Book Excerpt
In Control : No More Snapping at Your Family, Sulking at Work, Steaming in the Grocery Line, Seething in Meetings, Stuffing your Frustration
by Redford Williams and Virginia Williams

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An excerpt from In Control : No More Snapping at Your Family, Sulking at Work, Steaming in the Grocery Line, Seething in Meetings, Stuffing your Frustration by Redford Williams and Virginia Williams, published 2006 by Rodale Books.
Book excerpt reprinted with the permission of the publisher.
Copyright © 2006 Redford Williams and Virginia Williams




Excerpt from pages 10-12


Hostility isn't the only negative trait that can have an impact on people's health. Behavioral medicine research has identified a number of other risk factors with a definite link to serious health problems.


The negative impact of depression also increases the risk of developing coronary heart disease, and people who are depressed after having a heart attack are more likely to die within the following 6 months. Several studies have shown that patients with any disease -- diabetes is one example -- who are depressed end up needing more medical care, accounting for a disproportionate amount of medical costs.

Lack of adequate social support. People who have little support -- whether it's help with chores at home or someone to listen sympathetically -- are also more at risk. Social support acts as a buffer that enables people to cope better with whatever stresses they face, whether they're imposed by personality or life situations. Support is a function of both the person and the environment. Those of us who have a cynical mistrust of others are less likely to reach out for support, and some of us find ourselves in situations that simply don't include people who can be sources of support.

Stressful environments.

Jobs that impose high demands for output of services or products but allow workers little control over how those demands are met have been termed high-strain jobs. Psychologists Robert Karasek, PhD, of the University of Massachusetts, and Tores Theorell, MD, PhD, of the Karolinska Institute in Stockholm, Sweden, have documented that people working in high-strain jobs are more likely to develop high blood pressure, infections, and job-related injuries, as well as heart disease.

Risky behaviors.

People who are hostile, depressed, isolated, or in stressful life situations are more likely to overeat, smoke, and abuse alcohol.

Studies show that these different risk factors often cluster in the same individual. For example, in a study of working women, Redford and his colleagues found that those who reported high job strain were also more depressed, hostile, and socially isolated. As in people with high levels of hostility, these other psychosocial risk factors are associated with changes in biological functions, such as increases in adrenaline and cortisol, blood pressure and heart rate surges, higher cholesterol levels, and alterations in the immune system and blood-clotting mechanisms. All of these changes are felt to lead to disease.

Redford's research has continued to build upon the observation that these risk factors, along with the accompanying biological markers of stress and health-damaging behaviors, tend to cluster among certain groups. The people most likely to be affected are those stressed by lower income, education, and/or occupational levels. This clustering may be the result of reduced brain levels of the chemical serotonin, a neurotransmitter that nerves use to relay messages to one another. When serotonin levels are low, we are more likely to be angry, depressed, and anxious; to be less interested in relating to other people; to have greater fight-or-flight responses when stressed; and to smoke, drink, and eat more than is good for us. If true, this theory could point to the brain's serotonin system as a key neurobiological mechanism that regulates our ability to be in control. Two studies have found weaker brain serotonin function in persons with lower income and education levels.

In his most recent research, Redford has begun to study how genes that are involved in regulation of serotonin affect all of these health-damaging psychosocial, biological, and behavioral characteristics. This work is still in an early stage, but we have some likely hypotheses for where it will go. The serotonin "transporter" is a molecule that sits on the surface of serotonin nerve end. It's responsible for the reuptake of serotonin -- squelching the effects of the neurotransmitter after it's been released from the nerve endings. The gene responsible for making this transporter comes in various forms. Certain of these forms seem to make a person more likely to experience negative emotions, such as anger and depression, and to have greater adrenaline, blood pressure, and heart rate surges when angered.

Redford's ongoing work aims to identify the interactions between key genes and the environment and to help account for the clustering of health-damaging characteristics in the same individuals and groups. No doubt, we'll also learn more about how genes affect our ability to be in control in stressful situations.


Excerpt from pages 28-30


Studies Show It's Possible To Control How You React To Stress

Beginning in the early 1980s, several randomized clinical trials of behavioral strategies (the precursors of our 8-week program) targeted certain psychological and social risk factors in people with heart disease or cancer. By chance assignment, some subjects were taught the strategies, while others were put in a control group and didn't learn the strategies. Randomized clinical trials are considered the gold standard when it comes to proving that new treatments -- whether new drugs or behavioral approaches -- are effective in treating or preventing disease. These early studies found some amazing results.

-- People with malignant melanoma (a type of skin cancer) who received training in coping sills to handle stress slashed their recurrence rate by 50 percent and their death rate by an astonishing 70 percent.

-- Heart attack patients who received training that reduced both hostility and depression cut their risk of recurring heart attacks or death in half.

-- Other heart patients who were trained to use coping skills to reduce stress cut their risk of having subsequent heart attacks or needing bypass surgery or angioplasty by more than 50 percent. One of our corporate clients found that training decreased bad stuff, such as depression and hostility, and increased good stuff, such as social support and self-esteem, among employees. These results were obtained in what might be described as "open label trials" of our program (in other words, there was no randomized control group). Now there have been two carefully conducted randomized clinical trials of patients with heart disease that document these benefits more rigorously.

In the first, psychologist Karina Davidson, PhD, and her student Yori Gidron at Dalhousie University in Halifax, Nova Scotia, randomly assigned heart attack patients to groups that received either the usual care or training to reduce hostility, which was based on an earlier version of our 8-week program. At the end of eight training sessions, those in the hostility-reduction group showed significant decreases in both hostility and blood pressure compared with those who received the usual care. More important, when the researchers followed up with the patients after 2 months, they found that both hostility and blood pressure levels had decreased even further in those receiving hostility-reduction training, while levels had drifted up slightly in those receiving the usual care. After 6 months, those who had received hostility-reduction training had been hospitalized again for an average of only about 1/2 day, compared with 2.5 days for the usual-care group.

A more recent randomized clinical trial was conducted by psychologist George Bishop, PhD, at the National University of Singapore and the National Heart Centre there. In that study, people who had undergone coronary bypass surgery were randomly assigned to either the usual care or to our coping skills workshop. Because we trained Dr. Bishop and his colleagues to deliver the workshop, the training was provided to the patients in Singapore just as it is in the United States, with some adaptations for Far Eastern culture. (For example, instead of practicing assertion toward someone who has distressed you, you would have a friend or relative act as an intermediary, thereby ensuring that no one would lose face.)

As first presented at the Annual Scientific Sessions of the American Heart Association in Chicago in November 2002, Dr. Bishop's study both confirmed and extended the results obtained by Dr. Davidson and Gidron. When tested 3 months after the workshops were completed, the patients who received our training were better off on several fronts than those who received the usual care. For example:

-- They experienced less psychosocial bad stuff: lower scores on depression (a 60 percent decrease), anger (18 percent), and perceived stress (18 percent).

-- They experienced less biological bad stuff: lower resting heart rate (a 9 percent decrease) and reduced reactivity of blood pressure (56 percent) and heart rate (65 percent) when angered. They experienced more psychosocial good stuff: higher scores for satisfaction with social support (a 14 percent increase) and satisfaction with life (13 percent).

-- These results provide direct evidence that training in coping skills can really change not only people's ability to improve their emotional lives but also their physical prognoses and prospects for future health.

In Control : No More Snapping at Your Family, Sulking at Work, Steaming in the Grocery Line, Seething in Meetings, Stuffing your Frustration by Redford Williams and Virginia Williams,

(From the publisher's press release)

Have you ever lost your temper over trivial matters? Stuffed your anger deep inside? Sulked because you didn't get your way? Felt lost in an increasingly confusing modern world? If so, you may not be in control.

Redford Williams, MD, and Virginia Williams, PhD, are internationally recognized as experts in behavioral medicine. Together, they have developed a clinically proven program that reduces depression and helps people to lead healthier, more successful lives.

You'll start by taking a 30-question self-assessment quiz, which will pinpoint your trouble areas. For eight weeks, you'll then focus on each of those areas, learning to control your reactions, problem solve with creativity, assert yourself, and respond to difficult situations with poise and confidence.

Based on cutting-edge research by Redford and his colleagues, In Control draws on the most exciting developments in the field of behavioral medicine. With this easy-to-follow book, you'll learn to handle anything -- from stress at work to traffic jams and grocery store lines.

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"Most of us have never received emotional training. As a result, our emotions drive us rather than serve us, impairing our relationships, work, and life. Redford and Virginia Williams have come up with tested methods for changing this situation. They share their findings and very practical advice in this well-researched book."

-- Andrew Weil, MD, best-selling author of Healthy Aging: A Lifelong Guide to Your Physical and Spiritual Well-Being

"Few authors outline the adverse health consequences of anger as well as Redford and Virginia Williams. Their new book relates their years of research in the field, study of behavior skills, and real-life examples so that readers may ultimately recognize their emotions and remain as their title suggests -- In Control."

-- Congressman Tim Murphy, PhD, and Loriann Hoff Overlin, authors of Overcoming Passive-Aggression: How to Stop Hidden Anger from Spoiling Your Relationships, Career, and Happiness

"This excellent book makes a strong case for changing your emotional style to help yourself feel happier -- and maybe even healthier. The authors, international experts on the topic, outline clinically proven strategies in a highly readable format. A thought-provoking book about reshaping your life!"

-- Janice Kiecolt-Glaser, PhD., S. Robert Davis Chair of Medicine, professor and director, Division of Health Psychology, Department of Psychiatry, Ohio State University of Medicine

"In Control is based on solid scientific research and the exceptional professional skills and experience of the authors. Research has shown that the programs described in this volume have proved effective in helping people to overcome depression, hostile feelings, and social isolation while increasing emotional intelligence, self-efficacy, and self-esteem."

-- Charles D. Spielberger, PhD, ABPP, Distinguished Research Professor of Psychology; director, Center for Research in Behavioral Medicine and Health Psychology, University of South Florida; past president, American Psychological Association

"The balance we learn from In Control can have positive ripples in our work life, family life, and physical health -- especially our heart health. Williams helps us to heal our free-floating rage, redirecting that anger toward a healthy assertion -- and a healthy surrender. Reap the benefits of In Control, and you will live a vastly healthier life, in mind and in body."

-- Henry Dreher, director of Cancer Guide Consultations and author of Mind-Body Unity: A New Vision for Mind-Body Science and Medicine

"Redford and Virginia Williams draw upon research, as well as their marriage of 40 years, to develop this evidence-based program. Readers interested in living a happier, healthier life will want to learn these skills."

-- Paul T. Costa, Jr., PhD, professor of behavioral biology, Department of Psychiatry and Behavioral Sciences, Johns-Hopkins University of Medicine; and chief, Laboratory of Personality and Cognition Intramural Research Program, National Institute on Aging/NIH

In Control : No More Snapping at Your Family, Sulking at Work, Steaming in the Grocery Line, Seething in Meetings, Stuffing your Frustration by Redford Williams and Virginia Williams,


Redford Williams, M.D., is director of the Behavioral Medicine Research Center, professor of psychology, professor of psychiatry, and professor of medicine at the Duke University Medical Center. He has served as president of the American Psychosomatic Society, Society of Behavioral Medicine, and Academy of Behavioral Medicine Research, and he is president-elect of the International Society of Behavioral Medicine.

Virginia Williams, Ph.D., is the president of William Lifeskills, Inc., in Durham, North Carolina, and has organized and led workshops teaching the In Control process to thousands of individuals, corporations, and government agencies around the world.

The Williamses also coauthored Anger Kills, a bestseller, and Lifeskills. They live outside of Durham, North Carolina.

In Control : No More Snapping at Your Family, Sulking at Work, Steaming in the Grocery Line, Seething in Meetings, Stuffing your Frustration by Redford Williams and Virginia Williams,