11

In This Issue: } How Stress Affects Your Health

} 6 Soothing Ways to Ease Stress

} The New Age of Stress at Work

} Reduce Stress With Time Management

When stress grips your body, you know it. Your heart starts pounding, your muscles tense, your stomach feels tied in knots. Sometimes this response can be a good thing. It may help you escape from an attacker or win your tennis game. However, continued stress can have negative effects on your physical health.

The stages of stressOver 50 years ago, a scientist named Hans Selye recognized that stress was a major cause of illness. He broke the stress response into three stages, which he called the general adaptation syndrome.} The alarm stage occurs when you are frightened

or under threat. Your body goes on red alert, releasing stress hormones such as adrenaline and cortisol. These increase strength and concentration. Your heart speeds up, sending more blood and oxygen to your muscles so you

can take quick action. This “fight or flight” response can be lifesaving, but if it is prolonged it can take a toll on your body.

} The resistance stage occurs after the initial extreme reaction. Your body tries to adapt to the continued stress. If the stress passes, you can start to rebuild your defenses. If it becomes long-term, you move to the third stage.

} The exhaustion stage is the “burnout” or overload phase. Continued pounding by stress depletes your body’s reserves, which puts you at risk for disease.

This sequence may happen in response to either a physical threat (such as being in a car accident) or an emotional one (such as being laid off from your job). Facing multiple longterm stressors piles extra strain on your system and can quickly lead to exhaustion.

Stress Newsletter

How Stress Affects Your HealthStress can have far-ranging negative effects on your health. Learn what happens when you live with long-term stress.

22

Stress

The effects of stressStress can have effects throughout your body on both your physical and mental health. It can affect:} Digestion. Stress hormones slow the release of stomach

acid and interfere with how well the stomach can empty itself. This can cause stomachaches. These same hormones cause the colon to work faster and may lead to diarrhea.

} Heart and blood vessels. High levels of the stress hormone cortisol increase your heart rate and your blood pressure. Cortisol can also raise your cholesterol levels. These factors raise your risk for heart attacks and strokes.

} Immune system. Normally, your immune system responds to infections by releasing chemicals that aid in the healing process. The stress response weakens your immune system by reducing the release of chemicals, slowing wound healing and making you more likely to get colds and infections.

} Weight. Cortisol makes you crave fats and carbohydrates, which can cause you to gain weight. Cortisol also makes you more likely to put on weight in your abdominal area. Weight gain in this area raises your risk for heart disease and diabetes.

} Mental health. Being bombarded with stress hormones creates a constant state of tension and anxiety. Over

time this can set you up for depression, headaches or other problems, especially if they run in the family. Also, because your body is in a heightened state of arousal, you may have trouble sleeping.

Regaining your balanceIf stress has taken over your life, it’s time to regain some control. Your health depends on it. Here are some ideas:} Make time for regular, moderate exercise. It’s one of

the best stress-busters, and it can improve your mood and help control your weight. Check with your doctor to see what activity level is right for you.

} Spend some time doing things you enjoy. Go to a funny movie, take your kids fishing or have dinner with a friend.

} Learn some relaxation techniques, such as deep breathing or meditation.

} Treat yourself well. Make time for healthy meals and getting enough sleep. Avoid smoking, drinking too much and overeating.

If you still cannot get a handle on your stress, talk to your doctor. He or she might recommend a counselor who could help you find other ways to reduce or manage the stress in your life.

6 Soothing Ways to Ease StressLearn ways to calm the stress in your life.

Feeling stressed out? Most Americans do.Not all stress is bad. A certain amount of stress enables executives to perform at their peak. But too much stress can be harmful. Stress is linked to such chronic conditions such as heart disease and depression.

The trick is to manage or control stress to keep it within healthy limits. If your stress meter is soaring, learn to relax. Here are some soothing ways to handle the stress in your life.

33

Stress

1. BreatheYou’ve heard the expression, “take a breather”? Sometimes just five minutes of deep breathing is enough to ban stress.Most people take shallow breaths that fill only part of the lungs. Deep breathing gets more oxygen into the lungs and can help calm the brain. Try these steps:} Sit or lie with one hand on your belly.} Breathe in through your nose, filling your lungs. Focus

on making the hand on your belly rise.} Breathe out through your mouth, trying to empty

your lungs as much as you can. The hand on your belly should move in as your muscles tighten.

} Continue these deep, slow breaths, in through your nose, out through your mouth, making your belly rise and fall.

This simple but powerful exercise can be done almost anywhere. It can be combined with meditation or muscle relaxation.

2. Relax your musclesProgressive muscle relaxation is another simple way to ease stress. Practicing it can help you become aware of when you are holding stress in your body. Relaxing your muscles can help your mind relax too.} Lie down in a quiet place. Take a few minutes to

breathe slowly and deeply.} When you feel relaxed, start with your right foot.

Squeeze the muscles as tightly as you can. Hold while you count to 10.

} Relax your right foot. Take a few deep breaths.} Next, squeeze the muscles in your left foot while you

count to 10.} Relax and breathe.} Slowly work your way up your body (legs, belly, back,

chest, arms, neck, face), squeezing and relaxing each group of muscles.

3. Say yes to yogaYoga is a system of exercises (called asanas) for gaining bodily or mental control and well-being. The philosophy is that the breath, the mind and the body are so closely linked that whatever you do to one will affect the other. In addition to easing stress, yoga can improve strength, balance and flexibility.

Yoga is gentle form of exercise that is safe for most people when it’s practiced correctly. Consult a trained yoga teacher. Make sure you ask your doctor before you start any new activity.

4. Try tai chiTai chi is a series of postures that flow into one another through connecting transition moves. These slow, graceful and precise body movements are said to improve body awareness and enhance strength and coordination. At the same time, they are supposed to help the practitioner achieve inner peace. Like yoga, it is designed to enhance both physical and emotional health.Tai chi is a low-impact aerobic activity, so you can de-stress and burn some calories at the same time. Another advantage to tai chi is its low risk of injury.Take a tai chi class or buy a book or instructional video. Once you learn how to do tai chi, you can practice almost anywhere.

5. MeditateMeditation is a centuries-old spiritual practice that is also a powerful stress-buster. You learn to relax while focusing on a word, a sound or your own breathing. It can have a deeply calming effect.There are many different types of meditation. One type is mindfulness meditation. You can practice mindfulness while sitting in a quiet place or while walking. The key is to keep bringing your focus back to your breathing or your steps. When distractions come into your mind, observe them without judging, and let them go. The technique is simple, but achieving the desired result takes practice.

6. Get a massageIn massage therapy, the hands (or sometimes forearms, elbows and feet) are used to manipulate the soft body tissues. A good massage is not only relaxing, but it may also have some real healing benefits. Some studies have shown that the kneading and pressing of muscles slows the heart rate, lowers blood pressure, improves blood circulation, relaxes muscles and helps reduce stress levels.If you can’t fit in or afford a visit to a spa, ask your partner or friend for a neck, back or foot rub. Trading massages can be a relaxing way to reconnect after a stressful day.

44

Stress

The New Age of Stress at WorkLong-term job stress can grind you down. Learn more about stress and how to tame it in the workplace.

Your job used to be challenging but manageable. Now it seems no matter how fast you run, you can’t keep up. Your inbox is piling up and your boss is on your back.This scenario is all too common, according to the National Institute of Occupational Safety and Health (NIOSH). In national surveys:} 40 percent of workers say their job is very or

extremely stressful.} 75 percent say workers suffer more job-related stress

than workers in the previous generation.} 25 percent of employees say their job is their number

one stressor.Even if you love your job, long-term stress can grind you down. Read on to learn more about stress and how to tame it in the workplace.

From cave to cubicle: the stress responseStress is a necessary survival response that draws upon instinct, hormones and muscle. Our distant ancestors’ “fight or flight” response to stress allowed the human race to survive in a hostile environment.These days we no longer brandish a spear or need to outrun predators. Yet we still have the same quickened heartbeat and surging stress hormones when faced with a stressful situation. Those biological responses are lifesaving when we’re in danger, but they can damage our health if they become a way of life.A small dose of stress can be helpful. It may help you meet a deadline or score high on a presentation. But if stress becomes an everyday reality, it can lead to poor health. At first it can cause headaches, upset stomach and poor sleep. Over time it may lead to chronic health problems such as depression, back pain and heart disease.

Take your stress temperatureCertain factors are well-known causes of stress in the workplace. Some of these include:

} Lack of control or input} Heavy workload or too many responsibilities} Not being recognized or rewarded for your work} Working in dirty, noisy or uncomfortable surroundingsAre any of these at the bottom of your stress? Are there other factors that play a role? Pinpointing the causes of stress can help you find solutions.

Tame your stressThe good news is we live in an age when addressing work stress is important for business. Many managers know that stressed workers are not as productive, are more likely to get injured and take more sick days than workers who aren’t stressed.

If work stress is getting you down} Talk to your manager. Ask if there are ways to

restructure your job to make it more manageable. Be positive. Offer solutions, not just complaints.

} Explore work resources at your company. Find out if there is an employee assistance program (EAP) or stress management course you could access.

} Take good care of yourself. Be sure to eat well, get enough sleep and make time for exercise. You’ll handle stress better if you’re healthy.

} Get help if you need it. You may want to take a meditation, yoga or tai chi class. You might also consider seeing a therapist who could help you seek solutions to your work situation.

55

Stress

Reduce Stress With Time ManagementThe key to getting stress under control is effective time management. With good time management, you’ll get more done, feel better about yourself and lower your stress level. These tips can help.

Make a planUsing a to-do list is the most powerful way to get control of your time. Spend a little time at the start of each week making a list of what you need to accomplish. Some people use a day planner, electronic device or spreadsheet, but you can use a simple notebook.

PrioritizeOnce you have made a to-do list, rank each item by importance. Some people use a system of high, medium and low. Concentrate on things of high importance or urgency. Move those that are medium or low to the bottom of the list.

Be realistic

Allow a reasonable amount of time for each task. Don’t schedule every moment. Leave some space in your day when you can take breaks or fit in the unexpected.

Include time for yourself

Your health and well-being are important, so make sure you allow time for good meals, exercise, relaxation and your family and friends.

Review your to-do list every day

Check off items as you finish them. This can give you a sense of accomplishment. What you don’t finish one day can be moved to the next day.

Avoid procrastination

Putting off things you need to do just creates more stress. If you feel overwhelmed by a task, break it down into smaller parts. Tackle one part at a time. Give yourself a little reward when you finish each part.

Get help if you need it

See if there are tasks you can delegate to someone else. It can pay to give up some control in exchange for a less hectic schedule.

Learn to say “no”

Accepting more and more responsibilities is guaranteed to increase your stress. If you already have a full plate, don’t take on more.

Get organized

Spend a little time setting up your workspace so you know where things are. Choose a spot where you put your keys, briefcase, purse or other items you use every day. Then use it every time. This can save a lot of frustration and hours of wasted time.

Beware of time-wasters

Phone calls and email can interrupt concentration and eat up productive hours. Set up your phone to take messages and schedule a time of day to return calls. Ditto with email. Set aside a time for it (maybe 15 minutes in the morning and 15 minutes after lunch). Identify other time-wasters and how you could deal with them.

© 2012 United HealthCare Services, Inc.UHCEW484815-001

11

In This Issue: } 10 Ways to Simplify Your Life and Dial

Down Stress Levels

} Who Can I Talk to About Mental Health Issues?

} Can Exercise Keep You Mentally Sharp?

} Treating Depression

It seems like everyone is stressed out these days - from your co-workers, to your friends, to the person standing next to you in line.

Stress, by itself, isn’t necessarily bad. Low or even moderate amounts of stress can be good for us, provided we manage it in healthy ways. But poorly managed stress can take a toll. Heart disease, fatigue, and obesity are just a few of the potential consequences.

If stress is bothering you, consider the following 10 ways to regain control:

1. Recognize your symptoms. Your signs of stress may be different from someone else’s. Some people get angry. Others have trouble concentrating or making decisions. Some feel worried or depressed. For some, stress leads to physical symptoms such as headache, back pain, upset stomach, or trouble sleeping.

Mental Health

10 Ways to Simplify Your Life and Dial Down Stress LevelsStress may be inevitable. But how you deal with it is largely up to you. Here are some tools to help you manage the stress in your life.time. Even quick workouts can benefit your heart.

Video Spotlight:Job Stress: How to Keep Your Cool

Attention Deficit Hyperactivity Disorder: Myths and Facts

22

Mental Health

2. Identify the sources. What situations trigger your stress? Among other things, your stress may be linked to your family, health, work, or personal relationships. Keep in mind that stress is often caused by a change in your life, negative or positive. Marriage, divorce, job loss, or a promotion may all increase stress.

3. Evaluate your coping strategies. Examine the ways in which you deal with situations that cause you stress. Responses like smoking, drinking alcohol, or eating too much may feel good in the short run, but they can cause long-term harm.

4. Learn to say ‘no.’ Sometimes the best way to deal with unnecessary stress is to avoid it. Know your limits, and refuse to take on more responsibilities than you can handle.

5. Plan ahead. Don’t let your to-do list get out of control. Think about your day, and decide which tasks are the most important. Do those items first. Let other tasks drop to the bottom of - or even off - your list.

6. Create time to relax. It’s not always easy, but it’s important to make time for yourself. Take vacations or other breaks. Make time to read a good book, listen to music, watch a comedy, or just have a warm cup of tea. Some people find deep breathing exercises helpful for relieving stress.

7. Exercise regularly. A brisk walk, a bike ride, and a trip to the gym are just some of the physical activities that can help prevent or reduce stress. Aim to get 2 hours and 30 minutes of exercise each week. Talk to your doctor before increasing your activity level.

8. Eat healthfully. Eating balanced, nutritious meals throughout the day will help you cope with stress by keeping you energized and focused. Also, cut back on caffeine. You’ll feel more relaxed and will likely sleep better.

9. Talk to family and friends. Simply talking with supportive people can often bring stress relief, even if the stressful situation doesn’t change. By the same token, limit the time you spend with people who only add to your stress.

10. Get help. If stress seems overwhelming, consider talking to a mental-health professional. He or she can offer healthy stress-busting techniques.

33

PsychiatristsA psychiatrist is a medical or osteopathic doctor with special training in the diagnosis and treatment of mental and emotional illnesses. Like other doctors, psychiatrists can prescribe medication. A psychiatrist should have a state medical license and be board-eligible or board-certified by the American Board of Psychiatry and Neurology.

PsychologistsA psychologist has an advanced degree from an accredited graduate program in psychology and two or more years of supervised work experience. Most states require a doctoral degree and a state license for psychologists. Psychologists can make diagnoses, do psychological testing, and provide therapy.

Clinical social workersSocial workers have a master’s degree in social work from an accredited graduate program. They are trained to make diagnoses and provide individual and group therapy. Their qualifications should include a state license and membership in the Academy of Certified Social Workers.

Licensed professional counselorsA licensed professional counselor has a master’s degree in psychology, counseling or a related field. Licensed counselors are trained to diagnose and treat mental and emotional disorders. They are required to have a state license.

Marriage and family therapistsA marriage and family therapist (MFT) has at least a master’s degree and two years of supervised clinical experience. They are trained to diagnose and treat mental health and substance abuse problems from a family perspective. They can provide individual, couples, family and group therapy.

Certified mental health counselorsThese professionals have a master’s degree and several years of supervised clinical work experience in mental health. They can diagnose and provide treatment for many emotional and mental health issues. They are certified by the National Academy of Certified Clinical Mental Health Counselors.

Certified alcohol and drug abuse counselorsCertified alcohol and drug abuse counselors have specific clinical training in alcohol and drug abuse. They can diagnose substance abuse issues and provide individual and group counseling. They must carry a state license.

Mental Health

Who Can I Talk to About Mental Health Issues?Many different types of professionals offer talk therapy. Learn more about their training and how to choose a therapist.If you are struggling with an emotional problem, a mental health professional can help. Psychotherapy offered by a trained and licensed therapist can often successfully treat relationship problems and many mental health conditions, including depression and anxiety.

Many different types of professionals offer psychotherapy (talk therapy). Some of them can also prescribe medication if needed.

44

Can Exercise Keep You Mentally Sharp?Exercise helps both body and mind.Exercise maintains your body by keeping it fit and strong. Physical activity also helps ward off serious conditions like heart disease, diabetes and cancer. But exercise doesn’t just work wonders for your body. These effects apply to your brain, too. Physical activity sustains brain function and wards off declines in mental ability, too.

Experts say that exercise can help prevent mental decline as we age. Regular exercise may enhance memory and mood, and may improve our ability to juggle multiple mental tasks.

The aging brainSevere memory loss or other serious mental impairments are most often caused by disease. But age-related mental declines may be the result of decreased brain activity and stimulation. Both mental and physical exercise can help keep your brain sharp.

Your brain with exerciseSo how does physical activity boost brain power? It helps you:

} Think more clearly. Getting your heart rate up pumps blood to the brain. This helps your brain perform better. Low-impact exercises like walking may be best for “clearing your head” because muscles don’t work hard enough to use up extra oxygen and glucose.

Mental Health

Psychiatric nursesThese are registered nurses (RNs) with a master’s degree in psychiatric and mental health nursing. They may also be called advanced practice registered nurses, psychiatric nurse practitioners or psychiatric clinical nurse specialists. They can diagnose and treat people with mental health disorders, and in most states they can prescribe medication. They are certified by the American Nurses Credentialing Center and must have a state license.

Pastoral counselorsPastoral counselors are clergy with a degree in mental health and extensive supervised clinical practice. As a result, they approach emotional issues from both a psychological and a spiritual perspective. They are required to have certification from the American Association of Pastoral Counselors.

Choosing a therapistPicking a therapist is a very personal matter. It’s fine to get a name from a friend or family member. But a therapist may work well with someone you know and yet not be a good match for you.

To choose a therapist, first talk with him or her on the phone or in person. Find out about licensing and level of training, approach to psychotherapy, fees and any specialty area. Some therapists focus on one area, such as treating depression, traumatic stress, substance abuse or grief.

If you feel the therapist is a good fit for you, the next step is to make an appointment. But if you are not satisfied after meeting in person, keep looking. The type of training or license a therapist has is not the most important factor. What matters most is how well you connect with the therapist. You should be able to talk openly and feel heard and understood.

55

Mental Health

} Improve your memory. Experts say that exercise brings on the growth of nerve cells in the hippo campus, the region of your brain involved in memory. Studies show that seniors who walk regularly have better memories than inactive older adults. And the more you exercise, the better your memory gets.

} Better your ability to do complex tasks. One study found that aerobic exercise helped people with mild cognitive problems to organize information, pay attention and multi-task better. This may be because exercise helps the body move glucose to the brain, which improves its function.

} Possibly ward off Alzheimer’s disease. There is growing research that suggests regular exercise is linked with a lower risk of Alzheimer’s. Brain activity has been shown to increase with physical fitness. One study found that adults who exercised three times a week had a much lower chance of getting Alzheimer’s than those who didn’t.

} Ease depression and anxiety. Exercise increases the level of serotonin (a chemical that affects mood) in the brain. Low levels of serotonin are linked with clinical depression. Some studies show that exercise can work just as well as medication in treating mild depression in some people.

} Reduce stress. Physical activity helps lower the release of cortisol in your body. Cortisol is a hormone linked with stress.

} Help keep your blood pressure in check. High blood pressure can harm blood vessels in your brain and reduce your brain’s oxygen supply. This damages nerve cells that are used for decision-making and memory.

Time to get movingCheck with your doctor first before starting an exercise program. Then use these tips to get moving:

} Pick an activity you enjoy. Try walking, swimming or playing tennis. You’ll be more likely to stick with exercising if you enjoy doing it.

} Start slowly. Work your way up to at least 30 minutes of exercise most days of the week.

} Get a workout buddy. Exercise can help build friendships. It may be easier to stick to a fitness schedule if you have someone counting on you to show up.

Even if you’ve lived an inactive lifestyle up until now, regular activity will help keep your body - and brain - in shape.

Treating DepressionDepression is an illness, and it can be treated successfully. Learn about medications, talk therapy and other treatments that may be used.A first step in escaping from the fog of depression is recognizing that it is not part of who you are. Depression is an illness like high blood pressure, asthma and other medical problems, and it can be treated successfully. With proper treatment and support, you could feel better in a matter of weeks.

For treatment to work, you need help from an experienced doctor, one who can recommend treatments that are likely to work for your form of depression. A doctor may prescribe medications and/or refer you for psychotherapy or other treatments.

66

Mental Health

Antidepressant medicationsThere are many medications that are used to treat depression. Experts think they work by altering the levels of brain chemicals that affect mood. Antidepressants include:

} Selective serotonin reuptake inhibitors (SSRIs). These are the most commonly prescribed antidepressants. They include fluoxetine (Prozac), sertraline (Zoloft), paroxetine (Paxil) and citalopram (Celexa). Common side effects include nausea, insomnia, restlessness, dry mouth and decreased sex drive. SSRI side effects are usually mild, and most of them will go away within a few weeks.

} Other antidepressants such as bupropion (Wellbutrin), venlafaxine (Effexor) and duloxetine (Cymbalta).The side effects of these drugs vary. They may include nausea, fatigue, weight gain, nervousness, dry mouth and blurred vision.

} Tricyclic antidepressants such as amitriptyline or desipramine. Tricyclics are an older class of drugs, and they are more likely than SSRIs to cause side effects such as drowsiness, dry mouth and constipation. They may be tried if other antidepressants don’t work.

} Monoamine oxidase inhibitors (MAOIs). These older medications are rarely prescribed because of the risk of serious interactions with other drugs and certain foods.

Important things to keep in mind: } Antidepressants need time to work. It may be

as long as 12 weeks after you start taking an antidepressant before you feel better.

} People respond differently to antidepressants. Don’t be discouraged if one medication doesn’t work for you. Your doctor can change the dose or prescribe a different medication.

} Antidepressants often work best when combined with psychotherapy. Therapy can sometimes get to the root of the problems that contributed to your depression.

} Do not suddenly stop taking an antidepressant. This can cause unpleasant symptoms, including a return of depression. When you are ready to quit, your doctor can work with you to slowly taper the dose.

NOTE: Anyone being treated with antidepressants, especially people being treated for depression, should be watched closely for worsening depression and for suicidal thinking or behavior. Close watching may be especially important early in treatment or when the dose is changed (either increased or decreased). Discuss any concerns with your doctor. Call 9-1-1 right away if you or anyone is having thoughts of suicide or death.

NOTE: SSRI antidepressants, such as sertraline, citalopram and paroxetine, may slightly raise the risk of congenital heart defects if taken during the first trimester of pregnancy. Discuss the benefits and risks of antidepressants with your doctor if you are pregnant or plan to get pregnant. Do not stop taking these medications without first talking to your doctor.

PsychotherapyPsychotherapy involves talking with a mental health professional. It could be a psychiatrist, social worker, psychologist or counselor. Therapists can help depressed people gain insights about themselves and make positive changes in their behavior and feelings.

There are many types of psychotherapy to choose from. Two that are commonly used to treat depression are cognitive-behavioral therapy and interpersonal therapy.

} Cognitive-behavioral therapy can help identify and correct negative thought patterns. This can improve a person’s outlook and sense of self-worth.

} Interpersonal therapy looks at the relationships that may be at the root of depression.

Psychotherapy can often help relieve symptoms of depression. In general, people with severe depression respond best to a combination of psychotherapy and medication.

77

© 2012 United HealthCare Services, Inc.UHCEW574706-000

Transcranial magnetic stimulation (TMS)Transcranial magnetic stimulation is a treatment that stimulates the brain by delivering strong, focused magnetic pulses. It was approved in 2008 to treat major depression in adults who have not responded to standard treatments. TMS has fewer side effects than most other treatments for depression. Scalp pain and headache are the most common.

Electroconvulsive therapy (ECT)During ECT, a mild electric shock is applied to the brain while the person is asleep under anesthesia. ECT is a highly successful treatment for people with severe depression who can’t take medications. It may also be life-saving for those at high risk for suicide. Side effects may include short-term memory loss and confusion.

Light therapyPeople with severe seasonal affective disorder (SAD) often need bright light treatment (phototherapy). For this treatment, a person sits in front of a special light box each morning for half an hour or longer. The light box emits bright white light that is about 10 times stronger than regular lights. Side effects are uncommon but may include headaches or eyestrain.

Mental Health