How to Manage Stress

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Join us for a lecture about stress and how it can affect your behavior. Clinical psychologist Katherine DiDonato, PhD, will discuss cognitive behavioral techniques and other evidence-based approaches to help reduce stress and manage worry for a better life.

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How to Manage Stress

  1. 1. Stress & Anxiety What is it & What can be done about it? Presented by: Katherine DiDonato, PhD, ACT
  2. 2. Physical Results of Ongoing Stress • Heart disease  Diabetes  Asthma  PMS  Obesity  Infertility  Autoimmune diseases  Chronic pain  Migraines  Ulcers  Heartburn  High blood pressure  Skin problems  Irritable bowel syndrome
  3. 3. Emotional Results of On-Going Stress • Anxiety • Depression • Insomnia • Isolation • Conflict • Substance Abuse • BURNOUT
  4. 4. Today’s Objectives • What is Stress? • What is Burnout? • What is Anxiety? • Stress/Anxiety Management  Cognitive Techniques  Meditation and Relaxation  Social Connection  Medication
  5. 5. Stress is a normal component of the body’s response to demands that are placed on it. It is characterized by the body’s biochemical changes It can be health-enhancing or health-depleting What is Stress?
  6. 6. What is Stress?  When demands are in balance with your coping abilities and resources you do not feel stressed.  When demands are greater than your coping abilities you feel stressed.
  7. 7. Appraisal of Threats and Resources First we evaluate the threat. Is it?... •Positive / Negative •Controllable / Uncontrollable •Challenging / Boring •Irrelevant / Important If the answer is “negative, uncontrollable, important” = STRESS Then we evaluate our resources. Can I handle this stress? If the answer is “no” = STRESS
  8. 8. The Stress Response is the Body’s 911 System
  9. 9. Fight or Flight Reaction • Productive if you were in a situation where you need to protect yourself
  10. 10. It is a Matter of Perception  Since we are very rarely attacked by bears our perception of threat has changed  Now, a threat can be:  Social  Emotional  Financial  Work related
  11. 11. Sources of Stress The Good Retirement Get married Have children Buy a new home Go on vacation New Job, Promotion The Bad Break a leg Spouse becomes ill Child gets in trouble Lose wallet In-laws coming The Ugly Nasty car accident Bankruptcy Divorce Illness Loved one dying
  12. 12. Who Has Stress?
  13. 13. Stress Response = Good in Small Doses  Gives you a burst of energy when you need it  Increases your motivation to complete tasks  Protects you from harm  Prevents you from walking down a dark alley way at night
  14. 14. Stress and its impact on performance works in a bell curve More stress will help you give an optimal performance The “optimal” amount of stress is different for everyone Stress is Good in Small Doses
  15. 15. Stress Can be Health-Depleting "© copyright Mental Health America"
  16. 16. Negative Emotional Reactions  Feeling angry, irritable or easily frustrated  Feeling overwhelmed  Feeling nervous or anxious  Feeling afraid or worried  Feeling helpless or hopeless  Desire to hide or runaway
  17. 17. Negative Cognitive Reactions • Difficulty Making Decisions • Confusion • Difficulty Naming Familiar Items • Poor Concentration • Blaming Others • Memory Problems • Replaying Events Over & Over • Thinking the Future is bad
  18. 18. Behavioral Reactions • Difficulty functioning at work or home • Withdrawal • Isolation • Suspiciousness • Working more and being less productive • Excessive Humor or Silence • Increased Smoking, Alcohol or Food • Change in Activity Level • Angry Outbursts • Crying Spells • Sleep
  19. 19. What is Burnout?
  20. 20. Burnout - A State of Mental Exhaustion • Powerlessness  Hopelessness  Emotional exhaustion  Detachment  Isolation  Irritability  Frustration  Being trapped  Failure  Despair  Cynicism  Apathy
  21. 21. Stress Burnout  Characterized by over-engagement  Characterized by disengagement  Emotions are over-reactive  Emotions are blunted  Produces urgency and hyperactivity  Produces helplessness and hopelessness  Loss of energy  Loss of motivation, ideals, and hope  Leads to anxiety disorders  Leads to detachment and depression  Primary damage is physical  Primary damage is emotional  May kill you prematurely  May make life seem not worth living Stress vs. Burnout
  22. 22. What is Anxiety?
  23. 23. Anxiety Includes: • Fight or Flight Reaction • Avoidance Behavior • Worry or Concern  Concern about the physical reaction or its meaning  Concern about the future
  24. 24. Anxious Thinking • Future-Focused Predictions • Future is Bad • Reaction is as-if the bad thing is happening or going to happen • Avoidance / “Safety” Behaviors
  25. 25. Panic Attack = Fight or Flight • Discrete period of intense fear or discomfort in which four of the following develop abruptly & reach peak in 10 minute: • palpitations, pounding heart, racing heart • sweating • trembling/shaking • sensation of shortness of breath or smothering • feelings of choking • Chest pain or discomfort • Nausea or abdominal distress • feeling dizzy, unsteady, lightheaded, faint • derealization or depersonalization • fear of losing control or going crazy • fear of dying • paresthesias • chills/hot flashes From DSM-IV-TR Copyright 2000 American Psychiatrist Association
  26. 26. Stress Management
  27. 27. Stress Management • Cognitive Therapy Techniques - Learning ways to evaluate situations clearly.  Is there a true threat or not?  Is the situation exceeding my coping or am I just thinking it is?  If it is exceeding my coping what should I do about it?  Stress Reduction & Management  Reducing environmental stress  Changing your physical reactions  Pay it forward – helping others  Medication
  28. 28. Medication • Benzodiazepines  Xanax  Klonopin  Ativan • Antidepressants Zoloft  Lexapro  Prozac  Paxil • Buspar
  29. 29. Cognitive Therapy • Not simply the events in life that causes problems • How we think about those events • Take our thoughts to be 100% true • Focus on information that confirms them • Ignore or bend information that disconfirms
  30. 30. Using Cognitive Therapy • Identify the stressful, anxious thought • Consider the thought to be a hypothesis – Not a Fact • Use Socratic questioning to evaluate • GOAL = Realistic and Useful thinking • If needed, experiment to confirm or disconfirm the thought
  31. 31. Information Skewed Adapted from J.Beck (2005) Cognitive Therapy for Challenging Problems.
  32. 32. Thinking Errors • Fortune Telling  I know what is going to happen and it will be bad • All-or-Nothing Thinking (Black and White) • If I’m not a total Success, I’m a Failure • Catastrophizing • I’ll be so upset I will not be able to function • Discounting the Positive • I did this project well but I just got lucky • Emotional Reasoning • It’s true because I feel it is
  33. 33. Thinking Errors • Magnification/Minimization • Getting a B proves I’m stupid. I got an A+ because the test was easy • Mind Reading • He’s thinking that I don’t know what I’m doing • Personalization • He didn’t look at me because he hates me • Should and Must Statement • I must always do my best. I should never make a mistake
  34. 34. Thought Record Situation * Who * What * When * Where Moods What did you feel? (Rate 0 – 100) Negative Automatic Thoughts What was going thru your mind (thought/image)? (Rate 0-100) Socratic Questions to Evaluate the Negative Automatic Thought Are you using any Cognitive Distortions? Alternative Thought to Counter the Negative Automatic Thought Rate Moods & NATs Now  What make me think the thought is true?  What makes me think it is not true or not competly true?  What is an alternative way to look at the situation?  What is the worst thing that could happen and could I live thru it?  What is the best thing that could happen?  What is most likely to happen?  What will happen is I keep telling myself the same NAT over and over?  What if I was to change my thinking?  What would I tell a friend who was going thru the same exact thing I am going thru?
  35. 35. Situation * Who * What * When * Where Moods What did you feel? (Rate 0 – 100) Negative Automatic Thoughts What was going thru your mind (thought/image)? (Rate 0-100) Socratic Question to Evaluate the Negative Automatic Thought Are you using any Cognitive Distortions? Alternative Thought to Counter the Negative Automatic Thought Rate Moods & NATs Now Working on a project with co-worker. No contact for 2 days even though she had left them a message. Sad Despondent Anxious 85 They think the work I have done on the project is poor They don’t want to work on the project with me because they think I don’t know what I’m doing I’m a Failure 90  What make me think the thought is true?  What makes me think it is not true or not completely true?  What is an alternative way to look at the situation?  What is the worst thing that could happen and could I live thru it?  What is the best thing that could happen?  What is most likely to happen?  What will happen is I keep telling myself the same NAT over and over?  What if I was to change my thinking?  What would I tell a friend who was going thru the same exact thing I am going thru?
  36. 36. Testing Your Thoughts  Ask yourself:  What makes me think the thought is true?  What makes me think it is not true or not completely true?  What is an alternative way to look at the situation?  What is the worst thing that could happen and could I live through it?  What is the best thing that could happen?  What is most likely to happen?  What will happen if I keep telling myself the same NAT over and over?  What if I was to change my thinking?  What would I tell a friend who was going through the same exact thing I am going through?  Now that you have tested your NAT what is a more realistic way to think about your situation?
  37. 37. Evidence • Supports  No contact  Had some trouble on the project  Not feeling sharp  Hx • Refutes  Has a good relationship  No negative comments  Presented good ideas  Willing to meet  Mind Reading  Emotional Reasoning
  38. 38. Thought Record Situation * Who * What * When * Where Moods What did you feel? (Rate 0 – 100) Negative Automatic Thoughts What was going thru your mind (thought/image)? (Rate 0-100) Socratic Question to Evaluate the Negative Automatic Thought Are you using any Cognitive Distortions? Alternative Thought to Counter the Negative Automatic Thought Rate Moods & NATs Now Working on a project with co-worker. No contact for 2 days even though she had left them a message. Sad Despondent Anxious 85 They think the work I have done on the project is poor They don’t want to work on the project with me because they think I don’t know what I’m doing. I’m a failure 90  What make me think the thought is true?  What makes me think it is not true or not competly true?  What is an alternative way to look at the situation?  What is the worst thing that could happen and could I live thru it?  What is the best thing that could happen?  What is most likely to happen?  What will happen is I keep telling myself the same NAT over and over?  What if I was to change my thinking?  What would I tell a friend who was going thru the same exact thing I am going thru? I don’t know why they have not contacted me and it does not necessary mean they are unhappy with me. If they are unhappy with me then I can try to work it out with them and it does not say anything bad about me as a person. 75 Mood 45 AT 50
  39. 39. Coping Cards • Written reminders that can be carried • Excellent for practicing new way of thinking • Succinct responses to your stressful thoughts • Best after have uncovered distorted ideas
  40. 40. Behavioral Experiments  Reduce or eliminate avoidance behavior  Test stressful thoughts and assumptions  Get evidence for alternative perspectives
  41. 41. Stress Reduction & Management  Environmental Stress  Physical Reactions  Pay It Forward
  42. 42. Environment Reduce Stressors  For example:  Excessive temperatures  Excessive noise  Poor air quality  Reduce repetitive work tasking and strenuous movements  Alcohol
  43. 43. Physical Reactions • Increase  Exercise  Regular and Balanced Meals  Socializing  Sleep  Hobbies and Fun
  44. 44. Physical Reactions Relaxation Exercises Will reduce fight/flight reaction  Like riding a bike for the first time.  It is a skill that takes time and practice to do it effectively!  Don’t expect much after trying it one or two times  Relaxation exercises can seem deceptively simple at first  With practice they are very effective
  45. 45. Physical Reactions • Breathing Techniques • Mindfulness Meditation • Guided Imagery • Yoga
  46. 46. Pay It Forward New research suggests oxytocin may speed recovery from major stressors The more we give to others, & the more we get from others, the more oxytocin is released Being connected may protect you from stress Kelly McGonigal: “How to Make Stress Your Friend”
  47. 47. Resources • Academy of Cognitive Therapy  www.academyofct.org • Mind Over Mood  Dennis Greenberger, PhD & Christine Padesky, PhD • Worry Cure: 7 Steps to Curing Your Worry  Robert Leahy, PhD • Anxiety Free  Robert Leahy, PhD • Mindfulness for Beginners  Jon Kabat-Zinn, PhD (Audio CD) • Wherever You Go, There You Are: Meditation in Everyday Life  John Kabat-Zinn, PhD
  48. 48. Stress & Anxiety What is it & What can be done about it? Presented by: Katherine DiDonato, PhD, ACT

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