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Coun 106 final
 

Coun 106 final

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Anxiety Management powerpoint

Anxiety Management powerpoint

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  • Intro
  • …Are all words we might use to describe someone who has a problem with anxiety. If someone has too much stress for too long anxiety is very often the result. This class is about stress, anxiety and anxiety disorder and will aim to help you…Next slide
  • (slide)As we saw, anxiety results from too much stress for too long…so lets first visit what Stress is.Who has felt stress one point in your life?
  • “The subject of stress has become a common topic of conversation. We often hear friends, classmates, coworkers, and family members talk about the problems they have in managing the stresses of everyday living. We say we feel "burned out," stressed out, overwhelmed, angry, irritable, depressed, anxious, and on the verge of "losing it.”Class brainstorm:(Refer to definition on slide)
  • Before we explore the different ways stress manifests lets discuss the reaction: “fight or flight”What is it?(go over slide)Example of the caveman and tiger: “In the days of the cavemen, the fight or flight response was key to their survival. When faced with a threatening tiger, for instance, a caveman had two main choices. He could fight the tiger or he could run away. Either way, his body had to prepare quickly to respond. The caveman's heart began to race, his breathing rate increased, his pupils dilated, his muscles became tense, and his mind processed information rapidly. This natural response to danger helped the cavemen survive.”
  • More common example that we can probably relate to is Public Speaking.Physical – What happens in your bodyBehavioral – what you doCognitive – How you thinkEmotional – how you feel“A more contemporary example of a situation that invokes the stress response for many people is public speaking. This may not be a life and death situation, but many of us perceive this situation as somewhat threatening. If you find public speaking to be stressful, you might notice certain physical, behavioral, mental, and emotional responses when you have to speak in front of a group of people.”“I have drawn a blank body on the board. What are the Physical, Behavioral, Cognitive, and Emotional signs of stress?”(Overview slide after students give feedback)
  • Pass out hand out
  • “We addressed one common stressor that people feel. What are your own stressors at this time in your life?”Pass out handout on stressors. Have students work on handout.Have students share.
  • Experiencing some amount of stress in our lives is protective and adaptive. Our responses to stress help our minds and bodies to prepare for difficult challenges, and to react appropriately in a time of crisis. In fact, a certain amount of stress is necessary to help us perform at our best. Stress adds flavor, challenge and opportunity to life. Without stress, life could become quite dull and unexciting
  • Distress - “It is the all encompassing sense of being imposed upon by difficulties with no light at the end of the tunnel.” (Refer to slide)
  • “What do you think are some environmental factors that lead to stress?” (Refer to slide) “What do you think are some social factors that lead to stress?” (Refer to slide)
  • “What do you think are some physiological factors that lead to stress?” (Refer to slide) “How do thoughts lead to stress?” (Refer to slide) 
  • Flip over other handout and on back will see, Vulnerability to Stress worksheet. Use note cards if needed. “Were any of you surprised with your results? Did any of you agree/disagree with your score/result? If so why or why not?” “Before we address how to cope and manage stress lets look at why we stress out.”
  • “The interesting thing about stress is that it begins with our own perceptions of things!”Ex of perception:“If three of your friends all get a poor grade on a test, you might notice some different reactions. One friend may seem mildly annoyed for an hour or so. Another friend doesn't seem to be bothered at all. The third friend, however, might become quite alarmed by this poor grade. She can't get it off her mind, she vows to study three times as hard next time, she can't concentrate on her other work, and she might even find it difficult to fall asleep that evening. She might become increasingly concerned about all the grades she'll make this semester, and wonder whether her GPA will suffer.In a case such as this, a poor grade on a test means something different for each of your friends. The same situation has happened to all three, but each person feels more or less stressed about it because of what it means to him or her.”Irrational beliefs: “Example: A = losing a job, B = “This job was the most important thing in my life”, “What a no-good failure I am”, “My family will starve”, “I’ll never find a job as good”, “There’s nothing I can do about it”. These beliefs compound: C = misery and helplessness and divert from planning and deciding what to do next.”
  • Develop awareness… Study the examples of irrational beliefs in Table 3.3 and ask yourself whether any of them rings true to you. Also pay attention to your thoughts when you feel anxious or frustrated.Accuracy of thoughts: Are they guiding you toward a solution or are they compounding your problems? D they reflect reality or do they blow things out of proportion? Do they misplace the blame for failure or short comings?Prepare thoughtsReward yourself.
  • Later we will do an exercise to practice how to challenge irrational beliefs.
  • Pass out irrational beliefs table handout
  • Intro: “It is important for us to not only be aware of warning signals in our environment (external) such as events, but also the internal warning signals. We tend to ignore these internal warning signals and push ourselves harder, which just leads to more stress.” (Refer to slide) Pass out Stress Warning Signals worksheet.On the other side it the stress symptom checklist
  • (Intro to slide): “To this point, you have identified specific stressors in your life, your degree of vulnerability to the negative effects of stress, and your stress warning signs. We've also addressed how our thoughts and perceptions impact how stressed we might feel. Now what?”“You may already have things you do to help yourself relieve stress. The following pages offer 12 more suggestions. Please consider each one carefully, and think about how you can incorporate it into your life.”Find a support system. Find someone to talk to about your feelings and experiences. Speak to friends, family, a teacher, a minister, or a counselor. Sometimes we just need to "vent" or get something "off our chest." Expressing our feelings can be relieving, we can feel supported by others, and it can help us work out our problems.2. Change your attitude. Find other ways to think about stressful situations. "Life is 10% what happens to us, and 90% how we react to it." Talk to yourself positively. Remember, "I can handle it, " "this will be over soon," or "I have handled difficult things before, and I can do it again." Also, practice acceptance. We need to learn to accept things we cannot change without trying to exert more control over them. 3. Be realistic. Set practical goals for dealing with situations and solving problems. Develop realistic expectations of yourself and others. Setting our expectations or goals high may seem like a useful way to push ourselves and get things done, but we may also set ourselves up for disappointment and continued stress. Find the courage to recognize your limits
  • 4. Get organized and take charge. Being unorganized or engaging in poor planning often leads to frustration or crisis situations, which most always leads to feeling stressed. Plan your time, make a schedule, establish your priorities. Do this regularly until it becomes a productive habit. Take responsibility for your life. Be proactive. Problem solve and look for solutions rather than worry. 5. Take breaks, give yourself "me time." Learn that taking time to yourself for rejuvenation and relaxation is just as important as giving time to other activities. At minimum, take short breaks during your busy day. You might purposely schedule time in your day planner just for yourself so that you can recharge for all the other things you need to do. Learn your "red flags" for stress, and be willing to take time to do something about it.Take good care of yourself: Eat properly, get regular rest, keep a routine. Allow yourself to do something you enjoy each day. Paradoxically, the time we need to take care of ourselves the most, when we are stressed, is the time we do it the least. When we feel overwhelmed we tend to eat poorly, sleep less, stop exercising, and generally push ourselves harder. This can tax the immune system and cause us to become ill more easily. If we take good care of ourselves to begin with, we will be better prepared to manage stress and accomplish our tasks in the long run.
  • Learn to say "no." Learn to pick and choose which things you will say "yes" to and which things you will not. Protect yourself by not allowing yourself to take on every request or opportunity that comes your way. It is okay to decline a request for a favor. Saying "no" does not mean you are bad, self-centered, or uncaring. Learn skills of assertiveness so that you can feel more confident and have effective ways of saying "no."Get regular exercise. Exercising regularly can help relieve some symptoms of depression and stress, and help us to maintain our health. Exercise can build confidence, self-esteem, and self-image. It is also a great way to take time for yourself, blow off steam, and release physical tension.Get a hobby, do something different. For a balanced lifestyle, play is as important as work. Leisure activities and hobbies can be very enjoyable and inspiring, and they can offer an added sense of accomplishment to our lives. Don't quickly dismiss new opportunities.
  • Slow down. Know your limits and cut down on the number of things you try to do each day, particularly if you do not have enough time for them or for yourself. Be realistic about what you can accomplish effectively each day. Also, monitor your pace. Rushing through things can lead to mistakes or poor performance. Take the time you need to do a good job. Poorly done tasks can lead to added stress.Laugh, use humor. Do something fun and enjoyable such as seeing a funny movie, laughing with friends, reading a humorous book, or going to a comedy show.Learn to relax. Learn some relaxation exercises. Develop a regular relaxation routine. Try yoga, meditation, or some simple quiet time. Relaxation techniques are skills that need to be developed with patience and practice so that we can use them effectively during difficult times of stress later on. 
  • For this exercise I write on the board, one by one, a series of questions. I pause for a few minutes between each question so students have time to complete their responses. Each question illustrates a different type of cognitive therapy technique (interventions that also can be found in psychodynamic therapy).After we complete the exercise, we go back over the questions and discuss the intended purpose of that technique.
1. I often worry that I _________. (fill in the blank) I then say and write on the board,
2. If this worry of yours was indeed true, what does it mean to you and why does it bother you so much? Students then write their response. After they finish, I repeat the question, "If what you JUST wrote was indeed true, what does it mean to you and why does it bother you so much?" Once they finish writing, I AGAIN repeat the question, ""If what you JUST wrote was indeed true, what does it mean to you and why does it bother you so much?" Repeating this question helps uncover various layers or clusters of beliefs that may be "irrational," "faulty," or "pathogenic" (the term varying according to the specific theory). Next slide.I then say, "Look back over the various things you wrote so far and answer this question:"3. What's the worst thing that could possibly happen? What do you fear most of all? This question uncovers possible catastrophizing.
4. When you think of the worst thing that could happen, do you really think that it's likely to happen? If so, how could you learn to cope with it?The first question attempts to stimulate more rational, realistic thinking. The second encourages cognitive adapting to the situation. I then say, "Look back over the worrisome thoughts that you have written about so far, and answer this question:"
5. What do I (perhaps "secretly") get out of thinking like this? How does it work to my advantage?This question encourages the student to look at what might be called the "secondary gain," "ambivalence," or "conflict" related to those worrisome beliefs.
6. Persuade a FriendHere I tell the students to carry on a dialogue - in writing - with a friend. "Pretend that your friend has some of the same worrisome beliefs that you do. Look back over the things you wrote for questions 1-3. Pick out one of those statements and write it down, as if your friend just said it. Now skip a line, and write a response to your friend's statement. In that reponse, be a compassionate, rational, and realistic thinker. After you write your response, skip a line and have your friend reply. Maybe your friend is a bit stuck in his/her thinking. Then skip a line, and respond again to your friend. Keep this conversation going for 10 lines or so.This exercise encourages students to identify with and develop the rational, compassionate side of themselves.
7. Positive imagery antedotesI ask the students to select three positive images, real memory or imagination, related to: confidence & strength in your life... safety and peacefulness in your life... love in your life...I ask them to see each one clearly. Once those images are established, I ask them to imagine a real or imaginary scene related to one of their negative thoughts. I tell them that when the time feels right, they should move from the negative image to the positive one that feels like the right antedote, then back again to the negative image, repeating the cycle until they feel comfortable ending the exercise with the positive image firmly in mind.
8. I accept myself even though I __________ (do not use the word "am")I tell the students to write this sentence 10 times! This encourages "adaptive self talk" and "positive (healthy) thinking." Telling the students not to use the word "am" bypasses the tendency towards global labelling of oneself ("I accept myself even though I am a failure") and encourages them instead to focus on specific traits or behaviors.
  • I then say, "Look back over the various things you wrote so far and answer this question:”3. What's the worst thing that could possibly happen? What do you fear most of all? This question uncovers possible catastrophizing.
4. When you think of the worst thing that could happen, do you really think that it's likely to happen? If so, how could you learn to cope with it?The first question attempts to stimulate more rational, realistic thinking. The second encourages cognitive adapting to the situation. I then say, "Look back over the worrisome thoughts that you have written about so far, and answer this question:"
5. What do I (perhaps "secretly") get out of thinking like this? How does it work to my advantage?This question encourages the student to look at what might be called the "secondary gain," "ambivalence," or "conflict" related to those worrisome beliefs.

  • 6. Persuade a Friend Here I tell the students to carry on a dialogue - in writing - with a friend. "Pretend that your friend has some of the same worrisome beliefs that you do. Look back over the things you wrote for questions 1-3. Pick out one of those statements and write it down, as if your friend just said it. Now skip a line, and write a response to your friend's statement. In that reponse, be a compassionate, rational, and realistic thinker. After you write your response, skip a line and have your friend reply. Maybe your friend is a bit stuck in his/her thinking. Then skip a line, and respond again to your friend. Keep this conversation going for 10 lines or so.This exercise encourages students to identify with and develop the rational, compassionate side of themselves.
7. Positive imagery antedotesI ask the students to select three positive images, real memory or imagination, related to: confidence & strength in your life... safety and peacefulness in your life... love in your life...I ask them to see each one clearly. Once those images are established, I ask them to imagine a real or imaginary scene related to one of their negative thoughts. I tell them that when the time feels right, they should move from the negative image to the positive one that feels like the right antedote, then back again to the negative image, repeating the cycle until they feel comfortable ending the exercise with the positive image firmly in mind.
8. I accept myself even though I __________ (do not use the word "am")I tell the students to write this sentence 10 times! This encourages "adaptive self talk" and "positive (healthy) thinking." Telling the students not to use the word "am" bypasses the tendency towards global labelling of oneself ("I accept myself even though I am a failure") and encourages them instead to focus on specific traits or behaviors.
  • 7. Positive imagery antedotesI ask the students to select three positive images, real memory or imagination, related to: confidence & strength in your life... safety and peacefulness in your life... love in your life...I ask them to see each one clearly. Once those images are established, I ask them to imagine a real or imaginary scene related to one of their negative thoughts. I tell them that when the time feels right, they should move from the negative image to the positive one that feels like the right antedote, then back again to the negative image, repeating the cycle until they feel comfortable ending the exercise with the positive image firmly in mind.
8. I accept myself even though I __________ (do not use the word "am")I tell the students to write this sentence 10 times! This encourages "adaptive self talk" and "positive (healthy) thinking." Telling the students not to use the word "am" bypasses the tendency towards global labeling of oneself ("I accept myself even though I am a failure") and encourages them instead to focus on specific traits or behaviors.
  • Intro: “Relaxation techniques can help reduce emotional and physical sensations of stress, as well as the worry or stressful thoughts that may accompany them. If you can learn to relax your breathing and reduce your muscle tension, your mind will follow. Conversely, if you can learn to ease stressful thoughts and worry, your body will relax as well.”While there are numerous types of relaxation exercises, we will explore two of them here:
  • 1. Students sit comfortably for this activity 2. Use a calm, low, slow voice and give sufficient time between each visual suggestion for students to “ease” into the vision and “see” each step Close your eyes. “See” in your mind’s eye a beautiful beach. The sun is shining warmly, the breeze coming from the ocean is soft and warm, palm trees are overhead and a few seagulls circle about. Imagine walking barefoot in the warm sand, feel your feet sink in the sand with each step. Walk toward the water’s edge and let the water roll over your feet. Jump inthe water; it is warm, gentle and very refreshing. Come out of the water and walk to your big beach towel, lay down and relax. Rest for a while in all the peace and beauty surrounding you. Imagine how it looks, how it sounds, how it smells. Breathe in deeply the warm ocean air, stay as long as you like. When you are ready to leave, go to the edge of the water and throw in anything that has been bothering you, anything you wish to be rid of in your life, anything you are feeling sad or angry about, anything you worry about (e.g. problems at home, violence in your neighborhood, bullies, death of a loved one, issues with friends). Picture it as a big rock, a chain, a heavy bag over your shoulders, or any image that helps you see it as undesirable. Throw it in the ocean as far as you can. Watch it sink and get taken by the waves. When the “visit” is done, be thankful for the release of the burden, the problem, the worry; then walk peacefully back through the warm sand and take a rest on your beach towel. It doesn’t have to be a beach. It can be any place to event where they felt calm and safe. Pass out handout on relaxation exercises. Sometimes these techniques won’t be able to help decrease anxiety. We will first identify when stress/anxiety becomes more intense
  • Anxiety diary: For period of two weeks (or longer if you prefer) keep an hourly diary of your anxeity and activity level. Rate your anxiety from 0-10. Note down anything that seems important. Were you at work or home, who were you with, what were you doing, what were you thinking about? You may start to become more aware of situations that make you anxious or that you may even be avoiding. What is your general level of stress like? This information will help you begin to tackle your anxiety.If you become aware that you have a realistic worry or problem that you feel may be causing you anxiety, a problem solving approach may help. A good way to begin is to write down a problem. Define it as clearly as you can ex. “I never have money” is too vague, something like “I owe $5000 to different credit card companies”, is more helpful. Next write down as many possible solutions as you can. It doesn’t matter how silly. Try to think how you have solved similar problems in the past.Also look at handout, 24 positive coping strategies
  • Anxiety disorders are distinguished from everyday, normal anxiety in that they involve anxiety that 1) is more intense (for example panic attacks), 2) lasts longer (anxiety that may persist for months instead of going away after a stressful situation has passed), or 3) leads to phobias that interfere with your life.
  • Social Phobia- have fear of doing something that will be humiliating or embarrassing. Ex. Fear of public speakingImpact both social and occupational spaces. Agoraphobia – Fear of being in places where it might be difficult to escape or which help might not be available if they experience panicky symptoms. Often refuse to leave home.Example in book.
  • Physical symptoms: Shortness of breath or a feeling of being smotheredHeart palpitations – pounding heart or accelerated heart rateDizziness, unsteadiness, or faintnessTrembling or shakingFeeling of chokingSweatingNausea or abdominal distressFeeling of unreality – as if you’re not all thereNumbness or tingling in hands and feetHot and cold flashesChest pain or discomfortFears of going crazy or losing control Fears of dyingDiagnosed with this if have 2 or more panic attacks
  • Ways to address it: regular practice of deep relaxation, program of exercise, elimination of stimulants (caffeine, sugar, and nicotine) from your diet, learning to acknowledge and express your feelings, especially anger and sadness, adopting self-talk and “core beliefs” which promote a calmer and more accepting attitude toward life.
  • Pass out panic attack record handout
  • Generalized anxiety disorder is characterized by chronic anxiety that persists for at least six months but is unaccompanied by panic attacks, phobias, or obsessions. You simply experience persistent anxiety and worry without the complicating features of other anxiety disorders.
  • Obsessions may occur by themselves without necessarily being accompanied by compulsions. In fact, about 25% of the people who suffer from obsessive-compulsive disorder only have obsession and these often center around fears of causing harm to a loved one.The most common compulsions include washing, checking, and counting. OCD is often accompanied by depression and phobic avoidance.
  • PTSD may not begin for many months or years after the trauma, but it may last for years or even decades afterward.Anxiety related symptoms (rapid heart rate and feelings of anxiety and helplessness.Traumatic event is revisited in the form of intrusive memories, recurrent dreams ,and flashbacks. People try to avoid thoughts and activities connected to the trauma. Find it more difficult to enjoy life and may have sleep problems, irritable outbursts, difficulty concentrating, extreme vigilance, and an exaggerated “startle” response to sudden noise.
  • Long-Term, Predisposing CausesHeredityChildhood circumstancesYour parents communicate an overly cautious view of the worldYour parents are overly critical and set excessively high standardsEmotional insecurity and dependenceYour parents suppress your self-assertivenessPass out family background questionnaire handout Biological CausesShort-term, triggering causesStressors that precipitate panic attacksSignificant personal lossSignificant life changeStimulants and recreational drugsPass out the Life events survey handoutConditioning and the origin of phobiasTrauma, Simple phobias, and the post-traumatic stress disorder
  • Maintaining CausesAvoidance of Phobic situation Anxious self-talk – Internal monologue that is subtle that usually starts with “What if”. This self talk anticipates the worst before it even happens. This often can trigger panic attacks.Mistaken beliefs – Your negative self-talk comes from underlying mistaken beliefs about yourself, others, and “the way the world is.”Pass out mistaken beliefs handout Withheld feelings – Denying feelings of anger, frustration, sadness or even excitement can contribute to a state of free-floating anxiety. Free-floating anxiety is when you feel vaguely anxious without knowing why. Anxiety prone people are often born with a predisposition to be more emotionally reactive or volatile. Tend to grow up in families where obtaining parental approval takes precedence over expressing their needs and feelings. As adults they still feel it is more important to attain perfection or always be pleasing than to express strong feelings. Lack of assertivenessLack of self-nurturing skills – pervasive sense of insecurity. Unaware of how to love and nurture themselves, they suffer low self-esteem and may feel anxious or overwhelmed in the face of adult demands and responsibilities.Pass out affirmation handout and examples of affirmations handoutMuscle tension – when your muscles are tense, you feel “uptight”. Muscle tension tends to restrict your breathing. And when your breathing is shallow and restricted you are more likely to experience anxiety. Tense muscles also help to keep your feelings suppressed which can increase anxiety. When your body is tense, your mind has a greater tendency to race. Stimulants and other dietary factors – they can aggravate anxiety and leave you more vulnerable to panic attacks. High-stress lifestyle - Lack of meaning or sense of purpose
  • 2 therapies that are most successful with Anxiety DisordersCognitive behavioral therapy: focuses on linking the relationship between your thoughts and perceptions and how it influences our behavior. We did some activities earlier. Behavior Therapy: Systematic application of the principles of learning to the direct modification of a client’s problem behaviors.Behavior therapists draw upon the principles of classical and operant conditioning as well as observational learning.What does that mean?It’s a therapy that uses manipulation of environment to modify person’s behaviors. Can add the cognitive component to help clients figure out how their thoughts impact their behaviors as well.
  • Example of flooding: we learn through associations, so if we have a phobia it is because we associate the feared object or stimulus with something negative.if the patient suffered from arachnophobia, the therapist might lock them in a room full of spiders.[1] While the patient would initially be very anxious, the mind cannot stay anxious forever. When nothing bad happens the patient begins to calm down and so from that moment on associate a feeling of calm with the previously feared object.[1] Example of gradual exposure: Fear of elevators: 1) first stand outside the elevator, 2) stand outside with the door open, 3) taking the elevator down one floor, 4) then up one floor, 5) then down two floors, 6) etc. Examples of systematic desensitization:First taught relaxation skills.Once the individual has been taught these skills, he or she must use them to react towards and overcome situations in an established hierarchy of fears. The goal of this process is that an individual will learn to cope and overcome the fear in each step of the hierarchy, which will lead to overcoming the last step of the fear in the hierarchy.
  • Retreat – simply exit the situation until your anxiety subsides. Its very important to distinguish retreat from escape in withdrawing from a phobic situation. Retreat means that you leave a situation temporarily with the intention of returning when you feel better. Escape only serves to reinforce your phobia.Talk to another person – talking to someone nearby will help you get your mind off your panic symptoms and anxious thoughts.Move around or engage in physical activity – this helps you dissipate the extra energy or adrenalin created by the fight-or-flight reaction.Stay in the present – focus on concrete objects around you in your immediate environment. In a grocery store you might look at the people standing around and your surroundings. Engage in a Simple Repetitive Activity-these can help distract your attention from your panic symptoms or anxiety-provoking thoughts. (ex. Snap a rubber band against your wrist, sing, count backward from 100 by 3).Do something that require focused concentration – These work well as distractors from worry but not really when feeling anxious or panicky. Read a good novel or magazine, solve puzzles, knit or sew, engage in card or board games, play a musical instrument, plan your day’s activitiesPaint or play with clayExpress Anger – anger and anxiety are incompatible reactions. If you can express anger physically onto an object – not just talk about it – at the moment you feel sensations of panic coming on, you often can abort the occurrence of a panic attack. (pound on a pillow or your bed with both fists, scream into a pillow or in your car alone with the windows rolled up, hit a punching bag.
  • Experience something immediately pleasurablePractice abdominal breathing -

Coun 106 final Coun 106 final Presentation Transcript

  • Anxiety and Anxiety Management
    COUN 106
    Marisa Mariano, MFT
  • Agenda
    8:30-8:45 Attendance/Intro
    8:45-10:30 Class
    10:30-10:45 Break
    10:45-12:00 Class
    12:00-1:00 Lunch
    1:00-3:00 Class
    3:00-3:15 Break
    3:15-4:15 Class
    4:15-4:30 Closing
  • “Bad with your nerves”
    “A worrier”
    “Stressed out”
    “Unable to relax”
    “Tense and nervous”
  • Objectives
    Recognize whether or not you may be suffering from symptoms of anxiety
    Understand what stress, anxiety and anxiety disorders are, what can cause it and what can keep it going.
    Overcome your anxiety by learning better ways of coping with it.
  • What is Stress?
    Class brainstorm
    Stress can be defined as our mental,physical, emotional, and behavioral reactions to any perceived demands or threats.
  • Fight or Flight
    Physiological reaction (racing heartbeat, breathing rate increased, dilated pupils, tense muscles, and mind process information rapidly).
    When presented with a threat => our bodies react quickly to supply protection by "turning on the juices" and preparing to take action. This physiological reaction is known as the "fight or flight" response.
    Example : Caveman and tiger
  • Example #2: Public Speaking In groups, draw/list some examples of signs of stress in these various areas:
    Physical Behavioral
    Cognitive Emotional
  • Signs of stress
    Physical
    Increased heart rate
    Clammy or sweaty hands
    Physically shaking
    Rapid and shallow breathing
    Jaw tightens
    Light-headed
    Behavioral
    Stuttering
    Looking down a lot
    Avoid eye contact with the audience
    Absence on day of presentation
    Rushing through presentation
  • Signs of stress (cont’)
    Cognitive
    Your mind may go blank
    Your thoughts might race wildly.
    You might have thoughts about making a mistake or looking ridiculous in front of your peers.
    Emotional
    You might feel
    Very anxious
    Fearful
    Resentful/Angry
    Frustrated
  • Now let’s determine what your stressors are…
    Please fill out the handout “What Seems Stressful To You”.
    What are the different situations in your life that are causing the most stress at this time?
    One of the first steps to managing stress is to be able to identify what the stressors are in our lives.
  • Remember:
    Stress is a normal part of life!
    It can help us:
    • Learn to protect ourselves
    • Adapt
    • React appropriately to (a) situation(s)
    • Helps us perform our best
    • Adds flavor to our lives
  • Not All Stress is "Bad”There are two types of stress:
    Distressis a continuous feeling of being:
    Overwhelmed,
    Oppressed,
    Behind in our responsibilities
    Examples:
    financial difficulties,
    conflicts in relationships,
    excessive obligations,
    managing a chronic illness
    experiencing a trauma
    Eustress is a positive and beneficial form of stress.
    May be challenging but sources of the stress are opportunities that are meaningful.
    Helps provide us with energy and motivation to meet our responsibilities and achieve our goals.
    Examples:
    graduating from college,
    getting married,
    (+) Changes in our jobs
  • When stress and anxiety become a problem
    When the symptoms are:
    Severe and unpleasant
    Going on too long
    Happening too often
    Causing us to worry that there is something serious wrong
    Stopping us from doing what we want to do
  • What can lead to stress?
    Stress generally comes from 4 main areas:
    • Environmental factors
    • Social Factors
    • Physiological Factors
    • Thoughts
  • Four main sources of stress:
    Environmental Factors
    excessive noise,
    bad weather or natural disasters,
    traffic,
    pollution,
    problems with roommates or neighbors
    Social Factors
    deadlines,
    financial problems,
    group projects,
    disagreements,
    demands on time and attention,
    dating,
    balancing work and school,
    loss of a loved one,
    conflicts with family
  • Four main sources of stress
    Physiological
    adolescence,
    illness,
    accidents,
    lack of exercise,
    poor nutrition,
    alcohol or drug use/abuse,
    sleep disturbances,
    muscle tension,
    headaches,
    upset stomach
    Thoughts
    Our perception of events,
    expecting too much from others,
    making decisions,
    having a pessimistic attitude,
    expecting problem-free living,
    worrying,
    being a perfectionist,
    being competitive,
    being self-critical,
    making assumptions
  • How can too much “stress” affect us?
    Affect our physical and mental well being.
    Interfere with our normal daily activities.
    Diminish our self-esteem.
    Impair relationships.
    Decrease work and academic effectiveness.
    Can lead to self-blame, self-doubt, feeling burned out, or becoming clinically anxious or depressed.
  • Some important facts about stress:
    43% of adults experienced adverse health effects from stress
    75-90% of visits to a physician's office are for stress-related conditions and complaints
    Stress has been linked to the 6 leading causes of death: heart disease, cancer, lung ailments, accidents, cirrhosis of the liver, and suicide
    In the workplace, stress may be related to lost hours due to absenteeism, reduced productivity, and worker's compensation benefits. This costs the American industry more than $300 billion annually.
  • How vulnerable are you to stress?
    Fill out ‘Vulnerability to Stress Worksheet”
  • Why do we “stress out”?
    We stress out for 2 main reasons:
    1) We perceive a situation as dangerous, difficult, or painful.
    2) We don't believe we have the resources to cope.
  • Perception and stress
    How we perceive an event + the meaning we give to it = level that we feel stressed or not stressed about it. (Example: reaction to test results)
    Irrational beliefs that we have about ourselves also impact how well we can handle stressful events in our life.
    Ellis’s A  B  C
    A – Activating Event
    B – Beliefs
    C – Consequences (ability to cope)
    Ex. Losing a job
  • Irrational Beliefs
    Do any of these sound familiar to beliefs you may have of yourself or messages you have heard in your life?
  • How to address irrational beliefs?
    Remember this will require some work and won’t happen over night.
    First, develop awareness of the thoughts that seem to be making you unhappy/miserable
    Next, evaluate the accuracy of the thoughts.
    Then, prepare thoughts that are incompatible with the irrational thoughts and practice saying them firmly to yourself.
    Finally, reward yourself with a mental pat on the back for making effective changes in your beliefs and thought patterns
  • Now…
    Let’s try to address some of our irrational beliefs…
  • Identifying Irrational Beliefs that blow stressors out of proportion.
    First let’s look at some examples (refer to the handout).
    Do any of these sound familiar to you?
    Now, turn the paper over and fold it in half (vertically).
    Keep the paper folded.
    On one side write down some irrational beliefs you feel you may have or critical messages you may tell yourself.
    On the other side, how are some new ways (rational alternatives) of looking at the situation that keep things in perspective?
  • Some stress warning signals
    Important to be aware of external and internal warning signs.
    What are your stress symptoms when you feel stressed out?
    Fill out the “Stress Warning Signals Worksheet”
  • 12 Suggestions for Reducing Stress
    Find a support system.
    Change your attitude.
    “Life is 10% what happens to us and 90% how we react to it”.
    Be realistic.
  • 12 Suggestions for Reducing Stress (continued)
    Get organized and take charge!
    Take breaks, give yourself “me” time.
    Take good care of yourself.
  • 12 Suggestions for Reducing Stress (continued)
    Learn to say “no”.
    Get regular exercise.
    Get a hobby, do something different.
  • 12 Suggestions for Reducing Stress (continued)
    Slow down.
    Laugh, use humor.
    Learn to relax.
  • Activity: “The Way I Think”
    Answer the following questions on a separate piece of paper.
    1) “I often worry that I _____________.”
    2) If this worry of yours was indeed true, what does it mean to you and why does it bother you so much?
    2b) If what you JUST wrote was indeed true, what does it mean to you and why does it bother you so much?
    2c) If what you JUST wrote was indeed true, what does it mean to you and why does it bother you so much?
  • Activity: “The Way I Think” (cont)
    3) What’s the worst thing that could possibly happen? What do you fear most of all?
    4) When you think of the worst thing that could happen, do you really think that it’s likely to happen? If so, how could you learn to cope with it?
    5) What do I (perhaps “secretly”) get out of thinking like this? How does it work to my advantage?
  • Activity: “The Way I Think” (cont)
    6) Letter to your friend.
    Pretend your friend has some of the same worrisome beliefs that you do.
    Pick out one of the statements from questions 1-3 and write it down.
    Write a compassionate, rational, and realistic response to your friend’s statement
    Next line: Have your friend reply.
    Next line: respond again to your friend…try to keep the conversation going for 10 lines or so.
  • Activity: “The Way I Think” (cont)
    7) Positive imagery antedotes
    Select 3 positive images (real or imaginary) related to: 1) confidence and strength in your life, 2) safety and peacefulness in your life, 3) love in your life
    8) I accept myself even though I _____________.
    Do not use the word “am”
    Now write this down 10 times!!
    Adaptive self talk and positive thinking
  • 2 Types of Relaxation Exercises
    Deep Breathing
    When we are stressed our breathing becomes shallow and our frequency of breaths increase.
    Allows us to take fuller, slower breaths that reflect a true relaxed state.
    Visualization
    Giving our minds and bodies a “mini vacation”.
    Using imagery to fully immerse ourselves in a pleasant scene, noticing the sights, sounds, smells, and tactile sensations
  • Guided Visualization Exercise
    An example to relaxation exercises.
  • Discussion questions
    Where did your visualization take you?
    Do you feel more calm/relaxed after going through this exercise?
    What did you see, hear, feel, smell during your visualization/did anything in particular stand out?
    What was it like throwing your burdens into the water?
    How does it feel to be back in the classroom?
    Is this technique/exercise something you might do in the future to clam down, relax and reduce your stress?
  • Additional tools to managing stress and anxiety
    Anxiety Diary
    For 2 weeks or more, keep an hourly diary of your anxiety and activity level. Rate anxiety from 0-10.
    Problem solving (with realistic worries or problems)
    Write down a problem.
    Write down as many possible solutions as you can.
    Chose the best solution and write down all the steps to achieve it.
  • Stress/Anxiety vs. Anxiety Disorders
    Recap: Stress/anxiety is inevitable part of life.
    Anxiety disorders
    1) more intense than normal stress
    2) lasts longer
    3) leads to phobias that interfere with life
    Anxiety Disorders – criteria is established in the DSM-IV-TR
  • Anxiety Disorders
  • Types of Anxiety Disorders
    Phobias
    Specific Phobia
    Social Phobia
    Agoraphobia
    Panic Disorder
    Generalized Anxiety Disorder
    Obsessive Compulsive Disorder
    Post-Traumatic Stress Disorder
    Acute Stress Disorder
  • Phobias
    Example (Arachnophobia):
    http://www.youtube.com/watch?v=5ksMw4MJgn0&feature=related
    What did you notice?
    Specific Phobia: an excessive, irrational fear of a specific object or situation, such as snakes or heights. Examples include claustrophobia (fear of tight or enclosed spaces) and acrophobia (fear of heights).
    Social Phobia: Also called Social Anxiety Disorder, a social phobia is a persistent fear of social interactions in which one might be scrutinized or judged negatively by others.
    Agoraphobia:Fear of open or crowded places.
  • Panic Disorder
    Panic Disorder: Recurrent experiencing of attacks of extreme anxiety in the absence of external stimuli that usually elicit anxiety.
    Attacks are acute and seem to come “out of the blue” but may become associated with certain cues over time.
    Strong physical symptoms: shortness of breath, heavy sweating, tremors, and pounding of the heart and lasts for a few minutes
    Investigators estimate that 1% to 4% of the adult population is affected by panic disorder at some point in their lives.
  • Panic Attack
    A sudden surge of mounting physiological arousal
    Occurs out of the blue or in response to a phobic situation
    Bodily symptoms: heart palpitations, tightening in the chest or shortness of breath, choking sensations, dizziness, faintness, sweating, trembling, shaking, and/or tingling in the hands and feet.
    Psychological reactions: feelings of unreality, intense desire to run away and fears of going crazy , dying, or doing something uncontrollable.
  • Development of a Panic Attack
    Phase 1 Initiating Circumstances (internal or external)
    Phase 2 Slight increase in unusual or unpleasant body symptoms (i.e heart palpitations, shortness of breath, etc.)
    Phase 3 Internalization (Increased focus on symptoms makes them more noticeable and easily magnified)
    Phase 4 Catastrophic Interpretation (telling yourself the symptom is dangerous – ie. “I’ll have a heart attack,” “I’ll go completely out of control”, “I must leave at once”)
    Phase 5 Panic
  • Generalized Anxiety Disorder
    Example (What About Bob):
    http://www.youtube.com/watchv=RfrueeBmfXo&feature=related (0-1:33)
    What did you notice?
    Disorder involving persistent feelings of worry accompanied by states of bodily tension and heightened arousal.
    The anxiety isnotfocused on a specific object, situation or activity, but more on basic fears such as fear of losing control, not being able to cope, failure, rejection or abandonment, and death and disease.
    Symptoms may include motor tension, autonomic overarousal, feelings of dread and foreboding and excessive worrying and vigilance.
    Unable to exercise control over worrying
  • Obsessive Compulsive Disorder
    Example (As Good As It Gets):
    http://www.youtube.com/watch?v=44DCWslbsNM&feature=PlayList&p=F2B05F841C319A34&playnext=1&playnext_from=PL&index=34
    What did you notice?
    Obsessive-Compulsive Disorder: A disorder characterized by the presence of obsessions, compulsions or both.
    Obsession: A recurring thought or image that seems beyond one’s ability to control.
    Compulsion: An apparently irresistible urge to repeat an act or engage in ritualistic behavior such as hand washing.
  • Post Traumatic Stress Disorder and Acute Stress Disorder
    Example (Law and Order – SVU):
    http://www.youtube.com/watch?v=Ddi86i3vF6E&feature=PlayList&p=C460C4EF4209FF71&index=25 (0-1:20)
    What did you notice?
    Posttraumatic Stress Disorder (PTSD): A prolonged maladaptive reaction to a traumatic event that is characterized by intense fear, avoidance of stimuli associated with the event, and re-living of the event.
    Exposure to trauma in the form of physical attacks, combat, medical emergencies, accidents, terrorist attacks or witnessing a death can lead to PTSD.
    Acute Stress Disorder: Characterized by feelings of intense anxiety and feelings of helplessness during the first month following exposure to a traumatic event.
  • Group Activity:
    Break into groups
    In your group, determine which Anxiety Disorder your person has if any.
    What are the signs/symptoms they are experiencing?
  • Types of Anxiety Disorders
    Phobias
    Specific Phobia
    Social Phobia
    Agoraphobia
    Panic Disorder
    Generalized Anxiety Disorder
    Obsessive Compulsive Disorder
    Post-Traumatic Stress Disorder
    Acute Stress Disorder
  • Causal Factors of Anxiety Disorders
    Long-Term, Predisposing Causes
    • Heredity
    • Childhood circumstances
    • Your parents communicate an overly cautious view of the world
    • Your parents are overly critical and set excessively high standards
    • Emotional insecurity and dependence
    • Your parents suppress your self-assertiveness
    • Biological Causes
    Short-term, triggering causes
    • Stressors that precipitate panic attacks
    • Significant personal loss
    • Significant life change
    • Stimulants and recreational drugs
    • Conditioning and the origin of phobias
    • Trauma, Simple phobias, and the post-traumatic stress disorder
  • Causal Factors of Anxiety Disorders
    Maintaining Causes
    • Avoidance of Phobic situation
    • Anxious self-talk
    • Mistaken beliefs
    • Withheld feelings
    • Lack of assertiveness
    • Lack of self-nurturing skills
    • Muscle tension
    • Stimulants and other dietary factors
    • High-stress lifestyle
    • Lack of meaning or sense of purpose
  • Treatments for Anxiety Disorders
    Cognitive Behavioral Therapy
    Behavioral Therapy
  • Fear Reduction Methods
    Flooding: A person is exposed for prolonged intervals to a fear-evoking but harmless stimulus until fear is extinguished.
    Gradual exposure: Similar to flooding, but works upward in a hierarchy of progressively more fearful stimuli.
    Systematic Desensitization: method for reducing fears by associating a hierarchy of images of fear-evoking stimuli with deep muscle relaxation.
    Imagery Desensitization:
    Modeling: A technique in which a client observes and imitates a person who approaches and copes with feared objects or situations.
  • Imagery Desensitization
    Construct an appropriate hierarchy
    Imagine having to deal with this situation in a very limited way – one that hardly bothers you at all.
    Now imaging what would be the strongest or most challenging scene relating to your phobia and place it at the opposite extreme as the highest step in your hierarchy.
    Now take some time to imagine six or more scenes of graduated intensity related to your phobia and rank them according to your anxiety provoking potential.
  • How to practice Imagery Desensitization
    Relax
    Visualize yourself in a peaceful scene
    Visualize yourself in the first scene of your phobia hierarchy.
    If you experience mild to moderate anxiety (level 2 or 3 on the Anxiety Scale), spend 30 seconds to 1 minute in the scene, allowing yourself to relax to it.
    After a minute of exposure, retreat from the phobic scene to your peaceful scene.
  • How to practice Imagery Desensitization
    If visualizing a particular scene causes you strong anxiety (level 4 or above on the Anxiety scale), do not spend more than 10 seconds there. – go to a peaceful place.
    Continue progressing up your hierarchy step by step in imagination.
    Use worksheet
  • Example of Real Life Gradual Exposure
    Video with example of Behavioral Therapy – real life gradual exposure.
    From A&E show, “Obsessed”.
    http://www.aetv.com/obsessed/video/?bcpid=45697868001&bclid=23151005001&bctid=29322475001
  • Coping Strategies to Counteract Panic at an Early Stage
    Retreat
    Talk to another person
    Move around or engage in physical activity
    Stay in the present
    Engage in a simple repetitive activity
    Do something that requires focused concentration
    Express anger
  • Coping Strategies to Counteract Panic at an Early Stage
    Experience something immediately pleasurable
    Visualize a comforting person or scene
    Practice thought stopping
    Practice abdominal breathing
    Practice muscle relaxation
    Repeat positive coping statements
    Use breathing (or relaxation) in combination with coping statements
  • Books and other resources
    The Anxiety and Phobia Workbook, by Bourne, Edmund, Ph.D.
    Life After Stress, by Shaffer, Martin
    Guide to Stress Reduction, by Mason, John
    The Relaxation and Stress Reduction Workbook, by Davis, Martha
    Managing Anxiety, by Kennerley, Helen
    The Feeling Good Handbook, by Burns, David.
    Self-help for Your Nerves, by Weeks, Clare
    Feel the Fear and Do it Anyway, by Jeffers, Susan
    http://www.wellnessproposals.com/mental-health/handouts/stress-management/anxiety-disorders.pdf
  • I’d like to leave you all with a song…Avenue Q’s– “For Now”
    PRINCETON:
Why does everything have to be so hard?

GARYCOLEMAN:
Maybe you'll never find your purpose.

CHRISTMASEVE:
Lots of people don't.

PRINCETON:
But then- I don't know why I'm even alive!

KATEMONSTER:
Well, who does, really?
Everyone's a little bit unsatisfied.

BRIAN:
Everyone goes 'round a little empty inside.

GARYCOLEMAN:
Take a breath,
Look around,



  • Avenue Q – “For Now”
    BRIAN:
Swallow your pride,

KATEMONSTER:
or now...

BRIAN, KATE, GARY, CHRISTMAS EVE:
For now...

NICKY:
Nothinglasts,

ROD:
Life goes on,

NICKY:
Full of surprises.

ROD: 
You'll be faced with problems of all shapes and sizes.


  • Avenue Q – “For Now”
    CHRISTMAS EVE:
You're going to have to make a few compromises...
For now...

TREKKIE MONSTER:
For now...

ALL:
But only for now! (For now)
Only for now! (For now)
Only for now! (For now)
Only for now!

LUCY:
For now we're healthy.

BRIAN:
For now we're employed.
    

 


  • Avenue Q – “For Now”
    BAD IDEA BEARS:
For now we're happy...

KATE MONSTER:
If not overjoyed.

PRINCETON:
And we'll accept the things we cannot avoid, for now...

GARY COLEMAN:
For now...

TREKKIE MONSTER:
For now...

KATE MONSTER:
For now...


  • Avenue Q – “For Now”
    ALL:
But only for now! (For now)
Only for now! (For now)
Only for now! (For now)
Only for now!

Only for now!
(For now there's life!)
Only for now!
(For now there's love!)
Only for now!
(For now there's work!)
For now there's happiness!
But only for now!
(For now discomfort!)
Only for now!
(For now there's friendship!)
Only for now (For now!)
Only for now!

Only for now! (Sex!)
Is only for now! (Your hair!)
Is only for now! (George Bush!)
Is only for now!


  • Avenue Q – “For Now”
    Don't stress,
Relax,
Let life roll off your backs
Except for death and paying taxes,
Everything in life is only for now!

NICKY:
Each time you smile...

ALL:
...Only for now

KATEMONSTER:
It'll only last a while.

ALL:
...Only for now

PRINCETON:
Life may be scary...


  • Avenue Q – “For Now”
    ALL:
...Only for now
But it's only temporary
    Ba-dumba-dum
Ba-dumba-dum
Badumba-dum
Ba-dadadada
ba-dada-dadada-da
Ba-dumba-da, ba-dumba-da
ohhhh-

PRINCETON:
Everything in life is only for now.