Supplements

Sock's Toxicity And Drugs In RA:

Supplements

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The American Dietetic Association and other major medical organizations all agree that the best way to get the vitamins and minerals you need is through a nutritionally balanced diet. However, sometimes a supplement may be appropriate.

Even if you don't have a vitamin or mineral deficiency, a vitamin or mineral supplement may be appropriate for you if:

You're age 65 or older. As you get older, health problems can contribute to a poor diet, making it difficult for you to get the vitamins and minerals you need. You may lose your appetite, as well as some of your ability to taste and smell. Depression or problems with dentures can also inhibit eating. If you eat alone, you also may not eat enough to get all the nutrients you need from food.

In addition, as you get older, your body may not be able to absorb vitamins B-6, B-12 and D like it used to, making supplementation more necessary. There is also evidence that a multivitamin may improve your immune function and decrease your risk for some infections when you're older.

You're a postmenopausal woman. For some women, it can be difficult to obtain the recommended amounts of calcium and vitamin D without supplements. Both calcium and vitamin D supplements have been shown to protect against osteoporosis.

You don't eat well. If you don't eat the recommended five servings a day of fruits and vegetables, taking a multivitamin supplement may be reasonable. However, your best course of action would be to adopt better eating habits.

You're on a very low-calorie diet. If you eat fewer than 1,000 calories a day, you may benefit from a vitamin-mineral supplement. But remember — a very low-calorie diet limits the types and amounts of foods you eat and, in turn, the types and amounts of nutrients you receive. Very low-calorie diets should only be undertaken with guidance from your doctor.

You smoke. Tobacco decreases the absorption of many vitamins and minerals, including vitamin B-6, vitamin C, folic acid/folate and niacin. But vitamin and mineral supplements won't make up for the major health risks caused by smoking.

You drink alcohol excessively. Long-term excessive alcohol consumption can impair the digestion and absorption of thiamin, folic acid/folate and vitamins A, D and B-12. Altered metabolism also affects minerals such as zinc, selenium, magnesium and phosphorus. If you drink excessively, you also may substitute alcohol for food, resulting in a diet lacking in essential nutrients.

Excessive drinking is defined as more than one drink on a daily basis for nonpregnant women or anyone age 65 or older, and more than two drinks a day for men. Alcohol can cause a range of birth defects, the most serious being fetal alcohol syndrome (FAS). Because scientists do not know exactly how much alcohol it takes to cause alcohol-related birth defects, it's best not to drink any alcohol during pregnancy.

You're pregnant or trying to become pregnant. During this time, you need more of certain nutrients, especially calcium, folic acid and iron. Folic acid helps prevent neural tube defects, such as spina bifida, in your baby. Iron helps prevent fatigue by helping you make the red blood cells you need to deliver oxygen to your baby. Your doctor can recommend a supplement. It's important to start taking a supplement before becoming pregnant.

You eat a special diet. If your diet has limited variety because of food allergies or intolerance to certain foods, you may benefit from a vitamin-mineral supplement.

If you're a vegetarian who eliminates all animal products from your diet, you may need additional vitamin B-12. In addition, if you don't eat dairy products and don't get 15 minutes of sun each day on your skin, you may need to supplement your diet with calcium and vitamin D.

Your body can't absorb nutrients properly. If you have a disease of your liver, gallbladder, intestine or pancreas, or if you've had surgery on your digestive tract, you may not be able to digest and absorb nutrients properly. In such cases, your doctor may recommend that you take a vitamin or mineral supplement. A supplement may also be prescribed if you take antacids, antibiotics, laxatives or diuretics that interfere with nutrient absorption.

You may be confused about how much of a specific vitamin or mineral you need. Here's how to figure out what you need:

Recommended Dietary Allowances (RDAs) describe the average amount of each vitamin and mineral needed each day to meet the needs of nearly all healthy people. They're determined by the Food and Nutrition Board of the Institute of Medicine, part of the National Academy of Sciences.

RDAs for some vitamins and minerals vary according to your sex, age and physical condition, for example, pregnancy. Daily Values (DVs) are used on food and supplement labels. They're set by the Food and Drug Administration (FDA), but the DVs are based on data that's much older than the data that's used to determine the RDAs. The FDA bases DVs on a 2,000-calorie-a-day diet. Of course, individual needs may vary.

Many women and older adults may need only about 1,600 calories a day. Active women and most men need about 2,200 calories a day. Active men may need about 2,800 calories a day. If your calorie needs are greater or less than 2,000 a day, your DVs for various nutrients generally rise or fall accordingly.

Percent Daily Value tells you what percent of the DV one serving of a food or supplement supplies. For example, if the label on your multivitamin bottle says that your multivitamin provides 30 percent of the DV for vitamin E, you'll need another 70 percent to meet the recommended goal.

Daily Values for vitamins and minerals; If you decide to use a supplement, experts recommend choosing one that doesn't exceed 100 percent of the Daily Value for each vitamin and mineral, unless your doctor advises otherwise. Daily Values are listed on supplement labels. They're based on a daily intake of 2,000 calories and meet or exceed recommended vitamin and mineral needs for most people.

VITAMIN;100% DAILY VALUE;Vitamin A* ;5,000 International Units (IU)*
Vitamin C;60 milligrams (mg);Vitamin D 400 IU;Vitamin E 20 IU natural source or 30 IU synthetic source;Vitamin K;80 micrograms (mcg); Thiamin (vitamin B-1);1.5 mg;Riboflavin (vitamin B-2);1.7 mg; Niacin (vitamin B-3);20 mg;Pantothenic acid (vitamin B-5);10 mg; Pyridoxine (vitamin B-6);2 mg;Folic acid/folate (vitamin B-9)
0.4 mg or 400 mcg;Cobalamin (vitamin B-12) 6 mcg;Biotin 0.3 mg or 300 mcg;MINERAL;100% DAILY VALUE;Calcium;1,000 mg or 1 gram (g);Chloride 3,400 mg;Chromium;120 mcg;Copper;2 mg; Iodine; 150 mcg Iron**;18 mg**; Magnesium; 400mg; Manganese;2 mg; Molybdenum;75 mcg;Phosphorus;1,000 mg; Potassium;3,500 mg;Selenium;70 mcg;Zinc;15 mg;*New Recommended Dietary Allowances (RDAs) are lower: 3,000 IU a day for men and 2,330 IU a day for most women.

**For men and postmenopausal women, it's probably wise to use a pill with little or no iron (8 mg a day or less).

The roots of Thunder God Vine, a plant whose leaves and flowers are highly toxic, have been used medicinally in China for over 400 years. A root extract of this plant was shown to safely and effectively reduce pain and inflammation in a small group of people with treatment-resistant rheumatoid arthritis, according to a study funded by the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS).

The randomized, double-blind, placebo-controlled trial, published in the July issue of Arthritis & Rheumatism, is the first to test the use of an extract of this vine in rheumatoid arthritis patients in the United States.

Twenty-one rheumatoid arthritis patients completed a 20-week clinical trial of the ethanol/ethyl acetate extract. Patients were randomly assigned to one of three treatment groups: placebo, low-dose extract, or high-dose extract.

After four weeks, 80 percent of patients in the high-dose group and 40 percent in the low-dose group showed rapid improvement in symptoms compared with no improvement in the placebo group. Side effects were minor for all three treatment groups. Longer term studies with larger numbers of patients are needed to confirm the safety and benefits of the treatment.

According to senior author Peter Lipsky, M.D., scientific director of NIAMS, the extract is a particularly promising treatment for rheumatoid arthritis. It is unique, because it slows down the overactive immune system, reduces inflammation by turning off inflammatory genes such as tumor necrosis factor alpha, and reduces the activity of B and T cells.

Dr. Lipsky believes this plant extract has the potential to treat other immune diseases such as lupus, and is planning further studies. The extraction process, although time-consuming, is critical because it transforms the otherwise toxic and deadly Thunder God Vine into a therapeutic treatment.

Rheumatoid arthritis, a chronic inflammatory disease of the joint lining, often results in pain, stiffness, swelling, and loss of joint function. It occurs two to three times more often in women than in men.

An extract of the herb St. John's wort was no more effective for treating major depression of moderate severity than placebo, according to research published in the April 10 issue of the Journal of the American Medical Association.

The randomized, double-blind trial compared the use of a standardized extract of St. John's wort (Hypericum perforatum) to a placebo for treating major depression of moderate severity. The multi-site trial, involving 340 participants, also compared the FDA-approved antidepressant drug sertraline (Zoloft®) to placebo as a way to measure how sensitive the trial was to detecting antidepressant effects.

"Many Americans use dietary supplements like St. John's wort for depression without consulting a physician," says principal investigator Jonathan R.T. Davidson, M.D., professor of psychiatry and director of the Anxiety and Traumatic Stress Program at Duke University Medical Center. "We felt there was a need to conduct a trial that could help us determine where St. John's wort fits in the overall management of depression."

The trial, funded jointly by the National Center for Complementary and Alternative Medicine (NCCAM), the National Institute of Mental Health (NIMH), and the Office of Dietary Supplements (ODS), all components of the National Institutes of Health, was launched in response to growing use of St. John's wort in the United States and a need for more definitive data on its use for different types of depression.

Although several smaller European studies have suggested that St. John's wort is useful in treating mild to moderately severe depression, experts who reviewed those studies concluded that they had limitations and more rigorous trials were needed before firm conclusions could be drawn. Thus, NCCAM and its partners launched one of the first large-scale, multi-site clinical trials of St. John's wort in the United States.

"Our commitment is to apply exacting scientific methods to studying popular complementary and alternative medicine practices and to publish the results of such studies in critical peer-reviewed journals, so that the public and practitioners can make the most informed decisions about them," says Stephen E. Straus, M.D., NCCAM Director. "This study represents one of our first 'downpayments' on this commitment."

"St. John's wort is taken by many people for the relief of mild to moderate depression," notes Paul M. Coates, Ph.D., Director of ODS. "It is important to assess the efficacy and safety of this and other commonly used dietary supplement ingredients."

According to NIMH, major depression affects approximately 9.9 million American adults age 18 and older in a given year and is a leading cause of disability in the United States.

A person experiencing a major depressive episode, according to the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV), suffers from a depressed mood or loss of interest in normal activities that lasts most of the day nearly every day for at least 2 weeks; this mood can last longer if untreated.

Other than depressed mood or loss of interest, symptoms include at least four of the following: significant weight loss or gain, sleep disturbances, agitation or unusual slowness, fatigue or loss of energy, feelings of worthlessness or guilt, lack of concentration, or recurrent thoughts of death or suicide.

"Major depression is a serious public health concern. Determining whether an herbal product, such as St. John's wort, can work as a treatment is important," said Richard K. Nakamura, Ph.D., Acting Director, NIMH. "We are always seeking treatment options to add to the list of proven medications and psychotherapies available to those suffering from depression."

Study participants' initial diagnosis and severity of depression were confirmed using three primary measures: the DSM-IV depression criteria, the Hamilton Depression Scale (HAM-D), and the Global Assessment of Functioning Scale (GAF).

Participants who met DSM-IV criteria for major depression, who had initial HAM-D scores of 20 or higher, and who had at least moderately severe major depression according to the GAF, were recruited from 12 academic or community psychiatric research clinics across the country.

The study was conducted in two phases. The first 8-week phase, or acute phase, measured the number of people whose depression responded to treatment with St. John's wort (from 900 mg to 1,500 mg per day), sertraline (50 mg to 100 mg per day), or placebo; this phase was the primary focus of the study.

A second, or continuation, phase offered patients who had responded to their initial treatment another 18 weeks of therapy, which enabled researchers to gather data on longer-term use of the treatments. The preparation of St. John's wort used in this study is one sold and produced in Europe and used in many earlier, smaller depression trials.

Two primary outcomes were measured during the first phase of the trial: improvements in the HAM-D scores, indicated by a reduction in score, and complete response to treatment, indicated by overall reduction in both the HAM-D score to normal levels and Clinical Global Impressions-Improvement Scale (CGI-I) score.

The researchers found that HAM-D scores among patients taking St. John's wort dropped about 8.7 points on average versus approximately 9.2 points for placebo and 10.5 points for sertraline. They also found that approximately 24 percent of patients taking St. John's wort had full responses to treatment versus about 32 percent for placebo and 25 percent for sertraline.

The differences in these rates of response were not large enough to be statistically significant. However, additional analyses of the data showed that those taking sertraline improved significantly more than those on placebo and on St. John's wort on the CGI-I, a secondary measure of improvement.

In spite of this finding, the overall response to sertraline on the primary measures was not superior to that of placebo, an outcome which is not uncommon in trials of approved antidepressants. In fact, this apparent lack of efficacy occurs in up to 35 percent of trials of antidepressants.

"Overall, we found that patients taking either St. John's wort or placebo had similar rates of response according to scales commonly used for measuring depression," says Dr. Davidson. "And, although sertraline produced no greater effect than placebo on the primary measures, it fared better than placebo on the Clinical Global Impressions-Improvement scale and produced results consistent with its known benefits."

Some Factors To Consider;Alternatives:

Compliance sounds like a negative word,but patients can get themselves into a lot more trouble by deciding to stop taking something than if they talk to their physicians and say,"I've been feeling great for some time now. What are the long term goals with respect to my medication ?"

The medication can often be gradually reduced over time,but stopping it on your own is not an informed decision,it is foolish. The goal is to keep patients on the smallest long-term dosage that will control the disease.

One of the biggest danger is when a patient looks at side effects accompanying the medication without weighing them. The patient only hears or reads "side effects";they don't hear the frequency or chance of getting them. Even if its only one in a million,it bothers them. It's hard for physicians to convey the idea that the drug is clinically been tested,used with success on patients and approved by the FDA. Obviously it's safe to use in people,and the vast majority of people have no side effects, whatsoever.

On the other hand,the physician can't guarantee his patient won't have any side effects either. Therefore physicians monitor the patients for possible side effects and if the patient feels or sees any unusual symptoms,then the physician will either reduce the dose,stop the medication for a while,until symptoms subside,reduce the dose or stop the medication completely.

The patient has a role to play,they must educate themselves about all aspects of the disease. Keep in mind that every form of arthritis is different,and no two patients will exibit the same symptoms or have the drug affect them in the same way. Remember that there is many articles written on RA and medications may not have the same effect on the individual patient. We react differently to the disease,itself, and treatment.

Taking responsibility for your own health care isn't as daunting as it may sound,and the benefits are significant. The patient has a co-manager,the physician,who oversees the overall treatment regimen. certainly becoming more knowledgeable about your illness and treatment will have you less anxious and better able to cope with an occasional set back,or side effect if it does appear.

And getting actively involved will ensure the patient isn't overwhelmed by side effects from the medications. Merely knowing how to tell major from minor side effects,and what to do about both,strips them of their mystery and possible potential danger

Relaxation techniques are one of the most common approaches to stress reduction. These include meditation, progressive muscle relaxation, visualization and breathing exercises. Most are easy to learn. Often you need longer periods of practice when learning new approaches to stress reduction, and eventually it becomes a conditioned response.

Despite the fact that some people are cynical about the worth of such approaches, research has demonstrated consistent, powerful results. Stress researcher Hans Selye writes: "These practices should not be underestimated merely because science cannot explain them; they have worked for so long and in so many forms that we must respect them."

Recognizing that some people who practice meditation are capable of reducing their heart rate, blood pressure and oxygen consumption, Harvard University physician Herbert Benson set out several decades ago to understand how they do so. As a result, he developed and popularized a type of relaxation response, a simple practice that focuses on the qualities in meditation that create a sense of relaxation and stress reduction.

Here's how to do it: Every day, plan to spend some time at rest (not asleep). Sit someplace comfortable, close your eyes and relax your muscles. Then focus on your breathing, making it very regular, and continuously repeat one word. You can repeat the word aloud or in your mind.

But it should be either a simple word such as "relax" or "easy", a religious word or phrase, or a brief phrase that has no meaning -- such as the "om" used in transcendental meditation -- or one that simply does not make you think. Then just continue to breathe regularly, with your muscles relaxed. Relaxation is a skill that requires regular practice. It is not helpful to try it for the first time when under enormous stress.

Learn Progressive Muscle Relaxation: This technique helps you focus on each muscle and become familiar with the sensation of relaxing your entire body. You can start from your head and work your way to your toes. Tense your facial muscles by biting down and furrowing your brow. Hold the tension for five to 10 seconds, then quickly release it. Next, tense your shoulder muscles by shrugging your shoulders and tucking in your chin. Hold the tension for five to 10 seconds, then release it. After that, tense your arm muscles by making a fist. Hold the tension for five to 10 seconds, then quickly release it. And so on.

Simply continue to tighten a muscle and release it until you have worked all the way down your body. Mentally imagine the tension evaporating as you release the tension in each muscle. Focus on the warmth and heaviness of the body parts as they relax.

Do Visualization: Visualizing a pleasant place is a good way to remove yourself mentally from a stressful situation. To do this, sit or lie someplace comfortable and close your eyes. Practice the progressive muscle relaxation exercise. Allow whatever thoughts you have to pass through your mind without actually "thinking" about them.

Breathe slowly and deeply until you feel relaxed. Imagine you are someplace that makes you feel good and relaxed. This might be someplace in nature, such as the ocean's edge or the woods, or it might be more specific, such as a spot by the ocean where you have spent many restful vacations.

It also might be an image of a beautiful place that you have never visited, such as the Himalayan mountains. Focus on all five senses -- what you would see, feel, hear, taste and smell. Continue to visualize yourself there for five to 10 minutes. Then gradually return your focus to the room you are in and end the visualization.

Practice Relaxed Breathing Exercises: Take a deep breath in and out. Did you feel your chest expand and contract? Did your shoulders go up as you drew air into your lungs? This is the way many adults breathe. But to breathe more efficiently -- and in a way that promotes relaxation -- we should look to the way we breathe while asleep.

Typically, when in a relaxed sleeping state, we breathe from our diaphragm, the muscle between the abdomen and the chest. The chest does not obviously move in and out, and the shoulders do not move up and down. Instead, the abdomen rises with each breath we inhale and lowers with each breath we exhale. It is both more effortless and more efficient than the typical waking approach to breathing -- and, as a result, more relaxing.

How can you practice relaxed breathing?: Lie on your back on a bed or recliner. Place your feet slightly apart and lightly rest one hand on your abdomen, just near your navel. Rest your other hand on your chest. Inhale through your nose and exhale through your mouth.

Calmly exhale most of the air in your lungs. With each breath you take, focus on your breathing and recognize which hand is moving.

As you slowly count to four, gently inhale, slightly distending your abdomen to make it rise about one inch. Imagine warm air flowing into your lungs and to all parts of your body. Pause for one second. Then as you slowly count to four, gently exhale, letting your abdomen slowly fall and your diaphragm relax upward. Pause for another second. Repeat this process five to 10 times. When you feel familiar with it, you can practice relaxed breathing while seated and, then, while standing.

Write About Your Stress: The Journal of the American Medical Association revealed that writing about stressful experiences can do even more than that: It can help reduce the symptoms of common diseases, such as asthma and rheumatoid arthritis.

In the study, titled "Effects of Writing About Stressful Experiences on Symptom Reduction in Patients With Asthma or Rheumatoid Arthritis," one group of patients was asked to write about their most stressful life experience for 20 minutes a day over three consecutive days.

Another group was asked to spend an equal amount of time writing about their plans for the day. The results:Forty-seven percent of patients who wrote about their stressful experiences showed what physicians determined to be "clinically relevant improvement" in their conditions four months later.

Only 24 percent of the second group showed a similar improvement.
"Although it may be difficult to believe that a brief writing exercise can meaningfully affect health, this study replicates in a chronically ill sample what a burgeoning literature indicates in healthy individuals," writes Joshua M. Smyth, Ph.D., in the Department of Psychology at North Dakota State University, and his coauthors.

This growing research has revealed that writing about one's thoughts and feelings can lead to: Improvements in immune functioning -Fewer visits to the doctor -An increased sense of well-being.

Commenting on the value of writing about stressful experiences as a stress-reduction technique, David Spiegel, M.D., in the Department of Psychiatry and Behavioral Sciences at Stanford University, wrote, "Ventilation of negative emotion, even just to an unknown reader, seems to have helped these patients acknowledge, bear, and put into perspective their distress." In other words, "it is not simply mind over matter, but it is clear that mind matters."

The most common experiences written about by subjects of this study were the death of a loved one, relationship difficulties, a serious problem affecting someone close to them and involvement in or witness to a car wreck or other disaster.

Express Your Feelings: Why do women with breast cancer who express their anger live longer than those who don't? "There is evidence that resilience to stress, including disease-related distress, is associated with how people handle their emotions," according to David Spiegel, M.D., in the Department of Psychiatry and Behavioral Sciences at Stanford University.

This is why it is important to express your feelings, especially your negative feelings, when you are under stress. Studies have shown that the alternative -- suppressing negative feelings and maintaining "an upbeat or a rigidly positive attitude" -does far less to reduce stress than letting your feelings out. Being assertive in communicating your feelings, which in turn can lower your stress level, can have a significant effect on medical conditions .

Deflate The Danger Of Your Fears: The next time you feel yourself in the grip of a stressful situation, encourage yourself to look closely at your thoughts to see whether the situation merits as much stress as you feel.

Ask yourself these questions: What is the worst possible outcome that can develop from the situation? Is it likely that the worst possible outcome will occur? If so, how likely is it? How would such an outcome change your life?

Is there anything else you can do to influence the result, or have you done all that is possible? Asking yourself these questions can help free you from stress you cannot avoid or control, or can at least help to diminish it.

Remove Stressors: Are you are the kind of person who says "Sure!" but feels a knot in your stomach when a boss or colleague asks you to take on another project? Do you know you already have more responsibilities than you can comfortably handle? Then it's probably time that you set some limits for yourself.

Determine what you can realistically do, and simply stop promising more than you can reasonably handle. Be polite when you do. Just say, "No. With the current responsibilities I have, I cannot take on more at this time."

Manage Your Time: The more you think ahead about how to manage activities or control your time, the less stress you will experience. Or as one expert put it, "Knowing what is happening is preferable to being in the dark, having a strategy or defense ready is preferable to being unprepared and being able to avoid or terminate a stressor is better than sitting there and suffering."

One of the easiest ways to manage your time is by thinking about the demands or priorities you have and in what order you wish to address them. Some practical ways to take control of your situation is to write a list of items that need to be addressed, schedule time to work on the items you listed and organize the list and schedule by priority or necessity.

Developing a plan or strategy to follow may help you focus on the issues that are most important to you and therefore, help to control the amount of stress you feel about these issues.

Maintain A Healthy Diet: If you're like many people, you probably have your favorite comfort food that you reach for when you're stressed. It might be ice cream, potato chips or a juicy hamburger. Whatever it is, chances are it's relatively high in fat, sugar or salt -- in other words, from a health perspective, your comfort food is probably bad for you.

Next time you're under stress, make a special effort to keep eating a balanced nutritious diet and eat comfort foods in moderation. Several studies suggest that maintaining a good diet may help reduce the stress you feel.

Exercise: After more than 1,000 studies, experts agree that exercise can reduce your stress. For maximum effect, try an aerobic exercise (such as running, swimming or brisk walking) that increases your heart rate for 20 minutes or more. If you can't do that, even a 10-minute walk can help. Yoga and nonaerobic movement such as stretching also can reduce stress by inducing a calmer, meditationlike state.

One reason exercise helps reduce stress is because it distracts you from whatever it is that is causing stress. It also helps you eliminate excess energy, which can stem from and contribute to stress. Exercise has a calming effect and can lead to decreased emotional distress and better concentration. And it makes you feel more capable of handling challenges, such as tackling the cause of your stress.

Exercise also helps counter possible diseases that are exacerbated by chronic stress, such as coronary artery disease. Despite all of these benefits of exercise, people often stop exercising when they are under stress. There is nothing more important than exercise to help you handle the stress and counter the risk of illness.

Socialize: Because we are social creatures by nature, we need other people, particularly during stressful times. Having supportive friends, family members or colleagues is one of the most significant ways to reduce stress and the risk of medical conditions caused or worsened by chronic stress.

Discussing your difficulties with someone you trust helps relieve tension and may also help you begin to solve your problems. Or you may prefer to participate in a larger social event, such as a sports team, a spiritual group or a group that gathers around a common interest in a hobby or some other activity.

Many people use happy hour as a way to reduce stress. Although having one glass of wine with dinner may be helpful, excessive alcohol consumption does not help reduce stress and can make it worse. For more information, see What Makes Stress Worse? Using happy hour simply to be with friends can help lessen your stress. However, some social situations may not be beneficial. Situations that make you feel uncomfortable -- where you cannot relax and enjoy yourself -- may be harmful and increase your stress.

Seek Therapy:If you've tried numerous stress-reduction techniques but continue to feel more stress than is comfortable, you might want to talk to a therapist about: How to cope with stressful conditions with less difficulty How to better handle conflicts, manage anger or simply communicate with other people How to resolve some of the problems that are causing you stress. Or you might want to talk to a therapist who will work with you and the person you are locked in a stressful situation with, whether it is a spouse, a child or a coworker.

One way that therapists help people better handle -- or even prevent -- stress is known as stress inoculation training (SIT). SIT is carried out in three steps. First, the therapist teaches you about stress and reactions to stress, with an emphasis on how your thoughts about the situation can influence your stress level and how, consequently, changing your thoughts can alter your experience of stress.

Next, the therapist teaches you coping skills, such as cognitive restructuring, a technique that seeks to change negative thoughts and beliefs and encourage positive ones. Typically, the therapist works with you to examine and change the statements you make to yourself about your expectations and how you evaluate a situation for yourself.

Finally, the therapist works with you as you apply coping skills to stressful situations. Initially, the therapist will use imagery or role playing to "inoculate" you so that when stress actually occurs, you will have "immunity" to its ill effects.

Therapists also can help you cope with anger by heightening your awareness of anger and teaching you a variety of methods for expressing it constructively. (See treatment. )

In addition, therapists can help you work with other people to handle stressful marital, family and work-related conflicts. Family therapists, for example, can work with you and other family members to help you deal with a particularly rebellious adolescent, a family member's emotional problems or other issues. Although not actually seeking to resolve a problem for you, the therapist will try to help you understand and address it more effectively.

Marriage counselors, meanwhile, can help couples address problems that sometimes arise with major changes in a marriage, such as the birth of a child, the loss of parents or evolving sexual needs.

Counselors who address work-related conflicts can help you address the common communication problems that underlie tensions between colleagues.