Why Zebras Don't Get Ulcers: The Acclaimed Guide to Stress, Stress-Related Diseases, and Coping

by Robert M. Sapolsky

Among Type-A people, psychotherapy can change not only behaviors but also cholesterol profiles, risk of heart attack, and risk of dying, independent of changes in diet or other physiological regulators of cholesterol.

It is critical that one not walk away with the conclusion that in order to manage and minimize psychological stressors, the solution is always to have more of a sense of control, more predictability, more outlets, more social affiliation. These principles of stress management work only in certain circumstances. And only for certain types of people with certain types of problems.

Just Do It: The 80/20 Quality of Stress Management There’s this idea in a number of disciplines called the 80/20 rule. In retail business, it takes the form of, “20 percent of the customers account for 80 percent of the complaints.” In criminology, it’s, “20 percent of the criminals account for 80 percent of the crime.” Or, “20 percent of the research and design team accounts for 80 percent of the new ideas.” The numbers are not meant to be literal; it’s just a way of stating that causality is not equally distributed in a population of causal agents. I would apply the 80/20 rule to stress management: 80 percent of the stress reduction is accomplished with the first 20 percent of effort. What do I mean by this? Suppose you’re a Type-A nightmare, this hostile, curt, tightly wound misery to those around you. No number of times that friends and loved ones sit you down, warmly look you in the eyes, and then yell at you about your being a pain in the ass will cause anything to change. No number of doctor visits with elevated blood pressure readings are going to make a difference. It’s not going to happen until you’ve decided to change, and really decided, not just decided to try to make everyone else stop hassling you over some nonexistent problem. This is an essential truth for mental health professionals—the whole family that’s in therapy is desperately trying to get the one individual to make some changes, and nothing is going to happen if all he’s doing is staring sullenly...