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David Posen's Newest Book.
Using a holistic approach that combines elements of physiology, psychology and philosophy, Authenticity teaches readers to identify, acknowledge, and accept their true selves in order to make better, more informed, and realistic life choices. Drawing on real-life examples from his experience in stress management, Dr. Posen has identified five common problem areas that can lead to anxiety and unhappiness: personality traits, time and speed, sleep deprivation, values conflicts, and neglected passions. For each of these areas, the solution is surprisingly clear we must learn to live in a way that is authentic to our unique selves; we must live in harmony with who we genuinely are.

David Posen, MD


INTRODUCTION: Round Pegs in Square Holes—The Stress of Trying to Be What You’re Not

Introverts and Extraverts
Background History and Physiology
Implications and Consequences
Know Yourself, Achieve Harmony
Clarifying Some Misconceptions
What Now?

Our Race Against Time
How Did This Happen? A History Lesson
The Two Functions of Time
Costs and Consequences: Why Should You Care?
Prescriptions and Solutions
Is It Too Late to Turn Back the Clock? (Pun Intended)

Sleep Deprivation: Underestimated and Misunderstood
How Do You Know How Much Sleep You Need and Whether You’re Getting Enough?
Why We Sleep and the Cost of Sleep Deprivation
What’s the Solution?

What You Say vs. What You Do
Collective Values

Passions and Dreams: Signposts on Life’s Journey?
The Lucky Ones
How Do You Find or Discover Your Passions?
The Path Behind You and the Road Ahead
Dealing with Obstacles—and Reality!
Other Views and Final Thoughts

Music as Metaphor


Kimberly was a shy, quiet eight-year-old girl, not unlike her father. Her mother in contrast was bubbly and gregarious and kept urging her to be more outgoing. She tried to fake it but remembers feeling ill at ease, uncomfortable, trying to be the little girl her mother wanted her to be. Faking it was taking a toll. Kimberly developed headaches that lasted for years without her realizing why. Only in her twenties did she begin to under- stand what was happening. “I started to pay attention to my own feelings,” she said, “identifying them, acknowledging them, and accepting them.” Shortly thereafter, her symptoms resolved.

How many people find themselves in situations where they’re uncomfortable and don’t know why? They feel like something’s off or not quite right. Then they might start to feel inadequate. Even worse, they may blame themselves and feel guilty. Or they sense what the problem is but keep trying to be what others— especially parents, siblings, teachers, friends, and eventually bosses and spouses — want or expect them to be. Instead of honouring their feelings, they do what they feel is necessary to fit in. But always at a cost.

I’m a pretty fast skier — but not as fast as my older brothers. For years I tried to keep up with them, but it was more stressful than fun. Finally, I got some sense, gave up, and just skied at my own pace and met them at the bottom of the hill. When I accepted my own rhythm, my own comfortable speed — still pretty fast — it was exhilarating and I loved it. A friend of mine came from a family of lawyers. He was expected to follow in their footsteps. He reluctantly complied and went to law school — which he roundly disliked. Finally, he decided to do what he wanted to do. He left law school, went to teachers’ college and began a teaching career — which he soundly enjoyed.

Journalist Arianna Huffington tells the story of being sleep deprived for years because there were so many important things she wanted to do in her career in addition to being a mother. Sleep wasn’t high on the list. It finally caught up with her when she collapsed in her office, hit her head on the desk, and broke her cheekbone. That was the wake-up moment for her when she realized the importance of slumber. She started getting the sleep she needed and became a whole new person. Now a passionate advocate, she started what she calls the “Sleep Revolution.”

One of my patients worked in the accounting department of a company. When he was told to fiddle with the numbers in order to make them look better, he felt uncomfortable and lost a few nights of sleep, tossing and turning, wondering what to do. He finally decided that he couldn’t live with himself if he went along with the plan. So he quit his well-paying job because the values conflict he experienced wasn’t worth it to him.

These examples reflect problems that patients have brought to me for more than thirty years of stress counselling. There’s a recurring pattern. As life has gotten faster, fragmented, and frenetic, a lot of folks have become disconnected from who they really are. They’re like round pegs trying to squeeze into square holes. Much of the anxiety and depression that people suffer is a result of this conflict of trying to be what they’re not designed or inclined to be. They’re living lives that feel inauthentic.

This book is about the stress that comes from trying to be what you’re not — and about how to live more in harmony with yourself. It’s about being more self-aware and recognizing these (sometimes subtle) areas of conflict. Encompassing the insights of physiology, psychology, and philosophy, the book will explore five seemingly unrelated realms in which knowing yourself better will allow you to make more informed and realistic choices in life.

If you live in ways that are authentic, congruent, and true to yourself, you can live in sync with who you really are.

Praise for IS WORK KILLING YOU? A Doctor’s Prescription For Treating Workplace Stress.

“Dr. Posen’s work could not be more timely…We won’t make our world safer until we learn to manage our work and ourselves better.” – Margaret Heffernan, author of Willful Blindness: Why We Ignore the Obvious at Our Peril

“Posen makes a sound, compelling case for active stress reduction at work.” – Publishers Weekly

“Solid Advice for anyone who wants to transform their current workplace, or is looking for new employment.” – Winnipeg Free Press

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Dr. David Posen, a leading expert on stress mastery, gives us the definitive guide to treating — and eliminating — excessive stress in the workplace. Here he identifies the three biggest problems that contribute to burnout and low productivity: Volume, Velocity, and Abuse. Using revealing anecdotes and real- life case studies, he describes the physiological effects of stress, and illustrates how economic uncertainty, technology, and corporate culture have made the workplace more toxic than ever. Most importantly, he offers practical solutions and easy techniques to cope with workplace stress, and outlines what we can do collectively to maintain a healthy, productive atmosphere.

Witty, engaging, and accessible, Is Work Killing You? touches on everything from meetings to tweeting, fake work to face time, the overworked to the underemployed, and more. With this book, Dr. Posen gives us the tools to stop harming our most valuable resource — ourselves.


PREFACE: Why I Wrote This Book 1
Introduction Workplace stress — Setting the Context
Defining the Problem 9
What Is Stress and How Do You Know When You Have It? 13
Why Should You Care? Why Is This Important? 17
The Futility of It All: When Good Stress Becomes Bad Stress 23
Six Degrees of Stress: Everyone’s a Victim 28
Sources of Stress: The Big Three 34


Chapter 1 What Tips Us Over: The Causes of Overload 45
Chapter 2 Too Few Hands to Share the Load 55
Chapter 3 The Elephant in the Room: The Conspiracy of Silence 62
Chapter 4 Belief Systems and Changing the Corporate Zeitgeist 74
Chapter 5 The Fallacy of Face Time: Performance Measurement Has to Change 82
Chapter 6 The Lunacy of Long Hours and the Need to “Work Fresh” 87
Chapter 7 The Slippery Slope to Burnout 102
Chapter 8 Where’s Your Sweet Spot? The Zone for Optimal Performance 114
Chapter 9 Fake Work and Spinning Wheels: Prioritizing and Letting Stuff Go 121
Chapter 10 Slicing Up the Corporate Pie; Restoring the Basic Bargain 130


Chapter 11 Unrealistic Expectations: The Mind Trap That Fuels the Treadmill 143
Chapter 12 Realistic Expectations: Training Your Clients and Customers 155
Chapter 13 The Myth of Multi-tasking: Single-tasking and Focus 160
Chapter 14 Timeouts: The Pause That Refreshes 166
Chapter 15 Overuse and Misuse of Technology and How to Tame It 174
Chapter 16 Meetings: The Need for a New Meetings Manifesto 191
Chapter 17 Bureaucracy and Red Tape: Bumps on the Road to Productivity 199
Chapter 18 The Work-Life Interface: Balance or Blending? 204
Chapter 19 Health Habits and the Staggering Cost of Self-Neglect 216


Chapter 20 Identifying and Dealing with Problem People 225
Chapter 21 People Don’t Leave Jobs, They Leave Bosses 241
Chapter 22 The Games People Play: Office Politics 256
Chapter 23 The Keys to Employee Engagement and Stress Reduction 261
Chapter 24 The Obsession with Numbers 274
Chapter 25 Does It All Have to Be About Money? Must the Rich be Filthy Rich? 279


Pay Now or Pay Later: Prevention Is the Best (and Cheapest) Cure 289
What Companies Can Do to Decrease Workplace Stress 295
What Managers and Leaders Can Do 303
Throttling Back to Move Ahead: It’s Time to Recalibrate 308
Who Will Lead the Charge for Change? Who Will Bell the Cat? 312
Wrapping Up and Moving Forward 321



It happened again today. A patient sat down for his first appointment and told me a story of workplace stress that made me want to jump out of my chair, call his employer, and yell, “Stop killing this man!”

Joe was a smart, no-nonsense, down-to-earth guy with a warm smile and an easy laugh, but when he began to talk about his job, he became animated and upset. His knee started bouncing, his brow was furrowed, and the words poured out of him. As a physician who has done stress counselling for thirty years, it was a scene I’ve watched for many decades: agitated or depressed patients who finally get to tell their story at their own pace to a therapist who is eager to listen and help. At times Joe’s voice would rise with indignation and amazement at some of the ridiculous things going on in his company. More than once he said, “They just don’t get it!”

He was a supervisor working thirteen hours a day, six days a week, with only a half hour for lunch and no other breaks. He had no assis- tant, was required to attend eight to ten meetings a day (most of which were “wasteful”), had to field fifty to eighty emails a day—even on weekends and vacation — and he said, “The volume of work is incredi- ble.” He’d had three managers in eighteen months, and each had tried to restructure the department. He had a host of stress symptoms and health problems, among them low energy, insomnia, palpitations, high blood pressure, muscle tension, trouble with concentration and memory, and he was taking four different medications. He also had a spouse, a house, and a mortgage, so quitting his job wasn’t an option.

He applied for a transfer, but was told there was nothing available. He felt totally stuck, caught in a vise that was doing him in.
It’s a story I’ve been hearing from patients for most of my career. The people are different, the details vary, but the theme is always the same: Workplaces are making people sick.

In another instance, a woman came to see me about a work situation that involved frank psychological harassment by her boss. Over time, four other patients appeared in my office, all with similar stories. No wonder—they all worked for the same boss! (There’s nothing like word of mouth to keep a stress doctor busy.) Here were five decent, hard-working people who became stressed enough to seek professional help, all because of one abusive manager.

Organizations, and the people who run them, keep ramping up the stress levels of their employees. Some workers wear their stress as a badge of honour, a sign of macho toughness and strength, or they believe that stress is an indication of their level of dedication, commitment, and loyalty. For them, the more stress the better. For others it’s a nightmare. They think they have to suck it up and suffer in silence. They feel they have no choice and are resigned to “the new normal.” They accept that “that’s the way it is” as the pace of the work world speeds up, the economy sputters, and jobs are in short supply.

These notions have become a sacred cow that no one is willing to challenge. There’s a chill in the air about even addressing work- place stress. It’s the elephant in the room that people are reluctant to acknowledge, much less talk about—except in hushed tones—lest they

This book is based on four premises—observations I have made that compelled me to speak out:
1. Workplaces are making people sick.
2. Not enough people are talking about it, and when they do, nobody’s listening.
3. Much of the time and effort put in by stressed-out workers is unproductive.
4. Many of the solutions aren’t complicated.
I want to shine a light on the situation, offer some constructive strategies and solutions, and stimulate a conversation about how to fix these problems.


“Everyone can relate to this book! Dr. Posen teaches us, through practical and entertaining stories, how to make our lives better in every way – and inspires us to take action!” Jack Canfield, co-author of Chicken Soup for the Soul

“This book makes change seem fun rather than a chore. Dr. Posen shows you how to turn dreams into reality. Begin reading any page – you’ll not want to put this wonderful book down. Christine A. Padesky, PhD, co-author of Mind Over Mood, Director, Center for Cognitive Therapy, Newport Beach,CA

“For a Change: a practical book full of the clinical wisdom of an experienced physician” Dr. Stanley E. Greben, Professor Emeritus of Psychiatry University of Toronto

“This book is perceptive, instructive, productive and written in an entertaining fashion. It is a valuable addition to any growing person’s library.” Dr. Ron Taylor, Toronto Blue Jays Physician, Former Major League Baseball Pitcher

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Now updated and expanded, the bestselling Always Change a Losing Game explains how to make changes in your life. Whether you’re dealing with compulsive eating, addiction, struggling with kids, or stuck in an unhappy relationship or a deadā€end job, Dr. Posen provides practical guidelines that will help you make positive changes in your life. He does this by showing you how to take control of your life and transform the way you think, the way you behave and the lifestyle choices you make.

If what you’re doing and how you’re living are not producing the results you want, then you are playing a losing game. If you want things to get better, then you’ve got to change that losing game. This book is your key to success.


Acknowledgments 9

Preface 11

Introduction: Pre-Game Warm-up 13

Change 21
Rules of the Game 45

How to Recognize a Losing Game 48
Common Losing Games 57
Be Aware of Your Thinking 67
Becoming Aware of Your Mind Traps 73
The Power of Beliefs 90
Looking at How You Behave 100

Making Choices 122
Change Your Thinking 130
Reframing – Choosing the Way You Look at Things 142
Attention and Focus – Choosing Which Things You Look At 158
Keeping and Using Your Sense of Humor 166
Getting into Shape – Choosing Your Lifestyle 176
Taking Breaks from the Game – Leisure and Time-Outs 197
Choosing Your Behavior 210
You’re Not Alone – The Need for a Support System 234
If It’s Not Working, Stop Doing It – Why People Don’t Solve Problems 249

Giving Yourself Permission to Change 266
Making It Happen 277

Conclusion: Post-Game Wrap-Up and Celebration 293

Index 299


Pre-Game Warm-Up

THIS BOOK IS ABOUT MAKING CHANGES. In it I hope to show you that change is necessary, beneficial and easier than you think. It is not something to be afraid of.

Years ago, when I played tennis, I would stand at the baseline and hit the ball as hard as I could. I lost a lot of games that way. One day my brother suggested I play the net and take the offensive. I was reluctant to do that since volleying wasn’t one of my strengths. That’s when he pointed out that, since I wasn’t winning anyway, I really didn’t have much more to lose.

“Always change a losing game,” he said.

That sounded reasonable so I gave it a try. Remarkably, my play improved.

I soon realized that this wisdom also applies to everyday life. How often had I continued to do things that weren’t working (like spinning my tires when I was stuck in snow and just sinking deeper into the drifts)? How many times had I watched my patients and friends fail at diets or mismanage money, even through they were “replaying” previous behaviour? Using the sports analogy as a touchstone, I began to change my own “game “ (including a career switch at age forty-two) and to suggest that my patients do the same. It got great results. People started to take control of their lives, to feel better about themselves and to relieve stress by changing basic aspects of their behaviour and thinking.

“Always change a losing game” became my motto for success. We all play losing games at times. A losing game is simply a way of acting or thinking that is not working or is costing more than it’s worth (like using $5.00 worth of gas to save $3.00 on a purchase across town). Losing games like procrastination or eating poorly are very common. When my patients play losing games, I urge them to see that the logic from sports applies to everyday situations and can bring the same positive results.

Please note that, by comparing daily events to sports, I do not intend to trivialize life. Nor am I trying to exalt games and sports by suggesting they are as important as our lives. However, the principles that apply in sports often apply in life – and the lessons are easier to see and less threatening to acknowledge in that context.

Take the following example, where a sports principle helped a patient with a business problem. He was a “take charge” boss who barked orders at his staff and got grumbling and poor performance as a result. I suggested a light tone might work better to motivate his employees and improve their productivity.

To illustrate this suggestion I compared his management style to hitting a golf ball. When I first took up golf, I figured the best way to get power was to swing as hard as I could. I soon learned my logic was flawed. I hit the ball erratically, often topping it or slicing into the trees. The poor shots were as infuriating as they were puzzling. A friend suggested I swing a little slower and not try to “muscle” the ball. Lo and behold, the ball went straight and pretty far. I not only replaced a losing game with a winning one, I learned another important lesson: often in sports, as in life, less is more. Force doesn’t always win.

My patient got the message and he applied it immediately by softening his approach at work, being more courteous and giving praise when warranted, he found the mood in the office improved immeasurably – and so did the output and the bottom line. A change produced better results.
There are different ways for change to occur. Take the 1977 Grey Cup football game. The field at Montreal’s Olympic Stadium was so icy that neither team could get their footing. In the third quarter, the Montreal Alouettes took command of the game and won convincingly. Their secret was revealed after the game. At half-time they had taken all their players’ shoes and inserted dozens of staples in the soles. These gave them the traction they needed to overwhelm the Edmonton Eskimos, who were still slipping and sliding all over the field. In this case the team won by doing something different.

Winning can also result from thinking differently. In 1954, Roger Bannister ran the first four-minute mile in history. Almost immediately dozens of other runners broke the four-minute barrier, not because they could suddenly run faster but because they changed their attitude about how fast humans could run. By changing their beliefs about what was possible, runners were able to break through a psychological barrier that had stood for generations.


“The Little Book of Stress Relief” is filled with great tips and insights. And it’s fun to read!” Peter G. Hanson, M.D. author of The Joy of Stress and Stress for Success

“It’s amazing that such a little book can deliver such an impact! Superb!” Rita Emmett, author of “The Procrastinator’s Handbook”

“I love this guy!” The Edmonton Sun

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In the Little Book of Stress Relief, stress expert Dr. David Posen teaches us how to take back control of our lives and regain a satisfying work-life balance. Dr. Posen proposes that we change our fundamental thinking and lifestyle choices by becoming aware of our behaviour, making informed choices and giving ourselves permission to make necessary changes in our day-to-day lives. In 52 short sessions, one for each week of the year, Dr. Posen isolates specific causes of stress and provides detailed “prescriptions” for overcoming them, as well as easy-to-follow activities and exercises that will help with everything from getting enough sleep to overcoming procrastination to perfecting the art of prioritizing. You’ll also learn how to avoid letting other people’s stress rub off on you.

The Little Book of Stress Relief guides us through making small changes every day, changes that once implemented can have a profound positive effect on the quality of our lives.



Welcome 13
Is Stress a Friend or Foe? 16
Do You Know Your Signs of Stress? 19
Where Does Stress Come From? 22
Internal Sources of Stress 25
The Mind/Body Connection 28
Factors Influencing Our Stressful Interpretations 32
The Fascinating History of Stress Theory 35
Unrealistic Expectations 37
Use Your Stress Reactions Wisely 40

The Work–Life Balancing Act 42
The Power of Permission 45
Where’s the Pressure Coming From? 48
Peer Pressure and Corporate Culture 51
Setting Boundaries and Limits 55
Saying No 59
Sleep 62
Caffeine 65
Putting Your Work in Perspective 68
How to Leave Work at Work 71
Reclaiming Ownership of Your Time 74
Making Time for Leisure 77
Beliefs That Oppose Balance and Leisure 80
Pacing and Time-Outs 84
It’s Time to Plan Your Next Vacation 87
Burnout 90
Dealing with Deadlines 94
Prioritizing Tasks 97
Delegating 100
Communication Skills 103
Communication Aggravation 106
Dealing with Information Overload and Technostress 109
Handling Home Chores 113
Procrastination 116
Dealing with Clutter 119
Paper Clutter 122
Money and Stress 125
Trouble Making Decisions 129
Long-Distance Worrying 133
Closing “Open Circuits” 136
The Art of Reframing 139
Conversations with Yourself 142
Thought Stopping 145
Reframing Other People’s Behavior 148
Dealing with Difficult People 151
Stop Giving Power to Other People 154
Good Health—It’s Your Choice 157
How I Learned to Meditate 160
Relaxation Techniques 162
Outlets for Frustration 165
Dealing with Anger 168
Dealing with the Blues 172
The Importance of Social Support 175
How to Enjoy Holiday Stress 178
Feelings That Surface During the Holiday Season 182
New Year’s Resolutions 185
Wrap-Up 188
Appendix 1: How Stress Happens 192
Appendix 2: What Is Stress? 193
Appendix 3: What Are the Symptoms of Stress? 194
Appendix 4: External and Internal Sources of Stress 196
Resources 199
Index 203


What is the one condition every doctor shares with every patient? The answer is stress. It’s everywhere. Whenever people find out I’m a stress consultant (from librarians in Toronto to limo drivers in New Jersey to techies in California), they invariably say, “Boy, could I use your services!” We all know about stress from experiencing it—even suffering from it at times. What we don’t all know is what to do about it. That’s what this book is about. I became interested in stress in 1981. Actually, “hooked” would be more accurate. I was a family doctor, and had just received a flyer advertising a seminar in Montreal on heart disease. The topics included nutrition, exercise, stress management and sexuality (that was probably the teaser—I guess someone figured that, even at a medical meeting, sex sells!). The conference looked intriguing, and a few days off appealed to me, so I signed up. Little did I realize, when I got off the train on that sunny June afternoon, that my work life was about to change forever.

The program featured three lectures on stress management. I was riveted. The presenter was a young, funny, self-admittedly nervous psychologist—and she was fabulous! Not only was the information fascinating, but I could see how helpful it would be for my patients. Even more compelling was the fact that I could see huge potential benefits for myself. I was not the most laid-back guy in the world. And working in a high-pressure job only added to my stress. Those first presentations explained things I had been experiencing all my life, but had never previously understood. I have pursued the subjects of stress theory and stress management with a passion that has not abated in more than 30 years.

Over time, I began to appreciate the widespread impact of stress on my patients— not only on their health and emotional well-being, but also on their energy, productivity, relationships, self-esteem and overall quality of life. I also made big progress in handling my own stress.

Evidence of stress surrounds us, from cover stories in magazines to newspaper tales of road rage; from people around us looking harried and hurried to the face looking back at us in the mirror.

Statistics bear this out. According to a 2010 Globe and Mail series on stress, Canadians experience an average of fourteen stressful episodes a week. Twenty percent of workers reported high levels of “crunch time when they feel over- whelmed by overcrowded inboxes and jammed weekly schedules.” In 2008, close to two million Canadians were working more than fifty hours a week, up 23% from a decade earlier. Absentee rates for full-time employees increased by 21% in the past ten years. In the United States, the National Institute of Mental Health reports that more than 18% of adults suffer from an anxiety disorder each year. In his 2011 book Nerve, author Taylor Clark notes that “stress-related ailments cost the United States an estimated $300 billion per year in medical bills and lost productivity”—yes, billion with a “B.” He states that, in the past ten years, anxiety has surpassed depression as the number one mental health issue in the United States. An online 2011 survey conducted by Harris Interactive on behalf of the American Psychological Association revealed that “more than one third (36%) of employees report they are typically stressed out during the workday” and “20% report that their average daily level of stress from work is an 8, 9 or 10 on a 10 point scale.” Sort of catches your attention, doesn’t it?

As if the news of current stress levels isn’t bad enough, an earlier research study for the Heart and Stroke Foundation in 2000 showed that only 26% of Canadians felt that they knew how to handle their stress well. Dr. Rob Nolan, a Foundation spokesman, said that people often cope with stress by engaging in harmful lifestyle habits. “About 75% of the respondents say their coping mechanisms include eating fatty comfort foods, watching TV, smoking cigarettes or drinking alcohol.”

It seems safe to say that stress is a huge problem in our society and that most of us are not handling it very well.

We’re living in stressful times: economic upheaval: debt crises in Europe; stock market gyrations and volatility; job shortages since the 2008 market meltdown; climate change; natural and weather-related disasters such as earthquakes and hurricanes; political instability and unrest; ongoing fear of international terrorism and overall uncertainty. It’s easy to feel overwhelmed and powerless. In the face of these enormous problems, one might ask how relevant it is to deal with the smaller issues of day-to-day life. Ironically, it may be more important in difficult times. I believe that the less control you have over your external environment, the more important it is to take control of your internal environment.

Aim to take control of the things you can control. These include the way you think, the way you behave and the lifestyle choices you make. If you manage these issues better, you’ll have much more energy and resilience to deal with the larger, external forces that affect us all. And the good news is, you have more control than you think.

In the pages that follow, I will show you how to take more control of your life and handle stress with skill and confidence. I hope you find the journey both beneficial and enjoyable.

Each chapter begins with a story or analogy, followed by relevant information and suggestions. The chapters end with prescriptions: specific, simple, concrete things you can do over the next week to put the ideas into action. My goal is to have the book serve as a guide for making gradual changes that will reduce your stress and improve your health.

The book can be read in three possible ways. You can read it straight through as with any other book. Or you can go directly to specific chapters that interest you. Or you can use it as an action-oriented manual, reading one chapter per week and implementing the prescription over the ensuing seven days. If you want to read about any subject in greater detail, there is a reading list at the end, organized by topic. Whichever approach you take, I hope you find the book engaging, interesting, fun and of practical benefit as you deal with the stress of your life.