Change is inevitable, unavoidable and unpredictable; change does not signify an ending, but rather new beginnings. - A. Sicinskib

Does it surprise you to hear a staff nurse stating that they want to go into case management to reduce their job stress? Different stress, for sure, but we know that case management can be very stressful. Lately, I have been giving deep thought to reasons for stress and how we can decrease it. There are so many reasons for stress and the continuum can range from difficulty with a coworker, to hearing you have inoperable cancer. Parts of this Editorial are reminiscent of editorials on "mindfulness" and "resilience." If this is something you want to read about (or re-read), the search engine on our website, http://www.professionalcasemanagementjournal.com, is excellent.

Disclosure: I am not a psychologist, psychiatrist, or social worker (who are often more knowledgeable/educated on these topics). But I have had my share of tough situations and sad news, and so I have had plenty of experience trying not to slide down the "rabbit hole."

What is the foundational, primary cause of any stress? Fear. Often, fear of loss and more commonly, fear of loss of control (your life, someone else's life, loss of job/revenue, friendship, respect, image, the list can be long). So this begs the question: What if I could manage that fear of loss of control and not let it bother me as much? So I did some digging and found some interesting concepts and found it's all a question of balance.

The "law of control" and "losing-control anxiety" are not words I have commonly associated with stress; but control, lack of control, or "let it go," may all be at the core of stress. "Losing-control anxiety" is a psychological term, more easily understood if paired with the "law of control." The "law of control" essentially states that we feel good about ourselves in balance to the degree that we are in control of our lives. When there is some semblance of control over our lives (or at least we think we are in control), we feel more relaxed and can have a sense of fulfillment (Sicinskib, 2016). But when uncontrollable, seemingly random, events inject themselves into our lives, the stress and grief can be harsh; the feeling that your life has been changed by some chance event is upsetting.

"Losing-control anxiety" is when someone (a perfectionist, perhaps?) takes the fear of losing control to its extreme. This is the fear that if you don't manage to control the outcome of a future event, something terrible will happen. The core of the problem is the demand for certainty in a world that is nearly always uncertain (Cohen, 2011).

Life is full of seemingly uncontrollable events, from job stress (feeling unprepared to meet the demands of the job); to a new diagnosis where little medical intervention can be done; to world/natural disasters (floods, earthquakes, tsunamis); to the subtle stress of not knowing "where" the next violent action will take place (see Professional Case Management, November/December 2016, "Medical Case Management for Victims of Terror: A Report From Tel Aviv").

Job stress is a well-researched type of stress. What does this type of stress have to do with loss of control? Consider a poor orientation, or no experience with the patient population you are assigned to. Superimpose on that the dozens of requests (or demands) of the day. Until you can up your game through self-directed learning and time management, you may feel very out of control. What if you are accountable for specific outcomes of your employer's metrics, yet in reality, have little to no ability to impact the processes in which the metrics are based? It happens often. Another form of uncontrollable stress happens in our health care backyard. First, a test or procedure(s). Then "the results": a word or phrase is spoken that is enough to send the bravest into a tailspin: metastatic, ovarian, pancreatic, in lymph nodes, low survival rate, "we can try this."

Major events such as volcanoes, earthquakes, or forest fires-that change lives suddenly-and often, permanently. An earthquake in 2010 in Haiti and a tsunami in Japan in 2011 took 100,000's lives and left countless grieving and homeless. Some early warnings were noted, for sure, but no one had control over those events.

There are certainly some activities we can do, but keep in mind that we are not really talking about external control (other people, or what they think of you, or of earth events), but rather internal control-the control we have over our own thoughts, self-talk, and attitude. So, let's start 2017 with some techniques that really are within your zone of control:

1. Mindfulness, or present-moment awareness: If, at any moment, you feel you cannot control a segment of your life, it helps to focus on the present moment (and to realize this is just event is just a "segment" of your life-not all of it). Sometimes just getting into the "now" and realizing that at this moment, no tiger is chasing after you, you will expel the nonpresent fears and focus on (a) what is, (b) what can be done, and (c) what cannot be done. Some say that a few deep breaths will lead to the ability to ask better self-questions and put things in perspective, rather than feeling overwhelmed.

2. Refrain from demanding certainty; there is none. Re-read #1.

3. If you do worry, stop it. It does no good to go over and over about the same thing that (probably) has not even happened. But do practice foresight-the ability to see beyond your present circumstances. This could help you identify the best course of action.

4. Create contingency plans: We probably could not plan or prepare for the unexpected "surprise" that is in our current life, but now it is happening. We have to face it and may be able to move forward if we develop a contingency plan.

5. Humor-even in the most dire circumstances, some genius finds a way for humor-not at anyone's expense, but humor is truly healing.

6. And if all else fails: let go of what you cannot control (again, go back to #1: control always starts and ends in the present moment). There is a common saying that does help get humans through trying times: "This too shall pass." It always does.

"It is this contradiction between the demand for certainty and the reality of uncertainty that will continuously play out again and again without resolution, unless you give up the demand for certainty. It is you who must concede; for reality won't give up its uncertainty for you" (Cohen, 2011, p. 1). That may be the ultimate quote on control, one that gives a solid reason to just find your balance, and have a safe and healthy 2017.

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