Stress & Stress Management

Produced by Klinic Community Health Centre

January, 2010

Stress & Stress Management
Produced by Klinic Community Health Centre, January, 2010

Table of Contents
Introduction.....................................................................2 Stress: What is it?............................................................3 Sources of Stress .............................................................4 Types of Stressors ............................................................4 Internal Sources of Stress and Anxiety ................................6 Cognitive Aspects of Stress and Anxiety ..............................6 Anxious Thoughts.............................................................8 Signs and Symptoms of Stress Overload .............................8 Effects of Stress .............................................................10 50 Common Signs and Symptoms of Stress......................10 Diagram of the Effects of Stress on the Body ....................11 Questions to Consider When Assessing for Stress ..............12 The Stress Response ......................................................13 The Relaxation Response ................................................14 Stress Relieving Techniques.............................................15 Mindfulness.........................................................15 How to do a Mindfulness Exercise .........................15 10 Simple Ways to Practice Mindfulness Each Day ...18 Relaxation in a Hurry ...........................................18 Relaxing Your Body at Work ..................................19 Exercises.......................................................................20 Progressive Muscle Relaxation ...............................21 Deep Breathing....................................................22 Guided Imagery ...................................................23 Self Massage and Self Massage Techniques ............24 Thought Stopping Techniques..........................................26 List of 38 Stress Busters.................................................28 References ....................................................................29

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Introduction
Stress is a fact of everyday life. When people reach out for help, they are often dealing with circumstances, situations, and stressors in their lives that leave them feeling emotionally and physically overwhelmed. Many people feel that they have very little resources or skills to deal with the high levels of stress they are experiencing. The information in this manual has been compiled to provide information and education about stress, the effects of stress, and the most popular stress management and relaxation techniques that are being used today. This information could be helpful for people who want to learn how to react to stress in a more constructive, proactive way. The basic premise of this manual is that the benefits of stress reduction and relaxation techniques can be best noticed after they have been practiced regularly over a period of time.

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Stress: What is it?
Although we all talk about stress, it often isn’t clear what stress is really about. Many people consider stress to be something that happens to them, an event such as an injury or a job loss. Others think that stress is what happens to our body, mind, and behavior in response to an event (E.g. heart pounding, anxiety, or nail biting). While stress does involve events and our response to then, these are not the most important factors. Our thoughts about the situations in which we find ourselves are the critical factor. When something happens to us, we automatically evaluate the situation mentally. We decide if it is threatening to us, how we need to deal with the situation, and what skills we can use. If we decide that the demands of the situation outweigh the skills we have, then we label the situation as “stressful” and react with the classic “stress response.” If we decide that our coping skills outweigh the demands of the situation, then we don’t see it as “stressful.” Stress can come from any situation or thought that makes you feel frustrated, angry, or anxious. Everyone sees situations differently and has different coping skills. For this reason, no two people will respond exactly the same way to a given situation. Additionally, not all situations that are labeled “stressful” are negative. The birth of a child, being promoted at work, or moving to a new home may not be perceived as threatening. However, we may feel that situations are “stressful” because we don’t feel fully prepared to deal with them. Stress is a normal part of life. In small quantities, stress is good; it can motivate you and help you become more productive. However, too much stress, or a strong response to stress can be harmful. How we perceive a stress provoking event and how we react to it determines its impact on our health. We may be motivated and invigorated by the events in our lives, or we may see some as “stressful” and respond in a manner that may have a negative effect on our physical, mental, and social well-being. If we always respond in a negative way, our health and happiness may suffer. By understanding ourselves and our reaction to stress-provoking situations, we can learn to handle stress more effectively. In the most accurate meaning, stress management is not about learning how to avoid or escape the pressures and turbulence of modern living; it is about learning to appreciate how the body reacts to these pressures, and about learning how to develop skills which enhance the body’s adjustment. To learn stress management is to learn about the mind-body connection and to the degree to which we can control our health in a positive sense.

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Sources of Stress
We can experience stress from four basic sources: The Environment – the environment can bombard you with intense and competing demands to adjust. Examples of environmental stressors include weather, noise, crowding, pollution, traffic, unsafe and substandard housing, and crime. Social Stressors – we can experience multiple stressors arising from the demands of the different social roles we occupy, such as parent, spouse, caregiver, and employee. Some examples of social stressors include deadlines, financial problems, job interviews, presentations, disagreements, demands for your time and attention, loss of a loved one, divorce, and co-parenting. Physiological – Situations and circumstances affecting our body can be experienced as physiological stressors. Examples of physiological stressors include rapid growth of adolescence, menopause, illness, aging, giving birth, accidents, lack of exercise, poor nutrition, and sleep disturbances. Thoughts – Your brain interprets and perceives situations as stressful, difficult, painful, or pleasant. Some situations in life are stress provoking, but it is our thoughts that determine whether they are a problem for us.

Types of Stressors
Situations that are considered stress provoking are known as stressors. Stress is not always a bad thing. Stress is simply the body’s response to changes that create taxing demands. Many professionals suggest that there is a difference between what we perceive as positive stress, and distress, which refers to negative stress. In daily life, we often use the term “stress” to describe negative situations. This leads many people to believe that all stress is bad for you, which is not true. Positive stress has the following characteristics: • Motivates, focuses energy • Is short-term • Is perceived as within our coping abilities • Feels exciting • Improves performance In contrast, negative stress has the following characteristics: • Causes anxiety or concern • Can be short or long-term • Is perceived as outside of our coping abilities • Feels unpleasant • Decreases performance • Can lead to mental and physical problems
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It is somewhat hard to categorize stressors into objective lists of those that cause positive stress and those that cause negative stress, because different people will have different perceptions and reactions to particular situations. However, by generalizing, we can compile a list of stressors that are typically experienced as negative or positive to most people, most of the time. Examples of negative personal stressors can include: • The death of a partner • Filing for divorce • Losing contact with loved ones • The death of a family member • Hospitalization (oneself or a family member) • Injury or illness (oneself or a family member) • Being abused or neglected • Separation from a spouse or committed relationship partner • Conflict in interpersonal relationships • Bankruptcy/money problems • Unemployment • Sleep problems • Children’s problems at school • Legal problems • Inadequate or substandard housing • Excessive job demands • Job insecurity • Conflicts with team mates and supervisors • Lack of training necessary to do a job • Making presentations in front of colleagues or clients • Unproductive and time-consuming meetings • Commuting and travel schedules Examples of positive personal stressors might include: • Receiving a promotion at work • Starting a new job • Marriage or commitment ceremony • Buying a home • Having a child • Moving • Taking or planning a vacation • Holiday seasons • Retiring • Taking educational classes or learning a new hobby

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Internal Sources of Stress and Anxiety
Stressors are not always limited to situations where some external situation is creating a problem. Internal events such as feelings, thoughts, and habitual behaviors can also cause negative stress. Common internal sources of distress include: • Fears (e.g., fears of flying, heights, public speaking, chatting with strangers at a party) • Repetitive thought patterns • Worrying about future events (e.g., waiting for medical test results or job restructuring) • Unrealistic or perfectionist expectations Habitual behavior patterns that can lead to stress include: • Over scheduling • Failing to be assertive • Failing to set and maintain healthy boundaries • Procrastination and/or failing to plan ahead

Cognitive Aspects of Stress and Anxiety
Anxiety is a feeling that we commonly experience when faced with stressful life events. Anxiety can be one of the most distressing emotions that people feel. It is sometimes called “fear or nervousness”. Common reactions to anxiety include: Physical Symptoms: • Sweaty palms • Muscle tension • Racing heart • Flushed cheeks • Light headedness Behaviors: • Avoiding situations where experiencing anxiety might occur • Leaving situations when feelings of anxiety begins to occur • Trying to do things perfectly or trying to control events to prevent danger Moods: • Nervous • Irritable • Anxious • Panicky

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Thoughts: • Overestimation of danger • Underestimation of your ability to cope • Underestimation of help available • Worries and catastrophic thoughts Stressors can contribute to our feelings of anxiety. Examples of stressors that contribute to feelings of anxiety might include trauma (being abused, being in an accident, war); illness or death, things we are taught (“snakes will bite you”); things we observe (an article in the newspaper about a plane crash); and experiences that seem too much to handle (giving a speech, job promotion or termination, having a baby). The thoughts that accompany anxiety involve the perception that we are in danger or that we are threatened or vulnerable in some way. A threat of danger can be physical, mental, or social. A physical threat occurs when you believe that you will be physically hurt (e.g., a snake bite, a heart attack, being hit). A social threat occurs when you believe you will be rejected, humiliated, embarrassed, or put down. A mental threat occurs when something makes you worry that you are going crazy or losing your mind. The perception of the threats varies from person to person. Some people, because of their life experiences, may feel threatened very easily and will often feel anxious. Other people may feel a greater sense of safety or security. Certain life experiences such as growing up in a chaotic home with volatile surroundings may lead a person to conclude that the world and other people are dangerous. The perception of danger and sense of vulnerability may have helped a person survive as a child. Being able to recognize danger and its early warning signs are critical to one’s emotional and physical survival. Some may have developed a very fine ability to spot and respond to dangerous situations. As an adult, it may become important to evaluate whether or not its possible that one is over-responding to danger and threat. Perhaps the people in their adult life are not as threatening as the people in their childhood. One might consider whether or not their resources and abilities to cope as an adult open new and creative ways of responding to threat and anxiety.

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Anxious Thoughts
Anxious thoughts are future oriented and often predict catastrophe. Anxious thoughts often begin with, “What if…” and end with a disastrous outcome. Anxious thoughts frequently include images of danger as well. For example, a man with a fear of public speaking may, before a talk, think, “What if I stumble over my words? What if I forget my notes? What if people think I’m a fool and don’t know what I am talking about?” He may have an image of himself standing frozen in front of the crowd. These thoughts are all about the future and predict a dire outcome.

Signs and Symptoms of Stress Overload
It is important to learn how to recognize when your stress levels are “out of control” or having an adverse effect. The signs and symptoms of stress overload can be almost anything. Stress affects the mind, body, and behavior in many ways, and everyone experiences stress differently. Three common ways that people respond when they are overwhelmed by stress are: 1. An angry or agitated stress response. You may feel heated, keyed-up, overly emotional, and unable to sit still. 2. A withdrawn or depressed stress response. You shut down, space out, and show very little energy or emotion. 3. Both a tens and frozen stress response. You “freeze” under pressure and feel like you can’t do anything. You look paralyzed, but under the surface you may feel extremely agitated. The following lists some of the common warning signs and symptoms of stress. The more signs and symptoms you notice in yourself, the closer you might be to feeling stress overload. Cognitive Symptoms: • Memory problems • Inability or difficulty concentrating • Poor judgment • Seeing only the negative • Anxious, racing, or ruminating thoughts • Constant worrying Emotional Symptoms: • Moodiness • Irritability or short-tempered • Agitation, inability to relax

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• Feeling overwhelmed • Sense of loneliness or isolation • Depression or general unhappiness Physical Symptoms: • Aches and pains, muscle tension • Diarrhea or constipation • Nausea, dizziness, or butterflies in the stomach • Chest pain or rapid heartbeat • Loss of sex drive • Frequent colds • Shallow breathing and sweating Behavioral Symptoms: • Eating more or less • Sleeping too much or too little • Isolating yourself from others • Procrastinating or neglecting responsibilities • Using alcohol, cigarettes, or drugs to relax • Nervous habits (nail biting, pacing) Keep in mind that the signs and symptoms of stress also can be caused by other psychological and medical problems. If you’re experiencing any of the warning signs of stress, it’s important to see a doctor for an evaluation. Your doctor can help you determine whether or not your symptoms are stress related.

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Effects of Stress
Stress is difficult for professionals to define because it is a highly subjective phenomenon that differs for each of us. Things that are distressful for some individuals can be pleasurable for others. We also respond to stress differently. Some people blush, some eat more while others grow pale or eat less. There are numerous physical as well as emotional responses as illustrated by the following list of 50 common signs and symptoms of stress.

50 Common Signs and Symptoms of Stress
1. Frequent headaches, jaw clenching or pain 2. Gritting, grinding teeth 3. Stuttering or stammering 4. Tremors, trembling of lips, hands 5. Neck ache, back pain, muscle spasms 6. Light headedness, faintness, dizziness 7. Ringing in the ears 8. Frequent blushing, sweating 9. Dry mouth, problems swallowing 10. Cold or sweaty hands, feet 11. Frequent colds, infections 12. Rashes, itching, hives, “goose bumps” 13. Unexplained or frequent allergy attacks 14. Heartburn, stomach pain, nausea 15. Excess belching, flatulence 16. Constipation, diarrhea 17. Difficulty breathing, sighing 18. Sudden attacks of panic 19. Chest pain, palpitations 20. Frequent urination 21. Low sexual drive or performance 22. Excess anxiety, worry, guilt, nervousness 23. Increased anger, frustration, hostility 24. Depression, frequent or intense mood swings 25. Increased or decreased appetite 26. Insomnia, nightmares, disturbing dreams 27. Difficulty concentrating, racing thoughts 28. Trouble learning new information 29. Forgetfulness, disorganization, confusion 30. Difficulty in making decisions 31. Feeling overwhelmed 32. Frequent crying spells or suicidal thoughts 33. Feelings of loneliness or worthlessness 34. Little interest in appearance, punctuality 35. Nervous habits, feet tapping, fidgeting 36. Increased frustration, irritability 37. Overreaction to petty annoyances 38. Increased number of minor accidents 39. Obsessive/compulsive behaviors 40. Reduced work productivity 41. Lies or excuses to cover up poor work 42. Rapid or mumbled speech 43. Excessive defensiveness or suspiciousness 44. Problems with communication 45. Social withdrawal or isolation 46. Constant tiredness, weakness, fatigue 47. Frequent use of over-the-counter drugs 48. Weight gain or loss without diet 49. Increased smoking, alcohol, or drug use 50. Excessive gambling or impulse buying

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As demonstrated in the preceding list, stress can have wide ranging effects on emotion, mood, and behavior. Equally important but often less appreciated are effects on various systems, organs, and tissues all over the body, as illustrated in the following diagram.

Physical or mental stresses may cause physical illness as well as mental or emotional problems. Here are the parts of the body affected by stress:

The Effects of Stress
Brain: Stress triggers mental and emotional problems such as insomnia, headaches, personality changes, irritability, anxiety, and depression. Mouth: Mouth ulcers and excessive dryness are often symptoms of stress. Heart: Cardiovascular disease and hypertension are linked to accumulated stress. Lungs: High levels of mental or emotional stress adversely affect individuals with asthmatic conditions.

Hair: High stress levels may cause excessive hair loss and some forms of baldness.

Muscles: Spasmodic pains in the neck and shoulders, musculoskeletal aches, lower back pain, and various minor muscular twitches and nervous tics are more noticeable under stress.

Digestive tract: Stress can cause or aggravate diseases of the digestive tract including gastritis, stomach and duodenal ulcers, ulcerative colitis, and irritable colon.

Reproductive organs: Stress affects the reproductive system causing menstrual disorders and recurrent vaginal infections in women and impotence and premature ejaculation in men.

Skin: Some individuals react to stress with outbreaks of skin problems such as eczema and psoriasis.

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There are numerous emotional and physical disorders that have been linked to stress including depression, anxiety, heart attacks, stroke, hypertension, immune system disturbances that increase susceptibility to infections, a host of viral linked disorders ranging from the common cold to herpes to certain cancers, as well as autoimmune diseases like rheumatoid arthritis and multiple sclerosis. In addition, stress can have direct effects on the skin (rashes, hives, atopic dermatitis), the gastrointestinal system (GERD, peptic ulcer, irritable bowel syndrome, ulcerative colitis) and can contribute to insomnia and degenerative neurological disorders like Parkinson’s disease. In fact, it is hard to think of any disease in which stress cannot play an aggravating role or any part of the body that is not affected (see Effects of Stress on the Body diagram). This list will undoubtedly grow as the extensive ramifications of stress are increasingly being appreciated.

Questions to Consider When Assessing for Stress:
• • • • • • How do you know when you are stressed? Where do you feel stress in your body? What do you notice about your body, thoughts, and feelings when things are difficult? How do you behave when you are feeling stressed out? How do you react negatively or proactively to stress? How do you currently cope with stress?

Do you… (answer ‘O’ for often. ‘S’ for sometimes, or ‘R’ for rarely or never) __ regret being angry or short-tempered with others? __ feel like your emotions are getting the best of you? __ use alcohol, cigarettes, or drugs to cope with stress (prescription, counter, or street drugs)? __ have sleep problems (either sleep too much or not getting enough restful sleep)? __ feel like things are overwhelming or out of control? __ laugh or smile less than you used to? __ yell, cry, or withdraw a lot? __ feel sad, disappointed, or worried? __ eat too much or too little when you are stressed? __ feel that you are not in control of your life? __ have trouble letting go of things that are bothering you? __ blame yourself or think that nothing goes right? If you have answered often or sometimes to four or more of these questions, it may be time to address your stress.

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The Stress Response
The groundwork for the modern meaning of “stress” was laid by Dr. Walter B. Cannon, a physiologist at Harvard almost 100 years ago. He was the first to describe the “fight or flight response” as a series of involuntary physiological and biochemical changes that prepare you to deal with threats of danger. This response was critical to the survival of primitive humankind when requiring quick bursts of energy to fight or flee predators such as the saber-toothed tiger. Hans Selye, the first major researcher on stress, was able to trace what happens in your body during the fight or flight response. He found that any problem, real or imagined, could cause the cerebral cortex (the thinking part of the brain) to send an alarm to the hypothalamus (the main switch for the stress response, located in the midbrain). The hypothalamus then stimulates the sympathetic nervous system to make a series of changes in your body. Your heart rate, breathing rate, muscle tension, metabolism, and blood pressure all increase. Your hands and feet get cold as blood is directed away from your extremities and digestive system into the larger muscles that can help you fight or run. You experience butterflies in your stomach. Your diaphragm locks. Your pupils dilate to sharpen your vision and your hearing becomes more acute. While all of this is going on, something else happens that can have long-term negative effects if left unchecked. Your adrenal glands start to secrete corticoids (adrenaline, epinephrine, and norepinephrine), which inhibit digestion, reproduction, growth, and tissue repair and the responses of your immune and inflammatory systems. In other words, some very important functions that keep your body healthy begin to shut down. The stress response is useful and can be necessary in times of emergency, but the frequent or unrelenting triggering of the stress response in our modern life without a balancing relaxation response can contribute to a number of illnesses and symptoms. The same mechanism that turned the stress response on can turn it off. This is called the Relaxation Response. As soon as you decide that a situation is no longer dangerous, your brain stops sending emergency signals to your brain stem, which in turn ceases to send panic messages to your nervous system. Minutes after the danger signals stop, the flight or fight response burns out. Your metabolism, heart rate, breathing rate, muscle tension, and blood pressure all return to their normal levels. Many professionals suggest that you can use your mind to change your physiology for the better, and improve your health by using the natural restorative process called the Relaxation Response.

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The Relaxation Response
In the late 1960’s, at Harvard Medical School, where Walter B. Cannon performed fight or flight experiments 50 years earlier, Herbert Benson, M.D. found that there was a counterbalancing mechanism to the stress response. Just as stimulating an area of the hypothalamus can cause the stress response, activating other areas of the brain results in its reduction. He defined this opposite state the “relaxation response”. The relaxation response is a physical state of deep rest that changes the physical and emotional responses to stress. When eliciting the relaxation response: Your metabolism decreases Your heart beats slower and your muscles relax Your breathing becomes slower Your blood pressure decreases You return to a calmer state of being. If practiced regularly, it can have lasting effects. Eliciting the Relaxation Response Elicitation of the relaxation response is actually quite easy. There are two essential steps: 1. Repetition of a word, sound, phrase, prayer, or muscular activity. 2. Passive disregard of everyday thoughts that inevitably come to mind and the return to your repetition. The following is the generic technique that elicits the relaxation response: • Pick a focus word, short phrase, or prayer that is firmly rooted in your belief system, such as “one,” “peace,” “The Lord is my Shepard,” “Hail Mary full of grace,” or “Shalom”. • Sit quietly in a comfortable position. • Close your eyes. • Relax your muscles, progressing from your feet to your calves, thighs, abdomen, shoulders, head, and neck. • Breathe slowly and naturally, and as you do, say your focus word, sound, phrase, or prayer silently to yourself as you exhale. • Assume a passive attitude. Don’t worry about how well you’re doing. When other thoughts come to mind, simply say to yourself, “Oh well,” and gently return to your repetition. • Continue for ten to twenty minutes. • Do not stand immediately. Continue sitting quietly for a minute or so, allowing other thoughts to return. Then open your eyes and sit for another minute before rising. • Practice the technique once or twice daily (e.g., before breakfast and after dinner).

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Regular elicitation of the relaxation response has been scientifically proven to be an effective treatment for a wide range of stress-related disorders. In fact, to the extent that any disease is caused or made worse by stress, the relaxation response can help. Other techniques for evoking the relaxation response are: • • • • • Mindfulness Meditation Progressive Muscle Relaxation Deep Breathing Imagery Self-Massage

Stress Relieving Techniques
Mindfulness Meditation that cultivates mindfulness can be particularly effective at reducing stress, anxiety, depression, and other negative emotions. Mindfulness is the quality of being fully engaged in the present moment, without over-thinking or analyzing the experience. Rather than worrying about the future or dwelling on the past, mindfulness meditation switches the focus on what is happening right now. Mindfulness meditation is not equal to zoning out. It takes effort to maintain your concentration and to bring it back to the present moment when your mind wanders or you start to drift off. But with regular practice, mindfulness strengthens the areas of the brain associated with joy and relaxation. Mindfulness provides a potentially powerful antidote to the common causes of daily stress such as time pressure, distraction, agitation, and interpersonal conflicts. How to do a Mindfulness Exercise • Find a comfortable place to sit. It can be on a chair or on the floor, but do not slump or slouch. Keep your posture straight but relaxed, making sure you are not rigid or stiff. • Focus on your breathing. • Concentrate your attention completely on your breathing. Become aware of the sensations inside your air passages as the air enters the nose. Just become aware of that feeling as your breath goes in and out. Do not attempt to influence or check your breathing; just let it happen naturally. Marvel at the quality and precision of internal sensations that are normally ignored. Wonder at how deeply you can sense the air inside you. Just allow yourself time to be aware of the air going in and out, nothing else. Keep your mind on your breathing; become your breathing. • When thoughts come into your mind, that’s o.k. Just examine the thoughts for what they are, as if they were some strange animal that wandered into your sight. When these thoughts come into your mind, allow them to wander off on their own and wish them well on their way. Do not get involved in the thought. Just notice that it is there and return your focus to your breathing.

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• Treat each thought as a guest. When a thought or feeling arises, simply observe and acknowledge it. There is no need to interpret it or to use it. You might wonder where it came from, what caused it to surface now, what purpose it serves. Notice it like a precious jewel, turning it this way and that. If you feel yourself drifting away on a thought then just return and refocus on your breathing. Use your breathing as the anchor for your mindfulness. • Stay in the moment as long as you can. Continue to focus on your breathing. Aim to clear your mind completely for 5 minutes. With practice you will be able to extend the time to twenty minutes or more. • Notice the repeating thoughts. As you progress you will come to recognize that the same thoughts are appearing, over and over, even in your calmest moments. Notice them and let them pass by, returning your attention to your breath. The following mindfulness meditation techniques can also be helpful for stress relief. Body Scan – Body scanning promotes mindfulness by focusing your attention on various parts of your body. Like progressive muscle relaxation, you can start with your feet and work your way up. However, instead of tensing and relaxing your muscles, you simply focus on the way each part of your body feels, noticing any sensations without labeling then as “good or bad”. Walking Meditation – You don’t have to be seated or still to practice mindfulness. In walking meditation, mindfulness involves being focused on the physicality of each step; the sensation of your feet touching the ground; the rhythm of your breath while moving, and feeling the wind against your face. Mindful Eating – If you reach for food when you feel stressed, or you gulp your meals down in a rush, try eating mindfully. Sit down at the table and focus your full attention on the meal. This means no T.V., reading the newspaper, or eating on the run. Eat slowly, taking time to concentrate on each bite, noticing the texture and taste of the food. A Sample Meditation Exercise • When you practice meditation at home, you will need to choose a quiet place where you will not be disturbed. If you wish you may sit cross-legged on a cushion on the floor, you may kneel, or sit in a chair with your back straight. You should feel comfortable, but not so comfortable that you fall asleep. While practicing mindfulness, it is important to stay alert. • Remain seated in your chair. Sit with your back straight, feet flat on the floor, hands in your lap. Now close your eyes. • Just breathe normally through your nose. As you continue breathing normally through your nose, begin to focus your attention on the sensations in and around your nostrils, and on your upper lip just below your nostrils, that are caused by the breath passing in and out. You might feel a slight tickle, or a feeling of warmth or coolness, or heaviness or lightness. Just keep your concentration fixed there. This area is your

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anchor; the place you will always return to. Observe the changing sensations you experience in that area as the breath passes over your anchor. • At the beginning of every breath, try noticing everything you can about the sensations caused by just that one breath. Do the same for the next breath, just one breath at a time. • If thoughts arise, as they most certainly will, gently but firmly bring your awareness back to your anchor and remain focused on the in an out breath, one breath at a time. (Pause for a few seconds). • Again, focus all of your attention on the changing sensations around your nose and upper lip that are caused by the breath as it goes in and out. Notice whether the breath is long or short. Does the air pass through one or both nostrils? Is the air cool or warm? • If your mind wanders again, just note, “mind wandered away” and immediately return it to your anchor. It is the mind’s nature to wander and your job to train it, so just keep bringing it back. Gently but firmly bring it back. If you are having difficulty bringing it back, you can try counting your breaths, just up to 10. Continue focusing on the in and out breaths for another four minutes. I will let you know when the time is up. Following the meditation exercise ask yourself these questions: Open your eyes. How was that for you? Were you able to keep your attention focused on your anchor? Could you experience your breath? Where did you feel it? What sensations did you feel? Did you experience the wandering mind? It is very persistent isn’t it? Can you see how the wandering mind might get you into trouble if you are not aware of where it has wandered off to? • Were you able to bring your attention back to your anchor each time it has wandered away? It takes a lot of practice doesn’t it? • • • • • • • •

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Ten Simple Ways You Can Practice Mindfulness Each Day: 1. As you awaken in the morning, bring your attention to your breathing. Instead of letting your mind spin off into yesterday or today, take mindful breaths. Focus on your breathing, and sense the effects of breathing throughout your body. 2. Instead of hurrying to your usual routine, slow down and enjoy something special about the morning; a flower that bloomed, the sound of the birds, the wind in the trees. 3. On the way to work or school, pay attention to how you walk, drive or ride the transit. Take some deep breaths, relaxing throughout your body. 4. When stopped at a red light, pay attention to your breathing and enjoy the landscape around you. 5. When you arrive at your destination, take a few moments to orient yourself. Breathe consciously and calmly, relax your body, then begin. 6. When sitting at your desk or keyboard, become aware of the subtle signs of the physical tension and take a break or walk around. 7. Use the repetitive events of the day (the ringing telephone, a knock at the door, walking down the hall) as cues for a mini-relaxation. 8. Walk mindfully to your car or bus. Can you see and appreciate something new in the environment? Can you enjoy walking without rushing? 9. As you return home, consciously make the transition into your home environment. If possible, after greeting your family or housemates, give yourself a few minutes alone to ease the transition. 10. As you go to sleep, let go of today and tomorrow. Take some slow, mindful deep breaths. By following the main elements of mindfulness, combining awareness of your breath and with focusing on the activity at hand, you will be able toe experience every moment as fully as possible. Relax in a Hurry Mini-relaxation exercises help reduce anxiety and tension immediately. You can do them with your eyes open or closed. You can do them anywhere, any time, and no one will know that you are doing them. Some good times to “do a mini” are when you are: • Stuck in traffic • Put on hold during a phone call • In your doctor’s waiting room • Someone says something that upsets you • Waiting for a phone call • Sitting in a dentist’s chair • Feeling overwhelmed by what you need to accomplish in the near future • Standing in line • In pain

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“Mini’s” are most beneficial for people who elicit the relaxation response on a regular basis. However, they can make anyone feel refreshed, calmer, and better able to concentrate. The basic method for doing a “Mini” is quite simple: Put your hand just below your navel. Take a deep breath, bringing the air in through your nose and through your mouth. You should feel your stomach rising about an inch as you breathe in, and falling about an inch as you breathe out. This is diaphragmatic breathing. If this is difficult for you, lie on your back or on your stomach, where you will be more aware of your breathing pattern. Remember to relax your stomach muscles. Here are some variations: • Mini Version 1 Count very slowly to yourself from 10 down to zero, one number for each breath. With the first diaphragmatic breath, you say “10” to yourself, the next breath, you say “nine”, etc. If you start feeling light-headed or dizzy, slow down the counting. When you get to “zero”, see how you are feeling. If you are feeling better, great! If not, try doing it again. • Mini Version 2 As you inhale, count very slowly up to four. As you exhale, count slowly back down to one. Thus, as you inhale, you say to yourself, “one, two, three, four”. As you exhale, you say to yourself, “four, three, two, one.” Do this several times. • Mini Version 3 After each inhalation, pause for a few seconds. After you exhale, pause again for a few seconds. Do this for several breaths. Relax Your Body at Work One of the most common questions asked about stress is, “What can I do to de-stress during a busy day?” Fortunately, there is something you can do for yourself when you need to release tension and stiffness or simply refocus your mind. The following body-centered exercises work well in an office setting, as all you need to do is sit forward on a chair with your feet flat on the floor. You may increase the number of repetitions, as your body grows stronger and more flexible. Take a few minutes at the end of your exercise to sit comfortably, noticing your breath and releasing tension with each exhalation. You’ll be ready to return to work feeling more comfortable and refreshed.

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Exercises
Feet and Legs With legs outstretched: • Alternate curling and stretching the toes. Repeat three times and relax. • Alternate flexing (bending) and extending (stretching) the whole foot at the ankle. Repeat three times. • Rotate the ankles to the right as if drawing circles with your toes. Repeat three times. • Rotate the ankles to the left. Repeat three times. Arms and Hands • With arms extended out in front of you: • Move your hands up and down, bending from the wrist. Repeat three times. • Alternate stretching your fingers, then making a fist. Repeat three times. • Rotate your wrists three times, first to the right, then to the left. Relax. Repeat three times. Shoulders • Raise your right shoulder up toward your ear. On the exhale, release your shoulder down. Repeat three times. • Move your right shoulder forward. On the exhale, return it to the starting position. Repeat three times. • Move your right shoulder back. On the exhale, return it to the starting position. Repeat three times. • Repeat the sequence on the left side. • Bring both shoulders up towards your ears, tense, then drop your shoulders down as you exhale. Repeat three times. Head and Neck Hold each of these positions, taking three easy breaths and relaxing tension with each exhalation, then return your head to upright centre before doing the next movement. • Drop your chin to your chest. Feel the weight of your head stretch out the back of your neck. Hold. • Look as far as you can over your right shoulder. Hold. • Look as far as you can over your left shoulder. Hold. • Drop your right ear to your right shoulder. Hold. • Drop your left ear to your left shoulder. Hold.

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Progressive Muscle Relaxation *Be careful. Take care not to hurt yourself while tensing your muscles. You should never feel intense or shooting pain while completing this exercise. Make the muscle tension deliberate, but gentle. If you have problems with pulled muscles, broken bones, or any medical issue that would hinder physical activity, consult your doctor first. Progressive muscle relaxation is another effective and widely used strategy for stress relief. It is a great technique for reducing overall body tension. It involves a two-step process in which you tense and relax different muscles in the body. With regular practice, progressive muscle relaxation helps you recognize what tension as well as complete relaxation feels like in different parts of the body. This awareness helps you spot and counteract the first signs of the muscular tension that accompanies stress. As your body relaxes, so will your mind. You can combine deep breathing with progressive muscle relaxation for an additional level of relief from stress. As you practice tensing and relaxing all the muscle groups in your body, you can move to a shortened procedure, where you rapidly relax your whole body. As you reduce the tension you carry in your body, your whole being will feel less stress and you can enjoy increased physical and emotional health. Here’s how to get started: After finding a quiet place and several free minutes to practice progressive muscle relaxation, sit or lie down and make yourself comfortable. Loosen your clothing, take off your shoes and get comfortable. Take a few minutes to relax, breathing in and out in slow, deep breaths. • Begin by tensing all of the muscles in your face. Make a tight grimace, close your eyes as tightly as possible, clench your teeth, even move your ears up if you can. Hold this for a count of eight as you inhale. Now exhale as you relax completely. Let your face go completely lax, as though you were sleeping. Feel the tension seep from your facial muscles and enjoy the feeling. • Next, completely tense your neck and shoulders, again inhaling and counting to eight. Then exhale and relax. • Continue down your body, repeating the procedure with the following muscle groups: chest, abdomen, entire right arm, right forearm and hand (making a fist), entire left arm, left forearm and hand (again making a fist), buttocks, entire right leg, lower right leg, right foot, entire left leg, lower left leg, and left foot. For a shortened version, focus on the following four main muscle groups: 1) face; 2) neck, shoulders, and arms; 3) abdomen and chest; and 4) the buttocks, legs and feet. You can use progressive muscle relaxation to quickly de-stress anytime.

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Deep Breathing Deep breathing is a relaxation technique that can be self-taught. Deep breathing releases tension from the body and clears the mind, improving both physical and mental wellness. We tend to breathe shallowly or even hold our breath when we are feeling anxious. Sometimes we are not even aware of it. Shallow breathing limits your oxygen intake and adds further stress to your body. Breathing exercises can help to reduce this stress. The key to deep breathing is to breathe deeply from the abdomen, getting as much air as possible into your lungs. When you take deep breaths from the abdomen, rather than shallow breaths from your upper chest, you inhale more oxygen. The more oxygen you get, the less tense, short of breath, and anxious you feel. This kind of breathing is called diaphragmatic breathing. It means to breathe from the depths of your belly, rather than from your chest and nose. The importance of good posture cannot be overstated. While sitting, we tend to slouch, which compresses the diaphragm and other organs, resulting in shallow breathing. Slouching also strains muscles in the neck and back. It is helpful to sit in a chair with good back support to avoid fatigue that leads to slouching. There are many ways to practice deep breathing. Here is an example of a deep breathing exercise: • Sit comfortably with your back straight. Place one hand on your chest and the other on your stomach. Breathe in through your nose. Try to make the hand on your stomach rise, while keeping the hand on your chest still. Exhale through your mouth, pushing out as much air as you can while contracting your abdominal muscles. The hand on your stomach should move in as you inhale, but your other hand should move very little. Continue to breathe in through your nose and out through your mouth. Try to inhale enough so that your lower abdomen rises and falls. Count slowly as you exhale. If you have a hard time breathing from your abdomen while sitting up, try lying on the floor. • Sit back in your seat. Close your eyes. Take a deep breath. Breathe again. Now make your hands comfortable while keeping your eyes closed. You have a choice of any comfortable hand positions such as One hand on your belly, one on your chest Palms of hands on your knees Hands folded in your lap • Now sit back, feet on the floor, hands comfortable. Inhale slowly and deeply through your nose. Feel your stomach expand as your lungs fill with air. Now exhale through your mouth to the count of five. Pause. Repeat while inhaling through the nose and exhaling through your mouth and slowly count to five.

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• Again, in through your nose and out through your mouth counting to five. Sit and enjoy the calmness for a few minutes. • Turn your attention to breathing your tensions away. Focus on your feet. Feel all of the sensations there, feet and socks inside of your shoes, pressure on the floor, and any other sensations. Now, as you take a deep breath, breathe all of those feelings and sensations up into your lungs and then exhale them away. Go ahead. Deep breath in, bringing all of those sensations into your lungs, then exhale them away. Now, breathe in all those tensions in your legs and hips; big breath in and exhale those tensions away. All the tensions into your lungs and exhale them away. Your shoulders, arms, and hands – go ahead, and breathe the tensions in them away. Now your neck, jaw, eyes, and forehead. Breathe away the tensions in them. Now with two last, deep breaths, you can go back and breathe away any residual tensions. • Sit up straight. Do not arch your back. First, exhale completely through your mouth. Place your hands on your stomach, just above your waist. Breathe in slowly through your nose, pushing your hands out with your stomach. This ensures that you are breathing deeply. Imagine that you are filling your body with air from the bottom up. Hold your breath to a count of two to five, or whatever you can handle. It is easier to hold your breath if you continue to hold out your stomach. Slowly and steadily breath out through your mouth, feeling your hands move back in as you slowly contract your stomach, until most of the air is out. Exhalation is a little longer than inhalation. You can also do this exercise lying on your back. Deep breathing exercises can help you to relax before you go to sleep for the night, or fall back asleep if you awaken in the middle of the night. You can also practice deep breathing exercises standing (e.g., while standing in line at the grocery store), If you are really tense and feel as if you are holding your breath, simply concentrate on slowly breathing in and out. Guided Imagery Guided imagery is a convenient and simple relaxation technique that can help you quickly and easily manage stress and reduce tension in your body. It is virtually as easy as indulging in a vivid daydream and, with practice, this technique can help you to ease the tension and stress that you feel. When used as a relaxation technique, guided imagery involves imagining a scene in which you feel at peace, free to let go of all tension and anxiety. Choose whatever setting is most calming to you, whether a tropical beach, a favorite childhood spot, a therapist’s chair, or a quiet place in the woods. Here’s how to get started with guided imagery: • Get into a comfortable position. If lying down will likely put you to sleep, trying sitting cross-legged, or recline in a comfy chair. Close your eyes and breathe deeply, focusing on breathing in feelings of peace, and breathing out feelings of stress.

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• Once you get to a relaxed state, begin to envision yourself in the midst of the most relaxing environment you can imagine. For some, this could be floating in the cool, clear waters on a tropical beach, listening to smooth music playing in the background. For others, this might be sitting by a fire in a secluded snow cabin, deep in the woods, sipping hot chocolate and reading a good novel while wrapped in a plush blanket and fuzzy slippers. • As you imagine your scene, try to involve all of your senses. What does it look like? How does it feel? What special scents are involved? What is around you? Who is there or not there with you? What sounds do you hear? Focus your attention on the smells in the area. What does the air feel like on your skin? Do you feel any other sensations? • Stay here for as long as you like. Enjoy your surroundings and let yourself be far from what stresses you. When you’re ready to come back to reality, count back from ten or twenty, and tell yourself that when you get to one, you’ll feel more calm and refreshed, like returning from a mini-vacation, but you won’t have left the room! Tips: You may want to use ambient sounds that accompany your imagery. You may feel more immersed in your environment. You may also want to set a gentle radio alarm just in case you loose track of time or fall asleep. This might allow you to relax and let go, knowing your schedule won’t be in jeopardy. Self Massage Getting a massage provides deep relaxation, and as the muscles in your body relax, so does your overstressed mind. There are many simple self-massage techniques you can use to relax and release stress. Self-Massage techniques: Scalp Soother – Place your thumbs behind your ears while spreading your fingers on top of your head. Move your scalp back and forth slightly by making circles with your fingertips for 15-20 seconds. Easy on the Eyes – Close your eyes and place your ring fingers directly under your eyebrows, near the bridge of your nose. Slowly increase the pressure for 5-10 seconds, then gently release. Repeat 2-3 times. Sinus Pressure Relief – Place your fingertips at the bridge of your nose. Slowly slide your fingers down your nose and across the top of your cheekbones to the outside of your eyes. Repeat 3-4 times. Shoulder Tension Relief – Reach one arm across the front of your body to your opposite shoulder. Using a circular motion, press firmly on the muscle above your shoulder blade. Repeat on the other side.
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Foot Massage – Sit in a chair or on the floor. Get comfortable. You may or may not want to use lotion or oil. If you are sitting up, rest one foot on the opposite leg. Put one hand on top of the foot and the other closer to your toes, then stroke smoothly from your toes to your ankles. Glide your hands to the sole of your foot and massage the underside of your foot. Support your foot with one hand and with the other make a fist. With a circular motion move along the sole of your foot. Support your foot with one hand and work on each toe individually. Squeeze and gently twist and stretch each toe. Stroke around the ankle with your fingertips, as you stroke up toward the leg and then glide back to your toes. Finish by stroking your entire foot again. Do the same for the other foot. Face Massage – Begin by rubbing the palms of your hands together quickly. As you feel the heat build in your hands, stop rubbing your hands and place the now heated palms over your face. Feel the warmth, and the soothing sensation it immediately provides. Breathe deeply. Breathe in through the nose, filling your chest and stomach. Hold and slowly release through the mouth. You can have your eyes open or closed, whichever is more comfortable. Repeat the deep breathing several times until you begin to feel less stress. For relaxation, continue to breathe slowly and deeply throughout the entire selfmassage routine. Keep your head upright and centered. Use your thumbs for this exercise. Turn your hands outward, palms facing away from you. Place your thumbs at either side of the nose, beside the flares, where you feel a slight depression. Gently push in with your thumbs. Drag your thumbs across the sinuses, and maintain an even pressure throughout. Keep your thumbs on the face for the entire motion. Next, rest your thumbs on your neck or below the jaw. Take your four fingers, with your index finger at the top of the jaw and your baby finger lower along the jaw, and starting at the top of the jaw line massage along your jaw with tiny clockwise circular motions. As you do the circular motions, slowly move your fingers down along the course of your jaw until the fingers of both hands meet at the chin. Repeat at least 5 times.

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Thought Stopping Techniques
It has been well documented that negative and frightening thoughts invariably precede negative and frightening emotions. If the thoughts can be controlled, overall stress levels can be significantly reduced. Thought stopping involves concentrating on the unwanted thoughts and, after a short time, suddenly stopping and emptying the mind. The command “Stop” or a loud noise is generally used to interrupt the unpleasant thoughts. Instructions for Thought Stopping Explore and List Your Stressful Thoughts – Create a list of stressful thoughts to help you assess which recurrent thoughts are the most painful and intrusive. If a caller is struggling to identify stressful thoughts, here are some questions you can ask to help them: • Do you worry about being on time? • Do you worry about leaving the lights or the gas on, or whether the doors are locked? • Do you ever have persistent ideas that someone you know might be having an accident or that something might have happened to them? • Do you go back and think about a task you have already completed, wondering how you could have done it better? • Do you question yourself or have doubts about a lot of the things that you do? • Do you worry about money a lot? • Do you frequently think things will not get better and may, in fact, get worse? • Do you ruminate about details? • Do you worry about auto accidents? • Do you worry about getting trapped in crowds, on bridges, elevators and so on? • Does a negative feature of your appearance or your make-up preoccupy you at times? • Do you think again and again about your failures? Ask yourself these questions about each stressful thought you identified: • Is the thought realistic or unrealistic? • Is the thought productive or counter-productive? • Is the thought neutral or self-defeating? • Is the thought easy or hard to control? • Is it possible that this thought could come true? Just how probable is it? Thought stopping requires consistent motivation. Decide now if you really want to eliminate any of stressful thoughts you have listed. Select a thought that you feel strongly committed to extinguishing. Imagine that Thought – Close your eyes and bring into imagination a situation in which the stressful thought is likely to occur. Try to include normal as well as stressful thinking. In this way, you can interrupt the stressful thoughts while allowing a continuing flow of healthy thinking.

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Thought Interruption – Thought interruption can be accomplished initially by using one of two startler techniques: • Set an egg timer or alarm clock for 3 minutes. Look away, close your eyes, and ruminate on your stressful thought as described above in Step 2. When you hear the ring, shout, “Stop!” You may also want to raise your hand, snap your fingers or stand up. Let your mind empty all but the neutral and non-anxious thoughts. Set a goal of about 30 seconds after the stop, during which your mind remains blank. If the upsetting thought returns during that time, shout, “Stop!” again. • Tape record yourself loudly exclaiming, “Stop” at intermittent intervals (e.g. three minutes, two minutes, three minutes, one minute). You may find it useful to repeat the taped stop messages several times at five-second intervals. Proceed the same way as with the egg timer or alarm clock. The tape recording shapes and strengthens your thought control. Unaided Thought Interruption – Now take control of the thought stopping cue, without the timer or tape recorder. While ruminating on the stressful thought, shout, “Stop!” When you succeed in extinguishing the thought on several occasions with the shouted command, begin interrupting the thought with “Stop!” said in a normal voice. After succeeding in stopping the thought by using your normal speaking voice, start interrupting the thought with “Stop!” verbalized in a whisper. When the whisper is sufficient to interrupt stressful thoughts, use the sub-vocal command “Stop!” Imagine hearing “Stop!” shouted inside your mind. Success at this stage means that you can stop thoughts alone or in public, without making a sound or calling attention to yourself. Thought Substitution – The last of thought stopping involves thought substitution. In place of the stressful thought, make up some positive, assertive statements that are appropriate in the target situation. For example, if you are afraid of flying, you might say to yourself, “This is a fantastically beautiful view from way up here.” Develop several alternative statements to say to yourself, since the same response may lose its power through repetition. If the sub-vocalized “Stop” is not working for you, create a technique that you can use to substitute the word “Stop!” (e.g. keep a rubber band around your wrist, and snap it when unwanted thoughts occur). Be aware that thought stopping takes time. The thought will return and you will have to interrupt it again. The main effort is to stifle each thought just as it begins, and to concentrate on something else. The thoughts will return less and less readily in most cases.

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38 Stress Busters
1. Start off your day with breakfast. 2. Occasionally change your routine by meeting a friend or co-worker for breakfast. Allow time to relax and enjoy it. 3. Find some time during the day to meditate or listen to a relaxation CD. 4. Instead of drinking coffee all day, switch to fruit juice. 5. Organize your work - set priorities. 6. Don't try to be perfect. Don't feel like you must do everything. 7. Avoid trying to do two, three, or more things at a time. 8. Develop a support network. 9. If possible, reduce the noise level in your environment. 10. Always take a lunch break (preferably not at your desk). 11. Optimize your health with good nutrition, sleep and rest. 12. Get regular exercise. 13. Celebrate birthdays and other holidays. Turn more events into special occasions. 14. Look at unavoidable stress as an avenue for growth and change. 15. Avoid people who are "stress carriers." 16. Avoid people who are "negaholics." 17. Don't watch the 11 p.m. news. 18. Give yourself praise and positive strokes. 19. Develop a variety of resources for gratification in your life, whether it's family, friends, hobbies, interests, special weekends or vacations. 20. Treat yourself to "new and good things." 21. Be assertive. Learn to express your needs and differences, to make requests, and to say "no" constructively. 22. Seek out the emotional resources available to you such as co-workers, partner, friends and family. 23. Don't be afraid to ask questions or to ask for help. 24. Allow extra time to get to appointments. 25. Take deep breaths when you feel stressed. 26. Try to find something funny in a difficult situation. 27. Take an occasional "mental health day." 28. Adopt a pet. 29. Take a mindful walk. 30. Understand that we do not all see or do things in the same way. 31. Practice mindfulness - learn to live in the moment. 32. Become a less aggressive driver. 33. Show kindness and consideration. Open a door for someone, pick up litter, etc. 34. When stressed, ask yourself "Is this really important?" and "Will this really matter a year from now?" 35. Resist the urge to judge or criticize. 36. Become a better listener. 37. Be flexible with change - things don't always go as we planned. 38. If spiritual, pray; speak to God, a higher power, or your inner guide.

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References http://www.cmha.ca http://www.mentalhelp.net http://helpguide.org http://www.oprah.com http://stress.about.com http://www.psybersquare.com http://www.k-state.edu/counseling/student/biofedbk/sample5.html http://www.stress-relief-exercises.com http://www.hypknowsis.com http://www.info.med.yale.edu Davis, M., Robbins Eschelman, E., & McKay, M. (1995). The Relaxation & Stress Reduction Workbook. 4th ed. New Harbinger Publications. Oakland, CA. Greenberger, D., & Padeshy, C. (1995). Mind Over Mood. Change How You Feel by Changing the Way You Think. Guilford Publications. New York, NY.

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Stress is a normal part of life, but at times it may be too much and feel out of control.

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