The Stress Solution: Using Empathy and Cognitive Behavioral Therapy to Reduce Anxiety and Develop Resilience

The Stress Solution: Using Empathy and Cognitive Behavioral Therapy to Reduce Anxiety and Develop Resilience

by Arthur P. Ciaramicoli
The Stress Solution: Using Empathy and Cognitive Behavioral Therapy to Reduce Anxiety and Develop Resilience

The Stress Solution: Using Empathy and Cognitive Behavioral Therapy to Reduce Anxiety and Develop Resilience

by Arthur P. Ciaramicoli


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Therapeutic tools for fighting the anxiety, fear, and depression caused by stress

“We work too much, sleep too little, love with half a heart, and wonder why we are unhappy and unhealthy,” writes clinical psychologist Arthur Ciaramicoli. In The Stress Solution, Ciaramicoli provides readers with simple, realistic, powerful techniques for using empathy and cognitive behavioral therapy to perceive situations accurately, correct distorted thinking, and trigger our own neurochemistry to produce calm, focused energy. He developed this approach over thirty-five years of working with clients struggling with depression, anxiety, and addictions. Over and over again, he has helped sufferers overcome old hurts and combat performance anxiety, fears, and excessive worry. Ciaramicoli’s pioneering approach offers new promise to readers facing a variety of stress-based concerns.

Product Details

ISBN-13: 9781608684083
Publisher: New World Library
Publication date: 05/31/2016
Pages: 232
Sales rank: 806,747
Product dimensions: 5.50(w) x 8.40(h) x 0.60(d)

About the Author

Arthur P. Ciaramicoli, EdD, PhD, is a licensed clinical psychologist and the chief medical officer of, a popular mental health platform. He has been on the faculty of Harvard Medical School and chief psychologist of Metrowest Medical Center. The author of several books, including The Power of Empathy and Performance Addiction, he lives with his family in Massachusetts.

Read an Excerpt

The Stress Solution

Using Empathy and Cognitive Behavioral Theraphy to Reduce Anxiety and Develop Resilience

By Arthur P. Ciaramicoli

New World Library

Copyright © 2016 Arthur P. Ciaramicoli
All rights reserved.
ISBN: 978-1-60868-408-3


Why You Should Care about Stress

You cannot heal what you do not acknowledge, and what you do not consciously acknowledge will remain in control of you from within, festering and destroying you and those around you.

Richard Rohr, Breathing under Water

We often use the word stress casually, with little acknowledgment of its adverse effects. We even describe our stress in dismissive ways. For instance, a Fortune 500 executive may walk in the door after work looking distraught, and when her husband asks what is wrong, she may say, "Oh, I'm just stressed out with stuff at the office." An accountant may tells his client, "Don't worry; everyone's a little stressed during tax season." A single mom may sit by the side of the pool flipping through a magazine with an ad for an upcoming cruise that says, "Escape from the stresses of life." If only it were that simple.

It's not that we don't acknowledge the prevalence of stress: we've been doing so for decades. The cover story of Time magazine for the week of June 6, 1983, proclaimed that stress was the "epidemic of the Eighties," as Americans were "seeking cures for modern anxieties." More than thirty years later, stress is still wreaking havoc. All demographics — adolescents, young professionals, middle-aged workers, and retirees — are at risk from this silent and cumulative killer.

In 1994, the Harvard Business Review cited evidence that 60 to 90 percent of doctors' visits were tied to the effects of stress. Today, 66 percent of visits to primary care doctors are stress-related, and 50 percent of American workers say they stay awake at night troubled by physical or emotional effects of stress.

The physical repercussions of stress are indeed startling. These include:

• a decrease in immune system functionality

• heightened risk of heart disease and diabetes

• a spike in stress hormones that increase the risk of cancer

The potential to lose years of your life due to stress is very real.

In addition, occupational stress subjects you to cognitive symptoms of stress, including the following:

• repeated worrying

• weakened performance

• lack of judgment

• memory problems

Stress also plagues families and relationships by aggravating emotional symptoms such as excessive moodiness, irritability, and interpersonal conflict. These effects of stress influence how we relate to and how we are received by those close to us.

Deep down, you know that stress — perhaps even in a chronic form — has been crippling you. You know it because you feel it, and you are not alone. Two-thirds of adult Americans experiencing elevated stress levels report that their stress has escalated in the past year, according to a recent survey by the American Psychological Association.

But unless you are among the only 17 percent of Americans who actually talk to their health care providers about stress, it's likely that you try to ignore the problems that stress has the potential to unleash.

The most common areas of stress, according to the American Psychological Association's yearly studies, are money, family, and relationships. In essence, if you struggle financially or have family and relationship difficulties, then you are among the many who are not mentally ill but are instead suffering from chronic stress.

Psychologists have identified key variables that determine whether stress ultimately affects us positively or negatively:

• our perception of stress

• the meaning we attach to it

• our ability to cope with uncertainty and ambiguity

• the degree of control we have over the circumstances that produce stress


Ronda, a thirty-six-year-old mother of three, manages her art studio most weekdays and tries to get to the gym a few times a week, but she has been unable to do so with consistency. She worries about her overworked and highly stressed husband, Steve, who has not exercised in the last few years even though he knows the risks posed by his high blood pressure and high cholesterol levels. He is a committed father, but as a software sales representative for a large corporation, he travels frequently and is not available to help with the children as much as they both would like.

Ronda worries about her mother, who is in an unstable second marriage, and about her biological father, who remains unemployed and gets by doing odd jobs. She recently discovered that her father has occasionally been borrowing money from her husband. Steve's dad died two years ago, and Steve, as an only son, also feels responsible for taking care of his mother's needs and her home.

Ronda is very attractive, engaging, college-educated, and a former soccer player; you would assume on meeting her that she's in great health and quite happy. And the truth is that when she can calm down and catch her breath, she truly is quite happy, and she loves her husband and children. Most of her days, however, are spent rushing around, trying to make appointments on time and fulfill the many responsibilities of her daily life. Studies have shown that women tend to have higher rates of stress than men, with the key worries being money and paying bills.

Steve is an affable person, easy to like, but his self-care habits have deteriorated significantly, so that he now experiences back pain and difficulty relaxing. He often says kiddingly, "Stress is my middle name."

Ronda has recently begun suffering from tension headaches. Her memory has also failed her, which greatly increases her anxiety and lessens her confidence in her abilities: "I hope I'm not going senile, honestly — I have forgotten two appointments for the children in the last week, and my own dentist's appointment, and I am so spacey, it is scaring me."


The story of Ronda and Steve is typical of many young couples today. They are not mentally ill, and they do not need psychiatric medication, but they are aware of problems with their bodies and minds and are at a loss to explain or remedy them.

Regardless of age, our fast-paced lifestyle emphasizes achievement at all costs. We have high expectations of ourselves, driven by media and social-media images of the perfect life. In addition, many Americans are isolated: most people now have fewer close friends than in previous years. These pressures affect our sense of self, increasing the degree of stress we feel. No one is immune. The effects of stress can be devastating to our entire being, regardless of age, gender, or occupation.

Knowing how stress affects the brain and body will help you understand how you can limit the stress response. Stress begins in the amygdala, the emotional center of the brain. If your amygdala perceives a threat, whether it is the sound of footsteps behind you on a deserted street at night or a friend making a humiliating comment about you in the presence of others, it springs into action immediately. The amygdala sends a signal to the hypothalamus, a section of the brain that regulates hormone output. The hypothalamus alerts the adrenal glands to release the stress hormones cortisol and adrenaline. These stress hormones are released whether the threat is real or imagined. Training ourselves to distinguish between real and imaginary threats is a vital skill, and one that the use of empathy and CBT can help us develop.

Adrenaline raises your heart rate and blood pressure, and cortisol sends a surge of sugar to the blood to cope with physical demands. As this almost instantaneous reaction takes place, your immune system, digestion, sex drive, and other functions are put on hold. Memory, learning, and, most important, the ability to be empathic are compromised.

A survey conducted by researchers at Stanford University revealed disturbing results among ten- to fourteen-year-old girls, comparing those from households with stressed mothers to those raised in homes with little maternal stress. The participants from stressed homes showed premature cellular aging, equivalent to about six years of biological age. Stress also affects the immune system, leading to inflammation that can increase the proliferation of cancer cells. In one study of stress, one group of mice was subjected to stress by being isolated from others. All the mice were then injected with cells from human tumors. The researchers found that tumors were more likely to grow in the stressed mice. Among pregnant mice, those with increased stress hormones showed a decrease in fetal weight.

Stress hormones are released whether the threat is real or imagined.

* * *

Research further indicates that stress can cause:

• heart disease

• weight gain

• diabetes

• dementia

• anxiety

• depression

• hair loss

In addition, a 2015 study conducted by the Harvard and Stanford business schools examined job stresses and the relationship of the mental and physical effects of stress to mortality. The researchers found that the physical problems caused by work stress led to fatal conditions that accounted for 120,000 deaths each year, making work-related stress more deadly than Alzheimer's, influenza, or diabetes. Stress-related health issues are estimated to incur $180 billion of health care costs each year.

Finally, researchers are starting to find that long-term stress can have serious effects on the brain. The brain and the immune system are connected. Cells called microglia, which were thought to merely protect the immune system, are now known to make up 15 percent of our brain cells. Microglia cells help the brain repair damaged neurons, but if they are activated too often by stress, they produce inflammation in the brain. Researchers at Ruhr University Bochum have linked inflamed microglia cells to Alzheimer's disease, multiple sclerosis, and schizophrenia.

Good people like Ronda and Steve, and millions of others throughout the world, are suffering from a devastating condition that we must and can change. Yet 79 percent of Americans try to deal with stress on their own, never asking for or knowing how to obtain help. It is time for us to get serious about reducing stress, using the techniques of empathic CBT.

As you read through this book, remember that to rid yourself of undue stress, you need to do the exercises in each chapter. Not only will these exercises reinforce the concepts presented and help you gain perspective on the specific sources and effects of your own stress, but they will also help you gain a greater sense of control over your life. A study by Steve Maier of the University of Colorado indicates that the degree of control we feel over stress determines the degree to which we are affected physiologically. His research, and that of many other scientists, indicates that uncontrollable stressors are destructive, whereas stress that feels escapable is less damaging. Perception of control is the key to managing stress and being able to tolerate the uncertainty that is part of life.

Perception of control is the key to managing stress and being able to tolerate the uncertainty that is part of life.

* * *

It will take time to gain control and change the way you perceive stress. Please do not rush through this book as if it were a competition. Settle in, calm yourself, and complete a chapter every few days. If you rush, you will only continue the cycle of stress. Let us get started with balance and calm energy.

To begin with, please take the Stress Questionnaire in the appendix (page 176) to establish a baseline measure of your current stress levels. Then, as you work through the book, you can repeat the questionnaire and monitor your progress.


Expanding Our Humanity

The Discipline of Empathy

When you show deep empathy toward others, their defensive energy goes down, and positive energy replaces it. That's when you can get more creative in solving problems.

Stephen Covey, The 7 Habits of Highly Effective People

Empathy guides us in the accurate understanding of situations and relationships. When we live with empathy, we realize that it is a kind of virtual reality: we put ourselves in the other person's shoes, absorbing her experience, observing the world through her eyes, feeling her emotions, and imagining thinking her thoughts.

Empathy is also the key to negotiating and resolving conflict, whether between couples, communities, states, or countries — expanding our capacity to understand the person or groups we encounter.

Empathy is not, however, a tool or a technique that can be easily mastered. Empathy is instead an innate capacity that requires careful nurturing and constant attention. Empathy is a way of keeping our balance, which in turn helps others become balanced when they have lost their way.

Several studies have demonstrated that when you believe that empathy can be learned and that your capacity for empathy can grow, you are far more likely to expand your empathic range.

Empathy training teaches you to limit the influence of the primitive brain, using the neocortex — the thinking brain — to perceive reality accurately, without emotion or distortion. In a study in monkeys in which the neural wiring that supports empathy was severed, the monkeys could not interpret other animals' friendly or hostile behavior. They lived in isolation, ruled by the primitive brain's emotions of anger and fear.

* * *

Empathy training teaches you to limit the influence of the primitive brain, using the neocortex — the thinking brain — to perceive reality accurately, without emotion or distortion.

As our lives become more hectic, we sleep less and eat haphazardly, and our mood suffers. When we are angry or detached, our empathy suffers too. We must learn to slow down so that we can think clearly and react appropriately to a given situation. Most often we need the help of others to slow down and calm ourselves, confiding in those close to us so that we can begin the process of dissipating stress.

For Ronda and Steve, empathy suffers because of Steve's business travel. When they part on Sunday night, the family exchanges big hugs and loving kisses. Then Steve heads off to the airport, returning late on Thursday night. Ronda often feels increasingly frustrated as the week goes by. Steve, meanwhile, gets tired of sleeping in hotels and being away from his family, and he often feels he can't tolerate one more dinner listening to his customer telling the same stories. Both Ronda and Steve experience increasing stress levels that affect their communications. As the days pass, the text messages, phone calls, and evening Skype sessions have less warmth than earlier in the week.

When Steve arrives home at 11:30 pm on Thursday night, he is exhausted, and so is Ronda. She tries to stay awake to greet him, but she is dying to go to bed. Instead of greeting him with empathy, she keeps preparing the kids' lunches without looking up. Feeling offended, he withdraws into his cave space in his finished basement.

Ronda finishes her chores and mumbles good night to him downstairs; he says the same. He sits up watching sports highlights on ESPN until 1:00 am and falls asleep on the couch, while she sleeps alone in their bedroom. They both awaken during the night with a sense of exasperation. In the morning, they interact with the kids but are somewhat terse with each other. He hugs her good-bye, and she softens as she feels his touch. He heads off to work with an ache in his heart, not knowing that she is feeling the same way.

Empathy, and the understanding and positive neurochemicals it produces, cannot exist in the absence of trust and a sense of security, and these diminish when a person feels slighted or hurt. When we can empathize, we are less likely to be offended. We look beyond the surface to see what is affecting the other person. If, however, we are depleted and stressed, as Steve and Ronda both are, our empathic range becomes narrower. What we hear and perceive is greatly influenced by our emotions and by stress hormones.


Secondhand stress is becoming common in our tension-filled society. Our nervous systems talk to each other, and the stress of one person can easily affect others. Parents pass their stress to their children, spouses to each other, colleagues to colleagues, friends to friends. Increases in inflammation and blood pressure have been noted in couples who stress each other. Researchers at the University of Michigan noted that 33 percent of husbands and 26 percent of wives had high blood pressure in 2006, whereas in 2010 rates rose to 37 percent for men and 30 percent for women. Steve and Ronda are excellent examples of how stress passes between partners and then to the worlds they move in. Steve carries his low mood into his office, and Ronda carries hers to work. The children feel the tension between their parents as they get on the school bus. This state of mind will likely affect the children's ability to learn and their parents' performance at work.


Excerpted from The Stress Solution by Arthur P. Ciaramicoli. Copyright © 2016 Arthur P. Ciaramicoli. Excerpted by permission of New World Library.
All rights reserved. No part of this excerpt may be reproduced or reprinted without permission in writing from the publisher.
Excerpts are provided by Dial-A-Book Inc. solely for the personal use of visitors to this web site.

Table of Contents


CHAPTER 1 Why You Should Care about Stress,
CHAPTER 2 Expanding Our Humanity: The Discipline of Empathy,
CHAPTER 3 Empathic Listening: Loving Away Stress,
CHAPTER 4 The Soul's Pharmacy: How to Produce Calming Neurochemicals,
CHAPTER 5 The Illusions We Create: Seeing More Clearly with CBT,
CHAPTER 6 CBT in Action: Combating the Distortions of Personalization and Blame,
CHAPTER 7 CBT in Action: Combating Negative Self-Talk and Ending the Cycle of Stress,
CHAPTER 8 CBT in Action: Combating Performance Addiction,
CHAPTER 9 Clear Eyes: Perceiving the Truth through Empathy, Not Prejudice,
CHAPTER 10 Emotional Learning: Hurts That Never Heal,
CHAPTER 11 Empathy, Self-Care, and Well-Being,
CHAPTER 12 "Give and You Shall Receive": How Giving and Goodness Restore Calm,
CHAPTER 13 I Am Who I Am: How Authenticity Soothes the Soul,
FINAL THOUGHTS The Power of Deep Connections,

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