Session 2: Stress Management
Overview
I. Review of Homework – Practicing Relaxation Techniques
II. Patient’s View of Stress
III. Pieces of the Process
IV. Interpretations
V. Managing Stress
VI. Homework – Questions to Ask Yourself If You Are Worrying
VII. Relaxation Technique - Letting Go of Thoughts
II. Patient’s View of Stress
III. Pieces of the Process
IV. Interpretations
V. Managing Stress
VI. Homework – Questions to Ask Yourself If You Are Worrying
VII. Relaxation Technique - Letting Go of Thoughts
Session 1: Stress Management
I. Review of Homework – Practicing Relaxation Techniques
II. Patient’s View of Stress:
II. Patient’s View of Stress:
Events
Responses
Responses
Examples of responses to stress:
1. Physical Signs - muscle tension, heart rate increase, high blood pressure, sweating, breathing, adrenal gland secretion, constriction of blood vessels in extremities, and difficulty with concentration
2. Emotional Changes – uptight, irritable, angry, depressed, anxious, afraid
3. Behaviors – pacing, being aggressive, eating/drinking
Stress is not an event but a process. It is an interaction between an event and a person.
2. Emotional Changes – uptight, irritable, angry, depressed, anxious, afraid
3. Behaviors – pacing, being aggressive, eating/drinking
Stress is not an event but a process. It is an interaction between an event and a person.
III. Pieces of the Process:
Lets talk about some individual pieces of that process.
Saber-Toothed Tiger Story
IV. Interpretations:
1. The key to whether something is stressful seems to be the interpretation that a person makes about the stressful event.
2. A-B-C Model: Event-Interpretation-Response.
3. Emphasize the importance of interpretation by proving that no one can make you feel bad.
4. Kinds of interpretations that lead to problems, negative thoughts, bad attitude, catastrophizing, hopeless, terrible, nothing I can do.
2. A-B-C Model: Event-Interpretation-Response.
3. Emphasize the importance of interpretation by proving that no one can make you feel bad.
4. Kinds of interpretations that lead to problems, negative thoughts, bad attitude, catastrophizing, hopeless, terrible, nothing I can do.
V. Managing Stress
Stress Management Checklist
Think over the past few weeks, and recall a stressful event or series of stressful events. Use this checklist to determine how you managed the event(s) at the time.
The stressful event(s) was/were:
The stressful event(s) was/were:
1. Was I aware that I was stressed?
Yes
No
2. Was I able to predict the stress?
Yes
No
3. Was I able to avoid the stress?
Yes
No
4. Was I able to control the pace of things?
Yes
No
5. Did I have any outside support?
Yes
No
6. Did I perceive things in a positive light?
Yes
No
7. Did I deal with the stress directly?
Yes
No
8. Were my expectations realistic
Yes
No
9. Did exercise help me manage the stress?
Yes
No
10. Were relaxation strategies helpful?
Yes
No
11. Did I eat well and avoid stimulants?
Yes
No
12. Should I have sought more help?
Yes
No
Jamison, R. N. (1996). Learning to Master Your Chronic Pain. Sarasota, FL:
Professional Resource Press.
Professional Resource Press.
REAP
RECOGNIZE
Learn the “symptoms” of anxiety and accept the fact that you are anxious without belittling yourself. Remember that it is human to feel anxiety. It is o.k. to feel anxious!
Depersonalization
Indecisiveness
Events
Rapid Heart Rate
Avoidance
Fatigue
Shortness of Breath
Overeating
Restlessness
Feelings of Unreality
Crying
Faint Feelings
Perpetual Distortion
“Shoulds”
Preoccupation
Voice Shaking
Insomnia
Sweating
Bursts of Adrenaline
Panic
Low Self-Esteem
EVALUATE
1. Take a SUDS level (Subjective Units of Distress from 0 = no stress to 10 = freaked out!)
2. Is it real or imagined anxiety?
3. Can I do something about it? Can I really make a change? Or do I need to accept what is happening and let go?
4. Is it “probable” or merely “possible?”
5. Evaluate cognitive distortions.
ACT
Employ some specific anxiety-reducing behaviors.
1. Relaxation, deep breathing, letting go, “floating”
2. Exercise: take a walk, jog, bike, etc…
3. Divert the anxiety give yourself something else to worry about!
4. Face something you have avoided. The phone call you need to make, the “homework” you need to do, the person you need to see, the confrontation that is essential, whatever small or large thing about which you have procrastinated.
5. Improve nutrition: decrease caffeine, refined sugars, and additives.
6. Change ingrained behavior pattern: be assertive and start saying no.
PREVENT
Assume some lifestyle changes that will reduce overall anxiety.
1. Maintain regular relaxation, aerobic exercise, good health, and diet.
2. Regularly evaluate and change distorted and negative thought habits.
3. Regularly focus on the task at hand, rather than anxious feelings.
4. Relieve the fear of the unknown, get more training, reading, and learn new skills.
5. Regularly build social support system, be assertive, be open and be honest.
6. Regular stress inoculation; rehearse situations ahead of time, either imaginary or role-play.
7. Say “NO” sometimes.
8. Be aware of what you can control and what you cannot control.
1. Take a SUDS level (Subjective Units of Distress from 0 = no stress to 10 = freaked out!)
2. Is it real or imagined anxiety?
3. Can I do something about it? Can I really make a change? Or do I need to accept what is happening and let go?
4. Is it “probable” or merely “possible?”
5. Evaluate cognitive distortions.
ACT
Employ some specific anxiety-reducing behaviors.
1. Relaxation, deep breathing, letting go, “floating”
2. Exercise: take a walk, jog, bike, etc…
3. Divert the anxiety give yourself something else to worry about!
4. Face something you have avoided. The phone call you need to make, the “homework” you need to do, the person you need to see, the confrontation that is essential, whatever small or large thing about which you have procrastinated.
5. Improve nutrition: decrease caffeine, refined sugars, and additives.
6. Change ingrained behavior pattern: be assertive and start saying no.
PREVENT
Assume some lifestyle changes that will reduce overall anxiety.
1. Maintain regular relaxation, aerobic exercise, good health, and diet.
2. Regularly evaluate and change distorted and negative thought habits.
3. Regularly focus on the task at hand, rather than anxious feelings.
4. Relieve the fear of the unknown, get more training, reading, and learn new skills.
5. Regularly build social support system, be assertive, be open and be honest.
6. Regular stress inoculation; rehearse situations ahead of time, either imaginary or role-play.
7. Say “NO” sometimes.
8. Be aware of what you can control and what you cannot control.
VI. Homework – Question to Ask Yourself If You Are Worrying--- Worry Bottle
VII. Relaxation Technique - Letting Go of Thoughts
1. Find a relaxing position either in your chair or on the floor. Make sure not to cross your legs or arms. Take several deep breaths..
2. Imagine that you are sitting on the bank of a river, watching a leaf drift slowly down stream. Observe one thought, feeling, or perception as the leaf, and then let it drift out of sight. Return to gazing at the river, waiting for the next leaf to float by with a new thought..
3. Now take the next several minutes to observe the leaves as they pass by. .
2. Imagine that you are sitting on the bank of a river, watching a leaf drift slowly down stream. Observe one thought, feeling, or perception as the leaf, and then let it drift out of sight. Return to gazing at the river, waiting for the next leaf to float by with a new thought..
3. Now take the next several minutes to observe the leaves as they pass by. .
