As we look at approaches to managing stress, there are two levels to be discussed. The first is an overall understanding of the general principles involved in managing stress. The second level is concerned with taking these general principles and turning them into practical tools and approaches than can be used by people to manage their stress.

We will begin by looking at general principles of stress management. To start, we will return to a concept from an earlier section: the five stage stress response. What is the body trying to do with this response system? It is trying to gear the body up to handle the challenge, threat, or opportunity, then bring the body back to a less aroused state so the a person can rest, recover, and prepare for the next event.

Problems occur when the amount of time spent in the recovery stage is not sufficient to rest and recover from the time and energy spent in the response stage. Good stress management involves correcting this imbalance. There are a number of logical ways to work on correcting this imbalance. They are shown on the following page.

Restoring the Balance between Response and Recovery

Principle 1-E: Decrease the number of your ergotropic responses.
Principle 2-E: Decrease time spent in ergotropic responses.
Principle 3-E: Decrease the intensity of your ergotropic responses.
Principle 1-T: Increase the number of your trophotropic responses.
Principle 2-T: Increase the time spent in trophotropic responses.
Principle 3-T: Increase the intensity of your trophotropic responses.

Because stress takes place in an interaction between an individual and his/her environment, there will be internal and external factors involved in working with these principles. Generally speaking, all of the six principles can involve both internal and external solutions.

For example, in order to have fewer instances in which your body generates an ergotropic response, one solution is to avoid as many stressful events as possible. This is an external solution.

Likewise, if one wants to avoid too intense responses, or spending too much time in the response phase, a simple solution is to get away from any event that creates a too strong a stress response, or a response that goes on for too long a time. However, there are times when there is no possible way to avoid stress. Furthermore, there are people whose life experiences have made them experience almost any life event as stressful. And they cannot just avoid everything in life.

This is where the three ergotropic principles also have relevance to solutions that take place internally - within the perceptual and evaluatory systems of the person in question.

Internal solutions might require the person to alter his/her perceptions on what events are stressful, and how stressful they are. This is a fundamental feature of most successful psychotherapeutic approaches. The person might also need to alter his/her perceptions of the resources he/she has to bring to bear upon the event, as this affects the level of stress response that will be set in motion.

These internal solutions are particularly relevant to Principle Three, which is concerned with tuning down the level of the stress response to any event. The more successful a person is in targeting the level of response to exactly what is required to handle the challenge, threat or opportunity of any event, the better use that person will make of available resources of physical and emotional energy.

The trophotropic solutions are concerned with increasing the capacity of the body to set in motion the chemistry of the trophotropic responses. This means learning how to relax the body, to turn up and increase the trophotropic responses, even when ergotropic responses have been set in motion by stress.

While the body has built-in mechanisms to create trophotropic responses at a deep level, it is also possible to develop this capacity. With directed effort and much practice, you can learn to set in motion your body's trophotropic responses at will. Bio-feedback, progressive relaxation, and cognitive behavioral therapy all can help develop this skill. Further discussion on this topic will be raised later in this training.

In addition to these internal approaches, there are obviously also external ways to increase time spent in the rest and recovery stage: place one’s self in situations that are relaxing and restorative. This unusual approach to creating trophotropic responses, commonly known as "playing" or "taking a vacation", appears not to have gained widespread acceptance in this country.

These principles, with both internal and external ways to put them into effect, form the foundation of any attempts at stress management, as well as the foundation of our overall understanding of stress management at a theoretical level.

These two skill sets are largely influenced by the efforts of two extremely important areas of the brain: the pre-frontal cortex and the hypothalamus region of the limbic system. The pre-frontal cortex, in addition to other important functions, is involved in a number of emotional - and physical - regulatory functions. It has direct connections to the more primitive areas of the brain and helps to control them.

This is a very important area for taking information that has been gathered and stored in other parts of the neo-cortex, and creating a bridge to the limbic system and other deep and primitive areas of the brain.

The pre-frontal cortex is like a switchboard, with wires connected to both the new part of the brain and the old part of the brain. This is the bridge over which conscious thought and choice moves into the emotional and deeper areas of the brain to create the kind of change brought about by psychotherapy. It works closely with the hypothalamus in the limbic system, which is also like a switchboard, but at the deeper level of the brain.

The hypothalamus organizes and makes unified sense of the more primitive information from the instincts and emotions. The hypothalamus makes decision about how to respond to this information, and set the responses in motion, and also sends this more primitive information upward through the pre-frontal cortex, where it can be processed and analyzed.

The pre-frontal cortex, in turn, organizes and makes sense of the more complicated information from the neo-cortex, and sends messages back down to the hypothalamus. If the pre-frontal information is strong enough, it can convince the hypothalamus to alter the responses that have been set in motion.

Together, these two important areas of the brain arrive at important conclusions about what is going on inside and outside the person - and what to do about it. While they work somewhat separately, they try to communicate and reach a unified decision.

This is, of course, a somewhat simplified picture of what is going on. There are also other important parts of the brain that play a part in this orchestration of information compilation, assessment and exchange.

What is important to know for this training on stress management, however, is that the pre-frontal cortex is the gateway for our conscious decision making abilities to re-organize the physical landscape and chemistry of the stress response systems. If these pathways did not exist, once experiences, reactions and perceptions were laid down in the relatively hard-wired areas of the primitive brain, they would remain fixed and not repairable.

But these pathways do exist. Although change is sometimes very difficult when the laying down of early experience is powerful and traumatic, the road to change is there. If the hypothalamus and pre-frontal cortex did not communicate, psychotherapy would not work. The complicating factor is, of course, that the pathways for change exist in the brain where there are billions of brain cells with trillions of connections.

The job of the pre-frontal cortex, with the help of the hypothalamus, is to pick and choose from all these trillions of connections to decide what is the most important information, so the body can know how it should respond to any event that is occurring. How do these areas of the brain make these kinds of decisions, and what does that tell us about stress management?

There are some rules about what determines how information is given importance in the brain. Knowing these rules can help you understand how information is used in the brain, and how this affects the ergotropic and trophotropic response systems.

The first two rules can work against good stress management if a person has experienced early trauma. The earlier that information is laid down in primitive areas of the brain, the more "hard-wired" it is in the brain. This means it has more powerful connections that are harder to change.

The second rule is similar. The more information is connected to powerful emotional and instinctive responses - like terror or anguish - the higher priority the information will be given. This is because the emotional and instinctive responses are deeper in the brain, and more "hard-wired" than purely cognitive information.

As was noted earlier in this course, memory formation that occurs in the right side of the brain in close connection to the amygdala is much more difficult to access in order to create restructuring of the memory. Both early memories and extreme traumatic events are laid down in this process, which we called implicit memory.

This means as the hypothalamus and pre-frontal cortex begin to decide how to respond to something, the earliest, or most powerful emotional and instinctive information will be given priority in terms of deciding what response is required.

The third rule is that the more repetitively the same information is stored, the higher priority the information will have in decision making. If a person is repeatedly told bad things about his/her self-esteem, the information continues to acquire more strength the more often it is repeated.

Repetitive information acquires strength by accumulation. Literally more and more brain connections are laid down - like miniature wires - about the information. The more wires, the more electricity can flow through them, and the stronger the information flow becomes - like a river that has more tributaries flowing into it.

The fourth rule is that the information that has been the most recently experienced is most likely to have extra strength when it comes to decisions. Most clinicians experience this effect with clients. After a really good session, clients can be clear on the changes they need to make, and how to make them. A week later, when they come back, the changes have been forgotten and the clients have slid backwards.

There is a neurological principle that explains this process. When a brain cell is activated, then electricity runs through it. When this occurs, the neuron stays "excited" for a while from the electricity. This decreases electrical resistance and makes it easier for electricity to run through it again. The phenomenon occurring here is called "smoothing".

This makes it easier to re-access information that has recently been thought about. So information that is fresh in your head is given a little higher priority by the hypothalamus and pre-frontal cortex. This is why if you provide reassurance to a client, it can help him/her to stay calm for a while.

The trouble with smoothing, of course, is that it does not last forever. The neurons will return to a less excited state, and then information that seemed to make so much sense at the time will begin to fade.

For information to be more durable, it has to accumulate more neuronal connections by being shifted to longer term memory. This means it needs to be repeated enough times to make new connections, so it can then be given priority by the rule of repetition, or it needs to strike such a deep emotional/instinctive chord that it is given priority by the rule of emotional/instinctive connections.

The last rule is that information inputs that are supported by external events tends to be stronger than information that is supported only by memory or internal experience.

This sounds complicated, but it just means that we tend to respond more powerfully to things that are happening right now. What is happening in reality will have a strength that old memories and beliefs can't always stand against. If we are listening to a song on the radio, it makes it very hard to remember other songs, because most of the electricity of the brain is working in response to the song happening now.

Psychotherapy uses this to create corrective experiences. Brainwashing uses this to create more destructive changes in thinking.

It goes without saying that these rules can conflict with one another. If someone's irrational beliefs are too deeply set in the structures of his/her brain, because the events that caused them were too early and too many, the immediacy of the therapeutic relationship may not be able to create change. Likewise, the beneficial effects - through "smoothing" - of the most recent therapy session, can be lost to the immediacy of an ongoing destructive relationship.

These rules, however, can also work to support one another. You can use good therapeutic interventions in the present to stabilize a client's state, then repeat it over and over, always looking for ways to intervene that resonate deeply for the patient's emotional needs.

The pre-frontal cortex and the hypothalamus direct the process of rewiring the brain according to these rules. Because decreasing ergotropic responses and increasing trophotropic capacities is about change, these rules will inform our efforts to provide greater control over the internal aspects of stress management.

This means, in practical terms, that the internal aspects of stress management will involve:

- deep kinds of rewiring - through the pre-frontal cortex/hypothalamus connection
- targeting deep emotional, instinctive, and/or somatic resonances
- repetition to reinforce the desired changes
- use of the effects of "smoothing" from recently used pathways
- use of the strength of present reality

In the next section, we will look at how this affects stress management in very practical terms.

Review Questions for Section V

At this point in the training, the trainee should be able to answer the following questions:

What are the general stress management strategies involving knowledge of the ergotropic and trophotropic systems?

What two parts of the brain are thought to be key to important rewiring of powerful emotional memories like trauma?

In this section, four rules were mentioned concerning how the brain establishes priorities for memories stored in the brain. What are these four rules and how are they relevant to stress management and psychotherapy?