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Achieve Your Best HealthHealth Coaching for Stress Management

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Table of contentsIntroduction . . . . . . . . . . . . . . . . . 1

Am I ready for stress management? . . . . . . . . . .2

What is stress? . . . . . . . . . . . . . . . . 2 See how ready you are to manage your stress . . . . . . . . . . .3

How stressed am I? . . . . . . . . . . .4Causes of stress . . . . . . . . . . . . . . . .4 Signs and symptoms of stress . . . 6 Stress assessment . . . . . . . . . . . . . .7

The importance of stress management . . . . . . . . . . 9

Health risks of stress . . . . . . . . . . . 9 Benefits of stress management. . . 10 Fact or fiction? . . . . . . . . . . . . . . . . . 11

Preparing for stress management . . . . . . . . . . 12

Stress diary. . . . . . . . . . . . . . . . . . . . 12 Practice healthy habits. . . . . . . . . . 13 Physical activity . . . . . . . . . . . . . . . . 15 Sleep. . . . . . . . . . . . . . . . . . . . . . . . . 19 Stress-relief strategies . . . . . . . . . . 19 How do I stretch? . . . . . . . . . . . . . 24 Stress management goals. . . . . . 25 Stress management contract . . . 27

Managing my stress . . . . . . . . 28How to cope . . . . . . . . . . . . . . . . . 29 Daily life tips. . . . . . . . . . . . . . . . . . 30 Quick tips . . . . . . . . . . . . . . . . . . . . 33

Maintaining control over stress . . . . . . . . . . . . . . . . 34

Reward yourself . . . . . . . . . . . . . . 34 Prevent future stress . . . . . . . . . . 35 Remember the benefits . . . . . . . . 36 Resources . . . . . . . . . . . . . . . . . . . 36

Appendix . . . . . . . . . . . . . . . . . . 37Stress diary. . . . . . . . . . . . . . . . . . . .37 Food diary . . . . . . . . . . . . . . . . . . . 38 Activity log . . . . . . . . . . . . . . . . . . . 39 Goal chart . . . . . . . . . . . . . . . . . . . . 40

Health Coaching :: 1

Introduction

Congratulations! By opening this guide, you are one step closer to managing the stress in your life. The sooner you take action, the sooner you’ll see the rewards.

The truth is, we all experience stress at times. It may come from a quickly approaching deadline, a big presentation or a troubled relationship. While these pressures are common, few people know how to manage them — and prolonged stress can lead to serious health problems.But managing your stress benefits your health right away. It decreases your risk for multiple health problems and enhances your quality of life. This guide will teach you effective strategies to prevent, relieve and manage your stress for life.

You will face challenges along your journey, but this guide will help you overcome barriers. You will understand what causes stress and how it affects your health. You will learn how to select strategies for stress management. You will set goals for yourself and gain support. Stress is a natural part of life, and the good news is, it’s controllable. Let’s get started!

This document contains health information from third party companies.

Am I ready for stress management?

What is stress?Stress is different for every person. Stress is what you feel when you are faced with more than you think you can handle. It is a physical, emotional and mental response to new, unpleasant or threatening situations. Stress is actually a feeling, not a circumstance. When you feel stressed, your body responds in certain ways. Your heart rate increases, you sweat, you breathe faster and your digestion slows. Stress is not necessarily a bad thing. There are good types of stress that help you focus, give you a burst of energy or help you react quickly. There are also bad types of stress that harm your body. Large amounts of stress for a long period of time can do a lot of damage to your health. The good news is, stress is controllable, so it’s important that you learn to manage it.


See how ready you are to manage your stressStress management is a process. The first step is assessing your readiness to change. Look at the chart below to see how ready you are to manage stress. Check which stage describes you best.

Common statements

Description Time frameStage of change

c

“I am not interested in stress management. The stress in my life is not a problem.”

Unaware of problem, no interest in change

No intention of stress management within the next six months

How stressed am I? (Pre-contemplation)

c

“I know that I should do more to manage my stress, but I don’t know how to or if I’m ready.”

Aware of problem, beginning to think about stress management

Seriously considering stress management in the next six months

The importance of stress management (Contemplation)

c

“I need to manage my stress, and I plan on doing it soon.”

Realizes benefits of making changes and wants to take action soon

Preparing to manage stress in the next month

Preparing for stress management (Preparation)

c“I’m working on managing my stress every day.”

Actively taking steps toward stress management

Successful stress management from day one to six months

Managing my stress (Action)

c

“I feel confident in my ability to manage my stress.”

Initial goals reached

Successful stress management for more than six months

Maintaining control over stress (Maintenance)

Once you have decided which stage of change describes how you feel, flip to that section to read more.


Health Problems

M Chronic disease

M Disability

M Serious injury

Emotional Issues

M Depression

M Anxiety, worry or fear

M Anger

Major Life Changes

M Getting married

M Moving to a new area

M Starting a new job

M A death in the family

M Having a baby

Family/Relationship Issues

M Divorce

M Parenting difficulties

M Caring for an elderly parent

M Long-distance relationship

Job Troubles

M Pressure to perform

M Being overworked

M Conflict with coworkers

M Being demoted

M Unsafe working environment

Causes of stressBefore you can manage your stress effectively, you need to know what is causing it. Anything that causes stress is called a stressor. Throughout your stress management journey, you may discover stressors in your life you were not aware of. Do you feel that any of these stressors are present in your life? Check all that apply.

How stressed am I? (Pre-contemplation)


Financial Struggles

M Debt

M Bankruptcy

M Taxes

M Loss of job

Post-Traumatic Stress

M Experiencing life-threatening events such as war, rape or a natural disaster

Certain Personality Traits

M Pessimism

M Perfectionism (unrealistic expectations)

M Indecisiveness

M Disorganization

Environmental Stressors

M Pollution

M Noise

M Crime

M Weather

M Physical, verbal or emotional abuse

M Discrimination at work or in your community

Daily Hassles

M Car trouble

M Traffic

M Child care

M Household chores

Other

M Too many activities and/or responsibilities

M Poor time management skills

M Confusion about or changes in your beliefs or values

Can you think of any other causes of stress in your life?

__________________________

__________________________

__________________________

__________________________

__________________________

__________________________

__________________________

__________________________

__________________________


M Headaches

M Upset stomach, nausea or diarrhea

M Fatigue

M Constipation

M Back, chest or jaw pain

M Neck stiffness

M Worsened arthritis pain

M Depression, anxiety, frequent worrying

M Difficulty sleeping

M Difficulty remembering

M Difficulty concentrating

M Decreased job productivity

M Excessive and/or frequent crying

M Mood swings

M Change in appetite; sudden weight loss or weight gain

M Increase in use of tobacco, alcohol or other drugs

M Withdrawing from family and/or friends

M Neglecting your appearance

Stress affects your mind, body and behavior. Have you experienced any of these symptoms of stress? Check all that apply.

Signs and symptoms of stress


Too much change in your life contributes to stress and robs you of energy. The Holmes Scale can give you fresh insight about your current stress level. Too much change, in a short period of time, can take its toll on your health. Whenever possible, try to limit the changes in your life. Look over the events listed below. Mark the item if it has happened to you within the last 12 months. (You can multiply it by the number of times it has occurred to get a more accurate score.)

Event Points Yes/No Score1. Death of a spouse 100

2. Divorce 72

3. Marital separation 65

4. Death of a close family member 63

5. Personal injury or illness 53

6. Marriage 50

7. Marital reconciliation 45

8. Change in health of family member 44

9. Pregnancy 40

10. Addition of new family member 39

11. Job change 38

12. Change in financial status 37

13. Death of a close friend 36

14. Increase in arguments with significant other 35

15. Mortgage or loan of major purchase (home, etc.) 31

16. Foreclosure of mortgage or loan 30

17. Change in responsibilities of your job 29

18. Son or daughter leaving home 29

19. Trouble with in-laws 29

20. Outstanding personal achievement 28

21. Spouse begins or stops work outside the home 26

22. Revision of personal habits 24

23. Trouble with boss 23

24. Change in work hours or conditions 20

25. Change in residence 20

Stress assessment


Chart continues on next page.

Now, add up all the points you have to find your score.

Less than 150: no significant problems150–199: mild stress, 35 percent chance of illness or health change200–299: moderate stress, 50 percent chance of illness or health change, usually in next two years300 or more: major stress, 80 percent chance of illness or health breakdown

(Holmes-Rahe statistical prediction model)


Event Points Yes/No Score26. Change in sleeping habits 16

27. Change in eating habits 15

28. Vacation 13

29. Christmas 12

30. Minor violations of the law 11

TOTAL

Health risks of stressWhen stress is constant over a long period of time, it can cause permanent damage to your body and contribute to health risks. Check the conditions that you are currently experiencing or have experienced in the past.

The importance of stress management (Contemplation)Stress management is important for several reasons. Stress can damage your body in many ways. Here’s a look at how stress can affect your health.

M High blood pressure

M Chronic fatigue

M Depression and/or anxiety

M Frequent sickness or infection

M Abnormal heartbeat

M Low fertility

M Heart disease

M Problems during pregnancy

M Stroke

M Acne

M Erectile dysfunction

M Worsened asthma or COPD

M Chronic muscle tension

M Worsened allergies

M Irritable bowel syndrome

M Migraines

If you suffer from any of the health problems above, visit your doctor right away and stick to the treatment plan you are given.


• Lower blood pressure• Increased motivation and

confidence• Reduced risk of heart disease

• More energy• Increased productivity at work• Enhanced mood: reduced

anxiety and depression

Stress management improves your health right away. Here are some of the benefits:

Benefits of stress management

How would stress management benefit you? _______________________

_________________________________________________________

_________________________________________________________

_________________________________________________________

_________________________________________________________


Stress can cause you to get sick more often . (Fact)

Your body produces hormones when you are stressed. These stress hormones cause the immune system to slow down. As a result, people with high levels of stress are more likely to get sick.

Emotional stress is the main cause of stomach ulcers . (Fiction)

Emotional stress is not the main cause of stomach ulcers. But long-term stress does weaken your immune system and make you more prone to infection.

Avoiding situations that cause anxiety is the best way to manage stress . (Fiction)

In some cases, avoiding stressful situations is a good strategy, but you can’t always avoid stress. The best way to manage stress is to control the way you respond to it.

Stretching and deep-breathing exercises are two good ways to manage everyday stress . (Fact)

These two strategies are very effective in reducing levels of stress. Venting, ignoring stress or resting might make stress worse. Instead of venting, try deep-breathing exercises. Instead of ignoring your stress, plan ahead for stressful events. Instead of resting, get plenty of regular exercise.

Fact or fiction?


Stress diaryKeeping a stress diary will help you identify the causes of stress (stressors) in your life, as well as ways that you usually react to stress. Recognizing your stressors will help you make appropriate changes in your life to reduce stress. Make a note in your diary every time you feel stressed. Describe what led to the stress. Write down the level of stress you felt. Note your physical symptoms. And explain how you coped with the stress. Make copies of this diary so you can continue to track your stress on your stress management journey.

Date and time

Describe the stressor

How you felt

Level of stress

(scale of 1-5)

Physical symptoms

How you coped

Preparing for stress management (Preparation)


Healthy Eating

Eating healthy plays an important role in coping with stress. A healthy diet gives you energy and helps you focus. It also boosts your immune system and stabilizes your mood. Here are some tips to help you eat healthy.

• Eat well-balanced meals with a variety of fruits and vegetables, low-fat dairy products, whole grains, fish, poultry and lean meats.

• Avoid fatty, salty and high-sugar foods. If you are experiencing stress, these foods can upset your system even more.

• Limit your intake of fast foods and processed foods.

• Drink 6–8 glasses of water each day.

• Replace high-calorie snacks with fruit, cereal bars, pretzels, yogurt, rice cakes, juice and other low-calorie snacks.

• Don’t skip breakfast. Skipping breakfast can cause fatigue and headaches.

• Eat regular meals. Skipping meals can weaken your body’s ability to cope with stress.

It’s important to realize when stress is creeping up on you. Certain triggers (situations, people, time of day) may cause a stress response. Use the information from your stress diary and identify your most common stress triggers. Then list them below. Keep these triggers in mind as you look for ways to manage your stress.

1. _______________________________________________________

2. _______________________________________________________

3. _______________________________________________________

4. _______________________________________________________

Practice healthy habitsPracticing healthy habits is an important part of stress management. Try to eat healthy. Make sure you stay physically active. And get plenty of sleep. These help you prevent and cope with stress when it is unavoidable.


• Cut back on caffeine — it can make you anxious and prevent you from sleeping well. Try decaf versions of sodas, coffee and tea; or replace them with water, milk or 100 percent fruit juice.

• Avoid emotional overeating. Some people turn to food for comfort in times of stress, but overeating can lead to weight gain and other health problems.

• Drink alcohol in moderation. Men should have no more than two drinks per day (no more than one per day for men over age 65), and women should have no more than one drink per day.

Keep a food diary to track your eating habits. Then find ways you can begin to make healthy changes in your diet.

Date and time

What kind? (include

preparation)

How much?

What am I doing?

MoodDegree

of hunger (0-5)


• Elevates your mood• Lowers your blood pressure• Boosts your energy level• Helps you concentrate

• Increases your metabolism• Helps you sleep better• Relieves muscle tension

Physical activityPhysical activity is great for your physical health. It’s also great for your mental and emotional health. It plays an important role in coping with stress. Regular physical activity:

Check with your health care provider before engaging in any physical activity if any of these statements apply to you:

• Your health care provider said you have heart trouble, diabetes or asthma.

• When you are physically active, you have pains in your chest, neck, shoulder or arm.

• You often feel faint or have dizzy spells.

• You feel extremely breathless after you have been physically active.

• Your health care provider said you have high blood pressure.

• Your health care provider said you have bone or joint problems, such as arthritis.

• You are over 50 years old and are not used to doing moderate physical activity.

• You are pregnant.

• You smoke.

• You have a health problem or physical reason not mentioned above that might keep you from being physically active.

Source: U.S. Department of Health and Human Services; National Institutes of Health. Walking…A Step in the Right Direction, March 2007. Publication No. 07-4155.


So what’s the difference between moderate and vigorous activity?

• Moderate activities get you moving at a comfortable pace. They increase your heart rate without causing heavy breathing. During moderate-intensity activities, you should still be able to carry on a conversation comfortably. Examples include brisk walking, gardening, stretching, bicycling 5–9 mph and recreational swimming.

• Vigorous activities are faster and more intense than moderate activities. They significantly increase your heart rate and breathing. Examples include speed walking, jogging, biking uphill or over 10 mph, and swimming steady laps.


• For good health, get at least 30 minutes of physical activity most days of the week or 150 minutes per week.

• To lose weight or prevent weight gain, get 60–90 minutes of physical activity on most days of the week or more than 300 minutes per week.

You may think of physical activity as using special equipment or playing competitive sports. But physical activity simply means moving your body. You may be surprised at what activities are actually considered physical activity. Doing yard work, washing your car and mopping the floor are all forms of physical activity. For health benefits, physical activity should be moderate to vigorous in intensity. Here are the recommendations for physical activity:

Here are some tips for getting active!

1. If you haven’t been active in a while, start with low-intensity activities for short periods of time. Then gradually progress to more strenuous activities for longer periods of time.

2. Use your time wisely to incorporate physical activity into everyday activities. Stretch, lift weights, run or walk on a treadmill, or pedal on a stationary bike while watching TV or talking on the phone.

3. Work out at work. Instead of taking a coffee break, take a 10-minute brisk walk.

4. Mix it up. Engage in a variety of types of physical activity to prevent burnout. Choose activities that you enjoy.

5. Increase “everyday” activities. Take the stairs instead of the elevator. Park farther away from building entrances. Do yard work, housework, etc.

6. Establish a routine. Schedule time each day for physical activity. It will soon become a habit.

7. Get an exercise partner. This will make exercise more enjoyable for you.

8. If you join a gym, make sure you ask a manager or personal trainer to teach you how to use each piece of equipment to prevent injury.

9. Keep an activity log. This will help you track how much and what type of physical activity you are getting each day.



Sun Mon Tues Wed Thu Fri Sat

Moderate

Activity

Minutes

Vigorous

Activity

Minutes

Total

Minutes


Getting plenty of sleep is a critical part of stress management. It helps your mind and body function properly. It also helps you think more clearly, make better decisions and cope with challenging situations. Most people need about 6-9 hours of sleep each night. If you have difficulty sleeping, try these tips:

1. Don’t drink alcohol or caffeine in the evening; it can keep you awake.2. Take a warm bath before bed.3. Get plenty of physical activity during the day.4. Have a nighttime routine. Go to bed at the same time each night.5. Read a book or write in your journal before bed.

Sleep

Breathing ExerciseLie on your back in a comfortable position. Simply breathe in and out. As you breathe, place a hand on your stomach. You should feel your stomach rise and fall with each breath. Once your breathing is even and slow, start counting with each breath. Breathe in for a count of 3-5, filling your lungs completely, and breathe out for a count of 5-8, pushing all the air out of your lungs. If these counts are not comfortable for you, follow your own breathing pattern. Repeat four to five times, and you should feel more relaxed.

Mantra Breathing ExerciseLie on your back in a comfortable position. Simply breathe in and out. As you breathe place a hand on your stomach. You should feel your stomach rise and fall with each breath. As your breathing becomes slow and steady, repeat a one-syllable word like “peace” with each exhale you make. Each time you breathe out, say that word to yourself and focus on only that word. This will clear your mind. Repeat for five minutes and then slowly come back to normal breathing. You should now feel more relaxed.

Stress-relief strategies


Progressive Muscle RelaxationLie on your back in a comfortable position. Wear loose, comfortable clothing. As you breathe, place a hand on your stomach. You should feel your stomach rise and fall with each breath. As your breathing becomes slow and steady, start to tighten your calf muscles by pointing your toes. Keep your muscles tight for a count of 5 and then relax for a count of 5. Move up your legs to your thighs and tighten them for 5 counts, then relax for 5. Next, go to your bottom and squeeze tight for 5, then relax for 5. Make sure to continue to breathe consistently. Inhale deeply and exhale completely throughout this exercise. Continue this exercise by moving to your stomach, back, shoulders and face. Finally, tighten everything together at once for 5 counts and relax. Continue your breathing for a while until you feel you can open your eyes and sit up slowly.

MeditationMeditation involves total concentration on one thing. It can be a sound (waves crashing on the shore), a word (“peace”), an image (a beautiful sunset) or your breathing. This technique helps calm your thoughts and helps you live in the moment, focusing on only the present. Meditation reduces stress by lowering your blood pressure, relieving headaches, relieving anxiety and depression, giving you more energy, and boosting your self-confidence. Start by meditating for five to 15 minutes. Make sure you are in a comfortable position and wearing comfortable, loose-fitting clothes. Don’t get discouraged if your mind wanders at first. It will take practice to learn to stay focused.

Thought StoppingTake control over your stressful thoughts instead of letting them control you. When you feel yourself thinking negative thoughts:

1. Stop what you are doing2. Close your eyes3. Focus on the thought briefly4. Calmly count to five5. Yell “STOP,” picture yourself

yelling stop, or picture a stop sign or red light

6. Return to your activity


ImagerySometimes we have little or no control over stressful events in our lives. However, we do have the ability to control the way we respond to those events. Imagery is an effective technique used to remain relaxed in stressful situations. Here’s how. Use your imagination to recreate a peaceful or relaxing situation. It can be a memory or a pretend scenario. You can imagine that you are lying on the beach in the warm sun listening to the sound of crashing waves on the shore. Or you can image yourself watching a mountain sunrise with a warm cup of coffee in your hand. Visualize the scene in as much detail as possible. Include sights, sounds and smells. Relax and allow yourself to enjoy this scene for a few minutes, breathing calmly and evenly. Then return to your previous activity.

Rehearse Stressful EventsOnce you are aware of certain situations that stress you out, it’s helpful to prepare yourself for those situations. Rehearse them in your mind. Picture the situation in as much detail as possible. Imagine yourself reacting to those situations in a calm and rational way. Practice this technique for a few minutes twice a day, or until you feel relaxed.

Rational Positive ThinkingYou may not be aware of it, but you probably have mental conversations with yourself several times each day. This is called self-talk. When things aren’t going your way, you may give in to flawed thinking. You may let your emotions get the best of you. You may allow yourself to perceive your situation with extreme negativity. You might say things like, “This will never get better.” Or you might ask, “Why do bad things always happen to me?” When you get in this negative frame of mind, it is often hard to change your self-talk. People who are pessimists, indecisive and anxious are more prone to negative thinking. But regardless of personality, everyone is capable of changing his or her self-talk.

Positive thinking, or positive self-talk, is about learning to be happy in the middle of life’s problems. It’s all about changing your perspective. In fact, when it comes to stress, your attitude is much more important than your situation. Positive thinking neutralizes negative thinking. When you start to hear negative self-talk, replace that thought with a positive one. Rational thinking is about looking at a situation for what it really is, despite how


Stressor or situation

Negative thought

Rational positive thought

Stuck in traffic“I’ll probably get fired for

being late again.”

“This is a part of life and happens to everyone. I’ll get

there as soon as I can.”

you might perceive it. It’s about thinking more accurately and learning from negative thoughts.

When you’re stuck in traffic, remind yourself that it’s not the end of the world, but just a minor setback. When you recognize yourself giving in to negative thinking, stop, look at the big picture, and think about the

situation positively and rationally. Over time, your brain will get used to playing these messages, making it easier for you to manage stress. Use the chart below to become more aware of your self-talk and determine how you will change it.

MassageA massage can be deeply relaxing. It relieves stress, muscle tension and pain. Get a professional massage, ask a friend for a massage or practice self-massage.


YogaYoga reduces the physical effects of stress on the body. That’s why many people take up yoga. People feel more relaxed after a yoga class. The postures are helpful for reducing muscular tension, which reduces stress. We have a tendency to store stress throughout the muscles and tissues of the body. Yoga can be effective in releasing this stored stress. Most yoga classes include guided relaxation, meditation and breathing practices. These all have beneficial stress-reducing qualities.

BiofeedbackBiofeedback machines measure stress levels by monitoring heart rate, sweating, etc. These machines teach you what causes your body to undergo a stress response. You’ll learn how to better control your body’s response to stress. Then, you can learn to control your stress without the machines. Talk to your doctor if you are interested in using a biofeedback machine. You can also use the biofeedback method at home by taking your pulse before and after relaxation exercises. Your pulse should be lower after the relaxation exercises.

StretchingStretching helps you relax. It relieves muscle tension. It helps prevent injury and strengthens your joints. When you stretch:

1. First, make sure your muscles are warm. Take a five-minute walk or do 20 jumping jacks.

2. Take it slow. Start with easy stretches.

3. Stretching should never be painful.

4. Hold stretches for 10–15 seconds.

5. Continue breathing normally while stretching.

Now that you have read over these stress-relieving strategies, which techniques would you like to try?

_________________________

_________________________

_________________________

_________________________

_________________________

_________________________

_________________________

_________________________


How do I stretch?Here are a few stretches you can try at home, at work or before exercise.

Side ReachReach one arm over your head and to the side. Keep your hips steady and your shoulders straight to the side. Hold and repeat on the other side.

Wall PushLean your hands on a wall with your feet about three to four feet away from the wall. Bend one knee and point it toward the wall. Keep your back leg straight with your foot flat and your toes pointed straight ahead. Hold and repeat with he other leg.

Knee PullLean your back against a wall. Keep your head, hips and feet in a straight line. Pull one knee to your chest, hold, then repeat with the other leg.

Arm ReachRaise your right arm straight up in the air beside your right ear. Bend your elbow so that your hand is touching your back, or is pointing in that direction. Put your left hand on your right elbow and gently pull your right arm down. Repeat with the other arm.

Leg CurlPull your right foot to your buttocks with your right hand. Stand straight and keep your knee pointing straight to the ground. Hold and repeat with your left foot and hand.

HamstringStand straight up with your feet together and flat on the floor. Gently bend over as far as you can and let your arms hang down toward your toes. If you feel a stretch in the back of your thigh, hold for 10 seconds. (If you do not feel a stretch, lean down even farther, reaching toward your toes, until you feel a stretch.)


Stress management goalsBefore you set your stress management goals, think about your causes of stress (or stressors). Why do you want to reduce the stress in your life? And how are you going to reduce it? As you are writing your goals, make sure they are:

• Specific: exact, detailed, precise, well-defined. Specific goals answer these questions: who, what, when, where, why?

• Measurable: completion of goal is easily measured. Measureable goals answer these questions: how much, how will I know when I’ve reached my goal?

• Achievable: possible, doable, practical, reachable.

• Realistic: sensible, reasonable, logical — you are willing and able to reach this goal.

• Time-specific: completion of goal is assigned a specific date.

Goal setting is important to keep you on track. If you set goals and commit to them, you will be more likely to succeed in reducing stress. Remember these tips when you write your goals:

1. Plan for setbacks: Keep in mind that you will face barriers along the way. Don’t be too hard on yourself if you slip up.

2. Plan to have support: Make sure your close family and friends are aware of your stress management effort. Tell them about the specific stressors in your life and the strategies you will use to cope with them. It will be important to have people to support you during this time.

3. Plan to reward yourself: Rewards are a great motivator to keep you working toward your goals. Choose rewards special to you. Here are some ideas:

• A new piece of clothing• A new book or movie• A vacation• Tickets to a sporting event• A night out on the town

• A professional massage• Tickets to a concert or play

with friends• A gym membership


Make copies of this goal tracker and continue to track your progress throughout your stress management effort.

My goalHow I will

accomplish my goal

Benefits I will get from

reaching this goal

Target date for

achievement

My reward for reaching

my goal


Stress Management Contract

I, _______________________, am committed to stress management. I am making this commitment for the following reasons:

1. ___________________________________________________ .

2. ___________________________________________________ .

3. ___________________________________________________ .

4. ___________________________________________________ .

I am making this commitment not only to myself, but to the following people:

________________, ________________ and ________________. If I experience temptation to give up on my commitment, I will contact one of the people listed above for support and encouragement.

The stress management strategies I am going to use are:

1. ___________________________________________________ .

2. ___________________________________________________ .

3. ___________________________________________________ .

4. ___________________________________________________ .

My official start date is _____________. From this point on, I will be dedicated to managing my stress!

_________________________________ __________________ Your signature Date

_________________________________ __________________ Stress management ally signature Date


Managing my stress (Action)

Stress often results from feeling like we are out of control. Are you in control of your circumstances, or do they control you? The way you view the events in your life affects your thoughts, attitude, behavior and stress levels. One of the most important lessons to learn in stress management is that you do have control. You may not always have control over your circumstances, but you have complete control over the way you respond to those circumstances. Take ownership — don’t respond to stress as if you are a victim. Plan for ways to avoid stress and cope with it when it is unavoidable. Change your outlook — instead of blaming others for your circumstances. Face the fact that you always have a choice.

Don’t get discouraged if you don’t see big results right away. It may take a few weeks for you to experience the benefits of stress management. Remember, stress management is a process that takes time. The most important thing is to keep practicing! Use a variety of techniques until you discover what works best.


How to copeMany people cope with stress in unhealthy ways. They might overeat or use alcohol or tobacco. They might sleep too much, watch too much TV, lash out at others or avoid responsibilities. It’s important that you learn healthy ways to cope with stress. Here are three healthy ways to prevent or relieve stress:

Suppose you have an overwhelming workload at your job. You could ACCEPT the stressor by talking to a trusted coworker or remind yourself that the situation is only temporary. You could AVOID the stressor by saying “no” when asked to do more than you can handle. You could CHANGE the stressor by making a list of tasks and complete them in order of importance. Being prepared for stressful events is one of the best ways to prevent and relieve stress. Use your stress diary on page 12 to identify the most common stressors in your life. Then think about how you currently cope with those stressors, as well as better ways to cope next time. Use the chart below.

StressorCurrent

coping strategyBetter coping strategy (accept, avoid, change)

Overwhelming workload

OvereatingChange: make a list of tasks and rank them in order of importance

1. ACCEPT the stressor

2. AVOID the stressor

3. CHANGE the stressor


Daily life tipsGet help when neededAsking for help is not a weakness; it shows strength and intelligence. If you feel your stress is getting out of control, and you’re unable to cope with it, contact:

• Your doctor• A mental health professional

(therapist, counselor, psychologist, clergy)

• Your local hospital• A local mental health center

• A government agency (Look in the Resources section to find contact info for government agencies)

• An employee assistance program

Consult your primary care doctor if you experience any of these problems:

• Frequent anxiety, depression, crying spells, nervousness or inability to concentrate for at least a month

• Use alcohol or drugs to cope with stress

• A traumatic event (war, rape, a natural disaster) and are experiencing flashbacks, painful memories, nightmares, insomnia (trouble falling asleep or staying asleep), anxiety/panic attacks or depression

• An illness that you are unable to cope with or for which you do not seek proper treatment

• Easily angered and feel as though you are not able to control your anger

• Avoid certain situations that make you anxious, nervous, scared or angry at all costs

Your doctor may recommend treatment options such as medication, cognitive-behavioral therapy or other therapy if other stress-relieving strategies have not worked for you.


JournalingJournaling has many benefits. It can be an outlet for a variety of emotions like frustration, anger, joy and excitement. It can also help you identify causes of stress in your life and gain insight into your stressors, as well as possible solutions. Journaling before bed may even help you sleep. Try to journal every few days at the least. When you journal, answer these questions:

• Did you experience any stressful situations today? If so, how did you handle the situation?

• Did you laugh today?

• Are you facing any current challenges or important decisions?

• Do you feel anxious, sad, angry or frustrated? What can you do to cope with these feelings?

If journaling is helpful to you, consider purchasing a journal or diary.

AcceptanceLearn to accept what you can’t control. Dwelling on things you can’t control only leads to frustration. Work on developing traits like optimism (a positive outlook), assertiveness (tendency to take action) and a sense of humor. These qualities will help you cope with the stress in your life. Follow these easy tips:

1. Don’t waste time getting worked up over a situation that you can’t change. Instead, focus on having a positive attitude about it. Change the way you view the situation.

2. Take action when possible. Look for ways that you can improve the situation.

3. Don’t take things too seriously — learn to laugh more.

4. Live in the present. You can’t change the past or control the future, so don’t try to!


Turn off the technologyThese days, we are constantly being bombarded by cellphones ringing and emails popping up. Learn to set healthy boundaries with your technological devices. If you are stressed, turn off your cellphone and avoid checking your email. Obviously, if you are at work, this may not be possible. But in your free time, limit the number of demands and distractions in your life. Also, limit the amount of time you spend watching TV each day. Watching TV can be relaxing to a certain extent, but too much of anything can zap your strength and leave you feeling restless.

Laugh every dayLaughter is the best medicine. We have all heard this expression. But did you know that it’s actually true? Laughter is one of the best ways to relieve stress. After laughing, your body goes into a relaxed state, causing your heart rate and blood pressure to drop. Your immune system functioning improves, your muscles relax and you can even feel less pain. Laughing releases endorphins, a chemical produced in the body, which enhances your mood and helps you feel relaxed. Make time for laughter every day — watch your favorite funny sitcom, listen to a comedian, watch your kids

play or read the comics in the paper. Learn to laugh at life’s little setbacks and try not to take things so seriously.

Time managementMany of life’s stressors are caused by an overload of responsibility — too much to do and not enough time. That’s why learning how to manage your time more effectively is a great way to relieve stress.

Follow these tips for better time management:

• Prioritize tasks. Make a list of tasks and complete them in order of importance.

• Break down large tasks into smaller, more manageable tasks.

• Kill two birds with one stone. Combine tasks when possible.

• Ask for help. Delegate tasks to others when possible.

• Plan ahead. Make a schedule for completing tasks.

• Turn off distractions like phones, email, cellphones, etc.

• Learn to say “no” to extra responsibilities.


Consider getting a pet Particularly if you live by yourself, having a pet can greatly reduce stress, loneliness and depression. Stroking a pet can also lower your blood pressure and boost your immune system. Also, having a pet gives you a reason to get more exercise, a very effective way to reduce stress. Before adopting a pet, consider the pros and cons. Do you have the time and financial resources to feed and take care of a pet?

Don’t depend on alcohol, tobacco or other drugs to cope with stressUsing these substances can actually lead to higher stress levels. Alcohol might relax you temporarily, but it also raises levels of the stress hormones in your body. Overuse of alcohol can lead to depression and tobacco can cause many types of cancer, heart disease and other health problems. If you think you may have a dependence on alcohol, tobacco or any illicit drugs, contact your health care provider immediately to get help.

Quick tips• Count to 10

• Take a warm bath

• Have a hot cup of tea

• Do something for someone else

• Let yourself cry

• Talk to a friend or family member

• Do something you enjoy

• Listen to calming music

• Eliminate extra activities/responsibilities

• Wake up on time so you’re not rushed

• See challenges as opportunities for growth

• Make relaxation a part of your daily routine

• Focus on the present


Maintaining control over stress (Maintenance)

Reward yourselfYou may wonder whether you should continue to reward yourself as you maintain control over the stress in your life. The answer is — you should! It’s actually a great way to avoid relapse or setbacks in managing your stress. Reward yourself in ways that positively reinforce the changes you have made. Instead of focusing on your stress, remind yourself of all you have accomplished. Continue to track the goals you reach, as well as your rewards for achieving those goals. Use the goal tracker provided on page 26.


If thinking about a certain task stresses you out, take care of it right away . Planning ahead and taking immediate action causes less stress than waiting until the last minute. Avoiding a problem or responsibility won’t make your stress go away. You will have to deal with it at some point — better sooner than later!

If you get upset about something, don’t react immediately . Try to stay calm until you can think about the situation rationally. We all know that holding in your emotions can be bad for your health, but giving in to your anger

and throwing a fit is just as bad. Let yourself calm down before reacting to stressful situations. This will prevent you from saying or doing things you might later regret, leading to future stress.

Take a break, even on busy days . Even if you’re pressed for time, take a short break and try a few minutes of meditation, stretching or deep breathing. Each of these stress-relief strategies lowers your blood pressure, reduces muscle tension and helps you focus.

Make time for YOU time . Schedule time every day to do something you enjoy.

Prevent future stressAs you become more comfortable with managing your stress, begin looking for ways to avoid stressful situations altogether. Use the strategies below to prevent stress when you feel it creeping up on you.


Remember the benefitsIf you ever feel like giving up, remind yourself of the health benefits that you are experiencing through managing your stress. Review the benefits of stress management on page 10.

What benefits of stress management have you experienced so far?

1. _______________________________________________________

2. _______________________________________________________

3. _______________________________________________________

National Institute for Occupational Safety and Health (NIOSH)800-CDC-INFOwww.cdc.gov/niosh

American Institute of Stress 914-963-1200www.stress.org

American Psychological Association800-374-2721www.apa.org

Association for Applied Psychophysiology and Biofeedback800-477-8892www.aapb.org

National Institute of Mental Health (NIMH)866-615-6464www.nimh.nih.gov

These are independent companies and organizations that provide health care information on behalf of PAI.

Resources


Appendix

Stress diary

Date and time

Describe the stressor

How you felt

Level of stress

(scale of 1-5)

Physical symptoms

How you coped


Food diary

Date and time

What kind? (include

preparation)

How much?

What am I doing?

MoodDegree

of hunger (0-5)


Activity logSun Mon Tues Wed Thu Fri Sat

Moderate

Activity

Minutes

Vigorous

Activity

Minutes

Total

Minutes


Goal chart

My goalHow I will

accomplish my goal

Benefits I will get from

reaching this goal

Target date for

achievement

My reward for reaching

my goal

The information contained in this brochure is for educational purposes only. It does not represent a standard of care. Your physician must determine the

appropriateness of the information in light of all your circumstances. It is important to discuss options with your physician when deciding on the best treatment for you.

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