Download - 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