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Family, Environmental & Preventive Medicine
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Stress Fitness: Keys to Stress Mastery
Date: 07/20/2000

It is important to recognize the effects of stress and our reactions to stress in our daily life, and more importantly, in our overall health and well-being. We must not under estimate the role of stress in all aspects of our existence. We live in a time of unprecedented stressors and they indeed are taking their toll upon mankind.

The purpose of this monograph is to learn how your body reacts to stress internally and then learn how to use self-help techniques to change how stress affects you. By understanding what stress is, where it comes from and what relieves it, you can develop the ability to avoid stress overload and actually harness the energy of stress to improve your performance, maximize your sense of joy and fulfillment, increase your health and guarantee success in your life. This is the key to Stress Mastery!

What is Stress?
Stress is not something that just happens to you; It is WHAT YOU DO with what happens to you!

Stress is our response or our reaction to an event in our life. This event is termed the stressor. Stress is not something that is negative and to be avoided at all costs. The natural physiologic body responses to a stressor include five phases. These responses have been genetically determined and have been "ingrained" in our systems for millions of years as an important survival mechanism. This unconscious response is vitally important to understand how stressors affect us in today's "modern jungle":

• Demand/Threat Phase- This is the stressor that initiates the stress response in us. For example, divorce, financial problems, an illness, being stuck in traffic or any thing that triggers our stress responses.
• Arousal Phase- After you encounter the stressor, a message is then sent throughout your body that you have encountered a demand or threat (Phase 1). This is a survival message ingrained in our system to prepare for "fight" or "flight" and is carried by your sympathetic nervous system and endocrine system (especially your adrenal glands). This message is then sent to your heart (increased heart rate), respiratory diaphragm (increased breathing rate), digestion system (slow down digestion), immune system (decrease in the function of the immune system), skin (sweating), muscles (tension), emotions and thinking part of your brain (anxiety, anger, concern, fear) all in an effort to deal with the demand or threat: run away with extra energy or fight with extra strength! This phase is often termed the Fight or Flight Response and is automatically triggered in our bodies when we perceive a threat or a stressor.
• Action Phase- Includes all the physical or mental things you do to eliminate the threat or demand. There are two types of actions or responses, a specific response (Type I) that you consciously choose to perform and nonspecific (Type II) responses that are automatic and non helpful to you.
  • Specific Responses (Type I Response) are things that you do that actually reduce or eliminated the threat or demand and moves you directly to Step 4: Resolution and Recovery.
  • Nonspecific Responses (Type II Response) are non-effective things that occur to you that do not remove or change the threat or demand. These responses (as listed in the arousal phase) are perfect to get the body ready to fight a bear or lift in tree off a loved one, but in this type II situation (no immediate action available to resolve the threat) they just sap your energy, distract you from careful problem solving and make you feel physically ill! This is what we usually call "stress" and it leads to "stress overload" (see below).
• Resolution, Recovery and Relaxation Phase- The normal period of recovery from a stressful event involves an increased state of relaxation mentally, physically and emotionally. You actually become more relaxed then before the threat. It is during this time that your body is repairing the negative internal effects of the stress response. This is the time of physical organ regeneration.
• Normal Function Phase- All body, mind and emotional systems have returned to normal.

Types of Stressors
There are two types of stressors, Type I and Type II.

In a Type I stressor, the threat (stressor) is immediate, identifiable, and resolvable by some direct action, i.e. moving out of the path of an oncoming car; turning off the water to an overflowing bathtub. The key feature of a type I stress is that it comes from a type I stressor that can be quickly relieved by an immediate, direct action.

In contrast, in a Type II stressor, the threat is abstract, intangible, unidentifiable and with no clear action that can be taken to eliminate that threat. This leads to type II stress: persistent, unrelieved state of arousal. For example, your child needs surgery but your insurance won't cover it and you don't know where you'll get the money to pay for it! Since this arousal state is persistent, one never reaches the recovery and resolution phase, and consequently, mental, emotional, physical, behavioral and social problems develop.

As a result, a persistent type II stress state creates a vicious cycle:

• Chronic arousal response to a type II stress
• The next stressor occurs before the body has reached stage 4 recovery from the first stressor
• The accumulated stress saps your energy and adaptive potential- persistent tense muscles cause pain, persistent worry causes indecision and insomnia, tense emotions cause anger flare ups
• Seeking relief, your body turns to food, caffeine, alcohol, drugs, cigarettes, etc.
• You then feel embarrassed, ashamed and guilty about your behavior, which feelings are themselves a type II stressor!
• Eventually we reach of state of STRESS OVERLOAD, which leads to disease, addiction and compulsive behaviors.

Another way to look at the stress response is in the figure below:

Unhealthy stored psychological information »
Unhealthy mind-talk »
Fear and anxiety »
Emotional distress »
Chemical messengers in brain (imbalance) »
Physiologic stress (body talk) »
Increase risk of disease

Stress Prevention and Management
Our most important tool for stress prevention is to think clearly and rationally, see what options are available and choose the best one at the time. Frequently, this literally means, "choosing the lesser of two evils." This requires us to consciously and actively "take one step back" from the stressor, objectively analyze our responses to it and then take those measures that appear best to us to manage those responses. Essentially, this is performing a "quality control checkup" on all aspects of our being, mind, body and soul. The more often we perform our quality control checkup, the better the performance we will obtain from ourselves.
Step One

• Awareness is the first step in this process. To become aware of our unconscious and automatic responses to a stressor is having an understanding of how your individual body, mind and emotions talk to you. We frequently respond to stressors with various dysfunctional mind talk, emotion talk, body and behavior talk. However, many times we are totally unaware that these thoughts, emotions, body symptoms and behaviors are the result of us reacting to stressors. We just may not being putting "two and two together" or we may be denying that we are responding inappropriately to stressors. Moreover, at times it is very difficult to identify the major type II stressor. For example, past childhood abuse or other traumatic experiences (remembered or not remembered) of the past may be the real type II stressor; not necessarily the present stressors facing you. Most often, professional help is required in these cases to gently and carefully guide the person in identifying their stressors and helping them into recovery and resolution.
  • Dysfunctional mind talk includes excessive worry, insomnia, procrastination, difficulty making decisions, chronic self blaming, blaming others, and obsessive thinking.
  • Dysfunctional emotional talk includes fear, anger, guilt, depression, sadness, isolation, feeling of helplessness, anxiety, rage, and intense desire for someone else to take responsibility and save you.
  • Dysfunctional body talk includes headaches, backaches, indigestion, abdominal pain, skin rashes, sexual dysfunction, and chronic fatigue.
  • Dysfunctional behavior talk includes overeating, drinking, drug use, nail biting, or other compulsive behaviors and addictions.

Any or all of these responses may indicate to you the need to "bethink yourself" and initiate the next steps of stress management and prevention.
Step Two

• Adopting a Functional Response is the second step after identifying the stressor and becoming aware of your resultant dysfunctional responses. For optimal wellness and stress management, we must utilize a functional response or action based on the type of stressor facing you.
  • In a Type I Stressor, determine what action is needed to eliminate the threat (stressor): like turning off the water in the bathtub in an overflowing bathtub, terminating a dysfunctional relationship, getting a new job, or simply buying a new pair of shoes.
  • Since a Type II Stressor has no immediate direct action available, other techniques come into play to enable you to change your response to that Type II stressor from those dysfunctional mind, emotional, body and behavior responses to ones that are functional.

Changing Your Response to A Type II Stressor (Functional Responses)

There are 4 major responses to fear and stress:

• Continue to be angry, upset, anxious, guilty, or depressed (take no action and continue "As is")
• Assert yourself to change the situations
• Separate or divorce yourself from the stressor
• Accept the stressor or situation, Reframe the threat and then use Intentional Recovery Techniques (Functional Responses)

The key first step is to reframe and change the perception of the threat and stressor into a more positive light or as an opportunity to learn and grow! The best definition of mental health that we have discovered is Flexibility. That is, the less rigid you are in your beliefs and actions, the easier it is for you to change (be flexible) your responses to type II stressors.

Reframing Techniques
Reframing your mind talk may include the following examples. We recommend you choose the ones that most appeal to you and repeat them daily to yourself. Some even copy them and place the sayings about the household or keep them upon their person for frequent reminders. The Daily Survival Kit for Serious Illness included at the end of this monograph is another example of reframing technique.

• I am in this situation for some reason and am willing to learn from it
• What is it that I can learn from this seeming "bad and stressful situation" so that I can become a better person?
• Instead of lamenting a self pity "WHY ME!", think a rational and constructive "now why me?........ Now how can I benefit from this seemingly stressful situation?"
• Understanding and accepting that "There are no such things as mistakes, there are only learning experiences that are stepping stones to success."
• Things work out best for those who make the best of the way things work out
• Angels can fly because they take themselves lightly
• One may also choose to adopt attitudes and the reframing thought responses as given to us by philosophers and spiritual teachers of our past:
  • "Even so, always approach Darkness without fear! Then shalt thou find the Light! Meet sorrow with a trusting heart; so shalt thou discover an angel in disguise! God thinks no evil of thee, desires no wrong toward thee, has no punishment in store for thee; give thyself into His Hand and be at peace." Marie Correlli
  • "God grant me the serenity to accept the things I cannot change, courage to change to things I can and wisdom to know the difference." Anonymous
  • "In the midst of winter, I found within me an invincible summer." Albert Camus
  • "The mind's faculties are like instruments of steel in the process of being shaped, tempered and sharpened, or changed in form and structure by means of both heat and cold. The mental activities of man (and women) require daily testing and re-adjusting, and nothing better affords the opportunity for this than the demands of daily life (stressors) with its complications, intricacies, provocations and disappointments. The unpleasant experiences are as important to balanced development as the pleasant, just as both heat and cold are essential to the tempering of fine steel.... Nature wisely treats man (and women) as if it were good for him (and her) to carry burdens; to bear the heat or cold of the day, and to surmount obstacles; knowing that hardships, toil, and effort are to his ultimate advantage. Though a man's (and women's) obstacles may be seemingly insurmountable, he CAN overcome them or THEY WOULD NOT HAVE BEEN PLACED IN HIS WAY, and the effort or sacrifice required in the overcoming is always fully compensated." R. Swinburne Clymer, M.D.
  • One night a man had a dream. He dreamed he was walking along the beach with the LORD. Across the sky flashed scenes from his life. For each scene, he noticed two sets of footprints in the sand; one belonging to him, and the other to the LORD. When the last scene of his life flashed before him, he looked back at the footprints in the sand. He noticed that it happened at the very lowest and saddest times in his life. This really bothered him and he questioned the LORD about it. LORD, you said that once I decided to follow you, you'd walk with me all the way. But I have noticed that during the most troublesome times in my life, there is only one set of footprints. I don't understand why when I needed you most you would leave me. The LORD replied, AMy precious, precious child, I love you and I would never leave you. During your times of trial and suffering, when you see only one set of footprints, it was then that I carried you. Anonymous
  • "Master the lessons of your present circumstances. We do not move forward by resisting what is undesirable in our life today. We move forward, we grow, we change by acceptance. Avoidance is not the key; surrender opens the door. Listen to this truth: We are each in our present circumstances for a reason. There is a lesson, a valuable lesson, which must be learned before we can move forward. Something important is being worked out in us and in those around us. We may not be able to identify it today, but we can know that it is important. We can know it is good. Overcome not by force, overcome by surrender. The battle is fought, and won inside ourselves. We must go through it until we learn, until we accept, until we become grateful, until we are set free. Today I will be open to my present circumstances. I do not have to label, know, or understand what I'm learning; I will see clearly in time. For today, trust and gratitude are sufficient. Melody Beattie - "Surrender"

Intentional Recovery Techniques (Self Regulation)
As you attempt to reframe your stressors, you can also use specific techniques to engage in activities that intentionally create the proper conditions, which allow the system to relax and recover even though the vague threat/demand still lingers. In other words, intentionally going straight to step 4, the Resolution, Recovery and Relaxation Phase! Exercise, healthy diet, maintaining nurturing relationships and support structures, proper rest, and cultivating a good sense of humor are all important first steps in this process.

• Exercise is one of the best ways to alleviating the harmful effects of the fight-or-flight response and of using up the extra adrenaline circulating in your system. Exercise also releases morphine like compounds in your brain to produce a feeling of well-being, sometimes called a runner's high. These are the same compounds that are released during lovemaking and are called endorphins. In addition to the numerous health benefits of exercise, some authorities recommend it as a major treatment for depression! Finally, exercise is the most important factor in a weight loss program (what a nice side effect!). If your medical condition allows, we recommend 20-30 minutes of aerobic exercise, like walking, bicycle, running, and swimming, 3-5 times per week. The person with chronic fatigue syndrome should consult their health care provider on the appropriate level of exercise given the stage of their condition.
• Selective Awareness Techniques are probably the single most powerful tool to intentionally go to step 4 (resolution, recovery and relaxation) when no step 3 action is available. If your body and mind are busy trying to find a type I solution (change or remove yourself from the stressor) to a type II stressor (like a chronic illness in you or a loved one), you are in trouble! You need to identify type II stressors (awareness) and then use these intentional recovery techniques and self-regulation techniques to take you to step 4. These Selective Awareness Techniques include: Self Affirmations, Centering, Deep Relaxation Techniques and Positive Mental Imagery/Visualization. We are not born with these skills, but we can learn them; our survival in the modern jungle may depend on them!
  • Self Affirmations use mind talk and images to replace chronic worry and negative thoughts with ones of positive self-esteem and success. These positive statements, which we say or write to ourselves is a way of consciously challenging the old, destructive ideas that are clogging our minds. By merely saying a positive thought to yourself, you are invoking all of the power of your subconscious to make that thought come true. Your subconscious mind is just like a computer and consequently it will follow exactly the program given to it by the conscious mind. We are relearning one the most important lessons and miracles of life: that we have the absolute power to control our lives by controlling what we think and what we feel! Refer to Appendix A for examples of positive Self Affirmations.
  • Centering Techniques stop the excessive mental and physical activity to which we are so addicted and instead focus the mind to quiet our constant mind chatter. This enables you to listen to the mind, body, and emotional talk to quickly receive the messages that signal stress overload. Most of us spend our lives ruminating on the past or worrying about the future. Centering, also called Mindfulness, is a way of focusing on the here-and-now, of truly living in the present. Refer to Appendix B for specific instructions on Centering Techniques.
  • Deep Relaxation Techniques can be used to alter the physiological responses of stress arousal, i.e., slow heart rate, breathing to normal, etc. It brings serenity and tranquility to the body and emotions and restores the internal calm so the body can recover and resume the normal maintenance functions. Refer to Appendix C, Deep Relaxation Technique and Appendix D, The Breathing Exercise to Mobilize Your Inner Healing Forces.
  • Positive Mental Imagery and Visualization is a technique that is one step further than the above deep relaxation technique. It creates in your mind images and scenarios of relaxation, health and effective performance. The cassette tapes by Emmett Miller, M.D. can help you with guided imagery and visualization. These cassette tapes are NOT subliminal message tapes! You do not fall asleep, nor are you given hidden messages. These tapes merely help you to obtain a relaxed state and then help you with mentally picturing stress reduction, health and healing.
  • Prayer is a very powerful tool for stress management leading to resolution and recovery. It is frequently ignored and overlooked. Many prefer a prayer that that adheres to their individual religious faith or preference. For those who desire, we have included a non-denominational prayer for health, healing and well being in Appendix E.

The following tapes by Dr. Miller (Source Cassette Learning Systems, Inc) are recommended to start an imagery/visualization program:

• Letting Go of Stress, #23
• 10 Minute Stress Manager #53

Cassette Learning Systems, Inc., PO Box W, Stanford, CA 94305
800-528-2737, Fax 415-328-4412
Deep Healing Source (http://www.drmiller.com/index.html)

Summary
Stress is not about the external events in your life, it is not something that comes from the outside. It is your response to those events! It is what your mind and body do with their perception of those events. It comes from inside you and you are responsible for it. Stress is not a negative; it is an essential part of the stress-relaxation cycle. This cycle starts with the stressor (demand/threat), then the alarm/arousal phase (the call to action), next is the response- both the specific type I and the nonspecific type II response. If you cannot remove the stressor with a direct action, you may choose to resolve it through a shift in perception and/or a consciously induced relaxation. This leads to step 4- recovery and relaxation followed by a return to normal function.

When type II stress accumulates, you feel powerless and unable to act and hence the stress/recovery cycle is never completed and the system cannot return to normal function. It then fatigues, malfunctions and proceeds towards collapse. You become more susceptible to disease and dysfunctional emotions and addictive behaviors. Jobs, relationships and the ability to live a happy and fulfilling life suffer dramatically. The skills of shifting your perceptions and relaxing deeply can be learned and practiced. The skills of selective awareness, self affirmations, centering, deep relaxation, positive imagery and the healing breath exercise offer effective options for dealing with both current and accumulated stress.

The central feature of stress overload is helplessness- you may not be able to change what is happening outside, but you can change what is happening inside. You can learn to "keep your wits about you while everyone else is losing theirs". As you practice these techniques, you will realize you are not helpless and you can master stress. Stress is not what happens to you, it is what you do with what happens to you.

Appendix A: Self-Affirmations

The technique is simple. Just repeat any positive affirmation a minimum of three times in a row, either to yourself, out loud, out loud in front of a mirror (they do work better if stated out loud), or written. Do this 3 or more times per day. The best times to say them are in bed before going to sleep and in the morning before you get out of bed. You may do one at a time or choose several at once. One hint- the ones you disbelieve the most are probably the ones you need to say the most! Here are some examples, but you can make up any you wish:

• "I am calm and peaceful. I let go of stress quickly and easily"
• "I am getting better each and every day"
• "I am lovable"
• "I am a good person"
• "I trust myself and others"
• "I let go of the past quickly, easily and safely"
• "I control my life. I am in charge of my life, emotions, and relationships"
• "Good things happen to me"
• "I deserve to be happy"
• "I eat healthy"
• "I am perfect, whole and complete"
• "Every day in every way I am getting better and better, healthier and healthier, happier and happier"
• "I am a child of God"
• "I am divinely guided. The path I take is always the right path. I find a way where there is no way" or "God will always find a way where there is no way"

Appendix B: Centering or Mindfulness Technique

The first step of mindfulness meditation is to sit comfortably and relax. Close your eyes and notice your breathing. Breathing is extremely important for meditation and for reducing stress in general. If you are breathing from the upper part of you chest and your shoulders are rising and falling when you breathe, your breathing is too shallow and you will find it difficult to relax. Proper breathing comes from the diaphragm, the area in you abdomen below your ribs. You can see how your diaphragm works by lying on the floor and watching it as you breathe. Place your hand on your abdomen and as you breathe in your hand should rise to the ceiling. You should always breathe from your diaphragm, as deeply, slowly, and rhythmically as possible. As you start your mindfulness exercise; notice your breath and, each time you exhale, notice how you let go of your breath and your tension.

Focus your attention on the tip of your nose and feel your breath entering and leaving your nostrils. Feel your breath going in and out of your nostrils. And after a moment, just let yourself be aware of your breath as it leaves your nostrils. Throughout this meditation, keep your attention focused on your nostrils as you exhale each breath.

Observe your thoughts and feelings as they enter your mind; do not try to suppress them. One of the purposes of this exercise is to become aware of your thoughts and feelings. So as they come up, just notice what type of thought or feeling you have and label it. For example: "My stomach is growling and it's almost time for dinner," you might label "hunger" and "I'll never get all my work done," you could label "worry" or "job." "My foot hurts," would be "pain." After you have labeled the thought, return your attention back to your breath. Do not resist your thoughts because what you resist persists!

Centering may be performed for 5 to 10 minutes once or twice a day depending on your schedule and what feels comfortable to you. But it can also be practiced during your daily activities in a variety of ways.

Remember, centering helps us become aware of what is happening in the present moment by releasing us from our obsessive thoughts, our worries, and our fears. This technique teaches us to become a "detached observer" of our thoughts and feelings, by acknowledging them for what they are and then letting them go. It is when we become attached to our thoughts that we upset ourselves.

Appendix C: Deep Relaxation Technique

Start by sitting or lying in a comfortable position, close your eyes and breathe deeply and slowly. With each breath repeat: I am relaxed

After 1 or 2 minutes of performing step #1, memorize the following phrases and with your eyes still closed, repeat the following phrase slowly 5 to 10 times. Continue your slow deep breathing while you do this:

• My arms and legs are warm and heavy
• My heartbeat is slow and regular
• My breathing is free and easy
• My abdomen is warm
• My forehead is cool
• My mind is quiet and still

Once you have finished #2 and are in a nice, relaxed state, you may use any imagery technique you find useful to help your particular problem. The simplest and universally helpful is to perform the healing breath technique found in Appendix D.

Appendix D: Breathing Exercise to Mobilize Your Inner Healing Forces

We all have within us forces and powers that are unknown and untapped by most individuals. As a central part of our care we work with you to help you mobilize this healing potency. There are many ways that this energy can be released. One that we have found to be universally beneficial and effective is the use of the exercise on this sheet. The efficacy of this method of awakening your potential healing powers has been tested and confirmed by thousands of patient's worldwide. We know that it is successful. You have only to give it an honest try to prove its many benefits in your life.

The Technique
Assume a relaxed, comfortable position. Now slowly draw in a deep breath, which begins by lowering the diaphragm and then is completed by expanding the ribs. As you inhale hold this thought firmly in your mind:

"I draw into my body the universal forces of healing."

Or, alternatively you may hold the thought

"I draw into my body the healing forces of God"

Retain this breath for approximately five seconds while you direct your thoughts in this manner:

"I send these forces throughout my body to help heal and strengthen me."

Lastly, as you slowly exhale, and with all the feeling and dedication you can muster, send this thought to all fellow sufferers:

" I now willingly send love and all excess universal healing force to others."

This exercise should be repeated several times a day for the greatest benefit, however, do not
overdo in the beginning. It is necessary to give the body an opportunity to adapt to this new regime. Even when you are proficient you should not practice for more than five minutes at a time.

The release of healing power possible from following this procedure is incalculable, but you can prove its value to yourself if you will but be faithful with the practice. After each effort, be at peace within knowing that all is well and that the healing force just released will assure you of improvement. There is no condition that flesh is heir to that is not affected by this energy. With this healing power within there is always a way.

Appendix E: Non-denominational Healing Prayer

God, I pray that my heart be light, not heavy. Let me be full of courage, knowing that I stand as Spirit, with every right to all blessings. I will put away all thoughts of the past and know that now is the only time. I am Divine in Spirit with strength to meet all that is part of my destiny.

God, thou has created my Spirit in your Image. My Spirit cannot suffer; it cannot be sick. The Spirit knows no fear. I will obey Your command to my Spirit: Arise, Shine, for your are the Light. The Holiness of God is my Divine Inheritance. That Holiness shall show forth in my mind as harmony and happiness; in my body as wholeness and health.

God, I pray that this thought, born of the Spirit, is like the Light and casts out the darkness of all thoughts of disease and fear. Let this Light shine upon me; let it illumine my mind. Let it warm my heart. Let it heal my body by its beneficent healing power.

God, let Your Peace flow within me. Let Your Love flow within and about me. Your Light is my Light. As I become whole in the Spirit, I will manifest health now.

God, let peace be with me. Peace be in my heart. Peace with me as the breath of the morning. Peace. Peace. Peace. The Angel of Peace is within me to heal and to bless.

Amen. Amen. Amen.

Appendix F: Daily Survival Kit for Serious Illness
Adapted from Thomas L. McDermitt, "A long-time cancer patient and skeptic"

You don't have to agree with all of this all of the time. But if it generally speaks to you, try to read all or parts of it every day, or have it read to you. Part of the help is in the doing, regardless of your attitude or emotions on that day. On some levels the help is gradual and often not externally evident.

• Today I am going to try to live through this day only, and not dwell on or attempt to solve all my problems at once; just focus on the piece that is today. I can do something for several hours that would be difficult to even think about continuing for several months.
• Just for today, I am willing to accept the possibility that there is a purpose to this suffering; that it can be a source of meaning and growth for myself and others, though I may not always recognize the ways. And it seems possible that this suffering will not be in vain, because of what may be some kind of existence beyond.
• Just for today, let me remind myself that I am a worthwhile person; worth loving despite my weaknesses and limits. I deserve the efforts of others to help me through my illness.
• Just for today, I want to be aware that it is all right to want things from others at times. Illness brings out and intensifies the small child in all of us. And if I feel hurt when those who care for me cannot be there, it may help to remember that they also have needs, frailties and limitations of their own. A lack of response does not mean that they are personally rejecting me.
• Today I may feel the need to complain a great deal; I may have little tolerance; I may cry; I may scream. That does not mean that I am less courageous or less strong. All are ways of expressing anger over this mess, of mourning my losses. Endurance itself is courage.
• It is my life at stake now. So maybe today I can allow myself to be a little less concerned about the reactions or impressions of others. Maybe I can allow myself to feel a little less guilty or bad about what I did not accomplish or give. Perhaps today I can be a little more gentle toward myself.
• Surviving this may seem so difficult. At times it may seem impossible- that I have had enough. Down the line I will know if and when I have had enough, when I cannot push the limits any further. I will have the right to choose to take a break and rest, without feeling that I am "giving up." But today I think I can deal with this illness. Sorrow runs very deep, but I know I can rise again.
• Just for today, maybe I can give healing "the benefit of the doubt." The treatments I am using are powerful; the natural healing capacity of my body is powerful. Perhaps there is even healing power in my will to struggle, and in the collective love and will of others.
• Just for today, perhaps I can take heart that we are all connected. And I may still have some things left to contribute to the family of man; some light to add to the light. Even now my endurance (however imperfect) is a gift, an inspiration for others in their struggles.
• It seems reasonable that there is a season for everything, and a time for every purpose. Pain, weakness, and exhaustion may distort my senses and spirit. Today, however, I can at least find some hope in nature's way, if not in some master plan. The chances are fairly good, and it seems worthwhile to hope that I will have some cycle of wellness yet.

Highly recommended book on this subject:
The Physician Within, A Step-by-Step Guide to Living Well with Chronic Illness, by Catherine Feste. Henry Holt & Co. New York.