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Stress Management

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  1. 1. From Distressto De-stressDraft For consultation November 2011
  2. 2. ContentsGetting the most out of the bookletIntroductionUnderstanding Stress What is stress? Is stress a problem for you? Physical symptoms of stress Causes of stress What keeps stress going? Vicious cycle of stress Where next?How Stress affects the body The stress response HyperventilationGoing from Distress to De-Stress How to de-stress using relaxation Top tips for de-stressing Power breathing - controlled breathing The calming breath Progressive muscle relaxation Getting a good night’s sleepOther Tips for Managing Stress Improve your physical health Change your behaviour Change your thoughts Get practical Get informedUseful Links and Organisations2
  3. 3. Getting the most out of the booklet:What youll need: A notebook and pen (to keep notes and use to complete exercises within booklet). Time for reading and practising new skills. Somewhere quiet to read and practise new skills. To keep going and pace yourself by using a step by step approach. Support from a family member, friend or health professional if possible.If you are struggling to read and do the exercises in the booklet, do discuss thiswith a health worker, such as your doctor or practice nurse. Your concentration,energy or motivation levels may be low at the moment and there may be otherthings it would be better to try first. 3
  4. 4. IntroductionStress, nervousness, worry, panic, and fear are all words commonly used todescribe anxiety. This is something we all feel from time to time.Stress is a natural response to something that our body thinks is threatening.Stress affects how we think, behave and feel, both physically and in our mood.Although physical signs of stress are normal, and sometimes even useful, theycan be uncomfortable and distressing.This booklet is part of a set of booklets aimed at improving your well being andmood. It looks at your bodys physical signs of stress and how you can get ridof them. It shows how you can use relaxation, breathing and other ways to gofrom Distress to De-stress.The booklets are based on a Cognitive Behaviour Therapy (CBT) approach.This aims to identify unhelpful thinking patterns and behaviours and to changethem so as to make you feel better in your body and mood. Research hasproved this approach can help to manage common symptoms and problemsthat cause stress and keep it going.4
  5. 5. Understanding StressWhat is stress?Stress is the feeling we have when our body reacts to something it thinks is athreat. The physical signs result from our body getting ready either to fight thethreat or to run away from it. This is known as the fight-or-flight response.Stress is a normal reaction. A job interview, exams, taking a driving test,having to do something new or difficult at work – these can all make us feelanxious and stressed. This can sometimes help, for example, to push us toprepare for an exam or job interview. It can get us out of situations fast withoutthinking, such as jumping out of the way of an oncoming car.When is stress unhelpful? m Stress is a problem when we feel we cant cope with something and its out of our control. m Being stressed in situations where there is no threat/danger m It affects how you live your life m It stops you doing what you want m Worrying affects your sleep m Symptoms are severe/unpleasant m It happens too often and for too longIs stress a problem for you?Over the page there is a list of symptoms caused by stress.Please tick any that you often experience. 5
  6. 6. You feel… m Anxious, worried, fearful, nervous m Like something terrible is going to happen m Like things are out of your control m Tense/on edge/agitated m Mentally and physically tiredYou mind is... m Racing/difficult to switch off m Going over and over things m Difficult to focus and jumps from one topic to another m Over-estimating danger m Underestimating your ability to cope m Underestimating help available m Unable to control or stop worrying m Imagining the worse case scenario m Concentrating on what your body feels likeYour thoughts might be... m “I cant cope” m “Things are out of control” m “Im going mad” m “Im going to faint/collapse” m “Im going to have a heart attack” m “Im going to make a fool of myself” m “Ive got to leave, now!”You might behave by... m Not being able to sit still and/or finding it hard to relax m Starting one job before finishing another m Avoiding situations were anxiety might occur m Leaving situations that make me feel stressed/panicky m Trying to do things perfectly or trying to control events to prevent danger m Eating more or less m Drinking, taking drugs and/or smoking more6
  7. 7. Physical symptoms of stressPlease tick any symptoms that you experience regularly: m Can’t sleep m Dizzy m Tired m Headaches m Blurred vision m Pupils dilate m Tearful m Ringing ears m Hot and flushed m Heart racing m Heart palpitations m Chest pain m Butterflies in stomach m Feel sick m Need to go to toilet m Can’t concentrate m Forgetful m Depersonalisation - feel like you are not really there m Dry mouth m Throat tightening m Different taste/smell m Neck & shoulder m Muscles tense m Breathing fast & shallow m Hyperventilation m Shortness of breath m Sweating m Leg muscles tense m Shakiness m Numbness/tingling toes & fingersThis is how stress can affect the body.No wonder we can feel so bad when we are stressed out. 7
  8. 8. Causes of Stress Things we are excited about Things we are worried about Arguments Internet Debt IllnessThe future Aches & pains Responsibilities Where you liveRelationships Feeling lonely Childhood Life changes Alcohol misuse Divorce Feeling bored Children Getting married Kids playing up Moving house 8
  9. 9. What keeps stress going?Stress can become a long term problem because of: m Things that happen in your life: If we have lots of things we are trying to cope with in our lives (even if they are things we enjoy, like holidays), that can start our stress response and keep it going. m A vicious cycle of stress: This means our thoughts, physical symptoms and how we behave keep stress and worries going.Youve started to look at how stress affects you by using the checklists onpages 6 and 7. Now lets put it all together and look at how each of the areascombine to maintain stress.The diagram over the page shows that what we think about a situation orproblem may affect how we feel about it, physically and emotionally. It canalso change what we do or dont do (our behaviour).Look at the arrows in the diagram. They show how they all affect each other. 9
  10. 10. Things in your lifeThings in our lives and in our past all have an affect on emotions and how we think,physically feel and behave.So if you are worried about going to the shops a vicious cycle like this could develop: Thoughts “I can’t cope” “Something awful is going to happen...” Your thoughts affect your emotions... so if you think that you can’t cope, you are Behaviour likely to become Emotions anxious and stressed. Anxious, worried, Leave the situation nervous Your behaviour can further reinforce your Your thoughts, thoughts, so you and your emotions are relieved at first affect how you feel but when it happens physically... the ‘stress again you may feel response’ causes even less able to physical symptoms. cope. This leads to the vicious cycle. Physical Hot, heart pounding, breathing speeds up As your physical symptoms and emotions increase, this reinforces your thoughts that something bad is going to happen and affects the way you behave... So you leave the situation. 10
  11. 11. Use the sympton checker from page 6 and 7, or think of the last time you felt stressed,to have a go at drawing your own cycle on the blank diagram below: Things in your life Thoughts Behaviour Emotions Physical 11
  12. 12. The good news is that just as all the areas work together to maintain stress, if you work on making small changes in one of the areas, it will help with the others. So, by making changes to how you think or behave, or how your body reacts physically, you can make changes to how you feel and break the cycle of stress. Where Next? This booklet will help you to start making changes in the physical symptoms of stress. Turn over the page and read through the rest of this booklet. There are other booklets which will help you to: m manage your thoughts m change your behaviour m focus on things in your environment m focus on managing anxiety in more detail They are available m free in your local library m to buy from the website: m free to download from:
  13. 13. How Stress affects the bodyThe Stress Response (Fight and Flight System)Our bodies are really good at protecting us from danger. When the bodysenses a threat it releases lots of the hormone Adrenaline into the blood. Thismakes the body ready to react to the danger. It is an automatic reaction thatyou do not control.Imagine a caveman, hunting and gathering. If a sabre-toothed tiger jumpedout, he needs to either fight it or run away (flight). Adrenaline makes theheartbeat and breathing faster. This gets blood to the muscles and brain. Thismade the caveman more alert and his muscles had more strength and stamina.When he ran away or fought the sabre-toothed the effects of adrenaline woreoff and his body then returned to normal (as long as he got away!)The problem is that our bodies have this fight or flight reaction to things thatstress us out, like driving in rush hour traffic. But we rarely flee or fight our wayout of the situation. This means that the stress is not burnt off and it keeps onaffecting our bodies.The physical affects of stress can feel dangerous but it is normal. The tableover the page gives you more information about the symptoms of stress and thereason why the body has that response. 13
  14. 14. What happens Why Pumping blood to get oxygen and Heart racing glucose to the arm and leg muscles Heart palpitations and the brain. Breathing fast and shallow Shortness of breath Body needs more oxygen so the chest Chest pain muscles are being used a lot Tight chest Brain is working overtime. More Headaches blood to brain so it is ready for action Tense neck & shoulder muscles The body is getting ready for action Shaky legs and arms and more blood is going to muscles Butterflies in stomach feel sick Less blood to stomach and intestines Numbness / tingling toes and fingers Less blood to fingers and toes Vomiting Body wants to be lighter for escape Need to go to the toilet Dry mouth Body does not want to digest food Throat tightening when running away or fighting Sweating The body is getting ready to cool you Hot and flushed down. Extra activity will make you hot Nervous system uses up energy even Tired when the body is at rest Pupils get bigger to see surroundings Blurred vision better. Eyes take time to focus close Pupils dilate up Reaction to worry and the physical Tearful symptoms of stress Can’t concentrate Forgetful Nervous system is overloaded. The Feel like you are not really there brain is trying to process too much Can’t sleep information at once. Ringing in ears Strange taste / smell14
  15. 15. HyperventilationThis is when you breathe too much, with shallow fast breathing.Sometimes when we feel scared or stressed we can tend to over-breathe andthis can create more problems.The body reacts by: m Less blood goes to the brain - so you could feel dizzy, confused, have a sense of unreality. It may make your vision blurry and you feel breathless or as if you are choking. m Less blood gets to other parts of the body - so you can get numbness / tingling in hands and feet, faster heart rate and tight muscles. m Chest tightness or pains - your chest muscles are doing a lot of workHyperventilation is not dangerous. The symptoms will get less as you takecontrol your breathing. 15
  16. 16. Going from Distress to De-Stress So now you know what is happening to your body, the good news is that you can do something about it. The opposite of the ‘Fight and Flight’ system is the ‘Rest and Digest’ system. They are like two sides of a seesaw. The ‘Fight and Flight’ System is at one end and the ‘Rest and Digest’ System is at the other end. When stress is high, relaxation is low and when relaxation is high, stress is low. Stress ‘Fight and Flight’ Relaxation ‘Rest and Digest’ The body cannot be stressed and relaxed at the same time How to De-Stress using Relaxation Sometimes when we focus on what is stressing us out, it can make us feel even more stressed. This is because it sets off the ‘Fight and Flight’ system. So instead we need to set off the ‘Rest and Digest’ system to help the body and mind to deal with things more easily and with a clearer head.16
  17. 17. Why does Relaxation work? Relaxation techniques allow the ‘Rest and Digest’ system to take over. The body can then de-stress itself and reduce the unpleasant symptoms of stress. It can reduce the usual level of adrenaline in your blood. So it takes more to stress you out than it did before! It can improve your physical health, for example, it can lower blood pressure. Relaxation ‘Rest and Digest’ Stress ‘Fight and Flight’By learning the following techniques, you can take back control over yourbody. Instead of feeling rotten, you can spend some time practising thetechniques and start to feel better.The relaxation techniques covered in this guide are: m Controlled Breathing - Page 19 m Calming Breath - Page 21 m Progressive Muscle Relaxation - Page 21Turn to the next part of this guide to learn how. 17
  18. 18. Top Tips for De-Stressing Breathing Exercises Breathing is a simple way of taking back control of your body. It reduces the physical symptoms of stress. 1. Practise as much as possible - try at least 2-3 times a day 2. Get comfortable - where everything is ‘just right’ (some people call this the ‘Goldilocks Zone’ ). Not too hot, not too cold Not too hungry, not too full Nothing is too tight: Loosen any tight garments and take off shoes, watch, glasses etc if you want to. 3. Find a quiet location with nothing to distract you. 4. Choose a time of day when you feel most relaxed to begin with. 5. Make a decision not to worry about anything - if you don’t do it quite right, don’t worry, just practise some more. 6. Try to breathe in through the nose and out through the mouth. (Don’t get too worried about this as it is better to breathe than not!) Sometimes when people first begin to use breathing exercises they can feel dizzy. This is because the body is not used to lots of oxygen getting to the brain. So for the first few weeks, it is a good idea to lie down or sit when you practise your breathing exercises. Talk to your GP before you try these exercises if you have medical concerns about the breathing exercises and your health.18
  19. 19. Power Breathing - controlled breathingBreathing is a simple way to take back power and control over your body. 1. Lie down comfortably with your eyes closed. Let your arms, legs and feet flop out to the sides and let your mouth fall open if it feels comfortable. 2. Take your hands and place them on your stomach - at the level of your bellybutton. 3. Start by emptying your lungs (exhale) - pull your stomach in as much as possible as you breathe out. 4. Next breathe in (inhale) and push out your belly. Don’t worry about moving your chest. You should feel your hands rise up as your stomach goes out. Breathe in as deeply as feels comfortable. See the diagram over the page. 5. As you breathe out, feel your stomach fall. Try and breathe out as slowly as possible. And repeat for at least 5 minutes.Practising is the KeyYou may find that it feels weird and uncomfortable when you first startbreathing this way. This is because it is different from how you have beenbreathing for years.Fold your arms like you usually do - it feels really comfortable doesn’t it. Nowtry folding them the opposite way - it feels really strange and uncomfortable.But if you kept folding your arms like that, after a while it would feel OK.You may need to remind yourself to use your belly to breathe while you aregetting used to it. But after a while it will become a habit. You will breathewith your belly without having to think about it. It will just happen! 19
  20. 20. Breathing diagrams20
  21. 21. The Calming Breath - extend the out breathThis techniques leads to even deeper relaxation once you have mastered thepower breathing technique. 1. Sit down and close your eyes for a little while. 2. Practise the power breathing technique and in your head count how long it takes you to breathe in. 3. Now take longer to breathe out, for example if you breathe in to the count of 4, breathe out to the count of 6. 4. You could also hold your breath for a couple of seconds at the end of your out breath (but only if that is comfortable for you). 5. As you get used to this technique you can take even longer to breathe - just make sure you take longer to breathe out. For example: Take 10 to breathe in and 16 to breathe out.Progressive Muscle RelaxationYou are going to teach yourself to tense and then relax groups of muscles. Youshould breathe in whilst tensing and breathe out when you relax.When you do the exercise, focus on your muscles. If your attention wanders,bring it back to the particular muscle group youre working on.If an area feels painful when you tense it, then stop. If it continues to be aproblem then it is worth checking it out with you doctor or practice nurse.Each time you relax a group of muscles think how they feel when they arerelaxed. Don’t try to relax, just let go of the tension. Notice the differencebetween the tension and the relaxation. You might feel a slight tingling. This isthe relaxation starting to take effect. 21
  22. 22. Progressive Muscle Relaxation Lie down comfortably with your eyes closed. Concentrate on your breathing for a few minutes. Breathe slowly and calmly. Try to practise the power breathing and calming breath. Next follow this guide: 1. Hands: Clench your fists. Hold for 7-10 seconds and then release for 15- 20 seconds. 2. Biceps: Draw your forearms up toward your shoulders and "making a muscle" with both arms. Hold... and then relax. 3. Triceps: Extend your arms out straight and lock your elbows. Hold ... and then relax. 4. Forehead: Raise your eyebrows as far as you can. Hold ... and then relax. 5. Eyes: Clench your eyelids tightly shut. Hold... and then relax. 6. Jaw: Open your mouth so wide that you stretch the muscles around the hinges of your jaw. Then stick out your tongue. Hold ... and then relax. 7. Back of your neck: (Be gentle with this muscle group to avoid injury.) Pull your head way back, as if you were going to touch your head to your back. Hold ... and then relax. 8. Head: Take a few deep breaths and tune in to the weight of your head sinking into whatever surface it is resting on. 9. Shoulders: Raise them up as if you were going to touch your ears. Hold ... and then relax. 10. Shoulder blades: Push your shoulder blades back as if you were going to touch them together. Hold the tension in your shoulder blades ... and then relax. 11. Chest: Take in a deep breath. Hold for up to 10 seconds ... and then relax. 12. Stomach: Suck your stomach in. Hold ... and then release.22
  23. 23. 13. Lower back: (You should not do this exercise if you have lower back pain.) Arch it up. Hold ... and then relax. 14. Buttocks: Pull them together tightly. Hold ... and then relax. 15. Thighs: Squeeze together all the way down to your knees. 16. Calf muscles: Pull your toes toward you (flex carefully to avoid cramps). Hold ... and then relax. 17. Feet: Point your toes downward (like a ballerina!). Hold... and then relax. 18. Toes: Curl your toes downward. Hold ... and then relax. 19. Mentally scan your body for any tension that is left in any muscles. If a particular area remains tense, repeat one or two tense-relax cycles for that group of muscles.You can download an audio of a PMR exercise a good night’s sleepWithout a good night’s sleep everything can feel like it is hard work. Gettinga good nights sleep can be difficult at times, especially if you are stressed outabout something (or things!).The good news is that you can use all three of these exercises to help you get tosleep at night!So when you are lying in bed at night, trying to sleep, start with your breathing.Firstly, use your belly to breathe; then focus on extending your out breath.If you have restless legs or feel agitated, you could try the progressive musclerelaxation exercise to relax your body. Remember to be patient, and just keep practising. It takes time to learn new skills: how long did it take you to learn to walk? 23
  24. 24. Other Tips for Managing Stress Improve Your Physical Health m Eat Well - Eating the right things and avoiding the wrong things can affect your mood and ability to cope with stress. The Food and Mood booklet on the website has lots of good information. m Get Physical - Physical activity is great for releasing stress. Find an activity that you enjoy, maybe walking and listening to an audio book. The Physical Activity and Mood booklet on the website has lots of good information. m Listen to music - Can help to relax or give you energy. m Take time out to play - Having fun is a great way to reduce stress. m Know your physical symptoms - You can use relaxation exercises to reduce them as soon as they start. Change your Behaviour m Reduce your commitments - Allow some time for yourself. You can’t do everything yourself, so don’t be afraid to ask for help. m Take one thing at a time - Things can sometimes feel overwhelming. Set your priorities and tackle the most essential job first. The ‘How to Fix Almost Everything’ booklet available from and local libraries explains a simple way to solve problems. m Treat yourself - Take time out, enjoy being yourself and do something just for you. m Distract yourself - Having something else to focus on helps to lessen stress. So you could try out a new hobby! m Avoid self-medication - Using drugs or alcohol can often become an extra problem. m Ask for help if you need it - There are useful organisations at the back of this booklet.24
  25. 25. Change your Thoughts m Challenge your thoughts - Just because you think it, doesn’t make it true. The ‘Why does Everything Always Go Wrong’ booklet available from and local libraries. m Be creative -- Express yourself by painting, writing, dancing. The ‘Get Creative’ booklet is on the website and has lots of good ideas. m Do something for others - It makes you feel good and helps put your own life back in perspective. m Talk to someone you really trust - Just talking about what is stressing you out can make you feel better. Or use a helpline like the Samaritans: 08457 90 90 90 m Try computerised Cognitive Behavioural Therapy (cCBT) - three FREE websites are: m; m; and m m cCBT is also available from Self Help Services at venues across Manchester.Get Practical Manchester City Council: m Consumer Credit Counselling Service: m m m m Get Informed Mental Health In Manchester: m Royal College of Psychiatrists: m 25
  26. 26. Useful Links and Organisations: Manchester Primary Care Mental Health Team You can refer yourself to the team in your area for support with common mental health issues such as stress, anxiety and depression: m North Manchester: 0161 231 0017 m Central Manchester: 0161 861 2236 m South Manchester: 0161 946 8260 42nd Street: Offer a range services to young people (14-25 year olds) under stress and/or experiencing mental health problems m Helpline: 0161 832 0170 (Mon, Thu & Fri 12.30pm-4.30pm) African & Caribbean Primary Care Mental Health Service: Offer a range of services that accepts self referrals: m Telephone: 0161 226 9562 Anxiety UK: m Helpline: 08444 775 774 (Mon-Fri) Self Help Services: Offer a range of services including: m Counselling m Psychological Well Being Practitioners m Computerised Cognitive Behavioural Therapy m Self Help Groups m Range of courses m Telephone: 0161 226 3871 The Roby: m Telephone: 0161 257 265326