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 CLEVELAND, March 16 /PRNewswire/ -- Having headaches? Neck pain? No time to exercise or just relax?
 You may be a victim of your own success.
 Easily a fourth of 2,000-some patients seen in the Cleveland Clinic's Biofeedback and Stress Management Program are small-business owners and managers, often of family-owned businesses, said Jerry Kiffer, M.A., biofeedback therapist. What brings them here, he said, is "pain -- headache or neck and shoulder pain that interferes with their getting things done."
 Most clients are in their 30s and 40s, he said, and are experiencing symptoms "usually after many years of accumulated stress. The body's youthful defenses wear down."
 Small-business operators experience a unique type of stress, Kiffer said, especially when times are good and the business is expanding. "Growth is always stressful," he said. "It's a time of change and challenge. But when growth surpasses the ability to meet demands on a daily basis, that's an equation for stress.
 "Success results in the small-business owner's having to wear several hats: owner, salesman, marketer, computer expert, manager. Sometimes, the company is growing so fast, there is no established procedure for giving feedback to the people who started with the company. Subordinates can burn out -- middle managers burn out. Then, you start seeing turnover. Another contributor to stress is the lack of defined job titles. In a growing company, the job duties often change every few months.
 "If it's a family business, then you might have the stress of immediate family members, personality clashes, parent-child conflicts. And once you leave work, you're still talking about work, even on the weekends. The disagreements carry over into your private life. People start to feel trapped, and it's difficult to gain control."
 Kiffer said much of the business owner's stress has to do with his or her personality type.
 "Small-business owners are by nature entrepreneurs. The entrepreneurial personality has the elements of the Type A personality - - achievement and result-oriented. They are impatient and intolerant of ignorance and mistakes. They have a plan of action they want implemented immediately. They tend to be aggressive and time-oriented because time is money.
 "These characteristics lead to success. But there is a problem when people overdo it. You can have too much of a good thing. The issue is when the payoff is not as great as the risks: when you cut out exercising, don't take time to relax; when you overeat, drink and smoke too much. These are part of excessive, office-based lifestyles. You spend less time with the family, less time relaxing."
 "The key," Kiffer said, "is to have a Type A, or racehorse, mind with a Type B, or turtle, body. `Turtle' meaning relaxed, no excessive muscle tension, low heart rate normal blood pressure and no ulcers."
 Achieving this combination is a matter of changing one's behavior and thought processes, Kiffer said. This can be accomplished through counseling and biofeedback training, in which one learns why and how to relax.
 "People come to realize they are cutting themselves short, that they haven't had a hobby or been involved with their family for a long time. That's where the counseling part comes in, when we work with the individual and start to help him or her uncover this. Not only is the patient unhappy, but this may be one symptom of a larger process affecting the whole family."
 Kiffer likens counseling and biofeedback therapy to a college course. Usually six to 12 sessions are required, during which people are taught the skills that will help them relax.
 "We focus on changing behavior, on people being too busy. We provide relaxation cassette tapes, teach them meditative exercises, ask them to exercise. We take a cognitive approach -- what are their thought patterns, attitudes and beliefs that may influence them? We work with them to change their thinking, their perceptions of life. That's probably the hardest part, but it also leads to the greatest benefit. The more they work at uncovering their unconscious, automatic thought patterns, the better off they are. They learn to ask, `Is this attitude really helping me?'"
 Another important part of reducing stress is helping the person find his or her optimal performance level. In this, the staff uses similar techniques to those used with professional athletes, Kiffer explains.
 "A relationship has been determined between arousal and performance. If you think of a graph, with the X axis as arousal and the Y axis as performance, the relationship is an inverted U. Low arousal equals low performance, and excessive arousal equals low performance. You want to be at the top of the inverted U, with high performance but moderate arousal. Too much arousal causes the physical symptoms, such as headaches."
 Biofeedback equipment is used, which involves measuring skin temperature and muscle tension and then teaching the person to detect and control his mind's and body's reactions. For instance, one commonly used machine picks up electrical signals in the muscles and translates the signals into a form that the patient can detect. It triggers flashing lights or activates a beeper each time muscles grow more tense. To relax tense muscles, the person tries to slow down the flashing or beeping. In this way, a person learns how he feels when he is tense and when he is relaxed and can work toward greater relaxation.
 "We have people identify what it takes for their optimal performance," Kiffer said. "When people let go of some of the small things and the things they have no control over, they become more productive."
 Once the business owner or manager has dealt with his or her own stress, then steps can be taken to relieve employees' stress, Kiffer said. These steps include communicating better, defining job duties and hiring more people.
 "The greatest payoff is in having stress management intervention for the whole organization," Kiffer said. The Cleveland Clinic staff offers stress management seminars and lectures and acts as consultants.
 "When you care about your workers enough to help ease their stress, then you should consider hiring a consultant," he advised.
 The Cleveland Clinic Foundation is a multispecialty academic medical center providing state-of-the-art care while advancing the frontiers of medicine. Since its founding in 1921, the integration of clinical and hospital care with research and education in a private, non-profit group practice has distinguished the Cleveland Clinic in American medicine. Today at the Cleveland Clinic and Cleveland Clinic Florida, nearly 600 full-time salaried physicians represent more than 100 medical specialties and subspecialties. Every year the Cleveland Clinic and Cleveland Clinic Florida provide for more than 780,000 outpatient visits and 32,000 hospital admissions from throughout the United States and over 80 countries.
 -0- 3/16/93
 /CONTACT: Elaine DeRosa of The Cleveland Clinic Foundation, 216-444-8927/

CO: Cleveland Clinic Foundation ST: Ohio IN: HEA SU:

SM -- NYSFNS5 -- 6345 03/16/93 07:06 EST
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Date:Mar 16, 1993

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