Kick off your shoes, relax, and think about where you were before you started this program. Did stress seem like a big mystery, an ugly dragon you had to battle every day to stay in control of your life? Now think about your situation today, after months of practicing stress management techniques. Are you feeling calmer and more in control? When you feel the symptoms of stress coming on, do you find yourself thinking, “OK, I know what this is, and I know what to do about it”? Great, give yourself some credit! None of us feel calm every day of our lives, but you have come a long way from the person who filled out those first forms. If you don’t believe that, just look back at the forms and you will see. It is important to keep your expectations realistic—after all, you don’t want the process of mastering stress to cause you more stress! You cannot expect every one of your records to show zero stress.
As we have emphasized throughout the book, having some stress in your life is not only natural but healthy. It helps keep you motivated, and it keeps your life challenging enough to be interesting. You should also remember that the skills you have been learning are designed to last a lifetime. They will never be perfect, but they will become more effective the more you practice them. By now, for example, you can probably do your relaxation at will, wherever you happen to be. Just think how different that is from the first time you sat with your eyes closed in a dark room, struggling to concentrate.
As we have repeated throughout this book, the problem is not that you experience stress; the goal of this program is not to make you an unresponsive zombie. The problem is that you previously experienced stress so intensely or excessively that it controlled and ruined your life. We hope stress now no longer runs your life, and your feelings of anxiety, anger, frustration, and so on are within manageable levels.
Before we send you out to a lifetime of practice, we need to make one last point. No matter how skilled you become at practicing your relaxation techniques, there will probably be times in your life when circumstances leave you feeling extremely stressed. Everyone faces major upheavals—a loved one dying, a business failing, a family crisis coming to a head. When you face such situations, remind yourself of two very important things. First, feeling stress in trying times is natural and expected; there is a perfectly rational explanation for your response, and it’s part of being human—everyone’s life is punctuated with crises. But these things pass, and no matter how bad you feel, remember too that you are better off than you would have been before, because now you possess specific skills to help keep your stress from becoming excessive or going on longer than it should.
When you come up against a major life event that leaves you feeling highly stressed again, you need to remind yourself that you now have the skills to quickly regain control. Don’t be embarrassed to go back to basics and work through the skills in this program again. This is not an admission of defeat. You just have to remind yourself that, for all of us, sometimes life gets on top of us. When this happens, going back to your basic practice should quickly remind you of the skills you have learned. It will not take as long to master your stress the second time as it did this time.
Remember the basic message throughout our program. The more you practice, the more success you will have. If you incorporate realistic thinking and the other exercises into your daily life, they will become so automatic that you will not even notice you are doing them. You will just notice the effect—a calmer you. With your stress under control, you should be able to get excited about things again, and actually enjoy your job, your family, and your friends.
If you were taking a prescription drug for stress before you started this program, you may now be ready to stop taking it—if that’s what you want to do. We have not addressed this topic before now because it was important for you to learn to master your stress before stopping your medication. About half the people who were taking medication for stress feel ready to stop taking it by the time they finish this program. Many others stop within a year.
But do not rush yourself; there is no need to stop your medication until you are ready. And remember that you should always work with your doctor when making any change involving prescription medication.
The medications most commonly prescribed for relief of short-term stress are minor tranquilizers, most of which are part of a class known as benzodiazepines. This group includes dozens of types and brand names, among them clonazepam (Klonopin), diazepam (Valium), and alprazolam (Xanax).
These medications usually are prescribed only for short periods because people develop a tolerance for them. In other words, after a few weeks you would need more and more of the benzodiazepine to produce the same effect, and you would run the risk of becoming dependent on it. If you did develop dependence, you would experience withdrawal symptoms when you stopped taking it. For this reason, most doctors prescribe these minor tranquilizers only to help a patient through a difficult situation, not for long-term use.
Antidepressants are prescribed for long-term stress and anxiety. The most commonly prescribed are a category called selective serotonin reuptake inhibitors (SSRIs), which include sertraline (Zoloft), escitalopram (Lexapro), paroxetine (Paxil), fluoxetine (Prozac), and fluvoxamine (Luvox). Other categories include serotonin and noradrenaline reuptake inhibitors (SNRIs) such as venlafaxine (Effexor) and reversible inhibitors of monoamine oxidase A (RIMAs) such as moclobemide (Aurorix). Antidepressants can be taken for a longer time and are easier to withdraw from than the minor tranquilizers.
If you wish to stop using medication, we strongly encourage you to follow these guidelines and listen to your prescribing doctor:
• Withdraw slowly. Despite what you may have seen in the movies, “cold turkey” is not the way to go. Ask your doctor to help you work out a schedule for diminishing your dosage gradually.
• Set a target date. You and your doctor should pick a date by which you hope to be completely off medication. This date should be far enough away to allow for gradual tapering off, but not so far away that your goal seems unreachable.
• Use your stress management techniques.
Eliminating your medication is nothing to get stressed about! Most people can cope quite well with a gradual decrease in dosage. But some people find that their feelings of stress temporarily grow stronger as they begin withdrawing from a medication. This kind of “outbreak” of stress nearly always goes away after a week or two, as the medication clears out of your system. If you experience an outbreak, simply do your relaxation and try the other techniques you have been using all along. You may have to put up with a little discomfort as your body adjusts to the change in order to give up your medication.
For example, you may think that you are having a total relapse or that your anxious feelings will never end. But how likely is that, really? You just learned that a lot of people feel this way for a few days when they stop taking their tranquilizers, and that it does go away. Also, if you have been taking a small amount of a medication for a long time, your body may have little or no reaction, but you may feel insecure about not having your pills with you. Some of our clients carry pill bottles with them for a long time without ever taking a pill. (Some people even get the same secure feeling carrying an empty bottle.)
In this case, the stressful situation you are facing is being without pills. But what do you think would happen if you went a day or two without carrying your pill bottles around? Whatever that is, how likely is it to happen? And would it be so terrible if it did? Try some prediction testing on this situation. Go for a day without carrying your pill bottle—then two days. Check out what really happens—you might be surprised by the result. Utilizing your relaxation and realistic thinking, along with other stress reduction procedures, can help you stop taking medication for stress.
In a few people, withdrawal from a benzodiazepine can cause severe anxiety or panic attacks. Your doctor can help adjust your schedule to cope with this problem. Additionally, there are some very good nonmedication programs around for the treatment of panic attacks.
For further reading on this topic, the following book is recommended: M. W. Otto & M. H. Pollack (2009). Stopping Anxiety Medication Workbook, Second Edition. New York: Oxford University Press.
We hope that you enjoyed using this stress management program and that you got a lot out of it. By now your stress is hopefully much more under control. But remember that it is never a problem to go back and remind yourself of some of the lessons or to even start the program again. Although you shouldn’t need to practice all of the techniques formally or for long periods every day now, it is still important to practice regularly and to build all of the strategies into your daily life. In this way you will be able to keep mastering your stress for the rest of your life.