Session 2: Stress Management
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
Session 1: Stress Management
I. Review of Homework – Practicing Relaxation Techniques
II. Patient’s View of Stress:
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.
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.
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:
1. Was I aware that I was stressed?
2. Was I able to predict the stress?
3. Was I able to avoid the stress?
4. Was I able to control the pace of things?
5. Did I have any outside support?
6. Did I perceive things in a positive light?
7. Did I deal with the stress directly?
8. Were my expectations realistic
9. Did exercise help me manage the stress?
10. Were relaxation strategies helpful?
11. Did I eat well and avoid stimulants?
12. Should I have sought more help?
Jamison, R. N. (1996). Learning to Master Your Chronic Pain. Sarasota, FL:
Professional Resource Press.
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!
Rapid Heart Rate
Shortness of Breath
Feelings of Unreality
Faint Feelings
Perpetual Distortion
Voice Shaking
Bursts of Adrenaline
Low Self-Esteem

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.


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.


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. .
Death of a Painkiller?
2009-12-22 15:37:24

When an advisory panel to the Food and Drug Administration (FDA) recommended a ban on acetaminophen-containing pain relievers in June 2009, the response was quick and angry. We were deluged with consumer calls, says FDA spokeswoman Karen Riley. Why the outcry? The panel had suggested that the FDA remove acetaminophen from all prescription drugs, including Percocet and Vicodin, two of the most popular painkillers in the world. The panel also advised lowering the amount of acetaminophen in over-the-counter medications like Tylenol from 500 milligrams to 325, which would cap the maximum daily dose at 2,600 milligrams. The reason: Every year, about 400 Americans die and 42,000 more visit the ER because of acetaminophen overdoses, which can lead to liver damage.

The Sound of Music Eases Pain
2009-12-22 14:55:35
Researchers at Glasgow Caledonian University in Scotland found that people who were listening to their favorite music felt less pain and could stand pain for a longer period.
Running Barefoot Eases Pain
2009-12-22 14:54:49
Scientists have found that those who run barefoot, or in minimal footwear, have a very different stride from their shoe-wearing peers. The sneaker-less tend to avoid "heel-striking," and instead land on the ball of the foot or the middle of the foot. By landing on the middle or front of the foot, barefoot runners have almost no impact collision, much less than most shod runners generate when they heel-strike.