This document provides information on managing stress through establishing routines, avoiding unnecessary change, expressing frustration, negotiating and learning to manage time effectively. It discusses relaxation techniques like breathing exercises, muscle relaxation, autogenic training and meditation. Regular practice of relaxation techniques can help terminate stress reactions. Physical activity can help dissipate built up stress if done for well-being rather than ego purposes. Spirituality and religion can positively impact health through mechanisms like control theory and social support.

1. Managing Stress
Dr Zahiruddin Othman
Jabatan Psikiatri, PPSP
Last updated 17/02/05

2. Alleviating Adaptive Stress
Establish Routines
Make sure that your life
is ordered
Daily routines for work
and play
Regular eating and
exercise
Go to bed and get up at
regular hours
Set up regular times for
rest and relaxation
Avoid Change
If the life change
inventory suggests that
you are at risk from too
much change, stop
changing
e.g. don't move now
e.g. don't initiate a
lifestyle change now

3. Alleviating The Stress Of Frustration
Express your frustration
Determine your real outcomes
What do I want?
How will things be different and better in my life
when I get what I want?
What are my useful resources?
What has kept me from reaching this outcome
before?
Choose alternatives

4. Alleviating The Stress Of Overload
Express your feelings
Negotiate
Learn to delegate
Learn to manage time
effectively
Learn to say what you
want and how you feel
Examine personal
beliefs regarding
expectations of self and
others

5. Learn to Manage Time Effectively
Setting goals
Establish personal long term goals (plus plan of action) - 1 to
10 years
Establish medium term goals (plus plan) - 3 to 6 months
Every week, set priorities and plan of action for that week
Prioritize
Some tasks are not important ... do important things first
Scheduling
Break big tasks into smaller ones
Delegating
Don't be a perfectionist on a little task

6. Matrix of Time Management
Important Not important
Urgent
Attending job
interview
Picking up the
phone
Not urgent Exercise
Internet
chatting

7. Relaxation Techniques Help
Terminate The Stress Reactions

8. Breathing and Relaxation

9. Diaphragmatic Breathing
Lie on your back on a flat surface or in bed, with your
knees bent and your head supported. You can use a
pillow under your knees to support your legs. Place
one hand on your upper chest and the other just
below your rib cage. This will allow you to feel your
diaphragm move as you breathe.

10. Breathe in slowly through your nose so that your
stomach moves out against your hand. The hand
on your chest should remain as still as possible.
Breathe In

11. Tighten your stomach muscles, letting them fall
inward as you exhale. The hand on your upper
chest must remain as still as possible.
Breathe Out

12. Breathing Down
1. Sit comfortably left hand on
abdomen, right hand against it
2. Imagine a hollow pouch under your
hand ... breathe in so as to fill the
pouch - right to the top (initially 3
sec. inspiration, later 5 sec.) ...
"look" at the air going in
3. Hold your breath and imagine
being calm
4. Slowly exhale until the pouch is
empty

13. Practice 10-15 times a day.
Make it a ritual in the morning, afternoon, and
evening as well as during stressful situations.
After 1-2 of practice, omit the first step ... only
for learning.
Regular, consistent practice of these daily
exercises will lead to a calmer and more
relaxed attitude.

14. Controlled Tempo Breathing
Either sitting or lying with eyes closed
Diaphragmatic breathing
Concentrate on your breathing
Count number of pulses during normal
expiration (5-10?) ... get into a rhythm of equal
pulse beats during inspiration, holding breath
and expiration

15. Muscle Relaxation

16. Introduction
Key point is that we anticipate and when we
anticipate, we tense our muscles in advance ...
problem comes when we tense our muscles
for something which never happens
the longer we hold our muscles in a tense
position, the more likely we are to cause a
physical disorder ... therefore we should be
able to know
a) when they are tense, and
b) how to consciously relax them

17. Neuromuscular Exercise
Since muscles make up a large amount of
body tissue, relaxation of muscle tissue will
contribute greatly to whole body relaxation
Good, 1995: problems helped by muscle
relaxation include:
muscle contraction headaches
neck/back pain
essential hypertension
post surgical recovery

18. The Learning Phase
Need more structured time involvement,
concentration, and commitment.
Once you have perfected/ mastered it,
you will be able to choose the particular
exercise sequence that is most beneficial
and that meet your immediate needs.

19. Preparation
 Enhance concentration
 Environment
 Reduce external noise, soft music, dim lighting etc
 Your body
 Assume position that does not require muscle action to
maintain it, remove tight clothing

20. Lower Extremities Exercise
 Dorsiflexion of ankle joints
 Bend up the feet ... pull hard ... harder! And let go
 Plantar flexion of ankle joints
 Push the feet down as far as you can ... push
harder! And slacken the muscles completely

21. Hold and then relax while concentrating
on the feeling in the muscles on the
anterior side of the lower leg
Synchronize with breathing
Then concentrate on relaxation ... see
the muscle relaxing

23.  Extension of knee and hip.
 Straighten the knees as much as possible ...
 Now press the leg down into the mat ...
 Hard ... harder! Now relax ...

24. Trunk Exercise
 Extensor muscles of the spine
 Push the chest forward until you have hollowed the
back strongly ... lift a little more! And let go ...
 Abdominal muscles
 Pull the abdominal muscle until they are quite flat ...
pull a little bit more! And rest ...

25. Upper Extremities Exercise
 Finger and wrist extension
 Straighten the fingers and pull back the wrists ...
Pull hard
 Repeat 5 times

26.  Fingers and wrist flexion
 Clench your fists and curl your wrists inward

27.  Adduction of shoulder joints
 Straighten the arm against your sides ...
press tightly

28.  Shoulder shrug
 Shrug your
shoulder high ...
higher ... touch
your ears

29. Head, Neck, and Face Exercise
 Rotation.
 Shut the eyes ... now roll
the head slowly forward,
then slowly back ... roll the
head to the right, then
slowly to the left ... it’s
heavy ... and it’s rolling
easily – front to back, side
to side ...
 Now stop, with the face
turned forward, and rest ...

30.  Facial exercise
 Clench the teeth
together.
 Now draw up the
facial muscles very
tightly ... tighter!
And relax ...

31. Autogenic Relaxation Training
 A form of relaxation involving self-
directed mental images of of relaxed
states
 Simple yet advanced technique centers
on conditioned patterns of responses
that become associated with particular
thoughts
 Easier and faster to learn if you already
had other relaxation skills

32. Legs Heavy and Warm
 can be done either sitting or lying down
 attempt to produce a feeling of warmth
and heaviness in the legs
 repeated phrases stressing that the leg is
heavy, warm, relaxed and that you are calm
 move to other leg
 continue for five minutes and then rest
quietly

33. Example Script
My right leg is heavy
My right leg is heavy and warm
My right leg is warm and relaxed
I am calm and quite relaxed
My left leg is heavy
My left leg is heavy and warm
My right leg is warm and relaxed
I am calm and quite relaxed
I am quiet and at peace
I am relaxed

34. Arms Heavy and Warm
 Attempt to generate a feeling of warmth
in one arm
 Same set of repeated phrases switch to
the other arm
 Continue for five minutes and then rest
quietly

36. Visual Imagery
1. Quiet room with a soft and comfortable chair ...
four deep breaths ... more slowly (with holding
the breath in) each time ... feel the relaxation
2. Count back from 10 to 0 ... total relaxation at 0
3. Go to your special place ... stay for 4 minutes
(guess - don't time it) ... recall the feelings
4. Attention back to you ... count from 0 to 10 ...
total alertness at 10 ... feel how much more
energy you now have

37. Meditation Vs Physical Activity
 Meditation = prevention of
stress response
 Physical activity = dissipation
of built up stress
 To dissipate stress from
fear, ego threat
 To decrease reactivity
to future stress
 To achieve well-being
and tranquility

38. Exercise For Well-being And Tranquility
 Ego-involved exercise:
 Competitive golf, tennis
etc
 Goal is to enhance one's
ego by beating others
 Kriegel, 1984: competition
sometimes creates more
stress than it burns
 DeGues et al, 1993:
exercising while holding
"hateful" thoughts = high
HR and BP

39. Ego-void Exercise
 Running, biking,
swimming, skiing
 BUT ... ego
transcendence does not
come from competing
with oneself
 Therefore, don't always
measure performance
(e.g. against your past,
an ideal, etc)

40. Comprehensive Stress Management,
Greenberg, 2004
Religion And Spirituality
Spirituality is a person’s orientation
toward or experiences with transcendent
existential features of life (e.g., meaning,
direction, purpose, connectedness)
Religion is an external manifestation of
spiritual experience or an organized
social entity in which individuals share
some basic beliefs and practices

41. How Spirituality And Religion Affect Health
Control theory
Primary control (similar to problem focused
coping) refers to attempts to change the
situation
Secondary control (similar to emotion-
focused coping) refers to attempts to affect
or control oneself
Social support theory