Middle adulthood is a complex period of time that requires a multidimensional perspective to understand all the processes and changes that are occurring. The many changes during middle adulthood include physical, cognitive, and social differences. Many of these changes create significant stress, and it is important to understand how to deal with anxiety. Many of these coping mechanisms include awareness and cultivating a sense of self-efficacy and mastery (p. 482). There are many changes during middle adulthood that may require stress management techniques and interventions. During middle adulthood, biological and physical changes become evident. During this period, visual perception, hearing and the reproductive system decline. Adults who have never worn glasses or contact lenses may begin to need vision correction (p. 424). During this period, adults may also need more light to see than their younger friends (p. 424). During middle adulthood, men more commonly develop less sensitivity to high-pitched sounds (p. 424). This is why individuals during this stage find it more difficult to hear and interpret other voices. (p. 424). The female reproductive system begins to decline, slowly ending with menopause. The decline in circulating estradiol, the master estrogen hormone, causes many differences in reproductive health. During middle age, pubic hair thins, changes in vaginal chemistry occur, and labia begin to thin and wrinkle (p. 424). Chemical changes inside the vagina cause dryness and an increased chance of infections (p. 424). For men, the decrease in testosterone during middle age is only small, however the decrease causes lower bone density and loss of muscle mass... middle of paper......le to a disorder in some circumstances ( page 471). Stress can also cause immunosuppression, which inhibits the immune system, making the individual more likely to get sick (p. 472). In comparison to Dr. Siegel's video, the key to happiness may be awareness and absorption of life in the moment. Many people think too much about the past or future and miss the present moment. In the counseling profession I believe that middle age produces a lot of stress. I would suggest stress management techniques such as meditation and yoga. I would also suggest incorporating physical activity which is proven to increase endorphins in the body. For people who are having relationship difficulties I would suggest marriage counseling so they can understand each other's needs and learn to balance the negative and positive effects in their relationship.