According to the U.S. Department of Labor, the workplace is the greatest single source of stress, no matter what you do or how much you earn. The New York-based American Institute of Stress reports that as many as 75 to 90 percent of visits to physicians are related to stress -- at a price tag to American businesses of $200 to $300 billion a year.

In the San Francisco East Bay area, Kaiser Permanente is taking steps to hold down these costs and help employees handle their on-the-job stress at the same time. "Psychological issues can account for up to 60 percent of physical problems," said Kris Ludwigsen, Ph.D., the Kaiser Permanente clinical psychologist who started the innovative work stress group for Kaiser Permanente members and employees. The first step she took was to increase the awareness of work stress-related conditions among her co-workers. Next she expanded the idea by setting up group sessions for Kaiser Permanente members who need help handling stress. Part of the members' treatment consists of talking with co-workers or supervisors to help identify the causes of stress. These actions enable members to learn how to handle their stress while they're in the thick of it -- on the job. "We're trying to help people identify self-empowering strategies that they can use to deal with their stress, rather than file for disability or workmen's compensation," Dr. Ludwigsen said. All of the discussions are strictly confidential.

Work in the '90s comes with its own brand of stress -- longer work hours, mobile offices, and faster turnaround -- so what's the difference between "normal" work-related stress and how the people in Dr. Ludwigsen's group feel? "Most people can feel busy, pressured by time -- even overwhelmed -- and continue to cope well," said Dr. Ludwigsen. "When you begin to feel demoralized or like you're trapped in a corner -- that's when you need help." The warning signs can be psychological and physical. If you're forgetful, irritable, angry, quick to cry, have trouble sleeping, lack initiative, find it hard to concentrate or easy to be distracted, you may be over your limit for stress. If you're suffering from fatigue, migraine headaches, hypertension, stomach or bowel problems, teeth grinding or panic attacks, your body is telling you it isn't all in your mind.

One Central Valley resident (who wishes to remain anonymous) commutes to a job in Oakland. Plagued by an irritable bowel, she joined the group about a month ago. "Dr. Ludwigsen offers realistic suggestions," she said. "In my case, I'd avoided exercise because of my work hours. The doctor reminded me that exercise is something that really helps me deal with stress." Now, at 4 a.m. every morning, the participant rides her stationary fitness machine for a half hour. She's also trying to leave work after her eight hours are up, knowing that there's a lot of work left to do. "It's been really helpful," she said. "My stomach's been fine. I'm sleeping better at night. I leave each session feeling that I do have some power and control over my situation." "Once we learn to identify our early warning signs of stress, we work to develop strategies to alleviate that stress," Dr. Ludwigsen said. "For example, it may help to prioritize your activities, get more exercise, or say 'no' more often. The most important thing you can do is to find the right balance of work, rest and play."

First Aid for Stress -- Get the stress "out of your system" through physical exercise, yoga or a massage.

-- Find ways to relax and "switch gears" after work, such as reading, gardening and other hobbies or pursuits, listening to music, soaking in a hot tub, etc.

-- Take mini-breaks at work to exchange humor with a co-worker, do neck rolls, go for a quick walk at lunch, do mini- meditation visualizations of your favorite vacation, etc. To anchor the visualization, send yourself postcards while on the vacation and write on the back what made it so enjoyable.

-- Make a list of your activities and prioritize them into A, B, and C categories from most to least essential. Eliminate as many C's and B's as possible and focus on the A's.

-- Focus on doing one thing at a time rather than juggling several activities.

-- Think in terms of priorities rather than perfection in accomplishing tasks. Keep in mind that it's normal to feel overwhelmed at work these days.

-- On a difficult day ask for validation from a trusted coworker, close friend or partner who understands your work situation.

-- Think of your time as a valuable commodity. Learn to set limits and say "No" to requests. Some helpful phrases are "I'll think it over and get back to you in 24 hours" if you need time to develop a "no" answer. "I'm overcommitted right now; if I take this on, I'll have to let go of some other projects/activities. Which would you like me to put aside?"

-- Learn to identify your "early warning signs" of stress (forgetting, irritability, headaches, etc.) and take immediate action in some of the stress-reducing activities above.

-- Reduce TV watching, or other late night activities, and get to bed earlier to rejuvenate through sleep.

-- Find ways to integrate a sense of play throughout your work day, e.g., through Dilbert cartoons, funny pens or other desk toys; (at home play with your kids or your pets.) Personalize your workspace with photos & flowers or other items that have a grounding or relaxing influence.

-- Keep your favorite suggestions for reducing work stress on a yellow post-it note in a notebook or calendar.