Stress: Can We Cope?

By Claudia Wallis

COVER STORY

As modern pressures take their toll doctors preach relaxation

"Rule No. 1 is, don't sweat the small stuff. Rule No. 2 is, it's all small stuff. And if you can't fight and you can't flee, flow."

--University of Nebraska Cardiologist Robert Eliot, on how to cope with stress

It is the dawn of human history, and Homo sapiens steps out from his cave to watch the rising sun paint the horizon. Suddenly he hears a rustling in the forest. His muscles tense, his heart pounds, his breath comes rapidly as he locks eyes with a saber-toothed tiger. Should he fight or run for his life? He reaches down, picks up a sharp rock and hurls it. The animal snarls but disappears into the trees. The man feels his body go limp, his breathing ease. He returns to his darkened den to rest.

It is the start of another working day, and Homo sapiens steps out of his apartment building into the roar of rush hour. He picks his way through the traffic and arrives at the corner just in time to watch his bus pull away. Late for work, he opens his office door and finds the boss pacing inside. His report was due an hour ago, he is told; the client is furious. If he values his job, he had better have a good explanation. And, by the way, he can forget about taking a vacation this summer. The man eyes a paperweight on his desk and longs to throw it at his oppressor. Instead, he sits down, his stomach churning, his back muscles knotting, his blood pressure climbing. He reaches for a Maalox and an aspirin and has a sudden yearning for a dry martini, straight up.

The saber-toothed tiger is long gone, but the modern jungle is no less perilous. The sense of panic over a deadline, a tight plane connection, a reckless driver on one's tail are the new beasts that can set the heart racing, the teeth on edge, the sweat streaming. These responses may have served our ancestors well; that extra burst of adrenaline got their muscles primed, their attention focused and their nerves ready for a sudden "fight or flight." But try doing either one in today's traffic jams or boardrooms. "The fight-or-flight emergency response is inappropriate to today's social stresses," says Harvard Cardiologist Herbert Benson, an expert on the subject. It is also dangerous. Says Psychiatrist Peter Knapp of Boston University: "When you get a Wall Street broker using the responses a cave man used to fight the elements, you've got a problem."

Indeed we have. In the past 30 years, doctors and health officials have come to realize how heavy a toll stress is taking on the nation's well being. According to the American Academy of Family Physicians, two-thirds of office visits to family doctors are prompted by stress-related symptoms. At the same time, leaders of industry have become alarmed by the huge cost of such symptoms in absenteeism, company medical expenses and lost productivity. Based on national samples, these costs have been estimated at $50 billion to $75 billion a year, more than $750 for every U.S. worker. Stress is now known to be a major contributor, either directly or indirectly, to coronary heart disease, cancer, lung ailments, accidental injuries, cirrhosis of the liver and suicide--six of the leading causes of death in the U.S. Stress also plays a role in aggravating such diverse conditions as multiple sclerosis, diabetes, genital herpes and even trench mouth. It is a sorry sign of the times that the three bestselling drugs in the country are an ulcer medication (Tagamet), a hypertension drug (Inderal) and a tranquilizer (Valium). Concludes Dr. Joel Elkes, director of the behavioral medicine program at the University of Louisville: "Our mode of life itself, the way we live, is emerging as today's principal cause of illness."

Concern over the "stress epidemic" has prompted what may be called a mass fight-and-flight reaction. New fields have sprung into being: behavioral medicine, to battle stress-related illness; psychoneuroimmunology, to explore the way emotional states affect the body's defenses. Major corporations have established elaborate stress-management programs to help harried executives cope. And around the country, but especially in mellow-minded California, says Psychiatrist Mardi Horowitz of the University of California at San Francisco, "everyone is massaging, jogging and hot-tubbing to reduce this cumulative stress."

No one really knows if there is more stress now than in the past, but many experts believe it has become more pervasive. "We live in a world of uncertainties," says Harvard's Benson, "everything from the nuclear threat to job insecurity to the near assassination of the President to the lacing of medicines with poisons." Through television, these problems loom up under our very noses, and yet, says Psychologist Kenneth Dychtwald of Berkeley, Calif., the proximity only frustrates us: "We can't fight back with those people on TV."

The upheaval in society's most basic values adds greatly to the general level of anxiety. Even our pleasures are often fretful. When Psychiatrist George Serban of New York University conducted a nationwide poll of 1,008 mostly married men and women aged 18 to 60, he found that their greatest source of stress was the changes in society's attitudes toward sex, including sexual permissiveness and "the new social roles of the sexes." While stress might have once taken the form of an occasional calamity, it is now "a chronic, relentless psychosocial situation," says Dr. Paul Rosch, director of the American Institute of Stress in Yonkers, N.Y.

Curiously, Rosch notes, today's pressures have created a breed of thrill seekers who, often to their own detriment, prefer excitement over tranquillity. Life in the fast lane becomes a dangerous habit for them. "Skydivers get hooked on the jump," he says, "executives purposely arrive at the airport at the last possible minute. People today have become addicted to their own adrenaline secretion."

For all its present vogue, "stress" has only recently been admitted into the medical vocabulary. For years, doctors considered the term too unscientific to be taken seriously. "The moment you used the word, you were dismissed as a thinking individual," says Dr. Harold Ward, director of the stress medicine laboratory at the University of California at San Diego. One reason was the lack of an adequate definition for the concept. According to the late Dr. Hans Selye, the Austrian-born founding father of stress research, stress is simply "the rate of wear and tear in the body." But others persist in using the term to refer to any external stimulus that causes wear and tear, or to the resulting internal damage. This has led to considerable confusion. As one researcher has put it, "Stress, in addition to being itself, and the result of itself, is also the cause of itself."

Medical interest in the phenomenon began on the battlefield, where the devastating effects of chronic stress are unmistakable. During the Civil War, for example, palpitations were so commonplace that they became known as "soldier's heart." During World War I, the crippling anxiety called shell shock was at first attributed to the vibrations from heavy artillery, which was believed to damage blood vessels in the brain. This theory was abandoned by the time World War II came along, and the problem was renamed battle fatigue. By then the great Harvard physiologist Walter Cannon, along with Selye, had proved that psychological strain itself could cause dramatic hormonal changes and hence physiological symptoms. Selye showed that when the fight-or-flight response becomes chronic, as it does in battle, long-term chemical changes occur, leading to high blood pressure, an increased rate of arteriosclerosis, depression of the immune system and a cascade of other problems. "Humans have a fairly robust capacity to withstand a massive dose of acute stress," says Dr. Fred Goodwin, director of intramural research at the National Institute of Mental Health (NIMH). "Where we fall down is in our ability to mobilize for recurrent stressful episodes." Today the physiology of stress is being worked out in extraordinary detail. Says Neurochemist Jack Barchas of Stanford: "We have learned that even subtle behavior can markedly influence biochemistry" (see box).

War makes everyone anxious. But because most other kinds of stress are subjective, researchers have found it difficult to say just why a given situation is threatening. "I would die if I had to sit in a space capsule," says Boston University Psychiatrist Sanford Cohen. But while working with the early astronauts some 20 years ago, Cohen observed that "John Glenn just saw it as a job and went about it in a businesslike manner." Notes Benson: "A snowstorm is not stressful to a skier, but it is to someone who has an appointment across town."

In the early 1950s, University of Washington Psychiatrist Thomas Holmes determined that the single common denominator for stress, even for an astronaut, is "the necessity of significant change in the life pattern of the individual." Holmes found that among tuberculosis patients, for example, the onset of the disease had generally followed a cluster of disruptive events: a death in the family, a new job, marriage. Stress did not cause the illness, Holmes emphasizes--"It takes a germ"--but tension did seem to promote the disease process. Holmes discovered that merely discussing upsetting events could produce physiological changes. An experiment in which sample biopsies were taken before and after discussions of certain subjects showed that "we caused tissue damage just by talking about a mother-in-law's coming to visit," says Holmes. The example, he notes, is not facetious: "A person often catches a cold when a mother-in-law comes to visit. Patients mentioned mothers-in-law so often that we came to consider them a common cause of disease in the U.S."

In an attempt to measure the impact of "life change events," Holmes and Psychologist Richard Rahe, working together in the 1940s and '50s, asked 5,000 people to rate the amount of social readjustment required for various events. The result is the widely used Holmes-Rahe scale. At the top is death of a spouse (100 stress points), followed by divorce (73), marital separation (65), imprisonment (63) and death of a close family member (63). Not all stressful events are unpleasant. Marriage rates 50; pregnancy, 40; buying a house, 31; and Christmas, 12. Holmes went on to show that in a sample of 88 young doctors, those who totaled 300 or more units on the scale had a 70% chance of suffering ulcers, psychiatric disturbances, broken bones or other health problems within two years of the various crises; those who scored under 200 had only a 37% incidence of such infirmities. The scale proved to be an effective prognosticator as well: by tallying up the life stress of healthy college football players, Holmes and Rahe were even able to predict which ones would be injured during the next season.

The impact of major life events on health has been reconfirmed many times. A study published earlier this year in the British medical journal Lancet reported that the incidence of fatal heart attacks rose sharply in Athens in the days following the 1981 earthquake there. Stanford Neurochemist Barchas has found that a high score on the Holmes-Rahe scale is linked to elevated levels of the hormones associated with stress: adrenaline (which scientists have re-christened epinephrine), norepinephrine and beta-endorphin. An Australian study of bereavement has shown that eight weeks after the death of their spouses, widows and widowers have diminished immune responses, leaving them more vulnerable to infection and cancer.

Some experts do not agree I that the Holmes-Rahe scale is the best measure of personal stress. By conducting a series of surveys, Psychologist Richard Lazarus, of the University of California at Berkeley, has become convinced that the everyday annoyances of life, or "hassles," contribute more to illness and depression than major life changes. Lazarus cites a poem by Charles Bukowski to illustrate his point:

.. .It's not the large things that send a man to the madhouse. . . no, it's the continuing series of small tragedies that send a man to the madhouse

not the death of his love but a shoelace that snaps with no time left...

The snapped-shoelace factor ties in with a number of recent studies. In a survey of 210 Florida police officers, Psychologists Charles Spielberger and Kenneth Grier of the University of South Florida found that far more stressful than responding to a felony in progress or making arrests while alone was the day-to-day friction of dealing with what the officers saw as an "ineffective" judicial system and "distorted" press accounts about their work. In other stress surveys, police sergeants in Houston groused about paper pushing more than physical danger; teachers ranked administrative details second only to inadequate salary; air traffic controllers, whose high rate of hypertension and ulcers has been attributed to job pressure, complained more about such mundane matters as management, shift schedules and "irrelevant" chores than the strain of guiding heavy air traffic. Such traffic, however, does take a toll on people living close to airports. Blasted daily by noise, people near Los Angeles International Airport have been found to have higher rates of hypertension, heart disease and suicide than residents of quieter areas.

The relentless stresses of poverty and ghetto life have also been associated with higher health risks. Studies of poor black neighborhoods in Detroit and Boston have correlated hypertension, which is twice as common among American blacks as among whites, with overcrowded housing and high levels of unemployment and crime. Research conducted in Massachusetts by Epidemiologist David Jenkins, now on the faculty of the University of Texas Medical Branch in Galveston, showed that the two areas with the highest mortality rates in the state were the Boston black ghetto of Roxbury and the working-class white enclave of South Boston, which had been locked in a bitter feud over school busing. Mortality rates in these two "death zones" are elevated not only for hypertension-related ailments like stroke, but for all causes of death. Even the rate of cancer among Roxbury men was 37% above the state average.

Whether or not daily stresses and hassles do more damage than life-change events may, in the final analysis, be a moot point. A single event can cause smaller changes that touch every aspect of existence. Divorce, for example, "is not an isolated event," observes U.C.S.F. Psychiatrist Leonard Pearlin. "It is accompanied by some social isolation, a reduction in income and sometimes the problems of being a single parent. These become the chronic strains of life."

Joblessness has a similar ripple effect. The greatest source of stress is not the actual loss of the job but rather the gradual domestic and psychological changes it imposes. These can be devastating, says Sociologist M. Harvey Brenner, professor of health services administration at Johns Hopkins. Brenner has found that over a period of about 25 years beginning in the late 1940s, for each 1% increase in the national unemployment rate, there were 1.9% more U.S. deaths from heart disease and cirrhosis, 4.1% more suicides, and an upturn in the number of first-time admissions to state mental health facilities (up 4.3% for men, 2.3% for women).

To be sure, not everyone falls to pieces because of the loss of a job or even a spouse. While surveying unemployed workers in the Detroit area, University of Michigan Researcher Louis Ferman found one hard-luck victim who had been successively laid off by the Studebaker Corp. in 1962 when it was about to fold, a truck manufacturer that went under in the 1970s, and more recently during cutbacks at a Chrysler plant. By all accounts, "he should have been a basket case," says Ferman, "yet he was one of the best-adjusted fellows I've run into." Asked his secret, the man replied, "I've got a loving wife and go to church every Sunday."

Such examples have convinced stress scholars that far more important than the trials and tribulations in one's life is how one deals with them. Consequently, much research into stress and preventive medicine has focused on what psychologists call "hardiness" or coping behavior. Certain population groups are known to enjoy remarkable good health and longevity: Mormons, nuns, symphony conductors and women who are listed in Who's Who. This suggests that something in the way these people live, possibly even such abstractions as faith, pride of accomplishment or productivity, plays a role in diminishing the ill effects of stress. "The most significant observation," says Rosch of the American Institute of Stress, "is that widows die at rates three to 13 times as high as married women for every known major cause of death. Why? How does this work?"

Psychologists point to a number of personal factors that seem to be helpful in coping. Among them: the sense of being in control of one's life, having a network of friends or family to provide what researchers call "social support," and such personality factors as flexibility and hopefulness. At Johns Hopkins, Dr. Caroline Bedell Thomas has correlated psychological factors with the long-term health records of 1,337 medical students who graduated between 1948 and 1964. One of the strongest prognosticators of cancer, mental illness and suicide, she found, was "lack of closeness to parents" and a negative attitude toward one's family. A 1978 study of 7,000 people in Alameda County, Calif., confirmed the importance of social support. Epidemiologist Leonard Syme of Berkeley, Calif., who conducted the study, found that even after adjusting for such factors as smoking and histories of major illnesses, people with few close contacts were dying two to three times faster than those who regularly turned to their friends.

Animal studies also support the notion that company prevents misery. Squirrel monkeys become more agitated if alone when confronted with a boa constrictor than when several monkeys confront the snake together. Mice that are injected with cancer cells and then isolated develop tumors more rapidly than those who remain with their cage mates.

The warm family support given to Barney Clark was considered by his doctors to have been crucial to his remarkable endurance after receiving the artificial heart. Lonely heart attack patients have been shown to live longer when given a pet. Herpes sufferers seem to be helped just by participating in a self-help group. Says U.C.S.F. Psychiatrist Horowitz: "These self-help groups, for everything from single parents to rape victims, are very useful. They replace the smalltown systems that we've lost."

Studies of former Viet Nam prisoner; of war have revealed that communication with fellow captives, sometimes involving complex tapping codes, was a vital factor in their survival. In a book to be published this fall, one former P.O.W. relates that even while he was being beaten by his captors, he could hear other prisoners tapping out the supportive message "God bless you, Jim Stockdale."

Other studies of prisoners and hostages have also pointed up the importance of maintaining a sense of control over one's environment. NIMH Psychologist Julius Segal was astonished to learn that one of the American hostages in Iran achieved this by saving a bit of food from his meals and then offering it to anyone who came into his cell. That simple coping strategy had the effect of turning the cell into a living room, the hostage into a host welcoming visitors.

Research with animals has shown that when stressful stimuli can be regulated, they are rendered less damaging. University of Wisconsin researchers exposed monkeys to loud, irritating noise but allowed half of them to interrupt the sound by pulling on a chain. Though both groups of monkeys were exposed to the same noise, those with access to the chain showed lower levels of stress-related hormones in their blood. Being in control seemed to make the difference.

The same appears to be true of workers. Robert Karasek, an industrial-engineering professor at Columbia University, has found that people who have little control over their jobs, such as cooks, garment stitchers and assembly-line workers, have higher rates of heart disease than people who can dictate the pace and style of their work. Telephone operators, waiters, cashiers and others whose work makes substantial psychological demands but offers little opportunity for independent decision making are the worst off. This combination of high demands and low control, concludes Karasek, appears to raise one's risk of heart disease by "about the same order of magnitude as smoking or having a high cholesterol level."

In recent years doctors have come to recognize another psychological factor that drastically increases an individual's susceptibility to heart attacks and other stress-related illnesses: Type A behavior. First identified by San Francisco Cardiologists Meyer Friedman and Ray Rosenman, Type A has two main components, both of which can be recognized by giving standardized personality tests or conducting careful interviews with the patients. Says Friedman: "First, there is the tendency to try to accomplish too many things in too little time. Second, there is free-floating hostility. These people are irritated by trivial things; they exhibit signs of struggle against time and other people."

Type A has been accepted as a bona fide risk factor for heart disease by the American Heart Association and the National Heart, Lung and Blood Institute. Studies have shown that Type A's respond differently to stress than do calmer people classified as Type B's. When Dr. Redford Williams at Duke University asked a group of male undergraduates to perform a mental arithmetic task (serial subtraction of 13 from 7,683), the Type A students produced 40 times as much cortisol and four times as much epinephrine as their Type B classmates. The flow of blood to their muscles was three times as great, though there was no difference in their level of performance. "The Type A man is responding as though he were in an emergency or threatening situation," says Williams. The jolt of cortisol and epinephrine, he speculates, "could be causing more fat to be released into the blood, which may later be deposited around the heart."

Mort Ciment, 59, was what Friedman would call a typical Type A. Excitable to begin with, he worked as a Los Angeles commodities trader, a job he likens to "being in a mad cage." When the market was really moving, he says, "there was terrible tension. You'd leave to go to the bathroom, come back and find the position horribly changed." When he got home, he admits, "my nerves were singing, and I'd take it out on the nearest person."

All that ended three years ago when Ciment had a heart attack. A quadruple bypass saved his life, and a chastened Ciment resolved to slow down. He quit his job to become a stockbroker in a lowerkeyed office, and now devotes more time to hobbies. "Lining a coffin with gold," he says, "doesn't do the body any good."

Like thousands of other overwrought Americans, Ciment got professional help in learning to reduce and manage the stress in his life. At the California Institute for Behavorial Medicine in Beverly Hills, he underwent psychological counseling to change his Type A mindset, began an exercise program and learned to modify his diet. Programs like the one he attended have been booming in recent years. By one estimate, there are now more than 300 stress-management enterprises offering their services to hospitals, clinics and even corporations around the country, up from 120 last September. "Stress management has become a multimillion-dollar-a-year business," says Rosch of the American Institute of Stress.

Hospitals took the lead in treating stress by establishing clinics to help those for whom reducing tension was a matter of life and death: heart attack victims and severe hypertensives. Some of the advice offered to such patients is just plain common sense: quit smoking, lose weight, cut down on salt and caffeine (2 1/2 cups of coffee will double the level of epinephrine in the blood), take vacations regularly and exercise. In some cases drugs are used, typically beta blockers like Inderal, which interfere with the action of certain stress hormones. But the core of most stress-management programs, and what makes them distinctive, is teaching patients how to relax.

The guru of therapeutic relaxation is Cardiologist Benson. Back in 1968 he was persuaded by practitioners of Transcendental Meditation to study the effects of the technique on the body. To his surprise, Benson found that TM could elicit dramatic physiological changes, including decreased heart rate, lower blood pressure and reduced oxygen consumption. Meditation, says Benson, sets off "a built-in mechanism that is the opposite of the fight-or-flight response." Practiced ten to 20 minutes once or twice daily, it has been shown, by Benson and others, to produce a lasting reduction in blood pressure and other stress-related symptoms. Thus it is a natural antidote to tension.

TM is only one of several techniques that can be used to produce what Benson has termed the "relaxation response." The effect can be achieved just by following four simple steps: assume a comfortable position, close your eyes, concentrate on a single word, sound or phrase, and cast off all other thoughts. Instead of using the traditional mantra of TM, Benson's patients are encouraged to select a sound or image that appeals to them personally. One of his Jewish patients focuses on the word shalom; a Greek chants "Kyrie eleison " (Lord have mercy upon us); a Catholic recites the prayer "Lord Jesus have mercy "; others evoke the response by listening to soothing tapes of ocean waves. "As long as one can become passively unaware of the outside world," says Benson, "the method is not important."

In fact, techniques like muscle relaxation, biofeedback, self-hypnosis, rhythmic breathing and exercise can also elicit the relaxation response. These methods are now widely used at U.S. hospitals and clinics to treat such stress-related problems as migraine and tension headaches, Raynaud's disease (a circulatory disorder that causes painfully cold hands and feet), gastric ulcers and colitis. "Ten or 15 years ago, we thought there was no therapy for stress," says Stanford Psychiatrist Stewart Agras. "Now we know that relaxation is not a gimmick; it works."

At New York City's Columbia-Presbyterian Center for Stress and Pain-Related Disorders, Dr. Kenneth Greenspan claims to be able to reduce the severity and frequency of migraines in 80% of sufferers. The principal weapon: biofeedback. The patient is connected by sensor wires to a machine with a small screen that feeds back information on such physiological indexes of stress as blood pressure, tension in the facial muscles or, most frequently, the temperature of one's fingers -- the colder, the tenser. By loosening their muscles, breathing deeply or letting their thoughts drift, patients learn that they can control their stress response; they can make their blood pressure drop or the temperature in their hands rise by as much as twelve to 14 degrees. After six to ten sessions, at $150 each, patients are weaned from the machines and are able to elicit the relaxation response at home without mechanical prompting. "All biofeedback does is make you more aware of what's going on in your own body," says Psychologist Lyle Miller, who uses the technique at Boston University's biobehavioral sciences clinic. "There is a significant amount of voluntary control over so-called involuntary responses, as the yogis have demonstrated for centuries."

As biofeedback and other relaxation techniques gain acceptance, doctors are testing them against all sorts of ills. Duke Psychologist Richard Surwit has shown that biofeedback and progressive musclerelaxation exercises can help diabetics maintain steadier glucose levels. At Children's Orthopedic Hospital in Seattle, Dr. William Womack helps youngsters contend with the strains of growing up. Kurt Russell, 16, was immobilized by migraines for days at a time until Womack taught him a self-hypnosis technique. Now symptom-free, the teen-ager travels twice a day to a peaceful place in his mind. "You imagine yourself in the woods or skiing," says Russell. "It's pretty neat."

Some of the most remarkable work in relaxation has been done with cancer patients, who often suffer excruciating anguish over the uncertainty of their future and the horrors of treatment. Chemotherapy can be especially devastating. Patients become so apprehensive that they may feel nauseated just at the thought of treatment, says Psychologist Thomas Burish of Vanderbilt University. "One woman even vomited in a drugstore when she saw the nurse who administered her therapy." Burish has helped cancer patients control their anxiety and nausea through biofeedback and progressive muscle-relaxation training. While the technique is not a cure, he says, "pa-tients do gain a positive feeling of being in control again. It is one of the few things they can do to help themselves."

Regaining that sense of being in control is the principle behind another psychological technique designed to aid cancer patients. Devised by Fort Worth Radiologist Carl Simonton, the method requires the patient to imagine his tumor cells being hunted down and devoured by white-knight-like defender cells. Bizarre as it seems, the technique has helped "significant numbers" of terminally ill patients survive beyond all expectations, says Psychiatrist Cohen of Boston University. "How they do it, we do not know."

The relaxation boom has found a warm welcome in America's citadels of stress: large corporations. The reason, experts agree, comes down to the bottom line. By encouraging workers to reduce the strains on their hearts, backs and psyches, corporations can begin to lower the $125 billion or more annually spent on total health care for employees, a figure that has been rising by 15% a year. In addition, Benson points out, many firms are finally beginning to appreciate the long-established fact that too much stress makes workers inefficient. In 1908 Yale Psychologist Robert Yerkes, along with J.D. Dodson, demonstrated that pressure improves performance, but only up to a point; after that, efficiency drops off sharply. Relieving the strain with relaxation breaks, Benson concludes, "actually enhances performance."

About one out of five of the FORTUNE 500 companies now have some sort of stress-management program. Many are restricted to top executives, though studies have shown that the most stressed workers are in middle management. In addition to facing the pressures of climbing the corporate ladder, these workers are caught in a perilous bind: lots of responsibility but little control. Those who have surmounted these obstacles and made it to the top "have the fewest problems," says Dr. Gilbeart Ceilings, corporate medical director of New York Telephone Co.

Corporate efforts to reduce stress range from the commonplace alcoholism program to on-premise exercise facilities, meditation classes and company-sponsored biofeedback. At the Equitable Life Assurance Society in Manhattan, employees with frequent stress-related health complaints participated in an in-house biofeedback program and reduced their average number of visits to the company medical office from two dozen annually to fewer than six. According to Psychologist James Manuso, who ran the project, Equitable saved $5.52 in medical costs for every dollar invested.

At New York Telephone, a program involving periodic health exams for all employees and meditation lessons for those with stress-related symptoms has helped cut the corporate hypertension rate from 18%--about average for U.S. firms--to half that amount. New York Telephone estimates that it is saving $130,000 a year from reduced absenteeism alone.

Results like these have created an enormous demand for stress-management programs, and a small army of entrepreneurs has rushed in to fill the vacuum. New York Telephone's Collings reports getting "three or four offers a week to conduct relaxation programs." Not all of them are bargains. In an effort to bring some order to the booming and chaotic field, Rosch (whose respected American Institute of Stress is nonprofit) is establishing a data bank with information on the cost and effectiveness of stress-management programs. The result, he hopes, will be "a kind of Who's Who in stress. Right now there's no sense of pedigree."

Rosch and others point out that no single approach to relaxation is right for everyone. "Meditation may be good for somebody with hypertension," says Rosch, "and bad for someone with a peptic ulcer." One person may need psychotherapy to get at the roots of his Type A behavior, while another needs nothing more than regular exercise and vacations. Just as responses to stress vary widely according to age, sex, temperament and other factors, so do the requirements for treatment to offset it.

What no treatment programs attempt to do, however, is eliminate stress entirely. Nor should they. Hans Selye made a career of studying the ill effects of stress, but he nevertheless believed it was "the spice of life." Falling in love, catching a ride on an ocean wave, seeing a great performance of Hamlet--all can unleash the same stress hormones as do less uplifting experiences, sending the blood pressure soaring and causing the heart to palpitate madly. But who among us would give them up? "A certain amount of stress is a positive and pleasurable thing," says Neurochemist Barchas. "It leads to productivity in the human race."

As the relaxation boom spreads, as corporate America learns its mantras and chronic worriers unwind their minds, the point, then, is not to escape the effects of stress, which are inescapable in any case, but to channel and control them. Between the fight-or-flight spasms of too much tension and the dullness and dormancy of too little, the challenge for each person is to find the level of manageable stress that invigorates life instead of ravaging it. --By Claudia Wallis. Reported by Ruth Mehrtens Galvin/Boston and Dick Thompson/ San Francisco

With reporting by Ruth Mehrtens Galvin/Boston, Dick Thompson/San Francisco This file is automatically generated by a robot program, so viewer discretion is required.