Overly stressed: the global emotional tsunami.
Subject: Stress (Psychology) (Risk factors)
Stress (Psychology) (Care and treatment)
Recessions (United States)
Recessions (Influence)
Recessions (Psychological aspects)
Stress management (Methods)
Author: Reidenberg, Daniel J.
Pub Date: 09/22/2009
Publication: Name: Annals of the American Psychotherapy Association Publisher: American Psychotherapy Association Audience: Academic; Professional Format: Magazine/Journal Subject: Psychology and mental health Copyright: COPYRIGHT 2009 American Psychotherapy Association ISSN: 1535-4075
Issue: Date: Fall, 2009 Source Volume: 12 Source Issue: 3
Geographic: Geographic Scope: United States Geographic Code: 1USA United States
Accession Number: 208639924
Full Text: People everywhere seem to be more stressed. Work seems to be harder, complaints about everything in people's lives are being heard more frequently and with greater intensity, and reports of feeling anxious and depressed are being heard more and more. What happened to stress tolerance and why can we no longer relate this solely to the economy?

Most will say that the bad economy is hurting them personally. People are stressed about losing retirement funds, homes or home equity, and employment, along with dealing with mounting bills and credit card debt. Isn't this just an economic issue? Why can't we seem to be able to handle one area of our lives being so troublesome? What else is impacting us so profoundly? Therapists are seeing many things in their patients: fear, panic, anxiety, depression, irritability, relationship issues, and addictive behaviors.

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"Supportive friends are vital for people facing economic crisis," says Lanny Berman, Executive Director of the American Association of Suicidology. "A lack of supportive relationships is tied to higher suicide rates among the unemployed. Unemployed adults have two to four times the suicide rate of employed people, but coping skills in hard times vary widely," he adds (USA Today, Marilyn Elias, 3/12/09). Unfortunately, I often hear people saying they don't have the time or energy for others' problems; they are doing everything they can just to hold on themselves.

It is no surprise that economic challenges are taking a toll on the emotional and physical health of people. According to a USA Today/Gallop poll (conducted nearly one year ago--9/23/08), "more than half of Americans report irritability or anger, fatigue, and sleeplessness, and almost half say they self-medicate by overeating or indulging in unhealthy foods (USA Today, Sharon Jayson, Oct. 2008).

The economy is down. Financial pressures are hitting from every angle. Relationships are strained. Emotional and physical health is overly stressed. What is going on? Typically, we can handle stressors one, two, and sometimes three at once. Our tolerance level for stress mediates and we use various coping skills to accommodate. Even when these coping skills fail, most often we can seek professional and personal help and get through the tough times. But what we're dealing with today is an all-out global "emotional tsunami," and we are all dealing with it.

Tsunami

According to a friend of mine, famed meteorologist and entrepreneur Paul Douglas, a tsunami is "triggered by undersea earthquakes. They form immediately and usually reach the coastline within 1-3 hours of the quake itself, leaving some time for evacuation to higher ground. They slam ashore and then quickly recede" (personal conversation, July 17, 2009).

It is undeniable that we are in an "economic tsunami" of sorts. There are so many economic forces collapsing in unison, making it almost impossible to argue against this. However, it is my belief that what is happening today goes beyond just economics; several factors are coming together to create an "emotional tsunami."

Unlike the weather-related tsunami as described earlier, an emotional tsunami is worse. An emotional tsunami like the one we are experiencing is everywhere. It is not discriminatory; it impacts everyone. It is touching all aspects of our lives; not just economical, but social, political, emotional, medical, spiritual, and educational as well. Its path is world-wide and the wave seems to be never-ending. No one knows when this will end; for some of us, it may not end in this lifetime. That uncertainty and complete lack of control over when recovery and rebuilding can begin separates this from an economic, one-factor or one location tsunami to an emotional, multi-Factor, worldwide tsunami.

How long can we sustain this?

I have asked family, friends, and colleagues about the impact this seems to be having on those around us. Some people talked about it ending "someday," but they don't really have a sense of when that will be. Others have said: "I'm not sure I'll be around when it gets better," or "It may never return to what it was, at least not in my lifetime." Along the full continuum of pessimism to optimism, I get a strong sense that it is almost as if everyone is just holding on. As therapists, we know that "just holding on" takes a toll on the human psyche. Everyone can hold on for different lengths of time. As therapists, it behooves us to help clients assess their stress level, coping strategies, and how they are moderating stress. Early intervention could prevent disaster for many who can no longer "hold on" and begin to feel that letting go is an answer or option.

Chronic stress creates a vicious cycle for us. Our bodies are pre-wired to feel the stress and come up with solutions to resolve it. When the stresses begin to overwhelm our systems (i.e., multiple stresses, intensity of stresses, uncontrollable nature of ongoing stresses, etc.), our body's stress response system goes into overdrive. This too has limits. It is not only possible that the economy--only one facet of a person's life--could truly impact the emotional or mental health of one person, it is actually happening on a broad-based scale.

According to a 2009 editorial in The Japan Times, "The economic downturn has extended into the very psyche of Japan. A national health report at the end of last year found that one in five Japanese adults depends on alcohol or drugs to fall asleep. Stressful lifestyles are the root cause, with 58 percent of men and 64 percent of women describing themselves as under stress." In an economic-driven society that ties business success with life success, they are concerned about the economic times and suicide rates. "The (Japan) national suicide hotline registered 700,000 calls last year, with suicide rates 50 percent higher here than the world average, according to the World Health Organization." The editorial ended with a somewhat ominous statement: "As the economic crisis deepens, these psychological problems will likely worsen."

So the difference appears to be only in one's perception. In a weather-related tsunami, if there is enough time and the ability to warn of impending doom, there is an anticipation phase in which people prepare, assume, and mostly fear what will happen. They are not sure they will get through the disaster, and stress will build because of the unknown. The response (again, only if time allows) is to take whatever control they have to prepare for what will happen next.

My wise 88-year-old grandmother said to me: "It's like the singer who sees an article in the paper that says 'they've arrived on the music scene.' Well that didn't just happen overnight. They've been playing gigs for years. And this didn't just happen overnight either." She is right. None of us heard the earthquake that started the tsunami. As a result, we did not have time to prepare once the wave started coming ashore. Now people can't seem to take control of their lives because of the uncertainty in the economy and the emotional toll it takes on them as it worsens. We are living in a never-ending cycle of not knowing when this will end and/or what else might happen during the waiting period of the storm. Worse yet, we don't even know when the end of the storm will come and if/when rebuilding can start. We also don't know who or what will survive. Because there is no way to evaluate the damages from this emotional tsunami since we don't even know yet what they will be, how do we keep going on? Some tell me they just want to know: "Tell me when it is going to be over and I will figure out how to get through it." Others are just the opposite: "I don't know what's going to be left for me on the other side of this, so I can't think about that." In both cases, people are left with overwhelming struggles that are getting worse. "Recessions like the current one must be addressed by a two-pronged approach--practical and psychological" (The Japan Times, 2009). With that in mind, I would like suggest some things you can do with your clients to help them survive the current global emotional tsunami:

1. Talk with them about limiting the amount of time they watch or listen to various television/radio shows. After all, we are creatures of habit and familiarity. We watch, read, and listen to what feels most closely aligned to us and our thinking. In today's economically and highly politically charged climate, it might be helpful to suggest that clients limit their time listening to or watching political programs. As my wise grandmother said to me: "Rather than challenging me to be open to other views, watching that stuff only reinforces what I already think. This doesn't help me. It only makes me more frustrated with the other side!"

2. We seem to be a nation focused on the bad news. Limiting how much of the daily news we take in can help reduce the stresses we hear about everyday (homicides, assaults, foreclosures, war, etc.). Instead, suggest that your client replaces negative news time with something relaxing, peaceful, or calming such as listening to their favorite music, taking a walk or warm bath, working in the garden, or reading a good book. Writing or reconnecting with an old friend are additional positive things one can do to relieve stress.

3. Although required under ethical and state guidelines, too often I find therapists don't do and/or don't revise and update their treatment plans regularly with clients. Take this opportunity to revise your treatment plan with your client who should be an active participant in the process. In coming up with new goals that are more aligned with their current stresses, needs, wants, problem areas, etc., they may feel a greater sense of control over their lives and see a charted course of action. Help clients use their strengths to build on their areas of weakness. Also, try to use (and help clients use) positive, future-oriented language in their treatment plan and goals.

Another technique that may be a bit unconventional but in no way unethical would be to review your progress notes (or sections of them) with your client. Share with them phrases or impressions you've noted in their chart over time. After all, this is their life and it is their chart, so they can see it if they'd like. Take the opportunity to help them see the progress they have made and of which you have been a part. Your ability to provide them with a bigger-picture view can be very beneficial as they are living their daily lives and sharing with you week after week.

4. Help your clients define a new idea of "normal." People often set their expectations too high. In times of great stress through trying to attain these unrealistic expectations, you can help your clients redefine what realistic and achievable goals are. These can be the actual goals or the timeframe in which they are striving to meet them. Redefining a new "normal" for a client's particular issue or situation can help them see more accurately how far they've come or how successful they've already been, thereby increasing their self-esteem and reducing or eliminating the stress caused by trying to keep reaching (or truly exceeding) their definition of "normal."

5. When we lose control, we try to regain it in many ways, both internally and externally. We often look outside for direction or toward someone who can provide us that direction, hope, and leadership as we deal with the loss of control or chaos in our lives. Talk with your clients about how to find a mentor, role model, or leader whom they feel they can relate to, understand, and want to follow. Help them as they seek out qualities that are positive, healthy, and focused. Alternatively, some clients may benefit from you helping them develop their leadership skills and talents. This will give them a greater sense of control over their immediate and long-term success.

6. Know your stress level. You are not immune to what's happening, and your clients know that. Without going into self-disclosure and/or making the session about you, it is okay to acknowledge the fact that you too are human and have stress. Denying this may actually alienate you from your clients or give them a false sense that they should be trying to emulate you since you seem to have it so under control. Model awareness of the stress; manage it and find resources that best help you with it. In addition, I think it is important to acknowledge that as therapists we have the added stress with respect to our businesses. If we lose a client who can't afford to see us any longer, it directly impacts our finances, but we also maintain a level of concern for their well-being, knowing they will no longer receive any of our services. It is truly important to recognize and acknowledge your stress.

7. Remind your clients to do simple things daily to help reduce stress and improve their overall health. Eat healthy meals three times a day. In times of stress, many turn to high-calorie, sweet foods when fruits provide better nutritional value and do not have the same drag on the body as does candy. Get the right amount of sleep for your body. The amount of sleep our bodies need varies from 6-10 hours a day. The best gauge of determining if you have slept enough is not having to wake up to an alarm clock. Finding time to exercise, even 10 minutes a day, helps increase metabolism, energy, and stamina.

8. Do a perspective exercise with your clients. Ask them to write out their stresses on a piece of paper (e.g., spouse, kids, job, credit cards, etc.). Have them rate each on a scale of 1-10. Then ask your clients to look through a magazine and select some people for the purpose of comparison. Ask them to also pick a few people from their neighborhood and from other countries. Compare the levels of stress they believe each feels and discuss with them how important perspective is. They may find that when they felt their stress level for one factor was an 8 or 9, it really should have been a 5 or 6.

Here is an example. Steve is a 52-year-old married male with two kids, one in college and the other a junior in high school. He's worried about bills, driving his son to various activities, and a downturn in his business (about 15-20%). Steve rates his stress level at a 6. John is 50 and is also married with two kids who are the same ages as Steve's children. He has the same worries as Steve, but his wife was recently diagnosed with stage 3 breast cancer. John rates his stress level at a 7. There are a number of ways you can do an exercise like this with your clients to help them more accurately assess their stress levels and give them a sense of perspective. Steve (above) might say John's stress level should be much higher. This reaction provides an opportunity to discuss your client's stress level and how they can make changes in their life to moderate it where they can.

9. Get some rubber bands (wide enough to write on) or balloons. Ask your client to create a word or code system for their stresses and write it on the rubber band or the balloon. Let's use the balloon as an example here. Ask your client to blow up the balloon to where they believe their normal stress level to be. Measure that circumference. Now ask your client to blow up the balloon to where they feel their current stress level is and measure that. Next, have them blow up the balloon as far as they think they can without popping it. Discuss with them how each stress area impacts another stress area (i.e., if you are more stressed at work you are also more likely to have less stress tolerance at home with your spouse or children). Over time, watch the stress level of the balloon and work with your client on stress-reducing skills.

10. For those of you who work (or have worked) in the field of chemical dependency, you know that helping clients learn about their higher power and how to turn things over to that higher power is immensely important in treatment and long-term recovery. A higher power can be anything (spiritual, nature, place, etc.), but it is best not to have it be a person. In times like these when we need something to rely on no matter what, a higher power can be very helpful and relieving. Helping clients find a higher power to turn to that knows more, better understands, and is more able to handle the stress can help remind us of our humility and ability.

As I write this article, there is breaking news of legendary anchorman Walter Cronkite's death. I wonder how the "most trusted man in America," who as recently as last fall was reportedly still in fairly good health, could leave this world so suddenly. Like many, my guess is that he would have been impacted, at least on some level, by the market collapse of the fall and winter. Do you suppose he ever thought, "Will I live long enough to see this through?"

My grandmother does not believe she will see the end of our current crisis. Not only does she not believe that she will live long enough to see the economy return to what it was just a year or two ago, she doesn't even think about it that way. She said to me: "When you get to be even close to my age, you see everything quite differently than you did when you were younger. Back then, there was time for things to change even if it was far out in the future. Right now, I don't think that any of us can see how far out that might be."

Some do not know if they will survive this tsunami; Walter Cronkite did not. Hopefully most of us will, but maybe Cronkite's greatest gift to all of us is to learn that we all need to live in the moment with what we've got in front of us. The rest is truly either history or speculation, and as Walter Cronkite told us, "That, America, is the way it is."

By Dan Reidenberg, PsyD, FAPA, DAPA, CRS, MTAPA

Daniel J. Reidenberg, PsyD, FAPA, DAPA, CRS, MTAPA, is the chair of American Psychotherapy Association's Executive Advisory Board and has been a member since 1997. He is a Fellow and Master Therapist of the American Psychotherapy Association, the chair of the Certified Relationship Specialist, CRS, Advisory Board, and executive director of Suicide Awareness Voices of Education (SAVE) in Minneapolis, Minnesota. Contact him with your thoughts at dreidenberg@save.org.
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