If ever there was a Type-A prototype it would seem to be Dr. Charles F. Stroebel.
The psychiartrist-neurologist doesn't even like to talk about relaxation. "The word," he sniffs, "is hackneyed. People really don't have any idea how to relax."
He much prefers terms like "self-regulation," "stress-management" and a string of metaphors nicely delineating the all-too-common (but inappropriate) use of the reflex designed to help us fight tigers.
Stroebel, a transplanted Minnesotan who is director of research at the Hartford (Conn.) Institute of Living, worries a lot about humanity, about medicine, about stress and its good and bad effects. He also worries about taxes and things like that.
His A-Type mind is cherished by him and his colleagues and he appears to enjoy his A-Type life style. Although he hasn't yet beaten a longtime smoking habit, Charles Stroebel, 43, differs essentially from the classic hard-charging, super-achieving -- and usually short-lived -- A-type personality.
He is on the way to making sure he has a B-Type body. His is a technique he would like to share with anyone who will listen.
But first some background: Trained in psychophysiology, psychiatry and neurology, Stroebel was an early and leading advocate of such behavioral techniques as biofeedback and is past president of the Biofeedback Society of America.
Behavioral scientists, Stroebel believes, are about to hand the medical profession its third major revolution.
The first, he will tell you, was the advent of anethesia and antisepsis which "permitted pretty dependable surgery." The second: development of effective chemotherapies -- first antibiotics and then all the other medicines we've come up with.
"But," he says, "if we keep escalating the price of medical care at the rate it's going now . . . Well, I heard one economist say he didn't think there would be enough money in the gross national product to pay for medicine in the next 15 or 20 years."
Moreover, "As we've become more scientific with our medical practice and more specialized, we've begun to treat disease, rather than patients. The odd-time doc who didn't have anything much more than placebo effects to work with was very much involved in treating persons, and disease was almost a secondary issue."
Most physicians say that the "fight-or-flight trauma" is responsible for 50 to 70 percent of the complaints they see. In addition, says Stroebel, "One stress area that has been inadequately understood -- and this applies to the whole field of neurology or any other field of medicine -- is recognizing the fact that disease itself is a terrible stress.
"You're talking," he says, "about maybe 70 to 95 percent of all medicine" involving stress, one way or another.
"So we're almost being forced into trying to develop effective self-management behavioral strategies," to train people to "unlearn" the way they acquired stress-related illnesses, from pain to high blood pressure to even cancer.
"And," he told neurologists and behaviorial specialists at a Baltimore Kennedy Institute conference, "our medical colleagues are not going to buy a lot of behavioral approaches unless our techniques carry over 24 hours a day, just the way medication and surgical procedures will."
It was this concern that led Stroebel to devise the technique he calls QR -- the "quieting response." It is his hope that QR, along with Kiddie QR and another version for adolescents, will help provide a universal formula for a "Type-A Mind in a Type-B Body." (Also the title of his book due to be published this fall.)
Some 2,000 clinicians have incorporated Stroebel's QR -- adult version -- into their therapies. It is a technique used by Dr. Lillian Rosenbaum of the Georgetown University Family Center, at which Stroebel will participate in her May 17-18 biofeedback workshop.
QR is a 6-second technique that, when learned, will abort automatically the inappropriate stress response, yet permit the body to slip into what Stroebel calls "passing gear" for a real emergency.
Stroebel's wife, Elizabeth, a teacher in the Hartford school system for 20 years, and Dr. Margaret Holland from the University of South Florida (credited by Stroebel with suggesting the QR application to children), are promoting its use in teacher-training programs and workshops, or for children with special problems like cerebral palsy. It was adopted last month by the Mesa, Ariz., school system for its 30,000 children. aThe adult version is to be part of an upcoming stress-management program being prepared by a life insurance firm.
In his clinical and research practice, Stroebel said he "became concerned that many powerful techniques and therapies (such as biofeedback, assertiveness training and relaxation techniques), which were helping people to assume responsibility for much of their own health care, would not transfer out of training centers."
The dropout rate, he noticed, for those following a relaxation technique he had recommended was something like 95 percent after three months. Studies of other passive meditation routes showed similar results.
"Many individuals going to passive meditation route seemed to become Type-B dropouts in their brains, in addition to development Type-B bodies," says Stroebel. "By creating these passive meditative states, they put their bodies at rest physiologically, but they became vegetarian, strangely withdrawn and isolated dropout people that I didn't enjoy.
"I began to think to myself, 'If someone comes along and starts to talk about behavioral medicine and tells me that in order to self-regulate my physiology to minimize the possibility of development other significant diseases, that I can't use my Type-A mind, which I love, and I can't interract in our Type-A world, which I love . . . and if anybody tries to sell me more technique that forces me into some other mode of behavior, so I can't enjoy all of the fun things that the human brain is capable of, I'm not going to buy it.'
"I'd become a dropout, too, in terms of stopping the practice. And I think that's exactly what's happened to some of these (passive meditation) programs."
For adults, QR is what doctors call "a coupling reinforcement device that a person can carry out into real life and even into sleep when having a bad nightmare." (Studies on its carryover into sleep are incomplete, says Stroebel, but early returns are very promising.)
"It is," he says, "compatible with a Type-A life style . . . and permits the mind to pick the proper state of arousal in the body for the task at hand." t
By practicing QR daily, "at the scene of the crime of stress," or "any of the 50 or 100 times a day you are annoyed," it eventually (in about 6 months for an adult) becomes a reflex. It goes into operation automatically at the catch of a breath, usually the first sign of what stress guru Hans Selye calls the General Adaptation Syndrome, or the body's mobilization for emergency.
"A miracle," is the way Stroebel describes the effects of Kiddie QR, as used in a Greenwich, Conn., school.
"The teacher senses things are getting out of control, so she says, 'Okay, let's everybody do a QR.' And I'm sitting and watching 30 little squirmy bodies . . . and 6 seconds later she's got a bunch of kids with alert little minds -- and desquirmed bodies."