Medically Reviewed On: July 03, 2008

PAUL MONIZ: I'm Paul Moniz. Thank you for joining us. If you feel stressed out from time to time consider yourself normal. The demands of the business world, parenting and modern-day life are enough to drive just about anyone over the edge. But being stressed out is certainly different from suffering from clinical anxiety. Many people can weather even heavy stress; some even thrive on it. But sometimes the stress crosses the line to anxiety and knowing the warning signs could mean the difference between hopelessness and relative normalcy with treatment.

Here to talk about that are two clinical psychologists who work together. We have Dr. Fran Massino and Dr. Willy Wiener. Both are from the Institute for Performance Advancement in Manhattan and both deal with stress and anxiety in the workplace.

There are anti-anxiety medications. There are also some other treatments. Tell us about those.

FRANCIS MASSINO, PhD: A lot of times we will make a referral for psychopharmacological intervention when that is mandated. A lot of people want to try it on their own. A lot of people are resistant to that, but a lot of times we see a real need and make a referral to a psychiatrist.

PAUL MONIZ: What kinds of medications are prescribed?

WILLY WIENER, PhD: Paxil, Celexa, Prozac, Zoloft, all of these SSRIs have been shown to be quite effective in helping. The way we see it as psychologists is those drugs help you get to a point where you can learn to deal with your stress more effectively. So that if someone has become absolutely fearful of sitting in a conference at work, the drugs may make them take the edge off to the extent where they can walk in that room. But they've still got to learn how to cope in those situations for lasting changes to endure.

PAUL MONIZ: Is it generally a short term treatment? If someone removes the stressors in your lives, takes the medication for a certain amount of time while they're doing that, can they then get off the medication, or in some people, do they just have to take it indefinitely?

FRANCIS MASSINO, PhD: It really depends. I've seen both. When people really get it there are ways to change your thinking about your ability to problem solve, your ability to tackle a situation, to feel hopeful that there will be a more successful outcome. There are other people who are just predisposed to a more negative disposition. Those are people who come in and say I don't think I will ever be off the Paxil. So it really does vary due to individual differences.

PAUL MONIZ: For those patients who don't want to take any medicine, what kinds of cognitive therapies can you recommend?

WILLY WIENER, PhD: Thinking about your thinking and appraising situations in more adaptive ways, characteristic of anxiety disorders, people tend to see very innocuous events as dangerous often times. They see themselves as in great danger, in jeopardy. Looking at their events and their life in a more rational light and changing their thinking around certain issues can really help them adapt to life much more comfortably.

PAUL MONIZ: What about hooking up electrodes to your body, how does that help?

FRANCIS MASSINO, PhD: With the biofeedback, one of the things that we try to do is pair relaxation with more rationale thinking. A lot of times when you are perceiving something as being an immediate threat, it's harder to really reason through some of the options that are available to you. So by hooking up electrodes to fingertips or to different muscle groups you can, on a computer screen, help someone visualize the effects of breathing on the actual bodily functions, decreasing the heart rate with breathing, reducing blood pressure, helping muscle groups relax. So it's great to have that visual, rather than having a subjective experience where someone says, "I think I feel more relaxed." Actually pairing that with the objective data where you are looking at a computer screen saying, "Look at how you've reduced your heart rate. Look at how you've reduced your skin temperature."

PAUL MONIZ: So this is really a commitment because it's difficult to change the way you think. How do you do that?

WILLY WIENER, PhD: Yes, it is. Well, you practice. You write down your thoughts. You take note of your thoughts and you develop rational responses to them. We will have our clients actually write down their thinking in critical moments and then develop a rational response to that thinking. The idea is that you can train yourself to think differently. Obviously, we all have personalities that are different and will persist over long periods of time, but to some extent you can train your thinking to be more adaptive.

PAUL MONIZ: Can you give us an example of someone who may have been exhibiting behavior that's inappropriate or over anxious that upon reflection was able to come up with a more rational approach? What kinds of behavior are you talking about?

WILLY WIENER, PhD: When people are criticized, for instance, a lot of people become very angry, become very anxious, become very hurt in the face of any kind of criticism on the job. And of course, in today's workplace, which is more communicative and more demanding, that's not a very adaptive quality -- to fly off the handle every time you're criticized. So to take a step back, to breathe and to think about your thinking and maybe challenge the rule that no one can criticize me unfairly. And perhaps that it is okay that sometimes people criticize me unfairly. It may not be pleasant but it's survivable and it's not a catastrophe. So that kind of readjusting your thinking might help you get through the day more effectively.

PAUL MONIZ: Also having more confidence to approach the person in a proactive way can make you feel better in the end.

FRANCIS MASSINO, PhD: Definitely.

PAUL MONIZ: Because if you're so anxious and you're in this situation, you may not even know what to do. You may just completely withdraw as you were saying earlier.

FRANCIS MASSINO, PhD: Right. And we would like to remind people that there is always a choice. There are always options. There is always someone you can turn to and talk to about this. You can go home and talk with your husband or wife and organize your thinking around this to really work to identify what the difficulty is. You can speak with a co-worker or you can speak with someone in human resources, but there are always options. There are alternatives.

PAUL MONIZ: Guided imagery -- how can that help someone?

WILLY WIENER, PhD: Guided imagery helps you visualize a positive resolution to certain situations, and I think it can be very helpful to sort of see this go smoothly in your mind's eye. It develops the facility for it happening in real life.

PAUL MONIZ: Can you give us an example? For instance, let's say you're having a problem with someone in your family -- a family member who is a meddling person. How can this guided imagery help? Imagine the person just goes away.

FRANCIS MASSINO, PhD: That might be one way. Zap them out.

WILLY WIENER, PhD: You might envision yourself if this person wants to establish a boundary for themselves and be a little bit more assertive and has had difficulty doing that. You might imagine yourself doing this in a very relaxed way. See a vision of yourself relaxed and firmly assertively, not in an aggressive way, communicating your needs and doing that with poise and in a calm manner. It might help that person actually the next day or later that afternoon execute that and do it with a little more confidence.

FRANCIS MASSINO, PhD: We try to have people focus on behaving as well as they can or speaking as effectively as they can, or feeling as calm as they can. To really use this imagery to prepare themselves in every arena so that when the actual event occurs, they are as prepared as they possibly can be. We really do believe that with this family member if you imagine trying to approach and let's say there is not a positive resolution and that this person is not going to change, which is often the case. You can't change other people. You can only change the way you react to them. So we would have someone then visualize a way to turn his or her attention to another family member -- someone with whom the interactions are going to be more positive.

PAUL MONIZ: Okay, some very good advice. Dr. Fran Massino, thank you very much for your time. Dr. Willy Wiener, as well. Both from the Institute for Performance Advancement in Manhattan. Remember there is a difference between stress and clinical anxiety. If you have questions, and you cannot cope, you should consult a professional. I'm Paul Moniz, thanks for joining us.