When a stressed-out man walks into Alice Domar’s office and walks out an hour later with a relaxation tape in hand, chances are he’ll do what she recommends — take 20 minutes a day to listen to it. And feel much better.
But when a woman with the same — or worse — symptoms gets those tips and stress-reduction tapes, things turn out quite differently, says Domar, a psychologist at Deaconess Hospital.
“Women can’t do it. They can’t take 20 minutes for themselves. They say, `Who’ll watch the kids, cook dinner, do the laundry?’ ” she says. “Women feel guilty when they spend time on themselves.” Even exercise, she says, often becomes a mode of punishment for women, not a source of pleasure.
Whether or not women have more stress in their lives — and they may — they are certainly more upfront about it with health professionals. But they seem to have more trouble than men doing what often helps most: taking time for self-care, whether that’s meditation, exercise, yoga or a chat with a friend.
Starting as teen-agers, says psychologist Joan Borysenko of Boulder, Colo., girls begin to struggle with the issue of taking time for themselves, “and nobody resolves it by the end of adolescence. Women fight this all their lives.”
If you put yourself first, you’ll be “selfish;” if you put others first, you’ll be “selfless,” says Borysenko, who has a book on female biology and spirituality due out in January.
But recent research shows that if you are among the hustling hordes of harried heroines, there’s lots you can do to offset stress and the problems it can exacerbate, including hot flashes, infertility, PMS, chronic pain and depression.
First, especially if you’re a working mother, you can start with a healthy recognition of reality.
Two years ago, Labor Secretary Robert Reich released a major study confirming what women have long known. Women who work enjoy it — 79 percent say they “like” or “love” their jobs.
But they’re also stressed. In fact, 60 percent said stress is the most critical problem they face. Among other things, women still have trouble finding good childcare. They still earn less than men. And they still get less respect.
So it’s no surprise that working women with kids at home wind up with higher levels of the stress hormone cortisol in their urine than women in the same jobs without kids, says Dr. Redford Williams, director of the behavioral medicine research center at Duke University Medical Center.
Granted, men get stressed, too, both at home and at work. But one of the five biggest “psychosocial stress factors” — along with hostility, depression, social isolation and poverty — is having a “high-demand, low-control” job like being a file clerk or working on an assembly line, says Williams, and “women are more likely to be in low-control jobs.”
But women also have some advantages, says Williams. They clearly live longer than men and are “better off than men when it comes to being able to handle stress because they’re less hostile, better listeners and less aggressive.”
In fact, women can play to these social strengths to offset stress, he says. In his recent randomized study of 98 women, Williams found that 8-to-10-week stress management support groups clearly reduced stress among married mothers — far more so than simple group lectures.
But in reality, he says, “just about any stress management technique would work for women — if they’d use them.”
Getting women past that big “if” is the tough part, because “women have self-esteem issues,” says psychologist Domar, author of a new book called “Healing Mind, Healthy Woman.”
“They’re great at taking care of others, but not themselves.
“I’m not saying men don’t have self-esteem issues,” she adds, “but I find it easier to teach mind/body skills to men.”
Still, recent data show that once a woman allows herself time for stress reduction, troubling symptoms often improve. Some examples:
– Menopause. In a study by Domar and colleague Judith Irvin, 33 menopausal women were randomly assigned to listen to a relaxation tape for 20 minutes a day for seven weeks and keep a diary of this practice, to read daily for 20 minutes and keep a diary of this, or simply to record their hot flashes.
The women who practiced daily relaxation had a statistically significant — 28 percent — decline in hot flash intensity while the other two groups did not, says Domar, adding that these findings are in line with those of several other studies.
In another study, Domar showed that women with breast cancer who had hot flashes from the estrogen-blocking drug tamoxifen got a similar benefit from relaxation techniques.
– PMS, a set of symptoms including fatigue, irritability and mood swings that may precede a woman’s period. In a study of 70 women conducted with Irene Goodale, Domar randomly divided women into a group that practiced a relaxation technique daily, a group that read and a group that simply charted their PMS symptoms.
The women who were taught a meditation-like technique that Domar’s mentor, mind/body guru Dr. Herbert Benson, calls the “relaxation response” — which has been shown to decrease the body’s response to adrenalin — showed a 58 percent decline in PMS symptoms. The group that read had a 27 percent decline, and the women who simply charted symptoms, a 17 percent decline.
The improvement from simply charting symptoms, by the way, fits with a large body of research showing that just tracking your symptoms can help by enhancing a sense of control.
– Infertility. Domar’s previous research has shown that infertile women are often so depressed and anxious that their scores on mental health tests are indistinguishable from those of women with cancer, AIDS and heart disease.
But the nearly 300 women who have taken Domar’s 10-week program that teaches relaxation and other coping skills show a dramatic improvement in mental health, she says, ending up with mental health scores, on average, in the normal range.
And 42 percent get a bonus — pregnancy, though the most important outcome, she says, is that even women who do not get pregnant are much less distressed than they had been.
– Pain. Chronic pain is a major reason that patients, two-thirds of them women, flock to the stress reduction clinic at the UMass Medical Center in Worcester, says executive director Jon Kabat-Zinn.
While the Deaconess mind/body program stresses the relaxation response, including meditation or prayer by focusing on a word or mantra to clear the mind of distracting thoughts, Kabat-Zinn advocates another approach: mindfulness meditation.
In this technique, the goal is not to block things out but to “put out the welcome mat,” he says. “So if you have a headache or pain, you move into that sensation with awareness” — and without adding to distress by judging your own reactions.
Overall, his 8-week program leads to a 30 to 40 percent reduction in pain, he says, adding that pain reduction can be maintained for several years if patients keep meditating.
– Depression. Emerging data suggest that God may be as good as Prozac in fighting depression — especially for older women.
In a 1988 study of 850 people over 60, two-thirds of them women, Dr. Harold Koenig, a psychiatrist and head of Duke University’s Program on Religion, Aging and Health, found a strong link between “intrinsic religiosity” and well-being.
In other words, there seems to be something beneficial about having a strong faith, Koenig says, above and beyond the social support church activities can provides and regardless of financial status or physical health.
Perhaps a belief in God provides a worldview that gives peace by enabling people to understand negative events as God’s will, he says. Or perhaps it helps to believe that God is always there, even in the middle of the night or when death approaches.
The bottom line, say those who study women and stress, is that if you’re young and stressed, get going now. Don’t spend your whole life believing you don’t deserve time for yourself.
And there are signs, says Barrie R. Cassileth, a psychologist and medical sociologist at Duke and the University of North Carolina medical centers, that young women are doing just that.
“I hear it like a mantra,” she says of younger women’s determination to take care of themselves, a far cry from her mother’s days in which that attitude was almost “immoral.”
And if you’re an older woman and feeling stressed out?
Don’t give up. It’s never too late to learn to reduce stress, says Domar. And there may be an added bonus. “If you start treating yourself better,” she says, “you’ll not only profit yourself, you’ll be a great role model for your daughter, too.”
Judy Foreman is a member of the Globe staff. Her E-mail address, via Internet is: foreman(AT SIGN SYMBOL)globe.com
SIDEBAR:
To learn more
For more information on stress reduction programs, call:
- Division of Behavioral Medicine, Deaconess Hospital, 617-632-9530.
- Stress Reduction Clinic, UMass Medical Center, 508-856-2656.