STRESS MANAGEMENT

PACKAGE
STRESS MANAGEMENT
• Overview
• Assessment
• Fight or flight response
COPING
• Relaxation techniques
• Coping strategies
• Coping skills
• Self-care ideas
• Social support
• Positive self-talk

COGNITIVE INTERVENTIONS
• Stress-inducing attitudes inventory
• Unhelpful thinking styles
• Untwisting thinking
• Reality vs. expectations
• STOPP technique
PRACTICAL INTERVENTIONS
• Problem solving
• Time management tips
• Goal breakdown
• Stress management plan
 coping with
stress
Stress and Stressors Stress Management Tips
Stress is something that is part of normal life, in that it 1) Identify your stressors, and see if there are some
is experienced by everyone from time-to-time. things within your control to manage better. Some
However, some people suffer from stress which is so things will be beyond your control, for example if you
frequent or so severe that it can seriously impact on work a job that is based on working towards deadlines
their quality of life. Stress can come from a huge range then you can’t change this without changing jobs. But
of sources (stressors), such as: perhaps you can control some aspects, such as
◊ Relationships with others scheduling to have at least a short lunch break each
day, or to go to bed earlier so that you have more
◊ Work-related issues
energy to cope with the daytime.
◊ Study demands
2) Build regular exercise into your life - as well as being
◊ Coping with illness part of a healthy , balanced lifestyle and giving you
◊ Life changes, such as marriage, more energy, many people find that working out at the
retirement, divorce gym or playing sport helps them to unwind.
◊ Day-to-day activities and tasks 3) Make sure that you eat and sleep well.
◊ Positive events, such as 4) Take time out for family, friends and recreational
organising holidays or parties activities. Most of us know that this is important but
◊ Juggling many roles or tasks at we do not all do it. If you find it hard to make time for
the same time this, perhaps you need to take deliberate steps to have
time out, such as set aside one evening a week where
Some people are aware of what tends to trigger their you meet up with friends or enjoy a hobby, or set
stress, and this increases their ability to either prevent aside one day of the weekend for relaxing at home.
stress or to handle it more effectively. Many others are 5) Problem-solving techniques can be a useful way of
less able to deal with stress, and identifying stressors is clarifying the problem, brainstorming possible
a key step in this. If you often experience stress, take solutions, and then choosing one to put into action
some time to consider what tends to set it off for you. after listing the pros and cons of each option. See the
handout Problem Solving for more details about this.
Symptoms of Stress 6) Learn calming techniques such
Some people do not even notice that they are stressed as controlled breathing and 1..2..3..4..
until symptoms begin to occur, including: progressive muscle relaxation, to
◊ Irritability or moodiness train your mind and body to
◊ Interrupted sleep become more relaxed. These
◊ Worrying or feeling of anxiety techniques require practice but can
be helpful with regular use. See
◊ Back and neck pain
handouts Calming Technique and
◊ Frequent headaches, minor to migraine Progressive Muscle Relaxation.
◊ Upset stomach 7) You may wish to speak to a professional about
◊ Increased blood pressure assertiveness training and communication skills
◊ Changes in appetite which can help you to deal with challenging situations
◊ Rashes or skin breakouts more effectively, thereby reducing stress. See the
◊ Chest pains handout Assertive Communication.
◊ Making existing physical problems worse 8) Last but definitely not least, consider whether there is
negative thinking which is contributing to your
◊ More susceptible to cold/flu and slower recovery
stress. Negative thinking can make us worry more
These symptoms reduce quality of life, and people than is necessary, increasing stress, and generally does
suffering from stress may notice that work performance not motivate us to take positive actions. See the
or relationships suffer more as a result. You may be handouts Thinking & Feeling, Analysing Your Thinking and
able to use some the strategies listed here, or you may Changing Your Thinking.
find it useful to consult a professional for more help.
C entre for
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CI linical
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 Stress Management
Stress: an emotional and physical response to demanding situations, including
symptoms that may include worry, a feeling of being overwhelmed, increased heart rate,
headaches, sleep difficulties, procrastination, and more.

Describe your largest source of stress, in detail.

Briefly list two other stressors you are experiencing.

Circle any symptoms you have experienced in response to stress.

Anger / Frustration Anxiety Decreased Sex Drive Drug or Alcohol Use

Fatigue Headaches Indigestion Muscle Tension

Nail Biting Over or Under Eating Procrastination Sleep Difficulties

Social Withdrawal Teeth Grinding Worry Other

Contrary to popular belief, not all stress is bad. The stress response is a powerful tool
used by your body to increase the odds of overcoming obstacles. It’s when stress
becomes too intense, or lasts for too long, that it becomes problematic.

© 2017 Therapist Aid LLC 1 Provided by TherapistAid.com

 Stress Management
The negative effects of stress can be reduced with the use of social support, emotional
management skills, maintaining a healthy life balance, and attending to basic needs. In the
following pages, we’ll explore each of these strategies.

Social Support
Even when your social support cannot solve a problem, just talking can sometimes be enough.
When we talk about our problems, hormones are released inside our brains that ease the
undesirable symptoms of stress.

List three people who you can turn to for support.

Name: How they can help:

How can you use social support to ease one of your current stressors?

Emotional Management
Stress can trigger many emotions such as anxiety, self-doubt, and anger. When these feelings
are ignored, they can exacerbate the original stressor. Remember, emotional management isn’t
about eliminating emotions—it’s about dealing with them in a healthy way.

When faced with unpleasant emotions, do you have any habits or tendencies that worsen the situation?

List two ways that you have successfully handled unpleasant emotions in the past.

© 2017 Therapist Aid LLC 2 Provided by TherapistAid.com

 Stress Management
Life Balance
Stress can be especially destructive if your life is heavily focused on one area. For example, a
person who is only focused on a relationship will struggle if their relationship becomes rocky.

Rate each of the following life areas from 1 to 5. A “1” means that you devote little attention
to this part of your life, while a “5” means that you devote a high amount of attention to this area.

Career Family Fun / Recreation Spirituality

Socializing Intimate Relationship Education Other

Based upon your ratings, are there any areas where you would like to devote more attention?

Basic Needs
During periods of high stress, many people take shortcuts when it comes to their basic needs.
Examples include sleep, a healthy diet, exercise, and other forms of self-care. When basic needs
are neglected, health and mental well-being deteriorate, which contributes to additional stress.

Circle any basic needs that you tend to neglect during periods of high stress.

Sleep Healthy Diet Exercise Medical Adherence

medications, appointments, etc.

Managing
Personal Hygiene Social / Love Needs Other
Addictions

Describe the steps you can take to protect your basic needs during periods of high stress.

© 2017 Therapist Aid LLC 3 Provided by TherapistAid.com

 Relaxation Techniques
When a person is confronted with anxiety, their body undergoes several changes and
enters a special state called the fight-or-flight response. The body prepares to either
fight or flee the perceived danger.

During the fight-or-flight response it’s common to experience a “blank” mind, increased
heart rate, sweating, tense muscles, and more. Unfortunately, these bodily responses do
little good when it comes to protecting us from modern sources of anxiety.

Using a variety of skills, you can end the fight-or-flight response before the symptoms
become too extreme. These skills will require practice to work effectively, so don’t wait
until the last minute to try them out!

Deep Breathing
It’s natural to take long, deep breaths, when relaxed. However, during the fight-or-flight
response, breathing becomes rapid and shallow. Deep breathing reverses that, and sends
messages to the brain to begin calming the body. Practice will make your body respond
more efficiently to deep breathing in the future.

Breathe in slowly. Count in your head and make sure the inward breath lasts at least 5
seconds. Pay attention to the feeling of the air filling your lungs.
Hold your breath for 5 to 10 seconds (again, keep count). You don’t want to feel
uncomfortable, but it should last quite a bit longer than an ordinary breath.
Breathe out very slowly for 5 to 10 seconds (count!). Pretend like you’re breathing
through a straw to slow yourself down. Try using a real straw to practice.
Repeat the breathing process until you feel calm.

Imagery
Think about some of your favorite and least favorite places. If you think about the place
hard enough—if you really try to think about what it’s like—you may begin to have feelings
you associate with that location. Our brain has the ability to create emotional reactions
based entirely off of our thoughts. The imagery technique uses this to its advantage.

Make sure you’re somewhere quiet without too much noise or distraction. You’ll need a
few minutes to just spend quietly, in your mind.
Think of a place that’s calming for you. Some examples are the beach, hiking on a
mountain, relaxing at home with a friend, or playing with a pet.

TherapistAid.com © 2013 | Page 1

 Relaxation Techniques
Paint a picture of the calming place in your mind. Don’t just think of the place briefly—
imagine every little detail. Go through each of your senses and imagine what you would
experience in your relaxing place. Here’s an example using a beach:

a. Sight: The sun is high in the sky and you’re surrounded by white sand. There’s no
one else around. The water is a greenish-blue and waves are calmly rolling in
from the ocean.

b. Sound: You can hear the deep pounding and splashing of the waves. There are
seagulls somewhere in the background.

c. Touch: The sun is warm on your back, but a breeze cools you down just enough.
You can feel sand moving between my toes.

d. Taste: You have a glass of lemonade that’s sweet, tart, and refreshing.

e. Smell: You can smell the fresh ocean air, full of salt and calming aromas.

Progressive Muscle Relaxation

During the fight-or-flight response, the tension in our muscles increases. This can lead to a
feeling of stiffness, or even back and neck pain. Progressive muscle relaxation teaches us
to become more aware of this tension so we can better identify and address stress.

Find a private and quiet location. You should sit or lie down somewhere comfortable.
The idea of this technique is to intentionally tense each muscle, and then to release the
tension. Let’s practice with your feet.

a. Tense the muscles in your toes by curling them into your foot. Notice how it feels when
your foot is tense. Hold the tension for 5 seconds.

b. Release the tension from your toes. Let them relax. Notice how your fingers feel
differently after you release the tension.

c. Tense the muscles all throughout your calf. Hold it for 5 seconds. Notice how the feeling
of tension in your leg feels.

d. Release the tension from your calf, and notice how the feeling of relaxation differs.

Follow this pattern of tensing and releasing tension all throughout your body. After you
finish with your feet and legs, move up through your torso, arms, hands, neck, and head.

TherapistAid.com © 2013 | Page 2

 36. Hug a pillow or stuffed animal. 71. Try to make as many words out of

o p ing 37. Hyperfocus on something like a rock, your full name as possible .
C hand, etc. 72. Sort through your photographs.
s
Skill 38. Dance.
39. Make hot chocolate, milkshake or
73. Play with a balloon.
74. Give yourself a facial.
smoothie. 75. Find yourself some toys and play.
40. Play with modeling clay or Play- 76. Start collecting something.
1. Exercise (running, walking, etc.).
Dough. 77. Play video/computer games.
2. Put on fake tattoos.
41. Build a pillow fort. 78. Clean up trash at your local park.
3. Write (poetry, stories, journal).
42. Go for a nice, long drive. 79. Perform a random act of kindness
4. Scribble/doodle on paper.
43. Complete something you've been for someone.
5. Be with other people.
putting off. 80. Text or call an old friend.
6. Watch a favorite TV show.
44. Draw on yourself with a marker. 81. Write yourself an "I love you be-
7. Post on web boards, and answer
45. Take up a new hobby. cause…" letter.
others' posts.
46. Look up recipes, cook a meal. 82. Look up new words and use them.
8. Go see a movie.
47. Look at pretty things, like flowers or 83. Rearrange furniture.
9. Do a wordsearch or crossword .
art. 84. Write a letter to someone that you
10. Do schoolwork.
48. Create or build something. may never send.
11. Play a musical instrument.
49. Pray. 85. Smile at least five people.
12. Paint your nails, do your make-up or
50. Make a list of blessings in your life. 86. Play with little kids.
hair.
51. Read the Bible. 87. Go for a walk (with or without a
13. Sing.
52. Go to a friend's house. friend).
14. Study the sky.
53. Jump on a trampoline. 88. Put a puzzle together.
15. Punch a punching bag.
54. Watch an old, happy movie. 89. Clean your room /closet.
16. Cover yourself with Band-Aids where
55. Contact a hotline/ your therapist. 90. Try to do handstands, cartwheels, or
you want to cut.
56. Talk to someone close to you. backbends.
17. Let yourself cry.
57. Ride a bicycle. 91. Yoga.
18. Take a nap (only if you are tired).
58. Feed the ducks, birds, or squirrels. 92. Teach your pet a new trick.
19. Take a hot shower or relaxing bath.
59. Color with Crayons. 93. Learn a new language.
20. Play with a pet.
60. Memorize a poem, play, or song. 94. Move EVERYTHING in your room to a
21. Go shopping.
61. Stretch. new spot.
22. Clean something.
62. Search for ridiculous things on the 95. Get together with friends and play
23. Knit or sew.
internet. Frisbee, soccer or basketball.
24. Read a good book.
63. “Shop” on-line (without buying any- 96. Hug a friend or family member.
25. Listen to music.
thing). 97. Search on-line for new songs/
26. Try some aromatherapy (candle,
64. Color-coordinate your wardrobe. artists.
lotion, room spray).
65. Watch fish. 98. Make a list of goals for the week/
27. Meditate.
66. Make a CD/playlist of your favorite month/year/5 years.
28. Go somewhere very public.
songs. 99. Face paint.
29. Bake cookies.
67. Play the “15 minute game.” (Avoid
30. Alphabetize your CDs/DVDs/books.
something for 15 minutes, when time
31. Paint or draw.
is up start again.)
32. Rip paper into itty-bitty pieces
68. Plan your wedding/prom/other
33. Shoot hoops, kick a ball.
event.
34. Write a letter or send an email.
69. Plant some seeds. www.yourlifeyourvoice.org
35. Plan your dream room (colors/
70. Hunt for your perfect home or car
furniture).
on-line.
 Positive Self- talk / Coping Thoughts Worksheet

Positive statements encourage us and help us cope through distressing

times. We can say these encouraging words to ourselves, and be our own
personal coach. We have all survived some very distressing times, and we
can use those experiences to encourage us through current difficulties.
Examples of coping thoughts might be:

 Stop, and breathe, I can do this

 This will pass
 I can be anxious/angry/sad and still deal with this
 I have done this before, and I can do it again
 This feels bad, it’s a normal body reaction – it will pass
 This feels bad, and feelings are very often wrong
 These are just feelings, they will go away
 This won’t last forever
 Short term pain for long term gain
 I can feel bad and still choose to take a new and healthy direction
 I don’t need to rush, I can take things slowly
 I have survived before, I will survive now
 I feel this way because of my past experiences, but I am safe right now
 It’s okay to feel this way, it’s a normal reaction
 Right now, I am not in danger. Right now, I’m safe
 My mind is not always my friend
 Thoughts are just thoughts – they’re not necessarily true or factual
 This is difficult and uncomfortable, but it’s only temporary
 I can use my coping skills and get through this
 I can learn from this and it will be easier next time
 Keep calm and carry on
Write down a coping thought or positive statement for each difficult or distressing
situation – something you can tell yourself that will help you get through. Write them
down on a piece of card and carry it in your pocket or handbag to help remind you.
Difficult or distressing Coping thought / Positive statement
situation

www.get.gg © Carol Vivyan 2011. Permission to use for therapy purposes. www.getselfhelp.co.uk
Identifying stress-
inducing attitudes
Which of the following do you find yourself dealing with (come on, be honest!)? Choose the columns that
best describe your tendency to engage the attitudes and beliefs below and choose several to discuss at
your next session.

Attitude/Belief Not much Sometimes Frequently

Rigidity

Perfectionism

Intolerance for myself and others

Compulsion to overwork

Messages of unworthiness
(e.g., “I don’t deserve __”)

Obsession with envy

Feelings of incompetence

Phobias

Fear of committing

Non-acceptance of myself

Non-acceptance of others

Bitterness

Unprocessed regret

Sense that the world “should” be a certain way

Distorted sense of control

(either too much or too little)

Lack of perspective

Placing conditions on my happiness

Lack of gratitude
Unhelpful Thinking Styles

x
All or nothing Over-
thinking Sometimes called ‘black generalising
and white thinking’ Seeing a pattern based
“everything is
“everything upon a single event, or
If I’m not perfect I have failed always rubbish” being overly broad in the
“nothing good
“nothing conclusions we draw
Either I do it right or not at all ever happens”

Mental filter Disqualifying Discounting the good

Only paying attention to the positive things that have happened
certain types of evidence.
or that you have done for
Noticing our failures but +++ some reason or another
not seeing our successes
That doesn’t count

Jumping to There are two key types of Magnification Blowing things out of
conclusions jumping to conclusions: (catastrophising) proportion
• Mind reading & minimisation (catastrophising), or
(imagining we know what inappropriately shrinking
others are thinking) something to make it seem
• Fortune telling less important
2+2=5 (predicting the future)

Emotional
should
Using critical words like
reasoning Assuming that because we ‘should’, ‘must’, or ‘ought’
feel a certain way what we can make us feel guilty, or

must
think must be true. like we have already failed

I feel embarrassed so I must If we apply ‘shoulds’ to

be an idiot other people the result is
often frustration

Labelling Personalisation Blaming yourself or taking

Assigning labels to
ourselves or other people responsibility for

ID I’m a loser “this is something that wasn’t

completely your fault.

TUP Conversely, blaming other

my fault”
I’m completely useless
S They’re such an idiot people for something that
was your fault.

PSYCHOLOGYT LS http://psychology.tools
 TEN WAYS TO UNTWIST YOUR THINKING*

1. Counter the Distortion: Write down your negative thoughts so you can see
which of the cognitive distortions you're involved in. This will make it easier to
think about the problem in a more positive and realistic way.
2, Examine the Evidence: Instead of assuming that your negative thought is true,
examine the actual evidence for it. For example, if you feel that you never do
anything right, you could list several things you have done successfully.
a
J. The Double-standard Method: Instead of putting yourself down in a harsh,
condemning way, talk to yourself in the same compassionate way you would talk
to a friend with a similar problem.
4. The Experimental Technique: Do an experiment to test the validity of your
negative thoughts. For example, if, during an episode of panic, you become
tenified that you're about to die of a heat attack, you could jog or run up and
down several flights of stairs. This will prove that your heart is healthy and
strong.

5. Thinking in Shades of Gray: Although this method might sound drab, the
effects can be illuminating. Instead of thinking about your problems in all-or-
nothing extremes, evaluate things on a range from 1 to 100. When things don't
work out as well as you hoped, think about the experience as apartral success
rather than a complete failure. See what you can learn from the situation.
6. The Survey Method: Ask people questions to find out if your thoughts and
attitudes are realistic. For example, if you believe that public speaking anxiety is
abnormal and shameful, ask several friends if they ever felt nervous before they
gave a talk.

7. Define Terms: When you label yourself "inferior" or "a fool" or "a loser", ask
"What is the definition of 'a fool'?" You will feel better when you see that there is
no such thing as "a fool" or "a loser".
8. The Semantic Method: Simply substitute language that is less colorful and
emotionally loaded. This method is helpful for "should statements". Instead of
telling yourself "I shouldn't have made that mistake", you can say, "It would be
better if I hadn't made that mistake."
9. Re-attribution: Instead of automatically assuming that you are "bad" and
blaming yourself entirely for a problem, think about the many factors that may
have contributed to it. Focus on solving the problem instead of using up all your
energy blaming yourself and feeling guilty.
10. Cost-Benefit Analysis: List the advantages and disadvantages of a feeling (like
getting angry when your plane is late), a negative thought (like "no matter how
hard I try, I always screw up"), or a behavior pattern (like overeating and lying
around in bed when you're depressed). You can also use the Cost-Benefit
Analysis to modify a self-defeating belief such as "I must always try to be
perfect".

*Copyright 1989 by David Burns, M.D. from The Feeling Good Handbook
 REALITY vs EXPECTATIONS

It has been said that happiness equals reality divided by

expectations. If our reality is lower than how we expect life to
be, then we’re likely to feel unhappy or discontent.

This formula therefore suggests that our reality needs to be

equally balanced with our expectations. The more we can
get them in balance, then the happier, more content,
accepting or peaceful, we are likely to be.

Therefore, in order to make positive change, we can choose

to improve our reality, and/or lower our expectations.

Step 1 - Improve my Reality Step 2 - Lower my Expectations

Increase my coping skills: What do I expect my life to be like?

What can I learn to do differently to help me My home, my work-life, my relationships?
cope? E.g. STOPP, Mindfulness, Problem
solving, Goal setting, Thought record sheets
(www.get.gg/freedownloads2.htm)
What do I expect of the world, of others, of
myself?

Is there anything I can change about my Is there another way of looking at it?
situation? What would I say to a friend in this situation?
What? How? When?

Am I thinking that I always need to go through

life in top gear?
Struggling uphill in top gear won’t do!

Is there anything I can change about what I How might I change down a gear and lower my
do? Can I do react in a different way? expectations?

 Home

 Work / daily structure

What help or resources do I need to change

things?
 Relationships

 Finances

If I’ve done all I possibly can to change things

for the better, then maybe this is just the way
things are right now:  Other

“It is as it is”

www.getselfhelp.co.uk © Carol Vivyan 2011. Permission to use for therapy purposes. www.get.gg
 STOPP
STOP Take a OBSERVE PULL BACK PRACTISE WHAT WORKS
BREATH PUT IN SOME PERSPECTIVE

Stop and step Breathe slowly

back from the once or twice
situation, in
your mind

Is this fact or opinion?

See the situation as an outside observer.
What’s happening? Is there another way of looking at it?
What am I reacting to? What would someone else see and make of it?
What am I thinking and What advice would I give to someone else?
feeling? What’s ‘the helicopter view’? What can I do that will be most helpful?
What are the words that my What meaning am I giving this event for me to Will it be effective and appropriate?
mind is saying? react in this way? How important is it right Is it in keeping with my values and
What physical sensations do I now, and will it be in 6 months? principles?
notice in my body? Is my reaction in proportion to the actual What is best thing to do, for me, for
Where is my focus of attention? event? What will be the consequences of my others, for the situation?
action?

www.getselfhelp.co.uk © Carol Vivyan 2010. Permission to use for therapy purposes. Adapted from Ciarrochi & Bailey 2008 www.get.gg
Stress
Management Plan
My stress
The main reactions Strategies for Deadlines for
stressors in (symptoms of dealing with Support implementing Comments or
my life stress) the stressor(s) persons the strategies evaluations

Ex: Divorce after Digestive upset; Take a probiotic; My friends Chris Begin probiotic Getting all this
finding that my broken sleep; begin doing and Pat; also, my and meditation going should help
spouse was low self-esteem; meditation before counsellor. by next week my self-esteem,
cheating on me. feeling alone and bedtime; join local after consulting but if I am still
overwhelmed; kayaking club; with experts; join feeling “not okay”
difficulty complete series kayaking club in two months, I
concentrating; of counselling in three weeks will re-assess what
sense of sessions. after arranging else I need to do to
loneliness. childcare; finish feel better about
counselling in myself.
eight weeks.

Contract terms: I agree to enact the above health actions/behaviours to the best of my ability.

Signature Date