how to manage stress

Stress & AnxietyWhat is it

& What can be done about it?

Presented by:

Katherine DiDonato, PhD, ACT

Physical Results of Ongoing Stress

• Heart disease

Diabetes

Asthma

PMS

Obesity

Infertility

Autoimmune diseases

Chronic pain

Migraines

Ulcers

Heartburn

High blood pressure

Skin problems

Irritable bowel syndrome

Emotional Results of On-Going Stress

• Anxiety

• Depression

• Insomnia

• Isolation

• Conflict

• Substance Abuse

• BURNOUT

Today’s Objectives

• What is Stress?• What is Burnout?• What is Anxiety?• Stress/Anxiety Management

Cognitive Techniques Meditation and Relaxation Social Connection Medication

Stress is a normal component of the body’s response to demands that are placed on it. It is characterized by the body’s biochemical changes

It can be health-enhancing or health-depleting

What is Stress?

What is Stress?

When demands are in balance with your coping abilities and resources you do not feel stressed.

When demands are greater than your coping abilities you feel stressed.

Appraisal of Threats and Resources

First we evaluate the threat. Is it?...•Positive / Negative•Controllable / Uncontrollable•Challenging / Boring•Irrelevant / Important

If the answer is “negative, uncontrollable, important” = STRESS

Then we evaluate our resources. Can I handle this stress?If the answer is “no” = STRESS

The Stress Response is the Body’s 911 System

Fight or Flight Reaction

• Productive if you were in a situation where you need to protect yourself

It is a Matter of Perception Since we are very rarely attacked by bears our

perception of threat has changed

Now, a threat can be: Social Emotional Financial Work related

Sources of Stress

The GoodRetirement

Get married

Have children

Buy a new home

Go on vacation

New Job, Promotion

The BadBreak a leg

Spouse becomes ill

Child gets in trouble

Lose wallet

In-laws coming

The UglyNasty car accident

Bankruptcy

Divorce

Illness

Loved one dying

Who Has Stress?

Stress Response = Good in Small Doses

Gives you a burst of energy when you need it

Increases your motivation to complete tasks

Protects you from harm Prevents you from walking down a dark alley way at

night

Stress and its impact on performance works in a bell curve

More stress will help you give an optimal performance

The “optimal” amount of stress is different for everyone

Stress is Good in Small Doses

Stress Can be Health-Depleting

"© copyright Mental Health America"

Negative Emotional Reactions

Feeling angry, irritable or easily frustrated Feeling overwhelmed Feeling nervous or anxious Feeling afraid or worried Feeling helpless or hopeless Desire to hide or runaway

Negative Cognitive Reactions

• Difficulty Making Decisions• Confusion• Difficulty Naming Familiar Items• Poor Concentration• Blaming Others• Memory Problems• Replaying Events Over & Over• Thinking the Future is bad

Behavioral Reactions

• Difficulty functioning at work or home

• Withdrawal

• Isolation

• Suspiciousness

• Working more and being less productive

• Excessive Humor or Silence

• Increased Smoking, Alcohol or Food

• Change in Activity Level

• Angry Outbursts

• Crying Spells

• Sleep

What is Burnout?

Burnout - A State of Mental Exhaustion

• Powerlessness Hopelessness

Emotional exhaustion

Detachment

Isolation

Irritability

Frustration

Being trapped

Failure

Despair

Cynicism

Apathy

Stress Burnout Characterized by over-engagement Characterized by disengagement Emotions are over-reactive Emotions are blunted Produces urgency and hyperactivity Produces helplessness and hopelessness Loss of energy Loss of motivation, ideals, and hope Leads to anxiety disorders Leads to detachment and depression Primary damage is physical Primary damage is emotional May kill you prematurely May make life seem not worth living

Stress vs. Burnout

What is Anxiety?

Anxiety Includes:

• Fight or Flight Reaction

• Avoidance Behavior

• Worry or Concern Concern about the physical reaction or its

meaning Concern about the future

Anxious Thinking

• Future-Focused Predictions

• Future is Bad

• Reaction is as-if the bad thing is happening or going to happen

• Avoidance / “Safety” Behaviors

Panic Attack = Fight or Flight

• Discrete period of intense fear or discomfort in which four of the following develop abruptly & reach peak in 10 minute:

• palpitations, pounding heart, racing heart

• sweating

• trembling/shaking

• sensation of shortness of breath or smothering

• feelings of choking

• Chest pain or discomfort

• Nausea or abdominal distress

• feeling dizzy, unsteady, lightheaded, faint

• derealization or depersonalization

• fear of losing control or going crazy

• fear of dying

• paresthesias

• chills/hot flashesFrom DSM-IV-TR Copyright 2000 American Psychiatrist Association

Stress Management

Stress Management

• Cognitive Therapy Techniques - Learning ways to evaluate situations clearly.

Is there a true threat or not? Is the situation exceeding my coping or am I just thinking it is? If it is exceeding my coping what should I do about it?

Stress Reduction & Management Reducing environmental stress Changing your physical reactions Pay it forward – helping others

Medication

Medication

• Benzodiazepines Xanax Klonopin Ativan

• Antidepressants Zoloft Lexapro Prozac Paxil

• Buspar

Cognitive Therapy

• Not simply the events in life that causes problems

• How we think about those events

• Take our thoughts to be 100% true

• Focus on information that confirms them

• Ignore or bend information that disconfirms

Using Cognitive Therapy

• Identify the stressful, anxious thought

• Consider the thought to be a hypothesis – Not a Fact

• Use Socratic questioning to evaluate

• GOAL = Realistic and Useful thinking

• If needed, experiment to confirm or disconfirm the thought

Information Skewed

PackMan

I am afraid tofly in anairplane

(-)

(-)

(-)

(+)

(+)(+)

(-)

Adapted from J.Beck (2005) Cognitive Therapy for Challenging Problems.

Thinking Errors

• Fortune Telling I know what is going to happen and it will be bad

• All-or-Nothing Thinking (Black and White)• If I’m not a total Success, I’m a Failure

• Catastrophizing • I’ll be so upset I will not be able to function

• Discounting the Positive• I did this project well but I just got lucky

• Emotional Reasoning• It’s true because I feel it is

Thinking Errors

• Magnification/Minimization• Getting a B proves I’m stupid. I got an A+

because the test was easy

• Mind Reading• He’s thinking that I don’t know what I’m doing

• Personalization• He didn’t look at me because he hates me

• Should and Must Statement• I must always do my best. I should never make a mistake

Thought Record Situation

* Who* What* When* Where

Moods

What did you feel?(Rate 0 – 100)

Negative Automatic Thoughts

What was going thru yourmind (thought/image)? (Rate 0-100)

Socratic Questions toEvaluate the NegativeAutomatic Thought

Are you using anyCognitive Distortions?

Alternative Thought toCounter the NegativeAutomatic Thought

Rate Moods &NATsNow

What make me thinkthe thought is true?

What makes me thinkit is not true or notcompetly true?

What is an alternativeway to look at thesituation?

What is the worstthing that couldhappen and could Ilive thru it?

What is the best thingthat could happen?

What is most likelyto happen?

What will happen is Ikeep telling myselfthe same NAT overand over?

What if I was tochange my thinking?

What would I tell afriend who was goingthru the same exactthing I am goingthru?

Situation

* Who* What* When* Where

Moods

What did you feel?(Rate 0 – 100)

Negative Automatic Thoughts

What was going thru yourmind (thought/image)? (Rate 0-100)

Socratic Question toEvaluate the NegativeAutomatic Thought

Are you using anyCognitive Distortions?

Alternative Thought toCounter the NegativeAutomatic Thought

Rate Moods &NATsNow

Working on a project withco-worker.

No contact for 2 days eventhough she had left them amessage.

SadDespondentAnxious

85

They think the work Ihave done on the project ispoor

They don’t want to workon the project with mebecause they think I don’tknow what I’m doing

I’m a Failure

90

What make me thinkthe thought is true?

What makes me thinkit is not true or notcompletely true?

What is an alternativeway to look at thesituation?

What is the worstthing that couldhappen and could Ilive thru it?

What is the best thingthat could happen?

What is most likelyto happen?

What will happen is Ikeep telling myselfthe same NAT overand over?

What if I was tochange my thinking?

What would I tell afriend who was goingthru the same exactthing I am goingthru?

Testing Your Thoughts Ask yourself:

What makes me think the thought is true? What makes me think it is not true or not completely true? What is an alternative way to look at the situation?

What is the worst thing that could happen and could I live throughit?

What is the best thing that could happen? What is most likely to happen?

What will happen if I keep telling myself the same NAT over andover?

What if I was to change my thinking?

What would I tell a friend who was going through the same exactthing I am going through?

Now that you have tested your NAT what is a more realistic wayto think about your situation?

Evidence

• Supports No contact Had some trouble on

the project Not feeling sharp Hx

• Refutes Has a good relationship No negative comments Presented good ideas Willing to meet Mind Reading Emotional Reasoning

Thought Record Situation

* Who* What* When* Where

Moods

What did you feel?(Rate 0 – 100)

Negative Automatic Thoughts

What was going thru yourmind (thought/image)? (Rate 0-100)

Socratic Question toEvaluate the NegativeAutomatic Thought

Are you using anyCognitive Distortions?

Alternative Thought toCounter the NegativeAutomatic Thought

Rate Moods& NATs

Now

Working on a project withco-worker.

No contact for 2 days eventhough she had left them amessage.

SadDespondentAnxious

85

They think the work Ihave done on the project ispoor

They don’t want to workon the project with mebecause they think I don’tknow what I’m doing.

I’m a failure

90

What make me thinkthe thought is true?

What makes me thinkit is not true or notcompetly true?

What is an alternativeway to look at thesituation?

What is the worstthing that couldhappen and could Ilive thru it?

What is the best thingthat could happen?

What is most likelyto happen?

What will happen is Ikeep telling myselfthe same NAT overand over?

What if I was tochange my thinking?

What would I tell afriend who was goingthru the same exactthing I am goingthru?

I don’t know why they havenot contacted me and itdoes not necessary meanthey are unhappy with me.

If they are unhappy withme then I can try to work itout with them and it doesnot say anything bad aboutme as a person.

75

Mood45

AT50

Coping Cards

• Written reminders that can be carried

• Excellent for practicing new way of thinking

• Succinct responses to your stressful thoughts

• Best after have uncovered distorted ideas

Behavioral Experiments

Reduce or eliminate

avoidance behavior

Test stressful thoughts and assumptions

Get evidence for alternative perspectives

Stress Reduction & Management

Environmental Stress

Physical Reactions

Pay It Forward

Environment

Reduce Stressors

For example: Excessive temperatures Excessive noise Poor air quality Reduce repetitive work tasking and strenuous

movements Alcohol

Physical Reactions

• Increase Exercise Regular and Balanced Meals Socializing Sleep Hobbies and Fun

Physical Reactions

Relaxation ExercisesWill reduce fight/flight reaction

Like riding a bike for the first time. It is a skill that takes time and practice to do it effectively! Don’t expect much after trying it one or two times Relaxation exercises can seem deceptively simple at first With practice they are very effective

Physical Reactions

• Breathing Techniques

• Mindfulness Meditation

• Guided Imagery

• Yoga

Pay It Forward

New research suggests oxytocin may speed recovery from major stressors

The more we give to others, & the more we get from others, the more oxytocin is released

Being connected may

protect you from stress

Kelly McGonigal: “How to Make Stress Your Friend”

Resources

• Academy of Cognitive Therapy www.academyofct.org

• Mind Over Mood Dennis Greenberger, PhD & Christine Padesky, PhD

• Worry Cure: 7 Steps to Curing Your Worry Robert Leahy, PhD

• Anxiety Free Robert Leahy, PhD

• Mindfulness for Beginners Jon Kabat-Zinn, PhD (Audio CD)

• Wherever You Go, There You Are: Meditation in Everyday Life John Kabat-Zinn, PhD

Stress & AnxietyWhat is it

& What can be done about it?

Presented by:

Katherine DiDonato, PhD, ACT