Report on STRESS AND COUNSELING

ABSTRACT
Background
Stress is the general term applied to the pressures people feel in life. The presence of stress at work is almost inevitable in many jobs. However, individual differences account for a wide range of reactions to stress; a task viewed as challenging by one person may produce high levels of anxiety in another. Many People, like employees, develop emotional or physical problems because of stress. The difficulties may be temporary or enduring, and they may be caused by factors at work or out of workplace. No one is immune to stress, for it can affect employees at all level of the organization and when it is too severe or long lasting, it can negatively affect both the individual and the employer. Fortunately, many programs exist for preventing or managing stress. Therefore, it is very important to know what the stress is, how it comes about, and how it affects various elements of job performance. Counselling is also necessary for employees because of job and personal problems that subject them to excessive stress. In this difficult economy, someone may find it harder than ever to cope with challenges on the job. Both the stress we take with us when we go to work and the stress that awaits us on the job are on the rise and employers, managers, and workers all feel the added pressure. While some stress is a normal part of life, excessive stress interferes with your productivity and reduces your physical and emotional health, so its important to find ways to keep it under control. Fortunately, there is a lot that we can do to manage and reduce stress at work. This report discussed on stress, its nature, types and cause; effect of stress on the human being and organizational performance; management of stress; prevention of stress and on counseling.

Report on Stress and Counselling

1. Introduction

Stress is the physical and emotional strain caused by our responses to pressure. The source of stress can be external or internal; the demand can be positive or negative; arguably, there is no life at all without stress. When we are worried about being laid off our job, or worried about not having enough money to pay bills, or worried about our children or family members illness we feel stressed. In fact, to most of us, stress is synonymous with worry. If it is something that makes one worry, then it is stress. Stress can be Acute (short-term) or Chronic Stress (longterm). In this difficult economy, someone may find it harder than ever to cope with challenges on the job. Both the stress we take with us when we go to work and the stress that awaits us on the job are on the rise and employers, managers, and workers all feel the added pressure. While some stress is a normal part of life, excessive stress interferes with our productivity and has impact on our physical and emotional health, so it is important to find ways to keep it under control. Fortunately, there is a lot that we can do to manage and reduce stress at work. Stress is difficult for scientists or anyone to define because it is a subjective sensation combined with varied symptoms that differ for each of us. In addition, stress is not always a synonym for distress. If we consider some situations, like a steep roller coaster ride that cause fear and anxiety for some can prove highly pleasurable for others. Winning a race or election may be more stressful than losing but this is good stress. At the beginning, stress drives us and increases productivity up to a point, after which things rapidly deteriorate, and that level differs for each of us. It is much like the stress or tension on a violin string. Not enough produces a dull raspy sound and too much an irritating screech or snaps the string but just the correct degree of stress creates a beautiful tone. Similarly, we all have to find the right amount of stress that permits us to make pleasant music in our daily lives. A good Manager should always know how to utilize and transform stress so that it will make his under command more productive and less self-destructive.

2.

Objectives of the report

The main objective of this paper is to analysis the stress elaborately and subsequently its effect on individuals life especially in workplace situation. In our chronological discussion, we will also highlight the following features as a whole to understand: The factors, which determine stress; Causes and consequences of stress; Organizational Effects of Stress How to prevent stress Methods for managing stress; and Different types of counseling and their usefulness in stress management.

3.
3.1

Stress: it is almost impossible to live without some stress

Definition and Sign of stress

Stress is a biological term for the consequences of the failure of a human to respond appropriately to emotional or physical threats to the organism, whether actual or imagined. Dynamic condition in which an individual is confront with an opportunity, demand, or resource related to what the individual desires and for which the outcome is perceived to be both uncertain and important. Stress is almost inevitable and it gives life some spice and excitement as long as it is within control. The term "stress" was first used by Hans Selye in the 1930s.He later broadened and popularized the concept to include the response of the body to any demand. In Selye's (another popular Psychologist) terminology, "stress" refers to a condition, and "stressor" to the internal reaction causing stress. It includes a state of alarm and adrenaline production, short-term resistance as a coping mechanism, and exhaustion. It covers a huge range of phenomena from mild irritation to the kind of severe problems that might result in a real breakdown of health.Common stress symptoms

include irritability, muscular tension, inability to concentrate and a variety of physical reactions, such as headaches and incresed heart rate.

LABEL OF STRESS Signs of stress may be cognitive, emotional, physical or behavioral. When people feel stressed by something going on around them their body react bty releasing chemical in to blood that lead to different sign and symptom of stress and body acting either positivly or negetivly depending on situation. Signs of stress include poor judgment, a general negative outlook, excessive worrying, moodiness, irritability, agitation, inability to relax, feeling lonely or isolated, depressed, aches and pains, diarrhea or constipation, nausea, dizziness, chest pain, rapid heartbeat, eating too much or not enough, sleeping too much or not enough, withdrawing from others, procrastinating or neglecting responsibilities, using alcohol, cigarettes, or drugs to relax, and nervous habits (e.g. nail biting or pacing).

3.2

Factor determine the level of stress

It is estimated that one in five people experience work-related stress at some time during their lives. Research has shown that around 12 million adults suffer with mental health problems each year. Most of these suffer from anxiety and depression, much of which is related to stress. In spite of this, it is not always easy for individuals to recognize or acknowledge that they may be
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suffering from work-related stress. Different people respond to pressure in different ways. Following factors are the key determinant of stress and its extend: Importance: How significant the event is to the person? Uncertainty: Degree of clarity over what will happen? Familiarity: Duration: Knowledge: Experience of facing such events in the past Length of time the demands remain in place ? Accurate and relevant information .

However, considering the length of exposure of individuals to key factors the following are a list of responses that in combination may indicate that someone is suffering from stress: Attitude and Behaviour Loss of motivation and commitment. Common symptoms Lack of concentration at home and work.

Working increasingly longer or shorter Impaired sleep. hours. Feeling down, bouts of crying. Running late for meetings, or forgetting Poor appetite. about them altogether. Sexual difficulties. Become easily irritated and are prone to Decreased energy, fatigue. tearfulness. Relationship at Work May experience tension and conflict Tendency to withdraw from social symptoms of anxiety Palpitations, headache, backache,

with colleagues. contact. Work Performance Productivity is reduced. Feel constantly tired and have little
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breathing difficulties. Feeling tense, keyed up, on edge, worrying about things and panic attacks. Sickness Absence Overall sickness absence will increase

long term or intermittent.

energy. Experience indecisiveness. Feel unable to plan and control

workload.

3.3

Type of Stress

Stress is the physical and psychological process of reaction to and coping with events or situations that place extraordinary pressure upon a human being. Such events are usually sudden and often involve physical or emotional loss, such as witnessing cautions or destruction from combat or disaster or the serious injury or death of a relative, friend or co-worker, long away from the nearest ones. It is a normal reaction to an abnormal situation and serves primarily the function of self protection in the threatening situation, inability to concentrate full attention on a particular threat, mobilize maximum physical and prepare for action in order to respond to the threat. Depending on type of response on stress considering the intensity of the stressor that affect individuals performance stress can be divided as follows; Astress Insufficient stress to challenge or stimulate the person. The person regresses to a vegetative state adopting a Leave me alone attitude which may lead to what we call rust out. Eustress Stress of any kind which is beneficial Strategically planned use of controlled stress to produce specific goal towards enhancing wellness Physical training, games, sports, cultural programs, dancing, singing and laughing are example of eustress Distress Any stress beyond the healthy range & debilitating is called distress Have greater effect upon the individuals physical & psychological health Some part of the system breaks down which increases the level of distress and the use of adaptation capacity Unless, the causes withdrawn disease and death results

 May lead to what we call burn out. Moreover stress can also be divided according to extend of its intensity. According to the increasing intensity stress are three types: Basic Stress. Cumulative Stress. Traumatic Stress.

Every individual experiences Basic stress in daily situations that may produce tension, frustration, irritation, anger etc. A persons vulnerability (reaction) is largely determined by ones physical and psychological strength or weakness at these times and thus level of stress will vary accordingly. Reaction to stress depends on: Past experience. Education. Professional skills. Age. Level of physical fitness. Personal self esteem. Management skill of the

organization.

Stress consumes physical, cognitive and emotional energy. So it should not be allowed to accumulate to a point where it cannot be controlled. Cumulative stress is a result of strain that occurs too often (frequency), lasts too long (duration) and is too severe (intensity).In this circumstances, distress leads to exhaustion and other manifestations so that a person is unable to cope with the amount of stress he/she is experiencing. Often it is termed as adjustment disorder. Some examples are: Daily frustrations related to work load or sometimes to fulfil a seemingly Working environment with different and unfriendly management Some prolonged unpleasant situations are difficulty in housing, travels, foods, Prolonged personal stress of being away from home, friends and loved ones. Prolong absence of recreational facilities.
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impossible mandate. discrimination/humiliation, weather, behaviour, cultural incompatible situation. language, and culture etc.

Ignoring basic and regular requirement.

If cumulative stress is not cared for it may lead to burnout or flame out situation which may precede other way serious stress disorders. In burnout stress person exhibit changed attitude concerning his work, colleagues and the victims he or she witnessed, here signs of depression, loss of self confidence, diffused sadness, guilt and grief. In flame out stress it is rapid onset of burn out, it happened if periodic rest, proper food and exercise are over looked or ignored. Traumatic stress is the result of a single, sudden or violent assault, which harms or threatens, and individual or someone close to him or her either physically or psychologically. The following are examples of trauma, which may experienced in the fields: Being a powerless spectator of violence, murder, large scale massacres, Hearing first hand reports of ill treatment or tortures. Direct or indirect intimidations and threats. Bombing of buildings, mining of roads. Attacks on vehicles and convoys. Armed attacks and robberies. Witnessing large scale material destruction. The trauma, sometimes defined as critical incident stress is exacerbated because very often individual is unable to resist or change the plight of helpless victims. epidemics, disaster or famines.

3.4

Causes of Stress

Stress is becoming a major health and safety issue. When stress is continuous, when pressures are intense it can cause physical illness and psychological distress. When work is too fast, too heavy, or too unpleasant, stress can occur. And whether stress is caused by physical factors such as excessive noise or emotional factors such as the pace of work the results are the same. When stress becomes chronic the stress responses of elevated blood pressure, cholesterol, adrenal and blood sugar can lead to heart disease and other chronic diseases. So we can say that stress affects us all. If we can spot the symptoms than we can manage it. The causes of stress are called stressors. We all respond to stressors in different ways. Indeed, stress is the response to the stressors. The causes of stress are

a.

Threat

A perceived threat will lead a person to feel stressed. This can include physical threats, social threats, financial threat, and so on. In particular it will be worse when the person feels they have no response that can reduce the threat, as this affects the need for a sense of control. b. Fear

Threat can lead to fear, which again leads to stress. Fear leads to imagined outcomes, which are the real source of stress. c. Uncertainty

When we are not certain, we are unable to predict, and hence feel we are not in control, and hence may feel fear or feel threatened by that, which is causing the uncertainty. d. Cognitive dissonance

When there is a gap between what we do and what we think, then we experience cognitive dissonance, which is felt as stress. Thus, if I think I am a nice person then do something that hurts someone else, I will experience dissonance and stress. Dissonance also occurs when we cannot meet our commitments. We believe we are honest and committed, but when circumstances prevent us from meeting our promises we are faced with the possibility of being perceived as dishonest or incapable (i.e. a social threat). e. Life Causes

There are many causes of stress in life including: friend. Health: Crime: injury, Sexual illness, molestation, pregnancy. mugging, burglary, pick-pocketed. Death: of spouse, family, and Argument: with spouse, family, friends, co-workers, boss Physical changes: lack of

sleep, new work hours. New location: vacation,

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Self-abuse: Family Sexual

drug

abuse, separation, getting

moving house. investing it. Environment change: in Money: lack of it, owing it,

alcoholism, self-harm. change: problems: divorce, new baby, marriage. partner, with partner

school, job, house, town, jail. Responsibility increase: new dependent, new job.

f.

Stress at work

The six key stress factors are as follows: g. The demands of the job. The control staff has over how they do their work. The support they receive from colleagues and superiors. Their relationships with colleagues. Whether they understand their roles and responsibilities. How far the company consults staff over workplace changes. Other stress indicators at work include: Sickness absence. High staff turnover. Poor between teams. Bullying. Lack performance. Value and contribution. Technological change. Lack of clarity of roles and of feedback on communication Dissatisfaction with non-

monetary benefits. Working long hours. Boring and mundane work. One-off incidents. Uncomfortable workplace. Lack of training.

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responsibilities.

h.

Other Causes

There are other causes of stress. These may be environmental, organizational and individual forces. These forces, if negative lead to stress of different types:
a. b. c.

Physiological (e.g., Back trouble, migraine, blood pressure); Psychological (e.g., anger, anxiety, depression); and Behavioral (e.g., lower performance, absenteeism, smoking).

Our reaction to different stressors is often personal. Our bodies may react to stress in different ways. But there are some basic physical changes that occur that are typical of stress-reactions. Understanding what happens in our bodies when we experience stress helps us to understand why stress causes so many different diseases.So we must be very careful about stress which has a direct relation to our health. Both positive and negative events in one's life can be stressful. However, major life changes are the greatest contributorsIndividual Influences:most people. They place the greatest demand on resources of stress for for coping.
Family problems Financial problems 2. Past experience 3. Social support 1. Perception

Mediating factors

4. (Organisational factors) Explain and illustrate relationship Individual differences between stressors and stress 1. Workload 2. Job conditions

Physiological effects

Stressor s

3. Role conflict and ambiguity 4. Career development 5. Interpersonal relation 6. Aggressive behaviour

STRESS
Adjustment efforts:

Psychological effects

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1. Alarm Stage 2. Resistance stage 3. Exhaustion stage

Behavioural effects

7. Conflict between work and other roles

External forces: Economic, legal, political uncertainty

Certain environmental, organisational and individual factors (see the diagram) if negative will result in stress of varying degrees. These degrees may range from (see the diagram) 1. Alarm stage, 2. Resistance stage and 3. Exhaustion stage. The factors that cause stress are called the causal factors or widely known as the stressors. Normally stressors cause or control the level of stress. Thus, the relationship between stressors and stress is that of cause and effect. In fact, the stronger the stressors, the higher the stress. Thus, stressors and stress are positively related. However, there some other factors act between the stressors and stress (see the diagram) and indeed, influence the relationship or affect the extent of stress. These factors are called the mediating factors or mediators.

3.5

Identify the Sources of Stress in Life

Stress management starts with identifying the sources of stress in our life. This isnt as easy as it sounds. Our true sources of stress arent always obvious, and its all too easy to overlook our own stress-inducing thoughts, feelings, and behaviors. Sure, we may know that were constantly worried about work deadlines. But maybe its your procrastination, rather than the actual job demands, that leads to deadline stress. To identify our true sources of stress, look closely at your habits, attitude, and excuses:

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Do we explain away stress as temporary (I just have a million things going Do we define stress as an integral part of our work or home life (Things are

on right now) even though we cant remember the last time you took a breather? thats all). Do we blame our stress on other people or outside events, or view it as entirely normal and unexceptional? Until we accept responsibility for the role we play in creating or maintaining it, our stress level will remain outside our control. always crazy around here) or as a part of your personality (I have a lot of nervous energy,

3.6

Consequences of Stress

We all respond to stressors in different ways. Indeed, stress is the response to the stressors. This response induces General Adaptation Syndrome (a process by which individuals adjust to stressors). The General Adaptation Syndrome includes three phases:
a. Alarm: Hence, the body and mind prepare to respond to stressors by means of increasing

heart rate, muscle tension and so on. For example, you are asked to make presentation with a one day notice.
b. Resistance: Higher response/efforts to minimize the stressors. For example, you

brainstorm and panic while the preparation.

c. Exhaustion: After chronic exposure to stressors the body begins to wear down. Stress-

related illness such as insomnia, depression may occur. For example, you experience insomnia or even distress the night before. When stress becomes excessive, employee develop various symptoms of stress that can harm their job performance, health, and even threaten their ability to cope with the environment. Stress in the workplace often results because of poor time management, weak organizational skills, and a lack of ergonomics to help reduce all of these factors. Events producing Stress affect a person through FOUR areas of human functioning:

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Physical effects of stress: Mainly through the neuro-endocrinoimmunological pathway: Changes in the heart rate, blood pressure, respiration, gastric acidity, muscular tensing, intestinal motility etc. Emotional effects of stress: Through hypothalamus and endocrinal release; mainly responsible for the so called psychosomatic disorders. Mental effects of stress: The psychological effects of the above. Behavioural effects of stress: The behavioural effects of stress coping problems caused by stress.

There are several signs and symptoms that you may notice when you are experiencing stress. These signs and symptoms fall into four categories: Feelings, Thoughts, Behavior, and Physiology. When you are under stress, you may experience one or more of the following: a. Feelings

Feeling anxious. Feeling scared. Feeling irritable. Feeling moody. b. Thoughts c. Behavior Low self-esteem. Fear of failure. Inability to concentrate. Embarrassing easily. Worrying about the future. Preoccupation with thoughts/tasks. Forgetfulness.

Stuttering and other speech difficulties. Crying for no apparent reason. Acting impulsively. Startling easily.

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Laughing in a high pitch and nervous tone of voice. Grinding your teeth. Increasing smoking. Increasing use of drugs and alcohol. Being accident prone. Losing your appetite or overeating. d. Physiology Perspiration /sweaty hands.

Increased heart beat. Trembling./Nervous ticks. Dryness of throat and mouth. Tiring easily. Urinating frequently. Sleeping problems. Diarrhea / indigestion / vomiting. Butterflies in stomach. Headaches. Pain in the neck and or lower back. Loss of appetite or overeating. Susceptibility to illness.

3.7

Stress and Job Performance

Stress can be either helpful or harmful to job performance, depending on its level. The stress performance model presented below shows the relationship between stress and job performance.

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When there is no stress, job challenges are absent and performance tends to be low. As stress increases, performance tends to increase, because stress helps a person call up resources to meet job requirements. Constructive stress is a healthy stimulus that encourages s employees to respond to the challenges. Eventually, stress reaches a plateau that corresponds approximately with a persons top day-to-day performance capacity. At this stage additional stress, tend to produce no improvement. Finally, if stress becomes too great, it turns into a destructive force. Performance begins to decline at some point because excess stress interferes with performance. An employee loses the ability to cope ; she or he become unable to make decisions and exhibits erratic behavior. If stress increase a to a breaking point, performance becomes zero, the employee has a breakdown, become too ill to work, is fired, quits ,or refuses to come to work to face the stress. Two major factors help determine how stress will affect employees performance differently across similar job. Workers vulnerability to stress is a function of both internal and external stressor. One internal factor is an employees stress threshold the level of stressor ( the frequency and magnitude) that the person can tolerate before negative feelings of stress occurs and adversely affect performance. Some people have low threshold and the stress of even

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relatively small changes in their work routines causes a reduction in performance where as some people have a higher threshold staying cool, calm and productive longer under the same condition. A higher stress threshold and greater resiliency help prevent lowered performance unless stressor is major or prolong. The second internal factor that affecting employees stress is the amount of perceive control they have over their work and working condition. Employees who have a substantial degree of independence, autonomy, and freedom to make decision a seems to handle work pressure better. Type A and Type B Personalities Type A individuals have an intense desire to achieve, are extremely competitive, have a sense of urgency, are impatient, and can be hostile. A Type A personality is aggressively involved in a chronic, incessant struggle to achieve more and more in less and less time, and, if required to do so, against the opposing efforts of other things or other persons. They are always moving, walking, and eating rapidly, are impatient with the rate at which most events take place, are doing do two or more things at once and cannot cope with leisure time. They are obsessed with numbers, measuring their success in terms of how many or how much of everything they acquire

High

Job perfor mance

A B

Low Low Stress

High

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Type B individuals are more relaxed and easygoing. Type A individuals may get a lot accomplished in organizations, but they also are more easily frustrated, more involved in more conflicts, and more likely to develop coronary heart disease than Type B individuals. Type Bs never suffers from a sense of time urgency with its accompanying impatience and feels no need to display or discuss either their achievements or accomplishments unless such exposure is demanded by the situation. Play for fun and relaxation, rather than to exhibit their superiority at any cost and can relax without guilt.

3.8

Stress and Health Issues

Stress also leads to physical disorders, because the internal body system changes to try to cope with stress. Some physical disorders are short-range, such as an upset stomach. Others are long range, such as stomach ulcer. Stress over prolonged time also leads to degenerative diseases of the heart, kidneys, blood vessels, and other parts of the body. It can result in severe chest pain and tension headache. Stress and health are closely linked. It is well known that stress, either quick or constant, can induce risky body-mind disorders. Immediate disorders such as dizzy spells, anxiety, tension, sleeplessness, nervousness and muscle cramps can all result in chronic health problems. In the long run they may also affect our immune, cardiovascular and nervous systems. a. Cardiovascular ailments There are varying opinions on whether stress actually has any telling impact on our cardiovascular ailments or not. Research shows that in certain individuals stress does contribute to high blood pressure, high cholesterol, and other cardiac risk factors such as addictions and obesity. Stress induced or not, suffering from cardiac conditions is in itself quite stressful for most individuals and their families. Frequent stress responses of our body increase a host of molecules potentially dangerous for the optimal health of the heart. These are low-density lipoproteins (LDL, the "bad" form of cholesterol) and other lipid types such as triglycerides. Because stress delays the processing and clearance of these fats, their accumulation puts people at risk of developing atherosclerosis (or arteriosclerosis) and other heart diseases. As a response to daily stress, extreme reactors show a high level of palpitation and blood pressure in their body. According to a medical research, these surges may gradually result in

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injury to the coronary arteries and the heart. Even physical causes of stress such as vigorous physical activity and exercises can place demands on the heart muscle of the weak or of people already suffering from coronary blockage. The coronary artery becomes ischemic (i.e., starved for oxygen through a reduced amount of blood flow) in trying to meet the body`s increased demands. The ischemic heart muscle can cause either angina (chest pain) or heart attack (actual death of cardiac muscle). About a half of those patients who experience ischemia during exercise also experience it during mental stress, and this group of patients are more likely to suffer adverse cardiac events. It is evident that people who live in chronically stressed-out conditions are more likely to take up smoking, alcohol and substance abuse (drugs, prescribed or illegal), fall into eating disorders (unhealthy food habits) and inertia. Medical practitioners say all of these stress-related behaviours have a direct effect on the development of coronary artery diseases. b. High Blood Pressure/Hypertension Blood pressure fluctuates with age. It gradually increases, as we grow older. It is also known to vary according to the varying hours of the day. But, it has been medically proven that emotional and psychological disturbances due to acute or chronic causes of stress precipitate high blood pressure in human beings. c. Immune Related Disorders Stress is known to worsen many immune related medical conditions, including diabetes. Cortisol produced during stress situations may suppress the body's immune response, increasing susceptibility to infectious diseases. Results of a recent research have also shown that stressful life events can hasten the progression of AIDS in HIV-positive patients. The study shows that disease progression to AIDS was more rapid in the presence of severe life stressors, absence of social support systems, negative attitude as a coping mechanism, and elevated cortisol levels. Studies also suggest that frequent or chronic stress conditions increase the chances of bacterial infections such as tuberculosis and group-A streptococcal diseases (GAS). Though most GAS infections are relatively mild ailments such as `strep throat,` or impetigo (a form of skin allergy), on rare occasions it can even cause severe and terminal illnesses. These are known as invasive GAS infections. It occurs when the bacteria get past the defences of the infected person and enter into parts of the body where bacteria usually are not found, such as the blood, muscle, or the

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lungs. Two of the most severe, but least common, forms of invasive GAS disease are necrotic fasciitis (destroys muscles, fat, and skin tissue) and Streptococcal Toxic Shock Syndrome (causes blood pressure to drop rapidly and organs such as kidney, liver, lungs to fail), Attacks of flu, pneumonia and common cold are directly related to stressful life conditions. d. attack. e. Ulcers and Digestive Disorder In severe stress conditions blood supply to the stomach is restricted, hampering normal digestive functions. Also, the function of the entire intestine is controlled partly by the nervous system, which in turn is directly affected by stress. These conditions, including one`s diet during stress can offset gastrointestinal disorders such as an ulcer or irritable bowel syndrome. Stress can make these symptoms worse if somebody is already suffering from gastrointestinal disorders. f. Migraines/ Headaches/ Backaches It is now established that stress, cognitive appraisal, coping and migraine are reciprocally related. Stress is detrimental to the body and can cause back pains, neck pains and headaches. g. Cancer and Neuro-Degenerative Disorders A path breaking research conducted in the early 1990s showed stress induced reduction in TLymphocytes (white blood cells that destroy cancer cells) in the human body leading to an increase in metastasis. A later study on women suffering from breast cancer reestablished the previous finding and confirmed the fact that stressors cause lowest levels of natural-killer-cell activity in the body. Chronic stress induced homeostasis changes and immune reduction, tends to affect the balance between oxidants and antioxidants in the body. Many on-going studies have found that alteration in this balance in favour of oxidants may result in pathological responses causing functional disorders and diseases such as cancer and Alzheimer`s disease. It can also accelerate the aging process. For, oxidation increases electronegative constituents in body molecules mutilating the `blue print` of the cells. Multiplication of distorted cells can set in cancer. In his treatise on tumors, De Tumoribus, the Greek physician Galen, noted that melancholic Asthma In asthma patients, a stressful situation can make the airways over-reactive and precipitate an

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women stand a greater chance for developing of breast cancer than those with more optimistic and cheerful traits.

3.9

Stress Management

Stress is simply a fact of nature -- forces from the outside world affecting the individual. Hence, all living creatures are in a constant interchange with their surroundings (the ecosystem), both physically and behaviourally. This interplay of forces, or energy, is of course present in the relationships between all matter in the universe, whether they are living (animate) or not living (inanimate). However, there are critical differences in how different living creatures relate to their environment. These differences have far reaching consequences for survival. Because of the over abundance of stress in our modern lives, we usually think of stress as a negative experience. But from a biological point of view, stress can be neutral, negative, or positive. Stress has driven evolutionary change (the development and natural selection of species over time). Thus, the species that adapted best to the causes of stress (stressors) have survived and evolved into the plant and animal kingdoms we now observe. Man, because of the evolution of the human brain, especially the part called the neo-cortex, is the most adaptive creature on the planet. This adaptability is largely due to the changes and stressors that we have faced and mastered. Therefore, we, unlike other animals, can live in any climate or ecosystem, at various altitudes, and avoid the danger of predators. Moreover, most recently, we have learned to live in the air, under the sea, and even in space, where no living creatures that we know of have ever survived.

How can we manage stress?

If we think about the causes of stress, the nature of the stress response, and the negative effects of some types of stress (prolonged, unexpected, unmanageable), several healthy management strategies become clear. First, exercise. You see, since the stress response prepares us to fight or

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flee, our bodies are primed for action. Unfortunately, however, we usually handle our stresses while sitting at our desk, standing at the water cooler, or behind the wheel stuck in traffic. Exercise on a regular basis helps to burn off and use up the stress hormones and neurochemicals. Thus, exercise can help avoid the damage to our health that prolonged stress can cause. In fact, studies have found that exercise is a potent anti-depressant, anxiolytic (combats anxiety), and sleeping pill for many people, without taking any pills. For centuries in Eastern religious traditions, the benefits of meditation and other relaxation techniques have been well known. Now, Western medicine and psychology have rediscovered that particular wisdom, translated it into simple non-spiritual methods, and scientifically verified its effectiveness. Thus, one or two 20 to 30 minute meditation sessions a day can have lasting beneficial effects on health. Indeed, advanced mediators can even significantly control blood pressure and heart rate as well. Elimination of drug use and no more than moderate alcohol use are key to the successful management of stress. We know that people, when stressed, seek these outlets. But, we also know that many of these substances sensitize (make even more responsive) the stress response. As a result, small problems produce big surges of stress chemicals. What's more, these attempts with drugs and alcohol to mask stress often prevent the person from facing the problem directly. Consequently, they are not able to develop effective ways to cope with or eliminate the stress. In fact, even prescription drugs for anxiety, such as diazepam (Valium), lorazepam (Ativan), or alprazolam (Xanax), can be counter productive in the same way. Therefore, these medications should only be used cautiously under the strict guidance of a physician. If, however, stress produces a full blown psychiatric problem, like posttraumatic stress disorder (PTSD), clinical depression, or anxiety disorders, then psychotropic medications, particularly the SSRIs, are extremely useful. Examples of the SSRI (selective serotonin reuptake inhibitor) medications include sertraline (Zoloft), paroxetine (Paxil), or fluoxetine (Prozac). We know that chronic or uninterrupted stress is very harmful. It is important, therefore, to take breaks and decompress. Take lunch and don't talk about work. Take a walk instead of a coffee break. Use weekends to relax and don't schedule so many events that Monday morning will seem

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like a relief. Learn your stress signals. Take regular vacations, or even long weekends or mental health days, at intervals that you have learned are right for you. Create predictability in your work and home life as much as possible. Structure and routine in your life can't prevent the unexpected from happening. However, they can provide a comfortable framework from which to respond to the unexpected. Think ahead and try to anticipate the varieties of possibilities, good and bad, that may become realities at work or home. Generate scenarios and response plans. You may find that the "unexpected" really doesn't always come out of the blue. With this kind of preparation, you can turn stress into a positive force to work for your growth and change.

Methods for managing stress

Time Time Management Management

Physical Physical Exercise Exercise

Individual Stress Individual Stress Management Management

Relaxation Relaxation Training Training

Social Social Support Support

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a. Individual methods: Practicing time management principles such as: o making daily lists of activities to be accomplished o prioritizing activities by importance and urgency o scheduling activities according to the priorities set o knowing your daily cycle and handling the most demanding parts of your job during o the high part of your cycle when you are most alert and productive Noncompetitive physical exercise has long been recommended as a way to deal with excessive stress levels. Individuals can teach themselves to reduce tension through relaxation techniques such as meditation, hypnosis, and biofeedback. Having friends, family, or work colleagues to talk to provides an outlet for excessive stress. b. Professional help Organizational methods: Strategies that management might want to consider include: o improved personnel selection and job placement o use of realistic goal setting, redesigning of jobs o training

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o increased employee involvement o improved organizational communication o reward performance o establishment of corporate wellness programmes such as fitness programmes, health checks with feedback, weight loss clinics.

Action to reduce stress

a. Time management tips for reducing job stress Create a balanced schedule. Analyze your schedule, responsibilities, and daily

tasks. All work and no play is a recipe for burnout. Try to find a balance between work and family life, social activities and solitary pursuits, daily responsibilities and downtime. Dont over-commit yourself. Avoid scheduling things back-to-back or trying to fit too much into one day. All too often, we underestimate how long things will take. If you've got too much on your plate, distinguish between the "shoulds" and the "musts." Drop tasks that aren't truly necessary to the bottom of the list or eliminate them entirely. Try to leave earlier in the morning. Even 10-15 minutes can make the difference between frantically rushing to your desk and having time to ease into your day. Dont add to your stress levels by running late. Plan regular breaks. Make sure to take short breaks throughout the day to sit back and clear your mind. Also try to get away from your desk for lunch. Stepping away from work to briefly relax and recharge will help you be more, not less, productive. b. Task management tips for reducing job stress Prioritize tasks. Make a list of tasks you have to do, and tackle them in order of

importance. Do the high-priority items first. If you have something particularly unpleasant to do, get it over with early. The rest of your day will be more pleasant as a result.

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Break projects into small steps. If a large project seems overwhelming, make a

step-by-step plan. Focus on one manageable step at a time, rather than taking on everything at once. Delegate responsibility. You dont have to do it all yourself, whether at home, school, or on the job. If other people can take care of the task, why not let them? Let go of the desire to control or oversee every little step. Youll be letting go of unnecessary stress in the process. c. Reducing workplace stress by reducing bad habit

As you learn to manage your job stress and improve your work relationships, youll have more control over your ability to think clearly and act appropriately. You will be able to break habits that add to your stress at work and youll even be able to change negative ways of thinking about things that only add to your stress. Eliminate self-defeating behaviors Many of us make job stress worse with patterns of thought or behavior that keep us from relieving pressure on ourselves. If you can turn around these self-defeating habits, youll find employer-imposed stress easier to handle. Resist perfectionism. No project, situation, or decision is ever perfect, and you put undue stress on yourself by trying to do everything perfectly. When you set unrealistic goals for yourself or try to do too much, youre setting yourself up to fall short. Do your best, and youll do fine. Clean up your act. If youre always running late, set your clocks and watches fast and give yourself extra time. If your desk is a mess, file and throw away the clutter; just knowing where everything is saves time and cuts stress. Make to-do lists and cross off items as you accomplish them. Plan your day and stick to the schedule youll feel less overwhelmed. Flip your negative thinking. If you see the downside of every situation and interaction, youll find yourself drained of energy and motivation. Try to think positively

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about your work, avoid negative-thinking co-workers, and pat yourself on the back about small accomplishments, even if no one else does.

Manager or employers role to reduce stress at work place

It's in a manager's best interest to keep stress levels in the workplace to a minimum. Managers must act as positive role models, especially in times of high stress. All of the tips mentioned in this article are twice as important for managers to follow. If someone that we admire remains calm, it is much easier to remain calm ourselves and vice versa! There are also organizational changes that managers and employers can make to reduce workplace stress. Improve communication futures. Clearly define employees roles and responsibilities. Make communication friendly and efficient, not mean-spirited or petty. Consult the employees Give workers opportunities to participate in decisions that affect their jobs. Consult employees about scheduling and work rules. Be sure the workload is suitable to employees abilities and resources; avoid Show that individual workers are valued. Share information with employees to reduce uncertainty about their jobs and

unrealistic deadlines. Offer rewards and incentives Praise good work performance verbally and institutionally. Provide opportunities for career development. Promote an entrepreneurial work climate that gives employees more control

over their work. Cultivate a friendly social climate Provide opportunities for social interaction among employees.

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Establish a zero-tolerance policy for harassment. Make management actions consistent with organizational values

3.10 Social Support at Work and Home

Having close friends and family on whom you can count has far-reaching benefits for your health. Here's how to build and maintain these essential relationships.

It doesn't take a scientific study to show that surrounding yourself with supportive family, friends and co-workers can have a positive effect on your mental well-being, but there's plenty of research to confirm it. A strong social support network can be critical to help you through the stress of tough times, whether you've had a bad day at work or a year filled with loss or chronic illness. It's never too soon to cultivate these important relationships and your social support network can never have too many good friends. a. What is a social support network?

A social support network is different from a support group. A social support network is made up of friends, family and peers, while a support group is generally a structured meeting run by a mental health professional. Although both can play an important role in times of stress, a social support network is something you can develop when you're not under stress, providing the comfort of knowing that your friends are there for you if you need them. You don't need to formalize your support network with regular meetings or an official leader. A coffee break with a friend at work, a quick chat with a neighbor, a phone call to your sister, even a visit to church are all ways to reduce stress while fostering lasting relationships with the people close to you.

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b.

Benefits of a social support network

The positive effects of a support network include: Sense of belonging. Spending time with people helps ward off loneliness. Whether it's other new moms, dog lovers, fishing buddies or siblings, just knowing you're not alone can go a long way toward coping with stress. Increased sense of self-worth. Having people who call you a friend reinforces the idea that you're a good person to be around. Feeling of security. By reaching out and sharing yourself with others, you have the added security of knowing that if you start to show signs of depression or exhibit unhealthy lifestyle habits, your friends can help alert you to the problem. c. Cultivating your support network

The first step toward developing a strong support network is an evaluation of your own behavior as it relates to building and maintaining friendships. After all, relationships are a two-way street. The better a friend you are, the better your friends will be. Here are some suggestions for nurturing your relationships: Stay in touch. Answering phone calls, returning e-mails and reciprocating invitations let people know you care. Be proactive. Don't wait for someone else to make the first move. If you meet someone you think could be a good friend, invite him or her for coffee. Or be the one to strike up a conversation while in line at the grocery store. Know when to say "no" and when to say "yes." Spending time with people who aren't supportive can add stress and take away valuable time. On the other hand, don't decline an invitation because you feel shy or insecure. Don't compete. Be happy instead of jealous when your friends succeed, and they'll celebrate your accomplishments in return. Be a good listener. Find out what's important to your friends you might find you have even more in common than you think. Challenge yourself. Keep looking for ways to improve. Maybe it's by complaining less, being more generous or forgiving others' faults.

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Don't overdo it. In your zeal to extend your social network, be careful not to overwhelm friends and family with phone calls and e-mails. Save those high-demand times for when you really need them. Appreciate your friends and family. Take time to say thank you and express how important they are to you.

d.

Adding to your support network

Ready for more friends, but not sure where to find them? Here are some ideas for extending your social network: Visit the park. Whether you bring your dog, your kids or your running shoes, you'll have something to talk about. Volunteer. Pick a cause that's important to you, and you're sure to meet others who share a similar value system. Ask a friend. Next time you meet a friend for lunch, ask him or her to bring along someone else. Go back to school. A local college or community education course puts you in contact with others who share similar hobbies or pursuits. Look online. In-person relationships may be best, but if you're living in a small town or living abroad, you might find added support through chat rooms or online bulletin boards. Many good sites exist for people going through stressful times, such as chronic illness, loss of a loved one, new baby, divorce and other life changes. Just be sure to stick to reputable sites, and be cautious about arranging person-to-person meetings. e. A cautionary tale

Remember that the goal of extending your social support network is to reduce your stress level, not add to it. Here are some things to look out for when evaluating your relationships: Manage obligatory social ties. Some evidence shows that the negative consequences of maintaining obligatory relationships, such as with certain relatives or co-workers, can outweigh the benefits. Although you may not be able to cut ties with a nagging in-law, look for ways to manage the relationship so that it doesn't become a stressor for you.

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Beware of codependents. A support system with people who are engaged in the same unhealthy behaviors that you're trying to overcome whether it's substance abuse or simply a negative attitude can be damaging to your well-being. Avoid a sense of duty. The best support systems have no strings attached. If your peers are constantly demanding repayment for their efforts, or you feel pressured to conform to their beliefs, you're probably better off without them. Pick the right supporter. If you need help through a hard time, consider carefully which friend or family member to ask. A sibling might not be the best choice, for example, in dealing with grief over a lost parent because he or she too is affected by the loss.

f.

The bottom line: More friends, less stress

It's always a good time to make more friends or improve on the relationships you already have. Whether you're the one getting the support or the one doling out the encouragement, you'll reap the rewards of comfort and compassion. 4.

Counselling

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Counseling provides a safe, supportive, and private place to explore any difficulties or distress in life. This is a direct face-to-face conversation between a supervisor and a direct report. Used to help the employee identify the reason for poor performance to improve, not embarrass or humiliate him or her. Generally more formal than feedback and coaching and is required of a small percentage of employees. Exchange of ideas and feelings between two people, nominally a counselor and a counselee, so it is an act of communication. Workplace Counseling is discussion with an employee of a problem that usually has emotional content in order to help the employee cope with it better. Counseling seeks to improve employee mental health and well being. Good mental health means that people feel comfortable about themselves, right about other people, and able to meet the demand of life. Since it helps employees cope with problems, it should improve organizational performance, because employee become more cooperative worries less about personal problems, or improve in other ways. Emphasis on counseling also helps the organization become more human and considerate pf peoples problems. Both professionals and non-professionals may perform counseling. Human resource specialist or even supervisor who is not trained in counseling may counsel employees. Therapists and personal physicians also counsel employees, and even and employees friend may provide counseling if requited. Counseling can be equally important for professional and personal problems, since both types of problems may affect an employees performance on the job.

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4.1

Objective of Counselling

The main purpose of counseling is as follows: Communicate concerns to the employee Determine the cause of the employees activities Identify avenues for improvement and/or development of employees Improve employee performance Employees self- confidence, understanding, self-control and ability to work effectively are the main objective of counseling. Counseling allows the person to ventilate his feelings in a safe and accepting atmosphere. Sometimes this will be enough to help the individual. For instance, if the person has just lost a loved one, being able to express their sadness and loss in a caring setting may be all that is needed to provide the help they require. Help the counselee to place his problem in the context of reality without his emotions getting in the way. Enable the individual to choose among possible options the one which seems good for him. These objective are consistent with the supportive, collegial and system models of organizational behavior, which encourage employees growth and self- direction. They are also consistent with
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Maslows higher order needs and Alderfers growth needs, such as self-esteem and selfactualization. The counseling objective is achieved through one or more of the following counseling functions: Advice: Many persons think of counseling as primarily an advice-giving activity, but in reality it is but one of several functions that counselors perform. The giving of advice requires that a counselor makes judgments about a counselees problems and lay out a course of action. Herein lays the difficulty, because understanding another persons complicated emotions is almost impossible. Advice giving may breed a relationship in which the counselee feels inferior and emotionally dependent on the counselor. In spite of its ills, advice giving occurs in routine counseling sessions because members expect it and counselors tend to provide it. Reassurance: Counselling can provide members with re- assurance, which is a way of giving them courage to face a problem or confidence that they are pursuing a suitable course of action. Reassurance can be a valuable, though sometimes temporary, cure for a members emotional upsets. Sometimes just the act of talking with someone about a problem can bring about a sense of relief that will allow the member to function normally again. One trouble with reassurance is that the counselees do not always accept it. Even if counselees initially accept reassurance, their temporary self confidence may fade away as soon as they face their problem again, which means that little real improvement has been made. Their false sense of self- confidence may even lead them to make poor personal decision. Communication: For both upward and downward communication, counselling can play an important role. In an upward direction, it is a key way for employees to express their feelings to management. The channel are open, some of these signal act of upward counselling initiates upward signals and if

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will travel higher. An important part of any counsellors job is to discover emotional problems related to company policies and to interpret those types of problems to top management. Counselling also achieves downward communication because counsellors help interpret company activities to employees as they discuss problems related to them.

Release of emotional tension: People tend to get emotional release from their frustrations and other problems whenever they have an opportunity to tell someone about them. This is an important function of nearly all counseling is release of emotional tension; this release is sometimes called emotional catharsis. In this stage, they are relaxed, and their speech is more coherent and rational. This release of tension does not necessarily solve peoples problem, but it does remove mental blocks in the way of solution, enabling them to face their problem again and think constructively about them. In some cases emotional release accomplishes the whole job, dispelling employees problems as if they were mental ghost, which they largely were.

Clarified thinking: Clarified thinking tends to be a normal result of emotional release. In this case realistic thinking has encouraged due to the lack of involvement in the fact. The fact is that not all clarified thinking takes place while the counselor and counselee are talking. All or part of it may take place later as a result of developments during the counseling relationship. The net result of clarified thinking is that a person is encouraged to accept responsibility for problems and to be more realistic in solving them. In order to clarify the counselees thinking, the counselor serves as an aid only and refrains from telling the counselee what is right.

Reorientation:

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Reorientation is more than mere emotional release or clear thinking about a problem. It involves a change in the members emotional self through a change in basic goals and aspirations. Very often it requires a revision of the members level of aspiration to bring it more in line with actual attainment. It causes people to recognize and accept their own limitations. The counsellors job is to recognize those in need of reorientation before their need becomes severe, so that they can be referred to professional help. Reorientation is the kind of function needed to help alcoholics return to normalcy or to treat those with mental disorders.

4.2

Type of Counselling

Counselling should be looked upon in terms of the amount of direction that the counsellor gives the counselee. This direction ranges from full direction (directive counselling) to no direction (nondirective counselling).

Directive Counseling Directive counselling is the process of listening to a to members problem, deciding with the member what should be done, and then encouraging and motivating the person to do it. This type of counselling accomplishes the function of advice; but it may also reassure; give emotional release; and to a minor extent, clarify thinking. Mostly everyone likes to give advice, counsellors included, and it is easy to do. But is it effective? Does the counsellor really understand the members problem? Does the counsellor have the technical knowledge of human behaviour and the judgment to make the right decision? If the decision is right, will the member follow it? The answer to these questions is often no, and that is why advice- giving is sometimes an unwise act in counselling. Although advice-giving is of questionable value, some of the other functions achieved by directive counselling are worthwhile. If the counsellor is a good listener, then the member should experience some emotional release. As the result of the emotional release, plus ideas that the counsellor imparts, the member may also clarify

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thinking. Both advice and reassurance may be worthwhile if they give the member more courage to take a workable course of action that the member supports. Nondirective Counselling

Nondirective or client-centred, counselling is the process of skilful listening to a counsellor, encouraging the person to explain bothersome problems, and helping him or her to understand those problems and determine courses of action. This type of counselling focuses on the member, rather than on the counselor as a judge and advisor; hence, it is client-centered. Professional counselors use this type of counseling, but non professionals may use its techniques to work more effectively with service members. The unique advantage of non-directive counselling is its ability to cause the members reorientation. It stresse changing the person, instead of dealing only with the immediate problem in the usual manner of directive counseling. The counselor attempts to ask discerning questions, restate ideas, clarify feelings, and attempts to understand why these feelings exist. Professional counselors treat each counselee as a social and organizational equal. They primarily listen and try to help their client discover and follow improved courses of action. They especially listen between the lines to learn the full meaning of their clients feelings. They look for assumptions underlying the counselees statements and for the events the counselee may, at first, have avoided talking about. A persons feelings can be likened to an iceberg. The counselor will usually only see the revealed feelings and emotions. Underlying these surface indications is the true problem that the member is usually initially reluctant to reveal.

Participative Counseling:

Nondirective counseling of employees is limited because it requires professional counselors and is costly. Directive counseling often is not accepted by modern, independent employees. The type of counseling typically used in organizations is between the two extremes of directive and nondirective counseling. This middle ground is called participative counseling.
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This is also known as Cooperative counseling, which is a counselor counselee relationship that establishes a cooperative exchange of ideas to help solve a counselees problems. it ids neither wholly counselor-centered nor wholly counselee centered. Rather, the counselee and counselor mutually apply their different knowledge, perspectives and values to problems. perspective counseling integrates the idea of both participants in a counseling relationship, it is, therefore, a balanced compromise that combines many advantages of both directive and nondirective counseling while avoiding most of their disadvantages. Participative counseling starts by using the listening techniques of nondirective counseling, but as the interview progress, participative counselors may play a more active role than nondirective counselors would. They offer bits of knowledge and insight, they may discuss the situation from their broader knowledge of the organization, thus giving an employee a different view of the problem.

4.3

Limitation of Counselling

Nondirective counselling has several limitations, with all its advantages that restrict its use at work. First of all, it is more time consuming and costly than directive counselling. Since just one employee with one problem may require many hours of a counsellors time, the number of employee that a counsellor can assist is limited. To take this as a profession, individual need education, which are consequently expensive. Nondirective also depend on a capable, willing employee. It assumes that the employee possesses a drive for well being, has enough social intelligence to perceive what problem need solution, and has sufficient emotional stability to deal with them. The nondirective counsellor needs to be careful not to become crutch for emotionally dependent employees to lean on while they avoid their work responsibilities.

In some cases counselling itself insufficient because it necessary returns the employee to the same environment that caused the problem. The most important thing is providing psychological support to the employees with the better working environment. In this situation, the counsellor

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may step beyond the usual counselling role and give advice to management to take corrective action.

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The 9 Principle of Self-Healing

1. The principle of Self Respect : SLOW DOWN! 2. The principle of Awareness : 3. The principle of Letting Go: 4. The principle of Courage: NOTICE THAT YOU RESIST FEEL WHAT YOU RESIST ADRESS YOUR FEAR

5. The principle of Compassion: LET THERE BE FORGIVENESS 6. The principle of Responsibility: TAKE ACTION! 7. The principle of Love: YOU 8. The principle of Devotion: ASK FOR WHAT YOU NEED EMBRACE WHAT TROUBLES

9. The principle of Enlightenment: BE OPEN AND RECEIVE

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STRESS AND PERSONALITY SELF TEST Circle the number closest to where you belong between the two extremes: Don't mind leaving things temporarily unfinished Calm and unhurried about appointments Not competitive Listen well, let others finish speaking Never in a hurry, even when pressured Able to wait calmly Easy-going Take one thing at a time Slow and deliberate in speech Relaxed Express feelings openly Have a large number of interests Satisfied with life Never set own deadlines Feel limited responsibility Never judge things in terms of quantity, just quality Casual about work Not very precise Concerned with satisfying yourself, not others Slow doing things 1234567 1234567 1234567 1234567 1234567 1234567 1234567 1234567 1234567 1234567 1234567 1234567 1234567 1234567 1234567 1234567 1234567 1234567 1234567 1234567 Must get things finished once started Never late for appointments Highly competitive Anticipate others in conversation, interrupt, finishing their sentences Always in a hurry Uneasy when waiting Always going at full speed Try to do more than one thing at a time. What's next? Vigorous/forceful speech, use a lot of gestures Hard-driving Hold feelings in Few interests Ambitious Often set own deadlines Always feel responsible Quantity is more important Take work very seriously Very precise, careful about detail Want recognition from others for a job well done Fast doing things

Total Score: _____________________

Result:

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Score: 110 140 Type A Score: 80 109 Type A Score: 60 79 Type AB Score: 30 59 Type B Score: 0 29 Type B

Clients in this category, especially if they are over 40 and smoke, are likely to have a high risk of developing cardiac illness and should take strong measures to reduce stress.

Clients are in the direction of being cardiac prone, and should take strong measures to reduce stress.

Clients in this category are a mixture of A and B. This is a healthier pattern, but they have the potential to slip into A behavior and should recognize this.

Clients are generally relaxed and cope adequately with stress.

Clients are relaxed and cope well with stress, they are unlikely to develop any stress related illness.

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REFERENCES:

Bibliographical references:

Elkin, A., Rosch, P. (1990). Promoting mental health in the workplace: The prevention side of stress management. Occupational Medicine: State of the Art Review, 5, pp. 739-754. Friedman, M., Rosenman, R.H. (1959). Association of a specific overt behavior pattern with increases in blood cholesterol, blood clotting time, incidence of arcus senilis and clinical coronary artery diseases. Journal of American Medical Association, 2196, pp. 1286-1296.

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