This psychoeducational group session teaches participants about stress by having them complete individual and group stress index scales. The scales ask participants to assign points to different stressful events based on how stressful they would be. This allows participants to differentiate between a stressful event and their reaction to it. The goals are for participants to discuss different reactions to events, compare responses to others, and identify factors influencing individual stress responses. Understanding that stress is subjective helps participants learn they can manage stress by controlling their reactions rather than external events.

1. Psychoeducational Groups
David Barry
Understanding Stress
Description:
Stress is one of the primary factors that can lead to relapse and prevent individuals from managing
their lives successfully. It is inevitable that all individuals will experience stress from time to time.
What can help individuals more successfully manage their stress is to better understand the
relationships between the negative events, “stressors”, they may experience and how they react to
those stressors.
This session teaches participants how to begin to understand the difference between a ‘stressor”
and how the person responds to that event. This session is the first in a series of group sessions
that teach individuals how they can choose to respond to what is happening in their environments.
While the activity itself is a stress index scale this principle of “differentiating the event from the
experience of the event” is the key learning point to the session. In latter sessions this principle will
be used to help participants learn how to reframe situations that normally could produce negative
emotions.
Goals
At then end of this exercise participants will be able to:
1] Discuss events situations they may encounter and how much stress they associate with those
events.
2] Compare and contrast their reactions to stressful events with the responses of the other group
members.
3] Identify factors that influence how an individual may experience an event and explore the
“subjectivity” of individual reactions to eventssituations.
Materials Needed:
1. Copies of the stress index scale for each group participant.
2. An extra set of copies of the stress index scale for small group experience
3. A flip chart and pad for listing group responses
Note for Facilitator
The intent of this session is for participants to begin to differentiate between events they encounter
and their reactions to those events.
 Individuals each completing a stress index scale
 Small groups of 4-6 completing a group stress index scale [same scale]
 A review of small group scores
 A discussion of factors influencing how individuals would react differently to the
events listed on the scale
 A discussion of the individual’s experience of the event is what influences his
reactions.

2. Psychoeducational Groups
David Barry
Structure:
1] Briefly discuss with participants the history of the Holmes Ray Stress Index scale.1
2] Let participants know they are going to look at 10 potentially stressful items on a sample Stress
Index Scale. On the scale they will be asked to distribute 100 points amongst the various items
based on how stressful they think that event would be to them. For example for some people
“being transferred to another treatment setting” might only be 5 stress points while for others that
event might be 20 stress points. Give participants 10 minutes to individually distribute a total of 100
points between those 10 items.
3] After participants have individually rated the events on the “Stress Index Scale” they will be
asked to rate the same items as a group. [Small groups of 4-6 work best for this part of the
exercise.] The small groups will have 15 minutes to complete the group list.
SPECIAL NOTE
 Participants need to reach a consensus on how much stress the average person might
experience if he or she had any of the events identified in the scale happen to them.
 If the small groups seem to be having problems reaching consensus have them identify the
three most stressful events and the three least stressful events. Once this is done they can
begin to distribute the values.
4] Have a flip chart prepared listing items on the Stress Index Scale with room to the right of the
items to list the small groups weighting of the events. Give the small groups 10, 5 and 1-minute
warnings
5] Ask the small groups to report out their results and list results on the flip chart.
 Ask what factors influenced how they rated the different items.
 Review how those factors influenced the participants’ reactions to the events.
 Ask participants, “If the same events do not cause the same stress for everyone…. then what
is the main factor determining how an individual experiences stress?”
7] Reinforce the concept that it is not the event that causes individuals reactions but how the
individuals experiences that event.
Prompt Questions for the Small Group Activity
Before the actual activity starts list out on chart or board three questions you want participants to
think about during this activity.
 What factors influenced how they rated the different items?
 How various individual factors influenced the participants’ reactions to the events?
 If some of how we experience stress is “subjective” how can we help better manage our
stress?
Exercise: Stress Index Scale [Individual]
1
Holmes and Rayhe developed the Holmes-Rayhe Stress Index Scale while they were workers in a crisis
clinic in Boston. After seeing hundreds of individuals in crisis Holmes and Rayhe decided they could quantify
different events in terms of levels of stress associated with those events. They listed over 50 different types
of stressors and assigned a numerical value to those events. The numerical value was associated with the
level of stress that even would have for an individual. Holmes and Rayhe would then interview individuals
using the scale and check the various stressor the incoming client would identify. From the number of items
checked, Holmes and Rayhe would then total the accumulated stress points and identify if the individual was
experiencing one of 5 levels of stress.

3. Psychoeducational Groups
David Barry
Introduction: There are ten items listed below. You are to distribute 100 points to the total ten
items. The number of points you assign to any one item will represent how much stress that event
would have for you. For example wining $100,00 in a lottery might only be 2 stress points while
having an illness might have 25 stress points. Some of the items might not apply to you, such as
Getting Married, still rate the item thinking that if that item could apply to you, how you would
respond. You have 10 minutes to complete this task.
Stress Points Event
Being transferred to another treatment setting
Find out your mother is seriously ill
Moving to another city 50 miles away
A fire destroys your house
Become sick for over a month and not know why
Getting married
You loose your wallet and $250.00
You win $100,00 in the lottery
You break your arm in a bicycle accident
You or your partner become pregnant

4. Psychoeducational Groups
David Barry
Exercise: Stress Index Scale [Small Group]
Introduction: There are ten items listed below. As a group distribute 100 points to the total ten
items. The number of points assigned to any one item will represent how much stress you think
that event would have for the average person. For example wining $100,00 in a lottery might only
be 2 stress points while being sick might have 20 stress points. Some of the items might not apply
to you, such as becoming pregnant but rate the item on how you think it could impact on the
average person. You have 15 minutes to complete this task.
Stress Points Event
Being transferred to another treatment setting
Find out your mother is seriously ill
Moving to another city 50 miles away
A fire destroys your house
Become sick for over a month and not know why
Getting married
You loose your wallet and $250.00
You win $100,00 in the lottery
You break your arm in a bicycle accident
You or your partner become pregnant

5. Psychoeducational Groups
David Barry
Review of Exercise
After each set of participants completes the exercise ask them how they felt the exercise went.
 What factors influenced how they rated the different items?
 How various individual factors influenced the participants’ reactions to the events?
 If some of how we experience stress is “subjective” how can we help better manage our
stress?