This article is part of a series of help & information based articles created for publication for the Manchester Institute for Psychotherapy based in Chorlton, Manchester. The aim of this series of articles is to provide information that will help individuals who feel they want to explore the differing options in relation to treatment of their issues, with or without seeking professional help.                                                                                    

The aim of this article is to explore the many ways that stress takes hold in our lives & what you can do about it. Understanding stress is very important, as it helps reduce the levels of fear & anxiety that can build up around a lack of understanding & the feelings of lack of control that often go hand-in-hand with feelings of stress. In this article, I have explained what stress is, some of the differing types of stress, what you can do to help yourself, & what help is available for you.

This article will hopefully be a useful starting point for you in the management of your stress, whether you choose to tackle it alone, involve friends & family members, or seek medical/professional help. Helpful tips are provided & are in shaded boxes to assist you with finding them quickly. However, useful information is provided in the rest of the article, so please, if you can, read the whole article. It will help you gain an understanding of your individual Stress Response.

I feel stressed….what do I need to think about first?

Stress can be managed – this is the great news….but the longer you leave it to be dealt with, the harder it will be. Stress is not just a psychological issue. It affects you physiologically also. The affect it has on you depends on how serious the stress is, & what type of stress it is you are suffering from.

Helpful tips:

1. Ensure that you book a proper appointment with your doctor to discuss your feelings of stress, & not just an emergency appointment.
2. This will give you a decent chance to explain your feelings to your doctor & not just the 5 minutes that are allocated to patients for emergency appointments. Respect that you deserve & need that time to explain what is going on for you fully.
3. Don’t underestimate what you are feeling. You have a valid reason to see your doctor &/or to speak to other professionals about your feelings & how stress is affecting your day-to-day life, including the lives of other’s around you.
4. Think about what you want to tell the doctor & write it down if it will help you remember. Reading this article & thinking about how you are reacting to stress, & writing this down will help you process what is going on for you.
5. Don’t put reasons or excuses in the way of you getting help, e.g. I don’t get on with my doctor… he or she doesn’t like me…I don’t even get time to take lunch, how can I find time to go to the doctors…I’ll be ok when I’ve had a holiday or a decent night’s sleep…There is always a “good” reason why people can’t help themselves. Your behaviour may be the key to why you feel the way you do, so give yourself a break & go & get some help today.
6. Your health needs to come first. If you are unable to see your doctor, then don’t think that there is nowhere else to go with your issues. There is. (See the help & information section at the end of this article).
7. Don’t be discounted or fobbed off. The key word in the NHS is “Service” here. You are entitled to a good service, just as if you were in a restaurant. You have paid or are paying for this service via your taxes, so ensure you get what you need.
8. Get a second opinion…it is your right to ask for one. OK, so your doctor may not like it, but it is your health, welfare & happiness at stake here.
9. Write down how you are feeling on different days & at different times. This will help you remember what is going on for you. Many people who suffer from stress have memory issues, so writing things down is very useful. You can take it to the doctors with you, to show that you do care about your health & welfare & that how you are feeling is a serious problem for you.
10. Take one step at a time.
11. Listen to what your body is saying to you…sometimes this will be for you to GO SLOWER.
12. Don’t let the problem escalate. Deal with it NOW, before you get to a position where you become ill & probably need to take a long period of time to recover.
13. Don’t just accept pills without exploring other solutions. Taking medication can just mask the issue…it doesn’t always resolve it. However, for some people, medication will enable them to be put in a position where they can start to exist in a more appropriate & comfortable way to them, while they get additional help to deal with the root causes of the stress problem.
14. Explore what treatment options are available to you, on the NHS & from other organisations, e.g. alternative therapies, support groups etc…
15. Remember that you are important…more important than that pile of paperwork on your desk that needs doing, or the other chore you are expected to do. Put YOUR needs first for once, not your employer’s needs, or someone else’s.

How can stress affect me/my body?

These are just a few of the ways that stress can affect you:

Physical changes:                                        Mental/emotional changes:

Headaches                                                      Feelings of panic or anxiety

Stomach upsets or feeling sick                      Irritability

Back pain                                                        Depression

Trembling                                                        Poor concentration

Sweating                                                         Feeling helpless & lack of control

Difficulties sleeping                                         Lacking confidence

More colds or infections                                 Not wanting to socialise

Skin issues, e.g. eczema                               Memory loss

Weight gain/weight loss                                  Mood swings

Change in eating/drinking/smoking                Outbursts of anger

What happens to me when I get stressed?

Our reaction to stress is a primitive response. It dates back thousands of years to when humans faced life-threatening dangers every day. If you stumbled across a bear or tiger in the wild while looking for food, humans needed that quick rush of adrenalin to help them stay & fight, or run. So the first thing that usually happens when we get stressed is that our body goes into a state called Fight or Flight.

Demanding or new situations in our lives can still evoke this basic human chain reaction in our bodies, but today it might be a telephone call with an urgent request, a job interview, an argument with your partner, or facing financial issues that cause this stress response. The difference is there is no release of the chemicals in these situations. You have no chance to use up the adrenalin produced…it does not help you deal with the situation. This is when we feel wound up but with no release.

Usually these symptoms are not indications of anything serious & will go away when the stressful situation disappears, but they are signs that you should recognise you are under stress, & take some action about this.

When we face a threatening situation, the brain puts the body on alert by producing 2 chemicals – Adrenalin & Noradrenaline. These chemicals can:

• Raise blood pressure
• Increase your heartbeat
• Restrict blood flow to the skin
• Reduce stomach activity, often causing a feeling of “butterflies”
• Increase perspiration

At the same time, the body produces another chemical called Cortisol. This can:

• Release sugar & fat into the system
• Reduce the efficiency of the immune system, so we fight infections less well

These chemicals cause our muscles to tense & push blood to our muscles. As a result, our major organs don’t get as much blood, & our metabolism suffers as blood is taken away from our stomach. Digestion then can become problematic. Over long periods of time, individuals who remain stressed retain this level of vigilance. The body starts to feel worn out, & individuals can experience a wide range of emotions & bodily feelings as a result of staying stressed. In the long term, an individual may become “burnt out” as a result of staying in a state of a high stress response.

Is stress a good or a bad thing?

Stress can be a very good thing for us. Fight or Flight for example, does enable us to get up & out of situations very quickly that are or can be life threatening. So stress can be good for us too. 

In everyday situations, when we start to encounter stress we feel stimulated, often excited…we get an adrenalin rush, we work harder, push ourselves for longer, & sometimes this can be very enjoyable. People often refer to a positive stress response as being stimulated or feeling some pressure, rather than being stressed. However, what is occurring to you physiologically is exactly the same regardless of the term used.

The important thing with stress is being able to de-stress ourselves, in order that we don’t continue to remain at the high levels of stress, which eventually wears us down, & can in some cases lead to burn out.

Why is it said that we suffer from Stress with our modern lives more so than our parents or grandparents?

Over the years, the way we live our lives has changed. We have gone from a very physical state of existence, e.g. washing our own clothes, walking to & from the shops, not having the use of a car, being more active as families, to having a more sedentary lifestyle. We now use the car to go to the shops, have better public transport so we don’t have to walk as far; we rely on machines to do a vast proportion of what we used to do manually. Our parents & grandparents had normal human stress responses as we do, but the difference is our sedentary lifestyle now. Their everyday activities, being physical in nature, meant that the Adrenalin, Noradrenaline & Cortisol were exercised out naturally, enabling them to not have the same stress responses that we do today.

Causes of Stress

We can encounter stress from one or a mixture of the following situations. This list gives you a general idea of areas of possible stress (& is not exhaustive):

Relationship problems:                                           Family problems:

Compatibility with partner/friends                               Conflict within family

Money issues                                                              Problems with parents/children

Feeling dissatisfied in your relationship(s)                 Money issues

Conflict with partner/friends                                        Responsibilities being avoided

Bereavement, separation or loss                                Bereavement, separation or loss

Change in relationship                                                Becoming a parent

Workplace problems:                                               Health problems:

Unrealistic & unachievable targets being set             Feeling unwell regularly

Bullying or harassment                                               Feelings of lack of control

Conflict with work colleagues or managers                Lack of understanding of illness

Working too many hours                                             Poor communication by doctor

Disputes over pay & conditions                                  Limited or no support

Too few staff to cope with workload                           Pressure from work to return

Dangerous working environment

Personal ethics & company ethics clash

Environment problems:                                          

Unsuitable living arrangements                                 

Financial pressures                                                    

Unhealthy environment to live in                               

Excessive noise/smell/disturbance

Feeling unsafe at home
Moving house

Driving conditions & commuting

Whilst it can be said that most people, at one time at least in their lives, will encounter stress due to some of the above situations outlined, there are other types of situations that can & usually do cause a very different form of stress response. These are listed below under the heading “Trauma-related stress”.

What are the differing types of stress & what can I do?

There are many different types of stress, & each requires different attention, & affects different people in different ways. This is why getting a diagnosis from your doctor is very important. In some cases, your doctor may need to refer you to someone else for a fuller diagnosis. This person may be a psychiatrist, a psychologist or another mental health professional. If you present with certain symptoms, referring you to someone else is generally routine, but make sure you raise your fears & concerns, even if you can’t articulate them very well. 

An exhaustive list has not been provided below, but a few key types of Stress have been outlined.

Workplace Stress:

More than half of us who work suffer from stress, according to research published by the International Stress Management Association in November 2001. A Channel 4 Survey in 2000 found that stress was rising for nearly half of us. A total of 41% of those asked said their stress toll had increased in the previous 12 months.

Facts & figures about Workplace Stress in the UK:

• The average employee works 7 hours a week for nothing (source: TUC)
• Britons work the longest hours in Europe (source: TUC)

• Only 1 in 8 people who works long hours say they do so because they genuinely enjoy their jobs (source: Chartered Institute of Personnel Development)
• One-third of employees suffer sleepless nights due to stress (source: TUC)
• 55% of full-time employees say that work-related stress makes them bad-tempered at home (source: TUC)
• More than 2 million workers say their bosses are so overworked they don’t really have time to manage their staff properly (source TUC)
• More than 50% of people say they find it hard to cope with the pressure of work (source: TUC)
• Most managers think that working long hours is unacceptable but necessary for their career (source: The Quality of Working Life 1999 survey, the Institute of Management)

According to the Health & Safety Executive, Workplace Stress has been defined as

“the adverse reaction people have to excessive pressure or other types of demand placed on them. It arises when they worry that they can’t cope”.

The cost of stress at work can be:

• Job satisfaction
• Job performance
• Absenteeism & turnover of labour
• Litigation & healthcare
• Loss of vitality
• Miscommunication
• Poor decision making

Your employers have a duty of care to you. Do not underestimate the power of this.

The Health & Safety Executive has published reports & guides for managers about Stress at Work. If you are feeling stressed the following is important:

• Even if it is very hard to do, tell your line manager you are stressed & ask him/her for help.
• Note all dates / times of conversations / communications about your feelings of stress. Write down whom you spoke to, who else may have heard it, & a brief summary of what was discussed. This is to ensure you have a record in case things get bad at work, & you need to exit &/or seek legal assistance.
• Explore the possibility of taking time off. Even just a few days away may help you a lot.
• Speak to your doctor about your feelings & how they are affecting you. If you are being affected greatly by your feelings of stress, it may be necessary for you to take some time off to recover.
• Stress is an illness. It is not an excuse to watch daytime television! If you feel your line manager is not taking you seriously, then speak to your Human Resources, Personnel department, or Occupational Health department for support & advise.
• Don’t underestimate how you are feeling. If you feel ill, seek help.
• Seek legal advice if this has been ongoing for some time, or is very severe. Ensure you know where you stand. (Tip: if you have home insurance, you may be able to obtain legal help through that for a minimal cost, or no cost at all).

What employers can do to reduce stress:

• Investigate stress levels & their likely causes
• Make sure individuals are well matched to their jobs
• Set clearly defined objectives for staff
• Provide training in interpersonal skills
• Have proper procedures for investigating complaints
• Introduce flexible working hours
• Acknowledge the employee’s as having home lives & differing responsibilities which may, from time to time, conflict with work responsibilities
• Provide opportunities for staff to contribute ideas
• Provide support for staff experiencing high stress levels
• Encourage shorter hours, or for people to only work their contracted hours
• Ensure that Stress is taken seriously, e.g. write a Stress Policy, get advise from the Health & Safety Executive

Top Tips for managing stress at work:

• Say no to extra tasks
• Allow 10% of your time for unforeseen tasks
• Don’t take responsibility for other people’s workloads
• Start a job only when you have time to finish it
• Delegate more
• Be brief on the phone
• Don’t waste time chatting in the corridor, or limit it
• Start meetings on time & finish on time
• Avoid time wasters
• Prioritise your workload by implementing a 1 to 5 scale for incoming & outgoing work…then that way you deal with the really important things & don’t waste time on the things that can wait
• Don’t manage your employer’s responsibilities for them….if there is too much work for the number of staff employed, then it is a resource issue they need to manage. That is not your responsibility
• Ask for support when you need it
• Aim to keep your work in perspective. Nobody ever looks back on life & wishes they had spent more time in the office. Within 2 years of leaving, will you really remember people’s names there?
• Consider looking for another employer & weigh up your options

Trauma Related types of stress:

The difference between the above stressful situations & Trauma-related stress, is usually that with Trauma-related stress, individuals have encountered 1“an event or events that involved actual or threatened death or serious injury, or a threat to the physical integrity of self or others”…& 2“the person’s response involved intense fear, helplessness, or horror. Note: In children, this may be expressed instead by disorganized or agitated behaviour”.

When the initial stressor (the factor that creates the stress) is Trauma related, then the stress response can be very different to what otherwise could be termed as the relatively normal, although painful, life experiences that most humans encounter.

It is important to understand the difference. This effects the treatment you need, & therefore the methods used to get you well again.

You may suffer from Trauma-Related Stress if you have:

Been a victim of a crime, e.g. child abuse, rape, kidnap, violent behaviour, robbery, witnessed a murder etc..

Been a perpetrator of a crime, e.g. rape, kidnap, robbery, murder etc..

Been in the Armed Forces & served in combat

Lived in an area of combat/war/civil dispute e.g. Northern Ireland

Examples of Trauma-Related Stress Responses are when someone develops:

Post Traumatic Stress Disorder (PTSD)

Acute Stress Disorder (ASD)

Combat Stress/Shell Shock

Please see below for information

Post Traumatic Stress Disorder (PTSD)

PTSD is a complex stress disorder, & as such, it needs a proper & considered diagnosis, & proper treatment. The term PTSD is used widely, with little knowledge for the severe & debilitating symptoms that characterise this illness.

When you hear the term PTSD, people often think of flashbacks, nightmares, angry outbursts, symptoms of depression etc…As with all illnesses, or disorders, it is extremely important for people to understand that just because they have one or two of these symptoms, it does not necessarily mean they have PTSD.

PTSD can occur in individuals who have encountered: 1“an event or events that involved actual or threatened death or serious injury, or a threat to the physical integrity of self or others”…& 2“the person’s response involved intense fear, helplessness, or horror. Note: In children, this may be expressed instead by disorganized or agitated behaviour”.

These above 2 phrases that popularly categorise Post Traumatic Stress Disorder are just 2 aspects of diagnostic criteria out of pages of criteria that need to be assessed when an individual presents with such a strong stress response to their doctor.

People who suffer with PTSD may encounter all of, or some of the following (this list is not exhaustive):

• feelings & thoughts that the event is recurring
• frightening & repetitive dreams of the event may occur
• going into a state of severe distress when faced with something that reminds you of the traumatic event
• attempts to avoid thoughts, feelings or conversations associated with the trauma
• avoids activities, places or people that may remind you of the trauma
• being unable to remember important aspects of the trauma
• feeling detached or estranged from others
• difficulty sleeping
• being irritable & having angry outbursts
• having problems with concentration
• being hypervigilant (extreme awareness & vigilance in relation to your personal safety & environment)

There are 3 main types of PTSD:

Acute: if the duration of the symptoms is less than 3 months in total

Chronic: if the duration of the symptoms is 3 months or more

With Delayed Onset: if the onset of the symptoms is at least 6 months after the stressor (the event that caused the Stress response)

If you think you may have Post Traumatic Stress Disorder, you need to see your GP or another doctor as soon as possible, if your GP is not available. Many people are successfully treated & obtain a sense of normality back in their lives, even after a short period of time of receiving treatment (e.g. 3-6 months). In order for you to obtain a full & proper diagnosis, it is likely you will be referred to see a Psychiatrist. Unfortunately sometimes the wait to see a Psychiatrist can be months rather than weeks on the NHS. There are other options available to you & some Helpful Tips are:

• If you are encountering a severe level of distress & are having difficulty functioning on a day-to-day basis, you could go to your local Casualty / Accident & Emergency Department. It is likely that the doctor on duty will see you, & depending on his/her initial diagnosis, you may then be seen by the duty psychiatrist, hence your treatment may begin sooner rather than later. Please note: Accident & Emergency Department’s are for, as the name suggests, Accidents & Emergencies. If you feel you are in such a high level of distress that you cannot wait to be seen by a Psychiatrist, then this may be an option for you. You may be at the hospital for many hours & an overnight stay (or longer) may not be out of the question depending on your symptoms.
• Check your Private Health Care cover. Some companies do include cover for mental health issues. Ring your Private Health Care provider for details of what you need to do to obtain help.
• If you can afford to pay to see a Psychiatrist privately, speak to your GP about this (but be mindful that this may cost you hundreds of pounds, even for a consultation, & private treatment may/will cost you even more). He/she will advise you who is the best person for you to see, & may be able to give you the contact details of that Psychiatrist. In most cases, you will need a GP’s letter referring you, even if you are paying yourself. Don’t be shy asking about prices for consultations.
• If your GP is unable to recommend a Psychiatrist for you & leaves it up to you to find someone, then contact your local private hospital for information. Information about private hospitals is readily available on the Internet. If you do not have access to the Internet, look in Yellow Pages or contact your local library for help.

Helpful tip:

If your GP tells you that you have PTSD & you have only been in his/her surgery for 5-10 minutes, then it is unlikely that a full & proper psychological screening process has occurred. PTSD is a complex disorder, & if your GP tells you that you have it, ask to be referred to a Psychiatrist or another Mental Health Professional to get the diagnosis confirmed.

Combat Stress/Shell-shock:

Individuals who have encountered situations of war or civil dispute may be suffering from Combat Stress, which formerly has been referred to as Shell Shock. The symptoms for Combat Stress are very similar to Post Traumatic Stress Disorder, the main difference being that this form of Stress Response is related to someone’s occupation (e.g. armed forces) or someone who has encountered living in a war-zone or area of civil dispute.

Individuals who encounter this Stress Response often feel disorientated, they may feel like they are back in a stressful combat situation, they may display very high levels of being vigilant about safety etc…

Helpful Tips:

• There are organisations that specialise in the help & treatment of Services Personnel (whether current personnel or ex-personnel). In addition, there are organisations that provide support & advise to the partners & families of those who are suffering with this form of Stress Response. Please see the section at the end of this article entitled “What other help & information is available to me?”
• If you think that you are suffering with Combat Stress, you will need to see your GP in the first instance, or another doctor if your GP is not available. Please follow the guidelines as indicated above for Post Traumatic Stress Disorder.

Acute Stress Disorder:

3“The essential feature of Acute Stress Disorder is the development of characteristic anxiety, dissociative, & other symptoms that occurs within 1 month after exposure to an extreme traumatic stressor”.

Some of the symptoms of Post Traumatic Stress Disorder (PTSD) are very similar to the symptoms of Acute Stress Disorder, & this is why gaining a proper diagnosis is so important. Acute Stress Disorder has been mentioned in this article to show that there are many different types of stress responses.

Please follow the above guidelines for seeing your doctor for help & advise.

Stress Management Tips

If your type of stress falls into the everyday category, although your symptoms may be upsetting, you may feel very down & upset about it, some small changes in your life will assist you greatly:

1. Exercise more

Doctors don’t just recommend exercise because it can help with weight control, getting exercise is ESSENTIAL for stress relief.

So exercising helps get rid of the chemicals that can become a problem for us that appear when we get stressed. Don’t worry though, they will reappear when needed.

2. “Grounding” techniques

2.1 Sit with your feet firmly on the floor, so you are in a strong postural position.

2.2 It is good to have your feet roughly shoulder width apart

2.3 Feel the solidity of the ground underneath you

2.4 Close your eyes & imagine that your feet are rooted to the floor, & you feel strong & stable

2.5 Breath deeply through your nose & out of your mouth, slowing your breath

2.6 Imagine you are exhaling the frustration you have felt through the day

2.7 Breathe normally now

2.8 Open your eyes & still feel your feet on the floor & the stability of your posture

2.9 Repeat this exercise as needed. It can be done with your eyes open, if you need to do it at your desk

3. Alternative / Complimentary therapies

Explore the vast variety of therapies to see if there is anything that will help you get time to yourself, & in the process, give you space to unwind. Therapies will help with the management of your stress, but they won’t eradicate it for you.

4.   Learn to Meditate

Learn to meditate. Meditation has been scientifically proven to be good for us!

Meditation is an ancient discipline, but scientists have only recently developed tools sophisticated enough to see what goes on in your brain when you do it.

4“After training in meditation for eight weeks, subjects show a pronounced change in brain-wave patterns, shifting from the alpha waves of aroused, conscious thought to the theta waves that dominate the brain during periods of deep relaxation”.    

5.   See a Therapist or Counsellor

Seeing a therapist or counsellor will enable you to talk through your issues with someone who is separate to the issue. It may be that your patterns of behaviour are negatively influencing the way you live your life, & seeking support & gaining awareness of your process in this way may be very helpful for you.

A websites that may be of help to you in searching for a therapist or counsellor is:

www.uktherapists.com

 

What other help & information is available to me?

Below is a list of organisations that you can contact for help & advise, & websites that may provide you with helpful information.

Please note that it is worth checking with the organisation whether there will be any costs around the help they can offer you. Many may only be able to offer you support in the form of sending you information, rather than practical or one-on-one support.

(The information below is correct at the time this article was written.)

Health & Safety Executive              

www.hse.gov.uk

HSE Info line   Tel: 07801 545500  

Email: hseinformationservices@natbrit.com

Or write to:      HSE Information Services, Caerphilly Business Park, Caerphilly

CF83 3GG

International Stress Management Association (ISMA)   

www.isma.org.uk

Tel: 07000 780430

PO Box 348, Waltham Cross, EN8 8ZL

A registered charity, promoting sound knowledge & best practice in the prevention & reduction of stress. Sets professional standards.

Mental Health Foundation              

www.mentalhealth.org.uk

Tel: 020 7802 0300

Email: mhf@mhf.org.uk

83 Victoria Street, London SW1H 0HW

Researches into mental health issues & produces information sheets & other publications.

Mind                                                  

www.mind.org.uk

Info line:          08457 660 163 (Mondays to Fridays 9.15am-4.15pm)

Campaigns for better mental health services in England & Wales through its variety of offices. Publishes leaflets & books. Local groups offered.

Trades Union Congress (TUC)

www.tuc.org.uk

Tel: 020 7636 4030

Congress House, Great Russell Street, London WC1B 3LS

Has an affiliation with more than 70 unions representing nearly 7 million working people. Publishes a series of free booklets explaining your rights at work.

Ex-Services Mental Welfare Society (Combat Stress)

www.combatstress.org.uk

Welfare Support Teams available 9-5 Mondays -Fridays Tel: 01372 841600

Broadway House, The Broadway, Wimbledon SW19 1RL

contactus@combatstress.org.uk

Have regional offices in: Hollybush, Ayrshire, Manchester, St Ives, Cambridgeshire, Belfast, Cheddar, Somerset, Alton, Hampshire & Worcester. Ring main number for other numbers/contact details.

The Royal British Legion

www.britishlegion.org.uk

Legion line tel: 08457 725725

48 Pall Mall, London SW1Y 5JY

Soldiers, Sailors, Airmen & Families Association (SSAFA) Forces Help

www.ssafa.orh.uk

Central Office Tel: 020 7403 8783

The Queen Mother House, 19 Queen Elizabeth St, London SE1 2LP.

info@ssafa.org.uk

Each county in the UK has a local branch with divisional secretaries & welfare organisations.

Bibliography & References

Books:

“Diagnostic & Statistical Manual of Mental Disorders- 4^th Edition”, American Psychiatric Association. 2000, American Psychiatric Association

“The Stress of Combat, The Combat of Stress – Caring Strategies towards Ex-Service Men & Women”, Roy Brook. 1999, Alpha Press

“Tackling Work Related Stress – A Manager’s Guide to improving & maintaining employee health & well-being”, Health & Safety Executive. 2001, HSE Books

“Perpetration-Induced Traumatic Stress – The Psychological Consequences of Killing”, Rachel M. MacNair. 2002, Praegar

“Psychological & Psychosocial Consequences of Combat & Deployment – With Special Emphasis on the Gulf War”, David H. Marlowe.  2001, Rand

“Managing Workplace Stress – A Best Practice Blueprint”, Stephen Williams & Lesley Cooper. 2002, Wiley & Sons

Magazines/Other articles:

“The Science of Meditation”, Time Magazine, October 17^th 2003 edition

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1 From Page 467, Diagnostic & Statistical Manual of Mental Disorders 4^th Edition, American Psychiatric Association

2 From Page 467, Diagnostic & Statistical Manual of Mental Disorders 4^th Edition, American Psychiatric Association

1 From Page 467, Diagnostic & Statistical Manual of Mental Disorders 4^th Edition, American Psychiatric Association

2 From Page 467, Diagnostic & Statistical Manual of Mental Disorders 4^th Edition, American Psychiatric Association

3 Page 469, 308.3 Acute Stress Disorder, Diagnostic & Statistical Manual of Mental Disorders 4^th Edition, American Psychiatric Association.

4 Time Magazine, October 27^th 2003