13 for ways to improve decision-
making as a part of coping with stress. 
How and what you think determine your stress level
Humans are constantly anticipating what is going to happen,
sometimes accurately and often times incorrectly. We especially dwell
on the good and bad possible consequences of our actions and
choices. We can imagine how others will feel and act in the future. We
can understand and misunderstand why others do and feel the things
they do. All these cognitive abilities can serve us well or poorly; careful
planning for the future can help us cope and reduce our stress;
pessimistic predictions can make us miserable. For some reason, in
our current culture, we seem very unaware of the many ways we could
be viewing and interpreting a situation but aren't. Here is a classical
example of cognitive processing: 
Suppose you are waiting for your boy/girlfriend who is half an hour
late, which is unusual for him/her. You will think, "Why isn't he/she
here?" And, you may answer the question from several viewpoints
(called schemata by cognitive psychologists) or ways of understanding
the situation, e.g. you can apply a rejection interpretation: "he/she
isn't very concerned about or interested in me," or a threat
interpretation: "I wonder if he/she has met some attractive person on
the way here," or a catastrophe interpretation: "Oh, God, I hope
he/she hasn't had an accident--I heard a siren a minute ago," or a
shame interpretation: "I hope no one sees me waiting here, it's
embarrassing to be stood up," etc. All these interpretations would be
wrong if he/she simply got caught in traffic. Yet, each different
interpretation leads to a different emotion. But, you don't have to
force the data into any category (interpretation), you could refuse to
draw a conclusion and just find something else to do until the
boy/girlfriend shows up." But, most of us have our "favorite"
expectations or schemas or ways of looking at things--it is part of our
personality. By becoming aware of our tendencies to take certain
viewpoints that may be wrong, we can start to change by testing the
validity of our interpretations and opening our minds to more accurate
ways of understanding our situations (see the later sections describing
self-help methods). 
Let's consider the kind of cognitive schemas or structures of
agoraphobics that lead to feeling afraid of having a panic attack
(Hoffart, 1993). Such patients have certain beliefs: (1) once anxiety
about becoming terrified starts, it doesn't stop and just gets more
intense, (2) specific symptoms will lead to a disaster, e.g. rapidly
52
beating heart means a heart attack is imminent, dizziness will result in
your passing out, mental blocking indicates you are going crazy, and
(3) the only way to avoid death or other serious disaster is to get out
and keep out of those situations--to avoid getting scared and escape
immediately. So, what are the consequences of this kind of thinking?
They avoid situations that may bring on panic; they are very cautious
in public situations (avoid excitement and stay close to exits); they try
to control the symptoms (lean against wall when dizzy); they have an
escape plan, carry tranquilizers, go with a friend only on nice days and
when they are feeling good. In short, by so carefully avoiding the
scary situations, the agoraphobic never questions or tests his/her
beliefs about fears, so the phobias only grow, never shrink. So, to
reduce fears, the fundamental bases or beliefs (1, 2 & 3 above) on
which fears are built must be confronted, tested, and proven wrong.
Expose yourself to the feared situation and find out you don't die,
indeed the fear or panic decreases. 
In case you have difficulty believing that thoughts can have
powerful impact on fears, consider this interesting but unusual
example of how thoughts can radically influence our strong emotions.
Scary sports, like parachuting, give psychologists a rare opportunity to
repeatedly observe the relationship between thinking and fear. An
interesting thing happens as we become more experienced
parachutists. As one would expect, the beginning parachutist
experiences increasing stress immediately before the time to jump.
He/she is fairly relaxed the previous day and during the night. Early in
the morning on the day of the jump, there may be some mild
excitement. Even the ride to the airport is pretty calm. As he/she
gathers the equipment and prepares to board the plane, the anxiety
rises. As the plane takes off, his/her stress increases, until there is
very high anxiety while waiting for the "ready" signal from the
jumpmaster, approaching the door, looking out, and jumping. Few
people do this the first time without feeling terror ...for a few minutes. 
Now, what happens with an experienced parachutist? Well, he/she
is calmer than the beginner during the last few minutes before the
jump. That's no surprise. But why is he/she more calm? Apparently
because he/she is busy thinking about and planning or checking every
detail of the jump: Is my equipment in order? Do I remember what to
do? Where's the landing site? Where are the power lines? What's the
wind direction and speed? Cognitive functions are dominant--taking
care of business--and override the fear response. What happens with
the beginner? He/she is thinking about: Will the jumpmaster see that
I'm scared? What if the plane's tail hits me? I hope I don't freeze. I'm
really scared. Oh, God, I don't want Ann/Joe to see me splattered on
the ground. Again, our thoughts seem to determine our feelings. 
There is another interesting finding: the experienced parachutist is
more anxious than the beginning parachutist on the previous day,
during the night, early in the morning getting ready to go to the
airport, and after the jump is completed. Why? We don't know why.
Perhaps the total tension is about the same for experienced and
53
beginning parachutists but seasoned jumpers concentrate on
accomplishing the task (like professional performers on stage) and
have to release the stress before and after the jump. Epstein (1982)
points out the similarity to being alert and calm during a near accident
but becoming shaky and scared afterwards. 
If certain thoughts can reduce stress, other thoughts should be
able to increase stress. Some interesting research by Andrew Baum
deals with persons who had been in Vietnam or near the nuclear
accident at Three Mile Island (Adler, 1989). Persons who continued to
suffer intense prolonged stress had many more intrusive disturbing
thoughts about their experiences than persons with the same
background who experienced less stress. The question is: does more
intense physiological reactions of stress lead to more worried thoughts
(seems likely) or do distressing, unpleasant thoughts raise our stress
level (seems just as likely)? Another question is: do low stress people
just avoid unpleasant memories and thoughts or have they handled
the stress in some other way? One theory, suggested by Wegner
(1989) and Pennebaker (1991), and supported by some fascinating
studies, is that trying not to think about something stressful (i.e.
denying, suppressing, or not disclosing) actually results in more
uncontrollable negative thoughts about the situation. The deniers and
non-talkers believe they are solving the problem when actually they
may be making it worse. What is a better solution? Wegner and
Pennebaker and almost all insight therapists would say these people
need to think and talk about their stressful experiences and express
fully their emotions. Cognitive researchers disagree, believing some
people simply think about traumatic experiences differently than
others and, thus, experience different levels of stress. Thus, cognitive
therapists focus on changing the thoughts, not expressing the feelings.
Research of this reduction-of-feelings vs. cathartic disclosure issue is
badly needed. 
Self-confidence in coping skills  
Naturally, if our perceptions and thoughts determine our feelings,
then it is a small step to seeking mind control methods, which the
Greeks did 2000 years ago. If methods for altering your own thoughts
are important, then your faith or self-confidence in using your mind
logically and effectively becomes important. Bandura (1977, 1980,
1986) and his Social Learning Theory deserves much of the credit for
highlighting the notion of self-efficacy. When cognitive psychology
filled the void of behaviorism in the 1970's, the view of man returned
to "man is a rational organism" (or, if not rational, at least controlled
primarily by the mind). The conscious mind preoccupied psychologists,
instead of Skinner's behavior and environment, Freud's unconscious
instincts, or psychotherapy's emotions. A cognitive orientation
suggested that solutions to our problems involve acquiring the skills,
knowledge, and confidence necessary to handle the current situation.
That sounded reasonable and hopeful. Thus, the big push arose in the
1970's for cognitive self-control and self-help. And that mental set
determined that I sit here day after day summarizing how you can
54
better use your mind to do what you want to do. Psychologists (Moos
& Billings, 1982) have identified many coping skills; see the later
section on "How to Handle Stress." We will look deeper into the role
played by our self-confidence as a self-helper, called self-efficacy,
later in this chapter and in chapter 14. 
Does thinking explain all fears and anxiety?
Cognitive theory says that intense, specific fears are not caused by
something very painful or frightening being paired with the scary
object or event (illustrated by Little Albert in chapter 4) nor is some
vague or unconscious anxiety the source of a phobia. As we have
seen, the cognitive explanations of unrealistic fears and anxiety are (a)
that the perceived threat somehow becomes greatly exaggerated or
(b) our capacity to deal with the threat is seen as very inadequate or
(c) both. That is, we are saying, "This situation is horrible" and/or "I
can't handle it." 
It certainly is true that one doesn't have to have a traumatic
experience to acquire a specific phobia or intense chronic anxiety. Yet,
as already mentioned, basic learning principles could produce a phobia
or serious anxiety without a painful trauma being involved. More
examples: just imagining thousands of times making a fool of yourself
by making comments in class can create a fear of speaking up in class.
Avoiding approaching interesting people for years can make it too
scary to do. Moreover, cognitive psychology still has no clear
explanation of why the mind of a claustrophobic person exaggerates
the ideas of suffocating, being trapped and closed in, and loosing
control, while another person suffering from panic attacks fears open
spaces and is convinced that heart palpitations means he/she is having
a fatal heart attack. What makes the mind of a person with a fear of
flying jump to the conclusion that a crash is imminent? (Maybe
because his/her emotional system, based in part on non-cognitive
conditioning, is responding like crazy, in spite of what the logical part
of the mind is telling him/her.) 
In any case, while the Social Learning theorists make a lot out of
self-efficacy, it is no surprise that a person terrified by a large snake
will say "I can't get close to that snake," and that this behavioral
prediction is accurate. So what, if ratings of self-efficacy correlate
remarkably well with actual behavior? Does that prove thoughts
produce the fears? No, it's probably the other way around. Most people
simply have a good idea of how well they can handle a situation. I'm
pretty sure self-efficacy does not explain all behavior, but building our
feelings of self-efficacy is surely one of our better methods for gaining
some control over our lives. 
This three way connection between (1) appraising the
dangerousness of a situation, (2) evaluating our ability to handle the
situation, and (3) responding with fear or confidence in that situation
doesn't provide us with a complete scientific explanation of a phobia!
How and why does the belief develop that this harmless snake will hurt
55
me in some horrific way? How does the idea that a harmless snake
might hurt me get translated into a false perception of the snake as
life-threatening? Why and how does our cognitive estimate of our
ability to handle a specific situation, such as flying, sometimes
plummet suddenly? Science has not yet explained why and how
exaggerated threats are learned and combined with fluctuating
estimates of our self-efficacy in one specific phobic situation. And how
do those "snakes are horrible" and "I can't stand it" thoughts produce
sheer physical terror instantly? 
Surprisingly, high stress people do not have a lot more stressful
experiences than low stress people (except maybe the 10-15% who
"gravitate toward" serious trouble, usually involving conflicts with
people). It truly seems that stress for most people comes primarily
from the person's own personality or general nature, i.e. they are the
type, often with low self-esteem, that respond more intensely to
environmental stresses that are common in everyone's life. As
scientists trying to explain stress, however, it does little good to simply
label these people as "high anxious" or "lacking confidence." Good
explanations must be more precise and in more depth than that; we
must understand exactly why some people get up tight and fall apart
and others do not. Psychology is not doing a good job in this area, as
yet. 
Cognitive (self-efficacy) theory says, as we've seen, that
individuals interpret the same situation differently; they use different
schemas or interpretations--some see the problem as a minor
nuisance while others see it as a major catastrophe-and assess their
ability to handle it differently--"I can handle it" vs. "it's hopeless."
Thus, the level of insecurity differs from person to person. Okay, that
sounds good, but still the question is why? Some of us deny problems,
while others exaggerate problems. But, why? Some of us overestimate
our ability to handle a threatening situation, some are accurate, and
some grossly underestimate our coping skills. But, why? An effective
theory should be encouraging scientists to explore these whys in
detail: what causes the mental processes that lead, in part, to secure
coping and to overwhelmed panic. What are the origin and history of
the specific thoughts involved in exaggerating a threat? What is the
learning history of the thoughts, beliefs, skills and expectations
involved in becoming good self-helpers? (Limited ideas about how to
build self-efficacy are in methods #1 and #9 in chapter 14.) What kind
of societies, teachers, parents, and people, in what circumstances, find
this kind of information interesting and worthwhile...and who do
not...and why? 
Since Cognitive therapists believe that unwanted emotions are
caused by thoughts, this theory emphasizes the need to change or
remove the harmful thoughts, like self-doubts. (Besides, it's easier to
change thoughts than emotions.) But, when faced with the therapeutic
task of changing these thoughts, many Cognitive therapists turn to a
behavioral method, such as asking the patient to expose him/herself
to the scary social situation, etc. That is, it is easier, in turn, to change
56
behavior than thoughts (and perhaps it is more accurate to say that an
idea or a belief isn't really affirmed by the person until he/she acts
upon it or tests it out in real behavior). Thus, the Cognitive therapist
asks the patient to behaviorally check out his/her dire "it's hopeless"
predictions or conclusions, or the Rational-Emotive therapist directs
the shy client to find out it isn't awful to be turned down for a date, or
Bandura helps a snake phobic with a "I can't do it" attitude to
gradually approach a small snake and learn for certain "I can handle
it," etc. Thus, these therapists, especially the Social Learning theorists,
concentrate on building a sense of mastery (by increasing actual
behavioral competence), rather than focusing on reducing the anxiety
or correcting irrational thoughts or changing the self-talk involved in
self-efficacy. 
More specific directions for reducing fears, phobias, and self-
criticism are covered in the "Ways to handle stress and anxiety" and
the "Special anxiety-based problems" sections. How to stop destructive
self-criticism is discussed in Method #1 in chapter 14. 
Thoughts, emotions, and actions are all interrelated
As you can see, all three modalities--emotions, behavior, and
cognition--become impossibly enmeshed in most real life situations,
much like classical, operant, and observational learning are complexly
intertwined (see chapter 4). Therefore, any theory which attempts to
explain any one of the three modalities, say an emotion like anxiety,
without referring to both of the other two is probably questionable. It
is quite believable that our feelings are partially based on our views of
the world--our thoughts, our beliefs. But our thoughts, views, beliefs,
expectations, etc. are surely influenced by our emotions...and our
behaviors. It is not a one way street. Indeed, Bandura himself
provides an impressive list of ways we mentally justify being
behaviorally unkind to others (see chapter 7). These self-serving
cognitions (or excuses) are surely influenced greatly by emotions and
needs. So, which comes first or which is most powerful: the selfish
thoughts, the greedy emotions, or the mean, self-serving behavior? It
is a foolish question. We can assume all three complexly interact and
grow together. As we accept more of the complexity, we may be on
our way to understanding ourselves. I never told you that humans
were easy to understand. 
It will interest some of you that brain researchers, such as Joseph
LeDoux, believe that emotions and thoughts operate on two almost
entirely different nerve pathways; thus, we can fear a snake while
knowing it can't hurt us. The emotional "startle" reaction to a snake
might even be faster than the mental awareness of what it is that
scared us. He also says it is likely that recognizing a person is
processed by a different set of neurons than the ones that produce an
emotional dislike for that person (and, of course, we may like or dislike
a person without knowing why). It is also possible that early emotional
memories are, for this reason, powerful without any cognitive
memories of those experiences. So, we simply don't know much yet
57
about the interconnectedness of emotions and cognitions. There are
researchers who doubt that fears and anxiety are produced by
cognitions alone and that fearful emotions can be reduced by only
changing our thinking. Thoughts, emotions, and actions are so
intertwined that possibly you can't change one without modifying the
others, but there is no guarantee that changing one, say your thinking,
will always change another part, such as your fears (Beidel & Turner,
1986). For self-help, you'll need to use all the methods--cognitive,
emotional, and behavioral. 
Next we turn to a much older and more complex theory explaining
anxiety. It is partly cognitive too; it involves very intricate mental
processes, including coping and moral judgments. But, it also
recognizes innate biological drives, strong emotions, and unconscious
mental processes. No one can thoroughly explore and understand
human behavior, especially anxiety, or their own psyche without
knowing a little about Freudian theories. 
           
Psychological Theories
Psychoanalytic views 
Freud was an acute observer. However, at times he seemed to
have weird ideas, so much so he was ridiculed by his peers. But when
his ideas are thoroughly understood, they often do not seem so odd.
For example, he thought that we experienced "birth trauma" as we
were painfully and abruptly squeezed from our warm, safe, dark, quiet
place in mother's womb into a cold, demanding, changing, confusing,
dangerous world. Weird? Maybe. Maybe not; new newborns are much
more aware than we once thought they were. Freud felt birth was our
first stressful experience and that it influenced later experiences, like
when we were traumatized by mother leaving us for a few hours at
age 10-months or being terrified at age 3 when we thought we were
lost in a store. Surely earlier experiences affect later ones; our feelings
of helplessness, of "something awful is happening," of overwhelming
fear could be traced, in part, back to birth. 
As the first psychotherapist, starting over 100 years ago, Freud
treated many patients with fears and anxiety reactions. He wondered
how these emotions could be explained. His explanation started with
an infant innately driven by its "id" to eat (from mother's breast), to
eliminate, to be comfortable, to be held and loved, and to be touched
and have sensual stimulation. If those needs were not met, the child
experienced anxiety (a mild form of the first stress--the birth trauma).
To meet sexual (love) and death (aggression) needs and to relieve the
anxiety, a part of the id develops into a second part of the child's
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personality, a thinking, reasoning, perceiving, self-controlling part,
called the "ego". The ego devises many ways of coping, of meeting its
needs, of surviving. One means of coping could be to become
unusually close and dependent on one parent--a daddy's girl or a
mommy's boy. Or it might be to develop a fear of the dark that
justifies demanding that a parent put you to bed and stay there until
you are asleep. Or another way may be to become "sickly" to gain
attention and love. All these things help us feel less scared. As adults,
the ego is still handling "neurotic anxiety" by using "defense
mechanisms" and by developing fears and phobias (substitutes for the
real concerns), psychosomatic disorders, compulsions and excessive
orderliness, obsessions and excessive worries. All of these neurotic
symptoms help control or make up for the basic anxiety of not getting
the love, security, and sensual touching we want. That's not too weird
a notion, is it? 
Understanding how we handle neurotic anxiety was only part of
Freud's task. Freud treated patients with great guilt who had never
done anything wrong; he saw sexual-attention hungry children deny
their sexual interests (remember this was the Victorian era); he saw 5
and 6-year-olds who had a crush on one parent become more and
more like the other parent. So, he adopted the idea from ancient
Greek literature of "Oedipus and Electra Complexes:" we are in love
(whatever that means to a 3 or 4-year-old) with one parent but this is
real scary because the other parent might get jealous and hurt us,
including quit loving us or physically hurt us (castration anxiety!). How
do we handle this scary, threatening situation? With a clever stroke of
genius! We join forces with the competitor, we start using the same
sexed parent as a model. By joining the enemy we have avoided the
war; by identifying with the same sexed parent we have found a
means of controlling the dangerous (and thus scary and evil) impulses
(sexual attraction and hostility) within us. Soon, we no longer crave
physical contact with the parent of the opposite sex; boys of 8 or 10
want to be like their dads; girls like their moms. Young boys start to
think girls are yucky and a secret voice inside may be saying, "Whew!
Thank goodness I'm safe; I'm out of that scary triangle with mommy
and daddy." 
Part of the process of identifying with the same sexed parent is the
internalization of values, the development of a conscience which Freud
called the "superego". The superego, the part that makes us good
and considerate of others, is an outgrowth of the interactions that
many people consider so wicked--the Oedipus or Electra Complex.
Because we, as young children, have known birth trauma,
overwhelming fear and a sense of utter helplessness, and because we
so desperately want love, we handle our fears by developing at age 5
or 6 a set of rules to live by that will help us become a good boy or a
good girl. Rules such as: you should not get angry at your little
brother and try to kill him...or even think of it. You should not wish
you had mommy or daddy all to yourself because the other one would
have to die...and you can't think about that, it might come true. You
should not do sexual things, like try to suck mommy's breasts or feel
daddy's penis...and you shouldn't even think about dirty, nasty acts or
59
parts of the body. All these "shoulds" come from the superego part of
your personality. 
And so it is, according to Freud, that the savage beast within is
tamed by the ego and superego. And so it is that humans become
civilized. But, by the same taming, controlling mechanisms, we are
tormented. The superego makes demands that directly conflict with
the id; it generates guilt and shame when we do immoral things and
even when we have unacceptable urges or thoughts and maybe even
when we have unconscious urges. Freud called this "moral anxiety."
Much of our depression and low self-regard, perhaps our fear of
success and free-floating anxiety, may come from this source. 
Freud's notions of the mind have had a profound effect on how we
humans see ourselves. We will never be the same again. Few minds
have had such wide influence as Freud's. From anxious, tormented,
sick people (and from his own self-analysis), he conceived the mind as
a complex collection of dynamic, constantly struggling forces trying to
control one's life. There are three major parts of our personality: first,
the id, which includes the physical or sexual or love instincts and the
death or destructive instincts. The id wants to have all kinds of fun,
now! Also, it would like to destroy whatever got in its way. 
Second, the ego develops from the id. By using reason and contact
with the external world, the ego tries to satisfy the id's needs as much
as possible without alienating the sources of love. Of course, the ego
has to conceal many of its purposes; that is, they must be
accomplished secretly or unconsciously in a disguised form. This is
especially true after 5 or 6-years-of-age because the third force has
now come into being--the superego. 
The superego demands that we be good; otherwise, it causes us to
feel guilt, shame, and anxiety. The ego has the task of negotiating
between the id and the superego. Of course, they never agree. The
ego can find a few ways for the id to have a thrill and still avoid
chastisement from the superego. It isn't easy, but unconscious
manipulations, denial, fooling ourselves, irrational thinking, etc. help
one part of our personality deceive the other two parts. Furthermore,
the ego must rationally deal with the world, i.e. deal with questions
like: what am I capable of doing, what resources can I make use of,
how will other people react to my actions, how can I handle their
objections, etc., etc. Clearly this boiling cauldron of powerful,
unconscious, conflicting forces inside each of us would create stress,
right? 
Freud saw anxiety as a signal of danger. What danger? The threat
of these childhood memories and urges and fantasies coming into our
consciousness or actually being carried out. Events that happen to us
as adults might set off an old repressed urge or fear, such as losing
love. Immediately, we become anxious--often without knowing why.
To prevent anxiety, all of us develop massive defense mechanisms to
keep hidden the "true" causes of our childhood fears, urges, and
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shames. Thus, a psychodynamic therapist would assume that an
agoraphobic patient is symbolically terrified by a loss of love or
separation from a caretaker at home (maybe the birth trauma or
castration anxiety or loss of mommy or daddy's love through the
identification process or an actual lost of love due to divorce, etc.). In
short, our irrational adult fears and phobias are neurotic ways of
continuing to cope with childhood traumas. They are manifestations of
our earliest conflicts and stresses. 
Freud wrote 33 volumes, mostly about anxiety. He was a good
writer. Decide for yourself, on the basis of knowledge and reading his
books, how much you will believe of Freud's theories. It is important to
realize that you don't have to agree with everything Freud said in
order to find some wisdom in his writings. You don't have to accept
birth trauma or the Oedipus complex and castration anxiety before you
can believe in defense mechanisms. Indeed, almost all insightful
readers will say, "Oh, I do some things like that," after reading about
defense mechanisms. 
Psychological defense mechanisms
Freud's daughter, Anna, who did psychoanalysis until she died in
1982, summarized several ego defenses in The Ego and the
Mechanisms of Defense (1936). As noted above, the ego protects itself
from three threats: (l) the id, because the urges from the id can
become so strong that they overwhelm the ego, bringing with them
irrational chaos. Thus, we might panic if our sexual or brutally hostile
urges popped into our conscience. (2) The outside world or real
danger. For example, the ego would realize that a child's parents
staunchly forbid any aggression; thus, showing the slightest hint of
murderous urges to them would produce severe anxiety. Likewise, a
fear of driving recklessly or of being rejected by a lover may have a
certain basis in reality. (3) The superego is a threat to the ego too.
The basic duty of the ego is to find some satisfaction for the id. If the
superego detects any immoral aspects in our behavior, there is hell to
pay in the form of self-censure and guilt. The ego tries to avoid this
discomfort. But, keep in mind that, according to Freud's original
theory, the ego defenses are successful only so long as the conscious
part of the ego is unaware that another part of the ego is defending
itself! Uncovering some of your ego defenses may be interesting fun,
but your defenses against really threatening urges or ideas are not
likely to disclose what they are doing to your conscious awareness. 
Anna Freud used the defenses as hints of the repressed, scary
impulses (instincts) that were underlying the patient's troubles. For
example, the goodie-goodie 5-year-old dethroned king, who never
shows anger towards his younger sister, his competitor, is assumed to
be hiding his sibling rivalry. The defenses can also give us insight into
our own mental processes--sometimes mental gymnastics or
contortions. All defenses involve distortions of reality; they are ways of
61
feeling better by fooling ourselves. If we realized these defenses in our
lives, we might handle reality better. Almost all adjustment books
mention these defense mechanisms, even the writers who are
arrogantly critical of Freud. An excellent text about Sigmund and Anna
Freud and the ego defenses is by Christopher Monte (1980). 
Repression: shoving thoughts and urges that are unacceptable or
distressing into our unconscious. This is what happens to the
unacceptable urges of childhood--the ego represses them. Taboo
ideas, like incest, would probably never get into consciousness or, if
they got there, they'd be quickly repressed. Sometimes dreams or
slips of the tongue or attempts at humor reveal our unconscious
motives. For example, if a teacher ridiculed you in class, you might
dream he/she had a horrible auto accident. Or, trying hard to say
something nice to the teacher a few days later, you comment after
class, "Each of your lectures seems better than the next." Or, if you
were unfortunate enough to be asked to introduce your former teacher
at a symposium and said, "I'd like to prevent--huh--I mean present
Dr.___," some might guess the truth. All these speculations about
repressed feelings are just guesses. 
Repression must be distinguished from suppression and
withdrawal. Suppression is more conscious and deals with unpleasant
but not usually utterly despicable acts or thoughts. Examples: You
may want to forget a bad experience or an unpleasant chore to be
done (a term paper to write or expressing sympathy to a friend whose
mother has just died). You just forget to do things or you may
deliberately try to think of other things so you can "settle down" and
function better. It may, indeed, be rational to worry about one thing at
a time (suppressing the other worries) and to withdraw from a
stressful situation. Counting to 10 before acting in anger is another
good example of brief suppression. 
Dissociation: includes processes closely related to repressed and
distorted perspectives or memories (see the discussion in Trauma
above). Dissociation (or something like it) occurs in several forms,
ranging from very common occurrences, like "spacing out" or quickly
forgetting an embarrassing moment, to very pathological conditions,
like flashbacks, Multiple Personality Disorder (now called DID), or
Dissociative Amnesia. It seems to be the nature of the human mind to
select a preferred point of view or theory or "the right way" to do
things. Once you know or "feel" what is "right," then most different
opinions or ideas seem wrong to you. This tendency to accept one side
(point of view) results in rejecting many other perspectives, even if
each perspective holds some truth that might contribute to
understanding/solving a problem. This is called right/wrong or
either/or or black/ white or good/bad thinking. In effect, we lose track
or discount a little part of reality (in order to hold the belief that we
know the truth). If people know you believe one thing, they tend to
assume you disagree with the opposite. Examples: if you believe in
practical courses, they assume you are anti-academic; if they know
you recommend psychopharmacology, they assume you do not
62
advocate psychotherapy; if they know you are a strong advocate of
self-reliance, they assume you seldom vote for a Democrat. 
Usually strong trauma, intense pain, or an identity crisis is
associated with major dissociation. Combat may produce "battle
fatigue" or Post-Traumatic Stress Disorder. Awful accidents, near
death experiences, death of loved ones, physical or sexual abuse,
severe humiliation, and unbearable losses can lead to memory losses,
intense emotional reactions as if you were suddenly back in a
traumatic crisis, numbed feelings (e.g. cutting themselves without
feeling it), depersonalization (robot-like, "I know what is happening
but it doesn't seem like me"), two or more "personalities" inside trying
to control the same person, confused or Fugue states, etc. All these
reactions serve as a defense against pain, fear, helplessness, panic,
and other intense feelings or ideas. It is as though, under stress, our
normal stream of consciousness fails to integrate all of our thoughts,
emotions, somatic sensations, sense of identity, and knowledge of
what happened. Thus, one may remember what happened to them but
forget how they felt. Compared to repression, in dissociative reactions
memories are splintered and distorted, not just lost. Indeed, there is
often a repetition compulsion to repeat some part of the traumatic
experience, experiencing it over and over. We have already read about
dissociation in Trauma above and we will read more about it in Suicide
in chapter 6 and in discussions of serious pathological states in chapter
9. 
Denial: refusing to admit or face a threatening situation. Denial
can be unconscious as when a dying person refuses to admit what is
going to happen or when a person with a heart condition denies that
their overeating or smoking is of any consequence. Denial can be
semi-conscious as when a person refuses to see any problem in a
relationship when it is pretty obvious to everyone else. Denial is
probably quite conscious when a post-puberty young man of 13 says,
usually with a grin, "I'm not interested in girls." 
Research (Roth & Cohen, 1986) has shown that there are two
major ways to cope with stress: (a) avoiding, repressing, looking
away, forgetting, escaping and letting someone else be responsible or
(b) approaching, learning more, obsessing, being vigilant, and taking
charge of planning what to do. The first way (denial) reduces stress;
the second way (sensitization) increases our chances to cope. We all
use both ways, although we may tend in general to be avoiders or
approachers, while in specific situations, like facing surgery, we each
have our favorite way of coping. Which is the better way? 
Denial is probably better when the situation is out of your control
(a sudden crisis or in surgery) and approach is probably better when
you can do something about the situation (avoid or lessen a problem).
The disadvantages of each way are: more stress and useless worry for
the approachers, and more failures to act and lack of awareness for
the avoiders. As you can see, ideally we would use both avoiding and
approaching ways of coping with a particular stress over time. This
63
knowledge about denial is gradually being gathered (Breznitz, 1983).
For instance, Lazarus has found that patients facing surgery who deny
the dangers and have a false sense of security have a better post-
operative recovery (Derlega and Janda, 1981). However, many
patients could have avoided surgery in the first place by carefully
attending to their health. Thus, denial lets us eat lots of fat, relaxes us
during our heart attack, and then again interferes with our taking care
of serious health problems 
Regression: resorting to earlier ways of acting or feeling,
although it is no longer appropriate. Examples: Throwing a temper
tantrum like a 3-year-old at age 18. Under stress an adult might curl
up in bed, suck their thumb, and clutch their old teddy bear. A 23-
year-old experiencing serious financial difficulties might feel an urge to
return to his/her parent's home and let them take care of him/her.
These are not planned actions; they are old habits that return
automatically.              
Rationalization: Giving excuses for shortcomings and thereby
avoiding self-condemnation, disappointments, or criticism by others.
Examples: After stealing from a large company, "they won't miss it.
Everybody does it." After getting about average grades on the GRE
(not good enough to get into Ph. D. programs), "I would have hated
five more years of research and theory anyway." This is called "sour
grapes," from Aesop's tale about the fox who decided the grapes too
high to reach were sour anyway. The reverse is "sweet lemons," an
assumption that everything happens for the best, "failing the GRE's
was a blessing in disguise, now I know I want to become a counselor--
maybe a social worker--and not a Ph. D." 
Projection: Attributing to others one's own unacceptable
thoughts, feelings, impulses, etc. So, the white person with repressed
sexual urges may believe that all blacks are preoccupied with sex. The
moralistic spouse, who is tempted to have an affair, begins to
suspicion that his/her partner has been unfaithful. A slightly different
form of paranoid projection is when a self-critical feeling or idea is
attributed to others. Suppose a young woman from a religious family
has strong feelings against any sexual urges she might have and,
thus, almost never has them. She might start to believe, however,
that others are critical of her whenever she wears a dress that shows
her shape. 
Displacement: redirecting our impulses (often anger) from the
real target (because that is too dangerous) to a safer but innocent
person. The classic case is the frustrated worker, who can't yell at the
boss but comes home and yells at the spouse, who yells at the
children, who kick the dog, i.e. we take it out on the people we love.
Suppose we were very envious of the relationship between our sister
and our mother. Our feelings may never be expressed towards them
directly but take the form of resentment and distrust of most other
women. 
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Another form of displacement is what Anna Freud described as
"turning-against-self." In the last example, instead of the hatred of
one's sister and mother being turned on women in general, it could be
turned against oneself. This is a commonly assumed dynamic in
depression and suicide. 
Reaction formation: a denial and reversal of our feelings. Love
turns into hate or hate into love. "Hell has no fury like a spurned
lover." Where there is intense friction between a child and a parent, it
can be converted into exaggerated shows of affection, sometimes
sickeningly sweet and overly polite. The feelings and actions resulting
from a reaction formation are often excessive, for instance the loud,
macho male may be concealing (from himself) sexual self-doubts or
homosexual urges. Or, the person who is unconsciously attracted to
the same sex may develop an intense hatred of gays. People, such as
TV preachers who become crusaders against "loose morals”, may be
struggling with their own sexual impulses. 
Identification: allying with someone else and becoming like them
in order to allay anxiety. Remember Freud's notion that the Oedipus
and Electra Complexes are resolved by identification with the same
sexed parent. Other examples: occasionally an oppressed person will
identify with the oppressor, some Jews helped Hitler, some women
want their husbands to be dominant and feel superior to them and
other women. In other cases, a person may associate with and
emulate an admired person or group to reduce anxiety. High school
cliques serve this purpose. A new college freshman may feel tense and
alone and out of place; she notices that most other students are "a
little dressed up," not sloppy shirt and jeans. Her roommates insist on
studying from 7:00 to 10:00 every night except Friday and Saturday;
they are more serious than her old friends and their conversations
reflect these differences. They commented about her "country" accent
and the fact that she didn't watch the news. She started dressing up
occasionally, watched the news, got more interested in politics, and
studied a lot more than ever before. When she went home at
Christmas, her friends told her she had changed and dad commented
that he was losing his little girl. She didn't know it but she had
identified with a new group and learned to feel more comfortable. 
Sublimation: transforming unacceptable needs into acceptable
ambitions and actions. One may convert a compelling interest in
getting a parent's attention into a drive to do well in school. Sexual
drives can be pored into sports. Anger and resentment of the
advantages of others can be funneled into an obsession to excel in a
lucrative career. 
Fantasy: daydreams and their substitutes--novels and TV Soaps--
are escapes, a way to avoid our real worries or boredom. We may
imagine being highly successful when we feel unsuccessful; at least we
feel better for the moment. Actually, we often benefit by rehearsing in
fantasy for future successes. At other times, fantasies may provide a
way to express feelings we need to get off our chest. Fantasy is only a
65
defense when it is an escape. Anticipation of the future through
fantasy is a mark of an intelligent species. 
Many self-help methods use fantasy: covert rehearsal, covert
sensitization, desensitization, venting feelings, decision making,
empathy, increasing motivation and awareness and many others. If
fantasies can be therapeutic, then they can be harmful, e.g. imagining
awful consequences could create fears, sad thoughts may produce
depression, reliving an insult in fantasy might build anger. Fantasy
may be part of the problem or part of the solution. 
Compensation or substitution: trying to make up for some
feeling of inadequacy by excelling in some way. Alfred Adler, a free-
thinking student of Freud, observed that feelings of weakness and
inferiority are common when we are young. Much of life, he thought,
was devoted to compensating for our real or imaginary weaknesses,
i.e. striving for superiority. Both men and women strive for power,
competency, courage, wealth, and independence. Karen Horney wrote,
"The neurotic striving for power...is born of anxiety, hatred and
feelings of inferiority. ...the normal striving for power is born of
strength, the neurotic of weakness." 
Sometimes we work on improving in the area we are weak in, so
the skinny, shy child becomes Miss or Mr. America or the kid with
speech problems becomes a politician (like Demosthenes with rocks in
his mouth or Winston Churchill). Sometimes we find other areas to
make up for our weaknesses; the unattractive student becomes an
outstanding scholar, the average student becomes an outstanding
athlete, the person in an unsatisfying marriage becomes deeply
involved with the children. These are compensatory substitutions.
Many are good ways of handling stress; some are not, as when an
unloved teenager seeks love promiscuously. 
Undoing: if you have done something bad, sometimes you can
undo it or make up for it. Example: if you have said some very critical
and hurtful things about one of your parents or a friend, later you may
try to undo the harm by saying nice things about them or by be being
nice to them and apologizing (sometimes it is the overdone apology
that reveals the hostility). In essence it is having the decency to feel
guilty and do something about it. 
Freud used undoing to explain certain obsessive-compulsive acts,
e.g. a 17-year-old with masturbation guilt felt compelled to recite the
alphabet backwards every time he had a sexual thought. He thought
that would undo the sin. 
Intellectualization or isolation: hiding one's emotional
responses or problems under a facade of big words and pretending one
has no problem. Suppose you were listening to a friend describe going
through his parents' divorce. He may tell about deeply hurtful
situations but show no sadness or anger; he gives a superficial
behavioral description of what happened; he might even clinically
66
"analyze" his parents' underlying motives without showing his own
emotions. Likewise, people may discuss war without vividly feeling the
misery of many people dying. This is a repression of the painful parts.
Freud believed that the compulsive hand-washer was trying to cleanse
his hands of the guilt of masturbation but the feeling of guilt was
separated from the hand-washing. 
There are many other defense mechanisms ("acting out" as a way
of rebelling and reducing tension, "self-repudiation" to get others off
your back, seeking sympathy, etc.). More importantly, there are many
other much healthier ways of coping with stress, fears, and anxiety
which we will review later in this chapter and in chapter 12. 
As Sigmund Freud described ego defense mechanisms, the
processes were primarily unconscious. As Anna Freud and later
psychoanalysts studied these processes more intensely and re-defined
them, the mechanisms came to be seen as more conscious and
available to the ego (the conscious self) for dealing with anxiety. This
new focus on the ego as a coping, self-directing part of our personality
came after Freud. For Freud, however, the great driving forces were in
the id--the unconscious sexual and destructive instincts. The ego was
merely "a rider of a spirited horse" who tried to have some control
over the animal instincts. The later "ego psychologists" also extended
the role of the ego beyond reducing anxiety and into a means of
mastering and enjoying life. Today the Cognitive theorists tend to
believe, again, that the ego--the rational mind--is in charge or, at
least, has the potential to make a substantial difference. Freud would
say, if he were here today, that most of psychology has repressed and
denied his disturbing insights into the powerful sexual, selfish, hostile,
and irrational nature of man, just as he predicted we would. Could he
be right? Are we denying our basic biological and innate drives? 
It is likely that each of us can sometimes recognize when we use
defense mechanisms. We can't detect every time, but by being very
familiar with the common defense mechanisms and by being vigilant,
we can investigate our possible use of defense mechanisms and keep
ourselves honest. Most of the time (not all, as we saw in denial) it is
helpful to stay in touch with reality. Awareness is the mark of a
healthy, adjusted person. Work on it. 
More recent experimental investigations of defenses
Almost all of the information about defense mechanisms mentioned
above comes from pre-W.W.II psychoanalysts. Just to illustrate how
"scientific" beliefs wax and wane, history shows that many academic
psychologists during the 70's and early 80's rejected the notion of
unconscious thoughts and, especially, Freud's notions of unconscious
ego defenses. Clinical psychologists, however, in contrast to
experimentalists, continued using the idea of defenses. Then in the
late 1980's, cognitive researchers began to repeatedly find ample
evidence for unconscious mental processes. For example, experimental
studies have shown that experiences we have no conscious memory of
67
can have an influence on our performance of certain tasks; factors we
have no awareness of can influence our decision-making; procedures
that are at first conscious can be repeated often enough that they
become automatic and unconscious; in social interactions many people
deceive themselves in ways that build their self-esteem; children who
claim very high self-esteem are often hiding a profound sense of
inferiority, etc., etc. The researchers have often used different terms,
such as "scapegoating" instead of displacement, "self-presentation
ploys" instead reaction formation, "positive illusions" instead of denial,
"counterfactual thinking" instead of undoing, and so on (Cramer,
2000). But, a rose is a rose... 
Many benefits will come from the new experimental interests in
defensive cognitive processes. For one thing, there are clarifying
distinctions being made between coping processes and defense
mechanisms. Coping processes are conscious, intentional, learned,
and associated with normal adjustment. Defense mechanisms are
unconscious, unintentional, self-protective instincts or dispositions,
and associated with pathology (Cramer, 1998). This is a meaningful
difference, because different self-change techniques will surely be
needed for coping than for dealing with defenses. 
Another clarification emerging from the research is the distinction
between sometimes healthy or adaptive defense mechanisms and very
disturbed mental processes. Sublimation, suppression (sort of
conscious denial), altruism, humor, and even some denial in children
can be healthy and useful in certain circumstances. Also, some
defenses may temporarily help one adapt but in the long run interfere
with problem-solving: intellectualization, repression, undoing,
displacement, dissociation, idealization, misjudging one's power, and
others. Still other defenses alter our perception of reality and, thus,
interfere with solving our problems: denial, projection, rationalization,
and unrealistic fantasies. Some more hidden defenses are revealed by
certain maladaptive behaviors: acting out, severe withdrawal, passive-
aggressive acts, and so on. Lastly, extremely irrational defenses play a
central role in serious psychoses: delusional projection, serious
distortion of reality, complete denial of basic conditions, and so on.
The more maladaptive defenses that one uses, the more likely one has
a serious psychiatric disorder, many symptoms, and interpersonal
problems. 
If you compare Freud's defense mechanisms with modern research
finding, the traditional defenses seem more intuitively understandable
and more applicable to a wider range of situations. Eventually, with
more and more research, new findings will show us more details about
when and how defenses are used in specific circumstances. Then, we
will develop better ways to cope than by using defenses that rely on
distortions of reality. 
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Unconscious causes of fears
If exaggerated conscious thoughts of terrible consequences can
cause fears, why can't unconscious "thoughts" or urges cause fears?
This is speculation but worth understanding. The origin of many fears
is mysterious. A fear of knives is fairly common but the person doesn't
usually know the source. Hauck (1975) had a patient who looked for
worms, snakes, and bugs between the sheets and under her bed every
night for months. Freud described a famous case, Little Hans, a 5-
year-old boy who had a great fear of white horses with black mouths.
Where did these fears come from? 
Many persons, who develop such a fear of knives that they can't go
into the kitchen or have to throw away all their knives, often have a
very stressful relationship with someone. It may not be conscious, but
it is easy to speculate that inside somewhere there is a fear of losing
control over their anger or self-destruction. The knife phobia is
symbolic of the stress caused by anger underneath the conscious
surface. A person afraid of bugs and worms in bed may have had a
traumatic, dirty, disgusting sexual experience, part of which has been
repressed. Suppose a young person is sexually approached by an older
person; the young person may repress their own sexual interests and
the resulting guilt may surface as a phobia of bugs or ugly crawlies in
bed. Actually, the specific phobia may spread to a variety of things--
older people, specific places (like a woods), of sex with anyone, etc. 
After gathering 140 pages of information from Little Hans's father,
Freud believed that Little Hans unconsciously feared his father, which
got displaced to horses. What was the evidence? It was complicated
and fascinating. Read Freud. It basically involved the Oedipus
Complex. Little Hans liked getting into bed with his mother early in the
morning. He had a fascination at age 3 with his, his father's, his
mother's, and animals' sexual parts. His mother had told him his penis
would be cut off if he played with it. Also, Little Hans had seen pans of
blood after his little sister was born. Not long afterwards, he learned
that his mother had no penis, although he had told her he thought she
would have a big one "like a horse." One can see how Little Hans or
any child might think of the 3-year-old equivalent of "castration
anxiety." 
Little Hans also became very jealous of the attention given to his
little sister (sibling rivalry). He wished she had not been born. And he
started to fear (wish?) that his father would leave and never come
home. Obviously, Little Hans was very troubled. But how did he get a
fear of horses? Consider the ego defenses described above. Surely the
competition and hostility towards the father would be scary and be
repressed. His own resentment towards the father might be projected
to the father: "I hate him" becomes "he hates me" and wants to hurt
me. The unconscious hostile impulses towards the competitor (the
father) may seek expression in some way, some reasonably safe way--
through symbols or dreams. It's too scary to think consciously about
fighting with his father and being hurt, perhaps castrated, but he can
69
develop an irrational fear of being bitten by a white horse with a black
mouth. The phobia symbolizes the underlying conflict. And, by the
way, the father was, of course, white and had a black mustache! 
             
Summary of the Ways or Means by which Stress is Developed 
If psychologists completely understood how stress and fears
developed, we would know how to produce and reduce a phobia or an
anxiety state. We don't. There seems to be a wide variety of life
experiences which result in some form of stress, fear, anxiety, or
psychosomatic illness. It would be convenient if life were simpler but it
isn't. Perhaps a summary will help you review the ways you might
become stressed and anxious 
Environmental factors and processes
Changes, such as sudden trauma, several big crises, or many
small daily hassles, cause stress. Intense stress years earlier,
especially in childhood, can predispose us to over-react to
current stress. 
Events, such as barriers and conflicts that prevent the changes
and goals we want, create stress. Having little control over our
lives, e.g. being "on the assembly line" instead of the boss,
contrary to popular belief, often increases stress and illness. 
Many environmental factors, including excessive or impossible
demands, noise, boring or lonely work, stupid rules, unpleasant
people, etc., cause stress. 
Conflicts in our interpersonal relationships cause stress directly
and can eventually cause anxieties and emotional disorders. 
Constitutional or physiological processes
The human body has different ways of responding to stress;
one quick responding nerve-hormonal system involving
adrenaline, another long-lasting system involving cortisol, and
perhaps others. These systems not only determine the intensity
of our anxiety reactions but also our attitudes, energy level,
depression, and physical health after the stressful events are
over. As individuals, our nervous systems differ; however,
according to Richard Dienstbier at the University of Nebraska,
we may be able to modify our unique physiological reactions by
learning coping skills. 
The genetic, constitutional, and intrauterine factors influence
stress. Some of us may have been born "nervous" and
"grouches." Almost certainly we are by nature prone to be shy
or outgoing, and we inherit a propensity for certain serious
psychological disorders. We don't know yet if different
treatments are required for genetically determined problems
than for learned problems. 
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Learning processes
Having a "bad experience" causes us to later be stressed in that
situation, i.e. pairing a neutral stimulus (situation) with a
painful, scary experience will condition a fear response to the
previously neutral stimulus. (classical conditioning) 
Fears and other weaknesses may yield payoffs; the payoffs
(like attention or dependency) cause the fear to grow. (operant
conditioning) 
Avoiding frightening situations may reinforce and build fears
and stress. (operant conditioning--negative reinforcement) 
Cognitive learning processes
Seeing others afraid and being warned of real or nonexistent
dangers can make us afraid under certain conditions.
(modeling) This can include seeing a movie or TV or reading a
book or perhaps just fantasizing a danger. 
Some people have learned to see things negatively; they have
a mental set that causes them to see threats and personal
failure when others do not. Of course, seeing the situation as
negative ("terrible"), unpredictable, uncontrollable, or
ambiguous is stressful. 
Many long-lasting personality factors (neuroticism, pessimism,
distrust, lack of flexibility and confidence) are related to stress,
decision-making, and physiological responses. 
Having a negative self-concept--expecting to be nervous and a
loser--generates stress. 
Irrational ideas about how things "should be" or "must be" can
cause stress when we perceive that life is not unfolding as we
think it should. 
Believing that we are helpless, that we can't handle the
situation causes stress. 
Drawing faulty conclusions from our observations, such as
scary ideas, like "they don't like me" or "I'm inferior to them,"
or having unreasonable fantasies of awful consequences ("I'll
be mugged") increase our fears and restrict our activities. 
Pushing yourself to excel and/or failing to achieve a desired
goal and one's ideal lead to stress. 
Assigning fault for bad events, i.e. placing blame on self or on
others, causes stress and anger. 
Realizing we may have been wrong but wanting to be right
stresses most of us. Careful, logical decision-makers are usually
calm; people who have learned to be indecisive worriers or
quick impulsive risk-takers are tense. 
The ideas of dying, of loosing relationships and things we value,
of having a meaningless life, etc. scare us. 
Unconscious urges and processes
Having freedom and the associated responsibility can cause
anxiety and a retreat into submission to authority (see
71
Kohlberg's stage 4 in chapter 3), destructiveness, and
conformity, according to Fromm (Monte, 1980). 
Unconscious urges from childhood (Freud says sex and
aggression; Adler says overcoming inferiority; Horney says
resentment of parents) may cause stress. 
Unconscious conflicts--like Oedipus and Electra complexes--
cause stress which manifests itself symbolically as fears,
phobias, and neurotic symptoms. 
One emotion can be converted into another, e.g. anger
(wanting to kill someone) becomes fear (of knives) or lust
becomes suspicion that spouse has been unfaithful, but the
stress is not entirely avoided by this process. 
The list could go on and on. My intention isn't to give you a
"complete list" of sources of stress. I merely want you to realize there
are many possibilities to explore, if and when you go looking for the
sources of one of your anxieties. Be open-minded. Explore every trail.
You may discover very different, unique sources. Look in every nook,
consider every possibility. It can be an interesting investigation into
the workings of your mind. 
Summary of the Effects of Stress and Anxiety
The effects or consequences of stress are also numerous; they are
both positive and negative. First, the desirable results: 
1.
We need and enjoy a certain level of stimulation...a certain
number of thrills. It would be boring if we had no stresses and
challenges. Some people even make trouble for themselves to
keep from getting bored. 
2.
Stress is a source of energy that can be directed towards useful
purposes. How many of us would study or work hard if it were
not for anxiety about the future? 
3.
Mild to moderate anxiety makes us more perceptive and more
productive, e.g. get better grades or be more attentive to our
loved ones. 
4.
By facing stresses and solving problems in the past, we have
learned skills and are better prepared to handle future
difficulties. 
5.
Anxiety is a useful warning sign of possible danger--an
indication that we need to prepare to meet some demand and a
motivation to develop coping skills. Janis (1977) has studied
one aspect of this process by observing patients scheduled for
surgery. He found that patients with mild "anticipatory fear"
adjusted better after the surgery than those who were
traumatized or those who denied all worries. 
Other researchers have found personality differences: some
deniers do well post-operatively, others do not. This lead to an
investigation of how to prepare different personality types for surgery,
i.e. how to help the patients prepare to deal with a serious, painful
stress, by Shipley, Butt, Horowitz, and Farbry (1978). They studied
72
two personality types: repressors (deny feelings; "Forget about it; it's
in the doctor's hands") and sensitizers (open to feelings; "What are the
risks? I'm scared. Will it hurt a lot?"). 
One group of patients was shown an informative film about the
medical procedure; a second group saw the same film three times. A
third group didn't see it at all. There were repressors and sensitizers in
all three groups. The results? The sensitizers were quite anxious if they
hadn't seen the film, but the more they saw it the less stressed they
became. Thus, for sensitizers it is helpful to have a realistic, detailed
view of what will happen and to know the hazards as well as the help
and support available. But what about the repressors who start out
"dumb and happy?" Without the film, they are much more relaxed
during the painful medical operation than the sensitizers, but with one
prior viewing of the film, their heart rate during the operation was very
high, considerably higher than even the unprepared sensitizers.
However, if repressors had seen the film three times, they were fairly
relaxed during the medical procedure. Thus, some people--repressors-
-need to deny and avoid and think of other things or have lots of
advanced warning, information, practice, reassurance and support in
preparing for a stressful event. 
You should note two things: (l) this study involves a rare event--a
life-endangering time when someone else is in control of your life.
There is little you can do except try to keep your panic under control.
(2) This study involves only one personality factor from among
hundreds and only one approach to allaying fears from among
hundreds. But it illustrates the complex kind of information you and I
need to run our lives most effectively. We need more scientific
knowledge, and a willingness to learn and use that knowledge in our
own lives. 
The negative effects or consequences of stress and anxiety 
1.
Several unpleasant emotional feelings are generated--tension,
feelings of inadequacy, depression, anger, dependency and
others. 
2.
Preoccupation is with real or often exaggerated troubles--
worries, concerns about physical health, obsessions,
compulsions, jealousy, suspiciousness, fears, and phobias. 
3.
Most emotional disorders are related to stress; they either are
caused by stress and/or cause it or both. This includes the
concerns mentioned in 1 & 2 and the many psychological
disorders described in an Abnormal Psychology textbook. 
4.
Interpersonal problems can be a cause or an effect of stress--
feeling pressured or trapped, irritability, fear of intimacy, sexual
problems, feeling lonely, struggling for control, and others. 
5.
Feeling tired is common--stress saps our energy. 
6.
Many bad habits (e.g. procrastination, see chapter 4) and much
wasted time are attempts to handle anxiety. They may help
relieve anxiety temporarily but we pay a high price in the long
run. 
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7.
Psychosomatic ailments result from stress--a wide variety of
disorders are caused by psychological factors, maybe as much
as 50% to 80% of all the complaints treated by physicians. 
8.
High stress almost always interferes with one's performance
(unless it is a very simple task). It causes inefficiency at school
and on the job, poor decision-making, accidents, and even
sexual problems. In chapter 4 we discussed achievement needs
and how test scores relate to anxiety. Sarason (1975) found
that students with high test anxiety do more poorly on exams,
especially important tests, than less anxious peers, but they
profit more from the teacher's hints, suggestions, and advice
about taking the test. Janda (1975) observed that males with
sexual anxiety had difficulty perceiving the difference between
warm, friendly, approachable women and cold, aloof ones.
Other males notice the difference easily. 
9.
Anxiety and fear causes us to avoid many things we would
otherwise enjoy and benefit from doing. People avoid taking
hard classes, trying out for plays or the debate team,
approaching others, trying for a promotion, etc. because they
are afraid. It's regrettable. Let's do something about it. 
                
Ways of Handling Stress and Anxiety
How to Cope With Stress, Anxiety, and Fears
After determining the nature and seriousness of the stressful
situation you are in, your next task is to decide what you can do about
it. Do you need professional help? If not, how well can you handle the
threatening or challenging situation you face? Your answer to this
question--your ability to cope--determines, along with your
assessment of the importance and severity of the problem, how
anxious or scared you will be. This is where your skills, knowledge,
practice, experience, optimism, courage, etc. come into play--where
they pay off for you. This is where you pit all your self-help ability
against the threatening forces created by your situation. Your level of
anxiety will indicate the outcome of this battle: if you develop and
carry out a good battle plan, you should hold the anxiety to a
moderate level (assuming the stresses are controllable). If you feel
helpless, deny or run away, or, worse yet, blame yourself for the
problems, you will have a high level of distress in the long run
(Kleinke, 1991). 
Several studies have evaluated the effectiveness of ordinary
methods of dealing with stressful situations (Billings & Moos, 1981;
Lazarus & Folkman, 1984; Carver, Scheier & Weintraub, 1989). The
most effective methods of untrained people were: take responsibility
for planning a way to cope, take rational composed action and avoid
rash impulsive reactions, seek advice and support, look for something
74
to "get out of it," i.e. to learn from difficult situations, express feelings
privately but not publicly, stay confident, and use humor. The poorest
responses to stress were: being hostile and confrontive, publicly
venting strong feelings, self-blaming, indecisiveness, ignoring or
denying or downplaying the problem hoping it will go away, keeping
feelings to self or suppressing emotions, giving up trying, and escaping
by watching TV, working, eating, smoking, or drinking a lot. 
In short, people who handle difficult situations well are (1) quick to
take responsibility for handling the problems that come along, (2)
confident of their ability to deal with life's challenges, (3) actually able
to assess the situation accurately, get help as needed, and devise a
good plan, after considering many alternative approaches, and (4)
effective in carrying out the plan, learning and growing with each
problem so they can face the future with optimism. Well, of course!
That's Superhuman! The question is how do you learn all these good
things, right? 
Coping is not a process that comes easy or natural to anyone
(although skilled copers make it look easy). It requires a
conscientious, determined effort to learn about specific ways of coping
with diverse stresses long before the troubles arrive, an openness to
many solutions, careful observation of many peoples' coping
experiences, the courage to try different kinds of solutions, and a
willingness to honestly evaluate the effectiveness of your efforts to
handle stressful situations. Coping with stress requires effort over time
and involves the same self-help steps as any other problem (chapter
2). 
Now, let's get familiar with a wide variety of theoretically sound
ways of handling stress. Since there are so many sources or causes of
stress, there will be many possible "cures" or means of relief.
Moreover, your stress-reduction techniques need to be tailored to you
personally. The only way to know if some self-help method will work
for you is to try it. That may seem overwhelming but you need to be
familiar with many approaches because you will face many different
kinds of stress in your lifetime. The more competent you are with
many alternative solutions to problems, the better your chances of
winning your battles with stress. Do not try to control stress with
cigarettes, alcohol, excessive eating, shopping, gambling, excessive TV
or music, etc. 
Some treatment methods will probably work for you whether you
understand where your stress came from or not. A quick, easy solution
is great... sometimes. For instance, a relaxation technique or
tranquilizing drugs will slow and calm you down. If the stress is short-
lived, a little relaxation may be all you need. However, if the threat
you face is persistent, relaxation or drugs, either legal or illegal, deal
only with surface symptoms, they do not remove or alter the
underlying threatening causes. So, when the relaxation or drug effect
wears off, the original stress usually comes back. And, you are back
where you started. As with behaviors, many stresses can not be
75
mastered without understanding the causes and history of the
emotions. The treatment you need may have to be tailored to your
specific problem (which includes your unique underlying sources of
anxiety, if any). Miller and Smith (1993) provide tests to determine
the source and type of stress you are experiencing, then they suggest
techniques for your type of stress. It may be reasonable, though, to
try a quick, easy method first and see if it works. 
Some self-help approaches may, at first, seem unlikely to work.
For instance, say, you want to reduce your tension and anxiety, to
escape the pressures you are feeling. What probably seem to you most
likely to be effective are techniques that would help you calm down
and relax. And those methods are certainly reasonable choices, but
research has shown that having positive experiences and feelings
decreases our negative emotions, including stress, anxiety,
depression, anger and dependency. So, an anxious person might also
want to focus on increasing the positive events and feelings in their
life. This might include planning and doing interesting things, stopping
to "smell the roses," looking for the positive aspects of your situation,
reading and practicing positive self-changes (more optimism, more
happiness, higher self-esteem, greater toughness), taking pride in
planning and using ways to handle the anxiety, having more fun,
seeking more and deeper social contact and support, etc. There are
many ways to get where you want to go--be open-minded but make
use of research-based self-help methods. 
The purpose of the chapter, thus far, has been to give you an in
depth "understanding" of stress which will, in turn, give you confidence
and motivation to DO SOMETHING! Here is a list of possible self-help
approaches, but first heed this caution. 
WARNING: If you have serious psychological problems, you should
seek professional help immediately and not attempt self-help at all by
yourself.
What are serious problems? Being so anxious or confused that you
can't read extensively and carefully plan a self-help approach. Being so
distressed that you feel you must have quick or instant relief. Being so
upset that you seriously think of suicide. Being so uncomfortable that
you drink or use drugs excessively. Being so physically disabled,
especially with heart disease, brain damage, asthma, ulcers, or colitis,
that you require medical supervision and approval before undergoing
stress of moderate intensity. Being so psychologically concerned that
you already take psychopharmacological drugs or have a
76
psychotherapist with whom you should consult about any self-help
efforts. If any of these conditions apply to you, see a professional (or
continue with the one you are seeing). 
Attacking the behavioral-environmental parts of the problem
Confront the stressful situation
There are researchers who contend that the most effective way
(maybe the only way) to reduce a fear or phobia is to repeatedly face
and handle the scary situation (Marks, 1978; Jeffers, 1987; Greist,
Jefferson & Marks, 1986), if you can. You need to find out that the
imagined awful consequences don't actually occur (Epstein, 1983;
Rachman, 1990). So, if you are afraid of swimming, go swimming
every day and do it safely. If you are uncomfortable meeting people,
go to parties and socialize more, go out of your way to meet new
people. If you are afraid of speaking up in class, try to ask a question
or make a comment, when appropriate, every day in some class. Take
a speech class. 
This idea of getting back on a horse that has thrown you as soon
as possible is not a new idea. Almost 100 years ago, Freud said that
talking to a therapist would not overcome specific fears; instead you
have to confront the frightening situation. Most therapists today agree
that it is essential to practice approaching and handling stress, rather
than avoiding it. First, it may help to learn a good approach by
watching others (a model), seeking advice (read chapter 12!), or
correcting some false ideas you have about the situation (see
cognitive methods). Then, one might want to covertly (in
imagination) rehearse or to role-play with a friend an improved
approach to the situation (see chapter 13). Certainly some planning
and practice may be helpful, but don't get bogged down over-
preparing. Go do something! Take a friend along if there is any danger
or if you need support. You may also prefer to expose yourself to more
threatening situations gradually, developing skills and confidence as
you go. Marks (1978) suggests it doesn't matter much if you are
scared, what matters is that you have the courage to do it and stay in
the scary situation long enough to master it. The details for
confronting a fear are given in chapter 12.
Keep in mind that we are speaking only of physically harmless
situations. On the other hand, if you are afraid of water, a very real
fear if you can't swim, it would be both physically dangerous and
emotionally traumatic--just plain stupid--to go into deep water. Always
protect yourself from real dangers! 
Exposure doesn't always work well, however. Hoffart (1993) found
that about 50% of agoraphobics (afraid of having a panic attack in
public places) drop out or do not respond to exposure therapy. Almost
half of agoraphobics who stay in therapy and get some benefit
continue to have some symptoms. This has encouraged the
development of other methods, especially cognitive techniques. Also,
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social phobics get only modest benefit from exposure to social
situations. Stopa and Clark (1993) have an explanation of why
cognitive methods may work better with social phobics, namely, social
phobics don't pay attention to actual feedback from others but are
preoccupied with their own negative thoughts ("I'm boring... stupid...
silly") which causes them to avoid interacting. Perhaps (a) social skills
training, (b) more focus on other people's reactions, and (c)
attempting to be more outgoing would make socializing more
rewarding. Certainly, stopping the automatic barrage of negative self-
evaluations while interacting would help. 
Compulsions and little rituals of behavior, like washing our hands
excessively or checking the locks on the doors and windows several
times every night, are an attempt of reduce our anxiety. To stop these
useless behaviors, the most common approach is to expose ourselves
to the situation that sets off the compulsion but prevent the behavior--
the useless rituals--from occurring. See a discussion at the end of this
chapter about obsessive-compulsive disorders. 
Find causes and escape stress
If you don't know the causes of your tension (called free-floating
anxiety), a careful analysis will be worthwhile. As with any other
behavior, consider the suggestions in method #9 in chapter 11. Make
up a rating scale for your anxiety. Whenever the stress increases,
record in a journal the severity and what is going on: when it is, where
you are, what you are doing, whom you are with, what you are
thinking, what you would like to be doing, what else you are feeling,
etc. Try to figure out the causes. Remember social uneasiness,
depression, anger, and other reactions to stress may be inherited.
Also, chemicals and physiological conditions, like poor sleep, diet,
premenstrual changes, and hypoglycemia (low blood sugar), cause
emotions too, so look for those causes as well. 
Escape the stress --if practical, one might simply avoid the
uncomfortable situation. Changing your environment is an important
self-help method. This approach is most appropriate for a short-term
stress, but it can also involve escaping a constantly stressful
environment for a few minutes of relief. For the person under
continuous pressure--a demanding job, conflict with a co-worker, your
own competitive drive, undergoing a life crisis--it is good to "take a
break" every 2 or 3 hours by scheduling and insisting on some time for
yourself. What can you do? Meditate. Nap. Exercise (60% say exercise
mellows them out but few do it). Call a friend. Take a break to
socialize. You can do other things to improve your environment: avoid
the person who "drives you crazy." Take the bus instead of driving.
Reduce the noise. Also, be sure you allocate your time wisely; do the
most important work first, allow a little extra time, learn to say no. 
If you are in an unavoidable stressful environment, build up your
strength whenever you can. Get exercise and plenty of sleep, find
something interesting to do during your time off--a good book, a craft
78
or hobby, a vacation. Relax listening to music or playing a game or
watching mindless TV. Occasionally, take time for yourself, away from
everyone if possible. Do new and fun things on weekends. 
Be sure to examine your own attitude to see if the "pressure" is
coming from you. Are you a perfectionist or a irritable Type A
personality? Do you always have to sound brilliant and look sharp? Are
you frequently angry? Is this because you blame others for your
troubles? Are you anxious to beat out someone in your department?
Ask yourself: how important is this? Maybe you should take the
pressure off yourself and lighten up. Do you always try to please
others, putting in extra time on the job or spending holidays with
relatives or doing what your spouse wants or doing something every
weekend with the children? Decide what you would like to do part of
the time! Try doing something different. 
Sometimes a particularly troublesome task, person, or topic of
conversation could be avoided without any serious loss. By just not
attending to the sources of threat, we can avoid some stresses.
Remember, the experienced parachutist checks the equipment
carefully but doesn't think much about both his/her main and reserve
chutes not opening. Use thought stopping on useless worries (see
correcting misperceptions and the discussion of worries later).
A word of caution: remember escaping from fear is reinforcing.
Also, avoiding a scary task strengthens the frightening ideas and
neglects testing the false ideas that produce the fears. So, when you
stay away from a person or a situation that upsets you, you are likely
to tell yourself "I'm coping with this pretty well," but the fears are still
there. Your life is still restricted. Indeed, the longer and harder you
work to avoid the upsetting situation, the more intense the fear of that
situation may become. Besides, you have no practice coping with
these kinds of situations. So, use this method with caution. 
             
Support and self-help groups
Talk about your concerns with a friend, someone in a similar situation,
a teacher, or a professional counselor. Share your feelings. A
supportive, non-evaluative friend lowers our blood pressure during
stressful tasks. Type A middle-aged males with few friends were three
times (69% vs. 17%) more likely to die than Type A's with friends
(Orth-Gomer & Unden, 1990)--but do tense, sickly, dying males just
not attract friends or do friends improve our health? In any case, it
seems likely that we are less afraid and have more courage when
someone is with us holding our hand (Rachman, 1978). 
It has been estimated that 85% of us have struggled through some
stressful experience in the last five years. Mates are our most likely
source of support, then relatives and friends, then less likely co-
79
workers, parents, and children. If professionals are consulted, it's most
likely to be the family physician and clergy. Talking with anyone is a
good first step but neither (MD nor minister) may be good choices for
extensive help; physicians primarily give drugs, seldom information
about how to cope; some clergy specialize in building guilt, not
reducing stress. For the most competent professional help with
anxiety, go to your Mental Health Center for treatment or call and ask
them to recommend a good private practitioner. 
Currently, many millions of Americans are in support or self-help
groups dealing with over 350 different kinds of problems. Self-help,
sometimes called mutual help, groups are a growing source of help. AA
was one of the first such groups, then women's consciousness-raising
groups caught on in the 1960's. Now there are self-help groups for
almost every conceivable problem. They often limit admission to
people who have personally had the problem being discussed; usually
no professionals or "experts" are admitted. This makes it clear that
your improvement is your job, not in the hands of a "doctor." Members
of the groups share experiences, exchange practical information or
advice, and provide emotional support. Members feel better about
themselves by helping each other. Often the groups are so helpful that
members become intensely involved and dedicated. It is comforting to
be truly welcomed and understood by fellow sufferers. There is no
charge. 
Science is just beginning to evaluate the effectiveness of different
sources of support for different problems. A famous 10-year study at
Stanford found that cancer patients who participated in a support
group lived twice as long as those who didn't meet with a group.
Groups no longer have to meet face-to-face; within the last five years,
four research publications have documented the effectiveness of online
cancer support groups. Likewise, drug abuse prevention groups run by
older students (but still peers) get better results than teacher-led
groups. Many self-help group members are veterans of drug treatment
and psychotherapy; many believe they have gotten much more from
self-help groups than from professionals. The Self-Help Sourcebook
Online (http://www.selfhelpgroups.org/) summarizes more research
suggesting groups provide help also with diabetes, heart problems,
child abuse, mental illness (to both the patient and the family),
children of alcoholics, and other disorders or difficult circumstances. 
Self-help or mutual-helping groups provide many benefits:
suggestions about how to cope, a chance to learn from others'
experience, support and encouragement, meaningful and needed
friendships, and a reduction of guilt (by finding others like yourself),
and an increase in hope (Hodgson & Miller, 1982). Another major
advantage of mutual-helping groups is that they are not only a source
of support but they are also a place where the helpee can become the
helper. It's probably as beneficial to be a helper as to be a helpee,
maybe more so (Killilea, 1976). For more information about such
groups refer to Lieberman and Borman's (1979) Self-help Groups For
Coping With Crises.
80
But the early data suggest that social support is not always helpful
(although usually it is), that the "supporter" can be drained and the
"supportee" pressured, that many poor people prefer isolation to
exposure to a middle class helper, that relatives (e.g. 20% of the
mothers of young mothers) may be intrusive and bossy, that the best
source of support depends on the problem, that it is not the amount of
support but the nature of the help that counts, and that it may not be
the actual support so much as believing that dependable support is
available if and when it is needed that does the most good. There are
even times that you shouldn't help a friend: when he/she doesn't want
help, when he/she has enough help already (you should especially
avoid interfering with therapy), when he/she is doing something you
consider morally wrong, when he/she asks for but never takes your
advice, and when he/she is using you. 
One study illustrates the complexity of deciding "when will support
help?" Veiel (1993) found that depressed women who had been
hospitalized but were now recovered were harmed by post-hospital
stays at home surrounded by close family support. The more relatives
and fewer friends they had and the more they stayed at home and
didn't work outside the home, the more likely these women were to
become depressed again. It is not clear what caused the detrimental
effects, but we shouldn't conclude that support is always helpful. Note
that similar depressed women discharged from the hospital before full
recovery benefited from family support (as did recovered women who
worked and both recovered and unrecovered men). The important
point is: some friendships and group interactions are harmful. For
instance, groups of depressed people who merely share the misery of
their lives and neglect self-help may prolong each other's depression.
Likewise, there is clear evidence (Dishion, McCord & Poulin, 1999) that
interactions between delinquent adolescents lead to more trouble with
the law, drug use, violence, and even maladjustment as an adult.
Science is slowly discovering when and what kind of "support" is
unhelpful. Just as all therapy may not be helpful, all socializing is not
helpful either. 
What does this mean for self-help? First, don't hesitate to seek
help if you need it. And, don't hesitate to offer help. If a friend of
yours is having a hard time, avoiding him/her is far more often a
mistake than a wise decision. So, reach out and show your friend your
concern, then observe to see if he/she wants your help and in what
ways. You don't think you can help others? There are organizations
that specialize in teaching practical ways of becoming a better helper,
one-on-one or in a group. Try Re-Evaluation Counseling
(http://www.rc.org/) or Co-Counseling (http://www.cci-usa.org/) .
Both encourage a simple, believable way of helping and being helped,
based on the benefits of expressing strong feelings safely, called
discharging. Second, if the first group or source of help you reach out
to doesn't seem to be beneficial, quickly try another source of help.
Caution: going to a group with much more severe handicaps than you
have, can be traumatic. Another Caution: interacting at length with
people who have habits and attitudes you do not want to acquire is
probably unwise. Thirdly, one group, no matter how good, probably
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won't be the best source of help with all the problems you might face
in a life-time. Fourthly, self-help groups do not provide all the help you
need; you may need professional help (see Find a Therapist) and you
must use self-help methods outside your group (Tessina, 1993). 
In effect, you are changing your environment by seeking new
sources of support or help. Sometimes new viewpoints are necessary;
intimate friends (lovers, best friends, parents) may be too involved to
be good helpers. Beyond family, friends, physician, and clergy, there is
a bewildering array of possible sources of support, especially now that
the Internet is so popular. Just as it is difficult to know about and to
locate available self-help books, so it is difficult to know the
government supported agencies and the private self-help groups that
offer help in hundreds of problem areas. If you want to try a local
support group, start by calling your local Mental Health Center for
information. Sometimes the local newspaper and phone directory lists
groups. Also, the local United Fund and community library might have
a list of self-help groups. Perhaps easiest and best is to look up Self-
Help Sourcebook Online (http://mentalhelp.net/selfhelp/) which is a
great resource to help you find local groups by location and by
disorder/problem. You can also write or call American Self-Help
Clearinghouse, St. Charles-Riverside Medical Center, Denville, NJ
07834 (Phone: 1-201-625-7101). If there isn't a local group of interest
to you, this organization will help you establish your own self-help
group. The National Self-Help Clearinghouse, 25 West 42nd St., New
York, NY 10036 (Phone: 1-212-642-2944) is also helpful. A book by
Wuthnow (1994) provides information about the pros and cons of
joining a support group. Likewise, there are articles and studies
discussing the advantages, disadvantages, and effectiveness of online
self-help groups, e.g. go to http://www.mentalhelp.net/ or to
http://www.google.com/ and do a search for “effectiveness of self-
help groups.” Also see Dr. Suler
(http://www.rider.edu/~suler/psycyber/acoa.html) and Storm King
People have been drawn by the millions to groups--perhaps
appropriately called communities--on the Internet. How do you find
the best ones for you? I favor the online support groups designed for
many specific concerns, such as at Mental Earth Community
(http://www.mentalearth.com/) or PsychCentral’s Forums
(http://forums.psychcentral.com/). Comprehensive listings of online
support groups are provided by Support Groups.com
(http://www.support4hope.com/index.html) and by Dr. Grohol
Topica offers email discussion lists (http://lists.topica.com/). Email
support groups are also listed by Support Path.com
(
(http://forums.psychcentral.com). Many of the major medical Web
sites and sites for specific psychological problems, like depression,
panic disorder, battered women, rape victims, STD victims, etc. have
their own online discussion groups. Likewise, AOL has its own Online
Psych. Everyone could find a group of interest. 
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A few of the supportive agencies and groups in regard to stress
are: 
Local Mental Health Centers; Alcohol and Drug Abuse Centers.
Professionals work in these agencies; make use of them. Fees
are based on ability to pay. 
Local Alcoholics Anonymous (AA), and Al-Anon or Alateen for
relatives of alcoholics. These are self-help groups; no
professionals and no charge. See alcoholism in chapter 4 for
Web sites. 
Local and online self-help groups based on AA principles:
Gamblers Anonymous, Overeaters Anonymous, Neurotics
Anonymous, Psychotics Anonymous, Parents Anonymous (for
abusive parents), and others. See chapter 4 for possible Web
sites. 
Local and online groups for phobic, abused, abusing,
depressed, manic-depressive, schizophrenic, obsessive-
compulsive, workaholic, sex addicted, over spending, etc.
persons. 
Local and online groups for people who are going through a
crisis, such as death of a spouse or child, divorce of parents,
suicide by a relative, being fired, being dumped, suffering
AIDS, serious injury, mastectomy, vanished children, etc. 
Local diet and exercise clinics (see comments in chapter 4);
online dieting and eating disorders groups. See chapter 4. 
(http://www.parentswithoutpartners.org/) , Big Brother/Sister
ome.htm), Scouts, local sports-recreation programs, Foster
Grandparents, and others. 
Department of Family and Children Services, especially to
investigate child abuse; Welfare Departments; Food Stamp
Program. 
Women's organizations such as Women's Centers for abused
women, Women Against Rape, Day Care Cooperatives,
university programs in Adult Reentry and Woman Studies,
Family Planning Centers, YWCA, Displaced Homemakers
(employment services), Professional Women's Organizations,
Equal Rights Organizations and others. 
Organizations for the aged include Gray Panthers
(http://www.graypanthers.org/), Foster Grandparents, Visiting
Nurses Associations (for health care at home), Elder Hostel
Program (travel and education), Senior Citizen Centers, Council
on Aging or state Department of Aging, Meals-on-Wheels have
free meals for the elderly, and volunteer programs at nursing
homes and hospitals and so on. 
For employment problems: Employee Assistance Programs,
state Employment Office, Job Training Programs, Displaced
Worker Projects, Occupational Safety and Health Hot Lines,
community colleges offer various technical skills courses, and
there are many occupational-professional-union organizations. 
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Personal growth groups, Marriage Improvement Programs
encounter groups, workshops or courses on interpersonal
communication or specific concerns, self-help classes, etc. 
Many support groups are focused on specific health problems:
cancer, heart disease, leukemia, loss of a child, mentally and
physically handicapped children, etc. See the health Web sites
given later in this chapter. 
Warnings: A few self-help groups, similar to religious cults, become dominated by a
highly controlling leader who demands loyalty to him/her or to the group. Be leery of any
group that attempts to control your life. Likewise, avoid groups which offer mystical
experiences, such as talking with the dead or curing physical diseases, or which
specialize in uncovering repressed memories, such as childhood sexual abuse or past
lives.
 
Relaxation training 
One obvious way to counter stress and anxiety is to learn to do the
opposite, to relax. 2,500 years ago, Chinese philosophers, who
believed suffering was a part of existence, suggested a way to avoid
frustration: give up your wants and ambitions! They made a good
point but Westerners find it hard and undesirable to be goalless.
Besides the Buddhist's way, there are many other ways to relax: (a)
progressive (Jacobson, 1964) or deep-muscle relaxation, (b)
stretching or breathing exercises, (c) cue-controlled relaxation (pairing
relaxation with a word like "relax" and using the word as a command
when needed), (d) suggested relaxation of the body ("you are getting
relaxed, your arms are getting warm and heavy..."), (e) suggested
relaxation fantasies ("you are on a warm, sunny beach..."), (f)
cognitive and sensory tasks ("listen to this story...think about your
vacation...concentrate on..."), (g) meditation or Benson's method of
relaxing, and (h) biofeedback. Methods of relaxing are described in
chapter 12. Of course, there is also exercising, having sex, sleeping,
reading, watching TV, socializing, and diverting attention to pleasant
tasks. 
Since we each respond to stress in a different way--some worry,
some get mad, some get stomach or headaches, etc.--we each need
to find our own way to relax. Ask yourself if your anxiety is more
physical or mental. When you are anxious, if it is mostly physical, your
heart will speed up, you'll feel tense, perspire, freeze up, hands or
knees will shake, hands are cold and damp, stomach will get upset,
and you need to go to the bathroom. If your anxiety is mostly mental,
your mind can't concentrate, you have scary thoughts, worry a lot but
can't make decisions, and become obsessed with the problem you
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face. If your reaction to stress is mostly physical, try relaxing your
physical body by exercising, deep muscle relaxation, stretching, taking
a bath, getting a massage, etc. If your reaction is mostly mental, try
relaxation fantasies, meditation, cognitive tasks, reading, TV, calming
self-instructions, pleasant fantasies, etc. Haney and Boenisch (1987)
will help you find relief. 
There is accumulating evidence that the effects of relaxation, no
matter how achieved, last for a couple of hours beyond the 15 to 20
minute relaxation training period. This is true for exercise too. The
exact mechanism for this is not clear, however. The relaxation may
linger on or the stressed person may learn to briefly re-relax
themselves throughout the day. The latter view is suggested by
Stoyva and Anderson (1982) who contend that chronically anxious-
psychosomatic-insomniac patients have lost their ability to rest.
Biofeedback confirms this theory somewhat since anxious people
maintain physiological tension and psychological uptightness much
longer than other people. Thus, the best approach may be to teach
ourselves how to relax every few hours during stressful days. 
We may even be able eventually to develop a more relaxed
personality. Try to stay calm. Attend closely to what others say and
do. Don't interrupt. Talk less and speak softly, slowly, and in a gentle
manner. Don't get angry; just try to understand the other person's
viewpoint. Say enough to show you are empathic. Breathe slowly and
smile a lot. But don't be phony. 
Relaxation methods have helped with many kinds of stresses--
general anxiety, Type A personality, and psychosomatic disorders.
Many of the professional treatment programs emphasize frequent
relaxation of the muscles and reducing mental strain, such as self-
criticism, worry, and the excessive demands that we make of
ourselves ("do the laundry, fix the car, prepare a speech..."). Indeed,
one study indicated that relaxation does not occur because we relax
our muscles but rather because we relax our brain and stop sending
out "try harder messages" to our body (Stilson, Matus, & Ball, 1980).
How to relax by changing our thoughts is described in chapter 14.
Some of us apparently need to relax muscles, others need to stop
certain thoughts, others need to exercise, others need to sleep more
or better, others need to cuddle and have a massage, and others need
to read or listen to music, i.e. "different strokes for different folks." If
you don't know what you need to relax, try different approaches (see
chapters 12 and 14). Don't use smoking, drinking, bingeing, and
coffee as a way to relax. 
Some self-help approaches may, at first, seem unlikely to work.
For instance, say, you want to reduce your tension and anxiety, to
escape the pressures you are feeling. What probably seem to you most
likely to be effective are techniques that would help you calm down
and relax. And those methods are certainly reasonable choices, but
research has shown that having positive experiences and feelings
decrease our negative emotions, including stress, anxiety, depression,
85
anger and dependency. So, an anxious person might also want to
focus on increasing the positive events and feelings in their life. This
could include planning and doing interesting things, stopping to "smell
the roses," looking for the positive aspects of your situation, reading
and practicing positive self-changes (more optimism, more happiness,
higher self-esteem, greater toughness), taking pride in planning and
using ways to handle the anxiety, having more fun, seeking more and
deeper social contact and support, etc. There are many ways to get
where you want to go--be open-minded but make use of research-
based self-help methods. 
Desensitization
A method that must be considered for overcoming unreasonable or
excessive fears. This well researched procedure is based on the belief
that a strong relaxation response can gradually overpower and inhibit
a fear response to a particular stimulus. The desensitization method
involves first relaxing, then imagining mildly scary situations, and
works up to relaxing in the most scary (but not actually dangerous)
situations. This is a painless method of reducing anxiety or fear
reactions because you must stay deeply relaxed throughout the entire
process. It avoids all stressful actual confrontations with the scary
situation, being done entirely in one's imagination. So it is easy to
carry out and always available--it just takes fantasy (see in vivo and
Exposure for versions that require confronting the real situation). The
method was developed by a psychiatrist, Joseph Wolpe (1958), and
based on classical conditioning, using the same principles as Watson
and Jones in the 1920's. 
Extensive research has evaluated desensitization, indicating it is an
effective method, but powerful placebo or suggestion effects are just
about as effective, suggesting the method may not add a lot beyond
the expectation of improvement. Wolpe (1980) has claimed that the
method is also helpful with many psychosomatic disorders because it
reduces the underlying anxiety. No competent self-helper should
overlook desensitization as described in chapter 12; it is potentially
useful in any situation with any unwanted emotion. 
Flooding and venting feelings --experiencing and releasing intense
emotions is thought to be beneficial in a variety of ways. First of all,
Freud sought intense emotional reactions in therapy, called
abreactions. These repressed memories usually involved very painful
early childhood experiences. The patient would relive these
experiences and as a result gain insight into the source of his/her
current problems. With this new understanding, the fear, neurotic
behavior, or psychosomatic complaint will go away, supposedly. Primal
therapy, which uncovers the hurts of birth and early childhood, is
based on the same assumptions. The newer therapies by John
Bradshaw and others, which reclaim and nurture the hurt inner child,
also relive the disappointments of childhood. In a sense, like
desensitization, this is confronting the inner sources of fears and
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traumas, usually from childhood and often well repressed (see the end
of this list). 
Secondly, Stampfl & Levis (1967) developed a treatment method
that involved telling phobic patients horror stories that aroused their
intense fears. It was called implosive therapy and is now known as
imaginal flooding. The idea is for a phobic person to imagine scary
situations and experience the fear as intensely as possible. Usually the
therapist vividly describes the scary scenes, deliberately frightening
the patient as much as possible (he/she is told the purpose). The
phobic person continues imagining the stressful scenes for a long time.
Gradually the emotional reaction to the ghastly images declines.
Eventually the patient is imagining the terrifying fantasies but not
responding with fear. In this way, much like cue exposure for
compulsives, the connection between a stimulus (flying) and a
response (fear) was broken, i.e. unlearned. And, the patient has
learned that he/she can stand intense fears. 
Thirdly, another way to reduce a fear using flooding is to place
yourself in the actual frightening situation until the fear "runs down."
As in Exposure, the confrontation could result in a strong fear
response initially that gradually declines. Suppose you had a fear of
heights or elevators. Getting on an elevator might be terrifying but if
you stay on it all day, you learn three things: (a) nothing terrible
happens (beyond the initial stress and possible motion sickness), (b)
by the end of several hours you are going up and down without fear,
and (c) you are not weak, you can stand stress, you can master the
fear. Flooding is the treatment of choice for agoraphobia. 
Fourthly, a similar approach, using flooding, involves the
paradoxical intention of trying to increase a fear or anxiety. For
example, a female student in my class had a fear of the dark,
particularly coming home and imagining that someone was lurking in
the dark to assault her. She had never been attacked but it was a
serious and long-standing fear. First, she tried self-desensitization. It
did little good. Then she decided that whenever these scary fantasies
started, instead of resisting them she would try to see just how scary
she could make them. Much to her surprise, after trying to really scare
herself a few times, the fears diminished. It seemed to her as though
the unwanted fantasies went away (gave up?) as soon as they lost the
power to upset her. 
People who have panic attacks often think they are going to faint
or are having a heart attack and will die. So, therapists using
paradoxical intention may ask the patients to exaggerate their
symptoms, e.g. they might be instructed to become frightened and
sweat or to faint or to try to bring on a heart attack. Of course, these
dire expectations, that phobics desperately try to avoid, can't
ordinarily be produced even when they try hard to do so. So, people
can learn to "take charge" of their symptoms and, thus, the attacks
lose their power to scare the victim. 
87
Lastly, see the extensive discussion of catharsis in chapter 7. It is
commonly thought that getting feelings off your chest is helpful,
especially sadness and anger. Certainly many people find it helpful to
"have a good cry" or to admit openly that they are nervous and to "let
go" of those feelings. Telling others about our fears and doubts may be
the first step to finding out we aren't weird and to overcoming the
stress. 
Stress inoculation 
Epstein (1983) believes stress and anxiety are naturally reduced in
daily life by repeatedly and gradually thinking about more and more
upsetting aspects of a frightening situation. If the emotions become
too intense, however, the fears may build instead of diminish. But if
our anxiety responses remain within certain limits as we ruminate, we
can reduce our fears by imagining over and over specific details of
confronting our boss or jumping out of an airplane. It is a natural
healing process. If true, it is another explanation for desensitization.
We may not need to be deeply relaxed. 
What are the therapeutic implications of Epstein's notions? That we
can reduce unrealistic fears by experiencing (in reality or in fantasy)
the scary situation so long as the feared harm doesn't occur. We must
fully experience the stimulus situation without distortion or defenses.
So start with less scary aspects and work up to the most scary (like
the desensitization hierarchy--see chapter 12). As we experience the
stimulus and the fear, we come to realize that it is our view of the
situation--our incorrect expectations--that make it so scary, not the
actual stimuli. We learn to see the situation realistically. We gradually
reduce the fear response--so that we can be fairly calm parachuting
out of a plane at 10,000 feet. That is stress inoculation. 
For some people, stress inoculation is basically learning to "talk
yourself down" or facing a stress and finding ways to handle it. For
others (Meichenbaum & Cameron, 1983; Meichenbaum, 1985), "stress
inoculation training" is a complex therapy process (see method #7 in
chapter 12). It is a major part of Cognitive Behavior Therapy and
involves (a) helping the patient become a better observer and a more
accurate interpreter of incoming information. (b) Teaching stress
management skills, such as social interaction, problem solving, and
how to use self-instructions for relaxation, self-control, and praise (see
method #2 in chapter 11). (c) Help in applying the various self-help
skills in life. In short, this method is designed to be used by a
therapist, although the techniques are similar to what you are learning
in this book. In fact, written how-to instructions for stress inoculation
were recently provided test-phobic students (Register, Beckham, May
& Gustafson, 1991). The written material alone helped. 
Use "nervous energy" --channel the anxiety created by stress
into constructive, beneficial activities, such as taking a course,
preparing for a promotion, helping others, etc. Hans Selye believed
that meeting challenges, like competing in sports or being active in a
88
cause, produced "good stress" which gives us a rush or a "high"
feeling. Good stress keeps us motivated and enthusiastic about life.
So, Selye recommended that we expose ourselves to as many good
stresses as we can handle, so long as we don't get over loaded. When
a person becomes over loaded with good or bad stress, he/she should
use the energy in a way that works off some tension, e.g. playing
tennis, jogging, walking, doing aerobics, hard physical work, etc. In
short, make stress work for you. Turn frustrating obstacles into
exciting challenges. 
A related concept is that we need some stress--some pressure, not
too much--to do our best. Every athlete knows that he/she needs keen
competition to become his/her best. Every student should be aware
that the quality of his/her education is, in large measure, determined
by the motivation and ability of the competing students. The wise
person seeks, welcomes, and uses this pressure to achieve his/her
own highest potential. 
 
Develop toughness and skills
Physical demands must be made on the body to develop strength, we
must be exposed to bacteria and diseases to develop immunity to
them, and humans may need to be exposed to stresses and emotions
before we develop coping mechanisms and toughness. Type A
personalities with their hurried, competitive, tough, aggressive
behavior are actually weak at coping with stress, their bodies take a
long time to return to normal after becoming upset (and they have a
lot more illness and die earlier). Dienstbier (1989) points out that
people in very demanding and responsible positions develop very
healthy reactions to stress, providing they are in control and have an
opportunity to cope. If you give someone lots of responsibility and
little power, however, they develop very unhealthy reactions, including
feeling helpless. 
How do you develop toughness? By being repeatedly exposed to
demanding situations while having the skills, power, courage, and
confidence to deal with the challenges. It may help you become
psychologically tough if you physically exercise, but I suspect you
must gradually handle more and more stressful, difficult problems and
interactions at work or in your personal life, not just in the gym. Thus,
using relaxation methods to overcoming fears is only the beginning;
true toughness and durability comes after hard knocks. As we
discussed in Exposure above, our attitude has to change from "I can't
stand it" to "I can handle it." 
Salvatore Maddi and Suzanne Kobasa (1984) studied healthy
executives and tried to discover ways of increasing toughness. They
found hardy people were (a) committed to their work (they, like self-
actualizers, have a mission they believe in), (b) have a sense of
control over what happens in their life, and (c) zestfully seek and take
89
on challenges, feeling they will learn from the experiences. They
seldom get sick. They were tough. Maddi and Kobasa then tried to
teach less hardy managers to be psychologically tougher using three
methods: problem-solving to reduce the stress (much like the chapter
you are reading right now), focusing (for gaining awareness of hidden
emotions, see method #5f in chapter 15), and self-improvement
projects (to improve self-esteem and a sense of mastery). So, by
learning self-help, you are getting tougher (IF you expose yourself to
tough situations and come out a winner most of the time). You have to
move on from just handling anxiety to taking the many risks involved
in making lots of positive things happen in your life. 
Skills training --if we feel inadequate, one solution is to become
more adequate, even over-compensating for our real or imagined
weakness. Chapter 13 provides a variety of skills which might reduce
stress. Examples are: problem-solving ability, decision-making skills,
social skills, assertiveness skills, empathy responding skills, time