In the USA treatment of chronic disease accounts for 85 percent of health costs (Kuhn, 1999). As people live longer, health-care costs rise partly as a consequence of providing optimal treatment for symptom control in chronic illness. Also, the costs of occupational stress to business and industry are becoming increasingly recognized, with the estimation that of the approximately 550 million working days lost to absenteeism in the USA, over 50 percent of these are due to stress-related illness. A new and additional cost is that incurred by litigation against employers for job-related stress (Cooper & Cartwright, 1996). Thus it is in the interest of employers to promote and facilitate practices, including healthy diet, exercise and relaxation, aimed at the management and reduction of stress experienced by employees, within the context of the workplace.
The role of stress management in illness prevention
There is much people can do both to maintain optimal health and quality of life and to help to prevent the onset of illness. Premature death and approximately 50 percent of the incidence of heart disease, cancers, cerebrovascular disease and atherosclerosis is preventable through lifestyle and dietary modification (Centers for Disease Control and Prevention; Koop, 1988, cited in Kuhn, 1999). Modern medicine acknowledges the relevance of the biopsychosocial model in understanding the experience of the effects of illness for an individual from an holistic perspective, looking at the physical, social, psychological and spiritual effects of the onset of illness upon his or her life (Engel, 1980). The literature shows that stress is a major risk factor for many diseases, primarily because of the detrimental effects of stress upon the immune system, the optimal functioning of which is essential for the maintenance of good health.
A person experiencing life stressors may or may not perceive these as manageable and thus may perceive them as either threatening or challenging, depending upon his or her previous experience and perceived levels of confidence, self-esteem and sense of mastery in being able to overcome the problems associated with the perceived stressor. Thus a stressor is first appraised as being potentially threatening or challenging. A person then considers what resources he or she has to cope with the perceived stressor, whether it is perceived as overtaxing the resources of the person or can be managed with effort and support. When the body is in a state of tranquility and calmness, external events may be perceived as less harmful, bringing about the conditions for a person to feel more in control, use more positive self-talk, perceive him or herself as possessing the required coping skills to cope with the stressful situation, and to use more appropriate problem-solving behaviors with a sense of purpose rather than give up due to a sense of loss of control, perceived helplessness and fatalism (Palmer, 1996; Lazarus & Folkman, 1984).
Maintaining health on a day-to-day basis through stress reduction techniques
When the parasympathetic nervous system is regularly activated, as in during the relaxation response (Benson, 1975), the potential of the biochemicals associated with arousal to do physical harm is reduced, notably those associated with the longer term activation of the adrenal glands. Activation of these latter glands over a prolonged period leads to hyperactivity of other body systems and organs, with a detrimental effect on physical and mental health, some signs less obvious than others, such as increased potential for the blood to clot and changes in body fat levels. Ongoing distress, caused by prolonged activation of the sympathetic nervous system, with associated secretion of toxic neurochemical and stress hormones, may lead to suppression of the immune response due to excess cortisol and any of a number of disease outcomes, including coronary heart disease, hypertension, stomach and duodenal ulcers, some types of cancer and arthritis (Gregson and Looker, 1996).
Both the latter illnesses are highly associated with the experience of pain and reduced mobility, others are associated with sometimes severe discomfort, and all are associated with financial cost and reduced quality of life for the sufferer, as well as economic loss to employer and national exchequer. From the perspective of maintaining health on a day-to-day basis, stress management has a major role in illness prevention. The “new public health” movement recognizes the complexity of issues related to health promotion and illness prevention and aims to integrate primary, secondary and tertiary modes of illness prevention, by not distinguishing between prevention and cure but rather by addressing illness at all stages of disease progression alongside prevention interventions (Richards, 1996).
Conventional, complementary and alternative medicine: Their relevance for health promotion
Conventional, Western, allopathic medicine has, in modern times, often been the only system of medicine “taken seriously.” In order to help people to attain the highest possible level of health, the World Health Organization is now viewing non-allopathic therapies, which assist in helping to maintain health, as important potential contributions to health. Traditional medicines can be used as means of promoting health in healthy and sick people, and are generally divided into those that are considered alternative, i.e., those used instead of conventional, allopathic medicine, and those that are considered complementary, i.e. those used alongside conventional allopathic medicine, such as the touch therapies including, reflexology, aromatherapy and massage, and the so called mind body therapies that help people to change their thought processes and thus their behavior, such as relaxation, meditation and autogenic training. There is some overlap in these definitions, as some traditional medicines are in fact systems of medicine, such as acupuncture, which can be used along side allopathic medicine. Integrative medicine is a term coined by Weil to describe a synergistic combination of complementary and conventional therapies (Kuhn, 1999).
Kuhn (1999) describes how the National Institute of Health has defined seven areas relating to the practice of traditional medicine:
Herbal medicine, derived from culturally diverse traditional practices
Diet, nutrition and lifestyle changes, focusing on health maintenance and illness prevention
Mind/body or behavioral interventions fostering internal homeostasis and self-efficacy
Alternative systems of medical practice, again derived from culturally diverse traditional practices
Manual healing methods: For example the touch therapies, osteopathy and physical therapy
Bioelectromagnetics focusing on how people interact with electromagnetic fields
Pharmacological and biologic treatments not yet accepted by mainstream medicine
Endacott (1996) lists a wide range of therapies shown to be useful in the management of stress. He states that while alternative medicine was mainly used as separate from orthodox medicine, complementary therapies, first used in 1976 in the UK, is holism in practice, allowing health care professionals to seek to complement the needs of the patient. The “placebo effect” contributes to the healing process, as it is essential that the person utilizing a given complementary therapy believe in its efficacy. The main benefit for public health is that people know that they must play a role in their own health care. All complementary therapies offer the participant support during the therapy and may facilitate the participant to review his or her present lifestyle and relationship with the environment (Endacott, 1996). It is well-documented that the experience of hospitalization for severe illness, especially that involving the experience of pain, may remove sense of control and mastery from even the most confident and independent person.
Complementary therapies, as well as providing a means to maintain health and well-being for the healthy individual, may also help to restore sense of self-efficacy for the person who has experienced serious loss of health, by providing an environment of empathy, encouragement and support for the participant, thereby facilitating restoration of sense of control and confidence. A health-conscious person wanting to be “master of my fate” (Henley, cited in Endacott, 1996), may take responsibility to maximize his or her own health when well through the use of health enhancing strategies, which may include a nutritionally based diet and exercise. This strategy may be enhanced by the use of a preferred complementary therapy to facilitate and promote regular relaxation, internal homeostasis and stress reduction.
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