Stress Management - Sheldon Cohen Stress Test

Stress Management


Stress isn't just a catchall complaint; it's being linked to heart disease, immune deficiency and memory loss. We're learning that men and women process stress differently and that childhood stress can lead to adult health problems. The worst part is, we inflict it on ourselves.

By Jerry Adler


  • NEWSWEEK: Question and Answer Online Session June 14, 1999
  • The famous Sheldon Cohen STRESS-TEST


Time magazine's June 6, 1983 cover story referred to stress as "The Epidemic of the 80's" Today we know that Stress has become so pervasive, that it seems to permeate everything and everybody. There is Stress in being a student, a Child, a Teenager a Parent, a Doctor, a Patient, a Lawyer, a Boss, a Cop, a Driver, a Passenger, a Senior Citizen, a Business person, a Debtor, a Creditor etc. Then there is the stress of Bereavement, Divorce, Separation, Poverty, Social Isolation, Moving, Retirement, Bad debt loss etc. Today heightened attention to the role of stress due to its proven linkage to the cause of Heart Disease, Hypertension, Sudden Death, Depression, Anxiety, Smoking, Obesity, Alcoholism, Substance Abuse, Cancer, Arthritis, Gastrointestinal, Skin, and a host of infections and immune system disorders.

Stress was vital to survival once-an innate response to danger. Civilization, gives you the opportunity to experience an adrenaline rush at every traffic light. And-since all you're doing is sitting in your car-the elaborate preparations your body makes are wasted. Worse than wasted: every heartbeat at elevated blood pressure takes its toll on the arteries. The excess fats and glucose don't get metabolized right away, so they stay in the bloodstream. The fats contribute to the plaques that form inside blood vessels, which can lead to heart disease or strokes; high levels of glucose are a step in the direction of diabetes. "If you mobilize in the first place for a nonsense psychological stressor," says Robert Sapolsky of Stanford, a leading authority on stress, "by definition your defense becomes more damaging than the imaginary challenge."

A whole new body of research shows the damage stress wreaks on the body: not just heart disease and ulcers, but loss of memory, diminished immune function and even a particular type of obesity. That which doesn't kill you, it turns out, really does kill you in the end, but first it makes you fat.

Yet the stress reaction obviously serves an evolutionary purpose. It is, essentially, a response to danger, in two distinct phases. The first of these, involving the "sympathetic-adreno-medullary axis" (SAM), is the familiar flight-or-fight response. Your brain perceives a threat-a lion crouched in the brush is the classic illustration-and sends a message down the spinal cord to the medulla, or core, of the adrenal glands (chart), signaling it to pump out adrenaline. In a matter of seconds, the body is transformed. To prepare for exertion, blood pressure and heart rate skyrocket; the liver pours out glucose and calls up fat reserves to be processed into triglycerides for energy; the circulatory system diverts blood from nonessential functions, such as digestion, to the brain and muscles. This is precisely what you need if your goal is to survive the next 10 minutes.

The second phase to the stress reaction kicks in five to 10 minutes later. This "hypothalamic-pituitary-adrenocortical axis" (HPA) seems more closely associated with emotional and intellectual stress. Researchers have many clever ways of producing intellectual stress, such as asking subjects to name the color of ink a word is written in (blue) when the word itself spells out the name of a different color (red). The HPA axis originates in the hypothalamus, in the middle of the base of the brain. The hypothalamus signals the pituitary to produce a substance called ACTH, which stimulates the adrenal cortex to produce a set of hormones known as glucocorticoids: cortisone, cortisol and corticosterone.

The action of these is complex, because hormones almost always work as part of a loop of positive and negative feedbacks. Glucocorticoids seem to stimulate the hippocampus, a part of the brain vital to memory and learning. But an excess of these hormones can actually be toxic to the hippocampus. People with above-average glucocorticoid levels-including those with depression and post-traumatic-stress syndrome-tend to have impaired memory and cognition. Their hippocampi may actually appear shrunken in an MRI scan. Glucocorticoids also suppress parts of the immune system. Researchers still don't understand why the body should suppress immunity during times of stress-if anything, the opposite would seem to make sense. But the negative effects are clear: chronic stress leaves one more vulnerable to infections.

And, amazingly enough, stress can even change the shape of your body. Since the stress reaction involves mobilizing the body's fat reserves for energy, Peeke says, it makes sense to store that fat near the liver, which processes it so it can be metabolized in the muscles. Sure enough, fat cells in the abdomen appear to be especially sensitive to glucocorticoids, and people with a high concentration of those hormones tend to accumulate fat around their middles-a potbelly-even if the rest of their bodies are thin. Researchers think that waist-hip ratio, the relative circumference of those two body parts, could be a useful way to identify people at risk for stress-related disease.

Stress is an unavoidable phenomenon of life. Without stress, there would be no life. It is like getting exposed to radiation. Long term exposure to it could be hazardous. Increased stress results in increased productivity - up to a point. However, this level differs for each of us. The right degree of stress can create magnificent tones. We all need to find the proper level of stress that promotes optimal performance, and enables us to produce harmony in our lives.



Physical activity:

Start an individualized program of physical activity.

Decide on a specific time, type, frequency, and level of physical activity.


Plan to eat foods for improved health and well-being.

Use the food guide pyramid to help select healthy food choices.

Eat an appropriate amount of food at a reasonable schedule.

Positive thinking.

Refocus the negative to be positive. They say a 'dawn follows every morning'

Talk positively to yourself.

Plan some fun.

Make an effort to stop negative thoughts. Associating with people who have a positive approach and outlook to life helps.

Social support:

Make an effort to interact socially with people.

Reach out to individuals.

Nurture yourself and others.Religious institutions aid in this respect


Use relaxation techniques. There are many relaxation techniques (guided imagery, listening to music, etc.); learn about and try different techniques and choose one or two that work for you.

Take time for personal interests and hobbies.

Listen to one's body.Take a mini retreat.

Take up a hobby

Try Yoga.


NEWSWEEK: Question and Answer Online Session June 14, 1999

Jerry Adler and Geoffrey Cowley answer your questions on Stress:

Jerry Adler and Geoffrey Cowley: Hi, this is Geoff Cowley. I wrote the sidebar on strategies for combating stress. Happy to try my hand at a few questions.

Jerry Adler and Geoffrey Cowley: Hi, Jerry Adler here...don't ask me anything hard, it stresses me out.

St. Paul, MN: Do you know roughly what percentages of ulcers are caused by stress?

Jerry Adler and Geoffrey Cowley: That's hard to answer. Sapolsky, who's the authority on this, writes "it's probably safest to say that stress is not at the top of the list of causes, but near the top, with the capacity to worsen the effects of some of the more common causes, such as genetics or diet." And, of course, the new thinking on ulcers is that they're caused by bacterial infections.

Santa Monica, CA: You end the article by stating that the challenge is to master our responses, not the threats... this is true, however, don't you think we need to master the source of the threats as well?

Jerry Adler and Geoffrey Cowley: JA: Well, if you can stop people from honking at you when the light turns green, more power to you. Most of the stressors we encounter in life are probably out of our control, is my reaction.

Springfield, Mass.: Your articles talk about many therapies for stress. Have you heard of any medications a person can take that will reduce their chronic stress levels?

Jerry Adler and Geoffrey Cowley: GC: Whether we drink gin, take prescription tranquilizers or go to bed on hot milk and valerian, most of us medicate ourselves for stress in one way or another. In moderation, any of these remedies can be helpful. The catch, or course, is that the stronger ones can be addictive and deadly. Dr. Andrew Weil, director of the program in integrative medicine at the University of Arizona, Tucson, teaches a safe, effective alternative called Yoga breath. At stressful moments, stop to inhale deeply through the nose to a count of 4, pause briefly, and exhale to a count of 8. Weil has found that the exercise can
transform a person's physiology in less than a minute. "It lowers blood pressure and heart rate," he says, "and works better than medication to end panic attacks." Feelings of panic and intense anxiety stem partly from a lack of control. Drugs, even when they're effective, reinforce the feeling that control comes from outside. Breathing exercises place you in control of your body. What's more, they cost nothing, and they have no adverse side effects, only healthful ones.

Cleveland, OH: My diet and exercise routine is excellent, but I scored much above average on the "Stressed Out?" test. Regarding long-term effects, is it possible my healthy habits are balancing out mental irritations?

Jerry Adler and Geoffrey Cowley: GC: I often ask myself the same question. The short answer, thankfully, is yes. Regular exercise and a healthful diet have innumerable benefits. Studies suggest that even 30 minutes of vigorous exercise can actually quell the stress response, reducing anxiety and calming the patterns of brain activity associated with it. But if getting to the gym is just another thing to feel stressed about, it may not be doing you much good. Mounting evidence suggests that staying healthy also requires finding time to calm the mind and to connect with others. Dr. Dean Ornish is best known for the dietary component of his lifestyle-based program for combating heart disease. But he likes to tell the story of a patient he had -- a lonely, driven man who though diet and exercise were all there was to health. He adhered almost religiously to the Ornish diet, but dropped dead on a rowing machine as he pushed himself mercilessly to beat the imaginary opponent displayed on a video monitor.

Buffalo, NY: What do you think about the argument that most urban 9-to-5-ers have a higher stress level than those in suburban work environments? I have a friend that works in NYC that's always complaining about stress and I never feel that way, yet we have a similar home environment--three kids, happy marriages, same type of bills each month, and the same field of work. Is it true that the hustle and bustle can be the leading cause of stress?

Jerry Adler and Geoffrey Cowley: JA: It hasn't really be studied scientifically. Actually, one study suggests that, at least for kids, stress can be worse in the suburbs than in the cities...and there's plenty of hustle and bustle in trying to manage a busy suburban life. The pace of our lives is set by technology, which is ubiquitous.
Now, if you're talking about moving to the country, I'm with you there.

New York, NY: I've been getting headaches when I sit and type on my computer. Could they be more related to stress than bad posture?

Jerry Adler and Geoffrey Cowley: JA: Very important not to sit on your computer. But, yes, headaches can be a symptom.

Franklin Square, NY: When I was in college, my menstrual period stopped for approximately nine months. I went to the doctor and she asked me about my lifestyle, daily routine, eating patterns, etc. She came to the conclusion that it was stress-related. Can that really be the cause of such a long absence?

Jerry Adler and Geoffrey Cowley: JA: Yes, severe stress can cause amennorrhea. Nine months is a pretty long time, though.

San Juan, Puerto Rico: A lot is made of the fact that the late twentieth century is more stressful than any previous era, but don't you think that living in past eras was pretty stressful also? Before the advent of modern medicine, a mere bout of flu in your child could end in death. Before the implementation of modern communications technology, getting in touch with a doctor to take care of that child could be a matter of many, possibly life-saving, hours. Just because "life was simpler" 200 years ago, doesn't necessarily mean it wasn't stressful.

Jerry Adler and Geoffrey Cowley: JA: Well, I haven't lived in any past eras so I can't compare it directly...and neither can doctors, because the objective tests for stress didn't exist until recently. But common sense suggests that living in era when children often died before reaching adulthood...and even adults were only one bad harvest away from probably worse than coming back to where you parked and finding your car's been towed away. So, yes.

Youngstown, OH: Are there some warning signs people can watch for to tell if their stress level is too high? And are there some quick 'on the spot'ways to reduce it?

Jerry Adler and Geoffrey Cowley: GC: If you pay attention to your body, it's not hard to recognize a stress response. Our hearts race, our muscles contract, our hands may shake and our palms may sweat. Longer-term symptoms include prologed fatigue, insomnia, lack of appetite, loss of libido and an inability to concentrate. The best remedy I know of for acute, immediate stress is to take a moment to breathe slowly and deeply, clearing your mind of everything but the air passing through your nostrils. The exercise can quickly reduce heart rate and blood pressure, and restore your sense of control. Longer-term stress requires longer-term strategies, as I explain in this week's article.

Cleveland, OH: In your article you state that although women's blood pressure goes up less than men's when they're stressed, they experience stress more often. Does this mean that women also end up suffering more bad effects from stress--or less?

Jerry Adler and Geoffrey Cowley: JA: Not necessarily, except for the part about blood pressure. It is possible that estrogen plays a role in buffering the bad effects of stress, at least for women before menopause (or those in estrogen therapy post-menopause.) Other than that, no one really knows, the research on sex differences is pretty new.

Sante Fe, NM: I moved here a year ago from NYC. I had a job in new media and worked way too many hours a day, almost every day. It did a number on me physically and mentally and I finally got out. Although many larger corporations have noticed this as being a bad practice for their employees, there are still tons of companies our there that don't realize what an effect stress can have on the physical well-being of their employees. Shouldn't there be a nationwide summit on stress in the workplace so that companies will soon realize that in the long run, there wouldn't be as much burnout and turnover if they had services available for these types of people?

Jerry Adler and Geoffrey Cowley: JA: Did you move before or after your options vested? That would have a lot to do with it, I think...As far as the summit goes, the American Psychological Association and the National Institute for Occupational Safety and Health held a conference this past March on "Workstress and Health." Either of those groups ought to have more information for you.

Boone, North Carolina: Geoffrey Cowley's article mentioned that
"Melanoma patients who received six weeks of structured group support suffered only half as many recurrences as their peers". This seems like a success rate that would be competitive with conventional medicine or radiation-based therapies. Does it seem like researchers and the medical community are dedicating adequate resources to investigating these "non-conventional" or "holistic" therapies?

Jerry Adler and Geoffrey Cowley: I agree that the psychological component of chronic illnesses, such as cancer and heart disease, deserves more attention. When a new pharmaceutical drug doubles life expectancy (or halves the number of recurrences) among cancer patients, it quickly becomes the standard of care. That said, I think it's now widely acknowledged that group support is a critical component of cancer care, and most oncology clinics help their patients take advantage of it.

New York, NY: As an adult I notice that I get sick more than I did as a kid. Or when I go on vacation, I'll come down with something. My doctor says that stress is mostly the cause. I thought that germs cause colds and flu. How does stress suppress the immune system?

Jerry Adler and Geoffrey Cowley: JA: Germs do cause colds, of course, but there aren't any more germs around now than when you were a kid, are there? So it could be your immune system isn't as strong as it was, and yes, this could be the result of stress. Emotional and intellectual stress, in particular, result in the release of hormones called glucocorticoids, which suppress immune function. Researchers who sprayed cold germs into the noses of subjects found the ones under more stress got more colds.

Gesundheit. South Dakota: My husband has been searching for just about any excuse for why I haven't been all too chummy in bed. Now due to your cover story, he's convinced its stress. I finally agree with him. Do you think that actually having sex may even relieve some of my stress? I often assume that our problems in the bedroom create stress for me. But maybe it's the other way around.

Jerry Adler and Geoffrey Cowley: JA: Some of the problems you describe here go beyond what magazine writers are trained to deal with. However, the simple answer to your question is, yes, loss of libido can be a symptom of stress.

Somewhere, USA: You discussed the shape of the body changing due to fat deposits around the liver--and resulting accumulations in the belly. Are there specific measurements that can give us an idea of stress: proportions of body?

Jerry Adler and Geoffrey Cowley: JA: Technically, stress contributes to "visceral" fat, the kind that's down under your muscles--as distinct from "subcutaneous", the flabby kind. As far as proportions go, you can't tell where it comes from, but the goal is to keep the ratio of your waist measurement to your hips at .80 or less, to avoid health risks.

Woodside, Calif.: Is exercising enough when considering stress-reduction practices? My doctor says it's not sufficient. He recommends continuing exercise but also getting regular massages and practicing things like yoga. But who has the time for all of that? Any tips?

Jerry Adler and Geoffrey Cowley: GC: It's surprising to discover how you can make time for things -- a new baby, a thrilling book, a new lover-- if they matter to you. You may find that adding a 30-minute massage or meditation session to your weekly routine actually saves you time, by leaving you more relaxed, alert and efficient.

Tucson, Arizona: Will a person who has taken pharmacologic, ie., massive, doses of glucocorticoids, such as prednisone-synthetic cortisone--suffer: 1) permanent brain damage, 2) permanent alterations of stress response, or 3) other permanent effects?

Jerry Adler and Geoffrey Cowley: JA: This is a pretty new field of research. I don't think anyone has looked into the question of brain function and I'm not aware of any evidence on that point. Among the established long-term side effects of synthetic glucocoritcoids are higher risk for osteoporosis and suppressed immune function. That's why these drugs are prescribed so carefully.

New York, NY: In response to the other New Yorker who gets more colds as an adult: I've noticed that I've gotten more colds since I've been in NYC. Do you think it has something to do with the stress of being in a big city like New York--where people don't really care about you and can be rude? Or is it as simple as something like the germs in the subway system?

Jerry Adler and Geoffrey Cowley: JA: If you were the guy who beat me to a seat on the D train this morning, you deserve to get sick. Me, too, for that matter. There have been studies showing a higher rate of heart attacks in New York, compared to other U.S. cities. Whether this is a factor of stress, or pastrami, is unclear. As far as subway crowding goes, the answer is yes, it can give you colds...that's why you're more likely to get them in winter, when you're indoors among crowds more.

Fredericksburg Virginia: Can you discuss stress and its effect on
adolescents. Please include how it affects their development of coping skills.

Jerry Adler and Geoffrey Cowley: JA: What happens at puberty is that the stress responses of boys and girls differentiate--before then, boys and girls react similarly, but at puberty, the protective effects of estrogen seem to kick in for girls and their blood pressure doesn't go up as much as boys'. Extreme stress can suppress growth and result in short stature.

Virginia Beach VA: What did you find out about workplace stress?
What constitutes workplace stress and are we really addressing this adequately?

Jerry Adler and Geoffrey Cowley: GC: There's a common misperception that the busiest jobs are the most stressful. Studies suggest that the real problem is not overwork so much as a lack of control. In a groundbreaking 1990 study, researchers at Cornell Medical College found that workers whose jobs combined big demands with a relative lack of autonomy suffered three times the usual incidence of high blood pressure.
The implication is that smart employers could improve both health and morale by giving workers more latitude.

Laguna Beach, CA: In last week's Time, there was a brief article about virtual therapy at Web sites like What are your thoughts about these types of programs?

Jerry Adler and Geoffrey Cowley: GC: If Time magazine wrote about them, they must be terrific.

Swarthmore, PA: Wouldn't it make sense to lower the immune system response since more energy is required to respond to stress?

Jerry Adler and Geoffrey Cowley: JA: That's an interesting suggestion. I don't think the immune system itself requires very much energy to run (although I'm not an expert on it). However, some researchers have suggested that under stress, the cells of the immune system are destroyed so that the remnants of these cells can be used for energy. Sapolsky discusses this in his book: "In principle, this hypothesis makes some adaptive sense...nevertheless, this idea didn't last long. In a stressful emergency, energy comes from the liver and fat cells, not the immune system. ...If you were at the point of needing so much energy that you were cannibalizing your cells...the immune system would be an unlikely place to start."

New York, NY: I often have to work really late Friday nights. It's very stressful. Any suggestions?

Jerry Adler and Geoffrey Cowley: JA: I do, too, and the solution is to get your story in on time.

Chicago, IL: I am interested in learning more about the way a child's mind develops relative to the amount of stress they see and endure as a child. In particular, there was a comment in your article about children from stressful environments growing up to feel bored if they are not constantly stimulated as adults.

Jerry Adler and Geoffrey Cowley: JA: That's a fascinating area of research, but it's quite preliminary now, and a lot of the evidence comes from animal studies, not human ones. Children in stressful environments do seem more likely to grow up to be "hot" reactors--that is, people who show a large hormonal response to stress later in life.

Brooklyn, NY: Are there good herbal remedies for stress? A back rub and a jog around the block just isn't enough.

Jerry Adler and Geoffrey Cowley: GC: Several of them have won wide followings in recent years. Kava root is a natural tranquilizer that appears safe and nonaddictive. Some people report that St. John's wort helps alleviate stress and anxiety if used regularly. And valerian root, a mild sedative, may help ease stress-related insomnia. For more information on these and other natural remedies, you may want to consult "Healing Anxiety Naturally," by Dr. Harold Bloomfield (1998, HarperCollins).

New York, N.Y.: My son seems to be finding his first year at school a stressful experience and I've noticed he seems to have trouble falling asleep on school nights. Any ideas on how to help a seven-year-old beat stress?

Jerry Adler and Geoffrey Cowley: JA: The experts we talked to suggested that you talk to your child in advance about possible stressful events in school, talk through the scenarios and help them prepare responses, so they have a sense of control.

New York, NY: I wrote in about colds in New York. Your response to my question was slightly inappropriate, because I am a WOMAN! I hope you spend the whole day stressing about your mistake...

Jerry Adler and Geoffrey Cowley: JA: So sorry, my apologies. I've never been beaten to a seat on the subway by a woman.

College, USA: I'm supposed to be studying for an exam in my summer course, instead I'm "chatting" on your site. My question is: How are students with full courseloads and full-time jobs, because their mommy and daddy aren't paying for college, supposed to juggle everything that comes up when they just "have to" get those term papers in or else they'll have to repeat the class and thus spend another grand on tuition. In other words, I don't have the cash for massages and I don't have the spare time to do yoga because I'm either working or at class or in the library. Yikes! I hope this is just the case for my college years.

Jerry Adler and Geoffrey Cowley: JA: Yes, absolutely, life gets much, much better from here on.

Brooklyn, NY: Sometimes it hurts when I smile during client meetings. While I'm presenting slides, I get a searing pain running from the corners of my mouth, all the way down into the pit of my stomach. My co-workers feel that this is stress-related--that my smiles mask a sort of hostility and resentment--and recommend drinking fruit juice to "chill out." What do you think?

Jerry Adler and Geoffrey Cowley: GC: Speaking or performing publicly is, for many people, a horrendous stressor. I doubt fruit juice will solve your problem, but you may be able to ease the tension in those facial muscles by taking a moment before you start to breathe deeply and consciously relax them. Some performers take low doses of propanalol --a beta blocker used to treat high blood pressure -- to counter the paralyzing effects of stage fright. It can be very effective, but it requires a prescription. Don't try it without a doctor's help.

The STRESS-TEST ( Take the famous Sheldon Cohen Stress Test to see if you are 'stressed out')


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