I was absolutely sure that my skin condition (exzema) was made worse by stress. So, I have tried my hardest to reduce stress. I exercise, eat right, and have gotten better at meditation and relaxation. I am employed in a fairly high-demand position, so I do experience a lot of work-related pressure, mostly completing tasks that I have been assigned in a marketing firm. Unfortunately, my skin problems have not changed that much, nor have my irritable bowel type symptoms. I am not sure what to do next. Do you have any suggestions about reducing stress? --Signed: Confused About Stress in Missoula.

Dear Confused About Stress:

Thank you for writing! You are definitely not alone. In a sense, our whole culture is a bit confused about stress. I think this is true because we think a lot in terms of productivity, cost-effectiveness, and outcomes. When we think about stress reduction, we think about how best to achieve it and we come up with a whole new set of tasks -- exercise, eat right, learn to relax. Although it is a worthy endeavor to work towards healthy lifestyle changes, we can actually add more stress to our lives with this new "work." Here is what I consider to be a higher priority truth about many skin and gastrointestinal difficulties -- it's mostly about the lack of love.

Dean Ornish, in Love and Survival -- The Scientific Basis for the Healing Power of Intimacy, may have said it best: "...love and intimacy are at the root of what makes us sick and what makes us well... I am not aware of any factor in medicine -- not diet, not smoking, not stress, not genetics, not drugs, not surgery -- that has a greater impact on our quality of life." Unfortunately, significant receiving and giving of love is not a hallmark of our society, which is much more about independence and competition. That is why it is easier for most of us to talk about "stress reduction" than "getting more love." In my work, I try to simplify the concept of love and teach people about how powerful it is.

Eric Berne, one of the founders of transactional analysis, helped us understand more about love by adding new meaning to the word "stroke" -- "a unit of human recognition." The truth that humans have an inborn "stroke hunger" was established by the research of Rene Spitz and many others who proved that physical touch was required for human infant survival. It was also discovered that as we get older, we can get the same "stroking" from verbal feedback.

Verbal remarks can substitute for actual, physical strokes. It doesn't matter as much when we are younger whether the verbal stroking is criticism or praise because it is attention. However, if the verbal strokes we receive as a child are primarily "cold pricklies" (a transactional analysis term), then we learn to look for them because we equate cold pricklies with love. The earlier we are programmed to feel that we deserve such put-downs, the harder it is for us to get out of the habit of putting up with them or even seeking them. The opposite of cold pricklies is "warm fuzzies" (positive strokes).

One of the classic homework assignments that transactional analysts might give you to work on a skin problem is to get five people to call you by your first name everyday. In other words, your goal would be to seek out positive strokes (love). You can read much more about "stroke starvation" and love at Claude Steiner's Web site: www.emotional-literacy.com. Click on the word "love" when you go there.

Most often, the better we get at loving ourselves, expressing love, and getting and receiving positive attention, the less stress we will experience, even when bad things happen. To me, this is the true stress-reduction prescription we are all looking for. -- Best wishes, Dr. Debug.